313 results on '"Rodrigo Bagur"'
Search Results
2. Use of downstream stress imaging tests for risk stratification of patients presenting to the emergency department with chest pain and low HEART score
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Rodrigo Bagur, Nikolaos Tzemos, Rami M Abazid, Cigdem Akincioglu, Yves Bureau, Maged Elrayes, Sameh Awadallah, Mohamed M Ibrahim, Amer Alaref, and Nilkanth Patil
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Patients with low HEART (History, Electrocardiogram, Age, Risk factors, and Troponin level) risk scores who are discharged from the emergency department (ED) may present clinical challenges and diagnostic dilemmas. The use of downstream non-invasive stress imaging (NISI) tests in this population remains uncertain. Therefore, this study aims to investigate the value of NISI in risk stratification and predicting cardiac events in patients with low-risk HEART scores (LRHSs).Methods We prospectively included 1384 patients with LRHSs between March 2019 and March 2021. All the patients underwent NISI (involving myocardial perfusion imaging/stress echocardiography). The primary endpoints included cardiac death, non-fatal myocardial infarction and unplanned coronary revascularisation. Secondary endpoints encompassed cardiovascular-related admissions or ED visits.Results The mean patient age was 64±14 years, with 670 (48.4%) being women. During the 634±104 days of follow-up, 58 (4.2%) patients experienced 62 types of primary endpoints, while 60 (4.3%) developed secondary endpoints. Multivariable Cox models, adjusted for clinical and imaging variables, showed that diabetes (HR: 2.38; p=0.008), HEART score of 3 (HR: 1.32; p=0.01), history of coronary artery disease (HR: 2.75; p=0.003), ECG changes (HR: 5.11; p
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- 2024
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3. Dedicated Balloon Techniques for Coronary Calcium Modification
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Max W Maffey and Rodrigo Bagur
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Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Coronary calcification represents a significant technical challenge in percutaneous coronary intervention and is associated with worse clinical outcomes. Fortunately, a number of balloon-assisted technologies are available to aid in the management of coronary calcification before stenting. Adequate lesion preparation is crucial in the successful management of calcified coronary lesions. Balloon-based techniques can be a safe and effective method of lesion preparation and, as such, are an integral part of an interventionalist’s armamentarium. In this mini-review, we focus on the use of non-compliant balloons, super high-pressure non-compliant balloons, cutting balloons, scoring balloons and intravascular lithotripsy.
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- 2024
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4. Readmissions After Left Atrial Appendage Closure in Patients With Previous Ischemic Stroke or Transient Ischemic Attack
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Robert T. Sparrow, MD, HBA, Luciano A. Sposato, MD, MBA, Mohamad A. Alkhouli, MD, Santiago García, MD, Islam Y. Elgendy, MD, Adrian A. Kuchtaruk, BSc, Hani Jneid, MD, M. Chadi Alraies, MD, Nikolaos Tzemos, MD, Mamas A. Mamas, BMBCh, DPhil, and Rodrigo Bagur, MD, PhD, FRCPC, DRCPSC, FAHA, FSCAI
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: We examined the frequency and risk factors associated with readmission after left atrial appendage closure (LAAC) in patients with and without previous ischemic stroke and/or transient ischemic attack (TIA). Methods: Hospitalizations for LAAC were identified from the US National Readmission Database, 2016-2018. The primary outcome was the first unplanned readmission after LAAC, with readmission times stratified into those occurring within 0 to 30 days vs within 31 to 180 days. Patients were stratified based on the history of previous stroke and/or TIA. Results: Of 12,901 discharges after LAAC, 28% had previous stroke and/or TIA, and 8.2% had a readmission within 30 days while 18% had a readmission within 31 to 180 days. The rates of in-hospital complications and readmissions at both periods were not significantly different between individuals with vs without previous stroke and/or TIA. Cardiac causes accounted for 28% of readmissions within 30 days and 32% of those within 31 to 180 days, and congestive failure, bleeding, and infections were the most common readmission diagnoses. New stroke and/or TIA accounted for 4% and 6% of the total noncardiac readmissions within 30 days and 31 to 180 days, respectively, and the incidence was higher among those with previous stroke and/or TIA. Female sex and index hospitalization length of stay (LOS) > 1 day were factors independently associated with readmission within 30 days, whereas LOS, diabetes, renal disease, chronic obstructive pulmonary disease, and anemia were among the factors associated with readmissions within 31 to 180 days. Conclusions: Unplanned rehospitalizations were common after LAAC and had similar frequency for patients with vs without previous ischemic stroke and/or TIA. Female sex and index hospitalization LOS > 1 day were among the strongest factors that were independently associated with readmission within 30 days. Résumé: Contexte: Nous avons examiné la fréquence et les facteurs de risque des réadmissions consécutives à une fermeture de l'appendice auriculaire gauche (FAOG) chez les patients ayant ou non subi un accident vasculaire cérébral (AVC) ischémique et/ou un accident ischémique transitoire (AIT). Méthodologie: Les hospitalisations pour une FAOG ont été recensées au moyen de la US National Readmission Database (base de données nationale des réadmissions aux États-Unis) pour la période 2016-2018. Le critère d’évaluation principal était la première réadmission non prévue après une FAOG, avec stratification du moment de la réadmission selon que celle-ci était survenue de 0 à 30 jours ou de 31 à 180 jours après l’intervention. Les patients ont été stratifiés en fonction des antécédents d’AVC et/ou d’AIT. Résultats: Parmi les 12 901 patients ayant reçu leur congé de l’hôpital après une FAOG, 28 % avaient des antécédents d’AVC et/ou d’AIT; 8,2 % des patients admissibles ont été réadmis dans les 30 jours et 18 %, entre le 31e et le 180e jour suivant l’intervention. Aucune différence significative n’a été observée entre les patients ayant subi un AVC et/ou un AIT et les patients qui n’en avaient pas subi en ce qui concerne les taux de complications hospitalières et de réadmission durant ces deux périodes. Les causes cardiaques représentaient 28 % des réadmissions dans les 30 jours et 32 % des réadmissions entre le 31e et le 180e jour. L’insuffisance cardiaque congestive, les hémorragies et les infections ont été les causes les plus fréquentes de réadmission. Les nouveaux cas d’AVC et/ou d’AIT ont respectivement été à l’origine de 4 % et de 6 % de l’ensemble des réadmissions de cause non cardiaque dans les 30 jours, et entre le 31e et le 180e jour, et leur fréquence a été plus élevée chez les patients ayant des antécédents d’AVC et/ou d’AIT. Le sexe féminin et une durée d’hospitalisation initiale > 1 jour ont été des facteurs indépendants associés aux réadmissions dans les 30 jours, tandis que la durée de l’hospitalisation, un diabète, une néphropathie, une maladie pulmonaire obstructive chronique et une anémie faisaient partie des facteurs associés aux réadmissions entre le 31e et le 180e jour. Conclusions: Les réhospitalisations non prévues ont été courantes après une FAOG, et leur fréquence a été similaire en présence ou en l’absence d’antécédents d’AVC ischémique et/ou d’AIT. Le sexe féminin et une durée d’hospitalisation initiale > 1 jour ont été les facteurs les plus importants associés aux réadmissions dans les 30 jours.
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- 2023
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5. Simultaneous Hybrid Transcatheter Aortic Valve Implantation and Endoscopic Mitral Valve RepairNovel Teaching Points
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Christina Oatway, MD, Junichi Shimamura, MD, Rodrigo Bagur, MD, PhD, Satoru Fujii, MD, and Michael W.A. Chu, MD, MEd
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2023
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6. Cardiovascular outcomes and trends of Transcatheter vs. Surgical aortic valve replacement among octogenarians with heart failure: A Propensity Matched national cohort analysis
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Yasar Sattar, David Song, Talal Almas, Mohamed Zghouzi, Usama Talib, Abdul-Rahman M. Suleiman, Bachar Ahmad, Junaid Arshad, Waqas Ullah, Muhammad Zia Khan, Christopher M. Bianco, Rodrigo Bagur, Muhammad Rashid, Mamas A. Mamas, and M. Chadi Alraies
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Transcatheter aortic valve replacement ,Surgical aortic valve replacement ,Heart failure ,Heart Failure with reduced ejection fraction ,Heart Failure with preserved ejection fraction ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Heart failure (HF) is a complex clinical syndrome with symptoms and signs that result from any structural or functional impairment of ventricular filling or ejection of blood. Limited data is available regarding the in-hospital outcomes of TAVR compared to SAVR in the octogenarian population with HF. Methods: The National Inpatient Sample (NIS) database was used to compare TAVR versus SAVR among octogenarians with HF. The primary outcome was in-hospital mortality. The secondary outcome included acute kidney injury (AKI), cerebrovascular accident (CVA), post-procedural stroke, major bleeding, blood transfusions, sudden cardiac arrest (SCA), cardiogenic shock (CS), and mechanical circulatory support (MCS). Results: A total of 74,995 octogenarian patients with HF (TAVR-HF n = 64,890 (86.5%); SAVR n = 10,105 (13.5%)) were included. The median age of patients in TAVR-HF and SAVR-HF was 86 (83–89) and 82 (81–84) respectively. TAVR-HF had lower percentage in-hospital mortality (1.8% vs. 6.9%;p
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- 2022
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7. Quantitative Flow Ratio and Virtual Percutaneous Coronary Intervention for Serial Coronary Stenoses: Attractive Technology, But Still Crawling
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Wael Sumaya, Mamas A. Mamas, and Rodrigo Bagur
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Editorials ,coronary stenosis ,percutaneous coronary intervention ,physiology ,technology ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2022
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8. Aggressive Cholesterol Pericarditis With Minimal Effusion Masquerading as Treatment-Refractory Autoimmune DiseaseNovel Teaching Points
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Tahir S. Kafil, MD, FRCPC, Elena Tugaleva, MD, FRCPC, Muhammad M. Hashmi, MD, Omar Shaikh, BHSc, Yehia Fanous, MD, Tahir Dahrouj, BHSc, Maged Elrayes, MD, Lin-Rui Ray Guo, MD, FRCSC, Rodrigo Bagur, MD, PhD, FRCPC, and Nikolaos Tzemos, MD, FRCPC
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A middle-aged woman with rheumatoid arthritis presented with treatment-refractory pericarditis. Symptoms persisted despite escalation of immunosuppression, and she had recurrent admissions for heart failure. Imaging revealed minimal pericardial effusion and a thickened pericardium. Invasive hemodynamics confirmed constrictive physiology, and a pericardiectomy was required. Pathology testing confirmed cholesterol pericarditis, a rare condition of inflammatory cholesterol deposits within the pericardium. Previous reports describe moderate-to-large volumes of gold-coloured pericardial fluid. This case illustrates that cholesterol pericarditis can present with minimal pericardial effusion and rapidly progress to pericardial constriction. Résumé: Une femme d’âge moyen atteinte d’arthrite rhumatoïde a présenté une péricardite réfractaire. Les symptômes ont persisté en dépit de l’escalade de l’immunodépression. Elle a été admise de façon répétitive en raison d’insuffisance cardiaque. L’imagerie a révélé un épanchement péricardique minimal et un péricarde épaissi. L’exploration hémodynamique invasive a permis de confirmer la physiologie constrictive. Une péricardectomie a été nécessaire. L’examen pathologique a permis de confirmer la péricardite cholestérolique, une affection inflammatoire rare due aux dépôts de cholestérol dans le péricarde. Les observations précédentes décrivent des volumes modérés à élevés de liquide péricardique doré. Ce cas illustre que la péricardite cholestérolique peut se traduire par un épanchement péricardique minimal et progresser rapidement vers la péricardite constrictive.
