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Article ; Online: Acute myopericarditis caused by

Chehab, Omar / McGuire, Emma / Wani, Robert L Serafino / Weerackody, Roshan

European heart journal. Case reports

2020 Volume 4, Issue 4, Page(s) 1–5

Abstract: Background: Acute myopericarditis can be caused by a myriad of infectious and non-infectious aetiologies, however, it is often considered to be due to self-limiting viral infection. : Case summary: A 44-year-old man presented with fever, dyspnoea, ... ...

Abstract	Background: Acute myopericarditis can be caused by a myriad of infectious and non-infectious aetiologies, however, it is often considered to be due to self-limiting viral infection. Case summary: A 44-year-old man presented with fever, dyspnoea, and chest pain. He was found to have a large pericardial effusion with clinical signs of tamponade and sepsis. Therapeutic pericardiocentesis was performed and ceftriaxone and levofloxacin were administered. Fully sensitive Discussion: We report a rare case of
Language	English
Publishing date	2020-07-25
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytaa173
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Article ; Online: Thrombus Embolisation: Prevention is Better than Cure.

Choudry, Fizzah A / Weerackody, Roshan P / Jones, Daniel A / Mathur, Anthony

Interventional cardiology (London, England)

2019 Volume 14, Issue 2, Page(s) 95–101

Abstract: Thrombus embolisation complicating primary percutaneous coronary intervention in ST-elevation myocardial infarction is associated with an increase in adverse outcomes. However, there are currently no proven recommendations for intervention in the setting ...

Abstract	Thrombus embolisation complicating primary percutaneous coronary intervention in ST-elevation myocardial infarction is associated with an increase in adverse outcomes. However, there are currently no proven recommendations for intervention in the setting of large thrombus burden. In this review, we discuss the clinical implications of thrombus embolisation and angiographic predictors of embolisation, and provide an update of current evidence for some preventative strategies, both pharmacological and mechanical, in this setting.
Keywords	covid19
Language	English
Publishing date	2019-05-21
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2813989-6
ISSN	1756-1485 ; 1756-1477
ISSN (online)	1756-1485
ISSN	1756-1477
DOI	10.15420/icr.2019.11
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Article ; Online: Percutaneous Left Ventricular Unloading During High-Risk Coronary Intervention: Rationale and Design of the CHIP-BCIS3 Randomized Controlled Trial.

Ryan, Matthew / Ezad, Saad M / Webb, Ian / O'Kane, Peter D / Dodd, Matthew / Evans, Richard / Laidlaw, Lynn / Khan, Sohail Q / Weerackody, Roshan / Bagnall, Alan / Panoulas, Vasileios F / Rahman, Haseeb / Strange, Julian W / Fath-Ordoubadi, Farzin / Hoole, Stephen P / Stables, Rod H / Curzen, Nick / Clayton, Tim / Perera, Divaka

Circulation. Cardiovascular interventions

2024 Volume 17, Issue 3, Page(s) e013367

Abstract: Introduction: Percutaneous coronary intervention for complex coronary disease is associated with a high risk of cardiogenic shock. This can cause harm and limit the quality of revascularization achieved, especially when left ventricular function is ... ...

Abstract	Introduction: Percutaneous coronary intervention for complex coronary disease is associated with a high risk of cardiogenic shock. This can cause harm and limit the quality of revascularization achieved, especially when left ventricular function is impaired at the outset. Elective percutaneous left ventricular unloading is increasingly used to mitigate adverse events in patients undergoing high-risk percutaneous coronary intervention, but this strategy has fiscal and clinical costs and is not supported by robust evidence. Methods: CHIP-BCIS3 (Controlled Trial of High-Risk Coronary Intervention With Percutaneous Left Ventricular Unloading) is a prospective, multicenter, open-label randomized controlled trial that aims to determine whether a strategy of elective percutaneous left ventricular unloading is superior to standard care (no planned mechanical circulatory support) in patients undergoing nonemergent high-risk percutaneous coronary intervention. Patients are eligible for recruitment if they have severe left ventricular systolic dysfunction, extensive coronary artery disease, and are due to undergo complex percutaneous coronary intervention (to the left main stem with calcium modification or to a chronic total occlusion with a retrograde approach). Cardiogenic shock and acute ST-segment-elevation myocardial infarction are exclusions. The primary outcome is a hierarchical composite of all-cause death, stroke, spontaneous myocardial infarction, cardiovascular hospitalization, and periprocedural myocardial infarction, analyzed using the win ratio. Secondary outcomes include completeness of revascularization, major bleeding, vascular complications, health economic analyses, and health-related quality of life. A sample size of 250 patients will have in excess of 80% power to detect a hazard ratio of 0.62 at a minimum of 12 months, assuming 150 patients experience an event across all follow-up. Conclusions: To date, 169 patients have been recruited from 21 National Health Service hospitals in the United Kingdom, with recruitment expected to complete in 2024. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05003817.
MeSH term(s)	Humans ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/therapy ; Myocardial Infarction/etiology ; Percutaneous Coronary Intervention/adverse effects ; Prospective Studies ; Quality of Life ; Shock, Cardiogenic/diagnosis ; Shock, Cardiogenic/therapy ; Shock, Cardiogenic/etiology ; State Medicine ; Treatment Outcome ; Randomized Controlled Trials as Topic ; Multicenter Studies as Topic
Language	English
Publishing date	2024-02-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2450797-0
ISSN	1941-7632 ; 1941-7640
ISSN (online)	1941-7632
ISSN	1941-7640
DOI	10.1161/CIRCINTERVENTIONS.123.013367
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Article ; Online: Transient rise in His-lead threshold due to acute myocardial infarction.

