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BACKGROUND Data on trends, predictors, and outcomes of heart failure (HF) readmissions after transcatheter aortic valve replacement (TAVR) remain limited. Moreover, the relationship between hospital TAVR discharge volume and HF readmission outcomes has not been established. METHODS AND RESULTS The Nationwide Readmission Database was used to identify 30‐day readmissions for HF after TAVR from October 1, 2015, to November 30, 2018, using International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD‐10‐CM ) codes. A total of 167 345 weighted discharges following TAVR were identified. The all‐cause readmission rate within 30 days of discharge was 11.4% (19 016). Of all the causes of 30‐day rehospitalizations, HF comprised 31.4% (5962) of all causes. The 30‐day readmission rate for HF did not show a significant decline during the study period ( P trend =0.06); however, all‐cause readmission rates decreased significantly ( P trend =0.03). HF readmissions were comparable between high‐ and low‐volume TAVR centers. Charlson Comorbidity Index >8, length of stay >4 days during the index hospitalization, chronic obstructive pulmonary disease, atrial fibrillation, chronic HF, preexisting pacemaker, complete heart block during index hospitalization, paravalvular regurgitation, chronic kidney disease, and end‐stage renal disease were independent predictors of 30‐day HF readmission after TAVR. HF readmissions were associated with higher mortality rates when compared with non‐HF readmissions (4.9% versus 3.3%; P CONCLUSIONS During the study period from 2015 to 2018, 30‐day HF readmissions after TAVR remained steady despite all‐cause readmissions decreasing significantly. All‐cause readmission mortality and HF readmission mortality also showed a nonsignificant downtrend. HF readmissions were comparable across low‐, medium‐, and high‐volume TAVR centers. HF readmission was associated with increased mortality and resource use attributed to the increased costs of care compared with non‐HF readmission. Further studies are needed to identify strategies to decrease the burden of HF readmissions and related mortality after TAVR.

Introduction: Pacemaker implantation remains a frequent complication in patients undergoing transcatheter aortic valve implantation (TAVI). Outcomes of TAVI with a baseline first degree heart block (HB) remain unknown. Methods: The purpose of this study was to evaluate outcomes of TAVI in patients with a baseline first degree HB. We utilized the National Inpatient Sample (NIS) data from the year 2011 to 2018. Results: A total of 215,938 weighted hospitalizations for TAVI were included in the analysis. Of the patient undergoing the procedure, 11000 had baseline first degree HB (5.1%) and 204938 (94.9%) patients did not have first degree HB. Patients with first degree HB had higher rates of PPM implantation (17.1% vs. 10.1%, p Conclusions: In conclusion we report that PPM implantation rate is higher in patients with first degree HB and that age greater than 75, male sex, hypertension and chronic kidney disease are significant predictors of this adverse event.

Introduction: Contemporary data on stroke predictors and outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) remains limited. Hypothesis: Patients who develop a stroke while undergoing TAVI have increased in-hospital mortality and adverse events. Methods: We analyzed National Inpatient Sample (NIS) data from the year 2011 to 2018. Results: A total of 215,938 patients underwent TAVI. Of the patients who underwent TAVI, 4579 (2.2%) suffered from stroke and 211359 (97.8%) did not have a stroke. Adjusted mortality was higher in patients who had a stroke (10.9%) as compared to patients who did not have a stroke (3.1%). Patients with stroke were more likely to be discharged to nursing home compared to patients without a stroke (89.8% vs 47.7%). Multivariate logistic regression analysis showed that at baseline, age, female sex, atrial fibrillation, chronic kidney disease and peripheral vascular disease were significant predictors of stroke. Median Cost of care ($63367 vs $48070) and length of stay (8 vs 4 days) were considerably higher for patients with stroke when compared to the comparison group (p Conclusions: In conclusion we report that stroke is associated with increased mortality, morbidity, and resource utilization in patients undergoing TAVI. Baseline characteristics like age, gender, atrial fibrillation, chronic kidney disease and peripheral vascular disease are significant predictors of this adverse event.

