Incidence Of All-cause Mortality Research Articles

Outcomes of Patients Undergoing Rotational Atherectomy with Intra-Aortic Balloon Pump Support in Patients with Multivessel Disease and Low Left Ventricular Ejection Fraction.

The aim of the present study was to investigate whether intra-aortic balloon pump (IABP) support was associated with better outcomes after rotational atherectomy (RA) in patients with multivessel disease and low left ventricular ejection fraction (LVEF). Between January 2015 and December 2021, 596 consecutive patients with severely calcified coronary lesions who underwent elective RA were retrospectively enrolled. Of these, a total of 156 patients were included in this study based on the propensity score matching and divided into two groups according to elective IABP insertion (IABP group, n = 80) or no insertion (non-IABP group, n = 76) before the RA procedure. The primary endpoints were procedural success and major adverse cardiovascular events (MACE) before discharge. The secondary endpoints were mortality and readmission due to heart failure (HF) during 90-day and 180-day follow-up. 77 of patients (96.3%) in the IABP group and 72 of patients (94.7%) in the non-IABP group got procedural success (p = 0.714), separately. We had not observed significant differences in periprocedural complications except for less frequent hypotension in the IABP group (p 0.001). In-hospital MACE occurred in 7.5% of patients who received IABP support, which was significantly lower compared to the non-IABP group (p = 0.002). In addition, the cumulative incidence of readmission due to HF was also significantly lower in the IABP group during the 90-day (p 0.001) and 180-day (p = 0.004) follow-up. However, there were no significant differences between groups regarding the incidence of all-cause mortality. The present study suggests the important role of IABP support in improving the outcomes of patients after RA if multivessel disease and low LVEF are anticipated. Prophylactic IABP implantation was related to a lower incidence of in-hospital MACE, and readmission due to HF within 90-day and 180-day follow-up without significant impact on the procedural success and all-cause mortality.

Redo Surgical Aortic Valve Replacement versus Valve-In-Valve Transcatheter Aortic Valve Implantation: A Systematic Review and Reconstructed Time-To-Event Meta-Analysis.

Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) has emerged as a useful alternative intervention to redo-surgical aortic valve replacement (Redo-SVAR) for the treatment of degenerated bioprosthesis valve. However, there is no robust evidence about the long-term outcome of both treatments. The aim of this meta-analysis was to analyze the long-term outcomes of Redo-SVAR versus ViV-TAVI by reconstructing the time-to-event data. The search strategy consisted of a comprehensive review of relevant studies published between 1 January 2000 and 30 September 2022 in three electronic databases, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE. Relevant studies were retrieved for the analysis. The primary endpoint was the long-term mortality for all death. The comparisons were made by the Cox regression model and by landmark analysis and a fully parametric model. A random-effect method was applied to perform the meta-analysis. Twelve studies fulfilled the eligibility criteria and were included in the final analysis. A total of 3547 patients were included. Redo-SAVR group included 1783 patients, and ViV-TAVI included 1764 subjects. Redo-SAVR showed a higher incidence of all-cause mortality within 30-days [Hazard ratio (HR) 2.12; 95% CI = 1.49-3.03; p < 0.0001)], whereas no difference was observed between 30 days and 1 year (HR = 1.03; 95% CI = 0.78-1.33; p = 0.92). From one year, Redo-SAVR showed a longer benefit (HR = 0.52; 95% CI = 0.40-0.67; p < 0.0001). These results were confirmed for cardiovascular death (HR = 2.04; 95% CI = 1.29-3.22; p = 0.001 within one month from intervention; HR = 0.35; 95% CI = 0.18-0.71; p = 0.003 at 4-years follow-up). Although the long-term outcomes seem similar between Redo-SAVR and ViV-TAVI at a five-year follow-up, ViV-TAVI shows significative lower mortality within 30 days. This advantage disappeared between 30 days and 1 year and reversed in favor of redo-SAVR 1 year after the intervention.

Sacubitril/valsartan improves all-cause mortality in heart failure patients with reduced ejection fraction and chronic kidney disease

