Risultati per: Short Acting Opioid

Circulation, Volume 150, Issue Suppl_1, Page A4133654-A4133654, November 12, 2024. Introduction:Conventional cardiovascular disease (CVD) risk scores are inaccurate for prostate cancer patients (PC); the Guha-Stabellini machine learning (GS-ML) score shows promise but lacks external validation.Hypothesis:The GS-ML score is superior to conventional CVD scores in patients with PC.Aim(s):To conduct external validation of the GS-ML score in patients diagnosed with PC.Methods:The validation used holdout data from Seidman Cancer Center’s CAISIS platform (internal validation cohort) and RADICAL PC1 (external validation cohort; a prospective study of men diagnosed with PC within 1 year or starting ADT within 1 month of enrollment), matching covariates with the GS-ML score. With limited follow-up, short-term CVD (2,000 days from PC diagnosis) was the outcome. Performance was assessed via area under the receiver operating characteristic curve (AUC) with assistance from Youden statistic cutoff, comparing metrics with ACC/AHA pooled cohort equations (PCE), SCORE-2, and AHA-PREVENT scores. Atherosclerotic cardiovascular disease (ASCVD) included non-fatal ischemic stroke and myocardial infarction. CVD included ASCVD and heart failure.Results:We included 2,495 patients from RADICAL PC1 and 1,506 from the internal validation cohort (Table 1). In the internal validation cohort, the CVD AUCs were 0.58, 0.49, 0.65, 0,73, and 0.75 for PCE, SCORE2, PREVENT simple, PREVENT enhanced, and GS-ML score, respectively. In RADICAL PC1, the AUCs for CVD were 0.60, 0.43, 0.67, and 0.64 for PCE, SCORE2, PREVENT simple and GS-ML score, respectively. For ASCVD, internal validation cohorts’ AUCs were 0.63, 0.62, 0.66, 0.73, and 0.67 for PCE, SCORE2, PREVENT simple, PREVENT enhanced, and Guha-Stabellini, respectively. The RADICAL PC1 ASCVD AUCs were 0.64, 0.46, 0.65, and 0.61, for PCE, SCORE2, PREVENT simple and GS-ML scores, respectively,Conclusion(s):The GS-ML score was validated for PC patients, showing superior performance to PCE and SCORE2, and similar performance to AHA-PREVENT in predicting CVD. The European Cardio-Oncology guidelines should reconsider using SCORE2 for PC patients. Further improvement and validation with nationally representative datasets are needed to corroborate these findings and enhance the generalizability of the GS-ML score.

Circulation, Volume 150, Issue Suppl_1, Page A4137905-A4137905, November 12, 2024. Background:In out-of-hospital cardiac arrest (OHCA) patients with an initial shockable rhythm, epinephrine increases the likelihood of return of spontaneous circulation (ROSC), but its effect on neurological outcome remains uncertain. Epinephrine administered before extracorporeal resuscitation (ECPR), which is a non-pharmacological method to obtain ROSC, may have worsened neurological outcome.Aim:To evaluate the impact of prehospital epinephrine administration on the prognosis of OHCA patients undergoing ECPR.Methods:This is a retrospective analysis of a cohort study from a multicenter, prospective registry of 81234 OHCA patients between 2014 and 2021. After the application of exclusion criteria, 1061 OHCA patients with an initial shockable rhythm and who underwent ECPR were eligible for this study. The primary outcome was favorable neurological outcome at 30 days after the OHCA and the secondary outcome was ROSC during transfer. Patients who did and did not receive prehospital epinephrine were propensity score-matched on the basis of age, gender, witness arrest, bystander-initiated CPR, dispatcher-assisted CPR, advanced airway management, call-to-defibrillation interval, year and district.Results:Among 1061 eligible patients, 442 patients received epinephrine and 619 patients did not. Matching was successful in achieving covariate balance as shown by a standardized difference of

