Publications by authors named "Anoop Koshy"
Objective: To develop age-appropriate nonaGEnaRIan And cenTenarian suRgICal (GERIATRIC) risk tool for classifying patients who may or may not develop postoperative complications or die within their index hospital admission.
Background: There are no validated perioperative risk stratification tools for use in nonagenarian and centenarian patients-people aged 90 to 99 years and >100 years.
Methods: In this retrospective observational study, nonagenarians and centenarians undergoing any surgical procedure were profiled.
Article Synopsis
- The study evaluates the effectiveness and safety of three calcium modification techniques—rotational atherectomy (RA), orbital atherectomy (OA), and intravascular lithotripsy (IVL)—for treating coronary calcified nodules (CN) with the help of optical coherence tomography (OCT).
- Among 154 patients examined, the results showed no significant difference in the minimal stent area (MSA) or the incidence of target vessel failure (TVF) after one year across the three techniques. RA had an MSA of 6.23 mm², OA 5.75 mm², and IVL 6.24 mm². The one-year TVF rates were also similar
Long-Term Continuous Terlipressin Infusion Improves Cardiac Reserve in Patients With Decompensated Cirrhosis.
Clin Gastroenterol Hepatol
August 2024
Article Synopsis
- Long-term use of terlipressin, a treatment for hepatorenal syndrome, may improve subclinical cardiac dysfunction in patients with decompensated cirrhosis, as suggested by a study of 22 patients.
- After 12 weeks of terlipressin infusion, patients showed a significant increase in cardiac output in response to stress, indicating improved cardiac reserve.
- The study found that while resting cardiac output decreased, the number of patients with impaired cardiac reserve dropped significantly, highlighting terlipressin's potential benefits in managing cardiac health in liver disease.
The impact of stress testing to guide PCI in patients with chronic coronary disease.
Cardiovasc Revasc Med
August 2024
Background: Guidelines and international appropriate use criteria increasingly endorse non-invasive stress testing to evaluate patients with suspected chronic coronary disease (CCD). We sought to review the real-world utilisation of non-invasive stress testing and investigate whether their use prior to PCI associates with outcomes in patients with CCD.
Methods: Consecutive patients from a multicentre registry who underwent PCI for CCD between 2006 and 2018 were included.
Contrast-Induced Encephalopathy Following Transcatheter Aortic Valve Replacement: A Case Series.
J Soc Cardiovasc Angiogr Interv
May 2024
Contrast-induced encephalopathy (CIE) is an idiopathic reaction following iodine-contrast dye administration in patients undergoing angiographic procedures. While it has been well-documented following coronary and carotid interventions, literature on CIE following transcatheter aortic valve replacement is limited. We report the multidisciplinary management of 3 patients with CIE following transcatheter aortic valve replacement.
View Article and Find Full Text PDFManaging health care for older adults aged 75 years and older can pose unique challenges stemming from age-related physiological differences and comorbidities, along with elevated risk of delirium, frailty, disability, and polypharmacy. This review is aimed at providing a comprehensive analysis of the management of acute coronary syndromes (ACS) in older patients, a demographic substantially underrepresented in major clinical trials. Because older patients often exhibit atypical ACS symptoms, a nuanced diagnostic and risk stratification approach is necessary.
View Article and Find Full Text PDFBackground: It remains unclear whether procedural myocardial infarction (pMI) and spontaneous myocardial infarction (spMI) have a similar impact on prognosis.
Objectives: The aim of this study was to assess mortality after pMI and spMI.
Methods: Patients with chronic coronary syndrome (CCS) and baseline troponin ≤1× the upper reference level (URL) or with acute spMI who underwent percutaneous coronary intervention (PCI) were included.
Background: An optimal pharmacological strategy for fast-track cardiac anesthesia (FTCA) is unclear. This study evaluated the effectiveness and safety of an FTCA program using methadone and non-opioid adjuvant infusions (magnesium, ketamine, lidocaine, and dexmedetomidine) in patients undergoing coronary artery bypass grafting.
Methods: This retrospective, multicenter observational study was conducted across private and public teaching sectors.
Article Synopsis
- Some patients prefer a procedure called PCI instead of a surgery called CABG, even if doctors recommend CABG.
