Publications by authors named "Yasar Sattar"

63 Publications

Clinical Outcomes of Renal and Liver Transplant Patients undergoing Transcatheter Aortic Valve Replacement: Analysis of National Inpatient Sample Database.

Expert Rev Cardiovasc Ther 2021 Feb 22. Epub 2021 Feb 22.

Detroit Medical Center Heart Hospital , Detroit, MI, USA.

Background: The transcatheter aortic valve replacement (TAVR) has recently gained traction as a viable alternative to surgical aortic valve replacement, but data on its safety and clinical outcomes are limited.

Methods: We retrieved relevant demographic and clinical outcome data from the US National Inpatient Sample (NIS) for the year 2013-2016. The clinical outcomes between the TAVR with and without renal transplant (RT) and TAVR with and without liver transplant (LT) were ascertained using an adjusted odds ratio (aOR) with a 95% confidence interval (CI) on the Mantzel-Hensel test model.

Results: A total of 62,399 TAVR patients were identified; 62,180 (99.6%) with no history of transplant, RT 219 (0.4%) and LT patients 85 (0.1%). 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 (OR 0.67, 95% CI 0.36-1.34, p=0.34), renal (OR 0.61, 95% CI 0.32- 1.20, p=0.10) and neurological (OR 0.82, 95% CI 0.42-1.60, p=0.67) complications between patients with and without LT were identical.

Conclusion: 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
February 2021

Post-PCI Outcomes in STEMI Patients with Coronary Ectasia: Meta-analysis.

Expert Rev Cardiovasc Ther 2021 Feb 15. Epub 2021 Feb 15.

Cardiovascular Medicine, Detroit Medical Center, Wayne State University , Detroit, USA.

Background: Coronary ectasia (CE) is defined as dilation of the coronary artery, 1.5 times of the surrounding vessel. Outcomes of percutaneous intervention (PCI) in patients with CE presenting as ST-elevated myocardial infarction (STEMI) remains a topic of debate.

Methods: Studies comparing outcomes of PCI in CE versus no-ectasia (NE) STEMI patients were identified. Baseline angiographic characteristics including thrombolysis in myocardial infarction (TIMI) 0-1 flow, right coronary artery (RCA) involvement, and primary outcomes including thrombus aspiration, no-reflow, mortality, TIMI-3 post-PCI. Odds ratio (OR) and 95% confidence interval (CI) were calculated.

Results: Six studies (n=5746, CE-340 and NE-5406) qualified for the analysis. RCA involvement was more common in CE than NE, OR-1.39, (95%CI 1.06-1.82, p-0.02). Pre-procedure TIMI-0-1 was of comparable results between the groups (p-1.13). Higher thrombus aspiration for CE (OR 2.18, 95%CI 1.44-3.32; p-<0.001). CE had higher incidence of no-reflow (OR 4.07, 95%CI 2.42-6.84; p-<0.001). TIMI-3 flow post-PCI was achieved less commonly in the CE group (OR-0.64, 95%CI-0.48-0.86; p-<0.001). Mortality on follow-up was comparable (0.83, 95%CI 0.39-1.78; p-0.63). Metaregression analysis did not show confounding effect from comorbidities.

Conclusion: Coronary ectasia patients with STEMI had higher rates of PCI failure and no-reflow than NE, however, mortality on follow up was comparable.
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http://dx.doi.org/10.1080/14779072.2021.1889370DOI Listing
February 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 Feb 26:1-6. 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
February 2021

Outcomes of in-hospital cardiac arrest in COVID-19 patients: A proportional prevalence meta-analysis.

Catheter Cardiovasc Interv 2021 Feb 4. Epub 2021 Feb 4.

University of Massachusetts School of Medicine, Worcester, Massachusetts, USA.

Background: Limited epidemiological data are available on the outcomes of in-hospital cardiac arrest (CA) in COVID-19 patients.

Methods: We performed literature search of PubMed, EMBASE, Cochrane, and Ovid to identify research articles that studied outcomes of in-hospital cardiac arrest in COVID-19 patients. The primary outcome was survival at discharge. Secondary outcomes included return of spontaneous circulation (ROSC) and types of cardiac arrest. Pooled percentages with a 95% confidence interval (CI) were calculated for the prevalence of outcomes.

Results: A total of 7,891 COVID patients were included in the study. There were 621 (pooled prevalence 8%, 95% CI 4-13%) cardiac arrest patients. There were 52 (pooled prevalence 3.0%; 95% CI 0.0-10.0%) patients that survived at the time of discharge. ROSC was achieved in 202 (pooled prevalence 39%;95% CI 21.0-59.0%) patients. Mean time to ROSC was 7.74 (95% CI 7.51-7.98) min. The commonest rhythm at the time of cardiac arrest was pulseless electrical activity (pooled prevalence 46%; 95% 13-80%), followed by asystole (pooled prevalence 40%; 95% CI 6-80%). Unstable ventricular arrhythmia occurred in a minority of patients (pooled prevalence 8%; 95% CI 4-13%).

