Publications by authors named "Shamir Mehta"
Background: In the COMPLETE (Complete vs Culprit-Only Revascularization to Treat Multi-Vessel Disease After Early PCI for STEMI) trial, complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) reduced important outcomes compared with culprit-only percutaneous coronary intervention. Whether clinical outcomes in STEMI patients with MVD are influenced by the presence of a left anterior descending (LAD) nonculprit lesion (NCL) remains unknown.
Objectives: This study sought to compare: 1) cardiovascular outcomes among patients with an NCL in the proximal/mid-LAD to patients with an NCL in other locations; and 2) the benefit of NCL revascularization in patients with and without a proximal/mid-LAD NCL.
Article Synopsis
- * A total of 7062 patients participated, and the results showed no significant difference in primary cardiovascular outcomes between the colchicine group (9.1%) and the placebo group (9.3%) over a 3-year follow-up period.
- * Colchicine did lower C-reactive protein levels, indicating some anti-inflammatory effect, but it also caused more diarrhea compared to placebo, though serious infections were similar in both groups.
Background: Mineralocorticoid receptor antagonists have been shown to reduce mortality in patients after myocardial infarction with congestive heart failure. Whether routine use of spironolactone is beneficial after myocardial infarction is uncertain.
Methods: In this multicenter trial with a 2-by-2 factorial design, we randomly assigned patients with myocardial infarction who had undergone percutaneous coronary intervention to receive either spironolactone or placebo and either colchicine or placebo.
Article Synopsis
- - The TRILUMINATE Pivotal trial assessed the effects of tricuspid transcatheter edge-to-edge repair (T-TEER) on reducing tricuspid regurgitation (TR), a significant heart condition linked to increased health risks.
- - Involving 572 patients, mostly elderly women with prior heart conditions, the trial found that T-TEER effectively improved quality of life, with nearly half of those treated experiencing significant improvements in heart health assessments.
- - Results showed that while the treatment and control groups had similar rates of survival and heart-related surgeries, those who underwent T-TEER had notably better outcomes in TR severity and overall quality of life.
Article Synopsis
- The study systematically reviewed literature to evaluate how managing tooth wear affects the Oral Health Related Quality of Life (OHRQoL) in adults.
- Researchers followed established guidelines to select relevant studies and assess the quality of evidence, focusing on adult patients with moderate to severe tooth wear who received restorative treatments or counseling.
- Results showed that restorative treatment generally improves OHRQoL, while counseling had little to no impact; however, there were concerns about study biases, especially in non-randomized trials.
Impact of ticagrelor with or without aspirin on total and recurrent bleeding and ischemic events after percutaneous coronary intervention: A sub-study of the TWILIGHT trial.
Eur Heart J Cardiovasc Pharmacother
October 2024
Article Synopsis
- The study evaluates the impact of early discontinuation of aspirin in favor of ticagrelor monotherapy on bleeding and ischemic events in patients who underwent percutaneous coronary intervention (PCI).
- Results show that while ticagrelor monotherapy led to significantly fewer bleeding events compared to ticagrelor plus aspirin, the total ischemic events remained similar between the two groups.
- Overall, among high-risk PCI patients, ticagrelor alone was associated with reduced bleeding without increasing the risk of ischemic complications.
Background: Dual antiplatelet therapy (DAPT) for 12 months is the standard of care after coronary stenting in patients with acute coronary syndrome (ACS). The aim of this individual patient-level meta-analysis was to summarise the evidence comparing DAPT de-escalation to ticagrelor monotherapy versus continuing DAPT for 12 months after coronary drug-eluting stent implantation.
Methods: A systematic review and individual patient data (IPD)-level meta-analysis of randomised trials with centrally adjudicated endpoints was performed to evaluate the comparative efficacy and safety of ticagrelor monotherapy (90 mg twice a day) after short-term DAPT (from 2 weeks to 3 months) versus 12-month DAPT in patients undergoing percutaneous coronary intervention with a coronary drug-eluting stent.
Article Synopsis
- Complete revascularization is the standard treatment for older STEMI patients with multivessel disease, offering benefits shown in the FIRE trial, though long-term effects remain uncertain.
- A meta-analysis of several randomized clinical trials analyzed data from 1733 patients aged 75 and older, comparing complete versus culprit-only revascularization strategies.
- Results indicated that complete revascularization significantly reduced the risk of cardiovascular death or myocardial infarction in the long term, but did not show a difference in overall death rates compared to culprit-only revascularization.
Ischemic heart disease and stroke are the leading causes of death worldwide. Herein we review the burden, epidemiology, and risk factors for atherosclerotic cardiovascular disease (ASCVD). The focus of this review is on the current state of ASCVD in Canada, however, the findings regarding epidemiological trends are likely to be reflective of global trends, particularly in high-income countries, and the discussion regarding risk factors and lipid lowering is universally applicable.
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- * Recent studies have raised concerns about this 12-month regimen, suggesting adjustments based on patients' bleeding or ischemic risks, arguing some may benefit from shorter or longer durations.
- * Several strategies to modify DAPT practices, such as de-escalating to less potent medications or shortening therapy, have shown to reduce bleeding risks without significantly increasing cardiovascular issues, yet the 12-month recommendation remains unchanged in guidelines.
Article Synopsis
- - The CLEAR SYNERGY trial is investigating the safety and effectiveness of low-dose colchicine and spironolactone in reducing major cardiovascular events in patients recovering from a heart attack (myocardial infarction).
- - This large, randomized controlled study includes 7,062 participants from 104 centers across 14 countries and uses a factorial design to compare the treatments against placebos, focusing on specific cardiovascular outcomes.
