BCIS Number: 1406
John Radcliffe Oxford
- C Consultant
I am employed by the NHS but I am a vocal advocate of a comprehensive approach to clinical research. I am currently President of BCIS. I am a "high volume" coronary internationalist and undertake TAVI for patients with aortic stenosis. I have hosted live case sessions for TCT in the USA and EuroPCR in Paris as the Master Operator.
My research activity has two components to it. I am a very active participant in selected Commercial studies- these studies provide funding and experience for the research team that I lead. Importantly, high recruitment in Commercial trial allows this activity to be visible with regard to participation in the final manuscripts and data presentation. I then have a personal research programme which has been extremely productive in producing clinically relevant research. This productivity is reflected in published manuscripts, citations (I have >320 PUMED listed manuscripts and my Scopus h index is 42) and completed higher qualifications for the fellows that have worked with me.
I have been intimately involved with the initial clinical launch of drug eluting stents (DES) and championed the use of intravascular ultrasound (IVUS) within the UK. IVUS expertise was critical in being allowed to participate in landmark international interventional studies, eg Taxus and Endeavour. 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 and the joint 3rd largest recruiter worldwide in TAXUS. I was 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. This paper is cited in all of the contemporary guidelines for management of multivessel coronary artery disease. The HORIZONS trial was a randomised trial of patients undergoing primary PCI. I was UK PI for this study and wrote the MREC application- this lead to Bivalarudin being endorsed by NICE. E SELECT was a registry sponsored by Cordis. I was UK PI and international steering group member. More recently I have recruited patients into the Resolution (Cordis) Platinum (Boston Sci) Evolve (Boston Sci). In October 2010 I randomised the first patient in the world into Excel, a 1800 patient trial of stents vs surgery for left main coronary disease (Abbott). Current trials that I lead within Oxford and are currently recruiting include Ideal left main, Syntax 2, the UK Absorb registry. We are just initiating FAME-3, Galileo and the RESPOND registry.
Over the last 10 years I have used money generated by participation in commercial stent studies and supplemented it with additional funding from industry to fund my translational research into mechanisms of injury in PCI. This has involved obtaining funding for salary for 8 fellows. Initially we demonstrated the importance of Troponin elevation after PCI as it reflects new myocardial injury detected by MR imaging. We then investigated the mechanisms of these Troponin elevations and investigated changes in blood flow in these newly injured areas. I have done meta-analysis on the long term prognostic implication of revascularisation injury and written a number of editorials/reviews on the topic. I have completed a randomised controlled trial of PCI vs CABG with evidence of new myocardial injury as the endpoint- MICASA (Eurointervention). My analysis of the role of different markers of injury in MICASA was published in J Am Coll Cardiol. This work contributed to a significant change the biochemical definitions of revascularisation injury within subsequent trials of revascularisation strategy (6 Citations in the SCAI definition of procedural myocardial injury, Moussa et al J Am Coll Cardiol 2013:62;1663-70).
Most recently, I am now taking this work on the impact of revascularization coronary revascularization to the acute setting - primary PCI for STEMI. Many strategies have been proposed in order to prevent and/or to treat no reflow, but none have demonstrated a consistent beneficial effect. Reasons for this failure are debatable, but because of “real world” considerations, patients with the lowest clinical risk are most likely to be enrolled in trials of new interventional treatments versus “standard interventional therapy”. Consequently, to improve outcomes in STEMI patients at the higher risk, it is desirable to facilitate their identification early in the clinical course. We have documented the natural history of evolution of infarction comparing measurement in the catheter lab with functional change on MRI (published in J Am Coll Cardiol). We have then looked at the impact of stent implantation in this setting published in (European Heart Journal) and most recently created a score to predict the likelihood of an adverse outcome. Uniquely this score is applicable in the catheter lab at the time of revascularisation. This score has been validated prospectively in Oxford and externally in a retrospective European cohort. The paper has been submitted (this week) and I hope it may become a standard approach to assessing the applicability of technology in this clinical setting. Using these techniques we are selecting patients likely to have an adverse outcome for application of a new proposed approach to prevent no reflow using pressure controlled intermittent coronary sinus occlusion (PICSO). This treatment can be delivered percutaneously through a dedicated catheter available in commerce with a CE mark approval (PICSO Impulse catheter, Mirarcor Medical System GmbH, Vienna, Austria. Initial recruitment is proceeding well and we hope to have data in the Spring.
Adrian Banning - Research Profile
|Contracted time devoted to research||0.1 wte|
|Personal aspiration for research activity||Do more|
|Research experience - Specifics||I am employed by the NHS and have 2 BRC Pas. Since appointment as a Consultant, I have been vocal advocate of a comprehensive approach to clinical research with complete integration with the University system. My research activity has two components to it. I am a very active participant in selected Commercial studies- these studies provide funding and experience for the research team that I lead.|
|Number of current students||10|
|Number of awards in last 5 years||1|
|Main areas of research interest||
|Permission to share this data||yes|