Shikhar - Agarwal

Shikhar - Agarwal
Geisinger Health System | GHS · Department of Cardiovascular Medicine

MD MPH CPH FACP FACC

About

165
Publications
15,938
Reads
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4,632
Citations
Additional affiliations
July 2014 - June 2016
Cleveland Clinic
Position
  • Fellow
July 2011 - June 2014
Cleveland Clinic
Position
  • Fellow
July 2008 - June 2011
Cleveland Clinic
Position
  • Resident Doctor
Education
July 2007 - May 2008
Johns Hopkins Bloomberg School of Public Health
Field of study
  • Master of Public Health
August 2001 - December 2006
All India Institute of Medical Sciences, New Delhi
Field of study
  • Medical School

Publications

Publications (165)
Article
Objectives: The study aim is to determine whether invasive cardiac procedures following a 3-day (holiday) weekend have worse outcomes compared with procedures following a 2-day (normal) weekend. Background: Catheterization laboratory schedules after 3-day holiday weekends tend to be overloaded with urgent procedures for patients who have waited...
Article
Background Patients with iodinated contrast material (ICM) adverse reactions are at increased risk for breakthrough reactions. Previous studies suggest that the severity of a prior ICM adverse reaction corresponds to the severity of a repeat reaction. Objective We investigated whether the severity of prior ICM adverse reactions in patients receivi...
Article
Background Because of the COVID-19 pandemic, cath labs have had to modify their workflow for elective and urgent patients. Methods We surveyed 16 physicians across 3 hospitals in our healthcare system to address COVID-19 related concerns in the management of interventional and structural heart disease patients, and to formulate system wide criteri...
Article
There is growing interest in "minimalist" transcatheter aortic valve implantation (M-TAVI), performed with conscious sedation instead of general anesthesia (GA-TAVI). We assessed the impact of M-TAVI on procedural efficiency, long-term safety, and quality of life (QoL) in 477 patients with severe aortic stenosis (82 years, women 50%, STS 5.0), who...
Article
Background: Despite the demonstrated safety of the same-day discharge (SDD) after percutaneous coronary intervention (PCI), uptake of this program has been relatively poor in the United States. We evaluated the temporal trends and variations in the utilization of SDD after PCI during the contemporary era. In addition, we evaluated the predictors o...
Article
We aimed to evaluate the secular trends in demographics, risk factors, and clinical characteristics of patients presenting with acute myocardial infarction (AMI) or acute ischemic stroke (AIS), using a large nationally representative data set of in-hospital admissions. We used the 2003 to 2013 Nationwide Inpatient Sample. All admissions with primar...
Article
Background: Readmissions constitute a major healthcare burden among critical limb ischemia (CLI) patients. We aimed to study the incidence of readmission and factors affecting readmission in CLI patients. Methods: All adult hospitalizations with a diagnosis code for CLI were included from State Inpatient Databases from Florida (2009-2013), New Y...
Article
Since first performed in 2002 by Alan Cribier (1), transcatheter aortic valve replacement (TAVR) has emerged as an attractive alternative for the treatment of patients with severe symptomatic aortic stenosis (AS) who are inoperable or at high-risk for complications with surgical aortic valve replacement (SAVR), based in large part on the results of...
Article
Background: Prior studies of stroke and transient ischemic attack (TIA) after transcatheter aortic valve replacement (TAVR) are limited by reporting and follow-up variability. This is a comprehensive analysis of time-related incidence, risk factors, and outcomes of these events. Methods and results: From April 2007 to February 2012, 2621 patient...
Article
Background Few studies have explored percutaneous coronary intervention (PCI) in perioperative myocardial infarction (PMI), even though PMI is a major cause of mortality in patients undergoing urgent/emergent noncardiac surgery. Objectives This study sought to describe the angiographic characteristics and outcomes in patients presenting to the car...
Article
Data are limited about the prevalence trends of risk factors, lesion morphology, and clinical outcomes of coronary artery disease in patients, ≤ 45 years of age, undergoing percutaneous coronary intervention (PCI), between the Bare Metal Stent (BMS) (1994-2002) and Drug Eluting Stent (DES) (2003-2012) eras. From the PCI database at the Cleveland Cl...
