James N Slater, M.D.

Utility of combined two-dimensional and three-dimensional transesophageal imaging for catheter-based mitral valve clip repair of mitral regurgitation
Biner, Simon; Perk, Gila; Kar, Saibal; Rafique, Asim M; Slater, James; Shiota, Takahiro; Hussaini, Asma; Chou, Stanley; Kronzon, Itzhak; Siegel, Robert J
2011 Jun;24(6):611-617, Journal of the American Society of Echocardiography
BACKGROUND: Catheter-based mitral valve clip repair (CBMCR) is feasible for selected patients with mitral regurgitation (MR). Two-dimensional (2D) transesophageal echocardiography (TEE) is the standard modality for evaluating MR and procedural guidance. Recently, real-time three-dimensional TEE became available. The aim of this study was to evaluate the value of combined 2D and three-dimensional TEE for CBMCR. In evaluating MR for CBMCR, the confidence of interpretation of 2D TEE was compared with that of combined imaging for the localization of major valve pathology. In patients who underwent CBMCR, the outcomes and the duration of CBMCR were compared. METHODS: In this retrospective study, MR evaluation was performed by 2D TEE alone and by combined imaging in 80 and 57 patients, respectively. CBMCR was guided by 2D TEE alone in 20 patients and by combined imaging in 39 patients. RESULTS: Examination by combined imaging allowed en face visualization of mitral valve anatomy and MR jet origin. The confidence of interpretation by combined imaging was higher than for 2D TEE (1.1 +/- 0.3 vs 1.8 +/- 0.7, P < .001).The guidance of CBMCR by combined imaging facilitated alignment of the catheter trajectory, clip positioning, and orientation of clip arms. The procedural success and final MR grade were not different between the two study groups. However, the procedural time of CBMCR using combined imaging compared with that using 2D TEE guidance alone was shorter (241 +/- 58 vs 201 +/- 68 min, P = .035). CONCLUSIONS: The use of combined imaging compared with 2D TEE alone appears to enhance the confidence of interpretation concerning mitral pathology and catheter-clip system location and may also reduce CBMCR time
— id: 134181, year: 2011, vol: 24, page: 611, stat: Journal Article,

Effects of optimal medical treatment with or without coronary revascularization on angina and subsequent revascularizations in patients with type 2 diabetes mellitus and stable ischemic heart disease
Dagenais, Gilles R; Lu, Jiang; Faxon, David P; Kent, Kenneth; Lago, Rodrigo M; Lezama, Carlos; Hueb, Whady; Weiss, Melvin; Slater, James; Frye, Robert L
2011 Apr 12;123(14):1492-1500, Circulation
BACKGROUND: In the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial, an initial strategy of coronary revascularization and optimal medical treatment (REV) compared with an initial optimal medical treatment with the option of subsequent revascularization (MED) did not reduce all-cause mortality or the composite of cardiovascular death, myocardial infarction, and stroke in patients with type 2 diabetes mellitus and stable ischemic heart disease. In the same population, we tested whether the REV strategy was superior to the MED strategy in preventing worsening and new angina and subsequent coronary revascularizations. METHODS AND RESULTS: Among the 2364 men and women (mean age, 62.4 years) with type 2 diabetes mellitus, documented coronary artery disease, and myocardial ischemia, 1191 were randomized to the MED and 1173 to the REV strategy preselected in the percutaneous coronary intervention (796) and coronary artery bypass graft (377) strata. Compared with the MED strategy, the REV strategy at the 3-year follow-up had a lower rate of worsening angina (8% versus 13%; P<0.001), new angina (37% versus 51%; P=0.001), and subsequent coronary revascularizations (18% versus 33%; P<0.001) and a higher rate of angina-free status (66% versus 58%; P=0.003). The coronary artery bypass graft stratum patients were at higher risk than those in the percutaneous coronary intervention stratum, and had the greatest benefits from REV. CONCLUSIONS: In these patients, the REV strategy reduced the occurrence of worsening angina, new angina, and subsequent coronary revascularizations more than the MED strategy. The symptomatic benefits were observed particularly for high-risk patients. Clinical Trial Registration: URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00006305
— id: 134246, year: 2011, vol: 123, page: 1492, stat: Journal Article,

Mechanisms of Myocardial Infarction in Women Without Angiographically Obstructive Coronary Artery Disease
Reynolds HR; Srichai MB; Iqbal SN; Slater JN; Mancini GB; Feit F; Pena-Sing I; Axel L; Attubato MJ; Yatskar L; Kalhorn RT; Wood DA; Lobach IV; Hochman JS
2011 Sep 27;124(13):1414-1425, Circulation
BACKGROUND: . Unique identifier: NCT00798122
— id: 137093, year: 2011, vol: 124, page: 1414, stat: Journal Article,

Comparison of drug-eluting and bare metal stents for saphenous vein graft lesions (from the National Heart, Lung, and Blood Institute Dynamic Registry)
Baldwin, Drew E; Abbott, J Dawn; Trost, Jeffrey C; Vlachos, Helen A; Selzer, Faith; Glaser, Ruchira; Wilensky, Robert L; Slater, James N; Doucet, Serge; Naidu, Srihari S; Aronow, Herbert D; Williams, David O
2010 Oct 1;106(7):946-951, American journal of cardiology
The effectiveness and safety of drug-eluting stents (DES) compared with bare-metal stents (BMS) in saphenous vein graft (SVG) disease remains unclear. In particular, there is a paucity of data on long-term outcomes. In this study, 395 patients enrolled in the National Heart, Lung, and Blood Institute Dynamic Registry who underwent stenting of SVG lesions with BMS (n = 192) from 1999 to 2006 or DES (n = 203) from 2004 to 2006 were analyzed. Patients were followed prospectively for the occurrence of cardiovascular events and death at 3 years. Patients treated with DES were more likely to have diabetes mellitus and other co-morbidities and previous percutaneous coronary intervention. Treated lesions in DES patients were more complex than those in BMS patients. At 3 years of follow-up, the adjusted risk for target vessel revascularization (hazard ratio 1.03, 95% confidence interval 0.65 to 1.62, p = 0.91) and death or myocardial infarction (hazard ratio 0.72, 95% confidence interval 0.49 to 1.04, p = 0.08) was similar in patients treated with DES and those treated with BMS. The combined outcome of death, myocardial infarction, or target vessel revascularization excluding periprocedural myocardial infarction was also similar (adjusted hazard ratio 0.82, 95% confidence interval 0.62 to 1.09, p = 0.16). In conclusion, this multicenter nonrandomized study of unselected patients showed no benefit of DES in SVG lesions, including no reduction in target vessel revascularization, compared with BMS at 3 years. An adequately powered randomized controlled trial is needed to determine the optimal stent type for SVG percutaneous coronary intervention
— id: 133798, year: 2010, vol: 106, page: 946, stat: Journal Article,

Sex and race are associated with the absence of epicardial coronary artery obstructive disease at angiography in patients with acute coronary syndromes
Chokshi, Neel P; Iqbal, Sohah N; Berger, Rachel L; Hochman, Judith S; Feit, Frederick; Slater, James N; Pena-Sing, Ivan; Yatskar, Leonid; Keller, Norma M; Babaev, Anvar; Attubato, Michael J; Reynolds, Harmony R
2010 Aug;33(8):495-501, Clinical cardiology
BACKGROUND: A substantial minority of patients with acute coronary syndromes (ACS) do not have a diameter stenosis of any major epicardial coronary artery on angiography ('no obstruction at angiography') of >/= 50%. We examined the frequency of this finding and its relationship to race and sex. HYPOTHESIS: Among patients with myocardial infarction, younger age, female sex and non-white race are associated with the absence of obstructive coronary artery disease at angiography. METHODS: We reviewed the results of all angiograms performed from May 19, 2006 to September 29, 2006 at 1 private (n = 793) and 1 public (n = 578) urban academic medical center. Charts were reviewed for indication and results of angiography, and for demographics. RESULTS: The cohort included 518 patients with ACS. There was no obstruction at angiography in 106 patients (21%), including 48 (18%) of 258 patients with myocardial infarction. Women were more likely to have no obstruction at angiography than men, both in the overall cohort (55/170 women [32%] vs 51/348 men [15%], P < 0.001) and in the subset with MI (29/90 women [32%] vs 19/168 men [11%], P < 0.001). Black patients were more likely to have no obstruction at angiography relative to any other subgroup (24/66 [36%] vs 41/229 [18%] Whites, 31/150 [21%] Hispanics, and 5/58 [9%] Asians, P = 0.001). Among women, Black patients more frequently had no obstruction at angiography compared with other ethnic groups (16/27 [59%] vs 17/59 [29%] Whites, 17/60 [28%] Hispanics, and 3/19 [6%] Asians, P = 0.001). CONCLUSIONS: A high proportion of a multiethnic sample of patients with ACS were found to have no stenosis >/= 50% in diameter at coronary angiography. This was particularly common among women and Black patients.
— id: 111980, year: 2010, vol: 33, page: 495, stat: Journal Article,

Images and case reports in interventional cardiology. Left atrial hypertension as a result of occlusion of a patent foreman ovale
Kim, Eugene; Slater, James N; Kronzon, Itzhak
2010 Jun 1;3(3):e4-e5, Circulation: Cardiovascular Interventions
— id: 110106, year: 2010, vol: 3, page: e4, stat: Journal Article,

The Impact of Vascular Complications and Advanced Age on Outcomes Following Percutaneous Coronary Intervention
Bainey, K; Selzer, F; Bangalore, S; Todoran, T; Garg, P; Slater, J; Jacobs, A; Wilensky, R; Srinivas, V; Williams, D; Faxon, D
2009 NOV 3 ;120(18):S931-S932, Circulation
— id: 106979, year: 2009, vol: 120, page: S931, stat: Journal Article,

Clinical Outcomes of Percutaneous Coronary Intervention using Bivalirudin Versus Heparin plus Glycoprotein IIb/IIIa Inhibitors in the NHLBI Dynamic Registry
Iqbal, SN; Selzer, F; Feit, F; Glaser, R; Mulukutla, SR; Wilensky, RL; Abbott, JD; Williams, DO; Slater, J
2009 MAR 10 ;53(10):A66-A67, Journal of the American College of Cardiology
— id: 97554, year: 2009, vol: 53, page: A66, stat: Journal Article,

Presentation and Outcomes After Percutaneous Intervention for Acute Myocardial Infarction in the NLHBI Dynamic Registry: Saphenous Vein Grafts Versus Native Coronary Arteries
Iqbal, SN; Selzer, F; Naidu, SS; Doucet, S; Faxon, D; Jacobs, A; Slater, J
2009 MAR 10 ;53(10):A75-A75, Journal of the American College of Cardiology
— id: 98104, year: 2009, vol: 53, page: A75, stat: Journal Article,

