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Hillerson D, Li S, Misumida N, Wegermann ZK, Abdel-Latif A, Ogunbayo GO, Wang TY, Ziada KM. Characteristics, Process Metrics, and Outcomes Among Patients With ST-Elevation Myocardial Infarction in Rural vs Urban Areas in the US: A Report From the US National Cardiovascular Data Registry. JAMA Cardiol 2022; 7:1016-1024. [PMID: 36044196 PMCID: PMC9434481 DOI: 10.1001/jamacardio.2022.2774] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/06/2022] [Indexed: 11/14/2022]
Abstract
Importance Patients with ST-segment elevation myocardial infarction (STEMI) living in rural settings often have worse clinical outcomes compared with their urban counterparts. Whether this discrepancy is due to clinical characteristics or delays in timely reperfusion with primary percutaneous coronary intervention (PPCI) or fibrinolysis is unclear. Objective To assess process metrics and outcomes among patients with STEMI in rural and urban settings across the US. Design, Setting, and Participants This cross-sectional multicenter study analyzed data for 70 424 adult patients with STEMI from the National Cardiovascular Data Registry Chest Pain-MI Registry in 686 participating US hospitals between January 1, 2019, and June 30, 2020. Patients without a valid zip code were excluded, and those transferred to a different hospital during the course of the study were excluded from outcome analysis. Main Outcomes and Measures In-hospital mortality and time-to-reperfusion metrics. Results This study included 70 424 patients with STEMI (median [IQR] age, 63 [54-73] years; 49 850 [70.8%] male and 20 574 [29.2%] female; patient self-reported race: 6753 [9.6%] Black, 60 114 [85.4%] White, and 2096 [3.0%] of another race [including American Indian, Alaskan Native, Native Hawaiian, and Pacific Islander]; 5281 [7.5%] individuals of Hispanic or Latino ethnicity) in 686 hospitals (50 702 [72.0%] living in urban zip codes and 19 722 [28.0%] in rural zip codes). Patients from rural settings were less likely to undergo PPCI compared with patients from urban settings (14 443 [73.2%] vs 43 142 [85.1%], respectively; P < .001) and more often received fibrinolytics (2848 [19.7%] vs 937 [2.7%]; P < .001). Compared with patients from urban settings, those in rural settings undergoing PPCI had longer median (IQR) time from first medical contact to catheterization laboratory activation (30 [12-42] minutes vs 22 [15-59] minutes; P < .001) and longer median (IQR) time from first medical contact to device (99 minutes [75-131] vs 81 [66-103] minutes; P < .001), including those who arrived directly at PPCI centers (83 [66-107] minutes vs 78 [64-97] minutes; P < .001) and those who transferred to PPCI centers from another treatment center (125 [102-163] minutes vs 103 [85-135] minutes; P < .001). Among those who transferred in, median (IQR) door-in-door-out time was longer in patients from rural settings (63 [41-100] minutes vs 50 [35-80] minutes; P < .001). Out-of-hospital cardiac arrest was more common in patients from urban vs rural settings (3099 [6.1%] vs 958 [4.9%]; P < .001), and patients from urban settings were more likely to present with heart failure (4112 [8.1%] vs 1314 [6.7%]; P < .001). After multivariable adjustment, there was no significant difference in in-hospital mortality between rural and urban groups (adjusted odds ratio, 0.97; 95% CI, 0.89-1.06). Conclusions and Relevance In this large cohort of patients with STEMI from US hospitals participating in the National Cardiovascular Data Registry Chest Pain-MI Registry, patients living in rural settings had longer times to reperfusion, were less likely to receive PPCI or meet guideline-recommended time to reperfusion, and more frequently received fibrinolytics than patients living in urban settings. However, there was no difference in adjusted in-hospital mortality between patients with STEMI from urban and rural settings.
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Affiliation(s)
- Dustin Hillerson
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Shuang Li
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Naoki Misumida
- Gill Heart and Vascular Institute, University of Kentucky, Lexington
| | - Zachary K. Wegermann
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Ahmed Abdel-Latif
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor
- Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | | | - Tracy Y. Wang
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Khaled M. Ziada
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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Hillerson D, Whiteside HL, Dugan AJ, Coots RD, Tribble TA, Abdel-Latif A, Ogunbayo GO, Duncan MS, Gupta VA. Predicting mortality in nonsurgical patients before cannulation for veno-arterial extracorporeal life support: Development and validation of the LACT-8 score. Catheter Cardiovasc Interv 2022; 99:1115-1124. [PMID: 35114052 DOI: 10.1002/ccd.30106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES We sought to derive and validate a model to predict inpatient mortality after veno-arterial extracorporeal life support (VA-ECLS) based on readily available, precannulation clinical data. BACKGROUND Refractory cardiogenic shock supported by VA-ECLS is associated with high morbidity and mortality. METHODS VA-ECLS cases at our institution from January 2014 through July 2019 were retrospectively reviewed. Exclusion criteria were cannulation: (1) at another institution; (2) for primary surgical indication; or (3) for extracorporeal cardiopulmonary resuscitation. Multivariable logistic regression compared those with and without inpatient mortality. Multiple imputation was performed and optimism-adjusted area under the curve (oAUC) values were computed. RESULTS VA-ECLS cases from August 2019 through November 2020 were identified as a validation cohort. In the derivation cohort (n = 135), the final model included Lactate (mmol/L), hemoglobin (g/dl; Anemia), Coma (Glasgow Coma Scale [GCS] < 8) and resusciTATEd cardiac arrest (LACTATE score; oAUC = 0.760). In the validation cohort (n = 30, LACTATE showed similar predictability [AUC = 0.710]). A simplified (LACT-8) score was derived by dichotomizing lactate (>8) and hemoglobin (<8) and summing together the number of components for each patient. LACT-8 performed similarly (derivation, oAUC = 0.724; validation, AUC = 0.725). In the derivation cohort, both scores outperformed SAVE (oAUC = 0.568) and SOFA (oAUC = 0.699) scores. A LACT-8 ≥ 3 had a specificity for mortality of 97.9% and 92.9%, in the derivation and validation cohorts, respectively. CONCLUSIONS The LACT-8 score can predict inpatient mortality prior to before cannulation for VA-ECLS. LACT-8 can be implemented utilizing clinical data without the need for an online calculator.
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Affiliation(s)
- Dustin Hillerson
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Hoyle L Whiteside
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Adam J Dugan
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Riley D Coots
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Thomas A Tribble
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Ahmed Abdel-Latif
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Gbolahan O Ogunbayo
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Meredith S Duncan
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Vedant A Gupta
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA
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Hillerson D, Charnigo R, Moon Kim S, Iyengar A, Lane M, Misumida N, Kolodziej AR, Ogunbayo GO, Abdel-Latif A, Gurley JC, Booth DC. Ratio of Mixed Venous Oxygen Saturation-to-Pulmonary Capillary Wedge Pressure: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. Circ Heart Fail 2022; 15:e008838. [PMID: 35026961 DOI: 10.1161/circheartfailure.121.008838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hemodynamic values from right heart catheterization aid diagnosis and clinical decision-making but may not predict outcomes. Mixed venous oxygen saturation percentage and pulmonary capillary wedge pressure relate to cardiac output and congestion, respectively. We theorized that a novel, simple ratio of these measurements could estimate cardiovascular prognosis. METHODS We queried Veterans Affairs' databases for clinical, hemodynamic, and outcome data. Using the index right heart catheterization between 2010 and 2016, we calculated the ratio of mixed venous oxygen saturation-to-pulmonary capillary wedge pressure, termed ratio of saturation-to-wedge (RSW). The primary outcome was time to all-cause mortality; secondary outcome was 1-year urgent heart failure presentation. Patients were stratified into quartiles of RSW, Fick cardiac index (CI), thermodilution CI, and pulmonary capillary wedge pressure alone. Kaplan-Meier curves and Cox proportional hazards models related comparators with outcomes. RESULTS Of 12 019 patients meeting inclusion criteria, 9826 had values to calculate RSW (median 4.00, interquartile range, 2.67-6.05). Kaplan-Meier curves showed early, sustained separation by RSW strata. Cox modeling estimated that increasing RSW by 50% decreases mortality hazard by 19% (estimated hazard ratio, 0.81 [95% CI, 0.79-0.83], P<0.001) and secondary outcome hazard by 28% (hazard ratio, 0.72 [95% CI, 0.70-0.74], P<0.001). Among the 3793 patients with data for all comparators, Cox models showed RSW best associated with outcomes (by both C statistics and Bayes factors). Furthermore, pulmonary capillary wedge pressure was superior to thermodilution CI and Fick CI. Multivariable adjustment attenuated without eliminating the association of RSW with outcomes. CONCLUSIONS In a large national database, RSW was superior to conventional right heart catheterization indices at assessing risk of mortality and urgent heart failure presentation. This simple calculation with routine data may contribute to clinical decision-making in this population.
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Affiliation(s)
- Dustin Hillerson
- Lexington Veterans Affairs Health Care System, University of Kentucky, Lexington. (596), KY (D.H., M.L., N.M., A.A.-L., D.C.B.).,Gill Heart and Vascular Institute, University of Kentucky, Lexington. (D.H., R.C., A.I., N.M., A.R.K., G.O.O., A.A.-L., J.C.G., D.C.B.)
| | - Richard Charnigo
- Gill Heart and Vascular Institute, University of Kentucky, Lexington. (D.H., R.C., A.I., N.M., A.R.K., G.O.O., A.A.-L., J.C.G., D.C.B.).,Department of Biostatistics, University of Kentucky, Lexington. (R.C.)
| | - Sun Moon Kim
- Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (S.M.K.).,Department of Medicine, University of North Carolina at Chapel Hill (S.M.K.)
| | - Amrita Iyengar
- Gill Heart and Vascular Institute, University of Kentucky, Lexington. (D.H., R.C., A.I., N.M., A.R.K., G.O.O., A.A.-L., J.C.G., D.C.B.).,College of Medicine, University of Kentucky, Lexington. (A.I.)
| | - Matthew Lane
- Lexington Veterans Affairs Health Care System, University of Kentucky, Lexington. (596), KY (D.H., M.L., N.M., A.A.-L., D.C.B.).,College of Pharmacy, University of Kentucky, Lexington. (M.L.)
| | - Naoki Misumida
- Lexington Veterans Affairs Health Care System, University of Kentucky, Lexington. (596), KY (D.H., M.L., N.M., A.A.-L., D.C.B.).,Gill Heart and Vascular Institute, University of Kentucky, Lexington. (D.H., R.C., A.I., N.M., A.R.K., G.O.O., A.A.-L., J.C.G., D.C.B.)
| | - Andrew R Kolodziej
- Gill Heart and Vascular Institute, University of Kentucky, Lexington. (D.H., R.C., A.I., N.M., A.R.K., G.O.O., A.A.-L., J.C.G., D.C.B.)
| | - Gbolahan O Ogunbayo
- Gill Heart and Vascular Institute, University of Kentucky, Lexington. (D.H., R.C., A.I., N.M., A.R.K., G.O.O., A.A.-L., J.C.G., D.C.B.)
| | - Ahmed Abdel-Latif
- Lexington Veterans Affairs Health Care System, University of Kentucky, Lexington. (596), KY (D.H., M.L., N.M., A.A.-L., D.C.B.).,Gill Heart and Vascular Institute, University of Kentucky, Lexington. (D.H., R.C., A.I., N.M., A.R.K., G.O.O., A.A.-L., J.C.G., D.C.B.)
| | - John C Gurley
- Gill Heart and Vascular Institute, University of Kentucky, Lexington. (D.H., R.C., A.I., N.M., A.R.K., G.O.O., A.A.-L., J.C.G., D.C.B.)
| | - David C Booth
- Lexington Veterans Affairs Health Care System, University of Kentucky, Lexington. (596), KY (D.H., M.L., N.M., A.A.-L., D.C.B.).,Gill Heart and Vascular Institute, University of Kentucky, Lexington. (D.H., R.C., A.I., N.M., A.R.K., G.O.O., A.A.-L., J.C.G., D.C.B.)
