American Journal of Cardiology最新文献

{"title":"Comparison of Outcome After Percutaneous Coronary Intervention for De Novo and In-Stent Restenosis Indications","authors":"Lars Jakobsen MD ,&nbsp;Evald H. Christiansen MD ,&nbsp;Phillip Freeman MD ,&nbsp;Johnny Kahlert PhD ,&nbsp;Karsten Veien MD ,&nbsp;Michael Maeng MD ,&nbsp;Julia Ellert MD ,&nbsp;Steen D. Kristensen MD ,&nbsp;Martin K. Christensen MD ,&nbsp;Christian J. Terkelsen MD ,&nbsp;Troels Thim MD ,&nbsp;Jens Flensted Lassen MD ,&nbsp;Mikkel Hougaard MD ,&nbsp;Ashkan Eftekhari MD ,&nbsp;Rebekka V. Jensen MD ,&nbsp;Nicolaj B. Støttrup MD ,&nbsp;Jeppe G. Rasmussen MD ,&nbsp;Anders Junker MD ,&nbsp;Lisette O. Jensen MD","doi":"10.1016/j.amjcard.2024.10.019","DOIUrl":"10.1016/j.amjcard.2024.10.019","url":null,"abstract":"<div><div>In-stent restenosis (ISR) still occurs after percutaneous coronary intervention (PCI). Few studies have compared the outcomes of PCI for de novo stenosis with those of PCI for ISR, and the results are conflicting. The present study aimed to conduct this comparison. Using patient-level data from the randomized all-comer SORT OUT studies III to X, we included all patients with previous PCI and either an ISR or a de novo lesion as the study target lesion. Outcomes of interest were major adverse cardiac events (MACE) and target lesion revascularization (TLR) after 5 years. Of the 2,928 patients with a previous PCI included in the SORT OUT studies, 491 (17%) were treated for ISR and 2,437 (83%) for a de novo stenosis. Baseline characteristics did not differ significantly. At 5 years, MACE occurred in 148 patients (32%) in the ISR group and 654 patients (28%) in the de novo stenosis group (crude and adjusted hazard ratio 1.16 [95% confidence interval (CI) 0.97 to 1.38] and 1.16 [95% CI 0.97 to 1.38]). The risk of TLR was higher in the ISR group compared with the de novo stenosis group (crude and adjusted hazard ratio 1.64 [95% CI 1.24 to 2.17] and 1.71 [95% CI 1.27 to 2.30]). In conclusion, the risk of MACE was similar between PCI for ISR and PCI for de novo lesions after 5 years. However, the risk of TLR was higher in the ISR group compared with the de novo stenosis group.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"235 ","pages":"Pages 1-8"},"PeriodicalIF":2.3,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Diabetes Mellitus on Bifurcation Percutaneous Coronary Intervention: Insights from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions Registry","authors":"Dimitrios Strepkos MD ,&nbsp;Michaella Alexandrou MD ,&nbsp;Deniz Mutlu MD ,&nbsp;Pedro E.P. Carvalho MD ,&nbsp;Oleg Krestyaninov MD ,&nbsp;Dmitrii Khelimskii MD ,&nbsp;Barkin Kultursay MD ,&nbsp;Ali Karagoz MD ,&nbsp;Ufuk Yildirim MD ,&nbsp;Korhan Soylu MD ,&nbsp;Mahmut Uluganyan MD ,&nbsp;Olga Mastrodemos BA ,&nbsp;Bavana V. Rangan BDS, MPH ,&nbsp;Muhammad Hamza Saad Shaukat MD ,&nbsp;Sandeep Jalli DO ,&nbsp;Konstantinos Voudris MD, PhD ,&nbsp;M. Nicholas Burke MD ,&nbsp;Yader Sandoval MD ,&nbsp;Emmanouil S. Brilakis MD, PhD","doi":"10.1016/j.amjcard.2024.10.016","DOIUrl":"10.1016/j.amjcard.2024.10.016","url":null,"abstract":"<div><div>The impact of diabetes mellitus (DM) on the outcomes of bifurcation percutaneous coronary intervention (PCI) has received limited study. We compared the procedural characteristics and outcomes of patients with and without DM in 1,302 bifurcation PCIs (1,147 patients) performed at 5 centers between 2013 and 2024. The prevalence of DM was 33.8% (n = 388). Patients with diabetes were younger and had more cardiovascular risk factors and greater angiographic complexity, including more main vessel calcification and more frequent stenoses in the left main, proximal left anterior descending, and right coronary artery. There was no difference in technical (95.5% vs 94.9%, p = 0.613) or