- The study looked at the results of PCI in patients who were advised to have CABG but chose not to.
- It found that those who refused CABG had a higher risk of serious health issues, like death or stroke, after getting PCI compared to those who were advised to get PCI.
In a setting characterized by a growing prevalence of patients with alcohol-associated and metabolic dysfunction-associated steatotic liver diseases, coupled with an aging patient demographic, the incidence of cardiac comorbidities in liver transplant candidates is on the rise. These comorbidities not only pose barriers to transplant eligibility but also impact the intraoperative course and affect posttransplant outcomes. As such, there is a significant need to optimize the clinical management of these cardiac comorbidities.
View Article and Find Full Text PDFBackground/aims: The aim of this study was to prospectively evaluate stereotactic body radiotherapy (SBRT) with robotic radiosurgery in hepatocellular carcinoma patients with macrovascular invasion (HCC-PVT).
Materials And Methods: Patients with inoperable HCC-PVT, good performance score (PS0-1) and preserved liver function [up to Child-Pugh (CP) B7] were accrued after ethical and scientific committee approval [Clinical trial registry-India (CTRI): 2022/01/050234] for treatment on robotic radiosurgery (M6) and planned with Multiplan (iDMS V2.0).
Background: Redo-transcatheter aortic valve replacement (TAVR) can pin the index transcatheter heart valve leaflets open leading to sinus sequestration and restricting coronary access. The impact of initial implant depth and commissural alignment on redo-TAVR feasibility is unclear. We sought to determine the feasibility of redo-TAVR and coronary access after SAPIEN 3 (S3) TAVR stratified by implant depth and commissural alignment.
View Article and Find Full Text PDFBackground: Coronary alignment is proposed as an alternative to commissural alignment for reducing coronary overlap during transcatheter aortic valve replacement (TAVR). However, largescale studies are lacking.
Objectives: This study aimed to determine the incidence of coronary overlap with commissural vs coronary alignment using computed tomography (CT) simulation in patients undergoing TAVR evaluation.
Background: Coronary computed tomography angiography (CCTA) is increasingly being used in the preoperative workup for liver transplantation (LT). We sought to assess the utility of integrating CCTA with the novel CAD-LT (Coronary Artery Disease in Liver Transplantation) score and its impact on reducing the need for invasive coronary angiography prior to LT.
Methods: We conducted a retrospective cohort study of consecutive patients (age ≥ 18 years) who underwent CCTA for LT workup between 2011 and 2018 at the Victorian Liver Transplant Unit, Melbourne, Australia.
Early decongestion therapy with intravenous diuretics may be associated with improved outcomes in acute heart failure (AHF), however data is conflicting. This meta-analysis sought to evaluate the impact of door-to-IV diuretic (D2D) time on mortality in patients with AHF. Pooled estimates from observational studies comprising 28,124 patients, early IV diuresis (reference time 30-105 minutes) was associated with a 23% reduction in 30-day mortality in AHF (OR 0.
View Article and Find Full Text PDFBackground: Markers of systemic inflammation, such as high-sensitivity C-reactive protein (hsCRP), have been associated with the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) in patients undergoing percutaneous coronary intervention (PCI). Whether this risk varies according to the presence of high bleeding risk (HBR) conditions is unclear.
Objectives: The aim of this study was to evaluate the impact of systemic inflammation, as measured by hsCRP levels and cardiovascular outcomes in patients stratified by HBR status following PCI.
Background: Mineralocorticoid receptor antagonists (MRAs) have emerged as potential therapy to target the underlying arrhythmogenic substrate in atrial fibrillation (AF). Nevertheless, there have been inconsistent results on the impact of MRAs on AF.
Objective: We sought to evaluate the effect of MRAs on AF incidence and progression in patients with and without heart failure.
Aim: To assess the value of the thrombotic risk criteria proposed in the 2023 guidelines of the European Society of Cardiology (ESC) for the management of acute coronary syndrome (ACS) to predict the ischaemic risk after percutaneous coronary intervention (PCI).
Methods And Results: Consecutive patients with acute or chronic coronary syndrome undergoing PCI at a large tertiary-care center from 2014 to 2019 were included. Patients were stratified into low, moderate, or high thrombotic risk based on the ESC criteria.