1-year All-cause Mortality Research Articles

An explainable machine learning estimated biological age based on morphological parameters of the spine.

Accurately estimating biological age is beneficial for measuring aging and predicting risk. It is widely accepted that the prevalence of spine compression increases significantly with age. However, biological age based on vertebral morphological data is rarely reported. In this study, a total of 2,364 participants from the National Health and Nutrition Examination Survey were enrolled, and morphological parameters of the spine were collected from lateral radiographs scanned by dual energy X-ray absorptiometry. The biological age of the spine, called SpineAge, was calculated with the parameters by machine learning models. The SHapley Additive exPlanation was used for better interpreting each parameter's contribution. Besides, an Accelerated Aging Index (AAI) was defined as SpineAge minus chronological age and was used to quantify the accelerating aging degree of the spine. The results indicated that the SpineAge performed better than chronological age did in predicting 2-year and 5-year all-cause mortality. After adjusting all covariates, there was a significant association between AAI and all-cause mortality risk. Specifically, each 1-year increase in AAI was associated with a 25.9% increase in all-cause mortality risk (Hazards ratio, 1.259; 95% CI, 1.087-1.457; P < 0.001). Considering the first quartile of AAI as a reference, the mortality risks for the second, third, and fourth quartiles were 2.389 (95% CI, 1.064-5.364; P = 0.035), 5.911 (95% CI, 2.241-15.590; P < 0.001) and 22.925 (95% CI, 4.744-110.769; P < 0.001) times higher, respectively. Our study developed a novel and highly applicable biological-age predictor for predicting individualized long-term prognosis and facilitating personalized care.

Ten-year survival benefit and appropriateness of surgical versus percutaneous revascularization in synergy between percutaneous coronary intervention with Taxus and cardiac surgery randomized trial.

Average treatment effects from randomized trials do not reflect the heterogeneity of an individual's response to treatment. This study evaluates the appropriate proportions of patients for coronary artery bypass grafting, or percutaneous intervention based on the predicted/observed ratio of 10-year all-cause mortality in the SYNTAX population. The study included 1800 randomized patients and 1275 patients in the nested percutaneous (n = 198) or surgical (n = 1077) registries. The primary end point was 10-year all-cause mortality. The SYNTAX score II-2020 was validated internally in the randomized cohort and externally in the registry cohort. Proportions of patients with survival benefits from coronary artery bypass grafting or percutaneous intervention were determined using SYNTAX score II-2020. Ten-year mortality was 23.8% for coronary artery bypass grafting, 28.6% for percutaneous intervention in the randomized cohort, 27.6% for coronary artery bypass grafting and 55.4% for percutaneous intervention in the registries. In the coronary artery bypass grafting registry, the SYNTAX score II-2020 predicted 10-year mortality with helpful calibration and discrimination (C-index: 0.70, intercept: 0.00, slope: 0.76). The proportion of patients deriving a predicted survival benefit from coronary artery bypass grafting over percutaneous intervention was 82.4% (2143/2602) and 17.7% (459/2602) for the entire SYNTAX trial population, translating into a 4.7 to 1 appropriate ratio of treatment allocation to coronary artery bypass grafting and percutaneous intervention. Choosing a revascularization modality should depend on an individual's long-term prognosis rather than average treatment effects. Additionally, patients should be informed about their predicted prognosis. Registered on clinicaltrial.gov. NCT03417050 (https://clinicaltrials.gov/ct2/show/NCT03417050). NCT00114972 (https://www.clinicaltrials.gov/ct2/show/NCT00114972).

Utilization of SYNTAX Score II for Predictive Clinical Outcomes in Patients with Coronary Artery Disease and Chronic Renal Insufficiency Following Percutaneous Coronary Intervention.

