Aatish Garg

Outcomes and Resource Utilization in ST‐Elevation Myocardial Infarction in the United States: Evidence for Socioeconomic Disparities

Background Socioeconomic status (SES) as reflected by residential zip code status may detrimentally influence a number of prehospital clinical, access‐related, and transport variables that influence outcome for patients with ST‐elevation myocardial infarction (STEMI) undergoing reperfusion. We sought to analyze the impact of SES on in‐hospital mortality, timely reperfusion, and cost of hospitalization following STEMI. Methods and Results We used the 2003–2011 Nationwide Inpatient Sample database for this analysis. All hospital admissions with a principal diagnosis of STEMI were identified using ICD‐9 codes. SES was assessed using median household income of the residential zip code for each patient. There was a significantly higher mortality among the lowest SES quartile as compared to the highest quartile (OR [95% CI]: 1.11 [1.06 to 1.17]). Similarly, there was a highly significant trend indicating a progressively reduced timely reperfusion among patients from lower quartiles (OR [95% CI]: 0.80 [0.74 to 0.88]). In addition, there was a lower utilization of circulatory support devices among patients from lower as compared to higher zip code quartiles (OR [95% CI]: 0.85 [0.75 to 0.97]). Furthermore, the mean adjusted cost of hospitalization among quartiles 2, 3, and 4, as compared to quartile 1 was significantly higher by

Length of stay and long-term mortality following ST elevation myocardial infarction

913,

Comparison of acute elastic recoil between the SAPIEN‐XT and SAPIEN valves in transfemoral–transcatheter aortic valve replacement

2140, and

Full stent expansion of chronic total occlusion lesions requires prolonged inflation

4070, respectively. Conclusions Patients residing in zip codes with lower SES had increased in‐hospital mortality and decreased timely reperfusion following STEMI as compared to patients residing in higher SES zip codes. The cost of hospitalization of patients from higher SES quartiles was significantly higher than those from lower quartiles.

Percutaneous Left Atrial Appendage Occlusion for Stroke Prophylaxis in Nonvalvular Atrial Fibrillation : A Systematic Review and Analysis of Observational Studies

Over the last few decades, there has been a significant reduction in hospital length of stay (LOS) among patients undergoing percutaneous intervention (PCI) for ST elevation myocardial infarction (STEMI). Although studies have looked at predictors of long hospital stay after STEMI, the impact of LOS on long‐term outcomes after PCI remains unknown. We aimed to evaluate the association between LOS at the time of index hospitalization for PCI and long‐term mortality among patients presenting with STEMI.

In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective

The SAPIEN‐XT is a newer generation balloon‐expandable valve created of cobalt chromium frame, as opposed to the stainless steel frame used in the older generation SAPIEN valve. We sought to determine if there was difference in acute recoil between the two valves.

Incidence of Thromboembolic Complications Within 30 Days of Electrical Cardioversion Performed Within 48 Hours of Atrial Fibrillation Onset

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been associated in some studies with higher target vessel revascularization (TVR) rates than non-CTO PCI. Optimal stent inflation time and its effect on TVR in CTO PCI is unknown. We investigated the time required for stent deployment using the previously described pressure optimized protocol (POP), which uses stent balloon pressure stability rather than an arbitrary inflation time as an end point for balloon deflation. We also compared TVR with CTO PCI vs non-CTO using the POP protocol in both groups. METHODS Patients with successful CTO PCI using POP between 2012 and 2015 were included. Patients having non-CTO PCI using POP and matched for stent diameter and length and temporal proximity constituted the control group to compare inflation time (n=83 each). TVR at 1year was compared between PCI during the time period using POP (CTO=83, non-CTO=263). RESULTS Stent inflation time to achieve optimal stent inflation using POP was longer in CTO vs non-CTO lesions (136±60 vs 108±51s, p=0.001). TVR at 365days was similar in CTO and non-CTO cohorts (2.4% vs 2.6%, p=0.9). CONCLUSION Stent expansion using POP in CTO lesions requires longer inflation duration but leads to similar TVR rates at 1year in CTO PCI compared with non-CTO PCI.