Article
Background: 5% of patients undergoing coronary stenting have an indication for anticoagulation. The aim of our study was to determine the bleeding rates and complications in patients on triple oral antithrombotic therapy (TOAT) after coronary stenting. Methods: We studied patients who underwent coronary stenting in our institution between 2003-2...
Article
Degenerative mitral stenosis (DMS) is an important cause of mitral stenosis, developing secondary to severe mitral annular calcification. With the increase in life expectancy and improved access to health care, more patients with DMS are likely to be encountered in developed nations. These patients are generally elderly with multiple comorbidities...
Article
Background: Patients with a history of chest radiation prior to cardiac surgery, have poorer short and long-term outcomes. Aortic valve replacement (AVR) in this patient population can be technically challenging. We sought to compare the characteristics and outcomes in TAVR versus SAVR in this patient population.
Article
Background We assessed trends in incidence, in-hospital mortality, and admission among patients with adult congenital heart disease (ACHD) presenting to the emergency department (ED) from 2006 to 2012. HypothesisThere is a considerable burden of ACHD in the US EDs. Methods We used the 2006-2012 US Nationwide Emergency Department Sample. All ED visi...
Article
Background: Critical limb ischemia (CLI) continues to be a major cause of vascular related morbidity and mortality in the United States. Objectives: The study sought to characterize the trends in hospitalization of U.S. patients with CLI from 2003 to 2011, using the Nationwide Inpatient Sample. We compared the cost utilization and in-hospital ou...
Article
Full-text available
Background We aimed to assess trends in hospitalization, outcomes, and resource utilization among patients admitted with adult congenital heart disease (ACHD). Methods and Results We used the 2003–2012 US Nationwide Inpatient Sample for this study. All admissions with an ACHD were identified using standard ICD codes. Resource utilization was asses...
Article
Background: Operational inefficiencies are ubiquitous in several healthcare processes. To improve the operational efficiency of our catheterization laboratory (Cath Lab), we implemented a lean six sigma process improvement initiative, starting in June 2010. We aimed to study the impact of lean six sigma implementation on improving the efficiency a...
Article
Despite controversy about efficacy, mechanical circulatory support (MCS) is often utilized in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI). We aimed to characterize the variability in MCS utilization in cardiogenic shock patients across hospitals in the US, according to annual volume of primary percutaneous inter...
Article
Full-text available
Cardiovascular disease represents a leading cause of death in the United States and is responsible for 17% of national healthcare expenditures.[1][1]–[2][2] The field of cardiology, especially interventional cardiology, has witnessed significant advancement with several innovations in the last
Article
Background Unlike the developed countries, a home healthcare provisioning system (HHPS) is not widely prevalent in India. Our aim was to evaluate the knowledge, attitudes and perceptions of Indian patients in adopting the HHPS. Methods We used a paper based and online survey for adults in India to conduct the study. We used bar and pie charts to r...
Article
Early revascularization is the mainstay of treatment for cardiogenic shock (CS) complicating acute myocardial infarction. However, data on the contemporary trends in management and outcomes of CS complicating non-ST-elevation myocardial infarction (NSTEMI) are limited. We used the 2006 to 2012 Nationwide Inpatient Sample databases to identify patie...
Article
Current data regarding gender disparities in outcomes after acute pulmonary embolism (PE) are limited and controversial. We sought to assess the gender-specific rates and trends in treatment, outcomes, and complications after acute PE. We used the 2003 to 2011 Nationwide Inpatient Sample database for this analysis. All hospital admissions with a pr...
Article
Full-text available
Socioeconomic status (SES) as reflected by residential zip code may adversely influence outcomes for patients with acute pulmonary embolism (PE). We sought to analyze the impact of neighborhood SES on in-hospital mortality, use of thrombolysis, implantation of inferior vena cava (IVC) filters and cost of hospitalization following acute PE. We used...
Article
Over the last few decades, there has been a significant reduction in hospital length of stay (LOS) among patients undergoing percutaneous intervention (PCI) for ST elevation myocardial infarction (STEMI). Although studies have looked at predictors of long hospital stay after STEMI, the impact of LOS on long-term outcomes after PCI remains unknown....
