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6. Impact of preexisting coronary artery and peripheral artery disease on outcomes in diabetic patients after kidney transplant.

Author

Jiwani, Sania, Chan, Wan-Chi, Majmundar, Monil, Patel, Kunal N, Mehta, Harsh, Sharma, Aditya, Parmar, Gaurav, Wiley, Mark, Tadros, Peter, Hockstad, Eric, Yarlagadda, Sri G, Gupta, Aditi, and Gupta, Kamal

Subjects
PERIPHERAL vascular diseases, PEOPLE with diabetes, KIDNEY transplantation, CORONARY arteries, CHRONIC kidney failure
Abstract

Background: Atherosclerotic cardiovascular disease is highly prevalent in patients with end-stage kidney disease (ESKD). Kidney transplant (KT) improves patient survival and cardiovascular outcomes. The impact of preexisting coronary artery disease (CAD) and peripheral artery disease (PAD) on posttransplant outcomes remains unclear. Methods: This is a retrospective study utilizing the United States Renal Data System. Adult diabetic dialysis patients who underwent first KT between 2006 and 2017 were included. The study population was divided into four cohorts based on presence of CAD/PAD: (1) polyvascular disease (CAD + PAD); (2) CAD without PAD; (3) PAD without CAD; (4) no CAD or PAD (reference cohort). The primary outcome was 3-year all-cause mortality. Secondary outcomes were incidence of posttransplant myocardial infarction (MI), cerebrovascular accidents (CVA), and graft failure. Results: The study population included 19,329 patients with 64.4% men, mean age 55.4 years, and median dialysis duration of 2.8 years. Atherosclerotic cardiovascular disease was present in 28% of patients. The median follow up was 3 years. All-cause mortality and incidence of posttransplant MI were higher with CAD and highest in patients with polyvascular disease. The cohort with polyvascular disease had twofold higher all-cause mortality (16.7%, adjusted hazard ratio (aHR) 1.5, p < 0.0001) and a fourfold higher incidence of MI (12.7%, aHR 3.3, p < 0.0001) compared to the reference cohort (8.0% and 3.1%, respectively). There was a higher incidence of posttransplant CVA in the cohort with PAD (3.4%, aHR 1.5, p = 0.01) compared to the reference cohort (2.0%). The cohorts had no difference in graft failure rates. Conclusions: Preexisting CAD and/or PAD result in worse posttransplant survival and cardiovascular outcomes in patients with diabetes mellitus and ESKD without a reduction in graft survival. [ABSTRACT FROM AUTHOR]

Published
2024
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7. Impact of preexisting coronary artery and peripheral artery disease on outcomes in diabetic patients after kidney transplant

Author

Jiwani, Sania, primary, Chan, Wan-Chi, additional, Majmundar, Monil, additional, Patel, Kunal N, additional, Mehta, Harsh, additional, Sharma, Aditya, additional, Parmar, Gaurav, additional, Wiley, Mark, additional, Tadros, Peter, additional, Hockstad, Eric, additional, Yarlagadda, Sri G, additional, Gupta, Aditi, additional, and Gupta, Kamal, additional

Published
2023
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8. Nationwide Trends and Outcomes for Coronary Artery Bypass Grafting in End-Stage Kidney Disease and Stable Coronary Artery Disease

Author

Vasudeva, Rhythm, primary, Mehta, Harsh, additional, Chan, Wan-Chi, additional, Majmundar, Monil, additional, Yarlagadda, Sri G., additional, Downey, Peter, additional, Daon, Emmanuel, additional, Muehlebach, Greg, additional, Danter, Matthew, additional, Zorn, George, additional, Wiley, Mark, additional, Tadros, Peter, additional, Hockstad, Eric, additional, and Gupta, Kamal, additional

Published
2023
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10. Burden of Hypertensive Crisis in Patients With End-Stage Kidney Disease on Maintenance Dialysis: Insights From United States Renal Data System Database

Author

Pothuru, Suveenkrishna, primary, Chan, Wan-Chi, additional, Mehta, Harsh, additional, Vindhyal, Mohinder R., additional, Ranka, Sagar, additional, Hu, Jinxiang, additional, Yarlagadda, Sri G, additional, Wiley, Mark A., additional, Hockstad, Eric, additional, Tadros, Peter N, additional, and Gupta, Kamal, additional