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- 2022
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9. Transcatheter Balloon-Expandable Valve-in-Valve to Treat Severe Paravalvular Leak Secondary to ACURATE-neo Self-expanding Prosthesis–Annulus Mismatch
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William Peverill, MBBS, FRCPA, Michael W.A. Chu, MD, MSc, FRCSC, Pantelis Diamantouros, MD, FRCPC, and Rodrigo Bagur, MD, PhD, FRCPC, FAHA
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A 75-year-old male with severe symptomatic aortic stenosis underwent transcatheter aortic valve implantation with a Large (27-mm) ACURATE-neo transcatheter aortic valve, complicated by severe paravalvular leak. He developed rapid and progressive worsening heart failure. Reanalysis of the computed tomography images suggested evidence of prosthesis–annulus mismatch. Therefore, a redo transcatheter aortic valve implantation utilizing a 29-mm SAPIEN 3 transcatheter aortic valve was performed. This case illustrates the importance of proper valve sizing to avoid paravalvular leak, and how to safely cross an ACURATE-neo valve to avoid catheter entangling. Résumé: Un homme de 75 ans présentant une sténose aortique symptomatique sévère a subi l'implantation d'une valve aortique par cathéter, dont une ACURATE neo de 27-mm compliquée par une fuite paravalvulaire sévère. Par la suite, le patient a présenté une insuffisance cardiaque sévère . Une nouvelle analyse de ses examens tomodensitométriques a indiqué des signes d'incompatibilité entre la prothèse et l'anneau mitral. Il a donc fallu réaliser une nouvelle implantation valvulaire aortique par cathéter avec une valve SAPIEN 3 de 29 mm. Ce cas illustre l'importance d'une bonne évaluation de l'anneau valvulaire pour éviter les fuites paravalvulaires, et décrit comment traverser une valve ACURATE neo pour éviter l'enchevêtrement du cathéter.
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- 2021
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10. Transcatheter Aortic Valve Implantation With and Without Resheathing and Repositioning: A Systematic Review and Meta‐analysis
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Francesco Moroni, Lorenzo Azzalini, Lars Sondergaard, Guilherme F. Attizzani, Santiago García, Hani Jneid, Mamas A. Mamas, and Rodrigo Bagur
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aortic stenosis ,repositioning ,resheathing ,self‐expanding ,TAVI ,TAVR ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background There is a concern that resheathing/repositioning of transcatheter heart valves during transcatheter aortic valve implantation (TAVI) may lead to an increased risk of periprocedural complications. We aimed to evaluate the short‐ and long‐term impact on clinical outcomes of resheathing for repositioning of transcatheter heart valves during TAVI procedures. Methods and Results We conducted a systematic search of Embase, MEDLINE, and Cochrane Central Register of Controlled Trials databases to identify studies comparing outcomes between patients requiring resheathing/repositioning during TAVI and those who did not. Random‐effects meta‐analyses were used to estimate the association of resheathing compared with no resheathing with clinical outcomes after TAVI. Seven studies including 4501 participants (pooled mean age, 80.9±7.4 years; 54% women; and 1374 [30.5%] patients requiring resheathing/repositioning) were included in this study. No significant differences between the 2 groups were identified with regards to safety: 30‐day mortality (n=3125; odds ratio [OR], 0.74 [95% confidence interval [CI], 0.41–1.33]; I2=0%), stroke (n=4121; OR, 1.09 [95% CI, 0.74–1.62]; I2=0%), coronary obstruction (n=3000; OR, 2.35 [95% CI, 0.17–33.47]; I2=75%), major vascular complications (n=3125; OR, 0.92 [95% CI, 0.66–1.33]; I2=0%), major bleeding (n=3125; OR, 1.13 [95% CI, 0.94–2.01]; I2=39%), acute kidney injury (n=3495; OR, 1.30 [95% CI, 0.64–2.62]; I2=44%), and efficacy outcomes: device success (n=1196; OR, 0.77 [95% CI, 0.51–1.14]; I2=0%), need for a second valve (n=3170; OR, 2.86 [95% CI, 0.96–8.48]; I2=62%), significant (moderate or higher) paravalvular leak (n=1151; OR, 1.53 [95% CI, 0.83–2.80]; I2=0%), and permanent pacemaker implantation (n=1908; OR, 1.04 [95% CI, 0.68–1.57]; I2=58%). One‐year mortality was similar between groups (n=1972; OR, 1.00 [95% CI, 0.68–1.47]; I2=0%). Conclusions Resheathing of transcatheter heart valves during TAVI is associated with similar periprocedural risk compared with no resheathing in several patient‐important outcomes. These data support the safety of current self‐expanding transcatheter heart valves with resheathing features. Registration URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021273715.
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- 2022
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11. Outcomes of Elderly Patients Undergoing Left Atrial Appendage Closure
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Shubrandu S. Sanjoy, Yun‐Hee Choi, Robert T. Sparrow, Hani Jneid, J. Dawn Abbott, Luis Nombela‐Franco, Lorenzo Azzalini, David R. Holmes, M. Chadi Alraies, Islam Y. Elgendy, Adrian Baranchuk, Mamas A. Mamas, and Rodrigo Bagur
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anticoagulation ,atrial fibrillation ,comorbidities ,elderly ,left atrial appendage closure ,octogenarians ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Elderly patients have a higher burden of comorbidities that influence clinical outcomes. We aimed to compare in‐hospital outcomes in patients ≥80 years old to younger patients, and to determine the factors associated with increased risk of major adverse events (MAE) after left atrial appendage closure. Methods and Results The National Inpatient Sample was used to identify discharges after left atrial appendage closure between October 2015 and December 2018. The primary outcome was in‐hospital MAE defined as the composite of postprocedural bleeding, vascular and cardiac complications, acute kidney injury, stroke, and death. A total of 6779 hospitalizations were identified, of which, 2371 (35%) were ≥80 years old and 4408 (65%) were
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- 2021
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12. Resheathing and Repositioning During Transcatheter Aortic Valve Implantation
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Rodrigo Bagur
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Editorials ,aortic valve ,aortic valve stenosis ,transcatheter aortic valve replacement ,self‐expanding ,resheathing ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2021
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13. Methodological Rigor and Temporal Trends of Cardiovascular Medicine Meta‐Analyses in Highest‐Impact Journals
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Dhruv Mahtta, Ahmed Altibi, Mohamed M. Gad, Amjad Samara, Amr F. Barakat, Rodrigo Bagur, Hend Mansoor, Hani Jneid, Salim S. Virani, Mamas A. Mamas, Ahmad Masri, and Islam Y. Elgendy
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cardiovascular ,meta‐analysis ,quality assessment ,trend ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Well‐conducted meta‐analyses are considered to be at the top of the evidence‐based hierarchy pyramid, with an expansion of these publications within the cardiovascular research arena. There are limited data evaluating the trends and quality of such publications. The objective of this study was to evaluate the methodological rigor and temporal trends of cardiovascular medicine‐related meta‐analyses published in the highest impact journals. Methods and Results Using the Medline database, we retrieved cardiovascular medicine‐related systematic reviews and meta‐analyses published in The New England Journal of Medicine, The Lancet, Journal of the American Medical Association, The British Medical Journal, Annals of Internal Medicine, Circulation, European Heart Journal, and Journal of American College of Cardiology between January 1, 2012 and December 31, 2018. Among 6406 original investigations published during the study period, meta‐analyses represented 422 (6.6%) articles, with an annual decline in the proportion of published meta‐analyses (8.7% in 2012 versus 4.6% in 2018, Ptrend=0.002). A substantial number of studies failed to incorporate elements of Preferred Reporting Items for Systematic Reviews and Meta‐Analyses or Meta‐Analysis of Observational Studies in Epidemiology guidelines (51.9%) and only a minority of studies (10.4%) were registered in PROSPERO (International Prospective Register of Systematic Reviews). Fewer manuscripts failed to incorporate the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses or Meta‐Analysis of Observational Studies in Epidemiology elements over time (60.2% in 2012 versus 40.0% in 2018, Ptrend
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- 2021
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14. Tailored Versus Standard Hydration to Prevent Acute Kidney Injury After Percutaneous Coronary Intervention: Network Meta‐Analysis
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Francesco Moroni, Luca Baldetti, Conrad Kabali, Carlo Briguori, Mauro Maioli, Anna Toso, Emmanouil S. Brilakis, Hitinder S. Gurm, Rodrigo Bagur, and Lorenzo Azzalini
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contrast‐induced acute kidney injury ,coronary angiography ,hydration ,percutaneous coronary intervention ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Contrast‐induced acute kidney injury (CI‐AKI) is a serious complication after percutaneous coronary intervention. The mainstay of CI‐AKI prevention is represented by intravenous hydration. Tailoring infusion rate to patient volume status has emerged as advantageous over fixed infusion‐rate hydration strategies. Methods and Results A systematic review and network meta‐analysis with a frequentist approach were conducted. A total of 8 randomized controlled trials comprising 2312 patients comparing fixed versus tailored hydration strategies to prevent CI‐AKI after percutaneous coronary intervention were included in the final analysis. Tailored hydration strategies included urine flow rate–guided, central venous pressure–guided, left ventricular end‐diastolic pressure–guided, and bioimpedance vector analysis–guided hydration. Primary endpoint was CI‐AKI incidence. Safety endpoint was incidence of pulmonary edema. Urine flow rate–guided and central venous pressure–guided hydration were associated with a lower incidence of CI‐AKI compared with fixed‐rate hydration (odds ratio [OR], 0.32 [95% CI, 0.19–0.54] and OR, 0.45 [95% CI, 0.21–0.97]). No significant difference in pulmonary edema incidence was observed between the different hydration strategies. P score analysis showed that urine flow rate–guided hydration is advantageous in terms of both CI‐AKI prevention and pulmonary edema incidence when compared with other approaches. Conclusions Currently available hydration strategies tailored on patients' volume status appear to offer an advantage over guideline‐supported fixed‐rate hydration for CI‐AKI prevention after percutaneous coronary intervention. Current evidence suggests that urine flow rate–guided hydration as the most convenient strategy in terms of effectiveness and safety.
