Publications by authors named "Mitul Patel"

155 Publications

The Implementation and Outcomes of a Nurse-Run Extracorporeal Membrane Oxygenation Program, a Retrospective Single-Center Study.

Crit Care Explor 2021 Jun 15;3(6):e0449. Epub 2021 Jun 15.

Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, CA.

Due to a shortage of perfusionists and increasing utilization of extracorporeal membrane oxygenation in the United States, many programs are training nurses as bedside extracorporeal membrane oxygenation specialists (i.e., nurse-run extracorporeal membrane oxygenation). Our objective was to evaluate if a nurse-run extracorporeal membrane oxygenation program has noninferior survival to discharge and complication rates compared with a perfusionist-run extracorporeal membrane oxygenation program. Additionally, to sought to describe increases in extracorporeal membrane oxygenation capacity and the potential for cost savings by implementing a nurse-run extracorporeal membrane oxygenation program.
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http://dx.doi.org/10.1097/CCE.0000000000000449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208419PMC
June 2021

Advances in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.

Pulm Circ 2021 Apr-Jun;11(2):20458940211007385. Epub 2021 May 24.

Division of Pulmonary Critical Care Medicine, University of California San Diego, La Jolla, CA, USA.

Balloon pulmonary angioplasty (BPA) is an emerging treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who have inoperable, segmental/subsegmental disease, or residual disease after pulmonary endarterectomy. In the past decade, advances in the techniques for BPA have led to better clinical outcomes with improvements in hemodynamics, pulmonary perfusion, exercise tolerance, functional capacity, and quality of life. We present the experience with BPA at our university, the largest CTEPH center in the world, followed by reviewing the published data regarding the efficacy and safety of BPA in patients with CTEPH. There is increasing evidence to support that the initial hemodynamic improvement is sustained for ≥3 years after the procedure. Although infrequent, complications observed with BPA are associated with pulmonary vascular injury or rarely reperfusion pulmonary edema. As the technique for percutaneous pulmonary artery revascularization has improved, the procedural risk and complications have continued to decrease. This promising technique continues to develop, and future research is required to demonstrate the long-term benefits of BPA, standardize the technique, and define a uniform institutional infrastructure for providing BPA as a part of the treatment of CTEPH.
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http://dx.doi.org/10.1177/20458940211007385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150503PMC
May 2021

Prehospital Evaluation, ED Management, Transfers, and Management of Inpatient STEMI.

Interv Cardiol Clin 2021 Jul;10(3):293-306

UC San Diego Sulpizio Cardiovascular Center, 9452 Medical Center Drive #7411, La Jolla, CA 92037, USA; Division of Cardiovascular Medicine, UC San Diego Cardiovascular Institute, San Diego, CA, USA. Electronic address:

ST elevation myocardial infarction diagnoses have reduced in number over the past 10 years; however, associated morbidity and mortality remain high. Societal guidelines focus on early diagnosis and timely access to reperfusion, preferably percutaneous coronary intervention (PCI), with fibrinolytics reserved for those who cannot receive timely PCI. Proposed algorithms recommend emergency department bypass in stable patients with a clear diagnosis to reduced door-to-balloon time. Emergency providers should limit their evaluation, focusing on life-threatening comorbidities, unstable vitals, or contraindications to a catheterization laboratory. In-hospital patients prove diagnostically challenging because they may be unable to express symptoms, and reperfusion strategies can complicate other diagnoses.
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http://dx.doi.org/10.1016/j.iccl.2021.03.002DOI Listing
July 2021

Routine Analysis of N-Glycans Using Liquid Chromatography Coupled to Routine Mass Detection.

Methods Mol Biol 2021 ;2271:205-219

GlaxoSmithKline, Stevenage, UK.

Analysis of N-glycans are commonly conducted via enzymatic release, labeling, and liquid chromatography (LC) separation and fluorescent detection. Mass spectrometry (MS) has been increasingly used as an orthogonal detection method to provide additional structural information and increase the confidence of N-glycan analysis. In this chapter, we describe a method to perform routine analysis of N-glycans including the sample preparation with a signal-enhancement label, LC-MS data generation, and data analysis. Using this method, up to 24 N-glycan samples can be prepared at one time and analyzed by LC-MS. With the addition of automation platform, up to 96 N-glycan samples can be prepared and analyzed in a high-throughput manner.
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http://dx.doi.org/10.1007/978-1-0716-1241-5_15DOI Listing
June 2021

Endobronchial Carcinoids: Surgical Outcome in 100 Consecutive Patients and Factors Affecting Lung Preservation.

Indian J Surg Oncol 2021 Mar 21;12(1):190-198. Epub 2020 Oct 21.

Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India.

Bronchial carcinoids are slow-growing tumours of the neuroendocrine family. Most of them have a benign course with excellent outcome after complete resection. Due to their location in the primary bronchi, adequate resection with lung preservation requires considerable technical expertise. In this paper we present our surgical experience with endobronchial carcinoids and analyse the factors that predict possibility of lung preservation surgery. Retrospective analysis of a prospectively maintained database of patients operated for endobronchial carcinoids for the period March 2012 to September 2019 was carried out. Demographic factors and peri-operative variables were recorded and analysed. Factors that influence surgical outcome and possibility of lung preservation surgery were analysed. A total of 137 patients underwent surgery for resection of carcinoid tumours, out of which 100 had endobronchial carcinoids whereas 37 had peripheral carcinoids. The surgical procedure in 100 patients with endobronchial carcinoids included 14 left main bronchus sleeve resections, 13 pneumonectomies (7 right sided and 6 left sided), 10 right lower and middle bi-lobectomies, 10 lobectomies (4 left upper, 2 left lower and 4 right upper), and 53 sleeve lobectomies (18 left upper lobe sleeves, 8 left lower lobe sleeves, 20 right upper lobe sleeves, 5 right middle lobe sleeves and 2 right lower lobe sleeve lobectomies). There was no operative mortality. Median tumour size was 3.9 cm (range 5-130 mm). On univariate analysis, longer duration of symptoms was associated with poor surgical outcomes. On multivariate analysis, tumour in the main bronchus, duration of disease < 3 months ( = 0.006), left-sided disease ( = 0.03), and presence of healthy distal lung parenchyma ( < 0.001) were associated with successful lung preservation. Majority of endobronchial carcinoid tumours can be managed with lung-sparing procedures with minimal morbidity and mortality and excellent immediate and short-term outcomes. Early referral and experience of team performing these complex procedures are the key to success.
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http://dx.doi.org/10.1007/s13193-020-01248-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960861PMC
March 2021

Reducing suspicion of sexual abuse in paediatric chlamydial conjunctivitis using genotyping.

