In-hospital Morbidity Research Articles

In-Hospital and Medium-Term Morbidity and Mortality Outcomes of 12,526 Patients Who Underwent Surgical Versus Transcatheter Aortic Valve Replacement: An Australian-Statewide Population-Linkage Cohort Study

In-Hospital and Medium-Term Morbidity and Mortality Outcomes of 12,526 Patients Who Underwent Surgical Versus Transcatheter Aortic Valve Replacement: An Australian-Statewide Population-Linkage Cohort Study

Long-Term Outcomes of Bovine versus Porcine Mitral Valve Replacement: A Multicenter Analysis.

Recent national guidelines recommending mitral valve replacement (MVR) for severe secondary mitral regurgitation have resulted in an increased utilization of mitral bioprosthesis. There is a paucity of data on how longitudinal clinical outcomes vary by prosthesis type. We examined long-term survival and risk of reoperation between patients having bovine vs. porcine MVR. Study Design. A retrospective analysis of MVR or MVR + coronary artery bypass graft (CABG) from 2001 to 2017 among seven hospitals reporting to a prospectively maintained clinical registry was conducted. The analytic cohort included 1,284 patients undergoing MVR (801 bovine and 483 porcine). Baseline comorbidities were balanced using 1 : 1 propensity score matching with 432 patients in each group. The primary end point was all-cause mortality. Secondary end points included in-hospital morbidity, 30-day mortality, length of stay, and risk of reoperation. In the overall cohort, patients receiving porcine valves were more likely to have diabetes (19% bovine vs. 29% porcine; p < 0.001), COPD (20% bovine vs. 27% porcine; p=0.008), dialysis or creatinine >2 mg/dL (4% bovine vs. 7% porcine; p=0.03), and coronary artery disease (65% bovine vs. 77% porcine; p < 0.001). There was no difference in stroke, acute kidney injury, mediastinitis, pneumonia, length of stay, in-hospital morbidity, or 30-day mortality. In the overall cohort, there was a difference in long-term survival (porcine HR 1.17 (95% CI: 1.00-1.37; p=050)). However, there was no difference in reoperation (porcine HR 0.56 (95% CI: 0.23-1.32; p=0.185)). In the propensity-matched cohort, patients were matched on all baseline characteristics. There was no difference in postoperative complications or in-hospital morbidity and 30-day mortality. After 1 : 1 propensity score matching, there was no difference in long-term survival (porcine HR 0.97 (95% CI: 0.81-1.17; p=0.756)) or risk of reoperation (porcine HR 0.54 (95% CI: 0.20-1.47; p=0.225)). In this multicenter analysis of patients undergoing bioprosthetic MVR, there was no difference in perioperative complications and risk of reoperation of long-term survival after matching.

Postoperative acute kidney injury after thoracic endovascular aortic repair for acute type B aortic dissection

BackgroundThoracic endovascular aortic repair (TEVAR) has evolved as the standard for treating complicated acute type B aortic dissection (ATBAD). Acute kidney injury (AKI) is a common complication in critically ill patients and is commonly observed in patients with ATBAD. The purpose of the study was to characterize AKI after TEVAR. MethodsAll patients who underwent TEVAR for ATBAD from 2011 through 2021 were identified using the International Registry of Acute Aortic Dissection. The primary end point was AKI. A generalized linear model analysis was performed to identify a factor associated with postoperative AKI. ResultsA total of 630 patients presented with ATBAD and underwent TEVAR. The indication for TEVAR was complicated ATBAD in 64.3%, high-risk uncomplicated ATBAD in 27.6%, and uncomplicated ATBAD in 8.1%. Of 630 patients, 102 (16.2%) developed postoperative AKI (AKI group) and 528 patients (83.8%) did not (non-AKI group). The most common indication for TEVAR was malperfusion (37.5%). In-hospital mortality was significantly higher in the AKI group (18.6% vs 4%; P < .001). Postoperatively, cerebrovascular accident, spinal cord ischemia, limb ischemia, and prolonged ventilation were more commonly observed in the AKI group. The expected mortality was similar at 2 years between the two groups (P = .51). Overall, the preoperative AKI was observed in 95 (15.7%) in the entire cohort consisting of 60 (64.5%) in the AKI group and 35 (6.8%) in the non-AKI group. A history of CKD (odds ratio, 4.6; 95% confidence interval, 1.5-14.1; P = .01) and preoperative AKI (odds ratio, 24.1; 95% confidence interval, 10.6-55.0; P < .001) were independently associated with postoperative AKI. ConclusionsThe incidence of postoperative AKI was 16.2% in patients undergoing TEVAR for ATBAD. Patients with postoperative AKI had a higher rate of in-hospital morbidities and mortality than those without. A history of CKD and preoperative AKI were independently associated with postoperative AKI.

