Publications by authors named "Sunil Rao"
Evaluation of Peer Review of Percutaneous Coronary Intervention Operator Performance.
Circ Cardiovasc Qual Outcomes
January 2025
Background: Case-based peer review of percutaneous coronary intervention (PCI) is used by many hospitals for quality improvement and to make decisions regarding physician competency. However, there are no studies testing the reliability or validity of peer review for PCI performance evaluation.
Methods: We recruited interventional cardiologists from 12 Veterans Affairs Health System facilities throughout the United States to provide PCI cases for review.
Background: Clinical guidelines have concluded that there are insufficient data to provide recommendations for the hemoglobin threshold for the use of red cell transfusion in patients with acute myocardial infarction (MI) and anemia. After the recent publication of the Myocardial Infarction and Transfusion (MINT) trial, we performed an individual patient-level data meta-analysis to evaluate the effect of restrictive versus liberal blood transfusion strategies.
Methods: We conducted searches in major databases.
Inflammation has been demonstrated to negatively impact patients in the peri-ACS period. This narrative review outlines the inflammatory response in ACS, highlighting the role of the NLRP3 inflammasome pathway following acute plaque rupture and coronary intervention and its potential as a pharmacologic target. RECENT: nvestigators have leveraged medications targeting the NLRP3 inflammasome currently used for other inflammatory pathologies, including colchicine, tocilizumab and anakinra.
View Article and Find Full Text PDFVentricular arrhythmias (VA) are a major cause of morbidity and mortality in patients with coronary artery disease (CAD). Current guidelines recommend revascularization of significant CAD to improve survival in patients with ventricular fibrillation (VF), polymorphic ventricular tachycardia (VT), or those who are post-cardiac arrest. However, revascularization is not recommended for CAD patients with suspected scar-mediated monomorphic VT.
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- The COMPLETE trial showed that complete revascularization in STEMI patients with multivessel disease leads to better health outcomes than treating only the culprit lesion.
- This subanalysis focused on whether having a nonculprit lesion (NCL) in the proximal/mid left anterior descending artery (LAD) affects outcomes compared to NCLs in other locations.
- Results indicated that while the presence of a proximal/mid-LAD NCL did not significantly alter treatment benefits, complete revascularization consistently reduced major cardiovascular events across both groups.
Background: The optimal management of patients with intermediate-risk pulmonary embolism (PE), who have right heart dysfunction (determined by a combination of imaging and cardiac biomarkers) but a normal blood pressure, is uncertain. These patients suffer from reduced functional capacity and a lower quality of life over the long-term, despite use of anticoagulant therapy. Catheter-directed therapy (CDT) is a promising treatment for acute PE that rapidly removes thrombus and potentially improves cardiac dysfunction.
View Article and Find Full Text PDFBackground And Aims: Multiple randomized trials have shown that renal denervation (RDN) reduces blood pressure (BP) when compared with sham control but the antihypertensive efficacy of radiofrequency vs. ultrasound-based RDN is uncertain. We aimed to compare the outcomes of radiofrequency RDN (rRDN) and ultrasound RDN (uRDN), when compared with sham in patients with hypertension.
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- The study investigates the best duration and choice of antiplatelet therapy for patients with acute coronary syndrome after undergoing percutaneous coronary intervention.
- A network meta-analysis was conducted on 32 trials with over 103,000 patients, comparing 12-month dual-antiplatelet therapy (DAPT) with several other strategies, including varying doses and durations.
- The findings suggest that the combination of aspirin and ticagrelor for 3 months, followed by aspirin and clopidogrel, significantly lowers major adverse cardiovascular events compared to other DAPT strategies.
Background: The optimal hemoglobin threshold to guide red blood cell (RBC) transfusion for patients with acute myocardial infarction (MI) and anemia is uncertain.
Objective: To estimate the efficacy of 4 individual hemoglobin thresholds (<10 g/dL [<100 g/L], <9 g/dL [<90 g/L], <8 g/dL [<80 g/L], and <7 g/dL [<70 g/L]) to guide transfusion in patients with acute MI and anemia.
Design: Prespecified secondary analysis of the MINT (Myocardial Ischemia and Transfusion) trial using target trial emulation methods.