Circulation, Volume 150, Issue Suppl_1, Page A4139791-A4139791, November 12, 2024. Intro:Drug Development for Heart failure with Preserved Ejection Fraction (HFpEF) is a major challenge facing cardiovascular research due to its complex pathophysiology and existence of comorbidities, leading to recognize distinct HFpEF phenogroups. Animal model development should consider this heterogeneity and each model capturing features of specific phenogroups.Hypothesis:We established a 2-hit model consistent with one of the leading phenogroups, the cardiometabolic and mild hypertension associated HFpEF, by combining a high fat diet to trigger obesity/metabolic syndrome and L-NAME to induce mild hypertension (HFD/L-NAME). We evaluated the presence of HFpEF hallmark and corroborated our data with literature. Empagliflozin (EMPA), the clinical benchmark, was used to confirm the relevance of the model.Methods:To induce obesity/metabolic syndrome, mild and HFpEF, C57BL6N mice were fed HFD (60% Kcal from fat) and water with L-NAME (0.5g/l) for 8 weeks. Control mice (Ctrl) were fed normal chow and water. At 5weeks, mice were randomized based on E/A ratio and ejection fraction and were treated QD for 3weeks with vehicle or EMPA (10mg/kg). Then, treadmill exercise tolerance test was performed, cardiac geometry, systolic and diastolic function were evaluated by echocardiography and heart and lungs were harvested. Longitudinal blood pressure was evaluated by tail cuff.Results:Compared with Ctrl, HFD/L-NAME mice showed cardiac remodeling, preserved systolic function and moderate diastolic dysfunction characterized by inverted or pseudonormal profiles and higher filling pressure (E/A=1.2±0.04 E’/A’=1.1±0.02 E/E’=16.4±0.6 in HFD/L-NAME vs E/A=1.4 ± 0.02 E’/A’=1.3±0.01 E/E’=14.4±0.4 in Ctrl). HFD/L-NAME mice showed altered exercise capacity (p

Circulation, Volume 150, Issue Suppl_1, Page ASu1107-ASu1107, November 12, 2024. Introduction:Opioid overdose (OD) is a growing cause of cardiac arrest in the US, spurred by the rise of illegally manufactured fentanyl and analogs. Naloxone is a reversal agent that can be administered by bystanders. Intra-nasal (IN) naloxone is now widely available in pharmacies across the US. Despite increasing access, minority populations remain disproportionately affected by drug overdose deaths. There are many free online opioid OD educational videos. Digital media can be a powerful tool for mass education, but the effectiveness is unknown.Research Question and Aims:The goal of this study was to evaluate online opioid overdose videos for content and gender/racial representation.Methods:We performed an online search with the query “how to give Narcan” (popular term for IN naloxone). Results were limited to the first 52 Google, 50 YouTube, and 60 TikTok videos. Exclusion criteria included: animal victim, duplicate, or no mention of naloxone. For each video, 2 reviewers evaluated content and identified the race and gender of featured characters. Disagreements were resolved through consensus. The race and gender of featured characters was compared using a two proportion z-test. Inter-rater reliability (IRR) for each data point was calculated using the arithmetic mean of Cohen’s kappa.Results:Of 121 videos, the majority (87.6%) mentioned naloxone as a treatment for opioid OD; 62.8% provided instruction on how to administer IN naloxone, and 4.1% featured a testimonial. Only 43.0% provided a realistic visual demonstration of IN naloxone administration; 25.6% showed a realistic re-enactment of opioid overdose, and even fewer (19.0%) showed the dramatic response to naloxone. IRR was high for all categories.Videos predominantly featured white compared to non-white-appearing characters in both the victim (75.5 v. 17.8%, p< 0.00001) and rescuer roles (72.5 v 21.6%, p

