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Nelson AJ, Young R, Tarrar IH, Wojdyla D, Wang TY, Mehta RH. Temporal Trends in Risk Factors of Periprocedural Stroke in Patients Undergoing Percutaneous Coronary Intervention: Insights from the ACC NCDR CathPCI Registry. Am J Cardiol 2023; 204:284-286. [PMID: 37562194 DOI: 10.1016/j.amjcard.2023.07.104] [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: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Adam J Nelson
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Victorian Heart Institute, Melbourne, Victoria, Australia.
| | - Rebecca Young
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | | | - Daniel Wojdyla
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
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Mauro C, Chianese S, Cocchia R, Arcopinto M, Auciello S, Capone V, Carafa M, Carbone A, Caruso G, Castaldo R, Citro R, Crisci G, D’Andrea A, D’Assante R, D’Avino M, Ferrara F, Frangiosa A, Galzerano D, Maffei V, Marra AM, Mehta RM, Mehta RH, Paladino F, Ranieri B, Franzese M, Limongelli G, Rega S, Romano L, Salzano A, Sepe C, Vriz O, Izzo R, Cademartiri F, Cittadini A, Bossone E. Acute Heart Failure: Diagnostic-Therapeutic Pathways and Preventive Strategies-A Real-World Clinician's Guide. J Clin Med 2023; 12:jcm12030846. [PMID: 36769495 PMCID: PMC9917599 DOI: 10.3390/jcm12030846] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/01/2023] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
Acute heart failure (AHF) is the most frequent cause of unplanned hospital admission in patients of >65 years of age and it is associated with significantly increased morbidity, mortality, and healthcare costs. Different AHF classification criteria have been proposed, mainly reflecting the clinical heterogeneity of the syndrome. Regardless of the underlying mechanism, peripheral and/or pulmonary congestion is present in the vast majority of cases. Furthermore, a marked reduction in cardiac output with peripheral hypoperfusion may occur in most severe cases. Diagnosis is made on the basis of signs and symptoms, laboratory, and non-invasive tests. After exclusion of reversible causes, AHF therapeutic interventions mainly consist of intravenous (IV) diuretics and/or vasodilators, tailored according to the initial hemodynamic status with the addition of inotropes/vasopressors and mechanical circulatory support if needed. The aim of this review is to discuss current concepts on the diagnosis and management of AHF in order to guide daily clinical practice and to underline the unmet needs. Preventive strategies are also discussed.
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Affiliation(s)
- Ciro Mauro
- Cardiology Division, A. Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Salvatore Chianese
- Cardiology Division, A. Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Rosangela Cocchia
- Cardiology Division, A. Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
| | - Stefania Auciello
- First Aid—Short Intensive Observation Division, A. Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Valentina Capone
- Cardiology Division, A. Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Mariano Carafa
- Emergency Medicine Division, A. Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Andreina Carbone
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Giuseppe Caruso
- Long-Term Care Division, Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Rossana Castaldo
- Istituto di Ricovero e Cura a Carattere Scientifico SYNLAB SDN, Via Emanuele Gianturco, 113, 80143 Naples, Italy
| | - Rodolfo Citro
- Heart Department, University Hospital of Salerno, 84131 Salerno, Italy
| | - Giulia Crisci
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
| | - Antonello D’Andrea
- Department of Cardiology, Umberto I Hospital Nocera Inferiore, 84014 Nocera, Italy
| | - Roberta D’Assante
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
| | - Maria D’Avino
- Long-Term Care Division, Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Francesco Ferrara
- Heart Department, University Hospital of Salerno, 84131 Salerno, Italy
| | - Antonio Frangiosa
- Post Operative Intensive Care Division, A. Cardarelli Hospital, 80131 Naples, Italy
| | - Domenico Galzerano
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Vincenzo Maffei
- Post Operative Intensive Care Division, A. Cardarelli Hospital, 80131 Naples, Italy
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
| | - Rahul M. Mehta
- ProMedica Monroe Regional Hospital, Monroe, MI 48162, USA
| | - Rajendra H. Mehta
- Duke Clinical Research Institute, 300 W Morgan St., Durham, NC 27701, USA
| | - Fiorella Paladino
- First Aid—Short Intensive Observation Division, A. Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Brigida Ranieri
- Istituto di Ricovero e Cura a Carattere Scientifico SYNLAB SDN, Via Emanuele Gianturco, 113, 80143 Naples, Italy
| | - Monica Franzese
- Istituto di Ricovero e Cura a Carattere Scientifico SYNLAB SDN, Via Emanuele Gianturco, 113, 80143 Naples, Italy
| | - Giuseppe Limongelli
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Salvatore Rega
- Department of Public Health University “Federico II” of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, Antonio Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Andrea Salzano
- Istituto di Ricovero e Cura a Carattere Scientifico SYNLAB SDN, Via Emanuele Gianturco, 113, 80143 Naples, Italy
| | - Chiara Sepe
- Technical Nursing and Rehabilitation Service (SITR) Department, Cardarelli Hospital, 80131 Naples, Italy
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
| | - Eduardo Bossone
- Department of Public Health University “Federico II” of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
- Correspondence:
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Kochar A, Zheng Y, van Diepen S, Mehta RH, Westerhout CM, Mazer DC, Duncan AI, Whitlock R, Lopes RD, Argenziano M, de Varennes B, Alexander JH, Goodman SG, Fremes S. Predictors and associated clinical outcomes of low cardiac output syndrome following cardiac surgery: insights from the LEVO-CTS trial. Eur Heart J Acute Cardiovasc Care 2022; 11:818-825. [PMID: 36156131 DOI: 10.1093/ehjacc/zuac114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/23/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
AIMS High-risk cardiac surgery is commonly complicated by low cardiac output syndrome (LCOS), which is associated with high mortality. There are limited data derived from multi-centre studies with adjudicated endpoints describing factors associated with LCOS and its downstream clinical outcomes. METHODS AND RESULTS The Levosimendan in Patients with Left Ventricular Systolic Dysfunction Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass (LEVO-CTS) trial evaluated prophylactic levosimendan vs. placebo in patients with a reduced ejection fraction undergoing coronary artery bypass grafting (CABG) and/or valve surgery. We conducted a pre-specified analysis on LCOS, which was characterized by a four-part definition. We constructed a multivariable logistical regression model to evaluate risk factors associated with LCOS and performed Cox proportional hazards modelling to determine the association of LCOS with 90-day mortality. A total of 186 (22%) of 849 patients in the LEVO-CTS trial developed LCOS. The factors most associated with a higher adjusted risk of LCOS were pre-operative ejection fraction [odds ratio (OR) 1.26; 95% confidence interval (CI): 1.08-1.46 per 5% decrease] and age (OR 1.13; 95% CI: 1.04-1.24 per 5-year increase), whereas isolated CABG surgery (OR 0.44, 95% CI: 0.31-0.64) and levosimendan use (OR 0.65; 95% CI: 0.46-0.92) were associated with a lower risk of LCOS. Patients with LCOS had worse outcomes, including renal replacement therapy at 30-day (10 vs. 1%) and 90-day mortality (16 vs. 3%, adjusted hazard ratio of 5.04, 95% CI: 2.66-9.55). CONCLUSION Low cardiac output syndrome is associated with a high risk of post-operative mortality in high-risk cardiac surgery.
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Affiliation(s)
- Ajar Kochar
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, USA
| | - Yinggan Zheng
- Canadian VIGOUR Centre at the University of Alberta, 40129 Edmonton, AB T6G, Canada
| | - Sean van Diepen
- Canadian VIGOUR Centre at the University of Alberta, 40129 Edmonton, AB T6G, Canada
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Duke University Medical Center, 300 W. Morgan Street, Durham, NC 27701, USA
| | - Cynthia M Westerhout
- Canadian VIGOUR Centre at the University of Alberta, 40129 Edmonton, AB T6G, Canada
| | - David Cyril Mazer
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, 300 Bond Street, Toronto ON M5B 1W8, Canada
| | - Andra I Duncan
- Department of Cardiothoracic Anesthesia, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Richard Whitlock
- Division of Cardiac Surgery, Hamilton Health Sciences, 237 Barton Street East Hamilton, ON L8L 2X2, USA
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University Medical Center, 300 W. Morgan Street, Durham, NC 27701, USA
| | - Michael Argenziano
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University College of Physicians & Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Benoit de Varennes
- Department of Cardiovascular Surgery, McGill University Health Centre, 1001 boul. Decarie, Montreal QC H4A 3J1, Canada
| | - John H Alexander
- Duke Clinical Research Institute, Duke University Medical Center, 300 W. Morgan Street, Durham, NC 27701, USA
| | - Shaun G Goodman
- Canadian VIGOUR Centre at the University of Alberta, 40129 Edmonton, AB T6G, Canada
- Division of Cardiology, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Stephen Fremes
- Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, USA
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Carrena O, Young R, Tarrar IH, Nelson AJ, Woidyla D, Wang TY, Mehta RH. Trends in the Incidence and Fatality of Peripercutaneous Coronary Intervention Stroke. J Am Coll Cardiol 2022; 80:1772-1774. [DOI: 10.1016/j.jacc.2022.08.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022]
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Solomon R, Anne P, Swisher J, Nazeer B, Rosman H, Mehta RH, Maciejko JJ. Evaluating Statin Tolerability in Historically Intolerant Patients After Correcting for Subclinical Hypothyroidism and Vitamin D Insufficiency. High Blood Press Cardiovasc Prev 2022; 29:409-415. [PMID: 36063342 DOI: 10.1007/s40292-022-00537-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Atherosclerotic cardiovascular disease (ASCVD) is the major cause of morbidity and mortality worldwide. Statins provide primary and secondary ASCVD prevention. Intolerance due to statin-associated myalgias reduces long-term adherence, thus muting potential benefits. AIM Our analysis sought to determine whether transition from a lipophilic statin to a water-soluble statin, or correction of subclinical hypothyroidism and/or vitamin D insufficiency/deficiency (metabolic abnormalities), improved statin tolerance. METHODS We performed a retrospective analysis of the data from patients referred to our lipid clinic because of statin intolerance. Patients intolerant to a lipophilic statin were switched to a water-soluble statin. Patients having vitamin D insufficiency/deficiency or subclinical hypothyroidism were re-challenged with a water-soluble statin (or lipophilic statin with minimal systemic exposure) after correction of the metabolic abnormality. RESULTS 169 patients were statin intolerant. 86% (n = 145) were white and 48% (n = 81) were male. 82 of these patients had one or both metabolic abnormalities. The remaining patients (n = 87) had no metabolic abnormality, however, were unable to tolerate a lipophilic statin. 72% (n = 73) of eligible patients (n = 101), defined as those with a corrected metabolic abnormality or without a metabolic abnormality on a lipophilic statin, were able to tolerate a water-soluble statin or lipophilic statin with minimal systemic exposure. In addition, 75% (n = 127) of this total cohort met their LDL-C goal. CONCLUSIONS Our findings suggest that either correction of subclinical hypothyroidism and/or vitamin D insufficiency/deficiency or transition from a lipophilic statin to water-soluble statin (or lipophilic statin with minimal systemic exposure) improves statin tolerance.
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Affiliation(s)
- Robert Solomon
- Division of Cardiology, Ascension St. John Hospital, 22101 Moross Rd, Detroit, Michigan, 48236, United States.
| | - Premchand Anne
- Department of Internal Medicine, Ascension St. John Hospital, 22101 Moross Rd, Detroit, Michigan, 48236, United States
| | - Jordan Swisher
- Division of Cardiology, Ascension St. John Hospital, 22101 Moross Rd, Detroit, Michigan, 48236, United States
| | - Beshoy Nazeer
- Department of Internal Medicine, Ascension St. John Hospital, 22101 Moross Rd, Detroit, Michigan, 48236, United States
| | - Howard Rosman
- Division of Cardiology, Ascension St. John Hospital, 22101 Moross Rd, Detroit, Michigan, 48236, United States
| | - Rajendra H Mehta
- Division of Cardiology, Ascension St. John Hospital, 22101 Moross Rd, Detroit, Michigan, 48236, United States
| | - James J Maciejko
- Division of Cardiology, Ascension St. John Hospital, 22101 Moross Rd, Detroit, Michigan, 48236, United States.,Department of Internal Medicine, Ascension St. John Hospital, 22101 Moross Rd, Detroit, Michigan, 48236, United States
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Caruba T, Charles-Nelson A, Alexander JH, Mehta RH, Heringlake M, Toller W, Yavchitz A, Sabatier B, Chatellier G, Cholley B. Prophylactic levosimendan in patients with low ejection fraction undergoing coronary artery bypass grafting: A pooled analysis of two multicentre randomised controlled trials. Anaesth Crit Care Pain Med 2022; 41:101107. [PMID: 35643391 DOI: 10.1016/j.accpm.2022.101107] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess the effect of preoperative levosimendan on mortality at Day-90 in patients with left ventricular ejection fraction (LVEF) ≤ 40%, and to investigate a possible differential effect between patients undergoing isolated coronary artery bypass grafting (CABG) versus CABG combined with valve replacement surgery. DESIGN Pooled analysis of two multicentre randomised controlled trials (RCT) investigating prophylactic levosimendan versus placebo prior to CABG surgery on mortality at Day-90 in patients with LVEF ≤ 40%. A meta-analysis of all RCT investigating the same issue was also conducted. RESULTS A cohort of 1084 patients (809 isolated CABG, and 275 combined surgery) resulted from the merging of LEVO-CTS and LICORN databases. Seventy-two patients were dead at day 90. The mortality at day 90 was not different between levosimendan and placebo (Hazard Ratio (HR): 0.73, 95% CI: 0.41-1.28, p = 0.27). However, there was a significant interaction between the type of surgery and the study drug (p = 0.004). We observed a decrease in mortality at day 90 in the isolated CABG subgroup (HR: 0.39, 95% CI: 0.19-0.82, p = 0.013), but not in the combined surgery subgroup (HR: 1.73, 95% CI: 0.77-3.92, p = 0.19). The meta-analysis of 6 RCT involving 1441 patients confirmed the differential effect on mortality at day 30 between the 2 subgroups. CONCLUSIONS Preoperative levosimendan did not reduce mortality in a mixed surgical population with LV dysfunction. However, the subgroup of patients undergoing isolated CABG had a reduction in mortality at day 90, whereas there was no significant effect in combined surgery patients. This finding requires confirmation with a specific prospective trial.
