National Institute For Cardiovascular Outcomes Research Research Articles

Impact of explanted valve type on aortic valve reoperations: nationwide UK experience.

This nationwide retrospective cohort study assessed the impact of the explanted valve type on reoperative outcomes in aortic valve surgery within the UK over a 23-year period. Data were sourced from the National Institute for Cardiovascular Outcomes Research (NICOR) database. All patients undergoing first-time isolated reoperative aortic valve replacement between 1996 and 2019 in the UK were included. Concomitant procedures, homograft implantation or aortic root enlargement were excluded. Propensity score matching was utilized to compare outcomes and risk factors for in-hospital mortality was evaluated through multivariable logistic regression. Final model selection was conducted using Akaike Information Criterion through bootstrapping. The primary end point was in-hospital mortality, and secondary end points included postoperative morbidities. Out of 2371 patients, 24.9% had mechanical and 75% had bioprosthetic valves implanted during the primary procedure. Propensity matched groups of 324 patients each, were compared. In-hospital mortality for mechanical and bioprosthetic valve explants was 7.1% and 5.9%, respectively (P = 0.632). On multivariable logistic regression analysis, valve type was not a risk factor for mortality [odds ratio (OR) 0.62, 95% confidence interval (CI) 0.37-1.05; P = 0.1]. Age (OR 1.03, 95% CI 1.01-1.05; P < 0.05), left ventricular ejection fraction (OR 1.62, 95% CI 1.08-2.42; P < 0.05), creatinine ≥ 200 mg/dl (OR 2.21, 95% CI 1.17-4.04; P < 0.05) and endocarditis (OR 2.66, 95% CI 1.71-4.14; P < 0.05) emerged as risk factors for mortality. The type of valve initially implanted (mechanical or bioprosthetic) did not determine mortality. Instead, age, left ventricular ejection fraction, renal impairment and endocarditis were significant risk factors for in-hospital mortality.

Healthcare systems data in the context of clinical trials – A comparison of cardiovascular data from a clinical trial dataset with routinely collected data

BackgroundRoutinely-collected healthcare systems data (HSD) are proposed to improve the efficiency of clinical trials. A comparison was undertaken between cardiovascular (CVS) data from a clinical trial database with two HSD resources. MethodsProtocol-defined and clinically reviewed CVS events (heart failure (HF), acute coronary syndrome (ACS), thromboembolic stroke, venous and arterial thromboembolism) were identified within the trial data. Data (using pre-specified codes) was obtained from NHS Hospital Episode Statistics (HES) and National Institute for Cardiovascular Outcomes Research (NICOR) HF and myocardial ischaemia audits for trial participants recruited in England between 2010 and 2018 who had provided consent. The primary comparison was trial data versus HES inpatient (APC) main diagnosis (Box-1). Correlations are presented with descriptive statistics and Venn diagrams. Reasons for non-correlation were explored. ResultsFrom 1200 eligible participants, 71 protocol-defined clinically reviewed CVS events were recorded in the trial database. 45 resulted in a hospital admission and therefore could have been recorded by either HES APC/ NICOR. Of these, 27/45 (60%) were recorded by HES inpatient (Box-1) with an additional 30 potential events also identified. HF and ACS were potentially recorded in all 3 datasets; trial data recorded 18, HES APC 29 and NICOR 24 events respectively. 12/18 (67%) of the HF/ACS events in the trial dataset were recorded by NICOR. ConclusionConcordance between datasets was lower than anticipated and the HSD used could not straightforwardly replace current trial practices, nor directly identify protocol-defined CVS events. Further work is required to improve the quality of HSD and consider event definitions when designing clinical trials incorporating HSD.

1638 Decade-Long Trends in Surgery for Acute Type A Aortic Dissection

Abstract Background Little is known about unwarranted variations in care and outcomes of patients who undergo surgical repair for type A acute aortic dissection(TAAD). We aim to investigate decade-long trends in TAAD surgical repair in England. Method Retrospective review of the National Institute for Cardiovascular Outcomes Research (NICOR) National Adult Cardiac Surgery Audit (NACSA) registry from January 2009 to December 2018 , which prospectively collects demographic and peri-operative clinical information for all adult cardiac surgery procedures in the UK. Results Over the 10-year period,3,686 TAAD patients underwent surgical repair in England. A steady doubling in the overall number of operations conducted in England was observed from 237 cases recorded in 2009 to 510 in 2018. Number of procedures per hospital per year also doubled, from 10 in 2009 to 21 in 2018. The risk profile of the operated patients remained unchanged. Overall, in-hospital mortality was 17.4% with a trend toward lower mortality in the most recent years (from 22.8% in 2009 to 14.7% in 2018). There was a significant variation in operative mortality across regions with a trend towards lower mortality in regions with a high-volume hospital. Conclusions Surgery is the only treatment for acute TAAD but is associated with high mortality. Prompt diagnosis and referral to a specialist center is paramount. The number of operations conducted in England has doubled in 10 years and the associated survival following surgery has improved. Regional variations exist in service provision with a trend towards better survival in high volume centers.

