In-hospital Outcomes In Patients Research Articles

Significance of Anteroseptal Late Gadolinium Enhancement Among Patients With Acute Myocarditis

Anteroseptal location of late gadolinium enhancement (LGE) in patients with acute myocarditis (AM) detected by cardiovascular magnetic resonance may indicate an independent marker of unfavorable outcomes according to recent data. We aimed to evaluate the clinical characteristics, management, and inhospital outcomes in patients with AM with positive LGE based on its presence in the anteroseptal location. We analyzed data from 262 consecutive patients hospitalized with a diagnosis of AM with positive LGE within 5days of hospitalization (n=425). Patients were divided into 2 groups: those with anteroseptal LGE (n=25, 9.5%) and those with non-anteroseptal LGE (n=237, 90.5%). Except for age that was higher in patients with anteroseptal LGE, the demographic and clinical characteristics did not differ significantly between both groups including past medical history, clinical presentation, electrocardiogram parameters, and lab values. Moreover, patients with anteroseptal LGE were more likely to present with reduced left ventricular ejection fraction and to receive congestive heart failure treatments. Although univariate analysis showed that patients with anteroseptal LGE were more likely to have inhospital major adverse cardiac events (28% vs 9%, p=0.003), there was no difference inhospital outcomes on multivariable analysis between both groups (hazard ratio, 1.17 [95% confidence interval, 0.32 to 4.22], p=0.81). A higher left ventricular ejection fraction in either echocardiography or cardiovascular magnetic resonance corresponded to better inhospital outcomes regardless of the presence or absence of anteroseptal LGE. In conclusion, the presence of anteroseptal LGE did not confer additional prognostic value for inhospital outcomes.

Lipoprotein(a) Does Not Predict Thrombotic Events and In-Hospital Outcomes in Patients with COVID-19.

The prothrombotic and proinflammatory properties of lipoprotein(a) (Lp(a)) have been hypothesized to play a role in the pathogenesis of severe COVID-19; however, the prognostic impact of Lp(a) on the clinical course of COVID-19 remains controversial. This study aimed to investigate whether Lp(a) may be associated with biomarkers of thrombo-inflammation and the occurrence of thrombotic events or adverse clinical outcomes in patients hospitalized for COVID-19. We consecutively enrolled a cohort of patients hospitalized for COVID-19 and collected blood samples for Lp(a) assessment at hospital admission. A prothrombotic state was evaluated through D-dimer levels, whereas a proinflammatory state was evaluated through C-reactive protein (CRP), procalcitonin, and white blood cell (WBC) levels. Thrombotic events were marked by the diagnosis of deep or superficial vein thrombosis (DVT or SVT), pulmonary embolism (PE), stroke, transient ischemic attack (TIA), acute coronary syndrome (ACS), and critical limb ischemia (CLI). The composite clinical end point of intensive care unit (ICU) admission/in-hospital death was used to evaluate adverse clinical outcomes. Among 564 patients (290 (51%) men, mean age of 74 ± 17 years) the median Lp(a) value at hospital admission was 13 (10-27) mg/dL. During hospitalization, 64 (11%) patients were diagnosed with at least one thrombotic event and 83 (15%) patients met the composite clinical end point. Lp(a), as either a continuous or categorical variable, was not associated with D-dimer, CRP, procalcitonin, and WBC levels (p > 0.05 for all correlation analyses). In addition, Lp(a) was not associated with a risk of thrombotic events (p > 0.05 for multi-adjusted odds ratios) nor with a risk of adverse clinical outcomes (p > 0.05 for multi-adjusted hazard ratios). In conclusion, Lp(a) does not influence biomarkers of plasma thrombotic activity and systemic inflammation nor has any impact on thrombotic events and adverse clinical outcomes in patients hospitalized for COVID-19.

