151
|
Pierre K, Adedinsewo DA, Al-Hijji M, Miranda WR, Alkhouli M, Eleid MF, Guerrero M, Pollak PM, Rihal CS, El Sabbagh A. 30-day patient reported outcomes can be predicted by change in left atrial pressure and not change in transmitral gradient following MitraClip. Catheter Cardiovasc Interv 2021; 97:1244-1249. [PMID: 33502087 DOI: 10.1002/ccd.29477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/27/2020] [Accepted: 12/13/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Change in left atrial pressure (LAP) has been shown to be associated with symptom improvement post-MitraClip; however, the association between acute procedural changes in transmitral diastolic mean gradient (MG) compared to LAP and symptom improvement is not well established. METHODS 164 consecutive patients undergoing MitraClip at Mayo Clinic between June 2014 and May 2018 were included. Preclip and postclip MG and LAP were recorded. Baseline demographics, clinical, and echocardiographic outcomes, including 30-day New York Heart Association (NYHA) functional status were obtained from patient charts. RESULTS Median age was 81.5 years (IQR: 76.3, 87), 34% were female and 94.5% had NYHA class III and IV functional status at baseline. At baseline, median MG was 4 mmHg (IQR: 3, 5) and LAP was 19 mmHg (IQR: 16, 23.5). Following MitraClip deployment, the median MG was 4 mmHg (IQR: 3, 6) and the median LAP was 17 mmHg (IQR: 14, 21), 69.5% of patients had less than moderate MR. There was no statistically significant association between change in MG and NYHA functional class at 30 days (OR = 0.95, 95% CI: 0.76-1.20). However, a reduction in LAP following MitraClip deployment was significantly associated with improvement in NYHA functional status at 30 days following adjustments for age and sex (aOR 3.36, 95% CI: 1.34-8.65). There was no significant correlation between change in mean LAP and change in MG (p = .98). CONCLUSION Unlike change in left atrial pressure, change in MG post-MitraClip was not associated with patient reported outcomes at 30 days and did not correlate with change in left atrial pressure. Long-term follow up is needed to evaluate the impact of LA pressure on symptoms.
Collapse
Affiliation(s)
- Keniel Pierre
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Mohammed Al-Hijji
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter M Pollak
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
152
|
Annie FH, Bates M, Embrey S, Alkhouli M, Bhatt D, Misenheimer J, George H, Gwinn R, Nanjundappa A. NO EXCESS MORTALITY ASSOCIATED WITH CONCOMITANT ACE INHIBITOR OR ARB USE IN HOSPITALIZED PATIENTS WITH COVID-19. J Am Coll Cardiol 2021. [PMCID: PMC8091226 DOI: 10.1016/s0735-1097(21)04431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
|
153
|
Yao X, Van Houten H, Krumholz H, Kent D, Shah N, Abraham N, Graff-Radford J, Alkhouli M, Henk H, Sangaralingham LI, Gersh B, Friedman P, Holmes D, Noseworthy P. ASSOCIATION OF PERCUTANEOUS LEFT ATRIAL APPENDAGE OCCLUSION WITH STROKE, BLEEDING AND MORTALITY IN COMPARISON TO NOACS AMONG PATIENTS WITH AF. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
154
|
Omer MA, Brilakis ES, Kennedy KF, Alkhouli M, Elgendy IY, Chan PS, Spertus JA. Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Patients With Non-ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock. JACC Cardiovasc Interv 2021; 14:1067-1078. [PMID: 33933384 DOI: 10.1016/j.jcin.2021.02.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The aim of this study was to compare in-hospital outcomes and long-term mortality of multivessel versus culprit vessel-only percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI), multivessel disease (MVD) and cardiogenic shock. BACKGROUND The clinical benefits of complete revascularization in patients with NSTEMI, MVD, and cardiogenic shock remain uncertain. METHODS Among 25,324 patients included in the National Cardiovascular Data Registry CathPCI Registry from July 2009 to March 2018, the rates of in-hospital procedural outcomes were compared between those undergoing multivessel PCI and those undergoing culprit vessel-only PCI after 1:1 propensity score matching. Among patients aged ≥65 years matched to the Centers for Medicare and Medicaid Services database, long-term mortality was compared using proportional hazards analysis. RESULTS Multivessel PCI was performed in 9,791 patients (38.7%), which increased from 32.2% in 2010 to 44.2% in 2017 (p for trend <0.001). After 1:1 propensity matching (n = 7,864 in each group), those undergoing multivessel PCI had a 3.5% (95% confidence interval [CI]: 2.0% to 5.0%) lower absolute rate of in-hospital mortality (30.9% vs. 34.4%; p < 0.001; odds ratio [OR]: 0.85; 95% CI: 0.80 to 0.91), but a higher risk for bleeding (13.2% vs. 10.8%; p < 0.001; OR: 1.26; 95% CI: 1.15 to 1.40) and new requirement for dialysis (5.7% vs. 4.6%; p = 0.001; OR: 1.26; 95% CI: 1.10 to 1.46). Among those surviving to discharge, all-cause mortality was similar through 7 years (conditional hazard ratio: 0.95; 95% CI: 0.87 to 1.03; p = 0.20). CONCLUSIONS Nearly 40% of patients with NSTEMI with MVD and cardiogenic shock underwent multivessel PCI, which was associated with lower in-hospital mortality but greater peri-procedural complications. Among those surviving to discharge, multivessel PCI did not confer additional long-term mortality benefit.
Collapse
Affiliation(s)
- Mohamed A Omer
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
| | - Emmanouil S Brilakis
- Abbott Northwestern Hospital, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Paul S Chan
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, Missouri, USA
| |
Collapse
|
155
|
Abstract
Background Contemporary nationwide data on the use, predictors, and outcomes of mechanical valve replacement in patients less than 70 years of age are limited. Methods and Results We identified hospitalizations for aortic valve replacement (AVR) or mitral valve replacement (MVR) in the Nationwide Inpatient Sample between January 1, 2008, and December 31, 2017. The study's end points included predictors of mechanical valve replacement and risk‐adjusted in‐hospital mortality. Among 253 100 hospitalizations for AVR, the use rate of mechanical prosthesis decreased from 45.3% in 2008 to 17.0% in 2017. Among 284 962 hospitalizations for MVR, mechanical prosthesis use decreased from 59.5% in 2008 to 29.2% in 2017 (P for trend<0.001). In multilogistic regression analyses, female sex, prior sternotomy, prior defibrillator, and South/West geographic location were predictive of mechanical valve use. The presence of bicuspid valve was a negative predictor of mechanical AVR (odds ratio [OR], 0.68; 95% CI, 0.66–0.69; P<0.001), whereas mitral stenosis was associated with higher mechanical MVR (OR, 1.28; 95% CI, 1.22–1.33; P<0.001). Unadjusted in‐hospital mortality decreased over time with AVR but not with MVR, regardless of prosthesis choice. Using years 2008 and 2009 as a reference, risk‐adjusted mortality also decreased over time with AVR but did not decrease after MVR. Conclusions There is a substantial decline in the use of mechanical valve replacement among patients aged ≤70 years in the United States. Long‐term durability data on bioprosthetic valve replacement are needed to better define the future role of mechanical valves in this age group.
