Propensity-matched Analysis Research Articles

Characteristics and In-Hospital Outcomes of Single-Vessel Coronary Disease Intervention: A Propensity-Matched Analysis of the National Inpatient Sample Database 2016–2020

Background/Objectives: Few studies have analyzed in-hospital complications and events following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) procedures for patients who underwent these interventions for single-vessel coronary artery disease (CAD). This study aims to compare the outcomes of PCI and CABG in such patients using a large propensity-matched real-world database based on procedural codes. Methods: Adult patients receiving PCI or CABG for single-vessel CAD were identified from the 2016–2020 National Inpatient Sample (NIS) database. Any cases targeting multi-vessel disease or employing a multi-treatment approach were excluded using appropriate procedural codes. Differences in events and complications from admission to discharge were studied between the two procedures (PCI vs. CABG) via logistic regression analysis. Results: After propensity matching with 273,380 patients in both groups, complication risks such as cardiac tamponade (aOR: 3.6 [3.27–3.96]), acute kidney injury (aOR: 1.53 [1.51–1.56]), cardiogenic shock (aOR: 1.38 [1.34–1.40]), procedural bleeding (aOR: 1.75 [1.67–1.83]), acute ischemic stroke (aOR: 1.89 [1.80–1.97]), and all-cause mortality (aOR: 1.05 [1.02–1.08]) were higher among CABG patients. No differences were observed for events of cardiac perforation (aOR: 0.92, [0.84–1.01]). Conclusions: In this large real-world propensity-matched analysis, CABG was associated with higher risks of multiple in-hospital complications and all-cause mortality compared to PCI following a single-vessel coronary intervention.

Abstract 4137905: The association between prehospital epinephrine administration and short-term outcomes in patients with shockable out-of-hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: a propensity matched analysis

Background: In out-of-hospital cardiac arrest (OHCA) patients with an initial shockable rhythm, epinephrine increases the likelihood of return of spontaneous circulation (ROSC), but its effect on neurological outcome remains uncertain. Epinephrine administered before extracorporeal resuscitation (ECPR), which is a non-pharmacological method to obtain ROSC, may have worsened neurological outcome. Aim: To evaluate the impact of prehospital epinephrine administration on the prognosis of OHCA patients undergoing ECPR. Methods: This is a retrospective analysis of a cohort study from a multicenter, prospective registry of 81234 OHCA patients between 2014 and 2021. After the application of exclusion criteria, 1061 OHCA patients with an initial shockable rhythm and who underwent ECPR were eligible for this study. The primary outcome was favorable neurological outcome at 30 days after the OHCA and the secondary outcome was ROSC during transfer. Patients who did and did not receive prehospital epinephrine were propensity score-matched on the basis of age, gender, witness arrest, bystander-initiated CPR, dispatcher-assisted CPR, advanced airway management, call-to-defibrillation interval, year and district. Results: Among 1061 eligible patients, 442 patients received epinephrine and 619 patients did not. Matching was successful in achieving covariate balance as shown by a standardized difference of <10% for all variables (329 matched pairs). The proportion of patients with prehospital ROSC was significantly higher in those who received prehospital epinephrine than those who did not (36 [8%] vs 31 [5%]; adjusted odds ratio [OR] after propensity score-matching, 1.96 [95% CI 1.05-3.67], p=0.03). The proportion of patients with favorable neurological outcome at 30 days was not significantly lower in those who received prehospital epinephrine than those who did not (34 [8%] vs 78 [13%]; adjusted OR after propensity score-matching, 0.78 [95% CI 0.45-1.37], p=0.39). Conclusion: In patients with shockable OHCA and ECPR, prehospital epinephrine administration was significantly associated with increased ROSC before hospital arrival and not significantly with decreased favorable neurological outcome at 30 days.

Abstract 4144552: Difference in Characteristics and Outcomes of Atrial Fibrillation patients based on type of Heart Failure: An NRD Propensity Matched Analysis