Association of serum lipid profile ratios with disease severity and in-hospital outcome of patients with COVID-19

Background: The association of lipid ratios with the severity and hospital outcome of COVID-19 patients has been a topic of interest in the medical community. Lipids, particularly cholesterol and triglycerides, play a significant role in the human body, including cell membrane formation, energy storage and the regulation of various biological processes. The aim of this study was to assess the association of lipid ratio with the severity and hospital outcome of COVID-19 patients. Methods: This observational study was carried out in COVID unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) among hospital admitted COVID patients from March 2021 to February 2022. Results: Total patients were 138 including 65.9% males. Majority (27.5%) were in the 41-50 age group. One third (31.2%) were clinically severe COVID-19. There was overall significant difference of lipid ratio in different severity except LDL/HDL group (p>0.05). The correlation coefficients of disease severity with TC/HDL (rs)=.338, LDL/HDL (rs)=.289 and TG/HDL (rs)=.444. There was significant correlation between disease severity and lipid ratio having moderate correlation with TG/HDL and weak correlation with TC/HDL and LDL/HDL. The correlation coefficients between TC/HDL and hospital outcomes of use/development of rebreather (rs)=.217, HFNC (rs)=.282, ARDS (rs)=.307, arrhythmia (rs) = .201, HDU/ICU (rs)=.200 and ventilator (rs)=.072. There was significant correlation between TC/HDL and development of ARDS, use of rebreather and HFNC and no other significant correlation with other outcomes. The correlation coefficients between LDL/HDL and hospital outcomes of use/development of rebreather (rs)=.211, HFNC (rs)=.132, ARDS (rs)=.286, arrhythmia (rs)=.106, HDU/ICU (rs)=.064 and ventilator (rs)=.028. There was no significant correlation between LDL/HDL and hospital outcomes. The correlation coefficients between TG/HDL and hospital outcomes of use/development of rebreather (rs)=.427, HFNC (rs)=.271, ARDS (rs)=.502, arrhythmia (rs)=.088, HDU/ICU (rs)=.158 and ventilator (rs) =.041. There was significant correlation between TG/HDL and development of ARDS, also with use of rebreather and HFNC. No other significant correlation found with other outcomes. Conclusion: From the findings of this current study, in can be concluded that lipid ratios are associated with disease severity and hospital outcome of COVID-19 patients. There was moderate association between disease severity and TG/HDL and weak association with TC/HDL and LDL/HDL. There was also association between TC/HDL and the development of ARDS and the use of HFNC and between TG/HDL and the development of ARDS, the use of rebreather, and HFNC. BIRDEM Med J 2023; 13(2): 98-102

Use of Prognostication Instruments in Prognostication Procedures of Postanoxic Coma Patients over Time: A Retrospective Study.

Many survivors of cardiovascular arrest remain in a postanoxic coma. The neurologist's task is to provide the most accurate assessment of the patient's neurologic prognosis through a multimodal approach of clinical and technical tests. The aim of this study is to analyze differences and developments in the concept of neurological prognosis assessment and in-hospital outcome of patients over a five year-period. This retrospective observational study included 227 patients with postanoxic coma treated in the medical intensive care unit of the University Hospital, Mannheim from January 2016 to May 2021. We retrospectively analyzed patient characteristics, post-cardiac arrest care, and the use of clinical and technical tests for neurological prognosis assessment and patient outcome. Over the observation period, 215 patients received a completed neurological prognosis assessment. Regarding the multimodal prognostic assessment, patients with poor prognosis (54%) received significantly fewer diagnostic modalities than patients with very likely poor (20.5%), indeterminate (24.2%), or good prognosis (1.4%; p = 0.001). The update of the DGN guidelines in 2017 had no effect on the number of performed prognostic parameters per patient. The finding of bilaterally absent pupillary light reflexes or severe anoxic injury on CT contributed most to a poor prognosis category (OR 8.38, 95%CI 4.01-7.51 and 12.93, 95%CI 5.55-30.13, respectively), whereas a malignant EEG pattern and NSE > 90 µg/L at 72 h resulted in the lowest OR (5.11, 95%CI 2.32-11.25, and 5.89, 95%CI 3.14-11.06, respectively) for a poor prognosis category. Assessment of baseline NSE significantly increased over the years (OR 1.76, 95%CI 1.4-2.22, p < 0.001), and assessment of follow-up NSE at 72 h trended to increase (OR 1.19, 95%CI 0.99-1.43, p = 0.06). In-hospital mortality was high (82.8%), remained unchanged over the observation period, and corresponded to the number of patients in whom life-sustaining measures were discontinued. Among comatose survivors of cardiac arrest, the prognosis remains poor. Prognostication of a poor outcome led nearly exclusively to withdrawal of care. Prognostic modalities varied considerably with regard to their contribution to a poor prognosis category. Increasing enforcement of a standardized prognosis assessment and standardized evaluation of diagnostic modalities are needed to avoid false-positive prognostication of poor outcomes.

