1
|
Lodeen H, Esmati S, Okan T, Arastu A, Vilendecic D, Singh G, Mangla A, Moshayedi P, Lasic Z. The Simultaneous Occurrence of Acute ST-Elevation Myocardial Infarction, Acute Ischemic Stroke, and Pulmonary Embolism. Cureus 2023; 15:e44222. [PMID: 37767245 PMCID: PMC10522405 DOI: 10.7759/cureus.44222] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
Acute ST-elevation myocardial infarction (STEMI), acute ischemic stroke (AIS), and acute pulmonary embolism (PE) are life-threatening conditions, each posing a high risk of morbidity and mortality. When all three of these acute conditions occur simultaneously, the overall prognosis for the patient becomes considerably worse. We report a case of a 70-year-old woman who presented to the emergency department (ED) with a triad of acute STEMI, AIS, and PE as a consequence of atherosclerotic heart disease, atrial fibrillation, and a prolonged transatlantic flight. The diagnoses were promptly confirmed through emergent coronary and cerebral angiography, along with a computerized tomography pulmonary angiogram (CTPA). The patient underwent a combination of medical therapy and endovascular thrombectomy. However, she later developed a subarachnoid hemorrhage and eventually progressed to brain death.
Collapse
Affiliation(s)
- Homayoon Lodeen
- Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Saliman Esmati
- Internal Medicine, Jamaica Hospital Medical Center, New York , USA
| | - Tetyana Okan
- Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Azeem Arastu
- Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Dora Vilendecic
- Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Gagandeep Singh
- Cardiology, Northwell Health Lenox Hill Hospital, New York, USA
| | - Aditya Mangla
- Cardiology, Northwell Health Lenox Hill Hospital, New York, USA
| | - Pouria Moshayedi
- Interventional Neurology, Jamaica Hospital Medical Center, New York, USA
| | - Zoran Lasic
- Cardiology, Northwell Health Lenox Hill Hospital, New York, USA
| |
Collapse
|
2
|
Asemota D, Kassam Z, Voto C, Mangla A, Coven D, Lasic Z. Pseudoaneurysm Formation After "Preclose"-Assisted Impella Insertion in a Patient With Cardiogenic Shock. J Med Cases 2022; 13:202-206. [PMID: 35655626 PMCID: PMC9119370 DOI: 10.14740/jmc3841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/08/2021] [Indexed: 11/11/2022] Open
Abstract
The use of mechanical support devices such as the Impella CP (Abiomed, Danvers, MA) is a growing form of treatment for patients with cardiogenic shock (CS). Despite the increase in usage, there remains a dearth in literature regarding potential complications. Vascular complications such as pseudoaneurysms (PAs) are rare but important potential complications that can occur with use of the Impella. We present Impella-assisted percutaneous coronary intervention (PCI) in a patient with CS, "Preclosed" with the Perclose ProGlide (Abbott, Plymouth, MN) device complicated by development of a PA. A 62-year-old male patient with a history of diabetes and hypertension presented to our emergency room (ER) with chest pain and electrocardiogram (ECG) findings consistent with an acute anterior wall ST-elevation myocardial infarction (STEMI). This was further complicated by refractory CS. The patient was urgently taken to the cardiac catherization laboratory. After exchange of sequential dilators, a single Perclose device was used prior to the insertion of the Impella sheath. The patient then underwent a successful Impella-assisted PCI of his left anterior descending artery. Upon stabilization of hemodynamics, the patient was taken to the catheterization laboratory for Impella removal. After removal of Impella, imaging detected extravasation of contrast, without development of hematoma, later confirmed to be a PA via computed tomography (CT) scans and ultrasound Doppler imaging. The PA was successfully managed with injection of thrombin. The PA was likely caused by shearing forces of the dilators, the 14-F Impella sheath and foot of the device. We propose deploying the Perclose device earlier in the process of dilating the access site to avoid such complication. This is one of the first case reports that detail the occurrence and management of a PA with Impella insertion.
