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Guglin M, Zweck E, Kanwar M, Sinha SS, Bhimaraj A, Li B, Abraham J, Vallabhajosyula S, Hernandez-Montfort J, Kataria R, Burkhoff D, Kapur NK. Body Mass Index and Mortality in Cardiogenic Shock. ASAIO J 2024:00002480-990000000-00447. [PMID: 38527077 DOI: 10.1097/mat.0000000000002194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
We explored the association of body mass index (BMI) with mortality in cardiogenic shock (CS). Using the Cardiogenic Shock Working Group registry, we assessed the impact of BMI on mortality using restricted cubic splines in a multivariable logistic regression model adjusting for age, gender, and race. We also assessed mortality, device use, and complications in BMI categories, defined as underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obese (30-39.9 kg/m2), and severely obese (>40 kg/m2) using univariable logistic regression models. Our cohort had 3,492 patients with CS (mean age = 62.1 ± 14 years, 69% male), 58.0% HF-related CS (HF-CS), and 27.8% acute myocardial infarction (AMI) related CS. Body mass index was a significant predictor of mortality in multivariable regression using restricted cubic splines (p < 0.0001, p = 0.194 for nonlinearity). When stratified by categories, patients with healthy weight had lower mortality (29.0%) than obese (35.1%, p = 0.003) or severely obese (36.7%, p = 0.01). In HF-CS cohort, the healthy weight patients had the lowest mortality (21.7%), whereas it was higher in the underweight (37.5%, p = 0.012), obese (29.2%, p = 0.003), and severely obese (29.9%, p = 0.019). There was no difference in mortality among BMI categories in AMI-CS.
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Affiliation(s)
- Maya Guglin
- From Department of Cardiology, the Indiana University Health, Indianapolis, Indiana
| | - Elric Zweck
- Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
- Department of Cardiology, The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Manreet Kanwar
- Department of Cardiology, Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Shashank S Sinha
- Department of Cardiology, Inova Heart and Vascular Institute, Inova Fairfax Campus, Falls Church, Virginia
| | - Arvind Bhimaraj
- Department of Cardiology, Houston Methodist Research Institute, Houston, Texas
| | - Borui Li
- Department of Cardiology, The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Jacob Abraham
- Department of Cardiology, Providence Heart Institute, Portland, Oregon
| | | | - Jaime Hernandez-Montfort
- Department of Cardiology, Baylor Scott & White Health, Advanced Heart Failure Program Clinic, Temple, Texas
| | - Rachna Kataria
- Department of Cardiology, Brown University, Providence, Rhode Island
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel Burkhoff
- Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Navin K Kapur
- Department of Cardiology, The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
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Belur AD, Mehta A, Bansal M, Wieruszewski PM, Kataria R, Saad M, Clancy A, Levine DJ, Sodha NR, Burtt DM, Rachu GS, Abbott JD, Vallabhajosyula S. Palliative care in the cardiovascular intensive care unit: A systematic review of current literature. Cardiovasc Revasc Med 2024:S1553-8389(24)00112-X. [PMID: 38531709 DOI: 10.1016/j.carrev.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND There has been an evolution in the disease severity and complexity of patients presenting to the cardiac intensive care unit (CICU). There are limited data evaluating the role of palliative care in contemporary CICU practice. METHODS PubMed Central, CINAHL, EMBASE, Medline, Cochrane Library, Scopus, and Web of Science databases were evaluated for studies on palliative care in adults (≥18 years) admitted with acute cardiovascular conditions - acute myocardial infarction, cardiogenic shock, cardiac arrest, advanced heart failure, post-cardiac surgery, spontaneous coronary artery dissection, Takotsubo cardiomyopathy, and pulmonary embolism - admitted to the CICU, coronary care unit or cardiovascular intensive care unit from 1/1/2000 to 8/8/2022. The primary outcome of interest was the utilization of palliative care services. Secondary outcomes of included studies were also addressed. Meta-analysis was not performed due to heterogeneity. RESULTS Of 5711 citations, 30 studies were included. All studies were published in the last seven years and 90 % originated in the United States. Twenty-seven studies (90 %) were retrospective analyses, with a majority from the National Inpatient Sample database. Heart failure was the most frequent diagnosis (47 %), and in-hospital mortality was reported in 67 % of studies. There was heterogeneity in the timing, frequency, and background of the care team that determined palliative care consultation. In two randomized trials, there appeared to be improvement in quality of life without an impact on mortality. CONCLUSIONS Despite the growing recognition of the role of palliative care, there are limited data on palliative care consultation in the CICU.
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Affiliation(s)
- Agastya D Belur
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - Aryan Mehta
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Mridul Bansal
- Department of Medicine, East Carolina University Brody School of Medicine, Greenville, NC, United States of America
| | - Patrick M Wieruszewski
- Departments of Pharmacy and Anesthesiology, Mayo Clinic, Rochester, MN, United States of America
| | - Rachna Kataria
- Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America; Lifespan Cardiovascular Institute, Providence, RI, United States of America
| | - Marwan Saad
- Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America; Lifespan Cardiovascular Institute, Providence, RI, United States of America
| | - Annaliese Clancy
- Department of Pharmacy, Lifespan Health System, Providence, RI, United States of America
| | - Daniel J Levine
- Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America; Lifespan Cardiovascular Institute, Providence, RI, United States of America
| | - Neel R Sodha
- Lifespan Cardiovascular Institute, Providence, RI, United States of America; Division of Cardiothoracic Surgery, Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Douglas M Burtt
- Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America; Lifespan Cardiovascular Institute, Providence, RI, United States of America
| | - Gregory S Rachu
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - J Dawn Abbott
- Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America; Lifespan Cardiovascular Institute, Providence, RI, United States of America
| | - Saraschandra Vallabhajosyula
- Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America; Lifespan Cardiovascular Institute, Providence, RI, United States of America.
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Senman B, Jentzer JC, Barnett CF, Bartos JA, Berg DD, Chih S, Drakos SG, Dudzinski DM, Elliott A, Gage A, Horowitz JM, Miller PE, Sinha SS, Tehrani BN, Yuriditsky E, Vallabhajosyula S, Katz JN. Need for a Cardiogenic Shock Team Collaborative-Promoting a Team-Based Model of Care to Improve Outcomes and Identify Best Practices. J Am Heart Assoc 2024; 13:e031979. [PMID: 38456417 PMCID: PMC11009990 DOI: 10.1161/jaha.123.031979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/17/2024] [Indexed: 03/09/2024]
Abstract
Cardiogenic shock continues to carry a high mortality rate despite contemporary care, with no breakthrough therapies shown to improve survival over the past few decades. It is a time-sensitive condition that commonly results in cardiovascular complications and multisystem organ failure, necessitating multidisciplinary expertise. Managing patients with cardiogenic shock remains challenging even in well-resourced settings, and an important subgroup of patients may require cardiac replacement therapy. As a result, the idea of leveraging the collective cognitive and procedural proficiencies of multiple providers in a collaborative, team-based approach to care (the "shock team") has been advocated by professional societies and implemented at select high-volume clinical centers. A slowly maturing evidence base has suggested that cardiogenic shock teams may improve patient outcomes. Although several registries exist that are beginning to inform care, particularly around therapeutic strategies of pharmacologic and mechanical circulatory support, none of these are currently focused on the shock team approach, multispecialty partnership, education, or process improvement. We propose the creation of a Cardiogenic Shock Team Collaborative-akin to the successful Pulmonary Embolism Response Team Consortium-with a goal to promote sharing of care protocols, education of stakeholders, and discovery of how process and performance may influence patient outcomes, quality, resource consumption, and costs of care.
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Affiliation(s)
| | | | - Christopher F. Barnett
- Division of Cardiology, Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Jason A. Bartos
- Department of Medicine‐Cardiovascular DivisionUniversity of MinnesotaMinneapolisMNUSA
| | - David D. Berg
- Division of Cardiovascular MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | | | - Stavros G. Drakos
- Department of Medicine, Division of Cardiovascular Medicine and Nora Eccles Harrison Cardiovascular Research and Training InstituteUniversity of Utah School of MedicineSalt Lake CityUTUSA
| | | | - Andrea Elliott
- Department of Medicine‐Cardiovascular DivisionUniversity of MinnesotaMinneapolisMNUSA
| | - Ann Gage
- Department of Cardiovascular MedicineCentennial Medical CenterNashvilleTNUSA
| | - James M. Horowitz
- Division of CardiologyNew York University Grossman School of MedicineNew YorkNYUSA
| | - P. Elliott Miller
- Section of Cardiovascular Medicine, Yale School of MedicineNew HavenCTUSA
| | - Shashank S. Sinha
- Inova Schar Heart and Vascular, Inova Fairfax Medical CampusFalls ChurchVAUSA
| | - Behnam N. Tehrani
- Inova Schar Heart and Vascular, Inova Fairfax Medical CampusFalls ChurchVAUSA
| | - Eugene Yuriditsky
- Division of CardiologyNew York University Grossman School of MedicineNew YorkNYUSA
| | - Saraschandra Vallabhajosyula
- Division of Cardiology, Department of MedicineWarren Alpert Medical School of Brown University and Lifespan Cardiovascular InstituteProvidenceRIUSA
| | - Jason N. Katz
- Division of CardiologyNYU Grossman School of Medicine & Bellevue Hospital CenterNew YorkNYUSA
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Vallabhajosyula S, Mehta A, Bansal M, Jentzer JC, Applefeld WN, Sinha SS, Geller BJ, Gage AE, Rose SW, Barnett CF, Katz JN, Morrow DA, Roswell RO, Solomon MA. Training Paradigms in Critical Care Cardiology: A Scoping Review of Current Literature. JACC Adv 2024; 3:100850. [PMID: 38352139 PMCID: PMC10861182 DOI: 10.1016/j.jacadv.2024.100850] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Background Over the past decade there has been increasing interest in critical care medicine (CCM) training for cardiovascular medicine (CV) physicians either in isolation (separate programs in either order [CV/CCM], integrated critical care cardiology [CCC] training) or hybrid training with interventional cardiology (IC)/heart failure/transplant (HF) with targeted CCC training. Objective To review the contemporary landscape of CV/CCM, CCC, and hybrid training. Methods We reviewed the literature from 2000-2022 for publications discussing training in any combination of internal medicine CV/CCM, CCC, and hybrid training. Information regarding training paradigms, scope of practice and training, duration, sequence, and milestones was collected. Results Of the 2,236 unique citations, 20 articles were included. A majority were opinion/editorial articles whereas two were surveys. The training pathways were classified into - (i) specialty training in both CV (3 years) and CCM (1-2 years) leading to dual American Board of Internal Medicine (ABIM) board certification, or (ii) base specialty training in CV with competencies in IC, HF or CCC leading to a non-ABIM certificate. Total fellowship duration varied between 4-7 years after a three-year internal medicine residency. While multiple articles commented on the ability to integrate the fellowship training pathways into a holistic and seamless training curriculum, few have highlighted how this may be achieved to meet competencies and standards. Conclusions In 20 articles describing CV/CCM, CCC, and hybrid training, there remains significant heterogeneity on the standardized training paradigms to meet training competencies and board certifications, highlighting an unmet need to define CCC competencies.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Section of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
- Lifespan Cardiovascular Institute, Providence, RI
| | - Aryan Mehta
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT
| | - Mridul Bansal
- Department of Medicine, East Carolina University Brody School of Medicine, Greenville, NC
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Willard N Applefeld
- Division of Cardiovascular Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Shashank S Sinha
- Inova Fairfax Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA
| | - Bram J Geller
- Department of Cardiovascular Medicine and Department of Cardiovascular Critical Care Services, Maine Medical Center, Portland, ME
| | - Ann E Gage
- Centennial Heart, Centennial Medical Center, Nashville, TN
| | - Scott W Rose
- Division of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | | | - Jason N Katz
- Division of Cardiovascular Medicine, Department of Medicine, New York University School of Medicine, New York, NY
| | - David A Morrow
- Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Robert O Roswell
- Section of Cardiovascular Medicine, Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Michael A Solomon
- Department of Critical Care Medicine, Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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5
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Moras E, Abbott JD, Vallabhajosyula S. AABB recommends restrictive RBC transfusions for hospitalized adults and children. Ann Intern Med 2024; 177:JC14. [PMID: 38316008 DOI: 10.7326/j23-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
SOURCE CITATION Carson JL, Stanworth SJ, Guyatt G, et al. Red blood cell transfusion: 2023 AABB international guidelines. JAMA. 2023;330:1892-1902. 37824153.
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Affiliation(s)
- Errol Moras
- Ichan School of Medicine at Mount Sinai-Morningside West, New York, NY, USA (E.M., J.D.A.)
| | - J Dawn Abbott
- Ichan School of Medicine at Mount Sinai-Morningside West, New York, NY, USA (E.M., J.D.A.)
- Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, RI, USA (J.D.A., S.V.)
| | - Saraschandra Vallabhajosyula
- Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, RI, USA (J.D.A., S.V.)
