NCDR Study Examines Potential Implications of the PEGASUS-TIMI 54 Trial

New research looking at the use and cost implications of P2Y12 inhibitors found that they are not routinely used in the long-term care of myocardial infarction (MI) patients, and there is a higher cost per ischemic event for ticagrelor vs. clopidogrel, according to a study published April 21 in Open Heart. Steven M. Bradley, MD, FACC, et al., aimed to assess the real-world implications of the PEGASUS-TIMI 54 Trial using patients from the ACC's ACTION Registry as part of ACC's Research to Practice initiative – which identifies impactful cardiovascular research and analyzes its implications for contemporary clinical practice using ACC's NCDR clinical registries. Researchers looked at data between October 2010 and April 2013, and found that 41.1 percent of the 273,328 MI patients identified would have met the eligibility criteria for the trial. Results showed that among the 83,871 eligible patients with pharmacy claims data, only 27.5 percent were on a P2Y12 inhibitor one year post-MI, however usage declined at two and three years post-MI (11.5 percent and 6.3 percent, respectively), with the majority (79.2 percent) of these patients on clopidogrel. Read more.


More TAVR Experience Leads to Better Patient Outcomes

Hospitals where a greater number of transcatheter aortic valve replacement (TAVR) procedures are performed have better patient outcomes, suggesting that concentrating experience in higher volume heart valve centers might be a means of improving outcomes, according to a study published June 26 in the Journal of the American College of Cardiology. John D. Carroll, MD, FACC, et al., examined data from 42,988 procedures conducted at 395 hospitals participating in The Society of Thoracic Surgeons/ACC Transcatheter Valve Therapy (TVT) Registry from 2011 to 2015 to assess in-hospital major adverse events. Increasing site volume was associated with lower in-hospital risk-adjusted outcomes, including mortality (p < 0.02), vascular complications (p < 0.003) and bleeding (p < 0.001), but was not associated with stroke (p = 0.14). From the first case to the 400th case in the volume–outcome model, risk-adjusted adverse outcomes declined, including mortality (3.57 percent to 2.15 percent), bleeding (9.56 percent to 5.08 percent), vascular complications (6.11 percent to 4.20 percent) and stroke (2.03 percent to 1.66 percent). These rates were calculated for the "average" patient who carries the average characteristics of the overall study population. The association between TAVR volume and outcomes was most pronounced in the first 100 cases, indicating that there may be an early learning curve for the procedure. Beyond the initial 100 cases, procedural risk continued to decline but at a more gradual rate.

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