Flow Grade Research Articles

Correlation Analysis of Digital Mammography, Ultrasonography, and Pathologic Features in Pure Invasive Micropapillary Carcinoma of the Breast (PIMPC).

This study determined the digital mammography and ultrasonography imaging features of pure invasive micropapillary carcinoma of the breast (PIMPC) and the correlation with pathologic features. Nineteen patients diagnosed with PIMPC at Yantaishan Hospital from October 2015 to February 2022 were included in the study group. Forty patients with breast masses diagnosed as nonspecific invasive ductal carcinoma of the breast (NIDC) from July to December 2021 were included in the control group. Digital mammography and ultrasonography features were compared between the two groups. Patients with PIMPC had a younger age profile compared to patients with NIDC (P=0.017). Moreover, PIMPC masses were smaller than NIDC masses (P=0.040). Imaging features analysis revealed significant differences in age groups (<45 years: χ²=5.971, P=0.044) and the presence of spiculations or the crab claw sign (χ²=8.583, P=0.004) between patients with PIMPC and NIDC. However, there were no statistically significant differences in the presence of calcifications, blood flow grading, pathologic molecular subtypes between the study and control groups. The Ki-67 proliferative index (χ²=1.052, P=0.389), vascular invasion (χ²=2.263, P=0.197), and lymph node metastasis (χ²=1.968, P=0.386) showed no significant differences between PIMPC and NIDC patients. PIMPC imaging features show specificity, such as tiny breast masses, spiculated edges, or crab claw-like patterns, and malignant signs appeared when the lesion was <2 cm in diameter. PIMPC mainly occurs in middle-aged women 45-59 y of age. Patients with PIMPC and NIDC of the breast are frequently associated with lymph node metastases and greater than one-half of the cases (74%) were shown to have a Ki-67 index >30%, suggesting a significant risk of recurrence and metastasis. Early therapeutic care for these patients is crucial. These results warrant further validation with additional samples from several centers due to the limited single-center sample size in the current study.

VARIOUS ASPECTS OF PERCUTANEOUS CORONARY INTERVENTIONS AS PREDICTORS OF DEATH IN MYOCARDIAL INFARCTION AND CORONARY MICROVASCULAR OBSTRUCTION (NO-REFLOW)

HighlightsThe review analyzed the role of various preoperative indicators as predictors of long-term mortality in patients with myocardial infarction and coronary microvascular obstruction (no-reflow) that developed during percutaneous coronary intervention. As a result of a multifactorial analysis, taking into account the confounders available for evaluation, we have found that predilation serves as an independent predictor of death within two years. AbstractAim. To evaluate the role of various aspects of percutaneous coronary interventions (PCI) as predictors of long-term death in myocardial infarction (MI) and coronary microvascular obstruction (CMVO, no-reflow).Methods. The unmatched case-control study included 232 patients with type 1 MI and CMVO developed during PCI. CMVO criteria were as follows: TIMI flow grade &lt;3, Myocardial blush grade &lt;2, ST segment resolution after PCI &lt;70%. The “cases” group consisted of 54 (23.3%) patients who died within the next two years, the “controls” group consisted of 178 (76.7%) patients who survived. The analysis included the following indicators: predilation, high-pressure balloon post-dilation, vacuum assisted manual thromboaspiration, intra-aortic balloon pump, intracoronary administration of isosorbide dinitrate and verapamil hydrochloride, glycoprotein IIb/IIIa inhibitors and “potent” p2y12 inhibitors usage, bare-metal stents, stent implantation with exceeded rated burst pressure, 3 or more stents usage, PCI on more than one artery, the ratio of contrast agent volume to glomerular filtration rate (GFR) &gt;3.0. A univariate comparative analysis of the groups regarding PCI aspects and potential confounders was performed (Mann-Whitney, Fisher). To control the confounders, a multivariate analysis was carried out (logistic regression).Results. Differences were obtained for the following indicators: “predilation” – in 51 (94%) patients in the “cases” group and in 139 (78%) in the “control” group, p-value = 0.005; “intra-aortic balloon pump” – in 9 (17%) and 7 (4%) patients respectively, p-value = 0.003; “the ratio of contrast agent volume to GFR &gt;3.0” – in 26 (48%) and 48 (27%) patients, p-value = 0.005. Multivariate analysis revealed that only predilation was an independent predictor of death within two years – odds ratio 7.38 (95% confidence interval 1.70–49.04, p-value = 0.005).Conclusion. Predilation of the infarct-related coronary artery is an independent predictor of death within two years in MI patients who develop CMVO during PCI.

