Long-term All-cause Mortality In Patients Research Articles

Prognostic significance of albumin corrected anion gap in patients with acute pancreatitis: a novel perspective

This study aims to explore the relationship between the albumin-corrected anion gap (ACAG) and short- and long-term all-cause mortality (ACM) in patients with acute pancreatitis (AP) managed in the intensive care unit (ICU). We conducted a retrospective analysis utilizing data extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. This study sought to investigate the correlation between ACAG and ACM among patients diagnosed with AP across various disease stages. R statistical software was used to identify the optimal thresholds for ACAG. Kaplan-Meier survival curves and multivariate Cox proportional hazards regression models were employed to assess the association between ACAG and short- and long-term ACM of AP. The predictive ability, sensitivity, specificity, and area under the curve (AUC) of ACAG for short- and long-term ACM in AP were investigated using receiver operating characteristic analysis. Subgroup analyses were also conducted. A cohort comprising 605 participants was included in this study. The ideal threshold for ACAG identified by R statistical software was 21.5. Cox proportional hazards modeling revealed that there was an independent association between patients with AP with ACAG ≥ 21.5 and ACM at 3, 7, 10, 14, 28, 90, and 180 days and 1 year before and after adjustment for confounders. Survival curves demonstrated that patients with ACAG ≥ 21.5 had lower survival rates at 3, 7, 10, 14, 28, 90, and 180 days and 1 year. In addition, ACAG showed superior performance, with a larger AUC than the anion gap, albumin, and Systemic Inflammatory Response Syndrome score and Sequential Organ Failure Assessment at 3, 7, 10, 14, 28, 90, and 180 days and 1 year. Subgroup analysis revealed no significant interaction between ACAG and any subgroups Elevated levels of ACAG were found to be associated with increased short- and long-term ACM in patients with AP, and ACAG may be an independent predictor of ACM at different disease stages.

Prognostic value of glycaemic variability for mortality in critically ill atrial fibrillation patients and mortality prediction model using machine learning

BackgroundThe burden of atrial fibrillation (AF) in the intensive care unit (ICU) remains heavy. Glycaemic control is important in the AF management. Glycaemic variability (GV), an emerging marker of glycaemic control, is associated with unfavourable prognosis, and abnormal GV is prevalent in ICUs. However, the impact of GV on the prognosis of AF patients in the ICU remains uncertain. This study aimed to evaluate the relationship between GV and all-cause mortality after ICU admission at short-, medium-, and long-term intervals in AF patients.MethodsData was obtained from the Medical Information Mart for Intensive Care IV 3.0 database, with admissions (2008–2019) as primary analysis cohort and admissions (2020–2022) as external validation cohort. Multivariate Cox proportional hazards models, and restricted cubic spline analyses were used to assess the associations between GV and mortality outcomes. Subsequently, GV and other clinical features were used to construct machine learning (ML) prediction models for 30-day all-cause mortality after ICU admission.ResultsThe primary analysis cohort included 8989 AF patients (age 76.5 [67.7–84.3] years; 57.8% male), while the external validation cohort included 837 AF patients (age 72.9 [65.3–80.2] years; 67.4% male). Multivariate Cox proportional hazards models revealed that higher GV quartiles were associated with higher risk of 30-day (Q3: HR 1.19, 95%CI 1.04–1.37; Q4: HR 1.33, 95%CI 1.16–1.52), 90-day (Q3: HR 1.25, 95%CI 1.11–1.40; Q4: HR 1.34, 95%CI 1.29–1.50), and 360-day (Q3: HR 1.21, 95%CI 1.09–1.33; Q4: HR 1.33, 95%CI 1.20–1.47) all-cause mortality, compared with lowest GV quartile. Moreover, our data suggests that GV needs to be contained within 20.0%. Among all ML models, light gradient boosting machine had the best performance (internal validation: AUC [0.780], G-mean [0.551], F1-score [0.533]; external validation: AUC [0.788], G-mean [0.578], F1-score [0.568]).ConclusionGV is a significant predictor of ICU short-term, mid-term, and long-term all-cause mortality in patients with AF (the potential risk stratification threshold is 20.0%). ML models incorporating GV demonstrated high efficiency in predicting short-term mortality and GV was ranked anterior in importance. These findings underscore the potential of GV as a valuable biomarker in guiding clinical decisions and improving patient outcomes in this high-risk population.

