In-hospital Adverse Outcomes Research Articles

Cardiovascular Outcomes Among Patients with Acute Coronary Syndromes and Diabetes: Results from ACS QUIK Trial in India.

Despite cardiovascular disease being the leading cause of death in India, limited data exist regarding the factors associated with outcomes in patients with diabetes who suffer acute myocardial infarction (AMI). We examined 21,374 patients with AMI enrolled in the ACS QUIK trial. We compared in-hospital and 30-day major adverse cardiac events including death, re-infarction, stroke, or major bleeding in those with and without diabetes. The associations between diabetes and cardiac outcomes were adjusted for presentation and in-hospital management using logistic regression. Mean ± SD age was 60.1 ± 12.0 years, 24.3% were females, and 44.4% had diabetes. Those with diabetes were more likely to be older, female, hypertensive, and have higher Killip class but less likely to present with STEMI. Patients with diabetes had longer symptoms onset-to-arrival (median 225 vs 290 min; P < 0.001) and, in case of STEMI, longer door-to-balloon times (median, 75 vs 91 min; P < 0.001). Diabetes was independently associated with higher in-hospital death (adjusted odds ratio [aOR], 1.46; 95% CI, 1.12-1.89), in-hospital reinfarction (aOR, 1.52; 95% CI, 1.15-2.02), 30-day MACE (aOR, 1.33; 95% CI, 1.14-1.55) and 30-day death (aOR, 1.40; 95%CI, 1.16-1.69) but not 30-day stroke or 30-day major bleeding. Among patients presenting with AMI in Kerala, India, a considerable proportion has diabetes and are at increased risk for in-hospital and 30-day adverse cardiovascular outcomes. Increased awareness of the increased cardiovascular risk and attention to the implementation of established cardiovascular therapies are indicated for patients with diabetes in lower-middle-income countries who develop AMI. ClinicalTrials.gov Unique identifier: NCT02256658.

Association Between Chronic Liver Disease and Adverse In-Hospital Outcomes in Patients Undergoing CABG: A Propensity Score-Matched Analysis

Despite a 30% decline in the rate over the last decade, coronary artery bypass graft (CABG) surgery remains a common major surgical procedure with significant morbidity and mortality. Chronic liver disease (CLD) patients, with increased survival rates due to medical advancements, are now frequently being considered for CABG, bearing higher perioperative risks. This study investigates the association between CLD and in-hospital outcomes in CABG patients using retrospective data from the National Inpatient Sample (NIS) database (2016-2020) including 7,945 CLD patients undergoing CABG that were propensity score matched with an equivalent number of patients with no CLD undergoing CABG. Clinical variables were extracted using corresponding ICD-10 codes and multivariable logistic and linear regression models were used to assess in-hospital mortality, complications, and length of stay. The overall mortality rate was 5.5% (8.6% in the CLD group with cirrhosis, 5.9% CLD group without cirrhosis, and 2.8% in the non-CLD group, p<0.001). CLD with cirrhosis was associated with higher odds of mortality (AOR= 4.21, 95% CI [3.61, 4.94]) and length of stay (β = 1.03, 95% CI [1.01, 1.05]). CLD patients with cirrhosis demonstrated higher odds of perioperative cardiac complications (cardiac arrest, ventricular arrhythmias, tamponade, and shock), thromboembolic events, gastrointestinal bleeding, bowel ischemia, acute kidney injury, pneumonia, and sepsis. This study reveals a substantial impact of CLD on adverse outcomes in CABG patients, emphasizing the need for tailored preoperative assessments and postoperative care.

Impact of Insurance Status on Clinical Management and Outcomes of Patients with ST-Segment Elevation Myocardial Infarction: Findings from the Kuwait Catheterization Laboratory Project Registry

