Critical Pathways in Cardiology最新文献

{"title":"Access to Nonphysician Led Exercise Stress Echocardiography Reduces Wait Times and Improves Consumer Engagement.","authors":"Mark Whitman, Carly Jenkins, Prasad Challa","doi":"10.1097/HPC.0000000000000379","DOIUrl":"10.1097/HPC.0000000000000379","url":null,"abstract":"<p><p>The performance of nonphysician-led exercise stress testing with and without echocardiography has shown similar diagnostic utility and safety as physician-led models. While diagnostic accuracy and relative safety have been the focus of previous research, the current study aims to demonstrate efficiencies not previously reported, such as reduction in wait times for testing and improved service attendance. A nonphysician-led exercise stress echocardiography service was implemented on January 01, 2018; before this, all tests were performed under a physician-led model. Retrospective data was retrieved from both models (physician-led model from January 01, 2015 to December 31, 2017 and the nonphysician-led model from January 01, 2018 to December 31, 2023). Comparisons were made between the models regarding the number of tests performed, the average wait time to access testing, and the did not attend (DNA) rates. On average, 212 tests were performed in the physician-led model per year, with average wait times to access testing of 11.3 weeks and a DNA rate of 15.3%. In contrast, the nonphysician-led model performed on average 501 tests per year (135% increase) ( P < 0.001) with average wait times of 6 weeks (47% decrease) ( P < 0.01) and DNA rate of 4.8% (69% decrease). Despite the physician-led group displaying an overall higher cardiovascular disease risk, there were no adverse cardiovascular events at the time of testing in either model. Nonphysician-led exercise stress echocardiography remains as safe as physician-led models but demonstrates service improvements, including significant reductions in wait times and lower DNA rates.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0379"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Prevention of the Heart Attack The identification of Prodromal Symptom Recognition as the \"Rosetta Stone\" in decoding the heart attack problem.","authors":"Raymond D Bahr, Frank Breuckmann","doi":"10.1097/HPC.0000000000000395","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000395","url":null,"abstract":"<p><p>Chest discomfort before severe chest pain represents a clinical ischemia marker and indicates live myocardium in jeopardy and often precedes cardiac arrest or acute myocardial infarction (MI). The intermittent or stuttering symptoms that precede MI are referred to as \"prodromal symptoms\". These symptoms have been shown to correlate with cyclic ST changes and repeated episodes of spontaneous reperfusion and occlusion, occurring during a period of hours or days before the acute ischemia precedes to death or heart damage. These symptoms of premonitory angina have been associated with improved outcomes due to ischemic pre-conditioning or opening of collateral vascular channels around the area of ischemia. Acute prevention of an MI through prodromal symptoms recognition represents the opportunity for significantly reducing heart attack deaths. The early heart attack care (EHAC) program puts emphasis on prodromal symptom recognition and allows a shift in time backward to prevent the ischemic process from proceeding to MI. This strategy has been shown to pick up the 15% of the patients with ischemia in the low probability group and to reduce inappropriate admissions to the hospital as well as to reduce the number of patients with missed myocardial infarctions being sent home from the emergency department.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abnormal Ankle-Brachial Index and Risk of Cardiovascular and all-cause mortality in Patients with Chronic Kidney Disease: An Updated Systematic Review and Meta-analysis.","authors":"Mohammad Hazique, Arihant Surana, Kunal N Patel, Jawad Basit, Jason M Lazar, Timir K Paul, M Chadi Alraies","doi":"10.1097/HPC.0000000000000396","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000396","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a global health concern associated with an elevated risk of cardiovascular (CV) and all-cause mortality. The ankle-brachial index (ABI), a non-invasive diagnostic tool, is widely recognized for detecting peripheral arterial disease (PAD). This meta-analysis aims to assess whether abnormally low or high ABI values independently predict CV and all-cause mortality in CKD patients, including those on hemodialysis.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted following PRISMA guidelines, using PubMed, Cochrane, and Google Scholar databases through September 2024 to identify studies on abnormal ABI and mortality outcomes in CKD patients with or without hemodialysis. Data was analyzed with random-effects models, and subgroup analyses evaluated variations by patient characteristics, region, sample size, and follow-up duration.