Prognostic effects of glycaemic variability on diastolic heart failure and type 2 diabetes mellitus: insights and 1-year mortality machine learning prediction model

BackgroundDiastolic heart failure (DHF) and type 2 diabetes mellitus (T2DM) often coexist, causing increased mortality rates. Glycaemic variability (GV) exacerbates cardiovascular complications, but its impact on outcomes in patients with DHF and T2DM remains unclear. This study examined the relationships between GV with mortality outcomes, and developed a machine learning (ML) model for long-term mortality in these patients.MethodsPatients with DHF and T2DM were included from the Medical Information Mart for Intensive Care IV, with admissions (2008–2019) as primary analysis cohort and admissions (2020–2022) as external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the associations of GV with 90-day, 1-year, and 3-year all-cause mortality. The primary analysis cohort was split into training and internal validation cohorts, then developing ML models for predicting 1-year all-cause mortality in training cohort, which were validated using the internal and external validation cohorts.Results2,128 patients with DHF and T2DM were included in primary analysis cohort (meidian age 71.0years [IQR: 62.0–79.0]; 46.9% male), 498 patients with DHF and T2DM were included in the external validation cohort (meidian age 75.0years [IQR: 67.0–81.0]; 54.0% male). Multivariate Cox proportional hazards models showed that high GV tertiles were associated with higher risk of 90-day (T2: HR 1.45, 95%CI 1.09–1.93; T3: HR 1.96, 95%CI 1.48–2.60), 1-year (T2: HR 1.25, 95%CI 1.02–1.53; T3: HR 1.54, 95%CI 1.26–1.89), and 3-year (T2: HR 1.31, 95%CI: 1.10–1.56; T3: HR 1.48, 95%CI 1.23–1.77) all-cause mortality, compared with lowest GV tertile. Chronic kidney disease, creatinine, potassium, haemoglobin, and white blood cell were identified as mediators of GV and 1-year all-cause mortality. Additionally, GV and other clinical features were pre-selected to construct ML models. The random forest model performed best, with AUC (0.770) and G-mean (0.591) in internal validation, with AUC (0.753) and G-mean (0.599) in external validation.ConclusionGV was determined as an independent risk factor for short-term and long-term all-cause mortality in patients with DHF and T2DM, with a potential intervention threshold around 25.0%. The ML model incorporating GV demonstrated strong predictive performance for 1-year all-cause mortality, highlighting its importance in early risk stratification management of these patients.

Females are Associated with Lower Risks of Long-Term Mortality in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting.

In patients who underwent off-pump coronary artery bypass grafting (OPCABG), females were reported to have lower rates of in-hospital mortality rate and postoperative atrial fibrillation than males. However, the association between gender and long-term prognosis following OPCABG is rarely reported. This study aims to determine if women benefit more from OPCABG than men by comparing the difference in the risk of long-term all-cause mortality in patients with coronary chronic total occlusion (CTO). This is an observational, retrospective cohort study conducted in adult patients (≥18 years) with coronary CTO undergoing OPCABG at our hospital from January 2011 to December 2014. A multivariate Cox proportional hazards model was employed to assess the association of gender with the risk of all-cause mortality. A p-value of <0.05 was considered statistically significant. Totally 1,256 participants were enrolled, among which 321 (25.6%) were females and 935 (74.4%) were males. During a maximum follow-up of 10 years, the all-cause mortality rate in women was significantly lower than that in men (10.3% vs. 24.3%, p<0.01). Multivariate Cox regression analysis indicated that women were significantly associated with a lower risk of all-cause mortality (HR=0.30, 95% CI: 0.20-0.44; p<0.01) after controlling for potential confounding factors. Women benefit more from OPCABG surgery than men, as they have a lower risk of long-term all-cause mortality in patients with coronary CTO.

Relationship between preoperative glucose level and all-cause mortality in patients with osteoporotic vertebral compression fracture who underwent percutaneous vertebroplasty

To investigate the relationship between preoperative blood glucose levels and long-term all-cause mortality in patients with osteoporotic vertebral compression fractures (OVCF) who underwent percutaneous vertebroplasty (VP). This single-center retrospective study involved a chart review of patients admitted for VP to treat OVCF between 2013 and 2020. Patients with pathological or multiple fractures or those who did not undergo bone mineral density assessment were excluded. All relevant information was collected from electronic medical records. The survival status of all patients was confirmed at the end of March 2021. Cox proportional hazard models with multivariate adjustments were used to examine the effects of blood glucose levels on all-cause mortality. Overall, 131 patients were retrospectively analyzed (mean age: 75.8 ± 9.3 years, male patients: 26.7%) with a median follow-up period of 2.1 years. Preoperative hyperglycemia (hazard ratio: 2.668, 95% confidence interval [CI] 1.064, 6.689; p = 0.036) and glucose levels (hazard ratio: 1.007, 95% CI 1.002–1.012; p = 0.006) were found to be independently associated with a higher risk of all-cause mortality. This correlation remained significant even after adjusting for age and sex, and other factors and comorbidities that might affect outcomes (hazard ratio: 2.708, 95% CI 1.047, 7.003, p = 0.040 and 1.007; 95% CI 1.001, 1.013, p = 0.016, respectively). Furthermore, a history of diabetes mellitus was not a significant factor influencing long-term all-cause mortality. Preoperative glucose levels were found to be independently associated with survival outcomes in patients with OVCF who underwent VP. Conversely, diabetes mellitus was not associated with long-term all-cause mortality. Our findings highlight that preoperative hyperglycemia is a risk factor for long-term mortality in this aging surgical population.

