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Applied Health Research Centre co-authors four articles in two high-impact journals within four days, sharing decades of work that will impact patient care

Toronto, August 28, 2018

By Ana Gajic

Dr. Peter Jüni
Dr. Peter Jüni

The Applied Health Research Centre (AHRC) at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital has co-authored four articles in two high-impact journals within the last four days. This brings their total of publications in the two highest impact journals – The New England Journal of Medicine and The Lancet - to eight within the last year.

“We’ve been working on some of these trials for almost a decade,” said Dr. Peter Jüni, director of the AHRC. “It's wonderful to have them published in the top-ranked journals and is an indication of their likely future clinical impact.”

The AHRC is a not-for-profit academic research organization fully integrated with the Li Ka Shing Knowledge Institute that provides various services to support clinical research from study design to data analysis. Dr. Jüni noted that the AHRC’s ability to support trials that not only influence standards of patient care worldwide but are also presented and published in the most prestigious venues is a mark of the AHRC’s expertise.

“First, we’re lucky to work with excellent investigators,” he said. “Second, it also shows that St. Michael’s and the AHRC have enough experience, systematic understanding, high-quality processes in place and stamina to see the trials through to publication in world-renowned journals.”

This week, four articles supported by Dr. Jüni and his team appeared in The Lancet and The New England Journal of Medicine and were simultaneously presented at the European Society of Cardiology’s Annual Congress in Munich, Germany:

Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery – Published in The New England Journal of Medicine

This study – the world’s largest on this topic - was fully co-ordinated by the AHRC and found that lower thresholds for blood transfusions for cardiac surgery patients compared to traditional thresholds provide positive patient outcomes and safety at six months after surgery. This research has already started to change transfusion practices around the world, and the ‘restrictive therapy’ – or a lower threshold for transfusion – has already been adopted into guidelines and will likely become the standard of care worldwide.

Authors from St. Michael’s include: Dr. David Mazer as lead author and principal investigator, associate scientist in the Keenan Research Centre for Biomedical Science (KRCBS) of St. Michael’s; Dr. Jüni; Dr. Gregory Hare, associate scientist at the Li Ka Shing Knowledge Institute; Nikhil Mistry, research coordinator in the Department of Anesthesia; Kevin Thorpe and David Dai, biostatisticians at the AHRC; Judi Hall, manager of the clinical trials unit at the AHRC; Dr. Subodh Verma, director of the CardioLink platform at the KRCBS.

This study received funding from the Canadian Institutes of Heart Research, Canadian Blood Services, the National Health and Medical Research Council in Australia and the Health Research Council of New Zealand and the Canada Research Chairs Program.

Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial – Published in The Lancet

The general practice for catheter insertion used to be through femoral access, or insertion through the groin. This study compared femoral access to radial access, which is catheter insertion at the wrist. It found that access at the wrist is safer and presents a lower risk of bleeding and mortality for patients. This clinical trial also compared bivalirudin, a new pharmacological treatment, to heparin, the more traditional treatment that is used after catheter intervention. It showed that bivalirudin does not have a clear advantage over the traditional treatment. This study – the largest ever on this topic - showed that “radial access should become the default approach in patients who have an acute coronary syndrome and is changing treatment guidelines,” said Dr. Jüni.

Authors from St. Michael’s include: Dr. Jüni as senior author.

This study was funded by the Italian Society of Invasive Cardiology, The Medicines Company, Terumo, and the Canada Research Chairs Program.

Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial – Published in The Lancet

This study in 16,000 patients “attempted to break with the traditional antiplatelet treatment after stent implantation in patients with coronary artery disease and substitute two substances with just one,” Dr. Jüni said. The well-established method in cardiology is to use two substances to inhibit blood platelets after implanting a stent to lower the risk of thrombotic events in the new stent. Traditionally, this is done with aspirin and a second class of drugs – P2Y12 inhibitors. This study attempted to narrow the window during which a patient would have to take both medications and maximize patients’ time taking just ticagrelor, another antiplatelet treatment. The research did not suggest that this was a better treatment strategy for patients and “guidelines will not change but single treatment with ticagrelor appears very promising in patients with myocardial infarction.”

Authors from St. Michael's include: Dr. Jüni as one of the lead authors.

This study was funded by Astra Zeneca, the pharmaceutical company that produces ticagrelor; Biosensors, and The Medicines Company and the Canada Research Chairs Program.

Ultrathin-strut, biodegradable-polymer, sirolimus-eluting stents versus thin-strut, durable-polymer, everolimus-eluting stents for percutaneous coronary revascularisation: 5-year outcomes of the BIOSCIENCE randomised trial – Published in The Lancet

In percutaneous coronary intervention - a minimally-invasive procedure where modern stents are inserted into an artery using a small catheter to widen a narrowed blood vessel in the heart – there are one or two types of stents that have become the standard due to their efficacy. This study looked at a newer-generation stent and compared it to those that have worked well in the past. The research found that indeed the two stents are comparable, but there was a chance of an increased risk of death with the newer-generation stent. “We don’t understand why we got this signal of an increased risk of death with the new stent yet, and there will need to be more observation time and measurement to evaluate these results. Our findings show how important it is to perform long-term follow-ups in device trials,” said Dr. Jüni.

Authors from St. Michael's include: Dr. Jüni as one of the senior authors.

This study was funded by the Clinical Trials Unit of the University of Bern and Biotronik.

These papers are an example of how St. Michael's Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

St. Michael’s Hospital with Providence Healthcare and St. Joseph’s Health Centre now operate under one corporate entity as of August 1, 2017. United, the three organizations serve patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education.

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