Background: Emerging evidence from various countries suggests that ST-segment elevation myocardial infarction (STEMI) patients with differing health-care insurance types experience discrepancies in clinical management and outcomes. Kuwait government provides free essential treatments and medications to noninsured patients with certain emergency conditions. We aimed to compare differences in clinical management and in-hospital and 30-day outcomes in STEMI patients with different insurance types in Kuwait. Methods: Data were derived from Kuwait Catheterization Laboratory Project (Kuwait CLAP) registry. Adult patients (≥18 years) diagnosed with STEMI were enrolled in Kuwait CLAP registry between February 2020 and February 2021. Patients were categorized into insured and noninsured. The coprimary outcomes were the in-hospital and 30-day mortality in insured versus noninsured patients with STEMI. In-hospital and 30-day adverse cardiac outcomes were also compared. Results: Of 668 patients with STEMI, 116 (17%) were insured and 552 (83%) were not insured. Three (2.6%) of the insured and 9 (1.6%) of the noninsured patients suffered in-hospital mortality, while no patients in the insured group and four patients (0.7%) patients in the noninsured group suffered 30-day mortality, with no significant difference between the two groups (P = 0.447 and P = 1, respectively). The rates of in-hospital complications and 30-day adverse events were similar between the two groups. Conclusions: Our findings suggest no differences in acute or short-term outcomes among patients with different insurance status in Kuwait. These findings are reassuring knowing that the free essential services provided by Kuwait government for STEMI patients did not compromise the outcomes of noninsured compared to insured patients.

(457) - Adverse In-Hospital Outcomes of Left Ventricular of Ventricular Assist Device Recipients Developing Acute Kidney Injury

(457) - Adverse In-Hospital Outcomes of Left Ventricular of Ventricular Assist Device Recipients Developing Acute Kidney Injury

In-hospital outcomes and trends of patients with autoimmune diseases undergoing percutaneous coronary intervention: A nationwide analysis

BackgroundThe risk of coronary artery disease is exaggerated in patients with autoimmune diseases (AID). A higher risk of complications has been reported during and after percutaneous coronary intervention (PCI) in these patients. We aimed to analyze the in-hospital outcomes and trends of patients with AID, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD) undergoing PCI. MethodWe identified all PCI procedures using the National In-patient Sample database from 2016 to 2020. Stratified them into cohorts with RA, SLE and IBD and compared them to cohorts without AID. The Chi-square test and multivariate logistic regression were used for analysis. A p-value <0.005 was considered statistically significant. ResultWe identified 2,367,475 patients who underwent PCI. Of these, 1.6 %, 0.5 %, and 0.4 % had RA, IBD and SLE respectively. The odds of mortality were lower among patients with IBD (aOR: 0.56; CI 0.38–0.81, p = 0.002) but patients with RA had higher odds of having composite major complications [(MC) including cerebrovascular accident (CVA), cardiac arrest, acute heart failure (AHF), ventricular arrhythmia (VA), major bleeding, and acute kidney injury (AKI)] (aOR: 0.90; CI 0.83–0.98, p = 0.013). Our SLE cohort had higher rates of CVA (p = 0.017) and AKI (p = 0.002). Our cohort with IBD had lower rates of cardiac arrest but had longer hospital length of stay (4.9 days vs 3.9 days) and they incurred higher hospital charges compared to cohort without IBD. ConclusionThis study depicts the immediate adverse outcomes observed in patients with AID undergoing PCI. In contrast to those without AID, our cohorts with RA exhibited worse outcomes, as indicated by the higher odds of major complications. IBD is associated with lower risks of in-hospital adverse outcomes but with higher resource utilization.

Predictive value of NT-proBNP and hs-TnT for outcomes after pediatric congenital cardiac surgery.

The available evidence regarding the predictive value of troponins and natriuretic peptides for early postoperative outcomes in pediatrics is limited, controversial, and based on small sample sizes. We aimed to investigate the association of N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT) with the in-hospital adverse outcomes after congenital cardiac surgeries. A secondary analysis based on a prospective study of pediatric congenital heart disease (CHD) patients was conducted to investigate the association of NT-proBNP and hs-TnT tested within 6 hours postoperatively with in-hospital adverse events. A multivariate logistic regression analysis with a minimum P value approach was used to identify the optimal thresholds of NT-proBNP and hs-TnT for risk stratification. NT-proBNP and hs-TnT are positively correlated with cardiopulmonary bypass time, mechanical ventilation duration, and pediatric intensive care unit stay. The predictive performance of NT-proBNP is excellent for adverse events in both patients younger than 1 year [area under the curve (AUC): 0.771, 0.693-0.850] and those older than 1 year (AUC: 0.839, 0.757-0.922). However, hs-TnT exhibited a satisfactory predictive value solely in patients aged over 1 year. (AUC: 0.784, 0.717-0.852). NT-proBNP levels of 2000 to 10000ng/L [Odds Ratio (OR): 3.79, 1.47-9.76) and exceeding 10000ng/L (OR: 12.21, 3.66-40.80) were associated with a higher risk of postoperative adverse events in patients younger than 1 year. Patients older than 1 year, with NT-proBNP higher than 500ng/L (OR: 15.09, 6.05-37.66) or hs-TnT greater than 1200ng/L (OR: 5.50, 1.47-20.59), had a higher incidence of postoperative adverse events. NT-proBNP and hs-TnT tested within postoperative 6 hours demonstrated significant predictive value for postoperative adverse events in CHD patients older than 1 year. However, among CHD patients younger than 1 year, only NT-proBNP exhibited commendable predictive performance for postoperative adverse events.

