Farhan M. Asrar’s research while affiliated with University of Toronto and other places

Asrar et al. discuss the steps that the space sector is taking towards promoting equity, diversity, inclusion and accessibility, such as the world’s first parastronaut program. They propose that healthcare can learn from the space sector in enhancing disability inclusion and support for people, including healthcare workers, with disabilities.

Introduction: The evidence about the optimal revascularization strategy in patients with left-main coronary artery (LMCA) disease and impaired renal function is limited. Thus, we aimed to compare the outcomes of LMCA disease revascularization (PCI vs. CABG) in patients with and without impaired renal function. Methods: This retrospective cohort study included 2138 patients recruited from 14 centers between 2015 to 2019. We compared patients with impaired renal function who had PCI (n= 316) to those who had CABG (n= 121) and compared patients with normal renal function who had PCI (n= 906) to those who had CABG (n= 795). The study outcomes were in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE). Results: Multivariable logistic regression analysis showed that the risk of in-hospital MACCE was significantly higher in CABG compared to PCI in patients with impaired renal function [OR: 8.13 (95% CI: 4.19- 15.76), P<0.001] and normal renal function [OR: 2.59 (95% CI: 1.79- 3.73); P<0.001]. There were no differences in follow-up MACCE between CABG and PCI in patients with impaired renal function [HR: 1.14 (95% CI: 0.71- 1.81), P= 0.585] and normal renal function [HR: 1.12 (0.90- 1.39), P= 0.312]. Conclusions: PCI could have an advantage over CABG in revascularization of LMCA disease in patients with impaired renal function regarding in-hospital MACCE. The follow-up MACCE was comparable between PCI and CABG in patients with impaired and normal renal function.

Introduction: Evaluate the effects of baseline anemia and anemia following revascularization on outcomes in patients with Unprotected Left Main Coronary Artery (ULMCA) disease. Methods: This was a retrospective, multicenter, observational study conducted between January 2015 to December 2019. The data on patients with ULMCA who underwent revascularization through PCI or CABG was stratified by hemoglobin level at baseline into anemic and non-anemic groups to compare in-hospital events. The pre-discharge hemoglobin following revascularization was categorized into very low (<80 g/L for men & women), low (≥80 & ≤119 g/L for women & ≤129 g/L for men) and normal (≥130 g/L for men & ≥120 g/L for women) to assess impact on follow-up outcomes. Results: A total of 2138 patients were included, 796 (37.2%) of which had anemia at baseline. A total of 319 developed anemia after revascularization and moved from being non-anemic at baseline to anemic at discharge. There was no difference in hospital MACE and mortality between CABG and PCI in anemic patients. At a median follow-up time of 20 months (IQR: 27), patients with pre-discharge anemia who underwent PCI had higher incidence of congestive heart failure (P< 0.0001), and those who underwent CABG had significantly higher follow-up mortality (HR: 9.85 (95% CI: 2.53- 38.43), P= 0.001). Discussion/conclusion: In this Gulf LM study, baseline anemia had no impact upon in-hospital MACCE and total mortality following revascularization (PCI or CABG). However, pre-discharge anemia is associated with worse outcomes after unprotected LMCA disease revascularization, with significantly higher all-cause mortality in patients who had CABG, and higher incidence of CHF in PCI patients, at a median follow-up time of 20 months (IQR: 27).

Rationale: Exposure to poor air quality is associated with increased morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD), asthma and heart failure. A number of countries, including Canada, report utilization of the Air Quality Health Index (AQHI) and associated health messages tailored to different AQHI categories for the public and at-risk populations to reduce exposure, adjust physical activity and optimize clinical management. Studies indicate AQHI advisories may not adequately reach or inform at-risk populations. Objectives: The objectives of this study were to design a text alert system and evaluate the feasibility of delivering AQHI forecast alerts to participants when AQHI readings exceeded low health risk. Secondary and tertiary objectives were to determine the frequency and accuracy of the alerts. Methods: Feasibility was assessed by the following steps: • recruiting older adults with asthma, COPD and heart failure from primary care practices; • developing software for extracting AQHI data from the Health Canada database; • registering patients on the automatic dispatch messages system; and • automatically sending AQHI forecast alerts of moderate health risk or above to participants’ cell-phones the preceding night. Results: We successfully queried the Environment Canada database, detected AQHI alerts and delivered them to participants. Forecast alerts of moderate health risk were higher in summer and winter 2018-2019 in the study areas. The accuracy of AQHI forecast alerts for North Toronto versus Downtown Toronto were 81.7% (75.9 − 86.6%) and 80.7% (74.8 − 85.7%), respectively. Conclusions: Delivering AQHI alerts through text messages to patients in the primary care setting was feasible. Colder seasons should not be underestimated for moderate risk AQHI conditions.

Background: Atherosclerotic coronary plaque dissection (ACPD) is one cause of acute coronary syndrome caused by underlying atherosclerosis. Spontaneous coronary artery dissection (SCAD) occurs outside the setting of atherosclerosis among young women and individuals with few or no conventional atherosclerotic risk factors, and has emerged as an important cause of acute coronary syndrome, and sudden death. A comparison between ACPD and SCAD has not been previously addressed in the literature. Our study will compare ACPD and SCAD. Methods: Patients with confirmed diagnosis of SCAD and ACPD were retrospectively identified from 30 centers in 4 Arab Gulf countries between January 2011 and December 2017. In-hospital (VT/VF, MI, PCI, dissection extension, cardiogenic shock, death, ICD placement) and follow-up (MI, de-novo SCAD, spontaneous superior mesenteric artery dissection, death) events were compared between them. Results: 83 cases of SCAD and 48 ACPD were compared. ACPD patients were more frequently male (91.67% vs 49.40%, p<0.001) and older (58.5 vs 44, p<0.001). Cardiovascular risk factors were more prevalent in patients with ACPD, including diabetes mellitus (60.4% vs. 25.3%), dyslipidemia (62.5% vs. 38.5%), and hypertension (62.5% vs 31.3%), P<0.001. Hospital presentation of ST-elevation myocardial infarction was diagnosed in 48% of SCAD versus 27% of ACPD patients (p = 0.012). SCAD patients received medical-only treatment in 40% of cases and ACPD in 21% (p = 0.042). In-hospital and follow-up events were comparable in both groups (p = 0.25). Conclusions: Despite a completely different pathophysiology of ACS between SCAD and ACPD, in-hospital and follow-up events were comparable.