Independent Predictor Of Higher Risk Research Articles

Clinical impact and predictors of periprocedural myocardial injury among patients undergoing left bundle branch area pacing.

The clinical impact of Periprocedural myocardial injury (PMI) in patients undergoing permanent pacemaker implantation with Left Bundle Branch Area Pacing (LBBAP) is unknown. 130 patients undergoing LBBAP from January 2020 to June 2021 and completing 12months follow up were enrolled to assess the impact of PMI on composite clinical outcome (CCO) defined as any of the following: all-cause death, hospitalization for heart failure (HHF), hospitalization for acute coronary syndrome (ACS) and ventricular arrhythmias (VAs). High sensitivity Troponin T (HsTnT) was measured up to 24-h after intervention to identify the peak HsTnT values. PMI was defined as increased peak HsTnT values at least > 99th percentile of the upper reference limit (URL: 15pg/ml) in patients with normal baseline values. PMI occurred in 72 of 130 patients (55%). ROC analysis yielded a post-procedural peak HsTnT cutoff of fourfold the URL for predicting the CCO (AUC: 0.692; p = 0.023; sensitivity 73% and specificity 71%). Of the enrolled patients, 20% (n = 26) had peak HsTnT > fourfold the URL. Patients with peak HsTnT > fourfold the URL exhibited a higher incidence of the CCO than patients with peak HsTnT ≤ fourfold the URL (31% vs. 10%; p = 0.005), driven by more frequent hospitalizations for ACS (15% vs. 3%; p = 0.010). Multiple (> 2) lead repositions attempts, the use of septography and stylet-driven leads were independent predictors of higher risk of PMI with peak HsTnT > fourfold the URL. PMI seems common among patients undergoing LBBAP and may be associated with an increased risk of clinical outcomes in case of more pronounced (peak HsTnT > fourfold the URL) myocardial damage occurring during the procedure.

A cohort study on neuropathic pain of the saphenous nerve—factors influencing surgical outcome

BackgroundDue to its partially superficial course, the saphenous nerve is vulnerable to injury by trauma or surgery potentially leading to painful neuroma formation. Different surgical techniques to treat neuroma have been described, but so far, no one has proven to be superior to the others. The aim of this study was therefore to identify factors influencing the outcome of revision surgery in saphenous nerve neuropathic pain in our department.MethodsFrom 2010 to 2020, a total of 29 consecutive patients with neuropathic pain and suspected neuroma of the saphenous nerve underwent revision surgery. A medical chart review was performed to collect patient-, pain-, and treatment-specific factors. Outcomes were registered.ResultsPost revision surgery in neuropathic pain of the saphenous nerve, 16 (55.2%) patients suffered from persisting pain. In multivariable logistic regression models evaluating the risk of persisting pain post saphenous nerve revision surgery, both smoking and preoperative opiate consumption represented independent predictors of higher risk for persisting pain.ConclusionsPatients with injury to the saphenous nerve should be coached toward smoking cessation. Whenever possible, forgoing opiate treatment might be beneficial.Level of evidence: Level IV, Risk/Prognostic.

A Cohort Study on Neuropathic Pain of the Sural Nerve-Can Neurectomy Be Considered a Valid Treatment Option?

Sural nerve neuroma is often caused by an injury during prior surgery, for example, osteosynthesis or ligament refixations at ankle level. Different surgical techniques to treat neuroma have been described. Neurectomy of an injured symptomatic sural nerve has been described as a treatment option for neuropathic pain. The aim of this study was to evaluate the outcomes of this technique to operatively treat sural nerve neuroma in our department. From 2010 to 2020, a total of 30 consecutive patients with neuropathic pain and suspected neuroma of the sural nerve underwent sural nerve neurectomy. A medical chart review was performed to collect patient-, pain-, and treatment-specific factors. Outcomes were registered. After neurectomy, 22 patients (73.3%) had persisting pain. In logistic regression models evaluating the risk of persisting pain after sural nerve neurectomy, no independent predictor of higher risk of persisting pain could be identified. For sural nerve neuromas, neurectomy remains an option as the surgical morbidity is minor, but patients need to be counseled that only a fourth of those undergoing surgery will be pain-free afterward.

