Mahin Khan - Academia.edu (original) (raw)

Papers by Mahin Khan

Research paper thumbnail of Trends and Outcomes of Acute Heart Failure with Underlying Amyloidosis - a Retrospective Cohort Study from 2016-2019 National Inpatient Sample Database

Journal of the American College of Cardiology

Research paper thumbnail of Sex and Racial Differences in Common Cardiovascular Procedures - Trends and Outcomes

Journal of the American College of Cardiology

Research paper thumbnail of Impact of Obstructive Sleep Apnea on In-Hospital Outcomes of Patients with Non-ST Elevation Myocardial Infarction

Hearts

Background: Obstructive sleep apnea (OSA) is one of the most common breathing disorders. There ar... more Background: Obstructive sleep apnea (OSA) is one of the most common breathing disorders. There are uncertainties about its impact on the in-hospital outcomes of patients who suffer acute coronary syndromes. We studied the largest publicly available all-payer inpatient healthcare database in the United States (National Inpatient Sample) to determine the effects of obstructive sleep apnea on the in-hospital outcomes of patients admitted with non-ST elevation myocardial infarction (NSTEMI). Methods: All adult patients (age ≥ 18) admitted primarily for NSTEMI between September 2010 and September 2015 were identified in the National Inpatient Sample. They were then categorized into those with OSA and those without OSA. The main outcome was in-hospital mortality. Propensity scoring and logistic regression models were created to determine the outcomes. Results: There were 1,984,432 patients with NSTEMI (weighted estimates), 123,551 (6.23%) of who had diagnosed OSA while 1,860,881 (93.77%) ...

Research paper thumbnail of Trends and Outcomes of Transcatheter Aortic and Mitral Valve Procedures in Patients with Underlying Arrhythmias

Journal of the American College of Cardiology, 2022

Research paper thumbnail of In-hospital mortality and length of stay among patients with infective endocarditis and solid organ transplant: A study from National Inpatient Sample 2016–2019

Heliyon

Infective endocarditis (IE) is a rare but serious complication following a Solid Organ Transplant... more Infective endocarditis (IE) is a rare but serious complication following a Solid Organ Transplant (SOT). Due to the lack of sufficient studies, we aimed to compare in-hospital mortality and length of stay (LOS) of patients primarily admitted for IE (index or principal hospitalization) with history of SOT, including the subgroup of heart or lung transplant (HLT), to those without a history of SOT (non-SOT) or HLT (non-HLT). We used the 2016-2019 National Inpatient Sample, the largest all-payer inpatient hospital data from Healthcare Cost and Utilization Project (HCUP), including patients 18 years or older with IE, as a principal diagnosis for hospitalization. From 2016 to 2019, there were 56,330 principal or index hospitalizations for IE. Among them, 0.6 % (n ¼ 327) were SOT recipients, 0.1% (n ¼ 68) were HLT recipients, and 41.4% were females. The mean age was 51.9 AE 19.2 years. Compared to non-SOT controls, SOT recipients were older (mean age 59.3 vs. 51.8 years; P ¼ 0.002) and had higher Charlson-comorbidity-index (CCI) of 3 or more (87.7% vs. 33.2%; p < 0.001). SOT status was not statistically significant for a higher or lower odds of in-hospital mortality (adjusted odds ratio (aOR) 0.7; 95% confidence interval (CI): 0.2, 2.4; p ¼ 0.60) or increased or decreased LOS (coefficient:-0.1, 95% CI:-0.4, 0.1; p ¼ 0.23) among index IE hospitalizations after controlling for age, sex, race, hospital-region, hospital-teaching status, income, insurance status, and CCI. HLT status was also not associated with higher or lower odds of in-hospital mortality (aOR 1.4; 95% CI: 0.2, 13.1; p ¼ 0.77) or increased or decreased LOS (coefficient:-0.1, 95% CI:-0.3, 0.5; p ¼ 0.59). From 2016 to 2019, the rate of index IE hospitalization trends from 37.8 to 41.4 per 100,000 overall hospitalizations (p ¼ 0.001). We found the rate of index IE hospitalizations increasing with time. Among index IE hospitalizations, SOT, including a subgroup of HLT recipients, have similar in-hospital mortality and LOS compared to non-SOT or non-HLT groups. We need a larger sample size to comment on outcomes of IE hospitalizations with the HLT subgroup.