Article
Background Balloon-expandable valves (BEV) and self-expandable valves (SEV) are two major types of valves utilized for transcatheter aortic valve replacement (TAVR). We conducted a meta-analysis of available studies to compare the safety and efficacy of these two valve types. Methods Medline search was conducted using standard search terms to dete...
Article
Stroke is a widely recognized complication after aortic valve replacement (AVR), especially among elderly patients. The literature contains substantial variability in reports of the actual incidence of stroke after AVR among high-risk patients. Our objective was to define risk of stroke in patients undergoing surgical AVR, using a large national da...
Article
Delayed hyperenhancement (DHE) of the pericardium usually represents ongoing inflammation and may identify patients with constrictive pericarditis that will improve with anti-inflammatory therapy. However, a quantitative assessment of pericardial DHE has not been performed, and the hierarchical relationship among clinical factors, inflammatory mark...
Article
Full-text available
A 45-year-old man presented with non-tender soft tissue swelling on the medial aspect of the right foot with pain during dorsiflexion and eversion of the foot. X-ray (figure 1) and MRI (figure 2) of the mass revealed a heterogeneous soft tissue mass arising out of the calcaneal bone. Figure 1 demonstrates the X-ray showing the soft tissue mass in t...
Article
Full-text available
We sought to analyze the impact of socioeconomic status (SES) on in-hospital outcomes, cost of hospitalization, and resource use after acute ischemic stroke. We used the 2003-2011 Nationwide Inpatient Sample database for this analysis. All admissions with a principal diagnosis of acute ischemic stroke were identified by using International Classifi...
Article
Patients with hypertrophic cardiomyopathy (HCM) have exercise intolerance due to left ventricular outflow tract (LVOT) obstruction, mitral regurgitation, and left ventricular dysfunction. We sought to study predictors of outcomes in HCM patients undergoing cardiopulmonary stress testing (CPT). We studied 1,005 HCM patients (50 ± 14 years, 64% men,...
Article
Full-text available
Significant mitral regurgitation (MR) typically occurs as holosystolic (HS) or mid-late systolic (MLS), with differences in volumetric impact on the left ventricle (LV). We sought to assess outcomes of degenerative MR patients undergoing exercise echocardiography, separated based on MR duration (MLS versus HS). We included 609 consecutive patients...
Article
Commentary on: Cohen DJOsnabrugge RLMagnuson EAet al; SYNTAX Trial Investigators. Cost-effectiveness of percutaneous coronary intervention with drug-eluting stents versus bypass surgery for patients with 3-vessel or left main coronary artery disease: final results from the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Su...
Article
Firearm-related hospitalizations are a major burden to the current healthcare infrastructure. We examined the trends in the incidence and case-fatality rates of firearm-related hospitalizations over the past decade. We also hypothesized that major national economic perturbations would be partly responsible and correlate temporally with national fir...
Article
Full-text available
Background Socioeconomic status (SES) as reflected by residential zip code status may detrimentally influence a number of prehospital clinical, access‐related, and transport variables that influence outcome for patients with ST‐elevation myocardial infarction (STEMI) undergoing reperfusion. We sought to analyze the impact of SES on in‐hospital mort...
Article
Significant heterogeneity exists in the current literature around the actual incidence of stroke following aortic valve replacement (AVR) among high-risk patients. We aimed to evaluate the risk of stroke in patients undergoing surgical AVR from a large national database. Methods: We used the 2002-2011 Nationwide Inpatient Sample for this analysis....
Article
Despite significant controversy about the efficacy, mechanical circulatory support (MCS) is often utilized in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI). We aimed to characterize the trends and outcomes following the use of MCS devices in patients presenting with STEMI. Methods: We used the 2003-2011 US Nationw...
Article
Background: Socioeconomic status (SES) as reflected by residential zip code status may detrimentally influence a number of pre-hospital clinical, access-related and transport variables that influence outcome for patients with ST-elevation myocardial infarction (STEMI) undergoing reperfusion. We sought to analyze the relationship between SES and in-...
Article
Introduction: High risk percutaneous coronary interventions (PCI) may be preceded by elective support device insertion, though the evidence for such a practice is relatively weak. We sought to analyze the changing trends and predictors for prophylactic support device insertion in these patients over the last 20 years. Methods: Retrospective analysi...
