tbuckley/cabot-search huggingface dataset:
Abstract 16042: Sex/Gender Specific Differences in the Outcomes of Ventricular Arrhythmias Complicating Acute Myocardial Infarction
Authors: Favour Markson, Akanimo Antia, Saint-Martin Allihien, Sammudeen Ibrahim, Emmanuel Akuna, Kenneth Ong, Carlos L Alviar, Kevin F Kwaku
Journal: Circulation (2023)

Introduction: Ventricular Arrythmias (VA) is a common clinical problem in myocardial ischemia and the most common cause of sudden death in patients with Acute Myocardial Infarction (AMI). Studies have shown sex differences in the incidence, presentation, and outcomes of AMI. However, evidence on the sex differences in VA in patients with AMI is limited. In this study we evaluated the sex differences in the incidence and in- hospital outcomes of VA in patients who were admitted with AMI. Methods: Using the NIS 2016 - 2020, we retrospectively analyzed the data of patients admitted for AMI using the ICD 10 code (I21). Our primary population included patients who underwent reperfusion (PCI or CABG), 18 years and above, and had a secondary diagnosis of either Ventricular Fibrillation (VF) or Ventricular Tachycardia (VT). We excluded patients who had infiltrative cardiac diseases (Sarcoidosis, Lyme disease, amyloidosis) or long QT syndrome. We further divided our sample population into 2 groups based on their reported gender (Male or Female). Using a multivariate analysis, we compared the odds of VA and in-hospital outcomes between both subgroups of patients. Results: We identified 174,565 patients with VA in the setting of AMI. Of these 75.8% were males. VF was observed in 15,500 (36.4%) of female patients and 45,010 (34%) of male patients. The odds of VA after AMI were higher in Men (AOR): 1.72, CI: 1.67 - 1.78, p&lt;0.001). Male patients were more likely to have a history of myocardial infarction, smoking and Cocaine use while female patients were more likely to have DM, PVD and heart failure. Female patients had significantly higher odds of in-hospital mortality (AOR: 1.32, CI: 1.21 - 1.42, p&lt;0.001), cardiogenic shock (AOR: 1.08, CI: 1.01 - 1.15, p&lt;0.022) and Cardiac arrest (AOR:1.11, CI: 1.03 - 1.18, p&lt;0.002). However, they had significantly lower odds of defibrillator insertion (AOR: 0.57, CI: 0.47 - 0.68, p&lt;0.001) or catheter ablation (AOR: 0.51, CI: 0.27 - 0.98, p&lt;0.001) during the index admission. Conclusion: There are sex differences in the incidence and outcomes of VA in AMI, with women having lower odds of VA but worse hospital outcomes. Incorporation of women in more VA studies and may help us understand why these differences in outcomes exists
Abstract 14971: Rate of 30-Day Readmission and Economic Burden of End-Stage Renal Disease Patients Who Underwent Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Procedure for ST - Elevation Myocardial Infarction
Authors: Michael Fatuyi, Muayad Alzamara, Oluwasegun Akinti, Henry Aiwuyo, Kenneth Nworie, funlola bada, ADESINA ORIGBEMISOYE, Patrick Coello, Catherine Illah, Joseph Amoah, Yonael Ayinalem, Emmett Brennan, Alexa Kahn
Journal: Circulation (2023)

Introduction and Hypothesis: We sought to determine the 30-Day Readmission rate (30-DRr) of patients with End-Stage Renal Disease (ESRD) who underwent Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG) Procedure for ST-Elevation Myocardial Infarction (STEMI) and its impact on mortality and healthcare utilization in the United States. Methods: Using the 2020 National Readmission Database, we conducted a retrospective analysis of patients with ESRD after PCI and CABG procedure for STEMI as a principal diagnosis according to ICD-10 codes. Readmission was the first admission to any hospital for any non-trauma diagnosis within 30 days of the index admission. The primary outcome was 30DRr, while secondary outcomes were readmission mortality rate and resource utilization defined by length of stay and patient charge. Results: A total of 13,753 index hospitalization was observed with a mean age was 68.5 SD±12.9 years, and 60.4% of patients were males. The in-hospital mortality rate for index admission was 8.4% (1,153 of 13,753), while 30-DRr was 20.6% (2,596 of 12,600) (Figure 1). Among this group of readmitted patients (mean age was 66 SD±12.4 years, 59.6% of patients were males), the In-hospital mortality rate was 6.4% (166 of 2,596). However, observed 30-DRr among Non-ESRD patients was 9.02% (36,564 of 405,526), which is lower, as well as lower inpatient index and readmission mortality of 4.81% (19,507 of 405,426) and 4.83% (1,764 of 36,564) respectively. A healthcare economic burden of $214,000,000 among readmitted ESRD patients. Conclusions: Approximately 1 in 5 patients who underwent PCI and CABG procedure for STEMI with underlying ESRD had 30-DRr, with subsequent readmissions associated with healthcare spending. Readmission mortality was statistically lower than index mortality. ESRD patients are a vulnerable subset who will benefit from outpatient multidisciplinary care.
Abstract 15979: <i>En Bloc</i> Heart-Lung Transplantation and Vascular Reconstruction With Native Tissue in a Patient With Situs Inversus Totalis
Authors: Stefan Elde, Hanjay Wang, Michael J Paulsen, Y Joe J Woo, John Macarthur
Journal: Circulation (2023)

