Marc Katz

Current Clinical Outcomes of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting

BACKGROUND Randomized trials have compared coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). However, results of these trials in select patients may not accurately reflect current clinical practice using drug-eluting stents (DES) and off-pump CABG. We undertook a prospective registry of coronary revascularization by CABG on-pump and off-pump, and PCI with or without DES, to determine clinical outcomes. METHODS All patients undergoing isolated coronary revascularization in 8 community-based hospitals were enrolled. Preprocedural, intraprocedural, and postprocedural data were captured, with outcomes obtained at 18 months by patient and physician contact, and the Social Security Death Index. RESULTS The study enrolled 4336 patients, 71.2% PCI and 28.8% CABG. DESs were used in 2249 PCIs (73.1%), and 596 CABG procedures (47.8%) were off-pump. Incidence of major adverse cardiac events at 18 months was 14.7% for CABG vs 23.3% for PCI (p < 0.001). Cardiac death and myocardial infarction had similar rates. The need for repeat revascularization was significantly less with CABG (6.2% vs 13.6%, p < 0.001). Hazard ratio of CABG to PCI was 0.76 (95% confidence interval, 0.571 to 0.872). CABG outcome was similar on-pump and off-pump, as was repeat revascularization with DES (12.1%) vs BMS (14.9%; p = 0.096). Overall event-free survival was 85.3% in CABG and 76.8% in PCI (p < 0.001). CONCLUSIONS Rates of repeat revascularization were significantly higher for PCI than for CABG, but mortality and myocardial infarction were the same. There were no significant differences in outcomes between DES and BMS or between on-pump and off-pump CABG.

Pretransplant transfusions in cardiac allograft recipients.

The role of pretransplant transfusion in cardiac allograft recipients was determined retrospectively in 68 patients. Three groups were studied: group 1 (n=29) received no pretransplant transfusion, group 2 (n=15) received transfusion over one year prior to transplantation, and Group 3 (n=24) received 5 or 10 50–100 ml units of random donor red blood cells or buffy coat 2–4 weeks prior to transplantation. Data were analyzed for survival, number of rejection episodes, and number of infections. Immunosuppression included azathioprine, prednisone, and antithymocyte globulin. Survival in transfused patients (groups 2 and 3) was 68% and 51% at 1 and 5 years, respectively, while in the nontrans-fused population (group 1) it was 35% and 16%. The incidence of rejection episodes per year of survival was similar in the three groups (group 1: 1.3, group 2: 1.1, group 3: 1.3; P<0.05). The number of infections per year of survival were greater in the transfused patients but this did not achieve statistical significance (group 1: 1.0, group 2: 1.2, group 3: 1.7; P<0.05). Thus, we conclude that cardiac transplant recipients who have received blood transfusions prior to transplantation may have enhanced survival over patients who have not received preoperative transfusions.

MEDICARE REIMBURSEMENT ASSOCIATED WITH AN AMI HOSPITALIZATION AND 90-DAYS POST-DISCHARGE

Background: Proposed episode payment model (bundle) for acute myocardial infarction (AMI) necessitates understanding resource consumption. This study identifies resource consumption of Medicare beneficiaries (MBs), index hospitalization and 90 day post discharge, who sustained an AMI in FY 2014.

TCT-632 Predictive Value of Age-Adjusted Charlson Comorbidity Index for 1-Year, 3-Year and 5-Year Mortality in Patients Following Transcatheter Mitral Valve Repair

This study aimed to determine if age-adjusted Charlson comorbidity index could predict mortality in patients undergoing transcatheter mitral valve repair (TMVR), and to assess its discriminatory performance in long-term outcomes. Comorbidity increases markedly with aging, and they often negatively