Incidence, Outcomes, and Predictors of In-Hospital Acute Coronary Syndrome Following Endovascular Transcatheter Aortic Valve Replacement in the United States

Author: Salik Nazir, MD, Additional Authors**

See the poster.

Background:
Incidence and outcomes of acute coronary syndrome (ACS) immediately following transcatheter aortic valve replacement (TAVR) remain largely unknown.

Methods:
We queried the National Readmission Database from January 2012 to September 2015 for TAVR admissions with and without ACS, creating a propensity-matched cohort to compare outcomes.

Results:
A total of 48,454 patients underwent TAVR, with 1332 (2.75%) developing ACS. TAVR patients with ACS compared to those without ACS had a significantly higher incidence of acute kidney injury, ischemic stroke, vascular complications, blood transfusion, cardiogenic shock, cardiac arrest, mechanical circulatory support and in-hospital mortality (Figure 1). Additionally, TAVR with ACS had longer lengths of stay (median 10 days versus 6 days; p<0.001) and hospital charges (median $23,200 versus $19,000; P<0.001). Positive predictors of ACS were history of percutaneous coronary intervention (odds ratio, 1.43; 95% CI: 1.25-1.63), hyperlipidemia (odds ratio, 1.20; 95% CI: 1.07-1.34), chronic blood loss anemia (odds ratio, 2.16; 95% CI: 1.54-3.03), chronic kidney disease (odds ratio, 1.17; 95% CI: 1.04-1.31), fluid and electrolyte disorders (odds ratio, 1.65; 95% CI: 1.47-1.85) and weight loss (odds ratio, 1.53; 95% CI: 1.22-1.91)(Figure 2). Heart failure (34%) was the most common reason for readmission in the ACS cohort.

Conclusion:
In this nationwide observational study, ACS after TAVR was associated with worse clinical outcomes and increased healthcare resource utilization.

**Additional Authors

Salik Nazir, MD, University of Toledo Medical Center

Keerat Rai Ahuja, MD, Heart and Vascular Institute, Cleveland Clinic

Khalid Changal, MD, University of Toledo Medical Center

Mubbasher Syed, MD, University of Toledo Medical Center

Mohamed M. Gad, MD, Heart and Vascular Institute, Cleveland Clinic

Anas Saad, MD, Heart and Vascular Institute, Cleveland Clinic

Robert Grande, MD, Promedica Toledo Hospital, Toledo

Mujeeb Sheikh, MD, University of Toledo Medical Center

P. Kasi Ramanathan, MD, Promedica Toledo Hospital, Toledo

Program Director: Ehab Eltahawy, MD, FACC

Program Coordinator: Angie McCune