Collapse
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Fahad Alqahtani
- Division of Cardiology West Virginia University Morgantown WV
| | - Trevor Simard
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Sorin Pislaru
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Hartzell V Schaff
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Rich A Nishimura
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| |
Collapse
|
156
|
Alkhouli M, Kawsara A, Alqahtani F, Rihal CS. TAVR With or Without Embolic Cerebral Protection: Proper Use of Sample Weighting and Data Interpretation. JACC Cardiovasc Interv 2021; 13:2816-2817. [PMID: 33303122 DOI: 10.1016/j.jcin.2020.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 10/22/2022]
|
157
|
Mohamed MO, Van Spall HGC, Kontopantelis E, Alkhouli M, Barac A, Elgendy IY, Khan SU, Shing Kwok C, Shoaib A, Bhatt DL, Mamas MA. Corrigendum to: Effect of primary percutaneous coronary intervention on in-hospital outcomes among active cancer patients presenting with ST-elevation myocardial infarction: a propensity score matching analysis. Eur Heart J Acute Cardiovasc Care 2021; 10:1101. [PMID: 33783500 DOI: 10.1093/ehjacc/zuab013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
158
|
Alkhouli M, Alqahtani F, Kawsara A, Guerrero M, Eleid MF, Nkomo VT, Rihal CS, Crestanello JA. Association of Transcatheter Mitral Valve Repair Availability With Outcomes of Mitral Valve Surgery. J Am Heart Assoc 2021; 10:e019314. [PMID: 33754835 PMCID: PMC8174333 DOI: 10.1161/jaha.120.019314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Transcatheter mitral valve repair (TMVr) is currently offered at selected centers that meet certain operator and institutional requirements. We sought to explore the hypothesis that the availability of TMVr is associated with improved outcomes of MV surgery. Methods and Results We used the Nationwide Readmissions Database to identify patients who underwent MV surgery at centers with or without TMVr capabilities between January 1 and December 31, 2017. The primary end point was in‐hospital mortality. Secondary end points were postoperative complications, resource use, and 30‐day readmissions. A total of 24 477 patients from 595 centers (446 TMVr, 149 non‐TMVr) were included. There were modest but statistically significant differences in the prevalence of comorbidities between the groups. Patients at non‐TMVr centers had higher unadjusted in‐hospital mortality than those at TMVr centers (5.6% versus 3.6%, P<0.001). They also had higher rates of postoperative complications, longer hospitalizations, higher cost, and fewer home discharges but similar 30‐day readmission rates. After propensity matching, mortality remained higher at non‐TMVr centers (5.5% versus 4.0%, P<0.001). Rates of postoperative complications, prolonged hospitalizations, and nonhome discharges also remained higher. Postoperative mortality was consistently higher at non‐TMVr centers in multiple risk‐adjustment analyses incrementally accounting for differences in risk factors, surgical volume, availability of surgical repair, and excluding concomitant procedures. In the most comprehensive model, surgery at non‐TMVr centers was associated with higher odds of death (odds ratio, 1.41; 95% CI, 1.14–1.73; P=0.002). Conclusions Mitral valve surgery at TMVr centers is associated with improved in‐hospital outcomes compared with non‐TMVr centers.
Collapse
Affiliation(s)
| | - Fahad Alqahtani
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN.,Division of Cardiology Department of Medicine University of Kentucky Lexington KY
| | - Akram Kawsara
- Division of Cardiology Department of Medicine West Virginia University Morgantown WV
| | - Mayra Guerrero
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Mackram F Eleid
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | | | - Juan A Crestanello
- Department of Cardiovascular Surgery Mayo Clinic School of Medicine Rochester MN
| |
Collapse
|
159
|
Affiliation(s)
- Safi U Khan
- Department of Medicine, West Virginia University, 1 Medical Center Dr, Morgantown, WV 26505, USA
| | - Ahmad N Lone
- Department of Medicine, West Virginia University, 1 Medical Center Dr, Morgantown, WV 26505, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| |
Collapse
|
160
|
Elbadawi A, Elgendy IY, Albaeni A, Aly A, Almustafa A, Shahin HI, Chatterjee A, Alkhouli M, Khalife W, Kapadia S, Jneid H. Trends and Outcomes of Transcatheter Valve Implantation in Patients With Prior Mediastinal Radiation. Am J Cardiol 2021; 143:167-168. [PMID: 33453171 DOI: 10.1016/j.amjcard.2021.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
|
161
|
Siddiqi TJ, Usman MS, Shahid I, Ahmed J, Khan SU, Ya'qoub L, Rihal CS, Alkhouli M. Utility of the CHA2DS2-VASc score for predicting ischaemic stroke in patients with or without atrial fibrillation: a systematic review and meta-analysis. Eur J Prev Cardiol 2021; 29:625-631. [PMID: 33693717 DOI: 10.1093/eurjpc/zwab018] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/06/2021] [Accepted: 01/28/2021] [Indexed: 12/22/2022]
Abstract
AIMS Anticoagulants are the mainstay treatment for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), and the CHA2DS2-VASc score is widely used to guide anticoagulation therapy in this cohort. However, utility of CHA2DS2-VASc in NVAF patients is debated, primarily because it is a vascular scoring system, which does not incorporate atrial fibrillation related parameters. Therefore, we conducted a meta-analysis to estimate the discrimination ability of CHA2DS2-VASc in predicting ischaemic stroke overall, and in subgroups of patients with or without NVAF. METHODS AND RESULTS PubMed and Embase databases were searched till June 2020 for published articles that assessed the discrimination ability of CHA2DS2-VASc, as measured by C-statistics, during mid-term (2-5 years) and long-term (>5 years) follow-up. Summary estimates were reported as random effects C-statistics with 95% confidence intervals (CIs). Seventeen articles were included in the analysis. Nine studies (n = 453 747 patients) reported the discrimination ability of CHA2DS2-VASc in NVAF patients, and 10 studies (n = 138 262 patients) in patients without NVAF. During mid-term follow-up, CHA2DS2-VASc predicted stroke with modest discrimination in the overall cohort [0.67 (0.65-0.69)], with similar discrimination ability in patients with NVAF [0.65 (0.63-0.68)] and in those without NVAF [0.69 (0.68-0.71)] (P-interaction = 0.08). Similarly, at long-term follow-up, CHA2DS2-VASc had modest discrimination [0.66 (0.63-0.69)], which was consistent among patients with NVAF [0.63 (0.54-0.71)] and those without NVAF [0.67 (0.64-0.70)] (P-interaction = 0.39). CONCLUSION This meta-analysis suggests that the discrimination power of the CHA2DS2-VASc score in predicting ischaemic stroke is modest, and is similar in the presence or absence of NVAF. More accurate stroke prediction models are thus needed for the NVAF population.
Collapse
Affiliation(s)
- Tariq Jamal Siddiqi
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Izza Shahid
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Jawad Ahmed
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Lina Ya'qoub
- Division of Cardiology, Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| |
Collapse
|
162
|
Alkhouli M, Alqahtani F, Kawsara A, Pislaru S, Schaff HV, Nishimura RA. National Trends in Mechanical Valve Replacement in Patients Aged 50 to 70 Years. J Am Coll Cardiol 2021; 76:2687-2688. [PMID: 33243387 DOI: 10.1016/j.jacc.2020.09.608] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/24/2020] [Accepted: 09/20/2020] [Indexed: 12/24/2022]
|
163
|
Pajjuru VS, Thandra A, Guddeti RR, Walters RW, Jhand A, Andukuri VG, Alkhouli M, Spertus JA, Md VMA. Sex Differences in Mortality and 90-day Readmission Rates after Transcatheter aortic valve replacement (TAVR): A Nationwide Analysis from the United States. Eur Heart J Qual Care Clin Outcomes 2021; 8:135-142. [PMID: 33585884 DOI: 10.1093/ehjqcco/qcab012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/26/2021] [Accepted: 02/12/2021] [Indexed: 12/27/2022]
Abstract
AIM To assess gender differences in in-hospital mortality and 90-day readmission rates among patients undergoing Transcatheter aortic valve replacement (TAVR) in the United States. METHODS AND RESULTS Hospitalizations for TAVR were retrospectively identified in the National readmissions database (NRD) from 2012-2017. Gender based differences in in-hospital mortality and 90-day readmissions were explored using multivariable logistic regression models. During the study period, an estimated 171,361 hospitalizations for TAVR were identified, including 79,722 (46.5%) procedures in women and 91,639 (53.5%) in men. Unadjusted in-hospital mortality and 90-day all-cause readmissions were significantly higher for women compared to men (2.7% vs. 2.3%, p = .002; 25.1% vs. 24.1%; p = .012 respectively). After adjusting for baseline characteristics, women had 13% greater adjusted odds of in-hospital mortality (aOR: 1.13, 95% CI: 1.02-1.26, p = .017), and 9% greater adjusted odds of 90-day readmission compared to men (aOR: 1.09, 95% CI: 1.05-1.14, p < .001). During the study period, there was a steady decrease in hospital mortality (5.3% in 2012 to 1.6% in 2017; ptrend < .001) and 90-day (29.9% in 2012 to 21.7% in 2017; ptrend < .001) readmission rate in both genders. CONCLUSION In-hospital mortality and readmission rates for TAVR hospitalizations have decreased over time across both genders. Despite these improvements, women undergoing TAVR continue to have a modestly higher in-hospital mortality, and 90-day readmission rates compared to men. Given the expanding indications and use of TAVR, further research is necessary to identify the reasons for this persistent gap and design appropriate interventions.
