Madhu Natarajan

Madhu Natarajan
Population Health Research Institute | PHIRI · Knowledge Translation

About

234
Publications
18,196
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
12,358
Citations
Introduction
Skills and Expertise

Publications

Publications (234)
Article
Background: Mineralocorticoid receptor antagonists have been shown to reduce mortality in patients after myocardial infarction with congestive heart failure. Whether routine use of spironolactone is beneficial after myocardial infarction is uncertain. Methods: In this multicenter trial with a 2-by-2 factorial design, we randomly assigned patient...
Article
Background Timely diagnosis and treatment for ST-elevation myocardial infarction (STEMI) requires a coordinated response from multiple providers. Rapid intervention is key to reducing mortality and morbidity. Activation of the cardiac catheterization laboratory may occur through verbal communication and may also involve the secure sharing of electr...
Article
BACKGROUND The learning curve for new operators performing ultrasound-guided transfemoral access (TFA) remains uncertain. METHODS We performed a pooled analysis of the FAUST (Femoral Arterial Access With Ultrasound Trial) and UNIVERSAL (Routine Ultrasound Guidance for Vascular Access for Cardiac Procedures) trials, both multicenter randomized cont...
Preprint
BACKGROUND The delivery of timely and appropriate care is crucial for survival in patients experiencing ST-elevation myocardial infarction (STEMI). Efficient communication and exchange of test results between the referring emergency medicine (EM) physician or Emergency Medical Service (EMS) paramedic and the interventional cardiologist (IC) is esse...
Preprint
BACKGROUND Timely diagnosis and access to treatment for ST Elevation Myocardial Infarction (STEMI) requires a coordinated response from multiple providers. Rapid intervention is key to reduce mortality and morbidity. Activation of the cardiac catheterization laboratory may occur via verbal communication and may also involve the secure sharing of el...
Article
Background: The optimal strategy to prevent no-reflow in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) is unknown. Aims: We aimed to examine the effect of thrombectomy on the outcome of no-reflow in key subgroups and the adverse clinical outcomes associated with no-reflow. Methods: We p...
Article
Background: Whether ultrasound (US)-guided femoral access compared to femoral access without US guidance decreases access site complications in patients receiving a vascular closure device (VCD) is unclear. Aims: We aimed to compare the safety of VCD in patients undergoing US-guided versus non-US-guided femoral arterial access for coronary proce...
Article
Full-text available
Background Coronary computed tomographic angiography (CCTA) is preferable to invasive coronary angiography (ICA) for coronary artery disease (CAD) diagnosis in elective patients without known CAD. Methods We conducted a non-randomized interventional study involving two tertiary care centres in Ontario. From July 2018–February 2020, outpatients ref...
Article
Full-text available
Background: In patients with STEMI, early initiation of high-intensity statin, regardless of LDLcholesterol levels, is the standard of practice worldwide. Aims: To determine the effect of a similar early initiation strategy using PCSK9 inhibitor added to highintensity statin on LDL-cholesterol in acute STEMI. Methods: In a randomized, double-blind...
Article
Importance A significant limitation of femoral artery access for cardiac interventions is the increased risk of vascular complications and bleeding compared with radial access. Strategies to make femoral access safer are needed. Objective To determine whether routinely using ultrasonography guidance for femoral arterial access for coronary angiogr...
Article
Full-text available
Background A significant limitation of femoral artery access for cardiac interventions is the increased risk of vascular complications and bleeding compared to radial access. Ultrasound (US) guided femoral access may reduce major vascular complications and bleeding. We aim to determine whether routinely using US guidance for femoral arterial access...
Article
Full-text available
Background Preliminary evidence suggests that providing longer duration prescriptions at discharge may improve long-term adherence to secondary preventative cardiac medications among post-myocardial infarction (MI) patients. We implemented and assessed the effects of two hospital-based interventions—(1) standardized prolonged discharge prescription...
Article
Full-text available
Background Conventional clinical risk scores and diagnostic algorithms are proving to be sub-optimal in the prediction of obstructive coronary artery disease, contributing to the low-diagnostic yield of invasive angiography. Machine learning could help better predict which patients would benefit from invasive angiography versus other non-invasive d...
Article
Background The COMPLETE trial (Complete Versus Culprit-Only Revascularization to Treat Multi-Vessel Disease After Early PCI for STEMI) demonstrated that staged nonculprit lesion percutaneous coronary intervention (PCI) reduced major cardiovascular events in patients with ST-segment–elevation myocardial infarction and multivessel coronary artery dis...
