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International audience; BACKGROUND: Patient selection for transcatheter aortic valve implantation (TAVI) remains a major concern. Indeed, despite promising results, it is still unclear which patients are most and least likely to benefit from this procedure. AIMS: To identify predictors of 6-month poor clinical outcomes after TAVI. METHODS: Patients who were discharged from our institution with a transcatheter-implanted aortic valve were followed prospectively. Our population was divided into two groups ('good outcomes' and 'poor outcomes') according to occurrence of primary endpoint (composite of all-cause mortality, all stroke, hospitalizations for valve-related symptoms or worsening heart failure from discharge to 6 months or 6-month New York Heart Association functional class III or IV). Patient characteristics were studied to find predictors of poor outcomes. RESULTS: We included 163 patients (mean age, 79.9 ± 8.8 years; 90 men [55%]; mean logistic EuroSCORE, 18.4 ± 11.4%). The primary endpoint occurred in 49 patients (mean age, 83 ± 5 years; 31 men [63%]). By multivariable analysis, atrial fibrillation (odds ratio [OR] 3.94), systolic pulmonary artery pressure ≥60 mmHg (OR 7.56) and right ventricular dysfunction (OR 3.55) were independent predictors of poor outcomes, whereas baseline aortic regurgitation ≥2/4 (OR 0.07) demonstrated a protective effect. CONCLUSION: Atrial fibrillation, severe baseline pulmonary hypertension and right ventricular dysfunction (i.e. variables suggesting a more evolved aortic stenosis) were predictors of 6-month poor outcomes. Conversely, baseline aortic regurgitation ≥2/4 showed a protective effect, which needs to be confirmed in future studies. Our study highlights the need for a specific 'TAVI risk score', which could lead to better patient selection.

Aim To determine the optimal timing of catheterization in high risk acute coronary syndromes. Methods The randomized ABOARD study showed that in patients with acute coronary syndromes without ST-segment elevation, a “primary PCI” strategy compared with a strategy of intervention deferred to the next working day did not result in a difference in clinical outcome. We performed a new analysis of the ABOARD population which was divided into quartiles of time from randomization to catheterization. Like in the main analysis the primary endpoint was the peak troponin value during hospitalization and the key secondary end point was the composite of death, myocardial infarction, or urgent revascularization at 1 month follow-up. Results The population (n = 352) was divided into four quartile-groups. In the first quartile, catheterization was performed within the first 69 minutes (median: 50 minutes) after randomization, in the second group between 69 and 339 minutes (median: 118 minutes), in the third one between 339 and 1247 min (median: 1048 minutes) and in the last one over 1247 minutes (median 1448 minutes). Patients received intense antiplatelet therapy with a mean 660 mg (±268) loading dose and 111 mg (±40) maintenance dose of clopidogrel while 99% of the PCI patients received abciximab. Low-molecular-weight-heparins were used in 68% of patients and radial approach was predominant (84%).The mean (+/−SD) peak of troponin did not differ between the 4 groups (Q1 = 7.5 ng/mL ± 12.3, Q2 = 9 ng/mL ± 22.5, Q3 = 7 ng/mL ± 12.3, Q4 = 6.4 ng/mL ± 13.5) p = 0.66). The 30-day rate of death, myocardial infarction and urgent revascularization did not differ between the four groups. (Q1 = 20%) (23%), Q2 = 20 (23%) Q3 = 14 (16.1%), Q4 = 20 (22.7) p = 0.61). Rates of major bleeding complications were also similar in the four groups. Conclusion This refined analysis of the ABOARD study confirms the primary analysis of the two groups formed by randomization. Time to catheterization has no impact on clinical outcome when performed swiftly within the first 24 hours of admission.

BackgroundFew data are currently available about patients characteristics and procedural features associated with AKI after TAVI using the new recommended VARC definition.Methods99 patients underwent TAVI (1 procedural death, 78.8% transfemoral, 12.1% trans-apical/aortic and 9.1% subclavian access) between February 2009 and September 2011 at Rennes university hospital. Creatinine level was assessed daily at least up to 72 hours after TAVI. Patients’ characteristics, procedural features and outcomes according to VARC definitions were studied to evaluate determinants and prognostic impact of AKI.ResultsAKI occurred in 22 patients (22.2%). Among them, 5 were AKI 2 (5.1%), 8 were AKI 3 (9.1%) including 4 who needed dialysis (4%). At baseline, compared to no AKI or AKI 1, AKI 2 or 3 patients had a higher prevalence of moderate or severe chronic kidney disease (p=0.046) and ≥ grade 2 mitral regurgitation (p=0.03). During the post TAVI hospitalization, AKI 2 or 3 was associated to a higher rate of death from any cause (p=0.0009), major bleeding, acute heart failure (both p=0.002), infectious complications (p=0.0008) and longer total and ICU hospitalization duration (p=0.0004 and