222 results on '"David, Hasdai"'
Search Results
2. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery
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Sigrun, Halvorsen, Julinda, Mehilli, Salvatore, Cassese, Trygve S, Hall, Magdy, Abdelhamid, Emanuele, Barbato, Stefan, De Hert, Ingrid, de Laval, Tobias, Geisler, Lynne, Hinterbuchner, Borja, Ibanez, Radosław, Lenarczyk, Ulrich R, Mansmann, Paul, McGreavy, Christian, Mueller, Claudio, Muneretto, Alexander, Niessner, Tatjana S, Potpara, Arsen, Ristić, L Elif, Sade, Henrik, Schirmer, Stefanie, Schüpke, Henrik, Sillesen, Helge, Skulstad, Lucia, Torracca, Oktay, Tutarel, Peter, Van Der Meer, Wojtek, Wojakowski, Kai, Zacharowski, Juhani, Knuuti, Steen Dalby, Kristensen, Victor, Aboyans, Ingo, Ahrens, Sotiris, Antoniou, Riccardo, Asteggiano, Dan, Atar, Andreas, Baumbach, Helmut, Baumgartner, Michael, Böhm, Michael A, Borger, Hector, Bueno, Jelena, Čelutkienė, Alaide, Chieffo, Maya, Cikes, Harald, Darius, Victoria, Delgado, Philip J, Devereaux, David, Duncker, Volkmar, Falk, Laurent, Fauchier, Gilbert, Habib, David, Hasdai, Kurt, Huber, Bernard, Iung, Tiny, Jaarsma, Aleksandra, Konradi, Konstantinos C, Koskinas, Dipak, Kotecha, Ulf, Landmesser, Basil S, Lewis, Ales, Linhart, Maja Lisa, Løchen, Michael, Maeng, Stéphane, Manzo-Silberman, Richard, Mindham, Lis, Neubeck, Jens Cosedis, Nielsen, Steffen E, Petersen, Eva, Prescott, Amina, Rakisheva, Antti, Saraste, Dirk, Sibbing, Jolanta, Siller-Matula, Marta, Sitges, Ivan, Stankovic, Rob F, Storey, Jurrien, Ten Berg, Matthias, Thielmann, and Rhian M, Touyz
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Anti-thrombotic therapy ,Biomarkers ,Guidelines ,Non-cardiac surgery ,Peri-operative beta-blockers ,Peri-operative cardiac management ,Peri-operative myocardial injury/infarction ,Peri-operative treatment of arrhythmias ,Post-operative cardiac surveillance ,Pre-operative cardiac risk assessment ,Pre-operative cardiac testing ,Pre-operative coronary artery revascularization ,Pre-operative treatment of valvular disease ,Humans ,Risk Assessment ,Intraoperative Complications ,Postoperative Complications ,Cardiology and Cardiovascular Medicine - Abstract
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- 2022
3. Correction to: Preoperative evaluation of pulmonary hypertension in lung transplant candidates: echocardiography versus right heart catheterization
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Tal Abu, Amos Levi, David Hasdai, Mordechai R. Kramer, Tamir Bental, Tali Bdolah‑Abram, Arthur Shiyovich, Abed Samara, Hana Vaknin‑Assa, Leor Perl, Dror Rosengarten, Yaron Shapira, Ran Kornowski, and Keren Skalsky
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Cardiology and Cardiovascular Medicine - Published
- 2022
4. Inferior ST-Elevation Myocardial Infarction Presenting When Urgent Primary Percutaneous Coronary Intervention Is Unavailable: Should We Adhere to Current Guidelines?
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Hani Jneid, David Hasdai, Mahboob Alam, Juan Carlos Kaski, Glenn N. Levine, Barry F. Uretsky, John K. French, Yochai Birnbaum, and Dan Atar
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Male ,0301 basic medicine ,medicine.medical_specialty ,Statin ,medicine.drug_class ,medicine.medical_treatment ,Inferior Wall Myocardial Infarction ,Guidelines ,030204 cardiovascular system & hematology ,Risk Assessment ,Time-to-Treatment ,Fibrinolytic therapy ,03 medical and health sciences ,0302 clinical medicine ,Reperfusion therapy ,Risk Factors ,St elevation myocardial infarction ,medicine ,Humans ,Thrombolytic Therapy ,Pharmacology (medical) ,cardiovascular diseases ,Myocardial infarction ,Intensive care medicine ,Aged ,Pharmacology ,Aspirin ,business.industry ,Percutaneous coronary intervention ,General Medicine ,Evidence-based medicine ,medicine.disease ,ST-elevation myocardial infarction ,Treatment Outcome ,030104 developmental biology ,Invited Article ,Practice Guidelines as Topic ,ST Elevation Myocardial Infarction ,Female ,Guideline Adherence ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
The pivotal studies that led to the recommendations for emergent reperfusion therapy for ST-elevation myocardial infarction (STEMI) were conducted for the most part over 25 years ago. At that time, contemporary standard treatments including aspirin, statin, and even anticoagulation were not commonly used. The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines and the 2017 European Society of Cardiology guidelines give a class I recommendation (with the level of evidence A) for primary percutaneous coronary intervention (pPCI) in patients with STEMI and ischemic symptoms of less than 12 h. However, if the patient presents to a hospital without pPCI capacity, and it is anticipated that pPCI cannot be performed within 120 min of first medical contact, fibrinolytic therapy is indicated (if there are no contraindications) (class I indication, level of evidence A). Our review of the pertinent literature shows that the current recommendation for inferior STEMI is based on the level of evidence lower than A. We can consider level B even C, supporting the recommendation for fibrinolytic therapy if pPCI is not available for inferior STEMI.
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- 2020
5. Reversible P2Y12 inhibitor versus irreversible P2Y12 inhibitor in ACS patients undergoing PCI (the acute coronary syndrome israeli survey (ACSIS)
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Ronny Alcalai, R Beigel, B Mengesha, Mark Kheifets, David Hasdai, Zaza Iakobishvili, Ran Eliaz, Robert Klempfner, Amos Levi, Tal Ovdat, and Eran Kalmanovich
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Acute coronary syndrome ,medicine.medical_specialty ,P2Y12 ,business.industry ,Internal medicine ,Conventional PCI ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Abstract
Introduction Based on data from randomized controlled trials, both American and European guidelines recommend treating acute coronary syndrome (ACS) patients with second generation P2Y12 inhibitors.1,2 Direct head-to-head comparison of these agents was scarce until the recent publication of the ISAR-REACT-5 study which demonstrated the superiority of the Irreversible thienopyridine type P2Y12 inhibitor (prodrug) over the reversible P2Y12 inhibitor in terms of 1-year composite of death, myocardial infarction (MI), and stroke.3,4,5 Given the unexpected outcomes of this trial, we sought to perform a comparison of ticagrelor and prasugrel in real-life ACS patients. Purpose To compare the outcomes of ACS (acute coronary syndrome) patients undergoing in-hospital PCI (percutaneous coronary intervention) treated with the Irreversible thienopyridine type P2Y12 inhibitor (prodrug) versus the reversible P2Y12 inhibitor. Methods ACSIS (Acute Coronary Syndrome in Israel) is a national ACS snapshot survey conducted in all 25 cardiology departments in Israel since 2000 over a two-month period, every two to three years. Both the Irreversible thienopyridine type P2Y12 inhibitor (prodrug) and the reversible P2Y12 inhibitor were commercially introduced in Israel in 2010. We therefore considered patients enrolled in ACSIS surveys 2010–2018 for the present analysis. Results Among 7,233 patients enrolled to the ACSIS (Acute Coronary Syndrome in Israel) registry between 2010 and 2018, we identified 1133 eligible patients treated with the Irreversible thienopyridine type P2Y12 inhibitor (prodrug) and 825 with the reversible P2Y12 inhibitor. In hospital complication rates, including rates of stent thrombosis, were roughly similar between groups. Compared to the reversible P2Y12 inhibitor, the Irreversible thienopyridine type P2Y12 inhibitor (prodrug) was associated with lower 1-year death in ST-elevation myocardial infarction (STEMI) patient compared to non-ST-elevation ACS (NSTE-ACS) patients (p for interaction 0.03). In propensity score matched STEMI patients (502 receiving the Irreversible thienopyridine type P2Y12 inhibitor (prodrug), 251 the reversible P2Y12 inhibitor) 30-day re-hospitalization rate (p Conclusion The Irreversible thienopyridine type P2Y12 inhibitor (prodrug) was more effective than the reversible P2Y12 inhibitor in STEMI patients, but not in NSTE-ACS patients. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): the Israeli working group on acute cardiac care of the Israel heart society
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- 2021
6. Preoperative evaluation of pulmonary hypertension in lung transplant candidates: echocardiography versus right heart catheterization
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Tali Bdolah-Abram, Amos Levi, Yaron Shapira, Tal Abu, Hana Vaknin-Assa, Tamir Bental, David Hasdai, Mordechai R. Kramer, Arthur Shyovich, Ran Kornowski, Abed Samara, Leor Perl, Keren Skalsky, and Dror Rosengarten
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Male ,Right heart catheterization ,Cardiac Catheterization ,medicine.medical_specialty ,Hypertension, Pulmonary ,Pulmonary Artery ,Predictive Value of Tests ,Internal medicine ,Humans ,Medicine ,Arterial Pressure ,Registries ,Aged ,Retrospective Studies ,Lung ,business.industry ,Reproducibility of Results ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,medicine.anatomical_structure ,Echocardiography ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Lung Transplantation - Abstract
Background Right heart catheterization (RHC) and echocardiography are both routinely used for pulmonary hypertension (PH) assessment in LT candidates, although this is not mandatory according to guidelines. We aim to describe the correlation between the pulmonary artery systolic pressure (PASP) measured by echocardiography to that measured by RHC in this population. Methods From a retrospective registry of 461 LT candidates, undergoing RHC between 2015–2019, 393 consecutive patients were assessed for the presence of pulmonary hypertension according to two methods – echocardiography and RHC. The primary outcome was the correlation between the estimated PASP measured by echocardiography to that measured by RHC. Secondary outcome was the accuracy of the echocardiographic assessment of PH. Results Patients were predominantly males (63.6%) with a mean age of 61.46±8.33y. The two most common etiologies for lung failure were interstitial lung disease or pulmonary fibrosis (52.2%) and chronic obstructive pulmonary disease (30.5%). Estimated PASP as measured by echocardiography was available in 89.31% of the patients, with a mean value of 49.5±20.02 mmHg. Mean PASP measured by RHC was 42.47±17.96 mmHg. The correlation between the two measurements was moderate (Pearson's correlation: r=0.609, p10 mmHg differences between the two values in 79.9% of the patients. Conclusions In the pre-surgical evaluation of LT candidates, echocardiographic estimation of PASP has moderate correlation with the PASP measured by RHC and relatively poor accuracy. Funding Acknowledgement Type of funding sources: None.
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- 2021
7. Ticagrelor versus Prasugrel in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Analysis from the Acute Coronary Syndrome Israeli Survey
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Eran Kalmanovich, David Hasdai, Zaza Iakobishvili, Tal Ovdat, Bethlehem Mengesha, Ronny Alcalai, Roy Beigel, Mark Kheifets, Amos Levi, Ran Eliaz, and Robert Klempfner
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medicine.medical_specialty ,Acute coronary syndrome ,Ticagrelor ,Prasugrel ,medicine.medical_treatment ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Myocardial infarction ,cardiovascular diseases ,Acute Coronary Syndrome ,Israel ,Stroke ,business.industry ,Percutaneous coronary intervention ,medicine.disease ,Treatment Outcome ,Conventional PCI ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,CAD and AMI: Research Article ,Prasugrel Hydrochloride ,Mace ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Introduction: We aimed to compare the outcomes of acute coronary syndrome (ACS) patients undergoing in-hospital percutaneous coronary intervention treated with prasugrel versus ticagrelor. Methods: Among 7,233 patients enrolled to the Acute Coronary Syndrome Israeli Survey (ACSIS) between 2010 and 2018, we identified 1,126 eligible patients treated with prasugrel and 817 with ticagrelor. Comparison between the groups was performed separately in ST-elevation myocardial infarction (STEMI) patients, propensity score matched (PSM) STEMI patients, and non-ST-elevation ACS (NSTE-ACS) patients. Results: In-hospital complication rates, including rates of stent thrombosis, were not significantly different between groups. In PSM STEMI patients, 30-day re-hospitalization rate (p < 0.05), 30-day MACE (the composite of death, MI, stroke, and urgent revascularization, p = 0.006), and 1-year mortality rates (p = 0.08) were higher in the ticagrelor group compared to the prasugrel group; in NSTE-ACS patients, outcomes were not associated with drug choice. In Cox regression analysis applied on the entire cohort, prasugrel was associated with lower 1-year mortality in STEMI patients but not in NSTE-ACS patients (p for interaction 0.03). Conclusions: Compared to ticagrelor, prasugrel was associated with superior clinical outcomes in STEMI patients, but not in NSTE-ACS patients.
