Jorge F Saucedo

NorthShore University HealthSystem, Chicago, Illinois, United States

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Publications (130)986.15 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Patients with peripheral artery disease have walking impairment, greater thrombotic risk, and are often treated with exercise training. We sought to determine the effect of a 3-month-long exercise program on clot strength among patients with peripheral artery disease and intermittent claudication.
    01/2015; 3. DOI:10.1177/2050312115575938
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    ABSTRACT: Objectives Acute management of ST elevation myocardial infarction (STEMI) patients on chronic vitamin K antagonist (VKA) therapy is uncertain. This study aims to estimate in-hospital major bleeding risk among STEMI patients on chronic VKA treated with primary percutaneous coronary intervention (PCI); and determine the relationship between bleeding and acute treatments stratified by international normalised ratio (INR) values. Methods We retrospectively examined 120 270 STEMI patients treated with primary PCI at 586 national registry hospitals (2007-2012). Results Overall, 3101 patients (2.6%) were on VKA which was associated with increased in-hospital major bleeding risk when compared with patients not on VKA (17.0%, vs 10.1%; adjusted OR 1.26, 95% CI 1.13 to 1.40). In patients on VKA, admission INR >= 2.0 was not associated with an increase in bleeding risk compared to INR <2.0. Patients on VKA were more likely to receive clopidogrel or bivalirudin within 24 h of presentation (acute), but less likely to receive prasugrel, heparin, or glycoprotein IIb/IIIa inhibitors (GPI). In those patients, acute GPI was associated with increased bleeding risk (adjusted OR 1.92, 95% CI 1.54 to 2.40) while bivalirudin was associated with decreased risk (adjusted OR 0.69, 95% CI 0.55 to 0.86); bleeding risk associated with heparin, bivalirudin, ADP-receptor blockers, or GPI was similar between INR >= 2.0 and <2.0. Conclusions In STEMI patients treated with primary PCI, chronic VKA therapy was associated with a significant increase in in-hospital major bleeding risk compared to no VKA therapy, irrespective of whether admission INR was >= 2.0 or not. In patients on VKA, GPI was associated with increased bleeding risk while bivalirudin was associated with decreased risk.
    Heart (British Cardiac Society) 10/2014; 101(4). DOI:10.1136/heartjnl-2014-305931 · 6.02 Impact Factor
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    ABSTRACT: Background-Although randomized clinical trials have compared clopidogrel with higher potency ADP receptor inhibitors (ADPris) among patients with myocardial infarction, little is known about the frequency and factors associated with switching between ADPris in clinical practice. Methods and Results-We studied 47 040 patients with myocardial infarction treated with percutaneous coronary intervention, who received either clopidogrel or prasugrel within 24 hours of admission at 361 US hospitals from July 2009 to June 2011 using the merged Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines and CathPCI Registry database. Hierarchical logistic regression modeling was used to determine factors independently associated with in-hospital ADPri switching. Among 40 531 patients treated initially in-hospital with clopidogrel, 2125 (5.2%) were discharged on prasugrel; this frequency steadily increased from 0% to 7% during the study period. Among 6509 patients treated initially in-hospital with prasugrel, 751 (11.5%) were discharged on clopidogrel. The frequency of this switch increased from 6% to 18% during the first 2 quarters of the study period and decreased to 9% by the end. Switching clopidogrel to prasugrel was associated with high-risk angiographic characteristics (thrombotic, long, and bifurcating lesions), reinfarction in-hospital, and private health insurance coverage. Older age, previous cerebrovascular event, in-hospital coronary artery bypass grafting, in-hospital bleeding, and warfarin use at discharge were associated with switching prasugrel to clopidogrel. Conclusions-Clopidogrel and prasugrel are not uncommonly switched in-hospital in patients with myocardial infarction undergoing percutaneous coronary intervention. In contemporary US practice, in addition to risk for bleeding and recurrent ischemic events, medical drug coverage is a major determinant of ADPri selection.
