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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Incidence and Outcomes of Acute Coronary Syndrome After Transcatheter Aortic Valve Replacement
JACC: Cardiovascular Interventions, Volume 13, No. 8, Year 2020
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Description
Objectives: This study sought to address a knowledge gap by examining the incidence, timing, and predictors of acute coronary syndrome (ACS) after transcatheter aortic valve replacement (TAVR) in Medicare beneficiaries. Background: Evidence about incidence and outcomes of ACS after TAVR is scarce. Methods: We identified Medicare patients who underwent TAVR from 2012 to 2017 and were admitted with ACS during follow-up. We compared outcomes based on the type of ACS: ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina. In patients with non–ST-segment elevation ACS, we compared outcomes based on the treatment strategy (invasive vs. conservative) using inverse probability weighting analysis. Results: Out of 142,845 patients with TAVR, 6,741 patients (4.7%) were admitted with ACS after a median time of 297 days (interquartile range: 85 to 662 days), with 48% of admissions occurring within 6 months. The most common presentation was NSTEMI. Predictors of ACS were history of coronary artery disease, prior revascularization, diabetes, valve-in-TAVR, and acute kidney injury. STEMI was associated with higher 30-day and 1-year mortality compared with NSTEMI (31.4% vs. 15.5% and 51.2% vs. 41.3%, respectively; p < 0.01). Overall, 30.3% of patients with non–ST-segment elevation ACS were treated with invasive approach. On inverse probability weighting analysis, invasive approach was associated with lower adjusted long-term mortality (adjusted hazard ratio: 0.69; 95% confidence interval: 0.66 to 0.73; p < 0.01) and higher risk of repeat revascularization (adjusted hazard ratio: 1.29; 95% confidence interval: 1.16 to 1.43; p < 0.001). Conclusions: After TAVR, ACS is infrequent (<5%), and the most common presentation is NSTEMI. Occurrence of STEMI after TAVR is associated with a high mortality with nearly one-third of patients dying within 30 days. Optimization of care is needed for post-TAVR ACS patients and if feasible, invasive approach should be considered in these high-risk patients. © 2020 American College of Cardiology Foundation
Authors & Co-Authors
Mentias, Amgad
United States, Iowa City
University of Iowa Carver College of Medicine
Desai, Milind Y.
United States, Cleveland
Cleveland Clinic Foundation
Saad, Marwan
United States, Providence
Brown University
Horwitz, Phillip A.
United States, Iowa City
University of Iowa Carver College of Medicine
Rossen, James D.
United States, Iowa City
University of Iowa Carver College of Medicine
Panaich, Sidakpal S.
United States, Iowa City
University of Iowa Carver College of Medicine
Elbadawi, Ayman
United States, Galveston
The University of Texas Medical Branch at Galveston
Abbott, Jinnette Dawn
United States, Providence
Brown University
Sorajja, Paul
United States, Minneapolis
Abbott Northwestern Hospital
Jneid, Hani M.
United States, Houston
Baylor College of Medicine
Tuzcu, Murat
United States, Cleveland
Cleveland Clinic Foundation
Kapadia, Samir R.
United States, Cleveland
Cleveland Clinic Foundation
Vaughan-Sarrazin, Mary S.
United States, Iowa City
Iowa City va Health Care System
Statistics
Citations: 33
Authors: 13
Affiliations: 7
Identifiers
Doi:
10.1016/j.jcin.2019.11.027
ISSN:
19368798
Research Areas
Environmental
Noncommunicable Diseases
Violence And Injury
Study Design
Cohort Study