CRT-101.10 Outcomes of Underlying Infiltrative Cardiomyopathy in Percutaneous Coronary Intervention

Background: Evidence on the prognosis of infiltrative cardiomyopathy in patients undergoing percutaneous coronary intervention (PCI) has not been well established. Our objective was to assess the prevalence of infiltrative cardiomyopathy including amyloidosis, sarcoidosis and hemochromatosis in PCI patients and its effect on mortality. Methods: National Inpatient Sample 2016-2019 was used to conduct a retrospective analysis by identifying a cohort of patients who underwent PCI with infiltrative cardiomyopathy using respective ICD-10 codes. Primary outcome was the effect of infiltrative cardiomyopathy on mortality in patients undergoing PCI. Secondary outcomes were the independent predictors of mortality. Multivariate logistic regression model was used for analysis. Results: 1.93 million patients were hospitalized for undergoing PCI, out of which 6270 patients had infiltrative cardiomyopathy (prevalence 0.33%). Subgroup analysis showed that 710 patients had underlying amyloidosis (prevalence 0.04%), 4300 patients had sarcoidosis (prevalence 0.23%) and 1280 patients had hemochromatosis (prevalence 0.07%). Mean age of patients undergoing PCI with infiltrative cardiomyopathy was 61 years, 54% were females and 53.5% were white. Patients undergoing PCI were predominantly males (67%) but patient with infiltrative cardiomyopathy who underwent PCI were predominantly females (54%). Underlying amyloidosis was associated with two fold increased odds of mortality in patients undergoing PCI (OR 2.13, 95% CI 1.08-4.23, p=0.029). While sarcoidosis (OR 1.11, 95% CI 0.73-1.7, p=0.6) and hemochromatosis (OR 0.79, 95% CI 0.32-1.92, p=0.6) were not significantly associated with mortality in patients undergoing PCI. The independent predictors of mortality in patients undergoing PCI with infiltrative cardiomyopathy are arrhythmias (OR 2.59, OR 1.14-5.9, p=0.02), cardiac arrest (OR 10.3, CI 3.8-27.6, p=0.00), pulmonary embolism (OR 5.8, CI 1.06-32.4, p=0.04), kidney disease (OR 4.5, CI 1.99-10.3, p=0.00) and liver disease OR 3.5, CI 1.34-9.1, p=0.01). Conclusion: Prevalence of infiltrative cardiomyopathy in patients undergoing PCI is 0.33%. Amyloidosis is associated with significantly increased odds of mortality in patients undergoing PCI while sarcoidosis and hemochromatosis are not significantly associated with mortality. Arrhythmias, cardiac arrest, pulmonary embolism, kidney and liver disease are independently associated with increased mortality in infiltrative cardiomyopathy patients undergoing PCI

Mechanical Circulatory Support in Acute Myocardial Infarction and Cardiogenic Shock

Mechanical circulatory support devices are increasingly used for the treatment of acute myocardial infarction complicated by cardiogenic shock. These devices provide different levels of univentricular and biventricular support, have different mechanisms of actions, and provide different physiologic effects. Institutions require expert teams to safely implant and manage these devices. This article reviews the mechanism of action, physiologic effects, and data as they relate to the utilization of these devices

CRT-700.53 Risk of Heart Block Development in Surgical Management of Congenital Heart Disease