Accessing routinely collected health data to improve clinical trials: recent experience of access

BackgroundRoutinely collected electronic health records (EHRs) have the potential to enhance randomised controlled trials (RCTs) by facilitating recruitment and follow-up. Despite this, current EHR use is minimal in UK RCTs, in part due to ongoing concerns about the utility (reliability, completeness, accuracy) and accessibility of the data. The aim of this manuscript is to document the process, timelines and challenges of the application process to help improve the service both for the applicants and data holders.MethodsThis is a qualitative paper providing a descriptive narrative from one UK clinical trials unit (MRC CTU at UCL) on the experience of two trial teams’ application process to access data from three large English national datasets: National Cancer Registration and Analysis Service (NCRAS), National Institute for Cardiovascular Outcomes Research (NICOR) and NHS Digital to establish themes for discussion. The underpinning reason for applying for the data was to compare EHRs with data collected through case report forms in two RCTs, Add-Aspirin (ISRCTN 74358648) and PATCH (ISRCTN 70406718).ResultsThe Add-Aspirin trial, which had a pre-planned embedded sub-study to assess EHR, received data from NCRAS 13 months after the first application. In the PATCH trial, the decision to request data was made whilst the trial was recruiting. The study received data after 8 months from NICOR and 15 months for NHS Digital following final application submission. This concluded in May 2020. Prior to application submission, significant time and effort was needed particularly in relation to the PATCH trial where negotiations over consent and data linkage took many years.ConclusionsOur experience demonstrates that data access can be a prolonged and complex process. This is compounded if multiple data sources are required for the same project. This needs to be factored in when planning to use EHR within RCTs and is best considered prior to conception of the trial. Data holders and researchers are endeavouring to simplify and streamline the application process so that the potential of EHR can be realised for clinical trials.

Decade-Long Trends in Surgery for Acute Type A Aortic Dissection

Background: Little is known about unwarranted variations in care, with regional differences and outcomes of patients who undergo surgical repair for type A acute aortic dissection (TAAD) in England. We aim to investigate decade-long trends in TAAD surgical repair in England using national-level data. Method: Retrospective review of the National Institute for Cardiovascular Outcomes Research (NICOR) National Adult Cardiac Surgery Audit (NACSA) registry, which prospectively collects demographic, as well as pre-, peri- and post-operative clinical information, including mortality, for all major adult cardiac surgery procedures performed in the UK. We identified patients undergoing surgery for TAAD from January 2009 to December 2018 and reviewed trends in operative frequency and mortality. Findings: Over the 10-year period,3,686 TAAD patients underwent surgical repair in England. A steady doubling in the overall number of operations conducted in England was observed from 237 cases recorded in 2009 to 510 in 2018. Number of procedures per hospital per year also doubled, from 10 in 2009 to 21 in 2018. The risk profile of the operated patients remained unchanged. Overall, in-hospital mortality was 17.4% with a trend toward lower mortality in the most recent years (from 22.8% in 2009 to 14.7% in 2018). There was a significant variation in operative mortality across regions with a trend towards lower mortality in regions with a high-volume hospital. Interpretation: Surgery is the only treatment for acute TAAD but is associated with high mortality. Prompt diagnosis and referral to a specialist center is paramount. The number of operations conducted in England has doubled in 10 years and the associated survival following surgery has improved. Regional variations exist in service provision with a trend towards better survival in high volume centers. Funding Statement: British Heart Foundation and NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol. Declaration of Interests: Authors have no conflict of interests to declare. Ethics Approval Statement: This study is part of research approved by the Health Research Authority (HRA) and Health and Care Research Wales (HCRW) (IRAS ID: 278171).

Type A aortic dissection in patients over the age of seventy in the UK.

