38 results on '"Shah, Anoop S V"'
Search Results
2. We all breathe the same air ... and we are all mortal.
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Miller, Mark R, Shah, Anoop S V, and Newby, David E
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COVID-19 - Published
- 2020
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3. High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial.
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Shah, Anoop S. V., Anand, Atul, Strachan, Fiona E., Ferry, Amy V., Kuan Ken Lee, Chapman, Andrew R., Sandeman, Dennis, Stables, Catherine L., Adamson, Philip D., Andrews, Jack P. M., Anwar, Mohamed S., Hung, John, Moss, Alistair J., O'Brien, Rachel, Berry, Colin, Findlay, Iain, Walker, Simon, Cruickshank, Anne, Reid, Alan, and Gray, Alasdair
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ACUTE coronary syndrome , *TROPONIN , *MICROFILAMENT proteins , *PATIENTS , *ADIPOSE tissues , *COMPARATIVE studies , *CORONARY arteries , *CORONARY disease , *FAT cells , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *RESEARCH funding , *RISK assessment , *SURVIVAL analysis (Biometry) , *THREE-dimensional imaging , *EVALUATION research , *RANDOMIZED controlled trials , *PREDICTIVE tests , *PROPORTIONAL hazards models , *CORONARY angiography ,MYOCARDIAL infarction diagnosis ,CARDIOVASCULAR disease related mortality - Abstract
Background: High-sensitivity cardiac troponin assays permit use of lower thresholds for the diagnosis of myocardial infarction, but whether this improves clinical outcomes is unknown. We aimed to determine whether the introduction of a high-sensitivity cardiac troponin I (hs-cTnI) assay with a sex-specific 99th centile diagnostic threshold would reduce subsequent myocardial infarction or cardiovascular death in patients with suspected acute coronary syndrome.Methods: In this stepped-wedge, cluster-randomised controlled trial across ten secondary or tertiary care hospitals in Scotland, we evaluated the implementation of an hs-cTnI assay in consecutive patients who had been admitted to the hospitals' emergency departments with suspected acute coronary syndrome. Patients were eligible for inclusion if they presented with suspected acute coronary syndrome and had paired cardiac troponin measurements from the standard care and trial assays. During a validation phase of 6-12 months, results from the hs-cTnI assay were concealed from the attending clinician, and a contemporary cardiac troponin I (cTnI) assay was used to guide care. Hospitals were randomly allocated to early (n=5 hospitals) or late (n=5 hospitals) implementation, in which the high-sensitivity assay and sex-specific 99th centile diagnostic threshold was introduced immediately after the 6-month validation phase or was deferred for a further 6 months. Patients reclassified by the high-sensitivity assay were defined as those with an increased hs-cTnI concentration in whom cTnI concentrations were below the diagnostic threshold on the contemporary assay. The primary outcome was subsequent myocardial infarction or death from cardiovascular causes at 1 year after initial presentation. Outcomes were compared in patients reclassified by the high-sensitivity assay before and after its implementation by use of an adjusted generalised linear mixed model. This trial is registered with ClinicalTrials.gov, number NCT01852123.Findings: Between June 10, 2013, and March 3, 2016, we enrolled 48 282 consecutive patients (61 [SD 17] years, 47% women) of whom 10 360 (21%) patients had cTnI concentrations greater than those of the 99th centile of the normal range of values, who were identified by the contemporary assay or the high-sensitivity assay. The high-sensitivity assay reclassified 1771 (17%) of 10 360 patients with myocardial injury or infarction who were not identified by the contemporary assay. In those reclassified, subsequent myocardial infarction or cardiovascular death within 1 year occurred in 105 (15%) of 720 patients in the validation phase and 131 (12%) of 1051 patients in the implementation phase (adjusted odds ratio for implementation vs validation phase 1·10, 95% CI 0·75 to 1·61; p=0·620).Interpretation: Use of a high-sensitivity assay prompted reclassification of 1771 (17%) of 10 360 patients with myocardial injury or infarction, but was not associated with a lower subsequent incidence of myocardial infarction or cardiovascular death at 1 year. Our findings question whether the diagnostic threshold for myocardial infarction should be based on the 99th centile derived from a normal reference population.Funding: The British Heart Foundation. [ABSTRACT FROM AUTHOR]- Published
- 2018
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4. Long-Term Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury.
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Chapman, Andrew R., Shah, Anoop S. V., Kuan Ken Lee, Anand, Atul, Francis, Oliver, Adamson, Philip, McAllister, David A., Strachan, Fiona E., Newby, David E., Mills, Nicholas L., and Lee, Kuan Ken
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MYOCARDIAL infarction , *HEALTH outcome assessment , *CARDIOVASCULAR diseases , *CORONARY disease , *HEART failure , *HEART metabolism , *MYOCARDIAL infarction treatment , *BIOCHEMISTRY , *COMPARATIVE studies , *CAUSES of death , *PHENOMENOLOGY , *RESEARCH methodology , *MEDICAL cooperation , *MYOCARDIUM , *NECROSIS , *PROGNOSIS , *RESEARCH , *RESEARCH funding , *RISK assessment , *TIME , *EVALUATION research , *TROPONIN ,MYOCARDIAL infarction-related mortality - Abstract
Background: Type 2 myocardial infarction and myocardial injury are common in clinical practice, but long-term consequences are uncertain. We aimed to define long-term outcomes and explore risk stratification in patients with type 2 myocardial infarction and myocardial injury.Methods: We identified consecutive patients (n=2122) with elevated cardiac troponin I concentrations (≥0.05 µg/L) at a tertiary cardiac center. All diagnoses were adjudicated as per the universal definition of myocardial infarction. The primary outcome was all-cause death. Secondary outcomes included major adverse cardiovascular events (eg, nonfatal myocardial infarction or cardiovascular death) and noncardiovascular death. To explore competing risks, cause-specific hazard ratios were obtained using Cox regression models.Results: The adjudicated index diagnosis was type 1 or 2 myocardial infarction or myocardial injury in 1171 (55.2%), 429 (20.2%), and 522 (24.6%) patients, respectively. At 5 years, all-cause death rates were higher in those with type 2 myocardial infarction (62.5%) or myocardial injury (72.4%) compared with type 1 myocardial infarction (36.7%). The majority of excess deaths in those with type 2 myocardial infarction or myocardial injury were because of noncardiovascular causes (hazard ratio, 2.32; 95% confidence interval, 1.92-2.81 versus type 1 myocardial infarction). Despite this finding, the observed crude major adverse cardiovascular event rates were similar between groups (30.6% versus 32.6%), with differences apparent after adjustment for covariates (hazard ratio, 0.82; 95% confidence interval, 0.69-0.96). Coronary heart disease was an independent predictor of major adverse cardiovascular events in those with type 2 myocardial infarction or myocardial injury (hazard ratio, 1.71; 95% confidence interval, 1.31-2.24).Conclusions: Despite an excess in noncardiovascular death, patients with type 2 myocardial infarction or myocardial injury have a similar crude rate of major adverse cardiovascular events as those with type 1 myocardial infarction. Identifying underlying coronary heart disease in this vulnerable population may help target therapies that could modify future risk. [ABSTRACT FROM AUTHOR]- Published
- 2018
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5. Fire Simulation and Cardiovascular Health in Firefighters.
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Hunter, Amanda L., Shah, Anoop S. V., Langrish, Jeremy P., Raftis, Jennifer B., Lucking, Andrew J., Brittan, Mairi, Venkatasubramanian, Sowmya, Stables, Catherine L., Stelzle, Dominik, Marshall, James, Graveling, Richard, Flapan, Andrew D., Newby, David E., and Mills, Nicholas L.
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MYOCARDIAL infarction , *WELLENS' syndrome , *FIBRINOLYSIS , *THROMBOLYTIC therapy , *BLOOD platelets , *CARDIOVASCULAR diseases , *COMPARATIVE studies , *CROSSOVER trials , *ENDOTHELIUM , *FIRE fighters , *FIRES , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *RESEARCH funding , *THROMBOSIS , *EVALUATION research , *RANDOMIZED controlled trials - Abstract
Background: Rates of myocardial infarction in firefighters are increased during fire suppression duties, and are likely to reflect a combination of factors including extreme physical exertion and heat exposure. We assessed the effects of simulated fire suppression on measures of cardiovascular health in healthy firefighters.Methods: In an open-label randomized crossover study, 19 healthy firefighters (age, 41±7 years; 16 males) performed a standardized training exercise in a fire simulation facility or light duties for 20 minutes. After each exposure, ex vivo thrombus formation, fibrinolysis, platelet activation, and forearm blood flow in response to intra-arterial infusions of endothelial-dependent and -independent vasodilators were measured.Results: After fire simulation training, core temperature increased (1.0±0.1°C) and weight reduced (0.46±0.14 kg, P<0.001 for both). In comparison with control, exposure to fire simulation increased thrombus formation under low-shear (73±14%) and high-shear (66±14%) conditions (P<0.001 for both) and increased platelet-monocyte binding (7±10%, P=0.03). There was a dose-dependent increase in forearm blood flow with all vasodilators (P<0.001), which was attenuated by fire simulation in response to acetylcholine (P=0.01) and sodium nitroprusside (P=0.004). This was associated with a rise in fibrinolytic capacity, asymptomatic myocardial ischemia, and an increase in plasma cardiac troponin I concentrations (1.4 [0.8-2.5] versus 3.0 [1.7-6.4] ng/L, P=0.010).Conclusions: Exposure to extreme heat and physical exertion during fire suppression activates platelets, increases thrombus formation, impairs vascular function, and promotes myocardial ischemia and injury in healthy firefighters. Our findings provide pathogenic mechanisms to explain the association between fire suppression activity and acute myocardial infarction in firefighters.Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01812317. [ABSTRACT FROM AUTHOR]- Published
- 2017
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6. High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study.
