A Weekend Effect for PCI?
Few large-scale studies have assessed whether or not PCI procedures conducted during the weekend result in worse outcomes than procedures performed on weekdays. Nearly 1.3 million adults who underwent PCI were included in a study that compared in-hospital mortality after admission for PCI among those admitted during the weekend or on a weekday. The mortality rate observed for weekend admissions was 2.1%, compared with a rate of 1.2% that was seen in those receiving PCI on weekdays. PCI patients admitted on the weekend had an average length of stay of 4.2 days, whereas those admitted during weekdays stayed an average of 2.9 days.
Reducing Leg Inflammation After PAD Treatment
Patients who undergo percutaneous transluminal angioplasty and atherectomy for peripheral artery disease (PAD) often experience leg inflammation. For a study, researchers assessed rates of two inflammatory biomarkers at baseline as well as 24 hours after angioplasty or atherectomy in patients with PAD. Patients were randomized to receive an injection of a corticosteroid into the arterial wall immediately following the procedure or no such injection. At 24 hours after atherectomy or angioplasty, high-sensitivity C-reactive protein increased only 14% and 55%, respectively, for those who received the corticosteroid injection; the biomarker increased 138% and 208%, respectively, for controls. Also at 24 hours after atherectomy or angioplasty, monocyte chemoattractive protein-1 levels decreased 52% and 39%, respectively, for injection recipients, compared with increases of 16% and 17%, respectively, for controls.
Gender Differences in TAVR Outcomes
Previous studies have suggested gender-specific differences in outcomes following transcatheter aortic valve replacement (TAVR). A secondary analysis of data from a large trial assessed gender-specific outcomes of high-risk patients who underwent TAVR. At 48 hours after the procedure, rates of short-term bleeding were similar, registering about 8% for both genders. Rates of the combined endpoint of mortality, myocardial infarction, stroke, and major bleeding at up to 30 days were 16% for women and 15% for men. Women were older at baseline but had lower rates of diabetes and coronary artery disease. The authors noted that the study did not account for several potential confounders.
PCI for STEMI & 30-Day Mortality
Prior research on mortality in patients undergoing PCI during ST-elevation myocardial infarction (STEMI) indicates that most deaths are related to procedural complications. The relationship between cause of death and PCI in STEMI has not been well defined. Using a standardized data collection form, two cardiologists determined the cause and circumstance of death for patients who underwent PCI for STEMI for a study. More than 88% of deaths occurred during hospital admission. Refractory cardiogenic shock on admission was the most common cause of death (68%), followed by post-procedural left ventricular failure (26%). The investigators determined that 96% of deaths were mostly or entirely unpreventable.
Taking a Minimalist Approach to TAVR
For a study, researchers instituted a minimalist approach to transcatheter aortic valve replacement (TAVR) that included moderate sedation, no pulmonary artery or urinary catheters, arterial line removal within 4 hours, no post-TAVR narcotics, mobilization at 4 hours, ambulation within 8 hours, and reinstitution of home antihypertensive therapy (except atrioventricular nodal blockers) within 4 hours. Outcomes were compared before and after implementation of this minimalist approach. Investigators found that the treatment strategy was associated with significantly lower rates of 30-day mortality and significantly reduced average lengths of stay. The minimalist approach also led to more discharges within 1 or 2 days, a higher likelihood of patients being discharged home, and no increases in 30-day readmission rates.
TAVR Vs SAVR in Prior Transplant Patients
Evidence suggests that patients who previously received a non-cardiac organ transplant may be at particularly high risk if they are being considered for transcatheter aortic valve replacement (TAVR). Study investigators evaluated outcomes and complications among transplant patients who underwent TAVR or surgical aortic valve replacement (SAVR). In-hospital, all-cause mortality, surgical site infections, and vascular complication rates were similar for both treatment groups. SAVR was associated with a longer length of stay and higher total hospitalization costs. SAVR was also associated with higher rates of blood transfusion and increased rates of acute kidney injury. TAVR was associated with higher rates of requiring permanent pacemaker implantation. All-cause mortality was lower with TAVR following a propensity score-matched analysis.
NEWS FROM SCAI 2017