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Intracardiac Versus Transesophageal Echocardiography Guided Percutaneous Debulking of Tricuspid Endocarditis

Zhang, Robert S; Bailey, Eric; Maqsood, Muhammad H; Harari, Rafael; Bernard, Samuel; Xia, Yuhe; Keller, Norma; Alviar, Carlos L; Bangalore, Sripal
PMID: 38401653
ISSN: 1879-1913
CID: 5634712

Catheter-based therapy for intermediate or high-risk pulmonary embolism is associated with lower in-hospital mortality in patients with cancer: Insights from the National Inpatient Sample

Leiva, Orly; Yuriditsky, Eugene; Postelnicu, Radu; Yang, Eric H; Mukherjee, Vikramjit; Greco, Allison; Horowitz, James; Alviar, Carlos; Bangalore, Sripal
BACKGROUND:Pulmonary embolism (PE) is a common complication among patients with cancer and is a significant contributor to morbidity and mortality. Catheter-based therapies (CBT), including catheter-directed thrombolysis (CDT) and mechanical thrombectomy, have been developed and are used in patients with intermediate or high-risk PE. However, there is a paucity of data on outcomes in patients with cancer as most clinical studies exclude this group of patients. AIMS/OBJECTIVE:To characterize outcomes of patients with cancer admitted with intermediate or high-risk PE treated with CBT compared with no CBT. METHODS:Patients with an admission diagnosis of intermediate or high-risk PE and a history of cancer from October 2015 to December 2018 were identified using the National Inpatient Sample. Outcomes of interest were in-hospital death or cardiac arrest (CA) and major bleeding. Inverse probability treatment weighting (IPTW) was utilized to compare outcomes between patients treated with and without CBT. Variables that remained unbalanced after IPTW were adjusted using multivariable logistic regression. RESULTS:A total of 2084 unweighted admissions (10,420 weighted) for intermediate or high-risk PE and cancer were included, of which 136 (6.5%) were treated with CBT. After IPTW, CBT was associated with lower death or CA (aOR 0.54, 95% CI 0.46-0.64) but higher major bleeding (aOR 1.41, 95% CI 1.21-1.65). After stratifying by PE risk type, patients treated with CBT had lower risk of death or CA in both intermediate (aOR 0.52, 95% CI 0.36-0.75) and high-risk PE (aOR 0.48, 95% CI 0.33-0.53). However, patients with CBT were associated with increased risk of major bleeding in intermediate-risk PE (aOR 2.12, 95% CI 1.67-2.69) but not in those with high-risk PE (aOR 0.84, 95% CI 0.66-1.07). CONCLUSIONS:Among patients with cancer hospitalized with intermediate or high-risk PE, treatment with CBT was associated with lower risk of in-hospital death or CA but higher risk of bleeding. Prospective studies and inclusion of patients with cancer in randomized trials are warranted to confirm our findings.
PMID: 37997287
ISSN: 1522-726x
CID: 5608872

Body Mass Index and Clinical and Health Status Outcomes in Chronic Coronary Disease and Advanced Kidney Disease in the ISCHEMIA-CKD Trial

Mathew, Roy O; Kretov, Evgeny I; Huang, Zhen; Jones, Philip G; Sidhu, Mandeep S; O'Brien, Sean M; Prokhorikhin, Aleksei A; Rangaswami, Janani; Newman, Jonathan; Stone, Gregg W; Fleg, Jerome L; Spertus, John A; Maron, David J; Hochman, Judith S; Bangalore, Sripal; ,
OBJECTIVE:This study aimed to assess whether an obesity paradox (lower event rates with higher body mass index [BMI]) exists in participants with advanced chronic kidney disease (CKD) and chronic coronary disease in the International Study of Comparative Health Effectiveness of Medical and Invasive Approaches (ISCHEMIA)-CKD, and whether BMI modified the effect of initial treatment strategy. METHODS:). Associations between BMI and the primary outcome of all-cause death or myocardial infarction (D/MI), and all-cause death, cardiovascular death, and MI individually were estimated. Associations with health status were also evaluated using the Seattle Angina Questionnaire-7, the Rose Dyspnea Scale, and the EuroQol-5D Visual Analog Scale. RESULTS:was marginally associated with D/MI (HR 1.43 [1.00-2.04]) and greater dyspnea throughout follow-up (P < .05 at all time points). Heterogeneity of treatment effect between baseline BMI was not evident for any outcome. CONCLUSIONS:In the ISCHEMIA-CKD trial, an obesity paradox was not detected. Higher BMI was associated with worse dyspnea, and a trend toward increased D/MI and MI risk. Larger studies to validate these findings are warranted.
PMID: 37925061
ISSN: 1555-7162
CID: 5607182

