Impact of cardiac and noncardiac cirrhosis on coronary revascularization outcomes from the National Inpatient Sample, 2016 to 2018.

Data on coronary revascularization in patients with cirrhosis are scarce because it is often deferred in the setting of significant comorbidities and coagulopathies. It is unknown whether patients with cardiac cirrhosis have a worse prognosis. The National Inpatient Sample was surveyed to identify patients who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS) from 2016 to 2018. Those with and without liver cirrhosis were propensity score-matched and compared within the PCI and CABG cohorts. Primary outcome was in-hospital mortality. Patients with cirrhosis were further classified into cardiac and noncardiac cirrhosis and their in-hospital mortalities were compared. A total of 1,069,730 PCIs and 273,715 CABGs were performed for ACS, of which 0.6% and 0.7%, respectively, were performed in patients with cirrhosis. In both the PCI cohort (odds ratio = 1.56; 95% confidence interval, 1.10-2.25; P = 0.01) and the CABG cohort (odds ratio = 2.34; 95% confidence interval, 1.19-4.62; P = 0.01), cirrhosis was associated with higher in-hospital mortality. In-hospital mortality was greatest in cardiac cirrhosis (8.4% and 7.1%), followed by noncardiac cirrhosis (5.5% and 5.0%) and no cirrhosis (2.6% and 2.3%) in PCI and CABG cohorts, respectively. Higher in-hospital mortality and periprocedural morbidities should be considered when performing coronary revascularization in patients with cirrhosis.

Diurnal Fasting During Ramadan Leading to Superior Mesenteric Artery Syndrome.

Superior mesenteric artery (SMA) syndrome is a favorite of anatomists and clinicians because it results from extrinsic compression of the duodenum by the 2 vascular structures forming the aortomesenteric angle (the descending abdominal aorta and the SMA). Although it is an uncommon cause of upper gastrointestinal obstruction, SMA syndrome can cause significant morbidity. It is more common in younger people. Historically, it has been associated with weight loss and eating disorders, but there are several other risk factors that should be considered in the workup. Cases of SMA syndrome are typically managed conservatively, but surgical referral and intervention may be considered in situations that fail conservative management. We present a case of this rare syndrome in a young man with no medical or psychiatric history during diurnal voluntary fasting in the month of Ramadan.