Abstract 15087: Identifying Clinical Predictors of Mortality After PCI and the Impact of Complete Revascularization in Patients With Multi-vessel Coronary Artery Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zaid N Safiullah ◽  
Jianhui Zhu ◽  
Catalin Toma ◽  
Floyd W Thoma ◽  
Anson J Smith ◽  
...  
Keyword(s):  
Heart Failure ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Complete Revascularization ◽  
Clinical Predictors ◽  
Specific Patient ◽  
All Cause Mortality ◽  
Incomplete Revascularization ◽  
Artery Disease ◽  
Vessel Coronary Artery

Coronary revascularization for multi-vessel coronary artery disease (mvCAD) can be established through PCI or CABG. The benefit of surgical intervention over PCI has been attributed, in part, to more complete revascularization. However, among patients treated with PCI in the present era of drug-eluting stents, it is important to understand whether the completeness of revascularization is associated with mortality. Further, it is important to investigate this relationship in specific patient populations to determine which patients, if any, derive a survival benefit from complete revascularization. Moreover, it is critical to identify which factors are associated with higher mortality in this population to pinpoint potential areas of intervention to mitigate risk. In this propensity-score adjusted analysis, outcomes among 1,580 mvCAD patients who underwent PCI were analyzed and stratified by complete versus incomplete revascularization. The primary outcome was all-cause mortality. Complete revascularization was achieved in 28.4% of the cohort. Complete revascularization was not independently associated with survival compared with incomplete revascularization in the overall cohort (p=0.16). The predictors of increased all-cause mortality included advanced age, chronic lung disease, cardiogenic shock, diabetes, renal insufficiency, reduced left ventricular function, and left main stenosis. Complete revascularization was associated with reduced all-cause mortality in specific patient subsets including those with congestive heart failure and chronic lung disease. Our analysis elucidated numerous clinical predictors of all-cause mortality for mvCAD patients undergoing PCI. Complete revascularization was not among the independent predictors of mortality in the overall population and was associated with reduced mortality in patients with chronic lung disease, history of congestive heart failure and those who did not have previous PCI. While this study was not designed to test whether complete revascularization was superior to incomplete revascularization, the results suggest that when PCI is pursued among patients with mvCAD, achieving complete revascularization does not contribute to increased mortality.

scholarly journals Determinants and Impact of Heart Failure Readmission Following Transcatheter Aortic Valve Replacement

2020 ◽  
Vol 13 (7) ◽  
Author(s):  
Vincent Auffret ◽  
Abdelkader Bakhti ◽  
Guillaume Leurent ◽  
Marc Bedossa ◽  
Jacques Tomasi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Grade Iii

Background: Heart failure (HF) readmission is common post–transcatheter aortic valve replacement (TAVR). Nonetheless, limited data are available regarding its predictors and clinical impact. This study evaluated the incidence, predictors, and impact of HF readmission within 1-year post-TAVR, and assessed the effects of the prescription of HF therapies at discharge on the risk of HF readmission and death. Methods: Patients included in the TAVR registry of a single expert center from 2009 to 2017 were analyzed. Competing-risk and Cox regressions were performed to identify predictors of HF readmission and death. Results: Among 750 patients, 102 (13.6%) were readmitted for HF within 1-year post-TAVR. Overall, 53 patients (7.1%) experienced late readmissions (>30 days post-TAVR), and 17 (2.3%) had multiple readmissions. In ≈30% of readmissions, no trigger could be identified. Predominant causes of readmissions were changes in medication/nonadherence and supraventricular arrhythmia. Independent predictors of HF readmission included diabetes mellitus, chronic lung disease, previous acute HF, grade III or IV aortic regurgitation, and pulmonary hypertension both at discharge from the index hospitalization but not HF therapies. Overall, HF readmission did not significantly impact all-cause mortality (hazard ratio [HR], 1.36 [95% CI, 0.99–1.85]). However, late (HR, 1.90 [95% CI, 1.30–2.78]) and multiple HF readmissions (HR, 2.10 [95% CI,1.17–3.76]) were significantly associated with all-cause mortality. Prescription of renin-angiotensin system inhibitors at discharge was associated with a lower rate of all-cause mortality, especially among patients receiving doses of 25% to <50% (HR, 0.67 [95% CI, 0.48–0.94]) and 75% to 100% (HR, 0.61 [95% CI, 0.37–0.98]) of the optimal daily dose. Conclusions: HF readmission is common within 1-year of TAVR. Late and multiple HF readmissions associate with an increased risk of long-term all-cause mortality. Baseline comorbidities (diabetes, chronic lung disease, previous acute HF) and echocardiographic findings at discharge (grade III or IV aortic regurgitation, pulmonary hypertension) identified patients at high risk of HF readmission.