Determinants of serious in-hospital complications in patients with Killip class 1/2 ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention.

Killip classification has been used to stratify the risk of patients with acute myocardial infarction (AMI). There were many reports that Killip class 3 or 4 is closely associated with poor clinical outcomes. In other words, Killip class 1 or 2 is associated with favorable clinical outcomes in patients with AMI, especially when patients received primary percutaneous coronary intervention (PCI). However, some patients with Killip class 1/2 suffer from serious in-hospital complications. This study aimed to identify factors associated with serious in-hospital complications of ST-segment elevation myocardial infarction (STEMI) in patients with Killip class 1/2. The primary endpoint was serious in-hospital complications defined as the composite of in-hospital death and mechanical complications. We included 809 patients with STEMI, and divided them into the non-complication group (n = 791) and the complication group (n = 18). In-hospital death was observed in 14 patients (1.7%), and mechanical complications were observed in 4 patients (0.5%). Final TIMI flow ≤ 2 was more frequently observed in the complication group (33.3%) than in the non-complication group (5.4%) (p < 0.001). Multivariate logistic regression analysis revealed that serious in-hospital complication was associated with final TIMI flow grade ≤ 2 (Odds ratio 6.040, 95% confidence interval 2.042-17.870, p = 0.001). In conclusion, serious in-hospital complication of STEMI was associated with insufficient final TIMI flow grade in patients with Killip class 1/2. If final TIMI flow grade is suboptimal after primary PCI, we may recognize the potential risk of serious complications even when patients presented as Killip class 1/2.

Risk factors for electrical storms following percutaneous coronary intervention in patients with acute myocardial infarction: A meta-analysis.

Electrical storms (ESs) following percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients pose a significant challenge, affecting prognostic outcomes and increasing mortality. This meta-analysis synthesized data from 11 studies involving 9,666 AMI patients to identify risk factors associated with ES following PCI. Our findings revealed an average ES incidence of 7.70%, with identified risk factors including low thrombolysis in myocardial infarction (TIMI) flow grades (0-1), elevated cardiac troponin I levels, persistent hypotension, reperfusion arrhythmias, the right coronary artery being the infarct-related artery, increased diameter of the infarct-related artery, renal dysfunction, elevated creatine kinase-MB, and bradycardia. Notably, the use of β-blockers was found to significantly reduce the risk of ES. The study underscores the importance of early identification and management of these risk factors in AMI patients undergoing PCI to prevent the occurrence of ES, highlighting the protective role of β-blockers. This research provides a foundation for future strategies aimed at reducing the incidence and improving the prognosis of ES in this patient population.

Efficacy and Safety of Deferred Stenting in Geriatric Patients with STEMI and High Thrombus Burden.

Deferred stenting has been recognized as beneficial for patients with acute ST-segment elevation myocardial infarction (STEMI) accompanied by a high thrombus burden. Nevertheless, its efficacy and safety specifically in geriatric STEMI patients remain to be elucidated. This study aims to bridge this knowledge gap and assess the potential advantages of deferred stenting in an older patient cohort. In this study, 208 geriatric patients (aged 80 years) with STEMI and a high thrombus burden in the infarct-related artery (IRA) were enrolled. They were categorized into two groups: the deferred stenting group, where stent implantation was conducted after 7-8 days of continuous antithrombotic therapy, and the immediate stenting group, where stent implantation was performed immediately. In the deferred stenting group, the stents used were significantly larger in diameter and shorter in length compared to those in the immediate stenting group (p 0.05). This group also exhibited a lower incidence of distal embolism in the IRA, and higher rates of the thrombolysis in myocardial infarction (TIMI) blood flow grade 3 and myocardial blush grade 3 (p 0.05). Additionally, the left ventricular ejection fractions at the 1-year follow-up were significantly higher in the deferred stenting group than in the immediate stenting group (p 0.05). The rate of the major adverse cardiac events in the deferred stenting group was significantly lower than in the immediate stenting groups (p 0.05). Deferred stenting for geriatric patients with STEMI and high thrombus burden demonstrates significant clinical benefits. This approach not only reduces the incidence of distal embolism in the IRA, but also enhances myocardial tissue perfusion and preserves cardiac ejection function. Moreover, deferred stenting has proven to be safe in this patient population, indicating its potential as a preferred treatment strategy in such cases.