Hall, Robert / Jones, Daniel A / Muthumala, Amal / Weerackody, Roshan / Sohaib, Afzal / Monkhouse, Christopher

Pacing and clinical electrophysiology : PACE

2019 Volume 42, Issue 6, Page(s) 754–757

Abstract: An 85-year-old male was admitted to our center with a non-ST elevation myocardial infarction. The patient had a dual-chamber pacemaker in situ with an atrial and His lead. A transient increase in His threshold and loss of nonselective capture occurred at ...

Abstract	An 85-year-old male was admitted to our center with a non-ST elevation myocardial infarction. The patient had a dual-chamber pacemaker in situ with an atrial and His lead. A transient increase in His threshold and loss of nonselective capture occurred at the presentation of right coronary artery infarction, peaking during rotational atherectomy therapy causing loss of capture and complete atrioventricular block. A follow-up interrogation, 2 weeks postrevascularization, showed a return to a normal nonselective capture morphology and threshold measurements. Physicians should be aware of this complication in patients with His leads, particularly those with a history of coronary artery disease.
MeSH term(s)	Aged, 80 and over ; Atherectomy ; Bundle of His/physiopathology ; Electrodes, Implanted/adverse effects ; Humans ; Male ; Non-ST Elevated Myocardial Infarction/physiopathology ; Non-ST Elevated Myocardial Infarction/surgery ; Pacemaker, Artificial/adverse effects
Language	English
Publishing date	2019-02-15
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	424437-0
ISSN	1540-8159 ; 0147-8389
ISSN (online)	1540-8159
ISSN	0147-8389
DOI	10.1111/pace.13612
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Article ; Online: Arrhythmia and Death Following Percutaneous Revascularization in Ischemic Left Ventricular Dysfunction: Prespecified Analyses From the REVIVED-BCIS2 Trial.

Perera, Divaka / Morgan, Holly P / Ryan, Matthew / Dodd, Matthew / Clayton, Tim / O'Kane, Peter D / Greenwood, John P / Walsh, Simon J / Weerackody, Roshan / McDiarmid, Adam / Amin-Youssef, George / Strange, Julian / Modi, Bhavik / Lockie, Timothy / Hogrefe, Kai / Ahmed, Fozia Z / Behan, Miles / Jenkins, Nicholas / Abdelaal, Eltigani /

Anderson, Michelle / Watkins, Stuart / Evans, Richard / Rinaldi, Christopher A / Petrie, Mark C

Circulation

2023 Volume 148, Issue 11, Page(s) 862–871

Abstract: Background: Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these ... ...

