Author
Sunil V. Rao
Other affiliations: University of North Carolina at Chapel Hill, University of Texas Southwestern Medical Center, Icahn School of Medicine at Mount Sinai ...read more
Bio: Sunil V. Rao is an academic researcher from Duke University. The author has contributed to research in topics: Percutaneous coronary intervention & Conventional PCI. The author has an hindex of 73, co-authored 563 publications receiving 27865 citations. Previous affiliations of Sunil V. Rao include University of North Carolina at Chapel Hill & University of Texas Southwestern Medical Center.
Papers published on a yearly basis
Papers
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TL;DR: Bleeding complications have been associated with an increased risk of subsequent adverse outcomes, including MI, stroke, stent thrombosis, and death, in patients with ACS and in those undergoing percutaneous coronary intervention (PCI) as well as in the long-term antithrombotic setting.
Abstract: Advances in antithrombotic therapy, along with an early invasive strategy, have reduced the incidence of recurrent ischemic events and death in patients with acute coronary syndromes (ACS; unstable angina, non–ST-segment–elevation myocardial infarction [MI], and ST-segment–elevation MI).1,–,4 However, the combination of multiple pharmacotherapies, including aspirin, platelet P2Y12 inhibitors, heparin plus glycoprotein IIb/IIIa inhibitors, direct thrombin inhibitors, and the increasing use of invasive procedures, has also been associated with an increased risk of bleeding.
Editorial see p 2664
Bleeding complications have been associated with an increased risk of subsequent adverse outcomes, including MI, stroke, stent thrombosis, and death, in patients with ACS and in those undergoing percutaneous coronary intervention (PCI),5,–,10 as well as in the long-term antithrombotic setting.11,12 Thus, balancing the anti-ischemic benefits against the bleeding risk of antithrombotic agents and interventions is of paramount importance in assessing new therapies and in managing patients. Prior randomized trials comparing antithrombotic agents suggest that a reduction in bleeding events is associated with improved survival.13,14
Because prevention of major bleeding may represent an important step in improving outcomes by balancing safety and efficacy in the contemporary treatment of ACS, bleeding events have been systematically identified as a crucial end point for the assessment of the safety of drugs during the course of randomized clinical trials, and are an important aspect of the evaluation of new devices and interventional therapies.15 Unlike ischemic clinical events (eg, cardiac death, MI, stent thrombosis), for which there is now general consensus on end-point definitions,16,17 there is substantial heterogeneity among the many bleeding definitions currently in use. Lack of standardization makes it difficult to optimally organize key clinical trial processes such as adjudication, and even more difficult to interpret relative …
3,215 citations
TL;DR: The lower rate of local vascular complications may be a reason to use the radial approach in patients with acute coronary syndromes who were undergoing coronary angiography with possible intervention.
1,739 citations
TL;DR: In patients with acute coronary syndrome undergoing invasive management, radial as compared with femoral access reduces net adverse clinical events, through a reduction in major bleeding and all-cause mortality.
1,018 citations
Rutgers University1, Washington University in St. Louis2, University of British Columbia3, University of Ottawa4, University of Alabama at Birmingham5, University of Vermont6, University of Texas Health Science Center at Houston7, Food and Drug Administration8, Yale University9, Gulf Coast Regional Blood Center10, Duke University11, Emory University12, Englewood Hospital and Medical Center13, University of Massachusetts Medical School14, University of South Florida15
TL;DR: The AABB developed this guideline to provide clinical recommendations about hemoglobin concentration thresholds and other clinical variables that trigger RBC transfusions in hemodynamically stable adults and children.
Abstract: Description: Although approximately 85 million units of red blood cells (RBCs) are transfused annually worldwide, transfusion practices vary widely The AABB (formerly, the American Association of Blood Banks) developed this guideline to provide clinical recommendations about hemoglobin concentration thresholds and other clinical variables that trigger RBC transfusions in hemodynamically stable adults and children Methods: These guidelines are based on a systematic review of randomized clinical trials evaluating transfusion thresholds We performed a literature search from 1950 to February 2011 with no language restrictions We examined the proportion of patients who received any RBC transfusion and the number of RBC units transfused to describe the effect of restrictive transfusion strategies on RBC use To determine the clinical consequences of restrictive transfusion strategies, we examined overall mortality, nonfatal myocardial infarction, cardiac events, pulmonary edema, stroke, thromboembolism, renal failure, infection, hemorrhage, mental confusion, functional recovery, and length of hospital stay Recommendation 1: The AABB recommends adhering to a restrictive transfusion strategy (7 to 8 g/dL) in hospitalized, stable patients (Grade: strong recommendation; high-quality evidence) Recommendation 2: The AABB suggests adhering to a restrictive strategy in hospitalized patients with preexisting cardiovascular disease and considering transfusion for patients with symptoms or a hemoglobin level of 8 g/dL or less (Grade: weak recommendation; moderate-quality evidence) Recommendation 3: The AABB cannot recommend for or against a liberal or restrictive transfusion threshold for hospitalized, hemodynamically stable patients with the acute coronary syndrome (Grade: uncertain recommendation; very low-quality evidence) Recommendation 4: The AABB suggests that transfusion decisions be influenced by symptoms as well as hemoglobin concentration (Grade: weak recommendation; low-quality evidence)
994 citations
TL;DR: Blood transfusion in the setting of acute coronary syndromes is associated with higher mortality, and this relationship persists after adjustment for other predictive factors and timing of events.