Collapse
Affiliation(s)
- Daniel Asemota
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Zain Kassam
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Christian Voto
- Department of Medicine, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Aditya Mangla
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - David Coven
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Zoran Lasic
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| |
Collapse
|
3
|
Remillard TC, Kassam Z, Coven M, Mangla A, Lasic Z. Pulmonary Embolism Complicated With Cardiopulmonary Arrest Treated With Combination of Thrombolytics and Aspiration Thrombectomy. JACC Case Rep 2022; 4:576-580. [PMID: 35615215 PMCID: PMC9125515 DOI: 10.1016/j.jaccas.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/17/2022] [Accepted: 03/14/2022] [Indexed: 11/27/2022]
Abstract
Systemic thrombolytic therapy is frequently used in the treatment of massive pulmonary embolism. We describe a case of pulseless electrical activity arrest, refractory obstructive shock in the setting of massive pulmonary embolism despite tissue plasminogen activator that was successfully treated with catheter-directed aspiration thrombectomy. (Level of Difficulty: Intermediate.)
Collapse
|
4
|
Seto AH, Lasic Z. Radial Ultrasound: Seeing Is Better Than Feeling. Cardiovascular Revascularization Medicine 2019; 20:275-276. [DOI: 10.1016/j.carrev.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
|
5
|
Shah AB, Parmar YJ, Mangla A, Lasic Z, Coplan N. Dengue fever as a cause of perimyocarditis and low-pressure cardiac tamponade. Proc (Bayl Univ Med Cent) 2018; 31:487-489. [PMID: 30948988 DOI: 10.1080/08998280.2018.1482519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 10/28/2022] Open
Abstract
We describe a case of dengue shock syndrome, perimyocarditis, and low-pressure cardiac tamponade following a trip to the Caribbean. The case was managed in the critical care unit and 6 weeks after discharge the patient was asymptomatic with a normal ejection fraction. Dengue fever presenting as cardiac tamponade is exceedingly rare and emphasizes the importance of taking a thorough travel history as well as being aware of atypical manifestations of rare diseases to make a correct diagnosis.
Collapse
Affiliation(s)
- Ankit B Shah
- Department of Cardiovascular Medicine, Lenox Hill Hospital-Northwell HealthNew YorkNew York
| | - Yuvrajsinh J Parmar
- Department of Cardiovascular Medicine, Lenox Hill Hospital-Northwell HealthNew YorkNew York
| | - Aditya Mangla
- Department of Cardiovascular Medicine, Lenox Hill Hospital-Northwell HealthNew YorkNew York.,Department of Interventional Cardiology, Jamaica Hospital Medical CenterJamaicaNew York
| | - Zoran Lasic
- Department of Cardiovascular Medicine, Lenox Hill Hospital-Northwell HealthNew YorkNew York.,Department of Interventional Cardiology, Jamaica Hospital Medical CenterJamaicaNew York
| | - Neil Coplan
- Department of Cardiovascular Medicine, Lenox Hill Hospital-Northwell HealthNew YorkNew York
| |
Collapse
|
6
|
Shoja T, Basman C, Jain S, Mangla A, Lasic Z. Postpartum Sudden Cardiac Death After Spontaneous Coronary Artery Dissection in a Patient With Fibromuscular Dysplasia. Cardiol Res 2017; 8:327-330. [PMID: 29317976 PMCID: PMC5755665 DOI: 10.14740/cr587w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/12/2017] [Indexed: 11/11/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare entity that can cause acute myocardial infarction and sudden cardiac death (SCD) which often goes unrecognized. We report a case of SCAD in a young postpartum female who presented with sudden cardiac arrest. The patient was managed medically and found to have fibromuscular dysplasia (FMD). After being stabilized in the critical care unit, coronary angiography was performed which showed dissection of the left main artery, intramural hematoma, and the culprit lesion. Further investigation showed dissection of the left vertebral artery which was all consistent with a diagnosis of FMD. The patient was followed as an outpatient and a repeated coronary angiography demonstrated healed dissection site. In conclusion, this case exemplifies that prompt diagnosis along with medical management without the need of coronary artery bypass graft, and percutaneous coronary intervention can improve survival in SCAD.
