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Abdul-Kafi OS, Vidovich MI. Coronary Calcification Optical Coherence Tomography-Another Brick in the Wall. Am J Cardiol 2024; 217:167-168. [PMID: 38490336 DOI: 10.1016/j.amjcard.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Affiliation(s)
- Owais S Abdul-Kafi
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Mladen I Vidovich
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
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2
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Fernandez CM, Shroff AR, Vidovich MI. Interventional cardiologist perceptions about PCI without surgical backup-Results of an international survey. Catheter Cardiovasc Interv 2024; 103:20-29. [PMID: 38104311 DOI: 10.1002/ccd.30930] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/23/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) without surgical backup is becoming increasingly common in the United States. Additionally, a recent SCAI expert consensus document has liberalized recommendations for performing PCI without cardiac surgery on site (SOS). AIMS The current study sought to understand practice patterns and operator preferences with regard to performing PCI without SOS. METHODS Two internet-based surveys were distributed to interventional cardiologists worldwide. Survey items asked about operator demographics, procedural preferences when performing PCI without SOS, self-judged personality traits, and history of malpractice. RESULTS Between March 2021 and May 2021, 517 interventional cardiologists completed the survey; 341 of whom perform elective PCI without SOS (no-SOS operators), and 176 who perform elective PCI with surgical backup (SOS operators). Most operators were male 473 (91.5%). There was a greater proportion of SOS operators in academic practice (86 vs. 75, p < 0.001) and greater proportion of no-SOS operators in hospital-owned practices (158 vs. 56, p < 0.001). Lesion characteristics (left main, chronic total occlusions, and need for atherectomy) were the most important procedural attributes for no-SOS operators, and international operators reported higher comfort levels with PCI on high-risk lesions. Cumulative personality profile scores were similar between SOS and no-SOS operators. SOS operators expressed more concern with legal ramifications of performing PCI without SOS (2.57 vs. 2.34, p = 0.049). CONCLUSIONS In the absence of surgical backup, lesion characteristics were the most important consideration for PCI patient selection for operators worldwide. Compared to the United States, international operators were more confident in performing high-risk PCI without surgical backup.
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Affiliation(s)
| | - Adhir R Shroff
- Section of Cardiology, University of Illinois, Chicago, Illinois, USA
| | - Mladen I Vidovich
- Section of Cardiology, University of Illinois, Chicago, Illinois, USA
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3
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Grines CL, Box LC, Mamas MA, Abbott JD, Blankenship JC, Carr JG, Curzen N, Kent WDT, Khatib Y, Matteau A, Rymer JA, Schreiber TL, Velagapudi P, Vidovich MI, Waldo SW, Seto AH. SCAI Expert Consensus Statement on Percutaneous Coronary Intervention Without On-Site Surgical Backup. JACC Cardiovasc Interv 2023; 16:847-860. [PMID: 36725479 DOI: 10.1016/j.jcin.2022.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Cindy L Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Lyndon C Box
- West Valley Medical Center, Caldwell, Idaho, USA
| | | | - J Dawn Abbott
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - James C Blankenship
- The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Jeffrey G Carr
- CardiaStream-Tyler Cardiac and Endovascular Center, Tyler, Texas, USA
| | - Nick Curzen
- University of Southampton, Southampton, United Kingdom
| | - William D T Kent
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Yazan Khatib
- First Coast Cardiovascular Institute, Jacksonville, Florida, USA
| | - Alexis Matteau
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | | | | | | | | | - Stephen W Waldo
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Arnold H Seto
- Long Beach VA Health Care System, Long Beach, California, USA.
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4
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Vidovich MI. Three Decades of SVG PCI. JACC: Case Reports 2023; 10:101744. [PMID: 36974045 PMCID: PMC10039391 DOI: 10.1016/j.jaccas.2023.101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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5
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Brown JR, Solomon R, Stabler ME, Davis S, Carpenter-Song E, Zubkoff L, Westerman DM, Dorn C, Cox KC, Minter F, Jneid H, Currier JW, Athar SA, Girotra S, Leung C, Helton TJ, Agarwal A, Vidovich MI, Plomondon ME, Waldo SW, Aschbrenner KA, O'Malley AJ, Matheny ME. Team-Based Coaching Intervention to Improve Contrast-Associated Acute Kidney Injury: A Cluster-Randomized Trial. Clin J Am Soc Nephrol 2023; 18:315-326. [PMID: 36787125 PMCID: PMC10103221 DOI: 10.2215/cjn.0000000000000067] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/19/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Up to 14% of patients in the United States undergoing cardiac catheterization each year experience AKI. Consistent use of risk minimization preventive strategies may improve outcomes. We hypothesized that team-based coaching in a Virtual Learning Collaborative (Collaborative) would reduce postprocedural AKI compared with Technical Assistance (Assistance), both with and without Automated Surveillance Reporting (Surveillance). METHODS The IMPROVE AKI trial was a 2×2 factorial cluster-randomized trial across 20 Veterans Affairs medical centers (VAMCs). Participating VAMCs received Assistance, Assistance with Surveillance, Collaborative, or Collaborative with Surveillance for 18 months to implement AKI prevention strategies. The Assistance and Collaborative approaches promoted hydration and limited NPO and contrast dye dosing. We fit logistic regression models for AKI with site-level random effects accounting for the clustering of patients within medical centers with a prespecified interest in exploring differences across the four intervention arms. RESULTS Among VAMCs' 4517 patients, 510 experienced AKI (235 AKI events among 1314 patients with preexisting CKD). AKI events in each intervention cluster were 110 (13%) in Assistance, 122 (11%) in Assistance with Surveillance, 190 (13%) in Collaborative, and 88 (8%) in Collaborative with Surveillance. Compared with sites receiving Assistance alone, case-mix-adjusted differences in AKI event proportions were -3% (95% confidence interval [CI], -4 to -3) for Assistance with Surveillance, -3% (95% CI, -3 to -2) for Collaborative, and -5% (95% CI, -6 to -5) for Collaborative with Surveillance. The Collaborative with Surveillance intervention cluster had a substantial 46% reduction in AKI compared with Assistance alone (adjusted odds ratio=0.54; 0.40-0.74). CONCLUSIONS This implementation trial estimates that the combination of Collaborative with Surveillance reduced the odds of AKI by 46% at VAMCs and is suggestive of a reduction among patients with CKD. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER IMPROVE AKI Cluster-Randomized Trial (IMPROVE-AKI), NCT03556293.