The SYNTAX score II (SS II) has earned widespread recognition for use on individuals with coronary artery disease (CAD) due to its reliable predictions of 4-year all-cause mortality (ACM). This research focuses on substantiating the prognostic significance of using the SS II for patients experiencing concurrent chronic renal insufficiency (CRI) and CAD who have undergone percutaneous coronary intervention (PCI). This study retrospectively examined 2468 patients with concurrent CAD and CRI who underwent PCI. Based on their SS II, these participants were sorted into low-, medium-, and high-risk groups and monitored over a median of three years. The evaluation of the predictive precision of different SYNTAX scores for clinical outcomes in patients with CRI after PCI involved using time-dependent receiver operating characteristic (ROC) curves. These included the standard SS (SS), SS II, clinical SS (CSS), and residual SS (rSS). The primary outcomes were ACM and cardiac mortality (CM), while the secondary outcomes covered major adverse cardiovascular and cerebrovascular events (MACCEs), stroke, unplanned revascularization, and myocardial infarction (MI). Higher 5-year cumulative incidences of MACCEs, MI, CM, and ACM were observed significantly in patients in the high SS II category relative to those in the low and medium SS II categories. Multivariable Cox regression analysis confirmed that the SS II independently predicts ACM, CM, MI, and MACCEs as a prognostic marker. Additionally, the analysis of the time-dependent ROC curve demonstrated that the areas under the curve (AUC) for predicting CM and ACM were 0.772 and 0.767, respectively, which are superior to those of other SYNTAX scores (p < 0.05). As an independent predictor, the SS II is notable for its ability to forecast long-term adverse outcomes, including MACCEs, CM, ACM, and MI. For patients with coexisting CAD and CRI undergoing PCI, it provides significantly improved prognostic accuracy for 5-year ACM and CM compared to other SYNTAX scores.

Three-Year Outcomes Following TAVR in Younger (

Transcatheter aortic valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis, but data are limited on younger, low-risk patients. This analysis compares outcomes in low-surgical-risk patients aged <75 years receiving TAVR versus surgery. The Evolut Low Risk Trial randomized 1414 low-risk patients to treatment with a supra-annular, self-expanding TAVR or surgery. We compared rates of all-cause mortality or disabling stroke, associated clinical outcomes, and bioprosthetic valve performance at 3 years between TAVR and surgery patients aged <75 years. In patients <75 years, 352 were randomized to TAVR and 351 to surgery. Mean age was 69.1±4.0 years (minimum 51 and maximum 74); Society of Thoracic Surgeons Predicted Risk of Mortality was 1.7±0.6%. At 3 years, all-cause mortality or disabling stroke for TAVR was 5.7% and 8.0% for surgery (P=0.241). Although there was no difference between TAVR and surgery in all-cause mortality, the incidence of disabling stroke was lower with TAVR (0.6%) than surgery (2.9%; P=0.019), while surgery was associated with a lower incidence of pacemaker implantation (7.1%) compared with TAVR (21.0%; P<0.001). Valve reintervention rates (TAVR 1.5%, surgery 1.5%, P=0.962) were low in both groups. Valve performance was significantly better with TAVR than surgery with lower mean aortic gradients (P<0.001) and lower rates of severe prosthesis-patient mismatch (P<0.001). Rates of valve thrombosis and endocarditis were similar between groups. There were no significant differences in rates of residual ≥moderate paravalvular regurgitation. Low-risk patients <75 years treated with supra-annular, self-expanding TAVR had comparable 3-year all-cause mortality and lower disabling stroke compared with patients treated with surgery. There was significantly better valve performance in patients treated with TAVR. URL: https://clinicaltrials.gov; Unique identifier: NCT02701283.

Impact of Perioperative Pulmonary Artery Catheter Use on Clinical Outcomes Following Cardiac Surgery: A Nationwide Cohort Study

BackgroundEvidence on the effectiveness of pulmonary artery catheters (PACs) in cardiac surgery is scarce. Research QuestionDoes perioperative PAC use decrease on 1-year all-cause mortality in patients undergoing cardiac surgery? Study Design and MethodsThis nationwide, population-based cohort study included all adult patients who underwent cardiac surgery in Korea between January 2011 and December 2020 using a Korean health insurance claim database. We compared the primary outcome, the risk of 1-year all-cause mortality, between patients with and without perioperative use of PACs (PAC and no-PAC groups, respectively) using logistic regression analysis after stabilized inverse probability of treatment weighting. A subgroup analysis was performed to determine whether the association varied according to the type of cardiac surgery and institutional case volume. ResultsA total of 61,405 patients were analyzed. The PAC group had a significantly lower risk of 1-year all-cause mortality than that in the no-PAC group (adjusted odds ratio [OR], 0.81; 95% confidence interval [CI], 0.76–0.86). In the subgroup analysis, both the type of cardiac surgery and institutional case volume were identified as significant modifiers (all P for interaction<0.001). Specifically, the PAC group had a significantly lower risk of 1-year all-cause mortality following isolated off-pump coronary artery bypass grafting (adjusted OR, 0.54; 95% CI, 0.48–0.61) compared to the no-PAC group. PAC use was associated with a significant reduction in the risk of 1-year all-cause mortality in the lowest-case volume centers (<100 cases/year; OR, 0.70; 95% CI, 0.65–0.76). InterpretationPerioperative use of PACs was associated with a significant reduction in the risk of postoperative 1-year all-cause mortality. This association was predominantly driven by patients who underwent off-pump coronary artery bypass grafting and those who underwent cardiac surgery in less experienced centers.

