Publications by authors named "Yasar Sattar"

109 Publications

From Takotsubo to Yamaguchi.

Cureus 2022 Mar 28;14(3):e23561. Epub 2022 Mar 28.

Cardiology, Saint Vincent Hospital, Worcester, USA.

Our patient was a 56-year-old Caucasian female who had 34 emergency department visits to our center with recurrent chest pain, of which eleven were of cardiac etiology, involving cardiac causes over the period of seven years. Her chest pain was diagnosed as atypical during her previous visits. Chest CT revealed "ace-of-spades" in the cardiac transverse section. A transthoracic echocardiogram (TTE) demonstrated apical hypertrophy with end-systolic cavity obliteration and an ejection fraction (EF) of 65%-70%, seated amidst a normal-sized left ventricle, with normal wall thickness, indicating Yamaguchi syndrome. In the case report, we portray the need to widen the spectrum of differentials in an encounter with a patient presenting with chest pain.
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http://dx.doi.org/10.7759/cureus.23561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9044692PMC
March 2022

Epidemiology, clinical ramifications, and cellular pathogenesis of COVID-19 mRNA-vaccination-induced adverse cardiovascular outcomes: A state-of-the-heart review.

Biomed Pharmacother 2022 May 21;149:112843. Epub 2022 Mar 21.

Department of Interventional Cardiology, Detroit Medical Center, DMC Heart Hospital, Detroit, MI, USA.

The coronavirus disease 2019 (COVID-19) has overwhelming healthcare systems globally. To date, a myriad of therapeutic regimens has been employed in an attempt to curb the ramifications of a severe COVID-19 infection. Amidst the ongoing pandemic, the advent and efficacious uptake of COVID-19 vaccination has significantly reduced disease-related hospitalizations and mortality. Nevertheless, many side-effects are being reported after COVID-19 vaccinations and myocarditis is the most commonly reported sequelae post vaccination. Majority of these diseases are associated with COVID-19 mRNA vaccines. Various studies have established a temporal relationship between these complications, yet the causality and the underlying pathogenesis remain hypothetical. In this review, we aim to critically appraise the available literature regarding the cardiovascular side effects of the various mRNA vaccines and the associated pathophysiology.
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http://dx.doi.org/10.1016/j.biopha.2022.112843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8934717PMC
May 2022

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

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

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

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

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

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

Pakistan Institute of Medical Science, Islamabad, Pakistan.

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

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

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

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

Outcomes, Trends, and Predictors of Gastrointestinal Bleeding in Patients Undergoing Transcatheter Aortic Valve Implantation (from the National Inpatient Sample).

Am J Cardiol 2022 May 19;170:83-90. Epub 2022 Feb 19.

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

Major bleeding has been identified as one of the most common complications after transcatheter aortic valve implantation (TAVI) with some suffering gastrointestinal bleeding (GIB). This study aimed at assessing the incidence and predictors of GIB after TAVI in the United States. We performed a retrospective analysis of data from the National Inpatient Sample database from 2011 to 2018. A total of 216,023 hospitalizations for TAVI were included. Of the included patients, 2,188 (1%) patients had GIB, whereas 213,835 (99%) patients did not have GIB. The presence of arteriovenous malformation was associated with the highest odds of having a gastrointestinal bleed (odds ratio (OR) 24.8, 95% confidence interval (CI) 17.13 to 35.92). Peptic ulcer disease was associated with an eightfold increased risk of bleeding (OR 8.74, 95% CI, 6.69 to 11.43) followed closely by colorectal cancer (OR 7.89, 95% CI, 5.33 to 11.70). Other comorbidities that were associated with higher propensity-matched rates of GIB were chronic kidney disease (OR 1.27,95% CI, 1.14 to 1.41), congestive heart failure (OR 1.18, 95% CI,1.06 to 1.32), liver disease (OR1.83, 95% CI,1.53 to 2.19), end-stage renal disease (OR 2.08,95% CI, 1.75 to 2.47), atrial fibrillation (OR1.63,95% CI,  1.49 to 1.78), and lung cancer (OR 2.80, 95% CI,1.77 to 4.41). Patients with GIB had higher propensity-matched rates of mortality than those without GIB, (12.1% vs 3.2%, p <0.01). Patients with GIB had a higher median cost of stay ($68,779 vs $46,995, p <0.01) and a longer length of hospital stay (11 vs 3 days, p <0.01). In conclusion, health care use and mortality are higher in hospitalizations of TAVI with a GIB. Baseline comorbidities like peptic ulcer disease, chronic kidney disease, liver disease, atrial fibrillation and, colorectal cancer are significant predictors of this adverse event.
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http://dx.doi.org/10.1016/j.amjcard.2022.01.022DOI Listing
May 2022

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

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

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

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

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

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

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

Interhospital readmissions and early post-discharge outcomes of transcatheter mitral valve edge-to-edge repair.

Cardiovasc Revasc Med 2022 Feb 9. Epub 2022 Feb 9.

Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, United States of America. Electronic address:

Introduction: Fragmented postoperative care following elective procedures has been associated with poor outcomes. However, the association between interhospital readmission (IHR) and clinical outcomes after transcatheter edge-to-edge repair (TEER) is unknown.

Methods: Adults who underwent TEER between 2014 and 2018 were identified in the National Readmission Database (NRD). We classified patients who were re-hospitalized within 90-days after TEER as: patients admitted to the index hospital (same hospital readmission; SHR) and those admitted to a different hospital (interhospital readmission; IHR). We compared 90-day outcomes, cause of readmission, length of stay (LOS), and costs between the two groups. Moreover, we tested whether IHR was an independent predictor of 180-day morality using logistic regression.

Results: Of the 12,716 patients who underwent TEER, 2444 were hospitalized within 90-days; among those, 1179 (48.2%) were admitted to a different hospital (IHR). Cardiovascular causes of readmission were more common in the SHR group (63.5% vs 56.7%, P < 0.001). After PSM, major adverse events were higher in the SHR group during both the index admission and during rehospitalization. Also, during the readmission, LOS and cost of care were both higher in the SHR group, while non-home discharge rates were higher in the IHR group. In the logistic regression model, IHR was not independently associated with 180-day mortality.

Conclusion: Admission to a different hospital post TEER was not associated with higher adverse event rate. The current system of care wherein patients requiring TEER are referred to tertiary centers of excellence appears appropriate.
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http://dx.doi.org/10.1016/j.carrev.2022.01.025DOI Listing
February 2022

Acute myocardial infarction and acute heart failure among renal transplant recipients: a national readmissions database study.

J Nephrol 2022 Feb 9. Epub 2022 Feb 9.

Division of Cardiology, Promedica, Toledo, Toledo, OH, USA.

Background: The literature on the mortality and 30-day readmissions for acute heart failure and for acute myocardial infarction among renal-transplant recipients is limited.

Objective: To study the in-hospital mortality, cardiovascular complications, and 30-day readmissions among renal transplant recipients (RTRs).

Methods: Data from the national readmissions database sample, which constitutes 49.1% of all hospitals in the United States and represents more than 95% of the stratified national population, was analyzed for the years 2012-2018 using billing codes.

Results: A total of 588,668 hospitalizations in renal transplant recipients (mean age 57.7 ± 14.2 years; 44.5% female) were recorded in the study years. A total of 15,788 (2.7%) patients had a diagnosis of acute heart failure; 11,320 (71.7%) had acute heart failure with preserved ejection fraction and 4468 (28.3%) had acute heart failure with reduced ejection fraction; 17,256 (3%) patients had myocardial infarction, 3496 (20%) had ST-Elevation myocardial infarction while 13,969 (80%) had non-ST-elevation myocardial infarction. Overall, 11,675 (2%) renal-transplant patients died, of whom 757 (6.5%) had acute heart failure, 330 (2.8%) had acute reduced and 427 (3.7%) had acute preserved ejection fraction failure. Among 1652 (14.1%) patient deaths with myocardial infarction, 465 (4%) were ST-elevation- and 1187 (10.1%) were non-ST-Elevation-related. The absolute yearly mortality rate due to acute heart failure increased over the years 2012-2018 (p-trend 0.0002, 0.001, 0.002, 0.05, respectively), while the mortality rate due to myocardial infarction with ST-elevation decreased (p-trend 0.002).

Conclusion: Cardiovascular complications are significantly associated with hospitalizations among RTRs. The absolute yearly mortality, and rate of heart failure (with reduced or preserved ejection fraction) increased over the study years, suggesting that more research is needed to improve the management of these patients.
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http://dx.doi.org/10.1007/s40620-022-01252-wDOI Listing
February 2022

Safety and efficacy of drug-coated balloon for peripheral artery revascularization-A systematic review and meta-analysis.

Catheter Cardiovasc Interv 2022 03 18;99(4):1319-1326. Epub 2022 Jan 18.

Department of Cardiology, Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA.

Background: The relative merits of the drug-coated balloon (DCB) versus uncoated balloon (UCB) angioplasty in endovascular intervention for patients with symptomatic lower extremity peripheral arterial disease (PAD) remains controversial.

Methods: Online databases were queried with various combinations of keywords to identify relevant articles. Net adverse events (NAEs) and its components were compared using a random effect model to calculate unadjusted odds ratios (ORs).

Results: A total of 26 studies comprising 26,845 patients (UCB: 17,770 and DCB: 9075) were included. On pooled analysis, DCB was associated with significantly lower odds of NAE (OR: 0.47, 95% confidence interval [CI]: 0.36-0.61), vessel restenosis (OR: 0.46, 95% CI: 0.37-0.57), major amputation (OR: 0.68, 95% CI: 0.47-99), need for repeat target lesion (OR: 0.38, 95% CI: 0.31-0.47) and target vessel revascularization (OR: 0.62, 95% CI: 0.47-0.81) compared with UCB. Similarly, the primary patency rate was significantly higher in patients undergoing DCB angioplasty (OR: 1.44, 95% CI: 1.19-1.75), while the odds for all-cause mortality (OR: 0.96, 95% CI: 0.85-1.09) were not significantly different between the two groups. A subgroup analysis based on follow-up duration (6 months vs. 1 vs. 2 years) followed the findings of the pooled analysis with few exceptions.

