Previous History Of Stroke Research Articles

Temporal trends and prognostic significance of heart failure after acute myocardial infarction

Abstract Background There are limited and conflicting data regarding the incidence and prognostic impact of in-hospital heart failure (HF) complicating acute myocardial infarction (MI). The aim of this study was to examine temporal trends in the incidence and outcomes of systolic HF after acute MI in a large national cohort in South Korea. Methods The nationwide Korea Acute Myocardial Infarction Registry records baseline characteristics, treatments, and outcome of consecutive patients with acute MI admitted to hospitals capable of primary percutaneous coronary intervention (PCI) in South Korea. Systolic HF was defined as an ejection fraction ≤40% by echocardiography at admission. This study included 68,123 patients admitted for index acute MI between 2005 and 2020 (phase 1: 2005-2007, n=14,735; phase 2: 2008-2011, n=24,656; phase 3: 2012-2015, n=13,104; phase 4: 2016-2020, n=15,628). Results In all patients, the incidence of HF declined from 19.4% in phase 1 to 14.1% in phase 4 (p<0.001). This decrease was more pronounced in patients with ST-segment elevation MI (STEMI, from 20.9% to 15.8%) compared to those with non-ST-segment elevation MI (NSTEMI, from 17.9% to 12.3%). The use of PCI and of statins at discharge increased from 86% to 91.2% and from 75.1% to 92.2%, respectively (p<0.001 for all). Previous history of MI increased from 8.4% to 10.4% (p<0.001) whereas previous history of HF and stroke decreased from 6.3% to 1.3% and from 17.4% to 6.4%, respectively (p<0.001). The median symptom-to-door time decreased from 3.5 hours to 2.1 hours for STEMI and from 6.3 hours to 5.5 hours for NSTEMI (p<0.001). The median door-to-balloon time decreased from 107 min to 64 min for STEMI and from 26 hours to 14 hours for NSTEMI (p<0.001). The in-hospital and 12-month mortality rates for all patients decreased over the years from 5.0% to 3.3% and from 7.6% to 6.1%, respectively (p<0.001). However, in those who developed HF during the index MI, no significant declining trends were observed in in-hospital mortality (phase 1: 8.8%, phase 2: 7.95%, phase 3: 8.3%, phase 4: 7.3%, p=0.123) and 12-month mortality (phase 1: 15.4%, phase 2: 12.6%, phase 3: 19.4%, phase 4: 15.2%, p=0.270). Independent predictors of developing in-hospital HF were age >75 years, body mass index <18.5 kg/m2, symptom-to-door and door-to-balloon times, systolic blood pressure <100 mmHg at presentation, heart rate >90 min at presentation, presence of atrial fibrillation or diabetes, and previous history of MI, HF or stroke. Conclusions A marked reduction was found in the incidence of HF after acute MI between 2005 and 2020 in South Korea. However, in-hospital and 12-month mortality rates in HF patients remain unchanged, warranting intensive post-MI management with more aggressive efforts for secondary prevention.

Analyzing the economic ramifications of the broad implementation of generic prasugrel

Abstract Introduction The 2023 European Acute Coronary Syndrome (ACS) guidelines state that prasugrel (PRG) should be considered in preference to ticagrelor (TCG) in patients (pts) who proceed to percutaneous coronary angioplasty (PCI). In Portugal, PRG is less available due to earlier evidence considering pretreatment and contraindications for each drug. PRG (10mg) is currently a generic drug, while TCG is not. We aimed to evaluate the proportion of pts that could be switched from TCG to PRG, and the economic impact of a widespread national adoption. Methods To determine eligibility for generic PRG 10mg, we examined a single center prospective database of consecutive ACS pts undergoing PCI in a full year. Eligibility for TCG and PRG was based on drug specific contraindications, previous stroke for PRG and chronic liver disease (CLD) for TCG, and indication for PRG dose reduction (≤60 kg and ≥75 years). To estimate hospital costs we used the price per pill indicated by the pharmacy (0.98€ TCG, 0.67€ PRG). To obtain post-discharge and NHS savings we used the INFARMED public information. We estimated 3500 PCIs per year on a national level, based on published data. Results A total of 780 pts were included, median age 68±10.4years, 523 (67.1%) were male, 51.9% (n=406) had non-ST elevation ACS. Mean admission time was 8.36 days. Considering PRG and TCG contraindications, 157 pts (20.3%) had a previous history of stroke and 20pts (2.6%) had CLD. 150 pts (19.2%) had PRG dose reduction criteria. Eligible for PRG 10mg and TCG 90mg were 434 pts (57.8% of total PCI pts). Cost per admission would be 33 697.35€ for TCG and 17 617.28€ for PRG. At a national level, hospital costs can be reduced by 16080.07€. Considering the 1-year outpatient setting and a widespread generic PRG 10mg adoption, NHS savings are estimated in 898 323.59€, and patient savings in 401248.25€ (198.38€ per patient). Conclusions ACS pts in real-world scenarios exhibit both eligibility for PRG and TCG. Considering the lower cost, the NHS can potentially save 914 403,66€ (figure 1) annually through the widespread adoption of generic PRG 10mg.