Association of Serum Vit D level with in-Hospital Outcome in Patients with Acute Myocardial Infarction

Background: Low Vitamin D (Vit D) level is associated with disease severity amongst critical acute myocardial infarction (AMI) patients. This leads to the hypothesis that Vit D plays a role in the emergence of cardiac risk factors, contributing to worsening AMI patients' short- and long-term prognoses. Therefore, there is still unclear data showing the potential impact of Vit D insufficiency or deficiency on the morbidity and mortality of AMI patients. So far, there has been no research conducted in Pakistan examining whether or not Vit D status are association to the outcome of hospitalization for coronary artery disease. Objective: The objective of the study is to examine the relationship between Vit D status on hospital admission and subsequent mortality and morbidity among patients with acute myocardial infarction. Study Design: Cross sectional observational study Study Setting: This study was conducted in the department of Interventional Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi from Ist August 2022 to 31st January 2023. Methodology: Total 250 subjects were enrolled in the study and divided in to two groups. Group A with normal Vit D (30ng/ml or above) and Group B included lower Vit D level than 30ng/ml, all patients were suffering from AMI. Baseline demographic characteristics, including age, and gender (male/female), was recorded. The patients were tested for Vit D status and distributed in their respective groups. The history, complications, and clinical data were included. The stay in the hospital and any adverse outcomes that appeared during the stay were also recorded. The clinical results include HDL, TG, and troponin I of every patient were noted for the clinical correlation of AMI patients with adequate and deficiency of Vit D level. All the data was collected in the form of a questionnaire. The statistical analysis was done by using SPSS version 20. Results: Participants' mean ages were 53.8 and 5.9 years old. Group A (patients with low Vit D status) averaged 59.6 years of age, whereas Group B (58.9 years) had normal Vit D status. The analysis showed a statistically non- significant (p&gt;0.05) difference in average age between the groups. There were 250 patients, with male 43.6% and female 56.4%. Men (63.2%) and women (36.8%) were in Group A. There were 71.4% males and 28.6% females in Group B. We found out the 137(60.6%) significant adverse hospital outcomes (p&lt;0.001) in Group B and had a more significant proportion of patients with diabetes mellitus and who had smoked (p = 0.002 and 0.001, respectively). In a multivariate logistic regression smoking, diabetes, Troponin I and low vitamin showed the significant risk association (p&lt;0.001). Practical Implication: There is still a lack of conclusive evidence on the relationship between vitamin D insufficiency or deficiency and the morbidity and mortality of AMI patients. Until far, there has been no research in Pakistan linking serum vitamin D levels to in-hospital outcomes for patients suffering from acute myocardial infarction. Conclusion: The research shows an association between low Vit D status, adverse outcomes, and clinical parameters after AMI. A low blood Vit D level is independently associated to an increased risk of developing severe clinical outcomes during hospitalization, including death after an AMI. Keyword: Vit D, AMI, Vit D deficiency, low Vit D, Cardiovascular disease

