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:To evaluate safety and efficacy of distal right radial access (DRRA) compared to right radial access (RRA), for coronary procedures, in patients with smaller diameter radial arteries (SDRA) (radial artery diameter (RAD) < 2.1 mm).

Patients with severe coronary artery disease with a clinical indication for revascularization but who are at high procedural risk because of patient comorbidities, complexity of coronary anatomy, and/or poor hemodynamics represent an understudied and potentially underserved patient population. Through advances in percutaneous interventional techniques and technologies and improvements in patient selection, current percutaneous coronary intervention may allow appropriate patients to benefit safely from revascularization procedures that might not have been offered in the past. The burgeoning interest in these procedures in some respects reflects an evolutionary step within the field of percutaneous coronary intervention. However, because of the clinical complexity of many of these patients and procedures, it is critical to develop dedicated specialists within interventional cardiology who are trained with the cognitive and technical skills to select these patients appropriately and to perform these procedures safely. Preprocedural issues such as multidisciplinary risk and treatment assessments are highly relevant to the successful treatment of these patients, and knowledge gaps and future directions to improve outcomes in this emerging area are discussed. Ultimately, an evolution of contemporary interventional cardiology is necessary to treat the increasingly higher-risk patients with whom we are confronted.

Background:The duration of the QRS carries valuable information regarding structural disease, conduction defects, or even ischemia. Studies have shown that a widened QRS (>120) is associated with poor cardiovascular outcomes. In this study we investigated the impact of the presence of a widened QRS (wQRS )previous to Transcatheter Aortic Valve Replacement (TAVR) and clinical outcomes.Methods::Retrospective analysis of electronic medical records from 2018-2020 at the University of Illinois Chicago identified TAVR patients. Patients were placed into two groups: a wQRS and a nQRS group. Those with pacemakers prior to procedure were excluded. Primary outcomes included PPM placement prior to discharge, composite MACE (all-cause mortality, MI, or CVA), and (LOS) at 6 and 12 months.Results:We included 149 patients in this analysis. There were 76.1% male, 57.1% non-white, and 74 ± 13 years old on average. A wQRS was found in 46 (30.9%) and 103 (69.1%) were found to have a nQRS. Of this group, 40.2% had a history of congestive heart failure (CHF). The average ejection fraction (EF) was 50% with 80% of patients having a normal (EF). The CoreValve was placed in 65.7% of patient compared to 34.3% of patients having the Sapian valve placed. There were no differences in age, sex, or race between the two groups. Of all patient’s in the study, those with a wQRS were more likely to have a PPM placed prior to discharge compared to those with nQRS (17.4% (8) vs 5.8% (6) , p=0.025). Though not significant, 14% (13)of patients with the CoreValve placed required PPM prior to discharge compared to 2.5%(1) in the Sapian valve group (p=.175). There was no statistically significant difference in composite MACE, LOS, or significant bleeding events in either groups at 6 or 12 months.Conclusion:Our results suggest that patients with a wQRS are more likely to receive a PPM placement post TAVR during index hospitalization compared to those with a nQRS. This study suggests further investigation into the predictive nature of EKG parameters on clinical outcomes be done.

Introduction:Transcatheter Aortic Valve Replacement (TAVR) has become the primary therapeutic option for many patients with severe aortic stenosis (AS). As a result, anemia is a prevalent co-morbidity amongst the TAVR population. Recent studies have demonstrated pre-procedural anemia is associated with increased long-term mortality in TAVR patients. However, the comparison of TAVR patients’ post-procedural anemia and its effect on mortality has not been fully investigated.Methods:Retrospective analysis of electronic medical records from 2018-2021 at the University of Illinois at Chicago and Jesse Brown VA Medical Center identified TAVR patients. Primary outcomes included all-cause mortality and significant bleeding at 6-months and 12-months post-TAVR.Results:We included 160 patients in the analysis. They were 122 males, 56.88% non-white, and an average age of 73.88. At 6-months, patients who experienced all-cause mortality had an average hemoglobin of 9.85 (g/dL) compared to an average hemoglobin of 11.31 in those patients that survived (p = 0.020). There was no significant difference in major bleeding events between the two groups (p = 0.974) as well as no significant difference in past-medical history, including hypertension, hyperlipidemia (HLD), diabetes mellitus, history of stroke and history of myocardial infarction. At 12-months, patients who experienced all-cause mortality had an average hemoglobin of 10.18 compared to an average hemoglobin of 11.36 in those patients that survived (p = 0.014). There was no significant difference in major bleeding events (p = 0.753) and no significant difference in past-medical history, except for hyperlipidemia. The prevalence of HLD was 59.09% in those that experienced all-cause mortality compared to 78.72% in those that did not (p = 0.045).Conclusions:Our results suggest that patients with lower hemoglobin levels after TAVR are at a greater risk of all-cause mortality compared to those with higher hemoglobin levels. These patients may benefit from closer follow-up after the procedure.

