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Although acute myocardial infarction (AMI) is a disease predominantly affecting adults60 years of age, a significant proportion of the young population who have different risk profiles, are also affected. We undertook a retrospective analysis using National Inpatient Sample (NIS) 2010 to 2014 to evaluate gender differences in characteristics, treatments, and outcomes in the younger AMI population.The NIS 2010-2014 was used to identify all patient hospitalizations with AMI between 18 to45 years using ICD-9-CM codes. We demonstrated a gender-based difference of in-hospital all-cause mortality, other complications, and revascularization strategies in the overall AMI population and other subgroups of AMI [anterior wall ST-segment elevation MI (STEMI), and non-anterior wall STEMI and non-STEMI (NSTEMI)].A total of 156,018 weighted records of AMI hospitalizations were identified, of which 111,894 were men and 44,124 were women. Young women had a higher prevalence of anemia, chronic lung disease, obesity, peripheral vascular disease, and diabetes. Conversely, young men had a higher prevalence of dyslipidemia, smoking, and alcohol. Among non-traditional risk factors, women had a higher prevalence of depression and rheumatologic/collagen vascular disease. There was no difference in all-cause in-hospital mortality in women compared to men [2.03% vs 1.48%; OR 1.04, CI (0.84-1.29); P = .68], including in subgroup analysis of NSTEMI, anterior wall STEMI, and non-anterior wall STEMI. Women with AMI were less likely to undergo percutaneous coronary intervention [47.13% vs 61.17%; OR 0.66, 95% CI (0.62-0.70; P .001] and coronary artery bypass grafting [5.6% vs 6.0%; OR 0.73, 95% CI 0.64-0.83; P .001] compared to men. Women were also less likely to undergo percutaneous coronary intervention within 24 h of presentation (38.47% vs 51.42%, P .001).Despite higher baseline comorbidities in young women with AMI, there was no difference in in-hospital mortality in women compared to men. Additional studies are needed to evaluate the impact of gender on clinical presentation, treatment patterns, and outcomes of AMI in young patients.

Hyponatremia is a very common electrolyte abnormality, associated with poor short- and long-term outcomes in patients with heart failure (HF). Two opposite processes can result in hyponatremia in this setting: Volume overload with dilutional hypervolemic hyponatremia from congestion, and hypovolemic hyponatremia from excessive use of natriuretics. These two conditions require different therapeutic approaches. While sodium in the form of normal saline can be lifesaving in the second case, the same treatment would exacerbate hyponatremia in the first case. Hypervolemic hyponatremia in HF patients is multifactorial and occurs mainly due to the persistent release of arginine vasopressin (AVP) in the setting of ineffective renal perfusion secondary to low cardiac output. Fluid restriction and loop diuretics remain mainstay treatments for hypervolemic/ dilutional hyponatremia in patients with HF. In recent years, a few strategies, such as AVP antagonists (Tolvaptan, Conivaptan, and Lixivaptan), and hypertonic saline in addition to loop diuretics, have been proposed as potentially promising treatment options for this condition. This review aimed to summarize the current literature on pathogenesis and management of hyponatremia in patients with HF.