Conclusions: The use of DCB in lower extremity PAD intervention is associated with higher primary patency, lower restenosis, lower amputation rate, and decreased need for repeat revascularization with similar all-cause mortality as compared to UCB.
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http://dx.doi.org/10.1002/ccd.30074DOI Listing
March 2022

Real-world management and outcomes of 7 million patients with acute coronary syndrome according to clinical research trial enrollment status: A propensity matched analysis.

Eur Heart J Qual Care Clin Outcomes 2021 Dec 23. Epub 2021 Dec 23.

Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, UK.

Aims: We aimed to determine whether clinical outcomes and invasive care of acute coronary syndrome (ACS) patients participating in trials differed from non-participants, particularly including those who were trial-eligible.

Methods And Results: We included all hospitalizations with principal diagnosis of ACS in the US National Inpatient Sample between January 2004 and September 2015, stratified by trial enrollment and eligibility using the International Classification of Diseases, ninth revision. We conducted propensity score matching to investigate the following outcomes: all-cause mortality; major bleeding; stroke; composite of mortality, stroke and cardiac complications (major adverse cardiovascular/cerebrovascular events [MACCE]), coronary angiography (CA) and percutaneous coronary intervention (PCI). A total of 7,091,179 weighted ACS hospitalizations were analysed, including 19,684 (0.3%) trial participants and 7,071,495 non-participants (3,485,514 who were trial eligible). Trial participants were more likely to receive CA (Δ% 28.73%, 95%CI 27.22-30.24,p<0.001) and PCI (Δ% 27.13%, 95%CI 24.86-29.41,p<0.001), with decreased mortality (Δ% -3.51%, 95%CI -4.72 to -2.31,p<0.001), MACCE (Δ% -3.04%, 95%CI -4.55 to -1.53,p<0.001) and bleeding (Δ% -0.89%, 95%CI -1.59 to -0.19,p = 0.013) compared to non-participants. After accounting for eligibility, trial participants were more likely to undergo CA (Δ% 22.78%, 95%CI 21.58-23.99,p<0.001) and PCI (Δ% 23.95%, 95%CI 21.77-26.13,p<0.001), and had no difference in mortality (Δ% -0.21%, 95%CI -0.65-0.24,p = 0.362).

Conclusion: Among ACS patients, trial enrollment was associated with significantly greater invasive care and lower mortality than matched non-participants. Trial participants were more likely to be invasively managed even when compared to eligible non-participants, even though there was no difference in mortality.
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http://dx.doi.org/10.1093/ehjqcco/qcab098DOI Listing
December 2021

Meta-Analysis Comparing Gender-Based Cardiovascular Outcomes of Transradial Versus Transfemoral Access of Percutaneous Coronary Intervention.

Am J Cardiol 2022 01;162:49-57

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

Transradial (TR) access for percutaneous coronary intervention (PCI) improves outcomes and reduces the risk of major bleeding compared with transfemoral (TF) access. However, data on gender-stratified outcomes based on vascular access are limited. Databases were queried to find relevant articles. Primary outcomes, including major bleeding complications, mortality, and secondary outcome including major adverse cardiovascular events (MACEs), myocardial infarction, and cerebrovascular accidents, were analyzed using a random-effect model to calculate unadjusted odds ratio (OR) of TR-PCI and TF-PCI between the genders. A total of 9 studies comprising 3,889,257 patients (389,580 in the TR arm and 3,499,677 in the TF arm) were included. Males comprised 73% and 67% of the TR and TF arms, respectively. TR-PCI was associated with lower major bleeding (pooled OR 0.51, 95% CI 0.40 to 0.64, p = 0.00; female OR 0.49, 95% CI 0.34 to 0.71, p = 0.00; male OR 0.54, 95% CI 0.40 to 0.73, p = 0.00) and mortality (pooled OR 0.54, 95% CI 0.45 to 0.66, p = 0.00; female OR 0.56, 95% CI 0.44 to 0.71, p = 0.27; male OR 0.54, 95% CI 0.39 to 0.75, p = 0.00) regardless of gender as compared with TF-PCI. Furthermore, TR-PCI also showed lower MACE (pooled OR 0.74, 95% CI 0.66 to 0.84, p = 0.00; female OR 0.64, 95% CI 0.59 to 0.70, p = 0.00; male OR 0.81, 95% CI 0.66 to 0.98, p = 0.00) as compared with TF-PCI in both genders. On analysis of interaction magnitude of the difference of favor of female and male for TR-PCI showed no statistically significant measurable difference. Periprocedural myocardial infarction and cerebrovascular accidents were not statistically different in TR and TF-PCI and were not different based on gender. In conclusion, TR-PCI was associated with a lower risk of major bleeding, mortality, and MACE irrespective of gender. In conclusion, TR-PCI should be the default access.
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http://dx.doi.org/10.1016/j.amjcard.2021.08.059DOI Listing
January 2022

Accuracy of pulsatile photoplethysmography applications or handheld devices vs. 12-lead ECG for atrial fibrillation screening: a systematic review and meta-analysis.

