Publications by authors named "Chayakrit Krittanawong"

117 Publications

Is caffeine or coffee consumption a risk for new-onset atrial fibrillation? A systematic review and meta-analysis.

Eur J Prev Cardiol 2021 Oct;28(12):e13-e15

Department of Cardiovascular Diseases, Icahn School of Medicine at Mount Sinai St Luke's, Mount Sinai Heart, USA.

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http://dx.doi.org/10.1177/2047487320908385DOI Listing
October 2021

Misconceptions and Facts About Cardiac Amyloidosis.

Am J Cardiol 2021 Oct 2. Epub 2021 Oct 2.

Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri.

Cardiac amyloidosis is an important clinical entity associated with significant morbidity and mortality. Although the signs and symptoms can be apparent early in the disease course, diagnoses are often made late because of inadequate recognition. A diagnosis of cardiac amyloidosis requires careful scrutiny of a patient's symptoms, an electrocardiogram, and imaging studies, including echocardiography and magnetic resonance imaging. Further evaluation is required through the measurement of serum and urine light chains and the use of bone scintigraphy imaging to differentiate transthyretin amyloidosis from light-chain cardiac amyloidosis. The available treatments have expanded tremendously in recent years and have improved outcomes in the population with this disorder. Thus, it has become increasingly important to diagnose cardiac amyloidosis and provide timely therapies. This article will clarify the various misconceptions about cardiac amyloidosis and provide a framework for primary care providers to better identify this disease in their practice.
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http://dx.doi.org/10.1016/j.amjcard.2021.08.045DOI Listing
October 2021

The Reply.

Am J Med 2021 10;134(10):e532

Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.

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http://dx.doi.org/10.1016/j.amjmed.2021.06.009DOI Listing
October 2021

Public perception of heart failure on twitter: A sentiment analysis.

Prog Cardiovasc Dis 2021 Sep 22. Epub 2021 Sep 22.

Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.

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http://dx.doi.org/10.1016/j.pcad.2021.09.008DOI Listing
September 2021

A comparison of cardiovascular risk factors between Asian-Americans and non-Asian Americans: An analysis from the NHANES database.

Prog Cardiovasc Dis 2021 Sep 21. Epub 2021 Sep 21.

Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Section of Cardiology, Baylor College of Medicine, Houston, TX, United States of America.

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http://dx.doi.org/10.1016/j.pcad.2021.09.009DOI Listing
September 2021

Meta-Analysis of Percutaneous Coronary Intervention of Chronic Total Occlusions.

Am J Cardiol 2021 Nov 4;159:148-151. Epub 2021 Sep 4.

Michael E. DeBakey VA Medical Center, Houston, Texas; Section of Cardiology, Baylor School of Medicine, Houston, Texas.

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http://dx.doi.org/10.1016/j.amjcard.2021.08.011DOI Listing
November 2021

Association Between Cinnamon Consumption and Risk of Cardiovascular Health: A Systematic Review and Meta-Analysis.

Am J Med 2021 Aug 16. Epub 2021 Aug 16.

The Michael E. DeBakey VA Medical Center, Houston, Texas; Section of Cardiology, Baylor College of Medicine, Houston, Texas.

Background: Cinnamon has been used as a traditional herbal medication for decades. Several studies have investigated cinnamon consumption and cardiovascular risk. So far, the evidence remains inconclusive. Thus, we aim to systematically review the currently available literature and quantify the evidence, if possible.

Methods: We systematically searched Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception in 1966 through December 2020. The exposure of interest was cinnamon consumption, the outcome was cardiovascular risk defined as hemoglobin A1C, low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c). Two investigators independently reviewed the data. Conflicts were resolved through consensus. Random-effects meta-analyses were used.

Results: Of 23 studies (1070 subjects), the included studies were heterogeneous, generally of very poor quality. We found no difference in LDL-c levels in patients who consumed cinnamon vs those who did not, with a weighted mean difference (WMD) of 0.38 (confidence interval [CI], -6.07-6.83). We also found no difference in HDL-c between the 2 groups with WMD 0.40 (CI, -1.14-1.94). In addition, we found no statistical differences in hemoglobin A1C between the 2 groups with WMD of 0.0 (CI, -0.44-0.45).