Conclusion: This pooled analysis of studies showed that the survival post in-hospital cardiac arrest in COVID patients is dismal despite adequate ROSC obtained at the time of resuscitation. Nonshockable rhythm cardiac arrest is commoner suggesting a non-cardiac cause while cardiac related etiology is uncommon. Future studies are needed to improve the survival in these patients.
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http://dx.doi.org/10.1002/ccd.29525DOI Listing
February 2021

Angled microcatheter assisted antegrade dissection re-entry technique for tortuous totally occluded coronary arteries.

Cardiovasc Revasc Med 2021 Jan 7. Epub 2021 Jan 7.

Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA.

Background: Subacute total occlusion in the setting of a tortuous vessel can be a therapeutic challenge. we demonstrate a safe and successful approach to deploy drug eluting stent of this complex lesion by using angled microcatheter.

Case Presentation: A 61-year-old male with multiple atherosclerotic risk factors diagnosed with NSTEMI secondary to subacute total occlusion of the mid right coronary artery (RCA) with collaterals filling from septal perforators arising from mid left anterior descending artery. Due to severe tortuosity of RCA, the wire inside of Corsair microcatheter kept directing away from the lumen. Therefore, Corsair was exchanged for 90-degree SuperCross™ angled microcatheter that was rotated to direct its opening towards the lumen. A Confianza pro 12 wire was used to puncture into the lumen from the subinitimal position. SuperCross™ microcatheter was advanced over the wire into the lumen and eventually drug eluting stents were deployed successfully.

Conclusion: While facing subacute total occlusion with proximal end in a tortuous artery, SuperCross™ microcatheter assisted dissection reentry could be attempted after failure of antegrade wire escalation technique.

Learning Objective: Facilitate the use of SuperCross™ microcatheter assisted dissection reentry as a successful approach for subacute total occlusion in tortuous vessels.
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http://dx.doi.org/10.1016/j.carrev.2021.01.004DOI Listing
January 2021

Predictors and risk factors of short-term readmission of acute pericarditis.

Expert Rev Cardiovasc Ther 2021 Jan 26:1-8. Epub 2021 Jan 26.

Cardiology Department, Wayne State University/Detroit Medical Center , Detroit, Michigan, USA.

: The 30-day readmission risk factors for acute pericarditis are not well known. We investigated the risk factors and predictors of pericarditis from a national cohort. : Readmission data from the National Readmission Database (NRD) from the year 2016 were used to analyze the prevalence of risk factors and predictors of pericarditis 30-day readmission. : From the year 2016, 16,475 acute pericarditis hospitalizations were recorded. The rate of readmission from the year 2016 is similar to 2012 reported data (18%). A total of 13,844 patients (mean age 55.2 years, 40% of women) were found for acute pericarditis readmissions. The incidence rate of 30-day readmission of acute pericarditis patients in our study was 17.8% with the major cause of readmission was related to cardiovascular (pericarditis, endocarditis, and myocarditis) during 30-day follow-up. The median cost of the index and 30 days pericarditis admission $10,048 and $9,932, respectively. : Chronic comorbidities, prolonged hospitalization, and admission to a short-term hospital/left against medical advice admission to metropolitan teaching hospital were associated with a higher risk of 30-day readmission.
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http://dx.doi.org/10.1080/14779072.2021.1876564DOI Listing
January 2021

In-Hospital Outcomes and Trends of Endovascular Intervention vs Surgical Revascularization in Octogenarians With Peripheral Artery Disease.

Am J Cardiol 2021 Jan 15. Epub 2021 Jan 15.

Wayne State University, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan. Electronic address:

It is unknown whether endovascular intervention (EVI) is associated with superior outcomes when compared with surgical revascularization in octogenarian. National Inpatient Sample (NIS) database was used to compare the outcomes of limb revascularization in octogenarians who had surgical revascularization versus EVI. The NIS database's information on PAD patients ≥80-year-old who underwent limb revascularization between 2002 and 2014 included 394,504 octogenarian patients, of which 184,926 underwent surgical revascularization (46.9%) and 209,578 underwent EVI (53.1%). Multivariate analysis was performed to examine in-hospital outcomes. Trend over time in limb revascularization utilization was examined using Cochrane-Armitage test. EVI group had lower odds of in-hospital mortality (adjusted odds ratio [aOR]: 0.61 [95% CI: 0.58 to 0.63], myocardial infarction (aOR: 0.84 [95% CI: 0.81 to 0.87]), stroke (aOR: 0.93 [95% CI: 0.89 to 0.96]), acute kidney injury (aOR: 0.79 [95% CI: 0.77 to 0.81]), and limb amputation (aOR: 0.77 [95% CI: 0.74 to 0.79]) compared with surgical group (p < 0.001 for all). EVI group had higher risk of bleeding (aOR: 1.20 [95% CI: 1.18 to 1.23]) and vascular complications (3.2% vs 2.7%, aOR: 1.25 [95% CI: 1.19 to 1.30]) compared with surgical group (p < 0.001 for all). Within study period, EVI utilization increased in octogenarian patients from 2.6% to 8.9% (ptrend < 0.001); whereas use of surgical revascularization decreased from 11.6% to 5.2% (ptrend < 0.001). In conclusion, the utilization of EVI in octogenarians is increasing, and associated with lower risk of in-hospital mortality and adverse cardiovascular and limb outcomes as compared with surgical revascularization.
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http://dx.doi.org/10.1016/j.amjcard.2020.12.091DOI Listing
January 2021

Meta-Analysis Comparing the Safety and Efficacy of Single vs Dual Antiplatelet Therapy in Post Transcatheter Aortic Valve Implantation Patients.