J Interv Card Electrophysiol 2021 Nov 13. Epub 2021 Nov 13.

Cardiology, Detroit Medical Center Heart Hospital, 311 Mack Ave, Detroit, MI, 48201, USA.

Background: The relative accuracy of pulsatile photoplethysmography applications (PPG) or handheld (HH) devices compared with the gold standard 12-lead electrocardiogram (ECG) for the diagnosis of atrial fibrillation is unknown.

Methods: Digital databases were searched to identify relevant articles. Raw data were pooled using a bivariate model to calculate diagnostic accuracy measures and estimate Hierarchical Summary Receiver Operating Characteristic (HSROC).

Results: A total of 10 articles comprising 4296 patients (mean age 68.9 years, with 56% males) were included in the analysis. Compared with EKG, the pooled sensitivity of PPG and HH devices in AF detection was 0.93 (95% CI 0.87-0.96; p < 0.05) and 0.87 (95% CI. 0.74-0.94; p < 0.05), respectively. The pooled specificity of PPG and HH devices in AF detection was 0.91 (95% CI 0.88-0.94; p < 0.05) and 0.96 (95% CI 0.90-0.98; p < 0.05), respectively. The diagnostic odds ratio was 129 and 144 for PPG and HH devices, respectively. Fagan's nomogram showed the probability of a patient having AF and normal rhythm on PPG or HH devices was 2-3%, while the post-test probability of having AF with an irregular R-R interval on PPG or HH devices was 73% and 82%, respectively. The scatter plot of positive and negative likelihood ratio showed high confirmation of AF and reliability of exclusion of absence of irregular R-R intervals (positive likelihood ratio > 10, and negative likelihood ratio < 0.1) on HH devices while PPG was used as confirmation only.

Conclusions: The PPG or HH devices can serve as a reliable alternative for the detection of AF.
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http://dx.doi.org/10.1007/s10840-021-01068-xDOI Listing
November 2021

Outcomes of intravascular ultrasound versus optical coherence tomography guided percutaneous coronary angiography: A meta regression-based analysis.

Catheter Cardiovasc Interv 2022 01 20;99(1):E1-E11. Epub 2021 Oct 20.

Cardiology, Detroit Medical Center, Detroit, Michigan, USA.

Background: Studies comparing clinical outcomes with intravascular ultrasound (IVUS) versus optical coherence tomography (OCT) guidance for percutaneous coronary intervention (PCI) in patients presenting with coronary artery disease, including stable angina or acute coronary syndrome, are limited.

Methods: We performed a detailed search of electronic databases (PubMed, Embase, and Cochrane) for randomized controlled trials and observational studies that compared cardiovascular outcomes of IVUS versus OCT. Data were aggregated for the primary outcome measure using the random-effects model as pooled risk ratio (RR). The primary outcome of interest was major adverse cardiac events (MACE), cardiac mortality, and all-cause mortality. Secondary outcomes included myocardial infarction (MI), stent thrombosis (ST), target lesion revascularization (TLR), and stroke.

Results: A total of seven studies met the inclusion criteria, comprising 5917 patients (OCT n = 2075; IVUS n = 3842). OCT-PCI versus IVUS-guided PCI comparison yielded no statistically significant results for all the outcomes; MACE (RR 0.78; 95% confidence interval [CI], 0.57-1.09; p = 0.14), cardiac mortality (RR 0.97; 95% CI, 0.27-3.46; p = 0.96), all-cause mortality (RR 0.74; 95% CI, 0.39-1.39; p = 0.35), MI (RR 1.27; 95% CI, 0.52-3.07; p = 0.60), ST (RR 0.70; 95% CI, 0.13-3.61; p = 0.67), TLR (RR 1.09; 95% CI, 0.53-2.25; p = 0.81), and stroke (RR 2.32; 95% CI, 0.42-12.90; p = 0.34). Furthermore, there was no effect modification on meta-regression including demographics, comorbidities, lesion location, lesion length, and stent type.

Conclusions: In this meta-analysis, OCT-guided PCI was associated with no difference in clinical outcomes compared with IVUS-guided PCI.
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http://dx.doi.org/10.1002/ccd.29976DOI Listing
January 2022

Recurrent Coronary Artery Fistulae and a Novel Transforming Growth Factor Beta-3 Mutation.

Cureus 2021 Sep 6;13(9):e17780. Epub 2021 Sep 6.

Cardiology, Detroit Medical Center, Detroit, USA.

