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Yan JL, Kan WC, Kuo YH, Chen MY, Chen PY, Fu KH. Impact of metabolic syndrome on postoperative outcomes of transsphenoidal pituitary surgery: analysis of U.S. nationwide inpatient sample data 2005-2018. Front Endocrinol (Lausanne) 2024; 15:1235441. [PMID: 38590825 PMCID: PMC10999562 DOI: 10.3389/fendo.2024.1235441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Transsphenoidal surgery (TSS) is the preferred surgical method for most pituitary adenomas owing to high efficacy and low mortality. This study aimed to evaluate the influence of metabolic syndrome (MetS) on postoperative outcomes of TSS for pituitary adenoma. Methods This population-based, retrospective observational study extracted data of adults 20-79 y receiving TSS for pituitary adenoma from the US Nationwide Inpatient Sample (NIS) between 2005-2018. Primary outcomes were pituitary-related complications, poor outcomes (i.e., in-hospital mortality or unfavorable discharge), prolonged length of stay (LOS), and patient safety indicators (PSIs). Univariate and multivariate regressions were performed to determine the associations between study variables and outcomes. Results 19,076 patients (representing a 93,185 US in-patient population) were included, among which 2,109 (11.1%) patients had MetS. After adjustment, pre-existing MetS was not significantly associated with presence of pituitary-related complications and poor outcomes. In contrast, MetS was significantly associated with an increased risk for prolonged LOS (adjusted OR (aOR) = 1.19; 95% CI: 1.05-1.34), PSIs (aOR = 1.31; 95% CI: 1.07-1.59) and greater hospital costs (adjusted β = 8.63 thousand USD; 95% CI: 4.98-12.29). Among pituitary-related complications, MetS was independently associated with increased risk of cerebrospinal fluid (CSF) rhinorrhea (aOR = 1.22, 95% CI: 1.01, 1.47) but lowered diabetes insipidus (aOR = 0.83, 95% CI: 0.71, 0.97). Discussion MetS does not pose excessive risk of in-hospital mortality or unfavorable discharge. However, MetS independently predicted having PSIs, prolonged LOS, greater hospital costs, and CSF rhinorrhea. Study findings may help clinicians achieve better risk stratification before TSS.
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Affiliation(s)
- Jiun-Lin Yan
- Department of Neurosurgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Chin Kan
- Department of Radiology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yi-Hsien Kuo
- Department of Neurosurgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Mao-Yu Chen
- Department of Neurosurgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Pin-Yuan Chen
- Department of Neurosurgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Hao Fu
- Department of Neurosurgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
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Karaca G, Ekmekci A, Kimiaei A, Safaei S, Özer N, Tayyareci G. The Impact of the Neutrophil-to-Lymphocyte Ratio on In-Hospital Outcomes in Patients With Acute ST-Segment Elevation Myocardial Infarction. Cureus 2024; 16:e54418. [PMID: 38375058 PMCID: PMC10874904 DOI: 10.7759/cureus.54418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction The neutrophil-to-lymphocyte ratio (NLR) is a significant predictor of cardiovascular diseases, influencing their progression and prognosis. The exact role of the NLR in acute ST-segment elevation myocardial infarction (STEMI) is unclear. We investigated the possible association between peak NLR values within the first three days after STEMI onset and in-hospital outcomes in patients undergoing primary percutaneous coronary intervention (PCI). Methods This retrospective study included 641 patients who were diagnosed with acute STEMI and treated with primary PCI for 18 months at Dr. Siyami Ersek Hospital. The NLR was calculated using the maximum values obtained during the first three days after admission. The patients were divided into quartiles according to their NLR values for further analysis of potential complications during and after hospitalization, up to a follow-up period of three months. Results Significant differences were found in factors such as age, body mass index (BMI), and length of hospital stay among these groups. Specifically, we found that in-hospital mortality rates were significantly higher in the Q4 group, and there were variations in target vessel revascularization (TVR) rates, major adverse cardiac events (MACE) rates, and other clinical outcomes. Some parameters, such as reinfarction rates and certain procedural outcomes, did not show significant differences among the groups. However, despite the differences, most of the patients achieved successful outcomes after PCI, with the best results in the low NLR group and the worst results in the high NLR group. Conclusion Higher NLR values were associated with a higher risk of unfavorable outcomes during hospitalization.
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Affiliation(s)
| | | | - Ali Kimiaei
- Cardiology, Bahçeşehir University, Istanbul, TUR
| | | | - Nihat Özer
- Cardiology, Okan University, Istanbul, TUR
| | - Gülşah Tayyareci
- Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educational Research Hospital, Istanbul, TUR
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Bendetson JG, Baffoe-Bonnie AW. Type 2 Diabetes Status, Diabetes Complication Severity Index Scores, and Their Relationship With COVID-19 Severity: A Retrospective Cohort Study of Hospitalized Patients in a Southwest Virginia Health System. Cureus 2024; 16:e53524. [PMID: 38445145 PMCID: PMC10912820 DOI: 10.7759/cureus.53524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/07/2024] Open
Abstract
Background Studies have shown that patients with type 2 diabetes mellitus (T2DM) tend to have poorer outcomes associated with COVID-19, including increased rates of hospitalization, ICU admission, need for ventilatory support, and mortality. Methods We performed a retrospective cohort study that included all non-pregnant adult patients who were hospitalized as a result of COVID-19 in a Southwest Virginia health system between March 18, 2020, and August 31, 2022. T2DM status was treated as a binary variable. T2DM severity was assessed using the Diabetes Complications Severity Index (DCSI). Multivariate logistic regression was used to assess the relationship between T2DM status and COVID-19 severity outcomes. Multivariate logistic regression was also used to assess the relationship between DCSI score and COVID-19 severity outcomes among patients with an established diagnosis of T2DM at the time of COVID-19 hospital admission. Results Patients with T2DM had 1.27 times the odds of experiencing a poor COVID-19 clinical outcome (95% CI: 1.13, 1.43) and 1.35 times the odds of in-hospital mortality (95% CI: 1.14, 1.59) compared to patients without diabetes. Among patients with T2DM, increasing DCSI score was significantly associated with increased odds of experiencing a poor COVID-19 clinical outcome and in-hospital mortality. Conclusions Diabetic patients in our sample were at increased odds of experiencing poor COVID-19 clinical outcomes and in-hospital mortality compared to individuals without diabetes. Amongst patients with T2DM, increasing DCSI score was associated with worse COVID-19 outcomes. Clinical decision support tools may be able to utilize DCSI scores as an indicator of COVID-19 severity risk to facilitate decisions regarding treatment aggressiveness and resource allocation.
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Affiliation(s)
- Jesse G Bendetson
- Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Anthony W Baffoe-Bonnie
- Section of Infectious Diseases, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
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Garg M, Gupta M, Patel NN, Bansal K, Lam PH, Sheikh FH. Predictors and Outcomes of Sudden Cardiac Arrest in Heart Failure With Preserved Ejection Fraction: A Nationwide Inpatient Sample Analysis. Am J Cardiol 2023; 206:277-284. [PMID: 37725853 DOI: 10.1016/j.amjcard.2023.08.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023]
Abstract
Sudden cardiac arrest (SCA) is the leading cause of cardiovascular mortality in heart failure with preserved ejection fraction (HFpEF), contributing to around 25% of deaths observed in pivotal HFpEF trials. However, predictors and outcomes of in-hospital SCA in HFpEF have not been well characterized. We queried the Nationwide Inpatient Sample (2016 to 2017) to identify adult hospitalizations with a diagnosis of HFpEF. Patients with acute or chronic conditions associated with SCA (e.g., acute myocardial infarction, acute pulmonary embolism, sarcoidosis) were excluded. We ascertained whether SCA occurred during these hospitalizations, identified predictors of SCA using multivariate logistic regression, and determined outcomes of SCA in HFpEF. Of 2,909,134 hospitalizations, SCA occurred in 1.48% (43,105). The mean age of the SCA group was 72.3 ± 12.4 years, 55.8% were women, and 66.4% were White. Presence of third-degree atrioventricular block (odds ratio [OR] 5.95, 95% confidence interval [CI] 5.31 to 6.67), left bundle branch block (OR 1.96, 95% CI 1.72 to 2.25), and liver disease (OR 1.87, 95% CI 1.73 to 2.02) were the leading predictors of SCA in HFpEF. After excluding patients with do-not-resuscitate status, the SCA group versus those without SCA had higher mortality (25.9% vs 1.6%), major bleeding complications (4.1% vs 1.7%), increased use of percutaneous coronary intervention (2.5% vs 0.7%), and mechanical circulatory assist device (1.2% vs 0.1%). These observational inpatient data suggest identifiable risk factors for SCA in HFpEF including cardiac arrhythmias. Further research is warranted to identify the best tools to risk-stratify patients with HFpEF to implement targeted SCA prevention strategies.
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Affiliation(s)
- Mohil Garg
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Mohak Gupta
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Neel N Patel
- Department of Internal Medicine, New York Medical College, Landmark Medical Center, Woonsocket, Rhode Island
| | - Kannu Bansal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Phillip H Lam
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Farooq H Sheikh
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, District of Columbia.
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Di Marco M, Miano N, Marchisello S, Coppolino G, L’Episcopo G, Scilletta S, Spichetti C, Torre S, Scicali R, Zanoli L, Gaudio A, Castellino P, Piro S, Purrello F, Di Pino A. Indirect Effects of the COVID-19 Pandemic on In-Hospital Outcomes among Internal Medicine Departments: A Double-Center Retrospective Study. J Clin Med 2023; 12:5304. [PMID: 37629346 PMCID: PMC10455112 DOI: 10.3390/jcm12165304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/27/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
The coronavirus disease 19 (COVID-19) emergency led to rearrangements of healthcare systems with a significant impact on those internal medicine departments that had not been converted to COVID-19 wards. A reduced number of departments, indeed, had to cope with the same number of patients along with a lack of management of patients' chronic diseases. We conducted a retrospective study aimed at examiningthe consequences of the COVID-19 pandemic on internal medicine departments that were not directly managing COVID-19 patients. Data from 619 patients were collected: 247 subjects hospitalized in 2019 (pre-COVID-19 era), 178 in 2020 (COVID-19 outbreak era) and 194 in 2021 (COVID-19 ongoing era). We found that in 2020 in-hospital mortality was significantly higher than in 2019 (17.4% vs. 5.3%, p = 0.009) as well as length of in-hospital stay (LOS) (12.7 ± 6.8 vs. 11 ± 6.2, p = 0.04). Finally, we performed a logistic regression analysis of the major determinants of mortality in the entire study population, which highlighted an association between mortality, being bedridden (β = 1.4, p = 0.004), respiratory failure (β = 1.5, p = 0.001), glomerular filtration rate (β = -0.16, p = 0.03) and hospitalization in the COVID-19 outbreak era (β = 1.6, p = 0.005). Our study highlights how the COVID-19 epidemic may have caused an increase in mortality and LOS even in patients not directly suffering from this infection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonino Di Pino
- Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (M.D.M.); (N.M.); (S.M.); (G.C.); (G.L.); (S.S.); (C.S.); (S.T.); (R.S.); (L.Z.); (A.G.); (P.C.); (S.P.); (F.P.)
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Taha A, Badu I, Sandhyavenu H, Victor V, Duhan S, Atti L, Qureshi HM, Goni TS, Keisham B, Sandhya Venu V, Thyagaturu H, Gonuguntla K, Ullah W, Deshwal H, Balla S. Contemporary outcomes of long-term anticoagulation in COVID-19 patients: a regression matched sensitivity analysis of the national inpatient sample. Expert Rev Cardiovasc Ther 2023; 21:601-608. [PMID: 37409406 DOI: 10.1080/14779072.2023.2234282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/05/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The role of oral anticoagulation during the COVID-19 pandemic has been debated widely. We studied the clinical outcomes of COVID-19 hospitalizations in patients who were on long-term anticoagulation. RESEARCH DESIGN AND METHODS The Nationwide Inpatient Sample (NIS) database from 2020 was queried to identify COVID-19 patients with and without long-term anticoagulation. Multivariate regression analysis was used to calculate the adjusted odds ratio (aOR) of in-hospital outcomes. RESULTS Of 1,060,925 primary COVID-19 hospitalizations, 102,560 (9.6%) were on long-term anticoagulation. On adjusted analysis, COVID-19 patients on anticoagulation had significantly lower odds of in-hospital mortality (aOR 0.61, 95% CI 0.58-0.64, P < 0.001), acute myocardial infarction (aOR 0.72, 95% CI 0.63-0.83, P < 0.001), stroke (aOR 0.79, 95% CI 0.66-0.95, P < 0.013), ICU admissions, (aOR 0.53, 95% CI 0.49-0.57, P < 0.001) and higher odds of acute pulmonary embolism (aOR 1.47, 95% CI 1.34-1.61, P < 0.001), acute deep vein thrombosis (aOR 1.17, 95% CI 1.05-1.31, P = 0.005) compared to COVID-19 patients who were not on anticoagulation. CONCLUSIONS Compared to COVID-19 patients not on long-term anticoagulation, we observed lower in-hospital mortality, stroke and acute myocardial infarction in COVID-19 patients on long-term anticoagulation. Prospective studies are needed for optimal anticoagulation strategies in hospitalized patients.
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Affiliation(s)
- Amro Taha
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | - Irisha Badu
- Department of Internal Medicine, Onslow Memorial Hospital, Jacksonville, NC, USA
| | | | - Varun Victor
- Department of Internal Medicine, Canton Medical Education Foundation, Canton, Ohio, USA
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Lalitsiri Atti
- Department of Internal Medicine, Sparrow Hospital- Michigan State University, Lansing, MI, USA
| | | | | | - Bijeta Keisham
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Vasantha Sandhya Venu
- Department of Computer Science and Engineering, Vardhaman College of Engineering, Hyderabad, India
| | | | | | - Waqas Ullah
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Himanshu Deshwal
- Department of Medicine, Section of Pulmonary, Critical Care & Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Sudarshan Balla
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
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Miano N, Di Marco M, Alaimo S, Coppolino G, L'Episcopo G, Leggio S, Scicali R, Piro S, Purrello F, Di Pino A. Controlling Nutritional Status (CONUT) Score as a Potential Prognostic Indicator of In-Hospital Mortality, Sepsis and Length of Stay in an Internal Medicine Department. Nutrients 2023; 15:nu15071554. [PMID: 37049392 PMCID: PMC10096657 DOI: 10.3390/nu15071554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
The controlling nutritional status (CONUT) score represents poor nutritional status and has been identified as an indicator of adverse outcomes. Our aim was to evaluate the prognostic role of the CONUT score on in-hospital outcomes in an Internal Medicine Department. This is a retrospective study analyzing data from 369 patients, divided into four groups based on the CONUT score: normal (0-1), mild-high (2-4), moderate-high (5-8), and marked high (9-12). In-hospital all-cause mortality increased from normal to marked high CONUT score group (2.2% vs. 3.6% vs. 13.4% vs. 15.3%, p < 0.009). Furthermore, a higher CONUT score was linked to a longer length of hospital stay (LOS) (9.48 ± 6.22 vs. 11.09 ± 7.11 vs. 12.45 ± 7.88 vs. 13.10 ± 8.12, p < 0.013) and an increased prevalence of sepsis. The excess risk of a high CONUT score relative to a low CONUT score remained significant after adjusting for confounders (all-cause mortality: OR: 3.3, 95% CI: 1.1-9.7, p < 0.02; sepsis: OR: 2.7, 95% CI: 1.5-4.9, p < 0.01; LOS: OR: 2.1, 95% CI: 1.2-3.9, p < 0.007). The present study demonstrated that an increased CONUT score is related to a higher risk of short-term in-hospital death and complications.
