Celina Yong, MD, MBA, MSc

All Publications

• Racial and Ethnic Differences in Semaglutide Prescriptions for Veterans With Overweight or Obesity in the Veterans Affairs Healthcare System. Circulation. Cardiovascular quality and outcomes Tisdale, R. L., Beyene, T. J., Tang, W., Heidenreich, P., Asch, S. M., Yong, C. M. 2024: e011649

  View details for DOI 10.1161/CIRCOUTCOMES.124.011649

  View details for PubMedID 39524000

• Drug-Coated Balloons to Keep Interventions of the Side Branch Simple (KISS): KISS or Be KISS'D. Journal of the American College of Cardiology Ali, Z., Yong, C. M. 2024

  View details for DOI 10.1016/j.jacc.2024.09.020

  View details for PubMedID 39480377

• Transcatheter Interventions in Tricuspid Regurgitation: Shifting the focus beyond Quantity of Life to Quality of Life. Journal of the American College of Cardiology Gupta, A., Yong, C., Al-Lamee, R. 2024

  View details for DOI 10.1016/j.jacc.2024.10.085

  View details for PubMedID 39486556

• DEI Is Not Dead: A Framework for Cardiology Fellowship Programs. Journal of the American College of Cardiology Amponsah, D., Yong, C. M. 2024; 84 (14): 1367-1371

  View details for DOI 10.1016/j.jacc.2024.07.042

  View details for PubMedID 39322330

• Racial and Ethnic Differences in Adoption of Mitral Valve Transcatheter Edge-to-Edge Repair Over a Decade in the National Veterans Affairs Healthcare System. Journal of the American Heart Association Pillai, B., Beyene, T. J., Kang, G., Amponsah, D., Heidenreich, P. A., Yong, C. M. 2024; 13 (19): e035767

  View details for DOI 10.1161/JAHA.124.035767

  View details for PubMedID 39344644

• If We Measure, We Can Improve. Journal of the American College of Cardiology Yong, C. M., Dhruva, S. S. 2024; 84 (13): 1276-1278

  View details for DOI 10.1016/j.jacc.2024.07.031

  View details for PubMedID 39293888

• Artificial Intelligence to Promote Racial and Ethnic Cardiovascular Health Equity CURRENT CARDIOVASCULAR RISK REPORTS Amponsah, D., Thamman, R., Brandt, E., James, C., Spector-Bagdady, K., Yong, C. M. 2024

  View details for DOI 10.1007/s12170-024-00745-6

  View details for Web of Science ID 001294394200001

• Procedural Outcomes With Femoral, Radial, Distal Radial, and Ulnar Access for Coronary Angiography: A Network Meta-Analysis. Circulation. Cardiovascular interventions Maqsood, M. H., Yong, C. M., Rao, S. V., Cohen, M. D., Pancholy, S., Bangalore, S. 2024: e014186

  Abstract

  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.METHODS: PubMed, EMBASE, and clinicaltrials.gov databases were searched for randomized clinical trials that compared at least 2 of the 4 access sites in patients undergoing PCI or angiography. Primary outcomes were major bleeding and access site hematoma. Intention-to-treat mixed treatment comparison meta-analysis was performed.RESULTS: From 47 randomized clinical trials that randomized 38 924 patients undergoing coronary angiography or PCI, when compared with femoral access, there was a lower risk of major bleeding with radial access (odds ratio [OR], 0.46 [95% CI, 0.35-0.59]) and lower risk of access site hematoma with radial (OR, 0.34 [95% CI, 0.24-0.48]), distal radial (OR, 0.33 [95% CI, 0.20-0.56]), and ulnar (OR, 0.50 [95% CI, 0.31-0.83]) access. However, when compared with radial access, there was higher risk of hematoma with ulnar access (OR, 1.48 [95% CI, 1.03-2.14]).CONCLUSIONS: Data from randomized trials support guideline recommendation of class 1 for the preference of radial access over femoral access in patients undergoing coronary angiography or PCI. Moreover, distal radial and ulnar access can be considered as a default secondary access site before considering femoral access.REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42024512365.

  View details for DOI 10.1161/CIRCINTERVENTIONS.124.014186

  View details for PubMedID 39027936

• Novel Use of Z Codes to Identify Social Determinants of Cardiovascular Disease Outcomes. Circulation Song, N., Beyene, T. J., Amponsah, D. K., Asch, S. M., Heidenreich, P. A., Yong, C. M. 2024; 150 (3): 243-245

  View details for DOI 10.1161/CIRCULATIONAHA.124.069083

  View details for PubMedID 39008558

• The Current State of Coronary Revascularization: Coronary Artery Bypass Graft Surgery Versus Percutaneous Coronary Interventions. Current cardiology reports Krittanawong, C., Rizwan, A., Khawaja, M., Newman, N., Escobar, J., Virk, H. U., Alam, M., Al-Azzam, F., Yong, C. M., Jneid, H. 2024

  Abstract

  PURPOSE OF REVIEW: The optimal revascularization strategy for coronary artery disease depends on various factors, such as disease complexity, patient characteristics, and preferences. Including a heart team in complex cases is crucial to ensure optimal outcomes. Decision-making between percutaneous coronary intervention and coronary artery bypass grafting must consider each patient's clinical profile and coronary anatomy. While current practice guidelines offer some insight into the optimal revascularization approach for the various phenotypes of coronary artery disease, the evidence to support either strategy continues to evolve and grow. Given the large amount of contemporary data on revascularization, this review aims to comprehensively summarize the literature on coronary artery bypass grafting and percutaneous coronary intervention in patients across the spectrum of coronary artery disease phenotypes.RECENT FINDINGS: Contemporary evidence suggests that for patients with triple vessel disease, coronary artery bypass grafting is preferred over percutaneous coronary intervention due to better long-term outcomes, including lower rates of death, myocardial infarction, and target vessel revascularization. Similarly, for patients with left main coronary artery disease, both percutaneous coronary intervention and coronary artery bypass grafting can be considered, as they have shown similar efficacy in terms of major adverse cardiac events, but there may be a slightly higher risk of death with percutaneous coronary intervention. For proximal left anterior descending artery disease, both percutaneous coronary intervention and coronary artery bypass grafting are viable options, but coronary artery bypass grafting has shown lower rates of repeat revascularization and better relief from angina. The Synergy Between PCI with Taxus and Cardiac Surgery score can help in decision-making by predicting the risk of adverse events and guiding the choice between percutaneous coronary intervention and coronary artery bypass grafting. European and American guidelines both agree with including a heart team that can develop and lay out individualized, optimal treatment options with respect for patient preferences. The debate between coronary artery bypass grafting versus percutaneous coronary intervention in multiple different scenarios will continue to develop as technology and techniques improve for both procedures. Risk factors, pre, peri, and post-procedural complications involved in both revascularization strategies will continue to be mitigated to optimize outcomes for those patients for which coronary artery bypass grafting or percutaneous coronary intervention provide ultimate benefit. Methods to avoid unnecessary revascularization continue to develop as well as percutaneous technology that may allow patients to avoid surgical intervention when possible. With such changes, revascularization guidelines for specific patient populations may change in the coming years, which can serve as a limitation of this time-dated review.

  View details for DOI 10.1007/s11886-024-02090-x

  View details for PubMedID 38985226

• Underrepresentation of Women in Revascularization Trials. JAMA cardiology Yong, C. M., Fearon, W. F. 2024

  View details for DOI 10.1001/jamacardio.2024.0768

  View details for PubMedID 38717765

• Temporal Trends in Cardiovascular Disease Prevalence Among Asian American Subgroups. Journal of the American Heart Association Nguyen, K. T., Li, J., Peng, A. W., Azar, K., Heidenreich, P., Palaniappan, L., Yong, C. M. 2024: e031444

  Abstract

  Asian and multiracial individuals represent the 2 fastest growing racial and ethnic groups in the United States, yet most prior studies report Asian American and Native Hawaiian or Other Pacific Islander as a single racial group, with limited data on cardiovascular disease (CVD) prevalence among subgroups. We sought to evaluate temporal trends in CVD burden among disaggregated Asian subgroups.Patients with CVD based on International Classification of Diseases, Ninth Revision and Tenth Revision (ICD-9 and ICD-10) coding who received care from a mixed-payer health care organization in California between 2008 and 2018 were classified into self-identified racial and ethnic subgroups (non-Hispanic White [NHW], Asian Indian, Chinese, Filipino, Japanese, Korean, Native Hawaiian or Other Pacific Islander, and multiracial groups). Adjusted trends in CVD prevalence over time by subgroup were compared using logistic regression. Among 3 494 071 patient-years, prevalence of CVD increased faster among all subgroups except Japanese and Native Hawaiian or Other Pacific Islander patients (P<0.01 for each, reference: NHW). Filipino patients had the highest overall CVD prevalence, which increased from 34.3% to 45.1% over 11 years (increase from 17.3%-21.9%, P<0.0001, reference: NHW). Asian Indian patients had the fastest increase in CVD prevalence over time (16.9%-23.7%, P<0.0001, reference: NHW). Among subcategories of disease, hypertension increased faster among Asian Indian, Chinese, Filipino, Korean, and multiracial groups (P<0.01 for all, reference: NHW), and coronary artery disease increased faster among Asian Indian, Chinese, Filipino, and Japanese groups (P<0.05 for each, reference: NHW).The increasing prevalence of CVD among disaggregated Asian, Native Hawaiian or Other Pacific Islander, and multiracial subgroups over time highlights the importance of tailored approaches to addressing CVD in these diverse subpopulations.

  View details for DOI 10.1161/JAHA.123.031444

  View details for PubMedID 38606778

• SOCIAL FACTORS IMPACTING MORTALITY AMONG CARDIOVASCULAR DISEASE PATIENTS: INSIGHTS FROM THE VETERANS AFFAIRS HEALTHCARE SYSTEM Song, N., Beyene, T., Amponsah, D., Asch, S., Heidenreich, P. A., Yong, C. M. ELSEVIER SCIENCE INC. 2024: 2047

  View details for Web of Science ID 001324901502081

• ADVANCED CARDIOLOGY FELLOW PERSPECTIVES ON CONNECTING NATIONALLY VIA WHATSAPP Tapaskar, N., Ghatnekar, N., Lee, C., Abraham, S., Smith, A., Nechyporenko, A., Paulenka, Y., Yong, C. M. ELSEVIER SCIENCE INC. 2024: 2526

  View details for Web of Science ID 001324901502560

• ASSESSING BARRIERS TO AN EQUITABLE ACADEMIC WORKFORCE: INSIGHTS FROM A NATIONAL ACC FIT/EC SURVEY Tapaskar, N., Theriot, P., Velagapudi, P., Cullen, M. W., Wiggins, N., Bharadwaj, A., Yong, C. M. ELSEVIER SCIENCE INC. 2024: 2352

  View details for Web of Science ID 001324901502386

• RACIAL AND ETHNIC DIFFERENCES IN OBESITY TREATMENT STRATEGIES IN THE VETERANS AFFAIRS HEALTHCARE SYSTEM Tang, W., Tisdale, R., Beyene, T., Yong, C. M. ELSEVIER SCIENCE INC. 2024: 1701

  View details for Web of Science ID 001324901501733

• Racial/Ethnic Disparities in Aortic Valve Replacement Among Medicare Beneficiaries in the United States, 2012-2019. The American journal of medicine Gupta, A., Mori, M., Wang, Y., Pawar, S. G., Vahl, T., Nazif, T., Onuma, O., Yong, C. M., Sharma, R., Kirtane, A. J., Forrest, J. K., George, I., Kodali, S., Chikwe, J., Geirsson, A., Makkar, R., Leon, M. B., Krumholz, H. M. 2024

  Abstract

  PURPOSE: There are concerns that transcatheter or surgical aortic valve replacement (TAVR/SAVR) procedures are preferentially available to White patients.OBJECTIVE: Our objective was to examine differences in utilization of aortic valve replacement and outcomes by race/ethnicity in the US for patients with aortic stenosis.METHODS: We performed a serial cross-sectional cohort study of 299,976 Medicare beneficiaries hospitalized with principal diagnosis of aortic stenosis between 2012 and 2019 stratified by self-reported race/ethnicity (Black, Hispanic, Asian, Native American, and White). Outcomes included aortic valve replacement rates within 6 months of index hospitalization and associated procedural outcomes, including 30-day readmission, 30-day and 1-year mortality.RESULTS: Within 6 months of an index admission for aortic stenosis, 86.8% (122,457 SAVR; 138,026 TAVR) patients underwent aortic valve replacement. Overall, compared with White people, Black [HR 0.87 (0.85-0.89)], Hispanic [0.92 (0.88 - 0.96)], and Asian [0.95 (0.91 - 0.99)] people were less likely to receive aortic valve replacement. Among patients who were admitted emergently/urgently, White patients (41.1%, 95% CI 40.7-41.4) had a significantly higher aortic valve replacement rate compared with Black (29.6%, 95% CI 28.3-30.9), Hispanic (36.6%, 95% CI 34.0-39.3), and Asian patients (35.4%, 95% CI 32.3-38.9). Aortic valve replacement rates increased annually for all race/ethnicities. There were no significant differences in 30-day or 1-year mortality by race/ethnicity.CONCLUSIONS: Aortic valve replacement rates within six months of aortic stenosis admission are lower for Black, Hispanic, and Asian people compared to White people. These race-related differences in aortic stenosis treatment reflect complex issues in diagnosis and management, warranting a comprehensive reassessment of the entire care spectrum for disadvantaged populations.