Circulation, Volume 150, Issue Suppl_1, Page A4146863-A4146863, November 12, 2024. Introduction:The treatment of heart failure (HF) with hydralazine-isosorbide dinitrate (H-ISDN) in African Americans (AA) with New York Heart Association (NYHA) III-IV who remain symptomatic despite optimal medical therapy is a class Ia indication. However, the efficacy of guideline directed medical therapy (GDMT) which combines sodium-glucose cotransporter-2 inhibitors (SGLT2i) and H-ISDN in reducing hospital readmissions has not been well studied.Hypothesis:In self-identified AA adults with advanced heart failure on GDMT including hydralazine-isosorbide dinitrate, the use of a SGLT2i reduces hospitalization for HF.Methods:The patients studied were self-identified AA with advanced HF on GDMT [including any dose of an angiotensin receptor-neprilysin inhibitor (ARNi) or an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB), a mineralocorticoid receptor antagonist (MRA), a beta-blocker (BB), H-ISDN, with or without treatment with an SGLT2i]. Data was obtained from the Hospital Corporation of America (HCA) enterprise-wide database from January 2020 to September 2023 using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). The final cohort was divided into two groups: Group 1 consisted of those treated with an ARNi/ACEi/ARB, MRA, a beta blocker, and H-ISDN while Group 2 included those receiving the same combination of medications with the addition of an SGLT2i. Differences in baseline characteristics were analyzed between the two groups. Logistic regression was used to analyze the relationship between the treatment groups and hospital readmission within 90 days.Results:Only 517 AA met inclusion criteria and did not meet exclusion criteria, which included a history of valvular heart disease, hypertrophic or restrictive cardiomyopathy, active myocarditis, history of cardiac arrest, and life-threatening arrhythmias. When controlling for age, gender, diabetes, chronic kidney disease, atrial fibrillation, body mass index, and smoking status, there was no significant difference in the likelihood of 90-day hospital readmission between patients whose GDMT with H-ISDN included an SGLT2i and those whose treatment did not.Conclusions:The results suggest the incorporation of an SGLT2i into GDMT with H-ISDN in AA with advanced HF does not confer additional benefits in the reduction of short-term hospital readmissions for heart failure.

Circulation, Volume 150, Issue Suppl_1, Page A4146149-A4146149, November 12, 2024. Background:The WHO estimates that air pollution causes 7 million premature deaths or about 1 in 8 global deaths. Epidemiological studies indicate that 60-70% of the premature mortality attributed to air pollution are cardiovascular deaths especially in those with pre-existing conditions such as hypertension and heart failure. The underlying pathophysiological mechanisms by which exposures to air pollution worsen cardiovascular disease are unclear.Hypothesis:We hypothesized that the cardiovascular toxicity of particulate air pollution (PM2.5) exposure would be enhanced in the setting of hypertension.Methods:To test this, we combined air pollution exposure with a hypertension model (angiotensin II, 2.5 mg/kg bwt/day: ANGII osmotic pump) where normotensive and hypertensive male wildtype (WT, C57BL/6J) mice were exposed to filtered air or concentrated ambient PM2.5(CAP) for 3 weeks. To understand how combined hypertension and CAP exposure may alter cardiac remodeling, fibrosis and gene transcription (bulk RNAseq) were quantified.Results:Mice with ANGII-infusion developed hypertension (non-invasive tail cuff) that was significantly elevated by CAP exposure. Hypertensive mice also developed cardiac hypertrophy (heart weight/tibia length ratio, mg/mm) independent of exposure [hypertensive: WT+Air, 9.6±0.4; WT+CAP, 10.3±0.4; normotensive groups: WT+Air, 8.3±0.3; WT+CAP, 7.4±0.1). CAP exposure had no effect on differential gene transcription in normotensive mice, yet CAP exposure significantly induced 996 differentially expressed genes (DEG) in hypertensive mice (332 up, 664 down). Gene Ontogeny (GO) analysis found dysregulated gene clusters ( >40 genes) primarily for cardiac and striated muscle development and differentiation. Increased genes included caspase 12 (Casp12) and catechol-O-methyltransferase (Comt)genes that likely reflect enhanced apoptosis and sympathetic input. Downregulated genes included 2 collagen genes (Col5a3andCol6a3) and death inducer-obliterator 1 (Dido1) — reflecting dysregulated cardiac remodeling.Conclusions:Hypertension enhanced the susceptibility of short-term air pollution exposure to worsen cardiovascular effects especially cardiac remodeling. This study reveals potential genetic mechanisms by which air pollution hastens cardiac dysregulation and promotes heart failure – a serious, globally relevant cardiovascular health risk of particulate air pollution.