PO-05-159 IMPACT OF ARRHYTHMIAS IN PATIENTS ADMITTED WITH SARCOIDOSIS: A NATIONWIDE PERSPECTIVE

Sarcoidosis is a chronic granulomatous disorder with multiorgan involvement. Cardiac sarcoidosis is characterized by the growth of granulomas in any part of the heart which portends a poor prognosis. These granulomas can cause conduction abnormalities. However, less is known about the in-hospital outcomes in patients with sarcoidosis who have concurrent arrhythmias. We aimed to identify whether arrhythmia impacted these outcomes. Objective was to study the impact of arrhtymias on in-hospital outcomes in patients with sarcoidosis. We queried the National Inpatient Sample (NIS) database of 2018- 2020. Adults admitted with a primary or secondary diagnosis of sarcoidosis were included. This population was stratified into those with and without arrhythmia {atrial fibrillation [AF], atrial flutters, SVTs, heart blocks [first, second degree, complete heart blocks (CHB)], ventricular tachycardia [VT] and fibrillation [VF]}. Demographics and association with other comorbidities was studied. Multivariate regression analysis was performed to identify the impact of arrhythmias taking mortality as primary outcome and total hospital cost as secondary. A total of 383385 hospitalised patients had sarcoidosis. Of those, 85205 (22.22%) had arrhythmias. Mean age was 59 years and 54.03% were females. Traditional cardiac risk factors like diabetes mellitus (39.79% vs 37.61%, p<0.05),and hyperlipidemia (48.39% vs 38.79%, p<0.01) were more prevalent in the cohort of sarcoid patients with arrhythmias. The prevalence of valvular abnormalities(25.12% vs 16.85%,p<0.01), CAD (33.32% vs 17.72%, p<0.01) and old myocardial infarction (8.9% vs 5.32%, p<0.01) was also significantly higher in these patients. After adjusting for covariates, the odds of mortality was higher with VF, VT, CHB and AF in adult patients with sarcoidosis (table 1). The total hospital charge was also considerably more in sarcoid patients with concomitant VF, VT, CHB and AF (table 1). This study concludes that patients with sarcoidosis have a higher prevalence of risk factors like diabetes and hyperlipidemia and also how the presence of underlying arrhythmias leads to significantly worse outcomes in terms of mortality and in-hospital cost. These findings necessitate the need for further research to understand the pathophysiology of arrhythmias in Sarcoidosis cohort. This will further help in guiding therapeutic interventions to prevent the burden of arrhythmias in patients with sarcoidosis to improve patient outcomes.

A-17 | In-Hospital Outcomes of Patients With Gout Complicaited by Acute ST Elevation Myocardial Infarction (STEMI)

A-17 | In-Hospital Outcomes of Patients With Gout Complicaited by Acute ST Elevation Myocardial Infarction (STEMI)

B-58 | Impact of the “July Effect” on In-Hospital Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement

B-58 | Impact of the “July Effect” on In-Hospital Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement

CE-452776-4 ATRIAL FIBRILLATION IS ASSOCIATED WITH HIGHER INPATIENT MORTALITY AS COMPARED WITH SINUS TACHYCARDIA IN PATIENTS WITH CARDIOGENIC SHOCK