Association of serum nitric oxide metabolite level with mortality in patients undergoing coronary angiography

BackgroundNitric oxide (NO) is a relevant molecule for vascular homeostasis. The level of serum NO metabolites (NOx), which consist of nitrite and nitrate, has been investigated as an alternative biomarker of NO production, but its clinical value has not yet been determined. Methods and results143 patients (66 ± 12 years old) were followed up after coronary catheterization. During a median (inter-quartile range) observation period of 6.13 (3.32–9.21) years, there were 20 (14 %) all-cause deaths, including 11 (8 %) cardiovascular deaths, 17 (12 %) major adverse cardiovascular events, and 17 (12 %) hospital admissions for heart failure. Median NOx level was 34.5 μmol/L (23.9–54.3). NOx was a risk factor for all-cause death [hazard ratio (HR) by unit increase, 1.010, 95 % confidence interval (CI) 1.001–1.018; p = 0.021] and heart failure (HR 1.010, CI 1.001–1.019; p = 0.029). Even after adjustment for age, sex, coronary risk factors, C-reactive protein, log-transformed brain natriuretic peptide, estimated glomerular filtration rate, and nitrate treatment, NOx was a risk factor for all-cause death (HR 1.015, CI 1.004–1.027; p = 0.008) and admission with heart failure (HR 1.018, CI 1.005–1.018, p = 0.007). ConclusionsAn increase in serum NOx level does not herald a benign clinical course but is an independent predictor of high risk of any-cause mortality and heart failure.

P06.06 Clinical Implications of Tumour Spread Through Air Spaces (STAS) In Lung Adenocarcinoma Patients Treated With Surgery

Tumour spread through air spaces (STAS) in lung adenocarcinoma is a novel mechanism of invasion, which is important for pathologist to recognize. STAS has been proposed as an independent predictor of high risk of recurrence in patients with lung adenocarcinoma. The aim of this study was to assess the clinical implications of STAS and the distance from the edge of the tumor to the farthest STAS as prognostic factors in patients with lung adenocarcinoma treated with surgery.

High risk of burnout in medical students in Serbia, by gender: A cross-sectional study.

IntroductionBurnout syndrome is common among medical students, but findings about the gender differences in burnout are not consistent. The aim of this study was to assess high risk of burnout syndrome among medical students at one University in Serbia, by gender.MethodA cross-sectional study was conducted at the Faculty of Medical Sciences, University of Kragujevac in 2014. The Maslach Burnout Inventory—Student Survey was used for assessment of burnout level. A questionnaire on basic socio-demographic characteristics (age, gender, marital status, habits, etc.) and academic performance (year of study, cumulative total average grade, length of study, housing, study financing, etc.) was used. The study included a total of 760 medical students (760/836 medical students; participation rate: 90.9%). Logistic regression analysis was used to determine odds ratios (OR) with 95% confidence intervals (95% CI).ResultsSignificant gender differences were detected in prevalence of high risk of burnout syndrome (male students– 19.0% vs. female students– 12.8%, p = 0.024). A significant independent predictor of high risk for burnout syndrome in male medical students was study year (p for trend = 0.011), while in female medical students–study year (p for trend = 0.002) and use of sedatives (adjusted OR = 5.74, 95% CI = 1.96–16.77, p = 0.001).ConclusionOur results indicate the need to assess the risk of burnout syndrome at the very beginning of medical studies, in order to more effectively control the modifiable risk factors.

How does clinical profile and outcome differ in patients with Chronic Kidney Disease undergoing percutaneous coronary revascularization according to the severity of CKD? – CHANNEL Study

BackgroundChronic kidney disease (CKD) is an independent risk factor for the development of coronary artery disease. We evaluated outcomes amongst patients of CKD undergoing percutaneous coronary intervention (PCI) as assessed on severity of CKD based on estimated glomerular filtration rate (eGFR) at the time of PCI. Method and materialsWe analyzed 100 consecutive CKD patients who underwent PCI and were followed up for 1 year; an observational, prospective, open-label study. Multivariate and Receiver operator characteristics (ROC) analysis was used to determine the cut point ofeGFR for predicting 4-P major adverse cardiac events (MACE) outcomes defined as the composite of Cardiovascular (CV) mortality, heart failure hospitalization (HHF), repeat revascularization and non-fatal MI over 1 year follow up. ResultsAccording to eGFR cut-off value derived from ROC, patients were divided in to two groups based on eGFR cut-off of 36.25 mL/min/1.73 m2. Majority of patients (79%) were in Group 1 (eGFR >36.25 mL/min/1.73 m2). Group 2 had Lower HbA1C, hemoglobin and elevated level of urea as compared to group:1 (p=0.002,<0.0001 respectively). All-cause mortality had trend forbeing higher (6.3 vs. 19%) in group:2, but statistically non-significant (p = 0.17). Lower baseline LVEF (39 ± 10.08%) across the cohort was independent predictor of higher risk for HHF. eGFR <36.25 mL/mim/1.73 m2 was the most robust predictor of MACE, carrying a 3-fold increase in risk of 4-P MACE with significant association (0.69, CI 0.59 to 0.78, p = 0.0009). ConclusionsLower baseline eGFR was associated with higher incidence of 4 P MACE with best cut-off being eGFR <36.25 mL/min/1.73 m2. Lower Baseline LVEF was independent predictor from HHF across the cohort.