    Circulation Cardiovascular Interventions 08/2014; 7(4). DOI:10.1161/CIRCINTERVENTIONS.114.001555 · 6.98 Impact Factor
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    ABSTRACT: Patients with diabetes mellitus (DM) presenting with acute myocardial infarction (AMI) have worse outcomes versus those without DM. Comparative contemporary data in patients presenting with AMI with insulin-requiring diabetes mellitus (IRDM), noninsulin-requiring diabetes mellitus (NIRDM), and newly identified DM (hemoglobin A1C level >6.5%) versus patients without DM are limited. This observational study from the National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment and Intervention Outcomes Network-Get with the Guidelines (ACTION Registry-GWTG consisted of 243,861 patients with AMI from 462 US sites identified from January 2007 to March 2011 entered into the registry. Clinical characteristics, management, and in-hospital outcomes were analyzed. Patients with DM with non-ST-segment elevation myocardial infarction (NSTEMI; n = 53,094, 35%) were less likely to undergo diagnostic angiography or revascularization, whereas those with ST-segment elevation myocardial infarction (STEMI) (n = 21,507, 23%) were less likely to undergo reperfusion therapy compared with patients without DM. There was an increased adjusted risk of in-hospital mortality in the DM group in both the NSTEMI (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.06 to 1.22) and STEMI (OR 1.17, 95% CI 1.07 to 1.27) population. In patients with DM, the risk-adjusted in-hospital mortality was higher in patients with IRDM than those with NIRDM in the NSTEMI group (OR 1.12, 95% CI 1.01 to 1.24) but not in the STEMI group (OR 1.12, 95% CI 0.95 to 1.32). Newly diagnosed patients with DM presenting with AMI had similar unadjusted in-hospital outcomes compared with patients without DM. In conclusion, patients with DM presenting with AMI have a higher mortality risk than patients without DM. In patients with DM, those with IRDM presenting with NSTEMI had an increased mortality than those with NIRDM.
    The American Journal of Cardiology 07/2014; 114(8). DOI:10.1016/j.amjcard.2014.07.031 · 3.43 Impact Factor
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    ABSTRACT: Prior studies demonstrated that patients with ST-segment-elevation myocardial infarction presenting during off-hours (weeknights, weekends, and holidays) have slower reperfusion times. Recent nationwide initiatives have emphasized 24/7 quality care in ST-segment-elevation myocardial infarction. It remains unclear whether patients presenting off-hours versus on-hours receive similar quality care in contemporary practice.
    Circulation Cardiovascular Quality and Outcomes 07/2014; 7(5). DOI:10.1161/CIRCOUTCOMES.113.000740 · 5.66 Impact Factor
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    ABSTRACT: Peripheral artery disease (PAD) is associated with exercise impairment and greater thrombotic risk. We investigated whether clot formation and platelet aggregation assessed by thromboelastography and light-transmission aggregometry correlate with the severity of symptomatic PAD assessed by ambulatory function measures. We studied 40 symptomatic patients with PAD in whom severity of disease was assessed using ankle-brachial index, peak walking time (PWT), claudication onset time, peak oxygen uptake, daily ambulatory activity, and walking impairment questionnaire (WIQ) scores. Clot strength correlated negatively with peak oxygen uptake, PWT, WIQ distance, and stair-climbing scores. Time to clot formation did not correlate with exercise parameters. Platelet aggregation was negatively correlated with WIQ distance score and was positively correlated with PWT and peak oxygen uptake. In conclusion, clot strength and platelet aggregation correlated with objective and self-perceived ambulatory measures. Patients with PAD having more severe walking impairment may be likely to form stronger clots.