</p><p><strong>Results: </strong>The analysis included ten cohort studies comprising 13,378 participants. ABI values between 0.9 and 1.3 were defined as normal. Individuals with abnormally low ABI (<0.9) demonstrated a significantly higher incidence in CV mortality (HR = 2.23; CI: 1.75-2.83) and all-cause mortality (HR = 1.78; CI: 1.55-2.05). Those with high ABI ≥1.3 were associated with a 2.77-fold increase in CV mortality (HR = 2.77; CI: 1.74-4.41) and a 1.49 higher risk of all-cause mortality (HR = 1.49; CI: 1.09-2.02). Overall, abnormal ABI values were linked to a 1.74 higher risk of all-cause mortality (HR = 1.74; CI: 1.54-1.96) and a 2.34-fold increase in CV mortality (HR = 2.34; CI: 1.93-2.85). Subgroup analyses revealed higher mortality risks in hemodialysis patients compared to non-dialysis CKD patients and in studies conducted in Asia.</p><p><strong>Conclusion: </strong>Abnormal ABI values show a U-shaped relationship with mortality, serving as strong predictors of CV and all-cause mortality in CKD patients, particularly those on hemodialysis. Since CV and all-cause mortality is high in CKD patients, these findings suggest that ABI measurement is a useful screening technique to assist prognosticate such patients. Further studies are warranted to validate these findings and to better understand the prognostic utility of ABI across different CKD stages, including both dialysis-dependent and non-dialysis CKD patients.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Readmission Trends and Outcomes of Transcatheter Edge-to-Edge Repair of Mitral Regurgitation With and Without Atrial Fibrillation: A Propensity-Matched National Readmission Analysis.","authors":"Saliha Erdem, Amro Taha, Neel Patel, Anoop Titus, Muhammad Aamir, Yasemin Bahar, Yasar Sattar, Khola Waheed Khan, Waleed Alruwaili, Aneeza Jamshed, Nagib Chalfoun, Islam Y Elgendy, M Chadi Alraies","doi":"10.1097/HPC.0000000000000393","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000393","url":null,"abstract":"<p><strong>Background: </strong>The use of transcatheter edge-to-edge repair (TEER) for symptomatic mitral regurgitation is steadily increasing. However, the outcomes of TEER among patients with atrial fibrillation (AF), including readmission trends, remain unknown.</p><p><strong>Methods: </strong>The Nationwide Readmissions Database was queried between 2016 to 2020 to identify TEER patients with and without AF. The two groups were then compared using propensity score matching (PSM) and multivariate regression models. The outcomes included in-hospital mortality, acute kidney injury (AKI), heart failure, acute stroke, myocardial infarction (MI), post-procedure bleeding (PPB), and cardiac tamponade.</p><p><strong>Results: </strong>A total of 39,867 TEER procedure recipients were included over the study period, of which, 24,729 (62%) had AF compared to 15,138 (38%) with no AF diagnosis. On adjusted analysis, the AF group had a higher rate of inpatient mortality, AKI, heart failure (HF), and post-procedural bleeding (PPB). On the contrary, TEER with AF group had lower odds of MI. The risk of stroke and cardiac tamponade were similar between the two groups. The median length of stay (LOS) at index hospitalization was longer in the AF cohort in comparison with those without (2 days (IQR 5-1) vs 1 day (IQR 3-1)).</p><p><strong>Conclusion: </strong>AF in TEER procedure recipients was associated with worse outcomes including a higher rate of inpatient mortality, AKI, and HF compared to the patients without AF. Readmission rates at 30, 90, and 180 days were similar between the two groups.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Is Intravascular Ultrasound-guided Angiography a Better Choice than Angiography Alone for Patients with Acute Coronary Syndrome and Coronary Artery Disease? Unveiling the Efficacy and Safety of This Modern Imaging Method: A Systematic Review and Meta-Analysis.\"","authors":"Khaled M Harmouch, Mobeen Haider, Mohammad Hamza, Prakash Upreti, Yasemin Bahar, Mustafa Turkmani, Tea Rrapo, Nomesh Kumar, Manoj Kumar, Wasif Safdar, Yasar Sattar, Fnu Zafrullah, Abu Mhafouz, M Chadi Alraies","doi":"10.1097/HPC.0000000000000383","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000383","url":null,"abstract":"<p><strong>Introduction: </strong>Coronary angiography has been an established standard for over six decades for percutaneous coronary interventions (PCI), but its role is limited to assessing vascular lumen and anterograde flow. In the 1980s, intravascular ultrasonography (IVUS) gained traction in interventional cardiology for its advantages over angiography. Despite its precise evaluation of plaque burden and vessel wall structure for optimizing stent implantation, the literature reports varying outcomes on the efficacy and safety of IVUS-guided angiography in patients presenting with acute coronary syndrome (ACS) or coronary artery disease (CAD). To address this discrepancy, we conducted a comprehensive systematic review and meta-analysis to assess the efficacy and safety of utilizing IVUS vs angiography alone for PCI in these groups of patients.