  View details for DOI 10.1016/j.amjmed.2023.12.026

  View details for PubMedID 38190959

• Impact of Virtual Interviewing on Cardiovascular Fellowship Applicant Diversity: Insights From 2 Academic Programs. Journal of the American Heart Association Witting, C., Knowles, J. W., DeFaria Yeh, D., Beyene, T. J., Gummipundi, S. E., Heidenreich, P. A., Yong, C. M. 2023: e030255

  View details for DOI 10.1161/JAHA.123.030255

  View details for PubMedID 38156448

• Role of Artificial Intelligence in Cardiovascular Health Disparities: The Risk of Greasing the Slippery Slope. JACC. Advances Thamman, R., Yong, C. M., Tran, A. H., Tobb, K., Brandt, E. J. 2023; 2 (7): 100578

  View details for DOI 10.1016/j.jacadv.2023.100578

  View details for PubMedID 38939488

  View details for PubMedCentralID PMC11198264

• Myocardial Infarction Across COVID-19 Pandemic Phases: Insights From the Veterans Health Affairs System. Journal of the American Heart Association Yong, C. M., Graham, L., Beyene, T. J., Sadri, S., Hong, J., Burdon, T., Fearon, W. F., Asch, S. M., Turakhia, M., Heidenreich, P. 2023: e029910

  Abstract

  Background Cardiovascular procedural treatments were deferred at scale during the COVID-19 pandemic, with unclear impact on patients presenting with non-ST-segment-elevation myocardial infarction (NSTEMI). Methods and Results In a retrospective cohort study of all patients diagnosed with NSTEMI in the US Veterans Affairs Healthcare System from January 1, 2019 to October 30, 2022 (n=67 125), procedural treatments and outcomes were compared between the prepandemic period and 6 unique pandemic phases: (1) acute phase, (2) community spread, (3) first peak, (4) post vaccine, (5) second peak, and (6) recovery. Multivariable regression analysis was performed to assess the association between pandemic phases and 30-day mortality. NSTEMI volumes dropped significantly with the pandemic onset (62.7% of prepandemic peak) and did not revert to prepandemic levels in subsequent phases, even after vaccine availability. Percutaneous coronary intervention and coronary artery bypass grafting volumes declined proportionally. Compared with the prepandemic period, patients with NSTEMI experienced higher 30-day mortality during Phases 2 and 3, even after adjustment for COVID-19-positive status, demographics, baseline comorbidities, and receipt of procedural treatment (adjusted odds ratio for Phases 2 and 3 combined, 1.26 [95% CI, 1.13-1.43], P<0.01). Patients receiving Veterans Affairs-paid community care had a higher adjusted risk of 30-day mortality compared with those at Veterans Affairs hospitals across all 6 pandemic phases. Conclusions Higher mortality after NSTEMI occurred during the initial spread and first peak of the pandemic but resolved before the second, higher peak-suggesting effective adaptation of care delivery but a costly delay to implementation. Investigation into the vulnerabilities of the early pandemic spread are vital to informing future resource-constrained practices.

  View details for DOI 10.1161/JAHA.123.029910

  View details for PubMedID 37421288

• 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions) JACC-CARDIOVASCULAR INTERVENTIONS Bass, T. A., Abbott, J., Mahmud, E., Parikh, S. A., Aboulhosn, J., Ashwath, M. L., Baranowski, B., Bergersen, L., Chaudry, H. I., Coylewright, M., Denktas, A. E., Gupta, K., Gutierrez, J., Haft, J., Hawkins, B. M., Herrmann, H. C., Kapur, N. K., Kilic, S., Lesser, J., Lin, C., Mendirichaga, R., Nkomo, V. T., Park, L. G., Phoubandith, D. R., Quader, N., Rich, M. W., Rosen, K., Sabri, S. S., Shames, M. L., Shernan, S. K., Skelding, K. A., Tamis-Holland, J., Thourani, V. H., Tremmel, J. A., Uretsky, S., Wageman, J., Welt, F., Whisenant, B. K., White, C. J., Yong, C. M., ACC Competency Management Comm, Amer Assoc Thoracic Surg, Amer Soc Echocardiography, Heart Failure Soc Amer, Heart Rhythm Soc, Soc Cardiovasc Anesthesiologists, Soc Cardiovasc Computed Tomography, Soc Cardiovasc Magnetic Resonance, Soc Thoracic Surg, Soc Vasc Med 2023; 16 (10): 1239-1291

  View details for DOI 10.1016/j.jcin.2023.04.011

  View details for Web of Science ID 001011279100001

• Assessing and Addressing Social Determinants of Cardiovascular Health: JACC State-of-the-Art Review. Journal of the American College of Cardiology Brandt, E. J., Tobb, K., Cambron, J. C., Ferdinand, K., Douglass, P., Nguyen, P. K., Vijayaraghavan, K., Islam, S., Thamman, R., Rahman, S., Pendyal, A., Sareen, N., Yong, C., Palaniappan, L., Ibebuogu, U., Tran, A., Bacong, A. M., Lundberg, G., Watson, K. 2023; 81 (14): 1368-1385

  Abstract

  Social determinants of health (SDOH) are the social conditions in which people are born, live, and work. SDOH offers a more inclusive view of how environment, geographic location, neighborhoods, access to health care, nutrition, socioeconomics, and so on are critical in cardiovascular morbidity and mortality. SDOH will continue to increase in relevance and integration of patient management, thus, applying the information herein to clinical and health systems will become increasingly commonplace. This state-of-the-art review covers the 5 domains of SDOH, including economic stability, education, health care access and quality, social and community context, and neighborhood and built environment. Recognizing and addressing SDOH is an important step toward achieving equity in cardiovascular care. We discuss each SDOH within the context of cardiovascular disease, how they can be assessed by clinicians and within health care systems, and key strategies for clinicians and health care systems to address these SDOH. Summaries of these tools and key strategies are provided.

  View details for DOI 10.1016/j.jacc.2023.01.042

  View details for PubMedID 37019584

• Intravascular lithotripsy for the treatment of severely calcified coronary artery disease: A DISRUPT CAD III intravascular ultrasound substudy. Cardiovascular revascularization medicine : including molecular interventions Bhogal, S., Garcia-Garcia, H. M., Klein, A., Benzuly, K., Mangalmurti, S., Moses, J., Alaswad, K., Jaffer, F., Yong, C., Nanjundappa, A., Ben-Dor, I., Mintz, G. S., Hashim, H., Waksman, R. 2023

  Abstract

  Coronary intravascular lithotripsy (IVL) has emerged as a novel technique for the treatment of severely calcified coronary lesions. We evaluated the mechanism and efficacy of IVL in facilitating optimal stent implantation in heavily calcified coronary lesions using intravascular ultrasound (IVUS).Forty-six patients were initially enrolled as a part of the Disrupt CAD III study. Of these, 33 had pre-IVL, 24 had post-IVL, and 44 had post-stent IVUS evaluation. The final analysis was performed on 18 patients who had IVUS images interpretable at all three intervals. The primary endpoint was increase in minimum lumen area (MLA) from pre-IVL to post-IVL treatment to post-stenting.Pre-IVL, MLA was 2.75 ± 0.84 mm2, percent area stenosis was 67.22 % ± 20.95 % with maximum calcium angle of 266.90° ± 78.30°, confirming severely calcified lesions. After IVL, MLA increased to 4.06 ± 1.41 mm2 (p = 0.0003), percent area stenosis decreased to 54.80 % ± 25.71 % (p = 0.0009), and maximum calcium angle decreased to 239.40° ± 76.73° (p = 0.003). There was a further increase in MLA to 6.84 ± 2.18 mm2 (p < 0.0001) and decrease in percent area stenosis to 30.33 % ± 35.08 % (p < 0.0001) post-stenting with minimum stent area of 6.99 ± 2.14 mm2. The success rate of stent delivery, implantation, and post-stent dilation was 100 % post-IVL.In this first study evaluating the mechanism of IVL using IVUS, the primary endpoint of increase in MLA from pre-IVL to post-IVL treatment to post-stenting was successfully achieved. Our study showed that the use of IVL-assisted percutaneous coronary intervention is associated with improved vessel compliance, facilitating optimal stent implantation in de novo severely calcified lesions.

  View details for DOI 10.1016/j.carrev.2023.03.003

  View details for PubMedID 36934007

• 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. Circulation. Cardiovascular interventions Bass, T. A., Abbott, J. D., Mahmud, E., Parikh, S. A., Aboulhosn, J., Ashwath, M. L., Baranowski, B., Bergersen, L., Chaudry, H. I., Coylewright, M., Denktas, A. E., Gupta, K., Gutierrez, J. A., Haft, J., Hawkins, B. M., Herrmann, H. C., Kapur, N. K., Kilic, S., Lesser, J., Lin C, H., Mendirichaga, R., Nkomo, V. T., Park, L. G., Phoubandith, D. R., Quader, N., Rich, M. W., Rosenfield, K., Sabri, S. S., Shames, M. L., Shernan, S. K., Skelding, K. A., Tamis-Holland, J., Thourani, V. H., Tremmel, J. A., Uretsky, S., Wageman, J., Welt, F., Whisenant, B. K., White, C. J., Yong, C. M. 2023: e000088

  View details for DOI 10.1161/HCV.0000000000000088

  View details for PubMedID 36795800

• 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. Journal of the American College of Cardiology Bass, T. A., Abbott, J. D., Mahmud, E., Parikh, S. A., Aboulhosn, J., Ashwath, M. L., Baranowski, B., Bergersen, L., Chaudry, H. I., Coylewright, M., Denktas, A. E., Gupta, K., Gutierrez, J. A., Haft, J., Hawkins, B. M., Herrmann, H. C., Kapur, N. K., Kilic, S., Lesser, J., Lin, C. H., Mendirichaga, R., Nkomo, V. T., Park, L. G., Phoubandith, D. R., Quader, N., Rich, M. W., Rosenfield, K., Sabri, S. S., Shames, M. L., Shernan, S. K., Skelding, K. A., Tamis-Holland, J., Thourani, V. H., Tremmel, J. A., Uretsky, S., Wageman, J., Welt, F., Whisenant, B. K., White, C. J., Yong, C. M. 2023

  View details for DOI 10.1016/j.jacc.2022.11.002

  View details for PubMedID 36801119

• Temporal Trends in Gender of Principal Investigators and Patients in Cardiovascular Clinical Trials. Journal of the American College of Cardiology Yong, C., Suvarna, A., Harrington, R., Gummidipundi, S., Krumholz, H. M., Mehran, R., Heidenreich, P. 2023; 81 (4): 428-430

  View details for DOI 10.1016/j.jacc.2022.10.038

  View details for PubMedID 36697143

• Self-expanding Transcatheter vs Surgical Aortic Valve Replacement in Intermediate-Risk Patients: 5-Year Outcomes of the SURTAVI Randomized Clinical Trial. JAMA cardiology Van Mieghem, N. M., Deeb, G. M., Søndergaard, L., Grube, E., Windecker, S., Gada, H., Mumtaz, M., Olsen, P. S., Heiser, J. C., Merhi, W., Kleiman, N. S., Chetcuti, S. J., Gleason, T. G., Lee, J. S., Cheng, W., Makkar, R. R., Crestanello, J., George, B., George, I., Kodali, S., Yakubov, S. J., Serruys, P. W., Lange, R., Piazza, N., Williams, M. R., Oh, J. K., Adams, D. H., Li, S., Reardon, M. J. 2022; 7 (10): 1000-1008

  Abstract

  In patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limited.To report prespecified secondary 5-year outcomes from the Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement (SURTAVI) randomized clinical trial.SURTAVI is a prospective randomized, unblinded clinical trial. Randomization was stratified by investigational site and need for revascularization determined by the local heart teams. Patients with severe aortic valve stenosis deemed to be at intermediate risk of 30-day surgical mortality were enrolled at 87 centers from June 19, 2012, to June 30, 2016, in Europe and North America. Analysis took place between August and October 2021.Patients were randomized to TAVR with a self-expanding, supra-annular transcatheter or a surgical bioprosthesis.The prespecified secondary end points of death or disabling stroke and other adverse events and hemodynamic findings at 5 years. An independent clinical event committee adjudicated all serious adverse events and an independent echocardiographic core laboratory evaluated all echocardiograms at 5 years.A total of 1660 individuals underwent an attempted TAVR (n = 864) or surgical (n = 796) procedure. The mean (SD) age was 79.8 (6.2) years, 724 (43.6%) were female, and the mean (SD) Society of Thoracic Surgery Predicted Risk of Mortality score was 4.5% (1.6%). At 5 years, the rates of death or disabling stroke were similar (TAVR, 31.3% vs surgery, 30.8%; hazard ratio, 1.02 [95% CI, 0.85-1.22]; P = .85). Transprosthetic gradients remained lower (mean [SD], 8.6 [5.5] mm Hg vs 11.2 [6.0] mm Hg; P < .001) and aortic valve areas were higher (mean [SD], 2.2 [0.7] cm2 vs 1.8 [0.6] cm2; P < .001) with TAVR vs surgery. More patients had moderate/severe paravalvular leak with TAVR than surgery (11 [3.0%] vs 2 [0.7%]; risk difference, 2.37% [95% CI, 0.17%- 4.85%]; P = .05). New pacemaker implantation rates were higher for TAVR than surgery at 5 years (289 [39.1%] vs 94 [15.1%]; hazard ratio, 3.30 [95% CI, 2.61-4.17]; log-rank P < .001), as were valve reintervention rates (27 [3.5%] vs 11 [1.9%]; hazard ratio, 2.21 [95% CI, 1.10-4.45]; log-rank P = .02), although between 2 and 5 years only 6 patients who underwent TAVR and 7 who underwent surgery required a reintervention.Among intermediate-risk patients with symptomatic severe aortic stenosis, major clinical outcomes at 5 years were similar for TAVR and surgery. TAVR was associated with superior hemodynamic valve performance but also with more paravalvular leak and valve reinterventions.

