Marwan Badri

Medical malpractice litigation: a fellow's perspective.

The historical origin of medical malpractice litigation (MML) in the United States dates back to the first half of the 19th century [(1)][1]. At that time, most cases were related to poorly repaired fractures or were obstetrics cases. In recent decades, however, MML experienced a large-scale

INCIDENCE OF POSTOPERATIVE ATRIAL FIBRILLATION (POAF) AFTER ROBOTIC CABG VERSUS TRADITIONAL CABG AND ITS ASSOCIATED MORTALITY AND MORBIDITY

Postoperative Atrial Fibrillation (POAF) is a common complication following cardiac surgeries. Minimally invasive revascularization; like Robotic CABG (R-CABG) have shown comparable efficacy and shorter length of stay as compared to traditional sternotomy CABG. However, there is no data comparing

Precatheterization Use of P2Y12 Inhibitors in Non‐ST‐Elevation Myocardial Infarction Patients Undergoing Early Cardiac Catheterization and In‐Hospital Coronary Artery Bypass Grafting: Insights From the National Cardiovascular Data Registry®

Background Current guidelines recommend early P2Y12 inhibitor administration in non‐ST‐elevation myocardial infarction, but it is unclear if precatheterization use is associated with longer delays to coronary artery bypass grafting (CABG) or higher risk of post‐CABG bleeding and transfusion. This study examines the patterns and outcomes of precatheterization P2Y12 inhibitor use in non‐ST‐elevation myocardial infarction patients who undergo CABG. Methods and Results Retrospective analysis was done of 20 304 non‐ST‐elevation myocardial infarction patients in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry (2009–2014) who underwent catheterization within 24 hours of admission and CABG during the index hospitalization. Using inverse probability‐weighted propensity adjustment, we compared time from catheterization to CABG, post‐CABG bleeding, and transfusion rates between patients who did and did not receive precatheterization P2Y12 inhibitors. Among study patients, 32.9% received a precatheterization P2Y12 inhibitor (of these, 2.2% were given ticagrelor and 3.7% prasugrel). Time from catheterization to CABG was longer among patients who received precatheterization P2Y12 inhibitor (median 69.9 hours [25th, 75th percentiles 28.2, 115.8] versus 43.5 hours [21.0, 71.8], P<0.0001), longer for patients treated with prasugrel (median 114.4 hours [66.5, 155.5]) or ticagrelor (90.4 hours [48.7, 124.5]) compared with clopidogrel (69.3 [27.5, 114.6], P<0.0001). Precatheterization P2Y12 inhibitor use was associated with a higher risk of post‐CABG major bleeding (75.7% versus 73.4%, adjusted odds ratio 1.33, 95% confidence interval 1.22‐1.45, P<0.0001) and transfusion (47.6% versus 35.7%, adjusted odds ratio 1.51, 95% confidence interval 1.41‐1.62, P<0001); these relationships did not differ among patients treated with clopidogrel, prasugrel, or ticagrelor. Conclusions Precatheterization P2Y12 inhibitor use occurs commonly among non‐ST‐elevation myocardial infarction patients who undergo early catheterization and in‐hospital CABG. Despite longer delays to surgery, the majority of pretreated patients proceed to CABG <3 days postcatheterization. Precatheterization P2Y12 inhibitor use is associated with higher risks of postoperative bleeding and transfusion.

LBBB: The ECG Patterns and Cardiac Function in Patients With and Without Coronary Artery Disease

Left bundle branch block (LBBB) is a common conduction abnormality. Its prevalence increases from 0.4% at age 50 to 6.5% at age 80. (Eriksson, Hansson et al. 1998) LBBB is seen in many diseases such as coronary artery disease (CAD), hypertension, valvular heart disease, non-ischemic cardiomyopathies and conduction tissue defects/degenerations. (Nisse 1929; Jain and Mehta 2003) Identifying CAD in patients with LBBB has been the subject of many studies and remains a clinical challenge.

Isolated posteromedial papillary muscle endocarditis

A 69-year-old male presented with a 3-week history of fatigue. Physical examination revealed an Oslers node on the right index finger (see Supplementary data online, Figure S1 ), a Janeway lesion in the right palm (see Supplementary data online, Figure S2 ), and a splinter haemorrhage in the right middle finger. Laboratory data showed leucocytosis and methicillin-resistant Staphylococcus aureus grew …

Facing Procedural Complications as a Cardiovascular Trainee

For centuries, “ primum non nocere ,” or “first, do no harm,” has been one of the main bioethical principles taught to medical students around the world. However, almost all interventions undertaken by healthcare professionals are accompanied by some potential for harm. Even a simple

Coronary artery ostium occlusion—a rare manifestation of endocarditis

A 74-year-old male with past medical history of coronary artery disease, bioprosthetic aortic valve replacement and myeloproliferative disorder presented with fever and acute decompensated heart failure. Blood cultures grew S taphylococcus aureus . Transespohageal echocardiogram (TEE) revealed large mobile …

The Role of Aspirin in Primary Prevention of Vascular Events

We read with interest the meta-analysis conducted by Raju et al on the role of aspirin in primary prevention of cardiovascular disease. We are intrigued by the differences between the findings of this meta-analysis and a recent meta-analysis conducted by Seshasai et al. Both metanalyses included the same 9 clinical trials, with similar utcomes. Yet there are discrepancies between the 2 studies ith respect to the absolute number of strokes (720 vs 749), otal cardiovascular events (1861 vs 2107), total cardiovasular mortality (627 vs 674), and all-cause mortality (1859 s 1962) in the study by Raju et al compared with the study y Seshasai et al, respectively. The difference in cardiovascular events may be exlained by different definitions because the study by Sesasai et al does not define cardiovascular events. The difference in the other end points is more perplexing given

Adoption of the transradial approach for percutaneous coronary intervention and rates of vascular complications following transfemoral procedures: Insights from NCDR

This study was designed to examine the association between adopting the transradial approach for percutaneous coronary intervention (PCI) and rates of vascular complications following transfemoral PCI.

STAGED APPROACH TO CORONARY HYBRID CORONARY REVASCULARIZATION IN 515 CONSECUTIVE PATIENTS

Multiple options for the treatment of multivessel disease now exist including hybrid revascularization. Nuances in hybrid revascularization need further evaluation including timing of these procedures and optimal antiplatelet therapy. We retrospectively evaluated the efficacy of a staged hybrid