Introduction: Pacemaker implantation remains a frequent complication in patients undergoing transcatheter aortic valve implantation (TAVI). Outcomes of TAVI with a baseline first degree heart block (HB) remain unknown. Methods: The purpose of this study was to evaluate outcomes of TAVI in patients with a baseline first degree HB. We utilized the National Inpatient Sample (NIS) data from the year 2011 to 2018. Results: A total of 215,938 weighted hospitalizations for TAVI were included in the analysis. Of the patient undergoing the procedure, 11000 had baseline first degree HB (5.1%) and 204938 (94.9%) patients did not have first degree HB. Patients with first degree HB had higher rates of PPM implantation (17.1% vs. 10.1%, p<0.01). At baseline, age greater than 75 (Odds Ratio [OR], 1.26[confidence interval (CI), 1.10-1.45]), male gender (OR, 1.22[CI, 1.09-1.37]), atrial fibrillation (OR, 2.01[CI, 1.68-2.4]), hypertension (OR, 1.54[CI, 1.27-1.88]) and chronic kidney disease (OR, 1.22[CI, 1.08-1.37]) were significant predictors of PPM implantation in patients undergoing TAVI with a baseline first degree HB. In terms of resource utilization, patients with baseline first degree HB had higher median cost of stay ($ 48083 vs. $ 47081) Conclusions: In conclusion we report that PPM implantation rate is higher in patients with first degree HB and that age greater than 75, male sex, hypertension and chronic kidney disease are significant predictors of this adverse event.

Introduction: The need for increased utilization of hospice in the dying patients has been recognized in multiple fields including cardiology recently. The aim of this study to examine the trends in location of deaths in acute myocardial infarction (AMI) related deaths in the United States from 2003 to 2019. Methods: The CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was used to access the National Vital Statistics System data from 2003 to 2019. AMI related deaths in patients ≥ 25 years of age were identified from multiple causes of death. Joinpoint regression was used to examine changes in trend, annual percentage change (APC), and average annual percentage change (AAPC). Location of death was categorized as home, medical facility, hospice facility, nursing home/long term care (NH/LTC) and other/unknown. Results: Of AMI related deaths, 23.62% occurred at home, 0.94% at hospice facility, 39.64% at medical facility and 13.30% at NH/LTC. From 2003-2019, the number of deaths has increased at hospice facility (AAPC 24.7[95% CI, 18.1 to 31.6]) and decreased at both medical facilities (AAPC -3.1[95% CI, -3.5 to -2.8]) and NH/LTC (AAPC -4.3[95% CI, -4.6 to -3.9]). The number of deaths initially decreased at home till 2009 (APC -1.9[95% CI, -2.5 to -1.3]) followed by increase till 2019 (APC 1.5[95% CI, 1.2 to 1.8]). Conclusion: Although there was an increasing trend in AMI related mortality at hospice and home locations, rates of utilization of hospice facility remain very low.

Introduction: Comparative outcomes for percutaneous coronary intervention versus CABG surgery for left main coronary artery disease remains limited from a large national database. Methods: We studied comparative outcomes of PCI versus CABG using the US national inpatient sample database from 2015 to 2018 for left main disease presenting as STEMI. Results: A total of 930 and 535 patients with STEMI underwent PCI and CABG respectively. The patients undergoing PCI were older (67.5 years [Interquartile range (IQR),59-77]vs 67 [59-74]). Adjusted mortality was much higher in CABG (18.80%) as compared to PCI (7.6%). Higher percentage of patients were discharged to home after PCI as compared to CABG (49.70% vs 27.60%). Conversely, as compared to PCI a higher number of patients undergoing CABG were discharged to long-term care facility (71.90% VS 50.20%). Cost of care ($ 48703[IQR, 36803-71262] vs $ 30376 [19161-52207]) was considerably higher with CABG. The odds of in-hospital mortality and adverse events for CABG compared to PCI are depicted in figure 1. Conclusions: PCI may be associated with lower in-hospital mortality and adverse events when compared to CABG for unprotected left main disease.

Introduction: Data on outcomes of transcatheter mitral valve repair (TMVR) in patients with acute kidney injury (AKI) remains limited. Hypothesis: AKI is associated with worse outcomes in patients undergoing TMVR Methods: We utilized the United States National Inpatient Sample database from the year 2015 to 2018 to evaluate outcomes of TMVR in AKI. Results: A total of 21,505 weighted hospitalizations were included in the analysis. Of the patients who underwent TMVR 3350 (15.6%) developed acute kidney injury. The mean age of patients undergoing TMVR was higher for patients with AKI compared to patients who did not develop AKI was 77 and 76 years respectively. A logistic regression model adjusted for age, gender and baseline comorbidities was developed for predictors of AKI. On adjusted comparison liver disease (OR 2.4 95% CI, 2-2.9), peripheral vascular disease (1.35, 95% CI 1.2-1.53), congestive heart failure (2.76 95% CI, 2.34-3.26) and history of weight loss (1.92 95% CI 1.64-2.25) were significant predictors of AKI. In-hospital mortality was higher for patients with AKI versus no AKI (10.1% vs. 0.7%, p<0.01). Length of stay (13 vs 3 days) and cost of stay ($80787 vs. $ 44086) was significantly higher for patients with AKI versus those who did not develop AKI. Conclusions: AKI is associated with increased in hospital mortality and increased health care resource utilization in patients undergoing TMVR.

Introduction: Acute myocardial infarction (AMI) accounts for significant morbidity and mortality and the mortality may vary across regions and states. The aim of this study was to examine the trends in AMI related deaths stratified by regions in the United States from 1999 to 2019. Methods: We used CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access National Vital Statistics System data from 1999 to 2019. AMI related deaths, age >/=25 years were identified from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC) overall and stratified by regions. Results: AAMR was highest in South (91.7) followed by Midwest (88.2), Northeast (77.3), and West (64.6). APC in AAMR decreased across all the regions at variable pace. After initial decline, the decrease in APC in AAMR decelerated in South (-2.7) since 2012, Midwest (-3.0) and Northeast (-4.0) since 2009 and West (-2.7) since 2010. States with AAMRs >90th percentile included Arkansas (180.8), Kentucky (136.3), Mississippi (129.7), Tennessee (123.2), Missouri (121.2) and South Dakota (117.9) and <10th percentile included Alaska (44.0), Nevada (48.0), Minnesota (48.8), Hawaii (53.4), Colorado (54.0) and Montana (54.6). Conclusion: AMI related mortality in elderly has been decreasing at a variable pace in various regions. Significant disparities exist across various regions and states. Further research is needed to examine the underlying causes of these disparities and targeted interventions are required to address these disparities.