In-hospital Outcomes In Patients Research Articles

Characteristics and In-Hospital Outcomes of Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries ― Insights From the Real-World JAMIR Database ―

Characteristics and In-Hospital Outcomes of Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries ― Insights From the Real-World JAMIR Database ―

7679 The Role of Thyrotoxicosis in Determining Clinical Outcomes for Hospitalized Patients with Dilated Cardiomyopathy: A Propensity Match National Cohort

Abstract Disclosure: R. Mukhtar: None. H. Younas: None. A. Taha: None. D. Virlan: None. A. Ceban: None. A. Racovita: None. J. Patel: None. Background: Thyrotoxicosis, a condition associated with high morbidity and mortality, has been notably linked to adverse clinical outcomes in patients with cardiovascular diseases. This study aims to comprehensively analyze the clinical impact of thyrotoxicosis on in-hospital outcomes in patients hospitalized with DCM. Methods: Based on 2020 National In-patient Sample Database, DCM patients were categorized into two groups depending on whether thyrotoxicosis was present or absent at the time of admission. To evaluate the impact of thyrotoxicosis on clinical outcomes, comparative analyses were conducted using propensity score matching and multivariable regression analysis. All statistical analyses were performed using STAT v 17. Results: Among 545,390 hospitalizations for DCM, 2,900 (0.5%) patients were presented with thyrotoxicosis. Propensity score matching revealed that DCM patients with thyrotoxicosis had higher heart failure rates (7.87% vs. 5.62%, aOR: 1.39, 95% CI: 1.04-1.86, p-value: 0.03). There was no statistically significant difference in in-patient mortality (2.60% vs. 3.65%, aOR: 0.81, 95% CI 0.58-1.13, p-value: 0.21), conduction disorders (3.26% vs. 2.70%, aOR: 1.38, 95% CI: 0.89-2.13, p-value: 0.15), acute coronary artery syndrome (0.62% vs. 0.86%, aOR: 0.94, 95% CI: 0.54-1.64, p-value: 0.82), acute kidney injury (18.57% vs. 18.59%, aOR 0.99, 95% CI: 0.77-1.17, p-value: 0.62), and acute stroke (0.29% vs. 0.30%, aOR: 0.60, 95% CI: 0.15-2.44, p-value: 0.48) between DCM patients with and without thyrotoxicosis. Thyrotoxicosis was associated with increased length of stay [5 days (IQR: 6) vs. 4 days (IQR: 7)] and total charge [$54,256 (IQR: 82,126) vs. $47,942 (IQR: 75,003)] in patients admitted with DCM. Conclusion: This research indicates that DCM patients co-presenting with thyrotoxicosis have an increased risk of heart failure and resource utilization during hospitalization. There were no significant effects observed in conduction disorders, in-patient mortality, acute coronary, kidney, or stroke outcomes among DCM patients hospitalized with or without thyrotoxicosis. Future prospective studies are warranted to enhance our understanding of clinical outcomes associated with thyrotoxicosis in patients hospitalized with DCM. Presentation: 6/3/2024

Impact of Body Mass Index on In-Hospital Outcomes in Patients Receiving Leadless Pacemakers: A Five-Category Analysis

BackgroundThe adoption of leadless pacemakers (LPMs) is increasing, yet the impact of body mass index (BMI) on procedural outcomes remains underexplored. ObjectiveThis study aims to explore the impact of BMI on in-hospital outcomes for patients receiving leadless pacemaker (LPM) implantation. MethodsData from the National Inpatient Sample (NIS) from 2018-2021 was analyzed for patients over 18 who underwent LPM implantation, with specific inclusion and exclusion criteria applied. Patients were identified using International Classification of Diseases, 10th Revision (ICD-10) codes and categorized into BMI groups: underweight, normal, overweight, obese, and morbidly obese. The primary outcome assessed was in-hospital mortality. Secondary outcomes included blood transfusion, pericardial complications, infection/inflammation, removal/revision, and other complications. ResultsThe study included 3,832 patients who underwent LPM implantation between 2018 and 2021, weighted to represent 19,610 patients, with 3,540 having an appropriate BMI designation. Mortality was lower in the obese group (2.3%) compared to the non-obese group (2.7%) (aOR 0.462, 95% CI 0.259-0.623, p = 0.009). Compared to the normal weight group, those categorized as overweight, obese, and morbidly obese demonstrated a lower risk of in-hospital mortality (aOR 0.432, 95% CI 0.299-0.734, p = 0.009), (aOR 0.465, 95% CI 0.238-0.721, p < 0.001), and (aOR 0.299, 95% CI 0.153-0.586, p < 0.001) respectively. ConclusionThese findings support the existence of the obesity paradox in patients with LPM implantation, where higher BMI categories are associated with improved mortality outcomes, meeting our pre-specified primary endpoint. Further studies are needed to clarify the mechanisms behind these observations.