Collapse
Affiliation(s)
- Tannaz Shoja
- Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Richmond Hill, NY 11418, USA
| | - Craig Basman
- Lenox Hill Hospital Medical Center, 100 E 77th St, New York, NY 10075, USA
| | - Suresh Jain
- Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Richmond Hill, NY 11418, USA.,Lenox Hill Hospital Medical Center, 100 E 77th St, New York, NY 10075, USA
| | - Aditya Mangla
- Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Richmond Hill, NY 11418, USA.,Lenox Hill Hospital Medical Center, 100 E 77th St, New York, NY 10075, USA
| | - Zoran Lasic
- Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Richmond Hill, NY 11418, USA.,Lenox Hill Hospital Medical Center, 100 E 77th St, New York, NY 10075, USA
| |
Collapse
|
7
|
Seto AH, Roberts JS, Abu-Fadel MS, Czak SJ, Latif F, Jain SP, Raza JA, Mangla A, Panagopoulos G, Patel PM, Kern MJ, Lasic Z. Real-Time Ultrasound Guidance Facilitates Transradial Access. JACC Cardiovasc Interv 2015; 8:283-291. [DOI: 10.1016/j.jcin.2014.05.036] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/25/2014] [Accepted: 05/08/2014] [Indexed: 11/28/2022]
|
8
|
Arguelles E, de Elia C, Lasic Z. Acute Cardiorenal Syndrome Type 1 in Patients With Congestive Heart Failure Exacerbations Is Not an Indicator of Poor Outcome and Increased Mortality. Cardiol Res 2014; 5:72-74. [PMID: 28392878 PMCID: PMC5358177 DOI: 10.14740/cr332w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 11/13/2022] Open
Abstract
Background Over one million patients are hospitalized each year with acute decompensated heart failure (ADHF) in the US. Approximately 20% to 40% of them will develop acute cardiorenal syndrome type 1 (ACRS1) via multiple mechanisms. Methods From January 2010 to December 2010, 197 patients were diagnosed with ADHF. Initial N-terminal pro-brain natriuretic peptide (NT-pro BNP), creatinine levels throughout hospital stay, use of invasive mechanical ventilation, length of hospital stay and death were assessed for each patient. ACRS1 was diagnosed when an increase of creatinine > 0.3 mg/dL from baseline was noted during hospital stay. We sought to investigate whether presence of ACRS1 is associated with increased length of stay, need for mechanical ventilation and increased in-hospital mortality in patients admitted with ADHF. Results Total of 61 (31%) patients experienced ACRS1. Mean hospital stay for ACRS1 patients was 8.43 ± 6.28 days while for non-ACRS1 was 5.06 ± 4.19 (P < 0.0001). Twenty-eight (14%) patients required invasive mechanical ventilation (11 non-ACRS1 vs. 17 ACRS1). ACRS1 was associated with more frequent use of invasive ventilation (odd ratio 3.45, CI 1.52 - 7.79, P = 0.003). Fifteen (8%) patients expired (8 non-ACRS1 vs. 7 ACRS1). There was no difference in mortality between groups (odd ratio 2.07, CI 0.72 - 6.00, P = 0.18). Conclusions Development of ACRS1 was not associated with increased incidence of in-hospital mortality, but it prolonged hospital stay and need for mechanical ventilation.