The Abdominal Adiposity Index (A Body Shape Index) Predicts 10-Year All-Cause Mortality in Elderly Active Non-Obese Subjects

Background/Objectives: A Body Shape Index (ABSI), which accounts for waist circumference relative to mass and height, shows a robust association with mortality risk. The present study evaluates the effectiveness of ABSI as a predictor of 10-year all-cause mortality in physically active, non-obese elderly individuals. Methods: This prospective cohort study included 159 volunteers (94 women, aged 60–80 years), recruited in the frame of the “Physical Activity and Nutrition for Great Ageing” (PANGeA) Cross-border Cooperation Program Slovenia–Italy 2007–2013, and followed for 10 years. Baseline characteristics included anthropometric measurements, bioelectrical impedance analysis, and cardiovascular fitness tests (VO2max). Statistical analyses (Cox regression, Kaplan–Meier survival) were conducted to examine the relationship between ABSI and mortality. Results: During the 10-year follow-up, 10 deaths (6.7%) were recorded. ABSI (adjusted for age, smoking, comorbidities, and therapy) was an independent predictor of mortality (hazard ratio = 4.65, p &lt; 0.001). Higher ABSI scores were linked to reduced VO2max (r = −0.190, p = 0.017) and increased systolic blood pressure (r = 0.262, p = 0.001). An ABSI-based predictive model showed strong discriminatory power (AUROC = 0.91). Conclusions: ABSI is a reliable predictor of 10-year mortality in active, non-obese elderly individuals and may improve risk stratification in clinical practice.

Gender differences in the relationship between the systemic immune-inflammation index and all-cause and cardiovascular mortality among adults with hypertension: evidence from NHANES 1999-2018.

There are gender differences in hypertension and the effect of gender on the relationship between systemic immune-inflammation index (SII) and mortality in hypertensive patients is unclear. Hypertensive patients (n=7444) from ten cycles of the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018 were enrolled in this study. The maximally selected rank statistics method was employed to identify the optimal cut-off value for the SII. Survey-weighted Cox regression analysis was utilized to explore the links between SII and all-cause and cardiovascular mortality. Kaplan-Meier method and time-dependent receiver operating characteristic curve analysis was conducted to assess the predictive accuracy of SII for mortality. Whether SII was considered as a numerical variable or as a binary variable (higher- and lower-SII groups), higher SII levels were associated with a higher risk of all-cause and cardiovascular mortality in female hypertensive patients (all P < 0.001), but no such association was observed in the males. The area under the curve of the SII was 0.602, 0.595, and 0.569 for 3-, 5-, and 10-year all-cause mortality, respectively, in females, but was 0.572, 0.548, and 0.554 in males. High SII levels interacted with the poverty income ratio and physical activity to affect mortality in the male population (P for interaction < 0.05), and there was an interaction between race and SII in the female cardiovascular mortality rate (P for interaction < 0.05). Higher levels of SII may be closely related to the high risk of all-cause and cardiovascular mortality in hypertensive patients, and the results showed that this relationship is more significant and stable in the female group. High SII interacts with PIR, physical activity, and race to affect the mortality rate in different gender populations.