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Affiliation(s)
- Nicoletta Miano
- Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy
| | - Maurizio Di Marco
- Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy
| | - Salvatore Alaimo
- Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy
| | - Giuseppe Coppolino
- Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy
| | - Giuseppe L'Episcopo
- Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy
| | - Stefano Leggio
- Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy
| | - Roberto Scicali
- Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy
| | - Salvatore Piro
- Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy
| | - Antonino Di Pino
- Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy
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Gu HQ, Wang CJ, Zhang XM, Jiang Y, Li H, Meng X, Yang X, Liu LP, Zhao XQ, Wang YL, Wang YJ, Li ZX. Ten-year trends in sex differences in cardiovascular risk factors, in-hospital management, and outcomes of ischemic stroke in China: Analyses of a nationwide serial cross-sectional survey from 2005 to 2015. Int J Stroke 2023:17474930231158226. [PMID: 36752578 DOI: 10.1177/17474930231158226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Women with stroke differ from men in terms of risk factors, treatment, and outcomes. However, previous inconsistent results in China hampered the development of tailored sex-specific strategies for ischemic stroke management. We performed a nationwide serial cross-sectional survey to obtain national-level estimates to assess the 10-year trends in sex differences in cardiovascular risk factors, in-hospital management, and outcomes in China from 2005 to 2015. METHODS We used a two-stage random sampling design, economic-geographical region-stratified random sampling for hospitals first and then systematic sampling for patients, to obtain a nationally representative sample of ischemic strokes in China in 2005, 2010, and 2015. We extracted data on clinical characteristics, management measures (diagnostic tests, interventions, and secondary prevention treatments), in-hospital outcomes (all-cause in-hospital mortality, discharge against medical advice [DAMA], and a composite outcome of in-hospital death and DAMA), and comorbidities. We applied weights proportional to the inverse sampling fraction of hospitals within each stratum and the inverse sampling fraction of patients within each hospital. RESULTS A total of 26,900 ischemic stroke admissions were analyzed. Compared to men, women had a much lower prevalence of current smokers and a slightly higher prevalence of hypertension, diabetes, dyslipidemia, and atrial fibrillation at admission. Prevalence differences between sex in these cardiovascular risk factors were stable except for atrial fibrillation (decreased from 3.7% [95% CI: 1.8% to 5.7%] to 1.3% [95% CI: 0.5% to 2.0%]) and current smoker (increased from -18.0 [95% CI: -20.2% to -15.9%] to -25.6% [95% CI: -26.6% to -24.6%]). From 2005 to 2015, in-hospital management and outcomes were improved both for women and men, and sex differences in cerebrovascular assessment, cervical vessels assessment, and transthoracic echocardiography/transesophageal echocardiography were improved as well. However, women increased more slowly than men in the administration of clopidogrel (from 0.3% [95% CI: -0.9% to 1.4%) to -7.3% [95% CI: -8.7% to -6.0%]) and aspirin plus clopidogrel (0.3% [95% CI: -5.0% to 1.1%] to -5.0% [95% CI: -6.2% to -3.9%]). CONCLUSION Compared to men, women patients with ischemic stroke had a steadily higher prevalence of cardiovascular risk factors, a slower increase rate in the administration of key secondary prevention drugs, and comparable in-hospital outcomes. More effort should be paid to the treatment and control of cardiovascular risk factors and also to the prescription of antiplatelets at discharge for women.
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Affiliation(s)
- Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin-Miao Zhang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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9
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Oettinger V, Hilgendorf I, Wolf D, Stachon P, Heidenreich A, Zehender M, Westermann D, Kaier K, von zur Mühlen C. Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in Germany. Front Cardiovasc Med 2023; 10:1091983. [PMID: 37200971 PMCID: PMC10187752 DOI: 10.3389/fcvm.2023.1091983] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/17/2023] [Indexed: 05/20/2023] Open
Abstract
Background In pure aortic regurgitation, transcatheter aortic valve replacement (TAVR) is not yet used on a regular base. Due to constant development of TAVR, it is necessary to analyze current data. Methods By use of health records, we analyzed all isolated TAVR or surgical aortic valve replacements (SAVR) for pure aortic regurgitation between 2018 and 2020 in Germany. Results 4,861 procedures-4,025 SAVR and 836 TAVR-for aortic regurgitation were identified. Patients treated with TAVR were older, showed a higher logistic EuroSCORE, and had more pre-existing diseases. While results indicate a slightly higher unadjusted in-hospital mortality for transapical TAVR (6.00%) vs. SAVR (5.71%), transfemoral TAVR showed better outcomes, with self-expanding compared to balloon-expandable transfemoral TAVR having significantly lower in-hospital mortality (2.41% vs. 5.17%; p = 0.039). After risk adjustment, balloon-expandable as well as self-expanding transfemoral TAVR were associated with a significantly lower mortality vs. SAVR (balloon-expandable: risk adjusted OR = 0.50 [95% CI 0.27; 0.94], p = 0.031; self-expanding: OR = 0.20 [0.10; 0.41], p < 0.001). Furthermore, the observed in-hospital outcomes of stroke, major bleeding, delirium, and mechanical ventilation >48 h were significantly in favor of TAVR. In addition, TAVR showed a significantly shorter length of hospital stay compared to SAVR (transapical: risk adjusted Coefficient = -4.75d [-7.05d; -2.46d], p < 0.001; balloon-expandable: Coefficient = -6.88d [-9.06d; -4.69d], p < 0.001; self-expanding: Coefficient = -7.22 [-8.95; -5.49], p < 0.001). Conclusions TAVR is a viable alternative to SAVR in the treatment of pure aortic regurgitation for selected patients, showing overall low in-hospital mortality and complication rates, especially with regard to self-expanding transfemoral TAVR.
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Affiliation(s)
- Vera Oettinger
- Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Correspondence: Vera Oettinger
| | - Ingo Hilgendorf
- Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dennis Wolf
- Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Adrian Heidenreich
- Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Manfred Zehender
- Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center—University of Freiburg, Freiburg, Germany
| | - Constantin von zur Mühlen
- Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Hu D, Hao Y, Liu J, Yang N, Yang Y, Sun Z, Zhao D, Liu J. Inter-hospital transfer in patients with acute myocardial infarction in China: Findings from the improving care for cardiovascular disease in China-acute coronary syndrome project. Front Cardiovasc Med 2022; 9:1064690. [PMID: 36568538 PMCID: PMC9773877 DOI: 10.3389/fcvm.2022.1064690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
Background Little is known about the current scenario of inter-hospital transfer for patients with acute myocardial infarction (AMI) in China. Methods From November 2014 to December 2019, 94,623 AMI patients were enrolled from 241 hospitals in 30 provinces in China. We analyzed the pattern of inter-hospital transfer, and compared in-hospital treatments and outcomes between transferred patients and directly admitted patients. Results Of these patients, 40,970 (43.3%) were transferred from hospitals that did not provide percutaneous coronary intervention (PCI). The proportion of patients who were transferred from non-PCI hospital was 46.3% and 11.9% (P < 0.001) in tertiary hospitals and secondary hospitals, respectively; 56.2% and 37.3% (P < 0.001) in hospitals locating in low-economic regions and affluent areas, respectively. Compared with directly admitted patients, transferred patients had lower rates of reperfusion for STEMI (57.8% vs. 65.2%, P < 0.001) and timely PCI for NSTEMI (34.7%vs. 41.1%, P < 0.001). The delay for STEMI patients were long, with 6.5h vs. 4.5h from symptom onset to PCI for transferred and directly admitted patients, respectively. The median time-point was 9 days for in-hospital outcomes. Compared with direct admission, the hazard ratios and 95% confidence intervals associated with inter-hospital transfer were 0.87 (0.75-1.01) and 0.87 (0.73-1.03) for major adverse cardiovascular events and total mortality, respectively, in inverse probability of treatment weighting models in patients with STEMI, and 1.02 (0.71-1.48) and 0.98 (0.70-1.35), respectively, in patients with NSTEMI. Conclusion More than 40% of the hospitalized AMI patients were transferred from non-PCI-capable hospitals in China. Further strategies are needed to enhance the capability of revascularization and reduce the inequality in management of AMI.
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Huang L, Shi Y, Wang L, Rong L, Ren Y, Xu C, Wu J, Zhang M, Zhu L, Zhang J, Xu X, Hu W, Zhang J. Characteristics and in-hospital outcomes of elderly patients with cancer in a top-ranked hospital in China, 2016-2020: Real-world study. Cancer Med 2022; 12:2885-2905. [PMID: 36164280 PMCID: PMC9939123 DOI: 10.1002/cam4.5203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/08/2022] [Accepted: 08/23/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Cancer is mostly a disease of aging, and older patients with cancer are generally frailer. This study aimed to describe the characteristics and in-hospital outcomes and explore factors associated with duration, cost, and mortality during first hospitalization, in older patients with cancer admitted to a top-ranked hospital in China. METHODS Data on patients with solid cancer ≥65 years consecutively hospitalized in 2016-2020 were retrieved from the electronic medical records of Ruijin Hospital in Shanghai, China. Baseline characteristics, duration, cost, and mortality during hospitalization were described. Factors associated with duration, cost, and mortality during first hospitalization were explored using multivariable-adjusted logistic regression. RESULTS 20,650 eligible patients with male proportion of 59% and median age of 70 years were analyzed. 45% of the patients underwent resection in our hospital. Upon first admission, 49% of patients had hypertension, 19% diabetes, 22% weight loss, and 28% risks of malnutrition. The median duration and cost of first hospitalization were 9 days and 32,000 RMB, respectively. 118 (0.6%) and 228 (1.1%) deaths occurred during first and any hospitalization, respectively. For first hospitalization, longer duration and higher cost were positively associated with older ages, male gender, emergency admission, certain tumor locations and histology, histories of diabetes, cirrhosis, and anticoagulant intake, higher body mass index, weight loss, reduced food intake, risk of falling, and worse self-care ability; in-hospital mortality was positively associated with age ≥85 years, emergency admission, certain cancer types, histories of hypertension and psychotropic intake, reduced food intake, and worse self-care ability. CONCLUSIONS This study identified certain baseline patient and tumor characteristics, medical and medication histories, changes of weight and food intake, diet, and self-care ability which were independently associated with in-hospital outcomes among older patients with cancer admitted to our hospital and which should be paid special attention to. While the factors might not be easily modifiable, our study can help identify patients at higher risks of inferior in-hospital outcomes.
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Affiliation(s)
- Lei Huang
- Department of OncologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina,Medical Center on Aging of Ruijin Hospital, MCARJH, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Yan Shi
- Department of OncologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Lei Wang
- Medical Center on Aging of Ruijin Hospital, MCARJH, Shanghai Jiaotong University School of MedicineShanghaiChina,Department of GastroenterologyRuijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiPeople's Republic of China
| | - Lan Rong
- Department of GeriatricsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yan Ren
- Medical Center on Aging of Ruijin Hospital, MCARJH, Shanghai Jiaotong University School of MedicineShanghaiChina,Department of GeriatricsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Chenying Xu
- Medical Center on Aging of Ruijin Hospital, MCARJH, Shanghai Jiaotong University School of MedicineShanghaiChina,Department of GeriatricsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Junwei Wu
- Department of OncologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mingmin Zhang
- Computer Center, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Lifeng Zhu
- Computer Center, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
| | | | - Xiaofeng Xu
- Shanghai Chief Technician Studio (Information & Technology)ShanghaiChina
| | - Weiguo Hu
- Medical Center on Aging of Ruijin Hospital, MCARJH, Shanghai Jiaotong University School of MedicineShanghaiChina,Department of GeriatricsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina,Department of SurgeryRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jun Zhang
- Department of OncologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina,State Key Laboratory of Oncogenes and Related GenesShanghai Jiao Tong UniversityShanghaiChina
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Lanza O, Cosentino N, Lucci C, Resta M, Rubino M, Milazzo V, De Metrio M, Trombara F, Campodonico J, Werba JP, Bonomi A, Marenzi G. Impact of Prior Statin Therapy on In-Hospital Outcome of STEMI Patients Treated with Primary Percutaneous Coronary Intervention. J Clin Med 2022; 11. [PMID: 36142948 DOI: 10.3390/jcm11185298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Prior statin therapy has a cardioprotective effect in patients undergoing elective or urgent percutaneous coronary intervention (PCI). However, data on patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI are still controversial. We retrospectively evaluated the effect of prior statin therapy on in-hospital clinical outcomes in consecutive STEMI patients undergoing primary PCI. Methods: A total of 1790 patients (mean age 67 ± 11 years, 1354 men) were included. At admission, all patients were interrogated about prior (>6 months) statin therapy. The primary endpoint of the study was the composite of in-hospital mortality, acute pulmonary edema, and cardiogenic shock in patients with or without prior statin therapy. Results: A total of 427 patients (24%) were on prior statin therapy. The incidence of the primary endpoint was similar in patients with or without prior statin therapy (15% vs. 16%; p = 0.38). However, at multivariate analysis, prior statin therapy was associated with a lower risk of the primary endpoint, after adjustment for major prognostic predictors (odds ratio 0.61 [95% CI 0.39−0.96]; p = 0.03). Conclusions: This study demonstrated that prior statin therapy is associated with a better in-hospital clinical outcome in patients with STEMI undergoing primary PCI compared to those without prior statin therapy.
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Gregoriano C, Voelkle M, Koch D, Hauser SI, Kutz A, Mueller B, Schuetz P. Association of Different Malnutrition Parameters and Clinical Outcomes among COVID-19 Patients: An Observational Study. Nutrients 2022; 14. [PMID: 36014955 DOI: 10.3390/nu14163449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 01/03/2023] Open
Abstract
Background: Malnutrition is highly prevalent in medical inpatients and may also negatively influence clinical outcomes of patients hospitalized with COVID-19. We analyzed the prognostic implication of different malnutrition parameters with respect to adverse clinical outcomes in patients hospitalized with COVID-19. Methods: In this observational study, consecutively hospitalized adult patients with confirmed COVID-19 at the Cantonal Hospital Aarau (Switzerland) were included between February and December 2020. The association between Nutritional Risk Screening 2002 (NRS 2002) on admission, body mass index, and admission albumin levels with in-hospital mortality and secondary endpoints was studied by using multivariable regression analyses. Results: Our analysis included 305 patients (median age of 66 years, 66.6% male) with a median NRS 2002-score of 2.0 (IQR 1.0, 3.0) points. Overall, 44 patients (14.4%) died during hospitalization. A step-wise increase in mortality risk with a higher nutritional risk was observed. When compared to patients with no risk for malnutrition (NRS 2002 < 3 points), patients with a moderate (NRS 2002 3−4 points) or high risk for malnutrition (NRS 2002 ≥ 5 points) had a two-fold and five-fold increase in risk, respectively (10.5% vs. 22.7% vs. 50.0%, p < 0.001). The increased risk for mortality was also confirmed in a regression analysis adjusted for gender, age, and comorbidities (odds ratio for high risk for malnutrition 4.68, 95% CI 1.18 to 18.64, p = 0.029 compared to patients with no risk for malnutrition). Conclusions: In patients with COVID-19, the risk for malnutrition was a risk factor for in-hospital mortality. Future studies should investigate the role of nutritional treatment in this patient population.