Article
Full-text available
Background In patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), selecting antithrombotic regimen requires balancing risks of ischemic cardiac events, stroke, and bleeding. Methods We studied 467 patients with AF undergoing PCI from 12/2015 to 07/2018 identified via a chart audit by 47 Canadian cardiologist...
Article
Full-text available
Background As a result of the COVID-19 pandemic first wave, reductions in STEMI invasive care ranging from 23% to 76% have been reported from various countries. Whether it had any impact on coronary angiography (CA) volume or on mechanical support device use for ST-elevation myocardial infarction (STEMI) and post-STEMI mechanical complications in C...
Article
Full-text available
Background The incidence of Coronavirus disease 2019 (COVID-19) in patients with ST-segment elevation myocardial infarction (STEMI) has not been fully described. Methods All patients with STEMI undergoing primary percutaneous coronary intervention (PCI) in Ontario, Canada between March 1st and September 30th, 2020 were included. Rates of positive...
Article
Full-text available
Importance Patients with shorter ischemic times have a greater viable myocardium and may derive greater benefit from thrombus aspiration. Objective To study the association of thrombus aspiration with outcomes among patients presenting with ST-segment elevation myocardial infarction (STEMI) based on time. Design, Setting, and Participants The TOT...
Article
Full-text available
BACKGROUND The objective of this study was to evaluate adherence to guideline-recommended cardiac secondary prevention therapies by immigration and ethnicity. METHODS We conducted a retrospective sub-study of the Interventions Supporting Long-Term Adherence and Decreasing Cardiovascular Events (ISLAND) randomized control trial. A cohort of 1,642 p...
Article
Background: Although fractional flow reserve (FFR) thresholds have been established to guide the use of percutaneous coronary intervention (PCI) or medical therapy, little is known about the adherence to FFR thresholds for PCI in clinical practice and their association with clinical outcomes. Methods: Adults undergoing FFR assessment in a single ve...
Article
Full-text available
Background Based on high-quality evidence, guidelines recommend the long-term use of secondary prevention medications post-myocardial infarction (MI) to avoid recurrent cardiovascular events and death. Unfortunately, discontinuation of recommended medications post-MI is common. Observational evidence suggests that prescriptions covering a longer du...
Article
Full-text available
Background There is a lack of data on the burden of hospitalized AS in Canada. The primary study objective was to document the index and one-year costs of hospitalized patients with aortic stenosis (AS) in Canada. Secondary objectives were to explore results by treatment modality and Canadian provinces. Methods Hospitalized patients with a most re...
Article
Full-text available
Importance Although the heart team approach is recommended in revascularization guidelines, the frequency with which heart team decisions differ from those of the original treating interventional cardiologist is unknown. Objective To examine the difference in decisions between the heart team and the original treating interventional cardiologist fo...
Article
Full-text available
Objective: A randomized trial informed by the Health Action Process Approach evaluated interventions to improve cardiac rehabilitation completion following myocardial infarction. We investigated indirect effects of the interventions on completion via targeted constructs. Methods: In this theory-based process evaluation, participants in all 3 trial...
Article
Full-text available
(250 words) In Ontario, on March 16th, 2020, a directive was issued to all acute care hospitals to halt non-essential procedures in anticipation for a potential surge in COVID-19 patients. This included scheduled outpatient cardiac surgical and interventional procedures that required the use of intensive care units, ventilators, and skilled critica...
Preprint
BACKGROUND Based on high quality evidence, guidelines recommend the long-term use of secondary prevention medications post-myocardial infarction (MI) to help reduce recurrent cardiovascular events and death. Unfortunately, discontinuation of recommended medications post-MI is common. Observational evidence suggests that prescriptions covering a lon...
Article
Full-text available
Remote ambulatory cardiac monitoring (rACM) could identify high-grade AV block (AVB) before and after transcatheter aortic valve replacement (TAVR).Retrospective analysis of patients undergoing TAVR that underwent 14-day rACM before and after TAVR.Of 62 patients undergoing TAVR, 41 patients had rACM pre-TAVR. Three patients had asymptomatic AVB lea...
Article
Full-text available
The globe is currently in the midst of a COVID-19 pandemic resulting in significant morbidity and mortality. This pandemic has placed considerable stress on health care resources and providers. This document from the Canadian Association of Interventional Cardiology - Association Canadienne de Cardiologie d'intervention, specifically addresses the...
Article
Full-text available
Background: The COMPLETE (Complete vs Culprit-only Revascularization to Treat Multi-vessel Disease After Early PCI for STEMI) trial demonstrated that staged nonculprit lesion percutaneous coronary intervention (PCI) reduced major cardiovascular (CV) events in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary...