BMJ Case Rep 2021 Mar 29;14(3). Epub 2021 Mar 29.

Ophthalmology, Birmingham Children's Hospital, Birmingham, West Midlands, UK.

is a Gram-negative bacterium that causes urogenital tract infections, and ocular infections including trachoma, neonatal conjunctivitis and adult chlamydial inclusion conjunctivitis. A positive diagnosis in children often raises suspicions of sexual abuse. While outer membrane protein A () genotypes A-C are non-invasive and are associated with trachoma; genotypes D-K are often associated with sexually transmitted urogenital infections or sexually acquired chlamydial conjunctivitis. A 10-year-old female presented with a 7-month history of unilateral conjunctivitis with itching, watering and hyperaemia. She had recently moved from an urban centre in Afghanistan to the UK. A conjunctival swab taken from the child tested positive for Application of genotyping to conjunctival swab chlamydial DNA demonstrated that the had an genotype C. Chlamydial strains with this genotype cause trachoma and have never previously been associated with urogenital infection. This result supported cessation of child protection investigations.
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http://dx.doi.org/10.1136/bcr-2020-238871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009207PMC
March 2021

Video-assisted thoracoscopic surgery: The preferred method to manage pulmonary sequestration.

J Minim Access Surg 2021 Feb 11. Epub 2021 Feb 11.

Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India.

Background: This study aims at describing the feasibility and safety of video-assisted thoracic surgery (VATS) in benign diseases such as pulmonary sequestrations (PSs) and report the surgical outcomes.

Materials And Methods: This is a retrospective analysis of prospectively maintained data of 25 patients who were operated for PS over 7 years at a dedicated thoracic surgery centre in India. Pre-operative details, operative technique and details, post-operative details and complications were recorded and analysed.

Results: There were 15 (60%) males and 10 (40%) females, with a median age of 22.28 years (range, 16-28 years). All patients had intra-lobar type of sequestration. The most commonly involved was left lower lobe (n = 15 patients, 60%) followed by the right lower lobe (n = 10 patients, 40%). The origin of blood supply was from the descending thoracic aorta in 18 patients (72%), the abdominal aorta in 5 (20%) and the coeliac trunk and the inferior phrenic artery in one patient (4%) each. All patients underwent complete lobar resection. One patient was converted because of dense hilar adhesion. The average duration of surgery was 179 min and the average blood loss was 204 ml. The median hospital stay and chest tube duration were 4 and 3 days, respectively. One patient was re-explored because of post-operative bleeding. Only one patient had an air leak for >7 days. The median follow-up was 42 months (range, 6-90 months) without any recurrence.

Conclusions: VATS is a safe, feasible and effective option for PS at experienced centres.
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http://dx.doi.org/10.4103/jmas.JMAS_251_20DOI Listing
February 2021

Chronic total occlusion percutaneous coronary intervention in octogenarians and nonagenarians.

J Am Geriatr Soc 2021 Jun 16;69(6):1560-1569. Epub 2021 Feb 16.

Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.

Objective: The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study.

Methods: We compared in-hospital outcomes of CTO PCI between patients ≥80 vs. <80-years-old in 6233 CTO PCIs performed between 2012 and 2020 at 33 U.S. and international centers.

Results: There were 415 octogenarians and nonagenarians in our study (7% of the total population). Compared with younger patients, octo- and nonagenarians were less likely to be men (73% vs. 83.2%, p < 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p < 0.0001) and prior coronary artery bypass graft surgery (CABG) (43% vs. 29%, p < 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p < 0.0001), but had similar mean J-CTO scores (2.5 ± 1.3 vs. 2.4 ± 1.3, p = 0.08). They had lower technical and procedural success (82.2% vs. 86.3%, p = 0.0201; 80.3% vs. 84.8%, p = 0.016, respectively) and higher incidence of in-hospital major adverse cardiovascular events (3.4% vs. 1.8%, p = 0.021). On multivariable analysis PCI in octo- and nonagenarians was not independently associated with technical and procedural success or with in-hospital MACE.

Conclusion: CTO PCI is feasible in octo- and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients, likely related to more comorbidities and higher coronary lesion complexity.
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http://dx.doi.org/10.1111/jgs.17063DOI Listing
June 2021

A Novel Role of SLC26A3 in the Maintenance of Intestinal Epithelial Barrier Integrity.

Gastroenterology 2021 Mar 13;160(4):1240-1255.e3. Epub 2020 Nov 13.

Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois. Electronic address:

Background & Aims: The down-regulated in adenoma (DRA) protein, encoded by SLC26A3, a key intestinal chloride anion exchanger, has recently been identified as a novel susceptibility gene for inflammatory bowel disease (IBD). However, the mechanisms underlying the increased susceptibility to inflammation induced by the loss of DRA remain elusive. Compromised barrier is a key event in IBD pathogenesis. The current studies were undertaken to elucidate the impact of DRA deficiency on epithelial barrier integrity and to define underlying mechanisms.

Methods: Wild-type and DRA-knockout (KO) mice and crypt-derived colonoids were used as models for intestinal epithelial response. Paracellular permeability was measured by using fluorescein isothiocyanate-dextran flux. Immunoblotting, immunofluorescence, immunohistochemistry, and ribonucleoprotein immunoprecipitation assays were performed. Gut microbiome analysis was conducted to investigate the impact of DRA deficiency on gut microbial communities.