Collapse
Affiliation(s)
- Venkata S Pajjuru
- Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Abhishek Thandra
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Raviteja R Guddeti
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Ryan W Walters
- Department of Medicine, Division of Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, NE, USA
| | - Aravdeep Jhand
- Department of Medicine, Division of Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Venkata G Andukuri
- Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - John A Spertus
- Department of Medicine, Division of Cardiology, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Venkata M Alla Md
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, NE, USA
| |
Collapse
|
164
|
Alkhouli M, Alqahtani F, Hartsell Harris A, Hohmann SF, Rihal CS. Management Patterns and Outcomes of Acute Ischemic Stroke Complicating Transcatheter Aortic Valve Replacement. Stroke 2021; 52:e94-e96. [PMID: 33567872 DOI: 10.1161/strokeaha.120.032376] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN (M.A., F.A., C.S.R.)
| | - Fahad Alqahtani
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN (M.A., F.A., C.S.R.)
| | | | - Samuel F Hohmann
- Center for Advanced Analytics and Informatics, Chicago, IL (A.H.H., S.F.H.)
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN (M.A., F.A., C.S.R.)
| |
Collapse
|
165
|
Mohamed MO, Van Spall HGC, Kontopantelis E, Alkhouli M, Barac A, Elgendy IY, Khan SU, Kwok CS, Shoaib A, Bhatt DL, Mamas MA. Effect of primary percutaneous coronary intervention on in-hospital outcomes among active cancer patients presenting with ST-elevation myocardial infarction: a propensity score matching analysis. Eur Heart J Acute Cardiovasc Care 2021; 10:829-839. [PMID: 33587752 DOI: 10.1093/ehjacc/zuaa032] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/31/2022]
Abstract
AIMS Primary percutaneous coronary intervention (pPCI) is the gold standard, guideline-recommended revascularization strategy in patients presenting with ST-elevation myocardial infarction (STEMI). However, there are limited data on its use and effectiveness among patients with active cancer presenting with STEMI. METHODS AND RESULTS All STEMI hospitalizations between 2004 and 2015 from the National Inpatient Sample were retrospectively analysed, stratified by cancer type. Propensity score matching was performed to estimate the average treatment effect of pPCI in each cancer on in-hospital adverse events, including major adverse cardiovascular and cerebrovascular events (MACCE) and its individual components, and compare treatment effect between cancer and non-cancer patients. Out of 1 870 815 patients with STEMI, 38 932 (2.1%) had a current cancer diagnosis [haematological: 11 251 (28.9% of all cancers); breast: 4675 (12.0%); lung: 9538 (24.5%); colon: 3749 (9.6%); prostate: 9719 (25.0%)]. Patients with cancer received pPCI less commonly than those without cancer (from 54.2% for lung cancer to 70.6% for haematological vs. 82.3% in no cancer). Performance of pPCI was strongly associated with lower adjusted probabilities of MACCE and all-cause mortality in the cancer groups compared with the no cancer group. There was no significant difference in estimated average pPCI treatment effect between the cancer groups and non-cancer group. CONCLUSION Primary percutaneous coronary intervention is underutilized in STEMI patients with current cancer despite its significantly lower associated rates of in-hospital all-cause mortality and MACCE that is comparable to patients without cancer. Further work is required to assess the long-term benefit and safety of pPCI in this high-risk group.
Collapse
Affiliation(s)
- Mohamed O Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Harriette G C Van Spall
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Canada.,Population Health Research Institute, Hamilton, Canada
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Ana Barac
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington DC, USA
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Deepak L Bhatt
- Department of Cardiology, Brigham and Women's Hospital Heart & Vascular Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.,Population Health Research Institute, Hamilton, Canada
| |
Collapse
|
166
|
Alkhouli M, Alqahtani F, Jneid H, Al Hajji M, Boubas W, Lerman A. Age-Stratified Sex-Related Differences in the Incidence, Management, and Outcomes of Acute Myocardial Infarction. Mayo Clin Proc 2021; 96:332-341. [PMID: 33483147 DOI: 10.1016/j.mayocp.2020.04.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the impact of female sex on the incidence, management, and outcomes of myocardial infarction (MI) in different age groups. METHODS Patients admitted with ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI), between January 1, 2003, and December 31, 2015, were identified in the National Inpatient Sample. We compared STEMI and NSTEMI rates, management patterns, and in-hospital morbidity and mortality in men and women stratified into 4 age groups (<45, 45 to 64, 65 to 84, and ≥85 years of age). RESULTS A total of 6,720,639 weighted hospitalizations for MI (79.8% NSTEMI, and 20.2% STEMI) were included. The incidence rate of hospitalizations for MI was lower in women than men across all age groups. Women were less likely than men to undergo coronary angiography, revascularization, or to use circulatory-support devices. These differences were consistent across all age groups. Adjusted odds of death for women (vs men) varied by age: odds ratio (95% confidence interval) 1.08 (0.97 to 1.20), 1.05 (1.02 to 1.08), 0.92 (0.91 to 0.94), and 0.86 (0.85 to 0.88) for NSTEMI, and 1.15 (1.04 to 1.27), 1.22 (1.18 to 1.26), 1.09 (1.06 to 1.11), and 0.97 (0.94 to 0.99), for STEMI, in age groups (<45, 45 to 64, 65 to 84, and ≥85), respectively. The magnitude of differences in complications between men and women was higher in younger and middle-age patients. CONCLUSION Compared with men, women have lower incidence of MI and less likelihood of undergoing invasive treatment regardless of age. However, post-MI outcomes are age specific. The negative impact of female sex on most outcomes was most pronounced in young and middle-aged women.
Collapse
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Fahad Alqahtani
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY
| | - Hani Jneid
- Division of Cardiology, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston, TX
| | - Mohammed Al Hajji
- Division of Cardiology, Department of Medicine, West Virginia University Morgantown, WV
| | - Wafaa Boubas
- Division of Cardiology, Department of Medicine, West Virginia University Morgantown, WV
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
167
|
Simard T, Alqahtani F, Hibbert B, Mamas MA, El‐Hajj S, Harris AH, Hohmann SF, Alkhouli M. Sex‐specific in‐hospital
outcomes of transcatheter aortic valve replacement with third generation transcatheter heart valves. Catheter Cardiovasc Interv 2021; 98:176-183. [DOI: 10.1002/ccd.29499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/07/2020] [Accepted: 12/27/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester Minnesota USA
| | - Fahad Alqahtani
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester Minnesota USA
| | - Benjamin Hibbert
- CAPITAL Research Group University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University Keele UK
| | | | - Alyssa H. Harris
- Center for Advanced Analytics and Informatics Chicago Illinois USA
| | - Samuel F. Hohmann
- Center for Advanced Analytics and Informatics Chicago Illinois USA
- Department of Health Systems Management Rush University Chicago Illinois USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester Minnesota USA
| |
Collapse
|
168
|
Khan MZ, Munir MB, Khan SU, Subramanian CR, Khan MU, Asad ZUA, Talluri S, Madhanakumar A, Lone AN, Khan MS, Michos ED, Alkhouli M. Representation of women, older patients, ethnic, and racial minorities in trials of atrial fibrillation. Pacing Clin Electrophysiol 2021; 44:423-431. [PMID: 33512027 DOI: 10.1111/pace.14178] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/28/2020] [Accepted: 01/18/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Representation trends of women, older adults, and ethnic/racial minorities in randomized controlled trials (RCTs) of atrial fibrillation (AF) are uncertain. METHODS We systematically reviewed 134 AF related RCTs (phase II and III) encompassing 149,162 participants using Medline and ClinicalTrials.gov through April 2019 to determine representation trends of women, older patients (≥75 years), and ethnic/racial minorities. Weighted data on the prevalence of AF from epidemiological studies were used to compare the representation of the studied groups of interest in AF RCTs to their expected burden of the disease. RESULTS Only 18.7% of the RCTs reported proportion of older patients, and 12.7% RCTs reported ethnic/racial minorities. The proportions of women in RCTs versus general population were 35.2% and 35.1%, of Hispanics were 11.9% and 5.2%, of Blacks were 1.2% and 5.7%, of American Indian/Alaskans were 0.2% and 0.2%, of Asians were 14.2% and 2.4%, of native Hawaiian/Pacific Islanders were 0.05% and 0.1% and of non-Whites were 19.5% and 22.5%, respectively. The weighted mean age (SD) across the trials was 65.3 (3.2) years which was less than the corresponding weighted mean age of 71.1 (4.5) years in the comparative epidemiological data. CONCLUSION The reporting of older patients and ethnic/racial minorities was poor in RCTs of AF. The representation of women and American Indian/Alaskan natives matched their expected population share of disease burden. Hispanics and Asians were over-represented and Blacks, native Hawaiian/Pacific Islanders and non-Whites were under-represented in RCTs of AF.
