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Iwasawa J, Koruth JS, Mittnacht AJ, Tran VN, Palaniswamy C, Sharma D, Bhardwaj R, Naniwadekar A, Joshi K, Sofi A, Syros G, Choudry S, Miller MA, Dukkipati SR, Reddy VY. The impact of mechanical oesophageal deviation on posterior wall pulmonary vein reconnection. Europace 2021; 22:232-239. [PMID: 31755937 DOI: 10.1093/europace/euz303] [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: 07/16/2019] [Accepted: 11/18/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS During atrial fibrillation ablation, oesophageal heating typically prompts reduction or termination of radiofrequency energy delivery. We previously demonstrated oesophageal temperature rises are associated with posterior left atrial pulmonary vein reconnection (PVR) during redo procedures. In this study, we assessed whether mechanical oesophageal deviation (MED) during an index procedure minimizes posterior wall PVRs during redo procedures. METHODS AND RESULTS Patients in whom we performed a first-ever procedure followed by a clinically driven redo procedure were divided based on both the use of MED for oesophageal protection and the ablation catheter employed (force or non-force sensing) in the first procedure. The PVR sites were compared between MED using a force-sensing catheter (MEDForce), or no MED with a non-force (ControlNoForce) or force (ControlForce) sensing catheter. Despite similar clinical characteristics, the MEDForce redo procedure rate (9.2%, 26/282 patients) was significantly less than the ControlNoForce (17.2%, 126/734 patients; P = 0.002) and ControlForce (17.5%, 20/114 patients; P = 0.024) groups. During the redo procedure, the posterior PVR rate with MEDForce (2%, 1/50 PV pairs) was significantly less than with either ControlNoForce (17.7%, 44/249 PV pairs; P = 0.004) or ControlForce (22.5%, 9/40 PV pairs; P = 0.003), or aggregate Controls (18.3%, 53/289 PV pairs; P = 0.006). However, the anterior PVR rate with MEDForce (8%, 4/50 PV pairs) was not significantly different than Controls (aggregate Controls-3.5%, 10/289 PV pairs, P = 0.136; ControlNoForce-2.4%, 6/249 PV pairs, P = 0.067; ControlForce-10%, 4/40 PV pairs, P = 1.0). CONCLUSION Oesophageal deviation improves the durability of the posterior wall ablation lesion set during AF ablation.
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Affiliation(s)
- Jin Iwasawa
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jacob S Koruth
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alexander J Mittnacht
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Van N Tran
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Chandrasekar Palaniswamy
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Dinesh Sharma
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rahul Bhardwaj
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Aditi Naniwadekar
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kamal Joshi
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Aamir Sofi
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Georgios Syros
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Subbarao Choudry
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Marc A Miller
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Srinivas R Dukkipati
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Vivek Y Reddy
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; and Department of Anesthesiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Makhija RR, Palaniswamy C, Aronow WS. Closure of patent foramen ovale for secondary prevention of cryptogenic stroke: current perspectives. Arch Med Sci 2020; 16:1243-1246. [PMID: 32864016 PMCID: PMC7444727 DOI: 10.5114/aoms.2019.81744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/25/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Chandrasekar Palaniswamy
- Department of Medicine, Division of Cardiology, UCSF Fresno Medical Education Program, Fresno, CA, USA
| | - Wilbert S. Aronow
- Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, NY, USA
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Bhardwaj R, Naniwadekar A, Whang W, Mittnacht AJ, Palaniswamy C, Koruth JS, Joshi K, Sofi A, Miller M, Choudry S, Dukkipati SR, Reddy VY. Esophageal Deviation During Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2018; 4:1020-1030. [DOI: 10.1016/j.jacep.2018.04.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/05/2018] [Accepted: 04/05/2018] [Indexed: 11/28/2022]
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5
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Garg J, Chaudhary R, Shah N, Palaniswamy C, Bozorgnia B, Nazir T, Natale A, Kutyifa V. Right ventricular apical versus non-apical implantable cardioverter defibrillator lead: A systematic review and meta-analysis. J Electrocardiol 2017; 50:591-597. [DOI: 10.1016/j.jelectrocard.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Indexed: 10/19/2022]
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6
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Palaniswamy C, Koruth JS, Mittnacht AJ, Miller MA, Choudry S, Bhardwaj R, Sharma D, Willner JM, Balulad SS, Verghese E, Syros G, Singh A, Dukkipati SR, Reddy VY. The Extent of Mechanical Esophageal Deviation to Avoid Esophageal Heating During Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol 2017; 3:1146-1154. [PMID: 29759498 DOI: 10.1016/j.jacep.2017.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/27/2017] [Accepted: 03/05/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to determine the extent of lateral esophageal displacement required during mechanical esophageal deviation (MED) and to eliminate luminal esophageal temperature elevation (LETElev) during pulmonary vein (PV) isolation. BACKGROUND MED is a conceptually attractive strategy of minimizing esophageal injury while allowing uninterrupted energy delivery along the posterior left atrium during PV isolation. METHODS MED was performed using a malleable metal stylet within a plastic tube placed within the esophagus. Barium was instilled to characterize the trailing esophageal edge. For each MED attempt, the MEDEffective, defined as the distance from the trailing esophageal edge-to-ablation line, was correlated to occurrences of LETElev. RESULTS In 114 consecutive patients/221 PV pairs undergoing MED (age 62.1 ± 11 years, 75% men, 62%/38% paroxysmal/persistent AF), esophageal stretching invariably occurred such that the esophageal edge trailed behind the plastic tube. MEDEffective distances of 0 mm to 10 mm, 10 mm to 15 mm, 15 mm to 20 mm or >20 mm were achieved in 60 (27.1%), 64 (29%), 48 (21.7%), and 49 (22.2%) attempts, respectively. Overall, LET elevation >38°C occurred in 81 of 221 (36.7%) PV pairs. The incidence of LETElev among the 4 groups was 73.3%, 35.9%, 25%, and 4.1%, respectively. MEDEffective distances were 9.1 ± 6.5 mm and 18 ± 7.6 mm in patients with and without LETElev, respectively (p < 0.0001). Three patients (2.6%) experienced clinically significant MED-related trauma, albeit only with a stiffer stylet. CONCLUSIONS Mechanical esophageal deviation >20 mm from the PV ablation line prevents significant esophageal heating during PV isolation, but this level of displacement was difficult to safely achieve with this off-the-shelf mechanical stylet approach.
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Affiliation(s)
| | - Jacob S Koruth
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexander J Mittnacht
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marc A Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Subbarao Choudry
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rahul Bhardwaj
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dinesh Sharma
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jonathan M Willner
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sujata S Balulad
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth Verghese
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Georgios Syros
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anurag Singh
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York.
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7
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Garg J, Chaudhary R, Palaniswamy C, Shah N, Krishnamoorthy P, Bozorgnia B, Natale A. Cryoballoon versus Radiofrequency Ablation for Atrial Fibrillation: A Meta-analysis of 16 Clinical Trials. J Atr Fibrillation 2017; 9:1429. [PMID: 28496925 DOI: 10.4022/jafib.1429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 04/21/2016] [Revised: 08/10/2016] [Accepted: 08/24/2016] [Indexed: 11/10/2022]
Abstract
Introduction: We aimed to study the procedural characteristics, efficacy and safety of cryoballoon ablation (CBA) versus radiofrequency ablation (RFA) for catheter ablation of paroxysmal atrial fibrillation (AF). Methods: A systematic literature search was performed using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to clinical trials comparing CBA and RFA for AF. Outcomes were evaluated for efficacy, procedure characteristics and safety. For each study, odd ratio (OR) and 95% confidence intervals (CIs) were calculated for endpoints for both approaches. Results: We analyzed a total of 9,957 participants (3,369 in the CBA and 6,588 in RFA group) enrolled in 16 clinical trials. No significant difference was observed between CBA and RFA with regards to freedom from atrial arrhythmia at 12-months, recurrent atrial arrhythmias or repeat catheter ablation. CBA group had a significantly higher transient phrenic nerve injury (OR 14.19, 95% CI: 6.92-29.10; p<0.001) and persistent phrenic nerve injury (OR 4.62, 95% CI: 1.97-10.81; p<0.001); and a significantly lower pericardial effusion/cardiac tamponade (OR 0.43, 95% CI: 0.26-0.72; p=0.001), and groin site complications (OR 0.60, 95% CI: 0.38-0.93; p=0.02). No significant difference was observed in overall complications, stroke/thromboembolic events, major bleeding, and minor bleeding. Conclusion: CBA was non-inferior to RFA for catheter ablation of paroxysmal AF. RF ablation was associated with a higher groin complications and pericardial effusion/cardiac tamponade, whereas CBA was associated with higher rates of transient and persistent phrenic nerve injury.
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Affiliation(s)
- Jalaj Garg
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | - Rahul Chaudhary
- Department of Medicine, Sinai Hospital of Baltimore, Johns Hopkins University, Baltimore, MD
| | | | - Neeraj Shah
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | | | - Babak Bozorgnia
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX
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8
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Abstract
This review discusses the role of hemodynamic support for catheter ablation of unstable ventricular tachycardia, using commercially available mechanical circulatory support devices (intra-aortic balloon pump, Impella, TandemHeart, extracorporeal membrane oxygenation) and analyzes the published clinical experience of the safety and efficacy of these devices during ventricular tachycardia ablation. Appropriate selection of patients, device-specific characteristics, and hemodynamic monitoring is also discussed.
