Independent Predictor Of 1-year Mortality Research Articles

Preinjury Patient Characteristics and Postinjury Neurological Status Are Associated With Mortality Following Spinal Cord Injury.

Retrospective cohort study. This study investigates the association between spinal cord injuries (SCI) and post-injury mortality. SCIs) are severe conditions treated in the acute trauma setting. Owing to neurological deficits, unstable spinal columns, and associated injuries, these patients often have complex inpatient hospitalizations with significant morbidity and mortality. It is assumed that a high rate of postinjury mortality would follow such severe injuries; however, the effect of SCI and its treatment on predictors of longevity remain largely unknown. Patients seen at a regional referral center for SCI were reviewed from a prospectively maintained database. Four hundred and twenty-six patients with SCI and varying degrees of injury between 2004 and 2009 were collected. Injury characteristics, including injury severity score, level of SCI, and type of SCI were retrieved. To determine independent predictors of 5-year mortality, a logistic regression using patient and injury characteristics at the time of presentation was performed. Average age was 47.4 years (range: 14-95), and 74.5% (318/426) were male. Half of the cohort sustained low-energy mechanisms of injury (220/426; 52.4%). The 30-day, 90-day, 1-year, 2-year, and 5-year mortality rates in the SCI cohort were 6.6% (28/426), 9.2% (39/426), 12.0% (51/426), 15.0% (64/426), and 17.8%, respectively (76/426). Logistic regression demonstrated that increasing age (B = 1.06, P < 0.001), increasing ICU length-of-stay (B = 1.06; P = 0.002), decreased motor score at presentation (B = 0.98; P = 0.004), and lack of surgical intervention (B = 0.38; P < 0.001) were independent predictors of mortality at 5 years. There is substantial mortality associated with SCI. A significant proportion of the mortalities occurred acutely after injury. Mortality was associated with neurological deficit and severity of injury, as well as with preinjury patient characteristics. To combat this high rate of death, efforts are needed to address the concomitant disease processes associated with neurological deficits. 3.

18F-FDG PET-MRI with T1 MOLLI mapping to detect systemic sclerosis bowel inflammation and fibrosis

BackgroundSystemic sclerosis-associated gastrointestinal tract involvement (SSc-GIT) is an independent predictor of 2-year mortality in early SSc. Availability of non-invasive investigations will facilitate early diagnosis and monitoring. HypothesisWe investigate the role of 18F-FDG-PET-MRI in SSc-GIT, hypothesizing that i) higher bowel FDG-PET uptake, a surrogate biomarker for inflammation, distinguishes healthy bowel from inflamed SSc-GIT; ii) MRI T1-MOLLI mapping, a surrogate biomarker for cardiac fibrosis, distinguishes healthy bowel from fibrotic SSc-GIT. MethodsIn this prospective study, 16 SSc patients and 15 healthy controls were recruited. All SSc patients and 5 controls underwent PET-MRI (with T1-MOLLI mapping) on a Siemens 3T mMR; 10 controls underwent MRI without PET. Manual segmentation of the large and small bowels was performed jointly by two trained analysts in order to report T1 and PET values. Control dataset was used to assess normal healthy range. Mean T1 values, mean Tissue-to-Background (TBR) PET values, as well as amount of supposedly abnormal bowel (measured using the healthy ranges) was compared using Student’s t-test and Cohen’s d effect size. ResultsMean T1 values in large (1113 ± 182 ms vs 856 ± 176 ms; p-value < 0.001) and small bowel (1331 ± 239 ms vs 1169 ± 118 ms; p = 0.02) were higher in SSc patients than controls. 87.5% of the SSc patients’ bowel had at least a grade 3 segmental FDG-PET uptake, while no controls showed more than a grade 2 segmental uptake. Patients had higher large bowel mean PET TBR (1.12 ± 0.22) than controls (0.82 ± 0.20, p = 0.02). Using PET and T1 thresholds defined using the control PET-MR data, the percentage of supposedly healthy (non-fibrotic and non-inflamed) tissue was significantly lower in SSc patients (81.1 ± 13.1%) than controls (95.7 ± 3.1%, p = 0.03) for the large bowel. ConclusionOur novel study of FDG-PET-MRI in SSc-GIT demonstrated promising results in non-invasively evaluating concurrently bowel inflammation and fibrosis.

