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Prognostic significance of metaplasia in adenocarcinoma of the lung: A National Cancer Database analysis
No full textBackground: Pulmonary adenocarcinoma is a major subtype of non-small cell lung cancer (NSCLC), yet the impact of metaplasia within the tumor remains understudied. This study utilized the National Cancer Database (NCDB) to analyze the prognostic significance of metaplasia in pulmonary adenocarcinoma. Methods: Using the NCDB, we conducted a retrospective analysis on patients with lung adenocarcinoma from 2010 to 2017 and followed STROBE guidelines. Kaplan-Meier survival analysis and Accelerated Failure Time (AFT) model were used for estimation of survival outcomes. Covariates included age, sex, race, tumor grade, TNM stage, Charlson Comorbidity Index, insurance status, year of diagnosis, facility type, and treatment modality. Statistically significant variables from AFT were subgroup analyzed with multivariate logistic regression to identify the relative representation of these variables in metaplastic and non-metaplastic arms. Results: A total of 16,330,918 patients were included, with 16,302,690 (99.83%) diagnosed with non-metaplastic adenocarcinoma (NMAC) and 28,228 (0.17%) with metaplastic adenocarcinoma (MAC). The unadjusted median overall survival (mOS) was significantly lower in MAC (12.25 months) compared to NMAC (24.48 months, p \u3c 0.05). After covariate adjustment, MAC was associated with worse survival (HR 1.2, 95% CI: 1.12-1.28, p\u3c0.01). Logistic multivariate regression analysis identified significant predictors of MAC. Grade 4 tumors had the highest odds (OR: 103.10; 95% CI: 51.45-206.61; p\u3c0.01), followed by grade 3 tumors (OR: 20.05; 95% CI: 10.68-37.61; p\u3c0.01). Patients with M1b stage disease (OR: 1.31;95%CI: 1.13-1.52; p\u3c0.01) and those with a Charlson-Deyo Score of 1 (OR: 1.18; 95% CI: 1.03-1.35; p\u3c0.05) were also more likely to have MAC. In contrast, female patients (OR: 0.79;95%CI: 0.70-0.90; p\u3c0.01)TNMN3 stage patients (OR: 0.77;95%CI: 0.62-0.95; p\u3c0.05) were less likely to have metaplastic adenocarcinoma. Conclusions: Metaplastic adenocarcinoma was associated with significantly worse outcomes compared to non-metaplastic adenocarcinoma. High grade, advanced M1b stage, and burden of comorbidities partially explains these poor outcomes, however, further studies are needed to explore and delineate the underlying mechanisms driving the worse outcomes seen by metaplasia in pulmonary adenocarcinoma
TCT-1021 Incidence and Outcomes of Hospitalized Acute Ischemic Stroke Patients with subsequent ST-Segment-Elevation Myocardial Infarction
No full textBackground: Acute ischemic stroke (AIS) and ST-segment elevation myocardial infarction (STEMI) are two life-threatening, atherothrombotic conditions with overlapping risk profiles. While their individual pathophysiology is well described, the occurrence of STEMI during AIS hospitalization and its clinical impact remain underexplored. Methods: We analyzed 2,804,819 adult patients hospitalized with AIS from 2016-2021 using the National Inpatient Sample, a nationally representative database. Patients with concomitant STEMI were identified using ICD-10 Diagnostic codes; those with NSTEMI were excluded. The primary outcome was in-hospital mortality. Secondary outcomes included cardiogenic shock, cardiac arrest, acute kidney injury (AKI), procedural interventions, and resource utilization. Multivariable logistic regression adjusted for demographics, comorbidities, and hospital-level variables. Temporal trends were assessed over the 6-year period. Results: Among 2,804,819 AIS admissions, 6,550 (0.23%) had a STEMI during hospitalization. Patients with STEMI had significantly higher in-hospital mortality (24.96% vs 3.10%, p\u3c0.001). STEMI was independently associated with increased odds of mortality (OR 7.43, 95% CI 6.44-8.57), cardiogenic shock (OR 9.64, 95% CI 7.21-12.89), cardiac arrest (OR 7.76, 95% CI 6.01-10.03), and AKI (OR 1.96, 95% CI 1.72-2.23), among other complications. STEMI patients mroe frequently required PCI, mechanical circulatory support, intubation, and had longer hospital stays. From 