Research paper thumbnail of A Fatal Course from Colonoscopy to Sinus of Valsalva Rupture

Journal of the American College of Cardiology

Research paper thumbnail of Outcomes of Hospitalized Patients with Acute Ischemic Stroke and Concomitant Nstemi - Analysis from 2016-2019 National Inpatient Sample

Journal of the American College of Cardiology, Mar 1, 2022

Research paper thumbnail of Abstract 14211: In-Hospital Mortality and Length of Stay Among Patients Hospitalized With Acute Heart Failure and Vitamin D Deficiency: A Study From National Inpatient Sample 2016-2017

Circulation, Nov 16, 2021

Research paper thumbnail of Fear of COVID-19 leading to late presenting myocardial infarction complicated by cardiogenic shock due to ventricular septal rupture

BMJ Case Reports

Post myocardial ventricular septal rupture (VSR) is one of the most fatal complications of acute ... more Post myocardial ventricular septal rupture (VSR) is one of the most fatal complications of acute myocardial infarction (AMI) in spite of percutaneous and surgical closure. With the advancement of percutaneous coronary interventions in a timely manner, incidence of post MI VSR has declined remarkably. However, the COVID-19) pandemic-related late hospital presentations with AMI increases the possibilities of a potential upward shift in the incidence of post MI VSR. This case report aimed to increase awareness of negative contributions of the current pandemic to AMI and its fatal complications.

Research paper thumbnail of Abstract 16607: A Comparison Of Outcomes Between Patients At Low And Intermediate-risk With Aortic Stenosis Undergoing Transcatheter Or Surgical Valve Repair

Circulation, Nov 19, 2019

Research paper thumbnail of Abstract 14238: A Real-World Comparison of Percutaneous Coronary Intervention vs Coronary Artery Bypass in Patients With Chronic Total Occlusion

Circulation, Nov 16, 2021

Research paper thumbnail of Tele-Based Virtual BP Management by Pharmacist or Nurse Practitioner Versus Office-Based PCP Led Intervention in Management of Systolic Bp. A Systematic Review and Meta-Analysis

Journal of the American College of Cardiology, 2022

Background Telemedicine was quickly adopted by health systems throughout the United States during... more Background Telemedicine was quickly adopted by health systems throughout the United States during the COVID 19 pandemic crisis suggesting its relative feasibility and implementation. Nevertheless, there is limited data on whether a virtual blood pressure (BP) management approach is better than an office led approach. In this systematic review and meta-analysis of randomized clinical trials (RCTs) we aim to compare the differences in systolic BP (SBP) by NP or Pharmacist virtually as compared with primary care physician (PCP) in office. Methods We searched PubMed, MEDLINE, EMBASE, and Cochrane database for studies from January 2000 till October, 2021 with inclusion criteria of RCTs on pharmacist or NP based virtual (tele) BP management versus PCP based office visit (Usual Care) for BP management. Review manager 5.4 was used for data analysis. We used PRISMA guidelines to report synthesize and report our findings. Results We included nine RCTs which met our inclusion criteria with total of 3234 participants in both groups. There were 1615 participants in the APP tele visit group and 1619 participants in the PCP usual care/office visit group. Our results show that the use of NP/Pharmacist based telemedicine visit for SBP management was associated with statistically significant decrease in SBP compared to PCP based office visit (MD: -8.19, 95% CI -10.17, -6.21, P< 0.001, I2= 75%). In the analysis restricted to duration of follow up for less than 6 months (MD: -8.19, 95% CI: -11.74, -4.65, p<0.001) and 12 months (MD:-8.82, 95% CI: -11.21, -6.43, p=0.08), there is no statistically significant difference (p value=0.77). Both the NP as well as Pharmacist based tele visit to control SBP has shown better outcomes compared to PCP based office visit, NP vs PCP (MD: -8.78, 95% CI: -13.93, -3.64, P<0.001) and Pharmacist vs PCP (MD: -8.32, 95% CI: -10.58,-6.06, P<0.001), respectively. Conclusion Our study showed that tele-based intervention by NP/Pharmacist decreased SBP better than usual care in office by PCP. Virtual BP management should be further explored in these times of COVID-19 despite widespread heterogeneity of results and challenges related to the scope of practice and reimbursement of NP/pharmacists.

