First-Time Mother Receives Life-Saving Aortic Surgery

Updated on Jun 30, 2022 | Cardiology, Featured, Patient Stories

From left, Ismail El-Hamamsy, MD, PhD, Yulia Nurikyan, and Percy Boateng, MD.

A first-time mother received life-saving heart surgery at The Mount Sinai Hospital, thanks to her quick response to her symptoms and knowledge of her family’s health history, says a leader of her surgical team, Ismail El-Hamamsy, MD, PhD, Director of Aortic Surgery, Mount Sinai Health System, and first author of a recent paper on aortic dissection repair during the COVID-19 pandemic.

The patient, Yulia Nurikyan, was 38 weeks pregnant and had not been feeling well, with a backache that she thought was caused by her late-stage pregnancy. In mid-May, in the heat of the COVID-19 pandemic, she woke up at 5 am with a heavy feeling in her throat. She got out of bed for a glass of water, then fainted. Her husband, Antoan, quickly called 911, and an ambulance rushed her to Elmhurst Hospital in Queens.

Ms. Nurikyan told the medical team at Elmhurst that her father had died of an aortic dissection in his 40s, so they ordered a CT scan and other diagnostic tests, which showed that she had a bicuspid aortic valve. This was crucial information. About half of patients with this heart defect develop an aortic aneurysm, an enlargement of the vessel that can lead to aortic dissection. This is a tear in the inner layer of the aorta, the main blood vessel that brings oxygenated blood to the rest of the body. Some people with an aortic dissection feel no pain, but common symptoms are severe sudden pain in the upper back or chest, shortness of breath, and dizziness or fainting.

Ms. Nurikyan underwent an emergency C-section, delivering a baby girl, Livia. She held her daughter for a few minutes, then she was rushed to The Mount Sinai Hospital for emergency heart surgery, since the imaging tests suggested that her aorta was about to rupture, which could have proved fatal.

Yulia and Antoan Nurikyan with baby Livia.

“In cardiac surgery, this situation is at the top of the list of emergencies,” says Dr. El-Hamamsy, who treated Ms. Nurikyan as soon as she arrived. Dr. El-Hamamsy, senior faculty in Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, is an expert in the repair of aortic dissection and recently published a study that found a significant decline in reported cases during the COVID-19 crisis.

In the study, published in May in the Journal of the American College of Cardiology, researchers compiled data on surgical repair of acute Type A aortic dissection in 11 New York City hospitals from January 1, 2018, to April 15, 2020, counting March 1, 2020, as the first day of the COVID-19 pandemic in the city. The study found that these surgical repairs fell 76 percent after the COVID-19 pandemic began—from 12.8 cases per month before the pandemic to 3 cases per month after the pandemic.

The investigators presented several potential reasons for the decline, suggesting, for example, that some aortic dissection patients did not call for help, fearing COVID-19 infection; or busy first responders were delayed in providing aid; or overburdened emergency departments may have missed or delayed diagnoses. The study said, “Although no causal relationship can be firmly established among the drop in type A aortic dissections, the COVID-19 outbreak in New York City, and the increase in at-home deaths since the last week of March 2020, this gives pause for thought.”

Ms. Nurikyan experienced a Type A aortic dissection. In a successful procedure, Dr. El Hamamsy repaired her bicuspid aortic valve, removing some of the injured blood vessel and replacing it with a synthetic graft, working with David H. Adams, MD, the Marie-Josée and Henry R. Kravis Professor and Chair of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, and the Cardiac Surgeon-in-Chief of the Mount Sinai Health System, and Percy Boateng, MD, Assistant Professor of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai.

Ms. Nurikyan’s baby, Livia, had remained at Elmhurst, placed in neonatal intensive care because of fluid in her lungs. Ms. Nurikyan and daughter spent a week at separate hospitals, and her husband could not visit either of them due to safety rules during the pandemic, though the hospitals kept them in touch through video calls. The family was happily reunited on May 23, when Ms. Nurikyan was picked up by her husband and they went together to get Livia. “My baby was the one who got me through it,” she said in an article on her care in the Daily News. She said she was grateful for her healthier heart and for the compassionate and expert care her new family received.

