Fatal Death Research Articles

Association Between Cardiovascular Disease and Death by Anaphylaxis: A 20-Year Retrospective Study in Queensland, Australia.

Despite its severity, anaphylaxis carries a low mortality rate of less than 1%, making the cohort seen in the forensic pathology setting a small and unique subset of the majority of cases of anaphylaxis in the community. Clinically, cardiovascular disease has been recognized as a risk factor for fatal anaphylaxis; however, there is scant forensic pathology research investigating this risk factor, whereas autopsy textbooks emphasize physical respiratory changes seen in the broader clinical cohort. This 20-year retrospective study examined all fatal anaphylactic deaths in the state of Queensland, Australia, to document the underlying disease of the cases, tryptase levels, triggers, and postmortem findings. Our study found that cardiovascular disease was prevalent in 83.3% of cases of fatal anaphylaxis. Although asthma was prevalent in food-related fatal anaphylaxis (60%) in our cohort, it was poorly represented overall (28%), in contrast to clinical research. Additionally, only 43% of cases showed respiratory changes that were greater than mild. Our findings emphasize the difference between the clinical and postmortem anaphylaxis cohorts, and provide autopsy evidence of a potential role of cardiovascular disease in fatal anaphylaxis.

Leukemia Cancer Cells Segmentation and Classification using Machine Learning

Determining the aim of the project is to detect the leukemia at earlier stage with the help of image processing techniques. Leukemia means blood cancer which is featured by the uncontrolled and abnormal production of white blood cells (leukocytes) by the bone marrow in the blood. Acute Lymphoblastic Leukemia (ALL) is a type of leukemia which is more common in children. The term Acute‟ means that leukemia can progress quickly and if not treated may lead to fatal death within few months. Due to its non specific nature of the symptoms and signs of ALL leads wrong diagnosis. Even hematologist finds it difficult to classify the leukemia cells, there manual classification of blood cells is not only time consuming but also inaccurate. Therefore, early identification of leukemia yields in providing the appropriate treatment to the patient. Detection through images is fast and cheap method as there is no special need of equipment for lab testing. We have focused on the changes in the geometry of cells like area, perimeter and statistical parameters like mean and standard deviation which separates white blood cells from other blood components using processing tools like MATLAB. After recognizing its statistical properties, types of leukemia will be identified based on the irregularities in the shape.

Immediate hypersensitivity reactions to iodinated contrast media despite drug prophylaxis-a comparative retrospective cohort study of breakthrough reactions in Bern (Switzerland) and Seoul (South Korea).

Although several studies deal with breakthrough reactions (BTRs) in patients with contrast media (CM) hypersensitivity reactions, the phenomenon is still unclear. Therefore, this study aimed to analyse in depth patients with BTR in two countries. We retrospectively analysed the electronic medical records of in- and outpatients (random sample enrolment) from two academic hospitals of tertiary care (Seoul/South Korea, with a special monitoring system exclusively for CM hypersensitivity, and Bern/Switzerland, manually operated) with respect to basic epidemiological data, number of BTRs per patient, and severity grades of severity in follow-up analyses. The study period lasted from 2013 (2000 Bern) to 2017. We identified 445 BTR-patients (91.5% from Seoul) with 691 BTRs (94.5% from Seoul). Most reactions were mild, 11% moderate and 3.9% severe. In Seoul, we found patients with up to 10 BTRs, and in Bern, there were only patients with one BTR. Fatal reactions or deaths did not occur. In most cases, the severity of the BTRs and of the index reactions were identical (80.8%). Mild index reactions remained constant in 90.6%. In contrast, in moderate index reactions the severity decreased/remained identically in 86.8% and increased in 13.2%. In severe index reactions, 55.6% of BTR reactions were severe again, in 44.4% the severity decreased. In 158 BTRs (22.9%) the culprit iodinated contrast medium (ICM) of the index reaction induced the BTR. In the other 482 BTRs (69.8%) the culprit ICM was changed to another non-culprit ICM. To the best of our knowledge, this is the largest study on patients with BTRs, and the first study showing BTRs in two centers in two countries of two continents. The main differences between the two centers result from the different hospital size, the number of patients, and the different documentation [manual (Bern) vs. electronical screening (Seoul)]. BTRs are no contraindications for further ICM-application. We recommend performing an allergy skin test as basis for the decision-making process of the next contrast-enhanced image-guided examination.

