Coronary Artery Disease

Lead: Dr Roby Rakhit

Group Members: Dr Gerry Coghlan, Dr Tim Lockie, Dr Niket Patel, Dr Sundeep Kalra, Dr Dan Knight, Dr Tushar Kotecha, Dr Marianna Fontana, Angelique Smit, Jacolene Crause (clinical research nurses)

Location: Royal Free Hospital

Overview: The Royal Free is one of London`s dedicated heart attack centres and has a large and dynamic clinical programme (>1400 PCI pa) with expertise in intracoronary imaging (IVUS, OCT, photoacoustics) and coronary physiology. The interventional cardiology research theme includes cohort studies (registries, BCIS, NICOR), clinical trials, commercial and investigator-led studies. The group has a particular interest in platelet activation, inflammation in coronary artery disease and microparticle biology. The programme incorporates coronary physiology, intracoronary imaging (OCT), coronary CT and a strong translational research link with the Institute of Child Health. The group is developing novel perfusion imaging maps to detect myocardial ischaemia in conjunction with the cardiac MRI department. The second area of interest is the phenotyping and risk assessment of coronary artery disease in high risk individuals eg Diabetics, HIV, familial hyperlipidaemia and coronary artery ectasia. Local collaborations include the Hatter Institute (UCL), Clinical Biochemistry (RFH & UCLH), The National Amyloid Centre and cardiac MRI, Institute of Child Health, Barts Heart Centre, Royal Brompton and Harefield Hospital, St. Thomas` hospital and University of Leicester. There is an international link with Erasmus University, Rotterdam for intra-coronary imaging.

Highlights:

Initial Experience of a Second-Generation Self-Expanding Transcatheter Aortic Valve: The UK & Ireland Evolut R Implanters' Registry. Kalra SS, Firoozi S, Yeh J, Blackman DJ, Rashid S, Davies S, Moat N, Dalby M, Kabir T, Khogali SS, Anderson RA, Groves PH, Mylotte D, Hildick-Smith D, Rampat R, Kovac J, Gunarathne A, Laborde JC, Brecker SJ. JACC Cardiovasc Interv. 2017 Feb 13;10(3):276-282. doi: 10.1016/j.jcin.2016.11.025

Superior long term outcome associated with native vessel versus graft vessel PCI following secondary PCI in patients with prior CABG. Mavroudis CA, Kotecha T, Chehab O, Hudson J, Rakhit RD. Int J Cardiol. 2017 Feb 1;228:563-569. doi: 10.1016/j.ijcard.2016.11.031.

Intracoronary platelet and monocyte activation status within platelet-monocyte complexes are determinants of inflammation in ST elevation myocardial infarction1. Majumder B, Koganti S, Lowdell MW, Rakhit RD. Clin Hemorheol Microcirc. 2016 Nov 4;64(1):35-46. 

Zero-Flow Pressure Measured Immediately After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Provides the Best Invasive Index for Predicting the Extent of Myocardial Infarction at 6 Months: An OxAMI Study (Oxford Acute Myocardial Infarction). Patel N, Petraco R, Dall'Armellina E, Kassimis G, De Maria GL, Dawkins S, Lee R, Prendergast BD, Choudhury RP, Forfar JC, Channon KM, Davies J, Banning AP, Kharbanda RK. JACC Cardiovasc Interv. 2015 Sep;8(11):1410-21. doi: 10.1016/j.jcin.2015.04.029.

Synergistic adaptations to exercise in the systemic and coronary circulations that underlie the warm-up angina phenomenon. Lockie TP, Rolandi MC, Guilcher A, Perera D, De Silva K, Williams R, Asrress KN, Patel K, Plein S, Chowienczyk P, Siebes M, Redwood SR, Marber MS. Circulation. 2012 Nov 27;126(22):2565-74. doi: 10.1161/CIRCULATIONAHA.112.094292

Contact details: Angelique Smit (angelique.smit@nhs.net)