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Affiliation(s)
- Jeremiah R. Brown
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Richard Solomon
- University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Meagan E. Stabler
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Sharon Davis
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth Carpenter-Song
- Department of Psychiatry and Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Lisa Zubkoff
- Department of Medicine, University of Alabama at Birmingham and VA Birmingham Health Care, Birmingham, Alabama
| | - Dax M. Westerman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chad Dorn
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin C. Cox
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Freneka Minter
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hani Jneid
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Jesse W. Currier
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - S. Ahmed Athar
- Section of Cardiology, Loma Linda VA Medical Center, Loma Linda, California
- Department of Medicine, Division of Cardiology, Loma Linda University School of Medicine, Loma Linda, California
| | - Saket Girotra
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Ajay Agarwal
- Wright State University Dayton VA Medical Center, Dayton, Ohio
| | - Mladen I. Vidovich
- Section of Cardiology, Jesse Brown VA Medical Center and Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | - Stephen W. Waldo
- CART Program, VHA Office of Quality and Safety, Washington, DC
- Department of Medicine, Cardiology Section, Rocky Mountain Regional VA Medical Center, Aurora, Colorado
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Kelly A. Aschbrenner
- Department of Psychiatry and Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - A. James O'Malley
- Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Michael E. Matheny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Care Center, Tennessee Valley Healthcare System VA, Nashville, Tennessee
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6
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Mack G, Patnam M, Bhayani S, Vidovich MI. CRT-700.71 Clinical Characteristics of Patients With Heart Valve Replacements in the United States of America Emergency Departments. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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7
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Grapsa J, Walsh MN, Enriquez-Sarano ML, Sorgente A, Vidovich MI, Fischman DL, Fontes-Carvalho R, Vidal-Pérez R, Taramasso M, Moe TG, Santangeli P, Johar S, Restrepo AJ, Mahadevan V, Bates ER. 2022 Year in Review: Countdown of the Best Manuscripts in 2022. JACC Case Rep 2023; 7:101727. [PMID: 36776795 PMCID: PMC9911924 DOI: 10.1016/j.jaccas.2022.101727] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Julia Grapsa
- Guys and St Thomas NHS Trust, London, United Kingdom,Address for correspondence: Dr Julia Grapsa, Cardiology Department, Guys and St Thomas NHS Hospitals Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom. @JGrapsa
| | | | | | | | | | | | | | | | | | | | | | | | | | - Vaikom Mahadevan
- University of California-San Francisco San Francisco, California, USA
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8
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Bhattaram R, Bhayani S, Vidovich MI. CRT-500.13 Global Cardiovascular Sex Disparities vs. Income in the Organisation for Economic Co-operation and Development (OECD) Countries. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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9
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Vidovich MI. Believe in your CABG ACS PCI skills but never stop improving. Cardiovasc Revasc Med 2022; 44:51-52. [PMID: 36038494 DOI: 10.1016/j.carrev.2022.08.027] [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] [Received: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Mladen I Vidovich
- University of Illinois at Chicago, Chief of Cardiology, Jesse Brown VA Medical Center, Chicago, IL 60612, United States of America.
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10
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Khan A, Cho NA, Khan S, Belardo D, Gulati M, Vidovich MI. TOO INVASIVE? LIFESTYLE PRACTICES OF INVASIVE VERSUS NON-INVASIVE CARDIOLOGISTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02601-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Bhardwaj B, Gunzburger E, Valle JA, Grunwald GK, Plomondon ME, Vidovich MI, Aggarwal K, Karuparthi PR. Radial versus femoral access for left main percutaneous coronary intervention: An analysis from the Veterans Affairs Clinical, Reporting, and Tracking Program. Catheter Cardiovasc Interv 2021; 99:480-488. [PMID: 34847279 DOI: 10.1002/ccd.30024] [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: 07/26/2021] [Revised: 10/23/2021] [Accepted: 11/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We aimed to compare clinical characteristics and procedural outcomes of left main percutaneous interventions (LM-PCI) by transradial (TRA) versus transfemoral (TFA) approach in the VA healthcare system. BACKGROUND TRA for percutaneous coronary intervention (PCI) is steadily increasing. However, the frequency and efficacy of TRA for LM-PCI remain less studied. METHODS All LM-PCIs performed in the VA healthcare system were identified for fiscal year 2008 through 2018. Patients' baseline characteristics and procedure-related variables were compared by access site. Both short- and long-term clinical outcomes were analyzed using propensity score matching. RESULTS A total of 4004 LM-PCI were performed in the VA via either radial or femoral access from 2008 to 2018. Among these, 596 (14.9%) LM PCIs were performed via TRA. Use of TRA for LM-PCI increased from 2.2% to 31.5% over the study period. Propensity matched outcome analysis, comparing TRA versus TFA, showed a similar procedural success (98.4% for TRA vs. 97.8% for TFA; RR: 1.01 [0.98, 1.03]) and 1-year major adverse cardiovascular events (MACE) (25.9% for TRA vs. 26.8% TFA; RR: 0.96 [0.74, 1.25]). There were no statistically significant differences among secondary outcomes analyses including major bleeding. CONCLUSION Use of TRA for LM-PCI has been steadily increasing in the VA healthcare system. These findings demonstrate similar procedural success and 1-year MACE across access strategies, suggesting an opportunity to continue increasing TRA use for LM-PCI.
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Affiliation(s)
- Bhaskar Bhardwaj
- Section of Cardiology, Harry S. Truman VA Hospital, Columbia, Missouri, USA.,Division of Cardiovascular Disease, Department of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Elise Gunzburger
- VA Eastern Colorado Health Care System, Veterans Health Administration, Aurora, Colorado, USA
| | - Javier A Valle
- VA Eastern Colorado Health Care System, Veterans Health Administration, Aurora, Colorado, USA
| | - Gary K Grunwald
- VA Eastern Colorado Health Care System, Veterans Health Administration, Aurora, Colorado, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary E Plomondon
- VA CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, District of Columbia, USA
| | - Mladen I Vidovich
- Section of Cardiology, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Kul Aggarwal
- Section of Cardiology, Harry S. Truman VA Hospital, Columbia, Missouri, USA.,Division of Cardiovascular Disease, Department of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Poorna Raj Karuparthi
- Section of Cardiology, Harry S. Truman VA Hospital, Columbia, Missouri, USA.,Division of Cardiovascular Disease, Department of Medicine, University of Missouri, Columbia, Missouri, USA
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12
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Sanghvi SK, Vidovich MI. This Can Be as Easy as 1-2-3. JACC Case Rep 2021; 3:1382-1383. [PMID: 34505077 PMCID: PMC8414529 DOI: 10.1016/j.jaccas.2021.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 11/06/2022]
Abstract
The S1S2S3 pattern, in conjunction with right-dominant forces on a 12-lead electrocardiogram including a tall R-wave in lead V1 (R:S >1), deep S waves in the left precordial leads V5 and V6 (R:S <1), QRS interval <120 ms, and right atrial enlargement (P-wave in lead II >2.5 mm), is highly specific for right ventricular dysfunction with pulmonary hypertension. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Saagar K Sanghvi
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mladen I Vidovich
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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13
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Waldo SW, Plomondon ME, O'Donnell CI, Heidenreich PA, Riatt MH, Ballard-Hernandez J, Ortiz J, Varosy PD, Vidovich MI, O'Donnell CJ, Schofield R. Trends in cardiovascular procedural volumes in the setting of COVID-19: Insights from the VA clinical assessment, reporting, and tracking program. Catheter Cardiovasc Interv 2021; 98:E326-E328. [PMID: 32833343 PMCID: PMC7461497 DOI: 10.1002/ccd.29204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/02/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Stephen W Waldo
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Mary E Plomondon
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Colin I O'Donnell
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Paul A Heidenreich
- Medical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Merritt H Riatt
- Veterans Affairs Medical Center, Portland, Oregon, USA.,Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon, USA
| | | | - José Ortiz
- Department of Medicine, Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Paul D Varosy
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Mladen I Vidovich
- Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Christopher J O'Donnell
- Cardiology Section, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard Schofield
- Department of Veterans Affairs Medical Center, Gainesville, Florida, USA.,University of Florida College of Medicine, Gainesville, Florida, USA
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14
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Hudzik B, Hawranek M, Vidovich MI. Transradial Interventions at the Forefront of Innovation. Curr Probl Cardiol 2021; 47:100884. [PMID: 34120729 DOI: 10.1016/j.cpcardiol.2021.100884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 11/03/2022]
Abstract
Interventional cardiology has witnessed tremendous changes over the years from a mainly diagnostic approach in an elective population to therapeutic strategies in critically ill patients. Currently, we can treat a broad spectrum of coronary artery, peripheral artery, and structural heart diseases with less invasive, percutaneous approaches that we did not anticipate to be possible just a decade ago. It is certain that the interventional techniques will see further development and we will be able to treat by percutaneous methods more conditions previously thought beyond our reach. Regardless of the advances in catheter-based diagnostic and therapeutic techniques, one thing remains constant. They all require vascular access. And, vascular access is the first technical part of any percutaneous cardiovascular procedure that can determine its overall success. High-quality data together with the availability of training courses for interventional cardiologists and fellows-in-training ensure systematic use of the transradial approach (TRA) which has demonstrated a considerable benefit compared to transfemoral approach both in chronic and acute coronary syndromes. Constant improvement of TRA techniques will further facilitate transradial endovascular and structural interventions, and the growing use for high-risk and complex percutaneous coronary interventions. A continuously growing body of evidence is focused on surpassing current TRA limitations (specifically radial artery occlusion) and expanding alternative vascular accesses such as transulnar approach or distal TRA ("snuff-box" technique). Should this downsizing trend continue, we could see a further paradigm shift toward using the snuff-box technique.