Frequency of No-Reflow Phenomenon in Patients Treated with Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Background: The no-reflow phenomenon is a critical complication following percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI), which can significantly affect morbidity and mortality. Despite advancements in interventional cardiology, no-reflow remains a challenge, with various factors contributing to its occurrence. Objective: This study aims to identify independent risk factors for the no-reflow phenomenon in STEMI patients undergoing direct PCI and to develop a practical scoring system for predicting the likelihood of its occurrence. Methods: In a retrospective cohort analysis, 1,345 patients who underwent direct PCI at a single center were evaluated. Baseline characteristics, clinical manifestations, and angiographic findings were meticulously recorded. Multivariate logistic regression was employed to ascertain independent predictors for no-reflow. The derived scoring system was based on statistically significant variables, including age, collateral circulation, thrombus burden, lesion diameter, and ACEI/ARB therapy. Results: The mean age of the development cohort (n=1011) was 61.2±11.2 years, with the validation cohort (n=334) averaging 62.1±10.8 years. No-reflow was present in 80.1% of the development group with TIMI blood flow grade 1. Independent predictors of no-reflow included age ≥55 years (OR 2.100, p=0.001), collateral circulation &lt;grade 2 (OR 2.907, p=0.002), thrombus burden ≥4 points (OR 1.920, p&lt;0.001), and lack of ACEI/ARB therapy (OR 1.678, p=0.017). The scoring system demonstrated a sensitivity of 42.0% and a specificity of 78.4%, with PPV and NPV of 45.8% and 78.5%, respectively. Conclusion: The study identified several key predictors for no-reflow and established a scoring system that may aid clinicians in the early identification of patients at risk for no-reflow post-PCI. This scoring system, given its simplicity and reliance on readily available clinical data, has the potential to be incorporated into routine clinical practice, subject to validation in future prospective studies.

Use of the Indigo CAT RX aspiration system during percutaneous coronary intervention.

The use of the Indigo CAT RX Aspiration System (Penumbra Inc.) during percutaneous coronary intervention has received limited study. We retrospectively examined the clinical, angiographic, and procedural characteristics, outcomes, and follow-up of patients who underwent mechanical aspiration thrombectomy with the Indigo CAT RX system (Penumbra Inc.) at a large tertiary care hospital between January 2019 and April 2023. During the study period, 83 patients (85 lesions) underwent thrombectomy with the Indigo CAT RX. Mean patient age was 64.9 ± 14.48 years and 31.2% were women. The most common presentations were ST-segment elevation myocardial infarction (MI) (66.2%) and non-ST-segment elevation MI (26.5%). A final thrombolysis in MI flow grade of 3 and final myocardial blush grade of 3 were achieved in 76% and 46% of the cases, respectively. Technical success was achieved in 88.9% of the cases that included Indigo CAT RX treatment only, compared with 57.1% of the cases that also included manual aspiration. There were no device-related serious adverse events. At 30-day postprocedure, the incidence of major adverse cardiac events (composite of cardiovascular death, recurrent MI, cardiogenic shock, new or worsening New York Heart Association Class IV heart failure, stroke) was 8.5%: 1.3% stroke (postprocedure, in-hospital), 1.3% MI, 6.1% cardiac death, and 7.5% developed cardiogenic shock. Use of the Indigo CAT RX system is associated with high technical success and acceptable risk of complications, including stroke.

Outcome of Primary Percutaneous Coronary Intervention for STEMI due to Stent Thrombosis