Background: There is a paucity of data regarding the risk for heart block during surgical repair of congenital heart disease (CHD). We sought to identify the prevalence and prognosis of heart block in patient’s requiring surgical intervention for CHD. Methods: National Inpatient Sample 2016-2019 was used to conduct a retrospective analysis by identifying a cohort of patients admitted for surgical management for atrial septal defect repair/replacement (ASDR), ventricular septal defect repair/replacement (VSDR) and patent ductus arteriosus closure (PDAC) using respective ICD-10 codes. Primary outcome was the risk of developing heart blocks including atrioventricular and bundle branch/fascicular blocks which was assessed with multivariate logistic regression model. Results: 7.6% patients with ASD underwent ASDR, 10.4% patients with VSD underwent VSDR and 8.8% patients with PDA underwent PDAC. Heart blocks were observed in 12% of ASD patients undergoing ASDR, 10% of VSD patients undergoing VSDR and 8.8% of PDA patients undergoing PDAC. Mean age was 38.9 years for patients undergoing ASDR developing heart blocks, 11.48 years for patients undergoing VSDR developing heart blocks and 10.3 months for patients undergoing PDAC developing heart blocks. On analysis of patients who developed heart blocks after undergoing surgery for CHD, we found that 51.5% were males, 48.4% were females, 57.8% were white, 12.7% were African-American and 17.6% were Hispanic. ASDR was associated with increased odds of developing heart blocks in patients with ASD (OR 3.89, CI 3.6-4.2, p\u3c0.001) and VSDR was associated with increased odds of developing heart blocks in VSD patients (OR 9.31, CI 8-10.7, p\u3c0.001). While, PDAC was associated with even higher odds of developing heart blocks in PDA patients (OR 12.75, CI 10.4-15.6, p\u3c0.001). ASDR was associated with decreased mortality in ASD patients (OR 0.85, CI 0.74-0.98, p=0.036), VSDR had no significant association with mortality in VSD patients (OR 0.99, p=0.9) and PDAC was associated with minimally increased mortality (OR 1.16, CI 1.001-1.36, p=0.04). Conclusion: Heart blocks are prevalent among the patients undergoing surgical treatment for CHD. Surgical repair of CHD is strongly associated with the risk of developing heart blocks, highest risk being with PDAC followed by VSDR and ASDR

CRT-700.66 Principal Diagnosis and Independent Predictors for 30-Day Readmissions in Primary Cardiac Tumor Patients

Background: Primary cardiac tumors (PCT) are rare with an incidence of 0.3-0.7%. We aimed to study the rate, causes and independent predictors for 30-day readmissions in patients diagnosed with PCT using a national level database. Methods: We conducted a retrospective cohort analysis using the National Readmissions Database between 2016-2018. ICD-10 codes were used to identify patients with benign and malignant PCT. Patients \u3c18 years and December admissions were excluded. Primary outcomes were the readmission rate and principal diagnosis for 30-day readmissions in patients hospitalized with primary diagnosis of PCT. Multivariate logistic regression was used for analysis. Results: 4451 patients were admitted with the primary diagnosis of PCT, out of which 4348 patients were discharged alive. Among those discharged alive, 13.8% (599 patients) were readmitted within 30 days. The most common principal diagnosis for 30-day readmissions were subsequent admission for benign PCT (17.12%), atrial fibrillation (8.1%), sepsis (5.3%), pneumonia (4.04%), hypertensive heart disease with heart failure (2.6%), supraventricular tachycardia (2.54%), non-inflammatory pericardial effusion (2.31%), and pleural effusion (2.22). For the index admissions, 65.7% were females, and mean age was 60.8 years. The in-hospital mortality rate for index admissions was 2.28% while it was 2.36% for the readmission. For the index admission, mean length of stay was 8 days while mean total charges were $163,636. For all the readmissions combined, the total length of stay was 3598 days and combined total charges were$54.7 million. The independent predictors for readmission were atrial fibrillation (OR 0.71, p=0.02), myocardial infarction (OR 2.89, p=0.006), acute liver failure/hepatic cirrhosis (OR 2.34, p=0.02), and diabetes mellitus (OR 1.75, p=0.002). Conclusion: In patients with a principal diagnosis of PCT, the 30-day readmission rate is 13.8% and the most common principal diagnosis for readmissions are PCT complications, atrial fibrillation, supraventricular tachycardia, pneumonia, sepsis, hypertensive heart disease with heart failure, pericardial effusion, and pleural effusion

TCT-66 Door to Impella Placement in Acute Coronary Syndrome Complicated by Cardiogenic Shock: An Updated Meta-analysis