Primary anastomosis with diverting loop ileostomy versus Hartmann's procedure for acute complicated diverticulitis: analysis of the National Inpatient Sample 2015-2019.

Up to 50% of patients with acute complicated diverticulitis require operative management on their index admission. There is ongoing debate as to whether primary anastomosis with diverting ileostomy versus a Hartmann's procedure is the optimal surgical approach for these patients. This study aims to compare postoperative complications in patients undergoing either Hartmann's procedure or primary anastomosis and diverting ileostomy for perforated diverticulitis using recent National Inpatient Sample data. Patients who underwent either primary anastomosis with diverting ileostomy or Hartmann's procedure for acute complicated diverticulitis from the 2015 to 2019 NIS database sample were included. Primary outcomes were postoperative in-hospital mortality and morbidity. Secondary outcomes were postoperative cause-specific complications, total admission cost, and length of stay (LOS). Univariate and multivariate regression were utilized to compare the two operative approaches. Overall, 642 patients underwent primary anastomosis with diverting ileostomy and 4,482 patients underwent Hartmann's procedure. There was no difference in in-hospital mortality (OR 0.93, 95%CI 0.45-1.92, p = 0.84) or in-hospital morbidity (OR 1.10, 95%CI 0.90-1.35, p = 0.33). Adjusted analysis suggested shorter postoperative LOS for patients undergoing Hartmann's procedure (MD 0.79days, 95%CI 0.15-1.43days, p = 0.013) and decreased total admission cost (MD $4,893.99, 95%CI $1,425.04-$8,362.94, p = 0.006). The present study supports that primary anastomosis with diverting ileostomy is safe for properly selected patients presenting with complicated diverticulitis. Primary anastomosis with diverting ileostomy is associated with greater total hospitalization costs and LOS.

Obesity paradox: a myth or reality, time to reveal the fact in a South Asian cohort presenting with STE-ACS undergoing primary percutaneous coronary intervention

ObjectivesObesity is a globally well-established risk factor for atherosclerotic cardiovascular diseases; however, some studies have witnessed survival benefits among obese patients and this phenomenon is termed ‘the obesity paradox’. Our...

In-Hospital and One-Year Outcomes of Transcatheter Aortic Valve Replacement in Patients Requiring Supplemental Home Oxygen Use.

There have been limited reports with inconsistent results on the impact of long-term use of oxygen therapry (LTOT) in patients treated with transcatheter aortic valve replacement (TAVR). We compared in-hospital and intermediate TAVR outcomes in 150 patients requiring LTOT (home O2 cohort) with 2,313 non-home O2 patients. Home O2 patients were younger, and had more comorbidities including chronic obstructive pulmonary disease (COPD), diabetes, carotid artery disease, lower forced expiratory volume (FEV1) (50.3±21.1% vs. 75.0±24.7%, P < 0.001), and lower diffusion capacity (DLCO, 48.6±19.2% vs. 74.6±22.4%, P < 0.001). These differences represented higher baseline Society of Thoracic Surgeons (STS) risk score (15.5±10.2% vs. 9.3±7.0%, P < 0.001) and lower pre-procedure Kansas City Cardiomyopathy Questionnaire (KCCQ-12) scores (32.5 ± 22.2 vs. 49.1 ± 25.4, P < 0.001). The home O2 cohort required higher use of alternative TAVR vascular access (24.0% vs. 12.8%, P = 0.002) and general anesthesia (51.3% vs. 36.0%, P < 0.001). Compared to non-home O2 patients, home O2 patients showed increased in-hospital mortality (5.3% vs. 1.6%, P = 0.001), procedural cardiac arrest (4.7% vs. 1.0%, P < 0.001), and postoperative atrial fibrillation (4.0% vs. 1.5%, P = 0.013). At 1-year follow-up, the home O2 cohort had a higher all-cause mortality (17.3% vs. 7.5%, P < 0.001) and lower KCCQ-12 scores (69.5 ± 23.8 vs. 82.1 ± 19.4, P < 0.001). Kaplan-Meir analysis revealed a lower survival rate in the home O2 cohort with an overall mean (95% confidence interval (CI)) survival time of 6.2 (5.9 - 6.5) years (P < 0.001). Home O2 patients represent a high-risk TAVR cohort with increased in-hospital morbidity and mortality, less improvement in 1-year KCCQ-12, and increased mortality at intermediate follow-up.