2016 to 2021, STEMI incidence among AIS patients declined (∼30% to ∼20%), yet mortality in this subgroup remained disproportionately high. Conclusion: STEMI in patients hospitalized with AIS is associated with a seven-fold increased risk of in-hospital mortality and a dramatically worse secondary complications including cardiac arrest, cardiogenic shock, AKI, and need for further medical interventions. Despite a decreasing incidence over time, this overlap syndrome demands urgent clinical recognition and integrated neurologic-cardiac care pathways to improve recognition, management protocols, and interdisciplinary care strategies to mitigate morbidity and mortality in this high-risk population. Categories: ENDOVASCULAR: Stroke, Stroke Prevention, Carotid Interventio
Delayed or upfront brain radiotherapy in treatment-naïve lung cancer patients with asymptomatic or minimally symptomatic brain metastases and ALK rearrangements (DURABLE)
No full textBackground: Patients with non-small cell lung cancer (NSCLC) with ALK rearrangements have a high frequency of brain metastases. Alectinib was shown to be superior to crizotinib in the first-line treatment of patients with ALK-positive NSCLC in the ALEX trial, and the intracranial response rate (CNS ORR) was 85.7% with alectinib versus 71.4% with crizotinib in patients who received prior radiotherapy and 78.6% versus 40.0%, respectively, in those who had not. Alectinib has also shown benefit in earlier stages of NSCLC. Given the high intracranial efficacy rate demonstrated by alectinib, as well as the known toxicities of cranial irradiation, the role of early irradiation of CNS disease vs delaying radiation in favor of treatment with alectinib needs to be defined to inform clinical practice. Methods: NCT05987644 is a multi-center, multi-cohort study consisting of a Phase 1b and Phase 2 portion. The Phase 1b portion of the study is a single-arm, open label study of alectinib in patients with CNS disease. Twelve subjects will be enrolled in the Phase 1b portion of the study and treated with alectinib alone; patients with PD will come off study treatment and move on to standard of care treatment per national guidelines. The phase 2 portion will be a randomized, non-blinded, open-label study. Forty four subjects will be enrolled and randomized 1:1 to either alectinib upfront (Arm A) or alectinib + SRS (arm B). A group sequential design will be implemented with one interim analysis for futility and, and one final analysis using the composite outcome. The primary objective of phase 1b is to determine the safety and feasibility of delayed brain radiation in patients with ALK fusion positive NSCLC and CNS metastases. The primary objective of the phase 2 study is to determine whether treatment with alectinib results in preserved neurological status and control of CNS disease at 12 months compared to alectinib plus SRS. Secondary endpoint will be intracranial progression free survival at 12 months (icPFS12), response rate and icPFS, OS, and safety and tolerability. The study is open and accruing at 4 sites. Clinical trial information: NCT05987644. Research Sponsor: Genentech
Epidemiology of Shoulder Dislocations in the United States From 1990 to 2019: A Temporal Study Using the Global Burden of Disease Database
No full textIntroduction: The shoulder joint is a common site for joint dislocation, with many individuals suffering from recurrent dislocations following treatment. The purpose of this study was to evaluate the epidemiology of shoulder dislocations in the United States from 1990 to 2019.
Methods: The Global Burden of Disease database was utilized to collect epidemiological data on shoulder dislocations in the United States (U.S.) from 1990 to 2019. These data included age-standardized rates of years lived with disability (YLDs), prevalence rates, and incidence rates per 100,000 people. Using the U.S. Census Bureau definitions, the data were stratified into four regions: the Northeast, Midwest, South, and West. Bartlett\u27s test was used to assess whether the variance of the dataset was equal. Welch\u27s ANOVA was performed to assess differences in YLDs, prevalence rates, and incidence rates between regions.
