Both the EMPEROR-Preserved (he Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction) and DELIVER (Dapagliflozin Evaluation to Improve the LIVEs of ...Patients With PReserved Ejection Fraction Heart Failure) trials showed that sodium-glucose cotransporter inhibitors (SGLTis) reduced the risk of composite end points of cardiovascular mortality and heart failure (HF) hospitalizations in patients with HF with preserved ejection fraction (HFpEF).1,2 The trials quantified the treatment effects using hazard ratios (HRs), a relative estimate that may be challenging to interpret and communicate with patients.3 The restricted mean survival time (RMST), an area under the Kaplan–Meier curve, measures the average event-free time until a milestone time point, which can be interpreted in absolute terms and does not require proportional hazard assumptions.3 We estimated the cardiovascular effects of SGLTis in HFpEF using RMST to assess whether the benefits accumulate over time. Both the EMPEROR-Preserved (HR 0.73, 95% confidence interval CI 0.61 to 0.88) and the DELIVER trials (HR 0.82, 95% CI 0.73 to 0.92) showed a significant reduction in the primary end point with SGLTi versus placebo. ...we combined the effects to compute the RMST estimates with 95% CIs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Existing surgical aortic valve replacement risk models accurately predict the post- surgical aortic valve replacement morbidity and mortality, but factors associated with post transcatheter aortic ...valve Implantation (TAVI) mortality are not well known. The National Inpatient Sample was queried to identify all cases of TAVI. The association of baseline comorbidities with in-hospital mortality was determined using a binary logistic regression model to obtain adjusted odds ratios (aOR). A total of 161,049 patients underwent TAVI between 2010 and 2017. Of these, 157,151 (97.6%) survived while 3,898 (2.4%) died during hospitalization. The baseline characteristics of TAVI-survivors and non-survivors showed a significant amount of variation, including age (80 vs 82 years, p ≤ 0.0001) and female sex (46% vs 52%, p ≤ 0.0001), respectively. The non-survivors had significantly higher adjusted odds of renal failure requiring hemodialysis (aOR 2.59, 95% CI 2.24 to 2.99, p ≤ 0.0001), history of mediastinal radiation (aOR 2.71, 95% CI 1.02 to 7.20, p = 0.05), liver disease (aOR 3.04, 95% CI 2.63 to 3.51, p ≤ 0.0001), pneumonia (aOR 2.47, 95% CI 2.15 to 2.83, p ≤ 0.0001), cardiogenic shock (aOR 9.83, 95% CI 8.93 to 10.82, p ≤ 0.0001), ventricular tachycardia (aOR 2.12, 95% CI 1.88 to 2.40, p ≤ 0.0001), acute ST-elevation myocardial infarction (aOR 7.38, 95% CI 5.53 to 9.84, p ≤ 0.0001), stroke (aOR 2.25, 95% CI 1.99 to 2.54, p ≤ 0.0001), and acute infective endocarditis (aOR 5.74, 95% CI 3.65 to 9.02, p ≤ 0.0001) compared to TAVI-survivors. The yearly trend of mortality showed an increase in the absolute number of TAVI procedures and mortality but the yearly rate showed a decline in mortality after an initial peak during 2012.Patients with renal failure on dialysis, ST-elevation myocardial infarction, cardiogenic shock, infective endocarditis, liver disease and pneumonia have a higher rate of in-hospital mortality post TAVI.