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Seri A, Rabadi A, Baral N, Andi K, Hussain B, Bansal M, Mehta A, Vallabhajosyula S. Prevalence of respiratory failure and use of mechanical ventilation in heart failure patients undergoing left atrial appendage occlusion device implantation. Int J Cardiol 2024; 396:131552. [PMID: 37871662 DOI: 10.1016/j.ijcard.2023.131552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND We sought to evaluate respiratory complications in heart failure patients undergoing left atrial appendage occlusion (LAAO) for stroke prevention in atrial fibrillation. METHODS Adult admissions (>18 years) undergoing LAAO during 2016-2020 were identified from the National Inpatient Sample. Heart failure (HF) was stratified into systolic (SHF) and diastolic heart failure (DHF) and were compared to those without HF. Outcomes of interested included acute respiratory failure, use of non-invasive and invasive mechanical ventilation, and in-hospital mortality. RESULTS Of 74,440 admissions for atrial fibrillation undergoing LAAO, SHF and DHF were noted in 8335 (11.2%) and 10,925 (14.7%), respectively. The SHF cohort was predominantly male (78%) whereas DHF cohort were female (53%). Compared to those without HF, presence of SHF (2.3% vs. 0.6%; adjusted odds ratio [OR] 1.61 [95% confidence interval {CI} 1.10-2.36]; p = 0.01) and DHF (2.8% vs. 0.6%; adjusted OR 2.20 [95% CI 1.58-3.06]; p < 0.001) were associated with higher rates of acute respiratory failure. SHF (1.7% vs. 0.6%; adjusted OR 1.70 [95% CI 1.07-2.71]; p = 0.02) group but not DHF (1.2% vs. 0.6%; adjusted OR 1.21 [95% CI 0.78-1.89]; p = 0.39) was associated with higher rates of non-invasive ventilation, whereas the DHF group (0.9% vs. 0.2%; adjusted OR 1.91 [95% CI 1.08-3.34]; p = 0.02) but not SHF (0.8% vs. 0.2%; adjusted OR 1.54 [95% CI 0.83-2.84]; p = 0.17) was associated with higher rates of invasive mechanical ventilation use. In-hospital mortality was comparable between cohorts. CONCLUSION Compared to those without HF, atrial fibrillation admissions with HF undergoing LAAO had higher rates of acute respiratory failure and mechanical ventilation rates without differences in in-hospital mortality.
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Affiliation(s)
- Amith Seri
- Department of Medicine, McLaren Health Care/Michigan State University, Flint, MI, United States of America
| | - Alexander Rabadi
- Department of Medicine, McLaren Health Care/Michigan State University, Flint, MI, United States of America
| | - Nischit Baral
- Department of Medicine, McLaren Health Care/Michigan State University, Flint, MI, United States of America
| | - Kartik Andi
- Section of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Bilal Hussain
- Department of Medicine, Brooklyn Medical Center, Brooklyn, NY, United States of America
| | - Mridul Bansal
- Department of Medicine, East Carolina University Brody School of Medicine, Greenville, NC, United States of America
| | - Aryan Mehta
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America.
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7
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Vallabhajosyula S, Rab ST. Heterogeneity in Cardiogenic Shock Presentation and Care: A Cautionary Tale. Chest 2024; 165:5-6. [PMID: 38199735 DOI: 10.1016/j.chest.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
- Saraschandra Vallabhajosyula
- Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Lifespan Cardiovascular Institute, Providence, RI.
| | - Syed Tanveer Rab
- Department of Medicine,Section of Interventional Cardiology, Division of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, GA
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Gandhi KD, Moras EC, Niroula S, Lopez PD, Aggarwal D, Bhatia K, Balboul Y, Daibes J, Correa A, Dominguez AC, Birati EY, Baran DA, Serrao G, Mahmood K, Vallabhajosyula S, Fox A. Left Ventricular Unloading With Impella Versus IABP in Patients With VA-ECMO: A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 208:53-59. [PMID: 37812867 DOI: 10.1016/j.amjcard.2023.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 10/11/2023]
Abstract
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) use for circulatory support in cardiogenic shock results in increased left ventricular (LV) afterload. The use of concomitant Impella or intra-aortic balloon pump (IABP) have been proposed as adjunct devices for LV unloading. The authors sought to compare head-to-head efficacy and safety outcomes between the 2 LV unloading strategies. We conducted a search of Medline, EMBASE, and Cochrane databases to identify studies comparing the use of Impella to IABP in patients on VA-ECMO. The primary outcome of interest was in-hospital mortality. The secondary outcomes included transition to durable LV assist devices/cardiac transplantation, stroke, limb ischemia, need for continuous renal replacement therapy, major bleeding, and hemolysis. Pooled risk ratios (RRs) with 95% confidence interval and heterogeneity statistic I2 were calculated using a random-effects model. A total of 7 observational studies with 698 patients were included. Patients on VA-ECMO unloaded with Impella vs IABP had similar risk of short-term all-cause mortality, defined as either 30-day or in-hospital mortality- 60.8% vs 64.9% (RR 0.93 [0.71 to 1.21], I2 = 71%). No significant difference was observed in transition to durable LV assist devices/cardiac transplantation, continuous renal replacement therapy initiation, stroke, or limb ischemia between the 2 strategies. However, the use of VA-ECMO with Impella was associated with increased risk of major bleeding (57.2% vs 39.7%) (RR 1.66 [1.12 to 2.44], I2 = 82%) and hemolysis (31% vs 7%) (RR 4.61 [1.24 to 17.17], I2 = 66%) compared with VA-ECMO, along with IABP. In conclusion, in patients requiring VA-ECMO for circulatory support, the concomitant use of Impella or IABP had comparable short-term mortality. However, Impella use was associated with increased risk of major bleeding and hemolysis.
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Affiliation(s)
- Kruti D Gandhi
- Department of Internal Medicine, Mount Sinai Morningside/West, New York, New York
| | - Errol C Moras
- Department of Internal Medicine, Mount Sinai Morningside/West, New York, New York
| | - Shailesh Niroula
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, Michigan
| | - Persio D Lopez
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, New York
| | - Devika Aggarwal
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, New York
| | - Kirtipal Bhatia
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, New York
| | - Yoni Balboul
- Department of Internal Medicine, Mount Sinai Morningside/West, New York, New York
| | - Joseph Daibes
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, New York
| | - Ashish Correa
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai
| | | | - Edo Y Birati
- Poriya Medical Center, Bar-Ilan University, Israel
| | - David A Baran
- Heart, Vascular Thoracic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Gregory Serrao
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai
| | - Kiran Mahmood
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Arieh Fox
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai.
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9
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Ton VK, Kanwar MK, Li B, Blumer V, Li S, Zweck E, Sinha SS, Farr M, Hall S, Kataria R, Guglin M, Vorovich E, Hernandez-Montfort J, Garan AR, Pahuja M, Vallabhajosyula S, Nathan S, Abraham J, Harwani NM, Hickey GW, Wencker D, Schwartzman AD, Khalife W, Mahr C, Kim JH, Bhimaraj A, Sangal P, Zhang Y, Walec KD, Zazzali P, Burkhoff D, Kapur NK. Impact of Female Sex on Cardiogenic Shock Outcomes: A Cardiogenic Shock Working Group Report. JACC Heart Fail 2023; 11:1742-1753. [PMID: 37930289 DOI: 10.1016/j.jchf.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/30/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Studies reporting cardiogenic shock (CS) outcomes in women are scarce. OBJECTIVES The authors compared survival at discharge among women vs men with CS complicating acute myocardial infarction (AMI-CS) and heart failure (HF-CS). METHODS The authors analyzed 5,083 CS patients in the Cardiogenic Shock Working Group. Propensity score matching (PSM) was performed with the use of baseline characteristics. Logistic regression was performed for log odds of survival. RESULTS Among 5,083 patients, 1,522 were women (30%), whose mean age was 61.8 ± 15.8 years. There were 30% women and 29.1% men with AMI-CS (P = 0.03). More women presented with de novo HF-CS compared with men (26.2% vs 19.3%; P < 0.001). Before PSM, differences in baseline characteristics and sex-specific outcomes were seen in the HF-CS cohort, with worse survival at discharge (69.9% vs 74.4%; P = 0.009) and a higher rate of maximum Society for Cardiac Angiography and Interventions stage E (26% vs 21%; P = 0.04) in women than in men. Women were less likely to receive pulmonary artery catheterization (52.9% vs 54.6%; P < 0.001), heart transplantation (6.5% vs 10.3%; P < 0.001), or left ventricular assist device implantation (7.8% vs 10%; P = 0.01). Regardless of CS etiology, women had more vascular complications (8.8% vs 5.7%; P < 0.001), bleeding (7.1% vs 5.2%; P = 0.01), and limb ischemia (6.8% vs 4.5%; P = 0.001). More vascular complications persisted in women after PSM (10.4% women vs 7.4% men; P = 0.06). CONCLUSIONS Women with HF-CS had worse outcomes and more vascular complications than men with HF-CS. More studies are needed to identify barriers to advanced therapies, decrease complications, and improve outcomes of women with CS.
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Affiliation(s)
- Van-Khue Ton
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Manreet K Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Borui Li
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Song Li
- University of Washington Medical Center, Seattle, Washington, USA
| | - Elric Zweck
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Maryjane Farr
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shelley Hall
- Baylor University Medical Center, Dallas, Texas, USA
| | - Rachna Kataria
- Lifespan Cardiovascular Center, Brown University, Providence, Rhode Island, USA
| | - Maya Guglin
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Esther Vorovich
- Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois, USA
| | | | - A Reshad Garan
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mohit Pahuja
- University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | | | | | | | - Neil M Harwani
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Gavin W Hickey
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | - Wissam Khalife
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Claudius Mahr
- University of Washington Medical Center, Seattle, Washington, USA
| | - Ju H Kim
- Houston Methodist Research Institute, Houston, Texas, USA
| | | | - Paavni Sangal
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Yijing Zhang
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Karol D Walec
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Peter Zazzali
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
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Sandoval Y, Basir MB, Lemor A, Lichaa H, Alasnag M, Dupont A, Hirst C, Kearney KE, Kaki A, Smith TD, Vallabhajosyula S, Kayssi A, Firstenberg MS, Truesdell AG. Optimal Large-Bore Femoral Access, Indwelling Device Management, and Vascular Closure for Percutaneous Mechanical Circulatory Support. Am J Cardiol 2023; 206:262-276. [PMID: 37717476 DOI: 10.1016/j.amjcard.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/30/2023] [Accepted: 08/05/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Mir B Basir
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Alejandro Lemor
- Department of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Hady Lichaa
- Ascension Saint Thomas Heart, Ascension Saint Thomas Rutherford, Murfreesboro, Tennessee
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Colin Hirst
- Department of Cardiology, Ascension St. John Hospital-Detroit, Detroit, Michigan
| | | | - Amir Kaki
- Department of Cardiology, Ascension St. John Hospital-Detroit, Detroit, Michigan
| | - Timothy D Smith
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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11
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Verghese D, Bhat AG, Patlolla SH, Naidu SS, Basir MB, Cubeddu RJ, Navas V, Zhao DX, Vallabhajosyula S. Outcomes in non-ST-segment elevation myocardial infarction complicated by in-hospital cardiac arrest based on management strategy. Indian Heart J 2023; 75:443-450. [PMID: 37863393 PMCID: PMC10774581 DOI: 10.1016/j.ihj.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/19/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND There are limited data on in-hospital cardiac arrest (IHCA) complicating non-ST-segment-elevation myocardial infarction (NSTEMI) based on management strategy. METHODS We used National Inpatient Sample (2000-2017) to identify adults with NSTEMI (not undergoing coronary artery bypass grafting) and concomitant IHCA. The cohort was stratified based on use of early (hospital day 0) or delayed (≥hospital day 1) coronary angiography (CAG), percutaneous coronary intervention (PCI), and medical management. Outcomes included incidence of IHCA, in-hospital mortality, adverse events, length of stay, and hospitalization costs. RESULTS Of 6,583,662 NSTEMI admissions, 375,873 (5.7 %) underwent early CAG, 1,133,143 (17.2 %) received delayed CAG, 2,326,391 (35.3 %) underwent PCI, and 2,748,255 (41.7 %) admissions were managed medically. The medical management cohort was older, predominantly female, and with higher comorbidities. Overall, 63,085 (1.0 %) admissions had IHCA, and incidence of IHCA was highest in the medical management group (1.4 % vs 1.1 % vs 0.7 % vs 0.6 %, p < 0.001) compared to early CAG, delayed CAG and PCI groups, respectively. In adjusted analysis, early CAG (adjusted OR [aOR] 0.67 [95 % confidence interval {CI} 0.65-0.69]; p < 0.001), delayed CAG (aOR 0.49 [95 % CI 0.48-0.50]; p < 0.001), and PCI (aOR 0.42 [95 % CI 0.41-0.43]; p < 0.001) were associated with lower incidence of IHCA compared to medical management. Compared to medical management, early CAG (adjusted OR 0.53, CI: 0.49-0.58), delayed CAG (adjusted OR 0.34, CI: 0.32-0.36) and PCI (adjusted OR 0.19, CI: 0.18-0.20) were associated with lower in-hospital mortality (all p < 0.001). CONCLUSION Early CAG and PCI in NSTEMI was associated with lower incidence of IHCA and lower mortality among NSTEMI-IHCA admissions.
