Intermountain Healthcare's Cardiovascular Clinical Program is constantly seeking to improve care, learn about new treatment options, conduct investigational research, and implement clinical advances.
Some of the research we have been involved with:
Surgical Revascularization is Associated with Improved Long-term Outcomes Compared to Percutaneous Stenting in Patients with Multivessel Coronary Artery Disease
In this large real-world observational study of patients undergoing revascularization for multivessel coronary artery disease, there appears to be a long-term benefit, in relationship to both death and major adverse cardiac events, from bypass over ;stenting regardless of diabetic status. Although limited by its retrospective and observational nature, this study demonstrates that bypass remains an excellent option for revascularization in patients with multi-vessel coronary artery disease.
Extended Follow-up for Outcomes of Drug-Eluting Stents in “Real-World” Practice: Is Caution Indicated?
Three-year outcomes, in contrast to 6-month outcomes, in patients with drug-eluting stents suggest an increased risk of major adverse cardiac death, especially all-cause death, compared to bare metal stents. While drug-eluting stents demonstrated a lower risk of 6-month total vessel revascularization, extended follow up showed no difference in total vessel revascularization or myocardial infarction. Drug-eluting stent patients had a lower risk of bypass. Given the current dominance of drug-eluting stents in clinical practice, this raises alarm that long-term outcomes need more scrutiny.
Short-Term Exposure to Fine Particulate Air Pollution is Associated with the Risk of Ischemic Coronary Events, Especially among Patients with Coronary Disease
Short-term particulate exposures contributed to myocardial infarction and unstable angina events, especially among patients with underlying coronary artery disease and cardiac risk factors. Individuals with stable presentation and those with angiographically-demonstrated normal coronaries are not as susceptible to short-term particulate exposure.
Blood Transfusions Are Associated with Worse Outcomes Compared to No Transfusion in Patients with Similar Degrees of Anemia and Hematocrit Decline While Undergoing Coronary Angiography
When compared to non-transfused patients undergoing coronary angiography with similar baseline and decreased hematocrits, transfused patients were at increased risk of in-hospital, 6-month, and 1-year death. Furthermore, receiving ABO/Rh dissimilar blood was associated with a two-fold increase in mortality at one year. These results cast doubt on the practice of routinely transfusing blood in CAD patients without severe anemia.
A Rapid Genotyping Assay for Polymorphisms Affecting the Dose-Response to Warfarin Therapy
Here we first demonstrate the clinical feasibility of rapid genotyping to guide anticoagulation therapy in “real-time”. This rapid test method will allow same visit application of genotyping to enable genetic-driven dosing in clinical trials and practice with the goal of improving anticoagulant efficiency and safety. The success of this approach also may have broader implications for the practical use of clinical pharmacogenetics.
The Long-Term Safety and Efficacy of Combined Simvastatin and Fenofibrate Therapy in Diabetic Patients with Dyslipidemia: The DIACOR Study
In this 1-year randomized trial of diabetic patients, combination therapy of simvastatin (20 mg) and fenofibrate (160 mg) was safe, well-tolerated and more effective in positively affecting lipids than either form of monotherapy. Whether higher doses of statin in combination with fenofibrate may be even more effective and safe remains to be determined.
We Are Getting Fatter - But Are Our Cath Labs Ready?
A steady increase in weight was found over the past 13 years, a trend that is projected to continue. Cath labs will need to be properly accommodate this super-sized trend. Weight limitations will need to expand beyond 400-450 lbs and x-ray generators capable of higher than 100KW outputs will be required. With increased radiation dose (often 3-4 times that of a normal BMI) and repeat procedures now the norm to treat progressive CAD, the cumulative radiation exposure greatly increases risk of malignancy for this population. In addition, increasing occupational exposure to Cardiologists and staff from scatter radiation may reduce the numbers of patients able to be treated.
Lipoprotein-Associated Phospholipase A2 Is Especially Predictive of Coronary Artery Disease Among Patients with the Metabolic Syndrome
Predictive ability of LpPLA2 for CAD was enhanced in patients with MS and remained predictive of future CAD death as well. These findings emphasize the important role that vascular inflammation plays in atherosclerotic risk associated with the metabolic syndrome.
Percutaneous Coronary Intervention: It is Safe for Women as Long as They Receive the Right Medications
In a large, consecutive, series of patients treated with percutaneous coronary intervention, risks were similar at 30 days and 5 years for women and men. Women were found to be just as likely to receive appropriate secondary prevention medications at discharge and received just as much clinical benefit as men. Thus, women can undergo percutaneous coronary intervention in the current technology era with similar safety as men as long as they are given appropriate secondary prevention medications after.
Risk Scores Combining the Complete Blood Count and Basic Metabolic Profile are Highly Predictive of Death in Both Independent Training and Test Populations
In large 2 large populations, risk scores combining statistically weighted complete blood count (CBC) and basic metabolic panel (BMP) components were highly predictive of death. We propose these scores as important additions to risk prediction that can be easily computed in a clinical laboratory for use in improving patient care at negligible incremental cost.