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BACKGROUND: High-degree AV block (HDAVB) is a known complication after both transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Data about the contemporary practice pattern of permanent pacing, especially the timing of implantation, for HDAVB after TAVI compared to SAVR are limited. METHODS: Using the National Inpatient Sample database, we identified patients who underwent TAVI or SAVR from 2012 to 2014. We excluded patients with a prior pacemaker and implantable cardioverter defibrillator. The incidence of HDAVB, the rate of permanent pacemaker implantation and its timing were compared between TAVI and SAVR groups. RESULTS: We identified 33,690 and 202,110 patients who underwent TAVI and SAVR, respectively. HDAVB occurred in 3,480 patients (10.3%) in the TAVI group and 11,405 patients (5.6%) in the SAVR group (p

Pharmacodynamic (PD) studies comparing prasugrel and ticagrelor have reached inconsistent findings. Therefore, a comprehensive investigation comparing the PD effects of prasugrel vs. ticagrelor after switching from clopidogrel therapy, exploring both loading dose (LD) and maintenance dose (MD) regimens represented the aim of this study.Patients (n = 110) with coronary artery disease were randomized to prasugrel (60 mg LD/10 mg MD q.d.) or ticagrelor (180 mg LD/90 mg MD b.i.d) therapy for 1 week. Pharmacodynamic assessments were conducted using three assays (vasodilator-stimulated phosphoprotein, VerifyNow P2Y12, and light transmittance aggregometry, LTA) at baseline, 30 min, 2, 24 h, and 1 week. The impact of initiating ticagrelor MD 12 vs. 24 h after LD administration was also assessed. Switching clopidogrel-treated patients to an LD of prasugrel or ticagrelor was associated with a reduction in platelet reactivity at 30 min and was sustained at all time points up to 1 week with the MD (P0.001 for all assays). Platelet reactivity was similar with prasugrel and ticagrelor with all assays at 30 min, 2 h, and 1 week (P0.05 for all time points), with the exception of LTA at 30 min (lower with prasugrel; P = 0.003). At 24 h, platelet reactivity was lower among patients initiating ticagrelor MD after 12 vs. 24 h post-LD. Rates of high platelet reactivity (HPR) were markedly reduced and similar between groups.Prasugrel and ticagrelor exert similar levels of P2Y12 inhibition achieving more potent PD effects and reduced HPR rates compared with clopidogrel which are reached promptly following LD and sustained with MD.NCT01852175.

Objectives: We reviewed data to validate the use of a simplified STEMI Alert Clinical Tool for EMS personnel to use to activate cardiac cath labs for patients presenting with STEMIs. Methods: We retrospectively reviewed all ECGs transmitted by one EMS provider to an urban primary PCI facility from October 2009 to January 2011. We then applied the STEMI Alert Clinical Tool (Table 1) to determine if the patient would have qualified for cath lab activation from the field. A retrospective chart review was performed to determine the outcomes of each transmission within the corresponding time frames. Results: A total of 307 ECGs were transmitted during the selected time frame. A total of 10.7% (33 of 307) met criteria for cath lab activation based on the STEMI alert clinical tool. Of these 63.6% (21 of 33) were true positives and 36.4% (12 of 33) were false positives. The sensitivity of a positive alert was 95.5% (21 of 22) and the specificity was 95.8% (273 of 285). The positive predictive value (PPV) was 63.6% (21 of 33). One STEMI patient was missed by the clinical tool because the ECG did not read ***ACUTE MI***. The negative predictive value (NPV) was 99.6% (273 of 274). Conclusions: The data from this study shows that use of a STEMI Alert Clinical Tool has a relatively low PPV but a very high NPV. Thus, pre-hospital activation of cath labs may not be necessary for patients who fail to meet the STEMI alert criteria. In contrast, despite use of this tool a portion of patients will falsely activate the cath lab. Although this strategy may increase the risks of unnecessary financial and man power utilization to the hospital system, the risk of missing a STEMI can be high. Analyzing a larger patient population will be required to further define the value of using this clinical tool. Table 1 - Clinical Tool - All 7 must be "yes" to activate cath lab

Background: Rapid reperfusion of ST elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) improves outcomes. Systems have been developed in many areas to identify STEMI patients in the field using pre-hospital electrocardiograms (ECGs). The Zoll E-Series (ES) is a defibrillator/monitoring system that utilizes the GE Medical Systems 12SL interpretive algorithm to assist with identification of STEMIs. There is a lack of significant data measuring the accuracy of the Zoll ES and its algorithm, especially in the setting of a large urban population. Methods: We retrospectively looked at 307 consecutive ECGs transmitted by one emergency medical service (EMS) provider to an urban primary PCI facility from October 2009 to January 2011. All transmissions were from Zoll ES monitors. Multiple ECG computer interpretations were screened and filtered out to those labeled ***ACUTE MI***. A retrospective chart review was performed to determine the clinical outcome for each transmission in order to determine the performance of the interpretive algorithm in this population. Results: Overall, 307 ECGs were analyzed. A total of 7% (20 of 307) were confirmed STEMIs (Table 1). The computer reading shows a sensitivity of 95% (20 of 21) and specificity of 94% (268 of 286). There is a positive predictive value (PPV) of 53% (20 of 38). Conclusions: The initial data from this study shows that the Zoll ES has a remarkably high sensitivity of 95% but a poor PPV of 53%. This may be due to multiple confounders that result in STEMI “mimics.” The Zoll ES helps provide a pre-hospital ECG that serves as a powerful and life saving tool in the field. However, due to the low PPV, these findings reinforce that the pre-hospital ECG needs to be combined with an appropriate clinical history and additional human interpretation. Further studies analyzing a larger population of patients should be conducted to further assess the value of using this tool.

Diabetes mellitus (DM) patients have increased thromboxane A2 (TXA2) which activate TX prostanoid receptors (TPR). In DM patients, EV–077, a combined TXA2 synthase inhibitor and TPR antagonist, achieves more effective platelet inhibition compared with aspirin. However, the effects of EV–077 in