Case: A 62-year-old male with primary ciliary dyskinesia, bronchiectasis, dextrocardia, ccTGA, VSD, ASD, and severe ventricular dysfunction was listed for HLTx. Suitable organs became available from a 21-year-old male donor after brain death. The right sided aorta, persistent left superior vena cava (LSVC), RIJ, and LCFV were cannulated for CPB. The bloc was procured in the typical fashion along with the donor’s pericardium and intact innominate vein. During the recipient cardiectomy, the LSVC was transected proximally, and right atrial (RA) tissue preserved in continuity with the left inferior vena cava (LIVC). To achieve situs solitus positioning of the mediastinum, a pericardial sling was created by plicating the right pericardium to the diaphragmatic pericardium, and the left pericardium was augmented with excess donor pericardial tissue to create a neo-pericardium in the left chest. The recipient’s RA tissue was used to extend the LIVC by forming a cavoatrial conduit and anastomosed to the donor RA, which required a slightly counterclockwise rotation of the cardiac axis and facilitated positioning the left phrenic nerve posterior to the apex. The tracheal and aortic anastomoses were performed in the typical fashion. The donor innominate vein was of sufficient caliber and length to complete the anastomosis to the recipient LSVC and the donor RIJ was ligated. Discussion: HLTx remains the only definitive therapy for patients with combined end-stage cardiopulmonary disease. The leading indication for HLTx is congenital heart disease. Accordingly, centers performing HLTx must be experienced in complex vascular reconstructions and concomitant procedures to address a broad spectrum of anatomical variants. With thoughtful pre-operative planning, close communication with the procurement team, and surgical experience, these procedures may be performed without the use of synthetic materials that predispose to infectious and thromboembolic complications.
Abstract 18892: Sleep Duration is Linked to Cholesterol Levels Among Hispanics: Findings From the National Health Interview Survey
Authors: Mary Carrasco, Jesse Moore, Judite Blanc, Clarence Locklear, Debbie Chung, April Rogers, Girardin Jean Louis, Azizi A Seixas
Journal: Circulation (2023)

Introduction: Short sleep duration is associated with unhealthy cholesterol levels, a significant cardiovascular risk marker. Precious epidemiological studies indicate that cardiovascular disease (CVD) accounts for 20% of deaths among Hispanics, and 75% have at least one risk factor associated with cardiovascular health. Little is known about whether sleep duration contributes directly to cholesterol levels among Hispanics. Objectives: 1) Examine whether sleep duration predicts cholesterol levels; 2) Examine whether this relationship differs in Hispanics in comparison to non-Hispanics. Methods: This study was based on the 2020 National Health Interview Survey. Cholesterol, the outcome, is defined as whether an individual had high cholesterol during the last 12 months. Sleep quantity was categorized as follows: short sleep (&lt; 7 hours), healthy sleep (7-8 hours), and long sleep (≥9 hours). For stratified analyses, we investigated whether the relationship between sleep duration and cholesterol differed between Hispanics and non-Hispanics. We performed unadjusted and fully adjusted binary logistic regression analyses, with age, sex, education, income, and BMI as covariates. Results: Among 37,558 participants, the mean age was 46.64 (SD=23.22 years; female= 53.2%); 9.5% of the sample was Hispanic and 90.5% was non- Hispanic. The inferential analysis was split into 3 groups: Full sample, Non-Hispanic only, and Hispanic only. Multivariate-adjusted regression analyses indicated that there’s a stronger association between short sleep and high cholesterol among the Hispanic only group (OR=1.50, p=.001) when compared to Non-Hispanic only (OR=1.15, p=&lt;.001). Conclusions: Short sleep duration (≤6 hours) predicted high cholesterol for all three groups. Hispanics who suffer from short sleep are more vulnerable to having high cholesterol. Long sleep (≥9 hours) did not predict high cholesterol in any of the groups. Further research should look at if these findings are relative to cholesterol or other CVD risk factors, as well as what is the contribution of sleep, vs. diet, vs. exercise in reference to high cholesterol.
Abstract 15165: Clinical Characteristics and Outcome of Venous Thromboembolism in Patients After Surgical Procedure: From the COMMAND VTE Registry-2
Authors: Shunsuke Usami, Shuichiro Kaji, Kotaro Miyagawa, Minako Kinoshita, Satoshi Asada, Kazuhisa Kaneda, Yugo Yamashita, Takeshi Kimura
Journal: Circulation (2023)