Association Between Frailty and Adverse In-hospital Outcomes after Head and Neck Cancer Surgery Among US Older Adults

Association Between Frailty and Adverse In-hospital Outcomes after Head and Neck Cancer Surgery Among US Older Adults

Mean Platelet Volume and Its Association With In-Hospital Outcomes in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Background Mean platelet volume (MPV), reflecting platelet size and activation, has been associated with cardiovascular disease (CVD) risk and mortality. Yet, its prognostic significance in acute coronary syndrome (ACS) patients undergoing primary percutaneous coronary intervention (PCI) remains uncertain. This study investigates whether elevated MPV levels upon admission in ST-segment elevation myocardial infarction (STEMI) patients predict adverse in-hospital outcomes after primary PCI. Objectives The aim of this study was to measure MPV in patients with STEMI who underwent primary PCI and to evaluate its association with in-hospital outcomes such as death, recurrent myocardial infarction, heart failure, and bleeding. Methods We enrolled 400 consecutive patients with STEMI (mean age 56.20 years, 356 males, 44 females) who underwent primary PCI at our center. We obtained MPV values from complete blood count tests performed at admission. We divided the patients into two groups based on the normal MPV range of 7.40 to 12 fL. We compared the baseline characteristics and in-hospital outcomes of the two groups. We used Cox proportional hazards regression analysis to adjust for potential confounders and evaluate the impact of MPV on in-hospital outcomes. Results There was no significant difference in MPV values between the two groups (9.10 ± 1.20 fL vs. 9.00 ± 1.10 fL, p = 0.54). Patients who died exhibited higher age, male predominance, hypertension, diabetes, a lower left ventricular ejection fraction, lower levels of low-density lipoprotein cholesterol, and lower levels of hemoglobin and hematocrit compared to survivors. MPV was not associated with any of the in-hospital outcomes in the unadjusted or adjusted analyses. Conclusion In this cohort of patients with STEMI who underwent primary PCI, admission MPV was not a predictor of in-hospital outcomes. Further studies are needed to clarify the role of MPV in the pathophysiology and prognosis of ACS.

A Novel Predictive Model for Acute Kidney Injury Following Surgery of the Aorta.

Acute kidney injury (AKI) frequently occurs after aortic surgery and has a significant impact on patient outcomes. Early detection or prediction of AKI is crucial for timely interventions. This study aims to develop and validate a novel model for predicting AKI following aortic surgery. We enrolled 156 patients who underwent on-pump aortic surgery in our hospital from February 2023 to April 2023. Postoperative levels of eight cytokines related to macrophage polarization analyzed using a multiplex cytokine assay. All-subset regression was used to select the optimal cytokines to predict AKI. A logistic regression model incorporating the selected cytokines was used for internal validation in combination with a bootstrapping technique. The model's ability to discriminate between cases of AKI and non-AKI was assessed using receiver operating characteristic (ROC) curve analysis. Of the 156 patients, 109 (69.87%) developed postoperative AKI. Interferon-gamma (IFN- ) and interleukin-4 (IL-4) were identified as candidate AKI predictors. The cytokine-based model including IFN- and IL-4 demonstrated excellent discrimination (C-statistic: 0.90) and good calibration (Brier score: 0.11). A clinical nomogram was generated, and decision curve analysis revealed that the cytokine-based model outperformed the clinical factor-based model in terms of net benefit. Moreover, both IFN- and IL-4 emerged as independent risk factors for AKI. Patients in the second and third tertiles of IFN- and IL-4 concentrations had a significantly higher risk of severe AKI, a higher likelihood of requiring renal replacement therapy, or experiencing in-hospital death. These patients also had extended durations of mechanical ventilation and intensive care unit stays, compared with those in the first tertile (all p for group trend 0.001). We successfully established a novel and powerful predictive model for AKI, and demonstrating the significance of IFN- and IL-4 as valuable clinical markers. These cytokines not only predict the risk of AKI following aortic surgery but are also linked to adverse in-hospital outcomes. This model offers a promising avenue for the early identification of high-risk patients, potentially improving clinical decision-making and patient care.

