Independent Predictor Of One-year Mortality Research Articles

Predictive value of the systemic immune-inflammation index on one-year mortality in geriatric hip fractures.

Geriatric hip fractures are associated with a high incidence of mortality. This study examines the predictive value of the systemic immune-inflammation index (SII) on one-year mortality in elderly hip fracture patients. A single-center retrospective study was conducted between February 2017 and October 2020. Three hundred and eleven surgically treated consecutive hip fracture patients were included in the study. Admission, postoperative first day, and postoperative fifth-day SII values were calculated. The receiver operating characteristic (ROC) curve was used to calculate the cut-off values, and patients were divided into high and low groups according to these cut-off values. After univariate Cox regression analysis, significant factors were included in the multivariate Cox proportional hazards model to adjust the effect of covariates and explore independent predictive factors associated with mortality. Further subgroup analysis was performed to evaluate the accuracy of the results for different clinical and biological characteristics. The mean age was 80.7 ± 8.0 years, and women made up the majority (67.8%) of the patients. The one-year mortality rate was 28.0%. After univariate and multivariate analyses, high postoperative fifth-day SII remained an independent predictor of one-year mortality (adjusted HR 2.16, 95% CI 1.38-3.38, p = 0.001). Older age, male gender, Charlson comorbidity index (CCI) ≥ 2, and hypoalbuminemia were found to be other independent predictors. The optimal cut-off value of the postoperative fifth-day SII was calculated at 1751.9 units (p < 0.001). The postoperative fifth-day SII is a simple and useful inflammatory biomarker for predicting one-year mortality in patients with hip fracture.

Predictors of mortality one year after pelvic fractures in an older population: a retrospective cohort study.

Osteoporotic pelvic fractures have significant mortality and morbidity in the older population. The aim of this study was to investigate the factors predicting one-year mortality of patients sustaining a low-impact pelvic fracture (pelvic ring and acetabulum). A total of 282 patients aged ≥ 65 years presenting with a low-energy pelvic ring (n =254) or acetabular (n =28) fracture to the emergency department at the University Hospitals Leuven were included. Demographic and clinical data were retrospectively collected and predictors for mortality one year after pelvic ring fractures were evaluated. The one-year mortality after osteoporotic pelvic ring fractures and acetabular fractures was respectively 20.4% (95% CI 15.7-26.0) and 14% (95% CI 4.0-32.7). Multivariate logistic regression adjusted for confounders identified male gender (OR 3.18; 95% CI (1.06-9.49), p =0.038), a higher number of comorbidities (OR 1.5; 95% CI (1.16-1.95), p =0.002) and in-hospital complications (OR 5.00; 95% CI (1.39-17.97), p =0.014) as independent predictors of one-year mortality after pelvic ring fractures. The one-year mortality after low-energy pelvic is high and can be predicted by different patient characteristics. These findings can guide pelvis fracture treatment decisions in the older population.

Serum levels of the endoplasmic-reticulum-stress chaperone GRP78 are associated with inflammation, identify patients with coronary artery disease and predict mortality

Abstract Introduction Endoplasmic-reticulum-stress (ER Stress) and associated chaperones like the ER-Stress moderator GRP78 (glucose-regulated-protein, 78kDa) are involved in the pathogenesis of coronary artery disease (CAD). In addition to their intracellular effects, secretion and extracellular properties of chaperones, including GRP78, were recently described. In a recent study using proteomic data, we found coronary endothelial cells to secrete GRP78 into the extracellular space. Here, we investigated the significance of serum GRP78 in patients undergoing coronary angiography for suspected CAD. Methods Serum concentration of GRP78 was measured by ELISA in an all-comers cohort of 789 patients with clinical indication for coronary angiography. Samples were drawn from the arterial sheath. CAD was defined as &amp;gt;50% stenosis in any major epicardial coronary artery. Patients were stratified according to their clinical presentation (CCS: chronic coronary syndrome or ACS). Clinical endpoint was all-cause mortality after one year. Patients with malignant or active auto-immune diseases were excluded. Results Mean age was 70.8 ± 11.9 years and 65% of patients were male. 24% patients presented with acute coronary syndrome (ACS). CAD was found in 72.4% of patients. Mean GRP78 serum concentration was 2492 ng/ml. Increased levels of GRP78 (&amp;gt; median) were associated with diabetes (29.9% vs. 23.1%, p = 0.03), a higher BMI (28.9 kg/m2 ± 7.1 vs. 27.0 kg/m2 ± 6.0, p &amp;lt; 0.0001) and chronic kidney disease (CKD: 23.3 % vs. 17.1 %, p = 0.03). There was no difference regarding age or sex. We further compared GRP78 levels to other biomarkers including WBC, Hemoglobin, Troponin, Creatinine, and Interleukin-6 (IL-6). There was no association between GRP78 levels and the mentioned biomarkers, except for a positive correlation between GRP78 and levels of Interleukin-6 (Pearson r =0.14, p = 0.004). GRP78 levels were increased in patients with CAD when compared to patients without CAD (2640 ng/ml vs. 2178 ng/ml, p = 0.013). Interestingly, GRP78 levels were lower in patients with ACS than in patients with CCS (2284 ng/ml vs. 2822 ng/ml, p = 0.018). There was no difference between NSTEMI and STEMI patients. Finally, we assessed prognostic relevance of GRP78 in patients with CAD. Increased GRP78 levels were associated with lower occurrence of the clinical endpoint of one-year mortality (5.3% vs. 10.6 % vs. p = 0.016). Increased GRP78 levels were associated with reduced one-year mortality (HR: 0.48 [95% CI: 0.25 - 0.92]). After adjusting for IL-6, age, sex, BMI, diabetes, CKD, and ACS, GRP78 remained an independent predictor of one-year mortality in patients with CAD. Conclusion GRP78 serum levels are generally elevated in patients with CAD but are downregulated during ACS. Reduced levels are associated with increased one-year mortality. These results support previous findings that GRP78 secretion is a protective mechanism in cardiovascular diseases.