Cardiogenic shock (CS) is commonly associated with a compensatory atrial stress response like sinus tachycardia (ST) or atrial fibrillation (AF). However, there is paucity of data comparing inpatient outcomes in patients with cardiogenic shock presenting with AF versus ST. To compare the impact of AF and ST on in-hospital outcomes in patients admitted with cardiogenic shock. We queried the National Inpatient Sample database to identify primary hospitalizations of CS using ICD-9/ICD-10 CM codes between 2009 and 2019. The study cohort was further divided into three groups based on the concurrent diagnosis of AF, ST, and a comparator group of no AF/ST. Our cohort included a total of 1,376,187 hospitalizations with a diagnosis of CS. Multivariate analysis showed CS hospitalizations with AF as compared with ST, had significantly higher odds of all-cause in-hospital mortality [aOR 1.07 (1.03-1.11) p=0.0005], CRT implantation [aOR 2.38 (1.88-3.03) p<0.001] and AV node ablation [aOR 3.22 (2.63-4.00) p<0.001]. Patients hospitalized with CS without concurrent AF/ST vs concurrent AF had significantly higher odds of all-cause in-hospital mortality [aOR 1.07 (1.06-1.08) p<0.001] and utilization of mechanical circulatory support [aOR 1.33 (1.31-1.34) p<0.001] but lower odds of CRT [aOR 0.76 (0.73-0.80) p<0.001] and AV node ablation [aOR 0.38 (0.37-0.40) p<0.001]. Our data suggest that patients admitted for CS and AF have worse outcomes including higher inpatient mortality, compared to those with CS and ST. However, compared to those without ST or arrhythmias, AF patients had a lower in-hospital mortality. These data are hypothesis generating and merit further study to better inform management of patients with CS and atrial arrhythmias.

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.

Does the Type of Chronic Heart Failure Impact In-Hospital Outcomes for Aortic Valve Replacement Procedures?

This study assessed in-hospital outcomes of patients with chronic systolic, diastolic, or mixed heart failure (HF) undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). The Nationwide Inpatient Sample database was used to identify patients with aortic stenosis and chronic HF who underwent TAVR or SAVR between 2012 and 2015. Propensity score matching and multivariate logistic regression were used to determine outcome risk. A cohort of 9,879 patients with systolic (27.2%), diastolic (52.2%), and mixed (20.6%) chronic HF were included. No statistically significant differences in hospital mortality were noted. Overall, patients with diastolic HF had the shortest hospital stays and lowest costs. Compared with patients with diastolic HF, the risk of acute myocardial infarction (TAVR odds ratio [OR], 1.95; 95% CI, 1.20-3.19; P = .008; SAVR OR, 1.38; 95% CI, 0.98-1.95; P = .067) and cardiogenic shock (TAVR OR, 2.15; 95% CI, 1.43-3.23; P < .001; SAVR OR, 1.89; 95% CI, 1.42-2.53; P ≤ .001) was higher in patients with systolic HF, whereas the risk of permanent pacemaker implantation (TAVR OR, 0.58; 95% CI, 0.45-0.76; P < .001; SAVR OR, 0.58; 95% CI, 0.40-0.84; P = .004) was lower following aortic valve procedures. In TAVR, the risk of acute deep vein thrombosis and kidney injury was higher, although not statistically significant, in patients with systolic HF than in those with diastolic HF. These outcomes suggest that chronic HF types do not incur statistically significant hospital mortality risk in patients undergoing TAVR or SAVR.

PO-05-119 SEX DIFFERENCES IN IN-HOSPITAL OUTCOMES OF PATIENTS UNDERGOING VENTRICULAR TACHYCARDIA ABLATION: INSIGHTS FROM THE NATIONWIDE INPATIENT SAMPLE

There is limited data on the sex differences in in-hospital outcomes of patients undergoing ventricular tachycardia (VT) ablation. We aimedto utilize a nationwide cohort to determine the sex differences in in-hospital outcomes of patients undergoing VT ablation in the United States. We utilized the Nationwide Inpatient Sample (NIS) from 2016-2019 to identify the patients undergoing VT ablation. Primary outcome was in-hospital mortality. Secondary outcomes included cardiogenic shock, acute kidney injury (AKI), new requirement of dialysis, cardiac tamponade, blood transfusion, and vascular complications. Multivariate logistic regression was used to adjust for baseline characteristics. There were a total of 34,425 hospitalizations for VT ablation during 2016-2019, of which 8,262 (24%) were in female patients. Females undergoing VT ablation were younger and had significantly fewer comorbidities including congestive heart failure, peripheral vascular disease, coronary artery disease, chronic obstructive pulmonary disease, diabetes, and coagulopathy. After adjustment for baseline characteristics, there were no significant differences between females and males in adjusted in-hospital mortality [aOR: 1.03 (0.72-1.46), p=0.86], cardiac tamponade and blood transfusion. Females had significantly lower odds of developing AKI, however they were more likely to have vascular complications. Females represent one-fifth of patients undergoing VT ablation in the United States, and are younger and with fewer comorbidities compared to males. Although vascular complications were more common in females and AKI more frequent in males, no significant sex differences in other major peri-procedural complications and in-hospital mortality were found.