Quick Sequential Organ Failure Assessment Score in Recognizing Infected Patients with Organ Dysfunction &amp; Prediction of Mortality: Cohort Study

Objectives: To calculate the q-SOFA for postpartum patients admitted with infection and to correlate this with critical care unit admission &amp; patient outcome. Methods: An observational, prospective cohort hospital-based study. It was conducted in Omdurman Maternity Hospital from October 2018-to March 2019. The study included 59 postpartum patients who were diagnosed with postpartum infection; their q-SOFA score was calculated on admission and then on daily basis, to detect their in-hospital mortality and morbidity. The data was analyzed using SPSS, using Pearson Chi-square which was significant at P value of 0.05. Results: Fifty-nine participants were involved, mean age was 28years.Those who delivered by cesarean section was 54.3%, 33(55.9%) developed surgical site infection. Five patients (8.5%) died and 54 (91.5%) discharged. 17(28.8%) were admitted to critical care unit. q-SOFA score was calculated &amp; correlated to critical care unit admission &amp; fate of the patient using Pearson Chi-square which was found to be significant 0.01 and 0.001, respectively (P value of 0.05). Conclusion: q-SOFA is a useful tool in detecting infected patients at risk of poor outcome and death. If the score≥2 patients need to be, admitted to critical care units and to have further assessment.

Risk of in-hospital Deterioration for Children with Single Ventricle Physiology.

Children with single ventricle physiology (SV) are at high risk of in-hospital morbidity and mortality. Identifying children at risk for deterioration may allow for earlier escalation of care and subsequently decreased mortality.We conducted a retrospective chart review of all admissions to the pediatric cardiology non-ICU service from 2014 to 2018 for children < 18 years old. We defined clinical deterioration as unplanned transfer to the ICU or inpatient mortality. We selected children with SV by diagnosis codes and defined infants as children < 1 year old. We compared demographic, vital sign, and lab values between infants with and without a deterioration event. We evaluated vital sign and medical therapy changes before deterioration events.Among infants with SV (129 deterioration events over 225 admissions, overall 25% with hypoplastic left heart syndrome), those who deteriorated were younger (p = 0.001), had lower baseline oxygen saturation (p = 0.022), and higher baseline respiratory rate (p = 0.022), heart rate (p = 0.023), and hematocrit (p = 0.008). Median Duke Pediatric Early Warning Score increased prior to deterioration (p < 0.001). Deterioration was associated with administration of additional oxygen support (p = 0.012), a fluid bolus (p < 0.001), antibiotics (p < 0.001), vasopressor support (p = 0.009), and red blood cell transfusion (p < 0.001).Infants with SV are at high risk for deterioration. Integrating baseline and dynamic patient data from the electronic health record to identify the highest risk patients may allow for earlier detection and intervention to prevent clinical deterioration.

In-Hospital Clinical Features, Morbidity, and Mortality of Patients with Neurofibromatosis 1 in France: A Nationwide, Population-Based Retrospective Cohort Study

Neurofibromatosis 1 (NF1) is a multisystem disease that can affect nearly every organ system. The aim of our study was to describe the in-hospital population with NF1 in France. We conducted a nationwide retrospective cohort study using the French hospital administrative database. A total of 11,425 patients with NF1 (53.4% female, 19,080 person years) were identified from January 2013 to December 2019. A total of 23% had at least one diagnosis of a comorbidity or NF1-associated complication or disease, and it was highest in the age group of 10-15 years. A total of 2,601 (22.8%) had a diagnosis of cancer. There were 366 (3.2%) in-hospital deaths, and we observed a standardized mortality ratio of 4.14 (95% confidence interval= 3.71-4.56), with a higher standardized mortality ratio in women and in the age group of 10-15 years. The standardized incident ratio (SIR) of cancer was 10.3 (95% confidence interval= 9.6-11.1). We observed high SIR values for cancer in childhood, with a decrease toward that of the general population by age 70 years. We observed high SIRs for NF1-associated cancers: CNS SIR of 195.4 (95% confidence interval= 172.2-220.9) and small intestine SIR of 102.9 (95% confidence interval= 71.7-143.2). The study provides a better understanding of the prognosis in people living with NF1.