Background: Stent thrombosis (ST) is a critical complication following percutaneous coronary intervention (PCI), contributing significantly to morbidity and mortality in patients with ST-elevation myocardial infarction (STEMI). Advances in drug-eluting stent technology and antiplatelet therapy have mitigated, but not eliminated, the risk of ST. The management of STEMI due to ST in resource-limited settings remains a challenging endeavor, necessitating a comprehensive evaluation of treatment outcomes. Objective: To assess the mortality rates and clinical outcomes following primary PCI in patients with STEMI attributed to stent thrombosis in a resource-constrained setting, and to analyze the association of mortality with patient age and TIMI flow grade post-PCI. Methods: This quasi-experimental study was conducted at Lady Reading Hospital, Peshawar, from July to December 2023. A total of 150 patients presenting with STEMI due to ST and undergoing PCI were included. Diagnostic measures included electrocardiography, troponin levels, echocardiography, and angiography to assess left ventricular function and stent thrombosis. The procedures were performed by experienced interventional cardiologists, followed by standard post-procedure management. Data analysis was performed using SPSS version 25, focusing on mortality rates, the association of mortality with patient age, and TIMI flow grades. Results: Among the 150 patients studied, mortality was observed in 36 cases (24%). The mean age of patients who died was 48.33 years (SD = 14.267), compared to 42.47 years (SD = 12.618) for survivors, with a significant association between age and mortality (P = 0.02). Analysis of TIMI flow grade post-PCI revealed a strong correlation with mortality; patients with TIMI flow grades I and II exhibited higher mortality rates, with a highly significant P value of 0.0001. Conclusion: The study highlights a significant mortality rate among patients with STEMI due to stent thrombosis undergoing primary PCI in a resource-limited setting. Advanced age and lower TIMI flow grades post-PCI were significantly associated with increased mortality. These findings underscore the necessity for vigilant post-PCI monitoring and tailored management strategies to improve clinical outcomes in this high-risk population.

Multistage dynamic optimisation of ore flow for underground metal mines

ABSTRACT The purpose of transportation dispatching in underground mines is to achieve efficient connection and operation cycles between different stopes while ensuring efficient ore transportation from stopes to a mill. The transportation system of large underground mines is a typical complex transportation network with large-scale transportation equipment, which involves both continuous and batch transportation succession and the blending of ore with different grades. The equipment dispatching has an important impact on the ore flow rate, grade, and transportation costs. Therefore, the ore flow needs to be optimally controlled from the perspective of multistage dynamic ore blending. A new model is presented to optimise the ore transportation process considering the ore flow rate, grade, equipment, and transportation network constraints, which aims at minimising transportation costs. The model is verified through a case study of the Sanshandao gold mine in China.

Predictors of No-Reflow Phenomenon in Primary Percutaneous Coronary Intervention among Patients with Acute Myocardial Infarction

Background: The no-reflow phenomenon, characterized by the failure to restore myocardial blood flow after reopening an occluded artery in acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI), has significant implications for patient prognosis. Understanding the predictors of no-reflow is crucial for improving clinical outcomes in this high-risk population. Objective: This study aims to identify the predictors of the no-reflow phenomenon in patients with AMI undergoing PCI and to assess their impact on the efficacy of the intervention. Methods: Conducted at Lady Reading Hospital's Cardiology Department, this descriptive study retrospectively analyzed 120 AMI patients treated with PCI from May 2023 to November 2023. Ethical approval was obtained, and the study conformed to the Declaration of Helsinki. The diagnosis of AMI was based on clinical symptoms and electrocardiographic findings. Experienced cardiologists performed PCI, and no-reflow was defined using Thrombolysis in Myocardial Infarction (TIMI) flow grades and Myocardial Blush Grade (MBG). Data were analyzed using SPSS Version 25, focusing on demographic variables, clinical presentations, and procedural details to identify predictors of no-reflow. Results: Out of 120 patients, 70.8% were male. The incidence of no-reflow was 22.5%. Significant predictors of no-reflow included systolic blood pressure &lt; 100 mmHg (51.9% in no-reflow vs. 28.0% in normal flow, P=0.02), diabetes (59.3% vs. 34.4%, P=0.02), hypertension (77.8% vs. 31.2%, P=0.0001), and history of cardiovascular disease (11.1% vs. 2.2%, P=0.04). Conclusion: The study identified diabetes, hypertension, low systolic blood pressure, and a history of cardiovascular disease as significant predictors of the no-reflow phenomenon in AMI patients undergoing PCI. These findings highlight the importance of identifying and managing these risk factors to enhance the success of PCI and improve patient outcomes.

The Comparison of the Initial TIMI Flow Grade in Acute ST-Elevation Myocardial Infarction Patients Receiving Ticagrelor vs. Clopidogrel before Undergoing Primary Percutaneous Coronary Intervention: A Prospective Cohort Study.