The value of systemic immune inflammation index, white blood cell to platelet ratio, and homocysteine in predicting the instability of small saccular intracranial aneurysms

Inflammation has a destructive effect on the homeostasis of the vascular wall, which is involved in the formation, growth, and rupture of human intracranial aneurysms (IAs) disease progression. However, inflammation-related markers have not been well studied in the risk stratification of unruptured IAs. The purpose of this study was to investigate the predictive value of serum inflammatory markers in the unstable progression of small saccular intracranial aneurysms (SIAs). This study retrospectively included 275 patients with small SIAs (aneurysm diameter less than or equal to 7 mm), to compare the level difference of serum inflammatory complex marker systemic immune-inflammatory index (SII), white blood cell to platelet ratio (WPR), and homocysteine (Hcy) in patients with stable (asymptomatic unruptured) and unstable (symptomatic unruptured, ruptured) small SIAs. 187 patients (68%) had aneurysm-related compression symptoms and rupture outcomes. In the multivariate logistic regression after adjusting for baseline differences, SII, WPR, and Hcy were independent risk factors for the instability of small SIAs, the prediction model combined with other risk factors (previous stroke history, aneurysm irregularity) showed good predictive ability for the instability of small SIAs, with an area under the curve of 0.905. In addition, correlation analysis showed that SII, WPR, and Hcy also had significant differences in patients with symptomatic unruptured and ruptured small SIAs, and higher inflammation levels often promoted the disease progression of small SIAs. Higher levels of SII, WPR and Hcy can be used as independent predictors of instability of small SIAs. As an economical and convenient biomarker, it is crucial for clinical treatment strategies of stable small SIAs.

Association Between the Timing of Atrial Fibrillation Detection and Functional Outcome Following Mechanical Thrombectomy.

Atrial fibrillation detected after stroke (AFDAS) refers to the identification of newly diagnosed atrial fibrillation (AF) following an ischemic stroke in patients without known AF (KAF). The objective of this study was to compare the functional outcomes of patients diagnosed with AFDAS and those with KAF who underwent mechanical thrombectomy. We conducted a retrospective analysis of patients who underwent mechanical thrombectomy and with either new AF diagnosed during hospitalization or KAF. We compared the baseline characteristics, clinical, and procedure-related variables between those with AFDAS and KAF. The primary outcome was the achievement of functional independence, defined as a modified Rankin Scale score of 0 to 2, at 3 months after stroke. Of the 252 patients, 101 (40.1%) were classified into the AFDAS group. The KAF group exhibited a higher rate of stroke history compared with the AFDAS group (32.5% versus 13.9%; P=0.001). Tandem occlusion was more common in the KAF group (13.2% versus 5.9%), while M2 occlusion was more common in the AFDAS group (11.3% versus 20.8%). The proportion of patients who achieved functional independence was higher in the AFDAS group (37.7% versus 52.5%; P=0.029). Multivariable analysis showed that AFDAS was associated with a favorable functional outcome (odds ratio, 2.67 [95% CI, 1.39-5.14]; P=0.003). AFDAS demonstrated a positive association with functional independence in patients with stroke who underwent mechanical thrombectomy and were finally diagnosed to have AF during hospitalization. The observed disparities in occlusion site, intractable thrombus, and history of previous stroke may have contributed to these findings.

Effects of strategic white matter hyperintensities of cholinergic pathways on basal forebrain volume in patients with amyloid-negative neurocognitive disorders

BackgroundThe cholinergic neurotransmitter system is crucial to cognitive function, with the basal forebrain (BF) being particularly susceptible to Alzheimer’s disease (AD) pathology. However, the interaction of white matter hyperintensities (WMH) in cholinergic pathways and BF atrophy without amyloid pathology remains poorly understood.MethodsWe enrolled patients who underwent neuropsychological tests, magnetic resonance imaging, and 18F-florbetaben positron emission tomography due to cognitive impairment at the teaching university hospital from 2015 to 2022. Among these, we selected patients with negative amyloid scans and additionally excluded those with Parkinson’s dementia that may be accompanied by BF atrophy. The WMH burden of cholinergic pathways was quantified by the Cholinergic Pathways Hyperintensities Scale (CHIPS) score, and categorized into tertile groups because the CHIPS score did not meet normal distribution. Segmentation of the BF on volumetric T1-weighted MRI was performed using FreeSurfer, then was normalized for total intracranial volume. Multivariable regression analysis was performed to investigate the association between BF volumes and CHIPS scores.ResultsA total of 187 patients were enrolled. The median CHIPS score was 12 [IQR 5.0; 24.0]. The BF volume of the highest CHIPS tertile group (mean ± SD, 3.51 ± 0.49, CHIPSt3) was significantly decreased than those of the lower CHIPS tertile groups (3.75 ± 0.53, CHIPSt2; 3.83 ± 0.53, CHIPSt1; P = 0.02). In the univariable regression analysis, factors showing significant associations with the BF volume were the CHIPSt3 group, age, female, education, diabetes mellitus, smoking, previous stroke history, periventricular WMH, and cerebral microbleeds. In multivariable regression analysis, the CHIPSt3 group (standardized beta [βstd] = -0.25, P = 0.01), female (βstd = 0.20, P = 0.04), and diabetes mellitus (βstd = -0.22, P < 0.01) showed a significant association with the BF volume. Sensitivity analyses showed a negative correlation between CHIPS score and normalized BF volume, regardless of WMH severity.ConclusionsWe identified a significant correlation between strategic WMH burden in the cholinergic pathway and BF atrophy independently of amyloid positivity and WMH severity. These results suggest a mechanism of cholinergic neuronal loss through the dying-back phenomenon and provide a rationale that strategic WMH assessment may help identify target groups that may benefit from acetylcholinesterase inhibitor treatment.