  View details for DOI 10.1001/jamacardio.2022.2695

  View details for PubMedID 36001335

  View details for PubMedCentralID PMC9403849

• The Relationship between Rate and Volume of Intravenous Fluid Administration and Kidney Outcomes after Angiography. Clinical journal of the American Society of Nephrology : CJASN Soomro, Q. H., Anand, S. T., Weisbord, S. D., Gallagher, M. P., Ferguson, R. E., Palevsky, P. M., Bhatt, D. L., Parikh, C. R., Kaufman, J. S. 2022; 17 (10): 1446-56

  Abstract

  Contrast-associated AKI may result in higher morbidity and mortality. Intravenous fluid administration remains the mainstay for prevention. There is a lack of consensus on the optimal administration strategy. We studied the association of periprocedure fluid administration with contrast-associated AKI, defined as an increase in serum creatinine of at least 25% or 0.5 mg/dl from baseline at 3-5 days after angiography, and 90-day need for dialysis, death, or a 50% increase in serum creatinine.We conducted a secondary analysis of 4671 PRESERVE participants who underwent angiographic procedures. Although fluid type was randomized, strategy of administration was at the discretion of the clinician. We divided the study cohort into quartiles by total fluid volume. We performed multivariable logistic regression, adjusting for clinically important covariates. We tested for the interaction between fluid volume and duration of fluid administration, categorized as <6 or ≥6 hours.The mean (SD) age was 70 (8) years, 94% of participants were male, and median (interquartile range) eGFR was 60 (41-60) ml/min per 1.73 m2. The range of fluid administered was 89-882 ml in quartile 1 and 1258-2790 ml in quartile 4. Compared with the highest quartile (quartile 4) of fluid volume, we found a significantly higher risk of the primary outcome in quartile 1 (adjusted odds ratio, 1.58; 95% confidence interval, 1.06 to 2.38) but not in quartiles 2 and 3 compared with quartile 4. There was no difference in the incidence of contrast-associated AKI across the quartiles. The interaction between volume and duration was not significant for any of the outcomes.We found that administration of a total volume of 1000 ml, starting at least 1 hour before contrast injection and continuing postcontrast for a total of 6 hours, is associated with a similar risk of adverse outcomes as larger volumes of intravenous fluids administered for periods >6 hours. Mean fluid volumes <964 ml may be associated with a higher risk for the primary outcome, although residual confounding cannot be excluded.

  View details for DOI 10.2215/CJN.02160222

  View details for PubMedID 36008352

  View details for PubMedCentralID PMC9528263

• "Goldilocks" Approach to Deferred Stenting in ST-Segment-Elevation Myocardial Infarction. Journal of the American Heart Association Yong, C. M., Tamis-Holland, J. E. 2022: e025947

  View details for DOI 10.1161/JAHA.122.025947

  View details for PubMedID 35574950

• Sex-Specific Considerations in the Presentation, Diagnosis, and Management of Ischemic Heart Disease: JACC Focus Seminar 2/7. Journal of the American College of Cardiology Solola Nussbaum, S., Henry, S., Yong, C. M., Daugherty, S. L., Mehran, R., Poppas, A. 2022; 79 (14): 1398-1406

  Abstract

  There are sex-related differences in the epidemiology, presentation, diagnostic testing, and management of ischemic heart disease in women compared with men. The adjusted morbidity and mortality are persistently higher, particularly in younger women and Blacks. Women have more angina but less obstructive coronary artery disease, which affects delays in presentation and diagnosis and testing accuracy. The nonbiological factors play a significant role in access to care, ischemic heart disease management, and guideline adherence. Future research focus includes sex-specific outcomes, characterization of the biological differences, and implementation science around quality of clinical care.

  View details for DOI 10.1016/j.jacc.2021.11.065

  View details for PubMedID 35393022

• Temporal trends in transcatheter aortic valve replacement use and outcomes by race, ethnicity, and sex. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions Yong, C. M., Jaluba, K., Batchelor, W., Gummipundi, S., Asch, S. M., Heidenreich, P. 2022

  Abstract

  To identify trends in transcatheter aortic valve replacement (TAVR) use and outcomes by race (non-Hispanic White, Black), ethnicity (Hispanic), and sex over time.Despite rapid growth in TAVR use over time, our understanding of its use and outcomes among males and females of underrepresented racial/ethnic groups remains limited.A retrospective analysis of hospitalizations from 2013 to 2017 from the Healthcare Cost and Utilization Project database was performed.White patients comprised 65% (n = 2.16 × 107 ) of all hospitalizations, yet they comprised 83% (n = 176,887) of the admissions for aortic stenosis (p < 0.0001). Among 91,693 hospitalizations for aortic valve replacement, 64,069 were surgical (34.0% female, 7.0% Hispanic, and 5.9% Black) and 27,624 were transcatheter (46.6% female, 4.5% Hispanic, and 4.4% Black). Growth in TAVR volumes was the slowest among minorities and females. Hispanic males, Hispanic females, and White females had the highest in-hospital mortality (2.7%-3.3%; compared to White males, adjusted odds ratio: Hispanic males 1.9 [1.2-3.0], Hispanic females 1.9 [1.2-3.1], and White females 1.4 [1.2-1.7]). Despite less baseline vascular disease, females of all races/ethnicities had more vascular complications than men (female 5% vs. male 3.5%, p ≤ 0.001). Further adjustment for vascular complications only partially attenuated mortality differences. Black and Hispanic patients had a longer mean length of hospital stay than White patients, which was most pronounced among females. Pacemaker requirements were consistently low among all groups.Differences in TAVR growth and outcomes by race, ethnicity, and sex over time highlight areas for focused efforts to close gaps in minimally invasive structural heart disease care.

  View details for DOI 10.1002/ccd.30182

  View details for PubMedID 35395131

• SEX OF PRINCIPAL INVESTIGATORS AND PATIENTS IN CARDIOVASCULAR CLINICAL TRIALS Yong, C. M., Suvarna, A., Gummidipundi, S. ELSEVIER SCIENCE INC. 2022: 1470

  View details for Web of Science ID 000781026601569

• Coronary Artery Bypass Surgery After Transradial Catheterization: Implementing 2021 ACC/AHA/SCAI Revascularization Guidelines Into Clinical Practice. JACC. Case reports Gaudino, M., Yong, C. M., Chadow, D., Lawton, J., Tamis-Holland, J. 1800; 4 (1): 27-30

  Abstract

  The 2021 ACC/AHA/SCAI coronary artery disease revascularization guideline recommends radial artery (RA) access for coronary angiography and RA grafting over saphenous vein grafting in patients referred for coronary artery bypass grafting. We present a case of a patient who underwent coronary angiography via both RAs and therefore could notreceive RA bypass grafts. (Level of Difficulty: Advanced.).

  View details for DOI 10.1016/j.jaccas.2021.09.026

  View details for PubMedID 35036939

• 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation Lawton, J. S., Tamis-Holland, J. E., Bangalore, S., Bates, E. R., Beckie, T. M., Bischoff, J. M., Bittl, J. A., Cohen, M. G., DiMaio, J. M., Don, C. W., Fremes, S. E., Gaudino, M. F., Goldberger, Z. D., Grant, M. C., Jaswal, J. B., Kurlansky, P. A., Mehran, R., Metkus, T. S., Nnacheta, L. C., Rao, S. V., Sellke, F. W., Sharma, G., Yong, C. M., Zwischenberger, B. A. 2021: CIR0000000000001039

  Abstract

  The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use.A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Recommendations from the earlier percutaneous coronary intervention and coronary artery bypass graft surgery guidelines have been updated with new evidence to guide clinicians in caring for patients undergoing coronary revascularization. This summary includes recommendations, tables, and figures from the full guideline that relate to the top 10 take-home messages. The reader is referred to the full guideline for graphical flow charts, supportive text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in the development of this guideline.

  View details for DOI 10.1161/CIR.0000000000001039

  View details for PubMedID 34882436

• 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology Lawton, J. S., Tamis-Holland, J. E., Bangalore, S., Bates, E. R., Beckie, T. M., Bischoff, J. M., Bittl, J. A., Cohen, M. G., DiMaio, J. M., Don, C. W., Fremes, S. E., Gaudino, M. F., Goldberger, Z. D., Grant, M. C., Jaswal, J. B., Kurlansky, P. A., Mehran, R., Metkus, T. S., Nnacheta, L. C., Rao, S. V., Sellke, F. W., Sharma, G., Yong, C. M., Zwischenberger, B. A. 2021

  Abstract

  The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use.A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered.Recommendations from the earlier percutaneous coronary intervention and coronary artery bypass graft surgery guidelines have been updated with new evidence to guide clinicians in caring for patients undergoing coronary revascularization. This summary includes recommendations, tables, and figures from the full guideline that relate to the top 10 take-home messages. The reader is referred to the full guideline for graphical flow charts, supportive text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in the development of this guideline.

  View details for DOI 10.1016/j.jacc.2021.09.005

  View details for PubMedID 34895951

• 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology Lawton, J. S., Tamis-Holland, J. E., Bangalore, S., Bates, E. R., Beckie, T. M., Bischoff, J. M., Bittl, J. A., Cohen, M. G., DiMaio, J. M., Don, C. W., Fremes, S. E., Gaudino, M. F., Goldberger, Z. D., Grant, M. C., Jaswal, J. B., Kurlansky, P. A., Mehran, R., Metkus, T. S., Nnacheta, L. C., Rao, S. V., Sellke, F. W., Sharma, G., Yong, C. M., Zwischenberger, B. A. 2021

  Abstract

  The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use.A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered.Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.

  View details for DOI 10.1016/j.jacc.2021.09.006

  View details for PubMedID 34895950

• Trends in Transcatheter and Surgical Aortic Valve Replacement Among OlderAdults in the United States. Journal of the American College of Cardiology Mori, M., Gupta, A., Wang, Y., Vahl, T., Nazif, T., Kirtane, A. J., George, I., Yong, C. M., Onuma, O., Kodali, S., Geirsson, A., Leon, M. B., Krumholz, H. M. 2021; 78 (22): 2161-2172

  Abstract

  BACKGROUND: Recent trends, including survival beyond 30days, in aortic valve replacement (AVR) following the expansion of indications for transcatheter aortic valve replacement (TAVR) are not well-understood.OBJECTIVES: The authors sought to characterize the trends in characteristics and outcomes of patients undergoing AVR.METHODS: The authors analyzed Medicare beneficiaries who underwent TAVR and SAVR in 2012 to 2019. They evaluated case volume, demographics, comorbidities, 1-year mortality, and discharge disposition. Cox proportional hazard models were used to assess the annual change in outcomes.RESULTS: Per 100,000 beneficiary-years, AVR increased from 107 to 156, TAVR increased from 19 to 101, whereas SAVR declined from 88 to 54. The median [interquartile range] age remained similar from 77 [71-83] years to 78 [72-84] years for overall AVR, decreased from 84 [79-88] years to 81 [75-86] years for TAVR, and decreased from 76 [71-81] years to 72 [68-77] years for SAVR. For all AVR patients, the prevalence of comorbidities remained relatively stable. The 1-year mortality for all AVR decreased from 11.9% to 9.4%. Annual change in the adjusted odds of 1-year mortality was 0.93 (95%CI: 0.92-0.94) for TAVR and 0.98 (95%CI: 0.97-0.99) for SAVR, and 0.94 (95%CI: 0.93-0.95) for all AVR. Patients discharged to home after AVR increased from 24.2% to 54.7%, primarily driven by increasing home discharge after TAVR.CONCLUSIONS: The advent of TAVR has led to about a 60% increase in overall AVR in older adults. Improving outcomes in AVR as a whole following the advent of TAVR with increased access is a reassuring trend.

