Showing papers by "Lenox Hill Hospital published in 2013"

American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography.

Abstract: Allan L. Klein, MD, FASE, Chair, Suhny Abbara, MD, Deborah A. Agler, RCT, RDCS, FASE, Christopher P. Appleton, MD, FASE, Craig R. Asher, MD, Brian Hoit, MD, FASE, Judy Hung, MD, FASE, Mario J. Garcia, MD, Itzhak Kronzon, MD, FASE, Jae K. Oh, MD, FASE, E. Rene Rodriguez, MD, Hartzell V. Schaff, MD, Paul Schoenhagen,MD, Carmela D. Tan,MD, and Richard D.White, MD,Cleveland and Columbus, Ohio; Boston, Massachusetts; Weston, Florida; Scottsdale, Arizona; Rochester, Minnesota; Bronx and New York, New York

Selumetinib in women with recurrent low-grade serous carcinoma of the ovary or peritoneum: an open-label, single-arm, phase 2 study

Abstract: Summary Background Low-grade serous carcinoma of the ovary is chemoresistant but mutations in the MAPK pathway could be targeted to control tumour growth. We therefore assessed the safety and activity of selumetinib, an inhibitor of MEK1/2, for patients with this cancer. Methods In this open-label, single-arm phase 2 study, women (aged ≥18 years) with recurrent low-grade serous ovarian or peritoneal carcinoma were given selumetinib (50 mg twice daily, orally) until progression. The primary endpoint was the proportion of patients who had an objective tumour response according to RECIST version 1.1, assessed for all the treated patients. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00551070. Findings 52 patients were enrolled between Dec 17, 2007, and Nov 23, 2009. All were eligible for analyses. Eight (15%) patients had an objective response to treatment—one patient had a complete response and seven had partial responses. 34 (65%) patients had stable disease. There were no treatment-related deaths. Grade 4 toxicities were cardiac (one), pain (one), and pulmonary events (one). Grade 3 toxicities that occurred in more than one patient were gastrointestinal (13), dermatological (nine), metabolic (seven), fatigue (six), anaemia (four), pain (four), constitutional (three), and cardiac events (two). Interpretation Selumetinib is well tolerated, and is active in the treatment of recurrent low-grade serous carcinoma of the ovary or peritoneum. The findings suggest that inhibitors of the MAPK pathway warrant further investigation in these patients. Funding National Cancer Institute.

Efficacy and Safety of Apixaban Compared With Warfarin at Different Levels of Predicted International Normalized Ratio Control for Stroke Prevention in Atrial Fibrillation

Abstract: Background—In the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial, apixaban compared with warfarin reduced stroke and systemic embolism, ma...

First experience with a novel robotic remote catheter system: Amigo™ mapping trial

Abstract: Amigo™ (Catheter Robotics, Inc., Mount Olive, NJ) remote catheter system (RCS) was designed to provide a simple and relatively inexpensive system for remote catheter manipulation. The purpose of this study was to evaluate the performance and safety of Amigo in mapping the right side of the heart. This non-randomized, prospective clinical trial was conducted at 13 sites (NCT: #01139814). Using the controller, a mapping catheter was moved to eight pre-specified locations in a specific sequence: right ventricular apex, mid-right ventricular septum, right ventricular outflow tract, His-bundle position, coronary sinus ostium, high right atrium, lateral tricuspid annulus, and low lateral right atrium. The pre-specified efficacy endpoint was to achieve 80 % successful navigation to all locations. Time to each location, location accuracy, and quality of contact were confirmed by imaging and specific criteria for electrograms and pacing thresholds. In 181 patients, a total of 1,396 of 1,448 (96 %) locations were successfully mapped with all protocol criteria met (one-sided p value < 0.0001). The median time to move the catheter to a new location was 24 s. The Amigo-related major complication rate was 0 % which was significantly less than the predefined endpoint of 4 % (one-sided p = 0.003). We found the Amigo RCS to be safe and effective for positioning a mapping catheter at sites within the right atrium and ventricle.

