Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) presents increasing complexity in the presence of pulmonary arterial hypertension (PAH). This study aims to delineate the influence of PAH on in-hospital mortality and readmission rates among patients undergoing CTO-PCI, addressing a notable gap in current research. Analyzing data from the National Readmission Database (2016-2020), we identified patients admitted for CTO and undergoing PCI, subsequently stratifying them based on PAH diagnosis. Multivariate regression analysis was employed to examine the impact of PAH on primary (in- hospital mortality) and secondary (readmission rates) outcomes. Our findings indicated pronounced impact of PAH in the CTO-PCI patient cohort. Patients with PAH exhibited higher in-hospital mortality (1.1%) compared to non- PAH patients (0.7%). Also, the readmission rate was significantly higher in the PAH group (10.2% vs. 7% in non-PAH patients). PAH patients were older (mean age 72 vs. 66, p = 0.001) and had a higher prevalence of comorbid conditions such as congestive heart failure, electrolyte derangement, diabetes mellitus, acute kidney injury and longer hospital stays. This study reported heightened risks associated with PAH in patients undergoing CTO-PCI. This finding should be a call for enhanced clinical vigilance in care of this patients. Further research works in this field would help to develop guidelines in the care of the demographic.

Frailty poses significant risks for adverse health outcomes, particularly in complex medical procedures. The implications of frailty in patients receiving percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) are increasingly relevant yet insufficiently understood, especially concerning in-hospital outcomes. Utilizing the National Readmission Database (NRD) from 2016 to 2020, this study focused on patients undergoing PCI for chronic total occlusions (CTO). Patients were categorized into low and high-frailty risk groups using the Hospital Frailty Risk Score (HFRS). The primary analysis centered on 30-day readmission rates post-CTO PCI. Baseline characteristics are detailed in Table I. Our analysis revealed significant differences in 30-day readmission rates between frail and non-frail patients (19.6% vs. 7.1%, P = 0.005), as illustrated by the Kaplan-Meier Curve. In-hospital mortality was higher in frail patients (2.1%) than non-frail patients (0.7%, P = 0.2916), with details of other secondary outcomes presented in Table II. The overall readmission rate for the CTO cohort was 18.9%, emphasizing frailty's impact on these outcomes. This study highlights the significant influence of frailty on in-hospital outcomes for patients undergoing PCI for CTO. Frail patients face notably higher risks of 30-day readmission and in-hospital mortality compared to non-frail patients. These results underscore the importance of developing specialized care strategies and interventions for frail patients to enhance outcomes and ensure quality care in this vulnerable group.

Percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) present unique challenges in patients with active cancer due to their complex health profiles. This study aims to fill the gap in knowledge regarding the outcomes of CTO PCI in the cancer population, focusing on in-hospital mortality and readmission rates. National Inpatient Sample (2016-2020) were analyzed to identify patients with CTO who underwent PCI, with and without active cancer groups. Multivariate regression analysis determined the impact of cancer on in-hospital mortality (primary outcome) and readmission rates (secondary outcome). As shown in Table I, patients with active cancer were generally older (72 vs. 66 years, p <0.05) and had a distinct profile of comorbidities compared to non-cancer patients. In-hospital mortality was slightly higher in the cancer group (1.3% vs. 0.8%, p =0.33), and readmission rates were notably increased (9.3% vs. 7.1%, p =0.05). Secondary outcomes (Table II) revealed differences in post-procedural complications, acute kidney injury, and length of stay between the two groups. Patients with active cancer undergoing CTO PCI exhibit marginally higher in-hospital mortality and significantly higher readmission rates compared to those without cancer. These findings underscore the need for specialized care strategies and meticulous management in this high-risk group to improve procedural outcomes and reduce hospital readmissions. Further studies are warranted to refine patient care protocols and enhance overall treatment outcomes for this vulnerable population.

White Blood Cell (WBC) count is a marker of systemic inflammation and increased numbers are found to be associated with overall increased cardiovascular risk. Increased platelet reactivity is also seen in systemic inflammation. In this study, we aimed to determine whether WBC to platelet count ratio

Post-thrombotic syndrome (PTS), often the sequelae of deep vein thrombosis (DVT) in lower extremities, carries high morbidity and often mortality. Timely intervention is critical for preventing complications and salvaging the extremity. Of late, there is growing interest in endovascular techniques, including percutaneous angioplasty with stent placement. We describe a unique case of MayThurner syndrome complicated by PTS that was successfully treated using an endovascular approach.

