
Kreton MavromatisEmory University | EU · Department of Internal Medicine
Kreton Mavromatis
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131
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Introduction
Skills and Expertise
Publications
Publications (131)
BACKGROUND
The relationship between the extent and severity of stress-induced ischemia and the extent and severity of anatomic coronary artery disease (CAD) in patients with obstructive CAD is multifactorial and includes the intensity of stress achieved, type of testing used, presence and extent of prior infarction, collateral blood flow, plaque ch...
Background: Although residual angina after revascularization for chronic coronary disease (CCD) is common, it is unclear if the cause is incomplete revascularization of epicardial coronary disease or other ischemic mechanisms such as microvascular dysfunction or vasospastic angina.
Methods: Among invasively managed ISCHEMIA trial participants with...
BACKGROUND
The clinical impact of a chronic total occlusion (CTO) in patients with 3-vessel coronary artery disease undergoing fractional flow reserve–guided percutaneous coronary intervention (PCI) with current-generation drug-eluting stents or coronary artery bypass grafting (CABG) is unclear.
METHODS
The FAME 3 trial (Fractional Flow Reserve Ve...
BACKGROUND
The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated greater health status benefits with an initial invasive strategy, as compared with a conservative one, for patients with chronic coronary disease and moderate or severe ischemia. Whether these benefits vary globa...
Background:
Anatomic complete revascularization (ACR) and functional complete revascularization (FCR) have been associated with reduced death and myocardial infarction (MI) in some prior studies. The impact of complete revascularization (CR) in patients undergoing an invasive (INV) compared with a conservative (CON) management strategy has not bee...
Background:
The impact of complete revascularization (CR) on angina-related health status (symptoms, function, quality of life) in chronic coronary disease (CCD) has not been well studied.
Objectives:
Among patients with CCD randomized to invasive (INV) vs conservative (CON) management in ISCHEMIA (International Study of Comparative Health Effec...
Corresponding Author
Background:
Anatomical scoring systems have been used to assess completeness of revascularization but are challenging to apply to large real-world datasets.
Objectives:
The aim of this study was to assess the prevalence of complete revascularization and its association with longitudinal clinical outcomes in the U.S. Department of Veterans Affair...
Revascularization and medical therapy for chronic coronary disease have both evolved significantly over the last 50 years. A total of 4 contemporary randomized controlled trials- Clinical Outcomes Utilizing Revascularization and Aggressive drug Evaluation (COURAGE), Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D), Fractional...
Background
In the ISCHEMIA trial, individuals randomized to the conservative strategy (CON) could undergo coronary catheterization (cath) for suspicion of an endpoint event, persistent symptoms despite optimal medical therapy, or through protocol non-adherence. Understanding the reasons for cath in CON participants can aid in ISCHEMIA results inter...
Background
P2Y12 inhibitor medications are critical following percutaneous coronary intervention (PCI); however, adherence remains suboptimal. Our objective was to assess the effectiveness of a multifaceted intervention to improve P2Y12 inhibitor adherence following PCI.
Methods and Results
This was a modified stepped wedge trial of 52 eligible ho...
Background
In participants with concomitant chronic coronary disease and advanced chronic kidney disease (CKD), the effect of treatment strategies on the timing of dialysis initiation is not well characterized.
Methods and Results
In ISCHEMIA‐CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches–Chronic...
Background
Patients with three-vessel coronary artery disease have been found to have better outcomes with coronary-artery bypass grafting (CABG) than with percutaneous coronary intervention (PCI), but studies in which PCI is guided by measurement of fractional flow reserve (FFR) have been lacking.
Methods
In this multicenter, international, nonin...
Saphenous vein grafts (SVGs) have high rates of in-stent restenosis (ISR). We compared the baseline clinical and angiographic characteristics of patients and lesions that did develop ISR with those who did not develop ISR during a median follow-up of 2.7 years in the DIVA study (NCT01121224). We also examined the ISR types using the Mehran classifi...
Saphenous vein grafts (SVGs) remain the most frequently used conduits in coronary artery bypass graft surgery (CABG). Despite advances in surgical techniques and pharmacotherapy, SVG failure rates remain high, often leading to repeat coronary revascularization. The no-touch SVG harvesting technique (minimal graft manipulation with preservation of v...
