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  1. Article ; Online: A Placebo-Controlled Trial of PCI for Stable Angina. Reply.

    Al-Lamee, Rasha K / Rajkumar, Christopher A

    The New England journal of medicine

    2024  Volume 390, Issue 12, Page(s) 1151–1152

    MeSH term(s) Humans ; Angina, Stable/therapy ; Percutaneous Coronary Intervention ; Coronary Artery Disease ; Coronary Angiography
    Language English
    Publishing date 2024-03-20
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMc2400751
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  2. Article ; Online: Why Does a Cardiologist Believe in a Therapy? The Role of Intuitiveness and Understanding the Mechanism.

    Foley, Michael J / Rajkumar, Christopher A / Ahmed-Jushuf, Fiyyaz / Nowbar, Alexandra N / Simader, Florentina / Bello, Olamide / Al-Lamee, Rasha

    Circulation. Cardiovascular quality and outcomes

    2024  Volume 17, Issue 3, Page(s) e010664

    MeSH term(s) Humans ; Cardiologists ; Myocardial Infarction/therapy ; Percutaneous Coronary Intervention ; Treatment Outcome
    Language English
    Publishing date 2024-02-16
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2483197-9
    ISSN 1941-7705 ; 1941-7713
    ISSN (online) 1941-7705
    ISSN 1941-7713
    DOI 10.1161/CIRCOUTCOMES.123.010664
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  3. Article ; Online: Effect of coronary tortuosity on invasive physiology.

    Maznyczka, Annette / Rajkumar, Christopher / Hobson, Alex / Haworth, Peter Aj

    BMJ case reports

    2022  Volume 15, Issue 6

    Abstract: We present a case of angina, where extreme coronary tortuosity affected invasive physiology interpretation. Extreme coronary tortuosity may lower fractional flow reserve and instantaneous wave-free ratio. Therefore, invasive physiology can be misleading ... ...

    Abstract We present a case of angina, where extreme coronary tortuosity affected invasive physiology interpretation. Extreme coronary tortuosity may lower fractional flow reserve and instantaneous wave-free ratio. Therefore, invasive physiology can be misleading in this setting, when used to evaluate stenosis significance, or when used post-percutaneous coronary (PCI) intervention for physiology guided stent optimisation.
    MeSH term(s) Cardiac Catheterization ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Fractional Flow Reserve, Myocardial/physiology ; Humans ; Percutaneous Coronary Intervention ; Predictive Value of Tests ; Treatment Outcome
    Language English
    Publishing date 2022-06-10
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2022-249095
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  4. Article: Optimization and Validation of a Harmonized Protocol for Generating Therapeutic-Grade Dendritic Cells in a Randomized Phase II Clinical Trial, Using Two Varied Antigenic Sources.

    Seetharaman, Abirami / Christopher, Vasanth / Dhandapani, Hemavathi / Jayakumar, Hascitha / Dhanushkodi, Manikandan / Bhaskaran, Narmadha / Rajaraman, Swaminathan / Ranganathan, Rama / Sunder Singh, Shirley / Vijayakumar, Varalakshmi / Rajamanickam, Arivazhagan / Suri, Anil / Jagadish, Nirmala / Rajkumar, Thangarajan / Ramanathan, Priya

    Vaccines

    2024  Volume 12, Issue 2

    Abstract: Autologous dendritic cell (DC)-based immunotherapy is a cell-based advanced therapy medicinal product (ATMP) that was first introduced more than three decades ago. In the current study, our objective was to establish a harmonized protocol using two ... ...

    Abstract Autologous dendritic cell (DC)-based immunotherapy is a cell-based advanced therapy medicinal product (ATMP) that was first introduced more than three decades ago. In the current study, our objective was to establish a harmonized protocol using two varied antigenic sources and a good manufacturing practice (GMP)-compliant, manual method for generating clinical-grade DCs at a limited-resource academic setting. After obtaining ethical committee-approved informed consent, the recruited patients underwent leukapheresis, and single-batch DC production was carried out. Using responder-independent flow cytometric assays as quality control (QC) criteria, we propose a differentiation and maturation index (DI and MI, respectively), calculated with the QC cut-off and actual scores of each batch for comparison. Changes during cryopreservation and personnel variation were assessed periodically for up to two to three years. Using our harmonized batch production protocol, the average DI was 1.39 and MI was 1.25. Allogenic responder proliferation was observed in all patients, while IFN-gamma secretion, evaluated using flow cytometry, was detected in 10/36 patients and significantly correlated with CD8+ T cell proliferation (
    Language English
    Publishing date 2024-01-23
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2703319-3
    ISSN 2076-393X
    ISSN 2076-393X
    DOI 10.3390/vaccines12020112
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  5. Article ; Online: Cost-effectiveness analysis of percutaneous coronary intervention for single-vessel coronary artery disease

    Christopher Rajkumar

    BMJ Open, Vol 11, Iss

    an economic evaluation of the ORBITA trial

    2021  Volume 2

    Abstract: Objective To evaluate the cost-effectiveness of percutaneous coronary intervention (PCI) compared with placebo in patients with single-vessel coronary artery disease and angina despite anti-anginal therapy.Design A cost-effectiveness analysis comparing ... ...

