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The association of timing of coronary artery bypass grafting for non-ST-elevation myocardial infarction and clinical outcomes in the contemporary United States. Coron Artery Dis 2024; 35:261-269. [PMID: 38164979 DOI: 10.1097/mca.0000000000001314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND In contrast to the timing of coronary angiography and percutaneous coronary intervention, the optimal timing of coronary artery bypass grafting (CABG) in non-ST-elevation myocardial infarction (NSTEMI) has not been determined. Therefore, we compared in-hospital outcomes according to different time intervals to CABG surgery in a contemporary NSTEMI population in the USA. METHODS We identified all NSTEMI hospitalizations from 2016 to 2020 where revascularization was performed with CABG. We excluded NSTEMI with high-risk features using prespecified criteria. CABG was stratified into ≤24 h, 24-72 h, 72-120 h, and >120 h from admission. Outcomes of interest included in-hospital mortality, perioperative complications, length of stay (LOS), and hospital cost. RESULTS A total of 147 170 NSTEMI hospitalizations where CABG was performed were assessed. A greater percentage of females, Blacks, and Hispanics experienced delays to CABG surgery. No difference in in-hospital mortality was observed, but CABG at 72-120 h and at >120 h was associated with higher odds of non-home discharge and acute kidney injury compared with CABG at ≤24 h from admission. In addition to these differences, CABG at >120 h was associated with higher odds of gastrointestinal hemorrhage and need for blood transfusion. All 3 groups with CABG delayed >24 h had longer LOS and hospital-associated costs compared with hospitalizations where CABG was performed at ≤24 h. CONCLUSION CABG delays in patients with NSTEMI are more frequently experienced by women and minority populations and are associated with an increased burden of complications and healthcare cost.
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Percutaneous closure of ruptured sinus of Valsalva: A review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 60:91-94. [PMID: 37777419 DOI: 10.1016/j.carrev.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/09/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
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Trends and Inhospital Outcomes of Intravascular Imaging on Single-Vessel Coronary Chronic Total Occlusion Treated With Percutaneous Coronary Intervention. Am J Cardiol 2023; 206:79-85. [PMID: 37683583 PMCID: PMC10901566 DOI: 10.1016/j.amjcard.2023.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/10/2023]
Abstract
Intravascular imaging (IVI), including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), improves outcomes of percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). We sought to quantify temporal trends in the uptake of IVI for CTO-PCI in the United States. We identified adults who underwent single-vessel PCI for CTO between 2008 and 2020. We quantified yearly trends in the number of IVUS-guided and OCT-guided single-vessel CTO-PCIs by Cochran-Armitage and linear regression tests. We also examined the rates of inhospital mortality and other prespecified inhospital outcomes in patients who underwent CTO-PCIs with and without IVI, using logistic regression. Our study included a total of 151,998 PCIs on single-vessel CTOs, with the absolute number of CTO-PCIs decreasing from 12,345 in 2008 to 8,525 in 2020 (p trend <0.001). IVUS use has increased dramatically from 6% in 2008 to 18% in 2020 for single-vessel CTO-PCIs (p trend <0.001). Rates of OCT use have increased as well, from 0% in 2008 to 7% in 2020 (p trend <0.001). There was no difference in inhospital mortality between patients who underwent CTO-PCI with and without IVI (p logistic = 0.60). In the largest national analysis of single-vessel CTO-PCI trends to date, we found that the use of IVUS has increased substantially accompanied by a similar but lesser increase in the use of OCT. There were no differences in rates of inhospital mortality between patients who underwent single-vessel CTO-PCIs with and without IVI.
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Comparison of intravascular ultrasound, optical coherence tomography, and conventional angiography-guided percutaneous coronary interventions: A systematic review, network meta-analysis, and meta-regression. Catheter Cardiovasc Interv 2023; 102:440-450. [PMID: 37483068 PMCID: PMC10908343 DOI: 10.1002/ccd.30784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/02/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Intracoronary imaging modalities, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), provide valuable supplemental data unavailable on coronary angiography (CA) and have shown to improve clinical outcomes. We sought to compare the clinical efficacy of IVUS, OCT, and conventional CA-guided percutaneous coronary interventions (PCI). METHODS Frequentist and Bayesian network meta-analyses of randomized clinical trials were performed to compare clinical outcomes of PCI performed with IVUS, OCT, or CA alone. RESULTS A total of 28 trials comprising 12,895 patients were included. IVUS when compared with CA alone was associated with a significantly reduced risk of major adverse cardiovascular events (MACE) (risk ratio: [RR] 0.74, 95% confidence interval: [CI] 0.63-0.88), cardiac death (RR: 0.64, 95% CI: 0.43-0.94), target lesion revascularization (RR: 0.68, 95% CI: 0.57-0.80), and target vessel revascularization (RR: 0.64, 95% CI: 0.50-0.81). No differences in comparative clinical efficacy were found between IVUS and OCT. Rank probability analysis bestowed the highest probability to IVUS in ranking as the best imaging modality for all studied outcomes except for all-cause mortality. CONCLUSION Compared with CA, the use of IVUS in PCI guidance provides significant benefit in reducing MACE, cardiac death, and revascularization. OCT had similar outcomes to IVUS, but more dedicated studies are needed to confirm the superiority of OCT over CA.
