Dependence on permanent pacemakers inserted after transcatheter aortic valve implantation: predictive factors in a ten-year retrospective analysis: Rates and predictors of pacemaker dependence after TAVI.

AIMS: The requirement for a permanent pacemaker (PPM) is an important sequela after transcatheter aortic valve implantation (TAVI). The aim of this analysis was to identify predictive factors for pacemaker dependence in PPM-insertions post-TAVI. METHODS AND RESULTS: A retrospective analysis of all PPM insertions done between January 2009 and December 2018 (n=1,373) identified 33 patients who received a PPM within one month of TAVI. Thirty-two had completed a PPM check at one year and were included in the final analyses. Of those who had PPM insertions after TAVI, 41% (13/32) were not PPM-dependent at one year. This cohort was predominantly European (94%) and over half were octogenerians (56%). Statistically significant associations with being PPM-dependent at one year include intraoperative PPM dependence (OR 5.714 [95% CI: 1.163-28.070]; p=0.032), third-degree heart block being the indication for PPM insertion (OR 8.533 [95% CI: 1.616-45.063]; p=0.012) and mean valve depth over 6.0 mm (OR 6.222 [95% CI: 1.200-32.273]; p=0.030). CONCLUSIONS: A significant number of patients are not dependent on the PPMs inserted after TAVI. Although small, our study suggests that those who are pacing-dependent intraoperatively, have a third-degree heart block as their PPM indication or have a mean valve depth of over 6.0 mm, are more likely to be pacing-dependent in the long term. Larger studies are required to draw more definitive conclusions.

Characteristics, trends and outcomes in acute coronary syndromes in the renal replacement therapy population: a 10-year retrospective analysis of the Midlands Region, New Zealand.

Acute coronary syndrome (ACS) is one of the leading causes of mortality in the renal replacement therapy (RRT) population. We aimed to understand the characteristics, trends and outcomes of ACS in our local RRT population as a means to improve care and outcomes for this high-risk population. Using the ANZACS-QI database, we conducted a retrospective analysis of all ACS occurring in RRT patients between 1 January 2010-31 December 2019 managed at Waikato Hospital (n=135 at index ACS). In our cohort made up predominantly of Maori (55%) and European (34%) patients, 58% had diabetic nephropathy as their primary disease. Twenty-seven percent presented atypically and 65% had a delay of >72 hours from diagnosis to angiogram. There was a 49% mortality rate at one year post-index ACS. Factors associated with mortality at one year included: atypical presentation (chi-square statistic (X2) 7.250; p=0.0071), troponin delta >20% (X2 5.682; p=0.0171), peak troponin (point biserial correlation; r=0.2086; p=0.0473) and no revascularisation (X2 5.2419; p=0.0221). The findings in our cohort reiterate that patients on RRT are a vulnerable population who have poor outcomes associated with ACS, driven by multifactorial delays in diagnosis and treatment.

Selenium Supplementation and Prostate Health in a New Zealand Cohort.

BACKGROUND: There is variable reporting on the benefits of a 200 µg/d selenium supplementation towards reducing prostate cancer impacts. The current analysis is to understand whether stratified groups receive supplementation benefits on prostate health. METHODS: 572 men were supplemented with 200 µg/d selenium as selinized yeast for six months, and 481 completed the protocol. Selenium and prostate-specific antigen (PSA) levels were measured in serum at pre- and post-supplementation. Changes in selenium and PSA levels subsequent to supplementation were assessed with and without demographic, lifestyle, genetic and dietary stratifications. RESULTS: The post-supplementation selenium (p = 0.002) and the gain in selenium (p < 0.0001) by supplementation were significantly dependent on the baseline selenium level. Overall, there was no significant correlation between changes in PSA and changes in selenium levels by supplementation. However, stratified analyses showed a significant inverse correlation between changes in PSA and changes in selenium in men below the median age (p = 0.048), never-smokers (p = 0.031), men carrying the GPX1 rs1050450 T allele (CT, p = 0.022 and TT, p = 0.011), dietary intakes above the recommended daily intake (RDI) for zinc (p < 0.05), and below the RDI for vitamin B12 (p < 0.001). CONCLUSIONS: The current analysis shows the influence of life factors on prostate health benefits of supplemental selenium.

Beyond PSA: are new prostate cancer biomarkers of potential value to New Zealand doctors?

The widespread introduction of prostate-specific antigen (PSA) screening has enhanced the early detection of prostate cancer within New Zealand. However, uncertainties associated with the test make it difficult to confidently differentiate low-risk patients from those that require a definitive diagnostic biopsy. In consequence, the decisions surrounding prostate cancer treatment become extremely difficult. A number of new tests have become available which might have the potential to complement the current PSA screens. We review a number of the best validated of these which provide data that, although currently not available in clinical practice, some of these might have considerable potential to aid diagnosis, prognosis and therapeutic decisions for men with prostate cancer in New Zealand.