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  • 1
    Online Resource
    Online Resource
    Rehospitalization Events After Aortic Valve Replacement: Insights From the PARTNER Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation: Cardiovascular Interventions Vol. 15, No. 12 ( 2022-12)
    Details
    In: Circulation: Cardiovascular Interventions, Ovid Technologies (Wolters Kluwer Health), Vol. 15, No. 12 ( 2022-12)
    Abstract: Rehospitalization is a common end point in clinical trials of structural heart interventions, but whether rehospitalization is clinically and prognostically relevant in these patients is uncertain. The aim of this study was to evaluate the risk of rehospitalization events after aortic valve replacement (AVR) and their association with mortality and health status. Methods: The study population included patients who underwent transcatheter or surgical AVR in the PARTNER I‚ II‚ and III trials (Placement of Aortic Transcatheter Valves). Health status was assessed with the Kansas City Cardiomyopathy Questionnaire-overall summary score. The primary analysis focused on heart failure hospitalization within 1 year after AVR and its association with mortality, poor outcome (death, Kansas City Cardiomyopathy Questionnaire-overall summary score 〈 60 or decrease by ≥10), and health status at 1 year using adjusted models. Secondary analyses examined the prognostic associations of rehospitalization due to a composite of heart failure, valve-related, or procedure-related causes. Results: Among 3403 patients treated with AVR (2008 transcatheter AVR, 1395 surgical AVR), the 1-year incidence was 6.7% for heart failure hospitalization and 9.7% for rehospitalization due to a composite of heart failure, valve-related, or procedure-related causes. Heart failure hospitalization after AVR was associated with increased risk of 1-year mortality (hazard ratio, 3.97 [2.48 to 6.36] ; P 〈 0.001), poor outcome (OR, 2.76 [1.73 to 4.40]; P 〈 0.001), and worse health status (Kansas City Cardiomyopathy Questionnaire-overall summary mean difference −9.8 points [−13.8 to −5.8]; P 〈 0.001). Rehospitalization due to a composite of heart failure, valve-related, or procedure-related causes was similarly associated with increased 1-year mortality (hazard ratio, 4.64 [3.11 to 6.92]; P 〈 0.001), poor outcome (OR, 2.06 [1.38 to 3.07]; P =0.0004), and worse health status (Kansas City Cardiomyopathy Questionnaire-overall summary mean difference −8.8 points [−11.8 to −5.7]; P 〈 0.001). There was no effect modification by treatment type (transcatheter AVR versus surgical AVR) for these associations. Conclusions: Heart failure hospitalization and rehospitalization after AVR are associated with increased risk of mortality and worse 1-year health status. These findings confirm the clinical and prognostic relevance of rehospitalization end points for trials of AVR. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00530894.
    Type of Medium: Online Resource
    ISSN: 1941-7640 , 1941-7632
    URL: Article
    DOI: 10.1161/CIRCINTERVENTIONS.122.012195
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2450801-9
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  • 2
    Online Resource
    Online Resource
    Outcomes of Transcatheter Aortic Valve Replacement in Asymptomatic or Minimally Symptomatic Aortic Stenosis
    Elsevier BV ; 2023
    In:  JACC: Cardiovascular Interventions Vol. 16, No. 21 ( 2023-11), p. 2631-2641
    Details
    In: JACC: Cardiovascular Interventions, Elsevier BV, Vol. 16, No. 21 ( 2023-11), p. 2631-2641
    Type of Medium: Online Resource
    ISSN: 1936-8798
    URL: Article
    DOI: 10.1016/j.jcin.2023.07.007
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2452163-2
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  • 3
    Online Resource
    Online Resource
    Trends in invasive treatment of patients hospitalized with aortic stenosis complicated by cardiogenic shock
    Wiley ; 2022
    In:  Catheterization and Cardiovascular Interventions Vol. 100, No. 6 ( 2022-11), p. 1110-1116
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 100, No. 6 ( 2022-11), p. 1110-1116
    Abstract: Before the development of transcatheter aortic valve replacement (TAVR), balloon aortic valvuloplasty (BAV) was the only potential nonsurgical intervention for patients with aortic stenosis complicated by cardiogenic shock. Emergent TAVR is now an option and has shown acceptable outcomes compared with elective TAVR. We explored how treatment patterns for aortic stenosis and cardiogenic shock among patients received invasive intervention have shifted since TAVR was introduced. Methods We used the Nationwide In patients Sample to identify nonelective hospitalizations for patient with aortic stenosis complicated by cardiogenic shock who received invasive treatment (TAVR, BAV, or surgical aortic valve replacement [SAVR]). We