Coronary Intervention Rates Research Articles

Impact of coronary artery disease and revascularization on outcomes of transcatheter aortic valve replacement for severe aortic stenosis

Background/purposeTo evaluate the impact of coronary artery disease (CAD), percutaneous coronary intervention (PCI), and coronary lesion complexity on outcomes of transcatheter aortic valve replacement (TAVR) for aortic stenosis. Methods/materialsThis retrospective study included 1042 patients divided into two groups by the presence or absence of CAD (SYNTAX score 0, no history of revascularization). Propensity score matching was used to compare the two groups. The effect of PCI, SYNTAX score, and residual SYNTAX score was also analyzed. ResultsThe median age of the cohort was 82 years, and 641 patients had CAD. After propensity score matching, 346 pairs were analyzed. During 5 years of follow-up (median: 25, range 0–72 months), the rate of coronary intervention was significantly higher in CAD patients (p = 0.018). However, all-cause mortality, composite of all-cause mortality, stroke, and coronary intervention, and overt bleeding defined by VARC-3 were comparable. After stratification, in patients with creatinine ≥1.5 mg/dl, CAD was associated with a worse composite outcome (p = 0.016). Neither PCI nor SYNTAX score was associated with all-cause mortality in CAD patients. Similarly, residual SYNTAX score showed no association with mortality in patients undergoing PCI (all p values >0.7). PCI did not reach a significant difference in overt bleeding in CAD patients (adjusted p = 0.06). ConclusionsDespite a higher incidence of coronary interventions, major clinical outcomes were similar between patients with and without CAD after TAVR. In patients with chronic kidney disease, CAD may be associated with an adverse composite outcome. Neither PCI nor SYNTAX/residual SYNTAX score influenced all-cause mortality.

In-hospital mortality of patients with acute coronary syndrome (ACS) after implementation of national health insurance (NHI) in Indonesia

BackgroundThe National Health Insurance (NHI) was implemented in Indonesia in 2014, and cardiovascular diseases are one of the diseases that have overburdened the healthcare system. However, data concerning the relationship between NHI and cardiovascular healthcare in Indonesia are scarce. We aimed to describe changes in cardiovascular healthcare after the implementation of the NHI while determining whether the implementation of the NHI is related to the in-hospital mortality of patients with acute coronary syndrome (ACS).MethodsThis is a retrospective comparative study of two cohorts in which we compared the data of 364 patients with ACS from 2013 to 2014 (Cohort 1), before and early after NHI implementation, with those of 1142 patients with ACS from 2018 to 2020 (Cohort 2), four years after NHI initiation, at a tertiary cardiac center in Makassar, Indonesia. We analyzed the differences between both cohorts using chi-square test and Mann-Whitney U test. To determine the association between NHI and in-hospital mortality, we conducted multivariable logistic regression analysis.ResultsWe observed an increase in NHI users (20.1% to 95.6%, p < 0.001) accompanied by a more than threefold increase in patients with ACS admitted to the hospital in Cohort 2 (from 364 to 1142, p < 0.001). More patients with ACS received invasive treatment in Cohort 2, with both thrombolysis and percutaneous coronary intervention (PCI) rates increasing more than twofold (9.2% to 19.2%; p < 0.001). There was a 50.8% decrease in overall in-hospital mortality between Cohort 1 and Cohort 2 (p < 0.001).ConclusionsThis study indicated the potential beneficial effect of universal health coverage (UHC) in improving cardiovascular healthcare by providing more accessible treatment. It can provide evidence to urge the Indonesian government and other low- and middle-income nations dealing with cardiovascular health challenges to adopt and prioritize UHC.

Abstract 406: Texas Out of Hospital Cardiac Arrest Disparities for Rural Patient Care From Statewide Out-of-Hospital Cardiac Arrest Data Registry - The Texas Cares Project

Introduction: Out-of-hospital cardiac (OHCA) arrest victims from rural settings suffer worse outcomes. We evaluated the association between rural setting and post-arrest care and outcomes. Hypothesis: Receiving treatment for OHCA at a rural hospital will be associated with a lower rate of post OHCA care and lower rate of favorable neurologic outcomes (cerebral performance score 1 or 2). Methods: We performed a retrospective analysis of the Texas Cardiac Arrest Registry to Enhance Survival (CARES) from 2014-2021. We included adult OHCAs not listed as DNR. We defined hospital urbanicity as the proportion of OHCAs originating from rural census tracts. We defined hospitals as rural if more than 25% of included OHCAs were rural. We evaluated the association between rural hospital status and patient and prehospital care characteristics - age, race, initial rhythm, response time, bystander CPR - and hospital care characteristics - targeted temperature management (TTM) and percutaneous coronary intervention (PCI) rates. We evaluated the association between rural hospital status and favorable neurological outcomes with logistic regression, adjusted for patient and prehospital factors, hospital care, and census tract median household income. Results: We included 31,569 encounters with OHCA at 161 unique hospitals. The rural hospital group included 1,213 OHCA encounters (3.8%) at 25 hospitals (15.5%). Patient factors between groups were similar other than a higher rate of white patients in the rural group. Rates of angiography (16.1% non rural, 17.1% rural), PCI (8.2%, 8.7%), and TTM (30.6%,34.7%) were not statistically different. Treatment at rural hospitals was not associated with a statistically significant decreased odds of good neurological outcome (aOR 1.02, 95%ci 0.83-1.24). Conclusion: Treatment for OHCA at rural hospitals was not associated with a lower rate of post OHCA care or lower rate of favorable neurologic outcome