Introduction: Gastrointestinal bleeding remains one of the most common cause of major bleeding in patients undergoing transcatheter aortic valve implantation. Hypothesis: GI bleed is associated with worse outcomes in patients undergoing TAVI Methods: We investigated trends, outcomes and predictors of major bleeding from 2011 to 2018 using the national inpatient sample database. Results: A total of 216,023 weighted hospitalizations for TAVI were included in the analysis. Among the included hospitalizations, 2188 patients had GI bleed (1%) whereas 21,385 (99%) patients did not have GI bleed. Presence of peptic ulcer disease was found to be associated with the highest odds of having a GI bleed with an OR 10.24[95% CI, 7.93-13.22] followed closely by colorectal cancer OR 8.02[CI, 185.40-11.91]. Other comorbidities associated with higher adjusted rates of GI bleed were chronic kidney disease ([OR], 1.28[confidence interval (CI), 1.15-1.42]), congestive heart failure (OR, 201.21[CI, 1.08-1.35]), liver disease (OR, 1.82[CI, 1.52-1.2.18]), end stage renal disease (OR, 212.13[CI, 1.79-2.52]), atrial fibrillation (OR, 1.64[CI, 1.50-.77.]) and lung cancer (OR, 2.68[CI, 221.70-4.24]). Over the study period, mortality in patients with a GI bleed with TAVI decreased from 13.6% in 2011 to 11.50% in 2018 along with a decrease in mortality in TAVI without GI bleed group as well. Patients with GI bleed had increased mortality rates as compared those without GI bleed, (12.1% 10 vs 2.1%, p Conclusions: In conclusion, we report that mortality is higher in TAVI patients with a GI bleed. Presence of peptic ulcer disease, colorectal cancer or baseline comorbidities like atrial fibrillation and end stage renal disease are important predictors of this adverse event.

Background: Outcomes of coronary artery bypass grafting (CABG) versus (vs) percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndromes (ACS) with unprotected left main (ULM) as culprit vessel are not well represented in major clinical trials. We performed a meta-analysis and meta-regression of studies that compared the outcomes of CABG vs PCI in ULM in ACS. Methods: Medline, EmCare, CINHAL, Cochrane database, and Google Scholar were searched for studies comparing CABG vs PCI in patients who presented with ACS and was found to have ULM as culprit vessel. Our primary outcome was mortality at longest follow up. Our secondary Outcome was repeat revascularization at longest follow up. We used PM method with HKSJ adjustment to estimate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using I 2 statistics. Multivariable meta-regression analysis was used to account for heterogeneity. History of smoking, diabetes, hypertension and previous PCI was used for multivariable regression. R version 3.6.2 was used for all statistical analysis. Results: A total of 8 studies met our inclusion criteria. The follow up period varied from 6 months to 10 years. There was no significant difference in the risk of mortality between CABG vs PCI; RR: 1.31, CI: 0.76 - 2.27, I 2 = 71%. However, the PCI as compared to CABG was associated with higher risk repeat revascularization at longest follow up; RR: 2.64, 95% CI: 1.56 to 4.46, I 2 = 60%. Meta-regression analysis reported previous PCI to be associated with lower mortality with CABG [P value =0.01], while history of diabetes was associated with higher mortality with CABG [P value Conclusion: CABG vs PCI in ULM in ACS is associated with similar risk of mortality. Previous PCI and non-diabetics were associated with higher mortality with PCI as compared to CABG. However PCI as compared to CABG was associated with higher risk of repeat revascularizations.

Background: Cardiac sarcoidosis (CS) affects 35% of patients with pulmonary sarcoidosis (PS). CS presentation varies from asymptomatic patients to sudden cardiac death. The current screening modalities like EKG and conventional echocardiography lack sensitivity for early detection of CS. Speckle tracking echocardiography (STE) has shown potential for early detection of subclinical myocardial damage in patients with PS. We aimed to investigate the role of STE in early detection of CS. Methods: We queried Medline, EmCare, CINAHL, Cochrane Database and Google Scholar for articles investigating the role of left ventricle global longitudinal strain (LVGLS) in asymptomatic patients with PS versus (vs) controls. Studies that included patients with suspected or proven CS, patients with cardiac symptoms, arrhythmias, coronary artery disease or valvular abnormalities were excluded. The standard mean difference (SMD) in GLS for both groups was pooled using random effects model. Results: Our search yielded a total of 9 studies with a total of 967 patients with PS undergoing screening for CS. In individual studies, the baseline characteristics were not significantly different between both groups. Overall, the studies had more females than males. All patients in our cohort had preserved ejection fraction (EF) and no cardiac symptoms. The LVGLS was significantly decreased in the PS group as compared to controls, SMD: -3.98, (95% CI: -5.32 to -2.64; p-value 2 = 94.70%, Figure 1. Conclusion: As compared to controls, patients with PS with no clinically suspected or proven CS, and normal EF, have impaired LVGLS. More studies are warranted to investigate the role of LVGLS in CS screening.