Abstract	Background: Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these patients before implantation of a cardiac defibrillator because it is assumed that this may reduce the incidence of fatal and potentially fatal ventricular arrhythmias, although this premise has not been evaluated in a randomized trial to date. Methods: Patients with severe left ventricular dysfunction, extensive coronary disease, and viable myocardium were randomly assigned to receive either percutaneous coronary intervention (PCI) plus optimal medical and device therapy (OMT) or OMT alone. The composite primary outcome was all-cause death or aborted sudden death (defined as an appropriate implantable cardioverter defibrillator therapy or a resuscitated cardiac arrest) at a minimum of 24 months, analyzed as time to first event on an intention-to-treat basis. Secondary outcomes included cardiovascular death or aborted sudden death, appropriate implantable cardioverter defibrillator (ICD) therapy or sustained ventricular arrhythmia, and number of appropriate ICD therapies. Results: Between August 28, 2013, and March 19, 2020, 700 patients were enrolled across 40 centers in the United Kingdom. A total of 347 patients were assigned to the PCI+OMT group and 353 to the OMT alone group. The mean age of participants was 69 years; 88% were male; 56% had hypertension; 41% had diabetes; and 53% had a clinical history of myocardial infarction. The median left ventricular ejection fraction was 28%; 53.1% had an implantable defibrillator inserted before randomization or during follow-up. All-cause death or aborted sudden death occurred in 144 patients (41.6%) in the PCI group and 142 patients (40.2%) in the OMT group (hazard ratio, 1.03 [95% CI, 0.82-1.30]; Conclusions: PCI was not associated with a reduction in all-cause mortality or aborted sudden death. In patients with ischemic cardiomyopathy, PCI is not beneficial solely for the purpose of reducing potentially fatal ventricular arrhythmias. Registration: URL: https://www. Clinicaltrials: gov; Unique identifier: NCT01920048.
MeSH term(s)	Humans ; Male ; Aged ; Female ; Stroke Volume ; Death, Sudden, Cardiac/epidemiology ; Death, Sudden, Cardiac/etiology ; Death, Sudden, Cardiac/prevention & control ; Ventricular Function, Left ; Arrhythmias, Cardiac/etiology ; Ventricular Dysfunction, Left/etiology ; Defibrillators, Implantable/adverse effects ; Treatment Outcome
Language	English
Publishing date	2023-08-09
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIRCULATIONAHA.123.065300
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Article: Percutaneous balloon aortic valvuloplasty in the era of transcatheter aortic valve implantation: a narrative review.

Keeble, Thomas R / Khokhar, Arif / Akhtar, Mohammed Majid / Mathur, Anthony / Weerackody, Roshan / Kennon, Simon

Open heart

2016 Volume 3, Issue 2, Page(s) e000421

Abstract: The role of percutaneous balloon aortic valvuloplasty (BAV) in the management of severe symptomatic aortic stenosis has come under the spotlight following the development of the transcatheter aortic valve implantation (TAVI) technique. Previous ... ...

Abstract	The role of percutaneous balloon aortic valvuloplasty (BAV) in the management of severe symptomatic aortic stenosis has come under the spotlight following the development of the transcatheter aortic valve implantation (TAVI) technique. Previous indications for BAV were limited to symptom palliation and as a bridge to definitive therapy for patients undergoing conventional surgical aortic valve replacement (AVR). In the TAVI era, BAV may also be undertaken to assess the 'therapeutic response' of a reduction in aortic gradient in borderline patients often with multiple comorbidities, to assess symptomatic improvement prior to consideration of definitive TAVI intervention. This narrative review aims to update the reader on the current indications and practical techniques involved in undertaking a BAV procedure. In addition, a summary of the haemodynamic and clinical outcomes, as well as the frequently encountered procedural complications is presented for BAV procedures conducted during both the pre-TAVI and post-TAVI era.
Language	English
Publishing date	2016-12-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2747269-3
ISSN	2053-3624 ; 2044-6055
ISSN	2053-3624 ; 2044-6055
DOI	10.1136/openhrt-2016-000421
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Article: An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention.

Rathod, Krishnaraj Sinhji / Spagnolo, Marco / Elliott, Mark K / Beirne, Anne-Marie / Smith, Elliot J / Amersey, Rajiv / Knight, Charles / Weerackody, Roshan / Baumbach, Andreas / Mathur, Anthony / Jones, Daniel A

Clinical Medicine Insights. Cardiology

2020 Volume 14, Page(s) 1179546820951792

Abstract: Background: More than half of the patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) have multi-vessel coronary artery disease. This is associated with worse outcomes compared with ...

Abstract	Background: More than half of the patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) have multi-vessel coronary artery disease. This is associated with worse outcomes compared with single vessel disease. Whilst evidence now exists to support complete revascularisation for bystander disease the optimal timing is still debated. This study aimed to compare clinical outcomes in patients with STEMI and multi-vessel disease who underwent complete revascularisation as inpatients in comparison to patients who had staged PCI as early outpatients. Methods and results: We conducted an observational cohort study consisting of 1522 patients who underwent primary PCI with multi-vessel disease from 2012 to 2019. Exclusions included patients with cardiogenic shock and previous CABG. Patients were split into 2 groups depending on whether they had complete revascularisation performed as inpatients or as staged PCI at later outpatient dates. The primary outcome of this study was major adverse cardiac events (consisting of myocardial infarction, target vessel revascularisation and all-cause mortality).834 (54.8%) patients underwent complete inpatient revascularisation and 688 patients (45.2%) had outpatient PCI (median 43 days post discharge). Of the inpatient group, 652 patients (78.2%) underwent complete revascularisation during the index procedure whilst 182 (21.8%) patients underwent inpatient bystander PCI in a second procedure. Overall, there were no significant differences between the groups with regards to their baseline or procedural characteristics. Over the follow-up period there was no significant difference in MACE between the cohorts ( Conclusions: Our study demonstrated that the timing of bystander PCI after STEMI did not appear to have an effect on cardiovascular outcomes. We suggest that patients with multi-vessel disease can potentially be discharged promptly and undergo early outpatient bystander PCI. This could significantly reduce length of stay in hospital.
Language	English
Publishing date	2020-08-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2575256-X
ISSN	1179-5468
ISSN	1179-5468
DOI	10.1177/1179546820951792
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Article: Routine aspiration thrombectomy is associated with increased stroke rates during primary percutaneous coronary intervention for myocardial infarction.