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Shah, Anoop S. V., Anand, Atul, Sandoval, Yader, Kuan Ken Lee, Smith, Stephen W., Adamson, Philip D., Chapman, Andrew R., Langdon, Timothy, Sandeman, Dennis, Vaswani, Amar, Strachan, Fiona E., Ferry, Amy, Stirzaker, Alexandra G., Reid, Alan, Gray, Alasdair J., Collinson, Paul O., McAllister, David A., Apple, Fred S., Newby, David E., and Mills, Nicholas L.
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TROPONIN I , *ACUTE coronary syndrome , *CORONARY disease , *BIOMARKERS , *MYOCARDIAL infarction , *HOSPITAL admission & discharge , *LONGITUDINAL method , *MEDICAL cooperation , *PROGNOSIS , *RESEARCH , *RESEARCH funding , *TROPONIN , *DIAGNOSIS ,MYOCARDIAL infarction diagnosis - Abstract
Background: Suspected acute coronary syndrome is the commonest reason for emergency admission to hospital and is a large burden on health-care resources. Strategies to identify low-risk patients suitable for immediate discharge would have major benefits.Methods: We did a prospective cohort study of 6304 consecutively enrolled patients with suspected acute coronary syndrome presenting to four secondary and tertiary care hospitals in Scotland. We measured plasma troponin concentrations at presentation using a high-sensitivity cardiac troponin I assay. In derivation and validation cohorts, we evaluated the negative predictive value of a range of troponin concentrations for the primary outcome of index myocardial infarction, or subsequent myocardial infarction or cardiac death at 30 days. This trial is registered with ClinicalTrials.gov (number NCT01852123).Findings: 782 (16%) of 4870 patients in the derivation cohort had index myocardial infarction, with a further 32 (1%) re-presenting with myocardial infarction and 75 (2%) cardiac deaths at 30 days. In patients without myocardial infarction at presentation, troponin concentrations were less than 5 ng/L in 2311 (61%) of 3799 patients, with a negative predictive value of 99·6% (95% CI 99·3-99·8) for the primary outcome. The negative predictive value was consistent across groups stratified by age, sex, risk factors, and previous cardiovascular disease. In two independent validation cohorts, troponin concentrations were less than 5 ng/L in 594 (56%) of 1061 patients, with an overall negative predictive value of 99·4% (98·8-99·9). At 1 year, these patients had a lower risk of myocardial infarction and cardiac death than did those with a troponin concentration of 5 ng/L or more (0·6% vs 3·3%; adjusted hazard ratio 0·41, 95% CI 0·21-0·80; p<0·0001).Interpretation: Low plasma troponin concentrations identify two-thirds of patients at very low risk of cardiac events who could be discharged from hospital. Implementation of this approach could substantially reduce hospital admissions and have major benefits for both patients and health-care providers.Funding: British Heart Foundation and Chief Scientist Office (Scotland). [ABSTRACT FROM AUTHOR]- Published
- 2015
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7. Left Ventricular Hypertrophy With Strain and Aortic Stenosis.
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Shah, Anoop S. V., Chin, Calvin W. L., Vassiliou, Vassilis, Cowell, S. Joanna, Doris, Mhairi, T'ng Choong Kwok, Semple, Scott, Zamvar, Vipin, White, Audrey C., McKillop, Graham, Boon, Nicholas A., Prasad, Sanjay K., Mills, Nicholas L., Newby, David E., and Dweck, Marc R.
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AORTIC stenosis , *HYPERTROPHY , *ELECTROCARDIOGRAPHY , *LEFT heart ventricle , *CORONARY circulation - Abstract
Background--ECG left ventricular hypertrophy with strain is associated with an adverse prognosis in aortic stenosis. We investigated the mechanisms and outcomes associated with ECG strain. Methods and Results--One hundred and two patients (age, 70 years [range, 63-75 years]; male, 66%; aortic valve area, 0.9 cm² [range, 0.7-1.2 cm²]) underwent ECG, echocardiography, and cardiovascular magnetic resonance. They made up the mechanism cohort. Myocardial fibrosis was determined with late gadolinium enhancement (replacement fibrosis) and T1 mapping (diffuse fibrosis). The relationship between ECG strain and cardiovascular magnetic resonance was then assessed in an external validation cohort (n=64). The outcome cohort was made up of 140 patients from the Scottish Aortic Stenosis and Lipid Lowering Trial Impact on Regression (SALTIRE) study and was followed up for 10.6 years (1254 patient-years). Compared with those without left ventricular hypertrophy (n=51) and left ventricular hypertrophy without ECG strain (n=30), patients with ECG strain (n=21) had more severe aortic stenosis, increased left ventricular mass index, more myocardial injury (high-sensitivity plasma cardiac troponin I concentration, 4.3 ng/L [interquartile range, 2.5-13 ng/L| versus 7.3 ng/L [interquartile range, 3.2-20.8 ng/L] versus 18.6 ng/L [interquartile range, 9.0-45.2 ng/L], respectively; P<0.001) and increased diffuse fibrosis (extracellular volume fraction, 27.4±2.2% versus 21.2+2.9% versus 30.9±1.9%, respectively; P<0.001). All patients with ECG strain had midwall late gadolinium enhancement (positive and negative predictive values of 100% and 86%, respectively). Indeed, late gadolinium enhancement was independently associated with ECG strain (odds ratio, 1.73; 95% confidence interval, 1.08-2.77; P=0.02), a finding confirmed in the validation cohort. In the outcome cohort, ECG strain was an independent predictor of aortic valve replacement or cardiovascular death (hazard ratio, 2.67; 95% confidence interval, 1.35-5.27; P<0.01). Conclusion ECG strain is a specific marker of midwall myocardial fibrosis and predicts adverse clinical outcomes in aortic stenosis. [ABSTRACT FROM AUTHOR]
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- 2014
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8. Global association of air pollution and heart failure: a systematic review and meta-analysis.
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Shah, Anoop S. V., Langrish, Jeremy P., Nair, Harish, McAllister, David A., Hunter, Amanda L., Donaldson, Ken, Newby, David E., and Mills, Nicholas L.
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PHYSIOLOGICAL effects of air pollution , *PHYSIOLOGICAL effects of atmospheric aerosols , *HEART failure , *HEART diseases , *SYSTEMATIC reviews - Abstract
Background Acute exposure to air pollution has been linked to myocardial infarction, but its effect on heart failure is uncertain. We did a systematic review and meta-analysis to assess the association between air pollution and acute decompensated heart failure including hospitalisation and heart failure mortality. Methods Five databases were searched for studies investigating the association between daily increases in gaseous (carbon monoxide, sulphur dioxide, nitrogen dioxide, ozone) and particulate (diameter <2.5 µm [PM2.5] or <10 µm [PM10]) air pollutants, and heart failure hospitalisations or heart failure mortality. We used a random-effects model to derive overall risk estimates per pollutant. Findings Of 1146 identified articles, 195 were reviewed in-depth with 35 satisfying inclusion criteria. Heart failure hospitalisation or death was associated with increases in carbon monoxide (3.52% per 1 part per million; 95% CI 2.52-4.54), sulphur dioxide (2.36% per 10 parts per billion; 1.35-3.38), and nitrogen dioxide (1.70% per 10 parts per billion; 1.25-2.16), but not ozone (0.46% per 10 parts per billion; -0.10 to 1.02) concentrations. Increases in particulate matter concentration were associated with heart failure hospitalisation or death (PM2.5 2.12% per 10 µg/m³, 95% CI 1.42-2.82; PM10 1.63% per 10 µg/m³, 95% CI 1.20-2.07). Strongest associations were seen on the day of exposure, with more persistent effects for PM2.5. In the USA, we estimate that a mean reduction in PM2.5 of 3.9 µg/m³ would prevent 7978 heart failure hospitalisations and save a third of a billion US dollars a year. Interpretation Air pollution has a close temporal association with heart failure hospitalisation and heart failure mortality. Although more studies from developing nations are required, air pollution is a pervasive public health issue with major cardiovascular and health economic consequences, and it should remain a key target for global health policy. Funding British Heart Foundation. [ABSTRACT FROM AUTHOR]
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- 2013
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9. Measurement of cardiac troponin for exclusion of myocardial infarction - Authors' reply.
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Shah, Anoop S. V., Anand, Atul, Chapman, Andrew R., Newby, David E., Mills, Nicholas L., and High-STEACS Investigators
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TROPONIN , *ELECTROCARDIOGRAPHY , *ACUTE coronary syndrome , *DIAGNOSIS ,MYOCARDIAL infarction diagnosis - Abstract
A response from the author of the article "High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study," in the 2015 issue is presented.
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- 2016
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10. Comorbidity and health-related quality of life in people with a chronic medical condition in randomised clinical trials: An individual participant data meta-analysis.
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Butterly, Elaine W., Hanlon, Peter, Shah, Anoop S. V., Hannigan, Laurie J., McIntosh, Emma, Lewsey, Jim, Wild, Sarah H., Guthrie, Bruce, Mair, Frances S., Kent, David M., Dias, Sofia, Welton, Nicky J., and McAllister, David A.
