Center for Interventional Cardiology
Research Opportunities


Research Activities:

Coronary Physiology:
Habib Samady, MD and Michael Ragosta, MD

Present studies are investigating the effects of medical conditions such as diabetes mellitus, left ventricular hypertrophy, and myocardial infarction on the epicardial arteries and coronary microcirculation, using intracoronary pressure and doppler wires. We are also studying the incremental value of fractional flow reserve (FFR) over coronary angiography for assessment of moderate coronary lesions and investigating the value of FFR measurements for functional assessment of coronary stenoses in patients with prior myocardial infarction or left ventricular hypertrophy. Close collaboration has been established with the echocardiography (myocardial contrast echo), nuclear cardiology, and magnetic resonance imaging groups for conducting these studies.

Myocardial Viability:
Habib Samady, MD and Michael Ragosta, MD

Our laboratory has an interest in the assessment of myocardial viability in the cardiac catheterization laboratory. Ongoing research studies include: electromechanical mapping for "on-line" assessment of myocardial viability in ischemic cardiomyopathy; fractional flow reserve and nuclear scintigraphy for the assessment of residual myocardial viability early after acute myocardial infarction; and the impact of intravenous adenosine on myocardial salvage after acute ST elevation myocardial infarction. These investigations are conducted in close collaboration with nuclear cardiology, myocardial contrast echocardiography, and magnetic resonance imaging, and are being funded by industry grants.

Optimal Deployment of Intracoronary Stents and Instent Restenosis:
Habib Samady, MD and Michael Ragosta, MD

The use of intravascular ultrasound and fractional flow reserve to guide optimal stent deployment is being investigated. Furthermore, the mechanisms behind less than optimal stent deployment are being explored, with a view to designing therapeutic strategies to achieve optimal stent deployment. Investigation of optimal strategies to treat in-stent restenosis are being sought. These include conventional techniques such as balloon angioplasty, repeat stenting, rotational atherectomy, as well as novel techniques such as intravascular brachytherapy and coated stents.

Heart Outcomes Project:
Michael Ragosta, MD and Lawrence Gimple, MD

A prospective data base for collection of information at the point of care has been pioneered using the CAOS system (Clinically Automated Office Solutions). Comprehensive data collection including 1) pre-catheterization history and physical examination data; 2) details of medications, equipment utilized, and vital signs in the cath lab; 3) findings (hemodynamic and angiographic), including complications during heart catheterization and percutaneous intervention; 4) discharge medications; 5) echocardiography data; 6) early and late clinical outcomes. The accuracy of data entry is being monitored by regular audits. A number of outcomes based projects are therefore currently being designed. Funding from industry supports these initiatives.

Opportunities exist for Cardiology fellows to be involved in one or more of these clinical research projects, either during their clinical cardiology fellowship or dedicated time during the interventional cardiology fellowship. Funding is available through grants from the Society of Cardiac Angiography and Interventions and through industry support.

Multicenter Clinical Trials:
Ian Sarembock, MD, and Lawrence Gimple, MD

We have participated in numerous multicenter clinical trials over the past 5 years, including pharmacologic strategies and new devices. This endeavor is supported by a robust infrastructure of 3 highly skilled Research Nurses. The opportunity exists for fellows to play and important role in the recruiting of patients and participation in ancillary studies. Examples of trials over the past 5 years include:

1996-1998:

  • EPILOG/STENT: A multicenter, randomized trial evaluating 30-day and 6-month clinical outcomes with three different treatment strategies in patients undergoing percutaneous coronary intervention.
  • PURSUIT: A randomized, double-blind evaluation of the efficacy and safety of two dosing regimens of Integrelin versus placebo for reducing mortality and myocardial (Re) infarction in patients with unstable angina or Non-Q Wave Myocardial Infarction.
  • PAS: Paragon Elective or Acute Stenting Trial. evaluation of a new stent design.
  • OPUS-TIMI 16: A phase III international randomized, double blind, placebo controlled trial evaluating the efficacy and safety of Orbofiban in patients with unstable coronary syndromes.
  • PTMR: Phase II study of the safety and effectiveness of percutaneous transluminal myocardial revascularization in
    patients with class III and IV angina.
  • VEGF: A phase II, double blind, placebo controlled study to assess the effect of intracoronary and multiple
    intravenous administration of rhVEGF on exercise tolerance in adults with viable but underperfused myocardium.
  • OTIS: Optimal Treatment for In-Stent Restenosis. University of Virginia based clinical study to assess outcomes in
    three different treatment groups for patients with In-Stent Restenosis.
  • DISTINCT: Biocompatibles BiodivYsio Stent in Randomized Control Trial.

1999-2000:

  • OAT: Open Artery Trial
  • ACUTE II: A Randomized, Parallel, Double-Blind, Safety Study of Enoxaparin Versus Unfractionated Heparin in Tirofiban and Aspirin Treated patients With Unstable Angina/Non-Q-Wave Myocardial Infarction.
  • ESPRIT: Enhanced Suppression of the Platelet GP IIb/IIIa Receptor with Integrilin Therapy: A Multicenter, Randomized,
    Double-Blind Placebo-Controlled Study to Assess the Efficacy and Safety of the Double-Bolus Integrilin Dosing Regimen
    in Percutaneous Coronary Intervention with Stent Implantation.
  • PRESTO: Prevention of Restenosis with Tranilast and Its Outcomes: Phase III Placebo Controlled Trial.
  • AMISTAD II: A Randomized, Double-Blind, Placebo-Controlled Multicenter Trial to Evaluate the Efficacy and Safety of Adenosine as an Adjunct to Reperfusion Therapy (Thrombolysis or Mechanical Reperfusion) in the Treatment of Acute Anterolateral Myocardial Infarction.
  • FUSION: Fractional Flow Reserve and Ultrasound Indices For Objective Narrowing Assessment.

2000-2001:

  • TARGET: Comparison of Tirofiban and Abciximab in Percutaneous Coronary Intervention
  • VESTA/GUARD Study: Use of Velocity Stent and Umbrella Protective Device in Saphenous Vein Grafts
  • REPLACE: Use of Hirulog vs Glycoprotein IIb/IIIa Inhibitors in Coronary Intervention 
     

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