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Elbadawi A, Elgendy IY, Jimenez E, Omer MA, Shahin HI, Ogunbayo GO, Paniagua D, Jneid H. Trends and Outcomes of Elective Thoracic Aortic Repair and Acute Thoracic Aortic Syndromes in the United States. Am J Med 2021; 134:902-909.e5. [PMID: 33631161 DOI: 10.1016/j.amjmed.2021.01.021] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND There is a paucity of data on the contemporary outcomes and trends of elective thoracic aortic aneurysm repair and aneurysm-associated acute aortic syndrome. METHODS We queried the National Inpatient Sample (NIS) database years 2012-2016 to identify hospitalizations for elective thoracic aortic aneurysm repair and aneurysm-associated acute aortic syndrome. The main study outcome was in-hospital mortality. RESULTS The analysis yielded 24,295 hospitalizations for elective thoracic aortic aneurysm repair and 8875 hospitalizations for aneurysm-associated acute aortic syndrome. The number of hospitalizations for elective aortic repair significantly increased from 4375 in 2012 to 5450 in 2016 (Ptrend = .01). The number of hospitalizations for acute aortic syndrome numerically increased from 1545 in 2012 to 2340 in 2016 (Ptrend = .10). Overall in-hospital mortality for elective aortic repair was 2.4% with no change over time. In-hospital mortality for acute aortic rupture was 39.4% and for acute aortic dissection was 6.2% with no change over time. Hospitalizations for elective aortic repair had lower incidence of complications compared with those for aneurysm-associated acute aortic syndrome, including cardiogenic shock, cardiac arrest, acute stroke, and shorter length of stay. Factors associated with higher mortality among admissions undergoing elective aortic repair included older age, heart failure, valvular disease, and chronic kidney disease. Older age, coagulopathy, and fluid/ electrolytes disorders were associated with increased mortality among those with acute aortic syndrome. CONCLUSION Contemporary elective thoracic aortic aneurysm repair is associated with lower in-hospital mortality and morbidity when compared with a clinical presentation for an aneurysm-associated acute aortic syndrome. This should be taken into account when deciding the timing of elective aortic aneurysm repair and balancing the risks and benefits.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ernesto Jimenez
- Division of Cardiothoracic Surgery, Baylor School of Medicine, Houston, Tex
| | - Mohmed A Omer
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Hend I Shahin
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston
| | | | - David Paniagua
- Division of Cardiology, Baylor School of Medicine, Houston, Tex
| | - Hani Jneid
- Division of Cardiology, Baylor School of Medicine, Houston, Tex.
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Elbadawi A, Ugwu J, Elgendy IY, Megaly M, Ogunbayo GO, Omer MA, Elzeneini M, Chatila K, Al-Azizi K, Goel SS, Gafoor S. Outcomes of transcatheter versus surgical aortic valve replacement among solid organ transplant recipients. Catheter Cardiovasc Interv 2021; 97:691-698. [PMID: 33400380 DOI: 10.1002/ccd.29426] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/16/2020] [Accepted: 11/29/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a paucity of data regarding the outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) among solid-organ transplant recipients. METHODS Temporal trends in hospitalizations for aortic valve replacement among solid-organ transplant recipients were determined using the National Inpatient Sample database years 2012-2017. Propensity matching was conducted to compare admissions who underwent TAVR versus SAVR. The primary outcome was in-hospital mortality. RESULTS The analysis included 1,730 hospitalizations for isolated AVR; 920 (53.2%) underwent TAVR and 810 (46.7%) underwent SAVR. TAVR was increasingly utilized for solid-organ transplant recipients (Ptrend = 0.01), while there was no change in the number of SAVR procedures (Ptrend = 0.20). The predictors of undergoing TAVR for solid-organ transplant recipients included older age, diabetes, and prior coronary artery bypass surgery, while TAVR was less likely utilized in small-sized hospitals. TAVR was associated with lower in-hospital mortality after matching (0.9 vs. 4.7%, odds ratio [OR] 0.19; 95% confidence interval [CI] 0.11-0.35, p < .001) and after multivariable adjustment (OR 0.07; 95% CI 0.03-0.21, p < .001). TAVR was associated with lower rate of acute kidney injury, acute stroke, postoperative bleeding, blood transfusion, vascular complications, discharge to nursing facilities, and shorter median length of hospital stay. There was no difference between both groups in the use of mechanical circulatory support, hemodialysis, arrhythmias, or pacemaker insertion. CONCLUSION This contemporary observational nationwide analysis showed that TAVR is increasingly performed among solid-organ transplant recipients. Compared with SAVR, TAVR was associated with lower in-hospital mortality, complications, and shorter length of stay.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Justin Ugwu
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Michael Megaly
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Mohamed A Omer
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Mohammed Elzeneini
- Division of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Khaled Chatila
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Karim Al-Azizi
- Interventional Cardiology and Structural Heart Disease, The Heart Hospital Baylor Plano, Baylor Scott and White Health, Plano, Texas, USA
| | - Sachin S Goel
- Division of Cardiovascular Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Sameer Gafoor
- Swedish Medical Centre, Heart and Vascular Institute, Seattle, Washington, USA
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Elbadawi A, Albaeni A, Elgendy IY, Ogunbayo GO, Jimenez E, Cornwell L, Chatterjee A, Khalife W, Alkhouli M, Kapadia SR, Jneid H. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Prior Mediastinal Radiation. JACC Cardiovasc Interv 2020; 13:2658-2666. [PMID: 33213751 DOI: 10.1016/j.jcin.2020.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study sought to evaluate the trends and outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) among patients with prior mediastinal radiation from a national database. BACKGROUND There is a paucity of data about the temporal trends and outcomes of TAVR versus SAVR in patients with prior mediastinal radiation. METHODS The National Inpatient Sample database years 2012 to 2017 was queried for hospitalizations of patients with prior mediastinal radiation who underwent isolated AVR. Using multivariable analysis, the study compared the outcomes of TAVR versus SAVR. The main study outcome was in-hospital mortality. RESULTS The final analysis included 3,675 hospitalizations for isolated AVR; of whom 2,170 (59.1%) underwent TAVR and 1,505 (40.9%) underwent isolated SAVR. TAVR was increasingly performed over time (ptrend = 0.01), but there was no significant increase in the rates of utilization of SAVR. The following factors were independently associated with TAVR utilization: older age, chronic lung disease, coronary artery disease, chronic kidney disease, prior cerebrovascular accidents, prior coronary artery bypass grafting, and larger-sized hospitals, while women were less likely to undergo TAVR. Compared with SAVR, TAVR was associated with lower in-hospital mortality (1.2% vs. 2.0%, adjusted odds ratio: 0.27; 95% confidence interval: 0.09 to 0.79; p = 0.02). TAVR was associated with lower rates of acute kidney injury, use of mechanical circulatory support, bleeding and respiratory complications, and shorter length of hospital stay. TAVR was associated with higher rates of pacemaker insertion. CONCLUSIONS This nationwide observational analysis showed that TAVR is increasingly performed among patients with prior mediastinal radiation. TAVR provides an important treatment option for this difficult patient population with desirable procedural safety when using SAVR as a benchmark.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Aiham Albaeni
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Ernesto Jimenez
- Department of Cardiothoracic Surgery, Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Lorraine Cornwell
- Department of Cardiothoracic Surgery, Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Arka Chatterjee
- Banner University Medical Center, University of Arizona College of Medicine, Tucson, Arizona
| | - Wissam Khalife
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, Texas.
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Liu J, Elbadawi A, Elgendy IY, Megaly M, Ogunbayo GO, Krittanawong C, Tamis-Holland JE, Ballantyne CM, Khalid MU, Virani S, Gulati M, Albert M, Bozkurt B, Jneid H. Age-Stratified Sex Disparities in Care and Outcomes in Patients With ST-Elevation Myocardial Infarction. Am J Med 2020; 133:1293-1301.e1. [PMID: 32417118 DOI: 10.1016/j.amjmed.2020.03.059] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 03/15/2020] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Women are undertreated and have worse clinical outcomes than men after acute myocardial infarction. It remains uncertain whether the sex disparities in treatments and outcomes persist in the contemporary era and whether they affect all age groups equally. METHODS Using the National Inpatient Sample (NIS) registry, we evaluated 1,260,200 hospitalizations for ST-elevation myocardial infarction (STEMI) between 2010 and 2016, of which 32% were for women. The age-stratified sex differences in care measures and mortality were examined. Stepwise multivariable adjustment models, including baseline comorbidities, hospital characteristics, and reperfusion and revascularization therapies, were used to compare measures and outcomes between women and men across different age subgroups. RESULTS Overall, women with STEMI were older than men and had more comorbidities. Women were less likely to receive fibrinolytic therapy, percutaneous coronary intervention (PCI), and coronary artery bypass surgery across all age subgroups. Women with STEMI overall experienced higher unadjusted in-hospital mortality (11.1% vs 6.8%; adjusted odds ratio [OR] = 1.039, 95% confidence interval [CI]: 1.003-1.077), which persisted after multivariable adjustments. However, when stratified by age, the difference in mortality became non-significant in most age groups after stepwise multivariable adjustment, except among the youngest patients 19-49 years of age with STEMI (women vs men: 3.9% vs 2.6%; adjusted odds ratio = 1.259, 95% confidence interval: 1.083-1.464). CONCLUSIONS Women with STEMI were less likely to receive reperfusion and revascularization therapies and had higher in-hospital mortality and complications compared with men. Younger women with STEMI (19-49 years of age) experienced higher in-hospital mortality that persisted after multivariable adjustment.
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Affiliation(s)
- Jing Liu
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Tex
| | - Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Michael Megaly
- Division of Cardiovascular Medicine, Minneapolis Heart Institute, Minneapolis, Minn
| | | | | | | | - Christie M Ballantyne
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Tex
| | - Mirza U Khalid
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Tex
| | - Salim Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, Tex; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Tex
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Tucson
| | - Michelle Albert
- Division of Cardiology, University of California, San Francisco
| | - Biykem Bozkurt
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Tex
| | - Hani Jneid
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Tex.
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Elbadawi A, Mahtta D, Elgendy IY, Saad M, Krittanawong C, Hira RS, Omer M, Ogunbayo GO, Garratt K, Rao SV, Jneid H. Trends and Outcomes of Fibrinolytic Therapy for STEMI: Insights and Reflections in the COVID-19 Era. JACC Cardiovasc Interv 2020; 13:2312-2314. [PMID: 33032721 PMCID: PMC7535804 DOI: 10.1016/j.jcin.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 11/08/2022]
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Elbadawi A, Ahmed HMA, Elgendy IY, Omer MA, Ogunbayo GO, Abohamad S, Paniagua D, Jneid H. Outcomes of Acute Myocardial Infarction in Patients with Rheumatoid Arthritis. Am J Med 2020; 133:1168-1179.e4. [PMID: 32278845 DOI: 10.1016/j.amjmed.2020.02.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 02/05/2020] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is a paucity of data on the outcomes of acute myocardial infarction in patients with rheumatoid arthritis in the contemporary era. METHODS We queried the National Inpatient Sample database (2002-2016) for hospitalizations with acute myocardial infarction. We described the trends and outcomes of acute myocardial infarction-rheumatoid arthritis compared with acute myocardial infarction-no rheumatoid arthritis. RESULTS The analysis included 9,359,546 hospitalizations with acute myocardial infarction, of whom 123,783 (1.3%) had rheumatoid arthritis. There was an increase in the number of hospitalizations with acute myocardial infarction-rheumatoid arthritis (Ptrend < .001). There was an observed downtrend in mortality rates for acute myocardial infarction-rheumatoid arthritis (5.8% in 2002 vs 5.2% in 2016, Ptrend = .01) corresponding to an increase in the utilization of percutaneous coronary intervention (Ptrend < .001). In the overall cohort of acute myocardial infarction, rheumatoid arthritis was independently associated with lower rate of in-hospital mortality (adjusted odds ratio 0.90; 95% confidence interval, 0.81-0.99, P = .03). Compared with ST-elevation myocardial infarction (STEMI)-no rheumatoid arthritis, STEMI-rheumatoid arthritis was associated with lower in-hospital mortality and cardiac arrest, while it was associated with higher discharges to nursing facilities. No difference in mortality was observed among non-ST-elevation myocardial infarction (NSTEMI)-rheumatoid arthritis and NSTEMI-no rheumatoid arthritis, while NSTEMI-rheumatoid arthritis was associated with lower cardiac arrest, cardiogenic shock, and hemodialysis, at the expense of higher bleeding events and discharges to nursing facilities. CONCLUSION In this nationwide analysis, we found an increase in hospitalizations for acute myocardial infarction-rheumatoid arthritis. Among patients with acute myocardial infarction, rheumatoid arthritis was independently associated with lower in-hospital mortality, particularly in cases of STEMI.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston
| | - Hamdy M A Ahmed
- Division of Rheumatology and Clinial Immunology, University of Alabama at Birmingham, Birmingham.
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Mohmed A Omer
- Division of Cardiovascular Medicine, University of Missouri-Kansas City
| | | | - Samar Abohamad
- Department of Internal Medicine, Cairo University, Cairo, Egypt.
| | - David Paniagua
- Division of Cardiology, Baylor School of Medicine, Houston, Texas
| | - Hani Jneid
- Division of Cardiology, Baylor School of Medicine, Houston, Texas.