Conclusions: Our meta-analysis suggests that there is no association between cinnamon consumption and differences in LDL-c, HDL-c, and hemoglobin A1C levels. Further randomized control trials studies using a robust design with long-term cinnamon consumption are needed to further investigate any potential effect.
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http://dx.doi.org/10.1016/j.amjmed.2021.07.019DOI Listing
August 2021

Impact of Pulmonary Hypertension on In-Hospital Outcomes and 30-Day Readmissions Following Percutaneous Coronary Interventions.

Mayo Clin Proc 2021 08;96(8):2058-2066

Westchester Medical Center, New York Medical College, Valhalla, NY. Electronic address:

Objective: To evaluate the impact of pulmonary hypertension (PH) on percutaneous coronary intervention (PCI) outcomes and 30-day all-cause readmissions by analyzing a national database.

Methods: We queried the 2014 National Readmissions Database to identify patients undergoing PCI using International Classification of Diseases, Ninth Revision, Clinical Modification codes. These patients were then subcategorized based on the coded presence or absence of PH and further analyzed to determine the impact of PH on clinical outcomes, health care use, and 30-day readmissions.

Results: Among 599,490 patients hospitalized for a PCI in 2014, 19,348 (3.2%) had concomitant PH. At baseline, these patients were older with a higher burden of comorbidities. Patients with PH had longer initial hospitalizations and higher 30-day readmission rates and mortality than their non-PH counterparts. This was largely driven by cardiac causes, most commonly heart failure (20.3% vs 9.0%, P<.001) and non-ST-segment elevation myocardial infarction. Recurrent coronary events (17.5% vs 9.5%, P<.05) including ST-segment elevation myocardial infarction predominated in the non-PH group.

Conclusion: Patients with PH undergoing PCI are a high-risk group in terms of mortality and 30-day readmission rates. Percutaneous coronary intervention in patients with PH is associated with higher rates of recurrent heart failure and non-ST-segment elevation myocardial infarction, rather than recurrent coronary events or ST-segment elevation myocardial infarction. This perhaps indicates a predominance of demand ischemia and heart failure syndromes rather than overt atherothrombosis in the etiology of chest pain in these patients.
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http://dx.doi.org/10.1016/j.mayocp.2021.03.037DOI Listing
August 2021

The Reply.

Am J Med 2021 08;134(8):e466

Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.

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http://dx.doi.org/10.1016/j.amjmed.2021.04.011DOI Listing
August 2021

Trends, Prevalence, and Outcomes of Sudden Cardiac Arrest Post Cardiac Transplant: A Nationwide 16-Year Study.

Curr Probl Cardiol 2021 May 30:100901. Epub 2021 May 30.

Department of Cardiology, Division of Advanced Heart Failure and Transplant, Mount Sinai Morningside and West, NYC, NY. Electronic address:

Heart transplantation is the most effective long-term therapy for end-stage heart disease. There is limited data related to sudden cardiac arrest (SCA) in postheart transplant recipients. We aimed to describe the trends, and rate of SCA following heart transplantation and thereby identify clinical predictors as well as outcomes of SCA in patients post-transplant. We queried the National Inpatient Sample (NIS) with administrative codes for SCA and heart transplant. We assessed baseline differences between SCA and non-SCA admissions, with hazard ratios adjusted for age, gender, CCI, and race. Multivariable logistic regression models were generated to identify the independent predictors for SCA. There was a total of 30,020 hospitalizations of heart transplant recipients between 1999 and 2014 in the United States and among these 1,953 patients (6.5%) suffered SCA with an increasing trend of admissions for SCA. Among the patients who suffered from SCA, 18.83% died during the same hospitalization, 19.29% were discharged to a long-term facility, and 61.38% were discharged home. Multivariate analysis demonstrated that conduction system disorders (Hazard ratio [95% confidence interval]; 7.1 [4.5-11.1]), female gender (HR:1.2 [1.1-1.3]), diabetes (HR:1.4 [1.2-1.6]), and hypertension (HR:1.2 [1.1-1.4]) were the strongest predictors for SCA. SCA hospitalizations occur in 6.5% of patients post cardiac transplant and have been increasing from 1999 to 2014. Conduction block, graft rejection, female gender, hypertension, diabetes are independent predictors for SCA in heart transplant recipients.
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http://dx.doi.org/10.1016/j.cpcardiol.2021.100901DOI Listing
May 2021

Lipocalin 2: could it be a new biomarker in pediatric pulmonary hypertension associated with congenital heart disease?

