Citations

Background: The optimal timing of pacemaker reimplantation following transvenous lead removal (TLR) of infected cardiac implantable electronic device (CIED) remains unclear. Objective: Our study aimed to assess the impact of timing to pacemaker reimplantation after TLR of infected CIED on hospital outcomes. Method: Using the Nationwide Readmissions Database, patients aged ≥18 years who underwent new pacemaker implantation with percutaneous approach following TLR of infected CIED from 2017 to 2020 were identified. The study population was stratified based on the timing of pacemaker reimplantation following TLR of infected CIED: early (<5 days) vs delayed (≥5 days). Weighted-propensity-score matched conditional multivariable logistic regressions were performed to determine the impact of the timing on various outcomes. Results: In our study, 469 (66.9%) patients received early device reimplantation, and 232 (33.1%) patients received delayed device reimplantation (≥5 days). Post-procedurally, patients in the delayed group had a higher risk of prolonged hospital stay (95% CI OR: 42.37 (6.36 – 282.11); p<0.01) and non-home discharge (95% CI OR: 2.00 (1.35 – 2.95), p<0.01). There was no significant difference between both groups in the early mortality, 30-day readmission, and procedural complications. Conclusion: Our study suggests that time-to-device reimplantation from TLR of infected CIED did not affect the overall short-term in-hospital outcomes. However, delayed device reimplantation was associated with a higher rate of prolonged hospital stay and non-home discharge.

Background: About 25% of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) have chronic total occlusion (CTO) at non-culprit artery. However, the prognostic impact of CTO in these patients is still unclear. Aims: We aimed to investigate the impact of CTO at non-culprit artery on 1-year mortality in patients with AMI-CS using the multicenter registry of cardiogenic shock. Methods: A total of 1,247 patients presented with cardiogenic shock (CS) were enrolled in the SMART-RESCUE registry between January 2014 and December 2018. After exclusion of non-ischemic cause shock, ischemic cardiomyopathy, failed or no revascularization, vasospasm, and patients undergoing coronary artery bypass surgery, 695 patients underwent percutaneous coronary intervention (PCI). Among these, we analyzed 536 patients with multivessel disease (MVD) according to the presence of CTO at non-culprit artery. The study endpoint was a 1-year all-cause mortality. We also examined the incidence of 1-year cardiac death, and in-hospital death or renal replacement therapy (RRT). Results: A 141 patients (26.3%) of study population had CTO lesion at non-culprit artery. The CTO group had more patients with diabetes mellitus, and lesser patients with ST-elevation myocardial infarction. Although initial left ventricular ejection fraction was lower in CTO group (28.5 vs. 34.1%, P=0.005), initial systolic blood pressure (73.8 vs. 73.2 mmHg, P=0.822) and the level of lactate (6.6 vs. 6.4 mmol/L, P=0.804) were similar in both groups. Venoarterial extracorporeal membrane oxygenation was applied in 206 patients (38.4%), and its use rate was comparable in 2 groups (40.4 vs. 37.7%, P=0.571). Pre- (32.9 vs. 22.9, P <0.001) and post-PCI SYNTAX score (16.7 vs. 5.3, P <0.001) was significantly higher in CTO group. In CTO group, 53 patients (37.6%) had CTO at left main or left anterior descending artery, and only 19 patients (13.5%) in CTO group received PCI for CTO. In multivariate analysis, all-cause mortality at 1-year was significantly higher in CTO group (51.8 vs. 40.5%, hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.09-1.90, P=0.011). The incidences of 1-year cardiac death (45.4 vs. 32.4%, HR 1.55, 95% CI 1.15-2.10, P=0.004) and in-hospital death or RRT (46.8 vs. 36.5%, P=0.031) were also higher in CTO group. Conclusions: Non-culprit CTO lesion was associated with higher 1-year mortality in patients with AMI-CS and multivessel disease.