Predictors of in-hospital outcomes for diverticular bleeding patients: a retrospective analysis of National Inpatient Sample data (2016-2020).

Diverticular bleeding is the leading cause of lower gastrointestinal bleeding, affecting 3-5% of patients with diverticulosis. Current management protocols include resuscitation, diagnosis via direct visualization, computed tomography imaging, endoscopic interventions, angioembolization, and surgery when needed. However, predictive factors for outcomes and optimal interventions remain ambiguous. This retrospective cohort study analyzed data from the National Inpatient Sample (NIS) database (2016-2020) to determine predictors of adverse in-hospital outcomes in diverticular bleeding patients without perforation or abscess. Demographic and clinical data were extracted, and multivariate regression models were applied. Analysis was conducted using R statistical software (version 4.1.3), with significance set at P<0.05. A total of 28,269 patients hospitalized for diverticular bleeding were identified. Age >85 years, moderate to severe Charlson Comorbidity Index, hypovolemic shock, blood transfusion requirement, and requirement for colectomy were significantly associated with greater in-hospital mortality. Factors such as late colonoscopy timing and colon resection led to longer hospital stays, while arterial embolization was predicted by older age, Black race, hypovolemic shock, and blood transfusion. Predictors of colon resection included advanced age, presence of colon cancer, and hypovolemic shock. Our retrospective study identified significant predictors of in-hospital outcomes among patients with diverticular bleeding, informing risk stratification and management strategies. Further research is warranted to validate these findings and refine management algorithms for improved patient care. Integrating these insights into clinical practice may enhance outcomes and guide personalized interventions in diverticular bleeding management.

Clinical characteristics and course of pulmonary artery stump thrombosis following lung cancer surgery: A retrospective study from tertiary care hospital.

The data regarding pulmonary artery stump thrombosis (PAST) after lung cancer surgery are insufficient. The aim of the present study was to evaluate the incidence, clinical characteristics, and prognosis of PAST. We retrospectively investigated the incidence and clinical characteristics of PAST among patients who underwent lung resection for lung cancer at 2 institutions. We compared the clinical parameters between PAST and pulmonary embolism (PE) and examined the clinical course of patients with PAST. Of the 1885 patients, PAST was found in 36 patients (1.9%). Right lower lobectomy (n = 13) and middle-lower bilobectomy (n = 9) were the most common types of surgery. The median time interval from lung resection to the detection of PAST was 3.8 months. Immobilization and a history of cerebrovascular disease were not observed in the PAST group. Most of the patients with PAST (91.7%) were diagnosed incidentally, whereas many patients with PE (75.9%) were symptomatic at the time of diagnosis. During the follow-up, one patient (2.8%) had contralateral PE complications. However, no patients in the PAST group experienced pulmonary thromboembolism-related in-hospital death or adverse outcomes. There was no difference in the prognosis of patients with PAST according to the administration of anticoagulation. PAST was rarely detected in lung cancer patients on follow-up chest computed tomography after lung resection. Patients with PAST were asymptomatic in most cases and had relatively favorable clinical outcomes. However, these patients are at risk of contralateral PE, despite its rarity.