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Li H, Chen S, Wang S, Yang S, Cao W, Liu S, Song Y, Li X, Li Z, Li R, Liu X, Wang C, Chen Y, Xie F, He Y, Liu M. Elevated D-dimer and Adverse In-hospital Outcomes in COVID-19 Patients and Synergism with Hyperglycemia. Infect Drug Resist 2022; 15:3683-3691. [PMID: 35855759 PMCID: PMC9288185 DOI: 10.2147/idr.s367012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/08/2022] [Indexed: 01/20/2023] Open
Abstract
Aim One of the most common laboratory findings in COVID-19 patients has been observed to be hypercoagulability with elevated D-dimer levels. An activation of thrombosis may be generated by hyperglycemia. We aimed to explore the association between D-dimer and in-hospital outcomes, and evaluate the synergistic effect between elevated D-dimer and hyperglycemia on COVID-19 prognosis. Methods A retrospective cohort study was undertaken with 2467 COVID-19 inpatients. D-dimer and fasting blood glucose (FBG) on admission and adverse in-hospital outcomes (events of death and aggravated severity) were collected. Cox proportional risk model was performed to assess the association of D-dimer and adverse in-hospital outcomes, and the combined effects of D-dimer and FBG. Results Among these COVID-19 patients, 1100 (44.6%) patients had high D-dimer (≥0.50 mg/L). Patients with high D-dimer were older, with higher FBG (≥7.00 mmol/L), and had significantly higher adjusted risk of adverse in-hospital outcomes when comparing with those who with D-dimer<0.50 mg/L (hazard ratio, 2.73; 95% confidence interval, 1.46–5.11). Moreover, patients with high FBG and D-dimer levels had an increasing risk (hazard ratio, 5.72; 95% confidence interval: 2.65–12.34) than those with normal FBG and D-dimer. Conclusion Risk of adverse in-hospital outcomes is higher among patients with high D-dimer levels. Additionally, this study found for the first time that elevated D-dimer and hyperglycemia had a synergistic effect on COVID-19 prognosis, and this risk was independent of diabetes history.
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Affiliation(s)
- Haowei Li
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Shimin Chen
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Shengshu Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Shanshan Yang
- Department of Disease Prevention and Control, The 1st Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wenzhe Cao
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Shaohua Liu
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yang Song
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xuehang Li
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhiqiang Li
- Chinese PLA Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Rongrong Li
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiong Liu
- Chinese PLA Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Changjun Wang
- Chinese PLA Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Yong Chen
- Chinese PLA Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Fei Xie
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yao He
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Miao Liu
- Graduate School of Chinese PLA General Hospital, Beijing, People's Republic of China
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15
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Peng C, Yang F, Yu J, Chen C, He J, Jin Z. Temporal trends, predictors of blood transfusion and in-hospital outcomes among patients with severe burn injury in the United States-A national database-based analysis. Transfusion 2022; 62:1537-1550. [PMID: 35789008 DOI: 10.1111/trf.16999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/13/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Severe burn can be accompanied by life-threatening bleeding on some occasions, thus, blood transfusion is often required in these patients during their hospitalization. Therefore, we aimed to examine temporal trends, predictors, and in-hospital outcomes of blood transfusion in these patients in the United States. METHODS The National Inpatient Sample was used to identify severe burn patients between January 2010 and September 2017 in the United States. Trends in the utilization of blood transfusion were analyzed using the Cochran-Armitage trend test. Moreover, propensity score matching (PSM) was employed, and then in-hospital outcomes were compared between these two groups in the matched cohort. Multivariable logistic regressions were further used to validate the results of PSM. RESULTS Among 27,260 severe burn patients identified during the study period, 2120 patients (7.18%) received blood transfusion. Blood transfusion rates decreased significantly from 9.52% in 2010 to 5.02% in 2017 (p for trend <.001). In the propensity-matched cohort (2120 pairs with and without transfusion), patients transfused were at increased risk of in-hospital mortality (13.3% vs 8.77%, p < .001), overall postoperative complications (88.3% vs 72.59%, p < .001), longer hospital stays (defined as > median hospital stays = 5 d) (73.8% vs 50.6%, p < .001) and increased overall cost (defined as > median overall costs = 30,746) (81.6% vs 57.3%, p < .001). This was also the case for the multivariable analysis. CONCLUSIONS Blood transfusion following severe burn injury may be associated with worse clinical outcomes. The utility for blood transfusion in burn patients warrants further prospective exploration.
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Affiliation(s)
- Chi Peng
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
| | - Fan Yang
- Department of Plastic Surgery and Burns, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China.,Institute of Pathology and Southwest Cancer Center, Southwest Hospital, The Third Military Medical University, Chongqing, China
| | - Jian Yu
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
| | - Chenxin Chen
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
| | - Jia He
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
| | - Zhichao Jin
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
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Yang CC, Lee MH, Chen KT, Lin MHC, Tsai PJ, Yang JT. In-hospital outcomes of patients with spontaneous supratentorial intracerebral hemorrhage. Medicine (Baltimore) 2022; 101:e29836. [PMID: 35777064 PMCID: PMC9239614 DOI: 10.1097/md.0000000000029836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Spontaneous intracerebral hemorrhage (ICH) in the brain parenchyma accounts for 16.1% of all stroke types in Taiwan. It is responsible for high morbidity and mortality in some underlying causes. The objective of this study is to discover the predicting factors focusing on in-hospital outcomes of patients with spontaneous supratentorial ICH. Between June 2014 and October 2018, there were a total of 159 patients with spontaneous supratentorial ICH ranging from 27 to 91 years old in our institution. Twenty-three patients died during hospitalization, whereas 59 patients had an extended length of stay of >30 days. The outcomes were measured by inpatient death, length of stay, and activity of daily living (ADL). Both univariate and multivariate binary logistic regression, as well as multivariate linear regression, were used for statistical analysis. Multivariate binary linear regression analysis showed the larger hematoma in initial computed tomography scan of >30 cm3 (odds ratio [OR] = 2.505, P = .013) and concurrent in-hospital infection (OR = 4.173, P = .037) were both statistically related to higher mortality. On the other hand, in-hospital infection (≥17.41 days, P = .000) and surgery (≥11.23 days, P = .001) were correlated with a longer length of stay. Lastly, drastically poor change of ADL (ΔADL <-30) was associated with larger initial ICH (>30 cc, OR = 2.915, P = .049), in-hospital concurrent infection (OR = 4.695, P = .01), and not receiving a rehabilitation training program (OR = 3.473, P = .04). The results of this study suggest that age, prothrombin, initial Glasgow Coma Scale, computed tomography image, location of the lesion, and surgery could predict the mortality and morbidity of the spontaneous ICH, which cannot be reversed at the time of occurrence. However, effective control of international normalized ratio level, careful prevention against infection, and the aid of rehabilitation programs might be important factors toward a decrease of inpatient mortality rate, the length of stay, and ADL recovery.
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Affiliation(s)
- Chao-Chun Yang
- Department of Neurosurgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Ming-Hsue Lee
- Department of Neurosurgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Kuo-Tai Chen
- Department of Neurosurgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Martin Hsiu-Chu Lin
- Department of Neurosurgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Ping-Jui Tsai
- Department of Neurosurgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
- *Correspondence: Jen-Tsung Yang, No 6. West Sec, ChiaPu Rd, Puzi City, Chiayi County, Taiwan (e-mail: )
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Wang M, Liu J, Liu J, Hao Y, Yang N, Liu T, Smith SC, Huo Y, Fonarow GC, Ge J, Morgan L, Ma C, Han Y, Zhao D, Zhan S. Association Between Early Oral β-Blocker Therapy and In-Hospital Outcomes in Patients With ST-Elevation Myocardial Infarction With Mild-Moderate Heart Failure: Findings From the CCC-ACS Project. Front Cardiovasc Med 2022; 9:828614. [PMID: 35497978 PMCID: PMC9051227 DOI: 10.3389/fcvm.2022.828614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background There are limited data available on the impact of early (within 24 h of admission) β-blocker therapy on in-hospital outcomes of patients with ST-elevation myocardial infarction (STEMI) and mild-moderate acute heart failure. This study aimed to explore the association between early oral β-blocker therapy and in-hospital outcomes. Methods Inpatients with STEMI and Killip class II or III heart failure from the Improving Care for Cardiovascular Disease in China project (n = 10,239) were enrolled. The primary outcome was a combined endpoint composed of in-hospital all-cause mortality, successful cardiopulmonary resuscitation after cardiac arrest, and cardiogenic shock. Inverse-probability-of-treatment weighting, multivariate Cox regression, and propensity score matching were performed. Results Early oral β-blocker therapy was administered to 56.5% of patients. The incidence of the combined endpoint events was significantly lower in patients with early therapy than in those without (2.7 vs. 5.1%, P < 0.001). Inverse-probability-of-treatment weighting analysis demonstrated that early β-blocker therapy was associated with a low risk of combined endpoint events (HR = 0.641, 95% CI: 0.486-0.844, P = 0.002). Similar results were shown in multivariate Cox regression (HR = 0.665, 95% CI: 0.496-0.894, P = 0.007) and propensity score matching (HR = 0.633, 95% CI: 0.453-0.884, P = 0.007) analyses. A dose-response trend between the first-day β-blocker dosages and adverse outcomes was observed in a subset of participants with available data. No factor could modify the association of early treatment and the primary outcomes among the subgroups analyses. Conclusion Based on nationwide Chinese data, early oral β-blocker therapy is independently associated with a lower risk of poor in-hospital outcome in patients with STEMI and Killip class II or III heart failure.
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Affiliation(s)
- Miao Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Department of Epidemiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Jing Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Yongchen Hao
- Department of Epidemiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Na Yang
- Department of Epidemiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Tong Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Sidney C. Smith
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Gregg C. Fonarow
- Division of Cardiology, Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, United States
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Louise Morgan
- International Quality Improvement Department, American Heart Association, Dallas, TX, United States
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yaling Han
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Scheurig-Muenkler C, Schwarz F, Kroencke TJ, Decker JA. Impact of the COVID-19 Pandemic on In-Patient Treatment of Peripheral Artery Disease in Germany during the First Pandemic Wave. J Clin Med 2022; 11:2008. [PMID: 35407616 DOI: 10.3390/jcm11072008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 02/04/2023] Open
Abstract
Patients with peripheral artery disease (PAD) belong to a vulnerable population with relevant comorbidity. Appropriate care and timely treatment are imperative, but not readily assured in the current pandemic. What impact did the first wave have on in-hospital treatment in Germany? Nationwide healthcare remuneration data for inpatient care of the years 2019 and 2020 were used to compare demographic baseline data including the assessment of comorbidity (van Walraven score), as well as the encoded treatments. A direct comparison was made between the first wave of infections in 2020 and the reference period in 2019. The number of inpatient admissions decreased by 10.9%, with a relative increase in hospitalizations due to PAD Fontaine IV (+13.6%). Baseline demographics and comorbidity showed no relevant differences. The proportion of emergency admissions increased from 23.4% to 28.3% during the first wave to the reference period in 2019, and in-hospital mortality increased by 21.9% from 2.5% to 3.1%. Minor and major amputations increased by 24.5% and 18.5%. Endovascular and combined surgical/endovascular treatment strategies increased for all stages. Already in the first, comparatively mild wave of the pandemic, significantly fewer patients with predominantly higher-grade PAD stages were treated as inpatients. Consecutively, in-hospital mortality and amputation rates increased.
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19
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Espersen C, Platz E, Skaarup KG, Lassen MCH, Lind JN, Johansen ND, Sengeløv M, Alhakak AS, Nielsen AB, Bundgaard H, Hassager C, Jabbari R, Carlsen J, Kirk O, Lindholm MG, Kristiansen OP, Nielsen OW, Jeschke KN, Ulrik CS, Sivapalan P, Gislason G, Iversen K, Jensen JUS, Schou M, Skaarup SH, Biering-Sørensen T. Lung Ultrasound Findings Associated With COVID-19 ARDS, ICU Admission, and All-Cause Mortality. Respir Care 2022; 67:66-75. [PMID: 34815326 PMCID: PMC10408365 DOI: 10.4187/respcare.09108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND As lung ultrasound (LUS) has emerged as a diagnostic tool in patients with COVID-19, we sought to investigate the association between LUS findings and the composite in-hospital outcome of ARDS incidence, ICU admission, and all-cause mortality. METHODS In this prospective, multi-center, observational study, adults with laboratory-confirmed SARS-CoV-2 infection were enrolled from non-ICU in-patient units. Subjects underwent an LUS evaluating a total of 8 zones. Images were analyzed off-line, blinded to clinical variables and outcomes. A LUS score was developed to integrate LUS findings: ≥ 3 B-lines corresponded to a score of 1, confluent B-lines to a score of 2, and subpleural or lobar consolidation to a score of 3. The total LUS score ranged from 0-24 per subject. RESULTS Among 215 enrolled subjects, 168 with LUS data and no current signs of ARDS or ICU admission (mean age 59 y, 56% male) were included. One hundred thirty-six (81%) subjects had pathologic LUS findings in ≥ 1 zone (≥ 3 B-lines, confluent B-lines, or consolidations). Markers of disease severity at baseline were higher in subjects with the composite outcome (n = 31, 18%), including higher median C-reactive protein (90 mg/L vs 55, P < .001) and procalcitonin levels (0.35 μg/L vs 0.13, P = .033) and higher supplemental oxygen requirements (median 4 L/min vs 2, P = .001). However, LUS findings and score did not differ significantly between subjects with the composite outcome and those without, and were not associated with outcomes in unadjusted and adjusted logistic regression analyses. CONCLUSIONS Pathologic findings on LUS were common a median of 3 d after admission in this cohort of non-ICU hospitalized subjects with COVID-19 and did not differ among subjects who experienced the composite outcome of incident ARDS, ICU admission, and all-cause mortality compared to subjects who did not. These findings should be confirmed in future investigations. The study is registered at Clinicaltrials.gov (NCT04377035).
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Affiliation(s)
- Caroline Espersen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Elke Platz
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kristoffer Grundtvig Skaarup
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mats Christian Højbjerg Lassen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jannie Nørgaard Lind
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Dyrby Johansen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Sengeløv
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Alia Saed Alhakak
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne Bjerg Nielsen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jørn Carlsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ole Kirk
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Matias Greve Lindholm
- Department of Cardiology, Zealand University Hospital Roskilde, University of Copenhagen, Copenhagen, Denmark
| | - Ole Peter Kristiansen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Olav Wendelboe Nielsen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Nielsen Jeschke
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Pradeesh Sivapalan
- Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jens Ulrik Stæhr Jensen
- Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Schou
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Søren Helbo Skaarup
- Department of Respiratory Medicine, Aarhus University Hospital, University of Aarhus, Aarhus, Denmark
| | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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20
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Eertmans W, Kayaert P, Bennett J, Ungureanu C, Bataille Y, Saad G, Haine S, Coussement P, Pereira B, Agostoni P, Janssens L, Vandeloo B, Maréchal P, Cornelis K, de Hemptinne Q, Aminian A, Stammen F, Carlier S, Timmermans P, Vercauteren S, Sonck J, De Vroey F, Drieghe B, McCutcheon K, Scott B, Davin L, Gafari C, Dens J. The evolution of the CTO-PCI landscape in Belgium and Luxembourg: a four-year appraisal. Acta Cardiol 2021; 76:1043-1051. [PMID: 32755286 DOI: 10.1080/00015385.2020.1801197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND To chart the evolution of the CTO-PCI landscape in Belgium and Luxembourg, the Belgian Working Group on Chronic Total Occlusions (BWGCTO) was established in 2016. METHODS Between May 2016 and December 2019, patients undergoing a CTO-PCI treatment were prospectively and consecutively enrolled. Twenty-one centres in Belgium and one in Luxembourg participated. Individual operators had mixed levels of expertise in treating CTO lesions. Demographic, angiographic, procedural parameters and incidence of major adverse cardiac and cerebrovascular events (MACCE) were systematically registered. RESULTS Over a four-year enrolment period, 1832 procedures were performed in 1733 patients achieving technical success in 1474 cases (80%), with an in-hospital MACCE rate of 2.3%. Fifty-nine (3%) cases were re-attempt procedures of which 41 (69%) were successful. High-volume centres treated more complex lesions (mean J-CTO score: 2.15 ± 1.21) as compared to intermediate (mean J-CTO score: 1.72 ± 1.23; p < 0.001) and low-volume centres (mean J-CTO score: 0.99 ± 1.21; p = 0.002). Despite this, success rates did not differ between centres (p = 0.461). Overall success rates did not differ over time (p = 0.810). High-volume centres progressively tackled more complex CTOs while keeping success rates stable. In all centres, the most applied strategy was antegrade wire escalation (83%). High-volume centres more often successfully applied antegrade dissection and re-entry and retrograde techniques in lesions with higher complexity. CONCLUSION With variable experience levels, operators treated CTOs with high success and relatively few complications. Although AWE remains the most used technique, it is paramount for operators to be skilled in all contemporary techniques in order to be successful in more complex CTOs.