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- 2021
8. Characteristics Associated with Upper-Range Doses of Beta-Blockers and Angiotensin-Renin Inhibitors in Reduced Ejection Fraction
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Osnat, Itzhaki Ben Zadok, Daniel, Murninkas, Zaza, Iakobishvili, Henri, Jino, Esther, Yohananov, Shlomo, Birkenfeld, and David, Hasdai
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Heart Failure ,Male ,Angiotensin Receptor Antagonists ,Adrenergic beta-Antagonists ,Humans ,Angiotensin-Converting Enzyme Inhibitors ,Female ,Stroke Volume ,Middle Aged ,Aged ,Body Mass Index - Abstract
Heart failure (HF) patients with reduced ejection fraction (HFrEF) are frequently treated with sub-optimal doses of angiotensin converting enzyme-inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), and beta blockers (BBs).To determine factors associated with attaining upper-range doses in patients with HFrEF.We examined treatment in patients with left ventricular ejection fraction (LVEF) ≤ 40% in a community-based, dedicated heart-failure clinic. Upper-range doses were defined as ≥ 75% of target recommended doses by heart failure society guidelines.The majority of the 215 patients were men (82%); median age at presentation 73 years (interquartile range [IQR] 65-78) and LVEF of 30% (IQR 25-35%). Following the up-titration program, 41% and 35% of patients achieved upper-range doses of ACE-Is/ARBs and BBs, respectively. Higher body mass index (BMI) was the only parameter found to be associated with achieving upper-range doses of ACE-I/ARBs (odds ratio [OR] 1.13, 95% confidence interval [95%CI] 1.05-1.22, P = 0.001). More patients achieved this target as BMI increased, with a sharp decline in the highest obesity category (BMI ≥ 40 m2/kg). Attaining upper-range doses of BBs was associated with pre-existing diabetes mellitus (DM) (OR 2.6, 95%CI 1.34-5.19, P = 0.005); women were associated with attaining lower BBs doses (OR 0.34, 95%CI 0.13-0.90, P = 0.031).Achieving upper-range doses of ACE-Is/ARBs and BBs in HFrEF outpatients in a treatment up-titration program were associated with greater BMI and DM, respectively. These findings may serve as benchmarks for up-titration programs.
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- 2020
9. Does colchicine decrease the rate of recurrence of acute idiopathic pericarditis treated with glucocorticoids?
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Chava Chezar Azzerad, Zaza Iakobishvili, Ran Kornowski, Aviv Mager, Yeela Talmor, Avital Porter, and David Hasdai
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,030204 cardiovascular system & hematology ,Gastroenterology ,Cohort Studies ,Young Adult ,03 medical and health sciences ,chemistry.chemical_compound ,Pericarditis ,0302 clinical medicine ,Acute pericarditis ,Recurrence ,Prednisone ,Internal medicine ,medicine ,Humans ,Colchicine ,In patient ,030212 general & internal medicine ,Glucocorticoids ,Aged ,Retrospective Studies ,Aged, 80 and over ,Aspirin ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Length of Stay ,Middle Aged ,medicine.disease ,Treatment Outcome ,chemistry ,Acute Disease ,Cohort ,Cardiology ,Drug Therapy, Combination ,Female ,Acute idiopathic pericarditis ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background The traditional treatment of acute pericarditis includes non-steroidal anti-inflammatory agents (NSAIDs) or glucocorticoids. The addition of colchicine has been found to reduce the rate of recurrences. Glucocorticoids, however, may attenuate this effect, although the available data are limited. We examined the impact of colchicine on the rate of recurrence of acute idiopathic pericarditis pretreated with prednisone. Methods The frequency of recurrence in patients hospitalized for acute idiopathic pericarditis in a tertiary medical center in 2004–2014 who were treated with glucocorticoids or with non-steroidal therapy was assessed from the computerized hospital database. A retrospective design was used. Results The cohort included 199 patients aged 18–86 years. Sixty-two (31%) were treated with prednisone, 42 with colchicine and 20 without, and 133 with non-steroidal therapy; in 4 patients, therapy was not detailed. Follow-up ranged from 13 to 147 months (median, 48 months). Fifty-three patients (26.6%) experienced at least one recurrence of pericarditis. The recurrence rate was significantly higher in patients who received prednisone and colchicine (17/42, 40.5%) than in patients who received NSAIDs or aspirin and colchicine (8/44, 18.2%, p = 0.03) or any non-steroidal therapy (30/133, 22.6%, p = 0.03). There was no difference between the rate of recurrence in patients who were treated with prednisone alone (5/20, 25%) and those treated with NSAIDs or aspirin and colchicine or with any non-steroidal therapy (p = NS). Baseline characteristics and duration of follow-up were similar in patients with and without recurrence. Hospital stay was longer in patients treated with prednisone alone as compared to patients treated with prednisone and colchicine. There were no other differences in baseline characteristics between these groups. Conclusions The addition of colchicine to prednisone in patients admitted for acute idiopathic pericarditis does not reduce the risk of recurrence. This finding suggests that prednisone blunts the salutary effects of colchicine.
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- 2018
10. Comparison of Outcomes in Patients With Acute Coronary Syndrome Presenting With Typical Versus Atypical Symptoms
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Yoav Hammer, Roy Beigel, Nir Shlomo, Ilan Goldenberg, Zaza Iakobishvili, Ran Kornowski, Tal Cohen, David Hasdai, and Alon Eisen
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,Chest Pain ,Delayed Diagnosis ,Comorbidity ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Chest pain ,Risk Assessment ,Sensitivity and Specificity ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Severity of illness ,Palpitations ,Medicine ,Humans ,030212 general & internal medicine ,Hospital Mortality ,Registries ,Acute Coronary Syndrome ,Israel ,Survival analysis ,Aged ,Proportional Hazards Models ,business.industry ,Proportional hazards model ,Mortality rate ,Length of Stay ,Middle Aged ,medicine.disease ,Survival Analysis ,Hospitalization ,Dyspnea ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Although typical chest pain is an important clinical feature required for diagnosis of acute coronary syndrome (ACS), many patients present with atypical complaints. The full extent and implication of this presentation is largely unknown. The study aim was to evaluate possible relations and temporal trends between presenting symptoms and outcomes in patients with ACS. Data was obtained from the Acute Coronary Syndrome Israeli Survey on patients presenting with typical chest pain versus atypical complaints, including dyspnea, nonspecific chest pain, palpitations or other. Temporal trends analysis examined the early (2000 to 2006) versus the late (2008 to 2016) period. During 2000 to 2016, 14,722 patients with ACS were enrolled; 11,508 (79%) presented with typical chest pain and 3,214 (21%) with atypical complaints. Patients with atypical complaints were older, majority female, and had more co-morbidities (p
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- 2019
11. Characteristics and outcomes of patients with cancer presenting with acute myocardial infarction
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Tal Cohen, David Hasdai, Barbara G. Silverman, Shmuel Gottlieb, Tamy Shohat, Osnat Itzhaki Ben Zadok, Zaza Iakobishvili, Avital Porter, Avi Shimony, Roy Beigel, Ran Kornowski, and Nir Shlomo
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Male ,medicine.medical_specialty ,Time Factors ,Health Status ,MEDLINE ,Myocardial Infarction ,Comorbidity ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Sex Factors ,Risk Factors ,Internal medicine ,Neoplasms ,Medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Registries ,Israel ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Age Factors ,Cancer ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Observational study ,Female ,Myocardial infarction diagnosis ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment - Abstract
Limited data are available regarding the optimal management of patients with cancer in the acute myocardial infarction (AMI) setting.We studied consecutive patients with AMI included in a national registry (years 2010, 2016) with the diagnosis of past or active malignancy and followed them for 1 year.Our cohort consisted of 2937 cancer-naive patients and 152 patients with cancer, of whom 35% presented with active malignancies. Compared with cancer-naive patients, patients with cancer were older, with female predominance, and presented more often with a history of hypertension and chronic kidney disease (P0.001 for all comparisons). The rate of ST-elevation AMI was comparable (P=0.067). GRACE score more than 140 was more common in the cancer group (P0.001). Most patients with cancer were referred to coronary angiography, though less than cancer-naive patients (87 vs. 93%; P=0.004). The rate of percutaneous coronary intervention was similar (P=0.265). Propensity score matching demonstrated similar rates of in-hospital complications between groups, and no mortality or major cardiac adverse event differences were noted at 30 days. Moreover, short-term mortality was similar between patients with active versus past malignancies, and between patients with solid and nonsolid tumors. However, cancer in patients with AMI was found to predict an increased mortality risk at 1 year by multivariable analysis (hazard ratio=2.52; P0.001).Patients with cancer and AMI have a more complicated clinical presentation, yet their short-term prognosis is similar to cancer-naive patients. Nevertheless, 1-year outcome is worse.
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- 2019
12. Comparison of 18-Month Outcomes of Ambulatory Patients With Reduced (≤40%) Left Ventricular Ejection Fraction Treated in a Community-Based, Dedicated Heart Failure Clinic Versus Treated Elsewhere
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Shlomo Birkenfeld, Henri Jino, Daniel Murninkas, Ester Yohananov, David Hasdai, Osnat Itzhaki Ben Zadok, and Zaza Iakobishvili
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Male ,medicine.medical_specialty ,New York Heart Association Class ,Time Factors ,Treatment outcome ,Adrenergic beta-Antagonists ,Electric Countershock ,Angiotensin-Converting Enzyme Inhibitors ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,03 medical and health sciences ,Angiotensin Receptor Antagonists ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Israel ,Aged ,Mineralocorticoid Receptor Antagonists ,Retrospective Studies ,Community based ,Heart Failure ,Ejection fraction ,business.industry ,Retrospective cohort study ,Stroke Volume ,Odds ratio ,medicine.disease ,Survival Rate ,Treatment Outcome ,Heart failure ,Ambulatory ,Cardiology ,Female ,Guideline Adherence ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
We sought to examine the management and outcomes of ambulatory patients with heart failure and reduced ejection fraction in a community-based, dedicated clinic. Patients with left ventricular ejection fraction (LVEF) ≤40% were actively solicited to attend a community-based, dedicated clinic. Eligible patients who chose to decline constituted our control group. Of 552 patients with LVEF ≤40% (median age 73 years and median LVEF 35%), 304 (55%) agreed to attend the clinic. Patients with worse New York Heart Association class were more likely to attend the clinic (odds ratio 2.07 [1.45, 2.95], p0.001), whereas women were more likely to decline (odds ratio 0.63 [0.42, 0.93], p0.022). During 18 months of follow-up, patients in the dedicated clinic significantly improved their functional capacity (56% New York Heart Association 3 to 4 at baseline vs 27% at follow-up, p0.001) and LVEF (35% [interquartile range 25, 35] at baseline vs 35% (interquartile range 30, 40) at follow-up, p0.001). In comparison with patients managed routinely, patients treated in a dedicated clinic achieved better guideline-recommended pharmacological treatment (65% vs 85% receiving β blockers, p0.001, 65% vs 82% receiving renin-angiotensin inhibitors, p = 0.0006, 31% vs 45% receiving mineralocorticoid receptor antagonists, p0.001). During follow-up, electrical device implantation was similar (6% vs 7% of dedicated-HF-clinic patients, p = 0.700). Furthermore, overall survival was better in patients treated in the clinic (log rank p = 0.0006), even after censoring the first 4 months to account for potential bias (log rank p = 0.0232). In conclusion, management in a community-based, dedicated clinic compared with routine management was associated with augmented guideline-recommended treatment and improved survival.