Association of Left Atrial Volume Index with Adverse In-Hospital Outcome in Patients with St-Elevated Acute Myocardial Infarction

Background: Coronary heart disease is the leading cause of death worldwide, with acute STEMI being the most severe manifestation. Left atrium (LA) plays a major role in left ventricular performance. LA function is a surrogate marker of LV diastolic dysfunction. In recent past, several studies conducted in different parts in the world have focused on the effect of ASTEMI on the volume and function of left atrium. So, assessment of left atrial volume index (LAVI) by 2D echocardiography in patients who have suffered an acute STEMI helps to predict the adverse cardiovascular outcome. Objective: The aim of the study is to assess the LAVI for prediction of adverse in-hospital outcomes following acute STEMI patients admitted in a tertiary care hospital. Methods: This Hospital based prospective observational study was conducted in the department of cardiology in DMCH over 1-year period. Patients with acute STEMI admitted in the CCU of DMCH were approached for inclusion in the study. Clinical and echocardiographic parameters were collected within 48 hours of admission. LA volume is measured and then indexed to body surface area called LA volume index (LAVI) and the population was divided according to LAVI. The study comprised of 150 acute STE-MI patients and were divided into two groups, including 75 patients in each group. Patients with LAVI&gt;34 ml/m2and LAVI≤34 ml/m2 were assigned as Group I and Group II respectively &amp; followed up for adverse in-hospital outcome. All necessary information were recorded in a pretested case record form. Statistical analyses were done by SPSS 17.0. Result: The mean age was 57.7 ± 7.0 years ranging from 39 to 80 years. Most of the patients were male 109 (72.7%). Majority of the patients had anterior wall ( anterior, antero-septal &amp; extensive anterior) myocardial infarction (85%).It was observed that patients with LAVI&gt;34 ml/m2(Group I) had more adverse in-hospital outcomes than patients with LAVI≤34 ml/m2( Group II) (46.7% vs 14.7 % ;p&lt; 0.001 ).By multivariate logistic regression analysis, LAVI&gt;34 ml/m2 emerged as an independent significant predictor of adverse in-hospital outcome(Odds Ratio 6.55,95% confidence interval: 2.069 – 20.735, p = 0.001 ) Conclusion: In patients with acute STEMI, with LAVI&gt;34 ml/m2 had more adverse in-hospital outcomes than patients with LAVI≤34 ml/m2. So early assessment of LAVI by echocardiography is useful to predict adverse in-hospital outcome. Bangladesh Heart Journal 2024; 39(1): 10-16

Investigating the effects of frailty on six-month outcomes in older trauma patients admitted to UK major trauma centres: a multi-centre follow up study

BackgroundPre-injury frailty is associated with adverse in-hospital outcomes in older trauma patients, but the association with longer term survival and recovery is unclear. We aimed to investigate post discharge survival and health-related quality of life (HRQoL) in older frail patients at six months after Major Trauma Centre (MTC) admission.MethodsThis was a multi-centre study of patients aged ≥ 65 years admitted to five MTCs. Data were collected via questionnaire at hospital discharge and six months later. The primary outcome was patient-reported HRQoL at follow up using Euroqol EQ5D-5 L visual analogue scale (VAS). Secondary outcomes included health status according to EQ5D dimensions and care requirements at follow up. Multivariable linear regression analysis was conducted to evaluate the association between predictor variables and EQ-5D-5 L VAS at follow up.ResultsFifty-four patients died in the follow up period, of which two-third (64%) had been categorised as frail pre-injury, compared to 21 (16%) of the 133 survivors. There was no difference in self-reported HRQoL between frail and not-frail patients at discharge (Mean EQ-VAS: Frail 55.8 vs. Not-frail 64.1, p = 0.137) however at follow-up HRQoL had improved for the not-frail group but deteriorated for frail patients (Mean EQ-VAS: Frail: 50.0 vs. Not-frail: 65.8, p = 0.009). There was a two-fold increase in poor quality of life at six months (VAS ≤ 50) for frail patients (Frail: 65% vs. Not-frail: 30% p < 0.009). Frailty (β-13.741 [95% CI -25.377, 2.105], p = 0.02), increased age (β -1.064 [95% CI [-1.705, -0.423] p = 0.00) and non-home discharge (β -12.017 [95% CI [118.403, 207.203], p = 0.04) were associated with worse HRQoL at follow up. Requirements for professional carers increased five-fold in frail patients at follow-up (Frail: 25% vs. Not-frail: 4%, p = 0.01).ConclusionsFrailty is associated with increased mortality post trauma discharge and frail older trauma survivors had worse HRQoL and increased care needs at six months post-discharge. Pre-injury frailty is a predictor of poor longer-term HRQoL after trauma and recognition should enable early specialist pathways and discharge planning.

Serum CIRP increases the risk of acute kidney injury after cardiac surgery.

