• Complete Versus Culprit only Revascularisation in Patients with Cardiogenic Shock Complicating Acute Myocardial Infarction: Incidence and Outcomes from the London Heart Attack Group

      Rathod, Krishnaraj S.; Koganti, Sudheer; Jain, Ajay K.; Rakhit, Roby; Dalby, Miles C.; Lockie, Tim; Kalra, Sandeep; Malik, Iqbal S.; Knight, Charles; Whitbread, Mark; et al. (2020-03)
    • Contemporary trends in cardiogenic shock: Incidence, intra-aortic balloon pump utilisation and outcomes from the London Heart Attack Group

      Rathod, Krishnaraj S.; Koganti, Sudheer; Iqbal, M. Bilal; Jain, Ajay K.; Kalra, Sundeep S.; Astroulakis, Zoe; Lim, Pitt; Rakhit, Roby D.; Dalby, Miles C.; Lockie, Tim; et al. (2018-02)
    • Impact of Early (≤24 H) Versus Delayed (>24 H) Intervention in Patients With non-ST Segment Elevation Myocardial Infarction: An Observational Study of 20,882 Patients From the London Heart Attack Group

      Panoulas, Vasileios; Rathod, Krishnaraj S.; Jain, Ajay K.; Firoozi, Sam; Nevett, Joanne; Kalra, Sundeep Singh; Malik, Iqbal S.; Mathur, Anthony; Redwood, Simon; MacCarthy, Philip A.; et al. (2020-06-03)
    • Manual thrombus aspiration is not associated with reduced mortality in patients treated with primary percutaneous coronary intervention: an observational study of 10,929 patients with St-segment elevation myocardial infarction from the London heart attack group.

      Jones, Daniel A.; Rathod, Krishnaraj S.; Gallagher, Sean; Jain, Ajay K.; Kalra, Sundeep Singh; Lim, Pitt; Crake, Tom; Ozkor, Mick; Rakhit, Roby; Knight, Charles; et al. (2015-04)
    • Mechanical thrombectomy use is associated with decreased mortality in patients treated with primary percutaneous coronary intervention (9935 patients from the London Heart Attack Group)

      Modi, B.N.; Jones, Daniel A.; Rathod, Krishnaraj S.; Akhtar, M.M.; Jain, Ajay K.; Singh Kalra, S.; Crake, Tom; Meier, Pascal; Astroulakis, Zoe; Dollery, C.; et al. (2013-05)
      Introduction During Primary Percutaneous Coronary Intervention (PPCI) post ST-Segment Myocardial Infarction (STEMI), distal embolisation of thrombus may lead to failure to re-establish normal flow in the infarct-related artery. Manual thrombus aspiration has been shown to improve coronary perfusion as assessed by time to ST-segment resolution and myocardial blush grade. Evidence supporting the benefit of thrombus aspiration on clinical outcomes, however, is limited and inconsistent. We aimed to assess the impact of manual thrombectomy on mortality in patients presenting with STEMI across all PPCI centres in London over a 5 year period from 2007 until 2012. Methods This was an observational cohort study of 9935 consecutive patients with STEMI treated with PPCI between 2007 and 2012 at eight tertiary cardiac centres across London, UK. Patient's details were recorded at the time of the procedure into the British Cardiac Intervention Society (BCIS) database. Outcome was assessed by all-cause mortality. Anonymous datasets from the eight centres were merged for analysis. The primary end-point was all-cause mortality at a median follow-up of 2.0 years (IQR range 1.1 –3.1 years). Results Of the 9935 consecutive STEMI patients presenting for PPCI, 2859 had mechanical thrombectomy. Patients who had manual thrombectomy were significantly younger (average age 60.6 vs 62.9) and were less likely to have had a previous myocardial infarction (11.9% of thrombectomy patients vs 14.7% of nonthrombectomy patients). Patients receiving manual thromectomy were found to be significantly more likely to have had PPCI via a radial approach (33.1% in thrombectomy patients vs 19.9% in nonthromectomy patients). Procedural success (defined as TIMI 3 flow at the end of procedure) was found to be significantly more likely in patients receiving manual thrombectomy (89.5% vs 86.7%) (table 1). Patients with thrombectomy use had similar unadjusted all-cause mortality rates to those without thrombectomy use (12.7% vs 16.5%, p=NS) during the 5-year follow-up period (figure 1). After multivariable adjustment thrombectomy use was associated with significantly decreased mortality rates (HR: 0.82, 95% CI 0.68 to 0.9, p=0.04). Conclusion Mechanical thrombectomy use appears to be associated with improved outcome, in the form of decreased mortality, in this large observational trial. https://heart.bmj.com/content/heartjnl/99/suppl_2/A32.2.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/heartjnl-2013-304019.46
    • Out-of-hours primary percutaneous coronary intervention for ST-elevation myocardial infarction is not associated with excess mortality: a study of 3347 patients treated in an integrated cardiac network

