In-hospital Cardiovascular Outcomes Research Articles

Comparative Analysis of Angiographic Parameters and Percutaneous Coronary Intervention Outcomes in Diverse Populations in Türkiye.

Due to the conflict in Syria since 2011, more than 3.5 million Syrian citizens reside in Türkiye. Because Syrian patients were underrepresented in previous studies on percutaneous coronary intervention (PCI) outcomes, we aimed to analyze the severity of coronary artery disease and in-hospital outcomes of PCI in this population. We retrospectively analyzed 142 Syrian patients who underwent PCI at our center between June 2020 and October 2022 and compared the data with that of age- and sex-matched Turkish patients (n = 271) who also underwent PCI. We assessed comorbidities, coronary anatomy features, procedural complications, and in-hospital cardiovascular outcomes (Major Adverse Cardiac and Cerebrovascular Events, MACCE). The mean age of the study population was 57 ± 12 years, with 15% being female. Clinical indication and coronary anatomy features did not differ between the groups. However, the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score was higher in Syrian patients compared to Turkish patients (16 [11-22] vs. 12 [8-20]; P < 0.001). Complex PCI rates, in-hospital bleeding and contrast nephropathy were similar in both groups. MACCE was comparable between Syrian and Turkish patients (13 [4.8%] vs. 13 [9.2%], P = 0.083). Comparable MACCE rates were observed in both ethnic groups undergoing PCI, despite a higher SYNTAX score in Syrian patients. Future research should investigate whether similar in-hospital MACCE rates are observed in other regions of Türkiye and whether long-term cardiovascular outcomes differ between Turkish and Syrian patients.

Association of myocardial infarction with nonobstructive coronary arteries with in-hospital outcomes

Abstract Background Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA) is a disease classification that is not uncommonly encountered yet poorly characterized. The association of MINOCA with in-hospital cardiovascular outcomes has been inconsistently assessed with studies reporting conflicting results. The purpose of this meta-analysis is to evaluate the association of MINOCA with in-hospital cardiovascular outcomes. Methods A literature search was conducted for studies reporting on the association of MINOCA with clinical endpoints as compared to obstructive coronary artery disease (OCAD). The primary end-point was in-hospital mortality. Secondary endpoints included cardiogenic shock (CS) on admission and congestive heart failure (CHF) during hospitalization. Databases searched included Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results 19 studies with 851,886 patients who had acute myocardial infarction (AMI) (45,475 patients with MINOCA, 80,6411 with OCAD) met inclusion criteria. Mean age was 63, 64% were male. Patients with MINOCA had significantly lower risk of in-hospital mortality compared to patients with OCAD (OR 0.42, 95% CI 0.31-0.57; p&amp;lt;0.01), the overall effect size was large (z=5.59). Patients with MINOCA had significantly lower risk of having cardiogenic shock on presentation compared to OCAD, however had no difference in risk of developing CHF during hospitalization (OR 0.45, 95% CI 0.35-0.58; p&amp;lt;0.01; OR 0.78, 95% CI 0.55-1.10; p=0.15). Conclusions Our results suggest that MINOCA is associated with lower risk of in-hospital mortality and lower risk of presentation with cardiogenic shock compared to OCAD. However, patients with MINOCA appear to have a similar risk of developing CHF during hospitalization compared to patients with OCAD.

Abstract 16098: Cardiovascular Outcomes in Patients Hospitalized With Chronic Kidney Disease and COVID-19: A Nationwide Propensity-Matched Analysis

