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14. Prevalence and Impact of Concomitant Atrial Fibrillation in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction.

Author

Shakeel, Iqra, Sharma, Harish, Hodson, James, Iqbal, Hamna, Tashfeen, Rashna, Ludman, Peter F., Steeds, Richard P., Townend, Jonathan N., Doshi, Sagar N., and Nadir, M. Adnan

Subjects
MYOCARDIAL infarction, PERCUTANEOUS coronary intervention, ATRIAL fibrillation
Abstract

Background: Concomitant atrial fibrillation (AF) is associated with an adverse prognosis in patients with acute myocardial infarction (MI). However, it remains unclear whether this is due to a causal effect of AF or whether AF acts as a surrogate marker for comorbidities in this population. Furthermore, there are limited data on whether coronary artery disease distribution impacts the risk of developing AF. Methods: Consecutive patients admitted with acute MI and treated using percutaneous coronary intervention (PCI) at a single centre were retrospectively identified. Associations between AF and major adverse cardiac and cerebrovascular events (MACCEs) over a median of five years of follow-up were assessed using Cox regression, with adjustment for confounding factors performed using both multivariable modelling and a propensity-score-matched analysis. Results: AF was identified in N = 65/1000 (6.5%) of cases; these patients were significantly older (mean: 73 vs. 65 years, p < 0.001), with lower creatinine clearance (p < 0.001), and were more likely to have a history of cerebrovascular disease (p = 0.011) than those without AF. In addition, patients with AF had a greater propensity for left main stem (p = 0.001) or left circumflex artery (p = 0.004) involvement. Long-term MACCE rates were significantly higher in the AF group than in the non-AF group (50.8% vs. 34.2% at five years), yielding an unadjusted hazard ratio (HR) of 1.86 (95% CI: 1.32–2.64, p < 0.001). However, after adjustment for confounding factors, AF was no longer independently associated with MACCEs, either on multivariable (adjusted HR: 1.25, 95% CI: 0.81–1.92, p = 0.319) or propensity-score-matched (HR: 1.04, 95% CI: 0.59–1.82, p = 0.886) analyses. Conclusions: AF is observed in 6.5% of patients admitted with acute MI, and those with AF are more likely to have significant diseases involving left main or circumflex arteries. Although unadjusted MACCE rates were significantly higher in patients with AF, this effect was not found to remain significant after adjustment for comorbidities. As such, this study provided no evidence to suggest that AF is independently associated with MACCEs. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Influence of Gender on Clinical Outcomes Following Transcatheter Aortic Valve Implantation from the UK Transcatheter Aortic Valve Implantation Registry and the National Institute for Cardiovascular Outcomes Research

Author

Al-Lamee, Rasha, Broyd, Christopher, Parker, Jessica, Davies, Justin E., Mayet, Jamil, Sutaria, Nilesh, Ariff, Ben, Unsworth, Beth, Cousins, Jonathan, Bicknell, Colin, Anderson, Jonathan, Malik, Iqbal S., Chukwuemeka, Andrew, Blackman, Daniel J., Moat, Neil, Ludman, Peter F., Francis, Darrel P., and Mikhail, Ghada W.

Published
2014
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22. Isoprenaline induced myocardial infarction in a patient with high-grade atrioventricular block: a case report.

Author

Radhakrishnan, Ashwin, Ensam, Bode, Moody, William E, and Ludman, Peter F

Abstract

Background Isoprenaline is widely used in the treatment of symptomatic bradycardia. Myocardial infarction precipitated by the therapeutic use of isoprenaline has not been reported in the literature. Case summary We describe the case of a 67-year-old male patient who presented to our institution with symptomatic Mobitz type II 2:1 atrioventricular block. He had a several-month history of unexplained syncope. He had several cardiovascular risk factors but did not have a diagnosis of coronary artery disease. On admission, he was symptomatic with dizziness but had no chest pain. High-sensitivity troponin I was normal. After initiation of an isoprenaline infusion, he developed cardiac-sounding chest pain and an ischaemic electrocardiogram. Emergency coronary angiography was performed that demonstrated a severe mid-vessel stenosis in his right coronary artery that was treated with percutaneous coronary intervention and the deployment of one drug-eluting stent. He remained in Mobitz type II 2:1 atrioventricular block 48 hours after the procedure, and a dual-chamber permanent pacemaker was implanted. He was discharged in a stable condition with no further chest pain or bradyarrhythmia. Discussion To our knowledge, this is the first reported case of myocardial infarction precipitated by the therapeutic use of isoprenaline. Our hypothesis is that isoprenaline increased myocardial oxygen demand and induced a type 2 myocardial infarction in this patient with occult coronary artery disease. Isoprenaline should be used with caution in patients with confirmed or suspected coronary artery disease. [ABSTRACT FROM AUTHOR]