</p><p><strong>Methods: </strong>We conducted a comprehensive systematic review and meta-analysis to assess the efficacy and safety of IVUS-guided angiography in these patients. Electronic databases were searched, and 25 studies were included. Inclusion criteria were: 1) patients aged > 18 years, 2) patients with ACS or CAD undergoing IVUS-guided PCI or angiography-guided PCI, and 3) Randomized Clinical Trials (RCTs). Exclusion criteria comprised observational, non-randomized studies, case reports, clinical spotlights, and review articles. Studied outcomes included all-cause mortality, cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), need for coronary artery bypass graft (CABG), and stent thrombosis (ST).</p><p><strong>Results: </strong>Compared to angiography alone, IVUS-guided PCI demonstrated a significant reduction in cardiac death, TLR, and ST regardless of the follow-up period. No significant difference was observed between the two groups concerning all-cause mortality, and MI regardless of the follow-up period, and the need for CABG at one-year follow-up.</p><p><strong>Conclusion: </strong>Compared to angiography-guided PCI, IVUS-guided PCI is associated with a lower incidence of cardiac death, TLR, and ST.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of Atrial Fibrillation in Patients with Myocardial Infarction with Non-obstructive Coronary Arteries.","authors":"Abdul Rasheed Bahar, Yasemin Bahar, Paawanjot Kaur, George Kidess, Mohamad Hasan Jawadi, Mohamed S Alrayyashi, Olayiwola Bolaji, Timir K Paul, M Chadi Alraies","doi":"10.1097/HPC.0000000000000391","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000391","url":null,"abstract":"<p><strong>Background: </strong>Myocardial Infarction with non-obstructive coronary arteries (MINOCA) is defined as myocardial infarction with <50% stenosis of coronary arteries. Atrial fibrillation (AF) is a common arrhythmia that may influence MINOCA outcomes.</p><p><strong>Methods: </strong>We performed a retrospective analysis of the National Inpatient Sample (2016-2021), identifying MINOCA patients with and without AF using ICD-10-CM codes. Multivariable mixed-effects logistic regression and propensity score matching were applied to control for confounders and assess outcomes.</p><p><strong>Results: </strong>Of 94,840 MINOCA patients, 28,270 (30%) had AF. AF was associated with higher in-hospital mortality (3.74% vs. 2.75%, p=0.004), acute heart failure (38.33% vs. 34.97%, p<0.001), sudden cardiac arrest (2.54% vs. 1.73%, p<0.050), and cardiogenic shock (3.11% vs. 1.56%, p<0.001). AF independently predicted in-hospital mortality (adjusted odds ratio; aOR 1.3, 95% CI: 1.07-1.58, p<0.001), heart failure (aOR: 1.48, 95% CI: 1.38-1.59, p<0.001), cardiogenic shock (aOR: 1.85, 95% CI: 1.48-2.30, p<0.001), and acute kidney injury (aOR: 1.15, 95% CI: 1.07-1.24, p<0.001). There were no significant differences in percutaneous coronary intervention, mechanical circulatory support, or defibrillator use (p>0.050).</p><p><strong>Conclusion: </strong>AF in MINOCA is associated with worse in-hospital outcomes, including mortality, heart failure, acute kidney injury, and cardiogenic shock. AF may be a key prognostic marker in this population, warranting further research.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initiating Preventive Care for Hyperlipidemia in the Emergency Department: The EMERALD (Emergency Medicine Cardiovascular Risk Assessment for Lipid Disorders) Trial.","authors":"Nicklaus P Ashburn, Anna C Snavely, Molly R Ehrig, Michael D Shapiro, David M Herrington, David M Reboussin, Sabina B Gesell, Simon A Mahler","doi":"10.1097/HPC.0000000000000390","DOIUrl":"10.1097/HPC.0000000000000390","url":null,"abstract":"<p><strong>Background: </strong>Hyperlipidemia (HLD) is a major contributor to atherosclerotic cardiovascular disease (ASCVD). Nearly 30% of Emergency Department (ED) patients with chest pain have undiagnosed and/or unmanaged HLD, putting them at an increased risk of ASCVD. Although safe and effective HLD treatments exist, the ED traditionally focuses on acute care and does not offer preventive cardiovascular care services. This represents a large, missed opportunity to improve cardiovascular health for the millions of Americans evaluated in the ED each year who are not receiving appropriate preventive care in the outpatient setting. The goals of this study are to determine the efficacy of novel ED-initiated preventive care on lowering cholesterol while also informing our understanding of patient adherence and implementation determinants of ED-initiated preventive cardiovascular care.