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Kumar A, Shariff M, Majmundar M, Stulak JM, Anavekar N, Deshmukh A, Bashir R. Intravascular Ultrasound during Endovascular Intervention for Peripheral Artery Disease, by Severity, Location, Device, and Procedure. Am J Cardiol 2024; 225:41-51. [PMID: 38871159 DOI: 10.1016/j.amjcard.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/21/2024] [Accepted: 05/17/2024] [Indexed: 06/15/2024]
Abstract
There is limited evidence for the role of intravascular ultrasound (IVUS) in patients who underwent peripheral vascular intervention (PVI). We conducted retrospective cohort study utilizing the Healthcare Cost and Utilization Project-Agency for Healthcare Research and Quality National Readmission database to delineate outcomes in IVUS-guided PVI versus non-IVUS-guided PVI. The present study utilized National Readmission database between January 1, 2016, and December 31, 2019. We identified patients who underwent endovascular intervention for peripheral artery disease using relevant International Classification of Diseases, Tenth Revision, Procedural Coding System. The cohort was divided based on the use of IVUS during the procedure. The primary outcome was major amputation at 6 months after index hospitalization. Measured confounders were matched using propensity score inverse probability of treatment weighing method. We further performed a subgroup analysis based on disease severity, location of intervention, device, and procedure. A total of 434,901 hospitalizations were included in the present analysis. PVI with IVUS compared with no IVUS had similar risk of amputation at 6 months (195 of 8,939 [2.17%] vs 10,404 of 384,003 [2.71%]), hazard ratio 0.98, CI 0.77 to 1.25. Further, there was no difference in the rates of secondary outcomes. On subgroup analysis, amputation rates were significantly lower in patients with rest pain, in iliac intervention, or patients who underwent drug-eluting stent implantation with the use of IVUS compared with no IVUS. This nationwide observational study showed that there was no difference in major amputation rates with the use of IVUS in patients who underwent PVI. However, in subgroup of patients with rest pain, iliac intervention or drug-eluting stent implantation IVUS use was associated with significantly lower major amputation rates.
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Affiliation(s)
- Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio
| | - Mariam Shariff
- Department of Surgery, Mayo Clinic, Rochester, Minneapolis
| | - Monil Majmundar
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nandan Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Riyaz Bashir
- Department of Cardiovascular Disease, Temple University Hospital, Philadelphia, Pennsylvania.
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Rheaume BA, Adeel MY, Dahal K, Lee J. Recurrent Acute Limb Ischemia and Successful Treatment with Endovascular Thrombectomy. Yonsei Med J 2024; 65:488-491. [PMID: 39048325 PMCID: PMC11284302 DOI: 10.3349/ymj.2023.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/18/2024] [Accepted: 03/05/2024] [Indexed: 07/27/2024] Open
Abstract
Atrial fibrillation (AF) is associated with an increased risk of thromboembolic events; however, many patients with AF are noncompliant with medication regimens, which increases said risk substantially. Suboptimal health literacy presents significant hurdles to compliance with medical treatment. Here we present a case of an elderly Hispanic woman with AF and several comorbidities, including a history of dementia, who presented with consecutive recurrence of acute limb ischemia in the bilateral lower extremities just 3 days apart. Both events were successfully treated with endovascular thrombectomy. This case study not only showcases the efficacy of the latest endovascular technologies, but also draws attention to the importance of strict patient medication adherence in AF and the effects that health literacy can have on said adherence.
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Affiliation(s)
- Bruce A Rheaume
- The Pat and Jim Calhoun Cardiovascular Center, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Muhammad Y Adeel
- The Pat and Jim Calhoun Cardiovascular Center, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Khagendra Dahal
- Division of Cardiology, Creighton University, Omaha, NE, USA
| | - Juyong Lee
- The Pat and Jim Calhoun Cardiovascular Center, University of Connecticut School of Medicine, Farmington, CT, USA.
