
Kirk N GarrattChristiana Care Health System · Cardiology
Kirk N Garratt
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253
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Introduction
Skills and Expertise
Publications
Publications (253)
The COVID-19 pandemic led to disruptions in iodinated contrast media (ICM) production and produced a global product shortage in the spring of 2022. The ACIST CVi system is an automated contrast injector system approved by the FDA for multi-patient dosing of ICM from a single container. A transition from the traditional manifold system for contrast...
Background
Little is known about the bleeding risk associated with cangrelor use in patients with myocardial infarction (MI) who are exposed to an oral P2Y12 inhibitor before coronary angiography.
Methods
Cangrelor in Acute MI: Effectiveness and Outcomes (CAMEO) is an observational registry studying platelet inhibition for patients with MI. Upstre...
Background
In clinical trials, cangrelor has been shown to reduce percutaneous coronary intervention–related ischemic complications without increasing major bleeding. This study was performed to examine cangrelor use and transition to oral P2Y 12 inhibitors in routine clinical practice.
Methods and Results
The CAMEO (Cangrelor in Acute Myocardial...
Closed‐loop communication (CLC) is a fundamental aspect of effective communication, critical in the cardiac catheterization laboratory (cath lab) where physician orders are verbal. Complete CLC is typically a hospital and national mandate. Deficiencies in CLC have been shown to impair quality of care. Single center observational study, CLC for phys...
Objectives
The aim of this study was to examine the sex differences in the risk profile, management, and outcomes among patients presenting with acute myocardial infarction cardiogenic shock (AMI-CS).
Background
Contemporary clinical data regarding sex differences in the management and outcomes of AMI patients presenting with CS are scarce.
Metho...
Background
Little is known about the prevalence and prognostic impact of preexisting frailty on acute care and in-hospital outcomes in older adults in the setting of acute myocardial infarction (AMI).
Methods
Preexisting frailty was assessed at baseline in consecutive AMI patients ≥65 years of age treated at 778 hospitals participating in the NCDR...
Background
The Chest Pain–MI registry affords a 10-year perspective of the acute myocardial infarction (MI) patient characteristics, management, and clinical outcomes in the United States. We report the changes in the treatment and cardiovascular outcomes of acute MI patients over 10 years.
Methods
Annual trends in patient characteristics, in-hosp...
Background/purpose
The COBRA Polyzene F™ NanoCoated Coronary Stent System (PzF coated stent) stent demonstrated favorable clinical outcomes at 9 months but late results have not been reported. We sought to assess the late safety and effectiveness of the PzF coated stent for treatment of de novo coronary artery lesions.
Methods
Patients with de nov...
Background
Ticagrelor and prasugrel are potent P2Y12 inhibitors with superior efficacy compared with clopidogrel among patients with ST-segment–elevation myocardial infarction (STEMI), though use in recent practice is not well described. In this retrospective study, we assessed trends, predictors, and variation in use of P2Y12 inhibitors in patient...
Background
Little is known regarding use of cardiac therapies and clinical outcomes among older myocardial infarction ( MI ) patients with cognitive impairment.
Methods and Results
Patients ≥65 years old with MI in the NCDR (National Cardiovascular Data Registry) Chest Pain– MI Registry between January 2015 and December 2016 were categorized by pr...
The International Andreas Gruentzig Society is an educational society of physicians and scientists interested in cardiovascular and related fields. Members cooperate in the advancement of knowledge and education through research, publication, study, and teaching in the fields of cardiovascular disease. This summary reflects the proceedings from the...
Importance
Physicians have been criticized for having an overly enthusiastic response to new device approvals, especially for novel technologies. However, to our knowledge, the rates of new product adoption and patterns of new device usage in clinical practice have not been well described.
Objective
To characterize the patterns of uptake of biores...
Objectives
To assess closed‐loop communications (readback), a fundamental aspect of effective communication, among cardiovascular teams and assess improvement efforts.
Background
Effective communication within teams is essential to assure safety and optimal outcomes. Readback of verbal physician orders is a hospital and national requirement.
Meth...
See Article by Al'Aref et al.
Background: Benzodiazepines and opioids are commonly used for conscious sedation (CS) in cardiac catheterization laboratory (CCL) patients. Both drugs are known to predispose to hypoxemia, apnea and decreased responsiveness to PCO2, resulting in decreased arterial pH and PO2, as well as increased PCO2. We want to determine the effects of CS on arte...
Background: Despite considerable progress in the treatment of acute myocardial infarction (AMI), major disparities in care remain for the uninsured. Lack of insurance is associated with delays in seeking emergency care for AMI, and uninsured patients are less likely to receive guideline-directed medical therapy, invasive cardiac procedures, and hav...
