CLINICAL
NEWS JOURNAL WRAP
Kim Eagle, MD, and the editors of ACC.org, present relevant
articles taken from various journals.
In patients with
severe CLD, the
risk of death
is similar with
either transaortic
or transapical
approaches.
Does Chronic Lung Disease Affect
TAVR Outcomes?
Patients with moderate to severe
chronic lung disease (CLD) have an
increased risk of death up to 1 year
after Transcatheter Aortic Valve
Replacement (TAVR), according to
a recent study published in The Annals of Thoracic Surgery. In patients
with severe CLD, the risk of death
is similar with either transaortic or
transapical approaches.
For this study, clinical records for
11,656 patients undergoing TAVR
from 2001 to 2014 in The Society of
Thoracic Surgeons/American College
of Cardiology Transcatheter Valve
Therapy (TVT) Registry were linked
to Medicare hospital claims. Overall,
the median age of patients was 84
years and 51.7% were female. In addition, 3,225 (27.7%) of patients had
moderate or severe CLD.
Results found that patients with
22
CardioSource WorldNews
severe CLD were younger, more
likely to have symptoms of advanced
heart failure, more likely to have a
history of smoking, and more likely
to be 02 dependent than those with
mild or no CLD. Patients with severe
CLD also spent significantly more
time in the intensive care unit than
patients with moderate and no or
mild CLD, and they were significantly more likely to be discharge d
to an extended care or rehabilitation
hospital. Additionally, severe CLD
patients had a significantly higher
unadjusted incidence of in-hospital
mortality, however, no significant difference was found in the unadjusted
incidence of stroke. Patients with
moderate CLD did not experience
increased odds of in-hospital death.
Up through 1 year, patients with
moderate and severe CLD experi-
enced an increased risk of mortality
(but not an increased risk of stroke)
compared to patients with no or
mild CLD. In patients with severe
CLD, home 02 was present in 47.6%
of patients and pulmonary hypertension was present in 28.6% of
patients. Both of these were associated with an increased adjusted risk
of mortality up to 1 year. Home 02
was associated with a lower adjusted
1-year risk of stroke, but pulmonary
hypertension was not associated
with stroke risk.
The researchers also evaluated the subgroup of patients with
non-transfemoral access in order to
determine the association between
the transaortic and transapical approaches and outcomes. No significant differences were noted in the
length of intensive care, incidences of
in-hospital death, in-hospital stroke,
or discharge location between the
approaches. Additionally, no significant difference was seen in adjusted
1-year mortality.
The authors conclude that “fur-
ther research is necessary to understand strategies to mitigate risk associated with CLD and the long-term
implications of these findings.”
Suri RM, Gulack BC, Brennan JM, et al. Ann
Thoracic Surg. 2015;doi: 10.1016/j.athoracsur.2015.05.075. [Epub ahead of print]
Can a Flu Vaccine
Protect the Heart?
Patients with influenza (flu) infections
may be at a higher risk of acute myocardial infarction (AMI), but a flu vaccination may lower that risk, according to a
recent study published in Heart.
The relationship between AMI
and the flu has been known since the
1930s, after increased cardiovascular deaths were seen during the flu
season. While many countries recommend flu vaccinations for patients
at increased risk of complications,
including those with cardiovascular
disease, vaccine coverage remains
suboptimal in this population.
Researchers analyzed 16 casecontrolled studies—8 on flu vaccination, 10 on flu infection and AMI.
They found that flu infection was
significantly associated with AMI,
with cases having double the risk of
flu infection or respiratory tract infection compared with controls. The data
also showed a 29% pooled vaccination effectiveness in preventing AMI,
which is similar to the efficacy of
other secondary prevention measures
such a statins, antihypertensives and
smoking cessation interventions.
“Given the high global burden of
AMI, and ischemic heart disease being
the leading cause of death and disability in the world, influenza vaccination
could be added to other preventative
strategies and confer additional population health benefits on AMI prevention,” the authors write. They add that
vaccination is inexpensive, safe and
effective. Given that the risk of AMI
increases after 50 years of age, these
findings also add to the evidence base
October 2015