Impact of Frailty on In-Hospital Outcomes in Patients Who Underwent Percutaneous Left Atrial Appendage Occlusion

Impact of Frailty on In-Hospital Outcomes in Patients Who Underwent Percutaneous Left Atrial Appendage Occlusion

Clinical Characteristics and In-Hospital Outcomes in Patients with Iliopsoas Abscess: A Multicenter Study.

(1) Background: Iliopsoas abscess (IPA) is usually overlooked due to its nonspecific symptoms and signs. The resulting delayed diagnosis and treatment can increase morbidity and mortality. The purpose of the present study was to identify the risk factors for the unfavorable outcomes associated with IPA. (2) Methods: We included patients who presented to the emergency department and were diagnosed with IPA. The primary outcome was in-hospital mortality. Variables were compared, and the associated factors were examined with Cox proportional hazards model. (3) Results: Of the 176 patients enrolled, IPA was of primary origin in 50 patients (28.4%) and of secondary origin in 126 (71.6%). Skeletal origin was the most common source of secondary IPA (n = 92, 52.3%). The most common pathogens were Gram-positive cocci. Eighty-eight (50%) patients underwent percutaneous drainage, 32 (18.2%) patients underwent surgical debridement, and 56 (31.8%) patients received antibiotics. Multivariate analyses indicated that age > 65 (year) (HR = 5.12; CI 1.03-25.53; p = 0.046), congestive heart failure (HR = 5.13; CI 1.29-20.45; p = 0.021), and platelet < 150 (103/μL) (HR = 9.26; CI 2.59-33.09; p = 0.001) were significant independent predictors of in-hospital mortality in Model A, while the predictors in Model B included age > 65 (year) (HR = 5.12; CI 1.03-25.53; p = 0.046) and septic shock (HR = 61.90; CI 7.37-519.46; p < 0.001). (4) Conclusions: IPA is a medical emergency. Our study reported that patients with advanced age, congestive heart failure, thrombocytopenia, or septic shock had a significantly higher risk of mortality, and the recognition of the associated factors may aid in risk stratification and the determination of the optimal treatment plan for IPA patients.

STUDY OF HEMATOLOGICAL INDICES IN HEART FAILURE WITH REDUCED EJECTION FRACTION AND THEIR ASSOCIATION WITH IN-HOSPITAL OUTCOME.

Background And Objectives: In heart failure with reduced ejection fraction, various hematological parameters are known to be of prognostic signicance. This study aimed to correlate these parameters with in-hospital outcome in patients. Patients hospitalized heart failure Methods: were enrolled. Hematological indices, including white blood cell counts, neutrophil counts, neutrophil-to-lymphocyte ratio, platelet-tolymphocyte ratio and monocyte to lymphocyte ratio were recorded. The study considered 55 Results: patients out of which 29 were male and 26 were female.mean duration of stay in hospital was 5.29 + 3.12. ). Patients with NLR &gt; 3.74 &amp; with MLR &gt; 0.49 had a 8.41 &amp; 3.33 times higher risk of in-hospital mortality Interpretation And Conclusion: In this study ,NLR, MLR and PLR were independent predictors of in hospital mortality with NLR &gt; 3.74 having the highest independent predictor power in prediction of in-hospital mortality

In-hospital Outcomes For Patients With A Heart Transplant In Sepsis And Septic Shock

In-hospital Outcomes For Patients With A Heart Transplant In Sepsis And Septic Shock

Demographic characteristics, clinical presentation and in-hospital outcome among patients with Covid-19 in a Nigerian tertiary hospital.