BackgroundImpaired renal function is frequently observed in patients with heart failure and reduced ejection fraction (HFrEF). The differential effect of sacubitril/valsartan and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEIs/ARBs) on the clinical and renal outcomes in patients with HFrEF and chronic kidney disease (CKD) remains unknown.AimsThis study aimed to explore the differential effect of sacubitril/valsartan and ACEI/ARB on the clinical and renal outcomes as well as renal function over a 12-month follow-up period in HFrEF patients with and without CKD.MethodsPatients with HfrEF (LVEF ≤35%) and NYHA class ≥II were enrolled from the Chang Gung Research Database between 2017 and 2020. Baseline characteristics were compared between patients prescribed sacubitril/valsartan and ACEI/ARB. After propensity score matching, the following clinical and renal outcomes were compared between the two groups in patients with and without CKD over a 12-month follow-up period: acute kidney injury (AKI), emergent dialysis/renal death, HF hospitalization, cardiovascular mortality, and all-cause mortality.ResultsThis study enrolled 3735 HFrEF patients with a mean left ventricular EF of 27.56 ± 5.86%, who had been prescribed sacubitril/valsartan (N = 1708) or ACEI/ARB (N = 2027). After propensity score matching, the clinical and renal outcomes did not differ between the sacubitril/valsartan and ACEI/ARB groups in patients without CKD. In patients with CKD, the ACEI/ARB group had a significantly higher incidence of all-cause mortality than the sacubitril/valsartan group (14.89% vs. 10.50%; hazard ratio 1.46; 95% confidence interval 1.06–2.00; p = 0.02), and the incidence of AKI, HF hospitalization, and CV mortality did not differ between the two groups.ConclusionsSacubitril/valsartan had a lower all-cause mortality compared to ACEI/ARB in symptomatic HFrEF patients with CKD. Further prospective randomized studies are warranted to confirm our findings.

Family income and cardiovascular disease risk in American adults

Socioeconomic status is an overlooked risk factor for cardiovascular disease (CVD). Low family income is a measure of socioeconomic status and may portend greater CVD risk. Therefore, we assessed the association of family income with cardiovascular risk factor and disease burden in American adults. This retrospective analysis included data from participants aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) cycles between 2005 and 2018. Family income to poverty ratio (PIR) was calculated by dividing family (or individual) income by poverty guidelines specific to the survey year and used as a measure of socioeconomic status. The association of PIR with the presence of cardiovascular risk factors and CVD as well as cardiac mortality and all-cause mortality was examined. We included 35,932 unweighted participants corresponding to 207,073,472 weighted, nationally representative participants. Participants with lower PIR were often female and more likely to belong to race/ethnic minorities (non-Hispanic Black, Mexican American, other Hispanic). In addition, they were less likely to be married/living with a partner, to attain college graduation or higher, or to have health insurance. In adjusted analyses, the prevalence odds of diabetes mellitus, hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke largely decreased in a step-wise manner from highest (≥ 5) to lowest PIR (< 1). In adjusted analysis, we also noted a mostly dose-dependent association of PIR with the risk of all-cause and cardiac mortality during a mean 5.7 and 5.8 years of follow up, respectively. Our study demonstrates a largely dose-dependent association of PIR with hypertension, diabetes mellitus, CHF, CAD and stroke prevalence as well as incident all-cause mortality and cardiac mortality in a nationally representative sample of American adults. Public policy efforts should be directed to alleviate these disparities to help improve cardiovascular outcomes in vulnerable groups with low family income.

Cardiovascular outcomes in patients with cancer during a 5-year follow-up: Results from a French administrative database

BackgroundLimited data are available regarding the optimal management and prognosis of patients with cancer who develop an acute myocardial infarction. AimThe objective of this study was to analyse the characteristics and outcomes of patients according to cancer and myocardial infarction occurrence. MethodsBased on the French administrative hospital discharge database, the study collected information for all consecutive patients seen in French hospitals in 2013, excluding those with a history of myocardial infarction. The population was divided into two groups according to their history of cancer. We studied the following outcomes: all-cause and cardiovascular mortality; acute myocardial infarction; and ischaemic stroke. Data were collected after a 5-year follow-up. ResultsBetween 2013 and 2019, 3,381,472 patients were seen in French hospitals; among them, 3,323,757 had no history of myocardial infarction. Patients with a history of cancer (n=497,593) had higher incidences of all-cause mortality (17.82%/year vs 3.79%/year), cardiovascular mortality (1.61%/year vs 1.17%/year), myocardial infarction (0.82%/year vs 0.61%/year) and ischaemic stroke (0.91%/year vs 0.62%/year) compared with patients without cancer (n=2,826,164). After performing an adjusted competing-risk analysis, the cumulative incidence of acute myocardial infarction, cardiovascular death and ischaemic stroke incidence was found to be lower in patients with a history of cancer, whereas death of non-cardiac origin was more prevalent in patients with a history of cancer. ConclusionsIn this observational study, we have shown that patients with cancer have a higher incidence of all-cause mortality, cardiovascular mortality and myocardial infarction. However, multivariable analysis showed a lower cumulative incidence of these events.

Impact of the malnutrition on mortality in Rheumatoid arthritis patients: A cohort study from NHANES 1999-2014.