Background: Heart Failure(HF) significantly deteriorates outcomes in patients with Atrial Fibrillation. Heart Failure with Preserved Ejection Fraction(HFpEF) and Atrial Fibrillation(AFib) share common disease progression pathways and are gradually increasing in prevalence. Aim: We aim to study the variation in characteristics and outcomes based on type of heart failure in patients with AFib using the National Readmission Database(2016-2020). Methods: NRD database was used to identify patients with Atrial Fibrillation using ICD-10 codes. Patients were stratified into two groups based on the presence of systolic dysfunction and diastolic dysfunction. Patients with combined systolic and diastolic dysfunction were excluded. Information was collected on patient demographics, comorbidities, and outcomes. Propensity score matching was performed to compare outcomes among AFib patients with HFrEF and HFpEF. Results: A total of 6,673,080 patients with AFib and isolated systolic or isolated diastolic dysfunction were included in the analysis. 3,914,695(58.66%) had HFpEF and 2,758,385 (41.34%%) had HFrEF. In the HFpEF group 57.8% were females in comparison with 33.12% females in the HFrEF group. HFpEF group had a higher rate of hypertension (84.9% vs 82%, p<0.001), OSA(19.35 vs 14.9, p<0.001), immunocompromised status (0.06 vs 0.04%, p<0.001), hypothyroidism(23.7% vs 18.47%,P<0.001), Anemia(10.1% vs 7.95%, p<0.001), Pneumonia (13.51%) and Pulmonary disease(37.34% vs 30.98%) as compared to the HFrEF group. In the propensity matched analysis, HFpEF group had lower in-hospital death (5.26% vs 6.59%, p<0.001), acute kidney injury (33.19% vs 38.92%; p<0.001), stroke (0.99% vs 1.71%), cardiogenic shock (1.02% vs 3.29%; p<0.001), Myocardial infarction (3.60% vs 7.65%; p<0.001), sudden cardiac arrest (1.95% vs 2.62%;p<0.001), mechanical circulatory device use(0.16% vs 0.77%;p<0.001) and major adverse cardiovascular event(9.79% vs 16.06%;p<0.001). Discussion: In Afib patients with HFpEF, yearly admissions were higher in comparison to the HFrEF group. Furthermore, we found a higher prevalence of hypertension, obesity, OSA, pulmonary disease, pneumonia, immunocompromised status, hypothyroidism, and anemia in comparison with the HFrEF group. However, mortality rate in HFpEF group and MACE were lower. At present, there are no definite therapies for patients with HFpEF that have displayed a clear mortality benefit highlighting the need for further inquiry.

Abstract 4136203: Risk of Mortality and Heart Failure with Myosin Inhibition Among Hypertrophic Cardiomyopathy Patients

Background: While prior studies have established that mavacamten therapy in symptomatic obstructive hypertrophic cardiomyopathy (oHCM) leads to significant clinical and functional improvement, long-term data on the effect of mavacamten on mortality and heart failure with reduced ejection fraction (HFrEF) in these patients is lacking. Methods: In this retrospective cohort study utilizing electronic health record data from the TriNetX Network, we aimed to assess the association of mavacamten therapy with mortality and HFrEF compared to medical management among patients with oHCM between 04/2022 and 04/2024. The hazard ratio (HR) and 95% confidence interval (CI) for the study outcomes were estimated by comparing propensity-score matched groups. Results: Among 47,601 adults (45.4% females; mean age: 63.5±16.6 years), 701 and 46,900 patients were included in the mavacamten and medical management groups, respectively. ( Table ) In the propensity-matched analysis, mavacamten was associated with a lower risk of mortality (HR=0.40;95%CI:0.21-0.73,p=0.002), but a similar risk of incident HFrEF (HR=1.03;95%CI:0.56-1.88,p=0.93) compared with medical management. ( Figure ) Conclusions: The current study is among the first to report improved survival with mavacamten therapy among patients with oHCM utilizing real-world data. The similar risk of HFrEF between the mavacamten and medical management cohorts highlighted in this study indicates the efficacy of the Risk Evaluation and Mitigation Strategy (REMS) program in maintaining patient safety and offsetting any potential excess risk of HFrEF.

Investigating the impact of tumor size on survival outcomes in thymoma and thymic carcinoma patients using the SEER database.

This study aims to clarify the impact of tumor size on the prognosis of patients diagnosed with thymoma and thymic carcinoma, leveraging data from a population-based registry. Utilizing the SEER database, this retrospective analysis identified patients diagnosed with thymoma and thymic carcinoma from 2000 to 2020. Propensity score matching was employed to mitigate potential statistical biases between groups categorized by tumor size (≤ 6.5cm and > 6.5cm). The study included a total of 3857 patients, comprising 2688 with thymoma and 1169 with thymic carcinoma. Multivariate analysis demonstrated that tumors ≤ 6.5cm independently correlated with improved Cancer-Specific Survival (CSS) (p = 0.001; p < 0.001) and Overall Survival (OS) (p < 0 .001; p < 0.001) in both thymoma and thymic carcinoma cohorts. Subgroup analysis revealed that smaller tumors (≤ 6.5cm) conferred survival benefits in patients with Masaoka-Koga stage IIB thymomas and stage III/IV thymic carcinomas (thymoma: CSS: p < 0.0001; OS: p = 0.00045; thymic carcinoma: CSS: p = 0.028; OS: p = 0.014). Additionally, WHO type A/AB/B1 and type B2/B3 thymomas with tumors ≤ 6.5cm exhibited superior CSS (p = 0.005; p < 0.00018) and OS (p = 0.015; p = 0.0021). Through propensity matching analysis utilizing the SEER database, this study underscores the prognostic significance of tumor size in both early-stage thymoma and advanced-stage thymic carcinoma, identifying a critical threshold of 6.5cm. In the WHO classification, tumor size based on the cut-off value of 6.5cm has a greater impact on the prognosis of type B2/B3 (high-risk group) than A/AB/B1 (low-risk group).