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- 2018
13. Guideline‐Recommended Therapies and Clinical Outcomes According to the Risk for Recurrent Cardiovascular Events After an Acute Coronary Syndrome
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Zaza Iakobishvili, Michal Einhorn, Ran Kornowski, Ilan Goldenberg, Tamir Bental, Nir Shlomo, Guy Witberg, David Hasdai, Yoav Hammer, and Alon Eisen
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,Time Factors ,medicine.medical_treatment ,Myocardial Infarction ,risk score ,030204 cardiovascular system & hematology ,Risk Assessment ,acute coronary syndrome ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,guideline‐recommended therapies ,Risk Factors ,Cardiovascular Disease ,Internal medicine ,medicine ,Humans ,Thrombolytic Therapy ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Preventive Cardiology ,Israel ,Stroke ,Original Research ,Aged ,Quality and Outcomes ,Framingham Risk Score ,Unstable angina ,business.industry ,Incidence ,Mortality rate ,Percutaneous coronary intervention ,Middle Aged ,Prognosis ,medicine.disease ,cardiovascular outcomes ,Survival Rate ,Female ,Guideline Adherence ,Cardiology and Cardiovascular Medicine ,business ,secondary prevention ,TIMI ,Follow-Up Studies - Abstract
Background Patients who have had an acute coronary syndrome ( ACS ) are at increased risk of recurrent cardiovascular events; however, paradoxically, high‐risk patients who may derive the greatest benefit from guideline‐recommended therapies are often undertreated. The aim of our study was to examine the management, clinical outcomes, and temporal trends of patients after ACS stratified by the Thrombolysis in Myocardial Infarction (TIMI) risk score for secondary prevention, a recently validated clinical tool that incorporates 9 clinical risk factors. Methods and Results Included were patients with ACS enrolled in the biennial Acute Coronary Syndrome Israeli Surveys ( ACSIS ) between 2008 and 2016. Patients were stratified by the TIMI risk score for secondary prevention to low (score 0–1), intermediate (2), or high (≥3) risk. Clinical outcomes included 30‐day major adverse cardiac events (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1‐year mortality. Of 6827 ACS patients enrolled, 35% were low risk, 27% were intermediate risk, and 38% were high risk. Compared with the other risk groups, high‐risk patients were older, were more commonly female, and had more renal dysfunction and heart failure ( P P P Conclusions Despite an improvement in the management of high‐risk ACS patients, they are still undertreated with guideline‐recommended therapies. Nevertheless, the outcome of high‐risk patients after ACS has significantly improved in the past decade, thus they should not be denied these therapies.
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- 2018
14. P5567Treatment of late arrival ST-elevation myocardial infarction in a real world clinical survey
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Nir Shlomo, David Hasdai, Ran Kornowski, Aryeh Abelow, Roy Beigel, D Gavriely, Alon Eisen, Shmuel Gottlieb, Zaza Iakobishvili, Oren Zusman, and I Goldenberg
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medicine.medical_specialty ,St elevation myocardial infarction ,business.industry ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
15. P3501Characteristics and outcomes of cancer patients presenting with myocardial infarction
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Avital Porter, David Hasdai, Zaza Iakobishvili, Tal Cohen, O Itzhaki Ben Zadok, Roy Beigel, Shmuel Gottlieb, Nir Shlomo, and Ran Kornowski
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cancer ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Published
- 2018
16. 4059Guideline recommended therapies and clinical outcomes according to the risk for recurrent cardiovascular events after an acute coronary syndrome
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Z Iakobishvily, Yoav Hammer, David Hasdai, Tamir Bental, Alon Eisen, I Goldenberg, Ran Kornowski, and Nir Shlomo
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Acute coronary syndrome ,medicine.medical_specialty ,business.industry ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Intensive care medicine - Published
- 2018
17. Medical management: pharmacological therapy
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Aviv A. Shaul and David Hasdai
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medicine.medical_specialty ,Pharmacological therapy ,business.industry ,medicine ,cardiovascular diseases ,Intensive care medicine ,business - Abstract
The current armamentarium for the treatment of chronic ischaemic heart disease includes agents that are used to relieve angina or attenuate ischaemia, as well as agents that are administered regardless of symptom status to ameliorate prognosis. Beta blockers and calcium channel blockers are the mainstay treatments for angina and ischaemia relief. Adjunct therapy includes nitrates, ivabradine, ranolazine, nicorandil, and trimetazidine. Aspirin (alternatively, clopidogrel), statins (possibly with ezetimibe), and angiotensin-converting enzyme inhibitors (alternatively, angiotensin receptor blockers), are the mainstay agents to improve outcomes.
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- 2018
18. Calculated Risk for Sudden Cardiac Death in Patients with Apical Versus Nonobstructive Nonapical Hypertrophic Cardiomyopathy
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David Hasdai, Osnat Itzhaki Ben Zadok, Yaron Shapira, Guy Witberg, Daniel Monakier, and Mordehay Vaturi
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Adult ,Male ,medicine.medical_specialty ,Heart Ventricles ,Age at diagnosis ,030204 cardiovascular system & hematology ,Risk Assessment ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Family history ,business.industry ,Hypertrophic cardiomyopathy ,Clinical course ,Cardiomyopathy, Hypertrophic ,Middle Aged ,medicine.disease ,Death, Sudden, Cardiac ,Echocardiography ,Cohort ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
There are limited and conflicting data regarding the prognosis of patients with apical hypertrophic cardiomyopathy (HC) and their risk for sudden cardiac death (SCD). We used data from a single tertiary center for comparing the clinical course and the calculated risk for SCD in patients with nonobstructive apical HC (apical HC) versus patients with nonobstructive, nonapical HC (NONA HC). The 5-year SCD risk was calculated based on the HC risk-SCD tool. A total of 109 patients were included in the cohort of whom 44 (40%) patients were diagnosed with apical HC. The majority of patients were males with a median age at diagnosis of 40 years (interquartile range 26, 59 years). Patients with apical HC had a significant lower calculated 5-year risk for SCD compared with patients with NONA HC (2.65 ± 2.2% vs 4.00 ± 3.5%, respectively, p = 0.017), primarily due to a lower incidence of familial SCD (20% vs 43% respectively, p = 0.014). Only 9% of patients with apical HC had a calculated risk of >6% (implantable cardioverter-defibrillator recommended), as compared with 23% of patients with NONA HC. During a median follow-up of 1,018 days (interquartile range 546, 1449 days), apical HC patients tended to develop less malignant ventricular arrhythmia episodes compared with NONA HC patients (0% vs 7.7%, respectively, p = 0.060). In conclusion, apical HC patients have a lower calculated risk of SCD compared with NONA HC patients, mainly due to a lower incidence of family history of SCD. Thus, apical HC should be considered a form of HC less prone to SCD.
- Published
- 2018
19. Impact of Self-Reported Family History of Premature Cardiovascular Disease on the Outcomes of Patients Hospitalized for Acute Coronary Syndrome (from the Acute Coronary Syndrome Israel Survey [ACSIS] 2000 to 2013)
- Author
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Ilan Goldenberg, Alon Eisen, Amos Levi, Chava Chezar-Azerrad, Uri Landes, David Hasdai, Shmuel Gottlieb, Ran Kornowski, Roy Beigel, Nir Shlomo, and Zaza Iakobishvili
- Subjects
Adult ,Male ,medicine.medical_specialty ,Acute coronary syndrome ,Adolescent ,030204 cardiovascular system & hematology ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Genetic Predisposition to Disease ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Registries ,Family history ,Risk factor ,Acute Coronary Syndrome ,Israel ,Propensity Score ,Stroke ,Aged ,business.industry ,Unstable angina ,Age Factors ,Middle Aged ,medicine.disease ,Health Surveys ,Hospitalization ,Survival Rate ,Cardiovascular Diseases ,Cardiology ,Female ,Self Report ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
Family history of premature cardiovascular disease (FHpCVD) is a well-established risk factor for development of coronary artery disease. However, little is known about the impact of FHpCVD on the outcome of patients presenting with acute coronary syndrome (ACS). We therefore aimed to evaluate the outcomes of ACS patients grouped by the presence and/or absence of FHpCVD. All patients ≤65 at admission who had an ACS event and were enrolled in the national ACS Israel Survey registry from 2000 to 2013 were included. Patients were grouped by the presence or absence of self-reported FHpCVD. Nearest neighbor propensity score matching was applied to create an evenly matched cohort of patients. Outcomes included 30-day MACE (defined as the composite of death, unstable angina pectoris, myocardial infarction, stroke, stent thrombosis, and urgent revascularization) and its individual components. Of 7,173 ACS patients, 33.9% reported FHpCVD. These patients were younger, with lower prevalence of diabetes, previous cerebrovascular and kidney diseases, but had higher prevalence of smoking and hyperlipidemia (p0.001 for each). The propensity score-matching cohort included 1,793 pairs of evenly matched patients. The rate of 30-day MACE did not differ in the groups, as well as 1-year mortality (2.4% vs 2.2%, with vs without FHpCVD, respectively). During long-term follow-up (median 7.6 years), mortality rate was lower in the FHpCVD group (hazard ratio 0.82, 95% confidence intervals 0.69 to 0.99). In conclusion, we observed no differences in short- and intermediate-term outcomes based on the presence and/or absence of FHpCVD. However, patients with FHpCVD had better long-term survival.
- Published
- 2018
20. The association between eGFR in the normal or mildly impaired range and incident cadiovascular disease: Age and sex analysis
- Author
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Morton Leibowitz, Alon Eisen, David Hasdai, Ran D. Balicer, Yardena Rabi, Moshe Hoshen, Zaza Iakobishvili, Avital Porter, and Orna Reges
- Subjects
Adult ,Male ,medicine.medical_specialty ,Databases, Factual ,Renal function ,Disease ,030204 cardiovascular system & hematology ,Age and sex ,Cohort Studies ,03 medical and health sciences ,chemistry.chemical_compound ,Population based cohort ,Young Adult ,0302 clinical medicine ,Age Distribution ,Risk Factors ,Internal medicine ,Internal Medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Israel ,Sex Distribution ,Aged ,Aged, 80 and over ,Creatinine ,Unstable angina ,business.industry ,Incidence ,Middle Aged ,medicine.disease ,Coronary revascularization ,Logistic Models ,chemistry ,Cardiovascular Diseases ,Cardiology ,Female ,business ,Glomerular Filtration Rate - Abstract
Background Worse renal function, even in the normal or mildly impaired range, is associated with incident cardiovascular disease (CVD). Whether this association exists in both sexes across all ages is not known. Methods A population based cohort of individuals >22 years with no prior CVD and with an eGFR 60–130 ml/min/1.73 m2. eGFR was calculated using the CKD-EPI formula. Incident CVD was defined as either myocardial infarction, unstable angina pectoris, coronary revascularization, or cerebrovascular event. Incident CVD was examined separately in men and women in 3 age-groups (young, 22–40 years; middle-aged, 41–60 years; and elderly, ≥61 years), during a median follow-up of 96.0 months. Results Among 1,341,400 individuals (57% women, mean age 49.2 ± 16.6 years), men had more incident CVD as compared to women (34,968 vs. 23,515 total incident CVD) in all age-groups (0.6% vs. 0.2% in young; 6.2% vs. 2.0% in middle-aged; 13.4% vs. 8.4% in elderly, respectively). After adjustment for CVD risk factors, an increment of 10 units in eGFR was independently associated with a decrease of 5.4%, 3.4% and 5.4% in incident CVD in young, middle-aged and elderly men (p Conclusion Although incident CVD differs in men and women, as well as in different age-groups, a higher eGFR even in the normal or mildly impaired range is associated with lesser incident CVD in men and women of all ages.
