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Early readmissions (ERs) impose a huge cost to the health care system, lower patients'' quality of life, and may be an indicator of quality of initial care. We performed this single-center study to assess the incidence, predictors, and implications of 30-day readmission after percutaneous coronary intervention (PCI) in a tertiary care rural setting. In 4,262 consecutive patients who underwent PCI, we evaluated 30-day readmission rates and assessed demographic, clinical, and angiographic correlates of ER. Using Cox regression analyses, we estimated the multivariable impact of an ER on 1-year all-cause mortality and major adverse events (MACEs; death, myocardial infarction, target vessel revascularization, stent thrombosis). ER occurred in 486 patients (11.4%) including 366 (8.6%) for cardiac reasons and 120 (2.8%) for noncardiac reasons. Multivariable models predicting any readmission, cardiac readmission, and noncardiac readmission had c-statistic values of 0.63, 0.63, and 0.68, respectively. One-year mortality and MACEs were higher in the readmitted versus not readmitted patients (7.9% vs 3.2%, 18 vs 9.7%, p <0.0001 for the 2 comparisons). ER had a significant and independent impact on 1-year mortality (adjusted hazards ratio 2.2, 95% confidence interval 1.4 to 3.4) and MACEs (hazards ratio 2.2, 95% confidence interval 1.8 to 2.8). In conclusion, readmission within 30 days after PCI is common and frequently related to cardiac causes. Patients who require an ER after PCI have higher 1-year mortality and MACEs. [Copyright &y& Elsevier]

Previous studies have shown impressive short- and medium-term outcomes from drug-eluting stent (DES) implantation in coronary artery disease. We assessed long-term outcomes from DES versus bare metal stent (BMS) implantation in standard and off-label lesions. In 2,345 patients who survived event-free for ≥30 days after stent implantation for standard (n = 1,540, 66%) or off-label (805, 34%) lesions, we assessed time to occurrence of death, myocardial infarction (MI), death or MI, stent thrombosis, target vessel revascularization (TVR), and major adverse cardiovascular events (defined as composite of all study outcomes). Comparisons were made between standard and off-label lesion subsets and between DES and BMS in lesion subsets. Multivariable differences in outcomes between DES versus BMS were assessed using propensity-adjusted proportional hazards regression. Median follow-up duration was 3.4 years. Stenting of off-label lesions was associated with uniformly worse outcomes than stenting of standard lesions. After adjustment for lesion classification, propensity to receive DES, and baseline differences, DES implantation was associated with statistically significant decreases in death (adjusted hazard ratio 0.71, 95% confidence interval 0.51 to 0.98), TVR (hazard ratio 0.58, 95% confidence interval 0.39 to 0.85 for off-label subset; hazard ratio 0.33, 95% confidence interval 0.24 to 0.46 for standard subset), and major adverse cardiovascular events (hazard ratio 0.51, 95% confidence interval 0.42 to 0.61), without increase in MI, death/MI, or stent thrombosis. Elective TVR occurred in 272 patients and resulted in only 1 early death. In conclusion, compared with BMS, use of DES is associated with clinical benefit in standard and off-label lesions at late follow-up. Decrease in elective TVR does not explain the apparent mortality benefit from DES implantation. [Copyright &y& Elsevier]

Contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) has multiple definitions. We attempted to identify the optimal definition of CIN. In 985 patients undergoing PCI (derivation group), we assessed the prognostic significance of 4 commonly used contemporary definitions of CIN (increases in serum creatinine after PCI [δCr] >1.0 mg/dl, >0.5 mg/dl, and >25% after PCI; and the American College of Cardiology National Cardiovascular Data Registry definition) with respect to 6-month major adverse cardiovascular events (MACEs) and all-cause mortality (at 863 ± 324 days). Incidence of CIN ranged widely (2.0% to 15%) depending on the definition used. Only 2 definitions (δCr >0.5 mg/dl, >25%) consistently correlated with study outcomes. Using these 2 definitions, we devised a new grading system (grade 0 δCr ≤25% and ≤0.5 mg/dl; grade 1 δCr >25% but ≤0.5 mg/dl; and grade 2 δCr >0.5 mg/dl). Nephropathy grades (0 vs 1 vs 2) showed significant correlation with 6-month MACEs (12.4 vs 19.4 vs 28.6%, p = 0.003) and all-cause mortality (10.2 vs 10.4 vs 40.9%, p <0.0001). In multivariate analyses, the grading system showed an independent association with MACEs and mortality. The prognostic value of nephropathy grades was prospectively confirmed in an independent validation group of 539 patients. In conclusion, of the 4 contemporary definitions of CIN, only δCr >25% and >0.5 mg/dl consistently predicted adverse events after PCI. By unifying these 2 definitions, we devised a novel nephropathy grading system that is predictive of 6-month MACEs and all-cause mortality after PCI. [Copyright &y& Elsevier]

We evaluated the utility of a routine postprocedure course of unfractionated heparin after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in patients not receiving glycoprotein IIb/IIIa inhibitors. In the CADILLAC study, 2,082 patients with AMI who underwent primary PCI were randomized to receive stents versus percutaneous transluminal coronary angioplasty (PTCA), each with or without abciximab. In a subset of 976 patients who did not receive abciximab, we compared outcomes of patients who received postprocedural heparin (n = 758; 78%; median duration 2 days) with those who did not. In 421 patients treated with PTCA, postprocedural heparin use was associated with lower in-hospital major adverse cardiac events (MACEs; 5.3% vs 11.4%, p = 0.069), 1-year MACEs (22% vs 31%, p = 0.08), and decreased in-hospital moderate/severe bleeding (2.3% vs 8.9%, p = 0.01). By multivariate analyses, heparin use correlated with freedom from in-hospital and 1-year MACEs in patients after PTCA. In contrast, in 555 patients who underwent stenting, postprocedural heparin use was associated with increased bleeding and hospitalization costs without a decrease in early or late MACEs. In conclusion, in patients with AMI treated with coronary stenting without glycoprotein IIb/IIIa inhibitors, routine postprocedural heparin was not associated with any significant benefits and may be safely omitted. However, in a subset of patients treated with PTCA, postprocedural heparin use was independently associated with fewer in-hospital and 1-year MACEs. [Copyright &y& Elsevier]

Little is known about the influence of stenting versus balloon angioplasty on long-term outcomes (particularly mortality) after primary percutaneous coronary intervention (PCI). We evaluated 2,087 patients with ST-elevation myocardial infarction enrolled in various Primary Angioplasty in Myocardial Infarction (PAMI) trials in the United States, who underwent primary PCI. The main outcome was all-cause mortality at 5 years, obtained through the National Death Index. Of the 2,087 patients, stenting was performed in 692 (33%). The absolute difference in the hospital (2.2% vs 3.3%), 1-year (3.3% vs 5.2%), and 5-year (10% vs 13%) mortality rates favored patients receiving a stent versus conventional balloon therapy, with the difference increasing with time. A multivariate Cox model identified stent use (vs balloon alone) as an independent correlate of lower 5-year mortality (hazard ratio 0.60, 95% confidence interval 0.42 to 0.85). The absolute reduction in mortality was greatest in the highest risk group. In conclusion, compared with balloon angioplasty, stenting during primary PCI not only resulted in better angiographic and short-term outcomes, but also in a sustained beneficial effect on mortality at 5 years. These data support the routine use of coronary stenting in most patients undergoing primary PCI, when feasible. [Copyright &y& Elsevier]

