In patients undergoing transcatheter aortic valve implantation (TAVI), it is unclear whether same-day discharge (SDD) while adopting a device-agnostic approach is a safe strategy compared to non-SDD. We aim to compare TAVI patients who underwent SDD and non-SDD according to a predefined protocol. This is a prospective single-center study of consecutive patients who were scheduled for elective TAVI procedures. The primary endpoint was the composite of death, vascular access–related complications, any bleeding requiring hospitalization, all stroke (or transient ischemic attack), or new permanent pacemaker implantation at 30 days defined according to the Valve Academic Research Consortium 3 criteria. Out of 472 consecutive patients who underwent elective TAVI, 289 patients did not report procedural complications, of whom 60 (21%) were discharged on the same day. The mean age was 81 ± 7 years, with 60% of the cohort being male. There were no significant differences in clinical characteristics among patients according to their in-hospital SDD strategy. Pre-existing left or right bundle branch block was comparable between the 2 groups. The primary endpoint was reported in 2.8% of the entire cohort, with no significant difference between patients who underwent SDD TAVI and those who did not (1.7% vs. 3.1%, respectively, p = 0.56). Patients who had a self-expanding valve had a comparable primary endpoint to those who had a balloon-expandable valve, including readmission for a permanent pacemaker. SDD TAVI is a safe and feasible approach in patients who underwent an elective uneventful procedure, including patients who received self-expanding valves. Future studies are required to support these findings.

Background: Left bundle branch block (LBBB) following trans-catheter aortic valve implantation (TAVI) has been excluded from same-day discharge. Early identification of patients with stable LBBB can help facilitate same-day discharge. We aim to assess the role of 6-hour ECG to determine development of LBBB in patients undergoing TAVI. Methods: This is a prospective single-centre study of patients who have LBBB following elective TAVI procedures. All patients underwent ECGs pre-TAVI, as well as immediately, 6 h, and 24 h post-TAVI. Changes in ECG were compared at 6 and 24 h with the one immediately post TAVI. Results: The study included 115 patients with uncomplicated procedures. The mean age was 81 ± 7 years, with 54% male. A self-expanding valve was used in 67% of patients. Following TAVI, prolongations of PR interval and QRS duration were dynamic and reduced at 6 h. The change in PR interval at 6 and 24 h was comparable [−11 (−20 to 3) vs. −2 (−24 to 16) ms, p = 0.18]. Similarly, there was no statistical difference in the change of QRS duration at 6 and 24 h compared to the ECG immediately post-TAVI [−10 (−40 to −2) vs. −7 (−34 to 0) ms, p = 0.055]. Changes in ECG were also comparable in patients undergoing balloon-expandable and self-expanding valves. Conclusions: The current study supports that 6-hour ECG has the potential to reduce the need for prolonged continuous monitoring post-TAVI. ECG at 6 h can help optimise patient flow and facilitate early discharge. Future studies with larger sample sizes are required to confirm our findings.

Cardiovascular disease is the primary cause of mortality and morbidity in patients with chronic kidney disease (CKD), particularly those with end-stage renal disease (ESRD) undergoing hemodialysis. This paper examines the challenges of managing acute coronary syndrome (ACS) in ESRD patients, focusing on the delicate balance between thrombotic and bleeding risks. The review explores the mechanisms underlying the increased thrombotic risk in ESRD, including elevated platelet aggregation, endothelial dysfunction, and alterations in coagulation factors. Paradoxically, ESRD patients also exhibit higher bleeding tendencies due to platelet dysfunction and other uremia-related factors. The efficacy and safety of various antiplatelet therapies, including aspirin and P2Y12 inhibitors, are evaluated in this population. While potent P2Y12 inhibitors such as ticagrelor and prasugrel have demonstrated potential in reducing ischemic events, they are associated with an increased bleeding risk. The optimal duration of anti-platelet therapy (DAPT) in ESRD patients remains controversial, with studies suggesting potential benefits of prolonged DAPT but also increased bleeding risk. This review underscores the necessity for further research and patient inclusion in clinical trials to establish evidence-based guidelines for tailoring antithrombotic therapy in this high-risk population.

