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Article ; Online: Analyzing Clinical Evidence and Supporting Data: Intravascular Ultrasound Guidance in Percutaneous Coronary Intervention Outcomes.

Shafi, Irfan / Alraies, Chadi

2023

Language	English
Publishing date	2023-10-19
Publishing country	United States
Document type	Letter
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2023.09.078
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Article ; Online: Myocardial perfusion imaging in patients with subcutaneous implantable cardioverter defibrillators: Is this the correct test?

Dawdy, John / Akins, Xavier / Shafi, Irfan / Kottam, Anupama

Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology

2022 Volume 30, Issue 4, Page(s) 1713–1716

MeSH term(s)	Humans ; Defibrillators, Implantable ; Myocardial Perfusion Imaging ; Artifacts
Language	English
Publishing date	2022-06-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1212505-2
ISSN	1532-6551 ; 1071-3581
ISSN (online)	1532-6551
ISSN	1071-3581
DOI	10.1007/s12350-022-03016-2
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Article ; Online: Incidence and Predictors of Acute Limb Ischemia in Patients With Acute Myocardial Infarction-Insight from National Readmission Database.

Patil, Aadhar / Romero, Carlos Manuel / Shafi, Irfan / Sathianathan, Shyama / Zhao, Huaqing / Lakhter, Vladimir / Bashir, Riyaz

The American journal of cardiology

2023 Volume 204, Page(s) 333–338

Abstract: Acute limb ischemia (ALI) has been a rare complication of acute myocardial infarction (AMI), however, with the increasing use of mechanical circulatory devices it is seen more frequently. The incidence and predictors of ALI in patients with AMI in ... ...

Abstract	Acute limb ischemia (ALI) has been a rare complication of acute myocardial infarction (AMI), however, with the increasing use of mechanical circulatory devices it is seen more frequently. The incidence and predictors of ALI in patients with AMI in contemporary clinical practice are unknown. A retrospective review of patients with index hospitalization for AMI in the Nationwide Readmission Database from 2016 to 2019 was done. We evaluated the annual incidence of ALI and its impact on outcomes. We used multivariate logistic regression analysis to determine predictors of ALI. In 1,283,586 patients with AMI, 3,971 patients (0.31%) had ALI and 365 (0.03%) had limb amputation. The 3 major predictors of ALI were peripheral artery disease (odds ratio [OR] 11.91, 95% confidence interval [CI]: 10.78 to 13.51), intravascular microaxial left ventricular assist device (OR 4.39, 95% CI 3.86 to 5.00), and veno-arterial extracorporeal membrane oxygenation (OR 4.37, 95% CI 3.19 to 6.01). Intra-aortic balloon pump had a substantially lower predictive ability (OR 1.81, 95% CI 1.63 to 2.0, p <0.0001) than other forms of mechanical circulatory support. The mortality rate in patients with ALI was significantly higher than those without ALI (19.49% vs 4.85%, p <0.0001). Patients who developed ALI had higher rates of amputation (1.59% vs 0.02%, p <0.0001). This observational nationwide study showed that ALI is an important complication in patients with AMI and is more frequently seen in patients who have peripheral artery disease, and require a left ventricular assist device or venoarterial extracorporeal membrane oxygenation. This complication was also associated with significantly higher in-hospital mortality.
MeSH term(s)	Humans ; Incidence ; Patient Readmission ; Myocardial Infarction/complications ; Myocardial Infarction/epidemiology ; Ischemia/epidemiology ; Ischemia/etiology ; Peripheral Arterial Disease/complications ; Peripheral Arterial Disease/epidemiology ; Retrospective Studies ; Heart-Assist Devices/adverse effects ; Shock, Cardiogenic/etiology ; Shock, Cardiogenic/complications ; Treatment Outcome
Language	English
Publishing date	2023-08-11
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2023.07.021
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Article ; Online: Derivation and Validation of Spontaneous Coronary Artery Dissection Prediction Score in Patients With Myocardial Infarction.

Shafi, Irfan / Maruthi, Rohit / Khalid, Mohammad U / Juarez, Jordan J / Zhao, Huaqing / Lakhter, Vladimir / Bashir, Riyaz

The American journal of cardiology

2023 Volume 201, Page(s) 170–176

Abstract: Spontaneous coronary artery dissection (SCAD) is an important cause of acute myocardial infarction (AMI); however, the prevalence of SCAD and its predictors in AMI are unknown. We sought to derive and validate a simple score that can help predict SCAD in ...

