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Long-term dietary and weight changes following a short-term dietary intervention study: EVADE-CAD trial follow-up

Dogra, Siddhant; Woolf, Kathleen; Xia, Yuhe; Getz, Alec; Newman, Jonathan D; Slater, James; Shah, Binita
PMID: 34010190
ISSN: 1473-5830
CID: 4908372

Factors associated with participation in a short-term dietary intervention study among patients with established coronary artery disease: insights from the EVADE CAD trial

Rubinfeld, Gregory; Driggin, Elissa; Woolf, Kathleen; Slater, James; Newman, Jonathan D; Heffron, Sean; Shah, Binita
PMID: 32639244
ISSN: 1473-5830
CID: 4552562

Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients With COVID-19

Berger, Jeffrey S; Kunichoff, Dennis; Adhikari, Samrachana; Ahuja, Tania; Amoroso, Nancy; Aphinyanaphongs, Yindalon; Cao, Meng; Goldenberg, Ronald; Hindenburg, Alexander; Horowitz, James; Parnia, Sam; Petrilli, Christopher; Reynolds, Harmony; Simon, Emma; Slater, James; Yaghi, Shadi; Yuriditsky, Eugene; Hochman, Judith; Horwitz, Leora I
OBJECTIVE:<0.001). Rates of adverse events increased with the magnitude of D-dimer elevation; individuals with presenting D-dimer >2000 ng/mL had the highest risk of critical illness (66%), thrombotic event (37.8%), acute kidney injury (58.3%), and death (47%). CONCLUSIONS:Abnormal D-dimer was frequently observed at admission with COVID-19 and was associated with higher incidence of critical illness, thrombotic events, acute kidney injury, and death. The optimal management of patients with elevated D-dimer in COVID-19 requires further study.
PMID: 32840379
ISSN: 1524-4636
CID: 4574192

The renal transport of hippurate and protein-bound solutes

Kumar, Rohit; Adiga, Avinash; Novack, Joshua; Etinger, Alex; Chinitz, Lawrence; Slater, James; de Loor, Henriette; Meijers, Bjorn; Holzman, Robert S; Lowenstein, Jerome
Measurement of the concentration of hippurate in the inferior vena cava and renal blood samples performed in 13 subjects with normal or near-normal serum creatinine concentrations confirmed the prediction that endogenous hippurate was cleared on a single pass through the kidney with the same avidity as that reported for infused para-amino hippurate. This suggests that a timed urine collection without infusion would provide a measure of effective renal plasma flow. Comparison of the arteriovenous concentration differences for a panel of protein-bound solutes identified solutes that were secreted by the renal tubule and solutes that were subjected to tubular reabsorption.
PMID: 32097533
ISSN: 2051-817x
CID: 4324292

Comparison of Dietary Patterns, Perceptions of Health, and Perceived Barriers to a Heart Healthy Diet Before and After Coronary Artery Angiography

Ngai, Calvin; Ganguzza, Lisa; Flink, Laura; Woolf, Kathleen; Guo, Yu; Acosta, Victor; Gianos, Eugenia; Slater, James; Burdowski, Joseph; Shah, Binita
Poor dietary patterns are associated with coronary artery disease (CAD) and cardiovascular events. The aim of this study was to determine whether reported dietary patterns change after undergoing invasive coronary angiography. Participants without a history of coronary revascularization were prospectively enrolled before undergoing coronary angiography at a tertiary center between February 2015 and February 2017. Enrolled participants completed the Rate Your Plate (RYP) survey at baseline (before angiography), 1-month, and 6-month follow-ups. RYP scores range from 24 to 72 (higher scores indicate healthier dietary patterns) are presented as median (interquartile range), and are compared from baseline to follow-up using a nonparametric related-sample test. No dietary guidance was given outside of usual care. Of the 400 participants, 326 (82%) completed at least 1 follow-up survey with no differences in baseline characteristics of participants who had at least 1 versus no follow-up survey. The median RYP score significantly improved from baseline (53 [47 to 57]) to 1-month (58 [52 to 62]) and 6-month (59 [54 to 63]) follow-ups (p <0.001). Angiography demonstrated severe CAD in 125 (38%) and normal or nonobstructive CAD in 201 (62%) participants. RYP scores significantly improved over time in both groups (p <0.001), but the percent change in RYP score over time was greater in participants with versus without severe CAD (13.9% [5.8 to 22.5] vs 9.6% [4.8 to 19.1], p = 0.03). In conclusion, self-reported dietary patterns improved after invasive coronary angiography, particularly in the subset with CAD. Future studies to determine how best to utilize the periprocedural period to further improve dietary patterns in this population are warranted.
PMID: 30598243
ISSN: 1879-1913
CID: 3563302