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Affiliation(s)
- Dhiran Verghese
- Division of Cardiovascular Medicine, Department of Medicine, Naples Heart Institute, Naples, FL, USA
| | - Anusha G Bhat
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland, Baltimore, MD, USA
| | | | - Srihari S Naidu
- Division of Cardiovascular Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY, USA
| | - Mir B Basir
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Robert J Cubeddu
- Division of Cardiovascular Medicine, Department of Medicine, Naples Heart Institute, Naples, FL, USA
| | - Viviana Navas
- Division of Cardiovascular Medicine, Department of Medicine, Naples Heart Institute, Naples, FL, USA
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
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12
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Balakrishna AM, Kalathil RAM, Pusapati S, Atreya A, Mehta A, Bansal M, Aggarwal V, Basir MB, Kochar A, Truesdell AG, Vallabhajosyula S. Comparative Outcomes of Catheter-Directed Thrombolysis Plus Systemic Anticoagulation Versus Systemic Anticoagulation Alone in the Management of Intermediate-Risk Pulmonary Embolism in a Systematic Review and Meta-Analysis. Am J Cardiol 2023; 205:249-258. [PMID: 37619491 DOI: 10.1016/j.amjcard.2023.07.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023]
Abstract
There are limited and conflicting data on the initial management of intermediate-risk (or submassive) pulmonary embolism (PE). This study sought to compare the outcomes of catheter-directed thrombolysis (CDT) in combination with systemic anticoagulation (SA) to SA alone. A systematic search was conducted in MEDLINE, EMBASE, PubMed, and the Cochrane databases from inception to March 1, 2023 for studies comparing the outcomes of CDT + SA versus SA alone in intermediate-risk PE. The outcomes were in-hospital, 30-day, 90-day, and 1-year mortality; bleeding; blood transfusion; right ventricular recovery; and length of stay. Random-effects models was used to calculate the pooled incidence and risk ratios (RRs) with 95% confidence intervals (CIs). A total of 15 (2 randomized and 13 observational) studies with 10,549 (2,310 CDT + SA and 8,239 SA alone) patients were included. Compared with SA, CDT + SA was associated with significantly lower in-hospital mortality (RR 0.41, 95% CI 0.30 to 0.56, p <0.001), 30-day mortality (RR 0.34, 95% CI 0.18 to 0.67, p = 0.002), 90-day mortality (RR 0.34, 95% CI 0.17 to 0.67, p = 0.002), and 1-year mortality (RR 0.58, 95% CI 0.34 to 0.97, p = 0.04). There were no significant differences between the 2 cohorts in the rates of major bleeding (RR 1.39, 95% CI 0.72 to 2.68, p = 0.56), minor bleeding (RR 1.83, 95% CI 0.97 to 3.46, p = 0.06), and blood transfusion (RR 0.34, 95% CI 0.10 to 1.15, p = 0.08). In conclusion, CDT + SA is associated with significantly lower short-term and long-term all-cause mortality, without any differences in major/minor bleeding, in patients with intermediate-risk PE.
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Affiliation(s)
| | | | - Suma Pusapati
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Auras Atreya
- Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas School of Medicine, Little Rock, Arkansas
| | - Aryan Mehta
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Mridul Bansal
- Department of Medicine, East Carolina Brody School of Medicine, Greenville, North Carolina
| | - Vikas Aggarwal
- Section of Cardiovascular Medicine, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Mir B Basir
- Section of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Ajar Kochar
- Section of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | | | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
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13
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Khanna AK, O'Connell NS, Ahuja S, Saha AK, Harris L, Cusson BD, Faris A, Huffman CS, Vallabhajosyula S, Clark CJ, Segal S, Wells BJ, Kirkendall ES, Sessler DI. Incidence, severity and detection of blood pressure and heart rate perturbations in postoperative ward patients after noncardiac surgery. J Clin Anesth 2023; 89:111159. [PMID: 37295123 DOI: 10.1016/j.jclinane.2023.111159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/22/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023]
Abstract
STUDY OBJECTIVE We sought to determine changes in continuous mean and systolic blood pressure and heart rate in a cohort of non-cardiac surgical patients recovering on the postoperative ward. Furthermore, we estimated the proportion of vital signs changes that would remain undetected with intermittent vital signs checks. DESIGN Retrospective cohort. SETTING Post-operative general ward. PATIENTS 14,623 adults recovering from non-cardiac surgical procedures. INTERVENTIONS & MEASUREMENTS Using a wireless, noninvasive monitor, we recorded postoperative blood pressure and heart rate at 15-s intervals and encouraged nursing intervention as clinically indicated. MAIN RESULTS 7% of our cohort of 14,623 patients spent >15 sustained minutes with a MAP <65 mmHg, and 23% had MAP <75 mmHg for 15 sustained minutes. Hypertension was more common, with 67% of patients spending at least 60 sustained minutes with MAP >110 mmHg. Systolic pressures <90 mmHg were present for 15 sustained minutes in about a fifth of all patients, and 40% of patients had pressures >160 mmHg sustained for 30 min. 40% of patients were tachycardic with heart rates >100 beats/min for at least continuous 15 min and 15% of patients were bradycardic at a threshold of <50 beats/min for 5 sustained minutes. Conventional vital sign assessments at 4-h intervals would have missed 54% of mean pressure episodes <65 mmHg sustained >15 min, 20% of episodes of mean pressures >130 mmHg sustained >30 min, 36% of episodes of heart rate > 120 beats/min sustained <10 min, and 68% of episodes of heart rate sustained <40 beats per minute for >3 min. CONCLUSIONS Substantial hemodynamic disturbances persisted despite implementing continuous portable ward monitoring coupled with nursing alarms and interventions. A significant proportion of these changes would have gone undetected using traditional intermittent monitoring. Better understanding of effective responses to alarms and appropriate interventions on hospital wards remains necessary.
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Affiliation(s)
- Ashish K Khanna
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Outcomes Research Consortium, Cleveland, OH, USA.
| | - Nathaniel S O'Connell
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Sanchit Ahuja
- Outcomes Research Consortium, Cleveland, OH, USA; Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH and Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Amit K Saha
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA.
| | - Lynnette Harris
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA.
| | - Bruce D Cusson
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Ann Faris
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Center for Nursing Research, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
| | - Carolyn S Huffman
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Center for Nursing Research, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
| | - Saraschandra Vallabhajosyula
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Clancy J Clark
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Scott Segal
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA.
| | - Brian J Wells
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Center for Biomedical Informatics, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Eric S Kirkendall
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
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14
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Gurnani PK, Barlow B, Boling B, Busse LW, Diaz-Gomez JL, Ford J, Gibson GA, Khanna AK, Lee JS, Rivosecchi RM, Spezzano KM, Thornton N, Vallabhajosyula S, Witenko CJ, Wieruszewski PM. Major Publications in the Critical Care Pharmacotherapy Literature: 2022. Crit Care Explor 2023; 5:e0981. [PMID: 37753239 PMCID: PMC10519466 DOI: 10.1097/cce.0000000000000981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVES A number of trials related to critical care pharmacotherapy were published in 2022. We aimed to summarize the most influential publications related to the pharmacotherapeutic care of critically ill patients in 2022. DATA SOURCES PubMed/Medical Literature Analysis and Retrieval System Online and the Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update. STUDY SELECTION Randomized controlled trials, prospective studies, or systematic review/meta-analyses of adult critically ill patients assessing a pharmacotherapeutic intervention and reporting clinical endpoints published between January 1, 2022, and December 31, 2022, were included in this article. DATA EXTRACTION Articles from a systematic search and the Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update were included and stratified into clinical domains based upon consistent themes. Consensus was obtained on the most influential publication within each clinical domain utilizing an a priori defined three-round modified Delphi process with the following considerations: 1) overall contribution to scientific knowledge and 2) novelty to the literature. DATA SYNTHESIS The systematic search and Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update yielded a total of 704 articles, of which 660 were excluded. The remaining 44 articles were stratified into the following clinical domains: emergency/neurology, cardiovascular, gastroenterology/fluids/nutrition, hematology, infectious diseases/immunomodulation, and endocrine/metabolic. The final article selected from each clinical domain was summarized following a three-round modified Delphi process and included three randomized controlled trials and three systematic review/meta-analyses. Article topics summarized included dexmedetomidine versus other sedatives during mechanical ventilation, beta-blocker treatment in the critically ill, restriction of IV fluids in septic shock, venous thromboembolism prophylaxis in critically ill adults, duration of antibiotic therapy for Pseudomonas aeruginosa ventilator-associated pneumonia, and low-dose methylprednisolone treatment in severe community-acquired pneumonia. CONCLUSIONS This concise review provides a perspective on articles published in 2022 that are relevant to the pharmacotherapeutic care of critically ill patients and their potential impact on clinical practice.
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Affiliation(s)
- Payal K Gurnani
- Department of Pharmacy, Memorial Hermann The Woodlands Medical Center, The Woodlands, TX
| | - Brooke Barlow
- Department of Pharmacy, Memorial Hermann The Woodlands Medical Center, The Woodlands, TX
| | - Bryan Boling
- Department of Anesthesiology, Division of Critical Care Medicine, University of Kentucky, Lexington, KY
| | | | - Jose L Diaz-Gomez
- Department of Anesthesiology and Critical Care Medicine, Texas Heart Institute, Baylor College of Medicine, Houston, TX
| | - Jenna Ford
- Department of Neurology, University of Florida, Gainesville, FL
| | | | - Ashish K Khanna
- Department of Anesthesiology, Section of Critical Care Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC
| | | | | | | | - Nathan Thornton
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Saraschandra Vallabhajosyula
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Corey J Witenko
- Department of Pharmacy, New York-Presbyterian Hospital, New York, NY
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15
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Patlolla SH, Gilbert ON, Belford PM, Morris BN, Jentzer JC, Pisani BA, Applegate RJ, Zhao DX, Vallabhajosyula S. Escalation strategies, management, and outcomes of acute myocardial infarction-cardiogenic shock patients receiving percutaneous left ventricular support. Catheter Cardiovasc Interv 2023; 102:403-414. [PMID: 37473420 DOI: 10.1002/ccd.30786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/17/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND There are limited national-level data on the contemporary practices of mechanical circulatory support (MCS) use in acute myocardial infarction-cardiogenic shock (AMI-CS). METHODS We utilized the Healthcare Cost and Utilization Project-National/Nationwide Inpatient Sample data (2005-2017) to identify adult admissions (>18 years) with AMI-CS. MCS devices were classified as intra-aortic balloon pump (IABP), percutaneous left ventricular assist devices (pLVAD), or extracorporeal membrane oxygenation (ECMO). We evaluated trends in the initial device used (IABP alone, pLVAD alone or ≥2 MCS devices), device escalation, bridging to durable LVAD/heart transplantation, and predictors of in-hospital mortality and device escalation. RESULTS Among 327,283 AMI-CS admissions, 131,435 (40.2%) had an MCS device placed with available information on timing of placement. IABP, pLVAD, and ≥2 MCS devices were used as initial device in 120,928 (92.0%), 8202 (6.2%), and 2305 (1.7%) admissions, respectively. Most admissions were maintained on the initial MCS device with 1%-1.5% being escalated (IABP to pLVAD/ECMO, pLVAD to ECMO). Urban, medium, and large-sized hospitals and acute multiorgan failure were significant independent predictors of MCS escalation. In admissions receiving MCS, escalation of MCS device was associated with higher in-hospital mortality (adjusted odds ratio: 1.56, 95% confidence interval: 1.38-1.75; p < 0.001). Admissions receiving durable LVAD/heart transplantation increased over time in those initiated on pLVAD and ≥2 MCS devices, resulting in lower in-hospital mortality. CONCLUSIONS In this 13-year study, escalation of MCS in AMI-CS was associated with higher in-hospital mortality suggestive of higher acuity of illness. The increase in number of durable LVAD/heart transplantations alludes to the role of MCS as successful bridge strategies.
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Affiliation(s)
- Sri Harsha Patlolla
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Olivia N Gilbert
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Peter M Belford
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Benjamin N Morris
- Department of Anesthesia, Section of Critical Care Anesthesiology, Winston-Salem, North Carolina, USA
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Barbara A Pisani
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Anesthesia, Section of Critical Care Anesthesiology, Winston-Salem, North Carolina, USA
| | - Robert J Applegate
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - David X Zhao
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Saraschandra Vallabhajosyula
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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16
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Machanahalli Balakrishna A, Ismayl M, Goldsweig AM, Peters LA, Alla VM, Velagapudi P, Zhao DX, Vallabhajosyula S. Intracoronary Imaging Versus Coronary Angiography Guidance for Implantation of Second and Third Generation Drug Eluting Stents in a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Cardiol 2023; 202:100-110. [PMID: 37423173 DOI: 10.1016/j.amjcard.2023.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 07/11/2023]
Abstract
Intracoronary imaging (ICI) facilitates stent implant by characterizing the lesion calcification, providing accurate vessel dimensions, and optimizing the stent results. We sought to investigate the outcomes of routine ICI versus coronary angiography (CA) to guide percutaneous coronary intervention (PCI) with second- and third-generation drug-eluting stents. A systematic search of PubMed, Medline, and Cochrane databases was conducted from their inception to July 16, 2022 for randomized controlled trials comparing routine ICI with CA. The primary outcome was major adverse cardiovascular events. The secondary outcomes of interest were target lesion revascularization, target vessel revascularization, myocardial infarction, stent thrombosis, and cardiac and all-cause mortality. A random-effects model was used to calculate the pooled incidence and relative risk (RR) with 95% confidence intervals (CIs). A total of 9 randomized controlled trials with 5,879 patients (2,870 ICI-guided and 3,009 CA-guided PCI) met the inclusion criteria. The ICI and CA groups were similar in demographic characteristics and co-morbidity profiles. Compared with CA, patients in the routine ICI-guided PCI group had lower rates of major adverse cardiovascular events (RR 0.61, 95% CI 0.48 to 0.78, p <0.0001), target lesion revascularization (RR 0.60, 95% CI 0.43 to 0.83, p = 0.002), target vessel revascularization (RR 0.72, 95% CI 0.51 to 1.00, p = 0.05), and myocardial infarction (RR 0.48, 95% CI 0.25 to 0.95, p = 0.03). There were no significant differences in stent thrombosis or cardiac/all-cause mortality between the 2 strategies. In conclusion, routine ICI-guided PCI strategy, compared with CA guidance alone, is associated with improved clinical outcomes, largely driven by lower repeat revascularization.