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Affiliation(s)
- Thibaut Caruba
- AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | | | - John H Alexander
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Matthias Heringlake
- Dept. of Anaesthesiology and Intensive Care Medicine, Heart- and Diabetes Center, Karlsburg, Germany
| | | | - Amelie Yavchitz
- AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Brigitte Sabatier
- AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France; Inserm UMR_1138, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris Cité, F-75006 Paris, France and Inria, HeKA, PariSantéCampus, Paris, France
| | - Gilles Chatellier
- AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France; Université de Paris, F-75006 Paris, France
| | - Bernard Cholley
- AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France; Université de Paris, INSERM UMR_S 1140 "Innovations Thérapeutiques en Hémostase", F-75006 Paris, France.
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Singh H, Mehta RH, O'Neill W, Kapur NK, Lalonde T, Ohman M, Ghiu I, Chen-Hsing Y, Dutcheshen K, Schreiber T, Rosman H, Kaki A. Clinical features and outcomes in patients with cardiogenic shock complicating acute myocardial infarction: early vs recent experience with impella. Am Heart J 2021; 238:66-74. [PMID: 33848505 DOI: 10.1016/j.ahj.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To compare clinical features and outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) treated in the early experience with Impella percutaneous ventricular assist device and patients treated recently. BACKGROUND Since pre-market approval (PMA) of Impella device as treatment for AMICS, use of the device has grown considerably. METHODS We retrospectively analyzed 649 AMICS patients treated with perioperative Impella, with 291 patients treated from 2008 to 2014 comprising the early experience cohort and 358 patients treated from 2017 to 2019 comprising the recent experience cohort. The primary end point was risk adjusted in-hospital mortality. RESULTS Mean age and gender distribution of patients was similar in the two cohorts. The recent cohort had more invasive hemodynamic monitoring (64% vs 46%; P < .001) and less use of an intra-aortic balloon pump prior to Impella (15% vs 41%; P < .001). Recently treated patients were significantly more likely to receive Impella support prior to PCI (58% vs 44%; P = .005). In-hospital mortality was lower in the recent cohort (48% vs 56%; P = .043). This difference was however no longer significant after risk adjustment (adjusted OR 0.89, 95% CI 0.59-1.34, P = .59). Rates of acute kidney injury, major bleeding, and vascular complications requiring surgery were also significantly lower in the recent cohort. CONCLUSIONS Use of Impella for AMICS during recent years is associated with lower unadjusted in-hospital mortality, which may reflect better patient selection, earlier device implantation, and improved management algorithms. In-depth understanding of these factors may inform the development of future treatment protocols.
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Lowenstern A, Alexander KP, Hill CL, Alhanti B, Pellikka PA, Nanna MG, Mehta RH, Cooper LS, Bullock-Palmer RP, Hoffmann U, Douglas PS. Age-Related Differences in the Noninvasive Evaluation for Possible Coronary Artery Disease: Insights From the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) Trial. JAMA Cardiol 2021; 5:193-201. [PMID: 31738382 DOI: 10.1001/jamacardio.2019.4973] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Although cardiovascular (CV) disease represents the leading cause of morbidity and mortality that increases with age, the best noninvasive test to identify older patients at risk for CV events remains unknown. Objective To determine whether the prognostic utility of anatomic vs functional testing varies based on patient age. Design, Setting, and Participants Prespecified analysis of the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) study, which used a pragmatic comparative effectiveness design. Participants were enrolled from 193 sites across North America and comprised outpatients without known coronary artery disease (CAD) but with symptoms suggestive of CAD. Data were analyzed between October 2018 and April 2019. Interventions Randomization to noninvasive testing with coronary computed tomographic angiography or functional testing. Main Outcomes and Measures The composite of CV death/myocardial infarction (MI) over a median follow-up of 25 months. Results Among 10 003 PROMISE patients, we included the 8966 who received the noninvasive test to which they were randomized and had interpretable results; 6378 (71.1%) were younger than 65 years, 2062 (23.0%) were between ages 65 and 74 years, and 526 (5.9%) were 75 years and older. More than half of participants were women (4720 of 8966 [52.6%]). Only a minority of patients were of nonwhite race/ethnicity, a proportion that was lower among the older age groups (1071 of 6378 [16.8%] for <65 years; 258 of 2062 [12.5%] for age 65-74 years; 41 of 526 [7.8%] for ≥75 years). Compared with patients younger than 65 years, older patients were more likely to have a positive test result (age 65-74 years: odds ratio, 1.65; 95% CI, 1.42-1.91; age ≥75 years: odds ratio, 2.32; 95% CI, 1.83-2.95), regardless of noninvasive test completed. A positive functional test result was not associated with CV death/MI in patients younger than 65 years (hazard ratio [HR], 1.09; 95% CI, 0.43-2.82) but it was among older patients (age 65-74 years: HR, 3.18; 95% CI, 1.44-7.01; age ≥75 years: HR, 6.55; 95% CI, 1.46-29.35). Conversely, a positive anatomic test result was associated with CV death/MI among patients younger than 65 years (HR, 3.04; 95% CI, 1.46-6.34) but not among older patients (age, 65-74 years: HR, 0.67; 95% CI, 0.15-2.94; age ≥75 years: HR, 1.07; 95% CI, 0.22-5.34; P for interaction = .01). An elevated coronary artery calcium score was predictive of events in patients younger than 65 years (HR, 2.73; 95% CI, 1.31-5.69) but not for older patients (age 65-74 years: HR, 0.44; 95% CI, 0.14-1.42; age ≥75 years: HR, 1.31; 95% CI, 0.25-6.88). Conclusions and Relevance Older patients with stable symptoms suggestive of CAD are more likely to have a positive noninvasive test result and more coronary artery calcium. However, only a positive functional test result was associated with risk of CV death/MI. Age-specific approaches to noninvasive evaluation of CAD should be further examined. Trial Registration ClinicalTrials.gov identifier: NCT01174550.
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Affiliation(s)
- Angela Lowenstern
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Karen P Alexander
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - C Larry Hill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Brooke Alhanti
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - Michael G Nanna
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Lawton S Cooper
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | - Udo Hoffmann
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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Jawitz OK, Stebbins AS, Raman V, Alhanti B, van Diepen S, Heringlake M, Fremes S, Whitlock R, Meyer SR, Mehta RH, Stafford-Smith M, Goodman SG, Alexander JH, Lopes RD. Association between levosimendan, postoperative AKI, and mortality in cardiac surgery: Insights from the LEVO-CTS trial. Am Heart J 2021; 231:18-24. [PMID: 33127531 DOI: 10.1016/j.ahj.2020.10.066] [Citation(s) in RCA: 4] [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: 08/18/2020] [Accepted: 10/23/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We aimed to evaluate the association between levosimendan treatment and acute kidney injury (AKI) as well as assess the clinical sequelae of AKI in cardiac surgery patients with depressed left ventricular function (ejection fraction <35%). METHODS Patients in the LEVO-CTS trial undergoing on-pump coronary artery bypass grafting (CABG), valve, or CABG/valve surgery were stratified by occurrence and severity of postoperative AKI using the AKIN classification. The association between levosimendan infusion and AKI was modeled using multivariable regression. RESULTS Among 854 LEVO-CTS patients, 231 (27.0%) experienced postoperative AKI, including 182 (21.3%) with stage 1, 35 (4.1%) with stage 2, and 14 (1.6%) with stage 3 AKI. The rate of AKI was similar between patients receiving levosimendan or placebo. The odds of 30-day mortality significantly increased by AKI stage compared to those without AKI (stage 1: adjusted odds ratio [aOR] 2.0, 95% confidence interval [CI] 0.8-4.9; stage 2: aOR 9.1, 95% CI 3.2-25.7; stage 3: aOR 12.4, 95% CI 3.0-50.4). No association was observed between levosimendan, AKI stage, and odds of 30-day mortality (interaction P = .69). Factors independently associated with AKI included increasing age, body mass index, diabetes, and increasing baseline systolic blood pressure. Increasing baseline eGFR and aldosterone antagonist use were associated with a lower risk of AKI. CONCLUSIONS Postoperative AKI is common among high-risk patients undergoing cardiac surgery and associated with significantly increased risk of 30-day death or dialysis. Levosimendan was not associated with the risk of AKI.
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10
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Mekala K, Mehta RH, Joumaa M, Yamasaki H. Treatment of heavily calcified coronary artery stenosis using 3.5 mm peripheral intravascular lithotripsy balloon: case series. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33204979 PMCID: PMC7649492 DOI: 10.1093/ehjcr/ytaa211] [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] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/19/2019] [Accepted: 06/16/2020] [Indexed: 11/14/2022]
Abstract
Background Prevalence of coronary artery calcification is high among patients with advanced age, chronic kidney disease, and diabetes. Percutaneous coronary intervention of heavily calcified coronary artery remains a significant challenge for interventional cardiologists. Although there are several modalities available in treating calcified coronary arteries, lesion preparation of certain heavily calcified vessels remains inadequate prior to stent deployment and/or often associated with worse periprocedural adverse outcomes. Case summary We report feasibility and safety of 3.5 mm peripheral intravascular lithotripsy (IVL) for the treatment of severely calcified coronary stenosis in two patients after orbital atherectomy failed to debulk calcified plaque to enable stent deployment. Discussion Intravascular lithotripsy has recently emerged as a therapeutic option in treating calcified peripheral artery disease. However, coronary IVL is currently available only in a few centres in the USA. Studies are ongoing in the safety and efficacy of this technology in treating coronaries.
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Affiliation(s)
- Karthik Mekala
- Department of Cardiology, Ascension St. John Hospital, 22101 Moross Rd, Detroit, Michigan 48236, USA
| | - Rajendra H Mehta
- Duke Clinical Research Institute, 200 Morris St., Durham, NC 27701, USA
| | - Mouhammed Joumaa
- Department of Cardiology, Ascension St. John Hospital, 22101 Moross Rd, Detroit, Michigan 48236, USA
| | - Hiroshi Yamasaki
- Department of Cardiology, Ascension St. John Hospital, 22101 Moross Rd, Detroit, Michigan 48236, USA
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11
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Marroush TS, Sharma AV, Botros B, Szpunar S, Rosman HS, Mehta RH. Differences in Baseline Characteristics and Outcomes in Young Caucasians and African Americans with Acute Myocardial Infarction. Am J Med Sci 2020; 361:238-243. [PMID: 33054977 DOI: 10.1016/j.amjms.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/06/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The incidence of acute myocardial infarction (AMI) in young patients is increasing. While race-related differences in clinical characteristics and outcomes for older AMI patients have been well-studied, such differences in young patients are unknown. METHODS We performed a retrospective review of charts of Caucasian and African American (AA) patients <50 years of age, presenting with AMI between 2010 and 2017 in an urban, community hospital in Detroit, Michigan. RESULTS A total of 271 patients were identified with 156 being AAs (57.5%). Mean age was 43 years which was similar in both groups. AAs with AMI were 2.2 times more likely to be women and to have a history of diabetes and 1.2 times more likely to have BMI >30 kg/m2. History of coronary artery disease (1.8-fold) and hypertension (1.5-fold) were also more common in AAs. Overall presenting features were similar, other than that AAs presented more often with non-ST-elevation MI and tended to present less often with cardiac arrest. No differences were observed in the angiographic findings or in-hospital outcomes in the two groups, with the exception of lower need of mechanical support in AAs. CONCLUSIONS In conclusion, our data provide important, not previously described information on race-related differences in history, presentation, clinical and angiographic features and outcomes in AAs compared with Caucasians younger than 50 with AMI. These findings may have implications for tailoring specific preventive strategies to decrease the incidence of AMI and its associated adverse events in both racial groups.