procedural success (90.2% vs 91.3%, p = 0.540); provisional stenting was used less frequently in patients with diabetes (64.5% vs 71.1%, p = 0.015). Patients with diabetes had higher rates of repeat in-hospital PCI and acute kidney injury. Other in-hospital outcomes were similar after adjusting for confounders. During a median follow-up of 1,095 days, diabetes was independently associated with greater incidence of major adverse cardiovascular events (hazard ratio [HR] 2.04, 95% confidence intervals [CI] 1.52 to 2.72, p &lt;0.001), myocardial infarction (HR 1.94, 95% CI 1.05 to 3.25, p = 0.033), death (HR 2.26, 95% CI 1.46 to 3.51, p &lt;0.001), and target (HR 1.6, 95% CI 1.01 to 2.66, p = 0.045) and nontarget (HR 2.00, CI 1.06 to 3.78, p = 0.032) vessel revascularization. Patients with DM who underwent bifurcation PCI had greater risk of in-hospital repeat-PCI and major adverse cardiac events during follow-up than did those without diabetes.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"234 ","pages":"Pages 53-59"},"PeriodicalIF":2.3,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Intravenous Versus Intracoronary Adenosine in Coronary Reactivity Testing","authors":"Fazal Dalal DO ,&nbsp;Yissela Escobedo MD ,&nbsp;Jose Emilio Exaire MD ,&nbsp;Timothy A. Mixon MD ,&nbsp;Karim Al-Azizi MD ,&nbsp;Y. Darren Kumar MD ,&nbsp;Srini Potluri MD ,&nbsp;R. Jay Widmer MD, PhD","doi":"10.1016/j.amjcard.2024.10.011","DOIUrl":"10.1016/j.amjcard.2024.10.011","url":null,"abstract":"<div><div>Coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) obtained through coronary bolus thermodilution are used to assess and treat patients with angina and no obstructive coronary artery disease. Previous studies demonstrate comparable results assessing epicardial ischemia by fractional flow reserve using intravenous (IV) or intracoronary (IC) adenosine. It is unknown if there is a similarity between IC and IV hyperemia with adenosine when performing coronary reactivity testing (CRT). We reviewed CRT data and baseline demographics in a cohort of patients who underwent CRT for ischemia and no obstructive coronary artery disease. We evaluated CFR and IMR in patients whereby maximal hyperemia was obtained by both IC and IV means using linear regression, one-way analysis of variance, Wilcoxon, and Bland-Altman analysis. We assessed 62 patients with a median age of 60.5 years (50 to 67), and 72% were females. The average CFR with IC adenosine was 3.12 (2.31 to 4.06) and 2.71 (2.0 to 3.88) with IV adenosine, with an R² value of 0.50 (p &lt;0.0001)<strong>.</strong> The average IMR with IC adenosine was 28.23 (16.24 to 50.72) and 22.27 (14.79 to 37.0) with IV adenosine, with an R² value of 0.33 (p &lt;0.0001). Average intra-method variability between IC and IV adenosine was nonsignificant (p = 0.31 for CFR and p = 0.55 for IMR). Bland-Altman analysis showed reasonable agreement between IV and IC adenosine for CFR and IMR with slightly higher values using IC adenosine. Therefore, in CRT with bolus thermodilution, CFR and IMR values obtained with IC adenosine correlate well with those obtained with IV adenosine. This presents a potential alternative to IV adenosine for bolus thermodilution CRT.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"234 ","pages":"Pages 9-13"},"PeriodicalIF":2.