Am J Cardiol 2021 Jan 15. Epub 2021 Jan 15.

Detroit Medical Center, Heart Hospital, Detroit, Michigan. Electronic address:

The relative safety and efficacy of aspirin versus dual antiplatelet therapy (DAPT; aspirin+clopidogrel) in patients who underwent transcatheter aortic valve implantation (TAVI) and did not have a long-term indication for oral anticoagulation remains controversial. Digital databases were searched to identify relevant articles. The major safety end point was bleeding, while the efficacy end points included after-TAVI ischemic and thrombotic events. Data were analyzed using a random effect model to calculate the pooled unadjusted odds ratio (OR) for dichotomous outcomes. Eleven studies comprising 4805 patients (aspirin 2258, DAPT 2547) were included in the quantitative analysis. Patients receiving aspirin-alone had significantly lower odds of all cause bleeding (OR 0.41, 95% CI 0.29 to .057, p <0.00001), major vascular bleeding (OR 0.51, 95% CI 0.34 to 0.77, p = 0.001), Valve Academic Research Consortium 2 (VARC-2) major bleeding (OR 0.50, 95% CI 0.30 to 0.83 p = 0.008), VARC-2 minor bleeding (OR 0.55, 95% CI 0.31 to 0.97, p = 0.04), transfusion requirement (OR 0.39, 95%CI 0.15 to 0.0.98, p = 0.05) and major vascular complications (OR0.41, 95% CI 0.26 to 0.66, p = 0.0002) compared with after-TAVI patients receiving both aspirin and clopidogrel. These was no significant difference in the odds of VARC-2 life threatening bleeding (OR 0.52, 95% CI 0.25 to 1.07, p = 0.08), prosthetic valve thrombosis (OR 1.17, 95% CI 0.22 to 6.30, p = 0.85), cardiac tamponade (OR 0.77, 95% CI 0.20 to 2.98, p = 0.70), conversion to open procedure (OR 1.99, 95 % CI 0.42 to 9.44, p = 0.39), MI (OR 0.79 95% CI 0.38 to 1.64, p = 0.52), transient ischemic attack (TIA) (OR 0.89, 95% CI 0.12 to 6.44, p = 0.91), major stroke (OR 0.68 95 % CI 0.43 to 1.08, p = 0.10), disabling stroke (0R 1.01, 95% CI 0.41 to 2.48, p = 0.99), cardiovascular mortality (OR 0.81 95% CI 0.38 to 1.74, p = 0.59) and all-cause mortality (OR 0.86, 95% CI 0.63 to 1.16, p = 0.31) between the 2 groups. In conclusion, after-TAVI patients who received aspirin alone had lower bleeding events with no significant differences in mortality and stroke rate compared with those who received DAPT.
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http://dx.doi.org/10.1016/j.amjcard.2020.12.087DOI Listing
January 2021

Does pulmonary embolism in critically ill COVID-19 patients worsen the in-hospital mortality: A meta-analysis.

Cardiovasc Revasc Med 2020 Nov 25. Epub 2020 Nov 25.

Detroit Medical Center, Detroit, MI, USA.

Background: Mortality in critically ill COVID (coronavirus disease) patients secondary to pulmonary embolism (PE) has conflicting data. We aim to evaluate the mortality outcomes of critically ill patients with and without PE (WPE).

Methods: Three studies were identified after a digital database search on PE in ICU (intensive care unit) patients until September 2020. The primary outcome was mortality. Outcomes were compared using a random method odds ratio and confidence interval of 95%.

Results: A total of 439 patients were included in the study. Diabetes, hypertension, and renal replacement requirement had no statistically significant association between PE and WPE, p = 0.39, p = 0.23, and p = 0.29 respectively. The study revealed that males have higher odds of PE, OR-1.98, 95%CI-1.01-3.89; p = 0.05. In-hospital mortality results were comparable between PE and WPE after subgroup analysis and correction of heterogeneity, p = 0.25.

Conclusion: PE in critically ill COVID patients had similar in-hospital mortality outcomes as WPE patients. The findings are only hypotheses generated from observational studies and need future randomized, prospective clinical trials for a definitive conclusion.
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http://dx.doi.org/10.1016/j.carrev.2020.11.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7687401PMC
November 2020

Safety and efficacy of coronary intravascular lithotripsy for calcified coronary arteries- a systematic review and meta-analysis.

Expert Rev Cardiovasc Ther 2021 Jan 9;19(1):89-98. Epub 2020 Dec 9.

Department of Internal Medicine, Detroit Heart center/Wayne State University , Detroit, MI, USA.

