Naoki Misumida

Comparison of Outcomes in Patients Having Acute Myocardial Infarction With Versus Without Sickle-Cell Anemia

Sickle-cell disease (SCD) affects millions worldwide. Sickle-cell anemia (SCA), the most severe form of this disease, is the most common inherited blood disorder in the United States. There are limited data on the incidence, clinical characteristics, and outcomes of acute myocardial infarction (AMI) in these patients. Using data from the National Inpatient Sample database, we matched cases (AMI with SCA) with controls (AMI without SCA) in a 1:1 ratio for age, gender, race, and year of admission. We compared both groups in terms of clinical characteristics and inpatient outcomes and performed a logistic regression with mortality as the primary outcome. Using weighted samples, we also described trends of SCA in the general population of patients with AMI. Of the 2,386,657 admissions with AMI, SCA was reported in 501 (0.02%) patients, and 495 were successfully matched to controls. Patients with SCA were less likely to have risk factors for coronary artery disease than those without SCA. Patients with SCA were more likely to develop pneumonia, respiratory failure, and acute renal failure, and require mechanical ventilation, hemodialysis for acute renal failure and blood transfusion. In-hospital mortality was significantly higher in patients with SCA. In a multivariate analysis, SCA was an independent predictor of mortality (odds ratio 3.49; 95% confidence interval 1.99 to 6.12; pu2009=u2009<u2009.001). In conclusion, myocardial infarction occurs in patients with SCA at a relatively early age. These patients do not typically have the traditional risk factors for the acute coronary syndrome. Mortality in these patients is significantly higher in age-, gender-, and race-matched controls.

Racial differences in the neutrophil-to-lymphocyte ratio in patients with non-ST-segment elevation myocardial infarction.

ObjectivesThe neutrophil-to-lymphocyte ratio (NLR) predicts short-term and long-term mortalities in patients with stable and unstable coronary artery disease. However, it has been reported that white blood cell and neutrophil counts vary considerably among different races. We aimed to assess the impact of racial difference on NLR in our diverse population with non-ST-segment elevation myocardial infarction (NSTEMI). MethodsWe carried out a retrospective analysis of 456 consecutive NSTEMI patients who had undergone coronary angiography. The patients were divided into four groups on the basis of self-reported race: White, Hispanic, African-American, and Asian. NLR was compared among the four groups. Univariate and multivariate linear regression analyses were carried out between NLR and baseline clinical characteristics and angiographic findings. The primary outcome was inhospital mortality. ResultsThe median NLR in the entire study population was 3.47 (interquartile range, 2.16–5.57). NLR differed significantly among the four groups according to the Kruskal–Wallis test (P=0.03). NLR was significantly lower in the African-American group compared with the White group according to the Steel–Dwass test (P=0.03). Multivariate analysis revealed that African-American ethnicity was negatively associated with NLR (P=0.04). The second multivariate analysis using the White group as a reference also revealed that African-American ethnicity was negatively associated with NLR (P=0.04). There was no significant difference in inhospital mortality among the four groups. ConclusionThe present study demonstrated an independent association between race and NLR in patients with NSTEMI, suggesting that a tailored cutoff value according to race would provide more precise prognostic information.

Role of Routine Follow-up Coronary Angiography After Percutaneous Coronary Intervention ― Systematic Review and Meta-Analysis ―

BACKGROUNDnPrior studies have shown that routine follow-up coronary angiography (CAG) following percutaneous coronary intervention (PCI) increases the incidence of revascularization without a clear reduction in major adverse clinical events. However, none of these prior studies were adequately powered to evaluate hard clinical endpoints such as myocardial infarction (MI) or death and thus the clinical utility of such practice remains to be determined.Methodsu2004andu2004Results:We conducted a systematic review and meta-analysis of randomized trials that compared clinical outcomes after PCI between patients who underwent routine follow-up CAG and those who only had clinical follow-up. Five randomized trials, totaling 4,584 patients met our inclusion criteria, including studies that used sub-randomization and ones that assigned consecutive patients per study protocol. Our results showed that routine follow-up CAG was associated with a lower rate of MI (odds ratio [OR] 0.65; 95% confidence interval [CI] 0.46-0.91; P=0.01) without reduction in all-cause mortality (OR 0.87; 95% CI 0.59-1.28; P=0.48), and a higher rate of target lesion revascularization (OR 1.73; 95% CI 1.42-2.11; P<0.001).nnnCONCLUSIONSnOur meta-analysis demonstrated that routine follow-up CAG after PCI was associated with a higher rate of revascularization, but also with a reduction in the rate of subsequent MI. Further studies investigating the potential role of routine follow-up angiography may be warranted.

Higher Risk of Bleeding in Asians Presenting With ST-Segment Elevation Myocardial Infarction: Analysis of the National Inpatient Sample Database

Bleeding is a major complication in patients presenting with ST-segment elevation myocardial infarction (STEMI). Several studies suggested that Asians are more susceptible to bleeding when treated with antiplatelets, anticoagulants, and thrombolytic agents. In our study, we aimed to investigate the association between Asian ethnicity and bleeding events in patients who presented with STEMI. We analyzed the Nationwide Inpatient Sample database from 2002 to 2013 and identified patients hospitalized with a primary diagnosis of STEMI. We compared clinical outcomes between patients of Asian and white ethnicity. Primary outcome was inhospital major bleeding defined as a composite of intracranial hemorrhage and blood transfusions for bleeding events. After exclusions, an estimated 1 695 680 white and 46 563 Asian patients with STEMI were included in the analysis. Asian patients had a higher incidence of inhospital major bleeding (3.6% vs 2.2%, P < .001) without a significant difference in inhospital mortality (9.3% vs 8.7%, P = .06). Asian ethnicity was an independent predictor for major bleeding (estimated odds ratio: 1.32; 95% confidence interval: 1.16-1.51; P < .001). This increased risk of bleeding would warrant further investigation of optimal treatment strategies tailored for patients with STEMI of Asian ethnicity.