Abstract	Spontaneous coronary artery dissection (SCAD) is an important cause of acute myocardial infarction (AMI); however, the prevalence of SCAD and its predictors in AMI are unknown. We sought to derive and validate a simple score that can help predict SCAD in patients with AMI. We analyzed the Nationwide Readmissions Database and created a risk score for SCAD in patients with an index hospitalization for AMI. We used a multivariate logistic regression analysis to determine the independent predictors of SCAD, and each was assigned points proportional to its regression coefficient. Among 1,155,164 patients with AMI, 8,630 (0.75%) had SCAD. Based on the derivation cohort, the independent predictors of SCAD were fibromuscular dysplasia (odds ratio [OR] 67.0, 95% confidence interval [CI] 42.0 to 107.9, p <0.01), Marfan or Ehlers-Danlos syndrome (OR 4.7, 95% CI 1.7 to 12.5, p <0.01), polycystic ovarian syndrome (OR 5.4, 95% CI 3.0 to 9.8, p <0.01), female gender (OR 1.99, 95% CI 1.9 to 2.1, p <0.01), and aortic aneurysm (OR 1.41, 95% CI 1.1 to 1.7, p <0.01). The SCAD risk score included fibromuscular dysplasia (5 points), Marfan or Ehlers-Danlos syndrome (2 points), polycystic ovarian syndrome (2 points), female gender (1 point), and aortic aneurysm (1 point). The C-statistics of the score were 0.58 (derivation cohort) and 0.61 (validation cohort). In conclusion, the SCAD score is an easy bedside clinical tool that can help clinicians identify patients with AMI who are at risk for SCAD.
MeSH term(s)	Humans ; Female ; Marfan Syndrome ; Polycystic Ovary Syndrome ; Fibromuscular Dysplasia/epidemiology ; Coronary Vessels ; Vascular Diseases/diagnosis ; Vascular Diseases/epidemiology ; Vascular Diseases/etiology ; Myocardial Infarction/diagnosis ; Myocardial Infarction/epidemiology ; Risk Factors ; Ehlers-Danlos Syndrome ; Coronary Vessel Anomalies/diagnosis ; Coronary Vessel Anomalies/epidemiology ; Coronary Angiography
Language	English
Publishing date	2023-06-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2023.05.051
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Article ; Online: Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention Among Patients With Acute Coronary Syndrome.

Shafi, Irfan / Patel, Dhruvil Ashishkumar / Osman, Heba / Patel, Neel / Ramaseshan, Karthik / Goel, Mishita / Alraies, M Chadi

The American journal of cardiology

2023 Volume 204, Page(s) 115–121

Abstract: Intravascular ultrasound (IVUS) use in percutaneous coronary intervention (PCI) improves outcomes. However, data on outcomes of IVUS-guided PCI in patients presenting with acute coronary syndrome (ACS) is scarce. Therefore, we sought to study the ... ...

Abstract	Intravascular ultrasound (IVUS) use in percutaneous coronary intervention (PCI) improves outcomes. However, data on outcomes of IVUS-guided PCI in patients presenting with acute coronary syndrome (ACS) is scarce. Therefore, we sought to study the utilization rate and outcomes of IVUS-guided PCI in patients with ACS. Using the National Readmission database, we identified all patients with ACS who underwent PCI from 2016 to 2019. We used a 1:1 propensity-matched analysis to compare the outcome of patients with ACS who underwent PCI with and without IVUS. In 1,263,997 patients with ACS, 563,521 (44.6%) underwent PCI without IVUS and 40,095 (3.17%) underwent IVUS-guided PCI. A Propensity scored matched comparison of PCI with and without IVUS showed IVUS-guided PCI was associated with a lower risk of in-hospital mortality (odds ratio 0.74, 95% confidence interval 0.64 to 0.85, p <0.01) compared with PCI without IVUS. The utilization of IVUS increased from 2.64% in 2016 to 4.10% in 2019, p <0.001. In conclusion, IVUS-guided PCI is associated with lower in-hospital mortality in patients with ACS, yet the current utilization of IVUS-guided PCI remains low across the United States.
MeSH term(s)	Humans ; Percutaneous Coronary Intervention ; Acute Coronary Syndrome/surgery ; Treatment Outcome ; Ultrasonography, Interventional ; Time Factors ; Coronary Angiography ; Coronary Artery Disease
Language	English
Publishing date	2023-08-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2023.07.014
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Article ; Online: Association of vena cava filters and catheter-directed thrombolysis for deep vein thrombosis with hospital readmissions.