In-Hospital Outcomes of Patients with Non-ST Elevation Myocardial Infarction Undergoing Early Invasive Percutaneous Coronary Intervention

Methodology: A cross-sectional study was conducted in the Adult Cardiology Department at the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan, from August 2019 to February 2020. The study included 165 patients, both male and female, aged 40 to 75 years, who presented with NSTEMI and underwent early invasive PCI. All patients were either admitted through the emergency department or referred from outpatient services at NICVD. Comprehensive medical assessments were performed, and relevant medical history and clinical details were documented. PCI procedures were conducted under the supervision of experienced consultant cardiologists with over five years of procedural expertise. The primary outcomes evaluated were the incidence of cardiogenic shock, heart failure, and in-hospital mortality. Results: Of the 165 patients included in the study, 125 (75.8%) were male, with a mean age of 56.6±7.72 years and a mean BMI of 26.5±3.8 kg/m². Hypertension was prevalent in 100 (60.6%) patients, while 78 (47.3%) had diabetes mellitus. A history of smoking was reported in 70 (42.4%) patients. Heart failure emerged as the most common in-hospital adverse outcome, occurring in 25 (15.2%) patients, followed by cardiogenic shock in 9 (5.5%) patients, and in-hospital mortality in 20 (12.1%) patients. Conclusion: Among patients undergoing early invasive PCI following NSTEMI, heart failure was the most frequent adverse in-hospital outcome, followed by mortality and cardiogenic shock. These findings underscore the importance of vigilant monitoring and management of high-risk NSTEMI patients during the early stages of PCI intervention.

Prevalence, Characteristics, and Treatment Strategy of Different Types of Heart Failure in Patients With Nonvalvular Atrial Fibrillation.

Atrial fibrillation (AF) is the most common arrhythmia in patients with heart failure (HF). Epidemiological data regarding HF in patients with AF are lacking. We describe the epidemiology, clinical features, treatment strategies, and in-hospital outcomes in patients with AF and HF. Patients with HF and nonvalvular AF in the Improving Care for Cardiovascular Disease in China-AF cohort from February 2015 to December 2019 were included. Patients were stratified by left ventricular ejection fraction into HF with reduced EF, HF with mildly reduced EF, and HF with preserved EF groups. The primary outcome was the occurrence of hospitalization for major adverse cardiovascular events, including death, cardiogenic shock, cardiac arrest, and stroke. Overall, 16 562 patients with AF and HF were included (mean age: 72.35±11.07 years; 46.1% female). HF with preserved EF (63.1%) accounted for the largest proportion, followed by HF with mildly reduced EF (19.0%) and HF with reduced EF (17.9%). Different HF subtypes in patients with AF had unique baseline demographic and clinical characteristics after multinomial logistic regression analysis. Compared with the HF with preserved EF group, hospitalization for major adverse cardiovascular events was increased in the HF with mildly reduced EF group (odds ratio=1.55 [95% CI, 1.18-2.03]) and HF with reduced EF group (odds ratio 1.60 [95% CI, 1.21-2.13]) after adjusting for confounders. In this large Chinese AF registry, the distribution of HF differed from the non-AF population. Patients with AF with different types of HF have unique demographic and clinical characteristics. Occurrence rates of in-hospital outcomes were higher in patients with HF with mildly reduced EF and patients with HF with reduced EF compared with the HF with preserved EF group. URL: http://www.clinicaltrials.gov; Unique identifier: NCT02309398.

Obesity hypoventilation syndrome is associated with worse in-hospital outcomes in patients with acute myocardial infarction: A nationwide study

BackgroundObesity hypoventilation syndrome (OHS) is a condition characterized by obesity, daytime hypercapnia, and sleep-disordered breathing. The impact of OHS on outcomes in patients with acute myocardial infarction (AMI) remains poorly understood. MethodsWe conducted a retrospective analysis using data from the National Inpatient Sample (2016–2020) to evaluate the outcomes of patients with OHS admitted for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). ResultsAmong STEMI and NSTEMI patients, 0.15 % and 0.37 % had OHS, respectively. After adjusting for confounders, OHS was associated with higher odds of in-hospital mortality, cardiac arrest, acute kidney injury, renal replacement therapy, and respiratory failure requiring intubation in NSTEMI patients. In STEMI patients, OHS was associated with higher odds of cardiac arrest, acute kidney injury, and respiratory failure. ConclusionOHS is associated with worse clinical outcomes in patients admitted with AMI, particularly in those with NSTEMI.

