Racial Disparities in Atrial Fibrillation After Coronary Artery Bypass: Impact of Left Atrial Volume.

Background: Prior studies have demonstrated a lower prevalence of postoperative atrial fibrillation (POAF) in Black, Hispanic, Asian, and Native American patients compared with White cohorts after coronary artery bypass grafting. We hypothesized that preoperative differences in left atrial size may explain this disparity.

Methods: We assessed the incidence of new POAF in 1218 patients (215 minority patients and 1003 White patients) undergoing isolated, first-time coronary artery bypass grafting from January 2017 through September 2022.

Recovery From the Impact of COVID-19 on Treatment Times and Clinical Outcomes of Patients With ST-Segment Elevation Myocardial Infarction: An Interim Analysis.

Background: Previous studies have documented a negative impact of the COVID-19 pandemic on emergent percutaneous treatment of patients with ST-segment elevation myocardial infarction (STEMI), but few have examined recovery of healthcare systems in restoring prepandemic STEMI care.

Methods: Retrospective analysis was performed of data from 789 patients with STEMI from a large tertiary medical center treated with percutaneous coronary intervention between January 1, 2019, and December 31, 2021.

Results: For patients with STEMI presenting to the emergency department, median time from door to balloon was 37 minutes in 2019, 53 minutes in 2020, and 48 minutes in 2021 (P < .

The safety of carotid stenosis during vasodilator pharmacologic stress testing.

Background: While thousands of patients undergo stress testing annually, the risk of exercise and pharmacologic stress in patients with carotid artery disease has not been fully defined but is of concern as patients are at risk for cerebrovascular accidents and transient ischemic attacks.

Methods: All patients with either ultrasound or CTA evaluation of their carotid arteries from over a 10 year period who underwent stress testing within 180 days without intervening carotid intervention were reviewed for any adverse events within 24 hours of their stress test. The primary end point was any cerebrovascular event or syncope while the secondary endpoints included death, myocardial infarction, urgent angiography, urgent revascularization, or exaggerated hemodynamic response (systolic BP drop > 20 mmHg or systolic BP > 180 mmHg at peak stress).

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.

Impact of Gd-153 scanning line source attenuation correction on downstream invasive testing.

Background: Attenuation correction (AC) using hardware and software solutions has been shown to increase the specificity of SPECT MPI by decreasing false positive results and improving prognostic ability. Theoretically this should reduce downstream testing and unnecessary costs. We sought to assess the consequences of the use of Gd-153 scanning line source attenuation correction during SPECT myocardial perfusion imaging (MPI) on downstream invasive testing.

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).

Propensity matched analysis of bleeding and vascular complications associated with vascular closure devices vs standard manual compression following percutaneous coronary intervention.

Background: In patients undergoing percutaneous coronary intervention (PCI), controversy exists regarding the effect of vascular closure device (VCD) use on bleeding and vascular complications with limited data available for comparison of the different devices.

Methods: We developed propensity score matched groups, manual compression (MC) (n = 1,407) and VCD (n = 2,814), who underwent PCI in an eight-year period and compared their bleeding and vascular complications. Vascular closure device subtype analysis was also done.