Collapse
Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | | | - Muhammad Usman Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Zain Ul Abideen Asad
- Cardiovascular Disease Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Swapna Talluri
- Department of Medicine, Guthrie Health System/Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Aarthi Madhanakumar
- Department of Cardiovascular Medicine, Allegheny General hospital, Pittsburgh, Pennsylvania, USA
| | - Ahmad Naeem Lone
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, John H. Stroger Cook County Hospital, Chicago, Illinois, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
169
|
Osman M, Sulaiman S, Alqahtani F, Harris AH, Hohmann SF, Alkhouli M. Association of chronic kidney disease with in-hospital outcomes of endovascular stroke interventions. Cardiovasc Revasc Med 2021; 34:121-125. [PMID: 33514491 DOI: 10.1016/j.carrev.2021.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Data on the differential impact of chronic kidney disease (CKD) on the outcomes of endovascular stroke interventions (ESI) for acute ischemic stroke (AIS) are limited. METHODS Adult patients who underwent ESI for AIS between October 1st, 2015 and September 30th, 2019, were identified in a national multicenter database. The primary endpoints were in-hospital mortality and poor functional outcomes. Secondary endpoints included intracranial hemorrhage, mechanical ventilation, pneumonia, myocardial infarction, blood transfusion, length of stay, and cost. A multilevel mixed-effects regression model was used to derive adjusted outcomes. RESULTS A total of 22,193 AIS patients who underwent ESI at 99 centers were included. Among those, 18,881 (85%) had no CKD, and 3312 (15%) had CKD. Patients with CKD were older and had a higher prevalence of key comorbidities. After multivariable risk adjustment, patients with CKD had significantly higher in-hospital mortality (Odds Ratio [OR] 1.55 [95% Confidence Interval] [CI] 1.40-1.73, p < 0.01), and poor functional outcomes (OR 1.38, 95%CI 1.26-1.50, p < 0.01). Major complications, including mechanical ventilation, pneumonia, blood transfusion, and myocardial infarction, were more common among CKD patients, who also had longer hospitalizations and accrued higher cost. CONCLUSION The presence of CKD in patients with AIS treated with ESI is an independent predictor of in-hospital mortality and poor functional outcomes at discharge.
Collapse
Affiliation(s)
- Mohammed Osman
- Department of Cardiology, West Virginia University, Morgantown, WV, United States of America
| | - Samian Sulaiman
- Department of Cardiology, West Virginia University, Morgantown, WV, United States of America
| | - Fahad Alqahtani
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, United States of America
| | - Alyssa H Harris
- Center for Advanced Analytics and Informatics, Chicago, IL, United States of America
| | - Samuel F Hohmann
- Center for Advanced Analytics and Informatics, Chicago, IL, United States of America; Department of Health Systems Management, Rush University, Chicago, IL, United States of America
| | - Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, United States of America.
| |
Collapse
|
170
|
Kawsara A, Alqahtani F, Nkomo VT, Eleid MF, Pislaru SV, Rihal CS, Nishimura RA, Schaff HV, Crestanello JA, Alkhouli M. Determinants of Morbidity and Mortality Associated With Isolated Tricuspid Valve Surgery. J Am Heart Assoc 2021; 10:e018417. [PMID: 33399012 PMCID: PMC7955319 DOI: 10.1161/jaha.120.018417] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Whether the poor outcomes of isolated tricuspid valve surgery are related to the operation itself or to certain patient characteristics including late referral is unknown. Methods and Results Adult patients who underwent isolated tricuspid valve surgery were identified in the Nationwide Readmissions Database (2016–2017). Patients who had redo tricuspid valve surgery, endocarditis, or congenital heart disease were excluded. Multivariable logistic regression was performed to identify contributors to postoperative mortality. A total of 1513 patients were included (mean age 55.7±16.6 years, 49.6% women). Surrogates of late referral were frequent: 41% of patients were admitted with decompensated heart failure, 44.3% had a nonelective surgery status, 16.8% had advanced liver disease, and 31% had an unplanned hospitalization in the prior 90 days. The operation was performed on day 0 to 1 of the hospitalization in only 50% of patients, and beyond day 10 in 22% of patients. In‐hospital mortality occurred in 8.7% of patients. Median length of stay was 14 days (7–35 days), and median cost was $87 223 ($43 122–$200 872). In multivariable logistic regression analysis, surrogates for late referrals (acute heart failure decompensation, nonelective surgery status, or advanced liver disease) were the strongest predictors of in‐hospital mortality (odds ratio [OR], 4.75; 95% CI, 2.74–8.25 [P<0.001]). This was also consistent in a second model incorporating unplanned hospitalizations in the 90 days before surgery as a surrogate for late referral (OR, 5.50; 95% CI, 2.28–10.71 [P<0.001]). Conclusions The poor outcomes of isolated tricuspid valve surgery may be largely explained by the late referral for intervention. Studies are needed to determine the role of early intervention for severe isolated tricuspid regurgitation.
Collapse
Affiliation(s)
- Akram Kawsara
- Division of Cardiology Department of Medicine West Virginia University Morgantown WV
| | - Fahad Alqahtani
- Division of Cardiology Department of Medicine University of Kentucky Lexington KY
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Mackram F Eleid
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Sorin V Pislaru
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Rick A Nishimura
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery Mayo Clinic School of Medicine Rochester MN
| | - Juan A Crestanello
- Department of Cardiovascular Surgery Mayo Clinic School of Medicine Rochester MN
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| |
Collapse
|
171
|
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN.
| |
Collapse
|
172
|
Elsisy MF, Stulak JM, Alkhouli M. Incidence, Characteristics, and Outcomes of Emergent Isolated Coronary Artery Bypass Grafting. Am J Cardiol 2020; 137:20-24. [PMID: 32998004 DOI: 10.1016/j.amjcard.2020.09.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 11/18/2022]
Abstract
Data on emergency coronary artery bypass surgery (CABG) are limited. We studied patients who underwent isolated CABG at Mayo Clinic between 1993 and 2019. Baseline characteristics and in-hospital outcomes of emergent CABG were described in consecutive eras (1993 to 2000, 2001 to 2010, and 2011 to 2019). Cumulative survival was estimated by the Kaplan Meier method for the overall group, and stratified by the indication of surgery. In the 14,455 isolated CABG included, 427 (2.95%) were emergent. The number of emergent CABG decreased from 222 to 150 and 55 in the consecutive study eras. There was a temporal increase in the prevalence of heart failure, but no change in mean age, and prevalence of hypertension, diabetes, renal failure, or atrial fibrillation. The proportion of patients with failed/complicated percutaneous coronary intervention decreased from 38.2% in 1993 to 2000 to 22.7% in 2001 to 2010 and 25.5% in 2011 to 2019 (p = 0.003). In 2011 to 2019, 100% of patient received an internal mammary graft compared with 75.6% in 1993 to 2000 (p < 0.001). Operative mortality was 8.7% overall (8.6% in 1993 to 2000, 10.0% in 2001 to 2010, and 5.5% in 2011 to 2019, p = 0.56). There were no differences in postoperative complications except for the incidence of renal failure and new dialysis which increased over time. Predicted 10-year survival was 57.0% and was not different according to CABG indication (p = 0.12). In conclusion, we documented a temporal decrease in the incidence of emergent CABG between 1993 and 2019, especially those performed due to complications of coronary interventions. Despite the higher prevalence of left ventricular dysfunction and the more complete revascularization in more recent years, in-hospital mortality did not increase.
