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Adrian Banning


Professor of Interventional Cardiology

Over the last 5 years I have performed translational research into mechanisms of injury in PCI .  This has involved obtaining funding for salary for 7 fellows. This work has already produced 3 papers in Circulation (impact factor >10).  Initially we demonstrated the importance of Troponin elevation after PCI as it reflects new myocardial injury detected by MR imaging.  The second paper was chosen to have an accompanying editorial and it investigated the mechanisms of these Troponin elevations.  We then investigated changes in blood flow in these newly injured areas.  I also investigated the impact of opening chronic occlusions on myocardial function.  I have done meta-analysis on the long term prognostic implication of revascularisation injury and written a number of editorials/reviews on the topic.

More recently I have completed a randomised controlled  trial of PCI vs CABG with evidence of new myocardial injury as the endpoint (Eurointervention January 2011).  My analysis of the role of different markers of injury in this study has been published by J Am Coll Cardiol 2011 with an accompanying editorial.  This work is likely to change the biochemical definitions of revascularisation injury within subsequent trials of revascularisation strategy.

With the opening of the new Acute Vascular Imaging Centre inOxford, I am now taking this work on coronary revascularization to the acute setting (primary PCI for STEMI and NSTEMI), with analysis of upstream plaque characteristics and downstream acute myocardial tissue injury (oedema, necrosis, no-reflow etc).  This work has BRC funding and the first papers are currently being submitted.

 

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. The first paper from the registry has recently been accepted and I am 3rd author (J Am Coll Cardiol in press).

More recently I have recruited patients into the Resolution (Cordis) and Platinum (Boston Sci) trials, and we are currently recruiting into Evolve (Boston Sci). In October 2010 I randomised the first patient in the world into Excel, a 4000 patient trial of stents vs surgery for left main coronary disease (Abbott).

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).

For 5 years I collaborated with Cardiac Surgeon Steve Westaby and was the co-principal investigator on the Jarvik Artifical Heart programme in Oxford.  This is a left ventricular assist device (LVAD) designed for permanent implanation in patients not suitable for cardiac transplantation.  We implanted the first device in a patient for destination therapy (Lancet)  and then further implants in a number of patients.   We ultimately had the longest surviving patient treated with this technology (New Engl J Med)

I was a steering group and endpoint adjudicator for the international GALA (carotid endarterectomy:local vs GA) trial (Lancet 2009)

I was one of three members of the Data monitoring committee for the CARDIA trial which is a UKrevascularisation trial in diabetics.. I am currently recruiting to the Ripchord study which is a trial on clinical utilisation of the Radi Pressure  wire initiated by Dr Nick Curzen inSouthampton

I have collaborated with Prof Peter Rothwell in the OXVASC (see Lancet 2005) study.  Ongoing projects with Dr Banerjee will use the OXVASC database to compare presentation and outcomes of neurological and cardiac ischaemia.

Scopus h index 28- (accessed August 2012)

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Selected Publications

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Recent Publications

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