Publications by authors named "Salman Zahid"

29 Publications

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Comparative analysis of revascularization with percutaneous coronary intervention versus coronary artery bypass surgery for patients with end-stage renal disease: a nationwide inpatient sample database.

Expert Rev Cardiovasc Ther 2021 Jul 19. Epub 2021 Jul 19.

Baylor College of Medicine, Houston, Texas, USA.

Background: The role of PCI vs. CABG in patients with coronary artery disease (CAD) and concomitant end-stage renal disease (ESRD) remains unknown.

Research Design & Methods: The National Inpatient Sample (NIS) (2002-2017) was queried to identify all cases of CAD and ESRD. The relative merits of PCI vs. CABG were determined using a propensity-matched multivariate logistic regression model. Adjusted odds ratios (aOR) for mortality and other in-hospital complications were calculated.

Results: A total of 350,623 [CABG=112,099 (32%) and PCI=238524 (68%)] hospitalizations were included in the analysis. The overall adjusted odds for major bleeding (aOR 1.28, 95% CI 1.25-1.31, p=<0.0001), post-procedure bleeding (aOR 5.19, 95% CI 4.93-5.47, P=<0.0001), sepsis (aOR 1.29, 95% CI 1.26-1.33, P=<0.0001), cardiogenic shock (aOR 1.23, 95% CI 1.20-1.26, P=<0.0001) and in-hospital mortality (aOR 1.65, 95% CI 1.61-1.69, P=<0.0001) were significantly higher for patients undergoing CABG compared with PCI. The need for intra-aortic balloon pump (IABP) placement (aOR 2.52, 95% CI 2.45-2.59, P=<0.001) was higher in the CABG group, while the adjusted odds of vascular complications were similar between the two groups (aOR 0.99, 95% CI 0.94-1.06, P=0.82). As expected, patients undergoing CABG had a higher mean length of stay and mean cost of hospitalization.

Conclusion: CABG in ESRD may be associated with higher in-hospital complications, increased length of stay and higher resource utilization.
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http://dx.doi.org/10.1080/14779072.2021.1955350DOI Listing
July 2021

Predictors of Permanent Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement - A Systematic Review and Meta-Analysis.

J Am Heart Assoc 2021 Jul 14;10(14):e020906. Epub 2021 Jul 14.

Thomas Jefferson University Hospitals Philadelphia PA.

Background As transcatheter aortic valve replacement (TAVR) technology expands to healthy and lower-risk populations, the burden and predictors of procedure-related complications including the need for permanent pacemaker (PPM) implantation needs to be identified. Methods and Results Digital databases were systematically searched to identify studies reporting the incidence of PPM implantation after TAVR. A random- and fixed-effects model was used to calculate unadjusted odds ratios (OR) for all predictors. A total of 78 studies, recruiting 31 261 patients were included in the final analysis. Overall, 6212 patients required a PPM, with a mean of 18.9% PPM per study and net rate ranging from 0.16% to 51%. The pooled estimates on a random-effects model indicated significantly higher odds of post-TAVR PPM implantation for men (OR, 1.16; 95% CI, 1.04-1.28); for patients with baseline mobitz type-1 second-degree atrioventricular block (OR, 3.13; 95% CI, 1.64-5.93), left anterior hemiblock (OR, 1.43; 95% CI, 1.09-1.86), bifascicular block (OR, 2.59; 95% CI, 1.52-4.42), right bundle-branch block (OR, 2.48; 95% CI, 2.17-2.83), and for periprocedural atriorventricular block (OR, 4.17; 95% CI, 2.69-6.46). The mechanically expandable valves had 1.44 (95% CI, 1.18-1.76), while self-expandable valves had 1.93 (95% CI, 1.42-2.63) fold higher odds of PPM requirement compared with self-expandable and balloon-expandable valves, respectively. Conclusions Male sex, baseline atrioventricular conduction delays, intraprocedural atrioventricular block, and use of mechanically expandable and self-expanding prosthesis served as positive predictors of PPM implantation in patients undergoing TAVR.
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http://dx.doi.org/10.1161/JAHA.121.020906DOI Listing
July 2021

Comparison of In-Hospital Outcomes of Transcatheter Mitral Valve Repair in Patients With vs Without Pulmonary Hypertension (From the National Inpatient Sample).

Am J Cardiol 2021 Aug 29;153:101-108. Epub 2021 Jun 29.

Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia.

Pulmonary hypertension (PH) is common in patients with left heart disease and is present in varying degrees in patients with severe mitral valve disease. There is paucity of data regarding outcomes following transcatheter mitral valve repair (TMVr) in patients with PH. For this study, we analyzed NIS data from 2014 to 2018 using the ICD-9-CM and 10-CM codes. Baseline characteristics were compared using a Pearson chi-squared test for categorical variables and independent samples t-test for continuous variables. To account for selection bias, a 1:1 propensity match cohort was derived using logistic regression. Trend analysis was- done using linear regression. Of 21,505 encounters, 6780 encounters had PH. 6610 PH encounters were matched with 6610 encounters without PH. In-hospital mortality (3.3% versus 1.9%, p <0.01) was higher in PH population. Complications such as blood transfusion (3.6% versus 1.7%, p <0.01), GI bleed (1.4% versus 1%, p = 0.04), vascular complications (5.3% versus 3.3%, p <0.01), vasopressors use (2.9% versus 1.7%, p <0.01) and pacemaker placement (1.3% versus 0.8%, p = 0.01) remained significantly higher for encounters with PH. Multiple Logistic regression showed PH was associated with higher mortality (adjusted odds ratio [AOR], 1.68 [95% confidence interval [CI], 1.39-2.05], p <0.01). The mean length of stay (6.2 versus 5.3 days, p <0.01) and cost per hospitalization ($53,780 versus $50,801, p <0.01) remained significantly higher in the PH group when compared to group without PH. In conclusion, TMVr in PH as compared to without PH is associated with higher mortality, post-procedure complication rates, length of stay, and cost of stay.
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http://dx.doi.org/10.1016/j.amjcard.2021.05.022DOI Listing
August 2021

Safety and Efficacy of Colchicine in Patients with Stable CAD and ACS: A Systematic Review and Meta-analysis.