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QUALITY of life , *CLINICAL trials , *CHRONIC diseases , *RANDOMIZED controlled trials , *COMORBIDITY - Abstract
Background: Health-related quality of life metrics evaluate treatments in ways that matter to patients, so are often included in randomised clinical trials (hereafter trials). Multimorbidity, where individuals have 2 or more conditions, is negatively associated with quality of life. However, whether multimorbidity predicts change over time or modifies treatment effects for quality of life is unknown. Therefore, clinicians and guideline developers are uncertain about the applicability of trial findings to people with multimorbidity. We examined whether comorbidity count (higher counts indicating greater multimorbidity) (i) is associated with quality of life at baseline; (ii) predicts change in quality of life over time; and/or (iii) modifies treatment effects on quality of life. Methods and findings: Included trials were registered on the United States trials registry for selected index medical conditions and drug classes, phase 2/3, 3 or 4, had ≥300 participants, a nonrestrictive upper age limit, and were available on 1 of 2 trial repositories on 21 November 2016 and 18 May 2018, respectively. Of 124 meeting these criteria, 56 trials (33,421 participants, 16 index conditions, and 23 drug classes) collected a generic quality of life outcome measure (35 EuroQol-5 dimension (EQ-5D), 31 36-item short form survey (SF-36) with 10 collecting both). Blinding and completeness of follow up were examined for each trial. Using trials where individual participant data (IPD) was available from 2 repositories, a comorbidity count was calculated from medical history and/or prescriptions data. Linear regressions were fitted for the association between comorbidity count and (i) quality of life at baseline; (ii) change in quality of life during trial follow up; and (iii) treatment effects on quality of life. These results were then combined in Bayesian linear models. Posterior samples were summarised via the mean, 2.5th and 97.5th percentiles as credible intervals (95% CI) and via the proportion with values less than 0 as the probability (PBayes) of a negative association. All results are in standardised units (obtained by dividing the EQ-5D/SF-36 estimates by published population standard deviations). Per additional comorbidity, adjusting for age and sex, across all index conditions and treatment comparisons, comorbidity count was associated with lower quality of life at baseline and with a decline in quality of life over time (EQ-5D −0.02 [95% CI −0.03 to −0.01], PBayes > 0.999). Associations were similar, but with wider 95% CIs crossing the null for SF-36-PCS and SF-36-MCS (−0.05 [−0.10 to 0.01], PBayes = 0.956 and −0.05 [−0.10 to 0.01], PBayes = 0.966, respectively). Importantly, there was no evidence of any interaction between comorbidity count and treatment efficacy for either EQ-5D or SF-36 (EQ-5D −0.0035 [95% CI −0.0153 to −0.0065], PBayes = 0.746; SF-36-MCS (−0.0111 [95% CI −0.0647 to 0.0416], PBayes = 0.70 and SF-36-PCS −0.0092 [95% CI −0.0758 to 0.0476], PBayes = 0.631. Conclusions: Treatment effects on quality of life did not differ by multimorbidity (measured via a comorbidity count) at baseline—for the medical conditions studied, types and severity of comorbidities and level of quality of life at baseline, suggesting that evidence from clinical trials is likely to be applicable to settings with (at least modestly) higher levels of comorbidity. Trial registration: A prespecified protocol was registered on PROSPERO (CRD42018048202). Author summary: Why was this study done?: ➢ The EuroQol-5 dimension (EQ-5D) and SF-36 are questionnaire-based tools that combine measures of physical and mental health into overall quality of life scores. These scores are used in randomised controlled trials of drug treatments to estimate how treatments affect quality of life. These estimates then inform decisions about which treatments should be offered to people with specific conditions. ➢ Multimorbidity, the presence of 2 or more conditions, makes diagnosis and treatment more complex and is associated with worse quality of life in some settings. ➢ People with multimorbidity are underrepresented in clinical trials, and little is known about whether and how multimorbidity changes quality of life in clinical trials. This makes it difficult for clinicians and clinical guideline developers to determine how results from clinical trials should be applied to people with multimorbidity. What did the researchers do and find?: ➢ To address this uncertainty, we re-analysed data from existing clinical trials. Among 33,421 participants in 56 trials of new treatments for 16 different medical conditions, we used data on medication usage and medical histories to produce a comorbidity count (higher counts indicating more multimorbidity) for each individual. ➢ We then used statistical models to examine associations for comorbidity counts finding that higher comorbidity counts were associated with worse quality of life at trial entry and predicted a more rapid decline in quality of life over the course of the trial. However, having a higher comorbidity count did not change the effect of treatment on quality of life. What do these findings mean?: ➢ These findings suggest that where treatments improve quality of life for participants overall, they are similarly likely to do so for people with multimorbidity. ➢ Whether this is true for individuals with higher numbers of comorbidities or with conditions and treatments not included in our analyses remains uncertain. ➢ Nonetheless, our findings help inform clinical decision-making by reassuring clinicians, health economists, and guideline developers that overall trial results can be used when considering how best to manage many people with multimorbidity. [ABSTRACT FROM AUTHOR]
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- 2023
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11. Assessing trial representativeness using serious adverse events: an observational analysis using aggregate and individual-level data from clinical trials and routine healthcare data.
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Hanlon, Peter, Butterly, Elaine, Shah, Anoop S. V., Hannigan, Laurie J., Wild, Sarah H., Guthrie, Bruce, Mair, Frances S., Dias, Sofia, Welton, Nicky J., and McAllister, David A.
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Background: The applicability of randomised controlled trials of pharmacological agents to older people with frailty/multimorbidity is often uncertain, due to concerns that trials are not representative. However, assessing trial representativeness is challenging and complex. We explore an approach assessing trial representativeness by comparing rates of trial serious adverse events (SAE) to rates of hospitalisation/death in routine care.Methods: This was an observational analysis of individual (125 trials, n=122,069) and aggregate-level drug trial data (483 trials, n=636,267) for 21 index conditions compared to population-based routine healthcare data (routine care). Trials were identified from ClinicalTrials.gov . Routine care comparison from linked primary care and hospital data from Wales, UK (n=2.3M). Our outcome of interest was SAEs (routinely reported in trials). In routine care, SAEs were based on hospitalisations and deaths (which are SAEs by definition). We compared trial SAEs in trials to expected SAEs based on age/sex standardised routine care populations with the same index condition. Using IPD, we assessed the relationship between multimorbidity count and SAEs in both trials and routine care and assessed the impact on the observed/expected SAE ratio additionally accounting for multimorbidity.Results: For 12/21 index conditions, the pooled observed/expected SAE ratio was <1, indicating fewer SAEs in trial participants than in routine care. A further 6/21 had point estimates <1 but the 95% CI included the null. The median pooled estimate of observed/expected SAE ratio was 0.60 (95% CI 0.55-0.64; COPD) and the interquartile range was 0.44 (0.34-0.55; Parkinson's disease) to 0.87 (0.58-1.29; inflammatory bowel disease). Higher multimorbidity count was associated with SAEs across all index conditions in both routine care and trials. For most trials, the observed/expected SAE ratio moved closer to 1 after additionally accounting for multimorbidity count, but it nonetheless remained below 1 for most.Conclusions: Trial participants experience fewer SAEs than expected based on age/sex/condition hospitalisation and death rates in routine care, confirming the predicted lack of representativeness. This difference is only partially explained by differences in multimorbidity. Assessing observed/expected SAE may help assess the applicability of trial findings to older populations in whom multimorbidity and frailty are common. [ABSTRACT FROM AUTHOR]- Published
- 2022
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12. Less clarity as the fog begins to lift.
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Shah, Anoop S. V. and Newby, David E.
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AIR pollution , *HEALTH , *CARDIOVASCULAR diseases , *MYOCARDIAL infarction , *CORONARY disease , *CEREBROVASCULAR disease , *HEART failure - Abstract
The author discusses the adverse health effects of air pollution on cardiovascular disease. He discusses the use of database Myocardial Ischaemia National Audit Project to identify patients admitted for myocardial infarction. He also mentions the role of coronary heart disease, cerebrovascular disease and heart failure to cause morbidity and mortality.
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- 2014
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13. High-sensitivity troponin assays and the early rule-out of acute myocardial infarction.
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Shah, Anoop S. V., Newby, David E., and Mills, Nicholas L.
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TROPONIN , *FIRE assay , *BLOOD circulation , *THERAPEUTICS ,MYOCARDIAL infarction diagnosis - Abstract
The article focuses on high sensitivity troponin assays that are used for detection of acute myocardial infarction. It mentions that cardiac troponins are regulatory muscle proteins that are released in the blood circulation after a myocardial injury. It states the National Institute for Health and Clinical Excellence (NICE) guidelines to measure troponin levels on admission of patient and 12 hours after the onset of symptoms.
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- 2013
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14. Periprocedural type IVa myocardial infarction and the importance of platelet inhibition.
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Shah, Anoop S. V., Mills, Nicholas L., and Newby, David E.
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MYOCARDIAL infarction , *MYOCARDIAL infarction treatment , *MYOCARDIAL infarction complications , *BLOOD platelet activation , *THROMBOSIS , *PATIENTS - Abstract
The article discusses the findings of the study performed by Leonardi and colleagues on patients with periprocedural myocardial infarction. It explains the role of platelet activation and thrombosis in periprocedural myocardial infarction associated with percutaneous coronary intervention (PCI) procedures. It explains the treatment benefits of the receptor inhibitor cangrelor which effectively prevent the periprocedural myocardial infarction and the risk of death in patients.