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Elbadawi A, Elgendy IY, Mahmoud K, Barakat AF, Mentias A, Mohamed AH, Ogunbayo GO, Megaly M, Saad M, Omer MA, Paniagua D, Abbott JD, Jneid H. Temporal Trends and Outcomes of Mechanical Complications in Patients With Acute Myocardial Infarction. JACC Cardiovasc Interv 2020; 12:1825-1836. [PMID: 31537282 DOI: 10.1016/j.jcin.2019.04.039] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [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: 12/31/2018] [Revised: 04/22/2019] [Accepted: 04/30/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The aim of this study was to examine the temporal trends and outcomes of mechanical complications after myocardial infarction in the contemporary era. BACKGROUND Data regarding temporal trends and outcomes of mechanical complications after ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) are limited in the contemporary era. METHODS The National Inpatient Sample database (2003 to September 2015) was queried to identify all STEMI and NSTEMI hospitalizations. Temporal trends and outcomes of mechanical complications after STEMI and NSTEMI, including papillary muscle rupture, ventricular septal defect, and free wall rupture, were described. RESULTS The analysis included 3,951,861 STEMI and 5,114,270 NSTEMI hospitalizations. Mechanical complications occurred in 10,726 of STEMI hospitalizations (0.27%) and 3,041 of NSTEMI hospitalizations (0.06%), with no changes in trends (p = 0.13 and p = 0.83, respectively). The rates of in-hospital mortality in patients with mechanical complications were 42.4% after STEMI and 18.0% after NSTEMI, with no significant trend changes (p = 0.62 and p = 0.12, respectively). After multivariate adjustment, patients who had mechanical complications after myocardial infarction had higher in-hospital mortality, cardiogenic shock, acute kidney injury, hemodialysis, and respiratory complications compared with those without mechanical complications. Predictors of lower mortality in patients with mechanical complications who developed cardiogenic shock included surgical repair in the STEMI and NSTEMI cohorts and percutaneous coronary intervention in the STEMI cohort. CONCLUSIONS Contemporary data from a large national database show that the rates of mechanical complications are low in patients presenting with STEMI and NSTEMI. Post-myocardial infarction mechanical complications continue to be associated with high mortality rates, which did not improve during the study period.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas; Division of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
| | - Karim Mahmoud
- Department of Internal Medicine, Houston Medical Center, Warner Robbins, Georgia
| | - Amr F Barakat
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
| | - Ahmed H Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Michael Megaly
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota; Department of Cardiology, Hennepin Healthcare, Minneapolis, Minnesota
| | - Marwan Saad
- Division of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt; Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mohamed A Omer
- Department of Cardiovascular Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | - David Paniagua
- Division of Cardiology, Baylor School of Medicine and the Michael E DeBakey VAMC, Houston, Texas
| | - J Dawn Abbott
- Division of Cardiovascular Medicine, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Hani Jneid
- Division of Cardiology, Baylor School of Medicine and the Michael E DeBakey VAMC, Houston, Texas
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Elbadawi A, Hamed M, Elgendy IY, Omer MA, Ogunbayo GO, Megaly M, Denktas A, Ghanta R, Jimenez E, Brilakis E, Jneid H. Outcomes of Reoperative Coronary Artery Bypass Graft Surgery in the United States. J Am Heart Assoc 2020; 9:e016282. [PMID: 32691683 PMCID: PMC7792259 DOI: 10.1161/jaha.120.016282] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background There is a paucity of data on the trends and outcomes of reoperative coronary artery bypass graft (CABG) surgery during the current decade in the United States. Methods and Results We queried the National Inpatient Sample database (2002–2016) for all hospitalizations with isolated CABG procedure. We reported the temporal trends and outcomes of reoperative CABG versus primary CABG procedures. The main outcome was in‐hospital mortality. Among 3 212 768 hospitalizations with CABG, 46 820 (1.5%) had reoperative CABG. Over the 15‐year study period, there were no changes in the proportion of reoperative CABG (1.8% in 2002 versus 2.2% in 2016, Ptren=0.08), and the related in‐hospital mortality (3.7% in 2002 versus 2.7% in 2016, Ptrend=0.97). Reoperative CABG was performed in patients with increasingly higher risk profile. Compared with primary CABG, hospitalizations for reoperative CABG were associated with higher in‐hospital mortality (3.2% versus 1.9%, P<0.001), cardiac arrest, cardiogenic shock, vascular complications, and respiratory complications. Among hospitalizations for reoperative CABG, the predictors of higher mortality included history of heart failure and chronic kidney disease. Conclusions In this 15‐year nationwide analysis, reoperative CABG procedures were increasingly performed in patients with higher risk profile. In‐hospital mortality rates were relatively low and did not change during the examined period. Compared with primary CABG, reoperative CABG is associated with higher in‐hospital mortality.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine University of Texas Medical Branch Galveston TX
| | - Mohamed Hamed
- Department of Cardiology Ain Shams University Cairo Egypt
| | - Islam Y Elgendy
- Division of Cardiology Massachusetts General Hospital and Harvard Medical School Boston MA
| | - Mohmed A Omer
- Division of Cardiovascular Medicine University of Missouri Kansas City MO
| | | | - Michael Megaly
- Division of Cardiology Minneapolis Heart Institute Minneapolis MN
| | - Ali Denktas
- Section of Cardiology Baylor School of Medicine and the Michael E. DeBakey VA Medical Center Houston TX
| | - Ravi Ghanta
- Division of Cardiothoracic Surgery Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston TX
| | - Ernesto Jimenez
- Division of Cardiothoracic Surgery Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston TX
| | - Emanuel Brilakis
- Division of Cardiology Minneapolis Heart Institute Minneapolis MN
| | - Hani Jneid
- Section of Cardiology Baylor School of Medicine and the Michael E. DeBakey VA Medical Center Houston TX
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12
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Elbadawi A, Elgendy IY, Mohamed AH, Almahmoud MF, Omer M, Abuzaid A, Mahmoud K, Ogunbayo GO, Denktas A, Paniagua D, Banerjee S, Jneid H. Temporal Trends and Outcomes of Transcatheter Mitral Valve Repair and Surgical Mitral Valve Intervention. Cardiovasc Revasc Med 2020; 21:1560-1566. [PMID: 32620401 DOI: 10.1016/j.carrev.2020.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 03/03/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is a paucity of data regarding the contemporary changes in the uptake and outcomes of transcatheter mitral valve repair (TMVR) and surgical mitral valve repair/replacement (SMVR). METHODS We queried the NIS database (2012-2016) to identify hospitalizations for TMVR and SMVR. We reported the temporal trends for uptake of TMVR and SMVR and their in-hospital outcomes. RESULTS The analysis included 77,645 hospitalizations: 8760 (11.3%) for TMVR and 68,885 (88.7%) for SMVR. Those undergoing TMVR were older and had a higher prevalence of comorbidities, but shorter length of stay (5.5 ± 8.8 vs. 14.3 ± 13.8, p < 0.001) compared with SMVR. There was a marked increase in the number of TMVRs over time (from 420 in 2012 to 3850 in 2016; +917%; Ptrend = 0.008) but a modest increase in the number of SMVRs (+117%; Ptrend = 0.02). Overall, TMVR was associated with low in-hospital mortality (2%) and favorable safety profile. After adjusting for clinical and hospital variables, there were non-significant trends towards lower adjusted mortality among TMVR and SMVR (Ptrend = 0.16 and Ptrend = 0.13, respectively). Notably, among TMVR patients, female sex was associated with lower in-hospital mortality while CKD was associated with increased in-hospital mortality. There was a significant downtrend in the incidences of cardiac arrest, hemodialysis and length of stay in TMVR patients. CONCLUSION Real world data showed a steady increase in the number of TMVR and SMVR procedures. Overall, TMVR was associated with low in-hospital mortality and complications rates. Despite older age and increased comorbidities, TMVR patients had lower in-hospital mortality and shorter length than their SMVR counterparts.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Ahmed H Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, United States of America
| | - Mohamed F Almahmoud
- Division of Cardiovascular Medicine, University of South Carolina, Charleston, SC, United States of America
| | - Mohmed Omer
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - A Abuzaid
- Division of Cardiovascular Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Karim Mahmoud
- Department of Internal Medicine, Houston Medical Center, Warner Robins, GA, United States of America
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Ali Denktas
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, TX, United States of America
| | - David Paniagua
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, TX, United States of America
| | - Subhash Banerjee
- Division of Cardiovascular Medicine, University of Texas South Western, Dallas, TX, United States of America
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, TX, United States of America.
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Elbadawi A, Elzeneini M, Elgendy IY, Mahmoud K, Omer MA, Ogunbayo GO, Kayani W, Denktas A, Paniagua D, Jneid H. Temporal Trends and Outcomes of Percutaneous Coronary Atherectomy in the United States. J Invasive Cardiol 2020; 32:E110-E121. [PMID: 32357132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND There is paucity of data regarding the temporal trends and outcomes of coronary atherectomy in the United States. METHODS We queried the National Inpatient Sample database (2011-2016) for hospitalizations of patients undergoing coronary atherectomy procedures. We also compared outcomes of non-orbital vs orbital coronary atherectomy in a more contemporary cohort. RESULTS Our analysis included 2,990,223 hospitalizations with PCI, of which 114,462 (3.8%) included an atherectomy procedure. A significant increase in coronary atherectomy procedures was observed over time (0.66% in 2011 vs 8.9% in 2016; Ptrend=.04). There was an increase in in-hospital mortality associated with atherectomy procedures from 3.2% in 2011 to 4.7% in 2016 (Ptrend=.04), which paralleled the increase in patient comorbidities, use of mechanical circulatory devices (Ptrend<.001), and procedural complications. While several predictors of increased mortality after an atherectomy procedure were identified, the use of intravascular ultrasound (IVUS) was associated with lower mortality during atherectomy procedures (adjusted odds ratio [OR] = 0.61; 95% confidence interval [CI], 0.42-0.89), although its overall use was low (10.4%). Compared with other atherectomy procedures, orbital atherectomy was associated with lower in-hospital mortality (3.2% vs 4.7%; adjusted OR = 0.50; 95% CI, 0.30-0.81). CONCLUSION Our large national database analysis demonstrates an increase in the number of coronary atherectomy procedures and in their in-hospital mortality and complications over time. Orbital atherectomy appears to be associated with favorable outcomes compared with non-orbital atherectomy, and IVUS use was associated with lower mortality during atherectomy procedures. These associations do not necessarily imply causality and need to be confirmed in future randomized clinical trials.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hani Jneid
- Division of Cardiology, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard - MEDVAMC, 3C-300A, Houston, TX 77030 USA.
