Ismayl, Mahmoud

Background:Aortic valve replacement is the primary treatment for aortic valve disease and can be performed using either transcatheter (TAVR) or surgical (SAVR) approaches. The risk of aortic dissection (AD) with TAVR compared with SAVR remains unclear. We aimed to compare AD risk between TAVR and SAVR using a large, real-world cohort. Methods:We conducted a retrospective cohort analysis using the TriNetX research network. Patients with a diagnosis of aortic stenosis, aortic insufficiency, mixed aortic valve disease (AVD), or unspecified AVDwho underwent either TAVR or SAVR were included. A 1:1 propensity score-matching (PSM) based on baseline characteristics was performed to adjust for potential confounding. Logistic regression and Cox proportional hazards models were used to estimate odds ratios (ORs) and hazard ratios (HRs), with 95% confidence intervals (CIs).Results:Among 95,043 patients undergoing isolated aortic valve replacement, 20,237 matched pairs were analyzed after 1:1 PSM. Baseline characteristics were well balanced, with a mean age of 73.3 ± 9.3 years in the TAVR group and 73.2 ± 8.5 years in the SAVR group; 60.8% and 60.7% were male, respectively. TAVR was associated with significantly lower odds of composite AD than SAVR at all time points (1-year OR 0.60; 95% CI 0.44–0.82; 3-year OR 0.64; 95% CI 0.48–0.83; 5-year OR 0.66; 95% CI 0.51–0.85; p < 0.01 for all). Stratified analyses demonstrated lower odds of both Stanford type A and type B AD at all time points. Kaplan–Meier analysis demonstrated a separation in composite AD-free survival between the two groups (HR 0.66; 95% CI 0.51–0.86; p = 0.002).Conclusion:In this large, real-world cohort, despite a low event rate, TAVR was associated with a significantly lower likelihood of composite AD than SAVR.

ABSTRACT Background Concomitant atrial fibrillation (AF) and gastrointestinal (GI) bleeding present a clinical challenge due to recurrent bleeding risk associated with anticoagulation for AF‐associated stroke prevention. Left atrial appendage occlusion (LAAO) offers an alternative stroke prevention strategy, but its impact on recurrent GI bleeding remains unknown. Methods This retrospective, multicenter cohort study used the TriNetX database to identify adults with AF on oral anticoagulation and a history of GI bleeding. Patients were stratified by treatment with or without LAAO. 1:1 propensity score matching (PSM) was employed. The primary outcome was recurrent GI bleeding. Cox regression analysis was used to generate hazard ratios (HRs) with 95% confidence intervals (CIs). Odds ratios (ORs) were used to evaluate effect sizes between groups. Kaplan–Meier curves were used for time‐to‐event analyses. Results After PSM, 9259 patients were compared in each group. Odds of recurrent GI bleeding were consistently lower in patients undergoing LAAO than without LAAO across all follow‐up intervals: at 3 months (OR 0.84; 95% CI 0.78–0.91), 6 months, 1 year, 3 years, and 5 years (OR 0.87; 95% CI 0.82–0.92). Kaplan–Meier analysis demonstrated significantly lower risk of recurrent GI bleeding with LAAO (HR 0.80; 95% CI 0.76–0.84; p < 0.01). Conclusion In patients with AF and prior GI bleeding, LAAO was associated with a significantly lower risk of recurrent GI bleeding at short‐term and long‐term time intervals.

Abstract Aims Heart failure (HF) continues to portend significant morbidity and mortality within the USA. Data regarding the efficacy of mineralocorticoid receptor antagonists (MRAs) in HF with preserved ejection fraction (HFpEF) remains unclear. Finerenone, a non-steroidal MRA, has demonstrated reduction in hospitalizations in this population. However, the comparative efficacy of different MRA classes in these patients remains elusive. Methods and results We conducted a retrospective observational cohort study using the TriNetX research network. We applied 1:1 propensity score matching (PSM) to compare patients with HFpEF initiated on finerenone vs. spironolactone. We examined 1-year risks of HF exacerbation, acute kidney injury (AKI), electrolyte derangements, and cardiovascular outcomes. We identified 254,417 patients with HFpEF and MRA use. After PSM, each cohort contained 491 patients. Analysis revealed that finerenone use was associated with a significantly lower risk of HF exacerbation (hazard ratio [HR] = 0.63 [95% confidence interval [CI]: 0.54, 0.74], P &lt; 0.001), all-cause mortality (HR = 0.38 [95% CI: 0.23, 0.64], P &lt; 0.001), and hypokalaemia (HR = 0.58 [95% CI: 0.40, 0.85], P = 0.001). The aforementioned results, along with a reduction in AKI risk, were statistically significant after stratified subgroup analysis by diabetes mellitus and chronic kidney disease. Conclusion In this large real-world HFpEF cohort, finerenone use was associated with lower risks of HF exacerbation and all-cause mortality compared with spironolactone. These observational findings are hypothesis-generating and warrant confirmation in randomized trials.