Precocious Rupture of Abdominal Aortic Aneurysms Below Size Criteria for Repair: Risk Factors and Outcomes

Practice guidelines recommend elective repair for abdominal aortic aneurysms (AAA) ≥5.5cm in men and ≥5cm in women to prevent rupture; however, some rupture at smaller diameters. We identify risk factors for rupture (rAAA) below this threshold and compare outcomes following rAAA repair above/below size criteria. The Vascular Quality Initiative (2013-2019) was queried for patients undergoing repair for rAAA and stratified based on diameter into Small and Large cohorts [Small: <5.5cm (men), <5.0cm (women)]. Univariate analysis was performed, and Kaplan-Meier analysis compared overall survival, aneurysm-related mortality, and reintervention at 12-months. 5,162 rAAA were identified. Small rAAA patients [n = 588] were more likely to have hypertension (81.3% vs. 77.0%, p<0.02), diabetes (18.2% vs. 14.9%, p<0.04), and ESRD (2.9% vs. 0.9%, p<0.01), and be on optimal medical therapy (32.1% vs. 26.8%, p<0.01). Women were more likely to rupture at smaller diameters compared to men (p<0.01). Small rAAA patients were more likely to undergo EVAR (70.2% vs. 56.0%, p<0.01), and had lower in-hospital mortality (17.7% vs. 27.7%, p<0.01), and fewer perioperative complications across all categories. At 12-months, small rAAA patients had better overall survival, freedom from aneurysm-related mortality, and freedom from reintervention, largely driven by EVAR approach. More than 11% of patients presenting with ruptured AAA were below the recommended size threshold for repair, and they tended to be younger, non-white, and have hypertension, diabetes and/or renal failure. Patients with small rAAA experienced lower in-hospital morbidity and mortality and improved 1-year survival, and EVAR was associated with better outcomes than open repair. However, women more frequently rupture at smaller diameters compared to men. Given contemporary elective outcomes for women, a randomized controlled trial for EVAR vs. surveillance at a sex-specific size threshold is needed.

Can previous therapy with statin be considered a protective factor in acute coronary syndrome?

Abstract Funding Acknowledgements Type of funding sources: None. Background Statin therapy is nowadays a cornerstone in primary and secondary prevention of cardiovascular events. Purpose This retrospective observational study intends to characterise the influence of previous therapy with statins on clinical and electrocardiographic presentation of acute coronary syndrome (ACS) and on in-hospital morbidity and mortality. Methods We evaluated a population of 746 patients admitted in a Cardiac Care Intensive Unit diagnosed with ACS (D). We then considered two groups: patients with previous therapy with statins (D1) and patients without it (D2). We documented demographic factors, personal history, clinical and electrocardiographic presentation of ACS, coronary angiography and angioplasty. The following in-hospital complications were defined: heart failure (HF), cardiogenic shock, reinfarction, stroke, major bleeding and need for blood transfusion. In-hospital mortality was compared between both groups. Results D1 consisted of 37.5% of the population (N=280). These patients had a higher prevalence of hypertension (90.7% vs 65.4%, p &amp;lt;0.001), diabetes (45.0% vs 27.8%, p &amp;lt;0.001), dyslipidaemia (81.8% vs. 36.6%, p = 0.001), chronic renal failure (18.6% vs 7.6%, p = 0.001), stroke (10.7% vs. 4.5%, p = 0.003), previous myocardial infraction (MI) (45,0% vs 12,6%, p = 0.001) and previous coronary artery bypass graft (13.2% vs. 2.0%, p = 0.001). They also had more frequently smoking habits (37.4% vs 13.9%, p = 0.001). They were less frequently admitted with ST-elevation MI (24.6% vs 49.2%, p = 0.001) and more frequently with non-ST elevation MI (56.1% vs 40, 9%, p = 0.001) and unstable angina (10.7% vs 5.6%, p = 0.02). The rate of coronary angiography was similar, however patients receiving previous statin therapy underwent less angioplasty. During hospitalization, there were no differences in any of the complications considered, nor in in-hospital mortality between the 2 groups. Conclusions In patients with ACS, previous therapy with statins seems to influence the presentation of ACS but it does not affect in-hospital morbidity and mortality. An important percentage of patients with diabetes and of those with previous MI or stroke were not on statins therapy as recommended in the European guidelines.