Recent guidelines have stated that age alone should not be a limiting factor for offering life-saving surgery to patients with acute type A dissection (ATAD). The objective of this study was to review the outcomes of patients above the age of 70 undergoing surgery for type A aortic dissection (TAAD) in the UK. Prospectively collected data of procedures undertaken on patients with an age of 70 years or more were extracted from the National Institute for Cardiovascular Outcomes Research (NICOR) National Adult Cardiac Surgery Audit registry. All operations were performed in England and Wales between 1 April 2007 and 31 March 2013. The primary outcome for this study was in-hospital mortality. The secondary outcome was mid-term mortality followed up to 5 years. A total of 507 patients were included in the study. The highest number of procedures performed by a single surgeon during the study period was 12. The overall in-hospital mortality rate for all ATAD patients aged 70 or over was 22.5% (114 patients); the stroke rate was 11% (57) and postop dialysis rate 15% (76). ATAD is a life-threatening condition with a high mortality rate if left untreated. Our results show that surgery for ATAD in patients over 70 is feasible with acceptable mortality rates. However, similar to previous studies, rates of stroke in older patients may be higher. The present study supports the notion that age should not be a discriminating factor in operating on patients with TAAD.

The Myocardial Ischaemia National Audit Project (MINAP).

The Myocardial Ischaemia National Audit Project (MINAP) collects data from admissions in England, Wales, and Northern Ireland with Type 1 myocardial infarction (T1 MI). The project aims to improve clinical care through the audit process and to provide powerful high-resolution data for research. MINAP collects data spanning 130 data fields covering the course of patient care, from the moment the patient calls for professional help through to hospital discharge and rehabilitation. Data are entered by clinicians and clerical staff within hospitals, and pseudonymized records are uploaded centrally to the National Institute for Cardiovascular Outcomes Research (NICOR), hosted by Barts Health NHS Trust, London, UK. Two hundred and six hospitals submit over 92000 new cases to MINAP annually. Approximately 1.5 million patient records are currently held in the database. Patient demographics, medical history, clinical assessment, investigations, treatments, drug therapy prior to admission, during hospital stay, and at discharge are collected. Data completeness of three key data fields (age, admission blood pressure, and heart rate) is over 91%. Vital status following hospital discharge is obtained via linkage to data from the United Kingdom Office for National Statistics. An annual report is compiled using these data, with individual hospital summary data included. Datasets are available to researchers by application to NICOR. MINAP is the largest single healthcare system heart attack registry, and includes data from hospitalizations with T1 MI in England, Wales, and Northern Ireland. It includes high-resolution data across the patient pathway and is a powerful tool for quality improvement and research.

Contemporary epidemiology of infective endocarditis in patients with congenital heart disease: A UK prospective study

Infective endocarditis is a life-threatening complication of congenital heart disease (CHD), but there are few studies concerning the contemporary risk profile, preceding invasive procedures and outcomes in this patient population. The aim of this study was to investigate the epidemiology of infective endocarditis (IE) in patients with CHD. Cases of IE in children and adults with CHD were prospectively recorded as part of the UK National Institute for Cardiovascular Outcomes Research (NICOR) National Congenital Heart Disease Audit. Patients were entered into the database between April 2008 and March 2016. Eight hundred episodes of IE were recorded in 736 patients with CHD. Sixty-five patients (9%) were infants (aged <1 year), 235 (32%) were children (aged 1-15 years), and 436 (59%) were adults (aged >15 years). The most common diagnoses were Tetralogy of Fallot (n = 150, 22.8%), ventricular septal defect (n = 129, 19.6%) and bicuspid aortic valve (n = 70, 10.7%). Dental procedures preceded 67 of 635 episodes (11%) of IE, and non-dental invasive procedures preceded 177 of 644 episodes (27.4%). The most common causative organisms were streptococci, accounting for 40% of cases. Overall in-hospital mortality was 6.7%. On multivariable analysis, adverse factors associated with in-hospital mortality were staphylococcal infection and presence of an underlying atrioventricular septal defect. Infective endocarditis in patients with CHD is an ongoing clinical challenge. In contemporary practice in tertiary congenital centers, 1 of 15 patients do not survive to hospital discharge. Streptococci remain the most common causative organism, and antecedent dental or medical procedures were undertaken in a significant minority in the 3 months before diagnosis. The presence of an atrioventricular septal defect or staphylococcal infection is associated with significantly increased risk of early mortality.