Results: DRA-KO mice exhibited an increased colonic paracellular permeability with significantly decreased levels of tight junction/adherens junction proteins, including ZO-1, occludin, and E-cadherin. A similar expression pattern of occludin and E-cadherin was observed in colonoids derived from DRA-KO mice and short hairpin RNA-mediated DRA knockdown in Caco-2 cells. Microbial analysis showed gut dysbiosis in DRA-KO mice. However, cohousing studies showed that dysbiosis played only a partial role in maintaining tight junction protein expression. Furthermore, our results showed increased binding of RNA-binding protein CUGBP1 with occludin and E-cadherin genes in DRA-KO mouse colon, suggesting that posttranscriptional mechanisms play a key role in gut barrier dysfunction.

Conclusions: To our knowledge, our studies demonstrate a novel role of DRA in maintaining the intestinal epithelial barrier function and potential implications of its dysregulation in IBD pathogenesis.
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http://dx.doi.org/10.1053/j.gastro.2020.11.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956241PMC
March 2021

Impact of adherence to the hybrid algorithm for initial crossing strategy selection in chronic total occlusion percutaneous coronary intervention.

Rev Esp Cardiol (Engl Ed) 2020 Nov 12. Epub 2020 Nov 12.

Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States.

Introduction And Objectives: The hybrid algorithm was designed to assist with initial and subsequent crossing strategy selection in chronic total occlusion (CTO) percutaneous coronary interventions (PCIs). However, the success of the initially selected strategy has received limited study.

Methods: We examined the impact of adherence to the hybrid algorithm recommendation for initial CTO crossing technique selection in 4178 CTO PCIs from a large multicenter registry.

Results: The initial crossing strategy was concordant with the hybrid algorithm recommendation in 1833 interventions (44%). Patients in the concordant group had a similar age to those in the discordant group but a lower mean J-CTO score (2.0 ± 1.4 vs 2.8 ± 1.1; P < .01). The concordant group showed higher technical success with the first crossing strategy (68% vs 48%; P < .01) and higher overall technical success (88% vs 83%; P < .01) with no difference in the incidence of in-hospital major adverse events (1.8% vs 2.3%; P = .26). In multivariable analysis, after adjustment for age, prior myocardial infarction, prior PCI, prior coronary artery bypass grafting, J-CTO score, and scheduled CTO PCI, nonadherence to the hybrid algorithm was independently associated with lower technical success of the initial crossing strategy (odds ratio, 0.55; 95% confidence interval, 0.48-0.64; P < .01).

Conclusions: Adherence to the hybrid algorithm for initial crossing strategy selection is associated with higher CTO PCI success but similar in-hospital major adverse cardiac events.
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http://dx.doi.org/10.1016/j.rec.2020.09.009DOI Listing
November 2020

Principles of immunisation in children with solid organ transplant.

Arch Dis Child 2021 03 16;106(3):219-223. Epub 2020 Sep 16.

Department of Paediatric Hepatology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.

Vaccine-preventable diseases (VPD) are a significant risk to paediatric solid organ transplant (SOT) recipients on lifelong immunosuppressive therapy. Children progressing to end-stage organ dysfunction are unable to mount a robust immune response. Hence, it is important to plan vaccination early in the course of disease, especially if a child is anticipated to be a SOT candidate. Vaccine recommendations need to be individualised in this population based on vaccine history and serology. Catch-up or accelerated schedules may be used to complete vaccinations before transplant. Post-transplant, immunisation is recommenced in consultation with the transplant team taking into context the time since transplant and the intensity of the immunosuppressive regime. Inactivated vaccines are safe post-transplant but postexposure prophylaxis may still be required in children with inadequate immunity to VPD. Specific vaccines may be advised for SOT recipients travelling abroad (in consultation with a travel clinic) or those entering high-risk professions. Additionally, the vaccination status of all household members and close contacts should be reviewed and optimised, offering additional protection to the transplant recipient.
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http://dx.doi.org/10.1136/archdischild-2020-319822DOI Listing
March 2021

Infection Inhibits Colonic P-glycoprotein Expression.

Gene Rep 2020 Mar 31;18. Epub 2019 Oct 31.

Jesse Brown VA Medical Center, University of Illinois at Chicago, Chicago, IL.

P-glycoprotein (Pgp/MDR1) serves as a biological barrier that protects intestinal epithelial cells (IECs) by transporting out xenobiotics and bacterial toxins. Decreased Pgp function and expression has been seen in mouse models of inflammatory colitis and also in patients with IBD. Pgp knockout mice spontaneously develop severe colitis, which is also seen in human patients with ulcerative colitis. However, whether Pgp is also altered in infectious colitis is not known. (CR), a murine pathogen has been shown to cause colonic hyperplasia and colitis in mice by attaching to IECs. The current study investigated the direct effects of infection on intestinal Pgp expression in mice. Mice were challenged with a single dose of (1 × 10 CFU) by oral gavage for 9 days and Pgp expression in the ileum and colon was measured by real time qRT-PCR and immunofluorescence studies. Our results showed that infection significantly decreased Pgp mRNA and protein expression in the colon, although no significant change was observed in the ileum of mice. These findings suggest that inhibition of the efflux protein, Pgp by can cause perturbations in the intestinal epithelial integrity, which could further lead to the pathogenesis of intestinal inflammation as observed in infectious colitis.
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http://dx.doi.org/10.1016/j.genrep.2019.100549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451832PMC
March 2020

Biomarkers Enhance Discrimination and Prognosis of Type 2 Myocardial Infarction.

Circulation 2020 Oct 21;142(16):1532-1544. Epub 2020 Aug 21.

University of California, San Diego, La Jolla (Y.H., N.W., M.P.P., S.-X.N., G.M.V., L.B.D., A.M.).

Background: The observed incidence of type 2 myocardial infarction (T2MI) is expected to increase with the implementation of increasingly sensitive cTn assays. However, it remains to be determined how to diagnose, risk-stratify, and treat patients with T2MI. We aimed to discriminate and risk-stratify T2MI using biomarkers.

