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supplement for Early Invasive Versus Ischemia-Guided Strategy in Non-ST-Segment Elevation Acute Coronary Syndrome With Chronic Obstructive Pulmonary Disease: A National Inpatient Sample Analysis by Tomo Ando, Oluwole Adegbala, Hisato Takagi, Luis Afonso and Alexandros Briasoulis in Angiology

Sinus of Valsalva aneurysms (SOVAs) is a rare clinical entity, with less than 20% arising from the non-coronary cusp. We present a unique case of acquired non coronary cusp calcified SOVA rapidly progressing to rupture and intracardiac shunting. A 29 year old male with congenital obstructive

Use of percutaneous mechanical circulatory support (MCS) in patients with cardiogenic shock (CS) due to acute myocardial infarction (AMI) is rising. Hemodynamic monitoring of such patients is critial. The use of Pulmonary Artery Catheter (PAC) to guide treatment remains controversial. We examine the

Background: Prior studies have shown that hospital case volume is not associated with survival in patients with out-of-hospital cardiac arrest (OHCA). However, how case volume impact on survival for in-hospital cardiac arrest (IHCA) is unknown Methods: We queried the National Inpatient Sample (NIS) in the U.S. 2005-2011 to identify cases in which in-hospital CPR was performed for IHCA. Years > 2011 were excluded due to redesign of NIS that precludes case volume calculation. Restricted cubic spine was used to evaluate the association between hospital annual CPR volume and survival to hospital discharge. Further analysis was conducted with case volume in quartiles. Results: Across more than 1000 hospitals in NIS, we identified 137,466 cases (mean age 67, 45% female) of IHCA for which CPR was performed over the study period. Median [Q1, Q3] case volume was 68 [34, 100]. Compared to those in the 1 st quartile (q1) of case volume, hospitals in the 4 th quartile (q4) tends to have younger patients (mean=66 vs 68 yrs), higher comorbidities (median Elixhauser score=4 vs 3), large bed size (89 vs 37%), and in low income areas (37 vs 32%). After adjustment for patient and hospital factors, higher hospital case volume was inversely associated with lower rates of survival (Fig1). Risk-adjusted rates of survival from q1 through q4 were: 28.1%, 25.5%, 25.4% and 23.7%. We arrived at similar results when analysis was stratified by age, gender and hospital bed size (not shown) except that the difference across quartiles was more pronounced among small bed size hospitals (survival rate=27.4% in q1 vs 8.1% in q4). However, among those who survived to hospital discharge, nonroutine home discharge was higher among patients in q1 (73.9%) vs q4 (69.6%) Conclusion: Unlike OHCA, hospital case volume is inversely associated with survival to hospital discharge in patients undergoing CPR for IHCA. Hence, quality measures to reduce the incidence of CPR/IHCA have the potential to reduce in-hospital mortality

We aimed to identify risk factors of high hospitalization cost after transcatheter aortic valve implantation (TAVI). TAVI expenditure is generally higher compared with surgical aortic valve replacement. We queried the Nationwide Inpatient Sample database from January 2011 to September 2015 to identify those who underwent endovascular TAVI. Estimated cost of hospitalization was calculated by merging the Nationwide Inpatient Sample database with cost-to-charge ratios available from the Healthcare Cost and Utilization Project. Patients were divided into quartiles (lowest, medium, high, and highest) according to the hospitalization cost, and multivariable regression analysis was performed to identify patient characteristics and periprocedural complications associated with the highest cost group. A total of 9,601 TAVI hospitalizations were identified. Median in-hospital costs of the highest and lowest groups were $82,068 and $33,966, respectively. Patients in the highest cost group were older and more likely women compared with the lowest cost group. Complication rates (68.4% vs 22.5%) and length of stay (median 10 days vs 3 days) were both approximately 3 times higher and longer, respectively, in the highest cost group. Co-morbidities such as heart failure, peripheral vascular disease, atrial fibrillation, anemia, and chronic dialysis as well as almost all complications were associated with the highest cost group. The complications with the highest incremental cost were acute respiratory failure requiring intubation ($28,209), cardiogenic shock ($22,401), and acute kidney injury ($16,974). Higher co-morbidity burden and major complications post-TAVI were associated with higher hospitalization costs. Prevention of these complications may reduce TAVI-related costs.

Background Cardiac support with left ventricular assist devices (LVAD) is a growing field. LVAD are increasingly used for patients with advanced congestive heart failure. Multiple studies have evaluated the outcomes of cardiac support with LVAD in patients with and without diabetes mellitus (DM), yet we still have conflicting results. This study aimed to assess the clinical impact of diabetes mellitus on patients undergoing cardiac support with LVAD. Methods Diabetic patients who underwent mechanical support with LVAD between 2011 and 2014 were identified in the National Inpatient Sample (NIS) database using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). The primary outcome was the effect of diabetes mellitus on inpatient mortality. Secondary outcomes were the impact of diabetes on other immediate post-LVAD complications and the cost of hospitalization. Multivariable logistic regression models analysis was performed to address potential confounding. Results After adjusting for patient-level and hospital-level characteristics, diabetic patients who underwent cardiac support with LVAD have no significant increase in in-hospital mortality (OR: 0.79, 95% CI (0.57–1.10), p = 0.166), post-LVAD short-term complications and cost of hospitalization (OR: 0.97, 95% CI (0.93–1.01), p = 0.102). Conclusion Cardiac mechanical support with LVAD implantation is feasible and relatively safe in patients with diabetes and stage-D heart failure as a bridge for transplantation or as destination therapy for patients who are not candidates for transplantation. However, further trials and studies using bigger study sample and more comprehensive databases, need to be conducted for a stronger and more valid evidence.

Protein-energy malnutrition (PEM) diminishes amino acid and energy availability, impairing the body's healing capability after injury, such as in myocardial damage following acute myocardial infarction (AMI).We sought to investigate the influence of PEM on clinical outcomes of AMI.We identified records with a primary discharge diagnosis of AMI from the Nationwide Inpatient Sample (2012-2014), stratified by concomitant PEM. We matched PEM to no-PEM (1:1) using a greedy algorithm-based propensity methodology and estimated the impact of PEM on health outcomes (SAS 9.4).Of the 332,644 hospitalizations for AMI, 11,675 had concomitant PEM accounting for roughly $US 1.5 billion and over 119,792 hospital days. PEM was associated with older age (74.43- vs. 66.90-years; P 0.0001), female sex (49.19% vs. 38.44%; P 0.0001), black race (12.78% vs. 10.46%; P 0.0001), and higher comorbidity burden (Deyo3: 32.77% vs. 16.69%; P 0.0001). After propensity matching, PEM was associated with higher mortality (Adjusted odds ratio [AOR]: 1.59 [1.46-1.73]), cardiogenic shock (AOR: 2.26 [2.08-2.44]), discharge to secondary facilities (AOR: 2.21 [2.10-2.33]), charges ($135,500 [$131,956-139,139] vs. $81,084 [$79,241-82,970]), cardiac artery bypass surgery (AOR:1.81 [1.66-1.97]), intra-aortic balloon pump placement (AOR: 1.83 [1.65-2.04]) and longer length of stay (10.15- vs. 5.52-days).PEM is a predisposing factor for devastating clinical outcomes among AMI hospitalizations. Higher prevention, identification and management of PEM among high-risk individuals (older age, female sex, and black race) residing in the community are needed.