Patients with acute myocardial infarction (AMI) often have multiple co-morbidities that influence outcome. We sought to evaluate the impact of peripheral vascular disease (PVD) on the outcome of patients with AMI treated with primary angioplasty. We evaluated 3,716 patients with AMI who underwent emergency catheterization with planned primary angioplasty in the Primary Angioplasty in Myocardial Infarction trials. Patients with a history of PVD (claudication, stroke, or transient ischemic attack) were compared with patients without PVD. Of the 3,716 patients, 394 (10.6%) had PVD and were older, more often women, and more frequently had a history of diabetes mellitus, hypertension, smoking, congestive heart failure, angina, myocardial infarction, and coronary revascularization. They presented more often with a heart rate >100 beats/min, Killip class >1, lower ejection fraction, and multivessel disease. No difference was found in stent use, final percentage of stenosis, or Thrombolysis In Myocardial Infarction 3 flow. Patients with PVD had a twofold increased in-hospital mortality (5.3% vs 2.6%, p = 0.0021). The difference remained significant at 1 month, 6 months, and 1 year (12.6% vs 6%, p &#60; 0.0001). In multivariate logistic regression analysis, a history of PVD was an independent predictor of in-hospital mortality and death at 1 year (odds ratio 1.64, 95% confidence interval 1.04 to 2.57, p = 0.032). In conclusion, patients with AMI with PVD have increased co-morbidities and higher mortality despite treatment with primary angioplasty. The presence of PVD is an independent predictor of in-hospital mortality and death at 1 year. [Copyright &y& Elsevier]

The presence of bundle branch block (BBB) has been associated with poor outcomes in patients who have acute myocardial infarction. Whether this is true in the angioplasty era is not known. We sought to evaluate the outcome of patients with acute myocardial infarction and BBB who were treated with primary angioplasty. We evaluated 3,053 patients who underwent emergency catheterization in the PAMI trials. Patients who had left BBB (n = 48, 1.6%) on presenting electrocardiogram were compared with patients who had right BBB (n = 95, 3.1%) or no BBB (n = 2,910, 95.3%). Patients who had BBB were older and more frequently had diabetes mellitus, peripheral vascular disease, and previous coronary artery bypass grafting. They had lower ejection fraction and more multivessel disease. There were no significant differences in door-to-balloon time, final Thrombolysis In Myocardial Infarction flow grade or stent use. In-hospital major adverse cardiac events (death, ischemic target vessel revascularization, and reinfarction) were higher in patients who had BBB due primarily to increased in-hospital death (left BBB 14.6%, right BBB 7.4%, no BBB 2.8%, p &#60; 0.0001). In multivariate logistic regression analysis, left BBB was an independent predictor of in-hospital death (odds ratio 5.53, 95% confidence interval 1.89 to 16.1, p = 0.002). In conclusion, patients who have acute myocardial infarction and BBB have increased co-morbidities and higher mortality rates despite treatment with primary angioplasty. Despite early identification of multivessel disease with triage to angioplasty or coronary artery bypass grafting, if necessary, similar treatment times, and final Thrombolysis In Myocardial Infarction grade 3 flow, the presence of left BBB on admission electrocardiogram in patients who have acute myocardial infarction is an independent predictor of in-hospital mortality. Because 85% of deaths in patients who have left BBB occur within the first week, these patients should be recognized early and receive prompt and aggressive treatment. [Copyright &y& Elsevier]