Heart and Heart-Lung Transplantation in Adult Congenital Heart Disease (ACHD): A 4-Year Single-Centre Experience

Purpose Due to impressive improvements in surgical treatment, patients with complex CHD have better survival and may develop end-stage heart failure. The number of patients with CHD that need heart (HT) or heart-lung transplantation (HLT) has been increasing in the last decades. The purpose of our study is (1) to review our experience in these patients and (2) to describe perioperative course and outcomes of ACHD patients who required HT or HLT in our institution in the last 4 years. Methods We performed a retrospective single-centre analysis of HT and HLT performed in ACHD patients in Harefield Hospital from January 2015 to May 2018. Data were obtained from automated data collection systems, National Audit Databases (Mortality Grading and Congenital Surgery), and National Institute for Cardiovascular Outcomes Research (NICOR). Results Seven ACHD patients (mean age 44.4 ± 9.3 y, range 34-61) underwent HT (6) or HLT (1). Original cardiac diagnoses included repaired TOF (n=2), CCTGA (n=1), TGA with pulmonary hypertension (n=1), DILV (n=1), Ebstein's anomaly (n=1), and repaired DORV (n=1). Median duration of mechanical ventilation was 9.1 days. Tracheostomy was performed in 3 cases. All patients required high inotropic and vasopressor support (Adrenaline 6/7, Milrinone 7/7, Noradrenaline 7/7, Vasopressin 2/7, Levosimendan 2/7). iNO was used in all the cases with a median duration of 2.5 days. Mechanical circulatory support was required in 5 patients: 4 VA-ECMO (3 central, 1 post-operative peripheral) and 1 IABP. All patients received transfusion (RBC 6/7, PLT 7/7, Cryo 2/7 and FFP 5/7). The most common complications requiring surgical intervention were re-exploration for bleeding, embolectomy and gastrointestinal bleeding. Two patients died (ischaemic colitis, acute graft dysfunction), 55 and 7 days after transplantation respectively. Conclusion ACHD patients undergoing HT or HLT are high risk group of patients with complex anatomy and physiologic features. Our results were similar to those reported in literature describing elevated post-transplant morbidity and mortality. Nevertheless, the data suggest that transplantation may be successfully performed in carefully selected patients in a highly specialized and multidisciplinary team.

PP02 Using Real World Data To Identify The Market For A New Technology

IntroductionKing's Technology Evaluation Centre (KiTEC), a United Kingdom- based health technology assessment consultancy, was tasked with identifying a specific group of heart failure patients who had repeat readmissions in order to accurately identify the potential market for an innovative device designed to diagnose heart failure as a way to avoid costly and avoidable hospital readmissions. The device enables clinicians to remotely diagnose heart failure and appropriate medication can be administered instead of a hospital visit. Our methodology describes an accurate way to quantify the at risk population without the need for a costly trial.MethodsUsing big data from national registries – the heart failure specific National Institute for Cardiovascular Outcomes Research (NICOR) database and the national Hospital Episodes Statistics for the National Health Service (HES) – KiTEC has devised a methodology of linking the two datasets in order to (i) accurately identify patients with repeat readmissions over a 5-year period and (ii) calculate the risk factors for readmissions. Data is linked using a common field, meaning information from both databases can be analyzed at patient level (it is pseudo-anonymized before KiTEC receives it). This allows for unprecedented granularity, as we are able to exploit the heart failure specific detail of NICOR alongside the wealth of admissions data available in HES.ResultsThere are significant challenges surrounding the use of registry data, especially in the enormous size of the datasets and in privacy legislation aimed at protecting personally identifying data. The usual regulatory approvals for health research are also more complex when linked datasets are proposed. These are important considerations, especially when linking two complementary databases.ConclusionsThe use of real world data has the potential to paint a true and accurate picture of a patient population, while avoiding many of the biases inherent in typically research studies. However, there are other important challenges to overcome, namely difficulties analyzing huge datasets and navigating complex legislation to access patient data.

TCT-49 Long-term valve function 5-9 years after transcatheter aortic valve implantation: data from the UK-TAVI Registry. On behalf of the National Institute for Cardiovascular Outcomes Research (NICOR)

Little is known about the long-term durability of trans-catheter aortic heart valves, particularly beyond 5 years. In the UK 100% of cases are recorded on the UK TAVI database, and annual follow-up trans-thoracic echocardiography (TTE) is recommended. Data on all patients undergoing TAVI in the UK

United Kingdom: coronary and structural heart interventions from 2010 to 2015.

