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Tannu M, Hess CN, Gutierrez JA, Lopes R, Swaminathan RV, Altin SE, Rao SV. Polyvascular Disease: A Narrative Review of Risk Factors, Clinical Outcomes and Treatment. Curr Cardiol Rep 2024:10.1007/s11886-024-02063-0. [PMID: 38743352 DOI: 10.1007/s11886-024-02063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE OF REVIEW Polyvascular disease has a significant global burden and is associated with increased risk of major adverse cardiac events with each additional vascular territory involved. The purpose of this review is to highlight the risk factors, associated outcomes, emerging genetic markers, and evidence for screening and treatment of polyvascular disease. RECENT FINDINGS Polyvascular disease is the presence of atherosclerosis in two or more vascular beds. It has a significant global burden, with a prevalence of 30-70% in patients with known atherosclerosis. Patients with polyvascular disease experience elevated rates of cardiovascular death, myocardial infarction and stroke, especially among high-risk subgroups like those with type 2 diabetes mellitus and there is a step-wise increased risk of adverse outcomes with each additional vascular territory involved. Genetic analyses demonstrate that some individuals may carry a genetic predisposition, while others exhibit higher levels of atherogenic lipoproteins and inflammatory markers. Routine screening for asymptomatic disease is not currently recommended by major cardiovascular societies unless patients are high-risk. While there are no established protocols for escalating treatment, existing guidelines advocate for lipid-lowering therapy. Additionally, recent studies have demonstrated benefit from antithrombotic agents, such as P2Y12 inhibitors and low-dose anticoagulation, but the optimal timing and dosage of these agents has not been established, and the ischemic benefit must be balanced against the increased risk of bleeding in the polyvascular population. Due to the high prevalence and risks associated with polyvascular disease, early identification and treatment intensification are crucial to reduce disease progression. Future research is needed to develop screening protocols and determine the optimal timing and dosing of therapy to prevent ischemic events.
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Affiliation(s)
- Manasi Tannu
- Division of Cardiology, Duke University Health System, Durham, NC, USA.
- Duke Clinical Research Institute, Durham, NC, USA.
| | - Connie N Hess
- University of Colorado, School of Medicine and CPC Clinical Research, Aurora, CO, USA
| | | | - Renato Lopes
- Division of Cardiology, Duke University Health System, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Rajesh V Swaminathan
- Division of Cardiology, Duke University Health System, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | | | - Sunil V Rao
- NYU Langone Health System, New York, NY, USA
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Castillo Rodriguez B, Secemsky EA, Swaminathan RV, Feldman DN, Schlaich M, Battaglia Y, Filippone EJ, Krittanawong C. Opportunities and Limitations of Renal Denervation: Where Do We Stand? Am J Med 2024:S0002-9343(24)00219-5. [PMID: 38588936 DOI: 10.1016/j.amjmed.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024]
Abstract
Hypertension is a primary contributor to cardiovascular disease, and the leading risk factor for loss of quality adjusted life years. Up to 50% of the cases of hypertension in the United States remain uncontrolled. Additionally, 8%-18% of the hypertensive population have resistant hypertension; uncontrolled pressure despite 3 different antihypertensive agents. Recently, catheter-based percutaneous renal denervation emerged as a method for ablating renal sympathetic nerves for difficult-to-control hypertension. Initial randomized (non-sham) trials and registry analyses showed impressive benefit, but the first sham-controlled randomized controlled trial using monopolar radiofrequency ablation showed limited benefit. With refinement of techniques to include multipolar radiofrequency, ultrasound denervation, and direct ethanol injection, randomized controlled trials demonstrated significant blood pressure improvement, leading to US Food and Drug Administration approval of radiofrequency- and ultrasound-based denervation technologies. In this review article, we summarize the major randomized sham-controlled trials and societal guidelines regarding the efficacy and safety of renal artery denervation for the treatment of uncontrolled hypertension.
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Affiliation(s)
| | - Eric A Secemsky
- Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Rajesh V Swaminathan
- Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Dmitriy N Feldman
- Division of Cardiology, Interventional Cardiology and Endovascular Laboratory, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | - Markus Schlaich
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, University of Western Australia, Perth, Australia; Departments of Cardiology and Nephrology, Royal Perth Hospital, Western Australia, Australia; Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Yuri Battaglia
- Nephrology and Dialysis Unit, Pederzoli Hospital, Peschiera del Garda Verona, Italy; Department of Medicine, University of Verona, Italy
| | - Edward J Filippone
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pa
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Vedantam K, Torres CA, Martinsen BJ, Donatelle M, Shehadeh M, Flaherty JD, Swaminathan RV, Rao S, Leon MB, Kirtane AJ, Beohar N. Percutaneous Coronary Intervention and Discretionary Atherectomy in Patients with Aortic Stenosis: 2016-2019 National Inpatient Sample. Cardiovasc Revasc Med 2023; 53:13-19. [PMID: 36997465 DOI: 10.1016/j.carrev.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Patients with aortic stenosis (AS) usually have concomitant calcified coronary artery disease (CAD) requiring atherectomy to improve lesion compliance and odds of successful percutaneous coronary intervention (PCI). However, there is a paucity of data regarding PCI with or without atherectomy in patients with AS. METHODS The National Inpatient Sample (NIS) database was queried from 2016 through 2019 using ICD-10 codes to identify individuals with AS who underwent PCI with or without atherectomy (Orbital Atherectomy [OA], Rotational or Laser Atherectomy [non-OA]). Temporal trends, safety, outcomes, costs, and correlates of major adverse cardiovascular events (MACE) were assessed using discharge weighted data. RESULTS Hospitalizations of 45,420 AS patients undergoing PCI with or without atherectomy were identified and of those, 88.6 %, 2.3 %, and 9.1 % were treated with PCI-only, OA, or non-OA, respectively. There was an increase in PCIs (8855 to 10,885), atherectomy [OA (165 to 300) and non-OA (795 to 1255)], and intravascular ultrasound (IVUS) use (625 to 1000). The median cost of admission was higher in the atherectomy cohorts ($34,340.77 in OA, $32,306.2 in non-OA) as compared to the PCI-only cohort ($23,683.98). Patients tend to have decreased odds of MACE with IVUS guided atherectomy and PCI. CONCLUSIONS This large database revealed a significant increase in PCI with or without atherectomy in AS patients from 2016 to 2019. Considering the complex comorbidities of AS patients, the overall complication rates were well distributed among the different cohorts, suggesting that IVUS guided PCI with or without atherectomy in patients with AS is feasible and safe.
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Affiliation(s)
- Karthik Vedantam
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Christian A Torres
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Brad J Martinsen
- Scientific Affairs, Cardiovascular Systems Inc, St. Paul, MN, USA
| | - Marissa Donatelle
- Division of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Malik Shehadeh
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - James D Flaherty
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | | | - Sunil Rao
- Division of Cardiology, New York University, NY, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, NY, USA
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, NY, USA
| | - Nirat Beohar
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA.
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Tanaka J, Narcisse D, Gu L, Gutierrez A, Schulteis R, Swaminathan RV, Rymer J, Jones S, Rao SV. THE IMPACT OF THE COVID19 PANDEMIC ON PATIENTS WITH PERIPHERAL ARTERY DISEASE. J Am Coll Cardiol 2023. [PMCID: PMC9982838 DOI: 10.1016/s0735-1097(23)01245-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Parikh RV, Hebbe A, Barón AE, Grunwald GK, Plomondon ME, Gordin J, Yeh RW, Jneid H, Swaminathan RV, Waldo SW, Monto A, Secemsky E, Hsue PY. Clinical Characteristics and Outcomes Among People Living With HIV Undergoing Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. J Am Heart Assoc 2023; 12:e028082. [PMID: 36789851 PMCID: PMC10111473 DOI: 10.1161/jaha.122.028082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Background Clinical characteristics and outcomes in people living with HIV (PLWH) undergoing percutaneous coronary intervention (PCI) remain poorly described. We sought to compare real-world treatment of coronary artery disease, as well as patient and procedural factors and outcomes after PCI between PLWH and uninfected controls. Methods and Results We utilized procedural registry data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program between January 1, 2009 and December 31, 2019 to analyze patients with obstructive coronary artery disease on angiography. In the PCI subgroup, we used inverse probability of treatment weighting and applied Cox proportional hazards to evaluate the association of HIV serostatus with outcomes, including all-cause mortality at 5 years. Among 184 310 patients with obstructive coronary artery disease, treatment strategy was similar between PLWH and controls-35.7% versus 34.2% PCI, 13.6% versus 15% coronary artery bypass grafting, and 50.7% versus 50.8% medical therapy. The PCI cohort consisted of 546 (0.9%) PLWH and 56 811 (99.1%) controls. PLWH undergoing PCI had well-controlled HIV disease, and compared with controls, were younger, more likely to be Black, had fewer traditional risk factors, more acute coronary syndrome, less extensive coronary artery disease, and similar types of stents and P2Y12 therapy. However, PLWH experienced worse survival as early as 6 months post-PCI, which persisted over time and amounted to a 21% increased mortality risk by 5 years (hazard ratio, 1.21 [95% CI, 1.03-1.42; P=0.02]). Conclusions Despite well-controlled HIV disease, a more favorable overall cardiovascular risk profile, and similar PCI procedural metrics, PLWH still have significantly worse long-term survival following PCI than controls.
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Affiliation(s)
- Rushi V Parikh
- Division of Cardiology University of California, Los Angeles Los Angeles CA USA
| | - Annika Hebbe
- Rocky Mountain Regional Veterans Affairs Medical Center Aurora CO USA.,CART Program, Office of Quality and Patient Safety Veterans Health Administration Washington DC USA
| | - Anna E Barón
- Rocky Mountain Regional Veterans Affairs Medical Center Aurora CO USA.,Department of Biostatistics and Informatics University of Colorado Aurora CO USA
| | - Gary K Grunwald
- Rocky Mountain Regional Veterans Affairs Medical Center Aurora CO USA.,Department of Biostatistics and Informatics University of Colorado Aurora CO USA
| | - Mary E Plomondon
- CART Program, Office of Quality and Patient Safety Veterans Health Administration Washington DC USA
| | - Jonathan Gordin
- Division of Cardiology University of California, Los Angeles Los Angeles CA USA
| | - Robert W Yeh
- Smith Center for Outcomes Research in Cardiology, Division of Cardiology Beth Israel Deaconess Medical Center Boston MA USA
| | - Hani Jneid
- Division of Cardiology Baylor College of Medicine Houston TX USA
| | - Rajesh V Swaminathan
- Department of Medicine, Division of Cardiology Duke University School of Medicine Durham NC USA.,Duke Clinical Research Institute Durham NC USA.,Durham VA Healthcare System Durham NC USA
| | - Stephen W Waldo
- Rocky Mountain Regional Veterans Affairs Medical Center Aurora CO USA.,CART Program, Office of Quality and Patient Safety Veterans Health Administration Washington DC USA.,Division of Cardiology University of Colorado School of Medicine Aurora CO USA
| | - Alexander Monto
- San Francisco Veterans Affairs Medical Center San Francisco CA
| | - Eric Secemsky
- Smith Center for Outcomes Research in Cardiology, Division of Cardiology Beth Israel Deaconess Medical Center Boston MA USA
| | - Priscilla Y Hsue
- Division of Cardiology, Zuckerberg San Francisco General Hospital University of California, San Francisco San Francisco CA USA
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Weissler EH, Wang Y, Gales JM, Feldman DN, Arya S, Secemsky EA, Aronow HD, Hawkins BM, Gutierrez JA, Patel MR, Curtis JP, Jones WS, Swaminathan RV. Cardiovascular and Limb Events Following Endovascular Revascularization Among Patients ≥65 Years Old: An American College of Cardiology PVI Registry Analysis. J Am Heart Assoc 2022; 11:e024279. [PMID: 35723018 PMCID: PMC9238644 DOI: 10.1161/jaha.121.024279] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/21/2022] [Indexed: 11/17/2022]
Abstract
Background We aimed to characterize the occurrence of major adverse cardiovascular and limb events (MACE and MALE) among patients with peripheral artery disease (PAD) undergoing peripheral vascular intervention (PVI), as well as associated factors in patients with chronic limb threatening ischemia (CLTI). Methods and Results Patients undergoing PVI in the American College of Cardiology's (ACC) National Cardiovascular Data Registry's PVI Registry who could be linked to Centers for Medicare and Medicaid Services data were included. The primary outcomes were MACE, MALE, and readmission within 1 month and 1 year following index CLTI-PVI or non-CLTI-PVI. Cox proportional hazards regression was used to identify factors associated with the development of the primary outcomes among patients undergoing CLTI-PVI. There were 1758 (49.7%) patients undergoing CLTI-PVI and 1779 (50.3%) undergoing non-CLTI-PVI. By 1 year, MACE occurred in 29.5% of patients with CLTI (n=519), and MALE occurred in 34.0% of patients with CLTI (n=598). By 1 year, MACE occurred in 8.2% of patients with non-CLTI (n=146), and MALE occurred in 26.1% of patients with non-CLTI (n=465). Predictors of MACE at 1 year in CLTI-PVI included end-stage renal disease on hemodialysis, congestive heart failure, prior CABG, and severe lung disease. Predictors of MALE at 1 year in CLTI-PVI included treatment of a prior bypass graft, profunda femoral artery treatment, end-stage renal disease on hemodialysis, and treatment of a previously treated lesion. Conclusions Patients ≥65 years old undergoing PVI experience high rates of MACE and MALE. A range of modifiable and non-modifiable patient factors, procedural characteristics, and medications are associated with the occurrence of MACE and MALE following CLTI-PVI.
