Background Ventricular septal defect (VSD) is one of the most common congenital heart anomalies in childhood and there is an increasing prevalence of VSDs in the adult population. The long‐term risk of infective endocarditis (IE) is of concern. The aim of this study was to clarify and compare the incidence of IE in adults with repaired and unrepaired VSDs. Methods Patients with VSDs were identified using the Adult Congenital Heart Disease registry at the National Heart Centre Singapore. Patients were divided into Group 1 (repaired VSD) and Group 2 (unrepaired VSDs). The electronic medical records were searched for hospitalization due to IE during a 10‐year period (October 2, 2007—October 1, 2017). Results Four hundred seventy‐nine patients (53% male) were identified, with a mean age of 35.0 ± 13.7 years. There were 164 patients (34.2%) in Group 1 and 315 patients (65.8%) in Group 2. In total, there were eight episodes of IE from six patients (3 male, mean age of 42.2 ± 20.7 years). Two patients had recurrent IE. The overall incidence of IE was 1.67/1000 y, and this is 11–15‐fold higher compared to general adult population. The incidence of IE in Group 2 was 1.90/1000 y. There were no IE cases in Group 1. Conclusion Patients with VSDs, especially if unrepaired, carry a substantially increased risk of IE compared to the general population.

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Background: Activated partial thromboplastin time (aPTT)-based clot waveform analysis (CWA) is a plasma-based global haemostatic assay. Elevated CWA parameters have been associated with hypercoagulability in venous thromboembolism, but its role in arterial thrombotic disease is uncertain. This study aims to explore the relationship between aPTT-based CWA and acute myocardial infarction (AMI) and its complications. Methods: This is a retrospective case-control study that included patients with AMI who underwent emergency cardiac catheterisation and control patients who underwent elective orthopaedic and urological procedures. The pre-procedural aPTT and CWA parameters – min1, min2 and max2 – of AMI patients were compared against those of controls. Results: Compared to controls (N=109), patients with AMI (N=214) had shorter aPTT (26.7±3.3s vs 27.9±1.7s, P<0.001) and higher CWA parameters (min1: 6.11±1.40%/s vs 5.58±1.14%/s; min2: 0.98±0.23%/s2 vs 0.90±0.19%/s2; max2: 0.81±0.20%/s2 vs 0.74±0.16%/s2, all P≤0.001). Elevated CWA parameters, defined as having CWA values above their respective reference ranges, were associated with the occurrence of AMI, with odds ratio (OR) of 2.06 [95% confidence intervals (CI):1.10–3.86], 2.23 (95% CI:1.18–4.24) and 2.01 (95% CI:1.07–3.77) for min1, min2 and max2, respectively. Similarly, elevated min1 and min2 were both individually associated with the presence of adverse outcomes of AMI with ORs of 2.63 (95% CI:1.24–5.59). Conclusions: Patients with AMI had significantly increased CWA parameters. Elevated aPTT-based CWA parameters are significantly associated with the occurrence of AMI and its complications. Potential utility of CWA as risk and prognostic markers for AMI warrants future works.

Funding Acknowledgements Type of funding sources: None. Introduction Studies investigating the relationship between percutaneous coronary intervention operator volumes and patient adverse events largely, but not consistently, suggest an inverse association. A recent study of rotational atherectomy (Rota-PCI) suggests lower adverse events as operator volumes increased. Purpose In this study, we aimed to use a Southeast asian national registry to investigate the relationship of Rota-PCI operator volumes to patient selection, procedural success, and in-hospital outcomes. Methods Data from a national databank was analysed for all Rota-PCI procedures performed at public hospitals from 2013 to 2019. No procedures were excluded. Operator volumes were divided into 3 tertiles and logistic regressions were performed to investigate the association to patient selection, procedural success, and in-hospital clinical outcomes. Results A total of 1,278 Rota-PCI procedures, with 37 operators performing a median volume of 23 procedures per year was included. The tertiles had median volumes of 5, 17 and 30 annually respectively. Operators at the highest tertile performed Rota-PCI in more patients with renal disease (43% vs 49% vs 53%, Tertiles 1, 2, 3 respectively; p=0.006), ACS presentations (34% vs 37% vs 41%, p=0.036), severe left ventricular dysfunction (28% vs 42% vs 44%, p&lt;0.001), and left main disease (17% vs 24% vs 31%, p&lt;0.001). This group also attempted more lesions (2 vs 2 vs 3, p&lt;0.001), and utilized more circulatory support (4.2% vs 7% vs 12%, p&lt;0.001). Intracoronary imaging was used most by the lowest tertile (29% vs 24% vs 12%, p&lt;0.001). Operators at the highest tertile had a higher incidence of complete heart block (2.1% vs 0.8% vs 3.9%, p=0.05) but had no difference in coronary complications. There was an increase in length of stay (2 vs 3 vs 3 days, p&lt;0.001) but otherwise no difference in in-hospital outcomes of MI, major bleed, stroke and mortality in multivariate analysis. Conclusion In summary, in-hospital outcomes were similar between all three tertiles of operator volumes. These findings may reflect our local practice where operators appropriately triage Rota-PCI cases, with the most complex cases being assigned to high volume operators.

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