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Dive into the research topics where Chad Zack is active.

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Featured researches published by Chad Zack.


JAMA Internal Medicine | 2014

Comparative Outcomes of Catheter-Directed Thrombolysis Plus Anticoagulation vs Anticoagulation Alone to Treat Lower-Extremity Proximal Deep Vein Thrombosis

Riyaz Bashir; Chad Zack; Huaqing Zhao; Anthony J. Comerota; Alfred A. Bove

IMPORTANCE The role of catheter-directed thrombolysis (CDT) in the treatment of acute proximal deep vein thrombosis (DVT) is controversial, and the nationwide safety outcomes are unknown. OBJECTIVES The primary objective was to compare in-hospital outcomes of CDT plus anticoagulation with those of anticoagulation alone. The secondary objective was to evaluate the temporal trends in the utilization and outcomes of CDT in the treatment of proximal DVT. DESIGN, SETTING, AND PARTICIPANTS Observational study of patients with a principal discharge diagnosis of proximal or caval DVT from 2005 to 2010 in the Nationwide Inpatient Sample (NIS) database. We compared patients treated with CDT plus anticoagulation with the patients treated with anticoagulation alone. We used propensity scores to construct 2 matched groups of 3594 patients in each group for comparative outcomes analysis. MAIN OUTCOMES AND MEASURES The primary study outcome was in-hospital mortality. The secondary outcomes included bleeding complications, length of stay, and hospital charges. RESULTS Among a total of 90,618 patients hospitalized for DVT (national estimate of 449,200 hospitalizations), 3649 (4.1%) underwent CDT. The CDT utilization rates increased from 2.3% in 2005 to 5.9% in 2010. Based on the propensity-matched comparison, the in-hospital mortality was not significantly different between the CDT and the anticoagulation groups (1.2% vs 0.9%) (OR, 1.40 [95% CI, 0.88-2.25]) (P = .15). The rates of blood transfusion (11.1% vs 6.5%) (OR, 1.85 [95% CI, 1.57-2.20]) (P < .001), pulmonary embolism (17.9% vs 11.4%) (OR, 1.69 [95% CI, 1.49-1.94]) (P < .001), intracranial hemorrhage (0.9% vs 0.3%) (OR, 2.72 [95% CI, 1.40-5.30]) (P = .03), and vena cava filter placement (34.8% vs 15.6%) (OR, 2.89 [95% CI, 2.58-3.23]) (P < .001) were significantly higher in the CDT group. The CDT group had longer mean (SD) length of stay (7.2 [5.8] vs 5.0 [4.7] days) (OR, 2.27 [95% CI, 1.49-1.94]) (P < .001) and higher hospital charges (


Circulation-cardiovascular Interventions | 2015

Comparative Outcomes of Catheter-Directed Thrombolysis Plus Anticoagulation Versus Anticoagulation Alone in the Treatment of Inferior Vena Caval Thrombosis

Mohamad Alkhouli; Chad Zack; Huaqing Zhao; Irfan Shafi; Riyaz Bashir

85,094 [


International Journal of Cardiology | 2016

Iatrogenic atrial septal defect following transseptal cardiac interventions

Mohamad Alkhouli; Mohammad Sarraf; Chad Zack; David R. Holmes; Charanjit S. Rihal

69,121] vs


Heart | 2018

Isolated tricuspid regurgitation: outcomes and therapeutic interventions

Erin A. Fender; Chad Zack; Rick A. Nishimura

28,164 [


Circulation | 2015

Impact of Institutional Volume on Outcomes of Catheter Directed Thrombolysis in the Treatment of Acute Proximal Deep Vein Thrombosis A 6-Year US Experience (2005–2010)

Harish Jarrett; Chad Zack; Vikas Aggarwal; Vladimir Lakhter; Mohammad A. Alkhouli; Huaqing Zhao; Anthony J. Comerota; Alfred A. Bove; Riyaz Bashir

42,067]) (P < .001) compared with the anticoagulation group. CONCLUSIONS AND RELEVANCE In this study, we did not find any difference in the mortality between the CDT and the anticoagulation groups, but evidence of higher adverse events was noted in the CDT group. In the context of this observational data and continued improvements in technology, a randomized trial with outcomes such as mortality and postthrombotic syndrome is needed to definitively address this comparative effectiveness.


Circulation-cardiovascular Interventions | 2017

Morbidity and Mortality Associated With Balloon Aortic Valvuloplasty: A National Perspective

Mohamad Alkhouli; Chad Zack; Mohammad Sarraf; Riyaz Bashir; Rick A. Nishimura; Mackram F. Eleid; Vuyisile T. Nkomo; Gurpreet S. Sandhu; Rajiv Gulati; Kevin L. Greason; David R. Holmes; Charanjit S. Rihal