To date, echocardiography has not gained acceptance as an alternative imaging modality for the detection of massive pulmonary embolism (MPE) or submassive pulmonary embolism (SMPE). The objective of this study was to explore the clinical utility of early systolic notching (ESN) of the right ventricular outflow tract (RVOT) pulsed-wave Doppler envelope in the detection of MPE or SMPE.Two hundred seventy-seven patients (mean age, 56 ± 16 years; 52% women), without known pulmonary hypertension, who underwent contrast computed tomographic angiography for suspected pulmonary embolism (PE) and underwent echocardiography were retrospectively studied. Extent of PE was categorized using standard criteria. ESN identified from pulsed-wave spectral Doppler interrogation of the RVOT was analyzed, as were other echocardiography parameters such as McConnell's sign, the "60/60" sign, and acceleration and deceleration times of the RVOT Doppler signal. Analysis was conducted using probability statistics and receiver operating characteristic curve analysis.Of the 277 patients studied, 100 (44%) had MPE or SMPE, 87 (38%) had subsegmental PE, and 90 (39%) did not have PE. ESN was observed in 92% of patients with MPE or SMPE, 2% with subsegmental PE, and in no patients without PE. Interobserver assessment of early systolic notching demonstrated 97% agreement (κ = 0.93, P .001). Compared with more widely recognized echocardiographic parameters, the area under the receiver operating characteristic curve (AUC) of 0.96 (95% CI, 0.92-0.98) for ESN was superior to that for McConnell's sign (AUC, 0.75; 95% CI, 0.68-0.80), the 60/60 sign (AUC, 0.74; 95% CI, 0.68-0.79), and RVOT acceleration time ≤ 87 msec (AUC, 0.84; 95% CI, 0.79-0.88), as well as other study Doppler variables, in patients with computed tomography-confirmed MPE or SMPE.The pulmonary Doppler flow pattern of ESN appears to be a promising noninvasive sign observed frequently in patients with MPE or SMPE. Future prospective study to ascertain diagnostic utility in a broader population is warranted.

Introduction Takotsubo cardiomyopathy (TTCM), an entity first described in Japan over two decades ago following myocardial stunning cases without evidence of coronary stenosis, has emerged as a unique entity with global recognition. We sought to investigate the extent and magnitude of regional variations in its outcomes. Method We used the National Inpatient Sample (NIS) of the Agency for Healthcare Research and Quality (2010–2014). Risk-adjusted rates of outcomes across the US geographical regions were calculated by fitting a Poisson regression model with a robust error variance under generalized estimating equations. Discrete numeric variables with over-dispersed count distributions -length of stay and continuous variables with a right skewed spread- cost of hospitalization were modeled using a generalized linear regression with a negative binomial function and gamma function respectively. Result We found significant regional variations in-patient mortality. While there was significantly higher risk of in-hospital death in the West (5.28 [4.34–6.44]) vs 4.40 [3.57–5.43] vs 4.10 [3.38–498] vs 4.78 [3.96–5.77]), there was a different pattern of variation in the length of days with longer hospital stay in the Northeast. Likewise, the risk-adjusted rate of non-routine home discharges was highest for Northeast. The West had the highest cost of hospitalization (West: $40,217 vs. South: $28,465) Conclusion Significant geographic variation exists in the cost of hospitalization and in-hospital mortality of TTCM across the US. Understanding this variation requires a detailed understanding of the processes of care and identification of effective strategies to eliminate these disparities.

International audience; BACKGROUND:Abusive alcohol use has well-established health risks including causing liver disease (ALD) characterized by alcoholic steatosis (AS), steatohepatitis (AH), fibrosis, cirrhosis (AC) and hepatocellular carcinoma (HCC). Strikingly, a significant number of individuals who abuse alcohol also use Cannabis, which has seen increased legalization globally. While cannabis has demonstrated anti-inflammatory properties, its combined use with alcohol and the development of liver disease remain unclear.AIM:The aim of this study was to determine the effects of cannabis use on the incidence of liver disease in individuals who abuse alcohol.METHODS:We analysed the 2014 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (NIS) discharge records of patients 18 years and older, who had a past or current history of abusive alcohol use (n = 319 514). Using the International Classification of Disease, Ninth Edition codes, we studied the four distinct phases of progressive ALD with respect to three cannabis exposure groups: non-cannabis users (90.39%), non-dependent cannabis users (8.26%) and dependent cannabis users (1.36%). We accounted for the complex survey sampling methodology and estimated the adjusted odds ratio (AOR) for developing AS, AH, AC and HCC with respect to cannabis use (SAS 9.4).RESULTS:Our study revealed that among alcohol users, individuals who additionally use cannabis (dependent and non-dependent cannabis use) showed significantly lower odds of developing AS, AH, AC and HCC (AOR: 0.55 [0.48-0.64], 0.57 [0.53-0.61], 0.45 [0.43-0.48] and 0.62 [0.51-0.76]). Furthermore, dependent users had significantly lower odds than non-dependent users for developing liver disease.CONCLUSIONS:Our findings suggest that cannabis use is associated with a reduced incidence of liver disease in alcoholics.

Candidates for transcatheter aortic valve implantation (TAVI) are generally older with multiple co-morbidities and are therefore susceptible to nonelective admissions before scheduled TAVI. Frequency, predictors, and outcomes of TAVI after nonelective admission are under-explored. We queried the Nationwide Inpatient Sample database, an administrative database, from January 2012 to September 2015 to identify hospitalization in those age ≥50 who had transarterial TAVI. A propensity-matched cohort was created to compare the outcomes between nonelective and elective admission who had TAVI. The primary outcome was in-hospital mortality. A total of 9,521 TAVI admissions were identified during the study period. Of these admissions, 22.3% were nonelective admissions. Pulmonary circulation disorders (adjusted odds ratio [aOR] 1.38), anemia (aOR 1.54), congestive heart failure (aOR 1.37), chronic kidney disease (aOR 1.28; all p0.001), and atrial fibrillation (aOR 1.17, p = 0.006) were independent risk factors for nonelective admission. In a propensity-matched cohort (1,683 admissions in each cohort), in-hospital mortality was similar (4.0% vs 2.8%, p = 0.052). Nonelective admissions had higher rates of acute myocardial infarction (5.2% vs 0.7%), fatal arrhythmia (9.4% vs 6.0%), acute kidney injury (25.9% vs 17.1%), respiratory failure requiring intubation (0.26% vs 0.19%), cardiogenic shock (5.1% vs 2.1%; all p0.001), and bleeding requiring transfusion (13.1% vs 10.1%, p = 0.006) during the index-hospitalization. Hospital length of stay (11.4 days vs 6.5 days, p0.001) and hospital cost ($68,669 vs $57,442, p0.001) were both increased in nonelective admissions. Nonelective admission accounted for approximately one-fifth of total TAVI with significantly different cohort profiles. Our results suggest that nonelective TAVI has higher adverse outcomes and increased health resource utilization. Expedition in TAVI process in high-risk cohorts may result in better outcomes.