    Angiology 04/2014; 66(4). DOI:10.1177/0003319714532518 · 2.37 Impact Factor
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    ABSTRACT: High on-treatment platelet reactivity (HPR) has been identified as an independent risk factor for ischaemic events. The randomised, double-blind, TRIPLET trial included a pre-defined comparison of HPR in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) following a placebo/600-mg clopidogrel loading dose (LD) immediately before a subsequent prasugrel 60-mg or 30-mg LD. Platelet reactivity was assessed using the VerifyNow® P2Y12 assay (P2Y12 Reaction Units, PRU) within 24 hours (h) following the placebo/clopidogrel LD (immediately prior to prasugrel LD), and at 2, 6, 24, 72 h following prasugrel LDs. The impact of CYP2C19 predicted metaboliser phenotype (extensive metabolizers [EM] and reduced metabolisers [RM]) on HPR status was also assessed. HPR (PRU ≥240) following the clopidogrel LD (prior to the prasugrel LD) was 58.5% in the combined clopidogrel LD groups. No significant difference was noted when stratified by time between the clopidogrel and prasugrel LDs (≤6 hs vs>6 h). At 6 h following the 2nd loading dose in the combined prasugrel LD groups, HPR was 7.1%, with 0% HPR by 72 h. There was no significant effect of CYP2C19 genotype on pharmacodynamic (PD) response following either prasugrel LD treatments at any time point, regardless of whether it was preceded by a clopidogrel 600-mg LD. In conclusion, in this study, patients with ACS intended for PCI showed a high prevalence of HPR after clopidogrel 600-mg LD regardless of metaboliser status. When prasugrel LD was added, HPR decreased substantially by 6 h, and was not seen by 72 h.
    Thrombosis and Haemostasis 04/2014; 112(2). DOI:10.1160/TH13-09-0747 · 5.76 Impact Factor
  • Chapter: Abciximab
    J. Emilio Exaire, Jorge F. Saucedo
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    ABSTRACT: The use of abciximab in percutaneous coronary intervention (PCI) has helped reduce periprocedural ischemic complications and in some high-risk cohorts even mortality; however, most of the studies were performed in the era before the widespread use of prolonged dual antiplatelet therapy (DAPT). The most recent ACC/AHA/SCAI Guidelines continue to encourage the use of abciximab and other glycoprotein (GP)IIb/IIIa inhibitors in specific clinical settings. This review will focus in abciximab's clinical benefits in the current PCI era.
    Antiplatelet Therapy in Cardiovascular Disease, 03/2014: pages 125-130; , ISBN: 9781118275757
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    ABSTRACT: Secondary prevention trials have demonstrated the efficacy of statins in reducing cardiovascular morbidity and mortality in patients with coronary artery disease and events after percutaneous coronary intervention (PCI). However, there are few data describing the clinical value of statins in patients with coronary artery disease and chronic kidney disease (CKD) undergoing PCI. Of 10,148 patients who entered into Evaluation of Drug Eluting Stents and Ischemic Events, a multicenter registry of unselected patients undergoing PCI from July 2004 to December 2007, we studied 2,306 patients with CKD (estimated glomerular filtration rate ≤60 ml/min based on the Modified Diet in Renal Disease calculation). Patients were stratified into those receiving statins at discharge (n = 1,833, 79%) or not (n = 473, 21%). Patients in the statin group had a greater prevalence of hypertension, recent myocardial infarction (MI), and use of β blockers and angiotensin-converting enzyme inhibitors. Outcomes were assessed from discharge through 1-year follow-up. One-year all-cause mortality was 5.7% in statin group versus 8.7% in the no statin group (adjusted hazard ratio 0.55, 95% confidence interval 0.34 to 0.88). The composite of death, MI, and repeat revascularization was lower in statin group (adjusted hazard ratio 0.71, 95% confidence interval 0.51 to 0.99). In conclusion, among patients with CKD undergoing PCI, the prescription of statins at hospital discharge was associated with a significant improvement in subsequent outcomes including mortality and composite end point of death, MI, and repeat revascularization.
    The American journal of cardiology 11/2013; 113(4). DOI:10.1016/j.amjcard.2013.11.006 · 3.43 Impact Factor
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    ABSTRACT: <0.0001) but less likely to have received percutaneous coronary intervention (84.2% versus 35.3%; P<0.0001). Compared with patients with STEMI presenting with shock at admission, patients with NSTEMI presenting with shock had longer delays to percutaneous coronary intervention (1.2 versus 3.2 hours) and coronary artery bypass grafting (7.9 versus 55.9 hours). Cardiogenic shock in patients with STEMI was associated with a lower mortality risk (33.1% shock versus 2.0% no shock; adjusted odds ratio, 14.1; 95% confidence interval, 13.0-15.4; interaction P value <0.0001) compared with patients with NSTEMI (40.8% shock versus 2.3% no shock, odds ratio, 19.0; 95% confidence interval, 17.1-21.2).Conclusions-Cardiogenic shock is associated with high mortality in patients with STEMI and NSTEMI. However, urgent revascularization is more commonly pursued in patients with STEMI presenting with shock than in patients with NSTEMI. More research is needed to improve the outcomes for patients with MI presenting with shock, particularly those presenting with NSTEMI.
