Scottish Cardiac Society.

Abstract

Scottish Cardiac Society Post myocardial infarction VSD closure: experience from Edinburgh Royal Infirmary Jack PM Andrews, David Northridge and Miles WH Behan Cardiology Registrar, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK Consultant Cardiologist, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK Abstract Introduction: Post myocardial infarction ventricular septal defect (PMIVSD) is a devastating complication with an in hospital mortality of 42%. Surgical and percutaneous repair are the current treatment options. Here, we describe our experience of post MI VSD repair in the Royal infirmary of Edinburgh from May 2015 to July 2019. Methods: Data was collected from electronic case records. Baseline demographics, mode of presentation, VSD location, size and occluder device type were recorded. Major comorbidity and mortality at one year were recorded where possible. Results: 13 post MI VSD repairs were performed within the timeframe. Mean age at presentation was 70 11 years. 4 were from NHS Lothian, 8 from elsewhere in Scotland and one overseas patient. 7 were female. 8 presented with acute inferior STEMI, 3 anterior STEMI and two without ST elevation on the ECG. VSD location was inferior in 10 and anterior in 3. 9 were initially treated with percutaneous closure, 2 of which went on to have surgical revision. Of the 4 initially repaired surgically, 2 went on to have further percutaneous closure. 10 patients survived to discharge with 3 in hospital deaths (23% in hospital mortality). One year survival was 46% (6/13). Conclusions: In the era of primary PCI, post-infarction VSD is now a rare complication. Our in-hospital mortality rate of 23% suggests that the outlook for these patients may have improved, slightly, compared to historical series. Initial treatment choice between surgical or percutaneous repair requires multi-disciplinary team discussion and is based on clinical stability, operative risk and VSD morphology, and a significant proportion of cases (4 out of 13 in our series) will require both approaches. ReferenceIntroduction: Post myocardial infarction ventricular septal defect (PMIVSD) is a devastating complication with an in hospital mortality of 42%. Surgical and percutaneous repair are the current treatment options. Here, we describe our experience of post MI VSD repair in the Royal infirmary of Edinburgh from May 2015 to July 2019. Methods: Data was collected from electronic case records. Baseline demographics, mode of presentation, VSD location, size and occluder device type were recorded. Major comorbidity and mortality at one year were recorded where possible. Results: 13 post MI VSD repairs were performed within the timeframe. Mean age at presentation was 70 11 years. 4 were from NHS Lothian, 8 from elsewhere in Scotland and one overseas patient. 7 were female. 8 presented with acute inferior STEMI, 3 anterior STEMI and two without ST elevation on the ECG. VSD location was inferior in 10 and anterior in 3. 9 were initially treated with percutaneous closure, 2 of which went on to have surgical revision. Of the 4 initially repaired surgically, 2 went on to have further percutaneous closure. 10 patients survived to discharge with 3 in hospital deaths (23% in hospital mortality). One year survival was 46% (6/13). Conclusions: In the era of primary PCI, post-infarction VSD is now a rare complication. Our in-hospital mortality rate of 23% suggests that the outlook for these patients may have improved, slightly, compared to historical series. Initial treatment choice between surgical or percutaneous repair requires multi-disciplinary team discussion and is based on clinical stability, operative risk and VSD morphology, and a significant proportion of cases (4 out of 13 in our series) will require both approaches. Reference 1. Arnaoutakis GJ, Zhao Y, George TJ, et al. Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg 2012; 94: 436–443. Duration of dual antiplatelet therapy in coronary heart disease: a 60,000-patient meta-analysis of randomised controlled trials Anda Bularga, Mohammed Meah, Dimitrios Doudesis, Anoop SV Shah, Nicholas L Mills, Kuan Ken Lee and David E Newby BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK Abstract Introduction: Dual antiplatelet therapy (DAPT) is the cornerstone of pharmacological treatment for patients w ith acute coronary syndrome (ACS) and in those undergoing percutaneous coronary intervention for stable coronary disease. Despite widespread use, the optimal duration of DAPT remains uncertain. We present an updated metaanalysis comparing outcomes in shortterm DAPT ( 6 months) versus long-term DAPT ( 12 months). Methods: Four major databases were searched for randomised controlled trials of interest. Data were c ollec ted on the primary outcome of all-cause mortality. Secondary safety outcomes included any bleeding and major bleeding. Efficacy outcomes included cardiovascular death, myocardial infarction, stent thrombosis, coronary revascularization and thrombotic stroke. Further subgroup analysis stratified by index presentation and a sensitivity analysis to evaluate shorter duration DAPT restricted to studies comparing 3 months DAPT versus 12 months DAPTwas performed. Results: Nineteen randomised controlled trials were included (n1⁄4 60,879) in the primary analysis of which 8 compared shorter duration DAPT ( 3 months) with Scottish Medical JournalIntroduction: Dual antiplatelet therapy (DAPT) is the cornerstone of pharmacological treatment for patients w ith acute coronary syndrome (ACS) and in those undergoing percutaneous coronary intervention for stable coronary disease. Despite widespread use, the optimal duration of DAPT remains uncertain. We present an updated metaanalysis comparing outcomes in shortterm DAPT ( 6 months) versus long-term DAPT ( 12 months). Methods: Four major databases were searched for randomised controlled trials of interest. Data were c ollec ted on the primary outcome of all-cause mortality. Secondary safety outcomes included any bleeding and major bleeding. Efficacy outcomes included cardiovascular death, myocardial infarction, stent thrombosis, coronary revascularization and thrombotic stroke. Further subgroup analysis stratified by index presentation and a sensitivity analysis to evaluate shorter duration DAPT restricted to studies comparing 3 months DAPT versus 12 months DAPTwas performed. Results: Nineteen randomised controlled trials were included (n1⁄4 60,879) in the primary analysis of which 8 compared shorter duration DAPT ( 3 months) with Scottish Medical Journal 2021, Vol. 66(3) NP15–NP29 ! The Author(s) 2021 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0036933020986069 journals.sagepub.com/home/scm