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Introduction:Despite a notable 32.7% decline in mortality from ischemic heart disease since 1999, the prevalence of stable angina has not decreased. Up to 30% of patients have suboptimal pain relief even though they receive guideline-directed care. The aims of this pilot study were to evaluate preliminary efficacy of a standardized 12-point acupuncture prescription for reduction of pain, and improved functional status and health-related quality of life (HRQoL) for individuals with stable angina.Hypothesis:Acupuncture therapy would result in a reduction in pain and associated symptoms in individuals with stable angina.Methods:We conducted a randomized attention-controlled trial. Participants were enrolled from a predominantly urban minority community. Eligibility criteria included a diagnosis of stable angina for ≥1 month and experiencing symptoms at least once per week. Patients received either the standardized acupuncture protocol, twice a week for 5 weeks, or viewed videos unrelated to pain or heart disease. Outcome variables were measured with the McGill Pain Questionnaire Average Pain Intensity and pain now (at each visit) scales, and the Seattle Angina Questionnaire. Descriptive statistics and multivariable analyses of variance tests were performed.Results:The sample (n=24) had a mean age 59+12 years, was predominantly female (63%), and minority (8% White, 46% Black, 38% Hispanic, and 8% other). At study completion, primary outcomes of average pain intensity, worst pain in the last 24 hours, and pain now, were significantly lower in the acupuncture group. There was a significant improvement in functional status, symptoms, and HRQoL for the acupuncture group (Table).Conclusions:A standardized acupuncture protocol shows promise as a complementary therapy for symptom control for individuals with stable angina who are receiving care in a cardiology clinic which serves urban minorities.

Introduction:Social media (SoMe) platforms such as Twitter, Instagram, and Facebook are increasingly popular tools for dissemination of information. Currently, there is little research into SoMe and its utility in medical education (MedEd) at various training levels.Hypothesis:We hypothesize that residents will be more likely than medical students to use SoMe for MedEd and professional networking; that Twitter will be the dominant platform used by trainees for MedEd; that time constraints will be the primary barrier preventing trainees from using SoMe for MedEd; and that trainees who do use SoMe academically do so to network and collaborate.Methods:A survey based study was conducted at the University of Illinois College of Medicine. Surveys were sent to medical students and Internal Medicine residents and their responses recorded. Responses were anonymous. A Pearson Chi-Square analysis was used to analyze the categorical data.Results:Total of 294 responses were collected, 61 residents and 215 students. 51% (148) of responses were women. 50% (11/22) of medical students using Twitter use it for MedEd, vs 100% (9/9) of residents using Twitter use it for MedEd (p-value = 0.008). Only 22% (18/82, 7/31) of both residents and medical students using Instagram use it for MedEd. For residents and students alike, SoMe for MedEd was primarily used for up-to-date clinical guidelines rather than professional networking on both Twitter and Instagram (88% (14/16) and 67% (16/24) respectively). Among Instagram users, 71% (15/21) of trainees chose time constraint as the primary barrier to MedEd use. For Twitter, 100% (5/5) of trainees chose not knowing where to start as the primary barrier.Conclusion:Our study demonstrates that SoMe is a valid, but underutilized, education tool. Trainees most often utilized SoMe to keep up to date with clinical guidelines with Twitter being the most prominent platform for MedEd overall and engaging more residents than students. Targeted educational initiatives on these platforms may be a powerful platform to recruit trainees into the field of cardiology.