  View details for DOI 10.1016/j.jacc.2021.09.855

  View details for PubMedID 34823659

• How Gold Is the Gold Standard for Machine Learning-Based CT-FFR? JACC. Cardiovascular imaging Yong, C. M., Fearon, W. F. 2021

  View details for DOI 10.1016/j.jcmg.2021.10.002

  View details for PubMedID 34801451

• Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery. The New England journal of medicine Fearon, W. F., Zimmermann, F. M., De Bruyne, B., Piroth, Z., van Straten, A. H., Szekely, L., Davidavicius, G., Kalinauskas, G., Mansour, S., Kharbanda, R., Ostlund-Papadogeorgos, N., Aminian, A., Oldroyd, K. G., Al-Attar, N., Jagic, N., Dambrink, J. E., Kala, P., Angeras, O., MacCarthy, P., Wendler, O., Casselman, F., Witt, N., Mavromatis, K., Miner, S. E., Sarma, J., Engstrom, T., Christiansen, E. H., Tonino, P. A., Reardon, M. J., Lu, D., Ding, V. Y., Kobayashi, Y., Hlatky, M. A., Mahaffey, K. W., Desai, M., Woo, Y. J., Yeung, A. C., Pijls, N. H., FAME 3 Investigators 2021

  Abstract

  BACKGROUND: Patients with three-vessel coronary artery disease have been found to have better outcomes with coronary-artery bypass grafting (CABG) than with percutaneous coronary intervention (PCI), but studies in which PCI is guided by measurement of fractional flow reserve (FFR) have been lacking.METHODS: In this multicenter, international, noninferiority trial, patients with three-vessel coronary artery disease were randomly assigned to undergo CABG or FFR-guided PCI with current-generation zotarolimus-eluting stents. The primary end point was the occurrence within 1 year of a major adverse cardiac or cerebrovascular event, defined as death from any cause, myocardial infarction, stroke, or repeat revascularization. Noninferiority of FFR-guided PCI to CABG was prespecified as an upper boundary of less than 1.65 for the 95% confidence interval of the hazard ratio. Secondary end points included a composite of death, myocardial infarction, or stroke; safety was also assessed.RESULTS: A total of 1500 patients underwent randomization at 48 centers. Patients assigned to undergo PCI received a mean (±SD) of 3.7±1.9 stents, and those assigned to undergo CABG received 3.4±1.0 distal anastomoses. The 1-year incidence of the composite primary end point was 10.6% among patients randomly assigned to undergo FFR-guided PCI and 6.9% among those assigned to undergo CABG (hazard ratio, 1.5; 95% confidence interval [CI], 1.1 to 2.2), findings that were not consistent with noninferiority of FFR-guided PCI (P=0.35 for noninferiority). The incidence of death, myocardial infarction, or stroke was 7.3% in the FFR-guided PCI group and 5.2% in the CABG group (hazard ratio, 1.4; 95% CI, 0.9 to 2.1). The incidences of major bleeding, arrhythmia, and acute kidney injury were higher in the CABG group than in the FFR-guided PCI group.CONCLUSIONS: In patients with three-vessel coronary artery disease, FFR-guided PCI was not found to be noninferior to CABG with respect to the incidence of a composite of death, myocardial infarction, stroke, or repeat revascularization at 1 year. (Funded by Medtronic and Abbott Vascular; FAME 3 ClinicalTrials.gov number, NCT02100722.).

  View details for DOI 10.1056/NEJMoa2112299

  View details for PubMedID 34735046

• Addressing Functional Biases in Procedural Environments. Annals of surgery Soegaard Ballester, J. M., Han, J. J., Yong, C. M. 2021

  View details for DOI 10.1097/SLA.0000000000005211

  View details for PubMedID 34520425

• Gender Differences in the Pursuit of Cardiac Electrophysiology Training in North America. Journal of the American College of Cardiology Abdulsalam, N., Gillis, A. M., Rzeszut, A. K., Yong, C. M., Duvernoy, C. S., Langan, M., West, K., Velagapudi, P., Killic, S., O'Leary, E. L. 2021; 78 (9): 898-909

  Abstract

  BACKGROUND: Despite the increase in the number of female physicians across most specialties within cardiology,<10% of clinical cardiac electrophysiology (EP) fellows are women.OBJECTIVES: This study sought to determine the factors that influence fellows-in-training (FITs) to pursue EP as a career choice and whether this differs by gender.METHODS: The authors conducted an online multiple-choice survey through the American College of Cardiology to assess the decision factors that influence FITs in the United States and Canada to pursue cardiovascular subspecialties.RESULTS: A total of 933 (30.5%) FITs completed the survey; 129 anticipated specializing in EP, 259 in interventional cardiology (IC), and 545 in a different field or were unsure. A total of 1 in 7 (14%) FITs indicated an interest in EP. Of this group, more men chose EP than women (84% vs 16%; P< 0.001). The most important factor that influenced FITs to pursue EP was a strong interest in the field. Women were more likely to be influenced by having a female role model (P=0.001) compared with men. After excluding FITs interested in IC, women who deselected EP were more likely than men to be influenced by greater interest in another field (P = 0.004), radiation concerns (P = 0.001), lack of female role models (P = 0.001), a perceived "old boys' club" culture (P = 0.001) and discrimination/harassment concerns (P=0.001).CONCLUSIONS: Women are more likely than men to be negatively influenced by many factors when it comes to pursuing EP as a career choice. Addressing those factors will help decrease the gender disparity in the field.

  View details for DOI 10.1016/j.jacc.2021.06.033

  View details for PubMedID 34446162

• Pre-procedural barriers to accessing novel treatments for aortic stenosis among racial/ethnic minorities in the veterans affairs healthcare system. American heart journal plus : cardiology research and practice Kerkar, A., Gummidipundi, S., Heidenreich, P. A., Yong, C. M. 2021; 5: 100029

  Abstract

  Novel structural heart procedures offer life-saving treatment advantages, yet little is known about pre-procedural barriers to care by race/ethnicity.All echocardiograms performed at a Veterans Affairs hospital from 2015 to 2019 were reviewed to identify patients with severe aortic stenosis and their access to transcatheter aortic valve replacement (TAVR) by race/ethnicity.From 19,403 echocardiograms, 355 individuals were identified to have severe aortic stenosis (72.6% White, 9.8% Hispanic, 3.9% Black). There was a non-significant trend towards increased TAVR treatment among White compared to non-White patients (OR 2.02, CI 0.96-4.24, p = 0.063), which attenuated after adjustment for age and comorbidities. Reasons for not undergoing replacement included poor procedural candidacy (25.3%), loss of follow-up (17.8%), and patient refusal (16.4%).Racial/ethnic inequities were not detected in novel structural heart treatment within the VA. However, a high proportion of eligible patients did not receive procedural treatment due to patient refusal or loss of follow-up, highlighting barriers that require further study.

  View details for DOI 10.1016/j.ahjo.2021.100029

  View details for PubMedID 38560411

  View details for PubMedCentralID PMC10976283

• MENTOR study: Matching expectations and needs to optimize relationships in cardiovascular fellowship training. American heart journal plus : cardiology research and practice Odanovic, N., Clapham, K. R., Gul, B., Yong, C. M., Meadows, J. L., Altin, S. E. 2021; 4: 100019

  Abstract

  Mentorship is a key component of successful cardiology training. This study sought to understand the alignment of mentorship priorities for fellow-in-training (FIT) mentees and faculty mentors.Cross-sectional survey study.Online.Cardiology mentors and FIT mentees in the State of Connecticut.None.Likert-scale graded valuations on the importance of and satisfaction with various categories of mentorship by both mentors and mentees. Results were analyzed using Mann-Whitney, Kruskal-Wallis and Wilcoxon signed-rank tests, where appropriate.Forty-eight percent of FITs (n = 34) and 16% of faculty mentors (n = 34) responded to the survey. Of those, 74% of FITs identified a mentor within the first year of fellowship either by directly contacting the mentor or meeting them through a clinical rotation. Mentors significantly undervalued the importance to FITs of providing research opportunities (4.5 vs 3.6, p < 0.05), helping them make contacts (4.5 vs 3.7, p < 0.05) and providing job-search support (4.3 vs 3.3, p < 0.05). In contrast, mentors overestimated the value of work-life balance and clinical mentorship to FITs.FITs value support in research, job search support, and networking more than mentors realize, leading to an expectation-satisfaction gap in those areas of mentorship. Further studies to examine how mentors and mentees can best align their expectations may improve the efficacy of the mentorship process.

  View details for DOI 10.1016/j.ahjo.2021.100019

  View details for PubMedID 38559678

  View details for PubMedCentralID PMC10976293

• Addressing Equity and More in 2021: Call From Fellows-in-Training & Early Career SectionEditors. Journal of the American College of Cardiology Han, J. J., Vaduganathan, M., Yong, C. M. 2021; 77 (10): 1372–73

  View details for DOI 10.1016/j.jacc.2021.02.001

  View details for PubMedID 33706881

• DOES STUDY SUBJECT DIVERSITY INFLUENCE CARDIOLOGY RESEARCH SITE PERFORMANCE?: INSIGHTS FROM 2 U.S. NATIONAL CORONARY STENT REGISTRIES. American heart journal Batchelor, W. B., Damluji, A. A., Yong, C., Fiuzat, M., Barnett, S. D., Kandzari, D. E., Sherwood, M. W., Epps, K. C., Tehrani, B. N., Allocco, D. J., Meredith, I. T., Lindenfeld, J., O'Connor, C. M., Mehran, R. 2021

  Abstract

  BACKGROUND: Minorities and women are underrepresented in cardiovascular research. Whether their higher enrollment can be predicted or influences research site performance is unclear.METHODS: We evaluated 104 sites that enrolled 4,184 patients in the U.S. Platinum Diversity (PD) and Promus Element Plus (PE Plus) studies (2012 to 2016). Research sites were ranked from lowest to highest minority and female enrollment, respectively. United States Census bureau division and core-based statistical area (CBSA) populations were determined for each site and the following study performance metrics compared across quartiles of minority and female enrollment, respectively: (1) study subject enrollment rate (SER), (2) time to first patient enrolled, (3) rate of follow-up visits not done, (4) rate of follow-up visits out of window, and (5) protocol deviation rate (PDR). Multivariable regression was used to predict ER and PDR.RESULTS: Minority enrollment varied by region (p=0.025) and population (p=0.024) with highest recruitment noted in the Pacific, West South Central, South Atlantic, Mid-Atlantic and East North Central divisions. Female enrollment bore no relationship to region (p=0.67) or population (p=0.40). Median SER was similar in sites with the highest vs. lowest quartile of minority enrollment (4 vs. 5 patients per month, respectively, p=0.78) and women (4 vs. 4, respectively, p=0.21). Median PDR was lower in sites with the highest vs. lowest minority enrollment (0.23 vs. 0.50 PDs per patient per month, p=0.01) and women (0.37 vs. 0.28, p=0.04). However, this relationship did not persist after multivariable adjustment. All other site performance metrics were comparable across quartiles of minority and female enrollment.CONCLUSIONS: Minority, but not female enrollment, correlated with research site region and surrounding population. High enrollment of minorities and women did not influence study performance metrics, supporting continued efforts to increase clinical trial diversity.TRIAL REGISTRATION: The PD and PE Plus studies are registered at www.clinicaltrials.gov under identifiers NCT02240810 and NCT01589978, respectively. KEY POINTS Question: Does the enrollment of more Blacks, Hispanics and women in U.S. cardiovascular research studies influence the overall rate of study subject enrollment and/or other key study site performance metrics and can diverse enrollment be predicted?FINDINGS: In this pooled analysis of 104 sites that enrolled 4,184 patients in the Platinum Diversity and Promus Element Plus Post-Approval Studies, we found that the enrollment of higher proportions of underrepresented minorities and women was univariately associated with lower protocol deviation rates while having no effect on other site performance metrics. A site's geographic location and surrounding population predicted minority, but not female enrollment. Meaning: These findings suggest that cardiovascular research subject diversity may be predicted from site characteristics and enhanced without compromising key study performance metrics. These insights help inform future strategies aimed at improving clinical trial diversity.

  View details for DOI 10.1016/j.ahj.2021.02.003

  View details for PubMedID 33636137

• Temporal Trends in the Proportion of Women Physician Speakers at Major Cardiovascular Conferences. Circulation Yong, C. M., Balasubramanian, S., Douglas, P. S., Agarwal, P., Birgersdotter-Green, U., Gummidipundi, S., Batchelor, W., Duvernoy, C. S., Harrington, R. A., Mehran, R. 2021; 143 (7): 755–57

  View details for DOI 10.1161/CIRCULATIONAHA.120.052663

  View details for PubMedID 33587663

• 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation Lawton, J. S., Tamis-Holland, J. E., Bangalore, S., Bates, E. R., Beckie, T. M., Bischoff, J. M., Bittl, J. A., Cohen, M. G., DiMaio, J. M., Don, C. W., Fremes, S. E., Gaudino, M. F., Goldberger, Z. D., Grant, M. C., Jaswal, J. B., Kurlansky, P. A., Mehran, R., Metkus, T. S., Nnacheta, L. C., Rao, S. V., Sellke, F. W., Sharma, G., Yong, C. M., Zwischenberger, B. A. 2021: CIR0000000000001038

  Abstract

  The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use.A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.

  View details for DOI 10.1161/CIR.0000000000001038

  View details for PubMedID 34882435

• Cardiovascular Procedural Deferral and Outcomes over COVID-19 Pandemic Phases: A Multi-Center Study. American heart journal Yong, C. M., Spinelli, K. J., Chiu, S. T., Jones, B., Penny, B., Gummidipundi, S., Beach, S., Perino, A., Turakhia, M., Heidenreich, P., Gluckman, T. J. 2021

  Abstract

  The COVID-19 pandemic has disrupted routine cardiovascular care, with unclear impact on procedural deferrals and associated outcomes across diverse patient populations.Cardiovascular procedures performed at 30 hospitals across six Western states in two large, non-profit healthcare systems (Providence St. Joseph Health and Stanford Healthcare) from December 2018-June 2020 were analyzed for changes over time. Risk-adjusted in-hospital mortality was compared across pandemic phases with multivariate logistic regression.Among 36,125 procedures (69% percutaneous coronary intervention, 13% coronary artery bypass graft surgery, 10% transcatheter aortic valve replacement, and 8% surgical aortic valve replacement), weekly volumes changed in two distinct phases after the initial inflection point on February 23, 2020: an initial period of significant deferral (COVID I: March 15 to April 11) followed by recovery (COVID II: April 12 onwards). Compared to pre-COVID, COVID I patients were less likely to be female (p=0.0003), older (p<0.0001), Asian or Black (p=0.02), or Medicare insured (p<0.0001), and COVID I procedures were higher acuity (p<0.0001), but not higher complexity. In COVID II, there was a trend towards more procedural deferral in regions with a higher COVID-19 burden (p=0.05). Compared to pre-COVID, there were no differences in risk-adjusted in-hospital mortality during both COVID phases.Significant decreases in cardiovascular procedural volumes occurred early in the COVID-19 pandemic, with disproportionate impacts by race, gender, and age. These findings should inform our approach to future healthcare disruptions.