Identification of recurrence-associated gene signature and tumor immune microenvironment features in resected stage I NSCLC.

9080 Background: Surgery is the primary treatment for stage I NSCLC, but postoperative recurrence leads to poor prognosis. Alterations of tumor genes and immune microenvironment may be crucial factors for tumor recurrence; however, the detailed mechanisms remain unclear. Methods: A total of 130 resected stage I NSCLC patients were enrolled, 69 developed recurrence within three years and 61 without recurrence over five years. Whole exome sequencing (WES) was performed to evaluate genomic alterations. Immunohistochemistry was carried out to assess the expression of PD-L1, CD3 and CD8. We calculated density of CD3+ and CD8+ T cells in the center of tumors (CT) and invasive margins (IM), defined six immunoscore types based on the location and density of both cells, and performed ROC analysis to evaluate prognostic value of them. We further verified our results using stage I NSCLC cohorts from the Cancer Genome Atlas (TCGA) and Tumor immune estimation resource (TIMER) database. Results: In univariate analysis, lung adenocarcinoma (LUAD) patients showed significantly higher risk of recurrence (p = 0.008). There was no statistically significant correlation between recurrence and other clinical factors, including TNM stage. Although driver gene mutations, such as those of EGFR, had no correlation with recurrence, MUC4 mutation and high tumor mutation burden (TMB) were significantly associated with higher risk of recurrence (p = 0.001 and 0.0032, respectively). Enrichment analysis of KEGG pathways showed that Ras pathway mutations were significantly enriched in MUC4 mutant group and recurrence group (p = 0.02 and 0.05, respectively). 9.6% patients had PD-L1 positive expression (TPS≥1%), but showed no association with recurrence. Recurrence group had much lower density of CD8CT, CD8IM and CD3CT +T cells(p = 0.0026, 0.0022 and 0.0308, respectively). Immunoscore type V, based on the average of CD8CT, CD8IM and CD3CT + T cells, had the highest prognostic value (AUC = 0.764) and was used as the final immunoscore in our study. In multivariate analysis, we found MUC4 mutation and low immunoscore were independent predictors of higher risk of recurrence. Smoking history was also an independent prognostic factor in LUAD. While in LUSC, only immunoscore correlated with recurrence. In TCGA cohort, MUC4 mutation rate was significantly lower (3.6% vs. 24.3%, p &lt; 0.001) and had no correlation with risk of recurrence (p = 0.765). Besides, the tumor infiltrating CD8+ T cells also had no correlation with risk of recurrence (p = 0.469). Conclusions: In this study, we established a refined immunoscore with high prognostic value for tumor recurrence in stage I NSCLC. In addition, we showed for the first time a strong association between MUC4 mutation and recurrence, which might be mediated by the Ras pathway. Finally, the recurrence mechanisms might vary among different histological subtypes.

Assessing the risk of rapid radiographic progression in Hungarian rheumatoid arthritis patients

BackgroundThe outcome of rheumatoid arthritis (RA) should be determined early. Rapid radiological progression (RRP) is > or = 5 units increase according to the van der Heijde-Sharp score within a year. The risk of RRP can be estimated by a matrix model using non-radiographic indicators, such as C-reactive protein (CRP), rheumatoid factor (RF) and swollen joint count (SJC).Patients and methodsA non-interventional, cross-sectional, retrospective study was conducted in eleven Hungarian arthritis centres. We assessed RRP risk in biologic-naïve RA patients with the prevalence of high RRP risk as primary endpoint. RRP was calculated according to this matrix model. As a secondary endpoint, we compared RRP in methotrexate (MTX) responders vs non-responders.ResultsWe analyzed data from 1356 patients. Mean CRP was 17.7 mg/l, RF was 139.3 IU/ml, mean 28-joint disease activity score (DAS28) was 5.00 and mean SJC was 6.56. Altogether 18.2% of patients had high risk (≥40%) of RRP. RA patients with high RRP risk of RRP (n = 247) had significantly lower age compared to those with RRP < 40% (n = 1109). MTX non-response (OR: 16.84), male gender (OR: 1.67), erosions at baseline (OR: 1.50) and ACPA seropositivity (OR: 2.18) were independent predictors of high-risk RRP. Male gender (OR: 5.20), ACPA seropositivity (OR: 4.67) and erosions (OR: 7.98) were independent predictors of high RRP risk in MTX responders.ConclusionsIn this Hungarian study, high RRP risk occurred in 18% of RA patients. These patients differ from others in various parameters. RRP was associated with non-response to MTX.