BackgroundBiventricular failure is associated with high in‐hospital mortality. Limited data regarding the efficacy of biventricular Impella axial flow catheters (BiPella) support for biventricular failure exist. The aim of this study was to explore the clinical utility of percutaneously delivered BiPella as a novel acute mechanical support strategy for patients with cardiogenic shock complicated by biventricular failure. Methods and ResultsWe retrospectively analyzed data from 20 patients receiving BiPella for biventricular failure from 5 tertiary‐care hospitals in the United States. Left ventricular support was achieved with an Impella 5.0 (n=8), Impella CP (n=11), or Impella 2.5 (n=1). All patients received the Impella RP for right ventricular (RV) support. BiPella use was recorded in the setting of acute myocardial infarction (n=11), advanced heart failure (n=7), and myocarditis (n=2). Mean flows achieved were 3.4±1.2 and 3.5±0.5 for left ventricular and RV devices, respectively. Total in‐hospital mortality was 50%. No intraprocedural mortality was observed. Major complications included limb ischemia (n=1), hemolysis (n=6), and Thrombolysis in Myocardial Infarction major bleeding (n=7). Compared with nonsurvivors, survivors were younger, had a lower number of inotropes or vasopressors used before BiPella, and were more likely to have both devices implanted simultaneously during the same procedure. Compared with nonsurvivors, survivors had lower pulmonary artery pressures and RV stroke work index before BiPella. Indices of RV afterload were quantified for 14 subjects. Among these patients, nonsurvivors had higher pulmonary vascular resistance (6.8; 95% confidence interval [95% CI], 5.5–8.1 versus 1.9; 95% CI, 0.8–3.0; P<0.01), effective pulmonary artery elastance (1129; 95% CI, 876–1383 versus 458; 95% CI, 263–653; P<0.01), and lower pulmonary artery compliance (1.5; 95% CI, 0.9–2.1 versus 2.7; 95% CI, 1.8–3.6; P<0.05). ConclusionsThis is the largest, retrospective analysis of BiPella for cardiogenic shock. BiPella is feasible, reduces cardiac filling pressures and improves cardiac output across a range of causes for cardiogenic shock. Simultaneous left ventricular and RV device implantation and lower RV afterload may be associated with better outcomes with BiPella. Future prospective studies of BiPella for cardiogenic shock are required.

Background and Aim: Diastolic wall strain (DWS) has been proposed as a simple non-invasive measure of left ventricular (LV) stiffness. This study investigated DWS as a possible predictor of mortality in severe aortic stenosis (AS).Methods: 138 patients with severe AS (indexed aortic valve area [AVA]< 0.6cm(2)/m(2)) and normal ejection fraction (> 55%) were included. 52 patients (38%) had aortic valve interventions or poor image quality (n=5) and were excluded leaving 86 in the study group (84 +/- 8years, 70% female, 69% African American). DWS was defined as (LVPWs-LVPWd)/LVPWs where LVPWs=left ventricular posterior wall thickness in systole and LVPWd=left ventricular wall thickness in diastole.Results: Follow-up extended 2.0 +/- 1.9years (median 1.6years). Mean DWS for the group was 0.21 +/- 0.11 (normal=0.4 +/- 0.07). In patients who died, DWS was significantly lower than in survivors (0.18 +/- 0.09 vs 0.24 +/- 0.11, P=.02). By contrast, traditional measures of diastolic dysfunction did not predict death. Regression analysis showed DWS predicted death even after adjusting for age, sex, race, indexed AVA, symptoms (angina, shortness of breath, dizziness, syncope), and clinical factors (creatinine, smoking, diabetes, hypertension, hyperlipidemia) (HR 2.5 [95% CI 1.02-5.90], P <.05). The best cutoff value for DWS of 0.25 had a sensitivity of 42% and specificity of 83% for predicting death.Conclusion: DWS is an independent predictor of all-cause mortality in patients with severe AS, even after accounting for traditional clinical and echocardiographic parameters.

Background: Biventricular Impella (BiPella) is a novel acute mechanical support strategy for patients with BiVF. We hypothesized that indices of right ventricular-pulmonary arterial coupling are associated with clinical outcomes among BiPella recipients. Methods: We retrospectively analyzed