Anatomical Consideration of Dhamani Marma with SpecialReference to Vidhur Marma in Ayurveda

Marma sharira is known as the science of traumatological anatomy. Injuries to various structures of the body such as arteries, muscles, nerves, bones, and visceral organs may result in fatal injuries and death. Marmas in Ayurvedic classics are illustrated as the vital points in human body injury of which leads to termination of life. Acharya Sushruta has presented five types of marmas on structural basis, that is, Mansa-marma, Sira-marma, Snayu-marma, Asthi-marma, and Sandhi marma. Whereas according to acharya Vaghbhatt, there are six types of marmas. He has enumerated a sixth group of marma known as Dhamani Marma. Under the Dhamani Marmas which are nine in number he has presented Vidhur marma. The injury to which leads to deafness. The possible cause of deafness may be due to injury of an arterial structure that is Dhamani or snayu, that is, nerves. This article focuses on co-relating various anatomical structures such as arteries and nerves with Dhamani Marma explained by acharya Vagbhatt with special reference to Vidhur marma injury.

Understanding the health system utilisation and reasons for avoidable mortality after fatal injury within a Three-Delays framework in Karonga, Northern Malawi: a retrospective analysis of verbal autopsy data

ObjectivesTo use verbal autopsy (VA) data to understand health system utilisation and the potential avoidability associated with fatal injury. Then to categorise any evident barriers driving avoidable delays to care...

Analysis of Road Safety Based on Road Type on National Roads in Bali Province

The Province of Bali is one of the most popular tourist destinations in Indonesia which accounts for 40% of tourist visits in Indonesia. Apart from being a tourist spot, Bali also often hosts various state events. As a destination that is often in the public and world spotlight, it is important for Bali to have safer road infrastructure. However, based on data in the field, there are still many accidents that occur on National Roads in Bali and even tend to increase. If this is not handled, the impact will also be a problem in various aspects. This research aims to analyze road safety based on the type of road using the accident rate and fatality rate method on National Road sections in Bali Province. Based on the results of data analysis, this research shows the results of data accident rate or the highest accident rate is 160 incidents per 1 million vehicles per year on the Kosamba – Angentelu Bali road section. For data analysis of fatality rate or death rate, the highest is 245 per 1 million vehicles per year on Jalan A.Yani (Amlapura) Bali. And the type of road that has the highest accident rate and fatality rate number is the 2/2 UD road type.

PfAgo-Based Zika Virus Detection.

As a mosquito-borne flavivirus, Zika virus (ZIKV) has been identified as a global health threat. The virus has been linked to severe congenital disabilities, including microcephaly and other congenital malformations, resulting in fatal intrauterine death. Therefore, developing sensitive and specific methods for the early detection and accurate diagnosis of the ZIKV is essential for controlling its spread and mitigating its impact on public health. Herein, we set up a novel nucleic acid detection system based on Pyrococcus furiosus Argonaute (PfAgo)-mediated nucleic acid detection, targeting the non-structural protein 5 (NS5) region of the ZIKV genome (abbreviated ZIKV-PAND). Without preamplification with the polymerase chain reaction (PCR), the minimum detection concentration (MDC) of ZIKV-PAND was about 10 nM. When introducing an amplification step, the MDC can be dramatically decreased to the aM level (8.3 aM), which is comparable to qRT-PCR assay (1.6 aM). In addition, the diagnostic findings from the analysis of simulated clinical samples or Zika virus samples using ZIKV-PAND show a complete agreement of 100% with qRT-PCR assays. This correlation can aid in the implementation of molecular testing for clinical diagnoses and the investigation of ZIKV infection on an epidemiological scale.

