Publications by authors named "Salik Nazir"

85 Publications

Association of chronic renal insufficiency with in-hospital outcomes in primary atrial fibrillation hospitalizations.

Cardiovasc Revasc Med 2021 Jul 16. Epub 2021 Jul 16.

Duke Clinical Research Institute, Division of Cardiology, Duke University Medical Center, Durham, NC, USA.

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http://dx.doi.org/10.1016/j.carrev.2021.07.014DOI Listing
July 2021

Patient Characteristics and Outcomes of Type 2 Myocardial Infarction During Heart Failure Hospitalizations in the United States.

Am J Med 2021 Jun 29. Epub 2021 Jun 29.

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

Background: Type 2 myocardial infarction (MI) is increasingly diagnosed in patients with heart failure (HF). A paucity of data exists pertinent to the contemporary prevalence and impact of type 2 MI in HF patients. We studied the patient profiles and the prognostic impact of type 2 MI on outcomes of HF hospitalizations.

Methods: The Nationwide Readmission Database 2018 was queried for patients with HF hospitalizations with and without type 2 MI. Baseline characteristics, inpatient outcomes, and 30-day all-cause readmissions between both cohorts were compared.

Results: Of 1,072,674 primary HF hospitalizations included in the study, 28,813 (2.7%) had type 2 MI. Patients with type 2 MI were more likely to be males (56.5% vs. 51.6%; P<0.001), and had a higher prevalence of hypertension (94% vs. 92.2%; P<0.001), prior myocardial infarction (17.1% vs. 14.9%; P<0.001), anemia (9.1% vs. 8.1%; P<0.001), chronic kidney disease (55.7% vs. 49.4%; P<0.001), neurological disorders (9.4% vs. 7.3%; P<0.001), and weight loss (7.3% vs. 5.6%; P<0.001). Compared with their counterparts without type 2 MI, HF patients with type 2 MI had significantly higher in-hospital mortality (adjusted odds ratio [aOR], 1.53; 95% CI, 1.37-1.72), hospital costs (adjusted parameter estimate [aPE], $1,785; 95% CI, 1,388-2,182), discharge to nursing facility (aOR, 1.22; 95% CI, 1.15-1.29), longer LOS (aPE, 0.53; 95% CI, 0.42-0.64), and rate of 30-day all-cause readmissions (aOR, 1.06; 95% CI, 1.01-1.12).

Conclusion: Type 2 MI in patients hospitalized with HF is associated with higher mortality and resource utilization in the United States.
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http://dx.doi.org/10.1016/j.amjmed.2021.05.022DOI Listing
June 2021

Trends in Cerebral Embolic Protection Device Use and Association With Stroke Following Transcatheter Aortic Valve Implantation.

Am J Cardiol 2021 Aug 17;152:106-112. Epub 2021 Jun 17.

Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address:

Stroke remains a serious complication of transcatheter aortic valve implantation (TAVI). Prior studies examining the association between cerebral embolic protection device (CEPD) use and stroke following TAVI have produced conflicting results. We used the Nationwide Readmissions Databases to identify all percutaneous (non-transapical) TAVIs performed in the US from July, 2017 to December, 2018. Overlap propensity score weighted logistic regression models were used to determine the association between CEPD use and outcomes. The primary outcome was in-hospital stroke or transient ischemic attack (TIA). Among 50,000 percutaneous TAVIs (weighted national estimate: 88,886 [SE: 2,819]), CEPD was used in 2,433 (weighted national estimate: 3,497 [SE: 857]). Nationally, the utilization rate of CEPD was 3.9% (SE: 0.9%) of all TAVIs during the overall study period, which increased from 0.8% (SE: 0.4%) in 2017Q3 to 7.6% (SE: 1.6%) in 2018Q4 (p<0.001). The proportion of hospitals using CEPD increased from 2.3% in 2017Q3 to 14.7% in 2018Q4 (p<0.001). There were no significant differences in rates of in-hospital stroke/TIA in TAVIs with versus without CEPD (2.6% vs 2.2%; unadjusted OR [95% CI] 1.18 [0.98-1.52]; overlap propensity score weighted OR [95% CI] 1.19 [0.81-1.75]). CEPD use was not associated with statistically significant lower rates of in-hospital stroke, ischemic stroke, hemorrhagic stroke, TIA, all-cause mortality, or discharge to skilled nursing facility. In conclusion, the rates of CEPD utilization and proportion of TAVI hospitals using CEPD increased during the study period. The use of CEPD during TAVI was not associated with statistically significant lower rates of in-hospital stroke, TIA, or mortality.
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http://dx.doi.org/10.1016/j.amjcard.2021.04.038DOI Listing
August 2021

