In-hospital Prognosis Research Articles

IMPACT OF THE MEDITERRANEAN DIET ON PATIENTS WITH A FIRST ACUTE MYOCARDIAL INFARCTION

Several studies have evaluated the influence of different dietary habits on the risk of acute myocardial infarction and on the long-term prognosis after a coronary event, whilst no clear data are available on the in-hospital and short-term prognosis. We assessed the role of dietary habits and, in

Prognostic Significance of Complex Ventricular Arrhythmias Complicating ST-Segment Elevation Myocardial Infarction

The aim of the study was to assess the clinical significance of complex ventricular arrhythmias (VAs) (sustained ventricular tachycardia [sVT] and ventricular fibrillation [VF]) in patients with ST-segment elevation myocardial infarction (STEMI) depending on timing of arrhythmia. We analyzed 4,363 consecutive patients with STEMI treated invasively between 2004 and 2014. The median follow-up was 69.6 months (range: 0 to 139.8 months). The study population was divided into 2 main groups; VA group encompassed 476 patients (10.91%) with VAs, whereas 3,887 subjects (89.09%) without VT or VF were included into the control group. In VA population, prereperfusion VA (34.24%; n = 163) was the most common arrhythmia, whereas reperfusion-induced, early postreperfusion, and late postreperfusion VAs were diagnosed in 103 (21.64%), 103 (21.64%), and 107 (22.48%) patients, respectively. Every type of sVT or VF complicating STEMI portended significantly worse in-hospital prognosis, however a late onset arrhythmia was associated with the highest (over fivefold) and reperfusion-induced VA with the lowest (less than threefold) increase in mortality risk compared with the control group. On the contrary, long-term mortality was significantly increased only in subjects with late postreperfusion and prereperfusion VAs compared with VA-free population (43.93% and 36.81%, respectively vs 22.58%; p <0.001). Apart from cardiogenic shock on admission, late postreperfusion (hazard ratio 3.39) and prereperfusion VAs (hazard ratio 2.76) were the strongest independent predictors of death in the analyzed population. In conclusion, 1 in 10 patients with STEMI treated invasively was affected by sVT or VF. The clinical impact of VAs was strongly dependent on timing of arrhythmia.

Prognostic value of hyperglycemia on-admission in diabetic versus non-diabetic patients presenting with ST-elevation myocardial infarction in Tunisia

BackgroundHyperglycemia on-admission is a powerful predictor of adverse events in patients presenting for ST-elevation myocardial infarction (STEMI). AimIn this study, we sought to determine the prognostic value of hyperglycemia on-admission in Tunisian patients presenting with STEMI according to their diabetic status. MethodsPatients presenting to our center between January 1998 and September 2014 were enrolled. Hyperglycemia was defined as a glucose level ≥11mmol/L. In-hospital prognosis was studied in diabetic and non-diabetic patients. The predictive value for mortality of glycemia level on-admission was assessed by mean of the area under receiver operating characteristic (ROC) curve calculation. ResultsA total of 1289 patients were included. Mean age was 60.39±12.8years and 977 (77.3%) patients were male. Prevalence of diabetes mellitus was 70.2% and 15.2% in patients presenting with and without hyperglycemia, respectively (p<0.001). In univariate analysis, hyperglycemia was associated to in-hospital death in diabetic (OR: 8.85, 95% CI: 2.11–37.12, p<0.001) and non-diabetic patients (OR: 2.57, 95% CI: 1.39–4.74, p=0.002). In multivariate analysis, hyperglycemia was independently predictive of in-hospital death in diabetic patients (OR: 9.6, 95% CI: 2.18–42.22, p=0.003) but not in non-diabetic patients (OR: 1.93, 95% CI: 0.97–3.86, p=0.06). Area under ROC curve of glycemia as a predictor of in-hospital death was 0.792 in diabetic and 0.676 in non-diabetic patients. ConclusionIn patients presenting with STEMI, hyperglycemia was associated to hospital death in diabetic and non-diabetic patients in univariate analysis. In multivariate analysis, hyperglycemia was independently associated to in-hospital death in diabetic but not in non-diabetic patients.