Cardiac decompensation of patients before transcatheter aortic valve implantation-clinical presentation, responsiveness to associated medication, and prognosis.

Cardiac decompensation (CD) in patients with aortic stenosis is a "red flag" for future adverse events. We classified patients undergoing transcatheter aortic valve implantation (TAVI) into those with acute, prior, or no prior CD at the timepoint of TAVI and compared their clinical presentation, prognosis, and effects of the prescribed medication during follow-up. Retrospective analysis of patients of one center fulfilling the criteria of 30-day device success after transfemoral TAVI. From those patients with no CD (n = 1,985) ranging to those with prior CD (n = 497) and to those with acute CD (n = 87), we observed a stepwise increase in the proportion of patients in poor clinical condition, NYHA class III/IV, low psoas muscle area, fluid overload (rales, oedema, pleural effusion), reduced ejection fraction, renal insufficiency, and anemia. More diuretics but less renin-angiotensin system inhibitors (ACEI/ARB) were prescribed for patients with acute CD compared to other groups. Prior CD (hazard ratio and 95% CI 1.40; 1.02-1.91) and acute CD (1.72; 1.01-2.91), a reduced general condition (1.53; 1.06-2.20), fluid overload (1.54;1.14-2.08), atrial fibrillation (1.76; 1.32-2.33), and anemia (1.43;1.08-1.89) emerged as strong independent predictors of one-year mortality. In all three classes of CD, prescribing of ACEI/ARB was associated with a substantial improvement of survival. The clinical presentation of (acute or prior) cardiac decompensation in patients with AS overlapped substantially with that of patients with classical signs of heart failure. Our results may support an early treatment strategy in patients with left ventricular dysfuntion before clinical signs of congestion are manifest. Moreover, these patients require intensive medical attention after TAVI.

One-Year Survival for Developing Acute Kidney Injury in Adult Patients with AMI Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation.

The incidence of cardiogenic shock cases treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support has been on the rise. Acute kidney injury (AKI) is a significant complication of cardiogenic shock and a frequent serious complication in patients requiring ECMO-supported therapy. AKI is strongly associated with unfavorable patient prognosis. However, there is a paucity of data on the influence of AKI on the prognosis of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) who are receiving ECMO support, particularly with regard to long-term outcomes. This retrospective observational study included 103 patients in the People's Hospital of Guangxi Zhuang Autonomous Region from January 2017 and June 2022. AKI was defined according to Kidney Disease Improving Global Outcome (KDIGO) criteria. Cox regression and logistic regression were used to identify risk factors. In this study, the incidence of AKI was 63.11%, with AKI stage 1, 2, and 3 accounting for 21.36%, 12.62%, and 29.13%, respectively. Patients with severe AKI had significantly higher in-hospital mortality (43.33% vs 27.40%, P < 0.001), 30-day mortality (60.00% vs 31.51%, P = 0.001), and 1-year mortality (63.67% vs 34.25%, P<0.001) than those without severe AKI. Furthermore, severe AKI significantly increased the risk of one-year mortality (HR 10.816, CI 3.118-37.512, P<0.001). Baseline serum creatinine, baseline platelet, and active cardiopulmonary resuscitation were independent predictors of one-year mortality. In addition, baseline white blood cell count, baseline aspartate aminotransferase, baseline alanine aminotransferase (ALT), baseline serum creatinine, preoperative lactate, and postoperative mean arterial pressure were independent risk factors of severe AKI during hospitalization. In patients with AMI-CS receiving ECMO support, AKI is highly prevalent. Development of severe AKI significantly increased the risk of one-year mortality.

