Intra-aortic Balloon Counterpulsation and Infarct Size in Patients with Acute Anterior Myocardial Infarction without Shock: The CRISP AMI Randomized Trial

Cardiogenic shock (CS) carries high mortality and morbidity. Early revascularization is an important strategy in management of these patients. We sought to determine the outcomes and predictors of revascularization among patients with CS. Patients with CS and acute myocardial infarction were identified using the National Inpatient Sample (NIS) data from January 2002 to December 2014 using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Subsequently, patients who underwent revascularization were then selected. A total of 118,618 patients with CS were identified. Out of these, about 55,735 (47%) patients underwent revascularization. Mean age of patients who underwent revascularization was lower when compared with patients not who underwent revascularization (66.40 vs 72.24 years, p < 0.01). Patients who underwent revascularization had lower mortality when compared with patients not who underwent revascularization (25.1% vs 52.2%, p < 0.01). Extracorporeal membrane oxygenation and mechanical circulatory support devices were often utilized more in patients who underwent revascularization. Overall, we found modest increased trend of revascularization over our study years with decline in mortality. Female gender, weekend admission, drug abuse, pulmonary hypertension, anemia, renal failure, neurological disorders, malignancy were associated with lower odds of revascularization. In conclusion, in this large nationally represented US population sample of CS patients, we found revascularization rate of about 47% with improvement in overall mortality over our study years.

Trends, Outcomes, and Predictors of Revascularization in Cardiogenic Shock.

This interdisciplinary research on the Kiev folia, a 10th century Slavonic manuscript, shows how material and biological analyses as well as imaging methods can be applied to answer relevant questions that contribute to a better understanding of the history and conservation of ancient manuscripts. By applying non-invasive analytical methods, including X-ray Fluorescence analysis (XRF) and Fourier Transform Infrared spectroscopy in reflection mode (rFTIR), calcium oxalate related to the degradation phenomena of the ink material was detected, showing rFTIR bands at 1644 cm−1 and 1327 cm−1. Moreover, potassium ferrocyanide was identified on the peculiar blue stains visible on some folios. Multispectral images of these stains improved the legibility of the underlying letters in the near infrared range. Finally, shotgun metagenomic analyses gave insight into the possible animal origin of the skin(s) used for the manufacture of the codex and the microbiome colonizing its surface. The microbiome consisted mainly of viruses (53%) and bacteria (47%) represented by halotolerant/halophilic bacteria as well as bacteria and viruses typical of the human microbiome. In contrast, the proportion of eukaryotes (0.05%) and archaea (0.07%) was very low. This information served to determine the conservation status and the risk of deterioration of the manuscript. 

The Kiev Folia: An interdisciplinary approach to unravelling the past of an ancient Slavonic manuscript

The use of mechanical circulatory devices to support high-risk elective percutaneous coronary intervention (PCI) has become more common as the group of patients considered inoperable or high risk for surgical revascularization has grown. Most of the data examining outcomes in high-risk PCI are observational and retrospective. Limited prospective randomized studies have been unable to show improved clinical outcomes with routine mechanical circulatory support (MCS) in patients with a high burden of coronary artery disease and reduced ejection fraction. The role for MCS in high-risk PCI continues to evolve as understanding of the appropriate groups for this therapy evolves.

https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?article=1734&context=cardiology_articles