    Circulation Cardiovascular Quality and Outcomes 11/2013; 6(6). DOI:10.1161/CIRCOUTCOMES.113.000262 · 5.04 Impact Factor
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    ABSTRACT: The influence of the presenting electrocardiographic (ECG) findings on the treatment and outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) has not been studied in contemporary practice. We analyzed the clinical characteristics, in-hospital management, and in-hospital outcomes of patients with NSTEMI in the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines (ACTION Registry-GWTG) according to the presenting ECG findings. A total of 175,556 patients from 485 sites from January 2007 to September 2011 were stratified by the ECG findings on presentation: ST depression (n = 40,146, 22.9%), T-wave inversions (n = 24,627, 14%), transient ST-segment elevation (n = 5,050, 2.9%), and no ischemic changes (n = 105,733, 60.2%). Patients presenting with ST-segment depression were the oldest and had the greatest prevalence of major cardiac risk factors. Coronary angiography was performed most frequently in the transient ST-segment elevation group, followed by the T-wave inversion, ST-segment depression, and no ischemic changes groups. The angiogram revealed that patients with ST-segment depression had more left main, proximal left anterior descending, and 3-vessel coronary artery disease and underwent coronary artery bypass grafting most often. In contrast, patients with transient ST-segment elevation had 1-vessel CAD and underwent percutaneous coronary intervention the most. The unadjusted mortality was highest in the ST-segment depression group, followed by the no ischemic changes, transient ST-segment elevation, and T-wave inversion group. Adjusted mortality using the ACTION Registry-GWTG in-hospital mortality model with the no ischemic changes group as the reference showed that in-hospital mortality was similar in the transient ST-segment elevation (odds ratio 1.15, 95% confidence interval 0.97 to 1.37; p = 0.10), higher in the ST-segment depression group (odds ratio 1.46, 95% confidence interval 1.37 to 1.54; p <0.0001), and lower in the T-wave inversion group (odds ratio 0.91, 95% confidence interval 0.83 to 0.99; p = 0.026). In conclusion, the clinical and angiographic characteristics and treatment and outcomes of patients with NSTEMI differed substantially according to the presenting ECG findings. Patients with ST-segment depression have a greater burden of co-morbidities and coronary atherosclerosis and have a greater risk of adjusted in-hospital mortality compared with the other groups. These findings highlight the importance of integrating the presenting ECG findings into the risk stratification algorithm for patients with NSTEMI.
    The American journal of cardiology 10/2013; 113(2). DOI:10.1016/j.amjcard.2013.09.009 · 3.43 Impact Factor
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    ABSTRACT: BACKGROUND: ADDING A PRASUGREL LOADING DOSE (LD) TO A CLOPIDOGREL LD COULD BE DESIRABLE BECAUSE CLOPIDOGREL MAY FAIL TO PROVIDE ADEQUATE LEVELS OF PLATELET INHIBITION IN PATIENTS WITH ACUTE CORONARY SYNDROME UNDERGOING PERCUTANEOUS CORONARY INTERVENTION.METHODS AND RESULTS: THE PHARMACODYNAMIC RESPONSE OF PRASUGREL 60 MG LD ALONE WAS COMPARED WITH PRASUGREL 60 MG OR 30 MG ADDED 24 HOURS TO CLOPIDOGREL 600 MG IN TRANSFERRING FROM CLOPIDOGREL LOADING