Author(s): Balata H.; Blandin Knight S.; Barber P.; Evison M.; Booton R.; Crosbie P.A.J.; Colligan D.; Taylor S.; Tonge J.; Waplington S.; Crosbie E.J.; Duerden R.; Greaves M.; Sawyer R.; Sharman A.; Smith E.; Elton P.; Howells J.; Irion K.; Karunaratne D.; Kirwan M.; Slevin K.; Macnab A.; Miller C.; Mellor S.; Newton T.; Novasio J.; Taylor B.; Walsham A.; Whittaker J.
Source: Lung Cancer; Oct 2018; vol. 124 ; p. 148-153
Publication Date: Oct 2018
Publication Type(s): Article
Abstract:Background: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in populations eligible for lung cancer screening. The aim of this study was to determine whether a brief CV risk assessment, delivered as part of a targeted community-based lung cancer screening programme, was effective in identifying individuals at high risk who might benefit from primary prevention.

Methods: The Manchester Lung Screening Pilot consisted of annual low dose CT (LDCT) over 2 screening rounds, targeted at individuals in deprived areas at high risk of lung cancer (age 55-74 and 6-year risk >=1.51%, using PLCOM2012 risk model). All participants of the second screening round were eligible to take part in the study. Ten-year CV risk was estimated using QRISK2 in participants without CVD and compared to age (+/-5 years) and sex matched Health Survey for England (HSE) controls; high risk was defined as QRISK2 score >=10%. Coronary artery calcification (CAC) was assessed on LDCT scans and compared to QRISK2 score.

​Results: Seventy-seven percent (n=920/1,194) of screening attendees were included in the analysis; mean age 65.6 +/- 5.4 and 50.4% female. QRISK2 and lung cancer risk (PLCOM2012) scores were correlated (r = 0.26, p < 0.001). Median QRISK2 score was 21.1% (IQR 14.9-29.6) in those without established CVD (77.6%, n = 714/920), double that of HSE controls (10.3%, IQR 6.6-16.2; n = 714) (p < 0.001). QRISK2 score was significantly higher in those with CAC (p < 0.001). Screening attendees were 10-fold more likely to be classified high risk (OR 10.2 [95% CI 7.3-14.0]). One third (33.7%, n = 310/920) of all study participants were high risk but not receiving statin therapy for primary CVD prevention.

Discussion: Opportunistic CVD risk assessment within a targeted lung cancer screening programme is feasible and is likely to identify a very large number of individuals suitable for primary prevention.Copyright © 2018 Elsevier B.V.
Database: EMBASE

​Author(s): Her A.-Y.; Kim Y.H.; Shin E.-S.; Garg S.
Source: Coronary Artery Disease; Aug 2018; vol. 29 (no. 5); p. 403-408
Publication Date: Aug 2018
Publication Type(s): Article
Abstract:Objectives Periprocedural myocardial infarction (PMI) is reported to be associated with adverse long-term clinical outcomes. This study compared the rates of PMI following treatment of de novo coronary lesions using either a paclitaxel-coated balloon (PCB) or a newer-generation drug-eluting stent (DES). 

​Author(s): Her A.-Y.; Shin E.-S.; Lee J.M.; Garg S.; Doh J.-H.; Nam C.-W.; Koo B.-K.
Source: International Journal of Cardiovascular Imaging; Apr 2018 ; p. 1-9
Publication Date: Apr 2018
Publication Type(s): Article In Press
Abstract:There is limited data on the efficacy of paclitaxel-coated balloon (PCB) compared to stents for de novo coronary lesions. The purpose of this study was to compare the efficacy of PCB treatment with stent implantation for de novo coronary lesions after successful plain old balloon angioplasty (POBA) guided by fractional flow reserve (FFR). In 200 patients scheduled for elective percutaneous coronary intervention (PCI) for de novo lesions, FFR was measured after POBA (POBA-FFR). If POBA-FFR was >= 0.75, patients were treated with PCB (PCB group, n = 78) or stent (Stent group, n = 73). If POBA-FFR was < 0.75, stent was implanted as planned (Reference group, n = 42). The primary endpoint was late lumen loss at 9 months and the secondary endpoint was adverse cardiac events (cardiac death, myocardial infarction, target lesion thrombosis, or repeat revascularization) at 12 months follow-up. There was no between-group differences in the POBA-FFR (0.87 +/- 0.05 in PCB, 0.89 +/- 0.06 in stent, p = 0.101). At 9 months, late lumen loss was significantly lower in the PCB group compared to the Stent group (0.05 +/- 0.33 vs. 0.59 +/- 0.76 mm, p < 0.001). Adverse cardiac events were not different between the PCB, Stent and Reference groups (2.6, 5.5, and 9.5% respectively; p = 0.430 for PCB vs. Stent group; p = 0.229 for the reference vs. both other groups). PCB treatment guided by POBA-FFR showed excellent 9 months angiographic and functional results, as well as comparable 12 months clinical outcomes, compared with stent implantation for de novo coronary lesions.Copyright © 2018 Springer Science+Business Media B.V., part of Springer Nature
Database: EMBASE