Neurofilament light chain on intensive care admission is an independent predictor of mortality in COVID-19: a prospective multicenter study

BackgroundNeurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), and total-tau protein (tau) are novel blood biomarkers of neurological injury, and may be used to predict outcomes in critical COVID-19.MethodsA prospective multicentre cohort study of 117 consecutive and critically ill COVID-19 patients in six intensive care units (ICUs) in southern Sweden between May and November 2020. Serial NfL, GFAP and tau were analysed in relation to mortality, the Glasgow Outcome Scale Extended (GOSE) and the physical (PCS) and mental (MCS) components of health-related quality of life at one year.ResultsNfL, GFAP and tau on ICU admission predicted one-year mortality with an area under the curve (AUC) of 0.82 (95% confidence interval [CI] 0.74-0.90), 0.72 (95% CI 0.62-0.82) and 0.66 (95% CI 0.54-0.77). NfL on admission was an independent predictor of one-year mortality (p = 0.039). Low NfL and GFAP values were associated with good PCS (ge45) at one year but not with good MCS (ge45) or GOSE (ge5).ConclusionsNfL on ICU admission was an independent predictor of mortality. High levels of NfL, GFAP and tau were associated with mortality but not with poor GOSE in survivors at one year. Low levels of NfL and GFAP were associated with improved physical health-related quality of life.Graphical

A Novel Score to Predict One-Year Mortality after Transcatheter Aortic Valve Replacement, Naples Prognostic Score.

Background and Objectives: Aortic stenosis (AS) is a widespread valvular disease in developed countries, primarily among the elderly. Transcatheter aortic valve replacement (TAVR) has become a viable alternative to aortic valve surgery for patients with severe AS who are deemed a high surgical risk or for whom the AS is found to be inoperable. Predicting outcomes after TAVR is essential. The Naples Prognostic Score (NPS) is a new scoring method that evaluates nutritional status and inflammation. Our study is aims to examine the relationship between the NPS and outcomes for patients receiving TAVR. Material and Methods: We conducted a retrospective study of 370 patients who underwent TAVR across three tertiary medical centres from March 2019 to March 2023. The patients were divided into two groups based on their NPS, namely, low (0, 1, and 2) and high (3 and 4). Our study is primarily aimed to determine the one-year mortality rate. Results: Within one year, the mortality rate for the entire group was 8.6%. Nonetheless, the low-NPS group had a rate of 5.0%, whereas the high-NPS group had a rate of 13%. The difference between the two groups was statistically significant, with a p-value of 0.06. Conclusions: Our results show that NPS is an independent predictor of one-year mortality in patients undergoing TAVR.

Prognostic impact of small pericardial effusion in acute heart failure.

The relationship between small pericardial effusion (SPE) and outcomes has not been well studied in patients with heart failure. Therefore, we aimed to investigate the prevalence and importance of SPE in acute heart failure (AHF). A total of 398 hospitalized patients with AHF were retrospectively reviewed. Patients' baseline demographic, clinical, echocardiographic, and laboratory characteristics were noted. SPE was defined as the presence of a pericardial effusion <10mm. The primary outcome was one-year mortality. SPE was noted in 54 (13.6%) of the patients. Mortality at one year was greater for patients with a small effusion compared with those without SPE (44.4vs. 11.4%, respectively; p<0.001), and the one-year mortality rate for the whole group was 15.8%. Age (HR=1.12, 95% CI 1.054-1.854, p=0.024), N-terminal pro-B-type natriureticpeptide>4800 pg/ml (HR=1.628, 95% CI 01.102-4.805, p=0.001), left ventricular ejection fraction <30% (HR=1.878, 95% CI 1.154-4.524, p=0.001), and presence of SPE (HR=1.567, 95% CI 1.122-2.991, p=0.005) were independent predictors of one-year mortality on multivariate analysis. The presence of SPE on admission was an independent predictor of one-year mortality in AHF.

Functional continuum: independent predictor of one-year mortality and key decision-making element in older adults with severe aortic stenosis amenable to aortic valve replacement.

