Faculty Bibliography

IMPORTANCE/UNASSIGNED:Previous data suggest that the time changes associated with daylight savings time (DST) may be associated with an increased incidence of acute myocardial infarction (AMI). OBJECTIVE/UNASSIGNED:To determine whether the incidence of patients presenting with AMI is greater during the weeks during or after DST and compare the in-hospital clinical events between the week before DST and after DST. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional study examined patients enrolled in the Chest Pain MI Registry from 2013 to 2022. The study included patients who presented 1 week before DST, during the week of DST, or 1 week after DST (spring or fall) and assessed incidence of AMI, in-hospital mortality, stroke, and clinical outcomes during those times and compared the DST weeks with the week before or after. Data were analyzed from March 2024 to May 2025. MAIN OUTCOME AND MEASURE/UNASSIGNED:The main outcome was in-hospital mortality rate. The incidence ratio (IR) of AMI cases was calculated using the observed number of patients with AMI in the DST week divided by the number of patients with AMI who arrived 1 week before or after DST. RESULTS/UNASSIGNED:The final cohort included 168 870 patients (median [IQR] age, 65 [56-75] years, 57 023 females [33.8%]; 111 847 males [66.2%]) at 1124 hospitals during the study period. There were 28 678 patients (17.0%) with AMI treated during spring DST, 28 596 (16.9%) the week before, and 28 169 (16.7%) the week after. There were 27 942 patients (16.5%) with AMI treated during fall DST, 27 365 (16.2%) the week before, and 28 120 (16.7%) the week after. Patient characteristics were similar for the spring and fall DST analyses (spring and fall DST median [IQR] age across groups: 65 [56-74] years and 65 [56-75] years, respectively), and there were 28 725 females (33.6%) in the spring and 28 298 females (33.9%) in the fall. There was no significant difference in the incidence of AMI for the following time periods: spring DST week vs 1 week prior, spring DST week vs 1 week after, fall DST week vs 1 week prior, and fall DST week vs 1 week after. There were no significant differences in adjusted in-hospital outcomes for the 1 week before or after fall or spring DST. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This study found no significant difference in the incidence rates of AMI in DST weeks compared with the week before or after. Additionally, there were no differences in in-hospital clinical outcomes.

BACKGROUND/UNASSIGNED:Studies suggest percutaneous coronary intervention (PCI) guided by intracoronary imaging (ICI) results in larger balloon/stent diameters and longer stents. Whether this occurs in real-world PCI is poorly understood. METHODS/UNASSIGNED:De novo PCIs performed at 48 nonfederal Michigan hospitals between July 2019 and June 2022 were evaluated with regression modeling to evaluate associations between ICI-guided PCI and balloon/stent dimensions. The association between ICI-guided PCI and coronary dissection/perforation was assessed using adjusted odds ratios. RESULTS/UNASSIGNED:=0.33 for trend, respectively). CONCLUSIONS/UNASSIGNED:In real-world practice, ICI-guided PCI was associated with larger stent/balloon diameters and longer stents. While ICI use was associated with dissections and perforations, there was no significant increase in the rate of these complications despite significant increases in ICI use and stent/balloon sizes during the study period. Further research is needed to evaluate the association between ICI use and procedural complications.