Author(s): Her A.-Y.; Kim Y.H.; Cho K.-I.; Garg S.; Shin E.-S.
Source: Yonsei Medical Journal; 2017; vol. 58 (no. 5); p. 954-958
Publication Date: 2017
Publication Type(s): Article
PubMedID: 28792138
Available  at Yonsei Medical Journal -  from EBSCO (MEDLINE Complete)
Available  at Yonsei Medical Journal -  from Europe PubMed Central - Open Access
Available  at Yonsei Medical Journal -  from nih.gov
Abstract:Purpose: There are no sufficient data on the correlation between inter-arm blood pressure (BP) difference and coronary atherosclerosis found using coronary artery calcium score (CACS). We aimed to investigate if the increased difference in inter-arm BP is independently associated with severity of CACS. Materials and Methods: Patients who had >=3 cardiovascular risk factors or an intermediate Framingham Risk Score (FRS; >=10) were enrolled. Inter-arm BP difference was defined as the absolute difference in BP in both arms. Quantitative CACS was measured by using coronary computed tomography angiography with the scoring system. Results: A total of 261 patients were included in this study. Age (r=0.256, p<0.001), serum creatinine (r=0.139, p=0.030), mean of right arm systolic BP (SBP; r=0.172, p=0.005), mean of left arm SBP (r=0.190, p=0.002), inter-arm SBP difference (r=0.152, p=0.014), and the FRS (r=0.278, p<0.001) showed significant correlation with CACS. The increased inter-arm SBP difference (>=6 mm Hg) was significantly associated with CACS >=300 [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.12-4.22; p=0.022]. In multivariable analysis, the inter-arm SBP difference >=6 mm Hg was also significantly associated with CACS >=300 after adjusting for clinical risk factors (OR 2.34, 95 % CI 1.06-5.19; p=0.036). Conclusion: An increased inter-arm SBP difference (>=6 mm Hg) is associated with coronary atherosclerotic disease burden using CACS, and provides additional information for predicting severe coronary calcification, compared to models based on traditional risk factors. Copyright © Yonsei University College of Medicine 2017.
Database: EMBASE

Author(s): Her A.-Y.; Kim Y.H.; Cho K.-I.; Singh G.B.; Shin E.-S.; Garg S.; Koo B.-K.

Source: Yonsei Medical Journal; Jan 2017; vol. 58 (no. 1); p. 99-104

Publication Date: Jan 2017

Publication Type(s): Journal: Article

Available in full text at Yonsei Medical Journal 


Abstract:Purpose: This study compared the impact of paclitaxel-coated balloons (PCB) or drug eluting stents (DES) on peri-procedural myocardial infarction (PMI) on de novo coronary lesion in stable patients. Materials and Methods: In this observational study, we compared the incidence of PMI amongst patients with single vessel de novo coronary lesions who underwent treatment with a PCB or DES. Propensity score-matching analysis was used to assemble a cohort of patients with similar baseline characteristics. PMI was classified as myocardial infarction occurring within 48 hours after percutaneous coronary intervention with a threshold of 5 x the 99th percentile upper reference limit of normal for creatine kinase-myocardial band (CK-MB) or troponin T (TnT). Results: One hundred four patients (52 receiving PCB and 52 receiving DES) were enrolled in this study. The peak mean values of CK-MB and TnT were significantly higher in the DES group. There was a significantly higher rate of PMI in the DES group (23.1% vs. 1.9%, p=0.002). Total occlusion of the side-branch occurred in two patients treated with DES, while no patients treated with PCB. In multivariable analysis, DES was the only independent predictor of PMI compared with PCB (odds ratio 42.85, 95% confidence interval: 3.44-533.87, p=0.004). Conclusion: Treatment with a PCB on de novo coronary lesion might be associated with a significant reduction in the risk of PMI compared to DES. Copyright © Yonsei University College of Medicine 2017.
​
Database: EMBASE
 