A significant proportion of patients with acute myocarditis experience sudden cardiac death presumably due to cardiac arrhythmia. In this study, we explore the burden, the predictors of arrhythmia in acute myocarditis and the association between arrhythmias and adverse in-hospital outcomes. After evaluating the frequency of various tachyarrhythmias and bradyarrhythmia in myocarditis population, we built a logistic model to determine the independent predictors of arrhythmias in myocarditis and a 1:1 propensity-matched analysis to examine the impact of arrhythmias. Overall, cardiac arrhythmias were identified in 33.71% of the hospitalized myocarditis cases. Ventricular tachycardia and atrial fibrillation were most common arrhythmias. There were increased odds of in-hospital mortality, cardiogenic shock, use of mechanical circulatory support, pacemaker implantation, and nonroutine hospital discharges in the arrhythmia cohorts. Length of stay and cost of hospitalization were also significantly higher. A significant proportion of patients with myocarditis have cardiac arrhythmias. As the occurrence of arrhythmias in myocarditis is associated with worse outcomes, it may be important to risk stratify patient to identify those who will benefit from early intervention.

Objectives To assess the in-hospital outcomes of transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) in non-teaching hospitals. Background TAVR has become widely available in the United States. However, the comparative outcomes of TAVR vs. SAVR in non-teaching hospitals are largely under explored. Methods We queried the Nationwide Inpatient Sample database from 2011 to September 2015 to identify those who were 50 years or above and underwent either trans-arterial TAVR or SAVR at non-teaching hospital. In-hospital clinical outcomes were compared with odds ratio (OR) in propensity-matched cohorts. Results We identified un-weighted 957 and 7,465 SAVR admissions. In propensity-matched model, 596 admissions in each arm were included for final analysis. In-patient mortality (3.9 vs. 2.5%, OR 1.54, P = 0.34), acute kidney injury requiring dialysis (2.2 vs. 2.7%, OR 0.80, P = 0.57), stroke (2.0 vs. 3.2%, OR 0.61, P = 0.20), and pacemaker placement (8.9 vs. 6.4%, OR 1.47, P = 0.09) was similar between TAVR and SAVR. Sub-group analysis showed that female and those with prior coronary artery bypass surgery had higher risk of in-patient morality in TAVR admission. Cost was higher (59,103 vs. 53,411 dollars, P = 0.006) but length of stay was shorter in TAVR (6.9 vs. 10.2 days, P Conclusions TAVR conferred similar in-hospital mortality and major peri-procedural complications compared with SAVR in non-teaching hospitals. For those with limited access to teaching hospitals, non-teaching hospitals appear to be a reasonable option for candidates of aortic valve replacement for severe aortic stenosis.

The objective of this study was to evaluate the impact of heart failure (HF) etiology (ischemic cardiomyopathy [ICM] versus nonischemic cardiomyopathy) on in-hospital outcomes in patients undergoing left ventricular assist device (LVAD) placement using the Nationwide Inpatient Sample database. We identified patients who underwent LVAD placement from 2011 to 2014. The primary end point was the effect of ICM on in-hospital mortality. Secondary end points included periprocedural vascular complications requiring surgery, postoperative myocardial infarction, stroke, and hemorrhage requiring transfusion. We also assessed length of stay and cost of hospitalization. A mixed effects logistic model was used for clinical end points and a linear mixed model was used for cost and length of stay. In 3,511 patients who underwent LVAD placement (23.32% women and 56.23 ± 13.51 years old), the incidence of ICM was 53.5%. After adjusting for patient- and hospital-level characteristics, ICM was not found to influence in-hospital mortality (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.78 to 1.23). ICM was associated with an increased risk in periprocedural hemorrhage requiring transfusion (OR 1.29, 95% CI 1.08 to 1.53), vascular complications requiring surgery (OR 1.58 95% CI 1.10 to 2.28) and postoperative ST-segment myocardial infarction (OR 7.38 95% CI 5.33 to 10.24). In conclusion, ICM did not impact in-hospital mortality in patients who underwent LVAD placement but was associated with increased vascular complications, hemorrhage requiring transfusion, and postoperative myocardial infarction.

Background Chronic obstructive pulmonary disease ( COPD ) patients are at increased risk of respiratory related complications after cardiac surgery. It is unclear whether transcatheter aortic valve replacement ( TAVR ) or surgical aortic valve replacement ( SAVR ) results in favorable outcomes among COPD patients. Methods and Results Patients were identified from the Nationwide Inpatient Sample database from 2011 to 2014. Patients with age ≥60, COPD , and either went transarterial TAVR or SAVR were included in the analysis. A 1:1 propensity‐matched cohort was created to examine the outcomes. A matched pair of 1210 TAVR and 1208 SAVR patients was identified. Respiratory‐related complications such as tracheostomy (0.8% versus 5.8%; odds ratio [ OR ], 0.14; P OR , 0.63; P =0.002), reintubation (6.5% versus 10.0%; OR , 0.49; P OR , 0.41; P TAVR versus SAVR . Use of noninvasive mechanical ventilation was similar between TAVR and SAVR (4.1% versus 4.8%; OR , 0.84; P =0.41). Non‐respiratory‐related complications, such as in‐hospital mortality (3.3% versus 4.2%; OR , 0.64; P =0.035), bleeding requiring transfusion (9.9% versus 21.7%; OR , 0.38; P OR , 0.63; P OR , 0.19; P TAVR than SAVR . Cost ($56 099 versus $63 146; P P TAVR than SAVR . Conclusions TAVR portended significantly fewer respiratory‐related complications compared with SAVR in COPD patients. TAVR may be a preferable mode of aortic valve replacement in COPD patients.

Comparative outcomes of transcatheter aortic valve implantation (TAVI) in patients with and without hypothyroidism were not previously reported. This study aimed to appraise the clinical outcomes and impact of hypothyroidism on patients who underwent TAVI. Patients with hypothyroidism who underwent TAVI from 2011 to 2014 were identified in the National Inpatient Sample database using the International Classification of Diseases, ninth Revision, Clinical Modification. The primary outcome was the effect of hypothyroidism on inpatient mortality. Secondary outcomes were the impact of hypothyroidism on post-TAVI complications. We also evaluated the length of hospital stay and the cost of hospitalization. Propensity score-matched analysis was performed to address potential confounding. The hypothyroid patients who underwent TAVI had no significant increase in the risk of in-hospital mortality (odds ratio 0.78; 95% confidence interval 0.51 to 1.21, p = 0.282), or most postprocedural complications. However, hypothyroid patients were more likely to develop hemorrhage requiring transfusion (odds ratio 1.36, 95% confidence interval 1.05 to 1.76, p = 0.043). In conclusion, TAVI is a feasible and relatively safe alternative with reasonable in-hospital outcomes in patients with hypothyroidism and severe symptomatic aortic stenosis. However, hypothyroid patients are more likely to require a blood transfusion after TAVI. Additional randomized trials are needed to evaluate TAVR outcomes in hypothyroid patients.