Association of a Unique Cardiovascular Risk Profile With Outcomes in Hispanic Patients Referred for Percutaneous Coronary Intervention (from the National Heart, Lung, and Blood Institute Dynamic Registry)
Parikh, SV; Enriquez, JR; Selzer, F; Slater, JN; Laskey, WK; Wilensky, RL; Marroquin, OC; Holper, EA
2009 SEP 15 ;104(6):775-779, American journal of cardiology
Although previous studies have demonstrated that Hispanic patients have a higher cardiovascular risk profile than Caucasians and present at a younger age for percutaneous coronary intervention (PCI), limited studies exist examining the outcomes of Hispanics after PCI and potential explanations for differences noted. Using patients from the National Heart, Lung,. and Blood Institute Dynamic Registry waves I to 5 (1997 to 2006), demographic features, angiographic data, and 1-year outcomes of Hispanic patients (n = 542) versus Caucasian patients (n = 1,357) undergoing PCI were evaluated. Compared to Caucasians, Hispanic patients were younger and had more hypertension and diabetes mellitus, including more insulin-treated diabetes mellitus. Although mean lesion length was longer in Hispanics (15.4 vs 14.1 mm, p <0.001), there were no differences in the number of significant lesions or in the use of drug-eluting stents. At follow-up, Hispanics were more likely to report recent anginal symptoms but had a similar incidence of 1-year hospitalizations for angina. Adjusted 1-year hazard ratios for adverse events for Hispanics versus Caucasians revealed lower rates of coronary artery bypass graft surgery (hazard ratio 0.43, confidence interval 0.22 to 0.85, p = 0.02) and a trend toward lower rates of repeat revascularization (hazard ratio 0.76, confidence interval 0.57 to 1.03, p = 0.08). In conclusion, despite the presence of diabetes in almost 50% of Hispanic patients and longer lesions than in Caucasians, Hispanic patients were less likely to undergo coronary artery bypass graft surgery 1 year after PCI and had a trend toward lower rates of repeat revascularization. (C) 2009 Elsevier Inc. All rights reserved. (Am J Cardiol 2009;104:775-779)
— id: 102957, year: 2009, vol: 104, page: 775, stat: Journal Article,

Use of real time three-dimensional transesophageal echocardiography in intracardiac catheter based interventions
Perk, Gila; Lang, Roberto M; Garcia-Fernandez, Miguel Angel; Lodato, Joe; Sugeng, Lissa; Lopez, John; Knight, Brad P; Messika-Zeitoun, David; Shah, Sanjiv; Slater, James; Brochet, Eric; Varkey, Mathew; Hijazi, Ziyad; Marino, Nino; Ruiz, Carlos; Kronzon, Itzhak
2009 Aug;22(8):865-882, Journal of the American Society of Echocardiography
BACKGROUND: Real-time three-dimensional (RT3D) echocardiography is a recently developed technique that is being increasingly used in echocardiography laboratories. Over the past several years, improvements in transducer technologies have allowed development of a full matrix-array transducer that allows acquisition of pyramidal-shaped data sets. These data sets can be processed online and offline to allow accurate evaluation of cardiac structures, volumes, and mass. More recently, a transesophageal transducer with RT3D capabilities has been developed. This allows acquisition of high-quality RT3D images on transesophageal echocardiography (TEE). Percutaneous catheter-based procedures have gained growing acceptance in the cardiac procedural armamentarium. Advances in technology and technical skills allow increasingly complex procedures to be performed using a catheter-based approach, thus obviating the need for open-heart surgery. METHODS: The authors used RT3D TEE to guide 72 catheter-based cardiac interventions. The procedures included the occlusion of atrial septal defects or patent foramen ovales (n=25), percutaneous mitral valve repair (e-valve clipping; n=3), mitral balloon valvuloplasty for mitral stenosis (n=10), left atrial appendage obliteration (n=11), left atrial or pulmonary vein ablation for atrial fibrillation (n=5), percutaneous closures of prosthetic valve dehiscence (n=10), percutaneous aortic valve replacement (n=6), and percutaneous closures of ventricular septal defects (n=2). In this review, the authors describe their experience with this technique, the added value over multiplanar two-dimensional TEE, and the pitfalls that were encountered. RESULTS: The main advantages found for the use RT3D TEE during catheter-based interventions were (1) the ability to visualize the entire lengths of intracardiac catheters, including the tips of all catheters and the balloons or devices they carry, along with a clear depiction of their positions in relation to other cardiac structures, and (2) the ability to ability to demonstrate certain structures in an 'en face' view, which is not offered by any other currently available real-time imaging technique, enabling appreciation of the exact nature of the lesion that is undergoing intervention. CONCLUSION: RT3D TEE is a powerful new imaging tool that may become the technique of choice and the standard of care for guidance of selected percutaneous catheter-based procedures
— id: 101330, year: 2009, vol: 22, page: 865, stat: Journal Article,

Temporal Trends in Patient-Reported Angina at 1 Year After Percutaneous Coronary Revascularization in the Stent Era A Report From the National Heart, Lung, and Blood Institute-Sponsored 1997-2006 Dynamic Registry
Venkitachalam, L; Kip, KE; Mulukutla, SR; Selzer, F; Laskey, W; Slater, J; Cohen, HA; Wilensky, RL; Williams, DO; Marroquin, OC; Sutton-Tyrrell, K; Bunker, CH; Kelsey, SF
2009 NOV ;2(6):607-615, Ciculation : Cardiovascular quality & outcomes
Background-Percutaneous coronary intervention (PCI) has witnessed rapid technological advancements, resulting in improved safety and effectiveness over time. Little, however, is known about the temporal impact on patient-reported symptoms and quality of life after PCI. Methods and Results-Temporal trends in post-PCI symptoms were analyzed using 8879 consecutive patients enrolled in the National Heart, Lung, and Blood Institute-sponsored Dynamic Registry (wave 1: 1997 [bare metal stents], wave 2: 1999 [uniform use of stents], wave 3: 2001 [brachytherapy], wave 4, 5: 2004, 2006 [drug eluting stents]). Patients undergoing PCI in the recent waves were older and more often reported comorbidities. However, fewer patients across the waves reported post-PCI angina at one year (wave 1 to 5: 24%, 23%, 18%, 20%, 20%; P-trend<0.001). The lower risk of angina in recent waves was explained by patient characteristics including use of antianginal medications at discharge (relative risk [95% CI] for waves 2, 3, 4 versus 1: 1.0 [0.9 to 1.2], 0.9 [0.7 to 1.1], 1.0 [0.8 to 1.3], 0.9 [0.7 to 1.1]). Similar trend was seen in the average quality of life scores over time (adjusted mean score for waves 1 to 5: 6.2, 6.5, 6.6 and 6.6; P-trend=0.01). Other factors associated with angina at 1 year included younger age, female gender, prior revascularization, need for repeat PCI, and hospitalization for myocardial infarction over 1 year. Conclusion-Favorable temporal trends are seen in patient-reported symptoms after PCI in routine clinical practice. Specific subgroups, however, remain at risk for symptoms at 1 year and thus warrant closer attention. (Circ Cardiovasc Qual Outcomes. 2009;2:607-615.)
— id: 109073, year: 2009, vol: 2, page: 607, stat: Journal Article,

Twenty-year evolution of percutaneous coronary intervention and its impact on clinical outcomes: a report from the National Heart, Lung, and Blood Institute-sponsored, multicenter 1985-1986 PTCA and 1997-2006 Dynamic Registries
Venkitachalam, Lakshmi; Kip, Kevin E; Selzer, Faith; Wilensky, Robert L; Slater, James; Mulukutla, Suresh R; Marroquin, Oscar C; Block, Peter C; Williams, David O; Kelsey, Sheryl F
2009 Feb;2(1):6-13, Circulation: Cardiovascular Interventions
BACKGROUND: Percutaneous coronary intervention (PCI) has undergone rapid progress, both in technology and adjunct therapy. However, documentation of long-term temporal trends in relation to contemporary practice is lacking. METHODS AND RESULTS: We analyzed PCI use and outcomes in 8976 consecutive patients in the multicenter, National Heart, Lung, and Blood Institute-sponsored 1985-1986 percutaneous transluminal coronary angioplasty (PTCA) and 1997-2006 Dynamic Registries waves (wave 1: 1997-1998, bare-metal stents; wave 2: 1999, uniform use of stents; wave 3: 2001-2002, brachytherapy; waves 4 and 5: 2004-2006, drug-eluting stents). Patients undergoing PCI in the recent waves were older and more often reported comorbidities than those in the balloon era. PCI was more often performed for acute coronary syndromes and, in spite of the greater disease burden, was more often selective. Procedural success was achieved and maintained more often in the stent era. Significant reductions were observed in in-hospital rates (%) of myocardial infarction (PTCA Registry: 4.9; wave 1, 2.7; wave 2, 2.8; wave 3, 1.9; wave 4, 2.6; wave 5, 2; P(trend)<0.001) and emergency coronary artery bypass surgery (PTCA Registry: 3.7; wave 1, 0.4; wave 2, 0.4; wave 3, 0.3; wave 4, 0.4; wave 5, 0; P(trend)<0.001). Compared with the PTCA Registry, risk for repeat revascularization (31 to 365 days after index PCI) was significantly lower in the dynamic waves (adjusted hazard ratio: wave 1, 0.72; wave 2, 0.51; wave 3, 0.51; wave 4, 0.30; wave 5, 0.36; P<0.05 for all). CONCLUSIONS: Percutaneous interventions, in the last 2 decades, have evolved to include more urgent, comorbid cases, despite achieving high success rates with significantly reduced need for repeat revascularization
— id: 133652, year: 2009, vol: 2, page: 6, stat: Journal Article,

Sex and race are associated with the finding of non-obstructive coronary artery disease in patients with acute coronary syndromes
Chokshi, NP; Berger, RL; Hochman, JS; Keller, NM; Feit, F; Attubato, MJ; Slater, JN; Pena-Sing, I; Babaev, A; Reynolds, HR
2008 MAR 11 ;51(10):A217-A217, Journal of the American College of Cardiology
— id: 78384, year: 2008, vol: 51, page: A217, stat: Journal Article,

Rebuttal: Decreasing bleeding risk in coronary interventions
Yatskar, L; Slater, J
2008 APR 1 ;71(5):656-656, Catheterization & cardiovascular interventions
— id: 78180, year: 2008, vol: 71, page: 656, stat: Journal Article,

Evaluation of the abdominal aorta and the renal arteries with an intracardiac echocardiography probe placed in the inferior vena cava: a feasibility study
Kronzon, Itzhak; Chen, Carol; Chinitz, Larry A; Bernstein, Neil E; Slater, James N; Varkey, Mathew; Tunick, Paul A
2007 Feb;20(2):119-125, Journal of the American Society of Echocardiography
BACKGROUND: Ultrasound evaluation of the abdominal aorta and its branches is usually performed transabdominally. Not infrequently, the image quality is suboptimal. Recently, an intracardiac echocardiography probe has become commercially available. These probes are usually inserted intravenously and advanced to the right heart for diagnostic and monitoring purposes during procedures such as atrial septal defect closure and pulmonary vein isolation. Because of the close anatomic relation between the abdominal aorta and the inferior vena cava, we hypothesized that these probes would be useful in the evaluation of the abdominal aorta and the renal arteries. METHODS: Sixteen patients with normal renal function and no history of hypertension who were undergoing a pulmonary vein isolation procedure or atrial septal defect closure were studied. In each patient, the intracardiac echocardiography probe was inserted in the femoral vein and advanced to the right atrium for the evaluation of the left atrium and the pulmonary veins during the procedure. At the end of the therapeutic procedure, the probe was withdrawn into the inferior vena cava for the evaluation of the aorta and renal arteries. RESULTS: High-resolution images of the abdominal aorta from the diaphragm to its bifurcation were easily obtained in all patients. These images allowed for the evaluation of arterial size, shape, and blood flow. Both renal arteries were easily visualized in each patient. With the probe in the inferior vena cava, both renal arteries were parallel to the imaging plane and, therefore, accurate measurement of renal blood flow velocity and individual renal blood flow were measured
— id: 70878, year: 2007, vol: 20, page: 119, stat: Journal Article,