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Affiliation(s)
- Tariq S Marroush
- Division of Cardiovascular Disease, Ascension Saint John Hospital, Detroit, MI, United States.
| | - Amreeta V Sharma
- Department of Internal Medicine, Ascension Saint John Hospital, Detroit, MI, United States
| | - Bassent Botros
- Division of Cardiovascular Disease, Ascension Saint John Hospital, Detroit, MI, United States
| | - Susanna Szpunar
- Department of Graduate Medical Education, Ascension Saint John Hospital, Detroit, MI, United States
| | - Howard S Rosman
- Division of Cardiovascular Disease, Ascension Saint John Hospital, Detroit, MI, United States
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12
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Othman H, Seth M, Mehta RH, Gurm H, Daher E. Reply: Treating Chronic Total Occlusions Successfully. JACC Cardiovasc Interv 2020; 13:1835-1836. [PMID: 32763078 DOI: 10.1016/j.jcin.2020.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
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13
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Zein R, Seth M, Othman H, Rosman HS, Lalonde T, Alaswad K, Menees D, Daher E, Mehta RH, Gurm HS. Association of Operator and Hospital Experience With Procedural Success Rates and Outcomes in Patients Undergoing Percutaneous Coronary Interventions for Chronic Total Occlusions. Circ Cardiovasc Interv 2020; 13:e008863. [DOI: 10.1161/circinterventions.119.008863] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
An inverse relationship has been described between procedural success and outcomes of all major cardiovascular procedures. However, this relationship has not been studied for percutaneous coronary intervention (PCI) of chronic total occlusion (CTO).
Methods:
We analyzed the data on patients enrolled in Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry in Michigan (January 1, 2010 to March 31, 2018) to evaluate the association of operator and hospital experience with procedural success and outcomes of patients undergoing CTO-PCI. CTO-PCI was defined as intervention of a 100% occluded coronary artery presumed to be ≥3 months old.
Results:
Among 210 172 patients enrolled in the registry, 7389 (3.5%) CTO-PCIs were attempted with a success rate of 53%. CTO-PCI success increased with operator experience (45% and 65% in the lowest and highest experience tertiles) and was the highest for highly experienced operators at higher experience centers and the lowest for inexperienced operators at low experience hospitals. Multivariable logistic regression models (with spline transformed prior operator and institutional experience) demonstrated a positive relationship between prior operator and site experience and procedural success rates (likelihood ratio test=141.12, df=15,
P
<0.001) but no relationship between operator and site experience and major adverse cardiac event (likelihood ratio test=19.12, df=15,
P
=0.208).
Conclusions:
Operator and hospital CTO-PCI experiences were directly related to procedural success but were not related to major adverse cardiac event among patients undergoing CTO-PCIs. Inexperienced operators at high experience centers had significantly higher success but not major adverse cardiac event rates compared with inexperienced operators at low experience centers. These data suggested that CTO-PCI safety and success could potentially be improved by selective referral of these procedures to experienced operators working at highly experienced centers.
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Affiliation(s)
- Rami Zein
- Ascension St. John Hospital, Detroit, MI (R.Z., H.O., H.S.R., T.L., E.D.)
| | - Milan Seth
- University of Michigan, Ann Arbor, MI (M.S., D.M., H.S.G.)
| | - Hussein Othman
- Ascension St. John Hospital, Detroit, MI (R.Z., H.O., H.S.R., T.L., E.D.)
| | - Howard S. Rosman
- Ascension St. John Hospital, Detroit, MI (R.Z., H.O., H.S.R., T.L., E.D.)
| | - Thomas Lalonde
- Ascension St. John Hospital, Detroit, MI (R.Z., H.O., H.S.R., T.L., E.D.)
| | | | - Daniel Menees
- University of Michigan, Ann Arbor, MI (M.S., D.M., H.S.G.)
| | - Edouard Daher
- Ascension St. John Hospital, Detroit, MI (R.Z., H.O., H.S.R., T.L., E.D.)
| | - Rajendra H. Mehta
- Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M.). On Behalf of Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Investigators
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14
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Mauro C, Vriz O, Romano L, Citro R, Russo V, Ranieri B, Alamro B, Aladmawi M, Granata R, Galzerano D, Bellino M, Cocchia R, Mehta RM, Dellegrottaglie S, Alsergani H, Mehta RH, Bossone E. Imaging Cardiovascular Emergencies: Real World Clinical Cases. Heart Fail Clin 2020; 16:331-346. [PMID: 32503756 DOI: 10.1016/j.hfc.2020.03.003] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Cardiovascular emergencies represent life-threatening conditions requiring a high index of clinical suspicion. In an emergency scenario, a simple stepwise biomarker/imaging diagnostic algorithm may help prompt diagnosis and timely treatment along with related improved outcomes. This article describes several clinical cases of cardiovascular emergencies, such as coronary stent thrombosis-restenosis, takotsubo syndrome, acute myocarditis, massive pulmonary embolism, type A acute aortic dissection, cardiac tamponade, and endocarditis.
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Affiliation(s)
- Ciro Mauro
- Cardiology Division, A Cardarelli Hospital, Via Cardarelli 9, Naples I-80131, Italy
| | - Olga Vriz
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Luigia Romano
- Department of General and Emergency Radiology, A Cardarelli Hospital, Via Cardarelli 9, Naples I-80131, Italy
| | - Rodolfo Citro
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Largo Città d'Ippocrate, Salerno 84131, Italy
| | - Valentina Russo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, Naples I-80131, Italy
| | | | - Bandar Alamro
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Mohammed Aladmawi
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Riccardo Granata
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, Naples I-80131, Italy
| | - Domenico Galzerano
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Michele Bellino
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Largo Città d'Ippocrate, Salerno 84131, Italy
| | - Rosangela Cocchia
- Division of Cardiac Rehabilitation - Echo Lab, A Cardarelli Hospital, Naples, Italy
| | - Rahul M Mehta
- ProMedica Monroe Regional Hospital, 718 North Macomb Street, Monroe, MI 48162, USA
| | - Santo Dellegrottaglie
- Division of Cardiology, Clinica Villa dei Fiori, C.so Italia 157, 80011, Acerra, Naples, Italy
| | - Hani Alsergani
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Durham, 300 West Morgan Street, Durham, NC 27701, USA
| | - Eduardo Bossone
- Division of Cardiac Rehabilitation - Echo Lab, A Cardarelli Hospital, Naples, Italy.
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15
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Othman H, Seth M, Zein R, Rosman H, Lalonde T, Yamasaki H, Alaswad K, Menees D, Mehta RH, Gurm H, Daher E. Percutaneous Coronary Intervention for Chronic Total Occlusion—The Michigan Experience. JACC Cardiovasc Interv 2020; 13:1357-1368. [DOI: 10.1016/j.jcin.2020.02.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/27/2020] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
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16
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Edla S, Atti V, Kumar V, Tripathi B, Neupane S, Nalluri N, Abela G, Rosman H, Mehta RH. Comparison of nationwide trends in 30-day readmission rates after carotid artery stenting and carotid endarterectomy. J Vasc Surg 2020; 71:1222-1232.e9. [DOI: 10.1016/j.jvs.2019.06.190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/02/2019] [Indexed: 11/28/2022]
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17
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Fanaroff AC, Clare R, Pieper KS, Mahaffey KW, Melloni C, Green JB, Alexander JH, Jones WS, Harrison RW, Mehta RH, Povsic TJ, Moreira HG, Al-Khatib SM, Roe MT, Kong DF, Mathews R, Tricoci P, Holman RR, Wallentin L, Held C, Califf RM, Alexander KP, Lopes RD. Frequency, Regional Variation, and Predictors of Undetermined Cause of Death in Cardiometabolic Clinical Trials: A Pooled Analysis of 9259 Deaths in 9 Trials. Circulation 2019; 139:863-873. [PMID: 30586739 DOI: 10.1161/circulationaha.118.037202] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Modern cardiometabolic clinical trials often include cardiovascular death as a component of a composite primary outcome, requiring central adjudication by a clinical events committee to classify cause of death. However, sometimes the cause of death cannot be determined from available data. The US Food and Drug Administration has indicated that this circumstance should occur only rarely, but its prevalence has not been formally assessed. METHODS Data from 9 global clinical trials (2009-2017) with long-term follow-up and blinded, centrally adjudicated cause of death were used to calculate the proportion of deaths attributed to cardiovascular, noncardiovascular, or undetermined causes by therapeutic area (diabetes mellitus/pre-diabetes mellitus, stable atherosclerosis, atrial fibrillation, and acute coronary syndrome), region of patient enrollment, and year of trial manuscript publication. Patient- and trial-level variables associated with undetermined cause of death were identified using a logistic model. RESULTS Across 127 049 enrolled participants from 9 trials, there were 9259 centrally adjudicated deaths: 5012 (54.1%) attributable to cardiovascular causes, 2800 (30.2%) attributable to noncardiovascular causes, and 1447 (15.6%) attributable to undetermined causes. There was variability in the proportion of deaths ascribed to undetermined causes by trial therapeutic area, region of enrollment, and year of trial manuscript publication. On multivariable analysis, acute coronary syndrome or atrial fibrillation trial (versus atherosclerotic vascular disease or diabetes mellitus/pre-diabetes mellitus), longer time from enrollment to death, more recent trial manuscript publication year, enrollment in North America (versus Western Europe), female sex, and older age were associated with greater likelihood of death of undetermined cause. CONCLUSIONS In 9 cardiometabolic clinical trials with long-term follow-up, approximately 16% of deaths had undetermined causes. This provides a baseline for quality assessment of clinical trials and informs operational efforts to potentially reduce the frequency of undetermined deaths in future clinical research.
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Affiliation(s)
- Alexander C Fanaroff
- Division of Cardiology (A.C.F., C.M., J.H.A., W.S.J., R.W.H., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
| | - Robert Clare
- Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
| | - Karen S Pieper
- Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.)
| | - Chiara Melloni
- Division of Cardiology (A.C.F., C.M., J.H.A., W.S.J., R.W.H., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
| | - Jennifer B Green
- Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Division of Endocrinology (J.B.G.), Duke University School of Medicine, Durham, NC
| | - John H Alexander
- Division of Cardiology (A.C.F., C.M., J.H.A., W.S.J., R.W.H., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
| | - W Schuyler Jones
- Division of Cardiology (A.C.F., C.M., J.H.A., W.S.J., R.W.H., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
| | - Robert W Harrison
- Division of Cardiology (A.C.F., C.M., J.H.A., W.S.J., R.W.H., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
| | - Rajendra H Mehta
- Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
| | - Thomas J Povsic
- Division of Cardiology (A.C.F., C.M., J.H.A., W.S.J., R.W.H., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
| | - Humberto G Moreira
- Heart Institute (InCor), University of São Paulo Medical School, Brazil (H.G.M.)
| | - Sana M Al-Khatib
- Division of Cardiology (A.C.F., C.M., J.H.A., W.S.J., R.W.H., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
| | - Matthew T Roe
- Division of Cardiology (A.C.F., C.M., J.H.A., W.S.J., R.W.H., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
| | - David F Kong
- Division of Cardiology (A.C.F., C.M., J.H.A., W.S.J., R.W.H., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
| | - Robin Mathews
- Division of Cardiology (A.C.F., C.M., J.H.A., W.S.J., R.W.H., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
| | | | - Rury R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, United Kingdom (R.R.H)
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Institute, Uppsala University, Sweden (L.W., C.H.)
| | - Claes Held
- Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Institute, Uppsala University, Sweden (L.W., C.H.)
| | - Robert M Califf
- Division of Cardiology (A.C.F., C.M., J.H.A., W.S.J., R.W.H., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Verily Life Sciences, South San Francisco, CA (R.M.C.)
| | - Karen P Alexander
- Division of Cardiology (A.C.F., C.M., J.H.A., W.S.J., R.W.H., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
| | - Renato D Lopes
- Division of Cardiology (A.C.F., C.M., J.H.A., W.S.J., R.W.H., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC.,Duke Clinical Research Institute (A.C.F. R.C., K.S.P., C.M., J.B.G., J.H.A., W.S.J., R.W.H., R.H.M., T.J.P., S.M.A-K., M.T.R., D.F.K., R.M., R.M.C., K.P.A., R.D.L.), Duke University School of Medicine, Durham, NC
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Vora AN, Alexander JH, Wojdyla DM, Aronson R, Granger CB, Darius H, Windecker S, Mehran R, Averkov O, Budaj A, Kong DF, Kobalava Z, Mehta RH, Mirza Z, Guimaraes PO, Parkhomenko A, Quadros A, Thiele H, Goodman SG, Lopes RD. Hospitalization Among Patients With Atrial Fibrillation and a Recent Acute Coronary Syndrome or Percutaneous Coronary Intervention Treated With Apixaban or Aspirin: Insights From the AUGUSTUS Trial. Circulation 2019; 140:1960-1963. [PMID: 31553201 DOI: 10.1161/circulationaha.119.043754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amit N Vora
- UPMC Pinnacle, Harrisburg, PA (A.N.V.).,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.N.V., J.H.A., D.M.W., C.B.G., D.F.K., R.H.M., R.D.L.)
| | - John H Alexander
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.N.V., J.H.A., D.M.W., C.B.G., D.F.K., R.H.M., R.D.L.)
| | - Daniel M Wojdyla
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.N.V., J.H.A., D.M.W., C.B.G., D.F.K., R.H.M., R.D.L.)
| | | | - Christopher B Granger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.N.V., J.H.A., D.M.W., C.B.G., D.F.K., R.H.M., R.D.L.)
| | - Harald Darius
- Vivantes Neukoelln Medical Center, Berlin, Germany (H.D.)
