Utilization of intravascular imaging in elective non chronic total occlusion percutaneous intervention and chronic total occlusion percutaneous intervention: Trends in utilization and impact on in-hospital mortality.

OBJECTIVES: The objectives of this retrospective study include outcomes associated with and without intravascular imaging in cases of elective single vessel (SV) CTO PCI and in non-CTO PCI. METHOD: We explored the NIS database from October 1, 2015 to December 31, 2018 to identify 317,090 adult admissions with elective SV PCI. Admissions with STEMI and NSTEMI were excluded to identify elective cases only. Using the ICD 10 diagnosis code for CTO, we identified 33,345 admissions that underwent SV CTO PCI. We classified the remaining cases as SV non-CTO PCI. RESULTS: Intravascular imaging was utilized in 2930 (8.8%) cases in CTO PCI group and 23,710 (8.3%) cases in non-CTO PCI groups. The utilization of intravascular imaging (IVUS/OCT) significantly increased in elective SV CTO PCI, 6.4%-11.2%, p-trend<0.001 and non-CTO PCI group, 7.3%-9.0%, p-trend<0.001. There was no significance difference in mortality with and without intravascular imaging (combined IVUS/OCT vs no IVUS/OCT: 1.5% vs 1.3%, p = 0.195) in the CTO PCI group. But, in non-CTO PCI admissions, there was a significantly lower in-hospital mortality when intravascular imaging was used (0.7% vs 0.8%, p = 0.003). The cost of hospitalization was significantly higher when intravascular imaging was used in elective single vessel CTO PCI admissions, combined IVUS/OCT vs no IVUS/OCT: $27,427 vs $21,452, p < 0.001 and non-CTO PCI admissions, combined IVUS/OCT vs no IVUS/OCT: $23,620 vs $20,272, p < 0.001. CONCLUSIONS: In conclusion, despite the cost, intravascular imaging use decrease mortality in non-CTO PCI groups but there is no difference in mortality in CTO PCI groups.

Mechanical circulatory device utilization in cardiac arrest: Racial and gender disparities and impact on mortality.

The objectives of this retrospective study include identifying the utilization trend of mechanical circulatory devices (MCD) such as Intra-Aortic Balloon Pump (IABP), Impella and Extracorporeal Membrane Oxygenation (ECMO) in admissions with cardiac arrest, determining whether racial or gender disparities exist in their usage, and discerning if their use is associated with a reduction in mortality. By leveraging the National Inpatient Sample, we identified 229,180 weighted adult cardiac arrest admissions between October 1, 2015 and December 31, 2018. MCD were used in 6005 admissions (2.6%). IABP had the highest utilization, representing 77.8% of all MCDs, followed by Impella at 24.8%. The utilization of IABP decreased from 90.6% to 71.6%, while the use of Impella increased from 13.5% to 29.8% in this study period; both trends were statistically significant. MCD use was found to be lower in women compared to men (1.4% vs 3.6, P < 0.001) and in the Black population compared to White (1.5% vs 2.8%, P < 0.001). There was no difference in MCD utilization between Hispanic and the White cohorts. In-hospital mortality was lower in admissions associated with MCD (31.4% vs 45.9%, P < 0.001). ECMO was associated with the lowest mortality rate at 14.3%, followed by IABP at 28.1%. The use of Impella and combination therapy were not associated with a significant decrease in mortality. In conclusion, MCD use may decrease mortality in cardiac arrest, however their utilization appears to be lower in African Americans and in women.

Cerebral Cavernous Angioma Associated with Klippel Trenaunay Syndrome Treated with Gamma Knife Radiosurgery: Case Report and Literature Review.

Klippel Trenaunay syndrome (KTS) is a rare, sporadic congenital syndrome characterized by cutaneous hemangiomas, venous varicosities, and osseous-soft tissue hypertrophy of the affected limb. It is genetically heterogeneous, and its clinical presentation is variable. We report the case of a 13-year-old male with KTS, who presented with a cerebral cavernous angioma in the corpus callosum. To the best of our knowledge, this is the first reported case of its kind from Pakistan and the only known case in the literature of KTS to be treated with stereotactic radiosurgery. The possibilities of shared genetic pathways between KTS and cavernous angiomas and the need for neurovascular scrutiny in patients with this syndrome are discussed.

Antagonism of substance P and perception of breathlessness in patients with chronic obstructive pulmonary disease.

The objective of this study was to investigate whether substance P, an excitatory neuropeptide, modulates the perception of breathlessness by administering aprepitant, a selective antagonist that blocks neurokinin (NK)-1 receptor signaling. Individual targeted resistive load breathing (RLB) was used to provoke breathlessness. In Study 1, sixteen patients (age, 70±6 years) with chronic obstructive pulmonary disease (COPD) reported similar ratings of breathlessness during RLB between oral aprepitant (125mg) and placebo. After aprepitant, but not with placebo, there were significant increases in blood levels of substance P (+54±39%) and beta-endorphin (+27±17%). A similar design was used in Study 2 except that naloxone (10mg) was administered intravenously prior to RLB to block any effect of endogenous opioids. Nine patients with COPD reported comparable breathlessness ratings during RLB between aprepitant and placebo. Our results do not support a role for the substance P-NK-1 pathway in the perception of breathlessness in patients with COPD. With selective antagonism of NK-1 signaling, there was co-transmission of substance P and beta-endorphin neuropeptides.