NAHR-mediated copy-number variants in a clinical population: Mechanistic insights into both genomic disorders and Mendelizing traits

Abstract: We delineated and analyzed directly oriented paralogous low-copy repeats (DP-LCRs) in the most recent version of the human haploid reference genome. The computationally defined DP-LCRs were cross-referenced with our chromosomal microarray analysis (CMA) database of 25,144 patients subjected to genome-wide assays. This computationally guided approach to the empirically derived large data set allowed us to investigate genomic rearrangement relative frequencies and identify new loci for recurrent nonallelic homologous recombination (NAHR)-mediated copy-number variants (CNVs). The most commonly observed recurrent CNVs were NPHP1 duplications (233), CHRNA7 duplications (175), and 22q11.21 deletions (DiGeorge/velocardiofacial syndrome, 166). In the ∼25% of CMA cases for which parental studies were available, we identified 190 de novo recurrent CNVs. In this group, the most frequently observed events were deletions of 22q11.21 (48), 16p11.2 (autism, 34), and 7q11.23 (Williams-Beuren syndrome, 11). Several features of DP-LCRs, including length, distance between NAHR substrate elements, DNA sequence identity (fraction matching), GC content, and concentration of the homologous recombination (HR) hot spot motif 5'-CCNCCNTNNCCNC-3', correlate with the frequencies of the recurrent CNVs events. Four novel adjacent DP-LCR-flanked and NAHR-prone regions, involving 2q12.2q13, were elucidated in association with novel genomic disorders. Our study quantitates genome architectural features responsible for NAHR-mediated genomic instability and further elucidates the role of NAHR in human disease.

Ureteropyeloscopic treatment of large, complex intrarenal and proximal ureteral calculi

Abstract: UNLABELLED: Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Large upper tract urinary calculi, greater than 2 cm, have historically been treated with percutaneous nephrostolithotomy. In general, there has been a growing interest in employing retrograde, flexible ureteroscopy and laser lithotripsy in select patients who are either poor medical candidates for percutaneous lithotripsy or who may prefer a less invasive intervention. Properly selecting patients for this approach, designing specific treatments based on complex stone presentation and offering general information with regard to long-term outcomes and surgical risks have historically been based on results from small, multicentre series lacking uniformity of technique and long-term outcomes. Our initial multicentre experience employing ureteroscopic techniques to treat large upper urinary tract calculi was presented in 1998. This current work represented the largest single-centre experience, accrued prospectively over 10 years, where there was uniformity of technique and treatment algorithms. This study frames an argument for retrograde ureteroscopic lithotripsy not only in those who are at high risk for percutaneous nephrostolithotomy but in all who present with large, non-infected stone burdens. OBJECTIVE: To define the safety and efficacy of retrograde ureteroscopic lithotripsy in treating large, non-infectious intrarenal and proximal ureteral stone burdens. PATIENTS AND METHODS: Between 2000 and 2011, 145 patients with 164 large (2 cm or greater in diameter on standard imaging) non-infectious upper intrarenal and proximal ureteral calculi were chosen for retrograde ureteroscopic lithotripsy. Patients were treated with small diameter flexible fibre-optic ureteroscopes and holmium laser lithotripsy by a single surgeon. Second-look ureteroscopy was performed in patients with the largest calculi in whom there was a high index of suspicion of significant residual fragments. Stone clearance was defined as no fragments or a single fragment less than or equal to 4 mm in diameter on standard radiograph and sonography at 3-month follow-up. RESULTS: Our study included 103 male patients and 42 female patients with an average age of 55 years (range 16-86 years) and a mean stone diameter of 29 mm (range 20-70 mm) including 36 partial staghorn stone burdens (mean diameter 37 mm). Overall, 266 ureteroscopies were performed on 164 stone burdens (1.6 procedures per stone burden), clearing 143 stone burdens (87%). The highest clearance rates were observed for proximal ureteral (97%) and renal pelvic (94%) stones, while the lowest clearance rates were observed for lower pole (83%) and staghorn calculi (81%). Three patients required subsequent percutaneous therapy due to infectious material encountered at the time of ureteroscopy or inaccessible stone burdens secondary to infundibular stenosis. There were five minor postoperative complications, including four fevers and one patient with gross haematuria and clot retention, with no major intraoperative complications. CONCLUSIONS: In select patients, large, complex, metabolic upper urinary tract calculi can be treated safely and efficiently with retrograde ureteroscopic techniques. Staged, retrograde, flexible ureteroscopy is an alternative to percutaneous therapy with acceptable efficacy and low morbidity.

Evidence that acetylsalicylic acid attenuates inflammation in the walls of human cerebral aneurysms: preliminary results.