Acute kidney injury (AKI) is a frequent perioperative complication. The underlying mechanisms of cardiac surgery-associated AKI are still not completely elucidated. Cold-induced RNA-binding protein (CIRP) has been subsequently found to be regulated by various stress conditions. During cardiac surgery and cardiopulmonary bypass (CPB), the host is subjected to hypothermia and inadequate organ perfusion, resulting in an upregulation of CIRP secretion. The aim of this study is to evaluate the role of elevated extracellular CIRP level as a contributing factor in the development of AKI. A total of 292 patients who underwent cardiac surgery were retrospectively enrolled and their serum samples were collected preoperative and postoperative. Demographic data, intraoperative data, in-hospital outcomes, and the occurrence of AKI were also collected for the patients. The correlation between CIRP and intraoperative procedures, as well as its association with postoperative outcomes were analyzed. In multivariable analysis, higher ΔCIRP (p = 0.036) and body mass index (p = 0.015) were independent risk factors for postoperative AKI. Meanwhile, patients with postoperative AKI exhibited lower survival rate in 2-year follow-up (p = 0.008). Compared to off-pump coronary artery bypass grafting surgery, patients who underwent on-pump coronary artery bypass grafting, valve surgery, aortic dissection and other surgery showed higher ΔCIRP, measuring 1,093, 666, 914 and 258 pg/mL, respectively (p < 0.001). The levels of ΔCIRP were significantly higher in patients who underwent CPB compared to those who did not (793.0 ± 648.7 vs. 149.5 ± 289.1 pg/mL, p < 0.001). Correlation analysis revealed a positive correlation between ΔCIRP levels and the duration of CPB (r = 0.502, p < 0.001). Patients with higher CIRP levels are at greater risk of postoperative AKI (OR: 1.67, p = 0.032), especially the stage 2-3 AKI (OR: 2.11, p = 0.037). CIRP secretion increases with prolonged CPB time after cardiac surgery, and CIRP secretion is positively correlated with the duration of CPB. Cardiac surgeries with CPB exhibited significantly higher levels of CIRP compared to non-CPB surgeries. Elevation of CIRP level is an independent risk factor for the incidence of AKI, especially the severe AKI, and were associated with adverse in-hospital outcomes.

Predictive value of glycoprotein DKK3 for early neurological deterioration after ischemic stroke

ObjectiveTo explore the value of serum Dickkopf-3 (sDKK3) in predicting Early Neurological Deterioration (END) and in-hospital adverse outcomes in acute ischemic stroke (AIS) patients. MethodsAIS patients (n = 200) were included and assessed by the National Institutes of Health Stroke Rating Scale. Serum Dkk3 levels were assessed by ELISA. END was defined as an increase of ≥ 4 points in NIHSS score within 72h. The biological threshold of sDKK3 level and END occurrence were predicted based on X-tile software. Primary outcomes were END and all-cause death, and the secondary outcome was ICU admission during hospitalization. The logistic regression model and Cox risk regression model were applied to evaluate the relationship between DKK3 level and END incidence, all-cause in-hospital mortality, and in-hospital adverse outcomes (ICU admission). ResultsDuring hospitalization, the incidence of END in patients with AIS was 13.0 %, and the mortality rate within 7 days after END was 11.54 % (3/26). In patients below the serum DKK3 cutoff (93.0 pg/mL), the incidence of END was 43.5 % (20/48). Patients with lower sDKK3 levels were associated with a 1.188-fold increased risk of developing END (OR = 1.188, 95 % CI 1.055‒1.369, p < 0.0001). However, there was no significant association with admission to the ICU. sDKK3 below the threshold (93.0 pg/mL) was a risk factor for death. ConclusionPredictive threshold levels of serum DKK3 based on X-tile software may be a potential predictive biomarker of in-hospital END in patients with AIS, and low levels of DKK3 are independently associated with increased in-hospital mortality.