Demographics, Clinical Characteristics and In-Hospital Outcome of Coronavirus Disease 2019 (COVID-19) Patients With or Without Diabetes Mellitus

Introduction Diabetes Mellitus (DM) is one of the important co-morbidity that may negatively influence the clinical outcome of the coronavirus disease 2019 (COVID-19) if it co-exists. There is a paucity of data regarding the characteristics and outcomes of COVID-19 diabetic patients in comparison to non-diabetic patients. Thus, we aimed to compare demographics and clinical characteristics, and in-hospital outcome in COVID-19 positive patients with or without DM. Method This prospective observational study included all consecutive confirmed symptomatic and asymptomatic COVID-19 positive patients from March 8th 2020 to July 7th 2023at the National Heart Foundation Hospital &amp; Research Institute of Bangladesh. Patients were divided into two groups based on whether they had diabetes: Group I- patients with DM and group II- patients without DM. Baseline and clinical characteristics &amp; in-hospital outcome of patients in both groups were assessed for comparison. Result This study included a total of 2506 confirmed COVID-19 positive patients. Of them 1003 (40%) patients had DM (Group-I) &amp; 1503 (60%) were without DM (Group-II). Diabetic COVID-19 positive patients were older (56.87 ±11.84 years vs 45.92 ± 16.91 years; p=0.001) and had more co-morbidities (p= 0.001) than patients without DM. Only 4.2% healthcare personnel had DM. Diabetic patients (G-I) had more risk factors and comorbidities than non-diabetic patients (G-II): cardiovascular disease (90.4% vs 65.7%; p=0.001); hypertension (84.3% vs 41.4%; p=0.001); chronic kidney disease (47.7% vs 29.8%;p=0.001); smoking (37.8% vs 25.9%; p=0.001); dyslipidemia (37.2% vs 17.4%;p=0.001); and chronic obstructive pulmonary disease/bronchial asthma (7.5% vs 4.3%; p=0.001). Most of the patients with DM (G-I) were symptomatic (77.5% vs 66.7%; p=0.001). Shortness of breath was significantly higher in diabetic patients (44.8% vs 30.6%; p=0.001). Sore throat (12.0% vs 2.9%; p=0.001), diarrhea (5.4% vs 1.2%; 0.001), anosmia (10.6% vs 3.8%; p=0.001), and headache (16.5% vs 8.8%; p=0.001) were significantly higher in Group-II patients. Diabetic patients had more severe form of COVID-19 disease {(moderate: 3.5% vs 1.4%; p=0.001), (severe: 9.5% vs 4.1%; p=0.001), and (critical ill: 1.3% vs 0.4%; p=0.01)}.Most of the diabetic patients were hospitalized (52.0% vs 29.6%; p=0.001) and most of the non-diabetic patients were treated either in home isolation or in institutional isolation (70.4% vs 48.0%; p=0.001). COVID-19 patients with DM had worse outcome than patients without DM (mortality rate- 6.1% vs 2.6%; p=0.001). Conclusion COVID-19 diabetic patients were usually older, have more comorbidities, a higher probability of hospitalization, increased risk of severe/critical COVID-19 and associated with higher mortality rate as compared with patients without DM. Bangladesh Heart Journal 2024; 39(2): 108-116

In-Hospital Outcomes of Patients With Acute Respiratory Distress Syndrome Treated With Extracorporeal Membrane Oxygenation.

Treatment of acute respiratory distress syndrome (ARDS) with extracorporeal membrane oxygenation (ECMO) remains controversial. This study aims to examine outcomes in ARDS patients treated with or without ECMO. Using the National Inpatient Sample (NIS) database, all ARDS patients including those who were treated with ECMO were included in the analysis. Univariable and multivariable logistic regressions were used to estimate the odds of in-hospital outcomes between groups. A total of 2,540,350 patients were identified (2,538,849 with ARDS; 1,501 with ARDS on ECMO). The patients who underwent ECMO included younger patients and more men. Using ECMO in ARDS patients was associated with higher in-hospital mortality, cardiopulmonary arrest, major bleeding, sepsis, acute kidney injury, and longer hospital stays (31.7 vs. 8.3 days; p < 0.001 for all). A subgroup analysis based on age and sex had similar outcomes. Using ECMO in patients with ARDS was associated with worse in-hospital outcomes, including mortality and length of stay.

