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Initial single center ST-segment elevation myocardial infarction experience in New York before and during the COVID-19 pandemic [Letter]

Medranda, Giorgio A; Brahmbhatt, Kunal; Alawneh, Basem; Marzo, Kevin P; Schwartz, Richard K; Green, Stephen J
BACKGROUND/PURPOSE/OBJECTIVE:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a highly contagious and lethal virus, devastating healthcare systems throughout the world. Following a period of stability, the coronavirus disease 2019 (COVID-19) pandemic appears to be re-intensifying globally. As the virus continues to evolve, so does our understanding of its implications on ST-segment elevation myocardial infarction (STEMI). We sought to describe a single center STEMI experience at one of the epicenters during the COVID-19 pandemic. METHODS/MATERIALS/METHODS:We conducted a retrospective, observational study comparing STEMI patients during the pandemic period (March 1, 2020 to August 31, 2020) to those with STEMI during the pre-pandemic period (March 1, 2019 to August 31, 2019) at NYU Langone Hospital - Long Island, a tertiary care center in Nassau County, New York. Additionally, we describe our subset of COVID-19 patients with STEMI during the pandemic. RESULTS:The acute myocardial infarction (AMI) team was activated for a total of 183 patients during both periods. There were a similar number of AMI team activations during the pandemic period (n = 93) compared to the pre-pandemic period (n = 90). Baseline characteristics did not differ during both periods however, infection control measures and additional investigation were required to clarify the diagnosis during the pandemic, resulting in a signal towards longer door-to-balloon times (95.9 min vs. 74.4 min, p = 0.0587). We observed similar inpatient length of stay (LOS) (3.6 days vs. 5.0 days, p = 0.0901) and mortality (13.2% vs. 9.2%, p = 0.5876). There was a total of 6 COVID-19 positive patients who presented with STEMI, of which 4 were emergently taken to the cardiac catheterization laboratory with successful percutaneous coronary intervention (PCI) performed in 3 patients. The 2 patients who were not offered primary PCI expired, as both were treated medically, one with thrombolytics. CONCLUSIONS:Our single center study, in New York, at one of the epicenters of the pandemic, demonstrated a similar number of AMI team activations, mimicking the seasonal variability seen in 2019, but with a signal towards longer door-to-balloon time. Despite this, inpatient LOS and mortality remained similar.
PMCID:7837613
PMID: 33526393
ISSN: 1878-0938
CID: 4776042

PREDICTORS AND IMPACT OF PERSISTENT MITRAL REGURGITATION IN TRANSCATHETER AORTIC VALVE REPLACEMENT [Meeting Abstract]

Medranda, Giorgio; Schwartz, Richard; Green, Stephen
ISI:000647487500981
ISSN: 0735-1097
CID: 4893292

SHORT-TERM PROGNOSTIC IMPLICATIONS OF B-TYPE NATRIURETIC PEPTIDE IN TRANSCATHETER MITRAL VALVE REPAIR [Meeting Abstract]

Medranda, Giorgio; Marzo, Kevin; Kokotos, William; Donohue, Daniel; Naidu, Srihari; Daggubati, Ramesh; Schwartz, Richard; Green, Stephen
ISI:000647487501257
ISSN: 0735-1097
CID: 4893302

Outcome of Patients Having Transcatheter Mitral Valve Implantation for the Treatment of Degenerated Mitral Bioprostheses

Medranda, Giorgio A; Brahmbhatt, Kunal; Marzo, Kevin; Salhab, Khaled; Schwartz, Richard; Green, Stephen J
Transcatheter mitral valve implantation (TMVI) is at various levels of preclinical investigation and has proven to be more challenging than transcatheter aortic valve implantation due to more complex anatomy. The purpose of this study is to evaluate the short-term and long-term outcomes of high-risk patients who underwent TMVI for degenerated mitral bioprostheses. In this retrospective, observational study, we reviewed data on the first 26 patients with previous surgical mitral valve replacement or repair with annular ring that underwent TMVI using the balloon-expandable heart-valve system at our institution from 2014 to 2019. We reviewed pre/postprocedure echocardiographic data, in-hospital, 30-day data and 1-year outcomes. The indication for TMVI was mitral regurgitation (MR) in 9 patients, mitral stenosis in 9 patients and mixed mitral disease in 8 patients. There was a 100% device implantation success rate and a 96% in-hospital survival rate. Survival was 96% at 30 days and 85% at 1 year. Mean mitral gradient (MMG) improved postprocedure (13.3 mm Hg to 6.8 mm Hg, p <0.0001) and was sustained at 1 year (13.3 mm Hg to 7.2 mm Hg, p <0.0001). MR grade improved postprocedure (3+ to 1+, p <0.0001) and was sustained at 1 year (3+ to 0, p <0.0001). Additionally there was significant 30-day and 1-year improvements in patients' Kansas City Cardiomyopathy Questionnaire score after TMVI (47.8 to 75.7 to 84.0, p = <0.0001). In conclusion, our early experience with treatment of degenerated mitral bioprostheses using TMVI in high-risk patients resulted in significant short-term and sustained long-term improvements in mean mitral gradient, MR and heart failure symptoms.
PMID: 32713650
ISSN: 1879-1913
CID: 4581072

