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Abusnina W, Ismayl M, Al-Abdouh A, Ganesan V, Mostafa MR, Hallak O, Peterson E, Abdou M, Goldsweig AM, Aboeata A, Dahal K. IMPELLA VERSUS EXTRACORPOREAL MEMBRANE OXYGENATION IN CARDIOGENIC SHOCK: A SYSTEMATIC REVIEW AND META-ANALYSIS. Shock 2022; 58:349-357. [PMID: 36445229 DOI: 10.1097/shk.0000000000001996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
ABSTRACT Background: Cardiogenic shock (CS) carries high mortality. The roles of specific mechanical circulatory support (MCS) systems are unclear. We compared the clinical outcomes of Impella versus extracorporal membrane oxygenation (ECMO) in patients with CS. Methods: This is a systematic review and meta-analysis that was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. We searched PubMed, Cochrane Central Register, Embase, Web of Science, Google Scholar, and ClinicalTrials.gov (inception through May 10, 2022) for studies comparing the outcomes of Impella versus ECMO in CS. We used random-effects models to calculate risk ratios (RRs) with 95% confidence interval (CIs). End points included in-hospital, 30-day, and 12-month all-cause mortality, successful weaning from MCS, bridge to transplant, all reported bleeding, stroke, and acute kidney injury. Results: A total of 10 studies consisting of 1,827 CS patients treated with MCS were included in the analysis. The risk of in-hospital all-cause mortality was significantly lower with Impella compared with ECMO (RR, 0.80; 95% CI, 0.65-1.00; P = 0.05), whereas there was no statistically significant difference in 30-day (RR, 0.97, 95% CI, 0.82-1.16; P = 0.77) and 12-month mortality (RR, 0.90; 95% CI, 0.74-1.11; P = 0.32). There were no significant differences between the two groups in terms of successful weaning (RR, 0.97; 95% CI, 0.81-1.15; P = 0.70) and bridging to transplant (RR, 0.88; 95% CI, 0.58-1.35; P = 0.56). There was less risk of bleeding and stroke in the Impella group compared with the ECMO group. Conclusions: In patients with CS, the use of Impella is associated with lower rates of in-hospital mortality, bleeding, and stroke than ECMO. Future randomized studies with adequate sample sizes are needed to confirm these findings.
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Affiliation(s)
- Waiel Abusnina
- Department of Cardiology, Creighton University School of Medicine, Omaha, Nebraska
| | - Mahmoud Ismayl
- Department of Cardiology, Creighton University School of Medicine, Omaha, Nebraska
| | - Ahmad Al-Abdouh
- Department pf medicine, University of Kentucky, Lexington, Kentucky
| | - Vaishnavi Ganesan
- Department of Cardiology, Creighton University School of Medicine, Omaha, Nebraska
| | | | - Osama Hallak
- Division of Cardiology, Kettering Medical Center, Dayton, Ohio
| | - Emily Peterson
- Creighton University School of Medicine, Omaha, Nebraska
| | - Mahmoud Abdou
- Division of Cardiology, Emory University, Atlanta, Georgia
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ahmed Aboeata
- Department of Cardiology, Creighton University School of Medicine, Omaha, Nebraska
| | - Khagendra Dahal
- Department of Cardiology, Creighton University School of Medicine, Omaha, Nebraska
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Hallak O, Hallak A, Bob-Manuel T, Collins TJ. SUCCESSFUL EMBOLIZATION OF LAD ANEURYSM USING MULTIPLE HYDROCOILS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Agarwal A, Hallak O, Ahmad T. Periprocedural antiplatelet management in cardiac patients undergoing dental extraction: A case report and review of literature. Advances in Oral and Maxillofacial Surgery 2022. [DOI: 10.1016/j.adoms.2021.100245] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Khan AJ, Jan Liao C, Kabir C, Hallak O, Samee M, Potts S, Klein LW. Etiology and Determinants of In-Hospital Survival in Patients Resuscitated After Out-of-Hospital Cardiac Arrest in an Urban Medical Center. Am J Cardiol 2020; 130:78-84. [PMID: 32674809 DOI: 10.1016/j.amjcard.2020.06.019] [Citation(s) in RCA: 5] [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: 