In-hospital Heart Failure Research Articles

Atrial Fibrillation in Acute Coronary Syndrome - early onset impact on MACE

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Atrial Fibrillation (AF) complicates approximately 10% of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on ACS patients’ (pts) prognosis. Objective To evaluate early onset (≤48h) de novo atrial fibrillation (AF) as predictor of major adverse cardiovascular events (MACE) and in-hospital complications. Methods Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 8/01/2019. Pts were divided in two groups: A – early onset de novo AF (EOAF), and B – late onset de novo AF (LOAF). Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Univariate logistic regression was performed to assess if LOAF in ACS was a predictor of MACE or complications. Results 29851 pts had ACS. EOAF occurred in 584 pts (2.0%) and LOAF in 360 pts (1.2%). EOAF were younger (73 ± 13 vs 77 ± 10, p < 0.001) and smokers (21.3% vs 12.1%, p < 0.001). LOAF had higher rates of diabetes mellitus (40.1% vs 30.2%, p < 0.001), angina (30.8% vs 21.4%, p < 0.001), previous ACS (22.5% vs 15.4%, p = 0.006), previous revascularization (percutaneous coronary intervention 14% vs 9.5%, p = 0.032; coronary artery bypass surgery 8.4% vs 3.9%, p = 0.004). ST-segment elevation myocardial infarction (MI) rates were higher in EOAF (56.8% vs 46.9%, p = 0.003) and were admitted directly to the cath lab more often (21.7% vs 13.4%, p = 0.001). Non-ST elevation MI rates were higher in LOAF (44.2% vs 37.7%, p = 0.048). LOAF times from first symptoms to admission were longer (420min vs 183%, p < 0.001), mean brain natriuretic peptide levels were higher (579 vs 447, p = 0.009) and diuretics usage was more frequent (72.8% vs 54.3%, p < 0.001). EOAF had higher rates of heart failure (32.1% vs 17.2%, p < 0.001), atrioventricular block (10.5% vs 7.8%, p = 0.006) and sustained ventricular tachycardia (8.1% vs 3.1%, p = 0.001). LOAF had higher in-hospital mortality (14.2% vs 9.6%, p = 0.031) and longer hospital stay (12 days vs 7 days, p < 0.001). Logistic regression confirmed that EOAF was predictive of in-hospital heart failure (p < 0.001, OR 2.15) and atrioventricular block (p = 0.008, OR 7.46). Regarding 1 year-follow-up, EOAF had poorer prognosis comparing to LOAF (59.3% vs 73.0%, p = 0.018, OR 1.62, CI 1.09-2.42) Conclusion EOAF is predictive of MACE, namely heart failure and atrioventricular block, and is associated to poorer prognosis comparing to LOAF.

Echocardiographic parameters associated with in-hospital adverse outcomes in patients with Takotsubo syndrome.

Takotsubo syndrome (TTS) is an acute heart failure syndrome that leads to significant morbidity and mortality. We sought to evaluate the association of cardiac mechanics on presentation with in-hospital adverse outcomes in patients with apical TTS. We retrospectively identified 468 patients with TTS based on ICD-9/10 codes between 2006 and 2017. The association of echocardiographic parameters with a composite outcome of heart failure and all-cause mortality during the index hospitalization was analyzed. One hundred and forty one patients with the apical subtype and adequate imaging were included. 113 (80.1%) were female, left ventricular ejection fraction (LVEF) was 41.7%±12.4%, and global longitudinal strain was -10.1%±3.2%. The composite outcome occurred in 58 patients (41%), with heart failure occurring in 55 patients and death occurring in nine patients. Global longitudinal strain, global circumferential strain, global radial strain, right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular free wall strain were significantly worse in patients who experienced the composite outcome in univariate analyses. However, only LVEF was independently associated with the composite outcome in multivariable-adjusted analysis. In patients with apical TTS, the strain has limited prognostic utility in the acute setting compared to LVEF, which was the only echocardiographic parameter associated with in-hospital heart failure and all-cause mortality.

Sex differences in heart failure hospitalisation risk following acute myocardial infarction

ObjectiveWe evaluated the sex differences in 6-month heart failure (HF) hospitalisation risk in acute myocardial infarction (AMI) survivors.MethodsFor this retrospective cohort analysis, adult survivors of an AMI between January and...