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Chronological comparison of TAVI and SAVR stratified to surgical risk: a systematic review, meta-analysis, and meta-regression. Acta Cardiol 2023; 78:778-789. [PMID: 37294002 DOI: 10.1080/00015385.2023.2218025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 12/19/2022] [Accepted: 05/19/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has been established as a reasonable alternative to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis. However, long-term outcomes including valve durability and the need for reintervention are unanswered, especially in younger patients who tend to be low surgical risk. We performed a meta-analysis comparing clinical outcomes after TAVI and SAVR over 5 years stratified to low, intermediate, and high surgical risks. METHODS We identified propensity score-matched observational studies and randomised controlled trials comparing TAVI and SAVR. Primary outcomes, including all-cause mortality, moderate or severe aortic regurgitation, moderate or severe paravalvular regurgitation, pacemaker placement, and stroke, were extracted. Meta-analyses of outcomes after TAVI compared to SAVR were conducted for different periods of follow-up. Meta-regression was also performed to analyse the correlation of outcomes over time. RESULTS A total of 36 studies consisting of 7 RCTs and 29 propensity score-matched studies were selected. TAVI was associated with higher all-cause mortality at 4-5 years in patients with low or intermediate surgical risk. Meta-regression time demonstrated an increasing trend in the risk of all-cause mortality after TAVI compared with SAVR. TAVI was generally associated with a higher risk of moderate or severe aortic regurgitation, moderate or severe paravalvular regurgitation, and pacemaker placement. CONCLUSIONS TAVI demonstrated an increasing trend of all-cause mortality compared with SAVR when evaluated over a long-term follow-up. More long-term data from recent studies using newer-generation valves and state-of-the-art techniques are needed to accurately assign risks.
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A Rare Case of Regorafenib-Induced ST-Elevation Myocardial Infarction. Cureus 2023; 15:e39779. [PMID: 37398771 PMCID: PMC10312477 DOI: 10.7759/cureus.39779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
Regorafenib is an oral multi-kinase inhibitor that is used in the treatment of chemotherapy-resistant metastatic colorectal carcinoma. However, multi-kinase inhibitors have been known to cause cardiac side effects, most notably hypertension. Myocardial ischemia is a very extraordinary adverse effect of regorafenib. Our patient was a 74-year-old gentleman with stage IVa colon cancer who underwent a right colectomy with end ileostomy and was on cycle two of regorafenib during the presentation. He came in with acute onset chest pain that was intermittent, non-exertional, and radiating to the back. His left heart catheterization did not reveal any atherosclerotic lesions, and his ST-elevation myocardial infarction (STEMI) was deemed an extremely rare adverse event from regorafenib. We are herewith reporting a case of regorafenib-induced STEMI.
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Trends and impact of intravascular ultrasound and optical coherence tomography on percutaneous coronary intervention for myocardial infarction. IJC HEART & VASCULATURE 2023; 45:101186. [PMID: 36852085 PMCID: PMC9957744 DOI: 10.1016/j.ijcha.2023.101186] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
Background Intravascular imaging with either intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during percutaneous coronary intervention (PCI) is associated with improved outcomes, but these techniques have previously been underutilized in the real world. We aimed to examine the change in utilization of intravascular imaging-guided PCI over the past decade in the United States and assess the association between intravascular imaging and clinical outcomes following PCI for myocardial infarction (MI). Methods We surveyed the National Inpatient Sample from 2008 to 2019 to calculate the number of PCIs for MI guided by IVUS or OCT. Temporal trends were analyzed using Cochran-Armitage trend test or simple linear regression for categorical or continuous outcomes, respectively. Multivariable logistic regression was used to compare outcomes following PCI with and without intravascular imaging. Results A total of 2,881,746 PCIs were performed for MI. The number of IVUS-guided PCIs increased by 309.9 % from 6,180 in 2008 to 25,330 in 2019 (P-trend < 0.001). The percentage of IVUS use in PCIs increased from 3.4 % in 2008 to 8.7 % in 2019 (P-trend < 0.001). The number of OCT-guided PCIs increased 548.4 % from 246 in 2011 to 1,595 in 2019 (P-trend < 0.001). The percentage of OCT guidance in all PCIs increased from 0.0 % in 2008 to 0.6 % in 2019 (P-trend < 0.001). Intravascular imaging-guided PCI was associated with lower odds of in-hospital mortality (adjusted odds ratio 0.66, 95 % confidence interval 0.60-0.72, p < 0.001). Conclusions Although the number of intravascular imaging-guided PCIs have been increasing, adoption of intravascular imaging remains poor despite an association with lower mortality.
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Key Words
- BMS, Bare-metal stent
- CI, Confidence interval
- DES, Drug-eluting stent
- HCUP, Healthcare Cost and Utilization Project
- ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification
- ICD-10-PCS, International Classification of Diseases, 10th Revision, Procedural Coding System
- ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification
- ICD-9-PCS, International Classification of Diseases, 9th Revision, Procedural Coding System
- IVUS
- IVUS, Intravascular ultrasound
- Imaging
- Intravascular
- MI, Myocardial infarction
- Myocardial infarction
- NIS, National Inpatient Sample
- NSTEMI, Non-ST-elevation myocardial infarction
- OCT
- OCT, Optical coherence tomography
- PCI
- PCI, Percutaneous coronary intervention
- STEMI, ST-elevation myocardial infarction
- Trend
- U.S, United States
- aOR, Adjusted odds ratio
- cOR, Crude odds ratio
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Multimodality imaging for diagnosis of subclinical hereditary transthyretin cardiac amyloidosis. J Nucl Cardiol 2023; 30:792-799. [PMID: 34873643 DOI: 10.1007/s12350-021-02865-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
We present a case of a patient with worsening visual acuity and dense vitreal debris who was found to have vitreal transthyretin amyloid (ATTR) infiltration. Cardiac workup, performed to identify systemic amyloidosis, demonstrated focal myocardial amyloid infiltration on pyrophosphate (PYP) scintigraphy and cardiac magnetic resonance (CMR), resulting in a diagnosis of subclinical ATTR cardiac amyloidosis (ATTR-CA). Patient was identified as a carrier of p.S70R mutation which results in an aggressive ATTR phenotype. Patient is tolerating transthyretin silencer therapy well. Through this case, we discuss the role of a multimodality imaging approach for the diagnosis of subclinical ATTR-CA.