Transcatheter aortic valve replacement in the setting of left atrial appendage thrombus†

Left atrial appendage thrombus (LAT) was an exclusion criterion in the seminal transcatheter aortic valve replacement (TAVR) trials; however, such patients do undergo TAVR in the 'real-world' setting. This study sought to analyse outcomes after TAVR in patients with LAT or spontaneous echo contrast (SEC). All patients undergoing TAVR at our institution between March 2009 and December 2014 were prospectively analysed. The presence of LAT or SEC was determined via a retrospective chart review. Primary outcomes included 30-day and 1-year neurological events as well as mortality. Of the 369 patients undergoing TAVR, 3.8% (14) were found to have LAT and 6.8% (25) were found to have SEC, and they were separately compared to patients who did not have LAT or SEC. Significant differences were noted between groups with regard to preoperative renal function, atrial fibrillation and ejection fraction. Preoperative atrial fibrillation was the only independent predictor of LAT. No perioperative complications were associated with the presence of LAT or SEC. Specifically, no patient with LAT or SEC experienced a postoperative neurological event. While neither LAT nor SEC was an independent predictor of 30-day mortality, LAT was an independent predictor of 1-year mortality (odds ratio 3.573, 95% confidence interval 1.040-12.28; P = 0.042). The current study suggests that TAVR may be performed in patients with LAT and SEC with a low risk of embolic complications. While neither was an independent predictor of 30-day mortality, LAT was an independent predictor of 1-year mortality. Larger studies are needed to better study this phenomenon.

Model for end-stage liver disease predicts mortality after pericardiectomy for constrictive pericarditis.

Prognosis after pericardiectomy for constrictive pericarditis (CP) is affected by the aetiology of the constriction as well as by concomitant cardiac and non-cardiac disease, including liver dysfunction. However, few data exist on the risk stratification that accounts for liver function in patients with CP. We evaluated the effectiveness of the model for end-stage liver disease (MELD) score, an established measure of liver dysfunction, in predicting long-term survival and identifying other risk factors for death. A total of 79 patients who underwent pericardiectomy for CP at a single centre between 2009 and 2016 were analysed. The prognostic utility of the MELD score was evaluated in our cohort. Logistic regression and Cox proportional hazard regression analyses were performed to assess the association of various clinical variables with 1-year and overall mortality rates. With multivariable analysis, only the MELD score was an independent predictor of 1-year mortality (P < 0.001); apart from the MELD (P = 0.003) score, post-surgical CP (P = 0.016), total bilirubin level (P = 0.042) and the European System for Cardiac Operative Risk Evaluation score II (P = 0.002) were independent predictors of overall mortality after pericardiectomy. Overall survival decreased as the MELD score increased. Scores ≤ 7.5, 7.51-15.50 and >15.5 were associated with overall survival rates of 92.9%, 69.8% and 8.3%, respectively. In addition to the underlying aetiology, we demonstrated that assessment of liver dysfunction using the MELD score provides additional information about risk because it is associated with postoperative death in patients undergoing pericardiectomy for CP.

Functional status, pre-dialysis health and clinical outcomes among elderly dialysis patients

BackgroundElderly patients comprise the fastest growing population initiating dialysis in United States. The impact of poor functional status and pre-dialysis health status on clinical outcomes in elderly dialysis patients is not well studied.MethodsWe studied a retrospective cohort of 49,645 incident end stage renal disease patients that initiated dialysis between January 1, 2008 and December 31, 2008 from the United States Renal Data System with linked Medicare data covering at least 2 years prior to dialysis initiation. Using logistic regression models adjusted for pre-dialysis health status and other cofounders, we examined the impact of poor functional status as defined from form 2728 on 1-year all-cause mortality as primary outcome, type of dialysis modality (hemodialysis vs. peritoneal dialysis), and type of initial vascular access (arteriovenous access vs. central venous catheter) among hemodialysis patients as secondary outcomes.ResultsMean age was 72 ± 11 years. At dialysis initiation, 18.7% reported poor functional status, 88.9% had at least 1 pre-dialysis hospitalization, and 27.8% did not receive pre-dialysis nephrology care. In adjusted analyses, 1-year mortality was higher in patients with poor functional status (OR, 1.48; 95% CI, 1.40–1.57). Adjusted odds of being initiated on hemodialysis than peritoneal dialysis (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.16–1.66) were higher in patients with poor functional status. Poor functional status decreased the adjusted odds of starting hemodialysis with arteriovenous access as compared to central venous catheter (OR, 0.79; 95% CI, 0.72–0.86).ConclusionPoor functional status in elderly patients with end stage renal disease is associated with higher odds of initiating hemodialysis; increases the risk of central venous catheter use, and is an independent predictor of 1-year mortality.