Effects of Hyperglycemia on the In-hospital and Long-term Prognosis of Patients with Acute ST-segment Elevation Myocardial Infarction

Objective: A large amount of acute ST-segment elevation myocardial infarction (STEMI) patients have stress hyperglycemia on admission, which is associated with poor in-hospital and long-term prognosis. This research aimed to find the effects of hyperglycemia on in-hospital mortality, adverse cardiovascular events and long-term prognosis in patients with STEMI.Method: We conducted a prospective cohort study on 456 STEMI patients from January 2015 to December 2016 in Zhongda hospital affiliated to Southeast University. We recorded the baseline data, then used propensity matching (a ratio of 1:2) to balance the confounding variables and rule out the bias, according to the definition of stress hyperglycemia, admission random blood glucose >11.1 mmol/L, we divided patients into two groups: hyperglycemia group (71 cases) and non-hyperglycemia group (142 cases). We recorded and compared the baseline data, past history, auxiliary examination index, medication usage, coronary angiography data, and inhospital outcome between two groups. One-year follow-up main adverse cardiovascular and cerebrovascular events (MACCE) were recorded by telephone and clinic, we use X2 test to research the relationship between hyperglycemia and in-hospital outcome, we use ROC curve to assess the predictive value of hyperglycemia for in-hospital death both in diabetic and non-diabetic patients. Kaplan-Meier curve and Cox regression are used to evaluate the predictive value of stress hyperglycemia for the long-term prognosis.Result: Stress hyperglycemia occurred in 86 patients (18.9%), of whom 65 had diabetes history. There were 10 patients (14.1%) died in hospital in hyperglycemia group, 6 for malignant arrhythmia, 3 for cardiogenic shock and 1 for cardiac rupture. In the non-hyperglycemia group, the in-hospital mortality is 3.5% (P=0.028). The incidence of malignant arrhythmia and cardiogenic shock were higher in hyperglycemia group than control group (P=0.023, P=0.030). The ROC curve of admission random blood glucose predicting in-hospital deaths for non-diabetic patients and diabetic patients showed the area under curve and 95% CI were 0.627, 0.438 ~ 0.837; 0.786, 0.586 ~ 0.913 respectively. The incidence of one-year follow-up MACCE was about 41.7% in hyperglycemia group, and the incidence in the control group was 27.8% (P=0.018). Gender, age, diabetes, hypertension, previous myocardial infarction, hyperglycemia, left ventricular ejection fraction were included in Cox regression model of one-year followup MACCE in STEMI patients. Stress hyperglycemia was an independent risk factor for one-year follow-up MACCE in STEMI patients (OR=4.398, 95% CI=2.869 ~ 7.483, P<0.001).Conclusion: Hyperglycemia is a predictive factor for in-hospital death in STEMI patients, and it has good predictive value for the long-term prognosis.

Transcatheter aortic valve implantation and surgical aortic valve replacement among hospitalized patients with and without type 2 diabetes mellitus in Spain (2014\u20132015)