Timing of total joint arthroplasty post-COVID-19: an evaluation of the optimal window to minimize perioperative risks

BackgroundTotal hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed orthopedic procedures. This study aimed to evaluate the impact of COVID-19 status on postoperative complications and mortality in patients undergoing THA and TKA.MethodsA total of 110,186 underwent either THA or TKA. Patients were grouped based on their COVID-19 status, gathered from the National COVID-19 Cohort Collaborative (N3C) in the 12 weeks preceding surgery and compared for various variables, including age, sex, BMI, and Charlson Comorbidity Index (CCI) scores. COVID-19 status was defined as a positive test result that was closest to the date of surgery regardless of testing positive previously. Postoperative complications such as venous thromboembolism (VTE), sepsis, surgical site infection, bleeding, acute kidney injury (AKI), 30-day, and 1-year all-cause mortality were examined. To compare the variables, an odds ratio with a 95% confidence interval was calculated with a significant level set at P < 0.05. Logistic regression using R programming was utilized for these calculations.ResultsUnivariate analysis was performed and rates of VTE (1.02% vs. 3.35%), 30-day mortality (0.25% vs. less than 5%), and 1-year mortality (1.42% vs. 5.43%) were higher in the COVID-19-positive group for THA patients (P < 0.001). For TKA patients, only 30-day mortality was significantly higher in the COVID-19-positive group (P = 0.034). Multivariate logistic regression revealed that a positive COVID-19 diagnosis within two weeks of surgery and a CCI score > 3 were significant predictors of postoperative complications and mortality for both TKA and THA.ConclusionsPatients with a positive COVID-19 diagnosis within 12 weeks of THA or TKA carried a significantly higher risk for postoperative complications and mortality. In addition, a CCI score > 3 is also a significant risk factor. These findings emphasize the importance of vigilant preoperative screening and risk stratification in the era of COVID-19.

Baseline Platelet Count Predicts Infarct Size and Mortality after Acute Myocardial Infarction.

Platelets greatly contribute to cardiovascular diseases. We sought to explore the association of platelet counts with infarct size and outcome in patients presenting with acute ST-segment elevation MI (STEMI) treated with primary percutaneous coronary intervention (PPCI). In this retrospective study, we grouped 1,198 STEMI patients into tertiles (T) based on platelet count on admission: T1 = 102-206 [109 platelets/L] (n = 402), T2 = 207-259 [109 platelets/L] (n = 396), and T3 = 260-921 [109 platelets/L] (n = 400). Primary endpoint was 1-year all-cause mortality. Patients with highest platelet counts on admission showed the greatest area at risk and infarct size: area at risk (median) was 22.0% (interquartile range [IQR]: 12.0-39.8%) in T1, 21.0% (IQR: 11.0-37.1%) in T2, and 26.0% (IQR: 14.9-45.0%) of the left ventricle in T3 (p = 0.003); final infarct sizes after 7 to 14 days were as follows: 10.0% (IQR: 2.0-21.0%) in T1, 9.0% (IQR: 2.0-20.7%) in T2, and 12.0% (IQR: 3.0-27.3%) of the left ventricle in T3 (p = 0.015) as serial imaging revealed. At 1 year, 16 all-cause deaths occurred in T1, 5 in T2, and 22 in T3 (log-rank test, p = 0.006). After adjustment, T1 and T3 were associated with all-cause 1-year mortality (T1: hazard ratio [HR] = 3.40, 95% confidence interval [CI] = 1.23-9.54, p = 0.02; T3: HR = 3.55, 95% CI = 1.23-9.78, p = 0.01) compared with T2. At 5 years, all-cause mortality remained numerically higher in the T1 and T3. In patients with STEMI undergoing PPCI, low and high blood platelet levels on admission were associated with increased long-term mortality (Fig. 1).

Correlation between fruit consumption and 10-year all-cause mortality in patients with dyslipidemia.

Consuming fruit provides health benefits. Reportedly, increased fruit consumption reduces the risks of hypertension and cardiovascular disease. However, existing studies have not clarified the effect of fruit consumption on mortality risk in patients with dyslipidemia. This study aimed to assess the correlation between the consumption of different types of fruits and all-cause mortality in patients with dyslipidemia. A total of 2,184 patients with dyslipidemia were included in this study, and trends in the correlation between the frequency of consumption of different types of fruits and the 10-year all-cause mortality risk in patients with dyslipidemia were analyzed by smoothed curve fitting, Cox regression, and Kaplan-Meier curve analysis. Subgroup analysis and interaction test were applied to analyze the stability of the effect of apple consumption on 10-year all-cause mortality in patients with dyslipidemia. Smoothed curve fitting and Cox regression analyses revealed a significant reduction in the 10-year all-cause mortality risk in patients with dyslipidemia who consumed apples 3-4 times/week (hazard ratio [HR] = 0.61, 95% confidence interval [CI]: 0.43-0.87, p = 0.007) and in those who consumed bananas 3-4 times/week (HR = 0.71, 95% CI: 0.52-0.98, p = 0.039), with a more pronounced effect in patients who consumed both apples and bananas (HR = 0.55, 95% CI: 0.30-0.99, p = 0.045). Other fruits did not exhibit similar effects. Consuming apples or bananas 3-4 times/week significantly improved the 10-year survival rate in patients with dyslipidemia, and the effect was even more profound in patients who consumed both fruits.