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Affiliation(s)
- Bartosz Hudzik
- Third Department of Cardiology, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland; Department of Cardiovascular Disease Prevention, Medical University of Silesia, Bytom, Poland.
| | - Michał Hawranek
- Third Department of Cardiology, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland
| | - Mladen I Vidovich
- University of Illinois at Chicago, Chicago, IL; Jesse Brown VA Medical Center, Chicago, IL
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15
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Affiliation(s)
- Khalil Ibrahim
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mladen I. Vidovich
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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16
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Rao SV, Vidovich MI, Gilchrist IC, Gulati R, Gutierrez JA, Hess CN, Kaul P, Martinez SC, Rymer J. 2021 ACC Expert Consensus Decision Pathway on Same-Day Discharge After Percutaneous Coronary Intervention: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2021; 77:811-825. [PMID: 33423859 DOI: 10.1016/j.jacc.2020.11.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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17
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Hudzik B, Vidovich MI. Conquering Radial Artery Occlusion: New Skill to Learn. JACC Case Rep 2020; 2:2408-2410. [PMID: 34317182 PMCID: PMC8305037 DOI: 10.1016/j.jaccas.2020.11.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Bartosz Hudzik
- Third Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Disease, Zabrze, Poland
- Medical University of Silesia, Department of Cardiovascular Disease Prevention, Bytom, Poland
| | - Mladen I. Vidovich
- Division of Cardiology, Department of Internal Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Division of Cardiology, Jesse Brown VA Medical Center, Chicago, Illinois, USA
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18
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Affiliation(s)
- Mladen I Vidovich
- Division of Cardiology, Department of Internal Medicine, University of Illinois at Chicago, Chicago, Illinois.,Division of Cardiology, Jesse Brown VA Medical Center, Chicago, Illinois
| | - David L Fischman
- Division of Cardiology, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eric R Bates
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Abstract
A 61-year-old man presented with fever, shortness of breath, and new chest pain. An electrocardiogram (ECG) revealed Brugada-like ECG pattern. Emergent coronary angiography demonstrated normal coronary arteries. He was subsequently diagnosed with COVID-19. After a few days he felt better and the ECG Brugada-like pattern resolved.
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Affiliation(s)
- Mladen I Vidovich
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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20
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Abstract
The trend towards more minimally invasive procedures in the past few decades has resulted in an exponential growth in fluoroscopy-guided catheter-based cardiology procedures. As these techniques are becoming more commonly used and developed, the adverse effects of radiation exposure to the patient, operator, and ancillary staff have been a subject of concern. Although occupational radiation dose limits are being monitored and seldom reached, exposure to chronic, low dose radiation has been shown to have harmful biological effects that are not readily apparent until years after. Given this, it is imperative that reducing radiation dose exposure in the cardiac catheterization laboratory remains a priority. Staff education and training, radiation dose monitoring, ensuring use of proper personal protective equipment, employment of shields, and various procedural techniques in minimizing radiation must always be diligently employed. Special care and consideration should be extended to pregnant women working in the cardiac catheterization laboratory. This review article presents a practical approach to radiation dose management and discusses best practice recommendations in the cardiac catheterization laboratory.
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Affiliation(s)
- Sylvia Marie R Biso
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Mladen I Vidovich
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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21
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Schwarzman LS, Tofovic DS, Vidovich MI. CRT-300.05 Impact of Table Height on Radiation Dose Exposure for the Female Interventional Cardiologist. JACC Cardiovasc Interv 2020. [DOI: 10.1016/j.jcin.2020.01.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Shroff AR, Gulati R, Drachman DE, Feldman DN, Gilchrist IC, Kaul P, Lata K, Pancholy SB, Panetta CJ, Seto AH, Speiser B, Steinberg DH, Vidovich MI, Woody WW, Rao SV. SCAI expert consensus statement update on best practices for transradial angiography and intervention. Catheter Cardiovasc Interv 2019; 95:245-252. [DOI: 10.1002/ccd.28672] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Adhir R. Shroff
- Division of CardiologyDepartment of Medicine, University of Illinois at Chicago Chicago, IL
| | - Rajiv Gulati
- Cardiovascular DiseasesMayo Clinic Rochester Minnesota
| | | | - Dmitriy N. Feldman
- Weill Cornell Medical CollegeNew York Presbyterian Hospital New York New York
| | - Ian C. Gilchrist
- Milton S. Hershey Medical CenterPenn State University Hershey Pennsylvania
| | | | - Kusum Lata
- CardiologySutter Health Tracy, Sacramento California
| | - Samir B. Pancholy
- CardiologyNorth Penn Cardiovascular Specialists Clarks Summit Pennsylvania
| | | | - Arnold H. Seto
- CardiologyUniversity Of California Irvine Orange California
| | | | | | - Mladen I. Vidovich
- Division of CardiologyDepartment of Medicine, University of Illinois at Chicago Chicago, IL
| | - Walter W. Woody
- CardiologyBaptist Memorial Hospital‐North MS Oxford Mississippi
| | - Sunil V. Rao
- Department of MedicineDuke Clinical Research Institute Durham North Carolina
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Fernandez C, Fernandez A, Vidovich MI. Medicolegal Characteristics of Cardiac Tamponade Litigation: A Review of the LexisNexis Academic Database. Cardiovasc Revasc Med 2019; 21:122-126. [PMID: 31477448 DOI: 10.1016/j.carrev.2019.08.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/23/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review, describe, and analyze medicolegal literature involving cases of cardiac tamponade. BACKGROUND Currently, there are no studies known to these authors assessing the outcome patterns of medicolegal cases involving patients with cardiac tamponade. This potentially lethal condition may have serious consequences on both patients and clinicians. Thus, the literature was reviewed for patterns of liability and medical outcomes in patients who developed cardiac tamponade. METHODS Legal case opinions were reviewed from LexisNexis Academic that contained the search term "tamponade"; case characteristics, litigation outcomes, and medical outcomes were identified. RESULTS 230 case opinions were reviewed. 143 involved cardiac tamponade. Of these cases, 77 were medical malpractice cases, 30 were criminal cases, 11 were insurance claims, and the rest were other types. In malpractice cases, 35 (45%) patients were male, 69 (90%) formally named at least one doctor as a defendant, 54 (70%) claimed iatrogenicity as a cause of tamponade, and surgeons were the most commonly named defendants at 36 cases (47%). Open surgical drainage was the most common treatment at 28 (36%) cases and death was the outcome in 60 (78%) cases. Judgements were in favor of at least one doctor in 29 (42%) cases, against at least one doctor in 13 (19%) cases, and 12 (17%) cases involved a settlement by a physician. CONCLUSIONS This study describes previously unknown medicolegal characteristics of cardiac tamponade cases.
