Differences In Baseline Characteristics Research Articles

Dobutamine versus milrinone use in acute myocardial infarction related cardiogenic shock

Abstract Introduction Even though dobutamine and milrinone are both commonly used in the treatment of cardiogenic shock (CS), there is little evidence guiding the selection of inotrope. Even in the randomized DOREMI trial, in which both drugs were compared in the setting of cardiogenic shock, no significant differences were found in any of the outcomes. As a result, the choice of inotrope is left to the discretion of the treating physician. Purpose In this real world data study, we aimed to retrospectively identify patient-, treatment- and outcome characteristics of patients treated with either dobutamine or milrinone in the context of acute myocardial infarction (AMI) complicated by CS. Methods In the Netherlands, baseline, procedural and outcome data on patients undergoing PCI are prospectively registered within the Netherlands Heart Registration (NHR). Additionally, all patients with CS undergoing PCI were included in a CS registry by fourteen Dutch hospitals between 2017 and 2021. Patients were classified into groups based on the administration of either dobutamine or milrinone, initiated in the first 24 hours after PCI. Patients who received both were excluded from further analyses. Results A total of 2328 consecutive CS patients were included of whom 503 (22%) and 267 (12%) patients received dobutamine and milrinone respectively. At baseline, patients in the dobutamine group had higher eGFR (60.7 vs. 56.7 ml/min, p=0.016) and had a lower BMI (26.7 vs. 27.7 kg/m2, p=0.009). At presentation, the dobutamine group had a significantly lower heart rate (82.7 vs. 96.1 beats/minute, p<0.001) and presented more frequently with STEMI (86.1% vs. 73.4%). After PCI, administration of dobutamine was less often accompanied by noradrenaline (79.8% vs. 91.0%, p<0.001). Notably, the milrinone group had an increase in lactate after PCI more often (19.3% vs. 36.7%, <0.001), however it cannot be determined if the choice of drug was either influenced by the increase in lactate or if the lactate increased as a result of the initiation of the drug. Also, patients in the dobutamine group were less often intubated (53.3% vs. 64.4%, p=0.004) and less frequently supported by mechanical circulatory devices (32.8% vs. 41.2%, p=0.025). Lastly, 30-day mortality was significantly lower in the dobutamine group (41.7% vs. 50.8%, unadjusted p=0.020). Conclusions In this Dutch cohort of CS patients undergoing PCI, treatment and outcomes differed greatly between patient categories receiving either dobutamine or milrinone, most possibly due to differences in baseline characteristics. Importantly, patients treated with milrinone were sicker as was reflected by increase of lactate, higher heart rates at admission and higher rates of support by noradrenaline and mechanical devices. Therefore, in current practice, physicians seem to choose milrinone in more severe stages of shock. The results of this study demonstrate the need for implementation studies of available evidence.Kaplan Meier dobutamine vs. milrinoneTable dobutamine vs. milrinone

Outcomes with oral anticoagulation resumption or discontinuation after an anticoagulation-related event in patients with atrial fibrillation

Abstract Background There are uncertainties on the resumption of anticoagulation therapy in patients with non-valvular atrial fibrillation who experience a thrombotic or haemorrhagic event while on oral anticoagulation. Purpose We assessed the cumulative incidence of recurrent stroke, major bleeding and all-cause mortality associated with restarting antithrombotic treatment, after stroke or major bleeding during anticoagulation therapy for atrial fibrillation. Methods We included anticoagulated patients with atrial fibrillation that were discharged (2013-2020) from hospital for stroke, intracranial haemorrhage (ICH), and major bleeding. To adjust for competing risk of death and reduce confounding, we started the follow up after 120-days blanking period, counting events in patients resuming oral anticoagulation versus those that did not. Risks of all-cause mortality, thromboembolism, intracranial haemorrhage, and major bleeding were estimated with multivariable Cox proportional hazard models and propensity score to adjust for differences in baseline characteristics. Results 1029 patients (mean age 77 years) were included in the final cohort: 23% were ischemic stroke, 18% were ICH, and 59% major bleeding; of these, 77% resumed anticoagulation. Among patients with stroke as the index event (92% resumed anticoagulation) the cumulative incidence of events was significantly lower in patients resuming therapy (HR 0.2, 95%CI 0.1-0.4, p<0.01). In patients with ICH (64% resumed therapy) the cumulative incidence of events was lower in patients resuming anticoagulation (HR 0.4, 95%CI 0.2-0.7, p<0.01). Same was true for patients with major bleeding, with patients resuming therapy (76%), experiencing fewer events (HR 0.5, 95%CI 0.2-0.7, p<0.01). In the multivariable analysis considering age, sex and propensity score as covariates, resumption of anticoagulation significantly reduced the cumulative event rate (HR 0.5, 95%CI 0.4-0.6, p<0.01). Conclusion In patients with atrial fibrillation who experienced an anticoagulation-related event, resuming oral anticoagulation was associated with better outcomes for all-cause mortality and subsequent events as compared with patients who did not resume treatment.Stacked Area Charts and Cox regression

Dramatic improvements in survival in women and men with acute myocardial infarction over 30 years: a nationwide cohort study