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14
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Ogunbayo GO, Goodwin RP, Elbadawi A, Omar M, Hillerson D, Goodwin EM, Pecha R, Abdel-Latif A, Elayi CS, Messerli AW. Temporal Trends in the Use of Intravascular Imaging Among Patients Undergoing Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction in the United States. Am J Cardiol 2019; 124:1650-1652. [PMID: 31554597 DOI: 10.1016/j.amjcard.2019.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 01/01/2023]
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Elbadawi A, Mohamed AH, Elgendy IY, Ogunbayo GO, Megaly M, Shahin HI, Mahmoud K, Omer MA, Abuzaid A, Fujise K, Gilani S. Comparative Outcomes of Transapical Versus Transfemoral Access for Transcatheter Aortic Valve Replacement in Diabetics. Cardiol Ther 2019; 9:107-118. [PMID: 31713066 PMCID: PMC7237629 DOI: 10.1007/s40119-019-00155-5] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction The outcomes of transfemoral (TF) compared with transapical (TA) access for transcatheter aortic valve replacement (TAVR) in diabetics are unknown. Methods We queried the NIS database (2011–2014) to identify diabetics who underwent TAVR. We performed a propensity matching analysis comparing TF-TAVR versus TA-TAVR. Results The analysis included 14.555 diabetics who underwent TAVR. After matching, in-hospital mortality was not different between TF-TAVR and TA-TAVR. (3.5 vs. 4.4%, p = 0.11). TF-TAVR was associated with lower rates of cardiogenic shock (2.7 vs. 4.7%, p = 0.02), use of mechanical circulatory support (2.0 vs. 2.9%, p = 0.03), acute renal failure (17.8 vs. 26.5%, p < 0.001), major bleeding (35.8 vs. 40.7%, p < 0.001) and respiratory complications (1.1 vs. 4.4%, p < 0.001) compared with TA-TAVR. However, TF-TAVR was associated with a higher rate of vascular complications (2.9 vs. 0.9%, p < 0.001), cardiac tamponade (0.5 vs. 0.0%, p < 0.001), complete heart block (10.8 vs. 7.7%, p < 0.001) and pacemaker insertion (11.8 vs. 8.3%, p < 0.001). There was no difference between both groups in acute stroke (1.8 vs. 2.2%, p = 0.39), hemodialysis (2.0 vs. 2.2%, p = 0.71), and ventricular arrhythmias (4.9 vs. 4.2%, p = 0.19). Notably, TF-TAVR was associated with higher mortality, acute stroke, AKI, hemodialysis, PCI, and respiratory complications in complicated diabetics compared with non-complicated diabetics. Conclusions This observational analysis showed no difference in-hospital mortality between TF-TAVR and TA-TAVR among diabetic patients. Studies exploring the optimal access for TAVR among diabetics are recommended. Electronic supplementary material The online version of this article (10.1007/s40119-019-00155-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Ahmed H Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Michael Megaly
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Hend I Shahin
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Karim Mahmoud
- Department of Internal Medicine, Houston Medical Center, Warner Robbins, GA, USA
| | - Mohamed A Omer
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Ahmed Abuzaid
- Alaska Heart and Vascular Institute Anchorage, Alaska, US
| | - Ken Fujise
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Syed Gilani
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
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Elbadawi A, Elgendy IY, Mentias A, Saad M, Mohamed AH, Choudhry MW, Ogunbayo GO, Gilani S, Jneid H. Outcomes of urgent versus nonurgent transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 96:189-195. [PMID: 31647180 DOI: 10.1002/ccd.28563] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 10/13/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a paucity of data regarding the outcomes of transcatheter valve replacement (TAVR) performed in an urgent clinical setting. METHODS The Nationwide Inpatient Sample (NIS) database years 2011-2014 was used to identify hospitalizations for TAVR in the urgent setting. Using propensity score matching, we compared patients who underwent TAVR in nonurgent versus urgent settings. RESULTS Among 42,154 hospitalizations in which TAVR was performed, 10,114 (24%) underwent urgent TAVR. There was an uptrend in the rate of urgent TAVR procedures (p = .001). The rates of in-hospital mortality among this group did not change during the study period (p = .713). Nonurgent TAVR was associated with lower mortality (odds ratio [OR] = 0.78; 95% confidence interval [CI]: 0.69-0.89, p < .001) compared with urgent TAVR. Nonurgent TAVR was associated with lower incidence of cardiogenic shock (OR = 0.46; 95%CI: 0.40-0.53 p < .001), use of mechanical circulatory support devices (OR = 0.69; 95%CI: 0.59-0.82, p < .001), AKI (OR = 0.60; 95%CI: 0.56-0.64 p < .001), hemodialysis (OR = 0.67; 95%CI: 0.56-0.80 p < .001), major bleeding (OR = 0.94; 95%CI: 0.89-0.99 p = .045) and shorter length of stay (7.08 ± 6.317 vs. 12.39 ± 9.737 days, p < .001). There was no difference in acute stroke (OR = 0.96; 95%CI: 0.81-1.14, p = .636), vascular complications (OR = 1.07; 95%CI: 0.89-1.29, p = .492), and pacemaker insertions (OR = 0.92; 95%CI: 0.84-1.01, p = .067) between both groups. Among those undergoing urgent TAVR, subgroup analysis showed higher mortality in patients ≤80 years (p = .033), women (p < .001), chronic kidney disease (p = .001), heart failure (p < .001), and liver disease (p = .003). CONCLUSION In this large nationwide analysis, almost a quarter of TAVR procedures were performed in the urgent settings. Although urgent TAVR was associated with higher mortality and increased complications compared with nonurgent TAVR, the absolute difference in in-hospital mortality was not remarkably higher. Thus, urgent TAVR can be considered as a reasonable approach when indicated.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
| | - Marwan Saad
- Cardiovascular Institute, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ahmed H Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | | | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Syed Gilani
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, Texas
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Mullis AH, Ayoub K, Shah J, Butt M, Suffredini J, Czarapata M, Delisle B, Ogunbayo GO, Darrat Y, Elayi CS. Fluctuations in premature ventricular contraction burden can affect medical assessment and management. Heart Rhythm 2019; 16:1570-1574. [DOI: 10.1016/j.hrthm.2019.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Indexed: 10/27/2022]
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18
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Elbadawi A, Ahmed HMA, Mahmoud K, Mohamed AH, Barssoum K, Perez C, Mahmoud A, Ogunbayo GO, Omer MA, Jneid H, Chatterjee A. Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Rheumatoid Arthritis (from the Nationwide Inpatient Database). Am J Cardiol 2019; 124:1099-1105. [PMID: 31378321 DOI: 10.1016/j.amjcard.2019.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 11/29/2022]
Abstract
Little is known on the outcomes of surgical aortic valve replacement (SAVR) versus transcatheter aortic valve implantation (TAVI) in patients with rheumatoid arthritis (RA). We queried the Nationwide Inpatient Sample Database (2012 to 2016). We performed a propensity-score-matched analysis based on 25 clinical and hospital variables to compare patients with RA who underwent SAVR versus TAVI. Our primary outcome was in-hospital mortality. Our final analysis included 5,640 hospitalizations with RA who underwent isolated AVR; of whom, 2,465 (43.7%) underwent TAVI. There was an increasing trend in TAVI procedures during the study years (ptrend= 0.001). There was a trend toward reduced in-hospital mortality among TAVI compared with SAVR but did not reach statistical significance (0.8% vs 1.6%, odds ratio = 0.50; 95% confidence interval 0.23 to 1.06, p = 0.097). TAVI was associated with lower rates of postoperative bleeding (28.7% vs 43.9%, p <0.001), blood transfusion (12.3% vs 40.2%, p <0.001), acute kidney injury (9.8% vs 16.0%, p <0.001), cardiac tamponade (0.0% vs 1.6%, p <0.001), and discharges to skilled nursing facility (SNF) (20.1% vs 42.2%, p <0.001). However, TAVI was associated with a higher rate of complete heart block (14.3% vs 6.1%, p <0.001) and pacemaker implantations (14.8% vs 5.7%, p <0.001). There were no differences between both groups in cardiogenic shock, acute stroke, acute myocardial infarction, and vascular complications. In conclusion, real-word data showed no significant difference in in-hospital mortality between TAVI and SAVR in patients with RA. TAVI was associated with lower rates of acute kidney injury and bleeding complications at the expense of higher incidence of pacemaker implantations.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas.
| | - Hamdy M A Ahmed
- Division of Rheumatology, University of Alabama, Birmingham, Alabama
| | - Karim Mahmoud
- Department of Internal Medicine, Houston Medical Center, Warner Robbins, Georgia
| | - Ahmed H Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Kirolos Barssoum
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Christopher Perez
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Ahmad Mahmoud
- Department of Internal Medicine, University of Florida, Gainesville, Florida
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Mohamed A Omer
- Department of Cardiovascular Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas
| | - Arka Chatterjee
- Division of Cardiology, Division of Cardiovascular Disease, University of Alabama, Birmingham, Alabama
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Elbadawi A, Elgendy IY, Naqvi SY, Mohamed AH, Ogunbayo GO, Omer MA, Mentias A, Saad M, Abbott JD, Jneid H, Bhatt DL. Temporal Trends and Outcomes of Hospitalizations With Prinzmetal Angina: Perspectives From a National Database. Am J Med 2019; 132:1053-1061.e1. [PMID: 31047867 DOI: 10.1016/j.amjmed.2019.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/10/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Contemporary data regarding the temporal changes in prevalence and outcomes of hospitalizations with Prinzmetal angina are limited. METHODS We queried the National Inpatient Sample Database for the years 2002-2015 to identify hospitalizations with Prinzmetal angina. We described the temporal trends and outcomes in patients with Prinzmetal angina. RESULTS A total of 97,280 hospitalizations with Prinzmetal angina were identified. There was a significant increase in the number of hospitalizations with Prinzmetal angina (3678 in 2002 vs 8633 in 2015, Ptrend <.001) as well as the proportion of hospitalizations with Prinzmetal angina among those with chest pain (Ptrend <.001). There was an increase in the rates of in-hospital mortality (0.24% in 2002 vs 0.85% in 2015, Ptrend = .02), which corresponded to a progressive increase in the burden of comorbidities among patients with Prinzmetal angina. Age >65 years, history of heart failure, chronic kidney disease, chronic liver disease, and acute myocardial infarction upon presentation were independent predictors of in-hospital mortality. Compared with patients with acute myocardial infarction without Prinzmetal angina, those with Prinzmetal angina presenting with acute myocardial infarction had a lower incidence of in-hospital mortality (odds ratio 0.24, 95% confidence interval 0.14-0.41). CONCLUSIONS In this large national analysis, there has been an increase in the prevalence of hospitalizations with Prinzmetal angina. Older age, heart failure, chronic kidney disease, chronic liver disease, and acute myocardial infarction were predictors of higher mortality among patients with Prinzmetal angina. Patients with Prinzmetal angina who developed acute myocardial infarction had more favorable outcomes compared with myocardial infarction without Prinzmetal angina.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville
| | - Syed Yaseen Naqvi
- Division of Cardiovascular Medicine, University of Rochester, Rochester, N.Y
| | - Ahmed H Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, N.Y
| | | | - Mohamed A Omer
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City
| | - Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa, Iowa City
| | - Marwan Saad
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - J Dawn Abbott
- Division of Cardiovascular Medicine, Warren Alpert School of Medicine at Brown University, Providence, R.I
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, Tex
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass.
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Misumida N, Ogunbayo GO, Catanzaro J, Etaee F, Kim SM, Abdel‐Latif A, Ziada KM, Elayi CS. Contemporary practice pattern of permanent pacing for conduction disorders in inferior ST-elevation myocardial infarction. Clin Cardiol 2019; 42:728-734. [PMID: 31173380 PMCID: PMC6671775 DOI: 10.1002/clc.23210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Currently, there is no clear consensus regarding the optimal waiting period before permanent pacemaker implantation in patients with conduction disorders following an inferior myocardial infarction. HYPOTHESIS We aimed to elucidate the contemporary practice pattern of pacing, especially the timing of pacemaker implantation, for sinoatrial node and atrioventricular (AV) conduction disorders following an inferior ST-elevation myocardial infarction (STEMI). METHODS Using the National Inpatient Sample database from 2010 to 2014, we identified patients with a primary diagnosis of inferior STEMI. Primary conduction disorders were classified into: (a) high-degree AV block (HDAVB) consisting of complete AV block or Mobitz-type II second-degree AV block, (b) sinoatrial node dysfunction (SND), and (c) no major conduction disorders. RESULTS Among 66 961 patients, 2706 patients (4.0%) had HDAVB, which mostly consisted of complete AV block (2594 patients). SND was observed in 393 patients (0.6%). Among the 2706 patients with HDAVB, 267 patients (9.9%) underwent permanent pacemaker. In patients with HDAVB, more than one-third (34.9%) of permanent pacemakers were placed within 72 hours after admission. The median interval from admission to permanent pacemaker implantation was 3 days (interquartile range; 2-5 days) for HDAVB vs 4 days (3-6 days) for SND (P < .001). HDAVB was associated with increased in-hospital mortality, whereas SND was not. CONCLUSIONS In patients who developed HDAVB following an inferior STEMI, only one in 10 patients underwent permanent pacemaker implantation. Despite its highly reversible nature, permanent pacemakers were implanted relatively early.
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Affiliation(s)
- Naoki Misumida
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - Gbolahan O. Ogunbayo
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - John Catanzaro
- Devision of Cardiovascular MedicineUniversity of FloridaJacksonvilleFlorida
| | - Farshid Etaee
- Department of CardiologyUniversity of Texas Southwestern Medical CenterDallasTexas
| | - Sun Moon Kim
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - Ahmed Abdel‐Latif
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - Khaled M. Ziada
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - Claude S. Elayi
- Devision of Cardiovascular MedicineUniversity of FloridaJacksonvilleFlorida
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Ogunbayo GO, Misumida N, Goodwin E, Pecha R, Elbadawi A, Elayi CS, Abdel-Latif A, Gurley J, Messerli AW, Ziada K. Characteristics, Outcomes, and Predictors of Significant Pericardial Complications in Patients who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 124:321-322. [PMID: 31097194 DOI: 10.1016/j.amjcard.2019.04.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
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Abo-Aly M, Misumida N, Backer N, ElKholey K, Kim SM, Ogunbayo GO, Abdel-Latif A, Ziada KM. Percutaneous Coronary Intervention With Drug-Eluting Stent Versus Optimal Medical Therapy for Chronic Total Occlusion: Systematic Review and Meta-Analysis. Angiology 2019; 70:908-915. [PMID: 31256614 DOI: 10.1177/0003319719858823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The optimal treatment strategy for coronary chronic total occlusion (CTO) has not been well established. The benefit of percutaneous coronary intervention (PCI) was inferred mainly from observational studies comparing successful versus failed PCI without a control group receiving optimal medical therapy (OMT). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies comparing PCI using drug-eluting stent (DES) versus OMT alone in patients with CTO. Eight studies were identified: 3 RCTs and 5 observational studies. Among a total of 4784 included patients, 2461 patients underwent PCI and 2323 patients received OMT. There was a significant association between PCI and lower cardiac mortality (odds ratio = 0.62; 95% confidence interval 0.42-0.93; P = .02). There was no significant difference between PCI and OMT regarding major adverse cardiac events, recurrent myocardial infarction (MI), repeat revascularization, or stroke. In the RCT subset (1399 patients), there was no significant difference between PCI and OMT regarding clinical outcomes. Compared with OMT alone, PCI with DES for CTO was associated with lower cardiac mortality, mainly driven by observational studies, without significant difference in recurrent MI or repeated revascularization. Further RCTs are needed to investigate the role of PCI for management of patients with CTO.