Rev Cardiovasc Med 2021 Jun;22(2):531-536

Department of Echocardiography, Capital Medical University, Beijing Children's Hospital, National Center for Children's Health, 100045 Beijing, China.

The role of lipocalin 2 (LCN2) in pulmonary hypertension (PH) in pediatric patients with congenital heart disease (CHD) remains unclear. We sought to investigate whether LCN2 could be a potential biomarker for PH in pediatric patients who underwent surgery for CHD. From December 2018 to February 2020, patients undergoing surgical repair for congenital defects with and without PH were identified. Healthy children without CHD and PH served as controls. A mean pulmonary artery pressure (mPAP) >20 mmHg was used as the definition of PH. Blood samples and echocardiograms were obtained in all patients and right heart catheterization was performed in 79 patients. Multivariable logistic regression analysis was used to determine potential predictors for PH. Among 102 patients, the median age was 10 [Interquartile range (IQR) 7.0-13] months, and 37.5% were female. Compared to non-PH patients and controls, PH patients showed elevated levels of LCN2 ( < 0.001). In addition, LCN2 levels positively correlated with the invasive haemodynamic indices of PH. In univariate regression, LCN2 (odds ratio = 2.69 [1.06-5.31], < 0.001), N-Terminal pro Brain Natriuretic Peptide (NT-proBNP) (OR = 1.91 [1.21-7.56], = 0.03) and high-sensitive troponin T (hsTnT) (OR = 1.36 [1.01-3.57], = 0.01) were associated with PH; however, only LCN2 (OR = 1.68 [1.04-4.52], = 0.03) was significantly associated with PH on multivariate analysis. In conclusion, children with PH had increased LCN2 expression. LCN2 levels positively correlated with invasive indices of PH. These results indicate LCN2 could be a useful biomarker for prediction of PH in pediatric CHD cases.
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http://dx.doi.org/10.31083/j.rcm2202061DOI Listing
June 2021

Social media and predictive analysis regarding dietary approaches to stop hypertension.

Prog Cardiovasc Dis 2021 Jul 7. Epub 2021 Jul 7.

Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA; University of Bern, Switzerland; Jagiellonian University Krakow, Poland.

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http://dx.doi.org/10.1016/j.pcad.2021.07.006DOI Listing
July 2021

Prevalence and predictors of cost-related medication nonadherence in individuals with cardiovascular disease: Results from the Behavioral Risk Factor Surveillance System (BRFSS) survey.

Prev Med 2021 Jul 7;153:106715. Epub 2021 Jul 7.

Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States of America; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America. Electronic address:

Medication nonadherence is highly prevalent among patients with chronic cardiovascular disease. Poor adherence has been associated with increased morbidity and mortality. Medication cost is a major driver for medication nonadherence. Utilizing data from the 2016 to 2018 Behavioral Risk Factor Surveillance System (BRFSS) survey, we estimated the prevalence of cost-related medication nonadherence (CRMNA) among the overall population and among individuals who reported a history of diabetes, atherosclerotic cardiovascular disease (ASCVD), or hypertension. We then performed multivariable logistic regression to analyze sociodemographic factors associated with CRMNA. Our study population consisted of 142,577 individuals of whom 24% were older than 65 years, 47% were men, 66% were White, 17% Black, 35% had hypertension, 13% had diabetes mellitus, and 10% had ASCVD. CRMNA was reported in 10% of the overall population, 12% among those with hypertension, 17% among those with diabetes, and 17% among those with ASCVD. Age below 65 years, female gender, unemployment, lower income, lower educational attainment, having at least 1 comorbidity, and living in a state that did not expand Medicaid were independently associated with CRMNA. The prevalence of CRMNA increased with greater number of these high-risk sociodemographic factors. We conclude that the prevalence of CRMNA is 10% among U.S. adults overall and is higher among those with common chronic diseases. Risk factors associated with CRMNA should be addressed in order to improve adherence rates and health outcomes among high-risk individuals.
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http://dx.doi.org/10.1016/j.ypmed.2021.106715DOI Listing
July 2021

Insights from Twitter about novel COVID-19 symptoms.

Eur Heart J Digit Health 2020 Nov 23;1(1):4-5. Epub 2020 Nov 23.

Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.

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http://dx.doi.org/10.1093/ehjdh/ztaa003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7799127PMC
November 2020

Revascularization in Patients With Spontaneous Coronary Artery Dissection: Where Are We Now?