Impact of cerebral protection on observed versus predicted in-hospital stroke in a high stroke risk TAVR cohort

BackgroundDespite impressive improvements in the safety profile of Transcatheter aortic valve replacement (TAVR), the risk for peri-procedural stroke after TAVR has not declined substantially. In an effort to reduce periprocedural stroke, cerebral embolic protection (CEP) devices have been utilized but have yet to demonstrate benefit in all-comers. There is a paucity of data supporting the utilization of CEP in TAVR patients with an anticipated high risk for peri-procedural stroke.MethodsThe Transcatheter Aortic Valve Replacement In-Hospital Stroke (TASK) score is a clinical risk tool for predicting the in-hospital stroke risk of patients undergoing transfemoral TAVR. This score was used to identify high-risk patients and calculate the expected in-hospital stroke risk. This was a single-centre cohort study in all consecutive TAVR patients who had placement of CEP. The observed versus expected ratio for peri-procedural stroke was calculated. To obtain 95% credible intervals, we used 1000 bootstrapped samples of the original cohort sample size without replacement and recalculated the TASK predicted scores.ResultsThe study included 103 patients. The median age was 83 (IQR 78,89). 63 were male (61.1%) and 45 (43.69%) had a history of previous Stroke or TIA. Two patients had an in-hospital stroke after TAVR (1.94%). The expected risk of in-hospital stroke based on the TASK score was 3.39% (95% CI 3.07–3.73). The observed versus expected ratio was 0.57 (95% CI 0.52–0.64).ConclusionIn this single-center study, we found that in patients undergoing TAVR with high stroke risk, CEP reduced the in-hospital stroke risk by 43% when compared with the risk-score predicted rate.Clinical trial numberN/A.

The Etiology of Non-traumatic Loss of Consciousness in Patients Admitted to the Emergency Department

Background: Loss of consciousness (LOC) is one of the most common complaints in the emergency department (ED). This disorder can result from a wide range of clinical conditions, such as structural brain damage, infection, shock, respiratory failure, or psychiatric disorders. Objectives: This study was conducted with the aim of investigating the cause and prognosis of patients with non-traumatic LOC referred to two referral hospitals of Mashhad University. Methods: This prospective cohort study was conducted on 1000 patients presenting with complaints of LOC at Ghaem and Imam Reza hospitals in Mashhad in 2020. All patients with a decreased level of consciousness and a Glasgow Coma Scale (GCS) score of less than 14 were included in the investigation. Results: A total of 1037 patients participated in this study, while 37 patients were excluded. Of the participants, 524 (52.4%) were men and 476 (47.6%) were women. The average age was 59.85 ± 16.06 years, ranging from 18 to 95 years. The relatively common causes of LOC included sepsis (38.3%), stroke (9.2%), heart failure (8%), myocardial infarction (7.3%), meningitis (7.2%), hepatic encephalopathy (6.5%), and toxic alcohol ingestion (5.8%). Deceased patients were older, had higher respiratory rates and temperatures, and had lower blood sugar and blood pressure upon admission. A previous history of stroke, hyperlipidemia, hypertension, and diabetes were associated with death. The relationships between different study outcomes were assessed using multivariate binary logistic regression; a two-sided P &lt; 0.05 was considered significant. Conclusions: Patients presenting to the ED with LOC are more likely to die, making LOC a potential prognostic factor for in-hospital death.