Impact of day of admission on in-hospital outcomes of cardiogenic shock

BackgroundThe management of cardiogenic shock (CS) requires attentiveness to details and in some cases, invasive interventions. In the past, studies have shown relationships between the day of admission and cardiovascular outcomes. We aim to analyze the trends and in-hospital outcomes of patients admitted with CS over the weekends compared to weekdays. MethodWe identified all patients with CS from the National Inpatient Sample (NIS) database between 2016 and 2020. Using multivariate logistic regression analysis, baseline demographics and in-hospital outcomes were obtained and compared by weekend or weekday admission. ResultsOut of 854,684 CS admissions, 199,255 (23.6%) occurred on weekends. Patients admitted over the weekend had worse outcomes, including higher rates of mortality (aOR 1.09 CI 1.05 – 1.11, p<0.001), cardiac arrest (aOR 1.09 CI 1.04 -1.14, p<0.001), and respiratory failure. We also noted higher percutaneous coronary intervention (PCI) rates (aOR 1.2 CI 1.16 – 1.25, p<0.001) but lower rates of pulmonary artery catheterization (PAC) and post-procedure pneumothorax. Weekend admissions had shorter hospital lengths of stay, and they incurred lower charges ($223,222 vs. $247,908).Between 2016 and 2020, we observed a consistent downward trend in the mortality rates of the weekend and weekday CS admissions, with consistently higher weekend than weekday admissions. ConclusionWeekend admissions for CS are associated with worse outcomes, which have persisted for years. This now begs the question of whether physician dissatisfaction, understaffing, or burn-out are responsible for this finding.

Prehospital resuscitation : Current status, results and strategies for improvement in Germany

Out-of-hospital cardiac arrest (OHCA) is one of the most frequent causes of death in Europe and is associated with adismal prognosis. The annual incidence in Germany is approximately 100-120 per 100,000 inhabitants (ca. 80,000-100,000 cases). With the use of cardiopulmonary resuscitation (CPR) about 40% of patients have areturn of spontaneous circulation (ROSC); however, after OHCA only 15% of patients survive for 30 days and less than 10% survive with no or only minor neurological deficits. Data from the German Resuscitation Register demonstrate that there was no change in the results over the last 15years, despite all medical innovations, higher rates of coronary interventions, higher use of mechanical support systems and improvement in intensive care treatment. Ahigh proportion of patients with OHCA have acardiac or coronary cause. As shown by the data from the German Cardiac Arrest Register (G-CAR) an early coronary angiography is often carried out after CPR in Germany; however, in randomized clinical studies an immediate coronary angiography in patients with non-ST segment elevation in the electrocardiogram (ECG) was not associated with an improvement in the prognosis. In large randomized studies the use of mechanical CPR systems and the implantation of mechanical circulatory support devices after OHCA also did not lead to a reduction in mortality. The most important impact factor for the success of CPR is the time interval between collapse and start of CPR, if possible also by bystander resuscitation. Therefore, the focus of efforts for improving CPR should be on increasing the rate of patients with early CPR. Experiences from Denmark and The Netherlands indicate that this can be successful by education and training of the general population, telephone resuscitation and apps for alerting lay persons.

Pre-discharge heart failure with reduced ejection fraction In elderly patients after myocardial infarction

Background: The prognosis of elderly people with myocardial infarction has improved over the past decade thanks to advances in treatment, but the rate of heart failure due to coronary heart disease continues to increase. Currently, little is known about heart failure with reduced ejection fraction (HFrEF) before discharge in older adults with myocardial infarction. Objective: To determine the rate of pre-discharge heart failure with reduced ejection fraction in elderly patients after myocardial infarction and related factors. Methods: Cross-sectional study involving older patients with myocardial infarction from September 2022 to March 2023 in the Interventional Cardiology Department, Thong Nhat Hospital and the Interventional Cardiology Department, University Medical Center at Ho Chi Minh city. Results: Of 326 ≥ 60 years old patients presented with myocardial infarction, 100 patients (30.7%) had HFrEF before discharge. Compared with the non-HFrEF group, the pre-discharge HFrEF was older and more frail, had a lower rate of coronary angiography and coronary intervention. There was no difference in the BCIS-JS scores between 2 groups, although the pre-discharge BCIS-JS ratio was lower in the HFrEF group. Conclusion: In elderly patients with myocardial nfarction, our study found that the rate of pre-discharge HFrEF was 30.7%. The HFrEF group had a higher number of frail patients, more likely to be medically treated alone, and there was no difference in BCIS-JS scores. Key words: elderly patients; frailty; myocardial infarction; heart failure after myocardial infarction; heart failure reduced ejection fraction.

