Publications by authors named "Marcus Flather"

Article Synopsis
  • Percutaneous active mechanical circulatory support (MCS) devices are increasingly used for treating acute myocardial infarction-related cardiogenic shock (AMICS), but there is mixed evidence on their impact on patients' mortality rates.
  • This study conducted an individual patient data meta-analysis of randomised controlled trials to assess the effect of early routine active MCS versus control treatments on 6-month all-cause mortality in AMICS patients.
  • The analysis included nine studies with a total of 1114 patients and found that four trials evaluated venoarterial extracorporeal membrane oxygenation (VA-ECMO) while five focused on left ventricular unloading devices, contributing valuable insights into their effectiveness in this patient group.
View Article and Find Full Text PDF

Background: Whether a conservative strategy of medical therapy alone or a strategy of medical therapy plus invasive treatment is more beneficial in older adults with non-ST-segment elevation myocardial infarction (NSTEMI) remains unclear.

Methods: We conducted a prospective, multicenter, randomized trial involving patients 75 years of age or older with NSTEMI at 48 sites in the United Kingdom. The patients were assigned in a 1:1 ratio to a conservative strategy of the best available medical therapy or an invasive strategy of coronary angiography and revascularization plus the best available medical therapy.

View Article and Find Full Text PDF
Article Synopsis
  • A recent meta-analysis found that routine veno-arterial ECMO (VA-ECMO) does not improve outcomes for patients with acute myocardial infarction-related cardiogenic shock (AMI-CS), while a specific microaxial flow pump did lower mortality in a certain patient group.
  • Individual patient data from four randomized trials were analyzed, focusing on patients similar to those in the DanGer-Shock trial, which aimed at understanding the 180-day all-cause mortality rates with VA-ECMO.
  • Despite a numerically lower 6-month mortality rate with VA-ECMO (45% vs. 51% in control), the risks of major bleeding and peripheral vascular complications were higher, suggesting no clear mortality benefit in this population.
View Article and Find Full Text PDF
Article Synopsis
  • The article investigates minimal clinically important differences (MCIDs) in quality of life (QoL) for patients who underwent coronary artery bypass grafting (CABG) within the arterial revascularization trial (ART).
  • It uses quality of life measures such as the EQ-5D and SF-36 scores taken at baseline, 5 years, and 10 years post-surgery, finding significant improvements in QoL after CABG.
  • The identified MCIDs are linked to lower mortality risks long term, suggesting their importance for patient monitoring and clinical trial design.
View Article and Find Full Text PDF

Cardiac surgery may lead to myocardial damage and release of cardiac biomarkers through various mechanisms such as cardiac manipulation, systemic inflammation, myocardial hypoxia, cardioplegic arrest and ischaemia caused by coronary or graft occlusion. Defining perioperative myocardial infarction (PMI) after cardiac surgery presents challenges, and the association between the current PMI definitions and postoperative outcomes remains uncertain. To address these challenges, the European Association of Cardio-Thoracic Surgery (EACTS) facilitated collaboration among a multidisciplinary group to evaluate the existing evidence on the mechanisms, diagnosis and prognostic implications of PMI after cardiac surgery.

View Article and Find Full Text PDF
Article Synopsis
  • The study aimed to assess if a very early invasive strategy (IS) with possible revascularisation improves outcomes compared to standard care for high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS).
  • 425 patients were randomly assigned to either very early IS (within 90 minutes) or standard IS (within 72 hours), but the trial was halted early due to slow recruitment amid the COVID-19 pandemic.
  • At 12 months, there were no significant differences in clinical outcomes between the two groups, although the very early IS group had a shorter hospital stay.
View Article and Find Full Text PDF

Aims: The fragmentation and loss of elastic fibre in the tunica media of the aorta are pathological hallmarks of Marfan syndrome (MFS) but the dynamics of elastin degradation and its relationship to aortic size and physiological growth remain poorly understood.

Methods And Results: In this analysis of the AIMS randomized controlled trial, the association of plasma desmosine (pDES)-a specific biomarker of mature elastin degradation-with age and aortic size was analysed in 113 patients with MFS and compared to 109 healthy controls. There was a strong association between age and pDES in both groups, with higher pDES levels in the lower age groups compared to adults.