Importance of Positive T-wave in Lead aVR and Major Adverse Cardiac Events in Patients with ST Elevation Myocardial Infarction: A Cohort Study

Introduction: It is well known that ST-Segment Elevation Myocardial Infarction (STEMI) is a significant contributor to both illness and death on a global scale. An Electrocardiogram (ECG) is an easily accessible bedside tool for diagnosing acute myocardial infarction. The T wave is usually negative in lead aVR (augmented unipolar right arm lead). However, a positive T wave in lead aVR has been shown to be associated with adverse in-hospital outcomes in patients with Acute Coronary Syndrome (ACS). Aim: To examine whether a positive T wave in lead aVR can be used as an indicator to predict Major Adverse Cardiac Events (MACE) during the hospital stay in patients with STEMI. Materials and Methods: A cohort study was performed at Shri BM Patil Medical College, Hospital and Research Centre, Vijayapura, involving patients admitted with STEMI. A total of 98 newly diagnosed ST-segment elevation patients were classified into two groups: Group A (positive T wave) in lead aVR with an amplitude of ≥ 0 mV, and Group B (negative T wave) in lead aVR with an amplitude of ≤0 mV. The hospital stays of STEMI patients were evaluated for adverse cardiac events. Chi-square test was used to assess relationships between categorical variables. Results: A total of 98 patients were evaluated, among which two were excluded. Hence, among 96 patients considered, 25 were females and 71 were male, with average ages of 57 years in Group A and 55 years in Group B. Among the 96 patients, 34 had positive T waves (35.4%) and 62 had negative T waves (64.5%) in lead aVR. The study revealed significantly higher rates of in-hospital MACE (heart failure, pulmonary oedema, and arrhythmias) in patients with positive T waves (Group A) in lead aVR, with p-values &lt;0.05, which were statistically significant. Conclusion: The present study showed that a positive T wave in lead aVR is a valuable and cost-effective tool for predicting inhospital MACE in patients with STEMI. Utilising this simple and readily available ECG measurement could support clinicians in detecting high-risk patients who require closer monitoring and more aggressive interventions, potentially leading to improved patient outcomes and resource allocation.

Derived Time in Range and Other Metrics of Poor Glycemic Control Associated With Adverse Hospital Outcomes in Patients With Diabetes Mellitus Admitted to Non-ICU Wards at a Tertiary-Level Hospital in Colombia: A Cross-Sectional Study.

Aim: This study is aimed at assessing the prevalence of poor glycemic control using different metrics and its association with in-hospital adverse outcomes. Methods: This cross-sectional study was conducted in diabetic patients admitted to a third-level hospital in Colombia between January and July 2022. Poor glycemic control was determined using capillary glucose metrics, including mean glucose values outside the target range, derived time in range (dTIR) (100-180 mg/dL) < 70%, coefficient of variation (CV > 36%), and hypoglycemia (<70 mg/dL). Multiple regression models were adjusted for hospital outcomes based on glycemic control, as well as other sociodemographic and clinical covariates. Results: A total of 330 Hispanic patients were included. A total of 27.6% had mean glucose measurements outside the target range, 33% had a high CV, 64.8% had low dTIR, and 28.8% experienced hypoglycemia. The in-hospital mortality rate was 8.8%. An admission HbA1c level greater than 7% was linked to an increased mortality risk (p = 0.016), as well as a higher average of glucometer readings (186 mg/dL vs. 143 mg/dL; p < 0.001). A lower average of dTIR (41.0% vs. 60.0%; p < 0.001) was also associated with a higher mortality risk. Glycemic variability was correlated with an increased risk of mortality, hypoglycemia, delirium, and length of hospital stay (LOS). Conclusion: A significant number of hospitalized diabetic patients exhibit poor glycemic control, which has been found to be associated with adverse outcomes, including increased mortality. Metrics like dTIR and glycemic variability should be considered as targets for glycemic control, highlighting the need for enhanced management strategies.

Prognostic significance of gastrointestinal dysfunction in critically ill patients with COVID-19.