Abstract: ContextIt is unclear if blood transfusion in anemic patients with acute coronary
syndromes is associated with improved survival.ObjectiveTo determine the association between blood transfusion and mortality
among patients with acute coronary syndromes who develop bleeding, anemia,
or both during their hospital course.Design, Setting, and PatientsWe analyzed 24 112 enrollees in 3 large international trials of
patients with acute coronary syndromes (the GUSTO IIb, PURSUIT, and PARAGON
B trials). Patients were grouped according to whether they received a blood
transfusion during the hospitalization. The association between transfusion
and outcome was assessed using Cox proportional hazards modeling that incorporated
transfusion as a time-dependent covariate and the propensity to receive blood,
and a landmark analysis.Main Outcome MeasureThirty-day mortality.ResultsOf the patients included, 2401 (10.0%) underwent at least 1 blood transfusion
during their hospitalization. Patients who underwent transfusion were older
and had more comorbid illness at presentation and also had a significantly
higher unadjusted rate of 30-day death (8.00% vs 3.08%; P<.001), myocardial infarction (MI) (25.16% vs 8.16%; P<.001), and death/MI (29.24% vs 10.02%; P<.001)
compared with patients who did not undergo transfusion. Using Cox proportional
hazards modeling that incorporated transfusion as a time-dependent covariate,
transfusion was associated with an increased hazard for 30-day death (adjusted
hazard ratio [HR], 3.94; 95% confidence interval [CI], 3.26-4.75) and 30-day
death/MI (HR, 2.92; 95% CI, 2.55-3.35). In the landmark analysis that included
procedures and bleeding events, transfusion was associated with a trend toward
increased mortality. The predicted probability of 30-day death was higher
with transfusion at nadir hematocrit values above 25%.ConclusionsBlood transfusion in the setting of acute coronary syndromes is associated
with higher mortality, and this relationship persists after adjustment for
other predictive factors and timing of events. Given the limitations of post
hoc analysis of clinical trials data, a randomized trial of transfusion strategies
is warranted to resolve the disparity in results between our study and other
observational studies. We suggest caution regarding the routine use of blood
transfusion to maintain arbitrary hematocrit levels in stable patients with
ischemic heart disease.
979 citations
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TL;DR: The once-in-a-lifetime treatment with Abciximab Intracoronary for acute coronary syndrome and a second dose intravenously for atrial fibrillation is recommended for adults with high blood pressure.
Abstract: ACE
: angiotensin-converting enzyme
ACS
: acute coronary syndrome
ADP
: adenosine diphosphate
AF
: atrial fibrillation
AMI
: acute myocardial infarction
AV
: atrioventricular
AIDA-4
: Abciximab Intracoronary vs. intravenously Drug Application
APACHE II
: Acute Physiology Aand Chronic
7,519 citations
TL;DR: The current guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation are based on the findings of the ESC Task Force on 12 March 2015.
Abstract: ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).
6,866 citations
TL;DR: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation are published.
Abstract: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)
6,599 citations
TL;DR: Strong recommendations apply to most patients, whereas weak recommendations are sensitive to differences among patients, including their preferences.
5,924 citations
TL;DR: March 5, 2019 e1 WRITING GROUP MEMBERS Emelia J. Virani, MD, PhD, FAHA, Chair Elect On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee.
Abstract: March 5, 2019 e1 WRITING GROUP MEMBERS Emelia J. Benjamin, MD, ScM, FAHA, Chair Paul Muntner, PhD, MHS, FAHA, Vice Chair Alvaro Alonso, MD, PhD, FAHA Marcio S. Bittencourt, MD, PhD, MPH Clifton W. Callaway, MD, FAHA April P. Carson, PhD, MSPH, FAHA Alanna M. Chamberlain, PhD Alexander R. Chang, MD, MS Susan Cheng, MD, MMSc, MPH, FAHA Sandeep R. Das, MD, MPH, MBA, FAHA Francesca N. Delling, MD, MPH Luc Djousse, MD, ScD, MPH Mitchell S.V. Elkind, MD, MS, FAHA Jane F. Ferguson, PhD, FAHA Myriam Fornage, PhD, FAHA Lori Chaffin Jordan, MD, PhD, FAHA Sadiya S. Khan, MD, MSc Brett M. Kissela, MD, MS Kristen L. Knutson, PhD Tak W. Kwan, MD, FAHA Daniel T. Lackland, DrPH, FAHA Tené T. Lewis, PhD Judith H. Lichtman, PhD, MPH, FAHA Chris T. Longenecker, MD Matthew Shane Loop, PhD Pamela L. Lutsey, PhD, MPH, FAHA Seth S. Martin, MD, MHS, FAHA Kunihiro Matsushita, MD, PhD, FAHA Andrew E. Moran, MD, MPH, FAHA Michael E. Mussolino, PhD, FAHA Martin O’Flaherty, MD, MSc, PhD Ambarish Pandey, MD, MSCS Amanda M. Perak, MD, MS Wayne D. Rosamond, PhD, MS, FAHA Gregory A. Roth, MD, MPH, FAHA Uchechukwu K.A. Sampson, MD, MBA, MPH, FAHA Gary M. Satou, MD, FAHA Emily B. Schroeder, MD, PhD, FAHA Svati H. Shah, MD, MHS, FAHA Nicole L. Spartano, PhD Andrew Stokes, PhD David L. Tirschwell, MD, MS, MSc, FAHA Connie W. Tsao, MD, MPH, Vice Chair Elect Mintu P. Turakhia, MD, MAS, FAHA Lisa B. VanWagner, MD, MSc, FAST John T. Wilkins, MD, MS, FAHA Sally S. Wong, PhD, RD, CDN, FAHA Salim S. Virani, MD, PhD, FAHA, Chair Elect On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee
5,739 citations