In-hospital outcomes and postdischarge mortality in patients with acute coronary syndrome and atrial fibrillation.

Background: It is unclear whether advances in management of acute coronary syndrome (ACS) and introduction of novel oral anticoagulants have changed outcomes in patients with ACS with concomitant atrial fibrillation (AF).

Objective: This study aimed to examine the incidence of AF in patients admitted for ACS and to evaluate its association with adverse outcomes, given the recent advances in management of both diseases.

Methods: Natural language processing search algorithms identified AF in patients admitted with ACS across 13 Northwell Health Hospitals from 2015 to 2021.

The Simultaneous Occurrence of Acute ST-Elevation Myocardial Infarction, Acute Ischemic Stroke, and Pulmonary Embolism.

Acute ST-elevation myocardial infarction (STEMI), acute ischemic stroke (AIS), and acute pulmonary embolism (PE) are life-threatening conditions, each posing a high risk of morbidity and mortality. When all three of these acute conditions occur simultaneously, the overall prognosis for the patient becomes considerably worse. We report a case of a 70-year-old woman who presented to the emergency department (ED) with a triad of acute STEMI, AIS, and PE as a consequence of atherosclerotic heart disease, atrial fibrillation, and a prolonged transatlantic flight.

Repair of left ventricular aneurysm in the setting of noncompaction.

Although left ventricular (LV) aneurysm is a well-described complication of ischemic heart disease, it may less frequently develop in the setting of normal coronary anatomy and myocardial blood supply. LV noncompaction (LVNC) is a particularly rare etiology of LV aneurysm; in the few cases previously reported in the literature, non-surgical management was pursued. In this report, we discuss the surgical repair of an 'idiopathic' LV aneurysm in a patient who presented with multiple thromboembolic events, with LVNC as the likely etiology on the underlying LV pathology.

Pseudoaneurysm Formation After "Preclose"-Assisted Impella Insertion in a Patient With Cardiogenic Shock.

The use of mechanical support devices such as the Impella CP (Abiomed, Danvers, MA) is a growing form of treatment for patients with cardiogenic shock (CS). Despite the increase in usage, there remains a dearth in literature regarding potential complications. Vascular complications such as pseudoaneurysms (PAs) are rare but important potential complications that can occur with use of the Impella.

Pulmonary Embolism Complicated With Cardiopulmonary Arrest Treated With Combination of Thrombolytics and Aspiration Thrombectomy.

Systemic thrombolytic therapy is frequently used in the treatment of massive pulmonary embolism. We describe a case of pulseless electrical activity arrest, refractory obstructive shock in the setting of massive pulmonary embolism despite tissue plasminogen activator that was successfully treated with catheter-directed aspiration thrombectomy. ().

Dengue fever as a cause of perimyocarditis and low-pressure cardiac tamponade.

We describe a case of dengue shock syndrome, perimyocarditis, and low-pressure cardiac tamponade following a trip to the Caribbean. The case was managed in the critical care unit and 6 weeks after discharge the patient was asymptomatic with a normal ejection fraction. Dengue fever presenting as cardiac tamponade is exceedingly rare and emphasizes the importance of taking a thorough travel history as well as being aware of atypical manifestations of rare diseases to make a correct diagnosis.

Postpartum Sudden Cardiac Death After Spontaneous Coronary Artery Dissection in a Patient With Fibromuscular Dysplasia.

Spontaneous coronary artery dissection (SCAD) is a rare entity that can cause acute myocardial infarction and sudden cardiac death (SCD) which often goes unrecognized. We report a case of SCAD in a young postpartum female who presented with sudden cardiac arrest. The patient was managed medically and found to have fibromuscular dysplasia (FMD).

Real-time ultrasound guidance facilitates transradial access: RAUST (Radial Artery access with Ultrasound Trial).

Objectives: This study sought to assess the utility of ultrasound (US) guidance for transradial arterial access.

Background: US guidance has been demonstrated to facilitate vascular access, but has not been tested in a multicenter randomized fashion for transradial cardiac catheterization.

Methods: We conducted a prospective multicenter randomized controlled trial of 698 patients undergoing transradial cardiac catheterization.

Acute Cardiorenal Syndrome Type 1 in Patients With Congestive Heart Failure Exacerbations Is Not an Indicator of Poor Outcome and Increased Mortality.

Background: Over one million patients are hospitalized each year with acute decompensated heart failure (ADHF) in the US. Approximately 20% to 40% of them will develop acute cardiorenal syndrome type 1 (ACRS1) via multiple mechanisms.

Methods: From January 2010 to December 2010, 197 patients were diagnosed with ADHF.

Libman-Sacks endocarditis as the first manifestation of systemic lupus erythematosus in an adolescent, with a review of the literature.

