Featured Publications
Elevated renalase levels in patients with acute coronary microvascular dysfunction – A possible biomarker for ischemia
Safdar B, Guo X, Johnson C, D'Onofrio G, Dziura J, Sinusas AJ, Testani J, Rao V, Desir G. Elevated renalase levels in patients with acute coronary microvascular dysfunction – A possible biomarker for ischemia. International Journal Of Cardiology 2019, 279: 155-161. PMID: 30630613, PMCID: PMC6482834, DOI: 10.1016/j.ijcard.2018.12.061.Peer-Reviewed Original ResearchConceptsCoronary microvascular dysfunctionFramingham risk scorePET/CTChest painInflammatory markersMicrovascular dysfunctionEmergency departmentRisk scoreRb-82 PET/CTElevated renalase levelsAcute chest painCoronary artery diseaseC-reactive proteinVascular endothelial growth factorAnti-inflammatory proteinTumor necrosis factorEndothelial growth factorAngina historyCMD diagnosisRenalase levelsHypertensive crisisED presentationsHemodynamic instabilityArtery diseaseHeart failureSex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction
Lichtman JH, Leifheit EC, Safdar B, Bao H, Krumholz HM, Lorenze NP, Daneshvar M, Spertus JA, D'Onofrio G. Sex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction. Circulation 2018, 137: 781-790. PMID: 29459463, PMCID: PMC5822747, DOI: 10.1161/circulationaha.117.031650.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionPerception of symptomsChest painCare-seeking behaviorSymptom presentationYounger patientsMyocardial infarctionST-segment elevation acute myocardial infarctionMultivariable hierarchical logistic regressionIndex AMI hospitalizationMajority of womenHierarchical logistic regressionStress/anxietyVIRGO StudyMuscle painPatient characteristicsPredominant symptomAMI symptomsPerceive symptomsProdromal symptomsPatient interviewsHeart diseasePainAMI hospitalizationUS hospitalsPrevalence and characteristics of coronary microvascular dysfunction among chest pain patients in the emergency department
Safdar B, D’Onofrio G, Dziura J, Russell RR, Johnson C, Sinusas AJ. Prevalence and characteristics of coronary microvascular dysfunction among chest pain patients in the emergency department. European Heart Journal Acute Cardiovascular Care 2018, 9: 5-13. PMID: 29543037, DOI: 10.1177/2048872618764418.Peer-Reviewed Original ResearchConceptsCoronary microvascular dysfunctionCoronary artery diseaseCardiac positron emission tomography/Positron emission tomography/Chest pain patientsArtery diseaseAcute myocardial infarctionEmission tomography/Chest painMyocardial infarctionMicrovascular dysfunctionPain patientsEmergency departmentTomography/General emergency department populationLower coronary flow reserveNon-obstructive coronary arteriesPrior emergency department visitsTraditional cardiac risk factorsCardiac risk factorsModerate-risk patientsEmergency department visitsEmergency department patientsCoronary flow reserveEmergency department populationIdentifying Myocardial Ischemia due to Coronary Microvascular Dysfunction in the Emergency Department: Introducing a New Paradigm in Acute Chest Pain Evaluation
Safdar B, Ong P, Camici PG. Identifying Myocardial Ischemia due to Coronary Microvascular Dysfunction in the Emergency Department: Introducing a New Paradigm in Acute Chest Pain Evaluation. Clinical Therapeutics 2018, 40: 1920-1930. PMID: 30458932, DOI: 10.1016/j.clinthera.2018.09.010.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionRecurrent chest painCoronary microvascular dysfunctionChest painEmergency departmentHs-TnTMicrovascular dysfunctionMyocardial ischemiaAcute chest pain evaluationHigh-sensitivity troponin TDiagnosis of AMIType 2 acute myocardial infarctionElevated hs-TnTIschemia/necrosisChest pain evaluationGroup of patientsAssessment of symptomsIdentification of patientsAppropriate medical treatmentSex-specific thresholdsPulmonary embolismVasomotor disordersAortic dissectionPain evaluationEpicardial coronaries
2022
Sex and Race Differences in the Evaluation and Treatment of Young Adults Presenting to the Emergency Department With Chest Pain