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- 2013
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15. Neighborhood Characteristics and Bystander-Initiated CPR.
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Shah, Anoop S. V., Raj Bhopal, Shah, Keval S. V., Sasson, Comilla, Magid, David J., and Haukoos, Jason S.
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LETTERS to the editor , *CARDIOPULMONARY resuscitation - Abstract
A response from the author of the article "Association of Neighborhood Characteristics With Bystander-Initiated CPR," in the October 25, 2012 issue is presented.
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- 2013
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16. Provision of CPR differs across ethnic and racial groups.
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Shah, Keval S. V., Shah, Anoop S. V., and Bhopal, Raj
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ASIANS , *BLACK people , *CARDIOPULMONARY resuscitation , *RACE , *WHITE people - Abstract
A letter to the editor is presented in response to the article " Cardiopulmonary resuscitation," by Nolan J. and colleagues in the 3 October 2012 issue of British Medical Journal (BMJ).
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- 2012
17. Short term exposure to air pollution and stroke: systematic review and meta-analysis.
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Shah, Anoop S. V., Kuan Ken Lee, McAllister, David A., Hunter, Amanda, Nair, Harish, Whiteley, William, Langrish, Jeremy P., Newby, David E., and Mills, Nicholas L.
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STROKE diagnosis , *AIR pollution , *HOSPITAL admission & discharge , *EVALUATION of medical care , *META-analysis , *OZONE , *PATIENTS , *SERIAL publications ,STROKE risk factors - Abstract
STUDY QUESTION: What are the effects of short term exposure to air pollution on admissions to hospital for stroke or mortality from stroke? SUMMARY ANSWER: Short term exposure to both gaseous (except ozone) and particulate air pollutants is associated with an increase in admissions to hospital for stroke or mortality from stroke. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Stroke is a major cause of disability worldwide with an increasing incidence, particularly in low and middle income countries. Our findings suggest a strong association between short term exposure to both gaseous (except ozone) and particulate air pollution, and admissions to hospital for stroke or mortality from stroke. These associations were strongest in low and middle income countries, suggesting the need for policy changes to reduce personal exposure to air pollutants especially in highly polluted regions. [ABSTRACT FROM AUTHOR]
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- 2015
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18. High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study.
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Shah, Anoop S. V., Griffiths, Megan, Kuan Ken Lee, McAllister, David A., Hunter, Amanda L., Ferry, Amy V., Cruikshank, Anne, Reid, Alan, Stoddart, Mary, Strachan, Fiona, Walker, Simon, Collinson, Paul O., Apple, Fred S., Gray, Alasdair J., Fox, Keith A. A., Newby, David E., and Mills, Nicholas L.
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LONGITUDINAL method , *PROBABILITY theory , *RESEARCH funding , *SEX distribution , *TROPONIN , *DESCRIPTIVE statistics ,MYOCARDIAL infarction diagnosis - Abstract
The article discusses a study which demonstrated that the implementation of high sensitivity troponin assay with sex specific diagnostic thresholds may improve the diagnosis of myocardial infarction in women and identify those at high risk of reinfarction and death. It cites the differences in the diagnosis and management of myocardial infarction in men and women with suspected acute coronary syndrome. It also mentions the study's design, size, and duration.
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- 2015
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19. Impact of noncardiac findings in patients undergoing CT coronary angiography: a substudy of the Scottish computed tomography of the heart (SCOT-HEART) trial.
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Williams, Michelle C., Hunter, Amanda, Shah, Anoop S. V., Dreisbach, John, Weir McCall, Jonathan R., Macmillan, Mark T., Kirkbride, Rachael, Hawke, Fiona, Baird, Andrew, Mirsadraee, Saeed, van Beek, Edwin J. R., Newby, David E., and Roditi, Giles
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CORONARY angiography , *COMPUTED tomography , *DEFIBRILLATORS , *OBSTRUCTIVE lung diseases , *CHEST pain , *COMPARATIVE studies , *CORONARY disease , *DIAGNOSIS , *LUNG tumors , *RESEARCH methodology , *MEDICAL cooperation , *RADIONUCLIDE imaging , *RESEARCH , *STATISTICAL sampling , *EVALUATION research , *RANDOMIZED controlled trials - Abstract
Objectives: Noncardiac findings are common on coronary computed tomography angiography (CCTA). We assessed the clinical impact of noncardiac findings, and potential changes to surveillance scans with the application of new lung nodule guidelines.Methods: This substudy of the SCOT-HEART randomized controlled trial assessed noncardiac findings identified on CCTA. Clinically significant noncardiac findings were those causing symptoms or requiring further investigation, follow-up or treatment. Lung nodule follow-up was undertaken following the 2005 Fleischner guidelines. The potential impact of the 2015 British Thoracic Society (BTS) and the 2017 Fleischner guidelines was assessed.Results: CCTA was performed in 1,778 patients and noncardiac findings were identified in 677 (38%). In 173 patients (10%) the abnormal findings were clinically significant and in 55 patients (3%) the findings were the cause of symptoms. Follow-up imaging was recommended in 136 patients (7.6%) and additional clinic consultations were organized in 46 patients (2.6%). Malignancy was diagnosed in 7 patients (0.4%). Application of the new lung nodule guidelines would have reduced the number of patients undergoing a follow-up CT scan: 68 fewer with the 2015 BTS guidelines and 78 fewer with the 2017 Fleischner guidelines; none of these patients subsequently developed malignancy.Conclusions: Clinically significant noncardiac findings are identified in 10% of patients undergoing CCTA. Application of new lung nodule guidelines will reduce the cost of surveillance, without the risk of missing malignancy.Key Points: • Clinically significant noncardiac findings occur in 10% of patients undergoing CCTA. • Noncardiac findings may be an important treatable cause of chest pain • Further imaging investigations for noncardiac findings were recommended in 8% of patients after CCTA. • New lung nodule follow-up guidelines will result in cost savings. [ABSTRACT FROM AUTHOR]- Published
- 2018
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20. Trajectories of cardiac troponin in the decades before cardiovascular death: a longitudinal cohort study.
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Kimenai, Dorien M., Anand, Atul, de Bakker, Marie, Shipley, Martin, Fujisawa, Takeshi, Lyngbakken, Magnus N., Hveem, Kristian, Omland, Torbjørn, Valencia-Hernández, Carlos A., Lindbohm, Joni V., Kivimaki, Mika, Singh-Manoux, Archana, Strachan, Fiona E., Shah, Anoop S. V., Kardys, Isabella, Boersma, Eric, Brunner, Eric J., and Mills, Nicholas L.
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TROPONIN , *TROPONIN I , *COHORT analysis , *CARDIOVASCULAR diseases risk factors ,CARDIOVASCULAR disease related mortality - Abstract
Background: High-sensitivity cardiac troponin testing is a promising tool for cardiovascular risk prediction, but whether serial testing can dynamically predict risk is uncertain. We evaluated the trajectory of cardiac troponin I in the years prior to a cardiovascular event in the general population, and determine whether serial measurements could track risk within individuals. Methods: In the Whitehall II cohort, high-sensitivity cardiac troponin I concentrations were measured on three occasions over a 15-year period. Time trajectories of troponin were constructed in those who died from cardiovascular disease compared to those who survived or died from other causes during follow up and these were externally validated in the HUNT Study. A joint model that adjusts for cardiovascular risk factors was used to estimate risk of cardiovascular death using serial troponin measurements. Results: In 7,293 individuals (mean 58 ± 7 years, 29.4% women) cardiovascular and non-cardiovascular death occurred in 281 (3.9%) and 914 (12.5%) individuals (median follow-up 21.4 years), respectively. Troponin concentrations increased in those dying from cardiovascular disease with a steeper trajectory compared to those surviving or dying from other causes in Whitehall and HUNT (Pinteraction < 0.05 for both). The joint model demonstrated an independent association between temporal evolution of troponin and risk of cardiovascular death (HR per doubling, 1.45, 95% CI,1.33–1.75). Conclusions: Cardiac troponin I concentrations increased in those dying from cardiovascular disease compared to those surviving or dying from other causes over the preceding decades. Serial cardiac troponin testing in the general population has potential to track future cardiovascular risk. [ABSTRACT FROM AUTHOR]
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- 2023
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21. Association of HIV Infection With Cardiovascular Pathology Based on Advanced Cardiovascular Imaging: A Systematic Review.
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Hudson, Jonathan A., Majonga, Edith D., Ferrand, Rashida A., Perel, Pablo, Alam, Shirjel R., and Shah, Anoop S. V.