Background: The impact of time to hemodynamic support in acute myocardial infarction complicated by cardiogenic shock (AMICS) has yet to be defined. The aim of this meta-analysis was to evaluate the impact of timing of mechanical circulatory support (MCS) with Impella. Methods: a systematic literature review and meta-analysis was conducted using PubMed and Cochrane databases. All studies reporting short-term mortality rates and timing of Impella insertion, pre vs during/post PCI, were included. Primary end point was short-term mortality (≤30 days), while secondary end pointswere midterm mortality, device-related bleeding and limb ischemia. Results: Of 1,289 studies identified, 13 studies (6,810 patients; 2,970 patients identified as receiving Impella before PCI and 3,840 patients receiving Impella during/after PCI) were included in this analysis. Median age was 63.8 years (IQR 63-65.7 years), 76% of patients were male, and a high prevalence of cardiovascular risk factors was noted across the entire population. Short-term mortality was significantly reduced in those receiving pre-PCI Impella support, 37.2% vs 53.6% (RR 0.7; CI 0.56-0.88). Midterm mortality was also lower in the pre-PCI group, 47.9% vs 73% (RR 0.81; CI 0.68-0.97). The rates of device-related bleeding (RR 1.05; CI 0.47-2.33) and limb ischemia (RR 1.6; CI 0.63-2.15) were similar between the two groups. Conclusion: This analysis suggests that MCS placement with Impella prior to PCI in AMICS may have a positive impact on short- and midterm mortality compared with post-PCI placement, with similar outcome in terms of safety. Categories: CORONARY: Hemodynamic Support and Cardiogenic Shoc

TCT-121 Extraplaque Versus Intraplaque Tracking in Chronic Total Occlusion Percutaneous Coronary Intervention

Background: The impact of modern extraplaque (EP) tracking techniques on long-term outcomes remains controversial. Methods: We performed a systematic review and meta-analysis of studies that compared EP vs intraplaque (IP) tracking in CTO PCI. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Der-Simonian and Laird random-effects method. Results: Our meta-analysis included seven observational studies with 2,982 patients. Patients who underwent EP tracking had significantly more complex CTOs with higher J-CTO scores (2.9 ± 1.2 vs 1.6 ± 1.1, P \u3c 0.001), longer lesion length, more severe calcification, and significantly longer stented segments. During a median follow-up of 12 months (range 9-12 months), EP tracking was associated with a higher risk of major adverse cardiovascular events (MACE) (OR 1.50, 95% CI 1.10-2.06, P = 0.01) and target vessel revascularization (TVR) (OR 1.69, 95% CI 1.15-2.48, P = 0.01) compared with IP tracking. There was no difference in the incidence of all-cause death (OR 1.37, 95% CI 0.67-2.78, P = 0.39), myocardial infarction (MI) (OR 1.48, 95% CI 0.82-2.69, P = 0.20), or stent thrombosis (OR 2.09, 95% CI 0.69-6.33, P = 0.19) between EP and IP tracking. Conclusion: Compared with IP tracking, EP tracking was utilized in more complex and longer CTOs, required more stents, and was associated with a higher risk of MACE at 12 months, driven by a higher risk of TVR, but without an increased risk of death or MI. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP

Cardiac Tamponade Secondary to COVID-19

A 67-year-old female presented with upper respiratory symptoms and was diagnosed with COVID-19. She was found to have a large hemorrhagic pericardial effusion with echocardiographic signs of tamponade and mild left ventricular impairment. Clinical course was complicated by development of Takotsubo cardiomyopathy. She was treated with pericardiocentesis, colchicine, corticosteroids and hydroxychloroquine with improvement in symptoms

Mechanical circulatory support in acute myocardial infarction and cardiogenic shock: Challenges and importance of randomized control trials

BACKGROUND: Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is associated with significant morbidity and mortality. METHODS: We provide an overview of previously conducted studies on the use of mechanical circulatory support (MCS) devices in the treatment of AMI-CS and difficulties which may be encountered in conducting such trials in the United States. RESULTS: Well powered randomized control trials are difficult to conduct in a critically ill patient population due to physician preferences, perceived lack of equipoise and challenges obtaining informed consent. CONCLUSIONS: With growth in utilization of MCS devices in patients with AMI-CS, efforts to perform well-powered, randomized control trials must be undertaken