Article
Full-text available
Background: Remote ischemic conditioning (RIC) is a noninvasive therapeutic strategy that uses brief cycles of blood pressure cuff inflation and deflation to protect the myocardium against ischemia-reperfusion injury. We sought to compare major adverse cardiovascular events (MACE) for patients who received RIC before PCI for ST-segment-elevation m...
Article
Objectives: To assess the relationship between preprocedural anticoagulation use and clinical and angiographic outcomes. Background: For patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), the optimal timing of anticoagulant administration remains uncertain. Methods: Patients en...
Article
Background In patients with severe calcific aortic stenosis, transcatheter aortic valve replacement (TAVR) has been shown to significantly improve quality of life (QOL). However, changes in QOL at early follow-up (<1 month), and following next-day discharge are poorly understood. Methods A total of 411 patients at 13 centers were enrolled in the M...
Article
Optimal postprocedural antithrombotic regimen is uncertain after transcatheter aortic valve replacement (TAVR). We developed an online questionnaire on post-TAVR antithrombotic management. After research ethics board approval, we distributed the survey to TAVR implanters across Canada. A total of 24 TAVR implanters from 17 centres responded to the...
Article
Full-text available
Background To manage overcrowding and bed shortages in Canadian hospitals, same‐day discharge ( SDD ) after percutaneous coronary intervention ( PCI ) has emerged as a solution to improve resource utilization. However, limited information exists regarding current trends, hospital variation, and safety of SDD PCI in Canada. Methods and Results We e...
Article
Objectives: The authors sought to prospectively determine the safety and efficacy of next-day discharge using the Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) Clinical Pathway. Background: Transfemoral transcatheter aortic valve replacement (TAVR) is an alternative to surgery in high- and intermediate-risk patients; however, h...
Article
Full-text available
Rapid reperfusion of the infarct-related artery is the cornerstone of therapy for the management of acute ST-elevation myocardial infarction (STEMI). Canada's geography presents unique challenges for timely delivery of reperfusion therapy for STEMI patients. The Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology STEMI...
Article
Full-text available
Abstract Background Compared to ST-segment elevation myocardial infarction (STEMI) patients who present at centres with catheterization facilities, those transferred for primary percutaneous coronary intervention (PCI) have substantially longer door-in to door-out (DIDO) times, where DIDO is defined as the time interval from arrival at a non-PCI ho...
Article
Objectives: Patients with annular areas just above nominal S3 valve areas are at increased risk of over-sizing if a larger valve is implanted. We therefore evaluated the rate of permanent pacemaker (PPM) implantation associated with avoiding over-sizing by selective deployment balloon over-filling during transcatheter aortic valve replacement (TAV...
Article
Background: Despite evidence of high heritability, monogenic disorders are identified in a minor fraction of individuals with early-onset coronary artery disease (EOCAD). We hypothesized that some individuals with EOCAD carry a high number of common genetic risk variants, with a combined effect similar to Mendelian forms of coronary artery disease...
Article
Rationale, aims, and objectives: Access to timely ST-elevation myocardial infarction (STEMI) care is facilitated by paramedics and emergency medical services (EMS). However, a large proportion of STEMI patients do not access care through EMS. This study sought to identify patient-reported factors for their decision to use (or not use) EMS. Method...
Article
Background: The contribution of thrombosis to the aetiology of perioperative myocardial infarction (MI) is uncertain. We used optical coherence tomography (OCT) to determine the presence of thrombus and plaque morphology in patients experiencing a perioperative MI and matched patients experiencing a non-operative MI using OCT. Methods: We conduc...
Data
Table S1. Baseline Characteristics Grouped by Smoking Status Table S2. Baseline Characteristics Grouped by Clopidogrel Regimen (Standard Vs Double‐Dose)
Article
Full-text available
Background Prior Studies have suggested better outcomes in smokers compared with nonsmokers receiving clopidogrel (“smoker's paradox”). The impact of a more intensive clopidogrel regimen on ischemic and bleeding risks in smokers with acute coronary syndromes requiring percutaneous coronary interventions remains unclear. Methods and ResultsWe analyz...
Article
Background In patients with out-of-hospital cardiac arrest (OHCA) who achieve return of spontaneous circulation (ROSC), coronary angiography (CAG) may improve outcomes. We conducted a systematic review and meta-analysis to elucidate the benefit and optimal timing of early CAG in comatose OHCA patients with ROSC. Methods We searched MEDLINE, EMBASE...
Article
Background: The optimal antithrombotic regimen for patients with coexistent atrial fibrillation (AF) and coronary artery disease (CAD) requiring percutaneous coronary intervention (PCI) remains controversial.Methods: We performed a chart review of 2,645 consecutive patients with non-ST elevation or ST elevation myocardial infarction at a regional c...