Ms. Nurikyan’s quick response to her symptoms was crucial, Dr. El-Hamamsy says, a point reinforced by the recent study. “It is critical, as we adjust to the pandemic, to balance the public health imperative of social distancing with the individual need to consult in the presence of sudden severe symptoms. Furthermore, additional resources, ranging from telemedicine to numbers of first responders, should be greatly increased,” the study concluded. “This serves as a word of caution for cities yet to experience a surge in COVID-19 cases, as well as for future similar events.”

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Go Red for Women Celebrates Heart Health

Updated on Feb 26, 2020 | Cardiology, Community, Featured

Health fairs were held throughout the Mount Sinai Health System to raise awareness of women’s risk for disease. Above, the fair at The Mount Sinai Hospital.

Eat healthy, get plenty of exercise, manage stress, and know your numbers. This was some of the crucial advice dispensed at health fairs held throughout the Mount Sinai Health System in honor of Go Red for Women Day® on Friday, February 7. The fairs, which were spearheaded by the nurses of Mount Sinai Heart, also provided nutritious snacks and free health screenings. Go Red is an initiative of the American Heart Association with the goal of increasing the awareness that heart disease is the No. 1 cause of death for women. Says Beth Oliver, DNP, RN, Senior Vice President, Cardiac Services, Mount Sinai Health System: “We want all women to understand the importance of knowing their numbers—their cholesterol levels, weight, blood sugar, and blood pressure—and to understand the risks of stress, smoking, and a sedentary lifestyle.”

Mount Sinai Heart leaders and event organizers, from left: Miriam Challenger, Ambulatory Clinic Supervisor; Beth Oliver; DNP, RN, Senior Vice President, Cardiac Services, Mount Sinai Health System; Annapoorna S. Kini, MD, Director, Cardiac Catheterization Laboratory,The Mount Sinai Hospital; Mary Ann McLaughlin, MD, Medical Director, Cardiac Health Program; Maya Barghash, MD, Assistant Professor of Medicine (Cardiology); and Khalilah James, NP.

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Landmark Study on Aspirin for High-Risk Heart Patients Is Led by Mount Sinai

Oct 21, 2019 | Cardiology, Featured, Research

Roxana Mehran, MD, center, principal investigator of the TWILIGHT study, with leading collaborators in the study, from left, Annapoorna S. Kini, MD; Valentin Fuster, MD, PhD; Juan J. Badimon, PhD; George Dangas, MD, PhD; Usman Baber, MD, MS; and Samin K. Sharma, MD.

High-risk patients who have undergone a coronary stent procedure may not require long-term aspirin, according to a groundbreaking global study led by Roxana Mehran, MD, Director of the Center for Interventional Cardiovascular Research and Clinical Trials, Mount Sinai Heart, and the Mount Sinai Professor in Cardiovascular Clinical Research and Outcomes, Icahn School of Medicine at Mount Sinai.

“We showed that withdrawal of aspirin after three months in patients already on ticagrelor, a potent antiplatelet regimen, reduced bleeding significantly without the harm of increasing death or heart attacks,” says Dr. Mehran, global principal investigator of “Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention” (TWILIGHT), which was published in September 2019 in The New England Journal of Medicine.

Says Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital, “I am proud of our team for achieving such great success with our collaborators in the United States and around the world on this pioneering clinical trial.”

The study addresses long-standing questions about the treatment of high-risk patients after percutaneous coronary intervention (PCI), also known as angioplasty, which opens blocked arteries and restores normal blood flow to the heart. “The same patients who are at high risk for ischemic events—such as heart attack or stroke caused by blocked blood vessels—are also at high risk for bleeding events,” says Dr. Mehran. “You have to find the right balance in therapies, and it is not easily found.”

