Publications by authors named "Islam Y Elgendy"

314 Publications

Meta-analysis of provisional versus systematic double-stenting strategy for left main bifurcation lesions.

Cardiovasc Revasc Med 2022 Jul 27. Epub 2022 Jul 27.

Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Madrid, Spain. Electronic address:

Objective: We sought to compare the clinical outcomes with provisional versus double-stenting strategy for left main (LM) bifurcation percutaneous coronary intervention (PCI).

Background: Despite two recent randomized controlled trials (RCTs) and several observational reports, the optimal LM bifurcation PCI technique remains controversial.

Methods: PubMed, Cochrane Central Register of Controlled-Trials (CENTRAL), Clinicaltrials.gov, International Clinical Trial Registry Platform were leveraged for studies comparing PCI bifurcation techniques for LM coronary lesions using second-generation drug eluting stents (DES). The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes of interest were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), target vessel or lesion revascularization, and stent thrombosis.

Results: Two RCTs and 10 observational studies with 7105 patients were included. Median follow-up duration was 42 months (IQR: 25.7). Double stenting was associated with a trend towards higher incidence of MACE (odds ratio [OR] 1.20; 95 % confidence interval [CI] 0.94 to 1.53) compared with provisional stenting. This was mainly driven by higher rates of target lesion revascularization (TLR) (OR 1.50; 95 % CI 1.07 to 2.11). There were no statistically significant differences in the incidence of all-cause mortality, cardiovascular mortality, MI, or stent thrombosis. On subgroup analysis according to the study type, provisional stenting was associated with lower MACE and TLR in observational studies, but not in RCTs.

Conclusion: For LM bifurcation PCI using second-generation DES, a provisional stenting strategy was associated with a trend towards lower incidence of MACE driven by statistically significant lower rates of TLR, compared with systematic double stenting. These differences were primarily driven by observational studies. Further RCTs are warranted to confirm these findings.

Condensed Abstract: Despite the two recent randomized controlled trials (RCTs) EBC Main and DK-CRUSH-V, and several observational reports, the optimal LM bifurcation PCI technique remains controversial. We sought to compare the clinical outcomes with provisional versus double-stenting strategy for left main (LM) bifurcation percutaneous coronary intervention (PCI). Electronic databases were leveraged for studies comparing provisional versus double stenting PCI bifurcation techniques for LM coronary lesions using second-generation drug eluting stents (DES). Two RCTs and 10 observational studies with 7105 patients were included. Median follow-up duration was 42 months (IQR: 25.7). Double stenting was associated with a trend towards higher incidence of MACE (odds ratio [OR] 1.20; 95 % confidence interval [CI] 0.94 to 1.53) compared with provisional stenting. This was mainly driven by higher rates of target lesion revascularization (TLR) (OR 1.50; 95 % CI 1.07 to 2.11). There were no statistically significant differences in the incidence of all-cause mortality, cardiovascular mortality, MI, or stent thrombosis. On subgroup analysis according to the study type, provisional stenting was associated with lower MACE and TLR in observational studies, but not in RCTs. Further RCTs are warranted to confirm these findings.
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http://dx.doi.org/10.1016/j.carrev.2022.07.017DOI Listing
July 2022

Meta-Analysis of Efficacy of Vasopressin During Cardiopulmonary Resuscitation.

Am J Cardiol 2022 Aug 4. Epub 2022 Aug 4.

Department of Pulmonology and Critical Care, University at Buffalo, Buffalo NY.

Randomized controlled trials evaluating the efficacy of vasopressin versus standard of care during cardiopulmonary resuscitation (CPR) have yielded conflicting results. An electronic search of MEDLINE, Cochrane, and Embase databases was conducted through February 2022 for randomized controlled trials that evaluated the outcomes of vasopressin versus standard of care during CPR among patients with cardiac arrest. The primary outcome was the likelihood of spontaneous circulation (ROSC) return. Data were pooled using the random-effects model. The final analysis included 11 trials with 6,609 patients. The weighted mean age was 65.5 years, and 68.2% were men. There was no significant difference between the vasopressin and control groups in the likelihood of ROSC (33.1% vs 31.9%, odds ratio [OR] 1.23, 95% confidence interval [CI] 0.98 to 1.55). Subgroup analyses suggested that the use of vasopressin versus control increased the likelihood of ROSC when used in combination with steroids (p = 0.01) and in cases of in-hospital cardiac arrest (p = 0.01). There was no significant difference between the vasopressin and control groups in the likelihood of favorable neurological outcome (OR 1.14, 95% CI 0.75 to 1.71), in-hospital mortality (OR 0.89, 95% CI 0.60 to 1.31), or ventricular arrhythmias (OR 0.93, 95% CI 0.44 to 1.97). In conclusion, compared with the standard of care, the use of vasopressin during CPR did not increase the likelihood of ROSC among patients with cardiac arrest. There was no difference between the vasopressin and control groups in the likelihood of the favorable neurological outcome, in-hospital mortality, or ventricular arrhythmias.
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http://dx.doi.org/10.1016/j.amjcard.2022.06.042DOI Listing
August 2022

Hospital procedural volume and outcomes with catheter-directed intervention for pulmonary embolism: a nationwide analysis.