Published
2023
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24. Effect of Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement on All-Cause Mortality in Patients With Aortic Stenosis: A Randomized Clinical Trial

Author

Toff, William D., Hildick-Smith, David, Kovac, Jan, Mullen, Michael J., Wendler, Olaf, Mansouri, Anita, Rombach, Ines, Abrams, Keith R., Conroy, Simon P., Flather, Marcus D., Gray, Alastair M., MacCarthy, Philip, Monaghan, Mark J., Prendergast, Bernard, Ray, Simon, Young, Christopher P., Crossman, David C., Cleland, John G. F., de Belder, Mark A., Ludman, Peter F., Jones, Stephen, Densem, Cameron G., Tsui, Steven, Kuduvalli, Manoj, Mills, Joseph D., Banning, Adrian P., Sayeed, Rana, Hasan, Ragheb, Fraser, Douglas G. W., Trivedi, Uday, Davies, Simon W., Duncan, Alison, Curzen, Nick, Ohri, Sunil K., Malkin, Christopher J., Kaul, Pankaj, Muir, Douglas F., Owens, W. Andrew, Uren, Neal G., Pessotto, Renzo, Kennon, Simon, Awad, Wael I., Khogali, Saib S., Matuszewski, Maciej, Edwards, Richard J., Ramesh, Bandigowdanapalya C., Dalby, Miles, Raja, Shahzad G., Mariscalco, Giovanni, Lloyd, Clinton, Cox, Ian D., Redwood, Simon R., Gunning, Mark G., and Ridley, Paul D.

Subjects
Aged, 80 and over, Heart Valve Prosthesis Implantation, Male, Aortic Valve Insufficiency, General Medicine, Aortic Valve Stenosis, Transcatheter Aortic Valve Replacement, Treatment Outcome, Risk Factors, Aortic Valve, Heart Valve Prosthesis, Humans, Female, Aged, Original Investigation
Abstract

IMPORTANCE: Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement and is the treatment of choice for patients at high operative risk. The role of TAVI in patients at lower risk is unclear. OBJECTIVE: To determine whether TAVI is noninferior to surgery in patients at moderately increased operative risk. DESIGN, SETTING, AND PARTICIPANTS: In this randomized clinical trial conducted at 34 UK centers, 913 patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk due to age or comorbidity were enrolled between April 2014 and April 2018 and followed up through April 2019. INTERVENTIONS: TAVI using any valve with a CE mark (indicating conformity of the valve with all legal and safety requirements for sale throughout the European Economic Area) and any access route (n = 458) or surgical aortic valve replacement (surgery; n = 455). MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality at 1 year. The primary hypothesis was that TAVI was noninferior to surgery, with a noninferiority margin of 5% for the upper limit of the 1-sided 97.5% CI for the absolute between-group difference in mortality. There were 36 secondary outcomes (30 reported herein), including duration of hospital stay, major bleeding events, vascular complications, conduction disturbance requiring pacemaker implantation, and aortic regurgitation. RESULTS: Among 913 patients randomized (median age, 81 years [IQR, 78 to 84 years]; 424 [46%] were female; median Society of Thoracic Surgeons mortality risk score, 2.6% [IQR, 2.0% to 3.4%]), 912 (99.9%) completed follow-up and were included in the noninferiority analysis. At 1 year, there were 21 deaths (4.6%) in the TAVI group and 30 deaths (6.6%) in the surgery group, with an adjusted absolute risk difference of −2.0% (1-sided 97.5% CI, −∞ to 1.2%; P

Published
2022

25. Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)

Author

Capodanno, Davide, Petronio, Anna S., Prendergast, Bernard, Eltchaninoff, Helene, Vahanian, Alec, Modine, Thomas, Lancellotti, Patrizio, Sondergaard, Lars, Ludman, Peter F., Tamburino, Corrado, Piazza, Nicolò, Hancock, Jane, Mehilli, Julinda, Byrne, Robert A., Baumbach, Andreas, Kappetein, Arie Pieter, Windecker, Stephan, Bax, Jeroen, and Haude, Michael

Published
2017
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33. Impact of age on the prognostic value of left ventricular function in relation to procedural outcomes following percutaneous coronary intervention: Insights from the British cardiovascular intervention society

Author

Kwok, Chun Shing, Anderson, Simon G., McAllister, Katherine S.L., Sperrin, Matthew, OʼKane, Peter D., Keavney, Bernard, Nolan, James, Myint, Phyo Kyaw, Zaman, Azfar, Buchan, Iain, Ludman, Peter F., de Belder, Mark A., and Mamas, Mamas A.