Shafi, Irfan / Zlotshewer, Brooke / Zhao, Matthew / Lakhter, Vladimir / Bikdeli, Behnood / Comerota, Anthony / Zhao, Huaqing / Bashir, Riyaz

Journal of vascular surgery. Venous and lymphatic disorders

2023 Volume 12, Issue 1, Page(s) 101677

Abstract: Background: Acute deep vein thrombosis (DVT) affects >350,000 patients each year in the United States. Contemporary rehospitalization rates and predictors of acute DVT have not been well-characterized. We aimed to evaluate the all-cause 30-day ... ...

Abstract	Background: Acute deep vein thrombosis (DVT) affects >350,000 patients each year in the United States. Contemporary rehospitalization rates and predictors of acute DVT have not been well-characterized. We aimed to evaluate the all-cause 30-day readmission rate and its association with catheter-directed thrombolysis and vena cava filters in patients with proximal and caval DVT. Methods: Patients with an index hospitalization for acute proximal lower extremity DVT were evaluated for unplanned readmission rates at 30 days using the Nationwide Readmission Database from 2016 to 2017. We used Cox proportional hazard model to determine the predictors of 30-day readmissions and their association with inferior vena cava (IVC) filter and CDT use. Results: We identified 58,306 adult patients with an index hospitalization for acute proximal DVT. The unplanned 30-day rehospitalization rate was 14.7% (95% confidence interval [CI], 14.5-15.0%). There were 4995 patients (10.0%) who underwent CDT and 6085 (12.2%) who underwent IVC filter placement. In multivariable analysis, only CDT was associated with a lower hazard for rehospitalization (hazard ratio [HR], 0.77; 95% CI, 0.71-0.84; P < .001), whereas IVC filter placement (HR, 1.26; 95% CI, 1.19-1.34; P < .001), Charlson Comorbidity Index of >3 (HR, 1.47; 95% CI, 1.38-1.56; P < .001), malignancy (HR, 1.45; 95% CI, 1.34-1.57; P < .001), and length of stay >5 days (HR, 1.39; 95% CI, 1.33-1.46; P < .001), and acute kidney injury (HR, 1.18; 95% CI, 1.11-1.25; P < .001) were associated with higher readmission rates. Conclusions: The 30-day unplanned rehospitalization rate continues to be high in patients with acute proximal DVT. CDT was associated with lower rehospitalization rates, whereas IVC filter placement was associated with increased rehospitalization rates.
MeSH term(s)	Adult ; Humans ; United States ; Patient Readmission ; Thrombolytic Therapy/adverse effects ; Vena Cava Filters/adverse effects ; Treatment Outcome ; Venous Thrombosis/therapy ; Venous Thrombosis/drug therapy ; Catheters/adverse effects ; Risk Factors ; Retrospective Studies
Language	English
Publishing date	2023-09-09
Publishing country	United States
Document type	Journal Article
ISSN	2213-3348
ISSN (online)	2213-3348
DOI	10.1016/j.jvsv.2023.08.016
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Article ; Online: Prevalence and outcomes of heparin-induced thrombocytopenia in hospitalized patients with venous thromboembolic disease: Insight from national inpatient sample.

Shah, Neal B / Sharedalal, Parija / Shafi, Irfan / Tang, Alice / Zhao, Huaqing / Lakhter, Vladimir / Kolluri, Raghu / Rao, A Koneti / Bashir, Riyaz

Journal of vascular surgery. Venous and lymphatic disorders

2023 Volume 11, Issue 4, Page(s) 723–730

Abstract: Objective: The mainstay of therapy for patients with venous thromboembolic disease (VTE) is anticoagulation. In the inpatient setting, majority of these patients are treated with heparin or low molecular weight heparin. The prevalence and outcomes of ... ...