Methods: Patients presenting to the emergency department with chest pain, enrolled in the CHOPIN study (Copeptin Helps in the early detection Of Patients with acute myocardial INfarction), were retrospectively analyzed. Two cardiologists adjudicated type 1 MI (T1MI) and T2MI. The prognostic ability of several biomarkers alone or in combination to discriminate T2MI from T1MI was investigated using receiver operating characteristic curve analysis. The biomarkers analyzed were cTnI, copeptin, MR-proANP (midregional proatrial natriuretic peptide), CT-proET1 (C-terminal proendothelin-1), MR-proADM (midregional proadrenomedullin), and procalcitonin. The prognostic utility of these biomarkers for all-cause mortality and major adverse cardiovascular event (a composite of acute myocardial infarction, unstable angina pectoris, reinfarction, heart failure, and stroke) at 180-day follow-up was also investigated.

Results: Among the 2071 patients, T1MI and T2MI were adjudicated in 94 and 176 patients, respectively. Patients with T1MI had higher levels of baseline cTnI, whereas those with T2MI had higher baseline levels of MR-proANP, CT-proET1, MR-proADM, and procalcitonin. The area under the receiver operating characteristic curve for the diagnosis of T2MI was higher for CT-proET1, MR-proADM, and MR-proANP (0.765, 0.750, and 0.733, respectively) than for cTnI (0.631). Combining all biomarkers resulted in a similar accuracy to a model using clinical variables and cTnI (0.854 versus 0.884, =0.294). Addition of biomarkers to the clinical model yielded the highest area under the receiver operating characteristic curve (0.917). Other biomarkers, but not cTnI, were associated with mortality and major adverse cardiovascular event at 180 days among all patients, with no interaction between the diagnosis of T1MI or T2MI.

Conclusions: Assessment of biomarkers reflecting pathophysiologic processes occurring with T2MI might help differentiate it from T1MI. All biomarkers measured, except cTnI, were significant predictors of prognosis, regardless of the type of myocardial infarction.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.046682DOI Listing
October 2020

Is Increased Sleep Responsible for Reductions in Myocardial Infarction During the COVID-19 Pandemic?

Am J Cardiol 2020 09 20;131:128-130. Epub 2020 Jun 20.

Pulmonary Critical Care Section, Veterans Affairs (VA) San Diego Healthcare System, La Jolla, California; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, California. Electronic address:

The COVID-19 pandemic caused by the highly contagious SARS-CoV-2 virus has had devastating consequences across the globe. However, multiple clinics and hospitals have experienced a decrease in rates of acute myocardial infarction and corresponding cardiac catheterization lab activations, raising the question: Has the risk of myocardial infarction decreased during COVID? Sleep deprivation is known to be an independent risk factor for myocardial infarction, and sleep has been importantly impacted during the pandemic, possibly due to the changes in work-home life leading to a lack of structure. We conducted a social media-based survey to assess potential mechanisms underlying the observed improvement in risk of myocardial infarction. We used validated questionnaires to assess sleep patterns, tobacco consumption and other important health outcomes to test the hypothesis that increases in sleep duration may be occurring which have a beneficial impact on health. We found that the COVID-19 pandemic led to shifts in day/night rhythm, with subjects waking up 105 minutes later during the pandemic (p <0.0001). Subjects also reported going to sleep 41 minutes later during the pandemic (p <0.0001). These shifts led to longer duration of sleep during the COVID-19 pandemic. Before the pandemic, subjects reported sleeping 6.8 hours per night, which rose to 7.5 hours during the pandemic, a 44 minute or 11% increase (p <0.0001). We acknowledge the major negative health impact of the global pandemic but would advocate for using this crisis to improve the work and sleep habits of the general population, which may lead to overall health benefits for our society.
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http://dx.doi.org/10.1016/j.amjcard.2020.06.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305870PMC
September 2020

Diversity Within the Most Competitive Internal Medicine Fellowships: Examining Trends from 2008 to 2018.

J Gen Intern Med 2020 09 14;35(9):2537-2544. Epub 2020 Jul 14.

Department of Cardiology, University of California, San Diego, CA, USA.

Background: Prior studies have demonstrated the importance of diversity among physicians. Identifying trends in diversity within the most competitive internal medicine (IM) fellowships can guide focused efforts to address barriers to equal representation.

Objective: To examine the racial and gender composition of resident applicants and accepted fellows to the top five most competitive IM specialties.

Design: Survey data from the AAMC, JAMA, and NRMP were obtained. Fisher's exact tests were conducted to compare differences in representation between fellows in the most competitive specialties, resident applicants into those specialties, and categorical IM residents. Linear regression was used to analyze trends within each group.

Participants: Categorical IM residents and fellows at ACGME-accredited M.D. programs in the USA.

Main Measures: Proportion of each population by gender and race/ethnicity KEY RESULTS: Women saw an increase in representation among accepted fellows to the most competitive IM fellowships from 2008 to 2013 (+ 4.4%, p < 0.011), but the trend has since plateaued at a level (34%) significantly lower than their representation among IM residents (43%, p < 0.001). Black representation among accepted fellows (4.6%) has been increasing from 2008 to 2018 (+ 1.2%, p = 0.001), but is still significantly lower than their representation among IM residents (5.6%, p < 0.001). Hispanic resident applicant and fellow representation have seen minimal change.

Conclusion: Despite trends towards better representation among women and underrepresented minorities (URMs) among fellows in the most competitive IM specialties from 2008 to 2013, there has been a stagnation in both gender and racial diversity over the past 5 years. Further efforts must be undertaken to address barriers to entry and advocate for better representation of women and URMs in fellowship programs.
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http://dx.doi.org/10.1007/s11606-020-06008-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459033PMC
September 2020

Equipment utilization in chronic total occlusion percutaneous coronary interventions: Insights from the PROGRESS-CTO registry.

Catheter Cardiovasc Interv 2021 Mar 29;97(4):658-667. Epub 2020 Jun 29.

Columbia University, New York, USA.