Use of a prosthetic conduit for stent delivery in transcarotid artery revascularization for patients with unfavorable anatomy.

Transcarotid artery revascularization (TCAR) provides a safe alternative to carotid endarterectomy. The anatomic requirements include a 5-cmminimum clavicle to carotid bifurcation distance for sheath access proximal to the lesion. In the present report, we describe our experience with conduit use for patients not meeting that requirement. Patients undergoing elective TCAR with a conduit from 2021 to 2022 were retrospectively identified. After carotid artery exposure, a 6-mm prosthetic graft was anastomosed to the common carotid artery in an end-to-side fashion. After stent delivery, the conduit was ligated and oversewn. The patient demographics, procedural details, and outcomes were recorded and compared with our nonconduit TCAR experience. A total of 11 patients (64% male; age, 75± 5years) underwent TCAR with a conduit, 5 (46%) for symptomatic disease, and 77 patients underwent TCAR with no conduit, 52 (60%) with symptomatic disease (P= .50). Other than a higher rate of prior coronary interventions in the conduit group (55% vs 47%; P= .007), no significant differences were found in age, gender, race, comorbidities, or high risk for carotid endarterectomy criteria. In the conduit group, the average skin to carotid artery depth was 4.2cm (range, 1.9-6.1cm). The average clavicle to bifurcation distance was 4.4cm (range, 3.3-4.9cm) vs 6.5cm (range, 3.3-9.7cm; P= .002) in the nonconduit group. Dacron was the most common conduit material used (73%). No differences were found in the mean procedure times (121± 32 vs 129± 53minutes; P= .785) or flow reversal times (14± 5 vs 19± 13minutes; P=.989) for the conduit and nonconduit cohorts, respectively. Technical success was achieved in 100% of the conduit and nonconduit cases. Excluding one outlier of a prolonged stay (7days) for management of unrelated medical issues (gastrostomy tube placement for chronic dysphagia after mass resection and neck radiation), the mean hospital stay was 2days (1.2± 0.4 intensive care unit days) compared with 3.8± 5.7days for our nonconduit cohort (P= .2). Hypotension was the most common reason for delayed discharge for the conduit group (n=3; 27%). The average follow-up was 2.7months (range, 1-10months). For all 11 conduit patients, the stent remained patent without stenosis, thrombus, or pseudoaneurysm at the conduit stump site on surveillance duplex ultrasound. No strokes or complications had occurred at 30days in the conduit group compared with four strokes or transient ischemic attacks (P= .469) and 18 minor complications in the nonconduit group (P= .091). For patients lacking a sufficient distance between the clavicle and carotid artery bifurcation, a prosthetic conduit facilitates safe use of flow reversal for stent delivery and can be ligated at procedural completion without consequences.

Predictors of non-calcified plaque presence and future adverse cardiovascular events in symptomatic rural Appalachian patients with a zero coronary artery calcium score

BackgroundCoronary artery calcium (CAC) scoring is a proven predictor for future adverse cardiovascular events (CVE) in asymptomatic individuals. Data is emerging regarding the usefulness of non-calcified plaque (NCP) assessment on cardiac computed tomography (CCT) angiography in symptomatic patients with a zero CAC score for further risk assessment. MethodsA retrospective review from January 2019 to January 2022 of 696 symptomatic patients with no known CAD and a zero CAC score identified 181 patients with NCP and 515 patients without NCP by a visual assessment on CCT angiography. The primary endpoint was to identify predictors for NCP presence and adverse CVEs (death, myocardial infarction, or cerebrovascular accident) within two years. ResultsBased on logistic regression, age (OR 1.039, 95% CI [1.020–1.058], p ​< ​0.001), diabetes mellitus (OR 2.192, 95% CI [1.307–3.676], p ​< ​0.003), tobacco use (OR 1.748, 95% CI [1.157–2.643], p ​< ​0.008), low-density lipoprotein cholesterol level (OR 1.009, 95% CI [1.003–1.015], p ​< ​0.002), and hypertension (OR 1.613, 95% CI [1.024–2.540], p ​< ​0.039) were found to be predictors of NCP presence. NCP patients had a higher pretest probability for CAD using the Morise risk score (p ​< ​0.001∗), with NCP detection increasing as pretest probability increased from low to high (OR 55.79, 95% CI [24.26–128.26], p ​< ​0.001∗). 457 patients (66%) reached a full two-year period after CCT angiography completion, with NCP patients noted to have shorter follow-up times and higher rates of elective coronary angiography, intervention, and CVEs. The presence of NCP (aOR 2.178, 95% CI [1.025–4.627], p ​< ​0.043) was identified as an independent predictor for future adverse CVEs when adjusted for diabetes mellitus, age, and hypertension. ConclusionNCP was identified at high rates (26%) in our symptomatic Appalachian population with no known CAD and a zero CAC score. NCP was identified as an independent predictor of future adverse CVEs within two years.

