Introduction: Chronic total coronary occlusions (CTO) are frequent and found in up to half of the patients with CAD referred for elective angiography. Despite technical advancements in CTO interven...
Introduction: Catheter ablation is widely accepted intervention for atrial fibrillation (AF), but data is limited on contemporary trends in major complications and mortality due to the procedure. Methods: HCUP’s Nationwide inpatient sample (NIS) database was utilized from 2011-14 to identify the AF patients treated with Catheter Ablation using ICD-9- CM codes. χ 2 test was utilized to compare categorical variables, the student’s t-test for continuous variables and hierarchical mixed-effects logistic regression models for multivariate predictors of post-procedural complications. Results: In total 50,969 patients were identified undergoing AF ablation during the study period (37.6% female, 51.4 age ≥ 65). Overall complication rate was 5.5% with relative increase over study period (+56.4%, p < 0.001). In subgroup analysis of complication trends significant relative increase seen in respiratory (+352.7%, p < 0.001), neurological (+43.9%, p = 0.003) and vascular (+38.7%, p = 0.003) complications. While cardiac complications (+9.1%, p = 0.323) and In-hospital mortality (+ 60%, p = 0.173) showed insignificant change. On multivariate analysis of mortality and complication significant increased risk was associated with female gender (OR, 95% CI, p-value) (1.40, 1.17-1.68, p < 0.001), as well as higher comorbidity burden (CCI ≥ 1). While higher hospital volume (≥ 50 procedures) was associated with significantly decreased complication rates. Conclusions: Patients undergoing AF ablation showed an insignificant change in mortality, with increase trends of complication. Which was likely related to higher comorbidity burden over study period.
Background: Hypertrophic obstructive cardiomyopathy (HOCM) is the leading cause of sudden cardiac death (SCD) in young adults and ventricular arrhythmias are known to cause SCD in these high-risk patients. The risk of SCD increases with increasing age. This data is first of its kind to address the trends in the prevalence of arrhythmias in HOCM population. Methods: The study cohort was extracted from Nationwide inpatient sample (NIS) from 2000 to 2014. Appropriate international classification of diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes were used to diagnose HOCM (425.1 and 425.11) and arrhythmias (427.xx). P-values for trends were generated by Cochrane-Armitage test for categorical variables and simple linear regression for continuous variables. Results: We noted 49.13 % incidence of any arrhythmias in HOCM patients with a relative increase of 27.92% over study period (2000-2014). Atrial fibrillation was most prevalent arrhythmia in this patient population (33.39%).Highest increase in incidence over study period was observed in bundle branch blocks ( relative increase 189.64%), atrioventricular blocks ( relative increase 119.85%), premature atrial/ventricular complex ( relative increase 123.28%), atrial flutter ( relative increase 66.86%), ventricular tachycardia (relative increase 60.54%) and atrial fibrillation ( relative increase 24.31%). Conclusion: Patients with HOCM are at increased risk of arrhythmias. Even after improvement in the early diagnosis and treatment of these high-risk patients, the burden of arrhythmias i.e., AF, ventricular arrhythmias, premature arrhythmias and atrioventricular blocks has increased exponentially through 2000-2014. It was also accompanied by increase in-hospital mortality in HOCM population.
Background: Intravascular ultrasound (IVUS) has been used for a long time to guide percutaneous coronary intervention in different subsets of coronary lesions and could be used to navigate guidewire within the CTO segment. However, previously published national data demonstrating the role of IVUS in CTO appears sparse. Methods: HCUP’s Nationwide Inpatient Sample (NIS) database from 2008-2014 was utilized to identify CTO (414.2), IVUS (00.24) and PCI using appropriate ICD-9 codes. Logistic regression analysis was used to adjust for confounders for our outcome variable of inpatient mortality. Result: 878112 CTO admissions were identified during study period, of which 47.6% went for revascularization with PCI (26.7% female, 69.8% white, and 51.1% age ≥ 65). IVUS was used in 5.4 %(22730) of these CTO PCI. Univariate anlaysis revealed significantly different distribution of baseline risk factors (Table 1a). In hospital mortality was lower (1.86% vs 2.99%, p<0.0001) in IVUS group. Cost of care was higher in IVUS group while there was no difference in length of stay. After adjusting for confounders, in our multivariable analsis, use of IVUS was associated with reduced odds (0.64, CI 0.49-0.84, p=0.0012) of in hospital mortality(Table 1b). Conclusion: Intravascular ultrasound imaging was associated with lower in-hospital mortality compared to conventional angiographic approach in recanalization of CTO in this large national representative sample. Further research exploring role of IVUS in other outcomes such as procedural complications may establish it as an intergral part of CTO PCI.
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