BackgroundType 2 diabetes mellitus (T2DM) is strongly related to the in-hospital and short-term prognosis in patients with cardiovascular diseases needing surgical or invasive interventions. How T2DM might influence the treatment of aortic stenosis (AS) has not been completely elucidated for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). The aims of this study were: (1) to describe the use of aortic valve replacement procedures (TAVI and SAVR) among hospitalized patients with and without T2DM; and (2) to identify factors associated with in hospital mortality (IHM) among patients undergoing these procedures.MethodsWe analyzed data from the Spanish National Hospital Discharge Database between January 1, 2014 and December 31, 2015 for patients aged ≥ 40 years. We selected patients whose medical procedures included TAVI (ICD-9-CM codes 35.05, 35.06) and SAVR (ICD-9-CM codes 35.21, 35.22). We stratified each cohort by diabetes status: T2DM (ICD-9-CM codes 250.x0, 250.x2) and no diabetes. We retrieved data about specific comorbidities, risk factors, procedures, and specific in-hospital postoperative complications. Hospital outcome variables included IHM, and length of hospital stay (LOHS).ResultsWe identified a total of 2141 and 16,013 patients who underwent TAVI (n = 715; 33.39% with T2DM) and SAVR (n = 4057; 25.33% with T2DM). In patients who underwent TAVI we found no differences in IHM (3.64% in T2DM vs. 5.12% in non-T2DM, p = 0.603). In the cohort of SAVR, mean LOHS was significantly lower in patients with T2DM than in non-diabetic patients (13.77 vs. 17.27 days). IHM was lower in patients with T2DM (4.36% vs. 6.31%, p < 0.01). After multivariable adjustment for both procedures, patients with T2DM had significantly lower IHM than patients without diabetes (adjusted OR 0.60; IC 95% 0.37–0.99 for TAVI and adjusted OR 0.80; IC 95% 0.66-0-96 for SAVR).ConclusionsT2DM diabetic patients with AS undergoing a valvular replacement procedure through SAVR or TAVI did not have a worse prognosis compared to non-diabetic patients during hospitalization, showing lower IHM after multivariable adjustment. However, given the limitations of administrative data more prospective studies and clinical trials aimed at evaluating the influence of these procedures in diabetic patients with AS are needed.

Predictive value of apelin-12 in patients with ST-elevation myocardial infarction with different renal function: a prospective observational study

ObjectivesTo investigate factors predicting the onset of major adverse cardiovascular events (MACEs) after primary percutaneous coronary intervention (pPCI) for patients with ST-segment elevation myocardial infarction (STEMI) .BackgroundApelin-12 plays an essential...

Gastrointestinal Hemorrhage after Spontaneous Subarachnoid Hemorrhage: A Single-Center Cohort Study

Spontaneous subarachnoid hemorrhage (SAH) is a devastating disease, and gastrointestinal hemorrhage is one of several potential complications of acute strokes. We aim to analyze its prevalence, risk factors, and association with in-hospital prognosis following SAH. A total of 1047 adult patients with a primary diagnosis of spontaneous SAH were retrospectively enrolled. We retrieved medical information from the administrative database utilizing diagnostic and procedure codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Patients with SAH included 418 men and 629 women, and their mean age was 57.2 (standard deviation 14.6) years (range, 18–93 years). Gastrointestinal hemorrhage occurred in 30 of the 1047 patients, accounting for 2.9%. In a multivariate logistic regression model, the independent risk factors for gastrointestinal hemorrhage were liver disease and hydrocephalus. The in-hospital mortality rates were 43.3% and 29.3% in patients with and without gastrointestinal hemorrhage, respectively, but the difference was not statistically significant. In conclusion, the prevalence of gastrointestinal hemorrhage was 2.9% in patients hospitalized for spontaneous SAH. Underlying liver disease and the presence of hydrocephalus were both independent risk factors for this complication, which is a reminder to clinicians to pay increased attention in such cases.

Predictors of high Killip class after ST segment elevation myocardial infarction in the era of primary reperfusion

Background/IntroductionOutcome after ST segment elevation myocardial infarction (STEMI), has improved but patients with high Killip class still have a poor prognosis, and those ≥II need a closer monitoring in a specialized cardiac care unit. PurposeWe aimed to determine the predictors of Killip class in a group of patients admitted for acute STEMI. MethodsNon-interventional registry in a Cardiac Intensive Care Unit. Patients were consecutively included from January 2010 to April 2015, and multivariate analysis was performed to determine independent predictors of high Killip Class. ResultsWe included 1111 patients, mean age was 64.0±14.0years and 258 (23.2%) were female. Primary percutaneous coronary intervention was performed in 991 (89.2%), and 120 (10.8%) only received thrombolysis as acute reperfusion therapy. A total of 230 (20.7%) were in class II or higher. The independent predictors of Killip≥II were (odds ratio [95% confidence interval]): older age (2.1 [1.4–3.0]), female sex (1.6 [1.1–2.2]), diabetes (1.4 [1.0–2.1]), prior heart failure (3.2 [1.4–7.2]), chronic kidney disease (2.0 [1.1–3.6]), anaemia (3.0 [2.0–4.5]), multivessel disease (1.6 [1.1–2.2]), anterior location (2.4 [1.8–3.4]), time of evolution>2h (1.6 [1.1–2.4]), and TIMI flow-grade<3 (1.8 [1.2–2.7]). In-hospital mortality increased with Killip class (I 1.5%, II 3.7%, III 16.7%, IV 36.7%). ConclusionIn patients with STEMI Killip class can be predicted with variables available when primary percutaneous coronary intervention is performed and is strongly associated with in-hospital prognosis.

