Publications by authors named "Jennifer A Rymer"
The impact of intravascular imaging on percutaneous coronary intervention outcomes in acute myocardial infarction: a systematic review and meta-analysis.
Coron Artery Dis
July 2025
Background: Intravascular imaging (IVI) facilitates optimal outcomes in percutaneous coronary intervention (PCI). Focused data on the impact of IVI on outcomes of PCI in acute myocardial infarction (AMI), in particular, are scarce.
Methods: A systematic search of the PubMed, EMBASE, Medline, and Cochrane databases was conducted from their inception to 1 December 2024 for studies comparing IVI to coronary angiography alone to guide PCI in AMI.
Background And Aims: Radial access site for percutaneous coronary intervention (PCI) is recommended by clinical practice guidelines because of superior outcomes compared with femoral access site. Historically, the adoption of radial access site in the USA has lagged behind much of the rest of the world, but contemporary data on access site selection across the spectrum of clinical presentations and its association with outcomes are lacking.
Methods: A retrospective cohort study from the National Cardiovascular Data Registry's CathPCI Registry was conducted including PCIs performed between 1 January 2013 and 30 June 2022.
Background: Patients with both peripheral artery disease (PAD) and coronary artery disease are at heightened risk for adverse cardiovascular outcomes. Although long-term risk has been well documented, contemporary in-hospital outcomes for patients with PAD presenting with acute myocardial infarction (AMI) are less well characterized.
Methods: We analyzed 493 740 AMI hospitalizations from 670 US sites in the NCDR (National Cardiovascular Data Registry) Chest Pain-MI Registry between January 2019 and March 2023.
Ethical Considerations for Informed Consent in Acute Myocardial Infarction Clinical Trials.
Circ Cardiovasc Interv
July 2025
Obtaining informed consent for clinical trial participation in acute myocardial infarction presents unique ethical and logistical challenges because of the patient distress, sedation, and the urgency of treatment. Traditional consent procedures often conflict with the narrow enrollment windows, prompting the use of legally authorized representatives and short- and long-form consent models. Although these approaches enable faster trial enrollment, they may compromise patient autonomy, introduce selection bias, or create postenrollment ethical dilemmas.
View Article and Find Full Text PDFFemoropopliteal Endovascular Intervention: A Review of the Current Landscape.
Circ Cardiovasc Interv
May 2025
Superficial femoral artery disease poses significant challenges in patients with peripheral artery disease due to its unique anatomic and physiological characteristics. While conservative measures remain the initial approach for chronic, stable symptoms, endovascular therapies have gained prominence due to their minimally invasive nature, expedited recovery times, and preservation of future treatment options when performed correctly. Options for endovascular interventions include balloon angioplasty (percutaneous transluminal angioplasty [standard], drug-coated balloon), stenting (bare metal, drug-eluting, covered stents), with or without adjunct therapy (atherectomy or intravascular lithotripsy).
View Article and Find Full Text PDFVascular access requires a deliberate and thoughtful approach. Optimal femoral access involves understanding anatomic, fluoroscopic, and ultrasound principles. Combining all 3 approaches optimizes femoral access and minimizes complications, with ultrasound guidance showing the most promising results for procedural success and safety.
View Article and Find Full Text PDFSex differences in in-hospital outcomes and readmission rates after percutaneous coronary intervention.
Proc (Bayl Univ Med Cent)
January 2025
Background: Previous studies have reported worse outcomes in women following percutaneous coronary intervention (PCI), but contemporary studies examining sex differences in in-hospital outcomes and 90-day readmission risk are lacking. Therefore, we sought to compare 90-day readmission rates and in-hospital adverse outcomes after PCI.
Methods: We used the United States National Readmissions Database to stratify all inpatient PCIs from 2017 to 2018 by sex.
Background: Chronic limb-threatening ischemia (CLTI) in patients with chronic kidney disease (CKD) has a high risk of poor outcomes. We aimed to compare the outcomes of lower extremity revascularization in patients with CLTI stratified by CKD severity in patients enrolled in the prospective, randomized Best Endovascular vs Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial.
Methods: The BEST-CLI trial dataset was queried to categorize patients into three groups according to CKD stage.
Article Synopsis
- The study examines the use and outcomes of P2Y inhibitor pretreatment in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the U.S. from 2013 to 2023.
- P2Y inhibitor pretreatment rates decreased significantly from 24.8% to 12.4% over the study period, with only 15.9% in a recent cohort showing such treatment.
- There was notable variability in pretreatment rates among different operators and institutions, with no significant difference in in-hospital mortality between those who received pretreatment and those who did not.
Dual Antiplatelet and Anticoagulation Regimens for Women Undergoing Percutaneous Coronary Intervention.