Computed tomography predictors of mortality, stroke and conduction disturbances in women undergoing TAVR: A sub-analysis of the WIN-TAVI registry

BackgroundAortic valve calcification patterns were associated with short- and long-term outcomes in previous small observational datasets of patients undergoing transcatheter aortic valve implantation (TAVI). The specific impact of multi detector-row computed tomography (MDCT) findings on outcomes in women has not been reported. We sought to describe the associations between MDCT characteristics and clinical outcomes in a registry of 547 women undergoing TAVI. MethodsWIN-TAVI is the first all-female registry to study the safety and effectiveness of TAVI in women (n = 1019). Thirteen sites participated in the MDCT sub-study and contributed pre-TAVI MDCT studies in 547 consecutive subjects. All MDCT data were analyzed in an independent core lab blinded to clinical outcomes. Key measurements included number of valve leaflets, aortic annulus area and perimeter, left and right coronary artery height, aortic cusp calcium volume, commissural calcification and left ventricular outflow tract (LVOT) calcification. Calcium volume of the aortic valvular complex was quantified using a threshold relative to patient-specific contrast attenuation in the arterial blood pool. We examined univariate and multivariate associations between ECG-gated contrast MDCT characteristics and 1-year mortality or stroke, new pacemaker implantation and new onset atrial fibrillation (AF). ResultsThe CT sub-study sample had a mean age of 82.8 ± 6.3 years, mean logistic EuroSCORE of 17.8 ± 11.3%, and mean STS score of 8.2 ± 7.4%. Transfemoral access was used in 89.6% of patients. After multivariate adjustment, moderate or severe LVOT calcification was an independent predictor of 1-year mortality or stroke (HR = 1.91; 95% CI: 1.11–3.30; p = 0.02). Calcium volume in the right coronary cusp was an independent predictor of new pacemaker (HR = 1.18 per 100 m3 increment; p = 0.04), whereas calcium volume of the non-coronary cusp had a protective effect (HR = 0.78 per 100 mm3 increment; p = 0.004). Severe calcification of the non-coronary/right-coronary commissure was an independent predictor of new AF (HR = 5.1; p = 0.008). ConclusionComputed tomography provides important prognostic information in women undergoing TAVI. Moderate or severe LVOT calcification is associated to an almost two-fold increased risk of mortality or stroke at one year. Different calcification patterns of the aortic valve may predict diverse rhythm abnormalities.

Prevalence, Temporal Evolution, and Impact on Survival of Ventricular Conduction Blocks in Patients With Acute Coronary Syndrome and Cardiogenic Shock

Changes in QRS duration and pattern are regarded to reflect severe ischemia in acute coronary syndromes (ACS), and ventricular conduction blocks (VCBs) are recognized high-risk markers in both ACS and acute heart failure. Our aim was to evaluate the prevalence, temporal evolution, association with clinical and angiographic parameters, and impact on mortality of VCBs in ACS-related cardiogenic shock (CS). Data of 199 patients with ACS-related CS from a prospective multinational cohort were evaluated with electrocardiogram data from baseline and day 3. VCBs including left or right bundle branch block, right bundle branch block and hemiblock, isolated hemiblocks, and unspecified intraventricular conduction delay were assessed. Fifty percent of patients had a VCB at baseline; these patients were older, had poorer left ventricular function and had more often left main disease compared with those without VCB. One-year mortality was over 2-fold in patients with VCB compared with those without VCB (68% vs 32%, p<0.001). All types of VCBs at baseline were associated with increased mortality, and the predictive value of a VCB was independent of baseline variables and coronary angiography findings. Interestingly, 37% of the VCBs were transient, i.e., disappeared before day 3. However, 1-year mortality was much higher in these patients (69%) compared to patients with persistent (38%) or no VCB (15%, p<0.001). Indeed, a transient VCB was a strong independent predictor of 1-year mortality. In conclusion, our findings propose that any VCB in baseline electrocardiogram, even if transient, identifies very early patients at particularly high mortality risk in ACS-related CS.