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptoms of Anxiety and Depression in Patients Who Underwent Transcatheter Aortic Valve Implantation: The SAD-TAVI Study","authors":"Anant D. Butala MD ,&nbsp;Kartik Sehgal MD ,&nbsp;Ellen Gardner RN ,&nbsp;Dion Stub MBBS, PhD ,&nbsp;Sonny Palmer MBBS, DMedSci ,&nbsp;Samer Noaman MBChB, PhD ,&nbsp;Liam Guiney MBBS ,&nbsp;Nay M. Htun MBBS, PhD ,&nbsp;Rozanne Johnston RN ,&nbsp;Antony S. Walton MBBS ,&nbsp;Shane Nanayakkara MBBS, PhD","doi":"10.1016/j.amjcard.2024.10.007","DOIUrl":"10.1016/j.amjcard.2024.10.007","url":null,"abstract":"<div><div>Symptoms of anxiety and/or depression (SAD) commonly co-exist in severe aortic stenosis. In patients who underwent transcatheter aortic valve implantation (TAVI), these symptoms are associated with increased morbidity and mortality. Despite this, mental health remains under-researched in the TAVI literature. Drawing from the largest registry in Australia, we aimed to characterize the prevalence of SAD in TAVI patients. We also aimed to identify patient phenotypes at the highest risk of these symptoms, examine how they evolve after TAVI, and establish factors predictive of improvement and regression in mental health. A total of 1,279 patients who underwent TAVI between 2018 and 2023 included in a multi-center Australian registry were analyzed. The median age was 82 years (interquartile range 77 to 87), 41% were females, and the median Society of Thoracic Surgeons score was 3.9 (2.3 to 5.9). In addition, 353 patients (28%) reported moderate or worse SAD at baseline. Of this group, 260 (74%) had complete resolution in symptoms within 30 days. Body mass index &lt;25 kg/m² (adjusted odds ratio [aOR] 3.4, p &lt;0.001), vascular site complications (aOR 3.4, p = 0.029), and nonhome discharge (aOR 2.4, p = 0.036) independently predicted the persistence of SAD. Only 72 patients (8%) developed new-onset SAD at 30 days after TAVI. Nonhome discharge (aOR 2.12, p = 0.025) and a composite cardiovascular end point, including stroke, acute myocardial infarction, and heart failure readmission (aOR 2.55, p = 0.028), were independent predictors of new-onset SAD. In conclusion, SAD are common but under-recognized in aortic stenosis. TAVI is highly effective at improving these symptoms, and regular screening for mental health should be considered in the management of all TAVI patients.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"235 ","pages":"Pages 76-84"},"PeriodicalIF":2.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of Post Coronary Artery Bypass Grafting Atrial Fibrillation Patterns: Rationale and Design of an Investigator-Initiated Observational Study","authors":"Florian E.M. Herrmann MD ,&nbsp;Anders Jeppsson MD, PhD ,&nbsp;Efstratios I. Charitos MD, PhD ,&nbsp;Dana Dacian ,&nbsp;Jürgen Brömsen MD ,&nbsp;Sebastian Sadoni MD ,&nbsp;Hristo Kirov MD ,&nbsp;Torsten Doenst MD, PhD ,&nbsp;Gerd Juchem MD ,&nbsp;Christian Hagl MD","doi":"10.1016/j.amjcard.2024.10.017","DOIUrl":"10.1016/j.amjcard.2024.10.017","url":null,"abstract":"<div><div>New-onset postoperative atrial fibrillation (POAF) after cardiac surgery is associated with increased rates of adverse events (including mortality and stroke). Its incidence after coronary artery bypass grafting (CABG) is considered to be approximately 30%, and it is believed to be a transient condition. However, studies investigating POAF after CABG fail to provide appropriate data on incidence and arrhythmia patterns due to the use of intermittent rhythm detection strategies. These methods have a low sensitivity as compared with continuous monitoring. Subsequently, studies using these techniques most likely do not identify all patients with arrhythmia and do not adequately demonstrate the long-term incidence of arrhythmia, which in turn may affect its association with adverse events. The Characterization of Post Coronary Artery Bypass Grafting Atrial Fibrillation Patterns (CABG-AF) study (German Clinical Trials Register Number: DRKS00018887) tests the hypothesis that the incidence of AF in the first 12 months after CABG is significantly underestimated. CABG-AF is an investigator-initiated multicenter, prospective, observational study in which 196 patients with no history of arrhythmia who underwent first-time CABG receive an insertable cardiac