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Affiliation(s)
- E. Hope Weissler
- Division of Vascular and Endovascular SurgeryDepartment of SurgeryDuke University School of MedicineDurhamNC
| | - Yongfei Wang
- Section of Cardiovascular MedicineDepartment of Internal MedicineYale School of MedicineNew HavenCT
- Center of Outcome Research and EvaluationYale‐New Haven Health ServicesNew HavenCT
| | | | | | - Shipra Arya
- Division of Vascular and Endovascular SurgeryStanford University School of MedicinePalo AltoCA
| | - Eric A. Secemsky
- Division of CardiologyBeth Israel Deaconess Medical CenterBostonMA
- Smith Center for Outcomes Research in CardiologyBostonMA
| | - Herbert D. Aronow
- Lifespan Cardiovascular Institute/Alpert Medical School at Brown UniversityProvidenceRI
| | - Beau M. Hawkins
- Cardiovascular SectionUniversity of Oklahoma Health Sciences CenterOklahomaOK
| | - J. Antonio Gutierrez
- Division of CardiologyDuke University Health SystemDurhamNC
- Cardiology Section, Durham VA Medical CenterDurhamNC
| | | | - Jeptha P. Curtis
- Section of Cardiovascular MedicineDepartment of Internal MedicineYale School of MedicineNew HavenCT
- Center of Outcome Research and EvaluationYale‐New Haven Health ServicesNew HavenCT
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Gutierrez JA, Christian RT, Aday AW, Gu L, Schulteis RD, Shihai L, Petrini M, Sun AY, Swaminathan RV, Katzenberger DR, Banerjee S, Rao SV. Electronic alerts to initiate anticoagulation dialogue in patients with atrial fibrillation. Am Heart J 2022; 245:29-40. [PMID: 34808105 DOI: 10.1016/j.ahj.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/20/2021] [Accepted: 11/09/2021] [Indexed: 11/01/2022]
Abstract
IMPORTANCE The benefit of an electronic support system for the prescription and adherence to oral anticoagulation therapy among patients with atrial fibrillation (AF) and atrial flutter at heightened risk for of stroke and systemic thromboembolism is unclear. OBJECTIVE To evaluate the effect of a combined alert intervention and shared decision-making tool to improve prescription rates of oral anticoagulation therapy and adherence. DESIGN, SETTING, AND PARTICIPANTS A prospective single arm study of 939 consecutive patients treated at a large tertiary healthcare system. EXPOSURES An electronic support system comprising 1) an electronic alert to identify patients with AF or atrial flutter, a CHA2DS2-VASc score ≥ 2, and not on oral anticoagulation and 2) electronic shared decision-making tool to promote discussions between providers and patients regarding therapy. MAIN OUTCOMES AND MEASURES The primary endpoint was prescription rate of anticoagulation therapy. The secondary endpoint was adherence to anticoagulation therapy defined as medication possession ratio ≥ 80% during the 12 months of follow-up. RESULTS Between June 13, 2018 and August 31, 2018, the automated intervention identified and triggered a unique alert for 939 consecutive patients with AF or atrial flutter, a CHA2DS2-VASc score ≥2 who were not on oral anticoagulation. The median CHA2DS2-VASc score among all patients identified by the alert was 2 and the median untreated duration prior to the alert was 495 days (interquartile range 123 - 1,831 days). Of the patients identified by the alert, 345 (36.7%) initiated anticoagulation therapy and 594 (63.3%) did not: 68.7% were treated with a non-Vitamin K antagonist oral anticoagulant (NOAC), 22.0% with warfarin, and 9.3 % combination of NOAC and warfarin. Compared with historical anticoagulation rates, the electronic alert was associated with a 23.6% increase in anticoagulation prescriptions. The overall 1-year rate of adherence to anticoagulant therapy was 75.4% (260/345). CONCLUSION AND RELEVANCE An electronic automated alert can successfully identify patients with AF and atrial flutter at high risk for stroke, increase oral anticoagulation prescription, and support high rates of adherence.
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Vora AN, Swaminathan RV. Posting Another Win for Intravascular Imaging: Moving Away From Angiography-Only Percutaneous Coronary Intervention Toward a More Comprehensive Approach. Circ Cardiovasc Interv 2022; 15:e011670. [PMID: 35041451 DOI: 10.1161/circinterventions.121.011670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amit N Vora
- UPMC Heart and Vascular Institute, Harrisburg, PA (A.N.V.)
| | - Rajesh V Swaminathan
- UPMC Heart and Vascular Institute, Harrisburg, PA (A.N.V.)
- Duke University Medical Center, Durham, NC (A.N.V., R.V.S.). Duke Clinical Research Institute, Durham, NC (R.V.S.)
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Gutierrez JA, Samsky MD, Schulteis RD, Gu L, Swaminathan RV, Aday AW, Rao SV. Venous thromboembolism among patients hospitalized with COVID-19 at Veterans Health Administration Hospitals. Am Heart J 2021; 237:1-4. [PMID: 33745899 PMCID: PMC7970480 DOI: 10.1016/j.ahj.2021.03.010] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/09/2021] [Indexed: 01/25/2023]
Abstract
Patients with coronavirus disease 2019 (COVID-19) are at heightened risk of venous thromboembolic events (VTE), though there is no data examining when these events occur following a COVID-19 diagnosis. We therefore sought to characterize the incidence, timecourse of events, and outcomes of VTE during the COVID-19 pandemic in a national healthcare system using data from Veterans Affairs Administration.
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Naidu SS, Abbott JD, Bagai J, Blankenship J, Garcia S, Iqbal SN, Kaul P, Khuddus MA, Kirkwood L, Manoukian SV, Patel MR, Skelding K, Slotwiner D, Swaminathan RV, Welt FG, Kolansky DM. SCAI expert consensus update on best practices in the cardiac catheterization laboratory: This statement was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS) in April 2021. Catheter Cardiovasc Interv 2021; 98:255-276. [PMID: 33909349 DOI: 10.1002/ccd.29744] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022]
Abstract
The current document commissioned by the Society for Cardiovascular Angiography and Interventions (SCAI) and endorsed by the American College of Cardiology, the American Heart Association, and Heart Rhythm Society represents a comprehensive update to the 2012 and 2016 consensus documents on patient-centered best practices in the cardiac catheterization laboratory. Comprising updates to staffing and credentialing, as well as evidence-based updates to the pre-, intra-, and post-procedural logistics, clinical standards and patient flow, the document also includes an expanded section on CCL governance, administration, and approach to quality metrics. This update also acknowledges the collaboration with various specialties, including discussion of the heart team approach to management, and working with electrophysiology colleagues in particular. It is hoped that this document will be utilized by hospitals, health systems, as well as regulatory bodies involved in assuring and maintaining quality, safety, efficiency, and cost-effectiveness of patient throughput in this high volume area.
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Affiliation(s)
- Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - J Dawn Abbott
- Cardiovascular Institute of Lifespan, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jayant Bagai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Blankenship
- Cardiology Division, The University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Sohah N Iqbal
- Mass General Brigham Salem Hospital, Salem, Massachusetts, USA
| | | | - Matheen A Khuddus
- The Cardiac and Vascular Institute and North Florida Regional Medical Center, Gainesville, Florida, USA
| | - Lorrena Kirkwood
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | | | - Manesh R Patel
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - David Slotwiner
- Division of Cardiology, New York Presbyterian, Weill Cornell Medicine Population Health Sciences, Queens, New York, USA
| | - Rajesh V Swaminathan
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Frederick G Welt
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Daniel M Kolansky
- Division of Cardiovascular Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Brophy TJ, Warsavage TJ, Hebbe AL, Plomondon ME, Waldo SW, Rao SV, DeVore AD, Gutierrez JA, Swaminathan RV. Percutaneous coronary intervention in patients with stable coronary artery disease and left ventricular systolic dysfunction: insights from the VA CART program. Am Heart J 2021; 235:149-157. [PMID: 33567318 DOI: 10.1016/j.ahj.2021.02.002] [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: 08/28/2020] [Accepted: 02/03/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Revascularization of ischemic cardiomyopathy by coronary artery bypass grafting has been shown to improve survival among patients with left ventricular ejection fraction (LVEF) ≤35%, but the role of percutaneous coronary intervention (PCI) in this context is incompletely described. This study sought to evaluate the effect of PCI on mortality and hospitalization among patients with stable coronary artery disease and reduced left ventricular ejection fraction. METHODS We performed a retrospective analysis comparing PCI with medical therapy among patients with ischemic cardiomyopathy in the Veterans Affairs Health Administration. Patients with angiographic evidence of 1 or more epicardial stenoses amenable to PCI and LVEF ≤35% were included in the analysis. Outcome data were determined by VA and non-VA data sources on mortality and hospital admission. RESULTS From 2008 through 2015, a study sample of 4,628 patients was identified, of which 1,322 patients underwent ad hoc PCI. Patients were followed to a maximum of 3 years. Propensity score weighted landmark analysis was used to evaluate the primary and secondary outcomes. The primary outcome of all-cause mortality was significantly lower in the PCI cohort compared with medical therapy (21.6% vs 30.0%, P <.001). The secondary outcome of all-cause rehospitalization or death was also lower in the PCI cohort (76.5% vs 83.8%, P <.001). CONCLUSIONS In this retrospective analysis of patients with ischemic cardiomyopathy with coronary artery disease amenable to PCI and LVEF ≤35%, revascularization by PCI was associated with decreased all-cause mortality and decreased all-cause death or rehospitalization.
