Major Adverse Cardiovascular Cerebral Events Research Articles

Application of transthoracic echocardiography in patients receiving intermediate- or high-risk noncardiac surgery.

BackgroundCardiovascular events are the leading cause of perioperative complications among patients undergoing noncardiac surgery. However, the role of echocardiography for preoperative cardiac risk stratification prior to major noncardiac surgery is still controversial.MethodsThis retrospective study included a total of 1453 patients (51% male; age, 67 ± 16) who underwent intermediate- or high-risk major abdominal surgery or orthopedic surgery at two medical centers in South Taiwan between February 2013 and June 2016. All patients underwent preoperative transthoracic echocardiography (TTE). All of the included patients were followed up for 56 days after surgery. The primary endpoints were major adverse events (MAEs), i.e., all-cause mortality and major adverse cardiovascular-cerebral events (MACCEs).ResultsA total of 35 patients (2.4%) reached the primary endpoint: 24 patients (1.6%) died, and 17 patients (1.2%) had MACCEs. Patients with postsurgery MAEs had higher average E/e’ values, a lower Left ventricular (LV) ejection fraction, and higher prevalence of significant mitral regurgitation (MR) and moderate-advanced chronic kidney disease (CKD). Multivariate analysis showed that the modified Lee index and significant MR were independent prognostic predictors of MAEs.ConclusionPreoperative identification of significant MR on TTE is associated with increased MAEs at 56 days compared with that predicted by the modified Lee index alone in patients undergoing intermediate- or high-risk noncardiac surgery.

Which factor is the most effective one in metabolic Sydrome on the outcomes after coronary artery bypass graft surgery? A cohort study of 5\xa0Years

BackgroundMetabolic Syndrome and diabetes mellitus are risk factors for cardiovascular disease. However, the effects of Metabolic Syndrome with or without diabetes on perioperative and long-term morbidity and mortality after Coronary Artery Bypass Graft remain unclear.MethodsAn retrospective study was performed on 1166 patients who received isolated primary Coronary Artery Bypass Graft in Fuwai hospital. They were divided into three groups: control, Metabolic Syndrome of three factors together with diabetes and Metabolic Syndrome of three factors without diabetes (n = 868, 76 and 222 respectively). Analysis of variance, Chi-rank test, Fisher’s exact test, Log-rank test, Cox and Logistic regression models were used for data processing. Outcomes were postoperative and 5-year survival and morbidities.ResultsThere were no significant differences between groups in in-hospital postoperative complications, epinephrine use, stroke, atrial fibrillation, renal failure, coma, myocardial infarction and repeated revascularization. Patients in the Metabolic Syndrome with diabetes, Metabolic Syndrome without diabetes and control groups, respectively, showed significant difference in perioperative Major Adverse Cerebral Cardiovascular Events (30.3% vs. 21.2%, 16.7%, P = 0.0071) and mortality (11.8% vs. 2.7%, 3.11%, P = 0.0003). The Metabolic Syndrome with diabetes group had higher rates of perioperative mortality than Metabolic Syndrome without diabetes (P = 0.0017, P of Fisher Test = 0.0039). Compared with non-diabetic patients with Metabolic Syndrome, those with Metabolic Syndrome and diabetes had increased long-term mortality (Adjusted HR: 4.3; 95% CI: 1.4–13.3; P = 0.0113) and Major Adverse Cerebral Cardiovascular Events (Adjusted OR: 1.7; 95% CI: 1.0–2.8; P = 0.048). Control and non-diabetic Metabolic Syndrome groups did not differ in long-term mortality but controls had lower rates of Major Adverse Cerebral Cardiovascular Events (Adjusted OR: 0.79; 95% CI: 0.64–0.98; P = 0.0329).ConclusionsThere were significance differences between the three groups in perioperative Major Adverse Cerebral Cardiovascular Events and mortality after Coronary Artery Bypass Graft. Compared with non-diabetic Metabolic Syndrome patients, patients with Metabolic Syndrome and diabetes had higher long-term Major Adverse Cerebral Cardiovascular Events and mortality. While patients free of MetS and diabetes were associated with lower incidence of long-term Major Adverse Cerebral Cardiovascular Events after Coronary Artery Bypass Graft.

The prognostic value of left ventricular global peak systolic longitudinal strain in chronic peritoneal dialysis patients

BackgroundAlthough left ventricular (LV) global systolic longitudinal strain (GLS) reliably and accurately assesses LV systolic function and is also a powerful prognostic predictor, the importance and prognostic value of GLS in end-stage renal disease patients receiving maintenance peritoneal dialysis (PD) remain unclear. This study sought to determine the prognostic value of GLS in chronic PD patients. MethodsThis prospective study collected clinical and echocardiographic data from 106 stable PD patients (50.0±13.9years, 45% male) in a dialysis unit of a university hospital. These patients were enrolled from April 2010 to June 2010 and followed until August 2013 (follow-up duration 30.3±14.3months). The primary outcomes were the presence of major adverse events (MAEs), defined as all-cause mortality, and major adverse cardiovascular cerebral events (MACCEs), i.e. cardiovascular death, cardiac hospitalization, and stroke. ResultsTwenty-nine patients (27%) reported a primary outcome. Patients with MAEs had worse LV systolic function (MAEs vs. no MAEs, −14.8±2.8 vs. −17.1±2.5%, p=0.003). Using multivariate Cox regression analyses, being male, having a history of heart failure, diabetes mellitus, an increased pulse pressure (≥60mmHg), and GLS≥−15% were independent predictors of MAEs. The independent risk factors of MACCEs were a history of diabetes mellitus, an increased pulse pressure, and GLS≥−15%. After comparison of the overall log likelihood χ2 of the predictive power, GLS was found to add prognostic information to a model based on traditional risk factors. ConclusionGLS≥−15% provided additional prognostic information that allowed for the early identification of high-risk PD patients.

GW24-e0629 Affection for elective percutaneous coronary intervention with high dose clopidogrel

ObjectivesTo study therapeutic efficacy and safety of high dose clopidogrel in patients with coronary heart diseases (CHD) who underwent elective percutaneous coronary intervention (PCI).MethodsA total of 173 CHD patients underwent...