- Published
- 2017
21. Incidence and Prognosis of Pericarditis After ST-Elevation Myocardial Infarction (from the Acute Coronary Syndrome Israeli Survey 2000 to 2013 Registry Database)
- Author
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David Hasdai, Ran Kornowski, Ilan Goldenberg, Avital Porter, Nir Shlomo, Aviv Mager, Roy Beigel, Zaza Iakobishvili, Adi Lador, and Dina Vorobeichik
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,medicine.medical_treatment ,Infarction ,030204 cardiovascular system & hematology ,Revascularization ,03 medical and health sciences ,Pericarditis ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Myocardial infarction ,Registries ,Israel ,Survival rate ,Aged ,Retrospective Studies ,Ejection fraction ,business.industry ,Incidence (epidemiology) ,Incidence ,030208 emergency & critical care medicine ,Length of Stay ,Middle Aged ,medicine.disease ,Prognosis ,Survival Rate ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
There are scarce contemporary data regarding the incidence and prognosis of early postmyocardial infarction pericarditis (PMIP). Thus, we retrospectively analyzed 6,282 patients with ST-segment elevation myocardial infarction (STEMI) enrolled with known PMIP status in the Acute Coronary Syndrome Israeli Survey 2000 to 2013 registry. The primary outcome was the composite of all-cause mortality, nonfatal myocardial infarction, cerebrovascular event, stent thrombosis, or revascularization. The secondary outcomes were mortality and length of stay during the acute hospitalization. Overall, 76 patients with STEMI had PMIP (1.2%). PMIP incidence gradually decreased from 170 per 10,000 in 2000 to 110 per 10,000 in 2013, respectively (35% reduction, p for trend = 0.035). Patients with PMIP were younger (median 58.0 vs 61.0; p = 0.045), had less hypertension, higher cardiac biomarkers, and more frequently reduced left ventricular ejection fraction (87.0% vs 67.0%; p = 0.001). Patients with PMIP had longer time to reperfusion (225 minutes vs 183 minutes; p = 0.016) and length of stay (7.0 vs 5.0 days; p 0.001). The composite end point occurred similarly in patients with and without PMIP (10.5% vs 13.2%, respectively). There was no significant difference in 30-day, 1-year, and 5-year survival. In conclusion, PMIP is a relatively rare complication of STEMI in the coronary reperfusion era, portends worse short-term but not long-term outcomes, and is associated with bigger infarct size.
- Published
- 2017
22. 2014 ESC/EACTS Guidelines on myocardial revascularization
- Author
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Philippe Kolh, Stephan Windecker, Fernando Alfonso, Jean-Philippe Collet, Jochen Cremer, Volkmar Falk, Gerasimos Filippatos, Christian Hamm, Stuart J. Head, Peter Jüni, A. Pieter Kappetein, Adnan Kastrati, Juhani Knuuti, Ulf Landmesser, Günther Laufer, Franz-Josef Neumann, Dimitrios J. Richter, Patrick Schauerte, Miguel Sousa Uva, Giulio G. Stefanini, David Paul Taggart, Lucia Torracca, Marco Valgimigli, William Wijns, Adam Witkowski, Jose Luis Zamorano, Stephan Achenbach, Helmut Baumgartner, Jeroen J. Bax, Héctor Bueno, Veronica Dean, Christi Deaton, Çetin Erol, Robert Fagard, Roberto Ferrari, David Hasdai, Arno W. Hoes, Paulus Kirchhof, Patrizio Lancellotti, Ales Linhart, Petros Nihoyannopoulos, Massimo F. Piepoli, Piotr Ponikowski, Per Anton Sirnes, Juan Luis Tamargo, Michal Tendera, Adam Torbicki, John Pepper, Anelechi Anyanwu, Lina Badimon, Johann Bauersachs, Andreas Baumbach, Farzin Beygui, Nikolaos Bonaros, Marco De Carlo, Dobromir Dobrev, Joel Dunning, Eric Eeckhout, Stephan Gielen, Heyman Luckraz, Heiko Mahrholdt, Gilles Montalescot, Domenico Paparella, Ardawan J. Rastan, Marcelo Sanmartin, Paul Sergeant, Sigmund Silber, Juan Tamargo, Jurrien ten Berg, Holger Thiele, Robert-Jan van Geuns, Hans-Otto Wagner, Sven Wassmann, and Olaf Wendler
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,EuroSCORE ,General Medicine ,medicine.disease ,Revascularization ,Coronary artery disease ,Coronary artery bypass surgery ,Cardiothoracic surgery ,Internal medicine ,Cardiology ,Medicine ,Surgery ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Published
- 2014
23. P6297Does colchicine decrease the rate of recurrence of acute idiopathic pericarditis treated with glucocorticoids?
- Author
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Avital Porter, Aviv Mager, David Hasdai, Ran Kornowski, Y. Talmor, C. Chezar Azerrad, and Zaza Iakobishvili
- Subjects
chemistry.chemical_compound ,medicine.medical_specialty ,chemistry ,business.industry ,Internal medicine ,medicine ,Colchicine ,Acute idiopathic pericarditis ,Cardiology and Cardiovascular Medicine ,business ,Gastroenterology - Published
- 2017
24. P3646Trends in frequency and prognosis of post myocardial infarction pericarditis: ACSIS 2000–2013
- Author
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David Hasdai, Nir Shlomo, I Goldenberg, Aviv Mager, Ran Kornowski, Zaza Iakobishvili, Roy Beigel, Avital Porter, and Adi Lador
- Subjects
Pericarditis ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Post myocardial infarction - Published
- 2017
25. P208Early versus delayed angiography in non-ST-elevation myocardial infarction - insights from ACSIS
- Author
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David Hasdai, R. Alkalai, Shmuel Gottlieb, I. Goldenberg, S Matetzky, Shaul Atar, A. Shaul, Zaza Iakobishvili, Avi Shimony, M. Einhorn, Roy Beigel, Ran Kornowski, and Nir Shlomo
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,St elevation myocardial infarction ,business.industry ,Internal medicine ,Angiography ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
26. Utility of immune monitoring in heart transplant recipients on everolimus-based immune suppression
- Author
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Alexander Battler, David Hasdai, Victoria Yaari, Moshe Israeli, Alexander Yussim, Israel Matz, Tuvia Ben Gal, Benjamin Medalion, and Tirza Klein
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Immune monitoring ,Infections ,Gastroenterology ,Immunocompromised Host ,Immune system ,Monitoring, Immunologic ,Internal medicine ,medicine ,Humans ,Everolimus ,Aged ,Retrospective Studies ,Sirolimus ,Heart transplantation ,Transplantation ,business.industry ,Middle Aged ,Immune state ,ROC Curve ,Immunology ,Heart Transplantation ,Drug Therapy, Combination ,Female ,Infectious risk ,business ,Immunosuppressive Agents ,Follow-Up Studies ,medicine.drug - Abstract
Background Everolimus provides effective immune suppression (IS) after heart transplant (HTx). Its pharmacologic properties differentiate everolimus from other IS drugs. A non-invasive immune monitoring (IM) assay test appears to predict the immune state in HTx recipients on standard calcineurin-inhibitor-based IS. The utility of IM in HTx recipients on everolimus-based IS was evaluated. Methods Between June 2005 and June 2011, 34 adult HTx recipients followed up at our center received everolimus and had 381 IM assays that were performed at six months to 16-yr post-transplant. Results of the IM assay were correlated with infection and rejection episodes that occurred during the IM testing. Results In the everolimus-based IS group, there were 18 infectious episodes and four rejection episodes. The average IM score was significantly lower during infection than at steady state (188 ± 122 vs. 338 ± 137 ng/mL ATP, p
- Published
- 2014
27. Estimated glomerular filtration rate within the normal or mildly impaired range and incident non-valvular atrial fibrillation: Results from a population-based cohort study
- Author
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Moti Haim, Moshe Hoshen, Orna Reges, David Hasdai, Ran D. Balicer, Alon Eisen, Morton Leibowitz, and Zaza Iakobishvili
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Heart disease ,Epidemiology ,Non valvular atrial fibrillation ,Renal function ,Comorbidity ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Kidney ,Severity of Illness Index ,03 medical and health sciences ,Population based cohort ,chemistry.chemical_compound ,Young Adult ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Israel ,Aged ,Retrospective Studies ,Prosthetic valve ,Creatinine ,business.industry ,Incidence ,Atrial fibrillation ,Middle Aged ,medicine.disease ,chemistry ,Cardiology ,Female ,Kidney Diseases ,Cardiology and Cardiovascular Medicine ,business ,Glomerular Filtration Rate - Abstract
BackgroundLower estimated glomerular filtration rate, in particular in the significant renal impairment range (estimated glomerular filtration rate 22 years old) without rheumatic heart disease or prosthetic valves and with 60 ml/min/1.73 m2 10 m patient-years of follow-up (∼75% 65,000 individuals had ≥1 atrial fibrillation event (incident atrial fibrillation rate 5.1% and 5.8% excluding or includin...
- Published
- 2016
28. Prevalence of Carotid Artery Disease among Ambulatory Patients with Coronary Artery Disease
- Author
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Shirit, Kazum, Alon, Eisen, Eli I, Lev, Zaza, Iakobishvili, Alejandro, Solodky, David, Hasdai, Ran, Kornowski, and Aviv, Mager
- Subjects
Adult ,Aged, 80 and over ,Carotid Artery Diseases ,Male ,Cholesterol, LDL ,Coronary Artery Disease ,Middle Aged ,Coronary Vessels ,Peripheral Arterial Disease ,Risk Factors ,Hypertension ,Outpatients ,Linear Models ,Prevalence ,Humans ,Carotid Stenosis ,Female ,Age of Onset ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Aged ,Retrospective Studies - Abstract
Concomitant carotid artery disease (CaAD) in patients with coronary artery disease (CAD) is associated with worse cardiac and neurologic outcomes. The reported prevalence and risk factors for concomitant CaAD in CAD patients varied among previous studies.To examine these factors in ambulatory patients with CAD and well-documented cholesterol levels treated with cholesterol-lowering medications.We retrospectively analyzed prospectively collected data from 325 unselected patients with CAD (89 women, mean age 68.8 ± 9.9 years) undergoing routine evaluation at the coronary clinic of our hospital.The low density lipoprotein-cholesterol (LDL-C) was100 mg/dl in 292 patients (90%). Age at onset of CAD symptoms was 59.4 ± 10.8 years. Carotid stenosis ≥ 50% was seen in 83 patients (25.5%) and between 30% and 49% in 55 patients (17%) (duplex method). Carotid stenosis was significantly associated with hypertension (P = 0.032), peripheral arterial disease (P = 0.002) and number of coronary arteries with ≥ 50% stenosis (P = 0.002), and showed a borderline association with age at CAD onset (P = 0.062) and diabetes mellitus (P = 0.053). On linear regression analysis, independent predictors of CaAD were peripheral vascular disease (OR 3.186, 95% CI 1.403-7.236, P = 0.006), number of coronary arteries with ≥ 50% stenosis (OR 1.543, 95% CI 1.136-2.095, P = 0.005), and age at CAD onset (OR 1.028, 95% CI 1.002-1.054, P = 0.003). None of the variables studied predicted freedom from CaAD.Carotid atherosclerosis is very common in stable ambulatory patients with CAD regularly taking statins. The risk is higher in patients with peripheral arterial disease, a greater number of involved coronary arteries, and older age at onset of CAD.