Prognostic Implications of Baseline B-type Natriuretic Peptide in Patients Undergoing Transcatheter Aortic Valve Implantation

Medranda, Giorgio A; Salhab, Khaled; Schwartz, Richard; Green, Stephen J
B-type natriuretic peptide (BNP) levels have been shown to predict outcomes in surgical aortic valve replacement patients. BNP levels have not been well studied in patients undergoing transcatheter aortic valve implantation (TAVI). The purpose of this study is to define the utility of baseline BNP levels in predicting short-term outcomes after TAVI. In this retrospective, observational, study from 2012 to 2019, we reviewed data on 1297 low-risk, intermediate-risk and high-risk patients who underwent TAVI. Patients were dichotomized into those with baseline BNP levels above or below 500 pg/ml. Our primary outcome was a composite of inpatient stroke and death. Our secondary outcome was a composite of 30-day stroke, death and readmission. There were 975 patients with a baseline BNP level of <500 pg/ml and of those, 2% had our primary composite outcome and 13% of patients had our secondary composite outcome. There were 322 patients with a baseline BNP level of ≥500 pg/ml and of those, 6% had our primary composite outcome and 19% of patients had our secondary composite outcome. Those with a baseline BNP level ≥500 pg/ml were 3.47 times more likely (confidence of interval [CI] 1.727, 6.993, p = 0.0005) to have our primary composite outcome and were 1.72 times more likely (CI 1.186, 2.506, p = 0.0043) to have our secondary composite outcome. In conclusion, after adjustments for discrepant baseline characteristics, baseline BNP levels were independently predictive of a composite of inpatient stroke or death and a composite of 30-day stroke, death or readmission after TAVI. Those low, intermediate and high-risk patients whose baseline BNP is ≥500 pg/ml may ultimately require closer post-TAVI monitoring.
PMID: 32665134
ISSN: 1879-1913
CID: 4546362

A Balancing Act: The Impact of Reducing Mitral Regurgitation at the Expense of Increased Mitral Gradients Using Percutaneous Mitral Valve Repair [Meeting Abstract]

Medranda, Giorgio A.; Brahmbhatt, Kunal; Marzo, Kevin; Kokotos, William; Donohue, Daniel; Naidu, Srihari; Daggubati, Ramesh; Schwartz, Richard
ISI:000513916500145
ISSN: 1936-8798
CID: 4337112

Early Success Using Transcatheter Mitral Valve Replacement for the Treatment of Degenerated Mitral Bioprosthesis [Meeting Abstract]

Medranda, Giorgio A.; Brahmbhatt, Kunal; Schwartz, Richard; Green, Stephen J.
ISI:000513916500147
ISSN: 1936-8798
CID: 4337122

The Utility of Transcatheter Aortic Valve Replacement in Very Low-Gradient Severe Aortic Stenosis [Meeting Abstract]

Medranda, Giorgio A.; Salhab, Khaled; Schwartz, Richard; Green, Stephen J.
ISI:000513916500137
ISSN: 1936-8798
CID: 4337102

Baseline B-Type Natriuretic Peptide Predicts Inpatient Outcomes in Transcatheter Aortic Valve Replacement [Meeting Abstract]

Medranda, Giorgio A.; Salhab, Khaled; Schwartz, Richard; Green, Stephen J.
ISI:000513916500127
ISSN: 1936-8798
CID: 4337092

THE UTILITY OF BASELINE B-TYPE NATRIURETIC PEPTIDE FOR SHORT-TERM OUTCOMES IN TRANSCATHETER AORTIC VALVE REPLACEMENT [Meeting Abstract]

Medranda, Giorgio; Rosenblum, Jake; Salhab, Khaled; Schwartz, Richard; Green, Stephen
ISI:000460565901361
ISSN: 0735-1097
CID: 4067982