Source: Journal of epidemiology and community health; Nov 2016; vol. 70 (no. 11); p. 1057-1064

Publication Type(s): Journal Article

Author(s): Cho, Kyoung Im; Shin, Eun-Seok; Ann, Soe Hee; Garg, Scot; Her, Ae-Young; Kim, Jeong Su; Han, Jun Hee; Jeong, Myung Ho; KAMIR Registry

Abstract:There are limited data on the influence of gender on risk factors and clinical outcomes in young patients with acute myocardial infarction (AMI).        

This prospective study stratified outcomes according to gender in patients of age ≤50 years with a diagnosis of AMI, and who were enrolled in the nationwide registry of the Korea Working Group of Myocardial Infarction. The end point was the incidence of major adverse cardiovascular events (MACEs) defined as the composite of cardiac death, recurrent myocardial infarction (MI), and repeat revascularisation at 30 days and 1 year after admission.

The registry enrolled 30 001 patients with AMI, of whom 5200 met the study inclusion criteria; 4805 patients were male and 395 were female. Current smoking was significantly higher in men, while hypertension and diabetes mellitus were significantly more common in women. Women underwent less coronary revascularisation, and were less likely to be on optimal medical therapy compared with men despite having a higher Killip class at presentation and higher risk angiographic findings.

Although women had higher rates of MACEs (3.8% vs 1.8%, p=0.018 at 30 days and 7.8% vs 4.7%, p=0.004 at 1-year follow-up) compared with men, female gender was not an independent predictor of MACEs after adjusting for propensity score.      
There were significant gender differences in the risk factors for coronary artery disease and the short-term and long-term clinical outcomes of young patients with AMI. Continued preventive strategies should be focused on gender-different risk factor reduction in these young patients.


Available in full text at Journal of Epidemiology and Community Health 

​Source: Journal of the Intensive Care Society; Nov 2016; vol. 17 (no. 4); p. 302-313

Publication Type(s): Journal: Article

Author(s): Crossingham I.R.; Nethercott D.R.; Columb M.O.

Abstract:Background: Measuring cardiac output is common in critical care and perioperative medicine. Different monitoring systems are often judged against others in comparative studies. There is no agreed standard or definition on which to base the conclusions of such studies. Objectives: To review comparative studies of cardiac output monitors using an agreement:tolerability index (ATI) as a measure of monitor precision. To compare the ATI of a monitor with the conclusions of authors regarding agreement and clinical utility. Design: Systematic review of comparative studies of cardiac output monitoring systems. The precision of each monitor was standardised against an ATI using a tolerability interval based on the normal range for cardiac index. The conclusions of each study were described as positive, neutral or negative, depending on whether authors reported the monitor to be acceptably precise and/or clinically useful. Comparison was made between the precision of a monitor and the likelihood of it being favoured by authors. Data sources: PubMed was searched up to March 2012. Eligibility criteria: Studies published in English that compared two or more methods for measuring cardiac output in adult humans. Results: A total of 213 papers documenting 409 separate comparisons of two methods of measuring cardiac output were included. ATIs for the different comparisons varied from 0.07 to 6.84 (where an ATI 2 unacceptable agreement). Thirty-one percent of authors defined their own terms for acceptable agreement. ATI was only moderately correlated with the conclusions of the authors (Spearman rho = 0.47, P < 0.0001). Conclusions: Authors should define what constitutes acceptable agreement a priori when reporting comparative studies of cardiac output monitors. The ATI and the tolerability interval may be a useful basis for helping define acceptable precision. 

Available in full text at Journal of the Intensive Care Society -  from Highwire Press