: Intravascular lithotripsy (IVL) clinical efficacy and safety in the treatment of calcified coronary artery disease (CAC) is not well known. We sought to assess IVL safety and efficacy in CAC. : A comprehensive online databases search were performed to identify intravascular lithotripsy studies in patients with coronary artery disease. The primary outcome was IVL related change in the mean pre and post-procedural diameter of the coronary artery. : A total of 4 studies with 282 patients were included. The mean pre-IVL coronary diameter for all patients was 1.01 mm, while the mean post-IVL coronary diameter was 2.70 mm. The mean pre-post IVL diameter difference of coronary arteries on the pooled analysis was significantly lower by 4.08 mm (95% CI -4.94 to -3.30, p ≤ 0.00001). The Overall increase in the post-IVL lumen diameter was significantly higher than the pre-IVL diameter with a mean difference of -4.16 (95% CI -5.08 to -3.24, p = 0.000001). However, compared to pre-IVL, there was a significant reduction in the overall mean difference of luminal calcium angle after IVL of the stented coronary arteries (0.09, 95% CI 0.002-0.16, p = 0.01). : Intravascular lithotripsy can offer a significant improvement in the vessel lumen to facilitate coronary stent delivery and deployments in severely calcified coronary arteries.
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http://dx.doi.org/10.1080/14779072.2021.1845143DOI Listing
January 2021

COVID-19 Infection Complicated by a Complete Occlusion of the Left Circumflex Artery With Acute Restenosis After Drug-Eluting Stent Placement.

Cureus 2020 Sep 29;12(9):e10708. Epub 2020 Sep 29.

Interventional Cardiology, Detroit Medical Center Cardiovascular Institute, Detroit, USA.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause a hypercoagulable state that can complicate the management of patients presenting with acute myocardial infarction (MI). We present the case of a patient with coronavirus disease 2019 (COVID-19) with ST elevation MI who was treated with percutaneous coronary intervention and stenting to the left circumflex artery. He was treated appropriately with anticoagulation with appropriate activated clotting time. However, the coronary angiogram course was complicated with heavy thrombosis that involved the left circumflex artery and the left anterior descending artery. Physicians are urged to suspect heparin resistance in COVID-19 patients, particularly if those patients have venous thromboembolism or acute coronary syndrome while taking heparin.
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http://dx.doi.org/10.7759/cureus.10708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594670PMC
September 2020

Frequency, Trends, and Outcomes of Cerebrovascular Events Associated With Atrial Fibrillation Hospitalizations.

Am J Cardiol 2021 01 13;138:53-60. Epub 2020 Oct 13.

Division of Cardiovascular Medicine, Section of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.

The main objective is to estimate the frequency, temporal trends, and outcomes of cerebrovascular events associated with atrial fibrillation (AF) hospitalization in the United States. The national inpatient sample data was utilized to identify hospitalizations with a primary or secondary diagnosis of AF from January 1, 2005 through September 31, 2015 for the present analysis. Jonckheere-Terpstra Trend was utilized to analyze trends from 2005 to 2015. Global Wald score was used to assess relative contributions of various covariates towards stroke among AF hospitalizations. Between the years 2005 and 2015, there were 36,457,323 (95.2%) AF hospitalizations without cerebrovascular events and 1,824,608 (4.8%) with cerebrovascular events included in the final analysis. There was a statistically significant increase in the proportion of overall stroke, AIS, and AHS (p value <0.001) per 1,000 AF hospitalizations. The frequency of stroke per 1,000 AF hospitalizations was highest among patients with CHA2DS2VASc score ≥3 and Charlson's comorbidity index ≥3. The trend of in-hospital mortality decreased during the study period, however, it remained higher in those with cerebrovascular events compared to those without. Lastly, hypertension, advancing age, and chronic lung disease were major stroke predicting factors among AF hospitalizations. These cerebrovascular events were associated with longer length of stay and higher costs. In conclusion, the incidence of cerebrovascular events associated with AF hospitalizations remained significantly high and the trend continues to ascend despite technological advancements. Strategies should improve to reduce the risk of AF-related stroke in the United States.
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http://dx.doi.org/10.1016/j.amjcard.2020.10.015DOI Listing
January 2021

Temporal trends and outcomes in utilisation of transcatheter and surgical aortic valve therapies in aortic valve stenosis patients with heart failure.

Int J Clin Pract 2020 Sep 21:e13711. Epub 2020 Sep 21.

Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA.

Introductions & Aims: Heart failure (HF) is a common comorbidity in patients undergoing surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). We sought to access the temporal trends and outcomes of TAVR or SAVR in HF patients.

Method: The NIS database from 2011-2014 was queried for patients that underwent TAVR or SAVR and were subsequently diagnosed with HF. Temporal trends in the utilisation of TAVR or SAVR in HF patients were analysed.

Results: Among 27 982 patients who were diagnosed with HF of whom 17 681 (63.2%) had heart failure with reduced ejection fraction (HFrEF) while 10 301 (36.8%) had heart failure with preserved ejection fraction (HFpEF), 9049 (32.3%) underwent TAVR and 16 933 (76.7%) underwent SAVR. Patients with HFrEF and HFpEF had higher utilisation of TAVR compared with SAVR over the course of the study period (P trend < .001). TAVR was associated with lower mortality [2.8% in 2012 and 1.8% in 2014 (P .013)] compared with SAVR. Similarly, multiple logistic regression showed a statistically significant lower in-hospital mortality in the TAVR group compared with SAVR (aOR 0.634; CI 0.504, 0.798, P < .001).