Introduction: There is limited data describing the cardiovascular outcomes in patients with coronavirus 2019 (COVID-19) and chronic kidney disease (CKD). This study aims to investigate the impact of CKD on cardiovascular outcomes in patients hospitalized with COVID-19. Goals: To assess mortality, readmission, and other in-hospital cardiovascular outcomes in COVID-19 patients with and without CKD. Methods: Patients &gt;18 years hospitalized with a diagnosis of COVID-19 were identified in the 2020 National Readmissions Database. Patients with CKD 3, 4 and 5 were subsequently identified using relevant ICD-10 codes. Nearest propensity score matching was conducted using a 1:1 ratio for several demographic, social, and clinical variables. Outcomes with &lt;10 cases were excluded per HCUP rules. Results: Amongst 5,831 COVID-19 patients identified, 599 had either CKD stage 3, 4 or 5. Baseline characteristics are shown in Table 1. After matching, CKD was associated with higher rates of acute heart failure (HF) and acute kidney injury (AKI). Our analysis did not find any significant differences in mortality or readmission rates. Conclusions: Our analysis found a higher rate of Acute HF and AKI among COVID-19 patients with CKD 3-5 compared to those without CKD. Additional studies are needed to further characterize this observation.

In-Hospital Cardiovascular Outcomes of Coagulation Disorders on Covid-19 Hospitalization: A Nationwide Analysis

In-Hospital Cardiovascular Outcomes of Coagulation Disorders on Covid-19 Hospitalization: A Nationwide Analysis

B-41 | Trends of Transcatheter Aortic Valve Replacement Utilization, Mortality and In-Hospital Cardiovascular Outcomes Among Age Under and Over 65: Regression Matched Cohort

B-41 | Trends of Transcatheter Aortic Valve Replacement Utilization, Mortality and In-Hospital Cardiovascular Outcomes Among Age Under and Over 65: Regression Matched Cohort

CRT-200.04 In-Hospital Cardiovascular Outcomes of Coagulation Disorders on Covid-19 Hospitalization: A Nationwide Analysis

CRT-200.04 In-Hospital Cardiovascular Outcomes of Coagulation Disorders on Covid-19 Hospitalization: A Nationwide Analysis

In-Hospital Outcomes of COVID-19 Associated Myocarditis (from a Nationwide Inpatient Sample Database Study)

The prevalence of COVID-19 infection-related myocarditis, its in-hospital cardiovascular outcomes, and its impact on hospital cost and stay at national level are not well studied in the literature. The Nationwide Inpatient Sample Database from 2020 was queried to identify patients with COVID-19 and myocarditis versus those without myocarditis. Cardiovascular outcomes and resource utilization were studied among cohorts with COVID-19, with and without myocarditis, using descriptive statistics, multivariate regression matching, and propensity score matching using STATA version 17. Of 1,678,995 patients, 3,565 (0.21%) had COVID-19 with myocarditis, and 1,675,355 (99.78%) had COVID-19 without myocarditis. On multivariate regression analysis, we found higher odds of in-hospital mortality (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.27 to 1.9) in patients with myocarditis than in those without myocarditis, in addition to higher odds of major adverse cardiovascular and cerebrovascular events (aOR 3.54, 95% CI 2.8 to 4.4), acute kidney injury (aOR 1.29, 95% CI 1.27 to 1.9), heart failure (aOR 2.77, 95% CI 2.3 to 3.4), cardiogenic shock (aOR 10.2, 95% CI 7.9 to 13), myocardial infarction (aOR 5.74, 95% CI 4.5 to 7.3), and use of mechanical circulatory support (aOR 2.81, 95% CI 1.6 to 4.9). The propensity-matched cohort also favored similar outcomes. In conclusion, patients with COVID-19 and myocarditis had worse clinical outcomes, having a higher rate of in-hospital mortality, major adverse cardiovascular and cerebrovascular events with longer length of hospital stay, and higher hospitalization costs. Large prospective trials are necessary to validate these findings with diagnostic measures, including biopsy and cardiac magnetic resonance imaging for the extent of myocardial involvement.

Sleep Deprivation Is Associated With Increased Risk for Hypertensive Heart Disease: A Nationwide Population-Based Cohort Study.