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Affiliation(s)
| | - Mahmoud Ismayl
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, Department of Medicine, University of Nebraska School of Medicine, Omaha, Nebraska
| | - Luke A Peters
- Section of Cardiovascular Medicine, Department of Medicine and
| | - Venkata M Alla
- Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Poonam Velagapudi
- Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine and
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine and; Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
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17
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Titus A, Majmundar V, Taha A, Patel N, Sooraj M, Omkumar JM, Koshy RM, Saji AM, Sherif AA, Titus A, Kadavath S, Vallabhajosyula S, Nasir K, Dani SS. Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Non-ST-Elevation Myocardial Infarction-Propensity Matched Regression Analysis. Am J Cardiol 2023; 200:95-102. [PMID: 37307785 DOI: 10.1016/j.amjcard.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/13/2023] [Accepted: 05/16/2023] [Indexed: 06/14/2023]
Abstract
Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) is indicated in complex interventions. There is a paucity of evidence for outcomes with large studies on using IVUS during PCI in non-ST-elevation myocardial infarction (NSTEMI). Our objective was to compare the in-hospital outcome of IVUS-guided with that of nonguided PCI among NSTEMI hospitalizations. The National Inpatient Sample (2016 to 2019) was queried to identify all hospitalizations with a principal diagnosis of NSTEMI. In our study, we compared outcomes of PCI with and without IVUS guidance using a multivariate logistic regression model after propensity score matching, with the primary outcome being in-hospital mortality. A total of 671,280 NSTEMI-related hospitalizations were identified, of whom 48,285 (7.2%) underwent IVUS-guided PCI compared with 622,995 (92.8%) who underwent non-IVUS PCI. After adjusted analysis on matched pairs, we found that IVUS-guided PCI had a lower risk of in-hospital mortality than that of non-IVUS PCI (adjusted odds ratio [aOR] 0.736, confidence interval (CI) 0.578 to 0.937, p = 0.013). However, there was a higher use of mechanical circulatory support in the IVUS-guided PCI (aOR 2.138, CI 1.84 to 2.47, p <0.001) than in non-IVUS PCI. The odds of cardiogenic shock (aOR 1.11, CI 0.93 to 1.32, p = 0.233) and procedural complications (aOR 0.794, CI 0.549 to 1.14, p = 0.22) were similar between the cohorts. Hence, we conclude that patients with NSTEMIs who underwent IVUS-guided PCI had less risk of in-hospital mortality and a greater requirement of mechanical circulatory support than did those who underwent non-IVUS PCI, with no difference in procedural complications. Large prospective trials are essential to validate these findings.
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Affiliation(s)
- Anoop Titus
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Vidit Majmundar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Amro Taha
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, Illinois
| | - Nirav Patel
- Department of Internal Medicine, Saint Michael Medical Center, Newark, New Jersey
| | - Mannil Sooraj
- Department of Medicine, Chandramma Dayanand Sagar Institute of Medical Education and Research, Bangalore, Karnataka, India
| | - Janaki M Omkumar
- Department of Medicine, Government Medical College, Thrissur, India
| | - Rohan Mathews Koshy
- Department of Medicine, Government Medical College, Thiruvananthapuram, India
| | - Anu Mariam Saji
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Akil Adrian Sherif
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Aishwarya Titus
- Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, India
| | - Sabeeda Kadavath
- Department of Cardiology, St Bernards Healthcare, Jonesboro, Arkansas
| | | | - Khurram Nasir
- Department of Cardiology, Houston Methodist, Houston, Texas
| | - Sourabh S Dani
- Department of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts.
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18
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Machanahalli Balakrishna A, Dilsaver DB, Aboeata A, Gowda RM, Goldsweig AM, Vallabhajosyula S, Anderson JH, Simard T, Jhand A. Infective Endocarditis Risk with Melody versus Sapien Valves Following Transcatheter Pulmonary Valve Implantation: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. J Clin Med 2023; 12:4886. [PMID: 37568289 PMCID: PMC10419461 DOI: 10.3390/jcm12154886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Transcatheter pulmonary valve implantation (TPVI) is an effective non-surgical treatment method for patients with right ventricle outflow tract dysfunction. The Medtronic Melody and the Edwards Sapien are the two valves approved for use in TPVI. Since TPVI patients are typically younger, even a modest annual incidence of infective endocarditis (IE) is significant. Several previous studies have shown a growing risk of IE after TPVI. There is uncertainty regarding the overall incidence of IE and differences in the risk of IE between the valves. METHODS A systematic search was conducted in the MEDLINE, EMBASE, PubMed, and Cochrane databases from inception to 1 January 2023 using the search terms 'pulmonary valve implantation', 'TPVI', or 'PPVI'. The primary outcome was the pooled incidence of IE following TPVI in Melody and Sapien valves and the difference in incidence between Sapien and Melody valves. Fixed effect and random effect models were used depending on the valve. Meta-regression with random effects was conducted to test the difference in the incidence of IE between the two valves. RESULTS A total of 22 studies (including 10 Melody valve studies, 8 Sapien valve studies, and 4 studies that included both valves (572 patients that used the Sapien valve and 1395 patients that used the Melody valve)) were used for the final analysis. Zero IE incidence following TPVI was reported by eight studies (66.7%) that utilized Sapien valves compared to two studies (14.3%) that utilized Melody valves. The pooled incidence of IE following TPVI with Sapien valves was 2.1% (95% CI: 0.9% to 5.13%) compared to 8.5% (95% CI: 4.8% to 15.2%) following TPVI with Melody valves. Results of meta-regression indicated that the Sapien valve had a 79.6% (95% CI: 24.2% to 94.4%, p = 0.019; R2 = 34.4) lower risk of IE incidence compared to the Melody valve. CONCLUSIONS The risk of IE following TPVI differs significantly. A prudent valve choice in favor of Sapien valves to lower the risk of post-TPVI endocarditis may be beneficial.
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Affiliation(s)
| | - Danielle B. Dilsaver
- Department of Medicine, Division of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, NE 68124, USA
| | - Ahmed Aboeata
- Division of Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, NE 68124, USA
| | - Ramesh M. Gowda
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai Morningside and Beth Israel, New York, NY 10029, USA
| | - Andrew M. Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA 01199, USA
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE 68105, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Jason H. Anderson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Aravdeep Jhand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Bansal M, Mehta A, Machanahalli Balakrishna A, Kalyan Sundaram A, Kanwar A, Singh M, Vallabhajosyula S. RIGHT VENTRICULAR DYSFUNCTION IN SEPSIS: AN UPDATED NARRATIVE REVIEW. Shock 2023; 59:829-837. [PMID: 36943772 DOI: 10.1097/shk.0000000000002120] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
ABSTRACT Sepsis is a multisystem disease process, which constitutes a significant public health challenge and is associated with high morbidity and mortality. Among other systems, sepsis is known to affect the cardiovascular system, which may manifest as myocardial injury, arrhythmias, refractory shock, and/or septic cardiomyopathy. Septic cardiomyopathy is defined as the reversible systolic and/or diastolic dysfunction of one or both ventricles. Left ventricle dysfunction has been extensively studied in the past, and its prognostic role in patients with sepsis is well documented. However, there is relatively scarce literature on right ventricle (RV) dysfunction and its role. Given the importance of timely detection of septic cardiomyopathy and its bearing on prognosis of patients, the role of RV dysfunction has come into renewed focus. Hence, through this review, we sought to describe the pathophysiology of RV dysfunction in sepsis and what have we learnt so far about its multifactorial nature. We also elucidate the roles of different biomarkers for its detection and prognosis, along with appropriate management of such patient population.
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Affiliation(s)
- Mridul Bansal
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Aryan Mehta
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | - Arvind Kalyan Sundaram
- Section of Cardiovascular Medicine, Department of Medicine, UMass Chan-Baystate Medical Center, Springfield, Massachusetts
| | | | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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20
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Mehta A, Bansal M, Pokharel Y, Vallabhajosyula S. Constrictive Pericarditis: A Diagnostic Conundrum. Cureus 2023; 15:e39485. [PMID: 37362484 PMCID: PMC10290508 DOI: 10.7759/cureus.39485] [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: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
A 65-year-old male presented with chest pain, tachycardia, tachypnea, and diminished breath sounds. His lab investigations revealed an elevated leukocyte count, erythrocyte sedimentation rate, and B-type natriuretic peptide. Transthoracic echocardiography and chest imaging revealed the presence of pericardial effusion without tamponade and he was treated for presumed acute idiopathic pericarditis. He was started on indomethacin and colchicine but he stopped them prematurely due to side effects. Subsequently, he developed pleural effusions and ascites requiring multiple thoracenteses and paracenteses. Due to equivocal echocardiographic findings, he underwent invasive hemodynamic measurements which demonstrated equalization of filling pressures and ventricular interdependence, confirming constrictive pericarditis. Due to ongoing pericardial inflammation on cardiovascular magnetic resonance imaging, he was treated with a prednisone taper. Due to persistent symptoms and fibrosis of the pericardium on cross-section imaging, he underwent pericardiectomy. He did well with the procedure and has had an uneventful clinical follow-up.
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Affiliation(s)
- Aryan Mehta
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, USA
| | - Mridul Bansal
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, USA
| | - Yashashwi Pokharel
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, USA
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21
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Bansal M, Mehta A, Sarma AK, Niu S, Silaghi DA, Khanna AK, Vallabhajosyula S. Anti-N-methyl-D-aspartate receptor encephalitis in pregnancy associated with teratoma. Proc AMIA Symp 2023; 36:524-527. [PMID: 37334098 PMCID: PMC10269377 DOI: 10.1080/08998280.2023.2205814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 06/20/2023] Open
Abstract
A 36-year-old pregnant woman with a prior history of depression and recent gunshot wounds presented with sudden deterioration in her mental status. Clinical examination revealed psychosis, hallucinations, and lack of orientation, with an otherwise normal neurological and cardiorespiratory examination. Computed tomographic scan of her head was normal, and she was diagnosed with acute psychosis and excited delirium. She did not respond to supraphysiologic dosages of antipsychotic therapy and needed physical restraints for combativeness and agitation. Her cerebrospinal fluid analysis was negative for an infectious etiology, but was positive for anti-N-methyl-D-aspartate receptor encephalitis antibodies. Abdominal imaging revealed a right-sided ovarian cyst. Subsequently she underwent right-sided oophorectomy. Postoperatively the patient continued to have intermittent episodes of agitation requiring antipsychotic medications. Later, she was safely transitioned to home care with family support.
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Affiliation(s)
- Mridul Bansal
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Aryan Mehta
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Anand Karthik Sarma
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Shuo Niu
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Dan Alexandru Silaghi
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ashish K. Khanna
- Perioperative Outcomes and Informatics Collaborative, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Section on Critical Care Medicine, Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Outcomes Research Consortium, Cleveland, Ohio
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Perioperative Outcomes and Informatics Collaborative, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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22
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Bansal M, Mehta A, Wieruszewski PM, Belford PM, Zhao DX, Khanna AK, Vallabhajosyula S. Efficacy and safety of angiotensin II in cardiogenic shock: A systematic review. Am J Emerg Med 2023; 66:124-128. [PMID: 36753927 DOI: 10.1016/j.ajem.2023.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cardiogenic shock (CS) is associated with high morbidity and mortality. In recent times, there is increasing interest in the role of angiotensin II in CS. We sought to systematically review the current literature on the use of angiotensin II in CS. METHODS PubMed, EMBASE, Medline, Web of Science, PubMed Central, and CINAHL databases were systematically searched for studies that evaluated the efficacy of angiotensin II in patients with CS during 01/01/2010-07/07/2022. Outcomes of interest included change in mean arterial pressure (MAP), vasoactive medication requirements (percent change in norepinephrine equivalent [NEE] dose), all-cause mortality, and adverse events. RESULTS Of the total 2,402 search results, 15 studies comprising 195 patients were included of which 156 (80%) received angiotensin II. Eleven patients (84.6%) in case reports and case series with reported MAP data at hour 12 noted an increase in MAP. Two studies noted a positive hemodynamic response (defined a priori) in eight (88.9%) and five (35.7%) patients. Eight studies reported a reduction in NEE dose at hour 12 after angiotensin II administration and one study noted a 100% reduction in NEE dose. Out of 47 patients with documented information, 13 patients had adverse outcomes which included hepatic injury (2), digital ischemia (1), ischemic optic neuropathy (1), ischemic colitis (2), agitated delirium (1), and thrombotic events (2). CONCLUSIONS In this first systematic review of angiotensin II in CS, we note the early clinical experience. Angiotensin II was associated with improvements in MAP, decrease in vasopressor requirements, and minimal reported adverse events.