In the United Kingdom, a clinical data set is completed for every patient undergoing coronary intervention and certain structural interventions, and sent to central servers in the National Institute for Cardiovascular Outcomes Research (NICOR) on behalf of the British Cardiovascular Intervention Society (BCIS). These data are linked to the national mortality register. In addition, data are obtained about the structure of healthcare provision using an annual survey. Analyses of these data are provided for different audiences in several formats. Public reports of individual consultant operator activity and risk-adjusted outcomes from percutaneous coronary intervention (PCI) have also been produced annually since 2012. Transcatheter aortic valve implantation (TAVI) has been performed since 2007. Over 2,000 cases were performed in 2015, giving a rate of 30 per million population. Complications to discharge have fallen as case mix has changed and technologies improved. While the mean age has remained about 81 years, the logistic EuroSCORE of patients treated by TAVI has fallen from about 22 in 2010 to 18 in 2015. Tracked 30-day mortality was 3.7% in 2014. Left atrial appendage occlusion and patent foramen ovale (PFO) closure for stroke, and the use of the MitraClip® system (Abbott Vascular, Santa Clara, CA, USA) for mitral regurgitation have been funded through a process called "commissioning through evaluation".

TCT-333 Percutaneous Coronary Intervention in Octogenarians: A Risk Scoring System to Predict Outcomes in the Elderly On behalf of the British Cardiovascular Intervention Society (BCIS), and the National Institute for Cardiovascular Outcomes Research (NICOR)

TCT-333 Percutaneous Coronary Intervention in Octogenarians: A Risk Scoring System to Predict Outcomes in the Elderly On behalf of the British Cardiovascular Intervention Society (BCIS), and the National Institute for Cardiovascular Outcomes Research (NICOR)

Development and Validation of Elective and Nonelective Risk Prediction Models for In-Hospital Mortality in Proximal Aortic Surgery Using the National Institute for Cardiovascular Outcomes Research (NICOR) Database

To facilitate patient choice and the risk adjustment of consultant outcomes in aortic operations, reliable predictive tools are required. Our objective was to develop a risk prediction model for in-hospital mortality after operation on the proximal aorta. Data for 8641 consecutive UK patients undergoing proximal aortic operation from the National Institute for Cardiovascular Outcomes Research database from April 2007 to March 2013 were analyzed. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality. Model calibration and discrimination were assessed. In-hospital mortality was 4.6% in elective operations and 16.5% in nonelective operations. In the elective model, previous cardiac operation (adjusted odds ratio [OR] 4.1, 95% confidence interval [CI]: 3.0 to 4.7) and ejection fraction greater than 30% (adjusted OR 2.3, 95% CI: 1.7 to 3.1) were the strongest predictors of mortality (p<0.001). The area under the receiver operating characteristic (AUROC) curve was 0.805 (95% CI: 0.802 to 0.807) with a bias-corrected value of 0.795. Model calibration was acceptable (p= 0.427) on the basis of the Hosmer-Lemeshow goodness-of-fit test. In the nonelective model, salvage operations (adjusted OR 9.9, 95% CI: 6.5 to 15.2) and previous cardiac operation (adjusted OF 3.9, 95% CI: 3.0 to 5.0) were the strongest predictors of mortality (p < 0.001). The AUROC curve was 0.761 (95% CI: 0.761 to 0.765) with a bias-corrected value of 0.756, and model calibration was also found to be acceptable (p= 0.616). We propose the use of these risk models to improve patient choice and to enhance patients' awareness of risks and risk-adjust aortic operation outcomes for case-mix.

Trends in hospital treatments, including revascularisation, following acute myocardial infarction, 2003–2010: a multilevel and relative survival analysis for the National Institute for Cardiovascular Outcomes Research (NICOR)

ObjectiveTo investigate temporal changes in survival after acute myocardial infarction (AMI) by early invasive strategy.MethodsAccelerated failure time and 6-month relative survival analyses stratified by thrombolysis or primary percutaneous coronary intervention...

143 AN ALL-EMBRACING ANALYSIS COMBINING THE UK TAVI AND CARDIAC SURGICAL REGISTRIES (IN NICOR) TO DESCRIBE THE ACTIVITY, TREND AND OUTCOMES IN 36 026 PATIENTS WHO UNDERWENT AORTIC VALVE INTERVENTION IN THE 5 YEARS FROM 2006 TO 2010

