Publications by authors named "Neil O'leary"
Background: Recently, machine learning algorithms have identified preprocedural γ-glutamyl transferase (GGT) as a significant predictor of long-term mortality after coronary revascularization in the SYNTAX (Synergy Between PCI [Percutaneous Coronary Intervention] With Taxus and Cardiac Surgery) trial. The aim of the present study is to investigate the impact of preprocedural GGT on 10-year all-cause mortality in patients with complex coronary artery disease after revascularization.
Methods And Results: The SYNTAX trial was a randomized trial comparing PCI with coronary artery bypass grafting in 1800 patients with complex coronary artery disease.
Background: In patients with 3-vessel coronary artery disease (CAD) and/or left main CAD, individual risk prediction plays a key role in deciding between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
Objectives: The aim of this study was to assess whether these individualized revascularization decisions can be improved by applying machine learning (ML) algorithms and integrating clinical, biological, and anatomical factors.
Methods: In the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) study, ML algorithms (Lasso regression, gradient boosting) were used to develop a prognostic index for 5-year death, which was combined, in the second stage, with assigned treatment (PCI or CABG) and prespecified effect-modifiers: disease type (3-vessel or left main CAD) and anatomical SYNTAX score.
Article Synopsis
- * Researchers analyzed data from 206 patients, focusing on indicators like the quantitative flow ratio (μQFR) and the pullback pressure gradient (PPG) to assess disease diffuseness and its relationship with PCI outcomes.
- * Findings suggest that a diffuse CAD pattern before PCI is a significant predictor of poor immediate haemodynamic results, regardless of stent expansion quality, indicating the importance of assessing CAD patterns prior to intervention.
Article Synopsis
- There is a lack of comparative data on the effectiveness of sirolimus-coated balloons (SCBs) versus paclitaxel-coated balloons (PCBs) in treating small vessel disease (SVD).
- The study involved 121 patients and aimed to compare angiographic outcomes after 6 months of treatment with either SCB or PCB, with a focus on net lumen gain.
- Results showed that SCBs did not meet the noninferiority criterion for net lumen gain compared to PCBs, demonstrating less improvement and higher rates of restenosis.
Murray law-based quantitative flow ratio (µQFR) assesses fractional flow reserve (FFR) in bifurcation lesions using a single angiographic view, enhancing the feasibility of analysis; however, accuracy may be compromised in suboptimal angiographic projections. FFR is a well-validated non-invasive method measuring FFR from coronary computed tomographic angiography (CCTA). We evaluated the feasibility of µQFR in left main (LM) bifurcations, the impact of the optimal/suboptimal fluoroscopic view with respect to CCTA, and its diagnostic concordance with FFR.
View Article and Find Full Text PDFAngiography and optical coherence tomography derived shear stress: are they equivalent in my opinion?
Int J Cardiovasc Imaging
October 2023
Advances in image reconstruction using either single or multimodality imaging data provide increasingly accurate three-dimensional (3D) patient's arterial models for shear stress evaluation using computational fluid dynamics (CFD). We aim to evaluate the impacts on endothelial shear stress (ESS) derived from a simple image reconstruction using 3D-quantitative coronary angiography (3D-QCA) versus a multimodality reconstruction method using optical coherence tomography (OCT) in patients' vessels treated with bioresorbable scaffolds. Seven vessels at baseline and five-year follow-up of seven patients from a previous CFD investigation were retrospectively selected for a head-to-head comparison of angiography-derived versus OCT-derived ESS.
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- The study investigates whether coronary computed tomography angiography (CCTA) can effectively predict long-term survival in patients with severe heart conditions who have undergone revascularization.
- Researchers compared the prognostic value of the SYNTAX score II 2020 (SS-2020) obtained from both invasive coronary angiography (ICA) and CCTA to categorize patients based on their risk of mortality over five years.
- Results indicated that both ICA and CCTA showed similar effectiveness in predicting five-year mortality, allowing for the identification of high- and low-risk patients with comparable accuracy.
Objectives: The very long-term mortality of off-pump and on-pump coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in a randomized complex coronary artery disease population is unknown. This study aims to investigate the impact of on-pump and off-pump CABG versus PCI on 10-year all-cause mortality.
Methods: The SYNTAX trial randomized 1800 patients with three-vessel and/or left main coronary artery disease to PCI or CABG and assessed their survival at 10 years.
Aims: Risk stratification and individual risk prediction play a key role in making treatment decisions in patients with complex coronary artery disease (CAD). The aim of this study was to assess whether machine learning (ML) algorithms can improve discriminative ability and identify unsuspected, but potentially important, factors in the prediction of long-term mortality following percutaneous coronary intervention or coronary artery bypass grafting in patients with complex CAD.
Methods And Results: To predict long-term mortality, the ML algorisms were applied to the SYNTAXES database with 75 pre-procedural variables including demographic and clinical factors, blood sampling, imaging, and patient-reported outcomes.
Article Synopsis
- * It measured SWS changes before and after procedures, finding a significant decrease in strain at treatment sites and a shift of strain to the edges of the devices in both treatment groups.
- * The findings suggest that angiography-based SWS analysis can effectively evaluate the mechanical condition of coronary arteries after treatment, with similar outcomes for both BRS and DES.
Many attempts have been made to inhibit or counteract saphenous vein graft (SVG) failure modes; however, only external support for SVGs has gained momentum in clinical utility. This study revealed the feasibility of implantation, and showed good patency out to 12 months of the novel biorestorative graft, in a challenging ovine coronary artery bypass graft model. This finding could trigger the first-in-man trial of using the novel material instead of SVG.
