Several abstracts using data from the NCDR suite of registries are being presented at AHA 2024, taking place Nov. 16-18 in Chicago, IL.

The research explores same-day discharge (SDD) after atrial fibrillation (AFib) ablation, changes in contrast volume among patients undergoing PCI, outcomes for patients with peripheral artery disease (PAD) hospitalized for acute myocardial infarction (AMI), ICD implantation disparities and COVID-19, claims-based vs. registry-reported stroke events and more.

View abstract findings by registry below:

AFib Ablation Registry

SDD Following Catheter Ablation of AFib in the US
Amneet Sandhu, MD, FACC, et al., examined trends in SDD after AFib ablation by looking at 139,391 patients from the ACC’s AFib Ablation Registry. The rate of SDD increased from 0.99% in Q1 2016 to 62.3% in Q2 2023 (p<0.0001). Associated with overnight hospitalization were Black race (odds ratio [OR], 0.71; 95% CI, 0.65-0.78), persistent AFib classification (OR, 0.85; 95% CI, 0.82-0.88) and prior non-AFib catheter ablation (OR, 0.89; 95% CI, 0.85-0.93). The authors noted significant variation in SDD across the 197 hospitals included in the analysis (median OR, 4.12; 95% CI, 3.48-4.79) and “periprocedural complication rates of those undergoing same-day discharge were comparable to overnight hospitalization.”

Use and Clinical Outcomes Associated With Urgent vs. Elective Catheter Ablation of AFib in the US
Vincenzo Biagio Polsinelli, MD, et al., compared urgent and elective AFib ablation procedures captured by the ACC’s AFib Ablation Registry between January 2016 and June 2023. Out of 140,051 patients, 1.9% of procedures were urgent and 98.1% were elective. Rates of urgent ablation increased over the study period (from 0.5% in 2016 to 2.0% in 2023; p<0.0001), and urgent ablation was associated with significantly higher rates of procedural complications when compared with elective ablation (urgent 4.9% vs. elective 2.4%; p<0.0001).

CathPCI Registry

Changes in Contrast Volume Among Patients Undergoing PCI
Including 3,126,559 patients undergoing PCI captured by the ACC’s CathPCI Registry from April 2018 to December 2022, Nobuhiro Ikemura, MD, et al., investigated the temporal trends in contrast volume used during PCI among patients with varying preprocedural risk of acute kidney injury (AKI). Contrast volume declined over the study period (mean of 168.1±77.6 ml in Q2 2018 vs. 149.8±71.2 ml in Q4 2022; p<0.001), and lowest mean contrast doses were seen in patients with greatest AKI risk.

Outcomes of PCI Following TAVR
Christina Lalani, MD, et al., sought to determine the incidence rate of patients experiencing coronary events after TAVR along with the procedural characteristics and rate of adverse events when these patients undergo PCI by using both Medicare claims data and linked CathPCI Registry data. Among 52,780 Medicare patients, 10.6% experienced AMI and 5.4% underwent PCI at five years post TAVR. PCI success rates were similar for both patients with a history of TAVR and those without. However, after propensity matching, the authors found that “patients with a history of TAVR who underwent PCI had longer fluoroscopic times, more frequent in-hospital adverse events, and a higher likelihood of a repeat PCI.”

Small Delays in DTB Time For Patients Presenting With STEMI Do Not Impact Mortality
Studying a total of 447,355 patients from 2010 to 2021 in the ACC’s CathPCI Registry, Andrew Oseran, MD, et al., found that delays in door-to-balloon (DTB) time were not associated with greater risk of in-hospital mortality (OR, 0.99; 95% CI 0.95-1.03; p=0.7) when using “quasi-experimental methods less likely to be influenced by unmeasured confounding.” The same findings were observed when limiting the analysis to hospitals with larger differences between weekend and weekday DTB time (OR ,1.00; 95% CI, 0.96-1.03; p=0.85) and patients predicted to have the longest DTB times (OR, 1.00; 95% CI, 0.94-1.07; p=0.96).

