Spontaneous coronary artery dissection in a patient with autosomal dominant polycystic kidney disease: a case report

BACKGROUND: Spontaneous coronary artery dissection is an uncommon syndrome. Its prevalence among patients with polycystic kidney disease is very rare, with no previously reported involvement of the right posterior descending coronary artery. CASE PRESENTATION: We describe the case of a middle-aged Caucasian woman with polycystic kidney disease who presented with a non-ST elevation myocardial infarction. Cardiac catheterization revealed a dissection of her right posterior descending coronary artery. She was treated with dual antiplatelet therapy and had a favorable outcome. CONCLUSION: We report a rare and interesting case of spontaneous coronary artery dissection of the right posterior descending coronary artery in a patient with polycystic kidney disease. It is important to consider spontaneous coronary artery dissection in the differential diagnosis of patients with polycystic kidney disease who present with an acute coronary syndrome

Cerebral protection against left ventricular thrombus during transcatheter aortic valve replacement in a patient with critical aortic stenosis

Transcatheter aortic valve replacement is an increasingly common treatment of critical aortic stenosis. Many aortic stenosis patients have concomitant left ventricular dysfunction, which can instigate the formation of thrombus resistant to anticoagulation. Recent trials evaluating transcatheter aortic valve replacement have excluded patients with left ventricular thrombus. We present a case in which an 86-year-old man with known left ventricular thrombus underwent successful transcatheter aortic valve replacement under cerebral protection

Abstract 195: Length of Stay in High Risk Percutaneous Coronary Intervention in US: A 5 year Contemporary Experience

Background: High Risk Percutaneous Coronary Intervention (PCI) is increasingly being performed with the availability of hemodynamic support. The aim of this study was to determine the predictors of length of stay (LOS) for high risk PCI in US. Methods: We explored the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) using the ICD9 procedure code of 36.07 and 36.06 for PCI. NIS is largest all-payer dataset that represents 20% of all US hospitals. We included patients who had PCI from 2005 through 2010 who also underwent Percutaneous Circulatory Assist Device (PCAD) or Intra-aortic Balloon Pump (IABP) placement during the same hospital admission. Severity of comorbidities was defined by Deyo modification of Charlson’s Comorbidity Index (CCI). Hospitals were identified by a unique hospital identification number and hospital volume was determined by calculating the total number of PCI performed by an institution on year to year basis. Complications were based on Patient Safety Indicators (PSI) recognized by Agency for Health Care Research and Quality to monitor in hospital complications. We examined the predictors of LOS by a mixed effects linear regression model including patient demographics, admission characteristics, CCI quartiles with first quartile as a reference, hospital PCI volume quartiles, IABP or PCAD use and periprocedural complications. Hospital ID was incorporated as random effects in the model. Results: A total of 26,300 High Risk PCIs (weighted n = 130,151) were available for analysis. Factors associated with increased LOS were the use of IABP as compared to PCAD (+0.86 days, p=0.03), occurrence of any complication (+4.67 days, P < 0.001), high CCI (+2.5 days for CCI=2 and +4.1 days for CCI≥3, p<0.001 for both), teaching hospital (+0.96 days, p <0.001), presence of myocardial infarction (MI) or shock (+0.55 days, p = 0.002) and highest quartile of hospital PCI volume (+0.86 days, p<0.001). Factors associated with decreased LOS included private insurance (-0.9 days, p < 0.001) and self-pay or no insurance (-0.89 days, p<0.001). Conclusion: In our observational study based on a large database, use of IABP as compared to PCAD, occurrence of complications, CCI, teaching hospital, presence of MI or shock and high PCI volume were associated with increased LOS & having private insurance and self pay or no insurance was associated with decreased LOS

Abstract 305: Cost of Hospitalization for High Risk Percutaneous Coronary Intervention in the US: A 5-Year Contemporary Perspective

