Journal article
Incidence and Outcomes of Acute Coronary Syndrome After Transcatheter Aortic Valve Replacement
JACC. Cardiovascular interventions, Vol.13(8), pp.938-950
04/27/2020
DOI: 10.1016/j.jcin.2019.11.027
PMCID: PMC7202131
PMID: 32061612
Abstract
This study sought to address a knowledge gap by examining the incidence, timing, and predictors of acute coronary syndrome (ACS) after transcatheter aortic valve replacement (TAVR) in Medicare beneficiaries.
Evidence about incidence and outcomes of ACS after TAVR is scarce.
We identified Medicare patients who underwent TAVR from 2012 to 2017 and were admitted with ACS during follow-up. We compared outcomes based on the type of ACS: ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina. In patients with non–ST-segment elevation ACS, we compared outcomes based on the treatment strategy (invasive vs. conservative) using inverse probability weighting analysis.
Out of 142,845 patients with TAVR, 6,741 patients (4.7%) were admitted with ACS after a median time of 297 days (interquartile range: 85 to 662 days), with 48% of admissions occurring within 6 months. The most common presentation was NSTEMI. Predictors of ACS were history of coronary artery disease, prior revascularization, diabetes, valve-in-TAVR, and acute kidney injury. STEMI was associated with higher 30-day and 1-year mortality compared with NSTEMI (31.4% vs. 15.5% and 51.2% vs. 41.3%, respectively; p < 0.01). Overall, 30.3% of patients with non–ST-segment elevation ACS were treated with invasive approach. On inverse probability weighting analysis, invasive approach was associated with lower adjusted long-term mortality (adjusted hazard ratio: 0.69; 95% confidence interval: 0.66 to 0.73; p < 0.01) and higher risk of repeat revascularization (adjusted hazard ratio: 1.29; 95% confidence interval: 1.16 to 1.43; p < 0.001).
After TAVR, ACS is infrequent (<5%), and the most common presentation is NSTEMI. Occurrence of STEMI after TAVR is associated with a high mortality with nearly one-third of patients dying within 30 days. Optimization of care is needed for post-TAVR ACS patients and if feasible, invasive approach should be considered in these high-risk patients.
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Details
- Title: Subtitle
- Incidence and Outcomes of Acute Coronary Syndrome After Transcatheter Aortic Valve Replacement
- Creators
- Amgad Mentias - Roy J. and Lucille A. Carver College of MedicineMilind Y. Desai - Cleveland ClinicMarwan Saad - Brown UniversityPhillip A. Horwitz - University of IowaJames D. Rossen - University of IowaSidakpal Panaich - University of IowaAyman Elbadawi - The University of Texas Medical Branch at GalvestonJ. Dawn Abbott - Brown UniversityPaul Sorajja - Abbott Northwestern HospitalHani Jneid - Baylor College of MedicineE. Murat Tuzcu - Cleveland ClinicSamir Kapadia - Cleveland ClinicMary Vaughan-Sarrazin - Iowa City VA Health Care System
- Resource Type
- Journal article
- Publication Details
- JACC. Cardiovascular interventions, Vol.13(8), pp.938-950
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jcin.2019.11.027
- PMID
- 32061612
- PMCID
- PMC7202131
- ISSN
- 1936-8798
- eISSN
- 1876-7605
- Grant note
- DOI: 10.13039/100000049, name: National Institute on Aging
- Language
- English
- Date published
- 04/27/2020
- Academic Unit
- Neurology; Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Neurosurgery; Internal Medicine
- Record Identifier
- 9984302213202771
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