Introduction:There are well documented differences in TAVR outcomes among men and women from pre-procedure to 30-days post procedure. However, there is less data comparing the long-term differences in outcomes between genders. This study investigated cardiovascular outcomes between these two groups within 6 months of undergoing a TAVR.Methods:We performed a retrospective study among patients undergoing TAVR between March 2018 and June 2020 at the University of Illinois-Chicago (UIC) in Chicago, Illinois. Primary outcomes included composite MACE (CV death, MI and/or CVA) and all-cause death. Secondary outcomes included change in peak gradient, mean gradient, aortic valve area, and ejection fraction. Outcomes were analyzed at 6 months following the procedure. T and Chi square tests were used to analyze continuous/categorical variables, respectively.Results:There was a total of 115 patients (female: 25, male: 90) in the analysis. The female cohort was older and had a higher BMI. At baseline, the women had a higher peak gradient when compared to the men (64 vs 48mmHg, p=0.03). At 6 months, MACE (female=1.7 vs male=7%, p=0.9) and all cause death (4 vs 4.4%, p=0.9) were statistically similar. There was no significant difference in the change in ejection fraction or aortic valve area between men and women. There was no difference between peak aortic valve gradient or mean aortic valve gradient (p>0.05) between the groups immediately after the procedure or at 6 months following TAVR.Conclusion:Despite having higher baseline aortic valve gradients, women appeared to have similar procedural success and 6-month outcomes following TAVR as compared to men in this analysis. Women presenting with higher baseline gradients suggest that they may be under-diagnosed or misdiagnosed leading to delays in care. Further screening and earlier referral for women is important to maintaining good outcomes.

Background:Mitral regurgitation (MR) is seen in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). However, clinical outcomes in these patients have varied. The purpose of this study is to assess outcomes and changes in EF after TAVR in patients with concomitant MR.Methods:Retrospective chart review from March 2018-June 2020 identified all TAVR patients from the University of Illinois, Chicago. MR was assessed as none, mild, moderate, or severe regurgitation on baseline transthoracic echocardiogram. Patients were included if they demonstrated 6 or 12-month follow-up after valve replacement. Outcomes included all-cause mortality, major adverse cardiovascular events (MACE), clinically significant bleeding, and improvement in EF category, which included normal (50-70%), mildly (40-49%), moderately (30-39%), or severely (<30%) reduced.Results:118 patients (age 76±10 years, 79% male, 46% white) followed up at 6-months and 112 at 12-months. Of these, 33% had baseline MR with 79% being mild and 21% moderate. Patients with AS+MR were more likely to have atrial fibrillation (41.0 vs. 19.0%, p=0.01) and an EF<50% (33.3 vs. 8.9%, p=0.001) compared to those with AS only. After TAVR, patients with MR were more likely to show improvements in EF category at 6 months (19.4 vs. 5.5%, p=0.039, Fig. 1). In those with AS+MR vs. AS only, there were no differences in all-cause mortality (12.8 vs. 5.1%, p=0.14), MACE (17.9 vs. 8.9%, p=0.15), or bleeding (10.3 vs. 6.3%, p=0.45) at 6 months. There were also no differences in all-cause mortality (16.2 vs. 14.7%, p=0.83), MACE (24.3 vs. 20.0%, p=0.60), or bleeding (13.5 vs. 10.7%, p=0.66) at 12 months.Conclusion:At 6 and 12 months after TAVR, patients with AS+MR experienced similar clinical outcomes as compared to those with only AS. Patients with AS+MR were more likely to show increases in EF 6 months after valve replacement. Our results suggest that patients with AS+MR stand to benefit after TAVR.

Introduction:Chronic kidney disease (CKD) is known to accelerate the progression of aortic stenosis (AS) and portends adverse outcomes in patients treated with surgical valve replacement. Long-term outcomes in CKD patients after transcatheter aortic valve replacement (TAVR) have been less studied. The purpose of this study is to examine outcomes after TAVR in CKD patients as stratified by glomerular filtration rate (GFR).Hypothesis:CKD is associated with poorer outcomes after TAVR.Methods:Retrospective electronic medical record review from March 2018-June 2020 at the University of Illinois, Chicago and Jesse Brown Veteran’s Administration Medical Center (Chicago, Illinois) identified TAVR patients, who were included if they followed-up within 6 and 12 months of procedure. Patients were stratified into 4 classes by baseline GFR (mL/min): >90, 60-89, 30-59, <30 with the latter 3 groups comprising CKD patients. Outcomes were expressed as event rates and included 6 and 12-month MACE (all-cause mortality, MI, or CVA) and 30-day rehospitalization. Chi-square analysis was used to compare differences across GFR groups.Results:118 patients (age 76±10 years, 79% male, 46% white) followed up at 6-months and 112 did so at 12-months. There were no statistically significant differences in baseline demographics or comorbidities between CKD and non-CKD patients. CKD patients were more likely to experience MACE compared to non-CKD patients at 6 (p=0.04) and 12-months (p=0.009, Fig. 1). CKD patients also had a higher rate of 30-day rehospitalization (p=0.003).Conclusion:Our results demonstrate that CKD portends adverse outcomes after TAVR with CKD patients experiencing an increased risk of 6 + 12-month MACE and 30-day re-hospitalization. Decreasing GFR correlated with higher rates of MACE at 6 and 12 months.

