Publications by authors named "Michael G Nanna"
Introduction: The optimal revascularization strategy for patients with myocardial infarction (MI) and multivessel coronary artery disease (CAD) remains an area of research and debate. Fractional flow reserve (FFR)-guided complete revascularization (CR) by percutaneous coronary intervention (PCI) has emerged as an alternative to traditional culprit-only PCI.
Objective: To investigate the outcomes of FFR-guided CR versus culprit-only PCI in patients with MI and multivessel CAD.
Background: Randomized controlled trials (RCTs) of complete revascularization (CR) versus culprit-only revascularization (COR) in patients with ST-elevation myocardial infarction (STEMI) have shifted the recommendation for CR from class III to class I in the AHA/ACC/SCAI guidelines, but it remains unclear if the benefit of CR over COR extends to older adults, who have greater bleeding risk, comorbidity burden, and complexity of lesions. We performed a meta-analysis to place the results of the previous RCTs in the context of the recently published FIRE trial and the subgroup analysis of the COMPLETE trial in adults ≥75 years old.
Methods: We searched the literature from inception to October 21, 2023.
Background: Frailty is a common geriatric syndrome often coexisting with cardiovascular diseases such as atrial fibrillation (AF) and heart failure (HF) with reduced ejection fraction (HFrEF). While catheter ablation (CA) has demonstrated efficacy in reducing major adverse cardiovascular events and improving mortality and quality of life, the influence of frailty among this population remains unknown.
Objectives: The authors aimed to identify the prevalence of frailty among patients with HFrEF and AF undergoing CA and its influence on cardiovascular mortality and discharge disposition.
Frailty is a syndrome that can inform clinical treatments and interventions for older adults. Although implementation of frailty across medical subspecialties has the potential to improve care for the aging population, its uptake has been heterogenous. While frailty assessment is highly integrated into certain medical subspecialties, other subspecialties have only recently begun to consider frailty in the context of patient care.
View Article and Find Full Text PDFThe present guidelines recommend dual antiplatelet therapy (DAPT) for 6 to 12 months after percutaneous coronary intervention (PCI), with recent trials assessing the safety and efficacy of shortening DAPT duration to ≤3 months. A systematic search of PubMed, Scopus, and Cochrane Central databases identified studies comparing short DAPT, followed by P2Y12i monotherapy (78% ticagrelor) versus standard 12-month DAPT in patients who underwent PCI with a drug-eluting stent. A total of 9 randomized controlled trials, including 42,770 patients (short DAPT n = 21,370, 49.
View Article and Find Full Text PDFThis paper reviews the distinct clinical, pathophysiological, and therapeutic challenges faced by older women undergoing percutaneous coronary intervention (PCI). Older women present with a greater comorbidity burden, smaller coronary vessels, and post-menopausal hormonal changes, which increase procedural complexity and adverse cardiovascular outcomes. Despite these challenges, older women are less likely to receive evidence-based therapies, resulting in higher risks of major adverse cardiovascular events (MACE) and bleeding.
View Article and Find Full Text PDFBackground: Older adults with non-ST-segment-elevation acute coronary syndrome are less likely to undergo an invasive strategy compared with younger patients. Randomized controlled trials traditionally exclude older adults because of their high burden of geriatric conditions.
Methods And Results: We searched for randomized controlled trials comparing invasive versus medical management or a selective invasive (conservative) strategy for older patients (age≥75 years) with non-ST-segment-elevation acute coronary syndrome.
Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease caused by small- to medium-sized vessel vasculitis which can also impact the heart. Because of its rarity and diverse clinical manifestations, diagnosis can be challenging. Here, we present a unique case of EGPA causing perimyocarditis in a young female patient.
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- The study investigates the effects of beta-blocker (BB) use after a myocardial infarction (MI) in patients without heart failure or significantly reduced ejection fraction, aiming to clarify mixed findings from past research.
- Analyzing data from 24 studies involving over 290,000 patients, the research found that BB use was linked to an 11% reduction in all-cause mortality, though this result showed moderate to high variability across studies.