Atrial fibrillation in patients with ischaemic stroke: clinical characteristics and in-hospital outcomes. A pilot study

Introduction Thromboembolic complications are the most serious consequences of atrial fibrillation (MP). Atrial fibrillation significantly worsens prognosis in patients with ischemic stroke. The aim of the study was to evaluate the prevalence of MP in hospitalized patients due to ischemic stroke, the assessment of the incidence of co-morbidities and the evaluation of in-hospital prognosis in the study group. Methodology The retrospective study enrolled 2000 patients with cerebral stroke hospitalized in the years 2013-2014. The ischemic stroke was diagnosed on the basis of the patient's clinical picture and head imaging (TK or MRI head). Results In the whole study group (n = 2000), 579 patients (28.5%) had MP, MP (+), and 456 patients (78.8%) had arrhythmia prior to admission. The hospital, and 123 (21.2%) patients were first detected MP. The mean age of patients in the MP (+) group was 78.6 years, and in the MP group (-) 71.6 years. Carotid artery ultrasonography was performed in 1805 patients with ischemic stroke. This study demonstrated critical vasoconstriction (> 70%) in 232 patients (16.3%) in the MP (+) group and in 69 (11.9%) patients in the MP (-) group. Significant neurological deficit (> 10 points) at hospital admission was observed in 485 patients (34.2%) in the MP group (-) and 196 patients (33.85%) in the MP (+) group. At discharge from the hospital, 224 (15.7%) without MP had a significant neurological deficit or functional impairment, and in the MP (+) group it was 226 (39.03%). 229 patients (16.1%) without MP and 22 subjects (15.5%) with MP died during hospitalization. Conclusions Atrial fibrillation was often found in arrhythmia in patients with ischemic stroke. Patients with stroke and MP were older than patients with stroke and sinus rhythm. Critical stenosis of the carotid arteries was found in a higher proportion of patients with arrhythmia than sinus rhythm. 331/5000 Deterioration of the neurological deficit during hospitalization was reported in a higher proportion of patients with MP than without arrhythmias. In-hospital mortality in stroke patients was similar in patients with MP and in patients with sinus rhythm.

O12-2 - Neurohormonal Activation in Very Elderly Patients Over 80years Old with Acute Decompensated Heart Failure

Backgrounds: In heart failure, the adverse effects of neurohormonal activation are known and the suppression of renin aldosterone system is effective to improve the prognosis in clinical trial. However population for these trials is under 80 years old. This purpose is to assess whether neurohormonal factors are activated irrespective of age in patients with acute decompensated heart failure (ADHF). Methods: A total of 360 patients with ADHF were admitted in ICU (77 ± 12 years, male 197) for four years. The number of patients over and under 80 years old were 184 (O group), 176 (U group). Hemodynamics, blood chemistry, neurohormonal factors on admission and pre-hospital medication were studied retrospectively. Results: O group had significantly more female, lower hemoglobin, creatinine, uric acid, plasma rennin activity (PRA) and higher EF (P < .05). Death in hospital was 19 patients (5.3%). In Cox's proportional hazards analysis, higher BUN, logBNP, logPRA were an independent predictor of in-hospital death in all patients (HR1.014, 2.972, 1.839, P < .01). However, higher BUN was an independent predictor of in-hospital death in O group, not U group (HR1.057, 95%CI 1.033–1.081, P < .01). Conclusions: Neurohormonal activation and BUN elevation are the risk factor of in-hospital mortality in ADHF patients, but it is suggested that plasma renin is less activated and neurohormonal factor is not important for in-hospital prognosis in patients over 80 years old.