The silent storm: a case report of missed antenatal diagnosis leading to fatal respiratory distress and death in a rare case of congenital high airway obstruction syndrome

Congenital high airway obstruction syndrome in neonates is a rare, life-threatening condition characterized by upper airway obstruction. Typically diagnosed prenatally through advanced imaging, CHAOS results from anomalies such as laryngeal atresia or web or tracheal stenosis. Neonates with CHAOS face respiratory distress at birth, necessitating prompt intervention. Management often involves ex-utero intrapartum treatment procedure or tracheostomy to establish a secure airway. Timely diagnosis and multidisciplinary collaboration are crucial for optimizing outcomes in affected infants. Despite its rarity, CHAOS demands heightened clinical awareness to ensure swift, tailored interventions and improve the chances of neonatal survival. We report here a case of CHAOS which was not diagnosed on antenatal ultrasonography.

Fact vs. fiction: naloxone in the treatment of opioid-induced respiratory depression in the current era of synthetic opioids.

Opioid-induced respiratory depression (OIRD) deaths are ~80,000 a year in the US and are a major public health issue. Approximately 90% of fatal opioid-related deaths are due to synthetic opioids such as fentanyl, most of which is illicitly manufactured and distributed either on its own or as an adulterant to other drugs of abuse such as cocaine or methamphetamine. Other potent opioids such as nitazenes are also increasingly present in the illicit drug supply, and xylazine, a veterinary tranquilizer, is a prevalent additive to opioids and other drugs of abuse. Naloxone is the main treatment used to reverse OIRD and is available as nasal sprays, prefilled naloxone injection devices, and generic naloxone for injection. An overdose needs to be treated as soon as possible to avoid death, and synthetic opioids such as fentanyl are up to 50 times more potent than heroin, so the availability of new, higher-dose, 5-mg prefilled injection or 8-mg intranasal spray naloxone preparations are important additions for emergency treatment of OIRDs, especially by lay people in the community. Higher naloxone doses are expected to reverse a synthetic overdose more rapidly and the current formulations are ideal for use by untrained lay people in the community. There are potential concerns about severe withdrawal symptoms, or pulmonary edema from treatment with high-dose naloxone. However, from the perspective of first responders, the balance of risks would point to administration of naloxone at the dose required to combat the overdose where the risk of death is very high. The presence of xylazines as an adulterant complicates the treatment of OIRDs, as naloxone is probably ineffective, although it will reverse the respiratory depression due to the opioid. For these patients, hospitalization is particularly vital. Education about the benefits of naloxone remains important not only in informing people about how to treat emergency OIRDs but also how to obtain naloxone. A call to emergency services is also essential after administering naloxone because, although the patient may revive, they may overdose again later because of the short half-life of naloxone and the long-lasting potency of fentanyl and its analogs.

Effect of Asymptomatic Common Carotid Artery Dissection on the Prognosis of Patients With Acute Type A Aortic Dissection.

Acute type A aortic dissection can extend upwards to involve the common carotid artery. However, whether asymptomatic common carotid artery dissection (CCAD) requires surgical repair remains controversial. This study aimed to explore the effect of asymptomatic CCAD without surgical intervention on the prognosis of patients who underwent surgery for acute type A aortic dissection. Between January 2015 and December 2017, 485 patients with no neurological symptoms who underwent surgery for acute type A aortic dissection were enrolled in this retrospective cohort study. The patients were divided into 2 groups based on the exposure factor of CCAD. CCAD was detected in 111 patients (22.9%), and after adjusting baseline data (standardized mean difference <0.1), the 30-day mortality (17.1% versus 6.0%, P<0.001) and incidence of fatal stroke (7.7% versus 1.6%, P=0.001) were significantly higher in the group with CCAD. Univariable and multivariable Cox regression analyses found CCAD as an independent risk factor for 30-day mortality (hazard ratio [HR], 2.8 [95% CI, 1.5-5.2]; P=0.001). At a median follow-up of 6.2 years (interquartile range, 5.6-6.9 years), landmark analysis with a cutoff value of 1 month postoperatively showed a significant increase in mortality in the group with CCAD, especially in the first month (log-rank P=0.002) and no significant difference in survival after the first month postoperatively between the 2 groups (log-rank P=0.955). Asymptomatic CCAD increased the risk of early fatal stroke and death in patients with acute type A aortic dissection after surgery but did not affect midterm survival in patients who survived the early postoperative period.