Abstract 4146306: Rural Urban Disparities in Inpatient Outcomes of Chronic Limb-Threatening Ischemia in the United States

Background: Chronic limb-threatening ischemia (CLTI) is a severe form of peripheral artery disease characterized by chronic ischemic rest pain, non-healing wounds, or gangrene in one or both legs. With prevalence rates of 1-2% in the United States (increasing with age, with over 20% of adults over 70 diagnosed with CLTI) and 1-year mortality rates approaching 20-25%, CLTI is a critical public health issue due to its significant impact on patient morbidity, mortality, and healthcare resources. Aims: To understand if disparities exist between rural and urban inpatient outcomes for patients with CTLI. Methods: A retrospective analysis of the National Inpatient Sample database from 2016 to 2021 was conducted to identify patients admitted with CLTI according to ICD-10 codes. Patients were stratified by rural and urban status, followed by propensity-matched analysis to compare inpatient outcomes between these groups. Results: A total of 2,667,279 patients with CLTI, with 445255 (16.7%) categorized as rural status and the remaining 83.3% categorized as urban status, were included in this study. Patients belonging to rural status had an increased odds of in-hospital mortality (aOR)=1.35; 95% CI 1.26-1.45; p&lt;0.001), in-patient sudden cardiac arrest (aOR=1.27; 95% CI=1.13-1.43; p&lt;0.001), cerebrovascular accidents (aOR=1.31; 95% CI=1.19-1.45; p&lt;0.001), venous thromboembolism (aOR=1.18; 95% CI=1.09-1.27; p&lt;0.001), surgical site infection (aOR=1.25; 95% CI=1.16-1.35; p&lt;0.001), requirement for vasopressors (aOR=2.02; 95% CI=1.76-2.32; p&lt;0.001), invasive (aOR=1.18; 95% CI=1.10-1.26; p&lt;0.001) and non-invasive (aOR=1.37; 95% CI=1.25-1.50; p&lt;0.001) mechanical ventilation, hemodialysis (aOR=1.11; 95% CI=1.06-1.15; p&lt;0.001), major amputation (aOR=1.38; 95% CI=1.32-1.43; p&lt;0.001), surgical revascularization (aOR=1.53; 95% CI=1.46-1.60; p&lt;0.001), endovascular revascularization (aOR=1.53; 95% CI=1.46-1.60; p&lt;0.001), and blood transfusion (aOR=0.92; 95% CI=0.88-0.97; p=0.001). No difference was observed in the odds of acute myocardial infarction (aOR=1.06; 95% CI=0.99-1.14; p=0.082) and risk of acute kidney injury (aOR=0.99; 95% CI=0.96-1.02; p=0.485). Conclusions: Disparities in CLTI outcomes are evident, with patients from rural areas experiencing worse outcomes than their urban counterparts. Future research should focus on understanding the underlying causes of these disparities and developing targeted interventions to bridge the gap between rural and urban health care outcomes.

PATH-48. IMPACT OF DEPRESSION AND ITS TREATMENT ON SURVIVAL AND TUMOR PROGRESSION IN RTK2 GLIOBLASTOMAS: IDENTIFICATION OF A HIGH-RISK SUBGROUP

Abstract INTRODUCTION Depressive symptoms are prevalent among glioma patients while the impact on survival is not fully clear and underlying mechanisms remain poorly understood. Here, we investigated the impact of glioblastoma-associated depression as the disease-presenting symptom and the influence of antidepressant pharmacotherapy on glioblastoma progression. METHODS We performed a retrospective cohort study on glioblastoma patients treated at our institution. Patients with a new depression as presenting symptom were compared to non-depressive glioblastoma patients employing propensity-matched survival analysis. Additionally, tumor tissues were subjected to DNA methylation analysis (EPIC 850k array). In vitro proliferation assays were performed to investigate the effect of antidepressants on glioma cell growth. RESULTS Of 298 glioblastoma patients, 23 patients suffered from a tumor-associated depression and received antidepressants at time of diagnosis (14 SSRI, 3 NaSSA, 4 TCA and 2 unknown). Propensity-matched survival analysis revealed a shorter OS in the depression group (median OS: 8 vs. 14; HR = 2.247; 95% CI: 1 - 5.051; p &amp;lt; 0.05). Methylation subclass analysis indicated a predominance of RTK2 glioblastoma within the depression group (n = 14; 63.6%). Tumors of the depression group originated more likely in the frontal lobe (43.5% vs. 29.2%) and in the midbrain (13% vs. 2.43%). No significant differences in epigenetic neural signatures were found. Treatment with either citalopram or sertraline – the most frequently used antidepressants - significantly increased the proliferation index in RTK2 glioblastoma cultures but not RTK1 glioblastoma cultures. CONCLUSION Our study reveals a strong correlation between glioblastoma-associated depression with antidepressant treatment and worse outcome in glioblastoma of the DNA methylation subclass RTK2. These findings may reveal a potential causal link, raising awareness of the increased likelihood of depression and glioblastoma progression in a methylation-dependent manner, which could guide antidepressant treatment for improving patients’ quality of life.

Patients with multiple sclerosis have higher rates of worsening following total hip arthroplasty: a propensity-matched analysis.