Literature documenting the in-hospital cardiovascular outcomes of sleep deprivation (SD) patients is scarce. We aimed to compare inpatient cardiovascular outcomes in patients with sleep deprivation and those without sleep deprivation. We queried the National Inpatient Sample (NIS) database from 2016 to 2019 to conduct a retrospective observational study. Using the International Classification of Diseases, Tenth Revision (ICD-10) codes, we identified patients with sleep deprivation (SD) diagnosis and compared them to their counterparts without sleep deprivation (NSD). The cardiovascular outcomes of interest were hypertensive heart disease (HHD), atrial fibrillation (AF), and ST-segmentand non-ST-segment elevation myocardial infarction (STEMI and NSTEMI, respectively). We used multivariable regression analysis to unearth the relationship between sleep deprivation and cardiovascular disease. There were 28,484,087 patients admitted during the study period, among which 2.1% (6,08,059) with a mean age of 59 (sd=19) years had a sleep deprivation diagnosis unrelated to medical or psychiatric illness. Of these, 75.7% were Caucasians, 11.5% were Blacks, and 8% were Hispanics. Individuals with sleep deprivation had a higher odds ratio (OR) of HHD, i.e., OR=1.3 (1.29-1.31), p<0.0001. The odds of heart failure with reduced ejection fraction (HFrEF) was 0.9 (0.9-1.92), p=0.45; heart failure with preserved ejection fraction (HFpEF) was 0.98 (0.97-1.01), p=0.31; and the odds of the SD population for AF was 0.9 (0.89-1.03), p=0.11. Sleep deprivation seems to be more prevalent in the Caucasian population. Individuals with sleep deprivation have a higher risk of hypertensive heart disease but similar outcomes to the general population in terms of AF, HFrEF, and HFpEF.

Abstract 11760: Depression Paradox for In-Hospital Cardiovascular Outcomes in Obstructive Sleep Apnea - A National Population-Level Analysis

Background: ​​Depression is a frequently encountered comorbidity in patients with Obstructive Sleep Apnea (OSA), with a higher prevalence than the general population. However, there is limited data on the impact of psychiatric comorbidities on the outcomes of OSA. Methods: We identified OSA hospitalizations using the National Inpatient Sample (2018) and relevant ICD-10 codes. After propensity score matching, demographics and comorbidities were compared between the two groups of OSA with (OSA-D+) vs without depression (OSA-D-). The odds of in-hospital outcomes between them were analysed using multivariable regression analyses. Results: Of the 2169730 OSA hospitalizations, 20.1% had comorbid depression. Matched cohorts included 846150 admissions in both groups - OSA-D+ and OSA-D-.The OSA-D+ cohort often consisted of younger (median age, 64 vs 65); females (55.5% vs 55.2%) with both cohorts predominantly including white, Medicare enrollees. The OSA-D+ cohort had significantly higher rates (all p&lt;0.001) of comorbidities such as Hypertension (68.6% vs 64.6%); Diabetes (48.4% vs 47.4%); Hyperlipidemia (59.2% vs 53.5%); Congestive Heart Failure (21.7% vs 20.6%); Peripheral Vascular Disease (6.7% vs 6.3%); Anemia (22.4% vs 19.7%); Smoking (44.6% vs 41.8%); Substance abuse, prior MI,TIA/Stroke and Venous Thromboembolism compared to the OSA-D- group. Paradoxically, there was decreased all-cause mortality (OR:0.79, 95%CI 0.73-0.86), major adverse cardiac and cerebrovascular events (OR:0.83, 95%CI 0.80-0.87), acute MI (OR:0.80, 95%CI 0.76-0.85), dysrhythmia/AF (OR:0.81, 95%CI 0.79-0.83) and cardiac arrest including VF (OR:0.65, 95%CI 0.73-0.82) in the OSA-D+ cohort cohort during hospitalization (p&lt;0.001). Conclusion: Despite having more comorbidities, OSA patients with depression were found to have better in-hospital outcomes. Further studies are required for a conclusive reason for this paradoxical effect of co-morbid depression.