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Affiliation(s)
- Chandrasekar Palaniswamy
- Division of Cardiology, Department of Medicine, University of California San Francisco Fresno Medical Education Program, 155 N Fresno Street, Fresno, CA 93701, USA
| | - Marc A Miller
- Helmsley Electrophysiology Center, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
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9
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Nabors C, Forman L, Peterson SJ, Gennarelli M, Aronow WS, DeLorenzo L, Chandy D, Ahn C, Sule S, Stallings GW, Khera S, Palaniswamy C, Frishman WH. Milestones: a rapid assessment method for the Clinical Competency Committee. Arch Med Sci 2017; 13:201-209. [PMID: 28144272 PMCID: PMC5206368 DOI: 10.5114/aoms.2016.64045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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] [Received: 02/05/2016] [Accepted: 03/10/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Educational milestones are now used to assess the developmental progress of all U.S. graduate medical residents during training. Twice annually, each program's Clinical Competency Committee (CCC) makes these determinations and reports its findings to the Accreditation Council for Graduate Medical Education (ACGME). The ideal way to conduct the CCC is not known. After finding that deliberations reliant upon the new milestones were time intensive, our internal medicine residency program tested an approach designed to produce rapid but accurate assessments. MATERIAL AND METHODS For this study, we modified our usual CCC process to include pre-meeting faculty ratings of resident milestones progress with in-meeting reconciliation of their ratings. Data were considered largely via standard report and presented in a pre-arranged pattern. Participants were surveyed regarding their perceptions of data management strategies and use of milestones. Reliability of competence assessments was estimated by comparing pre-/post-intervention class rank lists produced by individual committee members with a master class rank list produced by the collective CCC after full deliberation. RESULTS Use of the study CCC approach reduced committee deliberation time from 25 min to 9 min per resident (p < 0.001). Committee members believed milestones improved their ability to identify and assess expected elements of competency development (p = 0.026). Individual committee member assessments of trainee progress agreed well with collective CCC assessments. CONCLUSIONS Modification of the clinical competency process to include pre-meeting competence ratings with in-meeting reconciliation of these ratings led to shorter deliberation times, improved evaluator satisfaction and resulted in reliable milestone assessments.
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Affiliation(s)
- Christopher Nabors
- Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA
| | - Leanne Forman
- Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA
| | | | - Melissa Gennarelli
- Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA
| | - Wilbert S. Aronow
- Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA
| | - Lawrence DeLorenzo
- Department of Medicine, Division of Pulmonary and Critical Care, New York Medical College at Westchester Medical Center, Valhalla, New York, USA
| | - Dipak Chandy
- Department of Medicine, Division of Pulmonary and Critical Care, New York Medical College at Westchester Medical Center, Valhalla, New York, USA
| | - Chul Ahn
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sachin Sule
- Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA
| | - Gary W. Stallings
- Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA
| | - Sahil Khera
- Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA
| | - Chandrasekar Palaniswamy
- Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA
| | - William H. Frishman
- Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA
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Brouwer TF, Miller MA, Quast AFB, Palaniswamy C, Dukkipati SR, Reddy V, Wilde AA, Willner JM, Knops RE. Implantation of the Subcutaneous Implantable Cardioverter-Defibrillator. Circ Arrhythm Electrophysiol 2017; 10:e004663. [DOI: 10.1161/circep.116.004663] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 09/12/2016] [Accepted: 12/08/2016] [Indexed: 11/16/2022]
Abstract
Background—
Alternative techniques to the traditional 3-incision subcutaneous implantation of the subcutaneous implantable cardioverter-defibrillator may offer procedural and cosmetic advantages. We evaluate 4 different implant techniques of the subcutaneous implantable cardioverter-defibrillator.
Methods and Results—
Patients implanted with subcutaneous implantable cardioverter-defibrillators from 2 hospitals between 2009 and 2016 were included. Four implantation techniques were used depending on physician preference and patient characteristics. The 2- and 3-incision techniques both place the pulse generator subcutaneously, but the 2-incision technique omits the superior parasternal incision for lead positioning. Submuscular implantation places the pulse generator underneath the serratus anterior muscle and subfascial implantation underneath the fascial layer on the anterior side of the serratus anterior muscle. Reported outcomes include perioperative parameters, defibrillation testing, and clinical follow-up. A total of 246 patients were included with a median age of 47 years and 37% female. Fifty-four patients were implanted with the 3-incision technique, 118 with the 2-incision technique, 38 with submuscular, and 37 with subfascial. Defibrillation test efficacy and shock lead impedance during testing did not differ among the groups; respectively,
P
=0.46 and
P
=0.18. The 2-incision technique resulted in the shortest procedure duration and time-to-hospital discharge compared with the other techniques (
P
<0.001). A total of 18 complications occurred, but there were no significant differences between the groups (
P
=0.21). All infections occurred in subcutaneous implants (3-incision, n=3; 2-incision, n=4). In the 2-incision group, there were no lead displacements.
Conclusions—
The presented implantation techniques are feasible alternatives to the standard 3-incision subcutaneous implantation, and the 2-incision technique resulted in shortest procedure duration.
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Affiliation(s)
- Tom F. Brouwer
- From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.)
| | - Marc A. Miller
- From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.)
| | - Anne-Floor B.E. Quast
- From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.)
| | - Chandrasekar Palaniswamy
- From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.)
| | - Srinivas R. Dukkipati
- From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.)
| | - Vivek Reddy
- From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.)
| | - Arthur A. Wilde
- From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.)
| | - Jonathan M. Willner
- From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.)
| | - Reinoud E. Knops
- From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.)
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Krishnamoorthy P, Garg J, Palaniswamy C, Pandey A, Ahmad H, Frishman WH, Lanier G. Epidemiology and outcomes of peripartum cardiomyopathy in the United States. J Cardiovasc Med (Hagerstown) 2016; 17:756-61. [DOI: 10.2459/jcm.0000000000000222] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Garg L, Garg J, Gupta N, Shah N, Krishnamoorthy P, Palaniswamy C, Bozorgnia B, Natale A. Gastrointestinal complications associated with catheter ablation for atrial fibrillation. Int J Cardiol 2016; 224:424-430. [PMID: 27690340 DOI: 10.1016/j.ijcard.2016.09.069] [Citation(s) in RCA: 30] [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: 04/12/2016] [Revised: 09/17/2016] [Accepted: 09/20/2016] [Indexed: 11/25/2022]
Abstract
Atrial fibrillation is the most common arrhythmia in the United States. With the ageing population, the incidence and prevalence of atrial fibrillation are on the rise. Catheter ablation of atrial fibrillation is a widely accepted treatment modality in patients with drug refractory symptomatic paroxysmal or persistent atrial fibrillation. The close proximity to the left atrium posterior wall makes the thermosensitive esophagus a potential site of injury during catheter ablation of AF leading to various gastrointestinal complications. The major gastrointestinal complications associated with catheter ablation include atrioesophageal fistula, gastroparesis, esophageal thermal lesions and esophageal ulcers. Multiple studies, case reports and series have described these complications with various catheter ablation techniques such as radiofrequency, cryoenergy and high frequency focused ultrasound energy ablation. This review addresses the gastrointestinal complications after AF ablation procedures and aims to provide the clinicians with an overview of clinical presentation, etiology, pathogenesis, prevention and management of these conditions.
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Affiliation(s)
- Lohit Garg
- Department of Medicine, Beaumont Health, Royal Oak, MI, United States
| | - Jalaj Garg
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, United States.
| | - Nancy Gupta
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Neeraj Shah
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, United States
| | - Parasuram Krishnamoorthy
- Department of Medicine, Division of Cardiology, Einstein Healthcare Network, Philadelphia, PA, United States
| | | | - Babak Bozorgnia
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, United States
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX, United States
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13
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Garg J, Chaudhary R, Krishnamoorthy P, Palaniswamy C, Shah N, Bozorgnia B, Natale A. Safety and efficacy of oral factor-Xa inhibitors versus Vitamin K antagonist in patients with non-valvular atrial fibrillation: Meta-analysis of phase II and III randomized controlled trials. Int J Cardiol 2016; 218:235-239. [PMID: 27236121 DOI: 10.1016/j.ijcard.2016.05.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 05/12/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Aim of our study was to assess the safety and efficacy on factor-Xa inhibitors (FXIs) in patients with non-valvular atrial fibrillation (NVAF) as compared to Vitamin K antagonist (VKA). METHODS Phase II and III randomized controlled trials that reported clinical safety and efficacy of FXI in patients with NVAF were identified from MEDLINE, Embase, and Cochrane Central Register of Controlled Trials through December 10, 2015. The primary safety outcome of our study was composite of stroke and systemic embolic event. Secondary outcomes studied were individual endpoints of primary safety outcome, major bleeding, clinically relevant non-major bleed (CRNMB), and all-cause mortality. RESULTS We included 11 RCTs with a total of 59,164 participants, of which 34,231 patients received oral FXI and 24,933 patients were on VKA with a mean follow-up of 369days. There was a significant reduction in primary outcome with FXI compared to VKA, 1,112 (3.4%) versus 816 (3.6%) events, respectively (OR 0.82; 95% CI 0.68-0.99). Use of FXI significantly reduced major bleeding events compared to VKA, OR 0.74, 95% CI 0.58-0.96, test for heterogeneity (I(2)=74%). Incidence of CRNMB was not different between FXI and VKA groups, OR 0.84, 95% CI 0.68-1.04. There was a significant reduction in all-cause mortality in FXI group compared to VKA group, OR 0.88, 95% CI 0.83-0.94 with no significant heterogeneity. CONCLUSION Use of FXI was associated with a significant reduction in major bleeding events and all-cause mortality without increased risk of stroke or SEE compared to VKA.