04/20/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality globally. The goals of this study were to describe common causes of OHCA in an urban US medical center, identify predictive factors for survival, and to assess whether neurological status upon return of spontaneous circulation might be predictive of outcomes: 124 consecutive patients aged 18 years and older with OHCA admitted at Advocate Illinois Masonic Medical Center were studied. All patients resuscitated in the field with return of spontaneous circulation then transferred to the emergency department were included. The Glasgow Coma Score (GCS) was evaluated immediately on hospital arrival. In the total group, 34% (42 of 124) were discharged alive. In patients with coronary artery disease (CAD), 51% (20 of 39) were discharged alive versus 26% (22 of 85) of non-CAD patients (p <0.01). Initial GCS ≥ 9 was highly predictive of survival: 94% (34 of 36) of patients with GCS ≥ 9 survived versus 9% (8 of 88) with GCS ≤ 8 (p <0.0001). Defibrillation in the field was predictive of survival (chi-square = 7.81, p = 0.005). In the CAD group, all 16 patients with GCS ≥ 9 on presentation to the Emergency Department survived whereas all 13 with GCS ≤ 5 died (both p <0.0001). In the non-CAD group, 18 of 20 patients with GCS ≥ 9 survived, whereas only 2 of 52 with GCS ≤ 5 survived (both p <0.0001). Multivariate analysis by logistic regression showed that the strongest predictor of survival in the non-CAD subgroup was GCS (OR 0.27, CI 0.19 to 0.55, p <0.001). In conclusion, the etiology of the OHCA, immediate neurologic status, and defibrillation in the field (suggesting presenting arrhythmia) were predictive of survival. Immediate neurological recovery (GCS ≥ 9) regardless of etiology was a strong predictor of survival to discharge. Additional predictive factors depend on the etiology of the OHCA event. These data suggest that these straightforward factors can be helpful in predicting outcome in patients resuscitated after OHCA.
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Mehta R, Tahir A, Hallak O, Gonzalez J. Collaborative Cardiac Care: A Comprehensive Heart Team Approach to Multiple Severe Vascular Conditions. JACC Case Rep 2019; 1:873-875. [PMID: 34316949 PMCID: PMC8288579 DOI: 10.1016/j.jaccas.2019.11.028] [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: 10/07/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 12/03/2022]
Abstract
Left main artery coronary disease represents the highest risk lesion of ischemic heart disease. Revascularization can be accomplished by surgery or percutaneous interventions. This study highlights the case of a patient with severe multiple peripheral vascular conditions and complex coronary anatomy treated with percutaneous coronary intervention using mechanical circulatory support. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Rohan Mehta
- Advocate Heart Institute, Illinois Masonic Medical Center, Chicago, Illinois
| | - Ammar Tahir
- Advocate Heart Institute, Illinois Masonic Medical Center, Chicago, Illinois
| | - Osama Hallak
- Advocate Illinois Masonic Medical Center, Chicago, Illinois
| | - Joaquin Gonzalez
- Advocate Heart Institute, Illinois Masonic Medical Center, Chicago, Illinois
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Ali A, Hallak O, Saad M, Omer M, Elbadawi A, Al-Azizi K, Elgendy I, Megaly M. TCT-633 Impact of Diabetes on the Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions: An Updated Systematic Review and Meta-Analysis. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.751] [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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Abugroun A, Iskander F, Hallak O, Iskander M, Klein LW. PATIENTS WITH TAKOTSUBO CARDIOMYOPATHY HAVE HIGHER PREVALENCE OF DEPRESSION AND ANXIETY THAN PATIENTS WITH ACUTE CORONARY SYNDROME: FROM THE NATIONAL INPATIENT SAMPLE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31420-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abugroun A, Hallak O, Ahmed F, Gaznabi S. Massive Hemorrhagic Pericardial Effusion With Cardiac Tamponade as Initial Manifestation of Mixed Connective Tissue Disease. Cardiol Res 2018; 9:68-71. [PMID: 29479391 PMCID: PMC5819634 DOI: 10.14740/cr654w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/20/2017] [Indexed: 11/22/2022] Open