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Ashoobi MT, Hemmati H, Aghayan HR, Zarei-Behjani Z, Keshavarz S, Babaloo H, Maroufizadeh S, Yousefi S, Farzin M, Vojoudi E. Wharton's jelly mesenchymal stem cells transplantation for critical limb ischemia in patients with type 2 diabetes mellitus: a preliminary report of phase I clinical trial. Cell Tissue Res 2024; 395:211-220. [PMID: 38112806 DOI: 10.1007/s00441-023-03854-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
Peripheral artery disease (PAD) affects more than 230 million people worldwide, with approximately 11% of patients presenting with advanced-stage PAD or critical limb ischemia (CLI). To avoid or delay amputation, particularly in no-option CLI patients with infeasible or ineffective revascularization, new treatment strategies such as regenerative therapies should be developed. Mesenchymal stem cells (MSCs) are the most popular cell source in regenerative therapies. They possess significant characteristics such as angiogenic, anti-inflammatory, and immunomodulatory activities, which encourage their application in different diseases. This phase I clinical trial reports the safety, feasibility, and probable efficacy of the intramuscular administration of allogeneic Wharton's jelly-derived MSCs (WJ-MSCs) in type 2 diabetes patients with CLI. Out of six screened patients with CLI, five patients were administered WJ-MSCs into the gastrocnemius, soleus, and the proximal part of the tibialis anterior muscles of the ischemic lower limb. The safety of WJ-MSCs injection was considered a primary outcome. Secondary endpoints included wound healing, the presence of pulse at the disease site, the absence of amputation, and improvement in visual analogue scale (VAS), pain-free walking time, and foot and ankle disability index (FADI). No patient experienced adverse events and foot or even toe amputation during the 6-month follow-up. Six months after the intervention, there were a significantly lower VAS score and significantly higher pain-free walking time and FADI score than the baseline, but no statistically significant difference was seen between other time points. In conclusion, allogeneic WJ-MSC transplantation in patients with CLI seems to be safe and effective.
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Affiliation(s)
- Mohammad Taghi Ashoobi
- Department of General Surgery, School of Medicine Road Trauma Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Hossein Hemmati
- Department of General Surgery, School of Medicine Road Trauma Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | - Hamid Reza Aghayan
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Zarei-Behjani
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Keshavarz
- School of Paramedicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamideh Babaloo
- Biotechnology Research Center, International Campus, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Saman Maroufizadeh
- Department of Biostatistics, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Saeed Yousefi
- Department of General Surgery, School of Medicine Road Trauma Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohaya Farzin
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Elham Vojoudi
- School of Paramedicine, Guilan University of Medical Sciences, Rasht, Iran.
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Majmundar M, Patel KN, Doshi R, Kumar A, Arora S, Panaich S, Kalra A. Transcatheter versus surgical mitral valve repair in patients with mitral regurgitation. Eur J Cardiothorac Surg 2024; 65:ezad391. [PMID: 38001034 DOI: 10.1093/ejcts/ezad391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES The aim of this study was to compare clinical outcomes of transcatheter and surgical mitral valve repair (SMVr) in primary mitral regurgitation (MR) and MR with heart failure with reduced ejection fraction (HFrEF). METHODS In this retrospective cohort study, we used the Nationwide Readmission Database to identify primary MR and MR with HFrEF patients who underwent transcatheter or SMVr from 2016 to 2019. A propensity score with 1:1 matching was applied. The primary outcome was a cumulative event rate of major adverse cardiovascular events (MACE), which was a composite of all-cause mortality, myocardial infarction, stroke, heart failure, cardiac arrest and mitral valve replacement. Other important secondary outcome was in-hospital mortality. RESULTS After propensity score matching, 2187 matched pairs were found in the primary MR cohort and 2178 matched pairs were found in the MR-HFrEF cohort. Transcatheter mitral valve repair (TMVr) had significantly higher medium-term MACE compared with SMVr in both cohorts (primary MR: hazard ratio: 1.73, 95% confidence interval: 1.33-2.26, P ≤ 0.001; MR-HFrEF: hazard ratio: 2.00, 95% confidence interval: 1.58-2.54, P ≤ 0.001). TMVr showed similar in-hospital mortality in both cohorts. CONCLUSIONS Although TMVr showed better short-term outcomes, it had significantly higher medium-term MACE than SMVr in both cohorts. Thus, shared decision-making should be performed for TMVr after discussing the benefits and risks in patients who can undergo SMVr.