It has been suggested that percutaneous coronary intervention (PCI) by high-volume operators may be associated with better outcomes. However, the relation between operator and outcome is confounded by hospital caseloads of PCI, with busier hospitals generally having better outcomes. We assessed the effect of operator characteristics (volume of PCI, years in practice, and board certification status) on contemporary outcomes of PCI in a busy center with high-volume operators. Between 1999 and 2001, 12,293 PCIs were performed at our center by 28 interventionalists. Patients'' clinical risk was assessed with the previously validated Beaumont PCI Risk Score. Operators were classified as producing low, medium, or high volume (tertiles of annual PCI volume ≤92, 93 to 140, or >140, respectively), as less, medium, or great experience (tertiles of years in practice ≤8, 9 to 14, or >14 years, respectively), and board certified (68%) or not. In-hospital death rate and a composite end point (death, coronary artery bypass graft surgery, myocardial infarction, or stroke) occurred in 0.99% and 2.59% of patients, respectively. Operator volume, experience, and board certification showed no univariate or multivariate relation with the study end points. The Beaumont PCI Risk Score showed a strong independent relation with in-hospital death rate (adjusted odds ratio 1.37, 95% confidence interval 1.31 to 1.43, p <0.0001) and composite end point (odds ratio 1.19, 95% confidence interval 1.16 to 1.22, p <0.0001). We conclude that, in contemporary PCI practice at a large center with high-volume operators, in-hospital outcomes are not affected by operator volume, experience, or board certification. Rather, patients'' clinical risk score is the overriding determinant of clinical outcomes. Our findings emphasize the power of a well-organized high-volume system to minimize the impact of operator factors on outcomes of PCI. [Copyright &y& Elsevier]

Radiocontrast-induced nephropathy (RCIN) after percutaneous coronary intervention (PCI) is associated with grave consequences, but risk stratification of patients has not been well elucidated. This analysis derived a time-insensitive score to predict the risk of RCIN after PCI. A derivation cohort (1993 to 1998) and a validation cohort (1999 to 2002) comprised 20,479 patients who underwent PCI. RCIN after PCI was defined as a ≥1.0 mg/dl increase in serum creatinine. Variables having an independent correlation for RCIN after PCI were used to derive the RCIN risk score from the derivation cohort and were tested in the validation cohort. RCIN occurred in 2% of patients after PCI. Independent variables (with weighted scores) include estimated creatinine clearance <60 ml/min (2), urgent PCI (2), intra-aortic balloon pump use (2), diabetes mellitus (1), congestive heart failure (1), hypertension (1), peripheral vascular disease (1), and contrast volume >260 ml (1). The incidence of RCIN after PCI increased with each unit increase in score (p <0.0001, concordance statistic 0.89). No patient with a score ≤1 developed nephropathy, whereas 26% of patients with a score ≥9 developed RCIN after PCI (p <0.0001). Propensity score analysis showed that patients who developed RCIN after PCI, irrespective of the need for hemodialysis, had higher in-hospital rates of major adverse cardiac events (odds ratio 15, 95% confidence interval 11 to 20, p <0.0001). RCIN occurred in 2.0% of PCI patients and was associated with a 15-fold increase in adverse cardiac events. The RCIN risk score was a clinical assessment tool with excellent predictive ability in identifying the larger population at risk for nephropathy in whom preventative strategies are indicated. [Copyright &y& Elsevier]

Our findings show significant variation in length of hospital stay among patients with acute myocardial infarction treated with primary percutaneous coronary intervention; length of stay can be predicted from baseline clinical and angiographic characteristics. Our investigation suggests the need for a multi-tier diagnostic-related group system for patients with acute myocardial infarction treated with percutaneous coronary intervention. [Copyright &y& Elsevier]