Collapse
Affiliation(s)
- Mohamed Farouk Elsisy
- Department of Cardiovascular Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - John M Stulak
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota.
| |
Collapse
|
173
|
Alkhouli M, Kawsara A, Alqahtani F, Badhwar V, Sengupta PP. Transcatheter Mitral Valve Repair Following Ring Annuloplasty: Technical Challenges and the Role of Invasive Hemodynamics. JACC Cardiovasc Interv 2020; 13:e207-e209. [PMID: 33189643 DOI: 10.1016/j.jcin.2020.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiology, West Virginia University, Morgantown, West Virginia, USA; Department of Cardiovascular Disease, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
| | - Akram Kawsara
- Department of Cardiovascular Disease, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Fahad Alqahtani
- Division of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Vinay Badhwar
- Department of Cardiovascular Disease, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Partho P Sengupta
- Department of Cardiovascular Disease, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| |
Collapse
|
174
|
|
175
|
Kawsara A, Sulaiman S, Linderbaum J, Coffey SR, Alqahtani F, Nkomo VT, Crestanello JA, Alkhouli M. Temporal Trends in Resource Use, Cost, and Outcomes of Transcatheter Aortic Valve Replacement in the United States. Mayo Clin Proc 2020; 95:2665-2673. [PMID: 33168160 DOI: 10.1016/j.mayocp.2020.05.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/27/2020] [Accepted: 05/28/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the contemporary trends in outcomes and resource use associated with transcatheter aortic valve replacement (TAVR) in the United States. METHODS We identified patients who underwent TAVR between January 1, 2012, and December 31, 2017, in the National Readmission Database. We assessed temporal trends in clinical outcomes, length-of-stay, non-home discharges, and cost of the index TAVR hospitalization. We also evaluated the changes in the burden of hospitalizations before and after TAVR. RESULTS A total of 89,202 patients were included. In-hospital mortality decreased from 5.3% (188) in 2012 to 1.6% (484) in 2017 (adjusted odds ratio: 0.37, 95% CI: 0.30 to 0.46). Risk-adjusted incidences of new dialysis, vascular complications, blood transfusion, and mechanical ventilation decreased, but strokes and pacemaker implantations remained unchanged. Length of stay decreased from median of 7 (interquartile range [IQR]: 4 to 11) to 2 (IQR: 2 to 5) days (P<.001). Risk-adjusted non-home discharges decreased from 32.2% (1134) to 15.5% (386) (P<.001). Median cost of the TAVR hospitalization decreased from $56,022 (IQR: $43,690 to $75,174) to $46,101 (IQR: $36,083 to $59,752) (P<.001). Pre-TAVR admissions at 30, 90, and 180 days decreased from 21.6% (713), 39.5% (1160), and 50.5% (1009) in 2012 to 15.5% (4451), 30.2% (7186), and 36.8% (5928) in 2017, respectively (P<.001). Similarly, re-hospitalizations at 30, 90, and 180 days post-TAVR decreased from 17.5% (531), 27.9% (657), and 34.2% (521) to 12.4% (3486), 21.1% (4783), and 29.1% (4306), respectively (P<.001). The expenditure on index, pre-, and post-TAVR hospitalizations increased from $0.53 to $2.8 billion between 2012 and 2017. CONCLUSION This study reflects the changes in the characteristics and outcomes of TAVR in the United States between 2012 and 2017. It also shows the temporal decrease in resource use, cost, and burden of hospitalizations among patients undergoing TAVR in the United States, but an increase in the overall expenditure on TAVR-related hospitalizations.
Collapse
Affiliation(s)
- Akram Kawsara
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, WV
| | - Samian Sulaiman
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, WV
| | - Jane Linderbaum
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN
| | - Sarah R Coffey
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN
| | - Fahad Alqahtani
- Division of Cardiology, Department of Medicine, University of Kentucky, Lexington, KY
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN
| | - Juan A Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic School of Medicine, Rochester, MN
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN.
| |
Collapse
|
176
|
Khan SU, Khan MU, Virani SS, Khan MS, Khan MZ, Rashid M, Kalra A, Alkhouli M, Blaha MJ, Blumenthal RS, Michos ED. Efficacy and safety for the achievement of guideline-recommended lower low-density lipoprotein cholesterol levels: a systematic review and meta-analysis. Eur J Prev Cardiol 2020; 28:2001-2009. [DOI: 10.1093/eurjpc/zwaa093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/23/2020] [Accepted: 09/22/2020] [Indexed: 12/22/2022]
Abstract
Abstract
Aim
The 2018 American Heart Association/American College of Cardiology/Multi-Society Cholesterol Guidelines recommended the addition of non-statins to statin therapy for high-risk secondary prevention patients above a low-density lipoprotein cholesterol (LDL-C) threshold of ≥70 mg/dL (1.8 mmol/L). We compared effectiveness and safety of treatment to achieve lower (<70) vs. higher (≥70 mg/dL) LDL-C among patients receiving intensive lipid-lowering therapy (statins alone or plus ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors).
Methods and results
Eleven randomized controlled trials (130 070 patients), comparing intensive vs. less-intensive lipid-lowering therapy, with follow-up ≥6 months and sample size ≥1000 patients were selected. Meta-analysis was reported as random effects risk ratios (RRs) [95% confidence intervals] and absolute risk differences (ARDs) as incident cases per 1000 person-years. The median LDL-C levels achieved in lower LDL-C vs. higher LDL-C groups were 62 and 103 mg/dL, respectively. At median follow-up of 2 years, the lower LDL-C vs. higher LDL-C group was associated with significant reduction in all-cause mortality [ARD −1.56; RR 0.94 (0.89–1.00)], cardiovascular mortality [ARD −1.49; RR 0.90 (0.81–1.00)], and reduced risk of myocardial infarction, cerebrovascular events, revascularization, and major adverse cardiovascular events (MACE). These benefits were achieved without increasing the risk of incident cancer, diabetes mellitus, or haemorrhagic stroke. All-cause mortality benefit in lower LDL-C group was limited to statin therapy and those with higher baseline LDL-C (≥100 mg/dL). However, the RR reduction in ischaemic and safety endpoints was independent of baseline LDL-C or drug therapy.
Conclusion
This meta-analysis showed that treatment to achieve LDL-C levels below 70 mg/dL using intensive lipid-lowering therapy can safely reduce the risk of mortality and MACE.
Collapse
Affiliation(s)
- Safi U Khan
- Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Muhammad U Khan
- Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center, Department of Medicine, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX 77030, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, John H Stroger Jr. Hospital of Cook County, 1969 Ogden Ave, Chicago, IL 60612, USA
| | - Muhammad Zia Khan
- Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Muhammad Rashid
- Department of Cardiology, Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Michael J Blaha
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287, USA
| | - Roger S Blumenthal
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287, USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287, USA
| |
Collapse
|
177
|
Affiliation(s)
- Yogesh N V Reddy
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Rick A Nishimura
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| |
Collapse
|
178
|
Elbadawi A, Albaeni A, Elgendy IY, Ogunbayo GO, Jimenez E, Cornwell L, Chatterjee A, Khalife W, Alkhouli M, Kapadia SR, Jneid H. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Prior Mediastinal Radiation. JACC Cardiovasc Interv 2020; 13:2658-2666. [PMID: 33213751 DOI: 10.1016/j.jcin.2020.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study sought to evaluate the trends and outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) among patients with prior mediastinal radiation from a national database. BACKGROUND There is a paucity of data about the temporal trends and outcomes of TAVR versus SAVR in patients with prior mediastinal radiation. METHODS The National Inpatient Sample database years 2012 to 2017 was queried for hospitalizations of patients with prior mediastinal radiation who underwent isolated AVR. Using multivariable analysis, the study compared the outcomes of TAVR versus SAVR. The main study outcome was in-hospital mortality. RESULTS The final analysis included 3,675 hospitalizations for isolated AVR; of whom 2,170 (59.1%) underwent TAVR and 1,505 (40.9%) underwent isolated SAVR. TAVR was increasingly performed over time (ptrend = 0.01), but there was no significant increase in the rates of utilization of SAVR. The following factors were independently associated with TAVR utilization: older age, chronic lung disease, coronary artery disease, chronic kidney disease, prior cerebrovascular accidents, prior coronary artery bypass grafting, and larger-sized hospitals, while women were less likely to undergo TAVR. Compared with SAVR, TAVR was associated with lower in-hospital mortality (1.2% vs. 2.0%, adjusted odds ratio: 0.27; 95% confidence interval: 0.09 to 0.79; p = 0.02). TAVR was associated with lower rates of acute kidney injury, use of mechanical circulatory support, bleeding and respiratory complications, and shorter length of hospital stay. TAVR was associated with higher rates of pacemaker insertion. CONCLUSIONS This nationwide observational analysis showed that TAVR is increasingly performed among patients with prior mediastinal radiation. TAVR provides an important treatment option for this difficult patient population with desirable procedural safety when using SAVR as a benchmark.
