Michael P. Thomas

Taken Out of Context

A 25-year-old woman with a history of depression, mitral-valve prolapse, and migraine headaches presented to a hospital emergency department with a 3-day history of subjective fever, diffuse arthralgia, and a severe generalized headache that was not characteristic of her previous migraines.

Outcome of Contemporary Percutaneous Coronary Intervention in the Elderly and the Very Elderly: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

There is a paucity of data on the outcome of contemporary percutaneous coronary intervention (PCI) in the elderly. Accordingly, we assessed the impact of age on outcome of a large cohort of patients undergoing PCI in a regional collaborative registry.

Acute Necrotizing Eosinophilic Myocarditis in a Patient Taking Garcinia Cambogia Extract Successfully Treated With High-Dose Corticosteroids

A previously healthy 48-year-old woman was evaluated for lightheadedness and chest heaviness 2 weeks after starting the herbal supplement Garcinia cambogia. She was found to be hypotensive and had an elevated serum troponin level. The patient had a progressive clinical decline, ultimately experiencing fulminant heart failure and sustained ventricular arrhythmias, which required extracorporeal membrane oxygenation support. Endomyocardial biopsy results were consistent with acute necrotizing eosinophilic myocarditis (ANEM). High-dose corticosteroids were initiated promptly and her condition rapidly improved, with almost complete cardiac recovery 1 week later. In conclusion, we have described a case of ANEM associated with the use of Garcinia cambogia extract.

Update on primary PCI for patients with STEMI

Primary PCI is the dominant reperfusion strategy for patients with ST-elevation myocardial infarction and continues to evolve. The purpose of this review is to summarize recent reports that focused on the relationship of door-to-balloon time with mortality, radial versus femoral artery access, aspiration thrombectomy, culprit versus multivessel primary PCI, drug-eluting stents, and anticoagulation and antiplatelet therapies.

Percutaneous Coronary Intervention Utilization and Appropriateness across the United States

Background Substantial geographic variation exists in percutaneous coronary intervention (PCI) use across the United States. It is unclear the extent to which high PCI utilization can be explained by PCI for inappropriate indications. The objective of this study was to examine the relationship between PCI rates across regional healthcare markets utilizing hospital referral regions (HRRs) and PCI appropriateness. Methods The number of PCI procedures in each HRR was obtained from the 2010 100% Medicare limited data set. HRRs were divided into quintiles of PCI utilization with increasing rates of utilization progressing to quintile 5. NCDR CathPCI Registry® data were used to evaluate patient characteristics, appropriate use criteria (AUC), and outcomes across the HRR quintiles defined by PCI utilization with the study population restricted to HRRs where ≥ 80% of the PCIs were performed at institutions participating in the registry. PCI appropriateness was defined using 2012 AUC by the American College of Cardiology (ACC)/American Heart Association (AHA)/The Society for Cardiovascular Angiography and Interventions (SCAI). Results Our study cohort comprised of 380,981 patients treated at 178 HRRs. Mean PCI rates per 1,000 increased from 4.6 in Quintile 1 to 10.8 in Quintile 5. The proportion of non-acute PCIs was 27.7% in Quintile 1 increasing to 30.7% in Quintile 5. Significant variation (p < 0.001) existed across the quintiles in the categorization of appropriateness across HRRs of utilization with more appropriate PCI in lower utilization areas (Appropriate: Q1, 76.53%, Q2, 75.326%, Q3, 75.23%, Q4, 73.95%, Q5, 72.768%; Inappropriate: Q1 3.92%, Q2 4.23%, Q3 4.32%, Q4 4.35%, Q5 4.05%; Uncertain: Q1 8.29%, Q2 8.84%, Q3 8.08%, Q4 9.01%, Q5 8.93%; Not Mappable: Q1 11.26%, Q2 11.67%, Q3 12.37%, Q4 12.69%, Q5 14.34%). There was no difference in risk-adjusted mortality across quintiles of PCI utilization. Conclusions Geographic regions with lower PCI rates have a higher proportion of PCIs performed for appropriate indications. Areas that perform more PCIs also appear to perform more elective PCI and many could not be mapped by the AUC.

When is it right to be wrong

Coronary angiography is a critical diagnostic tool for defining anatomy and guiding therapy in coronary artery disease. Not surprisingly, it has gained widespread use since Mason Sones first described it over 50 years ago with an estimated 2 million procedures performed each year in the United

Temporal trends in peripheral arterial interventions: Observations from the blue cross blue shield of michigan cardiovascular consortium (BMC2 PVI)

The aim is to examine trends in procedural indication, arterial beds treated, and device usage in peripheral arterial interventions (PVIs).

Cor Triatriatum: A Reversible Cause of Severe Pulmonary Hypertension

Cor triatriatum sinister is a congenital heart disorder that can lead to progressive dyspnea, pulmonary hypertension, and ultimately right ventricular (RV) failure. We report a case in which symptoms of progressive pulmonary hypertension were initially attributed to asthma, leading to a delayed diagnosis that resulted in suprasystemic pulmonary pressures and RV dysfunction. Rapid symptomatic and hemodynamic improvement was observed after surgical repair, with normalization of pulmonary artery pressures and RV function.

Percutaneous coronary intervention strategies in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease

Purpose of review This review aims to summarize recent reports on percutaneous coronary intervention (PCI) strategies for patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD). Recent findings Recent randomized clinical trials and meta-analyses have suggested that patients with STEMI and multivessel CAD may benefit more from multivessel PCI (either multivessel primary PCI or staged PCI before hospital discharge) than culprit vessel-only primary PCI. These reports have changed clinical practice guideline recommendations that now conclude that multivessel PCI may be considered in selected hemodynamically stable patients with significant noninfarct artery stenoses based on anatomic criteria alone. Fractional flow reserve measurement can document functional significance in nonculprit stenoses, but fractional flow reserve-guided PCI has not been shown to impact mortality or myocardial infarction rates. Additionally, nonculprit artery chronic total occlusion PCI was not effective in improving left ventricular function in one randomized trial. Summary Multivessel primary PCI or staged PCI is effective and safe in selected patients with STEMI and multivessel coronary disease. Future randomized controlled trials are needed to define the optimal timing of multivessel PCI, as well as the appropriate use of PCI in nonculprit stenoses.

PERCUTANEOUS VASCULAR INTERVENTION MARKET TRENDS: BULLISH ON LEGS, BEARISH ON RENALS- THE BLUE CROSS BLUE SHIELD OF MICHIGAN CARDIOVASCULAR CONSORTIUM EXPERIENCE

Peripheral arterial interventions (PVIs) are expanding. However, there is little data on the vascular beds treated and devices utilized. The study cohort was consecutive PVIs from January 2006 through December 2012 in the BMC2 PVI Registry. PVIs were divided by arterial segments to determine trends