Introduction: Transcatheter aortic valve replacement (TAVR) has been shown to be clinically and financially superior to surgical AVR (SAVR) in severe aortic stenosis (SAS), even in patients at low ...
Contributions: First 2 authors are co-first authors, contributing equally to this abstractBackgroundThis is the largest longitudinal nationally representative study of mortality, cost, and valvular procedure (pulmonary and tricuspid valve repair/replacements [PVR and TVR]) by malignant carcinoid tumor (MCT).MethodsMachine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) was conducted for the above outcomes in this case-control study of the United States' largest all-payer hospitalized dataset, the 2016-2018 National Inpatient Sample. Regression models were weighted by the complex survey design, know confounders, and the likelihood of undergoing valvular procedures.ResultsAmong 101,521,656 hospitalizations, 55,910 (0.06%) had an MCT. Patients with MCT versus those without were significantly more likely to die inpatient (2.93% versus 2.04, p=0.002) and have a longer mean length of stay (12.20 [SD 7.58] versus 4.62 [SD 6.91], p<0.001) and mean total cost ($70,252.18 [SD 114,165.66] versus 51,092.01 [94,182.69], p<0.001). There was a stepwise increased rate of TVR and PVR with each subsequent year, with significantly more TV (0.16% versus 0.01, p<0.001) and PV (0.03 versus 0.00, p=0.040) for MCT versus non-MCT for 2016 with comparable trends in 2017 and 2018. There were no significant procedural disparities among patients with MCT for sex, race, income, urban density, or geographic region with the exceptions of: 2017 regional disparities for PV (with the highest prevalence among procedures being done in the Western North at 50.00% [p=0.034]). In multivariable regression, MCT did not significantly increase the likelihood of TVR or PVR. In ML-PSr sub-group analysis restricted to MCT, neither TVR nor PVR significantly increased mortality, though it did respectively increase cost despite additional adjustment for length of stay (respectively $141,082.30, 95%CI 27,325.52-254,839.20, p=0.015; and $355,356.40, 95%CI 78,488.57-632,224.20, p=0.012).ConclusionsThis national propensity score suggests TVR and PVR are becoming more frequent including among those with MCT who appear to have safe though costlier inpatient outcomes.DisclosuresK. A. Honan Nothing to disclose. D. J. Monlezun Nothing to disclose. A. Badalamenti Nothing to disclose. J. W. Kim Nothing to disclose. V. Liu Nothing to disclose. S. Chauhan Nothing to disclose. A. Javaid Nothing to disclose. C. A. Simbaqueba Clavijo Nothing to disclose. N. Palaskas Nothing to disclose. B. Akkanti Nothing to disclose. I. Gregoric Nothing to disclose. M. Patel Nothing to disclose. M. Cilingiroglu Nothing to disclose. K. Marmagkiolis Nothing to disclose. C. A. Iliescu Nothing to disclose. Contributions: First 2 authors are co-first authors, contributing equally to this abstract BackgroundThis is the largest longitudinal nationally representative study of mortality, cost, and valvular procedure (pulmonary and tricuspid valve repair/replacements [PVR and TVR]) by malignant carcinoid tumor (MCT). This is the largest longitudinal nationally representative study of mortality, cost, and valvular procedure (pulmonary and tricuspid valve repair/replacements [PVR and TVR]) by malignant carcinoid tumor (MCT). MethodsMachine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) was conducted for the above outcomes in this case-control study of the United States' largest all-payer hospitalized dataset, the 2016-2018 National Inpatient Sample. Regression models were weighted by the complex survey design, know confounders, and the likelihood of undergoing valvular procedures. Machine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) was conducted for the above outcomes in this case-control study of the United States' largest all-payer hospitalized dataset, the 2016-2018 National Inpatient Sample. Regression models were weighted by the complex survey design, know confounders, and the likelihood of undergoing valvular procedures. ResultsAmong 101,521,656 hospitalizations, 55,910 (0.06%) had an MCT. Patients with MCT versus those without were significantly more likely to die inpatient (2.93% versus 2.04, p=0.002) and have a longer mean length of stay (12.20 [SD 7.58] versus 4.62 [SD 6.91], p<0.001) and mean total cost ($70,252.18 [SD 114,165.66] versus 51,092.01 [94,182.69], p<0.001). There