BackgroundThe association of chronic renal insufficiency with outcomes after percutaneous coronary intervention (PCI) in the current era of drug-eluting stents and modern antithrombotic therapy has not been well characterized.Methods and ResultsWe queried the 2007–2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years who underwent PCI. Multivariable logistic regression was used to compare in-hospital outcomes among patients with chronic kidney disease (CKD), patients with end-stage renal disease (ESRD), and those without CKD or ESRD. Of 3 187 404 patients who underwent PCI, 89% had no CKD/ESRD; 8.6% had CKD; and 2.4% had ESRD. Compared to patients with no CKD/ESRD, patients with CKD and patients with ESRD had higher in-hospital mortality (1.4% versus 2.7% versus 4.4%, respectively; adjusted odds ratio for CKD 1.15, 95% CI 1.12 to 1.19, P<0.001; adjusted odds ratio for ESRD 2.29, 95% CI 2.19 to 2.40, P<0.001), higher incidence of postprocedure hemorrhage (3.5% versus 5.4% versus 6.0%, respectively; adjusted odds ratio for CKD 1.21, 95% CI 1.18 to 1.23, P<0.001; adjusted odds ratio for ESRD 1.27, 95% CI 1.23 to 1.32, P<0.001), longer average length of stay (2.9 days versus 5.0 days versus 6.4 days, respectively; P<0.001), and higher average total hospital charges ($60 526 versus $77 324 versus $97 102, respectively; P<0.001). Similar results were seen in subgroups of patients undergoing PCI for acute coronary syndrome or stable ischemic heart disease.ConclusionsIn patients undergoing PCI, chronic renal insufficiency is associated with higher in-hospital mortality, higher postprocedure hemorrhage, longer average length of stay, and higher average hospital charges.

Peripheral arterial disease is an important predictor of cardiovascular morbidity and mortality. Patients with peripheral arterial disease are at a higher risk of myocardial infarction and stroke. The well-known coronary artery disease risk factors such as diabetes, hypertension, smoking and dyslipidemia are also risk factors for peripheral arterial disease. Hyperglycemia is an important mediator in the pathogenesis of this disease in diabetics, more so in women. The morbidity and poor outcomes associated with peripheral arterial disease in women are emerging. Women are more likely to present at an older age are often asymptomatic and have poorer outcomes with revascularization. Women experience specific sex-related challenges in the various diagnostic methods which could lead to a delay in diagnosis. This is a group which needs close attention and aggressive risk factor modification.

Apical hypertrophic cardiomyopathy (HCM) is a phenotypic variant of nonobstructive HCM, in which hypertrophy of the myocardium predominantly involves the left ventricular apex. It is common in Japanese and other Asian populations but is rare in the United States. Apical HCM has a relatively benign prognosis in terms of cardiovascular mortality; however, morbid events such as ventricular aneurysms, apical thrombi, diastolic dysfunction, atrial fibrillation, and myocardial infarction are not uncommon. We report a case of an 18-year-old white man who presented to our hospital after an out-of-hospital cardiac arrest. The patient had a witnessed collapse while playing basketball in the field. He was found to be pulseless and unresponsive by his coach, and cardiopulmonary resuscitation was immediately started. Upon arrival of emergency medical services, an automated external defibrillator advised shock and he was defibrillated thrice. Return of spontaneous circulation was achieved in 15 minutes. He was intubated for airway protection and was brought to the hospital. Therapeutic hypothermia was initiated. He demonstrated good neurological status after active rewarming. Subsequent cardiac magnetic resonance imaging was suggestive of apical HCM with right ventricular involvement. The patient underwent an implantable cardioverter defibrillator placement for secondary prevention and was subsequently discharged. In conclusion, apical HCM can rarely be associated with adverse cardiovascular events. The diagnosis may be missed on transthoracic 2-dimensional cardiac echocardiogram, and cardiac magnetic resonance imaging should be considered to exclude apical HCM in young patients who present after sudden cardiac arrest.

Left ventricular hypertrophy (LVH) and concentric LV remodeling (CR) are precursors to development of clinical heart failure (HF), and are associated with obesity, hypertension (HTN) and diabetes mellitus (DM), which are highly prevalent in Mexican Americans. Our study aimed to determine the prevalence of subclinical LV structural abnormalities (LVH or CR) and LV diastolic dysfunction (LVDD) in a sample of asymptomatic Mexican Americans in South Texas and determinants of these LV structural abnormalities. Methods: Demographic, cardiometabolic biomarkers, and body composition data were obtained in 1208 participants (66.3% females, mean age 53.0±0.4 years) without any CVD history from the community-based Cameron County Hispanic Cohort study. Echocardiography was used to determine LVH/CR (linear method) and LVDD was assessed using national guidelines. Those with LV systolic dysfunction (n=26) were excluded. Abdominal adiposity was determined by abdominal visceral fat mass (VAT) from dual-energy X-ray absorptiometry. Weighted ordinal logistic regression analyses were conducted adjusting for demographic and clinical covariates. Results: Weighted prevalence rates of LVH (16.6% ± 1.7%), CR (40.7% ± 2.0%) and LVDD (24.2% ± 1.8%) were high in this cohort. In men, age (p<0.01), obesity (p=0.04) and HTN (p<0.001) were positively related to LV abnormalities. In women, age (p<0.001), obesity (p<0.01), education (p=0.02), HTN (p<0.01) and DM (p<0.01) were related to LV abnormalities. VAT was associated with LV abnormalities in women (p=0.02), but not in men (p=0.08). Conclusion: More than half of this asymptomatic Hispanic cohort had evidence of LV structural abnormalities and almost a quarter had subclinical diastolic dysfunction. We noted a gender interaction, with diabetes and abdominal obesity seen to be significantly related to cardiac abnormalities only in women. Identifying subclinical changes in cardiac function in these high-risk patients may mitigate progression to clinical HF by early intervention.

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