Abstract Background Treatment of myocardial infarction (MI) has improved over the last decades due to the implementation of early revascularization and medical therapies for secondary prevention. The impact of these treatment changes on survival in women and men has not been documented over a 30-year perspective. Purpose The aim of this study was to assess implementation of new treatment strategies and their effects on changes in long-term outcomes in all patients with MI in Sweden over 30 years. Methods In SWEDEHEART, the Swedish register for coronary heart disease, we investigated treatments and outcomes and their associations in patients admitted with MI between 1991-2021. Patients were stratified in 2-year blocks, starting with a 3-year block for 1991-1993. Primary outcome was 1-year risk of cardiovascular (CV) mortality. Effect of treatments on outcome was assessed comparing observed event rates with event rates standardized by logistic regression accounting for differences in baseline characteristics and treatment. Results A total of 433,524 cases with MI were hospitalized between 1991-2021. Between 1991-1993 and 2020-2021, treatment with reperfusion and revascularization increased from 34.7% to 77.3%; in-hospital PCI from 1.8% to 73.8 %; dual antiplatelet therapy (DAPT) from 0.0% to 73.8%; statins from 3.0% to 91.7%; beta-blockers from 66.4% to 88.3%; and renin-angiotensin-system (RAS) inhibitors from 21.6% to 81.6% (Figure 1A). During the same period, the rates of 1-year CV mortality decreased from 24.1% to 8.3%. For women, CV mortality decreased from 28.9% to 10.3% and for men from 21.7% to 7.3%. When comparing observed with standardized event rates, most of the mortality improvement was explained by the implementation of early revascularization with PCI (Figure 1B). Conclusions In this unique nationwide cohort of patients with MI over 30 years, there was a gradual implementation of revascularization and novel medical treatment. Concurrently, there was a gradual absolute reduction in 1-year risk of CV mortality with 16 percentage points, which was similar in women and men. Most of the improvement in survival was related to implementation of early revascularization strategies. Figure 1 (A) Temporal trends in treatment and (B) crude and standardized rates of cardiovascular mortality within 1 year in patients with myocardial infarction over 30 years in Sweden.

Impact of atrial fibrillation on mortality and non-fatal cardiovascular outcomes in 152 638 patients admitted with congestive cardiac failure: a statewide population-linkage study

Abstract Background Congestive cardiac failure (CCF) and atrial fibrillation (AF) frequently co-exist, cause and exacerbate each other. Prior studies on the impact of AF in CCF patients yielded mixed findings. Purpose This study aims to examine the impact of AF on long-term outcomes including MACE (major adverse cardiovascular events defined as all-cause mortality and major cardiovascular outcomes including myocardial infarction, ischaemic stroke, CCF or revascularization) and other non-fatal vascular or bleeding outcomes in patients admitted with CCF. Methods Hospitalised patients in New South Wales (NSW), the largest state of Australia, from 1 July 2003 to 31 March 2021 with a primary diagnosis of CCF were identified from the statewide Admitted-Patient-Data-Collection database, stratified by AF (Prior-AF or New-AF during index CCF admission) and No-AF status, with follow-up until 31 March 2022. A linkage look-back to year-2001 was performed to identify prior-AF history. In addition to MACE, non-fatal outcomes assessed included recurrent admission with AF, haemorrhagic stroke, peripheral arterial thromboembolism, pulmonary embolism, and bleeding. Multivariable Cox regression was performed to assess the impact of AF on MACE. To account for the competing risk of death and assess the impact of AF on non-fatal cardiovascular outcomes, Fine-Gray competing risk analysis was performed. Results The cohort comprised 152 638 admitted CCF patients (median age: 80.4 years; 51.4% males): New-AF, n=16 371 (10.7%); Prior-AF, n=56 546 (37.0%) (Table 1). During a median follow-up of 2.5 years, compared to No-AF CCF patients, those with New-AF or Prior-AF had significantly higher rates of MACE (New-AF: 81.7% vs Prior-AF: 86.3% vs No-AF: 78.5%) driven by all-cause mortality (New-AF: 71.6% vs Prior-AF: 76.5% vs No-AF: 66.2%) (both logrank P<0.001). However, after adjusting for differences in baseline characteristics and admission year-groups, New-AF and Prior-AF status had differential impact on MACE compared to No-AF patients (adjusted hazard ratio [aHR]=0.93, 95% confidence interval [CI]=0.91-0.94; aHR=1.14, 95%CI=1.13-1.16 respectively; both P<0.001). Results were similar for all-cause death (aHR=0.94 and aHR=1.16 respectively; both P<0.001). Competing risk analyses showed that rehospitalisation for ischaemic stroke, AF, haemorrhagic stroke, peripheral arterial thromboembolism and bleeding were significantly higher in CCF patients with New-AF and Prior-AF (P<0.001), after adjusting for age, sex, referral source, year-groups, intensive-care-unit admission and Charlson comorbidities index (Table 2). Conclusion This study shows that AF status has a differential impact on clinical outcomes in patients admitted with CCF. Drivers behind this difference in outcomes require further study and strategies should be developed to minimise the risk of adverse clinical outcomes in this vulnerable group of patients.Table 1.Baseline characteristicsTable 2.Non-fatal CV outcomes

MINOCA due to vasospasm compared to other mechanisms: patients characteristics, evolution and prognosis

