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Endovascular procedures have superior short-term clinical and economic outcomes compared with open procedures for the treatment of AIOD in the inpatient setting. Further studies are needed to examine long-term outcomes and access-related issues.

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Methods | Using the 20% random sample of fee-for-service Medicare beneficiaries aged 65 years or older in the carrier and enrollment data from 2008 through 2012, we assessed 99m Tc radiotracer use in the approximately 2 million cardiac stress tests with SPECT-MPI performed during these years, using codes A9500 and A9502 to identify 99m Tc-labeled radiotracers. We calculated population-based rates of SPECT-MPI as well as rates for alternative testing modalities (stress echocardiography, computed tomography coronary angiography, and positron emission tomography-MPI) and downstream cardiac catheterization less than 90 days after index testing. We identified a priori the 6-month shortage during March through August 2010 due to shutdowns at the Petten High Flux and Chalk River Laboratories reactors, the 2 major producers of 99 Mo for the United States. We used descriptive statistics to document temporal trends. Multivariable logistic regression was used to estimate the odds of cardiac catheterization less than 90 days after SPECT-MPI depending on radiotracer use after adjusting for age, sex, and race. This study was approved by the University of Michigan Institutional Review Board. Informed consent was waived for this retrospective study.

BackgroundMyocarditis is a highly morbid complication of immune checkpoint inhibitor (ICI) use that remains inadequately characterized. The QRS duration and the QTc interval are standardized electrocardiographic measures that are prolonged in other cardiac conditions; however, there are no data on their utility in ICI myocarditis.MethodsFrom an international registry, ECG parameters were compared between 140 myocarditis cases and 179 controls across multiple time points (pre-ICI, on ICI prior to myocarditis, and at the time of myocarditis). The association between ECG values and major adverse cardiac events (MACE) was also tested.ResultsBoth the QRS duration and QTc interval were similar between cases and controls prior to myocarditis. When compared with controls on an ICI (93±19 ms) or to baseline prior to myocarditis (97±19 ms), the QRS duration prolonged with myocarditis (110±22 ms, p<0.001 and p=0.009, respectively). In contrast, the QTc interval at the time of myocarditis (435±39 ms) was not increased compared with pre-myocarditis baseline (422±27 ms, p=0.42). A prolonged QRS duration conferred an increased risk of subsequent MACE (HR 3.28, 95% CI 1.98 to 5.62, p<0.001). After adjustment, each 10 ms increase in the QRS duration conferred a 1.3-fold increase in the odds of MACE (95% CI 1.07 to 1.61, p=0.011). Conversely, there was no association between the QTc interval and MACE among men (HR 1.33, 95% CI 0.70 to 2.53, p=0.38) or women (HR 1.48, 95% CI 0.61 to 3.58, p=0.39).ConclusionsThe QRS duration is increased in ICI myocarditis and is associated with increased MACE risk. Use of this widely available ECG parameter may aid in ICI myocarditis diagnosis and risk-stratification.

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Delaying PLEX therapy for MG by more than 2 days after admission may lead to higher mortality and complication rates, and thus prompt therapy is warranted.