Primary percutaneous coronary intervention (PCI) is the best treatment for acute ST-elevation myocardial infarction (STEMI). Evidence is in favor of ticagrelor over clopidegrel in STEMI patients regarding the reduction of stent thrombosis risk during and after PCI. We compared initial thrombolysis in myocardial infarction (TIMI) flow in STEMI patients on ticagrelor vs. clopidogrel. This prospective cohort recruited 160 patients with acute STEMI, referred to the emergency department of Farshchian Heart Center, during March 2018-2019. Before angiography, the patients received clopidogrel (600 mg) or ticagrelor (180 mg) on top of aspirin. Initial TIMI flow was compared between the two groups as the primary outcome. A logistic regression was performed to calculate the predictors of initial TIMI flow. Analyses were performed using R, version 4.2.1. In ticagrelor and clopidogrel groups, the mean ± standard deviation age of the patients was 59.46 ± 13.11 and 61.34 ± 11.08 years (p value = 0.33), respectively. In the ticagrelor and clopidogrel groups, initial TIMI flow grades were as follows: 0 : 50% and 71.2%, I: 26.2% and 16.2%, II: 12.5% and 10%, and III: 12.9% and 2.5%, respectively (p value = 0.005). Final TIMI flow grades were as follows: I: 26.2% and 16.2%, II: 7.5% and 13.8%, and III: 66.3% and 70%, respectively (p value = 0.41). Ticagrelor was associated with significantly higher initial TIMI flow grade compared to the clopidogrel group (adjusted odds ratio: 2.90 (95% CI: 1.51-5.72)). In STEMI patients who were candidates for primary PCI, ticagrelor administration led to a better initial TIMI flow grade compared to clopidogrel.

A New Scoring System Predicting Side-Branch Occlusion in Patients Undergoing Left Main Bifurcation Intervention: The LM V-RESOLVE Score

BackgroundThe risk of side-branch (SB) occlusion is pivotal for decision making of stenting strategies during unprotected left main (LM) bifurcation percutaneous coronary intervention (PCI). Accordingly, this study aimed to develop a scoring system for predicting SB occlusion during unprotected LM bifurcation PCI. MethodsA total of 855 consecutive patients undergoing unprotected LM bifurcation PCI with provisional strategy at Fuwai Hospital from January 2014 to December 2016 were recruited. A prediction model was selected by means of all-subsets logistic regression, and a multivariable risk score (Left Main Visual Estimation for Risk Prediction of Side Branch Occlusion in Coronary Bifurcation Intervention [LM V-RESOLVE]) was then established with incremental weights attributed to each component variable based on its estimate coefficients. SB occlusion was defined as any decrease in Thrombolysis in Myocardial Infarction (TIMI) flow grade or absence of flow in SB after main vessel (MV) stenting. ResultsSB occlusion occurred in 19 LM bifurcation lesions (2.22%). In multivariable model, 3 variables, including MV/SB diameter ratio, MV plaque ipsilateral to SB, and baseline diameter stenosis of SB, were independent predictors for SB occlusion (model C-statistic 0.829, 95% confidence interval [CI] 0.735-0.923, with good calibration). The risk score had a C-statistics of 0.830 (95% CI 0.738-0.923) with good calibration. Satisfactory discriminative ability of the risk score was also preserved in external validation (C-statistic 0.794, 95% CI 0.691-0.896). ConclusionsThe LM bifurcation–specific novel scoring system, LM V-RESOLVE, based on 3 simple baseline angiographic findings, could help to rapidly discriminate lesions at risk of SB occlusion during LM bifurcation PCI.

Abstract TP217: Thrombus Migration in Acute Ischemic Stroke Patients Receiving Mechanical Thrombectomy

Background: Thrombus migration is occasionally observed during mechanical thrombectomy in acute ischemic stroke patients. However, the factors influencing migration and its impact on imaging and clinical prognosis remain unclear. We investigated the clinical and imaging predictors of thrombus migration and to evaluate the corresponding outcomes. Methods: We retrospectively analyzed data from patients with acute anterior circulation (internal carotid artery, M1, M2) stroke who underwent mechanical thrombectomy at two comprehensive stroke centers. Thrombus migration was defined as any distal movement of the proximal end of the thrombus on digital subtraction angiography (DSA) compared to pre-interventional computed tomography (CT) angiography. A comprehensive imaging review was performed, including Alberta Stroke Program Early CT Score, hyperdense vessel sign on non-contrast CT, collateral flow grading on CT angiography and DSA. Univariate and multivariable logistic regression analyses were performed to determine the association between clinical and imaging parameters and thrombus migration. In addition, we compared clinical outcomes according to the presence of thrombus migration. Results: Of the 365 patients enrolled, thrombus migration was observed in 81 patients (22.2%). In 40 of these, the thrombus migrated beyond the vessel segment. In multivariable analysis, hyperdense vessel sign (adjusted odds ratio [aOR], 5.41; 95% CI 2.9-10.07), older age (aOR, 1.04; 95% CI, 1.01-1.08), and onset-to-image time (aOR 1.00; 95% CI 0.99-1.00) were associated with thrombus migration. In particular, thrombus migration is an independent predictor of first-pass effect (aOR 2.17; 95% CI, 1.15-4.1). However, there was no significant effect on functional outcome as measured by modified Rankin Scale at 3 months. Conclusions: In large-vessel occlusion stroke, the location of the thrombus may change before mechanical thrombectomy compared to pre-interventional angiographic imaging. The composition of the thrombus, as indicated by the hyperdense vessel sign, may influence its tendency to migrate. While thrombus migration is associated with a first-pass effect, it does not influence functional outcomes.