Deaths due to rabies in Shivamogga, India: Case series and review

Rabies is a fatal disease and deaths due to this have been on the increase. This is due to a lack of awareness leading to failure to obtain proper treatment. We report five cases confirmed to be rabies virus positive, with Negri bodies in their neuronal tissues. Due to a lack of awareness, the individuals are failing to take proper postexposure prophylaxis. The people are avoiding going to health care hospitals as a result of which, after varying incubatory periods the individuals eventually are succumbing to the illness. They are exhibiting characteristic encephalitic symptoms, as a result of this deadly disease. Proper prevention and management, along with awareness among the people can decrease the fatality. Effective programs and continuous surveillance of rabid dogs, to effectively control their population and vaccinate them on a consecutive basis, can combat the virus and stop its spread.

Abstract 16725: Cost-Effectiveness Analysis of Intensive Treatment of Systolic Hypertension: Results From Sprint Patient-Level Data

Background: The Systolic Blood Pressure Intervention Trial (SPRINT) showed that treating patients at high risk for cardiovascular events but without diabetes or a history of stroke to a systolic blood pressure (SBP) target goal of &lt;120 mm Hg (Intensive Care, IC), compared with &lt;140 mm Hg (Standard Care, SC), resulted in lower rates of fatal and nonfatal major cardiovascular events and death. We examined the cost-effectiveness of IC vs SC over a life-time horizon, based on patient-level data, from a health-sector perspective. Methods: Patient-level data from SPRINT were used to calculate and estimate cost, effectiveness, quality adjusted life years (QALY), and the incremental cost-effectiveness ratio (ICER). For participants who died during the trial, life years and QALYs were estimated from in-trial analysis; for who survived to the end of the trial, pooled, harmonized data from six epidemiologic cohorts included in the National Heart, Lung, and Blood Institute Pooled Cohorts Study was used to estimate risk of lifetime primary fatal and non-fatal events and calculate life-years. Published utilities estimates were used to calculate QALYs. For participants without SPRINT lifetime primary event estimates, we applied multiple imputation method via machine learning to impute the life-years and QALYs. The ICER was expressed as cost per QALY gained. Results: IC participants were estimated to gain an average of 0.51 QALY (95% CI: 0.21, 0.81) relative to SC participants. Estimated total lifetime costs were $17,449 higher with IC (95% CI: $10,697, $24,201) than SC. The ICER for IC vs SC was $34,214 per QALY gained, with 68.5% of bootstrap-derived estimates &lt;$50,000/QALY. The results from multiple imputation chained equations for addressing missing data showed that IC is cost effectiveness at $50,000/QALY. Across various scenario analyses, we consistently found a more than 60% probability that IC is cost-effective over a lifetime when the willingness-to-pay value exceeds $100,000 per QALY. Conclusions: Based on participant-level trial and epidemiologic cohort data, IC is cost-effective, with significant clinical benefit at acceptable higher lifetime cost. Recommending intensive SBP targets in patients at high CVD risk is an effective, high-value therapy.