Research paper thumbnail of Coronary artery occlusion following low-power catheter ablation

Journal of Community Hospital Internal Medicine Perspectives, 2020

Myocardial infarction (MI) is an unusual but potentially serious complication of catheter ablatio... more Myocardial infarction (MI) is an unusual but potentially serious complication of catheter ablation procedures. This case describes the occurrence of acute myocardial infarction following lowpower ablation in a young patient and highlights the importance of maintaining high index of suspicion following catheter ablation irrespective of the ablation power used. A 22-year-old patient had low-power ablation of the right posteroseptal accessory pathway in the ostium of the coronary sinus on account of persistently symptomatic WPW syndrome with orthodromic re-entrant tachycardia. Two hours after the procedure, she developed moderately severe chest pain. Electrocardiogram showed ST elevation in the inferior leads. Coronary angiography showed 100% stenosis of the right coronary artery just beyond the posterior descending artery. She failed balloon angioplasty and a drug eluting stent was placed in the posterolateral branch of the right coronary artery. The symptoms resolved and follow up echocardiogram showed normal left ventricular systolic and diastolic functions with no regional wall motion abnormality. This case demonstrates the occurrence of MI following low-power catheter ablation. Patients should be monitored for this complication irrespective of the ablation power used.

Research paper thumbnail of Abstract 11689: Among Patients Hospitalized for Infective Endocarditis, There is No Association Between Solid Organ Transplant Recipient Status and In-Hospital Mortality: A Retrospective Cohort Study From National Inpatient Sample 2016-2017

Circulation, 2021

Introduction: Infective endocarditis (IE) is a serious complication following solid organ transpl... more Introduction: Infective endocarditis (IE) is a serious complication following solid organ transplant (SOT) including heart or lung transplant, however, we only have few outcome based studies on this topic. Hypothesis: SOT recipients hospitalized for IE have higher in-hospital mortality compared to non-SOT. Methods: This is a retrospective cohort study from IE hospitalizations using 2016-2017 National Inpatient Sample (NIS) in patients 18 years or older. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay (LOS), and total charges. We performed multivariable logistic regression (in-hospital mortality) and negative binomial regression models (LOS and total charges) to test our hypothesis. Model were adjusted for potential confounders including age, sex, race, insurance, income level, and comorbidities. STATA 17.0 (Stata-Corp LP, College Station, TX) was used for data analysis. Results: There were 14,294,784 hospitalizations in 2016 and 2017. Our final ...

Research paper thumbnail of Tee-Guided Bedside Impella Placement in Refractory Cardiogenic Shock Already Supported with Intra-Aortic Balloon Pump

Journal of the American College of Cardiology, 2021

Research paper thumbnail of Manufacturing of agricultural machinery in Bangladesh: opportunities and constraints

Agricultural Engineering International: The CIGR Journal, 2017

Despite numerous limitations, agricultural machinery (AM) manufacturing sub-sector inBangladeshis... more Despite numerous limitations, agricultural machinery (AM) manufacturing sub-sector inBangladeshis growing quite satisfactorily and has potential to make substantial contribution to much needed non-farm economic growth, employment generation, mechanization of on and off-farm agricultural activities, and as a whole orientation in the national development. This study made an attempt to take account of AM manufacturers, importers, traders/wholesalers and retailers, their associations, assess market potential and identify serious bottlenecks associated with this sub-sector. Stratified random sampling technique was used for identifying respondents in quantitative survey, while focus group discussions (FGDs) and Key Informant Interviews (KIIs) were conducted for qualitative investigation. In recent years, there are about 70 foundries, 800 agricultural machinery manufacturing industries and workshops, 1,500 spare parts manufacturing workshops, and about 20,000 repair and maintenance work...