Anti-Inflammatory Effects of a Vegan Diet Versus the American Heart Association-Recommended Diet in Coronary Artery Disease Trial

Shah, Binita; Newman, Jonathan D; Woolf, Kathleen; Ganguzza, Lisa; Guo, Yu; Allen, Nicole; Zhong, Judy; Fisher, Edward A; Slater, James
Background Dietary interventions may play a role in secondary cardiovascular prevention. hsCRP (High-sensitivity C-reactive protein) is a marker of risk for major adverse cardiovascular outcomes in coronary artery disease. Methods and Results The open-label, blinded end-point, EVADE CAD (Effects of a Vegan Versus the American Heart Association-Recommended Diet in Coronary Artery Disease) trial randomized participants (n=100) with coronary artery disease to 8 weeks of a vegan or American Heart Association-recommended diet with provision of groceries, tools to measure dietary intake, and dietary counseling. The primary end point was high-sensitivity C-reactive protein. A linear regression model compared end points after 8 weeks of a vegan versus American Heart Association diet and adjusted for baseline concentration of the end point. Significance levels for the primary and secondary end points were set at 0.05 and 0.0015, respectively. A vegan diet resulted in a significant 32% lower high-sensitivity C-reactive protein (β, 0.68, 95% confidence interval [0.49-0.94]; P=0.02) when compared with the American Heart Association diet. Results were consistent after adjustment for age, race, baseline waist circumference, diabetes mellitus, and prior myocardial infarction (adjusted β, 0.67 [0.47-0.94], P=0.02). The degree of reduction in body mass index and waist circumference did not significantly differ between the 2 diet groups (adjusted β, 0.99 [0.97-1.00], P=0.10; and adjusted β, 1.00 [0.98-1.01], P=0.66, respectively). There were also no significant differences in markers of glycemic control between the 2 diet groups. There was a nonsignificant 13% reduction in low-density lipoprotein cholesterol with the vegan diet when compared with the American Heart Association diet (adjusted β, 0.87 [0.78-0.97], P=0.01). There were no significant differences in other lipid parameters. Conclusions In patients with coronary artery disease on guideline-directed medical therapy, a vegan diet may be considered to lower high-sensitivity C-reactive protein as a risk marker of adverse outcomes. Clinical Trial Registration URL : . Unique identifier: NCT 02135939.
PMID: 30571591
ISSN: 2047-9980
CID: 3556002

Impact and trends of intravascular imaging in diagnostic coronary angiography and percutaneous coronary intervention in inpatients in the United States

Smilowitz, Nathaniel R; Mohananey, Divyanshu; Razzouk, Louai; Weisz, Giora; Slater, James N
BACKGROUND:Intravascular imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT) is an important adjunct to invasive coronary angiography. OBJECTIVES/OBJECTIVE:The primary objective was to examine the frequency of intravascular coronary imaging, trends in imaging use, and outcomes of patients undergoing angiography and/or percutaneous coronary intervention (PCI) in the United States. METHODS:Adult patients ≥18 years of age undergoing in-hospital cardiac catheterization from January 2004 to December 2014 were identified from the National Inpatient Sample (NIS). International Classification of Diseases, Ninth Revision (ICD-9) diagnosis and procedure codes were used to identify IVUS and OCT use during diagnostic angiography and PCI. RESULTS:Among 3,211,872 hospitalizations with coronary angiography, intracoronary imaging was performed in 88,775 cases (4.8% of PCI and 1.0% of diagnostic procedures), with IVUS in 98.9% and OCT in 1.1% of cases. Among patients undergoing PCI, the rate of intravascular coronary imaging increased from 2.1% in 2004-2005 to 6.6% in 2013-2014 (P < 0.001 for trend). Use of intravascular coronary imaging was associated with lower in-hospital mortality in patients undergoing PCI (adjusted OR 0.77; 95% CI 0.71-0.83). There was marked variability in intravascular imaging by hospital, with 63% and 13% of facilities using intravascular imaging in <5% and >15% of PCIs, respectively. CONCLUSIONS:In a large administrative database from the United States, intravascular imaging use was low, increased over time, and imaging was associated with reduced in-hospital mortality. Substantial variation in the frequency of intravascular imaging by hospital was observed. Additional investigation to determine clinical benefits of IVUS and OCT are warranted.
PMID: 30019831
ISSN: 1522-726x
CID: 3202192