Outcomes and Resource Utilization of Atrial Fibrillation Hospitalizations With Type 2 Myocardial Infarction.

Am J Cardiol 2021 Aug 12;152:27-33. Epub 2021 Jun 12.

ProMedica Heart Institute, ProMedica Toledo Hospital, Toledo, Ohio. Electronic address:

Scarce data exist on the prognostic impact of type 2 myocardial infarction (MI) in patients with AF. The Nationwide Readmission Database 2018 was queried for primary AF hospitalizations with and without type 2 MI. Complex samples multivariable logistic and linear regression models were used to determine the association between type 2 MI and outcomes (in-hospital mortality, index length of stay [LOS], hospital costs, discharge to nursing facility, and 30-day all-cause readmissions). Of 382,896 weighted primary AF hospitalizations included in this study, 7,375 (1.9%) had type 2 MI. AF with type 2 MI is associated with significantly higher in-hospital mortality (adjusted OR [aOR] 1.76; 95% CI 1.30 to 2.38), LOS (adjusted parameter estimate [aPE] 0.48; 95% CI 0.35 to 0.62), hospital costs (aPE 1307.75; 95% CI 986.05 to 1647.44), discharges to nursing facility (aOR 1.38; 95% CI 1.24 to 1.54), and 30-day all-cause readmissions (adjusted hazard ratio 1.17; 95% CI 1.07 to 1.27) compared to AF without type 2 MI. Heart failure, chronic kidney disease, neurologic disorders, and age (per year) were identified as independent predictors of mortality among AF patients with type 2 MI. In conclusion, type 2 MI in the setting of AF hospitalization is associated with high in-hospital mortality and increased resource utilization.
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http://dx.doi.org/10.1016/j.amjcard.2021.04.036DOI Listing
August 2021

Association of Acute Kidney Injury with Outcomes in Patients Undergoing Transcatheter Mitral Valve Repair.

Cardiology 2021;146(4):501-507. Epub 2021 Jun 15.

Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.

Introduction: Although transcatheter mitral valve repair (TMVr) is a contrast-free procedure, prior single-center studies have demonstrated a high incidence of acute kidney injury (AKI) following TMVr. The main objective of this study was to examine risk factors for AKI, and its association with outcomes in patients undergoing TMVr.

Methods: We queried the National Readmission Database to identify TMVr procedures performed between January 2014 and December 2017. Complex samples multivariable logistic and linear regression models were used to identify risk factors associated with AKI, as well as to determine the association between AKI and clinical outcomes (in-hospital mortality, index length of stay (LOS), 30-day all-cause readmissions, and 30-day heart failure [HF] readmissions).

Results: Of 14,623 patients who underwent TMVr during the study period, 2,001 (13.6%) had a diagnosis of AKI. HF, chronic kidney disease, chronic liver disease, fluid/electrolyte disorder, weight loss, nonelective admission, cardiogenic shock, and bleeding/transfusion were independently associated with an increased risk of AKI. In patients undergoing TMVr, AKI was associated with an increased risk of in-hospital mortality (adjusted odds ratio [aOR], 4.94; 95% confidence interval [CI], 2.92-8.34), 30-day all-cause readmissions (aOR, 1.91; 95% CI, 1.49-2.46), 30-day HF readmissions (aOR, 2.30; 95% CI, 1.38-3.84), and longer index LOS (adjusted parameter estimate, 5.78; 95% CI, 5.26-6.41).