Background: Utilization of intra-aortic balloon pump (IABP) and left ventricular assist device (LVAD) during percutaneous coronary intervention (PCI) has increased in recent years. We analyzed the trends and predictors of hospitalization cost associated with high risk PCI in US over a 5 year period (2005-2010). Methods: We queried the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) between 2005 and 2010 using the ICD9 procedure code of 36.07 and 36.06 for PCI. The NIS represents 20% of all hospitals in the US and is the largest all payer hospital discharge database. We defined high risk PCI as PCI plus LVAD (ICD-9 code 37.68, 37.62) or IABP placement (ICD-9 code 37.61) during the same hospital admission. We examined the selective contribution of patient demographics, insurance type, and hospital characteristics, Deyo modification of Charlson comorbidity index (CCI) and hospital PCI volume (split into quartiles with first quartile as referent) to hospitalization cost. For each year, cost was adjusted for inflation according to the 2010 cost. The independent predictors of hospitalization cost were calculated by mixed effects linear regression modeling incorporating hospital ID as random effects. Results: 26,300 (weighted n = 130,151) number of patients were identified. Overall hospitalization cost associated with high risk PCI increased from $137,354 in 2005 to$160,736 in 2010 (P<0.001), with $131,239 in 2005 to$158,937 in 2010 for IABP (P<0.001) and $185,774 in 2005 to$243,657 in 2010 for LVAD (P<0.001). The independent predictors of increased hospitalization cost associated with high risk PCI on a multivariable analysis included teaching hospital (+$10,212, p = 0.005), CCI = 2 (+$17,824, p= 0.001), CCI 3 or more (+$36,354, p= 0.001), presence of myocardial infarction (MI) or shock (+$9,094, p<0.001) and occurrence of any of periprocedural complication (+$68,704, p<0.001). The independent predictors of decreased hospitalization cost for high risk PCI included use of IABP vs. LVAD (-$51,783, p<0.001), female sex (-$3,567, p =0.01) and private insurance (-$6,840, p=0.001) or self-pay, no insurance (-$10,541, p<0.001) compared to Medicare/Medicaid as referent. Conclusion: In this observational study we demonstrated that increased hospitalization cost for high risk PCI is associated with teaching hospital, CCI, presence of MI or shock and occurrence of periprocedural complications. We also found use of IABP, female sex, having private, self-pay or no insurance to be associated with a decreased hospitalization cost related to high risk PCI in the US over a 5 year period from 2005-2010

Abstract 252: Cost of Hospitalization for Balloon Aortic Valvuloplasty in the US: A 10-Year Contemporary Perspective

Background: Limited data is available on health care cost of balloon aortic valvuloplasty (BAV). We analyzed trends and predictors of cost for BAV over the last decade (2001-2010). Methods: The analysis is based on Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) between 2001 and 2010 using the ICD9 procedure code of 35.96 for valvuloplasty. Only patients with age > 60 years with aortic stenosis were included & those with concomitant mitral, tricuspid or pulmonic stenosis were excluded. NIS represents 20% of all hospitals in US. We examined selective contribution of patient demographics, hospital characteristics, Charlson Comorbidity Index (CCI) and peri-procedural complications to hospitalization cost by using mixed effects linear regression modeling. For each year, cost was adjusted for inflation according to 2010 cost. Operator & hospital volume were calculated based on the unique operator and hospital identification numbers. Operator volume data were available for only 50% of the population. Results: Total 1,525 (weighted n = 7,595) BAV were performed from 2001 to 2010 with available cost data. Weighted cost of hospitalization for BAV increased from $21,562 in 2001 to$29,559 in 2010 (p for trend < 0.001). In a multivariable model including operator volume, 748 (weighted n = 3,708) BAV were available for analysis. The independent predictors of increased cost of hospitallization were occurrence of periprocedural complications ($22,509; p < 0.001), unstable patient, defined as having ICD-9 code for shock or ventilator dependence ($24,856; p < 0.001) and weekend admission ($11,416; p=0.002). Predictors of decreased cost for BAV were increase in operator volume (-$1,929 per every unit increase, p = 0.006). Increase in hospital valvuloplasty volume (-$1,644 per every 10 units increase, p = 0.2) showed a trend of decreasing cost, but this was statistically non-significant. Conclusion: In our current observational study we identified peri-procedural complications, unstable patient & weekend admission to be associated with increased cost & increase in operator volume to be associated with decreased cost of hospitalization for BAV. We also found a significant trend of increase in cost of hospitalization from 2001 to 2010