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Affiliation(s)
- Mridul Bansal
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Aryan Mehta
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Patrick M Wieruszewski
- Departments of Anesthesiology and Pharmacy, Mayo Clinic, Rochester, MN, United States of America
| | - P Matthew Belford
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America; Perioperative Outcomes and Informatics Collaborative (POIC), Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Ashish K Khanna
- Perioperative Outcomes and Informatics Collaborative (POIC), Wake Forest University School of Medicine, Winston-Salem, NC, United States of America; Section on Critical Care Medicine, Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America; Outcomes Research Consortium, Cleveland, OH, United States of America
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America; Perioperative Outcomes and Informatics Collaborative (POIC), Wake Forest University School of Medicine, Winston-Salem, NC, United States of America; Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America.
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23
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Blankenship JC, Doll JA, Latif F, Truesdell AG, Young MN, Ibebuogu UN, Vallabhajosyula S, Kadavath SM, Maestas CM, Vetrovec G, Welt F. Best Practices for Cardiac Catheterization Laboratory Morbidity and Mortality Conferences. JACC Cardiovasc Interv 2023; 16:503-514. [PMID: 36922035 DOI: 10.1016/j.jcin.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/19/2022] [Accepted: 10/04/2022] [Indexed: 03/18/2023]
Abstract
Cardiac catheterization laboratory (CCL) morbidity and mortality conferences (MMCs) are a critical component of CCL quality improvement programs and are important for the education of cardiology trainees and the lifelong learning of CCL physicians and team members. Despite their fundamental role in the functioning of the CCL, no consensus exists on how CCL MMCs should identify and select cases for review, how they should be conducted, and how results should be used to improve CCL quality. In addition, medicolegal ramifications of CCL MMCs are not well understood. This document from the American College of Cardiology's Interventional Section attempts to clarify current issues and options in the conduct of CCL MMCs and to recommend best practices for their conduct.
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Affiliation(s)
- James C Blankenship
- Division of Cardiology, University of New Mexico, Albuquerque, New Mexico, USA.
| | - Jacob A Doll
- University of Washington, Seattle, Washington, USA
| | - Faisal Latif
- SSM Health St. Anthony Hospital, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | | | - Michael N Young
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Uzoma N Ibebuogu
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Camila M Maestas
- Virginia Commonwealth University Pauley Heart Center, Richmond, Virginia, USA
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24
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Bansal A, Belford PM, Truesdell AG, Sinha SS, Zhao DX, Vallabhajosyula S. Meta-Analysis on Left Ventricular Unloading With Impella in Patients With Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation. Am J Cardiol 2023; 193:52-54. [PMID: 36871529 DOI: 10.1016/j.amjcard.2023.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Agam Bansal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - P Matthew Belford
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Alexander G Truesdell
- Viriginia Heart, Falls Church, Virginia; Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
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25
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Titus A, Majmundar V, Patel N, Omkumar JM, Koshy RM, Sooraj M, Titus A, Sherif AA, Saji AM, Kumar PA, Dasari M, kadavath S, Vallabhajosyula S, Dani SS. INTRAVASCULAR ULTRASOUND-GUIDED PERCUTANEOUS CORONARY INTERVENTION IN NON-ST-ELEVATION MYOCARDIAL INFARCTION: NATIONAL INPATIENT SAMPLE 2016-2019. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01800-4] [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: 03/06/2023]
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26
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Belur AD, Sedhai YR, Truesdell AG, Khanna AK, Mishkin JD, Belford PM, Zhao DX, Vallabhajosyula S. Targeted Temperature Management in Cardiac Arrest: An Updated Narrative Review. Cardiol Ther 2023; 12:65-84. [PMID: 36527676 PMCID: PMC9986171 DOI: 10.1007/s40119-022-00292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
The established benefits of cooling along with development of sophisticated methods to safely and precisely induce, maintain, monitor, and reverse hypothermia have led to the development of targeted temperature management (TTM). Early trials in human subjects showed that hypothermia conferred better neurological outcomes when compared to normothermia among survivors of cardiac arrest, leading to guidelines recommending targeted hypothermia in this patient population. Multiple studies have sought to explore and compare the benefit of hypothermia in various subgroups of patients, such as survivors of out-of-hospital cardiac arrest versus in-hospital cardiac arrest, and survivors of an initial shockable versus non-shockable rhythm. Larger and more recent trials have shown no statistically significant difference in neurological outcomes between patients with targeted hypothermia and targeted normothermia; further, aggressive cooling is associated with a higher incidence of multiple systemic complications. Based on this data, temporal trends have leaned towards using a lenient temperature target in more recent times. Current guidelines recommend selecting and maintaining a constant target temperature between 32 and 36 °C for those patients in whom TTM is used (strong recommendation, moderate-quality evidence), as soon as possible after return of spontaneous circulation is achieved and airway, breathing (including mechanical ventilation), and circulation are stabilized. The comparative benefit of lower (32-34 °C) versus higher (36 °C) temperatures remains unknown, and further research may help elucidate this. Any survivor of cardiac arrest who is comatose (defined as unarousable unresponsiveness to external stimuli) should be considered as a candidate for TTM regardless of the initial presenting rhythm, and the decision to opt for targeted hypothermia versus targeted normothermia should be made on a case-by-case basis.
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Affiliation(s)
- Agastya D Belur
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Yub Raj Sedhai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | | | - Ashish K Khanna
- Section of Critical Care Medicine, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Outcomes Research Consortium, Cleveland, OH, USA.,Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA
| | - Joseph D Mishkin
- Section of Advanced Heart Failure and Transplant Cardiology, Atrium Health Sanger Heart and Vascular Institute, Charlotte, NC, USA
| | - P Matthew Belford
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, 306 Westwood Avenue, Suite 401, High Point, Winston-Salem, NC, 27262, USA
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, 306 Westwood Avenue, Suite 401, High Point, Winston-Salem, NC, 27262, USA
| | - Saraschandra Vallabhajosyula
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA. .,Section of Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, 306 Westwood Avenue, Suite 401, High Point, Winston-Salem, NC, 27262, USA. .,Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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27
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Bhat AG, Verghese D, Harsha Patlolla S, Truesdell AG, Batchelor WB, Henry TD, Cubeddu RJ, Budoff M, Bui Q, Matthew Belford P, X Zhao D, Vallabhajosyula S. In-Hospital cardiac arrest complicating ST-elevation myocardial Infarction: Temporal trends and outcomes based on management strategy. Resuscitation 2023; 186:109747. [PMID: 36822461 DOI: 10.1016/j.resuscitation.2023.109747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND There are limited data on the relationship of ST-segment-elevation myocardial infarction (STEMI) management strategy and in-hospital cardiac arrest (IHCA). AIMS To investigate the trends and outcomes of IHCA in STEMI by management strategy. METHODS Adult with STEMI complicated by IHCA from the National Inpatient Sample (2000-2017) were stratified into early percutaneous coronary intervention (PCI) (day 0 of hospitalization), delayed PCI (PCI ≥ day 1), or medical management (no PCI). Coronary artery bypass surgery was excluded. Outcomes of interest included in-hospital mortality, adverse events, length of stay, and hospitalization costs. RESULTS Of 3,967,711 STEMI admissions, IHCA was noted in 102,424 (2.6%) with an increase in incidence during this study period. Medically managed STEMI had higher rates of IHCA (3.6% vs 2.0% vs 1.3%, p < 0.001) compared to early and delayed PCI, respectively. Revascularization was associated with lower rates of IHCA (early PCI: adjusted odds ratio [aOR] 0.44 [95% confidence interval (CI) 0.43-0.44], p < 0.001; delayed PCI aOR 0.33 [95% CI 0.32-0.33], p < 0.001) compared to medical management. Non-revascularized patients had higher rates of non-shockable rhythms (62% vs 35% and 42.6%), but lower rates of multiorgan damage (44% vs 52.7% and 55.6%), cardiogenic shock (28% vs 65% and 57.4%) compared to early and delayed PCI, respectively (all p < 0.001). In-hospital mortality was lower with early PCI (49%, aOR 0.18, 95% CI 0.17-0.18), and delayed PCI (50.9%, aOR 0.18, 95% CI 0.17-0.19) (p < 0.001) compared to medical management (82.5%). CONCLUSION Early PCI in STEMI impacts the natural history of IHCA including timing and type of IHCA.
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Affiliation(s)
- Anusha G Bhat
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland, Baltimore, MD, USA
| | - Dhiran Verghese
- Division of Cardiovascular Medicine, Department of Medicine, Naples Heart Institute, Naples, FL, USA
| | | | - Alexander G Truesdell
- Virginia Heart, Falls Church, VA, USA; Inova Heart and Vascular Institute, Falls Church, VA, USA
| | | | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, USA
| | - Robert J Cubeddu
- Division of Cardiovascular Medicine, Department of Medicine, Naples Heart Institute, Naples, FL, USA
| | - Matthew Budoff
- Division of Cardiovascular Medicine, Department of Medicine, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Quang Bui
- Division of Cardiovascular Medicine, Department of Medicine, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Peter Matthew Belford
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Patlolla SH, Truesdell AG, Basir MB, Rab ST, Singh M, Belford PM, Zhao DX, Vallabhajosyula S. No "July Effect" in the management and outcomes of acute myocardial infarction: An 18-year United States national study. Catheter Cardiovasc Interv 2023; 101:264-273. [PMID: 36617382 DOI: 10.1002/ccd.30553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/08/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND There has been conflicting reports on the effect of new trainees on clinical outcomes at teaching hospitals in the first training month (July in the United States of America). We sought to assess this "July effect" in a contemporary acute myocardial infarction (AMI) population. METHODS Adult (>18 years) AMI hospitalizations in May and July in urban teaching and urban nonteaching hospitals in the United States were identified from the HCUP-NIS database (2000-2017). In-hospital mortality was compared between May and July admissions. A difference-in-difference analysis comparing a change in outcome from May to July in teaching hospitals to a change in outcome from May to July in nonteaching hospitals was also performed. RESULTS A total of 1,312,006 AMI hospitalizations from urban teaching (n = 710,593; 54.2%) or nonteaching (n = 601,413; 45.8%) hospitals in the months of May and July were evaluated. May admissions in teaching hospitals, had greater comorbidity, higher rates of acute multiorgan failure (10.6% vs. 10.2%, p < 0.001) and lower rates of cardiac arrest when compared to July admissions. July AMI admissions had lower in-hospital mortality compared to May (5.6% vs. 5.8%; adjusted odds ratio 0.94 [95% confidence interval 0.92-0.97]; p < 0.001) in teaching hospitals. Using the difference-in-difference model, there was no evidence of a July effect for in-hospital mortality (p = 0.19). CONCLUSIONS There was no July effect for in-hospital mortality in this contemporary AMI population.
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Affiliation(s)
- Sri Harsha Patlolla
- Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | | | - Mir B Basir
- Division of Cardiovascular Medicine, Henry Ford Hospital and Health System, Detroit, Michigan, USA
| | - Syed T Rab
- Division of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter Matthew Belford
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - David X Zhao
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Saraschandra Vallabhajosyula
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Implementation Science, Section of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Adalja D, Zala H, Victor V, Sheth A, Willyard C, Suzuki E, Patel HP, Majmundar M, Vallabhajosyula S, Doshi R. Incidence, Current Guidelines and Management of Gastrointestinal Bleeding after Transcatheter Aortic Valve Replacement: A Systematic Review. Curr Cardiol Rev 2023; 19:e230622206351. [PMID: 35747979 PMCID: PMC10201885 DOI: 10.2174/1573403x18666220623150830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is a significant increase in morbidity and mortality in patients complicated by major bleeding following transcatheter aortic valve replacement (TAVR). It has become more challenging to manage such complications when the patient needs to be on anticoagulation or antiplatelet agent post-procedure to prevent thrombotic/embolic complications. METHODS We systematically reviewed all available randomized controlled trials and observational studies to identify incidence rates of gastrointestinal bleeding post-procedure. After performing a systematic search, a total of 8731 patients from 15 studies (5 RCTs and 10 non-RCTs) were included in this review. RESULTS The average rate of gastrointestinal bleeding during follow-up was 3.0% in randomized controlled trials and 1.9% among observational studies. CONCLUSION Gastrointestinal bleeding has been noted to be higher in the RCTs as compared to observational studies. This review expands knowledge of current guidelines and possible management of patients undergoing TAVR.