Abstract Introduction coronary vasospasm is a common cause of MINOCA (myocardial infarction with non-obstructive coronary arteries). The aim of this study is to compare characteristics and prognosis of patients (pts) with MINOCA due to vasospasm (MINOCA-V) vs those with MINOCA due to other causes (MINOCA-O). Methods we included all MINOCA pts between January 2015-December 2022. The definitions of MINOCA and vasospasm were based on European Clinical Guidelines. The diagnosis of vasospasm was made in the cath lab or with non-invasive bedside tests (ergonovine). The follow-up analysis included major adverse cardiovascular events (MACE: death from any cause, cardiovascular readmission, reinfarction and stroke). The median follow-up was 59.5 months [36-75]. Results there were a total of 120 MINOCA pts, of which 19 (16%) were MINOCA-V and 101 (84%) MINOCA-O (embolism, dissection, type II infarction, unknown). Regarding the clinical profile of MINOCA-V, they were fewer women (21 vs 49% p=0.03), younger (mean age 56±11 vs 63±15 p=0.03) and more smokers (78.9 vs 50.5% p=0.02). There were no significant differences in cocaine use (7.7 vs 5.5% p=0.75) or other baseline characteristics (Table 1). Not only there was a higher percentage of pts with ST elevation at admission in the vasospasm group (53 vs 12% p<0.01), but also they presented with a higher elevation of biochemical markers of myocardial damage (MMD), both troponin (125.11±203.8 vs 609.48±1661.2 ng/L,p<0.01) and CK (201±272.4 vs 338.75±384.3 U/L p=0.01). There were no significant differences in renal function (Cr 1.4±1.8 vs 1.1±1.5mg/dL p=0.15) and cholesterol levels (163.05±48 vs 172.6±65.7mg/dL p=0.99). The use of magnetic resonance imaging to complete diagnosis did not differ between both groups (26vs37% p=0.34), although it was more effective when approaching the etiology in MINOCA-O (0 vs 18%, p=0.04). The duration of admission was similar between both groups (6±4 days in MINOCA-V vs 5±4 in MINOCA-O, p=0.78). The treatment at discharge was different, being greater the use of nitrates (53vs10% p<0.01) and calcium antagonists (CA), both not dyhidropyridines (53 vs 7% p<0.01) and dihydropyridines (53 vs23% p=0.01) in MINOCA-V and less that of beta-blockers (BB) (0 vs 62% p<0.01) and acetylsalicylic acid (ASA) (32vs73% p<0.01). During follow-up, the evolution was similar in terms of mortality (HR 1.81 IC95%[0.33-10] p=0.2) and MACE (HR 1.76 IC95%[0.69-4.51] p=0.17). No differences were found in cardiovascular readmissions (HR 1.04 IC95%[0.35-3.07] p=0.29), stroke (no cases in both groups) and reinfarction (HR 1.3 IC95%[0.25-6.81] p=0.57). Conclusion we conclude that pts with MINOCA-V are more likely to be male, younger and smokers than MINOCA-O. They usually present with ST elevation and increased elevation of MMD. Treatment at discharge is different: with greater use of nitrates and CA and lower ASA and BB. The prognosis is similar in both groups with no significant differences in mortality or MACE.

Regular supervised exercise training improves endothelial function, early atherosclerosis, arterial stiffness and endothelial progenitor cells in PCI patients

Abstract Backgrounds A disrupted balance between endothelial injury and repair induces endothelial dysfunction and endothelial progenitor cells (EPC) augment vascular repair. So, exercise improves endothelial function through increased numbers of EPC. We investigated the effect of training on vascular health by measuring the number of circulating EPC, and assessing flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (IMT) in patients with percutaneous coronary intervention (PCI). Methods Fifty-nine patients who were done PCI recently were randomized to full medical treatments or additional 3 months regular supervised exercise program (4 times a week, 1 hr a day). FMD, baPWV, carotid IMT, HOMA, hs-CRP and lipid profiles were measured and circulating CD34/KDR, CD34/CD117 and CD34/CD133 EPC were quantified by flow cytometry at baselines and after 3 months. Results Finally 23 patients joined exercise program(control, N=28). There was no significant difference of baseline characteristics and medication between 2 groups. After 3 months, FMD improved significantly in exercise group (6.62% to 11.48%) compared with control group (7.61% to 8.45%) (P<0.001) (fig 1). Carotid IMT reduced significantly in exercise group (0.759mm to 0.707mm) compared with control group (P=0.015) (fig 2). ba-PWV reduced significantly in exercise group (1529cmm/s to 1455 cmm/s) compared with control group (P=0.016) (fig 3). Numbers of CD34/KDR, CD34/CD117 and CD34/CD133 EPCs increased significantly after exercise compared with control group (P= 0.041, 0.011, 0.022, respectively) (fig 4). We also could see to reduce waist to hip ratio in exercise group compared with control group (P<0.001). Conclusions Three months regular supervised exercise improved FMD, ba-PWV, carotid IMT and waist to hip ratio in PCI patients. and it augmented numbers of circulating EPCs. Our results showed that exercise contributes to additional improvement of vascular health in PCI patients with optimal medical treatments.