Extended aortic coverage in thoracic aortic endovascular repair is not associated with spinal cord ischemia

ObjectiveSpinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) remains a debilitating complication, occurring in 10% of patients. Studies have shown that extended aortic coverage is a risk factor for SCI. This study evaluates whether extended aortic length coverage is a significant risk factor for SCI. MethodsThis study retrospectively reviewed 277 consecutive patients who underwent TEVAR successfully between 2006 and 2021 at a single institution. The patients were classified into 2 groups: ≥205 mm and <205 mm of thoracic aortic coverage. Analysis of variance was used to compare these variables and associated aortic coverage between the 2 groups. Univariable logistical regression was used to compare SCI and associated factors. ResultsOf the 269 patients who underwent successful TEVAR, 127 (47.2%) had ≥205 mm and 142 (52.8%) had <205 mm of aorta coverage. Patients with ≥205 mm of thoracic aorta coverage were more likely to be smokers (P < .01) and to have a history of previous stroke (P < .05). Patients with extended coverage were more likely to receive a preoperative lumbar drain (LD) (P < .01). Extended aortic coverage was not associated with a higher risk of SCI compared to standard aortic coverage (4.7% vs 4.2%; P = .84). Extended aortic coverage with or without a preoperative LD did not have an association with SCI (P = .91). Type II endoleaks were seen more in extended aortic coverage (P < .01). ConclusionsExtended aortic coverage (compared with the standard approach) was not associated with a higher risk of SCI; however, this may have been mitigated by a higher prevalence of prophylactic lumbar drainage in this population.

May Measurement Month 2021: an analysis of blood pressure screening results from Uganda.

High blood pressure (BP) is the leading cause of cardiovascular disease in Uganda accounting for more than 50% of cardiovascular related deaths each year. In Uganda, more than 25% of adults have high BP with lack of awareness being the main barrier to achieving satisfactory control rates. May measurement month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of BP screening programmes. A cross-sectional survey of voluntary screenees aged 18 years and above was carried out between May and September 2021. Screening was carried out in two outpatient departments of two referral hospitals within the capital city, Kampala. BP measurements, the definition of hypertension and statistical analysis followed the standard MMM protocol. A total of 1671 people were screened and included in analysis. After multiple imputation, 1018 (60.9%) had hypertension. Of all 1018 participants with hypertension, 765 (75.1%) were aware and 750 (69.3%) were on antihypertensive medicine. Of the participants on antihypertensive medicine, 248 (35.2%) had controlled BP (<140/90 mmHg). Previous history of stroke and taking alcohol 1-6 times per week were significantly associated with higher diastolic BP. The MMM21 Uganda campaign highlights the importance of measuring BP as it generates real-time data on untreated and inadequately treated hypertension. This should motivate government and policy makers to promote routine local screening for BP.

Neurofilament Light Chain and Risk of Stroke in Patients With Atrial Fibrillation.

Biomarkers reflecting brain injury are not routinely used in risk assessment of stroke in atrial fibrillation (AF). Neurofilament light chain (NFL) is a novel biomarker released into blood after cerebral insults. We investigated the association between plasma concentrations of NFL, other biomarkers, and risk of stroke and death in patients with AF not receiving oral anticoagulation. For this observational study, baseline plasma samples were available from 3077 patients with AF randomized to aspirin in ACTIVE A (Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events; 2003 to 2008) and AVERROES (Apixaban Versus Acetylsalicylic Acid [ASA] to Prevent Stroke in Atrial Fibrillation Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment; 2007 to 2009). Median follow-up was 1.5 years. NFL was analyzed with a Single Molecule Array (Simoa). Associations with outcomes (total stroke or systemic embolism, ischemic stroke, cardiovascular death, and all-cause death) were explored with Cox regression models. In the combined cohort, the median NFL level was 16.9 ng/L (interquartile range, 11.1-26.5 ng/L), the median age was 71 years, 58% were men, and 13% had a history of previous stroke. NFL was associated with older age, higher creatinine, lower body mass index, previous stroke, female sex, and diabetes but not cardiac rhythm. Higher NFL was associated with a higher risk of stroke or systemic embolism (n=206) independently of clinical characteristics (hazard ratio, 1.27 [95% CI, 1.10-1.46] per doubling of NFL) and other biomarkers (hazard ratio, 1.18 [95% CI, 1.01-1.37]) and including in patients without previous stroke (hazard ratio, 1.23 [95% CI, 1.02-1.48]). NFL was also independently associated with cardiovascular (n=219) and all-cause (n=311) death. The C index for stroke using only NFL was 0.642, on par with the currently used clinical risk scores. Addition of information on NFL improved discrimination in a model also including clinical information, NT-proBNP (N-terminal pro-B-type natriuretic peptide), and high-sensitivity cardiac troponin T, yielding a C index of 0.727. NFL reflects overt and covert episodes of cerebral ischemia and improves risk assessment of stroke and death in patients with AF without oral anticoagulation, including in patients without previous stroke. The combination of NFL with information on age, history of stroke, and other biomarkers should be explored as a future avenue for stroke risk assessments in patients with AF.

Prevalence of cardiovascular drug-related adverse drug reactions consultations in UK primary care: A cross-sectional study.

