P676Percutaneous coronary intervention and clinical outcomes in patients with lymphoma: a 10-year period United States nationwide inpatient sample (NIS) analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J A Borovac ◽  
C S Kwok ◽  
M Konopleva ◽  
P Y Kim ◽  
N L Palaskas ◽  
...  
Keyword(s):  
United States ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Transient Ischemic Attack ◽  
Nationwide Inpatient Sample ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Hodgkin's Lymphoma ◽  
Bleeding Complications ◽  
Ischemic Attack

Abstract Background Clinical outcomes and characteristics of patients with lymphoma undergoing percutaneous coronary intervention (PCI) are unknown. Purpose To describe clinical characteristics and procedural outcomes in patients that underwent PCI and had a concurrent diagnosis of Hodgkin (HL) or non-Hodgkin (NHL) lymphoma and compare risks of complications and in-hospital mortality in lymphoma subtypes to patients without lymphoma. Methods A total of 6,413,175 PCI procedures undertaken in the United States between 2004 and 2014 in the Nationwide Inpatient Sample were included in the analysis. Multivariable regression analysis was performed in order to examine the association between lymphoma diagnosis and clinical outcomes post-PCI including complications and in-hospital mortality. Results Patients with lymphoma generally had a significantly higher incidence of post-PCI complications and in-hospital mortality compared to patients without lymphoma (Figure 1). Patients with lymphoma were more likely to experience in-hospital mortality (OR 1.34, 95% CI 1.20–1.49), stroke or transient ischemic attack (TIA) (OR 1.59, 95% CI 1.47–1.73), and any in-hospital complication (OR 1.19, 95% CI 1.14–1.25), following PCI. In the lymphoma subtype-analysis, diagnosis of HL was associated with an increased likelihood of in-hospital death (OR 1.31, 95% CI 1.17–1.48), any in-hospital complication (OR 1.20, 95% CI 1.14–1,26), bleeding complications (OR 1.12 95% CI 1.05–1.19) and vascular complications (OR 1.10 95% CI 1.03–1.17) while these risks were not significantly associated with NHL diagnosis. Finally, both types of lymphoma were associated with an increased likelihood of stroke/TIA following PCI, with this effect being twice greater for HL than NHL diagnosis (OR 1.66, 95% CI 1.52–1.81 and OR 1.33, 95% CI 1.06–1.66, respectively) (Table 1). Table 1. ORs for clinical outcomes Variable HL vs. No Lymphoma NHL vs. No Lymphoma Bleeding complications 1.12 (1.05–1.19) 1.07 (0.89–1.27) Vascular complications 1.10 (1.03–1.17) 1.13 (0.92–1.27) Cardiac complications 0.94 (0.85–1.03) 0.86 (0.68–1.11) Post-procedural stroke/TIA 1.66 (1.52–1.81) 1.33 (1.06–1.66) Any complication 1.20 (1.14–1.26) 1.04 (0.91–1.18) In-hospital mortality 1.31 (1.17–1.48) 0.89 (0.65–1.21) HL, Hodgkin's Lymphoma; NHL, non-Hodgkin's Lymphoma; TIA, Transient Ischemic Attack. Figure 1. Type of lymphoma and outcomes Conclusions While the incidence of lymphoma in the observed PCI cohort was low, a diagnosis of lymphoma was associated with an adverse prognosis following PCI, primarily in patients with a diagnosis of HL.

Outcome of Patients With Prior Stroke/Transient Ischemic Attack and Acute Coronary Syndromes

Angiology ◽  
2019 ◽  
Vol 71 (4) ◽  
pp. 324-332 ◽  
Author(s):  
Dongfeng Zhang ◽  
Xiantao Song ◽  
Yalei Chen ◽  
Sergio Raposeiras-Roubín ◽  
Emad Abu-Assi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Transient Ischemic Attack ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Specific Patient ◽  
Coronary Syndrome ◽  
International Multicenter Study ◽  
Ischemic Attack ◽  
The Impact ◽  
Prior Stroke

The association between prior stroke/transient ischemic attack (TIA) and clinical outcomes in patients with acute coronary syndrome (ACS) has not been well explored. We evaluated the impact of prior stroke/TIA on this specific patient population. We conducted an international multicenter study including 15 401 patients with ACS from the Bleeding Complications in a Multicenter Registry of Patients Discharged With Diagnosis of Acute Coronary Syndrome registry. They were divided into 2 groups: patients with and without prior stroke/TIA. The primary end point was death at 1-year follow-up. Prior stroke/TIA was associated with higher rate of 1-year death (8.7% vs 3.4%; P < .001). It was an independent predictor of 1-year death even after adjustment for confounding variables (odds ratio, 1.705; 95% confidence interval, 1.046-2.778; P = .032). Besides, patients with prior stroke/TIA had significantly increased 1-year reinfarction (5.6% vs 3.8%, P = .015), in-hospital bleeding (8.7% vs 5.8%, P < .001), and 1-year bleeding (5.2% vs 3.0%, P < .001). No difference of antithrombotic therapies or dual antiplatelet therapy (DAPT) types on outcomes was observed in patients with prior stroke/TIA. Prior stroke/TIA was associated with higher 1-year death for patients with ACS who underwent percutaneous coronary intervention. No benefits or harms were observed with different antithrombotic therapies or DAPT types in these patients.