Published
2023
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12. MAJOR CARDIOVASCULAR EVENTS AND ALL-CAUSE MORTALITY AFTER KIDNEY TRANSPLANTATION IN DIABETIC PATIENTS WITH PRE-EXISTING CORONARY ARTERY DISEASE OR PERIPHERAL VASCULAR DISEASE

Author

Jiwani, Sania Pyarali, primary, Chan, Wan-Chi, additional, Majmundar, Monil M., additional, Mehta, Harsh, additional, Yarlagadda, Sri G, additional, Gupta, Aditi, additional, Hockstad, Eric, additional, Wiley, Mark, additional, Tadros, Peter N., additional, and Gupta, Kamal, additional

Published
2023
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18. In-hospital Outcomes of Patients with Septic Shock and Underlying Chronic Atrial Fibrillation: A Propensity Matched Analysis from A National Dataset.

Author

Vindhyal, Mohinder R., Vasudeva, Rhythm, Pothuru, Suveenkrishna, James Kallail, K., Choi, Won, Ablah, Elizabeth, Hockstad, Eric, Shah, Zubair, and Gupta, Kamal

Subjects
ATRIAL fibrillation, HEALTH outcome assessment, SEPTIC shock, HOSPITAL patients, ARRHYTHMIA
Abstract

Introduction: Atrial fibrillation (AF) is one of the most common arrhythmias among hospitalized patients. Among patients admitted with septic shock (SS), the new occurrence of atrial fibrillation has been associated with an increase in intensive care unit (ICU) length of stay and in-hospital mortality. This is partially related to further reduction in cardiac output and thus worsening organ perfusion due to atrial fibrillation. However, there is a paucity of research on the outcomes of patients who have underlying chronic AF (UCAF) and then develop SS. This study aimed to identify the clinical characteristics and outcomes of patients with UCAF admitted with SS compared to patients with SS without UCAF. Methods: This study was a retrospective analysis of the 2016 and 2017 Nationwide Readmission Database. ICD-10 codes were used to identify patients with SS, and these patients were stratified into those with and without UCAF. Propensity matching analyses were performed to compare clinical outcomes and in-hospital mortality between the two groups. Results: A total of 353,422 patients with hospitalization for SS were identified, 5.8% (n = 20,772) of whom had UCAF. After 2:1 propensity matching, 20,719 patients were identified as having SS with UCAF, and 41,438 patients were identified as having SS without UCAF. Patients with SS and UCAF had a higher incidence of ischemic stroke [2.5% versus 2.2%, p = 0.012], length of stay [11.5 days versus 10.9 days, p < 0.001], mean total charges [$154,094 versus $144,037, p < 0.001] compared to those with SS without UCAF. In-hospital mortality was high in both groups, but was slightly higher among those with SS and UCAF than those with SS and no UCAF [34.4% versus 34.1%, p = 0.049]. Conclusions: This study identified UCAF as an adverse prognosticator for clinical outcomes. Patients with SS and UCAF need to be identified as a higher risk category of SS who will require more intensive management. [ABSTRACT FROM AUTHOR]

Published
2023
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21. Successful Percutaneous Management of LVAD Outflow Graft Stenosis: Role of Invasive Hemodynamics in Decision Making

Author

Dalia, Tarun, Goyal, Amandeep, Mehta, Harsh, Foster, Henedine C., Hockstad, Eric, Rohr, Aaron, Johnson, Philip, Abicht, Travis O., and Gupta, Bhanu P.

Subjects
FOS: Clinical medicine, FOS: Medical and health sciences
Abstract

Left ventricular assist device (LVAD) outflow graft stenosis (OGS) is a rare but lethal complication. We present a case of a 79-year-old male with pertinent past medical history of an LVAD implanted as destination therapy, stage III chronic kidney disease, and hypertension. He was admitted for low-flow alarms, and the echocardiogram showed stable right ventricle function and no pericardial effusion. Invasive hemodynamic assessments demonstrated a peak-to-peak gradient of 90 mm Hg in the outflow graft between the mid and distal ends of the graft on pullback. Contrast angiography confirmed OGS. The OGS was successfully treated with a VBX-covered stent (Gore). OGS should be considered when low flow alarms are found in patients with LVADs., Dalia, et al. Successful Percutaneous Management of LVAD Outflow Graft Stenosis: Role of Invasive Hemodynamics in Decision Making. The VAD Journal. 2022; 8(1):e2022819 https://doi.org/10.11589/vad/e2022819

Published
2022
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26. Cardiopulmonary arrest and extracorporeal membrane oxygenation: Case report and review

Author

Robinson, Alexander, Rali, Aniket, Shah, Zubair, Abicht, Travis, Hockstad, Eric, and Sauer, Andrew

Subjects
Cardiac arrest -- Diagnosis -- Care and treatment -- Case studies, Extracorporeal membrane oxygenation -- Usage, Health
Abstract

Byline: Alexander. Robinson, Aniket. Rali, Zubair. Shah, Travis. Abicht, Eric. Hockstad, Andrew. Sauer National trends suggest that less than one in four patients experiencing in-hospital cardiac arrest (IHCA) in the [...]