Adverse drug reactions (ADRs) represent a significant barrier to achieve optimal treatment outcomes. Cardiovascular drugs, including antihypertensive drugs, lipid-lowering drugs, and antithrombotic drugs, are among the most prescribed medications in the primary care setting. To estimate the prevalence of cardiovascular drug-related ADRs consultations in United Kingdom (UK) primary care and identify risk factors of these ADRs. This was a cross-sectional study of cardiovascular drug users between 2000-2019 using UK IQVIA Medical Research Data. ADRs consultations were identified using database screening method employing standardised designated codes. The overall and annual age-standardised prevalence was estimated using direct standardisation method using 2019 mid-year UK population. Risk factors of ADRs consultations were estimated using logistic regression model stratified by therapeutic areas. The standardised prevalence of consultations related to cardiovascular drugs ADRs was 10.60 (95% CI. 10.46, 10.75) per 1000 patients. Patients aged 70-79 years had the highest occurrence of ADRs consultations. The most frequently drug classes implicated in the ADRs consultations were statins (n = 9,993 events, 27.09%), beta-blockers (n = 8,538 events, 23.15%), ACEIs/ARBs (n = 8,345 events, 22.62%), and aspirin (n = 6,482 events, 17.57%). Risk factors of ADRs consultations were previous history of cardiovascular diseases, e.g., myocardial infarction and stroke; advanced age, comorbidities; diabetes and dyslipidaemia; and polypharmacy. The burden of cardiovascular drug-related ADRs consultations in primary care was considerable. Statins, beta-blockers, ACEIs/ARBs, and aspirin were the most frequently implicated drug classes. Closer clinical monitoring should be performed for patients affected by the ADRs to mitigate the risk of suboptimal treatment outcomes.

Risk Factors and Etiological Classification of Ischemic Stroke Subtypes in Southwest Iran

Precise categorization of the causes of ischemic stroke (IS) is crucial for optimizing stroke treatment and assessing the prognosis of patients. This cross-sectional study aimed to determine the risk factors and various subcategories of IS in Iranian patients. The study included all patients with IS referred to Golestan Hospital (Ahvaz, Iran) for one year. Their demographics and clinical data were collected. The etiology of IS was classified based on the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. A total of 1100 patients with IS were evaluated, 658 were male and 442 were female. They had an average age of 66 years (ranging between 20 and 99 years). The majority of them were in the 61-80 age group. The prevalence of risk factors for IS included hypertension (HTN) (71.4%), diabetes (50.4%), smoking (42.4%), history of previous stroke (28%), dyslipidemia (15.4%), and cardiovascular disease (22.5%). Three months after admission, the mortality rate was 10.7% and the majority of patients exhibited a lower level of disability based on the modified Rankin Score (mRS) compared to the time of admission. The frequency of all risk factors, except for HTN, differed significantly between genders (P&lt;0.05). Furthermore, the prevalence of risk factors varied significantly among different stroke etiologic subgroups (P&lt;0.05). The most common etiological factors identified by TOAST classification were associated with large artery atherosclerosis (LAA) and small artery occlusion (SAO). Significant variations were observed in the prevalence of different etiologic subtypes of stroke among genders and across different age groups.

Evaluation of Outcomes in Patients with Previous Stroke History following Cardiac Surgery: A Single-Center Study.

Background: The aim of the study to analyze the risk of complications, including neurological sequelae, alongside early and late mortality among patients with antecedent stroke subjected to cardiac surgical interventions with extracorporeal support. Material and methods: A single-center retrospective study was conducted on 10,685 patients who underwent cardiac surgery with extracorporeal circulation at the Department of Cardiac Surgery. The first group comprised all patients eligible for cardiac surgery with extracorporeal circulation. The second group consisted of patients with a preoperative history of stroke. Results: In the study, a statistically significant association was observed between preoperative stroke and the occurrence of postoperative pneumonia (OR = 1.482, p = 0.006), respiratory failure (OR = 1.497, p = 0.006), renal failure (OR = 1.391, p = 0.019), 30-day mortality (OR = 1.528, p = 0.026), 90-day mortality (OR = 1.658, p < 0.001), and one-year mortality (OR = 1.706, p < 0.001). Conclusions: Patients with a history of preoperative stroke more frequently experienced renal failure and respiratory-system complications such as pneumonia and respiratory failure. The survival time of patients with a history of preoperative stroke was shorter compared to that of the control group during the analyzed 30-day, 90-day, and one-year observation periods.

