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Assessment of coronary artery aneurysm after stent placement for myocardial infarction: evaluation by multidetector computed tomography [Case Report]

Gade, Christopher L; Lin, Fay; Feldman, Dmitriy N; Weinsaft, Jonathan W; Min, James K
PMID: 19083932
ISSN: 1876-861x
CID: 2667632

Clinical outcomes following multivessel versus single-vessel percutaneous coronary interventions in the contemporary drug-eluting stent era [Meeting Abstract]

Feldman, Dmitriy N; Gade, Christopher L; Minutello, Robert M; Bergman, Geoffrey; Wong, SChiu
ISI:000250393900250
ISSN: 0002-9149
CID: 2667772

Impact of bivalirudin on outcomes after percutaneous coronary revascularization with drug-eluting stents

Feldman, Dmitriy N; Wong, S Chiu; Gade, Christopher L; Gidseg, David S; Bergman, Geoffrey; Minutello, Robert M
BACKGROUND: The direct thrombin inhibitor bivalirudin has been found to be noninferior to heparin plus planned glycoprotein (GP) IIb/IIIa blockade in the prevention of acute ischemic end points and 1-year mortality after percutaneous coronary intervention (PCI) with bare metal stents. We investigated whether long-term outcomes after bivalirudin use remained comparable to heparin plus GP IIb/IIIa blockade in current clinical practice of drug-eluting stent use. METHODS: Using the 2004-2005 Cornell Angioplasty Registry, we studied 2504 consecutive patients undergoing urgent or elective PCI with periprocedural use of bivalirudin or heparin plus GP IIb/IIIa platelet inhibitors. Patients presenting with an acute ST-elevation myocardial infarction (MI) < or = 24 hours, thrombolytic therapy < or = 7 days, hemodynamic instability/shock, or renal insufficiency were excluded. RESULTS: Of the study cohort, 1340 patients (54%) received bivalirudin and 1164 patients (46%) received heparin plus GP IIb/IIIa blockade. The incidence of inhospital mortality (0.3% vs 0.2%, P = .692), MI (6.6% vs 8.1%, P = .191), and combined end point of death, stroke, emergent coronary artery bypass graft/PCI, and MI (6.9% vs 8.3%, P = .199) was similar in the bivalirudin and heparin plus GP IIb/IIIa inhibitor groups. There was a lower incidence of major (0.7% vs 1.9%, P = .012) and minor bleeding (9.6% vs 15.6%, P < .001) in the bivalirudin versus heparin plus GP IIb/IIIa inhibitor group. Mean clinical follow-up was 24.8 +/- 7.7 months. At follow-up, there were 87 (6.5%) deaths in the bivalirudin group versus 42 (3.6%) in the heparin plus GP IIb/IIIa inhibitor group (hazard ratio 1.87, 95% CI 1.30-2.71, P = .001). After a propensity score adjusted multivariate Cox analysis, bivalirudin use was associated with a nonsignificant trend toward increased long-term mortality (hazard ratio 1.45, 95% CI 0.98-2.16, P = .065). CONCLUSIONS: Compared with heparin plus GP IIb/IIIa inhibition, routine use of bivalirudin as the procedural anticoagulant in contemporary PCI with drug-eluting stents was associated with lower rates of inhospital complications and similar long-term all-cause mortality.
PMID: 17892994
ISSN: 1097-6744
CID: 2667642

Diagnostic impact of SPECT image display on assessment of obstructive coronary artery disease