Background Spontaneous coronary artery dissection (SCAD) is a very rare cause of acute coronary syndromes in young otherwise healthy patients with a striking predilection for the female gender. Unfortunately, SCAD can result in significant morbidities and mortality. The pathological mechanism has not been fully clarified yet but hormonal changes might represent a sufficiently convincing explanation for some patients with SCAD. We hypothesized that gender difference in mortality in SCAD patients. Methods Data for this retrospective cohort study were extracted from the Nationwide Inpatient Sample for 2014 using the 9th revision of the International Classification of Diseases (ICD) 414.12 (spontaneous coronary artery dissection). Demographics, in-hospital mortality, conventional risk factors (diabetes, hypertension, hyperlipidemia, alcohol and tobacco abuse), acute critical illnesses like sepsis, septic shock, stroke, acute respiratory insufficiency, acute renal failure, and chronic conditions (anxiety, depression, malignancy and metastatic diseases) were studied. Univariate and multivariate logistic regression modeling were performed to determine predictors associated with the development of inpatient mortality in SCAD patients. All analyses were conducted using R 3.4.0 and STATA/MP 14.2. All p-values were two-sided, and statistical significance was determined at the level of p Result A total of 270 SCAD patients were identified. Of those SCAD patients, no fibromuscular dysplasia (FMD) or pregnancy were identified. Patients were predominantly women (71%) and the mean age was 53 years. Overall in-hospital mortality was 5.6%, with 6.6% in male and 5.3% in female. Ethnicity, gender, stroke, acute renal failure, anxiety and depression did not predict mortality, length of stay, annual income, total hospital charge (all p>0.05). Multivariate analysis revealed no gender difference in SCAD patients and no independent predictors of mortality were identified. Conclusions This large nationwide study reveals that SCAD may be underdiagnosed but underutilization of work up such as FMD. SCAD is thought to be hormone related likely associated with female gender. Our results showed that no gender difference in mortality. Further large prospective studies are needed to determine gender difference in mortality and other predictors in mortality. Funding Acknowledgement Type of funding source: None

IntroductionAtrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and is a significant risk factor for ischemic stroke and death. Digitalis has been used for more than 200 years to treat heart conditions, including AF, and its use remains controversial due to uncertain long-term morbidity and mortality.MethodsWe conducted a cohort study of hospitalized patients with AF assessing the effects of digoxin on longterm all-cause mortality. Patients were divided into two groups: with and without heart failure (HF). We performed multivariable Cox regression analysis to assess hazard ratios (HR) for all-cause mortality depending on digoxin treatment and used propensity score matching to adjust for differences in background characteristics between treatment groups.ResultsAmong 2179 consecutive patients hospitalized with AF, the median age was 73 ± 14, and 52.5% of patients were male, 49% had HF, and 18.8% were discharged on digoxin. Median left ventricular ejection fraction in the whole cohort was 60 (IQR 40-65). Among patients with HF, 34.5% had preserved, 17.3% had mid-range and 48.1% had reduced left ventricular ejection fraction. The mean follow-up time was 3 ± 2.05 years. In patients without HF there was a statistically significant increased mortality in the digoxin subgroup after propensity score matching (HR = 2.23, 95% CI 1.42-3.51, p < 0.001). In contrast, in patients with HF, there was no difference in mortality between the treatment groups (p = 0.92).ConclusionsDigoxin use in our study was associated with increased mortality in patients with AF and without concomitant HF.

Introduction: Cardiovascular disease is a leading cause of morbidity and mortality in human immunodeficiency virus (HIV) infected adults, and should be managed more aggressively.Prior studies highlighted treatment disparities for Acute Coronary Syndrome (ACS) among HIV patients. This study aims at examining these disparities with the latest large cohort data. Hypothesis: HIV patient with ACS are as likely to receive cardiac revascularization related procedures compared to control group. Methods: We reviewed the Nationwide Inpatient Sample from 2013 to 2016 to identify patients with diagnosis of ACS (ST-elevation and non ST-elevation myocardial infarction, and unstable angina) to compare rates of cardiac procedures (Catheterization, Percutaneous Coronary Intervention - PCI - and Coronary Artery Bypass Graft - CABG) among groups of population of interest (control, asymptomatic HIV, symptomatic HIV). Results: Overall, 515,016 patients with primary diagnosis of ACS where identified and among them 2066 (0.40%) of ACS patients had diagnosis of HIV (asymptomatic and symptomatic). Multivariate regression analysis showed statistically significant lower procedural rates for catheterization (OR: 0.62, 95% CI: [0.52, 0.73]), PCI (OR: 0.80, 95% CI: [0.67, 0.96]) and CABG (OR: 0.70, 95% CI: [0.52, 0.93]) in symptomatic HIV compared to control group. For asymptomatic HIV patient group, no significant change of procedural rates were found compared to control group for catheterization, PCI and CABG (respectively OR: 0.90, 95% CI: [0.78, 1.05], OR: 1.13, 95% CI: [1.00, 1.26] and OR: OR: 0.87, 95% CI: [0.72, 1.04]). Conclusions: Analysis shows a treatment disparity for ACS for symptomatic HIV patients only as symptomatic HIV affected patients received less aggressive catheterization and revascularization management after ACS, compared to control group. However, this effect was not present for the asymptomatic HIV patient group.