Failure to rescue (FTR), death after major complications, has been well described in the surgical literature as a source of different outcomes in different hospitals. However, FTR has not been investigated in transcatheter aortic valve implantation (TAVI). Our aim was to assess the difference of in-patient mortality and FTR in different TAVI volume hospitals. We queried the Nationwide Inpatient Sample database from 2011 to 2015 to identify patients who had transarterial TAVI. FTR was calculated as those who had in-patient mortality with at least one with major perioperative complications. Hospitals were divided into three groups according to annual TAVI volume, the lowest quintile (≤30/year), second to fourth quintile (31 to 130/year), and highest quintile (≥130/year). Multivariate analysis was used to calculate risk adjusted in-patient mortality rate and FTR and was compared between these different volume hospitals. A total of 48,886 TAVI procedures were identified (10,407, 28,811, and 9,668 in low, intermediate, and high volume centers, respectively). Mean age, percentage of woman, and Elixhauser co-morbidity index was similar across different TAVI volume hospital. The incidence of major perioperative complications did not differ in different volume hospitals. Adjusted rate of in-patient mortality (2.3%, 1.87%, and 1.57% for low, intermediate, and high volume center, respectively, p0.001) were significantly less with greater hospital volume but FTR (8.24%, 8.20%, and 6.12% for low, intermediate, and high volume center, respectively, p = 0.29) were the same in the three groups. Our results suggest that FTR does not explain the variation of in-hospital mortality in different hospital volumes.

Supplemental Material, Supplement_xyz109976fbbe54e for Incidence, Trends, and Predictors of Palliative Care Consultation After Aortic Valve Replacement in the United States by Tomo Ando, Oluwole Adegbala, Takeshi Uemura, Emmanuel Akintoye, Said Ashraf, Alexandros Briasoulis, Hisato Takagi, and Luis Afonso in Journal of Palliative Care

Background and Aim. The effect of cannabis use on chronic liver disease (CLD) from Hepatitis C Virus (HCV) infection, the most common cause of CLD, has been controversial. Here, we investigated the impact of cannabis use on the prevalence of CLD among HCV infected individuals. Methods. We analyzed hospital discharge records of adults (age ≥ 18 years) with a positive HCV diagnosis. We evaluated records from 2007 to 2014 of the Nationwide Inpatient Sample (NIS). We excluded records with other causes of chronic liver diseases (alcohol, hemochromatosis, NAFLD, PBC, HBV, etc.). Of the 188,333 records, we matched cannabis users to nonusers on 1:1 ratio (4,728:4,728), using a propensity-based matching system, with a stringent algorithm. We then used conditional regression models with generalized estimating equations to measure the adjusted prevalence rate ratio (aPRR) for having liver cirrhosis (and its complications), carcinoma, mortality, discharge disposition, and the adjusted mean ratio (aMR) of total hospital cost and length of stay (LOS) [SAS 9.4]. Results. Our study revealed that cannabis users (CUs) had decreased prevalence of liver cirrhosis (aPRR: 0.81[0.72-0.91]), unfavorable discharge disposition (0.87[0.78-0.96]), and lower total health care cost ($39,642[36,220-43,387] versus $45,566[$42,244-$49,150]), compared to noncannabis users (NCUs). However, there was no difference among CUs and NCUs on the incidence of liver carcinoma (0.79[0.55-1.13]), in-hospital mortality (0.84[0.60-1.17]), and LOS (5.58[5.10-6.09] versus 5.66[5.25-6.01]). Among CUs, dependent cannabis use was associated with lower prevalence of liver cirrhosis, compared to nondependent use (0.62[0.41-0.93]). Conclusions. Our findings suggest that cannabis use is associated with decreased incidence of liver cirrhosis, but no change in mortality nor LOS among HCV patients. These novel observations warrant further molecular mechanistic studies.

The utilization of contemporary continuous-flow left ventricular assist device (CF-LVADs) has increased, accounting for90% of implants from 2009 to 2014. The present study aimed to identify the annual national estimates in utilization, in-hospital mortality, and major complications with CF-LVAD using data from the National Inpatient Sample, the largest all-payer inpatient data set in the United States, and the US Census Bureau, for the years 2009 to 2014. Participants included all adult patients who received CF-LVADs from 2009 to 2014. End points included in-hospital mortality, in-hospital complications, length of stay, cost, and disposition at the time of discharge. A total of 3,572 (weighted = 17,552) patients with left ventricular assist device (LVAD) implants were analyzed. LVAD implants increased significantly, with average annual change (%) of +12.6% (p 0.001). Rates of in-hospital mortality decreased by average annual rate of -5.3% (p = 0.02). The rates of major complications including ischemic stroke, major bleeding, and cardiac tamponade did not change significantly over the study period. However, we found a significant decrease in postoperative infections (p = 0.001) and respiratory complications (p = 0.03). Although the length of stay and disposition patterns did not change over time, we found a significant decrease in cost of hospitalization (p = 0.001). In conclusion, from 2009 to 2014, utilization of LVADs increased with concomitant decrease in in-hospital mortality rates, without significant changes in major complications.

BACKGROUND: Evidence exists for racial/ethnic differences in left ventricular mass index (LVMI). How this translates to future cardiovascular disease (CVD) events is unknown. HYPOTHESIS: The impact of racial/ethnic differences in LVMI on incident cardiovascular outcomes could have potential implications for the optimization of risk stratification strategies. METHODS: Using the prospectively collected database of the Multi‐Ethnic Study of Atherosclerosis (MESA) involving 4 racial/ethnic groups (non‐Hispanic Whites, Chinese, Blacks, and Hispanics) free of CVD at baseline, we assessed for racial/ethnic differences in the relationship between LVMI and incident CVD using a Cox model. RESULTS: 5004 participants (mean age, 62 ± 10 years; 48% male) were included in this study. After an average follow‐up of 10.2 years, 369 (7.4%) CVD events occurred. Significant racial/ethnic differences existed in the relationship between LVMI and incident CVD (P for interaction = 0.04). Notably, the relationship was strongest for Chinese (HR per 10‐unit increase in LVMI: 1.7, 95% CI: 1.1–2.8) and Hispanics (HR per 10‐unit increase in LVMI: 1.9, 95% CI: 1.5–2.2). Non‐Hispanic Whites demonstrated the lowest relationship (HR: 1.3, 95% CI: 1.1–1.5). LVMI values of 36.9 g/m(2.7), 31.8 g/m(2.7), 39.9 g/m(2.7), and 41.7 g/m(2.7) were identified as optimal cutpoints for defining left ventricular hypertrophy (LVH) for non‐Hispanic Whites, Chinese, Blacks, and Hispanics, respectively. In secondary analysis of LVH (vs no LVH) using these optimal cutpoints, we found a similar pattern of association as above (P for interaction = 0.04). For example, compared with those without LVH, Chinese with LVH had HR: 5.3, 95% CI: 1.6–17, whereas non‐Hispanic Whites with LVH had HR: 1.6, 95% CI: 1.2–2.1 for CVD events. CONCLUSIONS: Among 4 races/ethnicities studied, LVMI has more prognostic utility predicting future CVD events for Chinese and Hispanics and is least significant for non‐Hispanic Whites.

