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Faculty member's research leads to changes in guidelines
timir paul

JOHNSON CITY (Oct. 9, 2018) – The work of an East Tennessee State University faculty member has resulted in changes to specific cardiology procedure guidelines.

Dr. Timir Paul, director of cardiovascular research and associate professor in ETSU’s Quillen College of Medicine, helped create the new guidelines on myocardial revascularization – a procedure to open blocked heart arteries for patients with ischemic heart disease – after researching various outcomes of the intervention.

It has long been believed that the use of a specific device, known as an embolic protection device, during such cardiac procedures reduces complications. Through his research, however, Paul discovered this may not always be the case.

“My analysis indicates that the device does not provide a benefit in the contemporary interventional era and may even increase the risk of periprocedural myocardial infarction, which is the most common complication associated with the procedure,” Paul explained. “Contrary to the expected benefit of the use of embolic protection device, it was associated with several procedural complications including a 1.5-fold higher periprocedural myocardial infarction compared with no device.”

Paul and his team identified nearly 53,000 patients who had undergone the procedure and found no significant differences between those whose procedures were conducted with the device and those whose procedures did not include the use of the device.

Their work concluded that further trials are needed to evaluate long-term outcomes with routine use of the devices, but emphasized the need for a revision to the guideline recommendations related to device usage for the procedures until such trials are conducted. 

The findings resulted in an updating of the 2018 European Society of Cardiology guidelines on myocardial revascularization to change recommendations suggesting the device is “reasonable to use.” instead of “should be used” for all comers.

 The new guidelines recently were published in the European Heart journal, and Paul’s study was published in Circulation Cardiovascular Interventions.

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