Am J Cardiovasc Drugs 2021 Jun 21. Epub 2021 Jun 21.

Department of Medicine, Section of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.

Background: Evidence from recent trials has shown conflicting results in terms of the utility of colchicine in patients with coronary artery disease (CAD).

Methods: Multiple databases were queried to identify all randomized controlled trials (RCTs) comparing the merits of colchicine in patients with acute coronary syndrome (ACS) or stable CAD. The pooled relative risk ratio (RR) of major adverse cardiovascular events (MACE), its components, and gastrointestinal (GI) adverse events were computed using a random-effect model.

Results: Ten RCTs comprising a total of 12,761 patients were identified. At a median follow-up of 12 months, there was a significantly lower risk of MACE [RR 0.66, 95% confidence interval (CI) 0.45-96], ACS (RR 0.66, 95% CI 0.45-0.96), ischemic stroke (RR 0.42, 95% CI 0.22-0.81), and need for revascularization (RR 0.61, 95% CI 0.42-90) in patients receiving colchicine compared with placebo. A subgroup analysis based on the clinical presentation showed that the significantly lower incidence of MACE and stroke were driven by the patients presenting with ACS. The use of colchicine in patients with stable CAD did not reduce the incidence of MACE (RR 0.55, 95% CI 0.28-1.09), ACS (RR 0.52, 95% CI 0.25-1.08), or stroke (RR 0.61, 95% CI 0.33-1.13). There was no significant difference in the relative risk of cardiac arrest, ACS, cardiovascular mortality, and all-cause mortality between the two groups in both ACS and stable CAD populations. The risk of GI adverse events was significantly higher in patients receiving colchicine (RR 2.10, 95% CI 1.12-3.95).

Conclusion: In patients presenting with ACS, low-dose colchicine might reduce the incidence of MACE, stroke, and the need for revascularization at long follow-up durations. Colchicine might offer no benefits in reducing the risk of ischemic events in patients with stable angina.
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http://dx.doi.org/10.1007/s40256-021-00485-7DOI Listing
June 2021

Use and outcomes of cerebral embolic protection for transcatheter aortic valve replacement: A US nationwide study.

Catheter Cardiovasc Interv 2021 Jun 19. Epub 2021 Jun 19.

Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA.

Background: Outcomes data on the use of cerebral embolic protection devices (CPDs) with transcatheter aortic valve replacement (TAVR) remain limited. Previous randomized trials were underpowered for primary outcomes of stroke prevention and mortality.

Methods: The National Inpatient Sample and Nationwide Readmissions Database were queried from 2017 to 2018 to study utilization and inpatient mortality, neurological complications (ischemic stroke, hemorrhagic stroke, and transient ischemic attack), procedural complications, resource utilization, and 30-day readmissions with and without use of CPD. A 1:3 ratio propensity score matched model was created.

Results: Among 108,315 weighted encounters, CPD was used in 4380 patients (4.0%). Adjusted mortality was lower in patients undergoing TAVR with CPD (1.3% vs. 0.5%, p < 0.01). Neurological complications (2.5% vs. 1.7%, p < 0.01), hemorrhagic stroke (0.2% vs. 0%, p < 0.01) and ischemic stroke (2.2% vs. 1.4%, p < 0.01) were also lower in TAVR with CPD. Multiple logistic regression showed CPD use was associated with lower adjusted mortality (odds ratio (OR], 0.34 [95% confidence interval [CI], 0.22-0.52), p < 0.01) and lower adjusted neurological complications (OR, 0.68 (95% CI, 0.54-0.85], p < 0.01). On adjusted analysis, 30-day all-cause readmissions (Hazard ratio, HR 0.839, [95% CI, 0.773-0.911], p < 0.01) and stroke (HR, 0.727 [95% CI, 0.554-0.955), p = 0.02) were less likely in TAVR with CPD.

Conclusion: We report real-world data on utilization and in-hospital outcomes of CPD use in TAVR. CPD use is associated with lower inpatient mortality, neurological, and clinical complications as compared to TAVR without CPD.
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http://dx.doi.org/10.1002/ccd.29842DOI Listing
June 2021

Comparative safety of percutaneous ventricular assist device and intra-aortic balloon pump in acute myocardial infarction-induced cardiogenic shock.

Open Heart 2021 Jun;8(1)

Cardiology, Detroit Medical Center, Detroit, Michigan, USA

Background: The relative safety of percutaneous left ventricular assist device (pVAD) and intra-aortic balloon pump (IABP) in patients with cardiogenic shock after acute myocardial infarction remain unknown.

Methods: Multiple databases were searched to identify articles comparing pVAD and IABP. An unadjusted OR was used to calculate hard clinical outcomes and mortality differences on a random effect model.

Results: Seven studies comprising 26 726 patients (1110 in the pVAD group and 25 616 in the IABP group) were included. The odds of all-cause mortality (OR 0.57, 95% CI 0.47 to 0.68, p=<0.00001) and need for revascularisation (OR 0.16, 95% CI, 0.07 to 0.38, p=<0.0001) were significantly reduced in patients receiving pVAD compared with IABP. The odds of stroke (OR 1.12, 95% CI 0.14 to 9.17, p=0.91), acute limb ischaemia (OR=2.48, 95% CI 0.39 to 15.66, p=0.33) and major bleeding (OR 0.36, 95% CI 0.01 to 25.39, p=0.64) were not significantly different between the two groups. A sensitivity analysis based on the exclusion of the study with the largest weight showed no difference in the mortality difference between the two mechanical circulatory support devices.