The impact of functional capacity over the entire functional continuum in older adults undergoing aortic valve replacement (AVR) has not been studied to date. This study aims to analyze 1.- the distribution of a cohort of older adults presenting severe aortic stenosis (AS) amenable to AVR in the different categories of the Functional Continuum Scale (FCS); 2.- its association with decision-making regarding valve disease; and 3.- its impact upon the one-year mortality rate of surgical (SAVR), transcatheter (TAVR) aortic valve replacement, or the decision to provide conservative management (OMT). This prospective study included patients from the FRESAS (FRailty-Evaluation-in-Severe-Aortic-Stenosis) registry evaluated by the reference Heart-Team of a region in northern Spain. All the patients underwent comprehensive geriatric assessment. The study comprised 257 patients aged 84.0 ± 3.9years. SAVR: 25.3%, TAVR: 58.0% and OMT: 16.7%. Increased patient functional capacity was associated with an increased tendency to perform more invasive valve disease treatment. The overall one-year survival rate was 81.3%. One-year all-cause mortality: FCS-1 to FCS-2 "robust" 11.5%, FCS-3 to FCS-4 "prefrail" 14.7%, FCS-5 "frail" 19.2% and FCS-6 to FCS-8 "dependent" 45.0%; p < 0.001. Adjusted mortality analysis: FCS with HR = 1.206 [95%CI, 0.999-1.451 (p = 0.051)]; EuroSCORE-II with HR = 1.071 [95%CI, 1.006-1.161 (p = 0.033)]; and OMT with HR = 2.840 [95%CI, 1.409-5.772 (p = 0.004)] were retained in the final multivariable logistic regression model. In older AS patients amenable to AVR, the FCS is a useful predictive tool that may aid clinical decision-making.

C-reactive protein-to-albumin ratio is a predictor of 1-year mortality following liver transplantation.

Considering the importance of the inflammatory status of recipients on outcomes following liver transplantation (LT), we investigated the association between C-reactive protein-to-albumin ratio (CAR) and one-year mortality following LT and compared it with other parameters reflecting patients' underlying inflammatory status. A total of 3,614 consecutive adult LT recipients were retrospectively evaluated. Prognostic parameters were analyzed using area under the receiver operating characteristic curve (AUROC) analysis, and subsequent cutoffs were derived. For survival analysis, Cox proportional hazards and Kaplan-Meier analyses were performed. The AUROC for CAR to predict one-year mortality after LT was 0.68 (0.65-0.72), which was the highest compared with other inflammatory parameters, with the best cutoff of 0.34. A CAR ≥ 0.34 was associated with a significantly higher one-year mortality rate (13.3% vs. 5.8 %, log-rank P < 0.001) and overall mortality rate (24.5% vs. 12.9%, log-rank P = 0.039). A CAR ≥ 0.34 was an independent predictor of one-year mortality (hazard ratio, 1.40 [1.03-1.90], P = 0.031) and overall mortality (hazard ratio 1.39 [1.13-1.71], P = 0.002) after multivariable adjustment. Preoperative CAR (≥ 0.34) was independently associated with a higher risk of one-year and overall mortality after LT. This may suggest that CAR, a simple and readily available biomarker, maybe a practical index that may assist in the risk stratification of liver transplantation outcomes.

The prognostic value of speckle tracking echocardiography in patients hospitalized with COVID-19

Abstract Introduction In COVID-19 patients, both preexisting cardiovascular disease as well as cardiac injury resulting from SARS-CoV-2 infection are associated with increased mortality. We hypothesized that novel parameters of myocardial function may be useful in the assessment of in-hospital and long-term prognosis. Aim The aim of study was to determine the prevalence of myocardial dysfunction revealed by speckle tracking echocardiography and its association with in-hospital and one-year mortality. Methods The study group comprised 192 patients hospitalized in the cardiology department due to COVID-19. All patients underwent transthoracic echocardiographic examination with off-line analysis. Using speckle tracking technique, we measured the following parameters: left ventricular global longitudinal strain (GLS), right ventricular global longitudinal strain (RV-GLS), right ventricular free wall strain (RV-FWS) and myocardial work parameters – global work index (GWI), global wasted work (GWW), global constructive work (GCW) and global work efficiency (GWE). The primary outcome was in-hospital and one-year mortality. Results 112 patients (mean age 68±14 years, 76 (68%) male) had adequate image quality to evaluate strain-derived parameters. 27 patients died during hospitalization and 44 patients died within one-year after discharge. In-hospital non-survivors were older, had lower baseline oxygen saturation (SpO2) and had higher NTproBNP (Table 1). In non-survivors speckle-tracking echocardiography revealed significant impairment of left and right ventricular function compared to the group of survivors (Table 1). The independent predictors of in-hospital death were GWE (OR 0.85; 95% CI 0.78–0.93) and SpO2 on admission (OR 0.91; 95% CI 0.86–0.96). Based on the ROC curve analysis, the optimal cut-off points for predicting in-hospital death were identified: GWE ≤87% (sensitivity 63%, specificity 89%) and baseline SpO2 value ≤88% (sensitivity 81%, specificity 71%). The independent predictors of one-year mortality were: age (OR 1.28 [1.13–1.46]), NTproBNP (OR 1.002 [1.001–1.003]), baseline SpO2 (OR 0.71 [0.59–0.86]) and RV-GLS (OR 1.32 [1.12–1.55]). Based on the ROC curve analysis, the cut-off points optimal for predicting death within 12 months after COVID-19 were also identified: baseline SpO2 value ≤88% (sensitivity 69.8%, specificity 77.3%), age &amp;gt;60 years (sensitivity 90%, specificity 43%), NTproBNP &amp;gt;500 pg/ml (sensitivity 95%, specificity 41.8%), RV-GLS &amp;gt;−18.5 (sensitivity 93%, specificity 64.2%). Conclusions Two-dimensional speckle tracking echocardiography is a useful technique to evaluate myocardial function in COVID-19 patients and provides good prognostic value for identifying patients at risk of death during hospitalization and in long term follow-up. Funding Acknowledgement Type of funding sources: None.