Circulation, Volume 150, Issue Suppl_1, Page A4145682-A4145682, November 12, 2024. Background:Heart transplantation (HTx) is a life-saving procedure for patients with end-stage heart disease. Sarcoid myocarditis (SM) is a rare condition characterized by granulomatous inflammation of the myocardium. The mainstay of therapy is immunosuppression but the incidence of cardiac sarcoidosis leading to advanced heart failure is increasing. HTx is a valid option in such cases however post-HTx outcomes in sarcoid population have been poorly investigated.Methods:A retrospective analysis of the National Inpatient Sample (NIS) from 2016 to 2021 was conducted. Outcomes compared between sarcoid and non-sarcoid HTx groups were mortality, length of stay (LOS), hospital charges, transplant rejection and graft failure. Mann-Whitney U test was utilized to compare differences between non-parametric variables, while multivariable logistic regression was applied to adjust for confounders.Results:During our study period a total of 17,635 patients underwent HTx out of which 235 (0.013%) had HTx due to sarcoid myocarditis. Multivariable analysis revealed a comparable mortality between sarcoid and non-sarcoid HTx (Adjusted Mortality: aOR 1.35; CI 0.40-4.56; p=0.61). Median length of stay in sarcoid myocarditis group was 29[IQR19-55] vs 28[IQR16-50] p=0.57. Total hospitalization charges were also comparable 956,893[IQR 649,498-1,451,199] vs 800,898[IQR 533,047-1,349,074], p=0.18. There was no significant increase in transplant rejection (aOR 1.43; CI 0.64-3.20; p=0.37) or graft failure (aOR 1.92; CI 0.55- 6.70; p=0.30) in the sarcoid myocarditis group (Table 1, Table 2).Conclusion:Sarcoid myocarditis patients undergoing HTx showed comparable mortality, LOS, total hospital charges, transplant rejection, or graft failure rates to patients undergoing HTx for other causes.While these findings suggest that SM, while rare, does not adversely affect transplant outcomes, we strongly advocate for more studies to adjust for limitations.

Circulation, Volume 150, Issue Suppl_1, Page A4144822-A4144822, November 12, 2024. Background:The relationship between anion gap (AG) and short-term mortality in intensive care unit (ICU) sepsis patients complicated by pulmonary hypertension (PH) remains unclear.Methods:Retrospective analysis of incident sepsis patients complicated by PH first admitted to ICU in MIMIC database (2008 to 2019) were enrolled. Short-term outcomes include in-hospital mortality and 28-day mortality. According to the AG value (17.0 mmol/L), patients were divided into high and low AG groups. The Kaplan-Meier survival curve was used to compare the cumulative survival rates of the high and low groups using the log-rank test. Multivariable Cox regression analyses were constructed to assess the relationship between AG and short-term outcomes in sepsis patients complicated by PH.Results:2012 sepsis patients with pulmonary hypertension were included. The in-hospital mortality rates (11.4%) and 28-day mortality rates (12.8%) in the high AG group were higher than those in the low AG group (5.0% or 7.2%, respectively;P< 0.001). The Kaplan-Meier curve showed that the in-hospital and 28-day cumulative survival rates were lower in the high AG group than that in the low AG group (P< 0.001). Multivariable Cox regression analysis confirmed that elevated AG was an independent risk factor of in-hospital mortality, 28-day mortality, length of stay in ICU and hospital. The relationship between elevated AG and in-hospital mortality remain stable after subgroups analyses.Conclusions:Elevated serum AG is associated with increased risk-adjusted short-term mortality in sepsis patients complicated by PH, and it may remind clinicians to identify patients with poor prognosis as early as possible.