Conclusions: In patients with acute myocardial infarction complicated by cardiogenic shock, there is no significant difference in the adjusted risk of all-cause mortality, major bleeding, stroke and limb ischaemia between the devices. Randomised trials are warranted to investigate further the safety and efficacy of these devices in patients with cardiogenic shock.
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http://dx.doi.org/10.1136/openhrt-2021-001662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204163PMC
June 2021

Meta-analysis comparing valve-in-valve TAVR and redo-SAVR in patients with degenerated bioprosthetic aortic valve.

Catheter Cardiovasc Interv 2021 Jun 10. Epub 2021 Jun 10.

Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA.

Introduction: The comparative efficacy and safety of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) and redo-surgical AVR (redo-SAVR) in patients with degenerated bioprosthetic aortic valves remain unknown.

Method: Digital databases were searched to identify relevant articles. Unadjusted odds ratios for dichotomous outcomes were calculated using a random effect model. A total of 11 studies comprising 8326 patients (ViV-TAVR = 4083 and redo-SAVR = 4243) were included.

Results: The mean age of patients undergoing ViV-TAVR was older, 76 years compared to 73 years for those undergoing SAVR. The baseline characteristics for patients in ViV-TAVR vs. redo-SAVR groups were comparable. At 30-days, the odds of all-cause mortality (OR 0.45, 95% CI 0.30-0.68, p = .0002), cardiovascular mortality (OR 0.44, 95% CI 0.26-0.73, p = .001) and major bleeding (OR 0.29, 95% CI 0.15-0.54, p = .0001) were significantly lower in patients undergoing ViV-TAVR compared to redo-SAVR. There were no significant differences in the odds of cerebrovascular accidents (OR 0.91, 95% CI 0.52-1.58, p = .74), myocardial infarction (OR 0.92, 95% CI 0.44-1.92, p = .83) and permanent pacemaker implantation (PPM) (OR 0.54, 95% CI 0.27-1.07, p = .08) between the two groups. During mid to long-term follow up (6-months to 5-years), there were no significant differences between ViV-TAVR and redo-SAVR for all-cause mortality, cardiovascular mortality and stroke. ViV-TAVR was, however, associated with higher risk of prosthesis-patient mismatch and greater transvalvular pressure gradient post-implantation.

Conclusion: ViV-TAVR compared to redo-SAVR appears to be associated with significant improvement in short term mortality and major bleeding. For mid to long-term follow up, the outcomes were similar for both groups.
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http://dx.doi.org/10.1002/ccd.29789DOI Listing
June 2021

Predictors of Acute Kidney Injury After Transcatheter Aortic Valve Implantation (From National Inpatient Sample [2011-2018]).

Am J Cardiol 2021 Jul 15;151:120-122. Epub 2021 May 15.

Department of Medicine, West Virginia University, Morgantown, West Virginia.

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http://dx.doi.org/10.1016/j.amjcard.2021.04.003DOI Listing
July 2021

Trends, predictors, and outcomes of major bleeding after transcatheter aortic valve implantation, from national inpatient sample (2011-2018).

Expert Rev Cardiovasc Ther 2021 Jun 20;19(6):557-563. Epub 2021 May 20.

Department of Medicine, West Virginia University, Medicine, Morgantown, WV, USA.

Introduction: Major bleeding remains one of the most frequent complications seen in transcatheter aortic valve implantation (TAVI). The purpose of this study was to evaluate outcomes, trends, and predictors of major bleeding in patients undergoing TAVI.

Methods: We utilized the National Inpatient Sample (NIS) data from the year 2011 to 2018. Baseline characteristics were compared using a Pearsonχ2 test for categorical variables and Mann-Whitney U-Test for continuous variables. A multivariable logistic regression model was used to evaluate predictors of major bleeding. Propensity Matching was done for adjusted analysis to compare outcomes in TAVI with and without major bleeding.

Results: A total of 215,938 weighted hospitalizations for TAVI were included in the analysis. Of the patient undergoing the procedure, 20,102 (9.3%) had major bleeding and 195,836 (90.7%) patients did not have in-hospital bleeding events. Patients in the major bleeding cohort were older and had greater female gender representation. At baseline patients with thrombocytopenia (Odds Ratio [OR], 1.47[confidence interval (CI), 1.36-1.59]), colon cancer (OR, 1.70[CI, 1.27-2.28]), coagulopathy (OR, 1.17[CI, 1.08-1.27]), liver disease (OR, 1.31[CI, 1.21-1.41]), chronic obstructive pulmonary disease (OR, 1.29[CI, 1.25-1.33]), congestive heart failure (OR, 1.12[CI, 1.08-1.16]), and end-stage renal disease (ESRD) (OR, 1.47[CI, 1.38-1.57]) had higher adjusted rates of major bleeding. The percentage of adjusted in-hospital mortality (14.4% vs. 4.2%, P < 0.01) was significantly higher in the major bleeding group Patients with major bleeding had higher median cost of stay ($235,274 vs. $177,920) and length of stay (7 vs 3 days).

Conclusion: In conclusion, we report that mortality is higher in patients with major bleeding and that baseline comorbidities like ESRD, liver disease, coagulopathy and colonic malignancy are important predictors of this adverse event.
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http://dx.doi.org/10.1080/14779072.2021.1924678DOI Listing
June 2021

Gender, racial, ethnic and socioeconomic disparities in palliative care encounters in ischemic strokes admissions.

