Publications by authors named "Leroy Rabbani"
Background: This retrospective study addresses the role of operator and fluoroscopy equipment in reducing patient radiation exposure in the Cath lab.
Methods: Data from 99,400 procedures performed in our institution between 2007 and 2019 were reviewed. Dosimetric parameters included reference point air kerma (K), Kerma Area Product (P), fluoroscopic time, and contrast volume.
A single high-sensitivity troponin-T (hs-TnT) measurement may be sufficient to risk-stratify emergency department (ED) patients with possible acute coronary syndrome (ACS) using the recalibrated History, Electrocardiogram, Age, Risk Factors, Troponin (rHEART) score. We sought to validate this approach in a multiethnic population of United States patients and investigate gender-specific differences in performance. We conducted a secondary analysis of a prospective cohort study of adult ED patients with possible ACS at a single, urban, academic hospital.
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- Despite advancements in treatment, ST-elevation myocardial infarction (STEMI) still results in high mortality rates, leading to a greater focus on comfort-oriented care for those with poor prognoses.
- In a study of 536 STEMI patients, 11.4% died during hospitalization, with a significant number transitioning to comfort-focused care, especially those on mechanical circulatory support.
- Palliative care consultations were infrequent, occurring in only about 10% of cases, typically late in hospitalization, suggesting a need for earlier integration of comfort care strategies.
Article Synopsis
- The study examines outcomes of percutaneous coronary intervention (PCI) for de novo ostial right coronary artery (RCA) lesions, which have previously shown poor outcomes.
- Researchers utilized intravascular ultrasound (IVUS) to categorize 170 identified RCA stenoses into three morphological types: isolated ostial lesions, ostial lesions with calcified nodules (CN), and ostial lesions with diffuse disease.
- Results indicated that patients with CN had a significantly higher two-year target lesion failure (TLF) rate compared to those with diffuse disease, while isolated lesions resulted in no events, highlighting that lesion morphology is crucial for predicting clinical outcomes.
Article Synopsis
- Intravascular ultrasound studies reveal that about 25% of the left anterior descending (LAD) arteries have a myocardial bridge, which can affect stent performance.
- This study aimed to explore the relationship between myocardial bridges and chronic total occlusions (CTOs) in LAD lesions, as well as their impact on clinical outcomes after treatment.
- Results indicated that myocardial bridges were more frequent in LAD CTOs, and stents that extended into these bridges were linked to higher rates of target lesion failure compared to stents not extending into them.
Clinical pathways are useful tools for conveying and reinforcing best practices to standardize care and optimize patient outcomes across myriad conditions. The NewYork-Presbyterian Healthcare System has utilized a clinical chest pain pathway for more than 20 years to facilitate the timely recognition and management of patients presenting with chest pain syndromes and acute coronary syndromes. This chest pain pathway is regularly updated by an expanding group of key stakeholders, which has extended from the Columbia University Irving Medical Center to encompass the entire regional healthcare system, which includes 8 hospitals.
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- Many algorithms for evaluating acute coronary syndrome (ACS) in emergency departments depend on measuring changes in troponin levels over specific time intervals, which can be challenging in a busy setting.
- A study involving 821 patients indicated that using a troponin "velocity" approach (the rate of change in troponin levels) may effectively predict major cardiac events within 30 days, even without strict timing for specimen collection.
- The findings suggested that while the new velocity-based algorithm showed a decent negative predictive value, it performed comparably well when incorporated into existing European Society of Cardiology protocols using troponin measurements.
Background: There are numerous risk-prediction models applied to acute myocardial infarction-related cardiogenic shock (AMI-CS) patients to determine a more accurate prognosis and to assist in patient triage. There is wide heterogeneity among the risk models including the nature of predictors evaluated and their specific outcome measures. The aim of this analysis was to evaluate the performance of 20 risk-prediction models in AMI-CS patients.
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- The study investigates the causes of in-stent restenosis (ISR) in the right coronary artery (RCA), particularly focusing on mechanical and biological mechanisms.
- Using intravascular ultrasound (IVUS), researchers classified ISR lesions and found that 50% were due to mechanical issues like stent fractures or deformations, while 53% were related to biological factors like neointimal hyperplasia.
- The one-year target lesion failure rate was 11.5%, with significantly higher event rates (41.4%) for mechanically caused ISRs that were managed without new stents, highlighting the need for better treatment strategies.
Acute coronary syndromes (ACS) remain one of the leading causes of cardiovascular morbidity and mortality in the United States and around the world. Because of the acute nature of ACS presentations, timely identification, risk stratification, and intervention are of the utmost importance. Twenty years ago, we published the first iteration of our institutional chest pain clinical pathway in this journal, which separated patients presenting with chest pain into one of the 4 levels of decreasing acuity, with associated actions and interventions for providers based on the level.
View Article and Find Full Text PDFBackground: Although the presence of severe stenosis in the left main coronary artery (LMCA) is a well-established predictor of mortality, whether this extends to nonobstructive atherosclerosis in the LMCA is unknown.
Objectives: The aim of this study was to evaluate the association between LMCA disease by intravascular ultrasound (IVUS) and long-term mortality.
Methods: Between 2005 and 2013, 3,239 patients with LMCA IVUS imaging without LMCA revascularization (either before angiography or scheduled based on index angiography or IVUS) were included.