How are we to evaluate outcomes for the care that we provide, and how are we to benchmark ourselves compared with colleagues at other institutions? It is critical that we do this to improve our own performance, and it is also being demanded of us by other stakeholders in society. Indeed, regular public reporting of outcomes is now effectively manda...
Objectives:
The aim of this study was to assess the safety and effectiveness of the COBRA Polyzene-F NanoCoated Coronary Stent System (CeloNova Biosciences, San Antonio, Texas) for the treatment of de novo coronary artery lesions.
Background:
Polyzene-F-coated coronary stents have shown reduced thrombogenicity and inflammation in preclinical stu...
Should chronic total occlusions (CTOs) of coronary arteries be revascularized by coronary artery bypass graft (CABG) surgery? It would seem that this is not a question that is often asked, yet CTOs are common and are more commonly revascularized by CABG than by percutaneous coronary intervention (PCI). In this article, we review the epidemiology of...
Objectives:
The aim of this study was to explore whether the use of bleeding avoidance strategies (BAS) explains variability in hospital-level bleeding following percutaneous coronary intervention.
Background:
Prior studies have reported that bleeding rates following percutaneous coronary intervention vary markedly among hospitals, but the exten...
Objectives
The aim of this study was to explore whether the use of bleeding avoidance strategies (BAS) explains variability in hospital-level bleeding following percutaneous coronary intervention.
Background
Prior studies have reported that bleeding rates following percutaneous coronary intervention vary markedly among hospitals, but the extent to...
Importance:
Many patients undergo cardiac catheterization and/or percutaneous coronary intervention (PCI) before noncardiac surgery even though these procedures are not routinely indicated. Data on this cohort of patients are limited.
Objective:
To describe the characteristics, angiographic findings, and treatment patterns of clinically stable p...
Background:
-Patients with diabetes mellitus (DM) are at high risk for recurrent ischemic events after coronary stenting. We assessed the effects of continued thienopyridine among patients with DM participating in the Dual Antiplatelet Therapy (DAPT) Study as a prespecified analysis.
Methods and results:
-After coronary stent placement and 12 mo...
Contrast-induced nephropathy (CIN) following coronary angiography is associated with significant morbidity and mortality. Contrast media volume is the key risk factor for CIN in patients with chronic kidney disease undergoing coronary angiography and interventions. Very often, coronary interventions are avoided in such high-risk patients because of...
Background: Prolonged hospital stay (PHS) has been a costly health care issue. Using data from the Society of Thoracic Surgeons (STS) Database and the American College of Cardiology Foundation (ACCF) National Cardiovascular Data Registry (NCDR) in ASCERT, we examined the determinants of PHS in a 30-day period after the index hospitalization for pat...
Background: While cardiac catheterization and/or revascularization before noncardiac surgery is not routinely indicated, many patients undergo these procedures as part of a preoperative evaluation. The angiographic findings and treatment patterns of these patients are unknown.
Methods: Using the NCDR CathPCI registry, we performed a descriptive ana...
Objectives
This study sought to compare rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE) (composite of death, myocardial infarction, or stroke) after coronary stenting with drug-eluting stents (DES) versus bare-metal stents (BMS) in patients who participated in the DAPT (Dual Antiplatelet Therapy) study, an int...
Dual antiplatelet therapy (DAPT) is effective in preventing in-stent thrombosis (IST) after placement of drug-eluting coronary stents (DES) and in attenuating risk of athero-thrombotic events, primarily myocardial infarction , among patients with advanced coronary atherosclerosis. However, all studies of DAPT demonstrate an increased risk of modera...
Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella®; left atrial to femoral artery bypass pumps, specifically the TandemHeart...
This article provides a brief summary of the relevant recommendations and references related to percutaneous mechanical circulatory support. The goal was to provide the clinician with concise, evidence-based contemporary recommendations, and the supporting documentation to encourage their application. The full text includes disclosure of all releva...
Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHea...
Despite antirestenotic efficacy of coronary drug-eluting stents (DES) compared with bare metal stents (BMS), the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Although dual antiplatelet therapy (DAPT) beyond 1 year provides ischemic event protection after DES, ischemic event risk is perceived to be less after BMS,...
Background
Interventional cardiologists and staff are subject to unique physical demands that predispose them to distinct occupational health hazards not seen in other medical disciplines.Methods
To characterize the prevalence of these occupational health problems, The Society for Cardiovascular Angiography and Interventions (SCAI) surveyed its mem...
ASCERT (American College of Cardiology Foundation and the Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies) was a large observational study designed to compare the long-term effectiveness of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) to treat coronary a...