Conclusion: AKI in the setting of TMVr is common and is associated with worse clinical outcomes. Further studies are needed to determine if optimizing renal function prior to TMVr may improve outcomes, as well as to understand the impact of TMVr itself on renal function.
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http://dx.doi.org/10.1159/000516377DOI Listing
June 2021

Association of Peri-Procedural Major Bleeding With Outcomes in Patients Undergoing Transcatheter Mitral Edge-To-Edge Repair.

Am J Cardiol 2021 Aug 3;152:172-174. Epub 2021 Jun 3.

Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2021.04.025DOI Listing
August 2021

Sex-based differences in clinical outcomes and resource utilization of type 2 myocardial infarction.

Int J Cardiol 2021 Sep 29;338:24-29. Epub 2021 May 29.

Section of Cardiology, University of Toledo Medical Center, Toledo, OH, United States of America. Electronic address:

Background: Sex-based differences in clinical outcomes have been previously well described in type 1 myocardial infarction (T1MI). However, type 2 myocardial infarction (T2MI) is more common in contemporary practice, with scarce data regarding sex-based differences of outcomes.

Methods: The Nationwide Readmission Database 2018 was queried for hospitalizations with T2MI as a primary or secondary diagnosis. Complex samples multivariable logistic and linear regression models were used to determine the association between T2MI and outcomes (in-hospital mortality, index length of stay [LOS], hospital costs, discharge to nursing facility, and 30-day all-cause readmissions) in females compared to males with T2MI.

Results: A total of 252,641 hospitalizations [119,783 (47.4%) females and 132,858 (52.6%) males] were included in this analysis. Females with T2MI was associated with lower in-hospital mortality (adjusted odds ratio [aOR] 0.92; 95% confidence interval [CI] 0.88-0.96; P < 0.001), shorter LOS (adjusted parameter estimate [aPE] -0.28; 95% CI -0.38-0.17; P < 0.001), less hospital costs (aPE -1510.70; 95% CI -1916.04-1105.37; P < 0.001), and increased nursing home discharges (aOR 1.08; 95% CI 1.05-1.12; P < 0.001) compared to males with T2MI. Females and males with T2MI had similar rates of 30-day all-cause readmission (aOR 1.00; 95% CI 0.97-1.04; P = 0.841).

Conclusion: Among T2MI hospitalizations, females have lower in-hospital mortality, hospitalization costs, shorter LOS, and increased rates of nursing home discharge compared to males. Although statistically significant, the clinical significance of these small differences are unknown and require future studies.
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http://dx.doi.org/10.1016/j.ijcard.2021.05.043DOI Listing
September 2021

Home health care utilization trend, predictors, and association with early rehospitalization following endovascular transcatheter aortic valve replacement.

Cardiovasc Revasc Med 2021 May 24. Epub 2021 May 24.

Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA. Electronic address:

Background/purpose: Home healthcare (HHC) utilization is associated with higher rates of rehospitalization in patients with heart failure and transcatheter mitral valve repair. This study sought to assess the utilization, predictors, and the association of HHC with 30-day readmission in patients undergoing transcatheter aortic valve replacement (TAVR).

Methods/materials: We queried the Nationwide Readmission Database from January 2012 to December 2017 for TAVR discharges with and without HHC referral. Using multivariate analysis, we identified predictors of HHC utilization, and its association with outcomes.