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Affiliation(s)
- Devina Adalja
- Department of Internal Medicine, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Harshvardhan Zala
- Department of Clinical Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Varun Victor
- Department of Internal Medicine, Canton Medical Education Foundation, Canton, OH, USA
| | - Aakash Sheth
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Charles Willyard
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| | - Emi Suzuki
- Department of Pediatrics, UCSF- Fresno, Fresno, CA, USA
| | - Harsh P. Patel
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL, USA
| | - Monil Majmundar
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | | | - Rajkumar Doshi
- Department of Cardiology, St Joseph's University Medical Center, Paterson, NJ, USA
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Sandhyavenu H, Ullah W, Badu I, Taha A, Polam AR, Mir T, Brailovsky Y, Rajapreyar IN, Vallabhajosyula S, Alraies MC. Trends and outcomes of cardiogenic shock in Asian populations compared with non-Asian populations in the US: NIS Analysis (2002-2019). Expert Rev Cardiovasc Ther 2023; 21:67-74. [PMID: 36597921 DOI: 10.1080/14779072.2023.2162040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Current understanding of outcomes of cardiogenic shock (CS) in Asian populations is limited. We aim to study the clinical outcomes of CS in Asian population compared with non-Asians in the US. METHODS The National Inpatient Sample (NIS) database was queried between 2002-2019 to identify hospitalizations with CS. Race was classified as Asians and non-Asians. The adjusted odds ratios (aOR) for in-hospital outcomes were calculated using multivariate logistic regression analysis. RESULTS Results Of 1,573,285 CS hospitalizations, 48,398 (3%) were Asians and 1,524,887 (97%) were non-Asians between 2002-2019. Adjusted odds of in-hospital mortality (aOR 1.03, 95% CI 1.01-1.05), and use of intra-aortic balloon pump (IABP) (aOR 1.15, 95% CI 1.12-1.17) were significantly higher among Asians compared with non-Asians. The in-hospital mean cost of hospitalization was higher in Asian population ($63,787±$80,261) with CS compared with non-Asians ($56,207±$76,120, p < 0.001). The use of Impella (aOR 0.90, 95% CI 0.86-0.95) and left ventricular assist devices (LVAD) (aOR 0.71, 95% CI 0.65-0.77) were lower with no difference in the use of extracorporeal membrane oxygenation (ECMO) compared with non-Asians. CONCLUSION Asian populations with CS have higher in-hospital mortality, increased requirement of IABP and higher mean cost of hospitalization compared with non-Asians.
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Affiliation(s)
| | - Waqas Ullah
- Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Irisha Badu
- Internal Medicine, Onslow Memorial Hospital, Jacksonville, NC, USA
| | - Amro Taha
- Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | | | - Tanveer Mir
- Internal Medicine, Wayne State University, Detroit, MI, USA
| | | | | | | | - M Chadi Alraies
- Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, USA
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Machanahalli Balakrishna A, Ismayl M, Palicherla A, Aboeata A, Goldsweig AM, Zhao DX, Vallabhajosyula S. Impact of prior coronary artery bypass grafting on periprocedural and short-term outcomes of patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. Coron Artery Dis 2023; 34:42-51. [PMID: 36326179 DOI: 10.1097/mca.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The effect of prior coronary artery bypass graft (CABG) on the outcomes of transcatheter aortic valve replacement (TAVR) remains incompletely characterized. In this meta-analysis, we investigated the impact of prior CABG on TAVR outcomes. METHODS A systematic search was conducted in PubMed, Google Scholar, and Cochrane databases from inception to 24 July 2022, using the search terms 'TAVR', 'CABG', 'peri-procedural complications', and 'mortality'. The major outcomes were peri-procedural complications, intraprocedural mortality, 30-day mortality, and 30-day cardiac mortality. We used random-effects models to aggregate data and to calculate pooled incidence and risk ratios with 95% confidence intervals (CIs). RESULTS Among 116 results from the systematic search, a total of 8 studies (5952 patients) were included. Compared to patients without previous CABG, patients with prior CABG undergoing TAVR were younger, predominantly male sex, had more comorbidities, higher rates of peri-procedural myocardial infarction (MI) [relative risk (RR) 1.93; 95% CI, 1.09-3.43; P = 0.03], but lower rates of stroke (RR 0.71; 95% CI, 0.51-0.99; P = 0.04), major vascular complications (RR 0.70; 95% CI, 0.51-0.95; P = 0.02), and major bleeding (RR 0.70; 95% CI, 0.56-0.88; P = 0.002). There were no significant differences between the two cohorts in rates of pacemaker implantation, cardiac tamponade, acute kidney injury, intra-procedural mortality, 30-day mortality, and 30-day cardiac mortality. CONCLUSION Among patients undergoing TAVR, a history of prior CABG was not associated with an increased risk of periprocedural complications (except for acute MI) or short-term mortality compared to those without CABG.
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Affiliation(s)
| | - Mahmoud Ismayl
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Anirudh Palicherla
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Ahmed Aboeata
- Division of Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Maqsood MH, Ashish K, Truesdell AG, Belford PM, Zhao DX, Rab ST, Vallabhajosyula S. Role of adjunct anticoagulant or thrombolytic therapy in cardiac arrest without ST-segment-elevation or percutaneous coronary intervention: A systematic review and meta-analysis. Am J Emerg Med 2023; 63:1-4. [PMID: 36279808 DOI: 10.1016/j.ajem.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 12/07/2022] Open
Abstract
This study sought to compare the impact of additional anticoagulation or thrombolytic therapy in patients with cardiac arrest without ST-segment-elevation on electrocardiography and not receiving percutaneous coronary intervention. Three studies (two randomized controlled studies and one observational study) were included, which demonstrated that use of anticoagulation or thrombolytic therapy was associated with higher risk of bleeding, without improvements in time to return of spontaneous circulation or in-hospital mortality.
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Affiliation(s)
| | - Kumar Ashish
- Department of Medicine, CarolinaEast Medical Center, New Bern, NC, United States of America
| | - Alexander G Truesdell
- Virginia Heart/Inova Heart and Vascular Institute, Falls Church, VA, United States of America
| | - P Matthew Belford
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - S Tanveer Rab
- Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America; Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America.
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Doshi R, Vasudev R, Guragai N, Patel KN, Kumar A, Majmundar M, Doshi P, Patel P, Shah K, Santana M, Roman S, Vallabhajosyula S, Virk H, Bikkina M, Shamoon F. Clinical outcomes of MANTA vs suture-based vascular closure devices after transcatheter aortic valve replacement: An updated meta-analysis. Indian Heart J 2023; 75:59-67. [PMID: 36640840 PMCID: PMC9986740 DOI: 10.1016/j.ihj.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE A recently published randomized control trial showed different results with suture-based vascular closure device (VCD) than plug-based VCD in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). The learning curve for MANTA device is steep, while the learning curve for suture based VCD is shallow as the devices are quite different. In this meta-analysis, we have compared suture-based (ProGlide and Prostar XL) vs plug-based VCDs (MANTA). METHODS We performed a meta-analysis of all published studies (using PubMed/Medline and Cochrane databases) reporting the clinical outcome of plug-based vs suture-based VCDs in transfemoral TAVR patients. RESULTS We included nine studies with a total of 2865 patients (plug-based n = 1631, suture-based n = 1234). There was no significant difference in primary outcome of all bleeding when using plug-based as opposed to suture-based VCDs (RR 1.14 [0.62-2.06] I2 = 72%). There was no significant difference in the incidence of secondary outcomes between two groups including major life threatening bleeding (RR 1.16 [0.38-3.58] I2 = 65%), major vascular complications (RR 0.84 [0.35-2.00] I2 = 55%), minor vascular complications (RR 1.05 [0.56-1.95] I2 = 42%), pseudo aneurysm (RR 1.84 [0.11-29.98] I2 = 44%), stenosis-dissection (RR 0.98 [0.66-1.47] I2 = 0%), VCD failure (RR 1.71 [0.96-3.04] I2 = 0%), and blood transfusion (RR 1.01 [0.38-2.71], I2 = 61%). CONCLUSION Large bore arteriotomy closure with plug-based VCD was not superior to suture-based VCDs in this transfemoral TAVR population. There was very frequent use of secondary VCDs in suture-based VCD group which is not practical when using MANTA. Additional high-powered studies are required to determine the safety and efficacy of MANTA device.
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Affiliation(s)
- Rajkumar Doshi
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA.
| | - Rahul Vasudev
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Nirmal Guragai
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Kunal Nitinkumar Patel
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - Ashish Kumar
- Department of Internal Medicine Cleveland Clinic Akron General, Akron, OH, USA
| | - Monil Majmundar
- Department of Cardiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Preet Doshi
- Department of Medicine, MS Ramaiah Medical College, Bengaluru, India
| | - Prem Patel
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Kalpesh Shah
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Melvin Santana
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Sherif Roman
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Hartaj Virk
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Mahesh Bikkina
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Fayez Shamoon
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
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Vallabhajosyula S, Verghese D, Henry TD, Katz JN, Nicholson WJ, Jaber WA, Jentzer JC. Contemporary Management of Concomitant Cardiac Arrest and Cardiogenic Shock Complicating Myocardial Infarction. Mayo Clin Proc 2022; 97:2333-2354. [PMID: 36464466 DOI: 10.1016/j.mayocp.2022.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 07/26/2021] [Revised: 06/08/2022] [Accepted: 06/24/2022] [Indexed: 12/03/2022]
Abstract
Cardiogenic shock (CS) and cardiac arrest (CA) are the most life-threatening complications of acute myocardial infarction. Although there is a significant overlap in the pathophysiology with approximately half the patients with CS experiencing a CA and approximately two-thirds of patients with CA developing CS, comprehensive guideline recommendations for management of CA + CS are lacking. This paper summarizes the current evidence on the incidence, pathophysiology, and short- and long-term outcomes of patients with acute myocardial infarction complicated by concomitant CA + CS. We discuss the hemodynamic factors and unique challenges that need to be accounted for while developing treatment strategies for these patients. A summary of expert-based step-by-step recommendations to the approach and treatment of these patients, both in the field before admission and in-hospital management, are presented.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Dhiran Verghese
- Section of Advanced Cardiac Imaging, Division of Cardiovascular Medicine, Department of Medicine, Harbor UCLA Medical Center, Torrance, CA, USA; Department of Cardiovascular Medicine, NCH Heart Institute, Naples, FL, USA
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital Health Network, Cincinnati, OH, USA
| | - Jason N Katz
- Divisions of Cardiovascular Diseases and Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - William J Nicholson
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Wissam A Jaber
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
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Patel HP, Decter D, Thakkar S, Anantha-Narayanan M, Kumar A, Sheth AR, Zahid S, Patel BA, Patel T, Devani H, Shah V, Doshi PM, Patel S, Shariff M, Adalja D, Vallabhajosyula S, Doshi R. Impact of Chronic Kidney Disease on In-Hospital Outcomes of Hospitalizations With Acute Limb Ischemia Undergoing Endovascular Therapy. J Endovasc Ther 2022:15266028221134887. [PMID: 36401519 DOI: 10.1177/15266028221134887] [Citation(s) in RCA: 1] [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] [Indexed: 02/17/2024]
Abstract
PURPOSE Studies on outcomes related to endovascular treatment (EVT) in advanced stages of chronic kidney disease (CKD) and end-stage renal disease (ESRD) among hospitalizations with acute limb ischemia (ALI) are limited. METHODS The Nationwide Inpatient Sample was quarried from October 2015 to December 2017 to identify the hospitalizations with ALI and undergoing EVT. The study population was subdivided into 3 groups based on their CKD stages: group 1 (No CKD, stage I, stage II), group 2 (CKD stage III, stage IV), and group 3 (CKD stage V and ESRD). The primary outcome was all-cause in-hospital mortality. RESULTS A total of 51 995 hospitalizations with ALI undergoing EVT were identified. The in-hospital mortality was significantly higher in group 2 (OR = 1.17; 95% CI 1.04 - 1.32, p=0.009) and group 3 (OR = 3.18; 95% CI 2.74-3.69, p<0.0001) compared with group 1. Odds of minor amputation, vascular complication, atherectomy, and blood transfusion were higher among groups 2 and 3 compared with group 1. Group 2 had higher odds of access site hemorrhage compared with groups 1 and 3, whereas group 3 had higher odds of major amputation, postprocedural infection, and postoperative hemorrhage compared with groups 1 and 2. Besides, groups 2 and 3 had lower odds of discharge to home compared with group 1. Finally, the length of hospital stay and cost of care was significantly higher with the advancing CKD stages. CONCLUSION Advanced CKD stages and ESRD are associated with higher mortality, worse in-hospital outcomes and higher resource utilization among ALI hospitalizations undergoing EVT. CLINICAL IMPACT Current guidelines are not clear for the optimum first line treatment of acute limb ischemia, especially in patients with advanced kidney disease as compared to normal/mild kidney disease patients. We found that advanced kidney disease is a significant risk factor for worse in-hospital morbidity and mortality. Furthermore, patients with acute limb ischemia and advanced kidney disease is associated with significantly higher resource utilization as compared to patients with normal/mild kidney disease. This study suggests shared decision making between treating physician and patients when considering endovascular therapy for the treatment of acute limb ischemia in patients with advanced kidney disease.
