Edo Kaluski

Robert Packer Hospital

Background Sodium‐glucose cotransporter‐2 (SGLT2) inhibitors reduce atherosclerotic cardiovascular disease (ASCVD) events in patients with prior ASCVD and type 2 diabetes; however, this benefit is uncertain in patients without established ASCVD. Methods and Results Large‐scale cardiovascular outcome randomized controlled trials or their prespecifi...

Background: The association of repeat revascularization after percutaneous coronary intervention (PCI) with mortality is uncertain. Objectives: To assess the association of repeat revascularization after PCI with mortality in patients with coronary artery disease (CAD). Methods: We identified randomized controlled trials comparing PCI with cor...

Trans-catheter aortic valve replacement (TAVR) via tortuous iliofemoral access with prior endovascular aneurysm repair (EVAR) is challenging. 83 year old male with severe aortic stenosis and prior EVAR was evaluated for TAVR with 29 mm Edwards Sapien 3 valve. Right femoral access was planned with ipsilateral protection. CT angiogram showed EVAR wit...

Described is challenging trans-catheter aortic valve replacement (TAVR) procedure done via tortuous iliofemoral access with prior endovascular aneurysm repair. Detailed pre-procedural planning enabled the operators to overcome the challenges while employing the following 4 strategies: 1)Avoiding unnecessary challenging rewiring of the iliofemoral s...

V-stenting (VS) and simultaneously kissing stents (SKS) upfront 2-stent strategies for treating large diameter bifurcations and especially distal left main coronary artery (LMCA) disease. Former teaching suggests that the minimal requirements for VS and SKS requires 8F guiding catheters or 7.5F sheathless guide. Presented is the “2-Step refinement”...

Calcified left main coronary artery (LMCA) disease is poorly defined by noninvasive imaging while intracoronary imaging before the percutaneous coronary intervention (PCI) although helpful is often not feasible and infrequently done. Forward ablating tools like orbital atherectomy (OA) and rotational atherectomy are the most effective initial strat...

Background Evaluating premature (<65 years of age) mortality because of acute myocardial infarction (AMI) by demographic and regional characteristics may inform public health interventions. Methods and Results We used the Centers for Disease Control and Prevention’s WONDER (Wide‐Ranging Online Data for Epidemiologic Research) death certificate dat...

This manuscript describes the refinements of ipsilateral wire protection and bailout strategy for large-bore femoral access and especially transcatheter aortic valve replacement. This ipsilateral wire protection requires no additional expenses and can provide effective arteriotomy site protection without the need for contralateral femoral access, e...

The mortality effects and risk–benefit profile of low dose rivaroxaban (2.5 mg twice daily) in patients with coronary heart disease are not completely understood. Five randomized controlled trials (26,110 patients) were selected using PubMed and Cochrane library till April 2019. The background antiplatelet therapy was aspirin in 3 trials, P2Y12 inh...

Objective To evaluate contemporary national trends of morbidity, mortality, and healthcare utilization in patients with mitral regurgitation (MR) and co‐existing chronic liver disease (CLD) undergoing transcatheter mitral valve repair (TMVR). Methods The National Inpatient Sample (NIS) was used to assess trends in patients undergoing TMVR between...

Objective To assess contemporary national trends of comorbidities, outcomes, and health care resource utilization in patients with aortic stenosis (AS) and end‐stage renal disease (ESRD) undergoing transcatheter and surgical aortic valve replacement (TAVR and SAVR). Methods and Results The National‐Inpatient‐Sample was used to study trends in pati...

Introduction: Catheter ablation has shown to reduce mortality in patient with atrial fibrillation (AF) and heart failure (HF) with reduced ejection fraction. Its effect on mortality in patients without HF has not been well elucidated. Methods: Thirteen randomized controlled trials encompassing 3856 patients were selected using PubMed, Embase and th...

Valve-in-valve TAVR procedure stalled due to challenging aortic to prosthesis angle not allowing the advancement of the Evolut R into the failing 25 mm Magna prosthesis. Efforts to better align the TAVR device with the valve prosthesis by using conventional methods failed. Eventually, a buddy wire allowed advancement and successful deployment of th...

Described is a complication of rescue left main coronary stenting due to threatened left main closure following a "valve in valve" TAVR procedure. Left main stent post dilatation with a NC Trek balloon was complicated by a failure to deflate the balloon. The patient spiraled into cardiogenic shock and was stabilized by an intra-aortic balloon pump....