</p><p><strong>Methods: </strong>We will use a randomized, controlled, parallel group trial of 130 ED patients being evaluated for acute coronary syndrome (ACS) at a single site. Participants will be 40-75 years old with prior ASCVD, known diabetes, or 10-year ASCVD risk ≥7.5% who are not already receiving guideline-directed outpatient preventive care. Patients will be randomized with equal probability to EMERALD (Emergency Medicine Cardiovascular Risk Assessment for Lipid Disorders) or usual care. Patients in the EMERALD arm will be started on a statin and referred for 30-day follow-up with cardiology or primary care, depending on 10-year ASCVD risk level. Usual care arm patients will not be prescribed a statin in the ED and will be asked to follow-up with a primary care provider. The primary outcome will be percent change in low-density lipoprotein cholesterol (LDL-C) at 30-days. Secondary outcomes include percent change in LDL-C at 180-days and non-high-density lipoprotein cholesterol (non-HDL-C) at 30- and 180-days, the proportion of EMERALD patients who pick up their statin, and the proportion of patients who attend 30-day outpatient follow-up. We will also use mixed methods and semi-structured interviews to identify patient adherence facilitators and barriers as well as implementation determinants for Emergency Medicine providers.</p><p><strong>Discussion: </strong>This is the first study to evaluate a novel, protocolized ED-initiated preventive cardiovascular care approach for HLD. If successful, the EMERALD intervention may be able to improve the cardiovascular health for at-risk patients and serve as a use case for other modifiable cardiovascular disease risk factors, such as diabetes, hypertension, tobacco use, and obesity. This single site study will inform a planned multisite trial.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperuricemia and Cardiovascular Risk: Insights and Implications.","authors":"Abdalhakim Shubietah, Ameer Awashra, Fathi Milhem, Mohammad Ghannam, Moath Hattab, Islam Rajab, Haroun Neiroukh, Massa Zahdeh, Ahmad Nouri, Abdalrahman Assaassa, Kiran Nair, Ankit Sahni, Anan Abu Rmilah","doi":"10.1097/HPC.0000000000000388","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000388","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Hyperuricemia, characterized by elevated serum uric acid levels, has been linked to cardiovascular diseases such as hypertension, atrial fibrillation, chronic kidney disease, heart failure, metabolic syndrome, and coronary artery disease. This relationship, however, is complex; while some studies indicate a strong association, others suggest it may be influenced by confounding factors. The rising global prevalence of hyperuricemia underscores the necessity for a deeper understanding of its cardiovascular implications. Hyperuricemia results from an imbalance in uric acid production and excretion, driven by dietary factors, obesity, insulin resistance, and other conditions. Elevated uric acid levels contribute to cardiovascular risk through mechanisms such as inflammation, oxidative stress, endothelial dysfunction, and activation of the renin-angiotensin-aldosterone system. This review highlights the importance of ongoing research to clarify hyperuricemia's role in cardiovascular disease and suggests that urate-lowering therapies, such as xanthine oxidase inhibitors, may confer cardiovascular benefits; however, evidence remains conflicting. The CARES trial indicated an increased risk of cardiovascular and all-cause mortality with febuxostat compared to allopurinol, raising safety concerns. In contrast, the FAST trial demonstrated that febuxostat was non-inferior to allopurinol, with even lower all-cause mortality. These opposing findings emphasize the complexity of treatment decisions and the need for individualized management strategies for hyperuricemia. Clinical decisions should consider individual patient risks and characteristics. Ultimately, this comprehensive analysis aims to enhance prevention and management strategies for cardiovascular diseases related to hyperuricemia. The overview includes discussions on major studies such as the Framingham Heart Study, CARES, FAST, PRIZE, and FREED trials, examining their results. It explores whether hyperuricemia is a causal factor versus an associated risk factor and whether it serves as a marker or mediator of disease. Additionally, the review addresses novel biomarkers and predictive models, the management of hyperuricemia in the context of cardiovascular risk, the role of urate-lowering therapies in cardiovascular disease, variability