Abstract Aims Heart failure (HF) continues to be a major cause of morbidity and mortality worldwide, placing a significant burden on healthcare systems. Differences in the outcomes of HF hospitalizations for adults in teaching vs. non-teaching hospitals in urban settings are uncertain. We evaluated outcomes of HF hospitalizations in patients hospitalized in urban teaching vs. non-teaching hospitals in the United States. Methods and results HF hospitalizations were abstracted from the 2016 through 2022 Nationwide Readmissions Database and stratified into urban teaching vs. urban non-teaching hospital settings. Propensity-score matching was used to control for baseline differences between teaching and non-teaching hospital cohorts. Logistic regression and lognormal models were estimated to assess differences in inpatient mortality, length of stay (LOS), total costs, complications, and 30-day and 90-day all-cause readmissions. A total of 7 558 299 weighted HF hospitalizations were included in the analysis, of which 76.3% involved urban teaching hospitalizations. Compared to urban non-teaching, HF hospitalizations in urban teaching hospitals were associated with significantly higher odds of inpatient mortality (OR 1.19, 95% confidence interval [CI]: 1.16–1.22), complications including cardiogenic shock, cardiac arrest, Intra-aortic balloon pump, cardiopulmonary resuscitation, extracorporeal membrane oxygenation and mechanical ventilation use as well as more extended hospital LOS, higher total costs, palliative care consultation and readmissions rates (all P &lt; 0.001). 30-day and 90-day all-cause readmission rates were also statistically higher in teaching hospitals, though the difference was clinically non-significant. Conclusion HF hospitalizations in urban teaching hospitals were associated with higher inpatient mortality, complication rates, resource utilization, and palliative care consult rates than urban non-teaching hospitals.

Background: Heart failure (HF) continues to be a major cause of morbidity and mortality worldwide, placing a significant burden on healthcare systems. Differences in the outcomes of HF hospitalizations for adults in teaching vs. non-teaching hospitals in urban settings are uncertain. Research Question: Do outcomes of HF hospitalizations differ between patients hospitalized in urban teaching vs. non-teaching hospitals in the United States? Methods: HF hospitalizations were abstracted from the 2016 through 2022 Nationwide Readmissions Database and stratified into urban teaching vs. urban non-teaching hospital settings. Propensity-score matching was used to control for baseline differences between teaching and non-teaching hospital cohorts. Logistic regression and lognormal models were estimated to assess differences in inpatient mortality, length of stay (LOS), total costs, complications, and 30-day and 90-day all-cause readmissions. Odds ratios (OR) with associated 95% Confidence intervals (CI) and p-values were reported. Analyses were conducted via SAS v. 9.4. Results: A total of 7,558,299 weighted HF hospitalizations were included in the analysis, of which 76.3% involved urban teaching hospitalizations. Compared to urban non-teaching, HF hospitalizations in urban teaching hospitals were associated with higher odds of in-hospital mortality (OR 1.24, 95% CI:1.21-1.27); had higher complications, including cardiogenic shock (OR 2.58, 95% CI, 2.46, 2.70), cardiac arrest (OR 1.31, 95% CI, 1.27, 1.36), CPR (OR 1.28, 95% CI, 1.22, 1.34), and use of extracorporeal membrane oxygenation (OR 20.13, 95% CI, 13.0, 31.2), intra-aortic balloon pump (OR 4.46, 95% CI, 3.90, 5.10) and mechanical ventilation (OR 1.27, 95% CI, 1.23, 1.33); higher hospitalization cost (Ratio 1.18, 95% CI: 1.17,1.20), longer length of stay (OR 1.16, 95% CI: 1.15, 1.17) and a greater palliative care consultation rate (Ratio 1.35 (95% CI 1.30, 1.40) (all p<0.001) ( Figure 1 ). 30-day (OR 1.03, 95% CI: 1.02, 1.04) and 90-day (OR 1.05, 95% CI: 1.02, 1.07) all-cause readmission rates were also statistically higher (p<0.001), though the difference was clinically non-significant ( Figure 2 ). The home discharge rate was similar for teaching and non-teaching hospitals ( Figure 2 ). Conclusion: HF hospitalizations in urban teaching hospitals were associated with higher inpatient mortality, complication rates, resource utilization, and palliative care consult rates than urban non-teaching hospitals.