Outcomes among patients with non-ST-elevation myocardial infarction on chronic anticoagulation: Insights from the National Inpatient Sample.

Chronic systemic anticoagulation use is prevalent for various thromboembolic conditions. Anticoagulation (usually through heparin products) is also recommended for the initial management of non-ST-elevation myocardial infarction (NSTEMI). To evaluate the in-hospital outcomes of patients with NSTEMI who have been on chronic anticoagulation. Using the National Inpatient Sample (NIS) years 2016-2020, NSTEMI patients and patients with chronic anticoagulation were identified using the appropriate International Classification of Diseases, 10th version (ICD-10) appropriate codes. The primary outcome was all-cause in-hospital mortality while the secondary outcomes included major bleeding, ischemic cerebrovascular accident (CVA), early percutaneous coronary intervention (PCI) (i.e., within 24 h of admission), coronary artery bypass graft (CABG) during hospitalization, length of stay (LOS), and total charges. Multivariate logistic or linear regression analyses were performed after adjusting for patient-level and hospital-level factors. Among 2,251,914 adult patients with NSTEMI, 190,540 (8.5%) were on chronic anticoagulation. Chronic anticoagulation use was associated with a lower incidence of in-hospital mortality (adjusted odds ratio [aOR]: 0.69, 95% confidence interval [CI]: 0.65-0.73, p < 0.001). There was no significant difference in major bleeding (aOR: 0.95, 95% CI: 0.88-1.0, p = 0.15) or ischemic CVA (aOR: 0.23, 95% CI: 0.03-1.69, p = 0.15). Chronic anticoagulation use was associated with a lower incidence of early PCI (aOR: 0.78, 95% CI: 0.76-0.80, p < 0.001) and CABG (aOR: 0.43, 95% CI: 0.41-0.45, p < 0.001). Chronic anticoagulation was also associated with decreased LOS and total charges (adjusted mean difference [aMD]: -0.8 days, 95% CI: -0.86 to -0.75, p < 0.001) and (aMD:$-19,340, 95% CI: -20,692 to -17,988, p < 0.001). Among patients admitted with NSTEMI, chronic anticoagulation use was associated with lower in-hospital mortality, LOS, and total charges, with no difference in the incidence of major bleeding.

Risk Factors for Adverse In-Hospital Outcomes in Patients With Traumatic Blunt Thoracic Aortic Injuries Undergoing Thoracic Endovascular Aortic Repair (TEVAR): An Analysis of the US Nationwide Inpatient Sample.

Thoracic endovascular aortic repair (TEVAR) is a treatment for traumatic blunt thoracic aortic injury (BTAI) with good survival rates and safety. However, there is limited study on the risk factors for in-hospital mortality and complications. This study aimed to identify risk factors associated with poor in-hospital outcomes after TEVAR. This is a population-based, retrospective observational study. Data of adults ≥20 years admitted for BTAI who received TEVAR were extracted from the Nationwide Inpatient Sample (NIS) database 2005 to 2018. The primary outcome was in-hospital mortality, and the secondary outcomes were length of stay (LOS) and unfavorable discharge (ie, non-routine discharge, including nursing homes or long-term care facilities). Associations between study variables and in-hospital outcomes were determined using univariate and multivariable logistic and linear regression analyses. Data of 1095 participants (representing 5360 hospitalized patients in the United States) were analyzed. Multivariable analysis revealed that older age (adjusted odds ratio [aOR]=1.02) and having at least 1 perioperative complication (aOR=4.01) were significantly associated with increased risk for in-hospital mortality. Patients with at least 1 perioperative complication (aOR=11.19) had significantly increased odds for prolonged LOS. Risk for unfavorable discharge was significantly increased by older age (aOR=1.02), household income at quartile 2 (aOR=1.58), Charlson Comorbidity Index (CCI) 2 to 3 (aOR=1.66), and having at least 1 complication (aOR=3.94). Complications including perioperative cerebrovascular accident (CVA) (aOR=2.75), venous thromboembolism (VTE) (aOR=2.87), pneumonia (aOR=3.93), sepsis (aOR=4.69), infection (aOR=4.49), respiratory failure (aOR=4.55), mechanical ventilation (aOR=3.27), and acute kidney injury (AKI) (aOR=3.09) significantly predicted prolonged LOS. In adults with traumatic BTAI undergoing TEVAR, advanced age and perioperative complications are risk factors for poor in-hospital outcomes. Acute kidney injury, CVA, respiratory failure, and sepsis are strong predictors of prolonged LOS, unfavorable discharge, and in-hospital mortality. The study identifies advanced age and perioperative complications as key risk factors for poor in-hospital outcomes in patients undergoing TEVAR for BTAI. Clinicians should be vigilant in managing these patients, particularly those with comorbidities, to mitigate risks. The findings suggest a need for tailored perioperative care strategies to improve survival rates and reduce complications. This research highlights the critical importance of early identification and intervention in high-risk patients, offering an innovative approach to refining TEVAR protocols and enhancing patient outcomes in trauma care.

