Krishan Soni

Long-term outcomes of angiographically confirmed coronary stent thrombosis: results from a multicentre California registry

AIMS Limited data exist on long-term outcomes of patients with stent thrombosis (ST). Our aim was to describe the long-term outcomes after angiographically confirmed ST. METHODS AND RESULTS In this multicentre registry, consecutive cases of definite ST were identified between 2005 and 2013. Clinical and procedural characteristics, in-hospital outcomes and long-term survival up to five years were compared between those with and those without adverse cardiovascular and cerebrovascular events (MACCE), defined as all-cause mortality, myocardial infarction and stroke. Two hundred and twenty-one patients with 239 stent thrombosis events were identified. Patients who developed MACCE were older, less likely to be men, and less likely to have hypertension. Angiographic characteristics were similar. Patients who had a MACCE event showed a trend towards a lower likelihood of procedural success (86% vs. 91%, p=0.05). MACCE rates were 22% at one year and 41% at five years. All-cause mortality was 13% at one year and 24% at five years. On multivariable analysis, age, diabetes mellitus, active smoking and ST at a bifurcation were independently associated with the occurrence of MACCE up to five years. CONCLUSIONS Age, active smoking, diabetes mellitus and bifurcation disease are independently associated with long-term MACCE over a five-year follow-up period.

Who's Underworked and Who's Overworked Now? An Update on Radiologist Shortage and Surplus

OBJECTIVE The purpose of this study was to present an updated report on the radiologist surplus and shortage situation using a recently developed improved measure-namely, the extent to which radiologists desire less or more work if their income were to change by the same percentage as their workload. MATERIALS AND METHODS Non-individually identifiable data from the American College of Radiologys (ACRs) 2007 Survey of Diagnostic Radiologists were used. Responses were weighted to be representative of all posttraining professionally active radiologists in the United States. Information is presented for all radiologists and according to such factors as type and size of practice, radiologist subspecialty, and geographic region. Multivariable regression analysis was used to identify the probable causal links between desired workload change and characteristics of radiologists and the practices where they work. Comparisons were made with ACRs similar 2003 Survey of Radiologists. RESULTS The net average workload change sought in 2007 was an approximately 3% increase. In 2003, radiologists on average did not desire a statistically significant change in workload. Regression analysis for 2007 showed a pattern of relative shortages and surpluses that was generally, but not entirely, different from that found in 2003. CONCLUSION The overall balance between the demand and the supply of radiologists shifted toward a surplus between 2003 and 2007. According to our measure, we judge there was a close balance in 2003, but a 3% surplus in 2007. The employment market seems generally, but not universally, to self-correct relative shortages and surpluses in individual geographic areas and subspecialties within a few years.

Outcomes of primary percutaneous coronary intervention in acute myocardial infarction due to unprotected left main thrombosis: The Asia-Pacific Left Main ST-Elevation Registry (ASTER)

INTRODUCTION Prior studies of ULM STEMI have been confined to small cohorts. Recent registry data with larger patient cohorts have shown contrasting results. We aim to study the outcomes of patients with unprotected left main (ULM) ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). METHODS The Asia-pacific left main ST-Elevation Registry (ASTER) is a multicenter retrospective registry involving 4 sites in Singapore, South Korea, and the United States. The registry included patients presenting with STEMI due to an ULM coronary artery culprit lesion who underwent emergency PCI. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiovascular events. RESULTS A total of 67 patients (mean age 64.2 ± 12.8 years, 53 [79.1%] males) were included. The distal left main bifurcation was most commonly involved (85%, n = 57). Fifty one (76%) patients had TIMI 3 flow post-PCI. The in-hospital mortality rate was 47.8% (n = 32); 61% (n = 41) had cardiac failure, 4% (n = 3) had emergency coronary artery bypass grafting, 1% (n = 1) had a re-infarction, 3% (n = 2) had stroke and 55% (n = 37) had malignant ventricular arrhythmias. On multivariate analysis, predictors of in-hospital mortality included older age (odds ratio (OR) 1.085 (95% confidence interval (CI) 1.002-1.175), P = 0.044), diabetes mellitus (OR 10.882 (95%CI 11.074-110.287), P = 0.043) and absence of post-PCI TIMI 3 flow (OR 71.429 (95%CI 2.985-1000), P = 0.008). CONCLUSIONS STEMI from culprit unprotected left main coronary artery stenosis is associated with significant mortality and morbidity. Emergency PCI provides an important treatment option in this high-risk group, but in-hospital mortality remains high.

Percutaneous Closure of a Residual Left Atrial Appendage Leak After Lariat Procedure

A 77-year-old man with long-standing persistent atrial fibrillation, coronary artery disease, and systolic heart failure underwent left atrial appendage (LAA) ligation with a Lariat suture delivery device (SentreHEART, Redwood City, California), and subsequent pulmonary vein isolation. One month

ELECTROCARDIOGRAPHIC CHARACTERISTICS OF LEFT MAIN CORONARY ARTERY ST-ELEVATION MYOCARDIAL INFARCTION: RESULTS FROM A MULTICENTER REGISTRY

Left main coronary artery (LMCA) ST-elevation myocardial infarction (STEMI) is associated with significant morbidity and mortality. The aim of this study is to describe the electrocardiographic (ECG) characteristics correlating with clinical outcomes for patients with LMCA STEMI in a multicenter