Abstract 50: Atrial Fibrillation is Associated with Higher Stroke Rates in Takotsubo Cardiomyopathy

2017 ◽  
Vol 121 (suppl_1) ◽  
Author(s):  
Akintunde M Akinjero ◽  
Oluwole Adegbala ◽  
Nike E Akinjero ◽  
Eseosa Edo-Osagie ◽  
Tomi Akinyemiju
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Takotsubo Cardiomyopathy ◽  
Nationwide Inpatient Sample ◽  
Coronary Intervention ◽  
Independent Effect ◽  
Adjusted Risk ◽  
Representative Study ◽  
Percutaneous Coronary ◽  
Nationally Representative

Background: The prognosis of Takotsubo Cardiomyopathy (TTCM) is worse than in the general population. It is unclear how atrial fibrillation (AF) impacts this prognosis. We sought to evaluate the effect of concurrent AF on outcomes in patients with TTCM. Methods: We used the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to extract all hospitalizations between 2007 and 2011 with concurrent diagnosis of AF and TTCM. The ICD-9 CM codes for AF and TTCM were used. We compared patients admitted for TTCM who had coexisting AF to those without. We excluded patients below the age of 18 as well as those diagnosed with TTCM who later underwent percutaneous coronary intervention (PCI). Multivariate regression was used to assess the independent effect of coexisting AF on clinical outcomes (length of stay (LOS), stroke, and in-hospital mortality). Results: A total of 13,136 TTCM patients were studied. Of these, 2,083 (15.86%) had coexisting AF. Compared with those without, TTCM patients with coexisting AF had a greater multivariate-adjusted risk for increased stroke rate (aOR=1.66, 95% CI=1.27-2.18, Table 1). We found no significant association with in-hospital mortality (aOR=1.21, 95% CI=0.96-1.52) or LOS (aOR=1.21, 95% CI= 0.83-1.58). Conclusions: In this large, nationally representative study, we found higher stroke rates in patients with coexisting AF and TTCM. Our findings suggest the need for closer monitoring during hospitalization.

Abstract P426: Platelet Glycoprotein IIb/IIIa Inhibitors as an Adjunct to Stent Placement of Carotid Stenosis in Symptomatic Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Sachin M Bhagavan ◽  
Ammad Ishfaq ◽  
Muhammad F Ishfaq ◽  
Mukaish Kumar ◽  
Shruthi Pulimamidi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Carotid Stenosis ◽  
Transient Ischemic Attack ◽  
Stent Placement ◽  
Severe Disability ◽  
Platelet Glycoprotein ◽  
Carotid Stent ◽  
Significant Difference ◽  
Ischemic Attack

Background: Intra-arterial or intravenous platelet glycoprotein (GP) IIb/IIIa inhibitors have been used as adjunct to stent placement of carotid stenosis in patients with ischemic stroke or transient ischemic attack. Objective: To determine the proportion of patients with ischemic stroke or transient ischemic attack who received platelet GP IIb/IIIa inhibitors as adjunct to carotid stent placement and associated outcomes. Methods: We analyzed data from Cerner Health Facts® which collected data from participating facilities from January 1, 2000 to July 1, 2018. We identified patients with ischemic stroke or transient ischemic attack who underwent carotid stent placement for carotid stenosis and received Abciximab, Eptifibatide, or Tirofiban. Outcome was defined by discharge destination and classified into none to minimal disability, moderate to severe disability, or death. Results: A total of 8.4 % of 4567 patients with ischemic stroke or transient ischemic attack who underwent carotid stent placement for carotid stenosis received platelet GP IIb/IIIa inhibitors. Patients who received platelet GP IIb/IIIa inhibitors were more likely to experience cerebral ischemia (14.8% versus 7.5%) and undergo intubation/mechanical ventilation (4.4% versus 2%). There was a significant difference between patients who did or did not receive platelet GP IIb/IIIa inhibitors in terms of in hospital mortality rates (2.7% versus 1.2%, p=0.0152), none to mild disability (67.3% vs 75.7%, p=0.0003), and moderate to severe disability (30.1% vs 23.1%,p=0.0024). Conclusions: Adjunct use of platelet GP IIb/IIIa inhibitors in patients undergoing carotid stent placement for symptomatic carotid stenosis was associated with increased rates of in hospital mortality and moderate to severe disability.