Research paper thumbnail of Systematic Review and Meta-Analysis: Can We Compare Direct Oral Anticoagulants to Warfarin in Patients With Atrial Fibrillation and Bio-Prosthetic Valves?

Cureus, 2021

Background There are no clear consensus guidelines on the indications and types of anticoagulatio... more Background There are no clear consensus guidelines on the indications and types of anticoagulation therapies in patients with bio-prosthetic valves either with concomitant atrial fibrillation (AF) or sinus rhythm. In our meta-analysis, we assessed the safety and efficacy of DOACs as compared to the standard treatment with warfarin in patients with AF and bioprosthetic valves. Methods We included randomized controlled trials (RCTs), cohort studies in the English language, and studies reporting patients with valvular heart disease that included bioprosthetic valvular disease. A systematic literature review using Embase, PubMed, and Web of Science was performed using the terms "Direct Acting Oral Anticoagulant," "Oral Anticoagulants," "Non-Vitamin K Antagonist Oral Anticoagulant," "Atrial Fibrillation," "Bioprosthetic Valve" for literature published prior to January 2021. Extraction of data from included studies was carried out independently by three reviewers from Covidence. We assessed the methodical rigor of the included studies using the modified Downs and Black checklist. Results Four RCTs and one observational study (n=1776) were included in our study. A random-effect model using RevMan (version 5.4; The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen) was used for data analysis. The pooled data showed that there was a non-significant reduction in the incidence of stroke and systemic embolism in the patients taking DOACs as compared to warfarin (HR 0.69; 95% CI, 0.29, 1.67; I 2 = 50%). The incidence of major bleeding was lower in the DOACs group; the difference was statistically significant (HR 0.42; 95% CI, 0.26, 0.67; I 2 = 7%). The difference was not statistically significant for all-cause mortality in both groups (HR 1.24; 95% CI, 0.91, 1.67; I 2 = 0%). Conclusion Our results showed that there was no difference in the outcomes of stroke and systemic embolism between DOACs and warfarin but there were statistically significantly lower major bleeding events. We conclude that larger clinical trials are needed to assess the true safety and efficacy of DOACs in patients with AF and bioprosthetic valves.

Research paper thumbnail of Novel Modification of Impella Sheath to Prevent Limb Ischemia

ASAIO Journal, 2021

Limb ischemia is a dreaded complication of large-bore access during prolonged Impella support. We... more Limb ischemia is a dreaded complication of large-bore access during prolonged Impella support. We report a novel technique to modify 14F Impella sheath by creating two perfusion holes in the dorsal sheath surface to enable distal limb perfusion via dead space surrounding 9F Impella catheter in flow-occlusive iliofemoral arteries.

Research paper thumbnail of TCT CONNECT-51 Early Invasive Therapy Versus Ischemia-Guided Therapy in Older Adults With Non–ST-Segment Elevation Acute Coronary Syndromes: An Updated Meta-Analysis

Journal of the American College of Cardiology, 2020

Research paper thumbnail of In-Hospital Outcomes and Prevalence of Comorbidities in Patients with St-Elevation Myocardial Infarction with and without Infective Endocarditis: Insight from the National Inpatient Sample (2013-2014)

Journal of Investigative Medicine, 2020

In patients with infective endocarditis (IE), ST-elevation myocardial infarction (STEMI) is an un... more In patients with infective endocarditis (IE), ST-elevation myocardial infarction (STEMI) is an uncommon phenomenon. Due to limited data, we intend to evaluate the clinical outcomes in hospitalized patients with STEMI with and without underlying IE. Mortality and morbidity are exponentially worse in STEMI with concomitant IE when compared with without IE. Patients with primary diagnosis of STEMI with and without IE were identified by querying the Healthcare Cost and Utilization Project database of the National Inpatient Sample for the years 2013 and 2014 based on International Classification of Diseases, Ninth Revision codes. During 2013 and 2014, a total of 117,386 patients were admitted with the principle diagnosis of STEMI, out of whom 305 had comorbid IE. There was a significantly increased in-hospital mortality (27.5% vs 10.8%), length of stay (LOS) (14 days vs 5 days), acute kidney injury (AKI; 44.9% vs 18.7%), stroke (23.6% vs 3%), aortic valve replacement (9.5% vs 0.3%), mitr...