  View details for DOI 10.1016/j.ahj.2021.06.011

  View details for PubMedID 34181910

• When to Believe Unexpected Results for Ticagrelor or Prasugrel: Never Rarely Sometimes Always. JACC. Cardiovascular interventions Bittl, J. A., Yong, C. M., Sharma, G. 2020; 13 (19): 2248–50

  View details for DOI 10.1016/j.jcin.2020.08.012

  View details for PubMedID 33032713

• Heterogeneity of Treatment and Outcomes Among Asians With Coronary Artery Disease in the United States. Journal of the American Heart Association Manjunath, L., Chung, S., Li, J., Shah, H., Palaniappan, L., Yong, C. M. 2020: e014362

  Abstract

  Background Prior data demonstrate significant heterogeneity regarding coronary artery disease risk factors and outcomes among Asians in the United States, but no studies have yet examined coronary artery disease treatment patterns or outcomes among disaggregated Asian American subgroups. Methods and Results From a total of 772882 patients with known race/ethnicity and sex who received care from a mixed-payer healthcare organization in Northern California between 2006 and 2015, a retrospective analysis was conducted on 6667 adults with coronary artery disease. Logistic regression was used to examine medical and procedural therapies and outcomes by race/ethnicity, with adjustment for age, sex, income, and baseline comorbidities. Compared with non-Hispanic whites, Chinese were more likely to undergo stenting (50.9% versus 60.8%, odds ratio [OR] 1.39 [95% CI, 1.04-1.87], p=0.005), whereas Filipinos were more likely to receive bypass surgery (6.9% versus 20.5%, OR 2.65 [95% CI, 1.75-4.01], P<0.0001). After stenting, Chinese, Filipinos, and Japanese were more likely than non-Hispanic whites to be prescribed clopidogrel (86.2%, 83.0%, and 91.4% versus 74.5%, ORs 1.86 [95% CI, 1.13-3.04], 1.86 [95% CI, 1.01-3.44], and 4.37 [95% CI, 1.02-18.67], respectively, P<0.0001). Lastly, Chinese and Asian Indians were more likely than non-Hispanic whites to be diagnosed with a myocardial infarction within 1year postangiography (15.6% and 17.4% versus 11.2%, ORs 1.49 [95% CI, 1.02-2.19] and 1.68 [95% CI, 1.21-2.34], respectively, P<0.0001). Conclusions Disaggregation of Asian Americans with coronary artery disease into individual racial/ethnic subgroups reveals significant variability in treatment patterns and outcomes. Further investigation into these differences may expose important opportunities to mitigate disparities and improve quality of care in this diverse population.

  View details for DOI 10.1161/JAHA.119.014362

  View details for PubMedID 32390539

• Picking Up the Torch: Our Mission as the New FIT & EC Section Editors. Journal of the American College of Cardiology Yong, C. M., Han, J. J., Vaduganathan, M. n. 2020; 76 (2): 221–22

  View details for DOI 10.1016/j.jacc.2020.06.020

  View details for PubMedID 32646572

  View details for PubMedCentralID PMC7338029

• COVID-19: The Isolation That Has Brought Us Together. Journal of the American College of Cardiology Yong, C. n. 2020; 75 (20): 2639–41

  View details for DOI 10.1016/j.jacc.2020.04.014

  View details for PubMedID 32439014

  View details for PubMedCentralID PMC7159867

• Sex Differences in Oral Anticoagulation and Outcomes of Stroke and Intracranial Bleeding in Newly Diagnosed Atrial Fibrillation. Journal of the American Heart Association Yong, C. M., Tremmel, J. A., Lansberg, M. G., Fan, J. n., Askari, M. n., Turakhia, M. P. 2020: e015689

  Abstract

  Background Female sex is an independent predictor of stroke in patients with atrial fibrillation (AF). Older data suggest undertreatment with anticoagulation among women compared with men. However, it is unknown if novel therapies and updated guidelines have impacted sex differences in AF treatment and outcomes. Methods and Results We performed a retrospective cohort study of 2.3 million women and men with a new diagnosis of AF and CHA2DS2-VASc ≥2 from Marketscan US commercial claims data from 2008 to 2015 to determine whether women with AF remain undertreated and whether this difference mediates observed differences in outcomes. There were 358 649 patients with newly diagnosed AF (43% women). Compared with men, women were older, with higher CHA2DS2-VASc scores, and higher comorbidity burden (P<0.0001 for all). Oral anticoagulation-eligible women with CHA2DS2-VASc scores ≥2 were more likely to not receive anticoagulation (50.0% women versus 43.9% men). Women, compared with men, had a higher risk of ischemic stroke (adjusted hazard ratio [aHR], 1.27; 95% CI, 1.21-1.32; P<0.0001) and hospitalization (aHR, 1.06; 95% CI, 1.05-1.07, P<0.0001) but had a lower risk of intracranial bleeding (aHR, 0.91; 95% CI, 0.83-0.99, P=0.03). In mediation analysis, nonreceipt of oral anticoagulation partially mediated the observed increased risk of stroke and decreased risk of intracranial bleeding in women. Conclusions In the care of newly diagnosed AF in the United States, women, compared with men, are less likely to receive oral anticoagulation. This appears to mediate the increased risk of both stroke and hospitalization but also appears to mediate lower observed intracranial bleeding risk.

  View details for DOI 10.1161/JAHA.120.015689

  View details for PubMedID 32394763

• Integrating the ABC-Bleeding Risk Score Into Practice. JAMA network open Yong, C. M., Bittl, J. A. 2020; 3 (9): e2016126

  View details for DOI 10.1001/jamanetworkopen.2020.16126

  View details for PubMedID 32936295

• Cardiac Procedural Deferral during the Coronavirus (COVID-19) Pandemic. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions Yong, C. M., Ang, L. n., Welt, F. G., Gummidipundi, S. n., Henry, T. D., Pinto, D. S., Cox, D. n., Wang, P. n., Asch, S. n., Mahmud, E. n., Fearon, W. F. 2020

  Abstract

  We aimed to examine factors impacting variability in cardiac procedural deferral during the COVID-19 pandemic and assess cardiologists' perspectives regarding its implications.Unprecedented cardiac procedural deferral was implemented nationwide during the COVID-19 pandemic.A web-based survey was administered by SCAI and the ACC Interventional Council to cardiac catheterization laboratory (CCL) directors and interventional cardiologists across the United States during the COVID-19 pandemic.Among 414 total responses, 48 states and 360 unique cardiac catheterization laboratories were represented, with mean inpatient COVID-19 burden 16.4+21.9%. There was a spectrum of deferral by procedure type, varying by both severity of COVID-19 burden and procedural urgency (p<0.001). Percutaneous coronary intervention volumes dropped by 55% (p<0.0001) and transcatheter aortic valve replacement volumes dropped by 64%, (p=0.004), with cardiologists reporting an increase in late presenting ST-Elevation Myocardial Infarctions and deaths among patients waiting for transcatheter aortic valve replacement. Almost 1/3 of catheterization laboratories had at least one interventionalist testing positive for COVID-19. Salary reductions did not influence procedural deferral or speed of reinstituting normal volumes. Pandemic preparedness improved significantly over time, with the most pressing current problems focused on inadequate testing and staff health risks.During the COVID-19 pandemic, cardiac procedural deferrals were associated with procedural urgency and severity of hospital COVID-19 burden. Yet patients did not appear to be similarly influenced, with cardiologists reporting increases in late presenting ST-Elevation Myocardial Infarctions independent of local COVID-19 burden. The safety and importance of seeking healthcare during this pandemic deserves emphasis. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/ccd.29262

  View details for PubMedID 32882075

• Differences in Transcatheter Aortic Valve Replacement (TAVR) Outcomes by Gender and Race Over Time Yong, C., Jaluba, K., Heidenreich, P. ELSEVIER SCIENCE INC. 2019: B732

  View details for Web of Science ID 000487306300733

• Sex Differences in the Pursuit of Interventional Cardiology as a Subspecialty Among CardiovascularFellows-in-Training. JACC. Cardiovascular interventions Yong, C. M., Abnousi, F., Rzeszut, A. K., Douglas, P. S., Harrington, R. A., Mehran, R., Grines, C., Altin, S. E., Duvernoy, C. S., American College of Cardiology Women in Cardiology Leadership Council (ACC WIC), Society for Cardiovascular Angiography and Interventions Women in Innovations (SCAI WIN) 2019

  Abstract

  OBJECTIVES: The authors sought to determine the factors that influence fellows-in-training (FITs) to pursue a career in interventional cardiology (IC) and how these differ by sex.BACKGROUND: Despite increases in the proportion of women across numerous medical and surgical specialties over the last decade, IC still ranks at the bottom in terms of representation of women. It is unclear why this maldistribution persists.METHODS: An online survey of cardiovascular FITs was conducted under the direction of the American College of Cardiology Women in Cardiology Leadership Council to assess FIT perspectives regarding subspecialty choices.RESULTS: Of 574 respondents, 33% anticipated specializing in IC. Men were more likely to choose IC than women (39% men, 17% women, odds ratio: 3.98 [95% confidence interval: 2.38 to 6.68]; p< 0.001). Men were more likely to be married (p= 0.005) and have children (p= 0.002). Among married FITs, male IC FITs were more likely to have spouses who do not work (p= 0.003). Although men were more likely to be influenced by positive attributes to pursue IC, women were significantly more likely to be influenced negatively against pursuing the field by attributes including greater interest in another field (p= 0.001), little job flexibility (p= 0.02), physically demanding nature of job (p=0.004), radiation during childbearing (p< 0.001), "old boys' club" culture (p< 0.001), lack of female role models (p< 0.001), and sex discrimination (p< 0.001).CONCLUSIONS: Many factors uniquely dissuade women from pursuing IC compared with men, largely related to the culture of IC as a subspecialty. Targeted resolution of these specific factors may provide the most impact in reducing sex imbalances in the field.

  View details for PubMedID 30660463

• The efficacy and safety of cangrelor in single vessel vs multi vessel percutaneous coronary intervention: Insights from CHAMPION PHOENIX. Clinical cardiology Yong, C. M., Sundaram, V. n., Abnousi, F. n., Olivier, C. B., Yang, J. n., Stone, G. W., Steg, P. G., Michael Gibson, C. n., Hamm, C. W., Price, M. J., Deliargyris, E. N., Prats, J. n., White, H. D., Harrington, R. A., Bhatt, D. L., Mahaffey, K. W. 2019

  Abstract

  The intravenous, rapidly acting P2Y12 inhibitor cangrelor reduces the rate of ischemic events during PCI with no significant increase in severe bleeding. However, the efficacy and safety of cangrelor compared with clopidogrel in patients treated with single vessel (SV)-percutaneous coronary intervention (PCI) or multi vessel (MV)-PCI remains unexplored.We studied the modified intention-to-treat population of patients from the CHAMPION PHOENIX trial who were randomized to either cangrelor or clopidogrel. We used logistic regression and propensity score matching to evaluate the effect of cangrelor compared with clopidogrel on the primary efficacy outcome (composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis) at 48 hours. The safety outcome was moderate or severe Global Utilization of Streptokinase and tPA for Occluded Arteries bleeding at 48 hours.Cangrelor isas efficacious and safe as clopidogrel in both SVand MV PCI.Among 10 854 patients, 9204 (85%) underwent SV- and 1650 (15%) MV-PCI. After adjustment, cangrelor was associated with similar reductions vs clopidogrel in the primary efficacy outcome in patients undergoing SV-PCI (4.5% vs 5.2%; odds ratio [OR] 0.81 [0.66-0.98]) or MV-PCI (6.1% vs 9.8%, OR 0.59 [0.41-0.85]; Pint 0.14). Similar results were observed after propensity score matching (SV-PCI: 5.5% vs 5.9%, OR 0.93 [0.74-1.18]; MV-PCI: 6.2% vs 8.9%, OR 0.67 [0.44-1.01]; Pint 0.17). There was no evidence of heterogeneity in the treatment effect of cangrelor compared with clopidogrel for the safety outcome.In patients undergoing SV- or MV-PCI, cangrelor was associated with similar relative risk reductions in ischemic complications and no increased risk of significant bleeding compared with clopidogrel, which highlights the expanding repertoire of options for use in complex PCI.

  View details for DOI 10.1002/clc.23221

  View details for PubMedID 31254472

• A novel noninvasive method for remote heart failure monitoring: the EuleriAn video Magnification apPLications In heart Failure studY (AMPLIFY). NPJ digital medicine Abnousi, F., Kang, G., Giacomini, J., Yeung, A., Zarafshar, S., Vesom, N., Ashley, E., Harrington, R., Yong, C. 2019; 2: 80

  Abstract

  Current remote monitoring devices for heart failure have been shown to reduce hospitalizations but are invasive and costly; accurate non-invasive options remain limited. The EuleriAn Video Magnification ApPLications In Heart Failure StudY (AMPLIFY) pilot aimed to evaluate the accuracy of a novel noninvasive method that uses Eulerian video magnification. Video recordings were performed on the neck veins of 50 patients who were scheduled for right heart catheterization at the Palo Alto VA Medical Center. The recorded jugular venous pulsations were then enhanced by applying Eulerian phase-based motion magnification. Assessment of jugular venous pressure was compared across three categories: (1) physicians who performed bedside exams, (2) physicians who reviewed both the amplified and unamplified videos, and (3) direct invasive measurement of right atrial pressure from right heart catheterization. Motion magnification reduced inaccuracy of the clinician assessment of central venous pressure compared to the gold standard of right heart catheterization (mean discrepancy of -0.80cm H2O; 95% CI -2.189 to 0.612, p=0.27) when compared to both unamplified video (-1.84cm H2O; 95% CI -3.22 to -0.46, p=0.0096) and the bedside exam (-2.90cm H2O; 95% CI -4.33 to 1.40, p=0.0002). Major categorical disagreements with right heart catheterization were significantly reduced with motion magnification (12%) when compared to unamplified video (25%) or the bedside exam (27%). This novel method of assessing jugular venous pressure improves the accuracy of the clinical exam and may enable accurate remote monitoring of heart failure patients with minimal patient risk.