J Am Heart Assoc 2021 07 30;10(13):e018551. Epub 2021 Jun 30.

Section of Cardiology Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center Houston TX.

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http://dx.doi.org/10.1161/JAHA.120.018551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403332PMC
July 2021

Gender Differences in Premature Coronary Artery Disease (from the National Data from the NHANES Database).

Am J Cardiol 2021 08 23;153:142-144. Epub 2021 Jun 23.

Michael E. DeBakey VA Medical Center, Houston, Texas; Section of Cardiology, Baylor College of Medicine, Houston, Texas; Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, New York.

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http://dx.doi.org/10.1016/j.amjcard.2021.05.011DOI Listing
August 2021

Substance Use and Premature Atherosclerotic Cardiovascular Disease (From the CDC Behavioral Risk Factor Surveillance System [BRFSS] Survey).

Am J Cardiol 2021 08 6;152:177-178. Epub 2021 Jun 6.

Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2021.04.027DOI Listing
August 2021

Association of premature atherosclerotic cardiovascular disease with higher risk of cancer: a behavioral risk factor surveillance system study.

Eur J Prev Cardiol 2021 May 31. Epub 2021 May 31.

Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas 77030, USA.

Aim : The aim of this study was to investigate a possible association between atherosclerotic cardiovascular disease (ASCVD) and risk of cancer in young adults.

Methods : We utilized data from the Behavioral Risk Factor Surveillance System, a nationally representative US telephone-based survey to identify participants in the age group of 18-55 years who reported a history of ASCVD. These patients were defined as having premature ASCVD. Weighted multivariable logistic regression models were used to study the association between premature ASCVD and cancer including various cancer subtypes.

Results : Between 2016 and 2019, we identified 28 522 (3.3%) participants with a history of premature ASCVD. Compared with patients without premature ASCVD, individuals with premature ASCVD were more likely to be Black adults, have lower income, lower levels of education, reside in states without Medicaid expansion, have hypertension, diabetes mellitus, chronic kidney disease, obesity, and had delays in seeking medical care. Individuals with premature ASCVD were more likely to have been diagnosed with any form of cancer (13.7% vs 3.9%), and this association remained consistent in multivariable models (odds ratio, 95% confidence interval: 2.08 [1.72-2.50], P < 0.01); this association was significant for head and neck (21.08[4.86-91.43], P < 0.01), genitourinary (18.64 [3.69-94.24], P < 0.01), and breast cancer (3.96 [1.51-10.35], P < 0.01). Furthermore, this association was consistent when results were stratified based on gender and race, and in sensitivity analysis using propensity score matching.

Conclusion : Premature ASCVD is associated with a higher risk of cancer. These data have important implications for the design of strategies to prevent ASCVD and cancer in young adults.
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http://dx.doi.org/10.1093/eurjpc/zwab084DOI Listing
May 2021

Fibrinolytic Therapy in Patients with Acute ST-elevation Myocardial Infarction.

Interv Cardiol Clin 2021 07;10(3):381-390

Section of Cardiology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA; Interventional Cardiology Fellowship Program, Interventional Cardiology Research, Baylor College of Medicine, Interventional Cardiology, The Michael E. DeBakey VA Medical Center, MEDVAMC - 2002 Holcombe Boulevard, Cardiology 3C-320C, Houston, TX 77030, USA. Electronic address:

Fibrinolytic agents provide an important alternative therapeutic strategy in individuals presenting with ST-elevation myocardial infarction (STEMI). Ultimately, primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for most patients with STEMI, including elderly patients and patients with coronavirus disease 2019 (COVID-19) infection. Fibrinolytic therapy should always be considered when timely primary PCI cannot be delivered appropriately. Clinicians should promptly recognize the signs of fibrinolytic therapy failure and consider rescue PCI. When fibrinolytics are used, coronary angiography and revascularization should not be conducted within the initial 3 hours after fibrinolytic administration.
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http://dx.doi.org/10.1016/j.iccl.2021.03.011DOI Listing
July 2021

Hospital Readmission in Patients With Spontaneous Coronary Artery Dissection.

Am J Cardiol 2021 07 22;151:39-44. Epub 2021 May 22.

Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Minnesota. Electronic address:

Spontaneous coronary artery dissection (SCAD) can present with various clinical symptoms, including chest pain, syncope, and sudden cardiac death, particularly in those without atherosclerotic risk factors. In this contemporary analysis, we aimed to identify the causes and predictors of 30-day hospital readmission in SCAD patients. We utilized the latest Nationwide Readmissions Database from 2016 - 2017 to identify patients with a primary discharge diagnosis of SCAD. The primary outcome was 30-day readmission. Among 795 patients admitted with a principal discharge diagnosis of SCAD, 85 (11.3%) were readmitted within 30 days of discharge from index admission (69.8% women, mean age of 54.3 ± 0.8). More than half of the readmissions (57%) were cardiac-related readmissions. Common cardiac causes for 30-day hospital readmission were acute coronary syndrome (27.3%), chest pain/unspecified angina (24.6%), heart failure (17.5%), and recurrent SCAD (8.3%). In conclusion, we found that following hospitalization for SCAD, almost one-tenth of patients were readmitted within 30 days, largely due to cardiac cause . Risk stratifying patients with SCAD, identifying high-risk features or atypical phenotypes of SCAD, and using appropriate management strategies may prevent hospital readmissions and reduce healthcare-related costs. Further studies are warranted to confirm these causes of readmission in SCAD patients.
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http://dx.doi.org/10.1016/j.amjcard.2021.03.051DOI Listing
July 2021

Opportunities and challenges for artificial intelligence in clinical cardiovascular genetics.

Trends Genet 2021 09 27;37(9):780-783. Epub 2021 Apr 27.

The Hasso Plattner Institute for Digital Health at the Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

A combination of emerging genomic and artificial intelligence (AI) techniques may ultimately unlock a deeper understanding of heterogeneity and biological complexities in cardiovascular diseases (CVDs), leading to advances in prognostic guidance and personalized therapies. We discuss the state of AI in cardiovascular genetics, current applications, limitations, and future directions of the field.
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http://dx.doi.org/10.1016/j.tig.2021.04.004DOI Listing
September 2021

Machine learning and deep learning to predict mortality in patients with spontaneous coronary artery dissection.

Sci Rep 2021 04 26;11(1):8992. Epub 2021 Apr 26.

Icahn School of Medicine at Mount Sinai, The the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Heart, New York, NY, USA.

Machine learning (ML) and deep learning (DL) can successfully predict high prevalence events in very large databases (big data), but the value of this methodology for risk prediction in smaller cohorts with uncommon diseases and infrequent events is uncertain. The clinical course of spontaneous coronary artery dissection (SCAD) is variable, and no reliable methods are available to predict mortality. Based on the hypothesis that machine learning (ML) and deep learning (DL) techniques could enhance the identification of patients at risk, we applied a deep neural network to information available in electronic health records (EHR) to predict in-hospital mortality in patients with SCAD. We extracted patient data from the EHR of an extensive urban health system and applied several ML and DL models using candidate clinical variables potentially associated with mortality. We partitioned the data into training and evaluation sets with cross-validation. We estimated model performance based on the area under the receiver-operator characteristics curve (AUC) and balanced accuracy. As sensitivity analyses, we examined results limited to cases with complete clinical information available. We identified 375 SCAD patients of which mortality during the index hospitalization was 11.5%. The best-performing DL algorithm identified in-hospital mortality with AUC 0.98 (95% CI 0.97-0.99), compared to other ML models (P < 0.0001). For prediction of mortality using ML models in patients with SCAD, the AUC ranged from 0.50 with the random forest method (95% CI 0.41-0.58) to 0.95 with the AdaBoost model (95% CI 0.93-0.96), with intermediate performance using logistic regression, decision tree, support vector machine, K-nearest neighbors, and extreme gradient boosting methods. A deep neural network model was associated with higher predictive accuracy and discriminative power than logistic regression or ML models for identification of patients with ACS due to SCAD prone to early mortality.
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http://dx.doi.org/10.1038/s41598-021-88172-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076284PMC
April 2021

Outcomes of Acute Myocardial Infarction in Patients with Familial Hypercholesteremia.

Am J Med 2021 08 16;134(8):992-1001.e4. Epub 2021 Apr 16.

Section of Cardiology, Baylor School of Medicine, Houston, Tex. Electronic address:

Background: There is a paucity of contemporary data regarding the outcomes of acute myocardial infarction among patients with familial hypercholesteremia.

Methods: We queried the Nationwide Readmissions Database (2016-2018) for hospitalizations with acute myocardial infarction. Multivariable regression analysis was used to compare in-hospital outcomes and 30-day readmissions among patients with and without familial hypercholesteremia.

