Sex-specific short- and long-term outcomes in patients with leadless cardiac pacemakers.

Relation of Baseline Systolic Blood Pressure and Long-Term Outcomes in Ambulatory Patients With Chronic Mild to Moderate Heart Failure

Three-Year Clinical Impacts of Permanence, Resolution, and Absence of Newly-Developed Left Bundle Branch Block After Transcatheter Aortic Valve Replacement

Background The number of leadless cardiac pacemaker (LCP) implantations has increased over the recent years, being more frequently performed in elderly patients with multiple comorbidities. Purpose The aim of this study is to analyze periprocedural complications and outcome of LCP patients according to their comorbidity status. Methods This is a Swiss multi-centre, retrospective cohort study including all consecutive patients implanted with a LCP (Medtronic Micra VR or AV) between 2015 and 2022. Charlson Comorbidity Index (CCI) was determined and patients were divided into two groups: CCI ≤ 5 (low comorbidity) and CCI > 5 (high comorbidity). Periprocedural complications, in-hospital death, and all-cause mortality were assessed. Results A total of 863 patients (median age 81 years (IQR 76 – 86), male sex 65%) were included in the study, of which 58% had a CCI ≤ 5. Baseline characteristics of the 2 groups are summarized in the table. Patients in the high comorbidity group were older male presenting more frequently with ischemic cardiomyopathy, diabetes, chronic obstructive pulmonary disease, moderate to severe chronic kidney disease and malignancies. Urgent implantations were more frequent in the high comorbidity than in the low comorbidity group (65% vs. 50%, p<0.001). Overall periprocedural complication rate was 2.9% (n = 25) without significant differences between the two groups (2.9% in both groups, p = 1.0). Pericardial effusion requiring pericardiocentesis was the most frequent periprocedural complication (n = 8, 0.9%). Median hospitalization was significantly longer (5 vs. 3 days, p<0.001), and in-hospital mortality significantly higher (3.6% vs. 0.6%, p=0.002) in the high comorbidity group. None of the in-hospital deaths was deemed a periprocedural complication. Median follow-up was 15.4 months. As shown in the figure, all-cause mortality was significantly higher in the high morbidity group (HR 2.9, 95%-CI 2.2-3.8, p<0.001) resulting in a mortality of 58% at 3 years. Conclusions LCP implantation in patients with multiple comorbidities was equally safe with similar peri-procedural complication rates as compared to patients with less comorbidities. However, both in-hospital death and all-cause mortality during follow-up were significantly higher in the high comorbidity group, because patients were older and sicker. Given that costs of LCPs are substantially higher than standard transvenous pacemakers, further studies are necessary to assess cost-effectiveness in patients with high comorbidity and reduced life expectancy.Figure - Survival estimate according CCITable - Baseline characteristics

YKL-40 is significantly associated with the prevalence and severity of coronary artery disease (CAD). YKL-40 levels are significantly associated with variations in the CHI3L1 and TRIB1 genes. We investigated candidate genes for YKL-40 levels and evaluated the prognostic value of this biomarker and corresponding variants for long-term outcomes in patients with CAD. We included 4664 and 521 participants from the Taiwan Biobank (TWB) and CAD cohorts, respectively. Candidate variants for circulating YKL-40 levels were investigated using genome-wide association study (GWAS) data from the TWB cohort, and the results were validated in the CAD cohort. The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiac events (MACEs), which included the composite endpoints of all-cause mortality, nonfatal acute coronary syndrome, hospitalization for heart failure, and nonfatal stroke. According to the GWAS data from the TWB cohort, three CHI3L1 variants (rs4950928, rs10399931, and rs872129) and one TRIB1 variant (rs6982502) were independently associated with YKL-40 levels. These findings were validated in the CAD cohort. The combined CHI3L1 and TRIB1 weighted genetic risk scores (WGRSs) were not associated with the long-term outcomes (median follow-up period of 3.7 years) in patients with CAD. Conversely, patients with YKL-40 levels in the upper tertile had the highest rates of all-cause mortality and MACEs (log-rank p = 9.58 × 10−8 for all-cause mortality and 1.34 × 10−7 for MACEs). Furthermore, YKL-40 levels predicted poor clinical outcomes only in patients with multivessel CAD (log-rank p = 3.0 × 10−6 for all-cause mortality and 1.10 × 10−5 for MACEs) and not in patients with single-vessel CAD. This study revealed that YKL-40 levels but not the combined CHI3L1 and TRIB1 WGRSs were found to be independent predictors of poor clinical outcomes in patients with multivessel CAD.

Prognostic Value of Total Bilirubin in Patients With ST-Segment Elevation Acute Myocardial Infarction Undergoing Primary Coronary Intervention

