Incidence, outcomes, and predictors of in‐hospital acute coronary syndrome following endovascular transcatheter aortic valve replacement in the United States. Issue 5 (23rd December 2019)

• Record Type: Journal Article
• Authors: Nazir, Salik; Ahuja, Keerat R.; Donato, Anthony; Grande, Robert D.; Changal, Khalid; Gad, Mohamed M.; Saad, Anas; Verma, Beni R.; Syed, Mubbasher A.; Sheikh, Mujeeb; Kapadia, Samir; Ramanathan, P. Kasi
• Is Part Of: Catheterization and cardiovascular interventions. Volume 96:Issue 5(2020)
• Page Start: E527
• Page End: E534
• Publication Date: 2019-12-23
• Subjects: acute coronary syndrome -- outcomes -- transcatheter aortic valve replacement; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.28648
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Background: Incidence and outcomes of acute coronary syndrome (ACS) immediately following transcatheter aortic valve replacement (TAVR) remain largely unknown. Objectives: This study sought to assess the incidence, clinical characteristics, and outcomes of ACS following TAVR. Methods: We queried the National Readmission Database from January 2012 to September 2015 for TAVR admissions with and without ACS, creating a propensity‐matched cohort to compare outcomes. Results: A total of 48, 454 patients underwent TAVR, with 1, 332 (2.75%) developing ACS. TAVR patients with ACS compared to those without ACS had a significantly higher incidence of acute kidney injury (24.7 vs. 19.2%; p = .001), ischemic stroke (3.7 vs. 2.3%; p = .04), vascular complications (8.6 vs. 5.8%; p = .008), cardiogenic shock (9.8 vs. 1.9%; p < .001), cardiac arrest (5.1 vs. 2.8%; p = .002), mechanical circulatory support (8.1 vs. 1.5%; p < .001), and in‐hospital mortality (9.6 vs. 3.4%; p < .001). Additionally, TAVR with ACS had longer lengths of stay (median 10 days vs. 6 days; p < .001) and hospital charges (median $23, 200 vs. $19, 000; p < .001). Positive predictors of ACS were history of PCI (odds ratio, 1.43; 95% CI: 1.25–1.63), hyperlipidemia (odds ratio, 1.20; 95% CI: 1.07–1.34), chronic blood loss anemia (odds ratio, 2.16; 95% CI: 1.54–3.03), chronic kidney disease (odds ratio, 1.17; 95% CI: 1.04–1.31), fluid and electrolyte disorders (odds ratio, 1.65; 95% CI: 1.47–1.85), and weight loss (odds ratio, 1.53; 95% CI: 1.22–1.91). Heart failure (34%) was the most common reason for readmission in the ACS cohort. Conclusion: ACS after TAVR is uncommon but is associated with worse clinical outcomes and increased healthcare resource utilization.