Research paper thumbnail of Trends and Outcomes of Acute Heart Failure with Underlying Amyloidosis - a Retrospective Cohort Study from 2016-2019 National Inpatient Sample Database

Journal of the American College of Cardiology

Research paper thumbnail of Sex and Racial Differences in Common Cardiovascular Procedures - Trends and Outcomes

Journal of the American College of Cardiology

Research paper thumbnail of Impact of Obstructive Sleep Apnea on In-Hospital Outcomes of Patients with Non-ST Elevation Myocardial Infarction

Hearts

Background: Obstructive sleep apnea (OSA) is one of the most common breathing disorders. There ar... more Background: Obstructive sleep apnea (OSA) is one of the most common breathing disorders. There are uncertainties about its impact on the in-hospital outcomes of patients who suffer acute coronary syndromes. We studied the largest publicly available all-payer inpatient healthcare database in the United States (National Inpatient Sample) to determine the effects of obstructive sleep apnea on the in-hospital outcomes of patients admitted with non-ST elevation myocardial infarction (NSTEMI). Methods: All adult patients (age ≥ 18) admitted primarily for NSTEMI between September 2010 and September 2015 were identified in the National Inpatient Sample. They were then categorized into those with OSA and those without OSA. The main outcome was in-hospital mortality. Propensity scoring and logistic regression models were created to determine the outcomes. Results: There were 1,984,432 patients with NSTEMI (weighted estimates), 123,551 (6.23%) of who had diagnosed OSA while 1,860,881 (93.77%) ...

Research paper thumbnail of Trends and Outcomes of Transcatheter Aortic and Mitral Valve Procedures in Patients with Underlying Arrhythmias

Journal of the American College of Cardiology, 2022

Research paper thumbnail of In-hospital mortality and length of stay among patients with infective endocarditis and solid organ transplant: A study from National Inpatient Sample 2016–2019

Heliyon

Infective endocarditis (IE) is a rare but serious complication following a Solid Organ Transplant... more Infective endocarditis (IE) is a rare but serious complication following a Solid Organ Transplant (SOT). Due to the lack of sufficient studies, we aimed to compare in-hospital mortality and length of stay (LOS) of patients primarily admitted for IE (index or principal hospitalization) with history of SOT, including the subgroup of heart or lung transplant (HLT), to those without a history of SOT (non-SOT) or HLT (non-HLT). We used the 2016-2019 National Inpatient Sample, the largest all-payer inpatient hospital data from Healthcare Cost and Utilization Project (HCUP), including patients 18 years or older with IE, as a principal diagnosis for hospitalization. From 2016 to 2019, there were 56,330 principal or index hospitalizations for IE. Among them, 0.6 % (n ¼ 327) were SOT recipients, 0.1% (n ¼ 68) were HLT recipients, and 41.4% were females. The mean age was 51.9 AE 19.2 years. Compared to non-SOT controls, SOT recipients were older (mean age 59.3 vs. 51.8 years; P ¼ 0.002) and had higher Charlson-comorbidity-index (CCI) of 3 or more (87.7% vs. 33.2%; p < 0.001). SOT status was not statistically significant for a higher or lower odds of in-hospital mortality (adjusted odds ratio (aOR) 0.7; 95% confidence interval (CI): 0.2, 2.4; p ¼ 0.60) or increased or decreased LOS (coefficient:-0.1, 95% CI:-0.4, 0.1; p ¼ 0.23) among index IE hospitalizations after controlling for age, sex, race, hospital-region, hospital-teaching status, income, insurance status, and CCI. HLT status was also not associated with higher or lower odds of in-hospital mortality (aOR 1.4; 95% CI: 0.2, 13.1; p ¼ 0.77) or increased or decreased LOS (coefficient:-0.1, 95% CI:-0.3, 0.5; p ¼ 0.59). From 2016 to 2019, the rate of index IE hospitalization trends from 37.8 to 41.4 per 100,000 overall hospitalizations (p ¼ 0.001). We found the rate of index IE hospitalizations increasing with time. Among index IE hospitalizations, SOT, including a subgroup of HLT recipients, have similar in-hospital mortality and LOS compared to non-SOT or non-HLT groups. We need a larger sample size to comment on outcomes of IE hospitalizations with the HLT subgroup.