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The data on the safety and feasibility of performing concomitant or staged transcatheter edge-to-edge repair (TEER) of the mitral valve with transcatheter aortic valve implantation (TAVI) remains ...limited. The Nationwide Readmission Database was used to identify TEER and TAVI procedures from October 1, 2015 to December 31, 2019, using the International Classification of Diseases, Tenth Revision, Clinical Modification administrative data. A total of 627 weighted cases of TEER and TAVI procedures were included in the analysis. Of those cases, 453 underwent staged TEER after TAVI, whereas 174 had concomitant TAVI and TEER during the same admission. Patients who underwent staged procedures were mostly men (64.8%, p = 0.02) and had a higher median age of 85 years (interquartile range 79 to 88) versus 82 years (interquartile range 72 to 86) in the concomitant procedure group. The adjusted propensity-matched mortality rate was similar for staged versus same-admission procedures (6.1% vs 7.0%, p = 0.79). In-hospital complication rates, including acute kidney injury, vascular complications, need for percutaneous coronary intervention, mechanical support, and pacemaker implantation, were higher for the same-admission TEER and TAVI group than TEER performed as a staged procedure. Nonhome facility discharges and length of hospital stay (15 vs 4 days) were also significantly higher for the concomitant same-admission TEER and TAVI groups. In conclusion, there was no difference in in-hospital mortality rate between patients who underwent concomitant or staged TEER and TAVI procedures, whereas complication rates were significantly higher in the concomitant group.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
...we evaluated the 30-day readmission outcomes of patients hospitalized with HF during index admission for TAVI. The current TAVI risk calculator is useful in evaluating in-hospital mortality risk; ...however, given the results of our study, assessment of readmission risk along with mortality risk may be valuable to health systems and payers.4 These findings suggest a potential role for periprocedural risk-management optimization in this high-risk cohort of patients who undergo TAVI. ...we report poorer 30-day readmission outcomes in terms of mortality rate, readmission rate, and resource utilization when TAVI index hospitalizations are complicated by acute HF.Disclosures The authors have no conflicts of interest to declare.Funding None.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
A dual-band UHF/industrial, scientific and medical (ISM) compact rectenna with wideband UHF matching (855-935 MHz) covering all, EU, U.S., and Chinese UHF radio frequency identification (RFID), ...standards is presented. The proposed design consists of a compact single-port, dual-band antenna, a three-port dual-branch matching network, and two voltage doubler rectifiers implemented with Schottky diodes and terminated with a common 10 <inline-formula> <tex-math notation="LaTeX">\text{k}\Omega </tex-math></inline-formula> load. For each band, the measured RF-to-dc efficiency is around 60% for a −5 dBm unmodulated signal. The wideband behavior of the rectenna supports harvesting of multitone signals. The use of a six-tone signal increases the maximum RF-to-dc efficiency of the dual-band rectifier, from approximately 60% for a single-tone UHF signal (890 MHz) to 80% for a six-tone signal for a received RF power of −5 dBm in both cases. A signal generator is used to generate a six-tone signal of equally weighted and equally spaced (10 MHz separation) monochromatic tones, with a total bandwidth of 50 MHz. The measurement results demonstrate that the dc voltages rectified from the two separate RF signals are effectively superimposed on the load, providing a clear advantage compared to single-band rectennas. The single-layer, compact design with a size of <inline-formula> <tex-math notation="LaTeX">80\times45 </tex-math></inline-formula> mm 2 , with a high RF-to-dc efficiency, is an excellent candidate for wirelessly powered RFID tags.
