Wiener klinische Wochenschrift / Impact of bivalirudin on mortality and bleeding complications in acute coronary syndrome patients undergoing invasive revascularization : A real world experience

Background In a retrospective analysis of a prospective single center registry we compared the use of bivalirudin, unfractionated heparin (UFH) monotherapy, UFH + abciximab in 1240 consecutive patients with acute coronary syndrome (ACS) undergoing stent implantation. Results Bivalirudin was associated with tendentially reduced in-hospital minor or major bleeding rates compared to UFH monotherapy (5.9% vs. 9.4% adjusted odds ratio (OR) 0.82, 95% confidence interval CI 0.451.51, p = 0.53) and compared to the pooled UFH group (5.9% vs. 11.9%, adjusted OR 0.62, 95% CI 0.361.08, p = 0.09) but with significantly lower bleeding hazards compared to UFH + abciximab (5.9% vs. 16%, adjusted OR 0.41, 95% CI 0.220.78, p < 0.01). After 3 years of follow-up, adjusted cardiovascular mortality rates were similar between all groups, particularly between bivalirudin vs. UFH monotherapy (hazard ratio HR 1.12, 95% CI 0.582.16, p = 0.73) and vs. UFH + abciximab (HR 0.91, 95% CI 0.402.10, p = 0.83). Acute or subacute stent thrombosis occurred at a rate of 0.8% with no significant differences between the groups. Conclusions This retrospective analysis in a real world situation of medium to high-risk ACS patients undergoing invasive revascularization confirmed the results of most large-scale randomized trials by demonstrating reduced bleeding rates in favor of bivalirudin vs. UFH + GPI but with no significant differences between treatment strategies for long-term all-cause and cardiovascular mortality.(VLID)349626

Impact of On-Site Cardiac Surgery on Clinical Outcomes After Transfemoral Transcatheter Aortic Valve Replacement

OBJECTIVES This study sought to investigate the outcome of high-risk and inoperable patients with severe symptomatic aortic stenosis undergoing transfemoral transcatheter aortic valve replacement (TAVR) in hospitals with (iOSCS) versus without institutional on-site cardiac surgery (no-iOSCS). BACKGROUND Current guidelines recommend the use of TAVR only in institutions with a department for cardiac surgery on site. METHODS In this analysis of the prospective multicenter Austrian TAVI registry, 1,822 consecutive high-risk patients with severe symptomatic aortic stenosis undergoing transfemoral TAVR were evaluated. A total of 290 (15.9%) underwent TAVR at no-iOSCS centers (no-iOSCS group), whereas the remaining 1,532 patients (84.1%) were treated in iOSCS centers (iOSCS group). RESULTS Patients of the no-iOSCS group had a higher perioperative risk defined by the logistic EuroSCORE (20.9% vs. 14.2%; p CONCLUSIONS Patients undergoing transfemoral TAVR in hospitals without iOSCS had a significantly higher baseline risk profile. After propensity score matching short-and long-term mortality was similar between centers with and without iOSCS. (c) 2018 by the American College of Cardiology Foundation