Background: We examined guidewire and microcatheter utilization during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Methods: We examined device utilization in 2,968 CTO PCIs performed in 2,936 patients at 19 US and two international center between January 2016 and January 2019.

Results: The median number of antegrade guidewires used per case declined (5 in 2016 vs 3 in 2019) and was higher in higher complexity lesions (2 in J-CTO 0 vs. 8 in J-CTO 4 or 5 score). In antegrade-only procedures, the most frequently used guidewires were the Pilot 200 (Abbott Vascular, 37%), Fielder XT (Asahi Intecc, 25%) and Gaia third (Asahi Intecc, 18%), while the most commonly used microcatheters were the Turnpike Spiral (Vascular Solutions, 18%) and Turnpike (Vascular Solutions, 16%). Compared with 2012-2015, during 2016-2019 use of novel equipment such as the Gaia guidewires and the Turnpike microcatheters led to decreased use of Confianza Pro 12 (Asahi Intecc) wire and Corsair (Asahi Intecc) family of microcatheters. In retrograde cases, the guidewires most commonly used were the Sion (44%), Pilot 200 (27%) and Fielder FC (26%), while the Corsair/Corsair Pro, Turnpike LP (Vascular Solutions) and Caravel (Asahi Intecc) were the most frequently used microcatheters for collateral crossing (29%, 26% and 22%, respectively).

Conclusions: The most commonly used guidewires during CTO PCI are polymer-jacketed guidewires and the most commonly used microcatheters are torquable microcatheters.
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http://dx.doi.org/10.1002/ccd.29106DOI Listing
March 2021

Impact of Successful Chronic Total Occlusion Percutaneous Coronary Interventions on Subsequent Clinical Outcomes.

J Invasive Cardiol 2020 Nov 22;32(11):433-439. Epub 2020 Jun 22.

Minneapolis Heart Institute, 920 E 28th Street #300, Minneapolis, Minnesota 55407 USA.

Background: The impact of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on angina and subsequent incidence of major adverse cardiovascular event (MACE) rate remains controversial.

Methods: We compared patient- reported angina change and the incidence of MACE (defined as death, myocardial infarction [MI], target-vessel revascularization) between successful vs failed CTO-PCI in 1612 patients participating in a large, multicenter registry.

Results: CTO-PCI was successful in 1387 patients (86%). Compared with failed CTO-PCI, successful CTO-PCI patients were less likely to have history of heart failure (33% vs 41%; P=.02), prior MI (49% vs 62%; P<.01), or prior coronary revascularization (63% vs 71% [P=.03] for PCI and 30% vs 40% [P<.01] for coronary artery bypass graft surgery). Patients in the successful CTO-PCI group had lower J-CTO scores (2.4 ± 1.3 vs 3.1 ± 1.1; P<.01) and lower PROGRESS-CTO Complications scores (1.1 ± 1.0 vs 1.6 ± 1.0; P<.01). After a mean follow-up of 181 ± 153 days, patients with successful PCI were more likely to have angina improvement (83% vs 38%; P<.01) and had lower incidence of 1-year MACE (8% vs 15%; P<.01), death (3% vs 7%; P<.01), and MI (2% vs 4%; P=.02). On multivariable analysis, however, CTO-PCI success was not independently associated with MACE.

Conclusion: Compared with failed CTO-PCI, successful CTO-PCI is associated with better angina improvement and lower incidence of MACE (on univariable analysis) during follow-up.
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November 2020

Planned Robotic Chronic Total Occlusion Percutaneous Coronary Intervention: Feasibility Report.

J Invasive Cardiol 2020 Jun 24;32(6):201-205. Epub 2020 Apr 24.

Sulpizio Cardiovascular Center, 9434 Medical Center Drive, La Jolla, CA 92037.

Background: Complex robotic percutaneous coronary intervention (R-PCI) is technically possible and leads to clinically comparable outcomes compared with the manual approach. However, there are limited data on the feasibility of chronic total occlusion (CTO) revascularization via the R-PCI approach.

Methods: Ten consecutive patients undergoing R-PCI for a coronary CTO at a single tertiary academic center were analyzed. The PRECISION, PRECISION GRX, and PROGRESS CTO registries were utilized for data collection with regard to procedural/clinical details and results.

Results: Technical success, defined as successful CTO revascularization with full or partial robotic support, occurred in 7 of 10 patients. There were no periprocedural major adverse cardiac events. Average J-CTO score was 2; all procedures were performed from an antegrade approach. The time from robotic wire manipulation to completion of procedure regardless of method averaged 55.1 minutes; average fluoroscopy time was 29.9 minutes.

Conclusions: CTO revascularization via a robotic approach is feasible. Technical success may be best predicted by those patients with low J-CTO scores and lesions amenable to antegrade wire escalation technique. Given the potential benefits to both operators and patients, further research is warranted.
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June 2020

Effect of Chitin Nanocrystals on Crystallization and Properties of Poly(lactic acid)-Based Nanocomposites.

Polymers (Basel) 2020 Mar 24;12(3). Epub 2020 Mar 24.

Division of Materials Science, Luleå University of Technology, SE-97 187 Luleå, Sweden.

The crystalline phase of poly(lactic acid) (PLA) has crucial effects on its own properties and nanocomposites. In this study, the isothermal crystallization of PLA, triethyl citrate-plasticized PLA (PLA-TEC), and its nanocomposite with chitin nanocrystals (PLA-TEC-ChNC) at different temperatures and times was investigated, and the resulting properties of the materials were characterized. Both PLA and PLA-TEC showed extremely low crystallinity at isothermal temperatures of 135, 130, 125 °C and times of 5 or 15 min. In contrast, the addition of 1 wt % of ChNCs significantly improved the crystallinity of PLA under the same conditions owing to the nucleation effect of the ChNCs. The samples were also crystallized at 110 °C to reach their maximal crystallinity, and PLA-TEC-ChNC achieved 48% crystallinity within 5 min, while PLA and PLA-TEC required 40 min to reach a similar level. Moreover, X-ray diffraction analysis showed that the addition of ChNCs resulted in smaller crystallite sizes, which further influenced the barrier properties and hydrolytic degradation of the PLA. The nanocomposites had considerably lower barrier properties and underwent faster degradation compared to PLA-TEC110. These results confirm that the addition of ChNCs in PLA leads to promising properties for packaging applications.
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http://dx.doi.org/10.3390/polym12030726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183044PMC
March 2020

Temporal Trends in Chronic Total Occlusion Percutaneous Coronary Interventions: Insights From the PROGRESS-CTO Registry.