Age-Related Outcomes in Heart Failure with Mildly Reduced Ejection Fraction.

Objective: This study investigates age-related differences and outcomes in patients hospitalized with heart failure with a mildly reduced ejection fraction (HFmrEF). Background: The characterization of patients with HFmrEF and the prognostic value of age has rarely been investigated. Methods: Patients with HFmrEF were retrospectively included at one institution between 2016 and 2022. The distribution of HF aetiology and prognostic outcomes were investigated comparing patients with ≤40, >40 to ≤60, >60 to ≤80, and >80 years of age. The primary endpoint was long-term all-cause mortality. Kaplan-Meier and multivariable Cox proportional regression analyses were applied for statistics. Results: For the present study, 2184 patients with HFmrEF with a median age of 76 years were included. Non-ischemic cardiomyopathy was the most common HF aetiology in patients <40 years of age, whereas patients with 60-80 years of age (60.2%) and >80 years of age (58.2%) had the higher rates of ischemic cardiomyopathies. The risk of long-term all-cause mortality at 30 months was highest in patients with >80 years of age (HR = 2.167; 95% CI 1.928-2.436; p = 0.001), even after multivariable adjustment. Furthermore, patients with >80 years of age had the highest risk of HF-related rehospitalization (HR = 1.529; 95% CI 1.293-1.807; p = 0.001). Conclusions: Ischemic cardiomyopathy represents the most common cause of HF in elderly patients with HFmrEF, whereas younger patients were more likely to suffer from non-ischemic HF aetiologies. Increasing age was an independent predictor of long-term all-cause mortality in patients hospitalized with HFmrEF.

Predictive value of the triglyceride-glucose index for short- and long-term all-cause mortality in patients with critical coronary artery disease: a cohort study from the MIMIC-IV database

BackgroundTriglyceride-glucose (TyG) index is linked to a poor prognosis for cardiovascular condition and is a valid indicator of insulin resistance. This study evaluated the potential predicting usefulness of the TyG index for all-cause mortality, both short- and long-term, for those concerning critical coronary artery disease (CAD).MethodsIn this study, information from 5452 critically-ill individuals with CAD in intensive care units were gathered from the Medical Information Marketplace in Intensive Care (MIMIC-IV) database. Depending on the TyG index degree, the patients were categorized into three categories. Clinical outcomes included short-term (30-day) and long-term (365-day) all-cause mortality. The corresponding relationships involving the TyG index and clinical outcomes were examined by deploying restricted cubic spline (RCS) regression analysis and Cox proportional risk regression.ResultsAn increased TyG index was associated with increased 30-day (Tertile 1: 6.1%, Tertile 2: 7.3%, Tertile 3: 9.2%, P = 0.001) and 365-day (Tertile 1: 15.2%, Tertile 2: 17.0%, Tertile 3: 19.6%, P = 0.002) death rates across all causes. Cox regression with multiple variables indicates that higher TyG indices were linked to higher all-caused mortality hazard ratios throughout the short and long terms, with a larger predictive value for the former. RCS regression analyses suggested that the risk of death was notably and linearly that is associated with TyG index.ConclusionsThe TyG index is a reliable predictor of all-cause mortality at different stages in critically ill CAD patients, with a higher predictive ability for short-term mortality. Early intervention in patients with elevated TyG index may improve their survival outcomes. Future research should delve into understanding its pathophysiological mechanisms and develop intervention strategies based on the TyG index, providing new insights and strategies to enhance the outlook for critically ill CAD patients.

Association Between Frequency of Rehabilitation Therapy and Long-Term Mortality After Stroke: A Nationwide Cohort Study.