Serum levels of the endoplasmic-reticulum-stress chaperone GRP78 identify patients with coronary artery disease and predict mortality

Abstract Background Endoplasmic-reticulum-stress (ER Stress) and associated chaperones like the main ER-Stress moderator GRP78 (glucose-regulated-protein, 78kDa) are involved in the pathogenesis of coronary artery disease (CAD). In addition to their intracellular localization and effects, secretion and extracellular properties of chaperones, including GRP78, were recently described. However, a diagnostic or prognostic relevance of serum ER-chaperones in patients with CAD has not been established yet. Purpose To investigate the significance of serum GRP78 in patients undergoing coronary angiography for suspected CAD. Methods Serum concentration of GRP78 was measured by ELISA in 789 patients with indication for coronary angiography (both ACS and CCS). CAD was defined as &amp;gt;50% stenosis in any major coronary artery. Clinical endpoint was one-year all-cause mortality. Results Mean age was 70.8±11.9 years and 65% of patients were male. 192 (24%) patients presented with acute coronary syndrome (ACS). CAD was found in 72.4% of patients. Mean GRP78 serum concentration was 2492 ng/ml. Increased levels of GRP78 (&amp;gt; median) were associated with diabetes (29.9% vs. 23.1%, p=0.03), a higher BMI (28.9±7.1 kg/m2 vs. 27.0±6.0 kg/m2, p&amp;lt;0.0001) and chronic kidney disease (CKD: 23.3% vs. 17.1%, p=0.03). There was no difference regarding age or sex. GRP78 levels were increased in patients with CAD when compared to patients without CAD (2640 ng/ml [95% CI: 2415–2864] vs. 2178 ng/ml [95% CI: 1893–2463], p=0.013, Fig A). Interestingly, GRP78 levels were lower in patients with ACS than in patients with CCS (2284 ng/ml [95% CI: 1944–2642] vs. 2822 [95% CI: 2531–3113], p=0.018, Fig B). To further elucidate these findings, we analyzed available proteomics of patients with hypertrophic cardiomyopathy undergoing septal ablation as a model for a planned myocardial infarction (PMI)1. Coronary sinus blood samples drawn 10 and 60 min after PMI showed a downregulation of GRP78 levels compared to baseline. Finally, we assessed prognostic relevance of GRP78 in patients with CAD. Increased GRP78 levels were associated with lower one-year mortality (5.3% vs. 10.6% vs. p=0.016). Increased GRP78 levels were associated with reduced one-year mortality in both continuous (HR: 0.48 [95% CI: 0.25–0.92]) and categorial analyses stratified by median GRP78. After adjusting for age, sex, BMI, diabetes, CKD and ACS, GRP78 remained an independent predictor of one-year mortality (HR: 0.51 [0.26–0.96], p=0.039). Conclusion GRP78 serum levels are generally elevated in patients with CAD but downregulated during ACS. Reduced levels are associated with increased one-year mortality. These results support previous findings that GRP78 secretion is a protective mechanism in cardiovascular diseases. Further mechanistic studies are warranted to foster our understanding of the effects of extracellular GRP78 and to aid in the identification of modifying therapeutic targets. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): University hospital Bonn

Incidence and predictors of mortality after an electrical storm in the ICU.

For assessing predictors of early mortality following hospitalization for electrical storm (ES), only limited data are available. The purpose of this study was to assess the incidence and predictors of early mortality following hospitalization in the intensive care unit (ICU) for ES in a large retrospective study. In this retrospective study, we included all patients who were hospitalized for ES from July 2015 to May 2020 in our tertiary centre. A total of 253 patients were included. The median age was 66 [56; 73], and 64% had ischemic cardiomyopathy. A total of 37% of patients presented hemodynamic instability requiring catecholamine at admission. A total of 17% of patients presented an acute reversible cause for ES. The one-year mortality was 34% (95% CI, 30-43%), mostly driven by heart failure (HF). The multivariable Cox's regression model identified age, left ventricular ejection fraction, right ventricle dysfunction, haemoglobin level as independent predictors of one-year mortality. The use of catecholamine at admission was identified as the only variable related to the initial management of ES associated with an increased 30-day mortality risk (HR: 7.95 (95%CI, 3.18-19.85). In patients admitted for ES in ICU, the one-year mortality remains high and mostly driven by HF. The use of catecholamine at admission is associated with a seven-fold risk for mortality within 30 days. In such patients, the potential use of VT ablation can be questioned and a careful action plan regarding invasive HF-related therapy could be considered.

Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory support

AimThe aim of this study was to describe the survival and neurological outcome in patients with OHCA treated with and without mechanical circulatory support (MCS). MethodsThis was a retrospective observational cohort study on patients with OHCA admitted to Aarhus University Hospital, Denmark, between January 2015 and December 2019. Kaplan-Meier estimates were used to evaluate 30-day and 30–180-day survival. Cox regression analysis was used to assess the association between covariates and one-year mortality. ResultsAmong 1,015 patients admitted, 698 achieved return of spontaneous circulation (ROSC) before admission, 101 patients with refractory OHCA received mechanical circulatory support (MCS) and the remaining 216 patients with refractory OHCA did not receive MCS treatment. Survival to hospital discharge was 47% (478/1015). Good neurological outcome defined as Cerebral Performance Categories 1–2 were seen among 92% (438/478) of the patients discharged from hospital. Median low-flow was 15 [8–22] minutes in the ROSC group and 105 [94–123] minutes in the MCS group. Mortality rates were high within the first 30 days, however; 30–180-day survival in patients discharged remained constant over time in both patients with ROSC on admission and patients admitted with MCS. Advanced age > 70 years (hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.11–3.49), pulseless electrical activity (HR 2.39, 95% CI 1.25–4.60) and asystole HR 2.70, 95% CI 1.25–5.95) as initial rhythms were associated with one-year mortality in patients with ROSC. ConclusionsShort-term survival rates were high among patients with ROSC and patients receiving MCS. Among patients who survived to day 30, landmark analyses showed comparable 180-day survival in the two groups despite long low-flow times in the MCS group. Advanced age and initial non-shockable rhythms were independent predictors of one-year mortality in patients with ROSC on admission.

The Impact of Recipient Age on Outcomes of Simultaneous Heart-Lung Transplantation

<h3>Purpose</h3> The shortage of donor organs underscores the importance of identifying risk factors for adverse outcomes in multiorgan transplantation. Heart-lung transplantation (HLTx) is relatively uncommon, and there is a paucity of literature to suggest at what recipient age threshold mortality risk increases. This analysis aimed to identify a threshold of age that predicts adverse post-HLTx outcomes. <h3>Methods</h3> The United Network of Organ Sharing (UNOS) registry was used to identify adult combined HLTx from 2005-2021. The primary outcome was one-year mortality. Threshold regression analysis was used to identify the threshold at which age impacts one-year post-HLTx mortality. Patients were stratified according to the age threshold. Kaplan-Meier analysis was used to model survival, and multivariable Cox proportional hazards regression was used for risk-adjustment. <h3>Results</h3> 453 patients underwent HLTx in the study period. Threshold analysis identified that age >58 years impacted one-year mortality. Using this threshold, 47 (10.38%) patients were included in the older cohort, and 406 patients (89.62%) were included in the younger cohort. Older recipients were more likely to be male, have diabetes, and have higher lung allocation scores compared to younger recipients. On Kaplan Meier analysis, one-year survival was significantly lower in patients >58 years (64.7% vs 82.0%, <i>p</i> = 0.007). On multivariable analysis, the adjusted hazard for one-year mortality in recipients older than 58 years was 2.27 (95% CI [1.21-4.28], <i>p</i> =0.011). Recipient creatinine, total bilirubin, temporary mechanical circulatory support, and non-ABO-identical matching were also independent predictors of one-year mortality. Patients >58 years more frequently required new onset dialysis after HLTx (19.2% vs 12.8%, <i>p</i> = 0.031) and had a higher incidence of postoperative stroke (13.0% vs 4.5%, <i>p</i> = 0.040). <h3>Conclusion</h3> The threshold of recipient age above which one-year mortality risk most increases in HLTx is 58 years. Although age >58 is a risk factor for one-year mortality with over 2-fold increased risk as compared to younger patients, the majority (65%) of older HLTx recipients do survive to 1-year. These data suggest that older age should be heavily considered in the patient selection process for HLTx but may not necessarily need to serve as an absolute contraindication, particularly in the absence of other risk factors.

