Introduction: The Covid-19 pandemic has been associated with a reduction in STEMI volume in cardiac catheterization centers around the United States; yet a paradoxical increase in cardiovascular death within the same time period. Hypothesis: We hypothesized that reduction in STEMI volume during the COVID-19 pandemic may have been secondary to patient reluctance to present to the hospital. Methods: We performed a retrospective review of patients who presented to the emergency department from March 1st-April 19th, 2020 and March 1st-April 19th, 2019 across Northwell Health. Data on clinical comorbidities, time from symptoms onset, and patient outcomes was abstracted through manual chart review. The primary outcome of our study was time from onset of chest pain to presentation to the emergency room. Patients with COVID-19 were excluded from analysis. Variables were compared using the Chi-square test for categorical variables and the student-t for continuous variables. Results: In total 197 patients met our inclusion criteria, with 135 (69%) admitted in 2019 as compared to 62 (31%) presenting during the same time period in during the COVID-19 pandemic. There were no significant differences in the age of our patients and in comorbidities such as hypertension, hyperlipidemia, coronary artery disease, diabetes, chronic kidney disease, or chronic obstructive pulmonary disease. Patients who presented for STEMI during the COVID-19 waited significantly longer from time of onset of symptoms as compared to patients in 2019, (13.5 hours vs. 6.5 hours, p = .05). Patients who presented for STEMI in 2020 were more likely to die during hospitalization, but this did not reach statistical significance (9.7% vs 6.7%, p = .45). Conclusions: Reduction in STEMI volume during the COVID-19 pandemic may be related to patient reluctance to present to the hospital. Efforts to reduce the stigma of hospitalizations during the pandemic is important.
Transient right bundle branch block following blunt cardiac injury is a known but under-recognized manifestation of cardiac contusion. The first case documented in the medical literature occurred in 1952 in a 22-year-old man who was thrown from a motorcycle. Due to their relatively anterior location, the right ventricle and right bundle branch are at particular risk of injury in contusion. We present here a case in which a 24-year-old man suffered a blunt chest trauma leading to a right bundle branch block and elevated troponin levels, consistent with cardiac contusion. His conduction system abnormalities rapidly resolved and he recovered completely, with no clinical sequelae. .
Introduction: The initial evaluation of cardiomyopathy (CM) is a common diagnostic challenge. Invasive coronary angiography is routinely performed to exclude ischemic cardiomyopathy (ICM). Clinical...
There is growing evidence of the safety of same-day discharge for low-risk conscious sedated TAVR patients. However, the evidence supporting the safety of early discharge following GA-TAVR with routine transesophageal echocardiography (TEE) is limited.To assess the safety of early discharge following transcatheter aortic valve replacement (TAVR) using General Anesthesia (GA-TAVR) and identify predictors for patient selection.We used data from 2,447 TEE-guided GA-TAVR patients performed at Cedars-Sinai between 2016 and 2021. Patients were categorized into three groups based on the discharge time from admission: 24 h, 24-48 h, and >48 h. Predictors for 30-day outcomes (cumulative adverse events and death) were validated on a matched cohort of 24 h vs. >24 h using the bootstrap model.The >48 h group had significantly worse baseline cardiovascular profile, higher surgical risk, low functional status, and higher procedural complications than the 24 h and the 24-48 h groups. The rate of 30-day outcomes was significantly lower in the 24 h than the >48 h but did not differ from the 24-48 h (11.3 vs. 15.5 vs. 11.7%, p = 0.003 and p = 0.71, respectively). Independent poor prognostic factors of 30-day outcomes had a high STS risk of ≥8 (OR 1.90, 95% CI 1.30-2.77, E-value = 3.2, P < 0.001), low left ventricle ejection fraction of <30% (OR 6.0, 95% CI 3.96-9.10, E-value = 11.5, P < 0.001), and life-threatening procedural complications (OR 2.65, 95% CI 1.20-5.89, E-value = 4.7, P = 0.04). Our formulated predictors showed a good discrimination ability for patient selection (AUC: 0.78, 95% CI 0.75-0.81).Discharge within 24 h following GA-TAVR using TEE is safe for selected patients using our proposed validated predictors.
Introduction: There is limited evidence on ST elevation myocardial Infarction (STEMI) in COVID-19 patients. The aim of this study is to demonstrate the incidence of STEMI, clinical and angiographic outcomes, risk factors of COVID-19 patients among focal STEMIs, diffuse ST-elevation (STE), and no-STE. Methods: We retrospectively identified COVID-19 patients at 13 different hospitals from March 1 to April 30, 2020. All ECGs were analyzed for focal, diffuse or no-STE. Outcomes examined were death, ventilation, ICU admission, pressor and inotrope use and length of stay. Kaplan-Meier method estimated cumulative probability of death by STEMI status. Multivariate regression analysis identified association of STEMI and death. Results: There were 10,018 patients with 23,406 ECGs, of which 55 (0.5%) had focal STE, 22 (0.2%) had diffuse STE and 9,945 patients had no-STE. Death, length of stay, ICU stay, ventilator use, inotrope use, and pressor use were all statistically significant (p<0.0001) among no-STE, focal STE and diffuse STE groups. Cardiac catheterization performed on 10 STE patients, showed culprit lesions were left anterior descending artery 30%, right coronary artery 40% and no obstructive disease 30% of the time. Median symptom onset to ER presentation time in COVID STEMI was 12 hours. Figure 1 demonstrates the overall survival rates of 31%, 33%, and 6% in the no-STE, diffuse STE, and focal STE group, respectively ( P < .0001). Table 1 shows the strongest cardiac and ECG predictors of death in COVID-19 population. Conclusions: COVID-19 patients with focal STEMI and diffuse STE elevations are associated with worse survival and clinical outcomes.