Cardiovasc Revasc Med 2021 Apr 8. Epub 2021 Apr 8.

Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA.

Background: There is a scarcity of data on disparities in palliative care encounters in ischemic stroke patients. We have sought to answer these questions using the national inpatient database (NIS) data between 2002 and 2017. We aim to study gender, racial, regional, and socioeconomic disparities in palliative care encounters in ischemic stroke patients.

Methods: We have analyzed the NIS data from January 2002 to December 2017 using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), and ICD-10-CM codes. Linear regression was used for trend analysis and multiple logistic regression was used for adjusted analysis.

Results: A total of 9,542,169 discharge encounters with a diagnosis of ischemic stroke were recorded from 2002 to 2017. Out of these 412,394 (4.3%) had a palliative care (PC) encounter. The median age for patients with a PC encounter was 81 (Interquartile range [IQR 79-88]). PC encounters have shown a rapid increase over the years (from 0.5% in 2002 to 8.3% in 2017, p < 0.01). Adjusted multivariate analysis showed that African Americans (OR, 0.726 [95%CI, 0.716-0.736], p < 0.01), and Hispanics (OR, 0.738 [95%CI, 0.725-0.751]) were less likely to have a PC encounters. Females (OR, 1.18 7 [95% CI, 1.177-1.197], p < 0.01) were more likely to have PC encounters. Patients with better socio-economic status (OR, 1.034 [95%CI, 1.011-1.034], p < 0.01), having private insurance (OR, 1.562 [95%CI, 1.542-1.583], p < 0.01) and being in urban centers (OR, 1.815 [95%CI, 1.788-1.843], p < 0.01) were more likely to receive a PC encounter.

Conclusions: Significant racial, ethnic and socioeconomic disparities exist in PC encounters in ischemic stroke patients. The underlying reasons for this need to be explored further.
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http://dx.doi.org/10.1016/j.carrev.2021.04.004DOI Listing
April 2021

Trends in Infective Endocarditis in End-stage Renal Disease Patients (From National Inpatient Sample [2006-2017]).

Am J Cardiol 2021 05 3;147:149-150. Epub 2021 Mar 3.

Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia.

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http://dx.doi.org/10.1016/j.amjcard.2021.02.029DOI Listing
May 2021

Clinical outcomes of renal and liver transplant patients undergoing transcatheter aortic valve replacement: analysis of national inpatient sample database.

Expert Rev Cardiovasc Ther 2021 Apr 4;19(4):363-368. Epub 2021 Mar 4.

Department of Cardiology, Detroit Medical Center, Detroit, MI, USA.

The transcatheter aortic valve replacement (TAVR) has recently gained traction as a viable alternative to surgical aortic valve replacement (SAVR), but data on its safety and clinical outcomes in transplant patients are limited. We retrieved relevant demographic and clinical outcome data from the U.S. National Inpatient Sample (NIS) for the year 2012-2015. The clinical outcomes of TAVR in renal transplant (RT) and liver transplant (LT) were ascertained using an adjusted odds ratio (aOR) with a 95% confidence interval (CI) on Mantzel-Hensel test. A total of 62,399 TAVR patients were identified; 62,180 (99.6%) with no history of transplant, 219 (0.4%) with RT and 85 (0.1%) with LT. There was no significant difference in odds of in-hospital mortality (OR 0.61, 95% CI 0.25-1.5, p = 0.37), major cardiovascular, respiratory or neurological complications in patients with and without RT. Similarly, the odds of cardiac complications, renal and neurological complications between patients with and without LT were identical. Compared to non-transplant patients, TAVR appears to be associated with similar odds of major systemic complications or mortality in patients with a history of kidney or liver transplant.
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http://dx.doi.org/10.1080/14779072.2021.1892489DOI Listing
April 2021

Predictors of in-hospital mortality in patients with end-stage renal disease undergoing transcatheter aortic valve replacement: A nationwide inpatient sample database analysis.

Cardiovasc Revasc Med 2021 Feb 5. Epub 2021 Feb 5.

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

Background: Patients with end-stage renal disease (ESRD) were excluded from all major trials on the safety of transcatheter aortic valve replacement (TAVR). This study aims to identify the predictors of mortality due to the rising rate of TAVR utilization and subsequent mortality in patients with ESRD.

Methods: The National Inpatient Sample (NIS) (2002-2017) was queried to identify all patients with ESRD undergoing TAVR. The trend of all-cause mortality and its predictors were determined using a binary logistic regression model to obtain adjusted odds ratios (aOR).

Results: A total of 6836 patients (6341 survived, 495 died) were included in the analysis. The proportion of demographic and baseline comorbidities for survived vs. non-survived was nearly identical between the two groups. A rising trend in the utilization and mortality of TAVR in ESRD was noted. The adjusted odds of mortality was significantly higher for hypertension (6.92, 95% CI 3.78-12.66, p ≤ 0.0001), liver disease (4.51, 955 CI 3.30-6.17, p ≤ 0.0001), drug abuse (aOR 34.88, 95% CI 12.79-95.13, p ≤ 0.0001), periprocedural pneumonia (aOR 2.80, 95% CI 1.98-3.96, p ≤ 0.0001), cardiogenic shock (aOR, 5.97, 95% CI 4.63-7.70, p ≤ 0.0001), ST-elevation myocardial infarction (aOR 5.13, 95% CI 2.29-11.49, p ≤ 0.0001) and third-degree heart block (aOR 1.47, 955 CI 1.10-1.97, p0.01) in patients with ESRD undergoing TAVR. The mean length of stay and mean number of diagnoses recorded were also significantly higher for non-surviving TAVR patients.

