Higher Long-term Mortality Research Articles

PIK3R1, SPNB2, and CRYAB as Potential Biomarkers for Patients with Diabetes and Developing Acute Myocardial Infarction.

Background Young patients with type 2 diabetes mellitus (DM) and acute myocardial infarction (AMI) have high long-term all-cause and cardiovascular mortality rates. We aimed to investigate the differentially expressed genes (DEGs) that might be potential targets for DM patients with AMI. Methods Gene datasets GSE775, GSE19322, and GSE97494 were meta-analyzed to obtain DEGs of the left ventricle myocardium in infarcted mice. Gene datasets including GSE3313, GSE10617, and GSE136948 were meta-analyzed to identify DEGs in diabetes mice. A Venn diagram was used to obtain the overlapping DEGs. KEGG and GO pathway analyses were performed, and hub genes were obtained. Pivotal miRNAs were predicted and validated using the miRNA dataset in GSE114695. To investigate the cardiac function of the screened genes, a MI mouse model was constructed; echocardiogram, qPCR, and ELISA of hub genes were performed; ELISA of hub genes in human blood samples was also utilized. Results A total of 67 DEGs were identified, which may be potential biomarkers for patients with DM and AMI. GO and KEGG pathway analyses were performed, which were mainly enriched in response to organic cyclic compound and PI3K-Akt signaling pathway. The expression of PIK3R1 and SPNB2 increased in the MI group and was negatively correlated to left ventricular ejection fraction (LVEF), whereas that of CRYAB decreased and was positively correlated to LVEF. Patients with high CRYAB expression demonstrated a short hospital stay and the area under the curves of the three protein levels before and after treatment were 0.964, 0.982, and 0.918, suggesting that PIK3R1, SPNB2, and CRYAB may be diagnostic and prognostic biomarkers for the diabetes patients with AMI. Conclusion The screened hub genes, PIK3R1, SPNB2, and CRYAB, were validated as credible molecular biomarkers and may provide a novel therapy for diabetic cardiac diseases with increased proteotoxic stress.

Acute Occlusion of the Infarct-Related Artery as a Predictor of Very Long-Term Mortality in Patients with Acute Myocardial Infarction.

Aim The survey's aim was to examine the significance of infarct-related artery (IRA) occlusion (verified angiographically) on very long-term outcomes of patients with acute myocardial infarction, within the STEMI and NSTEMI diagnosis. Methods A single-center, nonrandomized, registry-based study on patients treated for acute coronary syndrome with percutaneous coronary intervention between June 2011 and December 2016 was conducted. Patients with angiographically proven IRA occlusion (100% stenosis with TIMI flow 0 distal to occlusion) were categorized as occlusive myocardial infarction (OMI) and patients with patent IRA (50–99% stenosis with TIMI 1–3 flow) were categorized as nonocclusive myocardial infarction (NOMI) and very long-term outcomes were analyzed. Data were collected prospectively from the hospital's PCI registry and the database of the Croatian Institute of Public Health. Results A total of 2450 patients were included in the study. 796 (32.5%) patients had NOMI and 1654 patients (67.5%) had OMI. According to ECG changes, 1534 patients presented with STEMI (62,6%) and 916 with NSTEMI (37,8%). 88% of STEMI patients presented with OMI and 12% with NOMI, while patients with NSTEMI in 33,8% presented with OMI and in 66,81% with NOMI. A median follow-up was 4.7 years. There was no significant difference in cardiovascular mortality between the groups (14.8% vs 13.1%; OMI vs NOMI, respectively; p=0.374) neither in all-cause mortality (19% vs 21.5%; OMI vs NOMI, respectively; p=0.374). Patients with NSTEMI had a significantly higher very long-term mortality (21.6% vs 18.1%; NSTEMI vs STEMI, respectively; p=0.029). Conclusion The main findings of the study are as follows: (1) total IRA occlusion was not associated with higher long-term mortality; (2) NSTEMI was associated with a higher mortality rate compared with STEMI, independent of angiographic presentation (OMI/NOMI); (3) IRA occlusion was not associated with significantly higher mortality rates in patients with STEMI and NSTEMI, respectively.

A 35-year follow-up study of patients admitted to methadone treatment between 1982-1984 in Asturias, Spain.