Determination of risk factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention

BackgroundTo determine the factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to establish its prognostic discriminant model.MethodsA total of 701 consecutive STEMI patients undergoing PCI were enrolled in this study. The patients were divided into two groups, good prognosis and poor prognosis, based on whether the patient had adverse outcomes (death or heart function ≥ grade III) at discharge. Demographic and basic clinical characteristics, diagnosis at admission (e.g., ventricular function, complications, or hyperlipidemia), and biomedical indicators (e.g., blood count, basal metabolism and biochemical composition, blood lipid and glucose levels, myocardial biomarkers, and coagulation) were collected and analyzed.ResultsWe determined 22 factors as risk factors for the in-hospital prognosis of STEMI patients after PCI: age, cardiac function during hospitalization, complications, history of diabetes mellitus, et al., among which the history of diabetes, uric acid, urea nitrogen, and activated partial thromboplastin time (APTT) were independent risk factors.ConclusionWe identified four independent risk factors for the in-hospital prognosis of STEMI patients after PCI and generated a prognostic model to predict the adverse outcomes of these patients.

The electrocardiographic “triangular QRS-ST-T waveform” pattern in patients with ST-segment elevation myocardial infarction: Incidence, pathophysiology and clinical implications

BackgroundA specific ECG pattern of presentation of ST-segment elevation acute myocardial infarction (STEMI), characterized by “triangular QRS-ST-T waveform” (TW), has been associated with poor in-hospital prognosis but longitudinal data on its incidence and clinical impact are lacking. We prospectively evaluated the incidence and prognostic meaning of the TW pattern in a cohort of consecutive STEMI patients. MethodsAll STEMI patients who presented within 12h of symptoms onset and showed no complete bundle branch block or paced ventricular rhythm were included. The TW pattern was defined as a unique, giant wave (amplitude≥1mV) resulting from the fusion of the QRS complex, the ST-segment and the T-wave and showing a “triangular” morphology with a positive polarity in the leads exploring the ischemic region. ResultsAmong 428 consecutive STEMI patients, 367 fulfilled the enrollment criteria. The TW pattern was identified in 5 of 367 patients (1.4%) on the admission ECG. This subset of STEMI patients with TW pattern significantly more often showed a left main coronary artery involvement (2/4, 50% vs 2/322, 0.6%; p<0.001), experienced ventricular fibrillation (5/5, 100% vs 35/362, 9.6% p<0.001), had cardiogenic shock (4/5, 80% vs. 14/362, 3.8%, p<0.001) and died during hospitalization (2/5, 40% vs 15/362, 4.1% p=0.02), compared with those with other ST-segment elevation ECG patterns. ConclusionsThe TW pattern is an uncommon ECG finding, which reflects the presence of a large area of transmural myocardial ischemia and predicts cardiogenic shock accounting for high in-hospital mortality. When present, this ECG pattern should prompt aggressive therapeutic strategies, including mechanical support of circulation.

P4283The impact of left ventricular dysfunction on in-hospital complications and 1-year prognosis in patients undergoing percutaneous coronary intervention in Japan: a report from KiCS-PCI-Registry

P4283The impact of left ventricular dysfunction on in-hospital complications and 1-year prognosis in patients undergoing percutaneous coronary intervention in Japan: a report from KiCS-PCI-Registry

Ventilator-associated pneumonia in adult intensive care unit prevalence and complications