The presence of intracoronary thrombus after percutaneous coronary intervention (PCI) worsens clinical outcomes. We performed this study to assess the incidence of intracoronary thrombus after primary angioplasty for acute myocardial infarction (AMI) and the clinical impact of nonocclusive thrombus. In 2,148 patients enrolled in the Primary Angioplasty in Myocardial Infarction (PAMI)-2, Stent PAMI, and PAMI No-Surgery-On-Site trials, we compared clinical and angiographic characteristics of 131 patients (6%) who had angiographically visible thrombus after PCI with those who did not (n = 2,017). In the subset of 2,115 patients with post-PCI Thrombolysis In Myocardial Infarction (TIMI) 2 or 3 flow, we assessed the impact of post-PCI thrombus (n = 110) on in-hospital, 1-month, and 1-year outcomes (reinfarction, ischemic target vessel revascularization [I-TVR], death, and major adverse cardiovascular events [MACEs] [i.e., death, reinfarction, or I-TVR]). Lack of stent use, presence of thrombus before PCI, and no history of PCI were independent correlates of post-PCI thrombus. Patients with nonocclusive thrombus after PCI had more reinfarctions during the index hospitalization (5.5% vs 2.0%, p = 0.03) and at 1 month (6.8% vs 2.3%, p = 0.01) and had nonsignificantly higher I-TVR (during hospitalization 5.5% vs 2.8%, p = 0.13; at 1 month 5.9% vs 3.4%, p = 0.17), but similar mortality and MACE rates as those without post-PCI thrombus. In multivariate analysis, post-PCI thrombus was not a significant predictor of in-hospital or 1-month reinfarction. At 1 year, clinical outcomes were similar between patient groups (reinfarction 8.3% vs 4.7%, p = 0.14; I-TVR 12.5% vs 12.1%, p = 0.91; death 5.9% vs 5.0%, p = 0.68; and MACEs 21% vs 18%, p = 0.54). We conclude that residual intracoronary thrombus after primary angioplasty is relatively uncommon. In patients who achieve TIMI 2 or 3 flow after PCI, intracoronary thrombus is associated with worse cardiovascular outcomes. However, differences in outcomes between patients with and without residual thombus are related to baseline clinical differences rather than thrombus per se. [Copyright &y& Elsevier]

We sought to determine whether diabetes mellitus independently conferred poor prognosis in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). In 3,742 patients enrolled in the Primary Angioplasty in Myocardial Infarction (PAMI) studies with the intention of undergoing primary PCI, we compared in-hospital mortality, 6-month mortality, and 6-month major adverse cardiovascular events (MACEs), i.e., composite of death, reinfarction, or ischemic target vessel revascularization (TVR), between diabetics (n = 626, 17%) and nondiabetics (n = 3,116, 83%). We evaluated the independent impact of diabetes on outcomes after adjustment for baseline clinical and angiographic differences. Diabetics had worse baseline clinical characteristics, longer pain onset-to-hospital arrival time, and longer door-to-balloon time. They had more multivessel coronary disease and lower left ventricular ejection fractions, but better baseline Thrombolysis In Myocardial Infarction (TIMI) flow. Diabetics underwent primary PCI less often (88% vs 91%, p = 0.01). During the index hospitalization, diabetics were more likely to die (4.6% vs 2.6%, p = 0.005). During 6-month follow-up, diabetics had higher incidences of death (8.1% vs 4.2%, p <0.0001) and MACEs (18% vs 14%, p = 0.036). In multivariate analysis, diabetes was independently associated with 6-month mortality (hazard ratio 1.53, 95% confidence interval 1.03 to 2.26, p = 0.03), but not with in-hospital mortality or 6-month MACEs. We conclude that diabetics with AMI have less favorable baseline characteristics and are less likely to undergo primary PCI than nondiabetics. Despite excellent angiographic results, diabetics had significantly worse 6-month mortality. [Copyright &y& Elsevier]