A New Combined Model for End-Stage Liver Disease Excluding INR (CMELD-XI) Score Better Predicts Pediatric Heart Transplant Outcomes

The Model for end-stage liver disease (MELD) score, derived based on serum creatinine, bilirubin, and INR, was developed to accurately predict the probability of waitlist mortality in patients awaiting a liver transplant. Subsequently, a MELD excluding INR (MELD-XI) score was adapted to predict mortality after heart transplant (HT). Our objective was to devise a new combined scoring model (defined as CMELD-XI, derived by adding the MELD-XI score with independent predictors of 1-year mortality) to accurately predict mortality after pediatric HT (PHT).

The Impact of Left Ventricular Diastolic Dysfunction on Clinical Outcomes After Transcatheter Aortic Valve Replacement

ObjectivesThis study sought to determine the impact of left ventricular diastolic dysfunction (LVDD) on clinical outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). BackgroundLeft ventricular (LV) hypertrophy in response to afterload increase promotes the development of LVDD and represents an early stage in the progression to valvular heart failure. MethodsIn a consecutive cohort of 777 aortic stenosis patients undergoing TAVR, LVDD was categorized according to the latest guidelines. The primary endpoint was 1-year all-cause mortality. ResultsThere were 545 (70.1%) patients with LVDD. Ninety-eight (18.0%), 198 (36.3%), and 104 (19.1%) patients were classified as LVDD grades I, II, and III, respectively. In 145 (26.6%) patients, LVDD grade could not be determined because of only 1 or 2 discrepant variables. One-year all-cause mortality was higher in patients with LVDD grades I (16.3%; adjusted hazard ratio [HR]adj: 2.32; 95% confidence interval [CI]: 1.15 to 4.66), II (17.9%; HRadj: 2.58; 95% CI: 1.43 to 4.67), and III (27.6%; HRadj: 4.21; 95% CI: 2.25 to 7.86) than in those with normal diastolic function (6.9%). The difference in clinical outcome emerged within 30 days, was driven by cardiovascular death, and maintained in a sensitivity analysis of patients with normal systolic LV function. Furthermore, LVDD grades I (HRadj: 2.36; 95% CI: 1.17 to 4.74), II (HRadj: 2.58; 95% CI: 1.42 to 4.66), and III (HRadj: 4.41; 95% CI: 2.37 to 8.20) were independent predictors of 1-year mortality. ConclusionsAdvancing stages of LVDD are associated with an incremental risk of all-cause mortality after TAVR, driven by cardiovascular death and taking effect as early as 30 days after the intervention.

Serum osteopontin in patients with lung cancer and chronic obstructive pulmonary disease: does the co-existence make the difference?

Osteopontin (OPN) is involved in cancer development and metastasis. Increased sputum OPN was detected in chronic obstructive pulmonary disease (COPD). We evaluated serum OPN levels in patients with lung cancer (LC) and/or COPD and aimed to determine OPN prognostic performance in 1-year mortality in LC and also its diagnostic performance in LC among COPD patients. We recruited 167 LC patients, 85 with concomitant COPD. 28 COPD patients served as control group. OPN levels were higher in LC compared to COPD alone (P=0.017) and higher in COPD and LC compared to COPD alone (P=0.031). No difference was observed in OPN levels between LC and COPD vs. LC without COPD (P=0.171). Serum OPN ≥50.3 ng/mL was an independent predictor of 1-year mortality in LC. OPN levels ≥35 ng/mL could predict the presence of LC among COPD patients. In patients with LC and/or COPD, LC is the major determinant for serum OPN. Serum OPN might be a promising prognostic biomarker of LC and a diagnostic biomarker of LC among COPD patients.

Sex-Related Anemia Contributes to Disparities in Outcome of Patients Younger Than 60 Years with ST-Elevation Myocardial Infarction.