One-year outcomes of invasively managed acute coronary syndrome patients with COVID-19

BackgroundThere is a limited data about the one-year outcomes of patients diagnosed with acute coronary syndrome (ACS) and coronavirus disease 2019 (COVID-19). ObjectivesTo assess one-year mortality of invasively managed patients with ACS and COVID-19 compared to ACS patients without COVID-19. MethodsIn our investigation, we defined the study time period as April 30 through September 1, 2020. The control groups consisted of ACS patients without COVID-19 at the same time period and ACS patients prior to the pandemic, within the same months as those of the study. COVID-19 infection was confirmed in all participants utilizing real-time polymerase chain reaction testing. ResultsThis investigation examined 721 ACS participants in total. Among the participants, 119 patients were diagnosed with ACS and COVID-19, while 149 were diagnosed with ACS and without COVID-19. The other 453 ACS participants were diagnosed before the outbreak of the pandemic, within the same months as those of the study. One-year mortality rates were higher in the ACS participants with COVID-19 than in the ACS participants without COVID-19 and the pre-COVID-19 ACS participants (21.3% vs. 6.5% vs. 6.9%, respectively). An ACS along with COVID-19 was the only independent predictor of one-year mortality (HR=2.902, 95%CI=1.211–6.824, P = 0.018). According to the Kaplan-Meier survival curves, patients with ACS and COVID-19 had a lower chance of survival in the short-term and one-year periods. ConclusionThis is believed to be the first study to report that ACS patients with COVID-19 had higher one-year risk of mortality compared to ACS patients without COVID-19.

Prognostic value of hemoglobin A1c level and one-year mortality in patients with non ST elevation myocardial infarction

HbA1c, the most commonly used indicator of chronic glucose metabolism, is closely associated with cardiovascular disease. However, the relationship between HbA1c and the mortality of non ST elevation myocardial infarction (NSTEMI) patients is still undefined. Here, we aim to assess the effect of HbA1c on in-hospital and one-year mortality in patients with NSTEMI. A total of 340 patients with NSTEMI, 240 patients with diabetes mellitus (DM) were enrolled stratified into two groups according to HbA1c level. The primary end points included major adverse cardiac events (MACE) and one-year mortality. The association between baseline hemoglobin A1c and MACE was examined. Subgroup analysis by diabetic control showed that elevated HbA1c is associated increased one-year mortality in NSTEMI patients with DM (10,68% vs. 1.29%); P = 0,011. We identified HbA1c (OR: 8.23, 95% CI 1.10-61.36; P = 0.008) as an independent predictor of MACE and mortality at one year. Results from our study indicate that the admission level of HbA1c reflecting diabetic control is a predictor of one-year mortality and MACE in patients with NSTEMI. These results identify HbA1c to be an independent predictor of one-year mortality in patients with NSTEMI with DM.

TAVI via alternative access routes: patient selection and 10-year center experience

Abstract Background Femoral access is considered the gold standard for transcatheter aortic valve implantation (TAVI). However, this route might be precluded due to the presence of tortuosity, small vessel diameter and/or peripheral artery disease. We aimed to investigate TAVI through an alternative access (AA), focusing on the selection criteria and clinical outcomes compared to the femoral route (TF). Methods We conducted an all-comers longitudinal single-centre prospective registry in whom a TAVI was performed. The feasibility, safety and efficacy of TAVI by means of an access route other than standard TF was assessed, according to the VARC-2 criteria. The prospective surgical criteria used at our institution to accept an AA route were: a) TF deemed inappropriate; b) acceptable haemorrhagic risk; c) acceptable general anaesthesia risk; and d) adequate anatomy and diameter within acceptable range (subclavian, axillar, transaortic) or e) age &amp;lt;85 years and non-frail patient (transapical). The primary endpoint was all-cause death at 1-year. Results From 2008 to 2018, there were 548 patients submitted to TAVI [median age 84 (79–87) years, males 45.4%]. An AA route was used in 100 patients (79 trans-apical, 9 trans-aortic, and 12 trans-subclavian), with a decreasing rate over follow-up (−11% per year). Compared to TF, these patients were younger [80 (77–84) vs. 85 (80–87) years; p&amp;lt;0.001) with a similar baseline surgical risk as per EuroSCORE II [5.1 (3.3–9.0) vs. 4.7 (3.3–7.0); p=0.410). AA patients presented a higher burden of atherosclerotic disease, namely coronary (54.0 vs. 41.3%; p&amp;lt;0.001) and peripheral artery disease (35.0 vs. 16.5%, p&amp;lt;0.001) despite a lower number of other comorbidities (e.g. glomerular filtration rate &amp;lt;50mL/min: 53.1 vs. 64.8%; p=0.030). Left ventricular ejection fraction (56±13 vs 55±12%; p=0.203) and aortic stenosis severity (e.g. valve area: 0.70±0.19 vs. 0.67±0.18cm2; p=0.302) were similar between groups. Haemorrhagic events (minor or major) following TAVI were less often documented in the AA group (11.0 vs 21.7%; p=0.015), contrasting with de novo atrial fibrillation (18.5 vs 7.6%; p=0.048). Overall, 67 patients met the primary endpoint (18.8 vs 16.2%; p=0.584). After adjusted multivariate analysis, the independent predictors of one-year mortality did not include the TAVI access route. Conclusion In the first 10 years of experience, 1 in every 6 patients was treated with a TAVI by means of an AA, most often trans-apically initially and, nowadays, via a trans-subclavian approach. The use of meticulous prospective selection criteria seems to explain the one-year similar results, regardless of the access route. Funding Acknowledgement Type of funding sources: None.