monitor for continuous postoperative rhythm monitoring. The primary end point of the study is any episode of AF within the first 12 months after surgery. Secondary end points include AF burden, AF density, and the ratio of silent to symptomatic AF episodes. End points will be investigated by automatic and patient-initiated data transfers from the implanted device, by telephone interview of patients, and by follow-up forms sent to patients by mail. The patients will be followed for a planned follow-up of 3 years. In conclusion, the CABG-AF study will provide information on the true incidence of AF after CABG and on the temporal patterns of the arrhythmia.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"234 ","pages":"Pages 47-52"},"PeriodicalIF":2.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Costs for Cardiovascular-Related Hospitalizations and Inpatient Procedures in the United States, 2016 to 2021","authors":"Amier Haidar MD, MPH ,&nbsp;Aryan Gajjar BS ,&nbsp;Rushi V. Parikh MD ,&nbsp;Peyman Benharash MD ,&nbsp;Gregg C. Fonarow MD ,&nbsp;Karol Watson MD, PhD ,&nbsp;Jack Needleman PhD ,&nbsp;Boback Ziaeian MD, PhD","doi":"10.1016/j.amjcard.2024.10.003","DOIUrl":"10.1016/j.amjcard.2024.10.003","url":null,"abstract":"<div><div>The current economic burden of cardiovascular (CV)-related hospitalizations grouped by diagnoses and procedures in the United States has not been well characterized. The objective was to identify current trends in CV-related hospitalizations, procedural utilization, and health care costs using the most recent 6 years of hospitalization data. A retrospective analysis of discharge data from the National Inpatient Sample database was conducted to determine trends in CV-related hospitalizations, costs, and procedures for each year from 2016 to the most recent available dataset, 2021. Total CV-related costs were adjusted to and reported in 2023 dollars. In 2021, there were 4,687,370 CV-related hospitalizations at a cost of $108 billion. Heart failure hospitalizations accounted for the highest costs at $18.5 billion, followed by non-ST-elevation myocardial infarction at $11.2 billion and stroke at $10.9 billion. Significant upward trends in costs from 2016 to 2021 were observed for heart failure, stroke, atrial fibrillation, ST-elevation myocardial infarction, chest pain, hypertensive emergency, ventricular tachycardia, aortic dissection, sudden cardiac death, pericarditis, supraventricular tachycardia, and pulmonary heart disease. Over the 6 observational years, total costs increased by over $10 billion, representing a 10% increase. However, the increases were not linear, as there was a significant increase of 6.5% from 2018 to 2019, then a decrease of over 7% from 2019 to 2020, followed by an increase of approximately 6% from 2020 to 2021. By 2030, total CV-related costs are projected to reach $131.3 billion. For all years, coronary procedures were the most performed, followed by extracorporeal membrane oxygenation, non-bypass peripheral vascular surgery, pacemaker placement, and coronary artery bypass graft surgery. Both transcatheter aortic valve replacement and MitraClip procedures demonstrated significant upward trends from 2016 to 2021. Overall, from the years 2016 to 2021, CV-related hospitalizations, costs, and procedures demonstrated upward trends. In conclusion, CV disease remains a high burden in the hospital setting with tremendous health care costs.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"234 ","pages":"Pages 63-70"},"PeriodicalIF":2.