Banco D, Chang J, Talmor N, Wadhera P, Mukhopadhyay A, Lu X, Dong S, Lu Y, Betensky RA, Blecker S, Safdar B, Reynolds HR. Sex and Race Differences in the Evaluation and Treatment of Young Adults Presenting to the Emergency Department With Chest Pain. Journal Of The American Heart Association 2022, 11: e024199. PMID: 35506534, PMCID: PMC9238573, DOI: 10.1161/jaha.121.024199.Peer-Reviewed Original ResearchConceptsChest painAcute myocardial infarctionEmergency departmentMultivariable adjustmentYoung adultsMyocardial infarctionBackground Acute myocardial infarctionRacial differencesCardiac biomarker testingHospital admissionClinical featuresConclusions WomenPhysician evaluationTriage levelBiomarker testingCardiac biomarkersWhite adultsNational estimatesObservation unitCP managementAdultsSurvey 2014WomenPainInfarction
2017
Ranolazine and Microvascular Angina by PET in the Emergency Department: Results From a Pilot Randomized Controlled Trial
Safdar B, D’Onofrio G, Dziura J, Russell RR, Johnson C, Sinusas AJ. Ranolazine and Microvascular Angina by PET in the Emergency Department: Results From a Pilot Randomized Controlled Trial. Clinical Therapeutics 2017, 39: 55-63. PMID: 28081848, PMCID: PMC10345862, DOI: 10.1016/j.clinthera.2016.12.002.Peer-Reviewed Original ResearchConceptsCoronary microvascular dysfunctionCoronary flow reserveCoronary artery diseaseChest painSymptomatic patientsArtery diseasePrimary outcomeEmergency departmentNonobstructive coronary artery diseaseRb-82 positron emission tomographyEffect of ranolazineRate-pressure productEmergency department patientsQTc-prolonging drugsRobust clinical trialsPositron emission tomographyHypertensive urgencyMicrovascular anginaMicrovascular dysfunctionUnderdiagnosed causeControlled TrialsDepartment patientsHeart failureAcute symptomsPressure product
2016
Women and Chest Pain: Recognizing the Different Faces of Angina in the Emergency Department.
Safdar B, D'Onofrio G. Women and Chest Pain: Recognizing the Different Faces of Angina in the Emergency Department. The Yale Journal Of Biology And Medicine 2016, 89: 227-38. PMID: 27354848, PMCID: PMC4918863.Peer-Reviewed Original ResearchConceptsCoronary artery diseaseAcute coronary syndromeChest painEmergency departmentMicrovascular dysfunctionED patientsCoronary artery endothelial dysfunctionCause of anginaCoronary artery dissectionCoronary artery spasmPersistent chest painRecurrent chest painSex-specific causesQuality of lifeArtery spasmArtery dissectionCoronary syndromeEndothelial dysfunctionMyocardial bridgingArtery diseasePoor functionCardinal symptomsAnginaPainPatientsIt’s not all Chest Pain: Sex and Gender in Acute Care Cardiology
Soffler M, McGregor A, Safdar B. It’s not all Chest Pain: Sex and Gender in Acute Care Cardiology. 2016, 6-23. DOI: 10.1017/cbo9781107705944.004.Peer-Reviewed Original ResearchMicrovascular Dysfunction as Opposed to Conduit Artery Disease Explains Sex-specific Chest Pain in Emergency Department Patients With Low to Moderate Cardiac Risk
Safdar B, Ali A, D’Onofrio G, Katz SD. Microvascular Dysfunction as Opposed to Conduit Artery Disease Explains Sex-specific Chest Pain in Emergency Department Patients With Low to Moderate Cardiac Risk. Clinical Therapeutics 2016, 38: 240-255.e1. PMID: 26778090, DOI: 10.1016/j.clinthera.2015.12.010.Peer-Reviewed Original ResearchConceptsChest painControl subjectsMicrovascular dysfunctionArtery diseaseObstructive coronary artery diseaseCommon emergency department presentationConduit vessel functionCoronary artery vasomotionTransient forearm ischemiaAcute chest painCardiac risk factorsPersistent chest painAcute coronary syndromeBrachial artery diameterFramingham risk scoreProspective cohort studyChest pain centerSystolic blood pressureAsymptomatic healthy volunteersCoronary artery diseaseEmergency department presentationsBrachial artery reactivityPeripheral microvascular dysfunctionHigh-resolution ultrasoundArtery dysfunction
2013
Incremental Value of Objective Cardiac Testing in Addition to Physician Impression and Serial Contemporary Troponin Measurements in Women
Diercks DB, Mumma BE, Peacock W, Hollander JE, Safdar B, Mahler SA, Miller CD, Counselman FL, Birkhahn R, Schrock J, Singer AJ, Nagurney JT. Incremental Value of Objective Cardiac Testing in Addition to Physician Impression and Serial Contemporary Troponin Measurements in Women. Academic Emergency Medicine 2013, 20: 265-270. PMID: 23517258, PMCID: PMC3725334, DOI: 10.1111/acem.12092.Peer-Reviewed Original ResearchConceptsObjective cardiac testingPhysician risk assessmentAcute myocardial infarctionAcute coronary syndromeCardiac testingNon-high riskNet reclassification indexChest painTroponin IEmergency departmentReclassification indexPresence of ACSAcute coronary syndrome studyMedian age 58 yearsNegative troponin ISerial cardiac markersSerial troponin IAge 58 yearsIncremental valueReceiver operator characteristic curveContemporary troponin assaysClinician risk assessmentOperator characteristic curveReclassified patientsCoronary syndrome
