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Dive into the research topics where Tony Hong is active.

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Featured researches published by Tony Hong.


Circulation-cardiovascular Interventions | 2011

Characterization of Operator Learning Curve for Transradial Coronary Interventions

Warren Ball; Waseem Sharieff; Sanjit S. Jolly; Tony Hong; Michael Kutryk; John J. Graham; Neil Fam; Robert J. Chisholm; Asim N. Cheema

Background—Transradial percutaneous coronary intervention (TR-PCI) improves clinical outcomes compared to the transfemoral (TF) approach. However, inadequate training and experience has limited widespread adoption by interventional cardiologists. Methods and Results—Clinical and procedural characteristics for TR-PCI were prospectively collected from 1999 to 2008. To identify minimum case volume for optimum clinical benefit, single-vessel TR-PCI cases were chronologically ranked and stratified into 1 to 50, 51 to 100, 101 to 150 and 151 to 300 case volume groups for operators starting the TR approach at the study institution. Cases by operators with a >300 TR-PCI case volume comprised the control group. TR-PCI failure rates, contrast use, guide usage, and fluoroscopy time were compared among groups. A total of 1672 patients underwent TR-PCI by 28 operators. TR-PCI failure occurred in 4% and was higher in the 1 to 50 case volume group compared to the 51 to 100 (P=0.007) and control (P=0.01) groups. Contrast use was greater in the 1 to 50 group (180±79 mL) compared to the 151 to 300 (157±75 mL, P=0.02) and control (168±79 mL, P=0.05) groups. Fluoroscopy time was higher in the 1 to 50 group (15±10 minutes) compared to the 101 to 150 (13±10 minutes, P=0.04) and control (12±9 minutes, P=0.02) groups. Reasons for TR-PCI failure included spasm (38%), subclavian tortuousity (16%), poor guide support (16%), failed access (10%), and radial loop (7%). Case volume was significantly correlated with TR-PCI failure (&bgr;=−0.0076, P=0.0028), and odds of failure was reduced by 32% for each 50 increments in case volume. Conclusions—TR-PCI success depends on operator experience, and a case volume of ≥50 cases is required to achieve outcomes comparable to experienced operators. These findings have implications both for PCI operators looking to expand their skills and for defining standards for training.


Jacc-cardiovascular Interventions | 2009

Mechanism and Predictors of Failed Transradial Approach for Percutaneous Coronary Interventions

Payam Dehghani; Atif Mohammad; Ravi Bajaj; Tony Hong; Colin M. Suen; Waseem Sharieff; Robert J. Chisholm; Michael Kutryk; Neil Fam; Asim N. Cheema

OBJECTIVES The study aimed to determine the mechanism and predictors of procedural failure in patients undergoing percutaneous coronary intervention (PCI) from the transradial approach (TR). BACKGROUND Transradial approach PCI reduces vascular complications compared with a transfemoral approach (TF). However, the mechanism and predictors of TR-PCI failure have not been well-characterized. METHODS The study population consisted of patients undergoing TR-PCI by low-to-intermediate volume operators with traditional TF guide catheters. Baseline characteristics, procedure details, and clinical outcomes were prospectively collected. Univariate and multivariate analyses were performed to determine independent predictors of TR-PCI failure. RESULTS A total of 2,100 patients underwent TR-PCI and represented 38% of PCI volume. Mean age was 64 +/- 12 years, and 17% were female. Vascular complications occurred in 22 (1%), and TR-PCI failure was observed in 98 (4.7%) patients. The mechanism of TR-PCI failure included inability to advance guide catheter to ascending aorta in 50 (51%), inadequate guide catheter support in 35 (36%), and unsuccessful radial artery puncture in 13 (13%) patients. The PCI was successful in 94 (96%) patients with TR-PCI failure by switching to TF. On multivariate analysis, age >75 years (odds ratio [OR]: 3.86; 95% confidence interval [CI]: 2.33 to 6.40, p = 0.0006), prior coronary artery bypass graft surgery (OR: 7.47; 95% CI: 3.45 to 16.19, p = 0.0002), and height (OR: 0.97; 95% CI: 0.95 to 0.99, p = 0.02) were independent predictors of TR-PCI failure. CONCLUSIONS Transradial approach PCI can be performed by low-to-intermediate volume operators with standard equipment with a low failure rate. Age >75 years, prior coronary artery bypass graft surgery, and short stature are independent predictors of TR-PCI failure. Appropriate patient selection and careful risk assessment are needed to maximize benefits offered by TR-PCI.


Catheterization and Cardiovascular Interventions | 2007

Comparison of radial versus femoral approach for percutaneous coronary interventions in octogenarians.

Ronen Jaffe; Tony Hong; Waseem Sharieff; Robert J. Chisholm; Michael Kutryk; Thierry Charron; Asim N. Cheema

Background: The safety and efficacy of a radial approach for percutaneous coronary intervention (PCI) in octogenarians is not well established. Methods: To evaluate the benefits of a radial approach for preventing vascular complications after PCI, clinical, procedural, and outcome data were prospectively collected and compared for 228 octogenarians undergoing elective PCI either through a radial or a femoral approach. Results: Radial approach was associated with longer cannulation (3.1 ± 2.9 vs. 2.0 ± 2.0 min, P < 0.001) and fluoroscopy times (19.3 ± 16.1 vs. 16.1 ± 11.8 min, P = 0.04), greater utilization of contrast media (224 ± 46 vs. 182 ± 20 ml, P < 0.001) and higher crossover rate (11 vs 4%, P = 0.03) to alternate access site compared with the femoral approach. However, ambulation time (5.2 ± 3.1 vs. 11.6 ± 6.3 hr, P < 0.001), access site bleeding (4 vs. 14%, P = 0.007), hematoma (1 vs. 11%, P = 0.001) or any vascular complication (5 vs 26%, P = 0.001) were significantly reduced with a radial approach. Procedural success rates were equivalent with both approaches. Multivariate regression analysis identified radial approach (OR = 0.23; CI = 0.08, 0.65) as an independent negative predictor of postprocedural vascular complications. Conclusion: Radial approach for PCI in octogenarians is technically challenging for the operator and exposes patients to greater volume of nephrotoxic contrast media. However, it results in early ambulation and significantly reduces vascular complications in this high risk population. These findings support a strategy of preprocedural risk assessment and use of radial approach for PCI in a select group of octogenarians to maximize benefits offered by this technique.