Abstract
Mixed connective tissue disease (MCTD) is a distinct entity of connective tissue disorders characterized by overlapping clinical features of various autoimmune diseases along with the presence of antibodies to ribonucleoprotein (anti-RNP). The prevalence of cardiac involvement in MCTD varies from 13% to 65% and accounts for approximately 20% of MCTD related mortality. In this case, we describe an elderly female patient with multiple complaints without a clear etiology on presentation. Echocardiogram revealed severe rapidly accumulating pericardial effusion causing tamponade necessitating pericardial window. Laboratory investigations showed positive ribonucleoprotein antibodies. Biopsy of pericardial tissue revealed fibrinous pericarditis. While pericarditis is commonly associated with MCTD, pericardial tamponade on the other hand is rarely described. This case highlights a very rare complication of the disease. Early recognition, prompt treatment, and regular follow-up with serial echo are essential for treatment.
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Affiliation(s)
- Ashraf Abugroun
- Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Osama Hallak
- Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Fatima Ahmed
- Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Safwan Gaznabi
- Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
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Abugroun A, Vilchez D, Hallak O, Shahrrava A. A History of Kawasaki Disease From Childhood and Coronary Artery Ectasia With Recurrent ST Elevation Myocardial Infarction: A Therapeutic Challenge. Cardiol Res 2017; 8:344-348. [PMID: 29317980 PMCID: PMC5755669 DOI: 10.14740/cr641w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/08/2017] [Indexed: 11/17/2022] Open
Abstract
Coronary artery ectasia (CAE) is an uncommon anomaly, usually found in 1.2-2% of patients undergoing coronary angiography, defined as a segment of the coronary artery that has a diameter of more than 1.5 times the normal adjacent segments. Atherosclerosis is considered as the cause of half of the CAE cases. We herein present a 65-year-old Asian male with past medical history of Kawasaki disease (KD) who developed recurrent episodes of inferior wall ST-elevation myocardial infarction (STEMI) despite treatment with dual antiplatelet therapy (DAPT). Repeat coronary angiogram showed severely ectatic and tortuous coronary arteries more predominant on the right coronary artery (RCA) with diffuse thrombus in its mid segment. Given his unfavorable vascular anatomy, the condition was managed medically with the addition of warfarin to his DAPT with target international normalized ratio (INR) 2 - 3. This case highlights the association of CAE with a prior history of KD and its therapeutic challenge.
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Affiliation(s)
- Ashraf Abugroun
- Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
- Corresponding Author: Ashraf Abugroun, Department of Internal Medicine, Advocate Illinois Masonic Medical Center, 836 W Wellington Ave, Chicago, IL 60657, USA.
| | - Daniel Vilchez
- Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Osama Hallak
- Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
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Lombo B, Hallak O, Dianna H, Rebecca D, Nader B, Hasan F, Spatz E, Fucci M. VIRTUAL CARDIAC DECISION UNIT ALGORITHM IMPROVES PATIENT OUTCOMES AND REDUCES COST. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hallak O, Hallak A, Alshammaa A, Aljundi L, Shehab O, Zarzour A, Tujjar O, Radaideh Q, Hallak O. PP-330 Persistent Significant Elevation of CK with Unknown Etiology. Am J Cardiol 2014. [DOI: 10.1016/j.amjcard.2014.01.360] [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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