Results: Of 60,950 TAVR discharges, 21,724 (35.7%) had HHC referral. On multivariable analysis, female sex (OR, 1.34; 95% CI, 1.29-1.40), non-elective admission (OR, 1.49; 95% CI, 1.42-1.56), diabetes mellitus (OR, 1.09; 95% CI, 1.05-1.13), prior stroke (OR, 1.06; 95% CI, 1.01-1.12), anemia (OR, 1.16; 95% CI, 1.11-1.21), and in-hospital complications including cardiogenic shock (OR, 1.37; 95% CI, 1.16-1.50), cardiac arrest (OR, 1.22; 95% CI, 1.00-1.50), stroke (OR, 2.62; 95% CI, 2.20-3.18), and new Permanent pacemaker (OR, 1.49; 95% CI, 1.41-1.58) were identified as independent predictors of HHC referral. HHC utilization was associated with longer median length of stay (4 days vs. 2 days, P < 0.001), higher rate of 30-day all-cause (15.5% vs. 10.6%, P < 0.001) and heart failure (2.1%vs. 1.1%, P < 0.001) readmission rates compared to those without HHC.

Conclusions: Our study identified a vulnerable group of TAVR patients that are at higher risk of 30-day readmission. Evidence-based interventions proven effective in reducing the burden of readmissions should be pursed in these patients to improve outcomes and quality of life.
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http://dx.doi.org/10.1016/j.carrev.2021.05.019DOI Listing
May 2021

Efficacy and safety of intravascular lithotripsy in calcified coronary lesions: A systematic review and meta-analysis.

Cardiovasc Revasc Med 2021 May 19. Epub 2021 May 19.

Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA.

Background: Intravascular lithotripsy (IVL) is a recently introduced therapeutic modality in the management of calcified coronary lesions (CCAD). IVL delivers sonic pressure waves to modulate calcium, hence promote vessel compliance and optimize stent deployment.

Methods: We performed a comprehensive literature search for studies that evaluated the utility of adjunctive IVL. The primary outcomes of our study were the clinical success, defined as the ability of IVL to produce residual diameter stenosis <50% (RDS < 50%) after stenting with no evidence of in-hospital major adverse cardiac events, and the angiographic success, defined as success in facilitating stent delivery with RDS < 50% and without serious angiographic complications. The secondary outcomes included post-IVL and post-stenting changes in lumen area, calcium angle, and the maximum calcium thickness. Proportional analysis was used for binary data and mean difference was used for continuous data. All meta-analyses were conducted using a random-effect model and 95% confidence intervals (CIs) were included.

Results: A total of eight single-arm observational studies, including 980 patients (1011 lesions), were included. 48.8% of the patients presented with acute coronary syndrome. Severe calcifications were present in 97% of lesions. Clinical success was achieved in 95.4% of patients (95%CI:92.9%-97.9%). Angiographic success was achieved in 97% of patients (95%CI:95%-99%). There was an overall increase in postprocedural lumen area as well as significant reduction of calcium angle and maximum calcium thickness.

Conclusions: IVL seems to have excellent efficacy and safety in the management of CCAD. However, adequately powered RCTs are needed to evaluate IVL compared to other calcium/plaque modifying techniques.
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http://dx.doi.org/10.1016/j.carrev.2021.05.009DOI Listing
May 2021

Transradial versus transfemoral access for cardiac catheterization: a nationwide pilot study of training preferences and expertise in The United States.

BMC Cardiovasc Disord 2021 May 21;21(1):250. Epub 2021 May 21.

Professor and Program Director of Cardiovascular Medicine and Interventional Cardiology, University of Toledo, 3000 Arlington Ave., MS 1118, Toledo, 43614, OH, USA.

Background: The objective was to assess current training preferences, expertise, and comfort with transfemoral access (TFA) and transradial access (TRA) amongst cardiovascular training fellows and teaching faculty in the United States. As TRA continues to dominate the field of interventional cardiology, there is a concern that trainees may become less proficient with the femoral approach.

Methods: A detailed questionnaire was sent out to academic General Cardiovascular and Interventional Cardiology training programs in the United States. Responses were sought from fellows-in-training and faculty regarding preferences and practice of TFA and TRA. Answers were analyzed for significant differences between trainees and trainers.