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Genetic Variants Linked to Susceptibility to Mechanical Prosthetic Valve Thrombosis","authors":"Semih Kalkan MD ,&nbsp;M. Ozan Gürsoy MD ,&nbsp;Ahmet Güner MD ,&nbsp;Semra Gürsoy MD ,&nbsp;Macit Kalçık MD ,&nbsp;Bilge Bilgen Geçkinli MD ,&nbsp;Kenan Delil MD ,&nbsp;Esra Arslan Ateş MD ,&nbsp;Eylem Gokmeydan Erdogan MD ,&nbsp;Sezin Canbek MD ,&nbsp;Emrah Bayam MD ,&nbsp;A. Çağrı Aykan MD ,&nbsp;Mehmet Aytürk MD ,&nbsp;Sabahattin Gündüz MD ,&nbsp;Mehmet Özkan MD","doi":"10.1016/j.amjcard.2024.10.014","DOIUrl":"10.1016/j.amjcard.2024.10.014","url":null,"abstract":"<div><div>Prosthetic valve thrombosis (PVT) is a critical and life-threatening condition driven by multifactorial etiologies, including genetic predispositions. The study was designed as a single-center retrospective manner. Echocardiographic features and genetic test including factor II/prothrombin (G20210A), factor V Leiden (G1691A), factor V R2 (A4070G), apolipoprotein (Apo) B-100 (G10708A), ApoE (C112R), ApoE (R158C), methylenetetrahydrofolate reductase (MTHFR) C677T, MTHFR A1298C, factor XIII G103T (V34L), β-fibrinogen (455G&gt;A), PAI-1 4G/5G, and HPA-1 GPIIIa (T196C) genotyping variations were assessed. We performed genetic tests on 175 patients with PVT (biologically women [n = 124, 70.9%], with a mean age of 49.8 ± 13.1 years) and 101 patients (biologically women [n = 57, 56.4%], with a mean age of 54.7 ± 13.6 years) without thrombus formation. The thrombosis group was significantly younger compared with controls (p = 0.004). The percentage of patients with mechanical aortic valves was significantly lower in the thrombosis group compared with controls (22.3% vs 34.7%, p = 0.025). A significant difference was observed between the thrombosis and control groups regarding the genotype ratios of factor II/prothrombin (G20210A) (heterozygous, 6.8% vs 1%, p = 0.043) and HPA-1 GPIIIa (T196C) (homozygous mutant, 7.8% vs 0%, p = 0.034). In addition, there was a significant association of heterozygous MTHFR (A1298C) variation with obstructive thrombosis compared with nonobstructive thrombosis (46.9% vs 29.2%, p = 0.046). In conclusion, this is the first study to report a potential association between genetic variants, including HPA-1 GPIIIa (T196C), factor II/prothrombin (G20210A), MTHFR (A1298C), and PVT, necessitating extensive further research and additional clinical consideration.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"234 ","pages":"Pages 22-29"},"PeriodicalIF":2.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Early Experience Using a Hybrid Graft for Aortic Arch Dissection","authors":"Emily Shih MD ,&nbsp;John B. Eisenga MD ,&nbsp;Kyle A. McCullough MD ,&nbsp;J. Michael DiMaio MD ,&nbsp;Charles S. Roberts MD","doi":"10.1016/j.amjcard.2024.10.013","DOIUrl":"10.1016/j.amjcard.2024.10.013","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"233 ","pages":"Pages 96-100"},"PeriodicalIF":2.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes After Percutaneous Coronary Intervention for Left Main Coronary Artery Disease in Patients of Diverse Race/Ethnicity","authors":"Pier Pasquale Leone MD, MSc ,&nbsp;Samantha Sartori PhD ,&nbsp;Jonathan Murphy MD ,&nbsp;Kenneth Smith MPH ,&nbsp;Angelo Oliva MD ,&nbsp;Mauro Gitto MD ,&nbsp;Benjamin Bay MD ,&nbsp;Anastasios Roumeliotis MD ,&nbsp;Birgit Vogel MD ,&nbsp;David Power MD ,&nbsp;Anton Camaj MD, MS ,&nbsp;Francesca Maria Di Muro MD ,&nbsp;Annapoorna Kini MD ,&nbsp;Samin Sharma MD ,&nbsp;Roxana Mehran MD ,&nbsp;George Dangas MD","doi":"10.1016/j.amjcard.2024.10.002","DOIUrl":"10.1016/j.amjcard.2024.10.002","url":null,"abstract":"<div><div>Data on percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) disease in patients of diverse race/ethnicity are scant. This study aimed to assess the impact of race/ethnicity on clinical outcomes at 12-month follow-up of patients with LMCA disease who underwent PCI with drug-eluting stent implantation. All patients who underwent PCI for LMCA disease between 2010 and 2019 at a tertiary care center were prospectively