Collapse
Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Aiham Albaeni
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Ernesto Jimenez
- Department of Cardiothoracic Surgery, Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Lorraine Cornwell
- Department of Cardiothoracic Surgery, Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Arka Chatterjee
- Banner University Medical Center, University of Arizona College of Medicine, Tucson, Arizona
| | - Wissam Khalife
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, Texas.
| |
Collapse
|
179
|
Alqahtani F, Osman M, Harris AH, Hohmann SF, Alkhouli M. Mortality and functional outcomes of endovascular stroke therapy in the United States. Catheter Cardiovasc Interv 2020; 97:470-474. [DOI: 10.1002/ccd.29385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Fahad Alqahtani
- Department of Cardiology Mayo Clinic School of Medicine Rochester Minnesota
| | - Mohammed Osman
- Department of Cardiology West Virginia University Morgantown West Virginia
| | | | - Samuel F. Hohmann
- Center for Advanced Analytics and Informatics Chicago Illinois
- Department of Health Systems Management Rush University Chicago Illinois
| | - Mohamad Alkhouli
- Department of Cardiology Mayo Clinic School of Medicine Rochester Minnesota
| |
Collapse
|
180
|
Alkhouli M, Rihal CS. In reply-Risk Framing in Cardiovascular Medicine I and II. Mayo Clin Proc 2020; 95:2569-2571. [PMID: 33153648 DOI: 10.1016/j.mayocp.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 09/08/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic Alix School of Medicine, Rochester, MN
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic Alix School of Medicine, Rochester, MN
| |
Collapse
|
181
|
Alqahtani F, Kawsara A, Alkhouli M. Trends in the Use of Isolated Surgical and Transcatheter Aortic Valve Replacement in Patients Younger Than 70 Years of Age. Mayo Clin Proc 2020; 95:2571-2572. [PMID: 33153649 DOI: 10.1016/j.mayocp.2020.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/14/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Fahad Alqahtani
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN
| | - Akram Kawsara
- Division of Cardiology, West Virginia University, Morgantown
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN
| |
Collapse
|
182
|
Khan SU, Kalra A, Kapadia SR, Khan MU, Zia Khan M, Khan MS, Mamas MA, Warraich HJ, Nasir K, Michos ED, Alkhouli M. Demographic, Regional, and State-Level Trends of Mortality in Patients With Aortic Stenosis in United States, 2008 to 2018. J Am Heart Assoc 2020; 9:e017433. [PMID: 33070675 PMCID: PMC7763421 DOI: 10.1161/jaha.120.017433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Aortic stenosis–related mortality might vary across demographic subsets, regions, and states in the United States. Methods and Results We reviewed the death certificate data from the Centers for Disease Control and Prevention Wide‐Ranging OnLine Data for Epidemiologic Research database to examine aortic stenosis–related mortality trends from 2008 to 2018. Crude and age‐adjusted mortality rates (AAMRs) per 100 000 people and annual percentage change with 95% CIs were calculated. Between 2008 and 2018, AAMR reduced from 12.7 to 11.5 (average annual percentage change, −1.0 [95% CI, −1.5 to −0.5]), because of an accelerated decline between 2015 and 2018 (annual percentage change, −4.4 [95% CI, −6.0 to −2.7]). Older (aged >85 years), male, and White patients had higher death rates than younger, female, and non‐White patients, respectively. Although mortality reduction was similar across sexes, significant mortality reduction was limited to White patients only. The AAMRs were higher in rural than urban areas. States with AAMRs >90th percentile were distributed in the West and the Northeast, and <10th percentile in the South. The AAMRs for sex and race were highest in the West and lowest in the South. None of the states located in the Midwest showed a significant reduction in mortality. Mortality remained stable for hospital setting and nursing home/long‐term care facility, except that the number of deaths increased at home and hospice facility since 2014. Conclusions The reduction in mortality in patients with aortic stenosis was not consistent among demographic subsets and states. The substantial public health and economic implications call for determination of underlying clinical and socioeconomic factors to narrow the gap.
Collapse
Affiliation(s)
- Safi U Khan
- Department of Medicine West Virginia University Morgantown WV
| | - Ankur Kalra
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH.,Section of Cardiovascular Research Heart, Vascular and Thoracic Department Cleveland Clinic Akron General Akron OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Muhammad U Khan
- Department of Medicine West Virginia University Morgantown WV
| | | | | | - Mamas A Mamas
- Keele Cardiovascular Research Group Keele University Stoke-on-Trent UK.,Department of Medicine Jefferson University Philadelphia PA
| | | | - Khurram Nasir
- Department of Cardiovascular Medicine Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Erin D Michos
- Division of Cardiology Department of Medicine Johns Hopkins School of Medicine Baltimore MD.,The Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | | |
Collapse
|
183
|
Osman M, Patel B, Munir MB, Kawsara A, Kheiri B, Balla S, Daggubati R, Michos ED, Alkhouli M. Sex-stratified analysis of the safety of percutaneous left atrial appendage occlusion. Catheter Cardiovasc Interv 2020; 97:885-892. [PMID: 33048417 DOI: 10.1002/ccd.29282] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/21/2020] [Accepted: 09/14/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES AND BACKGROUND There is insufficient current evidence about whether sex impacts outcomes of percutaneous left atrial appendage occlusion (LAAO). The aim of this study was to investigate the association between sex and short-term outcomes of LAAO. METHODS Patients who were hospitalized and underwent LAAO from October 2015 to December 2017 in the National Readmission Database were queried. The primary endpoint of interest was major in-hospital adverse events. Secondary endpoints included, 30-day readmission rate, nonhome discharge, and cost of hospitalization. Propensity score matching (1:1) was performed to compare the outcomes among women and men. RESULTS A total of 9,281 patients were included in the current analysis [women = 3,659 (39%); men = 5,622 (61%)]. Comparing women to men, women had lower prevalence of diabetes mellitus (30.6% vs 35.7%, p < .01), heart failure (28.6% vs 30.8%, p = .03), vascular disease (55.5% vs 69.6%, p < .01) and renal failure (18.3% vs 21.2%, p < .01), and higher CHA2 DS2 VASc score (5 [IQR4-6] vs 4 [IQR3-6], p < .01). After propensity-score matching, women had higher rate of major in-hospital adverse events (2.8% vs 1.9%; p < .01), and nonhome discharges (11.4% vs 6.7%; p < .01). Additionally, 30-day readmission rate was higher among women (10% vs 8.6%, p = .03). CONCLUSION Among hospitalized patients undergoing LAAO, women carry higher risk for major in-hospital adverse events, nonhome discharge, and 30-day readmission rates.
