Publications by authors named "Matthew Kelham"
Article Synopsis
- The BYPASS-CTCA trial found that using computed tomography cardiac angiography (CTCA) prior to invasive coronary angiography (ICA) in patients with previous bypass surgery reduces procedure time and the risk of kidney injury, improving patient satisfaction.
- In this study, 688 patients were divided into two groups: one receiving CTCA before ICA and the other receiving ICA alone, with follow-up averaging 3 years.
- Results showed that although benefits like being angina-free and improved quality of life were seen at 3 months, long-term outcomes showed CTCA/ICA patients had lower imaging resource use and fewer major adverse cardiac events compared to those who only had ICA.
Background: Despite tremendous therapeutic advancements, a significant proportion of coronary artery disease patients suffer from refractory angina pectoris, that is, quality-of-life-compromising angina that is non-manageable with established pharmacological and interventional treatment options. Adenoviral vascular endothelial growth factor-D (AdVEGF-D)-encoding gene therapy (GT) holds promise for the treatment of refractory angina.
Methods: ReGenHeart is an investigator-initiated, multicentre, randomised, placebo-controlled and double-blinded phase 2 clinical trial that aims to study the safety and efficacy of intramyocardially administered angiogenic AdVEGF-D GT for refractory angina.
Aims: The REGENERATE-COBRA trial (NCT05711849) will assess the safety and efficacy of an intracoronary infusion of autologous bone marrow-derived mononuclear cells in refractory angina patients with no revascularization options who are symptomatic despite optimal medical and device therapy.
Methods: REGENERATE-COBRA is a single site, blinded, randomized, sham-controlled, Phase II clinical trial enrolling 110 refractory angina patients with no revascularization options who are symptomatic despite optimal medical and device therapy. Patients will be randomized to either autologous bone marrow derived-mononuclear cells or a sham procedure.
Article Synopsis
- A routine invasive strategy is normally recommended for high-risk patients with non-ST-elevation acute coronary syndromes (NSTE-ACS), but patients with a history of coronary artery bypass graft (CABG) surgery were not included in significant trials informing these guidelines.
- A systematic review and meta-analysis evaluating 11 randomized controlled trials (RCTs) was performed to analyze outcomes such as mortality and hospitalization among patients with prior CABG receiving either routine invasive or conservative treatment for NSTE-ACS.
- The findings indicate that a routine invasive strategy does not offer any benefits over conservative treatment in terms of all-cause mortality, cardiac mortality, myocardial infarction, or cardiac-related hospitalization for patients with prior CABG.
Article Synopsis
- The study focuses on contrast-induced nephropathy (CIN), a type of kidney injury that can happen during heart procedures, and looks at how inorganic nitrate might help prevent it.
- In the trial called NITRATE-CIN, high-risk patients were given either potassium nitrate or a placebo for 5 days to see if it could lower the chances of developing CIN.
- Results showed that patients taking inorganic nitrate had a much lower rate of CIN (9.1%) compared to those on placebo (30.5%), and it also helped improve kidney function and reduce heart problems.
Background: Computed tomography cardiac angiography (CTCA) is recommended for the evaluation of patients with prior coronary artery bypass graft (CABG) surgery. The BYPASS-CTCA study demonstrated that CTCA prior to invasive coronary angiography (ICA) in CABG patients leads to significant reductions in procedure time and contrast-induced nephropathy (CIN), alongside improved patient satisfaction. However, whether CTCA information was used to facilitate selective graft cannulation at ICA was not protocol mandated.
View Article and Find Full Text PDFArticle Synopsis
- * Women with HF-CS tend to be older, have fewer prior heart issues, and lower rates of severe heart dysfunction compared to men, yet both genders received similar treatments.
- * Despite ranking equally in treatment use, the 30-day mortality rates were also comparable between sexes (around 53% for women and 51% for men), suggesting the need for further investigation into sex-specific treatment strategies.
Article Synopsis
- Researchers studied the use of mechanical circulatory support (MCS) in patients with non-ischaemic cardiogenic shock (CS), focusing on how left ventricular ejection fraction (LVEF) could influence patient outcomes.