Unfavorable Changes of Platelet Reactivity on Clopidogrel Therapy Assessed by Impedance Aggregometry Affect a Larger Volume of Acute Ischemic Lesions in Stroke.

Background: High on-treatment platelet reactivity or its equivalent—resistance to the antiplatelet agent—significantly reduces the efficacy of the therapy, contributing to a negative impact on stroke course. Previous studies demonstrated that aspirin resistance is associated with a larger size of acute ischemic infarct. Due to the increasing use of clopidogrel in the secondary prevention of stroke, we aimed to assess the impact of clopidogrel resistance on the size and extent of ischemic lesions, both acute and chronic. Methods: This prospective, single-center and observational study involved 74 ischemic stroke subjects, treated with 75 mg of clopidogrel. We used impedance aggregometry to determine platelet reactivity 6–12 h after a dose of clopidogrel as a first assessment and 48 h later as the second measurement. A favorable dynamics of platelet reactivity over time was the decrease in the minimum value equal to the median in the entire study. The volume of acute ischemic infarct was estimated within 48 h after onset in diffusion-weighted imaging and fluid-attenuated inversion recovery sequences of magnetic resonance and the severity of chronic vascular lesions by Fazekas scale. Results: Subjects with mild severity of chronic vascular lesions (Fazekas 1) exhibited a significant decrease of platelet reactivity over time (p = 0.035). Dynamics of platelet reactivity over time differed between subjects with large, moderate, mild and insignificant size of acute ischemic lesion (Kruskall-Wallis H = 3.2576; p = 0.048). In multivariate regression models, we reported unfavorable dynamics of platelet reactivity alone and combined with a high initial value of platelet reactivity as independent predictors of higher risk of a significant ischemic infarct volume (OR 7.16 95%CI 1.69–30.31, p = 0.008 and 26.49 95%CI 1.88–372.4, p = 0.015, respectively). Conclusions: We emphasized that unfavorable dynamics of platelet reactivity over time during clopidogrel therapy in acute phase of stroke affect the volume of acute infarct and the severity of chronic vascular lesions.

The epithelial-mesenchymal transition phenotype is associated with the frequency of tumor spread through air spaces (STAS) and a High risk of recurrence after resection of lung carcinoma

ObjectivesThe prognostic value of spread through air spaces (STAS) in lung carcinoma has been validated in independent cohorts. Epithelial-mesenchymal transition (EMT) is a biological process that promotes the migration and invasiveness of tumor cells. To investigate the role of the EMT phenotype in the occurrence of STAS, we analyzed patients with therapy-naive lung adenocarcinoma and squamous cell carcinoma undergoing lobectomy (n = 635). Materials and MethodsSTAS was defined by the presence of tumor cells within air spaces in the lung parenchyma beyond the edge of the main tumor. The expression of E-cadherin, vimentin, and ®-catenin was evaluated by immunohistochemistry using tissue microarray. Tumors were classified into three EMT phenotypes (epithelial, intermediate, and mesenchymal). Recurrence-free probability and overall survival were analyzed using the log-rank test and the Cox proportional hazards model. ResultsSTAS was less frequently observed in tumors with epithelial phenotype than in those with non-epithelial phenotype (p = 0.034), and more frequent in patients with nuclear β-catenin-positive tumors (p < 0.001). The EMT phenotype was an independent prognostic factor of recurrence (mesenchymal vs. epithelial: hazard ratio [HR] = 2.27, p = 0.014; mesenchymal vs. intermediate: HR = 2.13, p = 0.019). ConclusionWe have demonstrated that in patients with resected lung carcinoma, STAS was less frequent in tumors with an epithelial phenotype than in those with non-epithelial phenotype, and that the nuclear translocation of β-catenin was associated with a higher rate of STAS. The mesenchymal state was an independent predictor of high risk of recurrence in patients with STAS.