Younger women with ST-segment elevation myocardial infarction (STEMI) have a worse outcome than their age-matched male peers. Our aim was to assess whether there are sex-based differences in anemia on admission, and if they are associated with the outcome of patients with STEMI younger than 60 years undergoing primary percutaneous coronary intervention (PCI). Data of 2095 STEMI patients, 804 of whom were younger than 60 years, were analyzed. Data were analyzed using descriptive statistics. All-cause 30-day and 2-year mortality were documented. Women had a higher prevalence of anemia compared with men on admission (34.4% in women vs. 20.0% in men; p < 0.0001). The 30-day mortality was similar in both groups (5.5% in women vs. 3.3% in men; p = 0.17). Anemia on admission, age, cardiogenic shock, and diabetes predicted higher 30-day mortality. Two-year mortality was higher in women (9.8% in women vs. 4.8% in men; p = 0.023). Anemia on admission, age, cardiogenic shock, and diabetes were identified as independent predictors of 2-year mortality. Sex was not associated with 30-day or 2-year mortality. We found sex-based differences in anemia on admission in STEMI patients younger than 60 years. Anemia, but not sex, was linked to 30-day and 2-year mortality. Anemia on admission in women younger than 60 years may help to explain the increased 2-year sex-related mortality in younger STEMI patients undergoing primary PCI.

Novel predictors of outcome after coronary angioplasty with rotational atherectomy. Not only low ejection fraction and clinical parameters matter.

IntroductionMost established risk factors after rotational atherectomy (RA) of heavily fibro-calcified lesions are associated with patients’ general risk and clinical related factors and are not specific for either coronary and culprit lesion anatomy or the RA procedure.AimTo assess novel predictors of poor outcome after percutaneous coronary intervention using RA in an all-comers population.Material and methodsA total of 207 consecutive patients after RA were included in a single-center observational study. Primary endpoints were 1-year mortality and 1-year major adverse cardiac events (MACE). Secondary endpoints were angiographic and procedural success and in-hospital complications.ResultsProcedural complications occurred in 19 (8%) patients. In-hospital mortality was 1%, peri-procedural myocardial infarction (MI) was 9%, and acute stroke occurred in one patient. The 1-year MACE rate was 20% with all-cause mortality 10%, MI 10% and stroke 1%. Multivariable analysis revealed heart failure with left ventricle ejection fraction (LVEF) ≤ 35% (p = 0.02) and uncrossable lesion, as compared to undilatable lesion (p = 0.01), as independent predictors of 1-year mortality and residual SYNTAX score ≤ 8 as an independent predictor of favorable outcome (p = 0.04). Heart failure with LVEF ≤ 35% (p < 0.01) and uncrossable lesion (p = 0.04) were independent predictors of 1-year MACE.ConclusionsThe presence of a novel factor, uncrossable lesion, as compared to undilatable lesion, is associated with poor outcome, and low residual SYNTAX score ≤ 8 is associated with favorable outcome in 1-year follow-up after the RA procedure and can help in risk stratification of patients undergoing complex coronary intervention with RA.

Trends and Outcomes of Transcatheter Aortic Valve Implantation (TAVI) in Korea: the Results of the First Cohort of Korean TAVI Registry.

Background and ObjectivesThere has been no nation-wide data on the outcomes of transcatheter aortic valve implantation (TAVI) after commercialization of TAVI in Korea. We report clinical features and outcomes of the first cohort of TAVI performed from Jun 2015 to Jun 2017 in Korea.MethodsThe first cohort of Korean-TAVI (K-TAVI) registry includes 576 consecutive patients with severe symptomatic aortic stenosis who underwent TAVI from 17 Korean hospitals for 2 years.ResultsMost of TAVI procedures were performed for septuagenarians and octogenarians (90.8%) through transfemoral approach (98.3%). The rate of device success was 92.5% and permanent pacemaker was implanted in 5.6%. In successive years, incidences of paravalvular leakage (PVL) and major bleeding declined. Society of Thoracic Surgeons (STS) score was 5.2 (3.0 to 9.0) and 34.7% of patients had high surgical risk (STS ≥8). One-year all-cause death occurred in 8.9% and was significantly lower in low to intermediate risk one than in high risk (5.4% vs. 15.5%, p<0.001). The independent predictors of 1-year mortality were age (hazard ratio [HR], 1.087; 95% confidence interval [CI], 1.036–1.141; p=0.001), moderate or severe PVL (HR, 4.631; 95% CI, 1.624–13.203; p=0.004) and end-stage renal disease (HR, 5.785; 95% CI, 2.717–12.316; p<0.001).ConclusionsK-TAVI registry showed favorable 1-year outcomes with decreasing complication rate over time in real-world Korean patients. Two-thirds of patients were low to intermediate surgical risk and showed a significantly lower mortality than the high-risk patients, suggesting the promising future on the expanded indications of TAVI.