The objective was to evaluate outcomes in a heroin-dependent population 35 years after first enrolment in methadone maintenance treatment (MMT). An ad hoc protocol was used to assess drug misuse, treatment, and drug-related morbidity in the survivor sample. The standardized mortality ratio (SMR) and 95% confidence interval (CI) were calculated. A total of 214 heroin-dependent patients entered MMT between 1982 and 1984 in the Asturias Public Health Service. Information was received on 195 subjects, of whom 146 were deceased. Men accounted for 77.5% of the study cohort. Over the 35-year follow-up period, the SMR was 11.75 (95% CI = 9.95 - 13.77). In the survivor sample, 5.7% were still enrolled in MMT; human immunodeficiency virus (HIV) was diagnosed in 38.77% and hepatitis B/C in 73.46%. No differences were found between sexes in mortality or HIV and hepatitis B/C status. None of the female survivors were using heroin at the 35-year follow-up compared with 5.26% of males. In conclusion, our study confirms the high long-term mortality rate of heroin addicts, even after enrollment in MMT.

Abstract 8858: Reduced Left Ventricular Ejection Fraction is Associated with Higher Long-Term Mortality in Patients with Electrical Storm

Introduction: Little is known about the relationship between LV ejection fraction (EF) and mortality in contemporary patients with electrical storm (ES). Objective: EF at the time of admission for ES was organized into subgroups: EF ≤ 22% (A), 23-32% (B), 33-42% (C), 43-52% (D), and >52% (E). EF subgroups were compared to determine differences in 1-year all-cause mortality. Secondary outcomes included cardiogenic shock (CS), multiorgan system failure, acute tubular necrosis (ATN), and cardiac arrest. We hypothesize that patients with reduced EF will have poorer short-term prognosis and more in-hospital complications. Methods: Single center, retrospective study including consecutive patients admitted to the coronary ICU with ES between April 2014 - 2020. ES was defined as ≥ 3 isolated sustained ventricular arrhythmias or ICD therapies within 24 hours. Results: Of 214 patients admitted with ES, 203 had an echocardiogram on admission. 70 (34.5%) were group A, 58 (28.6%) group B, 36 (17.7%) group C, 23 (11.3%) group D, and 16 (7.9%) group E. The mean EF was 30 +/- 13% (Figure 1). The mean age was 64 +/- 13 years, 83.3% male. 1-year all-cause mortality between subgroups was significant by Kaplan-Meier survival estimate and Mantel-Cox log rank (χ 2 11.2; p 0.023; Figure 2). By Cox Regression using Group E as a reference, only Group A had a statistically significant difference in 1-year all-cause mortality (HR A/E 3.71 [95% CI 1.14 - 12.07]; p 0.029). Analysis of in-hospital complications showed a difference only in cardiogenic shock (p < 0.0001) with higher incidence in those with lower EF (Figure 3). Conclusions: In patients with ES, LVEF is significantly associated with all-cause 1-year mortality. Those with significantly impaired LVEF (≤ 22%) had higher 1-year all-cause mortality compared to those with preserved EF (> 52%).

Abstract 10735: Conduction Abnormalities and Pacemaker Implantation in Patients with Radiation-Associated Cardiac Disease

Introduction: We sought to study prevalence of conduction disease and permanent pacemaker (PPM) in patients presenting with radiation-associated cardiac disease (RACD) and its impact on long-term survival. Methods: We studied 699 patients with documented RACD (prior chest radiotherapy at a mean of 22 years prior) evaluated at a single center from 1998-2018. Conduction abnormalities and PPM at baseline were recorded, along with cardiac procedures performed during follow-up. Death was the primary endpoint. Results: Patients were divided into 4 groups: 1) no procedure during follow-up 2) 1 valve or coronary artery bypass grafting (CABG) or 1-valve+CABG surgery 3) Multivalve+/-CABG+/-aortic/pericardial surgery and 4)Trans catheter aortic valve replacement (TAVR). Relevant characteristics and outcomes are shown in Table. In total, 183 patients had a PPM (82 [45%] implanted during follow-up). Over a mean follow-up of 5±4 years (range 0-21 years), 370 patients (53%) patients died. On survival analysis, presence of PPM (HR 1.26 [1.03-1.54], p=0.03) was independently associated with higher long-term mortality; 109 (60%) patients with PPM died in the long-term vs. those without261 (51%, log-rank p-value=0.03). Conclusion: RACD patients have a high rate of mortality during longer-term follow-up, despite a low calculated preoperative risk. In addition, they have a high rate of conduction abnormalities with a high proportion requiring PPM, including at baseline, irrespective of need for a cardiac procedure. Presence of a PPM was independently associated with long-term risk of mortality.

