Fadi Ghrair, Jad Omran, Joseph Thomas, Kristina Gifft, Haytham Allaham, Mohammad Eniezat, Arun Kumar, Tariq Enezate
{"title":"合并经皮冠状动脉介入治疗和经导管主动脉瓣置换术的结果。","authors":"Fadi Ghrair, Jad Omran, Joseph Thomas, Kristina Gifft, Haytham Allaham, Mohammad Eniezat, Arun Kumar, Tariq Enezate","doi":"10.5114/amsad.2020.103092","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Coronary artery disease is a common diagnosis among patients undergoing transcatheter aortic valve replacement (TAVR). The treatment and timing of percutaneous coronary intervention (PCI) remain controversial. We sought to compare in-hospital periprocedural outcomes of combined TAVR and PCI during the same index hospitalization versus the isolated TAVR procedure.</p><p><strong>Material and methods: </strong>The study population was extracted from the 2016 Nationwide Readmissions Data (NRD) using International Classification of Diseases, tenth edition, clinical modifications/procedure coding system codes for TAVR, coronary PCI, and post-procedural complications. Study endpoints included in-hospital all-cause mortality, length of index hospital stay, cardiogenic shock, need for mechanical circulatory support (MCS) devices, mechanical complications of prosthetic valve, paravalvular leak (PVL), acute kidney injury (AKI), bleeding and total hospital charges. Propensity matching was used to adjust for baseline characteristics.</p><p><strong>Results: </strong>There were 23,604 TAVRs in the 2016 NRD, of which 852 were combined with PCI during the same index hospitalization. Mean age was 80.5 years and 45.9% were female. In comparison to isolated TAVR, TAVR-PCI was associated with higher in-hospital all-cause mortality (4.5% vs. 1.7%, <i>p</i> < 0.01), longer length of stay (10.5 vs. 5.4 days, <i>p</i> < 0.01), and higher incidence of cardiogenic shock (9.4% vs. 2.1%, <i>p</i> < 0.01), use of MCS devices (6.8% vs. 0.7%, <i>p</i> < 0.01), mechanical complications of prosthetic valve (6.8% vs. 0.7%, <i>p</i> < 0.01), PVL (0.9% vs. 0.4%, <i>p</i> = 0.01), AKI (25.5% vs. 11.5%, <i>p</i> < 0.01), bleeding (25.2% vs. 18.1%, <i>p</i> < 0.01), and total hospital charges ($354,725 vs. $220474, <i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>In comparison to isolated TAVR, combined TAVR-PCI was associated with a higher incidence of in-hospital morbidity and mortality. The association and mechanism of increased mortality warrant further study.</p>","PeriodicalId":8317,"journal":{"name":"Archives of Medical Sciences. Atherosclerotic Diseases","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2020-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f3/b8/AMS-AD-5-43135.PMC7885813.pdf","citationCount":"6","resultStr":"{\"title\":\"Outcomes of concomitant percutaneous coronary interventions and transcatheter aortic valve replacement.\",\"authors\":\"Fadi Ghrair, Jad Omran, Joseph Thomas, Kristina Gifft, Haytham Allaham, Mohammad Eniezat, Arun Kumar, Tariq Enezate\",\"doi\":\"10.5114/amsad.2020.103092\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Coronary artery disease is a common diagnosis among patients undergoing transcatheter aortic valve replacement (TAVR). The treatment and timing of percutaneous coronary intervention (PCI) remain controversial. We sought to compare in-hospital periprocedural outcomes of combined TAVR and PCI during the same index hospitalization versus the isolated TAVR procedure.</p><p><strong>Material and methods: </strong>The study population was extracted from the 2016 Nationwide Readmissions Data (NRD) using International Classification of Diseases, tenth edition, clinical modifications/procedure coding system codes for TAVR, coronary PCI, and post-procedural complications. Study endpoints included in-hospital all-cause mortality, length of index hospital stay, cardiogenic shock, need for mechanical circulatory support (MCS) devices, mechanical complications of prosthetic valve, paravalvular leak (PVL), acute kidney injury (AKI), bleeding and total hospital charges. Propensity matching was used to adjust for baseline characteristics.</p><p><strong>Results: </strong>There were 23,604 TAVRs in the 2016 NRD, of which 852 were combined with PCI during the same index hospitalization. Mean age was 80.5 years and 45.9% were female. In comparison to isolated TAVR, TAVR-PCI was associated with higher in-hospital all-cause mortality (4.5% vs. 1.7%, <i>p</i> < 0.01), longer length of stay (10.5 vs. 5.4 days, <i>p</i> < 0.01), and higher incidence of cardiogenic shock (9.4% vs. 2.1%, <i>p</i> < 0.01), use of MCS devices (6.8% vs. 0.7%, <i>p</i> < 0.01), mechanical complications of prosthetic valve (6.8% vs. 0.7%, <i>p</i> < 0.01), PVL (0.9% vs. 0.4%, <i>p</i> = 0.01), AKI (25.5% vs. 11.5%, <i>p</i> < 0.01), bleeding (25.2% vs. 18.1%, <i>p</i> < 0.01), and total hospital charges ($354,725 vs. $220474, <i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>In comparison to isolated TAVR, combined TAVR-PCI was associated with a higher incidence of in-hospital morbidity and mortality. The association and mechanism of increased mortality warrant further study.</p>\",\"PeriodicalId\":8317,\"journal\":{\"name\":\"Archives of Medical Sciences. 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Outcomes of concomitant percutaneous coronary interventions and transcatheter aortic valve replacement.
Introduction: Coronary artery disease is a common diagnosis among patients undergoing transcatheter aortic valve replacement (TAVR). The treatment and timing of percutaneous coronary intervention (PCI) remain controversial. We sought to compare in-hospital periprocedural outcomes of combined TAVR and PCI during the same index hospitalization versus the isolated TAVR procedure.
Material and methods: The study population was extracted from the 2016 Nationwide Readmissions Data (NRD) using International Classification of Diseases, tenth edition, clinical modifications/procedure coding system codes for TAVR, coronary PCI, and post-procedural complications. Study endpoints included in-hospital all-cause mortality, length of index hospital stay, cardiogenic shock, need for mechanical circulatory support (MCS) devices, mechanical complications of prosthetic valve, paravalvular leak (PVL), acute kidney injury (AKI), bleeding and total hospital charges. Propensity matching was used to adjust for baseline characteristics.
Results: There were 23,604 TAVRs in the 2016 NRD, of which 852 were combined with PCI during the same index hospitalization. Mean age was 80.5 years and 45.9% were female. In comparison to isolated TAVR, TAVR-PCI was associated with higher in-hospital all-cause mortality (4.5% vs. 1.7%, p < 0.01), longer length of stay (10.5 vs. 5.4 days, p < 0.01), and higher incidence of cardiogenic shock (9.4% vs. 2.1%, p < 0.01), use of MCS devices (6.8% vs. 0.7%, p < 0.01), mechanical complications of prosthetic valve (6.8% vs. 0.7%, p < 0.01), PVL (0.9% vs. 0.4%, p = 0.01), AKI (25.5% vs. 11.5%, p < 0.01), bleeding (25.2% vs. 18.1%, p < 0.01), and total hospital charges ($354,725 vs. $220474, p < 0.01).
Conclusions: In comparison to isolated TAVR, combined TAVR-PCI was associated with a higher incidence of in-hospital morbidity and mortality. The association and mechanism of increased mortality warrant further study.
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