Background: Spontaneous coronary artery dissection (SCAD) is a disease entity that often occurs in young, healthy women and can cause life-threatening ventricular arrhythmias and sudden cardiac arrest. However, the characteristics and outcomes of SCAD with cardiac arrest are not well characterized. Methods: This study investigated the baseline characteristics of SCAD patients with cardiac arrest using the National Inpatient Sample (NIS) database between 2016 and 2020. In addition, we also sought to determine the potential impact that implantable cardioverter defibrillator (ICD) therapy had on morbidity and mortality in SCAD patients presenting with cardiac arrest. Results: Our findings showed that the SCAD with cardiac arrest population had significantly higher comorbidities, including cardiac arrhythmias, congestive heart failure, pulmonary circulation disorders, liver diseases, solid tumors, coagulopathy, fluid disorders, chronic kidney disease (CKD), anemia secondary to deficiency, psychosis, neurological disorders, carotid artery disease, atrial fibrillation, ventricular arrhythmias (ventricular tachycardia (VT), ventricular fibrillation (VF)), and acute myocardial infarction (AMI), compared to the SCAD without cardiac arrest population. Likewise, for SCAD patients who did not have an ICD in place, we found increasing age, fluid and electrolyte disorders, uncomplicated diabetes, neurological disorders, peripheral vascular disease, pulmonary circulatory disorders, cardiac arrhythmias, and congestive heart failure to be associated with greater mortality. Conclusions: SCAD patients with certain comorbidities (e.g., pulmonary diseases, liver diseases, cancers, coagulopathy, and CKD) who presented with AMI or congestive heart failure should be monitored closely for ventricular arrhythmias as they have a higher chance of progressing to cardiac arrest. ICD therapy can be considered for these patients, but data on the success of this treatment option are limited, and more research needs to be performed to determine whether the benefits of this outweigh the risks.

Spontaneous coronary artery dissection (SCAD) can be treated conservatively. However, some SCAD patients can develop cardiogenic shock (CS). We evaluated the outcomes of SCAD-related CS using data from a national population-based cohort study from January 1, 2016, to December 30, 2019. In our study of 32,640 patients with SCAD, about 10.6% of patients presented with CS. We found that SCAD patients with CS had higher mortality and greater complications including use of mechanical circulatory devices, arrhythmias, respiratory support, and acute heart failure compared to those without CS. When comparing CS due to SCAD with that due to coronary artery disease, we found that although mortality rates were similar, those with CS due to SCAD were associated with higher risk of use of mechanical circulatory support, major bleeding, blood transfusion, and respiratory failure.

Précis: This study reports 12-month outcomes of combined phacoemulsification and Hydrus Microstent implantation in Asian eyes with moderate-to-severe normal tension glaucoma (NTG), demonstrating a significant reduction in glaucoma medications with an excellent intra and postoperative safety profile. Objective: To evaluate the 12-month safety and efficacy outcomes of combined phacoemulsification and Hydrus Microstent (Ivantis Inc.) implantation in Asian eyes with moderate to severe NTG. Methods: Retrospective study of consecutive surgeries performed from August 2019 to August 2021 in a single tertiary eye centre in Singapore. Outcome measures included a reduction in intraocular pressure (IOP), number of glaucoma medications, and intra and postoperative complications. Results: Data from 21 eyes of 21 subjects were analyzed. All subjects were ethnic Chinese, and the majority were males (14, 66.7%). At baseline, the mean IOP was 13.3 (2.3) mm Hg, all eyes had a Humphrey visual field mean deviation of ≥−6 dB [mean: −13.9 (4.3) dB], and all eyes were on at least one glaucoma medication. There was no statistically significant reduction in IOP at all time points compared with baseline (all P > 0.05). However, the median number of medications was reduced from 2 to 0 at all time points, up to postoperative month (POM) 12 (all P < 0.001). There were no intraoperative complications. No eyes underwent secondary glaucoma procedures nor lost any Snellen line of visual acuity by POM12. One (4.8%) eye experienced numerical hypotony at postoperative day 1, which resolved conservatively. Two (9.5%) eyes underwent laser iridoplasty for stent occlusion by iris. There was no deterioration in Humphrey visual field mean deviation at POM12 compared with baseline (n = 20, P > 0.05). Conclusion: Combined phacoemulsification and Hydrus Microstent implantation were effective in reducing medication burden in Asian eyes with moderate to severe NTG, up to 12 months postoperatively.