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Affiliation(s)
- Jalaj Garg
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, United States.
| | - Rahul Chaudhary
- Department of Medicine, Sinai Hospital of Baltimore, Johns Hopkins University, Baltimore, MD, United States
| | - Parasuram Krishnamoorthy
- Department of Medicine, Division of Cardiology, Einstein Healthcare Network, Philadelphia, PA, United States
| | | | - Neeraj Shah
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, United States
| | - Babak Bozorgnia
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, United States
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX, United States
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14
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Mehta V, Sukhija R, Mehra P, Goyal A, Yusuf J, Mahajan B, Gupta VK, Tyagi S, Palaniswamy C, Aronow WS. Multimarker risk stratification approach and cardiovascular outcomes in patients with stable coronary artery disease undergoing elective percutaneous coronary intervention. Indian Heart J 2016; 68:57-62. [PMID: 26896268 PMCID: PMC4759483 DOI: 10.1016/j.ihj.2015.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/29/2015] [Indexed: 11/19/2022] Open
Abstract
Aims We studied the utility of multimarker risk stratification approach to predict cardiovascular outcomes in patients with stable coronary artery disease, undergoing elective percutaneous coronary intervention (PCI). Methods We prospectively evaluated 302 consecutive patients with stable coronary artery disease and normal CPK-MB and cardiac troponin T levels, and who underwent elective PCI at our institution. The following cardiac biomarkers were measured before and between 12 and 24 h post-procedure: CK-MB, cardiac troponin T, hs-CRP, and NT-ProBNP. Patients were followed up for a minimum of 6 months. Results Post-PCI, CPK-MB levels were elevated but below myocardial infarction (MI) range in 70 patients (23%), and in the MI range in 6 patients (2%). Troponin T levels were detectable but below the 99th percentile (microleak) in 32 patients (10.6%) and elevated above the 99th percentile (periprocedural MI) in 104 patients (34.4%). At 9 months’ follow-up, 1% died, 2% had stable angina, 10.3% had non-fatal MI, and 87.7% remained asymptomatic. There was no significant difference in clinical events among groups stratified by elevation of one biomarker or multiple biomarkers. Conclusion Single or multiple biomarker strategy in patients with normal baseline biomarkers failed to predict major cardiac events after PCI over medium-term follow-up.
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Affiliation(s)
- Vimal Mehta
- Department of Cardiology, G.B. Pant Hospital, Delhi, India
| | - Rishi Sukhija
- Department of Medicine, Division of Cardiology, IU Health La Porte Hospital, IN, United States
| | | | - Anuj Goyal
- Department of Cardiology, G.B. Pant Hospital, Delhi, India
| | - Jamal Yusuf
- Department of Cardiology, G.B. Pant Hospital, Delhi, India
| | - Bhawna Mahajan
- Department of Biochemistry, G.B. Pant Hospital, Delhi, India
| | - V K Gupta
- Department of Biochemistry, G.B. Pant Hospital, Delhi, India
| | - Sanjay Tyagi
- Department of Cardiology, G.B. Pant Hospital, Delhi, India
| | | | - Wilbert S Aronow
- Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, NY, United States
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15
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Sule S, Palaniswamy C, Aronow WS, Adapa S, Khera S, Peterson SJ, Ahn C, Balasubramaniyam N, Nabors C. Etiology of Syncope in Patients Hospitalized With Syncope and Predictors of Mortality and Readmission for Syncope at 17-Month Follow-Up. Am J Ther 2016; 23:e2-6. [PMID: 22878409 DOI: 10.1097/mjt.0b013e3182459957] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Balasubramaniyam N, Harikrishnan P, Gupta T, wilbert S aronow, Palaniswamy C, Timmermans R, Ahmad H, Cooper HA, Panza JA. TCT-290 Fractional Flow Reserve Measurement in Non-ST-Elevation Myocardial Infarction: Analysis of the National Inpatient Sample Database. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.305] [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]
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17
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Sharma D, Miller MA, Palaniswamy C, Koruth JS, Dukkipati SR, Reddy VY. The Leadless Cardiac Pacemaker. JACC Clin Electrophysiol 2015; 1:335-336. [DOI: 10.1016/j.jacep.2015.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 04/24/2015] [Accepted: 05/06/2015] [Indexed: 11/26/2022]
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18
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Gass A, Palaniswamy C, Aronow WS, Kolte D, Khera S, Ahmad H, Cuomo LJ, Timmermans R, Cohen M, Tang GH, Kai M, Lansman SL, Lanier GM, Malekan R, Panza JA, Spielvogel D. Peripheral venoarterial extracorporeal membrane oxygenation in combination with intra-aortic balloon counterpulsation in patients with cardiovascular compromise. Cardiology 2015; 129:137-43. [PMID: 25277292 DOI: 10.1159/000365138] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [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: 04/24/2014] [Accepted: 06/06/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Patients with profound cardiovascular compromise have poor prognosis despite inotropic and intra-aortic balloon pump (IABP) support. Peripheral venoarterial extracorporeal membrane oxygenation (V-A ECMO) offers these patients temporary support as a bridge to various options including the 'bridge to recovery'. METHODS We studied the outcomes of 135 patients who underwent peripheral V-A ECMO and concomitant IABP implantation in our hospital from 2007 to 2012 for various clinical indications. The ECMO circuit consisted of a centrifugal pump and an oxygenator. RESULTS V-A ECMO was implanted in the cardiac catheterization laboratory in 51 patients (37.8%), at the bedside in 5 (3.7%) and in the operating room in 79 (58.5%). Mean duration of support was 8.5 ± 7.1 days. Median length of stay was 28 days (interquartile range 14-62). Complications included bleeding at the access site in 14.1%, stroke in 11.1% and vascular complications requiring intervention in 16.3%. Overall inhospital survival was 57.8% with outcomes including heart transplantation (3%), implantable left ventricular assist device (8.1% as bridge to transplantation and 6.7% as destination therapy), surgery (7.4%) and myocardial recovery (40.7%). Prior IABP use and axillary cannulation were independent predictors of reduced inhospital mortality, stroke or vascular injury. CONCLUSIONS Peripheral V-A ECMO with IABP is an effective therapy for patients with severely compromised cardiovascular function. It offers reasonable survival and a spectrum of definitive options from 'bridge to recovery' to heart transplantation for the management of this critically ill population.
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Affiliation(s)
- Alan Gass
- Division of Cardiology, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla, N.Y., USA
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19
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Krishnamoorthy P, Garg J, Sharma A, Palaniswamy C, Shah N, Lanier G, Patel NC, Lavie CJ, Ahmad H. Gender Differences and Predictors of Mortality in Takotsubo Cardiomyopathy: Analysis from the National Inpatient Sample 2009-2010 Database. Cardiology 2015; 132:131-136. [PMID: 26159108 DOI: 10.1159/000430782] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 11/10/2014] [Accepted: 04/16/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Takotsubo cardiomyopathy (TC) is characterized by left-ventricle apical ballooning with elevated cardiac biomarkers and electrocardiographic changes similar to an acute coronary syndrome. We studied the prevalence, in-hospital mortality, and predictors of mortality in TC. METHODS All patients ≥18 years of age diagnosed with TC were identified in the Nationwide Inpatient Sample (NIS) 2009-2010 database using the 9th revision of the International Classification of Diseases (ICD) 429.83. Demographics, conventional risk factors (diabetes, hypertension, hyperlipidemia, and tobacco abuse), acute critical illnesses like sepsis, acute cerebrovascular disease (cerebrovascular accident; CVA), acute respiratory insufficiency, and acute renal failure, and chronic conditions (anxiety, depression, and malignancy) were studied. RESULTS The prevalence of TC was 0.02% (n = 7,510). The total in-hospital mortality rate was 2.4%, with a higher mortality in men (4.8%) than in women (2.1%). Sepsis (9 vs. 4.2%; p < 0.01) was more prevalent in men with an increased prevalence of other critical illness, although this was not statistically significant. Age (OR 1.05; 95% CI 1.01-1.09), malignancy (OR 3.38; 95% CI 1.35-8.41), acute renal failure (OR 5.4; 95% CI 2.2-13.7), acute CVA (OR 9.4; 95% CI 2.96-29.8), and acute respiratory failure (OR 11.1; 95% CI 3.9-31.1) predicted mortality in fully adjusted models. CONCLUSION A higher mortality was seen in men, likely related to the increased prevalence of acute critical illnesses, ventricular arrhythmia, and sudden cardiac arrest. Acute CVA and respiratory failure were the strongest predictors of mortality. © 2015 S. Karger AG, Basel.