Eur Heart J Acute Cardiovasc Care 2022 Jul 13. Epub 2022 Jul 13.

Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY 40536, USA.

Aims: There is limited data on the association between hospital catheter-directed intervention (CDI) volume and outcomes among patients with acute pulmonary embolism (PE).

Methods And Results: The Nationwide Readmissions Database years 2016-2019 was utilized to identify hospitalizations undergoing CDI for acute PE. Hospitals were divided into tertiles based on annual CDI volume; low-volume (1-3 procedures), moderate-volume (4-12 procedures) and high-volume (>12 procedures). The primary outcome was all-cause in-hospital mortality. Among 1 436 382 PE admissions, 2.6% underwent CDI; 5.6% were in low-volume, 17.3% in moderate-volume and 77.1% in high-volume hospitals. There was an inverse relationship between hospital CDI volume and in-hospital mortality (coefficient  -0.344, P < 0.001). On multivariable regression analysis, hospitals with high CDI volume were associated with lower in-hospital mortality compared with hospitals with low CDI volume (adjusted odds ratio [OR] 0.71; 95% confidence interval [CI] 0.53, 0.95). Additionally, there was an inverse association between CDI volume and length of stay (LOS) (regression coefficient -0.023, 95% CI -0.027, -0.019) and cost (regression coefficient -74.6, 95% CI -98.8, -50.3). There were no differences in major bleeding and 30-day unplanned readmission rates between the three groups.

Conclusion: In this contemporary observational analysis of PE admissions undergoing CDI, there was an inverse association between hospital CDI volume and in-hospital mortality, LOS, and cost. Major bleeding and 30-day unplanned readmission rates were similar between the three groups.
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http://dx.doi.org/10.1093/ehjacc/zuac082DOI Listing
July 2022

Non-obstructive Plaque and Treatment of INOCA: More to Be Learned.

Curr Atheroscler Rep 2022 Jul 4. Epub 2022 Jul 4.

Division of Cardiovascular Medicine, University of Florida, 1329 SW 16th St, PO Box 100288, Gainesville, FL, USA.

Purpose Of Review: A significant proportion of patients evaluated for chest pain have ischemia with non-obstructive coronary artery disease (INOCA). Studies have shown INOCA is associated with increased risk of major adverse cardiac events and significant burden on the health care system.

Recent Findings: While there is scarce scientific evidence on management of INOCA, the CorMicA trial showed that stratified medical therapy based on the type of INOCA improved patients' symptoms and quality of life. There are multiple ongoing trials, including Women's IschemiA Trial to Reduce Events in Non-ObstRuctIve CORonary Artery Disease (WARRIOR trial), assessing the benefit of intensive medical therapy versus usual care for this increasingly recognized clinical entity. In this review, we discuss the definition of INOCA, epidemiology and risk factors, pathophysiology, and management as well as the current knowledge gaps and ongoing clinical trials in this arena.
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http://dx.doi.org/10.1007/s11883-022-01044-4DOI Listing
July 2022

Emergency department cardiovascular disease encounters and associated mortality in patients with cancer: A study of 20.6 million records from the USA.

Int J Cardiol 2022 Sep 22;363:210-217. Epub 2022 Jun 22.

Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, UK; Department of Cardiology, Thomas Jefferson University Philadelphia, PA, USA; Institute of Population Health, University of Manchester, UK. Electronic address:

Background: there is limited data on Emergency department (ED) cardiovascular disease (CVD) presentations and outcomes amongst cancer patients.

Objectives: The present study aimed to describe the clinical characteristics, prevalence, and clinical outcomes of the most common cardiovascular ED admissions in patients with cancer.

Methods: All ED encounters with a primary CVD diagnosis from the US Nationwide Emergency Department Sample between January 2016 to December 2018 were stratified by cancer type as well as metastatic status. Multivariable logistic regression was performed to determine the adjusted odds ratios of in-hospital mortality in different groups.

Results: From a total of 20,737,247 ED encounters with a primary CVD diagnosis, cancer was present in 3.4%. In patients with cancer the most common CVDs were DVT/PE (20%), hypertensive heart or kidney disease (14.7%), and AF/flutter (11.2%). The distribution of CVDs varied by cancer type, with AF/flutter most common in patients with lung cancer, AMI most common in patients with prostate cancer, heart failure most common in those with haematological malignancies, and patients with colorectal cancer having the greatest frequency of DVT/PE. Cancer status was independently associated with significantly higher risk of mortality in almost all CVD categories, consistent across all the cancer types, amongst which lung cancer patients had the highest risk of mortality across all CVD categories, except intracranial haemorrhage and hypertensive crisis.

Conclusions: Cardiovascular presentations to the ED varied by cancer subtype. Across all cancer subtypes, patients presenting with cardiovascular presentations carried a significantly increased risk of mortality compared to patients with no cancer.
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http://dx.doi.org/10.1016/j.ijcard.2022.06.053DOI Listing
September 2022

Invasive Management for Non-ST-Segment-Elevation Myocardial Infarction and Chronic Kidney Disease: Does One Size Fit All?