BackgroundVentilator-associated pneumonia (VAP) remains a common cause of intensive care unit (ICU) and hospital morbidity and mortality despite advances in diagnostic techniques and management. We aimed to determine the prevalence, possible complications and in-hospital prognosis of VAP in mechanically ventilated patients. MethodsThis prospective observational, case-control study, was carried out from September 2012 to August 2013. Forty-eight adult patients maintained on mechanical ventilation for more than 48 h in our ICU were enrolled in the study. VAP was diagnosed as new persistent pulmonary infiltrates on chest radiographs and, at least two of following: (1) fever of ≥38.3°C, (2) leukocytosis of ≥12,000⧹mm3, and (3) purulent tracheobronchial secretions. Endotracheal aspirate (ETA) samples of suspected cases were collected and processed as per standard protocols. ResultsThe primary underlying diagnosis was acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in 25 patients, congestive heart failure in 10, pneumonia in 6, post-operative in 5, neurological diseases in 2 patients. VAP developed in 17 patients (35.4%), gram-negative agents were the major offending pathogen (Pseudomonas aeruginosa accounting for 22.9%). The length of ventilation (LOV) and the length of ICU stay (LOSICU) were significantly higher in the VAP group (P=0.001, 0.0001 respectively). Severe sepsis/septic shock, acute respiratory distress syndrome (ARDS), atelectasis, and infection with multi-drug resistant organisms were more common in the VAP group. Conclusion: Ventilator-associated pneumonia was associated with a significant increase in ICU length of stay, time on mechanical ventilation and different complications.

In-hospital prognosis and long-term mortality of STEMI in a reperfusion network. \u201cHead to head\u201d analisys: invasive reperfusion vs optimal medical therapy

BackgroundST Segment Elevation Acute myocardial infarction (STEMI) preferred treatment is culprit artery reperfusion with primary percutaneous coronary intervention (PPCI). We ought to analyze the benefit of early reperfusion vs. optimal medical therapy in STEMI before and after the set-up of a regional STEMI network that prioritizes PPCI.MethodsBetween January 2002 and December 2013, 1268 STEMI patients were consecutively admitted in a University Hospital. Patients were classified in two groups: pre-STEMI Network (January 2002–June 2009; n = 670) and post-STEMI network (July 2009–December 2013; n = 598). Vital status was available at 2-year follow-up.ResultsThe STEMI network increased reperfusion (89.2% vs 64.4%, p < 0.001) mainly using PCI (99.0% vs 43.9%, p < 0.001). In univariate analysis, in-hospital mortality was significantly lower in the post-STEMI network period (2.51% vs. 7.16%, p < 0.001). After multivariate adjustment, including age, sex, comorbidities, severity and reperfusion therapy, a trend to a lower in-hospital mortality was observed (post-Network OR: 0.50, 95% CI:0.16–1.59, p = 0.24); this trend disappeared when optimal medical therapy was included in the model (post-Network OR: 1.14, 95% CI:0.32–4.08, p = 0.840). No differences in 2-year mortality were observed (post-Network HR: 0.83; CI 95%: 0.55–1.25, p = 0.37).ConclusionA STEMI network with PPCI 24/7 improved reperfusion therapy, resulting in an increase on PPCI. Despite in-hospital mortality decreased with a STEMI network, 2-year mortality remained similar in both periods, pre- and post-Network. Optimal medical therapy could be as important as reperfusion therapy in a STEMI reperfusion network.

In-hospital and Long-term Prognosis of Acute Inferior Myocardial Infarction with Cardiogenic Shock : Clinical Implication of Right Ventricular Infarction

In-hospital and Long-term Prognosis of Acute Inferior Myocardial Infarction with Cardiogenic Shock : Clinical Implication of Right Ventricular Infarction

Extracorporeal Membrane Oxygenation Outcomes in Acute Respiratory Distress Treatment: Case Study in a Chinese Referral Center.