Aspirin loading and coronary no-reflow after percutaneous coronary intervention in patients with acute myocardial infarction.

The association of aspirin loading with the risk of coronary no-reflow (CNR) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has not been investigated. We assessed the association of aspirin loading before PCI with CNR in patients with AMI. This study included 3100 patients with AMI undergoing PCI. Of them, 2812 patients received aspirin loading (a single oral [or chewed] or intravenous dose of 150-300 mg) and 288 patients did not receive aspirin loading before PCI. The primary endpoint was CNR, defined as Thrombolysis in Myocardial Infarction blood flow grade of <3 after the PCI. CNR occurred in 130 patients: 127 patients in the group with aspirin loading and 3 patients in the group without aspirin loading before PCI (4.5% vs. 1.0%; odds ratio [OR] = 4.50, 95% confidence interval, [1.42-14.21], p = 0.005). After adjustment, the association between aspirin loading and CNR was significant (adjusted OR = 4.49 [1.56-12.92]; p < 0.001). There was no aspirin loading-by-P2Y12 inhibitor (ticagrelor or prasugrel) interaction (pint = 0.465) or aspirin loading-by-chronic aspirin therapy on admission (pint = 0.977) interaction with respect to the occurrence of CNR after PCI. Chronic low-dose aspirin therapy on admission was not independently associated with higher risk of CNR after PCI (adjusted OR = 1.06 [0.65-1.72]; p = 0.824). In patients with AMI undergoing PCI, aspirin loading before the PCI procedure at the guideline-recommended doses was associated with higher odds of developing CNR. However, due to the limited number of events, the findings should be considered as hypothesis generating.

Prognostic performance of the IABP-SHOCK II Risk Score among cardiogenic shock subtypes in the critical care cardiology trials network registry

BackgroundRisk stratification has potential to guide triage and decision-making in cardiogenic shock (CS). We assessed the prognostic performance of the IABP-SHOCK II score, derived in Europe for acute myocardial infarct-related CS (AMI-CS), in a contemporary North American cohort, including different CS phenotypes. MethodsThe Critical Care Cardiology Trials Network (CCCTN) coordinated by the TIMI Study Group is a multicenter network of cardiac intensive care units (CICU). Participating centers annually contribute ≥2 months of consecutive medical CICU admissions. The IABP-SHOCK II risk score includes age >73 years, prior stroke, admission glucose >191 mg/dl, creatinine >1.5 mg/dl, lactate >5 mmol/l, and post-PCI TIMI flow grade <3. We assessed the risk score across various CS etiologies. ResultsOf 17,852 medical CICU admissions 5,340 patients across 35 sites were admitted with CS. In patients with AMI-CS (n=912), the IABP-SHOCK II score predicted a >3-fold gradient in in-hospital mortality (low risk = 26.5%, intermediate risk =52.2%, high risk = 77.5%, p<0.0001; c-statistic=0.67; Hosmer-Lemeshow p=0.79). The score showed a similar gradient of in-hospital mortality in patients with non-AMI-related CS (n=2,517, p<0.0001) and mixed shock (n=923, p<0.001), as well as in left ventricular (<0.0001), right ventricular (p = 0.0163) or biventricular (<0.0001) CS. The correlation between the IABP-SHOCK II score and SOFA was moderate (r2=0.17) and the IABP-SHOCK II score revealed a significant risk gradient within each SCAI Stage. ConclusionsIn an unselected international multicenter registry of patients admitted with CS, the IABP- SHOCK II score only moderately predicted in-hospital mortality in a broad population of CS regardless of etiology or irrespective of right, left, or bi-ventricular involvement.