Access site hematoma requiring blood transfusion predicts mortality in patients undergoing percutaneous coronary intervention: data from the National Heart, Lung, and Blood Institute Dynamic Registry
Yatskar, Leonid; Selzer, Faith; Feit, Fredrick; Cohen, Howard A; Jacobs, Alice K; Williams, David O; Slater, James
2007 Jun 1;69(7):961-966, Catheterization & cardiovascular interventions
OBJECTIVE: To determine both the etiology of and outcomes associated with access site hematoma requiring transfusion (HRT) in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: Access site hematoma in the setting of PCI is the most frequent periprocedural complication (2-12%). Antiplatelet and antithrombin therapy is designed to lower the incidence of adverse ischemic events while maintaining an acceptable rate of hemorrhagic complications. METHODS: This was a prospective, multi-center, cohort study of consecutive patients undergoing PCI during 3 NHLBI Dynamic Registry recruitment waves (1997-2002). The primary endpoints included the incidence of HRT, in-hospital death, and death at 1-year. RESULTS: The incidence of HRT was 1.8% and femoral access was common. Older age, lower BMI, female sex, concomitant renal, cerebrovascular, peripheral vascular, and pulmonary disease were significantly associated with HRT. Glycoprotein IIb/IIIa inhibitors, thrombolytic therapy, and postprocedure heparin were more commonly used in HRT patients, but there was no difference in thienopiridiene use. Attempted lesions in patients developing HRT were more often calcified, thrombotic, located in an ostial location, or class B2 or C. In-hospital mortality and 1-year death rate was 9 and 4.5 times higher in HRT patients respectively. Following adjustment, HRT remained independently associated with in-hospital mortality (OR 3.59, 95% CI 1.66-7.77) and 1-year death (hazard ratio [HR] 1.65, 95% CI 1.01-2.70, P = 0.048). Independent predictors of HRT included age, female sex, IIb/IIIa inhibitors, thrombolytic agents, and concomitant conditions. CONCLUSIONS: Access site complications, especially HRT, remain a very important predictor of adverse procedural success and patient outcome
— id: 73399, year: 2007, vol: 69, page: 961, stat: Journal Article,

Echocardiographic and angiographic correlations in patients with cardiogenic shock secondary to acute myocardial infarction
Berkowitz, M Joshua; Picard, Michael H; Harkness, Shannon; Sanborn, Timothy A; Hochman, Judith S; Slater, James N
2006 Oct 15;98(8):1004-1008, American journal of cardiology
In patients with cardiogenic shock (CS) complicating acute myocardial infarction, echocardiographic and angiographic findings are used to aid diagnosis, determine prognosis, and guide management. The purpose of this analysis from the Should we emergently revascularize Occluded Coronary arteries for Cardiogenic ShocK (SHOCK) trial is to identify relations between the angiographic and echocardiographic features of patients with CS. Such an analysis of the correlations between echocardiographic and angiographic findings in patients with CS may provide insights into the etiology and treatment of CS. In 302 randomized patients, an echocardiogram and an angiogram before revascularization were available in 127 patients. Although the median ejection fraction derived by echocardiography and left ventricular angiography was identical (30%), the positive correlation was weak (R2 = 0.209, p = 0.019). Patients with a larger number of diseased vessels had worse mitral regurgitation (MR) by echocardiography (p = 0.005). There was a significant but weak association between left ventricular angiographic MR grade and echocardiographic MR severity (R2 = 0.162, p = 0.015), but there was no association between culprit vessel and degree of MR. In conclusion, worse coronary artery disease is associated with more severe MR. Echocardiography and angiography are valuable and result in similar estimated ejection fractions in a large cohort, but there is wide variation between the techniques in patients
— id: 71985, year: 2006, vol: 98, page: 1004, stat: Journal Article,

Percutaneous PFO closure for the prevention of recurrent brain abscess
LaBarbera, Matthew; Berkowitz, M Joshua; Shah, Alan; Slater, James
2006 Dec;68(6):957-960, Catheterization & cardiovascular interventions
A patent foramen ovale (PFO) can act as a conduit between the venous and arterial circulations, allowing right-to-left shunting and bypass of the pulmonary circulation. Brain abscess may develop as a result of paradoxical embolism of organisms through a PFO. In this small series, we report on the closure of PFO for the prevention of recurrent brain abscess. Only prospective, randomized trials comparing PFO closure to conservative therapy could provide a definitive answer as to the optimal strategy for preventing recurrent cerebral abscess
— id: 70874, year: 2006, vol: 68, page: 957, stat: Journal Article,

Impact of platelet glycoprotein IIb/IIIa inhibitor therapy on in-hospital outcomes and long-term survival following percutaneous coronary rotational atherectomy
Berger, Jeffrey S; Slater, James N; Sherman, Warren; Green, Stephen J; Sanborn, Timothy A; Brown, David L
2005 Feb;19(1):47-54, Journal of thrombosis & thrombolysis
BACKGROUND: Percutaneous coronary rotational atherectomy (PCRA) is a potent stimulus of platelet activation and aggregation in vivo. For this reason, many patients undergoing PCRA are treated with platelet glycoprotein (GP) IIb/IIIa inhibitors. However, there is limited data regarding the ability of GP IIb/IIIa inhibitors to reduce ischemic complications of PCRA and no data regarding their effect on long-term survival. METHODS: Data on 1138 consecutive patients undergoing PCRA in 5 hospitals in 1998-1999 were pooled and analyzed. Long-term survival was available for all 530 patients treated in 3 of the hospitals. RESULTS AND CONCLUSIONS: GP IIb/IIIa inhibitors were administered to 315 of 1138 (28%) PCRA patients. There was no difference in age, gender or race among patients treated with and without GP IIb/IIIa antagonists. The prevalence of hypertension, diabetes, renal insufficiency and peripheral vascular disease did not differ between groups. Unstable angina was more common among patients treated with GP IIb/IIIa inhibitors (45% vs. 38%, P = 0.036) Patients treated with GP IIb/IIIa inhibitors had lower ejection fractions (50% vs. 55%, P < 0.001) and more 3-vessel coronary disease (24% vs. 16%, P = 0.002). Angiographic success was over 99% in both groups (P = NS). The frequency of major adverse cardiovascular events (MACE) was slightly greater in GP IIb/IIIa inhibitor treated patients (3.8% vs. 2.2%, P = 0.126). At a mean follow-up of 3 years, mortality was 13.3% in the GP IIb/IIIa treated patients and 12% in the untreated patients (P = 0.224). On Cox proportional hazards analysis, treatment with a GP IIb/IIIa inhibitor was not significantly associated with increased survival (Hazard Ratio, 0.81, 95% Confidence Interval, 0.631-1.039, P = 0.098). These data do not indicate a significant association between GP IIb/IIIa inhibitor treatment during PCRA and MACE or survival. CONDENSED ABSTRACT: There is limited data regarding the ability of GP IIb/IIIa inhibitors to reduce ischemic complications of percutaneous coronary rotational atherectomy (PCRA) and no data regarding their effect on long-term survival. These data do not indicate a significant association between GP IIb/IIIa inhibitor treatment during PCRA and MACE or survival
— id: 94800, year: 2005, vol: 19, page: 47, stat: Journal Article,

Outcome of patients aged >or=75 years in the SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK (SHOCK) trial: do elderly patients with acute myocardial infarction complicated by cardiogenic shock respond differently to emergent revascularization?
Dzavik, Vladimir; Sleeper, Lynn A; Picard, Michael H; Sanborn, Timothy A; Lowe, April M; Gin, Ken; Saucedo, Jorge; Webb, John G; Menon, Venu; Slater, James N; Hochman, Judith S
2005 Jun;149(6):1128-1134, American heart journal
BACKGROUND: In the SHOCK trial, the group of patients aged >or=75 years did not appear to derive the mortality benefit from early revascularization (ERV) versus initial medical stabilization (IMS) that was seen in patients aged <75 years. We sought to determine the reason for this finding by examining the baseline characteristics and outcomes of the 2 treatment groups by age. METHODS: Patients with cardiogenic shock (CS) secondary to left ventricular (LV) failure were randomized to ERV within 6 hours or to a period of IMS. We compared the characteristics by treatment group of patients aged >or=75 years and of their younger counterparts. RESULTS: Of the 56 enrolled patients aged >or=75 years, those assigned to ERV had lower LV ejection fraction at baseline than IMS-assigned patients (27.5% +/- 12.7% vs 35.6% +/- 11.6%, P = .051). In the elderly ERV and IMS groups, 54.2% and 31.3%, respectively, were women ( P = .105) and 62.5% and 40.6%, respectively, had an anterior infarction (P = .177). The 30-day mortality rate in the ERV group was 75.0% in patients aged >or=75 years and 41.4% in those aged <75 years. In the IMS group, 30-day mortality was 53.1% for those aged >or=75 years, similar to the 56.8% for patients aged <75 years. CONCLUSIONS: Overall, the elderly randomized to ERV did not have better survival than elderly IMS patients. Despite the strong association of age and death post-CS, elderly patients assigned to IMS had a 30-day mortality rate similar to that of IMS patients aged <75 years, suggesting that this was a lower-risk group with more favorable baseline characteristics. The lack of apparent benefit from ERV in elderly patients in the SHOCK trial may thus be due to differences in important baseline characteristics, specifically LV function, and play of chance arising from the small sample size. Therefore, the SHOCK trial overall finding of a 12-month survival benefit for ERV should be viewed as applicable to all patients, including those >or=75 years of age, with acute myocardial infarction complicated by CS
— id: 72003, year: 2005, vol: 149, page: 1128, stat: Journal Article,

Outcomes of multivessel stenting with bare metal versus drug-eluting stents in the dynamic registry
Holper, EM; Vlachos, H; Jacobs, AK; Williams, DO; King, S; Holmes, DR; Wilensky, RL; Abbott, D; Slater, J; Faxon, DP
2005 OCT 25 ;112(17):U542-U543, Circulation
— id: 60206, year: 2005, vol: 112, page: U542, stat: Journal Article,

Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry
Fincke, Rupert; Hochman, Judith S; Lowe, April M; Menon, Venu; Slater, James N; Webb, John G; LeJemtel, Thierry H; Cotter, Gad
2004 Jul 21;44(2):340-348, Journal of the American College of Cardiology
OBJECTIVES: We sought to analyze clinical, angiographic, and outcome correlates of hemodynamic parameters in cardiogenic shock. BACKGROUND: The significance of right heart catheterization in critically ill patients is controversial, despite the prognostic importance of the derived measurements. Cardiac power is a novel hemodynamic parameter. METHODS: A total of 541 patients with cardiogenic shock who were enrolled in the SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK (SHOCK) trial registry were included. Cardiac power output (CPO) (W) was calculated as mean arterial pressure x cardiac output/451. RESULTS: On univariate analysis, CPO, cardiac power index (CPI), cardiac output, cardiac index, stroke volume, left ventricular work, left ventricular work index, stroke work, mean arterial pressure, systolic and diastolic blood pressure (all p < 0.001), coronary perfusion pressure (p = 0.002), ejection fraction (p = 0.013), and pulmonary artery systolic pressure (p = 0.047) were associated with in-hospital mortality. In separate multivariate analyses, CPO (odds ratio per 0.20 W: 0.60 [95% confidence interval, 0.44 to 0.83], p = 0.002; n = 181) and CPI (odds ratio per 0.10 W/m(2): 0.65 [95% confidence interval, 0.48 to 0.87], p = 0.004; n = 178) remained the strongest independent hemodynamic correlates of in-hospital mortality after adjusting for age and history of hypertension. There was an inverse correlation between CPI and age (correlation coefficient: -0.334, p < 0.001). Women had a lower CPI than men (0.29 +/- 0.11 vs. 0.35 +/- 0.15 W/m(2), p = 0.005). After adjusting for age, female gender remained associated with CPI (p = 0.032). CONCLUSIONS: Cardiac power is the strongest independent hemodynamic correlate of in-hospital mortality in patients with cardiogenic shock. Increasing age and female gender are independently associated with lower cardiac power
— id: 43520, year: 2004, vol: 44, page: 340, stat: Journal Article,

