Deepak J. Pattanshetty

Elevated troponin predicts long-term adverse cardiovascular outcomes in hypertensive crisis: a retrospective study.

Background: Hypertensive crisis is associated with poor clinical outcomes. Elevated troponin, frequently observed in hypertensive crisis, may be attributed to myocardial supply-demand mismatch or obstructive coronary artery disease (CAD). However, in patients presenting with hypertensive crisis and an elevated troponin, the prevalence of CAD and the long-term adverse cardiovascular outcomes are unknown. Objective: We sought to assess the impact of elevated troponin on cardiovascular outcomes and evaluate the role of troponin as a predictor of obstructive CAD in patients with hypertensive crisis. Methods: Patients who presented with hypertensive crisis (n = 236) were screened retrospectively. Baseline and follow-up data including the event rates were obtained using electronic patient records. Those without an assay for cardiac Troponin I (cTnI) (n = 65) were excluded. Of the remaining 171 patients, those with elevated cTnI (cTnI ≥ 0.12 ng/ml) (n = 56) were compared with those with normal cTnI (cTnI < 0.12 ng/ml) (n = 115) at 2 years for the occurrence of major adverse cardiac or cerebrovascular events (MACCE) (composite of myocardial infarction, unstable angina, hypertensive crisis, pulmonary edema, stroke or transient ischemic attack). Results: At 2 years, MACCE occurred in 40 (71.4%) patients with elevated cTnI compared with 44 (38.3%) patients with normal cTnI [hazard ratio: 2.77; 95% confidence interval (CI): 1.79–4.27; P < 0.001]. Also, patients with elevated cTnI were significantly more likely to have underlying obstructive CAD (odds ratio: 8.97; 95% CI: 1.4–55.9; P < 0.01). Conclusion: In patients with hypertensive crisis, elevated cTnI confers a significantly greater risk of long-term MACCE, and is a strong predictor of obstructive CAD.

Inflammatory bowel 'Cardiac' disease: Point prevalence of atrial fibrillation in inflammatory bowel disease population

Background/Aim: Proinflammatory markers such as interleukin (IL)-6 have been closely associated with atrial fibrillation (AF). These markers are characteristically elevated in chronic inflammatory bowel disease (IBD) and positively correlate with disease activity. Although IBD and AF have similar pathogenesis, there have been very limited studies looking at their association. The aim of this study is to determine the prevalence of AF in patients with IBD. Patients and Methods: Medical records of patients with biopsy proven IBD (n = 203, both in and outpatient) were retrospectively reviewed. One hundred and forty-one IBD patients with documentary evidence of electrocardiograms (ECGs) were included. The “Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA)” study, a large cross-sectional study (n = 1.89 million) done to evaluate the prevalence of AF among the US population, was our control population. All ECGs available till December 2010 for each IBD patient were reviewed carefully for evidence of AF. We studied the prevalence of AF among IBD population and compared it to that of control (ATRIA) population. Results: The prevalence of AF was significantly higher among IBD patients compared with the ATRIA study patients (11.3% vs 0.9%, P < 0.0001). Additionally, the IBD patient population were much younger compared with the controls (64.4 ± 10.7 vs 71.2 ± 12.2, P = 0.02). Conclusion: AF has an overall higher prevalence across all age groups in IBD compared with the subjects of ATRIA study, which could be due to the chronic inflammatory state of IBD. Further studies are needed to study the association in detail.

Optimal duration of dual antiplatelet therapy after drug eluting stent implantation: a network meta-analysis.

Objective: There has been much debate regarding the optimal duration of dual antiplatelet therapy (DAPT) cover after drug eluting stent (DES) implantation. We aimed to assess the relative benefits of shorter and longer durations of DAPT coverage. Methods: We performed a network meta-analysis (NMA) of all the randomized clinical trials (RCT) comparing different time durations of DAPT cover. Results: We included 11 unique trials with a total of 33,458 patients; the longest duration of follow-up was 48 months and the shortest was 3 months. NMA results demonstrated that compared with 12 months, longer DAPT of 30 months reduced the hazard ratio (HR) of stent thrombosis (HR, 0.29; 95% CrI, 0.17–0.49). There was no difference in mortality between shorter and longer durations of DAPT except for 30 vs. 48 months (HR, 0.48; 95% CrI, 0.23–0.98). Compared with 12 months, longer DAPT of 30 months reduced the risk of myocardial infarction (HR, 0.47; 95% CrI, 0.37–0.61). Results also demonstrated that compared with 12 months, a shorter-term DAPT reduced the risk of major bleeding (6 months: HR, 0.53; 95% CrI, 0.29–0.98), whereas longer-term DAPT increased the risk of major bleeding (30 months: HR, 1.61; 95% CrI, 1.21–2.15). Conclusion: As expected, bleeding was less in the shorter duration regimens, whereas the ischemic outcomes were better in the longer duration ones.

BLEEDING RISK IS SIGNIFICANTLY HIGHER WITH TRIPLE ANTICOAGULANT THERAPY INCLUDING WARFARIN COMPARED WITH TRIPLE THERAPY INCLUDING NOVEL ORAL ANTICOAGULANT (NOAC) AGENTS

While triple anticoagulant therapy is associated with elevated hemorrhagic risk, it is oftentimes necessary in the clinical setting. Warfarin has been the bedrock component of triple therapy but NOAC as a triple therapy component is growing. Therefore, we sought to compare hemorrhagic risk with

TRIPLE ANTICOAGULANT THERAPY INCLUDING NOVEL ANTICOAGULANTS (NOACS) AND DUAL ANTIPLATELET THERAPY (DAPT) IS ASSOCIATED WITH SIGNIFICANTLY INCREASED HEMORRHAGE RISK THAN DAPT ALONE

About 5-10 % patients scheduled for coronary artery stenting require oral anticoagulation (OAC) for coexisting indications such as atrial fibrillation. Addition of DAPT to OAC (triple anticoagulant therapy) increases bleeding risk. However, there are no studies evaluating bleeding risk using triple