  View details for DOI 10.1038/s41746-019-0159-0

  View details for PubMedID 31453375

• Prevalence, Treatment, and Outcomes Among Asian Subgroups With Coronary Artery Disease Manjunath, L., Chung, S., Li Jiang, Palaniappan, L., Yong, C. M. LIPPINCOTT WILLIAMS & WILKINS. 2018

  View details for Web of Science ID 000528619407029

• Racial Differences in Quality of Care and Outcomes After Acute Coronary Syndrome. The American journal of cardiology Yong, C. M., Ungar, L., Abnousi, F., Asch, S. M., Heidenreich, P. A. 2018

  Abstract

  Guideline adherence and variation in acute coronary syndrome (ACS) outcomes by race in the modern era of drug-eluting stents (DES) are not well understood. Previous studies also fail to capture rapidly growing minority populations, such as Asians. A retrospective analysis of 689,238 hospitalizations for ACS across all insurance types from 2008 to 2011 from the Healthcare Cost and Utilization Project database was performed to determine whether quality of ACS care and mortality differ by race (white, black, Asian, Hispanic, or Native American), with adjustment for patient clinical and demographic characteristics and clustering by hospital. We found that black patients had the lowest in-hospital mortality rates (5% vs 6% to 7% for other races, p<0.0001, odds ratio [OR] 1.02, 95% confidence interval [CI] 0.97 to 1.07), despite low rates of timely angiography in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction, and lower use of DES (30% vs 38% to 40% for other races, p<0.0001). In contrast, Asian patients had the highest in-hospital mortality rates (7% vs 5% to 7% for other races, p<0.0001, odds ratio 1.13, 95% CI 1.08 to 1.20, relative to white patients), despite higher rates of timely angiography in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction, and the highest use of DES (74% vs 63% to 68% for other races, p<0.0001). Asian patients had the worst in-hospital mortality outcomes after ACS, despite high use of early invasive treatments. Black patients had better in-hospital outcomes despite receiving less guideline-driven care.

  View details for PubMedID 29655881

• THE EFFICACY AND SAFETY OF CANGRELOR FOR PATIENTS UNDERGOING SINGLE VESSEL VERSUS MULTI VESSEL PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM THE CHAMPION PHOENIX TRIAL Olivier, C., Abnousi, F., Sundaram, V., Yang, J., Stone, G., Steg, P., Gibson, C., Hamm, C., Price, M., Deliargyris, E., Prats, J., White, H., Harrington, R., Bhatt, D., Mahaffey, K., Yong, C., CHAMPION PHOENIX Investigators ELSEVIER SCIENCE INC. 2018: 29

  View details for DOI 10.1016/S0735-1097(18)30570-9

  View details for Web of Science ID 000429659700030

• Association of insurance type with receipt of oral anticoagulation in insured patients with atrial fibrillation: A report from the American College of Cardiology NCDR PINNACLE registry AMERICAN HEART JOURNAL Yong, C. M., Liu, Y., Apruzzese, P., Doros, G., Cannon, C. P., Maddox, T. M., Gehi, A., Hsu, J. C., Lubitz, S. A., Virani, S., Turakhia, M. P., ACC PINNACLE Investigators 2018; 195: 50–59

  View details for DOI 10.1016/j.ahj.2017.08.010

  View details for Web of Science ID 000417603100004

• Cangrelor reduces the risk of ischemic complications in patients with single-vessel and multi-vessel disease undergoing percutaneous coronary intervention: Insights from the CHAMPION PHOENIX trial. American heart journal Abnousi, F., Sundaram, V., Yong, C. M., Prats, J., Deliargyris, E. N., Stone, G. W., Hamm, C. W., Steg, P. G., Gibson, C. M., White, H. D., Price, M. J., Généreux, P., Desai, M., Yang, L., Ding, V. Y., Harrington, R. A., Bhatt, D. L., Mahaffey, K. W. 2017; 188: 147-155

  Abstract

  To examine the safety and efficacy of cangrelor in patients with single-vessel disease (SVD) and multi-vessel disease (MVD).Cangrelor, an intravenous, rapidly acting P2Y12 inhibitor, is superior to clopidogrel in reducing ischemic events among patients receiving percutaneous coronary intervention (PCI).We studied a modified intention to treat population of patients with SVD and MVD from the CHAMPION PHOENIX trial. The primary efficacy outcome was the composite of death, myocardial infarction (MI), ischemia-driven revascularization (IDR), and stent thrombosis (ST) at 48hours. The key safety outcome was non-coronary artery bypass grafting GUSTO severe bleeding at 48hours.Among 10,921 patients, 5,220 (48%) had SVD and 5,701 (52%) had MVD. MVD patients were older and more often had diabetes, hyperlipidemia, hypertension, prior stroke, and prior MI. After adjustment, MVD patients had similar rates of 48-hour death/MI/IDR/ST (6.3% vs 4.2%, adjusted odds ratio [OR] 1.6 [95% CI 0.42-6.06]) and GUSTO severe bleeding (0.1% vs 0.2%, P=.67) compared with SVD patients. Consistent with overall trial findings, cangrelor use reduced ischemic complications in patients with both SVD (3.9% vs 4.5%; OR 0.86, 95% CI 0.65-1.12) and MVD (5.5% vs 7.2%; OR 0.74, 95% CI 0.6-0.92, P-interaction=.43). GUSTO severe bleeding outcomes were not significantly increased with cangrelor or clopidogrel in either SVD or MVD patients.In the CHAMPION PHOENIX trial, MVD and SVD patients had similar ischemic outcomes at 48hours and 30days. Cangrelor consistently reduced ischemic complications in both SVD and MVD patients without a significant increase in GUSTO severe bleeding. CLINICAL PERSPECTIVES.

  View details for DOI 10.1016/j.ahj.2017.02.031

  View details for PubMedID 28577670

• Breaking the Catheterization Laboratory Ceiling. Journal of the American College of Cardiology Yong, C. M. 2017; 69 (21): 2668-2671

  View details for DOI 10.1016/j.jacc.2017.04.027

  View details for PubMedID 28545642

• Impact of Baseline Stroke Risk and Bleeding Risk on Warfarin International Normalized Ratio Control in Atrial Fibrillation (from the TREAT-AF Study) AMERICAN JOURNAL OF CARDIOLOGY Hellyer, J. A., Azarbal, F., Than, C. T., Fan, J., Schmitt, S. K., Yang, F., Frayne, S. M., Phibbs, C. S., Yong, C., Heidenreich, P. A., Turakhia, M. P. 2017; 119 (2): 268-274

  Abstract

  Warfarin prevents stroke and prolongs survival in patients with atrial fibrillation and flutter (AF, collectively) but can cause hemorrhage. The time in international normalized ratio (INR) therapeutic range (TTR) mediates stroke reduction and bleeding risk. This study sought to determine the relation between baseline stroke, bleeding risk, and TTR. Using data from The Retrospective Evaluation and Assessment of Therapies in Atrial Fibrillation (TREAT-AF) retrospective cohort study, national Veterans Health Administration records were used to identify patients with newly diagnosed AF from 2003 to 2012 and subsequent initiation of warfarin. Baseline stroke and bleeding risk was determined by calculating CHA2DS2-VASc and HAS-BLED scores, respectively. Main outcomes were first-year and long-term TTR and INR monitoring rate. In 167,190 patients, the proportion of patients with TTR (>65%) decreased across increasing strata of CHA2DS2-VASc and HAS-BLED. After covariate adjustment, odds of achieving TTR >65% were significantly associated with high CHA2DS2-VASc or HAS-BLED score. INR monitoring rate was similar across risk strata. In conclusion, increased baseline stroke and bleeding risk is associated with poor INR control, despite similar rates of INR monitoring. These findings may paradoxically limit warfarin's efficacy and safety in high-risk patients and may explain observed increased bleeding and stroke rates in this cohort.

  View details for DOI 10.1016/j.amjcard.2016.09.045

  View details for PubMedID 27836133

• Asians suffer the highest in-hospital mortality rates after acute coronary syndrome despite high use of early invasive procedures Yong, C., Abnousi, F., Asch, S., Heidenreich, P. ELSEVIER SCIENCE INC. 2016: B40

  View details for DOI 10.1016/j.jacc.2016.09.344

  View details for Web of Science ID 000397332900098

• Sedentary Behavior and Cardiovascular Morbidity and Mortality: A Science Advisory From the American Heart Association. Circulation Young, D. R., Hivert, M. F., Alhassan, S., Camhi, S. M., Ferguson, J. F., Katzmarzyk, P. T., Lewis, C. E., Owen, N., Perry, C. K., Siddique, J., Yong, C. M. 2016; 134 (13): e262-79

  Abstract

  Epidemiological evidence is accumulating that indicates greater time spent in sedentary behavior is associated with all-cause and cardiovascular morbidity and mortality in adults such that some countries have disseminated broad guidelines that recommend minimizing sedentary behaviors. Research examining the possible deleterious consequences of excess sedentary behavior is rapidly evolving, with the epidemiology-based literature ahead of potential biological mechanisms that might explain the observed associations. This American Heart Association science advisory reviews the current evidence on sedentary behavior in terms of assessment methods, population prevalence, determinants, associations with cardiovascular disease incidence and mortality, potential underlying mechanisms, and interventions. Recommendations for future research on this emerging cardiovascular health topic are included. Further evidence is required to better inform public health interventions and future quantitative guidelines on sedentary behavior and cardiovascular health outcomes.

  View details for DOI 10.1161/CIR.0000000000000440

  View details for PubMedID 27528691

• ASSOCIATION OF INSURANCE TYPE WITH RECEIPT OF ORAL ANTICOAGULATION IN ATRIAL FIBRILLATION: AN ANALYSIS OF THE AMERICAN COLLEGE OF CARDIOLOGY NCDR PINNACLE REGISTRY Yong, C. M., Liu, Y., Lei, L., Doros, G., Cannon, C., Maddox, T., Gehi, A., Virani, S., Turakhia, M., ACC PINNACLE Investigators ELSEVIER SCIENCE INC. 2016: 888

  View details for DOI 10.1016/S0735-1097(16)30889-0

  View details for Web of Science ID 000375188701732

• Racial Differences in Quality of Anticoagulation Therapy for Atrial Fibrillation (from the TREAT-AF Study) AMERICAN JOURNAL OF CARDIOLOGY Yong, C., Azarbal, F., Abnousi, F., Heidenreich, P. A., Schmitt, S., Fan, J., Than, C. T., Ullal, A. J., Yang, F., Phibbs, C. S., Frayne, S. M., Ho, P. M., Shore, S., Mahaffey, K. W., Turakhia, M. P. 2016; 117 (1): 61-68

  Abstract

  The influence of race on quality of anticoagulation control is not well described. We examined the association between race, international normalized ratio (INR) monitoring intensity, and INR control in warfarin-treated patients with atrial fibrillation (AF). Using data from the Veterans Health Administration (VHA), we performed a retrospective cohort study of 184,161 patients with a new diagnosis of AF/flutter from 2004 to 2012 who received any VHA prescription within 90 days of diagnosis. The primary predictor was race, ascertained from multiple VHA and linked Medicare demographic files. The primary outcome was first-year and long-term time in therapeutic range (TTR) of INR 2.0 to 3.0. Secondary outcomes were INR monitoring intensity and warfarin persistence. Of the 116,021 patients who received warfarin in the cohort, INR monitoring intensity was similar across racial groups. However, TTR was lowest in blacks and highest in whites (first year 0.49 ± 0.23 vs 0.57 ± 0.21, p <0.001; long term 0.52 ± 0.20 vs 0.59 ± 0.18, p <0.001); 64% of whites and 49% of blacks had long-term TTR >55% (p <0.001). After adjusting for site and patient-level covariates, black race was associated with lower first-year and long-term TTRs (4.2% and 4.1% below the conditional mean, relative to whites; p <0.0001 for both). One-year warfarin persistence was slightly lower in blacks compared to whites (58% vs 60%, p <0.0001). In conclusion, in patients with AF anticoagulated with warfarin, differences in INR control are most evident among blacks, underscoring the need to determine if other types of intensive management or warfarin alternatives may be necessary to improve anticoagulation among vulnerable AF populations.

  View details for DOI 10.1016/j.amjcard.2015.09.047

  View details for Web of Science ID 000368048900010

• Cangrelor Improves Ischemic Outcomes In Patients With Multivessel Disease And Single Vessel Disease Undergoing PCI: Insights From The CHAMPION PHOENIX Trial Abnousi, F., Sundaram, V., Prats, J., Deliargyris, E. N., Stone, G. W., Hamm, C., Steg, P. G., Gibson, C., White, H. D., Price, M. J., Yong, C., Desai, M., Harrington, R., Bhatt, D. L., Mahaffey, K. ELSEVIER SCIENCE INC. 2015: B35

  View details for DOI 10.1016/j.jacc.2015.08.118

  View details for Web of Science ID 000363329000076

• The Evolution of Temporary Percutaneous Mechanical Circulatory Support Devices: a Review of the Options and Evidence in Cardiogenic Shock CURRENT CARDIOLOGY REPORTS Abnousi, F., Yong, C. M., Fearon, W., Banerjee, D. 2015; 17 (6)

  Abstract

  Temporary percutaneous mechanical circulatory support (MCS) devices were introduced in the 1960s and have developed into a diverse portfolio of options currently available for left, right, and biventricular support. Patients undergoing high-risk percutaneous coronary interventions (PCI), patients with acute myocardial infarction (AMI), and patients with cardiogenic shock in particular may benefit from these options. In this review, we will discuss the currently available devices and the evidence supporting their use in cardiogenic shock.