Weinsaft, Jonathan W; Gade, Christopher L; Wong, Franklin J; Kim, Han W; Min, James K; Manoushagian, Shant J; Okin, Peter M; Szulc, Massimiliano
BACKGROUND: Diagnostic assessment of myocardial perfusion impacts the management of patients with suspected coronary artery disease (CAD). Although various image displays are available for single photon emission computed tomography (SPECT) interpretation, the effects of display differences on SPECT interpretation remain undetermined. METHODS AND RESULTS: We studied 183 patients undergoing SPECT, including 131 consecutive patients referred for angiography and 52 at low CAD risk. Studies were visually interpreted by use of color and gray images, with readers blinded to the results of the other display. In accordance with established criteria, a summed stress score (SSS) of 4 or greater was considered abnormal. The prevalence of abnormal SPECT findings was higher with gray images than with color images (54% vs 48%, P < .001) based on a uniform criterion (SSS > or =4). However, color images yielded equivalent sensitivity (79% vs 82%, P = .7) and improved specificity for global (50% vs 33%, P = .02) and vessel-specific CAD involving the right coronary artery (P < .01) and left anterior descending artery (P < .05). When the criterion for gray images was adjusted upward (SSS > or =5) to reflect increased mean defect severity (SSS of 5.1 vs 4.4, P = .01), gray and color images provided equivalent sensitivity and specificity for global and vessel-specific CAD. CONCLUSIONS: SPECT interpretation can vary according to image display as a result of differences in perfusion defect severity. Adjustment of abnormality criteria for gray images to reflect minor increases in defect severity provides equivalent diagnostic performance of gray and color displays for CAD assessment.
PMID: 17826319
ISSN: 1532-6551
CID: 2667652

Comprehensive evaluation of atrial septal defects in individuals undergoing percutaneous repair by 64-detector row computed tomography [Case Report]

Gade, Christopher L; Bergman, Geoffrey; Naidu, Srihari; Weinsaft, Jonathan W; Callister, Tracy Q; Min, James K
Transcatheter atrial septal defect closure is becoming more commonplace as it has been demonstrated to be safe, efficacious and associated with low morbidity. Pre-procedural assessment of individuals has primarily relied upon transesophageal echocardiography. We present four individuals who underwent both transesophageal echocardiography as well as cardiac multidetector computed tomography. In all four cases, multidetector computed tomography added incremental information above the transesophageal echocardiogram. Multidetector computed tomography may play an essential role in individuals with atrial septal defects undergoing percutaneous transcatheter closure.
PMID: 17028927
ISSN: 1569-5794
CID: 2667682

Impact of combination of glycoprotein IIb/IIIa inhibition and bivalirudin on long-term outcomes following PCI in real world clinical practice [Meeting Abstract]

Feldman, Dmitriy N; Gade, Christopher L; Gidseg, David S; Slotwiner, Alexander J; Juliano, Nickolas; Goel, Punit; Cuomo, Linda J; Parikh, Manish; Bergman, Geoffrey; Wong, SChiu; Minutello, Robert M
ISI:000244652100072
ISSN: 0735-1097
CID: 2667752

Outcomes following immediate (ad hoc) versus staged percutaneous coronary interventions (report from the 2000 to 2001 New York State Angioplasty Registry)

Feldman, Dmitriy N; Minutello, Robert M; Gade, Christopher L; Wong, S Chiu
Health care providers are under increasing pressure to lower costs by combining diagnostic and "ad hoc" interventional coronary procedures. Despite increasing use of such a treatment strategy, its effect on periprocedural safety has not been rigorously assessed in the current stent era. Using the 2000/2001 New York State Angioplasty Registry, we compared in-hospital clinical outcomes in 47,020 patients who underwent ad hoc percutaneous coronary interventions (PCIs) versus staged procedures. Patients with previous PCIs, acute myocardial infarction within 24 hours, thrombolytic therapy within 7 days, or those presenting with hemodynamic instability or shock were excluded. Patients in the staged intervention group were more likely to have hypertension, diabetes mellitus, peripheral vascular disease, previous stroke, heart failure, renal failure, previous coronary artery bypass grafting, and a lower left ventricular ejection fraction. Mortality rate (0.4% vs 0.4%, p = 0.299), major adverse cardiac events (0.7% vs 0.8%, p = 0.199), and incidence of renal failure/dialysis (0.1% vs 0.1%, p = 0.520) during in-hospital stay did not differ significantly between the ad hoc PCI and staged groups. There was a higher rate of access site injury in the staged cohort (0.4% vs 0.3%, p = 0.011), and this trend persisted after multivariate logistic regression analysis (odds ratio 1.34, 95% confidence interval 0.99 to 1.81, p = 0.061). In addition, patients with "high-risk" features had similar in-hospital clinical outcomes after either treatment approach. In conclusion, as currently practiced in New York State, the strategy of ad hoc PCI in selected patient cohorts appears to be as safe as the strategy of staged procedures.
PMID: 17293181
ISSN: 0002-9149
CID: 2667662

