Pajjuru, Venkata Siva Kumar

Background Rotational and orbital coronary atherectomy (CA) are commonly utilized to treat complex calcified coronary lesions. We conducted a meta-analysis to evaluate sex differences in procedural complications and clinical outcomes after CA. Methods PubMed, Google Scholar, and Cochrane databases were searched for all studies comparing sex differences in procedural and clinical outcomes following CA. The outcomes of interest were procedural complications (coronary dissection, stroke, major bleeding, coronary perforation, cardiac tamponade, and slow or no flow in target vessel) and the clinical outcomes (including early mortality, mid-term all-cause mortality, stroke, myocardial infarction, and target vessel revascularization). Pooled risk ratios (RRs) with their corresponding 95% confidence intervals (CIs) were calculated using the Mantel–Haenszel random-effects model. Results Six observational studies with 3517 patients (2420 men and 1035 women) were included in this meta-analysis. While there was no significant difference in the early mortality (RR, 1.14; 95% CI, 0.37–3.53; P = 0.83) between men and women, at a mean follow-up of 2.9 years, all-cause mortality was significantly higher in women (RR, 1.29; 95% CI, 1.11–1.49; P = 0.0009). Women had an increased risk of procedure-related stroke (RR, 3.98; 95% CI, 1.06–14.90; P = 0.04), coronary dissection (RR, 2.10; 95% CI, 1.23–3.58; P = 0.006), and bleeding (RR, 2.26; 95% CI, 1.30–3.93; P = 0.004), whereas the rates of coronary perforation, cardiac tamponade, and the risk of slow or no flow in the revascularized artery were similar in both. Conclusion In our analysis, women undergoing CA are at increased risk of mid-term mortality and procedure-related complications including stroke, coronary dissection, and major bleeding.

Background: There is limited contemporary data exploring the impact of hospital characteristics on the outcomes of AMI-CA patients. Methods: We used the National Inpatient Sample database (2000-2017), to identify adult admissions with a primary diagnosis of AMI and concomitant CA. Inter-hospital transfers were excluded and hospitals were classified based on location and teaching status (rural, urban nonteaching and urban-teaching), and bed size (small, medium and large) as specified by the Agency for Healthcare Research and Quality Results: Among 494,083 AMI-CA admissions, 9.3% received care at rural hospitals, 43.4% at urban non-teaching hospitals, and 47.3% at urban teaching hospitals. Compared to urban non-teaching and teaching hospitals, AMI-CA admissions at rural hospitals received lower rates of coronary angiography (36.5% vs 57.7% vs 69.1%), PCI (28.1% vs 42.6% vs 52.1%), CABG (3.4%, 7.6% vs. 10.1%), MCS (10.1% vs 17.8% vs 22.6%), and invasive mechanical ventilation (42.9%, 49.7% vs. 48.7%) (all p <0.001). Admissions to urban teaching hospitals had higher rates of acute organ failure, concomitant cardiogenic shock and higher rates of cardiac and non-cardiac procedures. When hospitals were stratified by bed-size, 9.8% of AMI-CA admissions were admitted to small hospitals, 26.0% to medium-sized, and 64.2% to large hospitals. Compared to medium and large hospitals, AMI-CA admissions at small hospitals had lower rates of coronary angiography (48.9% vs 56.8% vs 64.7%), PCI (37.5% vs 42.5% vs 48.4%), CABG (5.3%, 6.8% vs. 9.5%), MCS (14.3% vs 17.3% vs 21%), and invasive mechanical ventilation (48.3%, 50.1% vs. 48%) (all p <0.001). In-hospital mortality was higher in urban non-teaching (adjusted odds ratio [aOR] 1.17 [95% confidence interval {CI} 1.14-1.20]; p<0.001) and urban teaching hospitals (aOR 1.36 [95% CI 1.32-1.39]; p<0.001) compared to rural hospitals. Compared to small hospitals, medium (aOR 1.11 [95% CI 1.08-1.14]; p<0.001) and large hospitals (aOR 1.22 [95% CI 1.19-1.25]; p<0.001) were associated with higher in-hospital mortality. Conclusions: AMI-CA admissions to large and urban hospitals had higher in-hospital mortality compared to small and rural hospitals potentially due to greater acuity.

Abstract Aims To assess gender differences in in-hospital mortality and 90-day readmission rates among patients undergoing transcatheter aortic valve replacement (TAVR) in the USA. Methods and results Hospitalizations for TAVR were retrospectively identified in the National readmissions database (NRD) from 2012 to 2017. Gender based differences in in-hospital mortality and 90-day readmissions were explored using multivariable logistic regression models. During the study period, an estimated 171 361 hospitalizations for TAVR were identified, including 79 722 (46.5%) procedures in women and 91 639 (53.5%) in men. Unadjusted in-hospital mortality and 90-day all-cause readmissions were significantly higher for women compared with men (2.7% vs. 2.3%, P = 0.002; 25.1% vs. 24.1%, P = 0.012, respectively). After adjusting for baseline characteristics, women had 13% greater adjusted odds of in-hospital mortality [adjusted odds ratio (aOR): 1.13, 95% confidence interval (CI): 1.02–1.26, P = 0.017], and 9% greater adjusted odds of 90-day readmission compared with men (aOR: 1.09, 95% CI: 1.05–1.14, P &lt; 0.001). During the study period, there was a steady decrease in-hospital mortality (5.3% in 2012 to 1.6% in 2017; Ptrend &lt; 0.001) and 90-day (29.9% in 2012 to 21.7% in 2017; Ptrend &lt; 0.001) readmission rate in both genders. Conclusion In-hospital mortality and readmission rates for TAVR hospitalizations have decreased over time across both genders. Despite these improvements, women undergoing TAVR continue to have a modestly higher in-hospital mortality, and 90-day readmission rates compared with men. Given the expanding indications and use of TAVR, further research is necessary to identify the reasons for this persistent gap and design appropriate interventions.