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Affiliation(s)
- Christopher Fernandez
- Division of Cardiology, Department of Medicine, University of Illinois - Chicago, Chicago, IL, USA.
| | | | - Mladen I Vidovich
- Division of Cardiology, Department of Medicine, University of Illinois - Chicago, Chicago, IL, USA.
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Affiliation(s)
- Mladen I. Vidovich
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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26
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Fernandez C, Vidovich MI. 100.44 Medicolegal Characteristics of Cardiac Tamponade Litigation: A Review of the LexisNexis Academic Database. JACC Cardiovasc Interv 2019. [DOI: 10.1016/j.jcin.2019.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vidovich MI. When Patent Hemostasis Is Not Enough …. Cardiovasc Revasc Med 2018; 19:899-900. [PMID: 30551836 DOI: 10.1016/j.carrev.2018.11.010] [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: 11/28/2022]
Affiliation(s)
- Mladen I Vidovich
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois and Jesse Brown VA Medical Center, Chicago, Illinois.
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Shroff AR, Fernandez C, Vidovich MI, Rao SV, Cowley M, Bertrand OF, Patel TM, Pancholy SB. Contemporary transradial access practices: Results of the second international survey. Catheter Cardiovasc Interv 2018; 93:1276-1287. [PMID: 30456913 DOI: 10.1002/ccd.27989] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 09/13/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To gain insight into current practice of transradial angiography and intervention in the United States and around the world. BACKGROUND Transradial access (TRA) has grown worldwide. In a prior survey, there was significant practice variation and there was minimal US participation which limited the generalizability to US operators. METHODS We used an internet-based survey software program to solicit input from practicing interventional cardiologists from the United States and around the world. US operators were compared with outside the United States (OUS) operators and respondent-level comparisons were made with the prior survey to assess for temporal changes in practice. RESULTS Between August 2016 and January 1, 2017, 125 interventional cardiologists completed the survey representing 91 countries with the United States having 449 (39.9%) respondents. Preprocedure, noninvasive testing for collateral circulation is used more commonly in the United States (54.1%) than around the world (26.6%) but its use has decreased since 2010. In the US, 48.8% of operators never use ultrasound and 92.6% of OUS operators never use it; only 4.4% overall use ultrasound in >50% of cases. Use of bivalirudin has decreased in the US and OUS. Nearly, 30% of operators do not assess for radial artery patency following hemostasis. US respondents used TRA less commonly for primary PCI for STEMI than their global counterparts. CONCLUSIONS There is wide variation in how TRA procedures are performed including relatively low rates of adherence to practices that are known to improve outcomes. Further education aimed at increasing use of best practices will impact patient outcomes.
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Affiliation(s)
| | | | | | - Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina
| | - Michael Cowley
- Virginia Commonwealth University Medical Center, Richmond, Virginia
| | | | | | - Samir B Pancholy
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
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30
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Ross J, Vidovich MI. Relative importance of attribute preferences for radial vs. femoral arterial access: A crowdsourcing study of healthy online-recruited volunteers. Catheter Cardiovasc Interv 2018; 93:1237-1243. [PMID: 30341974 DOI: 10.1002/ccd.27941] [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: 09/03/2018] [Accepted: 10/01/2018] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) is typically performed with vascular access provided by the radial or femoral artery. However, little is known about how patients value aspects of these different vascular access approaches. METHODS Conjoint analysis is a survey-based statistical technique used in market research that helps determine how individuals value different attributes that make up a particular product or services. We utilized conjoint analysis to assess the relative importance of four attributes associated with PCI: access site, risk of bleeding, hospital stay, and radiation exposure. Participants were healthy individuals recruited by Amazon Mechanical Turk (MTURK). After completing a conjoint analysis survey, the software Conjoint.ly was used to calculate the relative importance for these four different attributes of PCI. RESULTS The relative importance of hospital stay, radiation exposure, bleeding risk, and procedure site was 32.7% (95% CI 29.5-35.8), 27.3% (95% CI 24.8-29.8), 24.4% (95% CI 22.3-26.5), and 15.7% (95% CI 13.6-17.8), respectively. The difference between these groups was statistically significant (P-value < 0.00001). The difference between duration of hospital stay and radiation exposure was statistically significant (P-value < 0.00433). CONCLUSION Patients undergoing PCI place largest relative value on duration of hospital stay. Access site appears the least valued attribute. These findings carry implications to guide further research on access site choices and the consent process in the context of shared decision-making.
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Affiliation(s)
- Jason Ross
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Mladen I Vidovich
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
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Maki KA, Griza DS, Phillips SA, Wolska BM, Vidovich MI. Altered Hand Temperatures Following Transradial Cardiac Catheterization: A Thermography Study. Cardiovasc Revasc Med 2018; 20:496-502. [PMID: 30078631 DOI: 10.1016/j.carrev.2018.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 06/27/2018] [Accepted: 07/24/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is concern about potential detrimental effects of transradial access (TRA) on radial artery structure, endothelial and hand function. This thermography study evaluated TRA impact on hand microvascular perfusion. METHODS AND RESULTS We prospectively measured hand thermography, radial and ulnar artery size and blood flow velocities in both catheterization and non-catheterization hands at baseline and 30-days after TRA in 158 patients. There were no differences in radial or ulnar arterial diameters or velocities pre- and post-TRA in catheterization and non-catheterization hands (p = NS). The absolute total hand thermography values post-TRA were increased in both catheterization and non-catheterization hand (pre-TRA 30.4 ± 2.9 vs. post-TRA 31.6 ± 2.6 p < 0.01; pre-TRA 30.2 ± 2.9, post-TRA 31.6 ± 2.6 p < 0.01, respectively). After ulnar artery occlusion, hand temperatures decreased in both catheterization and non-catheterization hands, both pre- and post-TRA and were similar in the catheterization and non-catheterization hands (p = NS). Total hand temperature decreased with ulnar artery occlusion and was significantly attenuated post-TRA (p < 0.001 both catheterization and non-catheterization hands). CONCLUSIONS TRA is associated with temperature changes in both catheterization and non-catheterization hands at one month after the index procedure. These changes likely represent a systemic response to local TRA stimulus.