Abstract 275: The Association Between Elevated Lipoprotein(a) And In-hospital Outcomes

Purpose: Elevated lipoprotein(a), Lpa, has quickly emerged as an independent cardiovascular disease risk factor with increased risk for adverse atherosclerotic Using the National Inpatient Sample (NIS) database, we sought to assess the association of elevated Lp(a) to in-hospital cardiovascular outcomes. Methods: We identified patients with elevated Lpa using ICD-10 code in the NIS data from the year 2019. We compared in-hospital outcomes between elevated and non-elevated Lpa groups before and after propensity score matching. We then performed a regression analysis on the matched cohort. Our predictors of interest were acute myocardial infarction (AMI), cerebrovascular disease (CEVD), peripheral vascular disease (PVD), and a composite outcome (cardiorisk) including, AMI, CEVD, and PVD. Results: In the unmatched cohort, the elevated Lpa group had higher incidences of AMI, CEVD, PVD, and the composite outcome (all p&lt;0.05). However, length of stay and cost of hospitalization did not differ considerably. After propensity score matching, the elevated Lpa group had higher rates of AMI (7.1% vs 1.2%, p&lt;0.001), CEVD (11.2% vs 2.8%, p&lt;0.001), PVD (1.8% vs 0.2%, p=0.021), and composite outcome (20% vs 6%, p&lt;0.01). Elevated Lpa group had longer length of stay 5±5 vs 4±3, p=0.002), and higher cost of hospitalization (69,060 ± 76,028 vs 20,992±15,065, p&lt;0.001). Multivariable regression analysis controlling for common predictors of atheroembolic risk showed higher odds of AMI (2.33, p&lt;0.001), CEVD (1.62, p= 0.002), PVD (2.22, p=0.094), and cardiorisk (1.68, p&lt;0.001) among the elevated Lpa group. Conclusion: Elevated Lpa is associated with a higher incidence of atheroembolic disease in this nationally representative sample and associated with a higher length of stay and healthcare costs. Further research is needed to fully understand its mechanism and possible treatment to reduce adverse cardiovascular outcomes.

Trends and Outcomes of Aortic Valve Replacement in Patients With Diabetes in the US.

AimsWe aimed to assess the trend and outcome of aortic valve replacement in patients with diabetes.BackgroundDiabetes is associated with higher cardiovascular events.MethodsData from the National Inpatient Sample was analyzed between 2012 and 2017. We compared hospitalizations and in-hospital cardiovascular outcomes in patients with diabetes to those without diabetes, hospitalized for aortic valve replacement.ResultsIn diabetes patients undergoing TAVR, the mean age of participants decreased from 79.6 ± 8 to 67.8 ± 8, hospitalizations increased from 0.97 to 7.68/100,000 US adults (p < 0.002 for both). There was a significant temporal decrease in mortality, acute renal failure (ARF), and stroke. Compared to non-diabetic patients, those with diabetes had a higher risk of stroke, ARF, and pacemaker requirement [adjusted OR = 1.174 (1.03–1.34), 1.294 (1.24–1.35), 1.153 (1.11–1.20), respectively], but a similar adjusted mortality risk. In diabetes patients undergoing sAVR, the mean age of participants decreased from 70.4 ± 10 to 68 ± 9 (p < 0.001), hospitalizations dropped from 7.72 to 6.63/100,000 US adults (p = 0.025), so did mortality, bleeding, and ARF. When compared to non-diabetes patients, those with diabetes were older and had a higher adjusted risk of mortality, stroke, and ARF [adjusted OR= 1.115 (1.06–1.17), 1.140 (1.05–1.23), 1.217 (1.18–1.26); respectively].ConclusionThe recent temporal trend of aortic valve replacement in patients with diabetes shows a significant increase in TAVR coupled with a decrease in sAVR. Mortality and other cardiovascular outcomes decreased in both techniques. sAVR, but not TAVR, was associated with higher in-hospital mortality risk.