- Published
- 2016
29. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation
- Author
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Philippe Kolh, Theresa McDonagh, Frans H. Rutten, Piotr Ponikowski, Jeroen J. Bax, Bogdan A. Popescu, A. John Camm, Annalisa Angelini, Stephan Windecker, Ottavio Alfieri, Andreas Goette, Robert Hatala, Christian Funck-Brentano, Robert Fagard, Udo Sechtem, Isabelle C. Van Gelder, and David Hasdai
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Management of atrial fibrillation ,Catheter ablation ,macromolecular substances ,Cardioversion ,Left atrial appendage occlusion ,Vernakalant ,chemistry.chemical_compound ,Physiology (medical) ,Internal medicine ,medicine ,reproductive and urinary physiology ,HAS-BLED ,urogenital system ,business.industry ,Atrial fibrillation ,medicine.disease ,Dronedarone ,chemistry ,embryonic structures ,Cardiology ,biological phenomena, cell phenomena, and immunity ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
2012 focused update of the ESC Guidelines for the management of atrial fibrillation : an update of the 2010 ESC Guidelines for the management of atrial fibrillation: developed with the special contribution of the European Heart Rhythm Association
- Published
- 2012
30. Clopidogrel Response Up to Six Months After Acute Myocardial Infarction
- Author
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Pablo Codner, Eli I. Lev, Abid Assali, Zaza Iakobishvili, Muthiah Vaduganathan, G Greenberg, David Hasdai, Eldad Rechavia, Alexander Battler, and Ran Kornowski
- Subjects
Male ,medicine.medical_specialty ,Ticlopidine ,Time Factors ,medicine.medical_treatment ,Myocardial Infarction ,P2Y12 ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Prospective Studies ,cardiovascular diseases ,Myocardial infarction ,Aspirin ,Clopidogrel response ,business.industry ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Clopidogrel ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Index hospitalization ,Platelet Aggregation Inhibitors ,Follow-Up Studies ,medicine.drug - Abstract
High on-treatment platelet reactivity (HTPR) despite clopidogrel therapy is associated with adverse cardiac events after acute myocardial infarction (AMI). Most studies to date have assessed clopidogrel response at a single time point before or after percutaneous coronary intervention (PCI). It is unclear, however, whether the HTPR phenotype is stable over time. Therefore, we aimed to examine response to clopidogrel in patients with AMI treated with PCI over a 6-month period. Patients (n = 57) with AMI treated with PCI were assessed for response to clopidogrel at 3 time points: in hospital, 30 days, and 6 months after index hospitalization. Response to clopidogrel was determined by the VerifyNow P2Y12 assay (reported as P2Y12 response units) and multiple electrode aggregometry (MEA; reported as aggregation units). HTPR was defined as ≥235 P2Y12 response units or ≥47 aggregation units. Patients' mean age was 54.5 ± 10.9 years, 91% were men, 19% had diabetes, and 74% were admitted with ST-segment elevation MI. HTPR based on MEA was observed in 22.8% of patients in hospital, 26.3% at 30 days, and 17.5% at 6 months (p = NS). HTPR based on the VerifyNow assay was observed in 38.6% of patients in hospital, 28.1% at 30 days, and 33.3% at 6 months (p = NS). Individual HTPR phenotypic assignment at baseline was stable in 73.7% (based on MEA) and 70.2% (based on VerifyNow) of patients at 6-month follow-up. In conclusion, this is the first study evaluating the stability of clopidogrel response over time after AMI. Rates of HTPR to clopidogrel therapy appear to be relatively stable up to 6 months after AMI.
- Published
- 2012
31. High Sensitivity Cardiac Troponin T Levels after Elective Cardioversion for Atrial Fibrillation/Flutter
- Author
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Zaza, Iakobishvili, Adaya, Weissler, Kiril, Buturlin, Gustavo, Goldenberg, Boris, Strassberg, Ruth, Tur, and David, Hasdai
- Subjects
Male ,Time Factors ,Atrial Flutter ,Troponin T ,Atrial Fibrillation ,Electric Countershock ,Humans ,Female ,Prospective Studies ,Middle Aged ,Biomarkers ,Aged ,Follow-Up Studies - Abstract
The kinetics of high sensitivity cardiac troponin T (hs-cTnT) levels after elective, biphasic, direct-current cardioversion for persistent atrial fibrillation/flutter remains unknown.We examined hs-cTnT kinetics in 24 patients at baseline and at 2, 6 and 24 hours post-cardioversion, and again at 7 and 30 days. We also examined levels of creatine kinase, aspartate aminotransferase, lactate dehydrogenase, brain natriuretic peptide (BNP), and high sensitivity C-reactive protein (hs-CRP).Median (25th, 75th interquartiles) baseline hs-cTnT concentration was 19.8 (10.4, 35.2) ng/L with 14 patients presenting with levels above the 99th percentile (13 ng/L). Hs-cTnT levels did not change significantly over time although they tended to decrease by 30 days, 18.8 ng/L (12.5, 23.3). There was no significant rise in other markers of myocardial injury. Similarly, BNP and hs-CRP levels were elevated at baseline and tended to decrease over time.Patients with persistent atrial fibrillation/flutter have elevated hs-cTnT levels, as part of a general rise in biomarkers such as BNP and hs-CRP, without a further rise after cardioversion. After cardioversion, there is a gradual non-significant decrease in biomarker levels over time, and thus a rise in hs-cTnT levels should not be attributed to cardioversion.
- Published
- 2015
32. Use of intravenous morphine for acute decompensated heart failure in patients with and without acute coronary syndromes
- Author
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Zaza Iakobishvili, Avraham Shotan, David Hasdai, Eytan Cohen, Amir Sandach, Aviv Mager, Solomon Behar, Alexander Battler, Moshe Garty, and Shmuel Gottlieb
- Subjects
Aspirin ,medicine.medical_specialty ,Acute coronary syndrome ,Acute decompensated heart failure ,Exacerbation ,business.industry ,medicine.disease ,Internal medicine ,Diabetes mellitus ,Heart failure ,Heart rate ,Emergency Medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Dyslipidemia ,medicine.drug - Abstract
Background: Current guidelines regarding the use of intravenous morphine (IM) in the management of patients with acute decompensated heart failure (ADHF) are discordant; whereas the American guidelines reserve IM for terminal patients, the European guidelines recommend its use in the early stage of treatment. Our aim was to determine the impact of IM on outcomes of ADHF patients. Methods: Stepwise logistic regression and propensity score analysis of ADHF patients with and without use of IM was performed in a national heart failure survey. Results: Of the 4102 enrolled patients, we identified 2336 ADHF patients, of whom 218 (9.3%) received IM. IM patients were more likely to have acute coronary syndromes, acute rather than exacerbation of chronic heart failure, and diabetes mellitus and dyslipidemia. They had higher heart rate, were less likely to receive diuretics and more likely to receive aspirin and statins. Unadjusted in-hospital mortality rates were 11.5% versus 5.0% for patients who did or did not r...
- Published
- 2011
33. Outcomes of acute heart failure associated with acute coronary syndrome versus other causes
- Author
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Shmuel Gottlieb, Moshe Garty, Solomon Behar, David Hasdai, Zaza Iakobishvili, Amir Sandach, Aviv Mager, Avraham Shotan, Alexander Battler, Gabriel Greenberg, and Eytan Cohen
- Subjects
Inotrope ,Coronary angiography ,medicine.medical_specialty ,Acute coronary syndrome ,business.industry ,medicine.medical_treatment ,Mortality rate ,Revascularization ,medicine.disease ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,Heart failure ,Emergency Medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,Prospective cohort study ,business - Abstract
Background: By and large, prior registries and randomized trials have not distinguished between acute heart failure (AHF) associated with acute coronary syndrome (ACS) versus other causes.Aims: To examine whether the treatments and outcomes of ACS-associated AHF are different from non-ACS-associated AHF.Methods: We examined in a prospective, nationwide hospital-based survey the adjusted outcomes of AHF patients with and without ACS as its principal cause.Results: Of the 4102 patients in our national heart failure survey, 2336 (56.9%) had AHF, of whom 923 (39.5%) had ACS-associated AHF. These patients were more likely to receive intravenous inotropes and vasodilators and to undergo coronary angiography and revascularization, but less likely to receive intravenous diuretics. The unadjusted in-hospital, 30-day, one-year, and four-year mortality rates for AHF patients with or without ACS were 6.5% versus 5.0% (P = 0.13), 10.3% versus 7.5% (P = 0.02), 26.6% versus 31.0% (P = 0.02), and 55.3% versus 63.3% (P = ...
- Published
- 2011
34. Effect of Narcotic Treatment on Outcomes of Acute Coronary Syndromes
- Author
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Aviv Mager, Zaza Iakobishvili, Shaul Atar, Arie Roth, Avital Porter, Solomon Behar, David Hasdai, Valentina Boyko, and Alexander Battler
- Subjects
Male ,Narcotics ,medicine.medical_specialty ,Acute coronary syndrome ,Narcotic ,medicine.medical_treatment ,Logistic regression ,Internal medicine ,medicine ,Retrospective analysis ,Humans ,Acute Coronary Syndrome ,Aged ,Retrospective Studies ,business.industry ,Middle Aged ,medicine.disease ,Coronary heart disease ,Administration, Intravesical ,Logistic Models ,Treatment Outcome ,Propensity score matching ,Cardiology ,Female ,Myocardial disease ,Cardiology and Cardiovascular Medicine ,business - Abstract
Current guidelines have recommended intravenous narcotics (IVNs) for patients with ST-segment elevation acute coronary syndromes (STEACS) and patients with non-STEACS (NSTEACS), although the safety of IVNs has been challenged. We performed a retrospective analysis of the 30-day outcomes stratified by IVN use among patients enrolled in a national survey, using logistic regression and propensity score analysis. Of the 765 patients with STEACS and 993 patients with NSTEACS, 261 (34.1%) and 97 (9.8%) had received IVNs, respectively. The patients with STEACS who received IVNs were more likely to undergo reperfusion (79.7% vs 55.2%, p0.0001), received it more rapidly (median 59 minutes vs 70 minutes, p = 0.02), and were more likely to undergo coronary angiography and revascularization. No difference was found in hemodynamic status. The patients with NSTEACS who received IVNs were more likely to present with Killip class II-IV (39.2% vs 10.0%, p0.001) and to have left ventricular systolic dysfunction (39.0% vs 17.0%, p0.001). No difference was found in the use of invasive procedures. Using propensity score analysis, of 249 matched STEACS pairs, the rate of 30-day death was lower in the group that had received IVNs (2.4% vs 6.2%, p = 0.04), and this trend persisted after logistic regression analysis (odds ratio 0.40, 95% confidence interval 0.14 to 1.14, p = 0.09). Using propensity score analysis, of 95 matched NSTEACS pairs, no difference was found in the 30-day death rate (2.2% for patients receiving IVNs vs 6.3%, p = 0.16), even after logistic regression analysis (odds ratio 0.56, 95% confidence interval 0.14 to 2.33, p = 0.43). In conclusion, IVNs were commonly used in different scenarios-patients with STEACS were more likely to receive IVNs in the context of prompt reperfusion, and patients with NSTEACS were more likely to receive IVNs in the context of heart failure. In both scenarios, IVN use did not adversely affect the outcomes.
- Published
- 2010
35. Impact of Homocysteine-Lowering Vitamin Therapy on Long-Term Outcome of Patients With Coronary Artery Disease
- Author
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Alexander Battler, Mordechai Shohat, Abid Assali, Ran Kornowski, Aviv Mager, Israel Eli Lev, Nira Koren-Morag, David Hasdai, and Katia Orvin
- Subjects
Adult ,Male ,Vitamin ,medicine.medical_specialty ,Homocysteine ,Coronary Artery Disease ,Gastroenterology ,Coronary artery disease ,chemistry.chemical_compound ,Folic Acid ,Internal medicine ,medicine ,Humans ,Methylenetetrahydrofolate Reductase (NADPH2) ,biology ,business.industry ,Proportional hazards model ,Hazard ratio ,Middle Aged ,medicine.disease ,Survival Analysis ,Confidence interval ,B vitamins ,Treatment Outcome ,Endocrinology ,chemistry ,Methylenetetrahydrofolate reductase ,Mutation ,Vitamin B Complex ,Cardiology ,biology.protein ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Elevated homocysteine levels are associated with increased risk for mortality in patients with coronary artery disease (CAD). However, the benefit of homocysteine-lowering therapy remains controversial. The aim of this study was to examine the impact of homocysteine-lowering therapy on the long-term outcomes of patients with CAD and its interaction with the methylenetetrahydrofolate reductase genotype. The study sample included 492 patients with early-onset CAD who were genotyped for the C677T mutation in the methylenetetrahydrofolate reductase gene or screened for elevated homocysteine from January 1997 to December 2002. Folic acidor =400 microg/day with or without additional B vitamins was administered at the attending physicians' discretion. There was no difference between treated (n = 140) and untreated patients in age, gender, or prevalence of coronary risk factors. Forty-six patients (9%) died during a median follow-up period of 115 months. Treatment was associated with significantly lower all-cause mortality in patients with homocysteine levels15 micromol/L (4% vs 32%, p0.001) but not in patients with lower levels (5% vs 7%, p0.05). On Cox regression analysis, the following factors were independently associated with all-cause mortality: vitamin therapy (hazard ratio 0.33, 95% confidence interval 0.11 to 0.98, p = 0.046), elevated homocysteine level (hazard ratio 3.5, 95% confidence interval 1.31 to 9.43, p = 0.013), and older age (hazard ratio 1.1, 95% confidence interval 1.04 to 1.14, p0.0001 for an increment of 5 years). The methylenetetrahydrofolate reductase genotype was not associated with outcomes. In conclusion, long-term folate-based vitamin therapy was independently associated with lower all-cause mortality in patients with CAD and elevated homocysteine levels. This association was not observed in patients with lower homocysteine levels.