We described the demographic/clinical characteristics and in-hospital outcome of patients with COVID-19 at the University of Nigeria Teaching Hospital (UNTH) during the first wave to inform evidence-based responses during subsequent waves in Africa. We conducted retrospective cohort analyses of adult patients ≥18 years with PCR or GeneXpert-confirmed SARS-CoV-2 infection. Data was extracted from patients' medical records from 1st May to 30th September 2020. Based on disease severity, patients were either hospitalized (82) or managed at home (90). Logistic regression and cox-proportional hazard models were used to determine predictors of severe COVID-19 disease and in-hospital mortality, respectively. Of 172 cases, 113 (65.7%) were males, and the mean age was 45 ± 19 years. The majority were urban dwellers (72.1%), 19.8% had a positive history of contact with a confirmed/suspected case, 15.7% were healthcare workers while 68 (39.5%) had co-morbidities. Symptomatic patients comprised 73.3% of cases. Fever (p=0.02) and breathlessness (p=0.03) were commoner in males while diarrhoea (p<0.01) was predominant in females. On multivariate analysis, severe COVID-19 was predicted by the presence of co-morbidity (AOR= 14.44, 95% C.I= 4.79- 43.58, p <0.001)and prior antibiotic/antimalarial use (AOR= 6.35, 95% C.I= 2.24- 18.05, p =0.001) while being a non-healthcare worker (AOR= 0.18, 95% C.I= 0.04-0.78, p=0.02) was protective. However, none of the variables assessed predicted in-hospital mortality. Our findings underscore the contributions of demographic variables in COVID-19 transmission and gender differences in clinical presentation. Underlying comorbidity likewise prior antimicrobial use increased the likelihood of severe COVID-19. The absence of mortality predictors in our study may be related to the relatively small number of deaths. Further studies are recommended to unravel the predominance of severe disease in healthcare workers.

Effect of Coronary Artery Dominance In-terms of Presentation and In-hospital Outcomes of patients undergoing Primary PCI for Culprit Proximal Left Anterior Descending Artery

Objectives: Objective of this study was to assess the difference in terms of presentation and in-hospital course between patients with right vs. left dominant arterial circulation undergoing “primary percutaneous coronary intervention (PCI)” for culprit proximal left anterior descending artery (LAD). Methodology: We included consecutive adult (≥18 years) patients diagnosed with STE-ACS undergoing primary PCI for culprit proximal LAD. Patients were categorized into right vs. left dominant circulation on left heart catheterization. Demographic, clinical characteristics, presentation, and hospital course were compared between the matched (propensity matched) and unmatched cohort of patients with right vs. left dominance. Results: We included 775 patients, out of which 81.3% (630) were males and mean age was 54.59 ± 11.3 years. On coronary angiogram left dominance was observed in 14.3% (111). Single vessel disease was higher with left compared to right dominant system, 53.2% vs. 43.5%, respectively. The rate of slow flow/no-reflow (15.4% vs. 7.2%; p=0.0.230), heart failure (9.3% vs. 6.3%; p=0.299), and in-hospital mortality (5.1% vs. 3.6%, p=0.493) were not different between right vs. left dominance, respectively. In the matched cohorts, the frequency of slow flow/no-reflow (15.3% vs. 7.2%; p=0.056), heart failure (6.3% vs. 6.3%; p&gt;0.999), and mortality (5.4% vs. 3.6%, p=0.493) were not different between right vs. left dominance, respectively. Conclusion: No significant increase in complications and outcomes is witnessed among patients with left dominant arterial circulation undergoing primary PCI for culprit proximal LAD. However, careful handling of left main during intervention is warranted due lack of support from right system.