Registry Study of Clinical Data and in Hospital Outcome in Patients Admitted with Acute Coronary Syndrome at Tanta University Hospital in 2019

Background: A quick but thorough assessment of the patient’s history and findings on physical examination, electrocardiography, and cardiac biomarker tests permit accurate diagnosis and aid in early risk stratification. This work aimed to analyze the diagnostic and prognostic tools, the modalities of management, and the hospital outcome of patients with acute coronary syndrome (ACS) at Tanta University Hospital in one year.
 Methods: This ACS registry at Tanta university hospital is a prospective observational registry for 200 consecutive admitted patients with proven ACS from January 2019 to January 2020.
 Results: A higher percent of hypertension, family history of ischemic heart disease and SCD, previous history of chronic kidney disease (CKD), and lower percent of a previous history of IHD in STEMI compared to NSTEMI/UA. In-hospital death, in-hospital reinfarction, and reduced ejection fraction are higher in STEMI than in NSTEMI/UA patients. (P value = 0.015, 0.018 and 0.001 respectively) without significant differences regarding in-hospital congestive heart failure (CHF) and ischemic stroke. History of CKD, higher Killip class, and in-hospital stroke were independently affecting in-hospital mortality. Also, the history of higher Killip class was independently affecting in-hospital reinfarction and in-hospital CHF. Old age and occurrence of in-hospital reinfarction were independently affecting in-hospital stroke.
 Conclusion: Hypertension, diabetes, dyslipidemia, and smoking are the major risk factors for ACS so, controlling these risk factors will improve in-hospital outcomes. In STEMI, most patients underwent PPCI, which was reflected in the outcome. In NSTEMI/UA patients, both conservative and invasive management was done, taking into consideration the risk stratification of each patient, making management easier and with a good outcome.

Renal profiling based on estimated glomerular filtration rate and spot urine sodium identifies high-risk acute heart failure patients.

In acute heart failure (AHF), assessment of renal function comprises estimation of glomerular filtration rate (eGFR), which does not provide any information about renal sodium/water handling. We describe the interactions between urinary sodium concentration and eGFR to better characterize AHF patients. In 219 patients with AHF, spot urine sodium (UNa+ ) and eGFR were assessed on admission, day 1 and day 2 of hospitalization. We found no correlation between UNa+ and eGFR (calculated on each consecutive day, as an average of all three values, and as changes from baseline; all P> 0.05). The population was subsequently divided into four profiles based on eGFR (preserved vs. impaired; cutoff of 60 mL/min/1.73 m2 ) and UNa+ (sodium excreter vs. non-excreter; cutoff of 60 mmol/L). At day 1, there were 70 (31.9%) patients classified as preserved eGFR/sodium excreter, 37 (16.8%) as impaired eGFR/sodium non-excreter, 72 (32.9%) as impaired eGFR/sodium excreter, and 40 (18%) as preserved eGFR/sodium non-excreter. Both sodium non-excreter profiles were associated with an increased risk of in-hospital heart failure worsening [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.3-6.4], inotrope use (OR 2.6, 95% CI 1.1-6.7) and rehospitalization due to AHF (OR 3.2, 95% CI 1.6-6.2; all P< 0.05). The preserved eGFR/sodium non-excreter profile was associated with highest 1-year mortality (52.5%) and remained an independent prognosticator after adjustment for other prognosticators (hazard ratio 2.9, 95% CI 1.7-5.2; P< 0.0005). In AHF, values of spot UNa+ and eGFR are not interrelated. Concomitant assessment of eGFR and spot UNa+ may be useful for better clinical and therapeutic profiling of patients.

Complete versus Staged Revascularization in Patients with Non-ST Segment Elevation Acute Coronary Syndrome (NSTE-ACS) and Multivessel Disease

Aim of the work: A study to compare 6-month clinical outcome of immediate multivessel PCI versus staged PCI in patients with NSTE-ACS and multi-vessel disease. Patients and methods: Randomized study included 100 patients with NSTE-ACS who were admitted to the CCU at Benha university hospital divided into 2 groups; group I & group II. Results: The in-hospital outcome in group I was 10% and in group II was 14% , 2% of the cases with in-hospital cardiogenic shock in group I and 2% of the cases in group II, 4% of the cases with in-hospital heart failure in group I and 6% of the cases in group II, In-hospital CIN occurred in 4% of the cases in group I and in 8% of the cases in group II, and this differences did not show any statistical significance (P>0.05). The 6-months outcome was assessed in 7% of all cases divided into 8% in group I and 6% in group II while 6-months recurrence of angina was detected in 3% of all cases divided into 4% in group I and 2% of the case in group II. 6-months heart failure was found in 4% of the whole cases divided into 2 cases in each group but 6-months all-cause mortality. 6-months urgent TVR and 6-months non-fatal MI were not found in any cases in this study. All of those outcomes did not show any statistical significance (P>0.05). Conclusion: Immediate complete revascularization resulted in similar rates of in-hospital and 6-month outcomes compared to staged revascularization.

