Faisal Latif

Temporal Trends and Outcomes of Patients Undergoing Percutaneous Coronary Interventions for Cardiogenic Shock in the Setting of Acute Myocardial Infarction: A Report From the CathPCI Registry

OBJECTIVES The purpose of this study was to examine the temporal trends in demographics, clinical characteristics, management strategies, and in-hospital outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (CS-AMI) who underwent percutaneous coronary intervention (PCI) from the Cath-PCI Registry (2005 to 2013). BACKGROUND The authors examined contemporary use and outcomes of PCI in patients with CS-AMI. METHODS The authors used the Cath-PCI Registry to evaluate 56,497 patients (January 2005 to December 2013) undergoing PCI for CS-AMI. Temporal trends in clinical variables and outcomes were assessed. RESULTS Compared with cases performed from 2005 to 2006, CS-AMI patients receiving PCI from 2011 to 2013 were more likely to have diabetes, hypertension, dyslipidemia, previous PCI, dialysis, but less likely to have chronic lung disease, peripheral vascular disease, or heart failure within 2 weeks (p < 0.01). Between 2005 and 2006 to 2011 and 2013, intra-aortic balloon pump use decreased (49.5% to 44.9%; p < 0.01), drug-eluting stent use declined (65% to 46%; p < 0.01), and the use of bivalirudin increased (12.6% to 45.6%). Adjusted in-hospital mortality; increased (27.6% in 2005 to 2006 vs. 30.6% in 2011 to 2013, adjusted odds ratio: 1.09, 95% confidence interval: 1.005 to .173; p = 0.04) for patients who were managed with an early invasive strategy (<24 h from symptoms). CONCLUSIONS Our study shows that despite the evolution of medical technology and use of contemporary therapeutic measures, in-hospital mortality in CS-AMI patients who are managed invasively continues to rise. Additional research and targeted efforts are indicated to improve outcomes in this high-risk cohort.

Comparison of radiation dose between different fluoroscopy systems in the modern catheterization laboratory: Results from bench testing using an anthropomorphic phantom

Variations in radiation dose between various X‐ray systems have received limited study.

SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory: (Endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologia intervencionista; Affirmation of value by the Canadian Association of interventional cardiology-Association canadienne de cardiologie d'intervention).

The SCAI Expert Consensus Statement: 2012 Best Practices in the Cardiac Catheterization Laboratory provides standards for preprocedure, intraprocedure, and postprocedure evaluation and management, and served as a patient-centered approach to safety and quality in the cardiac catheterization laboratory (CCL) [1]. It was noted that the CCL is a setting in which elective, urgent, and emergent percutaneous procedures are performed, and that high throughput and increasing patient complexity demand optimal periprocedural communication, clinical management, documentation, and protocol. Regulations primarily targeted at open surgical suites have the potential to negatively impact the quality of care because they shift the focus to performance measures that are not necessarily relevant to the CCL. Accordingly, directives were tailored to the percutaneous setting in order to assure quality and optimal patient safety while maintaining efficiency.

Racial/Ethnic Variation in Carotid Artery Revascularization Utilization and Outcomes Analysis From the National Cardiovascular Data Registry

Background and Purpose— It is not known whether racial or ethnic disparities observed with other revascularization procedures are also seen with carotid artery stenting (CAS) and endarterectomy (CEA). Methods— We compared the utilization and outcomes of CAS and CEA across racial/ethnic groups within the CARE Registry between May 2007 and December 2012. Results— Between 2007 and 2012, of the 13 129 patients who underwent CAS, majority were non-Hispanic whites (89.3%), followed by blacks (4.4%), Hispanics (4.3%), and other groups (2.0%). A similar distribution was observed among the 10 953 patients undergoing CEA (non-Hispanic whites, 92.6%; blacks, 3.5%; Hispanics, 2.8%; and other groups, 1.1%). During this time period, a trend toward proportionate increase in CAS utilization was observed in non-Hispanic whites and other groups, whereas the opposite was observed among Hispanics and blacks. This trend persisted even when hospitals performing both CAS and CEA were exclusively analyzed. Adherence to antiplatelet and statin therapy was significantly lower among blacks post CEA. In-hospital major adverse cardiac and cerebrovascular events remained comparable across groups post CAS and CEA. At 30 days, the incidence of stroke (7.2%) and major adverse cardiac and cerebrovascular events (8.8%) was higher among blacks post CEA (P<0.05), after risk adjustment. Conclusion— During the study period, utilization of CAS and CEA was highest among non-Hispanic whites. There was a trend toward increased CAS utilization over time among non-Hispanic whites and other groups, and a trend toward increased CEA utilization among Hispanics and blacks. In-hospital major adverse cardiac and cerebrovascular events remained comparable between groups, whereas 30-day major adverse cardiac and cerebrovascular events were significantly higher in blacks.

