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2.
J Am Coll Cardiol ; 77(17): 2187-2199, 2021 05 04.
Article in English | MEDLINE | ID: mdl-33926655

ABSTRACT

BACKGROUND: Among patients with acute coronary syndrome following transcatheter aortic valve replacement (TAVR), those presenting with ST-segment elevation myocardial infarction (STEMI) are at highest risk. OBJECTIVES: The goal of this study was to determine the clinical characteristics, management, and outcomes of STEMI after TAVR. METHODS: This was a multicenter study including 118 patients presenting with STEMI at a median of 255 days (interquartile range: 9 to 680 days) after TAVR. Procedural features of STEMI after TAVR managed with primary percutaneous coronary intervention (PCI) were compared with all-comer STEMI: 439 non-TAVR patients who had primary PCI within the 2 weeks before and after each post-TAVR STEMI case in 5 participating centers from different countries. RESULTS: Median door-to-balloon time was higher in TAVR patients (40 min [interquartile range: 25 to 57 min] vs. 30 min [interquartile range: 25 to 35 min]; p = 0.003). Procedural time, fluoroscopy time, dose-area product, and contrast volume were also higher in TAVR patients (p < 0.01 for all). PCI failure occurred more frequently in patients with previous TAVR (16.5% vs. 3.9%; p < 0.001), including 5 patients in whom the culprit lesion was not revascularized owing to coronary ostia cannulation failure. In-hospital and late (median of 7 months [interquartile range: 1 to 21 months]) mortality rates were 25.4% and 42.4%, respectively (20.6% and 38.2% in primary PCI patients), and estimated glomerular filtration rate <60 ml/min (hazard ratio [HR]: 3.02; 95% confidence interval [CI]: 1.42 to 6.43; p = 0.004), Killip class ≥2 (HR: 2.74; 95% CI: 1.37 to 5.49; p = 0.004), and PCI failure (HR: 3.23; 95% CI: 1.42 to 7.31; p = 0.005) determined an increased risk. CONCLUSIONS: STEMI after TAVR was associated with very high in-hospital and mid-term mortality. Longer door-to-balloon times and a higher PCI failure rate were observed in TAVR patients, partially due to coronary access issues specific to the TAVR population, and this was associated with poorer outcomes.


Subject(s)
Aortic Valve Stenosis/surgery , Postoperative Complications/etiology , Risk Assessment/methods , ST Elevation Myocardial Infarction/etiology , Transcatheter Aortic Valve Replacement/adverse effects , Aged, 80 and over , Coronary Angiography , Female , Follow-Up Studies , Global Health , Hospital Mortality/trends , Humans , Incidence , Male , Percutaneous Coronary Intervention , Postoperative Complications/epidemiology , Risk Factors , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/epidemiology , Time Factors
4.
JACC Cardiovasc Interv ; 14(2): 149-157, 2021 01 25.
Article in English | MEDLINE | ID: mdl-33358648

ABSTRACT

OBJECTIVES: This study sought to test the superiority in terms of efficacy and safety of a dedicated plug-based vascular closure device (VCD) during transcatheter aortic valve replacement (TAVR) over a suture-based VCD. BACKGROUND: Vascular complications after TAVR are relevant and often associated with VCD failure. METHODS: The MASH (MANTA vs. Suture-based vascular closure after transcatHeter aortic valve replacement) trial is an international, 2-center pilot randomized controlled trial comparing the MANTA VCD (Teleflex, Wayne, Pennsylvania) versus 2 ProGlides (Abbott Vascular, Abbott Park, Illinois). The primary composite endpoint consisted of access site-related major or minor vascular complications at 30-days' follow-up. Secondary endpoints included clinically relevant access site bleeding, time to hemostasis, and modified VCD failure (defined as failure to achieve hemostasis within 5 min or requiring additional endovascular maneuvers such as endovascular stenting, surgical techniques, or additional closure devices). Adverse events were adjudicated by an independent clinical events committee according to the VARC-2 definitions. RESULTS: A total of 210 TAVR patients were included between October 2018 and January 2020. Median age was 81 years, 54% were male, and the median STS score was 2.7%. There was no significant difference in the primary endpoint of access site-related vascular complications between MANTA and ProGlide (10% vs. 4%; p = 0.16). Clinically significant access site bleedings were similar with both closure techniques (9% vs. 6%; p = 0.57). Modified VCD failure occurred less frequently in MANTA versus ProGlide (20% vs. 40%; p < 0.01). Suture-based closure required more often additional closure devices, whereas MANTA numerically needed more covered stents and surgical bailouts. CONCLUSIONS: Plug-based large-bore arteriotomy closure was not superior to suture-based closure. Plug-based closure required fewer, but a different kind of bailout maneuvers.


Subject(s)
Catheterization, Peripheral , Sutures , Vascular Closure Devices , Aged, 80 and over , Female , Femoral Artery , Hemostatic Techniques , Humans , Male , Pilot Projects , Transcatheter Aortic Valve Replacement , Treatment Outcome
6.
EuroIntervention ; 16(2): e100-e102, 2020 Jun 12.
Article in English | MEDLINE | ID: mdl-32538787
7.
Expert Rev Cardiovasc Ther ; 11(10): 1417-24, 2013 Oct.
Article in English | MEDLINE | ID: mdl-24138527

ABSTRACT

Management strategies to ensure medication adherence for patients following percutaneous coronary intervention have not changed in recent years despite the dismal rates of non-compliance with dual antiplatelet therapy. The goal of this review is to emphasis the importance of dual antiplatelet therapy in patients following percutaneous coronary intervention, discuss the clinical and economic ramifications of premature discontinuation and strategies for improvement.


Subject(s)
Medication Adherence , Percutaneous Coronary Intervention/methods , Platelet Aggregation Inhibitors/therapeutic use , Drug Therapy, Combination , Health Care Costs , Humans , Platelet Aggregation Inhibitors/administration & dosage
8.
Curr Cardiol Rep ; 15(4): 350, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23420446

ABSTRACT

Adoption of the transradial approach for coronary procedures is rapidly growing in the US. A decrease in vascular complications and improved patient comfort are the primary benefits of this technique compared to femoral artery access. However, as this is still an invasive procedure, it is important for operators who utilize this technique to be aware of the known complications that are associated with radial access. Radial artery occlusion and spasm are the most common issues that occur with transradial procedures. Vascular complications such as perforations, forearm hematomas and pseudoaneurysm formation are much less common.


Subject(s)
Percutaneous Coronary Intervention/adverse effects , Radial Artery , Aneurysm, False/etiology , Arterial Occlusive Diseases/etiology , Cardiac Catheterization/adverse effects , Cardiac Catheterization/methods , Forearm , Hematoma/etiology , Humans , Percutaneous Coronary Intervention/methods , Radial Artery/injuries , Risk Factors
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