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Affiliation(s)
- Harsh P Patel
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA
| | - Dean Decter
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Mahesh Anantha-Narayanan
- Department of Interventional Cardiology, The University of Arizona and Banner University Medical Center, Phoenix, AZ, USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Aakash R Sheth
- Department of Internal Medicine, Louisiana State University, Shreveport, LA, USA
| | - Salman Zahid
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Bhavin A Patel
- Department of Cardiology, Apex Heart Institute, Ahmedabad, India
| | - Toralben Patel
- Department of Cardiovascular Diseases, AdventHealth Medical Group, Orlando, FL, USA
| | - Hiteshkumar Devani
- Department of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vrushali Shah
- Department of Endocrinology, University of Massachusetts, Worcester, MA, USA
| | | | - Smit Patel
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | | | - Devina Adalja
- Department of Medicine, Gujarat Medical Education & Research Society Gotri Medical College, Vadodara, India
| | | | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, NV, USA
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36
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Patlolla SH, Bhat AG, Sundaragiri PR, Cheungpasitporn W, Doshi RP, Siddappa Malleshappa SK, Pasupula DK, Jaber WA, Nicholson WJ, Vallabhajosyula S. Impact of Active and Historical Cancers on the Management and Outcomes of Acute Myocardial Infarction Complicating Cardiogenic Shock. Tex Heart Inst J 2022; 49:487440. [PMID: 36223249 PMCID: PMC9632367 DOI: 10.14503/thij-21-7598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND There are limited data on the outcomes of acute myocardial infarction-cardiogenic shock (AMI-CS) in patients with concomitant cancer. METHODS A retrospective cohort of adult AMI-CS admissions was identified from the National Inpatient Sample (2000-2017) and stratified by active cancer, historical cancer, and no cancer. Outcomes of interest included in-hospital mortality, use of coronary angiography, use of percutaneous coronary intervention, do-not-resuscitate status, palliative care use, hospitalization costs, and hospital length of stay. RESULTS Of the 557,974 AMI-CS admissions during this 18-year period, active and historical cancers were noted in 14,826 (2.6%) and 27,073 (4.8%), respectively. From 2000 to 2017, there was a decline in active cancers (adjusted odds ratio, 0.70 [95% CI, 0.63-0.79]; P < .001) and an increase in historical cancer (adjusted odds ratio, 2.06 [95% CI, 1.89-2.25]; P < .001). Compared with patients with no cancer, patients with active and historical cancer received less-frequent coronary angiography (57%, 67%, and 70%, respectively) and percutaneous coronary intervention (40%, 47%, and 49%%, respectively) and had higher do-not-resuscitate status (13%, 15%, 7%%, respectively) and palliative care use (12%, 10%, 6%%, respectively) (P < .001). Compared with those without cancer, higher in-hospital mortality was found in admissions with active cancer (45.9% vs 37.0%; adjusted odds ratio, 1.29 [95% CI, 1.24-1.34]; P < .001) but not historical cancer (40.1% vs 37.0%; adjusted odds ratio, 1.01 [95% CI, 0.98-1.04]; P = .39). AMI-CS admissions with cancer had a shorter hospitalization duration and lower costs (all P < .001). CONCLUSION Concomitant cancer was associated with less use of guideline-directed procedures. Active, but not historical, cancer was associated with higher mortality in patients with AMI-CS.
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Affiliation(s)
| | - Anusha G. Bhat
- Department of Cardiovascular Medicine, University of Maryland, Baltimore
, Department of Public Health Practice, School of Public Health and Health Sciences, University of Massachusetts, Amherst
| | - Pranathi R. Sundaragiri
- Department of Primary Care Internal Medicine, Wake Forest Baptist Health, High Point, North Carolina
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rajkumar P. Doshi
- Department of Medicine, University of Nevada School of Medicine, Reno, Nevada
| | - Sudeep K. Siddappa Malleshappa
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Deepak K. Pasupula
- Department of Cardiovascular Medicine, Mercy One Medical Center, Des Moines, Iowa
| | - Wissam A. Jaber
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - William J. Nicholson
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
, Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina
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Vallabhajosyula S, Kadavath S, Truesdell AG, Young MN, Batchelor WB, Welt FG, Kirtane AJ, Bortnick AE. It Is Time for Interventional Cardiology Fellowship to Join the National Resident Matching Program. JACC Cardiovasc Interv 2022; 15:1762-1767. [PMID: 36075647 PMCID: PMC9812285 DOI: 10.1016/j.jcin.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, and Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
| | - Sabeeda Kadavath
- Section of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Michael N Young
- Division of Cardiovascular Medicine, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | - Frederick G Welt
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ajay J Kirtane
- Columbia University Irving Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Anna E Bortnick
- Divisions of Cardiology and Geriatrics, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, The Bronx, New York, USA
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Sandhyavenu H, Badu I, Ullah W, Polam AR, Mir T, Titus A, Brailovsky Y, Rajapreyar I, Vallabhajosyula S, Alraies MC. TCT-71 Trend, Predictors, and Outcomes of Cardiogenic Shock in Asian Population: A Nationwide Inpatient Sample Database Study. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.086] [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: 10/14/2022]
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Machanahalli Balakrishna A, Reddi V, Belford PM, Alvarez M, Jaber WA, Zhao DX, Vallabhajosyula S. Intermediate-Risk Pulmonary Embolism: A Review of Contemporary Diagnosis, Risk Stratification and Management. Medicina (B Aires) 2022; 58:medicina58091186. [PMID: 36143863 PMCID: PMC9504600 DOI: 10.3390/medicina58091186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Pulmonary embolism (PE) can have a wide range of hemodynamic effects, from asymptomatic to a life-threatening medical emergency. Pulmonary embolism (PE) is associated with high mortality and requires careful risk stratification for individualized management. PE is divided into three risk categories: low risk, intermediate-risk, and high risk. In terms of initial therapeutic choice and long-term management, intermediate-risk (or submassive) PE remains the most challenging subtype. The definitions, classifications, risk stratification, and management options of intermediate-risk PE are discussed in this review.
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Affiliation(s)
| | - Vuha Reddi
- Department of Medicine, Danbury Hospital/Yale University School of Medicine, Danbury, CT 06810, USA
| | - Peter Matthew Belford
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27262, USA
| | - Manrique Alvarez
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27262, USA
| | - Wissam A. Jaber
- Section of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - David X. Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27262, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27262, USA
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27262, USA
- Correspondence: ; Tel.: +1-(336)-878-6000
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Patlolla SH, Kanwar A, Sundaragiri PR, Cheungpasitporn W, Doshi RP, Singh M, Vallabhajosyula S. Seasonal variation in the management and outcomes of cardiac arrest complicating acute myocardial infarction. QJM 2022; 115:530-536. [PMID: 34570233 DOI: 10.1093/qjmed/hcab246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/02/2021] [Accepted: 09/18/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are limited data on the influence of seasons on the outcomes of acute myocardial infarction-cardiac arrest (AMI-CA). AIM To evaluate the outcomes of AMI-CA by seasons in the United States. DESIGN Retrospective cohort study. METHODS Using the National Inpatient Sample from 2000 to 2017, adult (>18 years) admissions with AMI-CA were identified. Seasons were defined by the month of admission as spring, summer, fall and winter. The outcomes of interest were prevalence of AMI-CA, in-hospital mortality, use of coronary angiography, percutaneous coronary intervention (PCI), hospital length of stay, hospitalization costs and discharge disposition. RESULTS Of the 10 880 856 AMI admissions, 546 334 (5.0%) were complicated by CA, with a higher prevalence in fall and winter (5.1% each) compared to summer (5.0%) and spring (4.9%). Baseline characteristics of AMI-CA admissions admitted in various seasons were largely similar. Compared to AMI-CA admissions in spring, summer and fall, AMI-CA admissions in winter had slightly lower rates of coronary angiography (63.3-64.3% vs. 61.4%) and PCI (47.2-48.4% vs. 45.6%). Compared to those admitted in the spring, adjusted in-hospital mortality was higher for winter {46.8% vs. 44.2%; odds ratio (OR) 1.08 [95% confidence interval (CI) 1.06-1.10]; P < 0.001}, lower for summer [43% vs. 44.2%; OR 0.97 (95% CI 0.95-0.98); P < 0.001] and comparable for fall [44.4% vs. 44.2%; OR 1.01 (95% CI 0.99-1.03); P = 0.31] AMI-CA admissions. Length of hospital stay, total hospitalization charges and discharge dispositions for AMI-CA admissions were comparable across the seasons. CONCLUSIONS AMI-CA admissions in the winter were associated with lower rates of coronary angiography and PCI, and higher rates of in-hospital mortality compared to the other seasons.
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Affiliation(s)
- S H Patlolla
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA 55905
| | - A Kanwar
- Department of Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, USA 55455
| | - P R Sundaragiri
- Department of Primary Care Internal Medicine, Wake Forest Baptist Health, 404 W Westwood Avenue, High Point, NC, USA 27262
| | - W Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA 55905
| | - R P Doshi
- Division of Cardiovascular Medicine, Department of Medicine, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ, USA 07503
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA 55905
| | - S Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, USA 27157
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Balakrishna AM, Zhao DX, Vallabhajosyula S. TRIO Risk Score: Simple, Yet Complex. Mayo Clin Proc 2022; 97:1419-1421. [PMID: 35933129 DOI: 10.1016/j.mayocp.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
Affiliation(s)
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
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Thongprayoon C, Kattah AG, Mao MA, Keddis MT, Pattharanitima P, Vallabhajosyula S, Nissaisorakarn V, Erickson SB, Dillon JJ, Garovic VD, Cheungpasitporn W. Distinct phenotypes of hospitalized patients with hyperkalemia by machine learning consensus clustering and associated mortality risks. QJM 2022; 115:442-449. [PMID: 34270780 DOI: 10.1093/qjmed/hcab194] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 05/27/2021] [Revised: 07/03/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hospitalized patients with hyperkalemia are heterogeneous, and cluster approaches may identify specific homogenous groups. This study aimed to cluster patients with hyperkalemia on admission using unsupervised machine learning (ML) consensus clustering approach, and to compare characteristics and outcomes among these distinct clusters. METHODS Consensus cluster analysis was performed in 5133 hospitalized adult patients with admission hyperkalemia, based on available clinical and laboratory data. The standardized mean difference was used to identify each cluster's key clinical features. The association of hyperkalemia clusters with hospital and 1-year mortality was assessed using logistic and Cox proportional hazard regression. RESULTS Three distinct clusters of hyperkalemia patients were identified using consensus cluster analysis: 1661 (32%) in cluster 1, 2455 (48%) in cluster 2 and 1017 (20%) in cluster 3. Cluster 1 was mainly characterized by older age, higher serum chloride and acute kidney injury (AKI), but lower estimated glomerular filtration rate (eGFR), serum bicarbonate and hemoglobin. Cluster 2 was mainly characterized by higher eGFR, serum bicarbonate and hemoglobin, but lower comorbidity burden, serum potassium and AKI. Cluster 3 was mainly characterized by higher comorbidity burden, particularly diabetes and end-stage kidney disease, AKI, serum potassium, anion gap, but lower eGFR, serum sodium, chloride and bicarbonate. Hospital and 1-year mortality risk was significantly different among the three identified clusters, with highest mortality in cluster 3, followed by cluster 1 and then cluster 2. CONCLUSION In a heterogeneous cohort of hyperkalemia patients, three distinct clusters were identified using unsupervised ML. These three clusters had different clinical characteristics and outcomes.
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Affiliation(s)
- C Thongprayoon
- From the Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - A G Kattah
- From the Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - M A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - M T Keddis
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - P Pattharanitima
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, 10120, Thailand
| | - S Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - V Nissaisorakarn
- Department of Internal Medicine, MetroWest Medical Center, Framingham, MA 01702, USA
| | - S B Erickson
- From the Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - J J Dillon
- From the Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - V D Garovic
- From the Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - W Cheungpasitporn
- From the Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Mehta A, Bansal M, Vallabhajosyula S. In COVID-19 acute hypoxemic respiratory failure, awake prone positioning vs. the supine position reduces intubations. Ann Intern Med 2022; 175:JC81. [PMID: 35785529 DOI: 10.7326/j22-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Li J, Luo J, Pavlov I, et al. Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Lancet Respir Med. 2022;10:573-83. 35305308.
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Affiliation(s)
- Aryan Mehta
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA (A.M., M.B., S.V.)
| | - Mridul Bansal
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA (A.M., M.B., S.V.)
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Patlolla SH, Kanwar A, Belford PM, Applegate RJ, Zhao DX, Singh M, Vallabhajosyula S. Influence of Household Income on Management and Outcomes of Acute Myocardial Infarction Complicated by Cardiogenic Shock. Am J Cardiol 2022; 177:7-13. [PMID: 35701236 DOI: 10.1016/j.amjcard.2022.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 11/25/2022]
Abstract
The impact of socioeconomic status on care and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) remains understudied. Hence, adult admissions with AMI-CS were identified from the National Inpatient Sample database (2005 to 2017) and were divided into quartiles on the basis of median household income for zip code (0 to 25th, 26th to 50th, 51st to 75th, and 76th to 100th). In-hospital mortality, use of cardiac and noncardiac procedures, and resource utilization were compared between all 4 income quartiles. Among a total of 7,805,681 AMI admissions, cardiogenic shock was identified in 409,294 admissions (5.2%) with comparable prevalence of cardiogenic shock across all 4 income quartiles. AMI-CS admissions belonging to the lowest income quartile presented more often with non-ST-elevation myocardial infarction and had comparable use of coronary angiography and percutaneous coronary intervention but lower use of early coronary angiography, early percutaneous coronary intervention, mechanical circulatory support devices, and pulmonary artery catheterization than higher income quartiles. In the adjusted analysis, admissions belonging to the 0 to 25th income quartile (odds ratio [OR] 1.17 [95% confidence interval [CI] 1.15 to 1.20], p <0.001), 26th to 50th quartile (OR 1.11 [95% CI 1.09 to 1.14], p <0.001), and 51st to 75th income quartile (OR 1.06 [95% CI 1.04 to 1.09], p <0.001) had higher adjusted in-hospital mortality than the highest income quartile (76th to 100th). Lowest income quartile admissions had lower rates of palliative care consultations and higher rates of do-not-resuscitate status than the higher income quartiles. Hospitalization charges and length of stay were higher for admissions belonging to the highest income quartile. In conclusion, lowest income quartile AMI-CS admissions were associated with higher rates of non-ST-elevation myocardial infarction, lower use of mechanical circulatory support devices, and higher in-hospital mortality.