Background:Transcatheter aortic valve replacement (TAVR) is increasingly utilized in the treatment of aortic valve disease. We assess echocardiographic changes over time to evaluate cardiac remodeling following TAVR between Veteran (VA) and non-VA populations.Methods:Retrospective analysis of 121, single operator TAVR procedures completed between March 2018 and June 2020 at the University of Illinois Hospital in Chicago, IL. Patients included those referred from the affiliated Jessie Brown Veteran Affairs hospital with the following inclusion criteria: transthoracic echocardiogram (TTE) at baseline and 6-month follow-up. Chi-Square tests were used to analyze categorical variables, paired t-tests for continuous variables, and multivariate analysis for subgroups.Results:One hundred and fifteen patients (VA: 59, non-VA: 56) were included in this study. The population had a mean age of 77.0 vs 73.2, BMI of 28.2 vs 30.4, 96.6% vs 56.6% male (p<0.001), and 57.6% vs 33.9% White (p=0.011) between VA and non-VA patients respectively.Overall, there was no significant difference in chamber dimensions, LVEF, and RVSP; however, there was a significant decrease in wall thickness. Multivariate subgroup analysis showed no significant difference between groups except for RVSP.Conclusion:Overall, our study shows positive cardiac remodeling post TAVR, but there is no significant difference when comparing VA to non-VA populations. Although additional studies with larger sample sizes are warranted, the lack of disparity between these subgroups is reassuring.

Introduction:The association of socioeconomic status with health outcomes is well known. This study used zip codes as a surrogate for income and compared outcomes post-procedure and at 6 and 12 months following TAVR at an urban hospital.Methods:We performed a retrospective study on patients undergoing TAVR at the University of Illinois-Chicago(UIC) in Chicago, Illinois between March 2018 and June 2020. Using income data from the US Census Bureau, patients were placed into 2 groups: zip codes with a median income less than the national urban mean income of $54,296 (LMI) and greater than the average urban mean yearly income (GMI).Primary outcomes included composite MACE (CV death, MI and/or CVA), length of stay, and all-cause death. Secondary outcomes included CHF exacerbation, and repeat revascularization. Outcomes were analyzed at hospital discharge, 6 months and 12 months. T and Chi square tests were used to analyze continuous/categorical variables, respectively.Results:We analyzed 114 patients, 84 patients were categorized as LMI and 30 patients were categorized as GMI. 94.3% of the LMI group was Black, while only 62% of the GMI group was Black. Age and gender distributions were similar between groups. Initial post procedural outcomes showed no statistical difference between the LMI and GMI. The LMI group trended towards a longer length of stay than the GMI group (p=0.1). A history of heart failure was greater in the LMI group (p = 0.025). At 6 months there was a lower repeat revascularization rate in the LMI group compared to the GMI group (0% vs. 1.8%, p = 0.017). However, other outcomes including composite MACE (9.6% vs. 1.8%, p=0.3) and all cause death (6.1% vs. 0.9%p=0.4) were statistically similar. At 12 months only 112 patients had recorded outcomes. At this time, repeat revascularization was still significantly different (0% vs. 2.6%, p = 0.005) but all other outcomes remained nonsignificant.Results:Post TAVR, patients in the GMI group experienced a higher rate of repeat coronary revascularization as compared to the LMI group, although, the composite event rate was similar. Further investigation into this observation is warranted; however, overall outcomes between patients from poorer communities seems to be similar to wealthier communities.