Trends in primary percutaneous coronary intervention (PPCI) in patients presenting to non-PCI capable hospitals with stemi in new york state [Meeting Abstract]

Iqbal, S N; Bangalore, S; Guo, Y; Schoenfeld, M; Keller, N; Slater, J
Introduction: In patients presenting to non-PCI capable hospital with STEMI, the management options include transfer for primary PCI (PPCI) or administration of thrombolytics and transfer for PCI (lytics + PCI), a decision largely driven by the estimated door to device time. The 2013 AHA/ACC STEMI guidelines increased the door to device time for STEMI transfer patients from < 90 minutes to < 120 minutes. Whether this change has impacted management is not known.
Method(s): Patients in the New York (NY) State PCI Registry who underwent PCI (PPCI or lytics + PCI) for STEMI after being transferred from a non-PCI capable hospital in 2012 and 2014 were included in this study. Primary outcome was a change in the proportion of patients who underwent PPCI in relation to lytics + PCI in 2014 as compared with year 2012. Secondary outcomes were changes in transfer time (non-PCI capable transfer hospital door to PCI hospital door time), PCI hospital door to device time, transfer hospital door to device time in PPCI patients, and in-hospital mortality for all STEMI transfer patients who underwent PCI.
Result(s): There were 2019 and 1799 patients who underwent PCI (PCI or lytics +PCI) for a STEMI after presenting to a non-PCI capable hospital in NY State in 2012 and 2014 respectively. There was an increase in the proportion of patients receiving PPCI (vs lytics+ PCI) from 2012 to 2014 (74.15% to 78.32%, p = 0.0025). Moreover, in patients receiving PPCI, there was also a decrease in transfer time [median: 102 min (Q1:73, Q3162) to 97 min (Q1: 70, Q3:147),p = 0.005], PCI hospital door to device time [35 min (25,53) to 34 min (24, 51), p = 0.07), and transfer hospital door to device time [143 min (105, 220) to 134 min (102, 200), p = 0.005]. However, there was no change in mortality from 2012 to 2014 in all STEMI transfer patients who underwent PCI (2.13% vs 2.95%, p = 0.11).
Conclusion(s): Data from NY State indicates a significant increase in referral for PPCI in patients presenting with a STEMI to a non-PCI capable hospital with the change in guidelines increasing the door to device times for transfer patients. Whether such a strategy improves outcomes should be tested in further studies
ISSN: 1524-4539
CID: 3788612

Association between diet quality and measures of body adiposity using the Rate Your Plate survey in patients presenting for coronary angiography

Ganguzza, Lisa; Ngai, Calvin; Flink, Laura; Woolf, Kathleen; Guo, Yu; Gianos, Eugenia; Burdowski, Joseph; Slater, James; Acosta, Victor; Shephard, Tamsin; Shah, Binita
BACKGROUND: Diet is a modifiable risk factor for cardiovascular disease; however, dietary patterns are historically difficult to capture in the clinical setting. Healthcare providers need assessment tools that can quickly summarize dietary patterns. Research should evaluate the effectiveness of these tools, such as Rate Your Plate (RYP), in the clinical setting. HYPOTHESIS: RYP diet quality scores are associated with measures of body adiposity in patients referred for coronary angiography. METHODS: Patients without a history of coronary revascularization (n = 400) were prospectively approached at a tertiary medical center in New York City prior to coronary angiography. Height, weight, and waist circumference (WC) were measured; body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. Participants completed a 24-question RYP diet survey. An overall score was computed, and participants were divided into high (>/=58) and low (
PMID: 29168985
ISSN: 1932-8737
CID: 2792162

Mediastinal Hematoma and Tracheal Compression following Transradial Percutaneous Coronary Intervention

Smilowitz, Nathaniel R; Saric, Muhamed; Attubato, Michael J; Slater, James N
Vascular complications from transradial percutaneous coronary intervention (PCI) are rare. We report an unusual case of stridor after PCI due to brachiocephalic artery perforation, pseudoaneurysm formation, and development of a large mediastinal hematoma with tracheal compression. Endovascular repair of the brachiocephalic artery was achieved with covered stent placement at the neck of the pseudoaneurysm. This case highlights the importance of careful guide catheter placement from the right radial approach. Ultimately, rapid diagnosis of vascular perforation, appropriate airway management, and prompt endovascular repair of the injured vessel is critical to the successful management of this life-threatening condition.
PMID: 29682356
ISSN: 2090-6404
CID: 3052312