Perera, Dhanuka / Rathod, Krishnaraj S / Guttmann, Oliver / Beirne, Anne-Marie / O'Mahony, Constantinos / Weerackody, Roshan / Baumbach, Andreas / Mathur, Anthony / Wragg, Andrew / Jones, Daniel A

American journal of cardiovascular disease

2020 Volume 10, Issue 5, Page(s) 548–556

Abstract: Background: Recent studies have suggested that the routine use of aspiration thrombectomy catheters during primary percutaneous coronary intervention (PCI) do not result in improved mortality and may be associated with an increased stroke rate. This ... ...

Abstract	Background: Recent studies have suggested that the routine use of aspiration thrombectomy catheters during primary percutaneous coronary intervention (PCI) do not result in improved mortality and may be associated with an increased stroke rate. This study sought to investigate this hypothesis. Methods: This was an observational study analysing data from a prospective database of 6366 patients undergoing primary PCI between August 2003 and May 2015 at a UK cardiac centre. Patients' details were collected from the hospital electronic database. Primary outcome was thirty-day stroke rates. Results: 3989 (62.7%) patients underwent PCI alone and 2,377 (37.3%) patients underwent PCI with adjuctive thrombus aspiration. PCI alone group had an older demographic (63 (± 14) years vs 60.7 (± 14)), a lower proportion of male participants 75% vs 79% (P=0.001) and cardiovascular risk factors such as hypertension 22.4% vs 25.3% (P=0.007), hypercholesterolemia 18.5% vs 22.6% (P<0.0001) and a history of smoking 33.5% vs 44.3% (P<0.0001). Thrombus aspiration was associated with a higher 30-day stroke rate [16 (0.7%) vs 11 (0.3%) (HR 2.51; 95% CI 1.03-6.08, P 0.03). Multivariate analysis suggested that this increased risk of stroke was maintained following adjustment for confounders (HR: 1.86; 95% CI 1.02-4.38). There was 379 deaths of which 114 (4.8%) were in the thrombus aspiration cohort vs 265 (6.6%) in PCI only cohort over the follow-up period (60 months). This resulted in a significantly lower rate of all-cause-mortality HR 0.70 (95% CI 0.52-0.94; P 0.02). There was no statistically significant difference in observed myocardial infarction rates HR 0.76 (95% CI 0.47-1.23; P 0.27) and the rates of unscheduled revascularisations HR 0.70 (95% CI 0.43-1.13; P 0.14) between the two groups. Conclusions: Our data series of STEMI patients, suggest that routine thrombus aspiration during primary PCI is associated with a significantly higher stroke, rate however, thrombus aspiration reduced mortality rate. This is consistent with current guidelines which don't recommend the routine use of thrombus aspiration for primary PCI. A possible mortality reduction in patients with high thrombus grades was seen which may warrant further study.
Language	English
Publishing date	2020-12-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2616844-3
ISSN	2160-200X
ISSN	2160-200X
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Article ; Online: Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction.

The New England journal of medicine

2022 Volume 387, Issue 15, Page(s) 1351–1360

Abstract: Background: Whether revascularization by percutaneous coronary intervention (PCI) can improve event-free survival and left ventricular function in patients with severe ischemic left ventricular systolic dysfunction, as compared with optimal medical ... ...

