Controversies in the Management of ST Elevation Myocardial Infarction: Thrombin Inhibition.

Anticoagulation is essential in patients with ST elevation myocardial infarction (STEMI) to prevent further thrombosis and to maintain patency of the infarct-related artery after reperfusion. The various anticoagulant medications available for use in patients with STEMI include unfractionated heparin (UFH), low-molecular-weight heparin, fondaparinux, and bivalirudin, a direct thrombin inhibitor. The authors review the current anticoagulation strategies for patients with STEMI undergoing primary percutaneous coronary intervention (PCI), fibrinolysis, or no reperfusion. The authors present the latest evidence and controversies on this topic, with a focus on bivalirudin versus UFH in the setting of primary PCI for STEMI

Transcatheter Aortic Valve Replacement is Associated With a Higher Rate of Permanent Pacemaker Implantation Compared to Surgical Aortic Valve Replacement: A Propensity Matched Analysis (Poster).

Background Occurrence of conduction abnormalities requiring permanent pacemaker implantation (PPI) is a serious complication after both transcatheter (TAVR) & surgical (SAVR) aortic valve replacement. Methods Nationwide Inpatient Sample was queried from August 2011 to December 2012 using ICD-9 codes 35.05 & 35.06 for TAVR and 35.21 & 35.22 for SAVR. Patients undergoing other valve surgeries, bypass grafting & those with prior pacemakers or defibrillators were excluded. Propensity matching was performed (1:1) to match TAVR & SAVR cohorts on age, gender, right bundle branch block (RBBB), first degree AV block, bifascicular or trifascicular block, hospital region, teaching hospital status & hospital bed size. Logistic regression was performed to identify predictors of PPI. Differences in the two cohorts were tested using chi-square test. Results Total 2,990 patients (1,495 in TAVR group & 1,495 in SAVR group) were included, with mean age 80.2 +/- 9.0 years, 50.4% females & 83.2% Caucasians. RBBB (OR 2.3, 95% CI 1.4-4.0, p = 0.002) & bifascicular or trifascicular block (OR 6.9, 95% CI 2.8-17.0, p Conclusions PPI rates are higher after TAVR (with predominantly balloon expandable valves) compared to SAVR, after matching on demographic, EKG & hospital characteristics. This suggests greater damage to cardiac conduction system with TAVR compared to SAVR