To analyze in-hospital and 1-year morbidity and mortality associated with acute gastrointestinal dysfunction in critically ill patients with COVID-19 via a prespecified scoring system. Between March and July 2020, consecutive hospitalized patients with COVID-19 from a single institution were retrospectively analyzed by medical chart review. Only those who remained in the intensive care unit for more than 24 hours were included. Gastrointestinal dysfunction was assessed according to a predefined 5-point progressive gastrointestinal injury scoring system, considering the first 7 days of hospitalization. Laboratory data, comorbidities, the need for mechanical ventilation, the duration of intensive care unit stay, and subsequent in-hospital and 1-year mortality rates were also recorded. Among 230 patients who were screened, 215 were included in the analysis. The median age was 68 years (54 - 82), and 57.7% were male. The total gastrointestinal dysfunction scores were 0 (79.1%), I (15.3%), II (4.7%), III (0.9%), and IV (0%). Any manifestation of gastrointestinal dysfunction was present in 20.9% of all patients and was associated with longer lengths of stay (20 days [11 - 33] versus 7 days [4 - 16]; p < 0.001] and higher C-reactive protein levels on admission (12.8mg/mL [6.4 - 18.4] versus 5.7mg/mL [3.2 - 13.4]; p < 0.001). The gastrointestinal dysfunction score was significantly associated with mortality (OR 2.8; 95%CI 1.7 - 4.8; p < 0.001) and the need for mechanical ventilation (OR 2.8; 95%CI 1.7 - 4.6; p < 0.001). Both in-hospital and 1-year death rates progressively increased as gastrointestinal dysfunction scores increased. In the current series of intensive care unit patients with COVID-19, gastrointestinal dysfunction severity, as defined by a prespecified scoring system, was predictive of adverse in-hospital and 1-year outcomes.

Significance of CHA2DS2-VASc-Hs score in the prediction of adverse in-hospital outcomes in patients with Non-St segment elevation myocardial infarction

Significance of CHA2DS2-VASc-Hs score in the prediction of adverse in-hospital outcomes in patients with Non-St segment elevation myocardial infarction

Severity scale of coronary microvascular obstruction (no-reflow) during percutaneous coronary interventions in myocardial infarction patients

Introduction: There is no scale that combines the traditional criteria of coronary microvascular obstruction (CMVO, no-reflow phenomenon) to effectively assess the severity and prognosis of this complication.Objective: To develop and evaluate the severity scale of CMVO during percutaneous coronary intervention (PCI) for myocardial infarction (MI).Methods: The cohort study included 203 patients diagnosed with type 1 MI and CMVO during PCI. The CMVO criterion was TIMI flow grade (TFG) &lt;3 points. Using the proposed "CMVO Severity Scale" (CMVO-SS), three groups of patients were identified. CMVO grade 1 (mild): TFG 2 points, Myocardial blush grade (MBG) 2–3 points, ST segment resolution after PCI (rST) &gt;70%. CMVO grade 2 (moderate): TFG 2 points, MBG 0–1 points or rST &lt;70%. CMVO grade 3 (severe): TFG 0-1 points.Results: Distribution of groups with CMVO of the 1st, 2nd, and 3rd grade is 65 (32%) / 88 (43%) / 50 (25%) patients, respectively. Outcomes by group: acute heart failure grade 3–4 — 2 (3%) / 11 (13%) / 14 (28%), P &lt; .001; ejection fraction — 48 [44; 53] % / 46 [40; 50] % / 42 [39; 49] %, P = .004; in-hospital death — 1 (1.5%) / 12 (13.6%) / 16 (32.0%), P &lt; .001; two-year death — 8 (12.3%) / 19 (21.6%) / 22 (44.0%), P &lt; .001. The multivariate analysis revealed a two-year death odds ratio for the CMVO-SS of 2.40 [95% CI 1.23–5.17], P = .009. Two-year survival probability with CMVO-SS grade 1 was 87.7%, grade 2 — 78.4%, grade 3 — 56.0% (P &lt; .001).Conclusion: The proposed CMVO severity scale is associated with adverse in-hospital outcomes and two-year mortality. Received 15 May 2023. Revised 27 September 2023. Accepted 24 October 2023. Funding: The study was supported by the "Priority 2030" program. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.A. Frolov, E.G. Sharabrin, I.G. PochinkaData collection and analysis: A.A. Frolov, I.A. Frolov, K.V. KuzmichevStatistical analysis: A.A. Frolov, I.A. Frolov, K.V. KuzmichevDrafting the article: A.A. Frolov, I.G. Pochinka, I.A. FrolovCritical revision of the article: I.G. Pochinka, A.S. Mukhin, E.G. Sharabrin, V.N. SinyutinFinal approval of the version to be published: A.A. Frolov, I.G. Pochinka, I.A. Frolov, K.V. Kuzmichev, A.S. Mukhin, E.G. Sharabrin, V.N. Sinyutin