  View details for DOI 10.1007/s11886-015-0594-8

  View details for Web of Science ID 000353514800004

  View details for PubMedID 25899658

• Socioeconomic Inequalities in Quality of Care and Outcomes Among Patients With Acute Coronary Syndrome in the Modern Era of Drug Eluting Stents JOURNAL OF THE AMERICAN HEART ASSOCIATION Yong, C. M., Abnousi, F., Asch, S. M., Heidenreich, P. A. 2014; 3 (6)

  Abstract

  The rapidly changing landscape of percutaneous coronary intervention provides a unique model for examining disparities over time. Previous studies have not examined socioeconomic inequalities in the current era of drug eluting stents (DES).We analyzed 835 070 hospitalizations for acute coronary syndrome (ACS) from the Healthcare Cost and Utilization Project across all insurance types from 2008 to 2011, examining whether quality of care and outcomes for patients with ACS differed by income (based on zip code of residence) with adjustment for patient characteristics and clustering by hospital. We found that lower-income patients were less likely to receive an angiogram within 24 hours of a ST elevation myocardial infarction (STEMI) (69.5% for IQ1 versus 73.7% for IQ4, P<0.0001, OR 0.79 [0.68 to 0.91]) or within 48 hours of a Non-STEMI (47.6% for IQ1 versus 51.8% for IQ4, P<0.0001, OR 0.86 [0.75 to 0.99]). Lower income was associated with less use of a DES (64.7% for IQ1 versus 71.2% for IQ4, P<0.0001, OR 0.83 [0.74 to 0.93]). However, no differences were found for coronary artery bypass surgery. Among STEMI patients, lower-income patients also had slightly increased adjusted mortality rates (10.8% for IQ1 versus 9.4% for IQ4, P<0.0001, OR 1.17 [1.11 to 1.25]). After further adjusting for time to reperfusion among STEMI patients, mortality differences across income groups decreased.For the most well accepted procedural treatments for ACS, income inequalities have faded. However, such inequalities have persisted for DES use, a relatively expensive and until recently, controversial revascularization procedure. Differences in mortality are significantly associated with differences in time to primary PCI, suggesting an important target for understanding why these inequalities persist.

  View details for DOI 10.1161/JAHA.114.001029

  View details for Web of Science ID 000345067600027

  View details for PubMedID 25398888

  View details for PubMedCentralID PMC4338689

• Justification of an Introductory Electrocardiogram Teaching Mnemonic by Demonstration of its Prognostic Value AMERICAN JOURNAL OF MEDICINE Soofi, M., Yong, C., Froelicher, V. 2014; 127 (12): 1202-1207

  Abstract

  With diminishing time afforded to electrocardiography in the medical curriculum, we have found Sibbitt's simple mnemonic, the Diagonal Line Lead Rule, for a pattern recognition approach to 12-lead electrocardiogram (ECG) interpretation to be appreciated by students. However, it still lacks universal acceptance because its clinical utility has not been documented. The study objective was to demonstrate the clinical utility of the Diagonal Line Lead ECG Teaching Rule.After excluding ECGs of high-risk patients with Wolff-Parkinson-White syndrome and QRS durations greater than 120 ms, the initial ECGs of the remaining 43,798 patients were scored according to the Diagonal Line Lead Rule. A total of 45,497 patients from the Veterans Affairs Palo Alto Healthcare System were referred for a routine initial resting ECG from 1987 to 1999. We determined cardiovascular mortality with 8 years of follow-up.In patients with normal QRS duration, diagnostic Q-wave or T-wave inversions isolated to the diagonal line leads showed no increased risk of cardiovascular death. Q-wave or T-wave inversion in any other lead was significantly associated with cardiovascular death with an age-adjusted Cox hazard of 2.6 (confidence interval, 2.4-2.8; P < .0001) and an annual cardiovascular mortality rate of 3.0%. Leads V4-V6, I, and aVL were especially significant predictors of cardiovascular death, with a Cox hazard greater than 3.Our analysis demonstrates the prognostic power and clinical utility of a simple mnemonic for 12-lead ECG interpretation that can facilitate ECG teaching and interpretation.

  View details for DOI 10.1016/j.amjmed.2014.07.016

  View details for PubMedID 25065339

• Transcatheter CoreValve valve-in-valve implantation in a stentless porcine aortic valve for severe aortic regurgitation. Clinical case reports Yong, C. M., Buchbinder, M., Giacomini, J. C. 2014; 2 (6): 281-285

  Abstract

  We describe the first valve-in-valve Corevalve transcatheter aortic valve replacement in the St. Jude Toronto stentless porcine aortic valve in the United States, which enabled this 59-year-old patient with a history of bacterial endocarditis and aortic regurgitation to avoid heart transplant with complete resolution of his severe left ventricular dysfunction.

  View details for DOI 10.1002/ccr3.113

  View details for PubMedID 25548631

• Is the J Wave or the ST Slope Malignant ... or Neither? JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Yong, C., Froelicher, V., Wagner, G. 2014; 63 (17): 1811–12

  View details for DOI 10.1016/j.jacc.2013.09.076

  View details for Web of Science ID 000335312200023

  View details for PubMedID 24315921

• Patterns and prognosis of all components of the J-wave pattern in multiethnic athletes and ambulatory patients. American heart journal Muramoto, D., Yong, C. M., Singh, N., Aggarwal, S., Perez, M., Ashley, E., Hadley, D., Froelicher, V. 2014; 167 (2): 259-266

  Abstract

  Despite recent concern about the significance of the J-wave pattern (also often referred to as early repolarization) and the importance of screening in athletes, there are limited rigorous prognostic data characterizing the 3 components of the J-wave pattern (ST elevation, J waves, and QRS slurs). We aim to assess the prevalence, patterns, and prognosis of the J-wave pattern among both stable clinical and athlete populations.We retrospectively studied 4,041 electrocardiograms from a multiethnic clinical population from 1997 to 1999 at the Veterans Affairs Palo Alto Health Care System. We also examined preparticipation electrocardiograms of 1,114 Stanford University varsity athletes from 2007 to 2008. Strictly defined criteria for components of the J-wave pattern were examined. In clinical subjects, prognosis was assessed using the end point of cardiovascular death after 7 years of follow-up.Components of the J-wave pattern were most prevalent in males; African Americans; and, particularly, athletes, with the greatest variations demonstrated in the lateral leads. ST elevation was the most common. Inferior J waves and slurs, previously linked to cardiovascular risk, were observed in 9.6% of clinical subjects and 12.3% of athletes. J waves, slurs, or ST elevation was not associated with time to cardiovascular death in clinical subjects, and ST-segment slope abnormalities were not prevalent enough in conjunction with them to reach significance.J waves, slurs, or ST elevation was not associated with increased hazard of cardiovascular death in our large multiethnic, ambulatory population. Even subsets of J-wave patterns, recently proposed to pose a risk of arrhythmic death, occurred at such a high prevalence as to negate their utility in screening.

  View details for DOI 10.1016/j.ahj.2013.10.027

  View details for PubMedID 24439988

• Racial Disparities in Warfarin Time in INR Therapeutic Range in Patients With Atrial Fibrillation: Findings From the TREAT-AF Study Yong, C., Xu, X., Than, C., Ullal, A., Schmitt, S., Azarbal, F., Heidenreich, P., Turakhia, M. LIPPINCOTT WILLIAMS & WILKINS. 2013

  View details for Web of Science ID 000332162903466

• To the editor- blind men and the J wave-confusing aspects of the 2013 HRS Statement on Inherited Arrhythmic Diseases. Heart rhythm Yong, C., Froelicher, V., Wagner, G. 2013; 10 (11): e81-2

  View details for DOI 10.1016/j.hrthm.2013.09.057

  View details for PubMedID 24055948

• Prognostic implications of the J wave ECG patterns. Journal of electrocardiology Yong, C. M., Perez, M., Froelicher, V. 2013; 46 (5): 408-410

  View details for DOI 10.1016/j.jelectrocard.2013.06.010

  View details for PubMedID 23870660

• Variability in quantitative and qualitative analysis of intravascular ultrasound and frequency domain optical coherence tomography. Catheterization and cardiovascular interventions Abnousi, F., Waseda, K., Kume, T., Otake, H., Kawarada, O., Yong, C. M., Fitzgerald, P. J., Honda, Y., Yeung, A. C., Fearon, W. F. 2013; 82 (3): E192-9

  Abstract

  BACKGROUND: Frequency-domain optical coherence tomography (FD-OCT) is an intravascular imaging technique now available in the United States. However, the importance of level of training required for analysis using intravascular ultrasound (IVUS) and FD-OCT is unclear. The aim of this study was to evaluate inter- and intra-observer variability between expert and beginner analysts interpreting IVUS and FD-OCT images. METHODS AND RESULTS: Two independent expert analysts and two independent beginner analysts evaluated a total of 226 ± 2 stent cross-sections with IVUS and 232 ± 2 stent cross-sections with FD-OCT in 14 patients after stenting. Inter- and intra-observer variability for determining stent volume index (VI), as well as identifying incomplete stent apposition and dissection were assessed. The inter- and intra-observer variability of stent VI was minimal for both beginner and expert analysts regardless of imaging technology (random variability: 0.38 vs. 0.05 mm(3) /mm for IVUS, 0.26 vs. 0.08 mm(3) /mm for FD-OCT). Although qualitative IVUS analysis at the patient level revealed no significant difference between beginners and experts, this was not the case for FD-OCT. The number of overall qualitative findings noted by beginner and expert analysts were more variable (overestimated or underestimated) with FD-OCT. CONCLUSION: Despite varying levels of training, the increased resolution of FD-OCT compared to IVUS provides better detection and less variability in quantitative image analysis. On the contrary, this increased resolution not only increases the rate but also the variability of detection of qualitative image analysis, especially for beginner analysts. © 2013 Wiley Periodicals, Inc.

  View details for DOI 10.1002/ccd.24871

  View details for PubMedID 23412754

• J wave patterns and ST elevation in women. Journal of electrocardiology Yong, C. M., Zarafshar, S., Froelicher, V. 2013; 46 (5): 417-423

  View details for DOI 10.1016/j.jelectrocard.2013.06.027

  View details for PubMedID 23981308

• The Electrocardiogram at a Crossroads CIRCULATION Yong, C. M., Froelicher, V., Wagner, G. 2013; 128 (1): 79-82

  View details for DOI 10.1161/CIRCULATIONAHA.113.003557

  View details for PubMedID 23817483

• A novel stress echocardiography pattern for myocardial bridge with invasive structural and hemodynamic correlation. Journal of the American Heart Association Lin, S., Tremmel, J. A., Yamada, R., Rogers, I. S., Yong, C. M., Turcott, R., McConnell, M. V., Dash, R., Schnittger, I. 2013; 2 (2)

  Abstract

  Patients with a myocardial bridge (MB) and no significant obstructive coronary artery disease (CAD) may experience angina presumably from ischemia, but noninvasive assessment has been limited and the underlying mechanism poorly understood. This study seeks to correlate a novel exercise echocardiography (EE) finding for MBs with invasive structural and hemodynamic measurements.Eighteen patients with angina and an EE pattern of focal end-systolic to early-diastolic buckling in the septum with apical sparing were prospectively enrolled for invasive assessment. This included coronary angiography, left anterior descending artery (LAD) intravascular ultrasound (IVUS), and intracoronary pressure and Doppler measurements at rest and during dobutamine stress. All patients were found to have an LAD MB on IVUS. The ratios of diastolic intracoronary pressure divided by aortic pressure at rest (Pd/Pa) and during dobutamine stress (diastolic fractional flow reserve [dFFR]) and peak Doppler flow velocity recordings at rest and with stress were successfully performed in 14 patients. All had abnormal dFFR (≤0.75) at stress within the bridge, distally or in both positions, and on average showed a more than doubling in peak Doppler flow velocity inside the MB at stress. Seventy-five percent of patients had normalization of dFFR distal to the MB, with partial pressure recovery and a decrease in peak Doppler flow velocity.A distinctive septal wall motion abnormality with apical sparing on EE is associated with a documented MB by IVUS and a decreased dFFR. We posit that the septal wall motion abnormality on EE is due to dynamic ischemia local to the compressed segment of the LAD from the increase in velocity and decrease in perfusion pressure, consistent with the Venturi effect.