Serum Cardiac Troponin T Levels in Asymptomatic Elderly Nursing Home Residents

BackgroundThe definition of myocardial infarction relies on elevated troponin levels. However, elevated levels of high sensitive cardiac troponin (hs-cTnT) assays have been reported in elderly patients without acute myocardial infarction. We sought to determine whether elevated hs-cTnT levels have a prognostic value in stable elderly subjects without any acute illness. MethodsThe study cohort included residents of a nursing home who were asymptomatic without any acute medical problem. Serum hs-cTnT levels were measured, and participants were divided into high and low hs-cTnT groups. We measured hs-cTnT levels of young healthy volunteers as well and compared them with hs-cTnT levels of those nursing home residents. ResultsFifty-seven nursing home residents and 14 young volunteers were included in the study. The average age of nursing home residents was 83 ± 14 years, compared with 37 ± 3 years of the volunteers. Levels of hs-cTnT were significantly higher in the elderly compared with the volunteers (0.02 ± 0.016 ng/mL vs 0.005 ± 0.0003 ng/mL; P < .001); accordingly, we chose a cutoff of 0.02 ng/mL hs-cTnT and divided the 57 patients into 2 subgroups for further evaluation. After adjustment for age, gender, and glomerular filtration rate, the hs-cTnT was still an independent predictor of 1-year mortality (relative risk 2.04 [95% conficence interval, 2.009-29.45], P = .003). ConclusionsMild elevations of hs-cTnT levels are common in elderly patients, and hs-cTnT level is an independent marker of mortality risk in this population. For patients older than 70 years, a different hs-cTnT cutoff is required (eg, higher than 0.014 ng/mL).

Ankle-brachial pressure index as a predictor of the 2-year outcome after transcatheter aortic valve replacement: data from the Japanese OCEAN-TAVI Registry.

Peripheral artery disease plays a pivotal role for access site selection in transcatheter aortic valve replacement (TAVR). Abnormal ankle-brachial index (ABI) is a generalized mortality marker in many cardiovascular scenarios. However, the long-term outcomes in high-risk TAVR populations remain unclear. We investigated the association between low ABI and 2-year outcome after TAVR. Of 1613 patients enrolled in the OCEAN-TAVI registry, 1458 (90.4%) who underwent ABI before TAVR were divided into groups: patients with (1) ABI≥0.9 in both legs and (2) ABI<0.9 in either leg. Primary endpoint was all-cause death within 2years. ABI<0.9 was noted in 304 patients (20.8%). ABI<0.9-group had more frequent and severe comorbidities. Primary endpoint in ABI<0.9-group was significantly higher than that in ABI≥0.9-group (15.8 vs. 8.7%, p<0.001). This trend continued in the transfemoral (TF)-approach (14.9 vs. 7.5%, p<0.001), but not in the alternative approach (17.2 vs. 15.8%, p=0.815). Within 30days, ABI<0.9-group had a higher cardiac death rate (3.1 vs. 1.0%, p=0.033), whereas between 31days and 2years, non-cardiovascular death was more frequently observed (9.2 vs. 5.1%, p=0.003). In ABI<0.9-group, in-hospital vascular complications (11.9 vs. 4.9%, p<0.001) and acute kidney injury (10.8 vs, 5.7%, p=0.009) were more frequently found when using the transfemoral-approach. In multivariate analysis, ABI<0.9 was an independent predictor of 2-year mortality (adjusted hazard ratio 1.495, 95% CI 1.007-2.220, p=0.046). Pre-procedure ABI<0.9 is a useful prognostic marker for all-cause mortality, even in high-risk TAVR populations.

