Abstract 17088: In-Hospital Complications and Outcomes of Leadless Pacemaker Implantation: A Propensity-Score Matched Analysis From Nationwide Database

Introduction: There are no randomized controlled trials that compared the outcomes of leadless pacemaker (L-PPM) implantation with transvenous pacemaker (TV-PPM) and there is scarcity of data on real world outcomes. Methods: We queried National Inpatient Sample to identify all adult patients who had primary discharge diagnosis of conduction disorders or tachy-arrhythmias and excluded patients who had a concomitant procedure for valve replacement, coronary artery bypass grafting, ablation and/or cardiac implantable electronic device removal so that complications can be attributed to the pacemaker implantation. We included only procedures from November 2016 to December 2017 as Micra was the only available L-PPM during that period. For the comparison cohort we selected patients, during the same time period, who had a procedure code for single chamber pacemaker implantation in conjunction with right ventricular lead placement. We performed 1:1 propensity score matching and the variables used for matching are marked with asterisk in Table 1. All the codes used to identify complications has been previously validated from the Micra Post-approval registry and Coverage with Evidence Study. Results: Total of 1,305 patients for L-PPM and 13,905 patients in the TV-PPM group were included. Baseline characteristics with standardized mean difference before and after matching are shown in Table 1. Briefly, patients in L-PPM group were younger but had higher co-morbidities compared to TV-PPM group. The complications before and after matching are shown in Table 2. Conclusions: In conclusion, we found no significant difference between in-hospital complications after propensity score matching, with the exception of deep venous thrombosis. There was no difference between length of stay but cost for L-PPM was significantly higher. In this real-world analysis, we found that the leadless PPM implantation is safe in comparison to transvenous PPM.

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P965Prevalence, management strategies and outcomes of patients with coronary chronic total occlusions

European Heart Journal ◽

10.1093/eurheartj/ehz747.0559 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Guo ◽

J Wu ◽

L Zhong ◽

R C Huang

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Clinical Outcomes ◽

Cardiac Death ◽

Cardiovascular Health ◽

Artery Bypass ◽

Management Strategies ◽

Chronic Total Occlusions ◽

Significant Difference

Abstract Background Percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTOs) remains among the biggest challenges in interventional cardiology. However, limited data exist regarding the clinical outcomes of the three potential therapeutic strategies of PCI, coronary artery bypass grafting (CABG), and medical therapy (MT). Aims The aim of this study was to compare the clinical outcomes of CTO patients according to the initial treatment strategy. Methods and results Consecutive patients with at least one coronary CTO from January 2007 to December 2016 in our center were included and categorized as managed either by PCI, CABG, or MT. Propensity-score matching was also performed to adjust for baseline characteristics. The primary outcome was a major adverse cardiac event (MACE), such as cardiac death, myocardial infarction (MI), or target vessel revascularization (TVR). A total of 1655 patients with 1944 CTOs were enrolled in this study. The overall CTO prevalence was 10.5%. A CTO was treated by MT in 800 (48.3%) patients and PCI in 734 (44.4%), while 121 (7.3%) underwent CABG. The median overall follow-up duration was 3.6 (interquartile range = 2.1 to 5.0) years. Patients referred for MT had a higher incidence of MACE (28.0% vs. 17.3% and 12.4%, respectively; all p<0.001) and TVR (16.9% vs. 10.6% and vs. 7.4%, respectively; p<0.001 and = 0.005, respectively) than those managed by PCI and CABG. After propensity-score matching analysis, the rate of PCI was lower than that of MACE (19.2% vs. 28.9%, hazard ratio [HR] = 0.62, 95% confidence interval [CI] = 0.45–0.85, p=0.003) and TVR (HR = 0.53, 95% CI = 0.35–0.79, p=0.002) when compared with MT. There was no significant difference in the prevalence of MACE (18.5% vs. 23.1%, HR = 0.76, 95% CI = 0.53–1.09, p=0.126) or cardiac death (0.51; 0.23–1.15, 0.098) between the successful PCI and MT groups. Conclusions As an initial management strategy for patients with CTOs, PCI or CABG reduced the risk of MACE (driven by TVR), as compared with MT alone on follow-up. However, successful PCI did not reduce the long-term risk of MACE or cardiac death, as compared with MT alone. Acknowledgement/Funding Beijing Municipal Science and Technology Project (Z1611ehz747.05590516139) and BeijingLisheng Cardiovascular Health Foundation (LHJJ20158521)