Libman-Sacks endocarditis is rare in children and adolescents, more so as a first manifestation of systemic lupus erythematosus. Currently, sterile verrucous lesions of Libman-Sacks endocarditis are recognised as a cardiac manifestation of both systemic lupus erythematosus and antiphospholipid syndrome. They are clinically silent in a majority of the cases.

Access site complications following cardiac catheterization assessed by duplex ultrasonography.

Access site complications are major source of morbidity following cardiac catheterization. Their incidence varies in the literature because of multiple definitions and methods of determining the presence of particular complication. The aim of this prospective study was to determine the incidence of access site complications following cardiac catheterization using arterial duplex ultrasonography.

A prospective registry to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions using the "crush technique".

The "crush technique" has been proposed as an alternative approach to treat bifurcation lesions because of its predictability and high procedural success rate. However, few data are available regarding its safety and long-term efficacy. We report the long-term clinical outcomes of patients with coronary bifurcation lesions treated with sirolimus-eluting stents using the crush technique.

Effectiveness of the concomitant use of bivalirudin and drug-eluting stents (from the prospective, multicenter BivAlirudin and Drug-Eluting STents [ADEST] study).

Sirolimus-eluting stents (SESs) reduce restenosis compared with bare metal stents. Safety issues with drug-eluting stents are particularly important given concerns of possible increased thrombogenicity. Compared with heparin plus glycoprotein IIb/IIIa inhibitors, the direct thrombin inhibitor bivalirudin has been shown to reduce the risk of hemorrhagic complications in patients receiving bare metal stents, with similar efficacy in preventing ischemic complications.

Vascular closure devices: a review of their use after invasive procedures.

In the endovascular procedure setting, vascular closure devices (VCD) have emerged as an alternative to mechanical compression in order to achieve vascular hemostasis after puncture of the femoral artery. VCD are categorized based primarily on the principle mechanism of hemostasis, which includes biodegradable plug, suture, staples, or ultrasound. While VCD offer advantages over mechanical compression (shorter time to hemostasis and patient ambulation, high rate of patient satisfaction, and greater cost-effectiveness) complications related to the site of femoral access are still present.

Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary interventions.

Background: The relationship between low hematocrit and contrast-induced nephropathy has not been investigated.

Methods: Of 6,773 consecutive patients treated with percutaneous coronary intervention, contrast-induced nephropathy (an increase of >/=25% or >/=0.5 mg/dL in preprocedure serum creatinine, at 48 hours postprocedure) occurred in 942 (13.

Impact of anemia on outcomes of patients undergoing percutaneous coronary interventions.

Of 6,929 consecutive patients who were treated with percutaneous coronary intervention, 1,708 (24.6%) had anemia according to criteria of the World Health Organization. Compared with patients who did not have anemia, those who did have anemia were older, more frequently women and African-American, had a smaller body mass index, and higher frequencies of cardiovascular risk factors and co-morbid conditions.

A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation.

Objectives: We sought to develop a simple risk score of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI).

Background: Although several risk factors for CIN have been identified, the cumulative risk rendered by their combination is unknown.

Methods: A total of 8,357 patients were randomly assigned to a development and a validation dataset.

Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a meta-analysis.

Objectives: This study was designed to assess the safety of arteriotomy closure devices (ACDs) versus mechanical compression by meta-analysis in patients undergoing percutaneous transfemoral coronary procedures.

Background: Although ACDs are widely applied for hemostasis after percutaneous endovascular procedures, their safety is controversial.

Methods: Randomized, case-control, and cohort studies comparing access-related complications using ACDs versus mechanical compression were analyzed.

Comparison of safety and efficacy between first and second generation of angio-seal closure devices in interventional patients.

Arterial closure devices are safe and effective in selected patients, with complication rates similar to or lower than manual compression. The purpose of this study was to compare the safety and efficacy of the first- and new-generation Angio-Seal devices in patients undergoing PCI. This study found that the new Angio-Seal STS Platform device can secure hemostasis after PCI in a safe and effective manner similar to the old device.

Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention.

Chronic kidney disease (CKD) is a frequent complication of diabetes mellitus. However, the role of CKD in outcomes of patients with diabetes who have undergone percutaneous coronary intervention (PCI) has not been studied specifically. Therefore, we investigated the impact of CKD on prognosis of patients with diabetes who underwent PCI.

Prognostic significance of cerebrovascular and peripheral arterial disease in patients having percutaneous coronary interventions.

This study shows that cerebrovascular and peripheral arterial diseases frequently co-exist in patients with coronary artery disease who undergo percutaneous coronary interventions. These 2 conditions are associated with adverse in-hospital and 1-year outcomes and independently predict early and 1-year mortality.