Acute heart failure with mildly reduced ejection fraction and myocardial infarction: a multi-institutional cohort study

BackgroundLittle research has been done on ischemic outcomes related to left ventricular ejection fraction (EF) in acute decompensated heart failure (ADHF).MethodsA retrospective cohort study was conducted between 2001 and 2021 using the Chang Gung Research Database. ADHF Patients discharged from hospitals between January 1, 2005, and December 31, 2019. Cardiovascular (CV) mortality and heart failure (HF) rehospitalization are the primary outcome components, along with all-cause mortality, acute myocardial infarction (AMI) and stroke.ResultsA total of 12,852 ADHF patients were identified, of whom 2,222 (17.3%) had HFmrEF, the mean (SD) age was 68.5 (14.6) years, and 1,327 (59.7%) were males. In comparison with HFrEF and HFpEF patients, HFmrEF patients had a significant phenotype comorbid with diabetes, dyslipidemia, and ischemic heart disease. Patients with HFmrEF were more likely to experience renal failure, dialysis, and replacement. Both HFmrEF and HFrEF had similar rates of cardioversion and coronary interventions. There was an intermediate clinical outcome between HFpEF and HFrEF, but HFmrEF had the highest rate of AMI (HFpEF, 9.3%; HFmrEF, 13.6%; HFrEF, 9.9%). The AMI rates in HFmrEF were higher than those in HFpEF (AHR, 1.15; 95% Confidence Interval, 0.99 to 1.32) but not in HFrEF (AHR, 0.99; 95% Confidence Interval, 0.87 to 1.13).ConclusionAcute decompression in patients with HFmrEF increases the risk of myocardial infarction. The relationship between HFmrEF and ischemic cardiomyopathy, as well as optimal anti-ischemic treatment, requires further research on a large scale.

Generalizability of an EHR-network dataset to the United States for cardiovascular disease conditions: Comparison of Cerner real world data with the national inpatient sample

Electronic Health Record (EHR) data from health systems are increasingly being combined for clinical research purposes. Yet, it remains unclear whether these large EHR data sources provide a representative assessment of national disease prevalence and treatment. To evaluate this, we compared Cerner RealWorldData (CRWD), a large EHR data source, to those seen in the National Inpatient Sample (NIS) for three cardiovascular conditions (myocardial infarction (MI), congestive heart failure (CHF), and stroke. Adult patients (age ≥18 years) hospitalized with MI, CHF, and stroke were identified in both CRWD (86 health systems) and the NIS (4,782 hospitals). Patient demographics, comorbidities, procedures, outcomes (length of stay and in-hospital mortality) and hospital type (teaching or non-teaching) were compared between NIS and CRWD patients. Of 86 health systems participating in CRWD, 33 were excluded for potential data quality issues which accounted for about 11% of hospitalizations in the dataset, leaving 53 for inclusion in analysis which accounted for about 89% of hospitalizations in the dataset. Between January 1st 2017 and December 31st 2018, 116,956 MI, 188,107 CHF, and 93,968 stroke hospitalizations were identified in CRWD versus 2,245,300 MI, 4,310,745 CHF, and 1,333,480 stroke hospitalizations in the NIS. Patient demographics were similar among patients in CWRD and the NIS for all three cardiovascular groups except for ethnicity, with underrepresentation of Hispanic individuals in CRWD vs the NIS. Patients hospitalized in CRWD had a slightly higher proportion of coded co-morbidities compared with NIS hospitalizations due to a longer potential look-back period. For patients with MI, hospital mortality, length of stay, coronary artery bypass graft (CABG) rates, and percutaneous coronary intervention (PCI) rates were similar between CRWD and NIS. Additionally, there was similar in hospital mortality and length of stay for those with CHF and stroke hospitalizations between CRWD and NIS. On aggregate, characteristics of hospitalizations for MI, CHF, and stroke using EHR data from one nationwide EHR-derived database, CRWD, appears similar to characteristics of hospitalizations in the nationally representative NIS. Important limitations of CRWD include lack of geographic representativeness, under-representation of Hispanic adults, and the need to exclude health systems for missing data.