- Subgroup analyses indicated that while BBs provided mortality benefits in patients with a one-year event-free period, those benefits diminished over time, especially in individuals with preserved ejection fraction post-2010, where BBs showed no significant mortality reduction
Background: Patients with type 2 diabetes mellitus (DM) comprise more than a quarter of all patients undergoing percutaneous coronary intervention and are at higher risk of adverse events. We sought to reexamine the optimal duration of dual antiplatelet therapy (DAPT) postpercutaneous coronary intervention in patients with DM.
Methods: We systematically included randomized controlled trials comparing any 2 of 1, 3, 6, and 12 months of DAPT that reported major adverse cardiovascular events (MACE), net adverse clinical events (NACE), bleeding, or stent thrombosis in DM, and performed a frequentist network meta-analysis.
Article Synopsis
- * Frailty serves as an important indicator in CVD patients, affecting prevention strategies and complicating their participation in major clinical trials.
- * The review emphasizes the need for better understanding and management of frailty to improve CVD care and explores future approaches for detecting and modifying frailty in affected individuals.
Meta-analyses have suggested the risk of cardiovascular disease (CVD) events is significantly higher after a chronic obstructive pulmonary disease (COPD) exacerbation. However, many of these studies have included a broad array of CVD events or have been limited to highly selected patient populations potentially not generalizable to the broader population of COPD. We assessed the risk of atherosclerotic cardiovascular disease (ASCVD) hospitalizations after COPD hospitalization compared with before COPD hospitalization and identified patient factors associated with ASCVD hospitalizations after COPD hospitalization.
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- Complete revascularization after a myocardial infarction (MI) leads to lower all-cause mortality compared to just treating the main blockage (culprit revascularization) in patients with multivessel coronary artery disease.
- An analysis of 24 trials with over 16,000 patients showed that complete revascularization also significantly decreased rates of additional MIs and major cardiac events.
- Immediate complete revascularization is preferred over staged approaches for achieving better outcomes, while risks of stent thrombosis and other complications remained similar between methods.
Background: Cardiogenic shock (CS) in the setting of acute myocardial infarction (AMI) is associated with high morbidity and mortality. Frailty is a common comorbidity in patients with cardiovascular disease and is also associated with adverse outcomes. The impact of preexisting frailty at the time of CS diagnosis following AMI has not been studied.
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- A study analyzed 955,320 admissions for atrial fibrillation (AF) in the Midwest and Northeast U.S. from 2016 to 2020, organized by seasons.
- The results showed that winter had the highest admissions at 25.5%, followed by fall, summer, and spring, with significant differences noted across all seasons.
- The findings concluded that there is a clear seasonal pattern in AF admissions, with admissions peaking in winter and declining in spring.
Article Synopsis
- The study examines the long-term quality-of-life (QoL) outcomes for older adults (65+) with stable ischemic heart disease (SIHD) and diabetes after different treatment methods: intensive medical therapy (IMT) alone, revascularization (PCI or CABG) with optimal medical therapy (OMT).
- A total of 929 patients were analyzed over five years, revealing no significant differences in QoL metrics such as self-health score and Duke activity status index (DASI) between those who underwent PCI or CABG compared to those who received IMT alone.
- The findings suggest that both treatment approaches lead to similar QoL outcomes, highlighting the need for more targeted research in older adults regarding SIHD treatment, especially
Article Synopsis
- * Data was collected from 13,682 patients, and four different ML models were tested: Logistic Regression, Random Forest, Extreme Gradient Boosting, and Ada Boost, with Random Forest showing the best performance in predictions.
- * The findings revealed that age and comorbidities were significant predictors of mortality, and all models performed well, but Logistic Regression still offered similar predictive capabilities to the more complex ML methods.
Article Synopsis
- This study investigates the differences in procedural characteristics, patient outcomes, and case volumes between early-career and non-early-career interventional cardiologists in the U.S. from April 2018 to June 2022.
- Data from various medical databases revealed that early-career operators treated more critically ill patients, such as those with ST-segment myocardial infarction, despite having similar annual case volumes compared to their more experienced counterparts.
- The findings indicate that early-career cardiologists face higher predicted risks for mortality and bleeding in their patients, with statistical adjustments confirming a significant association between early-career status and increased risks.