Amivantamab compared with real-world therapies in patients with advanced non-small cell lung cancer EGFR Exon 20 insertion mutations after platinum-based chemotherapy

Background In the single-arm CHRYSALIS trial, advanced non-small cell lung cancer patients harboring epidermal growth factor receptor (EGFR) exon 20 insertion (Exon 20ins) showed durable responses to amivantamab, an EGFR-MET bispecific antibody targeting tumors with EGFR Exon 20ins. This study compared the effectiveness of amivantamab to real-world systemic anti-cancer therapies in Japan. Patients and methods External control patients were selected by applying CHRYSALIS eligibility to Japanese patients from LC-SCRUM-Asia. External control patients were included for every qualifying line of therapy after platinum-based chemotherapy. Propensity score weighting was applied to external control patients to adjust for differences in baseline characteristics. Outcomes were compared between external control patients, and all and Asian-only CHRYSALIS patients using weighted Cox proportional hazards regression models for progression-free survival (PFS), time to next therapy (TTNT), and overall survival (OS), and generalized estimating equations with repeated measurements for overall response rate (ORR). Results One hundred fifteen CHRYSALIS and 94 external control patients were identified. Compared to external control patients, amivantamab-treated patients had significantly longer OS (median OS 19.88 vs 14.09 months, HR [95% CI] 0.59 [0.40–0.88]), PFS (median PFS 6.74 vs 4.73 months, HR 0.59 [0.45–0.78]), TTNT (median TTNT 12.16 vs 5.09 months, HR 0.39 [0.29–0.53]), and significantly higher ORR (41.7% vs 14.1%). Analyses of amivantamab-treated Asian patients (n = 61) showed similar clinical benefits. Conclusion In the absence of clinical evidence from randomized clinical trials, this study reflects the benefit of amivantamab after platinum-based chemotherapy for advanced non-small cell lung cancer patients harboring EGFR Exon 20ins, compared to current real-world therapies.

Submuscular plating vs. elastic stable intramedullary nailing for diaphyseal femur fractures in children: a systematic review and meta-analysis.

This review evaluates the safety and efficacy of submuscular plating (SMP) vs. elastic stable intramedullary nailing (ESIN) in the treatment of pediatric femur shaft fracture. Studies comparing the efficacy and safety of SMP and ESIN in pediatric shaft fracture were retrieved from five databases (PubMed, Embase, Cochrane, OVID, and Web of Science) from inception to March 2023 using a systematic literature search strategy. A total of 13 outcome measures, such as perioperative parameters, clinical outcomes, and radiographic results, were included in the meta-analysis. Eight eligible studies involving 491 patients were included in the narrative synthesis. There were no significant differences in baseline characteristics between the two groups. Meta-analysis showed reduced radiation time (RT), soft tissue irritation and angular deformation in the SMP group than in the ESIN group. However, the SMP group had greater estimated blood loss (EBL) than the ESIN group. The duration of surgery, length of hospital stay (LOS), implant removal, complications requiring surgery, Flynn score, incidence of infection, fracture healing time, and limb length discrepancy (LLD) were similar between the two groups. Only one study reported higher incidences of fracture nonunion or delayed healing in the ESIN group. SMP is an effective and safe intervention superior to ESIN in reducing soft tissue irritation, angular deformation and radiation time. Given the presence of potential bias and heterogeneity, surgeons should select the treatment that would provide the best outcomes for EBL, LOS, operation time, and bone nonunion or delayed healing based on their experience. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023404118, Identifier PROSPERO (CRD42021228512).

Abstract 15595: In-Hospital Outcomes in Patients With Psoriasis Who Undergo Transcatheter Aortic Valve Replacement

Background Psoriasis is a chronic inflammatory condition associated with an increased prevalence of aortic stenosis (AS). There is paucity of evidence regarding transcatheter aortic valve replacement (TAVR) outcomes in patients with psoriasis. Methods: The National Inpatient Sample Database was queried from 2016-2019 for relevant ICD-10 diagnostic and procedural codes. Beeline characteristics and in-hospital TAVR outcomes were compared in patients with and without psoriasis. Multivariate logistic regression was performed for select outcomes to adjust for differences in baseline characteristics. A p value <0.05 was considered significant. Results: 227,920 hospitalizations for TAVR were identified of which 1,510 (0.6%) were patients with psoriasis. See Table 1 for baseline characteristics. Patients with psoriasis were more likely to be white, and have concurrent diagnoses of hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, obesity, tobacco use disorder, COPD, and thrombocytopenia. Adjusting for baseline characteristics, those with psoriasis were found to have higher rates of in-hospital all-cause mortality OR 2.20 [1.57-3.09], and major bleeding events OR 1.38 [1.13-1.69]. Conclusions: Psoriasis is associated with worse outcomes and higher in-hospital mortality in TAVR. Further studies are warranted to optimize outcomes in this higher risk cohort. Table 1. Patient Characteristics. Values are reported as mean ± standard deviation or median [interquartile range] for continuous variables. Categorical variables are represented as n (%). Between-group comparisons were performed for continuous data using T-test for parametric and Mann-Whitney U test for nonparametric variables, respectively. Categorical variables were compared using Chi squared test. A p-value <0.05 was considered significant (bold).