Conclusion: For patients with severe aortic valve stenosis and heart failure who undergo aortic valve intervention, TAVR is associated with less odds of in-hospital mortality compared with SAVR.
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http://dx.doi.org/10.1111/ijcp.13711DOI Listing
September 2020

Early intervention or watchful waiting for asymptomatic severe aortic valve stenosis: a systematic review and meta-analysis.

J Cardiovasc Med (Hagerstown) 2020 Nov;21(11):897-904

Detroit Medical Center, DMC Heart Hospital, Detroit, Michigan, USA.

Background: The management of patients with severe but asymptomatic aortic stenosis is challenging. Evidence on early aortic valve replacement (AVR) versus symptom-driven intervention in these patients is unknown.

Methods: Electronic databases were searched, articles comparing early-AVR with conservative management for severe aortic stenosis were identified. Pooled adjusted odds ratio (OR) was computed using a random-effect model to determine all-cause and cardiovascular mortality.

Results: A total of eight studies consisting of 2201 patients were identified. Early-AVR was associated with lower all-cause mortality [OR 0.24, 95% confidence interval (CI) 0.13-0.45, P ≤ 0.00001] and cardiovascular mortality (OR 0.21, 95% CI 0.06-0.70, P = 0.01) compared with conservative management. The number needed to treat to prevent 1 all-cause and cardiovascular mortality was 4 and 9, respectively. The odds of all-cause mortality in a selected patient population undergoing surgical AVR (SAVR) (OR 0.16, 95% CI 0.09-0.29, P ≤ 0.00001) and SAVR or transcatheter AVR (TAVR) (OR 0.53, 95% CI 0.35-0.81, P = 0.003) were significantly lower compared with patients who are managed conservatively. A subgroup sensitivity analysis based on severe aortic stenosis (OR 0.24, 95% CI 0.11-0.52, P = 0.0004) versus very severe aortic stenosis (OR 0.20, 95% CI 0.08-0.51, P = 0.0008) also mirrored the findings of overall results.

Conclusion: Patients with asymptomatic aortic valve stenosis have lower odds of all-cause and cardiovascular mortality when managed with early-AVR compared with conservative management. However, because of significant heterogeneity in the classification of asymptomatic patients, large scale studies are required.
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http://dx.doi.org/10.2459/JCM.0000000000001110DOI Listing
November 2020

Takotsubo syndrome vs anterior STEMI electrocardiography; a meta-analysis and systematic review.

Expert Rev Cardiovasc Ther 2020 Nov 3;18(11):819-825. Epub 2020 Sep 3.

Cardiovascular Medicine, Detroit Medical Center, Wayne State University , Detroit, USA.

Background: Takotsubo syndrome (TTS) and its differentiation from anterior wall ST-elevation myocardial infarction on electrocardiography (ECG) has been a debate.

Methods: Six studies comparing ECG changes in TTS and AW-STEMI were identified. The primary endpoint was reciprocal changes, presence of Q-waves, and QT-interval. An unadjusted odds ratio (OR) with a 95% confidence interval (CI) was calculated using Review Manager (RevMan) 5.3.

Results: Six studies consisting of 1090 patients (TTS = 220, AW-STEMI = 870) were included. Reciprocal changes on ECG were less commonly associated with TTS than AW STEMI with OR of 0.05 and 95%CI- 0.02-0.11 (P-<0.00001). Q-wave presence on ECG was comparable between the groups with OR-0.68, 95%CI-0.08-5.63 (p-0.72). QT interval on ECG was comparable between the two groups with OR-1.09, 95%CI-0.63-1.54 (p-<0.00001). There was minimal publication bias among the studies.

Conclusion: AW STEMI is associated with reciprocal changes. Q-waves and QT interval has no differentiating significance between AW STEMI and TTS.
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http://dx.doi.org/10.1080/14779072.2020.1813027DOI Listing
November 2020

An unusual case of fungal ball on implantable cardioverter defibrillator wire and literature review.

J Community Hosp Intern Med Perspect 2020 Aug 2;10(4):340-342. Epub 2020 Aug 2.

Internal Medicine, Abington Jefferson Hospital, Abington, PA, USA.

Cardiac Implantable Electronic Device (CIED) includes pacemakers and implantable cardioverter defibrillators (ICD). The device infection is classified into pocket and systemic infection. We present a case of candida fungemia secondary to dissemination from the fungal ball found on an ICD. Patient was successfully managed with IV fluconazole, ICD explantation and reimplantation. The purpose of this report is to highlight rare complications of ICD implantation and guide its clinical course and management.
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http://dx.doi.org/10.1080/20009666.2020.1772669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427435PMC
August 2020

Complications of leadless vs conventional (lead) artificial pacemakers - a retrospective review.

J Community Hosp Intern Med Perspect 2020 Aug 2;10(4):328-333. Epub 2020 Aug 2.

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

Background: Leadless pacemakers (LPM) are introduced in cardiovascular market with a goal to avoid lead- and pocket-associated complications due to conventional artificial pacemakers (CPM). The comparison of LPM and CPM complications is not well studied at a case by case level.

