Research Spotlight

Tajti, P., D. Karmpaliotis, K. Alaswad, C. Toma, J. W. Choi, F. A. Jaffer, A. H. Doing, M. Patel, E. Mahmud, B. Uretsky, A. Karatasakis, J. Karacsonyi, B. A. Danek, B. V. Rangan, S. Banerjee, I. Ungi and E. S. Brilakis (2018). “Prevalence, Presentation and Treatment of ‘Balloon Undilatable’ Chronic Total Occlusions: Insights from a Multicenter US Registry.” Catheter Cardiovasc Interv. Jan 23. [Epub ahead of print].

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BACKGROUND: The prevalence, treatment and outcomes of balloon undilatable chronic total occlusions (CTOs) have received limited study. METHODS: We examined the prevalence, clinical and angiographic characteristics, and procedural outcomes of percutaneous coronary interventions (PCIs) for balloon undilatable CTOs in a contemporary multicenter US registry. RESULTS: Between 2012 and 2017 data on balloon undilatable lesions were available for 425 consecutive CTO PCIs in 415 patients in whom guidewire crossing was successful: 52 of 425 CTOs were balloon undilatable (12%). Mean patient age was 65 +/- 10 years and most patients were men (84%). Patients with balloon undilatable CTOs were more likely to be diabetic (67 vs. 41%, P < 0.001) and have heart failure (44 vs. 28%, P = 0.027). Balloon undilatable CTOs were longer (40 mm [interquartile range, IQR 20-50] vs. 30 [IQR 15-40], P = 0.016), more likely to have moderate/severe calcification (87 vs. 54%, P < 0.001), and had higher J-CTO score (3.2 +/- 1.1 vs. 2.5 +/- 1.3, P < 0.001) and PROGRESS-CTO complications score (3.9 +/- 1.7 vs. 3.1 +/- 2.0, P < 0.005). They were associated with lower technical and procedural success (92 vs. 98%, P = 0.024; and 88 vs. 96%, P = 0.034, respectively) and higher risk for in-hospital major adverse events (8 vs. 2%, P = 0.008) due to higher perforation rates. The most frequent treatments for balloon undilatable CTOs were high pressure balloon inflations (64%), rotational atherectomy (31%), laser (21%), and cutting balloons (15%). CONCLUSIONS: Balloon undilatable CTOs are common and are associated with lower success and higher complication rates. CLINICAL TRIAL REGISTRATION: NCT02061436, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO).

Szerlip, M., S. Gualano, E. Holper, J. J. Squiers, J. M. White, D. Doshi, M. R. Williams, R. T. Hahn, J. G. Webb, L. G. Svensson, A. J. Kirtane, D. J. Cohen, P. S. Douglas, M. C. Alu, A. Crowley, E. M. Tuzcu, R. R. Makkar, H. C. Herrmann, V. Babaliaros, V. H. Thourani, M. B. Leon, S. K. Kodali and M. J. Mack (2018). “Sex-Specific Outcomes of Transcatheter Aortic Valve Replacement With the SAPIEN 3 Valve: Insights From the PARTNER II S3 High-Risk and Intermediate-Risk Cohorts.” JACC Cardiovasc Interv 11(1): 13-20.

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OBJECTIVES: The purpose of this study was to identify sex-specific outcomes of intermediate risk patients undergoing transcatheter aortic valve replacement with the SAPIEN 3 valve. BACKGROUND: A survival difference has been observed in women as compared with men in inoperable and high-risk patients receiving early-generation balloon-expandable valves for transcatheter aortic valve replacement (TAVR). Whether a sex-specific outcome difference persists with newer-generation valves and in lower-risk patients is unknown. METHODS: The PARTNER (Placement of Aortic Transcatheter Valves) II S3 trial included high-risk (HR) (Society of Thoracic Surgeons risk score >8% or heart team determination) and intermediate-risk (IR) (Society of Thoracic Surgeons risk score 4% to 8% or heart team determination) patients with severe symptomatic aortic stenosis who were treated with TAVR with the SAPIEN 3 valve. Patient characteristics and clinical outcomes at 30 days and 1 year were compared by sex. RESULTS: Between October 2013 and December 2014, 1,661 patients were enrolled: 583 were HR (338 men, 245 women) and 1,078 were IR (666 men, 412 women). In both cohorts, women were more likely than men to be frail (22% vs. 13%; p < 0.001), but less likely to have comorbid conditions of renal insufficiency, coronary artery disease, atrial fibrillation, or chronic obstructive pulmonary disease. Women were more likely to receive