scholarly journals Periprocedural anticoagulation in AF cryoballoon ablation in a nationwide registry: no difference in complication rates between strategies

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Zubkova ◽  
T Lubimceva ◽  
A Topchian ◽  
K Davtyan ◽  
E Artiykhina ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Vascular Complications ◽  
Funding Source ◽  
Cryoballoon Ablation ◽  
Complication Rates ◽  
Rf Ablation ◽  
Ischemic Attack

Abstract Background Standard treatment for patients with atrial fibrillation is pulmonary vein isolation (PVI). There are two widely adopted methods for PVI - cryoballon ablation (CBA) and radiofrequency (RF) ablation. There are several randomized studies evaluating different periprocedural anticoagulation strategies in patients undergoing PVI, and those mainly related to RF ablation procedures. However, there is a lack of data on safety of different anticoagulation strategies in CBA. Purpose To analyze the current anticoagulation approaches in patients undergoing cryoballoon ablation, the incidence and types of hemorrhagic and thromboembolic periprocedural events. The analysis was performed on data from the National cryoballoon AF ablation registry (NCT03040037). Methods Nineteen centers prospectively entered data into a web-based platform. The full data on AC therapy was available in 719 subjects. The specialists evaluated ischemic events clinically, and those included stroke, transient ischemic attack, pulmonary embolism or extracranial systemic embolism. Major bleedings were registered and classified according to the ISTH criteria. Results The mean CHA2DS2-VASc score was 2.0±1.4; mean BMI 29.5±4.8; mean GFR 92±28.9 ml/min. Periprocedurally, 574 (79.8%) subjects received direct oral anticoagulants (DOACs), 113 (15.7%) anti-vitamin K drugs (mainly warfarin); 16 (2%) patients received antiplathelet therapy. Uninterrupted DOAC therapy was used in 251 (34.9%) cases. Uninterrupted warfarin therapy was used in 36 (2%) patients. Bridging therapy was used in 325 (45.2%) patients. The total number of major adverse events was 25 (3.5%): 24 of them hemorrhagic and 1 transient ischemic attack (1 female patient on rivaroxaban with bridging). Five (0.7%) patients had hemopericardium: 3 - on uninterrupted rivaroxaban, 1 – rivaroxaban with bridging, 1 – interrupted apixaban. Seventeen (2.5%) patients had groin vascular complications and 1 -hemoptysis. Three patients died within 30 days following CBA from non-cardiovascular causes. There were no statistically significant differences in complications between patients receiving different periprocedural anticoagulation. Conclusions About 45% of patients referred for CBA receive bridging anticoagulation therapy in the periprocedural period. Although this is not in line with the current guidelines, we found no meaningful difference in complication rates between different anticoagulation approaches. CBA might be associated with different from RF ablation safety profile and requires randomized trials on periprocedural anticoagulation. Funding Acknowledgement Type of funding source: Other. Main funding source(s): RF President's council grant

Abstract T P273: Internet-Based Information Seeking Behavior for Transient Ischemic Attack

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Vida Abedi ◽  
Marieme Mbaye ◽  
Georgios Tsivgoulis ◽  
Shailesh Male ◽  
Nitin Goyal ◽  
...  
Keyword(s):  
United States ◽  
Transient Ischemic Attack ◽  
Information Seeking ◽  
Media Coverage ◽  
Information Seeking Behavior ◽  
Online Search ◽  
Seeking Behavior ◽  
Search Data ◽  
Ischemic Attack ◽  
Google Search

Background &Purpose: In recent years, Internet became an increasingly important tool for accessing health information and is being used more frequently to promote public health. In this study, we used Google search data to explore information seeking behavior for transient ischemic attack (TIA). Methods: We selected two groups of keywords related to TIA -“Transient Ischemic Attack” and “Mini Stroke” - after examining several related search keywords. We obtained all available online search data performed in the United States from the Google search engine for a ten year span - January 2004 to December 2013. The monthly and daily search data for the selected keywords were analyzed - using a moving window strategy - to explore the trends, peaks and declining effects. Results: There were three significant concurrent peaks in the Google search data for the selected keywords. Each peak was directly associated with media coverage and news headlines related to the incident of TIA in a public figure. (Figure 1) Following each event, it took an average of two weeks for the search trend to return to its respective average value. The trend was steady for “Transient Ischemic Attack”; however, the search interest for the keyword “mini stroke” shows a steady increase. The overall search interest for the selected keywords was significantly higher in the southeastern United States. Conclusions: Our study shows that changes in online search behavior can be associated with media coverage of key events (in our case TIA) in public figures. These findings suggest that online health promotion campaigns might be more effective if increased promptly after similar media coverage.