The progressive nature of multiple sclerosis (MS) may adversely affect outcomes following total hip arthroplasty (THA). As patient-reported outcome measures (PROMs) in this specific group are not well defined, this study aimed to compare the clinical outcomes and the rates of achieving the minimal clinically important difference for improvement (MCID-I) and worsening (MCID-W) between patients with MS and those without MS undergoing THA. We conducted a retrospective analysis of 375 THAs, including 75 MS patients and 300 propensity-matched non-MS patients (4:1), performed between 2016 and 2022. Collected PROMs included Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Mental and Physical, PROMIS Physical Function short form 10-a (PF-10a), and Hip disability and Osteoarthritis Outcome Score-Physical Function Short-form (HOOS-PS). Preoperative and postoperative PROMs and MCID-I/MCID-W rates were compared. A total of 375 THAs, including 75 MS and 300 matched non-MS patients, were analysed. MS patients had higher 90-day postoperative complication rates (9.3% vs. 2.3%, p = 0.012) and infection rates (4.0% vs. 0.3%, p = 0.006). The rates of achieving MCID-I and MCID-W were similar for PROMIS Global Mental, PROMIS Global Physical, and HOOS-PS, but MS patients had a higher rate of experiencing MCID-W for PROMIS PF-10a compared to non-MS patients (16.7% vs. 6.5%, p = 0.022). Additionally, MS patients had a longer mean hospital stay (2.4 vs. 1.9 days, p = 0.005) and lower rates of being discharged home (82.7% vs. 94.3%, p < 0.001). The present study found that MS patients experience similar rates of MCID-I and MCID-W in most PROMs but have a higher rate of MCID-W for PROMIS PF-10a and increased postoperative complications. These findings highlight the need for careful consideration of postoperative risks despite potential improvements. Further research is needed to explore the impact of MS progression on PROMs and perioperative outcomes.

Same day discharge after hepatectomy: Can it be done safely?

With the advent of minimally invasive techniques and enhanced recovery pathways, outpatient surgery is becoming increasingly common, but has not yet been extensively described in liver surgery. The aim of the present study was to analyze the incidence, characteristics, and outcomes of patients undergoing outpatient hepatectomy in the US. We utilized the National Surgical Quality Improvement Program (NSQIP) database for patients who underwent laparoscopic or robotic, elective hepatectomy from 2014 to 2021. Patients discharged on postoperative day 0 were assigned to the "same-day discharge" group, otherwise the patient was considered "admitted." Postoperative outcomes were compared with propensity-matched analysis. Multivariate analysis was performed to identify predictors of postoperative LOS (length of stay). We identified 7279 patients, of which 361 were in the same-day discharge cohort and 6918 were in the admitted cohort. For admitted patients, median postoperative length of stay was three days (SD = 6). Same-day discharge patients tended to be younger (age 59 vs. 62, p = .034) and more often ASA class ≤2 (49% vs. 29%, p < .001). Comorbidities such as hypertension (40% vs. 45%, p = .048) and diabetes (12% vs. 19%, p = .002) were less common in the same-day discharge cohort. On propensity-matched comparison, there was no significant difference in 30-day mortality (p > .9), 30-day readmission (p = .2), and overall postoperative complication rate (p = .2). Predictors of longer postoperative LOS included longer operative time, inpatient hospital status, preoperative transfusion, dependent functional status, and use of neoadjuvant chemotherapy. Our results indicate that for low-risk patients and uncomplicated cases, same-day discharge after minimally invasive, elective hepatectomy is feasible without compromising patient safety and outcomes.

Clinical Significance of Optical Coherence Tomography-Guided Percutaneous Coronary Intervention for In-Stent Restenosis Within Drug-Eluting Stents: Impact on Patient Outcomes.

The evidence for optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) in improving the prognosis of individuals with in-stent restenosis (ISR) is lacking. This retrospective study enrolled 588 consecutive individuals with drug-eluting stent ISR undergoing PCI from March 2010 to March 2022. Two hundred seven (35.2%) underwent OCT guidance, and 381 (64.8%) underwent angiography guidance. Clinical outcomes were analyzed using survival curves. The primary clinical endpoint was 2-year major adverse cardiovascular events (MACEs), a composite of all-cause death, myocardial infarction, and target-vessel revascularization. Compared with angiography guidance, OCT guidance demonstrated a higher frequency of drug-coated balloon use and adjunctive therapeutic modalities, including predilation, postdilation, nonslip element balloons, and noncompliant balloons (P<0.05). Following PCI, the OCT-guided group achieved a significantly larger minimum lumen diameter (2.36 versus 2.15 mm, P<0.001) and a lower percentage diameter stenosis (17% versus 20%, P<0.001) than the angiography-guided group. Survival analysis revealed significantly lower 2-year MACEs in the OCT-guided group compared with the angiography-guided group (7% versus 15%, P=0.007), validated in the propensity matching analysis (7% versus 15%, P=0.001). Multiple sensitivity analyses showed that OCT-guided PCI treatment was an independent protective factor for 2-year MACEs in individuals with drug-eluting stent ISR. Compared with angiography guidance, OCT guidance is associated with a lower 2-year MACE risk among individuals with drug-eluting stent ISR. Therefore, OCT should be actively considered for guiding PCI treatment in individuals with drug-eluting stent ISR. Url: clinicaltrials.gov. Identifier: NCT03809754.

A repeated gonadotropin-releasing hormone agonist trigger improves pregnancy outcomes of frozen-thawed embryo transfer in GnRH antagonist cycles: a retrospective propensity-matched score analysis.