Objectives
This study aimed to examine the concordance of coronary computed tomographic angiography (CCTA) assessment of coronary anatomy and invasive coronary angiography (ICA) as the reference standard in patients enrolled in the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA).
Background
P...
Background
The RESCUE (Randomized Evaluation of Patients with Stable Angina Comparing Utilization of Noninvasive Examinations) trial was a randomized, controlled, multicenter, comparative efficacy outcomes trial designed to assess whether initial testing with coronary computed tomographic angiography (CCTA) is noninferior to single photon emission...
Background:
Patients without obstructive coronary artery disease (CAD) may have epicardial or microvascular dysfunction. The purpose of this study was to characterize patterns of epicardial and microvascular dysfunction in men and women with stable and unstable angina undergoing functional coronary angiography to inform medical therapy.
Methods:...
Background
There is a paucity of data regarding the optimum timing of PCI in relation to TAVR.
Objective
We compared the major adverse cardiovascular and cerebrovascular events (MACCE) rates among patients who underwent percutaneous coronary intervention (PCI) before transcatheter aortic valve replacement (TAVR) with those who received PCI with/af...
Background
Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain.
Methods
We randomly assigned 5179 patients with moderate or severe ischemia to an initial invas...
Background
In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients.
Methods
We assessed angina-re...
Objectives
To compare transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) for patients in shock.
Background
There are minimal data on the clinical and echocardiographic outcomes for patients in shock that undergo TAVR and no data comparing these outcomes to similar patients undergoing SAVR.
Methods
This is...
Background:
Direct stenting without pre-dilation or post-dilation has been advocated for saphenous vein graft percutaneous coronary intervention to decrease the incidence of distal embolization, periprocedural myocardial infarction, and target lesion revascularization.
Methods:
We performed a post hoc analysis of patients enrolled in the DIVA (D...
Background:
Optimal medical therapy is endorsed by national guidelines in the management of ischemic heart disease; however, few studies have examined its long-term utilization following percutaneous coronary intervention (PCI) and association with clinical outcomes. We sought to assess longitudinal trends in medical therapy use after PCI and its...
Following primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction, microvascular perfusion is often impaired secondary to thrombotic embolization. Intracoronary (IC) fibrinolytic administration may reduce thrombotic burden and distal embolization. The ICE-T-TIMI-49 study evaluated the feasibility and safety...
Background:
P2Y12 inhibitors are critical following percutaneous coronary intervention (PCI) with stent placement; they reduce the risk of stent thrombosis and myocardial infarction. Despite the importance of the therapy, non-adherence is common among Veterans.
Methods and results:
Our main objective is to conduct a multi-site randomized stepped...
Objective
To evaluate contrast media (CM) volume (CMV) saved using the DyeVert™ Plus Contrast Reduction System (DyeVert Plus System, Osprey Medical) in patients undergoing diagnostic coronary angiogram (CAG) and/or percutaneous coronary interventional (PCI) procedures performed with manual injections.
Background
Current guidelines advocate for mon...
Background
We hypothesized that fractional flow reserve (FFR)–guided percutaneous coronary intervention (PCI) would be superior to medical therapy as initial treatment in patients with stable coronary artery disease.
Methods
Among 1220 patients with angiographically significant stenoses, those in whom at least one stenosis was hemodynamically sign...
Table S1. Hemodynamic and Intracoronary Doppler Measurements During the Individual Steps of the Study Protocol
Figure S1. Intracoronary Doppler tracing and respective hemodynamic measurements of a subject during the study protocol. Baseline (A) was the reference for acetylcholine (B) and adenosine (C). Pre‐MS (D) was the reference for MS (E), and...
Background
Coronary microvascular dysfunction may contribute to myocardial ischemia during mental stress (MS). However, the role of coronary epicardial and microvascular function in regulating coronary blood flow (CBF) responses during MS remains understudied. We hypothesized that coronary vasomotion during MS is dependent on the coronary microvasc...
Background:
Few studies have examined the efficacy of drug-eluting stents (DES) for reducing aortocoronary saphenous vein bypass graft (SVG) failure compared with bare-metal stents (BMS) in patients undergoing stenting of de-novo SVG lesions. We assessed the risks and benefits of the use of DES versus BMS in de-novo SVG lesions.