Association between apelin-12 and creatine kinase-MB, depending on success of reperfusion in STEMI patients.

Acute myocardial infarction is characterised by an imbalance in the supply and demand of oxygen in the heart. It requires urgent reperfusion, and poor outcomes are attributed to myocardial ischaemia-reperfusion injury. We aimed to evaluate the association between apelin-12 levels and creatine kinase-MB activity in predicting the effectiveness of reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) patients. In this study we included 72 patients with the following criteria: chest pain suggestive of myocardial ischaemia for at least 30 minutes, an electrocardiogram with ST-segment elevation (measured at the J-point) ≥ 2 mm in leads V2-V3 and/or ≥ 1 mm in the other leads, rise of specific biomarkers such as cardiac troponin and the MB fraction of creatine kinase (CK-MB), and those who underwent reperfusion therapy. Blood samples for the measurement of apelin-12 and creatine kinase-MB were collected 12 hours after the reperfusion therapy. In patients with thrombolysis in myocardial infarction (TIMI) flow grade ≤ 2, the median of the apelin-12 level was 1.80 ng/ml (0.46-9.20), and with TIMI flow 3, it was 5.76 ng/ml (1.14-15.2). Variability was observed in the apelin values (Mann-Whitney test) based on TIMI flow grade (p < 0.001), while no variability was observed for creatine kinase-MB (p < 0.18). The degree of association between apelin-12 and creatine kinase-MB levels was analysed with Pearson's correlation, enabling us to determine patients with successful reperfusion (determined as TIMI flow 3) (p < 0.004), and those with unsuccessful reperfusion (with TIMI flow ≤ 2) (p = 0.86). In STEMI patients undergoing reperfusion therapy, Apelin-12 level was associated with creatine kinase-MB activity according to the success of the reperfusion.

Analysis of ultrasonic imaging changes and factors related to malignant transformation in postmenopausal patients with endometrial polyps.

To examine the ultrasonic changes in postmenopausal endometrial polyps and analyze factors related to their malignant transformation. This retrospective study analyzed clinical data from 200 postmenopausal patients with endometrial polyps treated at Jinan Maternity and Child Care Hospital and Pingyin Hospital of Traditional Chinese Medicine from December 2020 to December 2023. All patients underwent pathological biopsies to diagnose the nature of the endometrial polyps. This study compared the clinical and ultrasonic imaging features of these patients and analyzed factors influencing the malignant transformation of postmenopausal endometrial polyps. Pathological findings classified 160 patients (80.00%) into the benign group and 40 patients (20.00%) into the malignant group. Significant differences were noted in endometrial thickness, polyp diameter, heterogeneity of lesion echogenicity, and vascularization between the groups (all P<0.05). The malignant group exhibited notably higher blood flow (Grade II+III constituted 70.00% compared to 29.38% in the benign group, P<0.05). The time average velocity (TAV), pulse index (PI), and resistance index (RI) were significantly lower in the malignant group (all P<0.05). The area under curve (AUC) values for TAV, PI, and RI in diagnosing malignant endometrial polyps were 0.754, 0.713, and 0.771, respectively. Increased body mass index (BMI), irregular premenopausal menstruation, and ≥2 occurrences of postmenopausal bleeding were identified as risk factors for malignant transformation (all P<0.05). These six indicators were used to create a predictive model for malignant transformation, achieving an AUC of 0.942. Malignancy in postmenopausal endometrial polyps is uncommon, yet distinct differences exist in the transvaginal color Doppler ultrasound characteristics between benign and malignant cases. Factors such as increased BMI, irregular premenopausal menstruation, and ≥2 occurrences of postmenopausal bleeding significantly contribute to the risk of malignant transformation. These findings, combined with ultrasound features, provide a robust basis for screening and monitoring these patients.

Analysis of risk factors for PCI no-reflow in coronary heart disease and construction of related prediction models.