B-27 | Rotational vs. Orbital Atherectomy Procedural Outcomes: A NCDR Data Registry Study

Rotational (RA) and orbital (OA) atherectomy for severely calcified coronary artery lesions (CCAS) may improve overall clinical outcomes. Little recent data comparing in-hospital outcomes between these methods exists. Patients undergoing OA or RA between 2016-2021 at 7 IU Health Hospitals were identified in the Indiana University Health Multicenter Cath Registry. Data was collected as defined by the National Cardiovascular Data Registry. Outcomes were analyzed by age, treated lesion length (TLL), and left ventricular ejection fraction (LVEF). In total, 868 patients (210 RA and 658 OA) were analyzed. RA and OA patients had similar age (RA: 50.6±11.27 years, OA: 51.2±9.88 years, p=0.51), TLL (RA: 41.2±25.49 mm, OA: 42.32±23.9 mm, p=0.56), and LVEF (RA: 50.6±12.8%, OA: 51.2±14%, p=0.60). OA patients had more dyslipidemia (0.91±0.28, p=0.02) and RA patients had higher rate of prior coronary intervention (0.62±0.49, p<0.001). Outcomes between RA and OA groups were not statistically significant (Table 1). On subgroup analysis, RA patients with LVEF < 35% had significantly more cardiac tamponade events (0.05±0.21, p=0.046). This retrospective multicenter analysis demonstrates that OA and RA have comparable clinical and procedural outcomes and are equally safe and effective in our institutions. Overall, events were low in both groups, but operators used OA 3.1 times more often to treat CCAS.

Comparison of care and outcomes for myocardial infarction by heart failure status between United Kingdom and Japan.

Prognosis for ST-segment elevation myocardial infarction (STEMI) is worse when heart failure is present on admission. Understanding clinical practice in different health systems can identify areas for quality improvement initiatives to improve outcomes. In the absence of international comparison studies, we aimed to compare treatments and in-hospital outcomes of patients admitted with ST elevation myocardial infarction (STEMI) by heart failure status in two healthcare-wide cohorts. We used two nationwide databases to capture admissions with STEMI in the United Kingdom (Myocardial ischemia National Audit Project, MINAP) and Japan (Japanese Registry of All Cardiac and Vascular Diseases-Diagnostic Procedure Combination, JROAD-DPC) between 2012 and 2017. Participants were stratified using the HF Killip classification into three groups; Killip 1: no congestive heart failure, Killip 2-3: congestive heart failure, Killip 4: cardiogenic shock. We calculated crude rate and case mix standardized risk ratios (CSRR) for use of treatments and in-hospital death. Patients were younger in the United Kingdom (65.4 [13.6] vs. 69.1 [13.0] years) and more likely to have co-morbidities in the United Kingdom except for diabetes and hypertension. Japan had a higher percentage of heart failure and cardiogenic shock patients among STEMI during admission than that in the United Kingdom. Primary percutaneous coronary intervention (pPCI) rates were lower in the United Kingdom compared with Japan, especially for patients presenting with Killip 2-3 class heart failure (pPCI use in patients with Killip 1, 2-3, 4: Japan, 86.2%, 81.7%, 78.7%; United Kingdom, 79.6%, 58.2% and 79.9%). In contrast, beta-blocker use was consistently lower in Japan than in the United Kingdom (61.4% vs. 90.2%) across Killip classifications and length of hospital stay longer (17.0 [9.7] vs. 5.0 [7.4] days). The crude rate of in-hospital mortality increased with increasing Killip class group. Both the crude rate and CSRR was higher in the United Kingdom compared with Japan for Killip 2-3 (15.8% vs. 6.4%, CSRR 1.80 95% CI 1.73-1.87, P<0.001), and similar for Killip 4 (36.9% vs. 36.3%, CSRR 1.11 95% CI 1.08-1.13, P<0.001). Important differences in the care and outcomes for STEMI with heart failure exist between the United Kingdom and Japan. Specifically, in the United Kingdom, there was a lower rate of pPCI, and in Japan, fewer patients were prescribed beta blockers and hospital length of stay was longer. This international comparison can inform targeted quality improvement programmes to narrow the outcome gap between health systems.

Abstract 13539: The Effect of Emergency versus Delayed Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-segment Elevation: A Meta-Analysis of Randomized Clinical Trials