Predictors and Hospital Outcomes in Pregnant Patients Undergoing Extracorporeal Membrane Oxygenation: A Nationwide Study

(Anesth Analg. 2022;135:1172–1179) Extracorporeal membrane oxygenation (ECMO) use, advanced cardiorespiratory support for patients with decreased cardiac or respiratory function, has been on the rise. ECMO for pregnant women has also become more common, however, studies on ECMO often lack inclusion of parturients. Given a lack of information regarding appropriate timing and indications for ECMO for pregnant women, this study seeks to identify in-hospital mortality and morbidity rates for parturients who underwent ECMO.

Impact of congenital heart disease on outcomes among pediatric patients hospitalized for COVID-19 infection

BackgroundCOVID-19 infection is generally regarded as an acute self-limiting illness in children, but it can cause significant morbidity and mortality in both healthy and high-risk children. There are limited data on the outcomes of children with congenital heart disease (CHD) and COVID-19. This study aimed to examine the risks of mortality, in-hospital cardiovascular and non-cardiovascular complications in this patient population.MethodsWe analyzed data from hospitalized pediatric patients from 2020 using the nationally representative National Inpatient Sample (NIS). Children hospitalized for COVID-19 were included, and weighted data were used to compare in-hospital mortality and morbidities between children with and without CHD.ResultsOut of 36,690 children admitted with a diagnosis of COVID-19 infection(ICD-10 code:U07.1 and B97.29) during calendar year 2020, 1240 (3.4%) had CHD. The risk of mortality in children with CHD was not significantly higher than those without CHD(1.2% vs. 0.8%, p = 0.50), with adjusted OR (aOR) of 1.7 (95% CI: 0.6–5.3). Tachyarrhythmias and heart block were more likely in CHD children with an aOR of 4.2 (95% CI: 1.8–9.9) and aOR of 5.0 (95% CI: 2.4–10.8), respectively. Similarly, respiratory failure [aOR = 2.0 (1.5–2.8)], respiratory failure requiring non-invasive mechanical ventilation [aOR = 2.7 (1.4–5.2)] and invasive mechanical ventilation [aOR = 2.6 (1.6-4.0)], and acute kidney injury [aOR = 3.4 (2.2–5.4)] were all significantly higher among patients with CHD. Median length of hospital stay in children with CHD was longer than those without CHD [5 days (IQR: 2–11) vs. 3 days (IQR: 2–5), p = < 0.001].ConclusionsChildren with CHD hospitalized with COVID-19 infection were at increased risk of serious cardiovascular and non-cardiovascular adverse clinical outcomes. They also had increased length of hospital stay and utilization of healthcare resources.

Impact of cannabis on outcome in patients following traumatic injury

IntroductionOutcomes of trauma patients who tested positive for cannabis at the time of admission showed variable results. Sample size and research methodology that was used in prior studies may have resulted in the conflict. The purpose of the study was to evaluate the impact of cannabis use on outcomes in trauma patients using national data. Our hypothesis was that the use of cannabis will impact outcomes. MethodsThe trauma quality improvement program (TQIP) Participant Use File (PUF) database of the calendar years 2017 and 2018 were accessed for the study. All trauma patients aged 12 years old and above who were tested for cannabis at the time of initial evaluation were included in the study. Variables included in the study were: race, sex, injury severity score (ISS), Glasgow Coma Scale (GCS) Score, Abbreviated Injury Scale (AIS) score of different body regions and comorbidities. Excluded from the study were all patients who were not tested for cannabis or tested for cannabis but were also tested positive for alcohol and other drugs and those suffering from mental conditions. Propensity matched analysis was performed. The outcome of interest was overall in-hospital mortality and complications. ResultsPropensity matched analysis created 28,028 pairs. The analysis showed no significant difference in-hospital mortality between cannabis positive and cannabis negative groups (3.2% vs. 3.2%). The median length of hospital stay in both groups was not significantly different (4 [IQR: 3–8] vs. 4 [IQR: 2–8] days). No significant difference was found between the two groups regarding hospital complications except in pulmonary embolism (PE) with 0.1% less incidence of PE in the cannabis positive group compared to the cannabis negative group (0.4 vs. 0.5%). The incidence of DVT was identical in both groups (0.9% vs. 0.9%). ConclusionCannabis was not associated with overall in-hospital mortality or morbidity. There was a slight decrease in the incidence of PE in the cannabis positive group.