Background Although myocardial infarction with nonobstructive coronary arteries (MINOCA) is more common in women, it is unknown whether sex is a risk factor for adverse outcomes in patients with MINOCA. We aimed to investigate the relationship between sex differences and outcomes of patients with MINOCA. Methods and Results A systematic literature search was performed in PubMed, Embase, and Cochrane databases from their inception until August 2023 for relevant studies. End points were pooled using the Hartung–Knapp–Sidik–Jonkman random‐effects model as odds ratio (OR) with 95% CIs. Nine studies, involving 30 281 patients with MINOCA (comprising 18 079 women and 12 202 men), were included in the study. Women were older and had a higher prevalence of hypertension, diabetes, and stroke compared with men. The median duration of follow‐up was 3.5 years, with an interquartile range of 2.2 to 4.2 years. Pooled analysis revealed no statistically significant difference in the risk of all‐cause mortality (OR, 1.03 [95% CI, 0.87–1.22]), major adverse cardiovascular events (OR, 1.18 [95% CI, 0.89–1.58]), heart failure (OR, 1.32 [95% CI, 0.57–3.03]), stroke (OR, 1.13 [95% CI, 0.56–2.26]), and myocardial infarction (OR, 1.04 [95% CI, 0.29–3.76]) between the 2 groups. Regarding short‐term outcomes, women had a significantly higher risk of in‐hospital major adverse cardiovascular events compared with men (OR, 1.33 [95% CI, 1.16–1.53]) whereas there was no significant difference in the risk of in‐hospital mortality (OR, 0.90 [95% CI, 0.64–1.28]) between the 2 patient groups. Conclusions Despite the differences in demographics and comorbidity profiles, there was no significant difference in the long‐term outcomes for patients with MINOCA between sexes. However, it is noteworthy that women experienced a higher risk of in‐hospital major adverse cardiovascular events compared with men.

Abstract Generative artificial intelligence (AI) holds immense potential for medical applications, but the lack of a comprehensive evaluation framework and methodological deficiencies in existing studies hinder its effective implementation. Standardized assessment guidelines are crucial for ensuring reliable and consistent evaluation of generative AI in healthcare. Our objective is to develop robust, standardized guidelines tailored for evaluating generative AI performance in medical contexts. Through a rigorous literature review utilizing the Web of Sciences, Cochrane Library, PubMed, and Google Scholar, we focused on research testing generative AI capabilities in medicine. Our multidisciplinary team of experts conducted discussion sessions to develop a comprehensive 32‐item checklist. This checklist encompasses critical evaluation aspects of generative AI in medical applications, addressing key dimensions such as question collection, querying methodologies, and assessment techniques. The checklist and its broader assessment framework provide a holistic evaluation of AI systems, delineating a clear pathway from question gathering to result assessment. It guides researchers through potential challenges and pitfalls, enhancing research quality and reporting and aiding the evolution of generative AI in medicine and life sciences. Our framework furnishes a standardized, systematic approach for testing generative AI's applicability in medicine. For a concise checklist, please refer to Table S or visit GenAIMed.org .

AbstractBackgroundThe impact of atrial fibrillation (AF) among patients with amyloidosis on in‐hospital outcomes is not well‐established. We aimed to examine in‐hospital outcomes among patients admitted with a primary diagnosis of AF with and without amyloidosis.Methods and ResultsWe queried the Nationwide Readmissions Database to compare the in‐hospital outcomes among AF patients with and without amyloidosis. Our study demonstrated that in‐hospital all‐cause mortality, adverse events, and 30‐day readmission were comparable between the two groups.ConclusionsPatients with AF and concurrent amyloidosis did not have worse in‐hospital outcomes than those with AF alone.