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HIV infection epidemiology , *HIV infection complications , *RESEARCH , *RESEARCH methodology , *SYSTEMATIC reviews , *CONTRAST media , *FIBROSIS , *EVALUATION research , *CHEMICAL elements , *COMPARATIVE studies , *CORONARY artery disease , *DISEASE complications - Abstract
Importance: HIV-associated cardiovascular disease is increasing in prevalence, but its mechanisms remain poorly understood.Objective: To systematically review data from advanced cardiovascular imaging studies evaluating computed tomographic coronary angiography, positron emission tomography (PET), and cardiac magnetic resonance (MR), in people living with HIV compared with uninfected individuals.Data Sources: Three databases and Google Scholar were searched for studies assessing cardiovascular pathology using computed tomographic coronary angiography, cardiac MR, PET, and HIV from inception to February 11, 2022.Study Selection: Two reviewers selected original studies without any restrictions on design, date, or language, investigating HIV and cardiovascular pathology.Data Extraction and Synthesis: One investigator extracted data checked by a second investigator. Prevalence ratios (PRs) and differences in inflammation among people living with HIV and uninfected individuals were qualitatively synthesized in terms of cardiovascular pathology. Study quality was assessed using the National Heart, Lung, and Blood Institute quality assessment tool for observational studies.Main Outcomes and Measures: Primary outcomes were computed tomographic coronary angiography-defined moderate to severe (≥50%) coronary stenosis, cardiac MR-defined myocardial fibrosis identified by late gadolinium enhancement, and PET-defined vascular and myocardial target to background ratio. Prevalence of moderate to severe coronary disease, as well as myocardial fibrosis, and PRs compared with uninfected individuals were reported alongside difference in vascular target to background ratio.Results: Forty-five studies including 5218 people living with HIV (mean age, 48.5 years) and 2414 uninfected individuals (mean age, 49.1 years) were identified. Sixteen studies (n = 5107 participants) evaluated computed tomographic coronary angiography; 16 (n = 1698), cardiac MRs; 10 (n = 681), vascular PET scans; and 3 (n = 146), both computed tomographic coronary angiography and vascular PET scans. No studies originated from low-income countries. Regarding risk of bias, 22% were classified as low; 47% moderate; and 31% high. Prevalence of moderate to severe coronary disease among those with vs without HIV ranged from 0% to 52% and 0% to 27%, respectively, with PRs ranging from 0.33 (95% CI, 0.01-15.90) to 5.19 (95% CI, 1.26-21.42). Prevalence of myocardial fibrosis among those with vs without HIV ranged from 5% to 84% and 0% to 68%, respectively, with PRs ranging from 1.01 (95% CI, 0.85-1.21) to 17.35 (95% CI, 1.10-274.28). Differences in vascular target to background ratio among those with vs without HIV ranged from 0.06 (95% CI, 0.01-0.11) to 0.37 (95% CI, 0.02-0.72).Conclusions and Relevance: In this systematic review of studies of advanced cardiovascular imaging, the estimates of the associations between HIV and cardiovascular pathologies demonstrated large amounts of heterogeneity. The findings provide a summary of the available data but may not be representative of all individuals living with HIV, including those from low-income countries with higher HIV endemicity. [ABSTRACT FROM AUTHOR]- Published
- 2022
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22. Mortality risk prediction of high-sensitivity C-reactive protein in suspected acute coronary syndrome: A cohort study.
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Kaura, Amit, Hartley, Adam, Panoulas, Vasileios, Glampson, Ben, Shah, Anoop S. V., Davies, Jim, Mulla, Abdulrahim, Woods, Kerrie, Omigie, Joe, Shah, Anoop D., Thursz, Mark R., Elliott, Paul, Hemmingway, Harry, Williams, Bryan, Asselbergs, Folkert W., O'Sullivan, Michael, Lord, Graham M., Trickey, Adam, Sterne, Jonathan AC, and Haskard, Dorian O.
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ACUTE coronary syndrome , *INTRA-abdominal hypertension , *C-reactive protein , *LIVER proteins , *MYOCARDIAL infarction , *COHORT analysis - Abstract
Background: There is limited evidence on the use of high-sensitivity C-reactive protein (hsCRP) as a biomarker for selecting patients for advanced cardiovascular (CV) therapies in the modern era. The prognostic value of mildly elevated hsCRP beyond troponin in a large real-world cohort of unselected patients presenting with suspected acute coronary syndrome (ACS) is unknown. We evaluated whether a mildly elevated hsCRP (up to 15 mg/L) was associated with mortality risk, beyond troponin level, in patients with suspected ACS. Methods and findings: We conducted a retrospective cohort study based on the National Institute for Health Research Health Informatics Collaborative data of 257,948 patients with suspected ACS who had a troponin measured at 5 cardiac centres in the United Kingdom between 2010 and 2017. Patients were divided into 4 hsCRP groups (<2, 2 to 4.9, 5 to 9.9, and 10 to 15 mg/L). The main outcome measure was mortality within 3 years of index presentation. The association between hsCRP levels and all-cause mortality was assessed using multivariable Cox regression analysis adjusted for age, sex, haemoglobin, white cell count (WCC), platelet count, creatinine, and troponin. Following the exclusion criteria, there were 102,337 patients included in the analysis (hsCRP <2 mg/L (n = 38,390), 2 to 4.9 mg/L (n = 27,397), 5 to 9.9 mg/L (n = 26,957), and 10 to 15 mg/L (n = 9,593)). On multivariable Cox regression analysis, there was a positive and graded relationship between hsCRP level and mortality at baseline, which remained at 3 years (hazard ratio (HR) (95% CI) of 1.32 (1.18 to 1.48) for those with hsCRP 2.0 to 4.9 mg/L and 1.40 (1.26 to 1.57) and 2.00 (1.75 to 2.28) for those with hsCRP 5 to 9.9 mg/L and 10 to 15 mg/L, respectively. This relationship was independent of troponin in all suspected ACS patients and was further verified in those who were confirmed to have an ACS diagnosis by clinical coding. The main limitation of our study is that we did not have data on underlying cause of death; however, the exclusion of those with abnormal WCC or hsCRP levels >15 mg/L makes it unlikely that sepsis was a major contributor. Conclusions: These multicentre, real-world data from a large cohort of patients with suspected ACS suggest that mildly elevated hsCRP (up to 15 mg/L) may be a clinically meaningful prognostic marker beyond troponin and point to its potential utility in selecting patients for novel treatments targeting inflammation. Trial registration: ClinicalTrials.gov - NCT03507309 Amit Kaura and colleagues investigate whether mildly elevated high sensitivity C-reactive protein is associated with mortality risk in patients with suspected acute coronary syndromes. Author summary: Why was this study done?: C-reactive protein (CRP) is a protein produced by the liver and released into the bloodstream in response to inflammation. A blood test called a high-sensitivity C-reactive protein (hsCRP) accurately measures low levels of CRP. In patients presenting with a suspected heart attack, low levels of hsCRP on admission may prove useful in predicting death beyond using troponin, a marker of heart muscle damage. What did the researchers do and find?: In this study of 102,337 patients with suspected heart attack, a higher hsCRP level was associated with a higher risk of death. This relationship was independent of the troponin level in all patients with suspected heart attack and was further verified in those who were confirmed to have a heart attack. What do these findings mean?: These findings suggest that hsCRP is a clinically meaningful marker of risk of death in addition to troponin in patients with suspected heart attack. hsCRP has potential utility in selecting patients with heart attack for new treatments that target reducing inflammation. [ABSTRACT FROM AUTHOR]
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- 2022
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23. Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19.
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Lee, Kuan Ken, Doudesis, Dimitrios, Ross, Daniella A., Bularga, Anda, MacKintosh, Claire L., Koch, Oliver, Johannessen, Ingolfur, Templeton, Kate, Jenks, Sara, Chapman, Andrew R., Shah, Anoop S. V., Anand, Atul, Perry, Meghan R., Mills, Nicholas L., on behalf of the DataLoch COVID-19 Collaboration, Harrison, Kathy, Stables, Catherine, Hume, Ally, Homan, David, and Waugh, Catriona
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SARS-CoV-2 , *COVID-19 , *HOSPITAL patients , *VIRAL transmission , *THROAT - Abstract
Background: Accurate diagnosis in patients with suspected coronavirus disease 2019 (COVID-19) is essential to guide treatment and limit spread of the virus. The combined nasal and throat swab is used widely, but its diagnostic performance is uncertain.Methods: In a prospective, multi-centre, cohort study conducted in secondary and tertiary care hospitals in Scotland, we evaluated the combined nasal and throat swab with reverse transcriptase-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in consecutive patients admitted to hospital with suspected COVID-19. Diagnostic performance of the index and serial tests was evaluated for a primary outcome of confirmed or probable COVID-19, and a secondary outcome of confirmed COVID-19 on serial testing. The diagnosis was adjudicated by a panel, who recorded clinical, laboratory and radiological features blinded to the test results.Results: We enrolled 1368 consecutive patients (median age 68 [interquartile range, IQR 53-80] years, 47% women) who underwent a total of 3822 tests (median 2 [IQR 1-3] tests per patient). The primary outcome occurred in 36% (496/1368), of whom 65% (323/496) and 35% (173/496) had confirmed and probable COVID-19, respectively. The index test was positive in 255/496 (51%) patients with the primary outcome, giving a sensitivity and specificity of 51.4% (95% confidence interval [CI] 48.8 to 54.1%) and 99.5% (95% CI 99.0 to 99.8%). Sensitivity increased in those undergoing 2, 3 or 4 tests to 60.1% (95% CI 56.7 to 63.4%), 68.3% (95% CI 64.0 to 72.3%) and 77.6% (95% CI 72.7 to 81.9%), respectively. The sensitivity of the index test was 78.9% (95% CI 74.4 to 83.2%) for the secondary outcome of confirmed COVID-19 on serial testing.Conclusions: In patients admitted to hospital, a single combined nasal and throat swab with RT-PCR for SARS-CoV-2 has excellent specificity, but limited diagnostic sensitivity for COVID-19. Diagnostic performance is significantly improved by repeated testing. [ABSTRACT FROM AUTHOR]- Published
- 2021
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24. Ex vivo 18F-fluoride uptake and hydroxyapatite deposition in human coronary atherosclerosis.