Previous studies have demonstrated conflicting results regarding the effects of rehabilitation therapy on poststroke mortality. We aimed to investigate the association between rehabilitation therapy, including both inpatient and outpatient treatment, within the first 6 months after stroke and long-term all-cause mortality in patients with stroke using the Korean National Health Insurance System data. A total of 10 974 patients newly diagnosed with stroke using the International Classification of Diseases, Tenth Revision, codes (I60-I64) between 2003 and 2019 were enrolled and followed up for all-cause mortality until 2019. Follow-up for mortality began 6 months after the index event. Poststroke patients were categorized into 3 groups according to the frequency of rehabilitation therapy: no rehabilitation therapy, ≤40 sessions and >40 sessions. Cox proportional hazards models were used to assess the mortality risk according to rehabilitation therapy stratified by disability severity measured based on activities of daily living 6 months after stroke onset. Within 6 months after stroke, 6738 patients (61.4%) did not receive rehabilitation therapy, whereas 2122 (19.3%) received ≤40 sessions and 2114 (19.3%) received >40 sessions of rehabilitation therapy. Higher frequency of rehabilitation therapy was associated with significantly lower poststroke mortality in comparison to no rehabilitation therapy (hazard ratio [HR], 0.88 [95% CI, 0.79-0.99]), especially among individuals with severe disability after stroke (mild to moderate: HR, 1.02 [95% CI, 0.77-1.35]; severe: HR, 0.74 [95% CI, 0.62-0.87]). In the context of stroke type, higher frequency of rehabilitation therapy was associated with reduced mortality rates compared with no rehabilitation therapy only in patients with hemorrhagic stroke (ischemic: HR, 1.04 [95% CI, 0.91-1.18]; hemorrhagic: HR, 0.60 [95% CI, 0.49-0.74]). We found a positive association between rehabilitation therapy within 6 months after stroke onset and long-term mortality in patients with stroke. A higher frequency of rehabilitation therapy would be recommended for poststroke patients, especially those with hemorrhagic stroke and severe disability.

A retrospective observational study evaluating the association between vasoactive–inotropic score and mortality after major abdominal surgery

The relationship between VISmax and mortality in patients undergoing major abdominal surgery remains unclear. This study aims to evaluate the association between VISmax and both short-term and long-term all-cause mortality in patients undergoing major abdominal surgery, VISmax was calculated (VISmax = dopamine dose [µg/kg/min] + dobutamine dose [µg/kg/min] + 100 × epinephrine dose [µg/kg/min] + 10 × milrinone dose [µg/kg/min] + 10,000 × vasopressin dose [units/kg/min] + 100 × norepinephrine dose [µg/kg/min]) using the maximum dosing rates of vasoactives and inotropics within the first 24 h postoperative ICU admission. The study included 512 patients first admitted to the intensive care unit (ICU) who were administered vasoactive drugs after major abdominal surgery. The data was extracted from the medical information mart in intensive care-IV database. VISmax was stratified into five categories: 0–5, > 5–15, > 15–30, > 30–45, and > 45. Compared to patients with the lowest VISmax (≤ 5), those with the high VISmax (> 45) had an increased risk of 30-day mortality (hazard ratio [HR] 3.73, 95% CI 1.16–12.02; P = 0.03) and 1-year mortality (HR 2.76, 95% CI 1.09–6.95; P = 0.03) in fully adjusted Cox models. The ROC analysis for VISmax predicting 30-day and 1-year mortality yielded AUC values of 0.69 (95% CI 0.64–0.75) and 0.67 (95% CI 0.62–0.72), respectively. In conclusion, elevated VISmax within the first postoperative 24 h after ICU admission was associated with increased risks of both short-term and long-term mortality in patients undergoing major abdominal surgery.

Association of Pan Immune-Inflammation Value with Long Term Outcomes of Acute Decompensated Heart Failure.

Although there have been significant improvements in the treatment of heart failure (HF) in recent decades, its prognosis remains poor. Although there are many biomarkers that can help predict the prognosis of patients with HF, there is a need for simpler, cheaper, and more easily available biomarkers. To evaluate the predictive value of pan-immune-inflammation value (PIV) in patients with acute decompensated HF. We analyzed 409 patients with HF with reduced ejection fraction who were hospitalized for acute decompensated HF. Patients were divided into 3 groups according to tertiles of PIV: tertile 1 (PIV < 357.25), tertile 2 (PIV ≥ 357.25 and < 834.55), and tertile 3 (PIV ≥ 834.55). P values < 0.05 were considered statistically significant. Kaplan-Meier curves and Cox proportional hazards regression models were used to evaluate the association between PIV and all-cause mortality. The primary outcome was 5-year all-cause mortality, and the secondary outcomes were in-hospital 30 days,, 180-day, and 1-year all-cause mortality. We showed that higher PIV value was associated with both primary and secondary outcomes. The Kaplan-Meier curve showed that patients with higher PIV values had an increased risk of short- and long-term all-cause mortality (log-rank p < 0.001). In the multivariate analysis, PIV was identified as an independent predictor of long-term all-cause mortality in patients with acute decompensated HF, and we observed a 1.96-fold increase in the hazard of an event (odds ratio: 1.96, 95% confidence interval: 1.330 to 2.908, p = 0.001). Our study showed that the novel biomarker PIV can be used as a predictor of prognosis in patients with acute decompensated HF.