Abstract 306: Evaluating Layperson CPR Performance Supported by a Just-in-Time Video Compared to a Standard Training Course

Background: Just-in-time (JIT) video training has been proposed as an alternative to in-person CPR courses, with associated time and cost savings. Research Question: Does a JIT training video improve layperson performance of CPR? Aim: Measure CPR performance using a JIT video compared to the American Heart Association (AHA) HeartSaver® CPR AED Training course. Methods: A convenience sample of laypeople was randomized to perform CPR in a simulated scenario a) after participating in an AHA HeartSaver® course led by experienced instructors, b) with access to a JIT training video, or c) control, with no assistance or training. CPR quality was assessed by trained evaluators and objective performance assessed using Laerdal QCPR-enabled simulators. The primary outcome was performance of correct CPR. Results: Of 230 eligible subjects, 226 were randomized with no significant differences in baseline characteristics across groups. Prevalence of correct CPR was low, though significantly higher in the AHA group (AHA: 40%, 95%CI 28-51; JIT: 15%, 95%CI 8-26; control 10%, 95%CI 4-19). Overall, 94% of participants performed compressions within 1 minute, with no difference between groups. An AED was called for more frequently in the AHA group (47%) than the JIT (15%) or control (10%) groups. Flow fraction was significantly better in the AHA group (89%, IQR 77-99) compared to the JIT (75%, IQR 47-90) or control (49%, IQR 22-74) groups and compression rates of 100-120 were more frequent in the AHA (51%) and JIT groups (47%) compared to controls (27%). Conclusions: While correct performance of specific CPR skills varied in this sample, laypersons using a JIT training video performed as well as those taking an AHA HeartSaver® course on several key measures such as rapid chest compression and compression rate. JIT video training may be a viable option for supporting untrained bystander CPR performance, though further evaluation is needed to identify optimal strategies for implementation.

Abstract 12328: Impact of Female Sex on Cardiogenic Shock Outcomes - A Cardiogenic Shock Working Group Report

Introduction: Studies reporting cardiogenic shock (CS) outcomes in women are scarce. Hypothesis: Among patients with CS complicating acute myocardial infarction (AMI-CS) and heart failure (HF-CS), women have worse survival at discharge and more vascular complications than men. Methods: We analyzed 5,083 CS patients in the Cardiogenic Shock Working Group. Propensity score matching (PSM) was performed using baseline characteristics. Logistic regression was performed for log odds of survival. Results: Among 5,083 patients, 1,522 were women (30%) with a mean age of 66.5±13.2 years. There were 30% women and 29.1% men with AMI-CS (p=0.03). More women presented with de novo HF-CS compared to men (26.2% vs. 19.3%, p<0.001). Before PSM, differences in baseline characteristics and sex-specific outcomes were seen in the HF-CS cohort, with worse survival at discharge (69.9% vs. 74.4%, p=0.009) (Figure A) and higher maximum SCAI stage E (26% vs. 21%, p=0.04) in women than men (Figure B). Women were less likely to receive pulmonary artery catheters (52.9% vs. 54.6%, p<0.001), heart transplant (6.5% vs. 10.3%, p<0.001) or left ventricular assist device (7.8% vs. 10%, p=0.01). Differences in AMI-CS cohort were less discrepant. Regardless of CS etiology, women had more vascular complications (8.8% vs. 5.7%, p<0.001), bleeding (7.1% vs. 5.2%, p=0.01), and limb ischemia (6.8% vs. 4.5%, p=0.001) (Figure C). More vascular complications persisted in women after PSM (10.4% women vs. 7.4% men, p=0.06). Conclusions: Women with HF-CS had worse outcomes and more vascular complications than men with HF-CS. More studies are needed to identify barriers to advanced therapies, decrease complications and improve outcomes of women with CS.

Abstract 15410: Obstacles to Implementation in a Heart Failure Nurse Practitioner and Pharmacist Lead Guideline Directed Medical Therapy Program

Background: The aim of this study was to describe differences in baseline characteristics of patients who did or did not complete a HF-GDMT optimization program at our institution and who reached vs did not reach target doses of therapies. Methods: We instituted a structured program in September 2020 led by a heart failure nurse practitioner and clinical pharmacist to optimize GDMT in a safe and expedited manner that involved telephone visits and labs every 2 weeks. Since this is an exploratory analysis differences between groups were reported with p values <0.10. Results: A total of 247 patients were enrolled. The average age of the cohort was 62.3 (13.9), 31% were women, 53% had new onset within 6 months of enrollment, and 66% were nonischemic. Overall, 198 (80%) patients completed the program and 49 (20%) did not. Non-completers were more likely to have transportation limitations (25% vs 5%; p<0.001 ), to be on Medicare or Medicaid (76% vs 54%; p=0.009 ), to be referred to a prescription assistance program (33% vs 21%; p=0.084 ), and were less likely to have commercial insurance (18% vs 39%; p=0.008 ). Among patients who completed the program only 48 (24.3%) reached the recommended doses of all medicines and 150 (75.7%) did not. Patients who reached the recommended doses were younger (mean age 57.5 vs 64.4; p= 0.002), and were more likely to have nonischemic vs ischemic cardiomyopathy (29% vs 16%; p=0.078) and chronic vs new onset disease (31% vs 18%; p=0.046). Patients under 50 were far more likely to reach target doses compared to those >80 (46% vs 4%). Conclusions: Important differences in patients who did or did not complete the program and who reached or did not reach target doses were identified. These differences help identify implementation challenges in real-world settings.