Background: The American College of Cardiology Foundation and The Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies (ASCERT) has demonstrated that coronary artery bypass graft (CABG) surgery was associated with reduced mortality compared to percutaneous coronary intervention (PCI) at 4 years...
Background:
Dual antiplatelet therapy is recommended after coronary stenting to prevent thrombotic complications, yet the benefits and risks of treatment beyond 1 year are uncertain.
Methods:
Patients were enrolled after they had undergone a coronary stent procedure in which a drug-eluting stent was placed. After 12 months of treatment with a th...
Background:
The TAXUS Liberté Post Approval Study (TL-PAS) contributed patients treated with TAXUS Liberté paclitaxel-eluting stent and prasugrel to the Dual Antiplatelet Therapy Study (DAPT) that compared 12 and 30 months thienopyridine plus aspirin therapy after drug-eluting stents.
Methods and results:
Outcomes for 2191 TL-PAS patients enroll...
This chapter provides a broad review of the recommended management approach for patients presenting with a non-ST-elevation myocardial infarction (NSTEMI) and the evidence base supporting these recommendations. For the purposes of the chapter, all treatment recommendations should be considered relevant for patients assessed as at least moderate ris...
In this issue of Circulation, Yeh and coworkers report the results of a study designed to provide insight into the frequency and impact of coronary artery bypass grafting surgery (CABG) surgical turn-down, that is, how often patients with an indication for CABG were declared unsuitable for it by a surgeon, and how that decision affected outcomes(1)...
Background:
Although electronic product identification in the consumer sector is ubiquitous, unique identification of medical devices is just being implemented in 2014. To evaluate unique device identifiers (UDIs) in health care, the US Food and Drug Administration (FDA) funded the Medical Device Epidemiology Network initiative, including a demons...
Background:
Guidewire-induced coronary perforation (CP) rate is reported to have increased.
Methods:
We analyzed 23,399 PCIs and identified 73 patients complicated by CP, of which 31 were guidewire induced. Patients were divided into two groups: group A (guidewire-induced CP) and group B (non-guidewire induced CP). Characteristics and outcomes w...
Background:
Guidelines recommend noninvasive tests (NITs) to risk stratify and identify patients with higher likelihood of coronary artery disease (CAD) prior to elective coronary angiography. However, a high percentage of patients are found to have nonobstructive CAD. We aimed to understand the relationship between patient characteristics, NIT fi...
Recent observational studies show that patients with multivessel coronary disease have a long-term survival advantage with coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention (PCI). Important nonfatal outcomes may also affect optimal treatment recommendation.
CABG was compared with percutaneous catheter intervent...
The goal of this study was to compare angiographic interpretation of coronary arteriograms by sites in community practice versus those made by a centralized angiographic core laboratory.
The study population consisted of 2013 American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) records with 2- and 3- vessel coronary disea...
Background
While electronic product identification in the consumer sector is ubiquitous, unique identification of medical devices is just being implemented in 2014. To evaluate Unique Device Identifiers (UDIs) in healthcare, the U.S. Food and Drug Administration (FDA) funded the Medical Device Epidemiology Network (MDEpiNet) initiative, including a...
IntroductionCardiac tamponade is a grave but fortunately uncommon complication of percutaneous coronary intervention (PCI). Few studies have specifically addressed angiographic characteristics and outcomes associated with delayed cardiac tamponade after PCI. With the current study we tried to define the incidence of this complication and to charact...
Cardiac tamponade constitutes the most severe clinical consequence of a coronary perforation (CP) during percutaneous coronary intervention (PCI).
We analyzed 23,399 PCIs and identified 73 patients complicated by CP (0.31%), of which 26 developed tamponade (0.11%). Patients were divided into two groups: CP with tamponade (group A) and CP without ta...
Improving myocyte salvage during acute myocardial infarction (AMI) has proved elusive; the keys to success seem to be the ability to lower oxygen demand of ischemic myocardium and also activate salvage enzyme pathways to take advantage of endogenous cardioprotective mechanisms. Pharmacologic approaches have been largely unsuccessful. A percutaneous...
Radial access for percutaneous coronary intervention (r-PCI) is associated with reduced vascular complications; however, previous reports have shown that <2% of percutaneous coronary intervention (PCI) procedures in the United States are performed via the radial approach. Our aims were to evaluate temporal trends in r-PCI and compare procedural out...
Background: Transradial (TRI) percutaneous coronary intervention (PCI) is associated with reduced risk of bleeding and vascular complications compared with femoral PCI (FPCI). Studies have suggested that TRI may reduce mortality among patients with ST-elevation myocardial infarction (STEMI), but its use in the United States has not been well descri...