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Affiliation(s)
- Mohamed Abo-Aly
- 1 Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Naoki Misumida
- 1 Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Neil Backer
- 1 Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Khaled ElKholey
- 2 Heart Rhythm Institute, Oklahoma University Health Science Center, Oklahoma City, OK, USA
| | - Sun Moon Kim
- 3 University of North Carolina Heart and Vascular Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gbolahan O Ogunbayo
- 1 Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Ahmed Abdel-Latif
- 1 Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Khaled M Ziada
- 1 Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
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Hillerson D, Ogunbayo GO, Salih M, Misumida N, Abdel-Latif A, Smyth SS, Messerli AW. Outcomes and Characteristics of Myocardial Infarction in Patients With Cirrhosis. J Invasive Cardiol 2019; 31:E162-E169. [PMID: 31257209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Patients with cirrhosis have increased bleeding risk due to coagulopathy and platelet sequestration, as well as inherent cardiovascular risk. We aim to assess the impact of cirrhosis on the revascularization rates and in-hospital outcomes in patients with acute myocardial infarction (AMI). METHODS We queried the National Inpatient Sample Database from 2010 to 2014 and identified hospitalizations with a primary diagnosis of AMI (n = 612,547); of these, a total of 3135 patients had a concomitant diagnosis of cirrhosis. We compared clinical outcomes between patients with cirrhosis and a propensity-score matched cohort without cirrhosis (n = 3086). RESULTS Patients with cirrhosis had a lower rate of ST-elevation MI (18.9% vs 26.7% in the cohort with no cirrhosis; P<.001), a lower rate of coronary angiography (51.4% vs 63.9% in the cohort with no cirrhosis; P<.001), and lower rates of revascularization by percutaneous coronary intervention (PCI) (28.7% vs 39.2% in the cohort with no cirrhosis; P<.001) or coronary artery bypass grafting (6.0% vs 12.9% in the cohort with no cirrhosis; P<.001). Gastrointestinal and postprocedural hemorrhage was more common in patients with cirrhosis (12.3% vs 7.1% in the cohort with no cirrhosis; P<.001), regardless of revascularization status, and cirrhosis patients also had a higher in-hospital mortality rate (8.7% vs 6.9% in the cohort with no cirrhosis; P<.01). PCI was independently associated with lower mortality in patients with cirrhosis (odds ratio, 0.57; 95% confidence interval, 0.33-0.98; P=.04). CONCLUSION Patients with cirrhosis presenting with AMI were highly selected to undergo coronary angiography and subsequent revascularization, and had higher mortality than those without cirrhosis. However, PCI was independently associated with lower mortality in patients with cirrhosis, although to less effect than non-cirrhotics, perhaps due to higher bleeding rates.
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Affiliation(s)
- Dustin Hillerson
- University of Kentucky College of Health Sciences, 900 S. Limestone, CTW 326, Lexington KY 40536 USA.
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Elbadawi A, Naqvi SY, Elgendy IY, Almahmoud MF, Hamed M, Abowali H, Ogunbayo GO, Jneid H, Ziada KM. Ethnic and Gender Disparities in the Uptake of Transcatheter Aortic Valve Replacement in the United States. Cardiol Ther 2019; 8:151-155. [PMID: 31240615 PMCID: PMC6828867 DOI: 10.1007/s40119-019-0138-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Little is known about ethnic and gender disparities for transcatheter aortic valve replacement (TAVR) procedures in the United States. METHODS We queried the Nationwide Inpatient Sample (NIS) database (2011-2014) to identify patients who underwent TAVR. We described the temporal trends in the uptake of TAVR procedures among various ethnicities and genders. RESULTS Our analysis identified 39,253 records; 20,497 (52.2%) were men and 18,756 (47.8%) were women. Among all TAVRs, 87.2% were Caucasians, 3.9% were African Americans (AA), 3.7% were Hispanics, and 5.2% were of other ethnicities. We found a significant rise in the trend of TAVRs in all groups: in Caucasian men (coefficient = 0.946, p < 0.001), Caucasian women (coefficient = 0.985, p < 0.001), AA men (coefficient = 0.940, p < 0.001), AA women (coefficient = 0.864, p < 0.001), Hispanic men (coefficient = 0.812, p = 0.001), Hispanic women (coefficient = 0.845, p < 0.001). Hence, the uptrend was most significant among Caucasian women, and relatively least significant among Hispanic men. Multivariate regression analysis was conducted to evaluate in-hospital mortality among different groups after adjusting for demographics and baseline characteristics. After multivariable regression for baseline characteristics overall, the in-hospital mortality per 100 TAVRs was highest among Hispanic men 5.5%, followed by Caucasian women 5.0%, Hispanic women 4.6%, AA women 3.7%, AA men 3.4%, and Caucasian men 3.38% (adjusted p value = 0.004). CONCLUSIONS In this observational study, we demonstrated that there is evidence of ethnic and gender differences in the overall uptake and adjusted mortality of TAVRs in the United States.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Syed Yaseen Naqvi
- Department of Cardiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Mohamed F Almahmoud
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Mohamed Hamed
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Hesham Abowali
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Khaled M Ziada
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
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Ogunbayo GO, Pecha R, Misumida N, Goodwin E, Ayoub K, Hillerson D, Elbadawi A, Abdel-Latif A, Elayi CS, Messerli AW, Smyth SS. Outcomes of fibrinolytic therapy for patients with metastatic cancer and acute pulmonary embolism. Pulm Pharmacol Ther 2019; 56:104-107. [PMID: 30959093 DOI: 10.1016/j.pupt.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/30/2019] [Accepted: 04/03/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Malignancy is a common cause of morbidity and mortality in the United States and around the world and the second leading cause of death in the United States. There is little data on the impact of metastatic cancer on the risk of hemorrhagic stroke or mortality among patients undergoing fibrinolytic therapy (FT) for acute PE. METHODS Using the National Inpatient Sample (NIS) database, we extracted admissions with a primary diagnosis of acute pulmonary embolism that underwent FT from 2010 to 2014. We performed a case control matched analysis between patients with and without metastatic cancer. Our primary outcome of interest was Mortality and our secondary outcome of interest was hemorrhagic stroke (HS). RESULTS Of the 883,183 patients with a primary diagnosis of acute PE between 2010 and 12014, 23,690 patients (2.7%) underwent FT. After exclusion, 22,592 patients were included in the analysis. Of these, 941 patients (4.2%) were reported to have metastatic cancer. There was a higher incidence of cerebrovascular accidents and intubation/mechanical ventilation in the metastatic cancer arm. Mortality was significantly higher in the metastatic cancer arm with no difference in the incidence of HS. In multivariate regression analysis, among all patients that underwent FT for acute PE, metastatic cancer was associated with a significant odds for mortality (OR 1.91, 95% CI 1.11-5.82, p < .001). CONCLUSION The presence of metastatic cancer in patients undergoing fibrinolytic therapy for acute pulmonary embolism is associated with increase mortality.
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Affiliation(s)
| | - Robert Pecha
- University of Kentucky Medical Center, Lexington, KY, USA
| | - Naoki Misumida
- University of Kentucky Medical Center, Lexington, KY, USA
| | | | - Karam Ayoub
- University of Kentucky Medical Center, Lexington, KY, USA
| | | | | | | | - Claude S Elayi
- University of Kentucky Medical Center, Lexington, KY, USA
| | | | - Susan S Smyth
- University of Kentucky Medical Center, Lexington, KY, USA
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Elbadawi A, Barssoum K, Abuzaid AS, Rezq A, Biniwale N, Alotaki E, Mohamed AH, Vuyyala S, Ogunbayo GO, Saad M. Meta-analysis of randomized trials on percutaneous patent foramen ovale closure for prevention of migraine. Acta Cardiol 2019; 74:124-129. [PMID: 29914296 DOI: 10.1080/00015385.2018.1475027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The role of percutaneous patent foramen ovale (PFO) closure for prevention of migraine is controversial. METHODS We performed a computerised search of MEDLINE, EMBASE and COCHRANE databases through December 2017 for randomised trials evaluating PFO closure versus control in patients with migraine headaches (with or without aura). The main study outcome was the reduction in monthly migraine attacks after PFO closure compared with the control group. RESULTS The final analysis included three randomised trials with a total of 484 patients. Reduction in monthly migraine attacks was higher in PFO closure compared with the control group (standardised mean difference-SMD = 0.25; 95% CI: 0.06-0.43; p = .01). There was higher reduction of monthly migraine days in PFO closure group compared with control group (SMD = 0.30; 95% CI: 0.08-0.53; p = .01). There was no statistically significant difference in complete resolution of migraine attacks (OR: 3.67; 95% CI: 0.66-20.41; p = .14) and in responders' rate (OR: 1.92; 95% CI: 0.76-4.85; p = .17) between PFO closure and control groups. In patients whose majority of migraine attacks are with aura, there was an observed reduction in migraine attacks in PFO closure compared with control groups (SMD = 0.86; 95% CI: 0.07-1.65; p = .03). CONCLUSION PFO closure might be beneficial in migraine patients by reducing migraine attacks and migraine days, especially in patients whose majority of migraine attacks are with aura. However, those benefits were not associated with an improvement in responders' rate or complete resolution of migraine; raising concerns on the magnitude of clinical benefit of PFO closure in migraine prevention.
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Affiliation(s)
- Ayman Elbadawi
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
- Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Kirolos Barssoum
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Ahmed S. Abuzaid
- Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE, USA
| | - Ahmed Rezq
- Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Nishit Biniwale
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Erfan Alotaki
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Ahmed H. Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Sowjanya Vuyyala
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Gbolahan O Ogunbayo
- Division of cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Marwan Saad
- Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
- Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Ogunbayo GO, Shrout TA, Misumida N, Abdel-Latif A, Smyth SS, Messerli AW, Ziada KM. Trends, Management Patterns, and Predictors of Leaving Against Medical Advice among Patients with Documented Noncompliance Admitted for Acute Myocardial Infarction. J Gen Intern Med 2019; 34:486-488. [PMID: 30402820 PMCID: PMC6445907 DOI: 10.1007/s11606-018-4671-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Gbolahan O Ogunbayo
- University of Kentucky Medical Center, Lexington, KY, USA. .,Division of Cardiovascular Medicine, The Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA.
| | - Tara A Shrout
- University of Kentucky Medical Center, Lexington, KY, USA.,Division of Cardiovascular Medicine, The Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Naoki Misumida
- University of Kentucky Medical Center, Lexington, KY, USA
| | | | - Susan S Smyth
- University of Kentucky Medical Center, Lexington, KY, USA
| | | | - Khalid M Ziada
- University of Kentucky Medical Center, Lexington, KY, USA
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Elbadawi A, Mentias A, Elgendy IY, Mohamed AH, Syed MH, Ogunbayo GO, Olorunfemi O, Gosev I, Prasad S, Cameron SJ. National trends and outcomes for extra-corporeal membrane oxygenation use in high-risk pulmonary embolism. Vasc Med 2019; 24:230-233. [PMID: 30834824 DOI: 10.1177/1358863x18824650] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about the temporal trends and outcomes for extra-corporeal membrane oxygenation (ECMO) in patients with high-risk pulmonary embolism (PE) in the United States. We queried the National Inpatient Sample (NIS) database from 2005 to 2013 to identify patients admitted with high-risk PE. Our objective was to determine trends for ECMO use in patients with high-risk PE. We also assessed in-hospital outcomes among patients with high-risk PE receiving ECMO. We evaluated 77,809 hospitalizations for high-risk PE. There was an upward trend in the utilization of ECMO from 0.07% in 2005 to 1.1% in 2013 ( p = 0.015). ECMO was utilized more in urban teaching hospitals and large hospitals. ECMO use was associated with lower mortality in patients with massive PE ( p < 0.001). In-hospital mortality for patients receiving ECMO was 61.6%, with no change over the observational period ( p = 0.68). Our investigation revealed several independent predictors of increased mortality in patients with high-risk PE using ECMO as hemodynamic support, including: age, female sex, obesity, congestive heart failure, and chronic pulmonary disease. ECMO, therefore, as a rescue strategy or bridge to definitive treatment, may be effective in the management of high-risk PE when selecting patients with favorable clinical characteristics.
