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The group used propensity score matching to compare 144 STEMI patients with a history of TAVR to 144 STEMI patients without a history of TAVR. Using the same technique, we compared 1,321 his NSTEMI patients with a history of TAVR to 1,321 his NSTEMI patients without a history of TAVR. These data revealed that the use of coronary artery revascularization (PCI or CABG) was similar among patients who had previously undergone her TAVR surgery. Treatment of 65.3% of her STEMI patients with a history of TAVR and 63.9% of her STEMI patients without such a history required coronary revascularization. On the other hand, the coronary revascularization rate in patients with NSTEMI was 41.4% in patients with a history of TAVR and 41.7% in patients without a history of TAVR.
“Future research should focus on elucidating the factors that explain the high mortality rate of STEMI patients after TAVR and identify targets to improve outcomes,” the authors concluded.
Click here for a complete analysis of the team.
Editorial offers perspective on life after TAVR
A corresponding editorial is also published JACC: Cardiovascular Intervention, we evaluated the research results in detail. The authors called the new study a “welcome addition to the literature,” but shared some caution.
“On the face of it, these findings appear reassuring given continued concerns that the presence of a TAVR valve may interfere with future coronary access, particularly in the setting of primary PCI for STEMI.” writes interventional cardiologist David Cohen, MD, MS. He collaborated with St. Francis Hospital and Heart Center and the Cardiovascular Research Foundation and is a co-author with Wally Omer, M.D., an interventional cardiologist at Northwell Health. “However, as the authors acknowledge, this study has important limitations that should be considered when interpreting the findings.”
One of those limitations is that the Vizient database “captures readmissions only if they occur in the same hospital where the patient received the index TAVR.” This suggests that her AMI rate after TAVR may have been underestimated.
“Deaths that occur at another hospital or entirely outside the hospital may also be underreported by hospital-centric databases, thereby overestimating each patient’s survival time and reducing the true incidence of MI. may be further underestimated,” they added.
Cohen et al. They noted that patients who return to the same hospital where they underwent TAVR are more likely to be treated by an interventional cardiologist with experience in “treating coronary arteries around and through transcatheter valves.” did. This could mean that the revascularization rates in this study represent some sort of “best-case scenario” rather than data that can be generalized to all hospitals in the United States.
“It is important to note that these limitations are not unique to this study and are shared to some degree by virtually all real-world evidence and postmarket surveillance studies in the United States,” the authors wrote. writing.
The two cardiologists concluded their editorial by praising the “important new information” contained in Dauerman et al.’s analysis.
“First, it is reassuring that the incidence of AMI after TAVR is relatively low and similar to that seen in the general population, even after accounting for the possibility of missing occult events,” the researchers said. are writing. “It is also encouraging that in post-TAVR patients presenting with STEMI or NSTEMI, the morbidity of invasive coronary angiography and PCI is similar to that seen in matched patients without TAVR. Further research using other data sources will be required to determine whether this finding is limited to TAVR centers or whether similar rates can be achieved in the general population.”
Click here to read the full editorial.
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