Patients with Rheumatoid arthritis (RA) are prone to malnutrition. However, it is rare studies assessing the relationship between malnutrition and all-cause mortality in patients with RA. To investigate the relationship between malnutrition and all-cause mortality in patients with RA in a large national sample cohort. We analyzed data on 1,976 adults ≥ 18 years of age during National Health and Nutrition Examination Survey (NHANES) 1999-2014. We chose the Controlled Nutritional Status Score (CONUT) and the Nutritional Risk Index (NRI) to assess the nutritional status of patients with RA. The Kaplan-Meier (KM) survival curves Cox proportional hazards regression models were used to analyze the associations between malnutrition and all-cause mortality. Of the 1,976 patients with RA (57.38 ± 0.40 years, female 59.9%, non-Hispanic white 69.9%), the prevalence of malnutrition was 18.8% by used the CONUT and 26.6% by used the NRI. The KM survival curves showed that malnutrition was associated with a higher incidence of all-cause mortality during the 10-year follow-up period (log-rank test, P < 0.001). In the fully corrected model, the adjusting hazard ratio (aHR) for all-cause mortality in patients with moderate to severe malnutrition with CONUT and NRI were 5.63 (95% CI, 2.55-12.45; P < 0.001) and 2.56 (95% CI, 1.81-3.62; P < 0.001), respectively, compared with patients without malnutrition. Malnutrition is very prevalent in patients with RA, approximately 18.8% (CONUT) to 26.6% (NRI). Malnutrition is strongly associated with an increased risk of all-cause mortality. These findings underscore the importance of attention and intervention in the nutritional status of patients with RA. Further clinical trials are needed to prospectively assess the effect of nutritional interventions on the prognosis of patients with RA.

Age-Bilirubin-International Normalized Ratio (INR)-Creatinine (ABIC) Score, a Potential Prognostic Model for Long-Term Mortality of CAD Patients After PCI.

Given that age, international normalized ratio (INR), total bilirubin, and creatinine are reported to be independent risk factors for predicting outcome in patients with coronary artery disease (CAD), it is possible that the age-bilirubin-INR-creatinine (ABIC) score might be a potential prognostic model for patients with CAD. A total of 6046 CAD patients after percutaneous coronary intervention (PCI) from the retrospective cohort study (Identifier: ChiCTR-ORC-16010153) were evaluated finally. The primary outcome long-term mortality and secondary endpoints mainly major adverse cardiovascular and cerebrovascular events (MACCEs) were recorded. Multivariate Cox regression models were used to determine risk factors for mortality and MACCEs. The ABIC score was significantly higher in the death group than in the survival group. After adjusting for other CAD risk factors, the ABIC score was identified to be an independent risk factor for long-term mortality by multivariate Cox analysis. When in the high ABIC group, the incidence of all-cause mortality would increased 1.7 times (adjusted HR=1.729 (1.347-2.218), P<0.001), and 1.5 times for cardiac death (adjusted HR=1.482 (1.126-1.951), P=0.005). The present study indicated that ABIC score≥7.985 predicts high long-term mortality and cardiac death risk for PCI patients. The ABIC score might be a potential prognostic model for patients with PCI.

Comparing Vitamin K Antagonists and Direct Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Transcatheter Aortic Valve Replacement: A Meta-Analysis.

Aortic stenosis (AS) is the most prevalent valvular disease in the elderly population and the prevalence of atrial fibrillation (AF) increases in the elderly population. Transcatheter aortic valve replacement (TAVR) becomes an important treatment for patients with AS at high surgical risk. This metanalysis aimed to compare the efficacy and safety of vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) in patients with AF undergoing TAVR. We searched the different databases for articles published before January 31, 2022. In total, 7 studies including 25,255 patients were analyzed. Data on demographics, comorbidities, CHA2DS2-VASc score, Society of Thoracic Surgeons (STS) score, and incidences of all-cause mortality, major bleeding, intracranial hemorrhage (ICH), stroke, and thromboembolic events were obtained and analyzed. The VKA group had a lower CHA2DS2-VASc score (3.2 ± 1.2 vs 3.3 ± 1.2; P < .001) and a higher STS score (6.6 ± 3.2 vs 6.1 ± 2.9; P < .001) than the DOAC group. The risks of all-cause mortality (odds ratio [OR]: 0.88; 95% confidence interval [CI], 0.67-1.16), ischemic stroke (OR: 1.06; 95% CI, 0.90-1.24), and thromboembolism (OR: 1.24; 95% CI, 0.63-2.47) in the DOAC group were comparable to the VKA group. The risks of major bleeding (OR: 0.77; 95% CI, 0.71-0.84) and ICH (OR: 0.62; 95% CI, 0.42-0.90) were lower in the DOAC group compared to the VKA group. DOACs were associated with lower risks of major bleeding and ICH, and comparable risks of all-cause mortality, ischemic stroke, and thromboembolism in patients with AF undergoing TAVR compared to VKAs.