2012
Diagnostic accuracy of a point-of-care troponin I assay for acute myocardial infarction within 3 hours after presentation in early presenters to the emergency department with chest pain
Diercks DB, Peacock WF, Hollander JE, Singer AJ, Birkhahn R, Shapiro N, Glynn T, Nowack R, Safdar B, Miller CD, Lewandrowski E, Nagurney JT. Diagnostic accuracy of a point-of-care troponin I assay for acute myocardial infarction within 3 hours after presentation in early presenters to the emergency department with chest pain. American Heart Journal 2012, 163: 74-80.e4. PMID: 22172439, DOI: 10.1016/j.ahj.2011.09.028.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionCare troponin IAcute coronary syndromeSymptom onsetMyocardial infarctionDiagnostic accuracyCoronary syndromeEmergency departmentSerial testingAmerican Heart Association/American CollegeTroponin ICriterion standard diagnosisInitial blood drawAvailable medical recordsCardiac marker testingPositive likelihood ratioSimilar diagnostic accuracyNegative likelihood ratioInvestigational markersIschemia evaluationCardiology criteriaChest painLikelihood ratioMedian ageMedian time
2011
Myeloperoxidase in the diagnosis of acute coronary syndromes: The importance of spectrum
Peacock WF, Nagurney J, Birkhahn R, Singer A, Shapiro N, Hollander J, Glynn T, Nowak R, Safdar B, Miller C, Peberdy M, Counselman F, Chandra A, Kosowsky J, Neuenschwander J, Schrock J, Plantholt S, Lewandrowski E, Wong V, Kupfer K, Diercks D. Myeloperoxidase in the diagnosis of acute coronary syndromes: The importance of spectrum. American Heart Journal 2011, 162: 893-899. PMID: 22093206, DOI: 10.1016/j.ahj.2011.08.017.Peer-Reviewed Original ResearchConceptsAcute coronary syndromeNoncardiac chest painCoronary syndromeMyocardial infarctionPredictive valueTroponin ISerial cardiac markersEmergency department patientsNegative predictive valuePositive predictive valuePositive likelihood ratioNegative likelihood ratioChest painLikelihood ratioSymptom onsetUnstable anginaDepartment patientsProspective studyRisk stratificationMean agePerfusion testingC-statisticFinal diagnosisPatientsCardiac markers
2010
Depression as Modifiable Coronary Risk Factor in the Emergency Department Chest Pain Observation Unit
Safdar B, Foody JM, D'Onofrio G. Depression as Modifiable Coronary Risk Factor in the Emergency Department Chest Pain Observation Unit. Critical Pathways In Cardiology A Journal Of Evidence-Based Medicine 2010, 9: 82-87. PMID: 20520215, DOI: 10.1097/hpc.0b013e3181db06ef.Peer-Reviewed Original ResearchConceptsCoronary risk factorsModifiable coronary risk factorsRisk factorsUrban tertiary care hospital EDChest pain observation unitTertiary care hospital EDEmergency department observation unitFramingham risk scoreObservation unitProspective observational studyHealth service utilizationSeverity of depressionBehavioral health referralsCPC patientsChest painNonprivate insuranceED visitsStudy nursesCardiac symptomsHigher obesityHospital EDSpecialty referralsFuture trialsHealth referralsQuick Inventory
2009
Improvements in Time to Reperfusion
Rao V, Safdar B, Parkosewich J, Lee LV, D'Onofrio G, Foody JM. Improvements in Time to Reperfusion. Critical Pathways In Cardiology A Journal Of Evidence-Based Medicine 2009, 8: 38-42. PMID: 19258837, DOI: 10.1097/hpc.0b013e318194e443.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAngioplasty, Balloon, CoronaryCohort StudiesElectrocardiographyEmergency Service, HospitalEmergency TreatmentFemaleHospitals, TeachingHumansIncidenceMaleMiddle AgedMyocardial InfarctionPrognosisRetrospective StudiesRisk AssessmentSeverity of Illness IndexSex FactorsSurvival AnalysisTime FactorsTreatment OutcomeUrban HealthConceptsPrimary percutaneous coronary interventionST-elevation myocardial infarctionYale-New Haven HospitalPrimary PCIChart-abstracted dataPercutaneous coronary interventionUrban teaching hospitalQuality of carePhysician-level interventionsSingle-site studyChest painCoronary interventionHospital-wide systemPhysician awarenessEmergency departmentMyocardial infarctionHeart diseaseSTEMI careImproved outcomesTeaching hospitalEarly presentationReperfusionTimely managementClinical initiativesWomen