Mechanical Circulatory Support in High-Risk Percutaneous Coronary Intervention

Objective Although the effect of coronary revascularization on clinical outcomes before and after transcatheter valve implantation (TAVI) is debatable, there is currently insufficient data to determine the most appropriate revascularization strategy. In this study, we present our single-center experience of percutaneous coronary intervention (PCI) and its effect on clinical outcomes and mortality in patients undergoing TAVI. Methods We performed a retrospective analysis of 526 consecutive patients at our center, and 127 patients with obstructive coronary artery disease were included in the study. Patients were divided into two groups: the revascularization group (group 1) and the non-revascularization group (group 2). Procedural complications and long-term all-cause mortality rates were compared between the two groups. Results Of the 526 patients, group 1 comprised 65 patients (12.3%) who underwent PCI, and group 2 comprised 62 patients (11.7%) who did not undergo revascularization. According to Valve Academic Research Consortium 2 criteria, post-procedural complications, including pericardial effusion, stroke, major vascular complications, major bleeding, and emerging arrhythmias, were similar between the groups. A Kaplan-Meier survival curve analysis showed no significant difference between the revascularization and non-revascularization groups (Overall: 40.0±2.8 month; 95% CI 34.4-45.6 month, p=0.959). After adjustment for basal SYNTAX score, chronic kidney disease stage, previous myocardial infarction, and baseline troponin levels, the long-term survival of group 1 was significantly longer when compared with group 2 (p=0.036). In 75.4% of cases, PCI was performed within 11.0±14.7 days before or after TAVI as a staged procedure. In 13.8% of cases, PCI was performed simultaneously with TAVI. While there was no significant difference in in-hospital, 6-month, and 1-year mortality rates between the simultaneous and staged PCI groups, there was a significant difference in 30-day mortality (11.1% vs. 0%, respectively; p=0.016). Conclusion Peri-procedural and long-term safety outcomes and mortality rates are not significantly different between revascularized and non-revascularized patients, and neither staged nor simultaneous PCI have adverse outcomes in patients undergoing TAVI.

Impact of coronary revascularization on outcomes of transcatheter aortic valve implantation.

Gemella haemolysans is a gram-positive coccoid, facultative anaerobe of the mucous membranes. In rare cases, it has been identified as an opportunistic pathogen in the development of endocarditis. Here, we describe a case of infective endocarditis in a patient with a bicuspid aortic valve. A 38-year-old man presented with the complaint of exertional dyspnea of one month duration. He was found to have leucocytosis and his blood cultures grew Gemella haemolysans. Trans-esophageal echocardiography showed a bicuspid aortic valve with 1.5 x 1.5 cm vegetative mass, severe aortic regurgitation, and an aortic root abscess. The patient was started on intravenous ampicillin and gentamycin. He then underwent mechanical aortic valve replacement and bovine reconstruction of the left ventricular outflow tract. Our case highlights the importance of considering atypical pathogens as causative agents of infective endocarditis.

/pdf/a-rare-case-of-infective-endocarditis-caused-by-gemella-1nr3vn4tsj.pdf

A Rare Case of Infective Endocarditis Caused by Gemella haemolysans.

Background: Review of the literature reveals difficulties re-engaging the coronary ostia after transcatheter aortic valve implantation (TAVI) with the CoreValve® device (Medtronic Inc., Minneapolis, MN, USA) due to its design and potential interference with diagnostic or interventional catheters. Our objective was to evaluate the feasibility and technical considerations of coronary procedures in these patients.Methods: Between October 2011 and November 2016, 573 patients underwent CoreValve TAVI at our hospital. Of these, 20 patients subsequently underwent 24 coronary procedures at our institution after TAVI and were included in this single-center retrospective analysis. Cardiac catheterization records and angiographic images were reviewed to evaluate for successful engagement of the coronary ostia and adequate angiographic result.Results: The left main was selectively engaged in 18 of 23 cases (79%) and subselectively engaged with good angiographic result in four cases (16%). The right coronary a...

Technical Considerations and Feasibility of Coronary Angiography and Percutaneous Coronary Intervention after CoreValve® Transcatheter Aortic Valve Implantation

Brugada syndrome is an inherited arrhythmia that increases a patient's risk of sudden cardiac death. Certain pharmacologic agents may induce a transient Brugada pattern on surface electrocardiogram (EKG). One of these is loperamide, an over-the-counter agent commonly used to manage diarrhea. We report the case of a patient who experienced EKG changes that mimicked Brugada pattern after excessive intake of loperamide.

/pdf/loperamide-mimicking-brugada-pattern-nr67mzgn19.pdf

Loperamide Mimicking Brugada Pattern

Loperamide induced brugada pattern

Due to advancing age and increasing comorbidities, the current population has a higher incidence of complex coronary artery disease, often without surgical options for revascularization. In this setting, hemodynamic support devices are an important adjunct in the interventionist's toolbox as they allow for a safer, more effective procedure. The following paper reviews the indications of various available mechanical support devices, highlights their clinical data and technical parameters, and offers a practical approach towards appropriate patient and device selection.

/pdf/mechanical-circulatory-support-in-high-risk-percutaneous-45a6wzvhq3.pdf

Mechanical Circulatory Support in High-Risk Percutaneous Coronary Intervention.

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