Background: Depression poses a major health challenge to patients with cardiovascular disease. But little is known about its impact on Non-ST-elevation myocardial infarction (NSTEMI). Methods: Using the data from the 2016 National Inpatient Sample database, we identified hospitalization with a principal diagnosis of NSTEMI with or without medical history of depression. Prevalence and baseline characteristic of NSTEMI patient with or without depression was delineated. Mortality, catheterization rate, length of stay, time to catheterization were compared using multivariate linear regression with adjustment for age, sex, race, region, hospital size, Charlson Comorbidity Index, tobacco, heart failure, diabetes, and stable coronary heart disease. Results: Depression was found in 42,914 (9.11%) of total NSTEMI admission of 470,933. A higher percentage of female and a higher prevalence of hypertension, hyperlipidemia, diabetes, and smoking (table 1) was observed in the depression group. No significant association between depression and in-hospital mortality in NSTEMI patient can be found after adjustment for confounders (odds ratio 0.88, p=0.08). However, having depression was associated with lower catheterization rate (odds ratio 0.91, p Conclusion: Depression is associated with decreased catheterization rate, increased length of stay and delayed catheterization in NSTEMI patient. Further investigation of the impact of depression on NSTEMI patient is warranted.

Background: Myocarditis of different etiologies can either present with different types of already existing arrhythmias or be the cause of subsequent arrhythmias. Literature have shown that both scenarios hold worse prognosis and outcomes. Methods: We conducted a retrospective cohort study based on the 2016 National Inpatient Sample of adults (>18 years) hospitalized for acute myocarditis of any kind as the primary admitting diagnosis and atrial fibrillation (AF) as a secondary concomitant diagnosis based on ICD-10 codes. All-cause mortality was our primary outcome while length of stay, in-hospital arrhythmia of any kind requiring DCCV, acute respiratory failure, the rate of endotracheal intubation, ICD device insertion and VAD placement during the same hospital stay were our secondary outcomes. We used multivariate regression adjusted for age, sex, race, history of coronary artery disease, history of congestive heart failure, Charlson comorbidity index, hospital region, size and teaching status. STATA-15 was used for statistical analysis. Results: In 2016, there were 8,110 admissions for myocarditis (37.9% females), out of whom 315 (3.9%) had concomitant AF. Mean age was 40y (39.5y without AF, 59y with AF). Our results, table 1, showed that myocarditis with AF significantly increased all-cause mortality (6.3% [20 of 315] vs 1.6% [130 of 7,760], OR 8.28, p Conclusion: Atrial fibrillation appears to be an independent risk factor for higher all-cause mortality rate in myocarditis and is also associated with higher rate of ICD device and VAD implantation during the same hospital stay. Thus, patients with AF who are hospitalized for myocarditis mostly have worse in-hospital outcomes.

Background: Obstructive sleep apnea (OSA) is present in almost 60% of patients with cerebrovascular disease and it is an independent predictor of ischemic stroke. Yet, the impact of OSA on outcomes of ischemic stroke is unclear. Some, small cohort studies indicate increased short-term mortality, whereas larger studies, with more complex logistic regression models, show decreased in-hospital mortality. Lower mortality could be attributed to chronic intermittent episodes of hypoxia affecting the remodeling of cerebral collateral circulation. We thought to investigate outcomes in a large unselected population of patients presenting with acute ischemic stroke. Methods: In a retrospective cohort study, using the 2014 Nationwide Inpatient Sample (NIS), we analyzed adult patients with acute ischemic stroke and OSA. We performed univariate analysis of age, sex, race, hospital location, hospital teaching status, insurance type, hospital bed size, Charlson Comorbidity Index and other relevant comorbidities and we included variables with p Results: A total of 95282 patients with acute ischemic stroke were identified. Patients with the associated diagnosis of OSA (5%) had a mean age of 66+/_0.2, vs 71+/_0.1, p Conclusion: Patients with OSA and ischemic stroke have a higher number of cardiovascular comorbidities. After adjustment with a complex multivariate regression model in a large population of patients, they have lower in-hospital mortality and lower incidence of hemiplegia. We also uncovered underdiagnosing of obstructive sleep apnea in National Inpatient Sample registry, which is a limitation of the study.