Anesthesia-Induced Intraprocedural Downgrading of Mitral Regurgitation During Transcatheter Edge-to-Edge Repair

During transcatheter edge-to-edge repair (TEER), the reduction of functional mitral regurgitation (FMR) severity, compared with baseline evaluation, is not uncommon. Because the procedural strategies are mainly guided by the location and severity of the regurgitant jets, intraprocedural downgrading (ID) of regurgitation severity could affect the procedural strategy and the results. The aim of this study was to evaluate the prevalence of ID during TEER and to compare early and midterm outcomes in patients with and without ID. All patients with moderate-to-severe or severe FMR who underwent TEER in San Raffaele Hospital between 2018 and 2020 were evaluated in this single-center, retrospective study. ID was defined as mild (1+) or moderate (2+) regurgitation degree during intraprocedural evaluation. The outcomes, assessed at discharge and at 2 years of follow-up, were all-cause mortality, heart failure hospitalization, and recurrence of mitral regurgitation >2+. The final study cohort included 55 patients: 42% presented with ID. At discharge, 85.5% of patients achieved regurgitation reduction to 2+ or less: 100% in patients with ID versus 75% in patients without ID, p <0.009. At 2 years, no significant difference in the incidence of all-cause mortality, heart failure hospitalization, and the recurrence of mitral regurgitation >2+ between patients with ID or without ID was found. In conclusion, ID is frequent during TEER in FMR. No baseline characteristics were found to identify this group of patients. In patients with ID, the combination of live intraprocedural imaging and baseline ambulatory assessment of regurgitant jets seems effective in the procedural guiding to achieve a successful and durable mitral repair.

1024 PROGNOSTIC VALUE OF CI-AKI AND HIS RELATIONSHIP WITH PERIPROCEDURAL MYOCARDIAL DAMAGE IN NSTEMI

Abstract Background Periprocedural myocardial damage and contrast-induced acute kidney injury (CI-AKI) are frequent complications of percutaneous coronary intervention (PCI) and impact prognosis. The possible associations and the prognostic role of these peri-procedural complications are still not well understood. Purpose To evaluate predictors and prognostic role of CI-AKI in patients with NSTEMI and the relationship between CI-AKI and periprocedural myocardial damage. Methods Patients with NSTEMI undergoing coronary angiography within 72 hours were enrolled from January 2016 to September 2021. To detect post-PCI acute myocardial damage in this setting of NSTEMI patients, we included only those with stable (≤ 20% variation) or falling pre-procedure baseline cardiac troponin (cTn) values. Serum cTnI were measured at baseline and at 3-6-12 hours after PCI in all patients. Periprocedural myocardial damage was evaluated according to postprocedural hsTnI criteria provided by most recent consensus documents. Renal injury was documented when absolute serume creatinine increased of ≥ 0.3 mg/dL or ≥ 50% within 72 hours or urine output reduced to ≤ 0.5 mL/Kg/hour for at least 6 hours. Results We enrolled 878 patients with NSTEMI undergoing PCI and with pre procedure stable cTn levels. 53 patients suffered from AKI post contrast and among these 8 patients exhibited myocardial periprocedural injury and 20 patients had periprocedural myocardial infarction according to European Society of Cardiology guidelines. Myocardial periprocedural damage occurred more frequently in the CI- AKI group compared to non-CI-AKI group (52% vs 38%, p = 0.01). Patients who experienced CI-AKI were significantly older (mean age 86 ± 4) and had more frequently cardiovascular risk factors such as diabetes (p &amp;lt; 0.001) and hypertension (p = 0.006), compared to non-CI-AKI group. Moreover NSTEMI patients with CI-AKI were more often on beta-blockers (p= 0.001) and statins (p &amp;lt; 0.001) and exhibited more frequently at admission ST-T segment (p &amp;lt; 0.000) and wall motion alterations at echocardiography evaluation (p = 0.004).Regarding intra-hospital outcomes, CI-AKI population experienced more frequently reinfarction (p = 0.02) and arrhythmias (p &amp;lt; 0.000) compared to others . Surprisingly, the multivariate logistic regression showed that the stronger predictor of CI-AKI was periprocedural myocardial infarction (p &amp;lt; 0.001). Finally, at 3 years of follow-up, in patients with CI-AKI there was more incidence of all-cause mortality (p = 0.001) and the composite of all-cause death, re-acute myocardial infarction and hospitalization for heart failure (p = 0.05) compared to non-CI-AKI group. Conclusion In NSTEMI patients, contrast-induced acute kidney injury was associated with majors adverse events, both intra-hospital and at long-term follow-up. Subjects who experienced acute kidney injury were older, had more comorbidities and had a worse clinical and instrumental profile at admission. CI-AKI was also associated with peri-procedural acute myocardial injury and infarction. More studies are needed to understand the patophysiological relations between these to post-PCI complications to improve their management.