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Affiliation(s)
- Ward Eertmans
- Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Johan Bennett
- Department of Cardiovascular Medicine, UZ Leuven, Leuven, Belgium
| | | | - Yoann Bataille
- Department of Cardiology, CHR de la Citadelle, Liège, Belgium
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Georges Saad
- Department of Cardiology, CHR de la Citadelle, Liège, Belgium
| | - Steven Haine
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Department of Cardiovascular Diseases, University of Antwerp, Wilrijk, Belgium
| | | | - Bruno Pereira
- Department of Cardiology, INCCI Haerz Center, Luxembourg, Luxembourg
| | | | - Luc Janssens
- Department of Cardiology, Imelda Ziekenhuis, Bonheiden, Belgium
| | - Bert Vandeloo
- Department of Cardiology, Centrum voor Hart- en Vaatziekten, UZ Brussel, Jette, Belgium
| | | | | | - Quentin de Hemptinne
- Department of Cardiology, CHU Saint-Pierre Université Libre de Bruxelles, Brussel, Belgium
| | - Adel Aminian
- Department of Cardiology, CHU Charleroi, Charleroi, Belgium
| | | | | | | | | | - Jeroen Sonck
- Department of Cardiology, Centrum voor Hart- en Vaatziekten, UZ Brussel, Jette, Belgium
- Department of Cardiology, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium
| | - Frédéric De Vroey
- Department of Cardiology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Benny Drieghe
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA), Middelheim Hospital, Antwerp, Belgium
| | | | - Chadi Gafari
- Department of Cardiology, CHU Ambroise Paré, Mons, Belgium
| | - Jo Dens
- Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
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21
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Khaled S, Babateen EM, Alhodian FY, AlQashqari RW, AlZaidi RS, Almaimani H, Alharbi NA, Samarin KE, Fallatah AA, Shalaby G. Cardiomyopathy Management and In-Hospital Outcomes in a Tertiary Care Center: Clinical Components and Venues of Advanced Care. Cureus 2021; 13:e19054. [PMID: 34824941 PMCID: PMC8612064 DOI: 10.7759/cureus.19054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background There are few reports on the prevalence of different types of cardiomyopathy, clinical presentation, severity, short-term outcomes, and implementation of advanced heart failure treatment. This study aimed to assess the prevalence, clinical background of different types of cardiomyopathy and to identify the candidate for advanced treatment in a tertiary care cardiac center with many advantages Method A single-center retrospective cohort study included 1069 patients admitted to our center and diagnosed with cardiomyopathy during 2019 and 2020 Results Out of 1069 cardiomyopathy patients admitted and diagnosed at our center between 2019 and 2020, 62% had ischemic cardiomyopathy (ICM), 36% had dilated cardiomyopathy (DCM), and 2% had hypertrophic cardiomyopathy (HOCM). ICM patients were older, showed a higher prevalence of both male gender and pilgrims, and they had more frequent cardiovascular risk factors compared to dilated cardiomyopathy group of patients. However, DCM patients with more severe heart failure symptoms (NYHA class III/IV), much worse LVEF, were subsequently considered deemed for aggressive diuretic therapy, and further advanced therapy (Sacubitril-Valsartan and device therapy) compared to ICM patients. ICM patients showed poor in-hospital outcomes compared to DCM group of patients (0.05 and <0.001) for an indication for mechanical ventilation and in-hospital mortality, respectively). Increased age, presence of renal dysfunction and lower LVEF were found the independent predictors of in-hospital mortality among our studied patients Conclusion There are discrepancies between DCM and ICM patients. Although DCM patients were younger at age and had fewer cardiovascular risk factors, they presented with severe symptoms and dysfunction, hence more eligible candidates for advanced heart failure treatment, and finally showed a lower mortality rate. Increased age, presence of renal dysfunction and lower LVEF were found the independent predictors of in-hospital mortality.
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Affiliation(s)
- Sheeren Khaled
- Cardiology, Cardiac Center, King Abdullah Medical City, Makkah, SAU.,Cardiology, Faculty of Medicine, Benha University, Benha, EGY
| | - Emad M Babateen
- Cardiology, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | | | | | - Reema S AlZaidi
- Cardiology, Medicine and Surgery, Taif University, Taif, SAU
| | - Hala Almaimani
- Cardiology, College of Medicine, Umm Alqura University, Makkah, SAU
| | | | - Kawlah E Samarin
- Cardiology, College of Medicine, Umm Alqura University, Makkah, SAU
| | - Amani A Fallatah
- Cardiology, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | - Ghada Shalaby
- Cardiology, Cardiac Center, King Abdullah Medical City, Makkah, SAU.,Cardiology, Faculty of Medicine, Zagazig University, Zagazig, EGY
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22
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You S, Sun X, Zhou Y, Zhong C, Chen J, Zhai W, Cao Y. The prognostic significance of white blood cell and platelet count for in-hospital mortality and pneumonia in acute ischemic stroke. Curr Neurovasc Res 2021; 18:427-434. [PMID: 34792010 DOI: 10.2174/1567202618666211118141803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND We investigated the combined effect of white blood cell (WBC) and platelet count on in-hospital mortality and pneumonia in acute ischemic stroke (AIS) patients. METHODS A total of 3,265 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided patients into four groups according to their level of WBC and platelet count: LWHP (low WBC and high platelet), LWLP (low WBC and low platelet), HWHP (high WBC and high platelet), and HWLP (high WBC and low platelet). A logistic regression model was used to estimate the combined effect of WBC and platelet counts on all-cause in-hospital mortality and pneumonia in AIS patients. RESULTS HWLP was associated with a 2.07-fold increase in the risk of in-hospital mortality in comparison to LWHP (adjusted odds ratio [OR] 2.07; 95% confidence interval [CI], 1.02-4.18; P-trend =0.020). The risk of pneumonia was significantly higher in patients with HWLP than those with LWHP (adjusted OR 2.29; 95% CI, 1.57-3.35; P-trend <0.001). The C-statistic for the combined WBC and platelet count was higher than WBC count or platelet count alone for the prediction of in-hospital mortality and pneumonia (all P < 0.01). CONCLUSION High WBC count combined with a low platelet count level at admission was independently associated with in-hospital mortality and pneumonia in AIS patients. Moreover, the combination of WBC count and platelet count level appeared to be a better predictor than WBC count or platelet count alone.
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Affiliation(s)
- Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004. China
| | - Xin Sun
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004. China
| | - Yi Zhou
- Department of Neurology, The First People's Hospital of Taicang, Suzhou 215400. China
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou 215123. China
| | - Juping Chen
- Department of Neurology, Hospital of Changshu Traditional Chinese Medicine, Suzhou 215000. China
| | - Wanqing Zhai
- Department of Neurology, The First People's Hospital of Taicang, Suzhou 215400. China
| | - Yongjun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004. China
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23
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Wu J, Cong X, Lou Z, Zhang M. Trend and Impact of Concomitant CABG and Multiple-Valve Procedure on In-hospital Outcomes of SAVR Patients. Front Cardiovasc Med 2021; 8:740084. [PMID: 34540926 PMCID: PMC8446624 DOI: 10.3389/fcvm.2021.740084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The trends of concomitant CABG and multiple-valve procedures and their impact on in-hospital outcomes in the context of transcatheter aortic valve replacement are unexplored. Methods: This was a retrospective cohort study using the administrative database of the U.S. national inpatient sample from 2012 to 2018 to identify patients who underwent SAVR with or without concomitant CABG and/or multiple-valve procedures. Results: During the study period, a total of 75,763 representing 378,815 patients underwent SAVR nationwide were identified, of whom 42,993 (55.1%) experienced isolated SAVR, 27,133 (34.8%) underwent concomitant CABG, 5,637 (7.2%) underwent multiple-valve procedures, and 2,298 (2.9%) underwent both concomitant CABG and multiple-valve procedures. The rate of multiple-valve procedures increased from 6.1% in 2012 to 9.2% in 2018 (P < 0.001 for trend). In-hospital mortality was 2.1, 3.9, 7.3, and 11.2% for isolated SAVR, SAVR with CABG, SAVR with multiple-valve procedures, and SAVR with CABG and multiple-valve procedures, respectively. After propensity matching, compared to isolated SAVR, the risk ratio for in-hospital mortality associated with concomitant CABG was 1.54 (CI 1.39-1.70). In multiple-valve procedures, it was 2.36 (CI 1.97-2.83), and in concomitant CABG and multiple-valve procedures, it was 2.92 (CI 2.29-3.73). Conclusions: The proportion of patients receiving multiple-valve procedures is increasing. While concomitant CABG moderately increased in-hospital mortality, multiple-valve procedures dramatically increased in-hospital mortality and complications, even after propensity score matching
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Affiliation(s)
- Jing Wu
- Institute of Translational Medicine, The First Hospital of Jilin University, Changchun, China
| | - Xiaoqiang Cong
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Zhiyang Lou
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Mingyou Zhang
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
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24
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Kljakovic Gaspic T, Pavicic Ivelja M, Kumric M, Matetic A, Delic N, Vrkic I, Bozic J. In-Hospital Mortality of COVID-19 Patients Treated with High-Flow Nasal Oxygen: Evaluation of Biomarkers and Development of the Novel Risk Score Model CROW-65. Life (Basel) 2021; 11:735. [PMID: 34440479 PMCID: PMC8399648 DOI: 10.3390/life11080735] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 01/16/2023] Open
Abstract
To replace mechanical ventilation (MV), which represents the cornerstone therapy in severe COVID-19 cases, high-flow nasal oxygen (HFNO) therapy has recently emerged as a less-invasive therapeutic possibility for those patients. Respecting the risk of MV delay as a result of HFNO use, we aimed to evaluate which parameters could determine the risk of in-hospital mortality in HFNO-treated COVID-19 patients. This single-center cohort study included 102 COVID-19-positive patients treated with HFNO. Standard therapeutic methods and up-to-date protocols were used. Patients who underwent a fatal event (41.2%) were significantly older, mostly male patients, and had higher comorbidity burdens measured by CCI. In a univariate analysis, older age, shorter HFNO duration, ventilator initiation, higher CCI and lower ROX index all emerged as significant predictors of adverse events (p < 0.05). Variables were dichotomized and included in the multivariate analysis to define their relative weights in the computed risk score model. Based on this, a risk score model for the prediction of in-hospital mortality in COVID-19 patients treated with HFNO consisting of four variables was defined: CCI > 4, ROX index ≤ 4.11, LDH-to-WBC ratio, age > 65 years (CROW-65). The main purpose of CROW-65 is to address whether HFNO should be initiated in the subgroup of patients with a high risk of in-hospital mortality.
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Affiliation(s)
- Toni Kljakovic Gaspic
- Department of Anesthesiology and Intensive Medicine, University Hospital of Split, 21000 Split, Croatia; (T.K.G.); (N.D.)
| | - Mirela Pavicic Ivelja
- Department of Infectious Diseases, University Hospital of Split, 21000 Split, Croatia; (M.P.I.); (I.V.)
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia;
| | - Andrija Matetic
- Department of Cardiology, University Hospital of Split, 21000 Split, Croatia;
| | - Nikola Delic
- Department of Anesthesiology and Intensive Medicine, University Hospital of Split, 21000 Split, Croatia; (T.K.G.); (N.D.)
| | - Ivana Vrkic
- Department of Infectious Diseases, University Hospital of Split, 21000 Split, Croatia; (M.P.I.); (I.V.)
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia;
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25
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Chen G, Li M, Wen X, Wang R, Zhou Y, Xue L, He X. Association Between Stress Hyperglycemia Ratio and In-hospital Outcomes in Elderly Patients With Acute Myocardial Infarction. Front Cardiovasc Med 2021; 8:698725. [PMID: 34355031 PMCID: PMC8329087 DOI: 10.3389/fcvm.2021.698725] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/25/2021] [Indexed: 01/08/2023] Open
Abstract
Backgrounds: Emerging evidence suggests that stress hyperglycemia ratio (SHR), an index of relative stress hyperglycemia, is of great prognostic value in acute myocardial infarction (AMI), but current evidence is limited in elderly patients. In this study, we aimed to assess whether SHR is associated with in-hospital outcomes in elderly patients with AMI. Methods: In this retrospective study, patients who were aged over 75 years and diagnosed with AMI were consecutively enrolled from 2015, January 1st to 2019, December 31th. Admission blood glucose and glycosylated hemoglobin (HbA1C) during the index hospitalization were used to calculate SHR. Restricted quadratic splines, receiver-operating curves, and logistic regression were performed to evaluate the association between SHR and in-hospital outcomes, including in-hospital all-cause death and in-hospital major adverse cardiac and cerebrovascular events (MACCEs) defined as a composite of all-cause death, cardiogenic shock, reinfarction, mechanical complications of MI, stroke, and major bleeding. Results: A total of 341 subjects were included in this study. Higher SHR levels were observed in patients who had MACCEs (n = 69) or death (n = 44) during hospitalization. Compared with a SHR value below 1.25, a high SHR was independently associated with in-hospital MACCEs (odds ratio [OR]: 2.945, 95% confidence interval [CI]: 1.626–5.334, P < 0.001) and all-cause death (OR: 2.871 95% CI: 1.428–5.772, P = 0.003) in univariate and multivariate logisitic analysis. This relationship increased with SHR levels based on a non-linear dose-response curve. In contrast, admission glucose was only associated with clinical outcomes in univariate analysis. In subgroup analysis, high SHR was significantly predictive of worse in-hospital clinical outcomes in non-diabetic patients (MACCEs: 2.716 [1.281–5.762], P = 0.009; all-cause death: 2.394 [1.040–5.507], P = 0.040), but the association was not significant in diabetic patients. Conclusion: SHR might serve as a simple and independent indicator of adverse in-hospital outcomes in elderly patients with AMI, especially in non-diabetic population.