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (S.W.)
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, and Cardiovascular Research Foundation, New York (R.M.)
| | - Oleg Averkov
- Pirogov Russian National Research Medical University, Moscow (O.A.)
| | - Andrzej Budaj
- Department of Cardiology, Grochowski Hospital, Warsaw, Poland (A.B.)
| | - David F Kong
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.N.V., J.H.A., D.M.W., C.B.G., D.F.K., R.H.M., R.D.L.)
| | | | - Rajendra H Mehta
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.N.V., J.H.A., D.M.W., C.B.G., D.F.K., R.H.M., R.D.L.)
| | | | | | | | - Alexandre Quadros
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil (A.Q.)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Germany (H.T.)
| | - Shaun G Goodman
- Canadian VIGOUR Center, University of Alberta, Edmonton (S.G.G.).,Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, ON, Canada (S.G.G.)
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.N.V., J.H.A., D.M.W., C.B.G., D.F.K., R.H.M., R.D.L.)
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van Diepen S, Mehta RH, Leimberger JD, Goodman SG, Fremes S, Jankowich R, Heringlake M, Anstrom KJ, Levy JH, Luber J, Nagpal AD, Duncan AE, Argenziano M, Toller W, Teoh K, Knight JD, Lopes RD, Cowper PA, Mark DB, Alexander JH. Levosimendan in patients with reduced left ventricular function undergoing isolated coronary or valve surgery. J Thorac Cardiovasc Surg 2019; 159:2302-2309.e6. [PMID: 31358329 DOI: 10.1016/j.jtcvs.2019.06.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 07/03/2018] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In the Levosimendan in Patients with Left Ventricular Systolic Dysfunction Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass (LEVO-CTS) trial, no differences in clinical outcomes were observed between levosimendan and placebo in a broad population of patients undergoing cardiac surgery. In previous studies, the benefits of levosimendan were most clearly evident in patients undergoing isolated coronary artery bypass grafting (CABG) surgery. In a prespecified analysis of LEVO-CTS, we compared treatment-related outcomes and costs across types of cardiac surgical procedures. METHODS Overall, 563 (66.4%) patients underwent isolated CABG, 97 (11.4%) isolated valve, and 188 (22.2%) combined CABG/valve surgery. Outcomes included the co-primary 4-component composite (30-day mortality, 30-day renal replacement, 5-day myocardial infarction, or 5-day mechanical circulatory support), the 2-component composite (30-day mortality or 5-day mechanical circulatory support), 90-day mortality, low cardiac output syndrome (LCOS), and 30-day medical costs. RESULTS The 4- and 2-component outcomes were not significantly different with levosimendan and placebo in patients undergoing CABG (15.2% vs 19.3% and 7.8% vs 10.4%), valve (49.0% vs 33.3% and 22.4% vs 2.1%), or combined procedures (39.6% vs 35.9% and 24.0% vs 19.6%). Ninety-day mortality was lower with levosimendan in isolated CABG (2.1% vs 7.9%; hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.11-0.64), but not significantly different in valve (8.3% vs 2.0%; HR, 4.10; 95% CI, 0.46-36.72) or combined procedures (10.4% vs 7.6%; HR, 1.39; 95% CI, 0.53-3.64; interaction P = .011). LCOS (12.0% vs 22.1%; odds ratio, 0.48; 95% CI, 0.30-0.76; interaction P = .118) was significantly lower in levosimendan-treated patients undergoing isolated CABG. Excluding study drug costs, median and mean 30-day costs were $53,707 and $65,852 for levosimendan and $54,636 and $67,122 for placebo, with a 30-day mean difference (levosimendan - placebo) of -$1270 (bootstrap 95% CI, -$8722 to $6165). CONCLUSIONS Levosimendan was associated with lower 90-day mortality and LCOS in patients undergoing isolated CABG, but not in those undergoing isolated valve or combined CABG/valve procedures.
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Affiliation(s)
- Sean van Diepen
- Division of Cardiology, Departments of Critical Care and Medicine, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada.
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Jeffrey D Leimberger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Shaun G Goodman
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada; Terrence Donnelly Heart Centre, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Fremes
- Schulich Heart Center, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Kevin J Anstrom
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Jerrold H Levy
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - A Dave Nagpal
- London Health Sciences Centre, London, Ontario, Canada
| | | | | | | | - Kevin Teoh
- Southlake Regional Health Center, Newmarket, Ontario, Canada
| | - J David Knight
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Patricia A Cowper
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Daniel B Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - John H Alexander
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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20
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Patel VH, Vendittelli P, Garg R, Szpunar S, LaLonde T, Lee J, Rosman H, Mehta RH, Othman H. Neutrophil-lymphocyte ratio: A prognostic tool in patients with in-hospital cardiac arrest. World J Crit Care Med 2019; 8:9-17. [PMID: 30815378 PMCID: PMC6388309 DOI: 10.5492/wjccm.v8.i2.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/24/2019] [Accepted: 01/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation (ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient’s prognosis. The neutrophil-lymphocyte ratio (NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with IHCA.
AIM To determine the prognostic significance of NLR in patients suffering IHCA who achieve ROSC.
METHODS A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value (NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis (area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and 42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came first.
RESULTS We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were female. In-hospital mortality occurred in 65%. The median NLR in survivors was 4.9 (range 0.6-46.5) compared with 8.9 (0.28-96) in non-survivors (P = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55 [odds ratio (OR) = 5.20, confidence interval (CI): 1.5-18.3, P = 0.01], older age (OR = 1.03, CI: 1.00-1.07, P = 0.05), and elevated serum lactate level (OR = 1.20, CI: 1.03-1.40, P = 0.02) were independent predictors of death.
CONCLUSION An NLR ≥ 4.5 may be a useful marker of increased risk of death in patients with IHCA.
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Affiliation(s)
- Vishal H Patel
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Philip Vendittelli
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Rajat Garg
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44915, United States
| | - Susan Szpunar
- Department of Biomedical Investigations and Research, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Thomas LaLonde
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - John Lee
- Department of Critical Care Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Howard Rosman
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 22705, United States
| | - Hussein Othman
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
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Eggebrecht H, Mehta RH. Transcatheter aortic valve implantation (TAVI) in Germany: more than 100,000 procedures and now the standard of care for the elderly. EUROINTERVENTION 2019; 14:e1549-e1552. [DOI: 10.4244/eij-d-18-01010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Neupane S, Khawaja O, Edla S, Singh H, Othman H, Bossone E, Yamasaki H, Rosman HS, Eggebrecht H, Mehta RH. Meta-analysis of drug eluting stents compared with bare metal stents in high bleeding risk patients undergoing percutaneous coronary interventions. Catheter Cardiovasc Interv 2018; 94:98-104. [DOI: 10.1002/ccd.28045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 09/08/2018] [Revised: 11/03/2018] [Accepted: 12/01/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Saroj Neupane
- Division of Cardiology, Department of Internal Medicine; Henry Ford Hospital; Detroit Michigan
| | - Owais Khawaja
- Division of Cardiology, Department of Internal Medicine; St John Hospital and Medical Center; Detroit Michigan
| | - Sushruth Edla
- Division of Cardiology, Department of Internal Medicine; St John Hospital and Medical Center; Detroit Michigan
| | - Hemindermeet Singh
- Cardiovascular Fellowship Program; Mercy-Health St Vincent Medical Center; Toledo Ohio
| | - Hussein Othman
- Division of Cardiology, Department of Internal Medicine; St John Hospital and Medical Center; Detroit Michigan
| | - Eduardo Bossone
- Cava de' Tirreni and Amalfi Coast Hospital; University of Salerno; Amalfi Italy
| | - Hiroshi Yamasaki
- Division of Cardiology, Department of Internal Medicine; St John Hospital and Medical Center; Detroit Michigan
| | - Howard S. Rosman
- Division of Cardiology, Department of Internal Medicine; St John Hospital and Medical Center; Detroit Michigan
| | - Holger Eggebrecht
- Cardioangiological Center Bethanien (CCB) and AGAPLESION Bethanien Hospital; Frankfurt Germany
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Eggebrecht H, Bestehorn K, Mehta RH. Reply to the letter to the editor by Doshi regarding the article "In-hospital outcomes after transcatheter or surgical aortic valve replacement in younger patients less than 75 years old: a propensity-matched comparison". EUROINTERVENTION 2018; 14:e486. [PMID: 30028305 DOI: 10.4244/eij-d-18-00236r] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Holger Eggebrecht
- Cardioangiologisches Centrum Bethanien (CCB) and AGAPLESION Bethanien Hospital, Frankfurt, Germany
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Neupane S, Singh H, Lämmer J, Othman H, Yamasaki H, Rosman HS, Bossone E, Mehta RH, Eggebrecht H. Meta-Analysis of Transcatheter Valve-in-Valve Implantation Versus Redo Aortic Valve Surgery for Bioprosthetic Aortic Valve Dysfunction. Am J Cardiol 2018; 121:1593-1600. [PMID: 29776652 DOI: 10.1016/j.amjcard.2018.02.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 10/17/2022]
Abstract
Transcatheter valve-in-valve implantation (ViV-TAVI) has evolved as an alternative to redo surgical valve replacement (redo-SAVR) for high-risk patients with aortic bioprosthetic valve (BPV) dysfunction. The differences in procedural success and outcomes in a large number of patients who underwent ViV-TAVI compared with redo-SAVR for aortic BPV dysfunction are not known. We conducted a meta-analysis of the previously reported studies to determine outcomes after ViV-TAVI and redo-SAVR. PubMed, MEDLINE, and Google Scholar databases were searched for studies that reported comparative outcomes of patients who underwent either ViV-TAVI or redo-SAVR. Four observational studies met the inclusion criteria, with a total of 489 patients, 227 of whom underwent ViV-TAVI and 262 underwent redo-SAVR. Thirty-day mortality was similar in 2 groups (5% vs 4%; odds ratio [OR] = 1.08, 95% confidence interval [CI] = 0.44 to 2.62) despite the higher operative risk in the ViV-TAVI cohort as evidenced by significantly higher EuroSCORE I or II. There were similar rates of stroke (2% vs 2%; OR = 1.00, 95% CI = 0.28 to 3.59), myocardial infarction (2% vs 1%; OR = 1.08, 95% CI = 0.27 to 4.33), and acute kidney injury requiring dialysis (7% vs 10%; OR = 0.80, 95% CI = 0.36 to 0.1.77) between 2 groups but a lower rate of permanent pacemaker implantation in the ViV-TAVI group (9% vs 15%; OR = 0.44, 95% CI = 0.24 to 0.81). This meta-analysis of nonrandomized studies with modest number of patients suggested that ViV-TAVI had similar 30-day survival compared with redo-SAVR for aortic BPV dysfunction.
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Eggebrecht H, Bestehorn K, Rassaf T, Bestehorn M, Voigtländer T, Fleck E, Schächinger V, Schmermund A, Mehta RH. In-hospital outcomes after transcatheter or surgical aortic valve replacement in younger patients less than 75 years old: a propensity-matched comparison. EUROINTERVENTION 2018; 14:50-57. [DOI: 10.4244/eij-d-17-01051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Edla S, Rosman H, Neupane S, Boshara A, Szpunar S, Daher E, Rodriguez D, LaLonde T, Yamasaki H, Mehta RH, Attallah A. Early Versus Delayed Use of Ultrasound-Assisted Catheter-Directed Thrombolysis in Patients With Acute Submassive Pulmonary Embolism. J Invasive Cardiol 2018; 30:157-162. [PMID: 29715164] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The effect of early vs delayed use of ultrasound-assisted catheter-directed thrombolysis (USAT) on invasive hemodynamics and in-hospital outcomes in patients with acute submassive pulmonary embolism (PE) is not well known. METHODS We evaluated 41 patients with submassive PE to study the association of early USAT (≤24 hours; n = 21) vs delayed USAT (>24 hours; n = 20) with change in invasive hemodynamic measures from pre USAT to post USAT. RESULTS Significantly greater improvement was observed in the early USAT group compared to the delayed group for median cardiac index (0.6 L/min/m² [IQR, 0.4-1.1 L/min/ m²] vs 0.4 L/min/m² [IQR, 0.1-0.6 L/min/m²]; P=.03), median pulmonary vascular resistance (3.4 Wood units [IQR, 2.5-4.1 Wood units] vs 0.5 Wood units [IQR, 0.2-1.3 Wood units]; P<.001), and mean right ventricular stroke work index (3.5 ± 2.0 g-m/m²/beat vs 2.3 ± 1.6 g-m/m2/beat; P=.04). Although not statistically significant, a trend in favor of early treatment was found for improvement in mean right ventricle to left ventricle diameter ratio (0.38 ± 0.17 vs 0.33 ± 0.21; P=.40), mean pulmonary artery pressure (8.4 ± 7.1 mm Hg vs 5.3 ± 5.2 mm Hg; P=.13), and median pulmonary artery pulsatility index (1.14 [IQR, 2.01-0.45] vs 0.65 [IQR, 0.22-1.78]; P=.49). The mean postprocedural length of stay was significantly lower in the early-USAT group (6.0 ± 2.7 days vs 10.1 ± 7.0 days; P=.02). Three patients experienced moderate bleeding (2 patients in the early-USAT group and 1 patient in the delayed-USAT group) and no major bleeds or in-hospital mortality occurred. CONCLUSION Early USAT was associated with greater improvement in pulmonary hemodynamics and shorter postprocedural length of stay compared with delayed USAT in patients with acute submassive PE.