Background: Gout has been shown to increase the risk of cardiovascular diseases among postmenopausal women. The mechanisms remain unclear. We sought to evaluate in-hospital outcomes among postmenopausal women hospitalized with coexisting gout and acute myocardial infarction (AMI). Methods: Data was retrieved from the Nationwide Inpatient Sample (NIS), using ICD-9-CM codes. We excluded women less than 55yrs old. Patients with acute myocardial infarction (AMI) and co-occurring gout were compared with those without gout. We then tested for associations with stroke, in-hospital mortality and length of stay using multivariate analysis to adjust for confounders. All analyses were performed using SAS. Results: There was a total of 335,403 hospital admissions for AMI. Out of these, 484 had co-occurring gout. Women with both co-occurring conditions were more likely to be white (64.1%). In adjusted models, co-occurring gout and AMI was significantly associated with a reduced likelihood of in-hospital mortality (aOR=0.50, 95% CI: 0.35-0.72, Table 1). However, co-occurring gout and AMI was not significantly associated with stroke rates (aOR=0.95, 95% CI: 0.59-1.55) or length of stay (aOR=1.46, 95% CI: 0.77-2.16). Conclusion: Results from this nationally representative sample suggests that co-occurring gout is associated with reduced in-hospital mortality among postmenopausal women admitted for AMI, while no significant associations were found for length of stay and stroke rates. Further prospective studies are needed to explore these associations.

Background and Objective: Marijuana use causes catecholamine surge with consequent tachycardia and elevation of both systolic and diastolic blood pressure. It is unclear if the catecholamine surge associated is sufficient to cause left ventricular wall apical ballooning (TakoTsubo Cardiomyopathy (TTC)). Given the similarity in the pathophysiology of TTC and mechanism of action of cannabis, we sought to investigate if there is any association. Methods: We obtained data from the HCUP-NIS of all patients older than 45 years hospitalized between 2012 - 2014. Our main outcome was diagnosis of TTC, and main exposure variables was cannabis use both identified using the ICD-9 codes. Using the SURVEYLOGISTICS procedure, we performed logistic regressions to estimate the odds of TTC diagnosis and in-hospital mortality among cannabis users adjusting for demographics, comorbidities, and other recreational drugs. Results: Of the 7,805,400 hospitalized patients who were > 45 years, 10,160 (0.1%) had a diagnosis of TTC, 54,311 (0.7%) were nondependent cannabis user and 5,045 (0.1%) were dependent cannabis users. We observed a significant association between TTC and nondependent cannabis use (OR 1.35, 95% CI: 1.10-1.65), but the association was nonsignificant for dependent cannabis use. After adjusting for potential confounders such as age, race, gender, comorbidities, cocaine, amphetamine and alcohol, nondependent cannabis use was associated with a 2-fold increased odds of TTC (AOR 2.00, 95% CI: 1.61-2.40). However, the association remained nonsignificant for dependent cannabis users (AOR 0.70, 95% CI: 0.25-1.92). Also, among patients diagnosed with TTC, there was no significant difference in the odds of in-hospital mortality among cannabis users (dependent and nondependent) when compared to nonusers (AOR 1.04, 95% CI: 0.39 - 2.70). Conclusion: In our study population, nondependent cannabis use was associated with significantly increased odds of TTC. However, among patients with TTC, in-hospital mortality rate was the same irrespective of cannabis exposure.

Background: The prognosis of Takotsubo Cardiomyopathy (TTCM) is worse than in the general population. It is unclear how atrial fibrillation (AF) impacts this prognosis. We sought to evaluate the effect of concurrent AF on outcomes in patients with TTCM. Methods: We used the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to extract all hospitalizations between 2007 and 2011 with concurrent diagnosis of AF and TTCM. The ICD-9 CM codes for AF and TTCM were used. We compared patients admitted for TTCM who had coexisting AF to those without. We excluded patients below the age of 18 as well as those diagnosed with TTCM who later underwent percutaneous coronary intervention (PCI). Multivariate regression was used to assess the independent effect of coexisting AF on clinical outcomes (length of stay (LOS), stroke, and in-hospital mortality). Results: A total of 13,136 TTCM patients were studied. Of these, 2,083 (15.86%) had coexisting AF. Compared with those without, TTCM patients with coexisting AF had a greater multivariate-adjusted risk for increased stroke rate (aOR=1.66, 95% CI=1.27-2.18, Table 1). We found no significant association with in-hospital mortality (aOR=1.21, 95% CI=0.96-1.52) or LOS (aOR=1.21, 95% CI= 0.83-1.58). Conclusions: In this large, nationally representative study, we found higher stroke rates in patients with coexisting AF and TTCM. Our findings suggest the need for closer monitoring during hospitalization.

Background: The need to balance bleeding and clotting risks after percutaneous coronary intervention (PCI) has led to interest in platelet function monitoring as a strategy to improve post-PCI outcomes. The prognostic value of platelet function testing in monitoring response to antiplatelet therapy after PCI remains unclear. Prior studies have been inconclusive. We sought to conduct an updated meta-analysis to address this gap in knowledge. Methods: We conducted a systematic search of EMBASE, PUBMED and the Cochrane libraries for studies since inception to December 2016 on platelet function monitoring. Our search yielded 203 studies, out of which 83 were extracted for full-text review. Only 3 studies met inclusion criteria. We pooled odds ratios using random-effects statistics, Mantel-Haenszel method. I2 and Chi- squared statistic was used to evaluate for heterogeneity. Publication bias was assessed using the funnel plot. Primary outcome was major adverse cardiovascular events (MACE). This was defined in the studies as a composite of cardiovascular death, myocardial infarction, stroke, stent thrombosis, and bleeding complications. Results: The 3 randomized controlled trials that were analyzed involved 3701 patients. There were 550 MACE (29.76%) in the platelet function monitored group compared with 514 (27.74%) in the control. MACE (Figure 1) was not significantly higher for the platelet function monitored group during follow-up compared with control (pooled Odds Ratio:1.11 [95% CI: 0.96-1.28], p = 0.15). Tests for heterogeneity were not significant, with I2 of 0%, Chi2 = 1.52 (p = 0.47); and small study bias was absent on visual inspection of the funnel plot. Conclusions: Platelet function monitoring continues to be used in practice. Results from this meta-analysis show no benefit of platelet function monitoring compared with conventional strategy with regards to MACE after PCI. Future research is needed to further evaluate this finding.

Background: Cannabidiol (CBD)-a component of cannabis with no psychoactive or cognitive effect has been proven in animal models to have a vasodilatory, anti-oxidant and anti-inflammatory effect on the blood vessels. However, it is unclear if cannabis users - while being exposed to its CBD constituents - benefit from its vasodilatory and anti-inflammatory effect in the prevention of acute myocardial infarction (MI). Objective: To investigate if there is a difference in the odds of MI among cannabis users when compared to nonusers. Methods: We used data from the Nationwide Inpatient Sample on patients ages 45 years and older admitted between 2012 - 2014. The main study outcome was clinical diagnosis of MI, and the main exposure variable was cannabis use identified using ICD-9 codes. Cannabis use was categorized into non-use, non-dependent, and dependent use. Multivariable logistic regression models were used to estimate the odds of MI and In-hospital mortality in relation to cannabis use adjusting for demographics, comorbidities, and use of other recreational drugs. Results: Of the 7, 995,162 hospitalized patients who were > 45 years, 532,112 (6.7%) had a diagnosis of MI, 56,836 (0.7%) were non-dependent cannabis user and 5,417 (0.1%) were dependent cannabis users. We observed a significant inverse association between cannabis use and MI (non-dependent OR: 0.86, 95% CI: 0.83-0.90; dependent OR 0.26, 95% CI: 0.21-0.31). After adjusting for confounding variables, the association was attenuated for non-dependent cannabis users (OR: 1.03, 95% CI: 0.99-1.06]). However, among dependent cannabis users, there was 66% decreased odds of MI when compared to nonusers. Also, cannabis use was associated with 32% decreased odds of in-hospital mortality among patients with MI when compared to nonuse. Conclusions: Using the largest national data, our study showed cannabis use was not a risk factor for MI and alternatively may point to a protective benefit in the diagnosis of MI and in-hospital mortality. Future prospective studies may aid in further exploring this association to maximize the therapeutic advantage of the cannabinoid system in MI prevention.