DOSE TO PRASUGREL LOADING DOSE IN ACUTE CORONARY SYNDROME PATIENTS STUDY: A MULTICENTER, RANDOMIZED, DOUBLE-BLIND, DOUBLE-DUMMY, 3-ARM, PARALLEL, ACTIVE-COMPARATOR CONTROLLED STUDY. TWO HUNDRED EIGHTY-TWO PATIENTS WERE RANDOMIZED TO 3 LD STRATEGIES: PLACEBO PLUS PRASUGREL 60 MG, CLOPIDOGREL 600 MG PLUS PRASUGREL 60 MG, OR CLOPIDOGREL 600 MG PLUS PRASUGREL 30 MG. PLATELET FUNCTION WAS ASSESSED USING VERIFYNOW P2Y12 REACTION UNITS (PRU) IMMEDIATELY BEFORE PRASUGREL LD, AND 2, 6, 24, AND 72 HOURS AFTER PRASUGREL LD IN 149 PATIENTS WITH EVALUABLE PLATELET FUNCTION STUDIES. AT 6 HOURS AFTER THE PRASUGREL 60 MG LD, THE LEAST SQUARES MEAN (95% CONFIDENCE INTERVAL) DIFFERENCE BETWEEN PLACEBO/PRASUGREL 60 MG AND CLOPIDOGREL 600 MG/PRASUGREL 60 MG (PRIMARY OUTCOME) WAS 22.2 (11.0 TO 55.5; P=0.19; LEAST SQUARES MEAN PRU 57.9 VERSUS 35.6, RESPECTIVELY). FOR CLOPIDOGREL 600 MG/PRASUGREL 30 MG (LEAST SQUARES MEAN PRU, 53.9), THE DIFFERENCE WAS 3.9 (28.2 TO 36.1; P=0.81) VERSUS PLACEBO/PRASUGREL 60 MG. NO SIGNIFICANT DIFFERENCES IN PRU WERE OBSERVED AT ANY TIME POINT ACROSS THE 3 GROUPS. THERE WERE FEW BLEEDING EVENTS OBSERVED REGARDLESS OF TREATMENT.CONCLUSIONS: PLATELET REACTIVITY WITH PRASUGREL 60 MG LD ADDED TO CLOPIDOGREL 600 MG LD WAS NOT SIGNIFICANTLY DIFFERENT COMPARED WITH PRASUGREL 60 MG LD ALONE IN ACUTE CORONARY SYNDROME PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01115738.
    Circulation Cardiovascular Interventions 09/2013; 6(5). DOI:10.1161/CIRCINTERVENTIONS.112.000063 · 6.98 Impact Factor
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    ABSTRACT: Clopidogrel response varies according to the presence of genetic polymorphisms. The CYP2C19*2 allele has been associated with impaired response; conflicting results have been reported for CYP2C19*17, ABCB1, and PON1 genotypes. We assessed the impact of CYP2C19, PON1, and ABCB1 polymorphisms on clopidogrel and prasugrel pharmacodynamic (PD) and pharmacokinetic (PK) parameters. Aspirin-treated patients (N=194) with coronary artery disease from two independent, prospective, randomised, multi-centre studies comparing clopidogrel (75 mg) and prasugrel (10 mg) were genotyped and classified by predicted CYP2C19 metaboliser phenotype (ultra metabolisers [UM] = *17 carriers; extensive metabolisers [EM] = *1/1 homozygotes; reduced metabolisers [RM] = *2 carriers). ABCB1 T/T and C/T polymorphisms and PON1 A/A, A/G and G/G polymorphisms were also genotyped. PD was assessed using VerifyNow® P2Y12 and vasodilator stimulated phosphoprotein (VASP) expressed as platelet reactivity index (PRI) after 14 days of maintenance dosing. Clopidogrel and prasugrel active metabolite (AM) exposure was calculated in a cohort of 96 patients. For clopidogrel, genetic variants in CYP2C19, but not ABCB1 or PON1, affected PK and PD. For prasugrel, none of the measured genetic variants affected PK or PD. Compared with clopidogrel, platelet inhibition with prasugrel was greater even in CYP2C19 UM phenotype. Prasugrel generated more AM and achieved greater platelet inhibition than clopidogrel irrespective of CYP2C19, ABCB1, and PON1 polymorphisms. The lack of effect from genetic variants on prasugrel AM generation or antiplatelet activity is consistent with previous studies in healthy volunteers and is consistent with improved efficacy in acute coronary syndrome patients managed with percutaneous coronary intervention.