Results: A total of 125 respondents (75 fellows-in-training and 50 faculty) completed and returned the survey. The average grade of comfort for TFA, on a scale of 0 to 10 (10 being most comfortable), was reported to be 6 by fellows-in-training and 10 by teaching faculty (p < 0.001). TRA was the first preference in 95% of the fellows-in-training compared to 69% of teaching faculty (p 0.001). While 62% of fellows believed that they would receive the same level of training as their trainers by the time they graduate, only 35% of their trainers believed so (p 0.004).

Conclusion: The shift from TFA to radial first has resulted in significant concern among cardiovascular fellows-in training and the faculty regarding training in TFA. Cardiovascular training programs must be cognizant of this issue and should devise methods to assure optimal training of fellows in gaining TFA and managing femoral access-related complications.
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http://dx.doi.org/10.1186/s12872-021-02068-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8139069PMC
May 2021

Association of Peri-Procedural Major Bleeding With Outcomes in Patients Undergoing Percutaneous Left Atrial Appendage Closure.

Am J Cardiol 2021 Jul 17;151:122-123. Epub 2021 May 17.

Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2021.04.004DOI Listing
July 2021

Association of acute kidney injury with outcomes in patients undergoing percutaneous left atrial appendage closure.

Catheter Cardiovasc Interv 2021 Apr 15. Epub 2021 Apr 15.

Section of Cardiology, Baylor College of Medicine, Houston, Texas.

Objectives: Using a large nationally representative database, we aimed to examine risk factors for acute kidney injury (AKI) and its association with outcomes in patients undergoing percutaneous left atrial appendage closure (LAAC).

Background: Previous small-scale studies have reported poor outcomes with AKI following percutaneous LAAC.

Methods: We queried the Nationwide Readmission Database to identify LAAC procedures performed from 2016 to 2017. Multivariable logistic and linear regression models were used to identify risk factors for AKI and determine the association between AKI and clinical outcomes. The primary outcome of interest was in-hospital mortality.

Results: Of 20,703 patients who underwent LAAC during the study period, 1,097 (5.3%) had a diagnosis of AKI. Chronic kidney disease, non-elective admission, coagulopathy, weight loss, prior coronary artery disease, heart failure, diabetes mellitus, and anemia were independently associated with an increased risk of AKI after LACC. In patients undergoing LAAC, AKI was associated with an increased risk of in-hospital mortality (adjusted odds ratio [aOR], 16.01; 95% CI, 8.48-30.21), stroke/transient ischemic attack (aOR, 2.50; 95% CI, 1.69-3.70), systemic embolization (aOR, 3.78; 95% CI, 1.64-8.70), bleeding/transfusion (aOR, 1.96; 95% CI, 1.50-2.56), vascular complications (aOR, 3.53; 95% CI, 1.94-6.42), pericardial tamponade requiring intervention (aOR, 6.83; 95% CI, 4.37-10.66), index length of stay (adjusted parameter estimate, 7.46; 95% CI, 7.02-7.92), and 180-day all-cause readmissions (aOR, 1.43; 95% CI, 1.09-1.88).

Conclusion: AKI in the setting of LAAC is uncommon but is associated with poor clinical outcomes. Further studies are needed to determine if a similar association exists for long-term outcomes.
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http://dx.doi.org/10.1002/ccd.29711DOI Listing
April 2021

Lung ultrasound-guided management to reduce hospitalization in chronic heart failure: a systematic review and meta-analysis.

Heart Fail Rev 2021 Apr 9. Epub 2021 Apr 9.

Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA.