To evaluate whether co-treatment of repeated GnRHa triggers with GnRH antagonist protocols can improve the clinical outcomes in in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) procedures. In this retrospective study, 712 Chinese Han women aged 20-42 undergoing autologous IVF/ICSI-ET with a flexible GnRH antagonist protocol were analyzed. The 735 cycles were split into the single (n = 238) and the repeated (n = 497) GnRHa groups. In the single GnRHa group, 0.2mg of triptorelin was given for oocyte maturation, whereas in the repeated GnRHa group, two doses of 0.2mg were administered 12h apart. PSM design was used for a fair comparison. The main study outcomes included the clinical pregnancy rate (CPR), live birth rate (LBR), good-quality embryo rate, and fertilization rate. Multivariate logistic regression analyses were used to identify all potential factors affecting clinical outcomes. Post-PSM, analysis of 159 cycles per group showed the repeated GnRHa group outperforming the single GnRHa group in IVF fertilization rates (71.5% vs. 67.7%, P < 0.05) and good-quality embryo rate (47.1% vs. 43.7%, P < 0.05). Furthermore, the repeated GnRHa group achieved higher CPR (72.6% vs. 53.4%, P < 0.05) and LBR (59.7% vs. 43.8%, P < 0.05) in FET cycles. Multivariate logistic regression indicated a significant negative correlation between the use of a single GnRHa trigger and both clinical pregnancy (OR = 0.382, P < 0.05) and live birth (OR = 0.518, P < 0.05). Our study reported that individuals who received a repeated GnRHa trigger exhibited higher CPR and LBR during FET cycles compared to those who received a single dose GnRHa trigger.

Mortality association with extremity trauma and transferring patients for higher level of care.

Rising healthcare costs and reduced Medicaid reimbursements pose lasting challenges for trauma centers. Various studies have highlighted the adverse effect of these cost-related circumstances on trauma center survival and the need for local hospitals to transfer patients to tertiary and quaternary care centers. Our study seeks to assess the relationship between patient transfer status to a higher-level health center and its association with mortality. A total of 19417 patients were identified, of which 15317 patients presented directly to the higher level health center, and 3830 patients who transferred from 49 different outside hospitals within a 500-mile radius. Data collection was collected from the receiving higher level of care hospital trauma registry. IBM SPSS version 23 was used to analyze the data. A 1:1 propensity-matched analysis based on age, sex, and injury severity score yielded 3566 patients that presented directly to ARMC and 3566 patients who were transferred to ARMC for a higher level of care. Amongst various factors we considered mechanism of injury, response levels, arrival methods, and transfusion of blood products. The univariate analysis of the propensity-matched analysis demonstrated 88% blunt injury in the nontransferred group and 82% in the transferred group (P<0.001). Overall, hospital mortality was 3% in nontransferred patients versus 4% in the transferred group (P<0.001). A multivariate logistic regression demonstrated mortality is more likely in patients with higher injury severity scores [odd ratio (OD) 2.351 (1.029-1.082), P<0.001] and lack of packed red blood cell (pRBC) transfusions received within first 4h [OD 6.852 (3.525-13.318), P=0.001]. The transfer of trauma patients with extremity injuries to level 1 trauma centers has significant implications on patient outcomes. In our retrospective observational cohort study, the authors noted increased mortality among patients with higher injury severity scores, penetrating injuries, pRBC administration within the first 4h of hospitalization, and among patient transfers.

Improved clinical and radiographic outcomes with expandable cages in transforaminal lumbar interbody fusion: a propensity-matched cohort analysis.

The restoration of sufficient overall lumbar lordosis (LL) and segmental LL (SL) is associated with achieving optimal sagittal balance, decreasing back pain, and enhancing functional outcomes for patients. Expandable cages were developed in hopes of improving radiographic parameters and clinical outcomes, although current clinical evidence is inconclusive. Here, the authors aimed to evaluate the clinical and radiographic outcomes in patients undergoing one- or two-level open transforaminal lumbar interbody fusion (TLIF) with expandable versus static cage placement, using propensity-matched cohorts. An institutional retrospective cohort of patients who underwent one- or two-level open TLIF with either expandable cage or static cage placement was identified. Using relevant preoperative covariates, including age, primary versus revision operation, number of cages implanted, and surgical level implanted, the authors built propensity-matched cohorts. They identified clinical outcomes in both cohorts, including operative characteristics and complication rates, along with pain, weakness, and sensory deficits over follow-up. Furthermore, they extracted and examined preoperative, postoperative, and last follow-up radiographic parameters. A total of 148 patients were included, and they were followed for a mean of 1.7 years (range 0.5-4.3 years). Propensity matching was used to create cohorts of patients who were similar with respect to age, surgical indication, revision status, number of cages implanted, surgical level implanted, and length of follow-up. Patients in both groups had similar preoperative radiographic parameters. Patients with expandable cages saw larger increases in SL, both postoperatively (5.3° ± 7.5° vs 1.6° ± 5.6°, p = 0.006) and at last follow-up (5.7° ± 7.4° vs 1.0° ± 6.1°, p = 0.003). They also saw significant improvements in pelvic incidence minus LL mismatch at last follow-up (-4.4° ± 13.2° vs 5.8° ± 13.8°, p = 0.009). No differences in intraoperative or perioperative complications were found, but patients with expandable cages were less likely to require readmission, develop adjacent-segment disease, or require revision surgery. They were also more likely to be symptom free at 1 month after surgery and at last follow-up. Expandable cages lead to better restoration of radiographic features, including SL and improvements in clinical outcomes, compared with static cages in propensity-matched cohorts in patients undergoing one- or two-level open TLIFs.