Introduction:Despite the success of Transcatheter Aortic Valve Replacement (TAVR) in improving morbidity and mortality among patients with aortic stenosis, few stand-alone programs currently exist within the VA system. Many VA centers have developed transfer arrangements with partner institutions to provide TAVR for their patients. There is minimal data for VA patients in such programs. We compared the outcomes of VA patients to non-VA patients undergoing TAVR at a partner institution.Methods:We performed a single-center retrospective study on all patients undergoing TAVR between March 2018 and June 2020. All procedures were performed at an academic medical center (AMC) in Chicago where VA patients were referred for TAVR. Primary outcomes included composite MACE (death from any cause, MI, CVA). Secondary outcomes included length of stay, bleeding events, AKI, change in ejection fraction, CHF exacerbations, and device-related complications. We assessed outcomes at hospital discharge, 6-month and 12-months.Results:There was a total of 115 patients (AMC: 56, VA: 59). Patient demographics between the two groups were significant for the VA group being 57.6% Caucasian and 96.6% male while the AMC group was 33.9% Caucasian and 56.6% male (for both p<0.01). There was no in-hospital mortality in either group. Total length of stay (p=0.6), ICU length of stay (p=0.4), procedure time (p=0.4) and baseline ejection fraction (p=0.8) were similar between both groups. At 6 months, the VA patients experienced a trend towards a higher incidence of composite MACE (VA: 11.9%, AMC: 5.4%, p=0.2). None of the secondary outcomes reached statistical significance. Ejection fraction and CHF exacerbations were similar between groups (p=0.9 and p=0.59). At 12 months there was no statistical difference in primary or secondary outcomes. Similar ejection fractions and CHF exacerbations at 12 months were also recorded.Conclusions:No difference between procedural, 6-month or 12-month outcomes between VA patients and non-VA patients undergoing TAVR were observed. Public-private partnerships can provide state of the art therapies to VA patients in an efficient and safe manner.

BackgroundObjective:Though the safety of transradial percutaneous coronary intervention (TRI) has been demonstrated in clinical trial and registry studies, adoption of TRI in the United States has been slow. We fielded a national survey with VA interventional cardiologists to understand factors influencing TRI use.

Background:Clinical trials demonstrate that percutaneous coronary intervention (PCI) can be safely performed at medical centers without on-site cardiothoracic (CT) surgery, and current PCI guidelines support this practice with effective quality oversight. Translation of these trial findings and guideline recommendations into clinical practice has not been described. In 2005, the VA initiated a policy to expand PCI access by performing procedures at centers without on-site CT surgery under strict quality standards. The impact of this policy on procedural and longer-term patient outcomes has not been evaluated.

Background:Patients undergoing percutaneous coronary intervention (PCI) represent a high-risk cohort for cardiovascular events. Lipid lowering therapy is an established core measure of secondary prevention in coronary artery disease management. The NCEP-ATPIII advises a minimum LDL level < 100 mgdL in patients with coronary heart disease (CHD). However, further research suggests that an LDL < 70 is more desirable in this population to further reduce adverse CHD endpoints.

Background:Blood pressure (BP) control in patients with coronary artery disease (CAD) decreases morbidity and mortality. The US Joint National Committee VII (JNC-7) recommends patients with underlying CAD have a goal systolic blood pressure (SBP) < 130 and a diastolic blood pressure (DBP) < 80. These goals can be achieved by using multiple classes of drugs, including beta-blockers (BB), angiotensin antagonists (ACE-IARB), calcium channel blockers (CCB), nitrates and diuretics.

Background:ACC guidelines suggests late outcomes in diabetic patients after percutaneous coronary intervention (PCI) are similar to non-diabetics if the hgbA1C can be maintained less than 7.0. To achieve this level of glycemic control many patients require the addition of insulin. The differences in outcomes amongst insulin dependent (IDDM) and non-insulin dependent (NIDDM) patients are not well known. We wish to analyze the cardiovascular (CV) outcomes and glycemic control of diabetic patients 6 months post PCI stratified by insulin usage.

Background:Blood pressure (BP) control in patients with coronary artery disease (CAD) is beneficial on morbidity and mortality, however the US Joint National Committee VII (JNC-7) also recommends systolic BP (SBP) <130 and diastolic BP (DBP) <80 for diabetic patients because diabetes itself is an additional risk for a cardiac event. This can be attained using beta-blockers (BB), angiotensin agonists (ACE-IARB), calcium channel blockers, diuretics and nitrates.

Background:According to the ADA cardiovascular disease (CV) is the major cause of morbidity and mortality for individuals with diabetes (DM) and the largest contributor to the cost of DM. Recent ACC guidelines suggest late outcomes in diabetic patients after percutaneous coronary intervention (PCI) are similar to non-DM if the hemoglobin A1C can be maintained less than 7.0. However, these same guidelines suggest there is inadequate data from which to infer impact on long-term outcomes after PCI for patients with DM. We wish to analyze the CV outcomes 6 months post PCI in diabetic patients.

Background:Control of blood pressure (BP) in patients with underlying coronary artery disease (CAD) provides a decreased risk in morbidity and mortality. According to the US Joint National Committee VII (JNC-7) recommendations, patients with underlying CAD should have goal blood pressures of systolic <130 and diastolic <80. These goals can be attained by using multiple classes of drugs including beta-blockers (BB), angiotensin agonists (ACE-IARB), calcium channel blockers (CCB), diuretics and nitrates.