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Manly DA, Karrowni W, Rymer JA, Kaltenbach LA, Swaminathan RV, Messenger JC, Abbott JD, Seto A, Panetta C, Brilakis E, Nikolakopoulos I, Gilchrist IC, Kaul P, Dakik H, Rao SV. Characteristics and Outcomes of Patients With History of CABG Undergoing Cardiac Catheterization Via the Radial Versus Femoral Approach. JACC Cardiovasc Interv 2021; 14:907-916. [PMID: 33812824 DOI: 10.1016/j.jcin.2021.01.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/18/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aims of this study were to examine rates of radial artery access in post-coronary artery bypass grafting (CABG) patients undergoing diagnostic catherization and/or percutaneous coronary intervention (PCI), whether operators with higher procedural volumes and higher percentage radial use were more likely to perform diagnostic catherization and/or PCI via the radial approach in post-CABG patients, and clinical and procedural outcomes in post-CABG patients who undergo diagnostic catherization and/or PCI via the radial or femoral approach. BACKGROUND There are limited data comparing outcomes of patients with prior CABG undergoing transradial or transfemoral diagnostic catheterization and/or PCI. METHODS Using the National Cardiovascular Data Registry CathPCI Registry, all diagnostic catheterizations and PCIs performed in patients with prior CABG from July 1, 2009, to March 31, 2018 (n = 1,279,058, 1,173 sites) were evaluated. Temporal trends in transradial access were examined, and mortality, bleeding, vascular complications, and procedural metrics were compared between transradial and transfemoral access. RESULTS The rate of transradial access increased from 1.4% to 18.7% over the study period. Transradial access was associated with decreased mortality (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.75 to 0.91), decreased bleeding (OR: 0.57; 95% CI: 0.51 to 0.63), decreased vascular complications (OR: 0.38; 95% CI: 0.30 to 0.47), increased PCI procedural success (OR: 1.11; 95% CI: 1.06 to 1.16; p < 0.0001), and significantly decreased contrast volume across all procedure types. Transradial access was associated with shorter fluoroscopy time for PCI-only procedures but longer fluoroscopy time for diagnostic procedures plus ad hoc PCI and diagnostic procedures only. Operators with a higher rate of transradial access in non-CABG patients were more likely to perform transradial access in patients with prior CABG. CONCLUSIONS The rate of transradial artery access in patients with prior CABG undergoing diagnostic catheterization and/or PCI has increased over the past decade in the United States, and it was more often performed by operators using a transradial approach in non-CABG patients. Compared with transfemoral access, transradial access was associated with improved clinical outcomes in patients with prior CABG.
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Affiliation(s)
- David A Manly
- Prisma Health-Upstate, Greenville Memorial Medical Campus, Greenville, South Carolina, USA
| | - Wassef Karrowni
- St. Luke's Hospital-Unity Point Health, Cedar Rapids, Iowa, USA
| | | | | | | | - John C Messenger
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - J Dawn Abbott
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Arnold Seto
- University of California-Irvine, Irvine, California, USA
| | | | | | | | - Ian C Gilchrist
- Penn State Heart and Vascular Institute, Hershey, Pennsylvania, USA
| | | | - Habib Dakik
- American University of Beirut, Beirut, Lebanon
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina, USA.
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13
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Weissler EH, Gutierrez JA, Patel MR, Swaminathan RV. Successful Peripheral Vascular Intervention in Patients with High-risk Comorbidities or Lesion Characteristics. Curr Cardiol Rep 2021; 23:32. [PMID: 33666765 DOI: 10.1007/s11886-021-01465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Certain comorbidities and lesion characteristics are associated with increased risk for procedural complications, limb events, and cardiovascular events following peripheral vascular intervention (PVI) in patients with peripheral arterial disease (PAD). The purpose of this review is to provide an overview of high-risk modifiable and unmodifiable patient characteristics and its relative impact on clinical outcomes such as amputation risk and mortality. Furthermore, general approaches to potentially mitigating these risks through pre-intervention planning and use of modern devices and techniques are discussed. RECENT FINDINGS Diabetes, tobacco use, and older age remain strong risk factors for the development of peripheral arterial disease. Recent data highlight the significant risk of polyvascular disease on major limb and cardiac events in advanced PAD, and ongoing studies are assessing this risk specifically after PVI. Challenging lesion characteristics such as calcified disease and chronic total occlusions can be successfully treated with PVI by utilizing novel devices (e.g., intravascular lithotripsy, re-entry devices) and techniques (e.g., subintimal arterial "flossing" with antegrade-retrograde intervention). Understanding high-risk patient comorbidities and lesion characteristics will improve our ability to counsel and manage patients with advanced PAD. Continued device innovation and novel techniques will aid in procedural planning for successful interventions to improve clinical outcomes.
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Affiliation(s)
- E Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC, USA
| | - J Antonio Gutierrez
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, Durham, NC, 27705, USA
| | - Manesh R Patel
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, Durham, NC, 27705, USA
| | - Rajesh V Swaminathan
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
- Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, Durham, NC, 27705, USA.
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14
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Gutierrez JA, Rao SV, Jones WS, Secemsky EA, Aday AW, Gu L, Schulteis RD, Krucoff MW, White R, Armstrong EJ, Banerjee S, Tsai S, Patel MR, Swaminathan RV. Survival and Causes of Death Among Veterans With Lower Extremity Revascularization With Paclitaxel-Coated Devices: Insights From the Veterans Health Administration. J Am Heart Assoc 2021; 10:e018149. [PMID: 33554613 PMCID: PMC7955346 DOI: 10.1161/jaha.120.018149] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The long‐term safety of paclitaxel‐coated devices (PCDs; drug‐coated balloon or drug‐eluting stent) for peripheral endovascular intervention is uncertain. We used data from the Veterans Health Administration to evaluate the association between PCDs, long‐term mortality, and cause of death. METHODS AND RESULTS Using the Veterans Administration Corporate Data Warehouse in conjunction with International Classification of Diseases, Tenth Revision (ICD‐10) Procedure Coding System, Current Procedural Terminology, and Healthcare Common Procedure Coding System codes, we identified patients with peripheral artery disease treated within the Veterans Administration for femoropopliteal artery revascularization between October 1, 2015, and June 30, 2019. An adjusted Cox regression, using stabilized inverse probability–weighted estimates, was used to evaluate the association between PCDs and long‐term survival. Cause of death data were obtained using the National Death Index. In total, 10 505 patients underwent femoropopliteal peripheral endovascular intervention; 2265 (21.6%) with a PCD and 8240 (78.4%) with a non‐PCD (percutaneous angioplasty balloon and/or bare metal stent). Survival rates at 2 years (77.4% versus 79.7%) and 3 years (70.7% versus 71.8%) were similar between PCD and non‐PCD groups, respectively. The adjusted hazard for all‐cause mortality for patients treated with a PCD versus non‐PCD was 1.06 (95% CI, 0.95–1.18, P=0.3013). Among patients who died between October 1, 2015, and December 31, 2017, the cause of death according to treatment group, PCD versus non‐PCD, was similar. CONCLUSIONS Among patients undergoing femoropopliteal peripheral endovascular intervention within the Veterans Administration Health Administration, there was no increased risk of long‐term, all‐cause mortality associated with PCD use. Cause‐specific mortality rates were similar between treatment groups.
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Affiliation(s)
- Jorge Antonio Gutierrez
- Division of Cardiology Department of Medicine Durham VA Medical Center Durham NC.,Division of Cardiology Duke University School of Medicine Durham NC.,Duke Clinical Research Institute Durham NC
| | - Sunil V Rao
- Division of Cardiology Department of Medicine Durham VA Medical Center Durham NC.,Division of Cardiology Duke University School of Medicine Durham NC.,Duke Clinical Research Institute Durham NC
| | - William Schuyler Jones
- Division of Cardiology Duke University School of Medicine Durham NC.,Duke Clinical Research Institute Durham NC
| | - Eric A Secemsky
- Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA.,Division of Cardiology Department of Medicine Harvard Medical School Boston MA
| | - Aaron W Aday
- Vanderbilt Translational and Clinical Cardiovascular Research Center Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville, TN
| | - Lin Gu
- Division of Cardiology Department of Medicine Durham VA Medical Center Durham NC
| | - Ryan D Schulteis
- Division of Cardiology Department of Medicine Durham VA Medical Center Durham NC
| | - Mitchell W Krucoff
- Division of Cardiology Department of Medicine Durham VA Medical Center Durham NC.,Division of Cardiology Duke University School of Medicine Durham NC.,Duke Clinical Research Institute Durham NC
| | | | - Ehrin J Armstrong
- Division of Cardiology Department of Medicine Rocky Mountain Regional VA Medical Center, Aurora CO
| | - Subhash Banerjee
- Division of Cardiology Department of Medicine Veterans Affairs North Texas Health Care System Dallas TX.,Division of Vascular Surgery Department of Surgery University of Texas Southwestern Medical Center Dallas TX
| | - Shirling Tsai
- Division of Cardiology Department of Medicine Veterans Affairs North Texas Health Care System Dallas TX.,Division of Vascular Surgery Department of Surgery University of Texas Southwestern Medical Center Dallas TX
| | - Manesh R Patel
- Division of Cardiology Duke University School of Medicine Durham NC.,Duke Clinical Research Institute Durham NC
| | - Rajesh V Swaminathan
- Division of Cardiology Department of Medicine Durham VA Medical Center Durham NC.,Division of Cardiology Duke University School of Medicine Durham NC.,Duke Clinical Research Institute Durham NC
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15
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Rymer JA, Swaminathan RV, Aday AW, Patel MR, Gutierrez JA. The Current Evidence for Lipid Management in Patients with Lower Extremity Peripheral Artery Disease: What Is the Therapeutic Target? Curr Cardiol Rep 2021; 23:13. [PMID: 33483872 DOI: 10.1007/s11886-021-01451-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW There is a lack of consistency among the ACC/AHA and ESC Guidelines on the treatment of patients with lower extremity PAD to a targeted LDL-c level. A review of the current guidelines, as well as the evidence that exists for use of various lipid-lower therapies in patients with PAD, is needed to guide clinical practice and to examine the current gaps in evidence that exist. RECENT FINDINGS There is evidence that statins and PCSK9 inhibitors reduce the risks of major adverse cardiovascular and limb events in patients with PAD. Most statin and non-statin trials have examined the association of LLT use with clinical outcomes, and not the association between the degree of LDL-c lowering and the reduction in risk of clinical outcomes. As such, there is a lack of agreement between the American and European PAD Guidelines over whether to treat patients with PAD to a targeted LDL-c goal. Both statins and PCSK9 inhibitors have been shown to reduce the risk of major cardiovascular and limb events in patients with PAD. Further research is needed to determine if target driven LDL-c lowering is associated with improved outcomes in patients with PAD.