Circulation, Volume 150, Issue Suppl_1, Page A4143745-A4143745, November 12, 2024. Background:Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is a complex procedure to restore blood flow in completely occluded coronary arteries with the aim of improving symptoms and quality of life. While CTO-PCI success rates have increased owing to advancements in antegrade and retrograde techniques, the choice of approach remains crucial. The antegrade approach is often the initial method chosen because of its relative simplicity, whereas the retrograde approach is considered in more complex cases or when the antegrade approach fails.Aims:The data suggest that the retrograde approach is associated with higher periprocedural complications, although the reports are conflicting. Our meta-analysis aimed to compare the efficacy and safety of the antegrade and retrograde approaches for CTO-PCI.Methods:A comprehensive literature search was conducted on PubMed, Embase, Google Scholar, and Scopus from inception until June 5, 2024. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using Review Manager, with a p-value of

Circulation, Volume 150, Issue Suppl_1, Page A4144188-A4144188, November 12, 2024. Objectives:Trans-catheter Aortic Valve Replacement (TAVR) is the preferred treatment of choice for improving clinical outcomes in patients with Severe Aortic Stenosis. Studies published in the past in patients undergoing TAVR with cancer have shown a lower risk of short-term mortality but an increased risk of long-term mortality. This study aims to compare short-term (within 30 days) and long-term (3 years) outcomes in patients with and without a diagnosis of cancer.Methods:Electronic databases like MEDLINE, PUBMED, and COCHRANE library were thoroughly searched from the date of inception till May2024. 4 observational prospective studies were included in this meta-analysis. Outcomes of interest included short-term mortality (3 year). The results were reported as Risk Ratio (RR) with 95% confidence intervals (CI), using a random effects model.Results:This meta-analysis included 6603 patients from 4 studies. Among those undergoing TAVR, individuals with cancer showed clinically significant reduction in short-term mortality (RR 0.63, 95% CI: 0.43-0.94, p = 0.02) but had higher rate of long-term mortality (RR 1.27, 95% CI: 1.15-1.42, p = 0.00001) compared to those without cancer. Additionally, more major bleeding episodes (RR of 1.17, 95% CI: 1.06- 1.29, p: 0.001) were observed in the cancer group compared to the non-cancer population. No significant difference was noted between the two groups regarding risk of Stroke (RR of 0.98, 95% CI: 0.67- 1.43, p: 0.91), pacemaker (PPM) insertion (RR 1.09, 95% CI: 0.96-1.24, p: 0.20), and Vascular site complications (RR 1.09, 95% CI: 0.95- 1.25, p: 0.20).Conclusion:Our study shows that cancer patients undergoing TAVR have good short-term mortality rates and comparable perioperative outcomes, but higher long-term mortality as compared to those without cancer. More randomized controlled trials are needed to further assess the long-term outcomes in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4136554-A4136554, November 12, 2024. Background:In 2023, the AHA published the PREVENT equations for estimating atherosclerotic cardiovascular disease (ASCVD) risk in adults aged 30-79 years.Research Questions:In young adults aged 20-39 years, does PREVENT improve risk prediction for 10- and 30-year ASCVD compared with existing risk assessment tools recommended in the current US guidelines (i.e., Pooled Cohort Equations [PCEs] and Pencina et al. equations)?Aims:To compare the performance of PREVENT vs. PCEs in predicting 10-year ASCVD, and PREVENT vs. Pencina equations in predicting 30-year ASCVD in young adults.Methods:We analyzed data from two complementary sources: (1) pooled data from two large cohorts: Coronary Artery Risk Development in Young Adults (CARDIA) and Framingham Heart Study (FHS; including the Offspring, Third Generation, Omni 1, and Omni 2 cohorts), and (2) electronic health records from Kaiser Permanente Southern California (KPSC). We included adults aged 20-39 years without a history of ASCVD at baseline. The outcome was incident ASCVD (defined as myocardial infarction, fatal coronary heart disease, fatal and nonfatal stroke) at 10 or 30 years. Model discrimination (Harrell’s C) and mean calibration (estimated as the ratio of predicted to observed event rates) were calculated for the overall population and stratified by sex and race/ethnicity.Results:We included 7,606 young adults (mean age 29 years, 53% female, 30% Black) from the pooled cohorts, and 284,667 (mean age 32 years, 61% female, 8% Black, 46% Hispanic) from KPSC. When predicting 10-year risk, PREVENT improved discrimination in both the pooled cohort (ΔHarrell’s C=0.052; 95% CI: 0.014, 0.095) and KPSC (ΔHarrell’s C=0.039; 95% CI: 0.028, 0.049) compared with the PCEs. PREVENT had good calibration (mean calibration ranged from 0.77 to 1.54), whereas the PCEs overestimated 10-year risk (mean calibration ranged from 1.99 to 4.82). When predicting 30-year risk, discrimination was similar for PREVENT and Pencina equations, but both algorithms underestimated 30-year risk with PREVENT showing worse calibration (mean calibration 0.61).Conclusion:PREVENT improved 10-year ASCVD risk prediction in young adults compared to the PCEs but underestimated 30-year risk.