Coronary artery disease: new insights into the pathophysiology, prevalence, and early detection of a monster menace
Slater, James; Rill, Velisar
2004 May;25(2):113-121, Seminars in ultrasound CT & MR
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the United States and other industrialized countries. In the undeveloped world a similar epidemic is brewing. A new pathophysiologic paradigm has emerged, which assigns the mediators of inflammation a much larger role in the disease process. This paradigm has helped explain the unpredictable nature of many adverse consequences of CAD. The long latent phase of the disease, and often sudden initial presentation, make efforts at early detection extremely important. Considerable work has been devoted to identify, as well as influence, predisposing risk factors for developing arteriosclerosis. Novel markers of inflammation, like C-reactive protein, have been identified and compared to traditional risk factors. In addition, new imaging modalities introduce the possibility of screening for subclinical disease. Electron beam and multidetector computed tomography (CT) scanners, as well as other techniques, are emerging as powerful tools to detect early disease presence and allow intervention to take place before major clinical events occur. Advances in our understanding of the pathophysiology of CAD, and our ability to image the stages of silent disease will go hand in hand to revolutionize our approach to prevention and treatment of this deadly malady
— id: 46103, year: 2004, vol: 25, page: 113, stat: Journal Article,

Benefits of direct angioplasty for women and men with acute myocardial infarction: results of the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes Angioplasty (GUSTO II-B) Angioplasty Substudy
Tamis-Holland, Jacqueline E; Palazzo, Angela; Stebbins, Amanda L; Slater, James N; Boland, Jean; Ellis, Stephen G; Hochman, Judith S
2004 Jan;147(1):133-139, American heart journal
BACKGROUND: Direct angioplasty (PTCA) and thrombolytic therapy are the chief therapies for treating an ST-segment elevation myocardial infarction (MI). OBJECTIVE: This study was designed to evaluate sex differences in the relative benefit of direct PTCA versus thrombolytic therapy among patients enrolled in the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes Angioplasty (GUSTO II-B PTCA) Substudy. METHODS: Women and men presenting with an acute ST-segment elevation MI were randomized to receive either direct PTCA or accelerated tissue plasminogen activator (t-PA). Patients were then randomized to treatment with either heparin or bivalirudin. A gender analysis of outcome was performed. RESULTS: Women were older than men (68.6 +/- 11.5 vs 59.5 +/- 12.0 years, P <.001) and were more likely to have diabetes (22.5% vs 13.5%, P <.0001) and hypertension (53.3% vs 34.8%, P =.001). After adjusting for differences in baseline variables, the odds ratio (OR) for reaching a 30-day clinical end point (death, nonfatal infarction, or nonfatal disabling stroke) was similar for women and men (1.35, 95% CI 0.88-2.08). The OR for reaching a clinical end point at 30 days for the PTCA-treated women compared with the t-PA-treated women was 0.685 (95% CI 0.36-1.32) and similar to the OR in men, 0.565 (95% CI 0.35-0.91), P for interaction =.535. Because women had a higher event rate than men, the absolute number of major events prevented when treating women with direct PTCA was higher than men (56 events/1000 women treated with PTCA vs 42 events per 1000 men treated with PTCA). CONCLUSIONS: Although the relative benefit of direct PTCA to t-PA for the treatment of an acute MI appears to be similar in women and men, women may derive a larger absolute benefit from direct PTCA
— id: 43525, year: 2004, vol: 147, page: 133, stat: Journal Article,

In-hospital outcomes of contemporary percutaneous coronary interventions in the very elderly
Dynina, Olga; Vakili, Babak A; Slater, James N; Sherman, Warren; Ravi, Kumar L; Green, Stephen J; Sanborn, Timothy A; Brown, David L
2003 Mar;58(3):351-357, Catheterization & cardiovascular interventions
Coronary heart disease is the leading cause of death among the elderly (> 65 years) and the very elderly (> 85 years). Little information is available regarding the outcome of very elderly patients referred for PCI in the current era of improved techniques, devices, and pharmacotherapy. The objective of the current study was to evaluate the clinical characteristics and outcomes of very elderly patients > or = 85 years of age in a large, contemporary, multi-institutional PCI database. Five hospitals in the New York City metropolitan area contributed these prospectively defined data elements on consecutive patients undergoing PCI from 1 January 1998 to 1 October 1999. Of 10,847 patients, 5,341 (49%) were younger than 65 years, 3,342 (31%) were 65-74 years, 1,885 (17%) were 75-84 years, and 279 (2.6%) were at least 85 years of age. Following PCI, the very elderly developed stroke (P < 0.001) and renal failure requiring dialysis (P = 0.002) more commonly than younger patients following PCI. The very elderly had a significantly increased in-hospital mortality rate at 2.5% (P < 0.001). However, on multivariate analysis, age > or = 85 years was not an independent predictor of in-hospital mortality (OR = 1.22; 95% CI = 0.37-4.07). The very elderly should not be refused PCI on the basis of advanced age alone
— id: 38017, year: 2003, vol: 58, page: 351, stat: Journal Article,

Early revascularization is associated with improved survival in elderly patients with acute myocardial infarction complicated by cardiogenic shock: a report from the SHOCK Trial Registry
Dzavik, V; Sleeper, L A; Cocke, T P; Moscucci, M; Saucedo, J; Hosat, S; Jiang, X; Slater, J; LeJemtel, T; Hochman, J S
2003 May;24(9):828-837, European heart journal
AIMS: The SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK (SHOCK) Trial showed no benefit of early revascularization in patients aged >/=75 years with acute myocardial infarction and cardiogenic shock. We examined the effect of age on treatment and outcomes of patients with cardiogenic shock in the SHOCK Trial Registry. METHODS AND RESULTS: We compared clinical and treatment factors in patients in the SHOCK Trial Registry with shock due to pump failure aged <75 years (n=588) and >/=75 years (n=277), and 30-day mortality of patients treated with early revascularization <18 hours since onset of shock and those undergoing a later or no revascularization procedure. After excluding early deaths covariate-adjusted relative risk and 95% confidence intervals were calculated to compare the revascularization strategies within the two age groups. Older patients more often had prior myocardial infarction, congestive heart failure, renal insufficiency, other comorbidities, and severe coronary anatomy. In-hospital mortality in the early vs. late or no revascularization groups was 45 vs. 61% for patients aged <75 years (p=0.002) and 48 vs. 81% for those aged >/=75 years (p=0.0003). After exclusion of 65 early deaths and covariate adjustment, the relative risk was 0.76 (0.59, 0.99; p=0.045) in patients aged <75 years and 0.46 (0.28, 0.75; p=0.002) in patients aged >/=75 years. CONCLUSIONS: Elderly patients with myocardial infarction complicated by cardiogenic shock are less likely to be treated with invasive therapies than younger patients with shock. Covariate-adjusted modeling reveals that elderly patients selected for early revascularization have a lower mortality rate than those receiving a revascularization procedure later or never
— id: 38907, year: 2003, vol: 24, page: 828, stat: Journal Article,

Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial
Sanborn, Timothy A; Sleeper, Lynn A; Webb, John G; French, John K; Bergman, Geoffrey; Parikh, Manish; Wong, S Chiu; Boland, Jean; Pfisterer, Matthias; Slater, James N; Sharma, Samin; Hochman, Judith S
2003 Oct 15;42(8):1373-1379, Journal of the American College of Cardiology
OBJECTIVES: The goal of this study was to describe the core laboratory angiographic findings of 'SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK' (SHOCK) trial participants and to determine the relationship of angiographic parameters to one-year survival. BACKGROUND: In the SHOCK trial, emergency revascularization improved one-year survival of patients with cardiogenic shock compared with initial medical stabilization including thrombolysis and intraaortic balloon counterpulsation. METHODS: Coronary angiography was performed by protocol in 147 of 152 (97%) patients in the emergency revascularization (ERV) group and by clinical selection in 100 of 150 (67%) patients in the initial medical stabilization (IMS) group. Of the other 50 IMS patients, 45 of 50 (90%) died rapidly and did not undergo angiography. RESULTS: Left ventricular ejection fraction was correlated with one-year survival in both treatment groups (p < 0.001). In the IMS group, the hazard ratio for death was 2.59 (95% confidence interval 1.47 to 4.58, p = 0.001) per diseased vessel (0/1 vs. 2 vs. 3). In the ERV group, the hazard ratio for death per diseased vessel was 1.11 (95% confidence interval 0.79 to 1.56, p = 0.559). Multivariate analysis of the angiography cohort (without regard for left ventriculogram measurements) identified initial Thrombolysis in Myocardial Infarction flow grade (p = 0.032), number of diseased vessels (for IMS patients only, p = 0.024), and culprit vessel (p = 0.004) as independent correlates of one-year survival, even after adjustment for key clinical factors. In the smaller cohort with left ventricular ejection fraction measured (n = 97), ejection fraction and culprit vessel remained independently correlated with survival. CONCLUSIONS: For patients in cardiogenic shock, left ventricular function and culprit vessel were independent correlates of one-year survival
— id: 38902, year: 2003, vol: 42, page: 1373, stat: Journal Article,

The impact of access site hematoma with transfusion in patients undergoing percutaneous coronary intervention: A report from the NHLBI dynamic registry
Slater, J; Selzer, F; Feit, F; Cohen, HA; Jacobs, AK; Williams, DO
2003 SEP 15 ;92(6A):18L-18L, American journal of cardiology
— id: 38554, year: 2003, vol: 92, page: 18L, stat: Journal Article,

The impact of adverse access site hematoma in patients undergoing percutaneous coronary intervention: A report from the NHLBI dynamic registry
Slater, J; Selzer, F; Feit, F; Cohen, HA; Jacobs, AK; Williams, DO
2003 OCT 28 ;108(17):356-356, Circulation
— id: 42564, year: 2003, vol: 108, page: 356, stat: Journal Article,

Coronary artery disease: new insights into the pathophysiology, prevalence and early detection of a monster menace
Slater, James; Rill, Velisar
2003 May;24(2):114-122, Seminars in ultrasound CT & MR
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the United States and industrialized countries. In the undeveloped world a similar epidemic is brewing. A new pathophysiologic paradigm has emerged, which assigns the mediators of inflammation a much larger role in the disease process. This paradigm has helped explain the unpredictable nature of many adverse consequences of CAD. The long latent phase of the disease and often sudden initial presentation make efforts at early detection extremely important. Considerable work has been devoted to identify as well as influence predisposing risk factors for developing arteriosclerosis. Novel markers of inflammation, like C-reactive protein, have been identified and compared to traditional risk factors. In addition, new imaging modalities introduce the possibility of screening for sub-clinical disease. Electron-beam and spiral CT scanners, as well as other techniques, are emerging as powerful tools to detect early disease presence and allow intervention to take place before major clinical events occur. Advances in our understanding of the pathophysiology and our ability to image the stages of silent disease will go hand in hand to revolutionize our approach to prevention and treatment of this deadly disease
— id: 46066, year: 2003, vol: 24, page: 114, stat: Journal Article,