Implication to Prevent Tachyarrhythmia by Amiodarone Therapy During Durable Left Ventricular Assist Device Supports.

To the Editor: Graboyes et al.1 demonstrated that prophylactic amiodarone therapy was associated with a reduction in the incidence of postoperative arrhythmias, particularly atrial arrhythmias, without incremental incidence of amiodarone-related adverse events among those receiving durable continuous-flow left ventricular assist devices (CF-LVAD). Several concerns have been raised. The implication to prevent all postoperative tachyarrhythmias following CF-LVAD implantation is uncertain.1 Ventricular arrhythmias was not associated with in-hospital mortality and morbidity in patients receiving CF-LVAD supports in the US nationwide database.2 In another study conducted in Japan, the existence of atrial fibrillation was not associated with the development of hemocompatibility-related adverse events during CF-LVAD supports.3 On the contrary, the frequent low-flow alerts were managed by catheter ablation to treat ventricular tachyarrhythmias in a case report.4 It might be of great interest to investigate tachyarrhythmia-induced hemodynamic deterioration as a primary outcome. The definition of prophylactic treatment is unclear. In the authors’ study, some patients had history of arrhythmias and others received antiarrhythmic agents during CF-LVAD supports.1 The concomitant use of renin-angiotensin-aldosterone system inhibitors, which might also suppress the development of tachyarrhythmias, is unclear. The authors followed liver and thyroid function during amiodarone therapy for the safety analyses but did not investigate the incidence of interstitial pneumonia, which is one of the most fatal drug-related adverse events.1 How was associated biomarkers such as KL-6 and SP-D during amiodarone therapy? Although it did not reach statistical significance, more patients receiving amiodarone trended to encounter death or CF-LVAD exchange. Could the authors clarify the causes of their death?

Peripheral artery disease in patients with acute coronary syndrome without ST-segment elevation: impact on therapy and prognosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Peripheral artery disease (PAD) is an important co-morbidity in non-ST-segment elevation acute coronary syndromes (NSTEMI), and its presence may affect the therapeutic approach and prognosis of these patients. Purpose To assess the impact of PAD presence on therapeutic approach, clinical outcome, and in-hospital and 1-year mortality in patients with NSTEMI. Methods We studied 7248 patients with NSTEMI included in a national multicenter registry. We considered 2 groups: patients with PAD and patients without PAD. Demographic variables, CV risk factors, inpatient therapy, left ventricular function (LVF), coronary angiography and revascularization strategy performed were recorded. The following in-hospital adverse events (AE) were defined: death, re-infarction, stroke, heart failure (HF), cardiogenic shock (CC), major bleeding (MH), need for blood transfusion (BT). Length of stay (IT) and in-hospital and 1-year mortality were evaluated. Multivariate analysis was performed to assess whether the presence of PAD is a predictor of HAS and/or 1-year mortality. Results The presence of PAD was 7.3% (526 patients). These patients were older (70±11 vs 67±13 years, p&amp;lt;0.001), higher prevalence of males (82.1 vs 70.7%, p&amp;lt;0.001), arterial hypertension (87.4 vs 74.1%, p&amp;lt;0.001), diabetes mellitus ( 55.3 vs 32.3%, p&amp;lt;0.001), dyslipidemia (76 vs 61.9%, p&amp;lt;0.001), previous AMI (48.4 vs 24.6%, p&amp;lt;0.001), previous PCI (28.4 vs 17.5%, p&amp;lt;0.001), CABG ( 20.0 vs 6.5%, p&amp;lt;0.001), stroke (25.4 vs 7.5%, p&amp;lt;0.001) and chronic renal failure (22.9 vs 6.3%, p&amp;lt;0.001). Patients with PAD: evolved more frequently in Killip≥II (26.0 vs 13.9%, p&amp;lt;0.001), with LV dysfunction (LVF&amp;lt;50%: 42.7 vs 28.3%, p&amp;lt;0.001) and the need for non-invasive ventilation (3 vs 1.7%, p=0.019). Patients with PAD were less frequently medicated with beta-blockers (75 vs 87.5%, p&amp;lt;0.001) and more frequently with diuretics (47.3 vs 26.6%, p&amp;lt;0.001). Patients with PAD underwent fewer coronary angiograms (69.8 vs 85.6%, p&amp;lt;0.002), but the femoral approach was more used (35.2 vs 21.4%) and had more multivessel disease (76.7 vs 52.4%, p&amp;lt;0.001). Patients with PAD had a longer in-hospital stay duration (median 7 vs 5 days, p&amp;lt;0.001), higher incidence of re-AMI (3.1 vs 1.4%, p=0.003), HF (26.7 vs 12.4%, p=0.002), CC (3.2 vs 1.8%, p=0.016), MH (2.3 vs 1.1%, p=0.001) and BT (4.6 vs 1.6%, p&amp;lt;0.001), but not stroke. In-hospital mortality was higher (4 vs 2%, p=0.003) as well as 1-year mortality (16.2 vs 6.2%, p&amp;lt;0.001). By multivariate analysis, PAD was an independent predictor of 1-year mortality (OR=1.57, 95% CI [1.04-2.58], p=0.032), but not of AE. Conclusion The presence of PAD affects the therapy and revascularization strategy in patients with NSTEMI, being associated with higher in-hospital morbidity and mortality. This co-morbidity constitutes an independent predictor of death at 1 year.