We hypothesized that pretreatment with β blockers may improve clinical outcomes after primary angioplasty for acute myocardial infarction. We pooled clinical, angiographic, and outcomes data on 2,537 patients enrolled in the Primary Angioplasty in Myocardial Infarction (PAMI), PAMI-2, and Stent PAMI trials. We classified patients into a β group (n = 1,132) if they received β-blocker therapy before primary angioplasty or a no-β group (n = 1,405) if they did not. We evaluated procedural complications and in-hospital and 1-year outcomes (death and major adverse cardiac events [death, reinfarction, target vessel revascularization, or stroke]) between groups. Beta patients were younger, had higher systolic blood pressure and heart rate, and were more likely to be in Killip class I at admission. They had lower left ventricular ejection fraction, greater door-to-balloon time, greater likelihood of having a left anterior descending artery culprit lesion, but a similar incidence of Thrombolysis In Myocardial Infarction 3 flow after angioplasty (92.6% vs 92.7%, p = 0.91). The β group had less procedural complications (23% vs 34%, p <0.0001) and a lower incidence of death (1.8% vs 3.7%, p = 0.0035) and major adverse cardiac events (5.5% vs 7.8%, p = 0.027) during hospitalization. At 1 year, mortality remained lower in β patients (4.9% vs 6.7%, log-rank p = 0.055). After adjustment for baseline differences, β patients had significantly lower in-hospital mortality (odds ratio 0.41; 95% confidence interval 0.20 to 0.84; p <0.0148) and nonsignificantly lower 1-year mortality (odds ratio 0.72; 95% confidence interval 0.47 to 1.08; p = 0.11). Thus, pretreatment with β blockers has an independent beneficial effect on short-term clinical outcomes in patients undergoing primary angioplasty for acute myocardial infarction. [Copyright &y& Elsevier]

From the cohort of 4,023 patients enrolled in the Primary Angioplasty for Myocardial Infarction (PAMI) trials, we pooled clinical, angiographic, and outcomes data on 1,521 patients with culprit lesions in the right coronary artery (RCA). We compared angiographic results, procedural complications, and in-hospital and 1-year clinical outcomes between patients with proximal RCA (n = 572) versus nonproximal RCA culprit lesions (n = 949). Patients with proximal RCA culprit lesions were older, had lower systolic blood pressure, greater diameter stenosis, and were less likely to have Thrombolysis In Myocardial Infarction (TIMI) 2 or 3 flow (19% vs 31%; p <0.0001) before percutaneous coronary intervention (PCI). After PCI, the incidence of TIMI 3 flow (94% vs 93%) was similar between groups. Patients with proximal RCA lesions were more likely to have bradyarrhythmias (30% vs 23%, p = 0.016) and require an intra-aortic balloon pump (IABP; 4.6% vs 2%, p = 0.034) during PCI. In-hospital complications, including mortality (2.3% vs 2.2%) and reinfarction (1.4% vs 1.1%), and the 1-year incidence of death, reinfarction, ischemia driven target vessel revascularization, and major adverse cardiovascular events were similar between groups. After adjustment for baseline differences, proximal RCA location of the culprit lesion was independently associated with greater IABP use (odds ratio 2.41, 95% confidence interval 1.04 to 5.58) but not with bradyarrhythmias during PCI. Thus, in patients with acute myocardial infarction referred for primary angioplasty, proximal RCA location of the culprit lesion is associated with excellent clinical outcomes that are similar to nonproximal RCA lesions. [Copyright &y& Elsevier]

Studies the length of hospital stay in patients with decompensated heart failure from moderate to severe left ventricular systolic dysfunction. Source of information on length of stay of patients during the index hospitalization, demographic factors, payor status, caregiver physician subspecialty and comorbid conditions; Variables that showed significant independent association with length of stay.

An adverse interaction between aspirin and angiotensin-converting enzyme (ACE) inhibitors is suspected in patients with heart failure, but the effect of combined therapy with these agents on hospital readmission rates is unknown. Our study found that combining aspirin with ACE inhibitors is associated with higher early readmission rates than use of ACE inhibitors alone, particularly in patients with depressed ejection fraction and in those without coronary artery disease. [ABSTRACT FROM AUTHOR]

Reports that simple clinical variales are markers of the propensity for re-admission in patients hospitalized with heart failure. Study methods and patients; Independent predictors used to assess the risk of early re-admission; Clinical factors that had a significant univariate association with the occurrence of early re-admissions.