Journal of the American College of Cardiology | 2011

Characterization of clopidogrel hypersensitivity reactions and management with oral steroids without clopidogrel discontinuation.

Asim N. Cheema; Atif Mohammad; Tony Hong; Henry R. Jakubovic; Gurpreet S. Parmar; Waseem Sharieff; M. Bernadette Garvey; Michael Kutryk; Neil Fam; John J. Graham; Robert J. Chisholm

OBJECTIVES The purpose of this study was to characterize clopidogrel hypersensitivity and describe its successful management with oral steroids without clopidogrel discontinuation. BACKGROUND Hypersensitivity reactions to clopidogrel are poorly understood and present difficulty in management. METHODS Patients diagnosed with clopidogrel hypersensitivity after percutaneous coronary intervention underwent evaluation and received oral prednisone without clopidogrel discontinuation. Cutaneous testing was performed after completion of clopidogrel therapy for diagnosis and assessment of cross-reactivity. RESULTS Sixty-two patients representing 1.6% of the percutaneous coronary intervention population developed clopidogrel hypersensitivity during the study period. The mean age was 62 ± 11 years, 71% of patients were male, and 35% reported prior adverse drug reaction. Clopidogrel hypersensitivity manifested as generalized exanthema in 79%, localized skin reaction in 16%, and angioedema or urticaria in 5% of patients. Biopsy of affected areas demonstrated a lymphocyte-mediated delayed hypersensitivity reaction. Complete resolution of hypersensitivity reaction was observed in 61 patients (98%) with a short course of oral prednisone. Cutaneous testing confirmed delayed hypersensitivity reaction to clopidogrel in 34 (81%) and immediate hypersensitivity in 3 of 42 patients (7%) tested. Allergenic cross-reactivity was observed for ticlopidine in 10 (24%), prasugrel in 7 (17%), and both ticlopidine and prasugrel in 3 patients (7%). Histological examination showed lymphocyte-mediated hypersensitivity in abnormal patch test areas. CONCLUSIONS Clopidogrel hypersensitivity is manifested as generalized exanthema and is caused by a lymphocyte-mediated delayed hypersensitivity in most patients. This can be managed with oral steroids without clopidogrel discontinuation. Allergenic cross-reactivity with ticlopidine, prasugrel, or both is present in a significant number of patients with clopidogrel hypersensitivity.


Journal of the American College of Cardiology | 2006

Adventitial Microvessel Formation After Coronary Stenting and the Effects of SU11218, a Tyrosine Kinase Inhibitor

Asim N. Cheema; Tony Hong; Nafiseh Nili; Amit Segev; John G. Moffat; Kenneth E. Lipson; Anthony R. Howlett; David W. Holdsworth; Michael J. Cole; Beiping Qiang; Frank D. Kolodgie; Renu Virmani; Duncan J. Stewart; Bradley H. Strauss


Clinical Cardiology | 2007

Intraluminal filling defects on coronary angiography: more than meets the eye.

Ronen Jaffe; Affan Irfan; Tony Hong; Robert J. Chisholm; Asim N. Cheema


International Journal of Cardiology | 2007

Buddy wire technique for stent placement at non-aorto ostial coronary lesions

Asim N. Cheema; Tony Hong


Journal of Invasive Cardiology | 2010

Efficacy and long-term safety of StarClose™ for hemostasis of arterial puncture sites distal to common femoral artery bifurcation after percutaneous coronary interventions.

Payam Dehghani; Atif Mohammad; Danny Marcuzzi; Tony Hong; Kate Holmes; Melma Jean S. Evangelista; Adrien Boutin; Howard Leong-Poi; Asim N. Cheema


Journal of Invasive Cardiology | 2010

Comparison of abciximab and eptifibatide on angiographic and clinical outcomes in rescue percutaneous coronary intervention for failed fibrinolytic therapy.

Ravi R. Bajaj; Atif Mohammad; Tony Hong; Affan Irfan; Waseem Sharieff; Alan Bagnall; Jo-Ann Christie; Michael Kutryk; Robert J. Chisholm; Asim N. Cheema


Journal of the American College of Cardiology | 2010

EFFICACY AND LONG TERM SAFETY OF STARCLOSE™, AN EXTRA LUMINAL CLIP VASCULAR CLOSURE SYSTEM, FOR HEMOSTASIS OF ARTERIAL PUNCTURES DISTAL TO COMMON FEMORAL ARTERY BIFURCATION AFTER PERCUTANEOUS CORONARY INTERVENTIONS

Payam Dehghani; Atif Mohammad; Daniel Marcuzzi; Tony Hong; Melma Jean S. Evangelista; Howard Leong-Poi; Asim N. Cheema

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Neil Fam

St. Michael's Hospital

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Atif Mohammad

University of Texas Southwestern Medical Center

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Affan Irfan

St. Michael's Hospital

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Atif Mohammad

University of Texas Southwestern Medical Center

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