Mohamed Omer

Trends of Incidence, Clinical Presentation, and In-Hospital Mortality Among Women With Acute Myocardial Infarction With or Without Spontaneous Coronary Artery Dissection: A Population-Based Analysis

OBJECTIVESnThe authors sought to determine the clinical characteristics and in-hospital survival of women presenting with acute myocardial infarction (AMI) and spontaneous coronary artery dissection (SCAD).nnnBACKGROUNDnThe clinical presentation and in-hospital survival of women with AMI and SCAD remains unclear.nnnMETHODSnThe National Inpatient Sample (2009 to 2014) was queried for all women with a primary diagnosis of AMI and concomitant SCAD. Iatrogenic coronary dissection was excluded. The main outcome was in-hospital mortality. Propensity score matching and multivariable logistic regression analyses were performed.nnnRESULTSnAmong 752,352 eligible women with AMI, 7,347 had a SCAD diagnosis. Women with SCAD were younger (61.7xa0vs. 67.1 years of age) with less comorbidity. SCAD was associated with higher incidence of in-hospital mortality (6.8%xa0vs. 3.4%). In SCAD patients, a decrease in in-hospital mortality was evident with time (11.4% in 2009 vs. 5.0% in 2014) and concurred with less percutaneous coronary intervention (PCI) (82.5% vs. 69.1%). Propensity score yielded 7,332 SCADxa0and 14,352 patients without SCAD. The odds ratio (OR) of in-hospital mortality remained higher with SCAD after propensity matching (OR: 1.87, 95% confidence interval [CI]: 1.65 to 2.11) and on multivariable regression analyses (OR: 2.41, 95% CI: 2.07 to 2.80). PCI was associated with higher mortality in SCAD patients presenting with non-ST-segment elevation myocardial infarction (OR: 2.01; 95% CI: 1.00 to 4.47), but not with STEMI (OR: 0.62; 95% CI: 0.41 to 0.96).nnnCONCLUSIONSnWomen presenting with AMI and SCAD appear to be at higher risk of in-hospital mortality. Lower ratesxa0of PCI were associated with improved survival, with evidence of worse outcomes when PCI was performed forxa0SCADxa0inxa0thexa0setting of non with ST-segment elevation myocardial infarction.

YOUNG PATIENT WITH DANON DISEASE PRESENTING WITH HIGH DEGREE ATRIO-VENTRICULAR BLOCK

Danon disease is a rare glycogen storage disease. Cardiac involvement results in Wolff-Parkinson-White (WPW) syndrome, left ventricular hypertrophy and ventricular fibrosis. The majority of patients die in early adulthood either from end-stage cardiomyopathy or ventricular arrhythmias. Therefore,

Meta-Analysis Comparing Catheter-Guided Ablation Versus Conventional Medical Therapy for Patients With Atrial Fibrillation and Heart Failure With Reduced Ejection Fraction

The prognostic benefit of catheter ablation (CA) for atrial fibrillation in the setting of heart failure (HF) with reduced ejection fraction (EF) is unclear. A systematic search of medical literature was limited to randomized controlled trials. The primary outcome was all-cause mortality, and secondary outcomes were HF hospitalizations, stroke, left ventricular EF improvement, change in 6-minute walk test, and change in Minnesota living with HF questionnaire (Δ MLHFQ). Random effects risk ratios (RR) were calculated for categorical outcomes and standardized mean differences (SMD) for continuous ones, using Der-Simonian and Liard model. A total of 775 ambulatory patients from 6 trials were included. The mean EF was 31% with a mean New York Heart Association classification class 2.5. At a mean follow-up of 26 months, CA was associated with lower incidences of all-cause mortality (RR 0.50, 95% confidence intervals [CI] 0.34 to 0.74, I2u202f=u202f0%, p <0.0001), and HF hospitalizations (RR 0.58, 95% CI 0.41 to 0.81, p = 0.002, I2u202f=u202f0%), with similar incidences of stroke. Left ventricular EF improvement (SMDu202f=u202f2.58, 95% CI 0.88 to 4.27), and change in Minnesota living with heart failure HF questionnaire (SMDu202f=u202f-0.40, 95% CI -0.65 to -0.14) were also in favor of CA, with no difference noted in change in 6-minute walk test. The incidence of all reported procedural complications (including major and minor) was 7.3%. In conclusion, CA of atrial fibrillation appears to be associated with improved survival and HF hospitalizations compared with medical therapy, with evidence of low ablation-related complications.

Stability of pacing indices and need for pacing in cardiac transplant patients over 1 year of follow-up

BackgroundA significant minority of cardiac transplant patients require permanent pacemaker (PPM) implant, primarily for sinus node dysfunction. The stability of pacing indices has not been determined in this unique patient population, and data regarding ongoing need for pacing are limited.MethodsPacing indices (sensing, threshold, and impedance) as well as the percentage of time patients required pacing were recorded, from 30 cardiac transplant patients that underwent PPM implant, over 1xa0year of follow-up. Repeated measure ANOVA (analysis of variance) was used to compare pacing indices and the percentage of time patients required pacing in each cardiac chamber (right atrium (RA) and right ventricle (RV)) and at different time points.ResultsThere was no difference in sensing among the follow-up time points (pu2009=u20090.9). Thresholds at 3xa0months were significantly higher compared to the day of implant (pu2009=u20090.005) and the day after implant (pu2009=u20090.03). Impedances at implant were significantly higher compared to day 1 (pu2009<u20090.001), 3xa0months (pu2009<u20090.003), and 12xa0months (pu2009<u20090.001) post-implant. The mean percentage of RA pacing was 85u2009±u20096% the day after implant, 74u2009±u20096% at 3xa0months, and 80u2009±u20096% at 1xa0year (pu2009=u20090.17).ConclusionIn cardiac transplant patients, pacing impedances decrease and thresholds trend up in short-term follow-up, but subsequent sensing, threshold, and impedance remain stable at 1xa0year. This is comparable to the pattern observed among noncardiac transplant PPM recipients. The atrial pacing percentage was stable over 1xa0year, suggesting continued relative sinus node dysfunction.