Jeffrey M. Schussler M.D.

Van Meter, C., A. Vasudevan, J. M. Cuccerre and J. M. Schussler (2018). “Time to discharge following diagnostic coronary procedures via transradial artery approach: A comparison of Terumo band and StatSeal hemostasis.” Cardiovasc Revasc Med Mar 24. [Epub ahead of print].

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BACKGROUND: The transradial artery (TRA) approach for cardiac catheterization is associated with fewer complications, earlier mobilization and a shorter stay at the hospital. The objective of this study was to determine whether hemostasis with a combination of a compression band (Terumo TR band) and a hemostatic patch (StatSeal) decreases the time to discharge from the hospital compared to the Terumo (TR) band alone in patients undergoing diagnostic coronary catheterizations through a TRA approach. METHODS: We retrospectively looked at 445 patients who underwent diagnostic coronary angiography through the TRA approach at the Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas between July 2016 and June 2017. The difference in the time to discharge between the two groups was assessed by a Wilcoxon Rank-sum test. RESULTS: The combination of a TR band and a StatSeal hemostatic patch was used in 70.3% (313) of the patients. Comparison of the two groups demonstrated a statistically significant reduction in time from the end of the procedure to discharge (p<0.001), with no significant alteration in safety among those with a combination of TR band and a StatSeal hemostatic patch. CONCLUSION: With increasing frequency of TRA procedures in the United States, we demonstrate one effective method to significantly reduce the time to radial hemostasis and reduce the time to patient discharge from the hospital.

Tecson, K. M., D. Brown, J. W. Choi, G. Feghali, G. V. Gonzalez-Stawinski, B. L. Hamman, R. Hebeler, S. R. Lander, B. Lima, S. Potluri, J. M. Schussler, R. C. Stoler, C. Velasco and P. A. McCullough (2018). “Major Adverse Renal and Cardiac Events Following Coronary Angiography and Cardiac Surgery.” Ann Thorac Surg. Feb 2. [Epub ahead of print].

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BACKGROUND: Patients at high risk for developing post-procedural complications may receive iodixanol, an iso-osmolar contrast, during coronary angiography to minimize the risk of renal toxicity. For those who additionally require cardiac surgery, the wait-time between angiography and surgery may be a modifiable factor capable of mitigating poor surgical outcomes; however, there have been inconsistsent reports regarding the optimal wait-time. We sought to determine the effects of wait time between angiogram and cardiac surgery, as well as contrast induced acute injury (CI-AKI) on the development of major adverse renal and cardiac events (MARCE). METHODS: We merged datasets to identify adults who underwent coronary angiography with iodixanol and subsequent cardiac surgery. RESULTS: Of 965 patients, 126 (13.1%) developed CI-AKI; 133 (13.8%) experienced MARCE within 30 days and 253 (26.2%) within 1 year of surgery. After adjusting for CI-AKI, age, and Thakar acute renal failure score, the effect of wait-time lost significance for the full cohort, but remained for the 654 who had coronary artery bypass grafting. Those with coronary artery bypass grafting within 1 day of coronary angiography had an approximate 2-fold increase in risk of MARCE (30-day hazard ratio =2.13, 95% confidence interval 1.16-3.88, p=0.014; 1-year hazard ratio =2.07, 95% confidence interval 1.32, 3.23, p = 0.002) compared to those who waited 5 or more days. CONCLUSIONS: Patients who suffered CI-AKI and had cardiac surgery within 1 day of angiography had increased risk of MARCE.

Farzad, A. and J. M. Schussler (2018). “Acute Myopericardial Syndromes.” Cardiol Clin 36(1): 103-114.