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Affiliation(s)
- Guo Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mingmin Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaodan Wen
- Department of Geriatrics, Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rui Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ling Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xuyu He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Osman M, Ghaffar YA, Osman K, Kheiri B, Mohamed MMG, Kawsara A, Balla S, Roda-Renzelli A, Daggubati R. Gender-based outcomes of coronary bifurcation stenting: A report from the National Readmission Database. Catheter Cardiovasc Interv 2021; 99:433-439. [PMID: 33991413 DOI: 10.1002/ccd.29704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/05/2021] [Accepted: 04/01/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is a paucity of data focusing on women's outcomes after percutaneous coronary interventions (PCI) for coronary bifurcation lesions (CBLs). METHODS Patients who received PCI for CBLs in the context of acute coronary syndrome (ACS) during the period of 01 October 2015- 31 December 2017, were identified from the United States National Readmission Database. The primary endpoint of this study was in-hospital major adverse events (MAEs). The secondary endpoints were in-hospital mortality, vascular complications, major bleeding, post-procedural bleeding, need for blood transfusion, severe disability surrogates (non-home discharge and need for mechanical ventilation), resources utilization surrogates (length of stay and cost of hospitalization), and 30-day readmission rate. A 1:1 propensity score matching was used to compare the outcomes between women and men. RESULTS A total of 25,050 (women = 7,480; men = 17,570) patients were included in the current analysis. After propensity score matching, women had higher in-hospital MAEs (7 vs 5.2%, p < .01), major bleeding (1.8 vs 0.8%, p < .01), post-procedural bleeding (6.1 vs 3.4%, p < .01), need for blood transfusion (6.4 vs 4.2%, p < .01), non-home discharges (10.2 vs 7.1%; p < .01), longer length of hospital stay (3 days [IQR 2-6] vs. 3 days [IQR 2-5], p < .01) and higher 30-day readmission rate compared to men (14.2 vs. 11.5%, p < .01). CONCLUSIONS Among all-comers who received PCI for CBLs in the context of ACS, women suffered higher MAEs and 30-day readmission rates compared to their men' counterparts. The higher MAEs in the women were mainly driven by higher postprocedural bleeding rates and the need for blood transfusion.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Yasir Abdul Ghaffar
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Khansa Osman
- Michigan Health Specialists, Michigan State University, Flint, Michigan, USA
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Akram Kawsara
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Anthony Roda-Renzelli
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Ramesh Daggubati
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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Marco-Martínez J, Elola-Somoza FJ, Fernández-Pérez C, Bernal-Sobrino JL, Azaña-Gómez FJ, García-Klepizg JL, Andrès E, Zapatero-Gaviria A, Barba-Martin R, Calvo-Manuel E, Canora-Lebrato J, Lorenzo-Villalba N, Méndez-Bailón M. Heart Failure Is a Poor Prognosis Risk Factor in Patients Undergoing Cholecystectomy: Results from a Spanish Data-Based Analysis. J Clin Med 2021; 10:1731. [PMID: 33923710 DOI: 10.3390/jcm10081731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The incidence of cholecystectomy is increasing as the result of the aging worldwide. Our aim was to determine the influence of heart failure on in-hospital outcomes in patients undergoing cholecystectomy in the Spanish National Health System (SNHS). Methods: We conducted a retrospective study using the Spanish National Hospital Discharge Database. Patients older than 17 years undergoing cholecystectomy in the period 2007–2015 were included. Demographic and administrative variables related to patients’ diseases as well as procedures were collected. Results: 478,111 episodes of cholecystectomy were identified according to the data from SNHS hospitals in the period evaluated. From all the episodes, 3357 (0.7%) were excluded, as the result the sample was represented by 474,754 episodes. Mean age was 58.3 (+16.5) years, and 287,734 (60.5%) were women (p < 0.001). A primary or secondary diagnosis of HF was identified in 4244 (0.89%) (p < 0.001) and mean age was 76.5 (+9.6) years. A higher incidence of all main complications studied was observed in the HF group (p < 0.001), except stroke (p = 0.753). Unadjusted in-hospital mortality was 1.1%, 12.9% in the group with HF versus 1% in the non HF group (p < 0.001). Average length of hospital stay was 5.4 (+8.9) days, and was higher in patients with HF (16.2 + 17.7 vs. 5.3 + 8.8; p < 0.001). Risk-adjusted in-hospital mortality models’ discrimination was high in both cases, with AUROC values = 0.963 (0.960–0.965) in the APRG-DRG model and AUROC = 0.965 (0.962–0.968) in the CMS adapted model. Median odds ratio (MOR) was high (1.538 and 1.533, respectively), stating an important variability of risk-adjusted outcomes among hospitals. Conclusions: The presence of HF during admission increases in hospital mortality and lengthens the hospital stay in patients undergoing cholecystectomy. However, mortality and hospital stay have significantly decreased during the study period in both groups (HF and non HF patients).
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Nishonov AB, Tarasov RS, Ivanov SV, Barbarash LS. [Coronary artery bypass grafting in myocardial infarction and unstable angina pectoris: in-hospital outcomes. Part 2]. Angiol Sosud Khir 2021; 27:151-157. [PMID: 33825742 DOI: 10.33529/angio2021104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To assess in-hospital outcomes of coronary artery bypass grafting in patients with acute coronary syndrome, depending on the presence or absence of myocardial infarction. PATIENTS AND METHODS Over the period from 2017 to 2018 within the framework of a single-centre register, the study enrolled a total of 166 consecutive patients admitted with non-ST segment elevation acute coronary syndrome and subjected to coronary artery bypass grafting. Depending on the outcome of acute coronary syndrome, the patients were divided into 2 groups: Group One included 98 (59%) patients with unstable angina pectoris and Group Two comprised 68 (41%) patients with myocardial infarction, who underwent surgery at an average of 16 (11; 20) days after manifestation of the clinical signs of myocardial infarction. The endpoints of the study were major adverse cardiovascular events during the in-hospital period: death, myocardial infarction, acute cerebral circulation impairment/transitory ischaemic attack, repeat revascularization, septic complications, multiple organ failure syndrome, wound infectious complications, requirement for repeated surgical debridement, remediastinotomy due to haemorrhage, the frequency of extracorporeal membrane oxygenation and renal replacement therapy. RESULTS The mortality rate in the compared groups was similar: 3% (n=3) and 3% (n=2), respectively. Perioperative myocardial infarction occurred in 1 (1%) patient of the first group, with no cases of this complication observed in the second group. The frequency of reoperations due to haemorrhage in the early postoperative period in the group of unstable angina pectoris amounted to 3% (n=3) and was associated with administration of dual antithrombotic therapy, with no cases of this complication in the group of myocardial infarction. Wound complication in the second group were observed in 7.6% (n=5) and in the first group in 4% (n=4) (p=0.33). The differences turned out to be statistically insignificant for such postoperative complications as multiple organ failure syndrome, requirement for repeated surgical debridement, renal replacement therapy, and extracorporeal membrane oxygenation. The residual SYNTAX Score in the group of myocardial infarction amounted to 2.3±2.8, whereas in the group of unstable angina pectoris to 2.3±3, thus suggesting complete revascularization in the total sample of patients with acute coronary syndrome. The average length of hospital stay (including the postoperative period) in the first group amounted to 26.3±6.6 days and in the second group to 27.4±7.2 days (p=0.53). The postoperative bed-day in the group with unstable angina pectoris was 12.6±3.2 and in the myocardial infarction group - 14.9±5.3 (p=0.06). CONCLUSION The obtained in-hospital outcomes suggest that coronary artery bypass grafting may be an efficient and safe method of complete revascularization for patients with non-ST-elevation acute coronary syndrome, including that resulting in myocardial infarction, performed averagely on day 16 (11; 20) after the onset of clinical manifestations of myocardial infarction.
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Affiliation(s)
- A B Nishonov
- Cardiosurgical Department, Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
| | - R S Tarasov
- Cardiosurgical Department, Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
| | - S V Ivanov
- Cardiosurgical Department, Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
| | - L S Barbarash
- Cardiosurgical Department, Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
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Matetic A, Contractor T, Mohamed MO, Bhardwaj R, Aneja A, Myint PK, Rakoski MO, Zieroth S, Paul TK, Mamas MA. Trends, management and outcomes of acute myocardial infarction in chronic liver disease. Int J Clin Pract 2021; 75:e13841. [PMID: 33220158 DOI: 10.1111/ijcp.13841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 12/14/2022] Open
Abstract
AIMS There are limited data on the management and outcomes of chronic liver disease (CLD) patients presenting with acute myocardial infarction (AMI), particularly according to the subtype of CLD. METHODS Using the Nationwide Inpatient Sample (2004-2015), we examined outcomes of AMI patients stratified by severity and sub-types of CLD. Multivariable logistic regression was performed to assess the adjusted odds ratios (aOR) of receipt of invasive management and adverse outcomes in CLD groups compared with no-CLD. RESULTS Of 7 024 723 AMI admissions, 54 283 (0.8%) had a CLD diagnosis. CLD patients were less likely to undergo coronary angiography (CA) and percutaneous coronary intervention (PCI) (aOR 0.62, 95%CI 0.60-0.63 and 0.59, 95%CI 0.58-0.60, respectively), and had increased odds of adverse outcomes including major adverse cardiovascular and cerebrovascular events (1.19, 95%CI 1.15-1.23), mortality (1.30, 95%CI 1.25-1.34) and major bleeding (1.74, 95%CI 1.67-1.81). In comparison to the non-severe CLD sub-groups, patients with all forms of severe CLD had the lower utilization of CA and PCI (P < .05). Among severe CLD patients, those with alcohol-related liver disease (ALD) had the lowest utilization of CA and PCI; patients with ALD and other CLD (OCLD) had more adverse outcomes than the viral hepatitis sub-group (P < .05). CONCLUSIONS CLD patients presenting with AMI are less likely to receive invasive management and are associated with worse clinical outcomes. Further differences are observed depending on the type as well as severity of CLD, with the worst management and clinical outcomes observed in those with severe ALD and OCLD.
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Affiliation(s)
- Andrija Matetic
- Department of Cardiology, University Hospital of Split, Split, Croatia
- Department of Pathophysiology, University of Split School of Medicine, Split, Croatia
| | | | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Rahul Bhardwaj
- Department of Cardiology, Loma Linda University, Loma Linda, CA, USA
| | - Ashish Aneja
- MetroHealth Heart and Vascular, Case Western Reserve University, Cleveland, OH, USA
| | - Phyo K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Mina O Rakoski
- Department of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, CA, USA
| | - Shelley Zieroth
- Section of Cardiology, University of Manitoba, Winnipeg, Canada
| | - Timir K Paul
- East Tennessee State University, Johnson City, TN, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
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Marco-Martínez J, Bernal-Sobrino JL, Fernández-Pérez C, Elola-Somoza FJ, Azaña-Gómez J, García-Klepizg JL, Andrès E, Zapatero-Gaviria A, Barba-Martin R, Marco-Martinez F, Canora-Lebrato J, Lorenzo-Villalba N, Méndez-Bailón M. Impact of Heart Failure on In-Hospital Outcomes after Surgical Femoral Neck Fracture Treatment. J Clin Med 2021; 10:969. [PMID: 33801169 DOI: 10.3390/jcm10050969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Femoral neck fracture (FNF) is a common condition with a rising incidence, partly due to aging of the population. It is recommended that FNF should be treated at the earliest opportunity, during daytime hours, including weekends. However, early surgery shortens the available time for preoperative medical examination. Cardiac evaluation is critical for good surgical outcomes as most of these patients are older and frail with other comorbid conditions, such as heart failure. The aim of this study was to determine the impact of heart failure on in-hospital outcomes after surgical femoral neck fracture treatment. METHODS We performed a retrospective study using the Spanish National Hospital Discharge Database, 2007-2015. We included patients older than 64 years treated for reduction and internal fixation of FNF. Demographic characteristics of patients, as well as administrative variables, related to patient's diseases and procedures performed during the episode were evaluated. RESULTS A total of 234,159 episodes with FNF reduction and internal fixation were identified from Spanish National Health System hospitals during the study period; 986 (0.42%) episodes were excluded, resulting in a final study population of 233,173 episodes. Mean age was 83.7 (±7) years and 179,949 (77.2%) were women (p < 0.001). In the sample, 13,417 (5.8%) episodes had a main or secondary diagnosis of heart failure (HF) (p < 0.001). HF patients had a mean age of 86.1 (±6.3) years, significantly older than the rest (p < 0.001). All the major complications studied showed a higher incidence in patients with HF (p < 0.001). Unadjusted in-hospital mortality was 4.1%, which was significantly higher in patients with HF (18.2%) compared to those without HF (3.3%) (p < 0.001). The average length of stay (LOS) was 11.9 (±9.1) and was also significantly higher in the group with HF (16.5 ± 13.1 vs. 11.6 ± 8.7; p < 0.001). CONCLUSIONS Patients with HF undergoing FNF surgery have longer length of stay and higher rates of both major complications and mortality than those without HF. Although their average length of stay has decreased in the last few years, their mortality rate has remained unchanged.
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Liu Y, Wang LF, Yang XC, Su PX, Li KB, Wang HS, Chen ML, Xu L, Zhong JC. In-hospital outcome of primary PCI for patients with acute myocardial infarction and prior coronary artery bypass grafting. J Thorac Dis 2021; 13:1737-1745. [PMID: 33841964 PMCID: PMC8024815 DOI: 10.21037/jtd-20-1813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background This study aims to analyze the in-hospital outcome of primary percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI) and prior coronary artery bypass grafting (CABG). Methods This was a retrospective study. From January 2011 to December 2018, the data of 78 consecutive patients (study group) with prior CABG, who received primary coronary angiography in the setting of ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI), were screened. The study group was compared with another well-matched 78 patients without a history of CABG (control group). The information of the coronary angiograms and clinical data of both groups were analyzed. Multivariate conditional logistic regression models were constructed to test the association between PCI success rate and the prior CABG at age ≥65 and <65 years, respectively. Results The results revealed that the primary PCI success rate in the study group was significantly lower than in the control group (67.9% vs. 92.3%, P<0.001) and in-hospital mortality was significantly higher than in control group (11.5% vs. 2.5%, P=0.03). The multivariate logistic regression analysis indicated that the primary PCI success rate was significantly associated with the history of prior CABG both in young patients [age <65 years; odds ratio (OR) =5.26, 95% confidence interval (CI): 1.69–16.47] and elderly (age ≥65 years; OR =13.76, 95% CI: 2.72–69.75). Conclusions The patients who receive primary PCI with AMI and prior CABG have poor in-hospital outcomes, with low PCI success rates and high mortality.
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Affiliation(s)
- Yu Liu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Le-Feng Wang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xin-Chun Yang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Pi-Xiong Su
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kui-Bao Li
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hong-Shi Wang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mu-Lei Chen
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Li Xu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiu-Chang Zhong
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Latif A, Ahsan MJ, Lateef N, Kapoor V, Mirza MM, Anwer F, Del Core M, Kanmantha Reddy A. Outcomes of surgical versus transcatheter aortic valve replacement in nonagenarians- a systematic review and meta-analysis. J Community Hosp Intern Med Perspect 2021; 11:128-134. [PMID: 33552435 PMCID: PMC7850375 DOI: 10.1080/20009666.2020.1843235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction: Since the approval of transcatheter aortic valve replacement (TAVR), nonagenarian group patients are being increasingly considered for TAVR. Therefore, we compared the clinical outcomes of surgical aortic valve replacement (SAVR) vs TAVR in nonagenarians with severe aortic stenosis. Methods: A literature search was performed using MEDLINE, Embase, Web of Science, Cochrane, and Clinicaltrials.gov for studies reporting the comparative outcomes of TAVR versus SAVR in nonagenarians. The primary endpoint was short-term mortality. Secondary endpoints were post-operative incidences of stroke or transient ischemic attack (TIA), vascular complications, acute kidney injury (AKI), transfusion requirement, and length of hospital stay. Results: Four retrospective studies qualified for inclusion with a total of 8,389 patients (TAVR = 3,112, SAVR = 5,277). Short-term mortality was similar between the two groups [RR = 0.91 (95% CI: 0.76–1.10), p = 0.318]. The average length of hospital stay was shorter by 3 days in the TAVR group (p = 0.037). TAVR was associated with a significantly lower risk of AKI [RR = 0.72 (95% CI: 0.62–0.83), p < 0.001] and a lower risk of transfusion [RR = 0.71 (95% CI: 0.62–0.81), p < 0.001]. There was no difference in risk of stroke/TIA[RR = 1.01 (95% CI: 0.70–1.45), p = 0.957]. The risk of vascular complications was significantly higher in the TAVR group [RR = 3.39 (95% CI: 2.65–4.333), p < 0.001]. Conclusion: In this high-risk population, TAVR compared to SAVR has similar short-term mortality benefit but has lower risks of perioperative complications and a higher number of patients being discharged to home.
