Publications by authors named "Ajay Kirtane"
Background: This retrospective study addresses the role of operator and fluoroscopy equipment in reducing patient radiation exposure in the Cath lab.
Methods: Data from 99,400 procedures performed in our institution between 2007 and 2019 were reviewed. Dosimetric parameters included reference point air kerma (K), Kerma Area Product (P), fluoroscopic time, and contrast volume.
Innovative therapies for hypertension are desperately needed given the rising prevalence and falling rates of control of hypertension despite an abundance of available medical therapies. Procedural interventions lower blood pressure without depending on adherence to medications, and endovascular renal denervation (RDN) is the interventional procedure with the best evidence base for the treatment of hypertension. After nearly two decades of study, with major refinements to devices, technique and trial design, two different systems for RDN received approval from the FDA in late 2023 for the treatment of hypertension.
View Article and Find Full Text PDFIschemic cardiomyopathy (ICM) is characterized by myocardial dysfunction due to myocardial ischemia, associated with the presence of significant coronary artery disease (CAD). We provide a comprehensive review of the current evidence for coronary revascularization in ICM, including consideration of the different modalities of coronary artery bypass grafting and percutaneous coronary intervention. In addition to a contemporary assessment of the literature, we aim to provide real-world insights and perspectives to guide clinical decision-making in this heterogeneous and complex patient population.
View Article and Find Full Text PDFAnticoagulation Among Patients Hospitalized for COVID-19 : A Systematic Review and Prospective Meta-analysis.
Ann Intern Med
January 2025
Background: Reported results of clinical trials assessing higher-dose anticoagulation in patients hospitalized for COVID-19 have been inconsistent.
Purpose: To estimate the association of higher- versus lower-dose anticoagulation with clinical outcomes.
Data Sources: Randomized trials were identified from the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.
Article Synopsis
- Patients who need oral anticoagulation and undergo coronary intervention can use a special stent (COBRA PzF) that may lower the need for long-term dual antiplatelet therapy (DAPT) while maintaining safety against blood clots.
- In a study, 996 patients were randomized to receive either the COBRA PzF stent with a short 14-day DAPT or a regular stent with longer DAPT durations of 3 to 6 months.
- Results showed that the COBRA stent did not significantly reduce bleeding compared to the control group and was not proven to maintain equivalent safety for thromboembolic events, indicating further investigation is needed.
Background: Renal-artery stenosis can be associated with difficult to control hypertension, although renal-artery stenting has not been shown to improve clinical outcomes. Alternative antihypertensive medications could potentially result in quality of life benefits with renal-artery stenting.
Methods: We performed a pre-specified quality of life sub-study of the CORAL trial-multicenter, randomized, open-label trial of renal-artery stenting versus medical therapy in patients with atherosclerotic renal-artery stenosis.
Article Synopsis
- A meta-analysis of randomized, sham-controlled trials was conducted to evaluate the effectiveness and safety of catheter-based renal denervation (RDN) in treating hypertension, involving 10 trials with a total of 2,478 patients.
- The study found that RDN significantly lowered both 24-hour and office systolic and diastolic blood pressure compared to sham procedures, without a notable difference in complications or changes in renal function.
- Overall, RDN appears to be a safe and effective method for reducing blood pressure in patients with hypertension, although significant variability was noted among the studies analyzed.
Article Synopsis
- A new implantable sensor has been created to measure the area of the inferior vena cava (IVC) to help monitor heart failure (HF) patients daily and predict fluid congestion.
- The study included 15 HF patients and assessed the sensor's safety, effectiveness, and data transmission, finding high accuracy in IVC measurements and excellent patient adherence to using the device.
- Results showed that the sensor was safe and effective, with improvements noted in patients' heart failure classification, indicating a need for further research into remote management of heart failure using this technology.
Article Synopsis
- Endovascular ultrasound renal denervation (uRDN) was shown to lower blood pressure effectively over 36 months in patients with resistant hypertension in the RADIANCE-HTN TRIO trial.
- The trial involved 69 patients receiving uRDN and 67 patients receiving a sham procedure, with follow-up showing significant blood pressure reductions from baseline and screening measurements.
- Results indicated that uRDN maintained its effectiveness without major safety issues throughout the 36-month follow-up period.
Article Synopsis
- A meta-analysis was conducted to evaluate the effectiveness and safety of catheter-based renal denervation (RDN) in patients with uncontrolled hypertension, including those on and off antihypertensive medications.
- The analysis included 15 randomized trials with a total of 2,581 patients, showing significant reductions in blood pressure for both groups, with larger decreases observed in those not taking medications.
