Introduction: ACC/AHA guidelines do not recommend a preferred anticoagulant for percutaneous coronary intervention (PCI). Data suggest that in patients at high bleeding risk, bivalirudin decreases bleeding compared to unfractionated heparin. National registries demonstrate a “risk-treatment paradox,” i.e. patients at high bleeding risk are less likely to receive bivalirudin than patients at low bleeding risk. Hypothesis: Objectives of this pilot study were to estimate periprocedural bleeding risk prior to PCI using a validated risk-scoring tool (NCDR risk model) and document subsequent changes in anticoagulant use and bleeding. Methods: In a baseline population (n=2,331) that underwent a total of 814 elective PCI procedures from April 2011 to March 2012, we retrospectively established a pre-PCI bleeding risk calculator that distinguished patients as high (score ≥12) or low bleeding risk (<12). Results: During the pilot period (1/14/2013 to 5/3/2013), four cardiologists completed 101 elective PCIs. There w...
The aim of the study is to evaluate current trends and long-term durability of both drug-eluting stents (DES) and drug-coated balloons (DCB) in the treatment of peripheral artery disease (PAD).
From 1987 to mid-1994 we performed 16 percutaneous balloon aortic valvuloplasties. All patients (mean age 80 years; 53% female, 47% male) had significant congestive heart failure from aortic valve stenosis; the majority were categorized as New York Heart Association Class IV (shortness of breath at rest). Twelve patients were not surgical candidates; four patients refused surgery. After valvuloplasty, all patients became asymptomatic (NYHA Class I & II), the average preprocedure valvular gradient of 59 mm Hg decreased to 31 mm Hg, and valve area increased from 0.8 cm2 (0.3 cm2-0.98 cm2) to 1.3 cm2 (0.6 cm2-1.44 cm2). The only complications were two minor groin hematomas (2 patients). Within 6 months, 50% of the patients were symptomatic again; the overall survival rate was 23 months. We conclude that in the proper environment this procedure can be effective and safe--even in high-risk elderly patients. Although symptom improvement is transient, valvuloplasty provides a valuable opportunity to treat intercurrent medical conditions and possibly follow up with surgery.
Background: Obesity is endemic in the United States. Previous studies have reported an obesity paradox in mortality associated with acute coronary syndrome (ACS). However, percutaneous coronary intervention (PCI) and inpatient mortality trends over a long period of time in this group of patients remain unknown. Aim: To evaluate PCI and inpatient mortality trends among ACS patients with obesity over a 15-year period. Methods: We used the National Inpatient Sample from 2005 to 2019 to identify the study population using the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification. The primary outcomes were (1) the trend in PCI use among obese patients admitted for ACS and (2) in-hospital mortality trends in these patients compared to non-obese ACS patients treated with PCI. The secondary outcome was total hospital costs over the years. Results: We evaluated 9,259,932 patients hospitalized in the United States for ACS. Of those, 1,345,937 (14.5%) were obese. Obese patients were younger (mean age 61 years) and had a higher percentage of females (41.3%) compared to non-obese counterparts (mean age 68 years, P<.001; 38.4% female, P<.001). Overall mortality among the obese patients was lower than in non-obese patients (3.0% vs 5.6%, P<.001). A total of 663,128 (49.2%) obese patients underwent PCI compared with 45% in the non-obese group (P<.001). From 2005 to 2019, the number of PCI procedures in the obese group increased approximately threefold (Figure 1A). During this period, the mortality rates among obese patients with ACS treated with PCI increased from 2.0% in 2005 to 2.9% in 2019 (P<.001), yet remained lower than those in the non-obese group, which experienced a slight decrease in mortality from 4.3% in 2005 to 3.8% in 2019 (P<.001) (Figure 1B). Length of stay and total cost were relatively similar, around 3.8 days and $23,000, respectively, in both groups. Conclusion: Over the past 15 years, an increasing trend of PCI adoption has been observed in obese patients. In these PCI-treated obese patients, we observed lower mortality rates compared with their non-obese counterparts. This obesity paradox suggests a potential protective effect of obesity, warranting further research to understand the underlying pathophysiology to improve treatment strategies for this demographic.