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Affiliation(s)
| | - Ardaas Kanwar
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - P Matthew Belford
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Robert J Applegate
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
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Patlolla SH, Kandlakunta H, Kuchkuntla AR, West CP, Murad MH, Wang Z, Kochar A, Rab ST, Gersh BJ, Holmes DR, Zhao DX, Vallabhajosyula S. Newer P2Y 12 Inhibitors vs Clopidogrel in Acute Myocardial Infarction With Cardiac Arrest or Cardiogenic Shock: A Systematic Review and Meta-analysis. Mayo Clin Proc 2022; 97:1074-1085. [PMID: 35662424 DOI: 10.1016/j.mayocp.2022.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/21/2021] [Revised: 01/18/2022] [Accepted: 02/15/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the outcomes, safety, and efficacy of dual antiplatelet therapy (DAPT) with newer P2Y12 inhibitors compared with clopidogrel in patients with acute myocardial infarction (AMI) complicated by cardiac arrest (CA) or cardiogenic shock (CS). PATIENTS AND METHODS MEDLINE, EMBASE, and the Cochrane Library were queried systematically from inception to January 2021 for comparative studies of adults (≥18 years) with AMI-CA/CS receiving DAPT with newer P2Y12 inhibitors as opposed to clopidogrel. We compared outcomes (30-day or in-hospital and 1-year all-cause mortality, major bleeding, and definite stent thrombosis) of newer P2Y12 inhibitors and clopidogrel in patients with AMI-CA/CS. RESULTS Eight studies (1 randomized trial and 7 cohort studies) comprising 1100 patients (695 [63.2%] receiving clopidogrel and 405 [36.8%] receiving ticagrelor or prasugrel) were included. The population was mostly male (68.5%-86.7%). Risk of bias was low for these studies, with between-study heterogeneity and subgroup differences not statistically significant. Compared with the clopidogrel cohort, the newer P2Y12 cohort had lower rates of early mortality (odds ratio [OR], 0.60; 95% CI, 0.45 to 0.81; P=.001) (7 studies) and 1-year mortality (OR, 0.51; 95% CI, 0.36 to 0.71; P<.001) (3 studies). We did not find a significant difference in major bleeding (OR, 1.21; 95% CI, 0.71 to 2.06; P=.48) (6 studies) or definite stent thrombosis (OR, 2.01; 95% CI, 0.63 to 6.45; P=.24) (7 studies). CONCLUSION In patients with AMI-CA/CS receiving DAPT, compared with clopidogrel, newer P2Y12 inhibitors were associated with lower rates of early and 1-year mortality. Data on major bleeding and stent thrombosis were inconclusive.
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Affiliation(s)
- Sri Harsha Patlolla
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN
| | - Harika Kandlakunta
- Department of Medicine, Staten Island University Hospital, Staten Island, NY
| | | | - Colin P West
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Department of Medicine, Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - M Hassan Murad
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ajar Kochar
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - S Tanveer Rab
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
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Vallabhajosyula S, Kumar V, Sundaragiri PR, Cheungpasitporn W, Miller PE, Patlolla SH, Gersh BJ, Lerman A, Jaffe AS, Shah ND, Holmes DR, Bell MR, Barsness GW. Management and Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Uninsured Compared With Privately Insured Individuals. Circ Heart Fail 2022; 15:e008991. [PMID: 35240866 PMCID: PMC9930186 DOI: 10.1161/circheartfailure.121.008991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are limited data on uninsured patients presenting with acute myocardial infarction-cardiogenic shock (AMI-CS). This study sought to compare the management and outcomes of AMI-CS between uninsured and privately insured individuals. METHODS Using the National Inpatient Sample (2000-2016), a retrospective cohort of adult (≥18 years) uninsured admissions (primary payer-self-pay or no charge) were compared with privately insured individuals. Interhospital transfers were excluded. Outcomes of interest included in-hospital mortality, temporal trends in admissions, use of cardiac procedures, do-not-resuscitate status, palliative care referrals, and resource utilization. RESULTS Of 402 182 AMI-CS admissions, 21 966 (5.4%) and 93 814 (23.3%) were uninsured and privately insured. Compared with private insured individuals, uninsured admissions were younger, male, from a lower socioeconomic status, had lower comorbidity, higher rates of acute organ failure, ST-segment elevation AMI-CS (77.3% versus 76.4%), and concomitant cardiac arrest (33.8% versus 31.9%; all P<0.001). Compared with 2000, in 2016, there were more uninsured (adjusted odds ratio, 1.15 [95% CI, 1.13-1.17]; P<0.001) and less privately insured admissions (adjusted odds ratio, 0.85 [95% CI, 0.83-0.87]; P<0.001). Uninsured individuals received less frequent coronary angiography (79.5% versus 81.0%), percutaneous coronary intervention (60.8% versus 62.2%), mechanical circulatory support (54% versus 55.5%), and had higher palliative care (3.8% versus 3.2%) and do-not-resuscitate status use (4.4% versus 3.2%; all P<0.001). Uninsured admissions had higher in-hospital mortality (adjusted odds ratio, 1.62 [95% CI, 1.55-1.68]; P<0.001) and resource utilization. CONCLUSIONS Uninsured individuals have higher in-hospital mortality and lower use of guideline-directed therapies in AMI-CS compared with privately insured individuals.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Vinayak Kumar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Pranathi R Sundaragiri
- Department of Primary Care Internal Medicine, Wake Forest Baptist Health, High Point, North Carolina
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - P Elliott Miller
- Division of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Allan S Jaffe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nilay D Shah
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota,Department of Health Services Research, Mayo Clinic, Rochester, Minnesota
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Singh S, Patlolla SH, Sundaragiri PR, Gurumurthy G, Cheungpasitporn W, Vallabhajosyula S. Acute myocardial infarction in heart transplant recipients: An 18-year national study. Am Heart J Plus 2022; 17:100167. [PMID: 38559875 PMCID: PMC10978363 DOI: 10.1016/j.ahjo.2022.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/29/2022] [Accepted: 05/29/2022] [Indexed: 04/04/2024]
Abstract
Among 11,622,528 acute myocardial infarction (AMI) hospitalizations, 892 had a history of heart transplantation (HT). In comparison to AMI admissions without HT, those with prior HT were more frequently complicated with cardiac arrest (8.3 % vs 5.0 %, p < 0.001), acute non-cardiac organ failure (17.4 % vs 9.4 %) (p < 0.001), lower rates of coronary angiography (55.4 % vs 63.6 %, p < 0.001), comparable rates of percutaneous coronary intervention (38.8 % vs 41.5 %, p = 0.10), higher rates of pulmonary artery catheterization (2.7 % vs 1.1 %, p < 0.001), invasive mechanical ventilation and acute hemodialysis compared to AMI admissions without HT. Compared to AMI admissions without HT, prior HT recipients had higher in-hospital mortality (11.8 % vs 6.2 %, adjusted odds ratio 2.87 [95 % CI 2.23-3.70]; p < 0.001).
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Affiliation(s)
- Sohrab Singh
- Department of Medicine, The Brooklyn Hospital, Brooklyn, NY, United States of America
| | - Sri Harsha Patlolla
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Pranathi R. Sundaragiri
- Section of Primary Care Internal Medicine, Wake Forest Baptist Health, High Point, NC, United States of America
| | - Gayathri Gurumurthy
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
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Ahmed AM, Tabi M, Wiley BM, Vallabhajosyula S, Barsness GW, Bell MR, Jentzer JC. Outcomes Associated With Cardiac Arrest in Patients in the Cardiac Intensive Care Unit With Cardiogenic Shock. Am J Cardiol 2022; 169:1-9. [PMID: 35045934 DOI: 10.1016/j.amjcard.2021.12.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/19/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022]
Abstract
Cardiac arrest (CA) is common and has been associated with adverse outcomes in patients with cardiogenic shock (CS). We sought to determine the prevalence, patient characteristics, and outcomes of CA in cardiovascular intensive care unit patients with CS. We queried cardiovascular intensive care unit admissions from 2007 to 2018 with an admission diagnosis of CS and compared patients with and without CA. Temporal trends were assessed using linear regression. The primary and secondary outcomes of in-hospital and 1-year mortality were analyzed using logistic regression and Cox proportional-hazards analysis, respectively. We included 1,498 patients, and CA was present in 510 patients (34%), with 258 (50.6% of patients with CA) having ventricular fibrillation (VF). Mean age was 68 ± 14 years, and 37% were females. The prevalence of CA decreased over time (from 43% in 2007 to 24% in 2018, p <0.001). Hospital mortality was 33.3% and decreased over time in patients without CA (from 30% in 2007 to 22% in 2018, p = 0.05), but not in patients with CA (p = 0.71). CA was associated with a higher risk of hospital mortality (51.0% vs 24.2%, adjusted odds ratio 2.15, 95% confidence interval [CI] 1.52 to 3.05, p <0.001), with no difference between VF CA and non-VF CA (p = 0.64). CA was associated with higher 1-year mortality (adjusted hazard ratio 1.53, 95% CI 1.24 to 1.89, p <0.001). In conclusion, CA is present in 1 of 3 of CS hospitalizations and confers a substantially higher risk of hospital and 1-year mortality with no improvement during our 12-year study period contrary to prevailing trends.
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Affiliation(s)
- Abdelrahman M Ahmed
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Meir Tabi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Brandon M Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jacob C Jentzer
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Patlolla SH, Pajjuru VS, Sundaragiri PR, Cheungpasitporn W, Sachdeva R, McDaniel MC, Kumar G, Rab ST, Vallabhajosyula S. Hospital-Level Disparities in the Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction. Am J Cardiol 2022; 169:24-31. [PMID: 35063262 DOI: 10.1016/j.amjcard.2021.12.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 12/21/2022]
Abstract
There are limited contemporary data evaluating the relation between hospital characteristics and outcomes of patients with cardiac arrest complicating acute myocardial infarction (AMI-CA). As such, we used the National Inpatient Sample database (2000 to 2017), to identify adult admissions with primary diagnosis of AMI and concomitant CA. Interhospital transfers were excluded, and hospitals were classified based on location and teaching status (rural, urban nonteaching, and urban teaching) and bed size (small, medium, and large). Among 494,083 AMI-CA admissions, 9.3% received care at rural hospitals, 43.4% at urban nonteaching hospitals, and 47.3% at urban teaching hospitals. Compared with urban nonteaching and teaching hospitals, AMI-CA admissions at rural hospitals received lower rates of cardiac and noncardiac procedures. Admissions to urban teaching hospitals had higher rates of acute organ failure, concomitant cardiogenic shock, and cardiac and noncardiac procedures. When hospitals were stratified by bed size, 9.8% of AMI-CA admissions were admitted to small capacity hospitals, 26.0% to medium capacity, and 64.2% to large capacity hospitals. The use of cardiac and noncardiac procedures was lower in small hospitals with higher rates of use in medium and large hospitals. In-hospital mortality was higher in urban nonteaching (adjusted odds ratio [OR] 1.17; 95% confidence interval [CI]1.14 to 1.20; p <0.001) and urban teaching hospitals (adjusted OR 1.36; 95% CI 1.32 to 1.39; p <0.001) compared with rural hospitals. Compared with small hospitals, medium (adjusted OR 1.11; 95% CI 1.08 to 1.14; p <0.001) and large hospitals (adjusted OR 1.22; 95% CI 1.19 to 1.25; p <0.001) were associated with higher in-hospital mortality. In conclusion, AMI-CA admissions to large and urban hospitals had higher in-hospital mortality compared with small and rural hospitals potentially owing to greater acuity.
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Bansal A, Verghese D, Vallabhajosyula S. Intra-Aortic Balloon Pump for Left Ventricular Unloading in Veno-Arterial Extracorporeal Membrane Oxygenation: The Last Remaining Indication in Cardiogenic Shock. J Am Heart Assoc 2022; 11:e025274. [PMID: 35377158 PMCID: PMC9075478 DOI: 10.1161/jaha.122.025274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Agam Bansal
- Department of Medicine Cleveland Clinic Foundation Cleveland OH
| | - Dhiran Verghese
- Section of Advanced Cardiac Imaging Division of Cardiovascular Medicine Department of Medicine Harbor-UCLA Medical Center Los Angeles CA
| | - Saraschandra Vallabhajosyula
- Division of Cardiovascular Medicine Department of Medicine Wake Forest University School of Medicine Winston-Salem NC
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