Collapse
Affiliation(s)
- Eric Arguelles
- Department of Internal Medicine, Jamaica Hospital Medical Center, Jamaica, NY, USA
| | - Carolina de Elia
- Department of Internal Medicine, New York Methodist Hospital, Brooklyn, NY, USA
| | - Zoran Lasic
- Department of Cardiology and Interventional Cardiology, Jamaica Hospital Medical Center, Jamaica, NY, USA
| |
Collapse
|
9
|
Seto A, Roberts JS, Abu-Fadel M, Czak S, Latif F, Jain S, Raza J, Mangla A, Panagopoulos G, Kern MJ, Lasic Z. TCT-278 Radial arterial access with ultrasound trial. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
10
|
Abstract
In the endovascular procedure setting, vascular closure devices (VCD) have emerged as an alternative to mechanical compression in order to achieve vascular hemostasis after puncture of the femoral artery. VCD are categorized based primarily on the principle mechanism of hemostasis, which includes biodegradable plug, suture, staples, or ultrasound. While VCD offer advantages over mechanical compression (shorter time to hemostasis and patient ambulation, high rate of patient satisfaction, and greater cost-effectiveness) complications related to the site of femoral access are still present. Efficacy and safety of VCD have been evaluated in a number of clinical trials, but to date there is still a lack of randomized clinical trials with sample sizes large enough to reveal superiority or non-inferiority of VCD compared with mechanical compression. Mechanical compression and VCD are effective and well tolerated in the setting of diagnostic procedures and procedures that do not use anticoagulation. For both methods, success rates are lower, and complication rates higher, in the setting of interventional procedures and when anticoagulation medications are used. Regardless of the device type, deployment failure is the major drawback of VCD. However, overall, meta-analysis data demonstrated that complications and success rates are not significantly different between mechanical compression and VCD. Current data suggest that the correct answer on whether or not to use VCD still remains in the operator domain where integration of clinical data and familiarity with a particular closure device plays a key role in achieving successful hemostasis and avoiding access site complication.
Collapse
Affiliation(s)
- Zoran Lasic
- Lenox Hill Hospital and Cardiovascular Research Foundation, New York 10022, USA.
| | | | | | | |
Collapse
|
11
|
Moussa I, Costa RA, Leon MB, Lansky AJ, Lasic Z, Cristea E, Trubelja N, Carlier SG, Mehran R, Dangas GD, Weisz G, Kreps EM, Collins M, Stone GW, Moses JW. A prospective registry to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions using the "crush technique". Am J Cardiol 2006; 97:1317-21. [PMID: 16635603 DOI: 10.1016/j.amjcard.2005.11.072] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [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: 09/27/2005] [Revised: 11/14/2005] [Accepted: 11/14/2005] [Indexed: 11/22/2022]
Abstract
The "crush technique" has been proposed as an alternative approach to treat bifurcation lesions because of its predictability and high procedural success rate. However, few data are available regarding its safety and long-term efficacy. We report the long-term clinical outcomes of patients with coronary bifurcation lesions treated with sirolimus-eluting stents using the crush technique. From April 2003 to May 2004, 120 patients with coronary bifurcation lesions were treated with sirolimus-eluting stents using the crush technique. Six months of clinical follow-up was completed in 95.8% of patients. Mean patient age was 64 years; 36% had diabetes mellitus, and the left anterior descending artery/diagonal was the most frequent bifurcation location (69%). Final kissing balloon inflation was performed in 87.5% of patients. Compared with the main vessel, side branch lesions were shorter, with a smaller reference diameter and final in-stent minimum lumen diameter. Procedural success was achieved in 97.5%. At 30 days of follow-up, 1 patient had died of noncardiac causes and 2 patients (1.7%) had subacute stent thrombosis. At 6 months of follow-up, target lesion revascularization was required in 13 patients (11.3%), all of whom had focal restenosis predominantly at the side branch ostium. In conclusion, the crush technique with final kissing balloon inflation can be safely used by experienced operators to treat highly complex bifurcation lesions with sirolimus-eluting stents. The safety profile of this technique is similar to that of other bifurcation stenting techniques reported thus far. Nonetheless, despite the excellent patency rates of the main vessel, the need for revascularization at the ostium of the side branch was not fully eliminated.