In the current standard of care, high-risk patients who have received a cardiac stent are advised to take dual-antiplatelet therapy (DAPT)—both aspirin and a drug from a class of strong antiplatelet medications called P2Y12 inhibitors, of which ticagrelor is one. These two medications prevent heart attack or stroke by reducing the risk of blood clots. DAPT combines two drugs with similar effects, Dr. Mehran says, like using both “a shotgun and slingshot” for self-defense. TWILIGHT examined the impact of taking ticagrelor alone versus ticagrelor plus aspirin on clinically relevant bleeding among high-risk patients.

Investigators enrolled 9,006 patients at 187 sites in the United States, Canada, Europe, and Asia. They were high risk, meaning they met criteria such as having long or complex lesions in coronary arteries, or disorders such as diabetes or chronic kidney disease. All patients had undergone PCI with at least one drug-eluting stent and were prescribed aspirin and ticagrelor. After a three-month course of DAPT, the 7,119 patients without major adverse events were randomized to take either DAPT or ticagrelor with a placebo for 12 months. Among patients who took DAPT, 7.1 percent had major bleeding, compared with 4 percent of those who took ticagrelor and a placebo, and there was no difference in the risk for heart attack, death, or stroke between the groups. “This simpler approach saved many bleeding events and preserved the benefit of the single potent blood thinner,” says Usman Baber, MD, MS, Assistant Professor of Medicine (Cardiology), Icahn School of Medicine, who was lead author of the study with Dr. Mehran, and Chair of the TWILIGHT Clinical Coordinating Center.

The results were corroborated by a sub-study led by Juan J. Badimon, PhD, Professor of Medicine (Cardiology), and Director of Atherothrombosis Research at Mount Sinai Heart. Using a tool he is renowned for developing, the Badimon Chamber, researchers measured the thrombogenicity or “stickiness” of the blood in a group of 42 TWILIGHT patients, testing samples taken before and after they completed the 12-month treatment. Like the clinical study, the study of blood samples found that withdrawing aspirin caused no additional clot formation.

“The findings are particularly important and have the potential to change PCI practice,” says a co-author of the TWILIGHT study, Samin K. Sharma, MD, Director of Clinical and Interventional Cardiology at The Mount Sinai Hospital, and Anandi Lal Sharma Professor of Medicine in Cardiology.

Dr. Mehran expressed profound gratitude to Mount Sinai, which was the global sponsoring organization of TWILIGHT. “This study gives you an idea of the things we are able to do as an institution,” she says, “bringing together all of our resources to answer important questions for physicians and enhance the outcome for patients.”

The drug ticagrelor is made by AstraZeneca, which provided Mount Sinai with an unrestricted grant to perform the investigator-initiated study. Dr. Mehran has received financial compensation as an advisory board member for AstraZeneca in the past, and she and Dr. Baber have received consulting fees from AstraZeneca in the past.

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Three Physicians at Mount Sinai Receive Top Safety Rating for Cardiac Catheterization

May 13, 2019 | Cardiology, Featured

The two-star designation for exceptional safety rates in percutaneous coronary interventions (PCI) was awarded to, from left, Samin K. Sharma, MD; Annapoorna S. Kini, MD; and Pedro Moreno, MD.

For the 21st consecutive year, The Mount Sinai Hospital’s Cardiac Catheterization Laboratory or its interventionalists have received the highest two-star safety rating from the New York State Department of Health (NYSDOH) for percutaneous coronary interventions (PCI), also known as angioplasty. PCI— one of the most common procedures for patients with coronary artery disease— opens blocked arteries and restores normal blood flow to the heart.

Mount Sinai was the only hospital at which three interventionalists received the two-star designation for safety rates significantly exceeding the statewide average. The physicians recognized were Samin K. Sharma, MD, Director of Clinical and Interventional Cardiology at The Mount Sinai Hospital, and the Anandi Lal Sharma Professor of Medicine in Cardiology; Annapoorna S. Kini, MD, Director of the Cardiac Catheterization Laboratory, and the Zena and Michael A. Wiener Professor of Medicine; and Pedro Moreno, MD, Professor of Medicine (Cardiology). They performed a total of 6,529 PCI procedures from December 1, 2013, to November 30, 2016.