Background: Acute myocardial infarction (AMI) represents a significant component of cardiovascular disease (CVD) mortality among the young and middle-aged populations of the United States (US). Research Question: To analyze the long-term trends and the impact of the COVID-19 pandemic on AMI-related mortality among the young and middle-aged populations of the US. Methods: Data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database were used to analyze death certificates from 1999 to 2023 for AMI-related deaths among the young and middle-aged population (aged 25-64) of the US. Age-adjusted mortality rates (AAMRs) per 100,000 people and associated annual percent changes (APCs) and average APC (AAPCs) were analyzed using Joinpoint regression analysis. Mortality trends were stratified by sex, race/ethnicity, and census region. Results: From 1999 to 2023, there were 970,454 AMI-related deaths among U.S. adults aged 25-64 years. The annual number of AMI-related deaths decreased from 44,040 in 1999 to 31,522 in 2023. The overall AAMR per 100,000 decreased from 31.02 deaths (95% CI, 30.73 to 31.31) in 1999 to 15.29 (95% CI, 15.11 to 15.46) in 2023 (AAPC -2.92%, 95% CI -3.22 to -2.75). The AAMR per 100,000 declined at a faster rate from 31.02 in 1999 to 19.57 in 2010 (1999-2010, APC -4.26), followed by a slower rate from 19.57 in 2010 to 16.67 in 2019 (2010-2019, APC -1.41), The declining trend was disrupted by a transient increase during the COVID-19 pandemic, with a peak AAMR of 19.73 (95% CI, 19.53 to 19.93) in 2021 (2019-2021, APC 8.52). The declining trend resumed from 2021 to 2023, with AAMR decreasing to the lowest levels of 15.29 in 2023 (2021-2023, APC -12.58). Heterogeneity across demographic and regional groups has narrowed during these 25 years. However, they are still prevalent, with men ( figure 1 ), non-Hispanic (NH) Black or African American, NH American Indian or Alaska Native ( figure 2 ), and the residents of the Southern United States ( figure 3 ) having higher mortality rates. Conclusion: Over the past 25 years, AMI-related mortality has declined in the young and middle-aged population of the US, although rates spiked during the COVID-19 pandemic before resuming their decline in 2022. While disparities among demographic and regional groups have narrowed, they still exist, necessitating comprehensive efforts to improve cardiovascular health outcomes.

Background Older adults undergoing percutaneous coronary intervention (PCI) face unique challenges due to complex anatomy and comorbidities. Intravascular imaging [including intravascular ultrasound (IVUS) and optical coherence tomography (OCT)] has been shown to improve PCI outcomes, but its benefits in older adults are less well established. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare intravascular imaging with angiography alone to guide PCI in older adults. Methods Cochrane, PubMed, and Scopus were searched for RCTs comparing intravascular imaging (IVUS or OCT) vs. angiography alone in adults aged ≥65 years. The outcome of interest was major adverse cardiovascular events (MACE) at the longest follow-up, as defined by each trial. Subgroup analyses were performed based on intravascular imaging modality, age group, and lesion complexity. Data were pooled using random-effects models, and heterogeneity was assessed using Higgins’ I ² statistic. Results Nine RCTs ( n = 7164, intravascular imaging = 3703, angiography alone = 3461) met the inclusion criteria. Intravascular imaging significantly reduced MACE compared with angiography alone [relative risk (RR) 0.66, 95% confidence interval (CI) 0.56–0.77; P < 0.001; I ² = 0%]. IVUS demonstrated superiority over angiography alone (RR 0.55, 95% CI 0.43–0.72; P < 0.001; I ² = 0%), while OCT demonstrated only a trend toward MACE reduction (RR 0.80, 95% CI 0.62–1.02). Subgroup analyses indicated consistent benefits with intravascular imaging for adults aged ≥65 and ≥70 years, respectively, and among those with complex coronary lesions (RR 0.65, 95% CI 0.53–0.79; P < 0.001). Conclusion Intravascular imaging guidance, especially IVUS, reduces MACE in older adults undergoing PCI compared with angiography alone.