Admission heart failure and coronary perfusion in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Studies demonstrated a link between the presence of HF on the admission of ACS patients and increased in-hospital morbidity and mortality. However, the literature did not establish the connection between the admission HF and the angiographic burden and the coronary vessel perfusion post-PPCI. Purpose To establish the correlation between acute HF on admission of STEMI patients, the coronary thrombus burden and the final coronary perfusion post PPCI. Methods We retrospectively studied 210 STEMI patients who presented to a single PPCI centre. We excluded post-fibrinolysis patients, patients with old stents and those who presented more than 24 hours after the onset of pain. We divided the studied cohort into two subgroups based on the presence of HF on presentation to the emergency department. We obtained Informed consent from all patients, and all procedures were done in compliance with the Helsinki declaration for research on human beings. Two blinded interventional cardiology consultants assessed the thrombus burden and coronary flow using TIMI grades of both variables. Results 20 patients (10%) of the studied group had HF on admission. There was no significant difference between the two subgroups regarding other cardiovascular risk factors (figure 1). The coronary thrombus burden did not differ significantly between the HF and no HF subgroups (50% vs 43.16%, respectively, p=0.557). However, the incidence of impaired coronary flow post-PPCI was significantly higher in the HF group (25% vs 8.4%, p=0.019) (figure 2). Multivariate logistic regression analysis showed that admission HF is an independent predictor of impaired perfusion post-PPCI ( OR= 5.49, 95% CI=1.54-19.49, p=0.01). Our study demonstrates the association between admission HF in STEMI patients undergoing PPCI and increased incidence of impaired coronary flow after PPCI. This finding was independent of the heavy coronary thrombus burden on angiography. Animal studies have demonstrated impaired coronary flow even in HF secondary to non-ischaemic causes.1,2 Possible mechanisms include impaired nitric oxide-mediated endothelium-dependent vasodilatation and enhanced vasoconstriction to mediators of neurohumoral activation.3 These mechanisms can explain our study's impaired coronary flow in HF patients. Conclusion Admission HF is an independent predictor of reduced coronary blood flow after PPCI. Timely treatment of STEMI patients can prevent HF development and improve their prognosis.

Impact of Preoperative Echocardiograms on In-Hospital Outcomes of Patients Undergoing Surgical Hip Fracture Repair and Their Clinical Appropriateness.