    Abstract Objective To evaluate the cost-effectiveness of percutaneous coronary intervention (PCI) compared with placebo in patients with single-vessel coronary artery disease and angina despite anti-anginal therapy.Design A cost-effectiveness analysis comparing PCI with placebo. A Markov model was used to measure incremental cost-effectiveness, in cost per quality-adjusted life-years (QALYs) gained, over 12 months. Health utility weights were estimated using responses to the EuroQol 5-level questionnaire, from the Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina trial and UK preference weights. Costs of procedures and follow-up consultations were derived from Healthcare Resource Group reference costs and drug costs from the National Health Service (NHS) drug tariff. Probabilistic sensitivity analysis was undertaken to test the robustness of results to parameter uncertainty. Scenario analyses were performed to test the effect on results of reduced pharmaceutical costs in patients undergoing PCI, and the effect of patients crossing over from placebo to PCI due to refractory angina within 12 months.Setting Five UK NHS hospitals.Participants 200 adult patients with stable angina and angiographically severe single-vessel coronary artery disease on anti-anginal therapy.Interventions At recruitment, patients received 6 weeks of optimisation of medical therapy for angina after which they were randomised to PCI or a placebo procedure.Outcome measures Incremental cost-effectiveness ratio (ICER) expressed as cost (in £) per QALY gained for PCI compared with placebo.Results The estimated ICER is £90 218/QALY gained when using PCI compared with placebo in patients receiving medical treatment for angina due to single-vessel coronary artery disease. Results were robust under sensitivity analyses.Conclusions The ICER for PCI compared with placebo, in patients with single-vessel coronary artery disease and angina on anti-anginal medication, exceeds the threshold of £30 000 used by ...
    Keywords Medicine ; R
    Subject code 610
    Language English
    Publishing date 2021-02-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Optimising physiological endpoints of percutaneous coronary intervention.

    Al-Lamee, Rasha / Rajkumar, Christopher A / Ganesananthan, Sashiananthan / Jeremias, Allen

    EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

    2021  Volume 16, Issue 18, Page(s) e1470–e1483

    Abstract: Invasive coronary physiology to select patients for coronary revascularisation has become established in contemporary guidelines for the management of stable coronary artery disease. Compared to revascularisation based on angiography alone, the use of ... ...

    Abstract Invasive coronary physiology to select patients for coronary revascularisation has become established in contemporary guidelines for the management of stable coronary artery disease. Compared to revascularisation based on angiography alone, the use of coronary physiology has been shown to improve clinical outcomes and cost efficiency. However, recent data from randomised controlled trials have cast doubt upon the value of ischaemia testing to select patients for revascularisation. Importantly, 20-40% of patients have persistence or recurrence of angina after angiographically successful percutaneous coronary intervention (PCI). This state-of-the-art review is focused on the transitioning role of invasive coronary physiology from its use as a dichotomous test for ischaemia with fixed cut-points, towards its utility for real-time guidance of PCI to optimise physiological results. We summarise the contemporary evidence base for ischaemia testing in stable coronary artery disease, examine emerging indices which allow advanced physiological guidance of PCI, and discuss the rationale and evidence base for post-PCI physiological assessments to assess the success of revascularisation.
    MeSH term(s) Angina Pectoris ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/surgery ; Humans ; Percutaneous Coronary Intervention/adverse effects ; Treatment Outcome
    Language English
    Publishing date 2021-04-02
    Publishing country France
    Document type Journal Article
    ZDB-ID 2457174-X
    ISSN 1969-6213 ; 1774-024X
    ISSN (online) 1969-6213
    ISSN 1774-024X
    DOI 10.4244/EIJ-D-20-00988
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    Zs.A 6680: Show issues Location:
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  7. Article: BleepPod: using smartphone technology to streamline telecommunications in an NHS setting.

    Rajkumar, Christopher / Warner, Elinor / Kinirons, Mark / Thakrar, Amit

    Future hospital journal

    2019  Volume 2, Issue Suppl 2, Page(s) s28

    Language English
    Publishing date 2019-05-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 2775176-4
    ISSN 2055-3331 ; 2055-3323
    ISSN (online) 2055-3331
    ISSN 2055-3323
    DOI 10.7861/futurehosp.2-2s-s28
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  8. Article ; Online: Revascularization in stable coronary artery disease.