Background: The MINT trial (Myocardial Ischemia and Transfusion) raised concern for harm from a restrictive versus liberal transfusion strategy in patients with acute myocardial infarction (MI) and anemia. Type 1 and type 2 MI are distinct pathophysiologic entities that may respond differently to blood transfusion. This analysis sought to determine whether the effects of transfusion varied among patients with a type 1 or a type 2 MI and anemia.
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- Calcified coronary lesions pose difficulties for percutaneous coronary interventions (PCIs), and coronary intravascular lithotripsy (IVL), approved in February 2021, offers a new approach but its adoption in the U.S. is not well understood.
- Among 2.7 million PCIs analyzed, 11.4% utilized calcium modification, with IVL usage increasing from 0% in late 2020 to 7.8% by late 2022, while coronary atherectomy slightly decreased.
- Significant variation in IVL use was observed across hospitals, with the treating hospital being the main factor influencing both calcium modification and IVL adoption in 2022.
The Path to a Match for Interventional Cardiology Fellowship: A Major SCAI Initiative.
J Soc Cardiovasc Angiogr Interv
July 2024
Article Synopsis
- The field of interventional cardiology (IC) has seen significant advancements and improved training programs over the last 40 years, including accredited fellowship programs and subspecialty certification.
- Despite these improvements, the application process for IC fellowships has been chaotic and inconsistent, causing stress and pressure on applicants due to competitive recruitment practices.
- A task force from the Society for Cardiovascular Angiography & Interventions has initiated a grassroots movement to create a national Match system for IC fellowships, aiming to establish fairness and equity in the application process.
Factor XIa inhibition as a therapeutic strategy for atherothrombosis.
J Thromb Thrombolysis
December 2024
Article Synopsis
- Doctors pick blood-thinning medicines (called anticoagulants) based on individual patient needs and how well the medicines work without causing too much bleeding.
- Newer medicines called direct oral anticoagulants are better than older ones, but they can still cause bleeding issues.
- Studies show that people with a certain genetic condition (factor XI deficiency) have a lower chance of blood clots and strokes without more bleeding, which makes targeting factor XI an exciting option for new blood thinners.
Introduction: Postoperative nausea, vomiting, and cough are the most common adverse effects of general anesthesia resulting in high discomfort to the patient resulting in uneasiness during the recovery period. This study aimed to compare the influence of intraoperative use of sevoflurane and isoflurane on postoperative nausea, vomiting, and cough.
Materials And Methods: After approval from the institutional ethical committee, this quantitative observational institutional study was conducted on all patients aged between 18 and 65 years undergoing surgery under general anesthesia at KMC Hospital, Mangalore.
Background: Radial artery access for coronary angiography or percutaneous coronary intervention (PCI) reduces the risk of death, bleeding, and vascular complications and is preferred over femoral artery access, leading to a class 1 indication by clinical practice guidelines. However, alternate upper extremity access such as distal radial and ulnar access are not mentioned in the guidelines despite randomized trials. We aimed to evaluate procedural outcomes with femoral, radial, distal radial, and ulnar access sites in patients undergoing coronary angiography or PCI.
View Article and Find Full Text PDFBackground: Complete revascularization improves cardiovascular outcomes compared with culprit-only revascularization in patients with acute myocardial infarction ([MI]; ST-segment-elevation MI or non-ST-segment-elevation MI) and multivessel coronary artery disease. However, the timing of complete revascularization (single-setting versus staged revascularization) is uncertain. The aim was to compare the outcomes of single-setting complete, staged complete, and culprit vessel-only revascularization in patients with acute MI and multivessel disease.
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- - This study investigates the characteristics and immunophenotypic profiles of individuals with peripheral artery disease (PAD) using data from the Project Baseline Health Study, highlighting a lack of previous research in this area.
- - Out of 2,209 participants, only a small percentage (2.6%) had PAD, with various comorbidities like smoking, hypertension, and diabetes being significantly higher in those with the disease compared to participants with normal ankle brachial indices.
- - The findings suggest that PAD may be underdiagnosed, particularly among women and Black or African American individuals, and propose that the identified immunophenotypic profile could aid in the early diagnosis of PAD.
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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