A multiparametric ICD algorithm for heart failure risk stratification: an analysis in clinical practice

Abstract Purpose A novel multiparametric algorithm based on implantable cardioverter defibrillator (ICD) sensors has been recently developed. The HeartLogic index combines multiple parameters, i.e. heart sounds, intrathoracic impedance, respiration pattern, night heart rate, and patient activity, in a single index. In the validation study, the HeartLogic alert condition was shown to identify patients during periods of significantly increased risk of heart failure (HF) events. We sought to evaluate the risk stratification ability of the algorithm in a group of patients who received the system in clinical practice. Methods The HeartLogic feature was activated in 257 ICD and cardiac resynchronization therapy ICD patients (186 male, 70±11 years, left ventricular ejection fraction 30±8%) at 11 centers. The median follow-up duration was 14 months [25–75 percentile: 7–19]. The HeartLogic algorithm automatically calculates a daily HF index and identifies periods in or out of an alert state relative to a configurable threshold (in this analysis set to 16). Results Patients experienced 40 HF hospitalizations requiring at least 1 overnight stay (0.14/patient-year) during the observation period (285 patient-years). The HeartLogic index crossed the threshold value 191 times in 105 patients. The time in the alert state was 27 patient-years, i.e. 9.5% of the total observation period. HF hospitalization rate while in alert was 0.96/patient-year and 0.05/patient-year while out of alert. The occurrence of ≥1 index crossing during follow-up was associated with the risk of HF hospitalization (odds ratio: 4.70, CI 95%: 1.79–12.4, p=0.002), independently from other baseline clinical variables. Conclusions Our analysis of data collected in clinical practice confirms that the multiparametric ICD algorithm is an independent predictor of higher risk of HF. In particular, it allows dynamic identification of time-intervals when patients are at significantly increased risk of worsening HF. This potentially helps better triage resources to a more vulnerable patient population. Funding Acknowledgement Type of funding source: None

Impact of Sleep-Disordered Breathing on Functional Outcomes in Ischemic Stroke: A Cardiopulmonary Coupling Analysis.

Cardiopulmonary coupling (CPC) analysis is an easily assessable method to evaluate sleep-disordered breathing (SDB); however, its prognostic impact in patients with acute ischemic stroke needs to be investigated. We performed a CPC analysis using Holter monitoring at the early stage of noncardioembolic ischemic stroke to investigate the prognostic effect of SDB on functional impairment at the 3-month follow-up. A total 615 patients with acute noncardioembolic ischemic stroke who underwent Holter monitoring within 30 days of stroke onset were enrolled from a multicenter, prospective, all-comer cohort. CPC analysis was conducted, and SDB was defined by the presence of narrow-band coupling during sleep time. We investigated the association between SDB and functional impairment at 3 months as measured by the modified Rankin Scale. Narrow-band coupling was present in 191 (31.1%) of 615 patients (mean age 64.5±12.6 years). The narrow-band group showed a significantly higher rate of severe functional impairment (modified Rankin Scale score >2; 45.5% versus 12.9%, P<0.001) and persistent disability (Δmodified Rankin Scale score ≤0; 53.9% versus 39.8%, P<0.001) at the 3-month follow-up. In multivariate analysis, narrow-band coupling was an independent predictor of higher risk of severe and persistent functional impairment at 3 months (odds ratio, 3.98 [95% CI, 2.34-6.78]; P<0.001; and odds ratio, 1.81 [95% CI, 1.23-2.66]; P<0.001, respectively). The results remained consistent after propensity-score matched analysis with 157 patient pairs (C-statistic=0.770). SDB assessed by CPC analysis at the early stage of ischemic stroke could predict severe and prolonged functional impairment at 3 months. CPC analysis using Holter monitoring can help predicting functional impairment in acute ischemic stroke.

P3715Impact of sleep-disordered breathing on short-term functional outcomes in ischemic stroke patients: a cardiopulmonary coupling analysis using holter-monitoring