AbstractBackgroundThis systematic review and meta‐analysis quantitatively examines the efficacy of angle‐based minimally invasive glaucoma surgery (MIGS) in normal tension glaucoma (NTG).MethodsA literature search was performed on Medline, Embase, PubMed, CINAHL and Cochrane Library from inception until 20 December 2022. Pilot, cohort, observational studies and randomised controlled trials including at least 5 subjects undergoing angle‐based MIGS (trabecular‐bypass devices, excisional trabeculotomy, goniotomy and ab‐interno canaloplasty) for NTG, with or without cataract surgery, were included. Meta‐analysis of continuous outcome using the meta routine in R version 2022.12.0+353 was performed to determine mean intraocular pressure (IOP) and anti‐glaucoma medication (AGM) reduction post‐operatively.ResultsOf the 846 studies initially identified, 15 studies with a pooled total of 367 eyes which underwent combined phacoemulsification and angle‐based MIGS were included for final meta‐analysis. Outcomes of the iStent were reported in 5 studies, iStent inject in 7 studies, Hydrus Microstent in 1 study, Kahook Dual Blade in 3 studies, and Trabectome in 2 studies. There was significant reduction in both IOP and AGM post‐operatively at 6 months (2.44 mmHg, 95%CI: 1.83–3.06; 1.21 AGM, 95%CI: 0.99–1.44), 12 months (2.28 mmHg, 95%CI: 1.71–2.84; 1.18 AGM, 95%CI: 0.90–1.47), 24 months (2.10 mmHg, 95%CI: 1.51–2.68; 1.26 AGM, 95%CI: 0.85–1.68) and 36 months (2.43 mmHg, 95%CI: 1.71–3.15, 0.87 AGM, 95%CI: 0.21–1.53) (all p < 0.05). Subgroup analysis on combined phacoemulsification‐iStent inject surgery demonstrated a reduction in both IOP (2.31 mmHg, 95%CI: 1.07–3.56, p < 0.001) and AGM (1.07 AGM, 95%CI: 0.86–1.29, p < 0.001) at 12 months post‐operatively.ConclusionsAngle‐based MIGS combined with phacoemulsification effectively reduces IOP and AGM in NTG eyes for up to 36 months after surgery.

Background: The aim of this study was to determine whether adding DE-CMR and/or TTE based parameters beyond known clinical factors provides incremental improvement of predicting long-term outcomes in STEMI patients who undergo acute reperfusion therapy. Methods and Results: One hundred twenty patients with first time STEMI who underwent PCI (74%), fibrinolysis (3%), and both (19%), were studied by both delayed enhancement cardiac magnetic resonance (DE-CMR) and transthoracic echocardiogram (TTE) during the acute phase of myocardial infarction. The primary endpoint was major adverse cardiac events (MACE). There were 28 events (6 deaths, 13 recurrent ischemia, and 9 heart failure) over a median follow-up of 4 years. We defined incremental increase in prognostic value by increase in Cox proportional hazards global chi square (χ 2 ) and/or increase in c-index with the addition of TTE and/or CMR parameters after adjusting for clinical variables. Among the clinical data, heart rate (HR: 1.02, p=0.047) and troponin (HR: 1.13, p=0.013) predicted MACE (χ 2 : 12.4, P=0.002; C index 0.69). After adjusting for these clinical factors, adding TTE parameters (left ventricular end systolic volume index [HR: 1.05, p<0.0001] and mitral valve deceleration time [HR: 0.99, p=0.036]), increased the global χ 2 to 24.6 and C index to 0.74 (p<0.0001). When CMR parameter (infarct size [HR: 2.92, p<0.0001]) was added to the clinical data alone, there was greater increase in global χ 2 to 36.8 and C index to 0.83 (p<0.0001). Addition of DE- CMR to clinical data combined with TTE measures showed significant incremental value with increased χ 2 difference of 17.6 (p<0.0001). There was no significant incremental value of adding TTE to clinical data combined with DE-CMR (p>0.05). Conclusion: DE-CMR provides significant incremental value for prognosticating adverse cardiac events over clinical data alone (or when in combination with TTE) in STEMI patients who undergo reperfusion therapy.