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Affiliation(s)
- Azka Latif
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Muhammad Junaid Ahsan
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Noman Lateef
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Vikas Kapoor
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Mohsin Mansoor Mirza
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | | | - Michael Del Core
- Department of Cardiology, CHI Health Heart and Vascular Institute, Omaha, Nebraska
| | - Arun Kanmantha Reddy
- Department of Cardiology, CHI Health Heart and Vascular Institute, Omaha, Nebraska
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Wang F, Wang L, Du H, You S, Zheng D, Zhong C, Sun Y, Ding C, Shan H, Cao Y, Liu CF. Elevated Total Homocysteine Predicts In-Hospital Pneumonia and Poor Functional Outcomes in Acute Ischemic Stroke. Curr Neurovasc Res 2020; 17:745-753. [PMID: 33319686 DOI: 10.2174/1567202617666201214111244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND We investigated the association between elevated total homocysteine (tHcy) levels upon hospital admission and short-term in-hospital outcomes, including pneumonia in acute ischemic stroke (AIS) patients. METHODS A total of 2,084 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided patients into four groups according to their level of admission tHcy: quartile (Q1) (<9.70 umol/L), Q2 (9.70-12.3 umol/L), Q3 (12.3-16.9 umol/L), and Q4 (≥16.9 umol/L). Logistic regression models were used to estimate the effect of tHcy on the short-term outcomes, including in-hospital pneumonia, all-cause in-hospital mortality, and poor outcome upon discharge (modified Rankin Scale score ≥3) in AIS patients. RESULTS The risk of in-hospital pneumonia was significantly higher in patients with the highest tHcy level (Q4) compared to those with the lowest tHcy level (Q1) (adjusted odds ratio [OR] 1.55; 95% confidence interval [CI], 1.03-2.33; P-trend =0.019). The highest tHcy level (Q4) was associated with a 3.35-fold and 1.50-fold increase in the risk of in-hospital mortality (OR 3.35; 95% CI, 1.11-10.13; P-trend =0.015) and poor outcome upon discharge (OR 1.50; 95% CI, 1.06-2.12; Ptrend =0.044) in comparison to Q1 after adjustment for potential covariates including pneumonia. CONCLUSION Having a high admission tHcy level was independently associated with in-hospital pneumonia, in-hospital mortality, and poor outcome upon discharge in AIS patients.
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Affiliation(s)
- Fuyu Wang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Lixuan Wang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Huaping Du
- Department of Neurology, The Affiliated Wujiang Hospital of Nantong University, Suzhou 215200, China
| | - Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Danni Zheng
- Discipline of Biomedical Informatics and Digital Health, Medicine Faculty, The University of Sydney, NSW, Australia
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
| | - Yaming Sun
- Department of Neurology, Zhangjiagang Hospital of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Suzhou 215600, China
| | - Chunqin Ding
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Haihua Shan
- Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Yongjun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
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Osman M, Syed M, Abdul Ghaffar Y, Patel B, Abugroun A, Kheiri B, Kawsara A, Kadiyala M, Balla S, Daggubati R. Gender-based outcomes of impeller pumps percutaneous ventricular assist devices. Catheter Cardiovasc Interv 2020; 97:E627-E635. [PMID: 33058477 DOI: 10.1002/ccd.29222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is paucity of data focusing on females' outcomes after the use of impeller pumps percutaneous ventricular assist devices (IPVADs). METHODS Patients who received IPVADs during the period of October 1st, 2015-December 31, 2017, were identified from the United States National Readmission Database. A 1:1 propensity score matching was used to compare the outcomes between females and males. RESULTS A total of 19,278 (Female = 5,456; Male = 13,822) patients were included in the current analysis. After propensity score matching and among all-comers who were treated with IPVADs, females had higher in-hospital major adverse events (MAEs) (38 vs. 32.6%, p < .01), mortality (31 vs. 28%, p < .01), vascular complications (3.3 vs. 2.1%, p < .01), major bleeding (7.8 vs. 4.8%, p < .01), nonhome discharges (21.6 vs. 16.3%; p < .01), and longer length of stay (7 days [IQR 2-12] vs. 6 days [IQR 2-12], p = .02) with higher 30-day readmission rate compared to males (20.5 vs.16.4%, p < .01). Furthermore, among patients who received the IPVADs for high-risk percutaneous coronary intervention (HRPCI), females continued to have worse MAEs, which was driven by high rates of major bleeding. However, among patients who received IPVADs for cardiogenic shock (CS) the outcomes of females and males were comparable. CONCLUSIONS Among all-comers who received IPVADs, females suffered higher morbidity and mortality compared to males. Higher morbidity driven mainly by higher rates of major bleeding was seen among females who received IPVADs for the hemodynamic support during HRPCI and comparable outcomes were observed when the IPVADs were used for CS.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Moinuddin Syed
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Yasir Abdul Ghaffar
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Brijesh Patel
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Ashraf Abugroun
- Department of Internal medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Akram Kawsara
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Madhavi Kadiyala
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Ramesh Daggubati
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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Latif A, Lateef N, Ahsan MJ, Kapoor V, Usman RM, Cooper S, Andukuri V, Mirza M, Ashfaq MZ, Khouzam R. Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Cardiac Surgery: Meta-Analysis and Systematic Review of the Literature. J Cardiovasc Dev Dis 2020; 7:jcdd7030036. [PMID: 32927705 PMCID: PMC7570107 DOI: 10.3390/jcdd7030036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 11/16/2022] Open
Abstract
The number of patients with severe aortic stenosis (AS) and a history of prior cardiac surgery has increased. Prior cardiac surgery increases the risk of adverse outcomes in patients undergoing aortic valve replacement. To evaluate the impact of prior cardiac surgery on clinical endpoints in patients undergoing transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR), we performed a literature search using PubMed, Embase, Google Scholar, and Scopus databases. The clinical endpoints included in our study were 30-day mortality, 1-2-year mortality, acute kidney injury (AKI), bleeding, stroke, procedural time, and duration of hospital stay. Seven studies, which included a total of 8221 patients, were selected. Our study found that TAVR was associated with a lower incidence of stroke and bleeding complications. There was no significant difference in terms of AKI, 30-day all-cause mortality, and 1-2-year all-cause mortality between the two groups. The average procedure time and duration of hospital stay were 170 min less (p ≤ 0.01) and 3.6 days shorter (p < 0.01) in patients with TAVR, respectively. In patients with prior coronary artery bypass graft and severe AS, both TAVR and SAVR are reasonable options. However, TAVR may be associated with a lower incidence of complications like stroke and perioperative bleeding, in addition to a shorter length of stay.
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Affiliation(s)
- Azka Latif
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
- Correspondence: ; Tel.: +1-402-651-4961
| | - Noman Lateef
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Muhammad Junaid Ahsan
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Vikas Kapoor
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Rana Mohammad Usman
- Department of Internal Medicine, University of Tennessee, Memphis, TN 38152, USA;
| | - Stephen Cooper
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Venkata Andukuri
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Mohsin Mirza
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Muhammad Zubair Ashfaq
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Rami Khouzam
- Department of Cardiology, University of Tennessee, Memphis, TN 38152, USA;
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Li P, Lu X, Kranis M, Wu F, Teng C, Cai P, Hashmath Z, Wang B. The association between anxiety disorders and in-hospital outcomes in patients with myocardial infarction. Clin Cardiol 2020; 43:622-629. [PMID: 32187718 PMCID: PMC7298986 DOI: 10.1002/clc.23358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anxiety disorders are prevalent in patients with myocardial infarction (MI), but the effects of anxiety disorders on in-hospital outcomes within MI patients have not been well studied. HYPOTHESIS To examine the effects of concurrent anxiety disorders on in-hospital outcomes in MI patients. METHODS We conducted a retrospective cohort study in patients with a principal diagnosis of MI with and without anxiety disorders in the National Inpatient Sample 2016. A total of 129 305 primary hospitalizations for acute MI, 35 237 with ST-segment elevation myocardial infarction (STEMI), and 94 068 with non-ST elevation myocardial infarction (NSTEMI) were identified. Of these, 13 112 (10.1%) had anxiety (7.9% in STEMI and 11.0% in NSTEMI). We compared outcomes of anxiety and nonanxiety groups after propensity score matching for the patient and hospital demographics and relevant comorbidities. RESULTS After propensity score matching, the anxiety group had a lower incidence of in-hospital mortality (3.0% vs 4.4%, P < .001), cardiac arrest (2.1% vs 2.8%, P < .001), cardiogenic shock (4.9% vs 5.6%, P = .007), and ventricular arrhythmia (6.7% vs 7.9%, P < .001) than the nonanxiety group. In the NSTEMI subgroup, the anxiety group had significantly lower rates of in-hospital mortality (2.3% vs 3.5%, P < .001), cardiac arrest (1.1% vs 1.5%, P = .008), and cardiogenic shock (2.8% vs 3.5%, P = .008). In the STEMI subgroup, we found no differences in in-hospital outcomes (all P > .05) between the matched groups. CONCLUSION Although we found that anxiety was associated with better in-hospital outcomes, subgroup analysis revealed that this only applied to patients admitted for NSTEMI instead of STEMI.
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Affiliation(s)
- Pengyang Li
- Department of MedicineSaint Vincent HospitalWorcesterMassachusettsUSA
| | - Xiaojia Lu
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Mark Kranis
- Department of CardiologySaint Vincent HospitalWorcesterMassachusettsUSA
| | - Fangcheng Wu
- Department of MedicineMemorial Hospital WestPembroke PinesFloridaUSA
| | - Catherine Teng
- Department of Medicine, Greenwich HospitalYale New Haven HealthGreenwichConnecticutUSA
| | - Peng Cai
- Department of Mathematical SciencesWorcester Polytechnic InstituteWorcesterMassachusettsUSA
| | - Zeba Hashmath
- Department of MedicineSaint Vincent HospitalWorcesterMassachusettsUSA
| | - Bin Wang
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
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Li P, Lu X, Teng C, Cai P, Kranis M, Dai Q, Wang B. The Impact of COPD on in-Hospital Outcomes in Patients with Takotsubo Cardiomyopathy. Int J Chron Obstruct Pulmon Dis 2020; 15:2333-2341. [PMID: 33061351 PMCID: PMC7532913 DOI: 10.2147/copd.s267289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/31/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is a known comorbidity of takotsubo cardiomyopathy (TCM), and COPD exacerbation is a potential triggering factor of TCM. The association between COPD and in-hospital outcomes and complications among TCM patients is not well established. We sought to assess the effect of COPD on hospitalized patients with a primary diagnosis of TCM. METHODS We conducted a retrospective cohort study in patients with a primary diagnosis of TCM with or without COPD using the latest National Inpatient Sample from 2016-2017. We identified 3139 patients admitted with a primary diagnosis of TCM by the ICD-10-CM coding system; 684 of those patients also had a diagnosis of COPD. We performed propensity score matching in a 1:2 ratio (n=678 patients, matched COPD group; n=1070, matched non-COPD group) and compared in-hospital outcomes and complications between TCM patients with and without a COPD diagnosis. RESULTS Before matching, the COPD group had worse outcomes compared with the non-COPD group in inpatient death (2.9% vs 1.3%, p=0.006), length of stay (LOS) (4.02±2.99 days vs 3.27±3.39 days, p<0.001), hospitalization charges ($55,242.68±47,637.40 vs $48,316.97±47,939.84, p=0.001), and acute respiratory failure (ARF) (22.5% vs 7.7%, p<0.001), respectively. After propensity score matching, the matched COPD group, compared with the matched non-COPD group, had a higher inpatient mortality rate (2.9% vs1.0%, p=0.005), longer LOS (4.02±3.00 days vs 3.40±3.54 days, p<0.001), higher hospitalization charges ($55,409.23±47,809.13 vs $46,469.60±42,209.10, p<0.001), and a higher incidence of ARF (22.6% vs 8.2%, p<0.001) and cardiogenic shock (5.6% vs 3.3%, p=0.024), respectively. CONCLUSION Patients with COPD who are hospitalized for TCM have higher rates of inpatient mortality, ARF, cardiogenic shock, as well as a longer LOS, and higher charges of stay than those without COPD. Prospective studies are warranted to examine the effect of early intervention or treatment of COPD on short- and long-term outcomes of TCM.
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Affiliation(s)
- Pengyang Li
- Department of Medicine, Saint Vincent Hospital, Worcester, MA01608, USA
| | - Xiaojia Lu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, People’s Republic of China
| | - Catherine Teng
- Department of Internal Medicine, Yale New Haven Health-Greenwich Hospital, Greenwich, CT06830, USA
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA01609, USA
| | - Mark Kranis
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA01608, USA
| | - Qiying Dai
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA01608, USA
| | - Bin Wang
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, People’s Republic of China
- Correspondence: Bin Wang Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, Guangdong515041, People’s Republic of ChinaTel +86-75488905399Fax +86 75488259850 Email
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Owusu-Guha J, Guha A, Miller PE, Pawar S, Dey AK, Ahmad T, Attar H, Awan FT, Mitchell D, Desai NR, Addison D. Contemporary utilization patterns and outcomes of thrombolytic administration for ischemic stroke among patients with cancer. Int J Stroke 2019; 16:150-162. [PMID: 31868139 DOI: 10.1177/1747493019895709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Thrombolytic therapy significantly improves outcomes among patients with acute ischemic stroke. While cancer outcomes have dramatically improved, the utilization, safety, and mortality outcomes of patients with cancer who receive thrombolytic therapy for acute ischemic stroke are unknown. METHODS Using a national database, we identified all hospitalizations for acute ischemic stroke requiring thrombolytic therapy between 2003 and 2015. Patients with contraindications to thrombolytic therapy were excluded. Following propensity score matching for comorbidity burden, trends in thrombolytic therapy use and its effect on in-hospital mortality, intracranial or all-cause bleeding, and the combined endpoint of mortality and all-cause bleeding, by presence/absence of cancer were evaluated. We also evaluated 30- and 90-day readmission rates post-thrombolytic therapy administration. RESULTS We identified 237,687 acute ischemic stroke hospitalizations requiring thrombolytic therapy, of which 26,328 (11%) had an underlying cancer. Over the study period, thrombolytic therapy use increased across all acute ischemic stroke admissions, irrespective of cancer presence (12.4/1000 in 2003 to 81.1/1000 in 2015, P < 0.0001). However, thrombolytic therapy utilization differed by cancer presence (4.8% cancer vs.·5.1% non-cancer, P = 0.001). There was no difference in intracranial bleeding (9.6% vs. 9.7%), all-cause bleeding (13.2% vs. 13.2%), or in-hospital mortality (7.6% vs. 7.2%). While there was no difference in 30-day readmission rates by cancer presence (24% vs. 29%, P = 0.40), at 90-days, cancer patients saw higher readmission rates (17.2% vs. 13.3%, P = 0.02). CONCLUSIONS Contemporary thrombolytic therapy use for acute ischemic stroke has risen, irrespective of presence of cancer. Yet, patients with comorbid cancer appear to see lower rates of thrombolytic therapy use for acute ischemic stroke, despite no difference in the rate of intracranial bleeding or mortality after adjustment for comorbidities.