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Affiliation(s)
- Monil Majmundar
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Rajkumar Doshi
- Department of Cardiology, St. Joseph's University Medical Centre, Paterson, NJ, USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Shilpkumar Arora
- Department of Cardiology, Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Sidakpal Panaich
- Division of Cardiovascular Medicine, University of Iowa, Iowa, IA, USA
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Cho NY, Tran Z, Bakhtiyar SS, Orellana M, Kronen E, Bowens N, Benharash P. Factors Associated With Early Amputation in Patients With Chronic Limb Threatening Ischemia. Am Surg 2023; 89:4111-4116. [PMID: 37212353 DOI: 10.1177/00031348231177945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Despite advancements in revascularization procedures, early amputation (EA) among patients with chronic limb threatening ischemia (CLTI) are still common. The present study evaluated clinical outcomes of patients with CLTI and factors associated with EA. METHODS The 2016-2019 Nationwide Readmission Database was queried to identify all adults (≥18 years) with CLTI of lower extremities undergoing limb salvage (LS) procedures. The primary outcome of the study was EA within 90 days of discharge. Secondary outcomes included infectious complication, length of stay (LOS), cumulative hospitalization cost and non-home discharge. RESULTS Of 103,703 patients who initially underwent surgical or endovascular revascularization, 10,439 (10.1%) subsequently underwent major amputation within 90 days of discharge. Following risk adjustment, factors associated with higher odds of EA were male sex, low-income quartile, tissue loss due to ulceration or gangrene, end-stage renal disease, and diabetes. Compared to those undergoing open revascularization, patients with endovascular limb salvage had a higher likelihood of having early amputation (AOR 1.41, 95% CI 1.31-1.51). Patients undergoing EA had greater odd of infectious complication, incremental LOS, incremental cost and non-home discharge. CONCLUSIONS We identified several risk factors to be associated with EA in patients with CLTI. These findings may supplement the objective performance goals for limb-related outcomes and facilitate institutional limb salvage programs.
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Affiliation(s)
- Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Zachary Tran
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | | | - Manuel Orellana
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Elsa Kronen
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nina Bowens
- Department of Surgery, Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Majmundar M, Patel KN, Doshi R, Mehta H, Vindhyal MR, Hance KA, Ali A, Gupta K. Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb-Threatening Ischemia. J Am Heart Assoc 2023; 12:e030294. [PMID: 37642031 PMCID: PMC10547316 DOI: 10.1161/jaha.123.030294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023]
Abstract
Background The impact of medical record-based frailty assessment on clinical outcomes in patients undergoing revascularization for critical limb-threatening ischemia (CLTI) is unknown. Methods and Results This study included patients with CLTI aged ≥18 years from the nationwide readmissions database 2016 to 2018 who underwent endovascular revascularization (ER) or surgical revascularization (SR). The hospital frailty risk score, a previously validated International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) claims-based score, was used to categorize patients into low- (<5), intermediate- (5-15), and high-risk (>15) frailty categories. Primary outcomes were in-hospital mortality and major amputation at 6 months. A total of 64 338 patients were identified who underwent ER (82.3%) or SR (17.7%) for CLTI. The mean (SD) age of the cohort was 69.3 (11.8) years, and 63% of patients were male. This study found a nonlinear association between hospital frailty risk score and in-hospital mortality and 6-month major amputation. In both ER and SR cohorts, the intermediate- and high-risk groups were associated with a significantly higher risk of in-hospital mortality (high-risk group: ER: odds ratio [OR], 7.2 [95% CI, 4.4-11.6], P<0.001; SR: OR, 28.6 [95% CI, 3.4-237.6], P=0.002) and major amputation at 6 months (high-risk group: ER: hazard ratio [HR], 1.6 [95% CI, 1.5-1.7], P<0.001; SR: HR, 1.7 [95% CI, 1.4-2.2], P<0.001) compared with the low-risk group. Conclusions The hospital frailty risk score, generated from the medical record, can identify frailty and predict in-hospital mortality and 6-month major amputation in patients undergoing ER or SR for CLTI. Further studies are needed to assess if this score can be incorporated into clinical decision-making in patients undergoing revascularization for CLTI.
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Affiliation(s)
- Monil Majmundar
- Department of Cardiovascular MedicineUniversity of Kansas Medical CenterKansas CityKSUSA
| | - Kunal N. Patel
- Department of Cardiovascular MedicineWest Virginia UniversityMorgantownWVUSA
| | - Rajkumar Doshi
- Department of CardiologySt. Joseph’s University Medical CenterPatersonNJUSA
| | - Harsh Mehta
- Department of Cardiovascular MedicineUniversity of Kansas Medical CenterKansas CityKSUSA
| | - Mohinder R. Vindhyal
- Department of Cardiovascular MedicineUniversity of Kansas Medical CenterKansas CityKSUSA
| | - Kirk A Hance
- Department of Surgery, Division of Vascular SurgeryUniversity of Kansas Medical CenterKSKansas CityUSA
| | - Adam Ali
- Department of RadiologyUniversity of Kansas Medical CenterKansas CityKSUSA
| | - Kamal Gupta
- Department of Cardiovascular MedicineUniversity of Kansas Medical CenterKansas CityKSUSA
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Salih M, Ibrahim R, Eljack A, Sayfo S. Successful Revascularization of Critical Limb Ischemia: A Challenging Case of a Unilateral Tibial-to-Tibial Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S194-S198. [PMID: 36804304 DOI: 10.1016/j.carrev.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/05/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
Critical limb ischemia requires urgent diagnosis and intervention. Limitations to percutaneous revascularization therapy stem from multilevel diseased vasculature. Retrograde revascularization utilizing anterior tibial artery access in complex and proximal lesions is an alternative route for intervention that can lead to limb salvage and symptom resolution.