Loeys-Dietz syndrome (LDS) is a rare connective tissue disease associated with mutations in transforming growth factor (TGF) signaling leading to an increased risk of arterial calcification, aneurysms, and/or dissections. We report a case in which genetics evaluation revealed a rare variant E244K in the TGFB3 gene. The variant leads to the substitution of glutamic acid for lysine, two amino acids with dissimilar properties. Analysis from evolutionary data shows the glutamic acid is maintained across species. The clinical significance of the E244K variant in association with LDS was never previously reported as pathologic. This case report aims to report that the significance of the E244K variant in the TGFB3 gene is found to be pathologic in our case. A search on the Genome Aggregation Database (gnomAD) did not reveal any previously identified individuals with this variant, despite being a well-covered region. ClinVar has a few entries for E244K, where most of them are listed as unknown significance. Bringing together the genotype evidence with our patient's clinical picture, we consider the variant to be pathogenic for this family.
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http://dx.doi.org/10.7759/cureus.17780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8496650PMC
September 2021

Outcomes of transcatheter aortic valve replacement in patients with and without atrial fibrillation: Insight from national inpatient sample.

Expert Rev Cardiovasc Ther 2021 Oct 3;19(10):939-946. Epub 2021 Nov 3.

Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA.

Background: Atrial fibrillation (AF) is one of the most frequent rhythm disturbance encountered in the population in general. Our study aims to evaluate the in-hospital outcomes of TAVR with AF.

Methods: We used National Inpatient Sample database from 2011 to 2018. Baseline characteristics and in-hospital outcomes were evaluated in TAVR based on AF status or not in both unmatched and propensity-matched cohorts.

Results: A total of 215,938 patients underwent TAVR during our study period and out of these AF was encountered in 89,587 (41.5%) patients. AF patients undergoing TAVR had a higher mean age and had an increased burden of key co-morbidities in the unmatched cohort. With propensity matched 1:1 analysis, AF had higher mortality as compared to no-AF group (2.4% vs. 2.1%, p < 0.01). The rate of cardiogenic shock (2.9% vs 2.1%), respiratory complications (9.9% vs 8.2%), acute kidney injury (15.6% vs 12.0%), vascular complications (5.0% vs 4.7%), and blood transfusion (10.4% vs 8.6%) was higher in TAVR patients with AF. A lower proportion of patients had routine discharge to home for TAVR with AF (80.8% vs 74.4%). Cost of hospitalization (23,0171[SD, 20,5242] vs 210,608[28,4203]) and length of stay (5.7[SD, 11.8] vs 4.29[7.2] days) were considerably higher in patients undergoing TAVR with AF.

Conclusion: Patients undergoing TAVR with concomitant AF tended to have increased mortality, complications, length, and cost of stay compared to non-AF patients.
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http://dx.doi.org/10.1080/14779072.2021.1988852DOI Listing
October 2021

Efficacy of remote dielectric sensing (ReDS) in the prevention of heart failure rehospitalizations: a meta-analysis.

J Community Hosp Intern Med Perspect 2021 20;11(5):646-652. Epub 2021 Sep 20.

Detroit Medical Center, Detroit, MI, USA.

The clinical efficacy of remote dielectric sensing (ReDS) monitoring is not well known. Digital databases were searched to identify relevant articles. Pooled unadjusted odds ratio (OR) for dichotomous outcomes were calculated using a random-effects model. Findings were reported as a point estimate with its 95% confidence interval (CI). A total of 985 patients across seven studies were included in the meta-analysis. Patients with heart failure monitored with ReDS had significantly lower odds of hospital readmission compared with non-ReDS patients (OR = 0.40; 95% CI 0.29-0.56; = 5.43 = 0.000, I2 = 0%). Subgroup analysis based on the duration of follow-up showed a lower odd of readmission within 30 days (OR = 0.36; 95% CI 0.18-0.71; = 2.93; = 0.003; I2 5.7%), as well as between 1 and 3 months (OR = 0.42; 95% CI 0.29-0.61; = 4.54; = 0.000; I2 = 0.0%). ReDS effect of lower readmissions of HF was observed irrespective of the duration of follow-up (<1-month vs 1-3 months). ReDS monitoring significantly lowers the odds of HF readmission within 3 months compared to participants not using ReDS.
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http://dx.doi.org/10.1080/20009666.2021.1955451DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462919PMC
September 2021

Safety and efficacy of the polymer-free and polymer-coated drug-eluting stents in patients undergoing percutaneous coronary intervention.

Catheter Cardiovasc Interv 2021 11 12;98(6):E802-E813. Epub 2021 Sep 12.

Department of Cardiology, Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA.

Introduction: The relative safety and efficacy of polymer-free (PF) versus polymer-coated (PC) drug-eluting stents (DES) in patients with angina or acute coronary syndrome (ACS) undergoing percutaneous coronary intervention has received limited study.

Method: Digital databases were queried to identify relevant studies. Major adverse cardiovascular events (MACE) and secondary outcomes were compared using a random effect model to calculate unadjusted odds ratios (OR).