Abstract 15226: Premature Ventricular Complexes Were Not Associated With an Increased Risk of Atrial Fibrillation in Patients Without Structural Heart Disease

Background: Recent studies have suggested that patients with premature ventricular complexes (PVCs) may have a higher risk for atrial fibrillation. However, the study bases are heterogenous, and it is currently unclear whether frequent PVCs are linked to an increased risk in patients where underlying structural heart disease has been thoroughly excluded. Research question: Do PVCs increase the risk of atrial fibrillation in patients without structural heart disease? Aim: To analyze the risk of new-onset atrial fibrillation in PVC patients without structural heart disease. Methods: We included PVC patients from three secondary centers in Stockholm, Sweden. The patients had no history of heart disease, normal results at exercise stress test and echocardiography, and no previous diagnosis of atrial fibrillation. For each case, four age- and sex-matched controls were obtained from the general population. Controls with previous heart disease or atrial fibrillation were excluded. We used inverse probability of treatment weighting (IPTW) to control for differences in baseline characteristics between the groups. An IPTW cause-specific hazards model was fitted using the cmprskcoxmsm package in R. Data are presented as hazard ratios (HR) with 95% confidence intervals (CI). Results: A total of 773 PVC patients and 3128 controls were included. The median age was 59 years, and 2285 (59%) were women. Patients with PVCs had a higher incidence of malignant diseases, hypertension, and hyperlipidemia. After inverse probability of treatment weighting, baseline characteristics were well-balanced between the groups. The median follow-up time was 5.2 years (maximum 6.5 years). The risk for atrial fibrillation was higher for patients with PVCs in the crude cohort (4.3% versus 2.0%), but there was no difference between the groups in the IPTW cohort after adjusting for death as competing risk (HR 1.50, 95% CI 0.88-2.57, p=0.14). Conclusion: PVC patients without structural heart disease did not have a higher risk of incident atrial fibrillation than age- and sex-matched controls from the general population. These results could argue against a causal relationship between PVCs and atrial fibrillation. However, more studies are needed to confirm the results.

Abstract 11700: Left Ventricular Global Longitudinal Strain After Transcatheter Aortic Valve Implantation in Patients With Preserved Ejection Fraction

Background: Left ventricular (LV) global longitudinal strain (GLS), which could assess subtle LV dysfunction, is already deteriorated in a certain number of aortic stenosis (AS) patients with preserved ejection fraction (EF). Although GLS improves after valve replacement, detailed outcome is not well understood. Research Question: In AS patients with preserved EF undergoing transcatheter aortic valve implantation (TAVI), is there a difference in post-procedural GLS between patients with and without reduced pre-procedural GLS? Aim: To elucidate the post-procedural course of GLS after TAVI. Methods: The present study was a single-center retrospective cohort study that included 119 out of 347 consecutive patients undergoing TAVI by excluding EF <50%, atrial fibrillation, inadequate echo image for analysis, and loss to follow-up echocardiography. Subjects were divided into two groups according to pre-procedural GLS: reduced GLS (r-GLS) (> -15%) and preserved GLS (p-GLS) (≤ -15%), and echocardiographic parameters at baseline and changes from baseline to mid-term follow-up (6 months to 1 year) were compared. Results: There was no significant difference in baseline characteristics ( Table ). Before the procedure, higher severity of AS, higher LV mass index and E/e’, and lower EF and peak left atrial longitudinal strain were observed in r-GLS. Both EF and LV mass index improved after TAVI in r-GLS and became comparable in p-GLS ( Figure ). After TAVI, GLS improved in r-GLS, but remained significantly inferior to p-GLS (-14.7 ± 2.3% vs. -16.5 ± 2.8%, P < 0.001; Figure ). Conclusions: In AS patients with preserved EF, GLS improved after TAVI in patients with r-GLS but remained inferior to those with p-GLS, suggesting underlying refractory myocardial damage presumably caused by more severe AS and consequently more severe LV hypertrophy in patients with r-GLS. It might indicate the possibility of GLS for determining optimal timing of TAVI in AS patients with preserved EF.

Abstract 12489: Sex Differences in Incidence and Outcomes of Patients With New-Onset Post-Transplant Diabetes Mellitus After Heart Transplantation