Risk Factors for Intraoperative Hypotension in Elderly Patients Undergoing Fast Track Hip Fracture Surgery under Spinal Anesthesia: A Retrospective Observational Study

Objective: Fast-track hip fracture surgery is urgent. Time-limited preoperative optimization increase the risk of perioperative cardiovascular issues, affecting postoperative outcomes. This study aimed to identify risk factors for intraoperative hypotension in elderly patients undergoing fast-track hip fracture surgery with spinal anesthesia. Materials and Methods: This retrospective observational analysis was conducted at a university-based hospital. Medical records from 2018 to 2022 were examined to compare variables associated with intraoperative hypotension. Multivariate logistic regression analysis was used to determine the risk variables for intraoperative hypotension. Results: The incidence of intraoperative hypotension was 50.1%. Significant factors associated with intraoperative hypotension included a history of previous stroke (adjusted odds ratio [OR]: 2.41; 95% confidence interval [CI]: 1.38–4.21, P = 0.002), a preoperative baseline SBP below 100 mmHg (adjusted OR: 2.34; 95% CI: 1.34–4.08, P = 0.003), a preoperative urine output less than 0.5 ml/kg/h (adjusted OR: 2.74; 95% CI: 1.07–6.96, P = 0.034), undergoing an intramedullary nail procedure (adjusted OR: 2.64; 95% CI: 1.85–3.77, P &lt; 0.001). Conversely, protective factors included receiving preoperative blood transfusions (adjusted OR: 0.43; 95% CI: 0.24–0.77, P = 0.004) and receiving a spinal bupivacaine dose of 7.5 mg or above (adjusted OR: 0.59; 95% CI: 0.36–0.95, P = 0.033). Conclusion: Modifiable factors include ensuring adequate preoperative intravascular volume to optimize urine output and blood pressure, and correcting anemia. Prioritizing these measures for at-risk patients can help prevent complicated hospital stays.

Relationship between maximum carotid plaque area and prognosis of patients with acute ischaemic stroke.

In this study, the relationship between maximum carotid plaque area and stroke prognosis was analysed by carotid ultrasonography, and the relevant risk factors affecting the prognosis of acute ischaemic stroke (AIS) were investigated to provide novel insights into stroke prevention and management. A total of 205 AIS patients with carotid plaques were included in this study. Based on the mRS score at discharge, patients with AIS were classified into the good prognosis group (mRS ≤ 2) and poor prognosis group (mRS ≥ 3). SPSS 25.0 was used to analyse the data. Univariate and multivariate analyses were performed on the two groups with good and poor prognosis. Comparison between good and poor prognosis in patients with AIS in different circulatory systems was performed using the Kruskal-Wallis test. Differences were considered statistically significant at P < 0.05. Comparison of baseline data revealed differences in carotid plaque diameter, carotid intima-media thickness, maximum carotid plaque area, history of previous stroke and plaque echogenicity between the good and poor prognosis groups (P < 0.05). Results of multifactorial analyses of logistic binary regression indicated that history of previous stroke and maximum carotid plaque area were predictors of poor prognosis, with odds ratio of 2.515 (95%CI [1.327-4.764]) and 1.019 (95%CI [1.006-1.032]), respectively. The maximum carotid plaque area and history of previous stroke are important predictors for assessing prognosis in patients with AIS.

Two novel nomograms predict 30-day mortality after off-pump coronary artery bypass grafting

BackgroundWith the development of surgical techniques and medical equipment, the mortality rate of off-pump coronary artery bypass grafting (CABG) has been declining year by year, but there is a lack of convenient and accurate predictive models. This study aims to use two nomograms to predict 30-day mortality after off-pump CABG. MethodsPatients with isolated off-pump CABG from January 2016 to January 2021 were consecutively enrolled. Potential predictive factors were first screened by lasso regression, and then predictive models were constructed by multivariate logistic regression. To earlier identify high-risk patients, two nomograms were constructed for predicting mortality risk before and after surgery. ResultsA total of 1840 patients met the inclusion and exclusion criteria. The 30-day mortality was 3.97 % (73/1840) in this cohort. Multivariate logistic analysis showed that age, BMI<18.5 kg/m2, surgical time, creatinine, LVEF, history of previous stroke, and major adverse intraoperative events (including conversion to cardiopulmonary bypass or implantation of intra-aortic balloon pump) were independently associated with 30-day mortality. Model 1 contained preoperative and intraoperative variables, and the AUC was 0.836 (p < 0.001). The AUC of the K-fold validation was 0.819. Model 2 was only constructed by preoperative information. The AUC was 0.745 (p < 0.001). The AUC of the K-fold validation was 0.729. The predictive power of Model 1 was significantly higher than the SinoScore (DeLong's test p < 0.001). ConclusionsThe two novel nomograms could be conveniently and accurately used to predict the risk of 30-day mortality after isolated off-pump CABG.