scholarly journals Associations between Pre-Admission Risk Scores and Two-Year Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients with Non-Valvular Atrial Fibrillation

2018 ◽  
Vol 45 (3-4) ◽  
pp. 170-179 ◽  
Author(s):  
Keisuke Tokunaga ◽  
Hiroshi Yamagami ◽  
Masatoshi Koga ◽  
Kenichi Todo ◽  
Kazumi Kimura ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Scale Score ◽  
Outcome Measures ◽  
Transient Ischemic Attack ◽  
Risk Scores ◽  
Modified Rankin Scale ◽  
Hemorrhagic Events ◽  
Ischemic Attack

Background: We aimed to clarify associations between pre-admission risk scores (CHADS2, CHA2DS2-VASc, and HAS-BLED) and 2-year clinical outcomes in ischemic stroke or transient ischemic attack (TIA) patients with non-valvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry. Methods: From 18 Japanese stroke centers, ischemic stroke or TIA patients with NVAF hospitalized within 7 days after onset were enrolled. Outcome measures were defined as death/disability (modified Rankin Scale score ≥3) at 2 years, 2-year mortality, and ischemic or hemorrhagic events within 2 years. Results: A total of 1,192 patients with NVAF (527 women; mean age, 78 ± 10 years), including 1,141 ischemic stroke and 51 TIA, were analyzed. Rates of death/disability, mortality, and ischemic or hemorrhagic events increased significantly with increasing pre-admission CHADS2 (p for trend <0.001 for death/disability and mortality, p for trend = 0.024 for events), CHA2DS2-VASc (p for trend <0.001 for all), and HAS-BLED (p for trend = 0.004 for death/disability, p for trend <0.001 for mortality, p for trend = 0.024 for events) scores. Pre-admission CHADS2 (OR per 1 point, 1.52; 95% CI 1.35–1.71; p <0.001 for death/disability; hazard ratio (HR) per 1 point, 1.23; 95% CI 1.12–1.35; p <0.001 for mortality; HR per 1 point, 1.14; 95% CI 1.02–1.26; p = 0.016 for events), CHA2DS2-VASc (1.55, 1.41–1.72, p < 0.001; 1.21, 1.12–1.30, p < 0.001; 1.17, 1.07–1.27, p < 0.001; respectively), and HAS-BLED (1.33, 1.17–1.52, p < 0.001; 1.23, 1.10–1.38, p < 0.001; 1.18, 1.05–1.34, p = 0.008; respectively) scores were independently associated with all outcome measures. Conclusions: In ischemic stroke or TIA patients with NVAF, all pre-admission risk scores were independently associated with death/disability at 2 years and 2-year mortality, as well as ischemic or hemorrhagic events within 2 years.

scholarly journals Complex Large-Bore Radial percutaneous coronary intervention: rationale of the COLOR trial study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038042
Author(s):  
Thomas A Meijers ◽  
Adel Aminian ◽  
Koen Teeuwen ◽  
Marleen van Wely ◽  
Thomas Schmitz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Ethics Committee ◽  
Bleeding Complications ◽  
Access Site ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Coronary Lesions

IntroductionThe radial artery has become the standard access site for percutaneous coronary intervention (PCI) in stable coronary artery disease and acute coronary syndrome, because of less access site related bleeding complications. Patients with complex coronary lesions are under-represented in randomised trials comparing radial with femoral access with regard to safety and efficacy. The femoral artery is currently the most applied access site in patients with complex coronary lesions, especially when large bore guiding catheters are required. With slender technology, transradial PCI may be increasingly applied in patients with complex coronary lesions when large bore guiding catheters are mandatory and might be a safer alternative as compared with the transfemoral approach.Methods and analysisA total of 388 patients undergoing complex PCI will be randomised to radial 7 French access with Terumo Glidesheath Slender (Terumo, Japan) or femoral 7 French access as comparator. The primary outcome is the incidence of the composite end point of clinically relevant access site related bleeding and/or vascular complications requiring intervention. Procedural success and major adverse cardiovascular events up to 1 month will also be compared between both groups.Ethics and disseminationEthical approval for the study was granted by the local Ethics Committee at each recruiting center (‘Medisch Ethische Toetsing Commissie Isala Zwolle’, ‘Commissie voor medische ethiek ZNA’, ‘Comité Medische Ethiek Ziekenhuis Oost-Limburg’, ‘Comité d’éthique CHU-Charleroi-ISPPC’, ‘Commission cantonale d'éthique de la recherche CCER-Republique et Canton de Geneve’, ‘Ethik Kommission de Ärztekammer Nordrhein’ and ‘Riverside Research Ethics Committee’). The trial outcomes will be published in peer-reviewed journals of the concerned literature.Trial registration numberNCT03846752.

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