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Effectiveness of Teicoplanin Versus β-lactam for Bacteremia Due to Methicillin-Susceptible Staphylococcus Aureus: A Propensity Score-Based Study

10.21203/rs.3.rs-59403/v1 ◽

2020 ◽

Author(s):

Chen-Hsiang Lee ◽

Ching-Yen Tsai ◽

I-Ling Chen

Keyword(s):

Staphylococcus Aureus ◽

Risk Factor ◽

Treatment Group ◽

Propensity Score ◽

Propensity Score Matching ◽

Clinical Outcomes ◽

Significant Risk ◽

Outcome Analysis ◽

Significant Difference ◽

Before And After

Abstract Background: Many studies have shown that vancomycin is inferior to β-lactam antibiotics in terms of effectiveness in the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. However, limited data are available regarding the comparison of clinical outcomes between patients receiving initial teicoplanin and those receiving β-lactam antibiotics for MSSA bacteremia.Methods: Eighty-four adults with MSSA bacteremia were included: initial teicoplanin treatment group (n=28) and β-lactam treatment group (n=56). The two groups were further stratified based on propensity score matching according to the outcome analysis using a logistic regression model. We investigated the clinical outcomes between the groups before and after propensity score matching after treatment completion.Results: Pittsburgh bacteremia score ≥4 (odds ratio, 60.6; 95%CI, 7.4–496.8) was an independent risk factor for unfavorable outcome. After propensity score matching, the initial teicoplanin treatment group and the β-lactam treatment group consisted of 28 patients each. No statistically significant differences were observed in the proportions of patients with favorable outcomes and 30-day overall mortality rates between the groups before and after propensity score matching after the completion of teicoplanin or β-lactam treatment. The Kaplan-Meier 30-day survival curve also showed no significant difference between the patients receiving initial teicoplanin treatment and those receiving β-lactam treatment before and after matching (hazard ratio, 1.84, 95%CI, 0.60–5.64; and 3.12, 95%CI, 0.98–9.99, respectively).Conclusions: There were no significant difference in clinical outcomes between initial teicoplanin treatment and β-lactam treatment among patients with MSSA bacteremia. Pittsburgh bacteremia score ≥4 was a significant risk factor for mortality.

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Rapid Deployment Aortic Valve Replacement with the Perceval S and Intuity Elite

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1716892 ◽

2020 ◽

Author(s):

Oliver J. Liakopoulos ◽

Stephen Gerfer ◽

Parwis Rahmanian ◽

Kaveh Eghbalzadeh ◽

Ilija Djordjevic ◽

...

Keyword(s):

Aortic Valve ◽

Propensity Score ◽

Aortic Valve Replacement ◽

Propensity Score Matching ◽

Valve Replacement ◽

Propensity Score Analysis ◽

Artery Bypass ◽

Pacemaker Implantation ◽

Effective Orifice Area ◽

Rapid Deployment

Abstract Background Rapid deployment aortic valve replacement (RDAVR) has emerged as an alternative to conventional aortic valve replacement. This single-center study retrospectively analyzed clinical outcomes and hemodynamic performance of the Perceval S (LivaNova) and Intuity Elite (Edwards LifeSciences) rapid deployment valves (RDVs) in a propensity score matched patient cohort. Methods A total of 372 consecutive patients with symptomatic aortic valve stenosis underwent RDAVR between 2012 and 2018 at our institution. The Intuity Elite (INT group) and Perceval S (PER group) were implanted in 251 and 121 patients, respectively. After 1:1 propensity score matching for relevant preoperative comorbidities, 107 patient pairs were compared with respect to relevant perioperative data including hemodynamic parameter, postoperative pacemaker implantation, and 30-day all-cause mortality. Results Propensity score matching resulted in balanced characteristics between groups. Cardiopulmonary bypass and aortic cross-clamp time did not differ between groups, but more patients in the INT group received coronary artery bypass grafting compared with the PER group (56 vs. 42%; p = 0.055). Thirty-day mortality (4.7 vs. 2.2%) and need for permanent pacemaker implantation (7 versus 4.4%) were comparable between the INT and PER groups for isolated AVR and also for combined procedures, respectively. Cerebrovascular events showed comparable low rates for both RDVs (INT group [1.9%] vs. PER group [2.8%]). Indexed effective orifice area was higher in the INT group (0.90 vs. 0.82 cm2/m2) and coupled to a lower peak (17 ± 7 vs. 22 ± 8) and mean (10 ± 5 vs. 12 ± 4) pressure gradients compared with the PER group. Conclusions Our propensity score analysis in AVR patients showed good hemodynamic characteristics with comparable 30-day mortality rate and complications rates for both investigated RDVs.