Cardiovascular and Venous Thromboembolic Risk With JAK Inhibitors in Immune-Mediated Inflammatory Skin Diseases: A Systematic Review and Meta-Analysis

Ingrassia, Jenne P; Maqsood, Muhammad Haisum; Gelfand, Joel M; Weber, Brittany N; Bangalore, Sripal; Lo Sicco, Kristen I; Garshick, Michael S
IMPORTANCE/UNASSIGNED:Janus kinase (JAK) inhibitors are an effective treatment option for patients with certain skin-related conditions, such as atopic dermatitis, alopecia areata, and vitiligo, but there is a current US Food and Drug Administration (FDA) boxed warning label for oral and topical JAK inhibitors regarding increased risk of major adverse cardiovascular events (MACE), venous thromboembolism (VTE), serious infections, malignant neoplasm, and death. However, this boxed warning was precipitated by results of the Oral Rheumatoid Arthritis Trial (ORAL) Surveillance study, which only included patients with rheumatoid arthritis, and the same association may not be observed in dermatologic conditions. OBJECTIVE/UNASSIGNED:To determine the risk of all-cause mortality, MACE, and VTE with JAK inhibitors in patients with dermatologic conditions. DATA SOURCES/UNASSIGNED:PubMed and were searched from database inception to April 1, 2023. STUDY SELECTION/UNASSIGNED:This review included phase 3 randomized clinical trials with a placebo/active comparator group of JAK inhibitors used for a dermatologic indication with FDA approval or pending approval or with European Union or Japanese approval. Studies without a comparison group, case reports, observational studies, and review articles were excluded. DATA EXTRACTION AND SYNTHESIS/UNASSIGNED:This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Adverse events using odds ratios (ORs) and 95% CIs were calculated using a random-effects model and the DerSimonian-Laird method. Studies were screened, data abstracted, and quality assessed by 2 independent authors. The protocol was prospectively registered with PROSPERO. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Primary outcomes were a composite of adjudicated MACE and all-cause mortality, and VTE. RESULTS/UNASSIGNED:The analysis included 35 randomized clinical trials with 20 651 patients (mean [SD] age, 38.5 [10.1] years; male, 54%) and a mean (SD) follow-up time of 4.9 (2.68) months. Findings did not show a significant difference between JAK inhibitors and placebo/active comparator in composite MACE and all-cause mortality (OR, 0.83; 95% CI, 0.44-1.57) or VTE (OR, 0.52; 95% CI, 0.26-1.04). CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this systematic review and meta-analysis, use of JAK inhibitors was not associated with increased risk of all-cause mortality, MACE, and VTE compared to the placebo/active comparator groups. Additional trials with long-term follow-up are needed to better understand the safety risks of JAK inhibitors used for dermatologic indications.
PMID: 37910098
ISSN: 2168-6084
CID: 5626452

Intravascular Ultrasound Optimization Criteria for Left Main Coronary Artery Stenting: In Pursuit of the Magic Numbers! [Editorial]

Bangalore, Sripal; Maehara, Akiko
PMID: 38227696
ISSN: 1941-7632
CID: 5626642

Quality and rapidity of anticoagulation in patients with acute pulmonary embolism undergoing mechanical thrombectomy

Zhang, Robert S; Ho, Alvin M; Elbaum, Lindsay; Greco, Allison A; Hall, Sylvie; Postelnicu, Radu; Mukherjee, Vikramjit; Maqsood, Muhammad H; Keller, Norma; Alviar, Carlos L; Bangalore, Sripal
The primary objective of our study was to determine the proportion of intermediate-risk PE patients undergoing mechanical thrombectomy (MT) who achieved therapeutic anticoagulation (AC) at the time of the procedure. The salient findings of our study showed that only a minority of patients (14.3%) were in the therapeutic range by ACT at the time of MT (primary outcome). Furthermore, in this higher-risk PE cohort selected for MT, 18.2% of patients were subtherapeutic after initially reaching therapeutic AC, 43% experienced supratherapeutic AC at some point before MT, and less than half (43%) attained therapeutic AC at 6 hours, highlighting the necessity for optimizing anticoagulation practices in acute PE.
PMID: 38071002
ISSN: 1097-6744
CID: 5589832

Validating the Composite Pulmonary Embolism Shock Score for Predicting Normotensive Shock in Intermediate-Risk Pulmonary Embolism