To analyze the risk factors of percutaneous coronary intervention (PCI) no-reflow in patients with coronary heart disease (CHD) and construct a predictive nomogram model. This retrospective study included 260 patients with CHD who underwent PCI in the Third Affiliated Hospital of Chongqing Medical University from January 2022 to December 2023. The subjects were divided into a PCI no-reflow group (n = 86) and normal reflow group (n = 174) based on thrombolysis in myocardial infarction (TIMI) blood flow grading. General data, PCI related data and laboratory indexes of patients were collected. Logistic regression was used to analyze the risk factors of no-reflow after PCI in CHD patients. Based on the significant variables from regression analysis, a nomogram prediction model was constructed by using R language. The accuracy of the model was evaluated by receiver operating characteristic (ROC) curve and calibration curve, and the decision curve was drawn to clarify the clinical utility of the model. Model performance metrics included area under the curve (AUC), accuracy, sensitivity and specificity. Multivariate logistic regression analysis showed that hypertension, cystatin C (Cys-C), hypersensitive c-reactive protein (hs-CRP) and platelet-to-lymphocyte ratio (PLR) were risk factors for no-reflow after PCI in CHD patients (OR > 1, P < 0.001), while ADAM metallopeptidase with thrombospondin type 1 motif 13 (ADAMTS-13) and lymphocyte (LYM) were protective factors (OR < 1, P < 0.001). The nomogram prediction model based on the above risk factors showed good predictive value. The AUC of the nomogram prediction model in the training set was 0.967 (95% CI: 0.946-0.989), with a specificity of 0.923 and a sensitivity of 0.908. In the validation set, the AUC was 0.894 (95% CI: 0.817-0.971), with a specificity of 0.807 and a sensitivity of 0.857. The calibration curve indicated good agreement between the predicted and actual probabilities, and the decision curve showed clinical benefit across a range of threshold probabilities in both the training and validation sets (0.0-0.99). The risk factors affecting the occurrence of no-reflow after PCI in patients with CHD include hypertension, serum Cys-C, hs-CRP, PLR, ADAMTS-13 and LYM levels. The nomogram risk prediction model based on the above factors is valuable for identifying patients with high risk of no-reflow after PCI.

Predicting central cervical lymph node metastasis in papillary thyroid carcinoma with Hashimoto's thyroiditis: a practical nomogram based on retrospective study.

In papillary thyroid carcinoma (PTC) patients with Hashimoto's thyroiditis (HT), preoperative ultrasonography frequently reveals the presence of enlarged lymph nodes in the central neck region. These nodes pose a diagnostic challenge due to their potential resemblance to metastatic lymph nodes, thereby impacting the surgical decision-making process for clinicians in terms of determining the appropriate surgical extent. Logistic regression analysis was conducted to identify independent risk factors associated with central lymph node metastasis (CLNM) in PTC patients with HT. Then a prediction model was developed and visualized using a nomogram. The stability of the model was assessed using ten-fold cross-validation. The performance of the model was further evaluated through the use of ROC curve, calibration curve, and decision curve analysis. A total of 376 HT PTC patients were included in this study, comprising 162 patients with CLNM and 214 patients without CLNM. The results of the multivariate logistic regression analysis revealed that age, Tg-Ab level, tumor size, punctate echogenic foci, and blood flow grade were identified as independent risk factors associated with the development of CLNM in HT PTC. The area under the curve (AUC) of this model was 0.76 (95% CI [0.71-0.80]). The sensitivity, specificity, accuracy, and positive predictive value of the model were determined to be 88%, 51%, 67%, and 57%, respectively. The proposed clinic-ultrasound-based nomogram in this study demonstrated a favorable performance in predicting CLNM in HT PTCs. This predictive tool has the potential to assist clinicians in making well-informed decisions regarding the appropriate extent of surgical intervention for patients.

Factors affecting TIMI (Thrombolysis In Myocardial Infarction) flow grade in patients undergoing primary PCI (Percutaneous Coronary Intervention).

Objective: To determine the causes of normal blood flow in coronary arteries in patients presenting with STEMI and receiving pPCI. Study Design: Observational study conducted retrospectively. Setting: National Institute of Cardiovascular Disease (NICVD) Karachi, Cath Lab. Period: August 17 2020 to November 2020. Material &amp; Methods: Data was obtained from patients presented to the emergency department with STEMI and experienced primary PCI in last two years from January 2016 to Decemebr 2018.Social Sciences (SPSS) version 19 was used analyze these data.Th in those patients who had suboptimal coronary blood flow. Young patients &lt;40 years of age had more (14%) normal coronary blood flow as compared to elders i.e &gt;40 years. Diabetes mellitus, Hypertension, and smoking had no significant impact on coronary blood flow in these patients. Conclusion: In this study, it was found that most of the coronary arteries had abnormal blood flow during primary PCI. Multiple factors are affecting the blood flow in coronaries. The onset of symptoms and the time presented in the hospital was the main factors. Further studies are required to find more reasons for having normal blood flow in coronaries in STEMI.