Methods: Comprehensive literature was searched on multiple databases performed from inception to December 2019 and revealed 204 cases that received LPM with a comparison of CPM. The data of complications were extracted, screened by independent authors and analyzed using IBM SPSS Statistics for Windows, Version 22.0 (Armonk, NY: IBM Corp.).

Results: The complications of CPM were high in comparison to LPM in terms of electrode dislodgement (56% vs 7% of cases, p-value < .0001), pocket site infection rate (16% vs 3.4%, p-value = 0.02), and a lead fracture rate (8% vs 0%, p-value = 0.04). LPMs had a statistically non-significant two-times high risk of pericardial effusion (8%) compared to CPMs (4%) with a p-value = 0.8.

Conclusion: LPMs appear to have a better safety profile than CPMs. There was a low pocket site and lead-related infections in LPM as compared to CPM. However, LPM can have twice the risk of pericardial effusion than CPMs, but this was not statistically significant.
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http://dx.doi.org/10.1080/20009666.2020.1786901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427453PMC
August 2020

Transcatheter Versus Surgical Aortic Valve Replacement in Renal Transplant Patients: A Meta-Analysis.

Cardiol Res 2020 Oct 1;11(5):280-285. Epub 2020 Aug 1.

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

Background: The outcome of transcutaneous aortic valve replacement (TAVR) in patients with kidney transplant is unknown, as majority of these patients were excluded from the major TAVR clinical trials. We sought to compare patients with severe aortic stenosis who underwent TAVR versus surgical aortic valve replacement (SAVR) with a history of kidney transplant.

Methods: PubMed, Google Scholar and Cochrane databases were searched to identify relevant articles. The incidence of all-cause mortality and acute kidney injury (AKI) was calculated using relative risk on a random effect model.

Results: A total of 1,538 patients (TAVR 328, SAVR 1,210) were included in the study. TAVR was associated with lower mortality as compared with SAVR at 30 days from the index procedure (odds ratio (OR) 0.48, 95% confidence interval (CI): 0.25 - 0.93; P = 0.03). One-year mortality was studied in three studies and showed comparable mortality in patients undergoing TAVR and SAVR (OR: 0.76, 95% CI: 0.10 - 5.51; P = 0.78). Compared to SAVR, TAVR carries an identical risk of AKI (OR: 0.44, 95% CI: 0.10 - 1.90; P = 0.27). A sensitivity analysis performed by exclusion of Voudris et al study showed a non-significant difference in the mortality incidence of two groups at 30 days (OR: 0.72, 95% CI: 0.27 - 1.91; P = 0.51).

Conclusions: In patients with a history of kidney transplant, TAVR was associated with a comparable risk of mortality and AKI compared to SAVR.
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http://dx.doi.org/10.14740/cr1092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430886PMC
October 2020

Safety and Efficacy of Hydroxychloroquine in COVID-19: A Systematic Review and Meta-Analysis.

J Clin Med Res 2020 Aug 4;12(8):483-491. Epub 2020 Jul 4.

Thomas Jefferson University, Philadelphia, PA, USA.

Background: During the initial phases of the coronavirus disease 2019 (COVID-19) epidemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ); however, recently, the Centers for Disease Control and Prevention (CDC) has recommended against routine use of HCQ outside of study protocols citing possible adverse outcomes.

Methods: Multiple databases were searched to identify articles on COVID-19. An unadjusted odds ratio (OR) was used to calculate the safety and efficacy of HCQ on a random effect model.

Results: Twelve studies comprising 3,912 patients (HCQ 2,512 and control 1400) were included. The odds of all-cause mortality (OR: 2.23, 95% confidence interval (CI): 1.58 - 3.13, P value < 0.00001) were significantly higher in patients on HCQ compared to patients on control agent. The response to therapy assessed by negative repeat polymerase chain reaction (PCR) (OR: 1.83, 95% CI: 0.50 - 6.75, P = 0.36), radiological resolution (OR: 1.98, 95% CI: 0.47 - 8.36, P value = 0.36) and the need for invasive mechanical ventilation (IMV) (OR: 1.21, 95% CI: 0.34 - 4.33, P value = 0.76) were identical between the two groups. Overall, four times higher odds of net adverse events (NAEs) were observed in the HCQ group (OR: 4.59, 95% CI 1.73 - 12.20, P value = 0.02). The measures for individual safety endpoints were also numerically lower in the control arm; however, none of these values reached the level of statistical significance.

Conclusions: HCQ might offer no benefits in terms of decreasing the viral load and radiological improvement in patients with COVID-19. HCQ appears to be associated with higher odds of all-cause mortality and NAEs.
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http://dx.doi.org/10.14740/jocmr4233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430873PMC
August 2020

Outcomes of percutaneous intervention in in-stent versus de-novo chronic total occlusion: a meta-analysis.

Expert Rev Cardiovasc Ther 2020 Nov 31;18(11):827-833. Epub 2020 Aug 31.

Cardiovascular Medicine, Wayne State University, Detroit Medical Center , Michigan, USA.

Background: Chronic total occlusion (CTO) is defined as coronary artery obstruction with no luminal continuity. Comparative outcomes of PCI in patients with in-stent CTO (IS-CTO) versus de-novo CTO are unclear.

