Professor of Interventional Cardiology
I perform translational research into mechanisms of injury in PCI and understanding reperfusion in ST elevation myocardial injury. Initially we demonstrated the importance of Troponin elevation after PCI as it reflects new myocardial injury detected by MR imaging. . We then investigated changes in blood flow in these newly injured areas and investigated the impact of opening chronic occlusions on myocardial function.
We completed a randomised controlled trial of PCI vs CABG with evidence of new myocardial injury as the endpoint (Eurointervention January 2011). Analysis of the role of different markers of injury in this study was published by J Am Coll Cardiol 2011 with an accompanying editorial. This work helped change the biochemical definitions of revascularisation injury within subsequent trials of revascularisation strategy.
We are currently investigating how to predict outcome in ST elevation myocardial infarction and how using these novel tools we might tailor therapy for those patients most at risk of adverse outcomes.
Industry sponsored research
I have been intimately involved with the initial clinical launch of drug eluting stents (DES) and championed the use of intravascular ultrasound (IVUS) within theUK. IVUS expertise was critical in being allowed to participate in landmark international interventional studies, eg Taxus and Endeavour. These studies have complex entry requirements and require careful five year follow up including 2 follow-up angiograms and intravascular ultrasound studies. Participation in these international clinical studies is subject to extremely intense scrutiny and external audit including review of individual angiograms, case records and outcomes. I was the 2nd largest recruiter worldwide to Taxus 2 (Circulation 2003)
At the time of recruitment, the TAXUS 6 study was the most complex pattern of disease then studied. I was the joint 3rd largest recruiter worldwide and a co author on the subsequent papers.
The Syntax trial was a landmark randomized study comparing drug eluting stents with coronary surgery in patients with complex coronary disease. I was the UK Principal Investigator (PI) for intervention and our centre became the 4th most successful recruitment centre in the world. I was the first author on the second publication (J Am Coll Cardiol 2010) focussing on the diabetic subset.
The HORIZONS trial was a randomised trial of patients undergoing primary PCI. I was UK PI for this study and wrote the MREC application.E SELECT was a registry sponsored by Cordis. I was UK PI and international steering group member. (J Am Coll Cardiol 2012).
More recently I randomised the first patient in the world into Excel, a trial of stents vs surgery for left main coronary disease (Abbott). Under my leadership Oxford recruiter the 2nd largest cohort of patients to this trial and I was one of the authors of the New England Journal of Medicine paper (2017)
Service development research
In 1999 we began day case treatment programmes for elective Percutaneous Coronary intervention (PCI). Subsequently I started day transfer for urgent cases with acute coronary syndromes. Both of these methods of service delivery were ground breaking and described in a peer review journal (Heart 2004). Transfer required a unique collaboration with St Johns Ambulance to arrange the return service. I obtained funding for this service from industry initially, until the NHS were prepared to cover the expense.
In August 2007, launching region-wide Primary PCI required cooperation with Ambulance trusts, colleagues from surrounding hospitals and multidisciplinary teams. This service has been successful in reducing hospital stay and probably improving outcomes. Currently >280 AMI patients/annum are being treated and the programme will treat up to 550 cases by 2012 We were the first service in the UK to initiate paramedic delivery of clopidogrel in the community prior to hospital transfer We were a reference site for the national NIAP project and our results were presented at the national launch of the report.
I was part of the British Cardiovascular Society (BCS)/Royal College of Physicians (RCP) working group with Prof Bowling on ageism in health care (Heart 2000).
I was co author of guidelines for care for patients with valvular heart disease (BCS and RCP) and I am leading a number of projects into the management of patient with aortic stenosis and management with TAVI- percutaneous aortic valves.
Scopus h index 43- (accessed August 2017)