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Teicoplanin versus β-lactam for febrile patients with Staphylococcus-like bacteremia: focus on methicillin-susceptible Staphylococcus aureus bacteremia

BMC Infectious Diseases ◽

10.1186/s12879-021-06111-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ching-Yen Tsai ◽

Chen-Hsiang Lee ◽

I-Ling Chen

Keyword(s):

Staphylococcus Aureus ◽

Risk Factor ◽

Treatment Group ◽

Propensity Score ◽

Propensity Score Matching ◽

Clinical Outcomes ◽

Significant Risk ◽

Outcome Analysis ◽

Significant Difference ◽

Before And After

Abstract Background Many studies have shown that vancomycin is inferior to β-lactam antibiotics in terms of effectiveness in the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. However, limited data are available regarding the comparison of clinical outcomes between patients receiving initial teicoplanin and those receiving β-lactam antibiotics for MSSA bacteremia. Methods Eighty-four adults with MSSA bacteremia were included: initial teicoplanin treatment group (n = 28) and β-lactam treatment group (n = 56). The two groups were further stratified based on propensity score matching according to the outcome analysis using a logistic regression model. We investigated the clinical outcomes between the groups before and after propensity score matching after treatment completion. Results Pittsburgh bacteremia score ≥ 4 (odds ratio, 60.6; 95%CI, 7.4–496.8) was an independent risk factor for unfavorable outcome. After propensity score matching, the initial teicoplanin treatment group and the β-lactam treatment group consisted of 28 patients each. No statistically significant differences were observed in the proportions of patients with favorable outcomes and 30-day overall mortality rates between the groups before and after propensity score matching after the completion of teicoplanin or β-lactam treatment. The Kaplan-Meier 30-day survival curve also showed no significant difference between the patients receiving initial teicoplanin treatment and those receiving β-lactam treatment before and after matching (hazard ratio, 1.84, 95%CI, 0.60–5.64; and 3.12, 95%CI, 0.98–9.99, respectively). Conclusions There were no significant difference in clinical outcomes between initial teicoplanin treatment and β-lactam treatment among patients with MSSA bacteremia. Pittsburgh bacteremia score ≥ 4 was a significant risk factor for mortality.

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Effectiveness of teicoplanin versus β-lactam for bacteremia due to methicillin-susceptible Staphylococcus aureus: a propensity score-based study

10.21203/rs.3.rs-59403/v2 ◽

2020 ◽

Author(s):

Ching-Yen Tsai ◽

Chen-hsiang Lee ◽

I-Ling Chen

Keyword(s):

Staphylococcus Aureus ◽

Risk Factor ◽

Treatment Group ◽

Propensity Score ◽

Propensity Score Matching ◽

Clinical Outcomes ◽

Significant Risk ◽

Outcome Analysis ◽

Significant Difference ◽

Before And After

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Multiple arterial coronary bypass grafting is associated with greater survival in women

Heart ◽

10.1136/heartjnl-2020-317737 ◽

2020 ◽

pp. heartjnl-2020-317737

Author(s):

Derrick Y Tam ◽

Rodolfo V Rocha ◽

Jiming Fang ◽

Maral Ouzounian ◽

Joanna Chikwe ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Artery Bypass ◽