Background: Undergoing surgical procedure is a risk factor for venous thromboembolism (VTE). However, the prognosis of VTE in patients after surgical procedure has not been fully evaluated in the Era of direct oral anticoagulant (DOAC). We elucidated the prognosis of VTE in patients who have undergone surgical procedure. Methods: The COMMAND VTE Registry-2 is a multicenter registry enrolling 5197 consecutive acute symptomatic VTE patients among 31 centers in Japan between January 2015 and August 2020. According to the history of surgical procedure within 2 months, we divided the study patients into 2 groups; Surgical group (N=793) and Non-surgical group (N=4404). Clinical outcome including all-cause death and recurrence of VTE was compared between the two groups. Results: There were more women in surgical group than non-surgical group (64% vs. 58%, P&lt;0.01). In addition, surgical group had higher prevalence of active cancer (34% vs. 28%, P&lt;0.01), and lower prevalence of kidney disease (16% vs. 20%, P&lt;0.01) than non-surgical group. The cumulative incidences of all-cause death and recurrent VTE at 2-year were significantly lower in surgical group than non-surgical group (all-cause death: 16.6±1.4% vs. 24.4±0.7%, P&lt;0.01; recurrent VTE: 2.8±0.7% vs. 5.7±0.4%, P&lt;0.01, respectively). In surgical group, Cox regression analysis identified diabetes mellitus as the independent risk factor for recurrence of VTE (hazard ratio 2.90; 95% confidence interval, 1.24-6.74; P=0.01). Conclusion: Patients after surgical procedure had lower mortality and incidence of recurrent VTE than non-surgical group. Diabetes mellitus is the independent risk factor for recurrence of VTE in patients after surgical procedure.
Abstract 15381: Clinical Outcomes of Post-Drug-Coated Balloon Angioplasty Dissection in Large De-Novo Coronary Artery Disease
Authors: Cheng Yang, Yong-Gang Sui, Jie Qian
Journal: Circulation (2023)

Introduction: Drug-coated balloon (DCB) may be an alternative to stents in the treatment of large native coronary artery disease. However, the complications of acute elastic recoil and coronary dissections confine the practical application of DCB. Little is known about the clinical outcomes of different types of dissection after DCB angioplasty with or without stenting. Aims: This study sought to investigate the clinical outcomes of post-DCB dissection in large de novo coronary artery disease. Methods: This was a retrospective observational study. A consecutive series of patients with large native coronary artery disease (reference diameter ≥ 3.0 mm) who occurred coronary dissections after the treatment of DCB angioplasty were included. These patients were divided into stented groups and non-stented groups depending on whether bail-out stents were employed. Post-angioplasty coronary artery dissections were classified into type A-F. The cumulative incidence of major adverse cardiac events (MACE) was compared between the two groups. Results: Between March 2017 and October 2022, 676 patients with large de novo coronary artery disease developed post-DCB angioplasty dissection, 554 of which treated with DCB only, 122 of which underwent bail-out stent implantation. These dissections were type A (60.5%), B (30.9%), C (6.5%), D (1.9%) and F (0.1%), respectively. During a mean follow-up of 1 year, MACE occurred in 60 patients (9 in the stented group and 51 in the non-stented group; 7.4% vs. 9.2%; p=0.522). For type B dissection, the rate of MACE was similar in the stented group than that in the non-stented group (11.1% vs. 8.2%; p=0.502). For type C dissection, the rate of MACE was numerically higher in the non-stented group than that in the stented group (9.5% vs. 0%; p=0.222). Conclusions: For post-DCB angioplasty dissection in large de-novo coronary artery disease, type B dissection requires no bail-out stent implantation and type C dissection deserves further investigation.
Abstract 18687: Cardio-Rheumatology: Coronary and Cerebrovascular Thromboses in Antiphospholipid Antibody Syndrome
Authors: Risheen Reejhsinghani
Journal: Circulation (2023)