Conclusion: Baseline hypertension, liver disease, third-degree heart block, periprocedural pneumonia, cardiogenic shock and STEMI can significantly increase the in-hospital mortality rate in ESRD patients undergoing TAVR.
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http://dx.doi.org/10.1016/j.carrev.2021.02.002DOI Listing
February 2021

Clinical outcomes of patients with diabetes mellitus and acute ST-elevation myocardial infarction following fibrinolytic therapy: a nationwide inpatient sample (NIS) database analysis.

Expert Rev Cardiovasc Ther 2021 Apr 26;19(4):357-362. Epub 2021 Feb 26.

Department of Cardiology, Detroit Medical Center, MI, USA.

The impact of diabetes mellitus (DM) on clinical outcomes of acute ST-segment elevation myocardial infarction (STEMI) following fibrinolytic therapy remains uncertain. We queried the National Inpatient Sample (NIS) for STEMI patients who received fibrinolytic therapy. Categorical and continuous variables were compared using the unadjusted odds ratio (uOR) and t-test analysis, respectively. A binary logistic regression model was used to control the outcomes for patient demographics, procedural characteristics, and baseline comorbidities. A total of 111,155 (no-DM 84,146, DM 27,009) were included. The unadjusted odds of in-hospital mortality (8.4% vs. 6.8%, uOR 1.25, 95% CI 1.19-1.31, P = <0.0001) and cardiogenic shock (7.7% vs. 6.2%, uOR 1.26, 95% CI 1.20-1.33, P = <0.0001) were significantly higher in patients with DM compared to those with no DM, respectively. The odds for major bleeding and cardiopulmonary arrest were significantly lower for in diabetes. The adjusted pooled estimates mirrored the unadjusted findings. Diabetic patients receiving fibrinolytic therapy for STEMI might have higher odds of all-cause mortality and cardiogenic shock compared to non-diabetic patients.
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http://dx.doi.org/10.1080/14779072.2021.1888716DOI Listing
April 2021

The impact of peripheral arterial disease on left ventricular assist device implantation: A propensity-matched analysis of the nationwide inpatient sample database.

Artif Organs 2021 Aug 11;45(8):838-844. Epub 2021 May 11.

Advanced Heart Failure & Cardiac Transplant, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Left ventricular assist device (LVAD) candidacy screening includes evaluation for peripheral arterial disease (PAD). However, given current evidence, the impact of PAD on post-LVAD complications remains unknown. The National Inpatient Sample (NIS) database (2002-2017) was utilized to identify all LVAD cases. The in-hospital safety endpoints included major cardiovascular adverse events and its components. A propensity-matched analysis was used to obtain adjusted odds ratios (aOR). A subgroup analysis of patients with diabetes mellitus (DM) with PAD was also performed. A total of 27 424 patients with LVAD implantation (PAD: 516 [1.8%] and no-PAD 26 908 [98.2%]) were included. There were significant intergroup differences in the demographics and baseline comorbidities. A weighted sample of 1053 (no-PAD 537, PAD 516) propensity-matched population was selected. The adjusted odds for in-hospital mortality (aOR 1.7; 95% CI, 1.2-2.44, P = .004) were found to be significantly higher for LVAD-patients with PAD. There was no significant difference in the adjusted odds of MACE (aOR 1.16, 95% CI 0.87-1.5), postprocedure bleeding (aOR 0.88, 95% CI 0.62-1.26, P = .54) and risk of pneumonia (aOR 0.67, 95% CI 0.44-1.15, P = .63) between the two groups. A selected cohort of DM-only population (7339) consistently showed a higher adjusted mortality rate in PAD patients with LVAD implantation (aOR 2.3, 95% CI 1.2-4.47, P = .01). The rate of MACE (P = .17), myocardial infarction (P = .12), stroke (P = .60), postprocedural (0.10), and major bleeding (P = .51) remained identical between patients with PAD and those with no-PAD. PAD confers an increased risk of in-hospital all-cause mortality in patients undergoing LVAD implantation. This risk increases further in patients with a concomitant diagnosis of DM.
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http://dx.doi.org/10.1111/aor.13934DOI Listing
August 2021

In-hospital outcomes of transcatheter mitral valve repair in patients with and without end stage renal disease: A national propensity match study.

Catheter Cardiovasc Interv 2021 Feb 1. Epub 2021 Feb 1.

Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA.

Objectives: To study trends of utilization, outcomes, and cost of care in patients undergoing undergoing transcatheter mitral valve repair (TMVr) with end-stage renal disease (ESRD).

Background: Renal disease has been known to be a predictor of poor outcome in patients with mitral valve disease. Outcome data for patients with ESRD undergoing TMVr remains limited. Therefore, our study aims to investigate trends of utilization, outcomes, and cost of care among patients with ESRD undergoing TMVr.

Methods: We analyzed NIS data from January 2010 to December 2017 using the ICD-9-CM codes ICD-10-CM to identify patients who underwent TMVr. Baseline characteristics were compared using a Pearson 𝜒 test for categorical variables and independent samples t-test for continuous variables. Propensity matched analysis was done for adjusted analysis to compare outcomes between TMVr with and without ESRD. Markov chain Monte Carlo was used to account for missing values.

Results: A total of 15,260 patients (weighted sample) undergoing TMVr were identified between 2010 and 2017. Of these, 638 patients had ESRD compared to 14,631 patients who did not have ESRD. Adjusted in-hospital mortality was lower in non-ESRD group (3.9 vs. <1.8%). Similarly, ESRD patients were more likely to have non-home discharges (85.6 vs. 74.9%). ESRD patients also had a longer mean length of stay (7.9 vs. 13.5 days) and higher mean cost of stay ($306,300 vs. $271,503).