      Rathod, Krishnaraj S.; Jones, Daniel A.; Gallagher, Sean M.; Bromage, Dan; Whitbread, Mark; Archbold, Andrew; Jain, Ajay K.; Mathur, Anthony; Wragg, Andrew; Knight, Charles (2013-06)
      OBJECTIVES: Timely delivery of primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST-segment elevation myocardial infarction (STEMI). Optimum delivery of PPCI requires an integrated network of hospitals, following a multidisciplinary, consultant-led, protocol-driven approach. We investigated whether such a strategy was effective in providing equally effective in-hospital and long-term outcomes for STEMI patients treated by PPCI within normal working hours compared with those treated out-of-hours (OOHs). DESIGN: Observational study. SETTING: Large PPCI centre in London. PARTICIPANTS: 3347 STEMI patients were treated with PPCI between 2004 and 2012. The follow-up median was 3.3 years (IQR: 1.2-4.6 years). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint was long-term major adverse cardiac events (MACE) with all-cause mortality a secondary endpoint. RESULTS: Of the 3347 STEMI patients, 1299 patients (38.8%) underwent PPCI during a weekday between 08:00 and 18:00 (routine-hours group) and 2048 (61.2%) underwent PPCI on a weekday between 18:00 and 08:00 or a weekend (OOHs group). There were no differences in baseline characteristics between the two groups with comparable door-to-balloon times (in-hours (IHs) 67.8 min vs OOHs 69.6 min, p=0.709), call-to-balloon times (IHs 116.63 vs OOHs 127.15 min, p=0.60) and procedural success. In hospital mortality rates were comparable between the two groups (IHs 3.6% vs OOHs 3.2%) with timing of presentation not predictive of outcome (HR 1.25 (95% CI 0.74 to 2.11). Over the follow-up period there were no significant differences in rates of mortality (IHs 7.4% vs OFHs 7.2%, p=0.442) or MACE (IHs 15.4% vs OFHs 14.1%, p=0.192) between the two groups. After adjustment for confounding variables using multivariate analysis, timing of presentation was not an independent predictor of mortality (HR 1.04 95% CI 0.78 to 1.39). CONCLUSIONS: This large registry study demonstrates that the delivery of PPCI with a multidisciplinary, consultant-led, protocol-driven approach provides safe and effective treatment for patients regardless of the time of presentation. https://bmjopen.bmj.com/content/bmjopen/3/6/e003063.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2013-003063
    • Outcome of inter-hospital transfer versus direct admission for primary percutaneous coronary intervention: An observational study of 25,315 patients with ST-elevation myocardial infarction from the London Heart Attack Group

      Rathod, Krishnaraj S.; Jain, Ajay K.; Firoozi, Sam; Lim, Pitt; Boyle, Richard; Nevett, Joanne; Dalby, Miles C.; Kalra, Sundeep S.; Malik, Iqbal S.; Sirker, Alexander; et al. (2020-03-20)