Several abstracts presented at TCT 2024, taking place Oct. 27-30 in Washington, DC, used data from ACC’s CathPCI Registry, Chest Pain – MI Registry and the STS/ACC TVT Registry to evaluate institutional volume and failure to rescue in TAVR, outcomes of sequential TAVR and mitral transcatheter edge-to-edge repair (TEER), the impact of coronary artery disease (CAD) and revascularization on health status and more.

Explore findings from the NCDR-based research below:  

Institutional Volume and Failure to Rescue in TAVR

Jayakumar Sreenivasan, MD, et al., assessed the relationship between hospital TAVR volume and failure to rescue, looking at 487,159 patients from 808 sites captured by the STS/ACC TVT Registry from 2017 to 2023. After adjustment, they found that lower-volume sites had significantly higher odds of major in-hospital complications (odds ratio [OR], 1.19; 95% CI, 1.08-1.32; p<0.001); however, no significant difference was found in failure to rescue (OR, 1.06; 95% CI, 0.92-1.21; p=0.42). Read more.

Temporal Changes in Procedural Success and Clinical Outcome of TEER by Mechanism of MR

Investigating the effectiveness of TEER to treat mitral regurgitation (MR), Zach Rozenbaum, MD, FACC, et al., looked at 68,028 patients from the STS/ACC TVT Registry from November 2013 to June 2023. Results showed the application of TEER for MR in nondegenerative etiologies has increased from 19% to 43% over the last 10 years, with the largest growth in functional MR. Technical success was more likely for atrial and ventricular functional MR than degenerative MR, and risk of one-year mortality was not higher with nondegenerative etiologies. Read more.

Outcomes of Sequential TAVR and Mitral TEER

In comparing one-year outcomes of patients with moderate to severe residual MR after TAVR undergoing sequential mitral TEER vs. TAVR alone, Andrew M. Vekstein, MD, et al., found that patients undergoing sequential TAVR and then mitral TEER saw improvement in MR severity and quality of life. Nevertheless, patients with persistent MR had a high risk of one-year mortality post TAVR, regardless of mitral intervention. Read more.

Impact of DST on Clinical Outcomes in Patients With AMI

Jennifer Rymer, MD, FACC, et al., investigated incidence rates and outcomes of 168,870 patients at 1,124 sites presenting with acute myocardial infarction (AMI) from the ACC’s Chest Pain – MI Registry to see if there was an association with daylight savings time (DST) and incidence of AMI. The authors found no significant difference in AMI rates during DST weeks compared with the week before or after, and no differences in in-hospital clinical outcomes, including death or stroke, were identified. Read more.

Impact of CAD and Revascularization on Health Status and Clinical Outcomes

Yasser M. Sammour, MD, MSc, et al., included 122,261 patients from the STS/ACC TVT Registry to determine the association between extent of CAD and health status and clinical outcomes after TAVR. They found no association between CAD and Kansas City Cardiomyopathy Questionnaire overall scores at both 30-day and one-year follow up; however, both single- and multivessel CAD were associated with higher one-year mortality and heart failure (HF) readmission. Undergoing PCI in the year prior to TAVR did lower the risk of HF hospitalization in patients with multivessel CAD but was not associated with any other improved outcomes. Read more.

A Validated Risk Model For AKI Prediction in Patients Undergoing TAVR

Howard Martin Julien, MD, MPH, FACC, et al., included 445,100 TAVR patients from 826 sites captured by the STS/ACC TVT Registry to generate a risk model for 30-day acute kidney injury (AKI) Stage III or new requirement for dialysis post TAVR. The final risk model had a C-statistic of 0.7452 (intercept = -0.427; slope = 1.587) for the validation cohort and included seven variables. The strongest predictors for severe, clinically significant AKI were clinical instability, presence of pre-procedure anemia and pre-procedure creatinine greater than 1.3 mg/dL. Read more.

Association of TVT Site Risk Adjusted Stroke Rates and SCL

After a state-level study found a positive association between risk adjusted stroke rates and Joint Commission Stroke Certification Designation level (SCL), G. Michael Deeb, MD, FACC, et al., set out to determine if these results were consistent nationally. They included 527,451 TAVR procedures at 800 sites, identifying SCL as an independent predictor of in-hospital all stroke rate (p=0.033) and TAVR trial participation as an independent predictor of 30-day stroke (p=0.039) and disabling stroke (p=0.007). Both SCL and trial participation were not associated with other clinical outcomes, indicating these factors may need to be accounted for in public reporting. Read more.

Operator-Level Use of IVL Across the US

By looking at data from 3,110,849 patients at 1,414 hospitals reported to the ACC’s CathPCI Registry, Jennifer Rymer, MD, FACC, et al., found a significant uptake of intravascular lithotripsy (IVL) by operators across the U.S. from April 2018 to December 2023, noting overall low rates of major complications. Factors strongly associated with higher use of IVL included operator PCI volume and patient case mix characteristics. Read more.

Learn more about the ACC’s CathPCI Registry, Chest Pain – MI Registry and the STS/ACC TVT Registry along with companion quality programs like Cardiac Cath Lab Accreditation, Chest Pain Center Accreditation and Transcatheter Valve Certification at CVQuality.ACC.org. 

Keywords: Transcatheter Cardiovascular Therapeutics, TCT24, National Cardiovascular Data Registries, CathPCI Registry, Chest Pain MI Registry, STS/ACC TVT Registry