This registry represents the largest published real-world experience of the Evolut R valve. The procedural success rate was high and safety was excellent, comparable with previous studies of the Evolut R valve and other second-generation devices. The low rate of complications represents an improvement on first-generation devices.
Coronary heart disease is the single largest cause of death in developed countries. Guidelines exist for the management of acute myocardial infarction (AMI), yet despite these, significant inequalities exist in the care of these patients. The elderly, deprived socioeconomic groups, females and non-caucasians are the patient populations where practice tends to deviate more frequently from the evidence base. Elderly patients often had higher mortality rates after having an AMI compared to younger patients. They also tended to present with symptoms that were not entirely consistent with an AMI, thus partially contributing to the inequalities in care that is seen between younger and older patients. Furthermore the lack of guidelines in the elderly age group presenting with AMI can often make decision making challenging and may account for the discrepancies in care that are prevalent between younger and older patients. Other patients such as those from a lower socioeconomic group, i.e., low income and less than high school education often had poorer health and reduced life expectancy compared to patients from a higher socioeconomic group after an AMI. Lower socioeconomic status was also seen to be contributing to racial and geographical variation is the care in AMI patients. Females with an AMI were treated less aggressively and had poorer outcomes when compared to males. However even when females were treated in the same way they continued to have higher in hospital mortality which suggests that gender may well account for differences in outcomes. The purpose of this review is to identify the inequalities in care for patients who present with an AMI and explore potential reasons for why these occur. Greater attention to the management and a better understanding of the root causes of these inequalities in care may help to reduce morbidity and mortality rates associated with AMI.
IntroductionWe explored the impact of transcatheter aortic valve implantation (TAVI) on pulmonary hypertension (PH) by assessing the prevalence and reversibility of PH in an unselected TAVI cohort. We also identified factors that may predict PH and regression of PH after TAVI.MethodsRetrospective analysis of a local TAVI database. 308 consecutive patients underwent TAVI between 2008–13. Pulmonary artery systolic pressure (PASP) was estimated from the velocity of tricuspid regurgitation jet using Bernouille principle; PH was diagnosed if PASP was ≥50mmHg. Simple correlation (Spearman’s rank rS) and regression analyses were used to determine predictors of PH and the change (and 95% confidence interval) in PASP (ΔPASP) after TAVI. Wilcoxon signed-rank Z-test was used to analyse ordinal data.Results71 (23%) patients had PH, in this group mean PASP before TAVI was 62 ± 6.5mmHg. PASP reduced in 56%, the mean ΔPASP was -12.8mmHg (95% C. I. -9.5 to -16.1, P < 0.001). PASP was weakly positively associated with the severity of MR (rS=0.276, p = 0.03); ΔPASP was associated only with baseline PASP (rS=0.3, p = 0.02) and change in LV end diastolic pressure (rS=0.4, p < 0.003). There were small improvements in severity of MR (Z=-3.5, p < 0.01) and a trend to improved LV function (Z=-1.9, p = 0.06) however regression analysis identified only change in LV end diastolic pressure to predict ΔPASP (p < 0.05).ConclusionPH is common and usually reversible post TAVI. MR is a significant predictor of PH, the only predictor of regression of PH is reduction in LV end-diastolic function at implantation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.