- - Results are expected to be presented in fall 2024, and the study aims to provide valuable data on these medications' impact on post-MI patients who have undergone a procedure called percutaneous coronary intervention.
Background: The learning curve for new operators performing ultrasound-guided transfemoral access (TFA) remains uncertain.
Methods: We performed a pooled analysis of the FAUST (Femoral Arterial Access With Ultrasound Trial) and UNIVERSAL (Routine Ultrasound Guidance for Vascular Access for Cardiac Procedures) trials, both multicenter randomized controlled trials of 1:1 ultrasound-guided versus non-ultrasound-guided TFA for coronary procedures. Outcomes included the composite of major bleeding or vascular complications and successful common femoral artery cannulation.
Article Synopsis
- Ticagrelor, when added to aspirin, was found to reduce major adverse cardiovascular events (MACE) but also increased the risk of bleeding in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease.
- In a study involving 19,220 patients over a median of 3 years, those with peripheral artery disease (PAD) who received the placebo had significantly higher risks of both MACE and limb events compared to those on ticagrelor.
- While ticagrelor demonstrated a reducing effect on limb events such as revascularization and acute limb ischemia, the overall bleeding risk also increased; further studies are necessary to explore the balance of benefits and risks in various patient groups.
Article Synopsis
- The study investigates whether ticagrelor or clopidogrel monotherapy is as effective as dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in preventing major adverse cardiovascular events like death, myocardial infarction (MI), or stroke.
- Researchers conducted a systematic review using data from various sources, analyzing patient information from randomized trials to compare the outcomes of the different treatments.
- The analysis included data from 25,960 PCI patients, showing that the efficacy and safety of ticagrelor or clopidogrel monotherapy were evaluated against DAPT to determine their noninferiority regarding adverse clinical outcomes.
Ticagrelor with or without aspirin following percutaneous coronary intervention in high-risk patients with concomitant peripheral artery disease: A subgroup analysis of the TWILIGHT randomized clinical trial.
Am Heart J
June 2024
Article Synopsis
- This analysis investigates whether patients with peripheral artery disease (PAD) benefit more from taking ticagrelor alone or in combination with aspirin after undergoing a procedure called percutaneous coronary intervention (PCI).
- The TWILIGHT trial involved patients at high risk for heart issues or bleeding, who were given either aspirin or a placebo alongside ticagrelor after 3 months of dual antiplatelet therapy, with outcomes assessed after 12 months.
- Results showed that while PAD patients faced higher risks of complications, those on ticagrelor monotherapy experienced fewer bleeding complications compared to those on combination therapy, without a rise in heart attack or stroke incidents.
Our objective was to evaluate the clinical effectiveness of the SYNERGY stent (Boston Scientific Corporation, Marlborough, Massachusetts) in patients with ST-elevation myocardial infarction (STEMI). The only drug-eluting stent approved for treatment of STEMI by the Food and Drug Administration is the Taxus stent (Boston Scientific) which is no longer commercially available, so further data are needed. The CLEAR (Colchicine and spironolactone in patients with myocardial infarction) SYNERGY stent registry was embedded into a larger randomized trial of patients with STEMI (n = 7,000), comparing colchicine versus placebo and spironolactone versus placebo.
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- - Antiplatelet therapy (APT) is crucial for preventing atherothrombotic events in patients with cardiovascular disease, and effective strategies need to consider both risk of adverse events and bleeding.
- - The updated Canadian guidelines provide recommendations on APT use for various conditions, including primary prevention, dual therapy duration post-PCI, and treatment of patients with acute coronary syndrome (ACS).
- - These guidelines are based on systematic reviews and meta-analyses, ensuring evidence-based approaches for managing APT in different patient scenarios, including those requiring surgery or oral anticoagulation.
Background: Nearly 20% of patients on ticagrelor experience dyspnea, which may lead to treatment discontinuation in up to one-third of cases.
Objectives: The authors sought to evaluate the incidence, predictors, and outcomes of dyspnea-related ticagrelor discontinuation after percutaneous coronary intervention (PCI).
Methods: In the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial, after 3 months of ticagrelor plus aspirin, patients were maintained on ticagrelor and randomized to aspirin or placebo for 1 year.
Background: In ST-segment elevation myocardial infarction (STEMI), complete revascularization with percutaneous coronary intervention (PCI) reduces major cardiovascular events compared with culprit-lesion-only PCI. Whether age influences these results remains unknown.
Methods: COMPLETE was a multinational, randomized trial evaluating a strategy of staged complete revascularization, consisting of angiography-guided PCI of all suitable nonculprit lesions, versus a strategy of culprit-lesion-only PCI.
Repeat coronary revascularization is a common adverse event after successful percutaneous coronary intervention. This analysis aimed to assess the effects of ticagrelor monotherapy on repeat clinically driven revascularization (CDR). In the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients after Coronary Intervention) trial, after 3 months of ticagrelor plus aspirin, high-risk patients were maintained on ticagrelor and randomly allocated to aspirin or placebo for 1 year.
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- - The COMPLETE trial found that complete revascularization for ST-segment-elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease significantly reduced the risk of major cardiovascular events compared to focusing only on the culprit lesion.
- - The study specifically analyzed the effects of complete revascularization in patients with and without diabetes, noting that diabetes leads to a worse prognosis post-STEMI.
- - Results showed that complete revascularization improved outcomes consistently for both groups, with no significant difference in effectiveness between diabetics and non-diabetics.
Patients with tooth wear are commonly encountered in general dental practice. When indicated, restorative rehabilitation is often accompanied by a request from the patient for an aesthetic, tooth-coloured outcome. This article seeks to provide an evidence-based approach, focussing on the longevity of the materials which can be used for the restorative treatment of tooth wear, as well as their modes of failure and observed performance.
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