Fatal architectures and death by design: the infrastructures of state-sponsored climate disasters in Angola and Mozambique

ABSTRACT This article addresses how African states respond to climate crisis, arguing that, beyond the agency and impact of climate phenomena such as drought and cyclones, they are active participants in the production of climate disasters and emergencies, mostly through infrastructural processes that affect land and resource use, and subsequently livelihoods. To demonstrate this, it uses the cases of the drought in southwestern Angola and cyclones in northern and central Mozambique, where such climate phenomena have exposed ‘fatal architectures’ that have dramatically raised the toll of climate victims and refugees. Both extractivist, agro-industrial and hydroelectric projects, as well as other, more deferred infrastructural designs (roads, communication networks, etc.) have challenged the traditional agency and resilience of local communities. Such new infrastructural projects also illustrate how certain perceived long-term solutions to address the climate crisis with industrial and energy reconversion towards greener energies can still become fatal architectures in the context of climate emergencies.

Ethnoracial Disparities in Rates of Non-Natural Causes of Death After the 2020 COVID-19 Outbreak in New York State

COVID-19 was associated with increases in non-natural cause mortality in the U.S., including deaths due to drug overdose, homicide, and motor vehicle crashes. Initial reports indicated higher rates of non-natural mortality among ethnoracial minority groups. This report aims to clarify these disparities by documenting trends in non-natural mortality across ethnoracial groups during the 2020 COVID-19 surge in New York State. We report monthly trends in non-natural cause mortality (overall and stratified by ethnoracial status) in New York State from January 2019 through December 2020, which included the COVID-19 onset in March 2020. Total mean monthly unintentional overdose rates per 100,000 increased from 17.45 (before surge: January 2019-February 2020) to 23.19 (after surge: March 2020-December 2020) (mean difference=5.73, 95% CI=3.82, 7.65; p<0.001).Mean monthly homicide death rates increased from 2.34 before surge to 3.55 after surge (mean difference=1.20, 95% CI=0.60, 1.81; p<0.001), with the increase seen primarily in the non-Latinx Black population. Although increasing unintentional overdose death rates before surge equally affected non-Latinx White, Latinx, and non-Latinx Black persons, they remained high for non-Latinx Black persons but dropped for the other 2 groups after the pandemic onset. None of the ethnoracial subgroups showed significant increases in suicide or motor vehicle crash death rates. Non-Latinx Black persons showed disproportionately high and sustained increased rates of unintentional overdose and homicide death rates after the 2020 COVID-19 surge in New York State. Fatality review and death scene investigation research is needed to better understand these disparities.

Report of 5146 Cases of Coronavirus Disease 2019-Related Mortality From Cook County, Illinois Causes of Death, Demographics, and Comorbidities.

A cross-sectional study used 5216 laboratory-confirmed coronavirus disease 2019 (severe acute respiratory syndrome coronavirus 2)-related mortality cases in Cook County of Illinois. The data set included each case's demographic data, manner of death, and comorbidities. The age ranged from 0 to 108 years, with a median of 73.5 years. There were few mortality cases in the age group younger than 30 years, and the incidence of fatal infection increased with age. We demonstrated an increased incidence of mortality in males compared with females (P < 0.01). The urban population had a higher incidence of fatal infection than the suburban population (P < 0.01). We found a significant increase (P < 0.01) in the incidence of fatal coronavirus disease 2019 (severe acute respiratory syndrome coronavirus 2) infection in African American males compared with background frequencies. Latino population demonstrated younger ages at death compared with the non-Latino population. Obesity and hypertension significantly predict fatal outcomes in the younger age group. In comparison, dementia and hypertensive and arteriosclerotic cardiovascular disease are significant predictive factors in the older age group. In a large data set, we demonstrated that the demographical distribution of the population and comorbidities is associated with the risk of fatal complications and death.