J Am Heart Assoc 2022 Jun 17:e026390. Epub 2022 Jun 17.

Division of Cardiology University of Texas Medical Branch Galveston TX.

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http://dx.doi.org/10.1161/JAHA.122.026390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238646PMC
June 2022

Radial first for STEMI and cardiogenic shock: Jumping in the water with your wrists tied.

Eur Heart J Qual Care Clin Outcomes 2022 Jun 14. Epub 2022 Jun 14.

Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY.

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http://dx.doi.org/10.1093/ehjqcco/qcac034DOI Listing
June 2022

Outcomes of transcatheter versus surgical aortic valve replacement in patients <60 years of age.

Cardiovasc Revasc Med 2022 May 17. Epub 2022 May 17.

Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, TX, United States of America. Electronic address:

Background: Transcatheter aortic valve replacement (TAVR) is an alternative therapeutic modality to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS). In the current analysis, we compare the characteristics and outcomes of AVR procedures in patients <60 years of age.

Methods: We queried the Nationwide Readmissions Database for all AVR hospitalizations in patients 18-59 years of age between January 2012 and December 2017. We performed a propensity score matching analysis (1:1) and compared baseline characteristics, procedural complications, and outcomes between TAVR and SAVR patients.

Results: A total of 72,356 hospitalizations for AVR were identified in patients <60 years of age. Compared to their SAVR counterparts, TAVR patients were older (52.5 ± 7.6) vs. 48.8 ± 9.6, p < 0.001), more likely to be women (37.9% vs. 28.0%, p < 0.001), and have history of prior radiation (8.3% vs. 0.7%, p < 0.001). After propensity score matching, TAVR patients had lower procedural complications, but a similar mortality rate compared to SAVR patients (2.9% vs. 3.0%, p = 0.77). TAVR was associated with a shorter length of hospital stay [4 [2-9] vs. 6 [5-11], p < 0.001), but no significant difference in the 30-day readmission rate was noted (16.2% vs. 16.8%, p-value = 0.49).

Conclusion: Our study demonstrates favorable short-term outcomes in younger patients undergoing TAVR, which improved over time. Further investigation of long-term outcomes in TAVR performed younger patients is warranted to draw a comprehensive picture of TAVR safety and efficacy in low-risk patients.
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http://dx.doi.org/10.1016/j.carrev.2022.05.008DOI Listing
May 2022

Contemporary National Trends and Outcomes of Pulmonary Embolism in the United States.

Am J Cardiol 2022 08 28;176:132-138. Epub 2022 May 28.

Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, University Hospitals, Cleveland, Ohio. Electronic address:

Contemporary data on the national trends in pulmonary embolism (PE) admissions and outcomes are scarce. We aimed to analyze trends in mortality and different treatment methods in acute PE. We queried the Nationwide Readmissions Database (2016 to 2019) to identify hospitalizations with acute PE using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. We described the national trends in admissions, in-hospital mortality, readmissions, and different treatment methods in acute PE. We identified 1,427,491 hospitalizations with acute PE, 2.4% of them (n = 34,446) were admissions with high-risk PE. The rate of in-hospital mortality in all PE hospitalizations was 6.5%, and it remained unchanged throughout the study period. However, the rate of in-hospital mortality in high-risk PE decreased from 48.1% in the first quarter of 2016 to 38.9% in the last quarter of 2019 (p-trend <0.001). The rate of urgent 30-day readmission was 15.2% in all PE admissions and 19.1% in high-risk PE admissions. In all PE admissions, catheter-directed interventions (CDI) were used more often (2.5%) than systemic thrombolysis (ST) (2.1%). However, in admissions with high-risk PE, ST remained the most frequently used method (ST vs CDI: 11.3% vs 6.6%). In conclusion, this study showed that the rate of in-hospital mortality in high-risk PE decreased from 2016 to 2019. ST was the most frequently used method for achieving pulmonary reperfusion in high-risk PE, whereas CDI was the most frequently used method in the entire PE cohort. In-hospital death and urgent readmissions rates remain significantly high in patients with high-risk PE.
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http://dx.doi.org/10.1016/j.amjcard.2022.03.060DOI Listing
August 2022

Fractional flow reserve versus angiography alone in guiding myocardial revascularisation: a systematic review and meta-analysis of randomised trials.

Heart 2022 May 13. Epub 2022 May 13.

Cardiology, Baylor College of Medicine, Houston, Texas, USA

Background: Randomised trials evaluating the efficacy and safety of fractional flow reserve (FFR)-guided versus angiography-guided revascularisation among patients with obstructive coronary artery disease (CAD) have yielded mixed results.

Aims: To examine the comparative efficacy and safety of FFR-guided versus angiography-guided revascularisation among patients with obstructive CAD.

Methods: An electronic search of MEDLINE, SCOPUS and Cochrane databases without language restrictions was performed through November 2021 for randomised controlled trials that evaluated the outcomes of FFR-guided versus angiography-guided revascularisation. The primary outcome was major adverse cardiac events (MACE). Data were pooled using a random-effects model.