Valve in valve transcatheter mitral valve replacement has emerged as a novel and less invasive alternative to redo surgical valve replacement in patients with degenerative bioprosthetic valve ...disease.1 Rapid technological advancement and refinement in techniques have led to an increased number of transvalvular procedures2 and reduction in associated complications, however, there is a paucity of data on the comparative safety and efficacy of transcatheter vs re do valve surgery. Previous studies by Kamioka et al and Murzi et al found no difference between MACE or major bleeding.3,4 However on pooled analysis after inclusion of data from study by Simonetto et al MACE and major bleeding were significantly lowered for ViV TMVR as compared to conventional surgery.5The odds of mortality and cerebrovascular events remained non-significant on pooled and stratified analysis for all three included studies345.Though previous studies have shown that repeat mitral valve intervention is associated with higher periprocedural mortality,6,7 the included studies have limited sample size and are thus not powered enough to detect a significant difference. ...ViV TMVR is associated with lower rate of MACE, bleeding complications and shorter hospital length of stay compared to re do valve surgery.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Immune checkpoint inhibitors are becoming an increasingly common treatment for advanced gastrointestinal cancer, but the possibility of immune‐related adverse events has raised concerns. This study ...aimed to evaluate the risks of immune‐related adverse events between patients who received immune checkpoint inhibitors and those who received chemotherapy among different types of gastrointestinal cancer. The study utilized data from the multicenter TriNetX database in the United States covering the period between 2015 and 2022. Hazard ratios and 95% confidence intervals were used to describe the relative hazard of immune‐related adverse events based on comparing time‐to‐event rates. Our study revealed that the incidence of immune‐related adverse events was significantly higher in patients who received immune checkpoint inhibitors and chemotherapy compared to those who received chemotherapy only in treating gastrointestinal cancer. CTLA‐4 inhibitors tended to have a higher rate of immune‐related adverse events compared to PD‐1/PD‐L1 inhibitors. Our study found a lower mortality rate among patients who developed immune‐related adverse events compared to those who did not after propensity score matching (HR, 0.661; 95% CI 0.620–0.704; p < .01). We provide important real‐world data on the incidence and impact of immune‐related adverse events in patients with advanced gastrointestinal cancer treated with immune checkpoint inhibitors. Our study's results support clinicians in making informed decisions about the potential benefits and risks of immune checkpoint inhibitor therapy for patients with gastrointestinal cancer.
What's new?
Immune checkpoint inhibitors are becoming an increasingly common treatment for advanced gastrointestinal cancer, but the possibility of immune‐related adverse events has raised concerns. This large retrospective cohort study confirms the association between immune checkpoint inhibitors and immune‐related adverse events across all gastrointestinal malignancies. CTLA‐4 inhibitors tended to have a higher rate of immune‐related adverse events, and the incidence of events varied depending on the type of gastrointestinal cancer. However, there was a lower mortality rate among patients who developed immune‐related adverse events. The findings could support clinicians in making decisions on immune checkpoint inhibitors therapy in patients with gastrointestinal cancer.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background
Outcomes data on the use of cerebral embolic protection devices (CPDs) with transcatheter aortic valve replacement (TAVR) remain limited. Previous randomized trials were underpowered for ...primary outcomes of stroke prevention and mortality.
Methods
The National Inpatient Sample and Nationwide Readmissions Database were queried from 2017 to 2018 to study utilization and inpatient mortality, neurological complications (ischemic stroke, hemorrhagic stroke, and transient ischemic attack), procedural complications, resource utilization, and 30‐day readmissions with and without use of CPD. A 1:3 ratio propensity score matched model was created.
Results
Among 108,315 weighted encounters, CPD was used in 4380 patients (4.0%). Adjusted mortality was lower in patients undergoing TAVR with CPD (1.3% vs. 0.5%, p < 0.01). Neurological complications (2.5% vs. 1.7%, p < 0.01), hemorrhagic stroke (0.2% vs. 0%, p < 0.01) and ischemic stroke (2.2% vs. 1.4%, p < 0.01) were also lower in TAVR with CPD. Multiple logistic regression showed CPD use was associated with lower adjusted mortality (odds ratio (OR, 0.34 95% confidence interval CI, 0.22–0.52), p < 0.01) and lower adjusted neurological complications (OR, 0.68 (95% CI, 0.54–0.85, p < 0.01). On adjusted analysis, 30‐day all‐cause readmissions (Hazard ratio, HR 0.839, 95% CI, 0.773–0.911, p < 0.01) and stroke (HR, 0.727 95% CI, 0.554–0.955), p = 0.02) were less likely in TAVR with CPD.
Conclusion
We report real‐world data on utilization and in‐hospital outcomes of CPD use in TAVR. CPD use is associated with lower inpatient mortality, neurological, and clinical complications as compared to TAVR without CPD.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