Pulmonary edema is a leading cause of hospital admissions, morbidity, and mortality in heart failure (HF) patients. A point-of-care lung ultrasound (LUS) is a useful tool to detect subclinical pulmonary edema. We performed a comprehensive literature search of multiple databases for studies that evaluated the clinical utility of LUS-guided management versus standard care for HF patients in the outpatient setting. The primary outcome of interest was HF hospitalization. The secondary outcomes were all-cause mortality, urgent visits for HF worsening, acute kidney injury (AKI), and hypokalemia rates. Pooled risk ratio (RR) and corresponding 95% confidence intervals (CIs) were calculated and combined using random-effect model meta-analysis. A total of 3 randomized controlled trials including 493 HF patients managed in the outpatient setting (251 managed with LUS plus physical examination (PE)-guided therapy vs. 242 managed with PE-guided therapy alone) were included in the final analysis. The mean follow-up period was 5 months. There was no significant difference in HF hospitalization rate between the two groups (RR 0.65; 95% CI 0.34-1.22; P = 0.18). Similarly, there was no significant difference in all-cause mortality (RR 1.39; 95% CI 0.68-2.82; P = 0.37), AKI (RR 1.27; 95% CI 0.60-2.69; P = 0.52), and hypokalemia (RR 0.72; 95% CI 0.21-2.44; P = 0.59). However, LUS-guided therapy was associated with a lower rate for urgent care visits (RR 0.32; 95% CI 0.18-0.59; P = 0.0002). Our study demonstrated that outpatient LUS-guided diuretic therapy of pulmonary congestion reduces urgent visits for worsening symptoms of HF. Further studies are needed to evaluate LUS utility in the outpatient treatment of HF.
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http://dx.doi.org/10.1007/s10741-021-10085-xDOI Listing
April 2021

Development of late amyloid cardiomyopathy following liver transplantation for hereditary Val30Met transthyretin amyloidosis.

Amyloid 2021 Apr 5:1-2. Epub 2021 Apr 5.

University of Michigan Division of Cardiovascular Medicine, Section of Cardiology, Ann Arbor Veterans Affairs Health System, Ann Arbor, MI.

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http://dx.doi.org/10.1080/13506129.2021.1904391DOI Listing
April 2021

Acute Compressive Coronary Artery Disease Due to Left Atrial Appendage Epicardial Occlusion.

JACC Cardiovasc Interv 2021 May 31;14(10):e113-e114. Epub 2021 Mar 31.

Department of Cardiothoracic Surgery, Promedica Toledo Hospital, Toledo, Ohio, USA.

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http://dx.doi.org/10.1016/j.jcin.2021.01.018DOI Listing
May 2021

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

Am J Med 2021 Jul 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

Association of Hospital Procedural Volume With Outcomes of Percutaneous Left Atrial Appendage Occlusion.

JACC Cardiovasc Interv 2021 Mar 1;14(5):554-561. Epub 2021 Mar 1.

Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address:

Objectives: The aim of this study was to examine the association between percutaneous left atrial appendage occlusion (LAAO) procedural volume and in-hospital outcomes.

Background: Several studies have demonstrated an inverse volume-outcome relationship for patients undergoing invasive cardiac procedures. Whether a similar association exists for percutaneous LAAO remains unknown.

Methods: Patients undergoing LAAO in 2017 were identified in the Nationwide Readmissions Database. Hospitals were categorized into 3 groups on the basis of tertiles of annual procedural volume: low (5 to 15 cases/year), medium (17 to 31 cases/year), and high (32 to 211 cases/year). Multivariate hierarchical logistic regression and restricted cubic spline analyses were performed to examine the association of hospital LAAO volume and outcomes. The primary outcome was in-hospital major adverse events (MAE), defined as a composite of mortality, stroke or transient ischemic attack, bleeding or transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion or tamponade requiring pericardiocentesis or surgery.

Results: This study included 5,949 LAAO procedures performed across 196 hospitals with a median annual procedural volume of 41 (interquartile range: 25 to 67). Low-volume hospitals had higher rates of in-hospital MAE (9.5% vs. 5.6%; p < 0.001), stroke or transient ischemic attack (2.1% vs. 1.3%; p = 0.049), and bleeding or transfusion (6.1% vs. 3.5%; p = 0.002) compared with high-volume hospitals. No differences were noted for other components of MAE and index length of stay. On multivariate analysis, higher procedural volume was associated with lower rates of in-hospital MAE, with an adjusted odds ratio for medium versus low volume of 0.69 (95% confidence interval: 0.46 to 1.04; p = 0.08) and for high versus low volume of 0.55 (95% confidence interval: 0.37 to 0.82; p = 0.003).