Description of Case: A 27-year-old male with antiphospholipid antibody syndrome (APLS) with a high-risk antibody profile presented for cardiac evaluation. APLS was diagnosed after presentation with acute cardioembolic stroke requiring thrombolysis. Echocardiography showed a normal ejection fraction, with multiple small echo-densities attached to the anterior and posterior leaflet tips of the mitral valve suggesting non-bacterial thrombotic endocarditis (NBTE). The patient was treated with warfarin and aspirin was recommended but declined. As the patient reported lightheadedness, a cardiac rhythm monitor was placed and showed two episodes of non-sustained ventricular tachycardia (NSVT). A cardiac MRI was then obtained, showing multifocal, subendocardial and mesocardial delayed gadolinium enhancement suggesting fibrosis, in a distribution most consistent with a multivessel embolic event. A CT coronary angiogram was performed to further evaluate the coronary arteries, revealing normal coronary anatomy, free from atherosclerotic plaque or thrombus. Beta-blocker therapy was initiated for arrhythmic episodes, with resolution of symptoms and no recurrence of NSVT on follow-up monitoring. Left ventricular (LV) function continued to remain preserved on follow-up imaging, with no progression of mitral valve vegetations on anticoagulation. Discussion: Cardiac involvement in APLS has been well described but largely centers around valvular disease and de novo venous and arterial thromboses. This case of cerebrovascular and coronary pathology in APLS as a likely consequence of thromboembolic phenomena is an unusual presentation and highlights the potential downstream consequences of left-sided valvular NBTE. A high index of suspicion is required to specifically evaluate for myocardial scarring despite normal LV function on echocardiography. The presence of myocardial fibrosis in these cases can act as a focus for scar-related ventricular arrhythmias, which if diagnosed and treated in a timely manner can limit further cardiovascular complications for the patient.
Abstract 15692: Clinical Outcomes in TAVR Patients Receiving Oral Anticoagulation Stratified by Baseline Creatinine Clearance Levels: A Subanalysis of the ENVISAGE-TAVI AF Trial
Authors: Roxana Mehran, Johny Nicolas, Cathy Chen, Christian Hengstenberg, James Jin, TETSUYA KIMURA, Petra Laeis, Martin Unverdorben, Nicolas Van Mieghem, Jose Zamorano, George Dangas
Journal: Circulation (2023)

Introduction: The ENVISAGE-TAVI AF (NCT02943785) trial compared edoxaban (EDO) vs vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) after successful transcatheter aortic valve replacement (TAVR). The effect of baseline creatinine clearance (CrCl) on efficacy and safety of EDO vs VKA in these patients is not well understood. Hypothesis: The efficacy and safety of EDO vs VKA in patients with AF undergoing TAVR will vary across the range of baseline CrCl. Methods: In this post-hoc analysis from the ENVISAGE-TAVI AF trial, we stratified patients by oral anticoagulation (OAC) strategy (EDO vs VKA) and CrCl (CrCl ≥90 mL/min, CrCl 60-89 mL/min, CrCl 45-59 mL/min, CrCl 30-44 mL/min, CrCl ≤29 mL/min). Results: Of 1426 patients included, 46.3% (n = 676) had CrCl from 60 to 89 mL/min. Patients with lower CrCl trended older in age than those with higher CrCl ( Table 1 ). The annualized event rates for all outcomes tended to increase with decreasing CrCl ( Table 2 ). Across the range of CrCl, patients receiving EDO vs VKA had higher rates of major bleeding and major gastrointestinal bleeding but lower rates of non-cardiovascular death. Major bleeding did not translate into increased all-cause death. Rates of intracranial hemorrhage were higher with EDO vs VKA in patients with CrCl ≥90 mL/min but lower in all other patients. For all-cause death, differences between EDO and VKA were numerical and did not reach statistical significance. Conclusions: In this ENVISAGE-TAVI AF subanalysis, decrements of CrCl appeared to correlate with rates of adverse outcome parameters more than OAC strategy. Due to low event rates in some outcomes, these results should be interpreted with caution.
Abstract 13663: 90-day Safety and Performance Outcomes With a Novel Extravascular ICD Lead
Authors: Karan S Saini, Sarin N Paluri, Abhishek Pandravada, Nicholas Philip, Martin C Burke
Journal: Circulation (2023)

