The American journal of cardiology
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Multicenter Study
Association of Autoimmune Connective Tissue Disease and Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation.
Patients with autoimmune connective tissue disease (CTD) are at higher risk for developing aortic valve pathology, but the safety and value of transcatheter aortic valve implantation (TAVI) in this population has not been investigated. This study evaluated mortality, complication, and readmission rates along with length of stay and total costs after TAVI in patients with CTD. We retrospectively reviewed 47,216 patients who underwent TAVI from the National Readmissions Database between January 2011 and September 2015. ⋯ However, CTD patients were more frequently readmitted for postoperative infection (9.4 vs 5.6%, p = 0.042) and septicemia (8.2 vs 4.5%, p = 0.019). After multivariable adjustment, CTD patients faced lower mortality at index hospitalization (odds ratio [OR] 0.56 [0.38 to 0.82], p = 0.003) but were more frequently readmitted for septicemia (OR = 1.95 [1.10 to 3.45], p = 0.023) and postoperative infection (OR = 3.10 [1.01 to 9.52], p = 0.048) relative to non-CTD patients. In conclusion, CTD is not a risk factor for in-hospital mortality but is an independent risk factor for infectious complications post-TAVI.
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Multicenter Study
Trends in Readmission and Costs After Transcatheter Implantation Versus Surgical Aortic Valve Replacement in Patients With Renal Dysfunction.
Patients with renal dysfunction are at increased risk for developing aortic valve pathology. In the present era of value-based healthcare delivery, a comparison of transcatheter and surgical aortic valve replacement (SAVR) readmission performance in this population is warranted. All adult patients who underwent transcatheter or SAVR from 2011 to 2014 were identified using the Nationwide Readmissions Database, containing data for nearly 50% of US hospitalizations. ⋯ Transcatheter aortic valve replacement in chronic kidney disease stage 1 to 3 patients had a higher rate of readmission due to heart failure and pacemaker placement than SAVR. Transcatheter aortic valve replacement was associated with increased costs compared with SAVR for all renal failure patients. In conclusion, in this national cohort of chronic and end-stage renal disease patients, transcatheter aortic valve implantation was associated with increased mortality, readmissions for chronic kidney disease stages1 to 3, and index hospitalization costs.
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Multicenter Study
In-Hospital Outcomes of Transcatheter Aortic Valve Implantation in Patients With Mitral Valve Stenosis.
Little is known about the outcome of patients with mitral stenosis (MS) who underwent transcatheter aortic valve implantation (TAVI). Therefore, we sought to evaluate the potential impact of MS on the outcome of patients who underwent TAVI using the US national cohort. Using weighted data from the National Inpatient Sample database between 2011 and 2015, we identified patients who had undergone a TAVI as a primary procedure. ⋯ A total of 62,110 patients underwent TAVI (mean age 81 ± 8.72, 47.4% females, and 3.7% African-Americans) and 887 patients had MS (1.43%). Patients with concomitant MS had higher in-hospital mortality (5.1% vs 3.5% adjusted odds ratio [aOR] 1.455; 95% confidence interval [CI] 1.059 to 2.001, p = 0.021), major adverse cardiac events (9.0% vs 7.1% aOR 1.297; 95% CI 1.012 to 1.663, p = 0.040), major bleeding (16.3% vs 12.1% aOR 1.303; 95% CI 1.067 to 1.593, p = 0.010), cardiac complications (21.8% vs 16.0% aOR 1.536; 95% CI, 1.300 to 1.815, p < 0.001), and acute myocardial infarction (4.5% vs 2.8% aOR 1.783; 95% CI 1.249 to 2.545, p = 0.007) when compared with patients without MS. In conclusion, MS is an independent risk factor for mortality and morbidity after TAVI procedure for patients with severe aortic stenosis.
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Randomized Controlled Trial Multicenter Study
Usefulness of Clopidogrel Loading in Patients Who Underwent Transcatheter Aortic Valve Implantation (from the BRAVO-3 Randomized Trial).
P2Y12-inhibitor initiation with clopidogrel using a loading dose (LD) versus no LD (NLD) provides more rapid inhibition of platelet activation and reduced risk of ischemic events after coronary stenting. Whether a similar beneficial effect is achieved in the setting of transcatheter aortic valve implantation (TAVI) is unknown. We evaluate the effects of preprocedural clopidogrel LD versus no NLD on 48-hour and 30-day clinical outcomes after TAVI. ⋯ Multivariable adjustment showed that clopidogrel LD did not affect any of the studied clinical events, including major vascular complications (odds ratio 0.91, 95% confidence interval 0.60 to 1.39, p = 0.67). Also patients on clopidogrel maintenance therapy and thus considered in steady state were not at reduced risk of major adverse cardiovascular events compared with patients not on clopidogrel (3.7% vs 5.2%, p = 0.36). In conclusion, in patients who underwent TAVI, use of clopidogrel LD was associated with higher vascular complications and otherwise similar clinical events compared to NLD patients.
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We investigated the association of perioperative antiplatelet therapy (APT) and outcomes in patients with drug-eluting stent (DES) placement for noncardiac surgery (NCS). In consecutive 23,358 patients who underwent percutaneous coronary interventions between 2005 and 2016, total of 2,179 patients that required 2,179 elective NCS after DES placement were retrospectively analyzed. A net adverse clinical event (NACE), composite of death, myocardial infarction, stent thrombosis, and major bleeding, was assessed at 30 days. ⋯ Our findings persisted (adjusted HR 1.26, 95% CI 0.51 to 3.10, p = 0.618) when those who continued dual-APT were excluded from the continuation of APT group due to a higher tendency of NACE compared with those who continued single-APT (adjusted HR 2.26, 95% CI 0.98 to 5.21, p = 0.055). However, the patients who discontinued APT for >7 days had a significantly higher NACE than those who discontinued for ≤7 days (adjusted HR 6.93, 95% CI 2.16 to 22.24, p = 0.001). In conclusion, discontinuation of APT may not be associated with higher NACEs 30 days postsurgery compared with continuation of APT, when APT was discontinued for ≤7 days in patients undergoing elective NCS after DES implantation.