Abstract: Background Inflammatory cells and molecules may play a critical role in formation and rupture of cerebral aneurysms Recently, an epidemiologic study reported that acetylsalicylic acid (ASA) decreases the risk of aneurysm rupture The goal of this study was to determine the effects of ASA on inflammatory cells and molecules in the walls of human cerebral aneurysms, using radiographic and histological techniques Methods and Results Eleven prospectively enrolled patients harboring unruptured intracranial aneurysms were randomized into an ASA-treated (81 mg daily) group (n=6) and an untreated (control) group (n=5) Aneurysms were imaged at baseline using ferumoxytol-enhanced MRI to estimate uptake by macrophages After 3 months, patients were reimaged before undergoing microsurgical clipping Aneurysm tissues were collected for immunostaining with monoclonal antibodies for cyclooxygenase-1 (COX-1), cyclooxygenase-2 (COX-2), microsomal prostaglandin E2 synthase-1 (mPGES-1), and macrophages A decrease in signal intensity on ferumoxytol-enhanced MRI was observed after 3 months of ASA treatment Expression of COX-2 (but not COX-1), mPGES-1, and macrophages was lower in the ASA group than in the control group Conclusions This study provides preliminary radiographical and histological evidence that ASA may attenuate the inflammatory process in the walls of human cerebral aneurysms Clinical Trial Registration URL: Unique identifier: [NCT01710072][1] [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01710072&atom=%2Fahaoa%2F2%2F1%2Fe000019atom

Risks and Benefits of Anticoagulation in Atrial Fibrillation Insights From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Registry

Abstract: Background—Patients with atrial fibrillation (AF) at the highest stroke risk derive the largest benefit from oral anticoagulation (OAC). Those with the highest stroke risk have been paradoxically less likely to receive OAC. This study assessed the association between stroke and bleeding risk on rates of OAC. Methods and Results—We analyzed OAC use among 10 098 patients with AF from 174 community-based outpatient practices enrolled in 2010–2011 in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). OAC was defined as warfarin or dabigatran use at study enrollment. Stroke and bleeding risk were calculated using congestive heart failure, hypertension, age, diabetes mellitus, prior stroke (CHADS2), and anticoagulation and risk factors in AF (ATRIA) scores, respectively. The mean subject age was 73 years; 58% were men. Overall, 76% of patients received OAC (71% warfarin and 5% dabigatran). The use of OAC increased among those with higher CHADS2 scores, from 53% for CHADS2=0 t...

Laboratory testing of rivaroxaban in routine clinical practice: when, how, and which assays.

Abstract: A number of target-specific oral anticoagulants (TSOAs) have been developed in recent years, and some have shown considerable promise in large-scale, randomized clinical trials in the prevention and treatment of thromboembolism. Unlike traditional anticoagulants, such as vitamin K antagonists, these TSOAs exhibit predictable pharmacokinetics and pharmacodynamics. Among these agents, rivaroxaban, a direct Factor Xa inhibitor, has been approved for clinical use in many countries for the management of several thromboembolic disorders. As with the other TSOAs, rivaroxaban is given at fixed doses without routine coagulation monitoring. However, in certain patient populations or special clinical circumstances, measurement of drug exposure may be useful, such as in suspected overdose, in patients with a haemorrhagic or thromboembolic event during treatment with an anticoagulant, in those with acute renal failure, or in patients who require urgent surgery. This article summarizes the influence of rivaroxaban on commonly used coagulation assays and provides practical guidance on laboratory testing of rivaroxaban in routine practice. Both quantitative measurement (using the anti-Factor Xa method) and qualitative measurement (using prothrombin time, expressed in seconds) are discussed, together with some practical considerations when performing these tests and interpreting the test results.