Circulation, Volume 150, Issue Suppl_1, Page A4140686-A4140686, November 12, 2024. Background:Comorbid diabetes mellitus (DM) is associated with worse outcomes in patients with chronic limb-threatening ischemia (CLTI). Both lower extremity bypass (LEB) and peripheral vascular interventions (PVI) have demonstrated improved outcomes in peripheral artery disease (PAD). However, comparative effectiveness data for LEB versus PVI in patients with CLTI and DM is limited.Objective:This study aimed to evaluate and compare 30-day and 90-day (1) all-cause mortality, and (2) major amputation rates among patients with CLTI and comorbid DM undergoing LEB versus PVI.Methods:Patients undergoing LEB and PVI were identified from the Vascular Quality Initiative registry, linked with Medicare claims outcomes data. Propensity scores were generated using 12 variables, and a 1:1 matching method was employed. The 30-day and 90-day mortality risks for LEB versus PVI were evaluated using Kaplan-Meier survival analysis and Cox proportional hazards models, incorporating interaction terms for DM. For amputation outcomes, cumulative incidence functions and Fine-Gray competing risks models were employed, with interaction terms for DM included.Results:Among 4,210 patients undergoing LEB or PVI (2,105 in each group), the mean age was 70.9 ± 10.9 years, with 69.3% being male and 76.4% white. DM was present in 62.3% (2,662 patients). In patients with DM, 30-day all-cause mortality rates were comparable between the LEB and PVI groups (2.1% vs. 2.6%; log-rank p-value=0.844). However, LEB was associated with significantly lower 90-day all-cause mortality rates compared to PVI (5.1% vs. 7.6%; log-rank p-value=0.013). Additionally, LEB was associated with a lower risk of 30-day major amputation rates compared to PVI (2.7% vs. 4.2%; p=0.049), though no significant difference was observed in 90-day major amputation rates (9.4% vs. 10.9%; p=0.196).Conclusion:Among patients with CLTI and comorbid DM, LEB was associated with a lower risk of 30-day major amputation rates and 90-day all-cause mortality compared to PVI. These findings provide contemporary insights into the management of CLTI in diabetic patients, supporting informed shared decision-making for those often considered high-risk for surgical intervention.