Cox Proportional Hazards Model ◽

Multivessel Disease ◽

Administrative Databases ◽

Rank Test ◽

Bypass Grafting ◽

Significant Difference ◽

Arterial Grafting

ObjectiveMultiple arterial grafting (MAG) in coronary artery bypass grafting (CABG) is associated with higher survival and freedom from major adverse cardiac and cerebrovascular events (MACCEs) in observational studies of mostly men. It is not known whether MAG is beneficial in women. Our objectives were to compare the long-term clinical outcomes of MAG versus single arterial grafting (SAG) in women undergoing CABG for multivessel disease.MethodsClinical and administrative databases for Ontario, Canada, were linked to obtain all women with angiographic evidence of left main, triple or double vessel disease undergoing isolated non-emergent primary CABG from 2008 to 2019. 1:1 propensity score matching was performed. Late mortality and MACCE (composite of stroke, myocardial infarction, repeat revascularisation and death) were compared between the matched groups with a stratified log-rank test and Cox proportional-hazards model.Results2961 and 7954 women underwent CABG with MAG and SAG, respectively, for multivessel disease. Prior to propensity-score matching, compared with SAG, those who underwent MAG were younger (66.0 vs 68.9 years) and had less comorbidities. After propensity-score matching, in 2446 well-matched pairs, there was no significant difference in 30-day mortality (1.6% vs 1.8%, p=0.43) between MAG and SAG. Over a median and maximum follow-up of 5.0 and 11.0 years, respectively, MAG was associated with greater survival (HR 0.85, 95% CI 0.75 to 0.98) and freedom from MACCE (HR 0.85, 95% CI 0.76 to 0.95).ConclusionsMAG was associated with greater survival and freedom from MACCE and should be considered for women with good life expectancy requiring CABG.

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Empiric use of anticoagulation in hospitalized patients with COVID-19: a propensity score-matched study of risks and benefits

Biomarker Research ◽

10.1186/s40364-021-00283-y ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Bo Yu ◽

Victor Perez Gutierrez ◽

Alex Carlos ◽

Gregory Hoge ◽

Anjana Pillai ◽

...

Keyword(s):

Mechanical Ventilation ◽

Propensity Score ◽

Propensity Score Matching ◽

Major Bleeding ◽

Risk Estimation ◽

Large Population ◽

Invasive Mechanical Ventilation ◽

Bleeding Risk ◽

Hospitalized Patients ◽

Significant Difference

Abstract Background Hospitalized patients with COVID-19 demonstrate a higher risk of developing thromboembolism. Anticoagulation (AC) has been proposed for high-risk patients, even without confirmed thromboembolism. However, benefits and risks of AC are not well assessed due to insufficient clinical data. We performed a retrospective analysis of outcomes from AC in a large population of COVID-19 patients. Methods We retrospectively reviewed 1189 patients hospitalized for COVID-19 between March 5 and May 15, 2020, with primary outcomes of mortality, invasive mechanical ventilation, and major bleeding. Patients who received therapeutic AC for known indications were excluded. Propensity score matching of baseline characteristics and admission parameters was performed to minimize bias between cohorts. Results The analysis cohort included 973 patients. Forty-four patients who received therapeutic AC for confirmed thromboembolic events and atrial fibrillation were excluded. After propensity score matching, 133 patients received empiric therapeutic AC while 215 received low dose prophylactic AC. Overall, there was no difference in the rate of invasive mechanical ventilation (73.7% versus 65.6%, p = 0.133) or mortality (60.2% versus 60.9%, p = 0.885). However, among patients requiring invasive mechanical ventilation, empiric therapeutic AC was an independent predictor of lower mortality (hazard ratio [HR] 0.476, 95% confidence interval [CI] 0.345–0.657, p < 0.001) with longer median survival (14 days vs 8 days, p < 0.001), but these associations were not observed in the overall cohort (p = 0.063). Additionally, no significant difference in mortality was found between patients receiving empiric therapeutic AC versus prophylactic AC in various subgroups with different D-dimer level cutoffs. Patients who received therapeutic AC showed a higher incidence of major bleeding (13.8% vs 3.9%, p < 0.001). Furthermore, patients with a HAS-BLED score of ≥2 had a higher risk of mortality (HR 1.482, 95% CI 1.110–1.980, p = 0.008), while those with a score of ≥3 had a higher risk of major bleeding (Odds ratio: 1.883, CI: 1.114–3.729, p = 0.016). Conclusion Empiric use of therapeutic AC conferred survival benefit to patients requiring invasive mechanical ventilation, but did not show benefit in non-critically ill patients hospitalized for COVID-19. Careful bleeding risk estimation should be pursued before considering escalation of AC intensity.