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- 2021
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15. Improving Electrocardiography Diagnostic Accuracy in Emergency Medical Services Personnel
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Ashlay A. Huitema, MD, Mistre Alemayehu, MSc, Orna L. Steiner, PhD, Rodrigo Bagur, MD, PhD, and Shahar Lavi, MD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Accuracy of electrocardiogram (ECG) interpretation is important for identification of ST-elevation myocardial infarction (STEMI) by Emergency Medical Services (EMS) personnel who recognize STEMI in the field and activate the coronary catheterization laboratory. According to previous research, there is improvement in diagnosis of STEMIs for healthcare providers who read an average of > 20 ECGs per week. This study evaluated the effectiveness of online ECG modules on improving diagnostic accuracy. Methods: EMS personnel received 25 ECGs per week to interpret via an online program. Diagnostic accuracy was assessed for improvement via completion of an ECG evaluation package before and after the intervention. Job satisfaction data were collected to determine the impact of the educational initiative. Results: A total of 64 participants completed the study. Overall, there was an improvement in ECG diagnostic accuracy from 50.8% to 61.2% (95% confidence interval [CI], 7.7-13.2; P < 0.0001). Specifically, there was significant improvement in the diagnosis of STEMI (8.5%; 95% CI, 4.9-12.3; P < 0.003) and supraventricular tachycardia (39.0%; 95% CI, 17.2-60.8; P < 0.008), with a trend toward improvement in all other diagnoses. These effects were sustained to 3 months (9.6%; 95% CI, 6.4-12.7; P < 0.0001). Improvement was seen regardless of employment experience and training. There was no significant impact on job satisfaction. Conclusions: ECG exposure remains an important factor in improving the accuracy of ECG diagnosis in EMS personnel. Online education modules provide an easily accessible way of improving ECG interpretation with the opportunity for positive downstream effects on patient outcomes and resource use. Résumé: Introduction: L’interprétation de l’électrocardiogramme (ECG) doit être précise pour détecter l’infarctus du myocarde avec élévation du segment ST (STEMI) puisque le personnel des services médicaux d’urgence (SMU) doit reconnaître sur le terrain le STEMI et faire démarrer le processus vers le laboratoire de cathétérisme coronarien. Selon une étude antérieure, on note une amélioration dans le diagnostic du STEMI chez les prestataires de soins de santé qui lisent en moyenne > 20 ECG par semaine. La présente étude a permis d’évaluer l’efficacité des modules d’ECG en ligne en fonction de l’amélioration de la précision du diagnostic. Méthodes: Le personnel des SMU recevait chaque semaine 25 ECG à interpréter au moyen d’un programme en ligne. On évaluait la précision du diagnostic en fonction de son amélioration en remplissant un module d’évaluation d’ECG avant et après l’intervention. Les données sur la satisfaction professionnelle étaient collectées pour déterminer les répercussions de l’initiative éducative. Résultats: Un total de 64 participants ont complété l’étude. Dans l’ensemble, on a noté une amélioration de la précision du diagnostic à l’ECG, soit de 50,8 % à 61,2 % (intervalle de confiance [IC] à 95 %, 7,7-13,2; P < 0,0001). Notamment, on a noté une amélioration importante dans le diagnostic du STEMI (8,5 %; IC à 95 %, 4,9-12,3; P < 0,003) et de la tachycardie supraventriculaire (39,0 %; IC à 95 %, 17,2-60,8; P
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- 2019
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16. Cerebral Embolic Protection in TAVI: Friend or Foe
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Michael Teitelbaum, Rafail A Kotronias, Luciano A Sposato, and Rodrigo Bagur
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Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Cerebrovascular accidents including stroke or transient ischaemic attack are one of the most feared complications after transcatheter aortic valve implantation. Transcatheter aortic valve implantation procedures have been consistently associated with silent ischaemic cerebral embolism as assessed by diffusion-weighted MRI. To reduce the risk of cerebrovascular accidents and silent emboli, cerebral embolic protection devices were developed with the aim of preventing procedural debris reaching the cerebral vasculature. The authors summarise the available data regarding cerebral embolic protection devices and its clinical significance.
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- 2019
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17. Priorities for Patient‐Centered Research in Valvular Heart Disease: A Report From the National Heart, Lung, and Blood Institute Working Group
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Brian R. Lindman, Suzanne V. Arnold, Rodrigo Bagur, Lindsay Clarke, Megan Coylewright, Frank Evans, Judy Hung, Sandra B. Lauck, Susan Peschin, Vandana Sachdev, Lisa M. Tate, Jason H. Wasfy, and Catherine M. Otto
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aortic valve ,heart valve ,heart valve surgery ,mitral valve ,patient‐centered care ,shared decision making ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Over the past decade, the field of valvular heart disease (VHD) has rapidly transformed, largely as a result of the development and improvement of less invasive transcatheter approaches to valve repair or replacement. This transformation has been supported by numerous well‐designed randomized trials, but they have centered almost entirely on devices and procedures. Outside this scope of focus, however, myriad aspects of therapy and management for patients with VHD have either no guidelines or recommendations based only on expert opinion and observational studies. Further, research in VHD has often failed to engage patients to inform study design and identify research questions of greatest importance and relevance from a patient perspective. Accordingly, the National Heart, Lung, and Blood Institute convened a Working Group on Patient‐Centered Research in Valvular Heart Disease, composed of clinician and research experts and patient advocacy experts to identify gaps and barriers to research in VHD and identify research priorities. While recognizing that important research remains to be done to test the safety and efficacy of devices and procedures to treat VHD, we intentionally focused less attention on these areas of research as they are more commonly pursued and supported by industry. Herein, we present the patient‐centered research gaps, barriers, and priorities in VHD and organized our report according to the “patient journey,” including access to care, screening and diagnosis, preprocedure therapy and management, decision making when a procedure is contemplated (clinician and patient perspectives), and postprocedure therapy and management. It is hoped that this report will foster collaboration among diverse stakeholders and highlight for funding bodies the pressing patient‐centered research gaps, opportunities, and priorities in VHD in order to produce impactful patient‐centered research that will inform and improve patient‐centered policy and care.
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- 2020
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18. Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy: A Systematic Review and Meta‐Analysis
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Rafail A. Kotronias, Chun Shing Kwok, Sudhakar George, Davide Capodanno, Peter F. Ludman, Jonathan N. Townend, Sagar N. Doshi, Saib S. Khogali, Philippe Généreux, Howard C. Herrmann, Mamas A. Mamas, and Rodrigo Bagur
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coronary artery disease ,percutaneous coronary intervention ,transcatheter aortic valve implantation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundRecent recommendations suggest that in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and coexistent significant coronary artery disease, the latter should be treated before the index procedure; however, the evidence basis for such an approach remains limited. We performed a systematic review and meta‐analysis to study the clinical outcomes of patients with coronary artery disease who did or did not undergo revascularization prior to transcatheter aortic valve implantation. Methods and ResultsWe conducted a search of Medline and Embase to identify studies evaluating patients who underwent transcatheter aortic valve implantation with or without percutaneous coronary intervention. Random‐effects meta‐analyses with the inverse variance method were used to estimate the rate and risk of adverse outcomes. Nine studies involving 3858 participants were included in the meta‐analysis. Patients who underwent revascularization with percutaneous coronary intervention had a higher rate of major vascular complications (odd ratio [OR]: 1.86; 95% confidence interval [CI], 1.33–2.60; P=0.0003) and higher 30‐day mortality (OR: 1.42; 95% CI, 1.08–1.87; P=0.01). There were no differences in effect estimates for 30‐day cardiovascular mortality (OR: 1.03; 95% CI, 0.35–2.99), myocardial infarction (OR: 0.86; 95% CI, 0.14–5.28), acute kidney injury (OR: 0.89; 95% CI, 0.42–1.88), stroke (OR: 1.07; 95% CI, 0.38–2.97), or 1‐year mortality (OR: 1.05; 95% CI, 0.71–1.56). The timing of percutaneous coronary intervention (same setting versus a priori) did not negatively influence outcomes. ConclusionsOur analysis suggests that revascularization before transcatheter aortic valve implantation confers no clinical advantage with respect to several patient‐important clinical outcomes and may be associated with an increased risk of major vascular complications and 30‐day mortality. In the absence of definitive evidence, careful evaluation of patients on an individual basis is of paramount importance to identify patients who might benefit from elective revascularization.
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- 2017
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19. Pre‐Implantation Balloon Aortic Valvuloplasty and Clinical Outcomes Following Transcatheter Aortic Valve Implantation: A Propensity Score Analysis of the UK Registry
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Glen P. Martin, Matthew Sperrin, Rodrigo Bagur, Mark A. de Belder, Iain Buchan, Mark Gunning, Peter F. Ludman, and Mamas A. Mamas
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aortic stenosis ,balloon valvuloplasty ,balloon‐expandable ,self‐expandable ,transcatheter aortic valve implantation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundAortic valve predilation with balloon aortic valvuloplasty (BAV) is recommended before transcatheter aortic valve implantation (TAVI), despite limited data around the requirement of this preprocedural step and the potential risks of embolization. This study aimed to investigate the trends in practice and associations of BAV on short‐term outcomes in the UK TAVI registry. Methods and ResultsEleven clinical endpoints were investigated, including 30‐day mortality, myocardial infarction, aortic regurgitation, valve dysfunction, and composite early safety. All endpoints were defined as per the VARC‐2 definitions. Odd ratios of each endpoint were estimated using logistic regression, with data analyzed in balloon‐ and self‐expandable valve subgroups. Propensity scores were calculated using patient demographics and procedural variables, which were included in the models of each endpoint to adjust for measured confounding. Between 2007 and 2014, 5887 patients met the study inclusion criteria, 1421 (24.1%) of whom had no BAV before TAVI valve deployment. We observed heterogeneity in the use of BAV nationally, both temporally and by center experience; rates of BAV in pre‐TAVI workup varied between 30% and 97% across TAVI centers. All endpoints were similar between treatment groups in SAPIEN (Edwards Lifesciences Inc., Irvine, CA) valve patients. After correction for multiple testing, none of the endpoints in CoreValve (Medtronic, Minneapolis, MN) patients were significantly different between patients with or without predilation. ConclusionsPerforming TAVI without predilation was not associated with adverse short‐term outcomes post procedure, especially when using a balloon‐expandable prosthesis. Randomized trials including different valve types are required to provide conclusive evidence regarding the utility of predilation before‐TAVI.