Mount Sinai’s exceptional ratings appeared in the latest NYSDOH report, released in April 2019, on the risk factors associated with PCI at 62 hospitals across New York State. The NYSDOH began publishing PCI safety ratings in 1995, in reports designed to help patients make better decisions about their care based upon a statistical review of each hospital’s data. “Patient safety is our top priority at The Mount Sinai Hospital Catheterization Laboratory,” Dr. Sharma says. “Our efficiency and safety outcomes are unparalleled, and we are very proud of this achievement, which is only possible because of the talented and dedicated interventional cardiology team.”

Dr. Kini says, “Our procedural outcomes data over the last several years support the statement that we have mastered the art of PCI. As a result, many patients who were considered too high-risk to receive care elsewhere are referred here. As we increasingly accept complex cases, our PCI complications continue to decline, which is a testament to the quality work this Cath Lab achieves.”

During the three-year period, The Mount Sinai Hospital had a risk-adjusted PCI mortality rate of 0.90 percent for all of its cases—emergency and non-emergency—significantly lower than the statewide average of 1.18 percent, while performing the largest number of procedures (10,888). For non-emergency cases, Mount Sinai’s PCI mortality rate was 0.58 percent, compared with the statewide average of 0.77 percent.

“I believe Mount Sinai is a leader in PCI for a few reasons,” says Dr. Moreno, Director of Cardiac Catheterization and Interventional Cardiology, Mount Sinai St. Luke’s. “Primarily, we have an extremely talented group of interventionalists and supporting staff. Second, we strictly abide by protocols and standards of care, while embracing new technologies and techniques, and finally, compassion and genuine concern for our patients’ health are our top priorities.”

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Going Red For Women’s Health

Updated on Jun 30, 2022 | Cardiology, Community

Heart health fairs were held throughout the Mount Sinai Health System in honor of Go Red for Women Day® on Friday, February 1.

The fairs, which attracted more than 1,000 participants, provided free screenings for blood pressure, total cholesterol, triglyceride levels, and body mass index.

The events recognized the American Heart Association’s Go Red campaign, which aims to raise awareness of heart disease, the No. 1 killer of women worldwide.

“A shared commitment to the cardiovascular health and well-being of our community makes this a success every year,” says Beth Oliver, DNP, RN, Senior Vice President, Cardiac Services, Mount Sinai Health System.

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Mary Ann McLaughlin, MD, MPH, Medical Director, Cardiac Health Program, Mount Sinai Health System, left; and Beth Oliver, DNP, RN.

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Honoring Leadership Excellence in Cardiovascular Care for Women

Updated on Jun 30, 2022 | Cardiology, Community, Women's Health

Roxana Mehran, MD, an internationally renowned clinician and researcher in the field of interventional cardiovascular disease, received the 2018 Wenger Excellence in Medical Leadership Award from WomenHeart: The National Coalition for Women With Heart Disease during a dinner on Monday, May 7, in Washington, D.C. Dr. Mehran is Professor of Medicine (Cardiology), and Population Health Science and Policy, and Director of Interventional Cardiovascular Research and Clinical Trials at the Zena and Michael A. Wiener Cardiovascular Institute of the Icahn School of Medicine at Mount Sinai.

The Wenger Awards are named for Nanette Kass Wenger, MD, a pioneer in women’s cardiovascular medicine and research, who trained at Mount Sinai. During the award presentation, WomenHeart cited Dr. Mehran’s work in promoting the inclusion and enrollment of women in clinical research, her numerous publications related to sex-based outcomes for women with cardiovascular disease, and her involvement in multiple organizations promoting the advancement of women’s causes in cardiovascular care and professionalism. In 2017, Dr. Mehran received the Bernadine Healy Leadership in Women’s Cardiovascular Disease Award from the American College of Cardiology.

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