Circulation, Volume 150, Issue Suppl_1, Page A4147145-A4147145, November 12, 2024. Introduction:Current guidelines recommend dual antiplatelet therapy (DAPT) for 6 months for stable ischemic heart disease and 12 months for acute coronary syndrome following percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. However, long-term DAPT is associated with increased bleeding risk.Objective:To compare short DAPT (≤3 months) followed by P2Y12 inhibitor (P2Y12i) monotherapy until 12 months vs. standard DAPT for 12 months in patients undergoing PCI with DES.Methods:We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing short DAPT followed by P2Y12i monotherapy vs. 12-month DAPT following PCI. The co-primary outcomes were composite major adverse cardiovascular/cerebrovascular events (MACCE) and net adverse clinical events (NACE; MACCE + bleeding events) at 12 months post-PCI. Secondary outcomes were major and any bleeding, myocardial infarction (MI), stroke, stent thrombosis, all-cause and cardiovascular mortality, and target vessel revascularization (TVR) at 12 months post-PCI.Results:The systematic review identified 8 randomized controlled trials including 39,782 patients (short DAPT n=19,877, 49.96%). MACCE (RR 0.88; 95%CI 0.78-0.98; p=0.023; I2=0%) and NACE (RR 0.75; 95%CI 0.65-0.86; p

Circulation, Volume 150, Issue Suppl_1, Page A4140779-A4140779, November 12, 2024. Background:Treatment of calcified coronary artery stenosis remains challenging and is associated with worse clinical outcomes. For successful PCI of calcified lesions, it is imperative to achieve sufficient plaque modification before stent implantation.Aims:The aims of the current study were to evaluate coronary microvascular dysfunction and short-term outcomes in heavy calcified coronary lesion underwent PCI with intravascular lithotripsy (IVL) versus rotational atherectomy (RA).Methods:We retrospectively analyzed 91 patients underwent PCI with severely calcified coronary stenosis treated with atherectomy devices. Of these, coronary microvascular function was assessed using temperature-sensor guidewire(PressureWire X, Abott) in 40 patients (IVL: 21, RA: 19) before and after PCI. Procedural success including successful stent delivery with

Circulation, Volume 150, Issue Suppl_1, Page A4135178-A4135178, November 12, 2024. Background:Tricuspid regurgitation (TR) is no longer considered forgotten. Transcatheter tricuspid valve repair/replacement (TVRR) has become widely accepted as gauged by clinical outcomes. FDA approved two tricuspid valve devices for the purpose of improving quality of life and not necessarily to improve TR severity. We aim to support evidence-based use of TVRR, by summarizing the latest evidence on the clinical effectiveness in terms of post-procedural length of hospital stay, readmissions for heart failure and procedure success if an Intracardiac device is present.Methods:We searched Pubmed, Embase and Cochrane databases and performed a meta-analysis of the included cohort studies using a fixed-effects model. Studies were excluded if they did not present an outcome in each intervention group or did not have enough information required for continuous data comparison. We performed a meta-analysis of hazard ratio (HR) for two outcomes and odds ratio (OR) for one outcome using the random effects model to remove inconsistency and compared the results with fixed effects model. The compared findings of both methods were similar. The variables used for analysis were number of events in exposure group and total amount of events. All data analyses were performed using MedCalc® Statistical Software version 22.023.Results:Of 161 potentially relevant studies, 8 retrospective studies with a total of 1,717 patients were included in the meta-analysis. Procedure (TVRR) success was associated with fewer readmissions for heart failure in all three studies included in the analysis of pooled HR (HR = 0.46, 95% confidence interval [CI]: 0.33 – 0.63, p

Circulation, Volume 150, Issue Suppl_1, Page A4147962-A4147962, November 12, 2024. Introduction:Heart transplants (HT) and left ventricular assist devices (LVADs) are treatment options for advanced heart failure refractory to standard therapy. Historically, LVADs have been used as either destination therapy or a bridge to transplant. However, recent changes to the organ allocation system have deprioritized patients on LVADs as transplant recipients, leading to divisive views on the role of an LVAD. We sought to describe outcomes with each modality, highlighting each option’s strengths and clinical utility.Aim:To assess costs related to index hospitalization, 30-day (30DRC) and 90-day (90DRC) readmission categories for both subgroups.Method:We analyzed the National Readmission Database (NRD) from January 1, 2018, to December 31, 2021, identifying patients with HT and LVAD via ICD-10-CM codes. We selected this recent time frame to limit the influence of older LVAD technology and heart allocation schemes. We excluded patients