J Invasive Cardiol 2020 Apr 20;32(4):153-160. Epub 2020 Mar 20.

Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly evolved in recent years.

Methods: We compared the clinical, angiographic, and technical characteristics, as well as procedural outcomes of CTO-PCIs in a multicenter registry between the "early era" (2012-2016) and the "current era" (2017-2019).

Results: Current era patients more often had stage III or IV angina compared with early era patients (71% vs 66%, respectively; P=.03) and were less likely to undergo ad hoc CTO-PCI (13% vs 16%, respectively; P=.04). The J-CTO score was slightly lower in the current era patients vs the early era patients (2.3 ± 1.4 vs 2.5 ± 1.3, respectively; P=.04). Use of antegrade wire escalation increased in the current era (92% vs 83% in the early era patients; P<.001) whereas use of retrograde crossing decreased (29% vs 39% in the early era; P<.001) and antegrade/ dissection re-entry decreased (23% vs 32% in the early era; P<.001). Technical success rates (85% in the current era vs 86% in the early era; P=.69) and procedural success rates (83% in the current era vs 85% in the early era; P=.15) were similar, whereas the incidence of in-hospital major cardiovascular events decreased in the current era (2% vs 3% in the early era; P=.04).

Conclusions: During recent years, ad hoc CTO-PCI decreased along with decreasing use of retrograde crossing and antegrade dissection and re-entry. Technical and procedural success rates remained stable, whereas the incidence of in-hospital MACE decreased.
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April 2020

Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention via Saphenous Vein Graft.

JACC Cardiovasc Interv 2020 02;13(4):517-526

Columbia University, New York, New York.

Objectives: The aim of this study was to examine the use of saphenous vein grafts (SVGs) for retrograde crossing during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Background: The use of SVGs for retrograde crossing during CTO PCI has received limited study.

Methods: A total of 1,615 retrograde CTO PCIs performed between 2012 and 2019 at 25 centers were examined. Clinical, angiographic, and technical characteristics and procedural outcomes were compared among retrograde cases via SVGs (SVG group) versus other collateral vessels (non-SVG group).

Results: Retrograde CTO PCI via SVGs was performed in 189 cases (12%). Patients in the SVG group were older (mean age 70 ± 9 years vs. 64 ± 10 years; p < 0.01) and had higher rates of prior myocardial infarction (62% vs. 51%; p < 0.01) and prior PCI (81% vs. 70%; p < 0.01). They were more likely to have moderate or severe calcification (81% vs. 65%; p < 0.01) and moderate or severe tortuosity (53% vs. 44%; p = 0.02) and had similar J-CTO (Multicenter CTO Registry in Japan) scores (3.2 ± 1.0 vs. 3.1 ± 1.1; p = 0.13) but higher PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores (4.7 ± 1.7 vs. 3.1 ± 1.1; p < 0.01). Technical (85% vs. 78%; p = 0.04) and procedural (81% vs. 74%; p = 0.04) success rates were higher in the SVG group, with no difference in in-hospital major adverse events (6.4% vs. 4.4%; p = 0.22). Contrast volume was lower in the SVG group (225 ml [173 to 325 ml] vs. 292 ml [202 to 400 ml]; p < 0.01).

Conclusions: Use of SVGs for retrograde crossing is associated with higher rates of technical and procedural success and similar rates of in-hospital major adverse cardiac events compared with retrograde CTO PCI via other collateral vessels.
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http://dx.doi.org/10.1016/j.jcin.2019.10.028DOI Listing
February 2020

and amoebic liver abscess in northern Sri Lanka: a public health problem.

Trop Med Health 2020 22;48. Epub 2020 Jan 22.

1School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.

() is a facultative protozoan parasite implicated in amoebic liver abscesses (ALA), the most common extraintestinal manifestation of this infection. is endemic to sub-tropical and tropical countries and has been a major public health concern in northern Sri Lanka (SLK) for the last three decades. This has been attributed to a multitude of factors such as poor sanitation, hygiene, male sex, middle age, overcrowding, unsanitary practices in the production of indigenous alcoholic beverages, and alcohol consumption. Additionally, while rates of have declined substantially throughout the rest of the island, largely due to better infrastructure, it remains pervasive in the northern peninsula, which is generally less developed. Infection arises primarily from fecal-oral transmission through the consumption of contaminated drinking water containing cysts. Upon ingestion, cysts multiply into trophozoites and colonize the host colonic mucosa using lectin and cysteine proteases as virulence factors, leading to host invasion. Symptoms occur along a spectrum, from asymptomatology, to pyrexia, abdominal cramping, and amoebic dysentery. Colonization of the colon results in the formation of distinct flask-shaped ulcers along the epithelium, and eventual penetration of the lamina propria via the production of matrix metalloproteinases. ALA then develops through trophozoite migration via the mesenteric hepatic portal circulation, where microabscesses coalesce to form a single, large right-lobe abscess, commonly on the posterior aspect. The progression of infection to invasive disease is contingent on the unique interplay between host and pathogen factors, such as the strength of host-immunity to overcome infection and inherent pathogenicity of the species. As a preventable illness, complications such as ALA impose a significant burden on the healthcare system. This mini-review highlights epidemiological trends, risk factors, diagnostic modalities, treatment approaches, and opportunities for prevention of -induced ALA, to help address this endemic problem on the island of SLK.
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http://dx.doi.org/10.1186/s41182-020-0193-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6977265PMC
January 2020

The Impact of Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention (Insights From PROGRESS-CTO Registry).