Ethnic differences in the presentation, treatment strategy, and outcomes of percutaneous coronary intervention (a report from the National Heart, Lung, and Blood Institute Dynamic Registry)
Slater, James; Selzer, Faith; Dorbala, Sharmila; Tormey, Deborah; Vlachos, Helen A; Wilensky, Robert L; Jacobs, Alice K; Laskey, Warren K; Douglas, John S Jr; Williams, David O; Kelsey, Sheryl F
2003 Oct 1;92(7):773-778, American journal of cardiology
Information about the impact of race/ethnicity on adverse outcomes after percutaneous coronary intervention (PCI) in the modern era is limited. Using consecutive patients from the National Heart, Lung, and Blood Institute Dynamic Registry, this study investigated differences in clinical presentation, treatment strategy, and acute and long-term outcomes in 3,669 white, 446 black, 301 Hispanic, and 201 Asian patients who underwent PCI. All comparisons were made to whites. Blacks were more likely than whites to be younger, women, and to present with a higher prevalence of cardiovascular risk factors (hypertension, diabetes, and smoking). Hispanics tended to be younger, hypertensive, diabetic, and to be undergoing their first cardiovascular procedure. Asians were, on average, younger, men, and presented more often with hypertension and diabetes than whites. Although the rate of stent implantation was significantly lower in blacks compared with whites (63% vs 74%, p <0.001), angiographic and procedural success rates were high (> or =95%) and did not differ by race/ethnicity. In-hospital mortality (0.2% vs 1.7%, p <0.05) and death/myocardial infarction (MI)/coronary artery bypass grafting (CABG) (3.1% vs 5.5%, p <0.05) were lower in blacks. All other in-hospital complications were similar to whites. At 1 year, there were no statistical differences in cumulative adverse event rates by ethnicity; however by 2 years there was a modestly higher mortality rate (adjusted RR 1.87; 95% confidence interval 1.15 to 3.04) and adverse event rate (death/MI, death/MI/CABG) among black patients. Thus, although differences in patient demographics, clinical presentation, angiographic characteristics and treatment strategies did not impact the incidence of acute and 1-year adverse outcomes of non-whites, there appears to be a significant reduction in event-free survival among blacks by 2 years
— id: 111728, year: 2003, vol: 92, page: 773, stat: Journal Article,

A propensity analysis of the impact of platelet glycoprotein IIb/IIIa inhibitor therapy on in-hospital outcomes after percutaneous coronary intervention
Vakili, Babak A; Kaplan, Robert C; Slater, James N; Sherman, Warren; Ravi, Kumar L; Green, Stephen J; Sanborn, Timothy A; Brown, David L
2003 Apr 15;91(8):946-950, American journal of cardiology
It is unknown whether the benefits of parenteral platelet glycoprotein (GP) IIb/IIIa inhibitors as an adjunct to percutaneous coronary intervention (PCI) demonstrated in randomized clinical trials extend to patients treated outside the setting of clinical trials. A contemporary registry of 10,847 consecutive PCI procedures was analyzed to determine the effect of GP IIb/IIIa inhibitor treatment on in-hospital major adverse coronary events ([MACEs] composite of death, urgent coronary artery bypass surgery, periprocedural myocardial infarction, abrupt closure, and stent thrombosis). In this registry, GP IIb/IIIa inhibitors were administered to 20.1% of patients. These patients were younger, more often men, and less often hypertensive than untreated patients. GP IIb/IIIa inhibitor-treated patients were more likely to present with acute myocardial infarction or unstable angina. Stents were placed in 79% of patients treated with GP IIb/IIIa inhibitors. MACEs occurred in 7.8% of GP IIb/IIIa inhibitor-treated patients compared with 3.8% of untreated patients (p <0.001). After multivariable adjustment for the propensity of GP IIb/IIIa inhibitor treatment as well as other possible confounders and interactions known to influence MACEs, GP IIb/IIIa inhibitor treatment was associated with a 57% increase in the risk of a MACE (odds ratio 1.57, 95% confidence interval 1.22 to 2.03; p = 0.0004). In a data set consisting of patients with a high degree of acuity predominantly treated with stent placement, GP IIb/IIIa inhibitor treatment is associated with an increase in thrombotic complications of PCI
— id: 38016, year: 2003, vol: 91, page: 946, stat: Journal Article,

One-year survival following early revascularization for cardiogenic shock
Hochman JS; Sleeper LA; White HD; Dzavik V; Wong SC; Menon V; Webb JG; Steingart R; Picard MH; Menegus MA; Boland J; Sanborn T; Buller CE; Modur S; Forman R; Desvigne-Nickens P; Jacobs AK; Slater JN; LeJemtel TH
2001 Jan 10;285(2):190-192, JAMA
CONTEXT: Cardiogenic shock (CS) is the leading cause of death for patients hospitalized with acute myocardial infarction (AMI). OBJECTIVE: To assess the effect of early revascularization (ERV) on 1-year survival for patients with AMI complicated by CS. DESIGN: The SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) Trial, an unblinded, randomized controlled trial from April 1993 through November 1998. SETTING: Thirty-six referral centers with angioplasty and cardiac surgery facilities. PATIENTS: Three hundred two patients with AMI and CS due to predominant left ventricular failure who met specified clinical and hemodynamic criteria. INTERVENTIONS: Patients were randomly assigned to an initial medical stabilization (IMS; n = 150) group, which included thrombolysis (63% of patients), intra-aortic balloon counterpulsation (86%), and subsequent revascularization (25%), or to an ERV group (n = 152), which mandated revascularization within 6 hours of randomization and included angioplasty (55%) and coronary artery bypass graft surgery (38%). MAIN OUTCOME MEASURES: All-cause mortality and functional status at 1 year, compared between the ERV and IMS groups. RESULTS: One-year survival was 46.7% for patients in the ERV group compared with 33.6% in the IMS group (absolute difference in survival, 13.2%; 95% confidence interval [CI], 2.2%-24.1%; P<.03; relative risk for death, 0.72; 95% CI, 0.54-0.95). Of the 10 prespecified subgroup analyses, only age (<75 vs >/= 75 years) interacted significantly (P<.03) with treatment in that treatment benefit was apparent only for patients younger than 75 years (51.6% survival in ERV group vs 33.3% in IMS group). Eighty-three percent of 1-year survivors (85% of ERV group and 80% of IMS group) were in New York Heart Association class I or II. CONCLUSIONS: For patients with AMI complicated by CS, ERV resulted in improved 1-year survival. We recommend rapid transfer of patients with AMI complicated by CS, particularly those younger than 75 years, to medical centers capable of providing early angiography and revascularization procedures
— id: 38019, year: 2001, vol: 285, page: 190, stat: Journal Article,

Percutaneous coronary intervention for cardiogenic shock in the SHOCK Trial Registry
Webb JG; Sanborn TA; Sleeper LA; Carere RG; Buller CE; Slater JN; Baran KW; Koller PT; Talley JD; Porway M; Hochman JS
2001 Jun;141(6):964-970, American heart journal
BACKGROUND: The SHOCK Registry prospectively enrolled patients with cardiogenic shock complicating acute myocardial infarction in 36 multinational centers. METHODS: Cardiogenic shock was predominantly attributable to left ventricular pump failure in 884 patients. Of these, 276 underwent percutaneous coronary intervention (PCI) after shock onset and are the subject of this report. RESULTS: The majority (78%) of patients undergoing angiography had multivessel disease. As the number of diseased arteries rose from 1 to 3, mortality rates rose from 34.2% to 51.2%. Patients who underwent PCI had lower in-hospital mortality rates than did patients treated medically (46.4% vs 78.0%, P < .001), even after adjustment for patient differences and survival bias (P = .037). Before PCI, the culprit artery was occluded (Thrombolysis In Myocardial Infarction grade 0 or 1 flow) in 76.3%. After PCI, the in-hospital mortality rate was 33.3% if reperfusion was complete (grade 3 flow), 50.0% with incomplete reperfusion (grade 2 flow), and 85.7% with absent reperfusion (grade 0 or 1 flow) (P < .001). CONCLUSIONS: This prospective, multicenter registry of patients with acute myocardial infarction complicated by cardiogenic shock is consistent with a reduction in mortality rates as the result of percutaneous coronary revascularization. Coronary artery patency was an important predictor of outcome. Measures to promote early and rapid reperfusion appear critically important in improving the otherwise poor outcome associated with cardiogenic shock
— id: 38018, year: 2001, vol: 141, page: 964, stat: Journal Article,

Cardiogenic shock with non-ST-segment elevation myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded coronaries for Cardiogenic shocK?
Jacobs AK; French JK; Col J; Sleeper LA; Slater JN; Carnendran L; Boland J; Jiang X; LeJemtel T; Hochman JS
2000 Sep;36(3 Suppl A):1091-1096, Journal of the American College of Cardiology
OBJECTIVES: We sought to determine the outcomes of patients with cardiogenic shock (CS) complicating non-ST-segment elevation acute myocardial infarction (MI). BACKGROUND: Such patients represent a high-risk (ST-segment depression) or low-risk (normal or nonspecific electrocardiographic findings) group for whom optimal therapy, particularly in the setting of shock, is unknown. METHODS: We assessed characteristics and outcomes of 881 patients with CS due to predominant left ventricular (LV) dysfunction in the SHOCK Trial Registry. RESULTS: Patients with non-ST-segment elevation MI (n = 152) were significantly older and had significantly more prior MI, heart failure, azotemia, bypass surgery, and peripheral vascular disease than patients with ST-elevation MI (n = 729). On average, the groups had similar in-hospital LV ejection fractions (approximately 30%), but patients with non-ST-elevation MI had a lower highest creatine kinase and were more likely to have triple-vessel disease. Among patients selected for coronary angiography, the left circumflex artery was the culprit vessel in 34.6% of non-ST-elevation versus 13.4% of ST-elevation MI patients (p = 0.001). Despite having more recurrent ischemia (25.7% vs. 17.4%, p = 0.058), non-ST-elevation patients underwent angiography less often (52.6% vs. 64.1%, p = 0.010). The proportion undergoing revascularization was similar (36.8% for non-ST-elevation vs. 41.9% ST-elevation MI, p = 0.277). In-hospital mortality also was similar in the two groups (62.5% for non-ST-elevation vs. 60.4% ST-elevation MI). After adjustment, ST-segment elevation MI did not independently predict in-hospital mortality (odds ratio, 1.30; 95% confidence interval, 0.83 to 2.02; p = 0.252). CONCLUSIONS: Patients with CS and non-ST-segment elevation MI have a higher-risk profile than shock patients with ST-segment elevation, but similar in-hospital mortality. More recurrent ischemia and less angiography represent opportunities for earlier intervention, and early reperfusion therapy for circumflex artery occlusion should be considered when non-ST-elevation MI causes CS
— id: 38021, year: 2000, vol: 36, page: 1091, stat: Journal Article,