Results: A total of 28 studies consisting of 23,198 patients were included in the final analysis. On pooled analysis, there was no significant difference in the odds of MACE (OR 0.98, 95% CI 0.91-1.08) and major bleeding (OR 0.87, 95% CI 0.61-1.24) between patients undergoing PF-DES versus PC-DES. Similarly, the odds of myocardial infarction, stroke, stent thrombosis, cardiovascular mortality and need for target vessel revascularization was similar between the two groups. PF-DES was favored due to significantly lower odds of non-cardiac death (OR 0.78, 95% CI 0.68-89) and all-cause mortality (OR 0.87, 95% CI 0.80-0.95), but had a higher need for target lesion revascularization (OR 1.2, 95% CI 1.02-1.42). A subgroup analysis based on follow up duration, clinical presentation, presence of diabetes and class of eluting drugs mirrored the net estimates for all outcomes with a few exceptions. A sensitivity and meta-regression analysis showed no influence of single-study and duration of antiplatelet therapy on pooled outcomes.

Conclusion: In patients presenting with angina or ACS, PF-DES might be favored due to lower all-cause mortality and equal risk of ischemic adverse cardiovascular and major bleeding events compared with PC-DES.
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http://dx.doi.org/10.1002/ccd.29953DOI Listing
November 2021

Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample.

J Am Heart Assoc 2021 09 28;10(17):e020948. Epub 2021 Aug 28.

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

Background Redo mitral valve surgery is required in up to one-third of patients and is associated with significant mortality and morbidity. Valve-in-valve transcatheter mitral valve replacement (ViV TMVR) is less invasive and could be considered in those at prohibitive surgical risk. Studies on comparative outcomes of ViV TMVR and redo surgical mitral valve replacement (SMVR) remain limited. Our study aimed to investigate the real-world outcomes of the above procedures using the National Inpatient Sample database. Methods and Results We analyzed National Inpatient Sample data using the () from September 2015 to December 2018. A total of 495 and 2250 patients underwent redo ViV TMVR and SMVR, respectively. The patients who underwent ViV TMVR were older (77 versus 68 years, <0.01). Adjusted mortality was higher in the redo SMVR group compared with the ViV TMVR group (7.6% versus <2.8%, <0.01). Perioperative complications were higher among patients undergoing redo SMVR including blood transfusions (38% versus 7.6%, <0.01) and acute kidney injury (36.7% versus 13.9%, <0.01). Cost of care was higher (USD$57 172 versus USD$52 579, <0.01), length of stay was longer (10 versus 3 days, <0.01), and discharge to home was lower (20.3% versus 64.6%, <0.01) in the SMVR group compared with the ViV TMVR group. Conclusions ViV TMVR is associated with lower mortality, periprocedural morbidity, and resource use compared with patients undergoing redo SMVR. ViV TMVR may be a viable option for some patients with mitral prosthesis dysfunction. Studies evaluating long-term outcomes and durability of ViV TMVR are needed. A patient-centered approach by the heart team, local institutional expertise, and careful preprocedure planning can help decision-making about the choice of intervention for the individual patient.
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http://dx.doi.org/10.1161/JAHA.121.020948DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649266PMC
September 2021

Coronavirus disease 2019 (COVID-19): Multisystem review of pathophysiology.

Ann Med Surg (Lond) 2021 Sep 23;69:102745. Epub 2021 Aug 23.

Division of Cardiology, West Virginia University, Morgantown, USA.

Coronavirus disease-19 (COVID-19) pandemic is associated with high morbidity and mortality. COVID-19, which is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2), affects multiple organ systems through a myriad of mechanisms. Afflicted patients present with a vast constellation of symptoms, from asymptomatic disease to life-threatening complications. The most common manifestations pertain to mild pulmonary symptoms, which can progress to respiratory distress syndrome and venous thromboembolism. However, in patients with renal failure, life-threatening cardiac abnormalities can ensue. Various mechanisms such as viral entry through Angiotensin receptor (ACE) affecting multiple organs and thus releasing pro-inflammatory markers have been postulated. Nevertheless, the predictors of various presentations in the affected population remain elusive. An ameliorated understanding of the pathology and pathogenesis of the viral infection has led to the development of variable treatment options, with many more that are presently under trial. This review article discusses the pathogenesis of multiple organ involvement secondary to COVID-19 infection in infected patients.
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http://dx.doi.org/10.1016/j.amsu.2021.102745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381637PMC
September 2021

Chronic inflammatory demyelinating polyneuropathy as a paraneoplastic manifestation of colorectal carcinoma: What do we know?

Ann Med Surg (Lond) 2021 Aug 9;68:102545. Epub 2021 Jul 9.

Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.

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http://dx.doi.org/10.1016/j.amsu.2021.102545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8376678PMC
August 2021

Extended spectrum beta lactamase producing eustachian valve infective endocarditis.

Ann Med Surg (Lond) 2021 Sep 10;69:102705. Epub 2021 Aug 10.

Division of Cardiology, West Virginia University, Morgantown, WV, USA.