Effectiveness of chest pain center accreditation on the hospital outcome of acute aortic dissection: a nationwide study in China

BackgroundThe National Chest Pain Center Program (NCPCP) is a nationwide, quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China. The benefits of chest pain center (CPC) accreditation on acute coronary syndrome have been demonstrated. However, there is no evidence to indicate whether CPC accreditation improves outcomes for patients with acute aortic dissection (AAD).MethodsWe conducted a retrospective observational study of patients with AAD from 1671 hospitals in China, using data from the NCPCP spanning the period from January 1, 2016 to December 31, 2022. The patients were divided into 2 groups: pre-accreditation and post-accreditation admissions. The outcomes examined included in-hospital mortality, misdiagnosis, and Stanford type A AAD surgery. Multivariate logistic regression was employed to explore the relationship between CPC accreditation and in-hospital outcomes. Furthermore, we stratified the hospitals based on their geographical location (Eastern/Central/Western regions) or administrative status (provincial/non-provincial capital areas) to assess the impact of CPC accreditation on AAD patients across various regions.ResultsThe analysis encompassed a total of 40,848 patients diagnosed with AAD. The post-accreditation group exhibited significantly lower rates of in-hospital mortality and misdiagnosis (12.1% vs. 16.3%, P < 0.001 and 2.9% vs. 5.4%, P < 0.001, respectively) as well as a notably higher rate of Stanford type A AAD surgery (61.1% vs. 42.1%, P < 0.001) compared with the pre-accreditation group. After adjusting for potential covariates, CPC accreditation was associated with substantially reduced risks of in-hospital mortality (adjusted OR 0.644, 95% CI 0.599–0.693) and misdiagnosis (adjusted OR 0.554, 95% CI 0.493–0.624), along with an increase in the proportion of patients undergoing Stanford type A AAD surgery (adjusted OR 1.973, 95% CI 1.797–2.165). Following CPC accreditation, there were significant reductions in in-hospital mortality across various regions, particularly in Western regions (from 21.5 to 14.1%). Moreover, CPC accreditation demonstrated a more pronounced impact on in-hospital mortality in non-provincial cities compared to provincial cities (adjusted OR 0.607 vs. 0.713).ConclusionCPC accreditation is correlated with improved management and in-hospital outcomes for patients with AAD.

Palliative care consultation in patients hospitalized with out-of-hospital cardiac arrest: Impact on invasive procedures, do-not-resuscitate orders, and healthcare costs

BackgroundThe impact of palliative care consultation on the management and outcomes of patients hospitalized with out-of-hospital cardiac arrest (OHCA) remains poorly understood. This study examined associations between palliative care consultation and in-hospital outcomes of patients hospitalized with OHCA, stratified by survival status. MethodThis cross-sectional study used data from the National Inpatient Sample (2016–2021). Adult patients hospitalized with OHCA who received cardiopulmonary resuscitation were included. Multivariable analyses assessed associations between palliative care consultation and outcomes in non-terminal and terminal OHCA hospitalizations, adjusting for demographics, hospital characteristics, and comorbidities. ResultsAmong 488,700 OHCA hospitalizations, palliative care consultation was associated with lower odds of invasive procedures in non-terminal hospitalizations, including percutaneous coronary intervention (PCI) (aOR 0.30, 95 % CI 0.25–0.36), mechanical circulatory support (aOR 0.54, 95 % CI 0.44–0.68), permanent pacemaker (aOR 0.27, 95 % CI 0.20–0.37) and implantable cardioverter defibrillator insertion (aOR 0.22, 95 % CI 0.16–0.31), and cardioversion (aOR 0.62, 95 % CI 0.55–0.70). In terminal hospitalizations, palliative care was associated with lower odds of PCI (aOR 0.78, 95 % CI 0.70–0.87) and cardioversion (aOR 0.91, 95 % CI 0.85–0.97), but higher odds of therapeutic hypothermia (aOR 3.12, 95 % CI 2.72–3.59), gastrostomy (aOR 1.22, 95 % CI 1.05–1.41), and renal replacement therapy (aOR 1.19, 95 % CI 1.12–1.26). Palliative care was associated with higher DNR utilization in both subgroups and lower hospital costs in non-terminal hospitalizations but higher costs in terminal hospitalizations. ConclusionPalliative care consultation in OHCA is associated with differences in invasive procedures, DNR utilization, and hospital costs, varying by survival status.