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Affiliation(s)
- Parasuram Krishnamoorthy
- Department of Cardiology, Einstein Institute for Heart and Vascular Health, Albert Einstein Medical Center, Philadelphia, Pa., USA
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20
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Gupta T, Paul N, Kolte D, Harikrishnan P, Khera S, Aronow WS, Mujib M, Palaniswamy C, Sule S, Jain D, Ahmed A, Cooper HA, Frishman WH, Bhatt DL, Fonarow GC, Panza JA. Association of chronic renal insufficiency with in-hospital outcomes after percutaneous coronary intervention. J Am Heart Assoc 2015; 4:e002069. [PMID: 26080814 PMCID: PMC4599544 DOI: 10.1161/jaha.115.002069] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background The association of chronic renal insufficiency with outcomes after percutaneous coronary intervention (PCI) in the current era of drug-eluting stents and modern antithrombotic therapy has not been well characterized. Methods and Results We queried the 2007–2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years who underwent PCI. Multivariable logistic regression was used to compare in-hospital outcomes among patients with chronic kidney disease (CKD), patients with end-stage renal disease (ESRD), and those without CKD or ESRD. Of 3 187 404 patients who underwent PCI, 89% had no CKD/ESRD; 8.6% had CKD; and 2.4% had ESRD. Compared to patients with no CKD/ESRD, patients with CKD and patients with ESRD had higher in-hospital mortality (1.4% versus 2.7% versus 4.4%, respectively; adjusted odds ratio for CKD 1.15, 95% CI 1.12 to 1.19, P<0.001; adjusted odds ratio for ESRD 2.29, 95% CI 2.19 to 2.40, P<0.001), higher incidence of postprocedure hemorrhage (3.5% versus 5.4% versus 6.0%, respectively; adjusted odds ratio for CKD 1.21, 95% CI 1.18 to 1.23, P<0.001; adjusted odds ratio for ESRD 1.27, 95% CI 1.23 to 1.32, P<0.001), longer average length of stay (2.9 days versus 5.0 days versus 6.4 days, respectively; P<0.001), and higher average total hospital charges ($60 526 versus $77 324 versus $97 102, respectively; P<0.001). Similar results were seen in subgroups of patients undergoing PCI for acute coronary syndrome or stable ischemic heart disease. Conclusions In patients undergoing PCI, chronic renal insufficiency is associated with higher in-hospital mortality, higher postprocedure hemorrhage, longer average length of stay, and higher average hospital charges.
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Affiliation(s)
- Tanush Gupta
- Department of Medicine, New York Medical College, Valhalla, NY (T.G., N.P., D.K., P.H., M.M., S.S.)
| | - Neha Paul
- Department of Medicine, New York Medical College, Valhalla, NY (T.G., N.P., D.K., P.H., M.M., S.S.)
| | - Dhaval Kolte
- Department of Medicine, New York Medical College, Valhalla, NY (T.G., N.P., D.K., P.H., M.M., S.S.)
| | - Prakash Harikrishnan
- Department of Medicine, New York Medical College, Valhalla, NY (T.G., N.P., D.K., P.H., M.M., S.S.)
| | - Sahil Khera
- Division of Cardiology, New York Medical College, Valhalla, NY (S.K., W.S.A., D.J., H.A.C., W.H.F., J.A.P.)
| | - Wilbert S Aronow
- Division of Cardiology, New York Medical College, Valhalla, NY (S.K., W.S.A., D.J., H.A.C., W.H.F., J.A.P.)
| | - Marjan Mujib
- Department of Medicine, New York Medical College, Valhalla, NY (T.G., N.P., D.K., P.H., M.M., S.S.)
| | | | - Sachin Sule
- Department of Medicine, New York Medical College, Valhalla, NY (T.G., N.P., D.K., P.H., M.M., S.S.)
| | - Diwakar Jain
- Division of Cardiology, New York Medical College, Valhalla, NY (S.K., W.S.A., D.J., H.A.C., W.H.F., J.A.P.)
| | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC (A.A.)
| | - Howard A Cooper
- Division of Cardiology, New York Medical College, Valhalla, NY (S.K., W.S.A., D.J., H.A.C., W.H.F., J.A.P.)
| | - William H Frishman
- Division of Cardiology, New York Medical College, Valhalla, NY (S.K., W.S.A., D.J., H.A.C., W.H.F., J.A.P.)
| | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.L.B.)
| | - Gregg C Fonarow
- David Geffen School of Medicine, University of California at Los Angeles, CA (G.C.F.)
| | - Julio A Panza
- Division of Cardiology, New York Medical College, Valhalla, NY (S.K., W.S.A., D.J., H.A.C., W.H.F., J.A.P.)
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21
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Harikrishnan P, Mujib M, Gupta T, Kolte D, Palaniswamy C, Khera S, Balasubramaniyam N, Aronow WS, Jain D, Sule S, Fonarow GC, Ahmed A, Frishman WH, Cooper HA, Jacobson J, Iwai S, Panza JA. Abstract 368: Association of Atrial Fibrillation with In-hospital Outcomes in ST-Elevation Myocardial Infarction - A Propensity Matched Study. Circ Cardiovasc Qual Outcomes 2015. [DOI: 10.1161/circoutcomes.8.suppl_2.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/16/2022]
Abstract
Background:
Atrial fibrillation is a relatively common comorbid condition in patients with coronary artery disease. However, there are limited data on the association of atrial fibrillation (AF) with outcomes in ST-elevation myocardial infarction (STEMI).
Methods:
We queried the 2003-2011 Nationwide Inpatient Sample databases using the ICD-9 diagnosis codes, to identify all patients > 18 years admitted with a primary diagnosis of STEMI. We studied the association of AF with in-hospital outcomes in these patients both by regression analysis and propensity match to adjust for demographics, hospital characteristics and co-morbidities.
Results:
Of the total 452,772 (64.5% men) STEMI hospitalizations, AF was documented in 58,273 (12.9%) cases. Patients with AF were older (mean age 75±12 vs 64±14 years; p<0.001) and had a higher proportion of women (42.5% vs 34.5%; p<0.001) than patients without AF. STEMI patients with AF had a higher risk-adjusted in-hospital mortality (OR 1.15, 95% CI 1.12-1.19, p<0.001), longer average length of stay (7 days vs 4 days, P<0.001) and higher average total hospital charges ($74,082 vs $57,331, P<0.001) than those without AF. Using propensity matching, 57,388 STEMI patients with AF were compared with the same number of patients without AF. Within these matched cohorts, STEMI patients with AF had higher in-hospital mortality (16.7% vs 15.1%, OR 1.13, 95% CI 1.09-1.16; p<0.001), longer average length of stay (7 days vs 6 days, P<0.001), and higher average total hospital charges ($73,832 vs $65,201, P<0.001) than patients without AF.
Conclusions:
In patients hospitalized with STEMI, AF was independently associated with modestly higher in-hospital mortality, higher hospital charges, and longer length of stay.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Ali Ahmed
- Veterans Administration Med Cntr, Washington, DC
| | | | | | | | - Sei Iwai
- Westchester Med Cntr, Valhalla, NY
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22
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Gupta T, Harikrishnan P, Kolte D, Khera S, Aronow WS, Mujib M, Palaniswamy C, Jain D, Ahmed A, Lanier GM, Cooper HA, Fonarow GC, Gass A, Panza JA. Abstract 169: Contemporary Trends in Utilization and Outcomes of Percutaneous Ventricular Assist Devices in Cardiogenic Shock Complicating ST-Elevation Myocardial Infarction in the United States. Circ Cardiovasc Qual Outcomes 2015. [DOI: 10.1161/circoutcomes.8.suppl_2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/16/2022]
Abstract
Background:
Percutaneous ventricular assist devices (pVAD) can be rapidly deployed in cardiac catheterization laboratory and have emerged as an effective modality for short-term hemodynamic support in patients with cardiogenic shock. There are limited data on contemporary trends in utilization and outcomes of pVAD in patients with cardiogenic shock complicating ST-elevation myocardial infarction (STEMI).
Objectives:
To determine the temporal trends in utilization and outcomes of pVAD in patients with cardiogenic shock complicating STEMI.
Methods:
We queried the 2007-2011 Nationwide Inpatient Sample databases to identify all patients aged ≥ 18 years with STEMI and cardiogenic shock. Patients who underwent pVAD implantation were then identified using ICD-9 procedure code 37.68. Temporal trends in utilization of pVAD in STEMI patients with cardiogenic shock and in-hospital outcomes in these patients were analyzed.