Endocarditis is an infection of the endocardium caused by a multitude of bacteria, including , viridans streptococci, S. bovis, or S. epidermidis, among others. It can cause a variety of physical findings, including new onset murmur, Osler nodes, and Janeway lesions. Endocarditis is diagnosed with multiple positive blood cultures with transesophageal echocardiogram (TEE) showing valvular vegetations. In this article, we present a 47 year old female with a history of ESRD on dialysis who presented with a bleeding fistula found to be in septic shock. Diagnosis of eustachian valve endocarditis with ESBL was made through positive blood cultures as well as using TEE. She was started on IV meropenem for seven days, to which the patient completed and eventually was discharged home with resolution of symptoms.
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http://dx.doi.org/10.1016/j.amsu.2021.102705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365431PMC
September 2021

Chilaiditi syndrome: A structural displacement in a heart failure patient.

Ann Med Surg (Lond) 2021 Aug 5;68:102687. Epub 2021 Aug 5.

Division of Interventional Cardiology, Detroit Medical Center, Detroit, MI, USA.

Background: Chilaiditi's sign is often found incidentally on chest or abdominal radiograph and can be accompanied by clinical symptoms such as abdominal pain, gastrointestinal complications, and less commonly associated with dyspnea.

Case Presentation: In this interesting case, we discover lingering dyspnea in our 79 year old male with a past medical history of asthma and heart failure with preserved ejection fraction admitted for acute heart failure exacerbation with reduced ejection fraction along with a new incidental finding of Chilaiditi's sign on chest radiograph. Patient received optimal diuretics and guideline-directed medical treatment for heart failure exacerbation, but mild dyspnea with pleuritic chest pain persisted. Dyspnea with pleurisy was likely attributed to a structural anatomical defect (Chilaiditi's sign) that can be picked up on imaging.

Conclusion: Chilaiditi syndrome can be an incidental cause of ongoing persistent dyspnea, and if symptoms are severe, intervention can be warranted for symptomatic resolution.

Learning Objective: Chilaiditi syndrome should be considered as a possible diagnosis among patients with a history of heart failure and incidental Chilaiditi's sign on chest radiographic imaging who suffer from persistent dyspnea and pleurisy despite optimal diuretics and guideline-directed medical treatment.
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http://dx.doi.org/10.1016/j.amsu.2021.102687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353377PMC
August 2021

Diagnosis and management of unilateral subclavian steal syndrome with bilateral carotid artery stenosis.

Ann Med Surg (Lond) 2021 Aug 26;68:102597. Epub 2021 Jul 26.

Division of Interventional Cardiology, Detroit Medical Center, Detroit, MI, USA.

Subclavian steal syndrome is a rare phenomenon occurring from retrograde blood flow in the vertebral artery due to proximal stenosis in the subclavian artery. As a result, the arm gets blood supply from the vertebral artery at the expense of the vertebrobasilar system. The patient remains largely asymptomatic until there is an increase demand for blood supply to the arm, resulting in a constellation of symptoms including dizziness, vertigo, blurred vision, diplopia, headache, syncope, postural hypotension, neurologic deficits, and rarely, memory problems. The management approach depends on the severity of clinical symptoms but includes medical treatment, endovascular therapy and lifestyle modifications.
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http://dx.doi.org/10.1016/j.amsu.2021.102597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8329505PMC
August 2021

Characteristics and hospital outcomes of coronary atherectomy within the United States: a multivariate and propensity-score matched analysis.

Expert Rev Cardiovasc Ther 2021 Sep 12;19(9):865-870. Epub 2021 Aug 12.

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

Background: Suboptimal stent delivery and deployment in calcified coronary lesions are associated with a poor clinical outcome.

Methods: Using the National Inpatient Sample database, we identified patients undergoing percutaneous coronary intervention (PCI). Comparison between procedural and hospital outcomes between patients who underwent atherectomy and those who did not.

Results: A total of 2,035,039 patients underwent PCI, of which 50,095 (2.4%) underwent lesion modification using atherectomy. After adjustment for baseline differences, patients who underwent atherectomy were found to have higher rates of in-hospital mortality (3.3% vs 2.2% adjusted Odds Ratio, aOR, 1.39; 95% confidence interval [CI], 1.31-1.46, P < 0.001), coronary artery dissection (1.7% vs 1.1%, aOR, 1.56; 95%, 1.45-1.67, P < 0.001) vascular complications (1.6% vs 1.0%, aOR, 1.52; 95%, 1.42-1.64, P < 0.001), major bleeding (6.3% vs 4.7%, aOR, 1.24; 95%, 1.18-1.28, P < 0.001), and acute kidney injury (AKI) (10.9%vs 9.1%, aOR, 1.07; 95%, 1.04-1.11, P < 0.001) when compared with non-atherectomy patients. Concomitant intravascular ultrasound (IVUS) imaging improved mortality, while other complication rates were not affected by imaging.

Conclusion: Coronary atherectomy was performed in patients with multiple comorbidities and was associated with higher in-hospital mortality and complications than the non-atherectomy group.
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http://dx.doi.org/10.1080/14779072.2021.1963233DOI Listing
September 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 08 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 Renin-Angiotensin-Aldosterone System Inhibitors in COVID-19 Population.

High Blood Press Cardiovasc Prev 2021 Jul 28;28(4):405-416. Epub 2021 Jun 28.