Prognostic implications of ST-segment elevation in lead aVR in patients with acute coronary syndrome: A meta-analysis.

BackgroundST‐segment elevation (STE) in lead aVR is a useful tool in recognizing patients with left main or left anterior descending coronary obstruction during acute coronary syndrome (ACS). The prognostic implication of STE in lead aVR on outcomes has not been established.MethodsWe performed a systematic search for clinical studies about STE in lead aVR in four databases including PubMed, EMBASE, Cochrane Library, and Web of Science. Primary outcome was in‐hospital mortality. Secondary outcomes included in‐hospital (re)infarction, in‐hospital heart failure, and 90‐day mortality.ResultsWe included 7 studies with a total of 7,700 patients. The all‐cause in‐hospital mortality of patients with STE in lead aVR during ACS was significantly higher than that of patients without STE (OR: 4.37, 95% CI 1.63 to 11.68, p = .003). Patients with greater STE (>0.1 mV) in lead aVR had a higher in‐hospital mortality when compared to lower STE (0.05–0.1 mV) (OR: 2.00, 95% CI 1.11–3.60, p = .02), However, STE in aVR was not independently associated with in‐hospital mortality in ACS patients (OR: 2.72, 95% CI 0.85–8.63, p = .09). The incidence of in‐hospital myocardial (re)infarction (OR: 2.77, 95% CI 1.30–5.94, p = .009), in‐hospital heart failure (OR: 2.62, 95% CI 1.06–6.50, p = .04), and 90‐day mortality (OR: 10.19, 95% CI 5.27–19.71, p < .00001) was also noted to be higher in patients STE in lead aVR.ConclusionsThis contemporary meta‐analysis shows STE in lead aVR is a poor prognostic marker in patients with ACS with higher in‐hospital mortality, reinfarction, heart failure and 90‐day mortality. Greater magnitude of STE portends worse prognosis. Further studies are needed to establish an independent predictive role of STE in aVR for these adverse outcomes.

Distractions When Viewing In-hospital Heart Failure Self-Care Videos and Change in Heart Failure Self-Care Knowledge

Introduction When viewing in-hospital HF education videos, internal (pain, nausea, fatigue, dyspnea) and external (alarms, ringing phone, caregiver or family interruptions, hallway noise) distractions could interfere with attentiveness and decrease patients’ understanding of educational content. Purpose To examine if optimization of learning is dependent on attentiveness, defined as the frequency of internal and external distractions when viewing video education. Methods This exploratory, prospective, single cohort study was conducted on 3 medical-surgical units comprising 42 beds at a small community hospital. Learning optimization was assessed by comparing pre- and post-video assessment scores of HF knowledge of self-care behaviors using a valid, reliable tool that was not based on content in the videos. Nurses recorded distractions during video viewing. Post-viewing, the HF knowledge assessment was repeated. Patient characteristics were retrieved from a hospital database. Demographics and change in knowledge scores were compared overall and by distraction groups using comparative statistics. Findings Among 60 participants, mean age was 73.9 ± 11.2 years and 50% were female. There was no difference in distractions (overall, internal or external) by patient characteristics. Pre and post video education, HF standardized knowledge scores were 72.5 ± 10.7 and 77.7 ± 10.5 respectively, p Conclusion In-hospital video education was associated with higher HF knowledge scores despite internal (primarily fatigue) or external (primarily nursing caregiver interruption) distractions and may promote self-care behaviors post-discharge.

Late outcomes of endovascular aortic stent graft therapy in patients with chronic kidney disease.

Endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) are effective and minimally invasive treatment options for high-risk surgical candidates. Nevertheless, knowledge about the management of aortic stent graft therapy in chronic kidney disease (CKD) is scarce. This study aimed to examine outcomes after EVAR and TEVAR in patients with CKD.Utilizing data from the Taiwan National Health Insurance Research Database, we retrospectively assessed patients who underwent EVAR and TEVAR therapy between January 1, 2006, and December 31, 2013. Patients were divided into CKD and non-CKD groups. Outcomes were in-hospital mortality, all-cause mortality, readmission, heart failure, and major adverse cardiac and cerebrovascular events.There were 1019 patients in either group after matching. The CKD group had a higher in-hospital mortality rate than the non-CKD group (15.2% vs 8.3%, respectively; odds ratio, 1.92; 95% confidence interval [CI], 1.46-2.54). Patients with CKD had higher risks of all-cause mortality including in-hospital death (46.1% vs 33.1%; hazard ratio [HR], 1.61; 95% CI, 1.35-1.92), readmission rate (62.6% vs 55.0%; subdistribution HR [SHR], 1.61; 95% CI, 1.32-1.69), redo stent (7.8% vs 6.2%; SHR, 1.50; 95% CI, 1.09-2.07), and major adverse cardiac and cerebrovascular events (13.3% vs 8.8%; SHR, 1.50; 95% CI, 1.15-1.95). The subgroup analysis did not demonstrate a variation in mortality between the TEVAR and EVAR cohorts (P for interaction = .725). The dialysis group had higher risks of all-cause mortality and readmission than the CKD without dialysis and non-CKD groups.Among EVAR/TEVAR recipients, CKD was independently associated with higher in-hospital mortality, postoperative complication, and all-cause mortality rates. Patients with end-stage renal disease on dialysis had worse outcomes than those in the CKD non-dialysis and non-CKD groups.

Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes.

AimsPatients with acute heart failure (AHF) are included into clinical trials regardless of differences in baseline clinical characteristics. The aim of this study was to assess patients with AHF according to the presence of central and/or peripheral congestion at hospital admission and evaluate treatment response and outcomes in studied phenotypes.Methods and resultsWe investigated retrospectively 352 patients (mean age: 68 ± 13 years, 77% men) hospitalized due to AHF with the signs of congestion on admission. Patients were divided according to the type of signs of congestion into three groups: A, isolated pulmonary congestion (n = 52, 15%); B, isolated peripheral congestion (n = 31, 9%); and C, signs of mixed (peripheral and central) congestion (n = 269, 76%). Patients from Group A had lower concentration of urea, bilirubin, and gamma‐glutamyl transferase whereas higher level of haematocrit, albumin, and leukocytes on admission. The highest baseline N‐terminal pro‐B‐type natriuretic peptide level (median: 4113 vs. 3634 vs. 6093 pg/mL) and percentage of patients with chronic heart failure (56 vs. 58 vs. 74%; A vs. B. vs. C, respectively, all P < 0.01) were observed in Group C. There were no differences in terms of demographics, co‐morbidities, left ventricular ejection fraction, and applied treatment between studied groups. Patients from Group A had the highest systolic blood pressure on admission (145 ± 37 vs. 122 ± 20 vs. 130 ± 29 mmHg) and the biggest decrease in systolic blood pressure [−22 (−45 to −4) vs. −2 (−13 to 2) vs. −10 (−25 to 0) mmHg] and heart rate [−16 (−35 to −1.5) vs. −1 (−10 to 5) vs. −7 (−20 to 0) b.p.m.] with the lowest weight change [−1.0 (−1.0 to 0) vs. −2.9 (−3.8 to −0.9) vs. −2.0 (−3.0 to −1.0) kg; all P < 0.01] after 48 h of hospitalization. There were differences in short‐term and long‐term outcomes with favourable results in Group A. Group A experienced less frequent in‐hospital heart failure worsening during the first 48 h (4 vs. 23 vs. 7%), had shorter length of hospital stay [6 (5–8) vs. 7 (5–11) vs. 7 (6–11) days], and had lower 1 year all‐cause mortality (12 vs. 28 vs. 29%; all P < 0.05). Presence of peripheral congestion on admission was independent predictor for all‐cause mortality within 1 year [hazard ratio (95% confidence interval): 2.68 (1.06–6.79); P = 0.04].ConclusionsPatterns of congestion in AHF are associated with differences in clinical characteristics, treatment response, and outcomes. It needs to be considered once planning clinical trials in AHF.