Abstract 11206: In-Hospital Outcomes of Aortic Valve Repair in Diabetes Patients: Data from the National Inpatient Sample

Introduction: Diabetes is associated with increased cardiovascular complications. Hypothesis: We hypothesized that patients hospitalized for aortic valve repair have a worse outcome in the presence of diabetes. Methods: Data from the National Inpatient Sample (NIS) was analysed between 2012 to 2017. We compared hospitalization, in-hospital cardiovascular outcomes and socio-economic outcomes between patients with diabetes vs non-diabetes hospitalized for SAVR and TAVR. Results: In diabetes patients undergoing TAVR, mean age of participants decreased from 79.6 ±8 to 67.8 ±8, total cases increased from the number of cases increased from 2280 to 18940 (p&lt;0.002 for both). Mortality, acute renal failure (ARF) and stroke decreased with time. When compared to non-diabetic patients, diabetes patients were younger and had a similar risk of mortality. However, they had a higher risk of stroke and ARF (adjusted OR= 1.174 [1.03-1.34], 1.294 [1.24-1.35]; respectively). In diabetes patients undergoing sAVR, mean age of participants decreased from 70.4 ±10 to 68 ±9 (p&lt;0.001). Total cases remained stable but mortality, bleeding, acute renal failure and vascular complications decreased with time (p&lt;0.036 for all). When compared to non-diabetic patients, diabetes patients were older and had a higher risk of mortality, stroke and ARF (adjusted OR= 1.115 [1.06-1.17], 1.140 [1.05-1.23], 1.217 [1.18-1.26]; respectively). Mortality of diabetes patients undergoing TAVR was initially higher than those in the TAVR group. However, the trend was inversed starting 2014 (Figure 1) Conclusions: Mortality and other cardiovascular outcomes are decreasing with time in patients with diabetes undergoing aortic valve repair. In TAVR patients, there was no difference in the burden of diabetes on mortality. However, SAVR patients with diabetes still experience a higher mortality rate. Nevertheless, most post-procedural complications are higher in the presence of diabetes

The relationship between history of thyroid diseases and risk of in-hospital cardiovascular outcomes in patients with atrial fibrillation: Findings From the CCC-AF (Improving Care for Cardiovascular Disease in China-Atrial Fibrillation) Project

BackgroundAtrial fibrillation (AF) has the close relation to thyroid dysfunction and these two diseases lead to poor cardiovascular outcomes. But the prognostic value of thyroid diseases in AF remains unclear. We aimed to determine whether history of thyroid diseases is associated with risk of in-hospital cardiovascular outcomes in AF. MethodsBased on the data from the CCC-AF (Improving Care for Cardiovascular Diseases in China-Atrial Fibrillation) project, 31,486 inpatients with a definitive diagnosis of AF and record of history of thyroid diseases were included. Logistic regression analysis was performed to investigate the relationship between history of thyroid diseases and risk of in-hospital major adverse cardiovascular events (MACE) in AF. ResultsAmong AF patients, 503 (1.6%) had a history of hypothyroidism, 642 (2.0%) had a history of hyperthyroidism and 30,341 (96.4%) had no thyroid dysfunction. During this hospitalization, 5146 (16.3%) AF patients suffered from MACE. The incidence was 13.1% in hypothyroidism, 16.3% in euthyroidism and 19.0% in hyperthyroidism, in which there was a significant difference among three groups (p=0.028). Multivariable logistic regression analysis revealed that history of hypothyroidism decreased but history of hyperthyroidism increased the risk of in-hospital MACE in AF patients (adjusted odds ratio [OR]=0.603; 95% confidence interval [CI], 0.449–0.811; p=0.001 versus adjusted OR=1.327; 95% CI, 1.060–1.661; p=0.013). ConclusionHistory of hypothyroidism was an independent protective factor, whereas history of hyperthyroidism was an independent risk factor for in-hospital cardiovascular outcomes in AF. Our study indicated that hyperthyroidism should be treated aggressively in order to improve the prognosis of AF.