Clinical outcomes and associated factors in patients who underwent percutaneous coronary intervention: a multicenter study in Ethiopia

Aims This study aimed to evaluate the clinical outcomes and associated factors in patients who underwent percutaneous coronary intervention (PCI). Methods This five-year retrospective cross-sectional study analyzed data from 241 patients who underwent urgent and primary PCI. Outcome measures included in-hospital mortality, major adverse cardiac and cerebrovascular events (MACCEs), postprocedural complications, and survival rates. Data were analysed using the Statistical Package for Social Sciences version 25. Cox proportional hazard regression models were used to assess predictors of in-hospital mortality. Kaplan-Meier analysis and the log-rank test were used to assess the overall survival rates and median survival time and to compare the survival probability curves for independent predictors. Hazard ratios (HRs) and 95% confidence intervals (CIs) were presented. Results One hundred forty-two patients underwent elective PCI with drug-eluting stent implantation (75.1%) as the reperfusion method. The in-hospital mortality and non-fatal MACCE rates were 3.7% and 24.1%, respectively. The predictors of in-hospital mortality were female sex (AHR = 8.39, 95% CI: 1.20–58.68, p = 0.03), preprocedural obesity (AHR = 6.54, 95% CI: 1.10–40.60, p = 0.04), previous myocardial infarction (AHR = 9.68, 95% CI: 1.66–56.31, p = 0.01), chronic heart failure (AHR = 9.21, 95% CI: 1.38–61.78, p = 0.02), and a previous history of stroke (AHR = 18.99, 95% CI: 1.59–227.58, p = 0.02). Notably, this study reported a high one-year survival rate. Conclusion Urgent and primary PCIs are critical interventions for patients with MI in Ethiopia, showing promising outcomes such as low in-hospital mortality and a high one-year survival rate. These findings underscore the importance of optimising access to PCI and related treatments to improve patient outcomes.

Impact of different dose reduction criteria on dose assignment of current DOACs and related outcomes: an analysis from 4-year data of the ETNA-AF Europe programme

Abstract Background Direct oral anticoagulants (DOACs) are the standard treatment for stroke prevention in patients with atrial fibrillation (AF). Pharmacological characteristics and dose reduction criteria of the four currently available DOACs are different. Several studies have reported frequent use of non-recommended doses of DOACs associated with worse clinical outcomes. Data from real-world studies, such as the edoxaban Treatment in routiNe clinical prActice (ETNA)-AF, may help assessing the size of this phenomenon and its impact on clinical outcomes. Purpose To evaluate the distribution of dose reduction criteria and explore associated outcomes in a large, unselected, real-world population using 4-year data from the ETNA-AF EU study. Methods The ETNA-AF EU is a prospective, observational, study to evaluate safety and effectiveness of edoxaban in patients with AF from Europe. Patients with available data regarding the SmPC dose reduction criteria of the four currently available DOACs were included. Patients with a creatinine clearance &amp;lt;30 mL/min were excluded. Patients were classified by dose reduction criteria for the different DOACs (i.e., full dose for all [FULL], reduced dose for all [REDUCED], patients not included in previous groups [INTERMEDIATE]). Results We included 12,866 patients from the ETNA-AF EU study. According to the SmPC dose reduction criteria, the percentage of patients that would be eligible for a dose reduction in the ETNA population was highly heterogenous across different DOACS: 5.7% for apixaban, 16.8% for rivaroxaban, 23.8% for edoxaban and 52.9% for dabigatran. Moreover, differences in the dose reduction criteria included in each SmPC was reflected by the distribution of patients in the three pre-specified groups. Among the 11,003 assignable patients, 42.4% would receive a full dose, 5.1% would receive a reduced dose and the largest percentage, 52.5%, was in the INTERMEDIATE group, which would receive either a full or reduced dose of any DOAC depending on the selected agent. Of the patients included in the INTERMEDIATE group, 65.2% received a full dose of edoxaban due to its specific labelling. Interestingly, the INTERMEDIATE group included the vast majority of patients known to be at risk of adverse events: very elderly (i.e., ≥85 yrs; 76.5%), frail as per investigator (73.3%), history of previous stroke (60.4%) or history of bleeding (61.3%). Clinical outcomes at four years were significantly higher in both the INTERMEDIATE and the REDUCED groups compared to the FULL group, with the only exception of haemorrhagic stroke (Table). Conclusion(s): According to the different dose reduction criteria of currently available DOACs, notable percentage of patients could receive either a full or a reduced dose depending on the DOAC chosen by the physician. Considering that the chosen dose of the DOAC has an impact on clinical outcomes, patients in the INTERMEDIATE group need careful assessment, which warrants further analysis.

Prediction of the success of electrical cardioversion in patients with atrial fibrillation using parameters obtained by spectral and vectorcardiographic analysis of the ECG