Conclusion: ESRD is associated with higher mortality, complications, and resource utilization compared to non-ESRD patients. It is important to include this data in shared decision-making process and patient selection.
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http://dx.doi.org/10.1002/ccd.29517DOI Listing
February 2021

Percutaneous coronary intervention in patients with cardiac allograft vasculopathy: a Nationwide Inpatient Sample (NIS) database analysis.

Expert Rev Cardiovasc Ther 2021 Mar 4;19(3):269-276. Epub 2021 Feb 4.

Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.

Cardiac allograft vasculopathy (CAV) is a major cause of heart transplant failure and mortality. The role of percutaneous coronary intervention (PCI) in these patients remains unknown.: The National Inpatient Sample (NIS) (2015-2017) was queried to identify all cases of CAV. The merits of PCI were determined using a propensity-matched multivariate logistic regression model. Adjusted odds ratios (aOR) for in-hospital complications were calculated.: A total of 2,380 patients (PCI 185, no-PCI 21,95) with CAV were included in the analysis. There was no significant difference in the odds of major bleeding (OR 1.87, 95% CI 0.94-3.7, = 0.11), post-procedure bleeding ( = 0.37), cardiogenic shock (OR 0.87, 95% CI 0.45-1.69, = 0.80), acute kidney injury (uOR 0.92, 95% CI 0.68-1.24, = 0.64), cardiopulmonary arrest (OR 0.84, 95% CI 0.34-2.11, = 0.88), and in-hospital mortality (OR 1.59, 95% CI 0.91-2.79, = 0.14) between patients undergoing PCI compared to those treated conservatively. A propensity-matched analysis closely followed the results of unadjusted crude analysis.: PCI in CAV may be associated with increased in-hospital complications and higher resource utilization.
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http://dx.doi.org/10.1080/14779072.2021.1882851DOI Listing
March 2021

Trends and Predictors of Transcatheter Aortic Valve Implantation Related In-Hospital Mortality (From the National Inpatient Sample Database).

Am J Cardiol 2021 03 30;143:97-103. Epub 2020 Dec 30.

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

Existing surgical aortic valve replacement risk models accurately predict the post- surgical aortic valve replacement morbidity and mortality, but factors associated with post transcatheter aortic valve Implantation (TAVI) mortality are not well known. The National Inpatient Sample was queried to identify all cases of TAVI. The association of baseline comorbidities with in-hospital mortality was determined using a binary logistic regression model to obtain adjusted odds ratios (aOR). A total of 161,049 patients underwent TAVI between 2010 and 2017. Of these, 157,151 (97.6%) survived while 3,898 (2.4%) died during hospitalization. The baseline characteristics of TAVI-survivors and non-survivors showed a significant amount of variation, including age (80 vs 82 years, p ≤ 0.0001) and female sex (46% vs 52%, p ≤ 0.0001), respectively. The non-survivors had significantly higher adjusted odds of renal failure requiring hemodialysis (aOR 2.59, 95% CI 2.24 to 2.99, p ≤ 0.0001), history of mediastinal radiation (aOR 2.71, 95% CI 1.02 to 7.20, p = 0.05), liver disease (aOR 3.04, 95% CI 2.63 to 3.51, p ≤ 0.0001), pneumonia (aOR 2.47, 95% CI 2.15 to 2.83, p ≤ 0.0001), cardiogenic shock (aOR 9.83, 95% CI 8.93 to 10.82, p ≤ 0.0001), ventricular tachycardia (aOR 2.12, 95% CI 1.88 to 2.40, p ≤ 0.0001), acute ST-elevation myocardial infarction (aOR 7.38, 95% CI 5.53 to 9.84, p ≤ 0.0001), stroke (aOR 2.25, 95% CI 1.99 to 2.54, p ≤ 0.0001), and acute infective endocarditis (aOR 5.74, 95% CI 3.65 to 9.02, p ≤ 0.0001) compared to TAVI-survivors. The yearly trend of mortality showed an increase in the absolute number of TAVI procedures and mortality but the yearly rate showed a decline in mortality after an initial peak during 2012.Patients with renal failure on dialysis, ST-elevation myocardial infarction, cardiogenic shock, infective endocarditis, liver disease and pneumonia have a higher rate of in-hospital mortality post TAVI.
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http://dx.doi.org/10.1016/j.amjcard.2020.12.031DOI Listing
March 2021

Impact of Arrhythmias on Hospitalizations in Patients With Cardiac Amyloidosis.

Am J Cardiol 2021 03 24;143:125-130. Epub 2020 Dec 24.

Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address:

Cardiac involvement in amyloidosis is associated with a poor prognosis. Data on the burden of arrhythmias in patients with cardiac amyloidosis (CA) during hospitalization are lacking. We identified the burden of arrhythmias using the National Inpatient Sample (NIS) database from January 2016 to December 2017. We compared patient characteristics, outcomes, and hospitalization costs between CA patients with and without documented arrhythmias. Out of 5,585 hospital admissions for CA, 2,020 (36.1%) had concurrent arrhythmias. Propensity-score matching for age, sex, income, and co-morbidities was performed with 1,405 CA patients with arrhythmias and 1,405 patients without. The primary outcome of all-cause mortality was significantly higher in CA patients with arrhythmia than without(13.9% vs 5.3%, p-value <0.001). Atrial fibrillation (AF) was the most common (72.2%) arrhythmia in CA patients with concurrent arrhythmia. The secondary outcomes of AF-related mortality (11.95% vs 9.16%, p-value = 0.02) and acute and acute on chronic as heart failure (HF) exacerbation (32.38% vs 24.91%, p-value <0.0001) were significantly higher in CA and concurrent arrhythmia compared with CA patients without. The total length of hospital stay (6[3 to 12] vs 5[3 to 10], p-value <0.001) and cost of hospitalization were ($ 15,086[7,813 to 30,373] vs $ 12,219[6,865 to 23,997], p-value = 0.001) were significantly greater among CA with arrhythmia compared with those without. These data suggest that the presence of arrhythmias in CA patients during hospital admission is associated with a poorer prognosis and may reflect patients with a higher risk of HF exacerbation and mortality.
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http://dx.doi.org/10.1016/j.amjcard.2020.12.024DOI Listing
March 2021

Meta-Analysis Comparing Culprit-Only Versus Complete Multivessel Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction.