Angiology 2020 03 17;71(3):274-280. Epub 2019 Dec 17.

Columbia University, New York, NY, USA.

The impact of peripheral artery disease (PAD) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We reviewed 3999 CTO PCIs performed in 3914 patients between 2012 and 2018 at 25 centers, 14% of whom had a history of PAD. We compared the clinical and angiographic characteristics and procedural outcomes of patients with versus without history of PAD. Patients with PAD were older (67 ± 9 vs 64 ± 10 years, < .001) and had a higher prevalence of cardiovascular risk factors. They also had more complex lesions as illustrated by higher Japanese CTO score (2.7 ± 1.2 vs 2.4 ± 1.3, < .001). In patients with PAD, the final crossing technique was less often antegrade wire escalation (40% vs 51%, < .001) and more often the retrograde approach (23 vs 20%, < .001) and antegrade dissection/reentry (20% vs 16%, < .001). Technical success was similar between the 2 study groups (84% vs 87%, = .127), but procedural success was lower for patients with PAD (81% vs 85%, = .015). The incidence of in-hospital major adverse cardiac events was higher among patients with PAD (3% vs 2%, = .046). In conclusion, patients with PAD undergoing CTO PCI have more comorbidities, more complex lesions, and lower procedural success.
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http://dx.doi.org/10.1177/0003319719895178DOI Listing
March 2020

Outcomes of subintimal plaque modification in chronic total occlusion percutaneous coronary intervention.

Catheter Cardiovasc Interv 2020 11 4;96(5):1029-1035. Epub 2019 Dec 4.

Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.

Background: When crossing into the distal true lumen fails during chronic total occlusion (CTO) percutaneous coronary intervention (PCI), subintimal plaque modification (SPM) is often performed to restore antegrade flow and facilitate subsequent lesion recanalization.

Methods: Between January 2012 and May 4, 2019, 4,659 CTO PCIs were included in the PROGRESS-CTO registry, of which 935 (20%) had a prior unsuccessful attempt. Of those 935 patients, 119 (13%) had prior SPM. We analyzed the outcomes of the 58 SPM procedures for which data were available, as well as the outcomes of the 60 subsequent CTO PCI attempts.

Results: Mean patient age was 67 ± 9 years and 86% were men. Patients had high prevalence of cardiovascular risk factors such as dyslipidemia (91%), hypertension (93%) diabetes (48%), prior PCI (61%), and prior coronary artery bypass graft surgery (47%). The target CTO lesions often had proximal cap ambiguity (54%), moderate/severe calcification (73%), moderate/severe tortuosity (63%), and high J-CTO score (mean 3.2 ± 1.1). The technical and procedural success of subsequent CTO PCI were high (83% for both) with an acceptable rate of in-hospital major adverse cardiovascular events (3.3%). Technical and procedural success were higher for repeat attempts that were performed ≥60 days after the index CTO PCI (94% vs. 69%, p = .015). Median (interquartile range) subsequent procedure time was 147 (100, 215) min, contrast volume was 185 (150, 260) ml, and air kerma radiation dose was 2.5 (1.4, 4.2) Gray.

Conclusion: Repeat CTO PCI attempts after SPM are associated with high likelihood for successful revascularization with acceptable risks.
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http://dx.doi.org/10.1002/ccd.28614DOI Listing
November 2020

Outcomes of fractional flow reserve-guided percutaneous coronary interventions in patients with acute coronary syndrome.

Catheter Cardiovasc Interv 2020 08 29;96(2):E149-E154. Epub 2019 Nov 29.

Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California.

Introduction: Fractional flow reserve (FFR) assessment has been validated as an effective tool to guide revascularization of stable coronary artery disease. The role of utilizing FFR in acute coronary syndrome (ACS) is less established.

Methods: The study population was extracted from the National Readmissions Data (NRD) 2014 using International Classification of Diseases, ninth edition, clinical modification (ICD-9-CM) codes for ACS, percutaneous coronary intervention (PCI), FFR, and periprocedural complications. Study endpoints included all-cause of in-hospital mortality, length of index hospital stay (LOS), acute kidney injury (AKI), bleeding, coronary dissection, total number of stents used, stroke, vascular complications (VCs), and the total charges of index hospitalization.

Results: A total of 304,548 discharges that had the diagnosis of ACS and treated invasively within the same index hospitalization (average age 65.1 years; 64% male) were identified. Among these, 7,832 had FFR guided invasive treatment (2.6%) which was associated with significantly lower in-hospital all-cause mortality (1.1 vs. 3.1%, p < .01), shorter LOS (4.6 vs. 5.3 days, p < .01), less AKI (12.5 vs. 14.6%, p < .01), less bleeding (7.0 vs. 8.5%, p < .01), and lower total charges ($99,805 vs. $105,736). There was no significant difference between both groups in terms of stroke (2.2 vs. 2.3%, p = .41), coronary dissection (0.7 vs. 0.8%, p = .34), VC (1.3 vs. 1.0% p = .01) or the total number of stents used (55.5 vs. 54.5% p = .34).

Conclusion: In patients presenting with an ACS FFR- guided PCI, as compared to angiography guided PCI, was associated with lower rates of in-hospital mortality, shorter LOS, less AKI, bleeding and lower hospital charges. There was no significant difference in terms of the incidence of stroke, coronary dissection, VC or the total number of stents used.
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http://dx.doi.org/10.1002/ccd.28611DOI Listing
August 2020

Transradial Repair of Type IA Endoleak.

J Invasive Cardiol 2019 Nov;31(11):E331-E332

Associate Director of Interventional Cardiology & Endovascular Medicine, Deborah Heart and Lung Center 200 Trenton Road, Browns Mills NJ 08054 USA.

An 81-year-old Caucasian male with a known abdominal aortic aneurysm (AAA) was referred to the endovascular clinic. One month after successful endovascular repair, surveillance CTA showed endoleak with presence of contrast within the aneurysmal sac. An elective repair was performed.
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November 2019

Technical and procedural outcomes of the retrograde approach to chronic total occlusion interventions.