Comparison between obese and non-obese nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver conditions that are characterized by excess accumulation of fat in the liver, and is diagnosed after exclusion of significant alcohol intake and other causes of chronic liver disease. In the majority of cases, NAFLD is associated with overnutrition and obesity, although it may be also found in lean or non-obese individuals. It has been estimated that 19.2% of NAFLD patients are lean and 40.8% are non-obese. The proportion of patients with more severe liver disease and the incidence of all-cause mortality, liver-related mortality, and cardiovascular mortality among non-obese and obese NAFLD patients varies across studies and may be confounded by selection bias, underestimation of alcohol intake, and unaccounted weight changes over time. Genetic factors may have a greater effect towards the development of NAFLD in lean or non-obese individuals, but the effect may be less pronounced in the presence of strong environmental factors, such as poor dietary choices and a sedentary lifestyle, as body mass index increases in the obese state. Overall, non-invasive tests, such as the Fibrosis-4 index, NAFLD fibrosis score, and liver stiffness measurement, perform better in lean or non-obese patients compared to obese patients. Lifestyle intervention works in non-obese patients, and less amount of weight loss may be required to achieve similar results compared to obese patients. Pharmacological therapy in non-obese NAFLD patients may require special consideration and a different approach compared to obese patients.

Time Trend in Incidence of Sudden Cardiac Death After Percutaneous Coronary Intervention from 2009 to 2017 (from the Japanese Multicenter Registry)

The advances in the integrated management of patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) have reduced subsequent cardiovascular events. Nonetheless, sudden cardiac death (SCD) remains a major concern. Therefore, we aimed to investigate the time trend in SCD incidence after PCI and to identify the clinical factors contributing to SCD. From a prospective, multicenter cohort registry in Japan, 8,723 consecutive patients with coronary artery disease undergoing PCI between 2009 and 2017 were included. We evaluated the SCD incidence 2years after PCI; all death events were adjudicated, and SCD was defined as unexpected death without a noncardiovascular cause in a previously stable patient within 24hours from the onset. The Fine and Gray method was used to identify the factors associated with SCD. Overall, the mean age of the patients was 68.3 ± 11.3years, and 1,173 patients (13.4%) had heart failure (HF). During the study period, the use of second-generation drug-eluting stents increased. The 2-year cumulative incidence of all-cause mortality and SCD was 4.29% and 0.45%, respectively. All-cause mortality remained stable during the study period (p for trend=0.98), whereas the crude incidence of SCD tended to decrease over the study period (p for trend=0.052). HF was the strongest predictor associated with the risk of SCD (crude incidence [vs non-HF] 2.13% vs 0.19%; p <0.001). In conclusion, the incidence of SCD after PCI decreased over the last decade, albeit the high incidence of SCD among patients with HF remains concerning.

Cardiovascular events and risk factors in hematological neoplasms patients treated with anthracyclines

Objective: To explore the incidence and risk factors of cardiovascular events in hematological neoplasms patients treated with anthracyclines in the real world. Methods: A total of 408 patients with lymphoma and leukemia, who were treated with anthracyclines during hospitalization in the First Affiliated Hospital of Dalian Medical University from January 1, 2018 to July 31, 2021, were included in this retrospective study. Patients were divided into cardiovascular event group (n=74) and non-cardiovascular event group (n=334). The primary endpoint was cardiovascular events (arrhythmia, heart failure, acute myocardial infarction etc.) after anthracyclines therapy. The secondary endpoint was all-cause mortality, cardiovascular-cause death, discontinued chemotherapy due to cardiovascular events. Multivariate regression analysis was used to investigate the risk factors of cardiovascular events. Kaplan-Meier was performed to calculate the incidence of all-cause mortality. Results: The mean age was (55.6±14.9) years, and there were 227 male patients (55.6%) in this cohort. The median follow-up time was 45 months. During follow-up, cardiovascular adverse events occurred in 74 patients (18.1%), including 45 heart failure (38 were heart failure with preserved ejection fraction), 30 arrhythmia, 4 acute myocardial infarction and 2 myocarditis/pericarditis. Multivariate regression analysis showed age (OR=1.024, 95%CI 1.003-1.045, P=0.027) and history of hypertension over 10 years (OR=2.328, 95%CI 1.055-5.134, P=0.036) were independent risk factors for the cardiovascular events. Kaplan-Meier survival curve showed mortality was significantly higher in cardiovascular event group than in non-cardiovascular event group (47.3% vs. 26.6%, P=0.001). In the cardiovascular event group, chemotherapy was discontinued in 9 cases (12.2%) due to cardiovascular events and cardiovascular death occurred in 7 cases (9.5%). Conclusions: Although heart failure is the main cardiovascular event in lymphoma and leukemia patients post anthracyclines therapy, other cardiovascular events especially arrhythmias are also common. The presence of cardiovascular events is associated with higher risk of all-cause mortality in these patients. Age and long-term hypertension are independent risk factors for cardiovascular events in lymphoma and leukemia patients after anthracyclines treatment.