Expanding the phenotypic and biochemical spectrum of NDUFAF3-related mitochondrial disease

Recessive variants in NDUFAF3 are a known cause of complex I (CI)-related mitochondrial disorders (MDs). The seven patients reported to date exhibited severe neurologic symptoms and lactic acidosis, followed by a fatal course and death during infancy in most cases.We present a 10-year-old patient with a neurodevelopmental disorder, progressive exercise intolerance, dystonia, basal ganglia abnormalities, and elevated lactate concentration in blood. Trio-exome sequencing revealed compound-heterozygosity for a pathogenic splice-site and a likely pathogenic missense variant in NDUFAF3. Spectrophotometric analysis of fibroblast-derived mitochondria demonstrated a relatively mild reduction of CI activity. Complexome analyses revealed severely reduced NDUFAF3 as well as CI in patient fibroblasts. Accumulation of early sub-assemblies of the membrane arm of CI associated with mitochondrial complex I intermediate assembly (MCIA) complex was observed. The most striking additional findings were both the unusual occurrence of free monomeric CI holding MCIA and other assembly factors.Here we discuss our patient in context of genotype, phenotype and metabolite data from previously reported NDUFAF3 cases. With the atypical presentation of our patient, we provide further insight into the phenotypic spectrum of NDUFAF3-related MDs. Complexome analysis in our patient confirms the previously defined role of NDUFAF3 within CI biogenesis, yet adds new aspects regarding the correct timing of both the association of soluble and membrane arm modules and CI-maturation as well as respiratory supercomplex formation.

Comparative Toxicology of Syringe Exchange and Post-Mortem Blood Samples in the District of Columbia: Trends and Affinity Analysis.

This cross-sectional analysis aimed to understand the similarities and differences between drugs detected in syringes collected from syringe service providers in the District of Columbia and fatal overdose deaths captured by the State Unintentional Drug Overdose Reporting System. Substance exposures for these fatal and non-fatal drug use outcomes have not been previously compared. Substance distributions were examined and a paired significance test was used to compare changes over time. Affinity analysis was employed to reveal substance co-occurrences. Between September, 2020-2022, 1,118 post-mortem blood samples and 3,646 syringes were processed, with fatal overdoses increasing 24.1%. Polysubstance use was more commonly found in post-mortem blood (82.5%) than syringe exchange samples (48.6%). Of samples containing opioids, 94.8% of blood samples and 86.3% of syringes contained fentanyl, fentanyl analogs, or fentanyl precursors/metabolites. Post-mortem blood samples had double the frequency of co-occurring stimulants and opioids (43.9%) as syringe exchange samples (21.8%). Major changes in occurrence frequency over time were found for opioid and stimulant exposure in both groups, especially in the increased occurrence of fluorofentanyl (>400%), methamphetamine (>90%), and xylazine (>60%) while the incidence of fentanyl, heroin, and metabolite morphine declined. These results indicate that while fatal use and syringe exchange populations have distinct substance exposures which may contribute to differences in mortality rate, their substance distributions have similar change magnitudes. This study highlights the utility of using multiple data sources to provide a comprehensive description of drug use patterns and discusses the limitations in reporting data from each source.

Quantitative estimation of TNF-α and IL-3 by using ELISA from human lung tissue in fatal asphyxial deaths