Background: Diabetic patients tend to have complex coronary artery disease (CAD). Understanding their procedural risk may help to guide treatment strategies. SYNTAX and the British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS) have been used to define complex CAD, but their use has not been compared in diabetic patients. Methods: This is a retrospective analysis of prospectively collected data of consecutive patients who underwent complex percutaneous coronary intervention (PCI) and were deemed unsuitable for surgical revascularization. Both SYNTAX and BCIS-JS were calculated by experienced operators who were blinded to patient’s outcome. The primary endpoint was all-cause mortality at 12 months. Results: Of 452 patients included in the study, diabetes was present in 35% patients. There was a modest relationship between BCIS-JS and SYNTAX score (Spearman r = 0.44, p < 0.001) and this relationship was even weaker in patients with diabetes (Spearman r = 0.32, p < 0.001). The primary endpoint was comparable in the non-diabetic group, irrespective of the score system (SYNTAX or BCIS-JS) used to define complex CAD. In contrast, there was a differential prognostic outcome in the diabetic group, whereby the primary endpoint was more frequently reported in diabetic patients with high versus low SYNTAX scores [HR 4.96, 95% CI (1.44–17.03), p = 0.011] but not when BCIS-JS was used. Conclusions: There was a modest relationship between BCIS-JS and SYNTAX score. Unlike BCIS-JS, the SYNTAX score identified those who are at increased risk of death among diabetic patients. Both scoring systems did not effectively differentiate mortality risk in non-diabetic patients. Future research is needed to confirm this study’s findings.

Background: Diabetic patients tend to have complex coronary artery disease (CAD). Understanding their procedural risk may help guiding treatment strategies. Syntax and British Cardiovascular Intervention Society) Jeopardy Score (BCIS-JS) have been used to define complex CAD but not compared in diabetic patients. Methods: This is a retrospective analysis of prospectively collected data of consecutive patients who underwent complex percutaneous coronary intervention (PCI) and were deemed unsuitable for surgical revascularization. Both syntax and BCIS-JS were calculated by experienced operators who were blinded to patient’s outcome. The primary endpoint was all-cause mortality at 12 months. Results: Of 452 patients included in the study, diabetes was present in 35% patients. There was a modest relationship between BCIS-JS and syntax score (Spearman r= 0.44, P< 0.001) and this relationship was even weaker in patients with diabetes (Spearman r= 0.32, P< 0.001). The primary endpoint was comparable in the non-diabetic group irrespective of the used score (syntax or BCIS-JS) to define complex CAD. In contrast, there was a differential prognostic outcome in the diabetic group, whereby the primary endpoint was more frequently reported in diabetic patients with high versus low syntax score [HR 4.96, 95% CI (1.44- 17.03), P= 0.011] but not when BCIS-JS was used. Conclusions: There was a modest relationship between BCIS-JS and syntax score. Unlike, BCIS-JS, syntax score identified patients who are at increased risk of death in diabetic patients. Both scoring system did not effectively differentiate mortality risk in non-diabetic patients. Future research is needed to confirm this study’s findings.

Cardiovascular disease is the primary cause of mortality and morbidity in patients with chronic kidney disease (CKD), particularly those with end stage renal disease (ESRD) undergoing hemodialysis. This paper examines the challenges of managing acute coronary syndrome (ACS) in ESRD patients, focusing on the delicate balance between thrombotic and bleeding risks. The review explores the mechanisms underlying the increased thrombotic risk in ESRD, including elevated platelet aggregation, endothelial dysfunction, and alterations in coagulation factors. Paradoxically, ESRD patients also exhibit higher bleeding tendencies due to platelet dysfunction and other uremia-related factors. The efficacy and safety of various antiplatelet therapies, including aspirin and P2Y12 inhibitors, are evaluated in this population. While potent P2Y12 inhibitors such as ticagrelor and prasugrel have demonstrated potential in reducing ischemic events, they are associated with an increased bleeding risk. The optimal duration of anti-platelet therapy (DAPT)in ESRD patients remains controversial, with studies suggesting potential benefits of prolonged DAPT but also increased bleeding risk. This review underscores the necessity for further research and patient inclusion in clinical trials to establish evidence-based guidelines for tailoring antithrombotic therapy in this high-risk population.