Abstract Background Sleep-disordered breathing (SDB) assessed by conventional polysomnography is reported to have close association with worsened clinical outcomes in patients with ischemic stroke. The cardiopulmonary coupling (CPC) analysis using Holter-monitoring is an easily assessable method to evaluate SDB. However, its prognostic impact needs to be investigated. Purpose The present study investigated the prognostic impact of SDB defined by CPC analysis using Holter-monitoring at early stage of ischemic stroke on the functional disability at 3-month follow-up. Methods Total 692 patients with acute ischemic stroke who underwent Holter-monitoring were enrolled. The CPC analysis was conducted and SDB was defined as the presence of narrow-band (NB) coupling during sleep time. We investigated the association between SDB and functional disability at 3-month measured by modified Rankin scale (mRS). Result The NB coupling was present in 216 (31.2%) of 692 patients with mean age of 64.2±12.8 years. The NB group showed significantly higher proportion of severe functional disability (mRS ≥3; 45.3% vs. 12.3%, p&lt;0.001) and persistent disability (ΔmRS≤0; 42.6% vs. 56.4%, p&lt;0.001) after 3-month. In multivariate analysis, the presence of NB coupling was an independent predictor of higher risk of both severe and persistent functional disability (HR: 3.97; 95% CI: 2.37–6.64; p&lt;0.001; and HR 1.92; 95% CI: 1.34–2.77; p&lt;0.001, respectively). The results were consistent after propensity-score matched analysis with 175 patient pairs (C-statistics=0.759). Parameters of functional disability Overall population (n=692) PSM population (n=350) no NB (n=476) NB (n=216) OR (95% CI) p-value no NB (n=175) NB (n=175) OR (95% CI) p-value Initial NIHSS ≥5 89 (18.6) 81 (37.5) &lt;0.001 52 (29.7) 52 (29.7) &gt;0.999 Discharge mRS ≥3 146 (30.6) 126 (58.3) &lt;0.001 90 (51.4) 89 (50.8) 0.915 3-month mRS ≥3 59 (12.3) 98 (45.3) 5.86 (4.00–8.60) &lt;0.001 38 (21.7) 72 (41.1) 2.52 (1.57–4.02) &lt;0.001 3-month ΔmRS ≤0 (persisent disability) 203 (42.6) 122 (56.4) 1.74 (1.26–2.41) 0.001 77 (44.0) 100 (57.1) 1.69 (1.11–2.58) 0.014 Data are expressed as n (%). mRS = modified Rankin's scale; NB = narrow-band; NIHSS = National Institutes of Health Stroke Scale; OR = odds ratio; PSM = propensity-score matched. Functional disabilities after 3-month Conclusion SDB assessed by CPC analysis at early phase of ischemic stroke was able to predict both greater and persistent functional disability at 3-month. The CPC analysis using Holter-monitoring is a useful modality for predicting functional disabilities in acute ischemic stroke.

4098Reduced skeletal muscle mass is associated to worsened long-term clinical outcomes in patients with coronary artery disease: a quantitative analysis by computed tomography

Abstract Background Sarcopenia is closely associated to poor clinical outcomes in patients with atherosclerotic cardiovascular disease (ASCVD). However, it is unclear whether the skeletal muscle mass at baseline has quantitative effect on future cardiovascular outcomes. Purpose We investigated the quantitative effect of skeletal muscle mass on future cardiovascular outcomes in patients with coronary artery disease (CAD). Methods Total 475 patients those who underwent successful percutaneous coronary intervention (PCI) for CAD and performed computed tomography (CT) scan within 30 days of PCI were enrolled. The cross-sectional area of skeletal muscle at the first lumbar vertebra (L1) level was measured. Whole study population was divided into 4 groups according to the sex-specific quartiles of skeletal muscle index (SMI). Primary outcome was all-cause mortality and secondary outcome was major adverse cardiovascular event (MACE) within 3 years of follow-up. Results Mean follow-up duration was 4.11±3.02 years and average time period from the date of PCI to CT scan was −3.33±11.72 days. The incidence of 3-year all-cause mortality (23.2% vs. 9.9% vs. 6.6% vs. 4.4%, p&lt;0.001) and MACE (42.9% vs. 24.0% vs. 14.3% vs. 6.2%, p&lt;0.001) was significantly higher in the group of lower quartiles of L1-SMI. In the fully adjusted multivariable analysis, lower quartiles of L1-SMI was an independent predictor of higher risk of all-cause mortality and MACE (lowest vs. highest quartile; OR: 4.90, 95% CI: 1.54 to 15.5, p=0.007; and OR: 12.3, 95% CI: 4.99 to 30.4, p&lt;0.001, respectively). Results of 3-year clinical outcomes SMI Q1 (n=124) SMI Q2 (n=116) SMI Q3 (n=112) SMI Q4 (n=123) Log-rank p-value All-cause mortality 27 (23.2) 11 (9.9) 7 (6.6) 5 (4.4) &lt;0.001 Non-fatal MI 9 (8.7) 3 (3.0) 2 (2.0) 3 (2.6) 0.038 Repeat revascularization 20 (24.9) 15 (15.2) 7 (7.1) 4 (3.8) &lt;0.001 Total MACEs 47 (42.9) 26 (24.0) 15 (14.3) 7 (6.2) &lt;0.001 Data are expressed as n (%). MACE = major adverse cardiovascular event; MI = myocardial infarction; SMI = skeletal muscle index; Q = quartile. Impact of reduced skeletal muscle on CAD Conclusion Skeletal muscle mass at baseline is a powerful predictor of future adverse clinical outcomes in patients with CAD undergoing successful PCI. Quantitative assessment of skeletal muscle mass at L1 level by CT scan provides prognostic implication for future cardiovascular risk stratification. Acknowledgement/Funding National Research Foundation of Korea (NRF-2016R1A2B3013825), Ministry of Future Creation and Science of Korea (2018K000255)

