Introduction: Bifurcation lesions present major percutaneous coronary interventional challenge. Data on outcomes in bifurcation lesion appears sparse and hence here we seek to evalute the procedura...
Introduction: In acute pulmonary embolism (PE), systemic thrombolysis(ST) therapy leads to early hemodynamic improvement, but associated with major bleeding, and is withheld in many patients at ris...
Background: There is sparse comparative data on short-term readmissions following Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Methods: The study cohort was derived from the National Readmission Data (NRD) 2013, a subset of the Healthcare Cost and Utilization Project (HCUP) sponsored by AHRQ. TAVR and SAVR were identified using appropriate ICD-9-CM codes (TAVR - 35.05, 35.06 & SAVR - 35.21, 35.22) as either primary or secondary procedural codes. Variables which could affect treatment assignment, were adjusted with propensity score match analysis and Match (1:1) cohort was generated. Readmission causes were identified by ICD 9 code in primary diagnosis. Results: Our analysis included 3,886 TAVR and SAVR procedures each in the propensity matched cohorts. There was no significant difference in terms of readmission rates amongst patients who underwent TAVR vs. SAVR [21.41% vs. 21.07% (OR: 1.02, 95% CI: 0.92 - 1.14) p = 0.702]. Cardiac etiologies were more likely to be responsible for readmissions following SAVR (42.66% vs. 35.91%, p = 0.006). Atrial fibrillation (AF) was a much more common cause of readmission following SAVR (7.81% vs. 3.37%, p <0.001). Overall vascular (3.24% vs. 1.32%, p = 0.006) and bleeding complications (9% vs. 6.2%, p = 0.025) were more likely to result in readmission in patients undergoing TAVR. Cost of care of index admission and readmission was similar in both groups. Readmission mortality was higher amongst patient with TAVR vs. SAVR (6.49 vs. 3.91, p = 0.02). 50% of TAVR and SAVR readmission occur within 11 days post discharge. Conclusion: In our study from a large nationwide database, there was no significant difference in readmission rate, median readmission rate and resource utilization between TAVR and SAVR. Arrhythmias especially AF accounted for more SAVR readmission and Bleeding/vascular complications were more commonly responsible for readmissions following TAVR.
Background: Poly-vascular disease, characterized by atherosclerosis in multiple vascular beds, significantly increases the risk of cardiovascular death, myocardial infarction, and stroke. The severity correlates with the number of affected regions. The Lipid Association of India classifies patients with poly-vascular disease in the extreme risk category and recommends a lower LDL cholesterol target ( < 30 mg/dl) compared to those with atherosclerosis in a single territory (<50 mg/dl). Research Hypothesis: Indian patients likely show a higher prevalence of poly-vascular disease, possibly explaining the aggressive atherosclerosis observed in Indian and South Asian populations. Aim: This study aimed to assess the prevalence of subclinical carotid and femoral artery disease in Indian patients with post-percutaneous coronary intervention (PCI). Methods: Post-PCI patients attending a cardiology outpatient clinic over eight months were enrolled. Exclusions were patients with prior ischemic stroke, vascular limb event and carotid or peripheral intervention. Femoral and carotid artery Doppler ultrasounds were performed for plaques. Plaque was defined as either intima-media thickness exceeding 1.5 mm or protruding into the lumen by at least 50% of the surrounding thickness. Results: A total of 357 patients (mean age 63.1±10.7 years; 80.9% male) were enrolled. Diabetes mellitus and hypertension were present in 33.3% and 53.8% of patients, respectively. A history of ACS was noted in 88.8% of participants. Double or triple vessel disease was observed in 75.6% of patients. Carotid and femoral plaques were detected in 78.4% and 65.2%, respectively, with both present in 56.3%, and either of them in 87.7%. Mean LDL-cholesterol was higher in patients with both carotid and femoral plaques than those without (57.23 ± 27.12 versus 54.49 ± 28.15 mg/dl, p<0.001). The majority (80.7%) were on combination LDL-cholesterol lowering treatment with high intensity statins plus ezetimibe or bempedoic acid. Conclusion: Indian patients with CAD and a history of PCI exhibit a high prevalence of diabetes, hypertension, and triple vessel disease. Poly-vascular disease was prevalent, with majority having either subclinical carotid or femoral artery disease. Given the high incidence of recurrent events in poly-vascular disease patients, cardiometabolic risk targets, especially the LDL-C targets for Indian patients, may need to be lower than Western guidelines suggest.
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