Methods:
Patient...
Objectives
To evaluate the role mitral regurgitation (MR) etiology and severity play in outcomes for patients undergoing transcatheter aortic valve replacement (TAVR).
Background
Multiple prior studies have investigated the influence of MR severity on outcomes for patients undergoing TAVR. Less has been published regarding the effects of MR etiolo...
Objectives:
This study sought to investigate predictors and safety of next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR).
Background:
Information about predictors and safety of NDD after TAVR is limited.
Methods:
The study reviewed 663 consecutive patients who underwent elective balloon-expandable TAVR (from July 2014...
Background:
Many patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis also have significant mitral regurgitation (MR). We sought to understand the association of concomitant MR with TAVR clinical outcomes, as well changes in MR following TAVR.
Methods:
Patients who underwent TAVR in the US Transcatheter Valve The...
Background
The Universal Definition of Myocardial Infarction recommends the 99th percentile concentration of cardiac troponin in a normal reference population as part of the decision threshold to diagnose type 1 spontaneous myocardial infarction. Adoption of this recommendation in contemporary worldwide practice is not well known.
Methods
We perfo...
Background:
Though several anatomical characteristics have been reported separately as risk factors for paravalvular leak (PVL) and landing zone (LZ) complications after transcatheter aortic valve replacement (TAVR), multivariate risk models are needed.
Methods:
Patients that underwent balloon-expandable TAVR with multidetector cardiac computed...
Objectives:
The authors sought to perform a meta-analysis of randomized clinical trials (RCTs) comparing the safety and efficacy of biodegradable polymer drug-eluting stents (BP-DES) to second-generation durable polymer drug-eluting stents (DP-DES).
Background:
Prior meta-analyses have established the superiority of BP-DES over bare-metal stents...
Background
Treatment for patients with end‐stage renal disease (ESRD) and severe aortic stenosis (AS) includes balloon aortic valvuloplasty (BAV), surgical (SAVR), or transcatheter (TAVR) aortic valve replacement. We compared outcomes among these strategies.
Methods
A retrospective review of patients with ESRD undergoing treatment for severe AS be...
Objectives:
To compare outcomes after minimalist and standard transfemoral transcatheter aortic valve replacement (TF-TAVR) in patients with severe chronic obstructive pulmonary disease (COPD).
Background:
TF-TAVR is increasingly performed with conscious sedation and transthoracic echocardiography guidance (minimalist). The safety/efficacy of th...
Background:
Screening for internal carotid artery stenosis (ICAS) with Doppler ultrasound is commonly used before cardiovascular surgery. Nevertheless, the relationship between ICAS and procedure-related stroke in isolated aortic valve replacement is unclear.
Methods:
We retrospectively reviewed patients with artery stenosis who underwent ICAS s...
RESCUE is a phase III, randomized, controlled, multicenter, comparative efficacy study, designed to compare two diagnostic imaging/treatment paradigms that use coronary computed tomography angiography (CCTA) or single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) for assisting in the diagnosis of ischemic heart diseas...
Background:
Neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratios (PLR) mark systemic inflammation. Patients with high NLR and PLR have worse cardiovascular disease and outcomes. We assessed the role of these ratios in predicting outcomes after transcatheter aortic valve replacement (TAVR).
Methods:
The association between NLR and PLR with...
Background:
Nontransfemoral (non-TF) transcatheter aortic valve replacement (TAVR) is often associated with worse outcomes than TF TAVR. We investigated the relationship between increasing Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) score and observed mortality and morbidity in TF and non-TF TAVR groups.
Methods:
We rev...
Objectives:
To evaluate the role of balloon annular sizing in transcatheter aortic valve replacement (TAVR).
Background:
Multidetector cardiac computed tomography (MDCT) is the gold standard for aortic annular sizing in TAVR. Balloon sizing is increasingly used in patients with borderline annular size and severe calcification. A comparison betwe...
Background: Patients with end-stage renal disease (ESRD) and severe aortic stenosis (AS) are a high risk population for which current treatment include balloon aortic valvuloplasty (BAV), surgical (SAVR) or transcatheter (TAVR) aortic valve replacement. We aimed to compare short-and one-year outcomes among these strategies.