BackgroundNo definitive conclusions have been drawn from the available data about the utilization of extracorporeal membrane oxygenation (ECMO) to treat severe acute respiratory distress syndrome (ARDS). The aim of this study was to review our center’s experience with ECMO and determine predictors of outcome from our Chinese center.Material/MethodsWe retrospectively analyzed a total of 23 consecutive candidates who fulfilled the study entry criteria between January 2009 and December 2015. Detailed clinical data, ECMO flow, and respiratory parameters before and after the introduction of ECMO were compared among in-hospital survivors and nonsurvivors; factors associated with mortality were investigated.ResultsHemodynamics and oxygenation parameters were significantly improved after ECMO initiation. Thirteen patients survived to hospital discharge. Univariate correlation analysis demonstrated that APACHE II score (r=−0.463, p=0.03), acute kidney injury (r=−0.574, p=0.005), membrane oxygenator replacement (r=−0.516, p=0.014) and total length of hospital stay (r=0.526, p=0.012) were significantly correlated with survival to hospital discharge, and that the evolution of the levels of urea nitrogen, platelet, and fibrinogen may help to determine patient prognosis. Sixteen patients referred for ECMO from an outside hospital were successfully transported to our institution by ambulance, including seven transported under ECMO support. The survival rate of the ECMO-transport group was comparable to the conventional transport or the non-transport group (both p=1.000).ConclusionsECMO is an effective alternative option for severe ARDS. APACHE II score on admission, onset of acute kidney injury, and membrane oxygenator replacement, and the evolution of levels of urea nitrogen, platelet, and fibrinogen during hospitalization may help to determine the in-hospital patient prognosis. By establishing a well-trained mobile ECMO team, a long-distance, inter-hospital transport can be administered safely.

Efficiency of novel splash-proof ventilator circuit component on VAP and the colonization of multiple-drug resistant bacteria prevention in patients undergoing mechanical ventilation: a prospective randomized controlled intervention study with 318 patients

To investigate the efficiency of closed tracheal suction system (CTSS) using novel splash-proof ventilator circuit component on ventilator-associated pneumonia (VAP) and the colonization of multiple-drug resistant bacteria (MDR) in patients undergoing mechanical ventilation (MV) prevention. A prospective single-blinded randomized parallel controlled intervention study was conducted. 330 severe patients admitted to the intensive care unit (ICU) of the First Hospital of Jiaxing from January 2014 to May 2016 were enrolled, and they were divided into open tracheal suction group, closed tracheal suction group, and splash-proof suction group on average by random number table. The patients in the three groups used conventional ventilator circuit component, conventional CTSS, and CTSS with a novel splash-proof ventilator circuit component for MV and sputum suction, respectively. The incidence of VAP, airway bacterial colonization rate, MDR and fungi colonization rate, duration of MV, length of ICU and hospitalization stay, and financial expenditure during hospitalization, as well as the in-hospital prognosis were recorded. After excluding patients who did not meet the inclusion criteria, incomplete data, backed out and so on, 318 patients were enrolled in the analysis finally. Compared with the open tracheal suction group, the total incidence of VAP was decreased in the closed tracheal suction group and splash-proof suction group [20.95% (22/105), 21.90% (23/105) vs. 29.63% (32/108)], but no statistical difference was found (both P > 0.05), and the incidence of VAP infections/1 000 MV days showed the same change tendency (cases: 14.56, 17.35 vs. 23.07). The rate of airway bacterial colonization and the rate of MDR colonization in the open tracheal suction group and splash-proof suction group were remarkably lower than those of closed tracheal suction group [32.41% (35/108), 28.57% (30/105) vs. 46.67% (49/105), 20.37% (22/108), 15.24% (16/105) vs. 39.05% (41/105)] with significantly statistical differences (all P < 0.05). Besides, no significantly statistical difference was found in the fungi colonization rate among open tracheal group, closed tracheal group, and splash-proof suction group (4.63%, 3.81% and 6.67%, respectively, P > 0.05). Compared with the closed tracheal suction group, the duration of MV, the length of ICU and hospitalization stay were shortened in the open tracheal suction group and splash-proof suction group [duration of MV (days): 8.00 (4.00, 13.75), 8.00 (5.00, 13.00) vs. 9.00 (5.00, 16.00); the length of ICU stay (days): 10.00 (6.00, 16.00), 11.00 (7.00, 19.00) vs. 13.00 (7.50, 22.00); the length of hospitalization stay (days): 16.50 (9.25, 32.00), 19.00 (10.50, 32.50) vs. 21.00 (10.00, 36.00)], and financial expenditure during hospitalization was lowered [10 thousand Yuan: 4.95 (3.13, 8.62), 5.47 (3.84, 9.41) vs. 6.52 (3.99, 11.02)] without significantly statistical differences (all P > 0.05). Moreover, no significantly statistical difference was found in the in-hospital prognosis among the three groups. CTSS performed using novel splash-proof ventilator circuit component shared similar advantages in preventing VAP with the conventional CTSS. Meanwhile, it is superior because it prevented the colonization of MDR and high price in the conventional CTSS.Clinical Trail Registration Chinese Clinical Trial Registry, ChiCTR-IOR-16009694.