Objectives:
The purpose of this study was to examine use and describe outcomes of radial access for percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
Background:
Transradial PCI (TRI) is associated with reduced risk of bleeding and vascular complications, as compared with femoral access...
Background: Using data from the Society of Thoracic Surgeons (STS) Database and the American College of Cardiology Foundation (ACCF) National Cardiovascular Data Registry (NCDR) in ASCERT, we examined the cost-effectiveness of coronary-artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI).
Methods: The STS Database and ACCF...
Objectives:
This study sought to provide a report to the public of data from the CathPCI Registry of the National Cardiovascular Data Registry.
Background:
The CathPCI Registry collects data from approximately 85% of the cardiac catheterization laboratories in the United States.
Methods:
Data were summarized for 6 consecutive calendar quarters...
We report a case of left main coronary artery (LMCA) aneurysm rupture while the patient was hospitalized and immediately after imaging with 2 noninvasive cardiac modalities.
An 85-year-old man with history of atrial fibrillation, prostate cancer, hypertension, and hyperlipidemia presented with sudden lightheadedness, chest pressure, and junctional...
Questions persist concerning the comparative effectiveness of percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG). The American College of Cardiology Foundation (ACCF) and the Society of Thoracic Surgeons (STS) collaborated to compare the rates of long-term survival after PCI and CABG.
We linked the ACCF National Car...
Stent restenosis remains a common complication of bare-metal stent (BMS) implantation. Even in the drug-eluting stent (DES) era, there remains a significant proportion of patients who may not be eligible for DES due to inability to comply with prolonged dual antiplatelet therapy. We reviewed the validity of empirical evidence that periprocedural tr...
The purpose of this study was to develop a long-term model to predict mortality after percutaneous coronary intervention in both patients with ST-segment elevation myocardial infarction and those with more stable coronary disease.
The American College of Cardiology Foundation CathPCI Registry data were linked to the Centers for Medicare and Medicai...
Most survival prediction models for coronary artery bypass grafting surgery are limited to in-hospital or 30-day end points. We estimate a long-term survival model using data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database and Centers for Medicare and Medicaid Services.
The final study cohort included 348 341 isolated coronary...
Observational studies of new coronary stents are necessary to assess performance in a variety of complex patient and lesion types. Furthermore, the optimal dose and duration of thienopyridine treatment is unclear, particularly in patients with complex clinical conditions. The TAXUS Libertē Post-Approval Study is designed to provide 5-year data on t...
High platelet reactivity while receiving clopidogrel has been linked to cardiovascular events after percutaneous coronary intervention (PCI), but a treatment strategy for this issue is not well defined.
To evaluate the effect of high-dose compared with standard-dose clopidogrel in patients with high on-treatment platelet reactivity after PCI.
Rando...
Coronary artery stents mechanically buttress the arterial wall and prevent negative remodeling, leading to increased lumen gain and less angiographic and clinical restenosis as compared with balloon angioplasty alone. Although stents prevent negative remodeling, they do not eliminate restenosis, as they cause complex arterial injury triggering resp...
Technical improvements permit the performance of percutaneous coronary interventions (PCI) reliably and safely. However, adverse events during such procedures have still not been eliminated. The purpose of this study was to assess the current rates of complications from PCI, as well as any changes from 1999 to 2006.
Prospectively collected Lenox Hi...
(J Interven Cardiol 2009;22:282–284)
Drug-eluting stents have significantly reduced the problem of restenosis, but there is an association between drug-eluting stents and stent thrombosis that can be a significant clinical problem resulting in myocardial infarction or death. The risk for stent thrombosis increases in certain clinical situations and has been reduced through the use of...
Although coronary angiography has been the gold standard for assessing coronary artery stenoses, it yields information primarily about the anatomical severity of coronary artery disease, which frequently does not correlate with its physiological severity. Coronary interventions (PTCA, atherectomy, laser, etc.) are performed primarily to improve cor...
Coronary artery disease is a progressive and diffuse process. The focus in the past decade was on the late stage of coronary atherosclerosis, with efforts being devoted to the development of thrombolytic drugs and sophisticated interventional devices. However, in spite of the success in decreasing morbidity and mortality from coronary atheroscleros...
The “no-reflow” phenomenon results from microcirculatory spasm and has significant hemodynamic and prognostic consequences. Adenosine is an effective microvessel vasodilator. We describe two cases of successful treatment of no-reflow with intracoronary adenosine after failure of intracoronary calcium channel blockers. (J Interven Cardiol 2000; 13:1...