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HOUSEHOLD INCOME AND READMISSIONS FOR ATRIAL FIBRILLATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00673-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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10
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TRENDS AND IMPACT OF INTRAVASCULAR ULTRASOUND AND OPTICAL COHERENCE TOMOGRAPHY ON PERCUTANEOUS CORONARY INTERVENTION FOR MYOCARDIAL INFARCTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Factor Xa inhibitors versus vitamin K antagonist in morbidly obese patients with venous thromboembolism: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:100. [PMID: 36814196 PMCID: PMC9945392 DOI: 10.1186/s12872-023-03067-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/13/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Guidelines have endorsed non-vitamin K antagonist oral anticoagulants (NOACs), consisting of factor Xa inhibitors (xabans) and direct thrombin inhibitors, as the first line of treatment in venous thromboembolism (VTE) and atrial fibrillation. However, morbidly obese patients were under-represented in landmark trials of NOACs. Therefore, this study aimed to systematically review and perform a meta-analysis of studies on xabans versus vitamin K antagonist (VKA) in this high-risk population with VTE. METHODS PubMed, Embase, Medline, Cochrane library, and Google Scholar databases were searched to identify studies that compared xabans and VKA in treating morbidly obese patients with VTE. Morbid obesity was defined as body weight ≥ 120 kg or BMI ≥ 40 kg/m2. Outcomes of interest included recurrent VTE, major bleeding, and clinically relevant non-major bleeding (CRNMB). RESULTS Eight studies comprising 30,895 patients were included. A total of 12,755 patients received xabans while 18,140 received VKAs. No significant difference in the odds of recurrent VTE (OR 0.75, 95% CI 0.55-1.01) and CRNMB (OR 0.69, 95% CI 0.44-1.09) was observed between the xabans group and the VKA group. However, the xabans group was associated with lower odds of major bleeding (OR 0.70, 95% CI 0.59-0.83). CONCLUSION Xabans have lower odds of major bleeding but similar odds of recurrent VTE when compared with VKAs in treating VTE in morbidly obese patients. Large registry analyses or future randomized controlled trials will be helpful in confirming these findings.
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CRT-700.14 Incremental Predictive Value of Cardiac Troponin Positivity and Right Ventricular Strain Added to PESI Risk Class in Submassive Pulmonary Embolism. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Network Meta-Analysis Comparing Angiotensin Receptor-Neprilysin Inhibitors, Angiotensin Receptor Blockers, and Angiotensin-Converting Enzyme Inhibitors in Heart Failure With Reduced Ejection Fraction. Am J Cardiol 2023; 187:84-92. [PMID: 36459752 PMCID: PMC10958453 DOI: 10.1016/j.amjcard.2022.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
The superiority of angiotensin receptor-neprilysin inhibitor (ARNI) over angiotensin-converting enzyme inhibitor (ACE-I) and angiotensin receptor blocker (ARB) has not been reassessed after the publication of recent trials that did not find clinical benefits. Therefore, we performed an updated network meta-analysis comparing the efficacy and safety of ARNI, ACE-I, ARB, and placebo in heart failure with reduced ejection fraction. We included randomized clinical trials that compared ARNI, ARB, ACE-I, and placebo in heart failure with reduced ejection fraction. We extracted prespecified efficacy end points and produced network estimates, p scores, and surface under the cumulative ranking curve scores using frequentist and Bayesian network meta-analysis approaches. A total of 28 randomized controlled trials including 47,407 patients were included. ARNI was associated with lower risk of all-cause mortality (relative risk [RR] 0.81, 95% confidence interval [CI] 0.68 to 0.96), cardiac death (RR 0.79, 95% CI 0.64 to 0.99), and major adverse cardiac events (MACEs; RR 0.83, 95% CI 0.72 to 0.97) but higher risk of hypotension (RR 1.46, 95% CI 1.02 to 2.10) than ARB. ARNI was associated with lower risk of MACE (RR 0.85, 95% CI 0.74 to 0.97), but higher risk of hypotension (RR 1.69, 95% CI 1.27 to 2.24) compared with ACE-I. P scores and surface under the cumulative ranking curve scores demonstrated superiority of ARNI over ARB and ACE-I in all-cause mortality, cardiac death, MACE, and hospitalization for heart failure. In conclusion, ARNI was associated with improved clinical outcomes, except for higher risk of hypotension, compared with ARB and ACE-I.