Results: From 1990 to 2019, there was an 8.69% decrease in mean YLDs, an 8.69% decrease in prevalence rates, and a 9.14% decrease in mean incidence rates of shoulder dislocations. Women experienced a 0.78% increase in mean YLDs, a 0.77% increase in mean prevalence rates, and a 0.27% increase in mean incidence rates of shoulder dislocation. Men experienced a 15.45% decrease in mean YLDs, a 15.45% decrease in mean prevalence rates, and a 15.82% decrease in mean incidence rate of shoulder dislocations. Regardless of region, men were more likely to experience a higher mean rate of YLDs (1.06 vs. 0.79, p\u3c 0.001), higher mean prevalence rates (17.16 vs. 12.70, p\u3c 0.001), and higher mean incidence rates (115.25 vs. 84.59, p\u3c 0.001) of shoulder dislocations. The West region experienced the highest mean rate of YLDs, the highest mean prevalence rates, and the highest mean incidence rates of shoulder dislocation. The Northeast region experienced the lowest mean rates of YLDs, mean prevalence rates, and mean incidence rates. Men experienced higher mean rates of YLDs, prevalence, and incidence of shoulder dislocations compared to women (p\u3c 0.001).
Conclusion: From 1990 to 2019, the U.S. witnessed a decline in mean YLDs, incidence, and prevalence rates for shoulder dislocations. This trend varied by gender, with men experiencing notable decreases across these metrics, while women saw slight increases. Overall, men consistently had higher rates of shoulder dislocations compared to women. Geographically, the Western region had the highest rates, whereas the Northeast had the lowest
Statewide Initiative to Increase Intracoronary Imaging Optimization in PCI: A Report From the BMC2 Registry
No full textBACKGROUND: This study assessed the temporal trend in intracoronary imaging (ICI)-guided percutaneous coronary intervention (PCI) concurrent with the implementation of a statewide quality improvement initiative to increase ICI use.
METHODS: The Blue Cross Blue Shield of Michigan Cardiovascular Consortium implemented a formal initiative to increase ICI use for PCI optimization in the state of Michigan between 2020 and 2023. The initiative included focused education for physicians, reporting of comparative institution-level ICI use, and tracking of ICI use as a performance metric. The primary measure of interest was the use of ICI to optimize PCI. A hierarchical Bayesian regression model was created to assess the increase in ICI use over time. The year in which a PCI was performed was included as a variable in the model to delineate the impact of time on the odds of ICI use.
RESULTS: Over the 5-year study period, a total of 140,739 PCIs were performed at 48 nonfederal hospitals in Michigan and represented the study population. A progressive and significant increase in ICI use to optimize PCI was observed from 7.3% in the first year to 44.0% in the fifth year of the study (P \u3c .001 for trend). Significant increases in ICI use were observed for all key subgroups including PCI in left main disease (19.3% to 78.5%; P \u3c .001), stent thrombosis (13.6% to 61.4%; P \u3c .001), and in-stent restenosis (8.7% to 50.6%; P \u3c .001). Each 1-year increase in time was associated with a significant increase in ICI use (adjusted odds ratio, 1.98; 95% credible interval, 1.95-2.00).
CONCLUSIONS: Concurrent with a statewide quality improvement initiative, a significant increase in ICI use to optimize PCI was observed among patients undergoing PCI in the state of Michigan
Cardiogenic Shock With Acute Myocardial Infarction Among Older Adults in the United States
No full textBACKGROUND: Characteristics and outcomes associated with cardiogenic shock (CS) with acute myocardial infarction (AMI) in older patients have not been well characterized.
OBJECTIVES: The purpose of this study was to investigate characteristics and outcomes of older patients admitted with CS with AMI.
METHODS: We used the National Inpatient Sample database to evaluate clinical characteristics of hospitalizations, clinical outcomes, and health care utilization of hospitalizations of older patients ≥80 years with CS and AMI from 2003 to 2021. We also compared data from older patients with a reference relatively younger patient population (18-79 years).
RESULTS: During the study period, 207,333 hospitalizations of older patients ≥80 years and 675,491 hospitalizations of patients 18 to 79 years were identified. Between the first 4 years of the study period (2003-2006) and the final 4-year interval of the study period (2016-2019), there was an increase in the number of hospitalizations of older patients with AMI and CS (39,220-51,640). On adjusted analysis, there were increases in the percentage of older patients undergoing treatment with percutaneous coronary intervention (19.2% to 34.1%; P \u3c 0.001) and encounters for palliative care (2.0% to 32.4%; P \u3c 0.001) alongside a decline in in-hospital mortality (61.4% to 49.0%; P \u3c 0.001) over the study period. Compared to patients 18 to 79 years of age, those aged ≥80 years had greater in-hospital mortality (51.8% vs 33.0%; P \u3c 0.001).