Interleukin-6, but not C-reactive protein, predicts the occurrence of cardiovascular events after drug-eluting stent for unstable angina.

BACKGROUND Evidences concerning the predictive value of baseline inflammatory biomarkers after drug-eluting stent (DES) placement are controversial, mainly because the use of statin was not precisely defined. OBJECTIVES The aim was to compare the differences between interleukin (IL)-6 and high-sensitivity C-reactive protein (hs-CRP) in predicting cardiovascular events 2 years after stenting in patients with unstable angina (UA) who had not received statin pretreatment. METHODS There were 1,896 patients included in this study. The primary end-point was the occurrence of cardiac death or myocardial infarction (MI). Secondary endpoints included all-cause death, stent thrombosis (ST), target lesion revascularization (TLR), target vessel revascularization (TVR), or a composite of major adverse cardiac events (MACE) at 2 years after the procedure. RESULTS During the median follow-up of 2.77 years, 96 patients experienced cardiac death (n = 37, 1.95%) or MIs (n = 70, 3.69%), 94 TLRs, 123 TVRs, 215 MACEs, and 21 definite or probable STs. In multivariable Cox proportional-hazards models and discrimination analysis, elevated IL-6 levels were superior to hs-CRP in predicting the occurrence not only of cardiac death or MI (HR 1.337, 95% CI 1.234-1.449, P < 0.001), but also of MACE and late-occurring definite/probable ST. Incorporation of IL-6 into conventional variables resulted in significantly increased c statistic for the prediction of end-points, with the exception of TLR and TVR. CONCLUSION Elevated IL-6 levels were independent predictors of cardiac death or MI, MACE, and late ST in patients with UA who had not received statin pretreatment, suggesting a role for IL-6 in the inflammatory risk assessment. Pathological studies have confirmed that atherosclerosis is a chronic inflammatory disease. Serum levels of high-sensitivity C-reactive protein (hs-CRP), matrix metalloproteinase, plasminogen activator inhibitor-1, the complement components C3a or C5a, and interleukin(IL)-6 were reported to provide strong and independent indications of the risk for future cardiovascular (CV) events, even among individuals who are thought to be free of vascular disease.

Indices of central aortic blood pressure and their impact on cardiovascular outcomes.

Elevated peripheral (brachial) blood pressure (PBP) is related to hard cardiovascular outcomes and remains the main target for antihypertensive therapy. However, central aortic blood pressure (CABP) can be measured noninvasively and could potentially prove to be a more important marker of cardiovascular diseases in future. Several studies have shown association of CABP with cardiovascular mortality, coronary artery disease, left-ventricular hypertrophy and atherosclerosis. Furthermore, the impact of various classes of antihypertensive agents on CABP is different from their impact on PBP. We review the significance of CABP in cardiovascular outcomes and the differential impact of antihypertensive therapy on CABP.

Role of hyperphosphatemia-mediated vascular calcification in cardiovascular outcomes and its management: a review.

Cardiovascular diseases are the leading cause of death in patients with advanced renal disease. Although atherosclerosis is the major contributor, vascular calcification also plays an important role in progression of coronary as well as peripheral arterial disease in these patients. A large body of evidence suggests that hyperphosphatemia is the major contributor in progressive vascular calcification. We examine this large body of evidence with respect to the role of hyperphosphatemia in inducing vascular calcification and how, as a result, this possibly impacts an increase in adverse cardiovascular events. We also review various options as to how treating hyperphosphatemia might effect a decrease in cardiovascular morbidity and mortality.