EuroIntervention 2020 12 4;16(11):e891-e899. Epub 2020 Dec 4.

Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.

Aims: The retrograde approach is critical for achieving high success rates in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), but has been associated with higher risk of complications. We examined the contemporary outcomes of the retrograde approach to CTO PCI aiming to identify areas in need of improvement.

Methods And Results: We compared the technical and procedural outcomes of retrograde (n=1,515) and antegrade-only CTO PCIs (n=2,686) in a contemporary multicentre CTO registry. The mean age of patients undergoing retrograde PCI was 65±10 years and 86% were men, with high prevalence of prior myocardial infarction (51%), prior PCI (71%), and coronary artery bypass graft surgery (45%). The mean J-CTO score (3±1 vs 2±1, p<0.001) was higher in retrograde PCIs. The most commonly used collateral channels were septals (65%), epicardials (32%), saphenous venous grafts (14%) and left internal mammary artery grafts (2%). Overall technical (79% vs 91%, p<0.001) and procedural (75% vs 90%, p<0.001) success rates were lower with the retrograde approach, and these patients had a higher rate of in-hospital major complications than antegrade-only PCI patients (5.1% vs 0.8%, p<0.001), due to higher mortality (1.1% vs 0.1%, p<0.001), acute myocardial infarction (1.9% vs 0.2%, p<0.001), repeat PCI (0.7% vs 0.1%, p=0.001), and pericardiocentesis (1.7% vs 0.3%, p<0.001).

Conclusions: In summary, the retrograde approach to CTO PCI is performed in higher complexity lesions and is associated with lower success rates and a higher rate of major complications.

Clinical Trial Registration: NCT02061436, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO).
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http://dx.doi.org/10.4244/EIJ-D-19-00441DOI Listing
December 2020

Homoarginine Supplementation Prevents Left Ventricular Dilatation and Preserves Systolic Function in a Model of Coronary Artery Disease.

J Am Heart Assoc 2019 07 15;8(14):e012486. Epub 2019 Jul 15.

2 Department of Biomedical Sciences New York Institute of Technology College of Osteopathic Medicine Old Westbury NY.

Background Homoarginine ( hA rg) has been shown to be cardioprotective in a model of ischemic heart failure; however, the mechanism remains unknown. hA rg can inhibit tissue-nonspecific alkaline phosphatase ( TNAP ), an enzyme that promotes vascular calcification. We hypothesized that hA rg will exert beneficial effects by reducing calcification in a mouse model of coronary artery disease associated with TNAP overexpression and hypercholesterolemia. Methods and Results TNAP was overexpressed in the endothelium in mice homozygous for a low-density lipoprotein receptor mutation (wicked high cholesterol [ WHC ] allele). WHC and WHC -endothelial TNAP mice received placebo or hA rg supplementation (14 mg/L in drinking water) starting at 6 weeks of age simultaneously with an atherogenic diet. Outcomes were compared between the groups after 4 to 5 weeks on treatment. Experiments were performed in males, which presented a study limitation. As expected, WHC -endothelial TNAP mice on the placebo had increased mortality (median survival 27 days, P<0.0001), increased coronary calcium and lipids ( P<0.01), increased left ventricular end-diastolic diameter ( P<0.0001), reduced ejection fraction ( P<0.05), and increased myocardial fibrosis ( P<0.0001) compared with WHC mice. Contrary to our hypothesis, hA rg neither inhibited TNAP activity in vivo nor reduced coronary artery calcification and atherosclerosis in WHC -endothelial TNAP mice; however, compared with the placebo, hA rg prevented left ventricular dilatation ( P<0.01), preserved ejection fraction ( P<0.05), and reduced myocardial fibrosis ( P<0.001). Conclusions The beneficial effect of hA rg supplementation in the setting of calcified coronary artery disease is likely due to its direct protective actions on the myocardial response to the ischemic injury and not to the inhibition of TNAP activity and calcification.
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http://dx.doi.org/10.1161/JAHA.119.012486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662144PMC
July 2019

Impact of concomitant treatment of non-chronic total occlusion lesions at the time of chronic total occlusion intervention.

Int J Cardiol 2020 01 3;299:75-80. Epub 2019 Jul 3.

Columbia University, New York, NY, USA.

Background: During chronic total occlusion (CTO) percutaneous coronary intervention (PCI), sometimes non-CTO lesions are also treated.

Methods: We compared the clinical and procedural characteristics and outcomes of CTO PCIs with and without concomitant treatment of a non-CTO lesion in a contemporary multicenter CTO registry.

Results: Of the 3598 CTO PCIs performed at 21 centers between 2012 and 2018, 814 (23%) also included PCI of at least one non-CTO lesion. Patients in whom non-CTO lesions were treated were older (65 ± 10 vs. 64 ± 10 years, p = 0.03), more likely to present with an acute coronary syndrome (32% vs. 23%, p < 0.01), and less likely to undergo PCI of a right coronary artery (RCA) CTO (46% vs. 58%, p < 0.01). The most common non-CTO lesion location was the left anterior descending artery (31%), followed by the circumflex (29%) and the RCA (25%).Combined non-CTO and CTO-PCI procedures had similar technical (88% vs. 87%, p = 0.33) and procedural (85% vs. 85%, p = 0.74) success and major in-hospital complication rates (3.4% vs. 2.7%, p = 0.23), but had longer procedure duration (131 [88, 201] vs. 117 [75, 179] minutes, p < 0.01), higher patient air kerma radiation dose (3.0 [1.9, 4.8] vs. 2.8 [1.5, 4.6] Gray, p < 0.01) and larger contrast volume (300 [220, 380] vs. 250 [180, 350] ml, p < 0.01).

Conclusions: Combined CTO PCI with PCI of non-CTO lesions is associated with similar success and major in-hospital complication rates compared with cases in which only CTOs were treated, but requires longer procedure duration and higher radiation dose and contrast volume.
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http://dx.doi.org/10.1016/j.ijcard.2019.06.077DOI Listing
January 2020
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