Christopher L. Gade

Hospital Volume Outcomes After Septal Myectomy and Alcohol Septal Ablation for Treatment of Obstructive Hypertrophic Cardiomyopathy: US Nationwide Inpatient Database, 2003-2011

IMPORTANCE Previous data on septal myectomy (SM) and alcohol septal ablation (ASA) in obstructive hypertrophic cardiomyopathy have been limited to small, nonrandomized, single-center studies. Use of septal reduction therapy and the effect of institutional experience on procedural outcomes nationally are unknown. OBJECTIVE To examine in-hospital outcomes after SM and ASA stratified by hospital volume within a large, national inpatient database. DESIGN, SETTING, AND PARTICIPANTS This study analyzed all patients who were hospitalized for SM or ASA in a nationwide inpatient database from January 1, 2003, through December 31, 2011. MAIN OUTCOMES AND MEASURES Rates of adverse in-hospital events (death, stroke, bleeding, acute renal failure, and need for permanent pacemaker) were examined. Multivariate logistic regression analysis was performed to compare overall outcomes after each procedure based on tertiles of hospital volume of SM and ASA. RESULTS Of 71 888 761 discharge records reviewed, a total of 11 248 patients underwent septal reduction procedures, of whom 6386 (56.8%) underwent SM and 4862 (43.2%) underwent ASA. A total of 59.9% of institutions performed 10 SM procedures or fewer, whereas 66.9% of institutions performed 10 ASA procedures or fewer during the study period. Incidence of in-hospital death (15.6%, 9.6%, and 3.8%; P < .001), need for permanent pacemaker (10.0%, 13.8%, and 8.9%; P < .001), and bleeding complications (3.3%, 3.8%, and 1.7%; P < .001) after SM was lower in higher-volume centers when stratified by first, second, and third tertiles of hospital volume, respectively. Similarly, there was a lower incidence of death (2.3%, 0.8%, and 0.6%; P = .02) and acute renal failure (6.2%, 7.6%, and 2.4%; P < .001) after ASA in higher-volume centers. The lowest tertile of SM volume among hospitals was an independent predictor of in-hospital all-cause mortality (adjusted odds ratio, 3.11; 95% CI, 1.98-4.89) and bleeding (adjusted odds ratio, 3.77; 95% CI, 2.12-6.70), whereas being in the lowest tertile of ASA by volume was not independently associated with an increased risk of adverse postprocedural events. CONCLUSIONS AND RELEVANCE In US hospitals from 2003 through 2011, most centers that provide septal reduction therapy performed few SM and ASA procedures, which is below the threshold recommended by the 2011 American College of Cardiology Foundation/American Heart Association Task Force Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy. Low SM volume was associated with worse outcomes, including higher mortality, longer length of stay, and higher costs. More efforts are needed to encourage referral of patients to centers of excellence for septal reduction therapy.

Trends in hospital treatments for peripheral arterial disease in the United States and association between payer status and quality of care/outcomes, 2007–2011

This study sought to identify the temporal trends of presenting diagnoses and vascular procedures performed for peripheral arterial disease (PAD) along with the rates of procedures and in‐hospital outcomes by payer status.

Comprehensive evaluation of atrial septal defects in individuals undergoing percutaneous repair by 64-detector row computed tomography

Transcatheter atrial septal defect closure is becoming more commonplace as it has been demonstrated to be safe, efficacious and associated with low morbidity. Pre-procedural assessment of individuals has primarily relied upon transesophageal echocardiography. We present four individuals who underwent both transesophageal echocardiography as well as cardiac multidetector computed tomography. In all four cases, multidetector computed tomography added incremental information above the transesophageal echocardiogram. Multidetector computed tomography may play an essential role in individuals with atrial septal defects undergoing percutaneous transcatheter closure.

Current and evolving stent evaluation by coronary computed tomographic angiography

Objectives: To demonstrate the variety of stent abnormalities that may be evaluated by coronary computed tomographic angiography (CTA). Background: The application of CTA to the evaluation of coronary stents has focused almost entirely on the detection of in‐stent restenosis. Methods: All CTA performed for stent evaluation at a single institution were reviewed. Results: In addition to in‐stent restenosis, stent fracture, and overlap failure, a multiplicity of stent‐related problems not previously addressed by CTA was categorized and illustrated: late stent thrombosis, jailed branches, edge stenosis, bifurcation stents, inadequate stent expansion, stent aneurysms, peri‐stent plaque, and stenting into bridged myocardium. Conclusions: CTA may be used to evaluate the full range of stent‐related problems. This work provides the framework for future studies validating these applications.

Assessment of coronary artery aneurysm after stent placement for myocardial infarction: evaluation by multidetector computed tomography

A 34 year-old man with a history of myocardial infarcion presented for assessment of coronary artery disease CAD). His medical history was significant for an inferior yocardial infarction that occurred 6 years before and was reated with percutaneous intervention. He experienced no schemic symptoms or events since. The patient expressed oncern over the extent of his CAD and underwent 64etector row computed tomography coronary angiography CCTA). CCTA showed a stent in the right coronary artery RCA) (Fig. 1A–D). The proximal portion of the stent was ccluded within a thrombosed outpouching of the vessel 1.5 cm diameter) most consistent with a thrombosed cornary artery aneurysm (Fig. 1E). Patency of the native RCA as apparent adjacent to the proximal portion of the stent.