Severe Persistent Synovitis After Cobalt-chromium Total Knee Arthroplasty Requiring Revision

Abstract: Implant-related hypersensitivity is a well-established cause of failure after total hip arthroplasty but is a rare complication after total knee arthroplasty (TKA). It remains a relatively unpredictable and poorly understood cause of implant-related failure. This article describes 5 patients (6 knees) who presented with persistent pain and hypertrophic synovitis after TKA using a cobalt-chromium component. Extensive perioperative workup, including white blood cell count, erythrocyte sedimentation rate, C-reactive protein, joint aspiration, and intraoperative cultures, ruled out infection as a cause of the symptoms. All knees demonstrated appropriate ligamentous balance and were well aligned, with all components noted to be well fixed at revision. In all patients, the clinical condition improved dramatically after revision to zirconium femoral and titanium metal-backed tibial components. Pain and functional outcome scores improved in all patients. Intraoperative histopathology revealed a thickened synovium with either a predominantly lymphocytic or histiocytic monocellular response. Final pathology confirmed that no infection was present in any patient. The goal of TKA is to produce a well-performing, pain-free joint. When patients present with recurrent pain and synovitis after TKA, infection must be excluded. When infection and instability have been excluded, metal hypersensitivity should be considered as a cause of primary TKA failure. In these patients, revision to a zirconium femoral component can provide predictable and effective clinical improvement.

Similar Improvement in Gait Parameters Following Direct Anterior and Posterior Approach Total Hip Arthroplasty

Abstract: Introduction: Direct anterior approach (DAA) total hip arthroplasty (THA) has been reported to be a muscle sparing approach. The purpose of this study was to compare gait patterns over time between patients undergoing THA via DAA and posterior approach (PA). Methods: 22 patients with unilateral primary hip osteoarthritis were prospectively enrolled and gait analysis was performed prior to, at 6 months and 1 year following THA via DAA and PA. All PA THA9s were performed by a single surgeon from January 2008 to February 2009; all DAA THA9s were performed by the same surgeon at the same institution from January 2010 to May 2011 with similar design of uncemented acetabular, femoral components and bearing surfaces. Reflective markers were placed on the lower extremity and motion data collected using six infrared cameras (Qtrac, Qualysis). Ground reaction forces were recorded with a multicomponent force plate (Kistler). A repeated-measures ANOVA was used to compare changes in gait parameters over time. Harris Hip Score was used to quantify pain and function. Results: There were 11 patients in both groups with similar age, sex and BMI distribution. Postoperatively, both groups demonstrated improvement in flexion/extension range of motion (ROM) (p = 0.006), peak flexion (p = 0.05) and extension moments (p = 0.004) with no differences between groups. Internal/external ROM improved significantly and was higher in DAA group as compared to PA group (p = 0.05). Gait velocity and single-leg stance time improved significantly in PA group (p = 0.001), but they were similar between groups postoperatively. Pain and function scores were also similar. Conclusions: THA performed via DAA and PA offer similar improvement in gait parameters at 6 months and 1 year follow-up with the exception of internal/external ROM. This might be indicative of altered hip mechanics related to release and repair of external rotators during PA THA.

Effect of Race and Ethnicity on Outcomes With Drug-Eluting and Bare Metal Stents Results in 423 965 Patients in the Linked National Cardiovascular Data Registry and Centers for Medicare & Medicaid Services Payer Databases

Abstract: Background—Black, Hispanic, and Asian patients have been underrepresented in percutaneous coronary intervention clinical trials; therefore, there are limited data available on outcomes for these race/ethnicity groups. Methods and Results—We examined outcomes in 423 965 patients in the National Cardiovascular Data Registry CathPCI Registry database linked to Medicare claims for follow-up. Within each race/ethnicity group, we examined trends in drug-eluting stent (DES) use, 30-month outcomes, and relative outcomes of DES versus bare metal stents. Overall, 390 351 white, 20 191 black, 9342 Hispanic, and 4171 Asian patients > 65 years of age underwent stent implantation from 2004 through 2008 at 940 National Cardiovascular Data Registry participating sites. Trends in adoption of DES were similar across all groups. Relative to whites, black and Hispanic patients undergoing percutaneous coronary intervention had higher long-term risks of death and myocardial infarction (blacks: hazard ratio, 1.28; 95% confidenc...

Delivery of Optimized Inpatient Anticoagulation Therapy: Consensus Statement from the Anticoagulation Forum

Abstract: This is a copy of an article published in the Annals of Pharmacotherapy © 2013 SAGE Publications

Objective Assessment of Perceived Age Reversal and Improvement in Attractiveness After Aging Face Surgery

Abstract: ImportancePrimary reasons why patients pursue aesthetic facial surgery are to look younger and more attractive; however, there is minimal literature about the effect of aesthetic facial surgery on ...