Published
2018

30. Impact of short term oral steroid use for intravenous contrast media hypersensitivity prophylaxis in diabetic patients undergoing nonemergent coronary angiography or interventions

Author

Amr, Bashar S., primary, Lippmann, Matthew, additional, Tobbia, Patrick, additional, Isom, Nicholas, additional, Dalia, Tarun, additional, Buechler, Tyler, additional, Pierpoline, Michael, additional, Patel, Nilay, additional, Hockstad, Eric, additional, Wiley, Mark, additional, Tadros, Peter, additional, Mehta, Ashwani, additional, Earnest, Matthew, additional, Chen, John G., additional, and Gupta, Kamal, additional

Published
2019
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34. Mildly symptomatic pulmonary emboli associated with electrophysiologic procedures: indications for anticoagulant use

Author

Hockstad, Eric and Gornick, Charles C.

Subjects
Anticoagulants (Medicine) -- Health aspects -- Complications and side effects, Pulmonary embolism -- Risk factors -- Complications and side effects, Electrotherapeutics -- Health aspects, Health, Complications and side effects, Risk factors, Health aspects
Abstract

Symptomatic pulmonary emboli complicating electrophysiologic procedures are uncommon. Asymptomatic or mildly symptomatic emboli are likely much more common. This case report highlights the problem of extensive, but mildly symptomatic, pulmonary [...]

Published
1994

36. Prognostic significance, angiographic characteristics and impact of antithrombotic and anticoagulant therapy on outcomes in high versus low grade coronary artery ectasia: A long-term follow-up study

Author

Gunasekaran, Prasad, primary, Stanojevic, Dusan, additional, Drees, Taylor, additional, Fritzlen, John, additional, Haghnegahdar, Megan, additional, McCullough, Matthew, additional, Barua, Rajat, additional, Mehta, Ashwani, additional, Hockstad, Eric, additional, Wiley, Mark, additional, Earnest, Matthew, additional, Tadros, Peter, additional, Genton, Randall, additional, and Gupta, Kamal, additional

Published
2018
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38. DUAL ANTIPLATELET THERAPY OR ORAL ANTICOAGULATION REDUCES THE INCIDENCE OF ACUTE CORONARY SYNDROMES IN PATIENTS WITH CORONARY ARTERY ECTASIA

Author

Gunasekaran, Prasad C., primary, Drees, Taylor, additional, Fritzlen, John, additional, Haghnegahdar, Megan, additional, Earnest, Matthew, additional, Mehta, Ashwani, additional, Hockstad, Eric, additional, Wiley, Mark, additional, Tadros, Peter, additional, Dawn, Buddhadeb, additional, and Gupta, Kamal, additional

Published
2018
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39. IMPACT OF ACUTE ADMINISTRATION OF CORTICOSTEROIDS PRIOR TO PERCUTANEOUS CORONARY ANGIOGRAPHY IN DIABETIC PATIENTS WITH CONTRAST ALLERGY

Author

Amr, Bashar, primary, Lippman, Matthew, additional, Patel, Nilay, additional, Tobbia, Patrick, additional, Pierpoline, Michael, additional, Buechler, Tyler, additional, Dalia, Tarun, additional, Isom, Nicholas, additional, Tadros, Peter, additional, Hockstad, Eric, additional, Earnest, Mathew, additional, Mehta, Ashwani, additional, Wiley, Mark, additional, Chen, John, additional, and Gupta, Kamal, additional

Published
2018
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40. CLINICAL PRESENTATION, NATURAL HISTORY AND MANAGEMENT OF CORONARY ARTERY ECTASIA

Author

Gunasekaran, Prasad C., primary, Masoomi, Reza, additional, Stanojevic, Dusan, additional, Drees, Taylor, additional, Fritzlen, John, additional, Haghnegahdar, Megan, additional, McCullough, Matthew, additional, Mehta, Ashwani, additional, Earnest, Matthew, additional, Wiley, Mark, additional, Hockstad, Eric, additional, Tadros, Peter, additional, and Gupta, Kamal, additional