Improved tricuspid regurgitation after transcatheter aortic valve replacement is associated with better survival: Systematic review and meta-analysis with reconstructed time-to-event data.

This meta-analysis compared survival outcomes among patients experiencing improvement in untreated significant tricuspid regurgitation (TR) following transcatheter aortic valve replacement (TAVR) for severe aortic stenosis, in contrast to those without improvement. MEDLINE and EMBASE were searched through January 2024. Pooled hazard ratios (HR) with 95% confidence intervals (CI) were computed. Employing network meta-analysis, a comparison involving four post-procedural TR categories (improved, no improvement, worsened, and no change) was executed. Subsequently, these categories were amalgamated into two groups (less TR after TAVR and same or greater TR after TAVR), and a standard meta-analysis was conducted. Kaplan-Meier curves depicting long-term all-cause mortality were reconstructed utilizing individual patient data derived from the studies. A systematic review identified seven non-randomized studies encapsulating 698 patients. Network meta-analysis revealed that improved TR after TAVR correlated with significantly lower long-term all-cause mortality compared to the remaining cohorts. Similarly, pooled all-cause mortality of standard meta-analysis demonstrated significant reduction in patients whose TR was sub-baseline than those exhibiting same or greater TR after TAVR (HR [95% CI] = 0.43 [0.32-0.58], p < .01). The hazard ratio, derived from reconstructed time-to-event data, showed a lower long-term all-cause mortality in patients with less TR after TAVR relative to the other cohort (HR [95% CI] = 0.46 [0.32-0.67], p < .01). This meta-analysis revealed that improved TR after TAVR correlates with superior long-term survival. The benefits of simultaneous or staged intervention on the tricuspid valve in individuals undergoing TAVR warrant validation in future investigations.

Association between serum creatinine to albumin ratio and short- and long-term all-cause mortality in patients with acute pancreatitis admitted to the intensive care unit: a retrospective analysis based on the MIMIC-IV database.

Serum creatinine (Cr) and albumin (Alb) are important predictors of mortality in individuals with various diseases, including acute pancreatitis (AP). However, most previous studies have only examined the relationship between single Cr or Alb levels and the prognosis of patients with AP. To our knowledge, the association between short- and long-term all-cause mortality in patients with AP and the blood creatinine to albumin ratio (CAR) has not been investigated. Therefore, this study aimed to evaluate the short- and long-term relationships between CAR and all-cause mortality in patients with AP. We conducted a retrospective study utilizing data from the Medical Information Market for Intensive Care (MIMIC-IV) database. The study involved analyzing various mortality variables and obtaining CAR values at the time of admission. The X-tile software was used to determine the optimal threshold for the CAR. Kaplan-Meier (K-M) survival curves and multivariate Cox proportional hazards regression models were used to assess the relationship between CAR and both short- and long-term all-cause mortality. The predictive power, sensitivity, specificity, and area under the curve (AUC) of CAR for short- and long-term mortality in patients with AP after hospital admission were investigated using Receiver Operating Characteristic analysis. Additionally, subgroup analyses were conducted. A total of 520 participants were included in this study. The CAR ideal threshold, determined by X-tile software, was 0.446. The Cox proportional hazards model revealed an independent association between CAR≥0.446 and all-cause mortality at 7-day (d), 14-d, 21-d, 28-d, 90-d, and 1-year (y) before and after adjustment for confounders. K-M survival curves showed that patients with CAR≥0.446 had lower survival rates at 7-d, 14-d, 21-d, 28-d, 90-d, and 1-y. Additionally, CAR demonstrated superior performance, with higher AUC values than Cr, Alb, serum total calcium, Glasgow Coma Scale, Systemic Inflammatory Response Syndrome score, and Sepsis-related Organ Failure Assessment score at 7-d, 14-d, 21-d, 28-d, 90-d, and 1-y intervals. Subgroup analyses showed that CAR did not interact with a majority of subgroups. The CAR can serve as an independent predictor for short- and long-term all-cause mortality in patients with AP. This study enhances our understanding of the association between serum-based biomarkers and the prognosis of patients with AP.