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- 2017
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20. Randomized Trial of Compression Duration After Transradial Cardiac Catheterization and Intervention
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Shahar Lavi, Asim Cheema, Andrew Yadegari, Zeev Israeli, Yaniv Levi, Sabrina Wall, Mistre Alemayehu, Yasir Parviz, Bogdan‐Dorian Murariu, Terry McPherson, Jaffer Syed, and Rodrigo Bagur
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angiography ,cardiac catheterization ,percutaneous coronary intervention ,vascular complications ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundRadial artery occlusion is a known complication following transradial cardiac catheterization. A shorter duration of postprocedural radial clamp time may reduce radial artery occlusion (RAO) but might be associated with incomplete hemostasis. Methods and ResultsIn total, 568 patients undergoing transradial diagnostic cardiac catheterization were randomly assigned to either 20 minutes (ultrashort) or 60 minutes (short) hemostatic compression time using patent hemostasis. Subsequently, clamp pressure was reduced gradually over 20 minutes. Access site hemostasis and RAO were assessed after clamp removal. Repeated assessment of RAO was determined at 1 week in 210 (37%) patients. Mean age was 64±11 years, and 30% were female. Percutaneous coronary intervention was performed in 161 patients. RAO immediately after clamp removal was documented in 14 (4.9%) and 8 (2.8%) patients in the 20‐ and 60‐minute clamp application groups, respectively (P=0.19). The incidence of grade 1 hematoma was higher in the 20‐minute group (6.7% versus 2.5%, P=0.015). RAO at 1 week after the procedure was 2.9% and 0.9% in the 20‐ and 60‐minute groups, respectively (P=0.36). Requirement for clamp retightening (36% versus 16%, P=0.01) was higher among patients who had RAO. Need for clamp retightening was the only independent predictor of RAO (P=0.04). ConclusionsUltrashort radial clamp application of 20 minutes is not preferable to a short duration of 60 minutes. The 60‐minute clamp duration is safe and provides good access site hemostasis with low RAO rates. Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT02269722.
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- 2017
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21. Impact of Incomplete Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease: A Systematic Review and Meta‐Analysis
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Vinayak Nagaraja, Sze‐Yuan Ooi, James Nolan, Adrian Large, Mark De Belder, Peter Ludman, Rodrigo Bagur, Nick Curzen, Takashi Matsukage, Fuminobu Yoshimachi, Chun Shing Kwok, Colin Berry, and Mamas A. Mamas
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complete revascularization ,incomplete revascularization ,major adverse cardiovascular events ,mortality ,percutaneous coronary intervention ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundUp to half of patients undergoing percutaneous coronary intervention have multivessel coronary artery disease (MVD) with conflicting data regarding optimal revascularization strategy in such patients. This paper assesses the evidence for complete revascularization (CR) versus incomplete revascularization in patients undergoing percutaneous coronary intervention, and its prognostic impact using meta‐analysis. Methods and ResultsA search of PubMed, EMBASE, MEDLINE, Current Contents Connect, Google Scholar, Cochrane library, Science Direct, and Web of Science was conducted to identify the association of CR in patients with multivessel coronary artery disease undergoing percutaneous coronary intervention with major adverse cardiac events and mortality. Random‐effects meta‐analysis was used to estimate the odds of adverse outcomes. Meta‐regression analysis was conducted to assess the relationship with continuous variables and outcomes. Thirty‐eight publications that included 156 240 patients were identified. Odds of death (OR 0.69, 95% CI 0.61‐0.78), repeat revascularization (OR 0.60, 95% CI 0.45‐0.80), myocardial infarction (OR 0.64, 95% CI 0.50‐0.81), and major adverse cardiac events (OR 0.63, 95% CI 0.50‐0.79) were significantly lower in the patients who underwent CR. These outcomes were unchanged on subgroup analysis regardless of the definition of CR. Similar findings were recorded when CR was studied in the chronic total occlusion (CTO) subgroup (OR 0.65, 95% CI 0.53‐0.80). A meta‐regression analysis revealed a negative relationship between the OR for mortality and the percentage of CR. ConclusionCR is associated with reduced risk of mortality and major adverse cardiac events, irrespective of whether an anatomical or a score‐based definition of incomplete revascularization is used, and this magnitude of risk relates to degree of CR. These results have important implications for the interventional management of patients with multivessel coronary artery disease.
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- 2016
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22. Transcatheter Aortic Valve Implantation With or Without Preimplantation Balloon Aortic Valvuloplasty: A Systematic Review and Meta‐Analysis
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Rodrigo Bagur, Chun Shing Kwok, Luis Nombela‐Franco, Peter F. Ludman, Mark A. de Belder, Sandro Sponga, Mark Gunning, James Nolan, Pantelis Diamantouros, Patrick J. Teefy, Bob Kiaii, Michael W. A. Chu, and Mamas A. Mamas
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aortic stenosis ,aortic valve replacement ,balloon aortic valvuloplasty ,transcutaneous aortic valve implantation ,transfemoral aortic valve implantation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundPreimplantation balloon aortic valvuloplasty (BAV) is considered a routine procedure during transcatheter aortic valve implantation (TAVI) to facilitate prosthesis implantation and expansion; however, it has been speculated that fewer embolic events and/or less hemodynamic instability may occur if TAVI is performed without preimplantation BAV. The aim of this study was to systematically review the clinical outcomes associated with TAVI undertaken without preimplantation BAV. Methods and ResultsWe conducted a search of Medline and Embase to identify studies that evaluated patients who underwent TAVI with or without preimplantation BAV for predilation. Pooled analysis and random‐effects meta‐analyses were used to estimate the rate and risk of adverse outcomes. Sixteen studies involving 1395 patients (674 with and 721 without preimplantation BAV) fulfilled the inclusion criteria. Crude device success was achieved in 94% (1311 of 1395), and 30‐day all‐cause mortality occurred in 6% (72 of 1282) of patients. Meta‐analyses evaluating outcomes of strategies with and without preimplantation BAV showed no statistically significant differences in terms of mortality (relative risk [RR] 0.61, 95% CI 0.32–1.14, P=0.12), safety composite end point (RR 0.85, 95% CI 0.62–1.18, P=0.34), moderate to severe paravalvular leaks (RR 0.68, 95% CI 0.23–1.99, P=0.48), need for postdilation (RR 0.86, 95% CI 0.66–1.13, P=0.58), stroke and/or transient ischemic attack (RR 0.72, 95% CI 0.30–1.71, P=0.45), and permanent pacemaker implantation (RR 0.80, 95% CI 0.49–1.30, P=0.37). ConclusionsOur analysis suggests that TAVI procedures with or without preimplantation BAV were associated with similar outcomes for a number of clinically relevant end points. Further studies including a large number of patients are needed to ascertain the impact of TAVI without preimplantation BAV as a standard practice.
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- 2016
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23. Procedural Time and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention
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Athanasios Rempakos, Spyridon Kostantinis, Bahadir Simsek, Judit Karacsonyi, James W. Choi, Paul Poommipanit, Jaikirshan J Khatri, Wissam Jaber, Stephane Rinfret, William Nicholson, Sevket Gorgulu, Farouc A. Jaffer, Raj Chandwaney, Luiz F. Ybarra, Rodrigo Bagur, Khaldoon Alaswad, Oleg Krestyaninov, Dmitrii Khelimskii, Dimitrios Karmpaliotis, Barry F. Uretsky, Korhan Soylu, Ufuk Yildirim, Srinivasa Potluri, Karim M. Al-Azizi, Bavana V. Rangan, Olga C. Mastrodemos, Salman Allana, Yader Sandoval, M. Nicholas Burke, Emmanouil S. Brilakis, and Tıp Fakültesi
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Cardiology and Cardiovascular Medicine - Abstract
Abstracat : Chronic total occlusion (CTO) percutaneous coronary interventions (PCIs) can be lengthy procedures. We sought to investigate the effect of procedural time on CTO PCI outcomes. We examined the procedural time required for the various steps of CTO PCI in 6,442 CTO PCIs at 40 US and non-US centers between 2012 and 2022. The mean and median procedure times were 129 § 76 and 112 minutes, respectively, with no significant change over time. The median times from access to wire insertion, guidewire manipulation time, and post crossing were 20, 32, and 53 minutes, respectively. Lesions crossed in
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- 2023
24. 3-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis
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John K. Forrest, G. Michael Deeb, Steven J. Yakubov, Hemal Gada, Mubashir A. Mumtaz, Basel Ramlawi, Tanvir Bajwa, Paul S. Teirstein, Michael DeFrain, Murali Muppala, Bruce J. Rutkin, Atul Chawla, Bart Jenson, Stanley J. Chetcuti, Robert C. Stoler, Marie-France Poulin, Kamal Khabbaz, Melissa Levack, Kashish Goel, Didier Tchétché, Ka Yan Lam, Pim A.L. Tonino, Saki Ito, Jae K. Oh, Jian Huang, Jeffrey J. Popma, Neal Kleiman, Michael J. Reardon, Paul Sorajja, Timothy Byrne, Merick Kirshner, John Crouch, Joseph Coselli, Guilherme Silva, Robert Hebeler, Robert Stoler, Ashequl Islam, Anthony Rousou, Mark Bladergroen, Peter Fail, Donald Netherland, W.A.L. Tonino, Arnaud Sudre, Pierre Berthoumieu, Houman Khalili, G. Chad Hughes, J Kevin Harrison, Ajanta De, Pei Tsau, Nicolas M. van Mieghem, Robert Larbalestier, Gerald Yong, Shikhar Agarwal, William Martin, Steven Park, Michael Reardon, Siamak Mohammadi, Josep Rodes-Cabau, Jeffrey Sparling, C. Craig Elkins, Brian Ganzel, Ray V. Matthews, Vaughn A. Starnes, Kenji Ando, Bernard Chevalier, Arnaud Farge, William Combs, Rodrigo Bagur, Michael Chu, Gregory Fontana, Visha Dev, Ferdinand Leya, J. Michael Tuchek, Ignacio Inglessis, Arminder Jassar, Nicolo Piazza, Kevin Lacappelle, Daniel Steinberg, Marc Katz, John Wang, Joseph Kozina, Frank Slachman, Robert Merritt, Bart Jensen, Jorge Alvarez, Robert Gooley, Julian Smith, Reda Ibrahim, Raymond Cartier, Joshua Rovin, Tomoyuki Fujita, Bruce Rutkin, Steven Yakubov, Howard Song, Firas Zahr, Shigeru Miyagawa, Vivek Rajagopal, James Kauten, Mubashir Mumtaz, Ravinay Bhindi, Peter Brady, Sanjay Batra, Thomas Davis, Ayman Iskander, David Heimansohn, James Hermiller, Itaru Takamisawa, Thomas Haldis, Seiji Yamazaki, Paul Teirstein, Norio Tada, Shigeru Saito, William Merhi, Stephane Leung, David Muller, Robin Heijmen, George Petrossian, Newell Robinson, Peter Knight, Frederick Ling, Sam Radhakrishnan, Stephen Fremes, Eric Lehr, Sameer Gafoor, Thomas Noel, Antony Walton, Jon Resar, David Adams, Samin Sharma, Scott Lilly, Peter Tadros, George Zorn, Harold Dauerman, Frank Ittleman, Erik Horlick, Chris Feindel, Frederick Welt, Vikas Sharma, Alan Markowitz, John Carroll, David Fullerton, Bartley Griffith, Anuj Gupta, Eduardo de Marchena, Tomas Salerno, Stanley Chetcuti, Ibrahim Sultan, Sanjeevan Pasupati, Neal Kon, David Zhao, and John Forrest
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Cardiology and Cardiovascular Medicine - Published
- 2023
25. Unplanned readmissions after Impella mechanical circulatory support
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Adrian A. Kuchtaruk, Robert T. Sparrow, Lorenzo Azzalini, Santiago García, Pedro A. Villablanca, Hani Jneid, Islam Y. Elgendy, M. Chadi Alraies, Shubrandu S. Sanjoy, Mamas A. Mamas, and Rodrigo Bagur
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Cardiology and Cardiovascular Medicine - Published
- 2023
26. Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention After a Previous Failed Attempt
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Athanasios Rempakos, Spyridon Kostantinis, Bahadir Simsek, Judit Karacsonyi, James W. Choi, Paul Poommipanit, Jaikirshan J. Khatri, Wissam Jaber, Stephane Rinfret, William Nicholson, Sevket Gorgulu, Farouc A. Jaffer, Raj Chandwaney, Luiz F. Ybarra, Rodrigo Bagur, Khaldoon Alaswad, Oleg Krestyaninov, Dmitrii Khelimskii, Dimitrios Karmpaliotis, Barry F. Uretsky, Korhan Soylu, Ufuk Yildirim, Srinivasa Potluri, Bavana V. Rangan, Olga C. Mastrodemos, Salman Allana, Yader Sandoval, Nicholas M. Burke, Emmanouil S. Brilakis, and Tıp Fakültesi
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Cardiology and Cardiovascular Medicine - Abstract
The impact of a previous failure on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We examined the clinical and angiographic characteristics and procedural outcomes of 9,393 patients who underwent 9,560 CTO PCIs at 42 United States and non-United States centers between 2012 and 2022. A total of 1,904 CTO lesions (20%) had a previous failed PCI attempt. Patients who underwent reattempt CTO PCI were more likely to have a family history of coronary artery disease (37% vs 31%, p 30 CTO PCIs annually were more likely to achieve technical success in patients with previous failure. In conclusion, a previous failed CTO PCI attempt was associated with higher lesion complexity, longer procedure time, and lower technical success; however, the association with lower technical success did not remain significant in multivariable analysis.