P1249Prognostic impact of sarcopenia on major adverse cardiovascular outcomes in coronary artery disease patients undergoing successful percutaneous coronary intervention

Abstract Background Sarcopenia is an emerging marker of frailty. Its prognostic impact on atherosclerotic cardiovascular disease (ASCVD) requires further investigation. Purpose We investigated the long-term prognostic impact of computed tomography (CT)-determined sarcopenia in patients with coronary artery disease (CAD). Methods Total 475 CAD patients those who underwent successful percutaneous coronary intervention (PCI) and performed CT scan within 30 days of PCI were enrolled. The cross-sectional area of skeletal muscle at the first lumbar vertebra (L1) level was measured. Sarcopenia was defined as L1 skeletal muscle index of less than 34.60 cm2/m2 for men and of less than 25.90 cm2/m2 for women. Primary outcome was 3-year all-cause mortality and secondary outcome was 3-year major adverse cardiovascular event (MACE), a composite of all-cause mortality, any myocardial infarction, and repeat revascularization. Results Sarcopenia was present in 214 (45.1%) of 475 patients. The incidence of 3-year all-cause mortality and MACE was significantly higher in patients with sarcopenia than in those without sarcopenia (17.7% vs. 5.7%, p&lt;0.001; and 35.0% vs. 11.2%, p&lt;0.001, respectively). In the fully adjusted multivariable analysis, sarcopenia was an independent predictor of higher risk of 3-year all-cause mortality (odds ratio [OR]: 2.98; 95% confidence interval [CI]: 1.35 to 6.58, p=0.007) and MACE (OR: 4.39; 95% CI: 2.49 to 7.73, p&lt;0.001). The results were consistent after propensity-score matched analysis with 100 pairs of study population (C-statistics = 0.868). Kaplan–Meier analysis of 3-year outcomes Overall population PSM population Sarcopenia (n=214) No sarcopenia (n=261) Log-rank p-value Sarcopenia (n=100) No sarcopenia (n=100) Log-rank p-value All-cause mortality 36 (17.7) 14 (5.7) &lt;0.001 19 (20.0) 7 (7.7) 0.013 Non-fatal MI 12 (6.6) 5 (2.0) 0.021 6 (7.0) 2 (2.3) 0.134 Repeat revascularization 32 (20.3) 14 (6.2) &lt;0.001 17 (23.3) 8 (8.0) 0.027 Total MACEs 68 (35.0) 27 (11.2) &lt;0.001 36 (39.3) 14 (15.4) 0.001 Data are expressed as n (%). MACE = major adverse cardiovascular event; MI = myocardial infarction; PSM = propensity-score matched. Clinical impact of sarcopenia on CAD Conclusion Sarcopenia is a useful predictor of adverse clinical outcomes in patients with CAD undergoing PCI. CT-determined sarcopenia may further aid in risk stratification and decision-making for patients with established ASCVD. Acknowledgement/Funding National Research Foundation of Korea (NRF-2016R1A2B3013825), Ministry of Future Creation and Science of Korea (2018K000255)

Glutathione transferase genotypes may serve as determinants of risk and prognosis in renal cell carcinoma

Renal cell carcinoma (RCC) represents a group of histologically similar neoplasms with significant intratumor and intertumor genetic heterogeneity. Recognized risk factors for RCC development include smoking, hypertension, obesity, as well as von Hippel-Lindau (VHL) disease. Inactivation of VHL, deregulated nuclear factor (erythroid-derived 2)-like 2 (Nrf2) pathway, and altered redox homeostasis, together with changes in glutathione transferase (GST) profile, are considered as important contributing factors in RCC development and progression. Although the available results of both gene-gene and gene-environment analysis are quite heterogeneous, they clearly indicate that certain GST genotypes may play a role as risk modifiers, either individually or in combination with other Phase I or Phase II gene polymorphisms, as well as in subjects exposed to relevant substrates. Seemingly, GST genotyping could identify individuals with impaired detoxification in renal parenchyma that are at higher risk of developing RCC. In addition to well established roles of GSTs in conjugation and biotransformation of xenobiotics, GSTs have emerged as significant regulators of pathways determining cell proliferation and survival. Indeed, there are evidence in favor of GST significance, not only in terms of risk for RCC development, but also with respect to progression and prognosis. So far, GSTM1-active genotype was confirmed to be an independent predictor of higher risk of overall mortality. Therefore, it is reasonable to assume that certain GST variants may assist in individual RCC risk assessment, as well as postoperative prognosis. Even more, GST profiling might contribute to development of personalized targeted therapy in RCC patients.