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Affiliation(s)
- Sushruth Edla
- VEP, 2nd Floor Cath Lab, 22101 Moross Road, Detroit, MI 48236 USA.
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Neupane S, Edla S, Maidona E, Sweet MC, Szpunar S, Davis T, LaLonde TA, Mehta RH, Rosman HS, Yamasaki H. Long-term outcomes of patients with diabetes mellitus undergoing percutaneous intervention for popliteal and infrapopliteal peripheral arterial disease. Catheter Cardiovasc Interv 2018. [DOI: 10.1002/ccd.27571] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Saroj Neupane
- Division of Cardiology; St John Hospital and Medical Center; Detroit Michigan
| | - Sushruth Edla
- Division of Cardiology; St John Hospital and Medical Center; Detroit Michigan
| | - Eesha Maidona
- Division of Cardiology; St John Hospital and Medical Center; Detroit Michigan
| | | | - Susan Szpunar
- Medical Education, St John Hospital and Medical Center; Detroit Michigan
| | - Thomas Davis
- Division of Cardiology; St John Hospital and Medical Center; Detroit Michigan
| | - Thomas A. LaLonde
- Division of Cardiology; St John Hospital and Medical Center; Detroit Michigan
| | | | - Howard S. Rosman
- Division of Cardiology; St John Hospital and Medical Center; Detroit Michigan
| | - Hiroshi Yamasaki
- Division of Cardiology; St John Hospital and Medical Center; Detroit Michigan
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Eggebrecht H, Mehta RH, Lubos E, Boekstegers P, Schofer J, Sievert H, Ouarrak T, Senges J, Schillinger W, Schmermund A. MitraClip in High- Versus Low-Volume Centers. JACC Cardiovasc Interv 2018; 11:320-322. [DOI: 10.1016/j.jcin.2017.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/05/2017] [Indexed: 11/27/2022]
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Ambulgekar NV, Grey SF, Rosman HS, Othman H, Davis TP, Nypaver TJ, Schreiber T, Yamasaki H, Lalonde TA, Henke PK, Gurm HS, Mehta RH, Grossman PM. Association of Anemia With Outcomes in Patients Undergoing Percutaneous Peripheral Vascular Intervention: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2 VIC). J Invasive Cardiol 2018; 30:35-42. [PMID: 29289948] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the clinical features and outcomes of patients with anemia undergoing percutaneous peripheral vascular intervention (PVI) in a contemporary registry. METHODS We evaluated the differences in the clinical features and outcomes of patients with and without anemia undergoing PVI in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2 VIC) registry. Anemia was defined using World Health Organization criteria. RESULTS Baseline anemia was present in 42.3% of 15,683 patients undergoing PVI. Compared to patients without anemia, those with anemia were older (mean age, 67 years vs 71 years), were more often black (16% vs 29%), and had higher comorbidities. Anemic patients were twice as likely to present with acute limb ischemia (5% vs 11%) and undergo urgent PVI (6% vs 15%) or below-the-knee PVI (18% vs 35%). Many in-hospital adverse events were higher in anemic patients. In a propensity-matched cohort, any adverse outcome (3.4% vs 8.4%; odds ratio [OR], 2.58; 95% confidence interval [CI], 1.94-3.42) or major cardiovascular event, defined as death, myocardial infarction, stroke, or amputation (1.1% vs 3.2%; OR, 2.96; 95% CI, 1.83-4.79) was more likely in anemic patients. Of all adverse events, the highest odds were observed for post-PVI transfusions and amputations in anemic patients. Multivariable logistic regression showed that baseline hemoglobin (1 g/dL below the normal value) was associated with greater risk of any adverse event (OR, 1.57; 95% CI, 1.47-1.68). CONCLUSION The prevalence of anemia was high among PVI patients and was associated with significantly greater likelihood of amputation, any adverse event, and major cardiovascular events. Whether preprocedure correction of anemia has the potential to decrease post-PVI adverse events remains to be studied.
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Affiliation(s)
| | | | | | - Hussein Othman
- St. John Hospital and Medical Center, 22101 Moross Road, Van Elslander Pavilion, 2nd Floor, Department of Cardiology, Detroit, MI 48236 USA.
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Eggebrecht H, Vaquerizo B, Moris C, Bossone E, Lämmer J, Czerny M, Zierer A, Schröfel H, Kim WK, Walther T, Scholtz S, Rudolph T, Hengstenberg C, Kempfert J, Spaziano M, Lefevre T, Bleiziffer S, Schofer J, Mehilli J, Seiffert M, Naber C, Biancari F, Eckner D, Cornet C, Lhermusier T, Philippart R, Siljander A, Giuseppe Cerillo A, Blackman D, Chieffo A, Kahlert P, Czerwinska-Jelonkiewicz K, Szymanski P, Landes U, Kornowski R, D’Onofrio A, Kaulfersch C, Søndergaard L, Mylotte D, Mehta RH, De Backer O. Incidence and outcomes of emergent cardiac surgery during transfemoral transcatheter aortic valve implantation (TAVI): insights from the European Registry on Emergent Cardiac Surgery during TAVI (EuRECS-TAVI). Eur Heart J 2017; 39:676-684. [DOI: 10.1093/eurheartj/ehx713] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [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: 06/15/2017] [Accepted: 11/24/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Holger Eggebrecht
- Department of Cardiology, Cardioangiologisches Centrum Bethanien (CCB) at the AGAPLESION Bethanien Hospital, Im Prüfling 21-25, 60389 Frankfurt, Germany
- Department of Cardiology, Herz- Thorax- Zentrum, Klinikum Fulda, Pacelliallee 4, 36043 Fulda, Germany
| | - Beatriz Vaquerizo
- Unidad de Cardiología Intervencionista, Departamento de Cardiología, Hospital del Mar, Passeig Marítim 25/29, 08003 Barcelona, Spain
| | - Cesar Moris
- Área del Corazón, Hospital Universitario Central de Asturias, Roma s/n, 33011 Oviedo, Asturias, Spain
| | - Eduardo Bossone
- Cardiology Division “Cava de'Tirreni and Amalfi Coast” Heart Department, University Hospital, Via de Marinis 4, 84013 Cava de'Tirreni, Italy
| | - Johannes Lämmer
- Department of Cardiology, Cardioangiologisches Centrum Bethanien (CCB) at the AGAPLESION Bethanien Hospital, Im Prüfling 21-25, 60389 Frankfurt, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Andreas Zierer
- Department of Thoracic and Cardiovascular Surgery, Kepler University Hospital, Krankenhausstr. 9, 4021 Linz, Austria
| | - Holger Schröfel
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Thomas Walther
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Smita Scholtz
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Tanja Rudolph
- Department of Cardiology, Heart Center, University of Cologne, Medizinische Klinik III, Kerpener Str. 3, 50937 Cologne, Germany
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Jörg Kempfert
- Department of Cardiac Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Marco Spaziano
- Department of Cardiology, Générale de Santé, Institut Cardiovasculaire Paris-Sud - Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Thierry Lefevre
- Department of Cardiology, Générale de Santé, Institut Cardiovasculaire Paris-Sud - Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Sabine Bleiziffer
- Department of Cardiovascular Surgery, German Heart Center, Technical University Munich, Lazarettstr. 36, 80636 Munich, Germany
| | - Joachim Schofer
- Medicare Center and Department for Percutaneous Treatment of Structural Heart Disease, Albertinen Heart Center, Wördemannsweg 25-27, 22527 Hamburg, Germany
| | - Julinda Mehilli
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University Munich and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Moritz Seiffert
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany
| | - Christoph Naber
- Department of Cardiology, Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45134 Essen, Germany
| | - Fausto Biancari
- Department of Cardiology, University of Oulu and Heart Center, University of Turku, Hämeentie 11 P.O. Box 52, 20521 Turku, Finland
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nuernberg, General Hospital Nuernberg, Medizinische Klinik 8, Breslauer Str. 201, 90471 Nürnberg, Germany
| | - Charles Cornet
- Cardiology Department. Interventional Cardiology Unit. University Hospital of Angers, 4 rue Larry, 49000 Angers, France
| | - Thibault Lhermusier
- Department of Cardiology, Toulouse Rangueil Hospital, Toulouse University School of Medicine, 1, Professeur Jean Poulhes Avenue, 31059 Toulouse, France
| | - Raphael Philippart
- Groupe Cardio-Vasculaire Interventionnel Clinique Pasteur, 45 avenue de Lombez BP 27617, 31076 Toulouse, France
| | - Antti Siljander
- Department of Cardiology, Kuopio University Hospital Heart Center, PL 100, 70029 KYS Kuopio, Finland
| | - Alfredo Giuseppe Cerillo
- UO Cardiochirurgia Ospedale del Cuore G. Pasquinucci Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100 Mass, Italy
| | - Daniel Blackman
- Department of Cardiology, Leeds Teaching Hospitals, LS23 6AL Leeds, UK
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Hospital, Olgettina Street 60, 20132 Milan, Italy
| | - Philipp Kahlert
- Department of Cardiology, West German Heart and Vascular Center, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | | | - Piotr Szymanski
- Valvular Heart Disease Department, National Institute of Cardiology, Alpejske 42, 06-628 Warsaw, Poland
| | - Uri Landes
- Cardiology Department, Rabin Medical Center and the “Sackler” Faculty of Medicine, Tel-Aviv University, Jabotinski St. 29, 39100 Petah-Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center and the “Sackler” Faculty of Medicine, Tel-Aviv University, Jabotinski St. 29, 39100 Petah-Tikva, Israel
| | - Augusto D’Onofrio
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, Azienda Ospedaliera-University of Padova, 2 Via Nicolò Giustiniani, 35128 Padova, Italy
| | - Carl Kaulfersch
- Department of Cardiology, Klinikum Klagenfurt, Sankt Veiter Straβe 47, Klagenfurt am Wörthersee, Austria
| | - Lars Søndergaard
- The Heart Center, Department of Cardiology Rigshospitalet University of Copenhagen, Blegdamsvej 9, 2200 Copenhagen, Denmark
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Rajendra H Mehta
- Department of Internal Medicine Division of Cardiology Duke University Medical Center and Duke Clinical Research Institute, 2400 Pratt Street Durham NC 27715, Durham, NC, USA
| | - Ole De Backer
- The Heart Center, Department of Cardiology Rigshospitalet University of Copenhagen, Blegdamsvej 9, 2200 Copenhagen, Denmark
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Zaitoun A, Al-Najafi S, Musa T, Szpunar S, Light D, Lalonde T, Yamasaki H, Mehta RH, Rosman HS. The association of race with quality of health in peripheral artery disease following peripheral vascular intervention: The Q-PAD Study. Vasc Med 2017; 22:498-504. [PMID: 28980511 DOI: 10.1177/1358863x17733065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Black patients have a higher prevalence of peripheral artery disease (PAD) than white patients, and also tend to have a greater extent and severity of disease, and poorer outcomes. The association of race with quality of health (QOH) after peripheral vascular intervention (PVI), however, is less well-known. In our study, we hypothesized that after PVI, black patients experience worse QOH than white patients. We retrospectively assessed racial differences in health status using responses to the Peripheral Arterial Questionnaire (PAQ) at baseline (pre-PVI) and up to 6 months following PVI among 387 patients. We used the PAQ summary score (which includes physical limitation, symptoms, social function and quality of life) as a measure of QOH. We compared QOH scores at baseline and at follow-up after PVI between black ( n=132, 34.1%) and white ( n=255, 65.9%) patients. We then computed the change in score from baseline to follow-up for each patient (the delta) and compared the median delta between the two groups. Multivariable regression was used to model the delta QOH after controlling for factors associated with race or with the delta QOH. There was no significant difference in mean QOH by race either at baseline ( p=0.09) or at follow-up ( p=0.45). There was no significant difference in the unadjusted median delta by race (white 25.3 vs black 21.5, p=0.28) and QOH scores improved significantly at follow-up in both groups, albeit the improvement was marginally lower in black compared with white patients after adjustment for baseline confounders ( b = -6.6, p=0.05, 95% CI -13.2, -0.11).