    Al-Lamee, Rasha K / Foley, Michael / Rajkumar, Christopher A / Francis, Darrel P

    BMJ (Clinical research ed.)

    2022  Volume 377, Page(s) e067085

    Abstract: Management of stable coronary artery disease (CAD) centers on medication to prevent myocardial infarction and death. Many anti-anginal medications also have benefit for reducing symptoms, and have been proven to be effective against placebo control. ... ...

    Abstract Management of stable coronary artery disease (CAD) centers on medication to prevent myocardial infarction and death. Many anti-anginal medications also have benefit for reducing symptoms, and have been proven to be effective against placebo control. Before effective preventive medications were available, patients with stable CAD often underwent revascularization with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI), on the plausible assumption that these procedures would prevent adverse events and reduce symptoms. However, recent randomized controlled trials have cast doubt on these assumptions.Considering results from the recent ISCHEMIA trial, we discuss the evidence base that underpins revascularization for stable CAD in contemporary practice. We also focus on patient groups at high risk of myocardial infarction and death, for whom revascularization is often recommended. We outline the areas of uncertainty, unanswered research questions, and key areas of potential miscommunication in doctor-patient consultations.
    MeSH term(s) Cardiovascular Agents ; Coronary Artery Bypass ; Coronary Artery Disease/diagnosis ; Humans ; Myocardial Infarction/etiology ; Percutaneous Coronary Intervention/adverse effects ; Treatment Outcome
    Chemical Substances Cardiovascular Agents
    Language English
    Publishing date 2022-06-13
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj-2021-067085
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  9. Article ; Online: Typical angina and coronary artery disease: is the common ground smaller than we think?

    Rajkumar, Christopher / Simader, Florentina / Al-Lamee, Rasha Kadem

    Heart (British Cardiac Society)

    2023  Volume 109, Issue 19, Page(s) 1422–1423

    MeSH term(s) Humans ; Coronary Artery Disease/diagnosis ; Angina Pectoris/diagnosis ; Angina Pectoris/etiology ; Coronary Angiography
    Language English
    Publishing date 2023-09-13
    Publishing country England
    Document type Editorial ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 1303417-0
    ISSN 1468-201X ; 1355-6037
    ISSN (online) 1468-201X
    ISSN 1355-6037
    DOI 10.1136/heartjnl-2023-322681
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  10. Article: Remote digital smart device follow-up in prospective clinical trials: early insights from ORBITA-2, ORBITA-COSMIC, and ORBITA-STAR.

    Ganesananthan, Sashiananthan / Rajkumar, Christopher A / Foley, Michael / Francis, Darrel / Al-Lamee, Rasha

    European heart journal supplements : journal of the European Society of Cardiology

    2022  Volume 24, Issue Suppl H, Page(s) H32–H42

    Abstract: Smart devices are a fundamental media for acquisition, processing, storage, and transfer of digital health data. The global penetration and high frequency usage of smart devices such as smartphones and fitness monitors provide us an opportunity for ... ...

    Abstract Smart devices are a fundamental media for acquisition, processing, storage, and transfer of digital health data. The global penetration and high frequency usage of smart devices such as smartphones and fitness monitors provide us an opportunity for incorporation into clinical trials to generate more clinically meaningful data. Reporting of angina can significantly vary between patients and also within patients at different timepoints. Furthermore, the nature of angina can lead to variation in ways patients adapt their activities of daily living and hence reporting of symptoms and quality of life. Current clinical trials investigating the effects of intervention on angina do not accurately incorporate these patient centred outcomes and considerations. Hence, methods to contemporaneously assess daily angina burden in a convenient, patient focused, and cost-effective manner are priorities for contemporary clinical trials to address. In this article, we provide our insights into the use of remote digital smart devices in clinical trials of stable coronary artery disease conducted by our research group. We discuss how our experiences from previous trials necessitated its incorporation and will provide us with important data that will inform clinical practice. We discuss the benefits and current challenges and limitations of smart device incorporation while providing our procedural workflow for how we incorporated smart devices into our clinical trials for others to consider. We hope that this approach will allow us to understand the perceptions and implications of angina on patient lives with greater granularity than previously explored.
    Language English
    Publishing date 2022-11-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 1463769-8
    ISSN 1554-2815 ; 1520-765X
    ISSN (online) 1554-2815
    ISSN 1520-765X
    DOI 10.1093/eurheartjsupp/suac058
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