Background: With increasing legalization of cannabis, there is a growing number of cannabis users in the US. Cannabidiol - a component of cannabis with no psychoactive or cognitive effect has been proven in animal models to have vasodilatory and anti-inflammatory effect on the blood vessels. However, in clinical literature, the association between cerebrovascular accident (CVA) and cannabis remains inconclusive. Objective: To examine if there is a difference in the prevalence of CVA among patients who use cannabis and non-users. Methods: We identified patients > 18 years (N=12,114,360) from the 2012 -2014 National Inpatient Sample database. Using the ICD-9 code, we categorized patients using cannabis (non-dependent and dependent users) and non-users. Our outcome of interest was prevalence of CVA in this population. Logistic regression analysis was performed to assess the association between cannabis use and CVA. Using multivariate regression model, we adjusted for known confounders of CVA; age, gender, race, insurance type, socioeconomic status, tobacco use, cocaine use, alcohol abuse, amphetamine use, hyperlipidemia, diabetes, hypertension, renal failure, prior history of CVA and family history of CVA. Results: From our study sample (12,114,360 hospitalized patients), 2.1% (253,752) had a diagnosis of CVA, 1.48% (179,576) were non-dependent cannabis users and 0.21% (25,968) dependent users. Among hospitalized patient, non-dependent cannabis use was associated with an 8% increased odds of CVA (AOR 1.08 [1.03-1.13]) compared to non-users. However, dependent cannabis use was associated with a 60% decreased odds of CVA (AOR 0.40 [0.31-0.49]) compared to non-users. Also, In-group comparison shows a 60% decreased odds of CVA among dependent cannabis users (AOR 0.36[0.29-0.46]) compared to non-dependent cannabis users. Conclusions: Non-dependent cannabis use was associated with a slightly increased odd of CVA while dependent cannabis use was independently protective against CVA. Our study used the largest repository of clinical information to explore this association, however we recommend more clinical study to explore this correlation in other to maximize the pharmacological benefit of cannabidiol in cannabis for the prevention of CVA.

Introduction: Cannabis is a commonly utilized recreational substance which contains numerous bioactive agents. As more states legalize the use of marijuana, it’s effect on various disease conditions is expected to become more pronounced. Cannabis’ anti-inflammatory effects could suppress pro-inflammatory conditions. For example, chronic inflammation with extracellular matrix degradation resulting in weakness and abnormal dilatation of the aortic wall is a hallmark of Aortic Aneurysm. We, therefore, hypothesized that cannabis users would have less prevalence of aortic aneurysms. Objective: To identify the relationship between chronic cannabis use (CU) and diagnosis of aortic aneurysms (AA) among hospitalized patients. Methods: After selecting patients who were 55 years and above from 2012 to 2014 National Inpatient Sample database, we identified those who had a diagnosis of Aortic Aneurysm and those who utilize Cannabis. We then stratified the CU into two groups: nondependent (NDU) and dependent users (DU). Using logistic regression, we estimated the Odds Ratio (AOR) after controlling for numerous factors. Results: In our total 10,461,694 sample, 99.6% (10,419,972) are non-users, 0.37% (38,514) are nondependent users and 0.03% (3,208) are dependent users. About 3.21% (336,202) of the patients had a diagnosis of AA versus 96.79% (10,125,492) without a diagnosis of AA. Compared to non-users of cannabis, the odds of AA is about 35% less among CU (AOR 0.66[0.62-0.71]), 40% less among DU (aOR 0.58[0.44-0.76]), and 33% less among NDU (AOR 0.67[0.62-0.72]). The odds of AA was lower in females (AOR 0.61[0.60-0.610]), but higher in many conditions such as: among >=65 years (AOR 1.16[1.15-1.17]), tobacco users (AOR 1.18[1.17-1.19]), predisposing hereditary conditions (AOR 5.31[4.60-6.13]), and atherosclerosis (AOR 3.04[3.00-3.08]). Conclusions: Our result shows that Cannabis use is associated with less occurrence of AA. Cannabidiol, an anti-inflammatory alkaloid in Cannabis could potentially suppress the release of proteolytic inflammatory mediators which might be responsible for the gradual weakening of the vascular walls. We recommend more basic research to evaluate this effect of Cannabidiol.

Background: In-stent restenosis accounts for major morbidity and mortality among patients treated with Bare-Metal Stents (BMS). Early efforts to treat BMS in-stent restenosis with plain balloon angioplasty and first generation drug eluting stents (DES) have been ineffective, leaving drug-eluting balloon (DEB) and second generation DES, such as everolimus eluting stents (EES), as the only remaining options. For BMS in-stent restenosis, studies performed so far have yielded conflicting results, while prior meta-analyses have been influenced by inclusion of observational studies. This is the first meta-analysis to compare EES versus DEB using results from only randomized controlled trials (RCTs). Methods: A systematic search of PUBMED and EMBASE databases was conducted from first available date to August, 2016 for RCTs comparing DEB with EES. Two reviewers evaluated studies for eligibility and extracted data with binary restenosis rate as the main endpoint. We identified 901 unique citations. Odds ratios were pooled using random-effects modeling. Funnel plots were used to assess publication bias. Heterogeneity was assessed using I 2 statistic. All analysis were performed using Review Manager (RevMan) version 5.3 (Cochrane Collaboration, 2014). Results: Three RCTs met study eligibility criteria, with 684 patients and a mean follow-up of 9.5 months. There were 184 and 185 patients in the EES and DEB arms respectively. In pooled analyses, EES was not superior to DEB in binary restenosis rates (pooled odds ratio: 0.76; 95% confidence interval: 0.25-2.32; P=0.14). Heterogeneity was minimal (I 2 = 49%), and the funnel plot did not suggest publication bias. Conclusion: In patients with BMS in-stent restenosis, there were no significant differences in binary restenosis rates between EES and DEB. Our results can enhance physician decision-making regarding choice of revascularization tool in this patient population.

Background: The overall mortality rate after acute myocardial infarction (AMI) is falling in the United States. However, outcomes remain unacceptably worse in females compared to males. It is not known how coexisting atrial fibrillation (AF) modify outcomes among the sexes. We sought to examine the association of sex with clinical characteristics and outcomes after AMI among patients with AF. Methods: We accessed the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), to extract all hospitalizations between 2007 and 2011 for patients above 18yrs with principal diagnosis of AMI and coexisting diagnosis of AF using ICD 9-CM codes. The NIS represents the largest all-payer hospitalization database in the United States, sampling approximately 8 million hospitalizations per year. We also extracted outcomes data (length of stay (LOS), stroke and in-hospital mortality) after AMI among Patients with AF. We then compared sex differences. Univariate and Multivariate analysis were conducted to determine the presence of statistically significant difference in outcomes between men and women. Results: A total of 184,584 AF patients with AMI were sampled, consisting of 46.82% (86,420) women and 53.13% (98,164) men. Compared with men, women with AF and AMI had a greater multivariate-adjusted risk for increased stroke rate (aOR=1.51, 95% CI=1.45-1.59), and higher in-hospital mortality (aOR=1.12, 95% CI=1.09-1.15). However, female gender was not significantly associated with longer LOS (aOR=-0.22, 95% CI= -0.29-(-0.14). Conclusion: In this large nationwide study of a population-based cohort, women experienced worse outcomes after AMI among patients with AF. They had higher in-hospital mortality and increased stroke rates. Our findings highlight the need for targeted interventions to improve these disparities in outcomes.