Results:
From 2007-2011, of 1,053,161 patients with STEMI, 100,881 (9.6%) had cardiogenic shock. The in-hospital mortality in patients with cardiogenic shock decreased from 39.2% in 2007 to 33.9% in 2011 (P
trend
<0.001, adjusted OR [per year] 0.98, 95% CI 0.97-0.99). Of the STEMI patients with cardiogenic shock, a total of 1,068 (1.1%) patients underwent pVAD implantation. The use of pVAD in STEMI patients with cardiogenic shock increased from 0.1% in 2007 to 2.6% in 2011 (P
trend
<0.001). The incidence of acute cerebrovascular accident in patients with pVAD was 6.7% with no significant temporal change in incidence (P
trend
=0.99). The incidence of acute gastrointestinal bleeding in these patients was 14.3% with no significant temporal change in incidence (P
trend
=0.52). The overall in-hospital mortality in patients who received pVAD was 49.6% with an increase in in-hospital mortality during the study period (P
trend
=0.03, adjusted OR [per year] 1.22, 95% CI 1.02-1.47). The average length of stay in these patients increased from 12 days to 15 days (P
trend
<0.001), whereas the average total hospital charges increased from $180,849 to $361,050 (P
trend
<0.001).
Conclusion:
In recent years, there has been an increase in utilization of pVAD in patients with cardiogenic shock complicating STEMI. However, this trend was not accompanied with a decrease in overall in-hospital mortality among patients who underwent pVAD implantation. There were also adverse temporal trends in the average length of stay and average hospital cost in STEMI patients with cardiogenic shock undergoing pVAD implantation.
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Harikrishnan P, Gupta T, Kolte D, Palaniswamy C, Khera S, Mujib M, Aronow WS, Jain D, Lanier G, Sule S, Fonarow GC, Ahmed A, Frishman WH, Cooper HA, Jacobson J, Iwai S, Panza JA. Abstract 269: Association of Atrial and Ventricular Arrhythmias with In-hospital Outcomes in Peripartum Cardiomyopathy. Circ Cardiovasc Qual Outcomes 2015. [DOI: 10.1161/circoutcomes.8.suppl_2.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/16/2022]
Abstract
Background:
Arrhythmias are relatively common in patients with non-ischemic cardiomyopathies. There are limited data on the association of atrial and ventricular arrhythmias with outcomes in patients with peripartum cardiomyopathy (PPCM).
Methods:
We queried the 2003-2011 Nationwide Inpatient Sample databases using the ICD-9 diagnostic codes 674.50 to 674.55, to identify all women aged between 15-55 years admitted with a diagnosis of PPCM. The various arrhythmias were identified using appropriate ICD-9 diagnostic codes - atrial fibrillation (AF) (427.31), atrial flutter (427.32), supraventricular tachycardia (SVT) (427.0), ventricular tachycardia (VT) (427.1), ventricular fibrillation (VF) (427.41 and 427.42). Multivariable adjusted logistic regression was used to study the association of arrhythmias with in-hospital mortality and multivariable adjusted linear regression was used to study the association of arrhythmias with length of stay and hospital charges.
Results:
From 2003 to 2011, 34,944 patients were hospitalized with PPCM. The mean age was 30±7 years. Among these patients with PPCM, ventricular tachycardia (VT) (4.8%) was the most common arrhythmia followed by atrial fibrillation (AF) (2.2%), ventricular fibrillation (VF) (1.3%), atrial flutter (0.8%) and supraventricular tachycardia (SVT) (0.6%). The risk adjusted in-hospital mortality was higher in PPCM patients with AF (3.6% vs 1.2%, adjusted OR 2.38, 95% CI 1.50-3.78), VT (3.7% vs 1.1%, adjusted OR 1.8, 95% CI 1.30-2.48) and VF (14.2% vs 1.1%, adjusted OR 5.39, 95% CI 3.75-7.74) compared to those without arrhythmias. Among the study population, the average length of stay was longer in patients with AF (8 vs 5 days, p<0.001), atrial flutter (10 vs 5 days, p<0.001), SVT (10 vs 5 days, p<0.001), VT (9 vs 5 days, p<0.001) and VF (10 vs 5 days, p<0.001). The average hospital charges was also higher in patients with AF ($74,799 vs $40,974; p=0.004), atrial flutter ($129,692 vs $41,042; p<0.001), SVT ($133,223 vs $41,165; p<0.001), VT ($97,525 vs $38,929; p<0.001) and VF ($158,381 vs $40,194; p<0.001).
Conclusions:
In patients hospitalized with PPCM AF, VT and VF were independently associated with significantly higher in-hospital mortality. Also in these patients AF, atrial flutter, SVT, VT and VF were independently associated with higher hospital charges and longer length of stay.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Ali Ahmed
- Veterans Administration Med Cntr, Washington, DC
| | | | | | | | - Sei Iwai
- Westchester Med Cntr, Valhalla, NY
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Gupta T, Harikrishnan P, Kolte D, Khera S, Aronow WS, Mujib M, Palaniswamy C, Ahmed A, Cooper HA, Fonarow GC, Panza JA. Abstract 272: Association of Renal Insufficiency With Outcomes of Percutaneous Coronary Intervention. Circ Cardiovasc Qual Outcomes 2015. [DOI: 10.1161/circoutcomes.8.suppl_2.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/16/2022]
Abstract
Background:
Limited data are available on the impact of chronic kidney disease (CKD) and end stage renal disease (ESRD) on outcomes after percutaneous coronary intervention (PCI).
Objectives:
To determine the association between baseline renal insufficiency with in-hospital outcomes after PCI.
Methods:
We queried the 2003-2011 Nationwide Inpatient Sample databases to identify all patients aged ≥ 18 years undergoing PCI. Patients who underwent coronary artery bypass grafting during the same admission were excluded. Patients with concomitant diagnosis of CKD (ICD-9 codes 585.1-585.5 and 585.9) and ESRD (ICD-9 diagnosis code 585.6 or procedure code for hemodialysis [39.95, excluding patients with concurrent diagnosis of acute renal failure] or peritoneal dialysis [54.98]) were then identified. Multivariable logistic regression was used to compare outcomes between patients with CKD and patients with ESRD to those without CKD or ESRD.
Results:
Of 6,417,970 patients who underwent PCI, 93.3% (mean age 64.2±12.3 years, 33.7% females) had no CKD/ESRD; 4.9% (mean age 71.5±11.3 years, 35% females) had CKD; and 1.8% (mean age 64.2±11.8 years, 42.2% females) had ESRD. The prevalence of smoking was highest in patients with no CKD/ESRD; that of dyslipidemia, coronary artery disease, prior myocardial infarction, atrial fibrillation, and obesity was highest in CKD patients; diabetes mellitus, hypertension, and congestive heart failure were most prevalent in ESRD patients (p<0.001 for all). Of patients undergoing PCI, 61.2% patients in no CKD/ESRD group had an acute coronary syndrome, as compared to 65.4% in CKD group, and 58.2% in ESRD group (p<0.001). Compared to patients with no CKD/ESRD, those with CKD and those with ESRD had higher in-hospital mortality and higher incidence of post-procedure hemorrhage. Baseline renal insufficiency was also associated with longer average length of stay and higher average total hospital charges (Table).
Conclusions:
In patients undergoing PCI, baseline renal insufficiency is associated with worse outcomes. Patients with CKD and patients with ESRD had increased in-hospital mortality, higher hemorrhagic complications, longer average length of hospital stay, and higher average hospital charges than those without CKD or ESRD.
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Garg J, Krishnamoorthy P, Palaniswamy C, Pandey A, Ahmad H. Predictors of in-hospital mortality in coronary artery dissection: Findings from the National Inpatient Sample 2009–2010. Cardiol J 2015; 22:135-40. [DOI: 10.5603/cj.a2014.0048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 05/10/2014] [Indexed: 11/25/2022] Open
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Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Ahn C, Iwai S, Jain D, Sule S, Ahmed A, Cooper HA, Frishman WH, Bhatt DL, Panza JA, Fonarow GC. Regional Variation in the Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States. Circulation 2015; 131:1415-25. [PMID: 25792560 DOI: 10.1161/circulationaha.114.014542] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [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: 11/26/2014] [Accepted: 02/13/2015] [Indexed: 11/16/2022]
Abstract
Background—
Regional variation in the incidence and outcomes of in-hospital cardiac arrest (IHCA) is not well studied and may have important health and policy implications.
Methods and Results—
We used the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients ≥18 years of age who underwent cardiopulmonary resuscitation (
International Classification of Diseases, Ninth Edition, Clinical Modification
procedure codes 99.60 and 99.63) for IHCA. Regional differences in IHCA incidence, survival to hospital discharge, and resource use (total hospital cost and discharge disposition among survivors) were analyzed. Of 838 465 patients with IHCA, 162 270 (19.4%) were in the Northeast, 159 581 (19.0%) were in the Midwest, 316 201 (37.7%) were in the South, and 200 413 (23.9%) were in the West. Overall IHCA incidence in the United States was 2.85 per 1000 hospital admissions. IHCA incidence was lowest in the Midwest and highest in the West (2.33 and 3.73 per 1000 hospital admissions, respectively). Compared with the Northeast, risk-adjusted survival to discharge was significantly higher in the Midwest (odds ratio, 1.33; 95% confidence interval, 1.31–1.36), South (odds ratio, 1.21; 95% confidence interval, 1.19–1.23), and West (odds ratio, 1.25; 95% confidence interval, 1.23–1.27). IHCA survival increased significantly from 2003 to 2011 in the United States and in all regions (all
P
trend
<0.001). Total hospital cost was highest in the West, whereas discharge to skilled nursing facility and use of home health care among survivors was highest in the Northeast.