We describe a successful bioprosthetic annular stretching in a patient with severe prosthetic aortic valve stenosis from a degenerated 19-mm Mitroflow valve (Sorin Group USA Inc, Arvada, CO, USA). This technique allowed for implantation of a 23-mm Evolut-R Pro valve (Medtronic, Minneapolis, MN, USA) with significant improvement in hemodynamics afte...

Background/Methods No studies have examined safety of a no fasting (NF) strategy as compared to current nil per os (NPO) practice in patients undergoing non emergent cardiac catheterization (CC). We compared these two strategies in this single center, prospective, randomized study. Fasting group was NPO for solids after midnight but could have clea...

Temporal and surgical risk dependent associations with clinical outcomes in patients receiving transcatheter versus surgical aortic valve implantation (TAVI vs SAVI) are uncertain. In this meta-analysis, 7 randomized controlled trials (7,771 patients) were included to investigate trends in outcomes in TAVI versus SAVI up to 5 years, and variation i...

Background: The role of nutritional supplements and dietary interventions in preventing mortality and cardiovascular disease (CVD) outcomes is unclear. Purpose: To examine evidence about the effects of nutritional supplements and dietary interventions on mortality and cardiovascular outcomes in adults. Data sources: PubMed, CINAHL, and the Coc...

Aim: The objective of this article is to review the contemporary literature on the use of antithrombotic therapy in patients with atrial fibrillation (AF) and coronary artery disease after undergoing percutaneous coronary intervention (PCI). Special consideration was given to the type and duration of therapy, treatment strategies for the elderly (...

Background: The objective of this study was to investigate whether baseline low-density lipoprotein cholesterol (LDL-C) levels influence total and cardiovascular mortality reduction associated with proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor therapy. Methods: In this meta-analysis, 9 randomized controlled trials were selected...

Aim and Methods This study compared clinical and financial outcomes in post–percutaneous coronary intervention (PCI) ambulatory patients (n = 308) managed by advanced practice providers (APPs) versus cardiologists (Physician Providers [PPs]) over a period of 12 months. Results Both groups (PPs, n = 164; APPs, n = 144) were similar in their baselin...

Background The relationship between lowering LDL (low‐density lipoprotein) cholesterol with contemporary lipid‐lowering therapies and incident diabetes mellitus (DM) remains uncertain. Methods and Results Thirty‐three randomized controlled trials (21 of statins, 12 of PCSK9 [proprotein convertase subtilisin/kexin type 9] inhibitors, and 0 of ezeti...

Table S1. Search Strategy Table S2. Cochrane Quality Risk Assessment Table S3. Baseline Characteristics of the Entire Study Population for Each Trial Table S4. Analyses According to Fixed‐Effects Model Table S5. Sensitivity Analyses According to Year of Publication and Definition of Diabetes Mellitus Figure S1. Funnel plot for publication bias...

Background and Purpose— The role of aspirin plus clopidogrel (A+C) therapy compared with aspirin monotherapy in patients presenting with acute ischemic stroke (IS) or transient ischemic attack remains uncertain. We conducted this study to determine the optimal period of efficacy and safety of A+C compared with aspirin monotherapy. Methods— Ten ran...

Background: There is inconsistency in the literature regarding the clinical effects of proton pump inhibitors (PPI) when added to dual antiplatelet therapy (DAPT) in subjects with coronary artery disease (CAD). We performed meta-analysis stratified by study design to explore these differences. Methods and results: 39 studies [4 randomized contro...

Background: The safety and efficacy of aspirin for the primary prevention of cardiovascular disease in patients with diabetes mellitus remains controversial. Design: A meta-analysis to investigate the effects of aspirin for the prevention of cardiovascular disease in diabetes mellitus. Methods: Ten randomized controlled trials were selected us...

The Impella CP (ICP) catheter (Abiomed) offers hemodynamic superiority over the intra-aortic balloon pump. However, device-specific issues are occasionally encountered, especially when long-term mechanical circulatory support (MCS) is required. These include ICP dislodgment, ICP mechanical failure, and the need to remove the ICP while maintaining a...

Background: The effects of increasing high-density lipoprotein cholesterol on cardiovascular outcomes remain uncertain. Design: We conducted a meta-analysis to investigate the effects of high-density lipoprotein cholesterol modifiers (niacin, fibrates and cholesteryl ester transfer protein inhibitors) on cardiovascular outcomes. Methods: Thirt...

Suboptimal iliofemoral artery access requiring alternative trans-catheter aortic valve replacement (TAVR) access is still encountered in 10-20% of subjects undergoing TAVR. Attempting suboptimal vascular access may result in excessive vessel injury, bleeding and even death. Reported is an innovative procedure to address suboptimal heavily calcified...

