PMID- 30442224
OWN - NLM
STAT- MEDLINE
DCOM- 20190829
LR  - 20190829
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 122
IP  - 11
DP  - 2018 Dec 1
TI  - Acute Coronary Syndromes in Heart Transplant Recipients (from a National Database 
      Analysis).
PG  - 1824-1829
LID - S0002-9149(18)31722-3 [pii]
LID - 10.1016/j.amjcard.2018.08.023 [doi]
AB  - With an expanding and aging heart transplant population, the incidence of acute 
      coronary syndromes (ACS) is expected to increase. Our study aims to report 
      current trends in in-hospital management and outcomes in heart transplant 
      recipients presenting with ACS. We conducted an analysis of the National 
      Inpatient Sample (2007 to 2014) to study the trends in hospitalization, 
      in-hospital management, and outcomes in heart transplant recipients with a 
      primary diagnosis of ACS. We included patients with ST elevation myocardial 
      infarction (STEMI), non-STEMI (NSTEMI) and those with unstable angina pectoris 
      (UAP). A total of 1,621 ACS (NSTEMI/UAP-76% vs STEMI-24%) hospitalizations were 
      identified. Despite 1,327 (81%) of patients who underwent left heart 
      catheterization, coronary revascularization was performed in only 576 patients 
      (36%). Mortality was significantly higher in patients presenting with STEMI 
      versus NSTEMI/UAP (28% vs 11%, respectively; p <0.05) and those who did not 
      undergo revascularization (19% vs 7%; p <0.05). Cardiogenic shock (CS) was 
      diagnosed in 14.5% patients. Mechanical circulatory support utilization was 
      higher in CS group compared with non-CS group (69% vs 2.8%; p <0.05), as was 
      in-hospital mortality (39% vs 10%; p <0.05). Repeat transplantation during the 
      index hospitalization was done in 4.5% of ACS patients. In conclusion, in heart 
      transplant recipients, ACS is associated with a high incidence of CS and 
      in-hospital mortality. Aggressive treatment strategy that includes 
      revascularization, mechanical circulatory support use (in those developing CS), 
      and urgent retransplantation in suitable candidates seems to lead to better 
      results than a more conservative strategy.
CI  - Copyright (c) 2018. Published by Elsevier Inc.
FAU - Shah, Zubair
AU  - Shah Z
AD  - Division of Cardiovascular Medicine, Department of Medicine, University of Utah 
      Health Science Center, Salt Lake City, Utah.
FAU - Rali, Aniket
AU  - Rali A
AD  - Division of Cardiovascular Medicine, Department of Medicine, University of Kansas 
      Medical Center, Kansas City, Kansas.
FAU - Vuddanda, Venkat
AU  - Vuddanda V
AD  - Department of Public Health, Harvard Medical School, Boston, Massachusetts.
FAU - Bullinger, Keith
AU  - Bullinger K
AD  - Division of Cardiovascular Medicine, Department of Medicine, University of Kansas 
      Medical Center, Kansas City, Kansas.
FAU - Masoomi, Reza
AU  - Masoomi R
AD  - Division of Cardiovascular Medicine, Department of Medicine, University of Kansas 
      Medical Center, Kansas City, Kansas.
FAU - Stehlik, Josef
AU  - Stehlik J
AD  - Division of Cardiovascular Medicine, Department of Medicine, University of Utah 
      Health Science Center, Salt Lake City, Utah.
FAU - Gupta, Kamal
AU  - Gupta K
AD  - Division of Cardiovascular Medicine, Department of Medicine, University of Kansas 
      Medical Center, Kansas City, Kansas. Electronic address: gupta@kumc.edu.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20180908
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
SB  - IM
MH  - Acute Coronary Syndrome/*epidemiology/etiology
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Transplantation/*adverse effects
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - *Registries
MH  - Retrospective Studies
MH  - *Transplant Recipients
MH  - United States/epidemiology
EDAT- 2018/11/18 06:00
MHDA- 2019/08/30 06:00
CRDT- 2018/11/17 06:00
PHST- 2018/06/06 00:00 [received]
PHST- 2018/08/08 00:00 [revised]
PHST- 2018/08/14 00:00 [accepted]
PHST- 2018/11/17 06:00 [entrez]
PHST- 2018/11/18 06:00 [pubmed]
PHST- 2019/08/30 06:00 [medline]
AID - S0002-9149(18)31722-3 [pii]
AID - 10.1016/j.amjcard.2018.08.023 [doi]
PST - ppublish
SO  - Am J Cardiol. 2018 Dec 1;122(11):1824-1829. doi: 10.1016/j.amjcard.2018.08.023. 
      Epub 2018 Sep 8.