Acute myocardial infarction complicated by systemic hypoperfusion without hypotension: report of the SHOCK trial registry
Menon V; Slater JN; White HD; Sleeper LA; Cocke T; Hochman JS
2000 Apr 1;108(5):374-380, American journal of medicine
BACKGROUND: Cardiogenic shock is usually characterized by inadequate cardiac output and sustained hypotension. However, following a large myocardial infarction, peripheral hypoperfusion can occur with relatively well maintained systolic blood pressure, a condition known as nonhypotensive cardiogenic shock. The aim of this study was to determine the characteristics of patients with this condition. METHODS: The SHOCK trial registry prospectively enrolled patients with suspected cardiogenic shock complicating acute myocardial infarction. We identified a group of 49 patients who presented with nonhypotensive shock, defined as clinical evidence of peripheral hypoperfusion with a systolic blood pressure >90 mm Hg without vasopressor circulatory support. Clinical characteristics, hemodynamic data, and outcomes in these patients were compared with a group of 943 patients with classic cardiogenic shock with hypotension. The age, gender, and distributions of coronary risk factors were similar in both groups. RESULTS: Patients with nonhypotensive shock were more likely to have an anterior wall myocardial infarction (71% versus 53%, P = 0.03). Both groups of patients had similar rates of treatment with thrombolytic therapy, angioplasty, and bypass surgery. Patients with nonhypotensive shock had an in-hospital mortality rate of 43% as compared with a rate of 66% among patients who had classic cardiogenic shock with hypotension (P = 0.001). Mortality among 76 patients who presented with a systolic blood pressure <90 mm Hg but no hypoperfusion was 26%. CONCLUSIONS: Even in the presence of normal blood pressure, clinical signs of peripheral hypoperfusion, which may be subtle, are associated with a substantial risk of in-hospital death following acute myocardial infarction
— id: 38022, year: 2000, vol: 108, page: 374, stat: Journal Article,

Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK?
Menon V; Webb JG; Hillis LD; Sleeper LA; Abboud R; Dzavik V; Slater JN; Forman R; Monrad ES; Talley JD; Hochman JS
2000 Sep;36(3 Suppl A):1110-1116, Journal of the American College of Cardiology
OBJECTIVES: We wished to assess the profile and outcomes of patients with ventricular septal rupture (VSR) in the setting of cardiogenic shock (CS) complicating acute myocardial infarction (MI). BACKGROUND: Cardiogenic shock is often seen with VSR complicating acute MI. Despite surgical therapy, mortality in such patients is high. METHODS: We analyzed 939 patients enrolled in the SHOCK Trial Registry of CS in acute infarction, comparing 55 patients whose shock was associated with VSR with 884 patients who had predominant left ventricular failure. RESULTS: Rupture occurred a median 16 h after infarction. Patients with VSR tended to be older (p = 0.053), were more often female (p = 0.002) and less often had previous infarction (p < 0.001), diabetes mellitus (p = 0.015) or smoking history (p = 0.033). They also underwent right-heart catheterization, intra-aortic balloon pumping and bypass surgery significantly more often. Although patients with rupture had less severe coronary disease, their in-hospital mortality was higher (87% vs. 61%, p < 0.001). Surgical repair was performed in 31 patients with rupture (21 had concomitant bypass surgery); 6 (19%) survived. Of the 24 patients managed medically, only 1 survived. CONCLUSIONS: There is a high in-hospital mortality rate when CS develops as a result of VSR. Ventricular septal rupture may occur early after infarction, and women and the elderly may be more susceptible. Although the prognosis is poor, surgery remains the best therapeutic option in this setting
— id: 38020, year: 2000, vol: 36, page: 1110, stat: Journal Article,

Cardiogenic shock due to cardiac free-wall rupture or tamponade after acute myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize occluded coronaries for cardiogenic shock?
Slater J; Brown RJ; Antonelli TA; Menon V; Boland J; Col J; Dzavik V; Greenberg M; Menegus M; Connery C; Hochman JS
2000 Sep;36(3 Suppl A):1117-1122, Journal of the American College of Cardiology
OBJECTIVES: We sought to compare the characteristics and outcomes of patients with acute myocardial infarction (MI) and cardiogenic shock (CS) caused by rupture of the ventricular free wall or tamponade versus shock from other causes. BACKGROUND: Free-wall rupture is a recognized cause of mortality in patients with acute MI. Some of these patients present subacutely, which provides an opportunity for intervention. Recognition of factors that distinguish them from the overall shock cohort would be beneficial. METHODS: The international SHOCK Trial Registry enrolled patients concurrently with the randomized SHOCK Trial. Thirty-six centers consecutively enrolled all patients with suspected CS after MI, regardless of trial eligibility. RESULTS: Of the 1,048 patients studied, 28 (2.7%) had free-wall rupture or tamponade. These patients had less pulmonary edema, less diabetes, less prior MI, and less prior congestive heart failure (all p < 0.05). They more often had new Q waves in two or more leads (51.9% vs. 31.5%, p < 0.04), but MI location and time to shock onset after MI did not differ. Of patients with rupture or tamponade, 75% had pericardial effusions. No hemodynamic characteristics identified patients with rupture/tamponade. Most patients with rupture/tamponade had surgery and/or pericardiocentesis (27/28); their in-hospital survival rate was identical to that of the group overall (39.3%). Women and older patients with rupture/tamponade tended to survive intervention less often. CONCLUSIONS: Free-wall rupture and tamponade may present as CS after MI, and survival after intervention is similar to that of the overall shock cohort. All patients with CS after MI should have echocardiography in order to detect subacute rupture or tamponade and initiate appropriate interventions
— id: 38934, year: 2000, vol: 36, page: 1117, stat: Journal Article,

Relation between infarct artery patency at late angiography after acute myocardial infarction and signal-averaged electrocardiography
Chandrasekaran S; Hochman JS; Slater JN; Palazzo AM; Morgan CD; Steinberg JS
1999 Sep 15;84(6):734-6, A8, American journal of cardiology
The angiograms of 89 patients were reviewed from the LATE Ancillary Study (randomized trial of recombinant tissue plasminogen activator vs placebo in patients with symptom onset after 6 hours of myocardial infarction) to determine patency of the infarct-related artery (IRA). In the occluded IRA group (n = 35), the incidence of signal-averaged electrocardiographic abnormality (fQRS > 120 ms) was significantly higher (p = 0.04), the filtered QRS duration was significantly longer (p = 0.007), and the V40 was significantly shorter (p = 0.02), compared with the patent IRA group (n = 54)
— id: 38023, year: 1999, vol: 84, page: 734, stat: Journal Article,

Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock
Hochman JS; Sleeper LA; Webb JG; Sanborn TA; White HD; Talley JD; Buller CE; Jacobs AK; Slater JN; Col J; McKinlay SM; LeJemtel TH
1999 Aug 26;341(9):625-634, New England journal of medicine
BACKGROUND: The leading cause of death in patients hospitalized for acute myocardial infarction is cardiogenic shock. We conducted a randomized trial to evaluate early revascularization in patients with cardiogenic shock. METHODS: Patients with shock due to left ventricular failure complicating myocardial infarction were randomly assigned to emergency revascularization (152 patients) or initial medical stabilization (150 patients). Revascularization was accomplished by either coronary-artery bypass grafting or angioplasty. Intraaortic balloon counterpulsation was performed in 86 percent of the patients in both groups. The primary end point was mortality from all causes at 30 days. Six-month survival was a secondary end point. RESULTS: The mean age of the patients was 66+/-10 years, 32 percent were women and 55 percent were transferred from other hospitals. The median time to the onset of shock was 5.6 hours after infarction, and most infarcts were anterior in location. Ninety-seven percent of the patients assigned to revascularization underwent early coronary angiography, and 87 percent underwent revascularization; only 2.7 percent of the patients assigned to medical therapy crossed over to early revascularization without clinical indication. Overall mortality at 30 days did not differ significantly between the revascularization and medical-therapy groups (46.7 percent and 56.0 percent, respectively; difference, -9.3 percent; 95 percent confidence interval for the difference, -20.5 to 1.9 percent; P=0.11). Six-month mortality was lower in the revascularization group than in the medical-therapy group (50.3 percent vs. 63.1 percent, P=0.027). CONCLUSIONS: In patients with cardiogenic shock, emergency revascularization did not significantly reduce overall mortality at 30 days. However, after six months there was a significant survival benefit. Early revascularization should be strongly considered for patients with acute myocardial infarction complicated by cardiogenic shock
— id: 38024, year: 1999, vol: 341, page: 625, stat: Journal Article,

Four-year follow-up of patients undergoing percutaneous balloon mitral commissurotomy. A report from the National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry
Dean LS; Mickel M; Bonan R; Holmes DR Jr; O'Neill WW; Palacios IF; Rahimtoola S; Slater JN; Davis K; Kennedy JW
1996 Nov 15;28(6):1452-1457, Journal of the American College of Cardiology
OBJECTIVES: This study reports the long-term outcome of patients undergoing percutaneous balloon mitral commissurotomy who were enrolled in the National Heart, Lung, and Blood Institute (NHLBI) Balloon Valvuloplasty Registry. BACKGROUND: The NHLBI established the multicenter Balloon Valvuloplasty Registry in November 1987 to assess both short- and long-term safety and efficiency of percutaneous balloon mitral commissurotomy. METHODS: Between November 1987 and October 1989, 736 patients > or = 18 years old underwent percutaneous balloon mitral commissurotomy at 23 registry sites in North America. The maximal follow-up period was 5.2 years. RESULTS: The actuarial survival rate was 93 +/- 1% (mean +/- SD), 90 +/- 1.2%, 87 +/- 1.4% and 84 +/- 1.6% at 1, 2, 3 and 4 years, respectively. Eighty percent of the patients were alive and free of mitral surgery or repeat balloon mitral commissurotomy at 1 year. The event-free survival rate was 80 +/- 1.5% at 1 year, 71 +/- 1.7% at 2 years, 66 +/- 1.8% at 3 years and 60 +/- 2.0% at 4 years. Important univariable predictors of actuarial mortality at 4 years included age > 70 years (51% survival), New York Heart Association functional class IV (41% survival) and baseline echocardiographic score > 12 (24% survival). Multivariable predictors of mortality included functional class IV, higher echocardiographic score and higher postprocedural pulmonary artery systolic and left ventricular end-diastolic pressures (p < 0.01). CONCLUSIONS: Percutaneous balloon mitral commissurotomy has a favorable effect on the hemodynamic variables of mitral stenosis, and long-term follow-up data suggest that it is a viable alternative with respect to surgical commissurotomy in selected patients
— id: 38025, year: 1996, vol: 28, page: 1452, stat: Journal Article,

Current spectrum of cardiogenic shock and effect of early revascularization on mortality. Results of an International Registry. SHOCK Registry Investigators
Hochman JS; Boland J; Sleeper LA; Porway M; Brinker J; Col J; Jacobs A; Slater J; Miller D; Wasserman H; et al.
1995 Feb 1;91(3):873-881, Circulation
BACKGROUND: Cardiogenic shock remains the leading cause of death of patients hospitalized with acute myocardial infarction (MI). This study was conducted to examine (1) the current spectrum of cardiogenic shock, (2) the proportion of patients who are potential candidates for a trial of early revascularization, and (3) the apparent impact of early revascularization on mortality. METHODS AND RESULTS: Nineteen participating centers in the United States and Belgium prospectively registered all patients diagnosed with cardiogenic shock. Two hundred fifty-one patients were registered. The mean age was 67.5 +/- 11.7 years, and 43% were women. Acute mitral regurgitation or ventricular septal rupture was the cause of shock in 8%. Concurrent conditions contributing to the development of shock were noted in 5%, and 2% had isolated right ventricular shock. Among the remaining 214 patients, nonspecific findings on the ECG associated with 'nontransmural' MI were seen in 14%. The median time to shock diagnosis after MI was 8 hours. The overall in-hospital mortality was 66%. Patients clinically selected to undergo cardiac catheterization were significantly younger and had a lower mortality than those not selected (51% versus 85%, P < .0001) even if they were not revascularized (58%). Mortality for patients undergoing percutaneous transluminal coronary angioplasty (PTCA) was 60% (n = 55) and 19% (n = 16) for coronary artery bypass graft surgery (CABG). Sixty percent (n = 150) of registered patients were judged eligible for a trial of early revascularization. Trial-eligible patients were significantly younger (65.4 +/- 11.0 versus 70.6 +/- 11.9 years, P < .001), had an earlier median time to shock onset after MI (6.5 versus 17.5 hours, P = .003), and had lower mortality (62% versus 73%, P = .077) than ineligible patients. CONCLUSIONS: Patients diagnosed with cardiogenic shock complicating acute MI are a heterogeneous group. Those eligible for a trial of early revascularization tended to have lower mortality. Patients selected to undergo cardiac catheterization had lower mortality whether or not they were revascularized. Emergent PTCA and CABG are promising treatment modalities for cardiogenic shock, but biased case selection for treatment may confound the data. Whether PTCA and CABG reduce mortality and which patient subgroups benefit most remain to be determined in a randomized clinical trial
— id: 38960, year: 1995, vol: 91, page: 873, stat: Journal Article,