Positive T wave in lead aVR as an independent predictor for 1-year major adverse cardiac events in patients with first anterior wall ST-segment elevation myocardial infarction

Positive T wave in lead aVR has been shown to predict an adverse in‐hospital outcome in patients with anterior wall ST‐segment elevation myocardial infarction (STEMI). However, the prognostic value of positive T wave in lead aVR on a long‐term outcome has not been fully explored.

Higher Risk of Bleeding in Asians Presenting With Non-ST-Segment Elevation Myocardial Infarction

Bleeding events are associated with unfavorable prognosis in patients with acute coronary syndromes. In a recent publication, we reported that Asian patients presenting with ST-segment elevation myocardial infarction are at a higher risk of bleeding than whites. Although similar results were noted in Asian patients with non-ST-segment elevation myocardial infarction (NSTEMI) using registry data from 2003 to 2005, characteristics of contemporary NSTEMI cohort and their bleeding risks may differ following advancements in troponin assays, changes in definition of myocardial infarction, and adoption of newer antiplatelet agents. In this context, we sought to reinvestigate the impact of Asian ethnicity on bleeding in a contemporary NSTEMI cohort. We analyzed the Nationwide Inpatient Sample database, a part of the Healthcare Cost and Utilization Project from the Agency for Healthcare Research and Quality, and identified all patients older than 18 years who were hospitalized with a primary diagnosis of NSTEMI (International Classification of Diseases diagnosis code 410.7x) between 2010 and 2014. The institutional review board of our facility determined that this study was exempted from formal review. The exclusion criteria, codes used to identify comorbidities and outcomes, and covariates included in multivariate models (except for systemic thrombolysis) were identical to our prior study. The primary outcome was in-hospital major bleeding, defined as a composite of intracranial hemorrhage and blood transfusion for bleeding events. All statistical analyses were performed with SPSS version 24.0 (IBM Corp, Armonk, New York). Data on race were missing in 7.9% of the population. After exclusions, 285 076 white and 8608 Asian patients were included. Hypertension, diabetes, renal failure, anemia, and cardiogenic shock were more commonly observed in Asians, while obesity was less prevalent (Table 1). Asian patients had a

Exploring the “Weekend Effect” on the Care of Patients with Left Ventricular Assist Devices

Using data from the National Inpatient Sample (NIS) database, with a weighted estimate of more than 35 million admissions per year. We identified patients 18 years or older with an ICD code signifying presence of a LVAD. Characteristics, comorbidities and clinical outcomes were compared between patients admitted on Citation: Ogunbayo G (2018) “Exploring the “Weekend Effect” on the Care of Patients with Left Ventricular Assist Devices”

Sex differences in complications of catheter ablation for atrial fibrillation: results on 85,977 patients

PurposeCatheter ablation (CA) is an effective treatment for atrial fibrillation (AF). The differences in complication rates and outcomes between women and men remain poorly studied. We aimed to study the sex differences in morbidity and mortality associated with CA in AF.MethodsUsing weighted sampling from the National Inpatient Sample database, women and men with a primary diagnosis of AF and a primary procedure of CA (2004–2013) were identified. We compared the following outcomes based on the sex: (1) major complications [post-procedure transfusion, cardiac drain or surgery, pulmonary embolism, cerebrovascular accident, major cardiac events, kidney failure requiring dialysis, and sepsis], (2) overall complications (minor and/or major complications), and (3) in-hospital mortality.ResultsAmong 85,977 patients who underwent CA for AF, 27821 (32.4%) were women. Overall complications were more frequent among women versus among men (12.4% versus 9.0%; pu2009<u20090.001), as well as major complications (4.7% versus 2.7%; pu2009<u20090.001). However, there was no difference in mortality (0.3% versus 0.2%; pu2009=u20090.22). After adjusting for other factors, women were more likely than men to have major complication (odds ratio 1.48, 95% CI 1.21–1.82; pu2009<u20090.001). Prior CABG was associated with lower risk of major complications in both sexes (odds ratio in the overall cohort 0.27, 95% CI 0.12–0.61; pu2009=u20090.002), mostly driven by the reduction in tamponade and pericardial drain.ConclusionsAmong patients who underwent catheter ablation for AF, the female sex was associated with higher rate of complications compared to male but no difference in mortality. Prior CABG was associated with a significant reduction of major complications in both sexes.

In-hospital outcomes of percutaneous ventricular assist devices versus intra-aortic balloon pumps in non-ischemia related cardiogenic shock

Introduction: This study compared inpatient outcomes related to the use of these two devices among patients who developed cardiogenic shock not due to acute myocardial infarction or coronary revascularization. Methods: We extracted admission‐level records of patients with a diagnosis of cardiogenic shock who underwent either PVAD or IABP implantation from the National Inpatient Sample (NIS) database from 2010 to 2014. Our outcomes of interest were mortality and length of stay. Results: Inpatient mortality was significantly higher in the PVAD cohort. In multivariate analysis, PVAD use in these patients was associated with higher mortality. There was no difference in the length of stay between both groups among patients that survived to discharge. Conclusion: In our analysis of the NIS database, the use of PVADs in patients with cardiogenic shock of non‐ischemic origin was associated with higher mortality when compared to IABP use.

Sex differences in the contemporary management of HIV patients admitted for acute myocardial infarction

Studies have reported sex differences in the management of patients with acute myocardial infarction (AMI) in the general population. This observational study is designed to evaluate whether sex differences exist in the contemporary management of human immunodeficiency virus (HIV) patients admitted for diagnosis of AMI.