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Contemporary weekend effect on management and in-hospital outcomes of non-ST elevation myocardial infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 50:61-62. [PMID: 36702666 DOI: 10.1016/j.carrev.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
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A systematic review and meta-analysis comparing radiofrequency catheter ablation with medical therapy for ventricular tachycardia in patients with ischemic and non-ischemic cardiomyopathies. J Interv Card Electrophysiol 2023; 66:161-175. [PMID: 35759160 DOI: 10.1007/s10840-022-01287-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients with cardiomyopathy, radiofrequency catheter ablation (CA) for ventricular tachycardia (VT) is an adjunctive and alternative treatment option to long-term anti-arrhythmic drug therapy. We sought to compare CA with medical therapy for the management of VT in patients with ischemic and non-ischemic cardiomyopathies. METHODS MEDLINE, Cochrane, and ClinicalTrials.gov databases were evaluated for relevant studies. RESULTS Eleven studies with 2126 adult patients were included (711 in CA, 1415 in medical therapy). In the randomized controlled trial (RCT) analysis, CA reduced risk of recurrent VT (risk ratio (RR) 0.79 [95% CI 0.67 to 0.93], p = 0.005), ICD shocks (RR 0.64 [95% CI 0.45 to 0.89] p = 0.008), and cardiac hospitalizations (RR 0.76 [95% CI 0.63 to 0.92] p = 0.005). There was no difference in all-cause mortality (RR 0.94, p = 0.71). In combined RCT and observational study analysis, there was a trend for reduction in all-cause mortality (RR 0.75 [95% CI 0.55 to 1.02] p = 0.07). In subgroup analysis of studies with mean left ventricular ejection fraction (LVEF) < 35%, CA demonstrated reduction in mortality (RR 0.71, p = 0.004), ICD shocks (RR 0.63, p = 0.03), VT recurrence (RR 0.76, p = 0.004), and cardiac hospitalizations (RR 0.75, p = 0.02). The subgroup of early CA prior to ICD shocks demonstrated reduction in ICD shocks (RR 0.57, p < 0.001) and VT recurrence (RR 0.74, p = 0.01). CONCLUSIONS CA for VT demonstrated a lower risk of VT recurrence, ICD shocks, and hospitalization in comparison to medical therapy. The subgroups of early CA and LVEF < 35% demonstrated better outcomes.
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Stress myocardial perfusion imaging vs. stress echocardiography for risk stratification of kidney transplant candidates: Does it even matter? J Nucl Cardiol 2022; 29:3000-3002. [PMID: 34961898 DOI: 10.1007/s12350-021-02883-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 01/18/2023]
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Identifying CRT responders: Moving from electrical to mechanical dyssynchrony. J Nucl Cardiol 2022; 29:2649-2651. [PMID: 35141842 DOI: 10.1007/s12350-022-02914-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
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Recurrent Coronary Vasospasm: A Case of Kounis Syndrome from Anaphylaxis to Contrast Dye. Methodist Debakey Cardiovasc J 2022; 18:29-36. [PMID: 35855403 PMCID: PMC9248981 DOI: 10.14797/mdcvj.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022] Open
Abstract
Kounis syndrome is characterized by acute coronary syndrome due to coronary vasospasm or thrombosis following exposure to an allergic stimulus. The presentation can be compounded by cardiovascular collapse due to cardiogenic shock from coronary vasospasm and associated vasodilatory shock from anaphylaxis. A high index of suspicion is crucial for prompt initiation of treatment, which focuses on managing the allergic or anaphylactic process. Here we present a case of coronary vasospasm and anaphylactic shock due to contrast dye exposure during percutaneous coronary intervention of an unstable coronary lesion and its associated diagnostic and therapeutic challenges.
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Abbreviated versus Standard Duration of DAPT after PCI: A Systematic Review and Network Meta-analysis. Am J Cardiovasc Drugs 2022; 22:633-645. [PMID: 35781867 DOI: 10.1007/s40256-022-00541-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) is typically continued for 6-12 months depending on clinical presentation. Recent studies have evaluated the safety of shorter durations of DAPT across stable and unstable coronary syndrome but are limited by smaller patient pools and varying indications. METHODS The present study performed a systematic review and network meta-analysis comparing abbreviated (1-3 months) with standard (6-12 months) duration of DAPT. Both conventional and frequentist network meta-analyses with a random-effects model were conducted. RESULTS Seventeen randomized controlled trials, nine of which included 1-3 months of DAPT, were selected. The risks of any bleeding (RR 0.68, 95% CI 0.54-0.85), major bleeding (RR 0.66, 95% CI 0.50-0.86), and net adverse clinical events (NACE) (RR 0.87, 95% CI 0.76-0.99) were lower with abbreviated (1-3 months) than standard-term (6-12 months) DAPT. No significant differences in the risk of myocardial infarction (RR 1.02, 95% CI 0.87-1.18), definite or probable stent thrombosis (RR 1.11, 95% CI 0.83-1.50), and major adverse cardiac events (MACE) (RR 0.96, 95% CI 0.86-1.06) were observed. Network meta-analysis demonstrated lower risk of any bleeding, major bleeding, and NACE with shorter durations of DAPT compared with 12 months. Risks of definite or probable stent thrombosis, myocardial infarction, and MACE were not significantly different. CONCLUSION The results support the growing body of evidence that abbreviated duration (1-3 months) of DAPT may be considered to reduce the risk of bleeding without any differences in myocardial infarction, stent thrombosis, or MACE.