Abstract 13183: Persistent Anemia Was Associated With Higher Long-Term Mortality in Patients With Chronic Kidney Disease Following Primary Percutaneous Coronary Intervention

Background: Anemia is one of the most common complications of chronic kidney disease (CKD), renal anemia, which has a significant link with increased risk of the morbidity, as well as the mortality of cardiovascular disease. However, the prognostic implication of the temporal change of anemia status has been rarely addressed, especially in secondary prevention of coronary artery disease (CAD). Methods and Results: This long-term (median follow-up range: 5.7 years) single center observational study involved consecutive 416 patients with CKD over stage 3 (defined by eGFR<60 ml/1.72/m 2 ) who underwent percutaneous coronary intervention (PCI) for the first time since 2003 to 2018. All-cause death was set as an endpoint. Participants were divided into 4 groups by the median of hemoglobin (Hb) at PCI (baseline, 12.0 mg/dl) and 8.1±2.1 months after PCI (follow-up, 12.7 mg/dl), respectively: Groups of Continuously high-Hb (n=146), Increased-Hb (n=51), Attenuated-Hb (n=61) and Persistently low-Hb (n=158). Categorized Cox proportional hazard analysis with setting Continuously high-Hb group as a reference showed a significantly increased risk of all-cause death in groups of Attenuated- (Hazard ratio (HR) 2.6, 95% confidence interval (CI) 1.3-5.2, p=0.01) and Persistently low-Hb (HR 2.6, 95%CI 1.4-4.8, p=0.002), respectively, while similar in Increased-Hb group (HR 1.1, 95%CI 0.3-3.2, p>0.5) (Figure) . Conclusion: This study showed a significant association between the reduced Hb overtime and increased mortality risk in patients with CKD and CAD, which might potentially indicate a prognostic merit of the intervention for renal anemia in this population.

Recovery after acute kidney injury requiring kidney replacement therapy in patients with left ventricular assist device: A meta-analysis.

BACKGROUNDAcute kidney injury (AKI) is a common and severe complication after left ventricular assist device (LVAD) implantation with an incidence of 37%; 13% of which require kidney replacement therapy (KRT). Severe AKI requiring KRT (AKI-KRT) in LVAD patients is associated with high short and long-term mortality compared with AKI without KRT. While kidney function recovery is associated with better outcomes, its incidence is unclear among LVAD patients with severe AKI requiring KRT. AIMTo identify studies evaluating the recovery rates from severe AKI-KRT after LVAD placement, which is defined by regained kidney function resulting in the discontinuation of KRT. Random-effects and generic inverse variance method of DerSimonian-Laird were used to combine the effect estimates obtained from individual studies.METHODSA total of 268 patients from 14 cohort studies that reported severe AKI-KRT after LVAD were included. Follow-up time ranged anywhere from two weeks of LVAD implantation to 12 mo. Kidney recovery occurred in 78% of enrollees at the time of hospital discharge or within 30 d. Overall, the pooled estimated AKI recovery rate among patients with severe AKI-KRT was 50.5% (95%CI: 34.0%-67.0%) at 12 mo follow up. Majority (85%) of patients used continuous-flow LVAD. While the data on pulsatile-flow LVAD was limited, subgroup analysis of continuous-flow LVAD demonstrated that pooled estimated AKI recovery rate among patients with severe AKI-KRT was 52.1% (95%CI: 36.8%-67.0%). Meta-regression analysis did not show a significant association between study year and AKI recovery rate (P = 0.08). There was no publication bias as assessed by the funnel plot and Egger's regression asymmetry test in all analyses.RESULTSA total of 268 patients from 14 cohort studies that reported severe AKI-KRT after LVAD were included. Follow-up time ranged anywhere from two weeks of LVAD implantation to 12 mo. Kidney recovery occurred in 78% of enrollees at the time of hospital discharge or within 30 d. Overall, the pooled estimated AKI recovery rate among patients with severe AKI-KRT was 50.5% (95%CI: 34.0%-67.0%) at 12 mo follow up. Majority (85%) of patients used continuous-flow LVAD. While the data on pulsatile-flow LVAD was limited, subgroup analysis of continuous-flow LVAD demonstrated that pooled estimated AKI recovery rate among patients with severe AKI-KRT was 52.1% (95%CI: 36.8%-67.0%). Meta-regression analysis did not show a significant association between study year and AKI recovery rate (P = 0.08). There was no publication bias as assessed by the funnel plot and Egger's regression asymmetry test in all analyses.CONCLUSIONRecovery from severe AKI-KRT after LVAD occurs approximately 50.5%, and it has not significantly changed over the years despite advances in medicine.