Analysis of diagnosis and prognosis of MRP8/14 on prostate cancer

Objective To compare the MRP8/14 level in Normal people, benign prostatic hyperplasia(BPH) patient and prostate cancer patient, and explore the relationgship between MRP8/14 and prostate cancer. Methods 150 cases of normal people, 150 cases of BPH patients and 150 cases of prostate cancer patients were chose from December 2012 to December 2014 in our hospital. ELISA method was used to detect the MRP8/14 level in each group. ROC cure was used to analyse the prediction value of MRP8/14 for prostate cancer. According to the cut off value of MRP8/14, prostate cancer patients were divided into MRP8/14 low value group (MRP8/14<cut off value) and MRP8/14 high value group (MRP8/14≥cut off value), and the difference of patient's clinical characteristics and survival function between high value group and low value group were explored. Results The MRP8/14 level of normal people was (966.7±152.8)ng/ml, while the BPH patient was (1 207.0±190.6)ng/ml, and the prostate cancer patient was (2 833.3±1 101.5)ng/ml, the difference is statistically significant. ROC analysis resμlt showed that the AUC for the prediction of prostate cancer was 0.887(95%CI 0.841-0.934), with a high statistical significance, indicating that MRP8/14 may possess high prediction value for prostate cancer. In addition, the cut off value was 2 845.682 ng/ml, with the specifity of 76.4% and sensitivity of 85.1%. According to the cut off value of MRP8/14, prostate cancer patients were divided into the low MRP8/14 group ( 2 and tumour stage>Ⅲ were much more in MRP8/14 high value group. PSA level, LDH level, AKP level, CRP level and Alkaline Phosphatase level were also significantly increased in MRP8/14 high value group. Besides, prostate cancer patient with an average follow-up of 2 years, a total of 32 cases of patients died, 12 cases in the MRP8/14 low value group with mortality of 13.6%, 20 cases in MRP8/14 high value group with mortality of 32.3%. Kaplan Meier survival function curve shows 2 years survival rate of patients in high value group was significantly reduced. Cox regression analysis showed that MRP8/14 was possible risk factors associated with mortality, and the independent predictors for all-cause mortality during follow-up. Conclusion MRP8/14 was significantly increased in prostate cancer patients, and it was an independent predictor of 2-year mortality in prostate cancer patients. Key words: Myeloid-related protein 8/14; Prostate cancer; Prognostic; Clinical significance

Prognostic significance of non-chest pain symptoms in patients with non-ST-segment elevation myocardial infarction.

Background/AimsChest pain is an essential symptom in the diagnosis of acute coronary syndrome (ACS). One-third of patients with ACS present atypically, which can influence their receiving timely lifesaving therapy.MethodsA total of 617 NSTEMI patients from the Korea Acute MI Registry (KAMIR) and the Korea Working Group on MI (KorMI) databases were analyzed. The study population was divided into two groups by symptoms at presentation (typical symptoms group, 128; atypical symptoms groups, 128).ResultsIn this study population, 23% of patients presented without chest pain. After propensity score matching, the contact-to-device time (2,618 ± 381 minutes vs. 1,739 ± 241 minutes, p = 0.050), the symptoms-to-balloon time (3,426 ± 389 minutes vs. 2,366 ± 255 minutes, p = 0.024), and the door-to-balloon time (2,339 ± 380 minutes vs. 1,544 ± 244 minutes, p = 0.002) were significantly higher in the patients with atypical symptoms than in those with typical symptoms, respectively. Atypical symptoms were an independent predictor for 1-year mortality (hazard ratio, 2.820; 95% confidence interval, 1.058 to 7.515; p = 0.038). The Kaplan-Meier estimates showed higher risk for 12-month mortality in patients with atypical symptoms (p = 0.048) and no significant difference for 12-month major adverse cardiac events (p = 0.487).ConclusionsAcute myocardial infarction patients with atypical symptoms were not rare in clinical practice and showed a high risk of delayed reperfusion therapy. After imbalance between the groups was minimized by use of propensity score matching, patients who presented atypically had a high mortality rate.

One-Year Survival after Inhospital Cardiac Arrest-Does Prearrest Sepsis Matter?

Cardiac arrest is not a common complication of sepsis, although sepsis has been recognized as one condition behind cardiac arrest. Our aim was to evaluate the prevalence of sepsis among patients with inhospital cardiac arrest (IHCA), and to determine if sepsis is associated with inferior outcome after IHCA. All consecutive emergency team dispatches in Turku University Hospital in 2011 to 2014 (n = 607) were retrospectively reviewed to identify the patients undergoing cardiopulmonary resuscitation (CPR) for IHCA (n = 301). The patient records were reviewed for the criteria of severe sepsis, organ dysfunction, and chronic comorbidities before IHCA. Outcome was followed for 1 year. The criteria for prearrest severe sepsis were met by 83/301 (28%) of the patients, and 93/301 (31%) had multiorgan dysfunction (3 or more organ systems). The patients with severe sepsis had higher mortality than those without severe sepsis, increasing from 30-day mortalities of 63/83 (76%) and 151/218 (69%), respectively (P = 0.256), to 1-year mortalities of 72/83 (87%) and 164/218 (75%), respectively (P = 0.030). Emergency admission, age, immunosuppression, DM, multiorgan dysfunction, and a nonshockable rhythm were independent predictors of 1-year mortality by multivariate logistic regression analysis. Six out of 83 patients with severe sepsis before IHCA (7%) survived 1 year with good neurological outcome (CPC scale 1). A high proportion of patients with IHCA have sepsis and multiorgan dysfunction, and their prognosis is worse than the prognosis of patients with IHCA in general.

