Parshva Patel

Comparison of Inhospital Mortality, Length of Hospitalization, Costs, and Vascular Complications of Percutaneous Coronary Interventions Guided by Ultrasound Versus Angiography

Despite the valuable role of intravascular ultrasound (IVUS) guidance in percutaneous coronary interventions (PCIs), its impact on clinical outcomes remains debatable. The aim of the present study was to compare the outcomes of PCIs guided by IVUS versus angiography in the contemporary era on inhospital outcomes in an unrestricted large, nationwide patient population. Data were obtained from the Nationwide Inpatient Sample from 2008 to 2011. Hierarchical mixed-effects logistic regression models were used for categorical dependent variables like inhospital mortality, and hierarchical mixed-effects linear regression models were used for continuous dependent variables like length of hospital stay and cost of hospitalization. A total of 401,571 PCIs were identified, of which 377,096 were angiography guided and 24,475 (weighted n = 119,102) used IVUS. In a multivariate model, significant predictors of higher mortality were increasing age, female gender, higher baseline co-morbidity burden, presence of acute myocardial infarction, shock, weekend and emergent admission, or occurrence of any complication during hospitalization. Significant predictors of reduced mortality were the use of IVUS guidance (odds ratio 0.65, 95% confidence interval 0.52 to 0.83; p <0.001) for PCI and higher hospital volumes (third and fourth quartiles). The use of IVUS was also associated with reduced inhospital mortality in subgroup of patients with acute myocardial infarction and/or shock and those with a higher co-morbidity burden (Charlsons co-morbidity index ≥2). In one of the largest studies on IVUS-guided PCIs in the drug-eluting stent era, we demonstrate that IVUS guidance is associated with reduced inhospital mortality, similar length of hospital stay, and increased cost of care and vascular complications compared with conventional angiography-guided PCIs.

Mortality among high-risk patients admitted with septic shock to U.S. teaching hospitals in July: Does the ‘July Effect’ exist?

Background The ‘July effect’ is a phenomenon of inferior delivery of care at teaching hospitals during July because of relative inexperience of new physicians. Objective To study the difference in mortality among septic shock patients during July and another month. Methods Using the U.S. Nationwide Inpatient Sample, we estimated the difference in mortality among septic shock patients admitted during May and July from 2003 to 2011. Results 117,593 and 121,004 patients with septic shock were admitted to non‐teaching and teaching hospitals, respectively, in May and July. High‐risk patients had similar mortality rates in non‐teaching hospitals and teaching hospitals. Mortality rates were higher in teaching versus non‐teaching hospitals in high‐risk patients both in May and July. Overall, mortality rates were higher in teaching versus non‐teaching hospitals both in May and July. Conclusion Similar trends in mortality are observed in both settings in May and July and no “July effect” was observed.

Non–ST‐Segment–Elevation Myocardial Infarction Among Patients With Chronic Kidney Disease: A Propensity Score–Matched Comparison of Percutaneous Coronary Intervention Versus Conservative Management

Background Chronic kidney disease (CKD) remains an independent predictor of cardiovascular morbidity and mortality. CKD complicates referral for percutaneous coronary intervention (PCI) in non–ST‐segment–elevation myocardial infarction (NSTEMI) patients because of the risk for acute kidney injury and the need for dialysis, with American College of Cardiology/American Heart Association guidelines underscoring the limited data on these patients. Methods and Results Using the National Inpatient Sample to analyze hospitalizations in the United States from 2004 to 2014, we sought to assess PCI utilization and in‐hospital outcomes in NSTEMI admissions with CKD. NSTEMI admissions were identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD‐9‐CM) code 410.7. CKD admissions were identified by ICD‐9‐CM code 585. Propensity score–matched cohorts of patients with NSTEMI were matched for age, sex, comorbidities, race, median household income, primary payer status, and hospital characteristics. Of 4 488 795 hospitalizations for NSTEMI, 31% underwent PCI. Overall, 89% of admissions had no CKD. In addition, 32% of NSTEMI admissions with no CKD and 23%, 14%, and 22% with CKD stages 3, 4, and 5 underwent PCI, respectively. Hospitalized NSTEMI patients with CKD stages 4 and 5 had 41% and 20% less likelihood, respectively, of undergoing PCI compared with those with no CKD. Among hospitalized NSTEMI patients with no CKD or CKD stage 3, 4, or 5, PCI‐treated groups had 63%, 57%, 39%, and 59% lower likelihood, respectively, of all‐cause, in‐hospital mortality compared with propensity score–matched medically managed groups. Conclusions PCI use decreased among hospitalized NSTEMI patients as CKD severity increased, and all‐cause, in‐hospital mortality was greater for NSTEMI patients admitted with more severe CKD regardless of treatment strategy.

The Potential Pozzolanic Activity of Different Ceramic Waste Powder as Cement Mortar Component (Strength Activity Index)

Under the strong contemporary demand for modern and environmental friendly materials, natural pozzolan can be proved to be such material and several researchers have focused their research efforts in using it as a partial substitute in the manufacture of concrete and mortar. Pozzolans are divided into two categories, namely the natural and the artificial, as metakaoline and silica fume (SF). In recent years, the industry has shifted to using natural pozzolans because of their lower cost and accessibility. A pozzolan is a siliceous material that can be used as an inexpensive Substitute for cement in mortar mixtures. The objective of this experimental study was to examine the possibility of reusing ceramic materials waste from ceramic industry as partial cement replacement in mortar and concrete. The different types of ceramic waste were finely ground to specific sizes (0–45 lm, 45–75 lm and 75–150 lm) from different industries and its pozzolanic activity was determined. The compressive strength activity index at 7, 28 days and accelerated curing was determined in mortars produced with each finely grounded waste ceramics and different percentages of partial cement replacement. As per Indian standard mortar bar tests on 70.6*70.6*70.6 mm3 size mortar specimens were performed and results concluded with comparison to nominal mix specimen. own text. Keywords— Ceramic material, pozzolonic, consistency, strength activity

TRENDS IN PREVALENCE AND IN-HOSPITAL MORTALITY OF NSTEMI PATIENTS WITH SOLID TUMOR CANCER: THE NATIONWIDE ANALYSIS FROM 1998-2013

Background: The prevalence and outcomes in patients presenting with acute coronary syndrome with pre-existing cancer has been under-represented in major clinical trials. We sought to assess the temporal trends in the prevalence of Non ST elevation Myocardial Infarction (NSTEMI) with the most

UTILITY OF INTRACARDIAC ECHOCARDIOGRAPHY IN SETTING OF CARDIAC DEVICE-RELATED ENDOCARDITIS AND LEAD EXTRACTION

Transesophageal echocardiography (TEE) is currently the gold standard for diagnosis of cardiac device- related endocarditis (CDE) with a sensitivity of 94-96%. Intracardiac echocardiography (ICE) is routinely used during lead extraction procedures for early identification of procedural complications