- Published
- 2009
36. Long-Term Outcome and its Predictors Among Patients With ST-Segment Elevation Myocardial Infarction Complicated by Shock
- Author
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Mandeep Singh, Eric J. Topol, Peter B. Berger, David R. Holmes, David Hasdai, Robert M. Califf, Jennifer A. White, and Patricia K. Hodgson
- Subjects
medicine.medical_specialty ,Heart disease ,business.industry ,Proportional hazards model ,Cardiogenic shock ,Streptokinase ,ST elevation ,Mortality rate ,medicine.disease ,Surgery ,Internal medicine ,Cardiology ,Medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Killip class ,medicine.drug - Abstract
Objectives This study sought to assess long-term outcome and determine its predictors among 30-day survivors of cardiogenic shock. Background Patients with cardiogenic shock have high in-hospital and 30-day mortality, but there are little data about those who survive beyond 30 days. Methods We analyzed baseline, in-hospital, and survival data from patients in the U.S. with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock enrolled in the GUSTO (Global Utilization of Streptokinase and Tissue-Type Plasminogen Activator for Occluded Coronary Arteries)-I trial and compared them with patients in the same trial who did not have shock. Results Of 22,883 patients enrolled in the U.S., shock occurred in 1,891 (8.3%); 953 (50.4%) survived 30 days and 527 (27.8%) survived 11 years. Of 20,992 U.S. patients without shock, 20,360 (96.9%) survived 30 days and 14,131 (67.3%) survived 11 years. After the first year, 2% to 4% of patients died each year regardless of whether they had cardiogenic shock. Using Cox proportional hazards models, we were able to predict long-term mortality in all U.S. GUSTO-I 30-day survivors from their baseline demographics and in-hospital complications. The strongest predictors were diabetes mellitus, cardiogenic shock, hypertension, previous myocardial infarction, current smoking, anterior infarct, higher Killip class, higher heart rate, and older age; patients >75 years were at highest risk. Percutaneous revascularization during the index hospitalization was associated with a reduced risk of death. Conclusions Among patients with cardiogenic shock who survive 30 days after STEMI, annual mortality rates of 2% to 4% approximate those of patients without shock.
- Published
- 2007
37. Cardiogenic Shock: Treatment
- Author
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David Hasdai and Zaza Iakobishvili
- Subjects
Inotrope ,Cardiac Catheterization ,medicine.medical_specialty ,medicine.medical_treatment ,Shock, Cardiogenic ,Cardiac resynchronization therapy ,Revascularization ,Counterpulsation ,Internal medicine ,Myocardial Revascularization ,Humans ,Medicine ,Intensive care medicine ,Cardiac catheterization ,Heart transplantation ,business.industry ,Cardiogenic shock ,Cardiovascular Agents ,General Medicine ,medicine.disease ,Cardiac surgery ,Echocardiography ,Shock (circulatory) ,Cardiology ,medicine.symptom ,business - Abstract
The treatment of cardiogenic shock complicating the acute coronary syndromes consists of medical therapy, percutaneous revascularization procedures, cardiac surgery, and the implantation of devices. Medical therapy is limited to different positive inotropic and vasoactive drugs, without any firm evidence of survival benefit using these drugs. Several new pharmacologic compounds are at different stages of clinical research, but are not yet routinely approved for the treatment of cardiogenic shock. The only evidence-based therapy with proven survival benefit is timely revascularization. Intra-aortic balloon pump counterpulsation maintains its central role as supportive treatment in cardiogenic shock patients. Anecdotal evidence is available about the use of ventricular assist devices, cardiac resynchronization therapy, and emergent heart transplantation.
- Published
- 2007
38. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology
- Author
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Lars Wallentin, A Budaj, Diego Ardissino, William Wijns, Francisco Fernández-Avilés, David Hasdai, J.-P Bassand, Keith A.A. Fox, Erik Magnus Ohman, Eric Boersma, and Christian W. Hamm
- Subjects
medicine.medical_specialty ,Medical education ,business.industry ,media_common.quotation_subject ,Conflict of interest ,Alternative medicine ,MEDLINE ,Evidence-based medicine ,Health outcomes ,Long-term care ,medicine ,Table (database) ,Quality (business) ,Cardiology and Cardiovascular Medicine ,business ,Psychiatry ,media_common - Abstract
Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim to assist physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks. The legal implications of medical guidelines have been discussed previously. A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/guidelines/rules). In brief, experts in the field are selected and undertake a comprehensive review of the published evidence for management and/or prevention of a given condition. A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk–benefit ratio. Estimates of expected health outcomes for larger societies are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to pre-defined scales, as outlined in Tables 1 and 2 . View this table: Table 1 Classes of recommendations View this table: Table 2 Levels of evidence The experts of the writing panels have provided disclosure statements of all relationships they may have which might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. Any changes in conflict of interest that arise during the writing period must be notified to the …
- Published
- 2007
39. Effect of No-Reflow During Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction on Six-Month Mortality
- Author
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Abid Assali, Shmuel Fuchs, Ran Kornowski, Alexander Battler, David Hasdai, Aviv Mager, Avital Porter, David Brosh, Igal Teplitsky, and Eldad Rechavia
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Coronary Angiography ,Internal medicine ,Angioplasty ,medicine ,Humans ,Prospective Studies ,cardiovascular diseases ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,Prospective cohort study ,Chi-Square Distribution ,business.industry ,Percutaneous coronary intervention ,Stent ,Middle Aged ,Prognosis ,medicine.disease ,Thrombosis ,Surgery ,Logistic Models ,Treatment Outcome ,surgical procedures, operative ,Conventional PCI ,cardiovascular system ,Cardiology ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,TIMI - Abstract
No-reflow is a frequent event during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), and it may affect cardiac prognosis. We evaluated the occurrence of no-reflow as a predictor of outcomes in patients who underwent PCI for AMI. We prospectively collected data from 599 consecutive patients who underwent stent-based PCI for ST-elevation AMI by identifying those with no-reflow (Thrombosis In Myocardial Infarction [TIMI] grade3 flow at completion of the procedure) and analyzing their baseline characteristics and clinical outcomes. Patients with no-reflow (n = 40, 6.7%) were older (67 +/- 13 vs 60 +/- 13 years, p = 0.002) and had longer ischemic times (5.5 +/- 3.7 vs 4.4 +/- 3.0 hours, p = 0.04) with more TIMI grade 0/1 flow at presentation (90% vs 64%, p = 0.001). No-reflow occurred mostly (73%) after stenting and often required intra-aortic balloon pump counterpulsation (30% vs 4.3%, p0.001). Peak creatine kinase level was higher in patients with no-reflow (2,700 +/- 1,900 vs 2,000 +/- 1,800, p = 0.03) and more often associated with moderate or severe left ventricular dysfunction (68% vs 45%, p = 0.006) and increased 6-month mortality (12.5% vs 4.3%, p = 0.04). By multivariate analysis, no-reflow was an independent predictor of long-term mortality (odds ratio 3.4, p = 0.02). In addition, renal failure (odds ratio 4.39, p = 0.0025) and preprocedure TIMI grade 0/1 flow (odds ratio 2.1, p = 0.003) were independent predictors of no-reflow. In conclusion, the association of no-reflow with longer ischemic time and worse initial TIMI flow may indicate the presence of highly organized thrombus burden with higher propensity for distal embolization. Regardless of its mechanism, no-reflow was an independent predictor of increased mortality.