CONCLUSIONS: From 2003 to 2021, for older patients with CS and AMI, hospitalizations increased, and mortality decreased
71716 | Leadless Pacemaker Deployment Post-EVOQUE TTVR: Procedural Insights and Early Outcomes
No full textBackground: Conduction block post TTVR with the Evoque valve can be a challenging scenario. Micra™ leadless pacemakers are a valuable pacing option in these patients as they do not involve a lead passing across the freshly implanted valve. The outcomes of patients undergoing Micra implantation post TTVR with the Evoque valve are not well known. Methods: We reviewed patients who developed high-grade AV block after EVOQUE TTVR between February 2024 and February 2025 and underwent Micra implantation. Clinical data, procedural details, technical challenges, and 30-day outcomes were analyzed. Results: Ten patients underwent successful Micra implantation post-EVOQUE. Multiple deployment attempts (up to 5) were often needed due to right heart dilation, valve-related interference, or rotated anatomy (Figure 1). Final device positions included apical and high septal locations. Pacing parameters were acceptable in all cases, though two had borderline thresholds. At 30 days, most patients had trivial or mild tricuspid regurgitation. One device dislodgement required reimplantation, and one patient died within 48 hours post-implant. [Formula presented] Conclusion: Micra implantation after EVOQUE TTVR is feasible but technically challenging. Procedural complexity is driven by anatomic distortion and valve-related barriers, requiring individualized approaches. Despite these challenges, short-term outcomes were generally favorable
Seeing The Change: How CT Enhances Planning And Prediction In Alcohol Septal Ablation
No full textIntroduction: Transcatheter mitral valve implantation is a minimally invasive option for treating mitral valve disease but is limited by the risk of left ventricular outflow tract (LVOT) obstruction, a high-morbidity and high-mortality event. Preprocedural alcohol septal ablation may reduce LVOT obstruction risk, but the myocardial remodeling process is not fully understood. Cardiac computed tomography (CCT) can be utilized to better understand this process. Methods: 10 patients who underwent preemptive alcohol septal ablation for LVOT obstruction risk were evaluated. Baseline and follow-up CCT studies were evaluated. Basal septal dimension, left ventricular (LV) diastolic dimension, and LV volumes were measured using 3D workstations in diastolic and systolic phases. LVOT prediction was performed using a computer aided design virtual valve implantation Boolean subtraction technique. Results: 7 patients were female (70%). Time between ablation and follow-up CCT scan was 38.6±21.6 days. Average volume of intracoronary alcohol administered was 2.0±0.7 mL. Average pre-ETOH septal ablation diastolic septal thickness was 13.3±2.2 mm and post ablation was 10.8±2.0 mm (P=0.0046) and pre-/post systolic septal thickness was 15.2±2.4 mm / 12.0±2.6 mm (P =0.0012); reflecting a reduction of 21.2±14.7%. Pre-/post LV diastolic dimension was 47.6±5.7 mm compared to 50.8±5.0 mm (P=0.0003). Pre-/post LV systolic dimension was 39.0±6.7 mm compared to 44.3±5.4 mm (P=0.003). Pre-/post LV diastolic volume 128.3±20.4 mL compared to 122.1±24.5 mL (P=0.12). Pre-/post LV systolic volume 44.1±18.6 mL compared to 44.7±19.4 mL (P=0.47). Pre-/post predicted LVOT was 109.2±78.4 mm2 compared to 164.6±98.7 mm2 (P=0.047). Conclusions: CCT provides insight into the myocardial remodeling process after alcohol septal ablation and shows a significant decrease in septal thickness and increase in LV linear dimensions. Lack of statistically significant differences in LV volumes are likely related to low sample size and small relative volumes of ablated tissue compared to overall ventricular volumes. Quantification of changes in septal thickness and LV dimensions contributes to better understanding of the post ablation remodeling process. Further study may facilitate improved patient selection via predictive modeling techniques for the virtual simulation of septal ablations. [Formula presented
Randomized comparison of left atrial appendage closure and oral anticoagulation after catheter ablation for atrial fibrillation: subanalysis of AF type