Pulmonary hypertension (PH) is a chronic pulmonary vascular disorder that can be caused by a variety of pathophysiological states. Five groups of PH sharing similar hemodynamics, and management were identified: 1) pulmonary arterial hypertension (Group 1); 2) PH due to left heart disease (Group 2); 3) PH due to chronic lung disease (Group 3); 4) chronic thromboembolic PH (Group 4); and 5) miscellaneous mechanisms (Group 5) [1]. Physiologically, PH is defined as mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg at rest or >30 mm Hg with exercise. Clinically, PH leads to right heart ventricular failure and cardiac death [2,3]. Group 2 PH is found commonly and is reported in >60% of heart failure patients [4]. Patients with chronic left heart failure often have other atrial arrhythmias. Atrial fibrillation (AF) is commonly encountered in >3 million people in the United States [5]. Heart failure patients are 5 to 10 times more likely to develop AF than healthy patients [6,7]. AF portends a worse long-term prognosis attributable to the loss of atrial kick, loss of atrioventricular synchrony, and the increased risk of stroke [8,9]. Similarly, the prevalence of Group 2 PH related AF is as high as 57%, and 23% in other forms of PH [10]. The cornerstone of surgical treatment of AF has been AF ablation. Haussaiguarre et al. first reported that AF initiates in the posterior wall of the left atrium near the ostium of pulmonary veins [11]. AF ablation is achieved either radio-frequency (electrocautery) or cryoablation. To date, limited data are available regarding the impact of PH on patients undergoing AF ablation. Therefore, we have demonstrated the effect of PH in patients getting AF ablation in this National Inpatient Sample (NIS) analysis.

Exercise induced dyspnea in patients with valvular surgical replacement has a broad differential, requiring extensive history combined with cardiac imaging. A 64-year-old male with medical history of rheumatic aortic valve stenosis with surgical stentless bioprosthetic aortic (Sorin SOLO) valve

Despite a low pre-test probability of coronary artery disease (CAD) in women of childbearing age, Spontaneous Coronary Artery Dissection (SCAD) remains the most common cause of acute coronary syndrome (ACS) in the gravid patient. A 39 year old female G1P1, pregnancy complicated by pre-eclampsia and

Acute coronary syndrome (ACS) is a leading cause of mortality among patients with non-dialytic end stage renal disease, also known as CKD Stage V (CKD V), and end-stage renal disease requiring hemodialysis (ESRD) and should be managed aggressively. Prior studies highlighted treatment disparities for

Hypertensive crisis is a serious medical condition defined as severely elevated blood pressure; typically the systolic blood pressure is above 180 mmHg, and/or the diastolic blood pressure is above 120 mmHg. Hypertensive crises are divided into two categories: hypertensive urgency and hypertensive emergency. Hypertensive urgency is asymptomatic while hypertensive emergency presents with end-organ damage requiring more aggressive blood-pressure lowering. The common presentations for neurological end-organ dysfunction in conjunction with hypertensive emergency include ischemic strokes, intracranial hemorrhage, subarachnoid hemorrhage, head trauma, and hypertensive encephalopathy. The occurrence of acute spontaneous subdural hematoma (SDH) as a neurological end-organ damage complicating hypertensive crisis is rare and should receive tight blood-pressure lowering to prevent further bleeding. We present a case of hypertensive emergency complicated with acute spontaneous SDH. .