Detroit Medical Center, DMC Heart Hospital, 311 Mack Ave, Detroit, MI, 48201, USA.

Introduction: The safety of renin-angiotensin-aldosterone system inhibitors (RAASi) among COVID-19 patients has been controversial since the onset of the pandemic.

Methods: Digital databases were queried to study the safety of RAASi in COVID-19. The primary outcome of interest was mortality. The secondary outcome was seropositivity improvement/viral clearance, clinical manifestation progression, and progression to intensive care units. A random-effect model was used to compute an unadjusted odds ratio (OR).

Results: A total of 49 observational studies were included in the analysis consisting of 83,269 COVID-19 patients (RAASi n = 34,691; non-RAASi n = 48,578). The mean age of the sample was 64, and 56% were males. We found that RAASi was associated with similar mortality outcomes as compared to non-RAASi groups (OR 1.07; 95% CI 0.99-1.15; p > 0.05). RAASi was associated with seropositivity improvement including negative RT-PCR or antibodies, (OR 0.96; 95% CI 0.93-0.99; p < 0.05). There was no association between RAASi versus control with progression to ICU admission (OR 0.99; 95% CI 0.79-1.23; p > 0.05) or higher odds of worsening of clinical manifestations (OR 1.04; 95% CI 0.97-1.11; p > 0.05). Metaregression analysis did not change our outcomes for effect modifiers including age, sex, comorbidities, RAASi type, or study type on outcomes.

Conclusions: COVID-19 is not a contraindication to hold or discontinue RAASi as they are not associated with higher mortality or worsening symptoms. Continuation of RAASi might be associated with favorable outcomes in COVID-19, including seropositivity/viral clearance.
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http://dx.doi.org/10.1007/s40292-021-00462-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237039PMC
July 2021

Clinical indicators for progression of nonalcoholic steatohepatitis to cirrhosis.

World J Gastroenterol 2021 Jun;27(23):3238-3248

Division of Gastroenterology, Icahn School of Medicine, Elmhurst Hospital, Elmhurst, NY 11375, United States.

Non-alcoholic fatty liver disease (NAFLD), is a disease spectrum characterized by fat accumulation in hepatocytes presenting as hepatic steatosis to advance disease with active hepatic inflammation, known as nonalcoholic steatohepatitis. Chronic steatohepatitis will lead to progressive hepatic fibrosis causing cirrhosis and increased risk for developing hepatocellular carcinoma (HCC). Fatty liver disease prevalence has increased at alarming rates alongside obesity, diabetes and metabolic syndrome to become the second most common cause of cirrhosis after alcohol related liver disease worldwide. Given this rise in prevalence, it is becoming increasingly more important to find non-invasive methods to diagnose disease early and stage hepatic fibrosis. Providing clinicians with the tools to diagnose and treat the full spectrum of NAFLD will help prevent known complications such as cirrhosis and HCC and improve quality of life for the patients suffering from this disease. This article discusses the utility of current non-invasive liver function testing in the clinical progression of fatty liver disease along with the imaging modalities that are available. Additionally, we summarize available treatment options including targeted medical therapy through four different pathways, surgical or endoscopic intervention.
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http://dx.doi.org/10.3748/wjg.v27.i23.3238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218360PMC
June 2021

In-hospital outcomes of endovascular versus surgical revascularization for chronic total occlusion in peripheral artery disease.

Catheter Cardiovasc Interv 2021 10 23;98(4):E586-E593. Epub 2021 Jun 23.

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

Background: The outcome of endovascular intervention (EVI) compared vs. surgical revascularization in patients with peripheral artery disease (PAD) due to chronic total occlusion (CTO) is unknown.

Methods: Using the National Inpatient Sample database between 2007 and 2014, we identified all PAD patients with CTO who had limb revascularization. Multivariate analysis was performed to estimate the odds of in-hospital mortality and adverse outcomes between both groups.

Results: A total of 168,420 patients who had peripheral CTO and underwent limb revascularization were identified. 99,279 underwent EVI, and 69,141 underwent surgical revascularization. The patients who underwent EVI were younger, more likely to be women and African American, and less likely to be white (p < 0.001 for all). EVI was associated with lower in-hospital mortality (1.2% vs 1.7%, adjusted odds ratio [aOR]: 0.54; 95% confidence interval [CI] 0.50-0.59). The EVI group had higher vascular complications, major bleeding, acute kidney injury (AKI), and major amputation compared with surgical revascularization. A subgroup analysis on patients with critical limb ischemia showed lower mortality in the EVI group (1.4% vs. 1.9, aOR 0.56; 95% CI 0.50-0.63). Although there was no difference in the incidence of AKI or major amputation between the two groups, the EVI group had higher vascular complication rates and major bleeding events.

Conclusion: EVI in PAD with CTO is associated with lower in-hospital mortality, likely due to the procedure's less-invasive nature; however, it is associated with higher postprocedural complications likely due to the CTO's complexity.
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http://dx.doi.org/10.1002/ccd.29827DOI Listing
October 2021
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