    Thrombosis and Haemostasis 09/2013; 110(20130905). DOI:10.1160/TH13-03-0263 · 5.76 Impact Factor
  • Tarun W Dasari, Bhavin Patel, Jorge F Saucedo
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    ABSTRACT: Neointimal hyperplasia after percutaneous coronary intervention is a major determinant of in-stent restenosis (ISR). Drug-eluting stents (DES) mitigate neointimal hyperplasia and thereby lead to a lower rate of ISR compared with bare-metal stents (BMS). Recent studies have demonstrated that short-term use of oral sirolimus after BMS leads to a significant reduction in ISR. We therefore sought to do a systematic review of studies to determine the angiographic and clinical benefits of early short-term use of oral sirolimus after BMS of native coronary arteries. We conducted PubMed, Embase, Cochrane database review, and Web of Science search of studies comparing oral sirolimus after BMS to BMS alone or DES. Outcomes analyzed were ISR and target lesion revascularization (TLR) as well as major adverse cardiovascular events. A total of 488 patients from 4 studies were included in the review (2006 to 2010). Three studies, comparing BMS alone versus BMS plus oral sirolimus, demonstrated significant reduction in ISR in the oral sirolimus group. Two of these studies also demonstrated significant reduction in TLR at 6-12 month follow-up. The fourth study comparing BMS plus oral sirolimus versus DES showed a lower but nonsignificant reduction in TLR in addition to significant cost saving in the group treated with oral sirolimus. In conclusion, our systematic review demonstrates that early short-term systemic use of sirolimus after BMS resulted in a significant reduction in ISR and TLR. In addition, ISR rates were comparable to DES with the added benefit of cost saving.
    The American journal of cardiology 08/2013; 112(9). DOI:10.1016/j.amjcard.2013.05.074 · 3.43 Impact Factor
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    ABSTRACT: OBJECTIVE: American Heart Association/American College of Cardiology guidelines recommend that patients with definite unstable angina or non-ST-segment elevation myocardial infarction (NSTEMI) receive dual antiplatelet therapy on presentation to the hospital when undergoing early invasive management or "as soon as possible" after admission when being managed conservatively. The guidelines do not specify whether these medications should be administered in the emergency department (ED). Our aim was to determine whether ED administration of a thienopyridine was associated with clinical outcomes among patients with NSTEMI. METHODS: We examined thienopyridine use in 39454 patients with NSTEMI who received a thienopyridine within 24 hours of presentation in the National Cardiovascular Data Registry's Acute Coronary Treatment and Intervention Outcomes Network-Get With The Guidelines Registry from January 2007 to June 2010. Patients who were not seen initially in the ED, were transferred in, or were missing time data were excluded. We analyzed the association between ED administration of thienopyridines and outcomes and patient demographics. RESULTS: Of the cohort receiving a thienopyridine within 24 hours, 9534 (24.2%) received it in the ED. Emergency department administration of a thienopyridine was not associated with in-hospital major bleeding (multivariable adjusted odds ratio, 0.99; 95% confidence interval, 0.91-1.09) or in-hospital mortality (adjusted 1.02; 95% confidence interval, 0.86-1.20). Independent predictors most strongly associated with ED thienopyridine administration were elevated troponin, ED length of stay, prior percutaneous coronary intervention, and initial electrocardiogram showing ischemic changes. CONCLUSIONS: There was no association between ED thienopyridine administration and in-hospital major bleeding or mortality. Emergency department length of stay, electrocardiographic changes, and elevated troponin were associated with ED thienopyridine administration.