Research paper thumbnail of A Fatal Course from Colonoscopy to Sinus of Valsalva Rupture

Journal of the American College of Cardiology

Research paper thumbnail of Outcomes of Hospitalized Patients with Acute Ischemic Stroke and Concomitant Nstemi - Analysis from 2016-2019 National Inpatient Sample

Journal of the American College of Cardiology, Mar 1, 2022

Research paper thumbnail of Abstract 14211: In-Hospital Mortality and Length of Stay Among Patients Hospitalized With Acute Heart Failure and Vitamin D Deficiency: A Study From National Inpatient Sample 2016-2017

Circulation, Nov 16, 2021

Research paper thumbnail of Fear of COVID-19 leading to late presenting myocardial infarction complicated by cardiogenic shock due to ventricular septal rupture

BMJ Case Reports

Post myocardial ventricular septal rupture (VSR) is one of the most fatal complications of acute ... more Post myocardial ventricular septal rupture (VSR) is one of the most fatal complications of acute myocardial infarction (AMI) in spite of percutaneous and surgical closure. With the advancement of percutaneous coronary interventions in a timely manner, incidence of post MI VSR has declined remarkably. However, the COVID-19) pandemic-related late hospital presentations with AMI increases the possibilities of a potential upward shift in the incidence of post MI VSR. This case report aimed to increase awareness of negative contributions of the current pandemic to AMI and its fatal complications.

Research paper thumbnail of Abstract 16607: A Comparison Of Outcomes Between Patients At Low And Intermediate-risk With Aortic Stenosis Undergoing Transcatheter Or Surgical Valve Repair

Circulation, Nov 19, 2019

Research paper thumbnail of Abstract 14238: A Real-World Comparison of Percutaneous Coronary Intervention vs Coronary Artery Bypass in Patients With Chronic Total Occlusion

Circulation, Nov 16, 2021

Research paper thumbnail of Tele-Based Virtual BP Management by Pharmacist or Nurse Practitioner Versus Office-Based PCP Led Intervention in Management of Systolic Bp. A Systematic Review and Meta-Analysis

Journal of the American College of Cardiology, 2022

Background Telemedicine was quickly adopted by health systems throughout the United States during... more Background Telemedicine was quickly adopted by health systems throughout the United States during the COVID 19 pandemic crisis suggesting its relative feasibility and implementation. Nevertheless, there is limited data on whether a virtual blood pressure (BP) management approach is better than an office led approach. In this systematic review and meta-analysis of randomized clinical trials (RCTs) we aim to compare the differences in systolic BP (SBP) by NP or Pharmacist virtually as compared with primary care physician (PCP) in office. Methods We searched PubMed, MEDLINE, EMBASE, and Cochrane database for studies from January 2000 till October, 2021 with inclusion criteria of RCTs on pharmacist or NP based virtual (tele) BP management versus PCP based office visit (Usual Care) for BP management. Review manager 5.4 was used for data analysis. We used PRISMA guidelines to report synthesize and report our findings. Results We included nine RCTs which met our inclusion criteria with total of 3234 participants in both groups. There were 1615 participants in the APP tele visit group and 1619 participants in the PCP usual care/office visit group. Our results show that the use of NP/Pharmacist based telemedicine visit for SBP management was associated with statistically significant decrease in SBP compared to PCP based office visit (MD: -8.19, 95% CI -10.17, -6.21, P< 0.001, I2= 75%). In the analysis restricted to duration of follow up for less than 6 months (MD: -8.19, 95% CI: -11.74, -4.65, p<0.001) and 12 months (MD:-8.82, 95% CI: -11.21, -6.43, p=0.08), there is no statistically significant difference (p value=0.77). Both the NP as well as Pharmacist based tele visit to control SBP has shown better outcomes compared to PCP based office visit, NP vs PCP (MD: -8.78, 95% CI: -13.93, -3.64, P<0.001) and Pharmacist vs PCP (MD: -8.32, 95% CI: -10.58,-6.06, P<0.001), respectively. Conclusion Our study showed that tele-based intervention by NP/Pharmacist decreased SBP better than usual care in office by PCP. Virtual BP management should be further explored in these times of COVID-19 despite widespread heterogeneity of results and challenges related to the scope of practice and reimbursement of NP/pharmacists.