Impact of systemic lupus erythematosus (SLE) on outcomes following aseptic and septic revision total knee arthroplasty: an analysis of the 2005-2018 nationwide inpatient sample.

Systemic lupus erythematosus (SLE) can adversely affect surgical outcomes, and the impact on revision total knee arthroplasty (TKA) outcomes is unclear. This study aimed to explore the impact of SLE on in-patient outcomes of revision TKA. The Nationwide Inpatient Sample (NIS) database from 2005 to 2018 was searched for patients aged ≥ 18years old who received revision TKA. Patients with and without SLE were propensity score matched (PSM) at a 1:4 ratio. Associations between SLE and in-hospital outcomes were examined using regression analyses. The study included 133,054 patients, with 794 having SLE. After 1:4 PSM, data of 3,970 patients were analyzed (SLE, 794; non-SLE, 3,176). Multivariate-adjusted analyses revealed that SLE patients had a significantly higher risk of postoperative complications (adjusted odds ratio [aOR] = 1.23, 95% confidence interval [CI]: 1.05-1.44, p = 0.011), non-routine discharge (aOR = 1.22, 95% CI: 1.02-1.46, p = 0.028), major blood loss (aOR = 1.19), respiratory failure/mechanical ventilation (aOR = 1.79), acute kidney injury (AKI) (aOR = 1.47), and wound dehiscence (aOR = 2.09). SLE patients also had a longer length of hospital stay (aBeta = 0.31) and greater total hospital costs (aBeta = 6.35) compared to non-SLE patients. Among those with aseptic failure, SLE patients had a significantly higher risk of postoperative complications (aOR = 1.23) and non-routine discharge (aOR = 1.36). SLE is independently associated with worse in-hospital outcomes in patients undergoing revision TKA. This study highlights the importance of heightened vigilance and tailored perioperative management for patients undergoing major surgeries in the background of SLE. Key Points • SLE significantly increases the risk of non-routine discharge, major blood loss, respiratory failure, acute kidney injury, and wound dehiscence, in patients undergoing aseptic and septic revision TKA. • Patients with SLE experience longer hospital stays and higher hospital costs compared to those without SLE. • The study's findings highlight the necessity for healthcare providers to consider the presence of SLE as a critical factor in preoperative planning and postoperative care to improve outcomes in revision TKA patients.

Sex Disparity in the In-Hospital Outcomes of Patients with Kidney Disease Admitted for Myocardial Infarction: Insights from a Large National Database.

There is limited evidence as to the effect of sex on the outcomes of patients admitted for ST-elevation myocardial infarction (STEMI) who have a concomitant diagnosis of chronic kidney disease (CKD) and end-stage renal disease (ESRD). We aimed to determine if there are differences in the outcomes between males and females in these patient populations. Data were obtained from the National Inpatient Sample database and patients were selected using the International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and -10) codes. Hospitalizations for patients with CKD who had STEMI from 2012 to 2020 were included. The primary outcome of interest was in-hospital mortality. Secondary outcomes evaluated included ischemic stroke, major bleeding complications, pressor requirement, permanent pacemaker implantation, percutaneous coronary intervention, coronary artery bypass grafting, surgery, pericardiocentesis, mechanical circulatory support, and mechanical ventilation. A total of 1,283,255 STEMI patients without CKD, 158,715 STEMI patients with CKD, and 22,690 STEMI patients with ESRD were identified and analyzed. Among patients with STEMI and CKD, females demonstrated higher in-hospital mortality compared to male counterparts (16.7% vs. 12.7%, aOR = 1.13, 95% CI: 1.05-1.21, p &lt; 0.01). While there was no sex difference in the in-hospital mortality among STEMI patients with ESRD, female patients in this group were less likely to receive coronary artery bypass grafting and mechanical circulatory support. Increased in-hospital mortality rates were shown for females admitted for STEMI with CKD. Among patients with ESRD who had STEMI, females were less likely to receive coronary artery bypass grafting and mechanical circulatory support. Further research needs to be conducted to better explain this said difference in outcomes.

