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We conducted a retrospective cohort study of the adverse events at one year post-cardiac computed tomography (cardiac CT) using data gathered from the Marshfield Clinic Health System (MCHS) Cardiac CT registry to compare non-fatal myocardial infarction (MI), revascularization, all-cause mortality, and composite major adverse cardiac events (MACE) one year following cardiac CT in patients with non-obstructive coronary artery disease (CAD) and normal coronary arteries. From 2009 to 2017, the records of 2,649 patients who underwent cardiac CT were reviewed. CAD detected by cardiac CT was defined as normal (0% luminal stenosis) and non-obstructive (1-49% luminal stenosis). Clinical outcomes were nonfatal MI, revascularization, including percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG), all-cause mortality, and MACE. Cohorts were compared using t-tests and Fisher exact tests, and a logistic regression was performed to assess risk of clinical outcomes at one year. Compared with patients with normal coronary arteries, patients with non-obstructive coronary disease on cardiac CT had higher event rates of MACE (3.7% vs. 1.2%; P =0.006), revascularization (1.1% vs. 0.2%; P=0.033), and all-cause mortality (1.7% vs. 0.4%; P=0.012). After adjusting for baseline difference in demographics, risk factors, and medication use, the odds ratio of revascularization was 3.77 (95% CI: 1.03,13.79) and MACEs was 2.06 (95% CI: 0.94,4.51). Symptomatic congenital heart diseases accounted for about 50% of the non-death MACEs. Cardiac CT-defined non-obstructive CAD was associated with higher rates of revascularization, all-cause mortality and MACE compared to those with normal coronary arteries.

Background Transcatheter aortic valve replacement (TAVR) is a rapidly evolving treatment for severe aortic stenosis. However, uncertainties exist for optimal valve selection as there are few long-term studies comparing patient survival by valve type. Objective We hypothesized that self-expandable valves (SEV) would provide a survival advantage over balloon expandable valves (BEV), as self-expandable valves continue to expand and might better accommodate to the anatomy of the aortic valve over time. Methods We examined outcomes according to valve type from a rural tertiary referral center between 2012 and 2017. Results Out of 269 patients, 77 deaths (28.6%) occurred over the study period with six deaths by 1 month post-TAVR and 37 deaths by 1 year post-TAVR. The median observation time for survivors was 21.5 months. The probability of survival at 3 years was 60.7% and 61.9% for patients who underwent treatment with SEV and BEV, respectively. There was no statistically significant difference in overall patient survival with or without adjustment for factors such as age, sex, race, and aortic valve area. Additionally, in a secondary analysis restricted to those patients treated in later years (2015-2017) survival among patients with BEV appeared superior (HR=0.456, p=0.015). Conclusion Patients who underwent TAVR at a rural medical center with an SEV showed similar survival compared to those who received a BEV. Superior survival was observed among those who received a BEV versus SEV between 2015 and 2017.

Fascia iliaca compartment block (FICB) has become a keystone technique for acute pain management in patients with hip and proximal femur fractures.To demonstrate that administering FICB preoperatively to patients with hip or proximal femur fractures in the emergency department (ED) is likely to reduce opioid use and related complications, and to decrease hospital length of stay (LOS).An unblinded study of adult patients with hip and proximal femur fractures who consented to receive an FICB with 30 cc of bupivacaine with epinephrine administered in the ED. We compared this group with a contemporaneous group of controls who only received systemic opioids. Over the course of approximately 6 months, main outcome measured between the two groups was amount of morphine equivalents given from block administration until 8 h after. We also compared complications such as delirium, constipation, and bleeding rates (oozing from injection site or hematoma formation).A total of 166 patients with hip and proximal femur fractures from August 12, 2018 to April 25, 2021; 81 received FICB plus systemic opioids, and 85 received only systemic opioids. Among the FICB group, morphine equivalents were reduced by 0.6 mg/h with no significant difference in LOS. A statistically significant difference in opioid-related adverse outcomes was found between the anticoagulated group vs. the no anticoagulation group.FICB is a safe and effective preoperative technique for initial pain management in patients with hip and proximal femur fractures, as it can also be used with additional systemic opioids. FICB administration may reduce systemic opioid use preoperatively, thus reducing opioid-related adverse effects with no significant impact on hospital LOS.

Although prior studies showed mean aortic valve pressure gradient (mAoVpg) dramatically drops in patients with severe aortic stenosis following Transcatheter Aortic Valve Replacement (TAVR) with different valve types; it is not well known if this drop in mAoVpg is sustained through the years after

There are few studies comparing paravalvular leak (PVL) rates by valve types in patients with severe aortic stenosis following Transcatheter Aortic Valve Repair (TAVR); and none over the years. We hypothesized that self-expandable valves (SEV) were associated with a lower PVL over the years than