Conclusions: Higher hospital procedural volume is associated with better outcomes for LAAO procedures. Further studies are needed to determine if this relationship persists for long-term outcomes.
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http://dx.doi.org/10.1016/j.jcin.2020.11.029DOI Listing
March 2021

Meta-analysis and critical review of observational studies comparing drug eluting and bare metal stents for revascularization of large coronary arteries.

Cardiovasc Revasc Med 2020 Nov 4. Epub 2020 Nov 4.

Cardiovascular Medicine and Interventional Cardiology, Promedica Toledo Hospital, OH, USA. Electronic address:

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http://dx.doi.org/10.1016/j.carrev.2020.11.003DOI Listing
November 2020

Association of hospital procedural volume with outcomes of urgent/emergent transcatheter edge-to-edge repair for mitral regurgitation.

Cardiovasc Revasc Med 2021 Jan 21. Epub 2021 Jan 21.

Department of Cardiology, Reading Hospital, Tower Health, West Reading, PA, United States of America. Electronic address:

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http://dx.doi.org/10.1016/j.carrev.2020.12.022DOI Listing
January 2021

Takotsubo syndrome: Does "Diabetes Paradox" exist?

Heart Lung 2021 Mar-Apr;50(2):316-322. Epub 2021 Jan 19.

Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, New York, USA. Electronic address:

Background: Previous small-scale studies have reported conflicting findings regarding the prevalence of diabetes mellitus (DM) and its association with outcomes in patients with takotsubo syndrome (TTS) OBJECTIVE: We sought to assess the prevalence of DM and its association with outcomes in TTS patients.

Methods: Nationwide inpatient sample (NIS) was queried to extract patient information from January 1, 2009 to September 30, 2015. Propensity score matching (PSM) was done to compare mortality and other in-hospital outcomes.

Results: A total of 40,327 hospitalizations for TTS were included. The prevalence of DM in TTS was 19.3% vs 23.1% (p-value < 0.01) in patients without TTS in the NIS from 2009 to 2015. In the PSM cohort, there was no difference in in-hospital mortality (1.1% vs 1.4%; p = 0.76), stroke (1.2% vs 0.9%; p = 0.09), cardiogenic shock (3.7% vs 3.9%; p = 0.61), cardiac arrest (1.2% vs 1.2%; p = 0.94), ventricular arrhythmias (3.7% vs 3.3%; p = 0.23), circulatory support (2.1% vs 1.8%; p = 0.17), and invasive mechanical ventilation (4.9% vs 4.7%; p = 0.54) in TTS patients with versus without diabetes. In sub-group analysis, diabetes with chronic complications patients were found to have lower mortality (0.7% vs 2.0%; p = 0.04) compared to patients without diabetes and those with uncomplicated diabetes (0.6% vs 2.6%; p = 0.002).

Conclusions: Prevalence of DM was lower in TTS in comparison to patients without TTS. In addition, complicated DM patients were found to have lower in-hospital mortality. Further studies are needed to assess the mid and long-term outcomes of DM with and without chronic complications in TTS.
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http://dx.doi.org/10.1016/j.hrtlng.2021.01.005DOI Listing
April 2021

Meta-Analysis of Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement.

Am J Cardiol 2021 01 24;139:138-139. Epub 2020 Oct 24.

Division of Cardiology, Reading Hospital-Tower Health System, West Reading, Pennsylvania.

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http://dx.doi.org/10.1016/j.amjcard.2020.10.038DOI Listing
January 2021

Multidetector computed tomography in transcatheter aortic valve replacement: an update on technological developments and clinical applications.

Expert Rev Cardiovasc Ther 2020 Oct 1;18(10):709-722. Epub 2020 Nov 1.

Department of Cardiology, Lundquist Institute , Torrance, CA, USA.