Szerlip, M. (2018). “Next-Day Discharge After Transcatheter Aortic Valve Replacement: A Goal or a Consequence?” JACC Cardiovasc Interv 11(2): 116-118.

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No abstract available.

Russell, K., J. R. Chung, A. S. Monto, E. T. Martin, E. A. Belongia, H. Q. McLean, M. Gaglani, K. Murthy, R. K. Zimmerman, M. P. Nowalk, M. L. Jackson, L. A. Jackson and B. Flannery (2018). “Influenza vaccine effectiveness in older adults compared with younger adults over five seasons.” Vaccine. Feb 28; 36(10): 1272-1278.

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BACKGROUND: There have been inconsistent reports of decreased vaccine effectiveness (VE) against influenza viruses among older adults (aged>/=65years) compared with younger adults in the United States. A direct comparison of VE over multiple seasons is needed to assess the consistency of these observations. METHODS: We performed a pooled analysis of VE over 5 seasons among adults aged>/=18years who were systematically enrolled in the U.S. Flu VE Network. Outpatients with medically-attended acute respiratory illness (cough with illness onset/=75, and>/=65years) to adults aged 18-49years by influenza type and subtype using interaction terms to test for statistical significance and stratified by prior season vaccination status. RESULTS: Analysis included 20,022 adults aged>/=18years enrolled during the 2011-12 through 2015-16 influenza seasons; 4,785 (24%) tested positive for influenza. VE among patients aged>/=65years was not significantly lower than VE among patients aged 18-49years against any subtype with no significant interaction of age and vaccination. VE against A(H3N2) viruses was 14% (95% confidence interval [CI] -14% to 36%) for adults>/=65years and 21% (CI 9-32%) for adults 18-49years. VE against A(H1N1)pdm09 was 49% (95% CI 22-66%) for adults>/=65years and 48% (95% CI 41-54%) for adults 18-49years and against B viruses was 62% (95% CI 44-74%) for adults>/=65years and 55% (95% CI 45-63%) for adults 18-49years. There was no significant interaction of age and vaccination for separate strata of prior vaccination status. CONCLUSIONS: Over 5 seasons, influenza vaccination provided similar levels of protection among older and younger adults, with lower levels of protection against influenza A(H3N2) in all ages.E

Sannino, A., M. Szerlip, K. Harrington, G. G. Schiattarella and P. A. Grayburn (2018). “Comparison of Baseline Characteristics and Outcomes in Men Versus Women With Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation.” Am J Cardiol. Jan 10. [Epub ahead of print].

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Female gender has been linked to increased risk of adverse events after surgical aortic valve replacement; however, the evidence regarding the role of gender differences on clinical outcomes in patients who underwent transcatheter aortic valve implantation (TAVI) is still debated. This retrospective study included 910 consecutive patients with severe, symptomatic aortic stenosis who underwent TAVI in 2 institutions from January 2012 to July 2016. The primary end point was all-cause mortality at 1 year after TAVI in women versus men. Women had a higher incidence of in-hospital vascular complications (7.8% vs 4.1%) and major or life-threatening bleeding (4.0% vs 1.6%) than men. At 1 year, women showed a lower mortality rate than men (7.0% vs 12.7%, adjusted hazard ratio [HR] 0.42, 95% confidence interval [CI] [0.23 to 0.76], p = 0.004). When stratifying by specific subgroups of interest, the survival benefit in women persisted in (1) patients with a Society of Thoracic Surgery risk score