Collapse
Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Brijesh Patel
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Muhammad Bilal Munir
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA.,Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Akram Kawsara
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Ramesh Daggubati
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| |
Collapse
|
184
|
Alahdab F, Zuhri Yafi R, Chaar A, Alrstom A, Alzuabi M, Alhalabi O, Hasan S, Mallak M, Jazayerli ML, Haydour Q, Alkhouli M, Alfarkh W, Murad MH. Aspirin dosage for the prevention of graft occlusion in people undergoing coronary surgery: A systematic review and meta-analysis. Avicenna J Med 2020; 10:198-207. [PMID: 33437691 PMCID: PMC7791283 DOI: 10.4103/ajm.ajm_17_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Aspirin is almost always used after coronary artery bypass graft (CABG) surgery; however, it is unclear what optimal dose should be prescribed. In this systematic review, we evaluated the effects of high versus low-dose aspirin in patients after CABG. Methods: A comprehensive database search was conducted in several databases from date of inception until February 2018. There were no language restrictions. We included studies that compared different doses of aspirin in patients that had undergone CABG surgery. We included studies that evaluated patient-important outcomes (mortality, cardiovascular events, and gastrointestinal bleeding); and if not reported, we collected data on the surrogate outcome thromboxane B2 (TXB2). We collected relevant data and performed a meta-analysis. Results: We identified 5903 references, and after two levels of screening by two independent reviewers, we included three randomized controlled trials in the meta-analysis with a total number of 122 participants. Mean age of trial participants was 65.63 years, and 88.68% were male. We planned to analyze all possible clinical outcomes, including mortality, recurrence, and hospitalization. However, no clinical outcomes are reported by the literature. The surrogate biochemical outcome of serum TXB2 was the only outcome reported by the eligible studies. High-dose aspirin (162–325mg once daily) achieved better suppression of TXB2 than low-dose aspirin (75–100mg once daily) (mean difference [MD], 2.00ng/mL, 95% confidence interval [CI]: 0.72–3.32; participants = 122; studies = 3; I2 = 0%). Conclusions: We found no clinical trials addressing any of the clinical outcomes of interest. High-dose aspirin was superior to low-dose aspirin in suppressing platelet function, a surrogate outcome. Trials evaluating clinical and patient-important outcomes are needed to better inform medical practice and fill this gap in clinical knowledge.
Collapse
Affiliation(s)
- Fares Alahdab
- Evidence-based Practice Center, Mayo Clinic, Rochester, Michigan, USA
| | - Ruba Zuhri Yafi
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Abdelkader Chaar
- Department of Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Ali Alrstom
- Department of Medicine, Damascus University, Almwasat Hospital, Damascus, Syrian Arab Republic
| | - Muayad Alzuabi
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Omar Alhalabi
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Somar Hasan
- Department of Ophthalmology, Jena University Hospital, Jena, Germany
| | - Mahmoud Mallak
- Children's University Hospital, Damascus, Syrian Arab Republic
| | | | - Qusay Haydour
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Michigan, USA
| | - Wedad Alfarkh
- Department of Pathology, Baylor College of Medicine, Rochester, Michigan, USA
| | | |
Collapse
|
185
|
Misumida N, Guerrero M, Pislaru SV, Alkhouli M, Rihal CS, Eleid MF. Hemodynamic response to transseptal transcatheter mitral valve replacement in patients with severe mitral stenosis due to severe mitral annular calcification. Catheter Cardiovasc Interv 2020; 97:E992-E1001. [DOI: 10.1002/ccd.29285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/19/2020] [Accepted: 09/13/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Naoki Misumida
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| | - Mayra Guerrero
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| | - Sorin V. Pislaru
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| | | | - Mackram F. Eleid
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| |
Collapse
|
186
|
Osman M, Al-Hijji M, Kawsara A, Patel B, Alkhouli M. TCT CONNECT-337 Comparative Outcomes of Mitral Valve in Valve Implantation vs. Redo Mitral Valve Replacement for Degenerated Bioprostheses. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
187
|
Abstract
Left atrial appendage closure has emerged as a feasible stroke prevention strategy in selected patients with nonvalvular atrial fibrillation. Since its commercial approval in the United States in 2015, the use of percutaneous left atrial appendage closure has witnessed a substantial growth. However, certain issues remain unresolved with the technology. Knowledge of these issues, their significance, and the current and future efforts to resolve them is key for proper informed decision making by physicians and patients.
Collapse
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
188
|
Mahowald MK, Alqahtani F, Alkhouli M. Comparison of Outcomes of Coronary Revascularization for Acute Myocardial Infarction in Men Versus Women. Am J Cardiol 2020; 132:1-7. [PMID: 32773227 DOI: 10.1016/j.amjcard.2020.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/25/2022]
Abstract
This study sought to examine the differences in the characteristics and outcomes between men and women who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) in contemporary US practice. The Nationwide Inpatient Sample was used to identify patients who underwent revascularization for AMI between January 1, 2003 and December 31, 2016. The primary outcome was in-hospital mortality. Propensity score matching was utilized to account for differences in baseline characteristics. In total, 3,603,142 patients were included, of whom only 1,180,436 (33%) were women. Compared with men, women were older and had higher prevalence of key co-morbidities including diabetes, hypertension, congestive heart failure, and chronic kidney and lung disease (p <0.001). In the PCI cohort, women were significantly less likely to undergo multivessel PCI, to receive mechanical circulatory support, or to undergo atherectomy. In the CABG group, women were more likely to have concomitant valve surgery. In the propensity-matched cohorts, in-hospital mortality was higher for women than men regardless of revascularization strategy: 7.6% versus 6.6% for PCI in ST-elevation myocardial infarction, 2.0% versus 1.9% for PCI in non-ST-elevation myocardial infarction, and 5.7% versus 4.3% for CABG in any AMI (p <0.001). Women also had higher rates of major complications, longer hospitalizations, higher costs, and were less likely to be discharged home (vs nursing facility). These sex-based differences persisted over the study 14-year period. In conclusion, in a contemporary nationwide analysis of propensity score-matched patients, women who undergo revascularization for AMI have worse in-hospital outcomes than men regardless of revascularization mode.