Impact of Door-to-Balloon Time in Patients With ST-Elevation Myocardial Infarction Who Arrived by Self-Transport - Acute Myocardial Infarction-Kyoto Multi-Center Risk Study Group.

Patients with ST-elevation myocardial infarction (STEMI) who arrive at a hospital via self-transport reportedly have a delayed door-to-balloon time (DBT). However, the clinical impacts of delayed DBT on in-hospital mortality among such patients are not well known.Methods and Results:In total, 1,172 STEMI patients who underwent primary percutaneous coronary intervention between January 2009 and December 2013 from the Acute Myocardial Infarction (AMI) Kyoto Registry were analyzed. Compared with the emergency medical service (EMS) group (n=804), the self-transport group (n=368) was younger and had a significantly longer DBT (115 min vs. 90 min, P<0.01), with fewer patients having a Killip classification of 2 or higher. The in-hospital mortality rate was lower in the self-transport group than in the EMS group (3.3% vs. 7.1%, P<0.01). A DBT >90 min was an independent predictor of in-hospital mortality in EMS patients (odds ratio (OR)=2.43, P=0.01) but not in self-transport patients (OR=0.89, P=0.87). The present study demonstrated that there was no relationship between in-hospital prognosis and DBT ≤90 min in STEMI patients using self-transport. The prognosis of these patients cannot be improved by focusing only on DBT. Treatment strategies based on means of transport should also be considered.

Complete Revascularization versus Culprit- Vessel Revascularization in Acute Myocardial Infarction: Six Months Follow-up

Background: The presence of multi-vessel disease (MVD) has been reported to be associated with worse prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Identification of optimal strategies for treating such patients is the subject of considerable interest and controversy. Objective: The aim of our study is to compare the in-hospital and short-term prognosis for patients presenting with STEMI who were treated by two different modalities. The treatment varied between target vessel revascularization (TVR) and complete revascularization (CR) in patients with MVD undergoing primary percutaneous coronary intervention (p-PCI). Methods: A total of 40 patients with recent STEMI and MVD undergoing p-PCI were randomized to CR (group A) or TVR (group B) during p-PCI and followed up for 6 months after hospital discharge. The patients were followed-up for incidence of major adverse cardiac events (MACE) (in-hospital, and at 1 and 6 months after discharge), contrast-induced nephropathy (CIN) and left ventricular ejection fraction (LVEF) improvement at 6 months. Results: Forty patients (mean age 55.2 ± 9.1 years; 33 males and 7 females) with comparable risk factors in the two groups were recruited in this study. Six months later, the patients in group A showed better improvement in systolic function as estimated by 2D echocardiography LVEF % (54.3 ± 9.1 to 58.4 ± 6.2; P-value 0.002) compared to group B (54.9 ± 5.2 to 55.7 ± 6.7; P-value 0.55). This improvement was more in patients with anterior wall myocardial infarctions. The incidence of MACE in both groups was comparable during the hospital stay and at 1 and 6 months follow-up. There were two MACE cases in group B, and no such case was observed in group A at 1 and 6 months follow-up (P-value 0.14). With regard to CIN, both groups showed similar results (2 cases in group A and 1 case in group B; P-value 0.54). The patients with door-to-balloon time less than 90 minutes were associated with better LVEF in comparison to those with a door-to-balloon time of more than 90 minutes (57.1 ± 6.3 vs. 50.5 ± 7.3; P-value 0.005). Conclusion: The results of our study showed that CR is safe during p-PCI and is associated with better left ventricular EF at 6 months, especially in anterior myocardial infarction.