  View details for DOI 10.1161/JAHA.113.000097

  View details for PubMedID 23591827

• Multivessel coronary artery disease predicts mortality, length of stay, and pressor requirements after liver transplantation. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Yong, C. M., Sharma, M., Ochoa, V., Abnousi, F., Roberts, J., Bass, N. M., Niemann, C. U., Shiboski, S., Prasad, M., Tavakol, M., Ports, T. A., Gregoratos, G., Yeghiazarians, Y., Boyle, A. J. 2010; 16 (11): 1242-8

  Abstract

  The optimal preoperative cardiac evaluation strategy for patients with end-stage liver disease (ESLD) undergoing liver transplantation remains unknown. Patients are frequently referred for cardiac catheterization, but the effects of coronary artery disease (CAD) on posttransplant mortality are also unknown. We sought to determine the contribution of CAD and multivessel CAD in particular to posttransplant mortality. We performed a retrospective study of ESLD patients undergoing cardiac catheterization before liver transplant surgery between August 1, 2004 and August 1, 2007 to determine the effects of CAD on outcomes after transplantation. Among 83 patients who underwent left heart catheterization, 47 underwent liver transplantation during the follow-up period. Twenty-one of all ESLD patients who underwent liver transplantation (45%) had CAD. Fifteen of the transplant patients with CAD (71%) had multivessel disease. Among transplant patients, the presence of multivessel CAD (versus no CAD) was predictive of mortality (27% versus 4%, P = 0.046), increased length of stay (22 versus 15 days, P = 0.050), and postoperative pressor requirements (27% versus 4%, P = 0.029). Interestingly, neither the presence of any CAD nor the severity of stenosis in any single coronary artery predicted mortality. Furthermore, none of the traditional clinical predictors (age, gender, diabetes, creatinine, ejection fraction, and Model for End-Stage Liver Disease score) were predictive of mortality among transplant recipients. In conclusion, multivessel CAD is associated with higher mortality after liver transplantation when it is documented angiographically before transplantation, even in the absence of severe coronary artery stenosis. This study provides preliminary evidence showing that there may be significant prognostic value in coronary angiography as a part of the pretransplant workup.

  View details for DOI 10.1002/lt.22152

  View details for PubMedID 21031539

• Severe H1N1-Associated acute respiratory distress syndrome: A case series. The American journal of medicine Lai, A. R., Keet, K., Yong, C. M., Diaz, J. V. 2010; 123 (3): 282-285.e2

  Abstract

  Acute respiratory distress syndrome resulting from novel influenza A virus (H1N1) infection remains uncommon.We describe the clinical profiles of adult patients with acute respiratory distress syndrome due to microbiologically confirmed H1N1 admitted to a medical intensive care unit in San Francisco, California over a 2-month period.Between June 1 and July 31, 2009, 7 patients (age range: 25-66 years; 4 patients under the age of 40 years; 6 male; 1 pregnant) were diagnosed with H1N1, with 5 of 6 (83%) having initial false-negative rapid testing. All developed respiratory failure complicated by acute respiratory distress syndrome, with 4 additionally developing multiorgan dysfunction. All were managed with a lung protective ventilator strategy (average number of days on the ventilator: 16), and 4 patients also required additional rescue therapies for refractory hypoxemia, including very high positive end-expiratory pressure, inhaled epoprostenol, recruitment maneuvers, and prone positioning. Despite these measures, 3 patients (43%) ultimately died.Clinicians should be vigilant for the potential of H1N1 infection to progress to severe acute respiratory distress syndrome in a variety of patient demographics, including younger patients without baseline cardiopulmonary disease. A high degree of suspicion is critical, especially with the relative insensitivity of rapid testing, and should prompt empiric antiviral therapy.

  View details for DOI 10.1016/j.amjmed.2009.11.004

  View details for PubMedID 20193840

• Factor Xa inhibitors in acute coronary syndromes and venous thromboembolism. Current vascular pharmacology Yong, C. M., Boyle, A. J. 2010; 8 (1): 5-11

  Abstract

  As an alternative to the inconvenient and labor intensive traditional anticoagulants, Factor Xa inhibitors may offer new options for the prevention and treatment of acute coronary syndromes (ACS) and venous thromboembolism (VTE). Fondaparinux, an indirect FXa inhibitor, has equivalent efficacy but decreased bleeding risk. It has been recommended by the American College of Cardiology (ACC)/American Heart Association (AHA) as the preferred anticoagulant in ACS patients with higher bleeding risk managed with a noninvasive strategy. Based on the composite results of several clinical trials, fondaparinux is also recommended for VTE prevention in the setting of major orthopedic surgery. Rivaroxaban, a direct FXa inhibitor, appears to have at least equal efficacy and safety to established anticoagulants in the prevention of VTE. With advantages such as oral administration and a wide therapeutic window, it may provide a useful alternative to current anticoagulants. Ongoing studies are exploring its use in treatment of VTE and ACS, as well as prevention of stroke among patients with atrial fibrillation. In this review, we examine the key recent studies on efficacy and safety of FXa inhibitors in ACS and VTE management.

  View details for PubMedID 19485937

• Safety of cardiac catheterization in patients with end-stage liver disease awaiting liver transplantation. The American journal of cardiology Sharma, M., Yong, C., Majure, D., Zellner, C., Roberts, J. P., Bass, N. M., Ports, T. A., Yeghiazarians, Y., Gregoratos, G., Boyle, A. J. 2009; 103 (5): 742-6

  Abstract

  Patients with end-stage liver disease (ESLD) are predisposed to bleeding complications due to thrombocytopenia, reduced synthesis of coagulation factors, and increased fibrinolytic activity. The exact incidence of vascular access site and bleeding complications related to cardiac catheterization in this group remains unknown. Eighty-eight consecutive patients with ESLD who underwent left-sided cardiac catheterization from August 2004 to February 2007 were identified. Eighty-one patients without known liver disease matched for age, gender, and body mass index who underwent left-sided cardiac catheterization during the same period were chosen as the control group. Vascular complications were defined as hematoma >5 cm, pseudoaneurysm, arteriovenous fistula, or retroperitoneal bleeding. Patients with ESLD had lower baseline mean hematocrit (32.3 +/- 6.0% vs 39.2 +/- 6.2%, p <0.001) and mean platelet count (90.1 +/- 66.3 vs 236.1 +/- 77.1 x 10(9)/L, p <0.001) compared with controls. They also had higher mean serum creatinine (1.9 +/- 1.7 vs 1.2 +/- 0.8 mg/dl, p = 0.002) and mean international normalized ratio (1.6 +/- 0.7 vs 1.1 +/- 0.2, p <0.001). There were more complicated pseudoaneurysms in the patients with liver failure (5.7% [5 of 88]), compared with 0% in controls (p = 0.029). Patients with ESLD had lower starting hemoglobin levels and greater reductions in hemoglobin after cardiac catheterization, resulting in greater need for packed red blood cell transfusion (16% vs 4%, p = 0.008), fresh frozen plasma (51.7% vs 1.2%, p <0.001), and platelet transfusions (48.3% vs 1.2%, p <0.001). Major bleeding was higher in the ESLD group (14.8% vs 3.7%, p = 0.014), driven mainly by the need for blood transfusion. In conclusion, despite severe coagulopathy, left-sided cardiac catheterization may be performed safely in this patient population, with correction of coagulopathy and meticulous attention to procedural technique.

  View details for DOI 10.1016/j.amjcard.2008.10.037

  View details for PubMedID 19231345

• Safety of cardiac catheterization in patients with end-stage liver disease prior to orthotopic liver transplantation Sharma, M., Yong, C., Zellner, C., Ports, T., Yeghiazarians, Y., Boyle, A. ELSEVIER SCIENCE INC. 2008: B96

  View details for Web of Science ID 000253997200409

• International differences in patient and physician perceptions of "high quality" healthcare: A model from pediatric cardiology AMERICAN JOURNAL OF CARDIOLOGY Garson, A., Yong, C. M., Yock, C. A., McClellan, M. B. 2006; 97 (7): 1073-1075

  Abstract

  Although the quality of health care would logically seem to be a universal concept, this study hypothesized that physicians and their patients could differ in their perceptions of "high-quality care" and that those beliefs might vary by country. Such a mismatch in beliefs may be especially important as clinical practice guidelines developed in the United States are globalized. A survey of 20 statements describing various components of health care delivery and quality was sent to pediatric cardiologists in 33 countries, who ranked the statements in order of priority for ideal health care. Each participating physician administered the questionnaire to the parents of children with congenital heart disease; 554 questionnaires were received and analyzed. A subanalysis of 9 countries with the largest number of responses was done (Canada, the Czech Republic, France, Germany, Italy, The Netherlands, Sweden, the United Kingdom, and the United States). Doctors and parents rated the same 4 statements among the top 5: "the doctor is skillful and knowledgeable"; "the doctor explains health problems, tests, and treatments in a way the patient can understand"; "a basic level of healthcare is available to all citizens regardless of their ability to pay"; and "treatment causes the patient to feel physically well." Overall, parents' responses differed more among countries than those of physicians; the magnitude of the difference between parents and physicians varied by country. This discrepancy highlights a potential mismatch between patients' and physicians' views about the desired components of health care delivery, in particular the application of American quality standards for health care to systems in other countries.

  View details for DOI 10.1016/j.amjcard.2005.10.051

  View details for Web of Science ID 000236708700029

  View details for PubMedID 16563919

• Standardized assessment of breast cancer surgical scars integrating the Vancouver Scar Scale, Short-Form McGill Pain Questionnaire, and patients' perspectives. Plastic and reconstructive surgery Truong, P. T., Abnousi, F., Yong, C. M., Hayashi, A., Runkel, J. A., Phillips, T., Olivotto, I. A. 2005; 116 (5): 1291-9

  Abstract

  Currently, there is no standardized, comprehensive method to assess surgical scars after breast cancer surgery. This article evaluates the application of the Vancouver Scar Scale, in conjunction with patients' scar self-rating and scar-related pain, in a cohort of breast cancer patients.Data were prospectively collected in 59 women with breast cancer. Scar assessment comprised: 1. objective rating by pairs of independent observers using the Vancouver Scar Scale; 2. patient's ratings of the scar's physical parameters and overall satisfaction; and 3. pain assessment using the Short-Form McGill Pain Questionnaire. A total of 212 scar scores (59 pairs of breast/chest wall and 47 pairs of axillary scar scores) were generated by 13 observers: three physicians, five radiation therapists, and five nurses. Internal consistency was tested using Cronbach's alpha statistics. Interobserver reliability was evaluated with Spearman's rho and intraclass correlation coefficient computations. Convergent validity of the observer and patient ratings was examined with Spearman's correlation statistics. Linear regression analysis was performed to identify significant factors associated with Vancouver Scar Scale scores and patient satisfaction.The Vancouver Scar Scale, patient self-rating scale, and Short-Form McGill Pain Questionnaire had acceptable internal consistency (Cronbach's alpha 0.79, 0.64, and 0.72 respectively). Interobserver reliability using the Vancouver Scar Scale was significant with Spearman's correlation coefficients of 0.53 for pliability, 0.47 for scar height, 0.49 for vascularity, 0.54 for pigmentation, and 0.66 for overall score (all p values < 0.001). Significant agreement between observer and patient ratings of scar pliability (p = 0.01) and color (p = 0.001) was demonstrated. Mild to moderate pain was reported by more than 40 percent of patients. Patient satisfaction was significantly associated with self-rating of scar pliability and pain, but not Vancouver Scar Scale scores.The Vancouver Scar Scale is a reliable and valid tool to objectively evaluate scars after breast cancer surgery. Evaluation of scar-related pain and patients' scar rating and satisfaction provide additional information relevant to scar assessment. This integrated approach is feasible in a busy clinical setting to advance care and research in scar management for breast cancer patients.

  View details for PubMedID 16217470

• Lymphovascular invasion is associated with reduced locoregional control and survival in women with node-negative breast cancer treated with mastectomy and systemic therapy. Journal of the American College of Surgeons Truong, P. T., Yong, C. M., Abnousi, F., Lee, J., Kader, H. A., Hayashi, A., Olivotto, I. A. 2005; 200 (6): 912-21

  Abstract

  The impact of lymphovascular invasion (LVI) on postmastectomy locoregional relapse (LRR) and its use in guiding locoregional therapy in node-negative breast cancer are unclear. This study evaluates the association of LVI with relapse and survival in a cohort of women with early-stage breast cancer.The study cohort comprised 763 women with pT1-2, pN0 breast cancer referred from 1989 to 1999 and treated with mastectomy and adjuvant systemic therapy without radiotherapy. Kaplan-Meier LRR, distant relapse, and overall survival rates at 7 years were compared between patients with and without LVI. Cox regression analyses were performed to evaluate the prognostic significance of LVI for relapse and survival.Median followup was 7.0 years (range 0.34 to 14.9 years). LVI was present in 210 (27.5%) patients. In log-rank comparisons of Kaplan-Meier curves stratified by LVI status, LVI-positive disease was associated with significantly higher risks of LRR (p = 0.006), distant relapse (p = 0.04), and lower overall survival (p = 0.02). In the multivariable Cox regression analysis, LVI was significantly associated with LRR (relative risk [RR] = 2.32; 95% CI, 1.26-4.27; p = 0.007), distance relapse (RR = 1.53; 95% CI, 1.00-2.35; p = 0.05), and overall survival (RR = 1.46; 95% CI, 1.04-2.07; p = 0.03). In patients with one of the following characteristics: age younger than 50 years, premenopausal status, grade III histology, or estrogen receptor-negative disease, 7-year LRR risks increased threefold from 3% to 5% when LVI was absent, to 15% to 20% in the presence of LVI.LVI is an adverse prognostic factor for relapse and survival in node-negative patients treated with mastectomy and systemic therapy. LVI, in combination with age older than 50 years, premenopausal status, grade III histology, or estrogen receptor-negative disease, identified patient subsets with 7-year LRR risks of approximately 15% to 20%. Prospective research is required to define the role of adjuvant radiotherapy in these patients.

  View details for DOI 10.1016/j.jamcollsurg.2005.02.010

  View details for PubMedID 15922205