Impact of Ticagrelor Versus Clopidogrel on Bleeding Outcomes of Isolated Coronary Artery Bypass Grafting.

Background: Increased bleeding risks have been documented in patients exposed to P2Y inhibitors within 5 days of coronary artery bypass surgery (CABG). This study aimed to determine the relative CABG bleeding risks of clopidogrel versus ticagrelor exposure and the proper time course of ticagrelor discontinuation prior to surgery.

Methods: Clinical outcomes were assessed in 2075 isolated CABG patients, including 375 who had received P2Y inhibitors within 5 days of surgery (155 clopidogrel, 213 ticagrelor, 7 prasugrel).

Outcomes of Transcatheter Aortic Valve Replacement in Patients Treated With Systemic Steroids.

Background: Chronic steroid therapy is associated with higher vascular complication rates in patients undergoing transcatheter aortic valve replacement (TAVR). The effect of corticosteroids on aortic annular complications has not been directly assessed in this population.

Methods: A retrospective analysis of 1095 patients undergoing transfemoral TAVR was performed.

Racial and Ethnic Disparities in the Use of Transcatheter Aortic Valve Replacement in the State of Connecticut.

Background: Although prior national reports have identified trends in the underutilization of transcatheter aortic valve replacement (TAVR) in Afro-American and Latino populations, racial and ethnic healthcare disparities in TAVR use in the State of Connecticut have not been previously reported.

Methods: We conducted a retrospective analysis of 1461 patients undergoing TAVR at our institute between from 2012 to 2020. Baseline demographics, procedural characteristics, clinical outcomes, median incomes and insurance coverage were compared between 1417 Caucasian and 44 minority patients, including 23 patients designated as Afro-American and 10 designated as Latino.

The impact of asthma on in-hospital outcomes of COVID-19 patients.

Objective: The impact of asthma as a possible risk factor for adverse clinical outcomes in patients diagnosed with COVID-19 remains controversial. The purpose of this study was to examine the impact of asthma on adverse clinical outcomes in a COVID-19 hospitalized cohort.

Methods: Retrospective, propensity-matched observational study of consecutive COVID-19-positive patients between February 24, 2020, and November 3, 2020 at a single health care system.

Benefit of Transcatheter Aortic Valve Replacement in Patients With Paradoxical Low-Flow Low-Gradient Versus High-Gradient Aortic Stenosis and Preserved Left Ventricular Function.

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Impact of Famotidine Use on Clinical Outcomes of Hospitalized Patients With COVID-19.

Introduction: To compare outcomes in patients hospitalized with coronavirus (COVID-19) receiving famotidine therapy with those not receiving famotidine.

Methods: Retrospective, propensity-matched observational study of consecutive COVID-19-positive patients between February 24, 2020, and May 13, 2020.

Results: Of 878 patients in the analysis, 83 (9.

Comparison of Benefit of Transcatheter Aortic Valve Implantation in Patients With Low Gradient Versus High Gradient Aortic Stenosis and Left Ventricular Dysfunction.

Patients with low gradient severe aortic stenosis (LG-AS) often exhibit significant limitations in functional status and quality of life. We aimed to evaluate the clinical effect of transcatheter aortic valve implantation (TAVI) on LG-AS patients compared to those with high transvalvular gradients and similar left ventricular dysfunction. Retrospective analysis of records for all patients with a left ventricular ejection fraction <50% who underwent TAVI at our institution was performed.

Comparative Outcomes of Balloon-Expandable S3 Versus Self-Expanding Evolut Bioprostheses for Transcatheter Aortic Valve Implantation.

To date, comparisons between the balloon-expandable Edwards Sapien S3 (S3) versus the self-expanding Evolut R or PRO (Evolut) valves have been limited with respect to procedural outcomes. We aim to compare the safety, efficacy, and procedural efficiency of the S3 versus the Medtronic Evolut bioprostheses in patients who underwent transcatheter aortic valve implantation for severe aortic stenosis. Retrospective analysis was performed of all consecutive transcatheter aortic valve implantation procedures performed through the transfemoral approach with either S3 or Evolut at our hospital between September 2015 and January 2019.

Propensity Matched Analysis Comparing Conscious Sedation Versus General Anesthesia in Transcatheter Aortic Valve Implantation.

Conscious sedation (CS) has been increasingly utilized in transcatheter aortic valve implantation (TAVI). We aim to compare safety, efficacy, efficiency, and direct cost outcomes of patients who underwent TAVI with general anesthesia (GA) to those with CS. Records for all adult patients undergoing transfemoral TAVI at our institution between February 2012 and September 2018 were retrospectively screened.

Prediction of Incident Delirium Using a Random Forest classifier.

Delirium is a serious medical complication associated with poor outcomes. Given the complexity of the syndrome, prevention and early detection are critical in mitigating its effects. We used Confusion Assessment Method (CAM) screening and Electronic Health Record (EHR) data for 64,038 inpatient visits to train and test a model predicting delirium arising in hospital.

Statin and Its Association With Delirium in the Medical ICU.

Objectives: To examine the association between statin use and the risk of delirium in hospitalized patients with an admission to the medical ICU.

Design: Retrospective propensity-matched cohort analysis with accrual from September 1, 2012, to September 30, 2015.

Setting: Hartford Hospital, Hartford, CT.

Analysis of multi-dimensional contemporaneous EHR data to refine delirium assessments.

Delirium is a potentially lethal condition of altered mental status, attention, and level of consciousness with an acute onset and fluctuating course. Its causes are multi-factorial, and its pathophysiology is not well understood; therefore clinical focus has been on prevention strategies and early detection. One patient evaluation technique in routine use is the Confusion Assessment Method (CAM): a relatively simple test resulting in 'positive', 'negative' or 'unable-to-assess' (UTA) ratings.