Study Objective: To evaluate whether the introduction of a 1-hour high-sensitivity cardiac troponin-T (hs-TnT) pathway for patients who present to the emergency department (ED) with suspected acute coronary syndrome (ACS) improves ED patient flow without changing the rate of "missed" major adverse cardiac events (MACE), compared to use of conventional cardiac troponin with an associated 3-hour pathway.
Methods: This was a prospective, uncontrolled observational study conducted before and after implementation of a 1-hour hs-TnT pathway at a high-volume urban ED. Patients undergoing evaluation for ACS in the ED were enrolled during their initial visit and clinical outcomes were assessed at 30 and 90 days.
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) following acute myocardial infarction with cardiogenic shock (AMI-CS) is increasing, but the ability to predict favorable outcomes with support remains limited. We retrospectively reviewed all patients with AMI-CS supported with VA-ECMO between December 2008 and June 2018. One hundred twenty-six patients received VA-ECMO for AMI-CS during the study period; of these, 39 (31.
View Article and Find Full Text PDFObjective: To determine the ability of quantitative electroencephalography (QEEG) to improve the accuracy of predicting recovery of consciousness by post-cardiac arrest day 10.
Methods: Unconscious survivors of cardiac arrest undergoing daily clinical and EEG assessments through post-cardiac arrest day 10 were studied in a prospective observational cohort study. Power spectral density, local coherence, and permutation entropy were calculated from daily EEG clips following a painful stimulus.
Objectives: To describe hemodynamic efficacy and clinical outcomes of Impella percutaneous left ventricular assist device (pLVAD) in patients with cardiogenic shock (CS).
Background: Percutaneous LVADs are increasingly used in CS management. However, device-related outcomes and optimal utilization remain active areas of investigation.
Purpose: To assess the potential clinical impact of an automated urine output (UOP) monitoring system in the intensive care unit.
Methods: Frequency of UOP documentation during a 20-month period was assessed in records of inpatients on the medicine floor, cardiac intensive care (CCU), and cardiothoracic-intensive care units (CTICU). Documentation timeliness (time between expected and observed UOP recording) was assessed over a 3-month period.
Article Synopsis
- Cardiovascular issues are common in COVID-19 patients and significantly increase the risk of death; diagnostic studies might help identify those at higher risk.
- An analysis of 887 COVID-19 patients revealed that 63% survived without mechanical ventilation, while 23% died; notable ECG findings included atrial fibrillation in 5% and ST-T wave changes in 38%.
- Factors like elevated cardiac troponin levels, older age, and specific heart rhythm abnormalities (like AF/AFL) were linked to a higher mortality rate, emphasizing the need for targeted cardiac assessments at admission.*
Article Synopsis
- The study aimed to determine if analyzing vital signs alongside ECG readings can better predict outcomes for COVID-19 patients.
- Data from 1,258 adults was collected in New York hospitals early in the pandemic, focusing on deaths and ventilation needs within 48 hours of diagnosis.
- Findings showed that specific ECG abnormalities correlated with worse outcomes, suggesting that combining these findings with respiratory vitals can improve early identification of patients at higher risk for deterioration.
Indications for and Findings on Transthoracic Echocardiography in COVID-19.
J Am Soc Echocardiogr
October 2020
Background: Despite growing evidence of cardiovascular complications associated with coronavirus disease 2019 (COVID-19), there are few data regarding the performance of transthoracic echocardiography (TTE) and the spectrum of echocardiographic findings in this disease.
Methods: A retrospective analysis was performed among adult patients admitted to a quaternary care center in New York City between March 1 and April 3, 2020. Patients were included if they underwent TTE during the hospitalization after a known positive diagnosis for COVID-19.
Critical care cardiology has been impacted by the coronavirus disease-2019 (COVID-19) pandemic. COVID-19 causes severe acute respiratory distress syndrome, acute kidney injury, as well as several cardiovascular complications including myocarditis, venous thromboembolic disease, cardiogenic shock, and cardiac arrest. The cardiac intensive care unit is rapidly evolving as the need for critical care beds increases.
View Article and Find Full Text PDFObjective: The mental health toll of COVID-19 on healthcare workers (HCW) is not yet fully described. We characterized distress, coping, and preferences for support among NYC HCWs during the COVID-19 pandemic.
Methods: This was a cross-sectional web survey of physicians, advanced practice providers, residents/fellows, and nurses, conducted during a peak of inpatient admissions for COVID-19 in NYC (April 9th-April 24th 2020) at a large medical center in NYC (n = 657).
Background: Nearly 30,000 patients with coronavirus disease-2019 (COVID-19) have been hospitalized in New York City as of April 14th, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill patients with COVID-19 in this setting are needed.
Methods: We prospectively collected clinical, biomarker, and treatment data on critically ill adults with laboratory-confirmed-COVID-19 admitted to two hospitals in northern Manhattan between March 2nd and April 1st, 2020.
The novel coronavirus disease 2019, otherwise known as COVID-19, is a global pandemic with primary respiratory manifestations in those who are symptomatic. It has spread to >187 countries with a rapidly growing number of affected patients. Underlying cardiovascular disease is associated with more severe manifestations of COVID-19 and higher rates of mortality.
View Article and Find Full Text PDFBackground: Over 40 000 patients with COVID-19 have been hospitalised in New York City (NY, USA) as of April 28, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill patients with COVID-19 in this setting are needed.
Methods: This prospective observational cohort study took place at two NewYork-Presbyterian hospitals affiliated with Columbia University Irving Medical Center in northern Manhattan.