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Affiliation(s)
- Katherine A Maki
- Jesse Brown VA Medical Center, Chicago, IL, United States of America; College of Nursing, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Decebal S Griza
- Jesse Brown VA Medical Center, Chicago, IL, United States of America
| | - Shane A Phillips
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Beata M Wolska
- Department of Physiology and Biophysics, Center for Cardiovascular Research, University of Illinois at Chicago, Chicago, IL, United States of America; Division of Cardiology, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Mladen I Vidovich
- Jesse Brown VA Medical Center, Chicago, IL, United States of America; Division of Cardiology, University of Illinois at Chicago, Chicago, IL, United States of America.
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Gunja A, Stanislawski MA, Barón AE, Maddox TM, Bradley SM, Vidovich MI. The implications of cocaine use and associated behaviors on adverse cardiovascular outcomes among veterans: Insights from the VA Clinical Assessment, Reporting, and Tracking (CART) Program. Clin Cardiol 2018; 41:809-816. [PMID: 29652077 DOI: 10.1002/clc.22961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/11/2018] [Revised: 03/22/2018] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cocaine use has been associated with adverse cardiovascular outcomes in patients with coronary artery disease (CAD). It is unclear whether this is due to direct effects of cocaine or other factors. HYPOTHESIS Cocaine use is associated with worse outcomes in patients undergoing cardiac catheterization METHODS: We used the Veterans Affairs database to identify veterans undergoing coronary catheterization between 2007 and 2014. We analyzed association between cocaine use and 1-year all-cause mortality, myocardial infarction (MI), and cerebrovascular accident (CVA) among veterans with obstructive CAD (N = 122 035). To explore factors contributing to these associations, we sequentially adjusted for cardiac risk factors, risky behaviors, and clinical conditions directly affected by cocaine. RESULTS 3082 (2.5%) veterans were cocaine users. Cocaine users were younger (median 58.2 vs 65.3 years; P < 0.001), more likely to be African American (58.9% vs 10.6%; P < 0.001), and had fewer traditional cardiac risk factors. After adjustment for cardiac risk factors, cocaine was associated with increased risk of mortality (HR: 1.23, 95% CI: 1.08-1.39), MI (HR: 1.40, 95% CI: 1.07-1.83), and CVA (HR: 1.88, 95% CI: 1.38-2.57). With continued adjustment, increased CVA risk remained significantly associated with cocaine use, whereas MI risk was mediated by risky behaviors and mortality was fully explained by conditions directly affected by cocaine. CONCLUSIONS Cocaine use is associated with adverse cardiac events in veterans with CAD. Contributors to this association are multifaceted and specific to individual cardiovascular outcomes, including associated risky behaviors and direct effects of cocaine. Effective intervention programs to reduce cardiac events in this population will require multiple components addressing these factors.
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Affiliation(s)
- Ateka Gunja
- Division of Cardiology, University of Illinois at Chicago.,Division of Cardiology, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
| | | | - Anna E Barón
- University of Colorado School of Medicine, Aurora.,Colorado CV Health Care System, Denver, Colorado.,Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado.,Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Thomas M Maddox
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Steven M Bradley
- Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado.,Minneapolis Heart Institute, Center for Healthcare Delivery Innovation, and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota (work completed while at VA Eastern Colorado Health Care System)
| | - Mladen I Vidovich
- Division of Cardiology, University of Illinois at Chicago.,Division of Cardiology, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
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34
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Challa KK, Kansal MM, Frazin L, Nikanorov A, Kohler R, Martinsen BJ, Vidovich MI. Coronary artery rotation in native and stented porcine coronary arteries. Catheter Cardiovasc Interv 2018; 91:1092-1100. [PMID: 28836331 DOI: 10.1002/ccd.27247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/03/2017] [Revised: 06/20/2017] [Accepted: 07/22/2017] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Coronary arteries are exposed to several complex biomechanical forces during the cardiac cycle. These biomechanical forces potentially contribute to both native coronary artery disease, development of atherosclerosis and eventual stent failure. The aim of the present study was to characterize and define coronary artery axial rotation and the effect of stent implantation on this biomechanical factor. METHODS Intravascular ultrasound (IVUS) images were obtained from porcine coronary arteries and analyzed in ultrasound analysis software used to evaluate myocardial strain and torsion in echocardiography. In this study the software was utilized for a novel application to evaluate coronary artery rotation and time-to-peak (TTP) rotation in porcine coronary arteries. Clockwise (CW) and counterclockwise (CCW) rotation of coronary arteries during the cardiac cycle and (TTP) rotation were measured. RESULTS A total of 11 (4 LAD, 4 LCX, 3 RCA) coronary artery segments were independently analyzed pre- and post-stent implantation for a total of 22 IVUS runs. CW and CCW rotation and TTP varied widely within coronary artery segments and between different coronary arteries. Stent implantation impacted degree, direction and TTP of coronary rotation. Measurement reliability was assessed and the intraclass correlation coefficient for maximum average CCW was 0.990 (95% confidence interval 0.980-0.996, P < 0.0001), indicating excellent agreement. CONCLUSIONS Coronary arteries display wide spectrum of CW and CCW rotation during the cardiac cycle. Coronary stents impact the degree and direction of coronary artery rotation. The implications of these findings on development of atherosclerosis and stent failure require further investigation.
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Affiliation(s)
- Karthik K Challa
- Department of Medicine, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois.,Division of Cardiology, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois.,Department of Veterans Affairs, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois
| | - Mayank M Kansal
- Department of Medicine, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois.,Division of Cardiology, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois.,Department of Veterans Affairs, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois
| | - Leon Frazin
- Department of Medicine, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois.,Division of Cardiology, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois.,Department of Veterans Affairs, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois
| | - Alex Nikanorov
- Clinical and Scientific Affairs, Cardiovascular Systems, Inc, St. Paul, Minnesota, 55112
| | - Robert Kohler
- Clinical and Scientific Affairs, Cardiovascular Systems, Inc, St. Paul, Minnesota, 55112
| | - Brad J Martinsen
- Clinical and Scientific Affairs, Cardiovascular Systems, Inc, St. Paul, Minnesota, 55112
| | - Mladen I Vidovich
- Department of Medicine, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois.,Division of Cardiology, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois.,Department of Veterans Affairs, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois
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Vidovich MI. Radial Percutaneous Coronary Intervention and Coronary Artery Bypass Grafts: Buy, Hold, or Sell? JACC Cardiovasc Interv 2018. [PMID: 29519383 DOI: 10.1016/j.jcin.2018.01.244] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Mladen I Vidovich
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois; Division of Cardiology, Jesse Brown VA Medical Center, Chicago, Illinois.