Management and Outcomes of Patients With STEMI During the COVID-19 Pandemic in China

BackgroundST-segment elevation myocardial infarction (STEMI) is a fatal cardiovascular emergency requiring rapid reperfusion treatment. During the coronavirus disease-2019 (COVID-19) pandemic, medical professionals need to strike a balance between providing timely treatment for STEMI patients and implementing infection control procedures to prevent nosocomial spread of COVID-19 among health care workers and other vulnerable cardiovascular patients. ObjectivesThis study evaluates the impact of the COVID-19 outbreak and China Chest Pain Center’s modified STEMI protocol on the treatment and prognosis of STEMI patients in China. MethodsBased on the data of 28,189 STEMI patients admitted to 1,372 Chest Pain Centers in China between December 27, 2019 and February 20, 2020, the study analyzed how the COVID-19 outbreak and China Chest Pain Center’s modified STEMI protocol influenced the number of admitted STEMI cases, reperfusion strategy, key treatment time points, and in-hospital mortality and heart failure for STEMI patients. ResultsThe COVID-19 outbreak reduced the number of STEMI cases reported to China Chest Pain Centers. Consistent with China Chest Pain Center’s modified STEMI protocol, the percentage of patients undergoing primary percutaneous coronary intervention declined while the percentage of patients undergoing thrombolysis increased. With an average delay of approximately 20 min for reperfusion therapy, the rate of in-hospital mortality and in-hospital heart failure increased during the outbreak, but the rate of in-hospital hemorrhage remained stable. ConclusionsThere were reductions in STEMI patients’ access to care, delays in treatment timelines, changes in reperfusion strategies, and an increase of in-hospital mortality and heart failure during the COVID-19 pandemic in China.

D-dimer and the incidence of heart failure and mortality after acute myocardial infarction

ObjectiveD-dimer might serve as a marker of thrombogenesis and a hypercoagulable state following plaque rupture. Few studies explore the association between baseline D-dimer levels and the incidence of heart failure...

Sex Differences in Acute Coronary Syndrome: Insights From an Observation Study in Low socio-economic Cohort From India

Aim: To study sex-related differences in acute coronary syndrome (ACS) presentation, management and in-hospital outcomes. Materials & methods: We studied 621 ACS patients (150 women, 471 men) of low socio-economic status from South India from February 2015 to January 2016. Multivariable logistic regression methods were used to assess sex differences in the in-hospital outcomes. Adjudicated major adverse cardiovascular events (MACE) included in-hospital cardiac arrest, cardiogenic shock, heart failure, re-infarction, stroke, major bleeding and mortality. Results & conclusion: Mean age in women was 60.97±11.23 years versus 54.5±10.87 years in men (p<0.001). Women had higher prevalence of hypertension and diabetes and presented with more non-ST elevation ACS. There were no differences in the use of antiplatelets, statins and other pharmacotherapy except for the higher use of nitrates in women. There were no differences in MACE rates between women and men (15.3 vs 9.6%; adjusted odds ratio: 1.43; CI: 0.76-2.69).

Impact of beta blockers on patients undergoing transcatheter aortic valve replacement: the OCEAN-TAVI registry

ObjectiveThere is paucity of data on optimal medical treatment, including use of beta blockers for patients undergoing transcatheter aortic valve replacement (TAVR). The study aimed to investigate the association of...

Predictors of ST Depression Resolution in STEMI Patients Undergoing Primary PCI and Its Clinical Significance.

PurposeST depression resolution (STD-R) in ECG is a prognostic factor indicative of successful fibrinolysis or angioplasty in the treatment of ST elevation myocardial infarction (STEMI) and subsequent mortality. We conducted this study to determine the clinical significance of STD-R and its predictors in patients with anterior STEMI undergoing primary percutaneous intervention (PPCI).MethodsAdmission documents of all patients with diagnosis of anterior STEMI who were admitted to a specialty heart center and underwent PPCI since July 2018 until July 2019 were examined. The amount of ST elevation and depression in all 12 leads of a standard ECG at admission and 90 minutes after PPCI was measured and resolution was determined. All patients were followed-up for 10.8±4.0 months.ResultsA total of 179 patients had ST depression besides elevation in the first ECG. Female gender, diabetes, not smoking, lower hemoglobin, and higher platelet counts were significantly more common in the group with less than 50% resolution of ST depression. STD-R <50% was significantly associated with the incidence of in-hospital acute heart failure and major adverse cardiac events (MACE) (p value: 0.025 and 0.012, respectively) and resolution of ST elevation ≥50% was associated with reduced in-hospital mortality (p value <0.0001). According to Kaplan–Meier curve, survival in the two groups of STE-R ≥50% and STE-R <50% was significantly different (Log rank: 31.18, p value<0.0001).ConclusionSTD-R can be considered to have high predictive power, like STE-R for predicting incidence of in-hospital acute heart failure and major adverse cardiac events.

