Abhimanyu Uberoi

Effect of clopidogrel use post coronary artery bypass surgery on graft patency.

BACKGROUND Clopidogrel use post coronary artery bypass grafting (CABG) has become more popular under the assumption that it improves graft patency. The purpose of this sub-analysis from the Randomized On and Off-Pump Bypass (ROOBY) trial is to evaluate the role of clopidogrel use post CABG to improve graft patency when added to standard aspirin therapy. METHODS The ROOBY trial was a multi-center, randomized, controlled clinical trial that compared on-pump versus off-pump coronary artery bypass grafting (CABG). Clopidogrel use post CABG was left at the discretion of the operator. Detailed data regarding the use and timing of clopidogrel post CABG were collected prospectively, along with 1-year angiograms to evaluate graft status. RESULTS Of the 2,203 subjects undergoing CABG, 953 patient records had complete clopidogrel use and 1-year angiographic data. Of these, 345 (36.2%) received clopidogrel post CABG prior to discharge. Compared with patients with no post-CABG clopidogrel use, baseline characteristics were similar for the clopidogrel group except for the following: lower preoperative aspirin use (80.2% vs 86.7%, p = 0.009); higher preoperative clopidogrel use (23.5% vs 14.0%, p < 0.001), less on-pump (35.9% vs 55.9%, p < 0.0001); and lower endoscopic vein harvesting (30.8% vs 42.5%, p < 0.001) rates. Overall 1-year graft patency rates were not different between the clopidogrel and no-clopidogrel groups (86.5% vs 85.3%, p = 0.43). Multivariable analyses did not alter these findings. CONCLUSIONS This study suggests that routine post-CABG clopidogrel use may not translate to improved 1-year graft patency. Future studies appear warranted to better define the role of more aggressive antiplatelet therapy post CABG on graft patency and clinical outcomes.

Marijuana and Listing for Heart Transplant A Survey of Transplant Providers

Background—There is no consensus within the heart transplant community about whether patients who use marijuana should be eligible for transplant listing, but several states have passed legislation prohibiting marijuana-using patients from being denied transplant listing based on their use of the substance. Methods and Results—We conducted an independent, voluntary, web-based survey of heart and lung transplant providers to assess current practice patterns and attitudes toward marijuana use in patients with advanced heart failure being considered for transplant. A total of 360 heart transplant providers responded from 26 countries. Nearly two thirds of respondents (n=222, 64.4%) supported listing patients with advanced, end-stage heart failure for transplant who use legal medical marijuana. Significantly, fewer respondents (n=96, 27.5%) supported transplant listing for patients using legal recreational marijuana. The majority of providers currently make patients eligible for transplantation after a period of abstinence from marijuana (n=241, 68.3%). There were no differences between the proportion of respondents supporting transplant listing after stratification by profession or country/region. Most (78.4%) survey respondents from states with laws prohibiting marijuana-using patients from being denied transplant listing reported denying all marijuana-using patients or mandating abstinence before transplant listing. Conclusions—The majority of heart and lung transplant providers in our study sample supports the listing of patients who use medical marijuana for transplant after a period of abstinence. Communication and collaboration between the medical community and legislative groups about marijuana use in transplant candidates is needed to ensure the best patient outcomes with the use of scarce donor organs.Background— There is no consensus within the heart transplant community about whether patients who use marijuana should be eligible for transplant listing, but several states have passed legislation prohibiting marijuana-using patients from being denied transplant listing based on their use of the substance. Methods and Results— We conducted an independent, voluntary, web-based survey of heart and lung transplant providers to assess current practice patterns and attitudes toward marijuana use in patients with advanced heart failure being considered for transplant. A total of 360 heart transplant providers responded from 26 countries. Nearly two thirds of respondents (n=222, 64.4%) supported listing patients with advanced, end-stage heart failure for transplant who use legal medical marijuana. Significantly, fewer respondents (n=96, 27.5%) supported transplant listing for patients using legal recreational marijuana. The majority of providers currently make patients eligible for transplantation after a period of abstinence from marijuana (n=241, 68.3%). There were no differences between the proportion of respondents supporting transplant listing after stratification by profession or country/region. Most (78.4%) survey respondents from states with laws prohibiting marijuana-using patients from being denied transplant listing reported denying all marijuana-using patients or mandating abstinence before transplant listing. Conclusions— The majority of heart and lung transplant providers in our study sample supports the listing of patients who use medical marijuana for transplant after a period of abstinence. Communication and collaboration between the medical community and legislative groups about marijuana use in transplant candidates is needed to ensure the best patient outcomes with the use of scarce donor organs.