- An analysis of 807 patients showed that while lower LVEF was linked to more severe shock, it didn't correlate with overall 30-day mortality risk; however, MCS appeared to reduce mortality in those with severely reduced LVEF (≤20%).
- The study suggests that incorporating LVEF into decision-making for MCS in non-ischaemic CS patients could improve patient outcomes by optimizing the benefit-risk ratio.
Article Synopsis
- - The study aimed to compare clinical characteristics and 30-day mortality rates between patients with de novo heart failure-related cardiogenic shock (HF-CS) and those with acute-on-chronic HF-CS, finding significant differences in outcomes.
- - An analysis of 1,030 patients revealed that while traditional markers of severity were similar, acute-on-chronic HF-CS was linked to higher mortality rates (55.9% vs. 45.5%) and greater severity of shock.
- - The results suggest that the chronicity of heart failure significantly influences the severity of cardiogenic shock, underlining the need to consider this factor in future clinical trials.
Article Synopsis
- Patients with prior coronary artery bypass grafting face increased complications when undergoing invasive coronary angiography, and this study examines whether computed tomography cardiac angiography (CTCA) can help mitigate this risk.
- A single-center randomized controlled trial was conducted, comparing outcomes between patients receiving CTCA prior to invasive coronary angiography versus those undergoing the procedure alone, focusing on procedural duration, patient satisfaction, and contrast-induced nephropathy.
- Results showed that the group receiving CTCA experienced a significantly shorter ICA procedure time (18.6 minutes vs. 39.5 minutes), indicating potential benefits of using CTCA in these patients.
Aims: Despite its high incidence and mortality risk, there is no evidence-based treatment for non-ischaemic cardiogenic shock (CS). The aim of this study was to evaluate the use of mechanical circulatory support (MCS) for non-ischaemic CS treatment.
Methods And Results: In this multicentre, international, retrospective study, data from 890 patients with non-ischaemic CS, defined as CS due to severe de-novo or acute-on-chronic heart failure with no need for urgent revascularization, treated with or without active MCS, were collected.
Article Synopsis
- The CREST tool was created to assess the death risk from circulatory causes in out-of-hospital cardiac arrest patients who do not have STEMI; this study aimed to validate its effectiveness with a different patient group and see if adding serum lactate levels improves it.
- The research involved analyzing the data from patients admitted with cardiac-related OHCA over 51 months, where the CREST score assigned points based on factors like heart conditions and ejection fraction.
- The results showed that the CREST score effectively predicted circulatory-aetiology deaths, but including lactate levels did not enhance its predictive power.
Therapeutic Implications of COVID-19 for the Interventional Cardiologist.
J Cardiovasc Pharmacol Ther
May 2021
Although COVID-19 is viewed primarily as a respiratory disease, cardiovascular risk factors and disease are prevalent among infected patients and are associated with worse outcomes. In addition, among multiple extra-pulmonary manifestations, there has been an increasing recognition of specific cardiovascular complications of COVID-19. Despite this, in the initial stages of the pandemic there was evidence of a reduction in patients presenting to acute cardiovascular services.
View Article and Find Full Text PDFBackground: Out-of-hospital cardiac arrest (OHCA) is a major cause of death worldwide. Recent guidelines recommend the centralisation of OHCA services in cardiac arrest centres to improve outcomes. In 2015, two major tertiary cardiac centres in London merged to form a large dedicated tertiary cardiac centre.
View Article and Find Full Text PDFA 19-year-old female with no medical history presented with bloody diarrhoea. Investigations revealed an acute kidney injury, thrombocytopenia and microangiopathic haemolysis. A diagnosis of haemolytic uraemic syndrome secondary to Shiga toxin-producing 055 was confirmed and supportive therapy commenced in the intensive therapy unit.
View Article and Find Full Text PDFObjective: Patient understanding of angiography and angioplasty is often incomplete at the time of consent. Language barriers and time constraints are significant obstacles, particularly in the urgent setting. We introduced digital animations to support consent and assessed the effect on patient understanding.
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