Rapid response system and outcomes in patients who underwent cranial neurosurgery: a nationwide cohort study.

Hospitals use rapid response systems (RRSs) to identify and treat patients whose conditions rapidly worsen after admission. However, no study has examined the effects of RRS deployment on the clinical outcomes of patients undergoing cranial neurosurgery. Thus, the authors investigated whether use of RRS affects clinical outcomes in these patients. This nationwide, retrospective, population-based cohort study included adult patients who underwent cranial neurosurgery in South Korea between January 1, 2019, and December 31, 2021. The authors classified patients admitted to hospitals that operated RRS into the RRS group and those admitted to hospitals that did not operate RRS into the non-RRS group. Overall, 73,600 hospitalized patients who underwent cranial neurosurgery were included in this study. These patients were divided into 2 groups: 38,544 (52.4%) were included in the RRS group and 35,066 (47.6%) in the non-RRS group. After propensity score matching, 40,058 patients (20,029 in each group) remained. The in-hospital mortality rate was 10.1% (2022/20,029) for the non-RRS group and 8.9% (1792/20,029) for the RRS group. In the logistic regression analysis, the in-hospital mortality rate of the RRS group was 12% (OR 0.88, 95% CI 0.82-0.94, p < 0.001) lower than that of the non-RRS group. The 1-year all-cause mortality rate was 26.5% (5300/20,029) in the non-RRS group and 24.6% (4921/20,029) in the RRS group. In the Cox regression analysis, the 1-year all-cause mortality rate of the RRS group was 9% (HR 0.91, 95% CI 0.88-0.95; p < 0.001) lower than that of the non-RRS group. This population-based cohort study revealed that implementing RRS was associated with enhanced short- and long-term survival outcomes in patients who underwent cranial neurosurgery. The authors' findings indicate that the introduction of RRS can enhance patient survival rates after cranial neurosurgery.

Update on Prosthesis–Patient Mismatch Following Transcatheter Aortic Valve Replacement in Asian Patients

BackgroundProsthesis–patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is of greater concern in Asians, considering their relatively smaller annular sizes compared with Westerners. However, the prognostic significance of PPM in Asian populations has not been demonstrated. ObjectivesThis study aimed to elucidate the prognostic value of PPM after TAVR in Asian patients. MethodsPatients undergoing TAVR from October 2013 to December 2019 were enrolled from the OCEAN-TAVI (Optimized CathEter vAlvular iNtervention—Transcatheter Aortic Valve Implantation) registry. PPM was classified based on the indexed effective orifice area as severe (≤0.65 cm2/m2) or moderate (0.66-0.85 cm2/m2) in the general population, and severe (≤0.55 cm2/m2) or moderate (0.56-0.70 cm2/m2) in the obese population (body mass index of ≥30 kg/m2). ResultsOf the 7,072 eligible patients, moderate and severe PPM were identified in 742 (10.5%) and 94 (1.3%) patients, respectively. Severe PPM relative to non-PPM was independently associated with higher adjusted risks for 3-year all-cause mortality (adjusted HR: 1.79; 95% CI: 1.16-2.78; P = 0.009) and heart failure hospitalization (adjusted HR: 1.88; 95% CI: 1.07-3.28; P = 0.027), whereas no significant difference in these outcomes was observed between moderate PPM and no PPM. ConclusionsSevere PPM following TAVR was observed in only 1.3% of our Japanese cohort, but was associated with an increased risk of mortality and heart failure hospitalization at 3 years. These results warrant the implementation of preventive strategies to obviate severe PPM after TAVR, also in Asian patients.