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Affiliation(s)
- Ayman Elbadawi
- 1 Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Amgad Mentias
- 2 Division of Cardiovascular Medicine, University of Iowa, Iowa City, IA, USA
| | - Islam Y Elgendy
- 3 Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Ahmed H Mohamed
- 4 Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Mohammed Hz Syed
- 4 Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Gbolahan O Ogunbayo
- 5 Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Odunayo Olorunfemi
- 4 Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Igor Gosev
- 6 Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Sunil Prasad
- 6 Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Scott J Cameron
- 6 Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY, USA.,7 Division of Cardiology, University of Rochester Medical Center, Rochester, NY, USA
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Elbadawi A, Elgendy IY, Ha LD, Saad M, Mahmoud K, Ogunbayo GO, Kumfa P, Rangasetty UC, Gilani S. National Trends of Percutaneous Coronary Intervention in Patients ≥70 Years of Age. Am J Cardiol 2019; 123:701-703. [PMID: 30595394 DOI: 10.1016/j.amjcard.2018.11.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Ayman Elbadawi
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt.
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
| | - Le Dung Ha
- Department of Cardiovascular Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Marwan Saad
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock AR; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Karim Mahmoud
- Department of Internal Medicine, Houston Medical Center, Warner Robbins, GA
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY
| | - Paul Kumfa
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX
| | | | - Syed Gilani
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX
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Ogunbayo GO, Elayi SC, Ha LD, Olorunfemi O, Elbadawi A, Saheed D, Sorrell VL. Outcomes of Heart Block in Myocarditis: A Review of 31,760 Patients. Heart Lung Circ 2019; 28:272-276. [DOI: 10.1016/j.hlc.2017.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 10/07/2017] [Accepted: 12/08/2017] [Indexed: 11/25/2022]
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Ogunbayo GO, Pecha R, Misumida N, Hillerson D, Elbadawi A, Abdel-Latif A, Elayi CS, Messerli AW, Smyth SS. Relation of CHA 2DS 2VASC Score With Hemorrhagic Stroke and Mortality in Patients Undergoing Fibrinolytic Therapy for ST Elevation Myocardial Infarction. Am J Cardiol 2019; 123:212-217. [PMID: 30415795 DOI: 10.1016/j.amjcard.2018.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 12/18/2022]
Abstract
Hemorrhagic stroke (HS) is a feared complication of Fibrinolytic therapy (FT). Risk assessment scores may help in risk stratification to reduce this complication. Patients (admissions) ≥18 years with a primary diagnosis of ST-elevation myocardial infarction (STEMI) who received systemic thrombolysis were extracted from Nationwide Inpatient Sample database and stratified and compared based on CHA2DS2VASC score 0 to 3, 4 to 6, and 7 to 9 as low, intermediate and high risk, respectively. The primary outcomes of interest were HS and mortality. We performed logistic regression analysis with a composite of HS and mortality as the primary end point. Of the 917,307 admissions with a primary diagnosis of STEMI, 39,579 (4.3%) underwent FT. The median score was 3 (interquartile range 1 to 5). The rate of HS significantly increased in the risk category compared with the low and intermediate groups (0.5% and 0.6% vs 4.1%; p <0.001). Mortality increased with increasing risk category (3.8% vs 10.5% vs 20.7%; p <0.001). Compared with the low-risk group patients in the intermediate (odds ratio 2.11 95% confidence interval [CI] 1.56 to 2.85; p <0.001) and high risk groups (odds ratio 3.47 95% CI 1.68 to 7.2; p <0.001) were more likely to experience the composite end point of HS or inpatient mortality. CHA2DS2VASC score performed better at predicting mortality (area under curve 0.67, 95% CI 0.64 to 0.7; p = 0.014) than HS (area under curve 0.6 95% CI 0.52 to 0.69; p = 0.021). In conclusion, patients with high CHA2DS2VASC score (7 to 9) are at a higher risk of hemorrhagic stroke and death after FT for STEMI. CHA2DS2VASC score performed better at predicting mortality than hemorrhagic stroke in this cohort.
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Elbadawi A, Elgendy IY, Ha LD, Mahmoud K, Lenka J, Olorunfemi O, Reyes A, Ogunbayo GO, Saad M, Abbott JD. National Trends and Outcomes of Percutaneous Coronary Intervention in Patients ≥70 Years of Age With Acute Coronary Syndrome (from the National Inpatient Sample Database). Am J Cardiol 2019; 123:25-32. [PMID: 30360891 DOI: 10.1016/j.amjcard.2018.09.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/16/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
Abstract
Several randomized trials have demonstrated the benefits of an invasive strategy for older patients with acute coronary syndromes (ACS); however, there are limited real-world data of the temporal trends in the use of percutaneous coronary intervention (PCI) in this population. This was a retrospective observational analysis. We queried the National Inpatient Sample database from 1998 to 2013 for patients aged ≥70 years who had non-ST-elevation acute coronary syndrome (NSTE-ACS) or ST-elevation myocardial infarction (STEMI). We reported the temporal trends of PCI and in-hospital mortality. A total of 6,720,281 hospitalizations with ACS were identified in advanced age patients, 18.3% of whom also underwent PCI. There was an upward trend in the rate of PCI in older adults ≥70 years with any ACS from 9.4% in 1998 to 28.3% in 2013 (p <0.001), as well as in cases of PCI for NSTE-ACS (7.3% in 1998 vs 24.9% in 2013, p <0.001) and PCI for STEMI (11% in 1998 vs 35.7% in 2013, p = 0.002). This upward trend was consistent in all age categories (70 to 79), (80 to 89) and ≥90 years. Despite an increase in the prevalence of comorbidities for ACS hospitalizations aged ≥70 years who received PCI, the in-hospital mortality rate showed a downward trend (p <0.001). Multivariate analysis adjusting for various comorbidities showed that PCI was associated with lower in-hospital mortality and length of hospital stay among elderly with NSTE-ACS and STEMI. In conclusion, in this 16-year analysis there was an increase in the rate of PCI procedures among older adults with ACS. PCI was independently associated with lower mortality in elderly patients with ACS.
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Elbadawi A, Elgendy IY, Mahmoud AH, Ogunbayo GO, Saad M, Megaly M, Alotaki E, Mentias A, Barakat AF, London B. Outcomes of Surgical Ablation in Patients With Atrial Fibrillation Undergoing Cardiac Surgeries. Ann Thorac Surg 2018; 107:1395-1400. [PMID: 30481521 DOI: 10.1016/j.athoracsur.2018.10.040] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/18/2018] [Accepted: 10/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surgical ablation procedure is commonly performed in patients with atrial fibrillation (AF) undergoing cardiac surgeries; however, the evidence regarding its impact on in-hospital cardiovascular outcomes is controversial. METHODS We queried the Nationwide Inpatient Sample Database for patients with AF who underwent cardiac surgeries from 1998 to 2013. We performed a propensity-score matching including 21 various baseline characteristics to compare those who underwent surgical ablation with those who had not. RESULTS A total of 47,964 hospitalizations were included in our final analysis. On propensity matching, 23,975 were in the surgical ablation group and 23,990 in the control group. The primary outcome of in-hospital mortality was lower in the surgical ablation group compared with the control group (3.6% versus 4.2%, p < 0.001). The surgical ablation group was associated with lower in-hospital cerebrovascular accident (2.0% versus 2.8%, p < 0.001), cardiogenic shock (2.6% versus 3.6%, p < 0.001), use of intraaortic balloon pump (5.1% versus 5.8%, p = 0.001), and shorter length of hospital stay (12.3 ± 10.1 versus 12.5 ± 10.3 days, p = 0.008). There was no difference between the surgical ablation and control groups in the incidence of cardiac tamponade (0.4% versus 0.3%, p = 0.296). The surgical ablation group was associated with a higher rate of complete heart block (5.2% versus 4.3%, p < 0.001) and permanent pacemaker insertion (8.6% versus 8.0%, p = 0.01). CONCLUSIONS In this large analysis of almost 50,000 patients with AF undergoing cardiac surgery, surgical ablation appears to be safe in the short term. Future studies should focus on evaluating the long-term effectiveness of this procedure.
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Affiliation(s)
- Ayman Elbadawi
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt.
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Ahmed H Mahmoud
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Marwan Saad
- Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt; Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Michael Megaly
- Minneapolis Heart Institute at Abbot Northwestern Hospital, Minneapolis, Minnesota
| | - Erfan Alotaki
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Amgad Mentias
- Department of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
| | - Amr F Barakat
- UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Barry London
- Department of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
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Misumida N, Abo-Aly M, Kim SM, Ogunbayo GO, Abdel-Latif A, Ziada KM. Efficacy and safety of short-term dual antiplatelet therapy (≤6 months) after percutaneous coronary intervention for acute coronary syndrome: A systematic review and meta-analysis of randomized controlled trials. Clin Cardiol 2018; 41:1455-1462. [PMID: 30225978 DOI: 10.1002/clc.23075] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/28/2018] [Accepted: 09/09/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients who undergo percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) are at increased risk for subsequent ischemic events. HYPOTHESIS Short-term dual antiplatelet therapy (DAPT) (≤6 months) is inferior to standard or long-term DAPT in patients who undergo PCI for ACS events. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials that compared short-term (≤6 months) to long-term (≥12 months) DAPT after PCI for ACS. We searched MEDLINE, EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Trials database. RESULTS Ten randomized controlled trials, including a total of 12 696 patients, met our inclusion criteria. For short-term DAPT, duration of therapy ranged from 3 to 6 months, while long-term DAPT ranged from 12 to 24 months. The majority of studies used clopidogrel and second-generation drug-eluting stents. No statistically significant difference was found between short-term and long-term DAPT with regard to myocardial infarction (odds ratio 1.21; 95% confidence interval 0.94-1.57; P = 0.14), stent thrombosis (odds ratio 1.54; 95% confidence interval 1.00-2.38; P = 0.052), or major bleeding events (odds ratio 0.74; 95% confidence interval 0.49-1.11; P = 0.14). There was no significant difference in all-cause mortality, cardiac death, or net adverse cardiac and cerebrovascular events. CONCLUSIONS Our meta-analysis demonstrated that short-term DAPT (<6 months) after PCI for ACS was not associated with increased risk of myocardial infarction or stent thrombosis when compared to long-term DAPT.
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Affiliation(s)
- Naoki Misumida
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky
| | - Mohamed Abo-Aly
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky
| | - Sun Moon Kim
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky
| | - Gbolahan O Ogunbayo
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky
| | - Ahmed Abdel-Latif
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky
| | - Khaled M Ziada
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky
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Misumida N, Ogunbayo GO, Kim SM, Abdel-Latif A, Ziada KM, Elayi CS. Frequency and Significance of High-Degree Atrioventricular Block and Sinoatrial Node Dysfunction in Patients With Non-ST-Elevation Myocardial Infarction. Am J Cardiol 2018; 122:1598-1603. [PMID: 30227965 DOI: 10.1016/j.amjcard.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/04/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
Characteristics of conduction disorders after ST-elevation myocardial infarction (STEMI) have been well described. In contrast, limited data are available on the incidence, treatment trends, and prognostic impact of conduction disorders after non-ST-elevation myocardial infarction (NSTEMI). Using the National Inpatient Sample database, we compared the characteristics and outcomes of conduction disorders in patients with a primary diagnosis of STEMI versus NSTEMI between 2010 and 2014. Conduction disorders were classified into high-degree AV block (HDAVB), consisting of complete AV block or Mobitz type II second-degree AV block, and sinoatrial node dysfunction (SND). We identified 135,468 STEMI patients and 281,928 NSTEMI patients. In contrast to the STEMI cohort where HDAVB was more common than SND (2.4% vs 0.5%), SND was observed more often in the NSTEMI cohort, presenting in 2,417 patients (0.9%), followed by HDAVB in 1,745 patients (0.6%). In patients who developed HDAVB, NSTEMI patients were more likely to undergo permanent pacemaker implantation than STEMI patients (30.0% vs 11.6%; p < 0.001). The rate of permanent pacemaker implantation for SND was comparable between STEMI and NSTEMI patients (33.9% vs 30.5%; p = 0.10). In the NSTEMI cohort, patients who developed HDAVB had higher in-hospital mortality than those without any major conduction disorders (16.6% vs 3.8%; p < 0.001). In conclusion, SND was more common than HDAVB in the NSTEMI cohort, in contrast to the predominance of HDAVB observed in the STEMI cohort. About one-third of patients who developed HDAVB after NSTEMI underwent pacemaker implantation, suggesting lower rates of spontaneous resolution of HDAVB, when compared with STEMI patients.