The Association of Sex with Unplanned Cardiac Readmissions following Percutaneous Coronary Intervention in Australia: Results from a Multicentre Outcomes Registry (GenesisCare Cardiovascular Outcomes Registry).

Unplanned cardiac readmissions in patients with percutaneous intervention (PCI) is very common and is seen as a quality indicator of in-hospital care. Most studies have reported on the 30-day cardiac readmission rates, with very limited information being available on 1-year readmission rates and their association with mortality. The aim of this study was to investigate the impact of biological sex at 1-year post-PCI on unplanned cardiac readmissions. Patients enrolled into the GenesisCare Cardiovascular Outcomes Registry (GCOR-PCI) from December 2008 to December 2020 were included in the study. A total of 13,996 patients completed 12 months of follow-up and were assessed for unplanned cardiac readmissions. All patients with unplanned cardiac readmissions in the first year of post-PCI were followed in year 2 (post-PCI) for survival status. The rate of unplanned cardiac readmissions was 10.1%. Women had a 29% higher risk of unplanned cardiac readmission (HR 1.29, 95% CI 1.11 to 1.48; p = 0.001), and female sex was identified as an independent predictor of unplanned cardiac readmissions. Any unplanned cardiac readmission in the first year was associated with a 2.5-fold higher risk of mortality (HR 2.50, 95% CI 1.67 to 3.75; p &lt; 0.001), which was similar for men and women. Unplanned cardiac readmissions in the first year post-PCI was strongly associated with increased all-cause mortality. Whilst the incidence of all-cause mortality was similar between women and men, a higher incidence of unplanned cardiac readmissions was observed for women, suggesting distinct predictors of unplanned cardiac readmissions exist between women and men.

The Efficacy and Safety of Direct Oral Anticoagulants versus Standard of Care in Patients without an Indication of Anti-Coagulants after Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials.

Transcatheter aortic valve replacement (TAVR) is now considered the mainstay of aortic stenosis management; however, the optimal antithrombotic therapy in patent without indications for an oral anticoagulant (OAC) is yet to be identified. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of direct oral anticoagulant (DOAC) treatment versus the standard of care in patients without indications of OACs after TAVR. We synthesized randomized controlled trials (RCTs) from Web of Science, SCOPUS, EMBASE, PubMed, and Cochrane until 18 August 2022. We used the risk ratio (RR) for dichotomous outcomes with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: CRD42022357027. Three RCTs with 2922 patients were identified. DOACs were significantly associated with higher incidence of all-cause mortality (RR: 1.68 with 95% CI [1.22, 2.30], p = 0.001), mortality due to non-cardiovascular causes (RR: 2.34 with 95% CI [1.36, 4.02], p = 0.002), and the composite outcome of death, myocardial infarction, or stroke (RR: 1.41 with 95% CI [1.13, 1.76], p = 0.002). However, DOACs were associated with decreased incidence of reduced leaflet motion (RLM) (RR: 0.19 with 95% CI [0.09, 0.41], p = 0.0001) and hypoattenuated leaflet thickening (HALT) (RR: 0.50 with 95% CI [0.36, 0.70], p = 0.0001). DOACs were effective to reduce RLM and HALT; however, the clinical effect of this is still controversial. DOACs were associated with worse efficacy and safety outcomes, including all-cause mortality. Further RCTs investigating the optimal antithrombotic regimen after TAVR.

Abstract 12102: Concomitance of Diabetes Mellitus and Prior Myocardial Infarction Associated With Poor Clinical Outcomes in Patients With Atrial Fibrillation: The Fushimi AF Registry