The association between culture positivity and long-term mortality in critically ill surgical patients

BackgroundThe long-term outcome is an essential issue in critically ill patients, and the identification of early determinant is needed for risk stratification of the long-term outcome. In the present study, we investigate the association between culture positivity during admission and long-term outcome in critically ill surgical patients.MethodsWe linked the 2015–2019 critical care database at Taichung Veterans General Hospital with the nationwide death registration files in Taiwan. We described the long-term mortality and proportion of culture positivity among enrolled subjects. We used a log-rank test to estimate survival curves between patients with and without positive cultures and a multivariable Cox proportional hazards regression model to determine hazard ratio (HR) and 95% confidence interval (CI).ResultsA total of 6748 critically ill patients were enrolled, and 32.5% (2196/6749) of them died during the follow-up period, with the overall follow-up duration was 1.8 ± 1.4 years. We found that 31.4% (2122/6748) of critically ill patients had at least one positive culture during the index admission, and the number of patients with positive culture in the blood, respiratory tract, urinary tract, skin and soft tissue and abdomen were 417, 1702, 554, 194 and 139, respectively. We found that a positive culture from any sites was independently associated with high long-term mortality (aHR 1.579, 95% CI 1.422–1.754) after adjusting relevant covariates, including age, sex, body-mass index, comorbidities, severity score, shock, early fluid overload, receiving mechanical ventilation and the need of renal replacement therapy for critical illness.ConclusionsWe linked two databases to identify that a positive culture during admission was independently correlated with increased long-term mortality in critically ill surgical patients. Our findings highlight the need for vigilance among patients with a positive culture during admission, and more studies are warranted to validate our findings and to clarify underlying mechanisms.

Gram-negative bacteria as a cause of mediastinitis after cardiac surgery.

Poststernotomy mediastinitis (PSM) remains a serious infection and is significantly associated with high morbidity, short-term and long-term mortality. Gram-negative bacteria (GNB) are an underestimated cause of PSM, and there is little information on the risk factors, prevention, diagnosis and management of GNB PSM. The pathogenesis of PSM is the result of a complex and multifactorial interplay between intraoperative wound contamination, host-related and surgical host factors but GNB are probably mostly translocated from other host site infections. GNB are frequent cause of PSM (18-38% of cases) and GNB PSM have shown to more frequently polymicrobial (20-44%). GNG PSM has shown to occur earlier than Gram-positive PSM. Early diagnosis is crucial to successful treatment. The management of PSM needs a combination of culture-directed antimicrobial therapy and an early extensive surgical debridement with either immediate or delayed closure of the sternal space. Antibiotic treatment choice and duration should be based on clinical evaluation, evolution of inflammatory markers, microbiological tests and imaging studies. Mortality has shown to be significantly higher with GNB PSM compared with other causes and the inappropriateness of initial antibiotic therapy may explain the worse outcome of GNB PSM. GNB PSM is usually undervalued in the setting of PSM and have shown to be a frequent cause of inappropriate treatment with adverse prognostic potential. There is a need for efforts to improve knowledge to prevent and adequately treat GNB PSM.

Relationship of PRECISE-DAPT and DAPT scores with mortality in patients admitted with acute coronary syndrome who undergo coronary stent implantation