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Affiliation(s)
- Jennifer A Rymer
- Division of Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27705, USA.
| | - Rajesh V Swaminathan
- Division of Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27705, USA
| | - Aaron W Aday
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manesh R Patel
- Division of Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27705, USA
| | - J Antonio Gutierrez
- Division of Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27705, USA
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16
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Naidu SS, Coylewright M, Hawkins BM, Meraj P, Morray BH, Devireddy C, Ing F, Klein AJ, Seto AH, Grines CL, Henry TD, Rao SV, Duffy PL, Amin Z, Aronow HD, Box LC, Caputo RP, Cigarroa JE, Cox DA, Daniels MJ, Elmariah S, Fagan TE, Feldman DN, Forbes TJ, Hermiller JB, Herrmann HC, Hijazi ZM, Jeremias A, Kavinsky CJ, Latif F, Parikh SA, Reilly J, Rosenfield K, Swaminathan RV, Szerlip M, Yakubov SJ, Zahn EM, Mahmud E, Bhavsar SS, Blumenthal T, Boutin E, Camp CA, Cromer AE, Dineen D, Dunham D, Emanuele S, Ferguson R, Govender D, Haaf J, Hite D, Hughes T, Laschinger J, Leigh SM, Lombardi L, McCoy P, McLean F, Meikle J, Nicolosi M, O'Brien J, Palmer RJ, Patarca R, Pierce V, Polk B, Prince B, Rangwala N, Roman D, Ryder K, Tolve MH, Vang E, Venditto J, Verderber P, Watson N, White S, Williams DM. Hot topics in interventional cardiology: Proceedings from the society for cardiovascular angiography and interventions 2020 think tank. Catheter Cardiovasc Interv 2020; 96:1258-1265. [PMID: 32840956 DOI: 10.1002/ccd.29197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/01/2020] [Indexed: 11/05/2022]
Abstract
The society for cardiovascular angiography and interventions (SCAI) think tank is a collaborative venture that brings together interventional cardiologists, administrative partners, and select members of the cardiovascular industry community for high-level field-wide discussions. The 2020 think tank was organized into four parallel sessions reflective of the field of interventional cardiology: (a) coronary intervention, (b) endovascular medicine, (c) structural heart disease, and (d) congenital heart disease (CHD). Each session was moderated by a senior content expert and co-moderated by a member of SCAI's emerging leader mentorship program. This document presents the proceedings to the wider cardiovascular community in order to enhance participation in this discussion, create additional dialogue from a broader base, and thereby aid SCAI and the industry community in developing specific action items to move these areas forward.
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Affiliation(s)
- Srihari S Naidu
- Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | | | - Beau M Hawkins
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | | | | - Frank Ing
- UC Davis Medical Center, Los Angeles, California, USA
| | | | - Arnold H Seto
- Long Beach VA Health Care System, Long Beach, California, USA
| | - Cindy L Grines
- Northside Cardiovascular Institute, Atlanta, Georgia, USA
| | | | - Sunil V Rao
- Duke University Hospital, Durham, North Carolina, USA
| | - Peter L Duffy
- First Health Cardiology-Pinehurst, Pinehurst, North Carolina, USA
| | - Zahid Amin
- Children's Hospital of Georgia, Augusta, Georgia, USA
| | - Herbert D Aronow
- Lifespan Cardiovascular Institute/Brown Medical School, Providence, Rhode Island, USA
| | - Lyndon C Box
- West Valley Medical Center, Caldwell, Idaho, USA
| | | | | | - David A Cox
- Cardiovascular Associates, Birmingham, Alabama, USA
| | | | - Sammy Elmariah
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas E Fagan
- Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | | | | | - James B Hermiller
- The St. Vincent Medical Group at The Heart Center, Indianapolis, Indiana, USA
| | - Howard C Herrmann
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Ziyad M Hijazi
- Weill Cornell Medical College, New York, NY. Sidra Medical and Research Center, Doha, Qatar
| | - Allen Jeremias
- St. Francis Hospital, The Heart Hospital, Roslyn, New York, USA
| | | | - Faisal Latif
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Sahil A Parikh
- New York Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - John Reilly
- Stony Brook University Hospital, Stony Brook, New York, USA
| | | | | | | | - Steve J Yakubov
- OhioHealth Heart & Vascular Physicians, Coshocton, Ohio, USA
| | - Evan M Zahn
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ehtisham Mahmud
- University of California, San Diego Sulpizio Cardiovascular Center, San Diego, California, USA
| | -
- Philips Healthcare, San Diego, California, USA
| | | | - Tico Blumenthal
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
| | | | | | | | | | | | | | | | | | - Joel Haaf
- Philips Healthcare, San Diego, California, USA
| | - Denise Hite
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
| | | | | | | | | | | | | | | | | | | | | | - Roberto Patarca
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
| | | | - Bucky Polk
- Philips Healthcare, San Diego, California, USA
| | | | | | - Dana Roman
- Janssen Pharmaceuticals, Raritan, New Jersey, USA
| | - Ken Ryder
- Abiomed, Danvers, Massachusetts, USA
| | | | - Eric Vang
- Medtronic, Minneapolis, Minnesota, USA
| | | | - Paula Verderber
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
| | - Nancy Watson
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
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17
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Feldman DN, Wang TY, Chen AY, Swaminathan RV, Kim LK, Wong SC, Minutello RM, Bergman G, Singh HS, Madias C. In-Hospital Bleeding Outcomes of Myocardial Infarction in the Era of Warfarin and Direct Oral Anticoagulants for Atrial Fibrillation in the United States: A Report From the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry. J Am Heart Assoc 2020; 8:e011606. [PMID: 30955406 PMCID: PMC6507194 DOI: 10.1161/jaha.118.011606] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background We sought to examine patient characteristics, peri‐infarction invasive and pharmacologic management, and in‐hospital major bleeding in myocardial infarction patients with atrial fibrillation or flutter, based on home anticoagulant use. Methods and Results We stratified patients by home anticoagulant: (1) no anticoagulant, (2) warfarin, and (3) direct oral anticoagulants (DOACs) among ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI (NSTEMI) patients with atrial fibrillation or flutter treated at 761 US hospitals in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry from January 2015 to December 2016. The primary outcome of our study was in‐hospital major bleeding. Multivariable logistic regression was used to examine the independent association between home anticoagulant and in‐hospital major bleeding. Among 6471 STEMI patients with atrial fibrillation or flutter, 15.7% were on warfarin and 13.0% on DOACs; among 19 954 NSTEMI patients, 22.8% were on warfarin and 15.4% on DOACs. In STEMI, door‐to‐balloon times were slightly higher in those on anticoagulant, with similar rates of angiography within 24 hours in the 3 groups. NSTEMI patients on anticoagulant were less likely to undergo angiography (49.3% no anticoagulant, 33.4% on warfarin, 36.4% on DOACs; P<0.01) or percutaneous coronary intervention within 24 hours (21.1% no anticoagulant, 14.3% on warfarin, 15.9% on DOACs; P<0.01). After multivariate adjustment, use of home warfarin (odds ratio: 1.00 [95% CI, 0.79–1.27] in STEMI and 1.13 [95% CI, 0.97–1.30] in NSTEMI) or DOAC (odds ratio: 0.93 [95% CI, 0.73–1.20] in STEMI and 0.97 [95% CI, 0.81–1.16] in NSTEMI) was not associated with increased in‐hospital major bleeding compared with no anticoagulant. Conclusions In routine clinical practice, home warfarin or DOAC therapy is not associated with an increased risk of in‐hospital bleeding compared with no anticoagulant.
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Affiliation(s)
- Dmitriy N Feldman
- 1 Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Tracy Y Wang
- 2 Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Anita Y Chen
- 2 Duke Clinical Research Institute Duke University Medical Center Durham NC
| | | | - Luke K Kim
- 1 Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - S Chiu Wong
- 1 Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Robert M Minutello
- 1 Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Geoffrey Bergman
- 1 Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Harsimran S Singh
- 1 Weill Cornell Medical College New York Presbyterian Hospital New York NY
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18
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Feldman DN, Armstrong EJ, Aronow HD, Banerjee S, Díaz-Sandoval LJ, Jaff MR, Jayasuriya S, Khan SU, Klein AJ, Parikh SA, Rosenfield K, Shishehbor MH, Swaminathan RV, White CJ. SCAI guidelines on device selection in Aorto-Iliac arterial interventions. Catheter Cardiovasc Interv 2020; 96:915-929. [PMID: 32406565 DOI: 10.1002/ccd.28947] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 01/18/2023]
Affiliation(s)
| | | | - Herbert D Aronow
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | | | | | | | - Safi U Khan
- West Virginia University, Morgantown, West Virginia, USA
| | | | - Sahil A Parikh
- Columbia University Medical Center, New York, New York, USA
| | | | - Mehdi H Shishehbor
- Univeristy Hospitals Cleveland Medical Center and Case Western Reserve, University School of Medicine, Cleveland, Ohio, USA
| | - Rajesh V Swaminathan
- Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Christopher J White
- Ochsner Clinical School, University of Queensland, AU, Ochsner Health System, New Orleans, Louisiana, USA
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19
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Szerlip M, Anwaruddin S, Aronow HD, Cohen MG, Daniels MJ, Dehghani P, Drachman DE, Elmariah S, Feldman DN, Garcia S, Giri J, Kaul P, Kapur NK, Kumbhani DJ, Meraj PM, Morray B, Nayak KR, Parikh SA, Sakhuja R, Schussler JM, Seto A, Shah B, Swaminathan RV, Zidar DA, Naidu SS. Considerations for cardiac catheterization laboratory procedures during the
COVID
‐19 pandemic perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (
SCAI ELM
) Members and Graduates. Catheter Cardiovasc Interv 2020; 96:586-597. [DOI: 10.1002/ccd.28887] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [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: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Molly Szerlip
- Department of Interventional CardiologyHeart Hospital Baylor Plano Plano Texas USA
| | - Saif Anwaruddin
- Department of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania USA
| | - Herbert D. Aronow
- Department of CardiologyLifespan Cardiovascular Institue East Providence Rhode Island USA
| | - Mauricio G. Cohen
- Cardiovascular DivisionUniversity of Miami Hospital Miami Florida USA
| | - Matthew J. Daniels
- Manchester Heart CentreManchester University NHS Foundation Trust Manchester UK
| | - Payam Dehghani
- Department of CardiologyPrairie Vascular Research Inc Regina Saskatchewan Canada
| | - Douglas E. Drachman
- Division of CardiologyMassachusetts General Hospital Boston Massachusetts USA
| | - Sammy Elmariah
- Division of CardiologyMassachusetts General Hospital Institute for Patient Care Boston Massachusetts USA
| | - Dmitriy N. Feldman
- Department of CardiologyJoan and Sanford I Weill Medical College of Cornell University New York New York USA
- Weill Cornell Medical College/NY Presbyterian Hospital
| | - Santiago Garcia
- Department of Interventional CardiologyMinneapolis Heart Institute at Abbott Northwestern Hospital Minneapolis Minnesota USA
| | - Jay Giri
- Department of CardiologyUniversity of Pennsylvania Philadelphia Pennsylvania USA
| | - Prashant Kaul
- Department of CardiologyPiedmont Atlanta Hospital Atlanta Georgia USA
| | - Navin K. Kapur
- Department of CardiologyTufts Medical Center Boston Massachusetts USA
| | | | - Perwaiz M. Meraj
- Department of CardiologyHofstra Northwell School of Medicine Hempstead New York USA
- Zucker School of Medicine at Hofstra/Northwell health
| | - Brian Morray
- Department of PediatricsSeattle Children's Hospital Seattle Washington USA
| | - Keshav R. Nayak
- Department of CardiologyScripps Mercy Hospital San Diego San Diego California USA
| | - Sahil A. Parikh
- Center for Interventional Vascular TherapyColumbia University Medical Center/NY Presbyterian Hospital Brooklyn New York USA
| | - Rahul Sakhuja
- Department of Interventional CardiologyMassachusetts General Hospital Boston Massachusetts USA
| | | | - Arnold Seto
- Department of CardiologyVeterans affairs Washington District of Columbia USA
- University of California Irvine
| | - Binita Shah
- Department of Internal Medicine, CardiologyNew York University School of Medicine New York New York USA
| | - Rajesh V. Swaminathan
- Department of CardiologyDuke University School of Medicine Durham North Carolina USA
| | - David A. Zidar
- Department of CardiologyCase Western Reserve University Hospital Cleveland Ohio USA
| | - Srihari S. Naidu
- Department of CardiologyWestchester Medical Center and New York Medical College Valhalla New York USA
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20
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Affiliation(s)
- Rajesh V Swaminathan
- 1 Division of Cardiology Department of Medicine Duke University School of Medicine and the Duke Clinical Research Institute Durham NC
| | - W Schuyler Jones
- 1 Division of Cardiology Department of Medicine Duke University School of Medicine and the Duke Clinical Research Institute Durham NC
| | - Manesh R Patel
- 1 Division of Cardiology Department of Medicine Duke University School of Medicine and the Duke Clinical Research Institute Durham NC
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21
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O’Connor KD, Brophy T, Fonarow GC, Blankstein R, Swaminathan RV, Xu H, Matsouaka RA, Albert NM, Velazquez EJ, Yancy CW, Heidenreich PA, Hernandez AF, DeVore AD. Testing for Coronary Artery Disease in Older Patients With New-Onset Heart Failure: Findings From Get With The Guidelines-Heart Failure. Circ Heart Fail 2020; 13:e006963. [PMID: 32207996 PMCID: PMC10790075 DOI: 10.1161/circheartfailure.120.006963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current guidelines recommend evaluation for underlying heart disease and reversible conditions for patients with new-onset heart failure (HF). There are limited data on contemporary testing for coronary artery disease (CAD) in patients with new-onset HF. METHODS We performed an observational cohort study using the Get With The Guidelines-Heart Failure registry linked to Medicare claims. All patients were aged ≥65 and hospitalized for new-onset HF from 2009 to 2015. We collected left ventricular ejection fraction (LVEF), prior HF history, and in-hospital CAD testing from the registry, as well as testing for CAD using claims from 90 days before to 90 days after index HF hospitalization. RESULTS Among 17 185 patients with new-onset HF, 6672 (39%) received testing for CAD, including 3997 (23%) during the index hospitalization. Testing for CAD differed by LVEF: 53% in HF with reduced EF (LVEF ≤40%), 42% in HF with borderline EF (LVEF, 41%-49%), and 31% in HF with preserved EF (LVEF ≥50%). After multivariable adjustment, patients who received testing for CAD, compared with those who did not, were younger and more likely to be male, have a smoking history, have hyperlipidemia, and have HF with reduced ejection fraction or HF with borderline ejection fraction (all P<0.05). CONCLUSIONS The majority of patients hospitalized for new-onset HF did not receive testing for CAD either during the hospitalization or in the 90 days before and after. The rates of testing for CAD were higher in patients with LVEF ≤40% though remained low. These data highlight an opportunity to improve care by identifying appropriate candidates for optimal CAD medical therapy and revascularization.