Introduction: Post-transplant diabetes mellitus (PTDM) is a common complication following heart transplantation (HT), mostly commonly occurring in the first year after transplant. A few risk factors for the development of PTDM have been identified, including immunosuppressive medications such as calcineurin inhibitors and glucocorticoids. Some studies have suggested that among HT recipients, women have higher rates of acute rejection which may necessitate higher doses of steroids and further hyperglycemia. However, differences between sexes in the incidence of PTDM after HT have not been established. Methods: A retrospective review of patients who underwent HT at a large-volume center between January 1, 2010 and December 31, 2019 was performed. Patients undergoing re-transplantation or dual-organ transplantation were excluded. PTDM was defined as hemoglobin A1C≥6.5% or a random glucose >200 after HT among patients with no prior history of DM. Predictors of PTDM by sex were analyzed with logistic regression, and post-transplant outcomes were analyzed with Chi-Square analysis. Results: Among 317 transplant patients without pre-transplant DM, 71 (22.4%) patients were identified who had PTDM: 24 females (33.7%), 47 males (66.2%). There were no statistically significant differences in baseline characteristics between males and females who developed PTDM including age, race, pre-transplant HTN, calcineurin or steroid dosing at 1 month and 1 year post-transplant. Baseline HTN (OR 2.9, [1.3, 6.7], p=0.009) and mean steroid dose over the first 2 years post-transplant (OR 1.2, [1.0, 1.3], p=0.006) were predictors of PTDM in females but not in males, and mean tacrolimus dose was a predictor in males (OR 1.1, [1.0, 1.2], p=0.001) but not in females. Time to PTDM diagnosis did not differ by sex (log-rank p=0.56). Additionally, post-transplant outcomes in patients with PTDM including acute cellular rejection, antibody-mediated rejection, coronary allograft vasculopathy and death did not differ by sex. Conclusion: PTDM is a common complication of HT. Our study suggests that risk factors for PTDM among HT recipients differ by sex. Future studies should investigate the mechanisms underlying these differences to further guide sex-specific post-HT care.

Abstract 17625: Comparative Analysis of Mortality and Amputation Rates in Patients Undergoing Atherectomy for Infra-Popliteal Peripheral Arterial Disease: Insight From the VQI

Introduction: Infra-popliteal peripheral arterial disease (IPPAD) poses challenges due to complex vasculature. The BASIL-2 trial demonstrated superiority in endovascular treatment compared with surgical bypass in patients with IPPAD. However, the choice of endovascular modality has not been conclusive. Hypothesis: Combining plain balloon angioplasty (POBA)+atherectomy is associated with improved clinical outcomes compared to POBA. Methods: Patients that underwent POBA vs POBA+Atherectomy for IPPAD from the Vascular Quality Initiative database were identified. Propensity score matching (PSM) was employed to balance the distribution of confounding variables for mortality identified on multivariable logistic regression. Patient characteristics and long-term outcomes between the two treatment groups were compared. Results: A total of 10,494 individuals (74.6%) were treated with POBA, while 3,569 (25.4%) were treated with POBA+atherectomy. PSM ensured minimal differences in baseline characteristics, such as indication for procedure and prior revascularization. The atherectomy group was associated with higher technical success and lower perioperative complications, such as renal complications and hematoma, at the expense of higher rates of distal embolization. During long term follow up, patients who underwent atherectomy had lower rates of major amputation but lower freedom from reintervention. There were no differences in major adverse limb events and mortality. Conclusion: Combining POBA with atherectomy appears to be a safe approach in IPPAD, with lower rates of long-term amputation at the cost of higher risk for future re-intervention.

Abstract 18197: Relationship Between Donor Ejection Fraction and Left Ventricular Wall Thickness With Mortality Among Heart Transplants Recipients

Introduction: Limited availability of donor hearts contributes to significant mortality in patients waitlisted for heart transplantation (HTx). Donor hearts with reduced ejection fraction (EF) and left ventricular hypertrophy are considered to adversely affect long term HTX outcomes and are rejected. Objective: To determine the relationship of donor’s EF and left ventricular wall thickness (LVWT) with mortality in HTx recipients. Method: Retrospective analysis from The United Network for Organ Sharing (UNOS) registry. Adult HTx recipients with donor's EF and LVWT recorded from 2006 to 2022 were included. Study sample was grouped into four groups (Group 1 EF>50% & LVWT<1.4cm, group 2 EF≤50% & LVWT<1.4cm, group 3 EF>50% & LVWT≥1.4cm, and group 4 EF≤50% & LVWT≥1.4cm) according to donor characteristics. Primary end point: mortality (30 days, 1 year, and 5 years). Results: 21,012 patients were included, in which 19,205(91.4%) were in group 1, 898(4.3%) in group 2, 867(4.1%) in group 3, and 42(0.2%) in group 4. There were significant differences in baseline characteristics between the groups (Table 1). Unadjusted mortality was 6.3%, 6.0%, 6.0%, and 2.4% (p=0.86) at 30 days; 16.2%, 13.5%, 16.8%, and 7.3% (p=0.08) at 1 year; and 32.2%, 29.2%, 35.4%, and 29.0% (p=0.18) at 5 years, respectively (Table 1 and Figure 1). Neither adjusted mortality was different across the groups (Table 2). Conclusion: There were no significant differences in recipient mortality in different groups based on donor EF and LVWT. Expanding the donor selection criteria would allow for increase in the donor pool and assist in decreasing the mortality, while on the wait list for HTx.