Comparison of outcomes of percutaneous coronary interventions in patients of three age groups (<60, 60 to 80, and >80 years) (from the New York State Angioplasty Registry)

Feldman, Dmitriy N; Gade, Christopher L; Slotwiner, Alexander J; Parikh, Manish; Bergman, Geoffrey; Wong, S Chiu; Minutello, Robert M
Octogenarians have been under-represented in percutaneous coronary intervention (PCI) trials despite an increase in referrals for PCI. As the United States population ages, the number of high-risk PCIs in the elderly will continue to increase. This study investigated the effect of age on short-term prognosis after PCI in 3 age groups. Using the 2000/2001 New York State Angioplasty Registry, we compared in-hospital mortality and major adverse cardiac events (MACEs; death, stroke, or coronary artery bypass grafting) in emergency and elective PCI cohorts across 3 age categories of patients: 10,964 patients who underwent emergency PCI (<60 years of age, n = 5,354; 60 to 80 years of age, n = 4,939; >80 years of age, n = 671) and 71,176 patients who underwent elective PCI (<60 years of age, n = 24,525; 60 to 80 years of age, n = 40,869; >80 years of age, n = 5,782). Patients were considered to have undergone an emergency PCI if they had an acute myocardial infarction within 24 hours, had thrombolytic therapy within 7 days, or presented with hemodynamic instability or shock. Elderly patients had more co-morbidities, including more extensive coronary atherosclerosis, hypertension, peripheral vascular disease, and renal insufficiency, and presented more frequently with hemodynamic instability or shock. In the emergency PCI group, in-hospital mortality (1.0% vs 4.1% vs 11.5%, p <0.05) and MACEs (1.6% vs 5.2% vs 13.1%, p <0.05) increased incrementally by age group. In the elective PCI group, rates of in-hospital complications were considerably lower, with an incremental increase in mortality (0.1% vs 0.4% vs 1.1%, p <0.05) and MACEs (0.4% vs 0.7% vs 1.6%, p <0.05). Age was strongly predictive of in-hospital mortality for emergency and elective PCI by multivariate analysis. In conclusion, elective PCI in the elderly has favorable outcome and acceptable short-term mortality in the stent era. Elderly patients, in particular octogenarians undergoing emergency PCI, have a substantially higher risk of in-hospital death.
PMID: 17134624
ISSN: 0002-9149
CID: 2667672

Bivalirudin use is associated with increased long-term mortality in ACS patients undergoing drug-eluting stents implantation [Meeting Abstract]

Feldman, Dmitriy N; Gidseg, David S; Gade, Christopher L; Slotwiner, Alexander J; Cuomo, Linda J; Juliano, Nickolas; Parikh, Manish; Naidu, Srihari; Bergman, Geoffrey; Wong, SC; Minutello, Robert M
ISI:000241792803489
ISSN: 0009-7322
CID: 2667742

Impact of bivalirudin on long-term outcomes following PCI with drug-eluting stents in real world clinical practice [Meeting Abstract]

Feldman, Dmitriy N; Gidseg, David S; Gade, Christopher L; Slotwiner, Alexander J; Juliano, Nickolas; Cuomo, Linda J; Parikh, Manish; Naidu, Srihari; Bergman, Geoffrey; Wong, SChiu; Minutello, Robert M
ISI:000241442800032
ISSN: 0002-9149
CID: 2667712