Objectives:
The aim of this study was to examine the frequency, associations, and outcomes of native coronary artery versus bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (CABG) in the Veterans Affairs (VA) integrated health care system.
Background:
Patients with prior CABG surgery of...
Background
Severe aortic stenosis (AS) is commonly associated with mitral regurgitation (MR) in patients undergoing transcatheter aortic valve replacement (TAVR). The natural history of MR is not well defined in this population.
Methods
Consecutive high risk, inoperable patients undergoing TAVR between 2007 and 2011 for AS has echos at baseline and...
Chronic obstructive pulmonary disease (COPD) has been identified as a risk factor for morbidity and mortality after transcatheter aortic valve replacement (TAVR). We hypothesized that a portion of pulmonary dysfunction in patients with severe aortic stenosis may be of cardiac origin, and has potential to improve after TAVR.
A retrospective analysis...
A minimalist approach for transcatheter aortic valve replacement (MA-TAVR) utilizing transfemoral access under conscious sedation and transthoracic echocardiography is increasing in popularity. This relatively novel technique may necessitate a learning period to achieve proficiency in performing a successful and safe procedure. This report evaluate...
Transcatheter aortic valve replacement (TAVR) may offer extreme-aged patients a treatment alternative to surgical aortic valve replacement (SAVR). The objective of this study was to describe outcomes of TAVR in nonagenarians using transfemoral and alternative access techniques.
In a retrospective review, we found 95 nonagenarians who underwent TAVR...
This chapter focuses on the impact that medical therapy, diet, and psychosocial factors have on cardiovascular disease (CVD). It reviews the clinical data related to the prevention and medical management of CVD and highlights emerging therapies as well. There has been increasing interest in the primary and secondary prevention of atherosclerosis to...
Patients with diabetes have a high incidence of coronary artery disease, with particularly high rates of acute coronary syndromes and mortality. Revascularization by coronary artery bypass grafting was found to be effective in reducing angina and mortality in patients with extensive coronary artery disease over 30 years ago. Percutaneous coronary i...
Patient characteristics and procedural outcomes from nontransfemoral (non-TF) transcatheter aortic valve replacement (TAVR) in high-risk or inoperable patients with aortic stenosis have been incompletely reported. The purpose of this study was to compare outcomes with non-TF TAVR access techniques including transapical (TA), transaortic (TAo), and...
Objective: Stromal derived factor-1α/CXCL12 is a chemoattractant responsible for homing of progenitor cells to ischemic tissues. We aimed to investigate the association of plasma CXCL12 with long-term cardiovascular outcomes in patients with coronary artery disease (CAD). Methods: 785 patients aged: 63 ± 12 undergoing coronary angiography were inde...
Background:
We hypothesized that in patients with stable coronary artery disease and stenosis, percutaneous coronary intervention (PCI) performed on the basis of the fractional flow reserve (FFR) would be superior to medical therapy.
Methods:
In 1220 patients with stable coronary artery disease, we assessed the FFR in all stenoses that were visi...
Background:
An increasing number of patients with prior coronary artery bypass grafting (CABG) now present with severe aortic stenosis. The proposed benefit of surgical (SAVR) vs transcatheter aortic valve replacement (TAVR) is unknown. The objective of this study was to compare short-term and midterm outcomes of patients undergoing isolated SAVR...
Objectives:
The aim of this study was to compare transfemoral transcatheter aortic valve replacement (TF TAVR) performed in a catheterization laboratory (minimalist approach [MA]) with TF TAVR performed in a hybrid operating room (standard approach [SA]).
Background:
A MA-TF TAVR can be performed without general anesthesia, transesophageal echoc...
Background: 30-day readmission after percutaneous coronary intervention (PCI) is a common, expensive and potentially preventable problem. The relationship between 30-day readmission and long-term patient outcomes has not been studied within integrated care delivery settings. We sought to determine the association between 30-day readmission after PC...
Background: Angina-related health status as measured by the Seattle Angina Questionnaire (SAQ) has been shown to predict outcomes in patients with coronary artery disease (CAD), but few data are available for women. We sought to investigate the prognostic role of angina health status domains in predicting long-term outcomes in women.
Methods: 1062...
Importance
Many patients with peripheral artery disease (PAD) have walking impairment despite therapy. Experimental studies