C-fos expression in vivo in human lymphocytes in response to stress
Platt JE; He X; Tang D; Slater J; Goldstein M
1995 Jan;19(1):65-74, Progress in neuro-psychopharmacology & biological psychiatry
1. Blood samples from which lymphocytes were isolated were obtained from patients immediately prior to cardiac catheterization (stress period) and again four to five hours later (post-stress period). Blood was also taken from a normal non-stressed control subject. 2. Lymphocyte c-fos mRNA was reverse transcribed followed by strand synthesis of DNA template and amplification using PCR with sequence-specific primers. 3. C-fos mRNA was detectable in lymphocytes from the normal control subject and in patient samples obtained immediately prior to cardiac catheterization, but was not detectable in patient samples obtained four to five hours later. 4. Possible mechanisms for these findings include a stress-related decrease in lymphocyte proliferation and differentiation or a negative feedback effect of the c-fos protein on transcription of the c-fos gene. 5. These findings suggest that it may be possible to monitor peripheral early gene expression as a marker for a variety of conditions including stress, psychiatric disorders and the response to psychotropic drugs
— id: 12838, year: 1995, vol: 19, page: 65, stat: Journal Article,

Percutaneous left atrial to femoral arterial bypass pumping for circulatory support in high-risk coronary angioplasty [see comments]
Glassman E; Chinitz LA; Levite HA; Slater J; Winer H
1993 Jul;29(3):210-216, Catheterization & cardiovascular diagnosis
Left atrial to femoral arterial bypass was evaluated as a means of supporting patients who were considered to be at high risk for the performance of percutaneous transluminal coronary angioplasty. A 20 French drainage catheter was inserted percutaneously into the left atrium via a modified transseptal technique. Blood was withdrawn from the left atrium and returned through a femoral arterial cannula using a roller pump. Thirteen patients were treated in this fashion with excellent circulatory support. Pump flows varied from 1.5 to 3 liters per minute and bypass time ranged from 27 to 106 min (mean = 43 +/- 17). Aortic mean pressure was well supported during balloon inflation. No significant complications were encountered. Neither an oxygenator nor a perfusionist is required. The ability to obtain direct left ventricular decompression offers a major potential advantage. Further evaluation of this technique for the support of such patients is indicated
— id: 6384, year: 1993, vol: 29, page: 210, stat: Journal Article,

Relation between pulmonary artery pressure and mitral stenosis severity in patients undergoing balloon mitral commissurotomy
Otto CM; Davis KB; Reid CL; Slater JN; Kronzon I; Kisslo KB; Bashore TM
1993 Apr 1;71(10):874-878, American journal of cardiology
— id: 38026, year: 1993, vol: 71, page: 874, stat: Journal Article,

PERCUTANEOUS LEFT ATRIAL FEMORAL BYPASS FOR THE TREATMENT OF CARDIOGENIC-SHOCK
WINER, HE; GLASSMAN, E; SLATER, J; CHINITZ, LA; LEVITE, HA; RIBAKOVE, G
1992 JUL-AUG ;4(6):300-302, Journal of invasive cardiology
— id: 51906, year: 1992, vol: 4, page: 300, stat: Journal Article,

Comparison of cardiac catheterization and Doppler echocardiography in the decision to operate in aortic and mitral valve disease [see comments]
Slater J; Gindea AJ; Freedberg RS; Chinitz LA; Tunick PA; Rosenzweig BP; Winer HE; Goldfarb A; Perez JL; Glassman E; et al
1991 Apr;17(5):1026-1036, Journal of the American College of Cardiology
Clinical decisions utilizing either Doppler echocardiographic or cardiac catheterization data were compared in adult patients with isolated or combined aortic and mitral valve disease. A clinical decision to operate, not operate or remain uncertain was made by experienced cardiologists given either Doppler echocardiographic or cardiac catheterization data. A prospective evaluation was performed on 189 consecutive patients (mean age 67 years) with valvular heart disease who were being considered for surgical treatment on the basis of clinical information. All patients underwent cardiac catheterization and detailed Doppler echocardiographic examination. Three sets of two cardiologist decision makers who did not know patient identity were given clinical information in combination with either Doppler echocardiographic or cardiac catheterization data. The combination of Doppler echocardiographic and clinical data was considered inadequate for clinical decision making in 21% of patients with aortic and 5% of patients with mitral valve disease. The combination of cardiac catheterization and clinical data was considered inadequate in 2% of patients with aortic and 2% of patients with mitral valve disease. Among the remaining patients, the cardiologists using echocardiographic or angiographic data were in agreement on the decision to operate or not operate in 113 (76% overall). When the data were analyzed by specific valve lesion, decisions based on Doppler echocardiography or catheterization were in agreement in 92%, 90%, 83% and 69%, respectively, of patients with aortic regurgitation, mitral stenosis, aortic stenosis and mitral regurgitation. Differences in cardiac output determination, estimation of valvular regurgitation and information concerning coronary anatomy were the main reasons for different clinical management decisions. These results suggest that for most adult patients with aortic or mitral valve disease, alone or in combination, Doppler echocardiographic data enable the clinician to make the same decision reached with catheterization data
— id: 14079, year: 1991, vol: 17, page: 1026, stat: Journal Article,

Percutaneous double-balloon valvuloplasty of porcine bioprosthetic valves in the tricuspid position
Attubato MJ; Stroh JA; Bach RG; Slater J; Feit F
1990 Jul;20(3):202-204, Catheterization & cardiovascular diagnosis
This is a description of the first two reported cases of double-balloon valvuloplasty in the treatment of porcine bioprosthetic valve stenosis in the tricuspid position. In both cases, the double-balloon technique resulted in a better hemodynamic improvement than single-balloon valvuloplasty and was well tolerated. Double-balloon valvuloplasty is a reasonable alternative to surgical replacement of a stenotic bioprosthesis in the tricuspid position
— id: 37088, year: 1990, vol: 20, page: 202, stat: Journal Article,

Ten-year experience with aortic valve replacement in 482 patients 70 years of age or older: operative risk and long-term results
Galloway AC; Colvin SB; Grossi EA; Baumann FG; Sabban YP; Esposito R; Ribakove GH; Culliford AT; Slater JN; Glassman E; et al.
1990 Jan;49(1):84-91, Annals of thoracic surgery
A retrospective analysis of an institutional experience with aortic valve replacement (AVR) in patients 70 years of age or older during 1976 to 1987 was performed. The study was prompted in part by the current interest in palliative aortic valvoplasty, an interest based to a certain extent on the impression that AVR in the elderly has a high mortality. The mean age of the patients was 75.0 +/- 4.0 years (+/- the standard deviation) (range, 70 to 89 years). Eighty-three percent of patients received porcine valves and 17%, mechanical valves. Preoperatively 32% were in New York Heart Association class III, and 59% were in class IV. Operative mortality was 5.6% for elective isolated AVR for aortic stenosis (19% of all patients), 8.2% for all isolated AVR (38%), and 12.4% overall. Concomitant operative procedures were done in 62.0%; AVR with coronary artery bypass grafting (42%) had an operative mortality of 14.3%. Multivariate analysis showed significant predictors of operative mortality to be emergency operation (p less than 0.01), isolated aortic regurgitation (p = 0.01), and previous cardiac operation (p = 0.02). Follow-up (34 +/- 27 months) was 94% complete. Five-year survival from late cardiac-related death was 81.0%. The constant yearly hazard rate for late death for patients 70 years of age or older who underwent AVR was 5.42% per year, which is similar to the 5.77% per year rate calculated for age-matched and sex-matched controls. Five-year freedom from reoperation was 99%; from late thromboembolic complications, 91%; and from late anticoagulant-related complications, 94%. Freedom from all valve-related morbidity and mortality was 61% at 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 28923, year: 1990, vol: 49, page: 84, stat: Journal Article,

Doppler echocardiographic flow velocity measurements in the superior vena cava during the Valsalva maneuver in normal subjects
Gindea, A J; Slater, J; Kronzon, I
1990 Jun 1;65(20):1387-1391, American journal of cardiology
The hemodynamic manifestations of the Valsalva maneuver are in part the result of changes in the venous return accompanying changes in intrathoracic pressure. Doppler echocardiography was performed during Valsalva maneuver in 13 normal subjects. Superior vena cava flow velocities and flow velocity integrals were measured in all 13 subjects. In the 5 subjects in whom the superior vena cava was clearly visualized throughout the maneuver, vena cava diameter was also analyzed. The superior vena cava flow velocity integral at rest was 17 +/- 2 cm. It diminished significantly, disappeared or reversed (-13 +/- 6 cm, p less than 0.001) with phase I of the maneuver. During the maintenance phase (phase II), the flow velocity integral increased significantly (31 +/- 2 cm, p = 0.05 vs baseline and phase I) and was associated with a decrease in superior vena cava lumen diameter at the time of Valsalva and continuing throughout the strain. With release of the maneuver (phase III), there was a sudden significant increase in flow velocity integral (61 +/- 2 cm, p = 0.005 vs phase II) and superior vena cava lumen diameter. Subsequently, superior vena cava flow velocity integral returned to baseline values. This study suggests that one of the ways in which the Valsalva maneuver leads to decreased venous return may be by direct external compression of the superior vena cava
— id: 100104, year: 1990, vol: 65, page: 1387, stat: Journal Article,

EFFECT OF COLLATERAL VESSELS ON EXERCISE TEST-PERFORMANCE IN SEVERE SINGLE VESSEL CORONARY-ARTERY DISEASE
Katz, E; Kaplan, B; Perez, J; Slater, J; Glassman, E; Rey, M; Slater, W
1990 Oct;38(3):A764-A764, Clinical research
— id: 31919, year: 1990, vol: 38, page: A764, stat: Journal Article,