Results: The final analysis included seven trials with 5094 patients. The weighted mean follow-up duration was 38 months. Compared with angiography guidance, FFR guidance was associated with fewer number of stents during revascularisation (standardised mean difference=-0.80; 95% CI -1.33 to -0.27), but no difference in total hospital cost. There was no difference between FFR-guided and angiography-guided revascularisation in long-term MACE (13.6% vs 13.9%; risk ratio (RR) 0.97, 95% CI 0.85 to 1.11). Meta-regression analyses did not reveal any evidence of effect modification for MACE with acute coronary syndrome (p=0.36), proportion of three-vessel disease (p=0.88) or left main disease (p=0.50). There were no differences between FFR-guided and angiography-guided revascularisation in the outcomes all-cause mortality (RR 1.16, 95% CI 0.80 to 1.68), cardiovascular mortality (RR 1.27, 95% CI 0.50 to 3.26), repeat revascularisation (RR 0.99, 95% CI 0.81 to 1.21), recurrent myocardial infarction (RR 0.92, 95% CI 0.74 to 1.14) or stent thrombosis (RR 0.61, 95% CI 0.31 to 1.21).

Conclusion: Among patients with obstructive CAD, FFR-guided revascularisation did not reduce the risk of long-term adverse cardiac events or the individual outcomes. However, FFR-guided revascularisation was associated with fewer number of stents.

Prospero Registration Number: CRD42021291596.
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http://dx.doi.org/10.1136/heartjnl-2021-320768DOI Listing
May 2022

Trends in Timing of Coronary Angiography in Patients With Out-of-Hospital Cardiac Arrest and Non-ST Elevation Myocardial Infarction: A Real-World Analysis.

Am J Cardiol 2022 06 22;173:160-162. Epub 2022 Apr 22.

Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Division of Cardiology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.

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http://dx.doi.org/10.1016/j.amjcard.2022.03.048DOI Listing
June 2022

Pulmonary Hypertension in Pregnancy: Challenges and Solutions.

Integr Blood Press Control 2022 2;15:33-41. Epub 2022 Apr 2.

Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA.

Pulmonary hypertension (PH) is a heterogeneous disease characterized by an elevated mean pulmonary artery pressure of 20 mm Hg or above. PH is a prevalent condition among women of reproductive age and is linked with poor prognosis during pregnancy. Pregnancy is a stressful event and complicates the management and prognosis in patients with PH. In this review, we discuss the pathogenesis, clinical presentation as well as therapeutic options for PH during pregnancy. We also highlight knowledge gaps to guide future research.
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http://dx.doi.org/10.2147/IBPC.S242242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8985908PMC
April 2022

Impact of COVID-19 on Management Strategies for Coronary and Structural Heart Disease Interventions.

Curr Cardiol Rep 2022 06 28;24(6):679-687. Epub 2022 Mar 28.

Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA.

Purpose Of Review: The COVID-19 pandemic has created unprecedented challenges globally, with significant strain on the healthcare system in the United States and worldwide. In this article, we review the impact of COVID-19 on percutaneous coronary interventions and structural heart disease practices, as well as the impact of the pandemic on related clinical research and trials. We also discuss the consensus recommendations from the scientific societies and suggest potential solutions and strategies to overcome some of these challenges.

Findings: With the limited resources and significant burden on the healthcare system during the pandemic, changes have evolved in practice to provide care to the highest risk patients while minimizing unnecessary exposure during elective surgical or transcatheter procedures. The COVID-19 crisis has significantly impacted the management of patients with acute coronary syndromes, chronic coronary syndromes, and structural heart disease.
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http://dx.doi.org/10.1007/s11886-022-01691-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8960209PMC
June 2022

FFR- Versus Angiography-Guided Revascularization for Nonculprit Stenosis in STEMI and Multivessel Disease: A Network Meta-Analysis.

JACC Cardiovasc Interv 2022 03;15(6):656-666

Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar. Electronic address:

Objectives: The aim of this study was to examine the efficacy and safety of fractional flow reserve (FFR)-guided versus angiography-guided approaches for nonculprit stenosis among patients with acute ST-segment elevation myocardial infarction (STEMI) and multivessel disease.

Background: The optimal strategy to guide revascularization of nonculprit stenosis among patients with STEMI and multivessel disease remains uncertain.

Methods: Electronic databases were searched for randomized trials evaluating the outcomes of culprit-only revascularization, angiography-guided complete revascularization (CR), or FFR-guided CR. A pairwise meta-analysis comparing CR versus culprit-only revascularization and a network meta-analysis comparing the different revascularization techniques were conducted. The primary outcome was major adverse cardiac events (MACE).

Results: The analysis included 11 trials with 8,195 patients. CR (ie, angiography-guided or FFR-guided CR) was associated with a lower incidence of MACE (odds ratio [OR]: 0.46; 95% CI: 0.35 to 0.59), cardiovascular mortality (OR: 0.63; 95% CI: 0.41 to 0.98), recurrent myocardial infarction (OR: 0.67; 95% CI: 0.48 to 0.95), and repeat ischemia-driven revascularization (OR: 0.26; 95% CI: 0.19 to 0.35). Network meta-analysis demonstrated that the incidence of MACE was lower with both angiography-guided CR (OR: 0.43; 95% CI: 0.31 to 0.58) and FFR-guided CR (OR: 0.52; 95% CI: 0.35 to 0.78) compared with a culprit-only approach, while there was no difference in risk for MACE between angiography-guided and FFR-guided CR (OR: 0.81; 95% CI: 0.51 to 1.29).