Background: Recent studies have shown that patients with endometriosis have an increased risk of coronary artery disease. Inflammatory diseases that increase the risk of coronary artery disease have also been shown to worsen outcomes. We sought to evaluate the effect of co-occurring endometriosis among women with myocardial infarction (MI) on stroke, length of stay (LOS) and in-hospital mortality. Methods: Data was obtained from the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS). We studied women ages 18 and above hospitalized for MI between 2007 and 2011. Admissions for endometriosis, MI and outcomes data were extracted using ICD-9 CM codes. We estimated weighted frequencies and proportions for all patients admitted for MI, co-occurring endometriosis and for all covariates. We then performed bivariate parametric tests of association as appropriate. In order to evaluate the independent effect of co-occurring endometriosis and MI on stroke, LOS and in-hospital mortality, we constructed multivariate regression models. Results: We found a total of 420,940 hospital admissions for myocardial infarction. Out of these, 80 had co-occurring endometriosis. Women with these co-occurring conditions were more likely to be white (67.5%) and privately insured (53.8%). In adjusted models, compared to those without, women with co-occurring endometriosis and MI did not have a significantly higher risk of stroke (aOR=1.10, 95% CI: 0.27- 4.56) or prolonged LOS (aOR=1.29, 95% CI: 0.45 - 3.04). Risk was not found to be increased for in-hospital mortality (aOR=0.71, 95% CI: 0.26 - 1.95). Conclusion: Our study shows that co-occurring endometriosis among women with MI was not significantly associated with worse in-hospital outcomes. Larger, prospective, studies with longer follow-up time after discharge are needed to further evaluate this association.

Background: The association between hyperthyroidism and Takotsubo Cardiomyopathy (TTCM) has only been reported in isolated case reports and a recent single center study with inconclusive results. It is known that elevated thyroid hormone causes an increased sympathetic modulation of heart rate. It has also been shown that TTCM occurs in the setting of acute stressful illnesses involving excess catecholamine release. What is unclear is whether hyperthyroid states can predispose to TTCM. This is the first nationwide study of this association. Methods: We used ICD-9 CM codes to extract data from the Nationwide Inpatient Sample database from 2007-2011. Patients with TTCM and coexisting hyperthyroidism were compared with TTCM patients without coexisting hyperthyroidism. We excluded persons below the age of 18 as well as patients diagnosed with TTCM who later underwent percutaneous coronary intervention (PCI). Multivariate logistic regression was used to assess the independent effect of coexisting hyperthyroidism on the occurrence of TTCM. Results: A total of 33,639,230 patients were included, where 123,923 patients had hyperthyroidism while 32,400,000 did not have hyperthyroidism. There were 101 (0.08%) TTCM patients with coexisting hyperthyroidism compared to 13,893 (0.04%) without (p Conclusion: In this large, nationwide study, hyperthyroidism was associated with increased risk of TTCM. This association was strongest among hispanics. Further research is needed to understand the mechanisms behind this association.

Background: The pathogenesis of Takotsubo Cardiomyopathy (TTCM) remains poorly understood. Several case reports have described the occurrence of TTCM in patients with preexisting valvular heart disease (VHD). We sought to examine the association between preexisting VHD and TTCM in hospitalized patients. Methods: Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), all hospitalizations between 2007 and 2011 with preexisting diagnosis of VHD and admitting diagnosis of TTCM were extracted using ICD-9 CM codes. We compared patients admitted for TTCM who had preexisting VHD to those without. We excluded patients below the age of 18 as well as those diagnosed with TTCM who later underwent percutaneous coronary intervention (PCI). Multivariate logistic regression was used to assess the independent effect of preexisting VHD on both occurrence of TTCM and clinical outcomes (length of stay (LOS), stroke and in-hospital mortality). Results: In our study, 613 (0.06%) out of the 1,084,719 hospitalized patients with preexisting VHD, had TTCM, compared to 13,381 (0.04%) out of the 31,460,000 with no preexisting VHD (p Conclusion: In this large, nationwide study, preexisting VHD was associated with worse clinical outcomes in patients hospitalized for TTCM. Our results can guide future clinical decision-making regarding prompt risk factor identification for poor prognosis in TTCM patients. Future prospective studies are needed to further evaluate this association.

Background: Diabetes has been associated with complications and poor perioperative outcomes. In Radiofrequency catheter ablation - therapy of choice for drug refractory atrial fibrillation and flutter, association between diabetes and procedural complications are less documented. Objectives: To examine if there is a difference in perioperative complications in patients with chronic diabetes who underwent RFA for atrial fibrillation/flutter when compared with non-diabetics. Methods: We selected patients > 45 years from the National Inpatient Survey data 2014. We identified 8356 patients (69.6 ± 9.1yrs) who underwent catheter ablation. Logistic regression analyses were performed to investigate the difference in perioperative complications (hemorrhage, cardiac perforation, cardiac complications, respiratory complications, peripheral vascular complications, stroke and in-hospital mortality) between diabetics and non-diabetics. All models were adjusted for age, gender, race, residential income, insurance, co-morbidities, hospital bed size, hospital location/teaching status, hospital region, length of stay and median household income. Results: Among our selected 8356 patients, 5777(69.1%) were non-diabetics, 2203(26.4%) had uncomplicated diabetes and 376 (4.5%) complicated diabetes. Overall there were 634 events (240 hemorrhages, 56 perforations, 163 cardiac complications, 43 respiratory complications, 12 strokes, 40 peripheral vascular complications and 80 in-hospital death. Rates of complications were the same among diabetes and non-diabetics. In the multivariate models, the odds of complications remain statistically non-significant across all the groups. However, among all the patients who underwent RFA, there is an increased odds of hemorrhage among patients with Medicare insurance versus private insurance (OR 1.73 95%CI 1.11-2.70), peripheral vascular complications among hospitals in the south (OR 3.35 95%CI 1.30-9.62), respiratory complications among patients with CHF (4.60 95%CI 1.68-12.60), death among patients with renal failure (OR 2.22 95%CI 1.32-3.73) and hospitals in the south (2.55 95% CI 1.08-6.0) and west (OR 3.23 95%CI 1.25-8.3) compared to the northeast. Odds of stroke were less among both urban non-teaching (OR 0.02 95%CI 0.01 - 0.34) and teaching hospital (OR 0.05 95%CI 0.01-0.36) when compared to rural hospital. Conclusions: RFA has a similar procedural safety in diabetics when compared to non-diabetic patients. It remains a safe procedure in diabetics with drug-refractory atrial fibrillation and flutter. Renal failure, CHF, type of Insurance, hospital location and teaching status are predictors of complications after RFA.