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Liu E, Hsueh L, Kim H, Vidovich MI. Global geographical variation in patient characteristics in percutaneous coronary intervention clinical trials: A systematic review and meta-analysis. Am Heart J 2018; 195:39-49. [PMID: 29224645 DOI: 10.1016/j.ahj.2017.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/02/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND We sought to determine whether there are differences in enrolled patients' risk factors in published percutaneous coronary intervention (PCI) trials between various continents. METHODS We systematically identified clinical trials evaluating PCI interventions through PubMed. We reviewed 701 studies between 1990 and 2014 from North America (N=135), Europe (N=403), and Asia (N=163), examining the prevalence of cardiovascular risk factors-hypertension (HTN), diabetes mellitus (DM), hyperlipidemia (HL), smoking, sex, and body mass index. We performed meta-regression with random- and mixed-effects models to compare patient baseline characteristics between continents and linear meta-regression analysis to test trends over time. RESULTS In meta-regression with random-effects model, North American trials recruited the lowest proportion of male participants (71.32%), followed by Asian (74.41%) and European trials (76.47%; P<.0001). North American trials enrolled the highest proportion of patients with HTN (63.17%, P=.0035) and HL (63.72%, P<.0001), whereas Asia enrolled the highest proportion of DM patients (29.64%, P<.0001) and smoking (38.41%, P=.0144). When adjusting for other moderators such as publication date, body mass index, and sex in meta-regression with mixed-effects model, age was significantly positively correlated with HTN, HL, DM, and smoking (P<.001). Body mass index was significantly higher in Europe and North America than in Asia. All enrollment risk factors demonstrated (β<0.02) statistically significant temporal trends over time, except for sex. CONCLUSIONS There are major continental differences in risk factors among patients enrolled in PCI trials from various continents. Clinical trial results may not be applicable to patient populations from another region.
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Vora AN, Stanislawski M, Grunwald GK, Plomondon ME, Rumsfeld JS, Maddox TM, Vidovich MI, Woody W, Nallamothu BK, Gurm HS, Rao SV. Association Between Chronic Kidney Disease and Rates of Transfusion and Progression to End-Stage Renal Disease in Patients Undergoing Transradial Versus Transfemoral Cardiac Catheterization-An Analysis From the Veterans Affairs Clinical Assessment Reporting and Tracking (CART) Program. J Am Heart Assoc 2017; 6:e004819. [PMID: 28420645 PMCID: PMC5532998 DOI: 10.1161/jaha.116.004819] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/30/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are at increased risk for bleeding, transfusion, and dialysis after cardiac catheterization. Whether rates of these complications are increased in this high-risk population undergoing transradial access compared with transfemoral access is unknown. METHODS AND RESULTS From the Veterans Affairs (VA) Clinical Assessment Reporting and Tracking program, we identified 229 108 patients undergoing cardiac catheterization between 2007 and 2014, of which 48 155 (21.0%) had baseline glomerular filtration rate (GFR) between 15 and 59 mL/min. We used multivariable Cox modeling to determine the independent association between transradial access and postprocedure transfusion as well as progression to new dialysis by degree of renal dysfunction. Overall, 35 979 (15.7%) of patients underwent Transradial access. Transradial patients tended to be slightly younger, but, overall, had similar rates of CKD compared to transfemoral patients (24.3% vs 27.1%). Transradial patients had longer fluoroscopy times (7.2 vs 6.0 minutes; P<0.001), but lower contrast use (85.0 vs 100.0 mL; P<0.001). The estimated rate of blood transfusion within 48 hours was lower among transradial patients (0.85% vs 1.01%) as were rates of new dialysis at 1 year (0.58% vs 0.71%). After multivariable adjustment, transradial access was associated with lower rates of progression to dialysis at 1 year overall (hazard ratio [HR], 0.83; 95% CI, 0.70-0.98), with no trend of increased risk for dialysis by degree of CKD compared with transfemoral access. Transradial access was associated with greater reduction in transfusion rates with increasing degree of CKD (P value for trend=0.04: non-CKD: HR, 0.99; 95% CI, 0.73-1.34; GFR 45-59 mL/min: HR, 0.93; 95% CI, 0.70-1.23; GFR 30-44 mL/min: HR, 0.73; 95% CI, 0.51-1.03; GFR 15-29 mL/min: HR, 0.43; 95% CI, 0.20-0.90). CONCLUSIONS Among patients undergoing cardiac catheterization in the VA health system, transradial access was associated with lower risk for postprocedure transfusion within 48 hours among patients with more-severe CKD, and with lower risk of progression to end-stage renal disease at 1 year compared with transfemoral access. These data provide additional evidence that transradial access may provide significant benefit in this high-risk population.
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Affiliation(s)
| | - Maggie Stanislawski
- VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Aurora, CO
| | - Gary K Grunwald
- VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Aurora, CO
| | - Mary E Plomondon
- VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Aurora, CO
| | - John S Rumsfeld
- VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Aurora, CO
| | - Thomas M Maddox
- VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Aurora, CO
| | | | - Walter Woody
- GV (Sonny) Montgomery Veterans Administration Medical Center, Jackson, MS
| | - Brahmajee K Nallamothu
- Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence, University of Michigan Medical Center University of Michigan Cardiovascular Center CVC Cardiovascular Medicine, Ann Arbor, MI
| | - Hitinder S Gurm
- VA Ann Arbor Healthcare System and Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, MI
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Ismail S, Wong C, Rajan P, Vidovich MI. ST-elevation acute myocardial infarction in pregnancy: 2016 update. Clin Cardiol 2017; 40:399-406. [PMID: 28191905 DOI: 10.1002/clc.22655] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/09/2016] [Indexed: 12/26/2022] Open
Abstract
Acute myocardial infarction (AMI) during pregnancy or the early postpartum period is rare, but can be devastating for both the mother and the fetus. There have been major advances in the diagnosis and treatment of acute coronary syndromes in the general population, but there is little consensus on the approach to diagnosis and treatment of pregnant women. This article reviews the literature relating to the pathophysiology of AMI in pregnant patients and the challenges in diagnosis and treatment of ST-elevation myocardial infarction (STEMI) in this unique population. From a cardiologist, maternal-fetal medicine specialist, and anesthesiologist's perspective, we provide recommendations for the diagnosis and management of STEMI occurring during pregnancy.