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Ogunbayo GO, Charnigo R, Darrat Y, Shah J, Patel R, Suffredini J, Wilson W, Parrott K, Kusterer N, Biase LD, Natale A, Morales G, Elayi CS. Comparison of Complications of Catheter Ablation for Ventricular Arrhythmias in Adults With Versus Without Structural Heart Disease. Am J Cardiol 2018; 122:1345-1351. [PMID: 30115423 DOI: 10.1016/j.amjcard.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/03/2018] [Accepted: 07/03/2018] [Indexed: 12/31/2022]
Abstract
Catheter ablation (CA) is an effective treatment for ventricular arrhythmias (VA), with a potential for complications. The presence of structural heart disease (SHD) is associated with a higher complication rate although there is no data comparing CA of VA between patients with SHD and those without. We aimed to compare trends, morbidity, and mortality associated with real world practice of CA for VA (ventricular tachycardia and premature ventricular contraction) based on the presence of SHD. Using weighted sampling in the National Inpatient Sample database, we collected and compared characteristics and outcomes of patients with or without SHD that underwent CA of VA. Among 34,907 patients that underwent CA for VA (1999-2013), 18,014 (51.6%) had SHD. Major and all complications occurred among 1,135/18,014 (6.3%) and 2139/18,014 (11.9%) patients with SHD respectively compared with 355/16,893 (2.1%) and 739/16,893 (4.4%) for patients without SHD, p < 0.001 for both comparisons. Furthermore, 452/18,014 (2.51%) with SHD died versus 20/16,893 (0.12%) without SHD, p < 0.001. Heart failure was associated with an odds ratio (OR) of 3.09 for major complications (95%CI: 1.53-6.27, p = 0.002) for patients with SHD while coronary artery disease OR for major complications was 2.47 (95%CI: 1.44-4.23, p = 0.001) for patients without SHD. There was a significant increase in major complications over the 15-year study period in patients with SHD, p < 0.001. In conclusion, the presence of SHD during CA for VA increased the complication rate of major and any complications by approximately threefold for both and the hospital mortality by >20-fold compared with patients without SHD.
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Misumida N, Pagath M, Ogunbayo GO, Wilson RE, Kim SM, Abdel-Latif A, Elayi CS. Characteristics of and current practice patterns of pacing for high-degree atrioventricular block after transcatheter aortic valve implantation in comparison to surgical aortic valve replacement. Catheter Cardiovasc Interv 2018; 93:E385-E390. [PMID: 30302907 DOI: 10.1002/ccd.27915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/30/2018] [Revised: 08/17/2018] [Accepted: 09/09/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE We aimed to investigate the current practice patterns of permanent pacing, especially the timing of implantation, for high-degree AV block (HDAVB) following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). BACKGROUND Comparative data regarding current practice patterns of permanent pacing for HDAVB between TAVI and SAVR is limited. METHODS Using the National Inpatient Sample database, we identified patients who underwent TAVI or SAVR between 2012 and 2014. The incidence of HDAVB, the rate of permanent pacemaker implantation, and the timing of implantations were compared between TAVI and SAVR groups. RESULTS We identified 33 690 and 202 110 patients who underwent TAVI and SAVR, respectively. HDAVB occurred in 3480 patients (10.3%) in the TAVI group and 11 405 patients (5.6%) in the SAVR group (P < 0.001). Among the patients who developed HDAVB, patients in the TAVI group were more likely to undergo permanent pacemaker implantation than those in the SAVR group (74.1% vs 64.7%; P < 0.001). The median interval from TAVI to pacemaker implantation was 2 days (interquartile range 1-3 days) vs 5 days (interquartile range 3-7 days) from SAVR to pacemaker implantation (P < 0.001). Among the patients who developed HDAVB, TAVI was associated with higher rates of permanent pacemaker implantation after adjusting for other comorbidities (odds ratio 1.41:95% confidence interval 1.13-1.77; P = 0.003). CONCLUSIONS HDAVB occurred more commonly after TAVI compared to SAVR. HDAVB after TAVI compared to SAVR was associated with a higher rate of permanent pacemaker implantation at an earlier timing from the index procedure.
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Affiliation(s)
- Naoki Misumida
- Gill Heart and Vascular Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington
| | - Mariah Pagath
- Gill Heart and Vascular Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington
| | - Gbolahan O Ogunbayo
- Gill Heart and Vascular Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington
| | - Ryan E Wilson
- Gill Heart and Vascular Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington
| | - Sun Moon Kim
- Gill Heart and Vascular Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington
| | - Ahmed Abdel-Latif
- Gill Heart and Vascular Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington
| | - Claude S Elayi
- Gill Heart and Vascular Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington
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Ogunbayo GO, Misumida N, Ayoub K, Hailemariam Y, Hillerson D, Elbadawi A, Abdel-Latif A, Smyth S, Ziada K, Messerli AW. Temporal trends, characteristics and outcomes of fibrinolytic therapy for ST-elevation myocardial infarction among patients 80 years or older. Catheter Cardiovasc Interv 2018; 92:E425-E432. [PMID: 30269436 DOI: 10.1002/ccd.27833] [Citation(s) in RCA: 1] [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: 05/16/2018] [Revised: 06/30/2018] [Accepted: 07/28/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pharmacologic reperfusion therapy is a recommended and effective strategy in patients with ST-elevation myocardial infarction (STEMI) when percutaneous coronary intervention (PCI) is not available. This study investigates temporal trends and outcomes of fibrinolytic therapy (FT) in elderly patients with STEMI. METHODS Using the Nationwide Inpatient Sample database, we extracted patients ≥80 years a primary diagnosis of STEMI admitted between 2010 and 2014. Using ICD codes, we identified patients who underwent FT. We performed temporal trend analysis, then compared characteristics and inpatient outcomes in the FT group versus no-FT group. Our primary outcome of interest was hemorrhagic stroke (HS). We also assessed the impact of HS on mortality and discharge to skilled nursing facility (SNF). RESULTS Of the 917,307 patients with STEMI, 16.1% (n = 147,874) were aged 80 or older. Primary PCI was performed in 46.2%, 2.4% underwent FT, and 51.3% had neither pharmacologic nor mechanical revascularization. The rate of FT increased (1.9%-2.4%) in a nonlinear trend over the five years of the study. The FT group was eight times more likely to suffer HS (P < 0.001). FT was an independent predictor of HS (OR 7.90, 95% CI 4.36-14.30; P < 0.001), whether they underwent PCI or not. HS was an independent predictor of mortality and SNF discharge. CONCLUSION FT in patients 80 years or older presenting with STEMI was associated with an eight-fold increase in HS and no associated mortality advantage, both with or without PCI. These data underscore the increased risk of FT in the elderly.
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Affiliation(s)
- Gbolahan O Ogunbayo
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Naoki Misumida
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Karam Ayoub
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Yared Hailemariam
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Dustin Hillerson
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Ayman Elbadawi
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Ahmed Abdel-Latif
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Susan Smyth
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Khaled Ziada
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Adrian W Messerli
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
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Ogunbayo GO, Messerli AW, Ha LD, Elbadawi A, Olorunfemi O, Darrat Y, Guglin M, Okwechime R, Akanya D, Abdel-Latif A, Smyth SS, Elayi CS. Trends in the Incidence and In-Hospital Outcomes of Patients With Atrial Fibrillation Complicated by Non-ST-Segment Elevation Myocardial Infarction. Angiology 2018; 70:317-324. [PMID: 30231624 DOI: 10.1177/0003319718801087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atrial fibrillation (AF) can present with non-ST-segment elevation myocardial infarction (NSTEMI). The incidence, characteristics, outcomes, and treatment of this subgroup of patients with AF remains poorly studied. Using data from the National Inpatient Sample database, we (1) compared baseline characteristics of patients with AF with/without NSTEMI, (2) evaluated their outcomes and associated trends over the study period (2004-2013), and (3) evaluated revascularization (by percutaneous coronary intervention or coronary artery bypass graft [CABG]) and the impact on patient outcomes. Of the 3 923 436 patients admitted with a primary diagnosis of AF, 47 785 (1.2%) had a secondary diagnosis of NSTEMI. In this subgroup with AF and NSTEMI, there was a significant trend toward a decrease in mortality ( P = .002), stroke ( P < .001), and gastrointestinal bleeding ( P < .001) during the study period. Compared to unrevascularized patients, revascularized patients were more likely to be younger (72.2 ± 10.2 vs 77.0 ± 11.8 years old, P < .001), male (57.8 vs 42.7%, P < .001), and had a much higher incidence of coronary risk factors. Revascularization was associated with increased survival in multivariable analysis (odds ratio: 0.562, 95% confidence interval: 0.334-0.946, P = .03). In conclusion, among patients admitted with AF, 1.2% were diagnosed with NSTEMI. A minority of patients with AF and NSTEMI underwent revascularization and had better in-hospital outcomes.
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Affiliation(s)
- Gbolahan O Ogunbayo
- 1 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Adrian W Messerli
- 1 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Le Dung Ha
- 2 Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Ayman Elbadawi
- 2 Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Odunayo Olorunfemi
- 2 Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Yousef Darrat
- 1 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Maya Guglin
- 1 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Remi Okwechime
- 3 Department of Internal Medicine, Wychoff Heights Medical Center, NY, USA
| | - Deborah Akanya
- 4 Department of Internal Medicine, St Vincents Medical Center, Bridgeport, CT, USA
| | - Ahmed Abdel-Latif
- 1 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Susan S Smyth
- 1 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Claude S Elayi
- 1 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
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Elbadawi A, Elgendy IY, Mohamed AH, Barssoum K, Alotaki E, Ogunbayo GO, Ziada KM. Clopidogrel Versus Newer P2Y12 Antagonists for Percutaneous Coronary Intervention in Patients with Out-of-Hospital Cardiac Arrest Managed with Therapeutic Hypothermia: A Meta-Analysis. Cardiol Ther 2018; 7:185-189. [PMID: 30182342 PMCID: PMC6251818 DOI: 10.1007/s40119-018-0118-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction The impact of therapeutic hypothermia (TH) on outcomes of percutaneous coronary intervention (PCI) and the optimal antiplatelet treatment remains debatable. Methods Electronic databases were searched for randomized trials and observational studies to evaluate the available clinical evidence comparing the use of clopidogrel versus newer P2Y12 antagonists in cases of TH after PCI. The primary outcome was in-hospital definite stent thrombosis while the secondary outcomes were in-hospital mortality and major bleeding. Fixed-effects risk ratios (RRs) were estimated using Mantel–Haenszel method. Results The final analysis included five studies with a total of 290 patients. There was no difference in the incidence of stent thrombosis (RR 0.92; 95% CI 0.35–2.38), in-hospital mortality (RR 1.38; 95% CI 0.72–2.65), and major bleeding (RR 0.89; 95% CI 0.33–2.40) between patients receiving clopidogrel versus those receiving newer agents. Conclusions This meta-analysis showed no difference between clopidogrel and newer antiplatelet agents in the incidence of stent thrombosis or in-hospital mortality for PCI in cases of TH. Further randomized studies are needed to explore the optimal dual antiplatelet treatment in TH. Electronic supplementary material The online version of this article (10.1007/s40119-018-0118-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
| | - Ahmed H Mohamed
- Internal Medicine Department, Rochester General Hospital, Rochester, NY, USA
| | - Kirolos Barssoum
- Internal Medicine Department, Rochester General Hospital, Rochester, NY, USA
| | - Erfan Alotaki
- Internal Medicine Department, Rochester General Hospital, Rochester, NY, USA
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Khaled M Ziada
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
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Ogunbayo GO, Ha LD, Ahmad Q, Misumida N, Elbadawi A, Olorunfemi O, Kolodziej A, Messerli AW, Abdel-Latif A, Elayi CS, Guglin M. In-hospital outcomes of percutaneous ventricular assist devices versus intra-aortic balloon pumps in non-ischemia related cardiogenic shock. Heart Lung 2018; 47:392-397. [DOI: 10.1016/j.hrtlng.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 02/04/2018] [Indexed: 10/17/2022]
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Misumida N, Ogunbayo GO, Kim SM, Abdel-Latif A, Ziada KM, Sorrell VL. Clinical Outcome of Takotsubo Cardiomyopathy Diagnosed With or Without Coronary Angiography. Angiology 2018; 70:56-61. [DOI: 10.1177/0003319718782049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Takotsubo cardiomyopathy (TC) is definitively diagnosed following the exclusion of acute coronary syndrome. We aimed to examine the rate of coronary angiography in patients diagnosed with TC and also the outcome of patients with TC diagnosed with or without coronary angiography. We analyzed the National Inpatient Sample database from 2010 to 2014 and identified patients hospitalized with a primary diagnosis of TC. We compared in-hospital mortality between patients who underwent coronary angiography and those who did not. We also evaluated the association between coronary angiography and in-hospital mortality using a propensity score–adjusted multivariable analysis. Among 22 818 patients diagnosed with TC, 87.4% underwent coronary angiography and 12.6% did not. Patients who did not undergo coronary angiography had a higher in-hospital mortality than those who did (3.0% vs 0.9%; P < .001). Increased mortality in patients who did not undergo coronary angiogram was observed in both male (8.0% vs 2.8%; P = .03) and female patients (2.6% vs 0.7%; P < .001) and in patients 61 to 80 years old and ≥81 years old, but not in patients ≤60 years old. Multivariable analysis demonstrated that the lack of coronary angiography was independently associated with higher in-hospital mortality (adjusted odds ratio: 2.92; 95% confidence interval: 1.52-5.65; P = .001).