PROGNOSTIC IMPACT OF PRE AND POST-PROCEDURAL CARDIAC BIOMARKERS FOR TRANSCATHETER AORTIC VALVE IMPLANTATION

Both pre- and post-procedural cardiac biomarkers (troponin and NT-pro-BNP) were advocated as independent prognostic factors after transcatheter aortic valve implantation (TAVI), with an increased 1-month and 1-year mortality, but with contradictory results. The aim of this study was to assess the prognostic impact of these biomarkers in a large single-centre prospective TAVI database. All consecutive patients undergoing TAVI at our institution between October 2006 and October 2015 were included prospectively. Pre-procedural troponin and NT-pro-BNP were assessed the day before the procedure and post-procedural measurements were performed the day after the procedure. These measurements were included in a Cox proportional hazards model along with other pre-procedural variables. Key endpoints were mortality at 1 month and 1 year. In total, 1390 patients were included in this study (66.8% transfemoral). Mean age was 83.4±36.8 years and 47.7% were female. Mean logistic EuroScore was 17.3 ± 11.0%. Median pre- and post-procedural troponin levels were 0.33 ng/L (interquartile range: 0.02 - 2.90) and 0.25 ng/L (0.14 - 2.85), respectively (paired Wilcoxon test: p=0.26). Median pre- and post-procedural NT-pro-BNP level were 1878 XXX (interquartile range: 739 - 4141) and 1714 XXX (684 - 4277), respectively (paired Wilcoxon test: p=0.59). Mortality at 1 month and 1 year were 6.3% (n=87) and 13.9 %(n=190), respectively. Pre-procedural troponin was a predictor of 1-year mortality (HR= 1.07 per increase in 1 ng/L; p=0.021) but not of 1-month mortality. After adjustment for the logistic Euroscore, pre-procedural troponin remained an independent predictor of 1-year mortality (HR: 1.05 per increase in 1 ng/L; p=0.05). Post-procedural troponin, change in troponin, pre- and post-procedural NT-pro-BNP were not predictive of mortality (all p=ns). Four independent predictors of elevated pre-procedural troponin levels were identified: elevated pre-procedural BNP levels, male sex, atrial fibrillation and low glomerular filtration rate. Pre-procedural troponin is associated with 1-year mortality after TAVI. This measurement could be performed to further risk-stratify patients before the procedure.

Effect of Age and Renal Function on Survival After Left Ventricular Assist Device Implantation

Left ventricular assist devices (LVAD) are increasingly used, especially as destination therapy in in older patients. The aim of this study was to evaluate the effect of age on renal function and mortality in the first year after implantation. A retrospective multicenter cohort study was conducted, evaluating all LVAD patients implanted in the 2 participating centers (age ≥18 years). Patients were stratified according to the age groups <45, 45-54, 55-64, and ≥65 years old. Overall, 241 patients were included (mean age 52.4 ± 12.9 years, 76% males, 33% destination therapy). The mean estimated Glomerular Filtration Rate (eGFR) at 1 year was 85, 72, 69, and 49 mL/min per 1.73 m2 in the age groups <45(n = 65, 27%), 45-54(n = 52, 22%), 55-64(n = 87, 36%), and ≥65 years (n = 37, 15%) p <0.001)), respectively. Older age and lower eGFR at baseline (p <0.01) were independent predictors of worse renal function at 1 year. The 1-year survival post-implantation was 79%,84%, 68%, and 54% for those in the age group <45, 45-54, 55-64 and ≥65 years (Log-rank p = 0.003). Older age, lower eGFR and, INTERMACS class I were independent predictors of 1-year mortality. Furthermore, older patients (age > 60 years) with an impaired renal function (eGFR <55 mL/min per 1.73 m2) had a 5-fold increased hazard ratio for mortality during the first year after implantation (p <0.001). In conclusion, age >60 years is an independent predictor for an impaired renal function and mortality. Older age combined with reduced renal function pre-implantation had a cumulative adverse effect on survival in patients receiving a LVAD.