Introduction. The prognosis of patients with out-of-hospital cardiac arrest (OHCA) is poor, with high mortality rates and poor neurological outcomes. Early coronary angiography (CAG) is recommended in patients with ST-segment elevation myocardial infarction (STEMI) associated with cardiac arrest; however, performing early or delayed CAG in patients with OHCA without STEMI is unclear. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) to investigate the efficacy of early versus delayed CAG in patients with OHCA without STEMI. Methods. We searched Web of Science, SCOPUS, EMBASE, PubMed (MEDLINE), and CENTRAL from inception till June 2022. We included only RCTs that compared early versus delayed CAG in patients with OHCA. The main outcomes were percutaneous coronary intervention (PCI) rate, 30-day all-cause mortality, and neurological recovery (cerebral performance category (CPC) &lt; 3). We used the fixed-effect model to pool the risk ratio (RR) with a 95% confidence interval (CI). Results. We included seven RCTs with a total of 2104 patients. The overall risk ratio showed no difference between early and delayed CAG regarding PCI rate (RR: 1.06 with 95% [0.92, 1.23] p= 0.43), 30 days mortality (RR: 1.08 with 95% CI [0.97, 1.20] p= 0.15, and neurological recovery (RR: 1.04 with 95% CI [0.95, 1.13] p= 0.4). Conclusion. Among patients who experience an OHCA without STEMI, a strategy of performing early CAG provided no benefits in respect to the rate of PCI, 30 days mortality, and neurological recovery compared to delayed CAG.

10-Year Temporal Trends of In-Hospital Mortality and Emergency Percutaneous Coronary Intervention for Acute Myocardial Infarction.

The mortality rate of acute myocardial infarction (AMI) has improved dramatically because of reperfusion therapy during the last 40 years; however, recent temporal trends for AMI have not been fully clarified in Japan. The purpose of this study was to elucidate the temporary trend in in-hospital mortality and treatment of AMI for the last decade in the Tokyo Metropolitan area. We enrolled 30,553 patients from the Tokyo Cardiovascular Care Unit Network Registry, diagnosed with AMI from 2007 to 2016, as part of an ongoing, multicenter, cohort study. We analyzed the temporal trends in basic characteristics, treatment, and in-hospital mortality of AMI. The overall emergency percutaneous coronary intervention (PCI) rate significantly increased (P< 0.001). In particular, it remarkably increased in patients older than 80 years of age (58.3% to 70.3%, P< 0.001) and patients with Killip III or IV (Killip III, 46.9% to 65.7%; Killip IV, 65.2% to 76.6%, P< 0.001 for both). The crude and age-adjusted in-hospital mortality remained low (5.2% to 8.2% and 3.4% to 5.5%, respectively) and significantly decreased during the decade (P< 0.001). The in-hospital mortality remarkably decreased in patients older than 80 years of age (17.3% to 12.7%, P< 0.001) and in those with cardiogenic shock (38.5% to 27.3%, P< 0.001). This large cohort study from Tokyo revealed that in-hospital mortality of AMI significantly decreased with the increase in emergency percutaneous coronary intervention rate over the decade, particularly for high-risk patients such as older patients and those with cardiogenic shock.

Predictive value of post-percutaneous coronary intervention fractional flow reserve: a systematic review and meta-analysis.

We aimed to investigate the relationship between post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) and clinical outcome using a systematic review with a study-level meta-analysis. MEDLINE, Embase, and CENTRAL were systematically searched for articles with clinical follow-up reporting mean or median final post-PCI FFR. The main outcome was a composite of major adverse cardiac events (MACE) including all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR). Meta-regression analyses were performed on mean post-PCI FFR values. A total of 62 studies with 12340 patients and 12923 stented vessels were included, with follow-ups ranging from 1 to 89 months. Post-PCI FFR was not continuously associated with the rate of 1-year MACE or 1-year TVR using meta-regression models accounting for heterogeneous follow-up lengths. For studies comparing high vs. low post-PCI FFR, low post-PCI FFR was associated with high risk ratio for MACE {1.97 [95% confidence interval (CI):1.45-2.67]}, all-cause death [1.59 (95% CI: 1.08-2.34)], MI [3.18 (95% CI: 1.84-5.50)], TVR [2.08 (95% CI: 1.63-2.65)] and angina status [2.50 (95% CI: 1.53-4.06)] using different optimal cut-off values spanning from 0.80 to 0.95. We found no clear continuous association between post-PCI FFR and clinical outcomes in this systematic study-level meta-analysis. In a subset of studies investigating binary classification, high post-PCI FFR was associated with a better clinical outcome than low post-PCI FFR.We investigated the relationship between post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) and rate of major adverse cardiac events (MACE), including all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR), using a systematic review and study-level meta-analysis, pooling 12340 patients from 62 studies. Mean post-PCI FFR was not continuously associated with a 1-year MACE rate accounting for heterogenous follow-up lengths. Still, the risk ratio favoured high post-PCI FFR for reduced MACE, all-cause death, MI, TVR, and better angina status using different cut-offs.