- Published
- 2007
40. Valves in the Heart of the Big Apple V: Evaluation and Management of Valvular Heart Diseases 2007.Third Annual Scientific Session: Heart Valve Society of America, New York City, N.Y., April 12–14, 2007
- Author
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Kurt Boman, Harun Evrengul, E. Vizzardi, Jacob Goldstein, M. Metra, Daniel P. Shmorhun, Yu Shu Li, Chia-Ti Tsai, Pei-Leun Kang, Ke Ping Yang, Kai Mortensen, Gerhard Blazek, Claudia Stöllberger, Christopher Gans, Rodolfo Ventura, Debabrata Mukherjee, J. Kogias, Holger Diedrichs, Sena Tokay, Sungha Park, Seyhan Tanriverdi, James Blasetto, Adam Torbicki, David Köhler, Ken-ichi Sugimoto, Joško Osredkar, C. Fiorina, Akira Suda, Pablo Ancillo, Ahmet Oktay, Se-Jung Yoon, D. Tanne, Gertrud Wüstefeld, Refik Erdim, Matthias Pfisterer, Teiichi Yamane, Anthony Roselli, Daniel Petrovič, Chi Young Shim, Erol Saygili, Xue-Bing Li, H. Asuman Kaftan, Muhammet Ali Aydin, Uwe Nixdorff, Barbara Lewis, Susan Harris, Zaza Iakobishvili, Dariusz A. Kosior, Ulrich Keller, Renata Verhovec, Basil S. Lewis, Lutz Klinghammer, V. Boyko, V. Caldir, Ronen Jaffe, Basheer Karkabi, Daniel Seidensticker, Robert H. G. Schwinger, Shih Kai Lin, Tsutomu Yoshikawa, S. Behar, John Kao, Midori Yamakawa, Andreas Schuchert, Yung-Zu Tseng, Mona Olofsson, Ronen Rubinshtein, Miodrag Filipovic, Kimiaki Komukai, U. Guray, Yuichiro Maekawa, Gabriele Pfitzer, Ling-Ping Lai, Zenon S. Kyriakides, Hiroyuki Hazeyama, Ralph Stephan von Bardeleben, Manfred D. Seeberger, Konrad Frank, Josef Finsterer, Kamran Aghasadeghi, S. Kormaz, Chanmi Park, Hartwig Wolburg, Hemender S. Vats, Elinor Miller, M. Haim, Yohei Ohno, Param P. Sharma, Takashi Kohno, U. Goldbourt, Hiromichi Hara, Hyun Young Park, Joji Urata, Taro Date, Ming-Ren Chen, S. Nodari, Shye-Jao Wu, Nurullah Tuzun, Shiro Iwanaga, A. Serdar Fak, Donald G. Vidt, S. Cay, Chun-Peng Liu, Doron Zahger, Holger K. Eltzschig, Mojca Globočnik Petrovič, Ing-Sh Chiu, Namsik Chung, Yasar Enli, Juey-Jen Hwang, S. Sideris, David J. Moliterno, Jonathan Rosen, Toshihisa Anzai, H. Sasmaz, Esra Saygili, Yuan-Sheng Liu, Halil Tanriverdi, K. Tsatiris, David Hasdai, Toshihide Shinozaki, M.B. Yilmaz, Mei-Hwan Wu, R. Zimlichman, Borut Peterlin, Gautam Nayak, M. Bonios, Fu-Tien Chiang, Moshe Y. Flugelman, L. Dei Cas, Knut Gjesdal, Maria Winkler-Dworak, Susanne Mohr-Kahaly, Carsten Zobel, Amir Aslani, Grzegorz Opolski, Tobias Eckle, Guang Yuan Mar, Omur Kuru, Y. Guray, Dan Edebro, Fernando Arós, Pedro Morillas, David A. Halon, Rita Dictiar, Tao Yu Lee, Deniz Seleci, Takashi Sakamoto, Raban Jeger, Stephanie Zug, Jochen Müller-Ehmsen, Ping Zhang, Hai-Cheng Zhang, Bermseok Oh, Hidehiro Kaneko, Zhi-Hong Zhao, Shmuel Gottlieb, Chuen-Wang Chiou, Thomas Meinertz, Z. Matas, Hung-Chi Lue, Jiunn-Lee Lin, Dan Atar, Yangsoo Jang, José Luis Priego Bermejo, Gökmen Gemici, Karin Klingel, Alex I. Malinin, George Arealis, Hakan Tezcan, Savvas Nikolidakis, Young Guk Ko, Daisuke Utsunomiya, Donghoon Choi, Birgit Bölck, Satoshi Ogawa, Kotaro Naito, Arne Warth, Solomon Behar, Pedro Pabón, John J. Hayes, Yuan Xu, M. Benderly, Humberto Vidaillet, Ming Hua Luo, Hui-Chong Li, Avital Porter, Yasushi Asakura, C. Melexopoulou, Stephan Willems, Jou-Kou Wang, Yasuo Sugano, Taiji Nishiharu, Marion Faigle, P. Exarchos, Seibu Mochizuki, Haim Hammerman, Yasuyuki Yamashita, Robert J. Goldberg, Shih Hung Hsiao, Hung Tae Kim, Nevzat Karabulut, Carmen Fernández, Hanoch Hod, Michael Koutouzis, Vicente Bertomeu, Obaida R. Rana, Hannes Reuter, Kazuo Awai, James Shepherd, Ikuo Taniguchi, Victor L. Serebruany, Chuen-Den Tseng, and Ji-Hong Guo
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Internal medicine ,General surgery ,Cardiology ,Medicine ,Pharmacology (medical) ,Heart valve ,Session (computer science) ,Cardiology and Cardiovascular Medicine ,business - Published
- 2007
41. The Implementation of Guidelines and Prognosis among Patients with Acute Coronary Syndromes Is Influenced by Physicians’ Perception of Antecedent Physical and Cognitive Status
- Author
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Avital Porter, Haim Hammerman, Shmuel Gottlieb, Solomon Behar, Rita Dictiar, Hanoch Hod, David Hasdai, Zaza Iakobishvili, and Doron Zahger
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,genetic structures ,Attitude of Health Personnel ,Antecedent (logic) ,Health Status ,media_common.quotation_subject ,Myocardial Infarction ,Perception ,medicine ,Humans ,Cognitive status ,Pharmacology (medical) ,Angina, Unstable ,Prospective Studies ,Intensive care medicine ,Aged ,media_common ,business.industry ,Middle Aged ,Prognosis ,medicine.disease ,Chronic Disease ,Practice Guidelines as Topic ,Female ,Guideline Adherence ,Cognition Disorders ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background/Aims: Physicians’ perception of antecedent physical/cognitive status may account for the suboptimal implementation of acute coronary syndrome (ACS) guidelines. Methods: In an ACS survey of all cardiac wards, physicians’ perception of antecedent physical/cognitive status was prospectively recorded and categorized as either normal, mildly impaired or significantly impaired. We examined the impact of antecedent status on the use of evidence-based medications and procedures and on mortality. Results: Of the 2,021 patients, 1,025 (51%) had ST elevation. Impaired antecedent physical/cognitive status was diagnosed in 417 patients (20.6%), more commonly among non-ST-elevation patients (26.2 vs. 15.2%). Patients with impaired physical/cognitive status, with or without ST elevation, had significantly worse baseline demographic and clinical characteristics. They less often received aspirin, clopidogrel, platelet glycoprotein IIb/IIIa receptor antagonists, statins and β-adrenergic blockers, and significantly less often underwent in-hospital catheterization and revascularization. Reperfusion treatment was given significantly less frequently to ST elevation patients with impaired status (63.0% for normal vs. 50.8% and 33.3% for mildly and significantly impaired status, respectively; p = 0.001). After adjustment for differences in baseline characteristics, impaired antecedent status remained independently associated with lower use of these therapies and higher mortality rates. Conclusions: ACS guideline implementation is significantly influenced by physicians’ perception of antecedent physical/cognitive status, and thus is a crucial parameter for understanding ACS management and outcomes.
- Published
- 2007
42. Trends in Management, Hospital and Long-Term Outcomes of Elderly Patients with Acute Myocardial Infarction
- Author
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Silviu Wagner, Solomon Behar, David Hasdai, Jonathan Leor, Amir Sandach, Doron Zahger, Abraham Adunsky, Shmuel Gottlieb, Hanoch Hod, Haim Hammerman, Manfred S. Green, and Roseline Schwartz
- Subjects
Male ,Coronary angiography ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Reperfusion therapy ,Internal medicine ,Long term outcomes ,medicine ,Humans ,Prospective Studies ,Registries ,Myocardial infarction ,Israel ,Aged ,Aged, 80 and over ,Aspirin ,business.industry ,Percutaneous coronary intervention ,General Medicine ,Odds ratio ,medicine.disease ,Confidence interval ,Surgery ,Hospitalization ,Survival Rate ,Logistic Models ,Outcome and Process Assessment, Health Care ,Female ,business ,medicine.drug - Abstract
Purpose The number of elderly patients with acute myocardial infarction (AMI) is growing rapidly, and their early and postdischarge mortality is high. Several studies have reported a decline in mortality after myocardial infarction; however, the magnitude of the decline among the elderly has not been fully investigated. Methods We assessed trends in management, in-hospital, and long-term outcomes of 1475 elderly patients (aged ≥75 years, 42% women) hospitalized with AMI in all 25 operating coronary care units in Israel between 1992 and 2002, from our prospective nationwide biennial surveys. Results Between 1992 and 2002, a significant increase was observed in the use of acute reperfusion therapy (27%-48%), coronary angiography (6%-47%), percutaneous coronary intervention (3%-33%), coronary bypass (2%-8%), aspirin (53%-88%), beta-blockers (18%-65%), angiotensin-converting enzyme inhibitors (26%-63%), and lipid-lowering drugs (0%-43%). These changes were associated with a 42% reduction in 30-day mortality (27.6%-16.1%; adjusted odds ratio 0.57; 95% confidence interval [CI], 0.36-0.93). One-year cumulative mortality declined by 20% (37%-29%; adjusted odds ratio 0.74; 95% CI, 0.49-1.13). Conclusions The management of elderly patients with AMI changed substantially during the last decade. This change was associated with a significant reduction in early mortality, whereas cumulative 1-year mortality improved only slightly. Better adherence to in-hospital management guidelines and better implementation of postdischarge health policy may further decrease mortality and morbidity in the elderly after AMI.
- Published
- 2007
43. Gender differences in mortality after acute myocardial infarction with mild to moderate heart failure
- Author
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Moti Haim, Alexander Battler, Yuval Konstantino, David Hasdai, Elvira Chen, Valentina Boyko, and Solomon Behar
- Subjects
Male ,Coronary angiography ,medicine.medical_specialty ,Cardiac output ,Percutaneous ,Multivariate analysis ,Cardiac Output, Low ,Myocardial Infarction ,Coronary Angiography ,Sex Factors ,Recurrence ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Myocardial infarction ,Israel ,Aged ,Chi-Square Distribution ,business.industry ,Mortality rate ,Prognosis ,medicine.disease ,Logistic Models ,Heart failure ,Emergency Medicine ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Chi-squared distribution - Abstract
Heart failure (HF) is associated with poor outcome after acute myocardial infarction (AMI). Women have higher mortality rate than men after AMI, however, it is unknown whether women with HF after AMI have different prognosis than men.To compare the prognosis of men and women with AMI and mild-moderate HF.We analyzed data of 3456 consecutive patients with AMI hospitalized in all cardiac care units in Israel during two nationwide surveys.Among patients with AMI and HF on admission: women were older, had more risk factors, and were less likely to undergo percutaneous coronary angiography/intervention. Women with HF had higher (7-days, 30-days, and 1-year) crude mortality rates than men. However, adjusted mortality rates were not significantly different between genders.Women with AMI complicated by HF had higher crude mortality rate than men that was eliminated after multivariate analysis, suggesting that the higher mortality rate may be attributed to increased prevalence of risk factors and lower rate of revascularization and medical therapies among women. Women with AMI and HF should be considered as a high-risk subgroup with adverse outcome. It remains to be determined whether more intensive management will improve their prognosis.
- Published
- 2007
44. Antecedent left ventricular mass and infarct size in ST-elevation myocardial infarction
- Author
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David Hasdai, Shula Imbar, Alexander Battler, David Brosh, Avital Porter, Zaza Iakobishvili, and Vladimir Danicek
- Subjects
Male ,medicine.medical_specialty ,Heart disease ,Heart Ventricles ,Myocardial Infarction ,Platelet Glycoprotein GPIIb-IIIa Complex ,Electrocardiography ,Internal medicine ,medicine ,Humans ,Myocardial infarction ,Creatine Kinase ,Aged ,Ultrasonography ,biology ,business.industry ,Incidence (epidemiology) ,ST elevation ,Models, Cardiovascular ,Middle Aged ,medicine.disease ,Infarct size ,Heart failure ,Circulatory system ,biology.protein ,Cardiology ,Female ,Creatine kinase ,Cardiology and Cardiovascular Medicine ,business - Abstract
Increased left ventricular mass index (LVMI) is associated with a greater incidence of acute myocardial infarction (AMI), but there are no data regarding its impact on infarct size.The objective of this study was to determine whether LVMI impacts on infarct size.We analyzed consecutive patients with a first ST-elevation AMI and successful reperfusion of the culprit artery who underwent an echocardiographic assessment of LVMI and regional wall motion score index (RWMSI)72 hours post AMI.Of the 165 patients (76.4% men) with a mean age of 61.0 +/- 13.9 years, 53.9% had anterior wall involvement and 59.3% had increased LVMI. There were no significant differences in baseline characteristics between patients with and without increased LVMI, except for a greater prevalence of hypertension among patients with increased LVMI (44.0% vs 22.4%, P.001). The distributions of anterior wall AMI location and culprit artery involvement were similar between the groups. Patients with increased LVMI were more likely to present with single-vessel coronary artery disease (P = .04) and heart failure upon presentation (P = .03). There was no significant difference between patients with and without increased LVMI in peak creatine kinase (2106.8 +/- 1642.7 vs 2551.2 +/- 2357.4 U/L, P = .16) or RWMSI (1.62 +/- 0.44 vs 1.61 +/- 0.38, P = .91). In addition, no correlation was observed between LVMI as a continuous variable and RWMSI (r = 0.11, P = .18) or peak creatine kinase values (r = 0.02, P = .81).Among patients with a first ST-elevation AMI and successful reperfusion, antecedent increased LVMI was fairly common and did not impact on infarct size.