Takotsubo syndrome, initially described in the 1990s by Sato, has been increasingly recognized around the world. Pathophysiology is directed towards central role of catecholamine surge , but other aspects like microvascular endothelial dysfunction and vasospasm have also been described. Dyspnea and chest pain are most common manifestations, but syncope can also be seen. Right ventricular involvement is not uncommon, and left ventricular outflow tract obstruction is a frequent complication. EKG can differentiate between Takotsubo syndrome and myocardial infarction, but coronary angiography should always be performed. Although treatment has been angiotensin converting enzyme inhibitors and betablockers, recent evidence from nonrandomized studies shows no benefit on betablockers regarding outcomes.

Suboptimal echocardiograms are common in critically ill patients. The obstacles that interfere with optimal echocardiographic imaging in cardiac care unit patients include suboptimal positioning, obesity, hyperinflated lungs due to mechanical ventilation, lung disease, subcutaneous emphysema, surgical incisions, chest tubes, bandages, and crowded quarters. It is well known that use of contrast in echocardiography significantly improves the image quality, but despite that, contrast echocardiography is widely underused. The current chapter outlines the basics of contrast echocardiography as it applies to critical care.

The field of critical care cardiology has evolved considerably over the past few decades. Cardiac units in the 1970s and the 1980s were practically coronary care units, where the units most frequently were populated by patients with acute and often uncomplicated myocardial infarction or unstable angina. Detection and rapid treatment of arrhythmias were the primary goals of therapy. Contemporary cardiac care units (CCU) have transformed into Cardiac intensive care units (CICU) where the focus has since shifted towards the management of patients with multisystem diseases, advanced hemodynamics compromise, complex ventricular arrhythmias, and established or incipient multi-organ failure. The two most common clinical scenarios leading to acute chest pain syndrome in CCU patients are acute coronary syndrome and acute aortic syndrome.

Sudden cardiac arrest carries a grave prognosis. The management of cardiac arrest is algorithmic because providers typically have limited knowledge of the patient’s past medical history. Peri-resuscitation echocardiography provides an invaluable real-time bedside diagnostic tool that can identify some of the potentially reversible causes of cardiac arrest and can be regarded as analogous to pulse oximetry or ECG monitoring.

Echocardiography is essential in evaluating patients with acute and subacute dyspnea. Depending on the urgency and severity of patient’s condition the applications of echocardiography can range from immediate point-of-care ultrasound to assess for gross abnormalities (such as pericardial effusion) to detailed evaluation of underlying structural heart disease. We present a structured approach to evaluation of patients with acute and subacute dyspnea utilizing a wide range of echocardiographic techniques.

Current guidelines recommend against revascularization of the noninfarct artery during the index percutaneous coronary intervention (PCI) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI). This was based largely on observational studies with few data coming from randomized controlled trials (RCTs). Recently, several small-to-moderate sized RCTs have provided data, suggesting that a multivessel revascularization approach may be appropriate. We performed a meta-analysis of RCTs comparing multivessel percutaneous coronary intervention (MV PCI) versus culprit vessel-only revascularization (COR) during primary PCI in patients with STEMI and multivessel coronary disease (MVCD). We searched Medline, PubMed, and Scopus databases for RCTs comparing MV PCI versus COR in patients with STEMI and MVCD. The incidence of all-cause death, cardiac death, recurrent myocardial infarction, and revascularization during follow-up were extracted. Four RCTs fit our primary selection criteria. Among these, 566 patients underwent MV PCI (either at the time of the primary PCI or as a staged procedure) and 478 patients underwent COR. During long-term follow-up (range 1 to 2.5 years), combined data indicated a significant reduction in all-cause mortality (relative risk [RR] 0.57, 95% confidence interval [CI] 0.36 to 0.92, p = 0.02) and in cardiac death (RR 0.38, 95% CI 0.20 to 0.73, p = 0.004) with MV PCI. In addition, there was a significantly lower risk of recurrent myocardial infarction (RR 0.41, 95% CI 0.23 to 0.75; p = 0.004) and future revascularization (RR 0.37, 95% CI 0.27 to 0.52; p0.00001). In conclusion, from the RCT data, MV PCI appears to improve outcomes in patients with STEMI and MVCD.