Results: The analysis included 1,363,488 hospitalizations with acute myocardial infarction. The prevalence of familial hypercholesteremia was 0.07% among acute myocardial infarction admissions. Compared with those without familial hypercholesteremia, admissions with familial hypercholesteremia were younger and had less comorbidities but were more likely to have had prior infarct and revascularization. Admissions with familial hypercholesteremia were more likely to present with ST-elevation myocardial infarction and undergo revascularization. After multivariable adjustment, there was no difference in in-hospital case fatality among patients with hypercholesteremia compared with those without it (adjusted odds ratio [aOR] = 0.76; 95% confidence interval [CI] 0.41-1.39). Admissions with acute myocardial infarction and familial hypercholesteremia had higher adjusted rates of cardiac arrest and utilization of mechanical support. There were no group differences in overall 30-day readmission (aOR 0.75; 95% CI 0.51-1.10) or 30-day readmission for acute myocardial infarction. However, a nonsignificant trend toward higher readmission for percutaneous coronary intervention was observed among patients with familial hypercholesteremia (aOR 1.89; 95% CI 0.98-3.64).

Conclusion: In this contemporary nationwide observational analysis, patients with familial hypercholesteremia represent a small proportion of the overall population with acute myocardial infarction and have a distinctive clinical profile but do not appear to have worse in-hospital case fatality compared with those without familial hypercholesteremia.
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http://dx.doi.org/10.1016/j.amjmed.2021.03.013DOI Listing
August 2021

Incidence and Predictors of Sudden Cardiac Arrest in Sarcoidosis: A Nationwide Analysis.

JACC Clin Electrophysiol 2021 09 31;7(9):1087-1095. Epub 2021 Mar 31.

Icahn School of Medicine; St. Luke's-Roosevelt-Mount Sinai, New York, New York, USA. Electronic address:

Objectives: This study sought to identify electrocardiographic (ECG) and clinical predictors of sudden cardiac arrest (SCA) in sarcoidosis.

Background: Sudden cardiac death (SCD) is the leading cause of death in cardiac sarcoidosis (CS) and may be the earliest manifestation of disease. Widespread or repeated advanced imaging is a challenging solution to this problem. ECG is an affordable and widely accessible modality that could help guide diagnostic approaches and risk stratification.

Methods: Data were obtained from the National Inpatient Sample (2005-2017) using International Classification of Diseases-9th Revision and -10th Revision-Clinical Modification. The primary outcome was to identify predictors of SCA, whereas predictors of SCA in young individuals and those with normal ventricular function served as secondary measures. Furthermore, temporal trends in sarcoidosis as well as SCA were also analyzed. Logistic regression analysis was used to calculate odds ratios, following which a multivariable regression was used to adjust for potential confounders.

Results: Electrocardiographic markers of AV node dysfunction or bundle branch block are associated with substantially increased risk of SCA in a limited proportion of patients (8.6%). This association is also observed among younger patients (<40 years) and those with normal ventricular function.

Conclusions: ECG evidence of AV nodal dysfunction or distal conduction disease should raise suspicion for cardiac involvement in patients with sarcoidosis and are associated with increased risk of SCA. ECG markers could help identify patients who would benefit from advanced imaging. The sensitivity of ECGs is, however, limited and presence of a normal ECG does not reflect a low risk of SCA.
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http://dx.doi.org/10.1016/j.jacep.2021.01.022DOI Listing
September 2021

Long-Term Outcomes Comparing Medical Therapy versus Revascularization for Spontaneous Coronary Artery Dissection.

Am J Med 2021 07 25;134(7):e403-e408. Epub 2021 Mar 25.

Michael E. DeBakey VA Medical Center, Houston, Tex; Section of Cardiology, Baylor School of Medicine, Houston, Tex.