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Impact of Pulmonary Embolism on Cardiac Bypass Surgery Outcomes. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022. [DOI: 10.1016/j.carrev.2022.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Myocarditis After COVID-19 Vaccination: A Systematic Review of Case Studies. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022. [PMCID: PMC9359476 DOI: 10.1016/j.carrev.2022.06.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Predictors for Mortality in Patients Admitted for Transcatheter Mitral Valve Repair: An Insight From the National Inpatient Sample Database From 2016 and 2017. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022. [DOI: 10.1016/j.carrev.2022.06.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Temporal Trends of Periprocedural Stroke in Patients Who Underwent Carotid Artery Stenting From 2006 to 2017: Retrospective Analysis From the National Inpatient Database. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022. [DOI: 10.1016/j.carrev.2022.06.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Systematic Review and Network Meta-Analysis Comparing Bifurcation Techniques for Percutaneous Coronary Intervention. J Am Heart Assoc 2022; 11:e025394. [PMID: 35723005 PMCID: PMC9238651 DOI: 10.1161/jaha.122.025394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/07/2022] [Indexed: 12/14/2022]
Abstract
Background Bifurcation lesions account for 20% of all percutaneous coronary interventions and represent a complex subset which are associated with lower procedural success and higher rates of restenosis. The ideal bifurcation technique, however, remains elusive. Methods and Results Extensive search of the literature was performed to pull data from randomized clinical trials that met predetermined inclusion criteria. Conventional meta-analysis produced pooled relative risk (RR) and 95% CI of 2-stent technique versus provisional stent on prespecified outcomes. Both frequentist and Bayesian network meta-analyses were performed to compare bifurcation techniques. A total of 8318 patients were included from 29 randomized clinical trials. Conventional meta-analysis showed no significant differences in all-cause mortality, cardiac death, major adverse cardiac events, myocardial infarction, stent thrombosis, target lesion revascularization, and target vessel revascularization between 2-stent techniques and provisional stenting. Frequentist network meta-analysis revealed that double kissing crush was associated with lower cardiac death (RR, 0.57; 95% CI, 0.38-0.84), major adverse cardiac events (RR, 0.50; 95% CI, 0.39-0.64), myocardial infarction (RR, 0.60; 95% CI, 0.39-0.90), stent thrombosis (RR, 0.50; 95% CI, 0.28-0.88), target lesion revascularization, and target vessel revascularization when compared with provisional stenting. Double kissing crush was also superior to other 2-stent techniques, including T-stent or T and protrusion, dedicated bifurcation stent, and culotte. Conclusions Double kissing crush was associated with lower risk of cardiac death, major adverse cardiac events, myocardial infarction, stent thrombosis, target lesion revascularization, and target vessel revascularization compared with provisional stenting and was superior to other 2-stent techniques. Superiority of 2-stent strategy over provisional stenting was observed in subgroup meta-analysis stratified to side branch lesion length ≥10 mm.
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Myocarditis after COVID-19 mRNA vaccination: A systematic review of case reports and case series. Clin Cardiol 2022; 45:691-700. [PMID: 35652390 PMCID: PMC9286338 DOI: 10.1002/clc.23828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 01/05/2023] Open
Abstract
Background The coronavirus disease of 2019 (COVID‐19) is a global pandemic with over 266 million cases and 5 million deaths worldwide. Anti‐COVID‐19 vaccinations have had exceptional success in subduing the incidence, prevalence, and disease severity of COVID‐19, but rare cases of myocarditis have been reported after COVID‐19 vaccinations. Hypothesis Myocarditis occurring after COVID‐19 mRNA vaccinations have distinguishable clinical characteristics. They usually have a favorable prognosis. Methods We performed a systematic literature search on PUBMED and MEDLINE database from inception to December 5, 2021. Studies were analyzed based on predetermined eligibility criteria. Results A total of 57 studies containing 275 cases of COVID‐19 vaccine‐associated myocarditis were catalogued. Mean age was 26.7 years and male to female ratio was 14:1. For 86.9% of patients, myocarditis occurred after the second dose. Average time to onset and length of hospitalization were 3.7 and 3.9 days, respectively. Prognosis was largely benign, but there was a 1.1% reported mortality. Chest pain (95.2%), elevation of troponin (100%), and ST elevation on electrocardiography (68.5%) were common. Nonsteroidal anti‐inflammatory drugs (81.4%) were the most used medication, followed by colchicine (33.1%). Conclusions Patients with COVID‐19 vaccine‐associated myocarditis are usually younger males presenting with chest pain 3–4 days after receiving their second dose of COVID vaccine. Diagnosis is made by exclusion of all other etiologies. Given significant population benefit from COVID‐19 vaccination, physicians should continue to encourage vaccination while remaining vigilant of the very rare occurrence of myocarditis following COVID‐19 vaccination.
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A META-ANALYSIS OF IMMEDIATE VERSUS DELAYED CORONARY ANGIOGRAPHY IN PATIENTS WITH OUT-OF-HOSPITAL CARDIAC ARREST. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01891-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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ABBREVIATED VERSUS STANDARD DURATION OF DUAL ANTIPLATELET THERAPY AFTER PCI: A META-ANALYSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01812-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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MALIGNANCIES AND PULMONARY EMBOLISM: IN-HOSPITAL MORTALITY RATES STRATIFIED BASED ON TYPE OF CANCER FROM NATIONAL INPATIENT SAMPLE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02665-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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The Prognostic Value of MPI in CKD: Can we do better? J Nucl Cardiol 2022; 29:155-157. [PMID: 33608852 DOI: 10.1007/s12350-021-02545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
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CRT-700.54 Predictors for Mortality in Patients Admitted for Transcatheter Mitral Valve Repair: An Insight From the National Inpatient Sample Database From 2016 and 2017. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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CRT-200.09 Myocarditis After COVID-19 Vaccination: A Systematic Review of Case Studies. JACC Cardiovasc Interv 2022. [PMCID: PMC8860243 DOI: 10.1016/j.jcin.2022.01.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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CRT-300.02 Temporal Trends of Periprocedural Stroke in Patients Who Underwent Carotid Artery Stenting From 2006 to 2017: Retrospective Analysis From the National Inpatient Database. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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TCT-461 Long-Term Outcomes After Transcatheter Tricuspid Valve Intervention for Significant Tricuspid Regurgitation: A Pooled Analysis. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Automatic extraction and stenosis evaluation of coronary arteries in invasive coronary angiograms. Comput Biol Med 2021; 136:104667. [PMID: 34315031 DOI: 10.1016/j.compbiomed.2021.104667] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/13/2021] [Accepted: 07/17/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) is the leading cause of death in the United States (US) and a major contributor to healthcare cost. Accurate segmentation of coronary arteries and detection of stenosis from invasive coronary angiography (ICA) are crucial in clinical decision making. PURPOSE We aim to develop an automatic method to extract coronary arteries by deep learning and detect arterial stenosis from ICAs. METHODS In this study, a deep learning model which integrates a feature pyramid with a U-Net++ model was developed to automatically segment coronary arteries in ICAs. A compound loss function which contains Dice loss, dilated Dice loss, and L2 regularization was utilized to train the proposed segmentation model. Following the segmentation, an algorithm which extracts vascular centerlines, calculates the diameters, and measures the stenotic levels, was developed to detect arterial stenosis. RESULTS AND CONCLUSIONS In the dataset consisting of 314 ICAs obtained from 99 patients, the segmentation model achieved an average Dice score of 0.8899, a sensitivity of 0.8595, and a specificity of 0.9960. In addition, the stenosis detection algorithm achieved a true positive rate of 0.6840 and a positive predictive value of 0.6998 on all types of stenosis, which has great promise to advance to clinical uses and could provide auxiliary suggestions for CAD diagnosis and treatment.