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Moss, Alastair J., Sim, Alisia M., Adamson, Philip D., Seidman, Michael A., Andrews, Jack P. M., Doris, Mhairi K., Shah, Anoop S. V., BouHaidar, Ralph, Alcaide-Corral, Carlos J., Williams, Michelle C., Leipsic, Jonathon A., Dweck, Marc R., MacRae, Vicky E., Newby, David E., Tavares, Adriana A. S., and Sellers, Stephanie L.
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ACUTE coronary syndrome , *CALCIFICATIONS of the breast , *RADIOACTIVE tracers , *HYDROXYAPATITE , *OSTEOPONTIN - Abstract
Early microcalcification is a feature of coronary plaques with an increased propensity to rupture and to cause acute coronary syndromes. In this ex vivo imaging study of coronary artery specimens, the non-invasive imaging radiotracer, 18F-fluoride, was highly selective for hydroxyapatite deposition in atherosclerotic coronary plaque. Specifically, coronary 18F-fluoride uptake had a high signal to noise ratio compared with surrounding myocardium that makes it feasible to identify coronary mineralisation activity. Areas of 18F-fluoride uptake are associated with osteopontin, an inflammation-associated glycophosphoprotein that mediates tissue mineralisation, and Runt-related transcription factor 2, a nuclear protein involved in osteoblastic differentiation. These results suggest that 18F-fluoride is a non-invasive imaging biomarker of active coronary atherosclerotic mineralisation. [ABSTRACT FROM AUTHOR]
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- 2020
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25. Guiding Therapy by Coronary CT Angiography Improves Outcomes in Patients With Stable Chest Pain.
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Adamson, Philip D, Williams, Michelle C, Dweck, Marc R, Mills, Nicholas L, Boon, Nicholas A, Daghem, Marwa, Bing, Rong, Moss, Alastair J, Mangion, Kenneth, Flather, Marcus, Forbes, John, Hunter, Amanda, Norrie, John, Shah, Anoop S V, Timmis, Adam D, van Beek, Edwin J R, Ahmadi, Amir A, Leipsic, Jonathon, Narula, Jagat, and Newby, David E
- Abstract
Background: Within the SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) trial of patients with stable chest pain, the use of coronary computed tomography angiography (CTA) reduced the rate of death from coronary heart disease or nonfatal myocardial infarction (primary endpoint).Objectives: This study sought to assess the consistency and mechanisms of the 5-year reduction in this endpoint.Methods: In this open-label trial, 4,146 participants were randomized to standard care alone or standard care plus coronary CTA. This study explored the primary endpoint by symptoms, diagnosis, coronary revascularizations, and preventative therapies.Results: Event reductions were consistent across symptom and risk categories (p = NS for interactions). In patients who were not diagnosed with angina due to coronary heart disease, coronary CTA was associated with a lower primary endpoint incidence rate (0.23; 95% confidence interval [CI]: 0.13 to 0.35 vs. 0.59; 95% CI: 0.42 to 0.80 per 100 patient-years; p < 0.001). In those who had undergone coronary CTA, rates of coronary revascularization were higher in the first year (hazard ratio [HR]: 1.21; 95% CI: 1.01 to 1.46; p = 0.042) but lower beyond 1 year (HR: 0.59; 95% CI: 0.38 to 0.90; p = 0.015). Patients assigned to coronary CTA had higher rates of preventative therapies throughout follow-up (p < 0.001 for all), with rates highest in those with CT-defined coronary artery disease. Modeling studies demonstrated the plausibility of the observed effect size.Conclusions: The beneficial effect of coronary CTA on outcomes is consistent across subgroups with plausible underlying mechanisms. Coronary CTA improves coronary heart disease outcomes by enabling better targeting of preventative treatments to those with coronary artery disease. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590). [ABSTRACT FROM AUTHOR]- Published
- 2019
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26. Coronary Artery Plaque Characteristics Associated With Adverse Outcomes in the SCOT-HEART Study.
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Williams, Michelle C, Moss, Alastair J, Dweck, Marc, Adamson, Philip D, Alam, Shirjel, Hunter, Amanda, Shah, Anoop S V, Pawade, Tania, Weir-McCall, Jonathan R, Roditi, Giles, van Beek, Edwin J R, Newby, David E, and Nicol, Edward D
- Abstract
Background: Unlike most noninvasive imaging modalities, coronary computed tomography angiography can characterize subtypes of atherosclerotic plaque.Objectives: The purpose of this study was to investigate the prognostic implications of adverse coronary plaque characteristics in patients with suspected coronary artery disease.Methods: In this SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) post hoc analysis, the presence of adverse plaque (positive remodeling or low attenuation plaque), obstructive disease, and coronary artery calcification within 15 coronary segments was assessed on coronary computed tomography angiography of 1,769 patients who were followed-up for 5 years.Results: Among study participants (mean age 58 ± 10 years; 56% male), 608 (34%) patients had 1 or more adverse plaque features. Coronary heart disease death or nonfatal myocardial infarction was 3 times more frequent in patients with adverse plaque (n = 25 of 608 [4.1%] vs. n = 16 of 1,161 [1.4%]; p < 0.001; hazard ratio [HR]: 3.01; 95% confidence interval (CI): 1.61 to 5.63; p = 0.001) and was twice as frequent in those with obstructive disease (n = 22 of 452 [4.9%] vs. n = 16 of 671 [2.4%]; p = 0.024; HR: 1.99; 95% CI: 1.05 to 3.79; p = 0.036). Patients with both obstructive disease and adverse plaque had the highest event rate, with a 10-fold increase in coronary heart disease death or nonfatal myocardial infarction compared with patients with normal coronary arteries (HR: 11.50; 95% CI: 3.39 to 39.04; p < 0.001). However, these associations were not independent of coronary artery calcium score, a surrogate measure of coronary plaque burden.Conclusions: Adverse coronary plaque characteristics and overall calcified plaque burden confer an increased risk of coronary heart disease death or nonfatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590). [ABSTRACT FROM AUTHOR]- Published
- 2019
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27. Serial troponin measurements to monitor risk and response to endothelin A antagonism in chronic kidney disease.
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Anand, Atul, Farrah, Tariq E, Miller-Hodges, Eve, Shah, Anoop S V, Strachan, Fiona E, Carter, Edwin, Johnston, Neil R, Webb, David J, Mills, Nicholas L, and Dhaun, Neeraj
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CHRONIC kidney failure , *TROPONIN , *ENDOTHELINS , *ANGIOTENSIN converting enzyme , *TYPE 2 diabetes , *FOCAL segmental glomerulosclerosis , *CARDIOVASCULAR diseases risk factors - Published
- 2021
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28. High-Sensitivity Cardiac Troponin I and Clinical Risk Scores in Patients With Suspected Acute Coronary Syndrome.
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Chapman, Andrew R., Hesse, Kerrick, Andrews, Jack, Ken Lee, Kuan, Anand, Atul, Shah, Anoop S. V., Sandeman, Dennis, Ferry, Amy V., Jameson, Jack, Piya, Simran, Stewart, Stacey, Marshall, Lucy, Strachan, Fiona E., Gray, Alasdair, Newby, David E., Mills, Nicholas L., and Lee, Kuan Ken
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MYOCARDIAL infarction , *CORONARY disease , *HEART failure , *CARDIOLOGY , *TROPONIN - Abstract
Background: High-sensitivity cardiac troponin assays can help to identify patients who are at low risk of myocardial infarction in the emergency department. We aimed to determine whether the addition of clinical risk scores would improve the safety of early rule-out pathways for myocardial infarction.Methods: In 1935 patients with suspected acute coronary syndrome, we evaluated the safety and efficacy of 2 rule-out pathways alone or in conjunction with low-risk TIMI (Thrombolysis In Myocardial Infarction) (0 or 1), GRACE (Global Registry of Acute Coronary Events) (≤108), EDACS (Emergency Department Assessment of Chest Pain Score) (<16), or HEART (History, ECG, Age, Risk factors, Troponin) (≤3) scores. The European Society of Cardiology 3-hour pathway uses a single diagnostic threshold (99th percentile), whereas the High-STEACS (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome) pathway applies different thresholds to rule out (<5 ng/L) and rule in (>99th percentile) myocardial infarction.Results: Myocardial infarction or cardiac death during the index presentation or at 30 days occurred in 14.3% of patients (276/1935). The European Society of Cardiology pathway ruled out 70%, with 27 missed events giving a negative predictive value of 97.9% (95% CI, 97.1-98.6). The addition of a HEART score ≤3 reduced the proportion ruled out by the European Society of Cardiology pathway to 25% but improved the negative predictive value to 99.7% (95% CI, 99.0-100; P<0.001). The High-STEACS pathway ruled out 65%, with 3 missed events for a negative predictive value of 99.7% (95% CI, 99.4-99.9). No risk score improved the negative predictive value of the High-STEACS pathways, but all reduced the proportion ruled out (24% to 47%; P<0.001 for all).Conclusions: Clinical risk scores significantly improved the safety of the European Society of Cardiology 3-hour pathway, which relies on a single cardiac troponin threshold at the 99th percentile to rule in and rule out myocardial infarction. Where lower thresholds are used to rule out myocardial infarction, as applied in the High-STEACS pathway, risk scores halve the proportion of patients ruled out without improving safety.Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01852123. [ABSTRACT FROM AUTHOR]- Published
- 2018
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29. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction.