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Affiliation(s)
- Jocelyn Owusu-Guha
- Cardio-Oncology Program, Division of Cardiovascular Medicine, 2647Ohio State University, Columbus, OH, USA.,Pharmacy Department, Riverside Methodist Hospital, Columbus, OH, USA
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiovascular Medicine, 2647Ohio State University, Columbus, OH, USA.,Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH, USA
| | - P Elliott Miller
- Division of Cardiology, 5755Yale University School of Medicine, New Haven, CT, USA
| | - Sumeet Pawar
- Division of Cardiology, 5755Yale University School of Medicine, New Haven, CT, USA
| | - Amit K Dey
- National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Tariq Ahmad
- Division of Cardiology, 5755Yale University School of Medicine, New Haven, CT, USA
| | - Hatim Attar
- Department of Neurology, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Farrukh T Awan
- Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Darrion Mitchell
- Department of Radiation Oncology, 2647Ohio State University, Columbus, OH, USA
| | - Nihar R Desai
- Division of Cardiology, 5755Yale University School of Medicine, New Haven, CT, USA.,Center for Outcomes Research and Evaluation, New Haven, CT, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiovascular Medicine, 2647Ohio State University, Columbus, OH, USA
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Abstract
Objective Glucose and lactate levels in patients at the time of admission have been studied in diverse patient groups. Some studies suggest that elevated glucose levels at admission predict worse outcomes. Elevated Lactate levels have also been reported to be directly associated with increased mortality. We wanted to determine if the combination of admission glucose and lactate levels improves the predictability of inpatient mortality and length of stay (LOS). Methods This is a retrospective study. We included all adult patients admitted at an academic medical center from October 1, 2015 to September 30, 2016. We collected basic clinical information, including age, gender, admission glucose and lactate levels, LOS, and mortality. We separated outcomes based on glucose and lactate levels by dividing them into quartiles. We also stratified patients based on normal lactate (<2.0 mmol/L), high lactate (2.0-4.0 mmol/L), and very high lactate (>4 mmol/L) levels; and on normal glucose (60-140 mg/dl), high glucose (140-200 mg/dl), and very high glucose (>200 mg/dl) levels. Results A total of 5,436 adult patients were included in our study. The median age was 58 years, and 57% of the patients were male. The median LOS was 6 days, and the overall in-hospital mortality rate was 11%. When the patients were separated in quartiles based on admission glucose values, mortality was higher in the 4th quartile (≥173 mg/dL): 14.87%, probability value (p): <0.001. When the patients were separated in quartiles based on lactate levels, the mortality was higher in the 4th quartile (≥2.23 mmol/L): 21.95%, p: 0.001. When the patients were paired according to normal, high, or very high lactate and glucose levels, the groups that had higher mortality were as follows: normal glucose/very high lactate: 32.43%; high glucose/very high lactate: 34.04%; and very high glucose and very high lactate: 39.15%. The groups with very high glucose and very high lactate had increased odds of mortality when compared with the other groups (p: <0.001). Conclusions Admission glucose and lactate levels provide useful information in the estimation of inpatient mortality. The LOS was shortened in the groups with higher glucose, lactate, or both. The combination of glucose and lactate levels predicted mortality better than either value alone.
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Affiliation(s)
- David Sotello
- Internal Medicine/Pulmonary and Critical Care Medicine, Texas Tech Health Sciences Center, Lubbock, USA
| | - Shengping Yang
- Biostatistics, Pennington Biomedical Research Center, Baton Rouge, USA
| | - Kenneth Nugent
- Internal Medicine/Pulmonary and Critical Care Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
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Rehman S, Li X, Wang C, Ikram M, Rehman E, Liu M. Quality of Care for Patients with Acute Myocardial Infarction (AMI) in Pakistan: A Retrospective Study. Int J Environ Res Public Health 2019; 16:E3890. [PMID: 31615067 DOI: 10.3390/ijerph16203890] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 12/21/2022]
Abstract
A wide variation exists in the practice patterns of acute myocardial infarction (AMI) care worldwide, leading to differences in clinical outcomes. This study aims to evaluate the quality of process care and its impact on in-hospital outcomes among AMI patients in Pakistan, as no such study has been conducted in Pakistan thus far based upon recommended guidelines. We investigated a sample of 2663 AMI patients across 11 territory hospitals in Punjab province of Lahore, Faisalabad, Multan, Rawalpindi, and Islamabad from January 1, 2016 to December 31, 2017, with an in-hospital mortality rate of 8.6%. We calculated compliance rates of quality indicators (QIs) for all eligible patients. The association between process care and in-hospital outcome was assessed using hierarchical generalized linear model that adjusted for patient and hospital characteristics. In addition, we examined the effect of patient composite scores on clinical outcomes. Aspirin (73.08%) and clopidogrel (67.86%) indicated relatively better conformance than other QIs. The percutaneous coronary intervention also showed significantly low adherence. All QIs showed no significant association with in-hospital mortality. In contrast, 4 out of 8 QIs were observed positively correlated with in-hospital length of stay (LOS). The overall patient composite score was found to be statistically significant with in-hospital LOS. The assessment of quality of care showed low adherence to clinical care recommendations, and increased adherence was associated with longer in-hospital LOS among AMI patients. Evaluation of valid QIs for AMI treatment and their impact on in-hospital outcomes is an important tool for improving health care delivery in the overall AMI population in Pakistan. Low adherence to performance measures strongly compel to focus on guideline-based tools for AMI in Pakistan.
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Lin Y, Peng Y, Chen Y, Li S, Huang X, Zhang H, Jiang F, Chen Q. Association of lymphocyte to monocyte ratio and risk of in-hospital mortality in patients with acute type A aortic dissection. Biomark Med 2019; 13:1263-1272. [PMID: 31584289 DOI: 10.2217/bmm-2018-0423] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aim: The aim of the study was to evaluate the relationship between lymphocyte to monocyte ratio (LMR) at admission and in-hospital mortality of patients with acute type A aortic dissection (AAAD). Patients & methods: We enrolled 536 patients with AAAD between June 2013 and December 2017. Patients were divided into two groups: the deceased group and the survival group. Results: In multivariable analysis, the association between LMR and in-hospital mortality was still significant. When the Q4 was set as the reference value, the odds ratios values of Q1, Q2 and Q3 were 4.4 (95% CI: 2.2-8.9; p < 0.001), 1.4 (95% CI: 1.1-3.4; p = 0.03) and 1.7 (95% CI: 0.8-2.9; p = 0.158). Conclusion: Lower LMR may be independently associated with in-hospital mortality in AAAD.
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Affiliation(s)
- Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, PR China.,Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, PR China
| | - Yanchun Peng
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, PR China
| | - Yiping Chen
- Department of Nursing, Fujian Medical University, Fuzhou, PR China
| | - Sailan Li
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, PR China.,Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, PR China
| | - Xizhen Huang
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, PR China.,Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, PR China
| | - Haoruo Zhang
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, PR China
| | - Fei Jiang
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, PR China.,Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, PR China
| | - Qiong Chen
- Department of Nursing, Fujian Medical University, Fuzhou, PR China
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42
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Gao S, Liu Q, Ding X, Chen H, Zhao X, Li H. Predictive Value of the Acute-to-Chronic Glycemic Ratio for In-Hospital Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention. Angiology 2019; 71:38-47. [PMID: 31554413 PMCID: PMC6886151 DOI: 10.1177/0003319719875632] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study investigated whether a novel index of stress hyperglycemia might have a better prognostic value compared to admission glycemia alone in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). The acute-to-chronic glycemic ratio was expressed as admission blood glucose (ABG) devided by the estimated average glucose (eAG), and eAG was derived from the glycated hemoglobin (HbA1c). A total of 1300 consecutive patients with STEMI treated with PCI were included. Baseline data and outcomes were analyzed. The study end point was a composite of in-hospital all-cause death, cardiogenic shock, and acute pulmonary edema. Accuracy was defined with area under the curve (AUC) by a receiver–operating characteristic (ROC) curve analysis. After multivariate adjustment, both ABG/eAG and ABG were closely associated with an increased risk of the composite end point in nondiabetic patients. However, only ABG/eAG (odds ratio = 2.45, 95% confidence interval: 1.24-4.82, P = .010), instead of ABG, was associated with the outcomes in diabetic patients. Compared to ABG, ABG/eAG had an equivalent predictive value in nondiabetic patients but a superior discriminatory ability in diabetic patients (AUC improved from 0.52-0.63, P < .001). Taken together, ABG/eAG provides more significant in-hospital prognostic information than ABG in diabetic patients with STEMI after PCI.
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Affiliation(s)
- Side Gao
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qingbo Liu
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaosong Ding
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xueqiao Zhao
- Division of Cardiology, Clinical Atherosclerosis Research Lab, University of Washington, Seattle, WA, USA
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Metabolic Disorders Related Cardiovascular Disease, Beijing, China
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Kazantsev AN, Tarasov RS, Burkov NN, Volkov AN, Grachev KI, Iakhnis EI, Lider RI, Shabaev AR, Barbarash LS. [ In-hospital outcomes of transcutaneous coronary intervention and carotid endarterectomy in hybrid and staged regimens]. Angiol Sosud Khir 2019; 25:101-107. [PMID: 30994615 DOI: 10.33529/angio2019114] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The aim of this study was comparative assessment of in-hospital outcomes after hybrid and staged surgical management of patients presenting with haemodynamically significant lesions of the coronary (CA) and brachiocephalic arteries (BCA) treated by means of either endovascular or surgical techniques. Over the period from 2010 to 2017, we operated on a total of 197 patients with stenotic lesions of the carotid and coronary arteries. The strategy of revascularization included transcutaneous coronary intervention (TCI) and carotid endarterectomy (CEA). Of these, 73 (37%) patients underwent staged revascularization of the brain and myocardium in various sequence (TCI-CEA or CEA-TCI), with a mean interval between the operations amounting to 9.89±7.36 months. Unfavourable outcomes were regarded as the development of such significant cardiovascular events as myocardial infarction (MI), acute impairment of cerebral circulation, death, repeat unplanned revascularization. For hybrid strategy (TCI+CEA) the index period of assessing the outcomes was the single in-hospital period, whereas for the staged strategy it was the time period beginning from the in-hospital period of the primary operation and ending by the in-hospital period of the second stage. The groups were comparable by the absolute majority of the parameters. More than half of the patients were elderly males. One third had a history of MI. The findings of coronary angiography most often revealed lesions of 1-2 CAs. The average parameters of carotid artery stenosis, according to the BCA angiography varied from 74.9 to 82.6%, with bilateral occlusive stenotic lesions being revealed in every third patient. In connection with more frequent involvement of 1-2 CAs the patients underwent implantation of 1-2 stents. In our sample we used a total of 247 stents. Of these, 119 were uncoated and 128 were drug-eluting stents. No between-group significant differences in the development of unfavourable cardiovascular events during the in-hospital postoperative period were revealed. However, despite this, a pronounced negative tendency of the complication rate was noted in the group of staged revascularization. Non-optimal time intervals between the stages of the operations in a third of cases exceeded one year on the patient's own initiative. Nearly a quarter of patients did not come for the second stage of revascularization. An important finding of our study was no increase in the risk of stent thrombosis in hybrid operations compared with the staged approach, despite administration of a loading dose of clopidogrel after CEA, but not before TCI. Another significant result was the fact of greater availability of revascularization of the myocardium and the brain within the framework of the hybrid strategy as compared with the staged one, which may play an important role in prevention of ischaemic unfavourable events in the remote period of follow up.
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Affiliation(s)
- A N Kazantsev
- Research Institute for Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
| | - R S Tarasov
- Research Institute for Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
| | - N N Burkov
- Research Institute for Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
| | - A N Volkov
- Kemerovo Regional Clinical Cardiological Dispensary named after Academician L.S. Barbarash, Kemerovo, Russia
| | - K I Grachev
- Kemerovo State Medical University of the RF Ministry of Public Health, Kemerovo, Russia
| | - E Ia Iakhnis
- Kemerovo State Medical University of the RF Ministry of Public Health, Kemerovo, Russia
| | - R Iu Lider
- Kemerovo State Medical University of the RF Ministry of Public Health, Kemerovo, Russia
| | - A R Shabaev
- Kemerovo Regional Clinical Cardiological Dispensary named after Academician L.S. Barbarash, Kemerovo, Russia
| | - L S Barbarash
- Research Institute for Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
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Tarasov RS, Kazantsev AN, Burkov NN, Anufriyev AI, Yakhnis YY, Grachev KI, Shabayev AR, Mironov AV, Barbarash LS. [ In-hospital outcomes of carotid endarterectomy depending on severity of contralateral lesion]. Khirurgiia (Mosk) 2018:61-68. [PMID: 30531739 DOI: 10.17116/hirurgia201810161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To compare in-hospital outcomes of carotid endarterectomy (CEE) in patients with different lesion of contralateral internal carotid artery (ICA). MATERIAL AND METHODS There were 730 CEE procedures in patients with bilateral ICA lesion for the period 2011-2016. All patients were divided into 4 groups depending on contralateral ICA stenosis grade: group 1 - stenosis up to 60% (42.6%, n=311); group 2 - 60-90% (18.7%, n=137); group 3 - 90-99% (25.9%, n=189); group 4 - occlusion (12.7%, n=93). Endpoints were unfavorable cardiovascular events including death, myocardial infarction (MI), stroke/TIA, significant hemorrhage by BARC scale (Bleeding Academic Research Consortium). RESULTS In-hospital mortality and incidence of MI, stroke/TIA were similar in all groups. However, there were no cardiovascular complications in patients with critical contralateral stenosis or occlusion. Bleeding followed by redo surgery was the most frequent complication. Overall incidence of adverse cardiovascular events did not exceed 1.23%. CONCLUSION There was no correlation between contralateral ICA stenosis and incidence of in-hospital adverse events including death, MI, stroke/TIA. Currently, technique of CEE is well developed that is associated with low incidence of postoperative complications.
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Affiliation(s)
- R S Tarasov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - A N Kazantsev
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - N N Burkov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - A I Anufriyev
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Ye Ya Yakhnis
- Kemerovo State Medical University of Healthcare Ministry of the Russian Federation, Kemerovo, Russia
| | - K I Grachev
- Kemerovo State Medical University of Healthcare Ministry of the Russian Federation, Kemerovo, Russia
| | - A R Shabayev
- Kemerovo Regional Clinical Cardiology Dispensary, Kemerovo, Russia
| | - A V Mironov
- Kemerovo Regional Clinical Cardiology Dispensary, Kemerovo, Russia
| | - L S Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
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Maeremans J, Kayaert P, Bataille Y, Bennett J, Ungureanu C, Haine S, Vandendriessche T, Sonck J, Scott B, Coussement P, Dendooven D, Pereira B, Frambach P, Janssens L, Debruyne P, Van Mieghem C, Barbato E, Cornelis K, Stammen F, De Vroey F, Vercauteren S, Drieghe B, Aminian A, Debrauwere J, Carlier S, Coosemans M, Van Reet B, Vandergoten P, Dens JA. Assessing the landscape of percutaneous coronary chronic total occlusion treatment in Belgium and Luxembourg: the Belgian Working Group on Chronic Total Occlusions (BWGCTO) registry. Acta Cardiol 2018; 73:427-436. [PMID: 29183248 DOI: 10.1080/00015385.2017.1408891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Important developments in materials, devices, and techniques have improved outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), and resulted in a growing interest in CTO-PCI. The Belgian Working Group on Chronic Total Occlusions (BWGCTO) working group aims to assess the evolution within the CTO-PCI landscape over the next years. Methods: From May 2016 onwards, patients undergoing CTO-PCI were included in the BWGCTO registry by 15 centres in Belgium and Luxemburg. Baseline, angiographic, and procedural data were collected. Here, we report on the one-year in-hospital outcomes. Results: Over the course of one year, 411 procedures in 388 patients were included with a mean age of 64 ± 11 years. The majority were male (81%). Relatively complex CTOs were treated (Japanese CTO score =2.2 ± 1.2) with a high procedure success rate (82%). Patient- and lesion-wise success rates were 83 and 85%, respectively. Major adverse in-hospital events were acceptably low (3.4%). Antegrade wire escalation technique was applied most frequently (82%). On the other hand, antegrade dissection and re-entry and retrograde strategies were more frequently applied in higher volume centres and successful for lesions with higher complexity. Conclusion: Satisfactory procedural outcomes and a low rate of adverse events were obtained in a complex CTO population, treated by operators with variable experience levels. Antegrade wire escalation was the preferred strategy, regardless of operator volume.