Collapse
Affiliation(s)
- Issam Moussa
- Cardiovascular Research Foundation and New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Dangas G, Lasic Z, Mehran R, Cox D, Ghali MGH, Henry TD, Teirstein PS, Stella JF, Browne KF, Lewis SA, Knopf W, Leon MB, Moses JW, Stone GW. Effectiveness of the concomitant use of bivalirudin and drug-eluting stents (from the prospective, multicenter BivAlirudin and Drug-Eluting STents [ADEST] study). Am J Cardiol 2005; 96:659-63. [PMID: 16125490 DOI: 10.1016/j.amjcard.2005.04.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 03/17/2005] [Revised: 04/13/2005] [Accepted: 04/13/2005] [Indexed: 10/25/2022]
Abstract
Sirolimus-eluting stents (SESs) reduce restenosis compared with bare metal stents. Safety issues with drug-eluting stents are particularly important given concerns of possible increased thrombogenicity. Compared with heparin plus glycoprotein IIb/IIIa inhibitors, the direct thrombin inhibitor bivalirudin has been shown to reduce the risk of hemorrhagic complications in patients receiving bare metal stents, with similar efficacy in preventing ischemic complications. The safety and efficacy of percutaneous coronary intervention (PCI) with SESs and bivalirudin anticoagulation have not been prospectively studied. This prospective study performed at 9 United States hospitals evaluated 1,182 patients referred for PCI with SESs in whom the procedural anticoagulant was bivalirudin. Clopidogrel was administered before PCI in 79% of patients, and only 5.3% received procedural glycoprotein IIb/IIIa inhibitors. At 30 days, major adverse cardiac events occurred in 7.1% of patients, including 0.3% mortality, 4.4% myocardial infarction (defined as creatine kinase-MB >3x normal), 1.7% target vessel revascularization, and 0.6% stent thrombosis. Major bleeding occurred in only 0.8% of patients. Thus, use of bivalirudin as the procedural anticoagulant to support SES implantation in a "real world" population of patients undergoing PCI results in low rates of major adverse cardiac events, stent thrombosis, and major bleeding.
Collapse
Affiliation(s)
- George Dangas
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Nikolsky E, Mehran R, Lasic Z, Mintz GS, Lansky AJ, Na Y, Pocock S, Negoita M, Moussa I, Stone GW, Moses JW, Leon MB, Dangas G. Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary interventions. Kidney Int 2005; 67:706-13. [PMID: 15673320 DOI: 10.1111/j.1523-1755.2005.67131.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The relationship between low hematocrit and contrast-induced nephropathy has not been investigated. METHODS Of 6,773 consecutive patients treated with percutaneous coronary intervention, contrast-induced nephropathy (an increase of >/=25% or >/=0.5 mg/dL in preprocedure serum creatinine, at 48 hours postprocedure) occurred in 942 (13.9%) patients. RESULTS Rates of contrast-induced nephropathy steadily increased as baseline hematocrit quintile decreased (from 10.3% in the highest quintile to 23.3% in the lowest quintile) (chi(2) for trend, P < 0.0001). Stratification by baseline estimated glomerular filtration rate (eGFR) and baseline hematocrit showed that the rates of contrast-induced nephropathy were the highest (28.8%) in patients who had the lowest level for both baseline eGFR and hematocrit. Patients with the lowest eGFR but relatively high baseline hematocrit values had remarkably lower rates of contrast-induced nephropathy (15.8%, 12.3%, 17.1%, and 15.4% in 2nd, 3rd, 4th, and 5th quintiles of baseline hematocrit, respectively) (P < 0.0001). The rates of contrast-induced nephropathy increased with increment in change in hematocrit. Patients in the lowest quintile of baseline hematocrit with absolute hematocrit drop >5.9% had almost doubled rates of contrast-induced nephropathy compared with patients with hematocrit change <3.4% (38.1% vs. 18.8%, respectively) (P < 0.0001). By multivariate analysis, lower baseline hematocrit was an independent predictor of contrast-induced nephropathy; each 3% decrease in baseline hematocrit resulted in a significant increase in the odds of contrast-induced nephropathy in patients with and without chronic kidney disease (11% and 23%, respectively). When introduced into the multivariate model instead of baseline hematocrit, change in hematocrit also showed a significant association with contrast-induced nephropathy. CONCLUSION Lower hematocrit is an important risk factor for contrast-induced nephropathy. Whether correcting the hematocrit prepercutaneous coronary intervention might decrease the rates of contrast-induced nephropathy should be addressed in a prospectively designed trial.