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Newby, David E., Adamson, Philip D., Boon, Nicholas A., Dweck, Marc R., Hunter, Amanda, Lewis, Stephanie, Mills, Nicholas L., Norrie, John, Shah, Anoop S. V., van Beek, Edwin J. R., Williams, Michelle C., Berry, Colin, Roditi, Giles, Flather, Marcus, Forbes, John, MacLean, Scott, Timmis, Adam D., and SCOT-HEART Investigators
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CHEST pain treatment , *CARDIOVASCULAR system , *CHEST pain , *COMPARATIVE studies , *CORONARY disease , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL care , *MEDICAL cooperation , *MYOCARDIAL infarction , *RESEARCH , *STATISTICAL sampling , *EVALUATION research , *RANDOMIZED controlled trials , *RELATIVE medical risk , *DISEASE incidence , *CORONARY angiography , *PREVENTION - Abstract
Background: Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown.Methods: In an open-label, multicenter, parallel-group trial, we randomly assigned 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years.Results: The median duration of follow-up was 4.8 years, which yielded 20,254 patient-years of follow-up. The 5-year rate of the primary end point was lower in the CTA group than in the standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.004). Although the rates of invasive coronary angiography and coronary revascularization were higher in the CTA group than in the standard-care group in the first few months of follow-up, overall rates were similar at 5 years: invasive coronary angiography was performed in 491 patients in the CTA group and in 502 patients in the standard-care group (hazard ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was performed in 279 patients in the CTA group and in 267 in the standard-care group (hazard ratio, 1.07; 95% CI, 0.91 to 1.27). However, more preventive therapies were initiated in patients in the CTA group (odds ratio, 1.40; 95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio, 1.27; 95% CI, 1.05 to 1.54). There were no significant between-group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause.Conclusions: In this trial, the use of CTA in addition to standard care in patients with stable chest pain resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years than standard care alone, without resulting in a significantly higher rate of coronary angiography or coronary revascularization. (Funded by the Scottish Government Chief Scientist Office and others; SCOT-HEART ClinicalTrials.gov number, NCT01149590 .). [ABSTRACT FROM AUTHOR]- Published
- 2018
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30. Comparison of the Efficacy and Safety of Early Rule-Out Pathways for Acute Myocardial Infarction.
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Chapman, Andrew R., Anand, Atul, Boeddinghaus, Jasper, Ferry, Amy V., Sandeman, Dennis, Adamson, Philip D., Andrews, Jack, Tan, Stephanie, Cheng, Sheun F., D'Souza, Michelle, Orme, Kate, Strachan, Fiona E., Nestelberger, Thomas, Twerenbold, Raphael, Badertscher, Patrick, Reichlin, Tobias, Gray, Alasdair, Shah, Anoop S. V., Mueller, Christian, and Newby, David E.
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MYOCARDIAL infarction treatment , *TROPONIN , *DRUG efficacy , *CORONARY disease , *AGE distribution , *BIOCHEMISTRY , *CLINICAL trials , *COMPARATIVE studies , *DECISION making , *HEALTH status indicators , *PHENOMENOLOGY , *RESEARCH methodology , *MEDICAL cooperation , *MYOCARDIAL infarction , *PROGNOSIS , *RESEARCH , *RESEARCH funding , *RISK assessment , *SEX distribution , *TIME , *EVALUATION research , *PREDICTIVE tests , *ACUTE coronary syndrome , *DIAGNOSIS ,MYOCARDIAL infarction diagnosis ,MYOCARDIAL infarction-related mortality - Abstract
Background: High-sensitivity cardiac troponin assays enable myocardial infarction to be ruled out earlier, but the optimal approach is uncertain. We compared the European Society of Cardiology rule-out pathway with a pathway that incorporates lower cardiac troponin concentrations to risk stratify patients.Methods: Patients with suspected acute coronary syndrome (n=1218) underwent high-sensitivity cardiac troponin I measurement at presentation and 3 and 6 or 12 hours. We compared the European Society of Cardiology pathway (<99th centile at presentation or at 3 hours if symptoms <6 hours) with a pathway developed in the High-STEACS study (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome) population (<5 ng/L at presentation or change <3 ng/L and <99th centile at 3 hours). The primary outcome was a comparison of the negative predictive value of both pathways for index type 1 myocardial infarction or type 1 myocardial infarction or cardiac death at 30 days. We evaluated the primary outcome in prespecified subgroups stratified by age, sex, time of symptom onset, and known ischemic heart disease.Results: The primary outcome occurred in 15.7% (191 of 1218) patients. In those less than the 99th centile at presentation, the European Society of Cardiology pathway ruled out myocardial infarction in 28.1% (342 of 1218) and 78.9% (961 of 1218) at presentation and 3 hours, respectively, missing 18 index and two 30-day events (negative predictive value, 97.9%; 95% confidence interval, 96.9-98.7). The High-STEACS pathway ruled out 40.7% (496 of 1218) and 74.2% (904 of 1218) at presentation and 3 hours, missing 2 index and two 30-day events (negative predictive value, 99.5%; 95% confidence interval, 99.0-99.9; P<0.001 for comparison). The negative predictive value of the High-STEACS pathway was greater than the European Society of Cardiology pathway overall (P<0.001) and in all subgroups, including those presenting early or known to have ischemic heart disease.Conclusions: Use of the High-STEACS pathway incorporating low high-sensitivity cardiac troponin concentrations rules out myocardial infarction in more patients at presentation and misses 5-fold fewer index myocardial infarctions than guideline-approved pathways based exclusively on the 99th centile.Clinical Trial Registration: URL: http://clinicaltrials.gov. Unique identifier: NCT01852123. [ABSTRACT FROM AUTHOR]- Published
- 2017
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31. Controlled Exposures to Air Pollutants and Risk of Cardiac Arrhythmia.
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Langrish, Jeremy P., Watts, Simon J., Hunter, Amanda J., Shah, Anoop S. V., Bosson, Jenny A., Unosson, Jon, Barath, Stefan, Lundbäck, Magnus, Cassee, Flemming R., Donaldson, Ken, Sandström, Thomas, Blomberg, Anders, Newby, David E., and Mills, Nicholas L.
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ARRHYTHMIA , *AIR pollution , *CONFIDENCE intervals , *CROSSOVER trials , *RESEARCH funding , *ENVIRONMENTAL exposure , *DESCRIPTIVE statistics , *ODDS ratio , *DISEASE risk factors - Abstract
Background: Epidemiological studies have reported associations between air pollution exposure and increases in cardiovascular morbidity and mortality. Exposure to air pollutants can influence cardiac autonomic tone and reduce heart rate variability, and may increase the risk of cardiac arrhythmias, particularly in susceptible patient groups. Objectives: We investigated the incidence of cardiac arrhythmias during and after controlled exposure to air pollutants in healthy volunteers and patients with coronary heart disease. Methods: We analyzed data from 13 double-blind randomized crossover studies including 282 participants (140 healthy volunteers and 142 patients with stable coronary heart disease) from whom continuous electrocardiograms were available. The incidence of cardiac arrhythmias was recorded for each exposure and study population. Results: There were no increases in any cardiac arrhythmia during or after exposure to dilute diesel exhaust, wood smoke, ozone, concentrated ambient particles, engineered carbon nanoparticles, or high ambient levels of air pollution in either healthy volunteers or patients with coronary heart disease. Conclusions: Acute controlled exposure to air pollutants did not increase the short-term risk of arrhythmia in participants. Research employing these techniques remains crucial in identifying the important pathophysiological pathways involved in the adverse effects of air pollution, and is vital to inform environmental and public health policy decisions. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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32. 18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial.
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Joshi, Nikhil V., Vesey, Alex T., Williams, Michelle C., Shah, Anoop S. V., Calvert, Patrick A., Craighead, Felicity H. M., Su Ern Yeoh, Wallace, William, Salter, Donald, Fletcher, Alison M., van Beek, Edwin J. R., Flapan, Andrew D., Uren, Neal G., Behan, Miles W. H., Cruden, Nicholas L. M., Mills, Nicholas L., Fox, Keith A. A., Rudd, James H. F., Dweck, Marc R., and Newby, David E.
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POSITRON emission tomography , *TOMOGRAPHY , *ATHEROSCLEROTIC plaque , *ATHEROSCLEROSIS , *CORONARY disease , *DIAGNOSIS , *SODIUM fluoride ,MYOCARDIAL infarction diagnosis - Abstract
The article discusses the results of a study that examined the use of combined positron emission tomography (PET) and computed tomogtaphy (CT) to identify ruptured and high-risk atherosclerotic plaques with the use of tracers, F-sodium fluoride and F-fluorodeoxyglucose. Topics discussed include coronary uptakes for both tracers in patients with myocardial infarction and F-sodium flouride PET-CT as the first non-invasive imaging method to identify ruptured and high-risk plaques.
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- 2014
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33. 18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial.