Conclusions: Among patients with STEMI and multivessel disease, CR, with angiographic or FFR guidance for nonculprit stenosis, was associated with lower incidence of adverse events compared with culprit-only revascularization. FFR-guided CR was not superior to angiography-guided CR in reducing the incidence of adverse events. Future studies investigating other tools to risk-stratify nonculprit stenoses are encouraged.
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http://dx.doi.org/10.1016/j.jcin.2022.01.002DOI Listing
March 2022

Sex Differences in Management and Outcomes of Acute Myocardial Infarction Patients Presenting With Cardiogenic Shock.

JACC Cardiovasc Interv 2022 03;15(6):642-652

Section of Cardiology, Baylor School of Medicine, Houston, Texas, USA.

Objectives: The aim of this study was to examine the sex differences in the risk profile, management, and outcomes among patients presenting with acute myocardial infarction cardiogenic shock (AMI-CS).

Background: Contemporary clinical data regarding sex differences in the management and outcomes of AMI patients presenting with CS are scarce.

Methods: Patients admitted with AMI-CS from the National Cardiovascular Data Registry Chest Pain-MI registry between October 2008 to December 2017 were included. Sex differences in baseline characteristics, in-hospital management, and outcomes were compared. Patients ≥65 years of age with available linkage data to Medicare claims were included in the analysis of 1-year outcomes. Multivariable logistic regression and Cox proportional hazards models adjusting for patient and hospital-related covariates were used to estimate sex-specific differences in in-hospital and 1-year outcomes, respectively.

Results: Among 17,195 patients presenting with AMI-CS, 37.3% were women. Women were older, had a higher prevalence of comorbidities, and had worse renal function at presentation. Women were less likely to receive guideline-directed medical therapies within 24 hours and at discharge, undergo diagnostic angiography (85.0% vs 91.1%), or receive mechanical circulatory support (25.4% vs 33.8%). Women had higher risks of in-hospital mortality (adjusted OR: 1.10; 95% CI: 1.02-1.19) and major bleeding (adjusted OR: 1.23; 95% CI: 1.12-1.34). For patients ≥65 years of age, women did not have a higher risk of all-cause mortality (adjusted HR: 0.98; 95% CI: 0.88-1.09) and mortality or heart failure hospitalization (adjusted HR: 1.01; 95% CI: 0.91-1.12) at 1 year compared with men.

Conclusions: In this large nationwide analysis of patients with AMI-CS, women were less likely to receive guideline recommended care, including revascularization, and had worse in-hospital outcomes than men. At 1 year, there were no sex differences in the risk of mortality. Efforts are needed to address sex disparities in the initial care of AMI-CS patients.
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http://dx.doi.org/10.1016/j.jcin.2021.12.033DOI Listing
March 2022

Meta-Analysis Comparing Distal Radial Versus Traditional Radial Percutaneous Coronary Intervention or Angiography.

Am J Cardiol 2022 05 2;170:31-39. Epub 2022 Mar 2.

Division of Interventional Cardiology, Baylor College of Medicine, Houston, Texas. Electronic address:

Data comparing outcomes of distal radial (DR) and traditional radial (TR) access of coronary angiography and percutaneous coronary intervention (PCI) are limited. Online databases including Medline and Cochrane Central databases were explored to identify studies that compared DR and TR access for PCI. The primary outcome was the rate of radial artery occlusion (RAO) and access failure. Secondary outcomes included access site hematoma, access site bleeding, access site pain, radial artery spasm, radial artery dissection, and crossover. Unadjusted odds ratios (ORs) with a random-effect model, 95% confidence interval (CI), and p <0.05 were used for statistical significance. Metaregression was performed for 16 studies with 9,973 (DR 4,750 and TR 5,523) patients were included. Compared with TR, DR was associated with lower risk of RAO (OR 0.51, 95% CI 0.29 to 0.90, I = 42.6%, p = 0.02). RAO was lower in DR undergoing coronary angiography rather than PCI. Access failure rate (OR 1.77, 95% CI 0.69 to 4.55, I 87.36%, p = 0.24), access site hematoma (OR 1.11, 95% CI 0.68 to 1.83, I 0%, p = 0.68), access site pain (OR 2.22, 95% CI 0.28 to 17.38, I 0%, p = 0.45), access site bleeding (OR 1.11, 95% CI 0.16 to 7.62, I 85.11%, p = 0.91), radial artery spasm (OR 0.79, 95% CI 0.49 to 1.29, I 0%, p = 0.35), radial artery dissection (OR 1.63, 95% CI 0.46 to 5.84, I 0%, p = 0.45), and crossover (OR 1.54, 95% CI 0.64 to 3.70, I 25.48%, p = 0.33) did not show any significant difference. DR was associated with lower incidence RAO when compared with TR, whereas other procedural-related complications were similar.
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http://dx.doi.org/10.1016/j.amjcard.2022.01.019DOI Listing
May 2022

Clinical and angiographic success and safety comparison of coronary intravascular lithotripsy: An updated meta-analysis.