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Affiliation(s)
- Mohammed Salih
- Baylor University Medical Center, The Heart Hospital, 1100 Allied Drive, Plano, TX 75093, United States of America.
| | - Ramzi Ibrahim
- Department of Medicine, Banner University Medical Center-University of Arizona, 1501 N. Campbell Ave., Tucson, AZ 85724, United States of America
| | - Ammar Eljack
- Baylor University Medical Center, The Heart Hospital, 1100 Allied Drive, Plano, TX 75093, United States of America
| | - Sameh Sayfo
- Baylor University Medical Center, The Heart Hospital, 1100 Allied Drive, Plano, TX 75093, United States of America
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Patel KN, Majmundar M, Khawaja T, Doshi R, Kaur A, Mehta H, Gupta K. Causes and Predictors of 30-Day Readmission in Patients With COVID-19 and ST-Segment-Elevation Myocardial Infarction in the United States: A Nationwide Readmission Database Analysis. J Am Heart Assoc 2023; 12:e029738. [PMID: 37489728 PMCID: PMC10492991 DOI: 10.1161/jaha.123.029738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023]
Abstract
Background Rates, causes, and predictors of readmission in patients with ST-segment-elevation myocardial infarction (STEMI) during COVID-19 pandemic are unknown. Methods and Results All hospitalizations for STEMI were selected from the US Nationwide Readmissions Database 2020 and were stratified by the presence of COVID-19. Primary outcome was 30-day readmission. Multivariable hierarchical generalized logistic regression analysis was performed to compare 30-day readmission between patients with STEMI with and without COVID-19 and to identify the predictors of 30-day readmissions in patients with STEMI and COVID-19. The rate of 30-day all-cause readmission was 11.4% in patients with STEMI who had COVID-19 and 10.6% in those without COVID-19, with the adjusted odds ratio (OR) not being significantly different between the two groups (OR, 0.88 [95% CI, 0.73-1.07], P=0.200). Of all 30-day readmissions in patients with STEMI and COVID-19, 41% were for cardiac causes. Among the cardiac causes, 56% were secondary to acute coronary syndrome, while among the noncardiac causes, infections were the most prevalent. Among the causes of 30-day readmissions, infectious causes were significantly higher for patients with STEMI who had COVID-19 compared with those without COVID-19 (29.9% versus 11.3%, P=0.001). In a multivariable model, congestive heart failure, chronic kidney disease, low median household income, and length of stay ≥5 days were found to be associated with an increased risk of 30-day readmission. Conclusions Post-STEMI, 30-day readmission rates were similar between patients with and without COVID-19. Cardiac causes were the most common causes for 30-day readmissions, and infections were the most prevalent noncardiac causes.