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Affiliation(s)
- Anwar Zaitoun
- 1 Division of Cardiology, St John Hospital and Medical Center, Detroit, MI, USA
| | - Saif Al-Najafi
- 2 Division of Cardiology, Rush University Hospital, Chicago, IL, USA
| | - Thaer Musa
- 3 Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Susan Szpunar
- 4 Department of Medical Education, St John Hospital and Medical Center, Detroit, MI, USA
| | - Dawn Light
- 1 Division of Cardiology, St John Hospital and Medical Center, Detroit, MI, USA
| | - Thomas Lalonde
- 1 Division of Cardiology, St John Hospital and Medical Center, Detroit, MI, USA
| | - Hiroshi Yamasaki
- 1 Division of Cardiology, St John Hospital and Medical Center, Detroit, MI, USA
| | | | - Howard S Rosman
- 1 Division of Cardiology, St John Hospital and Medical Center, Detroit, MI, USA
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Nowak B, Misselwitz B, Przibille O, Mehta RH. Pacemaker implantation and mortality: no role as a quality control indicator: Author's reply. Europace 2017; 19:1587. [PMID: 28934411 DOI: 10.1093/europace/eux270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bernd Nowak
- CCB, Cardioangiologisches Centrum Bethanien, Im Pruefling 23, D-60389, Frankfurt am Main, Germany
| | | | - Oliver Przibille
- CCB, Cardioangiologisches Centrum Bethanien, Im Pruefling 23, D-60389, Frankfurt am Main, Germany
| | - Rajendra H Mehta
- Duke Clinical Research Institute and, Duke University Medical Center, Durham, NC, USA
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Jalal S, Mustapha JA, Rosman HS, Mehta RH, Davis TP. Distal Cuff Occlusion: A Novel, Simple Approach for Distal Embolic Protection in Peripheral Vascular Intervention. J Invasive Cardiol 2017; 29:297-300. [PMID: 28878099] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To evaluate the feasibility, effectiveness, and safety of the cuff-occlusion method for distal embolic protection in peripheral artery disease. METHODS AND RESULTS We evaluated 61 patients who underwent peripheral vascular intervention (PVI) for infrainguinal lesion at a single center where a blood pressure cuff occlusion method for distal embolic protection was utilized during the procedure. Primary endpoint included incidence of distal embolization, acute limb ischemia, or emergency limb amputation. Safety endpoints were freedom from bleeding, vessel perforation, or dissection. Lesion location was in the superficial femoral artery in 39% of cases and popliteal and infrapopliteal in 61% of patients. Procedural success was achieved in 98.4% of patients and 1 patient had distal embolization. There was no bleeding or perforation or major flow-limiting vessel dissection. CONCLUSION Our study demonstrated that the cuff-occlusion strategy was feasible and safe for protection form distal embolization in PVI. Further study is required to evaluate the efficacy and safety of this novel method compared with existing devices for distal protection.
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Affiliation(s)
- Shwan Jalal
- St. John Hospital & Medical Center, 22101 Moross Road VEP, 2nd Floor, Detroit, MI 48236 USA.
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Mehta RH, Leimberger JD, van Diepen S, Meza J, Wang A, Jankowich R, Harrison RW, Hay D, Fremes S, Duncan A, Soltesz EG, Luber J, Park S, Argenziano M, Murphy E, Marcel R, Kalavrouziotis D, Nagpal D, Bozinovski J, Toller W, Heringlake M, Goodman SG, Levy JH, Harrington RA, Anstrom KJ, Alexander JH. Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery. N Engl J Med 2017; 376:2032-2042. [PMID: 28316276 DOI: 10.1056/nejmoa1616218] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Levosimendan is an inotropic agent that has been shown in small studies to prevent or treat the low cardiac output syndrome after cardiac surgery. METHODS In a multicenter, randomized, placebo-controlled, phase 3 trial, we evaluated the efficacy and safety of levosimendan in patients with a left ventricular ejection fraction of 35% or less who were undergoing cardiac surgery with the use of cardiopulmonary bypass. Patients were randomly assigned to receive either intravenous levosimendan (at a dose of 0.2 μg per kilogram of body weight per minute for 1 hour, followed by a dose of 0.1 μg per kilogram per minute for 23 hours) or placebo, with the infusion started before surgery. The two primary end points were a four-component composite of death through day 30, renal-replacement therapy through day 30, perioperative myocardial infarction through day 5, or use of a mechanical cardiac assist device through day 5; and a two-component composite of death through day 30 or use of a mechanical cardiac assist device through day 5. RESULTS A total of 882 patients underwent randomization, 849 of whom received levosimendan or placebo and were included in the modified intention-to-treat population. The four-component primary end point occurred in 105 of 428 patients (24.5%) assigned to receive levosimendan and in 103 of 421 (24.5%) assigned to receive placebo (adjusted odds ratio, 1.00; 99% confidence interval [CI], 0.66 to 1.54; P=0.98). The two-component primary end point occurred in 56 patients (13.1%) assigned to receive levosimendan and in 48 (11.4%) assigned to receive placebo (adjusted odds ratio, 1.18; 96% CI, 0.76 to 1.82; P=0.45). The rate of adverse events did not differ significantly between the two groups. CONCLUSIONS Prophylactic levosimendan did not result in a rate of the short-term composite end point of death, renal-replacement therapy, perioperative myocardial infarction, or use of a mechanical cardiac assist device that was lower than the rate with placebo among patients with a reduced left ventricular ejection fraction who were undergoing cardiac surgery with the use of cardiopulmonary bypass. (Funded by Tenax Therapeutics; LEVO-CTS ClinicalTrials.gov number, NCT02025621 .).
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Affiliation(s)
- Rajendra H Mehta
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Jeffrey D Leimberger
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Sean van Diepen
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - James Meza
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Alice Wang
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Rachael Jankowich
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Robert W Harrison
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Douglas Hay
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Stephen Fremes
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Andra Duncan
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Edward G Soltesz
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - John Luber
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Soon Park
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Michael Argenziano
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Edward Murphy
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Randy Marcel
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Dimitri Kalavrouziotis
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Dave Nagpal
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - John Bozinovski
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Wolfgang Toller
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Matthias Heringlake
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Shaun G Goodman
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Jerrold H Levy
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Robert A Harrington
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Kevin J Anstrom
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - John H Alexander
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
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Nowak B, Misselwitz B, Przibille O, Mehta RH. Is mortality a useful parameter for public reporting in pacemaker implantation? Results of an obligatory external quality control programme. Europace 2017; 19:568-572. [PMID: 28431064 DOI: 10.1093/europace/euw079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/01/2016] [Indexed: 11/12/2022] Open
Abstract
AIMS To evaluate if public reporting of pacemaker implantation-associated mortality is meaningful in a large contemporary patient cohort. METHODS AND RESULTS The database of the obligatory external quality control programme in the Federal State of Hessen, Germany, of patients undergoing permanent pacemaker (PPM) implantation was evaluated retrospectively. We compared the baseline features of patients who died compared with those who did not during hospitalization after PPM. Of 5079 patients who underwent PPM implantation in 2009, 74 (1.5%) died during the hospital stay. Cause of death was available in 70/74 patients (94.6%) who died. Deceased patients were older (79.6 ± 8.7 vs. 76.3 ± 9.9 years, P = 0.006), had worse American Society of Anesthesiologists (ASA) physical status (P < 0.001), lower ejection fraction (P < 0.001), a greater prevalence of high-degree atrioventricular-block (44.3 vs. 35.0%, P = 0.001), and were more likely to receive single-chamber devices (41.4 vs. 25.0%, P < 0.002). Perioperative complications were similar in both cohorts. Death was not attributable directly to PPM procedure in any patients but was related to (i) non-device-related infections (28.6%), (ii) heart failure (25.7%), (iii) extracardiac diseases (21.4%), (iv) multiorgan failure (8.6%), (v) previous resuscitation with hypoxic brain damage (8.6%), and (vi) arrhythmogenic death (7.1%). CONCLUSION Mortality associated with PPM implantation in vast majority of cases was not related to the procedure, but to comorbidities and other existing diseases at the time of PPM implantation. Thus, PPM implantation in-hospital mortality should not be chosen for public reporting comparing hospital quality, even after adjusting for baseline risk.
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MESH Headings
- Aged
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/prevention & control
- Cardiac Pacing, Artificial/mortality
- Cardiac Pacing, Artificial/statistics & numerical data
- Causality
- Cohort Studies
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Female
- Hospital Mortality
- Hospitalization/statistics & numerical data
- Humans
- Incidence
- Male
- Outcome Assessment, Health Care/standards
- Outcome Assessment, Health Care/statistics & numerical data
- Pacemaker, Artificial/statistics & numerical data
- Quality Control
- Risk Assessment/methods
- Risk Management/statistics & numerical data
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Bernd Nowak
- CCB, Cardioangiologisches Centrum Bethanien, Im Pruefling 23, D-60389 Frankfurt a.M., Germany
| | | | - Oliver Przibille
- CCB, Cardioangiologisches Centrum Bethanien, Im Pruefling 23, D-60389 Frankfurt a.M., Germany
| | - Rajendra H Mehta
- Duke Clinical Research Institute and Duke University Medical Center, Durham, NC, USA
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Mehta RH, Van Diepen S, Meza J, Bokesch P, Leimberger JD, Tourt-Uhlig S, Swartz M, Parrotta J, Jankowich R, Hay D, Harrison RW, Fremes S, Goodman SG, Luber J, Toller W, Heringlake M, Anstrom KJ, Levy JH, Harrington RA, Alexander JH. Levosimendan in patients with left ventricular systolic dysfunction undergoing cardiac surgery on cardiopulmonary bypass: Rationale and study design of the Levosimendan in Patients with Left Ventricular Systolic Dysfunction Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass (LEVO-CTS) trial. Am Heart J 2016; 182:62-71. [PMID: 27914501 DOI: 10.1016/j.ahj.2016.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Low cardiac output syndrome is associated with increased mortality and occurs in 3% to 14% of patients undergoing cardiac surgery on cardiopulmonary bypass (CPB). Levosimendan, a novel calcium sensitizer and KATP channel activator with inotropic, vasodilatory, and cardioprotective properties, has shown significant promise in reducing the incidence of low cardiac output syndrome and related adverse outcomes in patients undergoing cardiac surgery on CPB. METHODS LEVO-CTS is a phase 3 randomized, controlled, multicenter study evaluating the efficacy, safety, and cost-effectiveness of levosimendan in reducing morbidity and mortality in high-risk patients with reduced left ventricular ejection fraction (≤35%) undergoing cardiac surgery on CPB. Patients will be randomly assigned to receive either intravenous levosimendan (0.2 μg kg-1 min-1 for the first hour followed by 0.1 μg/kg for 23hours) or matching placebo initiated within 8hours of surgery. The co-primary end points are (1) the composite of death or renal replacement therapy through day 30 or perioperative myocardial infarction, or mechanical assist device use through day 5 (quad end point tested at α<.01), and (2) the composite of death through postoperative day 30 or mechanical assist device use through day 5 (dual end point tested at α<.04). Safety end points include new atrial fibrillation and death through 90days. In addition, an economic analysis will address the cost-effectiveness of levosimendan compared with placebo in high-risk patients undergoing cardiac surgery on CPB. Approximately 880 patients will be enrolled at approximately 60 sites in the United States and Canada between July 2014 and September 2016, with results anticipated in January 2017. CONCLUSION LEVO-CTS, a large randomized multicenter clinical trial, will evaluate the efficacy, safety, and cost-effectiveness of levosimendan in reducing adverse outcomes in high-risk patients undergoing cardiac surgery on CPB. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT02025621).
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Beckman JA, Mehta RH, Isselbacher EM, Bossone E, Cooper JV, Smith DE, Fang J, Sechtem U, Pape LA, Myrmel T, Nienaber CA, Eagle KA, O'Gara PT. Branch vessel complications are increased in aortic dissection patients with renal insufficiency. Vasc Med 2016; 9:267-70. [PMID: 15678618 DOI: 10.1191/1358863x04vm561oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Morbidity and mortality from aortic dissection remain high despite advances in diagnosis and treatment. Simple markers to identify patients at high risk for non-aortic complications of dissection are lacking. We investigated the effect of renal insufficiency on the presentation, complications, and outcome of patients with acute aortic dissection. We evaluated 638 patients with type A and 365 patients with type B aortic dissection enrolled in the International Registry of Acute Aortic Dissection (IRAD) between January 1996 and December 2000. Chi-squared and Student’s t testing were performed to identify the effect of renal insufficiency on patient presentation, management, and outcome. Patients with renal insufficiency more often required nitroprusside for blood pressure control (type A: 40.7% vs 31.1%, p 1/4-0.049; type B: 66.7% vs 37.3, p 1/4-0.0001) and had a greater risk of mesenteric ischemia (type A: 10.7% vs 1.4%, p < 0.0001; type B: 17.7% vs 3.0%, p < 0.0001). In conclusion, aortic dissection patients with renal insufficiency are at increased risk for drug-resistant hypertension and aortic branch vessel compromise. Routine measurement of serum creatinine provides a readily accessible clinical marker for important complications. Upon recognition, renal impairment indicates a need for close monitoring, aggressive blood pressure control, and evaluation of aortic branch vessel circulations.