12 years of implementation of cardiovascular intervention techniques at of Hue University of Medicine and Pharmacy Hospital

Background: Cardiovascular Center has implemented interventional cardiology techniques since 2009 including coronary stenting, congenital heart intervention and pacemaker placement. Percutaneous coronary intervention is currently an effective treatment method for coronary artery disease. Congenital heart diseases by Amplatzer device is an effective method of treatment of congenital heart diseases. Permanent pacemaker implantation is currently the most effective modern treatment for dangerous bradyarrhythmias. Methods: All cases of coronary artery stenosis with indications for intervention, congenital heart disease including atrial septal defect, ventricular septal defect, and ductus arteriosus with the indication for intervention by percutaneous occlusion, bradyarrhythmias have indications for pacemaker placement were included in the study. Methods of book research, retrospective. Results: 1) The rate of emergency coronary intervention 26.7%. The success rate of the procedure is 95.0%. The complication rate of coronary intervention in highrisk patients was 9.4%. 2) There were 254 (68.8%) cases of VVI(R) single-chamber pacemaker and 115 (31.2%) cases of dual-chamber pacing. The complication rate was 4.6%. The success rate of the procedure is 98.7%. 3) The results of the percutaneous septal defect occlusion procedure achieved a complete success of 93.33%, ductal occlusion achieved a complete success of 100%, and ventricular septal defect occlusion with the Amplatzer instrument achieved 100% success. 100% successful results after 3 months of follow-up. Complications in patients after occlusion of atrial septal defect with Amplatzer device were 6.67%, and no complications in the group with ductus arteriosus and ventricular septal defect were noted. Conclusion: Interventional coronary stenting, pacemaker placement, and congenital heart disease interventions are safe and effective methods with high success rates. Key words: Cardiovascular intervention, deployment

Cardiovascular disease risk factors and outcomes of acute myocardial infarction in young adults in two nationwide cohorts in the united states

Abstract Funding Acknowledgements Type of funding sources: None. Background Acute myocardial infarction (AMI) can have considerable morbidity and devastating socioeconomic and psychological consequences in young adults. Previous studies reveal that the decline in mortality in AMI has mainly been in the older population while being comparatively less significant in younger patients. This study compares young adults (18 to 44 years) hospitalized with AMI across two nationwide cohorts, 2007 and 2017, in the United States (US). It examines the burden of AMI hospitalizations, the prevalence of comorbidities, and in-hospital outcomes in young adults a decade apart. It highlights the rise in AMI hospitalizations, lack of decrease in mortality, sex-based and racial disparities, the surge in post-MI complications, and the decline in reperfusion interventions in young AMI patients over a decade. Purpose Coronary heart disease prevalence is challenging to ascertain in younger adults because of limited data and frequent silent clinical presentations. AMI and its complications can cause considerable morbidity, psychological trauma, and socioeconomic burden in the young. Methods We identified hospitalizations for AMI in young adults in 2007 and 2017 using the weighted data from the National Inpatient Sample (NIS), which covers 20% of stratified data of all non-federal community hospitals in the US. We compared the following data between the two cohorts: admission rates, sociodemographic features, in-hospital morbidity, complications, mortality, rate of coronary interventions, and healthcare utilization between the two cohorts. We used Pearson’s Chi-square test and Mann-Whitney U test to compare categorical and continuous variables, respectively. We also applied multivariable regression analyses to assess and compare the risk of cardiovascular complications and in-hospital mortality while controlling for confounders, including age, sex, race, median household income quartile, primary insurance enrolment, and pre-existing comorbidities. Results AMI’s incidence was higher in males in both the cohorts, although with a decline (71.1% vs 66.1%), whereas it rose from 28.9% to 33.9% in females. Hypertension (47.8% vs 60.7%), smoking (49.7% vs 55.8%), obesity (14.8% vs 26.8%), and diabetes mellitus (22.0% vs 25.6%) increased in the 2017 cohort (Table 1). We found no significant difference in all-cause mortality (aOR = 1.01 (0.93-1.10), p=0.749). Post-AMI complications, cardiogenic shock (aOR = 1.16 (1.06-1.27), p=0.001), and fatal arrhythmias increased. Reperfusion interventions decreased in the 2017 cohort (PCI; aOR=0.95 (0.91-0.98), p&amp;lt;0.001; CABG; aOR=0.66 (0.61-0.71), p&amp;lt;0.001) (Table 2). Conclusion Our study highlights the rise in AMI hospitalizations, plateauing of mortality, gender disparity, the surge in post-MI complications, and a reassuring decline in the requirement of reperfusion interventions in young AMI patients over a decade.

Factors Associated with the Extent of Coronary Artery Disease and the Attained Outcome of Percutaneous Coronary Intervention at Gesund Cardiac and Medical Center, Addis Ababa, Ethiopia.