Background Recent reports suggest altered antithrombotic efficacy and higher risk of bleeding with new oral anticoagulants (NOACs) in patients with renal insufficiency. A meta-analysis was performed to evaluate the efficacy and safety with recommended doses of NOAC compared with conventional treatment in patients with renal insufficiency. Methods PubMed, Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases were searched from January 1, 2001 through March 23, 2014. Randomized controlled trials that compared NOACs (rivaroxaban, apixaban, and dabigatran) with comparators (vitamin K antagonist/warfarin, low molecular weight heparin, aspirin, placebo) were selected. We defined moderate renal insufficiency as creatinine clearance (estimated glomerular filtration rate [eGFR]) of 30-49 mL/min, and mild renal insufficiency as eGFR 50-79 mL/min. Results There were 40,693 patients with renal insufficiency in 10 trials. Compared with other anticoagulants in patients with mild renal insufficiency there was significantly less major or clinically relevant nonmajor bleeding (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.72-0.90) and stroke or systemic embolism (OR, 0.70; 95% CI, 0.54-0.92) with NOACs. Using random effects meta-analysis, there was significantly less stroke or systemic embolism (OR, 0.72; 95% CI, 0.57-0.92) and a trend toward less major or clinically relevant nonmajor bleeding (OR, 0.82; 95% CI, 0.59-1.14) with the NOACs among patients with moderate renal insufficiency, and this became statistically significant when evaluated using a fixed effects model. NOACs showed efficiency comparable with conventional anticoagulants for prevention of venous thromboembolism or related mortality. Conclusions In patients with renal insufficiency, recommended doses of novel anticoagulants are noninferior and relatively safe compared with conventional anticoagulants.

Ventricular-arterial stiffening is a part of the aging process that is amplified by various comorbidities. It affects normal cardiovascular reserve and limits exercise capacity. The aim of this study was to explore the association of physiologic determinants of ventricular-arterial interaction with exercise capacity in patients referred for exercise echocardiography with exertional dyspnea.A total of 93 patients with exertional dyspnea without chest pain were evaluated using the Bruce protocol. Patients with left ventricular ejection fractions50% and those with exercise-induced myocardial ischemia were excluded. Poor exercise tolerance was defined as inability to achieve 8 metabolic equivalents.Thirty-seven patients (40%) had poor exercise tolerance. These patients were older (mean age, 60 vs 54 years, P = .01), more likely to carry the diagnosis of hypertension (84% vs 41%, P.01), and more likely to be treated with antihypertensive medications. In multivariate logistic regression analysis, left atrial volume index (P = .04) and arterial elastance (P.01) were significant predictor of poor exercise capacity, while left ventricular ejection fraction, tissue Doppler indices, and global longitudinal strain were not significant.Effective arterial elastance determined noninvasively before stress echocardiography appears to be an independent predictor of exercise tolerance in patients with exertional dyspnea.

a Department of Internal Medicine/Cardiology, University of Miami/Jackson Memorial Hospital, Miami, FL, United States b Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States c Department of Cardiology, Baylor College of Medicine, Houston, TX, United States d Department of Cardiology, Columbia College of Physicians and Surgeons, St. Luke's Hospital, New York, NY, United States

Peripheral artery disease (PAD) is an underdiagnosed and undertreated disease. In patients having acute coronary syndrome (ACS) it has shown to be associated with worse prognosis. In this National inpatient sample (NIS) study, we aimed to evaluate impact of PAD on mortality and morbidity for

Takotsubo cardiomyopathy(TTC) is being increasingly recognized cardiac condition. Atrial fibrillation (AF) is also one of the most common causes of supraventricular arrhythmia. In this National Inpatient Sample (NIS) study, we aimed to evaluate the impact of AF in patients with TTC. In this

AF is one of the most common cardiac arrhythmias leading to increased morbidity and mortality. It is associated with structural heart disease, HTN, diabetes and sleep apnea (SA). The relation between AF and SA has been well documented. We aim to determine the impact of SA in the outcomes of AF in

Systemic autoimmune disease Systemic Lupus Erythematosus (SLE) is associated with accelerated atherosclerosis, and are two times more prone to develop coronary artery disease. In this National Inpatient Sample (NIS) study we compared the mortality and morbidity outcomes in patients of STEMI with or