    The American journal of emergency medicine 05/2013; 31(7). DOI:10.1016/j.ajem.2013.03.001 · 1.15 Impact Factor
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    ABSTRACT: The benefit of an invasive strategy in non-ST-segment elevation myocardial infarction (NSTEMI) was established from randomized trials that included few anemic patients. The aim of this study was to describe the characteristics, therapies, and mortality of patients with NSTEMIs who undergo an invasive strategy in relation to their admission hemoglobin levels. Data from 73,067 patients with NSTEMIs who underwent cardiac catheterization and who were captured by the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines (ACTION-GWTG) were examined. Patients were divided into 3 hemoglobin groups on the basis of initial hemoglobin level: (1) <10 g/dl, (2) 10 to 12 g/dl, or (3) >12 g/dl. Patients with hemoglobin <10 g/dl had more co-morbidities and more 3-vessel coronary artery disease at catheterization compared with those with hemoglobin >12 g/dl (46.2% vs 33.9%, all p values <0.0001). They received fewer acute antithrombotic therapies, less often underwent revascularization (57.4% vs 74.1%), and had higher rates of red blood cell transfusion before catheterization (32.1% vs 0.3%, all p values <0.0001). After adjustment, in-hospital mortality was inversely associated with initial hemoglobin, with a 7% increase for each 1 g/dl decrease in hemoglobin lower than 15 g/dl (odds ratio 1.07, 95% confidence interval 1.02 to 1.11). In conclusion, in patients presenting with NSTEMIs and managed with an invasive strategy, a lower hemoglobin level is associated with more extensive coronary artery disease, less use of revascularization and evidence-based therapies, and increased mortality.
    The American journal of cardiology 02/2013; 111(8). DOI:10.1016/j.amjcard.2012.12.041 · 3.43 Impact Factor
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    ABSTRACT: The prevalence of high platelet reactivity (HPR) in patients who have switched from clopidogrel to prasugrel during maintenance phase after an acute coronary syndrome (ACS) event is unknown. Therefore, the effect of switching from clopidogrel to prasugrel on the prevalence of HPR was evaluated. This analysis from the previously reported SWAP (SWitching Anti Platelet) study assessed HPR at baseline, 2 and 24 hours, and seven days after switching from clopidogrel to prasugrel maintenance dose (MD), with or without a prasugrel loading dose (LD) using four definitions: maximum platelet aggregation (MPA)>65% (primary endpoint), MPA>50%, P2Y12 reaction units (PRU)>235, and platelet reactivity index (PRI) ≥50%. A total of 95 patients were available for analysis; 56 patients provided DNA for genetic assessments of cytochrome P450 (CYP) 2C19. There were 26 (27.4%) patients with HPR at the end of the clopidogrel run-in (defined as MPA>65%). The HPR prevalence varied by each definition and ranged from 19% (PRU>235) to 68% (PRI ≥50 %). A significantly higher HPR prevalence was observed during clopidogrel versus the combined prasugrel therapy groups at seven days as measured by MPA>65% (21.2% vs. 4.5%, p<0.05), PRU>235 (18.8% vs. 0%, p=0.001), and PRI ≥50 % (66.7% vs. 7.9%, p<0.0001). There was a significantly higher percentage of subjects carrying at least one reduced function allele with HPR measured by MPA>65% (p=0.02) or PRU>235 (p=0.05) than non-carriers with HPR. Switching ACS patients during maintenance clopidogrel therapy to prasugrel with or without an LD is associated with a reduced HPR prevalence and may provide an alternative strategy to treat patients with HPR, independent of CYP2C19 genotype.
    Thrombosis and Haemostasis 12/2012; 109(2). DOI:10.1160/TH12-06-0378 · 5.76 Impact Factor
  • Nishit Patel, Jorge Saucedo
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    ABSTRACT: Deep vein thrombosis and pulmonary embolism are major causes of morbidity and mortality in trauma patients. Anticoagulation therapy is often contraindicated in these patient populations. The retrievable inferior vena cava (IVC) filter provides a good option for preventing pulmonary embolism in the immediate injury and postoperative periods. Bedside IVC filter placement by guidance of intravascular ultrasound eliminates the risk of transportation; it is safe, efficient, and cost effective. We hereby present a case of bedside IVC filter placement in a morbidly obese patient with modified intravascular ultrasound approach.
