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Flecainide toxicity and BRASH syndrome unmasking severe coronary artery disease: A diagnostic and management challenge
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Premature menopause and risk of cardiovascular outcomes: A propensity-matched analysis using the TriNetX research network
No full textGLP-1 receptor agonists in hypertrophic cardiomyopathy: Mortality benefit with complex cardiovascular risk profile
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Contrast Perfusion Echocardiography Rises to Meet the Challenge of Magnetic Resonance Imaging
No full textEmergent fat embolization for coronary perforation: Expanding the toolbox in complex PCI
No full textBackground: Coronary artery perforation is a rare but life-threatening complication of percutaneous coronary intervention (PCI). Standard management includes balloon tamponade, coil embolization, or covered stent placement. Case: A 61-year-old male with diabetes, hypertension, and hyperlipidemia presented with anterior ST-elevation myocardial infarction (STEMI). Angiography showed 100% occlusion of the proximal left anterior descending (LAD) artery. After drug-eluting stent (DES) placement, plaque shift led to first diagonal branch occlusion. Balloon angioplasty caused vessel perforation and tamponade, confirmed by transthoracic echocardiogram (TTE). Emergent pericardiocentesis was performed with autotransfusion. Coil embolization failed due to catheter limitations. Discussion: Autologous fat embolization was performed by harvesting pericardial fat and injecting it into the perforated vessel, achieving temporary hemostasis. Recurrent bleeding necessitated return to the lab, where a covered stent was deployed. The patient was stabilized and discharged on indefinite dual antiplatelet therapy (DAPT). Conclusion: Autologous fat embolization may serve as a novel, life-saving temporizing option for coronary perforation when conventional strategies are unsuccessful
Impact of transcatheter or surgical aortic valve performance on 5-year outcomes in patients at ≥ intermediate risk
No full textBackground:The incidence and clinical importance of bioprosthetic valve dysfunction (BVD) in patients undergoing supra-annular, self-expanding transcatheter aortic valve replacement (TAVR) or surgery is not well understood.
Objectives:The purpose of this study was to evaluate the 5-year incidence and clinical outcomes of BVD in patients undergoing CoreValve/Evolut TAVR or surgery.
Methods:This post hoc analysis pooled data from the U.S. High Risk Pivotal (n = 726) and SURTAVI (n = 1,618) randomized controlled trials (RCTs), the Extreme Risk Pivotal trial (n = 608), and CoreValve Continued Access Study (n = 2,654). The primary endpoint was the incidence of BVD through 5 years from the RCTs. The association of BVD with 5-year clinical outcomes was evaluated in the pooled RCT and non-RCT populations.
Results:Of 5,606 patients evaluated, 3,070 (54.8%) were men, and the mean age was 82.2 ± 7.4 years. A total of 2,344 RCT patients, including 1,227 who received TAVR and 1,117 who received surgery, and 3,262 non-RCT TAVR patients were included. The rate of BVD was lower in RCT patients undergoing CoreValve/Evolut TAVR compared with surgery (9.7% vs 15.3%; subdistribution HR: 0.57; 95% CI: 0.45-0.73; P \u3c 0.001). In the pooled RCT and non-RCT cohort, BVD was associated with increased 5-year all-cause mortality (HR: 1.49; 95% CI: 1.32-1.68; P \u3c 0.001), cardiovascular mortality (HR: 1.76; 95% CI: 1.52-2.03; P \u3c 0.001), and hospitalization for valve disease or worsening heart failure (HR: 1.48; 95% CI: 1.23-1.78; P \u3c 0.001).
Conclusions:Five-year valve performance was significantly better after CoreValve/Evolut TAVR compared with surgery. Development of BVD in TAVR and surgery patients was associated with worsened 5-year clinical outcomes. (Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement, NCT01240902 ; Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI], NCT01586910 ; Safety and Efficacy Continued Access Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in Very High Risk Subjects and High Risk Subjects Who Need Aortic Valve Replacement, NCT01531374 )
Active compression during external cardioversion of atrial fibrillation: A meta-analysis of randomized controlled trials
No full textObjectives:Direct current cardioversion (DCCV) is commonly used for atrial fibrillation, but there is uncertainty about whether active chest compression improves its effectiveness. This meta-analysis evaluates the impact of active compression on cardioversion outcomes.
Methods:A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) retrieved from PubMed, Scopus, WOS, Embase, and Cochrane Library till September 2024. Statistical analysis was performed using R software (version 4.3.1), applying risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI).
Prospero id:CRD42024595499.
Results:Four RCTs with 737 patients were included. When compared to the no-compression approach, active compression during DCCV was not associated with any significant difference in cardioversion success (RR: 1.10; 95% CI [0.96, 1.25], p = 0.16), first shock success (RR: 1.62; 95% CI [0.94, 2.81], p = 0.08), number of shocks (MD: -0.32; 95% CI [-1.01, 0.36], p = 0.36), or crossover success (MD: 0.76; 95% CI [0.33, 1.77], p = 0.52). However, active compression was associated with a reduced successful shock energy (MD: -23.97 J; 95% CI [-26.84, -21.10], p \u3c 0.01).
Conclusion:Active compression during DCCV does not significantly improve cardioversion success but may reduce the energy required for successful cardioversion, suggesting potential safety benefits. However, further studies are needed to determine its clinical relevance
A model for policy reforms to remove barriers in nursing licensure applications
No full textEngaging nurses with lived experience in mental health, substance use, and suicide is critical for meaningful policy reform that benefits both the nursing workforce and the communities they serve. Informed by lived experiences, barriers such as invasive licensure application questions, public disclosure of protected health information (PHI) during disciplinary proceedings, and limitations in Alternative to Discipline (ATD) programs were elevated. This article outlines a grassroots advocacy approach involving voluntary disclosure from nurses with lived experience, coalition building with the Dr. Lorna Breen Heroes\u27 Foundation, and collaboration with state licensure bodies to drive targeted reforms. These include rephrasing mental health-related licensure questions, improving ATD program support and accessibility, and ensuring PHI confidentiality. This model is replicable and offers a compassionate path to improving nurse retention and mental health support