There is a scarcity of data defining hemodynamic correlates of renal function in pulmonary hypertension (PH). The aim of this study was to assess the correlation between standard and novel hemodynamic indices, including the pulmonary artery pulsatility index (PAPi) and the right atrial to pulmonary capillary wedge pressure (RA:PCWP) ratio, and renal function in PH. We conducted a retrospective study of adult patients with PH diagnosed by right-heart catheterization (RHC) between January 2007 and October 2012 at Einstein Medical Center, Philadelphia. Patients with end-stage renal disease were excluded. Pulmonary artery pulse pressure, RA:PCWP, PAPi (pulmonary artery pulse pressure/RA), as well as standard RHC variables were studied. The final cohort consisted of 171 patients. The median age was 59±13 years, 52% were men, and the mean pulmonary arterial pressure was 39±8.9 mm Hg. Sixty-eight patients had worsening creatinine from the time of admission to the time of RHC. Patients with a RA:PCWP of >0.86 had a significantly higher creatinine level at RHC (2.2±1.0 vs. 1.7±1.7 mg/dL, P=0.01) and worsening creatinine (+0.9±0.9 vs. +0.4±0.3 mg/dL, P=0.03). The major finding of this study is that in PH (all groups), worsening renal function from the time of admission to RHC correlated significantly with high RA:PCWP and low ejection fraction. High RA:PCWP was found to be a better predictor of worsening renal function than other novel and standard hemodynamic indices such as elevated right atrial pressure and PAPi.

Introduction: Percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) has been a major challenge due to technical difficulties with increased complication rates. Approximately 1...

Background: There is limited data on hemodynamic predictors of renal function in patients with left ventricular systolic dysfunction and pulmonary hypertension. Our objective was to analyze the strength of correlation between standard and novel hemodynamic indices, including right atrial to pulmonary capillary wedge ratio (RA:PCWP) and pulmonary artery pulsatility index (PAPi), with renal function in patients with systolic dysfunction {left ventricular ejection fraction (LVEF) ≤35%} who had pulmonary hypertension (mean pulmonary artery pressure ≥ 25 mm Hg). Methods: We retrospectively screened 250 patients with systolic dysfunction and pulmonary hypertension, who underwent a right heart catheterization (RHC) between 2007 and 2012 at Einstein Medical Center, Philadelphia. Patients with underlying chronic kidney disease (GFR <60 mL/min/1.73m 2 ) were excluded. Correlation between standard RHC variables, pulmonary artery pulse pressure (PAPP), PAPi (PAPP/RA) and RA:PCWP ratio with renal function were studied. Results: The final cohort consisted of 108 patients, with mean age 59±12 years and 66% male. Forty-six patients had worsening creatinine from the time of admission to RHC. The group with worsening creatinine (n=46) had a higher RA:PCWP ratio (0.64±0.25 vs. 0.52±18; p<0.01) than the group with no change or an improvement in the creatinine (n=59). When comparing these two groups, RA:PCWP ratio was the only hemodynamic variable which was significantly different. Patients with a RA:PCWP ratio of ≥0.86 (n=11) had a higher creatinine at the time of RHC (2.13±0.84 vs. 1.64±0.75 mg/dL; p=0.04) and an increase in creatinine from the time of admission to the RHC (increased by 0.38±0.62 vs. decreased by 0.04±59 mg/dL; p=0.02) when compared to the group with a RA:PCWP ratio <0.86 (n=94). Conclusion: RA:PCWP ratio is a better predictor of renal dysfunction than the standard RHC variables in patients with systolic dysfunction and pulmonary hypertension.

Introduction Increased platelet reactivity (PR) while on antiplatelet therapy is associated with worse outcomes. There are conflicting results regarding the influence of renal function on PR in patients taking clopidogrel. Here we assessed the relationship between renal function, PR, and outcomes in a community practice setting. Methods We retrospectively reviewed 98 consecutive, non-dialysis patients admitted for major adverse cardiovascular events (MACE) to our institution between 2011 and 2012 that had PR values measured with the VerifyNow P2Y12 Assay. High PR was defined as a PRU >230 and low PR as a PRU ≤178. Renal function was classified based on estimated glomerular filtration rate at the time of assay. All cause mortality, readmissions, length of stay (LOS), and number of cardiac catheterizations were reviewed over 455 days. Results The prevalence of PRU>230 was 100% in stage 4 and 5 CKD, 42.9% in stage 3, 53.8% in stage 2, and 53.3% in stage 1 (p=0.049, figure 1). In patients presenting with acute coronary syndromes (n=49), a significant positive association existed between PRU and total number of cardiac catheterizations (p=0.014). Overall patients with PRU value >230 had longer LOS when compared to those with PRU≤230 (median of 2 days vs. 1 day, p=0.049). A positive correlation between HbA1c and PRU was also found (p=0.018). All 8 deaths had abnormal PRU (3 patients with PRU≤178, 5 patients with PRU>230). Conclusion Advanced CKD is associated with impairment of platelet inhibition by clopidogrel measured with the VerifyNow P2Y12 Assay. Elevated PRU is associated with worse outcomes. We observed a significant correlation between HbA1c and degree of platelet inhibition.