Does robotic surgical assistant (ROSA) functionally aligned TKA lead to higher satisfaction than conventional mechanically aligned TKA: A propensity-matched pair analysis

ObjectivesTotal knee arthroplasty (TKA) is the established treatment for severe knee osteoarthritis, with robotic-assisted TKA (rTKA) proposed to enhance surgical precision and potentially improve outcomes. This study investigates whether functionally-aligned rTKA using the ROSA Knee System results in superior functional outcomes and patient satisfaction compared to conventional mechanically aligned TKA (mTKA). MethodsWe conducted a retrospective, propensity-score matched cohort study including 154 patients (46 rTKA, 108 mTKA) who underwent primary TKA by a single surgeon from October 2020 to October 2023. Functionally-aligned (FA) rTKA was performed using the ROSA Knee System. Patients were assessed using the Short-Form 36 (SF36), Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and Oxford Knee Score (OKS) preoperatively and at 6 months postoperatively. Immediate postoperative outcomes such as pain at rest and movement, ambulation distance, and range of motion were measured. Statistical analysis evaluated results at a 95 % confidence interval, with significance at P < 0.05. ResultsNo significant differences were observed in immediate postoperative pain at rest (P = 0.988), pain during movement (P = 0.634), ambulation distance (P = 0.243), and range of motion (P = 0.752) between the groups. At 6 months, there were no significant differences between rTKA and mTKA in achieving the minimal clinically important difference for SF36 (P = 0.996), KSKS (P = 0.150), KSFS (P = 0.091), and OKS (P = 0.949). No significant differences were noted for satisfaction levels (P = 0.315) and fulfilled expectations (P = 0.557) between both groups. ConclusionsAt 6 months postoperatively, FA rTKA demonstrated equivalent outcomes and satisfaction levels compared to mTKA. Future research should focus on examining longer-term follow-up outcomes, quantifying gap balance in MA mTKA to allow direct comparison with rTKA and studying alternative personalised alignment rTKA strategies to enhance patient outcomes.

Comparative Effectiveness of Ozanimod and Vedolizumab as First-Line Advanced Therapies in Ulcerative Colitis: A Propensity-Matched Cohort Analysis.

There is limited real-world evidence comparing the effectiveness of ozanimod to vedolizumab as first-line advanced therapies in patients with ulcerative colitis (UC). We conducted a retrospective cohort study using TriNetX, a multi-institutional US database in adults with UC who were initiated on ozanimod compared to vedolizumab between January 1, 2021 and 22 June, 2024. The primary outcome was to compare the risk of a composite outcome of corticosteroid use, colectomy, or change to another advanced therapy between the 2 cohorts within 12 months. 1:1 propensity score matching (PSM) was performed for demographics, comorbid conditions, disease extent, laboratory parameters, and previous corticosteroid use. The risk was expressed as an adjusted odds ratio (aOR) with 95% CIs. We identified 222 patients in the ozanimod cohort (mean age 41.2 ± 15.7, 46.3% male sex, 68% White, and 22.5% ulcerative proctitis), and 4145 patients in the vedolizumab cohort (mean age 47.4 ± 18.3, 45.2% male sex, 69.7% White, and 17.2% ulcerative proctitis). After PSM, there was no significant difference in the risk of the composite outcome (aOR 0.92, 95% CI, 0.63-1.36) and corticosteroid use (aOR 0.80, 95% CI, 0.53-1.18) between the 2 cohorts within 12 months. There was a higher risk of change in therapy in the ozanimod cohort (aOR 1.95, 95% CI, 1.09-3.49) compared to the vedolizumab cohort. Colectomy rates were low in both cohorts (<0.04%). Our real-world study showed that ozanimod use is associated with similar corticosteroid use but higher odds of a change in therapy compared to vedolizumab when used as first-line therapy in patients with UC. Further prospective studies are needed to understand long-term outcomes.

Long term follow up of Implantable Cardioverter Defibrillators (ICD) in hypertrophic cardiomyopathy: is subcutaneous the way forward?