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Affiliation(s)
- Kyle D. O’Connor
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC
| | - Todd Brophy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Gregg C. Fonarow
- Division of Cardiology, University of California, Los Angeles, CA
| | - Ron Blankstein
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA
| | | | - Haolin Xu
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC
| | - Roland A. Matsouaka
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Nancy M. Albert
- Office of Nursing Research and Innovation, Cleveland Clinic, Cleveland, OH
| | - Eric J. Velazquez
- Department of Medicine, Division of Cardiology, Yale University School of Medicine, New Haven, CT
| | - Clyde W. Yancy
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Paul A. Heidenreich
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Medicine, Division of Cardiology, Stanford University, Stanford, CA
| | - Adrian F. Hernandez
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC
| | - Adam D. DeVore
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC
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O'Connor K, Brophy T, Fonarow GC, Blankstein R, Swaminathan RV, Xu H, Matsouaka R, Albert NM, Velazquez EJ, Yancy CW, Heidenreich PA, Hernandez A, DeVore A. LIMITED TESTING FOR CORONARY ARTERY DISEASE IN PATIENTS WITH NEW-ONSET HEART FAILURE: FINDINGS FROM GET WITH THE GUIDELINES - HEART FAILURE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gutierrez JA, Swaminathan RV. Correcting the Cold Foot: Surgery or Endovascular? Circ Cardiovasc Interv 2020; 13:e008790. [PMID: 31948268 DOI: 10.1161/circinterventions.119.008790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J Antonio Gutierrez
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC
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Abstract
Peripheral vascular intervention (PVI) improves quality of life and reduces major adverse limb events in patients with peripheral arterial disease. PVI is commonly performed via the femoral artery, and the most common adverse periprocedural event is a vascular access complication. Transradial access for PVI has the potential to reduce vascular access complications and improve patient outcomes. Further study is needed to elucidate the risks of stroke, acute kidney injury, and radiation exposure in the setting of transradial PVI. As transradial access for PVI progresses, it will be important to build the evidence base along with procedural experience.
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Affiliation(s)
| | - Sunil V Rao
- Division of Cardiology, Duke Clinical Research Institute, Duke University, 200 Morris Street, Durham, NC 27701, USA
| | - Rajesh V Swaminathan
- Division of Cardiology, Duke Clinical Research Institute, Duke University, 200 Morris Street, Durham, NC 27701, USA
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Abstract
PURPOSE OF REVIEW To review the contemporary evidence for robotic-assisted percutaneous coronary and vascular interventions, discussing its current capabilities, limitations, and potential future applications. RECENT FINDINGS Robotic-assisted cardiovascular interventions significantly reduce radiation exposure and orthopedic strains for interventionalists, while maintaining high rates of device and clinical success. The PRECISE and CORA-PCI studies demonstrated the safety and efficacy of robotic-assisted percutaneous coronary intervention (PCI) in increasingly complex coronary lesions. The RAPID study demonstrated similar findings in peripheral vascular interventions (PVI). Subsequent studies have demonstrated the safety and efficacy of second-generation devices, with automations mimicking manual PCI techniques. While innovations such as telestenting continue to bring excitement to the field, major limitations remain-particularly the lack of randomized trials comparing robotic-assisted PCI with manual PCI. Robotic technology has successfully been applied to multiple cardiovascular procedures. There are limited data to evaluate outcomes with robotic-assisted PCI and other robotic-assisted cardiovascular procedures, but existing data show some promise of improving the precision of PCI while decreasing occupational hazards associated with radiation exposure.
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Affiliation(s)
- Zachary K Wegermann
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA. .,Duke Clinical Research Institute, Durham, NC, USA.
| | - Rajesh V Swaminathan
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Sunil V Rao
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
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Gutierrez JA, Bhatt DL, Banerjee S, Glorioso TJ, Josey KP, Swaminathan RV, Maddox TM, Armstrong EJ, Duvernoy C, Waldo SW, Rao SV. Risk of obstructive coronary artery disease and major adverse cardiac events in patients with noncoronary atherosclerosis: Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) Program. Am Heart J 2019; 213:47-56. [PMID: 31102799 DOI: 10.1016/j.ahj.2019.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/07/2019] [Indexed: 11/30/2022]
Abstract
We sought to determine the risk of obstructive coronary artery disease (oCAD) associated with noncoronary atherosclerosis (cerebrovascular disease [CVD] or peripheral arterial disease [PAD]) and major adverse cardiac events following percutaneous coronary intervention (PCI). METHODS Rates of the angiographic end point of oCAD were compared among patients with and without noncoronary atherosclerosis undergoing coronary angiography within the Veterans Health Administration between October 2007 and August 2015. The primary angiographic end point of oCAD was defined as left main stenosis ≥50% or any stenosis ≥70% in 1, 2, or 3 vessels. In patients who proceeded to PCI, the rate of the composite clinical end point of death, myocardial infarction, or stroke was compared among those with concomitant noncoronary atherosclerosis (CVD, PAD, or CVD + PAD) versus isolated CAD. RESULTS Among 233,353 patients undergoing angiography, 9.6% had CVD, 12.4% had PAD, and 6.1% had CVD + PAD. Rates of oCAD were 57.9% for neither CVD nor PAD, 66.4% for CVD, 73.6% for PAD, and 80.9% for CVD + PAD. Compared with patients without noncoronary atherosclerosis, the adjusted risk of oCAD with CVD, PAD, or CVD + PAD was 1.03 (95% CI 1.02-1.04), 1.10 (95% CI 1.09-1.11), and 1.12 (95% CI 1.11-1.13), respectively. In patients who underwent PCI, the adjusted hazard for death, myocardial infarction, or stroke among those with CVD, PAD, or CVD + PAD was 1.36 (95% CI 1.26-1.45), 1.53 (95% CI 1.45-1.62), and 1.72 (95% CI 1.59-1.86), respectively. CONCLUSIONS In patients undergoing coronary angiography, noncoronary atherosclerosis was associated with increased burden of oCAD and adverse events post-PCI.
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Affiliation(s)
- J Antonio Gutierrez
- Durham VA Medical Center, Duke Clinical Research Institute, Duke University, School of Medicine, Durham, NC.
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA
| | - Subhash Banerjee
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center and VA North Texas Health Care System, Dallas, TX
| | | | | | - Rajesh V Swaminathan
- Durham VA Medical Center, Duke Clinical Research Institute, Duke University, School of Medicine, Durham, NC
| | - Thomas M Maddox
- Cardiology Division, Washington University School of Medicine, St Louis, MO
| | | | - Claire Duvernoy
- VA Ann Arbor Healthcare System, University of Michigan Health System, Ann Arbor, MI
| | | | - Sunil V Rao
- Durham VA Medical Center, Duke Clinical Research Institute, Duke University, School of Medicine, Durham, NC
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Fanaroff AC, Swaminathan RV. Physiologic Assessment of Stent Deployment. Circ Cardiovasc Interv 2019; 12:e007955. [PMID: 31018665 DOI: 10.1161/circinterventions.119.007955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexander C Fanaroff
- Duke University Medical Center, the Duke Clinical Research Institute, Durham, NC
| | - Rajesh V Swaminathan
- Duke University Medical Center, the Duke Clinical Research Institute, Durham, NC
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Kim LK, Yeo I, Cheung JW, Swaminathan RV, Wong SC, Charitakis K, Adejumo O, Chae J, Minutello RM, Bergman G, Singh H, Feldman DN. Thirty-Day Readmission Rates, Timing, Causes, and Costs after ST-Segment-Elevation Myocardial Infarction in the United States: A National Readmission Database Analysis 2010-2014. J Am Heart Assoc 2018; 7:e009863. [PMID: 30371187 PMCID: PMC6222940 DOI: 10.1161/jaha.118.009863] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/23/2018] [Indexed: 01/14/2023]
Abstract
Background Readmission after ST-segment-elevation myocardial infarction ( STEMI ) poses an enormous economic burden to the US healthcare system. Efforts to prevent readmissions should be based on understanding the timing and causes of these readmissions. This study aimed to investigate contemporary causes, timing, and cost of 30-day readmissions after STEMI . Methods and Results All STEMI hospitalizations were selected in the Nationwide Readmissions Database ( NRD ) from 2010 to 2014. The 30-day readmission rate as well as the primary cause and cost of readmission were examined. Multivariate regression analysis was performed to identify the predictors of 30-day readmission and increased cumulative cost. From 2010 to 2014, the 30-day readmission rate after STEMI was 12.3%. Within 7 days of discharge, 43.9% were readmitted, and 67.3% were readmitted within 14 days. The annual rate of 30-day readmission decreased by 19% from 2010 to 2014 ( P<0.001). Female sex, AIDS , anemia, chronic kidney disease , collagen vascular disease, diabetes mellitus, hypertension, pulmonary hypertension, congestive heart failure , atrial fibrillation, and increased length of stay were independent predictors of 30-day readmission. A large proportion of patients (41.6%) were readmitted for noncardiac reasons. After multivariate adjustment, 30-day readmission was associated with a 47.9% increase in cumulative cost ( P<0.001). Conclusions Two thirds of patients were readmitted within the first 14 days after STEMI , and a large proportion of patients were readmitted for noncardiac reasons. Thirty-day readmission was associated with an ≈50% increase in cumulative hospitalization costs. These findings highlight the importance of closer surveillance of both cardiac and general medical conditions in the first several weeks after STEMI discharge.
