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Mishra V, Desai R, Chhina AK, Raina J, Itare V, Patel M, Doshi R, Gangani K, Sachdeva R, Kumar G. Cardiovascular disease risk factors and outcomes of acute myocardial infarction in young adults in two nationwide cohorts in the united states. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.045] [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: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Acute myocardial infarction (AMI) can have considerable morbidity and devastating socioeconomic and psychological consequences in young adults. Previous studies reveal that the decline in mortality in AMI has mainly been in the older population while being comparatively less significant in younger patients. This study compares young adults (18 to 44 years) hospitalized with AMI across two nationwide cohorts, 2007 and 2017, in the United States (US). It examines the burden of AMI hospitalizations, the prevalence of comorbidities, and in-hospital outcomes in young adults a decade apart. It highlights the rise in AMI hospitalizations, lack of decrease in mortality, sex-based and racial disparities, the surge in post-MI complications, and the decline in reperfusion interventions in young AMI patients over a decade.
Purpose
Coronary heart disease prevalence is challenging to ascertain in younger adults because of limited data and frequent silent clinical presentations. AMI and its complications can cause considerable morbidity, psychological trauma, and socioeconomic burden in the young.
Methods
We identified hospitalizations for AMI in young adults in 2007 and 2017 using the weighted data from the National Inpatient Sample (NIS), which covers 20% of stratified data of all non-federal community hospitals in the US. We compared the following data between the two cohorts: admission rates, sociodemographic features, in-hospital morbidity, complications, mortality, rate of coronary interventions, and healthcare utilization between the two cohorts. We used Pearson’s Chi-square test and Mann-Whitney U test to compare categorical and continuous variables, respectively. We also applied multivariable regression analyses to assess and compare the risk of cardiovascular complications and in-hospital mortality while controlling for confounders, including age, sex, race, median household income quartile, primary insurance enrolment, and pre-existing comorbidities.
Results
AMI’s incidence was higher in males in both the cohorts, although with a decline (71.1% vs 66.1%), whereas it rose from 28.9% to 33.9% in females. Hypertension (47.8% vs 60.7%), smoking (49.7% vs 55.8%), obesity (14.8% vs 26.8%), and diabetes mellitus (22.0% vs 25.6%) increased in the 2017 cohort (Table 1). We found no significant difference in all-cause mortality (aOR = 1.01 (0.93-1.10), p=0.749). Post-AMI complications, cardiogenic shock (aOR = 1.16 (1.06-1.27), p=0.001), and fatal arrhythmias increased. Reperfusion interventions decreased in the 2017 cohort (PCI; aOR=0.95 (0.91-0.98), p<0.001; CABG; aOR=0.66 (0.61-0.71), p<0.001) (Table 2).
Conclusion
Our study highlights the rise in AMI hospitalizations, plateauing of mortality, gender disparity, the surge in post-MI complications, and a reassuring decline in the requirement of reperfusion interventions in young AMI patients over a decade.
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Affiliation(s)
- V Mishra
- Sir JJ Group of Hospitals, Mumbai, India
| | - R Desai
- Atlanta VA Medical Healthcare System, Cardiology, Atlanta, United States of America
| | - AK Chhina
- Washington D.C. Va Medical Center, Washington, DC, United States of America
| | - J Raina
- Brookdale University Hospital & Medical Center, Internal Medicine, Brooklyn, United States of America
| | - V Itare
- Brookdale University Hospital & Medical Center, Internal Medicine, Brooklyn, United States of America
| | - M Patel
- Smt. BK Shah Medical Institute and Research Centre, Medicine, Vadodara, India
| | - R Doshi
- St Joseph’s Regional Medical Center, Paterson, United States of America
| | - K Gangani
- Texas Health Arlington Memorial Hospital, Internal Medicine, Arlington, Texas, USA
| | - R Sachdeva
- Atlanta VA Medical Healthcare System, Cardiology, Atlanta, United States of America
| | - G Kumar
- Atlanta VA Medical Healthcare System, Cardiology, Atlanta, United States of America
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Hanna B, Desai R, Sachdeva S, Singh S, Gangani K, Taha Y, Echols M, Paul T, Berman A, Bloom H, Kumar G, Sachdeva R. Pulmonary artery injury in left atrial appendage closure device implantation: a systematic review of a potentially fatal complication. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0667] [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: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary artery (PA) injury is a rarely reported complication following percutaneous left atrial appendage closure (LAAC). This study aims to systematically review all reported cases of PA injury associated with LAAC.
Methods
PubMed/Medline, SCOPUS, EMBASE, Google Scholar and the MAUDE databases were searched to find studies reporting PA injury during or after LAAC with the Amplatzer Amulet (AA), Amplatzer Cardiac Plug (ACP) or Watchman device through October 2019. Categorical data were reported in terms of numbers and/or percentages (%).