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- The study aimed to assess the effectiveness of a deep learning algorithm for measuring plaque burden (PB) using optical coherence tomography (OCT) and compare it to traditional intravascular ultrasound (IVUS).
- The analysis involved 5-year follow-up images from 15 patients, focusing on how well the algorithm's PB measurements matched those from IVUS, with attention given to different levels of media visibility in OCT images.
- Results showed strong agreement between the two methods (ICC = 0.81) and high diagnostic accuracy for detecting significant PB, suggesting the deep learning approach could be a valuable addition to standard OCT imaging techniques.
Impact of residual angina on long-term clinical outcomes after percutaneous coronary intervention or coronary artery bypass graft for complex coronary artery disease.
Eur Heart J Qual Care Clin Outcomes
August 2023
Aims: The aim of this study was to investigate the impact on 10-year survival of patient-reported anginal status at 1 year following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD) and/or three-vessel CAD (3VD).
Methods And Results: In this post hoc analysis of the randomized SYNTAX Extended Survival study, patients were classified as having residual angina (RA) if their self-reported Seattle Angina Questionnaire angina frequency (SAQ-AF) scale was ≤90 at the 1-year follow-up post-revascularization with PCI or CABG. The primary endpoint of all-cause death at 10 years was compared between the RA and no-RA groups.
Article Synopsis
- The study focuses on how preprocedural physical and mental health impacts outcomes for patients with complex coronary artery disease undergoing either PCI or CABG, using data from the SYNTAXES trial.* -
- Higher scores in physical and mental health were linked to lower 10-year mortality rates; specifically, a 10-point increase in these scores reduced the risk of death significantly.* -
- Among patients with good health scores, CABG offered a better survival rate than PCI, while no significant differences in mortality were found for those with lower health scores.*
Objective: We sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD).
Methods: This post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed.
Article Synopsis
- Proton pump inhibitors (PPIs) may interfere with the effectiveness of traditional antiplatelet medications like clopidogrel and aspirin, potentially increasing heart-related issues post-heart procedures.
- This study, part of the GLOBAL LEADERS trial, evaluated patient outcomes based on PPI use in two different antiplatelet therapy scenarios following heart surgeries.
- Results showed that PPI use raised cardiovascular risks in patients on aspirin but did not affect those on ticagrelor monotherapy, suggesting that further research is needed to understand this interaction.
Objectives: This study aimed to investigate the impact of mechanical factors at baseline on the patency of a restorative conduit for coronary bypass grafts in an ovine model at serial follow-up up to 1 year.
Methods: The analyses of 4 mechanical factors [i.e.
Article Synopsis
- * This trial will involve 2,540 participants randomized to receive either PCI guided by QFR or standard care, utilizing a specific stent that allows for shorter anti-clotting therapy post-procedure.
- * The primary goal is to see if QFR-guided PCI is as effective as usual care in preventing major cardiac events within one year, with follow-ups lasting up to three years.
Background: Creatinine clearance (CrCl) is an independent determinant of mortality in predictive models of revascularisation outcomes for complex coronary artery disease.
Aims: This study aimed to investigate the impact of preprocedural biological markers on 10-year mortality following coronary revascularisation.
Methods: The SYNTAX Extended Survival (SYNTAXES) study evaluated the 10-year vital status follow-up of 1,800 patients with de novo three-vessel (3VD) and/or left main coronary artery disease (LMCAD) randomised to include percutaneous or surgical coronary revascularisation.
Article Synopsis
- The study aimed to compare long-term all-cause mortality between patients undergoing percutaneous coronary intervention (PCI) and those receiving coronary artery bypass grafting (CABG) with either multiple arterial grafting (MAG) or single arterial grafting (SAG).
- A total of 1,743 patients were followed for an average of 11.9 years, revealing that all-cause mortality was significantly lower in the MAG group compared to PCI, while SAG did not show a significant difference.
- The results indicate that for patients with three-vessel disease (3VD), both MAG and SAG offered better survival rates than PCI, whereas for those with left main coronary artery disease (LMCAD), there were no significant differences in mortality
Article Synopsis
- The article investigates the 10-year all-cause death rates in patients with three-vessel disease (3VD) or left main coronary artery disease (LMCAD) who underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI), focusing on the impact of diabetes.
- In diabetics, initial results indicated a higher mortality rate with PCI compared to CABG at 5 years, but by 10 years, the rates were similar for both procedures regardless of diabetic status, with a slight advantage seen for CABG in insulin-treated patients.
- The study concludes that while CABG may offer some survival benefits for patients with insulin-dependent diabetes, further research is needed to understand the long-term outcomes associated
Background: The benefit of optimal medical therapy (OMT) on 5-year outcomes in patients with 3-vessel disease and/or left main disease after percutaneous coronary intervention or coronary artery bypass grafting (CABG) was demonstrated in the randomized SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial.
Objectives: The objective of this analysis is to assess the impact of the status of OMT at 5 years on 10-year mortality after percutaneous coronary intervention or CABG.
Methods: This is a subanalysis of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study, which evaluated for up to 10 years the vital status of patients who were originally enrolled in the SYNTAX trial.
Article Synopsis
- The study aimed to understand the long-term outcomes of elderly patients (>70 years) with complex coronary artery disease who underwent either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG).
- Results showed no significant differences in 10-year all-cause mortality, life expectancy, and 5-year major adverse cardiac events (MACCE) between the two procedures among elderly patients with three-vessel or left main disease.
- Additionally, both procedures yielded similar quality of life outcomes after five years, indicating that the choice of revascularization strategy may not greatly impact these patients' long-term health outcomes.