Introduction: Long-term transvenous implantable cardioverter defibrillator (ICD) leads have many pitfalls. There is in development a novel extravascular (EV) ICD lead for sensing and defibrillation of ventricular tachyarrhythmias (VT/VF) utilizing commercially available DF-4 ICD pulse generators. We evaluate here 90-day safety and performance outcomes for delivery, stability, sensing, and defibrillation using this prototype EV lead. Methods: 18 patients scheduled to undergo de novo or replacement ICD were enrolled in a prospective, nonrandomized study (SECURE-EV STUDY). Each subject was simultaneously implanted with EV ICD lead (AtaCor, SanClemente, CA) attached to a commercially available ICD pulse generator. Study lead was delivered with a designed tool into left parasternal anterior mediastinum via a selected 4th, 5th or 6th intercostal space. Over 90 days pts were evaluated intermittently for defibrillation energy requirements, matched sensing events between both devices, stability of lead position and adverse events. Results: 16/18 of enrolled subjects received study device. Lead failed implant in 2 due to (1) intercostal ossification and (1) mediastinal adhesions. Prior to 30-days, 4 subjects were withdrawn from study due to pneumothorax, wound dehiscence, death unrelated to IV-ICD implantation and early elective lead removal. Over 90-days of simultaneous sensing, 4 events of VT/VF in 3 pts were detected by both devices. There was 1 AF discrimination error &amp; 1 atrial oversensing event detected by both devices. There were 4 events of non-cardiac noise in 4 pts detected by EV-ICD only. 1 event of Twave oversensing was detected by TV-ICD. 23 conversion tests in 13 subjects were performed at energy (26 to 30 J delivered, 1 tested with 35J) at 30- and 90-day visits, with successful conversion in all 23. Mean time between fibrillation detection and shock delivery was 10.7 seconds. Conclusion: This study showed feasibility of sensing and defibrillating induced VT/VF with intercostal placed prototype extravascular ICD lead. Findings with ICD lead was consistent across 4 commercially available ICDs. Simultaneous sensing of VT/VF in ambulatory pts was matched. Non-cardiac inappropriate sensing with EV-ICD lead is being addressed in new prototype.
Abstract 15010: Relationship Between Low Diastolic Blood Pressure, All-Cause Mortality and Cardiovascular Outcomes: A Meta-Analysis
Authors: Muhammad Shariq Usman, Tariq J Siddiqi, Amna Siddiqui, Laibah Khan, Aisha Shabbir, Ali Salman, Michael E Hall, George E Taffet
Journal: Circulation (2023)

Background: Reduction of diastolic blood pressure (DBP) below 70mmHg may decrease perfusion to the heart and worsen cardiovascular (CV) outcomes. However, studies assessing the association between low DBP and clinical outcomes have yielded inconsistent results. Aim: To meta-analyze the association between low DBP and CV outcomes. Methods: We searched the MEDLINE, Scopus, and Cochrane CENTRAL databases up until December 2022 for studies reporting the risk of all-cause mortality (ACM) or CV outcomes in patients with low versus normal DBP. Patients with a DBP of 70-80mmHg were considered the control and were compared to those with a DBP of 60-69mmHg and &amp;lt;60mmHg. Outcomes of interest were all-cause mortality (ACM), major adverse cardiac events (MACE), myocardial infarction (MI), and ischemic stroke. Subgroup analysis was performed to assess whether pre-existing CV disease was an effect modifier. Findings from studies were pooled using a random-effects model to derive hazard ratios (HRs) and 95% confidence intervals. Results: Ten studies (n = 1,998,223 participants) met the eligibility criteria. A mean achieved DBP&amp;lt;60mmHg was associated with a significantly increased risk of ACM (HR: 1.48 [1.26, 1.74]; P &amp;lt; 0.001) compared with a mean achieved DBP of 70-80mmHg ( Fig. 1a ). This association was significantly stronger in patients with pre-existing CV disease (P-interaction &amp;lt; 0.001). A DBP&amp;lt;60mmHg was also associated with a higher risk of MACE (HR: 1.84 [1.28, 2.65]; P &amp;lt; 0.001) and MI (HR: 1.49 [1.13, 1.97]; P &amp;lt; 0.001). However, a DBP&amp;lt;60mmHg had no significant association with ischemic stroke. A mean achieved DBP 60-69mmHg was associated with a significantly increased risk of ACM (HR: 1.11 [1.03, 1.20]; P &amp;lt; 0.001; Fig. 1b ), but not MACE, MI, or ischemic stroke. Conclusion: Reduction of DBP below 70mmHg, particularly below 60mmHg, is associated with an increased risk of mortality. This association is stronger in patients with pre-existing CV disease.