Management of ST-elevation myocardial infarction complicated by cardiogenic shock (STEMI-CS) has evolved in the last decade. There is a paucity of data on readmissions in this study population. We aim to assess the burden and predictors of 30-day readmissions in this population This is a

Carotid artery stenosis (CAS) is common in older adults undergoing transcatheter aortic valve replacement (TAVR). CAS may be associated with increased risk of periprocedural stroke (PPS) and major cardiovascular events. Carotid filter protection (sentinel system) systems are frequently used to

Transcatheter Aortic Valve Replacement (TAVR) has shown to have a profound effect on postoperative vascular hemodynamics in studies. It is not well known whether hemodynamic changes associated with TAVR adversely affects TAVR outcomes. Therefore, we conducted a large database analysis to look for

Objective We performed a meta-analysis of randomized controlled trials of statin loading prior to percutaneous coronary intervention (PCI). Background Statin loading prior to PCI has been shown to decrease peri-procedural myocardial infarction (pMI) but less is known regarding the clinical benefit of pre-procedural statin loading. Methods We searched for trials of statin naive patients presenting with stable angina or NSTE-ACS and treated with statins prior to PCI. We evaluated the incidence of pMI and major cardiac events including spontaneous myocardial infarction, death, and target vessel revascularization. Results Out of 1,210 articles, 14 randomized controlled trials were included in this meta-analysis. Among 3,146 patients, 1,591 patients were randomized to a loading dose of statin before PCI and 1,555 patients were given statin therapy initiated only after the PCI. Statin loading prior to PCI was associated with a 56% relative reduction in pMI (OR: 0.44, 95% CI: 0.35–0.56; P

Objective of our study was to find out survival benefit of performing percutaneous coronary intervention (PCI) in patients with cardiac arrest. The study population was derived from the nationwide inpatient sample (NIS) database from 2008 to 2012. Cardiac arrest, ventricular fibrillation (Vfib), ventricular tachycardia (Vtach), asystole/pulseless electrical activity (PEA) and ST elevation myocardial infarction (STEMI) were identified using appropriate international classification of disease (ICD-9) diagnostic codes and PCI was identified using appropriate ICD-9 procedural code. The primary endpoint was in-hospital mortality. Multivariate analysis (odds ratio , 95% confidence interval, p value) showed increased mortality with older age (1.01, 1.01-1.02, p

We describe our experience with the Advanced Cardiac Admission Program (ACAP) at our institution. The ACAP program is a hospital-wide implementation of critical pathways-based management of all cardiac patients. Data review of patients admitted for acute coronary syndromes from the ACAP–PAIN database and a comparative study of outcomes before and after implementation of the pathways-based assessment and treatment protocols. In the pre-ACAP and post-ACAP patient groups, antiplatelet use at admission improved from 50% to 75% (p

The diagnosis and management of pericardial disease are very challenging for clinicians. The evidence base in this field is relatively scarce compared with other disease entities in cardiology. In this article, we outline a unified, stepwise pathway-based approach for the management of pericardial disease. We used the "CHASER" acronym to define the entry points into the pathway. These include chest pain, hypotension or arrest, shortness of breath, echocardiographic or other imaging finding of pericardial effusion, and right-predominant heart failure. We propose a score for the assessment of pericardial effusion that is composed of the following 3 parameters: the etiology of the effusion, the size of the effusion, and the echocardiographic assessment of hemodynamic parameters. The score is applied to clinically stable patients with pericardial effusion to quantify the necessity of pericardial effusion drainage. A stepwise, pathway-based approach to the management of pericardial disease is intended to provide guidance for clinicians in decision-making and a patient-tailored evidence-based approach to medical and surgical therapy for pericardial disease. The pathway for the management of pericardial disease is the ninth project to be incorporated into the "Advanced Cardiac Admission Program" at Saint Luke's Roosevelt Hospital Center of Columbia University in New York. Further studies should focus on the validation of the feasibility, efficacy, and reliability of this pathway.