Impact of Chronic Heart Failure on Acute Pulmonary Embolism in-Hospital Outcomes (From a Contemporary Study)

There is a paucity of evidence on the impact of chronic heart failure (HF) on acute pulmonary embolism (PE) hospitalization outcomes. The aim of this study was to evaluate the in-hospital outcomes of patients with chronic HF and acute PE. A total of 1,391,145 hospitalizations with acute PE from the National Inpatient Sample Database from 2011 to 2019 were included. The database was queried for relevant International Classification of Diseases, Ninth and Tenth Revisions procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes for patients with acute PE were compared in patients with and without a history of chronic HF. Multivariate logistic regression analyses were performed, adjusting for age, race, gender, and statistically significant co-morbidities between cohorts. A pvalue <0.001 was considered significant. Overall, the mean age was 65.2±16years; 50.9% of patients were women, and 230,875 patients (16.6%) had chronic HF. The patients in the chronic HF cohort were predominantly older (mean age 69.0 vs 61.4years) and male (49.9% vs 48.3%). In the multivariate model, chronic HF was associated with increased all-cause mortality (odds ratio [OR] 1.6, 95% confidence interval [CI], 1.57 to 1.63, 10.4% vs 5.7%), acute respiratory distress (OR 1.7, 95% CI 1.70 to 1.74, 39.5% vs 22.1%), cardiac arrest (OR 1.4, 95% CI 1.40 to 1.49, 3.9% vs 2.2%), and cardiogenic shock (OR 3.0, 95% CI 2.85 to 3.06, 4.2% vs 1.2%). All pvalues were <0.001.In conclusion, patients with PE and chronicHF are associated with increased in-hospital complications compared with patients with PE and without chronic HF.Prospective studies are needed to evaluate optimal management strategies in this population at high risk.

In-hospital Outcomes of Patients With and Without Previous Coronary Artery Bypass Graft Surgery Who Present With a Non-ST-Segment Elevation Myocardial Infarction

The clinical course of patients with a previous coronary artery bypass graft surgery (CABG) presenting with non-ST-elevation myocardial infarction (NSTEMI) is not well defined. We aimed to compare the management and outcomes of patients with and without previous CABG who present with an NSTEMI. Patients hospitalized with an NSTEMI between 2002 and 2018 were identified from the National Inpatient Sample. The baseline characteristics and outcomes of patients with and without a previous CABG were compared. The outcomes included the rates of invasive procedures (defined as coronary angiography, percutaneous coronary intervention [PCI], or CABG), and its individual components, and in-hospital mortality. A total of 1,445,545 cases of NSTEMI were found, of which 133,691 (9.3%) had a previous CABG. Patients with a previous CABG were older (72.4 vs 68.6years, p <0.001), more likely men (68.8% vs 56.9%, p <0.001), and of White race (79.7% vs 74.8%, p <0.001). The previous CABG cohort had lower rates of invasive procedures (50.4% vs 65.6%, p <0.001), PCI (23.7% vs 32.0%, p <0.001), or CABG (1.2% vs 10.6%; p <0.001) in the unmatched analysis. The results were consistent in the propensity score-matched analysis with the previous CABG group less likely to receive any invasive procedures (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.47 to 0.49), including coronary angiography (OR 0.54, 95% CI 0.53 to 0.55), PCI (OR 0.66, 95% CI 0.64 to 0.67), or repeat CABG (OR 0.11, 95% CI 0.10 to 0.12). Moreover, the risk of in-hospital mortality was higher in the previous CABG group (OR 1.15, 95% CI 1.10 to 1.21). In the subset of patients who were revascularized in both groups, this excess mortality was no longer observed (OR 0.82, 95% CI 0.66 to 1.03). In conclusion, a previous CABG in patients who present with NSTEMI is associated with lower rates of invasive procedures and revascularization and higher in-hospital mortality than patients without a previous CABG.