Abstract	Background: Whether revascularization by percutaneous coronary intervention (PCI) can improve event-free survival and left ventricular function in patients with severe ischemic left ventricular systolic dysfunction, as compared with optimal medical therapy (i.e., individually adjusted pharmacologic and device therapy for heart failure) alone, is unknown. Methods: We randomly assigned patients with a left ventricular ejection fraction of 35% or less, extensive coronary artery disease amenable to PCI, and demonstrable myocardial viability to a strategy of either PCI plus optimal medical therapy (PCI group) or optimal medical therapy alone (optimal-medical-therapy group). The primary composite outcome was death from any cause or hospitalization for heart failure. Major secondary outcomes were left ventricular ejection fraction at 6 and 12 months and quality-of-life scores. Results: A total of 700 patients underwent randomization - 347 were assigned to the PCI group and 353 to the optimal-medical-therapy group. Over a median of 41 months, a primary-outcome event occurred in 129 patients (37.2%) in the PCI group and in 134 patients (38.0%) in the optimal-medical-therapy group (hazard ratio, 0.99; 95% confidence interval [CI], 0.78 to 1.27; P = 0.96). The left ventricular ejection fraction was similar in the two groups at 6 months (mean difference, -1.6 percentage points; 95% CI, -3.7 to 0.5) and at 12 months (mean difference, 0.9 percentage points; 95% CI, -1.7 to 3.4). Quality-of-life scores at 6 and 12 months appeared to favor the PCI group, but the difference had diminished at 24 months. Conclusions: Among patients with severe ischemic left ventricular systolic dysfunction who received optimal medical therapy, revascularization by PCI did not result in a lower incidence of death from any cause or hospitalization for heart failure. (Funded by the National Institute for Health and Care Research Health Technology Assessment Program; REVIVED-BCIS2 ClinicalTrials.gov number, NCT01920048.).
MeSH term(s)	Humans ; Heart Failure/etiology ; Heart Failure/therapy ; Percutaneous Coronary Intervention ; Stroke Volume ; Treatment Outcome ; Ventricular Dysfunction, Left/drug therapy ; Ventricular Dysfunction, Left/etiology ; Ventricular Dysfunction, Left/mortality ; Ventricular Dysfunction, Left/surgery ; Ventricular Function, Left ; Coronary Artery Disease/complications ; Coronary Artery Disease/drug therapy ; Coronary Artery Disease/mortality ; Coronary Artery Disease/surgery ; Cardiovascular Agents/therapeutic use ; Myocardial Ischemia/drug therapy ; Myocardial Ischemia/etiology ; Myocardial Ischemia/mortality ; Myocardial Ischemia/surgery
Chemical Substances	Cardiovascular Agents
Language	English
Publishing date	2022-08-27
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMoa2206606
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Article ; Online: Simulation of cardiac emergencies with real patients.

Williams, Howell / Yang, Lisa / Gale, Jessica / Paranehewa, Sakitha / Joshi, Abhishek / Westwood, Mark / Weerackody, Roshan

The clinical teacher

2015 Volume 12, Issue 5, Page(s) 341–345

Abstract: Background: Simulation training with manikin simulators for medical emergencies is increasingly used in medical training. The assessment of a manikin, in particular history and examination, is very different to that of a real patient. We sought to ... ...

Abstract	Background: Simulation training with manikin simulators for medical emergencies is increasingly used in medical training. The assessment of a manikin, in particular history and examination, is very different to that of a real patient. We sought to combine aspects of traditional simulation training with the assessment of real hospital in-patients. Study design: In-patients who had recently experienced a cardiac emergency were asked to recall their symptoms as if they were still present. Medical students assessed these patients in the role of foundation year-1 (FY1) doctors, supervised by core medical trainee (CMT) doctors, and were encouraged to formulate a differential diagnosis and initial management plan. The students filled in a questionnaire prior to, immediately after and 1 week after each simulation session. This included a self-assessment of confidence in managing cardiac emergencies, as well as knowledge-based questions on aspects of assessment and management of cardiac emergencies. We sought to combine aspects of traditional simulation training with the assessment of real hospital in-patients Results: Confidence in managing cardiac emergencies was initially low, but significantly increased after one simulation training session (p < 0.001). This increase was sustained on re-assessment 1 week after the training session (p < 0.001). In addition to the increase in confidence, a significant and sustained increase in knowledge score was also observed (p < 0.001). Conclusion: Simulation training with real patients led to an immediate and sustained increase in self-assessed confidence. There was also an increase in medical knowledge of the assessment and management of cardiac emergencies. This simulation technique is inexpensive, easily reproducible and can be used to complement learning from traditional simulation training with manikins.
MeSH term(s)	Atrial Fibrillation/therapy ; Clinical Competence ; Emergencies ; Humans ; Internship and Residency/organization & administration ; Myocardial Infarction/therapy ; Self Concept ; Simulation Training/organization & administration ; Ventricular Dysfunction, Left/therapy
Language	English
Publishing date	2015-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2151518-9
ISSN	1743-498X ; 1743-4971
ISSN (online)	1743-498X
ISSN	1743-4971
DOI	10.1111/tct.12322
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