Treatment Bias in Management of HIV Patients Admitted for Acute Myocardial Infarction: Does It Still Exist?

INTRODUCTION: Previous studies have reported lower rates of coronary angiography and revascularization, and significantly higher mortality among patients infected with human immunodeficiency virus (HIV) presenting with acute myocardial infarction (AMI). This observational study was designed to evaluate characteristics and inpatient outcomes of patients with seropositive HIV infection presenting with AMI. METHODS: Using the National Inpatient Sample (NIS) database, we identified patients (admissions) with a primary diagnosis of myocardial infarction and a co-occurring HIV. We described baseline characteristics and outcomes. Our primary outcomes of interest were prevalence of coronary angiography, revascularization (percutaneous coronary intervention (PCI) or CABG), and mortality. RESULTS: From 2010 to 2014, of about 2,977,387 patients with a primary diagnosis of AMI, 10,907 (0.4%) were HIV seropositive. Patients with HIV were younger and more likely to be African American or Hispanic. Coronary angiography and revascularization were performed more frequently in the HIV population. The higher prevalence of revascularization was driven by a higher incidence of PCI. In a multivariable model, patients with HIV were no more likely to undergo revascularization than the general population. This was also the case for PCI. Unadjusted all-cause mortality was lower among patients with HIV. After controlling for confounders, this finding was not significant (OR 0.97, 95% CI 0.75-1.25, p = 0.79). The length of stay between both groups was comparable. CONCLUSION: In this current analysis, we did not note any treatment bias or difference in the rate of in-hospital total mortality for HIV-seropositive patients presenting with AMI compared with the general population.

Head and neck surgery is a risk factor for atrial fibrillation: incidence and outcomes.

Atrial fibrillation (AF) is the most common postoperative arrhythmia and can cause increased length of stay, costs, morbidity, and mortality. Little information exists about postoperative AF after major head and neck surgery, but it is thought to occur more frequently than after surgery at other extra-thoracic sites. A retrospective cohort study was implemented, including patients who had undergone major head and neck surgery and who had follow-up records covering a minimum of 60 days postoperative. The main outcome was the incidence of new onset postoperative AF after major head and neck surgery; secondary outcomes were the incidence of any AF, the role of cardiology, predictors of AF postoperatively, and clinical outcomes. A total 337 patients were included. Twenty-four patients experienced AF postoperatively (7.1%), of whom 12 (3.6%) had new onset AF. New onset AF was associated with advanced age of ≥65 years (odds ratio 11.6, P=0.027) and having a laryngectomy (odds ratio 9.9, P=0.003). Postoperative AF following major head and neck surgery is not a rare phenomenon and can be associated with considerable morbidity and costs due to the need for intensive care, specialty consultations, additional testing and laboratory studies, and cardiology follow-up.

How To Achieve Durable Pulmonary Vein Antral Isolation?

The inability to achieve durable pulmonary vein isolation(PVI) remains a major limitation to a catheter ablation for thew treatment of atrial fibrillation(AF), potentially resulting in AF recurrence.In this review,we discuss the research performed investigating methods to improve lesion permanence for the goal of durable PVI.Investigations evaluted procedural techniques,various catheres utilized, adjunctive pharamacologic therapy and novel energy sources designed to improve ablation lesion permanence are discussed.