International audience; Cannabis use is associated with reduced prevalence of obesity and diabetes mellitus (DM) in humans and mouse disease models. Obesity and DM are a well-established independent risk factor for non-alcoholic fatty liver disease (NAFLD), the most prevalent liver disease globally. The effects of cannabis use on NAFLD prevalence in humans remains ill-defined. Our objective is to determine the relationship between cannabis use and the prevalence of NAFLD in humans. We conducted a population-based case-control study of 5,950,391 patients using the 2014 Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Survey (NIS) discharge records of patients 18 years and older. After identifying patients with NAFLD (1% of all patients), we next identified three exposure groups: non-cannabis users (98.04%), non-dependent cannabis users (1.74%), and dependent cannabis users (0.22%). We adjusted for potential demographics and patient related confounders and used multivariate logistic regression (SAS 9.4) to determine the odds of developing NAFLD with respects to cannabis use. Our findings revealed that cannabis users (dependent and non-dependent) showed significantly lower NAFLD prevalence compared to non-users (AOR: 0.82[0.76-0.88]; p

Percutaneous mechanical circulatory support (pMCS) is increasingly used in cardiogenic shock (CS). However, sex differences in outcomes in patients with CS treated with pMCS have not been previously studied. The National Inpatient Sample Database was queried from January 2006 to September 2015 to

Transcatheter aortic valve replacement (TAVR) expenditure is generally higher compared with surgical aortic valve replacement. In order to minimize the cost, identification of patient characteristics and perioperative complications associated with elevated cost post-TAVR would improve patient

Older patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) are frequently encountered in routine clinical practice. However, real-world data on the use, influencing factors, clinical outcomes, and economic burden of early invasive strategy versus initial conservative

Purpose In the setting of Cardiogenic Shock (CS), impaired biventricular function can lead to an acute decrease in renal function via reduced renal perfusion and increased renal venous pressure. In a nationally representative sample, we sought to analyze the characteristics and outcomes of patients hospitalized with CS requiring renal replacement therapy (hemodialysis) for acute kidney injury (AKI-HD). Methods We utilized data from the National Inpatient Sample to calculate national rates of in-hospital mortality, use of temporary mechanical support (T-MCS), vascular injury requiring surgery (VI), length of stay (LOS) and hospitalization cost from 2010 to 2015. We compared the in-hospital outcomes between CS with AKI-HD and a propensity score-matched group without AKI-HD Results We identified 6,076 patients (weighted n=29,921) with CS and AKI-HD and 81,865 (weighted n=403,081) with CS not AKI-HD. Patients with CS and AKI-HD were more likely to have diabetes mellitus [40.3% vs. 34.5%, standardized difference (SD) 0.12], pre-existing chronic kidney disease (48.8% vs. 28.2%, SD 0.4) and higher comorbidity burden as assessed by Elixhauser score (score ≥4 in 74.6% vs. 50.6%) compared with CS patients without AKI-HD. After matching 5,513 cases for patient-level and hospital-level characteristics, CS with AKI-HD was associated with significantly higher in-hospital mortality (73.1% vs. 53.5%, p Conclusion AKI-HD occurred in approximately 7% of patients with CS in years 2010-2015 and was associated with significantly increased in-hospital morbidity and mortality, LOS and cost.

Purpose Although renal function may improve after left ventricular assist devices (LVAD) implantation, acute kidney injury (AKI) requiring hemodialysis (HD) therapy can occur post-operatively. We sought to investigate in-hospital outcomes and readmissions among patients who developed AKI requiring HD during index admission for LVAD implantation. Methods We utilized data from the National Readmissions Database and the US Census Bureau to calculate annual national rates of in-hospital mortality, stroke, post-operative bleeding, length of stay, hospital cost and readmissions among patients who underwent implantation and developed acute kidney injury(AKI) requiring hemodialysis (HD) for years 2012 to 2014. Results We identified 208 patients with AKI on HD after LVAD implantation (weighted = 536). Among these patients, 68.5% had chronic kidney disease and 45.8% diabetes before LVAD implantation. Rates of in-hospital mortality (from 55.53% in 2012 to 34.67 % in 2014, p=0.025), length of stay (from 66.8 days in 2012 to 52.1 days in 2014, p Conclusion In-hospital mortality and length of stay are decreasing in patients requiring HD for AKI after LVAD implantation but remain higher than LVAD recipients without AKI on HD. A significant percentage of these patients who survive hospital discharge require maintenance hemodialysis.

The impact of chronic thrombocytopenia (cTCP), defined as platelets count of < 150,000 cells/ml, on clinical outcomes after transcatheter aortic valve implantation (TAVI), MitraClip, permenant pacemaker(PPM), implantable-cardioverter defibrillator(ICD), cardiac resynchronization therapy(CRT), left

In order to improve PCE-based ASCVD risk prediction, especially for those with intermediate risk (i.e. 5-7.5%), the ACC/AHA risk assessment working group had called for research into novel risk markers. We therefore evaluated the incremental benefit of LV mass index (LVMI) over the PCE We included

In the setting of Cardiogenic Shock (CS), impaired biventricular function can lead to an acute decrease in renal function via reduced renal perfusion and increased renal venous pressure. In a nationally representative sample, we sought to analyze the characteristics and outcomes of patients

Background Carotid endarterectomy and carotid artery stenting are effective treatment procedures for carotid artery stenosis. Although diabetes mellitus is highly prevalent among patients undergoing these revascularization procedures, few studies have examined their impact on periprocedural outcomes. Objectives The study aimed to determine whether perioperative outcomes among patients undergoing carotid artery stenting and carotid endarterectomy varied depending on the presence of diabetes with or without chronic complications. Methods We examined adults aged 45 and above hospitalized between 2007 and 2011 in U.S. hospitals who underwent carotid artery revascularization procedures. We used data from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample and evaluated the influence of diabetes with or without chronic complications on outcomes. Results Among patients receiving carotid artery stenting, diabetic patients with chronic complications had significantly increased odds of acute kidney injury (odds ratio [OR]: 3.17, 95% confidence interval [CI]: 2.31-4.35) and longer hospital stay (β: 1.98, 95% CI: 1.58-2.38) compared with nondiabetic patients. Diabetic patients with chronic complications receiving carotid endarterectomy experienced increased odds of myocardial infarction (OR: 1.12, 95% CI: .90-1.40), stroke (OR: 1.29, 95% CI: .97-1.72), perioperative infection (OR: 2.45, 95% CI: 1.29-4.65), mortality (OR: 1.48, 95% CI: 1.01-2.16), and longer hospital stay (β (days): 2.05, 95% CI: 1.90-2.20) compared with nondiabetic patients. No significant increased odds of perioperative outcomes were observed among diabetic patients without chronic complications. Conclusions Uncomplicated diabetes did not appear to convey a higher odds of perioperative outcomes among patients undergoing revascularization. However, the presence of diabetes with chronic complications is an important risk factor in the carotid endarterectomy category.

Peripheral artery disease (PAD) has been associated with adverse outcomes in patients undergoing TAVR. The procedural (in-hospital) risk of adverse events has not been studied. We aimed to study the in-hospital outcomes of TAVR in patients with and without PAD using the National Inpatient Sample (