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Affiliation(s)
- Joren Maeremans
- Faculty of Medicine and Life Sciences, Universiteit Hasselt , Hasselt , Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg , Genk , Belgium
| | - Peter Kayaert
- Department of Cardiology, Universitair Ziekenhuis Brussel , Brussels , Belgium
- Department of Cardiology, Universitair Ziekenhuis Gent , Ghent , Belgium
| | - Yoann Bataille
- Department of Cardiology, CHR de la Citadelle , Liège , Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, Universitair Ziekenhuis Leuven , Leuven , Belgium
| | - Claudiu Ungureanu
- Department of Cardiology, Hôpital de Jolimont , Haine-Saint-Paul , Belgium
| | - Steven Haine
- Department of Cardiology, Universitair Ziekenhuis Antwerpen , Edegem , Belgium
| | - Tom Vandendriessche
- Department of Cardiology, Universitair Ziekenhuis Antwerpen , Edegem , Belgium
| | - Jeroen Sonck
- Department of Cardiology, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Benjamin Scott
- Department of Cardiology, Hartcentrum ZNA , Antwerpen , Belgium
| | | | | | - Bruno Pereira
- Department of Cardiology, INCCI Haerz Zenter , Luxembourg , Luxembourg
| | - Peter Frambach
- Department of Cardiology, INCCI Haerz Zenter , Luxembourg , Luxembourg
| | - Luc Janssens
- Department of Cardiology, Imelda Ziekenhuis , Bonheiden , Belgium
| | | | - Carlos Van Mieghem
- Department of Cardiology, Onze-Lieve-Vrouw Ziekenhuis Aalst , Aalst , Belgium
| | - Emanuele Barbato
- Department of Cardiology, Onze-Lieve-Vrouw Ziekenhuis Aalst , Aalst , Belgium
| | | | | | - Frederic De Vroey
- Department of Cardiology, Grand Hôpital de Charleroi , Charleroi , Belgium
| | | | - Benny Drieghe
- Department of Cardiology, Universitair Ziekenhuis Gent , Ghent , Belgium
| | - Adel Aminian
- Department of Cardiology, CHU Charleroi , Charleroi , Belgium
| | | | | | - Mark Coosemans
- Department of Cardiology, AZ Turnhout , Turnhout , Belgium
| | - Bert Van Reet
- Department of Cardiology, AZ Turnhout , Turnhout , Belgium
| | | | - Jo Andre Dens
- Faculty of Medicine and Life Sciences, Universiteit Hasselt , Hasselt , Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg , Genk , Belgium
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Nalluri N, Atti V, Patel NJ, Kumar V, Arora S, Nalluri S, Nelluri BK, Maniatis GA, Kandov R, Kliger C. Propensity matched comparison of in-hospital outcomes of TAVR vs. SAVR in patients with previous history of CABG: Insights from the Nationwide inpatient sample. Catheter Cardiovasc Interv 2018; 92:1417-1426. [PMID: 30079611 DOI: 10.1002/ccd.27708] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/03/2018] [Accepted: 05/30/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The incidence of patients with previous history of coronary artery bypass grafting (CABG) presenting for aortic valvular replacement has been consistently on the rise. Repeat sternotomy for surgical aortic valve replacement (SAVR) carries an inherent risk of morbidity and mortality when compared to Transcatheter aortic valve replacement (TAVR). METHODS The Nationwide inpatient sample (NIS) from 2012 to 2014 was queried using the International Classification of Diseases-Ninth edition, Clinical Modification (ICD-9-CM) codes to identify all patients ≥ 18 years with prior CABG who underwent TAVR (35.05 and 35.06) or SAVR (35.21 and 35.22). Propensity score matching (1:1) was performed and in-hospital outcomes were compared between matched cohorts. RESULTS From 2012 to 2014, there was progressive increase in the annual number of TAVR procedures from 1485 to 4020, with a decrease in patients undergoing SAVR from 2330 to 1955 (Ptrend < 0.0001) in the above population. There was no significant difference in in-hospital mortality rates. Compared to SAVR, TAVR was associated with lower risk of stroke (1.2% vs. 3.3%, P = 0.009), AKI (12.9% vs. 21.3%, P < 0.0001), myocardial infarction (0.9% vs. 2.7%, P = 0.01) and major bleeding (9.1% vs. 25.1%, P < 0.0001). TAVR was associated with higher risk of pacemaker implants (9.6% vs. 4.9%, P = 0.001) and trend toward lower risk of vascular complications (2.3% vs. 4.1%, P = 0.05). CONCLUSION In this large cohort of patients with previous CABG, there is no significant difference in in-hospital mortality between TAVR and SAVR. TAVR was associated with lower risk of in-hospital outcomes.
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Affiliation(s)
- Nikhil Nalluri
- Department of Cardiology, Staten Island University Hospital, New York City, New York
| | - Varunsiri Atti
- Department of Internal medicine, Michigan State University-Sparrow Hospital, East Lansing, Michigan
| | - Nileshkumar J Patel
- Department of Cardiology, University of Miami-Jackson Memorial Hospital, Miami, Florida
| | - Varun Kumar
- Department of Cardiology, Mount Sinai St Luke's Roosevelt hospital, New York City, New York
| | - Shilpkumar Arora
- Department of Internal medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania
| | | | | | - Gregory A Maniatis
- Department of Cardiology, Staten Island University Hospital, New York City, New York
| | - Ruben Kandov
- Department of Cardiology, Staten Island University Hospital, New York City, New York
| | - Chad Kliger
- Department of Cardiology, Structural Heart Disease Lenox Hill Hospital, New York City, New York
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Tsampalieros A, Knoll GA, Dixon S, English S, Manuel D, Van Walraven C, Taljaard M, Fergusson D. Case Mix, Patterns of Care, and Inpatient Outcomes Among Ontario Kidney Transplant Centers: A Population-Based Study. Can J Kidney Health Dis 2018; 5:2054358117730053. [PMID: 30034813 PMCID: PMC6050611 DOI: 10.1177/2054358117730053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 08/04/2017] [Indexed: 12/30/2022] Open
Abstract
Background: Significant variation in both patient case mix and the structure of care in kidney transplantation has been previously described in the United States. Objective: The objective of our study was to characterize patient case mix, patterns of care, and inpatient outcomes across 5 kidney transplant centers in the province of Ontario, Canada. Design: This was a retrospective population-based cohort study using health care administrative databases. Setting: The setting is Ontario, Canada. Patients: We included adult (≥18 years) transplant recipients who received a primary, solitary kidney between January 1, 2000, and December 31, 2013 (N = 5037). Methods: Using linked administrative health care databases, we characterized kidney transplant recipient and donor factors, center characteristics, provider characteristics, and inpatient outcomes across transplant centers in Ontario. To compare case mix–adjusted differences in length of stay across centers, multivariable Cox proportional hazards regression was used to obtain hazard ratios (HRs) for each center relative to the average across all centers. Center volume and provider characteristics were added to the models to examine whether these factors explain differences in length of stay across centers. Results: We noted significant differences across transplant centers in patient race, cause of end-stage renal disease, body mass index, comorbidities, time on dialysis, and donor type. Mean annual transplant center volumes during the study period ranged between 51.5 (9.3) and 101.7 (23.9) transplants/year across centers (P < .0001). Physician specialty most responsible for in-hospital transplant care varied significantly across centers with the most common combination being nephrologist and urologist. Less than 31 deaths occurred in hospital during the index transplant admission but mortality risk did not differ significantly between centers. Overall, 25.1% of recipients required dialysis in hospital post transplantation (range across centers 18.3%-33.5%, P < .0001) and 24.7% of recipients spent time in the intensive care unit (ICU; range across centers: 5.7%-58.0%, P < .0001). The proportion of participants requiring dialysis did not change with time (P = .12), whereas the proportion staying in the ICU increased steadily over time (P < .0001). The median length of stay in hospital after transplantation ranged from 7 to 9 days across centers (P < .0001) and decreased significantly over time. After adjusting for patient case mix as well as center and provider factors, HRs for length of stay censored at the time of death ranged between 0.75 (95% confidence interval [CI]: 0.69-0.82) and 1.29 (95% CI: 1.20-1.38) across centers. Center volume and provider experience were not independently associated with length of hospital stay. Limitations: Data were missing (0.8%-18.4%) for certain covariates of interest. Conclusions: This study found significant heterogeneity across kidney transplant centers in case mix, practice patterns, and inpatient outcomes. Future studies are needed to examine the influence of length of stay and practice patterns on long-term outcomes such as patient/graft survival and quality of life.
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Affiliation(s)
- Anne Tsampalieros
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Greg A Knoll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,Division of Nephrology, Kidney Research Center, Department of Medicine, University of Ottawa, Ontario, Canada
| | - Stephanie Dixon
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Shane English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,Department of Medicine (Critical Care), University of Ottawa, Ontario, Canada
| | - Douglas Manuel
- Department of Family Medicine, University of Ottawa, Ontario, Canada
| | - Carl Van Walraven
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,Department of Medicine, University of Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada
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Briceño DF, Gupta T, Romero J, Kolte D, Khera S, Villablanca PA, Tran A, Mohanty S, Trivedi C, Mohanty P, Gianni C, Kim SG, Garcia M, Fonarow GC, Bhatt DL, Natale A, Di Biase L. Catheter ablation of ventricular tachycardia in nonischemic cardiomyopathy: A propensity score-matched analysis of in-hospital outcomes in the United States. J Cardiovasc Electrophysiol 2018; 29:771-779. [PMID: 29399923 DOI: 10.1111/jce.13452] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/21/2018] [Accepted: 01/26/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Monomorphic ventricular tachycardia (VT) is an important cause of morbidity and mortality. Use and outcome data of catheter ablation for VT in nonischemic cardiomyopathy (NICM) are limited. METHODS AND RESULTS We obtained data from the 2003-2014 National Inpatient Sample databases. We used propensity score matching to compare patients undergoing catheter ablation versus medical therapy of VT related to NICM, and described the temporal trends in utilization and in-hospital outcomes of catheter ablation of VT in patients with NICM in the United States. From 2003 to 2014, of 133,529 patients hospitalized with the principal diagnosis of VT in NICM, 14,651 (11.0%) underwent catheter ablation. In this period, there was an increasing trend in utilization of catheter ablation (9.3% in 2003-2004 to 12.1% in 2003-2014, adjusted OR [per year], 1.12; 95% CI, 1.08-1.16; Ptrend < 0.001). After propensity score matching, in-hospital mortality occurred in 172 of 14,318 (1.2%) patients in the catheter ablation group, compared with 297 of 14,156 (2.1%) of patients undergoing medical therapy (47% lower; 43% relative difference [adjusted OR, 0.53; 95% CI, 0.43-0.66]). CONCLUSIONS In patients with NICM, catheter ablation of VT is associated with lower in-hospital mortality compared with those managed medically. The utilization rates of CA for VT related to NICM have increased in the past decade. Adequately powered randomized trials will be necessary to confirm these findings.
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Affiliation(s)
- David F Briceño
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tanush Gupta
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jorge Romero
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dhaval Kolte
- Division of Cardiology, Brown University, Providence, RI, USA
| | - Sahil Khera
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Pedro A Villablanca
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - An Tran
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Prasant Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Soo G Kim
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mario Garcia
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, CA, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Luigi Di Biase
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
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Doshi R, Shah P, Meraj P. Gender disparities among patients with peripheral arterial disease treated via endovascular approach: A propensity score matched analysis. J Interv Cardiol 2017; 30:604-611. [PMID: 28815727 DOI: 10.1111/joic.12431] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Remarkable improvement in the treatment of Peripheral Arterial Disease (PAD) has led to changes in revascularization strategies from traditional open surgery to less invasive endovascular management. However, few studies are available on gender disparities in patients with PAD treated via an endovascular approach. This study was designed to analyze gender related differences with respect to in-hospital outcomes in PAD patients. METHODS Our data was obtained from National Inpatient Sample (NIS) 2012 through 2014. We used International Classification of Diseases, 9th Revision, Clinical Modification diagnostic and procedural codes appropriate for PAD and endovascular treatment. Endovascular treatment included drug eluting stent, bare metal stent, atherectomy or angioplasty of lower extremity arteries. A propensity score matching was performed to adjust for imbalances between variables. RESULTS Females presented late with more comorbidities and underwent more emergent/urgent procedures. After performing propensity score matched analysis, 25 758 patients were included in each group. There was no difference in in-hospital mortality between males and females in matched cohorts (2.3% vs 2.4%, P = 0.25). Acute renal failure, gangrene, infection, and composite of all complications were higher in males. Only blood transfusion was noted higher in females. CONCLUSION This study revealed no difference in in-hospital mortality between males and females undergoing endovascular peripheral intervention. Males have a higher rate of complications compared to females which explains the higher cost of care in males. Further research with long-term follow up is needed to see if there is any difference with regards to long-term outcomes and re-admission.
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Affiliation(s)
- Rajkumar Doshi
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Priyank Shah
- Department of Cardiology, Medical College of Georgia-Southwest Clinical Campus, Albany, Georgia
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
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50
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Desai R, Rupareliya C, Patel U, Naqvi S, Patel S, Lunagariya A, Mahuwala Z. Burden of Arrhythmias in Epilepsy Patients: A Nationwide Inpatient Analysis of 1.4 Million Hospitalizations in the United States. Cureus 2017; 9:e1550. [PMID: 29018647 PMCID: PMC5630461 DOI: 10.7759/cureus.1550] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Arrhythmias have been one of the common complications in epilepsy patients and have also been the reason for death. However, limited data exist about the burden and outcomes of arrhythmias by subtypes in epilepsy. Our study aims at evaluating the burden and differences in outcomes of various subtypes of arrhythmias in epilepsy patient population. The Nationwide Inpatient Sample (NIS) database from 2014 was examined for epilepsy and arrhythmias related discharges using appropriate International Classification of Disease, Ninth Revision Clinical Modification (ICD-9-CM) codes. The frequency of arrhythmias, gender differences in arrhythmia by subtypes, in-hospital outcomes and mortality predictors was analyzed. A total of 1,424,320 weighted epilepsy patients was determined and included in this study. Around 23.9% (n =277,230) patients had cardiac arrhythmias. The most frequent arrhythmias in the descending frequency were: atrial fibrillation (AFib) 9.7%, other unspecified causes 7.3%, sudden cardiac arrest (SCA) 1.4%, bundle branch block (BBB) 1.2%, ventricular tachycardia (VT) 1%. Males were more predisposed to cardiac arrhythmias compared to females (OR [odds ratio]: 1.1, p <0.001). The prevalence of most subtypes arrhythmias was higher in males. Arrhythmias were present in nearly a quarter of patients with epilepsy. Life threatening arrhythmias were more common in male patients. The length of stay (LOS) and mortality were significantly higher in epilepsy patients with arrhythmia. It is imperative to develop early diagnosis and prompt therapeutic measures to reduce this burden and poor outcomes due to concomitant arrhythmias in epilepsy patients.
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Affiliation(s)
- Rupak Desai
- Research Coordinator, Atlanta Veterans Affairs Medical Center
| | | | | | - Syeda Naqvi
- Jinnah Postgraduate Medical Centre, Jinnah Sindh Medical University (SMC)
| | - Smit Patel
- Department of Neurology, University of Connecticut Health Center
| | | | - Zabeen Mahuwala
- Department of Neurology, University Of Kentucky College of Medicine
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