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Joshi, Nikhil V, Vesey, Alex T, Williams, Michelle C, Shah, Anoop S V, Calvert, Patrick A, Craighead, Felicity H M, Yeoh, Su Ern, Wallace, William, Salter, Donald, Fletcher, Alison M, van Beek, Edwin J R, Flapan, Andrew D, Uren, Neal G, Behan, Miles W H, Cruden, Nicholas L M, Mills, Nicholas L, Fox, Keith A A, Rudd, James H F, Dweck, Marc R, and Newby, David E
- Abstract
Background: The use of non-invasive imaging to identify ruptured or high-risk coronary atherosclerotic plaques would represent a major clinical advance for prevention and treatment of coronary artery disease. We used combined PET and CT to identify ruptured and high-risk atherosclerotic plaques using the radioactive tracers (18)F-sodium fluoride ((18)F-NaF) and (18)F-fluorodeoxyglucose ((18)F-FDG).Methods: In this prospective clinical trial, patients with myocardial infarction (n=40) and stable angina (n=40) underwent (18)F-NaF and (18)F-FDG PET-CT, and invasive coronary angiography. (18)F-NaF uptake was compared with histology in carotid endarterectomy specimens from patients with symptomatic carotid disease, and with intravascular ultrasound in patients with stable angina. The primary endpoint was the comparison of (18)F-fluoride tissue-to-background ratios of culprit and non-culprit coronary plaques of patients with acute myocardial infarction.Findings: In 37 (93%) patients with myocardial infarction, the highest coronary (18)F-NaF uptake was seen in the culprit plaque (median maximum tissue-to-background ratio: culprit 1·66 [IQR 1·40-2·25] vs highest non-culprit 1·24 [1·06-1·38], p<0·0001). By contrast, coronary (18)F-FDG uptake was commonly obscured by myocardial uptake and where discernible, there were no differences between culprit and non-culprit plaques (1·71 [1·40-2·13] vs 1·58 [1·28-2·01], p=0·34). Marked (18)F-NaF uptake occurred at the site of all carotid plaque ruptures and was associated with histological evidence of active calcification, macrophage infiltration, apoptosis, and necrosis. 18 (45%) patients with stable angina had plaques with focal (18)F-NaF uptake (maximum tissue-to-background ratio 1·90 [IQR 1·61-2·17]) that were associated with more high-risk features on intravascular ultrasound than those without uptake: positive remodelling (remodelling index 1·12 [1·09-1·19] vs 1·01 [0·94-1·06]; p=0·0004), microcalcification (73% vs 21%, p=0·002), and necrotic core (25% [21-29] vs 18% [14-22], p=0·001).Interpretation: (18)F-NaF PET-CT is the first non-invasive imaging method to identify and localise ruptured and high-risk coronary plaque. Future studies are needed to establish whether this method can improve the management and treatment of patients with coronary artery disease.Funding: Chief Scientist Office Scotland and British Heart Foundation. [ABSTRACT FROM AUTHOR]- Published
- 2014
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34. Mortality risk prediction of high-sensitivity C-reactive protein in suspected acute coronary syndrome: A cohort study.
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Kaura, Amit, Hartley, Adam, Panoulas, Vasileios, Glampson, Ben, Shah, Anoop S V, Davies, Jim, Mulla, Abdulrahim, Woods, Kerrie, Omigie, Joe, Shah, Anoop D, Thursz, Mark R, Elliott, Paul, Hemmingway, Harry, Williams, Bryan, Asselbergs, Folkert W, O'Sullivan, Michael, Lord, Graham M, Trickey, Adam, Sterne, Jonathan Ac, and Haskard, Dorian O
- Abstract
Background: There is limited evidence on the use of high-sensitivity C-reactive protein (hsCRP) as a biomarker for selecting patients for advanced cardiovascular (CV) therapies in the modern era. The prognostic value of mildly elevated hsCRP beyond troponin in a large real-world cohort of unselected patients presenting with suspected acute coronary syndrome (ACS) is unknown. We evaluated whether a mildly elevated hsCRP (up to 15 mg/L) was associated with mortality risk, beyond troponin level, in patients with suspected ACS.Methods and Findings: We conducted a retrospective cohort study based on the National Institute for Health Research Health Informatics Collaborative data of 257,948 patients with suspected ACS who had a troponin measured at 5 cardiac centres in the United Kingdom between 2010 and 2017. Patients were divided into 4 hsCRP groups (<2, 2 to 4.9, 5 to 9.9, and 10 to 15 mg/L). The main outcome measure was mortality within 3 years of index presentation. The association between hsCRP levels and all-cause mortality was assessed using multivariable Cox regression analysis adjusted for age, sex, haemoglobin, white cell count (WCC), platelet count, creatinine, and troponin. Following the exclusion criteria, there were 102,337 patients included in the analysis (hsCRP <2 mg/L (n = 38,390), 2 to 4.9 mg/L (n = 27,397), 5 to 9.9 mg/L (n = 26,957), and 10 to 15 mg/L (n = 9,593)). On multivariable Cox regression analysis, there was a positive and graded relationship between hsCRP level and mortality at baseline, which remained at 3 years (hazard ratio (HR) (95% CI) of 1.32 (1.18 to 1.48) for those with hsCRP 2.0 to 4.9 mg/L and 1.40 (1.26 to 1.57) and 2.00 (1.75 to 2.28) for those with hsCRP 5 to 9.9 mg/L and 10 to 15 mg/L, respectively. This relationship was independent of troponin in all suspected ACS patients and was further verified in those who were confirmed to have an ACS diagnosis by clinical coding. The main limitation of our study is that we did not have data on underlying cause of death; however, the exclusion of those with abnormal WCC or hsCRP levels >15 mg/L makes it unlikely that sepsis was a major contributor.Conclusions: These multicentre, real-world data from a large cohort of patients with suspected ACS suggest that mildly elevated hsCRP (up to 15 mg/L) may be a clinically meaningful prognostic marker beyond troponin and point to its potential utility in selecting patients for novel treatments targeting inflammation.Trial Registration: ClinicalTrials.gov - NCT03507309. [ABSTRACT FROM AUTHOR]- Published
- 2022
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35. Implementation of a Sensitive Troponin I Assay and Risk of Recurrent Myocardial Infarction and Death in Patients With Suspected Acute Coronary Syndrome.
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Mills, Nicholas L., Churchhouse, Antonia M. D., Kuan Ken Lee, Anand, Atul, Gamble, David, Shah, Anoop S. V., Paterson, Elspeth, MacLeod, Margaret, Graham, Catriona, Walker, Simon, Denvir, Martin A., Fox, Keith A. A., and Newby, David E.
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ACUTE coronary syndrome , *CARDIAC patients , *DIAGNOSIS , *CORONARY disease ,MYOCARDIAL infarction diagnosis - Abstract
The article discusses a study which investigated the link between lowering the diagnostic threshold for myocardial infarction (MI) with a sensitive troponin assay and improved clinical outcomes. The study involved patients with acute coronary syndrome (ACS) admitted to the Royal Infirmary of Edinburgh in Scotland. Less than 0.05 ng/mL plasma troponin concentrations were found in 1,340 patients. An increase in the diagnosis of MI due to the implementation of a sensitive troponin assay was observed in patients with suspected ACS.
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- 2011
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36. High-Sensitivity Cardiac Troponin I and the Diagnosis of Coronary Artery Disease in Patients With Suspected Angina Pectoris.
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Adamson, Philip D., Hunter, Amanda, Madsen, Debbie M., Shah, Anoop S. V., McAllister, David A., Pawade, Tania A., Williams, Michelle C., Berry, Colin, Boon, Nicholas A., Flather, Marcus, Forbes, John, McLean, Scott, Roditi, Giles, Timmis, Adam D., van Beek, Edwin J. R., Dweck, Marc R., Mickley, Hans, Mills, Nicholas L., and Newby, David E.
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TROPONIN I , *ANGINA pectoris , *CARDIAC imaging , *ANGIOGRAPHY ,CORONARY artery abnormalities - Abstract
BACKGROUND: We determined whether high-sensitivity cardiac troponin I can improve the estimation of the pretest probability for obstructive coronary artery disease (CAD) in patients with suspected stable angina. METHODS AND RESULTS: In a prespecified substudy of the SCOT-HEART trial (Scottish Computed Tomography of the Heart), plasma cardiac troponin was measured using a high-sensitivity single-molecule counting assay in 943 adults with suspected stable angina who had undergone coronary computed tomographic angiography. Rates of obstructive CAD were compared with the pretest probability determined by the CAD Consortium risk model with and without cardiac troponin concentrations. External validation was undertaken in an independent study population from Denmark comprising 487 patients with suspected stable angina. Higher cardiac troponin concentrations were associated with obstructive CAD with a 5-fold increase across quintiles (9% to 48%; P<0.001) independent of known cardiovascular risk factors (odds ratio, 1.35; 95% confidence interval, 1.25-1.46 per doubling of troponin). Cardiac troponin concentrations improved the discrimination and calibration of the CAD Consortium model for identifying obstructive CAD (C statistic, 0.788-0.800; P=0.004; χ² =16.8 [P=0.032] to 14.3 [P=0.074]). The updated model also improved classification of the American College of Cardiology/American Heart Association pretest probability risk categories (net reclassification improvement, 0.062; 95% confidence interval, 0.035-0.089). The revised model achieved similar improvements in discrimination and calibration when applied in the external validation cohort. CONCLUSIONS: High-sensitivity cardiac troponin I concentration is an independent predictor of obstructive CAD in patients with suspected stable angina. Use of this test may improve the selection of patients for further investigation and treatment. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01149590. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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37. Potential link between ozone and recurrent stroke.
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Shah AS, Newby DE, Mills NL, Shah, Anoop S V, Newby, David E, and Mills, Nicholas L
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- 2010
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38. Neighborhood characteristics and bystander-initiated CPR.
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Shah AS, Shah KS, Bhopal R, Shah, Anoop S V, Shah, Keval S V, and Bhopal, Raj
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- 2013
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