Abstract Introduction International guidelines recommend using risk score tools that allow us to assess the risk of bleeding and ischemia when deciding on DAPT. In our research, we aimed to examine the mortality relationship of new risk scores, DAPT and PRECISE-DAPT scores. Method Between 2013–2014, 948 patients admitted to our clinic with ACS were included in our study. We excluded 688 patient (no contact number,CABG, medical treatment, use of oral anticoagulation, active malignant cancer). 260 patients admitted with acute coronary syndrome (58%, 8 STEMI, 35%, 4 non-STEMI, 5%, 4 Unstable angina pectoris) who undergo coronary stent implantation were included in the study. We aimed to focus on the patients who undergo percutaneous coronary intervention and their risk of mortality. The patients' records were retrospectively analyzed through the hospital information system and archive records. Laboratory results, echocardiography and CAG reports of the patients, disease histories were obtained from the information recorded through the system. With these data, PRECISE-DAPT and DAPT scores of patients were calculated. Results The number of patients with a PRECISE-DAPT Score ≥25 was 62 (23.8%). The number of patients with DAPT Score ≥2 was 193 (74.2%). Mortality occurred in 49 (18.8%) patients. Patients with PRECISE-DAPT ≥25 and those with PRECISE-DAPT <25 were compared in terms of mortality and mortality was significantly higher in the high-scoring group [P <0.001 OR 6.94 C (3.53–13.62)]. The patients were divided into 4 groups (PRECISE-DAPT 25 and DAPT ≥2, PRECISE-DAPT ≥25 and DAPT ≥2, PRECISE-DAPT 25 and DAPT 2, PRECISE-DAPT ≥25 and DAPT 2) according to PRECISE-DAPT and DAPT score. Mortality was significantly higher regardless of DAPT score in patients with high PRECISE-DAPT scores (p<0.001). We evaluated the relationship between PRECISE-DAPT score and major bleeding and all bleeding. Compared to the group there was no significant difference in all bleeding events (P=0.56) and major bleeding events (P=0.23). The relationship between bleeding events and mortality was evaluated. There was no significant difference in mortality (p=0.689) with all bleeding events; but mortality was significantly increased in patients with major bleeding [P=0.025 OR 6.16 (1,33–28,49)]. Conclusion In our study, we observed that the patient group with a high PRECISE-DAPT score had a high mortality rate regardless of the DAPT score. The PRECISE-DAPT score is a useful tool in determining the group with high long-term mortality in patients who present with acute coronary syndrome and undergo percutaneous coronary intervention. The clinician should use the PRECISE-DAPT score when deciding on the duration of dual antiplatelet therapy in this patient group and these patients with high scores need to be monitored more closely. The data we have obtained from our study is retrospective and these results need to be supported by prospective and large studies. Funding Acknowledgement Type of funding sources: None.

Sex-related differences in long-term mortality after coronary artery bypass graft surgery: a systematic review and meta-analysis

Abstract Background This meta-analysis assessed the sex-related differences in long-term mortality (>7 years) after Coronary Artery Bypass Graft (CABG) Surgery. Purpose Women has higher incidence of short-term cardiovascular mortality after CABG compared to men. However, data about long-term differences are controversial. Methods We searched the databases for studies reporting sex-specific mortality following CABG including Ovid MEDLINE, Ovid, Embase, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL from inception up to December 31st, 2020. The search was not restricted to time or publication status. Outcomes included rates of long-term mortality (>7 year or longer). Results A total of 518 studies were resulted from literature search. A total of 14 studies and 204,223 patients; 158,663 men and 45,556 women, with a mean age of the men 60.2 years and 63.2 years for women, were included in our systematic review and meta-analysis. Our analysis suggested sex-related differences in long-term mortality (>7 years) following CABG (odds ratio (1), 1.15; 95% confidence interval (2), 1.017–1.30; P<.02). Conclusions Our results suggest that women had higher long-term mortality following CABG compared with men. It is the largest study to date of sex-specific differences in long-term mortality (>7 years). Funding Acknowledgement Type of funding sources: None. Meta-analysisDemographics

Prognosis of adverse outcomes in patients with ST-elevation myocardial infarction and acute ischemic kidney injury