Collapse
|
14
|
Lasic Z, Bolon D, Kesanakurthy S, Nikolsky E, Coplan N, Leon MB, Wolff SD. Images in cardiology: A saphenous vein graft aneurysm fistula causing pulmonary artery dissection. Clin Cardiol 2004; 27:450. [PMID: 15346840 PMCID: PMC6653994 DOI: 10.1002/clc.4960270805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Zoran Lasic
- Lenox Hill Heart and Vascular Institute of New York, New York, USA
| | | | | | | | | | | | | |
Collapse
|
15
|
Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, Mintz GS, Lansky AJ, Moses JW, Stone GW, Leon MB, Dangas G. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 2004; 44:1393-9. [PMID: 15464318 DOI: 10.1016/j.jacc.2004.06.068] [Citation(s) in RCA: 658] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2004] [Revised: 06/14/2004] [Accepted: 06/22/2004] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We sought to develop a simple risk score of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). BACKGROUND Although several risk factors for CIN have been identified, the cumulative risk rendered by their combination is unknown. METHODS A total of 8,357 patients were randomly assigned to a development and a validation dataset. The baseline clinical and procedural characteristics of the 5,571 patients in the development dataset were considered as candidate univariate predictors of CIN (increase >or=25% and/or >or=0.5 mg/dl in serum creatinine at 48 h after PCI vs. baseline). Multivariate logistic regression was then used to identify independent predictors of CIN with a p value <0.0001. Based on the odds ratio, eight identified variables (hypotension, intra-aortic balloon pump, congestive heart failure, chronic kidney disease, diabetes, age >75 years, anemia, and volume of contrast) were assigned a weighted integer; the sum of the integers was a total risk score for each patient. RESULTS The overall occurrence of CIN in the development set was 13.1% (range 7.5% to 57.3% for a low [<or=5] and high [>or=16] risk score, respectively); the rate of CIN increased exponentially with increasing risk score (Cochran Armitage chi-square, p < 0.0001). In the 2,786 patients of the validation dataset, the model demonstrated good discriminative power (c statistic = 0.67); the increasing risk score was again strongly associated with CIN (range 8.4% to 55.9% for a low and high risk score, respectively). CONCLUSIONS The risk of CIN after PCI can be simply assessed using readily available information. This risk score can be used for both clinical and investigational purposes.