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Affiliation(s)
- Luke K. Kim
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Ilhwan Yeo
- Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Jim W. Cheung
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | | | - S. Chiu Wong
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Konstantinos Charitakis
- Department of CardiologyMcGovern Medical SchoolUniversity of Texas Health Science CenterHoustonTX
| | - Oluwayemisi Adejumo
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - John Chae
- Weill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Robert M. Minutello
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Geoffrey Bergman
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Harsimran Singh
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Dmitriy N. Feldman
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
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Kampaktsis PN, Ullal AV, Swaminathan RV, Minutello RM, Kim L, Bergman GS, Feldman DN, Singh H, Wong SC, Okin PM. Absence of electrocardiographic left ventricular hypertrophy is associated with increased mortality after transcatheter aortic valve replacement. Clin Cardiol 2018; 41:1246-1251. [PMID: 30062778 DOI: 10.1002/clc.23034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/27/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Electrocardiographic (ECG) left ventricular hypertrophy (LVH) has been associated with increased mortality in patients with asymptomatic aortic stenosis (AS) and hypertension. However, patients with symptomatic AS undergoing transcatheter aortic valve replacement (TAVR) have higher percentages of myocardial fibrosis or amyloidosis that have been associated with decreased ECG voltage and worse outcomes. HYPOTHESIS We tested the hypothesis that baseline ECG LVH is independently associated with increased all-cause mortality after TAVR. METHODS A total of 231 patients (96 men; mean age 84.7 ± 7.8 years) that underwent TAVR at our institution were included. Cornell voltage, defined as SV3 + RaVL, was used to assess for presence of ECG LVH using gender-specific cut-off values. We used the Kaplan-Meier estimator to derive survival curves. Multivariate Cox regression analysis was used to compare mortality between patients without vs with ECG LVH and adjust for echocardiographic LVH and predictors of mortality in this cohort. RESULTS Over a follow-up time of 16.3 ± 10.4 months, the absence of ECG LVH was significantly associated with increased mortality (40.4% vs 23.6% at 2-years, log rank P = 0.003). After adjusting for echocardiographic LVH and predictors of mortality in our cohort, the absence of ECG LVH remained a predictor of increased mortality (HR = 1.79, CI 95% 1.02-3.14, P = 0.042). CONCLUSIONS The absence of ECG LVH was independently associated with increased mortality in patients undergoing TAVR. Baseline ECG may have an important prognostic role in these patients and could lead to further testing to evaluate for myocardial fibrosis or amyloidosis.
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Affiliation(s)
| | - Ajayram V Ullal
- Department of Cardiology, Harbor-UCLA Medical Center, Torrance, California
| | | | - Robert M Minutello
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Luke Kim
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Geoffrey S Bergman
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Dmitriy N Feldman
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Harsimran Singh
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Shing Chiu Wong
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Peter M Okin
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York
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Kim LK, Yeo I, Cheung J, Feldman DN, Swaminathan RV, Kamel H. Impact of Evolving Comorbidities on Outcomes After Catheter Ablation of Atrial Fibrillation in the United States Between 2003 and 2013. JACC Clin Electrophysiol 2018; 4:704-706. [DOI: 10.1016/j.jacep.2017.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 12/26/2017] [Accepted: 12/28/2017] [Indexed: 11/25/2022]
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Seto AH, Shroff A, Abu-Fadel M, Blankenship JC, Boudoulas KD, Cigarroa JE, Dehmer GJ, Feldman DN, Kolansky DM, Lata K, Swaminathan RV, Rao SV. Length of stay following percutaneous coronary intervention: An expert consensus document update from the society for cardiovascular angiography and interventions. Catheter Cardiovasc Interv 2018; 92:717-731. [DOI: 10.1002/ccd.27637] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Arnold H. Seto
- Department of Medicine; Long Beach Veterans Affairs Healthcare System, Long Beach, California
| | - Adhir Shroff
- Department of Medicine; University of Illinois at Chicago, Chicago, Illinois
| | - Mazen Abu-Fadel
- Department of Internal Medicine, Section of Cardiovascular Medicine; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - James C. Blankenship
- Department of Cardiology, Section of Interventional Cardiology; Geisinger Medical Center, Danville, Pennsylvania
| | | | - Joaquin E. Cigarroa
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Gregory J. Dehmer
- Department of Medicine (Cardiology Division) Texas A&M University College of Medicine; Scott & White Medical Center; Temple Texas
| | - Dmitriy N. Feldman
- New York-Presbyterian Hospital; Weill Cornell Medical College; New York New York
| | - Daniel M. Kolansky
- Cardiovascular Medicine Division; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kusum Lata
- Sutter Tracy Community Hospital, Sutter Medical Network, Tracy, California
| | | | - Sunil V. Rao
- Division of Cardiology; Duke Clinical Research Institute, Durham, North Carolina
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Feldman DN, Armstrong EJ, Aronow HD, Gigliotti OS, Jaff MR, Klein AJ, Parikh SA, Prasad A, Rosenfield K, Shishehbor MH, Swaminathan RV, White CJ. SCAI consensus guidelines for device selection in femoral-popliteal arterial interventions. Catheter Cardiovasc Interv 2018; 92:124-140. [DOI: 10.1002/ccd.27635] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [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: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Herbert D. Aronow
- The Warren Alpert Medical School of Brown University; Providence Rhode Island
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Swaminathan RV, Rao SV. Robotic-assisted transradial diagnostic coronary angiography. Catheter Cardiovasc Interv 2018; 92:54-57. [DOI: 10.1002/ccd.27480] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/15/2017] [Accepted: 12/08/2017] [Indexed: 11/07/2022]
Affiliation(s)
| | - Sunil V. Rao
- Durham VA Medical Center, 508 Fulton Street; Durham North Carolina 27705
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Al'Aref SJ, Swaminathan RV, Feldman DN. Endovascular therapy of axillary artery disease with drug-coated balloon angioplasty. Proc (Bayl Univ Med Cent) 2017; 30:431-434. [PMID: 28966454 DOI: 10.1080/08998280.2017.11930217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The occurrence of upper-extremity arterial disease is less common than that of the lower extremities. Nevertheless, exercise-induced symptoms, when present, can significantly affect functional capacity and limit quality of life. We report a case of exertional right upper-extremity pain and severe right axillary artery disease that was revascularized using an off-label drug-coated balloon technology with resolution of symptoms.
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Affiliation(s)
- Subhi J Al'Aref
- Dalio Institute of Cardiovascular Imaging, New York Presbyterian Hospital, New York, New York (Al'Aref); Duke University Medical Center and the Duke Clinical Research Institute, Durham, North Carolina (Swaminathan); and Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York (Feldman)
| | - Rajesh V Swaminathan
- Dalio Institute of Cardiovascular Imaging, New York Presbyterian Hospital, New York, New York (Al'Aref); Duke University Medical Center and the Duke Clinical Research Institute, Durham, North Carolina (Swaminathan); and Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York (Feldman)
| | - Dmitriy N Feldman
- Dalio Institute of Cardiovascular Imaging, New York Presbyterian Hospital, New York, New York (Al'Aref); Duke University Medical Center and the Duke Clinical Research Institute, Durham, North Carolina (Swaminathan); and Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York (Feldman)
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Feldman DN, Swaminathan RV, Geleris JD, Okin P, Minutello RM, Krishnan U, McCormick DJ, Bergman G, Singh H, Wong SC, Kim LK. Comparison of Trends and In-Hospital Outcomes of Concurrent Carotid Artery Revascularization and Coronary Artery Bypass Graft Surgery: The United States Experience 2004 to 2012. JACC Cardiovasc Interv 2017; 10:286-298. [PMID: 28183469 DOI: 10.1016/j.jcin.2016.11.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to compare trends and outcomes of 3 approaches to carotid revascularization in the coronary artery bypass graft (CABG) population when performed during the same hospitalization. BACKGROUND The optimal approach to managing coexisting severe carotid and coronary disease remains controversial. Carotid endarterectomy (CEA) or carotid artery stenting (CAS) are used to decrease the risk of stroke in patients with carotid disease undergoing CABG surgery. METHODS The authors conducted a serial, cross-sectional study with time trends of 3 revascularization groups during the same hospital admission: 1) combined CEA+CABG; 2) staged CEA+CABG; and 3) staged CAS+CABG from the Nationwide Inpatient Sample database 2004 to 2012. The primary composite endpoints were in-hospital all-cause death, stroke, and death/stroke. RESULTS During the 9-year period, 22,501 concurrent carotid revascularizations and CABG surgeries during the same hospitalization were performed. Of these, 15,402 (68.4%) underwent combined CEA+CABG, 6,297 (28.0%) underwent staged CEA+CABG, and 802 (3.6%) underwent staged CAS+CABG. The overall rate of CEA+CABG decreased by 16.1% (ptrend = 0.03) from 2004 to 2012, whereas the rate of CAS+CABG did not significantly change during these years (ptrend = 0.10). The adjusted risk of death was greater, whereas risk of stroke was lower with both combined CEA+CABG (death odds ratio [OR]: 2.08, 95% confidence interval [CI]: 1.08 to 3.97; p = 0.03; stroke OR: 0.65, 95% CI: 0.42 to 1.01; p = 0.06) and staged CEA+CABG (death OR: 2.40, 95% CI: 1.43 to 4.05; p = 0.001; stroke OR: 0.50, 95% CI: 0.31 to 0.80; p = 0.004) approaches compared with CAS+CABG. The adjusted risk of death or stroke was similar in the 3 groups. CONCLUSIONS In patients with concomitant carotid and coronary disease undergoing combined revascularization, combined CEA+CABG is utilized most frequently, followed by staged CEA+CABG and staged CAS+CABG strategies. The staged CAS+CABG strategy was associated with lower risk of mortality, but higher risk of stroke. Future studies are needed to examine the risks/benefits of different carotid revascularization strategies for high-risk patients requiring concurrent CABG.
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Affiliation(s)
- Dmitriy N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
| | - Rajesh V Swaminathan
- Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
| | - Joshua D Geleris
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Peter Okin
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Robert M Minutello
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Udhay Krishnan
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Daniel J McCormick
- Department of Cardiovascular Medicine, Pennsylvania Hospital-University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Geoffrey Bergman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Harsimran Singh
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - S Chiu Wong
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Luke K Kim
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
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Zhong M, Kim LK, Swaminathan RV, Feldman DN. Renal Denervation to Modify Hypertension and the Heart Failure State. Interv Cardiol Clin 2017; 6:453-464. [PMID: 28600097 DOI: 10.1016/j.iccl.2017.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sympathetic overactivation of renal afferent and efferent nerves have been implicated in the development and maintenance of several cardiovascular disease states, including resistant hypertension and heart failure with both reduced and preserved systolic function. With the development of minimally invasive catheter-based techniques, percutaneous renal denervation has become a safe and effective method of attenuating sympathetic overactivation. Percutaneous renal denervation, therefore, has the potential to modify and treat hypertension and congestive heart failure. Although future randomized controlled studies are needed to definitively prove its efficacy, renal denervation has the potential to change the way we view and treat cardiovascular disease.