Interv Cardiol Clin
January 2025
Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention is necessary for preventing stent thrombosis and ensuring long-term cardiovascular protection. It is important to be thoughtful in balancing thrombotic and bleeding risk when deciding therapy regimen and duration. Revascularization randomized trials have studied many specific, at-risk populations; however, women remain underrepresented.
View Article and Find Full Text PDFBackground: Older adults with non-ST-segment-elevation acute coronary syndrome are less likely to undergo an invasive strategy compared with younger patients. Randomized controlled trials traditionally exclude older adults because of their high burden of geriatric conditions.
Methods And Results: We searched for randomized controlled trials comparing invasive versus medical management or a selective invasive (conservative) strategy for older patients (age≥75 years) with non-ST-segment-elevation acute coronary syndrome.
Article Synopsis
- Patients with heart failure (HF) and coronary artery disease (CAD) are at a higher risk of dying than those with HF from other causes.
- Revascularization can help patients with CAD-related symptoms, like a recent heart attack or severe chest pain that isn't relieved by medication.
- For patients whose main issues are related to heart failure, like shortness of breath without a heart attack, the advantages of revascularization are not as clear; the review proposes a guide for diagnosis and treatment.
Use of Calcium Modification During Percutaneous Coronary Intervention After Introduction of Coronary Intravascular Lithotripsy.
J Soc Cardiovasc Angiogr Interv
February 2024
Article Synopsis
- Calcified coronary lesions pose difficulties for percutaneous coronary interventions (PCIs), and coronary intravascular lithotripsy (IVL), approved in February 2021, offers a new approach but its adoption in the U.S. is not well understood.
- Among 2.7 million PCIs analyzed, 11.4% utilized calcium modification, with IVL usage increasing from 0% in late 2020 to 7.8% by late 2022, while coronary atherectomy slightly decreased.
- Significant variation in IVL use was observed across hospitals, with the treating hospital being the main factor influencing both calcium modification and IVL adoption in 2022.
SCAI Expert Consensus Statement on the Management of Calcified Coronary Lesions.
J Soc Cardiovasc Angiogr Interv
February 2024
The prevalence of calcification in obstructive coronary artery disease is on the rise. Percutaneous coronary intervention of these calcified lesions is associated with increased short-term and long-term risks. To optimize percutaneous coronary intervention results, there is an expanding array of treatment modalities geared toward calcium modification prior to stent implantation.
View Article and Find Full Text PDFArticle Synopsis
- Elevated levels of interleukin-6 (IL-6) are linked to worse health outcomes, including higher mortality rates and heart failure, in patients regardless of existing cardiovascular disease (CVD).
- This study analyzed data from the Multi-Ethnic Study of Atherosclerosis (MESA) to explore the relationship between IL-6 levels and various health outcomes across different racial and ethnic groups, finding that those in the highest IL-6 category faced significantly greater risks.
- The findings indicate that high IL-6 levels are consistently associated with increased all-cause and cardiovascular mortality, as well as heart failure, impacting individuals across diverse racial and ethnic backgrounds.
Article Synopsis
- The study investigates how different data sources (like electronic health records, insurance claims, and participant reports) contribute to analyzing clinical outcomes in a pragmatic randomized clinical trial (RCT) involving patients with atherosclerotic cardiovascular disease.
- Conducted from April 2016 to June 2019, the ADAPTABLE study looked at the effects of daily aspirin doses on certain health events, while comparing participant data availability to enhance understanding of outcome rates.
- The findings revealed a predominance of participant-reported and EHR data, with only a small percentage relying solely on claims data, indicating the need for further study on the varying contributions of each data source to overall clinical results.
Article Synopsis
- This study investigates the differences in procedural characteristics, patient outcomes, and case volumes between early-career and non-early-career interventional cardiologists in the U.S. from April 2018 to June 2022.
- Data from various medical databases revealed that early-career operators treated more critically ill patients, such as those with ST-segment myocardial infarction, despite having similar annual case volumes compared to their more experienced counterparts.
- The findings indicate that early-career cardiologists face higher predicted risks for mortality and bleeding in their patients, with statistical adjustments confirming a significant association between early-career status and increased risks.
Article Synopsis
- This study focuses on the risk of late ventricular tachycardia (VT) and ventricular fibrillation (VF) in patients who have undergone primary percutaneous coronary intervention (PCI) for STEMI, noting that while mortality risk is low, incidents of VT and VF may occur post-procedure.
- Researchers analyzed data from 174,126 patients treated with primary PCI between 2015 and 2018, discovering that 8.9% experienced VT or VF, with 2.4% specifically having late VT or VF occurring after the procedure.
- The study identified demographic data showing a median age of 63 for patients with late VT or VF, and the findings highlight