Abstract	Objective: The mainstay of therapy for patients with venous thromboembolic disease (VTE) is anticoagulation. In the inpatient setting, majority of these patients are treated with heparin or low molecular weight heparin. The prevalence and outcomes of heparin-induced thrombocytopenia (HIT) in hospitalized patients with venous thromboembolic disease (VTE) is unknown. Methods: This nationwide study identified patients with VTE from the National Inpatient Sample database between January 2009 and December 2013. Among these patients, we compared in-hospital outcomes of patients with and without HIT using a propensity score-matching algorithm. The primary outcome was in-hospital mortality. Secondary outcomes included rates of blood transfusions, intracranial hemorrhage, gastrointestinal bleed, length of hospital stay, and total hospital charges. Results: Among 791,932 hospitalized patients with VTE, 4948 patients (0.6%) were noted to have HIT (mean age, 62.9 ±16.2 years; 50.1% female). Propensity-matched comparison showed higher rates of in-hospital mortality (11.01% vs 8.97%; P < .001) and blood transfusions (27.20% vs 20.23%; P < .001) in patients with HIT compared with those without HIT. No significant differences were noted in intracranial hemorrhage rates (0.71% vs 0.51%; P > .05), gastrointestinal bleed (2.00% vs 2.22%; P > .05), length of hospital stay (median, 6.0 days; interquartile range [IQR], 3.0-11.0 vs median, 6.0 days; IQR, 3.0-10.0 days; P > .05), and total hospital charges (median, $36,325; IQR, $17,798-$80,907 vs median, $34,808; IQR, $17,654-$75,624; P > .05). Conclusions: This nationwide observational study showed that 0.6% of hospitalized patients with VTE in the United States have HIT. The presence of HIT was associated with higher in-hospital mortality and blood transfusion rates compared with those without HIT.
MeSH term(s)	Humans ; Female ; United States/epidemiology ; Middle Aged ; Aged ; Male ; Anticoagulants/adverse effects ; Inpatients ; Venous Thromboembolism/chemically induced ; Venous Thromboembolism/diagnosis ; Venous Thromboembolism/epidemiology ; Prevalence ; Treatment Outcome ; Retrospective Studies ; Venous Thrombosis/therapy ; Thrombocytopenia/chemically induced ; Thrombocytopenia/diagnosis ; Thrombocytopenia/epidemiology
Chemical Substances	Anticoagulants
Language	English
Publishing date	2023-03-07
Publishing country	United States
Document type	Observational Study ; Journal Article
ISSN	2213-3348
ISSN (online)	2213-3348
DOI	10.1016/j.jvsv.2023.02.001
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Article ; Online: Diplopia as the initial symptom of multiple myeloma in a patient with sarcoidosis.

Yazdanpanah, Omid / Kaur, Jasleen / Shafi, Irfan / Sarakbi, Housam A

BMJ case reports

2020 Volume 13, Issue 8

Abstract: We present the case of a 45-year-old man with a known history of sarcoidosis who presented with double vision and headache. On examination, he was found to have left abducens and hypoglossal nerve palsy. CT and then MRI demonstrated extensive osseous ... ...

Abstract	We present the case of a 45-year-old man with a known history of sarcoidosis who presented with double vision and headache. On examination, he was found to have left abducens and hypoglossal nerve palsy. CT and then MRI demonstrated extensive osseous lesions with a large expansile mass involving the clivus bone and sphenoid sinus. Laboratory data were remarkable for normocytic anaemia, low anion gap and elevated total protein which raised the suspicion for multiple myeloma. Subsequent protein electrophoresis and immunofixation illustrated monoclonal spike of IgG lambda present in the gamma zone. This was followed by a bone marrow biopsy that demonstrated plasma cells compromising around 80% of marrow cellularity. Left sphenoidal mass biopsy was consistent with plasmacytoma. Based on these findings, the patient was initially started on palliative radiation to shrink the intracranial tumour and is currently undergoing induction chemotherapy.
MeSH term(s)	Brain/diagnostic imaging ; Brain/pathology ; Brain Neoplasms/complications ; Brain Neoplasms/diagnosis ; Brain Neoplasms/therapy ; Diplopia/diagnosis ; Diplopia/etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multiple Myeloma/complications ; Multiple Myeloma/diagnosis ; Multiple Myeloma/therapy ; Sarcoidosis/complications
Language	English
Publishing date	2020-08-24
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2020-235725
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Article: Contemporary Catheter-Based Treatment Options for Management of Acute Pulmonary Embolism.