Not Your Typical Hole-in-the-Wall: Percutaneous Closure of an Acquired Post-Myocardial Infarction Ventriculoatrial Gerbode Defect.

A 58-year-old male patient presented with an inferior ST-segment elevation myocardial infarction complicated by a ventricular septal defect (VSD). The VSD was surgically repaired, but basal extension of necrotic tissue obligated a second repair 2 weeks later. Subsequently, he again presented in

TCT-772 High prevalence of pelvic venous compression syndrome among patients with chronic venous insufficiency and effective treatment with venous stenting

May-Thurner Syndrome is the pathologic compression of the L common iliac vein by the R common iliac artery and has an incidence of 22%, in a cadaver study. Venous compression syndrome (VCS) can also occur in the external iliac, common femoral vein and R sided veins as well. VCS prevalence ranges

TCT-784 An Innovative MRA Technique for Simultaneous Imaging of Artery and Vein for Diagnosis of Venous Compression Syndrome

METHODS From January 2008 to May 2015, a total of 226 consecutive patients with 250 wounds underwent complete angiosome-targeted PTA for only ischemic foot wound and multi-vessel BTK artery disease. We evaluated the clinical outcome of angiosome-targeted single-vessel versus multi-vessel PTA. The primary endpoint was defined as the complete wound healing within 12 months without death before wound healing, unexpected amputation or flap or target vessel revascularization, or death. The secondary endpoint of the study was the major adverse limb event (MALE) at 1 year.

OUTCOMES OF TRANSCATHETER CLOSURE OF POST-MYOCARDIAL INFARCTION VENTRICULAR SEPTAL DEFECT

As care and outcomes for acute myocardial infarction (MI) continue to improve, ventricular septal defect (VSD) remains a very serious mechanical complication of acute MI that is associated with high mortality and morbidity. Patients with post-MI VSD are often late presenting acute coronary syndrome

Marijuana and Listing for Heart TransplantCLINICAL PERSPECTIVE

Background—There is no consensus within the heart transplant community about whether patients who use marijuana should be eligible for transplant listing, but several states have passed legislation prohibiting marijuana-using patients from being denied transplant listing based on their use of the substance. Methods and Results—We conducted an independent, voluntary, web-based survey of heart and lung transplant providers to assess current practice patterns and attitudes toward marijuana use in patients with advanced heart failure being considered for transplant. A total of 360 heart transplant providers responded from 26 countries. Nearly two thirds of respondents (n=222, 64.4%) supported listing patients with advanced, end-stage heart failure for transplant who use legal medical marijuana. Significantly, fewer respondents (n=96, 27.5%) supported transplant listing for patients using legal recreational marijuana. The majority of providers currently make patients eligible for transplantation after a period of abstinence from marijuana (n=241, 68.3%). There were no differences between the proportion of respondents supporting transplant listing after stratification by profession or country/region. Most (78.4%) survey respondents from states with laws prohibiting marijuana-using patients from being denied transplant listing reported denying all marijuana-using patients or mandating abstinence before transplant listing. Conclusions—The majority of heart and lung transplant providers in our study sample supports the listing of patients who use medical marijuana for transplant after a period of abstinence. Communication and collaboration between the medical community and legislative groups about marijuana use in transplant candidates is needed to ensure the best patient outcomes with the use of scarce donor organs.Background— There is no consensus within the heart transplant community about whether patients who use marijuana should be eligible for transplant listing, but several states have passed legislation prohibiting marijuana-using patients from being denied transplant listing based on their use of the substance. Methods and Results— We conducted an independent, voluntary, web-based survey of heart and lung transplant providers to assess current practice patterns and attitudes toward marijuana use in patients with advanced heart failure being considered for transplant. A total of 360 heart transplant providers responded from 26 countries. Nearly two thirds of respondents (n=222, 64.4%) supported listing patients with advanced, end-stage heart failure for transplant who use legal medical marijuana. Significantly, fewer respondents (n=96, 27.5%) supported transplant listing for patients using legal recreational marijuana. The majority of providers currently make patients eligible for transplantation after a period of abstinence from marijuana (n=241, 68.3%). There were no differences between the proportion of respondents supporting transplant listing after stratification by profession or country/region. Most (78.4%) survey respondents from states with laws prohibiting marijuana-using patients from being denied transplant listing reported denying all marijuana-using patients or mandating abstinence before transplant listing. Conclusions— The majority of heart and lung transplant providers in our study sample supports the listing of patients who use medical marijuana for transplant after a period of abstinence. Communication and collaboration between the medical community and legislative groups about marijuana use in transplant candidates is needed to ensure the best patient outcomes with the use of scarce donor organs.