Results
We found 13 cases (mean age 71.4 yrs) with reported PA injury associated with LAAC. Of these, 9 were case reports, 3 were reported in observational studies, and 1 was in the MAUDE database. Most cases (n=8) were reported in Europe followed by Australia (n=2) and Asia (n=2). The indication for device implantation in all patients was a high bleeding risk with anticoagulation for atrial fibrillation. Five cases were reported with the ACP (1/5 patients died), 5 with AA (2/5 patients died), and 3 with the Watchman (1/2 patients died). Acute and late presentations following implantation were reported for all three devices. 69.2% of cases (9/13) occurred acutely (during or within 24 hours of intervention). Of these, 3/9 occurred during device implantation. 2/4 of the delayed cases occurred >2 weeks following implantation. The mortality rate for acute and delayed cases was 22% (2/9 patients) and 50% (2/4 patients), respectively. A majority of the cases were attributable to barb/strut/hook injury of the PA. PA injury was associated with a mortality rate of approximately 31%. All surviving patients were managed with surgical intervention.
Conclusion
PA injury is an infrequently reported complication following LAAC and is associated with high mortality. Cases can present acutely (intra-procedurally or within 24 hours) or delayed (>24 hours post-implantation). A majority of cases are due to direct injury of the PA by the struts/hooks/barbs of the device. Practitioners should be cognizant of this life-threatening complication, which requires a high index of suspicion for diagnosis and can occur weeks after device implantation.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- B Hanna
- Morehouse School of Medicine, Atlanta, United States of America
| | - R Desai
- Atlanta Veterans Affairs Medical Center, Cardiology, Atlanta, United States of America
| | - S Sachdeva
- Lady Hardinge Medical College and Hospitals, Department of Medicine, New Delhi, India
| | - S Singh
- Amsterdam University Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands (The)
| | - K Gangani
- Texas Health Arlington Memorial Hospital, Department of Internal Medicine, Arlington, Texas, United States of America
| | - Y Taha
- Morehouse School of Medicine, Atlanta, United States of America
| | - M Echols
- Morehouse School of Medicine, Atlanta, United States of America
| | - T.K Paul
- East Tennessee State University, Division of Cardiology, Johnson city, Tennessee, United States of America
| | - A Berman
- Augusta University, Augusta, United States of America
| | - H Bloom
- Atlanta Veterans Affairs Medical Center, Cardiology, Atlanta, United States of America
| | - G Kumar
- Atlanta Veterans Affairs Medical Center, Cardiology, Atlanta, United States of America
| | - R Sachdeva
- Morehouse School of Medicine, Atlanta, United States of America
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Desai R, Sachdeva S, Singh S, Rajan S, Shaik A, Haider M, Fong H, Gangani K, Sachdeva R, Kumar G. Rates and causes of readmissions following index admissions for Takotsubo syndrome-a meta-analysis of 118,941 index hospitalizations. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1246] [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: 11/13/2022] Open
Abstract
Abstract
Background
Rising trends in takotsubo syndrome (TTS)-related complications warrant data to identify the rate, causes and predictors of readmission on a large scale. We conducted the first-ever meta-analysis to evaluate the pooled rate of short-term and long-term readmissions after index TTS admissions.
Methods
PubMed/Medline, EMBASE and SCOPUS databases were systematically reviewed to find studies through October 2019 reporting rates and causes of readmission following index TTS admissions. Random effects models were used to estimate pooled rates and causes of readmissions and I2 statistics were used to report inter-study heterogeneity.
Results
A total of 16 cohorts with 118,941 TTS index admissions (mean age 65–75 yrs; female >85%, median follow-up 272.5 days) revealed a 16.6% [95% CI-13.2%-20.3%, I2=99%] pooled rate of readmission. Short-term and long-term pooled readmission rates are displayed in Fig.1. The readmission rate was higher in cohorts with young patients (<70 vs. >70 yrs), smaller sample size (n<100 vs. n>100) and single-centres vs. multicentres. Studies published from the USA (16.4% vs. 14.9%) had a higher readmission rate as compared to Italy. The most frequent causes were cardiac (40.6%), respiratory (15.7%) and renal (7.0%). Among readmissions with cardiac diagnoses, heart failure was most common (40.1%).
Conclusions
This global meta-analysis revealed that the pooled rate of readmission following index TTS admissions was ∼17% and causes were mainly cardiac or respiratory.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- R Desai
- Atlanta Veterans Affairs Medical Centre, Division of Cardiology, Atlanta, United States of America
| | - S Sachdeva
- Lady Hardinge Medical college and hospitals, Delhi, India
| | - S Singh
- Amsterdam University Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands (The)
| | - S.K Rajan
- Medical City Plano, Department of Medicine, plano, Texas, United States of America
| | - A.S Shaik
- Silver Lane Medical Centre, Department of Medicine, East Hartford, Connecticut, United States of America
| | - M Haider
- New York-Presbyterian Hospital, Department of Internal Medicine, New York, United States of America
| | - H.K Fong
- UC Davis Medical Centre, Division of Cardiovascular Medicine, Sacramento, United States of America
| | - K Gangani
- Texas Health Arlington Memorial Hospital, Department of Internal Medicine, Arlington, Texas, United States of America
| | - R Sachdeva
- Morehouse School of Medicine, Atlanta VA Medical centre & Medical College of Georgia, Division of Cardiology, Augusta,Georgia, United States of America
| | - G Kumar
- Emory University & Atlanta VA Medical Centre, Division of Cardiology, Atlanta, Georgia, United States of America
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