Collapse
Affiliation(s)
- Roxana Mehran
- Cardiovascular Research Foundation, Columbia University Medical Center, New York, New York 10022, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Nikolsky E, Mehran R, Halkin A, Aymong ED, Mintz GS, Lasic Z, Negoita M, Fahy M, Krieger S, Moussa I, Moses JW, Stone GW, Leon MB, Pocock SJ, Dangas G. Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a meta-analysis. J Am Coll Cardiol 2004; 44:1200-9. [PMID: 15364320 DOI: 10.1016/j.jacc.2004.06.048] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [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: 02/18/2004] [Revised: 06/01/2004] [Accepted: 06/09/2004] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study was designed to assess the safety of arteriotomy closure devices (ACDs) versus mechanical compression by meta-analysis in patients undergoing percutaneous transfemoral coronary procedures. BACKGROUND Although ACDs are widely applied for hemostasis after percutaneous endovascular procedures, their safety is controversial. METHODS Randomized, case-control, and cohort studies comparing access-related complications using ACDs versus mechanical compression were analyzed. The primary end point was the cumulative incidence of vascular complications, including pseudoaneurysm, arteriovenous fistula, retroperitoneal hematoma, femoral artery thrombosis, surgical vascular repair, access site infection, and blood transfusion. RESULTS A total of 30 studies involving 37,066 patients were identified. No difference in complication incidence between Angio-Seal and mechanical compression was revealed in the diagnostic (Dx) setting (odds ratio [OR] 1.08, 95% confidence interval [CI] 0.11 to 10.0) or percutaneous coronary interventions (PCI) (OR 0.86, 95% CI 0.65 to 1.12). Meta-analysis of randomized trials only showed a trend toward less complications using Angio-Seal in a PCI setting (OR 0.46, 95% CI 0.20 to 1.04; p = 0.062). No differences were observed regarding Perclose in either Dx (OR 1.51, 95% CI 0.24 to 9.47) or PCI (OR 1.21, 95% CI 0.94 to 1.54) setting. An increased risk in complication rates using VasoSeal in the PCI setting (OR 2.25, 95% CI 1.07 to 4.71) was found. The overall analysis favored mechanical compression over ACD (OR 1.34, 95% CI 1.01 to 1.79). CONCLUSIONS In the setting of Dx angiography, the risk of access-site-related complications was similar for ACD compared with mechanical compression. In the setting of PCI, the rate of complications appeared higher with VasoSeal.
Collapse
Affiliation(s)
- Eugenia Nikolsky
- Cardiovascular Research Foundation and the Lenox Hill Heart and Vascular Institute, New York, New York 10022, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Nikolsky E, Mehran R, Aymong ED, Mintz GS, Lansky AJ, Lasic Z, Negoita M, Fahy M, Pocock SJ, Na Y, Krieger S, Moses JW, Stone GW, Leon MB, Dangas G. Impact of anemia on outcomes of patients undergoing percutaneous coronary interventions. Am J Cardiol 2004; 94:1023-7. [PMID: 15476616 DOI: 10.1016/j.amjcard.2004.06.058] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [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: 06/08/2004] [Revised: 06/28/2004] [Accepted: 06/28/2004] [Indexed: 10/26/2022]
Abstract
Of 6,929 consecutive patients who were treated with percutaneous coronary intervention, 1,708 (24.6%) had anemia according to criteria of the World Health Organization. Compared with patients who did not have anemia, those who did have anemia were older, more frequently women and African-American, had a smaller body mass index, and higher frequencies of cardiovascular risk factors and co-morbid conditions. Patients who had anemia compared with those who did not have anemia had significantly (p <0.0001) higher mortality rates during hospitalization (1.9% vs 0.4%) and at 1 year (12.8% vs 3.5%). After adjustment for potential confounders, baseline hematocrit remained a significant predictor of a 1-year mortality rate (hazard ratio 0.93 per 1% increase in hematocrit, 95% confidence interval 0.91 to 0.95).