Management of hepatocellular adenoma: comparison of resection, embolization and observation

Abstract: Introduction Hepatocellular adenoma (HA) is an uncommon benign hepatic tumour with the potential for malignant change or spontaneous haemorrhage. Resection has been the recommended treatment, but outcomes with other approaches are ill defined.

Bilateral thalamic infarcts due to occlusion of the Artery of Percheron and discussion of the differential diagnosis of bilateral thalamic lesions

Abstract: The Artery of Percheron is a rare vascular variant in which a single dominant thalamoperforating artery arises from one P1 segment and bifurcates to supply both paramedian thalami. Occlusion of this uncommon vessel results in a characteristic pattern of bilateral paramedian thalamic infarcts with or without mesencephalic infarctions. We report a case of a 31-year-old man with acute bilateral thalamic infarcts and a truncated Artery of Percheron demonstrated on magnetic resonance angiography (MRA). Occlusion of the vessel was presumably due to embolism from a patent foramen ovale that was subsequently closed. The case presentation is followed by a discussion of bilateral paramedian thalamic infarcts including the causes and clinical presentation. The differential diagnosis of vascular and nonvascular etiologies of bilateral thalamic lesions is also discussed.

Nine-month results of the REFORM study: a prospective, single-arm, multicenter clinical study of the safety and effectiveness of the Formula™ balloon-expandable stent for treatment of renal artery stenosis.

Abstract: Objectives To evaluate the 9-month safety and effectiveness outcomes of the Formula™ balloon-expandable renal stent (Cook Medical, Bloomington, IN) for the treatment of atherosclerotic renal artery stenosis (RAS) following suboptimal angioplasty. Background Atherosclerotic RAS can cause hypertension and ischemic nephropathy. When clinically indicated, an interventional approach with renal angioplasty and stent implantation is the preferred method for revascularization of atherosclerotic renal artery stenoses. Methods The REFORM study is a prospective, multicenter, single-arm study of stent implantation following suboptimal PTRA using the Formula stent. One hundred patients with atherosclerotic ostial renal artery lesions =18 mm in length with a >50% residual stenosis following PTA were enrolled. The primary endpoint was 9-month primary patency. Results The 9-month primary patency rate was 91.7%. The 9-month major adverse event rate was 2.2%. Mean systolic blood pressure was significantly decreased at follow-up (from 150 ± 21 mm Hg at baseline to 141 ± 21 mm Hg at 9 months; P = 0.003). Mean serum creatinine (SCr) level and mean estimated glomerular filtration rate (eGFR) were not significantly different at 9 months. A clinically meaningful improvement in renal function (i.e., =25% increase in eGFR or =0.5 mg/dl decrease in SCr) was observed in 9% of patients at 1 month and 12% of patients at 9 months. A clinically meaningful decline in renal function (i.e., =25% decrease in eGFR or =0.5 mg/dl increase in SCr) was observed in only 3% of patients at 1 month and 7% of patients at 9 months. Conclusions The Formula stent was safe and effective in treating atherosclerotic RAS following suboptimal angioplasty. © 2013 Wiley Periodicals, Inc.

Midterm Results of a Femoral Stem With a Modular Neck Design: Clinical Outcomes and Metal Ion Analysis

Abstract: Background There are numerous concerns associated with femoral stems that feature a modular neck design, including the potential for corrosion, modular neck fracture, and adverse local tissue reactions. These stems have a higher-than-anticipated rate of failure in registry results, but large single-center cohort studies are lacking. Methods This is a retrospective, single-surgeon cohort of 133 hips in 119 patients implanted with a single dual-tapered titanium alloy stem with a modular titanium alloy neck (Profemur® Z; Wright Medical Technology, Arlington, TN). Several bearing surface combinations were used, including metal-on-polyethylene, ceramic-on-polyethylene, metal-on-metal, and ceramic-on-ceramic couples. Patients were evaluated at a mean of 4.5 years (range 2.0–9.0 years) with Harris Hip scores (HHS), radiographic analysis, and metal ion testing. Results Mean HHS were 84.8 points at latest follow-up (range, 30 to 100 points). Five hips were revised during the study period, for an overall Kaplan-Meier survival of 0.881 at 8 years. There was only one modular neck fracture (0.75%), but others demonstrated ALTR or corrosion at the neck-body interface. Mean serum titanium levels were 4.3 ng/dL (range, Conclusions The Profemur® Z stem offers good clinical results in the majority of patients with a low rate of modular neck fracture, however there is an increased rate of femoral revision at mid-term follow-up consistent with registry results. We urge caution in the use of stem designs with a modular neck as this additional interface creates a site for unique failure mechanisms that do not occur with monolithic stem designs.