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Left ventricular regional asynchrony: Earliest marker for ischemic cardiomyopathy? J Nucl Cardiol 2021; 28:1051-1054. [PMID: 32901419 DOI: 10.1007/s12350-020-02355-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
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USE OF COLCHICINE FOR SECONDARY PREVENTION OF CARDIOVASCULAR EVENTS: SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01383-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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ST SEGMENT ELEVATIONS AND COVID-19- A CASE SERIES. J Am Coll Cardiol 2021. [PMCID: PMC8091292 DOI: 10.1016/s0735-1097(21)03387-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Invasive therapy versus conservative therapy for patients with stable coronary artery disease: An updated meta-analysis. Clin Cardiol 2021; 44:675-682. [PMID: 33742721 PMCID: PMC8119834 DOI: 10.1002/clc.23592] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/21/2021] [Accepted: 03/03/2021] [Indexed: 01/09/2023] Open
Abstract
Background Heart disease remains the leading cause of death in the United States. Although there are clear indications for revascularization in patients with acute coronary syndromes, there is debate regarding the benefits of revascularization in stable ischemic heart disease. We sought to perform a comprehensive meta‐analysis to assess the role of revascularization compared to conservative medical therapy alone in patients with stable ischemic heart disease. Hypothesis There is no significant difference in all‐cause mortality or cardiovascular mortality between invasive and medical arms. Methods We performed a systematic literature search from January 2000 to June 2020. Our literature search yielded seven randomized controlled trials. We analyzed a total of 12 013 patients (6109 in revascularization arm and 5904 in conservative medical therapy arm). Primary outcome was all‐cause mortality. Secondary outcomes included major adverse cardiac events (MACE) (death, myocardial infarction [MI], or stroke), cardiovascular mortality, MI, and stroke. Additional subgroup analysis for all‐cause mortality was performed comparing percutaneous coronary intervention (PCI) with bare metal stent versus conservative therapy; and PCI with drug eluting stent versus conservative therapy. Results There was no statistically significant difference in primary outcome of all‐cause mortality between either arm (odds ratio [OR] = 0.95; 95% CI [confidence interval], 0.83 to 1.08; p = .84). There were statistically significant lower rates of MACE (death, MI or stroke) in the revascularization arm when compared to conservative arm. Conclusions Our analysis did not show any survival advantage of an initial invasive strategy over conservative medical therapy in patients with stable coronary artery disease (CAD).
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The clot thickens: role of mechanical thrombectomy in intermediate to high-risk pulmonary embolism in the peri-operative setting-a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab014. [PMID: 33569531 PMCID: PMC7859591 DOI: 10.1093/ehjcr/ytab014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/15/2020] [Accepted: 01/11/2020] [Indexed: 12/03/2022]
Abstract
Background European Society of Cardiology (ESC) recommends catheter-directed thrombectomy for management of high-risk pulmonary embolism (PE) with contraindications to thrombolytics or in patients that have failed thrombolytic therapy, as well as intermediate-risk PE with haemodynamic deterioration. In this case report, the role of catheter-directed mechanical thrombectomy is highlighted in the urgent peri-operative setting. Case summary A 71-year-old female presented with 10 days of progressive lower extremity weakness and was found to have malignant cord compression along with incidental saddle, intermediate–high-risk PE that extended to all lobes on chest computed tomography. Given the intermediate to high-risk PE with acute cor pulmonale, urgent need for surgery, and risk of haemodynamic collapse upon induction of general anaesthesia, the decision was made to proceed with urgent percutaneous treatment of the PE. Percutaneous catheter-directed thrombectomy was successfully performed. The patient returned to the intensive care unit in stable condition and was able to then receive urgent cord decompression and further treatment for malignancy with no complication. Discussion In this case, single-session thrombectomy resulted in rapid reduction of pre-operative cardiopulmonary risk by alleviating the right ventricular strain, allowing urgent cord decompression surgery to proceed with optimized haemodynamics, no bleeding events, and no further oxygen requirements. While peri-operative risk stratification for cardiovascular outcomes is well established in current guidelines, there are no clear guidelines for peri-operative risk stratification in the setting of pulmonary embolism. The importance of the multidisciplinary PE Response Team is thus emphasized, as well as the importance of continuous evaluation of clinical decompensation in PE.