Prediction of pneumonia 30-day readmissions: a single-center attempt to increase model performance.

Background: Existing models developed to predict 30 days readmissions for pneumonia lack discriminative ability. We attempted to increase model performance with the addition of variables found to be of benefit in other studies.

Methods: From 133,368 admissions to a tertiary-care hospital from January 2009 to March 2012, the study cohort consisted of 956 index admissions for pneumonia, using the Centers for Medicare and Medicaid Services definition.

Major adverse cardiac events among postpercutaneous coronary intervention patients on clopidogrel and proton pump inhibitors.

Objective: To determine if concomitant use of proton pump inhibitors (PPIs) and clopidogrel is associated with adverse events among postpercutaneous coronary intervention (PCI) patients.

Methods: This is a single-center, retrospective case-control study of 3,287 consecutive patients on clopidogrel who underwent PCI. Univariate and multivariate analyses determined if concomitant PPI and clopidogrel use was associated with major adverse cardiac events (MACE).

Long-term efficacy and safety of sirolimus-eluting vs bare-metal stents.

Background: Although previous studies have documented persistent clinical benefit of sirolimus-eluting stents (SES)in reducing the need for target vessel revascularization without an increase in myocardial infarction (MI) or mortality, the long-term safety and efficacy of CYPHER stent use in routine clinical practice, including off-label stent implantation, remains uncertain.

Methods: We compared long-term clinical outcomes in 2,550 patients treated with one or more SES with 1,022 patients treated with one or more bare metal or heparin-coated stents (BMS). The study groups included 1,058 SES patients (41.

Drug-eluting stent implantation results in effective treatment of small coronary artery disease (DESIRE Small CAD).

Objective: Sirolimus-eluting stents (SES) have been shown to significantly reduce restenosis in the treatment of lesions in large coronary arteries. We assessed and compared the in-hospital and long-term outcomes of patients treated with SES and bare-metal stents (BMS) for small coronary artery disease.

Methods: We compared 448 patients who underwent SES implantation in small coronary arteries (<2.

Effectiveness and cost-effectiveness of facilitated percutaneous coronary intervention compared with primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction transferred from community hospitals.

Background: Primary percutaneous coronary intervention ([PCI], percutaneous transluminal coronary angioplasty+stenting) for ST-segment elevation myocardial infarction (STEMI) is regarded as superior to fibrinolysis even if it means that patients need to be transferred from one center to another to undergo the procedure. However, this inevitable delay between symptom onset and PCI, caused by the time required to travel, might increase the occurrence of cardiac events. A hybrid method called facilitated PCI uses fibrinolysis and/or glycoprotein (GP) IIb/IIIa inhibitors before transfer to a tertiary medical center where urgent PCI might be performed.

Impact of fluid balance on incidence of atrial fibrillation after cardiothoracic surgery.

Excessive fluid administration after cardiothoracic surgery has been proposed as a cause of postoperative atrial fibrillation. In this study, we observed that fluid balance and volume administered on postoperative day 2 was greater in patients who developed postoperative AF than in those who did not. We also found that net fluid balance on postoperative day 2 was an independent predictor of postoperative AF among patients not receiving prophylactic therapy.

Treating hypothyroidism improves endothelial function.

Hypothyroidism patients have increased cardiovascular risk, although the mechanism is not defined. Endothelial dysfunction may initiate atherosclerosis, is present in patients with hypothyroidism, and therefore may link hypothyroidism and vascular disease. We are unaware of studies examining the effect of thyroid replacement therapy on endothelial function in hypothyroid patients.

Acute beta-blockade reduces the extent and severity of myocardial perfusion defects with dipyridamole Tc-99m sestamibi SPECT imaging.

Objectives: The goal of this study was to examine the effect of acute beta-blockade on dipyridamole Tc-99m sestamibi myocardial perfusion imaging (DMPI).

Background: Studies suggest that antianginal drugs may reduce the presence and severity of myocardial perfusion defects with dipyridamole stress. However, there are no data regarding specific drugs.

Biological variation for N-terminal pro- and B-type natriuretic peptides and implications for therapeutic monitoring of patients with congestive heart failure.

Given the limitations of low enrollments, this study suggests that a change of 130% for B-type natiuretic peptide (BNP) and 90% for N-terminal (NT)-proBNP are necessary before results of serially collected data can be considered statistically different. This study also shows that there are important differences in the performance of BNP versus NT-proBNP in monitoring patients with congestive heart failure that need to be further explored.

Duration of abnormal SPECT myocardial perfusion imaging following resolution of acute ischemia: an angioplasty model.

Objectives: This study was designed to determine how long nuclear myocardial perfusion imaging (MPI) remains abnormal following transient myocardial ischemia.

Background: Acute rest MPI identifies myocardial ischemia with a high sensitivity when the radionuclide is injected during chest pain. However, the sensitivity of this technique is uncertain when the radionuclide is injected following the resolution of symptoms.

Visual assessment of left ventricular perfusion and function with electrocardiography-gated SPECT has high intraobserver and interobserver reproducibility among experienced nuclear cardiologists and cardiology trainees.

Background: Stress electrocardiography (ECG)-gated single photon emission computed tomography (SPECT) for assessment of left ventricular perfusion and function improves the confidence of interpretation and enhances specificity for detection of coronary artery disease. The reproducibility of visual interpretation of ECG-gated SPECT images and the significance of training and experience have not been reported previously in a large series of consecutive patients. We evaluated both intraobserver and interobserver agreement of interpretation of ECG-gated SPECT images among 3 cardiology trainees and 3 experienced nuclear cardiologists from 3 institutions.