Methods: An extensive literature search was done for outcomes of PCI in patients undergoing IS-CTO and de-novo CTO. The primary endpoint was major adverse cardiac events (MACE) and secondary endpoints were cardiovascular mortality, MI, and procedural success. Odds ratio (OR) with a 95% confidence interval (CI) was calculated using RevMan 5.3.

Results: Five studies consisting of 3,681 patients (IS-CTO = 464, de-novo CTO = 3,217) were included. PCI in IS-CTO was associated with a significantly higher odds of MACE (OR 2.21, 95% CI 1.32-3.68, p = 0.002) and MI (OR 4.31, 95% CI 1.94-9.58, p = 0.0003) compared to patients with de-novo CTO. Mortality outcome (OR 1.49, 95% CI 0.93-2.39, p = 0.10) between the two groups was similar. Overall odds of procedural-success were similar among the groups (OR 1.11, 95% CI 0.84-1.46, p = 0.47).

Conclusion: PCI for in-stent CTO might be associated with higher odds of MACE and MI compared to PCI for de-novo CTO. However, cardiovascular mortality or failure of procedure are similar.
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http://dx.doi.org/10.1080/14779072.2020.1813026DOI Listing
November 2020

The efficacy and safety of transradial and transfemoral approach in treatment of coronary chronic total occlusion: a systematic review and meta-analysis.

Expert Rev Cardiovasc Ther 2020 Nov 27;18(11):809-817. Epub 2020 Oct 27.

Department of Cardiology, Wayne State University, Detroit Medical Center , Detroit, Michigan, USA.

Background: The clinical efficacy and safety of transradial (TR) percutaneous coronary intervention (PCI) in comparison to transfemoral (TF) for chronic total occlusion (CTO) is not well studied in literature. : We sought to study the outcome and complications associated with TR compared with TF for CTO interventions.

Methods: After a systematic literature search was done in PubMed and EMBASE, we performed a meta-analysis of studies comparing TF and TR for CTO PCI. : Twelve studies with 19,309 patients were included. Compared to those who has TF access, individuals who were treated via TR approach had statistically significant lower access complication rates [odds ratio (OR): 0.33; 95% confidence interval (CI): 0.22 to 0.49; p < 0.0001]. The procedural success was in the favor of TR method (OR: 1.4; 95% CI: 1.31-1. 51; p < 0.0001). The incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and contrast-induced nephropathy were similar in both groups.

Conclusion: When compared with TF access interventions in CTO PCI; the TR approach appears to be associated with far less access-site complications, higher procedural success, and comparable MACCE.
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http://dx.doi.org/10.1080/14779072.2020.1813025DOI Listing
November 2020

Reply to "SARS-CoV-2-associated Takotsubo is not necessarily triggered by the infection".

Int J Cardiol Heart Vasc 2020 Oct 6;30:100613. Epub 2020 Aug 6.

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

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http://dx.doi.org/10.1016/j.ijcha.2020.100613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409938PMC
October 2020

Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis.

J Interv Cardiol 2020 26;2020:4081642. Epub 2020 Jul 26.

Thomas Jefferson University, Philadelphia, PA, USA.

Background: The safety and efficacy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for stable left main coronary artery disease (LMCAD) remains controversial.

Methods: Digital databases were searched to compare the major adverse cardiovascular and cerebrovascular events (MACCE) and its components. A random effect model was used to compute an unadjusted odds ratio (OR).

Results: A total of 43 studies (37 observational and 6 RCTs) consisting of 29,187 patients (PCI 13,709 and CABG 15,478) were identified. The 30-day rate of MACCE (OR, 0.56; 95% CI, 0.42-0.76;  = 0.0002) and all-cause mortality (OR, 0.52; 95% CI, 0.30-0.91;  = 0.02) was significantly lower in the PCI group. There was no significant difference in the rate of myocardial infarction (MI) ( = 0.17) and revascularization ( = 0.12). At 5 years, CABG was favored due to a significantly lower rate of MACCE (OR, 1.67; 95% CI, 1.18-2.36;  = <0.04), MI (OR, 1.67; 95% CI, 1.35-2.06;  = <0.00001), and revascularization (OR, 2.80; 95% CI, 2.18-3.60;  = <0.00001), respectively. PCI was associated with a lower overall rate of a stroke, while the risk of all-cause mortality was not significantly different between the two groups at 1- ( = 0.75), 5- ( = 0.72), and 10-years ( = 0.20). The Kaplan-Meier curve reconstruction revealed substantial variations over time; the 5-year incidence of MACCE was 38% with CABG, significantly lower than 45% with PCI ( = <0.00001).

Conclusion: PCI might offer early safety advantages, while CABG provides greater durability in terms of lower long-term risk of ischemic events. There appears to be an equivalent risk for all-cause mortality.
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http://dx.doi.org/10.1155/2020/4081642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399756PMC
January 2021

COVID-19 cardiovascular epidemiology, cellular pathogenesis, clinical manifestations and management.

Int J Cardiol Heart Vasc 2020 Aug 14;29:100589. Epub 2020 Jul 14.