IMPORTANCE/UNASSIGNED:Both myocardial infarction (MI) and anemia have deleterious effects on health-related quality of life (QOL). Red blood cell (RBC) transfusion may improve QOL after MI by relieving symptoms and/or increasing functional capacity. OBJECTIVE/UNASSIGNED:To evaluate whether a liberal transfusion strategy compared with a more restrictive transfusion strategy affects QOL in patients with MI and anemia. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This analysis of QOL as a prespecified secondary outcome of the Myocardial Ischemia and Transfusion (MINT) trial, a randomized clinical trial comparing a liberal vs restrictive RBC transfusion strategy, included participants from 144 sites across 6 countries. Hospitalized adults with acute MI and anemia (hemoglobin [Hb] less than 10 g/dL). The MINT trial randomized 3504 patients, and this analysis included those who had QOL data collected and those who died before the 30-day follow-up period. Data were collected from April 2017 to April 2023, and data were analyzed from February 2024 to January 2025. INTERVENTIONS/UNASSIGNED:The MINT trial randomized patients to a restrictive (Hb of 7 to 8 g/dL) or a liberal (Hb of less than 10 g/dL) RBC transfusion strategy. MAIN OUTCOMES AND MEASURES/UNASSIGNED:QOL was measured using the EQ-5D-5L 30 days after randomization. RESULTS/UNASSIGNED:Of 2844 included patients, 1551 (54.5%) were male, and the mean (SD) age was 71.9 (11.5) years. A total of 2525 (88.8%; 1254 [49.7%] in the restrictive group and 1271 [50.3%] in the liberal group) had QOL data, and 319 (11.2%) died before 30-day follow-up. Overall, there were no differences in mean or median scores for any EQ-5D-5L QOL outcome between assigned transfusion strategies at 30 days postrandomization. Although a higher percentage of patients in the liberal compared with the restrictive transfusion group reported no problems compared with any problem in usual activities (506 of 1268 [39.9%] vs 473 of 1247 [37.9%]), mobility (474 of 1270 [37.3%] vs 460 of 1254 [36.7%]), and self-care (858 of 1271 [67.5%] vs 803 of 1254 [64.0%]) domains, none of these differences were statistically significant. Adjusted mixed-effects linear regressions showed no association between assigned transfusion strategy and mean differences in any QOL outcome. Adjusted regressions in several prespecified subgroups showed an association between a liberal transfusion strategy and better QOL scores in domains related to functional capacity, but the effects were only statistically significant in patients with a history of heart failure (Health Today rating: β, 2.06 [95% CI, -0.23 to 4.35] vs -1.44 [95% CI, -3.81 to 0.92]; P = .04). CONCLUSIONS AND RELEVANCE/UNASSIGNED:This secondary analysis of the MINT trial found that in patients with MI and anemia, a liberal transfusion strategy compared with a restrictive transfusion strategy did not affect QOL outcomes 30 days after randomization. This suggests that higher Hb levels maintained with RBC transfusion may not offer significant benefits to QOL overall in patients with MI and anemia. Additional studies may be useful for further examining and validating transfusion's effect on QOL in patients with MI and heart failure. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT02981407.

BACKGROUND AND AIMS/OBJECTIVE:Radial access site for percutaneous coronary intervention (PCI) is recommended by clinical practice guidelines because of superior outcomes compared with femoral access site. Historically, the adoption of radial access site in the USA has lagged behind much of the rest of the world, but contemporary data on access site selection across the spectrum of clinical presentations and its association with outcomes are lacking. METHODS:A retrospective cohort study from the National Cardiovascular Data Registry's CathPCI Registry was conducted including PCIs performed between 1 January 2013 and 30 June 2022. The comparative safety of radial vs femoral access site for PCI was evaluated with instrumental variable analysis, a technique that can be used to support causal inference, exploiting operator variation in access site preferences as the instrumental variable. RESULTS:Overall, 6 658 479 PCI procedures were performed during the study period, of which 40.4% (n = 2 690 355) were performed via radial access site, increasing from 20.3% in 2013 to 57.5% in 2022. This increase was seen in all geographic regions and across the full spectrum of presentations, with the largest relative increase seen in patients with ST-elevation myocardial infarction. Overall, 2 420 805 PCIs met inclusion criteria for the comparative safety analysis. In instrumental variable analyses, radial access site was associated with lower in-hospital mortality [absolute risk difference (ARD) -.15%, 95% confidence interval (CI) -.20 to -.10], major access site bleeding (ARD -.64%, 95% CI -.68 to -.60), and other major vascular complications (ARD -.21%, 95% CI -.23 to -.18) but a higher risk of ischaemic stroke (ARD .05%, 95% CI .03-.08). There was no association with the falsification endpoint of gastrointestinal or genitourinary bleeding (ARD .00%, 95% CI -.03-.03). CONCLUSIONS:Over the past decade, use of radial access site for PCI has increased 2.8-fold in the USA and now represents the dominant form of access site across all procedural indications. Based on instrumental variable analyses, PCI with radial access site had lower rates of in-hospital mortality, major access site bleeding, and other major vascular complications compared with femoral access site but a slightly higher risk of ischaemic stroke in contemporary practice.