IN-HOSPITAL BLOOD PRESSURE VARIABILITY AS A PREDICTOR OF CARDIOVASCULAR EVENTS AND RENAL DYSFUNCTION IN THE SETTING OF ACUTE MYOCARDIAL INFARCTION

Abstract Objective: Recent data have associated blood pressure variability (BPV) with cardiovascular morbidity and renal dysfunction but not in the setting of acute coronary syndrome (ACS). The aim of this study is to determine the impact short-term BPV on in-hospital cardiovascular outcomes and renal function in patients suffering a myocardial infarction (MI). Design and method: A total population of 250 MI patients (79.6% male; mean age 62.5 years;68.4% hypertensives)underwent 24-h ambulatory BP measurement during their hospitalization. The parameters of BPV analyzed were: a) 24-h standard deviation (SD), b) coefficient of variation (CV) and c) average real variability (ARV) of systolic and diastolic BP. The study population was divided intoa STEMI (n = 127) and a non-STEMI (n = 123) group. Cardiovascular outcomes included: new onset of ACS, pulmonary edema, hypertensive emergency, life threatening arrhythmias,whereas worsening of renal function (WRF) was defined as a reduction of GFR &gt; or = 25% according to the RIFLE criteria. No deaths or strokes occurred. Results: In the total population a significant association was demonstrated between SBP CV andthe incidence of cardiovascular outcomes (OR = 1.136; 95% CI: 0.452–1.819; P = 0.001). After separate analysis for each MI group, SBP CV remained a predictor in the STEMI group (OR = 1.825; 95% CI: 0.814–2.835; P = 0.001). Regarding WRF CV SBP demonstrated a prognostic role (OR = 1.946; 95% CI:0.923–2.969; P &lt; 0.001)in the entire population. Results for STEMI group were similar (OR = 3.769; 95% CI:2.056–5.481; P &lt; 0.001). However, non-STEMI group failed to demonstrate any significant associations. We therefore, conducted multivariate regression models for STEMI group, in which the CV SBP retained predictive value of cardiovascular outcomes (OR = 1.502; 95% CI:0.470–2.534; P = 0.005) and WRF (OR = 4.139; 95% CI:2.423–5.962; P &lt; 0.001)independently of age, gender, history of hypertension, diabetes mellitus (DM), smoking and low-density lipoprotein (LDL-C). Conclusions: In the setting of STEMI, assessment of BPV using CV could have a prognostic role of in-hospital cardio-renal outcomes suggesting a clinical need for further individualization of BP regulation in the integrative ACS management.

The relationship between history of thyroid diseases and risk of in-hospital cardiovascular outcomes in patients with atrial fibrillation: Findings From the CCC-AF (Improving Care for Cardiovascular Disease in China-Atrial Fibrillation) Project

BackgroundAtrial fibrillation (AF) has the close relation to thyroid dysfunction and these two diseases lead to poor cardiovascular outcomes. But the prognostic value of thyroid diseases in AF remains unclear. We aimed to determine whether history of thyroid diseases is associated with risk of in-hospital cardiovascular outcomes in AF. MethodsBased on the data from the CCC-AF (Improving Care for Cardiovascular Diseases in China-Atrial Fibrillation) project, 31,486 inpatients with a definitive diagnosis of AF and record of history of thyroid diseases were included. Logistic regression analysis was performed to investigate the relationship between history of thyroid diseases and risk of in-hospital major adverse cardiovascular events (MACE) in AF. ResultsAmong AF patients, 503 (1.6%) had a history of hypothyroidism, 642 (2.0%) had a history of hyperthyroidism and 30,341 (96.4%) had no thyroid dysfunction. During this hospitalization, 5146 (16.3%) AF patients suffered from MACE. The incidence was 13.1% in hypothyroidism, 16.3% in euthyroidism and 19.0% in hyperthyroidism, in which there was a significant difference among three groups (p=0.028). Multivariable logistic regression analysis revealed that history of hypothyroidism decreased but history of hyperthyroidism increased the risk of in-hospital MACE in AF patients (adjusted odds ratio [OR]=0.603; 95% confidence interval [CI], 0.449–0.811; p=0.001 versus adjusted OR=1.327; 95% CI, 1.060–1.661; p=0.013). ConclusionHistory of hypothyroidism was an independent protective factor, whereas history of hyperthyroidism was an independent risk factor for in-hospital cardiovascular outcomes in AF. Our study indicated that hyperthyroidism should be treated aggressively in order to improve the prognosis of AF.