Abstract Introduction Young patients have greater risks of longer-term complications including inappropriate therapy (IT) from Implantable Cardioverter Defibrillators (ICD) than older ICD patients. In prevention of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM), these complications are critical in determining treatment thresholds. When comparing transvenous ICDs (TV), subcutaneous ICDs (SICD) may have different risks &amp; benefits that define their relative utility. We investigated TV &amp; SICD outcomes in a propensity matched cohort of HCM patients. Methods We used electronic health records in a retrospective study of HCM patients receiving an ICD between 2006-22 at tertiary centre. Indications for ICD implantation, including type of device, were determined by the treating cardiomyopathy team according to ESC guidance. All TV device types were included &amp; eligibility for SICD included passing screening in at least 1 sensing vector. Outcome data included patients lost to follow-up until the last device check &amp; patients who had both device types were included twice. Patients were censored after their first IT for an analysis of IT, &amp; their first ‘ICD complication’ for that analysis. ICD complications are defined as all other complications that resulted in a re-intervention procedure (excl SICD battery advisory), or extra procedure at box change. The audit was registered with local institutional review board for ethical approval. Propensity scoring was used for stratification and covariate adjustment. Matching was conducted using the 12 baseline variables. Associations with IT, ICD complications and their composite were assessed using proportional hazard regression (Cox) models, with time to event starting at implant date. Univariable &amp; multivariable regression analyses were used as appropriate. Hazard ratios (HRs) of 95% confidence intervals were estimated by fitting a model with the propensity score and dichotomous variable (TV vs SICD). A p value of &amp;lt;0.05 was considered statistically significant. Analyses were conducted using R- Version 2023.06.0+421. Results Mean age was 55±14.2 years with follow-up of 73±63 months; 70.7% were male. Of a total of 611 patients, with 469 in the TV group &amp; 164 in the SICD. SICD patients had fewer complications, with no differences in IT across all and propensity matched analyses (CI 0.64), fig 1. Conclusion In HCM, when compared to TV, SICDs are associated with fewer ICD complications &amp; not associated with more frequent IT. Intriguingly, there was a higher rate of IT with the first generation SICD, causing the wide IT errors at longer durations. Complications over long term follow up require more assessment, but the absence of TV lead intervention creates reduced risks for SICD complications. In HCM patients without pacing needs, SICDs may be preferred for HCM-SCD prevention. In addition, the lower risks associated with SICD could lead to lower treatment thresholds for people with elevated lifetime HCM-SCD risk.

Transcatheter versus surgical aortic valve replacement in patients younger than 65 years: analysis from the national inpatient sample database

Abstract Background Data on the relative utilization and outcomes of transcatheter aortic valve replacement (TAVR) versus surgical AVR (SAVR) in patients &amp;lt;65 years are limited. Purpose To compare the relative utilization and outcomes of TAVR versus SAVR in patients &amp;lt;65 years in the United States. Methods We queried the National Inpatient Sample (2016-2020) to identify patients &amp;lt;65 years hospitalized for isolated AVR. In-hospital outcomes of TAVR versus SAVR were compared using multivariable regression and propensity-matching analyses. Results Of 74,155 patients aged &amp;lt;65 years hospitalized for isolated AVR, 17,300 (23.3%) underwent isolated TAVR, and 56,855 (76.7%) underwent isolated SAVR. From 2016-2020, the use of TAVR increased, while the use of SAVR decreased in patients &amp;lt;65 years (both ptrend&amp;lt;0.01). Factors independently associated with TAVR selection in patients &amp;lt;65 years included female sex, congestive heart failure, pulmonary disease, renal failure, liver disease, cancer, and prior revascularization. Factors independently associated with SAVR selection included bicuspid aortic valve. After adjustment for baseline characteristics, TAVR was associated with lower odds of in-hospital mortality (adjusted odds ratio [aOR] 0.61, 95% confidence interval [CI] 0.38-0.97), stroke (aOR 0.58, 95% CI 0.38-0.90), acute kidney injury (aOR 0.41, 95% CI 0.34-0.49), and major bleeding (aOR 0.62, 95% CI 0.38-0.96), and higher vascular complications compared with SAVR (aOR 2.39, 95% CI 1.75-3.24). Length of stay was shorter and nonhome discharges were lower with TAVR (all p&amp;lt;0.01). Similar findings were observed in the propensity-matched cohort. Conclusions This nationwide observational analysis showed that TAVR is a feasible treatment option for patients &amp;lt;65 years with lower in-hospital mortality and resource utilization compared with SAVR.Central Illustration

Transcatheter vs. surgical aortic valve replacement in patients with aortic stenosis and cardiogenic shock.

Patients with aortic stenosis (AS) and cardiogenic shock (CS) are an extremely high-risk population with a poor prognosis in the absence of definitive therapy. We aimed to compare the outcomes of transcatheter aortic valve replacement (TAVR) with those of surgical aortic valve replacement (SAVR) in patients with AS-CS. We queried the Nationwide Readmission Database (2016-21) to identify patients hospitalized for AS-CS who underwent isolated TAVR or SAVR. In-hospital outcomes of TAVR vs. SAVR were compared using multivariable regression and propensity-matching analyses. Ninety-day readmissions were compared using a Cox proportional hazards regression model. A total of 16 161 patients were hospitalized for AS-CS, of whom 6470 (40.0%) underwent isolated TAVR and 9691 (60.0%) underwent isolated SAVR. From 2016 through 2021, the proportion of TAVR increased from 29.5 to 46.5% and the proportion of SAVR correspondingly decreased in AS-CS (Ptrend < 0.01). After adjustment for baseline characteristics, TAVR was associated with lower odds of stroke [adjusted odds ratio (aOR) 0.63, 95% confidence interval (CI) 0.47-0.84], acute kidney injury (aOR 0.80, 95% CI 0.69-0.93), and major bleeding (aOR 0.54, 95% CI 0.40-0.71) and higher odds of vascular complications (aOR 1.56, 95% CI 1.23-1.97) compared with SAVR. In-hospital mortality, myocardial infarction, permanent pacemaker placement, and 90-day all-cause and heart failure readmissions showed similar rates between TAVR and SAVR. However, hospital length of stay was shorter and total costs and non-home discharges were lower with TAVR than with SAVR. This nationwide observational analysis showed that TAVR is increasingly performed in patients with AS-CS and is associated with similar rates of in-hospital mortality and 90-day readmissions but lower rates of in-hospital complications and resource utilization compared with SAVR.