Transesophageal echocardiography to detect atrial clots in candidates for percutaneous transseptal mitral balloon valvuloplasty
Kronzon I; Tunick PA; Glassman E; Slater J; Schwinger M; Freedberg RS
1990 Nov;16(5):1320-1322, Journal of the American College of Cardiology
Left atrial thrombi are common in patients with mitral stenosis. When percutaneous balloon mitral valvuloplasty is performed on such patients, there is a potential risk of thrombus dislodgment and embolization. In this study conventional transthoracic echocardiography and transesophageal echocardiography were performed for percutaneous balloon mitral valvuloplasty on 19 consecutive candidates (6 men, 13 women, 23 to 81 years old). In five patients (26%), transesophageal echocardiography revealed a left atrial thrombus; in only one of these was there a suspicion of left atrial thrombus on transthoracic echocardiography. Balloon mitral valvuloplasty was canceled in four of the five patients. Three underwent mitral valve surgery that confirmed the echocardiographic findings. Transesophageal echocardiography is better than conventional transthoracic echocardiography in detecting left atrial clots in candidates for balloon mitral valvuloplasty. Because of the potential risk of embolization, transesophageal echocardiography is recommended in all candidates for balloon mitral valvuloplasty
— id: 14292, year: 1990, vol: 16, page: 1320, stat: Journal Article,

Echocardiographic and hemodynamic characteristics of atrial septal defects created by percutaneous valvuloplasty
Kronzon I; Tunick PA; Goldfarb A; Freedberg RS; Chinitz L; Slater J; Schwinger ME; Gindea AJ; Glassman E; Daniel WG
1990 Jan-Feb;3(1):64-71, Journal of the American Society of Echocardiography
Twenty-nine patients were studied by pulsed, continuous wave, and color Doppler before and after percutaneous transseptal valvuloplasty. New atrial septal defects were detected in 14 patients, and the patients were monitored for up to 320 days after the procedure. The diameter of the defect, best evaluated by the transesophageal approach, was 3 to 15 mm. A narrow, high velocity (1.4 to 3.1 meters per second) left-to-right shunt jet was detected in 13 of 14 patients. The shunt jet was continuous in nine of 14 patients, late systolic-holodiastolic in four patients, and bidirectional in one patient. Cardiac catheterization in nine patients confirmed the Doppler findings and demonstrated a peak pressure gradient of 10 to 32 mm Hg between the left and right atria. Oximetry revealed a calculated pulmonary to systemic flow ratio ranging from 2.3:1 in the patient with the largest atrial septal defect by echocardiography to 1:1 (no oxygen saturation step-up) in the patient with the smallest atrial septal defect. In the three patients who underwent cardiac surgery, the operative findings confirmed those of echocardiography. We concluded that atrial septal defects are common after transseptal valvuloplasty. Usually, their relatively small size and the underlying valvular disease that produces high left atrial pressure are responsible for the high pressure gradient between the left and right atria. This results in the high velocity and continuous shunt jet detected by Doppler echocardiography
— id: 63046, year: 1990, vol: 3, page: 64, stat: Journal Article,

TRANSESOPHAGEAL ECHOCARDIOGRAPHY IMPROVES THE DIAGNOSTIC- ACCURACY OF OSTIAL STENOSIS OF THE LEFT MAIN CORONARY-ARTERY
Kronzon, I; Schrem, SS; Tunick, PA; Slater, J
1990 Oct;82(4):625-625, Circulation
— id: 31912, year: 1990, vol: 82, page: 625, stat: Journal Article,

Transesophageal echocardiography in the diagnosis of ostial left coronary artery stenosis
Schrem SS; Tunick PA; Slater J; Kronzon I
1990 Sep-Oct;3(5):367-373, Journal of the American Society of Echocardiography
The diagnosis of ostial stenosis of the left main coronary artery is usually made by use of coronary angiography. However, positioning of the catheter across the obstruction may obscure this diagnosis during contrast injection. Although a damping of arterial pressure when the catheter enters the left coronary artery may suggest ostial stenosis, it may not be possible to make this diagnosis with certainty during cardiac catheterization. We report a series of four patients in whom the left coronary ostium and proximal left coronary arteries were visualized by means of transesophageal echocardiography. Both ostial narrowing by plaque and abnormally fast flow velocities were seen. In each case the echocardiographic findings contributed to the subsequent management of the patients
— id: 63040, year: 1990, vol: 3, page: 367, stat: Journal Article,

Discrete atherosclerotic coronary artery aneurysms: a study of 20 patients
Tunick PA; Slater J; Kronzon I; Glassman E
1990 Feb;15(2):279-282, Journal of the American College of Cardiology
The incidence, angiographic features and natural history of discrete atherosclerotic coronary aneurysms were evaluated in 20 patients with 22 aneurysms (0.2% of 8,422 patients referred for coronary angiography). Fifteen aneurysms (68%) were in the left anterior descending, four (18%) in the circumflex, two (9%) in the right and one (5%) in the left main coronary artery. Aneurysm diameter ranged from 4 to 35 mm (mean 8); 95% of aneurysms were adjacent to a severe obstruction. Seventy-five percent of patients had severe triple vessel disease that included severe left main disease in 15%. Total obstruction of one or two arteries was present in 75%. In patients with wall motion abnormalities, 78% of the abnormalities were in the distribution of the aneurysm. Follow-up (range 1 to 90 months [mean 30]) was obtained in all 20 patients. There were two cardiac and two noncardiac deaths; 12 patients had coronary bypass surgery and of 16 survivors, 13 were angina-free. In conclusion, discrete coronary aneurysms are much less common than diffuse ectasia. Unlike ectasia, they are never found in arteries without severe stenosis, and are most common in the left anterior descending coronary artery. Associated coronary artery disease is more severe in patients with discrete aneurysms than in those with diffuse ectasia. Discrete coronary aneurysms do not appear to rupture, and their resection is not warranted
— id: 63045, year: 1990, vol: 15, page: 279, stat: Journal Article,

Transesophageal echocardiography during percutaneous mitral valvuloplasty
Kronzon I; Tunick PA; Schwinger ME; Slater J; Glassman E
1989 Nov-Dec;2(6):380-385, Journal of the American Society of Echocardiography
Transesophageal echocardiography was performed during mitral balloon valvuloplasty. It provided valuable information about the position of the transseptal needle, wires, and balloon catheter throughout the procedure, and it helped in the immediate evaluation of its results. Transesophageal echocardiography was well tolerated and there were no complications
— id: 10442, year: 1989, vol: 2, page: 380, stat: Journal Article,

Right atrial papillary fibroelastoma: diagnosis by transthoracic and transesophageal echocardiography and percutaneous transvenous biopsy
Schwinger ME; Katz E; Rotterdam H; Slater J; Weiss EC; Kronzon I
1989 Nov;118(5 Pt 1):1047-1050, American heart journal
— id: 10431, year: 1989, vol: 118, page: 1047, stat: Journal Article,

Coronary artery aneurysms: a transesophageal echocardiographic study
Tunick PA; Slater J; Pasternack P; Kronzon I
1989 Jul;118(1):176-179, American heart journal
— id: 10554, year: 1989, vol: 118, page: 176, stat: Journal Article,

Candida albicans-infected transvenous pacemaker wire: detection by two-dimensional echocardiography
Cole, W J; Slater, J; Kronzon, I; Galler, M; Trehan, N; Cohen, M; Gargiulo, A
1986 Feb;111(2):417-418, American heart journal
— id: 100118, year: 1986, vol: 111, page: 417, stat: Journal Article,

Long-term follow-up after mitral valve reconstruction: incidence of postoperative left ventricular outflow obstruction
Galler, M; Kronzon, I; Slater, J; Lighty, G W Jr; Politzer, F; Colvin, S; Spencer, F
1986 Sep;74(3 Pt 2):I99-103, Circulation
Reconstructive surgery of the mitral valve has been an alternative to mitral valve replacement in patients with mitral regurgitation. Previously, we reported on postoperative left ventricular outflow tract obstruction associated with systolic anterior motion of the anterior mitral leaflet. The current study was designed to evaluate the incidence of this complication and the long-term results of mitral valve reconstructive surgery. Sixty-five patients, aged 19 to 78 years, had mitral valve reconstructive surgery. Two patients died perioperatively, and three died late after surgery. The 60 surviving patients were studied by M mode, two-dimensional, and Doppler echocardiography 1 to 55 months postoperatively (mean 21). Fifty patients had no evidence of postoperative mitral regurgitation, two patients had moderate mitral regurgitation, three patients had mild mitral regurgitation, and five patients had trace mitral regurgitation. No significant mitral stenosis was detected in any patient postoperatively. After surgery, the diameter of the left ventricular outflow tract was significantly smaller than that before surgery. The echocardiograms of six patients showed abnormal systolic anterior motion of the anterior mitral leaflet that was not observed preoperatively. Doppler echocardiography demonstrated pressure gradients across the left ventricular outflow tract between 10 and 64 mm Hg. Inhalation of amyl nitrite increased these gradients. An additional patient who had systolic anterior motion but no gradient developed a 36 mm Hg gradient after inhalation of amyl nitrite. The remaining patients had no gradient induced by amyl nitrite. Abnormal systolic anterior motion of the anterior mitral leaflet may be surgically induced by changes in left ventricular geometry and the size of the left ventricular outflow tract during systole.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 100115, year: 1986, vol: 74, page: I99, stat: Journal Article,

INOSINE ENHANCES SALVAGE OF REPERFUSED MYOCARDIUM
GROSS, E; SLATER, J; NATHAN, I
1986 APR ;34(2):A305-A305, Clinical research
— id: 41395, year: 1986, vol: 34, page: A305, stat: Journal Article,

NORMAL LEFT-VENTRICULAR ECHOCARDIOGRAMS IN PATIENTS WITH AORTIC-STENOSIS
Lipton, M; Slater, J; Kramer, P; Schwartz, W; Winer, H; Kronzon, I; Glassman, E
1986 FEB ;7(2):A30-A30, Journal of the American College of Cardiology
— id: 51208, year: 1986, vol: 7, page: A30, stat: Journal Article,

THE INFLUENCE OF CORONARY-ARTERY DISEASE ON THE HEMODYNAMIC PROFILE OF PATIENTS WITH ANGINA AND AORTIC-STENOSIS
Lipton, M; Slater, J; Kramer, P; Schwartz, W; Winer, H; Kronzon, I; Glassman, E
1986 FEB ;7(2):A171-A171, Journal of the American College of Cardiology
— id: 51209, year: 1986, vol: 7, page: A171, stat: Journal Article,

THE EFFECT OF VESSEL EDGE DEFINITION ON STATISTICAL ERRORS IN DSA MEASUREMENTS
RUSINEK, H; SLATER, J; GLASSMAN, E
1986 OCT ;74(4):484-484, Circulation
— id: 41341, year: 1986, vol: 74, page: 484, stat: Journal Article,

Inosine enhances salvage of reperfused myocardium
Connolly MW; Grossi EA; Slater J; Krieger KH
1985 Nov-Dec;42(6):469-471, Current surgery
— id: 33357, year: 1985, vol: 42, page: 469, stat: Journal Article,

LEFT-VENTRICULAR OUTFLOW TRACT ANATOMY IN PATIENTS WITH MITRAL ANNULAR CALCIFICATION
SLATER, J; KRONZON, I; COHEN, ML
1984 ;86(2):315-315, Chest
— id: 40921, year: 1984, vol: 86, page: 315, stat: Journal Article,

Doppler echocardiography and computed tomography in diagnosis of left coronary arteriovenous fistula
Slater, J; Lighty, G W Jr; Winer, H E; Kahn, M L; Kronzon, I; Isom, O W
1984 Dec;4(6):1290-1293, Journal of the American College of Cardiology
A 37 year old man with recurrent episodes of endocarditis was found to have a large left coronary arteriovenous fistula communicating with the right atrium. The origin and termination of the fistula were identified using computed tomography and two-dimensional Doppler echocardiography. Coronary angiography confirmed the diagnosis and the patient underwent a successful operation
— id: 100121, year: 1984, vol: 4, page: 1290, stat: Journal Article,