The Impact of Iron Deficiency on Prognosis in Stroke and Non-Stroke Populations: A Retrospective Cohort Study

Background and AimsIron deficiency (ID) leads to a significant global health burden, but research on the impact of ID on the prognosis of stroke patients is rare. We aim to investigate the impact of ID on the all-cause mortality of both the stroke and non-stroke individuals. Methods and ResultsThis retrospective cohort study used data from the National Health and Nutrition Examination Survey (NHANES) conducted from 1999 to 2002. The follow-up period for the participants extended until December 31, 2019. Overall, 7239 participants were enrolled, out of which 200 had a history of stroke. There was no difference in the prevalence of ID (ferritin <100 ng/mL or serum ferritin concentration 100-299 ng/mL with transferrin saturation (TSAT) <20%) between stroke and non-stroke individuals (68% vs 65%, P =0.5) even after propensity score matching (68% vs 63%, P =0.5). In stroke survivors, ID was found to be associated with a higher risk of all-cause mortality over a 5-year period (HR: 4.16, 95% CI: 1.54-11.3, P = 0.005). Additionally, there was no link between ID and all-cause mortality in individuals without stroke. Moreover, we did not observe a significant association between dietary iron, total folate, and ID in stroke patients. ConclusionStroke survivors with low serum ferritin levels have an increased risk of 5-year all-cause mortality. Health care providers should consider screening for ID among individuals with a history of stroke. Future clinical trials examining the effects of iron therapy on patients with stroke and coexisting ID are warranted.

Impact of More Than 1 Distal Anastomosis on the Same Territory in 3-Vessel Disease Patients

BackgroundPrevious studies defined complete revascularization as the placement of at least 1 bypass graft to each diseased coronary territory. This study was conducted to evaluate whether putting more than 1 graft to each diseased coronary territory is beneficial for patients with 3-vessel disease (3VD) who underwent coronary artery bypass grafting (CABG). MethodsAmong 1859 patients who underwent primary isolated CABG, 1008 patients (male-to-female ratio, 841:239; mean age, 67.0 ± 9.3 years) who underwent OPCAB for 3VD and in whom complete revascularization was achieved were retrospectively enrolled. Complete revascularization was defined as at least 1 graft to each coronary artery territory. The median follow-up duration was 86.6 months (interquartile range, 53.0-126.9). ResultsA total of 829 patients (82.2%) had more than 3 distal anastomoses, whereas the other 179 patients had 3 distal anastomoses. Hypertension (n = 729; 72.3%) and diabetes (n = 556; 55.2%) were the most common comorbidities without any intergroup differences. The early mortality rate was 1.0% (n = 10). Late death occurred in 337 of 998 early survivors. Five- and 10-year all-cause mortality rates were 18.0% and 36.0%, respectively. Cumulative incidences of cardiac deaths were 5.2% and 9.2%, respectively. The inverse probability treatment weighting–adjusted multivariate analyses showed that having more than 3 distal anastomoses was associated with lower all-cause mortality and cardiac death (hazard ratio, 0.76 [95% CI, 0.57-0.99] and hazard ratio, 0.50 [95% CI, 0.31-0.83], respectively). ConclusionsGrafting more than 1 diseased vessel in each diseased coronary territory during CABG may be beneficial for patients with 3VD in terms of all-cause mortality and cardiac death.

Impact of symptom-to-balloon time in patients with non-ST-segment elevation myocardial infarction and complex lesions.

Considering the limited data regarding clinical outcomes of patients with non-ST-segment on the ECG elevation myocardial infarction (NSTEMI), this study compared the outcomes of patients undergoing percutaneous coronary intervention with newer-generation drug-eluting stents stratified by the presence/absence of complex lesions and symptom-to-balloon time (SBT; <48 h or ≥48 h). We enrolled 4373 patients with NSTEMI from the Korea Acute Myocardial Infarction Registry-National Institute of Health dataset and stratified them into the complex group (2106 patients; SBT < 48 h, n = 1365; SBT ≥48 h, n = 741) and the noncomplex group (2267 patients; SBT < 48 h, n = 1573; SBT ≥48 h, n = 694). The primary outcome was the 3-year all-cause mortality rate. The secondary outcomes were any major adverse cardiac events (MACE), including cardiac death (CD), recurrent myocardial infarction, and stroke. The incidence of all-cause mortality (adjusted hazard ratio, 0.656; P = 0.009), CD (P = 0.037), and MACE (P = 0.047) in the complex group and of stroke in the noncomplex group (P = 0.020) were significantly lower in patients with SBT < 48 h than in those with SBT ≥48 h. Among patients with SBT < 48 h, the stroke incidence (P = 0.019) was higher in the complex group than in the noncomplex group, while among patients with SBT ≥48 h, the MACE incidence (P = 0.011) was higher in the former than in the latter. SBT reduction effectively decreased the 3-year mortality in patients with NSTEMI in the complex group compared with the noncomplex group.