Article
Background: Guidelines recommend cardiac rehabilitation and long-term use of cardiac medications for most patients who have had a myocardial infarction (MI), but adherence to these secondary prevention treatments is suboptimal. Methods: This is a multicenter, pragmatic, 3-arm randomized trial. Eligible patients (n = 2,742) with obstructive coron...
Article
Full-text available
Background Taking all recommended secondary prevention cardiac medications and fully participating in a formal cardiac rehabilitation program significantly reduces mortality and morbidity in the year following a heart attack. However, many people who have had a heart attack stop taking some or all of their recommended medications prematurely and ma...
Article
Objective: Our objective was to evaluate sex-differences in outcomes after trans-catheter aortic valve replacement (TAVR) in a population-based cohort from Ontario, Canada. Background: Prior studies comparing outcomes in men and women after TAVR have yielded divergent results. Some studies have suggested that women have better survival than men...
Article
Trans-catheter aortic valve implantation (TAVI) is the treatment of choice for inoperable and high risk patients with severe aortic stenosis. Our objectives were to elucidate potential differences in clinical outcomes and safety between balloon-expandable versus self-expandable trans-catheter heart valves (THV). We performed a retrospective cohort...
Article
This article has no abstract; the first 100 words appear below. The treatment of patients with atrial fibrillation who undergo percutaneous coronary intervention (PCI) is a common clinical dilemma. Approximately 10 to 15% of patients undergoing PCI have a history of atrial fibrillation.¹ Patients with atrial fibrillation are at increased risk for s...
Article
Full-text available
Background: Despite evidence-based recommendations, adherence with secondary prevention medications post-myocardial infarction (MI) remains low. Taking medication requires behaviour change, and using behavioural theories to identify what factors determine adherence could help to develop novel adherence interventions. Objective: Compare the utility...
Article
Cardiovascular disease encompasses coronary artery disease and valvular heart disease and the prevalence of both increases with age. Over the past decade the landscape of interventional cardiology has evolved to now encompass a new set of percutaneous procedures outside the coronary tree; including transcatheter aortic valve implantation, transcath...
Article
Full-text available
Background The adoption of the transradial (TR) approach over the traditional transfemoral (TF) approach has been hampered by concerns of increased radiation exposure—a subject of considerable debate within the field. We performed a patient‐level, multi‐center analysis to definitively address the impact of TR access on radiation exposure. Methods...
Article
Patient presentation: A 29-year-old woman born in Canada, gravida 3, para 2 at 12 weeks gestation, presented to the cardiac pregnancy clinic with a 1-month history of progressive shortness of breath on exertion and chest discomfort. Her medical history was significant for stenosis of a congenital bicuspid aortic valve for which she underwent surgic...
Article
Background: Patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction are at increased risk for adverse events. It is unclear if image guidance by optical coherence tomography (OCT) can improve outcomes in these patients. We compared OCT-guided versus angiography-guided primary PCI for ST-s...
Article
Introduction: Cardiac rehabilitation (CR) has a proven morbidity and mortality benefit, yet rates of referral remain low. We sought to elucidate the knowledge, utilization, referral, and endorsement practices of cardiac rehabilitation in a tertiary care centre.Methods: A 13-question survey was electronically distributed to all Internal Medicine res...
Article
Introduction: Cardiac rehabilitation (CR) has a proven morbidity and mortality benefit, yet rates of referral remain low. We sought to elucidate the knowledge, utilization, referral, and endorsement practices of cardiac rehabilitation in a tertiary care centre. Methods: A 13-question survey was electronically distributed to all Internal Medicine re...
Article
Full-text available
Background: Atrial fibrillation (AF) produces a five-fold increase in the risk of stroke, and the exclusion of the left atrial appendage (LAA), the main source of thrombi, is an interesting therapeutic option in patients with contraindication for oral anticoagulation. Objectives: The goal of this study was to evaluate the initial experience, immedi...
Article
This editorial refers to ‘The effect of cangrelor and access site on ischaemic and bleeding events: insights from CHAMPION PHOENIX’, by J.A. Gutierrez et al ., on page doi:10.1093/eurheartj/ehv498 In this issue of the journal, Gutierrez and colleagues present the radial vs. femoral subgroup analysis of the Cangrelor versus Standard Therapy to Ach...
Article
Background: Two large trials have reported contradictory results at 1 year after thrombus aspiration in ST elevation myocardial infarction (STEMI). In a 1-year follow-up of the largest randomised trial of thrombus aspiration, we aimed to clarify the longer-term benefits, to help guide clinical practice. Methods: The trial of routine aspiration T...