[This corrects the article DOI: 10.1016/j.jscai.2024.102397.].

BACKGROUND/UNASSIGNED:Injection of contrast media for rapid measurement of contrast fractional flow reserve (cFFR) obviates the side effects and time requirements of adenosine fractional flow reserve (aFFR) and improves diagnostic performance relative to nonhyperemic pressure ratios. However, studies of cFFR have had variable delivery of contrast. We evaluated the diagnostic performance of cFFR using an automated contrast injector with a standardized volume and rate of delivery of contrast to the reference standard aFFR. METHODS/UNASSIGNED:) and RXi/Navvus FFR microcatheter. The diagnostic performance of cFFR was assessed using a 0.83 cutoff value based on published literature. Optimal cFFR cutoffs were also determined and illustrated using Bland-Altman analysis. RESULTS/UNASSIGNED:A total of 192 lesions from 178 patients were included in the per-protocol analysis (69 with an aFFR ≤0.80 and 109 with an aFFR >0.80). Using a cFFR cutoff value of ≤0.83, the accuracy, sensitivity, and specificity of cFFR were 0.89 (95% CI, 0.83-0.93), 0.70 (95% CI, 0.58-0.81), and 0.99 (95% CI, 0.95-1.00), respectively. The mean difference between cFFR and aFFR was 0.05 (-0.04 to 0.13). A cFFR threshold of ≤0.85 had the highest accuracy in predicting aFFR ≤0.80 with accuracy, sensitivity, and specificity equaling 0.90 (95% CI, 0.84-0.94), 0.87 (95% CI, 0.77-0.94), and 0.91 (95% CI, 0.84-0.95), respectively. CONCLUSIONS/UNASSIGNED:cFFR utilizing standardized parameters for contrast delivery leads to clinically acceptable levels of diagnostic performance compared with traditional aFFR to identify physiologically significant intermediate lesions. Future data evaluating the impact on clinical outcomes of cFFR-guided percutaneous coronary intervention are warranted. REGISTRATION/UNASSIGNED:URL: https://www.clinicaltrials.gov; Unique identifier: NCT03557385.

BACKGROUND:Patients undergoing atrial fibrillation (AF) ablation have historically been hospitalized overnight or longer postprocedure. National rates of same-day discharge (SDD) following AF ablation remain unknown. METHODS AND RESULTS/RESULTS:<0.0001), surpassing overnight hospitalization in Q1 of 2021. The likelihood of SDD increased significantly over time (odds ratio [OR], 1.26 per quarter-year [95% CI, 1.26-1.26]) with substantial variation across hospitals (median OR, 4.12 [95% CI, 3.48-4.79]). Those discharged the same day were less likely of Black race (OR, 0.71 [95% CI, 0.65-0.78]) and to have persistent AF (OR, 0.85 [95% CI, 0.82-0.88]) and cardiomyopathy (OR, 0.87 [95% CI, 0.84-0.91]). In total, major and overall complication rates were 0.70% and 2.13%, respectively. Major and overall complication rates were 0.03% and 0.19% for SDD and 0.24% and 0.98%, respectively, for overnight hospitalization. CONCLUSIONS:Rates of SDD following AF ablation markedly increased over time, corresponding with onset of the COVID-19 pandemic, with substantial hospital variation. SDD patients had fewer comorbid conditions and were less likely to have persistent AF. Postprocedural complication rates with SDD were low and comparable with patients hospitalized overnight.