Zhang, Robert S; Alam, Usman; Sharp, Andrew S P; Giri, Jay S; Greco, Allison A; Secemsky, Eric A; Postelnicu, Radu; Sethi, Sanjum S; Alviar, Carlos L; Bangalore, Sripal
PMID: 38063026
ISSN: 1941-7632
CID: 5591522

Comparison of Intravascular Imaging, Functional, or Angiographically Guided Coronary Intervention

Kuno, Toshiki; Kiyohara, Yuko; Maehara, Akiko; Ueyama, Hiroki A; Kampaktsis, Polydoros N; Takagi, Hisato; Mehran, Roxana; Stone, Gregg W; Bhatt, Deepak L; Mintz, Gary S; Bangalore, Sripal
BACKGROUND:In patients undergoing percutaneous coronary intervention (PCI), it remains unclear whether intravascular imaging guidance or functional guidance is the best strategy to optimize outcomes and if the results are different in patients with vs without acute coronary syndromes (ACS). OBJECTIVES/OBJECTIVE:The purpose of this study was to evaluate clinical outcomes with imaging-guided PCI or functionally guided PCI when compared with conventional angiography-guided PCI. METHODS:We searched PUBMED and EMBASE for randomized controlled trials investigating outcomes with intravascular imaging-guided, functionally guided, or angiography-guided PCI. The primary outcome from this network meta-analysis was trial-defined major adverse cardiovascular event (MACE)-a composite of cardiovascular death, myocardial infarction (MI), and target lesion revascularization (TLR). PCI strategies were ranked (best to worst) using P scores. RESULTS:Our search identified 32 eligible randomized controlled trials and included a total of 22,684 patients. Compared with angiography-guided PCI, intravascular imaging-guided PCI was associated with reduced risk of MACE (relative risk [RR]: 0.72; 95% CI: 0.62-0.82), cardiovascular death (RR: 0.56; 95% CI: 0.42-0.75), MI (RR: 0.81; 95% CI: 0.66-0.99), stent thrombosis (RR: 0.48; 95% CI: 0.31-0.73), and TLR (RR: 0.75; 95% CI: 0.57-0.99). Similarly, when compared with angiography-guided PCI, functionally guided PCI was associated with reduced risk of MACE and MI. Intravascular imaging-guided PCI ranked first for the outcomes of MACE, cardiovascular death, stent thrombosis, and TLR. The results were consistent in the ACS and non-ACS cohorts. CONCLUSIONS:Angiography-guided PCI had consistently worse outcomes compared with intravascular imaging-guided and functionally guided PCI. Intravascular imaging-guided PCI was the best strategy to reduce the risk of cardiovascular events.
PMID: 37995152
ISSN: 1558-3597
CID: 5608732

Percutaneous Debulking of a Tricuspid Valve Papillary Fibroelastoma: A Rare Presentation and Management Approach

Zhang, Robert S; Harari, Rafael; Kelly, Sean M; Talmor, Nina; Rhee, Aaron J; Panhwar, Muhammad S; Yee-Chang, Melissa; Nayar, Ambika C; Keller, Norma M; Alviar, Carlos L; Bangalore, Sripal
PMID: 38047386
ISSN: 1942-0080
CID: 5597802

A Clinical Perspective on Arsenic Exposure and Development of Atherosclerotic Cardiovascular Disease

Kaur, Gurleen; Desai, Karan P; Chang, Isabella Y; Newman, Jonathan D; Mathew, Roy O; Bangalore, Sripal; Venditti, Ferdinand J; Sidhu, Mandeep S
Cardiovascular risk has traditionally been defined by modifiable and non-modifiable risk factors, such as tobacco use, hyperlipidemia, and family history. However, chemicals and pollutants may also play a role in cardiovascular disease (CVD) risk. Arsenic is a naturally occurring element that is widely distributed in the Earth's crust. Inorganic arsenic (iAs) has been implicated in the pathogenesis of atherosclerosis, with chronic high-dose exposure to iAs (> 100 µg/L) being linked to CVD; however, whether low-to-moderate dose exposures of iAs (< 100 µg/L) are associated with the development of CVD is unclear. Due to limitations of the existing literature, it is difficult to define a threshold for iAs toxicity. Studies demonstrate that the effect of iAs on CVD is far more complex with influences from several factors, including diet, genetics, metabolism, and traditional risk factors such as hypertension and smoking. In this article, we review the existing data of low-to-moderate dose iAs exposure and its effect on CVD, along with highlighting the potential mechanisms of action.
PMID: 35029799
ISSN: 1573-7241
CID: 5119142