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Acute myopericardial syndromes are common but can be challenging to manage and potentially have life-threatening complications. Careful clinical history, physical examination, electrocardiogram interpretation, and application of diagnostic criteria are needed to make an accurate diagnosis, exclude concomitant disease, and properly treat patients. Therapy for acute pericarditis should be guided per the underlying cause. For the most common causes, nonsteroidal antiinflammatory drugs or aspirin with the addition of colchicine remains the mainstay of therapy. Patients with hemodynamic compromise who are resistant to therapy or display high-risk features should prompt hospitalization and initiation of more aggressive and/or invasive therapy.

Vasudevan, A., K. M. Tecson, J. Bennett-Firmin, T. Bottiglieri, L. R. Lopez, M. Peterson, M. Sathyamoorthy, R. Schiffmann, J. M. Schussler, C. Swift, C. E. Velasco and P. A. McCullough (2017). “Prognostic value of urinary 11-dehydro-thromboxane b2 for mortality: A cohort study of stable coronary artery disease patients treated with aspirin.” Catheter Cardiovasc Interv: 2017 Nov [Epub ahead of print].

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AIM: There is a variable cardiovascular risk reduction attributable to aspirin because of individual differences in the suppression of thromboxane A2 and its downstream metabolite 11-dehydro-thromboxane B2 (11dhTxB2 ). The aim of this study is to evaluate the optimal cut point of urinary 11dhTxB2 for the risk of mortality in aspirin-treated coronary artery disease (CAD) patients. METHODS AND RESULTS: This was a prospective cohort study including stable CAD patients who visited the Baylor Heart and Vascular Hospital in Dallas or the Texas Heart Hospital Baylor Plano, TX between 2010 and 2013. The outcome of all-cause mortality was ascertained from chart review and automated sources. The 449 patients included in this analysis had a mean age of 66.1 +/- 10.1 years. 67 (14.9%) patients died within 5 years; 56 (87.5%) of the 64 patients with known cause of death suffered a cardiovascular related mortality. Baseline ln(urinary 11dhTxB2 /creatinine) ranged between 5.8 and 11.1 (median = 7.2) with the higher concentrations among those who died (median: 7.6) than those who survived (median = 7.2, P < 0.001). Using baseline ln(11dhTxB2 ) to predict all-cause mortality, the area under the curve was 0.70 (95% CI: 0.64-0.76). The optimal cut point was found to be ln(7.38) = 1597.8 pg/mg, which had the following decision statistics: sensitivity = 0.67, specificity = 0.62, positive predictive value = 0.24, negative predictive value = 0.92, and accuracy = 0.63. CONCLUSION: Our data indicate the optimal cut point for urine 11dhTxB2 is 1597.8 (pg/mg) for the risk prediction of mortality over five years in stable patients with CAD patients treated with aspirin.

Kivelevitch, D., J. M. Schussler and A. Menter (2017). “Coronary plaque characterization in psoriasis.” Circulation 136(3): 277-280.

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Psoriasis is strongly associated with multiple comorbidities, including obesity, tobacco smoking, diabetes mellitus, dyslipidemia, hypertension, and psychiatric, autoimmune, renal, and cardiovascular diseases, among others.5 Multiple publications have confirmed the association between psoriasis and vascular disease.5–8 Patients with psoriasis, especially those <50 years old and with more severe disease, are at higher risk of developing coronary artery disease (CAD).9 Furthermore, patients with moderate to severe psoriasis have a reduced life expectancy of ≈4 to 5 years relating to cardiovascular disease (CVD). Traditional risk assessment tools such as the Framingham risk score do not appropriately estimate this CAD risk. Recent studies that used both noninvasive and invasive coronary artery studies of patients with psoriasis and have shown a higher prevalence of CAD in patients with psoriasis compared with healthy individuals.10–13 Our recent coronary artery calcium score study of 129 patients with psoriasis with moderate to severe disease revealed a risk similar to that of patients with type II diabetes mellitus and significantly higher than that of healthy patients.10 One of the major areas of research and interest in the therapy of moderate to severe psoriasis is the potential benefit of systemic therapies such as methotrexate and biological therapies, especially tumor necrosis factor-α antagonist agents, on CAD.14