Introduction: Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of patients with underlying sever aortic valve stenosis across all spectrum of the disease. CT imaging is so crucial to the pre procedural planning, to incorporate the information from the CT imaging in the decision making intraprocedurally and to predict and identity the post procedural complications.: In this article, we review available studies on CT role in TAVR procedure and provide update on the technological developments and clinical applications.: CT imaging, with its high resolution, and in particular its utilization in aortic annular measurements, bicuspid aortic valve assessment, hypoattenuated leaflet thickening and valve in valve therapy proved to be the ideal approach to study the mechanisms of aortic stenosis, detection of high-risk anatomy, more accurate risk stratification and thus to allow a personalized catheter based intervention of the affected patients.
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http://dx.doi.org/10.1080/14779072.2020.1837624DOI Listing
October 2020

Coronary Angiography in Patients With Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation: A Systematic Review and Meta-Analysis.

JACC Cardiovasc Interv 2020 10;13(19):2193-2205

Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio. Electronic address:

Objectives: The authors conducted a meta-analysis to study clinical outcomes in patients who underwent early versus nonearly coronary angiography (CAG) in the setting of out-of-hospital cardiac arrest (OHCA) without ST-segment elevation.

Background: The benefit of performing early CAG in patients with OHCA without STE remains disputed.

Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from inception until February 21, 2020. Early and nonearly CAG patients were identified on the basis of the definitions mentioned in respective published studies. The primary outcome studied was 30-day mortality. Secondary outcomes were neurological status and the rate of percutaneous coronary intervention (PCI) following cardiac arrest.

Results: Of 4,516 references, 11 studies enrolling 3,581 patients were included in the final meta-analysis. Random-effects analysis showed no differences in 30-day mortality (risk ratio [RR]: 0.86; 95% confidence interval [CI]: 0.71 to 1.04; p = 0.12; I = 74%), neurological status (RR: 1.08; 95% CI: 0.94 to 1.24; p = 0.28; I = 69%), and rate of PCI (RR: 1.22; 95% CI: 0.94 to 1.59; p = 0.13; I = 67%) between the 2 groups. Diabetes mellitus, chronic renal failure, previous PCI, and lactate level were found to be significant predictors of 30-day mortality on meta-regression (p < 0.05).

Conclusions: This analysis shows that there is no significant difference in 30-day mortality, neurological status, or rate of PCI among patients with OHCA without STE treated with early versus nonearly CAG. Thirty-day mortality is determined by presentation comorbidities rather than revascularization.
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http://dx.doi.org/10.1016/j.jcin.2020.07.018DOI Listing
October 2020

Meta-Analysis of the Efficacy and Safety of Genotype-Guided Strategy for Selection of P2Y Inhibitors in Coronary Artery Disease.

Am J Cardiol 2020 12 19;136:168-170. Epub 2020 Sep 19.

Division of Cardiology, University of Toledo Medical Center, Toledo, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2020.09.023DOI Listing
December 2020

Association of Body Mass Index With Outcomes in Patients Undergoing Transcatheter Mitral Valve Repair.

Am J Cardiol 2020 11 9;134:158-160. Epub 2020 Sep 9.

Division of Cardiology, University of Toledo Medical Center, Toledo, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2020.09.001DOI Listing
November 2020

Meta-Analysis Comparing Angiography-Guided Versus FFR-Guided Coronary Artery Bypass Grafting.

Am J Cardiol 2020 11 9;135:184-185. Epub 2020 Sep 9.

Department of Cardiovascular Medicine, University of Toledo, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2020.09.002DOI Listing
November 2020

Multiarterial Versus Single-Arterial Grafting.

Am J Cardiol 2020 11 10;134:147-148. Epub 2020 Aug 10.

Department of Cardiovascular Medicine, University of Toledo Health Sciences, Toledo, Ohio.

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http://dx.doi.org/10.1016/j.amjcard.2020.07.055DOI Listing
November 2020

Age-Related Variations in Takotsubo Syndrome in the United States.

Am J Cardiol 2020 10 21;133:168-170. Epub 2020 Jul 21.

Icahn School of Medicine at Mount Sinai, New York, New York; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, New York. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2020.07.023DOI Listing
October 2020
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