Predictive Ability of Inflammatory Markers on In-Hospital Outcomes in Patients Admitted to Coronary Care Unit (MORCOR-TURK INFLAME).

We investigated the prognostic implications of the systemic immune-inflammatory index (SII), atherogenic index of plasma (AIP), C-reactive protein/albumin ratio (CAR), neutrophil-lymphocyte ratio (NLR), prognostic nutritional index (PNI), and triglyceride/glucose index (TGI) in the MORtality predictors in the CORonary Care Units in TURKey (MORCOR-TURK) population. This is the largest registry of coronary care unit (CCU) patients in Turkey (3157 patients admitted to CCU in 50 different centers). The study population was divided into two according to in-hospital survival status; 137 patients (4.3%) died in-hospital follow-up. A significant correlation was found between death and SII, CAR, NLR, and PNI but not for AIP and TGI in logistic regression. In Model 1 (combining parameters proven to be risk predictors), the -2 log-likelihood ratio was 888.439, Nagelkerke R2 was 0.235, and AUC (area under curve) was 0.814 (95% CI: 0.771-0.858). All other models were constructed by adding each inflammatory marker separately to Model 1. Only Model 3 (CAR + Model 1) had a significantly greater AUC than Model 1 (DeLong P = .01). Our study showed that CAR, but not other inflammatory index, is a significant predictor of in-hospital mortality in CCU patients when added to proven risk predictors.

Association of admission blood glucose and in- hospital outcome after Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

Background: The effects of glucose abnormalities on in-hospital outcome after Primary Percutaneous Coronary Intervention (PCI) in acute STEMI remain unclear. The study assessed the relationship of admission blood glucose level to in-hospital outcome in patients presenting with a STEMI and treated with Primary PCI. Methods: This prospective study was conducted in the department of cardiology, NICVD, Dhaka Bangladesh from May 2018 to April 2019.Total 80 patients with admission normal blood glucose and hyperglycemia with acute STEMI underwent Primary PCI were considered for the study. Results: Mean age of the studied patient was 44.0±9.1 years ranging from 30 to 61 years and the mean age of the group II patients was 48.0±7.8 years ranging from 37 to 61 years. Itwas found that acute heart failure occurred 10% in group II and 2.5% in group I patients with statistically significant (p=0.04) difference. Cardiogenic shock observed 2.5% patients in group II and 2.5% patients in group I with statistically no significant (p=0.56) difference. Significant arrhythmias were found 5% patients in group II and 2.5% in group I patients with statistically no significant (p=0.40) difference. No MI and CVA were occurred in both group of patients. In group II, 2.5% patients died and no patients died in group I with statistically no significant (p=0.31) difference. Conclusion: Admission hyperglycemia is a predictor of poor prognosis in STEMI patients undergoing primary PCI. Cardiovasc j 2024; 16(2): 70-77

Two Decades of CABG in the UK: A Propensity Matched Analysis of Outcomes by Conduit Choice.

Background/Objectives: Grafting of LIMA to LAD has long been considered the gold-standard conduit choice for patients undergoing CABG. Despite this, the LSV remains the most used conduit by volume and some patients may not receive even a single arterial conduit. However, the outcomes in this group are not frequently explored. This study, therefore, compares in-hospital outcomes of patients who underwent CABG without any arterial conduits to those who received at least one arterial conduit. Methods: Retrospective propensity-matched database analysis of consecutive patients undergoing CABG in the UK between 1996 and 2019 using data from the National Adult Cardiac Surgery Audit. Results: 335,144 patients underwent CABG, with 6% receiving venous conduits only; matched outcomes are reported for 39,812 patients. In both unmatched and matched groups, we found a significant increase in mortality with the use of veins only (matched mortality 5.3% vs. 3.8%, p < 0.001) with estimated treatment effect for mortality OR 1.43, p < 0.001 (95% CI: 1.31-1.57). We also identified greater rates of post-operative dialysis, IABP insertion, and length of hospital stay in this group. Conclusions: We identified a significant increase in in-hospital mortality with the use of veins only compared to using at least one arterial graft to the LAD. While a single arterial graft should be prioritised wherever possible, venous revascularisation retains a critical role for specific patients. We must, therefore, continue to conduct research addressing the mechanisms underlying and propagating vein graft disease in order better to optimise outcomes for this niche patient group after CABG.

In-hospital outcome of patients hospitalized for leukemia with comorbid acute decompensated heart failure: An analysis of National Inpatient Sample (NIS).