Novel risk model for one-year mortality and guidance of management strategy in isolated severe secondary tricuspid regurgitation

Abstract Background Isolated severe tricuspid regurgitation (TR) is a challenging valve lesion to manage because of adverse prognosis, and surgery remains controversial especially in secondary etiologies. We aimed to devise a risk model to predict one-year mortality in isolated secondary TR patients, and evaluated whether risk category influenced the association between tricuspid valve surgery and survival. Methods Consecutive patients with isolated severe secondary TR by echocardiography during 2004–2018 were retrospectively studied. A multivariable model was developed for one-year all-cause mortality from two thirds of study patients (randomly-selected derivation cohort), and then assessed in the remaining patients (validation cohort). Associations between tricuspid valve surgery and survival were analyzed overall and in risk categories in multivariable analyses. Results Amongst 8575 isolated TR patients with secondary etiologies, mean age was 71.3±14.5 years and 5153 (60.1%) were female. Tricuspid valve surgery was performed in 487 (5.7%) patients, and was independently associated with improved survival during follow-up with hazards ratio 0.57 (95% confidence interval 0.41–0.81) in multivariable analysis. One-year mortality occurred in 2108 (24.6%) patients, and an additive risk score out of 14 based on independent predictors of one-year mortality is shown in the Table 1. The c-statistic for the derivation cohort was 0.712, and for the validation cohort 0.729. By risk score category, one-year mortality was 5.7% for 0–1 (low), 10.1% for 2–3 (mildly elevated), 24.3% for 4–7 (moderately elevated) and 50.9% for &amp;gt;7 (severely elevated), as shown in Figure 1. Surgery was associated with improved survival in the three higher score categories of isolated TR patients (P&amp;lt;0.001 to P=0.037), but did not improve survival in lower risk patients with scores of 0–1 (P=0.140). Conclusion We devised and validated a novel risk model which moderately discriminated one-year mortality for isolated severe secondary TR. The score may help guide decision-making for management strategy in those with elevated scores, when the under-utilized tricuspid valve surgery is associated with improved survival, and further research is necessary to apply this score for those considering for transcatheter therapies. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): National Heart Foundation of New Zealand Table 1Figure 1

Frailty, malnutrition, and the endocrine system impact outcome in patients undergoing aortic valve replacement.

Frailty is a multidimensional syndrome that affects mortality after aortic valve replacement (AVR). Malnutrition is often associated with the development of frailty. However, data regarding the association of frailty with nutritional status and underlying endocrinological dysregulation in patients with severe aortic valve stenosis are limited. We aimed to systematically screen for frailty and malnutrition, to evaluate for underlying endocrinological disorders and inflammation, and to assess the ability of these parameters to predict outcomes after AVR. Our study included 373 patients undergoing transcatheter and surgical AVR. Frailty was assessed using the Fried Frailty Phenotype (FFP), Essential Frailty Toolset, Lawton-Brody, and Katz Index. Malnutrition was measured using the Mini Nutritional Assessment (MNA-LF) and Controlling Nutritional Status. Outcomes of interest were 30-day and one-year mortality. The prevalence of frailty ranged from 6.4% to 65.7% and malnutrition from 5.9% to 10.5%, depending on the evaluation tool. Both parameters were associated with higher levels of cortisol and parathormone as well as lower levels of IGF-1, testosterone, DHEAS, and c-reactive protein. Malnutrition was associated with increased 30-day mortality, and both frailty and malnutrition with increased one-year mortality. In a multivariate analysis, malnutrition measured by the MNA-LF (OR: 2.32 [95%CI: 1.19-4.53], p= 0.01) and frailty as assessed by the FFP (OR: 1.42 [95%CI: 1.02-1.96], p= 0.03) were independent predictors of one-year mortality. The prevalence of frailty and malnutrition varies significantly depending on the assessment tool. Both syndromes share common endocrinological alterations. Frailty and malnutrition are independent risk factors for mortality after AVR.