Background : Patients with diabetes mellitus (DM) have high risk of cardiovascular events such as cardiovascular death, stroke, heart failure and so on. Patients with history of myocardial infarction (MI) are also at high risk. The outcomes of patients with nonvalvular atrial fibrillation (NVAF) who have both DM and history of MI are unclear. Methods : From the Fushimi AF registry, we obtained NVAF patients who had both DM and history of MI (DM+MI+: N=107), either DM or history of MI (DM-MI+: N=156, and DM+MI-: (N=935), and neither DM nor history of MI (DM-MI-: N=3,197). Major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause mortality were evaluated. MACCE was defined as composite events of cardiovascular death, myocardial infarction, stroke, and admission for heart failure. Results: The median follow-up period was 1,851 (interquartile range: 790-2,924) days. DM+MI+ patients were often male and had more heart failure, chronic renal disease, dyslipidemia, hypertension, and paroxysmal AF than other patients. DM+MI+patients had also higher risk scores (CHADS 2 , CHA 2 DS 2 -VASc and HAS-BLED scores). DM+MI+ patients had significantly higher incidence (% per patient-year) of MACCE and all-cause mortality than others (Figure A and B. MACCE: DM+MI+ 18.8%, DM-MI+ 8.0%, DM+MI- 6.1%, DM-/MI- 4.9%, log rank P&lt;0.001, all-cause mortality: 10.2%, 6.1%, 5.2%, 4.5%, respectively, log rank P&lt;0.001). In multivariate analysis, DM+MI+ was significantly associated with the incidence of MACCE compared with DM-/MI- (adjusted hazard ratio [95% confidence interval], 1.97 [1.36-2.87], P&lt;0.001), although DM-MI+ and DM+MI had no association with it. In addition, DM+MI+ had no significant association with the incidence of all-cause mortality after multivariate adjustment. Conclusion: Patients with NVAF who have both DM and history of MI had more comorbidities and had significant association with adverse cardiovascular events.

Abstract 15873: Trends, Predictors, and Cardiovascular Outcomes Among Primary vs Secondary Takotsubo Syndrome - Nationwide Inpatient Sample Analysis

Introduction: Takotsubo Syndrome (TTS), also known as stress-induced cardiomyopathy can be primary/idiopathic or secondary to physical stressor including acute illness. There is limited data on cardiovascular outcomes among primary TTS (pTTS) and secondary (sTTS). Methods: The National Inpatient Sample from the year 2016 to 2019 was queried to assess outcomes in pTTS and sTTS. The primary outcome was all-cause mortality, and secondary outcomes were acute kidney injury (AKI) heart failure (HF), stroke, cardiogenic shock (CS), and sudden cardiac arrest (SCA).We did trend analysis of outcomes, length of stay (LOS) and inflation adjusted hospital charges. The primary analysis used was pearson chi-Square, linear regression, and multivariate matching using STATA 17MP. Results: A total of 158,715 patients (pTTS n= 57,560 (38%); sTTS n= 101,155 (62%)). The cohorts were female predominant. On univariate and chi-square linear regression, we found higher odds and incidence of all-cause mortality, AKI, heart failure, and stroke in sTTS as compared to pTTS. After matching for confounding variables, all-cause mortality (OR 1.3; CI 1.1 - 1.56; p &lt; 0.001), and AKI (OR 1.10; CI 1.03 - 1.03; p &lt; 0.001) was still high in sTTS, but interestingly HF (OR 0.93; CI 0.88 - 0.99 ; p = 0.023), stroke (aOR 0.50; CI 0.43-0.59; p &lt; 0.001), and MCS (aOR 0.61; CI 0.47-0.79; p &lt; 0.001) were lower in sTTS as compared to pTTS. There was no difference in CS and SCA between pTTS and sTTS. Self-pay and prior CABG were most predictive of mortality for sTTS. Yearly trend analysis showed an uptrend for all non-HF outcomes in both pTTS and sTTS, a stable trend for HF, while trends showed higher incidence of CS in sTTS as compared to pTTS. Mean LOS and inflation adjusted hospital charges were higher in sTTS compared to pTTS. Conclusions: sTTS have worse cardiovascular outcomes as compared to pTTS and associated with higher inflation adjusted hospital charges and length of stay likely due to critical underlying primary illness.

Abstract 12371: Impact of Guideline-Directed Medical Therapy on 5-year Mortality in Patients With Newly Diagnosed Peripheral Artery Disease

Introduction: Current guidelines recommend that patients with peripheral artery disease (PAD) should be treated with antithrombotic agents, renin-angiotensin-system (RAS) blocker, and statin. However, the clinical impact of guideline-directed medical therapy (GDMT) on long-term mortality for newly diagnosed PAD is not clear. Objective: To investigate the prevalence of GDMT and evaluate 5-year mortality according to GDMT after PAD diagnosis. Methods: This retrospective cohort study using a nationwide health insurance claim data in Korea included patients with newly diagnosed with PAD from 2002 to 2015. GDMT was defined as the use of all drugs, including antithrombotic agents, RAS blocker, and statin, within 3 months after PAD diagnosis. The primary endpoint was all-cause mortality. Results: We finally investigate 19,561 patients with newly diagnosed PAD. Among the study population, 4,378 patients (22.4%) were categorized as GDMT and 15,183 patients (77.6%) were non-GDMT. During the 5-year follow-up duration, GDMT showed a lower incidence of all-cause mortality compared to non-GDMT (2.8% vs. 4.8%; hazard ratio [HR], 0.514; 95% confidence interval [CI], 0.424-0.623; p&lt;0.011). Even after propensity matched population, GDMT showed lower mortality rate than non-GDMT (HR 0.283; 95% CI, 0.217-0.370; p&lt;0.001). Among non-GDMT regimens, patients without both RAS blockers and statins had a higher 5-year mortality compared to GDMT (HR 5.324; 95% CI, 3.812-7.438; p&lt;0.001). Conclusions: After PAD diagnosis, GDMT was associated with a lower incidence of mortality. This large-scale retrospective cohort analysis showed insufficient prevalence of GDMT among PAD patients.