Abstract Background The category of patients with ST-segment elevation myocardial infarction (STEMI) remains in the focus of attention of cardiologists across the globe due to the high rates of hospital and long-term mortality. Acute ischemic kidney injury represents one of the most serious complications of STEMI, due to its highly negative impact on the disease prognosis. Therefore, it is critical for a clinician to identify STEMI and acute ischemic kidney injury patients who are at high risk of developing adverse outcomes. Purpose To identify key prognostic markers of adverse outcomes in patients with STEMI and acute ischemic kidney injury. Methods The study included 173 patients (ages 37–75), who were admitted to the intensive care unit with STEMI. Two groups of patients were identified based on their renal function: a group with STEMI and acute ischemic kidney injury (main group, n=111) and a group with STEMI and normal renal function (comparison group, n=62). Acute ischemic kidney injury diagnosis was confirmed on the basis of KDIGO (2012) recommendations - when patients with MI were hospitalized with creatinine level increased by up to ≥1.5 times as compared to baseline creatinine level before hospital admission. A critical condition for confirming the diagnosis was absence of chronic kidney disease and urinary tract disorders in patients' medical history. To identify risk factors of adverse outcomes, multivariate logistic regression analysis was used. Results Regression analysis was performed in order to build a predictive model for the development of adverse outcomes (death from cardiovascular causes, recurrent MI, unstable angina within 12 months). The analysis was based on the results of clinical, laboratory and instrumental evaluations of the focus patients. The derived prognostic model included the following features: age, level of the N-terminal fragment of brain natriuretic peptide (NT-pro-BNP), C-reactive protein level, creatinine level and local contractility index. A mathematical model for predicting the likelihood of adverse outcomes was developed on the basis of regression analysis data. ROC analysis including building of a ROC curve was conducted in order to test the quality of the model; the AUC was 0,996. The resulting model achieved 90,6% sensitivity, 100% specificity and 97,1% positive predictive value. Conclusion The following prognostic markers of adverse outcomes development in patients with STEMI and acute ischemic kidney injury were identified as most critical: age, NT-pro-BNP level, C-reactive protein level, creatinine level and local contractility index based on echocardiography results. The mathematical model for predicting the likelihood of adverse outcomes, developed as a result of the study, will become a powerful clinical tool for improving the survival rate in patients with STEMI and acute ischemic kidney injury. Funding Acknowledgement Type of funding sources: None.

The association between international normalized-ratio and long-term mortality in patients with coronary artery disease: a large cohort study

Abstract Background The association between international normalized-ratio (INR) and long-term prognosis among patients with coronary artery disease (CAD) without atrial fibrillation (AF) or anticoagulant therapy was still unclear. We analyzed the association of INR levels and long-term mortality in a large cohort of CAD patients without atrial fibrillation or using of anticoagulant drugs. Method We obtained data from 44,662 patients who were diagnosed with CAD and had follow-up information from January 2008 to December 2018. The patients were divided into 4 groups (Quartile 1: INR ≤0.96; Quartile2: 0.961.06). The main endpoint was long-term all-cause death. Kaplan-Meier curve analysis and Cox proportional hazards models were used to investigate the association between quartiles of INR levels and long-term all-cause mortality. Result During a median follow-up of 5.25 years, 5,613 (12.57%) patients died. We observed a non-linear shaped association between INR levels and long-term all-cause mortality. Patients in high INR level (Quartile4: INR >1.06) showed a significantly higher long-term mortality than other groups (Quartile2 or 3 or 4), (Compared with Quartile 1, Quartile 2 [0.961.06], aHR=1.33, 95% CI: 1.22–1.45, P<0.05). Conclusion Our study demonstrates high levels of INR were associated with an increased risk of all-cause mortality. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): This study was supported by Guangdong Provincial People's Hospital Dengfeng Project Fund (DFJH201919) and The National Science Foundation for Young Scientist of China (grant no.8197021596, 81500520). Survival curves for mortalitySubgroup analysis

Conservative management of acute coronary syndromes in chronic kidney disease patients: a deadly sin

Abstract Background/Introduction Chronic kidney disease (CKD) is associated with worse prognosis in acute coronary syndromes (ACS). Purpose We sought to investigate the prognostic effect of non-invasive management of ACS in CKD patients in a tertiary University Hospital. Methods Two hundred and one patients (mean age 66.5±13.6 years, 150 males) admitted to our Hospital with ACS from 2016–2017 were included in the study. Patients were followed for a median of 2 years post the index event. CKD was defined by an estimated glomerular filtration rate (eGFR) <60 ml/min/m2, as assessed by the Modification of Diet in Renal Disease (MDRD) equation. We grouped patients into four groups according to their CKD status and whether they underwent coronary angiography or not. The primary outcome was all-cause death and secondary outcomes were cardiovascular and non-cardiovascular death. Results The majority of patients (n=120, 60%) presented with non-ST elevation ACS (NSTE-ACS), whereas 81 patients as ST-elevation myocardial infarction (STEMI) (40%). Fifty-four patients (27%) were identified as CKD patients (of whom 5 were on dialysis). Overall, 29 patients (14.4%) did not undergo coronary angiography. Patients at a higher age and with CKD were more likely to not undergo angiography. Thirty-seven (18.4%) died during follow-up (25 non-cardiovascular deaths and 12 cardiovascular deaths). Patients with conservative treatment and CKD had the worse prognosis (Hazard ratio [HR] =11.00, 95% Confidence intervals [CI] 4.00 to 30.24, p<0.001) followed by non-CKD patients with conservative treatment (HR=4.37, 95% CI 1.20 to 15.90, p=0.025) compared to non-CKD patients treated invasively (reference group) after adjusting for age, gender, STEMI/NSTE-ACS diagnosis (Figure). Results were similar for non-cardiovascular death, whereas regarding cardiovascular death only the group with CKD and conservative treatment had a lower survival compared to the reference group (HR=26.5, 95% CI 2.9 to 241.7, p=0.004) Conclusions Patients with ACS and CKD are less likely to receive invasive management and have higher mortality from both cardiovascular and non-cardiovascular causes than patients without CKD. Conservative management of ACS was associated with higher long-term mortality versus invasive management in all patients, regardless of CKD status. Funding Acknowledgement Type of funding sources: None.