Published
2017
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41. SAFETY AND FEASIBILITY OF ROTATIONAL ATHERECTOMY IN ELDERLY PATIENTS WITH SEVERE AORTIC STENOSIS AND CALCIFIC CORONARY ARTERY DISEASE UNDERGOING EVALUATION FOR TRANSCATHETER AORTIC VALVE REPLACEMENT

Author

Lippmann, Matthew, primary, Patel, Jigar, additional, Kvapil, Jared, additional, Pierpoline, Michael, additional, Tadros, Peter, additional, Wiley, Mark, additional, Earnest, Matthew, additional, Mehta, Ashwani, additional, Hockstad, Eric, additional, and Gupta, Kamal, additional

Published
2017
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44. Safety and Feasibility of Rotational Atherectomy in Elderly Patients With Severe Aortic Stenosis.

Author

Lippmann M, Patel J, Kvapil J, Westover D, Pierpoline M, Tadros P, Wiley M, Zorn G 3rd, Muehlebach G, Mehta A, Hockstad E, Earnest M, and Gupta K

Subjects
Aged, Aged, 80 and over, Elective Surgical Procedures methods, Female, Humans, Male, Monitoring, Intraoperative methods, Outcome and Process Assessment, Health Care, Risk Adjustment methods, Severity of Illness Index, United States, Vascular Calcification diagnosis, Vascular Calcification surgery, Aortic Valve diagnostic imaging, Aortic Valve surgery, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis surgery, Atherectomy, Coronary adverse effects, Atherectomy, Coronary methods, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods
Abstract

Background: Percutaneous coronary intervention (PCI) followed by transcatheter aortic valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis (AS) and coronary artery disease (CAD). In many, the coronary arteries are severely calcified and best treated with rotational atherectomy (RA). However, RA is not routinely performed in severe AS patients due to safety concerns. There is a paucity of data on the safety of RA in severe AS patients with calcific CAD., Methods: We retrospectively analyzed the medical records of 29 patients with severe AS who underwent elective RA-facilitated PCI at our center between January 1, 2011 and December 31, 2015., Results: Twenty-nine patients (mean age, 79.8 ± 8.8 years) were enrolled. Mean aortic valve area was 0.71 ± 0.20 cm², mean aortic valve gradient was 40.32 ± 9.88 mm Hg. All PCIs were successful (mean diameter stenosis, 86.3 ± 7.6%; mean burr size, 1.62 ± 0.19 mm). Nineteen patients (65.5%) required temporary pacemaker. Eight patients (27.6%) required vasopressors during PCI. There was a significant reduction in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) during RA, but without clinical events. No procedure was aborted and there were no deaths or clinical myocardial infarctions., Conclusion: RA-facilitated PCI can be safely performed in elderly patients with severe AS and severely calcified CAD with low risk of complications. There was a significant but transient drop in SBP, DBP, MAP, and HR during RA. However, this was not associated with clinically significant adverse events.

Published
2017

45. Spontaneous coronary artery perforation secondary to a sirolimus-eluting stent infection.

Author

Garg RK, Sear JE, and Hockstad ES

Subjects
Aged, 80 and over, Angioplasty, Balloon, Coronary, Coronary Artery Disease diagnostic imaging, Echocardiography, Fatal Outcome, Female, Humans, Rupture, Spontaneous, Staphylococcal Infections etiology, Coronary Artery Disease microbiology, Coronary Artery Disease therapy, Drug-Eluting Stents adverse effects, Immunosuppressive Agents adverse effects, Prosthesis-Related Infections diagnosis, Sirolimus adverse effects
Abstract

Coronary stent infection is exceedingly rare despite the widespread use of percutaneous coronary intervention (PCI). The utilization of drug-eluting stents (DES) may have a higher theoretical risk of infection due to their local immunosuppressant effect. Vigilance in suspecting stent infection is important, as the associated mortality rate is approximately 50%. We discuss the case of a patient who presented with an infected DES 2 weeks after implantation which led to spontaneous Type II coronary perforation. The perforation was sealed with prolonged balloon inflation, and the patient was treated with intravenous antibiotics. This is the first reported case of a patient with a stent infection who presented with a spontaneous coronary perforation.

Published
2007

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