Collapse
|
189
|
Osman M, Patel B, Munir M, Kawsara A, Kheiri B, Daggubati R, Michos E, Alkhouli M. TCT CONNECT-445 Sex-Stratified Analysis of the Safety of Percutaneous Left Atrial Appendage Occlusion: An Insight From the National Readmission Database. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
190
|
Jung R, Simard T, Don C, Di Santo P, Adamo M, Valentini F, Benito-González T, Fernandez-Vazquez F, Estevez-Loureiro R, Conti N, Rapezzi C, Biagini E, Parlow S, Shorr R, Levi A, Diaz Fernandez JF, Haberman D, Alessandra S, Alkhouli M, Marini C, Bargagna M, Schiavi D, Denti P, Buzzatti N, Hynes M, Mesana T, Labinaz M, Markovic S, Pappalardo F, Taramasso M, Hibbert B. TCT CONNECT-336 Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation: A Patient-Level, Multicenter Analysis. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
191
|
|
192
|
Osman M, Al-Hijji MA, Kawsara A, Patel B, Alkhouli M. Comparative Outcomes of Mitral Valve in Valve Implantation Versus Redo Mitral Valve Replacement for Degenerated Bioprotheses. Am J Cardiol 2020; 132:175-176. [PMID: 32723558 DOI: 10.1016/j.amjcard.2020.06.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
|
193
|
Khan SU, Khan MZ, Lone AN, Khan MS, Subramanian CR, Michos ED, Alkhouli M. Trends of Comorbidities in Clinical Trials of Atrial Fibrillation. Am J Cardiol 2020; 131:127-128. [PMID: 32709421 DOI: 10.1016/j.amjcard.2020.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
|
194
|
Ullah W, Gowda SN, Khan MS, Sattar Y, Al-khadra Y, Rashid M, Mohamed MO, Alkhouli M, Kapadia S, Bagur R, Mamas MA, Fischman DL, Alraies MC. Early intervention or watchful waiting for asymptomatic severe aortic valve stenosis: a systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2020; 21:897-904. [DOI: 10.2459/jcm.0000000000001110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
195
|
Killu AM, Guerrero M, Siontis KC, El Sabbagh A, Eleid MF, Alkhouli M, Rihal C, Asirvatham SJ. A novel technique—Prophylactic septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement (RADIO‐TMVR). J Cardiovasc Electrophysiol 2020; 31:3048-3055. [DOI: 10.1111/jce.14720] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Ammar M. Killu
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
| | - Konstantinos C. Siontis
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
| | - Mackram F. Eleid
- Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
| | - Charanjit Rihal
- Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
| | - Samuel J. Asirvatham
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine Mayo Clinic Hospital Rochester Minnesota USA
- Department of Pediatric and Adolescent Medicine Mayo Clinic Hospital Rochester Minnesota USA
- Department of Biomedical Engineering Mayo Clinic Hospital Rochester Minnesota USA
| |
Collapse
|
196
|
Usman MS, Siddiqi TJ, Khan MS, Ahmed A, Ali SS, Michos ED, Hall ME, Krasuski RA, Greene SJ, Butler J, Alkhouli M. A Meta-analysis of the Relationship Between Renin-Angiotensin-Aldosterone System Inhibitors and COVID-19. Am J Cardiol 2020; 130:159-161. [PMID: 32624189 PMCID: PMC7266568 DOI: 10.1016/j.amjcard.2020.05.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/29/2020] [Indexed: 12/22/2022]
Affiliation(s)
| | - Tariq Jamal Siddiqi
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Shahzeb Khan
- Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Areeba Ahmed
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Saad Ali
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Richard A Krasuski
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
197
|
Annie F, Bates MC, Nanjundappa A, Bhatt DL, Alkhouli M. Prevalence and Outcomes of Acute Ischemic Stroke Among Patients ≤50 Years of Age With Laboratory Confirmed COVID-19 Infection. Am J Cardiol 2020; 130:169-170. [PMID: 32690214 PMCID: PMC7293843 DOI: 10.1016/j.amjcard.2020.06.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/09/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Frank Annie
- Charleston Area Medical Center Institute (CAMC) for Academic Medicine and CAMC Health, Education and Research Institute, Charleston, West Virginia
| | - Mark C Bates
- Charleston Area Medical Center Institute (CAMC) for Academic Medicine and CAMC Health, Education and Research Institute, Charleston, West Virginia; West Virginia University, Charleston Division, Charleston, West Virginia
| | - Aravinda Nanjundappa
- Charleston Area Medical Center Institute (CAMC) for Academic Medicine and CAMC Health, Education and Research Institute, Charleston, West Virginia; West Virginia University, Charleston Division, Charleston, West Virginia
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
198
|
Khan SU, Khan MU, Virani SS, Khan MS, Khan MZ, Rashid M, Kalra A, Alkhouli M, Blaha MJ, Blumenthal RS, Michos ED. Efficacy and Safety for the Achievement of Guideline-Recommended Lower Low-Density Lipoprotein Cholesterol Levels: A Systematic Review and Meta-Analysis. Am J Prev Cardiol 2020. [DOI: 10.1016/j.ajpc.2020.100050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
199
|
Kawsara A, Sulaiman S, Alqahtani F, Eleid MF, Deshmukh AJ, Cha YM, Rihal CS, Alkhouli M. Temporal Trends in the Incidence and Outcomes of Pacemaker Implantation After Transcatheter Aortic Valve Replacement in the United States (2012-2017). J Am Heart Assoc 2020; 9:e016685. [PMID: 32862774 PMCID: PMC7726966 DOI: 10.1161/jaha.120.016685] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Nationwide studies documenting temporal trends in permanent pacemaker implantation (PPMI) following transcatheter aortic valve replacement (TAVR) are limited. Methods and Results We selected patients who underwent TAVR between 2012 and 2017 in the National Readmission Database. The primary end point was the 6‐year trend in post‐TAVR PPMI at index hospitalization and at 30, 90, and 180 days after discharge. The secondary end point was the association between PPMI and in‐hospital mortality, stroke, cost, length of stay, and disposition. Among the 89 202 patients who underwent TAVR, 77 405 (86.8%) with no prior pacemaker or defibrillator were included. Patients who required PPMI had a higher prevalence of atrial fibrillation (43.6% versus 38.7%, P<0.001) and conduction abnormalities (28.4% versus 15.3%, P<0.001). The incidence of PPMI during index admission increased from 8.7% in 2012 to 13.2% in 2015, and then decreased to 9.6% in 2017. The incidence of inpatient PPMI within 30 days after discharge increased from 0.5% in 2012 to 1.25% in 2017 (Ptrend<0.001). Inpatient PPMI beyond 30 days remained rare (<0.5%) during the study period. After risk adjustment, PPMI was not associated with in‐hospital mortality or stroke but was associated with increased nonhome discharge, longer hospitalization, and higher cost. The incremental expenditure associated with post‐TAVR PPMI during index admission increased from $9.6 million to $72.2 million between 2012 and 2017. Conclusions After an upward trend, rates of PPMI after TAVR in the United States stabilized at ~10% in 2016 to 2017, but there was a notable increase in PPMI within 30 days after the index admission. PPMI was not associated with increased in‐hospital morbidity or mortality but led to longer hospitalization, higher cost, and more nonhome discharges.
Collapse
Affiliation(s)
- Akram Kawsara
- Division of Cardiology Department of Medicine West Virginia University Morgantown WV
| | - Samian Sulaiman
- Division of Cardiology Department of Medicine West Virginia University Morgantown WV
| | - Fahad Alqahtani
- Division of Cardiology Department of Medicine University of Kentucky Lexington KY
| | - Mackram F Eleid
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Abhishek J Deshmukh
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Yong-Mei Cha
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| |
Collapse
|
200
|
Alkhouli M, Alqahtani F, Hopkins LN, Harris AH, Hohmann SF, Tarabishy A, Holmes DR. Clinical Outcomes of On-Site Versus Off-Site Endovascular Stroke Interventions. JACC Cardiovasc Interv 2020; 13:2159-2166. [PMID: 32861630 DOI: 10.1016/j.jcin.2020.05.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/14/2020] [Accepted: 05/12/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim of this study was to assess whether offering local endovascular stroke therapy (EST) rather than transferring patients off-site to receive EST would improve outcomes. BACKGROUND There are limited data to determine whether offering EST on-site rather than transferring patients to receive EST off-site improves clinical outcomes. METHODS A large academic consortium database was queried to identify patients with acute ischemic stroke who received EST between October 2015 and September 2019. Primary endpoints were in-hospital mortality and poor functional outcomes. Secondary endpoints were major complications, length of stay, and cost. Baseline characteristics were adjusted for using propensity score matching and multivariate risk adjustment. RESULTS A total of 22,193 patients with acute ischemic stroke who underwent EST (50.8% on-site, 49.2% off-site) were included. Mean ages were 67.9 ± 15.5 years and 68.4 ± 15.5 years, respectively (p = 0.03). In the propensity score matching analysis, mortality and poor functional outcomes were higher in the off-site EST group (14.7% vs. 11.2% and 40.7% vs. 35.9%, respectively; p < 0.001). In the risk-adjusted analyses with different models, in-hospital mortality and poor functional outcomes remained significantly higher in the off-site EST group. In the most comprehensive model (adjusting for age, sex, demographics, risk factors, tissue plasminogen activator use, and institutional EST volume), in-hospital mortality and poor functional outcomes were significantly higher in the off-site EST group, with odds ratios of 1.38 (95% confidence interval: 1.26 to 1.51) and 1.26 (95% confidence interval: 1.18 to 1.34), respectively (p < 0.001). The incidence of intracranial hemorrhage and mechanical ventilation was higher in the off-site group, but cost was higher in the on-site group in both the propensity score matching and risk-adjusted analyses. CONCLUSIONS In contemporary U.S. practice, patients with acute ischemic stroke treated with EST on-site had lower in-hospital mortality and better functional outcomes compared with those transferred off-site for EST.
Collapse
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota.
| | - Fahad Alqahtani
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - L Nelson Hopkins
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Alyssa H Harris
- Center for Advanced Analytics and Informatics, Chicago, Illinois
| | - Samuel F Hohmann
- Center for Advanced Analytics and Informatics, Chicago, Illinois; Department of Health Systems Management, Rush University, Chicago, Illinois
| | - Abdul Tarabishy
- Division of Neuroradiology, West Virginia University, Morgantown, West Virginia
| | - David R Holmes
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
| |
Collapse
|