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Affiliation(s)
- Sahar Ismail
- Division of Cardiology, Emory University, Atlanta, Georgia
| | - Cynthia Wong
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Priya Rajan
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mladen I Vidovich
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
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Gunja A, Pandey Y, Xie H, Wolska BM, Shroff AR, Ardati AK, Vidovich MI. Image noise reduction technology reduces radiation in a radial-first cardiac catheterization laboratory. Cardiovasc Revasc Med 2016; 18:197-201. [PMID: 28089778 DOI: 10.1016/j.carrev.2016.12.017] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/16/2016] [Accepted: 12/22/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Transradial coronary angiography (TRA) has been associated with increased radiation doses. We hypothesized that contemporary image noise reduction technology would reduce radiation doses in the cardiac catheterization laboratory in a typical clinical setting. METHODS AND RESULTS We performed a single-center, retrospective analysis of 400 consecutive patients who underwent diagnostic and interventional cardiac catheterizations in a predominantly TRA laboratory with traditional fluoroscopy (N=200) and a new image noise reduction fluoroscopy system (N=200). The primary endpoint was radiation dose (mGy cm2). Secondary endpoints were contrast dose, fluoroscopy times, number of cineangiograms, and radiation dose by operator between the two study periods. Radiation was reduced by 44.7% between the old and new cardiac catheterization laboratory (75.8mGycm2±74.0 vs. 41.9mGycm2±40.7, p<0.0001). Radiation was reduced for both diagnostic procedures (45.9%, p<0.0001) and interventional procedures (37.7%, p<0.0001). There was no statistically significant difference in radiation dose between individual operators (p=0.84). In multivariate analysis, radiation dose remained significantly decreased with the use of the new system (p<0.0001) and was associated with weight (p<0.0001), previous coronary artery bypass grafting (p<0.0007) and greater than 3 stents used (p<0.0004). TRA was used in 90% of all cases in both periods. Compared with a transfemoral approach (TFA), TRA was not associated with higher radiation doses (p=0.20). CONCLUSIONS Image noise reduction technology significantly reduces radiation dose in a contemporary radial-first cardiac catheterization clinical practice.
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Affiliation(s)
- Ateka Gunja
- Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL; Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Yagya Pandey
- Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL; Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Hui Xie
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL; Faculty of Health Sciences, Simon Fraser University
| | - Beata M Wolska
- Department of Physiology and Biophysics, Center for Cardiovascular Research, University of Illinois at Chicago, Chicago, IL
| | - Adhir R Shroff
- Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL; Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Amer K Ardati
- Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL; Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Mladen I Vidovich
- Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL; Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL.
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Voudris KV, Vidovich MI. Orbital Atherectomy in Women 2.0 - Another Brick in the Wall. J Invasive Cardiol 2016; 28:444-445. [PMID: 27801656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Speiser B, Pearson K, Xie H, Shroff AR, Vidovich MI. Compared to femoral venous access, upper extremity right heart catheterization reduces time to ambulation: A single center experience. Catheter Cardiovasc Interv 2016; 89:658-664. [DOI: 10.1002/ccd.26573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/08/2016] [Accepted: 04/22/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Bernadette Speiser
- Department of Veterans Affairs; Jesse Brown VA Medical Center; Chicago Illinois
| | - Katrina Pearson
- Department of Veterans Affairs; Jesse Brown VA Medical Center; Chicago Illinois
| | - Hui Xie
- Division of Epidemiology and Biostatistics; University of Illinois at Chicago; Chicago Illinois
| | - Adhir R. Shroff
- Department of Veterans Affairs; Jesse Brown VA Medical Center; Chicago Illinois
- Division of Epidemiology and Biostatistics; University of Illinois at Chicago; Chicago Illinois
| | - Mladen I. Vidovich
- Department of Veterans Affairs; Jesse Brown VA Medical Center; Chicago Illinois
- Division of Epidemiology and Biostatistics; University of Illinois at Chicago; Chicago Illinois
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Voudris KV, Vidovich MI. Medicolegal implications of radial and femoral access for coronary angiography and intervention in 2016: Focus on retroperitoneal hemorrhage. J Transl Int Med 2016; 4:29-34. [PMID: 28191515 PMCID: PMC5290912 DOI: 10.1515/jtim-2016-0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] Open
Abstract
BACKGROUND AND OBJECTIVES Retroperitoneal hemorrhage is a rare but serious complication of transfemoral approach (TFA) and TFA percutaneous coronary intervention (PCI). Radial approach for coronary angiography and intervention (transradial approach, TRA) is associated with lower access site complications and reduced blood transfusion rates. Retroperitoneal bleeding has not been described with TRA. This study sought to evaluate the relationship between femoral access for coronary angiography (TFA) and PCI-induced retroperitoneal hemorrhage and the resulting medical litigation in the United States. METHODS From 342 lawsuit claim records identified in LexisNexis database search, 17 cases of TFA and TFAPCI-related retroperitoneal hemorrhage decided between 1995 and 2015 were included in the study. Claims were thoroughly reviewed and information about the date the case was decided, patient outcome, the plaintiff, the defendant, the claim, and the trial outcome were extracted. RESULTS The most common filled claim was medical malpractice (53% of the cases), followed by wrongful death (18%) and review of the Commissioner's decision to deny the application for supplemental security income (12%). Forty-seven percent of the cases were won by the defense, 29% by the plaintiff, and 24% were remanded for a new trial. In 82% of the cases, physicians were sued, but only 14% of the cases were won by the plaintiff. In 59% of the claims, the patient died; however, 70% of those cases were decided in favor of the defending physician and hospital. CONCLUSION Retroperitoneal hemorrhage is an uncommon complication of TFA and TFA PCI and is associated with high mortality rates. Physicians should able to identify this complication early and address it in a timely manner based on the applicable standard of care. TRA and TRA PCI is a reliable alternative and may potentially reduce medicolegal liability related to access site choice.
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Affiliation(s)
- Konstantinos V. Voudris
- Department of Medicine, University of Illinois at Chicago / Advocate Christ Medical Centre, Chicago, IL 60612, USA
| | - Mladen I. Vidovich
- Division of Cardiology, University of Illinois at Chicago, Chicago, IL 60612, USA
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Casey DB, Stewart D, Vidovich MI. CRT-200.04 Diagnostic Coronary Angiography: Initial Results of a Simulation Program. JACC Cardiovasc Interv 2016. [DOI: 10.1016/j.jcin.2015.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Sawlani N, Shroff A, Vidovich MI. Aortic dissection and mortality associated with pregnancy in the United States. J Am Coll Cardiol 2015; 65:1600-1. [PMID: 25881947 DOI: 10.1016/j.jacc.2014.12.066] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 12/14/2014] [Indexed: 12/26/2022]
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Vidovich MI, Khan AA, Xie H, Shroff AR. Radiation safety and vascular access: attitudes among cardiologists worldwide. Cardiovasc Revasc Med 2015; 16:109-15. [PMID: 25669957 DOI: 10.1016/j.carrev.2015.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 11/26/2014] [Revised: 01/15/2015] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To determine opinions and perceptions of interventional cardiologists on the topic of radiation and vascular access choice. BACKGROUND Transradial approach for cardiac catheterization has been increasing in popularity worldwide. There is evidence that transradial access (TRA) may be associated with increasing radiation doses compared to transfemoral access (TFA). METHODS We distributed a questionnaire to collect opinions of interventional cardiologists around the world. RESULTS Interventional cardiologists (n=5332) were contacted by email to complete an on-line survey from September to October 2013. The response rate was 20% (n=1084). TRA was used in 54% of percutaneous coronary interventions (PCIs). Most TRAs (80%) were performed with right radial access (RRA). Interventionalists perceived that TRA was associated with higher radiation exposure compared to TFA and that RRA was associated with higher radiation exposure that left radial access (LRA). Older interventionalists were more likely to use radiation protection equipment and those who underwent radiation safety training gave more importance to ALARA (as low as reasonably achievable). Nearly half the respondents stated they would perform more TRA if the radiation exposure was similar to TFA. While interventionalists in the United States placed less importance to certain radiation protective equipment, European operators were more concerned with physician and patient radiation. CONCLUSIONS Interventionalists worldwide reported higher perceived radiation doses with TRA compared to TFA and RRA compared to LRA. Efforts should be directed toward encouraging consistent radiation safety training. Major investment and application of novel radiation protection tools and radiation dose reduction strategies should be pursued.