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Affiliation(s)
- Naoki Misumida
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Gbolahan O. Ogunbayo
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Sun Moon Kim
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Ahmed Abdel-Latif
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Khaled M. Ziada
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Vincent L. Sorrell
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
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Elbadawi A, Elgendy IY, Ha LD, Mentias A, Ogunbayo GO, Tahir MW, Biniwale N, Olorunfemi O, Barssoum K, Guglin M. National Trends and Outcomes of Endomyocardial Biopsy for Patients With Myocarditis: From the National Inpatient Sample Database. J Card Fail 2018; 24:337-341. [DOI: 10.1016/j.cardfail.2018.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 12/11/2022]
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Elgendy IY, Ha LD, Elbadawi A, Ogunbayo GO, Olorunfemi O, Mahmoud AN, Mojadidi MK, Abuzaid A, Anderson RD, Bavry AA. Temporal Trends in Inpatient Use of Intravascular Imaging Among Patients Undergoing Percutaneous Coronary Intervention in the United States. JACC Cardiovasc Interv 2018; 11:913-915. [DOI: 10.1016/j.jcin.2018.01.254] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/09/2018] [Accepted: 01/23/2018] [Indexed: 10/17/2022]
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Ogunbayo GO, Bidwell K, Misumida N, Ha LD, Abdel-Latif A, Elayi CS, Smyth S, Messerli AW. Sex differences in the contemporary management of HIV patients admitted for acute myocardial infarction. Clin Cardiol 2018; 41:488-493. [PMID: 29672871 DOI: 10.1002/clc.22902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/03/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Studies have reported sex differences in the management of patients with acute myocardial infarction (AMI) in the general population. This observational study is designed to evaluate whether sex differences exist in the contemporary management of human immunodeficiency virus (HIV) patients admitted for diagnosis of AMI. HYPOTHESIS There is no difference in management of HIV patients with AMI. METHODS Using the National Inpatient Sample database, we identified patients with a primary diagnosis of AMI and a secondary diagnosis of HIV. We described baseline characteristics and outcomes using NIS documentation. Our primary areas of interest were revascularization and mortality. RESULTS Among 2 977 387 patients presenting from 2010 to 2014 with a primary diagnosis of AMI, 10907 (0.4%) had HIV (mean age, 54.1 ± 9.3 years; n = 2043 [18.9%] female). Females were younger, more likely to be black, and more likely to have hypertension, diabetes, obesity, and anemia. Although neither males nor females were more likely to undergo coronary angiography in multivariate analysis, revascularization was performed less frequently in females than in males (45.4% vs 62.7%; P < 0.01), driven primarily by lower incidence of PCI. In a multivariate model, females were less likely to undergo revascularization (OR: 0.59, 95% CI: 0.45-0.78, P < 0.01), a finding driven solely by PCI (OR: 0.64, 95% CI: 0.49-0.83, P < 0.01). All-cause mortality was similar in both groups. CONCLUSIONS AMI was more common in males than females with HIV. Females with HIV were more likely to be younger and black and less likely to be revascularized by PCI.
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Affiliation(s)
- Gbolahan O Ogunbayo
- Division of Cardiology, Department of Internal Medicine, University of Kentucky, Lexington
| | - Katrina Bidwell
- Division of Cardiology, Department of Internal Medicine, University of Kentucky, Lexington
| | - Naoki Misumida
- Division of Cardiology, Department of Internal Medicine, University of Kentucky, Lexington
| | - Le Dung Ha
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Ahmed Abdel-Latif
- Division of Cardiology, Department of Internal Medicine, University of Kentucky, Lexington
| | - Claude S Elayi
- Division of Cardiology, Department of Internal Medicine, University of Kentucky, Lexington
| | - Susan Smyth
- Division of Cardiology, Department of Internal Medicine, University of Kentucky, Lexington
| | - Adrian W Messerli
- Division of Cardiology, Department of Internal Medicine, University of Kentucky, Lexington
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Elbadawi A, Elgendy IY, Ha LD, Baig B, Saad M, Adly H, Ogunbayo GO, Olorunfemi O, Mckillop MS, Maffett SA. In-Hospital Cerebrovascular Outcomes of Patients With Atrial Fibrillation and Cancer (from the National Inpatient Sample Database). Am J Cardiol 2018; 121:590-595. [PMID: 29352566 DOI: 10.1016/j.amjcard.2017.11.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 12/12/2022]
Abstract
Limited data are available regarding the impact of cancer on cerebrovascular accidents in patients with atrial fibrillation (AF). We queried the Nationwide Inpatient Survey Database to identify patients who have diagnostic code for AF. We performed a 1:1 propensity matching based on the CHA2DS2VASc score and other risk factors between patients with AF who had lung, breast, colon, and esophageal cancer, and those who did not (control). The final cohort included a total of 31,604 patients. The primary outcome of in-hospital cerebrovascular accidents (CVA) was lower in the cancer group than in the control group (4% vs 7%, p < 0.001), but with only a weak association (ф = -0.067). In-hospital mortality was higher in the cancer group than in the control group (18% vs 11%, p < 0.001; ф = -0.099). A subgroup analysis according to cancer type showed similar results with a weak association with lower CVA in breast cancer (4% vs 7%; ф = -0.066, p < 0.001), lung cancer (4% vs 6%; ф = -0.062, p < 0.001), colon cancer (4% vs 6%; ф = -0.062, p < 0.001), and esophageal cancer (3% vs 7%; ф = -0.095, p < 0.001) compared with the control groups. A weak association with higher in-hospital mortality was demonstrated in lung cancer (20% vs 11%; ф = -0.127, p < 0.001), colon cancer (16% vs 11%; ф = -0.076, p < 0.001), and esophageal cancer (20% vs 12%; ф = -0.111, p < 0.001) compared with the control groups, but no significant difference between breast cancer and control groups in mortality (11% vs 11%; ф = -0.002, p = 0.888). In conclusion, in patients with AF, cancer diagnosis may not add a predictive role for in-hospital CVA beyond the CHADS2VASc score.
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Abou-Ismail MY, Ogunbayo GO, Secic M, Kouides PA. Outgrowing the laboratory diagnosis of type 1 von Willebrand disease: A two decade study. Am J Hematol 2018; 93:232-237. [PMID: 29098718 DOI: 10.1002/ajh.24962] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/24/2017] [Accepted: 10/31/2017] [Indexed: 11/06/2022]
Abstract
Von Willebrand Factor (VWF) levels are known to increase with age in the general population, but that effect is unclear in von Willebrand disease (VWD) patients. Thus, it is important to assess the trends of VWF levels with age, and the extent and rate of their normalization in patients with VWD. In a retrospective cohort study, we reviewed the medical records of 126 patients between 1996 and 2016 who met the NHLBI diagnostic criteria for type 1 VWD or "Low VWF" (LVWF). We followed all their historically documented VWF antigen (VWF:Ag), VWF activity (VWF:RCo), and Factor VIII (FVIII) levels longitudinally over time, correlating data with clinical setting at time of testing. The average duration of follow-up was 10.5 ± 3.7 years (SD). Out of the total study population, 27.8% achieved the primary outcome of complete normalization (CN) of both VWF:Ag and VWF:RCo levels, including 19.6% and 32.5% of those with VWD and LVWF, respectively. Linear regression demonstrated statistically significant positive trends of VWF:Ag, VWF:RCo, FVIII with time, calculated at 2.4, 1.4, and 1.4 U dL-1/year, respectively (P < .001 each). In the largest study population of VWD patients to date whose levels were followed longitudinally, there is a statistically significant rise in VWF:Ag, VWF:RCo, and FVIII levels observed with time. CN of both VWF:Ag and VWF:RCo levels was observed in almost a third of patients with VWD or LVWF, over an average of 10 years. Whether the bleeding phenotype also improves is unclear and requires further study.
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Affiliation(s)
| | | | | | - Peter A. Kouides
- Department of Medicine; Rochester General Hospital; Rochester New York
- Mary M. Gooley Hemophila Center; Rochester New York
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Misumida N, Ogunbayo GO, Kim SM, Abdel-Latif A, Ziada KM. Higher Risk of Bleeding in Asians Presenting With Non-ST-Segment Elevation Myocardial Infarction. Angiology 2017; 69:555-556. [DOI: 10.1177/0003319717736609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Naoki Misumida
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Gbolahan O. Ogunbayo
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Sun Moon Kim
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Ahmed Abdel-Latif
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Khaled M. Ziada
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
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Elbadawi A, Elgendy IY, Megaly M, Ha LD, Mahmoud K, Alotaki E, Ogunbayo GO, Baig B, Abuzaid A, Saad M, Depta JP. Meta-Analysis of Randomized Trials of Intracoronary Versus Intravenous Glycoprotein IIb/IIIa Inhibitors in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Am J Cardiol 2017; 120:1055-1061. [PMID: 28826897 DOI: 10.1016/j.amjcard.2017.06.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/10/2017] [Accepted: 06/29/2017] [Indexed: 01/29/2023]
Abstract
The efficacy and safety of glycoprotein IIb/IIIa inhibitors via intracoronary (IC) route versus the intravenous (IV) route are not well known. We conducted this meta-analysis of randomized trials evaluating the role of IC versus IV glycoprotein IIb/IIIa in patients undergoing primary percutaneous coronary intervention. The analysis included 14 trials with a total of 3,754 patients. The primary outcome of major adverse cardiac events (MACE) had no statistically significant difference between the IC and the IV groups (relative risk [RR] 0.74, 95% confidence interval [CI] 0.51 to 1.10). Subgroup analysis showed that short-term MACE (i.e., ≤3 months) was reduced in the IC compared with the IV group; however, long-term MACE (>3 months) was not. IC group was superior in achievement of post-procedural Thrombolysis In Myocardial Infarction 3 flow (RR 1.06, 95% CI 1.01 to 1.11), myocardial blush grade II to III (RR 1.15, 95% CI 1.08 to 1.23), ST-segment resolution rates (RR 1.15, 95% CI 1.03 to 1.29; p = 0.01), and improvement of left ventricular ejection fraction (standardized mean difference = 4.32, 95% CI 0.91 to 7.74). There was a trend for lower stent thrombosis with IC route (RR 0.50, 95% CI 0.24 to 1.03). There was no significant difference between the 2 groups in all-cause mortality, re-infarction, and major bleeding. In conclusion, despite lack of significant difference in overall MACE outcome, IC glycoprotein IIb/IIIa inhibitors may improve short -term MACE, Thrombolysis In Myocardial Infarction 3 flow, myocardial blush grade II- to III rates, ST-segment resolution, and left ventricular ejection fraction compared with the IV route.
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Elbadawi A, Ogunbayo GO, Elgendy IY, Olorunfemi O, Saad M, Ha LD, Alotaki E, Baig B, Abuzaid A, Shahin HI, Shah A, Rao M. Impact of Left Atrial Appendage Exclusion on Cardiovascular Outcomes in Patients With Atrial Fibrillation Undergoing Coronary Artery Bypass Grafting (From the National Inpatient Sample Database). Am J Cardiol 2017; 120:953-958. [PMID: 28754565 DOI: 10.1016/j.amjcard.2017.06.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/23/2017] [Accepted: 06/13/2017] [Indexed: 02/08/2023]
Abstract
Left atrial appendage (LAA) exclusion is performed by some surgeons in patients with atrial fibrillation (AF) who undergo coronary artery bypass grafting (CABG). However, the available evidence regarding the efficacy and safety of this procedure remains mixed. We queried the Nationwide Inpatient Survey Database for the 10-year period from 2004 to 2013. Using International Classification of Diseases, Ninth Edition, Clinical Modification diagnosis codes, we identified patients who had a diagnosis of AF and underwent a primary procedure of CABG with or without LAA exclusion. We then performed a 1:5 matching based on the CHA2DS2VASc score between patients who got LAA exclusion and those who did not (control group). The primary outcome was the incidence of in-hospital cerebrovascular events, whereas the secondary outcomes included in-hospital bleeding events, pericardial effusion, cardiac tamponade, postoperative shock, and mortality. Our analysis included a total of 15,114 patients. Patients who underwent LAA exclusion had significantly less incidence of cerebrovascular events (2.0% vs 3.1%, p = 0.002). However, LAA exclusion group had higher incidences of bleeding events (36.4% vs 21.3%, p <0.001), pericardial effusion (2.7% vs 1.2%, p <0.001), cardiac tamponade (0.6% vs 0.2%, p <0.001), and postoperative shock (1.2% vs 0.4%, p <0.001). LAA exclusion was associated with higher in-hospital mortality (1.6% vs 0.3%, p <0.001). Multivariate regression analysis showed that LAA exclusion was significantly associated with lower cerebrovascular accident events and higher in-hospital mortality. In conclusion, LAA exclusion in patients with AF undergoing CABG might be associated with a lower incidence of in-hospital cerebrovascular events. This benefit is offset by a higher incidence of higher bleeding events, pericardial effusion, cardiac tamponade, postoperative shock, and in-hospital mortality.
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