Int J Cardiol Heart Vasc 2022 Apr 24;39:100975. Epub 2022 Feb 24.

Pakistan Institute of Medical Science, Islamabad, Pakistan.

Background: Intravascular lithotripsy (IVL) can be used to assist stent deployment in severe coronary artery calcifications (CAC).

Methods: Studies employing IVL for CAC lesions were included. The primary outcomes included clinical and angiographic success. The secondary outcomes, including lumen gain, maximum calcium thickness, and calcium angle at the final angiography site, minimal lumen area site, and minimal stent area site, were analyzed by the random-effects model to calculate the pooled standardized mean difference. Tertiary outcomes included safety event ratios.

Results: Seven studies (760 patients) were included. The primary outcomes: pooled clinical and angiographic success event ratio parentage of IVL was 94.4% and 94.8%, respectively. On a random effect model for standard inverse variance for secondary outcomes showed: minimal lumen diameter increase with IVL was 4.68 mm (p-value < 0.0001, 95% CI 1.69-5.32); diameter decrease in the stenotic area after IVL session was -5.23 mm (95 CI -22.6-12.8). At the minimal lumen area (MLA) and final minimal stent area (MSA) sites, mean lumen area gain was 1.42 mm (95% CI 1.06-1.63; p < 0.00001) and 1.34 mm (95% CI 0.71-1.43; p < 0.00001), respectively. IVL reduced calcium thickness at the MLA site (SMD -0.22; 95% CI -0.40-0.04; P = 0.02); calcium angle was not affected at the MLA site. The tertiary outcomes: most common complication was major adverse cardiovascular events (n = 48/669), and least common complication was abrupt closure of the vessel (n = 1/669).

Conclusions: Evidence suggests that IVL safely and effectively facilitates stent deployment with high angiographic and clinical success rates in treating severely calcified coronary lesions.
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http://dx.doi.org/10.1016/j.ijcha.2022.100975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8881660PMC
April 2022

Comparison of left atrial appendage parameters using computed tomography vs. transesophageal echocardiography for watchman device implantation: a systematic review & meta-analysis.

Expert Rev Cardiovasc Ther 2022 Feb 4;20(2):151-160. Epub 2022 Mar 4.

Detroit Medical Center, Wayne State University, Detroit, MI, USA.

Background: Inaccurate sizing of left atrial appendage (LAA) occlusion devices is associated with increased stroke risk. We compared the LAA size to implant the Watchman device assessed by computed tomography (CT) to transesophageal echocardiography (TEE).

Methods: Databases were searched to identify studies comparing LAA anatomical measurements and procedural outcomes across imaging modalities for the Watchman device implantation.

Results: Seven studies were included in the analysis (242 patients on TEE, and 232 on CT). The LAA orifice was larger when sized with CT compared to TEE (CT mean vs TEE SMD 0.30 mm, 95%CI 0.09-0.51 mm, P < 0.01; and CT max vs TEE SMD 0.69 mm, 95%CI 0.51-0.87 mm, P < 0.001). Additionally, CT, including CT-based 3-dimensional models, had higher odds of predicting correct device size compared to TEE (OR 1.64; 95%CI 1.05-2.56; P = 0.03). CT resulted in a lower fluoroscopy time vs TEE (SMD -0.78 min, 95% CI -1.39 to -0.18, P = 0.012). No significant differences were found in device clinical outcomes.

Conclusion: Compared to TEE, CT resulted in larger LAA orifice measurements, improved odds of predicting correct device size, and reduced fluoroscopy time in patients undergoing LAA occlusion with the Watchman device. There were no significant differences in other procedural outcomes.
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http://dx.doi.org/10.1080/14779072.2022.2043745DOI Listing
February 2022

Estimate and Temporal Trends of Buerger Disease Hospitalizations in the United States.

Am J Cardiol 2022 04 12;169:158-160. Epub 2022 Feb 12.

Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2022.01.014DOI Listing
April 2022

Palliative Care Penetration Among Hospitalizations with Acute Pulmonary Embolism: A Nationwide Analysis.

J Palliat Care 2022 Feb 9:8258597221078389. Epub 2022 Feb 9.

Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.