Chest Pain – MI Registry

Higher GRACE Score is Associated With Lower Invasive Coronary Angiography Use
Looking at patients who presented with NSTEMI to a single academic medical center and captured by the ACC’s Chest Pain – MI Registry over a 12-month period, Sarah Slone, DNP, APRN, FNP-BC, CCRN, PhD, et al., examined whether increasing Global Registry of Acute Coronary Events (GRACE) score was associated with use of invasive coronary angiography. Of 434 patients included, invasive coronary angiography was used in 94% of cases. Increasing GRACE score was associated with lower invasive coronary angiography use (adjusted OR [aOR], 0.60; 95% CI, 0.19-1.91) with patients in the high-risk category less likely to receive the intervention than patients in the low-risk category (aOR, 0.22; 95% CI, 0.07-0.62). The authors highlight that “influence of patient factors as well as provider and patient risk aversion on [invasive coronary angiography] selection must be explored to better understand incongruence with guideline recommendations.”

Inpatient Outcomes For Patients With PAD Hospitalized For AMI
Including 493,740 patients from the ACC’s Chest Pain – MI Registry, Jason Gusdorf, MD, et al., looked at characteristics, major bleeding and mortality of AMI patients with PAD. Results showed that patients with PAD hospitalized for AMI had an increased risk of mortality (aOR, 1.25; 95% CI, 1.19-1.31) and major bleeding (aOR, 1.23; 95% CI, 1.17-1.28), with this elevated risk driven by patients aged 65 years or older. The authors additionally found worse outcomes in patients with PAD vs. without PAD for cardiac arrest (6.4% vs. 4.6%), cardiogenic shock (6.9% vs. 4.8%), heart failure (2.5% vs. 1.0%), stroke (1.4% vs. 0.9%) and new dialysis requirement (2.5% vs. 1.0%).

Evolving Trends and Outcomes of P2Y12 Inhibitor Pretreatment in NSTE-ACS in the US
A study simultaneously published in JACC looked at a cohort of 110,148 patients captured by ACC’s Chest Pain – MI Registry between January 2019 and March 2023, Hiroki Ueyama, MD, et al., found that 15.9% received P2Y12 inhibitor pretreatment for non-ST-elevation acute coronary syndrome (NSTE-ACS) with significant variability observed by changing institution or hospital region (OR, 3.63; 95% CI, 3.54-3.74 and 3.21; 95% CI, 2.90-3.54, respectively). No significant differences in in-hospital all-cause death, recurrent MI or major bleeding were observed between groups, but among patients who underwent CABG, pretreatment was associated with longer length of stay (11.2±5.1 days vs. 9.8±5.0 days; p<0.001). In a related editorial comment by Joseph M. Kim, MD, et al., they add, “the growing body of evidence points to a clear message: routine pretreatment with a P2Y12 inhibitor before PCI is not beneficial in patients presenting with NSTE-ACS.”

EP Device Implant Registry

Disparities in Defibrillator Implantations During COVID-19
Saima Karim, DO, FACC, et al., compared primary and secondary prevention ICD implantation rates across sex, race and ethnicity to see if strains on the U.S. health care system from the COVID-19 pandemic had an impact on disparities in procedure use. Looking at 239,014 patients captured by the EP Device Implant Registry, ICD implantation decreased overall from an average monthly rate of 3,271 in Q1 2016 to 2,334 in Q4 2022 (p=0.017). Historical disparities in ICD implantation for women, racial and ethnic minorities were observed throughout the study period but did not increase (p-value interactions were 0.79 for sex, 0.47 for race and 0.095 for ethnicity). Primary prevention ICD decreased more significantly than secondary prevention ICD (p<0.0001) over the study period.

LAAO Registry

Claims-Based vs. Registry-Reported Stroke Events
Kamil Faridi, MD, et al., compared stroke events in Medicare claims data and events reported through the ACC’s LAAO Registry to determine the reliability of administrative claims data. Including 71,043 patients total, they found that “administrative claims data had moderate agreement with adjudicated registry-reported stroke events,” and noted that “claims data may not reliably capture all stroke events in real-world practice.”

Access full abstracts and additional session details by searching the AHA 2024 online program planner. For more information on NCDR, ACC Accreditation Services and other ACC quality improvement programs, visit CVQuality.ACC.org.

Keywords: American Heart Association, AHA Annual Scientific Sessions, AHA24, National Cardiovascular Data Registries, CathPCI Registry, Chest Pain MI Registry, LAAO Registry, AFib Ablation Registry, EP Device Implant Registry