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- 2023
27. Complete Versus Incomplete Percutaneous Coronary Intervention-Mediated Revascularization in Patients With Chronic Coronary Syndromes
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Rahul, Kurup, Harindra C, Wijeysundera, Rodrigo, Bagur, and Luiz F, Ybarra
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General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Multivessel coronary artery disease (CAD) is associated with worse outcomes across the spectrum of clinical presentations. The prognostic implications of completeness of revascularization in CAD patients, especially those with chronic coronary syndromes (CCS), remain highly debated. This is largely due to the use of non-standardized definitions for complete revascularization (CR) and incomplete revascularization (ICR) within previously published studies, lack of randomized clinical data, varying revascularization methods and heterogenous study populations. In particular, the utility and effectiveness of PCI-mediated CR for CCS remains unknown. In this review, we discuss the various definitions used for CR vs. ICR, highlight the rationale for pursuing CR and summarise the current literature regarding the effects of PCI-mediated CR on clinical outcomes in patients with CCS.
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- 2023
28. Mechanical Circulatory Support in Patients With COVID-19 Presenting With Myocardial Infarction
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Raviteja R, Guddeti, Cristina, Sanina, Rajiv, Jauhar, Timothy D, Henry, Payam, Dehghani, Ross, Garberich, Christian W, Schmidt, Keshav R, Nayak, Jay S, Shavadia, Akshay, Bagai, Chadi, Alraies, Aditya, Mehra, Rodrigo, Bagur, Cindy, Grines, Avneet, Singh, Rajan A G, Patel, Wah Wah, Htun, Nima, Ghasemzadeh, Laura, Davidson, Deepak, Acharya, Ameer, Kabour, Abdul Moiz, Hafiz, Shy, Amlani, Hal S, Wasserman, Timothy, Smith, Navin K, Kapur, and Santiago, Garcia
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Cardiology and Cardiovascular Medicine - Abstract
ST-segment elevation myocardial infarction (STEMI) complicating COVID-19 is associated with an increased risk of cardiogenic shock and mortality. However, little is known about the frequency of use and clinical impact of mechanical circulatory support (MCS) in these patients. We sought to define patterns of MCS utilization, patient characteristics, and outcomes in patients with COVID-19 with STEMI. The NACMI (North American COVID-19 Myocardial Infarction) is an ongoing prospective, observational registry of patients with COVID-19 positive (COVID-19+) with STEMI with a contemporary control group of persons under investigation who subsequently tested negative for COVID-19 (COVID-19-). We compared the baseline characteristics and in-hospital outcomes of COVID-19+ and patients with COVID-19- according to the use of MCS. The primary outcome was a composite of in-hospital mortality, stroke, recurrent MI, and repeat unplanned revascularization. A total of 1,379 patients (586 COVID-19+ and 793 COVID-19-) enrolled in the NACMI registry between January 2020 and November 2021 were included in this analysis; overall, MCS use was 12.3% (12.1% [n = 71] COVID-19+/MCS positive [MCS+] vs 12.4% [n = 98] COVID-19-/MCS+). Baseline characteristics were similar between the 2 groups. The use of percutaneous coronary intervention was similar between the groups (84% vs 78%; p = 0.404). Intra-aortic balloon pump was the most frequently used MCS device in both groups (53% in COVID-19+/MCS+ and 75% in COVID-19-/MCS+). The primary outcome was significantly higher in COVID-19+/MCS+ patients (60% vs 30%; p = 0.001) because of very high in-hospital mortality (59% vs 28%; p = 0.001). In conclusion, patients with COVID-19+ with STEMI requiring MCS have very high in-hospital mortality, likely related to the significantly higher pulmonary involvement compared with patients with COVID-19- with STEMI requiring MCS.
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- 2023
29. Performance of administrative database frailty instruments in predicting clinical outcomes and cost for patients undergoing transcatheter aortic valve implantation: a historical cohort study
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Zhe Li, Harindra C. Wijeysundera, Rodrigo Bagur, Davy Cheng, Janet Martin, Bob Kiaii, Feng Qiu, Jiming Fang, and Ava John-Baptiste
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Anesthesiology and Pain Medicine ,General Medicine - Abstract
Frailty instruments may improve prognostic estimates for patients undergoing transcatheter aortic valve implantation (TAVI). Few studies have evaluated and compared the performance of administrative database frailty instruments for patients undergoing TAVI. This study aimed to examine the performance of administrative database frailty instruments in predicting clinical outcomes and costs in patients who underwent TAVI.We conducted a historical cohort study of 3,848 patients aged 66 yr or older who underwent a TAVI procedure in Ontario, Canada from 1 April 2012 to 31 March 2018. We used the Johns Hopkins Adjusted Clinical Group (ACG) frailty indicator and the Hospital Frailty Risk Score (HFRS) to assign frailty status. Outcomes of interest were in-hospital mortality, one-year mortality, rehospitalization, and healthcare costs. We compared the performance of the two frailty instruments with that of a reference model that adjusted baseline covariates and procedural characteristics. Accuracy measures included c-statistics, Akaike information criterion (AIC), Bayesian information criterion (BIC), integrated discrimination improvement (IDI), net reclassification index (NRI), bias, and accuracy of cost estimates.A total of 863 patients (22.4%) were identified as frail using the Johns Hopkins ACG frailty indicator and 865 (22.5%) were identified as frail using the HFRS. Although agreement between the frailty instruments was fair (Kappa statistic = 0.322), each instrument classified different subgroups as frail. Both the Johns Hopkins ACG frailty indicator (rate ratio [RR], 1.13; 95% confidence interval [CI], 1.06 to 1.20) and the HFRS (RR, 1.14; 95% CI, 1.07 to 1.21) were significantly associated with increased one-year costs. Compared with the reference model, both the Johns Hopkins ACG frailty indicator and HFRS significantly improved NRI for one-year mortality (Johns Hopkins ACG frailty indicator: NRI, 0.160; P0.001; HFRS: NRI, 0.146; P = 0.001) and rehospitalization (Johns Hopkins ACG frailty indicator: NRI, 0.201; P0.001; HFRS: NRI, 0.141; P = 0.001). These improvements in NRI largely resulted from classification improvement among those who did not experience the event. With one-year mortality, there was a significant improvement in IDI (IDI, 0.003; P0.001) with the Johns Hopkins ACG frailty indicator. This improvement in performance resulted from an increase in the mean probability of the event among those with the event.Preoperative frailty assessment may add some predictive value for TAVI outcomes. Use of administrative database frailty instruments may provide small but significant improvements in case-mix adjustment when profiling hospitals for certain outcomes.RéSUMé: OBJECTIF: L’utilisation d’indicateur de fragilité pourrait améliorer l’évaluation pronostique des patients bénéficiant d’un remplacement valvulaire aortique par voie percutanée (procédure TAVI). Peu d’études ont évalué et comparé la performance des instruments d’évaluation de la fragilité développés à partir de données administratives chez les patients bénéficiant d’un TAVI. Nous avions pour objectif d’examiner la performance des instruments d’évaluation de la fragilité développés à partir de données administratives dans la prédiction des issues cliniques et des coûts chez les patients ayant bénéficié d’un TAVI. MéTHODE: Nous avons réalisé une étude de cohorte historique auprès de 3848 patients âgés de 66 ans ou plus qui ont bénéficié d’une procédure TAVI en Ontario, Canada, du 1
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- 2022
30. Double-blind, placebo-controlled evaluation of biorest liposomal alendronate in diabetic patients undergoing PCI: The BLADE-PCI trial
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Philippe Généreux, Gil Chernin, Abid R. Assali, Jan Z. Peruga, Simon D. Robinson, Erick Schampaert, Rodrigo Bagur, Samer Mansour, Josep Rodés-Cabau, Margaret McEntegart, Robert Gerber, Philippe L'Allier, Ranil de Silva, Benoit Daneault, Suneil K. Aggarwal, Vladimír Džavík, M. Ozgu Ozan, Ori Ben-Yehuda, Akiko Maehara, Gregg W. Stone, and Michael Jonas
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Percutaneous Coronary Intervention ,Treatment Outcome ,Alendronate ,Neointima ,Diabetes Mellitus ,Humans ,Drug-Eluting Stents ,Coronary Artery Disease ,Coronary Angiography ,Cardiology and Cardiovascular Medicine ,Tomography, Optical Coherence - Abstract
Diabetes mellitus (DM) is an important predictor of neointimal hyperplasia (NIH) and adverse clinical outcomes after percutaneous coronary intervention (PCI). LABR-312, a novel intravenous formulation of liposomal alendronate, has been shown in animal models to decrease NIH at vascular injury sites and around stent struts. The aim of the Biorest Liposomal Alendronate Administration for Diabetic Patients Undergoing Drug-Eluting Stent Percutaneous Coronary Intervention trial was to assess the safety, effectiveness, and dose response of LABR-312 administered intravenously at the time of PCI withDES in reducing NIH as measured by optical coherence tomography postprocedure in patients with DM.Patients with DM were randomized to a bolus infusion of LABR-312 vs placebo at the time of PCI. Dose escalation of LABR-312 in the study arm was given: 0.01 mg, 0.03 mg, and 0.08 mg. The primary endpoint was the in-stent %NIH volume at 9 months as measured by optical coherence tomography.From September 2016 to December 2017, 271 patients with DM undergoing PCI were enrolled; 136 patients were randomized to LABR-312 infusion and 135 patients were randomized to placebo. At 9-month follow-up, no difference was seen in the primary endpoint of %NIH between LABR-312 and placebo (13.3% ± 9.2 vs 14.6% ± 8.5, P = .35). No differences were present with the varying LABR-312 doses. Clinical outcomes at 9 months were similar between groups.Among patients with DM undergoing PCI with drug-eluting stents, a bolus of LABR-312 injected systematically at the time of intervention did not result in a lower rate in-stent %NIH volume at 9-month follow-up.
