e18631 Background: Patients with localized and advanced malignancy are usually excluded from randomized clinical trials of drug-eluting stents and anti-platelet therapy. We aimed to evaluate short term outcomes of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with localized and metastatic malignancy. Methods: Analysis from the Nationwide inpatient sample January 2016 to December 2018 of patients with localized and advanced malignancy admitted for a percutaneous coronary intervention with drug-eluting stents. Primary outcome was in-hospital mortality. Secondary outcomes were post-procedural complications and healthcare-utilization. Multivariate regression analysis was performed to adjust for confounders. Results: During 2016 – 2018 a total of weighted 1, 244, 550 PCI with DES were performed. 97.9 % in patients without cancer, 1.6% (n=21,125) patients with localized cancer and 0.3 % (n=4,765) with metastatic cancer. During hospitalization patient with cancer were more likely to develop respiratory failure, need for mechanical ventilation, AKI, and to receive blood products. After multivariate regression analysis patients with localized malignancy did not have any difference in-hospital mortality, total charges, cost, cardiac arrest or post procedural bleeding but had less LOS, respiratory failure, AKI requiring HD, post-procedural CVA and higher post-procedural blood transfusion when compared with patients without cancer. Conclusions: Patients with metastatic malignancy have higher in-hospital mortality when compared to patients without cancer. Patients with localized or advanced malignancy do not have higher in hospital complications. Blood transfusion is higher in patients with malignancy but is not related to procedure.[Table: see text]

e18620 Background: Hospital readmissions after cardiac procedures are increasingly the major focus of quality improvement efforts. Although some reflect appropriate care, others are potentially preventable readmissions (PPRs). We aim to describe the burden, timing, and factors associated with readmissions after transcatheter aortic valve replacement (TAVR) in patients with malignancy. Methods: We performed a retrospective study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for TAVR with a concomitant diagnosis of malignancy. We aimed to identify 30-day readmission rate, mortality, healthcare related utilization of resources and other independent predictors of readmission. Results: A total of 2,213 patients with malignancy underwent TAVR. The 30-days readmission rate was 16% (n=355). Main causes of readmissions were found to be heart failure, sepsis, acute hypercapnic respiratory failure, coronary artery disease with angina, and AKI with ATN. Readmitted patients were more likely to come from small metropolitan areas (43.1% vs 33.6, p≤0.01), micropolitan areas (1.4% vs 0.35%, p≤0.01), rural hospital (20.3% vs 8.8%, p≤0.01), non-teaching hospital (23.5% vs 9.1%, p≤0.01), and small sized hospitals (11.5% vs 4%, p≤0.01). Patients re-admitted were more likely to have malnutrition (8% vs 3.2%, p≤0.01), new VTEs (3.8% vs 0.6, p≤0.01), AKI (26% vs 13.6%, p≤0.01) and deaths (4.6% vs 1.7%, p≤0.01). The total health care in-hospital economic burden of readmission was $5.9 million in total charges and $25 million in total costs. Independent predictors of readmission were disposition to short-term skilled nursing facilities, home-health care, and sepsis. Conclusions: We concluded that readmissions after TAVR in patients with malignancy are associated with higher in-hospital mortality rate and pose a higher health care burden. We also identified risk factors that can be targeted to decrease readmissions after TAVR, health care burden, and patient mortality.[Table: see text]

e18601 Background: Reducing the 30-day readmission is one of the quality performance measures upon which hospitals are being evaluated. Readmissions represent a significant economic burden to the patients and the health care system. Index admission for myocardial infarctions requiring PCI with a concurrent diagnosis of malignancy represents a critical part of the population due to the association between cancer and the pro-thrombotic state that renders them at high risk of readmission. By harnessing the power of large datasets such as the NRD (National Readmission Database), we sought to find associations that, together, could aid in the development of better public and private policies that would make patient care more efficient. Methods: We conducted a retrospective study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for myocardial infarction requiring PCI with a concurrent diagnosis of malignancy. We aimed to identify the 30-day readmission rate, mortality, healthcare-related utilization resources, and independent readmission predictors. Results: A total of 8,350 patients with malignancy underwent PCI. The 30-day readmission rate was 17.8%. The main causes for readmission were sepsis, ventricular fibrillation, recurrent STEMI. Compared to initial admissions, readmitted patients were less likely to require mechanical ventilation (7.3% vs. 5.2%; P = 0.05), intra-aortic balloon pump placement (4.1 vs 0.4; P < 0.01), IMPELLA device use (4.0 vs 0.3; P < 0.01), less had private insurance (16.2% vs 12.9%; P = 0.02), less developed shock (7.7% vs 3.2%; P < 0.01), & less had major bleeding (2.0% vs 0.1%; P < 0.01). Readmission was associated with lower in-hospital mortality rate (1.5% vs. 0.1%; P < 0.01), but more likely to require hemodialysis (4.3% vs 6.6%; P < 0.01), & have venous thromboembolism (VTE) (1.9% vs 3.2%; P < 0.01). The total health care in-hospital economic burden of readmission was $937 million in total charges for patients and $224 million in total costs for hospitals. Independent predictors of readmission were female gender, the disposition to a short-term hospital or skilled nursing facility, prolonged length of stay, inpatient hemodialysis, and VTE episodes. Conclusions: Readmissions after PCI in patients with malignancy are associated with a lower in-hospital mortality rate but pose a high health care burden. We identified potential risk factors that, if targeted, could lead to a reduction in readmissions after PCI in cancer patients, & therefore decrease health care costs.

SUMMARYDermatitis herpetiformis or Duhring-Brocq disease is a chronic, autoimmune, pleomorphic disease, characterized by lesions on extension surfaces, accompanied by intense pruritus, and is usually associated with celiac disease, gluten sensitivity, gluten sensitivity ataxia and some forms of IgA neuropathy. Two cases of dermatitis herpetiformis are presented in female patients and we make a brief review of the literature on the treatment of this pathology.

The lesion of Dieulafoy is a vascular malformation characterized by the presence of a large arterial vessel in the submucosa and occasionally in the mucosa, which can erode and cause severe, recurrent and sometimes fatal hemorrhage. It is a rare cause of gastrointestinal bleeding and responds to less than 2% of episodes of acute gastrointestinal bleeding. The duodenal Dieulafoy lesion has been reported in a small number of cases and the intradiverticular is exceptional. Endoscopy is the diagnostic method of choice and in the last decade endoscopic therapy is the preferred technique due to its high effectiveness and low incidence of complications. We present the case of an 82-year-old patient with severe upper gastrointestinal bleeding due to an intradiverticular duodenal injury diagnosed in emergency endoscopy and treated effectively by rubber band ligation.