BLOOD PRESSURE VARIABILITY AS A PREDICTOR OF IN-HOSPITAL CARDIO-RENAL OUTCOMES IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective:Data are scarce regarding the possible prognostic role of blood pressure variability (BPV) in the setting of acute coronary syndrome (ACS). The aim of this study is to determine the impact short-term BPV on in-hospital cardiovascular outcomes and renal function in patients suffering a myoc

Door-to-Balloon Time (DTBT) and Length of Stay (LOS) in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention (PPCI) at Frankston Hospital

Background/Aim: Door-to-balloon time (DTBT) is a key performance quality metric in STEMI management. We aimed to evaluate DTBT and outcomes of STEMI patients undergoing primary percutaneous coronary intervention (PPCI) at Frankston Hospital. Method: We retrospectively analysed all STEMI patients who underwent PPCI in 2016–2017. Clinical characteristics, DTBT, length of in-hospital stay (LOS), in-hospital cardiovascular outcomes and uptake of secondary prevention medical therapy were compared between the 2016 and 2017 cohorts. Results: There were a total of 103 and 96 STEMIs undergoing PPCI in 2016 and 2017 respectively. Baseline characteristics were similar between both cohorts, mean age 62 ± 13 years and 77% male. The overall median DTBT was 58 (IQR 36–87) minutes. Median DTBT was significantly shorter in 2017 compared to the previous year [47 (IQR 41–81) minutes vs. 66 (IQR 46–89) minutes, p = 0.003]. However, median LOS was longer in the 2017 STEMI cohort [90 (IQR 75–106) hours vs. 85 (IQR 69–98) hours, p = 0.047]. In-hospital mortality and recurrent myocardial infarction were low in both cohorts (2% vs. 3%, p = 0.45; 0% vs. 1%, p = 0.30 respectively). There was an improvement in adherence to guideline-recommended preventative medication prescriptions in 2017 (dual antiplatelet therapy 91% vs. 96%, p = 0.23; statin 93% vs. 100%, p = 0.01; angiotensin converting enzyme inhibitor 83% vs. 96%, p = 0.004; beta blocker 82% vs. 93%, p = 0.02). Conclusion: DTBT in STEMI patients undergoing PPCI at Frankston Hospital continued to decrease over time and was well within the guideline-recommended timeframe of <90 minutes. Adherence to prescribing secondary prevention therapeutics also improved in 2017 compared to the previous year.

Outcomes of Surgical Ablation in Patients With Atrial Fibrillation Undergoing Cardiac Surgeries

Surgical ablation procedure is commonly performed in patients with atrial fibrillation (AF) undergoing cardiac surgeries; however, the evidence regarding its impact on in-hospital cardiovascular outcomes is controversial. We queried the Nationwide Inpatient Sample Database for patients with AF who underwent cardiac surgeries from 1998 to 2013. We performed a propensity-score matching including 21 various baseline characteristics to compare those who underwent surgical ablation with those who had not. A total of 47,964 hospitalizations were included in our final analysis. On propensity matching, 23,975 were in the surgical ablation group and 23,990 in the control group. The primary outcome of in-hospital mortality was lower in the surgical ablation group compared with the control group (3.6% versus 4.2%, p<0.001). The surgical ablation group was associated with lower in-hospital cerebrovascular accident (2.0% versus 2.8%, p < 0.001), cardiogenic shock (2.6% versus 3.6%, p < 0.001), use of intraaortic balloon pump (5.1% versus 5.8%, p= 0.001), and shorter length of hospital stay (12.3 ± 10.1 versus 12.5 ± 10.3 days, p= 0.008). There was no difference between the surgical ablation and control groups in the incidence of cardiac tamponade (0.4% versus 0.3%, p= 0.296). The surgical ablation group was associated with a higher rate of complete heart block (5.2% versus 4.3%, p < 0.001) and permanent pacemaker insertion (8.6% versus 8.0%, p= 0.01). In this large analysis of almost 50,000 patients with AF undergoing cardiac surgery, surgical ablation appears to be safe in the short term. Future studies should focus on evaluating the long-term effectiveness of this procedure.

