RA is safe and effective, with high rate of procedural success and relatively low incidence of MACE. PVD, DM, ACS presentation and SYNTAX score were significant predictors for MACE. © 2016 Wiley Periodicals, Inc.

Objective: To describe the contemporary management and outcomes of patients presenting with ST‐segment‐elevation myocardial infarction (STEMI) in Australia. Design, participants and setting: Observational analysis of data for patients who presented with suspected STEMI and enrolled in the Australian Acute Coronary Syndrome Prospective Audit from 1 November 2005 to 31 July 2007. Main outcome measures: Factors associated with use of reperfusion therapy and timely use of reperfusion therapy, and the effects of reperfusion on mortality. Results: In total, 755 patients had suspected STEMI. Median time to presentation was 105 minutes (IQR, 60–235 minutes). Reperfusion therapy was used in 66.9% of patients (505/755), and timely reperfusion therapy in 23.1% (174/755). Thombolysis was administered in 39.2% of those who received reperfusion therapy (198/505), while 60.8% (307/505) received primary percutaneous intervention. Cardiac arrest (OR, 2.83; P = 0.001) and treatment under the auspices of a cardiology unit (OR, 2.14; P = 0.02) were associated with use of reperfusion therapy. A normal electrocardiogram on presentation (OR, 0.42; P = 0.01), left bundle branch block (OR, 0.18; P = 0.001), acute pulmonary oedema (OR, 0.34; P < 0.01), history of diabetes (OR, 0.54; P < 0.01), and previous lesion on angiogram of > 50% (OR, 0.51; P = 0.001) were associated with not using reperfusion. Inhospital mortality was 4.0% (30/755), mortality at 30 days was 4.8% (36/755), and mortality at 1 year was 7.8% (59/755). Receiving reperfusion therapy of any kind was associated with decreased 12‐month mortality (hazard ratio [HR], 0.44; 95% CI, 0.25–0.78; P < 0.01). Timely reperfusion was associated with a reduction in mortality of 78% (HR, 0.22; P = 0.04). There were no significant differences in early and late mortality in rural patients compared with metropolitan patients (P = 0.66). Conclusion: Timely reperfusion, not the modality of reperfusion, was associated with significant outcome benefits. Australian use of timely or any reperfusion remains poor and incomplete.

ObjectiveWe sought to objectively quantify the independent impact of significant mitral regurgitation (MR) on prognosis in patients with multiple comorbidities and ascertain the extent to which median survival is affected by increasing comorbidities.MethodsThis was a retrospective matched cohort study using a clinical-echocardiography reporting database linked to a clinical and administrative database in an Australian tertiary hospital. We identified our study cohort (patients with significant MR) and control cohort (without MR) on transthoracic echocardiographies performed between 2005 and 2010. The main outcome measures were mortality and heart failure rehospitalisation. A Cox proportional hazards model was used to adjust for clinical covariates and the ‘win ratio’ methodology was utilised to estimate the impact of MR on main outcomes.ResultsA total of 218 matched patients with and without significant MR were followed-up for 1 year. Significant MR was associated with an adjusted HR for mortality of 1.83 (95% CI 1.28 to 2.62, p<0.001). The win ratio for death and death or heart failure readmission was 0.57 (95% CI 0.40 to 0.78, p=0.0002) and 0.53 (95% CI 0.39 to 0.71, p<0.0001), respectively. Significant MR with left ventricular (LV) systolic dysfunction and age between 75 and 85 years were associated with a substantial reduction in median survival by 2.3 years. Significant MR with LV systolic dysfunction, age beyond 85 and advance comorbidities were associated with a lesser reduction in median survival by 0.2 years.ConclusionsSignificant MR in patients with multiple comorbidities leads to increase in death and heart failure rehospitalisation with reduced estimated median survival. However, its impact diminishes with increasing comorbidities.

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Background: TAVI is a rapidly emerging modality for aortic valve replacement among the elderly with significant comorbidities. Its high cost remains a considerable limitation.Objective: The impact of patient's expected survival on the economic value of TAVI was examined.Methods: Patients with severe AS were identified from the FMC echocardiographic database excluding known dementia, CVA, malignancies and prior valve surgery. Survival status and death were determined by clinical followup and interrogation of state-based clinical records repository. Survival beyond observed data were calculated using a Royston-Parmar model adjusted for age, renal impairment, Charlson index and LV function. Predetermined hospital costs, prosthesis, ICU, ward stay, investigations and recurrent CCF admissions were used. Estimates of cost effectiveness were calculated by differential survival and costs between TAVI patients and medically managed patients throughout four years using the Monte-Carlo simulation.Results: 538 patients with severe AS were identified. Fifty-six patients underwent TAVI in FMC. Median age was 85.25 years (i.q.r. 80.0-90.0 years). Unadjusted hazard ratio with TAVI (0.46, 95% CI 0.24-0.89, p = 0.022) was greater than observed in PARTNERS (HR, 0.55) but this benefit diminished after adjusting for comorbidities, (0.64, 95% CI 0.31-1.35, p = NS). Estimated cost for TAVI in the first year was ∼$80,000. Estimated cost per life saved over four years was $71,788 (±$50,891).Conclusion: Current costing suggests the expected survival of patients independent of severe AS needs to exceed four years for TAVI to be economically attractive when considering survival alone. Quality of life considered, this survival threshold may be shortened.