Applied Pathology for Interventions of Coronary Chronic Total Occlusion.

Percutaneous coronary intervention of chronically occluded vessels can result in significant improvement in symptoms, relieve myocardial ischemia, and affect a reduction in major adverse cardiac events. Likelihood of achieving successful revascularization can be significantly enhanced with a thorough understanding of the pathology of these occluded coronary arteries. In this chapter, various steps and techniques to cross the CTO lesion and recanalize it are discussed in details.

Radiation Safety During Interventions of Coronary Chronic Total Occlusion.

During percutaneous coronary interventions (PCI) for chronic total occlusion (CTO), prolonged procedures increase the risk of excessive radiation exposure. These situations harbor a major concern to protect patients and personnel in the cardiac interventional laboratory (CCL). Important questions regarding radiation safety for interventional cardiologists performing PCI for CTO lesions are discussed and concrete applications are suggested.

Pigment Epithelial-Derived Factor and Acute Coronary Syndrome: A Novel Protective Biomarker but Not for Routine Clinical Use at Present

er values indicate greater risk) have been reported to correlate with a poor outcome [7–16] . However, at present, the effect of biomarker-targeted therapy in ACS (with the exception of LDL-targeted treatment with statins [17–19] ) remains to be proven. The search for novel biomarkers which provide additional prognostic information is under active investigation at present, and several novel biomarkers of inflammation, coagulation, oxidative stress, and endothelial damage, among others, are being actively pursued [15, 20–28] . In patients with heart failure, high-sensitivity troponin has recently been shown to correlate with left-ventricular end-diastolic pressure and microvascular endothelial dysfunction and, therefore, might help guide ongoing therapy in these patients [29] . In this issue of Cardiology , Liu et al. [30] report yet another biomarker, pigment epithelial-derived factor (PEDF), which they conclude is protective against ACS. PEDF is a 50-kDa glycoprotein which belongs to the serpin protease inhibitor supergene family [31, 32] . It is widely expressed throughout the human body and has been shown to have anti-inflammatory, anti-oxidant, anti-angiogenic, anti-thrombotic, anti-tumorigenic, neutrophilic, and neuroprotective characteristics [31–33] . They report that their ACS patients (n = 200), comprising patients with unstable angina and myocardial infarction, had significantly lower mean values of PEDF (7.31 ± 2.21 μg/ml) than age-matched controls (n = 160) without The acute coronary syndrome (ACS) is invariably a consequence of plaque rupture inside the coronary artery vessel wall, with resultant disruption of the endothelial lining, subsequent deposition of platelets over the exposed area, and variable superimposed thrombus formation [1–4] . Resultant clinical presentation of unstable angina, acute non-ST-segment elevation or ST-segment elevation myocardial infarction, or sudden ischemic cardiac death is determined by the location and size of the ruptured plaque, extent of the superimposed thrombus, and distal platelet or thrombus embolization [1–4] . Clinical risk factors, such as older age, gender, family history of coronary artery disease (CAD), diabetes mellitus, previous history of a myocardial infarction, severity of underlying CAD, extent of myocardial damage, hypertension and chronic kidney disease, determine the outcome of these patients [5, 6] . In addition, several established biomarkers, such as peak creatine kinase-MB, peak troponin T and I, and elevated B-type natriuretic peptide, provide prognostic information [5, 6] . Total, and lowand high-density-lipoprotein cholesterol, and newer biomarkers, such as lipoprotein-associated phospholipase A 2 , high-sensitivity C-reactive protein, DNA polymorphism, fibrinogen, fibrinogen degradation products and heat shock protein (HSP70), provide prognostic information for subsequent death and myocardial infarction in patients with established CAD [7–16] . Higher values of these biomarkers (with the exception of HDL where lowReceived: August 27, 2013 Accepted: August 27, 2013 Published online: October 31, 2013