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Affiliation(s)
- Mladen I Vidovich
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
| | - Asrar A Khan
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Hui Xie
- Division of Epidemiology and Biostatistics and Cancer Center, University of Illinois at Chicago, Chicago, Illinois
| | - Adhir R Shroff
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
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Vidovich MI, Rao SV, Gokhale M, Plomondon ME, Bryson CL, Tsai TT, Shroff AR, Bradley SM. Primary non-interventional operator vascular access choice is associated with lower use of radial PCI: insights from the VA CART. Cardiovasc Revasc Med 2014; 15:439-41. [PMID: 25284809 DOI: 10.1016/j.carrev.2014.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/16/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Mladen I Vidovich
- Jesse Brown VA Medical Center, Chicago, IL; University of Illinois at Chicago, IL.
| | - Sunil V Rao
- Durham VA Medical Center, Durham, NC; Duke University School of Medicine, Durham, NC
| | | | - Mary E Plomondon
- VA Eastern Colorado Health Care System, Denver, CO; University of Colorado School of Medicine, Aurora, CO
| | - Christopher L Bryson
- Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA
| | - Thomas T Tsai
- VA Eastern Colorado Health Care System, Denver, CO; University of Colorado School of Medicine, Aurora, CO; Institute for Health Research, Kaiser Permanente Colorado; University of Colorado School of Medicine, Denver
| | - Adhir R Shroff
- Jesse Brown VA Medical Center, Chicago, IL; University of Illinois at Chicago, IL
| | - Steven M Bradley
- VA Eastern Colorado Health Care System, Denver, CO; University of Colorado School of Medicine, Aurora, CO
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Ertel AW, Shroff AR, Vidovich MI. Myocardial infarction due to intracoronary embolization of percutaneous coronary intervention packaging. Catheter Cardiovasc Interv 2014; 84:677-81. [PMID: 24510613 DOI: 10.1002/ccd.25427] [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: 12/06/2013] [Revised: 01/16/2014] [Accepted: 02/05/2014] [Indexed: 11/07/2022]
Abstract
Intracoronary device loss is occasionally encountered and removal is commonly performed at the time of the procedure. We report a case of removal of a retained coronary balloon protective plastic tubing inadvertently left in the coronary artery for a month and associated with myocardial infarction. Optical coherence tomography was used to visualize the foreign body prior to removal with a snare. To our knowledge this is the first report of a removal of disposable packaging equipment after prolonged intracoronary dwell time.
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Affiliation(s)
- Andrew W Ertel
- Division of Cardiology, Jesse Brown Veterans Administration Medical Center and University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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Patel H, Shivaraju A, Fonarow GC, Xie H, Gao W, Shroff AR, Vidovich MI. Temporal trends in the use of intraaortic balloon pump associated with percutaneous coronary intervention in the United States, 1998-2008. Am Heart J 2014; 168:363-373.e12. [PMID: 25173549 DOI: 10.1016/j.ahj.2014.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND With conflicting evidence regarding the usefulness of intraaortic balloon pump (IABP), reports of IABP use in the United States have been inconsistent. Our objective was to examine trends in IABP usage in percutaneous coronary intervention (PCI) in the United States and to evaluate the association of IABP use with mortality. METHODS This is a retrospective, observational study using patient data obtained from the Nationwide Inpatient Sample database from 1998 to 2008. Patients undergoing any PCI (1,552,602 procedures) for a primary diagnosis of symptomatic coronary artery disease and acute coronary syndrome, including non-ST-elevation myocardial infarction and ST-elevation myocardial infarction, were evaluated. RESULTS The overall use of IABP significantly decreased during the study period from 0.99% in 1998 to 0.36% in 2008 (univariate and multivariate P for trend < .0001). Patients who received IABP had substantially higher rates of shock compared with those who did not receive IABP (38.09% vs 0.70%; P < .0001), which was associated with markedly higher inhospital mortality rates (20.31% vs 0.72%; P < .0001). However, IABP use significantly decreased in patients with shock (36.5%-13.4%) and acute myocardial infarction (2.23%-0.84%) (univariate and multivariate P for trend for both < .0001). A temporal reduction in all-cause PCI-associated mortality from 1.1% in 1998 to 0.86% in 2008 (univariate and multivariate P for trend < .0001) was also observed. CONCLUSIONS The utilization of IABP associated with PCI significantly decreased between 1998 and 2008 in the United States, even among patients with acute myocardial infarction and shock.
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Shivaraju A, Yu C, Kattan MW, Xie H, Shroff AR, Vidovich MI. Temporal trends in percutaneous coronary intervention--associated acute cerebrovascular accident (from the 1998 to 2008 Nationwide Inpatient Sample Database). Am J Cardiol 2014; 114:206-13. [PMID: 24952927 DOI: 10.1016/j.amjcard.2014.04.044] [Citation(s) in RCA: 7] [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: 02/27/2014] [Revised: 04/17/2014] [Accepted: 04/17/2014] [Indexed: 11/24/2022]
Abstract
Acute cerebrovascular accident (CVA) after percutaneous coronary intervention (PCI) for acute coronary syndrome and coronary artery disease is associated with high rates of morbidity and mortality. Nationwide Inpatient Sample from 1998 to 2008 was used to identify 1,552,602 PCIs performed for acute coronary syndrome and coronary artery disease. We assessed temporal trends in the incidence, predictors, and prognostic impact of CVA in a broad range of patients undergoing PCI. The overall incidence of CVA was 0.56% (95% confidence interval [CI] 0.55 to 0.57). The incidence of CVA remained unchanged over the study period (adjusted p for trend=0.2271). The overall mortality rate in the CVA group was 10.76% (95% CI 10.1 to 11.4). The adjusted odds ratio (OR) of CVA for in-hospital mortality was 7.74 (95% CI 7.00 to 8.57, p<0.0001); this remained high but decreased over the study period (adjusted p for trend<0.0001). Independent predictors of CVA included older age (OR 1.03, 95% CI 1.02 to 1.03, p<0.0001), disorder of lipid metabolism (OR 1.31, 95% CI 1.24 to 1.38, p<0.001), history of tobacco use (OR 1.21, 95% CI 1.10 to 1.34, p=0.0002), coronary atherosclerosis (OR 1.56, 95% CI 1.43 to 1.71, p<0.0001), and intra-aortic balloon pump use (OR 1.39, 95% CI 1.09 to 1.77, p=0.0073). A nomogram for predicting the probability of CVA achieved a concordance index of 0.73 and was well calibrated. In conclusion, the incidence of CVA associated with PCI has remained unchanged from 1998 to 2008 in face of improved equipment, techniques, and adjunctive pharmacology. The risk of CVA-associated in-hospital mortality is high; however, this risk has decreased over the study period.
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