was a stepwise increased rate of TVR and PVR with each subsequent year, with significantly more TV (0.16% versus 0.01, p<0.001) and PV (0.03 versus 0.00, p=0.040) for MCT versus non-MCT for 2016 with comparable trends in 2017 and 2018. There were no significant procedural disparities among patients with MCT for sex, race, income, urban density, or geographic region with the exceptions of: 2017 regional disparities for PV (with the highest prevalence among procedures being done in the Western North at 50.00% [p=0.034]). In multivariable regression, MCT did not significantly increase the likelihood of TVR or PVR. In ML-PSr sub-group analysis restricted to MCT, neither TVR nor PVR significantly increased mortality, though it did respectively increase cost despite additional adjustment for length of stay (respectively $141,082.30, 95%CI 27,325.52-254,839.20, p=0.015; and $355,356.40, 95%CI 78,488.57-632,224.20, p=0.012). Among 101,521,656 hospitalizations, 55,910 (0.06%) had an MCT. Patients with MCT versus those without were significantly more likely to die inpatient (2.93% versus 2.04, p=0.002) and have a longer mean length of stay (12.20 [SD 7.58] versus 4.62 [SD 6.91], p<0.001) and mean total cost ($70,252.18 [SD 114,165.66] versus 51,092.01 [94,182.69], p<0.001). There was a stepwise increased rate of TVR and PVR with each subsequent year, with significantly more TV (0.16% versus 0.01, p<0.001) and PV (0.03 versus 0.00, p=0.040) for MCT versus non-MCT for 2016 with comparable trends in 2017 and 2018. There were no significant procedural disparities among patients with MCT for sex, race, income, urban density, or geographic region with the exceptions of: 2017 regional disparities for PV (with the highest prevalence among procedures being done in the Western North at 50.00% [p=0.034]). In multivariable regression, MCT did not significantly increase the likelihood of TVR or PVR. In ML-PSr sub-group analysis restricted to MCT, neither TVR nor PVR significantly increased mortality, though it did respectively increase cost despite additional adjustment for length of stay (respectively $141,082.30, 95%CI 27,325.52-254,839.20, p=0.015; and $355,356.40, 95%CI 78,488.57-632,224.20, p=0.012). ConclusionsThis national propensity score suggests TVR and PVR are becoming more frequent including among those with MCT who appear to have safe though costlier inpatient outcomes. This national propensity score suggests TVR and PVR are becoming more frequent including among those with MCT who appear to have safe though costlier inpatient outcomes.
Approximately 60,000-100,000 Americans die from deep venous thrombosis or pulmonary embolism annually, while the overall estimate of individuals affected is 30,000-600,000. Inferior vena cava (IVC) filter placement has emerged as a break-through endovascular technique which has gained increasing acceptance and has probably saved thousands of lives by preventing fatal thromboembolic events. However, in the absence of a national IVC filter registry an accurate estimate of device complications is currently unavailable. We present a case of symptomatic IVC syndrome due to IVC interruption in a patient with a non-retrievable IVC filter. This patient was initially managed with balloon angioplasty and mechanical thrombectomy with suboptimal results and subsequently with stent placement through the IVC filter.
Objectives: To evaluate the role of platelet count and thromboelastogram (TEG) in the treatment of thrombocytopenic cancer patients with suspected coronary artery disease (CAD). Background: Cancer patients with CAD and thrombocytopenia are often treated non-invasively due to perceived high risk of bleeding. We sought to evaluate coagulability based on TEG and determine if platelet count and TEG could predict bleeding risk/mortality among cancer patients undergoing coronary angiography (CA). Methods: Baseline demographics, platelet count, and TEG parameters were recorded among cancer patients that underwent CA and had a concomitant TEG. Logistic regression and univariate proportional hazards regression analysis were performed to determine the impact of platelet count and coagulability on 24-month overall survival (OS). Results: All patients with platelet count 50,000/mm3 groups, as well as the improved survival, suggest that with appropriate clinical indication and risk/benefit assessment, a cut-off of 50,000/mm3 platelets can be considered for CA in cancer patients.