Published
2015
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36. Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries

Author

Kristensen, Steen D., Laut, Kristina G., Fajadet, Jean, Kaifoszova, Zuzana, Kala, Petr, Di Mario, Carlo, Wijns, William, Clemmensen, Peter, Agladze, Vaja, Antoniades, Loizos, Alhabib, Khalid F., De Boer, Menko-Jan, Claeys, Marc J., Deleanu, Dan, Dudek, Dariusz, Erglis, Andrejs, Gilard, Martine, Goktekin, Omer, Guagliumi, Giulio, Gudnason, Thorarinn, Hansen, Kim Wadt, Huber, Kurt, James, Stefan, Janota, Tomáš, Jennings, Siobhan, Kajander, Olli, Kanakakis, John, Karamfiloff, Kiril K., Kedev, Sasko, Kornowski, Ran, Ludman, Peter F., Merkely, Béla, Milicic, Davor, Najafov, Ruslan, Nicolini, Francesca A., Noč, Marko, Ostojic, Miodrag, Pereira, Hélder, Radovanovic, Dragana, Sabaté, Manel, Sobhy, Mohamed, Sokolov, Maxim, Studencan, Martin, Terzic, Ibrahim, Wahler, Steffen, Widimsky, Petr, Mühlberger, Volker, Najafov, Ruslan, Legrand, V., Spuzic, M., Hajric, R., Markota, D., Srdic, S., Jorgova, Julia, Velchev, Vassil, Petrov, Ivo, Nikolic Heitzler, V., Babic, Z., Nicolaides, Evagoras, Christodulides, Theodoros, Georgiou, Panagiota, Jansky, Petr, Stasek, Josef, Terkelsen, Christian Juhl, Galatius, Søren, Sørensen, Rikke, Sobhy, Mohamed, Shal, Ahmed El, Romppanen, Hannu, Müller, Alfred, Rustige, Jörg, Alexopoulos, Dimitrios, Kallikazaros, Ioannis, Papaioannou, Georgios, Becker, David, Ungi, Imre, Kiss, Robert Gabor, Skuladottir, Frida Bjork, Bjornsdottir, Thora K., Cavanagh, Brendan, Twomey, Kathleen, Daly, Kieran, Matetzky, Shlomi, De Luca, Leonardo, Cremonesi, Alberto, Bovenzi, Francesco, Zakke, IIja, Maca, Aija, Narbute, Inga, Antov, S., Koch, Karel T., Mimoso, Jorge, Almeida, Manuel, Pereira, Ernesto, Tatu, Gabriel, Vinereanu, Dragos, DʼAngeli, Cinzia, Nedeljkovic, Milan, Vukcevic, Vladan, Dobric, Milan, Hricak, V., Kovař, F., Kurray, P., Peral, Vincente, Tresserras, Ricard, Regueiro, Ander, Erne, Paul, Rickli, Hans, Windecker, Stephan, Kozan, Omer, Ertas, Gokhan, Kervan, Umit, Birkhead, John, and Sokolov, Yuriy

Published
2014
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41. Early Acurate Neo transcatheter heart valve degeneration in a haemodialysis patient successfully managed with Sapien 3 Ultra: a case report.

Author

Savvoulidis, Panagiotis, Nadir, Adnan, Ludman, Peter F, and Doshi, Sagar N

Subjects
HEART valves, HEART valve prosthesis implantation, BIOPROSTHETIC heart valves, AORTIC stenosis, AORTIC valve diseases, CHEST pain, MUCOCUTANEOUS lymph node syndrome
Abstract

Background Aortic valve disease is the most prevalent valvular abnormality in the developed world and carries a high risk of morbidity and mortality. Transcatheter aortic valve replacement (TAVR) is favoured over open-heart surgery in high-risk patient categories and is increasingly used in lower-risk groups. End stage kidney disease (ESKD) is associated with premature calcific degeneration of bioprosthetic heart valves. Redo-TAVR requires meticulous pre-procedural planning to avoid the important risks of sinus sequestration and impaired coronary access. Transcatheter aortic valve replacement with the Acurate Neo transcatheter heart valve (THV) has been clinically available for a short time only and there are limited reports describing redo-TAVR in the Acurate Neo. Case summary We present a case of early, rapid onset, structural valve degeneration in a Acurate Neo, supra-annular, self-expanding THV in a dialysis patient. The patient presented with chest pain and breathlessness 4 years after TAVR with a Acurate Neo for severe stenosis of a bicuspid aortic valve. Echocardiogram now showed severe stenosis of the THV and computed tomography revealed severe THV leaflet calcification but no pannus or leaflet thrombus. After careful pre-procedural planning a S3 Ultra balloon-expandable valve was selected and positioned relatively high to pin the first THV leaflets in a fully open position without compromising coronary artery flow or coronary access. Discussion End stage kidney disease may cause rapid, calcific degeneration of TAVR valves leading to presentation with severe aortic stenosis. Redo-TAVR in the Acurate Neo THV with a Sapien 3 Ultra is feasible with careful pre-procedural planning to mitigate the risks of sinus sequestration and impaired coronary access. [ABSTRACT FROM AUTHOR]