Early neuro-prognostication with the Patient State Index and suppression ratio in post-cardiac arrest patients

Cardiopulmonary resuscitation guidelines recommend multimodal neuro-prognostication after cardiac arrest using neurological examination, electroencephalography, biomarkers, and brain imaging. The Patient State Index (PSI) and suppression ratio (SR) represent the depth and degree of sedation, respectively. We evaluated the predictive ability of PSI and SR for neuro-prognostication of post-cardiac arrest patients who underwent targeted temperature management. This prospective observational study was conducted between January 2017 and August 2020 and enrolled adult patients in an intensive care unit (ICU) with non-traumatic out-of-hospital cardiac arrest with return of spontaneous circulation (ROSC). PSI and SR were monitored continuously during ICU stay, and their maximum, mean, and minimum cutoff values 24 h after ROSC were analyzed to predict poor neurologic outcome and long-term survival. The final analysis included 103 patients. A mean PSI ≤ 14.53 and mean SR > 36.6 showed high diagnostic accuracy as single prognostic factors. Multimodal prediction using the mean PSI and mean SR showed the highest area-under-the-curve value of 0.965 (95% confidence interval 0.909-0.991). Patients with mean PSI ≤ 14.53 and mean SR > 36.6 had relatively higher long-term mortality rates than those of patients with values >14.53 and ≤ 36.6, respectively. The PSI and SR are good predictors for early neuro-prognostication in post-cardiac arrest patients.

Association of glaucoma with 10-year mortality in a population-based longitudinal study in urban Southern China: the Liwan Eye Study

ObjectivesTo investigate the association between glaucoma and 10-year mortality rate in an adult population in China.DesignPopulation-based cohort study.SettingThe Liwan Eye Study, China.Participants1405 baseline participants aged 50 years and older were...

The impact of low income on long-term mortality of myocardial infarction patients: results from the Brazilian Heart Study

Background Low socioeconomic status has for long been considered an important modifiable risk factor for developing cardiovascular disease, plausibly by lower access to healthcare, lower therapeutic adhesion, and overlapping of other known risk factors. Nevertheless, whether family income and social isolation of poor communities seen in Brazil impact outcomes following ST segment elevation myocardial infarction (STEMI) remain scarcely understood. Methods STEMI diagnosed patients were consecutively enrolled from the Brazilian Heart Study (ClinicalTrials.gov Identifier: NCT02062554) and categorized according to median family income (US$350), address-based human development index (HDI), and distance between communities and a tertiary hospital (DCTH). Incidence of death after 48 months was compared by using adjusted Cox regressions. p-values <0.05 were considered significant. Results Among 542 subjects, there were 69 deaths (13.2%) after a median follow-up time of 611 days (IQR =724). The low-income group had a higher incidence of all-cause mortality compared to high income (18.4 vs. 7.1%; p=.001), with an adjusted HR of 2.16 (95%CI: 1.25-3.75; p=.006). Compared to high income, low income individuals had worst clinical presentation of myocardial infarction and less frequently received dual antiplatelet therapy and statins at hospital discharge. Population attributable risk of low income was 44.8%. HDI and DCTH did not influence the delay to reperfusion therapy nor the risk of death. Conclusions Low-income was independently associated with a higher long-term mortality rate, lower prescription of guidelines-recommended therapy, and worst clinical presentation of myocardial infarction in STEMI patients.

Association between computed tomography-derived tricuspid annular dimensions and prognosis: insights from whole-beat computed tomography assessment.