Background: The optimal revascularization strategy in patients with multi-vessel disease (MVD) presenting with acute myocardial infarction (AMI) and cardiogenic shock (CS) remains unclear. Objective: To investigate the comparative differences between culprit-only revascularization (COR) versus instant multi-vessel revascularization (IMVR) in AMI...

Background: The optimal preventive strategy for contrast induced acute kidney injury (CIAKI) in patients undergoing cardiac catheterization remains uncertain. Objective: We conducted Bayesian network meta-analysis (NMA) to compare different preventive strategies for CIAKI in these cohorts. Methods: Forty-nine randomized controlled trials were...

Objectives: This study sought to compare the efficacy and safety of catheter ablation (CA) with those of medical therapy (MT) for the treatment of atrial fibrillation (AF). Background: The preferred therapeutic strategy for subjects with AF remains unclear. Methods: A total of 17 randomized controlled trials were selected using Medline, EMBASE, and...

Aim: To compare relative efficacy and safety of mechanical compression devices (AutoPulse and LUCAS) with manual compression in patients with cardiac arrest undergoing cardiopulmonary resuscitation (CPR). Methods: For this Bayesian network meta-analysis, seven randomized controlled trials (RCTs) were selected using PubMed/Medline, EMBASE, and CE...

Background: The ideal oral anticoagulant agent during catheter ablation (CA) for atrial fibrillation (AF) remained unclear. Hypothesis: Novel oral anticoagulants (NOACs) are safer and effective compared to uninterrupted vitamin K antagonists (U-VKA) among patients requiring CA for AF. Methods: Four randomized controlled trials (RCTs) and 9 obs...

Background The comparative effects of statins, ezetimibe with or without statins and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors remain unassessed. Design Bayesian network meta-analysis was conducted to compare treatment groups. Methods Thirty-nine randomized controlled trials were selected using MEDLINE, EMBASE, and CENTRAL...

Major vascular complications still occur in ~4.2% of transcatheter aortic valve replacement (TAVR) procedures. These complications are a major safety drawback of TAVR when compared to surgical aortic valve replacement (SAVR). Contemporary strategies designed to minimize and effectively treat vascular complications are of immense importance to a suc...

Current clinical practice prefers oral anticoagulant (OAC) plus dual antiplatelet therapy (DAPT) in atrial fibrillation (AF) after percutaneous coronary intervention (PCI). We conducted a meta-analysis to test the hypothesis that the superiority of OAC plus DAPT is mainly endorsed by observational studies, while on the contrary, randomized clinical...

The evidence to support implantable cardioverter defibrillator (ICD) in subjects with non-ischemic cardiomyopathy (NICM) for primary prevention of sudden cardiac death (SCD) is not robust. This meta-analysis intends to assess the impact of routine ICD implantation for primary prevention of mortality due to SCD in NICM based on all the published ran...

Introduction: Current American Heart Association guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and P2Y receptor antagonists after percutaneous coronary intervention (PCI) with stent implantation or acute coronary syndrome (ACS). Up to 10 % of these patients have atrial fibrillation (AF) requiring prolonged oral anticoagulation...

Aims To assess whether continuous positive airway pressure (CPAP) therapy reduces major adverse cardiovascular events (MACE) in patients with moderate-to-severe obstructive sleep apnoea (OSA). Methods and results A total of 235 articles were recovered using MEDLINE, EMBASE and Cochrane library (inception–December 2016) and references contained in t...

Transradial access (TRA) for coronary angiography and interventional procedures has grown in popularity due to enhanced patient safety (ie, reduced major vascular and bleeding complications), early patient ambulation, and reduced hospital stay when compared with femoral artery access.However, TRA has its limitations, including asymptomatic radial a...

The significance of adding new oral anticoagulants (NOACs) to antiplatelet therapy in patients with acute coronary syndrome (ACS) is unclear. We conducted a meta-analysis to assess the safety and efficacy of adding NOACs (apixaban, rivaroxaban, and dabigatran) to single antiplatelet agent (SAP) or dual antiplatelet therapy (DAPT) in patients with A...

Use of X-ray contrast allows us to differentiate between two or more adjacent structures on radiographic studies. The X-ray contrast agent can be the one with increase X-ray absorption, like iodine and a barium X-ray contrast agent or the one with decrease X-ray absorption like air and carbon dioxide contrast agent. Each contrast agent possesses di...