Endovascular Versus Surgical Revascularization for Chronic Mesenteric Ischemia: Insights From the National Inpatient Sample Database

ObjectivesThis study sought to compare in-hospital major adverse cardiac and cerebrovascular events (MACCE) following endovascular therapy with open surgery for chronic mesenteric ischemia (CMI). BackgroundThere are limited contemporary data on in-hospital cardiovascular outcomes among patients with CMI undergoing revascularization via endovascular therapy versus open surgery in the United States. MethodsPatients with CMI undergoing endovascular or surgical (mesenteric bypass or endarterectomy) revascularization between 2007 and 2014 were identified from the National Inpatient Sample. Weighted national estimates were obtained. Primary and secondary endpoints were MACCE (death, myocardial infarction, stroke, cardiac post-operative complications) and composite in-hospital complications (MACCE + post-operative peripheral vascular complications, gastrointestinal hemorrhage, major bleeding, and bowel resection), respectively. Propensity score matching was used to obtain a balanced cohort of 880 unweighted patients in each group. ResultsOf 4,150 patients with CMI, 3,206 (77.2%) underwent endovascular therapy and 944 (22.8%) underwent surgery (weighted national estimates of 15,850 and 4,687, respectively). In the propensity-matched cohort, MACCE and composite in-hospital complications occurred significantly less often after endovascular therapy than surgery (8.6% vs. 15.9%; p < 0.001; and 15.3% vs. 20.3%; p < 0.006). Endovascular therapy was also associated with lower median hospital costs ($20,807.00 [interquartile range: $13,640.20 to $32.754.50] vs. $31,137.00 [interquartile range: $21,680.40 to $52,152.20]; p < 0.001, respectively) and shorter length of stay (5 [interquartile range: 2 to 10] vs. 10 [interquartile range: 7 to 17] days, respectively; p < 0.001) compared with open surgery. ConclusionsIn a large, retrospective analysis of patients with CMI, endovascular therapy remained the dominant revascularization modality, and was associated with lower rates of MACCE, composite in-hospital complications, lower costs, and shorter length of stay compared with surgery.

Effect of a Shortened-Duration Eptifibatide Infusion (75 mg) as Adjunctive Therapy for Percutaneous Coronary Intervention on Inhospital Cardiovascular Outcomes and Bleeding

A retrospective cohort analysis was conducted on patients who underwent percutaneous coronary intervention (PCI) before and after a practice change which reduced the infusion duration of eptifibatide from 18 hours to the time required for completion of a single vial of 75 mg initiated during PCI. Primary end points were inhospital cardiovascular events, target vessel revascularization, and major or minor bleeding. The secondary end point was drug cost. A total of 1,647 patients received the standard-duration infusion (18 hours), and 1,237 received the short-duration infusion. The median infusion times were 18.1 hours (interquartile range 17.7 to 18.7) and 6.6 hours (interquartile range 5.6 to 11.3) in the standard- and short-duration groups, respectively. No differences were found for the rate of inhospital cardiovascular events (2.0% vs 1.9%, respectively; p = 0.78) or inhospital revascularization (0.2% vs 0.3%, respectively; p = 0.68). Also, no statistically significant difference was observed in major bleeding (standard 4.3% vs short 4.4%; p = 0.94) or minor bleeding (standard 3.3% vs short 2.3%; p = 0.09). In conclusion, using a shortened infusion reduced eptifibatide use by an average of 1.6 vials at cost savings of $823 per patient and resulted in no difference in inhospital cardiovascular events, revascularization, or bleeding.