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Chemoembolization Plus Radiotherapy versus Chemoembolization Plus Sorafenib for the Treatment of Hepatocellular Carcinoma Invading the Portal Vein: A Propensity Score Matching Analysis

Cancers ◽

10.3390/cancers12051116 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1116 ◽

Cited By ~ 1

Author(s):

Hee Ho Chu ◽

Jin Hyoung Kim ◽

Ju Hyun Shim ◽

Sang Min Yoon ◽

Pyeong Hwa Kim ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Propensity Score ◽

Portal Vein ◽

Propensity Score Matching ◽

Combined Treatment ◽

Correct Selection ◽

Advanced Hepatocellular Carcinoma ◽

Entire Study ◽

Treatment Type ◽

Significant Difference

A combination of transarterial chemoembolization (TACE) plus sorafenib or radiotherapy (RT) has demonstrated efficacy in patients with advanced hepatocellular carcinoma (HCC). Here, the two combined treatment approaches were compared in patients with HCC and portal vein tumor thrombus (PVTT). Data from 307 patients treated with TACE plus RT (n = 203) or TACE plus sorafenib (n = 104) as first-line treatment for HCC with PVTT were retrospectively evaluated. Using the propensity model to correct selection bias, 87 patients were included from each treatment group. During follow up (median, 12 months) in the entire study population, the median progression-free survival (PFS) and overall survival (OS) were significantly longer in the TACE plus RT group than in the TACE plus sorafenib group (6.5 vs. 4.3 months, respectively; p = 0.017 and 16.4 vs. 12 months, respectively; p = 0.007). Following propensity score matching, the median PFS and OS in the two groups showed no statistically significant difference. Multivariable analysis found no significant association between PFS or OS and the treatment type. In conclusion, this retrospective study of data from patients with advanced HCC with PVTT shows that PFS and OS did not differ significantly in patients treated with TACE plus RT and TACE plus sorafenib.

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Clinical features and outcomes of combined hepatocellular carcinoma and cholangiocarcinoma versus hepatocellular carcinoma versus cholangiocarcinoma after surgical resection: a propensity score matching analysis

BMC Gastroenterology ◽

10.1186/s12876-020-01586-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chih-Wen Lin ◽

Tsung-Chin Wu ◽

Hung-Yu Lin ◽

Chao-Ming Hung ◽

Pei-Min Hsieh ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Surgical Resection ◽

Disease Free Survival ◽

Clinicopathological Features ◽

Free Survival ◽

Before And After ◽

Disease Free

Abstract Background Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is an infrequent type of primary liver cancer that comprises hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). This study investigated the clinicopathological features and prognosis among cHCC-CC, HCC, and CC groups. Methods We prospectively collected the data of 608 patients who underwent surgical resection for liver cancer between 2011 and 2018 at E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. Overall, 505 patients with cHCC-CC, HCC, and CC were included, and their clinicopathological features, overall survival (OS), and recurrence were recorded. OS and recurrence rates were analyzed using the Kaplan–Meier analysis. Results In the entire cohort, the median age was 61 years and 80% were men. Thirty-five (7.0%) had cHCC-CC, 419 (82.9%) had HCC, and 51 (10.1%) had CC. The clinicopathological features of the cHCC-CC group were more identical to those of the HCC group than the CC group. OS was significantly lower in the cHCC-CC group than in the HCC group but was not significantly higher in the cHCC-CC group than in the CC group. The median OS of cHCC-CC, HCC, and CC groups was 50.1 months [95% confidence interval (CI): 38.7–61.2], 62.3 months (CI: 42.1–72.9), and 36.2 months (CI: 15.4–56.5), respectively. Cumulative OS rates at 1, 3, and 5 years in cHCC-CC, HCC, and CC groups were 88.5%, 62.2%, and 44.0%; 91.2%, 76.1%, and 68.0%; and 72.0%, 48.1%, and 34.5%, respectively. After propensity score matching (PSM), OS in the cHCC-CC group was not significantly different from that in the HCC or CC group. However, OS was significantly higher in the HCC group than in the CC group before and after PSM. Furthermore, the disease-free survival was not significantly different among cHCC-CC, HCC, and CC groups before and after PSM. Conclusion The clinicopathological features of the cHCC-CC group were more identical to those of the HCC group than the CC group. The OS rate was significantly lower in the cHCC-CC group than the HCC group. However, after PSM, OS and disease-free survival in the cHCC-CC group were not significantly different from those in the HCC or CC group.

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