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- 2022
31. Teamwork makes Dreamwork: Patient-Centered Care includes Rescue Cardiac Surgery during Transcatheter Aortic Valve Implantation
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Santiago Besa, Rodrigo Bagur, Matthew Valdis, and Michael W A Chu
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Pulmonary and Respiratory Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
32. Outcomes of Percutaneous Coronary Intervention in Patients With Acquired Immunosuppression
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Gemina Doolub, Ofer Kobo, Mohamed O. Mohamed, Waqas Ullah, M. Chadi Alraies, Poonam Velagapudi, Jolanta M. Siller-Matula, Ariel Roguin, Rodrigo Bagur, and Mamas A. Mamas
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Immunosuppression Therapy ,Stroke ,Percutaneous Coronary Intervention ,Treatment Outcome ,Risk Factors ,Humans ,Hospital Mortality ,Cardiology and Cardiovascular Medicine ,Ischemic Stroke ,Retrospective Studies - Abstract
There are limited data on the clinical outcomes of percutaneous coronary intervention (PCI) in patients with acquired immunosuppression who are frequently underrepresented in clinical trials. All PCI procedures between October 2015 and December 2018 in the Nationwide Inpatient Sample were retrospectively analyzed, stratified by immunosuppression status. Multivariable logistic regression models were performed to examine (1) the association between immunosuppression status and in-hospital outcomes, expressed as adjusted odds ratio (aOR) with 95% confidence intervals (CIs) and (2) predictors of mortality among patients with severe acquired immunosuppression. In this contemporary analysis of nearly 1.5 million PCI procedures, approximately 4% of patients who underwent PCI had acquired immunosuppression. Of these, chronic steroid use accounted for approximately half of the cohort who underwent PCI who had acquired immunosuppression, with the remainder divided between hematologic cancer, solid organ active malignancy, and metastatic cancer, with the latter group having the highest rates of composite of in-hospital mortality or stroke (9.3%) (mortality 7.5% and acute ischemic stroke 2.4%). In conclusion, immunosuppression was independently associated with increased adjusted odds of adverse clinical outcomes, specifically mortality or stroke (aOR 1.11, 95% CI 1.06 to 1.15, p0.001) and in-hospital mortality (aOR 1.21, 95% CI 1.13 to 1.29, p0.001), with outcomes dependent on the cause of immunosuppression.
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- 2022
33. Association of diabetes mellitus and its types with in-hospital management and outcomes of patients with acute myocardial infarction
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Priyanka Sethupathi, Andrija Matetić, Vijay Bang, Phyo K. Myint, Ivan Rendon, Rodrigo Bagur, Carlos Diaz-Arocutipa, Alejandro Ricalde, Aditya Bharadwaj, and Mamas A. Mamas
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
34. Microembolism and Other Links Between Migraine and Stroke: Clinical and Pathophysiologic Update
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Simona Sacco, Andrea M. Harriott, Cenk Ayata, Raffaele Ornello, Rodrigo Bagur, Amado Jimenez-Ruiz, and Luciano A. Sposato
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Review ,Neurology (clinical) - Abstract
Migraine and stroke are highly prevalent diseases with a high effect on quality of life, with multiple epidemiologic, pathophysiologic, clinical, and prognostic areas of overlap. Migraine is a risk factor for stroke. This risk is explained by common risk factors, migraine-specific mechanisms, and non–migraine-specific mechanisms that have a relevant role in patients with migraine with aura (e.g., atrial fibrillation and paradoxical embolism through a patent foramen ovale). Another important link between migraine aura and ischemic stroke is cardiac embolism. Cardioembolism is the most frequent cause of ischemic stroke, and increasing evidence suggests that microembolism, predominantly but not exclusively originating in the heart, is a contributing mechanism to the development of migraine aura. In this review, we discuss epidemiologic aspects of the association between migraine and ischemic stroke, the clinical presentation of ischemic strokes in patients with migraine, and the differentiation between migrainous and nonmigrainous infarctions. After that, we review migraine-specific and non–migraine-specific stroke mechanisms. We then review updated preclinical and clinical data on microembolism as a cause of migraine aura. In the last section, we summarize knowledge gaps and important areas to explore in future research. The review includes a clinical vignette with a discussion of the most relevant topics addressed.
- Published
- 2023
35. Sex differences in outcomes of transcatheter edge‐to‐edge repair with MitraClip: A meta‐analysis
- Author
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Lina Ya'Qoub, Mohamed Gad, Nadeen N. Faza, Katherine J. Kunkel, Rawan Ya'acoub, Pedro Villablanca, Rodrigo Bagur, Mirvat Alasnag, Marvin Eng, and Islam Y. Elgendy
- Subjects
Heart Valve Prosthesis Implantation ,Male ,Stroke ,Cardiac Catheterization ,Sex Characteristics ,Treatment Outcome ,Humans ,Mitral Valve ,Mitral Valve Insufficiency ,Female ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Transcatheter edge-to-edge repair (TEER) with MitraClip improves outcomes among select patients with moderate-to-severe and severe mitral regurgitation; however, data regarding sex-specific differences in the outcomes among patients undergoing TEER are limited.An electronic search of the PubMed, Embase, Central, and Web of Science databases for studies comparing sex differences in outcomes among patients undergoing TEER was performed. Summary estimates were primarily conducted using a random-effects model.Eleven studies with a total of 24,905 patients (45.6% women) were included. Women were older and had a lower prevalence of comorbidities, including diabetes, chronic kidney disease, and coronary artery disease. There was no difference in procedural success (odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.55-1.05) and short-term mortality (i.e., up to 30 days) between women and men (OR: 1.16, 95% CI: 0.97-1.39). Women had a higher incidence of periprocedural bleeding and stroke (OR: 1.34, 95% CI: 1.15-1.56) and (OR: 1.57, 95% CI: 1.10-2.25), respectively. At a median follow-up of 12 months, there was no difference in mortality (OR: 0.98, 95% CI: 0.89-1.09) and heart failure hospitalizations (OR: 1.07, 95% CI: 0.68-1.67). An analysis of adjusted long-term mortality showed a lower incidence of mortality among women (hazards ratio: 0.77, 95% CI: 0.67-0.88).Despite a lower prevalence of baseline comorbidities, women undergoing TEER with MitraClip had higher unadjusted rates of periprocedural stroke and bleeding as compared with men. There was no difference in unadjusted procedural success, short-term or long-term mortality. However, women had lower adjusted mortality on long-term follow-up. Future high-quality studies assessing sex differences in outcomes after TEER are needed to confirm these findings.
- Published
- 2022
36. Safety and efficacy of drug‐coated balloon for peripheral artery revascularization—A systematic review and meta‐analysis
- Author
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Waqas Ullah, Mohammad Zghouzi, Zeeshan Sattar, Bachar Ahmad, Salman Zahid, Abdul‐Rahman M. Suleiman, Yasar Sattar, Muhammad Zia Khan, Timir Paul, Rodrigo Bagur, Mohammad Imran Qureshi, David L. Fischman, Subhash Banerjee, Anand Prasad, and M. Chadi Alraies
- Subjects
Femoral Artery ,Peripheral Arterial Disease ,Treatment Outcome ,Coated Materials, Biocompatible ,Humans ,Popliteal Artery ,Radiology, Nuclear Medicine and imaging ,Constriction, Pathologic ,General Medicine ,Cardiology and Cardiovascular Medicine ,Angioplasty, Balloon ,Vascular Patency - Abstract
The relative merits of the drug-coated balloon (DCB) versus uncoated balloon (UCB) angioplasty in endovascular intervention for patients with symptomatic lower extremity peripheral arterial disease (PAD) remains controversial.Online databases were queried with various combinations of keywords to identify relevant articles. Net adverse events (NAEs) and its components were compared using a random effect model to calculate unadjusted odds ratios (ORs).A total of 26 studies comprising 26,845 patients (UCB: 17,770 and DCB: 9075) were included. On pooled analysis, DCB was associated with significantly lower odds of NAE (OR: 0.47, 95% confidence interval [CI]: 0.36-0.61), vessel restenosis (OR: 0.46, 95% CI: 0.37-0.57), major amputation (OR: 0.68, 95% CI: 0.47-99), need for repeat target lesion (OR: 0.38, 95% CI: 0.31-0.47) and target vessel revascularization (OR: 0.62, 95% CI: 0.47-0.81) compared with UCB. Similarly, the primary patency rate was significantly higher in patients undergoing DCB angioplasty (OR: 1.44, 95% CI: 1.19-1.75), while the odds for all-cause mortality (OR: 0.96, 95% CI: 0.85-1.09) were not significantly different between the two groups. A subgroup analysis based on follow-up duration (6 months vs. 1 vs. 2 years) followed the findings of the pooled analysis with few exceptions.The use of DCB in lower extremity PAD intervention is associated with higher primary patency, lower restenosis, lower amputation rate, and decreased need for repeat revascularization with similar all-cause mortality as compared to UCB.