Abstract 11512: Association Between Use of Oral Anticoagulants After Minor Bleeding and Mortality Outcomes in Patients With Atrial Fibrillation: The Fushimi AF Registry

Introduction: Oral anticoagulants (OAC) reduce the risk of ischemic stroke, but may increase the risk of major or minor bleeding in atrial fibrillation (AF) patients. However, little is known about the management of anticoagulation in patients with AF after a minor bleeding event. This study assessed the association between use of OAC and outcomes in AF patients after minor bleeding. Methods: The Fushimi AF Registry is a community-based prospective survey of the AF patients in Fushimi-ku, Kyoto, Japan. A total cohort of 4,489 AF patients were analyzed in the present study. We investigated patients in whom minor bleeding occurred during follow-up period, and compared between patients with OAC and those without OAC after minor bleeding. Results: During the median follow-up period of 1,844 days, minor bleeding occurred in 744 patients (5.7% per patient-year). After excluding patients with missing prescription data after minor bleeding, 494 patients were prescribed OAC and 234 were not prescribed after minor bleeding. Patients with OAC were more often non-paroxysmal type of AF (27.4% vs 48.0%, p&lt;0.01), and were more likely to have previous thromboembolism (23.3% vs 11.5%, p&lt;0.01) and heart failure (29.4% vs 19.2%, p&lt;0.01). They had significantly higher CHADS2 score (2.11 vs 1.79, p&lt;0.01). They were less likely to have history of major bleeding (2.6% vs 5.6%, p&lt;0.05). All-cause mortality after minor bleeding occurred in 91 patients with OAC (4.5% per patient-year) and 62 (7.5% per patient-year) patients without OAC with hazard ratio (HR) 0.62 (95% confidence interval [CI], 0.45-0.86; p&lt;0.01). After adjusted by age, sex, type of AF, and comorbidities, patients with OAC after minor bleeding were significantly associated with lower incidence of all-cause mortality (HR 0.52 [95% CI, 0.37-0.73; p&lt;0.01]). Conclusions: Conclusion: Use of OAC after minor bleeding was significantly associated with lower incidence of all-cause mortality in Japanese AF patients.

Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Low-risk Patients: A Meta-Analysis Based on a 2-Year Follow-Up.

Previous studies have shown that transcatheter aortic valve implantation is the best alternative therapy to surgical aortic valve replacement in high-risk surgical patients with aortic stenosis. However, it is not clear whether transcatheter aortic valve implantation can be utilized in low-risk surgical patients with aortic stenosis. This studyaimed to evaluate the safety and efficacy of transcatheter aortic valve implantation in low-risk patients. From the outset of our initiative until April 2022, PubMed, EMBASE, and the Cochrane database were thoroughly searched, yielding the selection of 3 randomized controlled trials including 2644 patients with aortic stenosis, to assess outcome measures at distinct follow-up time. The mean Society of Thoracic Surgeons Predicted Risk of Mortality score of patients was 2.2. At the 30-day and 1-year follow-up, transcatheter aortic valve implan- tation was associated with a lower incidence of all-cause mortality, cardiovascular mor- tality, acute kidney injury (stage 2 or 3), life-threatening or significant bleeding, and new atrial fibrillation but an increased risk of permanent pacemaker implantation. At the 2-year follow-up, transcatheter aortic valve implantation only had an advantage in new atrial fibrillation (relative risk, 0.27; 95% CI, 0.14-0.51; P &lt; .0001), with no significant differ- ence in all-cause mortality or cardiovascular mortality. For low-risk surgical patients with aortic stenosis, compared to surgical aortic valve replacement, transcatheter aortic valve implantation was associated with lower all-cause mortality at 30-day follow-up and lower cardiovascular mortality at 1-year follow-up. Except for the advantages in new atrial fibrillation, transcatheter aor- tic valve implantation had no significant impact on mortality at 2-year follow-up.