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Affiliation(s)
- Kunal N. Patel
- Department of Internal MedicineSaint Peter’s University HospitalNew BrunswickNJUSA
- Now with Department of Cardiovascular MedicineWest Virginia University Medicine Heart and Vascular InstituteMorgantownWVUSA
| | - Monil Majmundar
- Department of Cardiovascular MedicineUniversity of Kansas Medical CenterKansas CityKSUSA
| | - Tasveer Khawaja
- Department of Internal MedicineCase Western Reserve University, University HospitalsClevelandOHUSA
| | - Rajkumar Doshi
- Department of CardiologySt. Joseph’s University Medical CenterPatersonNJUSA
| | - Avleen Kaur
- Department of Internal MedicineMaimonides Medical CenterBrooklynNYUSA
| | - Harsh Mehta
- Department of Cardiovascular MedicineUniversity of Kansas Medical CenterKansas CityKSUSA
| | - Kamal Gupta
- Department of Cardiovascular MedicineUniversity of Kansas Medical CenterKansas CityKSUSA
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Patel KN, Majmundar M, Vasudeva R, Doshi R, Kaur A, Mehta H, Gupta K. Impact of Gender, Race, and Insurance Status on Inhospital Management and Outcomes in Patients With COVID-19 and ST-Elevation Myocardial Infarction (a Nationwide Analysis). Am J Cardiol 2023; 198:14-25. [PMID: 37196529 DOI: 10.1016/j.amjcard.2023.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/30/2023] [Accepted: 04/15/2023] [Indexed: 05/19/2023]
Abstract
There is a paucity of data exploring the impact of gender, race, and insurance status on invasive management and inhospital mortality in patients with COVID-19 with ST-elevation myocardial infarction (STEMI) in the United States. The National Inpatient Sample database for the year 2020 was queried to identify all adult hospitalizations with STEMI and concurrent COVID-19. A total of 5,990 patients with COVID-19 with STEMI were identified. Women had 31% lower odds of invasive management and 32% lower odds of coronary revascularization than men. Black patients had lower odds of invasive management (odds ratio [OR] 0.61, 95% confidence interval [CI] 0.43 to 0.85, p = 0.004) than White patients. Black and Asian patients had lower odds of percutaneous coronary intervention (Black: OR 0.55, 95% CI 0.38 to 0.80, p = 0.002; Asian: OR 0.39, 95% CI 0.18 to 0.85, p = 0.018) than White patients. Uninsured patients had higher odds of getting percutaneous coronary intervention (OR 1.78, 95% CI 1.05 to 2.98, p = 0.031) and lower odds of inhospital mortality (OR 0.41, 95% CI 0.19 to 0.89, p = 0.023) than privately insured patients. Patients with out-of-hospital STEMI had 19 times higher odds of invasive management and 80% lower odds of inhospital mortality than inhospital STEMI. In conclusion, we note important gender and racial disparities in invasive management of patients with COVID-19 with STEMI. Surprisingly, uninsured patients had higher revascularization rates and lower mortality than privately insured patients.
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Affiliation(s)
- Kunal N Patel
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Monil Majmundar
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Rhythm Vasudeva
- Department of Internal Medicine, University of Kansas School of Medicine, Wichita, Kansas
| | - Rajkumar Doshi
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, New Jersey
| | - Avleen Kaur
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Harsh Mehta
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Kamal Gupta
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas.
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Berchiolli R, Bertagna G, Adami D, Canovaro F, Torri L, Troisi N. Chronic Limb-Threatening Ischemia and the Need for Revascularization. J Clin Med 2023; 12:jcm12072682. [PMID: 37048765 PMCID: PMC10095037 DOI: 10.3390/jcm12072682] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Patients presenting with critical limb-threatening ischemia (CLTI) have been increasing in number over the years. They represent a high-risk population, especially in terms of major amputation and mortality. Despite multiple guidelines concerning their management, it continues to be challenging. Decision-making between surgical and endovascular procedures should be well established, but there is still a lack of consensus concerning the best treatment strategy. The aim of this manuscript is to offer an overview of the contemporary management of CLTI patients, with a focus on the concept that evidence-based revascularization (EBR) could help surgeons to provide more appropriate treatment, avoiding improper procedures, as well as too-high-risk ones. METHODS We performed a search on MEDLINE, Embase, and Scopus from 1 January 1995 to 31 December 2022 and reviewed Global and ESVS Guidelines. A total of 150 articles were screened, but only those of high quality were considered and included in a narrative synthesis. RESULTS Global Vascular Guidelines have improved and standardized the way to classify and manage CLTI patients with evidence-based revascularization (EBR). Nevertheless, considering that not all patients are suitable for revascularization, a key strategy could be to stratify unfit patients by considering both clinical and non-clinical risk factors, in accordance with the concept of individual residual risk for every patient. The recent BEST-CLI trial established the superiority of autologous vein bypass graft over endovascular therapy for the revascularization of CLTI patients. However, no-option CLTI patients still represent a critical issue. CONCLUSIONS The surgeon's experience and skillfulness are the cornerstones of treatment and of a multidisciplinary approach. The recent BEST-CLI trial established that open surgical peripheral vascular surgery could guarantee better outcomes than the less invasive endovascular approach.
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Affiliation(s)
- Raffaella Berchiolli
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Giulia Bertagna
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Daniele Adami
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Francesco Canovaro
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Lorenzo Torri
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
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