Radiation exposure among patients with the highest CT scan utilization in the emergency department

Abstract: The risk of cancer from computed tomography (CT) scan radiation is a rising concern in the medical field. Our objectives were to determine how many patients received more than ten CT scans in an academic emergency department (ED) over the course of 7 years and to quantify their radiation exposure and lifetime attributable risk of cancer. An electronic chart review was performed at our urban academic institution with an annual census of 110,000 patients. All patients who underwent a CT scan performed during ED management between the dates of January 2001 and December 2007 were identified. Specific predetermined data elements (e.g., subject demographics, type of CT scan) were extracted by two researchers blinded to hypothesis, using a preformatted data form. After identifying patients with more than ten CTs performed during the study period, radiation exposure was calculated based on accepted and reported radiation doses for the respective anatomic CTs, and lifetime attributable cancer risk was calculated based on the seventh report of the Biological Effects of Ionizing Radiation (BEIR VII) projections. Over the 7-year study period, 24,393 patients received 34,671 CT scans. The vast majority of patients (17,909) received a single CT. Twenty-six (0.1 %) patients received more than ten CTs totaling 374 scans with an average radiation exposure of 83.4 mSv. The maximum lifetime attributable risk for any individual in this cohort was 1.7 % above the baseline cancer risk. Among those undergoing CT imaging in our ED, high-exposure patients (greater than ten scans) constituted a significant minority, while more than one in four patients underwent more than one CT scan during the study period. While the presumed overall risk of radiation-induced cancer continues to be low, it is important for the emergency physician to use clinical knowledge as well as concern for the patient when utilizing radiographic imaging. Increasing attributable cancer risk may have important public health implications in the future, regardless of the low individual risk.

New avenues for anticoagulation in atrial fibrillation.

Abstract: Vitamin K antagonists (VKAs) were, until recently, the only option for chronic anticoagulation in patients with atrial fibrillation. Three new oral anticoagulants have been tested for this indication in recent randomized trials: dabigatran, rivaroxaban, and apixaban. They offer the promise of consistent effect without the need for monitoring drug levels. Overall, efficacy and safety appear to be noninferior, and in some instances superior, to warfarin. However, the new drugs have their downsides, and switching from warfarin is not recommended for all patients. This review focuses on the available evidence and attempts to provide guidance to clinicians in the field. Clinical Pharmacology & Therapeutics (2013); 93 1, 68–77. doi:10.1038/clpt.2012.197

Cardiac tamponade complicating coronary perforation during angioplasty: short-term outcomes and long-term survival.

Abstract: Background Cardiac tamponade constitutes the most severe clinical consequence of a coronary perforation (CP) during percutaneous coronary intervention (PCI). Methods We analyzed 23,399 PCIs and identified 73 patients complicated by CP (0.31%), of which 26 developed tamponade (0.11%). Patients were divided into two groups: CP with tamponade (group A) and CP without tamponade (group B). Characteristics and outcomes were compared and a multivariate model was developed to evaluate the independent contribution of tamponade on mortality. Results All patients with tamponade were treated with pericardiocentesis. Tamponade increased the risk of death by more than 3-fold (odds ratio [OR] = 3.3; 95% confidence interval [CI],1.01-10.6; P=.047) relative to patients with CP but no tamponade. CP with tamponade during non-elective PCI carried a significantly worse long-term prognosis (P=.001) than the same complications during elective PCI. The use of glycoprotein IIb/IIIa inhibitors and bivalirudin did not differ between groups. Polytetrafluoroethylene-covered stents were used similarly between the two groups, while coil embolization was used more often in group A (P=.003). Emergent cardiac surgery was needed in 3 patients (11.5%) in group A versus 1 patient (2.1%) in group B. Conclusions Tamponade complicating CP during PCI has short- and long-term major adverse effects. In-hospital mortality after tamponade and referral for emergent surgical treatment have decreased. Nonetheless, tamponade in this setting increases risk of death by >3-fold. PCI of complex lesions with an expected increased risk of perforation should be undertaken cautiously among patients with non-elective PCI because of increased early and late risk of death.