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Affiliation(s)
- Joshua A Beckman
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
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Prates PRL, Williams JB, Mehta RH, Stevens SR, Thomas L, Smith PK, Newby LK, Kalil RAK, Alexander JH, Lopes RD. Clopidogrel use After Myocardial Revascularization: Prevalence, Predictors, and One-Year Survival Rate. Braz J Cardiovasc Surg 2016; 31:106-14. [PMID: 27556308 PMCID: PMC5062735 DOI: 10.5935/1678-9741.20160019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/08/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction Antiplatelet therapy after coronary artery bypass graft (CABG) has been used.
Little is known about the predictors and efficacy of clopidogrel in this
scenario. Objective Identify predictors of clopidogrel following CABG. Methods We evaluated 5404 patients who underwent CABG between 2000 and 2009 at Duke
University Medical Center. We excluded patients undergoing concomitant valve
surgery, those who had postoperative bleeding or death before discharge.
Postoperative clopidogrel was left to the discretion of the attending
physician. Adjusted risk for 1-year mortality was compared between patients
receiving and not receiving clopidogrel during hospitalization after
undergoing CABG. Results At hospital discharge, 931 (17.2%) patients were receiving clopidogrel.
Comparing patients not receiving clopidogrel at discharge, users had more
comorbidities, including hyperlipidemia, hypertension, heart failure,
peripheral arterial disease and cerebrovascular disease. Patients who
received aspirin during hospitalization were less likely to receive
clopidogrel at discharge (P≤0.0001). Clopidogrel was
associated with similar 1-year mortality compared with those who did not use
clopidogrel (4.4% vs. 4.5%, P=0.72). There
was, however, an interaction between the use of cardiopulmonary bypass and
clopidogrel, with lower 1-year mortality in patients undergoing off-pump
CABG who received clopidogrel, but not those undergoing conventional CABG
(2.6% vs 5.6%, P Interaction = 0.032). Conclusion Clopidogrel was used in nearly one-fifth of patients after CABG. Its use was
not associated with lower mortality after 1 year in general, but lower
mortality rate in those undergoing off-pump CABG. Randomized clinical trials
are needed to determine the benefit of routine use of clopidogrel in
CABG.
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Affiliation(s)
- Paulo Roberto L Prates
- Instituto de Cardiologia-Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | - Judson B Williams
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, United States
| | - Rajendra H Mehta
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, United States
| | | | - Laine Thomas
- Duke Clinical Research Institute, Durham, NC, United States
| | - Peter K Smith
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, United States
| | - L Kristin Newby
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, United States
| | - Renato A K Kalil
- Instituto de Cardiologia-Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | - John H Alexander
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, United States
| | - Renato D Lopes
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, United States
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39
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Parvataneni KC, Piyaskulkaew C, Szpunar S, Sharma T, Patel V, Patel S, Davis T, Lalonde T, Yamasaki H, Rosman HS, Mehta RH. Relation of Baseline Renal Dysfunction With Outcomes in Patients Undergoing Popliteal and Infrapopliteal Percutaneous Peripheral Arterial Interventions. Am J Cardiol 2016; 118:298-302. [PMID: 27236250 DOI: 10.1016/j.amjcard.2016.04.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 11/30/2022]
Abstract
Renal dysfunction is a major risk factor for peripheral arterial disease (PAD). Infrapopliteal PAD is associated with more co-morbid conditions and worse prognosis than suprapopliteal PAD. Long-term outcomes of patients with renal dysfunction and popliteal or infrapopliteal PAD undergoing peripheral vascular intervention (PVI) are not well described. We retrospectively evaluated long-term outcomes in 726 patients undergoing infrapopliteal PVI categorized into 3 glomerular filtration rate (GFR)-based groups: GFR (≥60 ml/min/1.73 m(2)), GFR (<60 ml/min/1.73 m(2)), and those on dialysis. At mean follow-up of 36 ± 20 months, amputation rates were 3%, 5%, and 11% with mortality rates of 23%, 36%, and 56% in normal renal function, chronic kidney disease (adjusted odds ratio [OR] for amputation 1.75, 95% CI 0.73 to 4.21; adjusted OR for mortality 1.53, 95% CI 1.05 to 2.23, p = 0.028), and dialysis (adjusted OR for amputation 2.43, 95% CI 0.84 to 7.02, p = 0.100; adjusted OR for mortality 4.51, 95% CI 2.46 to 8.26, p <0.0001) groups, respectively. Repeat revascularization was similar in all 3 groups at roughly 25%. In conclusion, chronic kidney disease and dialysis were associated with increased major amputations and mortality in patients who received PVI for popliteal and infrapopliteal PAD.
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MESH Headings
- Aged
- Aged, 80 and over
- Amputation, Surgical/statistics & numerical data
- Angioplasty, Balloon
- Angioplasty, Balloon, Laser-Assisted
- Comorbidity
- Constriction, Pathologic/epidemiology
- Constriction, Pathologic/surgery
- Female
- Glomerular Filtration Rate
- Humans
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/therapy
- Male
- Odds Ratio
- Peripheral Arterial Disease/epidemiology
- Peripheral Arterial Disease/surgery
- Popliteal Artery/surgery
- Renal Dialysis
- Renal Insufficiency, Chronic/epidemiology
- Retrospective Studies
- Risk Factors
- Treatment Outcome
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Affiliation(s)
- Kesav C Parvataneni
- Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan.
| | | | - Susan Szpunar
- Department of Medical Education, St. John Hospital and Medical Center, Detroit, Michigan
| | - Tarun Sharma
- Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, Michigan
| | - Vishal Patel
- Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, Michigan
| | - Saurabhkumar Patel
- Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, Michigan
| | - Thomas Davis
- Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan
| | - Thomas Lalonde
- Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan
| | - Hiroshi Yamasaki
- Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan
| | - Howard S Rosman
- Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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40
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Manfredini R, Gallerani M, Boari B, Salmi R, Mehta RH. Seasonal Variation in Onset of Pulmonary Embolism is Independent of Patients' Underlying Risk Comorbid Conditions. Clin Appl Thromb Hemost 2016; 10:39-43. [PMID: 14979403 DOI: 10.1177/107602960401000106] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 12/23/2022] Open
Abstract
As for many cardiovascular events, pulmonary embolism (PE) is not randomly distributed over time, but shows rhythmic patterns. The purpose of this study was to investigate whether such temporal pattern of occurrence varied in subgroups of patients according to different risk comorbid conditions. All cases of PE observed at the Hospital of Ferrara, Italy, from 1998 to 2001, were considered. After determination of the day of onset, the population was grouped by gender and the most common underlying risk comorbid conditions, e.g., deep vein thrombosis (DVT), neoplasms, cardiomyopathies, traumas/surgical operations, diabetes mellitus, pulmonary diseases, hypertension, cerebrovascular diseases, heart failure, hematologic diseases. For statistical analysis, chi-square test for goodness of fit and partial Fourier series were used. A total of 784 cases (mean age 71 ± 14 years) were included. Frequency of onset was higher in winter for total population (p=0.002), men (p=0.004), DVT (p=0.001), pulmonary disease (p=0.008), cardiomyopathies (p=0.011), and major traumas/surgical operations (p=0.049). Chronobiologic analysis identified a winter peak for total population (p=0.008), men (p<O.OOl), DVT (p=0.006), pulmonary diseases (p=0.017), and hypertension (p=0.026). This study confirms the winter peak of PE and provides evidence that it is not influenced by the underlying clinical conditions, but probably by endogenous variations.
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Affiliation(s)
- R Manfredini
- Section of Internal Medicine, Department of Clinical and Experimental Medicine, University of Ferrara, Italy.
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41
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Eggebrecht H, Bestehorn M, Haude M, Schmermund A, Bestehorn K, Voigtländer T, Kuck KH, Mehta RH. Outcomes of transfemoral transcatheter aortic valve implantation at hospitals with and without on-site cardiac surgery department: insights from the prospective German aortic valve replacement quality assurance registry (AQUA) in 17 919 patients. Eur Heart J 2016; 37:2240-8. [DOI: 10.1093/eurheartj/ehw190] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/20/2016] [Indexed: 11/14/2022] Open
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42
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Vavalle JP, van Diepen S, Clare RM, Hochman JS, Weaver WD, Mehta RH, Pieper KS, Patel MR, Patel UD, Armstrong PW, Granger CB, Lopes RD. Renal failure in patients with ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention: Predictors, clinical and angiographic features, and outcomes. Am Heart J 2016; 173:57-66. [PMID: 26920597 DOI: 10.1016/j.ahj.2015.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 12/05/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Among patients presenting with ST-segment elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PCI), the associations between clinical outcomes and both baseline renal function and the development of acute kidney injury (AKI) have not been reported in a trial population with unselected baseline renal function. METHODS Patients enrolled in the APEX-AMI trial who underwent primary PCI for the treatment of STEMI were categorized according to (a) baseline renal function and (b) the development of AKI. Patient characteristics, clinical outcomes, and treatment patterns were analyzed according to baseline renal function and the development of AKI. A prediction model for AKI after primary PCI for STEMI was also developed. RESULTS A total of 5,244 patients were included in this analysis and stratified according to baseline estimated glomerular filtration rate (eGFR) (milliliters per minute per 1.73 m(2)) of >90, 60 to 90, 30 to 59, or <30 or as dialysis dependent. Patients with lower eGFR were older, more often female, and less often treated with evidence-based medicines and had worse angiographic outcomes and higher mortality. The rates of AKI for patients with a baseline eGFR of >90, 60 to 90, 30 to 59, and <30 were 2.5%, 4.1%, 8.1%, and 1.6%, respectively (P < .0001). The strongest predictors of AKI were age and presenting in Killip class III or IV. CONCLUSIONS Among patients undergoing primary PCI for STEMI, impaired renal function at presentation and development of post-PCI AKI were highly associated with worse clinical and angiographic outcomes, including death. The risk of developing AKI was low and only modestly associated with baseline renal function.
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43
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Khambatta S, Othman H, Seth M, Lalonde T, Rosman HS, Gurm HS, Mehta RH. Association Of Bleeding Avoidance Strategies with age-related bleeding and In-hospital mortality in patients undergoing percutaneous coronary Interventions. Cardiovasc Revasc Med 2016; 17:233-40. [PMID: 26994504 DOI: 10.1016/j.carrev.2016.02.014] [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] [Received: 12/22/2015] [Revised: 02/13/2016] [Accepted: 02/24/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The association of bleeding avoidance strategy (BAS) (consisting of a combination of radial access, bivalirudin [rather than heparin +/- glycoprotein GPIIb/IIIa antagonists], and/or vascular closure devices after femoral access) with bleeding and in-hospital outcomes has not been evaluated among elderly patients undergoing percutaneous coronary interventions (PCI). METHODS We studied BAS use, bleeding and in-hospital mortality among 121,635 patients categorized by age (<50, 50-59, 60-69, 70-79, and ≥80years) undergoing PCI from the BMC2 registry (1/2010-12/2013). RESULTS The use of BAS decreased marginally with age and despite improved utilization over time, remained lower among the elderly. BAS was used in a much lower risk cohort among all age groups. Nonetheless, compared with no BAS, the use of this strategy was associated with lower bleeding (adjusted OR 0.984, 95% CI 0.980-0.985) and in-hospital mortality (adjusted OR 0.996, 95% CI 0.994-0.997) among all age-groups. Similar relative reduction in the risk of bleeding was observed among all age groups with BAS use with lowest risk (thus greatest absolute risk reduction given their highest risk for bleeding) for the oldest cohort. CONCLUSIONS BAS use decreased with age among patients undergoing PCI despite its association with lower in-hospital mortality. Although overall utilization improved over time, it still remained lower in the elderly cohort, a group likely to benefit most from it. These data identified an opportunity to design strategies to improve BAS use particularly among high-risk elderly patients undergoing PCI so as to decrease bleeding and reduce related adverse events and costs.