Background—The contemporary practice patterns and role of catheter-directed thrombolysis (CDT) in the treatment of inferior vena cava thrombosis is unknown. Methods and Results—The Nationwide Inpatient Sample database was used to identify patients with a principal discharge diagnosis of inferior vena cava thrombosis (International Classification of Diseases-Ninth Revision-Clinical Modification, 453.2) from 2005 to 2011. We compared patients treated with CDT plus anticoagulation with patients treated with anticoagulation alone. We used propensity scores to construct 2 matched groups of 563 patients for comparative outcomes analysis. Among 2674 patients admitted with inferior vena cava thrombosis, 718 (26.9%) underwent CDT. The national CDT utilization rates increased from 16.0% in 2005 to 34.7% in 2011 (P<0.001). Based on the propensity-matched comparison, the inhospital mortality was not significantly different between the CDT and the anticoagulation groups (2.0% versus 1.4%; P=0.49). The rates of pulmonary embolism (12.1% versus 7.8%; P=0.02), intracranial hemorrhage (1.6% versus 0.2%; P=0.03), and acute renal failure (13.9% versus 9.4%; P=0.02) were significantly higher in the CDT group. The CDT group had longer length of stay and higher hospital charges compared with the anticoagulation group. Conclusions—There has been a steady increase in the use of CDT in the treatment of patients with inferior vena cava thrombosis in the United States. This observational study showed no significant difference in mortality between CDT versus anticoagulation alone; however, the bleeding events and resource utilization were higher in the CDT group. Adequately powered randomized controlled trials are needed in this area.


Catheterization and Cardiovascular Interventions | 2017

Characteristics and outcomes of re-do percutaneous paravalvular leak closure: Re-Do percutaneous paravalvular leak closure

Mohammed Al-Hijji; Mohamad Alkhouli; Mohammad Sarraf; Chad Zack; Joseph F. Malouf; Vuyisile T. Nkomo; Allison K. Cabalka; Guy S. Reeder; Charanjit S. Rihal; Mackram F. Eleid

In the Era of expanding use of transseptal structural heart disease interventions and catheter ablation techniques for atrial fibrillation, there is increasing interest in the iatrogenic atrial septal defect (iASD) often associated with these procedures. The purpose of this review is to summarize the current evidence on the incidence and clinical impact of iASD, to identify possible predictors of persistent iASD, and to propose a standardized method for the detection, follow up and management of iASD.


Circulation-heart Failure | 2017

Atrial Septostomy to Treat Stiff Left Atrium Syndrome

Pranav Chandrashekar; Jae Yoon Park; Mohammad A. Al-Hijji; Yogesh N.V. Reddy; Chad Zack; Guy S. Reeder; Robert F. Rea; Barry A. Borlaug

Isolated tricuspid regurgitation (TR) can be caused by primary valvular abnormalities such as flail leaflet or secondary annular dilation as is seen in atrial fibrillation, pulmonary hypertension and left heart disease. There is an increasing recognition of a subgroup of patients with isolated TR in the absence of other associated cardiac abnormalities. Left untreated isolated TR significantly worsens survival. Stand-alone surgery for isolated TR is rarely performed due to an average operative mortality of 8%–10% and a paucity of data demonstrating improved survival. When surgery is performed, valve repair may be preferred over replacement; however, there is a risk of significant recurrent regurgitation after repair. Existing society guidelines do not fully address the management of isolated TR. We propose that patients at low operative risk with symptomatic severe isolated TR and no reversible cause undergo surgery prior to the onset of right ventricular dysfunction and end-organ damage. For patients at increased surgical risk novel percutaneous interventions may offer an alternative treatment but further research is needed. Significant knowledge gaps remain and future research is needed to define operative outcomes and provide comparative data for medical and surgical therapy.


Circulation-cardiovascular Interventions | 2017

Successful Percutaneous Mitral Paravalvular Leak Closure Is Associated With Improved Midterm Survival

Mohamad Alkhouli; Chad Zack; Mohammad Sarraf; Mackram F. Eleid; Allison K. Cabalka; Guy S. Reeder; Donald J. Hagler; Joseph Maalouf; Vuyisile T. Nkomo; Charanjit S. Rihal

Background— The use of catheter-directed thrombolysis (CDT) in the treatment of acute proximal lower-extremity deep vein thrombosis is increasing in the United States and has been linked to higher bleeding rates. Whether this relationship is interrelated with institution volume of CDT is unknown. Methods and Results— The Nationwide Inpatient Sample database was used to identify all patients admitted with a principal diagnosis of proximal or inferior vena caval deep vein thrombosis and treated with CDT from 2005 to 2010. Institutions were divided into high-volume (≥6 procedures a year) and low-volume (<6 procedures a year) centers. Propensity score matching was used to create 2 matched groups for comparative analysis. A total of 90 618 patients were hospitalized for proximal lower-extremity deep vein thrombosis, and 3649 patients (4.1%) underwent CDT. In-hospital mortality was significantly lower at high-volume centers (0.6% versus 1.5%; P=0.04) with a trend toward lower intracranial hemorrhage rates compared with low-volume centers (0.4% versus 1%; P=0.07). No significant difference was seen with blood transfusion (10.4% versus 10.8%; P=0.70), gastrointestinal bleeding (1.4% versus 1.8%; P=0.35), or pulmonary embolism rates (18.4% versus 17.9%; P=0.72). Median length of stay was similar (6 days) and hospital charges were higher (


Journal of the American College of Cardiology | 2013

THE EFFECT OF INFERIOR VENA CAVA FILTER PLACEMENT ON IN–HOSPITAL OUTCOMES IN PATIENTS WITH LOWER EXTREMITY DEEP VEIN THROMBOSIS

Chad Zack; Riyaz Bashir; John P. Gaughan; Alfred A. Bove

65 500 versus

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Vikas Aggarwal

Albert Einstein College of Medicine

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