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Middle-Aged Man With Unstable Angina and an Inaccessible Right Coronary Artery. Cureus 2020; 12:e11156. [PMID: 33251064 PMCID: PMC7686933 DOI: 10.7759/cureus.11156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Acute myocardial ischemia and infarction from retrograde dissection of the aortic root into the coronary ostia is a potentially fatal condition. Unrecognized type A aortic dissection at the time of angiography for acute coronary syndrome (ACS) carries a high burden of morbidity and mortality. Cardiac computed tomography angiography (CCTA) has emerged as one of the instrumental tools in the diagnosis of retrograde coronary involvement from type A aortic dissections. We present a case of ACS secondary to retrograde aortic dissection extending into the right coronary artery (RCA) suspected during coronary angiography and confirmed by CCTA. The patient was managed surgically with aortic root replacement and coronary artery bypass grafting.
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Impact of pretransplant mitral annular calcification on the incidence of cardiac events after renal transplantation. Nephrol Dial Transplant 2020; 35:526-533. [PMID: 31006008 DOI: 10.1093/ndt/gfz063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/10/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mitral annular calcification (MAC) is associated with increased risk of major adverse cardiac events. We hypothesized that MAC, identified on a pretransplant transthoracic echocardiography (TTE), is predictive of cardiac events following renal transplantation (RT). METHODS In a retrospective cohort of consecutive RT recipients, pretransplant MAC presence and severity were determined on TTE performed within 1 year prior to transplant. MAC severity was quantified based on the circumferential MAC extension relative to the mitral valve annulus. Post-transplant cardiac risk was assessed using the sum of risk factors (range: 0-8) set forth by the American Heart Association/American College of Cardiology Foundation consensus statement on the assessment of RT candidates. Subjects underwent pretransplant stress single-photon emission computed tomography myocardial perfusion imaging and followed for post-transplant composite outcome of cardiac death or myocardial infarction (CD/MI). RESULTS Among 336 subjects (60.5% men; mean age 52 ± 12 years), MAC was present in 78 (23%) patients. During a mean follow-up of 3.1 ± 1.9 years, a total of 70 events were observed. Patients with MAC had a higher event rate compared with those without MAC (34.6% versus 17.8%, log-rank P = 0.001). There was a stepwise increase in CD/MI risk with increasing MAC severity (P for trend = 0.002). MAC-associated risk remained significant after adjusting for sex, duration of dialysis, sum of risk factors, ejection fraction and perfusion abnormality burden, providing an incremental prognostic value to these parameters (Δχ2 =4.63; P = 0.031). CONCLUSION Among RT recipients, the burden of pretransplant MAC is an independent predictor of post-transplant risk of CD/MI. MAC should be considered in the preoperative assessment of RT candidates.
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Ayub MT, Arif AW, Usman M, Almani MU, Vij A, Yadav N. True or False? A case of Left Ventricular Aneurysm with Review of Diagnostic Modalities.. [DOI: 10.22541/au.159586016.63574164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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498 Patient safety alert: Medical image manipulation as a safety hazard for wrong-site procedures. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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SYMPTOMATIC RADIAL ARTERY OCCLUSION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Meta-Analysis Comparing Double Versus Triple Antithrombotic Therapy in Patients With Atrial Fibrillation and Coronary Artery Disease. Am J Cardiol 2020; 125:19-28. [PMID: 31837732 DOI: 10.1016/j.amjcard.2019.09.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
Atrial fibrillation (AF) and concomitant coronary artery disease (CAD) create a therapeutic dilemma as the risk of bleeding with triple antithrombotic therapy (TATT) must be balanced against the risk of ischemic events with double antithrombotic therapy (DATT). The aim of this meta-analysis is to compare the efficacy and safety of DATT versus TATT in AF and CAD. MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched for relevant articles published from inception to May 1, 2019. Studies comparing the safety and efficacy of DATT versus TATT in patients with AF and CAD were included. Among 9 studies, where 6,104 patients received DATT and 7,333 patients received TATT, there was no statistically significant difference in the outcomes of mortality, nonfatal myocardial infarction, stent thrombosis, and stroke. There was a lower rate of major bleeding in DATT (risk ratio [RR] 0.64 [95% confidence interval [CI] 0.54 to 0.75]; p <0.001). There was no significant difference in stent thrombosis (RR 1.52 [95% CI 0.97 to 2.38]; p = 0.07). However, subgroup analysis of trials with direct oral anticoagulant use demonstrated a borderline higher rate of stent thrombosis in DATT (RR 1.66 [95% CI 1.01 to 2.73]; p = 0.05). In conclusion, DATT showed no difference in the outcomes of mortality, stroke, nonfatal myocardial infarction, and stent thrombosis compared with TATT. DATT demonstrated a lower rate of major bleeding. DATT demonstrated a borderline higher rate of stent thrombosis in the subgroup analysis of trials with direct oral anticoagulant which needs to be evaluated in further studies.
