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IntroductionCoronary artery disease is a common diagnosis among patients undergoing transcatheter aortic valve replacement (TAVR). The treatment and timing of percutaneous coronary intervention (PCI) remain controversial. We sought to compare in-hospital periprocedural outcomes of combined TAVR and PCI during the same index hospitalization versus the isolated TAVR procedure.Material and methodsThe study population was extracted from the 2016 Nationwide Readmissions Data (NRD) using International Classification of Diseases, tenth edition, clinical modifications/procedure coding system codes for TAVR, coronary PCI, and post-procedural complications. Study endpoints included in-hospital all-cause mortality, length of index hospital stay, cardiogenic shock, need for mechanical circulatory support (MCS) devices, mechanical complications of prosthetic valve, paravalvular leak (PVL), acute kidney injury (AKI), bleeding and total hospital charges. Propensity matching was used to adjust for baseline characteristics.ResultsThere were 23,604 TAVRs in the 2016 NRD, of which 852 were combined with PCI during the same index hospitalization. Mean age was 80.5 years and 45.9% were female. In comparison to isolated TAVR, TAVR-PCI was associated with higher in-hospital all-cause mortality (4.5% vs. 1.7%, p < 0.01), longer length of stay (10.5 vs. 5.4 days, p < 0.01), and higher incidence of cardiogenic shock (9.4% vs. 2.1%, p < 0.01), use of MCS devices (6.8% vs. 0.7%, p < 0.01), mechanical complications of prosthetic valve (6.8% vs. 0.7%, p < 0.01), PVL (0.9% vs. 0.4%, p = 0.01), AKI (25.5% vs. 11.5%, p < 0.01), bleeding (25.2% vs. 18.1%, p < 0.01), and total hospital charges ($354,725 vs. $220474, p < 0.01).ConclusionsIn comparison to isolated TAVR, combined TAVR-PCI was associated with a higher incidence of in-hospital morbidity and mortality. The association and mechanism of increased mortality warrant further study.

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Introduction Percutaneous mitral valve repair with Mitraclip device has been approved for the treatment of symptomatic mitral valve regurgitation in patients deemed high surgical risk. It's unclear whether the presence of preexisting coronary arterial disease (CAD) affects the postprocedural outcomes of Mitraclip. Methods The study population was extracted from the 2016 Nationwide Readmissions Data (NRD) using the International Classification of Diseases, Tenth Revision, Clinical Modifications/Procedure Coding System (ICD‐10‐CM/PCS) for Mitraclip, preexisting CAD, and postprocedural complications. Study primary endpoints included in‐hospital all‐cause mortality, cardiogenic shock, acute myocardial infarction (AMI), acute kidney injury (AKI), stroke, acute respiratory failure, length of hospital stay (LOS), and 30‐day readmission rate. Results A total of 2,539 discharges that had Mitraclip during the index hospitalization, 62.3% had history of preexisting CAD. Mean age was 78.5 years and 46.6% were female. Overall, the presence of preexisting CAD was associated with higher AMI (1.6 vs. 0.4%, p < .01), however, there was no significant differences in terms of in‐hospital all‐cause mortality (2.2 vs. 2.6%, p = .52), cardiogenic shock (3.4 vs. 4.1%, p = .39), AKI (14.7 vs. 13.6%, p = .43), stroke (0.9 vs. 0.5%, p = .31), acute respiratory failure (9.7 vs. 8.8%, p = .43), LOS (5.3 vs. 5.3 days, p = .85) or 30‐day readmission rate (14.6 vs. 14.4%, p = .92). These results persisted after adjustment for baseline characteristics. The subgroup of CAD patients who received percutaneous coronary intervention (PCI) was associated with higher in‐hospital mortality (22.5 vs. 2.0%, p < .01), cardiogenic shock (25.0 vs. 3.3%, p < .01), AMI (22.5 vs. 0.8%, p < .01), AKI (55.0 vs. 13.7%, p < .01), stroke (10.0 vs. 0.6%, p < .01), acute respiratory failure (45.0 vs. 8.8%, p < .01), and longer LOS (21.5 vs. 5.1 days, p < .01), however there was no significant difference in 30‐day readmission rate (15.0 vs. 14.5%, p = .95). Conclusions Preexisting CAD was associated with higher in‐hospital AMI post‐Mitraclip but with comparable mortality and other morbidities. Patients who received PCI during the same index hospitalization had higher in‐hospital mortality and morbidity.

Acute myocardial infarction (AMI) is a common medical condition that requires appropriate revascularization in a timely manner. Percutaneous revascularization (PR) was the first line treatment option when feasible. Limited data is available comparing PR to surgical revascularization (SR) in the AMI setting. Study population was extracted from the 2016 Nationwide Readmissions Data using International Classification of Diseases, tenth edition codes for AMI, PR, SR, and procedural complications. Endpoints included in-hospital all-cause mortality, length of index hospital stay (LOS), stroke, acute kidney injury, bleeding, blood transfusion, acute respiratory failure, and total hospital charges. The study identified 45,539 discharges with a principal admission diagnosis of AMI who had either PR or SR as a principal procedure. Single vessel revascularization was performed in 67.8% (93.1% had PR versus 6.9% had SR, p<0.01). Multivessel revascularization was performed in 32.2% (64.8% had PR versus 35.2% had SR, p<0.01). In comparison to SR, PR was associated with higher in-hospital all-cause mortality (P<0.01), shorter LOS (p<0.01), and lower incidence of post-procedural stroke (p<0.01), acute kidney injury (p<0.01), bleeding (p<0.01), need for blood transfusion (p<0.01), acute respiratory failure (p<0.01), and total hospital charges (p<0.01). In a subgroup analysis, SR mortality benefit persisted in patients who had multivessel revascularization, but not in single vessel revascularization. In patients presented with AMI, PR was associated with higher in-hospital all-cause mortality but lower morbidity, shorter LOS, and lower total hospital charges than SR. However, the mortality benefit of SR was seen in multivessel revascularization only, and not in single vessel revascularization.