173 Background: Recent evidence found increase incidence of heart failure in leukemia patients, influenced by various factors such as the underlying disease and medication usage. Nevertheless, there remains a scarcity of data regarding the in-hospital outcome for individuals admitted for leukemia with comorbid acute decompensated heart failure. Thus, we aim to examine the impact of heart failure on clinical outcomes in leukemia patients. Methods: We utilized the 2020 U.S. National Inpatient Sample (NIS) to investigate patients admitted for leukemia with concurrent diagnosis of heart failure, identified through ICD-10 CM codes. Adjusted odds ratios (aORs) for predefined outcomes were determined using multivariable logistic and linear regression model, adjusting for comorbidities. The primary outcome assessed was inpatient mortality, while secondary outcomes included complications related to various body systems. Results: We identified 43,955 patients with a primary discharge diagnosis of leukemia. The mean age was 54.5 years; 49.7% were female. Caucasians accounted for 66%, followed by African Americans (13%). Of these, 11.86% (5,220/43,955) had a concurrent diagnosis of heart failure. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, comorbid acute decompensated heart failure was associated with higher in-hospital mortality (aOR 1.57, 95% CI: 1.2, 1.94, p &lt; 0.001), higher mean length of stay (Beta-coefficient 1.93; 95% CI: 0.65, 3.21, p = 0.003), mean total hospital cost (Beta-coefficient 9,472, 95% CI: 2,339, 16,604, p = 0.004), shock (aOR 2.41, 95% CI: 1.84, 3.15, p &lt; 0.001), sepsis (aOR 1.71, 95%CI: 1.38, 2.12, p &lt; 0.001), acute respiratory failure (aOR 2.37, 95% CI: 1.96, 2.87, p &lt; 0.001), and acute kidney injury (aOR 1.57, 95% CI: 1.32, 1.85, p &lt; 0.001). Conclusions: Our study revealed that hospitalized leukemia patients with concurrent heart failure experience higher risk of in-hospital mortality and various adverse in-hospital outcomes. Close monitoring of this factor during hospitalization is essential, and additional longitudinal research is warranted to fully understand this association.

Immune and inflammation features of severe and critical Omicron infected patients during Omicron wave in China

ObjectiveThe current study aimed to investigate the baseline immune and inflammatory features and in-hospital outcomes of patients infected with the Omicron variant (PIWO) who presented with different disease severities during the first wave of mass Omicron infections in the Chinese population has occurred.MethodA cross‐sectional study was conducted on 140 hospitalized PIWO between December 11, 2022, and February 16, 2023. The clinical features, antibodies against SARS-CoV-2, immune cells, and inflammatory cytokines among mildly, severely, and critically ill PIWO at baseline and during follow-up period were compared.ResultPatients with severe (n = 49) and critical (n = 35) disease were primarily male, needed invasive mechanical ventilation treatment, and exhibited higher mortality than those with mild disease (n = 56). During acute infection, SARS-CoV-2-specific antibody levels fluctuated with disease severity, serum antibodies increased and the incidence of severe cases decreased in critically ill PIWO over time. Antibody titers in severe or critical PIWO with no antibody responses at baseline did not increase significantly over time. Meanwhile, CD4+T cell, CD8+T cell, and natural killer cell counts were negatively correlated with disease severity, whereas interleukin (IL)-6 and IL-10 levels were positively correlated. In addition, combined diabetes, immunosuppressive therapy before infection, serum amyloid A, IL-10 and neutrophil counts were independently associated with severe and critical illness in PIWO. Among the 11 nonsurvivors, 8, 2, 1 died of respiratory failure, sudden cardiac death, and renal failure, respectively. Compared with survivors, nonsurvivors exhibited lower seropositivity of SARS-CoV-2-specific antibody, reduced CD3+T and CD4+T cell counts, and higher IL-2R, IL-6, IL-8, and IL-10 levels. Of note, lactate dehydrogenase was a significant risk factor of death in severe or critically ill PIWO.ConclusionThis present study assessed the dynamic changes of SARS-CoV-2-specific antibodies, immune cells and inflammatory indexes between severely and critically ill PIWO. Critical and dead PIWO featured compromised humoral immune response and excessive inflammation, which broadened the understanding of the pathophysiology of Omicron infection and provides warning markers for severe disease and poor prognosis.

Comparison of In-Hospital Outcomes in Patients Transferred for Left Ventricular Assistance Device vs Those With in-House Support in STEMI Complicated by Cardiogenic Shock.

Comparison of In-Hospital Outcomes in Patients Transferred for Left Ventricular Assistance Device vs Those With in-House Support in STEMI Complicated by Cardiogenic Shock.