Marijuana and Listing for Heart TransplantCLINICAL PERSPECTIVE: A Survey of Transplant Providers

Background—There is no consensus within the heart transplant community about whether patients who use marijuana should be eligible for transplant listing, but several states have passed legislation prohibiting marijuana-using patients from being denied transplant listing based on their use of the substance. Methods and Results—We conducted an independent, voluntary, web-based survey of heart and lung transplant providers to assess current practice patterns and attitudes toward marijuana use in patients with advanced heart failure being considered for transplant. A total of 360 heart transplant providers responded from 26 countries. Nearly two thirds of respondents (n=222, 64.4%) supported listing patients with advanced, end-stage heart failure for transplant who use legal medical marijuana. Significantly, fewer respondents (n=96, 27.5%) supported transplant listing for patients using legal recreational marijuana. The majority of providers currently make patients eligible for transplantation after a period of abstinence from marijuana (n=241, 68.3%). There were no differences between the proportion of respondents supporting transplant listing after stratification by profession or country/region. Most (78.4%) survey respondents from states with laws prohibiting marijuana-using patients from being denied transplant listing reported denying all marijuana-using patients or mandating abstinence before transplant listing. Conclusions—The majority of heart and lung transplant providers in our study sample supports the listing of patients who use medical marijuana for transplant after a period of abstinence. Communication and collaboration between the medical community and legislative groups about marijuana use in transplant candidates is needed to ensure the best patient outcomes with the use of scarce donor organs.Background— There is no consensus within the heart transplant community about whether patients who use marijuana should be eligible for transplant listing, but several states have passed legislation prohibiting marijuana-using patients from being denied transplant listing based on their use of the substance. Methods and Results— We conducted an independent, voluntary, web-based survey of heart and lung transplant providers to assess current practice patterns and attitudes toward marijuana use in patients with advanced heart failure being considered for transplant. A total of 360 heart transplant providers responded from 26 countries. Nearly two thirds of respondents (n=222, 64.4%) supported listing patients with advanced, end-stage heart failure for transplant who use legal medical marijuana. Significantly, fewer respondents (n=96, 27.5%) supported transplant listing for patients using legal recreational marijuana. The majority of providers currently make patients eligible for transplantation after a period of abstinence from marijuana (n=241, 68.3%). There were no differences between the proportion of respondents supporting transplant listing after stratification by profession or country/region. Most (78.4%) survey respondents from states with laws prohibiting marijuana-using patients from being denied transplant listing reported denying all marijuana-using patients or mandating abstinence before transplant listing. Conclusions— The majority of heart and lung transplant providers in our study sample supports the listing of patients who use medical marijuana for transplant after a period of abstinence. Communication and collaboration between the medical community and legislative groups about marijuana use in transplant candidates is needed to ensure the best patient outcomes with the use of scarce donor organs.

Complete revascularisation or culprit artery only in cardiogenic shock: the real shock is the lack of data!

Approximately 40–65% of patients presenting with ST elevation myocardial infarction (STEMI) have multivessel disease (MVD). These patients have higher mortality and worse clinical outcomes than patients with STEMI with single vessel disease irrespective of haemodynamic status.1–3 Despite this common clinical scenario, the data available to guide management of these patients is remarkably sparse. The recommendations from the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) and the European Society of Cardiology (ESC) Guidelines have been stronger than the data supporting those guidelines, but that is changing. For patients with STEMI presenting without cardiogenic shock, Percutaneous Coronary Intervention (PCI) of a non-culprit vessel is currently considered a class III indication, meaning the risk outweighs the benefit and the procedure SHOULD NOT be performed (not helpful and may be harmful). Despite the Class III indication, registries indicate 10–25% of patients with STEMI in fact undergo multivessel PCI. The recent publication of two randomised trials, Preventative Angioplasty in Acute Myocardial Infarction (PRAMI) and Complete Versus culprit-Lesion only PRimary PCI Trial (CvLPRIT), has dramatically changed our thinking for patients with STEMI with MVD and without cardiogenic shock.2 ,3 Both trials found complete revascularisation was associated with a reduction in major adverse cardiac events (MACE) compared with ‘culprit only’ PCI. Following successful primary PCI in the PRAMI trial, 465 patients with MVD were randomised to either ‘preventive PCI’ of all lesions ≥50% during the same setting or ‘culprit only’ PCI. The trial was stopped early due to a significantly lower MACE rate (composite of death from cardiac cause, non-fatal myocardial infarction (MI) or refractory angina) in the ‘preventive PCI’ arm (9% vs 23% in the ‘culprit only’ arm; p value <0.001). In the CvLPRIT trial, patients with successful PCI and MVD were randomised to PCI of all …