Preoperative transthoracic echocardiograms (TTE) before hip fracture repairs are controversial. This study aimed to quantify the frequency of ordering TTE, the appropriateness of testing based on current guidelines, and the impact of TTE on in-hospital morbidity and mortality outcomes. This retrospective chart review of adult patients admitted with hip fracture compared the length of stay (LOS), time to surgery, in-hospital mortality, and postoperative complications between TTE and non-TTE groups. TTE patients were risk stratified using the Revised Cardiac Risk Index (RCRI) to compare TTE indication according to current guidelines. Of the 490 patients included in this study, 15% received preoperative TTE. The median LOS of the TTE and non-TTE groups was 7.0 and 5.0 d, respectively, whereas the median time to surgery was 34 and 14 h, respectively. The odds of in-hospital mortality remained significantly higher in the TTE group after adjusting for RCRI but not when adjusted for the Charlson Comorbidity Index. Significantly more patients in the TTE groups had postoperative heart failure and up triage in the intensive care unit. Furthermore, 48% of patients with an RCRI score of 0 received preoperative TTE, with cardiac history as the most typical indication. TTE changed perioperative management in 9% of patients. Patients subjected to TTE before hip fracture surgery had a longer LOS and time to surgery, with higher mortality and intensive care unit up triage rates. TTE evaluations were typically conducted for inappropriate indications, which rarely made meaningful changes to patient management.

D-27 | Impact of Frailty on Mortality, Procedural Complications, and Resource Utilization in Patients Undergoing Transcatheter Mitral Valve Replacement

Transcatheter mitral valve replacement (TMVR) has recently emerged as a new frontier in the field of cardiac structural interventions. We aimed to determine the impact of frailty on outcomes in patients undergoing TMVR using a nationally representative real-world cohort of patients. Patients with and without frailty undergoing TMVR were identified using ICD-10-CM codes from the National Inpatient Sample database for the years 2016-2019. The outcomes (in-hospital mortality, procedural complications, and resource utilization) of patients with frailty were compared with those without frailty. (Table 1) Among 3,830 patients undergoing TMVR, 498 (13%) were frail as compared to 3,332 (87%) patients without frailty. Baseline characteristics and crude outcomes are demonstrated in Table 1. In the multivariable model adjusted for potential confounders, frail patients as compared to non-frail patients had higher odds of in-hospital mortality (adjusted odds ratio [aOR]:3.88; 95% CI: 1.81-8.34; p<0.01), cardiogenic shock (aOR:2.85; 95% CI:1.53-5.29; p<0.01), need for dialysis (aOR: 3.20; 95% CI:1.63-6.28; p<0.01), need for mechanical ventilation (aOR: 4.02; 95% CI: 2.31-6.98; p<0.01) and length of stay (adjusted mean difference: 8.52; 95% CI: 5.92-11.12; p<0.01) days but no difference in the odds of vascular complications, stroke, need for mechanical circulatory support, blood transfusion or new pacemaker implantation. In a large contemporary cohort of patients undergoing TMVR, frailty has a high prevalence of approx. 13% and is associated with higher odds of in-hospital morbidity and mortality.

Maternal and Placental Risk Factors for Small Gestational Age and Fetal Malnutrition.

This case-control study was conducted to identify maternal and placental risk factors of small-for-gestational-age (SGA) and fetal malnutrition. Cases comprised 104 consecutively delivered SGA neonates (determined as per INTERGROWTH- 21st standard). An equal number of next-born gestation and gender-matched appropriatefor- gestational age (AGA) neonates served as controls. Maternal risk factors were enquired, and placentae were evaluated by clinical and histopathological examination. Nutrition of the neonates was assessed by the clinical assessment of nutrition (CAN) score. Univariate and multivariate logistic regression analysis was done to identify the maternal and placental risk factors. The prevalence of SGA in the present study was 23.9%. Maternal fever [adjusted Odds Ratio (aOR), 95% confidence interval (CI), 16.3 (3.5-124.1); p = 0.001], presence of placental syncytial knots [aOR (95% CI), 2.9 (1.1-9.1); p = 0.04] and placental calcifications [aOR (95% CI), 3(1.1- 8.7); p = 0.03], were identified as independent predictors of SGA using multivariate logistic regression analysis. Malnutrition (SCORE <25) affected 64% of SGA and 16.3% of AGA neonates. The only risk factor significantly associated with malnourished SGA was prematurity, whereas malnourished AGA was significantly associated with prematurity and fetal distress. In-hospital morbidities significantly higher in SGA were perinatal asphyxia, respiratory distress, need for respiratory support, polycythemia, hypoglycemia, and feeding intolerance. Mortality before discharge was 4.8% and 3.8% in SGA and AGA population, respectively (p > 0.05). Neonatal outcomes were comparable among well-nourished, malnourished SGA and AGA groups. Maternal fever, placental syncytial knots, and calcifications were independent risk factors of SGA, whereas prematurity and fetal distress were responsible for malnutrition.