Research paper thumbnail of Coronary artery occlusion following low-power catheter ablation

Journal of Community Hospital Internal Medicine Perspectives, 2020

Myocardial infarction (MI) is an unusual but potentially serious complication of catheter ablatio... more Myocardial infarction (MI) is an unusual but potentially serious complication of catheter ablation procedures. This case describes the occurrence of acute myocardial infarction following lowpower ablation in a young patient and highlights the importance of maintaining high index of suspicion following catheter ablation irrespective of the ablation power used. A 22-year-old patient had low-power ablation of the right posteroseptal accessory pathway in the ostium of the coronary sinus on account of persistently symptomatic WPW syndrome with orthodromic re-entrant tachycardia. Two hours after the procedure, she developed moderately severe chest pain. Electrocardiogram showed ST elevation in the inferior leads. Coronary angiography showed 100% stenosis of the right coronary artery just beyond the posterior descending artery. She failed balloon angioplasty and a drug eluting stent was placed in the posterolateral branch of the right coronary artery. The symptoms resolved and follow up echocardiogram showed normal left ventricular systolic and diastolic functions with no regional wall motion abnormality. This case demonstrates the occurrence of MI following low-power catheter ablation. Patients should be monitored for this complication irrespective of the ablation power used.

Research paper thumbnail of Abstract 11689: Among Patients Hospitalized for Infective Endocarditis, There is No Association Between Solid Organ Transplant Recipient Status and In-Hospital Mortality: A Retrospective Cohort Study From National Inpatient Sample 2016-2017

Circulation, 2021

Introduction: Infective endocarditis (IE) is a serious complication following solid organ transpl... more Introduction: Infective endocarditis (IE) is a serious complication following solid organ transplant (SOT) including heart or lung transplant, however, we only have few outcome based studies on this topic. Hypothesis: SOT recipients hospitalized for IE have higher in-hospital mortality compared to non-SOT. Methods: This is a retrospective cohort study from IE hospitalizations using 2016-2017 National Inpatient Sample (NIS) in patients 18 years or older. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay (LOS), and total charges. We performed multivariable logistic regression (in-hospital mortality) and negative binomial regression models (LOS and total charges) to test our hypothesis. Model were adjusted for potential confounders including age, sex, race, insurance, income level, and comorbidities. STATA 17.0 (Stata-Corp LP, College Station, TX) was used for data analysis. Results: There were 14,294,784 hospitalizations in 2016 and 2017. Our final ...

Research paper thumbnail of Tee-Guided Bedside Impella Placement in Refractory Cardiogenic Shock Already Supported with Intra-Aortic Balloon Pump

Journal of the American College of Cardiology, 2021

Research paper thumbnail of Manufacturing of agricultural machinery in Bangladesh: opportunities and constraints

Agricultural Engineering International: The CIGR Journal, 2017

Despite numerous limitations, agricultural machinery (AM) manufacturing sub-sector inBangladeshis... more Despite numerous limitations, agricultural machinery (AM) manufacturing sub-sector inBangladeshis growing quite satisfactorily and has potential to make substantial contribution to much needed non-farm economic growth, employment generation, mechanization of on and off-farm agricultural activities, and as a whole orientation in the national development. This study made an attempt to take account of AM manufacturers, importers, traders/wholesalers and retailers, their associations, assess market potential and identify serious bottlenecks associated with this sub-sector. Stratified random sampling technique was used for identifying respondents in quantitative survey, while focus group discussions (FGDs) and Key Informant Interviews (KIIs) were conducted for qualitative investigation. In recent years, there are about 70 foundries, 800 agricultural machinery manufacturing industries and workshops, 1,500 spare parts manufacturing workshops, and about 20,000 repair and maintenance work...

Research paper thumbnail of Systematic Review and Meta-Analysis: Can We Compare Direct Oral Anticoagulants to Warfarin in Patients With Atrial Fibrillation and Bio-Prosthetic Valves?