Singh, Maninder / Shafi, Irfan / Rali, Parth / Panaro, Joseph / Lakhter, Vladimir / Bashir, Riyaz

Current treatment options in cardiovascular medicine

2021 Volume 23, Issue 7, Page(s) 44

Abstract: Introduction: Acute pulmonary embolism (PE) remains an important cause of cardiovascular mortality and morbidity in the USA and worldwide. Catheter-based therapies are emerging as a new armamentarium for improving outcomes in these patients.: Purpose ... ...

Abstract	Introduction: Acute pulmonary embolism (PE) remains an important cause of cardiovascular mortality and morbidity in the USA and worldwide. Catheter-based therapies are emerging as a new armamentarium for improving outcomes in these patients. Purpose of review: The purpose of this review is to familiarize the clinicians with (1) various types of catheter-based modalities available for patients with acute PE, (2) advantages, disadvantages, and appropriate patient selection for the use of these devices, and (3) evidence base and the relevance of such therapies in the COVID-19 pandemic. Recent findings: There are four main types of catheter-based therapies in acute PE: (1) standard catheter-directed thrombolysis (CDT), (2) ultrasound-assisted CDT, (3) pharmacomechanical CDT, and (4) mechanical thrombectomy without thrombolysis. Ultrasound-assisted thrombolysis is the most widely studied modality in this group; however, evidence base for other catheter-based technologies is rapidly emerging. Summary: Current use of catheter-based therapies is most suitable for patients with intermediate and high-risk acute PE. The adoption of a multidisciplinary approach like the pulmonary embolism response team (PERT) is desirable for appropriate patient selection and possibly/potentially improving patient outcomes. We discuss the current status of these therapies.
Language	English
Publishing date	2021-05-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057337-6
ISSN	1534-3189 ; 1092-8464
ISSN (online)	1534-3189
ISSN	1092-8464
DOI	10.1007/s11936-021-00920-7
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Article ; Online: Incidence and predictors of acute limb ischemia in acute myocardial infarction complicated by cardiogenic shock.

Romero, Carlos M / Shafi, Irfan / Patil, Aadhar / Secemsky, Eric / Weinburg, Ido / Kolluri, Raghu / Zhao, Huaqing / Lakther, Vladimir / Bashir, Riyaz

Journal of vascular surgery

2022 Volume 77, Issue 3, Page(s) 906–912.e4

Abstract: Objective: To describe the incidence and predictors of acute limb ischemia (ALI) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).: Methods: Patients with index hospitalizations for AMI complicated by ... ...

Abstract	Objective: To describe the incidence and predictors of acute limb ischemia (ALI) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Methods: Patients with index hospitalizations for AMI complicated by cardiogenic shock from 2016 to 2019 in the US National Readmission Database were identified. We evaluated the incidence of ALI and its associated mortality, length of stay, and cost of hospitalization. We used multivariable logistic regression to determine independent predictors of ALI in this population. Results: A total of 84,615 patients had AMI complicated by cardiogenic shock and 1302 (1.54%) developed ALI. The rates of ALI increased from 1.29% in 2016 to 1.66% in 2019 (P ≤ .002). The use of microaxial mechanical circulatory support increased from 2.25% in 2016 to 13.36% in 2019 (P = .0001). The major predictors of ALI included peripheral arterial disease (odds ratio [OR], 7.34; 95% confidence interval [CI], 6.12-8.81), venoarterial extracorporeal membrane oxygenation (OR, 4.40; 95% CI, 3.19-6.07), and microaxial mechanical circulatory support (OR, 3.12; 95% CI, 2.74-3.55). ALI in patients with cardiogenic shock was associated higher mortality (39.20% vs 33.53%; P ≤ .0001). Conclusions: This nationwide observational study shows that ALI is an important complication of AMI with cardiogenic shock. This complication is associated with higher mortality. In addition to peripheral artery disease, the use of mechanical circulatory devices was associated with significantly higher rates of ALI.
MeSH term(s)	Humans ; Shock, Cardiogenic ; Incidence ; Treatment Outcome ; Hospital Mortality ; Myocardial Infarction ; Peripheral Arterial Disease/complications ; Heart-Assist Devices/adverse effects ; Retrospective Studies
Language	English
Publishing date	2022-11-16
Publishing country	United States
Document type	Observational Study ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2022.11.044
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