Sex-related differences in patients with ST-segment elevation myocardial infarction

To determine the epidemiological characteristics, location of the infarction, type and times of reperfusion, as well as in-hospital adverse events, distributed by sex in patients with ST-segment elevation myocardial infarction (STEMI) in Peru. It is a sub-analysis of the PEruvian Registry of ST-segment Elevation Myocardial Infarction (PERSTEMI), which was an observational, prospective and multicenter study about patients over 18 years-old, who were hospitalized for ST-segment elevation myocardial infarction. Epidemiological and clinical characteristics, management and in-hospital adverse events were compared according to sex. 396 patients were studied, 20.9% were female, with a predominance of octogenarian population over men. High blood pressure was the most frequent risk factor in women (74.7 Vs. 50%, p = 0.001); as well as atypical clinical manifestations such as dyspnea (40.9 Vs. 27.1%, p = 0.012) and syncope (10.8 vs. 3.8%, p = 0.017). On the other hand, the inferior wall myocardial infarction was more frequent in women (51.8 vs. 38.98%). There were no significant differences regarding the reperfusion therapy used (Fibrinolysis, primary PCI, PCI in general); as well as in times of ischemia (6 vs. 5.6 hours, p = 0.456), reperfusion times and hospital stay between both sexes. However, the female sex presented higher in-hospital mortality (21.6 vs. 7%, p = 0.001), mechanical complications (8.4 vs. 1.9%, p = 0.008), cardiogenic shock (15.6 vs. 9.5%, p= 0.087) and heart failure (33.7 vs. 24.9%, p = 0.072). STEMI in females presents at significantly older age compared to males and is associated with higher in-hospital mortality and mechanical complications.

Radial or femoral access in primary percutaneous coronary intervention (PCI): Does the choice matters?

BackgroundThis study was conducted with the aim of providing a quantitative appraisal of clinical outcomes of trans-radial access for primary percutaneous coronary interventions (PCI) in patients with ST-segment evaluation myocardial infarction (STEMI). MethodsIn this study, we compared two propensity-matched cohorts of patients who underwent primary PCI via trans-radial (TRA) and trans-femoral access (TFA) in a 1:1 ratio. The profile of two cohorts was matched for gender, age, and body mass index, diabetes, hypertension, family history, and smoking. The outcomes of primary PCI were compared for the two cohorts which included all-cause in-hospital mortality, heart failure, re-infarction, cardiogenic shock, bleeding, transfusion, cerebrovascular accident, and dialysis. ResultsThis analysis was performed on a total of 2316 patients with 1158 patients each in the TRA and TFA group. We observed significantly lower rates of mortality, 0.8% (9) vs. 3.5% (41); p < 0.001 and bleeding, 0.5% (6) vs.1.6% (19); p = 0.009 with shorter hospital stay, 1.61 ± 1.39 vs. 1.98 ± 1.5 days, in trans-radial vs. trans-femoral. However, both fluoroscopic time and contrast volume were significantly higher in the TRA as compared to TFA group 15.57 ± 8.16 vs. 12.79 ± 7.82 min; p < 0.001 and 143.22 ± 45.33 vs. 133.78 ± 45.97; p < 0.001 respectively. ConclusionsCompared with TFA access, TRA for primary PCI is safe for patients with STEMI, it was found to be associated with a significant reduction in in-hospital mortality and bleeding complications.

Predictive values of D-dimer for the long-term prognosis of acute ST-segment elevation infarction: A retrospective study in southwestern China.