Am J Cardiol 2021 01 13;139:34-39. Epub 2020 Oct 13.

Thomas Jefferson University, Philadelphia, Pennsylvania.

ST-segment elevation myocardial infarction (STEMI) in patients with concomitant multivessel coronary artery disease is associated with poor prognosis. We sought to determine the merits of percutaneous coronary intervention of the culprit-only revascularization (COR) compared with multivessel revascularization (MVR) approach. Multiple databases were queried to identify relevant articles. Data were analyzed using a random-effect model to calculate unadjusted odds ratio (OR) and relative risk. A total of 28 studies comprising 26,892 patients, 18,377 in the COR and 8,515 in the MVR group were included. The mean age of patients was 63 years, comprising 72% of male patients. The baseline characteristics of the 2 treatment groups were comparable. On a median follow-up of 1-year, COR was associated with a significantly higher odds of major adverse cardiovascular events (MACE; OR 1.36, 95% confidence interval [CI] 1.10 to 1.70, p = 0.005), angina (OR 2.28, 95% CI 1.83 to 2.85, p ≤ 0.00001) and revascularization (OR 1.76, 95% CI 1.22 to 2.54, p = 0.002) compared with patients undergoing MVR for STEMI. The all-cause mortality (OR 1.18, 95% CI 0.91 to 1.53, p = 0.22), cardiovascular mortality (OR 1.30, 95% CI 0.98 to 1.72, p = 0.07), rate of heart failure (OR 1.17, 95% CI 0.86 to 1.59, p = 0.31), need for coronary artery bypass graft (CABG) (OR 1.47, 95% CI 0.82 to 2.64, p = 0.19), repeat myocardial infarction (MI) events (OR 1.23, 95% CI 0.93 to 1.64, p = 0.15) and risk of stroke (OR 1.27 95% CI 0.68 to 2.34, p = 0.45%) were similar between the two groups. A subgroup analysis based on follow-up duration and study design mostly followed the results of the pooled analysis except that the risk of repeat MI events were significantly lower in the MVR group across RCTs (OR 1.46, 95% CI 1.10 to 1.94, p = 0.009). In contrast to the culprit-only approach, MVR in patients with STEMI is associated with a significant reduction in MACE, angina and need for revascularization.
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http://dx.doi.org/10.1016/j.amjcard.2020.10.009DOI Listing
January 2021

Homocystinuria in a 14-year old girl manifesting as central retinal artery occlusion: A case report.

J Pak Med Assoc 2020 Jul;70(7):1263-1265

Department of Ophthalmology, Khyber Teaching Hospital, Peshawar, Pakistan.

Central retinal artery occlusion (CRAO) is one of the causes of sudden loss of vision. Homocystinuria is an autosomal recessive inherited disorder and is characterized by increased levels of homocysteine in the urine and blood. We present a case of homocyistinuria in a 14-year girl, presenting as CRAO with a family history of vascular thrombotic events. The patient did not have any local predisposing factors or prior history of thromboembolic episodes. Left eye fundus examination revealed a pale retina with sparing of cilioretinal artery. On examination Visual acuity of the right eye was 6/6 and left eye was completely blind with no perception of light. Homocysteine level on admission was 34.60umol/l. Patient was started on Rivaroxaban 10mg, Vitamin B6 , Vitamin B12 and folic acid. On follow up examination after 2 months the visual acuity in the left eye was 6/9. The dramatic improvement in the visual acuity can be attributed to the sparing of the cilioretinal artery. Followup Homocysteine levels after two months of treatment was 12umol/l. Ophthalmologist should be aware of this rare manifestation of homocystinuria as CRAO as they can play an important role of diagnosing the underlying medical illness.
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http://dx.doi.org/10.5455/JPMA.23704DOI Listing
July 2020

Gender Disparities in Percutaneous Mitral Valve Repair (from the National Inpatient Sample).

Am J Cardiol 2020 10 16;132:179-181. Epub 2020 Jul 16.

Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia.

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http://dx.doi.org/10.1016/j.amjcard.2020.07.021DOI Listing
October 2020

The Effect of Enhanced External Counterpulsation (EECP) on Quality of life in Patient with Coronary Artery Disease not Amenable to PCI or CABG.

Cureus 2020 May 6;12(5):e7987. Epub 2020 May 6.

Cardiology, Hayatabad Medical Complex, Peshawar, PAK.

Enhanced External Counterpulsation (EECP) is a non-invasive FDA approved therapy for patients with refractory angina pectoris. The EECP mechanism of action is similar to that of an intra-aortic balloon pump (IABP) by administering a vigorous pressure pulse via external blood pressure cuffs during the diastole. The benefit of EECP includes improvement in angina severity, angina stability, maximal walking capacity and generalized improvement in overall health. Seatle Angina Questionnaire (SAQ) is a valid, reliable and sensitive measure of health-related quality of life. It is also a sensitive and reproducible evaluation tool to measure the response to an intervention. We did a pre-test post-test designed prospective study to evaluate the effect of EECP on the quality of life in patients with CAD. There was a significant difference between SAQ-7 health-related quality of life between the pre-EECP and post-EECP groups (P value= <0.01). Moreover, a positive correlation was reported between the New York Heart Association (NYHA) Functional Classification before treatment and post-EECP SAQ-7 health-related quality of life (P value=0.015).
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http://dx.doi.org/10.7759/cureus.7987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273423PMC
May 2020

Total Occlusion of Abdominal Aorta in Takayasu Arteritis.