Association of Increased Inter-arm Blood Pressure Difference with Long-term Clinical Outcomes in Patients with Acute Myocardial Infarction Who Underwent Percutaneous Coronary Intervention

Objective Patients with acute myocardial infarction (AMI) often have peripheral artery disease (PAD). It is well known that the long-term clinical outcomes of AMI are worse in patients with a low ankle-brachial index (ABI) than in patients with a preserved ABI. Unlike ABI, the association between the inter-arm blood pressure difference (IABPD) and clinical outcomes in patients with AMI has not yet been established. This retrospective study examined whether or not the IABPD is associated with long-term clinical outcomes in patients with AMI. Methods We included 979 patients with AMI and divided them into a high-IABPD group (IABPD ≥10 mmHg, n=31) and a low-IABPD group (IABPD <10 mmHg, n=948) according to the IABPD measured during hospitalization for AMI. The primary endpoint was the all-cause mortality rate. Results During a median follow-up duration of 694 days (Q1, 296 days; Q3, 1,281 days), 82 all-cause deaths were observed. Kaplan-Meier curves showed that all-cause death was more frequently observed in the high-IABPD group than in the low-IABPD group (p<0.001). A multivariate Cox hazard analysis revealed that a high IABPD was significantly associated with all-cause death (hazard ratio 2.061, 95% confidence interval 1.012-4.197, p=0.046) after controlling for multiple confounding factors. Conclusion A high IABPD was significantly associated with long-term all-cause mortality in patients with AMI. Our results suggest the usefulness of the IABPD as a prognostic marker for patients with AMI.

Right Heart Remodeling and Outcomes in Patients With Tricuspid Regurgitation: A Literature Review and Meta-Analysis

Functional tricuspid regurgitation (TR) can develop either because of right ventricular (RV) remodeling (ventricular functional TR) and/or right atrial dilation (atrial functional TR). This meta-analysis aimed to investigate the association between right heart remodeling and long-term (>1 year) all-cause mortality in patients with significant TR (at least moderate,≥2+). MEDLINE, ISI Web of Science, and SCOPUS databases were searched. Studies reporting data on at least 1 RV functional parameter and long-term all-cause mortality in patients with significant TR were included. This study was designed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) requirements. Out of 8,902 studies, a total of 14 were included, enrolling 4,394 subjects. The duration of follow-up across the studies varied, ranging from a minimum of 15.5months to a maximum of 73.2months. Overall, long-term all-cause mortality was 31% (95%CI: 20%-41%; P≤ 0.001). By means of meta-regression analyses, an inverse relation was found between tricuspid annular plane systolic excursion (11 studies enrolling 3,551 subjects,-6.3% [95%CI:-11.1% to-1.4%]; P = 0.011), RV fractional area change (9 studies, 2,975 subjects,-4.4% [95%CI:-5.9% to-2.9%]; P< 0.001), tricuspid annular dimension (7 studies, 2,986 subjects,-4.1% [95%CI:-7.6% to-0.5%]; P = 0.026), right atrial area (6 studies, 1,920 subjects,-1.9% [95%CI:-2.5% to-1.3%]; P< 0.001) and mortality. RV dysfunction parameters are associated to worse clinical outcomes in patients with TR, whereas right atrial dilatation is linked to a better prognostic outcome. Further studies are needed to unravel the pathophysiological differences within the functional TR spectrum. (Right heart remodeling and outcomes in patients with tricuspid regurgitation; CRD42023418667).

Association between different insulin resistance surrogates and all-cause mortality in patients with coronary heart disease and hypertension: NHANES longitudinal cohort study

BackgroundStudies on the relationship between insulin resistance (IR) surrogates and long-term all-cause mortality in patients with coronary heart disease (CHD) and hypertension are lacking. This study aimed to explore the relationship between different IR surrogates and all-cause mortality and identify valuable predictors of survival status in this population.MethodsThe data came from the National Health and Nutrition Examination Survey (NHANES 2001–2018) and National Death Index (NDI). Multivariate Cox regression and restricted cubic splines (RCS) were performed to evaluate the relationship between homeostatic model assessment of IR (HOMA-IR), triglyceride glucose index (TyG index), triglyceride glucose-body mass index (TyG-BMI index) and all-cause mortality. The recursive algorithm was conducted to calculate inflection points when segmenting effects were found. Then, segmented Kaplan–Meier analysis, LogRank tests, and multivariable Cox regression were carried out. Receiver operating characteristic (ROC) and calibration curves were drawn to evaluate the differentiation and accuracy of IR surrogates in predicting the all-cause mortality. Stratified analysis and interaction tests were conducted according to age, gender, diabetes, cancer, hypoglycemic and lipid-lowering drug use.Results1126 participants were included in the study. During the median follow-up of 76 months, 455 participants died. RCS showed that HOMA-IR had a segmented effect on all-cause mortality. 3.59 was a statistically significant inflection point. When the HOMA-IR was less than 3.59, it was negatively associated with all-cause mortality [HR = 0.87,95%CI (0.78, 0.97)]. Conversely, when the HOMA-IR was greater than 3.59, it was positively associated with all-cause mortality [HR = 1.03,95%CI (1.00, 1.05)]. ROC and calibration curves indicated that HOMA-IR was a reliable predictor of survival status (area under curve = 0,812). No interactions between HOMA-IR and stratified variables were found.ConclusionThe relationship between HOMA-IR and all-cause mortality was U-shaped in patients with CHD and hypertension. HOMA-IR was a reliable predictor of all-cause mortality in this population.