Patterns of Postdiagnosis Depression Among Late-Stage Cancer Patients

The incidence of depression after a late-stage cancer diagnosis is poorly understood and has not been the subject of intense investigation. We used population-based data to examine trends in postdiagnosis depression incidence among racial/ethnic and sexual groups. We identified 123,066 patients diagnosed with late-stage breast, prostate, lung, or colorectal cancer from 2001 to 2013 in the Surveillance Epidemiology and End Results Medicare-linked database. The primary outcome was the incidence of postdiagnosis depression after a late-stage cancer diagnosis. Trend analysis was performed using the Cochran-Armitage test. Stratified incidence rates were calculated for the racial/ethnic and sexual groups. The incidence of depression after cancer diagnosis increased from 15.3% in 2001 to 24.1% in 2013, P trend<0.0001. About 50% of depression was reported in the first 3 months of stage IV cancer diagnosis. A total of 19,775 (20.0%) non-Hispanic whites, 1937 (15.9%) non-Hispanic blacks, and 657 (12.7%) Hispanics were diagnosed with depression during a mean follow-up of 2.7 months (interquartile range: 0.9 to 10.2 mo). The incidence of depression is significantly higher among females than males, 22.7% versus 16.3%, P<0.0001. In the multivariable logistic regression, non-Hispanic whites and females were still independent predictors of higher risk of postdiagnosis depression. There are significant differences in the incidence of postdiagnosis depression among racial/ethnic and sexual groups in the United States. The consideration of racial/ethnic in depression prevention and diagnosis among cancer patients should be discussed as a matter of importance to ensure that there is no diagnosis bias among non-Hispanic blacks and Hispanics.

Prognostic Impact of Low Skeletal Muscle Mass on Major Adverse Cardiovascular Events in Coronary Artery Disease: A Propensity Score-Matched Analysis of a Single Center All-Comer Cohort.

The impact of sarcopenia on atherosclerotic cardiovascular disease remains unclear. We aimed to investigate the prognostic impact of sarcopenia on coronary artery disease (CAD). A total of 475 patients with CAD who underwent successful percutaneous coronary intervention (PCI) and computed tomography (CT) were enrolled. The cross-sectional area of skeletal muscle at the first lumbar (L1) vertebral level was measured, and sex-specific cut-off values of L1 skeletal muscle index (L1 SMI; male <31.00 cm2/m2, female <25.00 cm2/m2) were obtained. The primary outcome was 3-year all-cause mortality and the secondary outcome was 3-year major adverse cardiovascular events (MACEs). Low L1 SMI was present in 141 (29.7%) of 475 patients. The incidence of all-cause mortality (23.7% vs. 5.9%, p < 0.001) and MACEs (39.6% vs. 11.8%, p < 0.001) was significantly higher in patients with low L1 SMI than in those with high L1 SMI. In multivariate analysis, low L1 SMI was an independent predictor of higher risk of all-cause mortality (hazard ratio (HR): 4.07; 95% confidence interval (CI): 1.95–8.45; p < 0.001) and MACEs (HR: 3.76; 95% CI: 2.27–6.23; p < 0.001). These findings remained consistent after propensity score-matched analysis with 91 patient pairs (C-statistic = 0.848). CT-diagnosed low skeletal muscle mass is a powerful predictor of adverse outcomes in patients with CAD undergoing PCI.

Serial assessment of spot urine sodium predicts effectiveness of decongestion and outcome in patients with acute heart failure.

The clinical significance of the measurement of urine sodium concentration (UNa+ ) in response to loop diuretic administration in patients with acute heart failure (AHF) is still unsettled. We studied the association of serial measurements of spot UNa+ during the first 48 h of AHF treatment with the indices of decongestion, renal function, and prognosis. We enrolled 111 AHF patients, all of whom received intravenous furosemide on admission. The mean spot UNa+ significantly increased in the 6 h sample (P< 0.05 vs. baseline) and returned to baseline values in the 24 and 48 h samples. Based on the increase or decrease/no change of UNa+ in the 6 and 48 h samples vs. baseline, patients were divided into two groups at each time point, respectively. Patients did not differ in baseline clinical and laboratory characteristics. Patients with a decrease/no change of UNa+ in the 6 and 48 h samples had a lower weight loss during hospitalization. Patients with a decrease/no change of UNa+ in the 48 h sample had a poorer diuretic response and a significant increase in the urinary levels of the tubular biomarkers: kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin. Low UNa+ and decrease/no change in UNa+ in the 6 and 48 h samples were independent predictors of higher risk of all-cause mortality during 1-year follow-up (all P< 0.05). In AHF, low spot UNa+ and lack to increase UNa+ in response to intravenous diuretics are associated with poor diuretic response, markers of tubular injury and high risk of 1-year mortality.