Case series Patient: Male, 56 • Female, 70 • Female, 55 • Female, 55 Final Diagnosis: Stress induced cardiomyopathy Symptoms: Chest pain • shortness of breath Medication:— Clinical Procedure: Cardiac catheterization Specialty: Cardiology Objective Unusual clinical course Background Various physical and emotional factors have been previously descr...

Objective To investigate the safety and efficacy of percutaneous coronary interventions (PCI) versus coronary artery bypass graft (CABG) surgery for left main coronary artery (LMCA) disease. Methods Six randomised controlled trials (RCTs) were reviewed by searching PubMed/Medline, Embase and the Cochrane Library. Estimates were pooled according...

Objectives The objective of this clinical trial was to evaluate the long-term effect of endothelin receptor antagonism with bosentan on the morbidity and mortality of patients with severe chronic heart failure. Background Endothelin may play a role in heart failure, but short-term clinical trials with endothelin receptor antagonists have reported...

With the advance of radial access and ulnar access there has been an increased interest in performing right heart catheterization (RHC) and right-heart based procedures via antecubital venous access. Our purpose is to describe the venous anatomy of the upper extremities, technique, equipment, and cost for employing this approach. Reported also is t...

Background: Previous reports have been inconsistent in generating a consensus for optimal treatment strategy for patients with percutaneous coronary intervention (PCI) who also require oral anticoagulation (OAC). We conducted a traditional and network meta-analysis to evaluate the safety and efficacy of anti-thrombotic regimens in this subset of p...

Coronary artery perforation during percutaneous intervention is a rare but potentially life threatening complication. The treatment of coronary perforation can be challenging in view of potential life threatening consequences such as cardiac tamponade or myocardial infarction. Presented is a clinical course of a 69year-old female who developed card...

The ulnar artery is similar in size to the radial artery, however it is more difficult to palpate and access. For those physicians who mastered trans-ulnar access (TUA) this access site serves as an alternative to trans radial access (TRA) when the radial artery access is rendered suboptimal (by palpation, ultrasound examination or previous procedu...

The choice of an oral anticoagulant (OAC) for patients with nonvalvular atrial fibrillation (NVAF) is a major and complex clinical decision taking into account the individual risk-benefit ratio and bearing in mind the chronicity of therapy. This review focuses on the safety and efficacy of new oral anticoagulants (NOACs) compared with conventional...

Since the updated pulmonary hypertension (PH) guidelines published in 2015, two major landmark trials have provided additional insight regarding therapeutic algorithms of PH. In this review, we concisely summarized the key findings of peer reviewed studies published in the last one year in the field of PH. These studies enhanced our therapeutic abi...

In the recent years it has become apparent that angiography--based assessment of coronary artery stenosis suffers from considerable inaccuracy and pitfalls. Besides inter--observer variability in assessing stenosis severity, the correlation between angiographic severity and ischemia is suboptimal. Percutaneous coronary intervention (PCI) guided by...

Pulmonary hypertension (PH) is the common hemodynamic consequence of various pathophysiologic mechanisms. Since the publication of the most current American and European guidelines (2009) new agents were introduced into the clinical arena while data regarding former drugs has been substantiated. The therapeutic endeavor of evaluating new therapies...

Acute ST-Elevation myocardial (STEMI) infarction due to septic embolism is rare and management strategies differ from those applied to atherothrombotic STEMI. A 70 years old male with aortic valve endocarditis and persistent bacteremia developed acute inferior wall STEMI due to septic embolism. Due to inferior STEMI accompanied by hemodynamic insta...

Concentric hypertrophy is thought to transition to left ventricular (LV) dilatation and systolic failure in the presence of long standing hypertension (HTN). Whether or not this transition routinely occurs in humans is unknown. We consecutively enrolled African American patients hospitalized for acute decompensated volume overload heart failure (HF...

The use of transradial access for cardiac catheterization and percutaneous coronary intervention (PCI) has increased substantially in recent years. However, the transradial approach may not be feasible in certain patients. Although the transulnar approach can serve as an alternative approach in these subjects, it is infrequently used. We performed...

Background: Although hypothyroidism (HT) is known to be associated with worse cardiovascular outcomes, little data exists on its influence on clinical outcomes in patients undergoing percutaneous coronary interventions (PCI). Methods: In this prospective observational registry at a single center, we studied 1317 patients who underwent successful PC...

A 72-year-old male with end stage renal disease presented with febrile illness and was found to have Methicillin-resistant Staphylococcus Aureus bacteremia that persisted despite antibiotic therapy. On the 5th hospitalization day, patient developed acute inferior wall ST-elevation myocardial infarction (STEMI). Coronary angiography revealed right c...