No full textBackground/Introduction: Cardiac ablation is effective at reducing the symptoms associated with arrhythmia. If anticoagulation is ceased postablation, contrary to clinical guidelines, patients are at increased risk of stroke due to the potential for asymptomatic atrial fibrillation (AF). Although left atrial appendage closure (LAAC) is an approved treatment to decrease the risk of thromboembolism from the left atrial appendage, it has not been well-studied following AF ablation. Purpose: OPTION compared the safety and efficacy of LAAC in a contemporary postablation clinical AF patient population at risk of stroke to contemporary oral anticoagulation (OAC). In this prespecified subanalysis, treatment characteristics and outcomes by AF type (paroxysmal and persistent) will be evaluated. Methods: OPTION is a multinational, multicenter, randomized, controlled trial. Catheter ablation patients were eligible if the procedure occurred 90 to 180 days prior to or was scheduled within 10 days of randomization. Patients were randomized 1:1 to ablation+LAAC versus ablation +OAC (95% DOAC) stratified by study site and ablation cohort (sequential or concomitant). The primary safety endpoint was non-procedural bleeding through 36 months based on International Society on Thrombosis and Haemostasis [ISTH] major bleeding or clinically relevant non-major bleeding definitions. The primary efficacy endpoint was the composite of all-cause death, stroke, or systemic embolism at 36 months. The secondary endpoint was ISTH major bleeding through 36 months. Additional endpoints include ablation and LAAC procedural characteristics, arrythmia recurrence, and quality of life. Results: A total of 803 patients were randomized to catheter ablation+LAAC and 797 to ablation+OAC. Overall, patients were 70±8 years old, one-third were women, mean CHA2DS2-VASc score was 3.5±1.3, and mean HAS-BLED was 1.2±0.8. Approximately 60% of patients had paroxysmal AF and 40% had persistent AF in each treatment arm. OPTION met its primary and secondary endpoints. In the subgroup of patients with paroxysmal AF, the primary efficacy endpoint occurred in 3.5% of LAAC and 4.0% OAC patients at 3 years. In patients with persistent AF, the rate was 8.0% in the LAAC and 9.0% in the OAC cohort. The primary safety endpoint occurred at a rate of 8.1% in LAAC and 18.1% in OAC-treated patients with paroxysmal AF. The rates were 8.9% in LAAC and 16.9% in OAC-treated patients with persistent AF. The rate of the secondary endpoint was 2.8% in the LAAC and 4.6% in OAC patients with paroxysmal AF. In patients with persistent AF, this rate was 5.5% in the LAAC and 5.8% in the OAC cohorts. Conclusion(s): In OPTION, among patients undergoing AF ablation, LAAC resulted in significantly less non-procedural bleeding than oral anticoagulation, while preserving similarly low rates of stroke, systemic embolism or death. Outcomes were consistent among patients with paroxysmal and persistent AF
TCT-37 Impact of LVEF on Baseline Characteristics and Outcomes in TTVR Recipients
No full textBackground: Severely reduced left ventricular ejection fraction (LVEF \u3c35%) may influence outcomes in transcatheter tricuspid valve replacement (TTVR), yet data in this population remain limited. Methods: We analyzed 167 patients undergoing TTVR at a single center, stratified by LVEF \u3c35% vs. ≥35%. Baseline characteristics, device success, length of stay (LOS), and 30-day readmission were compared using appropriate statistical tests. Results: Thirteen patients (7.8%) had LVEF \u3c35%. Device success was slightly lower in the reduced EF group (92.3% vs. 97.4%, p = 0.293). Median LOS was similar (8.0 vs. 7.0 days, p = 0.908). Thirty-day readmission was higher in the LVEF \u3c35% group (15.4% vs. 7.1%, p = 0.288), though not significant. Baseline characteristics showed lower BMI (24.1 vs. 27.3, p = 0.045) and higher BNP (1562 vs. 408 pg/mL, p = 0.001) in the reduced EF group. Fewer were female (30.8% vs. 63.6%, p = 0.034). [Formula presented] Conclusion: TTVR in patients with LVEF \u3c35% is feasible, with comparable procedural success and hospital stay. These patients present with distinct clinical profiles, including lower BMI and higher BNP. Further studies are warranted to evaluate long-term outcomes in this high-risk subgroup. Categories: STRUCTURAL: Valvular Disease and Intervention: Tricuspi