Multidisciplinary nutritional support team and mortality in critically ill patients with acute respiratory distress syndrome.

A careful approach is required when providing nutritional support to patients with acute respiratory distress syndrome (ARDS). This study investigated whether implementing a multidisciplinary nutritional support team (NST) is associated with improved survival outcomes in patients with ARDS. In a nationwide population-based cohort study, all adult patients admitted to the intensive care unit (ICU) in South Korea with a primary diagnosis of ARDS from January 1, 2017, to December 31, 2021, were included. The NST comprised four professionals (physicians, full-time nurses, full-time pharmacists, and full-time clinical dietitians). Patients admitted to ICUs with and without the NST system were allocated to the NST and non-NST groups, respectively. The analysis comprised a total of 15,555 patients with ARDS. Among them, 6615 (42.5%) were in the NST group, and 8940 (57.5%) were in the non-NST group. After adjusting for covariates in the multivariable logistic regression, the NST group showed a 19% lower 30-day mortality than the non-NST group (odds ratio: 0.81, 95% confidence interval: 0.75-0.87, p < .001). Furthermore, after adjusting for covariates in multivariable Cox regression, the NST group showed a 12% lower 1-year all-cause mortality than the non-NST group (hazard ratio: 0.88, 95% confidence interval: 0.85-0.92, p < .001). NST implementation was associated with enhanced 30-day and 1-year survival rates in patients with ARDS. These findings indicate that nutritional support provided by the NST may influence the survival outcomes of patients with ARDS in the ICU.

Global Leadership Initiative on Malnutrition-defined malnutrition coexisting with visceral adiposity predicted worse long-term all-cause mortality among inpatients with decompensated cirrhosis

Background/objectivesMalnutrition coexisting with abdominal adipose tissue accumulation bring a double burden on prognosis. More recently, the Global Leadership Initiative on Malnutrition (GLIM) has reached a novel consensus concerning the diagnostic criteria, that is, a two-step modality combining nutritional risk screening and subsequent phenotypic/etiologic parameters for comprehensive evaluation in hopes of harmonizing the malnutrition diagnosis. We aimed to elucidate their synergistic impact among inpatients with decompensated cirrhosis concerning long-term mortality.Subjects/methodsMalnutrition, visceral obesity, and visceral adiposity were defined by the Global Leadership Initiative on Malnutrition (GLIM), visceral fat area (VFA), and visceral to subcutaneous adipose tissue area ratio (VSR) on computed tomography, respectively. Accordingly, the patients were categorized into different groups given their nutritional status and visceral obesity/adiposity. Multivariate Cox regression was performed to identify independent risk factors associated with 1-year all-cause mortality. Kaplan–Meier curves with log-rank tests were compared among distinct groups.ResultsTotally, 295 patients were recruited. GLIM, VFA, and VSR identified 131 (44.4%), 158 (53.6%), and 59 (20%) patients with malnutrition, visceral obesity and visceral adiposity, respectively. Malnutrition coexisted with visceral obesity in 55 (MO group) relative to visceral adiposity in 40 patients (MA group). Multivariate Cox analysis showed that MA (hazard ratio: 2.48; 95% confidence interval: 1.06, 5.79; P = 0.036) was independently associated with dire outcome rather than MO. Moreover, patients with cirrhosis in the MA group had the worst survival status when compared with other groups (log-rank test: P < 0.001).ConclusionsThe current study indicated that coexisting GLIM-defined malnutrition and VSR-defined visceral adiposity were in relation to worse long-term mortality among inpatients. It is imperative to delicately manage nutritional status and provide personalized treatment in this vulnerable subgroup for achieving better prognosis.

Temporal trends in the treatment and outcome of nonagenarians with acute coronary syndrome.