- Published
- 2022
37. Racial, ethnic and socioeconomic disparities in patients undergoing transcatheter mitral edge-to-edge repair
- Author
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Gilbert H.L. Tang, Jason H. Wasfy, Tsuyoshi Kaneko, Shubrandu S. Sanjoy, Pedro A. Villablanca, Brian R. Lindman, Robert T. Sparrow, Rodrigo Bagur, Mamas A. Mamas, M. Chadi Alraies, Mayra Guerrero, Yun-Hee Choi, Ashish Pershad, and Luciano A. Sposato
- Subjects
medicine.medical_specialty ,Population ,Ethnic group ,Psychological intervention ,Internal medicine ,Ethnicity ,medicine ,Humans ,Hospital Mortality ,Healthcare Disparities ,Adverse effect ,education ,Socioeconomic status ,Aged ,education.field_of_study ,business.industry ,Hispanic or Latino ,medicine.disease ,United States ,Black or African American ,Cohort ,Income ,Observational study ,Cardiology and Cardiovascular Medicine ,business ,Mitral valve regurgitation - Abstract
Background Transcatheter mitral edge-to-edge repair (TEER) is an increasingly common procedure performed on patients with severe mitral regurgitation. This study assessed the impact of race/ethnicity and socioeconomic status on in-hospital complications after TEER. Methods Cohort-based observational study using the National Inpatient Sample between October 2013 and December 2018. The population was stratified into 4 groups based on race/ethnicity and quartiles of neighborhood income levels. The primary outcome was in-hospital complications, defined as the composite of death, bleeding, cardiac and vascular complications, acute kidney injury, and ischemic stroke. Results 3795 hospitalizations for TEER were identified. Patients of Black and Hispanic race/ethnicity comprised 7.4% and 6.4%, respectively. We estimated that White patients received TEER with a frequency of 38.0/100,000, compared to 29.7/100,000 for Blacks and 30.5/100,000 for Hispanics. In-hospital complications occurred in 20.2% of patients and no differences were found between racial/ethnic groups (P = 0.06). After multilevel modelling, Black and Hispanic patients had similar rate of overall in-hospital complications (OR: 0.84, CI:0.67–1.05 and OR: 0.84, CI:0.66–1.07, respectively) as compared to White patients, however, higher rates of death were observed in Black patients. Individuals living in income quartile-1 had worse in-hospital outcomes as compared to quartile-4 (OR: 1.19, CI:0.99–1.42). Conclusion In this study assessing racial/ethnic disparities in TEER outcomes, aged-adjusted race/ethnicity minorities were less underrepresented as compared to other structural heart interventions. Black patients experienced a higher rate of in-hospital death, but similar overall rate of post-procedural adverse events as compared to White patients. Lower income levels appear to negatively impact on in-hospital outcomes. Brief summary This study appraises race/ethnic and socioeconomical disparities in access and outcomes following transcatheter mitral edge-to-edge repair. Racial minority groups were less underrepresented as compared to other structural heart interventions. While Black patients experienced a higher rate of in-hospital death, they experienced similar overall rate of post-procedural complications compared to White patients. Lower income levels also appeared to negatively impact on outcomes.
- Published
- 2021
38. Valvular Heart Disease in Relation to Race and Ethnicity
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Julio A. Lamprea-Montealegre, Shakirat Oyetunji, Rodrigo Bagur, and Catherine M. Otto
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Cardiology and Cardiovascular Medicine - Published
- 2021
39. Association between acute myocardial infarction and death in 386 patients with a thrombus straddling a patent foramen ovale
- Author
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Maria Bres-Bullrich, Amado Jiménez-Ruiz, Andrew Gibson, Palak Shah, Juan C. Vargas-González, Luciano A. Sposato, and Rodrigo Bagur
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Adult ,medicine.medical_specialty ,Myocardial Infarction ,Foramen Ovale, Patent ,Logistic regression ,Coronary artery disease ,Paradoxical embolism ,Internal medicine ,medicine ,Humans ,Hospital Mortality ,Myocardial infarction ,Thrombus ,Acute mi ,business.industry ,Thrombosis ,Middle Aged ,medicine.disease ,Stroke ,Cardiology ,Patent foramen ovale ,Female ,Risk of death ,Cardiology and Cardiovascular Medicine ,business ,Embolism, Paradoxical - Abstract
Right atrial thrombi are rarely found straddling a patent foramen ovale (PFO). A thrombus straddling a PFO (TSPFO), also known as impending paradoxical embolism, is a medical emergency associated with up to 11.5% risk of death within 24 h of being diagnosed. We hypothesized that acute myocardial infarction (MI) and ischemic stroke (IS) diagnosed upon the admission of patients with TSPFO are associated with increased risk of death. We also investigated if specific acute therapies are associated with reduced in-hospital mortality.We performed a systematic search including case reports and series of adult patients with TSPFO published from 1950 to October 30, 2020. We gathered patient-level data and we applied a logistic regression model to evaluate on the risk of in-hospital death. We performed time-trends and several sensitivity analyses.We included 386 cases with a TSPFO comprised in 359 publications. The median age was 61 years and 51.2% were females. Fifty (13.0%) patients died during hospital stay, 82 (21.2%) had an acute IS, and 18 (4.6%) had an acute MI diagnosed upon admission. Acute MI (OR 7.83, 95%CI 2.70-22.7; P 0.0001), but not IS, was associated with increased risk of death. Right atrial thrombectomy was associated with a 65% decreased in-hospital mortality (OR 0.35, 95%CI 0.18-0.70, P = 0.003). Results remained unchanged on sensitivity analyses.In this systematic review of 386 cases of TSPFO, acute MI but not IS was associated with 8-fold increased risk of death, while surgical thrombectomy was associated with a significant 65% reduction of in-hospital mortality.
- Published
- 2021
40. Simultaneous Hybrid Transcatheter Aortic Valve Implantation and Endoscopic Mitral Valve Repair
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Christina Oatway, Junichi Shimamura, Rodrigo Bagur, Satoru Fujii, and Michael W.A. Chu
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Case Report ,Cardiology and Cardiovascular Medicine - Published
- 2022
41. Impact of the admitting ward on care quality and outcomes in non-ST-segment elevation myocardial infarction: insights from a national registry
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Benoy N. Shah, Rafail A. Kotronias, Mamas A. Mamas, Rodrigo Bagur, Hude Quan, Ahmad Shoaib, Chris P Gale, Saadiq M Moledina, Louise Y. Sun, and Phyo K. Myint
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Percutaneous Coronary Intervention ,Pharmacotherapy ,RA0421 ,Internal medicine ,Humans ,Medicine ,ST segment ,Registries ,Myocardial infarction ,Non-ST Elevated Myocardial Infarction ,Aged ,business.industry ,Health Policy ,R735 ,Percutaneous coronary intervention ,Guideline ,medicine.disease ,Hospitals ,Cohort ,Conventional PCI ,ST Elevation Myocardial Infarction ,Female ,Original Article ,Cardiology and Cardiovascular Medicine ,business ,RA ,Mace - Abstract
Aims Little is known about the association between the type of admission ward and quality of care and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI). Methods and results We analysed data from 337 155 NSTEMI admissions between 2010 and 2017 in the UK Myocardial Ischaemia National Audit Project (MINAP) database. The cohort was dichotomised according to receipt of care either on a medical (n = 142,876) or cardiac ward, inclusive of acute cardiac wards and cardiac care unit (n = 194,279) on admission to hospital. Patients admitted to a cardiac ward were younger (median age 70 y vs. 75 y, P Conclusion Patients with NSTEMI admitted to a cardiac ward on admission were more likely to receive guideline directed management and had better clinical outcomes.
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- 2021
42. Surgical Explantation After TAVR Failure
- Author
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Vinayak N. Bapat, Syed Zaid, Shinichi Fukuhara, Shekhar Saha, Keti Vitanova, Philipp Kiefer, John J. Squiers, Pierre Voisine, Luigi Pirelli, Moritz Wyler von Ballmoos, Michael W.A. Chu, Josep Rodés-Cabau, J. Michael DiMaio, Michael A. Borger, Rudiger Lange, Christian Hagl, Paolo Denti, Thomas Modine, Tsuyoshi Kaneko, Gilbert H.L. Tang, Aditya Sengupta, David Holzhey, Thilo Noack, Katherine B. Harrington, Siamak Mohammadi, Derek R. Brinster, Marvin D. Atkins, Muhanad Algadheeb, Rodrigo Bagur, Nimesh D. Desai, Oliver D. Bhadra, Lenard Conradi, Christian Shults, Lowell F. Satler, Basel Ramlawi, Newell B. Robinson, Lin Wang, George A. Petrossian, Martin Andreas, Paul Werner, Andrea Garatti, Flavien Vincent, Eric Van Belle, Francis Juthier, Lionel Leroux, John R. Doty, Joshua B. Goldberg, Hasan A. Ahmad, Kashish Goel, Ashish S. Shah, Arnar Geirsson, John K. Forrest, Kendra J. Grubb, Sameer Hirji, Pinak B. Shah, Giuseppe Bruschi, Guido Gelpi, Igor Belluschi, Maral Ouzounian, Marc Ruel, Talal Al-Atassi, Joerg Kempfert, Axel Unbehaun, Nicholas M. Van Mieghem, Thijmen W. Hokken, Walid Ben Ali, Reda Ibrahim, Philippe Demers, Alejandro Pizano, Marco Di Eusanio, Filippo Capestro, Rodrigo Estevez-Loureiro, Miguel A. Pinon, Michael H. Salinger, Joshua Rovin, Augusto D'Onofrio, Chiara Tessari, Antonio Di Virgilio, Maurizio Taramasso, Marco Gennari, Andrea Colli, Brian K. Whisenant, Tamim M. Nazif, Neal S. Kleiman, Molly Y. Szerlip, Ron Waksman, Isaac George, Tom C. Nguyen, Francesco Maisano, G. Michael Deeb, Joseph E. Bavaria, Michael J. Reardon, Michael J. Mack, William T. Brinkman, Timothy J. George, Srinivasa Potluri, William H. Ryan, Justin M. Schaffer, Robert L. Smith, Molly Szerlip, Tamim Nazif, Hussein Rahim, Kendra Grubb, Marvin Atkins, Sachin Goel, Neal Kleiman, Michael Reardon, John Doty, Brian Whisenant, Michael Salinger, Lowell Satler, Christian Schults, Susan Fisher, Sophia L. Alexis, Chad A. Kliger, Bruce Rutkin, Pey-Jen Yu, George Petrossian, Newell Robinson, Michael Deeb, Jessica Oakley, Joseph Bavaria, Nimesh Desai, Lisa Walsh, Tom Nguyen, Hasan Ahmad, Joshua Goldberg, David Spielvogel, John Forrest, Michael Chu, Raymond Cartier, Josep Rodes-Cabau, Alain-Philippe Abois, Munir Boodhwani, Alexander Dick, Christopher Glover, Marino Labinaz, Buu-Khanh Lam, Cedric Delhaye, Adeline Delsaux, Tom Denimal, Anaïs Gaul, Mohammad Koussa, Thibault Pamart, Svetlana Sonnabend, Markus Krane, Andrea Munsterer, Michael Borger, Philippe Kiefer, Oliver Bhadra, Len Conradi, Bruno Merlanti, Claudio F. Russo, Claudia Romagnoni, Nicholas Van Mieghem, and Miguel Pinnon
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Mortality rate ,medicine.disease ,Surgery ,Stenosis ,Valve replacement ,Interquartile range ,Concomitant ,medicine ,Endocarditis ,Paravalvular leak ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Objectives The aim of this study was to evaluate clinical characteristics, mechanisms of failure, and outcomes of transcatheter aortic valve replacement (TAVR) explantation. Background Surgical explantation following TAVR may be required for structural valve degeneration, paravalvular leak, infection, or other reasons. However, in-depth data on indications and outcomes are lacking. Methods Data from a multicenter, international registry (EXPLANT-TAVR) of patients who underwent TAVR explantation were reviewed retrospectively. Explantations performed during the same admission as initial TAVR were excluded. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 6.7 months (interquartile range [IQR]: 1.0-18.8 months) after TAVR explantation and was 97.7% complete at 30 days and 86.1% complete at 1 year. Results From November 2009 to September 2020, 269 patients across 42 centers with a mean age of 72.7 ± 10.4 years underwent TAVR explantation. About one quarter (25.9%) were deemed low surgical risk at index TAVR, and median Society of Thoracic Surgeons risk at TAVR explantation was 5.6% (IQR: 3.2%-9.6%). The median time to explantation was 11.5 months (IQR: 4.0-32.4 months). Balloon-expandable and self-expanding or mechanically expandable valves accounted for 50.9% and 49.1%, respectively. Indications for explantation included endocarditis (43.1%), structural valve degeneration (20.1%), paravalvular leak (18.2%), and prosthesis-patient mismatch (10.8%). Redo TAVR was not feasible because of unfavorable anatomy in 26.8% of patients. Urgent or emergency cases were performed in 53.1% of patients, aortic root replacement in 13.4%, and 54.6% had concomitant cardiac procedures. Overall survival at last follow-up was 76.1%. In-hospital, 30-day, and 1-year mortality rates were 11.9%, 13.1%, and 28.5%, respectively, and stroke rates were 5.9%, 8.6%, and 18.7%, respectively. Conclusions The EXPLANT-TAVR registry reveals that surgical risks associated with TAVR explantation are not negligible and should be taken into consideration in the lifetime management of aortic stenosis.