Article
Full-text available
Transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI) has emerged as an attractive treatment strategy for the treatment of patients with severe symptomatic aortic stenosis (AS), particularly those who are inoperable or at high risk for surgical aortic valve replacement. Several multicentre registries and ra...
Article
Background Computed tomography (CT) imaging has not been systematically studied for predicting vascular complications during transcatheter aortic valve replacement (TAVR). Methods Clinical data were obtained from the electronic medical record and analysis was performed for each individual patient's iliofemoral CT angiogram. Sheath : femoral artery...
Article
Background: We sought to assess the utility of left ventricular global longitudinal strain (LV-GLS) in predicting mortality in moderate to severe and paradoxical severe aortic stenosis (AS) patients with preserved ejection fraction. Methods and results: We studied 395 AS patients (70 ± 14 years, 57% men) with aortic valve area <1.3 cm(2) evaluat...
Article
Background: In patients with possible acute coronary syndromes, guidelines recommend routine provocative testing after negative cardiac biomarkers. We hypothesized that myocardial perfusion imaging would be low yield with limited short-term value and that early revascularization would not affect mortality. Methods and results: We identified cons...
Conference Paper
Introduction: High risk percutaneous coronary interventions (PCI) may be preceded by elective support device insertion, though the evidence for such a practice is relatively weak. We sought to analyze the changing trends and predictors for prophylactic support device insertion in these patients over the last 20 years. Methods: Retrospective analys...
Article
Background: The long-term outcomes of transcatheter aortic valve replacement (TAVR) in inoperable patients with severe aortic stenosis remain unknown. Methods and results: In the Placement of Aortic Transcatheter Valves (PARTNER) study, 358 patients were randomly assigned to TAVR or standard therapy. We report the 3-year outcomes on these patien...
Article
Objectives: This study investigated whether patients with patent foramen ovale (PFO) have an increased risk of stroke due to permanent pacemaker (PPM)/implantable cardioverter-defibrillator (ICD) implantation. Background: Data are lacking on the risk of stroke in patients with PFO and implantable intracardiac devices, either a PPM or an ICD. We...
Article
Background: Diabetes mellitus adversely affects outcomes in patients undergoing percutaneous coronary intervention. The association of baseline hemoglobin A1c (HbA1c) at the time of percutaneous coronary intervention with long-term mortality is unknown. Methods and results: Consecutive patients with diabetes mellitus undergoing percutaneous coro...
Article
Background—X-ray use in the catheterization laboratory is guided by the principle of as low as reasonably achievable. In accordance with this principle, we reduced the default fluoroscopic frame rate from 10 to 7.5 frames/s and increased the emphasis on the use of low-dose acquisition starting January 1, 2013. We aimed to study the impact of these...
Article
Background: Chronic obstructive pulmonary disease (COPD) and atherosclerotic vascular disease share several etiopathogenic factors. Purpose: To compare the prevalence of self-reported cardiovascular and cerebrovascular disease (CCVD) between COPD and non-COPD subjects using the National Health and Nutrition Examination Survey (NHANES) database....
Article
Objectives This study compared the prognosis of patients with proximal cardiac allograft vasculopathy (CAV) treated with percutaneous intervention (PCI) to the prognosis of those with severe CAV not amenable to PCI. Background CAV is a progressive form of arterial narrowing affecting patients with orthotopic heart transplants (OHTs). PCI has been...
Conference Paper
Full-text available
Does Residential Zip Code Predict Adverse Outcomes Following ST Elevation Myocardial Infarction: A Nationwide Population Based Study Category: Acute Coronary Syndromes, Myocardial Infarction, Thrombectomy and Vulnerable Plaque Authors: Shikhar Agarwal, Cleveland Clinic, United States; Aatish Garg, Cleveland Clinic, United States; Akhil Parashar, Cl...
Article
Objectives Our aim was to study the relationship between beam angulation and air kerma in a modern cardiac catheterization laboratory. Background Recent reports have identified the merits of reducing radiation scatter, an important determinant of radiation dose in the catheterization laboratory. Radiation scatter is poorly characterized in the con...