SGLT2-'eyes' on the reno-protection prize: reduction of post-PCI contrast-associated AKI in diabetic patients using SGLT2 inhibitors

Abstract Background Chronic therapy with sodium-glucose cotransporter 2 inhibitors (SGLT2i) is associated with long term reno-protective benefits. There are limited data on the benefits of these agents against the risk of contrast-associated acute kidney injury (CA-AKI). Purpose The goal of our study was to assess the comparative efficacy of SGLT2i for the prevention of CA-AKI in diabetic patients undergoing PCI. Methods The study population included all diabetic patients enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium Percutaneous Coronary Intervention (BMC2PCI) registry, a clinical registry of all PCI cases at non-federal hospitals in the state of Michigan, USA. Included patients underwent PCI between January 2022 and September 2023. Patients on dialysis were excluded. Predicted AKI risk was calculated using a previously validated and published machine learning BMC2 risk model. The primary outcome of CA-AKI was defined as an elevation in serum creatinine of ≥0.5 mg/dL following PCI. Risk-adjusted AKI rates were estimated by the product of event observed/expected ratio and overall collaborative AKI rate. Propensity matching on 23 covariates was used to adjust for the non-random use of SGLT2i. Results A total of 19,078 diabetic patients were included, of whom 3,087 (16.2%) were prescribed SGLT2i prior to PCI. Patients treated with SGLT2i were younger (66.1 vs 68.3 years), more likely to be men (73.3% vs 65.3%), have heart failure (50.4% vs 42.4%), have prior PCI (58.4% vs 48.8%), and have co-prescription of insulin (43.8% vs 37.3%) (p&amp;lt;0.001 for all). After propensity matching, no significant baseline difference between cohorts remained, with an absolute standardized difference less than 10% on all covariates. The pre-procedural use of SGLT2i was associated with a lower incidence of CA-AKI in unadjusted analysis (2.7% vs 3.8%, p=0.003) and after adjusting for the baseline predicted risk of CA-AKI (2.2% vs 2.8%, adjusted OR 0.69, 95% CI 0.54-0.89, p=0.0045). In a propensity-matched analysis, the use of SGLT2i was strongly associated with a reduced adjusted risk for CA-AKI (2.2 % vs 2.8%, adjusted OR 0.72, 95% CI 0.62-0.84, p=0.026). Conclusions Among patients with diabetes presenting for PCI, pre-procedural use of SGLT2i was associated with a significant reduction in the risk of CA-AKI. These results should compel further investigation into the beneficial effects of SGLT2 inhibitors in reducing the risk of CA-AKI.

Bioprosthetic versus mechanical prostheses in patients aged 50 to 70 years undergoing aortic valve replacement surgery: outcomes analysis from propensity score matching

Abstract Introduction Despite increasing use of bioprosthetic surgical aortic valve replacement (bAVR) in patients ≤70 years [1, 2], the relative benefits compared to mechanical valve replacement (mAVR) remain uncertain [3, 4]. Purpose The current study aims to compare mortality and other important clinical endpoints by prosthesis type for patients aged 50-70 years who received an AVR in a well-characterised Australian cohort. Methods A retrospective cohort study was designed utilising the WAVES Patient Registry and incorporating linked administrative outcome data including all patients who had an AVR in Western Australian public hospitals between 2010-2020. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular (CV) mortality, separately and combined with non-fatal myocardial infarction and non-fatal stroke (MACE), major bleeding, and days alive and out of hospital (DAOH). Outcomes were compared based on a propensity-matched analysis (including demographics, biometrics, and clinical characteristics). Results Within the initial cohort of 727 patients undergoing surgical AVR (mean age = 63 ± SD 6), a propensity-matched cohort identified 151 patients each with bAVR (mean age = 61 ± 4) and mAVR (mean age = 60 ± 5). Patients who received mAVR versus bAVR had improved all-cause survival (Hazard Ratio [HR] 0.50; 95% CI 0.25-0.99) but increased risk of major bleeding (HR 4.85; 95% CI 1.57-14.98). There were no significant differences in CV mortality (HR 0.58; 95% CI 0.19-1.74), MACE (HR 0.59; 95 % CI 0.32-1.07), or DAOH by prosthesis type (P = 0.452). Conclusions Patients aged 50-70 years who underwent mAVR had lower risk of all-cause mortality compared with bAVR, despite higher bleeding risk. Although risks of CV mortality and MACE were lower in mAVR, statistical significance was not reached, likely due to the small sample size. Larger studies are necessary to confirm these findings, which have important clinical implications.