D-dimer is a primary degradation product of cross-linked fibrin, and can be an effective diagnostic factor of venous thromboembolism. However, its prognostic role in patients with acute ST-segment elevation myocardial infarction (STEMI) remains controversial. This study aimed to investigate whether D-dimer has a predictive value for long-term prognosis in patients with STEMI.We retrospectively enrolled 872 STEMI patients treated with primary percutaneous coronary intervention. Patients were divided into quartiles according to their admission D-dimer increased multiple, with the highest quartile (G4) (n = 219) defined as increased multiple ≧1.33, and the lowest quartile (G1) (n = 215) as increased multiple ≦0.33.Compared with G1, higher in-hospital heart failure (40.2% vs 10.2%, P < .0001), malignant arrhythmia (14.2% vs 2.3%, P < .0001), and all-cause mortality (5.9% vs 0%, P < .0001) rates were observed in G4. After a follow-up period of 29 months, 84 patients had died. In the Cox multivariate analysis, a high admission D-dimer increased multiple (≧1.33) was found to be an independent predictor of all-cause mortality (hazards ratio: 2.53, 95% confidence interval: 1.02–6.26, P = .045).Thus, there was an association between a high D-dimer level and the increase in in-hospital major adverse cardiovascular events, such as heart failure, malignant arrhythmias, and death. High D-dimer level was also an independent predictor of long-term all-cause mortality.

The value of heat shock protein (HSP) 60 on in-hospital and short-term prognosis in patients with acute ST segment elevation myocardial infarction

Aim: HSP60 has previously been shown to be an independent risk factor for congestive heart failure. Recently, increased HSP60 values have been shown to be associated with increased mortality in patients hospitalized with acute heart failure. The purpose of our study was to determine whether HSP 60 is an independent predictor of in-hospital or short-term mortality in patients with acute ST segment elevation myocardial infarction (STEMI) and to assess whether it may be used as an early predictor of in-hospital heart failure or cardiogenic shock development in the same population. Methods: A total of 221 patients over 18 years of age presenting within 12 hours after the onset of symptoms with STEMI between 2011 and 2013 were enrolled to our study. Our study was designed as a prospective cohort. Several clinical conditions, such as clinical heart failure, development of cardiogenic shock and death during hospitalization were recorded together with the data pertaining to the length of hospital stay, MI localization, revascularization strategy and risk factors associated with coronary heart disease. Patients were called 1 month after discharge to find out if anyone had died. Results: HSP 60 values were significantly higher in patients who died during hospitalization (P=0.004) or within 1 month after discharge (P=0.020). These results were independent from other factors associated with mortality following STEMI. Significant association was found between HSP60 value and in-hospital development of cardiogenic shock (P=0.03) or heart failure (P=0.03). Conclusion: HSP60 was found to be independently associated with increased mortality in patients admitted for STEMI and therefore may be used as a promising predictor of mortality.

Impact of concurrent right ventricular myocardial infarction on outcomes among patients with left ventricular myocardial infarction

To compare in-hospital outcomes between left ventricular myocardial infarction (LVMI) patients with and without right ventricular myocardial infarction (RVMI). Patients with acute ST-segment elevation MI (STEMI) undergoing primary percutaneous coronary intervention (PCI) were enrolled and divided into LVMI with and without RVMI groups. Between-group differences and in-hospital outcomes were compared. Compared to patients without RVMI, patients with RVMI were more likely to be male, have higher body mass index, serum levels of C-reactive protein (8.9 ± 2.4 vs 6.2 ± 2.1 mg/dL), B-type natriuretic peptide (1295 ± 340 vs 872 ± 166 pg/mL) and cardiac troponin-I (8.6 ± 2.9 vs 5.2 ± 2.1 ng/mL), and have diabetes (36.3% vs 3.4%) and dyslipidemia (53.4% vs 48.1%). Patients with RVMI had lower left and right ventricular ejection fraction (50.5 ± 5.6% vs 53.4 ± 3.8% and 33.6 ± 2.9% vs 45.7 ± 2.0%), but had higher mean pulmonary artery pressure (30.6 ± 3.3 vs 23.8 ± 3.1 mm Hg). Compared to patients without RVMI, patients with RVMI had higher odds of in-hospital all-cause mortality (4.1% vs 1.0%) and new onset acute heart failure (3.4% vs 1.0%). After adjusted for confounding factors, LVMI with RVMI remained independently associated with composite outcomes, with odds ratio 1.66 (95% confidence interval 1.39–2.04). Compared to isolated LVMI patients, those with concomitant RVMI have higher odds of in-hospital complications, particularly all-cause mortality and new onset acute heart failure.