James A ShandWestern Health and Social Care Trust · Department of Cardiology
James A Shand
MBBS, FRCP, MD
About
29
Publications
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Introduction
Skills and Expertise
Additional affiliations
August 2012 - August 2013
Publications
Publications (29)
Introduction
Spontaneous coronary artery dissection (SCAD) is a rare, yet increasingly recognised cause of acute coronary syndrome. Current management is largely based on expert consensus resulting in significant treatment variability. To date, characterization of the Irish SCAD population has been limited to single centre studies. We therefore aim...
Background
European guidelines advise that patients suffering ST-segment elevation myocardial infarction (STEMI) should be revascularized within 120 minutes of diagnosis. The preferred method of revascularization is primary percutaneous coronary intervention (pPCI). We analysed the Northern Irish STEMI database to establish the proportion of pPCI d...
Background:
In the last decade, percutaneous coronary intervention (PCI) has evolved toward the treatment of complex disease in patients with multiple comorbidities. Whilst there are several definitions of complexity, it is unclear whether there is agreement between cardiologists in classifying complexity of cases. Inconsistent identification of c...
BACKGROUND
When a patient is suspected of having an acute myocardial infarction (AMI), patients are accepted or ‘turned-down’ for primary percutaneous coronary intervention (PPCI) partly based on clinical assessment of the 12-lead electrocardiogram (ECG) and STEMI criteria.
OBJECTIVE
This paper aims to retrospectively interrogate the agreement rat...
Background
When a patient is suspected of having an acute myocardial infarction, they are accepted or declined for primary percutaneous coronary intervention partly based on clinical assessment of their 12-lead electrocardiogram (ECG) and ST-elevation myocardial infarction criteria.
Objective
We retrospectively determined the agreement rate betwee...
Background/introduction:
Type 4a myocardial infarction (MI) occurs when myocardial injury is combined with either symptoms suggestive of myocardial ischaemia, new left bundle branch block, angiographic loss of patency of a major artery or imaging suggestive of new loss of myocardium. Myocardial injury is defined as a rise of >5 x 99th upper refere...
Rotational atherectomy (RA) of calcified coronary lesions has been used for almost 3 decades. Through plaque modification, it allows adequate stent expansion, theoretically reducing stent thrombosis and restenosis. UK data demonstrate increasing use of RA over recent years. Since January 2016, we have maintained a prospective registry of all RA cas...
Introduction
From the 15th September 2014 every citizen in Northern Ireland has 24/7 access to Cardiac Catheterisation for patients experiencing an acute STEMI or emergent PCI. In one of the 2 designated Primary Percutaneous Coronary Intervention (PPCI) enabled centres, registrar cover is not available, therefore the responsibility to activate the...
Introduction Heart-type Fatty Acid-Binding Protein (H-FABP) may be useful for early diagnosis of ACS1,2 and has been associated with increased cardiovascular events. Type 4a procedural myocardial infarction (MI) may occur after percutaneous coronary intervention (PCI).3 Little is known about the use of early biomarkers as predictors of cardiovascul...
Objectives:
To define the size of the left mainstem coronary artery (LMS) in the Northern Irish population and investigate the clinical feasibility, safety, and efficacy of post dilation beyond nominal diameter of current generation Drug eluting stent (DES) when treating the LMS.
Background:
There is no prospective data examining the need, feasi...
To investigate the outcomes of a cohort of acute and elective percutaneous coronary intervention (PCI) patients who were discharged home 6 hours postprocedure.
Contemporary PCI is safe with a low rate of acute complications. It is well established as a day procedure in elective cases; however, data are lacking in acute cases.
We describe a prospect...
Recently, the phenomenon of longitudinal coronary stent deformation or the 'concertina stent has been recognized. Bench testing has indicated that this may, in part, be related to stent design. It appears that fewer ring connectors, and in particular their orientation to the longitudinal axis of the stent, may increase the propensity of a stent to...
To address concerns of late and very late stent thrombosis associated with first generation drug-eluting stent technology, novel approaches are being tested including stents with bioabsorbable polymers (including Biomatrix Flex™, Nobori™ and Synergy™), polymer-free drug delivery systems (including Biofreedom™ and Yukon®) and drug-eluting balloons (...
Multiple key cardiology trials have been presented or published over recent months, several with the potential to change clinical practice. In this article, we summarize and place in clinical context new trial findings regarding anticoagulation in the cardiac catheterization laboratory (enoxaparin, fondaparinux and unfractionated heparin), the impl...
Dual antiplatelet therapy with aspirin and a platelet adenosine diphosphate P2Y(12) receptor blocker reduces the risk of major adverse cardiovascular events following percutaneous coronary intervention or an acute coronary syndrome. Clopidogrel is the most widely used P2Y(12) receptor blocker, but has suboptimal speed of onset of action and maximal...
The small but absolute increase in late and very late stent thrombosis associated with drug-eluting stent technology may in part be related to the permanent, durable polymers currently employed with these stent platforms. Research has recently focused on two strategies to combat this problem; bioabsorbable polymers and polymer-free stents. This art...
The diagnosis of acute myocardial infarction currently rests on the measurement of troponin, a biomarker of myocardial necrosis. Unfortunately, the current generation troponin assays detect troponin only 6-9 h after symptom onset. This can lead to a delay in diagnosis and also excessive resource utilization when triaging patients who, ultimately, h...
In the management of chronic stable angina, percutaneous coronary intervention (PCI) provides symptomatic relief of angina rather than improvement of prognosis. Current guidelines recommend optimization of medical therapy prior to elective PCI. It is not clear if these guidelines are adhered to in clinical practice.
The aim of this multi-centre stu...
During 2009, multiple major cardiology trials have been presented or published. In this paper, we summarize and place in clinical context the new trial findings regarding anticoagulation (dabigatran), antiplatelet therapy (ticagrelor, clopidogrel, prasugrel and aspirin), percutaneous coronary management (thrombectomy, multivessel/left main disease...