Outcomes of percutaneous coronary interventions in patients with liver transplant.

OBJECTIVE: Our aim is to describe characteristics of liver transplant patients undergoing percutaneous coronary interventions (PCI) as well as in-hospital outcomes including the mortality and peri-procedural complications from the largest publicly available inpatient database in the United States from 2002 to 2014. BACKGROUND: Outcomes of PCI are well studied in patients with end-stage liver disease but not well studied in patients who receive liver transplant (LT). METHODS: Data derived from Nationwide Inpatient Sample (NIS) were analyzed for years 2002-2014. Adult Hospitalizations with PCI were identified using ICD-9-CM procedure codes. LT status and various complications were identified by using previously validated ICD-9-CM diagnosis codes. Endpoints were in-hospital mortality and peri-procedural complications. Propensity match analysis was performed to compare the endpoints between two groups. RESULTS: During the study period, 8,595,836 patients underwent PCI; 4,080 (0.04%) patients had prior LT status. 93% of patients were above age 59 years, 79% were males and 69% were nonwhites. Out of the total patients with LT status, 73% had hypertension, 57% had diabetes mellitus, and 47% had renal failure. Post-PCI complications were studied further in both liver and non-LT patients after 1:1 propensity match which showed the incidence of acute kidney injury (AKI) was higher in LT group (12.3 vs 10.7%, p = .024) but dialysis requiring AKI was similar. CONCLUSION: Among the LT recipients undergoing PCI, majority were nonwhite males. Almost more than half of the recipients had diabetes mellitus and renal failure. Incidence of AKI was higher in LT group, but other peri-procedural complications were comparable.

Kounis Syndrome: An Allergic Acute Coronary Syndrome Due to a Bee Sting.

Kounis syndrome, also known as allergic acute coronary syndrome, is defined as the occurrence of acute coronary syndrome (ACS) in the setting of an allergic or hypersensitivity reaction. Although Kounis syndrome is not an uncommon disease, many cases go undiagnosed or unrecognized. Patients with systemic allergic reactions associated with evidence of ACS should be suspected of Kounis syndrome because the outcome could be devastating if not treated promptly. The physician must be aware of Kounis syndrome because the treatment modality differs from traditional ACS.

The Tale of a Rubbery White Clot: Poorly Differentiated Spindle Cell Sarcoma Presenting As Superior Vena Cava Syndrome.

Sarcoma is an uncommon neoplasm of mesenchymal origin (1). The presentation is usually vague. It may present as a mass in the thigh or retroperitoneum, with resultant pain or paresthesia of the affected area. The diagnosis is very challenging due to its indistinct presentation. The prognosis remains poor due to delays in diagnosis and few available therapeutic options. We herein report the first case of superior vena cava (SVC) syndrome caused by spindle cell sarcoma.