Asphyxia-related deaths have always been a challenging task in the specialty of forensic pathology. Apart from helpful macroscopical signs (e.g., strangulation marks, cyanosis, petechial haemorrhage, and lung edema), recent literature indicates that prolonged asphyxia is sufficient to induce an increase in mast cells (MC). Inflammatory cells migrate from the bone marrow to the lungs, aiding in the diagnosis of fatal asphyxial death. The present study analyzed human lung tissue samples from 90 medico-legal autopsy cases, including 45 asphyxial deaths and 45 controls (non-asphyxial deaths). The cases ranged from 2 to 68 years, with a mean age of 33.23 years. In 90 cases, 74 cases were of males, and 16 were of females. Human lung tissue samples were analyzed by using the sandwich ELISA method. The results indicated a statistically significant increase in TNF-α and IL-3 concentration in fatal asphyxial deaths, including those caused by hanging, drowning, and smothering. Mean ± SD in asphyxial and non-asphyxial cases for the TNF-α and IL-3 concentration statistically analysed. In asphyxial cases, the average IL-3 concentration (Conc.) was 1558.50 ± 350.53 pg/ml, and the average TNF-α concentration (Conc.) was 499.75 ± 479.41 pg/ml. In contrast, in non-asphyxial cases, the average IL-3 concentration (Conc.) was found to be 849.73 ± 484.99 pg/ml, and the average TNF-α concentration (Conc.) was 208.08 ± 81.23 pg/ml. The mean change in IL-3 and TNF-α (Conc.) values are found to significant (<0.01) in asphyxial cases as compared to non-asphyxial cases. The ROC (Receiver operating characteristic curve) analysis revealed that TNF-α (AUC = 0.89) and IL-3 (AUC = 0.87) concentration (conc.) were stronger predictors of asphyxial deaths with an optimal cut-off value of 455.20 pg/ml for TNF-alpha and 1700.62 pg/ml for IL-3 respectively. Our findings imply that mast cells (MC) are critical in fatal hypoxia-related mortality and that TNF-α and IL-3 can be reliable markers for detecting mast cells in asphyxial deaths. It could be very beneficial to forensic pathologists tasked with differentiating fatal asphyxial fatalities from other causes of death.

Metabolic activation and cytotoxicity of metaxalone mediated by cytochrome P450 enzymes and sulfotransferases

Metaxalone (MTX) is a central nervous system (CNS) depressant used for the treatment of acute skeletal muscle pain. Several cases of fatal overdose deaths in the clinical use of MTX, along with the presence of ischemic hepatitis in deceased patients, have been documented. The present study aimed to investigate the metabolic activation of MTX and to define the possible correlation between the metabolic activation and cytotoxicity of MTX. An oxidative metabolite (M1) and a GSH conjugate (M2) were observed in S9 fraction incubations as well as in rat primary hepatocyte culture after exposure to MTX. M1 and M2 were also observed in bile of MTX-treated rats. CYP2A6 was found to dominate the oxidation of MTX. Both methoxsalen (MTS, a CYP2A6 inhibitor) and 2,6-dichloro-4-nitrophenol (DCNP, a sulfotransferase inhibitor) dramatically decreased the formation of M2. Pre-treatment of primary hepatocytes with DCNP or MTS significantly decreased the susceptibility to the cytotoxicity of MTX.

Clinical characteristics and in - hospital outcome of acute coronary syndrome in patients with three - vessel and/ or left main coronary artery disease after percutaneous coronary intervention

ABSTRACT Background: Many studies in Vietnam have shown that there is an increasing number of patients hospitalized due to acute coronary syndrome (ACS) with multivessel stenosis and/or with left main stenosis. The SYNTAX score based on the results of percutaneous coronary angiography is valuable for risk stratification of patients requiring coronary revascularization, especially for those with multivessel coronary artery disease, then optimizing the clinicians’ decision on percutaneous coronary intervention or bypass surgery for these patients. This study aims to: (1) investigate some clinical characteristics of ACS patients with multivessel and/or left main coronary artery disease (LMCAD); (2) characterize coronary artery lesions according to SYNTAX score by the results of percutaneous coronary angiography; and (3) evaluate intervention outcomes and in - hospital outcomes of these patients treated by percutaneous coronary intervention. Methods: 121 patients with three - vessel and/or LMCAD treated at 115 People’s Hospital in Ho Chi Minh city, from July 2019 to July 2020. Research design: retrospective; collecting clinical characteristics, and coronary intervention results during the in - hospital stay. Results: Mean age 66.03 ± 11.84, male/female ratio 3/1; average total coronary lesions 3.1 ± 1.2 lesions in left anterior descending (LAD) and right coronary artery (RCA), mean SYNTAX score 27.7 ± 6.21; Short - term intervention outcomes: anatomical success 99.2%, procedural success 98.34%, major in - hospital main cardiovascular events including fatal death and other - causes mortality during hospitalization was 2.4%, the cumulative intra - and post - procedure complications was 8.2%.