Conclusions—
We observed significant regional variation in IHCA incidence, survival, and resource use in the United States. This variation was explained only partially by differences in patient and hospital characteristics. Further studies are needed to identify other potential factors responsible for these regional differences to improve outcomes after IHCA.
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Affiliation(s)
- Dhaval Kolte
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
| | - Sahil Khera
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
| | - Wilbert S. Aronow
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
| | - Chandrasekar Palaniswamy
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
| | - Marjan Mujib
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
| | - Chul Ahn
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
| | - Sei Iwai
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
| | - Diwakar Jain
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
| | - Sachin Sule
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
| | - Ali Ahmed
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
| | - Howard A. Cooper
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
| | - William H. Frishman
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
| | - Deepak L. Bhatt
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
| | - Julio A. Panza
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
| | - Gregg C. Fonarow
- From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.)
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Gupta T, Harikrishnan P, Kolte D, Khera S, Subramanian KS, Mujib M, Masud A, Palaniswamy C, Sule S, Jain D, Ahmed A, Lanier GM, Cooper HA, Frishman WH, Bhatt DL, Fonarow GC, Panza JA, Aronow WS. Trends in management and outcomes of ST-elevation myocardial infarction in patients with end-stage renal disease in the United States. Am J Cardiol 2015; 115:1033-41. [PMID: 25724782 DOI: 10.1016/j.amjcard.2015.01.529] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 12/22/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 12/01/2022]
Abstract
Acute myocardial infarction in patients with end-stage renal disease (ESRD) is associated with increased risk of morbidity and mortality. Limited data are available on the contemporary trends in management and outcomes of ST-elevation myocardial infarction (STEMI) in patients with ESRD. We analyzed the 2003 to 2011 Nationwide Inpatient Sample databases to examine the temporal trends in STEMI, use of mechanical revascularization for STEMI, and in-hospital outcomes in patients with ESRD aged ≥18 years in the United States. From 2003 to 2011, whereas the number of patients with ESRD admitted with the primary diagnosis of acute myocardial infarction increased from 13,322 to 20,552, there was a decrease in the number of STEMI hospitalizations from 3,169 to 2,558 (ptrend <0.001). The overall incidence rate of cardiogenic shock in patients with ESRD and STEMI increased from 6.6% to 18.3% (ptrend <0.001). The use of percutaneous coronary intervention for STEMI increased from 18.6% to 37.8% (ptrend <0.001), whereas there was no significant change in the use of coronary artery bypass grafting (ptrend = 0.32). During the study period, in-hospital mortality increased from 22.3% to 25.3% (adjusted odds ratio [per year] 1.09; 95% confidence interval 1.08 to 1.11; ptrend <0.001). The average hospital charges increased from $60,410 to $97,794 (ptrend <0.001), whereas the average length of stay decreased from 8.2 to 6.5 days (ptrend <0.001). In conclusion, although there have been favorable trends in the utilization of percutaneous coronary intervention and length of stay in patients with ESRD and STEMI, the incidence of cardiogenic shock has increased threefold, with an increase in risk-adjusted in-hospital mortality, likely because of the presence of greater co-morbidities.
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Affiliation(s)
- Tanush Gupta
- Department of Medicine, New York Medical College, Valhalla, New York
| | | | - Dhaval Kolte
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Sahil Khera
- Division of Cardiology, New York Medical College, Valhalla, New York
| | | | - Marjan Mujib
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Ali Masud
- Division of Cardiology, New York Medical College, Valhalla, New York
| | | | - Sachin Sule
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Diwakar Jain
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Ali Ahmed
- Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia
| | - Gregg M Lanier
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Howard A Cooper
- Division of Cardiology, New York Medical College, Valhalla, New York
| | | | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregg C Fonarow
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Julio A Panza
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Wilbert S Aronow
- Division of Cardiology, New York Medical College, Valhalla, New York.
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Zak M, Castiblanco SA, Garg J, Palaniswamy C, Jacobs LE. Periprocedural Management of New Oral Anticoagulants in Atrial Fibrillation Ablation. J Cardiovasc Pharmacol Ther 2015; 20:457-64. [PMID: 25827857 DOI: 10.1177/1074248415576193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 10/30/2014] [Accepted: 02/08/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients who undergo catheter ablation for atrial fibrillation (AF) are at increased risk of developing thromboembolic and bleeding complications periprocedurally. Many patients are now on newer oral anticoagulants (NOACs), but data regarding their safety and efficacy during AF ablation are limited. METHODS AND RESULTS This article reviews the literature in PubMed from 1998 to 2014 and includes clinical trials and meta-analysis that analyzed the safety and efficacy of NOACs during AF catheter ablation. Dabigatran seems to be as effective and safe as warfarin, although most data are from single-center studies, with small samples and very low overall bleeding and thromboembolic complications. Periprocedural anticoagulation protocols also vary greatly between studies. Some recent meta-analysis has shown that warfarin could still be a safer and more effective alternative. There are fewer studies with rivaroxaban in AF ablation, and there have been no meta-analysis yet comparing rivaroxaban to warfarin or dabigatran. There seems to be no significant differences in safety or efficacy of rivaroxaban compared to warfarin. Interestingly, there are no available data for apixaban in AF ablation yet. DISCUSSION There are no consensus guidelines regarding the use of NOACs during AF ablation. Dabigatran and rivaroxaban seem as safe and effective as warfarin, although larger studies with standardized protocols are needed, as available studies may be underpowered to detect small differences in bleeding and thromboembolic rates.
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Affiliation(s)
- Martin Zak
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | | | - Jalaj Garg
- Department of Medicine, Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Chandrasekar Palaniswamy
- Department of Medicine, Division of Cardiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Larry E Jacobs
- Department of Medicine, Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
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Harikrishnan P, Gupta T, Kolte D, Palaniswamy C, Khera S, Aronow W, Mujib M, Jain D, Sule S, Fonarow G, Ahmed A, Frishman W, Cooper H, Jacobson J, Iwai S, Panza J. TEMPORAL TRENDS IN INCIDENCE OF VENTRICULAR ARRHYTHMIAS AND ASSOCIATION OF VENTRICULAR ARRHYTHMIAS WITH OUTCOMES IN ST-ELEVATION MYOCARDIAL INFARCTION. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60041-9] [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]
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Khera S, Kolte D, Subramanian K, Khanna N, Mujib M, Aronow W, Ahn C, Palaniswamy C, Timmermans R, Cooper H, Fonarow G, Frishman W, Panza J, Bhatt D. TEMPORAL TRENDS IN REVASCULARIZATION AND OUTCOMES OF ST-ELEVATION MYOCARDIAL INFARCTION IN YOUNGER ADULTS IN THE UNITED STATES. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60002-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mujib M, Mazumder NK, Kolte D, Khera S, Aronow W, Harikrishnan P, Palaniswamy C, Sule S, Ahmed A, Jain D, Lanier G, Gass A, Cooper HA, Fonarow G, Panza J. DONOR-RECIPIENT RACE MISMATCH INCREASES GRAFT FAILURE AND MORTALITY AFTER ADULT HEART TRANSPLANTATION: A PROPENSITY-MATCHED STUDY OF THE UNITED NETWORK FOR ORGAN SHARING DATABASE. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60900-7] [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: 11/29/2022]
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Gupta T, Harikrishnan P, Kolte D, Khera S, Aronow W, Mujib M, Palaniswamy C, Ahmed A, Jain D, Sule S, Lanier G, Cooper H, Fonarow G, Panza J. OUTCOMES OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: A UNITED STATES POPULATION-BASED STUDY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60951-2] [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]
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Harikrishnan P, Gupta T, Kolte D, Palaniswamy C, Khera S, Aronow W, Mujib M, Balasubramaniyam N, Jain D, Sule S, Fonarow G, Ahmed A, Cooper H, Jacobson J, Iwai S, Panza J. ASSOCIATION OF ARRHYTHMIAS WITH OUTCOMES IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: AN ANALYSIS OF THE NATIONWIDE INPATIENT SAMPLE 2003-2011. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60296-0] [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: 11/17/2022]
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Harikrishnan P, Gupta T, Kolte D, Palaniswamy C, Khera S, Aronow W, Mujib M, Subramanian K, Jain D, Sule S, Fonarow G, Ahmed A, Cooper H, Jacobson J, Iwai S, Panza J. BURDEN OF ARRHYTHMIAS IN PATIENTS WITH ALCOHOLIC CARDIOMYOPATHY: FINDINGS FROM THE NATIONWIDE INPATIENT SAMPLE 2003-2011. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60297-2] [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]
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Mujib M, Khanna N, Mazumder NK, Aronow WS, Kolte D, Khera S, Palaniswamy C, Jain D, Lanier GM, Sule S, Ahmed A, Levy WC, Prabhu SD, Cooper HA, Panza JA, Gass AL, Fonarow GC. Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients: a propensity-matched nationwide inpatient sample study. Clin Cardiol 2015; 38:300-8. [PMID: 25684174 DOI: 10.1002/clc.22391] [Citation(s) in RCA: 7] [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: 12/02/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The prevalence and contemporary trends of pre-heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database. HYPOTHESIS Pre-HT coagulopathy is associated with increased in-hospital mortality. METHODS Among 2454 adult HT recipients from the 2003 to 2010 Nationwide Inpatient Sample databases, 707 (29%) had pre-HT coagulopathy (defined as a comorbidity variable, based on International Classification of Diseases, Ninthe Revision, Clinical Modification and Diagnosis Related Group codes). We used propensity scores for coagulopathy to assemble a matched cohort of 664 pairs of patients with and without coagulopathy balanced in 54 baseline characteristics. RESULTS The prevalence of pre-HT coagulopathy increased from 17% in 2003 to 44% in 2010 (P for trend <0.001). In-hospital mortality occurred in 8.6% and 4.7% of matched HT recipients with and without coagulopathy, respectively (hazard ratio: 1.81; 95% confidence interval [CI]: 1.17-2.80; P = 0.008). Coagulopathy was not significantly associated with post-HT graft complications (odds ratio [OR]: 1.20; 95% CI: 0.95-1.52; P = 0.131) but was associated with increased blood transfusions (OR: 1.92; 95% CI, 1.54-2.41; P < 0.001). Coagulopathy and no-coagulopathy groups had no difference in median length of stay (22 days in each group, P = 0.746), but median total hospital charges were higher among patients with coagulopathy compared to those without (US$425 643 vs US$389 656; P = 0.008). CONCLUSIONS In this national study of HT recipients, pretransplant coagulopathy was common, increased over time, and was not significantly associated with post-HT graft complications or increased hospital stay. However, it was associated with increased bleeding risk, in-hospital mortality, and total hospital charges. These findings may have implications for the selection of patients for HT.
