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Polymer-Free Drug-Coated Coronary Stents in Patients with Stable Coronary Artery Disease at High Bleeding Risk

Panchal, Hemang B; Daggubati, Ramesh; Zhao, David; Rao, Sunil V; Paul, Timir
PURPOSE OF REVIEW:Patients with stable coronary artery disease (CAD) and a high risk of bleeding are not ideal candidates for a polymer-based drug-eluting stent (DES) because it requires 6-12 months of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). The purpose of this review is to assess the angiographic and clinical outcomes of polymer-free drug-coated stents (PF-DCS) in stable CAD patients with a high bleeding risk. RECENT FINDINGS:Several randomized controlled trials (RCTs) have compared angiographic and clinical outcomes of PF-DCS with bare-metal stents (BMS), permanent polymer (PP)-DES, or biodegradable polymer (BP)-DES. However, none of these studies particularly recruited patients with stable CAD and a high risk of bleeding. Furthermore, there are limited data available on duration of DAPT following PF-DCS placement. PF-DCS has a better efficacy and similar safety as compared with BMS. PF-DCS with dual drug is noninferior to currently available PP-DES. Further RCTs are needed to assess the safety and efficacy of PF-DCS to BP-DES and PP-DES comparing shorter to standard durations of DAPT.
PMID: 28185168
ISSN: 1534-3170
CID: 3407312

Hospital Readmission as a Transcatheter Aortic Valve Replacement Performance Measure: Too Soon? [Comment]

Swaminathan, Rajesh V; Rao, Sunil V
PMID: 28034847
ISSN: 1941-7632
CID: 5224882

The Systematic Evaluation of Identifying the Infarct Related Artery Utilizing Cardiac Magnetic Resonance in Patients Presenting with ST-Elevation Myocardial Infarction

Hamo, Carine E; Klem, Igor; Rao, Sunil V; Songco, Vincent; Najjar, Samer; Lakatta, Edward G; Raman, Subha V; Harrington, Robert A; Heitner, John F
BACKGROUND:Identification of the infarct-related artery (IRA) in patients with STEMI using coronary angiography (CA) is often based on the ECG and can be challenging in patients with severe multi-vessel disease. The current study aimed to determine how often percutaneous intervention (PCI) is performed in a coronary artery different from the artery supplying the territory of acute infarction on cardiac magnetic resonance imaging (CMR). METHODS:We evaluated 113 patients from the Reduction of infarct Expansion and Ventricular remodeling with Erythropoetin After Large myocardial infarction (REVEAL) trial, who underwent CMR within 4±2 days of revascularization. Blinded reviewers interpreted CA to determine the IRA and CMR to determine the location of infarction on a 17-segment model. In patients with multiple infarcts on CMR, acuity was determined with T2-weighted imaging and/or evidence of microvascular obstruction. RESULTS:A total of 5 (4%) patients were found to have a mismatch between the IRA identified on CMR and CA. In 4/5 cases, there were multiple infarcts noted on CMR. Thirteen patients (11.5%) had multiple infarcts in separate territories on CMR with 4 patients (3.5%) having multiple acute infarcts and 9 patients (8%) having both acute and chronic infarcts. CONCLUSIONS:In this select population of patients, the identification of the IRA by CA was incorrect in 4% of patients presenting with STEMI. Four patients with a mismatch had an acute infarction in more than one coronary artery territory on CMR. The role of CMR in patients presenting with STEMI with multi-vessel disease on CA deserves further investigation.
PMCID:5218460
PMID: 28060863
ISSN: 1932-6203
CID: 4777652

Incidence and Predictors of Anemia Complicating Heart Failure: The RBC HEART Study [Meeting Abstract]

Go, Alan S.; Tabada, Grace H.; Leong, Thomas K.; Gurwitz, Jerry; Artz, Andrew; Schrier, Stanley; Rao, Sunil V.; Barnhart, Huiman; Reynolds, Kristi; Smith, David H.; Peterson, Pamela N.; Sung, Sue Hee; Cohen, Harvey J.
ISI:000437035901218
ISSN: 0009-7322
CID: 5226762

Association Between Operator PCI Volume and Long-term Outcomes in Older Adults: A Report From The NCDR CathPCI Registry [Meeting Abstract]

Fanaroff, Alexander C.; Zakroysky, Pearl; Wojdyla, Daniel; Sherwood, Matthew W.; Roe, Matthew T.; Wang, Tracy Y.; Peterson, Eric D.; Gurm, Hitinder S.; Cohen, Mauricio G.; Messenger, John C.; Rao, Sunil V.
ISI:000437035901271
ISSN: 0009-7322
CID: 5226772

Post-Traumatic Stress Disorder and Heart Failure Among a Nationwide Sample of US Veterans [Meeting Abstract]

Cerbin, Lukasz P.; Fudim, Marat; Devaraj, Srikant; Ajam, Tarek; Rao, Sunil V.; Kamalesh, Masoor
ISI:000437035902198
ISSN: 0009-7322
CID: 5226782

Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease [Comment]

Vora, Amit N; Rao, Sunil V; Stone, Gregg W
PMID: 28032958
ISSN: 1533-4406
CID: 5224872

Anticoagulation in coronary intervention

Zeymer, Uwe; Rao, Sunil V; Montalescot, Gilles
Percutaneous coronary intervention (PCI) induces thrombin generation and is associated with the risk of acute, subacute, or long-term ischaemic events. Therefore, intravenous anticoagulation is recommended to minimize thrombotic complications. The intensity and duration of anticoagulation needed are dependent on the clinical presentation (elective PCI for stable coronary artery disease, PCI for non-ST elevation acute coronary syndromes, or primary PCI for ST-segment elevation myocardial infarction) and procedural features. As both ischaemic and periprocedural bleeding complications are associated with acute and long-term mortality, the optimal level of anticoagulation and the best agents are a matter of debate. Despite a number of limitations and the lack of large randomized clinical trials, unfractionated heparin (UFH) is still been used in the majority of interventions. Intravenous enoxaparin, a low-molecular-weight heparin, leads to a more predictable level of anticoagulation and has been compared with UFH in patients with elective PCI and primary PCI with favourable results. The direct thrombin inhibitor bivalirudin has been studied in numerous trials and consistently shown to reduce bleeding complications when compared with UFH with or without glycoprotein IIb/IIIa inhibitors. This review will summarize the current status of anticoagulation for PCI and the results of most recent trials and give recommendations for different clinical scenarios.
PMID: 26946415
ISSN: 1522-9645
CID: 5224622

Same-Day Discharge After Percutaneous Coronary Intervention-Reply

Shroff, Adhir; Gilchrist, Ian C; Rao, Sunil V
PMID: 27706465
ISSN: 2380-6591
CID: 5224812

CASE 11-2016 Perioperative Coronary Thrombosis in a Patient With Multiple Second-Generation Drug-Eluting Stents: Is It Time for a Paradigm Shift? [Case Report]

Essandoh, Michael K; Dalia, Adam A; George, Barry S; Flores, Antolin S; Otey, Andrew J; Kirtane, Ajay J; Broderick, Thomas M; Rao, Sunil V
PMID: 27543999
ISSN: 1532-8422
CID: 5224742