View Article and Find Full Text PDF
Article Synopsis
  • A study evaluated the impact of diabetes and obesity on ten-year outcomes after coronary artery bypass graft (CABG) surgery, focusing on all-cause mortality and other health complications.
  • Results indicated that patients with diabetes, especially those with insulin-dependent diabetes, faced a significantly higher risk of mortality and sternal wound complications compared to those without diabetes, regardless of obesity status.
  • Interestingly, obesity alone did not increase long-term mortality risk, suggesting that it may have a "protective" effect when coupled with diabetes in CABG patients.
View Article and Find Full Text PDF

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with cardiogenic shock despite the lack of evidence from adequately powered randomised clinical trials. Three trials reported so far were underpowered to detect a survival benefit; we therefore conducted an individual patient-based meta-analysis to assess the effect of VA-ECMO on 30-day death rate.

Methods: Randomised clinical trials comparing early routine use of VA-ECMO versus optimal medical therapy alone in patients presenting with infarct-related cardiogenic shock were identified by searching MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and trial registries until June 12, 2023.

View Article and Find Full Text PDF
Article Synopsis
  • Patients with diabetes show improved long-term survival rates when treated with bilateral internal thoracic arteries (BITA) compared to single internal thoracic artery (SITA), while the benefits for patients with obesity remain unclear.
  • The study reviewed multiple studies and showed a significant reduction in mortality for BITA in diabetic patients, but a non-significant trend in obesity patients; however, sternal wound complications were more common with BITA in both groups.
  • Overall, while BITA could be beneficial for diabetic patients, its potential complications raise concerns, leading to a recommendation for more research, especially regarding its use in patients with obesity.
View Article and Find Full Text PDF

Aim: Transfemoral Trans-catheter Aortic Valve Replacement (TF-TAVR) is a safe and effective therapy compared with surgical aortic valve replacement (SAVR) in patients across all risk profiles using balloon-expandable valves (BEV) and self-expanding valves (SEV). Our aim was to compare safety and efficacy of BEV vs. SEV in high-risk patients undergoing TF-TAVR.

View Article and Find Full Text PDF

Background: Cardiogenic shock (CGS) occurs in 10% of patients presenting with acute myocardial infarction (MI), with in-hospital mortality rates of 40-50% despite revascularisation.

Aims: The EURO SHOCK trial aimed to determine if early use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) could improve outcomes in patients with persistent CGS following primary percutaneous coronary intervention (PPCI).

Methods: This multicentre, pan-European trial randomised patients with persistent CGS 30 minutes after PPCI of the culprit lesion to receive either VA-ECMO or continue with standard therapy.

View Article and Find Full Text PDF
Article Synopsis
  • This research looked at how reliable two different computer programs are at measuring a heart problem called mitral regurgitation (MR) using special heart scans.
  • They used data from 35 patients and tested different ways to measure MR.
  • The study found that both computer programs worked really well together, showing that the new 4D-flow method is just as good as the older methods for measuring MR.
View Article and Find Full Text PDF
Article Synopsis
  • This study looked at how well a new kind of heart scanning called 4D flow cardiac MRI works compared to a traditional method called Doppler echocardiography when measuring heart function.
  • They found that the results from both methods for measuring how quickly blood flows through the heart were very similar in different groups of patients, whether their heartbeats were normal or irregular.
  • Overall, the new MRI method was just as good as the traditional method for measuring important heart speed indicators, which can help doctors understand heart health better.
View Article and Find Full Text PDF

Aortic stenosis (AS) is a serious and complex condition, for which optimal management continues to evolve rapidly. An understanding of current clinical practice guidelines is critical to effective patient care and shared decision-making. This state of the art review of the 2021 European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines and 2020 American College of Cardiology/American Heart Association Guidelines compares their recommendations for AS based on the evidence to date.

View Article and Find Full Text PDF

Background: To validate the k-adaptive-t autocalibrating reconstruction for Cartesian sampling (kat-ARC), an exclusive sparse reconstruction technique for four-dimensional (4D) flow cardiac magnetic resonance (CMR) using conservation of mass principle applied to transvalvular flow.

Methods: This observational retrospective study (2020/21-075) was approved by the local ethics committee at the University of East Anglia. Consent was waived.

View Article and Find Full Text PDF