Integration of palliative care in the management of critical illnesses has been linked with a better quality of life for patients and their families. Yet, there is a paucity of data regarding the role of palliative care for acute pulmonary embolism (PE) hospitalizations which is a leading cause of cardiovascular death in the United States. Using the Nationwide Inpatient Sample years 2005-2015, acute PE hospitalizations were identified by using ICD-9-codes. The primary outcome was the trends of palliative care penetration during acute PE hospitalizations and the main secondary outcome was the factors associated with palliative care utilization. Among 505,485 acute PE hospitalizations, 15,522 (3.1%) had a palliative care encounter. Hospitalizations with high-risk PE versus non-high-risk PE showed a higher utilization for palliative care (7.6% vs. 2.7%, P < 0.001). The annual trends of palliative care penetration among hospitalizations with PE showed a rising pattern (0.6% in 2005 vs. 5.6% in 2015, P<0.001). A similar trend was observed among those with high-risk PE (0.8% in 2005 vs. 12.8% in 2015, P<0.001). The trends of palliative care utilization among cancer and non-cancer admissions increased over time (1.3%in 2005 to 15.5% in 2015 vs. 0.5% in 2005 to 3.9% in 2015, both P-<0.001). Some racial and regional disparities were identified among the predictors of palliative care utilization. Palliative care penetration among acute PE hospitalizations remains suboptimal even among high-risk PE, and cancer hospitalizations, but has been increasing in recent years. Future studies are needed to investigate the barriers for palliative care utilization and narrowing this gap among admissions with acute PE.
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http://dx.doi.org/10.1177/08258597221078389DOI Listing
February 2022

Sex differences in outcomes of transcatheter edge-to-edge repair with MitraClip: A meta-analysis.

Catheter Cardiovasc Interv 2022 05 30;99(6):1819-1828. Epub 2022 Jan 30.

Department of Medicine, Weill Cornell Medicine, Doha, Qatar, Qatar.

Background: Transcatheter edge-to-edge repair (TEER) with MitraClip improves outcomes among select patients with moderate-to-severe and severe mitral regurgitation; however, data regarding sex-specific differences in the outcomes among patients undergoing TEER are limited.

Methods: An electronic search of the PubMed, Embase, Central, and Web of Science databases for studies comparing sex differences in outcomes among patients undergoing TEER was performed. Summary estimates were primarily conducted using a random-effects model.

Results: Eleven studies with a total of 24,905 patients (45.6% women) were included. Women were older and had a lower prevalence of comorbidities, including diabetes, chronic kidney disease, and coronary artery disease. There was no difference in procedural success (odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.55-1.05) and short-term mortality (i.e., up to 30 days) between women and men (OR: 1.16, 95% CI: 0.97-1.39). Women had a higher incidence of periprocedural bleeding and stroke (OR: 1.34, 95% CI: 1.15-1.56) and (OR: 1.57, 95% CI: 1.10-2.25), respectively. At a median follow-up of 12 months, there was no difference in mortality (OR: 0.98, 95% CI: 0.89-1.09) and heart failure hospitalizations (OR: 1.07, 95% CI: 0.68-1.67). An analysis of adjusted long-term mortality showed a lower incidence of mortality among women (hazards ratio: 0.77, 95% CI: 0.67-0.88).

Conclusions: Despite a lower prevalence of baseline comorbidities, women undergoing TEER with MitraClip had higher unadjusted rates of periprocedural stroke and bleeding as compared with men. There was no difference in unadjusted procedural success, short-term or long-term mortality. However, women had lower adjusted mortality on long-term follow-up. Future high-quality studies assessing sex differences in outcomes after TEER are needed to confirm these findings.
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http://dx.doi.org/10.1002/ccd.30110DOI Listing
May 2022

Coronary Microvascular Dysfunction in Patients with Non-Obstructive Coronary Arteries: Current Gaps and Future Directions.

Drugs 2022 Feb 29;82(3):241-250. Epub 2022 Jan 29.

Division of Cardiovascular Medicine, University of Florida, 1329 SW 16th St, PO Box 100288, Gainesville, FL, 32610, USA.

There has been increasing interest in open artery syndrome, also known as ischemia with non-obstructive coronary arteries (INOCA). INOCA has been increasingly recognized as a heterogeneous clinical entity. Diagnostic evaluation of this heterogeneous entity, including invasive assessment, remains key to diagnose this clinical condition and provide the appropriate treatment. Importantly, medical stratification based on the type of INOCA has shown benefit in improving the symptoms in these patients, as illustrated in the CorMicA trial. The Women's IschemiA Trial to Reduce Events in Non-ObstRuctIve CORonary Artery Disease (WARRIOR) is another promising landmark trial that is currently enrolling patients and will address some of the unanswered questions for management of women with INOCA. In this review, we discuss the pathophysiology, management options, knowledge gaps, and future directions while highlighting the rationale and design of the ongoing WARRIOR trial.
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http://dx.doi.org/10.1007/s40265-021-01667-yDOI Listing
February 2022

Symptomatic improvement using the New York Heart Association classification as a predictor for survival after transcatheter edge-to-edge repair of the mitral valve.

Int J Cardiol 2022 04 23;353:49-50. Epub 2022 Jan 23.

Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar. Electronic address:

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http://dx.doi.org/10.1016/j.ijcard.2022.01.041DOI Listing
April 2022

Intracoronary eptifibatide with vasodilators to prevent no-reflow in diabetic STEMI with high thrombus burden. A randomized trial.

Rev Esp Cardiol (Engl Ed) 2022 Jan 14. Epub 2022 Jan 14.

Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.

Introduction And Objectives: To study the impact of injecting intracoronary eptifibatide plus vasodilators via thrombus aspiration catheter vs thrombus aspiration alone in reducing the risk of no-reflow in acute ST-elevation myocardial infarction (STEMI) with diabetes and high thrombus burden.