- Published
- 2021
43. Transcatheter Aortic Valve Replacement Through a Single Femoral Access: A Multicenter Experience
- Author
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Stefan, Toggweiler, Rodrigo, Bagur, Carla Romina, Agatiello, Carlos, Giuliani, Federico, Moccetti, Pantelis, Diamantouros, Horacio, Medina de Chazal, Ignacio Miguel, Seropian, Mathias, Wolfrum, and Matias, Sztejfman
- Subjects
Aged, 80 and over ,Male ,Transcatheter Aortic Valve Replacement ,Time Factors ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,Humans ,Female ,Aortic Valve Stenosis ,Prosthesis Design ,Aged - Abstract
During the past few years, physicians have optimized transcatheter aortic valve replacement and its periprocedural management, with the minimalist approach becoming popular. We aimed to further simplify the procedure using a single femoral access (the "all-in-one" technique). Here, we report a multicenter experience with TAVR with Acurate neo/neo2 transcatheter heart valves (Boston Scientific) through a single, large-bore, femoral sheath.Patients underwent TAVR with the Acurate neo or neo2 through a single femoral access at 4 centers. The large sheath was used for both the delivery catheter and the pigtail used to visualize the aortic root.A total of 157 patients (59% women) with a mean age of 82 ± 6 years underwent TAVR with the Acurate neo (n = 100) or the Acurate neo2 (n = 57). The procedure was successfully performed through a single large sheath in all patients. Median duration of hospitalization stay was 2 days (interquartile range, 1-3 days). On echocardiography before discharge, the mean gradient was 7 ± 3 mm Hg and 7 patients (4.4%) had more than mild paravalvular leak. At 30 days, a major vascular complication had occurred in 2 patients (1.3%), 2 patients (1.3%) had suffered a stroke, and only 4 patients (2.5%) had required new permanent pacemaker implantation. A total of 3 patients (1.9%) had died.An all-in-one access technique allows safe implantation of Acurate neo and neo2 transcatheter heart valves, with low rates of periprocedural complications and favorable short-term outcomes.
- Published
- 2022
44. Single Access for Transfemoral Transcatheter Aortic Valve Implantation With the Acurate neo/neo 2 Self-Expanding Valve
- Author
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Rodrigo Bagur, Michael W.A. Chu, Santiago Ordoñez, Matthew Valdis, Jill Gelinas, Gloria Chaumont, Patrick J. Teefy, and Pantelis Diamantouros
- Subjects
Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,Humans ,Aortic Valve Stenosis ,Cardiology and Cardiovascular Medicine ,Prosthesis Design - Published
- 2022
45. Prognostic Effect of Race on the Risk of Contrast-Associated Acute Kidney Injury Among Patients Who Undergo Percutaneous Coronary Intervention
- Author
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Francesco Moroni, Juan Ignacio Damonte, Devi Preetham R. Veeramgari, Krishna Ravindra, Sagar Sudhakar Prabhu, Mahreed Khan, Xin Wei, Luz Maria Vilca, Giuseppe Biondi-Zoccai, Rodrigo Bagur, Antonio Abbate, and Lorenzo Azzalini
- Subjects
Percutaneous Coronary Intervention ,Risk Factors ,Creatinine ,Humans ,Contrast Media ,Acute Kidney Injury ,Cardiology and Cardiovascular Medicine ,Prognosis - Published
- 2022
46. Aggressive Cholesterol Pericarditis With Minimal Effusion Masquerading as Treatment-Refractory Autoimmune Disease
- Author
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Rodrigo Bagur, Tahir Dahrouj, Elena Tugaleva, Lin-Rui Ray Guo, Tahir S. Kafil, Yehia Fenous, Nikolaos Tzemos, Maged Elrayes, Omar Shaikh, and Muhammad M. Hashmi
- Subjects
medicine.medical_specialty ,Pericardial constriction ,business.industry ,medicine.medical_treatment ,Pericardial fluid ,medicine.disease ,Pericardial effusion ,Pericarditis ,medicine.anatomical_structure ,Effusion ,Internal medicine ,Heart failure ,cardiovascular system ,medicine ,Cardiology ,Pericardium ,Cardiology and Cardiovascular Medicine ,business ,Pericardiectomy - Abstract
A middle-aged woman with rheumatoid arthritis presented with treatment refractory pericarditis. Symptoms persisted despite escalation of immunosuppression and she had recurrent admissions for heart failure. Imaging revealed minimal pericardial effusion and a thickened pericardium. Invasive hemodynamics confirmed constrictive physiology and a pericardiectomy was required. Pathology confirmed cholesterol pericarditis, a rare condition of inflammatory cholesterol deposits within the pericardium. Previous reports describe moderate-to-large volumes of gold-coloured pericardial fluid. This case illustrates that cholesterol pericarditis can present with minimal pericardial effusion and rapidly progress to pericardial constriction.
- Published
- 2022
47. LB-11 | Core-Laboratory Angiographic Characteristics and Mortality of Patients With STEMI and COVID-19: Insights from the NACMI Registry
- Author
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Payam Dehghani, Jyotpal Singh, G.B. John Mancini, Larissa Stanberry, Seth Bergstedt, Mina Madan, Brian C. Case, Rajan A. Patel, Jay H. Stone, Catherine Benziger, Nima Ghasemzadeh, Cindy L. Grines, Jay Shavadia, Deepak Acharya, Nosheen Javed, Anna Bortnick, Jose M. Wiley, Rodrigo Bagur, Ross Garberich, Santiago Garcia, and Timothy D. Henry
- Published
- 2023
48. B-18 | Procedural Time and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from the PROGRESS-CTO Registry
- Author
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Athanasios Rempakos, Spyridon Kostantinis, Bahadir Simsek, Judit Karacsonyi, James W. Choi, Paul Poommipanit, Jaikirshan Khatri, Wissam A. Jaber, Stéphane Rinfret, William J. Nicholson, Şevket Görgülü, Farouc A. Jaffer, Raj H. Chandwaney, Luiz Fernando Ybarra, Rodrigo Bagur, Khaldoon Alaswad, Oleg Krestyaninov, Dmitrii Khelimskii, Dimitrios Karmpaliotis, Barry F. Uretsky, Korhan Soylu, Ufuk Yildirim, Srini Potluri, Karim Al-Azizi, Bavana V. Rangan, Olga Mastrodemos, Salman S. Allana, Yader B. Sandoval, M. Nicholas Burke, and Emmanouil S. Brilakis
- Published
- 2023
49. Natural History of Left Ventricle Thrombus After ST-Segment Elevation Myocardial Infarction
- Author
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Rami M. Abazid, Andrew Frost, Usha Manian, Rodrigo Bagur, and Nikolaos Tzemos
- Published
- 2023
50. Initial Findings From the North American COVID-19 Myocardial Infarction Registry
- Author
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Santiago Garcia, Payam Dehghani, Cindy Grines, Laura Davidson, Keshav R. Nayak, Jacqueline Saw, Ron Waksman, John Blair, Bagai Akshay, Ross Garberich, Christian Schmidt, Hung Q. Ly, Scott Sharkey, Nestor Mercado, Carlos E. Alfonso, Naoki Misumida, Deepak Acharya, Mina Madan, Abdul Moiz Hafiz, Nosheen Javed, Jay Shavadia, Jay Stone, M. Chadi Alraies, Wah Htun, William Downey, Brian A. Bergmark, Jospeh Ebinger, Tareq Alyousef, Houman Khalili, Chao-Wei Hwang, Joshua Purow, Alexander Llanos, Brent McGrath, Mark Tannenbaum, Jon Resar, Rodrigo Bagur, Pedro Cox-Alomar, Ada C. Stefanescu Schmidt, Lindsey A. Cilia, Farouc A. Jaffer, Michael Gharacholou, Michael Salinger, Brian Case, Ameer Kabour, Xuming Dai, Osama Elkhateeb, Taisei Kobayashi, Hahn-Ho Kim, Mazen Roumia, Frank V. Aguirre, Jeffrey Rade, Aun-Yeong Chong, Hurst M. Hall, Shy Amlani, Alireza Bagherli, Rajan A.G. Patel, David A. Wood, Frederick G. Welt, Jay Giri, Ehtisham Mahmud, and Timothy D. Henry
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Revascularization ,outcomes ,D2B, door to balloon ,PPCI, primary percutaneous coronary intervention ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Epidemiology ,PUI, person under investigation ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Registries ,Young adult ,Prospective cohort study ,Stroke ,IQR, interquartile range ,Original Investigation ,COVID-19, coronavirus disease 2019 ,SCAI, Society for Cardiac Angiography and Interventions ,business.industry ,SARS-CoV-2 ,Percutaneous coronary intervention ,COVID-19 ,STEMI, ST-segment elevation myocardial infarction ,medicine.disease ,United States ,MI, myocardial infarction ,ST Elevation Myocardial Infarction ,Observational study ,ACC, American College of Cardiology ,Cardiology and Cardiovascular Medicine ,business ,ST-segment myocardial infarction - Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI). Objectives The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI. Methods A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies. STEMI patients with confirmed COVID+ (group 1) or suspected (person under investigation [PUI]) (group 2) COVID-19 infection were included. A group of age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) serves as the control group for comparison of treatment strategies and outcomes (group 3). The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization. Results As of December 6, 2020, 1,185 patients were included in the NACMI registry (230 COVID+ patients, 495 PUIs, and 460 control patients). COVID+ patients were more likely to have minority ethnicity (Hispanic 23%, Black 24%) and had a higher prevalence of diabetes mellitus (46%) (all p, Central Illustration
- Published
- 2021
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