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The prognostic value of heart rate response during vasodilator stress myocardial perfusion imaging in patients with end-stage renal disease undergoing renal transplantation. J Nucl Cardiol 2019; 26:814-822. [PMID: 28924814 DOI: 10.1007/s12350-017-1061-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/31/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND In asymptomatic end-stage renal disease (ESRD) patients undergoing vasodilator stress myocardial perfusion imaging (MPI) prior to renal transplantation (RT), the impact of pre-transplant heart rate response (HRR) to vasodilator stress on post-RT outcomes is unknown. METHODS We analyzed a retrospective cohort of asymptomatic patients with ESRD who underwent a vasodilator stress SPECT-MPI and subsequently received RT. Blunted HRR was defined as HRR <28% for regadenoson stress and <20% for adenosine stress. The primary endpoint was major adverse cardiac events (MACE), defined as cardiac death or myocardial infarction. Clinical risk was assessed using the sum of risk factors set forth by the AHA/ACCF consensus statement on the assessment of RT candidates. RESULTS Among 352 subjects, 140 had an abnormal pre-transplant HRR. During a mean follow-up of 3.2 ± 2.0 years, 85 (24%) MACEs were observed. Blunted HRR was associated with increased MACE risk (hazard ratio 1.72; 95% confidence interval 1.12-2.63, P = 0.013), and remained significant after adjustment for gender, sum of AHA/ACCF risk factors, summed stress score, baseline heart rate, and β-blocker use. HRR was predictive of MACE in patients with normal MPI and irrespective of clinical risk. Blunted HRR was associated with a significant increase in post-operative (30-day) MACE risk (17.9% vs 8.5%; P = 0.009). CONCLUSION In asymptomatic ESRD patients being evaluated for RT, a blunted pre-transplant HRR was predictive of post-RT MACE. HRR may be a valuable tool in the risk assessment of RT candidates.
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866 Patient with paroxysmal nocturnal hemoglobinuria (PNH) and aplastic anemia presenting with progressive purpuric nodules. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Validation of a clinical pathway to assess asymptomatic renal transplant candidates using myocardial perfusion imaging. J Nucl Cardiol 2018; 25:2058-2068. [PMID: 28484986 DOI: 10.1007/s12350-017-0901-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 04/06/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND An AHA/ACCF scientific statement proposed 8 risk factors to assess the need for noninvasive coronary artery disease (CAD) surveillance in asymptomatic patients undergoing evaluation for kidney transplantation. The clinical application of these risk factors and the role of noninvasive testing in this context have not been defined. METHODS AND RESULTS We retrospectively followed a cohort of 581 consecutive kidney transplant recipients of whom 401 had pre-transplant radionuclide myocardial perfusion imaging (MPI) and 90 had pre-transplant coronary angiography. The sum of pre-transplant AHA/ACCF risk factors (age >60 years, hypertension, diabetes, cardiovascular disease, dyslipidemia, smoking, dialysis >1 year, left ventricular hypertrophy) was calculated. MPI scans were analyzed by a "blinded" reader. Patients were followed for a mean of 3.7 ± 2.3 years post-transplant for major adverse cardiac events (MACE), defined as cardiac death or non-fatal myocardial infarction. The sum of risk factors was associated with modest discriminatory capacity for obstructive angiographic CAD (area under the curve [AUC], 0.70; P = 0.004), 30-day post-operative MACE (AUC, 0.60; P = 0.036), and long-term MACE (AUC, 0.63; P < 0.001). A threshold of ≥3 risk factors was optimal for identifying patients at risk. MPI provided incremental predictive value for obstructive CAD (P = 0.02) and long-term MACE (P = 0.04) but not post-operative MACE (P = 0.56). MPI was best predictive of long-term MACE in intermediate risk (3-4 risk factors) patients. CONCLUSIONS Asymptomatic kidney transplant candidates with ≥3 AHA/ACCF risk factors are at increased cardiac risk, and should be considered for noninvasive CAD surveillance. Intermediate risk patients (3-4 factors) benefit the most from pre-transplant MPI to define long-term MACE risk.
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Meta-Analysis Comparing Dual Antiplatelet Therapy Versus Single Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation. Am J Cardiol 2018; 122:1401-1408. [PMID: 30340696 DOI: 10.1016/j.amjcard.2018.06.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/20/2018] [Accepted: 06/26/2018] [Indexed: 11/28/2022]
Abstract
The present American College of Cardiology/American Heart Association guidelines (Grade IIb, level of evidence C) recommend dual antiplatelet therapy (DAPT) with aspirin and clopidogrel for 6 months followed by lifelong aspirin after transcathter aortic valve implantation (TAVI). However, studies that have compared DAPT to single antiplatelet therapy (SAPT) after TAVI have questioned this recommendation as DAPT has been associated with more bleeding events compared with SAPT. We performed a meta-analysis of all the trials that compared DAPT to SAPT in patients who underwent TAVI. Three randomized trials and 4 nonrandomized studies were included. The primary endpoint was the rate of ischemic stroke. Secondary end points were the rates of myocardial infarction, life threatening bleeding (LTB), significant bleeding (LTB and major bleeding), and death. The Mantel-Haenszel random effects model was used to calculate the combined odds ratios (OR) and 95% confidence intervals (CI) for outcomes at 30days and up to 6 to 12months follow-up. The LTB (OR 2.73, 95% CI 1.31 to 5.69, p = 0.007) and significant bleeding rates (OR 2.76, 95% CI 1.57 to 4.85, p = 0.0004) were significantly higher in DAPT arm at 30days. Significant bleeding (OR 2.24, 95% CI 1.33 to 3.79, p = 0.002) was still significantly higher in the DAPT arm but there was only a nonsignificant trend toward higher LTB (OR 1.93 95% CI 0.61 to 6.03, p = 0.26) at 6 to 12 month follow up. There was no difference in mortality, ischemic stroke and myocardial infarction at 30days or 6 to 12month follow up. In conclusion, our meta-analysis shows that DAPT after TAVI does not confer any additional benefit over SAPT in TAVI.
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