Cureus 2019 Jul 1;11(7):e5058. Epub 2019 Jul 1.

Cardiology, Hayatabad Medical Complex, Peshawar, PAK.

Takayasu arteritis is a type of large vessel vasculitis that mainly affects the aorta and its major branches. The disease can have a myriad of manifestations ranging from non-specific symptoms of low-grade fever and weight loss to lower limb claudication. A 21-year-old woman presented with uncontrolled hypertension for the last six months. The CT aortogram revealed total occlusion of the abdominal aorta with collateral vessels formed by the right and left internal mammary artery. We present a case of Takayasu arteritis in a 21-year-old woman with complete obstruction of the abdominal aorta. She was treated only with oral medications. The associated review of the literature is also discussed.
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http://dx.doi.org/10.7759/cureus.5058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721881PMC
July 2019

A case of peripartum cardiomyopathy presenting as bilateral acute limb ischaemia and gangrene.

J Pak Med Assoc 2019 Aug;69(8):1216-1218

Department of Cardiology, Medical Teaching Institution, Khyber Teaching Hospital.

Peripartum cardiomyopathy (PPCM) is a condition of unknown etiology that presents as heart failure due to left ventricular systolic dysfunction in the last of month of pregnancy and up to six months after giving birth. PPCM predisposes towards thrombo-embolism and an acute limb ischaemia can be a manifestation of this disease. We present a case of a 23-year-old lady presenting an acute lower limb ischaemia four months post-partum. Doppler ultrasound showed bilateral femoral emboli and cardiac ECHO showed a 24% ejection fraction. Amputation was performed on both limbs, below her right knee and above her left knee. The patient was started on heart failure medication and her symptoms improved with diuretic therapy, confirming the diagnoses of PPCM. It is important to recognise acute limb ischaemia as a rare manifestation of PPCM, as a timely diagnosis and effective treatment of the disease can improve the prognosis. We believe this is the first case to be reported in medical literature from Pakistan of a patient presenting PPCM with bilateral acute limb ischaemia and gangrene.
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August 2019

Systemic Lupus Erythematosus Presenting as Optic Neuropathy: A Case Report.

Cureus 2019 Jun 3;11(6):e4806. Epub 2019 Jun 3.

Ophthalmology, Khyber Teaching Hospital, Peshawar, PAK.

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease with a wide variety of clinical presentations as a result of its effect on several organ systems. Optic nerve involvement in SLE is very uncommon, but optic neuritis can be the initial manifestation of SLE. A previously healthy 47-year-old woman developed blurring of vision in the left eye for the last three weeks and associated periorbital pain that worsened with eye movement. On a review of systems, she reported a photosensitivity rash, painless oral ulcers, and generalized arthralgia. On examination, she had relative afferent pupillary defect (RAPD) in the left eye. A visual field analysis revealed bilateral arcuate defects. Positive antinuclear antibodies (ANA), anti-beta2-glycoprotein I, and low complement levels of C4 were found consistent with the diagnosis of SLE. We present a case of optic neuropathy as the initial manifestation of SLE in a 47-year-old lady and an associated review of the literature.
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http://dx.doi.org/10.7759/cureus.4806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682382PMC
June 2019

A case of Vogt Koyanagi Harada disease in a 16 year old girl.

J Pak Med Assoc 2017 Nov;67(11):1759-1761

Department of Ophthalmology, Medical Teaching Institution, Khyber Teaching Hospital.

Vogt Koyanagi Harada (VKH) is an autoimmune disease with widespread systemic manifestations. It typically presents with bilateral sudden painless loss of vision. It is mainly characterized by serous retinal detachment, iridocyclitis and choroidal swelling. The disease is more common in females and maximus incidence occurs in the age group of 30 to 40 years. We present a case of a 16-year-old girl who presented with sudden bilateral painless loss of vision. Fundus examination and OCT scanning confirmed bilateral serous retinal detachment. Patient was started on IV methylprednisolone and the patient showed excellent response with marked improvement in visual acuity. VKH is very uncommon in children and is usually missed. It is important for general practitioners and ophthalmologists to know about this rare cause of painless loss of vision so that it could be managed adequately.
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November 2017

Angiofibroma In A 50-Year-Old Patient.

J Ayub Med Coll Abbottabad 2017 Jul-Sep;29(3):499-501

Department of Medicine, Khyber Medical College, Peshawar, Pakistan.

Juvenile Angiofibroma (JNA) is a benign tumour that tends to bleed and occur in the nasopharynx with most cases occurring in pre-pubertal and adolescent males 10-20 years. We present the case of a 50-year-old male shopkeeper who consulted the ENT out patients' department (OPD) of Khyber Teaching Hospital (KTH) with the chief complaint of right sided nasal obstruction for the last 2.5 months which was associated with two episodes of epistaxis and diplopia which started 2 months back. He complained of right sided frontal and periorbital pain for the last 15 days. Past medical and surgical history was insignificant. Computerized Tomography (CT) scan without contrast and magnetic resonance imaging (MRI) showed finding consistent with a pedunculated tumour like growth. After baseline investigations, surgery was done and a Wilson's incision was given and the mass was excised and sent to the lab for histopathological report which showed angiofibroma. The age of the patient shows that this is a very rare case of angiofibroma. Dissection of such tumours is important as they have propensity to bleed. Excision along with biopsy is the method of choice. Proper surgical techniques and use of better medical technology are required to make and early diagnosis. Further studies/case reports around the world would assert our findings that a nasopharyngeal angiofibroma can also be found in middle aged men.
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April 2019
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