Background Alanine aminotransferase (ALT) is referred as liver transaminase and predominantly expressed by hepatocytes. Previous evidences showed that high levels of ALT were reversely associated with short- and long-term outcomes in patients with myocardial infarction. Besides, low lymphocyte has been demonstrated to be significantly correlated with adverse clinical outcomes in coronary artery disease (CAD). However, evidences about the relationship between ALT-to-lymphocyte ratio (ALR) and outcomes in CAD patients with normal liver function are limited. The aim of this study was to assess the relationship between ALR and clinical outcomes in patients with CAD. Methods This is a retrospective cohort study, and a total of 3561 patients were enrolled in Clinical Outcomes and Risk Factors of Patients with CAD after percutaneous coronary intervention (PCI), from January 2013 to December 2017. After excluding patients with liver dysfunction, we finally enrolled 2714 patients. These patients were divided into two groups according to ALR value: the lower group (ALR < 14.06, n = 1804) and the higher group (ALR ≥ 14.06, n = 910). The average follow-up time was 37.59 ± 22.24 months. Results We found that there were significant differences between the two groups in the incidence of all-cause mortality (ACM) (P < 0.001) and cardiac mortality (CM) (P=0.010). Kaplan–Meier survival analysis suggested that CAD patients with higher ALR tended to have an increased accumulated risk of ACM and CM (log rank P < 0.001 and P=0.006, respectively). Multivariate Cox regression analysis showed that ALR was an independent predictor of ACM (hazard ratio (HR) = 2.017 (95% confidence interval (CI): 1.289–3.158), P=0.002) and CM (HR = 1.862 (95% CI: 1.047–3.313), P=0.034). We did not find significant difference in the incidence of major adverse cardiovascular events (MACEs) and major adverse cardiovascular and cerebrovascular events (MACCEs) between the two groups after adjustments of confounders. Conclusion Our results indicate that ALR is an independent predictor of long-term adverse outcomes in CAD patients who underwent PCI.

Combined Impact of Chronic Kidney Disease and Contrast Induced Acute Kidney Injury on Long-term Outcomes in Patients with Acute Lower Limb Ischaemia

792 Acute Coronary Syndrome in Patients With Normal or Non-Obstructive Coronary Artery Disease: Patient Characteristics and Long-Term Outcomes

PO-693-05 REMOVAL OF A CHRONICALLY-IMPLANTED LEADLESS VENTRICULAR PACEMAKER AFTER 9-YEARS USING A HIGHLY TORQUE RETRIEVAL CATHETER A CASE REPORT

POSTER PRESENTATIONS

Prognostic Impact of the Geriatric Nutritional Risk Index on Long-Term Outcomes in Patients Who Underwent Percutaneous Coronary Intervention

BackgroundThe effect of diabetes mellitus (DM) and chronic kidney disease (CKD) on long-term outcomes in patients receiving percutaneous coronary intervention (PCI) is unclear.MethodsA total of 1394 patients who underwent PCI were prospectively enrolled and divided into 4 groups according to the presence or absence of DM or CKD. Baseline characteristics, risk factors, medications, and angiographic findings were compared. Determinants of long-term outcomes in patients undergoing PCI were analyzed.ResultsPatients with DM and CKD had the highest all-cause mortality and cardiovascular mortality (both P < 0.01) but there were no differences existed in myocardial infarction (MI) or repeated PCI among the 4 groups (P = 0.19, P = 0.87, respectively). Patients with DM and CKD had the lowest even-free rate of all-cause mortality, cardiovascular mortality, MI, and repeated PCI (P < 0.001, P < 0.001, P < 0.001, and P = 0.002, respectively). In the Cox proportional hazard model, patients with both DM and CKD had the highest risk of all-cause mortality (HR: 3.25, 95% CI: 1.85–5.59), cardiovascular mortality (HR: 3.58, 95% CI: 1.97–6.49), MI (HR: 2.43, 95% CI: 1.23–4.08), and repeated PCI (HR: 1.79, 95% CI: 1.33–2.41). Patients with CKD alone had the second highest risk of all-cause mortality (HR: 2.04, 95% CI: 1.15–3.63), cardiovascular mortality (HR: 2.13, 95% CI: 1.13–4.01), and repeated PCI (HR: 1.47, 95% CI: 1.09–1.97).ConclusionsDM and CKD had additive effect on adverse long-term outcomes in patients receiving PCI; CKD was a more significant adverse predictor than DM.

Interventional therapy of coronary artery disease in China: retrospective and perspective

World Kidney Day 2011: Protect Your Kidneys, Save Your Heart

Elevated central pulse pressure (CPP) had a negative influence on long-term outcome in patients with hypertension (HT). However, little is known about the impact of central pulse pressure on long-term outcomes in hypertensive patients undergoing PCI. A total number of 1184 hypertensive patients who received PCI procedure were prospectively collected. They were divided into two groups according to the median of central pulse pressure. Baseline characteristics, risk factors, hemodynamic data including central systolic pressure (CSP), central diastolic pressure (CDP) and CPP were measured. Invasive strategies were also analyzed to compare the long term outcome between patients with reference CPP and patients with high CPP. We further analyzed the predictors for myocardial infarction (MI), mortality, repeated PCI procedure in hypertensive patients undergoing PCI. We found patients in the reference CPP group had a lower CSP and higher CDP compared with high CPP group (Both P < 0.001) and male preponderance (P < 0.001). Patients with diabetes and chronic kidney disease (CKD) tend to have a high CPP (both P < 0.001). Drugs including Angiotensin Converting Enzyme inhibitors (ACEI) and statin were used more frequently in patients with reference CPP group (P = 0.035 and P = 0.001, respectively). Freedom from all-cause mortality and cardiovascular(CV) mortality was lower in the patients with high CPP group (P = 0.001, P = 0.01, respectively).Logistic regression revealed that CPP is a major predictor for all-cause mortality and repeated PCI procedure [hazard ratio (HR): 2.46 and 1.41, respectively]. In hypertensive patients receiving PCI, elevated CPP had a negative impact on long-term mortality; CPP also strongly predicts all-cause mortality and repeated PCI procedures in hypertensive patients undergoing PCI.