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Introduction: Mortality following cardiac arrest (CA) is extremely high, with rates as high as 91.5% after out-of-hospital cardiac arrest (OHCA) and 76.1% after in-hospital cardiac arrest (IHCA). This study assessed the clinical profile and outcomes of a large cohort of patients undergoing primary percutaneous coronary intervention (PCI) for OHCA to determine its effect on clinical outcomes and mortality. Methods: 247,456 patients with OHCA due to acute coronary syndrome (ACS) were abstracted from the Nationwide Inpatient Sample database (2001-2011). Results: Among 247,456 OHCA patients, 11,111 (4.5%) had PCI while 236,345 (95.5%) did not. Patients who underwent PCI were younger than those who did not receive PCI (64 vs. 66 years), p p p p 65 years, female gender, AA or Hispanic race, advanced cancer, and liver dysfunction as independent factors associated with increased mortality, while PCI conferred a survival advantage in OHCA, p 50 years old, and those with Medicare. PCI significantly reduces mortality in OHCA patients and should be considered in all OHCA patients. Further investigation and development of methods to overcome the apparent socioeconomic barriers to PCI is required.

Introduction: Aortic dissection is a rare complication of Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS), but is associated with mortality rates of up to 20%. This study assessed the demographic and clinical profile of a large cohort of patients undergoing PCI for ACS to assess patient and clinical risk factors that may predispose to the development of aortic dissection. Methods: The Nationwide Inpatient Sample (NIS) database (2001-2011) was used to abstract admission data on patients undergoing PCI for ACS. Results: 777,595 patients underwent PCI and 380 (0.05%) developed aortic dissection. Patients who developed aortic dissection were more often older (68 vs. 64 years), female (47.4% vs. 33.8%), insured through Medicare (56.2% vs. 50.7%), Medicaid (7.9% vs. 5.3%) or uninsured/self-pay (6.3% vs. 4.7%), p < 0.05. Patients with aortic dissection had a higher rate of ventricular fibrillation (6.3% vs. 1.8%), cerebrovascular accident (2.4% vs. 0.4%), longer lengths of hospitalization (9 days vs. 3 days), as well as higher mortality (13.2% vs. 1.4%), p < 0.001. Multivariate analysis identified female gender, Hispanic race, uninsured/self-pay, fluid and electrolyte disorders, and peripheral vascular disease (PVD) as independent risk factors for aortic dissection after PCI. Conclusion: Aortic dissection is a rare complication of PCI, which occurs more often in older patients with Medicare insurance status. Hispanics, females, uninsured patients and those with PVD are at the highest risk of aortic dissection. Clinicians should be more cognizant of patients at increased risk of developing PCI in order to institute earlier screening in high-risk patients.

Introduction: Optimal glycemic control in cardiac surgery patients remains a laudable but confusing practice. Existing studies have primarily employed two maintenance strategies using either intensive insulin therapy (IIT) (maintain glucose p = 0.628), ICU LOS (MD = -0.073 days, 95% CI = -0.324 to 0.178; p = 0.568), or hospital LOS (MD = 0.269, 95% CI = -2.158 to 2.696; p = 0.828). No difference in AF rates (RR = 0.887, 95% CI = 0.681 to 1.155; p = 0.375) or deep sternal infection (RR = 0.985, 95% CI = 0.357 to 2.720; p = 0.977) were observed. Conclusion: IIT targeting blood sugar levels of 80 - 120 mg/dl have no effect on perioperative outcomes in cardiac surgery patients. IIT is associated with similar mortality, ICU LOS, hospital LOS, AF rates, and deep sternal infection rates compared to more liberal glycemic strategies. IIT should not replace CIT as the standard of care in cardiac surgery patients.