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

Coronavirus Disease 2019 (COVID-19) is a rapidly progressing global pandemic that may present with a variety of cardiac manifestations including, but not limited to, myocardial injury, myocardial infarction, arrhythmias, heart failure, cardiomyopathy, shock, thromboembolism, and cardiac arrest. These cardiovascular effects are worse in patients who have pre-existing cardiac conditions such as coronary artery disease, hypertension, diabetes mellitus, and coagulation abnormalities. Other predisposing risk factors include advanced age, immunocompromised state, and underlying systemic inflammatory conditions. Here we review the cellular pathophysiology, clinical manifestations and treatment modalities of the cardiac manifestations seen in patients with COVID-19.
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http://dx.doi.org/10.1016/j.ijcha.2020.100589DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359794PMC
August 2020

Safety and efficacy of anticoagulant monotherapy in atrial fibrillation and stable coronary artery disease: A systematic review and meta-analysis.

Eur J Intern Med 2020 11 22;81:54-59. Epub 2020 Jul 22.

Thomas Jefferson University, Philadelphia, PA, USA.

Background: Adjunctive use of oral anticoagulant (OAC) and antiplatelet therapy (APT) in patients with stable coronary artery disease (CAD) and nonvalvular atrial fibrillation (AF) is a challenge of daily practice.

Methods: A comprehensive literature search of databases was performed to identify studies comparing the safety and efficacy of OAC monotherapy and combined therapy (OAC plus single (S) APT). Events including major adverse cardiovascular events (MACE), all-cause mortality, stroke and major bleeding were analyzed.

Results: Seven articles comprising 11,070 subjects were identified. Combined therapy was associated with a significantly higher risk of major bleeding (pooled hazard ratio (HR) of 1.62, 95% CI 1.40-1.86, p=<0.0001) compared to the OAC monotherapy. There was no significant difference between the two comparison arms in terms of MACE (HR 1.14; 95% CI 0.97-1.34, p = 0.11), stroke (HR 1.05; 95% CI 0.77-1.43, p = 0.78) and all-cause mortality (HR 1.15; 95% CI 0.94-1.40, p = 0.16). Stratified analysis by inclusion of only patients with coronary stents attenuated the safety effect of monotherapy. Subgroup analysis based on the study design, type of OAC, major bleeding criteria and APT revealed findings consistent with the pooled HR. The combined therapy group had a 19% and 38% higher risk of MACE in studies with a history of MI (p = 0.03) and with the use of rivaroxaban (p = 0.02), respectively.

Conclusion: OAC monotherapy might have a lower incidence of major bleeding events with no higher overall risk of MACE, ischemic stroke and all-cause mortality compared to the combined therapy group.
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http://dx.doi.org/10.1016/j.ejim.2020.06.035DOI Listing
November 2020

COVID-19 Presenting as Takotsubo Cardiomyopathy Complicated with Atrial Fibrillation.

Int J Cardiol Heart Vasc 2020 Aug 10;29:100580. Epub 2020 Jul 10.

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

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http://dx.doi.org/10.1016/j.ijcha.2020.100580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348613PMC
August 2020

Comparative accuracy of non-invasive imaging versus right heart catheterization for the diagnosis of pulmonary hypertension: A systematic review and meta-analysis.

Int J Cardiol Heart Vasc 2020 Aug 1;29:100568. Epub 2020 Jul 1.

Thomas Jefferson University, PA, United States.

Background: Right heart catheterization (RHC) is the gold-standard in the diagnosis of pulmonary hypertension (PH) but at the cost of procedure-related complications. We sought to determine the comparative accuracy of RHC versus non-invasive imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and transthoracic echocardiography (TTE).

Methods: Pulmonary hypertension was defined as a mean pulmonary artery pressure (mPAP) of>20 mmHg. Multiple databases were queried for relevant articles. Raw data were pooled using a bivariate model to calculate the measures of diagnostic accuracy and to estimate Hierarchical Summary Receiver Operating Characteristic (HSROC) on Stata 13.

Results: A total of 51 studies with a total patient population of 3947 were selected. The pooled sensitivity and specificity of MRI for diagnosing PH was 0.92(95% confidence interval (CI) 0.88-0.96) and 0.86 (95% CI, 0.77-0.95), respectively. The net sensitivities for CT scan and TTE were 0.79 (95% CI 0.72-0.89) and 0.85 (95% CI 0.83-0.91), respectively. The overall specificity was 0.82 (0.76-0.92) for the CT scan and 0.71 (95% CI 0.61-0.84) for TTE. The diagnostic odds ratio (DOR) for MRI was 124 (95% CI 36-433) compared to 30 (95% CI 11-78) and 24 (95% 11-38) for CT scan and TTE, respectively. Chi-squared (2) test showed moderate heterogeneity on the test for equality of sensitivities and specificities.

Conclusions: MRI has the highest sensitivity and specificity compared to CT and TTE. MRI can potentially serve as a surrogate technique to RHC for the diagnosis of PH.
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http://dx.doi.org/10.1016/j.ijcha.2020.100568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7334462PMC
August 2020

Reply to the "Detailed association between peripheral arterial disease and comorbidity following left ventricular assist device implantation".

Int J Cardiol Heart Vasc 2020 Aug 28;29:100565. Epub 2020 Jun 28.

Abington Jefferson Health, Abington, PA, USA.

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http://dx.doi.org/10.1016/j.ijcha.2020.100565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330064PMC
August 2020