In Ethiopia, objective evidences showing pathologic features and clinical characteristics predicting the extent of coronary artery disease are scanty. The present study is aimed at assessing factors associated with the extent of coronary artery disease and the attained outcomes in patients undergoing percutaneous coronary intervention. A retrospective observational study of 197 patients that have undergone percutaneous coronary intervention was undertaken. Data were entered using Epi data version 4.2 and exported to Statistical Package for Social Science version 25 for analysis. Descriptive statistics such as frequencies and percentages were used to summarize the findings. Logistic regression was carried out to test the association between dependent and independent variables. The mean age of the study participants was 58.6 with standard deviation (SD) of 11.5 and male to female ratio of 4.2. The majority, [110 (55.8%)], had ST segment elevation myocardial infarction. Nearly two-third of the study participants had documented heart failure. Dyslipidemia [AOR 4.2(95%; CI:1.29-14.00)] and left ventricular hypertrophy [AOR 4.1(95%; CI:1.38-12.40)] were associated with extent of coronary artery disease on adjusted analysis. In the large majority, 169 patients (85.8%), thrombolysis in myocardial infarction 3 flow grade was achieved. Dyslipidemia and left ventricular hypertrophy predicted multi-vessel coronary artery disease. There is a high frequency of post myocardial infarction heart failure, underscoring the need for centers of excellence and implementation of health education programs targeting the importance of primary prevention and timely revascularization. The success rate of percutasneous coronary intervention at Gesund Cardiac and Medical Center is praiseworthy.

Abstract MP39: Association Of Race And Ethnicity On The Management Of Acute Non-st Elevation Myocardial Infarction

Background: Whether differences in acute coronary syndrome (ACS) management are explained or attenuated by social risk factors has important implications for the development of interventions to address health inequities. We examined the associations between (1) race and ethnicity and (2) annual household income with the management of non-ST elevation Myocardial Infarction (NSTEMI). Hypothesis: We hypothesized we would identify racial and ethnic differences in the acute management of NSTEMI and that annual household income would attenuate such differences. Methods: We employed administrative claims of commercially insured and Medicare Advantage beneficiaries (Optum’s de-identified Clinformatics® Data Mart Database) to examine the rates of coronary angiography and percutaneous coronary intervention (PCI) by race and ethnicity as well as the contributions of social risk factors, particularly annual household income, toward racial and ethnic differences. Race and ethnicity were categorized as Asian, Black, Hispanic, or White. Covariates included demographics (age, sex); conditions compromising the Elixhauser Comorbidity Index; and social risk factors (annual household income, educational attainment). Results: We identified 87,094 individuals (age 73.8±11.6 years; 55.6% male; 2.6% Asian, 13.4% Black, 11.2% Hispanic, 72.7% White) with NSTEMI events from 2017 to 2019. The overall incidence rate for coronary angiography was 555 per 1,000 individuals (95% Confidence Interval [CI] 550-560) and for PCI was 297 per 1,000 (95% CI 293-300). Individuals of Black race were 7% less likely to undergo coronary angiography (95% CI 1.02-1.12) and 17% less likely to undergo PCI (95% CI 1.11-1.23) than those of White race. Hispanic individuals were 13% less likely (95% CI 1.08-1.19) to undergo coronary angiography and 18% less likely to undergo PCI (95% CI 1.12-1.24) than White individuals. Higher annual household income attenuated differences in the receipt of PCI for Asian and Black individuals but not those of Hispanic ethnicity. Conclusion: We identified significant racial and ethnic differences in the management of individuals presenting with NSTEMI that were marginally attenuated by higher household income. Our findings demonstrate continued evidence of health inequities in contemporary ACS treatment.

Impact of COVID-19 on Acute MI and Percutaneous Coronary Intervention Rates and Outcomes in South East Asia and the Middle East

Background: Previous studies have reported mixed findings regarding the effects of COVID-19 on percutaneous coronary intervention (PCI) and acute MI (AMI) procedural volumes and case fatalities, as well as on ST-elevation MI (STEMI) door-to-balloon time (DTB). This study characterised the effects of COVID-19 on AMI and PCI volumes and mortality outcomes in countries from Asia and the Middle East, which faced repeated waves of COVID-19. Methods: Pooled data on AMI and PCI case volumes were collected in 4-weekly blocks from Malaysia, Singapore and Abu Dhabi from 2019 (pre-COVID-19) and 2020 (during COVID-19). These were compared against reported COVID-19 case numbers. Case fatality rates, STEMI patient demographics and STEMI DTB times were compared between the pre- and during COVID-19 periods. Results: During the COVID-19 pandemic, there was a comparative reduction in non-STEMI (NSTEMI) cases in Singapore (from 814 to 722; p=0.025) and Malaysia (from 925 to 604; p&lt;0.001), but not in Abu Dhabi (from 144 to 188; p=0.010). PCI volumes fell significantly in Singapore (from 13,089 to 11,449; p=0.020), but not in Malaysia or Abu Dhabi. STEMI volume remained similar before and during COVID-19. There were no significant differences in in-hospital mortality for NSTEMI, STEMI or PCI between the two periods. Conclusion: COVID-19 resulted in a fall in NSTEMI and PCI cases, potentially as a result of patients deferring contact with healthcare institutions. With appropriate protocols and systems, it is possible to provide coronary intervention services in the middle of a pandemic without compromising on mortality or DTB outcomes.