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Affiliation(s)
- Marjan Mujib
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Neel Khanna
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Nabila K Mazumder
- Department of Medicine, Flushing Hospital Medical Center, Flushing, New York
| | - Wilbert S Aronow
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Dhaval Kolte
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Sahil Khera
- Division of Cardiology, New York Medical College, Valhalla, New York
| | | | - Diwakar Jain
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Gregg M Lanier
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Sachin Sule
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Ali Ahmed
- Department of Medicine, Washington DC VA Medical Center, Washington, DC
| | - Wayne C Levy
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Sumanth D Prabhu
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Howard A Cooper
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Julio A Panza
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Alan L Gass
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Gregg C Fonarow
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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Palaniswamy C, Garg J, Dutta T, Shah A, Gass A, Lanier GM. Cavitation phenomenon: A Novel Echocardiographic Finding in Pump Thrombosis. J Card Fail 2014; 20:874-5. [DOI: 10.1016/j.cardfail.2014.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
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Pandey A, Garg J, Krishnamoorthy P, Palaniswamy C, Doshi J, Lanier G, Ahmad H. Predictors of Coronary Artery Disease in Patients with Behçet's Disease. Cardiology 2014; 129:203-6. [DOI: 10.1159/000365139] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/06/2014] [Indexed: 11/19/2022]
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Khera S, Kolte D, Iwai S, Palaniswamy C, Harikrishnan P, Gupta T, Mujib M, Jain D, Cooper HA, Aronow WS, Fonarow GC, Panza JA. Permanent pacemaker utilization in older patients with syncope and carotid sinus syndrome. Int J Cardiol 2014; 176:1137-8. [PMID: 25156837 DOI: 10.1016/j.ijcard.2014.07.287] [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: 07/15/2014] [Accepted: 07/27/2014] [Indexed: 10/24/2022]
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Khera S, Kolte D, Aronow WS, Palaniswamy C, Subramanian KS, Hashim T, Mujib M, Jain D, Paudel R, Ahmed A, Frishman WH, Bhatt DL, Panza JA, Fonarow GC. Non-ST-elevation myocardial infarction in the United States: contemporary trends in incidence, utilization of the early invasive strategy, and in-hospital outcomes. J Am Heart Assoc 2014; 3:jah3604. [PMID: 25074695 PMCID: PMC4310389 DOI: 10.1161/jaha.114.000995] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [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: 12/20/2022]
Abstract
Background There has been a paradigm shift in the definition of timing of early invasive strategy (EIS) for patients admitted with non‐ST‐elevation myocardial infarction (NSTEMI) in the last decade. Data on trends of EIS for NSTEMI and associated in‐hospital outcomes are limited. Our aim is to analyze temporal trends in the incidence, utilization of early invasive strategy, and in‐hospital outcomes of NSTEMI in the United States. Methods and Results We analyzed the 2002–2011 Nationwide Inpatient Sample databases to identify all patients ≥40 years of age with the principal diagnosis of acute myocardial infarction (AMI) and NSTEMI. Logistic regression was used for overall, age‐, sex‐, and race/ethnicity‐stratified trend analysis. From 2002 to 2011, we identified 6 512 372 patients with AMI. Of these, 3 981 119 (61.1%) had NSTEMI. The proportion of patients with NSTEMI increased from 52.8% in 2002 to 68.6% in 2011 (adjusted odds ratio [OR; per year], 1.055; 95% confidence interval [CI], 1.054 to 1.056) in the overall cohort. Similar trends were observed in age‐, sex‐, and race/ethnicity‐stratified groups. From 2002 to 2011, utilization of EIS at day 0 increased from 14.9% to 21.8% (Ptrend<0.001) and utilization of EIS at day 0 or 1 increased from 27.8% to 41.4% (Ptrend<0.001). Risk‐adjusted in‐hospital mortality in the overall cohort decreased during the study period (adjusted OR [per year], 0.976; 95% CI, 0.974 to 0.978). Conclusions There have been temporal increases in the proportion of NSTEMI and, consistent with guidelines, greater utilization of EIS. This has been accompanied by temporal decreases in in‐hospital mortality and length of stay.
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Affiliation(s)
- Sahil Khera
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Dhaval Kolte
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Wilbert S Aronow
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Chandrasekar Palaniswamy
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Kathir Selvan Subramanian
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Taimoor Hashim
- University of Alabama at Birmingham, Birmingham, AL (T.H., A.A.)
| | - Marjan Mujib
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Diwakar Jain
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Rajiv Paudel
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Ali Ahmed
- University of Alabama at Birmingham, Birmingham, AL (T.H., A.A.)
| | - William H Frishman
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Julio A Panza
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Gregg C Fonarow
- David-Geffen School of Medicine University of California at Los Angeles (UCLA), Los Angeles, CA (G.C.F.)
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Gupta T, Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Jain D, Sule S, Ahmed A, Iwai S, Eugenio P, Lessner S, Frishman WH, Panza JA, Fonarow GC. Relation of smoking status to outcomes after cardiopulmonary resuscitation for in-hospital cardiac arrest. Am J Cardiol 2014; 114:169-74. [PMID: 24878124 DOI: 10.1016/j.amjcard.2014.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
Abstract
In-hospital cardiac arrest (IHCA) is common and is associated with poor prognosis. Data on the effect of smoking on outcomes after IHCA are limited. We analyzed the Nationwide Inpatient Sample databases from 2003 to 2011 for all patients aged≥18 years who underwent cardiopulmonary resuscitation (CPR) for IHCA to examine the differences in survival to hospital discharge and neurologic status between smokers and nonsmokers. Of the 838,464 patients with CPR for IHCA, 116,569 patients (13.9%) were smokers. Smokers were more likely to be younger, Caucasian, and male. They had a greater prevalence of dyslipidemia, coronary artery disease, hypertension, chronic pulmonary disease, obesity, and peripheral vascular disease. Atrial fibrillation, heart failure, and diabetes mellitus with complications were less prevalent in smokers. Smokers were more likely to have a primary diagnosis of acute myocardial infarction (14.8% vs 9.1%, p<0.001) and ventricular tachycardia or ventricular fibrillation as the initial cardiac arrest rhythm (24.3% vs 20.5%, p<0.001). Smokers had a higher rate of survival to hospital discharge compared with nonsmokers (28.2% vs 24.1%, adjusted odds ratio 1.06, 95% confidence interval 1.05 to 1.08, p<0.001). Smokers were less likely to have a poor neurologic status after IHCA compared with nonsmokers (3.5% vs 3.9%, adjusted odds ratio 0.92, 95% confidence interval 0.89 to 0.95, p<0.001). In conclusion, among patients aged ≥18 years who underwent CPR for IHCA, we observed a higher rate of survival in smokers than nonsmokers-consistent with the "smoker's paradox." Smokers were also less likely to have a poor neurologic status after IHCA.