- RDN was found to be effective in lowering blood pressure while also demonstrating a good safety profile, confirming its potential as a treatment option for uncontrolled hypertension.
Article Synopsis
- A study examined the safety and effectiveness of one-month dual antiplatelet therapy (DAPT) in high bleeding risk patients undergoing PCI with Resolute Onyx stents, focusing on differences between Asian and non-Asian patients.
- The results showed no significant differences in serious ischemic outcomes (like cardiac death or heart attacks) between matched groups from both regions, each with 12% incidence.
- However, Asian patients experienced significantly fewer major bleeding events (4%) compared to non-Asian patients (9%), despite similar initial bleeding risk profiles after matching.
Risk of Bleeding Among Cangrelor-Treated Patients Administered Upstream P2Y Inhibitor Therapy: The CAMEO Registry.
J Soc Cardiovasc Angiogr Interv
February 2024
Article Synopsis
- The study investigated the bleeding risk associated with cangrelor in patients with myocardial infarction (MI) who had previously taken an oral P2Y inhibitor before angiography.
- The CAMEO registry analyzed 1802 patients treated with cangrelor, finding that 21.4% had also received an oral P2Y inhibitor within the previous 24 hours.
- Results showed no significant difference in bleeding rates between patients with and without prior oral P2Y inhibitor exposure, indicating that cangrelor use does not substantially increase bleeding risk in either group.
The Path to a Match for Interventional Cardiology Fellowship: A Major SCAI Initiative.
J Soc Cardiovasc Angiogr Interv
July 2024
Article Synopsis
- The field of interventional cardiology (IC) has seen significant advancements and improved training programs over the last 40 years, including accredited fellowship programs and subspecialty certification.
- Despite these improvements, the application process for IC fellowships has been chaotic and inconsistent, causing stress and pressure on applicants due to competitive recruitment practices.
- A task force from the Society for Cardiovascular Angiography & Interventions has initiated a grassroots movement to create a national Match system for IC fellowships, aiming to establish fairness and equity in the application process.
Article Synopsis
- The study investigates the use of off-label peripheral drug-coated balloons (P-DCB) for treating coronary in-stent restenosis (ISR) in patients, as dedicated drug-coated balloons are not available in the U.S.
- Data from 31 patients treated at a high-volume center showed that a significant percentage had recurrent ISR and high-grade symptoms, with most lesions found in native coronary arteries.
- Follow-up indicated that while no post-procedural heart attacks occurred, there was a notable recurrence rate of ISR, with only 44.7% of patients free from further issues at the time of follow-up.
Article Synopsis
- * A total of 205 patients participated, with a 1-year target-vessel failure (TVF) rate of 7.4%, significantly below the performance goal set at 24.5%, and a 3-year TVF rate of 12.1%.
- * The findings indicate that using a provisional stenting approach for bifurcation lesions with the Resolute Onyx ZES led to positive clinical outcomes, suggesting it
SCAI Position Statement on Renal Denervation for Hypertension: Patient Selection, Operator Competence, Training and Techniques, and Organizational Recommendations.
J Soc Cardiovasc Angiogr Interv
August 2023
Article Synopsis
- Despite advancements in treatment, ST-elevation myocardial infarction (STEMI) still results in high mortality rates, leading to a greater focus on comfort-oriented care for those with poor prognoses.
- In a study of 536 STEMI patients, 11.4% died during hospitalization, with a significant number transitioning to comfort-focused care, especially those on mechanical circulatory support.
- Palliative care consultations were infrequent, occurring in only about 10% of cases, typically late in hospitalization, suggesting a need for earlier integration of comfort care strategies.
Article Synopsis
- A meta-analysis was conducted on ten randomized, sham-controlled trials involving 2,478 patients with hypertension to evaluate the efficacy and safety of catheter-based renal denervation (RDN) using first- and second-generation devices.
- The results showed that RDN significantly lowered both 24-hour and office systolic and diastolic blood pressure compared to a sham procedure, with reductions of up to 6.6 mmHg for systolic BP.
- Safety outcomes revealed no significant differences in adverse events, including vascular complications and renal function changes, between the RDN and sham groups, indicating that RDN is both effective and safe.
Article Synopsis
- Accurate IVUS measurements are crucial for optimizing coronary interventions by selecting the right device size and ensuring stent expansion.
- This study aimed to evaluate a machine learning (ML) model's effectiveness in automatically segmenting coronary artery images to determine vessel and lumen sizes, using expert analysis for comparison.
- Results showed strong correlation between ML and expert measurements, achieving over 90% accuracy in selecting appropriate balloon sizes based on vessel and lumen dimensions.