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Affiliation(s)
| | - Hussein Othman
- St. John Hospital and Medical Center, Detroit, Michigan.
| | - Milan Seth
- University of Michigan, Ann, Arbor, Michigan
| | | | | | | | - Rajendra H Mehta
- Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina
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44
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Jalal S, Lalonde TA, Yamasaki H, Boshara A, Rosman HS, Mehta RH, Davis TP. Novel CenterCross and MultiCross devices for the treatment of infrainguinal chronic total occlusions: initial single-centre experience. EUROINTERVENTION 2016; 11:1063-9. [PMID: 26788708 DOI: 10.4244/eijv11i9a214] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Our aim was to evaluate the effectiveness and safety of CenterCross/MultiCross devices to facilitate the crossing of chronic total occlusions in peripheral arteries. METHODS AND RESULTS This was a single-centre study in which 53 consecutive patients who were not amenable to initial attempts at crossing using standard guidewires underwent an attempt to recanalise chronically occluded infrainguinal peripheral arteries with MultiCross/CenterCross devices. The primary endpoint of interest was the ability to advance the guidewire beyond the chronic total occlusion (CTO) lesions with the use of these devices. Safety endpoints were freedom from bleeding, distal embolisation and vessel perforation, dissection or need for emergent surgical intervention. Popliteal artery and below lesions were the most commonly treated, comprising 89% of the total. The CTO lesions were crossed successfully in 92.4% of the cases within a relatively short time (5.5±3.5 minutes). There was no bleeding, dissection or need for emergent surgery and 98.1% and 96.2% of the patients were free from distal embolisation and perforations, respectively. CONCLUSIONS Our study demonstrated that MultiCross and CenterCross were effective and safe for recanalisation of peripheral CTO lesions which were not amenable to conventional guidewires. Further study is required to define the role of these novel devices in the treatment of complex lesions, particularly CTOs in patients with peripheral arterial disease.
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Affiliation(s)
- Shwan Jalal
- St. John Hospital and Medical Center, Detroit, MI, USA
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45
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Mehta RH, Shahian DM, Sheng S, O’Brien SM, Edwards FH, Jacobs JP, Peterson ED. Association of Hospital and Physician Characteristics and Care Processes With Racial Disparities in Procedural Outcomes Among Contemporary Patients Undergoing Coronary Artery Bypass Grafting Surgery. Circulation 2016; 133:124-30. [DOI: 10.1161/circulationaha.115.015957] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022]
Abstract
Background—
Previous studies have reported that black patients undergoing coronary artery bypass surgery had worse outcomes than white patients, even after accounting for patient factors. The degree to which clinician, hospital, and care factors account for these outcome differences remains unclear.
Methods and Results—
We evaluated procedural outcomes in 11 697 blacks and 136 362 whites undergoing isolated coronary artery bypass surgery at 663 Society of Thoracic Surgery Database participating sites (January 1, 2010 to June 30, 2011) adjusted for patients’ clinical and socioeconomic features, hospital and surgeon effects, and care processes (internal mammary artery graft and perioperative medications use). Relative to whites, blacks undergoing coronary artery bypass surgery were younger, yet had higher comorbidities and more adverse presenting features. Blacks were also more likely to be treated at hospitals with higher risk-adjusted mortality. The use of internal mammary artery was marginally lower in blacks than in whites (93.3% versus 92.2%,
P
<0.0001). Unadjusted mortality and major morbidity rates were higher in blacks than in whites (1.8% versus 2.5%,
P
<0.0001) and (13.6% versus 19.4%,
P
<0.0001), respectively. These racial differences in outcomes narrowed but still persisted after adjusting for surgeon, hospital, and care processes in addition to patient and socioeconomic factors (odds ratio, 1.17; 95% confidence interval, 1.00–1.36 and odds ratio, 1.26; 95% confidence interval, 1.19–1.34, respectively).
Conclusions—
The risks of procedural mortality and morbidity after coronary artery bypass surgery were higher among black patients than among white patients. These differences were in part accounted for by patient comorbidities, socioeconomic status, and surgeon, hospital, and care factors, as well, as suggested by the reduction in the strength of the race-outcomes association. However, black race remained an independent predictor of outcomes even after accounting for these differences.
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Affiliation(s)
- Rajendra H. Mehta
- From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M., S.S., S.M.O’B., E.D.P.); Massachusetts General Hospital, Boston (D.M.S.); The Society of Thoracic Surgeons, Chicago, IL (F.H.E.); and John Hopkins University, Baltimore, MD (J.P.J.)
| | - David M. Shahian
- From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M., S.S., S.M.O’B., E.D.P.); Massachusetts General Hospital, Boston (D.M.S.); The Society of Thoracic Surgeons, Chicago, IL (F.H.E.); and John Hopkins University, Baltimore, MD (J.P.J.)
| | - Shubin Sheng
- From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M., S.S., S.M.O’B., E.D.P.); Massachusetts General Hospital, Boston (D.M.S.); The Society of Thoracic Surgeons, Chicago, IL (F.H.E.); and John Hopkins University, Baltimore, MD (J.P.J.)
| | - Sean M. O’Brien
- From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M., S.S., S.M.O’B., E.D.P.); Massachusetts General Hospital, Boston (D.M.S.); The Society of Thoracic Surgeons, Chicago, IL (F.H.E.); and John Hopkins University, Baltimore, MD (J.P.J.)
| | - Fred H. Edwards
- From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M., S.S., S.M.O’B., E.D.P.); Massachusetts General Hospital, Boston (D.M.S.); The Society of Thoracic Surgeons, Chicago, IL (F.H.E.); and John Hopkins University, Baltimore, MD (J.P.J.)
| | - Jeffery P. Jacobs
- From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M., S.S., S.M.O’B., E.D.P.); Massachusetts General Hospital, Boston (D.M.S.); The Society of Thoracic Surgeons, Chicago, IL (F.H.E.); and John Hopkins University, Baltimore, MD (J.P.J.)
| | - Eric D. Peterson
- From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M., S.S., S.M.O’B., E.D.P.); Massachusetts General Hospital, Boston (D.M.S.); The Society of Thoracic Surgeons, Chicago, IL (F.H.E.); and John Hopkins University, Baltimore, MD (J.P.J.)
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46
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Eggebrecht H, Mehta RH. Transcatheter aortic valve implantation (TAVI) in Germany 2008-2014: on its way to standard therapy for aortic valve stenosis in the elderly? EUROINTERVENTION 2016; 11:1029-33. [DOI: 10.4244/eijy15m09_11] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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47
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Harskamp RE, Hoedemaker N, Newby LK, Woudstra P, Grundeken MJ, Beijk MA, Piek JJ, Tijssen JG, Mehta RH, de Winter RJ. Procedural and clinical outcomes after use of the glycoprotein IIb/IIIa inhibitor abciximab for saphenous vein graft interventions. Cardiovasc Revasc Med 2015; 17:19-23. [PMID: 26626961 DOI: 10.1016/j.carrev.2015.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 09/18/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) poses a high-risk for distal coronary thromboembolic events. Glycoprotein IIb/IIIa inhibitors are frequently used in hope of reducing the impact of this, although the safety and efficacy of these drugs to improve outcomes in this setting are understudied. METHODS Patients were included if they had prior coronary artery bypass surgery and subsequently underwent PCI of ≥1 SVG graft at a Dutch academic center between 1997 and 2008. These patients were matched 1:1 based on peri-procedural use of abciximab using a propensity-score matching algorithm based on 17 variables. Conditional logistic regression and Cox regression stratified on matched pairs were performed to evaluate the association between abciximab use and MACCE (the composite measure of mortality, myocardial infarction, stroke and repeat revascularization) at 30days and up to 1year. RESULTS The composite of 30-day MACCE occurred in 18 patients (15.3%) in the abciximab group and 16 patients (13.6%) in the propensity matched control group (OR: 1.13, 95% CI: 0.57-2.21, p=0.73). At 1-year follow-up, MACCE rates were also similar (32.5% vs. 33.9%, HR: 0.97, 95% CI: 0.59-1.59). Major bleeding (BARC types 3a-c) was higher in the abciximab group (11.9% vs. 4.2%, OR: 2.80, 95% CI: 1.01-7.77). Ischemic outcomes did not differ among patients with acute coronary syndromes. CONCLUSION The use of intravenous abciximab was not associated with improved clinical outcomes up to 1-year among patients undergoing SVG PCI, but was related to more bleeding.
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Affiliation(s)
- Ralf E Harskamp
- Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands; VU University Medical Center, Amsterdam, the Netherlands; Duke Clinical Research Institute, Durham, NC, USA.
| | - Niels Hoedemaker
- Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
| | | | - Pier Woudstra
- Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
| | - Maik J Grundeken
- Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel A Beijk
- Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
| | - Jan J Piek
- Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
| | - Jan G Tijssen
- Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
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48
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Piyaskulkaew C, Parvataneni K, Ballout H, Szpunar S, Sharma T, Almahmoud M, LaLonde T, Davis T, Mehta RH, Yamasaki H. Laser in infrapopliteal and popliteal stenosis 2 study (LIPS2): Long-term outcomes of laser-assisted balloon angioplasty versus balloon angioplasty for below knee peripheral arterial disease. Catheter Cardiovasc Interv 2015; 86:1211-8. [PMID: 26489379 DOI: 10.1002/ccd.26145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/17/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Laser-assisted balloon angioplasty (LABA) has been shown to be more effective in achieving angiographic success for treatment for below knee peripheral artery disease (PAD) compared with balloon angioplasty alone(BA). However, long-term outcomes of LABA compared with BA for popliteal and infrapopliteal PAD are unknown. METHODS We evaluated data on 726 patients undergoing LABA (n = 395) and BA (n = 331) for popliteal and infrapopliteal PAD retrospectively at a single center (2007-2012). Outcomes included long-term ipsilateral major limb amputation, revascularization and mortality (median follow-up = 36 months). RESULTS Baseline features were similar in two groups with the exception of more TASC-D lesions (92.4 vs. 66.5%; P < 0.0001) and chronic total occlusions (86.4 vs. 49.5%; P < 0.0001) in LABA group. Angiographic success was higher in LABA compared with BA (97.7 vs. 89.2%; P < 0.0001). Ipsilateral major limb amputation (4.1 vs. 5.1%, P = 0.48) and repeat revascularization (25.1 vs. 23.3%, P = 0.47) were similar in LABA and BA patients despite unfavorable baseline angiographic characteristics in the former. Compared with BA, death was more frequently in LABA group (35.2 and 26.3%, P = 0.01), a reflection of higher comorbid conditions in this group (adjusted HR 1.05, 95% CI 0.79-1.39). CONCLUSION Despite worse baseline angiographic characteristics compared with BA, LABA was associated with higher angiographic success and similar ipsilateral major amputation, repeat revascularization, and long-term mortality. Future randomized clinical trial should evaluate the efficacy of LABA compared with BA (particularly drug-eluting) in improving limb salvage and reducing repeat revascularization in these high-risk PAD patients.
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Affiliation(s)
| | - Kesav Parvataneni
- St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group)
| | - Hussein Ballout
- St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group)
| | - Susan Szpunar
- St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group)
| | - Tarun Sharma
- St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group)
| | | | - Thomas LaLonde
- St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group)
| | - Thomas Davis
- St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group)
| | - Rajendra H Mehta
- Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina
| | - Hiroshi Yamasaki
- St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group)
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49
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Eggebrecht H, Mehta RH, Kahlert P, Schymik G, Lefèvre T, Lange R, Macaya C, Mandinov L, Wendler O, Thomas M. Emergent cardiac surgery during transcatheter aortic valve implantation (TAVI): insights from the Edwards SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) registry. EUROINTERVENTION 2015; 10:975-81. [PMID: 24235321 DOI: 10.4244/eijv10i8a165] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIMS Transcatheter aortic valve implantation (TAVI) carries the risk of intraprocedural complications that may ultimately require emergent cardiac surgery (ECS). However, few data exist on the incidence, reasons and outcomes of patients needing ECS during TAVI. We analysed data from 2,307 TAVI patients, prospectively enrolled in the multicentre Edwards SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) registry. METHODS AND RESULTS Twenty-seven (1.2%) of 2,307 patients required ECS. The rates of ECS were similar for patients undergoing transapical TAVI compared with transfemoral TAVI (1.1% vs. 1.2%). The leading causes for ECS were embolisation/migration of the TAVI valve prosthesis (9/27, 33%) and procedure-related aortic injury (n=7, 26%). Thirty-day mortality of ECS was high (51.9%) and showed cause-specific differences, with 100% mortality in patients with aortic rupture or cardiac tamponade, 0% death in those with acute aortic regurgitation and intermediate risk of death or intermediate mortality in those with aortic injury or valve embolisation/migration. CONCLUSIONS Rates of ECS during TAVI were low (1.2%). Although ECS was performed without time delay, emergent surgery was associated with a 30-day mortality of 52%. Complications with dramatic acute consequences (annular rupture, aortic injury) had higher mortality than those with less acute deterioration (aortic regurgitation). Prevention of complications requiring ECS during TAVI appears to be of critical importance, focusing on less traumatic, more flexible delivery catheter systems and retrievable valves to reduce the risk of aortic injury and valve embolisation, the two most common causes of ECS.
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Harskamp RE, Vassiliades TA, Mehta RH, de Winter RJ, Lopes RD, Xian Y, Peterson ED, Puskas JD, Halkos ME. Comparative Effectiveness of Hybrid Coronary Revascularization vs Coronary Artery Bypass Grafting. J Am Coll Surg 2015; 221:326-34.e1. [DOI: 10.1016/j.jamcollsurg.2015.03.012] [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] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/01/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
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