- Published
- 2006
45. Echocardiography Versus Right-Sided Heart Catheterization Among Lung Transplantation Candidates
- Author
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David Shitrit, Itsik Ben-Dor, Gideon Sahar, Avraham Raccah, David Hasdai, Zaza Iakobishvilli, and Mordechai R. Kramer
- Subjects
Lung Diseases ,Pulmonary and Respiratory Medicine ,Thorax ,Cardiac Catheterization ,medicine.medical_specialty ,medicine.medical_treatment ,Pulmonary Artery ,medicine.artery ,Internal medicine ,Preoperative Care ,medicine ,Humans ,Lung transplantation ,Retrospective Studies ,Lung ,business.industry ,Patient Selection ,Respiratory disease ,Middle Aged ,Sudden infant death syndrome ,medicine.disease ,Echocardiography, Doppler ,Surgery ,Transplantation ,medicine.anatomical_structure ,Blood pressure ,Pulmonary artery ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Lung Transplantation - Abstract
Right-heart-catheterization and transthoracic echocardiography are routine tests to measure pulmonary artery systolic pressure among lung transplantation candidates. Echocardiography may be as accurate as right-heart-catheterization, without the inherent risks of an invasive test.We examined the correlation between pulmonary pressures estimated by echocardiography versus right-heart-catheterization among lung transplantation candidates and their correlation to measurements during lung transplantation. Our cohort included all lung transplantation candidates during 1997 through 2004 who initially underwent pulmonary pressure evaluation by right-heart-catheterization and echocardiography, as well as measurements during lung transplantation.Of the 106 candidates, evaluation by transthoracic echocardiography was possible in 79 (74.5%). Median pulmonary systolic pressures by right-heart-catheterization was 44.0 [33.2-50.0] mm Hg and by echocardiography 40.0 [32.5-51.5] mm Hg (r = 0.80, p0.0001). In 14 (17.7%) patients the difference between the 2 methods was20 mm Hg. The median time interval between echocardiography and right-heart-catheterization was 65 [40-155] days. The median value of pulmonary systolic pressure measured during lung transplantation in 44 (70.1%) of 62 patients was 39.5 [31.0-50.0] mm Hg. The time interval right-heart-catheterization-to-lung transplantation was 143 [87-339] days and echocardiography-to-lung transplantation 229 [130-367] days. The correlation between measurements during lung transplantation and initial measurements by right-heart-catheterization and echocardiography were r = 0.50 and r = 0.31, respectively, with corresponding p values of p = 0.001 and p = 0.07.For lung transplantation candidates and a suitable transthoracic echocardiography estimate of pulmonary systolic pressure, the need for right-heart catheterization, with its inherent risks for complications, may be foregone. The weak correlation between the initial and intraoperative measurements, probably stemming from the significant time interval, suggests that serial measurements may be needed.
- Published
- 2006
46. Aspirin, Warfarin and a Thienopyridine for Acute Coronary Syndromes
- Author
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Yuval Konstantino, Solomon Behar, Zaza Iakobishvili, Amir Sandach, Shmuel Gottlieb, Doron Zahger, David Hasdai, Avital Porter, Hanoch Hod, and Haim Hammerman
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,Ticlopidine ,Thienopyridine ,Pyridines ,Coronary Disease ,Risk Factors ,Hematologic Agents ,Internal medicine ,medicine ,Humans ,Ventricular Function ,Pharmacology (medical) ,cardiovascular diseases ,Dual therapy ,Aspirin ,business.industry ,Warfarin ,Syndrome ,Clopidogrel ,medicine.disease ,Cardiology ,Drug Therapy, Combination ,Female ,Cardiology and Cardiovascular Medicine ,business ,circulatory and respiratory physiology ,medicine.drug - Abstract
Background: Although clopidogrel and aspirin (dual therapy, DT) are used for acute coronary syndrome (ACS), sometimes treatment with warfarin (triple therapy, TT) is required. Aim: To determine the incidence, complications, and outcomes of TT. Methods: We analyzed Israeli surveys of ACS from 2000 to 2004. Results: In these surveys, 5,706 (96%) were discharged alive from hospital. Post-ACS TT and DT were 76 patients (1.3%) and 2,661 patients (46.7%), respectively. The TT group was older with more prior cardiac disease. During hospitalization, the TT patients received more intravenous anticoagulant and antithrombotic agents, and had more heart failure, arrhythmias, ischemia, and major bleeding (2.6 vs. 0.6%, p = 0.03). There were no differences in adjusted 30-day and 6-month mortality between the 2 groups. Conclusion: TT is feasible among ACS patients who require concomitant warfarin treatment.
- Published
- 2006
47. Urgent Cardiac Resynchronization Therapy in Patients with Decompensated Chronic Heart Failure Receiving Inotropic Therapy
- Author
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Zaza Iakobishvili, Jairo Kusniec, Yuval Konstantino, Orna Arad, Alexander Battler, Avital Porter, David Hasdai, Alexander Mazur, Boris Strasberg, and Tuvia Ben-Gal
- Subjects
Inotrope ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Decompensated chronic heart failure ,Cardiac resynchronization therapy ,medicine.disease ,Internal medicine ,Heart failure ,Cardiology ,medicine ,Pharmacology (medical) ,In patient ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: It remains unknown whether patients with severe decompensated class IV heart failure (HF) receiving intravenous inotropic treatment benefit from cardiac resynchronization therapy (CRT). Methods: We identified patients who underwent urgent CRT implantation due to decompensated class IV HF necessitating intravenous inotropic therapy. Results: Of 10 patients with chronic ischemic cardiomyopathy (median QRS duration of 170 ms), CRT implantation was associated with symptomatic improvement in 8 patients. The mortality rate was 50% during a median follow-up of 9.5 months, with a median CRT-to-death duration of 6 months. Conclusions: CRT was feasible among class IV patients receiving inotropic treatment and was associated with clinical improvement.
- Published
- 2006
48. Which Factors Are Associated with the Application of Reperfusion Therapy in ST-Elevation Acute Coronary Syndromes?
- Author
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Martin H. Prins, David Hasdai, Mattie J. Lenzen, Anselm K. Gitt, Robby Nieuwlaat, Harry J.G.M. Crijns, Nicolas Danchin, Eric Boersma, W.J.M. Scholte op Reimer, Alexander Battler, and M. L. Simoons
- Subjects
medicine.medical_specialty ,Acute coronary syndrome ,Myocardial reperfusion ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,ST elevation ,Percutaneous coronary intervention ,Thrombolysis ,medicine.disease ,Reperfusion therapy ,Internal medicine ,medicine ,Cardiology ,Pharmacology (medical) ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography - Abstract
Background/Aims:A large proportion of patients with a ST-elevation acute coronary syndrome do not receive reperfusion therapy. In order to contribute to a better understanding of the clinical decision making process, we analyzed which factors are associated with the application of reperfusion therapy. Methods: From the Euro Heart Survey of Acute Coronary Syndromes I, 4,260 patients with ST-elevation acute coronary syndrome were selected for the current analysis, of which 1,539 (36%) patients received fibrinolysis and 904 (21%) primary percutaneous coronary intervention (PCI). The analysis contained 32 variables on demographics, medical history, admission parameters and reperfusion therapy. Results: A short pre-hospital delay, arrival in a hospital with PCI facilities, severe ST-elevation, and participation in a clinical trial were the strongest predictors for receiving reperfusion therapy. Primary PCI was more likely to be performed than fibrinolysis in patients with a long pre-hospital delay, arriving in a hospital with PCI facilities, not participating in a clinical trial, and with at least one previous PCI. Conclusion:Hospital facilities and culture, pre-hospital delay and infarction size play a major role in management decisions regarding reperfusion therapy in ST-elevation acute coronary syndrome. This analysis indicates which factors require special attention when implementing and reviewing the reperfusion guidelines.
- Published
- 2006
49. Short-term triple therapy with aspirin, warfarin, and a thienopyridine among patients undergoing percutaneous coronary intervention
- Author
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Yuval Konstantino, Zaza Iakobishvili, Alexander Battler, Leeor Shachar, David Hasdai, and Avital Porter
- Subjects
Male ,medicine.medical_specialty ,Thienopyridine ,Pyridines ,medicine.medical_treatment ,Coronary Disease ,Hemorrhage ,Coronary Angiography ,Drug Administration Schedule ,Hematoma ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Angioplasty, Balloon, Coronary ,Aged ,Retrospective Studies ,Aspirin ,business.industry ,Warfarin ,Anticoagulants ,Percutaneous coronary intervention ,Atrial fibrillation ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Clopidogrel ,Survival Analysis ,Echocardiography, Doppler ,Surgery ,Research Design ,Conventional PCI ,Drug Therapy, Combination ,Female ,Blood Coagulation Tests ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Objectives: To assess bleeding complications among patients undergoing percutaneous coronary intervention (PCI) and receiving triple therapy of warfarin, aspirin, and a thienopyridine. Background: Triple therapy of warfarin, aspirin, and a thienopyridine is strongly discouraged, given the potential risk of bleeding complications. Methods and Results: Post-PCI patients receiving triple therapy thereafter underwent assessment for bleeding complications. Continuous variables are presented as median (25th–75th percentiles). The study group included 180 patients (80% males; age 65 (52, 75.5)). PCI was on an urgent/emergent basis in 86.6%. The main indications for warfarin use were left ventricular mural thrombus and atrial fibrillation (46.9 and 36.9% respectively). Glycoprotein IIb/IIIa receptor antagonists were used in 47.7%. Post-PCI triple therapy duration was 30 days (30, 30). During the post-triple therapy, 104 patients (57.8%) continued treatment with warfarin and aspirin for 376 days (150, 775). During the triple therapy period, 20 patients developed bleeding complications, (mean INR 2.1 ± 0.7 at 7 (6, 8.5) days post-PCI): 2 major groin hematoma (initial phase of warfarin treatment during overlap with heparin) and 18 minor. During post-triple therapy, primarily under warfarin and aspirin, 19 patients developed bleeding complications: 1 major and 18 minor. Conclusion: Short-term triple therapy after PCI was not associated with prohibitively high bleeding complication rates, and thus should be favorably considered in patients with a clear indication for warfarin use. © 2006 Wiley-Liss, Inc.
- Published
- 2006
50. Is Routine Coronary Angiography and Revascularization Indicated Among Patients Undergoing Evaluation for Lung Transplantation?
- Author
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Itsik Ben-Dor, Zaza Iakobishvili, Gideon Sahar, Mordechai R. Kramer, David Hasdai, and David Shitrit
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Infarction ,Coronary Disease ,Coronary Angiography ,Critical Care and Intensive Care Medicine ,Revascularization ,Ventricular Function, Left ,Cohort Studies ,Coronary artery disease ,Oxygen Consumption ,Internal medicine ,Myocardial Revascularization ,medicine ,Humans ,Lung transplantation ,cardiovascular diseases ,Contraindication ,Retrospective Studies ,business.industry ,Contraindications ,Patient Selection ,Reproducibility of Results ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Surgery ,Transplantation ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Lung Transplantation - Abstract
Objectives To review coronary artery disease (CAD) prevalence among lung transplantation (LTx) candidates, the time interval from coronary angiography (CA) to LTx/death, and postrevascularization outcomes. Background CA is advised for LTx candidates because significant CAD is a contraindication for LTx. Methods We monitored all LTx candidates from 1997 who underwent CA. Significant CAD was defined as stenosis ≥ 70% in diameter. Results Of 118 candidates > 40 years old (68.3% men; median age, 58 years; 25 to 75th interquartiles, 53 to 61 years), 59 patients underwent LTx, 56 patients were eligible for LTx, and 3 patients were excluded due to CAD. Significant CAD was detected in 21patients (17.8%), nonsignificant CAD was found in 21 patients (17.8%), and no CAD was found in 76 patients (64.4%), without significant differences in the demographic/clinical profile among patients with or without significant CAD. Among 21 patients with significant CAD, 12 patients (57.1%) underwent successful percutaneous coronary intervention (PCI), 1 patient had failed to respond to PCI, and 8 patients (38.1%) had no intervention. After PCI, one patient had periprocedural infarction, one patient had stent thrombosis, and one patient had symptomatic restenosis. The median time interval CA to LTx/death/last visit among the 115 candidates was 166 days (interquartiles, 48 to 410 days). Death occurred before LTx in 30 patients (53.5%) during a follow-up of 312 days (interquartiles, 46 to 664 days) and after LTx in 14 patients (23.7%) during a follow-up of 142 days (interquartiles, 73 to 304 days), without any difference in outcome based on severity of CAD in the two groups (p = 0.7 and p = 0.6, respectively). Conclusions CAD prevalence among LTx candidates is low and cannot be accurately predicted by risk factors. Revascularization may be associated with complications, and the time interval between revascularization and LTx may be long. Conversely, certain patients with significant CAD underwent LTx without complications. The practice of routine CA and revascularization prior to LTx should be reconsidered, and perhaps reserved for selected patients with high-risk features.
- Published
- 2005
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