scholarly journals Determinants, impact, and association with heart failure therapies of heart failure readmission after transcatheter aortic valve replacement

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Auffret ◽  
A Bakhti ◽  
G Leurent ◽  
M Bedossa ◽  
S Sharobeem ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Grade Iii

Abstract Aims To evaluate the incidence, predictors, and impact of heart failure (HF) readmission within 1-year post-transcatheter aortic valve replacement (TAVR), and assess the effects of the prescription of guidelines-recommended therapies (i.e. renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists) at discharge on the risk of HF readmission and death. Methods and results Patients included in the TAVR registry of a single expert centre from 2009 to 2017 were analysed. Competing-risk and Cox regressions were performed to identify predictors of HF readmission and death. Among 750 patients, 102 (13.6%) were readmitted for HF within 1-year post-TAVR. The 30-day incidence of HF readmission was 6.6%, 53 patients (7.1%) experienced late readmissions (&gt;30 days post-TAVR), and 17 (2.3%) had multiple readmissions. Independent predictors of HF readmission included diabetes mellitus, chronic lung disease, previous acute HF, grade III or IV aortic regurgitation, and pulmonary hypertension both at discharge from the index hospitalisation but not guidelines-recommended therapies. Overall, HF readmission did not significantly impact all-cause mortality (HR: 1.36, 95% CI: 0.99–1.85). However, late (HR: 1.90, 95% CI: 1.30–2.78) and multiple HF readmissions (HR: 2.10, 95% CI: 1.17–3.76) were significantly associated with all-cause mortality. Prescription of RAS inhibitors at discharge was associated with a lower rate of all-cause mortality, especially among patients receiving doses of 25–&lt;50% (HR: 0.67, 95% CI: 0.48–0.94), and 75–100% (HR: 0.61, 95% CI: 0.37–0.98) of the optimal daily dose. Conclusion HF readmission is common within 1-year of TAVR. Late and multiple HF readmissions associate with an increased risk of long-term all-cause mortality. Baseline comorbidities (diabetes, chronic lung disease, previous acute HF) and echocardiographic findings at discharge (grade III or IV aortic regurgitation, pulmonary hypertension) identified patients at high-risk of HF readmission. Guidelines-recommended therapies did not significantly affect the 1-year risk of HF readmission. Funding Acknowledgement Type of funding source: None

Abstract 11242: Impact of Peripheral Artery Disease on Prognosis in Heart Failure Patients

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yuichi Nakamura ◽  
Akiomi Yoshihisa ◽  
Hiroyuki Kunii ◽  
Mai Takiguchi ◽  
Takeshi Shimizu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Ischemic Heart Disease ◽  
Cardiac Death ◽  
Independent Predictor ◽  
Cardiac Mortality ◽  
Peripheral Artery ◽  
All Cause Mortality ◽  
Artery Disease

Background: A history of peripheral artery disease (PAD) is an independent predictor of cardiac mortality in patients with ischemic heart disease. However, it still remains unclear whether PAD predicts worsening heart failure (HF), cardiac and all-cause mortality in HF patients. Methods and Results: Consecutive 388 HF patients admitted to our hospital for the treatment of decompensated HF were divided into 2 groups based on the presence of PAD: HF with PAD (PAD group, n = 103) and HF without PAD (non-PAD group, n = 285). We compared echocardiographic and laboratory findings, and followed the event of worsening HF, cardiac death, non-cardiac death, and all-cause mortality between the two groups. The PAD group, as compared to non-PAD group, had 1) higher age (69.2 vs. 64.5 years old, P=0.001), 2) higher incidence of New York Heart Association functional class III or IV (56.3% vs. 37.2%, P = 0.001), 3) lower levels of hemoglobin (12.3 vs. 12.9 g/dl, P = 0.020), 4) higher levels of B-type natriuretic peptide (591.0 vs. 256.9 pg/ml, P = 0.017), 5) lower estimated glomerular filtration rate (GFR) (46.2 vs. 58.9 ml/min/1.73m 2 , P < 0.001), and 6) lower left ventricular ejection fraction (42.0 vs. 48.7%, P < 0.001). In the follow-up period (mean 765.6 days), Kaplan-Meier analyses (Figure) showed that the event-free survival from worsening HF, cardiac death, non-cardiac death and all-cause death was significantly higher in non-PAD group than in PAD group (P = 0.017, P < 0.001, P = 0.001 and P = 0.005, respectively, by a log-rank test). In the Cox proportional hazard analyses after adjusting for age, gender, ejection fraction, estimated GFR, and the presence of ischemic heart disease, PAD was an independent predictor of cardiac death (hazard ratio (HR) 2.09, P = 0.019) and all-cause mortality (HR 2.16, P = 0.002) in HF patients. Conclusions: PAD is an independent predictor of cardiac mortality and all-cause mortality in HF patients.

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