The ideal management of spontaneous coronary artery dissection (SCAD) has yet to be clearly defined. We conducted a comprehensive search of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception from 1966 through September 2020 for all original studies (randomized controlled trials and observational studies) that evaluated patients with SCAD. Study groups were defined by allocation to medical therapy (medical therapy) versus invasive therapy (invasive therapy) (ie, percutaneous coronary intervention or coronary artery bypass grafting). The risk of death (risk ratio [RR] = 0.753; 95% confidence interval [CI]: 0.21-2.73; I = 21.1%; P = 0.61), recurrence of SCAD (RR = 1.09; 95% CI: 0.61-1.93; I = 0.0%; P = 0.74), and repeat revascularization (RR = 0.64; 95% CI: 0.21-1.94; I = 57.6%; P = 0.38) were not statistically different between medical therapy and invasive therapy for a follow-up ranging from 4 months to 3 years. In conclusion, in this meta-analysis of observational studies, the long-term risk of death, recurrent SCAD, and repeat revascularization did not significantly differ among patients with SCAD treated with medical therapy compared with those treated with invasive therapy. These findings support the current expert consensus that patients should be treated with medical therapy when clinically stable and no high-risk features are present. Further large-scale studies including randomized controlled trials are needed to confirm these findings.
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http://dx.doi.org/10.1016/j.amjmed.2021.02.011DOI Listing
July 2021

Cardiology at University Hospital Reina Sofia de Cordoba, Spain.

Eur Heart J 2021 06;42(21):2035-2038

The Michael E. DeBakey VA Medical Center Baylor College of Medicine Section of Cardiology 1 Baylor Plaza, Houston, TX 77030, USA.

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http://dx.doi.org/10.1093/eurheartj/ehaa1038DOI Listing
June 2021

Recreational substance use among patients with premature atherosclerotic cardiovascular disease.

Heart 2021 04 15;107(8):650-656. Epub 2021 Feb 15.

Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, USA

Objective: Despite an upsurge in the incidence of atherosclerotic cardiovascular diseases (ASCVD) among young adults, the attributable risk of recreational substance use among young patients has been incompletely evaluated. We evaluated the association of all recreational substances with premature and extremely premature ASCVD.

Methods: In a cross-sectional analysis using the 2014-2015 nationwide Veterans Affairs Healthcare database and the Veterans wIth premaTure AtheroscLerosis (VITAL) registry, patients were categorised as having premature, extremely premature or non-premature ASCVD. Premature ASCVD was defined as having first ASCVD event at age <55 years for men and <65 years for women. Extremely premature was defined as having first ASCVD event at age <40 years while non-premature ASCVD was defined as having first ASCVD event at age ≥55 years for men and ≥65 years for women. Patients with premature ASCVD (n=135 703) and those with extremely premature ASCVD (n=7716) were compared against patients with non-premature ASCVD (n=1 112 455). Multivariable logistic regression models were used to study the independent association of all recreational substances with premature and extremely premature ASCVD.

Results: Compared with patients with non-premature ASCVD, patients with premature ASCVD had a higher use of tobacco (62.9% vs 40.6%), alcohol (31.8% vs 14.8%), cocaine (12.9% vs 2.5%), amphetamine (2.9% vs 0.5%) and cannabis (12.5% vs 2.7%) (p<0.01 for all comparisons). In adjusted models, the use of tobacco (OR 1.97, 95% CI 1.94 to 2.00), alcohol (OR 1.50, 95% CI 1.47 to 1.52), cocaine (OR 2.44, 95% CI 2.38 to 2.50), amphetamine (OR 2.74, 95% CI 2.62 to 2.87), cannabis (OR 2.65, 95% CI 2.59 to 2.71) and other drugs (OR 2.53, 95% CI 2.47 to 2.59) was independently associated with premature ASCVD. Patients with polysubstance use had a graded response with the highest risk (~9-fold) of premature ASCVD among patients with use of ≥4 recreational substances. Similar trends were observed among patients with extremely premature ASCVD. Gender interactions with substance use were significant (p-interaction <0.05), with recreational substance use and premature ASCVD showing stronger associations among women than in men with premature ASCVD.

Conclusions: All subgroups of recreational substances were independently associated with a higher likelihood of premature and extremely premature ASCVD. Recreational substance use confers a greater magnitude of risk for premature ASCVD among women. A graded response relationship exists between increasing number of recreational substances used and higher likelihood of early-onset ASCVD.
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http://dx.doi.org/10.1136/heartjnl-2020-318119DOI Listing
April 2021

Impact of a High-Shrimp Diet on Cardiovascular Risk: An NHANES Analysis.

Mayo Clin Proc 2021 02;96(2):506-508

Department of Cardiovascular Diseases, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, New York, Section of Cardiology, Baylor College of Medicine, Houston, Texas.

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http://dx.doi.org/10.1016/j.mayocp.2020.10.044DOI Listing
February 2021
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