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Affiliation(s)
- Ming Zhong
- Division of Cardiology, Interventional Cardiology and Endovascular Laboratory, Weill Cornell Medical College, New York Presbyterian Hospital, 520 East 70th street, New York, NY 10021, USA
| | - Luke K Kim
- Division of Cardiology, Interventional Cardiology and Endovascular Laboratory, Weill Cornell Medical College, New York Presbyterian Hospital, 520 East 70th street, New York, NY 10021, USA
| | - Rajesh V Swaminathan
- Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA
| | - Dmitriy N Feldman
- Division of Cardiology, Interventional Cardiology and Endovascular Laboratory, Weill Cornell Medical College, New York Presbyterian Hospital, 520 East 70th street, New York, NY 10021, USA.
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Abstract
Coronary angiography has traditionally been used as the final diagnostic tool in the evaluation of coronary artery disease (CAD). However, conventional angiography identifies anatomically obstructive coronary disease, but it is limited in its ability to identify hemodynamically significant lesions. The emergence of fractional flow reserve (FFR) technology, in conjunction with angiography, offers a functional, as well as anatomic, assessment of epicardial coronary obstructions. Several pivotal studies have demonstrated that FFR-guided coronary revascularization is a safe and effective in patients with single and multivessel CAD. There are emerging data to suggest that FFR may also play an integral role in planning surgical revascularization and in the evaluation of post-coronary artery bypass patients and their graft patency. This review will explore the physiologic underpinnings of FFR methodology, its clinical value and limitations, and its applications in coronary artery bypass grafting (CABG) surgery.
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Affiliation(s)
- Tara Shah
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
| | - Joshua D Geleris
- Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
| | - Ming Zhong
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
| | - Rajesh V Swaminathan
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC 27705, USA
| | - Luke K Kim
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
| | - Dmitriy N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
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Goyal P, Paul T, Almarzooq ZI, Peterson JC, Krishnan U, Swaminathan RV, Feldman DN, Wells MT, Karas MG, Sobol I, Maurer MS, Horn EM, Kim LK. Sex- and Race-Related Differences in Characteristics and Outcomes of Hospitalizations for Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2017; 6:JAHA.116.003330. [PMID: 28356281 PMCID: PMC5532983 DOI: 10.1161/jaha.116.003330] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Sex and race have emerged as important contributors to the phenotypic heterogeneity of heart failure with preserved ejection fraction (HFpEF). However, there remains a need to identify important sex‐ and race‐related differences in characteristics and outcomes using a nationally representative cohort. Methods and Results Data were obtained from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project—Nationwide Inpatient Sample files between 2008 and 2012. Hospitalizations with a diagnosis of HFpEF were included for analysis. Demographics, hospital characteristics, and age‐adjusted comorbidity prevalence rates were compared between men and women and whites and blacks. In‐hospital mortality was determined and compared for each subgroup. Multivariable regression analyses were used to identify and compare correlates of in‐hospital mortality for each subgroup. A sample of 1 889 608 hospitalizations was analyzed. Men with HFpEF were slightly younger than women with HFpEF and had a higher Elixhauser comorbidity score. Men experienced higher in‐hospital mortality compared with women, a finding that was attenuated after adjusting for comorbidity. Blacks with HFpEF were younger than whites with HFpEF, with lower rates of most comorbidities. Hypertension, diabetes, anemia, and chronic renal failure were more common among blacks. Blacks experienced lower in‐hospital mortality compared with whites, even after adjusting for age and comorbidity. Important correlates of mortality among all 4 subgroups included pulmonary circulation disorders, liver disease, and chronic renal failure. Atrial fibrillation was an important correlate of mortality only among women and blacks. Conclusions Differences in patient characteristics and outcomes reinforce the notion that sex and race contribute to the phenotypic heterogeneity of HFpEF.
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Affiliation(s)
- Parag Goyal
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY .,Division of Clinical Epidemiology and Evaluative Sciences Research, Weill Cornell Medical College, New York, NY
| | - Tracy Paul
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Zaid I Almarzooq
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Janey C Peterson
- Division of Clinical Epidemiology and Evaluative Sciences Research, Weill Cornell Medical College, New York, NY
| | - Udhay Krishnan
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
| | | | - Dmitriy N Feldman
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Martin T Wells
- Departments of Statistical Science and Social Statistics, Cornell University, Ithaca, NY
| | - Maria G Karas
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Irina Sobol
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Mathew S Maurer
- Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY
| | - Evelyn M Horn
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Luke K Kim
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
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Armstrong EJ, Chhatriwalla AK, Szerlip M, Swaminathan RV, Patel RAG. Late breaking trials of 2016 in structural heart disease and peripheral artery disease: Commentary covering ACC, EuroPCR, SCAI, TCT, VIVA, ESC, and AHA. Catheter Cardiovasc Interv 2017; 89:1093-1099. [PMID: 28303672 DOI: 10.1002/ccd.27004] [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] [Received: 01/12/2017] [Accepted: 02/04/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Ehrin J Armstrong
- University of Colorado and Denver VA Medical Center, Denver, Colorado
| | | | | | - Rajesh V Swaminathan
- Division of Cardiology, Duke University Medical Center and the Duke Clinical Research Institute, Durham, North Carolina
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Cheung JW, Ip JE, Markowitz SM, Liu CF, Thomas G, Feldman DN, Swaminathan RV, Lerman BB, Kim LK. Trends and outcomes of cardiac resynchronization therapy upgrade procedures: A comparative analysis using a United States National Database 2003-2013. Heart Rhythm 2017; 14:1043-1050. [PMID: 28214565 DOI: 10.1016/j.hrthm.2017.02.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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] [Received: 12/26/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND While outcomes after de novo cardiac resynchronization therapy (CRT) implantations have been reported, there are limited data on CRT upgrade procedures. OBJECTIVE The purpose of this study was to examine trends and in-hospital outcomes of patients undergoing CRT upgrade procedures by using a large national inpatient database. METHODS Using the National Inpatient Sample database, we identified all patients undergoing CRT upgrade and de novo CRT implants between 2003 and 2013. Rates of in-hospital adverse events such as death, cardiac perforation, pneumothorax, and lead revision were examined. Multivariate regression analysis was performed to compare outcomes after CRT upgrade and those after de novo CRT implant procedures. RESULTS Between 2003 and 2013, 19,546 CRT upgrade procedures and 464,246 de novo CRT implants were recorded. Rates of in-hospital mortality of patients undergoing CRT upgrade were significantly higher than those of patients undergoing de novo CRT implant (1.9% vs 0.8%; P < .001). Compared with de novo CRT implants, CRT upgrades were independently associated with increased mortality (adjusted odds ratio [OR] 1.91; 95% confidence interval [CI] 1.67-2.19; P < .001), cardiac perforation (OR 3.20; 95% CI 2.71-3.77; P < .001), and need for lead revision (OR 2.09; 95% CI 1.88-2.3; P < .001). CONCLUSION In a large national inpatient cohort, CRT upgrade procedures were associated with higher rates of in-hospital mortality and procedural complications as compared with de novo CRT implants.
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Affiliation(s)
- Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York.
| | - James E Ip
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Steven M Markowitz
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Christopher F Liu
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - George Thomas
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Dmitriy N Feldman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Rajesh V Swaminathan
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Bruce B Lerman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Luke K Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York
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Affiliation(s)
- Rajesh V. Swaminathan
- From the Division of Cardiology, Duke University Medical Center and the Duke Clinical Research Institute, Durham, NC
| | - Sunil V. Rao
- From the Division of Cardiology, Duke University Medical Center and the Duke Clinical Research Institute, Durham, NC
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Voudris KV, Wong SC, Kaple R, Kampaktsis PN, de Biasi AR, Weiss JS, Devereux R, Krieger K, Kim L, Swaminathan RV, Feldman DN, Singh H, Skubas NJ, Minutello RM, Bergman G, Salemi A. Transapical transcatheter aortic valve replacement in patients with or without prior coronary artery bypass graft operation. J Cardiothorac Surg 2016; 11:158. [PMID: 27899140 PMCID: PMC5129212 DOI: 10.1186/s13019-016-0551-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 11/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background Transapical approach (TA) is an established access alternative to the transfemoral technique in patients undergoing transcatheter aortic valve replacement (TAVR) for treatment of symptomatic aortic valve stenosis. The impact of prior coronary artery bypass grafting (CABG) on clinical outcomes in patients undergoing TA-TAVR is not well defined. Methods A single center retrospective cohort analysis of 126 patients (male 41%, mean age 85.8 ± 6.1 years) who underwent TA balloon expandable TAVR (Edwards SAPIEN, SAPIEN XT or SAPIEN 3) was performed. Patients were classified as having prior CABG (n = 45) or no prior CABG (n = 81). Baseline clinical characteristics, in-hospital, 30-day, 6 months and one-year clinical outcomes were compared. Results Compared to patients without prior CABG, CABG patients were more likely to be male (62.2 vs. 29.6%, p < 0.001) with a higher STS score (11.66 ± 5.47 vs. 8.99 ± 4.19, p = 0.003), history of myocardial infarction (55 vs. 21.1%, p < 0.001), implantable cardioverter defibrillator (17.8 vs. 3.7%, p = 0.017), left main coronary artery disease (42.2 vs. 4.9%, p < 0.001), and proximal left anterior descending coronary artery stenosis (57.8 vs. 16%, p < 0.001). They also presented with a lower left ventricular ejection fraction (%) (42.3 ± 15.3 vs. 54.3 ± 11.6, p < 0.01) and a larger effective valve orifice area (0.75 ± 0.20 cm2 vs. 0.67 ± 0.14 cm2, p = 0.025). There were no intra-procedural deaths, no differences in stroke (0 vs. 1.2%, p = 1.0), procedure time in hours (3.50 ± 0.80 vs. 3.26 ± 0.86, p = 0.127), re-intubation rate (8.9 vs. 8.6% p = 1.0), and renal function (highest creatinine value 1.73 ± 0.71 mg/ml vs.1.88 ± 1.15 mg/ml, p = 0.43). All-cause mortality at 6 months was similar in both groups (11.4, vs. 17.3% p = 0.44), and one-year survival was 81.8 and 77.8% respectively (p = 0.51). On multivariate analysis, the only factor significantly associated with one-year mortality was prior history of stroke (HR, 2.76; 95% CI, 1.06-7.17, p = 0.037). Conclusion Despite the higher baseline clinical risk profile, patients with history of prior CABG undergoing TA-TAVR had comparable in-hospital, 6 months and one-year clinical outcomes to those without prior CABG.