Abstract 18383: Body Composition Changes in Peak Oxygen Uptake Responders and Non-Responders During Cardiac Rehabilitation

Introduction: Cardiac rehabilitation (CR) is known to improve peak oxygen uptake (VO 2 peak) and body composition (BC). However, not all CR patients improve VO 2 peak and it remains unclear if non-responders also exhibit limited improvement in BC. This study aimed to examine if non-responders to VO 2 peak also demonstrate limited improvement in BC and whether BC is related to VO 2 peak changes in CR patients. Methods: Retrospective analysis of patients who completed CR between 2015 and 2022 at Mayo Clinic. The study included 143 patients who completed both dual-energy X-ray absorptiometry and cardiopulmonary exercise testing before and after CR. Patients were grouped by VO 2 peak response to CR (36 non-responders=Δ≤0 vs 107 responders=Δ>0 mL/kg/min). Within and between-group differences were assessed by paired and independent t-tests respectively. Regression models were used to evaluate whether baseline BC or ΔBC predict VO 2 peak changes. Results: As an entire cohort there were significant mean improvements in VO 2 peak and BC (Table 1, p<0.05). VO 2 peak increased in 75% of patients (responders: Δ 2.9±2 vs non-responders: Δ -2.1 ±2, mL/kg/min, p<0.05). There were no significant differences in baseline characteristics between groups including BC (Table 2, p>0.05); however, non-responders had significantly shorter duration and exercise sessions compared to responders (Table 2, p<0.001). Non-responders for VO 2 peak exhibited a significant improvement in body fat mass, body lean percentage, body fat percentage, and fat mass index (all p<0.001), with no differences in ΔBC between groups (Table 3). Regression models revealed no significant BC predictors for VO 2 peak. Conclusion: Despite significant improvements in BC, 25% of patients did not improve VO 2 peak with CR. These data suggest VO 2 peak improvement is not related to baseline BC or change in BC. These findings suggest the need for additional strategies to maximize improvements in VO 2 peak for patients undergoing CR.

Abstract 17970: Incidence and Impact of Contrast-Associated Acute Kidney Injury in High-Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention

Introduction: Contrast-associated acute kidney injury (CA-AKI) is associated with increased morbidity and mortality following percutaneous coronary intervention (PCI). The incidence and impact of CA-AKI in high-bleeding risk (HBR) patients undergoing PCI remain unknown. Methods: We included patients who underwent PCI at a tertiary care center (Mount Sinai Hospital, NY) between 2012 and 2019. Patients were classified as HBR if they met ≥1 major or ≥2 minor criteria according to the Academic Research Consortium (ARC)-HBR definition. CA-AKI was defined according to the Acute Kidney Injury Network as an increase in serum creatinine by ≥50% or ≥0.3 mg/dL within 48 hours after PCI. The primary outcome was all-cause death within 1 year after PCI. Secondary outcomes included myocardial infarction, stent thrombosis, all-cause stroke, post-discharge and all bleeding. Results: Out of 16,966 patients, 7,295 (43.0%) were classified as HBR. CA-AKI occurred in 10.8% of HBR and 3.0% of non-HBR patients (p<0.001). Among HBR patients, those who had CA-AKI were younger and had a higher prevalence of anemia (81.4% vs. 67.7%, p<0.001), diabetes (66.8% vs. 52.8%, p<0.001), and kidney disease (83.8% vs. 50.8%, p<0.001) than those who did not. In contrast, fewer differences in baseline characteristics were observed in non-HBR patients with vs. without CA-AKI. The occurrence of CA-AKI was associated with an increased risk of all-cause death (HBR: HR 3.13, 95% CI [2.39-4.09]; non-HBR: HR 9.11, 95% CI [4.91-16.9]) and other adverse events in both HBR and non-HBR patients (Figure 1). Interestingly, a significant interaction was noted between HBR status and CA-AKI with respect to all-cause death (p-interaction=0.002). Conclusions: CA-AKI occurred at a significantly higher rates in HBR vs. non-HBR patients undergoing PCI and was associated with a significant increase in adverse events. Nonetheless, the impact of CA-AKI on all-cause death was lower in HBR vs. non-HBR patients.

Fatigue measured with the Multidimensional Fatigue Inventory in a population of intensive care patients at the post-intensive care clinic: A prospective longitudinal study

ObjectivesFatigue is a common symptom in former intensive care unit patients. Earlier research suggests that it is a lasting problem. This study aimed to further investigate the incidence of fatigue through the Multidimensional fatigue inventory (MFI-20) up to three years post intensive care. Method/SampleIn this prospective longitudinal study 56 former patients accepted inclusion and 55 patients filled out the questionnaire MFI-20 on one, two or three occasions; 49 at the visit at the post intensive care clinic, 21 after one year and 29 at three years after discharge from intensive care. MFI-20 can be interpreted through its total score or divided into five sub scores: general fatigue, physical fatigue, reduced activity, reduced motivation and mental fatigue. Baseline characteristics were collected, and statistical significance was measured with the help of SPSS software. ResultsThe median ages for the three time points were 59, 61 and 62 respectively. There were more men in each group; 59, 57 and 62 %, but there were no significant differences in baseline characteristics between the groups. Based on the total fatigue score 67 % (n = 33) had severe fatigue 2–9 months after intensive care. The incidence of severe fatigue for one and three years was 48 % (n = 10) and 45 % (n = 13). Younger patients had significantly higher fatigue scores in general fatigue, reduced motivation and total score at the first two time points. After one year they also had significantly higher scores in the reduced activity subscale. Women had significantly higher fatigue scores than men in mental fatigue. ConclusionsFatigue is a common symptom in intensive care patients up to three years post intensive care. Younger patients have higher fatigue scores than older patients up to one year after intensive care. Implications for clinical practiceHealthcare professionals in hospitals and in out-patient care need knowledge about fatigue in former critically ill patients in order to support the management of their fatigue.