Collapse
Affiliation(s)
- Eugenia Nikolsky
- Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York 10022, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Nikolsky E, Mehran R, Turcot D, Aymong ED, Mintz GS, Lasic Z, Lansky AJ, Tsounias E, Moses JW, Stone GW, Leon MB, Dangas GD. Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. Am J Cardiol 2004; 94:300-5. [PMID: 15276092 DOI: 10.1016/j.amjcard.2004.04.023] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [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: 03/24/2003] [Revised: 04/13/2004] [Accepted: 04/13/2004] [Indexed: 10/26/2022]
Abstract
Chronic kidney disease (CKD) is a frequent complication of diabetes mellitus. However, the role of CKD in outcomes of patients with diabetes who have undergone percutaneous coronary intervention (PCI) has not been studied specifically. Therefore, we investigated the impact of CKD on prognosis of patients with diabetes who underwent PCI. Of 1,575 diabetic patients who underwent PCI, 1,046 (66%) had preserved renal function, 492 (31%) had CKD (baseline serum creatinine >1.5 mg/dl or estimated glomerular filtration rate <60 ml/min/1.73 m(2)) without dialysis, and 37 (2.3%) were dependent on dialysis. Patients with CKD versus those without CKD had more in-hospital complications, including mortality (2.6% vs 0.5%, respectively; p <0.0001), neurologic events (3.1% vs 0.6%, p = 0.0001), and gastrointestinal bleeding (2.9% vs 0.9%, p = 0.01). Contrast-induced nephropathy after PCI (increase > or =25% and/or > or =0.5 mg/dl of serum creatinine before PCI vs 48 hours after PCI) was found in 15% of patients without CKD versus 27% of those with CKD, and de novo dialysis was instituted in 0.1% versus 3.1%, respectively. Contrast-induced nephropathy was independently predicted (all p <0.0001) by peri-PCI hypotension (odds ratio [OR] 2.62), insulin treatment (OR 1.84), and volume of contrast medium (OR 1.30). The 1-year mortality rate was strikingly higher (all p <0.0001) in patients with CKD who did not receive dialysis (16%) and those on dialysis (44%) compared with the group with preserved renal function (5%). Contrast-induced nephropathy was among the independent predictors of a 1-year mortality rate (OR 2.75, p <0.001).
Collapse
Affiliation(s)
- Eugenia Nikolsky
- Cardiovascular Research Foundation, and Lenox Hill Heart and Vascular Institute, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Lasic Z, Mehran R, Dangas G, Mintz G, Nikolsky E, Tsounias E, Udani PC, Adamian M, Adamian J, Moussa I, Collins M, Stone G, Moses J. Comparison of safety and efficacy between first and second generation of angio-seal closure devices in interventional patients. J Invasive Cardiol 2004; 16:356-8. [PMID: 15282426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Arterial closure devices are safe and effective in selected patients, with complication rates similar to or lower than manual compression. The purpose of this study was to compare the safety and efficacy of the first- and new-generation Angio-Seal devices in patients undergoing PCI. This study found that the new Angio-Seal STS Platform device can secure hemostasis after PCI in a safe and effective manner similar to the old device. The new platform is easier for the operator and for the patients.
Collapse
Affiliation(s)
- Zoran Lasic
- Department of Interventional Cardiology, Lenox Hill Hospital, 100 East 77th Street, New York, NY 10021, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Nikolsky E, Mehran R, Dangas GD, Lasic Z, Mintz GS, Negoita M, Lansky AJ, Stone GW, Moussa I, Iyer S, Na Y, Moses JW, Leon MB. Prognostic significance of cerebrovascular and peripheral arterial disease in patients having percutaneous coronary interventions. Am J Cardiol 2004; 93:1536-9. [PMID: 15194030 DOI: 10.1016/j.amjcard.2004.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2003] [Revised: 03/01/2004] [Accepted: 03/01/2004] [Indexed: 10/26/2022]
Abstract
This study shows that cerebrovascular and peripheral arterial diseases frequently co-exist in patients with coronary artery disease who undergo percutaneous coronary interventions. These 2 conditions are associated with adverse in-hospital and 1-year outcomes and independently predict early and 1-year mortality.
Collapse
|
21
|
Weisz G, Halkin A, Costantini CO, Michev I, Reyes A, Moussa I, Lasic Z, Vagaonescu T, Illic V, Leon MB, Colombo A, Moses JW. 1063-65 Coronary blood flow velocity and myocardial perfusion with balloon occlusion and filter-based distal protection devices in saphenous vein graft stenting: Early experience of two centers. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90222-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
22
|
Knezevic D, Moses J, Lasic Z, Li Y, Maida R, Ilic V, Bolon D, Zaric M, Rustemli A, Aboufares A, Coplan N, Dangas G, Moussa I. Frequency and causes of early hospital readmission for chest pain after contemporary coronary stent implantation. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80181-4] [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: 10/27/2022]
|