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Affiliation(s)
- Konstantinos V Voudris
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - S Chiu Wong
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Ryan Kaple
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Polydoros N Kampaktsis
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Andreas R de Biasi
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Jonathan S Weiss
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Richard Devereux
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Karl Krieger
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Luke Kim
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Rajesh V Swaminathan
- Department of Cardiology, Duke University Medical Center and the Duke Clinical Research Institute, Durham, NC, USA
| | - Dmitriy N Feldman
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Harsimran Singh
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Nikolaos J Skubas
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Robert M Minutello
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Geoffrey Bergman
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Arash Salemi
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA. .,Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
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Feldman DN, Aronow HD, Swaminathan RV, Dawn Abbott J, Tremmel JA, Kapur NK, Breinholt JP, Asgar AW, Pinto DS, Tu TM, Rosenfield KM, Naidu SS. Investing in our future: Update on the SCAI Emerging Leader Mentorship (ELM) Program. Catheter Cardiovasc Interv 2016; 88:674-677. [DOI: 10.1002/ccd.26814] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Herbert D. Aronow
- Warren Alpert Medical School of Brown University; Providence; Rhode Island
| | - Rajesh V. Swaminathan
- Duke University Medical Center; Duke Clinical Research Institute; Durham North Carolina
| | - J. Dawn Abbott
- Warren Alpert Medical School of Brown University; Providence; Rhode Island
| | - Jennifer A. Tremmel
- Stanford University Medical Center, Department of Medicine (Cardiovascular); Stanford California
| | | | | | | | - Duane S. Pinto
- Beth Israel Deaconess Medical Center; Boston Massachusetts
| | - Thomas M. Tu
- Louisville Cardiology Group, Interventional Cardiology; Louisville Kentucky
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Schulman-Marcus J, Shah T, Swaminathan RV, Feldman DN, Wong SC, Singh HS, Minutello RM, Bergman G, Kim LK. Comparison of Recent Trends in Patients With and Without Major Depression and Acute ST-Elevation Myocardial Infarction. Am J Cardiol 2016; 118:779-784. [PMID: 27453511 DOI: 10.1016/j.amjcard.2016.06.051] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 12/11/2022]
Abstract
Depression has been associated with adverse outcomes after acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). However, trends over time in the incidence and inhospital treatment of STEMI for patients with co-morbid depression in the current era are unknown. We conducted a serial, cross-sectional analysis of patients with STEMI (weighted n = 3,057,998) in the National Inpatient Sample from 2003 to 2012. We examined trends in STEMI incidence and percutaneous coronary intervention (PCI) for patients with and without depression. We used multivariate logistic regression to assess observed differences and to explore trends in inhospital mortality. Depression was present in 153,180 (5%) of the sample. Patients with depression were more likely to be female (55% vs 37%), of white race (86% vs 78%), and had lower crude mortality (12.0% vs 14.2%; p <0.001 for all). Over time, STEMI incidence decreased 52% in patients without depression (p for trend <0.001) but remained stable in those with depression (p for trend 0.74). Although the use of PCI increased in all subgroups over the study duration (p for trend <0.001), depression was associated with lower adjusted odds of PCI (odds ratio 0.90, 95% confidence interval 0.89 to 0.92, p <0.001). In conclusion, in contrast to the wider population, the incidence of STEMI is not decreasing in patients with co-morbid depression. Patients with STEMI and co-morbid depression are less likely to receive revascularization therapy with PCI. These concerning differences warrant further attention.
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Affiliation(s)
- Joshua Schulman-Marcus
- Department of Medicine, Weill Cornell Medical College, New York, New York; Department of Radiology, Weill Cornell Medical College, New York, New York.
| | - Tara Shah
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Rajesh V Swaminathan
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Dmitriy N Feldman
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Shing-Chiu Wong
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Harsimran S Singh
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Robert M Minutello
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Geoffrey Bergman
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Luke K Kim
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
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Patel AD, Ibrahim M, Swaminathan RV, Minhas IU, Kim LK, Venkatesh P, Feldman DN, Minutello RM, Bergman GW, Wong SC, Singh HS. Five-year mortality outcomes in patients with chronic kidney disease undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2016; 89:E124-E132. [PMID: 27519355 DOI: 10.1002/ccd.26664] [Citation(s) in RCA: 8] [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] [Received: 06/30/2016] [Accepted: 07/03/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine peri-procedural and long-term outcomes in patients with chronic kidney disease (CKD) undergoing percutaneous coronary interventions (PCI). BACKGROUND Patients with advanced CKD are considered high risk when undergoing PCI. Limited published data exist on quantifying risk and assessment of long-term outcomes after PCI in this group. METHODS Examining the Cornell Coronary Registry, we prospectively collected data of 6,478 consecutive patients who underwent elective or urgent PCI between 2009 and 2013. Patients were grouped into CKD stages by estimated glomerular filtration rate (eGFR) according to KDOQI guidelines. Procedural and 30-day outcomes are reported with assessment of long-term differences in 5-year all-cause mortality. RESULTS Patients were grouped by CKD stages: 1,351 patients with eGFR ≥90 mL/min/1.73 m2 (stage 1), 2,882 with eGFR 60-89 (stage 2), 1,742 with eGFR 30-59 (stage 3), 191 with eGFR 15-29 (stage 4), and 312 with eGFR <15 or on dialysis (stage 5). The incidence of post-procedural acute heart failure, stroke, new dialysis requirement, transfusions, and bleeding events were higher in patients with greater CKD stage (P < 0.05). Five-year Kaplan-Meier overall survival among CKD stages 1-5 was 98.1, 95.5, 91.8, 82.5, and 76.9%, respectively (P < 0.001 by log-rank test). The hazard ratios of all-cause mortality for CKD stages 2-5 as compared to stage 1 by multivariate Cox regression analysis were as follows: 1.32 (P = 0.26), 2.04 (P < 0.01), 2.79 (P < 0.01), and 5.49 (P < 0.001). CONCLUSION Among patients undergoing PCI, lower GFR is associated with decreased long-term survival. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Agam D Patel
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Mohammed Ibrahim
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Rajesh V Swaminathan
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Irfan U Minhas
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Luke K Kim
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Prashanth Venkatesh
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Dmitriy N Feldman
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Robert M Minutello
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Geoffrey W Bergman
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - S Chiu Wong
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Harsimran S Singh
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
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Swaminathan RV, Feldman DN, Pashun RA, Patil RK, Shah T, Geleris JD, Wong SC, Girardi LN, Gaudino M, Minutello RM, Singh HS, Bergman G, Kim LK. Gender Differences in In-Hospital Outcomes After Coronary Artery Bypass Grafting. Am J Cardiol 2016; 118:362-8. [PMID: 27269585 DOI: 10.1016/j.amjcard.2016.05.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [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: 01/13/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 12/21/2022]
Abstract
Women historically have a greater risk of operative mortality than men after coronary artery bypass grafting (CABG). There is paucity of contemporary data in gender outcomes of surgical revascularization and understanding modifiable factors that contribute to gender differences are critical for quality improvement and practice change. We, therefore, sought to examine whether the gender gap in CABG outcomes is closing in the contemporary era by conducting a retrospective analysis from the Nationwide Inpatient Sample database from 2003 to 2012. We included all patients who underwent isolated CABG surgery (n = 2,272,998; female n = 623,423 [27.4%]; male n = 1,649,575 [72.6%]). The annual rate of CABG surgeries decreased by 53.7% in men and 57.8% in women over the 10-year study period. Although internal mammary artery use in women was less frequent than in men in 2003 (77.4% vs 81.9%, p <0.001), a significant uptrend closed this gap by 2012 (86.2% vs 87.0%, ptrend 0.003). Overall, unadjusted in-hospital mortality was greater in women (3.2% vs 1.8%, p <0.001). Female gender remained an independent predictor of mortality after multivariate adjustment (odds ratio 1.40, 95% CI 1.36 to 1.43, p <0.001) across all age groups. However, in-hospital mortality decreased at a faster rate in women (3.8% to 2.7%, RR -29.1%, ptrend 0.002) than in men (2.2% to 1.6%, RR -25.7%, ptrend <0.001) from 2003 to 2012. In conclusion, CABG rates in the United States are decreasing over time, yet in-hospital mortality continues to improve. Women have worse in-hospital outcomes than men; however, the gender gap is slowly closing.
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Affiliation(s)
- Rajesh V Swaminathan
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
| | - Dmitriy N Feldman
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Raymond A Pashun
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Rupa K Patil
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Tara Shah
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Joshua D Geleris
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Shing-Chiu Wong
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York; Department of Cardiovascular Sciences, Catholic University, Rome, Italy
| | - Robert M Minutello
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Harsimran S Singh
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Geoffrey Bergman
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Luke K Kim
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
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Kim LK, Looser P, Swaminathan RV, Horowitz J, Friedman O, Shin JH, Minutello RM, Bergman G, Singh H, Wong SC, Feldman DN. Sex-Based Disparities in Incidence, Treatment, and Outcomes of Cardiac Arrest in the United States, 2003-2012. J Am Heart Assoc 2016; 5:JAHA.116.003704. [PMID: 27333880 PMCID: PMC4937290 DOI: 10.1161/jaha.116.003704] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies have shown improving survival after cardiac arrest. However, data regarding sex-based disparities in treatment and outcomes after cardiac arrest are limited. METHODS AND RESULTS We performed a retrospective analysis of all patients suffering cardiac arrest between 2003 and 2012 using the Nationwide Inpatient Sample database. Annual rates of cardiac arrest, rates of utilization of coronary angiography/percutaneous coronary interventions/targeted temperature management, and sex-based outcomes after cardiac arrest were examined. Among a total of 1 436 052 discharge records analyzed for cardiac arrest patients, 45.4% (n=651 745) were females. Women were less likely to present with ventricular tachycardia/ventricular fibrillation arrests compared with men throughout the study period. The annual rates of cardiac arrests have increased from 2003 to 2012 by 14.0% (Ptrend<0.001) and ventricular tachycardia/ventricular fibrillation arrests have increased by 25.9% (Ptrend<0.001). Women were less likely to undergo coronary angiography, percutaneous coronary interventions, or targeted temperature management in both ventricular tachycardia/ventricular fibrillation and pulseless electrical activity/asystole arrests. Over a 10-year study period, there was a significant decrease in in-hospital mortality in women (from 69.1% to 60.9%, Ptrend<0.001) and men (from 67.2% to 58.6%, Ptrend<0.001) after cardiac arrest. In-hospital mortality was significantly higher in women compared with men (64.0% versus 61.4%; adjusted odds ratio 1.02, P<0.001), particularly in the ventricular tachycardia/ventricular fibrillation arrest cohort (49.4% versus 45.6%; adjusted odds ratio 1.11, P<0.001). CONCLUSIONS Women presenting with cardiac arrests are less likely to undergo therapeutic procedures, including coronary angiography, percutaneous coronary interventions, and targeted temperature management. Despite trends in improving survival after cardiac arrest over 10 years, women continue to have higher in-hospital mortality when compared with men.
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Affiliation(s)
- Luke K Kim
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Patrick Looser
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Rajesh V Swaminathan
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - James Horowitz
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Oren Friedman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Ji Hae Shin
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Robert M Minutello
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Geoffrey Bergman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Harsimran Singh
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - S Chiu Wong
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Dmitriy N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
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Kim LK, Swaminathan RV, Looser P, Minutello RM, Wong SC, Bergman G, Naidu SS, Gade CLF, Charitakis K, Singh HS, Feldman DN. Hospital Volume Outcomes After Septal Myectomy and Alcohol Septal Ablation for Treatment of Obstructive Hypertrophic Cardiomyopathy. JAMA Cardiol 2016; 1:324-32. [DOI: 10.1001/jamacardio.2016.0252] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Luke K. Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Rajesh V. Swaminathan
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Patrick Looser
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Robert M. Minutello
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - S. Chiu Wong
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Geoffrey Bergman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Srihari S. Naidu
- Division of Cardiology, Winthrop University Hospital, Mineola, New York
| | - Christopher L. F. Gade
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Konstantinos Charitakis
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Harsimran S. Singh
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Dmitriy N. Feldman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
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50
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Kim LK, Looser P, Swaminathan RV, Minutello RM, Wong SC, Girardi L, Feldman DN. Outcomes in patients undergoing coronary artery bypass graft surgery in the United States based on hospital volume, 2007 to 2011. J Thorac Cardiovasc Surg 2016; 151:1686-92. [DOI: 10.1016/j.jtcvs.2016.01.050] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/11/2016] [Accepted: 01/26/2016] [Indexed: 11/25/2022]
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