AimsTricuspid regurgitation (TR) has been associated with outcome in patients treated with transcatheter aortic valve implantation (TAVI). Tricuspid annulus (TA) dimensions are associated with TR. However, the TA is highly dynamic during the cardiac cycle, and the interaction between the TA dimensions, TR, and patient prognosis has never been evaluated. This study aimed to characterize the dynamics of the TA along with the cardiac cycle and its association with prognosis in patients undergoing TAVI.Methods and resultsPatients with severe aortic stenosis who underwent whole-beat computed tomography (n = 393, mean age 80 ± 7 years, 53% male) were included. The ratio between anterior-posterior (AP) and septal-lateral (SL) diameter of the TA was calculated at end-systole (ES), mid-diastole (MD), and end-diastole (ED) to characterize the TA shape throughout the cardiac cycle. The primary endpoint was all-cause mortality. During a median follow-up of 3.6 (1.7–5.5) years, 146 patients died. While all the TA parameters at ES and MD were not associated with all-cause mortality, a low AP/SL ratio at ED (more circular geometry) was independently related with all-cause mortality (hazard ratio: 4.717, 95% confidence interval: 1.481–15.152; P = 0.009). In addition, a more circular TA shape at ED (AP/SL ratio < 1.20) was also associated with more right atrial and ventricular dilation, more frequently significant TR, and a higher prevalence of atrial fibrillation.ConclusionCircular remodelling of the TA shape at ED is associated with more right atrial and ventricular dilation, and a higher long-term mortality after TAVI. The evaluation of the TA shape at ED may be a useful parameter in the risk stratification of patients undergoing TAVI.

Effect of Permanent Pacemaker Implantation After Valve Surgery on Long-Term Outcomes.

Patients are prone to permanent pacemaker implantation (PPM) after valve surgery, yet current data on the effects of postoperative PPM are scarce and large-scale studies are lacking. The aim of this study was to determine rates and long-term outcomes of PPM after cardiac valve surgery.Methods and Results:A total of 24,014 patients who received valve surgery from 2000 to 2013 were identified from the Taiwan National Health Insurance Research Database. The number of valve surgeries and the proportion of PPM implantations after valve surgery increased (P<0.001). After 1 : 5 propensity score matching, 602 and 3,010 patients were categorized to the PPM and non-PPM groups, respectively. Late outcomes included all-cause mortality, cardiovascular death, sepsis, and readmission due to any cause. The mean follow up was 4.3 years. PPM was associated with a higher all-cause mortality rate (33.6% vs. 29.8%; hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.98-1.32), though not significant at the threshold of P<0.05. PPM was also associated with higher all-cause mortality rates in subgroups that received mitral valve (MV) replacement surgery, combined aortic valve replacement (AVR) with MV surgeries, and combined AVR with tricuspid valve surgeries. The PPM rate after valve surgery is increasing, and is associated with short-term adverse effects. Patients with PPM may have a higher long-term mortality rate.

Mortality in 98 type 1 diabetes mellitus and type 2 diabetes mellitus: Foot ulcer location is an independent risk determinant.

We previously demonstrated in both a longitudinal study and in meta-analysis (pooled relative-risk RR, 2.45) that all-cause mortality is significantly higher in people with diabetes foot ulceration (DFU) than with those without a foot ulcer. In this prospective study, we looked at the factors linked to mortality after presentation to podiatry with DFU. Ninety-eight individuals recruited consecutively from the Salford Royal Hospital Multidisciplinary Foot Clinic in Spring 2016 were followed up for up to 48months. Data concerning health outcomes were extracted from the electronic patient record (EPR). Seventeen people (17) had type 1 diabetes mellitus, and 81 had type 2 diabetes mellitus. Thirty-one were women. The mean age (range) was 63.6 (28-90) years with maximum diabetes duration 45years. Mean HbA1c was 72 (95% CI: 67-77) mmol/mol; 97% had neuropathy (International Working Group on the Diabetic Foot (IWGDF) monofilament); 62% had vascular insufficiency (Doppler studies); 69% of ulcers were forefoot, and 23% of ulcers were hind foot in location. Forty of 98 (40%) patients died in follow-up with 27% of death certificates including sepsis (not foot-related) and 35% renal failure as cause of death. Multivariate regression analysis indicated a 6.3 (95% CI: 3.9-8.1) fold increased risk of death with hind foot ulcer, independent of age/BMI/gender/HbA1c/eGFR/total cholesterol level. This prospective study has indicated a very high long-term mortality rate in individuals with DFU, greater for those with a hind foot ulcer and shown a close relation between risk of sepsis/renal failure and DFU mortality, highlighting again the importance of addressing all risk factors as soon as people present with a foot ulcer.