Mayank Yadav

Incidence, Predictors, and Prognostic Impact of Late Bleeding Complications After Transcatheter Aortic Valve Replacement

BACKGROUND The incidence and prognostic impact of late bleeding complications after transcatheter aortic valve replacement (TAVR) are unknown. OBJECTIVES The aim of this study was to identify the incidence, predictors, and prognostic impact of major late bleeding complications (MLBCs) (≥30 days) after TAVR. METHODS Clinical and echocardiographic outcomes of patients who underwent TAVR within the randomized cohorts and continued access registries in the PARTNER (Placement of Aortic Transcatheter Valves) trial were analyzed after stratifying by the occurrence of MLBCs. Predictors of MLBCs and their association with 30-day to 1-year mortality were assessed. RESULTS Among 2,401 patients who underwent TAVR and survived to 30 days, MLBCs occurred in 142 (5.9%) at a median time of 132 days (interquartile range: 71 to 230 days) after the index procedure. Gastrointestinal complications (n = 58 [40.8%]), neurological complications (n = 22 [15.5%]), and traumatic falls (n = 11 [7.8%]) were identified as the most frequent types of MLBCs. Independent predictors of MLBCs were the presence of low hemoglobin at baseline, atrial fibrillation or flutter at baseline or 30 days, the presence of moderate or severe paravalvular leak at 30 days, and greater left ventricular mass at 30 days. MLBCs were identified as a strong independent predictor of mortality between 30 days and 1 year (adjusted hazard ratio: 3.91; 95% confidence interval: 2.67 to 5.71; p < 0.001). CONCLUSIONS MLBCs after TAVR were frequent and associated with increased mortality. Better individualized and risk-adjusted antithrombotic therapy after TAVR is urgently needed in this high-risk population. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).

Prediction of Coronary Risk by SYNTAX and Derived Scores Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery

The introduction of the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score has prompted a renewed interest for angiographic risk stratification in patients undergoing percutaneous coronary intervention. Syntax score is based on qualitative and quantitative characterization of coronary artery disease by including 11 angiographic variables that take into consideration lesion location and characteristics. Thus far, this score has been shown to be an effective tool to risk-stratify patients with complex coronary artery disease undergoing percutaneous coronary intervention in the landmark SYNTAX trial, as well as in other clinical settings. This review provides an overview of its current applications, including its integration with other nonangiographic clinical scores, and explores future applications of the SYNTAX and derived scores.

SYNTAX score and the risk of stent thrombosis after percutaneous coronary intervention in patients with non‐ST‐segment elevation acute coronary syndromes: An ACUITY trial substudy

We sought to investigate the relationship between the SYNTAX score (SS) and stent thrombosis (ST) in patients with non‐ST‐segment elevation acute coronary syndromes (NSTE‐ACS) undergoing percutaneous coronary intervention (PCI).

Angiographic predictors of 2-year stent thrombosis in patients receiving drug-eluting stents: Insights from the ADAPT-DES study.

We sought to identify angiographic predictors of 2‐year stent thrombosis (ST) in the ADAPT‐DES study.

Effect of Baseline Thrombocytopenia on Ischemic Outcomes in Patients With Acute Coronary Syndromes Who Undergo Percutaneous Coronary Intervention.

BACKGROUND Acquired thrombocytopenia (TP) has been associated with short- and long-term adverse outcomes after percutaneous coronary intervention (PCI), but the role of baseline TP is less well defined. We sought to evaluate the effect of TP on long-term adverse outcomes in patients with acute coronary syndromes (ACS) who undergo PCI. METHODS Data from 10,603 patients who underwent PCI for non-ST-elevation ACS or ST-elevation myocardial infarction were pooled from 2 large-scale randomized trials, Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) and Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI). Patients were stratified according to baseline platelet counts. Those with platelet counts <150,000/mm(3) were considered to have normal platelet counts. Adverse event rates were compared between groups with and without multivariable adjustment. RESULTS Baseline TP was present in 607 (5.7%) patients. The unadjusted 1-year rates of death (6.7% vs 3.6%; P < 0.0001), occurrence of major adverse cardiac event (MACE) (20.8% vs 15.6%; P = 0.0002), and target lesion revascularization (TLR; 9.4% vs 7.2%; P = 0.01) were significantly higher in patients with baseline TP compared with patients with normal platelet counts. By multivariable analysis, the presence of TP at baseline was an independent predictor of 1-year death (hazard ratio [HR], 1.74; 95% confidence interval [CI], 1.12-2.69; P = 0.01), ischemic TLR (HR, 1.37; 95% CI, 1.04-1.81; P = 0.03), and MACE (HR, 1.39; 95% CI, 1.09-1.79; P = 0.009). CONCLUSIONS The presence of baseline TP in the setting of ACS patients who undergo PCI was strongly predictive of death, ischemic TLR, and MACE at 1 year. Baseline TP might be a useful baseline clinical parameter to estimate future ischemic risk after PCI.

IMPACT ON TWO-YEAR OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION COMPLEXITY AND PLATELET REACTIVITY AMONG PATIENTS WITH STABLE CORONARY ARTERY DISEASE: INSIGHT FROM THE ADAPT-DES STUDY

methods: ADAPT-DES was a prospective, multicenter registry of patients successfully treated with one or more drug-eluting stents. NonACS pts were classified in two groups according to the complexity of the PCI (complex PCI was defined as ≥3 stents implanted, use of rotational atherectomy, saphenous vein graft, bifurcation with two stents implanted, and left main PCI) and stratified according to platelet reactivity (low: PRU <208 vs. high: PRU ≥208). Two-year outcomes were compared.

TCT-322 The Smoker’s Paradox Revisited: A 5-Year Patient-Level Pooled Analysis of 17 Randomized Controlled Trials

TCT-321 Definite and probable stent thrombosis after revascularization with drug-eluting stents with a biodegradable polymer. From the randomized SORT OUT VII Trial Lisette Okkels Jensen, Michael Maeng, Bent Raungaard, Knud Noerregaard Hansen, Johnny Kahlert, Svend Eggert Jensen, Hans Erik Bøtker, Henrik Hansen, Jens Flensted Lassen, Evald Christiansen Odense University Hospital, Odense, Denmark; Aarhus University Hospital, Aarhus N, Denmark; Aalborg University Hospital, Aalborg, Denmark; Odense Universitets Hospital, Odense, Denmark; Rutgers Robert Wood Johnson Medical School; Aalborg University Hospital, Aalborg, Denmark; Weatherhead PET Center, McGovern Medical School at UTHealth; Unknown, Odense, Denmark; The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark

TCT-756 Incidence, Predictors, and Prognostic Impact of Late Bleeding (≥30 days) Complications after Transcatheter Aortic Valve Replacement (TAVR)

The incidence and prognostic impact of late bleeding complications (LBC) after TAVR are unknown. We sought to identify the incidence, predictors, and prognostic impact of LBC (≥30 days) after TAVR. Clinical and echocardiographic outcomes of patients who underwent TAVR within the randomized

Association Between Coronary Calcification and Bleeding After Pci in Acs: Pooled Analysis From Horizons-Ami and Acuity Trials

PCI of calcified compared to non-calcified coronary lesions have been associated with higher rates of adverse ischemic events. However, the potential association between coronary calcification and bleeding events has not been examined. Data from 6,855 pts with UA-NSTEMI or STEMI treated by PCI were