explored the proportion treated with each treatment modality over time, the patient characteristics and in‐hospital mortality associated with each treatment, and used multivariable logistic regression to examine whether changes in in‐hospital mortality over time differed by treatment. Results Between 2010 and 2019, we identified 9899 hospitalizations for decompensated aortic stenosis with cardiogenic shock during which patients received invasive treatment (TAVR 17.7%, BAV 20.2%, SAVR 62.1%). Use of both TAVR and BAV has increased over time compared with SAVR (TAVR 6.6% ≥ 33.8%, BAV 8.4% ≥ 23.2%, SAVR 91.6% ≥ 43.0%; p   〈  0.001 for trend). The overall in‐hospital mortality rate was 21.0%, which decreased over time for all treatments (TAVR 20.0% ≥ 18.8%, BAV 66.0% ≥ 25.5%, SAVR 17.7% ≥ 11.8%; linear trend p   〈  0.001 for each), with lower mortality for TAVR versus BAV at all time points. Patients treated with TAVR (vs. BAV) were less likely to require mechanical ventilation (36.8% vs. 46.3%, p   〈  0.001) or mechanical circulatory support (22.5% vs. 29.9%, p   〈  0.001). In the multivariable analysis, the interaction between treatment and time was not significant ( p  = 0.245), indicating the reduction in in‐hospital mortality over time did not differ among the treatments. Conclusions Since the introduction of TAVR, there has been a shift toward increased use of nonsurgical invasive treatments (both BAV and TAVR) for aortic stenosis and cardiogenic shock. Although in‐hospital mortality has declined, it remains high in all groups, but particularly among patients treated with BAV, where the severity of cardiogenic shock appears to be higher than in those treated with other modalities.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v100.6
    DOI: 10.1002/ccd.30413
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2001555-0
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  • 4
    Online Resource
    Online Resource
    Association of Statin Use and Mortality After Transcatheter Aortic Valve Replacement
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of the American Heart Association Vol. 8, No. 8 ( 2019-04-16)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 8 ( 2019-04-16)
    Abstract: Statins may reduce mortality after transcatheter aortic valve replacement (TAVR) through prevention of atherosclerotic events or pleiotropic effects. However, the competing mortality risks in TAVR patients may dilute any positive effect of statins. We sought to understand the association of statin use with post‐TAVR mortality. Methods and Results We included high– or intermediate–surgical risk patients who underwent TAVR as a part of the PARTNER (Placement of Aortic Transcatheter Valves) II and Sapien 3 trials and registries. Outcomes included 2‐year all‐cause, cardiovascular, and noncardiovascular mortality. We used propensity score matching to generate matched pairs between those discharged on a statin and those not on a statin after TAVR. Bias was explored with falsification end points (urinary infection, hip fracture). Among 3956 patients who underwent TAVR, we matched 626 patients on a statin with 626 patients not on a statin at discharge. Among matched patients, statin use was associated with lower risk of all‐cause (hazard ratio [HR] 0.65, 95% CI 0.49‐0.87, P =0.001), cardiovascular (HR 0.66, 95% CI 0.46‐0.96, P =0.030), and noncardiovascular mortality (HR 0.64, 95% CI 0.44‐0.99, P =0.045) compared with no statin use. The survival curves diverged within 3 months and continued to separate over a median follow‐up of 2.1 years. The falsification end points were similar among groups (urinary infection, P =0.66; hip fracture, P =0.64). Conclusions In an observational, propensity‐matched analysis of TAVR patients, statin use was associated with lower rates of cardiovascular and noncardiovascular mortality compared with no statin use. Given the early emergence of the apparent protective effect of statins, this result may be driven either by pleiotropic effects or by residual confounding despite propensity‐matching methodology.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.118.011529
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2653953-6
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  • 5
    Online Resource
    Online Resource
    Stroke After Surgical Versus Transfemoral Transcatheter Aortic Valve Replacement in the PARTNER Trial
    Elsevier BV ; 2018
    In:  Journal of the American College of Cardiology Vol. 72, No. 20 ( 2018-11), p. 2415-2426
    Details
    In: Journal of the American College of Cardiology, Elsevier BV, Vol. 72, No. 20 ( 2018-11), p. 2415-2426
    Type of Medium: Online Resource
    ISSN: 0735-1097
    URL: Article
    DOI: 10.1016/j.jacc.2018.08.2172
    RVK:
    XA 17760
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 1468327-1
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