Background: Octogenarians and nonagenarians are under-represented in major clinical trials studying the role of anticoagulation (AC) in atrial fibrillation (AF). These patients are at an increased risk of bleeding owing to their frailty, their propensity for falls, and frequently impaired kidney function. We performed a meta-analysis of studies that investigated the role of AC in these patients. Methods: We queried Medline, EmCare, CINHAL, Cochrane Database, and Google Scholar for studies investigating the role of AC for AF in octogenarians and nonagenarians. Our primary efficacy outcome was major thromboembolism (TE), and secondary safety outcome was major bleeding (MB). We used the PM method with HKSJ adjustment to estimate risk ratio (RR) with a 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I 2 . R version 3.6.2 was used for statistical analysis. Heterogeneity was addressed using outlier analysis. dmetar() package in R was used, and the pooled estimate was re-calculated, excluding the outliers. Results: Ten observational studies, including a total of 34,697 patients were included. There was no difference in the risk of TE [RR: 0.82, 95% CI: 0.49-1.38, I 2 =74%] or MB [RR: 1.00, 95% CI: 0.55-1.83, I 2 =88%] between the AC and Non-AC group. However, the pooled estimates were associated with considerable heterogeneity. Outlier analysis identified two studies "Perera et al., 2009" and "Yamashita et al., 2016" as an outlier for pooled estimation of TE, while [1] "Siu et al., 2014", "Bertozzo et al., 2016", "Ekerstad et al., 2018" and "Alnsasra et al., 2018" were outliers in the pooled estimate of MB. Following exclusion of outliers for each endpoint, the reanalyzed RR for TE and MB were [RR: 0.94, 95% CI: 0.82- 1.09, I 2 =0%] and [RR: 1.57, 95% CI: 1.41- 1.74, I 2 =0%]. Conclusion: There was no difference in the risk of TE, while the risk of MB increased with the use of AC for AF in octogenarians and nonagenarians.

Background: Long term outcomes of culprit multi-vessel and left main patients who presented with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) are not well defined. Randomized trials comparing the two modalities constituted mainly of patients with stable coronary artery disease (SCAD). We performed a meta-analysis of studies that compared the long term outcomes of CABG vs. PCI in NSTE-ACS. Methods: Medline, EmCare, CINAHL, Cochrane databases were queried for relevant articles. Studies that included patients with SCAD and ST-elevation myocardial infarction were excluded. Our primary outcome was major adverse cardiac events (MACE) at 3-5 years, defined as a composite of all-cause mortality, stroke, re-infarction and repeat revascularization. The secondary outcome was re-infarction at 3 to 5 years. We used the Paule-Mandel method with Hartung-Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I 2 statistics. All statistical analysis was carried out using R version 3.6.2 Results: Four observational studies met our inclusion criteria with a total number of 6695 patients. At 3 to 5 years, the PCI group was associated with a higher risk of MACE as compared to CABG, (RR): 1.52, 95% CI: 1.28 to 1.81, I 2 =0% (PANEL A). The PCI group also had a higher risk of re-infarctions during the period of follow up, RR: 1.88, 95% CI 1.49 to 2.38, I 2 =0% (PANEL B). Conclusion: In this meta-analysis, CABG was associated with a lower risk of MACE and re-infarctions as compared to PCI during 3 to 5 years follow up period.

Background: The optimum revascularization modality in multi-vessel and left main disease patients presenting with non-ST elevation acute coronary syndrome (non-STE-ACS) is not well studied. The current recommendations are based on studies that primarily included patients with stable angina. Patients with non-STE-ACS were under-represented in clinical trials. We performed a meta-analysis of studies comparing coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in non-STE-ACS, and reporting 30 days major adverse cardiac events (MACE). Methods: We searched Medline, EmCare, CINAHL, Cochrane database, and Google Scholar for relevant articles. We excluded studies that included patients with stable coronary artery disease and ST elevation myocardial infarction. Our primary outcome was 30 days MACE defined as all-cause death, stroke, repeat revascularization and re-infarction. We used the Paule-Mandel method with the Hartung-Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with a 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I 2 statistics. To account for heterogeneity, a meta-regression analysis was performed. Results: Five observational studies met our inclusion criteria summing to a total number of 7161 patients. At 30 days, there was no difference between CABG vs. PCI in terms of MACE, RR: 0.96, 95% CI 0.38 to 2.39, I 2 = 81% (Panel A). A meta-regression analysis reported that a history of PCI was associated with a lower risk of MACE with CABG compared to PCI (Panel B). Conclusion: At 30 days, there was no difference in MACE between the CABG and PCI groups. However, a history of PCI was associated with a lower risk of MACE in patients who underwent CABG.