The predictive value of PRECISE-DAPT score for long-term mortality in patients with acute coronary syndrome complicated by cardiogenic shock.

Besides its primary clinical utility in predicting bleeding risk in patients with acute coronary syndrome (ACS), the PRECISE-DAPT (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Anti-Platelet Therapy) score may also be useful for predicting long-term mortality in ACS patients presenting with cardiogenic shock (CS) since several studies have reported an association between the score and certain cardiovascular conditions or events. The aim of the present study was to evaluate the utility of the PRECISE-DAPT score for predicting the long-term all-cause mortality in patients (n = 293) with ACS presenting with CS. The PRECISE-DAPT score was calculated for each patient who survived in hospital, and the association with long-term mortality was studied. Median follow-up time was 2.7years. The performance of the final model was determined with measurements of its discriminative power (Harrell's and Uno'sC indices and time-dependent area under the receiver operating characteristic curve [AUC]) and predictive accuracy (coefficient of determination [R2] and likelihood ratio χ2). Hazard ratios (HRs) were used to assess the relationship between the variables of the model and long-term all-cause death. All-cause death occurred in 197 patients (67%). There was apositive association between the PRECISE-DAPT score (change from 17 to38 was associated with anHR of 2.42 [95% CI: 1.59-3.68], R2 = 0.209, time-dependent AUC = 0.69) and the risk of death such that in the adjusted survival curve, the risk of mortality increased as the PRECISE-DAPT score increased. The PRECISE-DAPT score may be auseful easy-to-use tool for predicting long-term mortality in patients with ACS complicated by CS.

Low Transvalvular Flow Rate in Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI) Is a Predictor of Mortality: The TFR-TAVI Study

Transvalvular flow rate (TFR) represents a better reflection of transvalvular flow than the stroke volume index (SVi), and has recently emerged as a useful prognostic tool in patients undergoing surgical aortic valve replacement. There is a paucity of data investigating the role of TFR and its relationship with other clinical or echocardiographic factors in patients undergoing transcatheter aortic valve implantation (TAVI). This was a retrospective single-centre study of 629 consecutive patients who underwent TAVI between March 2009 and September 2020. Pre-TAVI low TFR was defined as <200 c/s. The primary study end point was all-cause mortality. Low TFR was observed in 41.8% (263/629) of included patients and was associated with increasing age, low body surface area, hypertension, diabetes, atrial fibrillation, left ventricular (LV) dysfunction, and significant mitral regurgitation. LV function status and severity of aortic valve disease were independent predictors of low TFR. Low TFR was significantly associated with long-term all-cause mortality even after adjustment for other risk factors (adjusted hazard ratio [aHR] 1.44; 95% confidence interval [CI] 1.02-2.03; p=0.038). When data were stratified according to SVi, low TFR was an independent predictor of long-term all-cause mortality in patients with normal SVi (aHR 1.98; 95% CI 1.06-3.69; p=0.032) but not in patients with low SVi (HR 1.23; 95% CI 0.71-2.11; p=0.46; p=0.016 for interaction). Low TFR is common in patients undergoing TAVI and is an independent predictor of all-cause mortality, particularly in patients with normal SVi.

Systemic inflammation 72 hours after cardiac arrest is associated with poor neurological outcome and long term all-cause mortality - the prospective Norwegian Cardio-Respiratory Arrest Study (NORCAST)