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Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Ahn C, Jain D, Gass A, Ahmed A, Panza JA, Fonarow GC. Abstract 29: Temporal Trends in Incidence and Outcomes of Peripartum Cardiomyopathy in the United States: A Nationwide Population-Based Study. Circ Cardiovasc Qual Outcomes 2014. [DOI: 10.1161/circoutcomes.7.suppl_1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/16/2022]
Abstract
Background:
The reported incidence of peripartum cardiomyopathy (PPCM) in the United States varies widely. Furthermore, limited information is available on the temporal trends in incidence and outcomes of PPCM.
Objectives:
To determine the overall incidence and complication rates of PPCM, and to analyze temporal trends in incidence and outcomes of PPCM in the United States.
Methods:
We queried the 2004 to 2011 Nationwide Inpatient Sample databases to identify all women aged 15 to 54 years with the diagnosis of PPCM using ICD-9-CM codes 674.5x. Temporal trends in incidence (per 10,000 live births), maternal major adverse events (MAE defined as in-hospital mortality, cardiac arrest, heart transplant, mechanical circulatory support, acute pulmonary edema, thromboembolism or implantable cardioverter defibrillator/permanent pacemaker implantation), cardiogenic shock, and length of stay were analyzed.
Results:
From 2004 to 2011, we identified 34,219 women aged 15 to 54 years with PPCM. The overall PPCM rate was 10.3 per 10,000 (or 1 in 968) live births. PPCM incidence increased from 8.5 to 11.8 per 10,000 live births (p
trend
<0.001) during the study period. MAE occurred in 13.5% of patients. The most common complication in women with PPCM was thromboembolism (6.6%). The incidence of other complications was - in-hospital mortality in 1.3%, cardiac arrest in 2.1%, heart transplant in 0.5%, use of mechanical circulatory support in 1.5%, acute pulmonary edema in 1.8%, ICD/PPM placement in 2.9%, and cardiogenic shock in 2.6% There was no temporal change in MAE rate, except a small increase in in-hospital mortality [0.7% in 2004 to 1.8% in 2011, adjusted OR (per year) 1.08, 95% CI 1.02-1.14, p
trend
=0.006] and use of mechanical circulatory support [0.9% in 2004 to 2.2% in 2011, adjusted OR (per year) 1.08, 95% CI 1.03-1.14, p
trend
=0.002]. Cardiogenic shock increased from 1.0% in 2004 to 4.0% in 2011 [adjusted OR (per year) 1.16, 95% CI 1.11-1.21, p
trend
<0.001]. Mean length of stay decreased during the study period.
Conclusion:
From 2004 to 2011, the incidence of PPCM has increased in the United States. Maternal MAE rates overall have remained unchanged while cardiogenic shock, need for mechanical circulatory support, and in-hospital mortality have increased during the study period. Further study of the mechanisms underlying these adverse trends in the incidence and outcomes of PPCM are warranted.
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Affiliation(s)
| | | | | | | | | | - Chul Ahn
- UT Southwestern Med Cntr, Dallas, TX
| | | | | | - Ali Ahmed
- Univ of Alabama at Birmingham and VA Med Cntr, Birmingham, AL
| | | | - Gregg C Fonarow
- David-Geffen Sch of Medicine, Univ of California at Los Angeles (UCLA), Los Angeles, CA
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Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Ahn C, Jain D, Gass A, Ahmed A, Panza JA, Fonarow GC. Temporal trends in incidence and outcomes of peripartum cardiomyopathy in the United States: a nationwide population-based study. J Am Heart Assoc 2014; 3:e001056. [PMID: 24901108 PMCID: PMC4309108 DOI: 10.1161/jaha.114.001056] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 04/29/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The reported incidence of peripartum cardiomyopathy (PPCM) in the United States varies widely. Furthermore, limited information is available on the temporal trends in incidence and outcomes of PPCM. METHODS AND RESULTS We queried the 2004-2011 Nationwide Inpatient Sample databases to identify all women aged 15 to 54 years with the diagnosis of PPCM. Temporal trends in incidence (per 10 000 live births), maternal major adverse events (MAE; defined as in-hospital mortality, cardiac arrest, heart transplant, mechanical circulatory support, acute pulmonary edema, thromboembolism, or implantable cardioverter defibrillator/permanent pacemaker implantation), cardiogenic shock, and mean length of stay were analyzed. From 2004 to 2011, we identified 34 219 women aged 15 to 54 years with PPCM. The overall PPCM rate was 10.3 per 10 000 (or 1 in 968) live births. PPCM incidence increased from 8.5 to 11.8 per 10 000 live births (Ptrend<0.001) over the past 8 years. MAE occurred in 13.5% of patients. There was no temporal change in MAE rate, except a small increase in in-hospital mortality and mechanical circulatory support (Ptrend<0.05). Cardiogenic shock increased from 1.0% in 2004 to 4.0% in 2011 (Ptrend<0.001). Mean length of stay decreased during the study period. CONCLUSION From 2004 to 2011, the incidence of PPCM has increased in the United States. Maternal MAE rates overall have remained unchanged while cardiogenic shock, utilization of mechanical circulatory support, and in-hospital mortality have increased during the study period. Further study of the mechanisms underlying these adverse trends in the incidence and outcomes of PPCM are warranted.
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Affiliation(s)
- Dhaval Kolte
- Department of Medicine, New York Medical College, Valhalla, NY (D.K., S.K., M.M.)
| | - Sahil Khera
- Department of Medicine, New York Medical College, Valhalla, NY (D.K., S.K., M.M.)
| | - Wilbert S. Aronow
- Division of Cardiology, New York Medical College, Valhalla, NY (W.S.A., C.P., D.J., A.G., J.A.P.)
| | - Chandrasekar Palaniswamy
- Division of Cardiology, New York Medical College, Valhalla, NY (W.S.A., C.P., D.J., A.G., J.A.P.)
| | - Marjan Mujib
- Department of Medicine, New York Medical College, Valhalla, NY (D.K., S.K., M.M.)
| | - Chul Ahn
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (C.A.)
| | - Diwakar Jain
- Division of Cardiology, New York Medical College, Valhalla, NY (W.S.A., C.P., D.J., A.G., J.A.P.)
| | - Alan Gass
- Division of Cardiology, New York Medical College, Valhalla, NY (W.S.A., C.P., D.J., A.G., J.A.P.)
| | - Ali Ahmed
- University of Alabama at Birmingham and VA Medical Center, Birmingham, AL (A.A.)
| | - Julio A. Panza
- Division of Cardiology, New York Medical College, Valhalla, NY (W.S.A., C.P., D.J., A.G., J.A.P.)
| | - Gregg C. Fonarow
- David‐Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA (G.C.F.)
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Krishnamoorthy P, Garg J, Palaniswamy C, McClung J, Cuomo L, Lanier G, Ahmad H, Frishman W. PREDICTORS OF MORTALITY AND GENDER DIFFERENCES IN TAKOTSUBO CARDIOMYOPATHY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60831-7] [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: 11/30/2022]
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Harikrishnan P, Kolte D, Palaniswamy C, Khera S, Mujib M, Aronow W, Iwai S, Eugenio P, Lessner S, Ahmed A, Ferrick A, Fonarow G, Frishman W, Panza J. CATHETER ABLATION OF VENTRICULAR TACHYCARDIA: TEN-YEAR TRENDS IN UTILIZATION, IN-HOSPITAL COMPLICATIONS, AND IN-HOSPITAL MORTALITY IN PATIENTS WITH ISCHEMIC CARDIOMYOPATHY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60294-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Garg J, Krishnamoorthy P, Palaniswamy C, Aronow W, Doshi J, Lanier G, Cuomo L, Ahmad H, Panza J. PREVALENCE AND PREDICTORS OF CORONARY ARTERY DISEASE IN BEHCET'S DISEASE. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61324-3] [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: 10/25/2022]
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Kolte D, Khera S, Aronow W, Mujib M, Palaniswamy C, Jain D, Sule S, Frishman W, Ahmed A, Fonarow G, Panza J. PRIMARY PAYER STATUS AND OUTCOMES IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60056-5] [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: 11/16/2022]
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Krishnamoorthy P, Garg J, Palaniswamy C, Lanier G, Cuomo L, Ahmad H, Frishman W. RACIAL AND GENDER DIFFERENCES IN RISK FACTORS AND OUTCOMES ASSOCIATED WITH LONG QTC SYNDROME: INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE DATABASE 2009-10. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60447-2] [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: 11/16/2022]
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Khera S, Kolte D, Aronow W, Mujib M, Palaniswamy C, Ahmed A, Jain D, Sule S, Fonarow G, Iwai S, Eugenio P, Lessner S, Panza J. SMOKING STATUS AND SURVIVAL AFTER CARDIOPULMONARY RESUSCITATION FOR IN-HOSPITAL CARDIAC ARREST: ANALYSIS OF THE 2003-2011 NATIONWIDE INPATIENT SAMPLE DATABASES. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60301-6] [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]
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Mujib M, Aronow W, Lanier G, Kolte D, Khera S, Palaniswamy C, Sule S, Fonarow G, hmed L, Frishman W, Gass A, Prabhu S, Panza J. A SMOKER'S PARADOX IN HEART TRANSPLANT RECIPIENTS: FINDINGS FROM THE NATIONWIDE INPATIENT SAMPLE 2003-2010. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60883-4] [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: 10/25/2022]
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