Abstract Introduction Electrical cardioversion (ECV) still presents a treatment option for atrial fibrillation (AF). Despite the great success rate in the acute setting, its long-term success rate is low. The aim of the study was to find predictors of SR maintenance after ECV using spectral and vectorcardiographic (VCG) analysis of the ECG curve. Methods Consecutive patients with AF referred for elective ECV were prospectively enrolled. The digital ECG recording obtained before the ECV was analyzed using spectral and VCG analysis. All patients had Holter monitoring and clinical follow-up three months after cardioversion to assess SR maintenance. Atrial fibrillation activity was analyzed by spectral analysis, determining the dominant frequency (DF), RI (regularity index) and OI (organization index). QRS complexes were analyzed by vectorcardiography and dXmean, dYmean and dZmean (derivation of VCG signals) parameters were determined. Using logistic regression (LR) with backward parameter reduction, separate and combined predictive models of SR maintenance were calculated based on both the analysis from the VCG data and the spectral analysis data. Additional models with a forward selection of clinical variables were also calculated. The efficiency of the models was evaluated on a separate test subset of the data (N=32). Results A total of 80 patients were enrolled (age 70+10 years, 48 (64%) men, CHADSVASc 3.17+1.5, BMI 29.75kg/m2). At the 3-month follow-up, AF recurrence was present in 36 patients (45%). Using only vectorcardiographic parameters, dXmean (OR 3.07, 95 %CI 1.14- 8.63), p=0.001) and dYmean (OR 0.26, 95% CI 0.09-0.72), p &amp;lt;0.001) best predicted the SR maintenance (AUC of 0.72). Using only spectral analysis parameters, the best predictor was DF (OR 3.07, 95%CI 1.14-8.63), p=0.012) with AUC of 0.66. By combining the results of spectral analysis and vectorcardiography, an AUC of 0.78 was achieved. Among the clinical parameters, the most significant predictors were insufficiently controlled arterial hypertension and previous history of stroke. Conclusion Digital analysis of ECG curves using deeper mathematical models provides a better predictive model than classical clinical and echocardiographic models. The combination of spectral analysis of fibrillation atrial activity and vectorocardiographic analysis of QRS complexes revealed more accurate predictive information compared to both analyses alone.

#2201 Assessment of long-term cardiovascular comorbidities in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis

Abstract Background and Aims ANCA associated vasculitis (AAV) is closely correlated to elevated cardiovascular disease (CVD) rates, positioning it a one of the leading causes of death among these patients. The impact of AAV on the risk of CVD has not been described in large prospective cohorts with a long-term follow up. The aim of our study was to evaluate the occurrence of cardiovascular events, encompassing major adverse cardiovascular events (MACE), to delineate associated risk factors, and to draw comparisons with other cohorts of patients diagnosed with CKD. Method We included 848 patients with a diagnosis of AAV who participated in 7 EUVAS RCTs (NORAM, CYCAZAREM, CYCLOPS, MEPEX, IMPROVE, RITUXVAS, and MYCYC), recruited from 74 centers in 17 European countries. The three-point MACE outcome was defined as acute myocardial infarction (AMI), stroke, or death from cardiovascular event. We used multivariate logistic regression analysis to assess the risk factors of MACE. Patients from our cohort were compared to the patients from the Chronic Renal Insufficiency Cohort (CRIC), which is a multicenter, prospective observational cohort study of participants with CKD. Results During the median follow up of 8 years (range 0-24.5, IQR: 2.9-13.6), 100 (11.8%) patients developed diabetes, 98 (13.4%) coronary heart disease (CHD), 90 (12.1%) hypertension, 70 (9.6%) deep vein thrombosis (DVT), 43 patients (5.9%) had a stroke and 28 (3.8%) an AMI. The number of MACE during FU was 144 (17%). MACE was more frequent among patients older than 65 years (n = 62 (43.1%); p-value: 0.013). CVD was the primary cause of death in 43 patients (14%). During the first 5 years after randomization, there was a significant increase in the number of cardiovascular events compared to the period 6 years- end of follow up (CHD: n = 55 vs n = 23, p ≤ 0.001; DVT: n = 55 vs n = 29; p &amp;lt; 0.001; stroke: n = 35 vs n = 24, p-value &amp;lt; 0.001). The prognostic factors for MACE in our cohort were hemodialysis dependency during RCT, age, male sex, previous history of CHD and stroke, and occurrence of diabetes during follow up. Within the subset of patients who underwent kidney biopsy, those in the crescentic class (n = 16) followed by the mixed class (n = 15) exhibited a significant higher incidence of MACE (p = 0.02). When compared to the cohort of patients with CKD from the CRIC study, the risk for CHD was higher (13.4% (95% CI: 11.16-16.11) vs 5.4% (95% CI 4.5-6.5); respectively; RR: 2.49 (95% CI 1.91-3.24); p-value&amp;lt;0.01). Additionally, there was a higher risk for stroke (5.6% (95% CI 4.2-7.4) vs 2.8% (95% CI 2.2- 3.7); RR 1.97 (95% CI: 1.33- 2.91) p-value: 0.0006). Conclusion Patients with AAV had an increased risk of stroke and CHD compared to patients with CKD from other etiologies. During the first years after diagnosis, there is an increased risk for CVD occurrence. The prognostic factors for MACE in our cohort were hemodialysis dependency, age, male sex, previous story of CHD and stroke, and diabetes during follow up. Patients with AAV should be considered at high cardiovascular risk; therefore, the therapeutic approach should include the management of traditional cardiovascular risk factors and lifestyle modification. Efforts should be made to meet strict therapeutic targets and to implement early CVD detection programs.