    The Journal of invasive cardiology 12/2012; 24(12):E311-E313. · 0.82 Impact Factor
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    ABSTRACT: OBJECTIVES: To compare outcomes of patients receiving drug-eluting stents (DES) versus bare metal stents (BMS) during percutaneous coronary intervention (PCI) of saphenous vein bypass grafts (SVG). BACKGROUND: Long-term benefits of DES versus BMS are well established for native vessel PCI. Benefit in patients undergoing SVG intervention is less certain. We used data from a multicenter registry (evaluation of drug eluting stents and ischemic events, EVENT) to compare outcomes among patients treated with DES versus BMS 1-year following SVG interventions. METHODS: Between July 2004 and December 2007, 684 patients in EVENT underwent SVG PCI (515 DES only, 169 BMS only). The primary endpoint was a composite of death, myocardial infarction (MI), and target lesion revascularization between hospital discharge and 1-year follow-up. Propensity score stratification was used to adjust for differences between groups. RESULTS: Baseline demographic and clinical characteristics of patients treated with DES and BMS were similar. The DES group had fewer men and a higher prevalence of prior PCI. Patients receiving DES had less angiographic thrombus, less frequent use of embolic protection devices, greater total stent length, and smaller maximum stent diameters. Unadjusted outcomes between discharge and 1-year follow-up did not differ between the groups. After risk adjustment, the primary outcome was less frequent among patients treated with DES (adjusted HR = 0.48, 95% CI = 0.27-0.84, P < 0.01) with similar relative benefits across the individual endpoints. CONCLUSIONS: Among patients undergoing SVG PCI in a "real world" registry analyzed using propensity score stratification, treatment with DES compared with BMS was associated with reduced MACE at 1 year following PCI. © 2012 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 12/2012; 80(7). DOI:10.1002/ccd.24352 · 2.40 Impact Factor
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    ABSTRACT: An early invasive management strategy is recommended for patients with non-ST-segment elevation myocardial infarction (NSTEMI) who do not have a contraindication to cardiac catheterization (CCC). However, the frequency of CCC reporting has not been delineated, and the relationship of CCC reporting to hospital-level guidelines adherence for NSTEMI has not been investigated. We used the American College of Cardiology National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines database to evaluate variations in hospital-level reporting of CCC for 111,320 patients with NSTEMI admitted to 370 hospitals with revascularization capabilities in the United States from 2007 to 2010 and how these variations were associated with guideline adherence and in-hospital mortality. Hospitals were grouped into tertiles based on rates of reported CCCs. Treatment patterns and in-hospital mortality rates were evaluated across hospital tertiles separately for patients with and without a reported CCC. A total of 18,290 (16.4%) of 111,320 patients with NSTEMI had a reported CCC, but hospital-level CCC reporting varied considerably (low tertile 0%-8.2%, intermediate tertile >8.2%-18.8%, and high tertile >18.8%-75.6%). Patients with a reported CCC had more comorbidities and high-risk features compared with patients without a CCC. The use of most guideline-recommended medications and in-hospital mortality rates were similar across hospital tertiles-both for patients with and without a reported CCC. The reporting of CCC among patients with NSTEMI varies widely across US hospitals and does not appear to be related to guidelines adherence or in-hospital mortality rates. These findings suggest that it will be a challenge to standardize the reporting of CCC and thus use invasive management to assess the quality of NSTEMI care.
    American heart journal 10/2012; 164(4):502-8. DOI:10.1016/j.ahj.2012.07.005 · 4.56 Impact Factor

Publication Stats

3k Citations
986.15 Total Impact Points

Institutions

  • 2013–2014
    • NorthShore University HealthSystem
      • Division of Cardiology
      Chicago, Illinois, United States
    • University of Oklahoma
      Norman, Oklahoma, United States
  • 2008–2013
    • Oklahoma City University
      Oklahoma City, Oklahoma, United States
    • The University of Tennessee Health Science Center
      • Department of Medicine
      Memphis, TN, United States
  • 2005–2013
    • University of Oklahoma Health Sciences Center
      • • Section of Molecular Medicine
      • • Department of Internal Medicine
      Oklahoma City, Oklahoma, United States
  • 2006
    • Duke University
      Durham, North Carolina, United States
  • 1999–2005
    • University of Arkansas at Little Rock
      Little Rock, Arkansas, United States
  • 2002
    • University of Arkansas for Medical Sciences
      Little Rock, Arkansas, United States
    • Centro Médico de Caracas
      Caracas, Distrito Federal, Venezuela
  • 1998–2001
    • Washington Hospital Center
      Washington, Washington, D.C., United States
  • 1996
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States