In 39 patients undergoing electrical cardioversion for atrial fibrillation (AF), we examined the effect of total electrical energy used for cardioversion on postcardioversion peak left atrial (LA) rapid filling velocity (A) and the atrial emptying fraction, and recovery of LA effective mechanical atrial function (defined as peak A velocity > or = 0.50 m/s), as assessed by transthoracic echocardiography. In a subset of 27 patients who underwent pre- and postcardioversion transesophageal echocardiography, we assessed the relation between total electrical energy and LA appendage filling and emptying velocities and spontaneous echo contrast. Patients were randomized to receive an initial shock of 1.5 J/kg based on body weight, or 2.5, 3.5, 5 J/kg, or 360 J, followed sequentially by higher shock intensities until sinus rhythm was achieved. Patients were classified into 4 groups based on quartiles of total energy delivered for cardioversion. Conversion to sinus rhythm was associated with a significant decrease in the LA appendage filling velocities (0.42 +/- 0.20 m/s vs 0.29 +/- 0.14 m/s; p = 0.002) and LA appendage emptying velocities (0.40 +/- 0.22 m/s vs 0.29 +/- 0.18 m/s; p = 0.03), but no change in the incidence of spontaneous echo contrast (61% vs 70%, p = 0.08). The 4 groups of patients did not differ with respect to postcardioversion LA appendage filling velocities, LA appendage emptying velocities, incidence of spontaneous echo contrast, or worsening of spontaneous echo contrast. Similarly, the change in LA appendage filling and emptying velocities associated with cardioversion was not different between the groups. Furthermore, postcardioversion peak A velocity and atrial emptying fraction and recovery of effective mechanical atrial function were similar between the 4 groups. These results suggest that in patients undergoing electrical cardioversion for AF, the total electrical energy used for cardioversion has no effect on the mechanical function of the left atrium or LA appendage following cardioversion. [ABSTRACT FROM AUTHOR]

We found that of 1,192 patients who underwent primary percutaneous coronary intervention and who had final Thrombolysis In Myocardial Infarction grade 3 flow at the conclusion of the procedure, transient no-reflow occurred in 16 patients (1.3%). Compared with patients without transient no-reflow during the procedure, those with transient no-reflow had higher in-hospital (2% vs 13%, p = 0.04) and 6-month mortality (3% vs 31%, adjusted odds ratio 5.4, 95% confidence interval 1.01 to 29.0, p = 0.0001). [Copyright &y& Elsevier]

Little information exists on the features that influence risk factors for death at 1 year among 30-day survivors of ST-elevation myocardial infarction (STEMI) that is treated with primary percutaneous coronary intervention (PCI). Accordingly, we examined 3,280 patients with STEMI who were enrolled in Stent-PAMI and CADILLAC trials, were treated with primary PCI, and survived >30 days after STEMI. Death at 1 year occurred in 74 patients (2.3%) who survived >30 days after their index STEMI. Patients who died at 1 year were more likely to be older and women and have lower body weight and greater prevalence of previous stroke. Similarly, the sum of ST elevations, 3-vessel or left anterior coronary disease, and final Thrombolysis In Myocardial Infarction grade <3 flow was higher, whereas left ventricular ejection fraction was lower among patients who died versus those who survived. The multivariate logistic regression model identified age >70 years (odds ratio [OR] 3.3 95% confidence interval [CI] 1.9 to 5.7), weight <80 kg (OR 1.9, 95% CI 1.1 to 3.6), any tachyarrhythmia during index hospitalization (defined as ventricular or supraventricular tachycardia that required treatment) (OR 2.4, 95% CI 1.2 to 4.8), number of diseased coronary arteries (OR 1.5, 95% CI 1.1 to 2.1), and left ventricular ejection fraction (each 10% decrease, OR 1.5, 95% CI 1.2 to 1.8) as factors independently associated with risk of death at 1 year among 30-day survivors. In conclusion, our study provides a method for clinicians to advise patients who are treated with primary PCI and survive the acute phase of STEMI with regard to patients’ long-term prognosis, thus enhancing planning and setting up of realistic expectations. [Copyright &y& Elsevier]