enrolled. Clinical outcomes were assessed per each race/ethnic group. The primary end point was the composite of all-cause death, myocardial infarction, or stroke at 12 months. A total of 774 consecutive patients with known race/ethnicity were prospectively enrolled (62.1% [n = 481] Caucasian, 17.2% [n = 133] Hispanic, 12.7% [n = 98] Asian, and 8.0% [n = 62] African-American). Compared with Caucasians, the hazard rate of the primary end point tended to be lower in Asian patients (6.1% vs 14.2%; hazard ratio [HR] 0.41, 95% confidence interval [CI] 0.16 to 1.03) and similar in African-American (13.7% vs 14.2%; HR 0.93, 95% CI 0.40 to 2.16) and Hispanic patients (14.2% vs 14.2%; HR 1.02, 95% CI 0.58 to 1.78). Hazard rates of target vessel or lesion revascularization were comparable among the 4 groups. Cox multivariable regression adjustment confirmed consistent findings and revealed higher hazard rates of postdischarge bleeding in African-Americans compared with Caucasians (HR 5.89, 95% CI 1.00 to 34.5). In conclusion, within a racially/ethnically diverse cohort of patients who underwent PCI for LMCA disease, when compared with Caucasians, Asians had lower risk of all-cause death, myocardial infarction, or stroke, whereas African-Americans had increased risk of postdischarge bleeding.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"234 ","pages":"Pages 90-98"},"PeriodicalIF":2.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes Following Arteriovenous Fistula Creation in Medicare Beneficiaries With End-Stage Kidney Disease","authors":"Nathan W. Kong MD ,&nbsp;Joseph M. Kim MD ,&nbsp;Anna K. Krawisz MD ,&nbsp;Patrick Heindel MD, MPH ,&nbsp;Archana Tale MPH ,&nbsp;Yang Song MSc ,&nbsp;Jeffrey L. Weinstein MD ,&nbsp;Mohamad A. Hussain MD, PhD ,&nbsp;Eric A. Secemsky MD, MSc","doi":"10.1016/j.amjcard.2024.10.006","DOIUrl":"10.1016/j.amjcard.2024.10.006","url":null,"abstract":"<div><div>The objective of this study was to measure the contemporary patency rates and frequency of interventions required for arteriovenous fistula (AVF) care in a representative US population of patients with end-stage kidney disease, including by age, race, and gender. All Medicare beneficiaries aged &gt;20 years who underwent AVF graft creation for end-stage kidney disease between 2017 and 2019 were included for analysis. The primary end points included primary patency, primary assisted patency, postintervention patency, and fistula functionality up to 1 year after AVF placement. The secondary end point included admission for an associated adverse event after AVF creation. Multivariate analysis of patency rates was also assessed. Of 43,457 patients included in the analysis, the cumulative primary patency at 90 days was 68.4% and at 1 year, 31.5%. At 1 year, the primary assisted patency rate, postintervention patency, and fistula use were 70.4%, 30.2%, and 59.1%, respectively. There was no difference in primary patency rates when comparing age groups (age 40 to 59 years: hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.95 to 1.06, p = 0.84 or age ≥60 years: HR 0.99, 95% CI 0.93 to 1.04, p = 0.61) with the reference of age group 20 to 39 years. Women were at greater risk of experiencing primary patency failure than were men (HR 1.16, 95% CI 1.14 to 1.20, p &lt;0.001), and Black patients were at greater risk of experiencing primary patency failure than were White patients (HR 1.34, 95% CI 1.31 to 1.38, p &lt;0.001). The cumulative incidence of admissions for adverse events was 32.6% at 1 year. In conclusion, our findings suggest that the real-world AVF patency rates remain low, with disproportionately low rates in women and Black patients.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"234 ","pages":"Pages 79-86"},"PeriodicalIF":2.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}