Purpose Transcatheter aortic valve implantation (TAVI), allows treatment of patients with aortic stenosis for whom there were previously no therapeutic options available (or only at prohibitive risk). This, and evolving population demographics, have resulted in a rapid change in the overall management of all patients with aortic valve disease. The purpose of this study was to describe trends in activity levels, demographics and clinical outcomes of all patients who underwent aortic valve implantation (by surgical or catheter based approaches) during the first few years of TAVI roll out in England and Wales. Methods All cardiac surgical procedures and all catheter based implants (TAVIs) in the UK are entered into National Registries hosted by NICOR (National Institute for Cardiovascular Outcomes Research). These Registries have the same infrastructure and contain the same demographic data with compatible definitions. All aortic valve interventions over 5 years between 1 January 2006 and 31 December 2010 were included in this analysis, which was restricted to England and Wales where near 100% mortality tracking could be effected for both Registries. Results 35 406 patients underwent surgical AVR (isolated or with concomitant CABG) (SAVR); 1620 underwent TAVI. The numbers of SAVR peaked in 2008 then declined slightly (for the first time ever in the UK). There was a steady growth in TAVI, so that by 2010 TAVI represented just over 10% of all interventions for aortic stenosis. For patients >80 years old there was almost a 100% increase in all aortic valve interventions (from 1055 up to 2035 in 2010). This increase was about 50% due to an increase in TAVI and 50% SAVR. There was a very marked variation in the rate of uptake of TAVI by geographical region ranging from 1.4 to 36 pmp (rising to between 4.3 and 47 pmp in 2011). The TAVI cohort had a much greater risk profile even in the patients >80 years old. The 30 day and 1 year mortality was predictably higher in the TAVI cohort but this decreased markedly from 13.9% in 2007 to 6.2% in 2010. The trends in the timing of death post procedure between the conventional and TAVI groups will be presented, as will the 2011 data which will have been validated by January 2013 (a further >1000 TAVI procedures). Conclusions By capturing all procedures in England and Wales, this study provides a detailed insight into the evolution of aortic intervention during the introduction of TAVI in a defined population.

An assessment of composite measures of hospital performance and associated mortality for patients with acute myocardial infarction. Analysis of individual hospital performance and outcome for the National Institute for Cardiovascular Outcomes Research (NICOR)

To investigate whether a hospital-specific opportunity-based composite score (OBCS) was associated with mortality in 136,392 patients with acute myocardial infarction (AMI) using data from the Myocardial Ischaemia National Audit Project (MINAP) 2008-2009. For 199 hospitals a multidimensional hospital OBCS was calculated on the number of times that aspirin, thienopyridine, angiotensin-converting enzyme inhibitor (ACEi), statin, β-blocker, and referral for cardiac rehabilitation was given to individual patients, divided by the overall number of opportunities that hospitals had to give that care. OBCS and its six components were compared using funnel plots. Associations between OBCS performance and 30-day and 6-month all-cause mortality were quantified using mixed-effects regression analysis. Median hospital OBCS was 95.3% (range 75.8-100%). By OBCS, 24.1% of hospitals were below funnel plot 99.8% CI, compared to aspirin (11.1%), thienopyridine (15.1%), β-blockers (14.7%), ACEi (19.1%), statins (12.1%), and cardiac rehabilitation (17.6%) on discharge. Mortality (95% CI) decreased with increasing hospital OBCS quartile at 30 days [Q1, 2.25% (2.07-2.43%) vs. Q4, 1.40% (1.25-1.56%)] and 6 months [Q1, 7.93% (7.61-8.25%) vs. Q4, 5.53% (5.22-5.83%)]. Hospital OBCS quartile was inversely associated with adjusted 30-day and 6-month mortality [OR (95% CI), 0.87 (0.80-0.94) and 0.92 (0.88-0.96), respectively] and persisted after adjustment for coronary artery catheterization [0.89 (0.82-0.96) and 0.95 (0.91-0.98), respectively]. Multidimensional hospital OBCS in AMI survivors are high, discriminate hospital performance more readily than single performance indicators, and significantly inversely predict early and longer-term mortality.

TCT-96 Influence Of Gender On Clinical Outcomes Following Transcatheter Aortic Valve Implantation: Results From The UK TAVI Registry On Behalf Of The UK TAVI Steering Group And The National Institute For Cardiovascular Outcomes Research

Female sex is associated with adverse outcomes following conventional aortic valve replacement. We investigate gender differences following transcatheter aortic valve implantation (TAVI) in the UK's National Institute for Cardiovascular Outcomes Research (NICOR) TAVI Registry. Retrospective

The UK transcatheter aortic valve implantation registry; one of the suite of registries hosted by the National Institute for Cardiovascular Outcomes Research (NICOR)

This registry was set up to create a comprehensive record of all TAVI procedures performed in the United Kingdom since the introduction of the technique in 2007, to help drive...