in guidelines and recommendations, and the impact of hyperuricemia in special populations such as those with diabetes and chronic kidney disease. The cardiovascular risk associated with hyperuricemia across various demographics is also discussed. Furthermore, the review suggests that existing risk scores might be modified to include uric acid levels in patients with hyperuricemia. • Hyperuricemia is linked to cardiovascular diseases through inflammation, oxidative stress, and endothelial dysfunction. • Urate-lowering therapies may offer cardiovascular benefits but require individualized risk assessment. • Cardiovascular risks of hyperuricemia vary by demographi","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Perforation Occurring During Percutaneous Coronary Intervention Is Associated With Persistently High Mortality and Complications.","authors":"Mohammad Reza Movahed, Nishant Satapathy, Mehrtash Hashemzadeh","doi":"10.1097/HPC.0000000000000373","DOIUrl":"10.1097/HPC.0000000000000373","url":null,"abstract":"<p><strong>Introduction: </strong>Coronary perforation is one of the major complications of percutaneous coronary intervention (PCI). The goal of this study was to evaluate adverse outcomes and mortality in patients suffering from coronary perforation during PCI above the age of 30.</p><p><strong>Methods: </strong>The National Inpatient Sample database, years 2016-2020, was studied using International Classification of Diseases, Tenth Revision codes. Patients suffering from perforation were compared with patients without perforation during PCI.</p><p><strong>Results: </strong>PCI was performed in a weighted total of 10,059,269 patients. Coronary perforation occurred in 11,725 (0.12%) of all PCI performed. The mortality rate of patients with perforations was very high in comparison to patients without perforations. (12.9% vs. 2.5%, odds ratio, 5.6; CI, 5-6.3; P < 0.001). Furthermore, patients with coronary perforations had much higher rates of urgent coronary bypass surgery, tamponade, cardiac arrest, and major cardiovascular outcomes. Mortality remained high and over 10% in the 5-year study period.</p><p><strong>Conclusions: </strong>Using a large national inpatient database, all-cause inpatient mortality in patients with coronary perforation is very high (over 10%), with persistently high mortality rates over the years, suggesting that treatment of perforations needs further improvement.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0373"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Single Long Stents Versus Overlapping Stents on Clinical Outcomes in Primary PCI.","authors":"Guilherme Pinheiro Machado, Martin Negreira-Caamaño, Daniel Tébar Márquez, Marcia Moura Schmidt, Alan Pagnoncelli, Gustavo Neves de Araujo, Sandro Cadaval Goncalves, Marco Wainstein, Alexandre Schaan de Quadros, Alfonso Jurado-Román, Rodrigo Wainstein","doi":"10.1097/HPC.0000000000000371","DOIUrl":"10.1097/HPC.0000000000000371","url":null,"abstract":"<p><strong>Background: </strong>Patients with long coronary lesions undergoing primary percutaneous coronary intervention (pPCI) have higher rates of adverse clinical events. Both stent length and stent overlap are associated with worse outcomes; however, data comparing very long stent (VLS) to overlapping stents (OSs) are limited, particularly during pPCI. This study aimed to compare the impact of a single VLS versus ≥2 OSs on clinical outcomes in a multicenter registry of patients undergoing pPCI.</p><p><strong>Methods: </strong>This study included patients with ST-segment elevation myocardial infarction (STEMI) who underwent pPCI using a single VLS (≥38 mm) or ≥2 OS (total stent length, ≥38 mm) in the culprit lesion. After propensity score matching based on tortuosity, calcification, Killip class, culprit lesion length ≥40 mm, and culprit vessel, the final cohort for analysis was selected. The primary endpoint was a combination of mortality and target lesion failure (reinfarction, stent thrombosis, or new revascularization) at 2 years.</p><p><strong>Results: </strong>Among 647 consecutive STEMI patients who underwent pPCI between March 2016 and September 2022, 353 received VLS and 294 received OSs. After propensity score matching, 264 patients remained (132 in each group). The occurrence of the primary outcome (VLS: 12.9 vs. OS: 15.9%; P = 0.86), all-cause mortality (VLS: 7.6 vs. OS: 9.8%; P = 0.51), and target lesion failure (VLS: 8.3 vs. OS: 6.8, P = 0.64) were similar between the 2 groups.</p><p><strong>Conclusions: </strong>In this cohort of real-world patients with STEMI undergoing pPCI, we found no significant difference in outcomes between VLS and OSs. Both strategies are reasonable treatment options for STEMI patients.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0371"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}