Cureus, 2021

Background There are no clear consensus guidelines on the indications and types of anticoagulatio... more Background There are no clear consensus guidelines on the indications and types of anticoagulation therapies in patients with bio-prosthetic valves either with concomitant atrial fibrillation (AF) or sinus rhythm. In our meta-analysis, we assessed the safety and efficacy of DOACs as compared to the standard treatment with warfarin in patients with AF and bioprosthetic valves. Methods We included randomized controlled trials (RCTs), cohort studies in the English language, and studies reporting patients with valvular heart disease that included bioprosthetic valvular disease. A systematic literature review using Embase, PubMed, and Web of Science was performed using the terms "Direct Acting Oral Anticoagulant," "Oral Anticoagulants," "Non-Vitamin K Antagonist Oral Anticoagulant," "Atrial Fibrillation," "Bioprosthetic Valve" for literature published prior to January 2021. Extraction of data from included studies was carried out independently by three reviewers from Covidence. We assessed the methodical rigor of the included studies using the modified Downs and Black checklist. Results Four RCTs and one observational study (n=1776) were included in our study. A random-effect model using RevMan (version 5.4; The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen) was used for data analysis. The pooled data showed that there was a non-significant reduction in the incidence of stroke and systemic embolism in the patients taking DOACs as compared to warfarin (HR 0.69; 95% CI, 0.29, 1.67; I 2 = 50%). The incidence of major bleeding was lower in the DOACs group; the difference was statistically significant (HR 0.42; 95% CI, 0.26, 0.67; I 2 = 7%). The difference was not statistically significant for all-cause mortality in both groups (HR 1.24; 95% CI, 0.91, 1.67; I 2 = 0%). Conclusion Our results showed that there was no difference in the outcomes of stroke and systemic embolism between DOACs and warfarin but there were statistically significantly lower major bleeding events. We conclude that larger clinical trials are needed to assess the true safety and efficacy of DOACs in patients with AF and bioprosthetic valves.

Research paper thumbnail of Novel Modification of Impella Sheath to Prevent Limb Ischemia

ASAIO Journal, 2021

Limb ischemia is a dreaded complication of large-bore access during prolonged Impella support. We... more Limb ischemia is a dreaded complication of large-bore access during prolonged Impella support. We report a novel technique to modify 14F Impella sheath by creating two perfusion holes in the dorsal sheath surface to enable distal limb perfusion via dead space surrounding 9F Impella catheter in flow-occlusive iliofemoral arteries.

Research paper thumbnail of TCT CONNECT-51 Early Invasive Therapy Versus Ischemia-Guided Therapy in Older Adults With Non–ST-Segment Elevation Acute Coronary Syndromes: An Updated Meta-Analysis

Journal of the American College of Cardiology, 2020

Research paper thumbnail of In-Hospital Outcomes and Prevalence of Comorbidities in Patients with St-Elevation Myocardial Infarction with and without Infective Endocarditis: Insight from the National Inpatient Sample (2013-2014)

Journal of Investigative Medicine, 2020

In patients with infective endocarditis (IE), ST-elevation myocardial infarction (STEMI) is an un... more In patients with infective endocarditis (IE), ST-elevation myocardial infarction (STEMI) is an uncommon phenomenon. Due to limited data, we intend to evaluate the clinical outcomes in hospitalized patients with STEMI with and without underlying IE. Mortality and morbidity are exponentially worse in STEMI with concomitant IE when compared with without IE. Patients with primary diagnosis of STEMI with and without IE were identified by querying the Healthcare Cost and Utilization Project database of the National Inpatient Sample for the years 2013 and 2014 based on International Classification of Diseases, Ninth Revision codes. During 2013 and 2014, a total of 117,386 patients were admitted with the principle diagnosis of STEMI, out of whom 305 had comorbid IE. There was a significantly increased in-hospital mortality (27.5% vs 10.8%), length of stay (LOS) (14 days vs 5 days), acute kidney injury (AKI; 44.9% vs 18.7%), stroke (23.6% vs 3%), aortic valve replacement (9.5% vs 0.3%), mitr...