Published
2022
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49. Novel United Kingdom prognostic model for 30-day mortality following transcatheter aortic valve implantation

Author

Martin, Glen P, Sperrin, Matthew, Ludman, Peter F, de Belder, Mark A, Redwood, Simon R, Townend, Jonathan N, Gunning, Mark, Moat, Neil E, Banning, Adrian P, Buchan, Iain, and Mamas, Mamas A

Subjects
Adult, Aged, 80 and over, Male, Time Factors, transcatheter valve interventions, aortic stenosis, Reproducibility of Results, Aortic Valve Stenosis, Middle Aged, Risk Assessment, United Kingdom, Decision Support Techniques, Transcatheter Aortic Valve Replacement, Benchmarking, Treatment Outcome, Predictive Value of Tests, Risk Factors, Valvular Heart Disease, Humans, Female, Registries, Aged, Quality Indicators, Health Care
Abstract

Objective Existing clinical prediction models (CPM) for short-term mortality after transcatheter aortic valve implantation (TAVI) have limited applicability in the UK due to moderate predictive performance and inconsistent recording practices across registries. The aim of this study was to derive a UK-TAVI CPM to predict 30-day mortality risk for benchmarking purposes. Methods A two-step modelling strategy was undertaken: first, data from the UK-TAVI Registry between 2009 and 2014 were used to develop a multivariable logistic regression CPM using backwards stepwise regression. Second, model-updating techniques were applied using the 2013–2014 data, thereby leveraging new approaches to include frailty and to ensure the model was reflective of contemporary practice. Internal validation was performed by bootstrapping to estimate in-sample optimism-corrected performance. Results Between 2009 and 2014, up to 6339 patients were included across 34 centres in the UK-TAVI Registry (mean age, 81.3; 2927 female (46.2%)). The observed 30-day mortality rate was 5.14%. The final UK-TAVI CPM included 15 risk factors, which included two variables associated with frailty. After correction for in-sample optimism, the model was well calibrated, with a calibration intercept of 0.02 (95% CI −0.17 to 0.20) and calibration slope of 0.79 (95% CI 0.55 to 1.03). The area under the receiver operating characteristic curve, after adjustment for in-sample optimism, was 0.66. Conclusion The UK-TAVI CPM demonstrated strong calibration and moderate discrimination in UK-TAVI patients. This model shows potential for benchmarking, but even the inclusion of frailty did not overcome the need for more wide-ranging data and other outcomes might usefully be explored.

Published
2018

50. Do frailty measures improve prediction of mortality and morbidity following transcatheter aortic valve implantation? An analysis of the UK TAVI registry

Author

Martin, Glen P, Sperrin, Matthew, Ludman, Peter F, deBelder, Mark A, Gunning, Mark, Townend, John, Redwood, Simon R, Kadam, Umesh T, Buchan, Iain, and Mamas, Mamas A

Subjects
Male, risk stratification, Cardiovascular Medicine, Transcatheter Aortic Valve Replacement, Predictive Value of Tests, Risk Factors, Humans, Registries, Mortality, Geriatric Assessment, transcatheter aortic valve implantation, Risk stratification, Aged, Proportional Hazards Models, Retrospective Studies, Aged, 80 and over, Transcatheter aortic valve implantation, Frailty, Research, Clinical prediction models, clinical prediction models, RC666, mortality, R1, Logistic Models, England, Female
Abstract

Objectives\ud Previous studies indicate frailty to be associated with poor outcomes following transcatheter aortic valve implantation (TAVI), but there is limited evidence from multicentre registries. The aim was to investigate the independent association of frailty with TAVI outcomes, and the prognostic utility of adding frailty into existing clinical prediction models (CPMs).\ud \ud Design\ud The UK TAVI registry incorporated three frailty measures since 2013: Canadian Study of Health and Ageing, KATZ and poor mobility. We investigated the associations between these frailty measures with short-term and long-term outcomes, using logistic regression to estimate multivariable adjusted ORs, and Cox proportional hazards models to explore long-term survival. We compared the predictive performance of existing TAVI CPMs before and after updating them to include each frailty measure.\ud \ud Setting\ud All patients who underwent a TAVI procedure in England or Wales between 2013 and 2014.\ud \ud Participants\ud 2624 TAVI procedures were analysed in this study.\ud \ud Primary and secondary outcomes\ud The primary endpoints in this study were 30-day mortality and long-term survival. The Valve Academic Research Consortium (VARC)-2 composite early safety endpoint was considered as a secondary outcome.\ud \ud Results\ud KATZ

Published
2018
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