Ventricular fibrillation (VF) developing out of hospital or even in hospital has a reported prognosis for survival that is &#60;50%. We examined the prognosis for VF in 19,497 patients undergoing percutaneous coronary intervention and identified 164 who had VF (0.84%). The time to defibrillation was &#60;1 minute and was successful in all without sequelae. Thus, VF developing in the catheterization laboratory is unique in terms of prognosis. [Copyright &y& Elsevier]

Sex-based disparities in outcomes are reported for various cardiovascular procedures. This study aimed to assess the difference in outcomes in patients who underwent WATCHMAN device implant based on sex. Patients who underwent WATCHMAN device placement, from 2016 to 2018, were identified from the National Inpatient Sample database. The primary outcome was inpatient mortality, and the secondary outcomes were the length of stay (LOS), hospitalization cost (HOC), and periprocedural complications. A logistic regression model was built to perform an adjusted analysis for the outcomes. A total of 12,327 patients underwent WATCHMAN device placement. Female patients were older and more likely to have hypertension (p <0.01) and less likely to have peripheral arterial disease (5.6 vs 7.2, p <0.01), chronic kidney disease (21% vs 26%, p <0.01), and diabetes (18% vs 20%, p = 0.03) and were also at a higher risk for certain periprocedural complications, including pericardiocentesis and anemia requiring blood transfusion (p <0.01 for all). In the unadjusted analysis, the female sex was associated with longer LOS (1.5 vs 1.3 days, p <0.01) and inpatient mortality (0.23 vs 0.10, p = 0.05). The HOC was numerically higher in women but statistically nonsignificant ($120,791 vs $118,554, p = 0.1). In the stepwise, backward, multivariate regression analysis, the female sex  was an independent risk factor for higher LOS (1.5 vs 1.3 days, p <0.01, 95% confidence interval 1.3 to 1.4) after adjusting for potential confounders. The inpatient mortality and HOC were similar between 2 groups after adjusting for potential cofounders in the multivariate regression analysis. Our study suggests that the female sex is an independent risk factor for longer LOS among patients hospitalized for WATCHMAN device placement., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)

There is growing interest in "minimalist" transcatheter aortic valve implantation (M-TAVI), performed with conscious sedation instead of general anesthesia (GA-TAVI). We assessed the impact of M-TAVI on procedural efficiency, long-term safety, and quality of life (QoL) in 477 patients with severe aortic stenosis (82 years, women 50%, STS 5.0), who underwent M-TAVI (n = 278) or GA-TAVI (n = 199). M-TAVI patients were less likely to have NYHA Class ≥3, valve-in-valve TAVI, and receive self-expanding valves. M-TAVI was completed without conversion to GA in 269 (97%) patients. M-TAVI was more efficient that GA-TAVI including shorter lengths of stay (2 vs 3 days, p <0.0001), higher likelihood of being discharged home (87% vs 72%, p <0.0001), less use of blood transfusions (10% vs 22%, p = 0.0008), inotropes (13% vs 32%, p <0.0001), contrast volume (50 vs 90 ml, p <0.0001), fluoroscopy time (20 vs 24 minute, p <0.0001), and need for >1 valves (0.4 vs 5.5%, p = 0.0004). At 1-month, death/stroke (M-TAVI vs GA-TAVI 4.0 vs 6.5%) and a "safety composite" end point (death, stroke, transient ischemic attack, myocardial infarction, new dialysis, major vascular complication, major or life-threatening bleeding, and new pacemaker: 17.6% vs 21.1%) were similar (p = NS for both). At a median follow-up of 365 days, survival curves showed similar incidence of death/stroke as well as the safety composite end point between the groups. QoL scores were similar at baseline and 1-month after TAVI. In multivariable analyses, M-TAVI showed significant improvements in all parameters of procedural efficiency. In conclusion, M-TAVI is more efficient than GA-TAVI, with similar safety at 1-month and long-term, and similar QoL scores at 1 month., (Copyright © 2020 Elsevier Inc. All rights reserved.)