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Introduction:The appropriate strategy for revascularization in patients with coronary artery disease (CAD) and concomitant end-stage renal disease (ESRD) is unknown. The aim of this study was to determine the hospital and patient levels predictors of the type of revascularization strategy pursued in patients hospitalized with non-ST wave elevation myocardial infarction (NSTEMI) and ESRD.Methods:Study cohorts were derived from the Nationwide Inpatient Sample (NIS) 2016-19. Study variables were identified using ICD-10-CM-codes. Patients presenting with cardiogenic shock were excluded. The primary outcomes were the predictors of the type of revascularization strategy pursued. Multivariable logistic regression was used to adjust for potential confounders.Results:There were a total of 87,800 hospitalizations for NSTEMI with comorbid ESRD, out of which 8060 (53%) underwent multi-vessel PCI and 6909 (46%) underwent CABG. Patients undergoing CABG were younger, had a lower proportion of females, and higher burden of comorbidities (including arrhythmias, coagulopathy, valvular heart disease, morbid obesity, and active drug abuse disorder) than those undergoing MvPCI. Multivariate patient-level and hospital-level predictors are demonstrated in Figure 1. As expected, CABG was associated with significantly higher odds of in-hospital mortality (OR:2.01 (1.3-3.1), p<0.01), length of stay (8.9 days longer, p<0.01), and total hospitalization charges (152,527$ higher, p<0.01) as compared to MvPCI. There was no difference in the odds of stroke between both cohorts.Conclusion:Patient-level factors (including female gender, age, comorbidities (arrhythmias, peripheral vascular disease, diabetes, coagulopathy, history of CABG or PCI, prior stroke/TIA), and hospital levels factors (bed size, hospital procedural volume) independently predicted the type of revascularization strategy pursued in patients hospitalized for NSTEMI with ESRD.

Introduction:Approximately 33% of patients undergoing transcatheter aortic valve replacement (TAVR) have an indication for long-term anticoagulation. In clinical routine, anticoagulation is often discontinued 2 to 4 days before TAVR. The purpose of this meta-analysis was to compare the safety and efficacy of TAVR in patients with per-procedural continuation vs interruption of anticoagulation.Methods:An electronic search was performed using PubMed and Ovid Medline from inception to May 2022. The primary outcome of interest was life-threatening or major bleeding. The secondary outcomes were all-cause mortality, stroke, vascular complications, need for blood transfusion, and closure device failure.Results:Three observational studies were included in our final analysis which consisted of 2,286 patients, with anticoagulation being continued in 1,069 patients and interrupted in 1,217 patients. Although, there was no significant difference in our primary outcome of life-threatening or major bleeding between both groups, there was a trend toward decreased risk of bleeding in patients who were continued on anticoagulation (RR: 0.81; CI: 0.65 to 1.0; I2: 0%, p=0.05). There was a significantly lower risk of stroke (RR: 0.55; CI: 0.35 to 0.88; I2: 0%, p=0.01) and need for blood transfusion (RR: 0.72; CI: 0.59 to 0.87; I2: 0%, p<0.01) in patients who were continued on anticoagulation as compared to those in whom anticoagulation was interrupted. There was no significant difference in the all-cause mortality (RR: 0.76; CI: 0.49 to 1.19; I2: 10%, p=0.24), major vascular complications (RR: 0.86; CI: 0.68 to 1.09; I2: 0%, p=0.22), or closure device failure (RR: 0.90; CI: 0.51 to 1.59; I2: 0%, p=0.72) between both the cohorts.Conclusions:In a patient undergoing TAVR who requires long-term anticoagulation, continuing anticoagulation is superior to interrupting anticoagulation in reducing the risk of stroke without any increase in life-threatening or major bleeding.