Methods: The study involved 413 diabetic STEMI patients with high thrombus burden, randomized to intracoronary injection (distal to the occlusion) of eptifibatide, nitroglycerin and verapamil after thrombus aspiration and prior to balloon inflation (n=206) vs thrombus aspiration alone (n=207). The primary endpoint was post procedural myocardial blush grade and corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC). Major adverse cardiovascular events were reported at 6 months.

Results: The intracoronary eptifibatide and vasodilators arm was superior to thrombus aspiration alone regarding myocardial blush grade-3 (82.1% vs 31.4%; P=.001). The local intracoronary eptifibatide and vasodilators arm had shorter cTFC (18.16±6.54 vs 29.64±5.53, P=.001), and better TIMI 3 flow (91.3% vs 61.65%; P=.001). Intracoronary eptifibatide and vasodilators improved ejection fraction at 6 months (55.2±8.13 vs 43±6.67; P=.005). There was no difference in the rates of major adverse cardiovascular events at 6 months.

Conclusions: Among diabetic patients with STEMI and high thrombus burden, intracoronary eptifibatide plus vasodilators injection was beneficial in preventing no-reflow compared with thrombus aspiration alone. Larger studies are encouraged to investigate the benefit of this strategy in reducing the risk of adverse clinical events.
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http://dx.doi.org/10.1016/j.rec.2021.10.012DOI Listing
January 2022

Frailty Among Patients With Acute ST-Elevation Myocardial Infarction in the United States: The Impact of the Primary Percutaneous Coronary Intervention on In-Hospital Outcomes.

J Invasive Cardiol 2022 Jan;34(1):E55-E64

Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom.

Objectives: To determine the average treatment effect (ATE) of primary percutaneous coronary intervention (pPCI) versus medical treatment (MT) on in-hospital outcomes across the spectrum of frailty in patients with ST-elevation myocardial infarction (STEMI).

Methods: Adult patients hospitalized for STEMI between October 2015 until December 2017 from the National Inpatient Sample (NIS) database were retrospectively analyzed and stratified by the Hospital Frailty Risk Score into low, intermediate, and high frailty risk subgroups. Propensity score matching analysis was performed to estimate the ATE of pPCI in each frailty subgroup. The primary outcome was all-cause in-hospital death.

Results: A total of 429,070 patients were included in the final analysis, with 28.4% at an increased frailty risk. Frail patients were significantly less likely to receive pPCI (85.6%, 47.2%, and 22.6% for low, intermediate, and high frailty risk groups). Rates of adverse in-hospital events including death, cerebrovascular event, and major bleeding were significantly higher in patients with increased frailty risk. pPCI was associated with a significant reduction of in-hospital death in low (-8.0%), intermediate (-14.6%), and high (-14.7%) frailty subgroups, compared to MT (P<.001).

Conclusions: pPCI was associated with reduced rates of in-hospital death in patients with frailty presenting with STEMI. These findings suggest a benefit of pPCI in this complex patient population, although based on observational data. Long-term effects and safety need to be investigated in future studies.
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January 2022

Targeted Hypothermia vs Targeted Normothermia in Survivors of Cardiac Arrest: A Systematic Review and Meta-Analysis of Randomized Trials.

Am J Med 2022 05 24;135(5):626-633.e4. Epub 2021 Dec 24.

Section of Cardiology, Baylor College of Medicine, Houston, Texas. Electronic address:

Background: The role of targeted hypothermia in patients with coma after cardiac arrest has been challenged in a recent randomized clinical trial.

Methods: We performed a computerized search of MEDLINE, EMBASE, and Cochrane databases through July 2021 for randomized trials evaluating the outcomes of targeted hypothermia vs normothermia in patients with coma after cardiac arrest with shockable or non-shockable rhythm. The main study outcome was mortality at the longest reported follow-up.

Results: The final analysis included 8 randomized studies with a total of 2927 patients, with a weighted follow-up period of 4.9 months. The average targeted temperature in the hypothermia arm in the included trials varied from 31.7°C to 34°C. There was no difference in long-term mortality between the hypothermia and normothermia groups (56.2% vs 56.9%, risk ratio [RR] 0.96; 95% confidence interval [CI], 0.87-1.06). There was no significant difference between hypothermia and normothermia groups in rates of favorable neurological outcome (37.9% vs 34.2%, RR 1.31; 95% CI, 0.99-1.73), in-hospital mortality (RR 0.88; 95% CI, 0.77-1.01), bleeding, sepsis, or pneumonia. Ventricular arrhythmias were more common among the hypothermia vs normothermia groups (RR 1.36; 95% CI, 1.17-1.58; P = .42). Sensitivity analysis, excluding the Targeted Hypothermia vs Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial, showed favorable neurological outcome with hypothermia vs normothermia (RR 1.45; 95% CI, 1.17-1.79).

Conclusion: Targeted temperature management was not associated with improved survival or neurological outcomes compared with normothermia in comatose patients after cardiac arrest. Further studies are warranted to further clarify the value of targeted hypothermia compared with targeted normothermia.
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http://dx.doi.org/10.1016/j.amjmed.2021.11.014DOI Listing
May 2022
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