Abstract Background Post-cardiac arrest (CA) anoxic brain injury seems to involve local and systemic inflammation. The interleukin (IL)-1/IL-6 pathway has gained increased interest both as prognostic markers and as possible targets for intervention. Purpose To evaluate the associations of the IL-1 receptor family, IL-6 and procalcitonin as a marker of systemic inflammation, with neurological outcome and long-term all-cause mortality in patients with out-of-hospital cardiac arrest (OHCA). Methods In this prospective observational study, we included 259 adult patients (&amp;gt; 18 years) hospitalized after OHCA. Blood sampling were performed on admission and 72 hours after cardiac arrest. IL-1 receptor antagonist (IL-1ra), ST2 (soluble interleukin 1 receptor-like 1), IL-6 and procalcitonin were analysed on admission and 72 hours after cardiac arrest. Neurological outcome was measured as cerebral performance category score (CPC score) assessed by two experienced neurologists six months after OHCA. CPC score was dichotomized into good (CPC score 1-2) or poor (CPC score 3-5) neurological outcome. All-cause mortality was registered after median 10.7-year follow-up. Results Patients with poor neurological outcome six months after CA (red bars) had significant higher levels of IL-6 (p = 0.002), IL-1Ra (p &amp;lt; 0.001), ST2 (p &amp;lt; 0.001) and procalcitonin (p &amp;lt; 0.001) 72 hours after CA (Fig. 1). High levels of IL-6, IL-1Ra, ST2 and procalcitonin measured 72 hours after cardiac arrest were significantly associated with long-term all-cause mortality (Fig. 2). Conclusions High levels of inflammatory biomarkers 72 hours after CA were significantly associated with poor neurological outcome and long-term all-cause mortality.Figure 1Figure 2

PO-02-026 LONG-TERM MORTALITY IN PATIENTS WITH ISCHEMIC VERSUS NONISCHEMIC CARDIOMYOPATHY FOLLOWING CARDIAC RESYNCHRONIZATION THERAPY

Studies have shown comparable benefits in all-cause mortality in patients with ischemic (ICM) vs. nonischemic cardiomyopathy (NICM) following cardiac resynchronization therapy (CRT). Data on long-term outcomes of CRT between these etiologies is limited. We aim to evaluate long-term all-cause mortality in patients with ICM and NICM that have undergone CRT. We conducted a retrospective analysis of patients with ICM and NICM that have undergone CRT within the Mayo Clinic Health System since 2002. Patients with LVEF ≤ 35% pre-implant were included in the study. All-cause mortality data were compared between the two groups. Data from 872 (59%) patients with ICM and 614 (41%) patients with NICM that underwent CRT implantation between 11/2002 and 7/2022 were analyzed. 85% of patients with ICM were males compared to 64% of patients with NICM (p<0.001). The average age at implant was significantly lower among patients with NICM compared to ICM (68 vs. 73 years, p<0.001). The median age at implant among patients with NICM was 69 (IQR 59-77.5), and among patients with ICM was 74 (interquartile range [IQR] 68-79). Mean pre-implant LVEFs were 22% in both groups (p = NS). Survival distributions for patients with ICM and NICM that had undergone CRT were significantly different (log-rank p<0.001), with lower all-cause mortality for patients with NICM than with ICM. Following CRT, patients with NICM have lower all-cause mortality as compared to patients with ICM. However, randomized trials with control group data are needed to comment on the relative mortality benefit of CRT in these two modalities over the long term.

Expression Patterns of MiR-125a and MiR-223 and Their Association with Diabetes Mellitus and Survival in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome

Background: MicroRNAs (miRNA, miR) are small, non-coding RNAs which have become increasingly relevant as diagnostic and prognostic biomarkers. The objective of this study was the investigation of blood-derived miRNAs and their link to long-term all-cause mortality in patients who suffered from non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods: This study was an observational prospective study, which included 109 patients with NSTE-ACS. Analysis of the expression of miR-125a and miR-223 was conducted by polymerase chain reaction (PCR). The follow-up period comprised a median of 7.5 years. Long-term all-cause mortality was considered as the primary endpoint. Adjusted Cox-regression analysis was performed for prediction of events. Results: Increased expression of miR-223 (>7.1) at the time point of the event was related to improved long-term all-cause survival (adjusted (adj.) hazard ratio (HR) = 0.09, 95% confidence interval (95%CI): 0.01-0.75; p = 0.026). The receiver operating characteristic (ROC) analysis provided sufficient c-statistics (area under the curve (AUC) = 0.73, 95%CI: 0.58-0.86; p = 0.034; negative predictive value of 98%) for miR-223 to predict long-term all-cause survival. The Kaplan-Meier time to event analysis showed a separation of the survival curves between the groups at an early stage (log rank p = 0.015). Higher plasma miR-125a levels were found in patients with diabetes mellitus vs. in those without (p = 0.010). Furthermore, increased miR-125a expression was associated with an elevated HbA1c concentration. Conclusions: In this hypothesis-generating study, higher values of miR-223 were related to improved long-term survival in patients after NSTE-ACS. Larger studies are required in order to evaluate whether miR-223 can be used as a suitable predictor for long-term all-cause mortality.