Nonagenarians are a fast-growing age group among acute coronary syndrome (ACS) patients. While new therapeutic options have improved outcomes of ACS patients, data regarding very elderly ACS patients are limited. We aimed to evaluate temporal trends in the treatment and outcomes of nonagenarian ACS patients. Included were ACS patients aged below 90 years enrolled in ACS Israeli Survey. Patients were divided into two groups according to enrolment period: early (2000-2010) and recent (2012-2021). The primary endpoints were 30-day major adverse cardiovascular events and all-cause mortality. Secondary outcomes included in-hospital and 1-year all-cause mortality. Included were 316 elderly ACS patients. Of them, 184 were enrolled in the early and 132 in recent surveys. Patients enrolled in the recent period were more commonly referred for an invasive strategy and more commonly received guideline-based medical therapy. All-cause mortality at 30 days was significantly lower in the recent group compared with the early group (12.5 and 26.1%, respectively, P = 0.005). Rates of 30-day major adverse cardiovascular events were also significantly lower in the recent group (21.9 and 35.9%, respectively, P = 0.012). Patients in the recent group received more aggressive medical therapy in discharge but at 30-day follow-up, no difference in medical treatment was observed in the two groups. There were no significant differences in 1-year mortality rates. Treatment of nonagenarians with ACS has improved over the past decade. Treatment improvement was associated with a significant improvement in 30-day outcomes without any effect in 1 year. Nevertheless, even with contemporary treatment, nonagenarians with ACS remain a high-risk group with high mortality rates.

A Novel Metabolomic Aging Clock Predicting Health Outcomes and Its Genetic and Modifiable Factors.

Existing metabolomic clocks exhibit deficiencies in capturing the heterogeneous aging rates among individuals with the same chronological age. Yet, the modifiable and non-modifiable factors in metabolomic aging have not been systematically studied. Here, a new aging measure-MetaboAgeMort-is developed using metabolomic profiles from 239,291 UK Biobank participants for 10-year all-cause mortality prediction. The MetaboAgeMort showed significant associations with all-cause mortality, cause-specific mortality, and diverse incident diseases. Adding MetaboAgeMort to a conventional risk factors model improved the predictive ability of 10-year mortality. A total of 99 modifiable factors across seven categories are identified for MetaboAgeMort. Among these, 16 factors representing pulmonary function, body composition, socioeconomic status, dietary quality, smoking status, alcohol intake, and disease status showed quantitatively stronger associations. The genetic analyses revealed 99 genomic risk loci and 271 genes associated with MetaboAgeMort. The tissue-enrichment analysis showed significant enrichment in liver. While the external validation of the MetaboAgeMort is required, this study illuminates heterogeneous metabolomic aging across the same age, providing avenues for identifying high-risk individuals, developing anti-aging therapies, and personalizing interventions, thus promoting healthy aging and longevity.

Rapid response system and mortality in intensive care unit: a nationwide cohort study in South Korea.

The beneficial effects of a rapid response system (RRS) on clinical outcomes in patients admitted to a ward have been established. However, the relationship between RRS implementation and clinical outcomes in patients in the intensive care unit (ICU) has not yet been established. Therefore, we aimed to investigate whether the RRS affects clinical outcomes in critically ill patients admitted to the ICU. As a nationwide, population-based cohort study, all adult patients who were admitted to the ICU from 1 January 2019 to 31 December 2021 in South Korea were included. Patients in hospitals with an RRS formed the RRS group; those in hospitals lacking an RRS constituted the non-RRS group. In total, 900,606 patients admitted to the ICU were included in the final analysis. Among them, 365,305 (40.6%) were assigned to the RRS group, and 535,301 (59.4%) were assigned to the non-RRS group. After propensity score (PS) matching, a total of 454,748 patients (227,374 in each group) were included in the final analysis. In the PS-matched cohort, the RRS group showed 8% (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.91, 0.94; P < 0.001) and 11% (hazard ratio: 0.89, 95% CI: 0.88, 0.90; P < 0.001) lower in-hospital mortality rates and 1-year all-cause mortality rates than the non-RRS group, respectively. In addition, ICU readmission rates and the occurrence rate for adverse events during hospitalization in the RRS group were 3% (OR: 0.97, 95% CI: 0.95, 0.98; P < 0.001) and 21% (OR: 0.79, 95% CI: 0.78, 0.80; P < 0.001) lower than those in the non-RRS group, respectively. RRS deployment was linked to lower in-hospital and 1-year all-cause mortality rates, ICU readmission rates, and the occurrence of adverse events during hospitalization among ICU patients. The findings indicate that using the RRS could assist not only patients in the ward but also critically ill patients in the ICU.