Mortality Events Research Articles

Revisiting Left Atrial Appendage Closure Versus Oral Anticoagulants in Recurrent Atrial Fibrillation Management: An Updated Systematic Review and Meta-Analysis.

Atrial fibrillation (AF) is a significant public health problem due to its association with coronary heart disease, stroke, and mortality, especially in the elderly. Therefore, traditional warfarin therapy, direct oral anticoagulants (DOACs), and the recent left atrial appendage closure (LAAC) have been compared as treatment approaches. In this regard, we aimed to synthesize the current evidence regarding the comparison these mentioned modalities in patients with AF. A comprehensive database search for records comparing LAAC and DOACs in patients with AF was conducted until December 15, 2023. An updated meta-analysis was conducted using fixed and random effect models to calculate odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CIs) for dichotomous and continuous outcomes, respectively. Eleven studies were eligible that included a total of 68171 patients. Compared to DOACs, the LAAC group had a lower rate of hospital stay duration (MD -1.23; 95% CI -1.51 to -0.95;p< 0.001). There was no statistically significant difference between LAAC and DOACs in terms of the composite outcome of stroke, systemic embolism, cardiovascular death, all-cause mortality, ischemic stroke and thromboembolic events ischemic, major bleeding and cardiovascular mortality (OR 0.83, 95% CI 0.27-2.48,P= 0.73).Our meta-analysis showed a lower rate of hospital stay duration that favors LAAC. However, the risk of composite outcomes of stroke, systemic embolism, cardiovascular death, all-cause mortality, ischemic stroke, thromboembolic events, ischemic stroke, major bleeding, and cardiovascular mortality was similar between the two treatment groups.

Medicare Advantage Is Associated With Higher Mortality After Antibiotic Spacer Placement for Periprosthetic Joint Infection

BackgroundPrivatized Medicare Advantage (MA) plans are an alternative to traditional Medicare (TM). We sought to identify differences in 90-day postoperative mortality and nonfatal adverse events between TM and MA patients undergoing stage 1 antibiotic spacer placement for periprosthetic joint infection (PJI) of the hip or knee. MethodsA nationally representative database was queried from 2015 to 2021 for adult patients undergoing stage 1 antibiotic spacer placement for PJI. Using the International Classification of Disease, 10th Revision, and Current Procedural Terminology codes, as well as hospital charges for antibiotics, patients undergoing stage 1 exchange arthroplasty for PJI were identified. Patients were then grouped into TM and MA cohorts. The primary outcome was the odds of 90-day mortality. Multivariable logistic regressions were conducted to address possible confounding demographic, comorbidity, and hospital characteristics. ResultsOf the 40,346 patients undergoing stage 1 spacer placement for PJI, 16,637 (41.2%) had TM coverage and 9,218 (22.8%) had MA coverage. Mortality within 90 days of surgery was higher in the MA cohort (1.4% versus 1.0%, P = 0.004). Multivariable logistic regression demonstrated significantly higher adjusted odds of mortality (adjusted odds ratio = 1.42, 95% confidence interval = 1.11 to 1.81, P = 0.005) in MA patients compared to TM. ConclusionsEven after accounting for available confounders with our multivariable analyses, patients enrolled in an MA plan were more than 40% more likely to die within 90 days of surgery compared to patients who have TM coverage. Further study is necessary to better understand the underlying cause of this finding.

Performance of Three Creatinine-Based Equations in Predicting All-Cause Mortality and Cardiovascular Events in a Multiethnic Asian Population: The Singapore Epidemiology of Eye Diseases Study

Performance of Three Creatinine-Based Equations in Predicting All-Cause Mortality and Cardiovascular Events in a Multiethnic Asian Population: The Singapore Epidemiology of Eye Diseases Study

Prognostic impact of insulin- and non-insulin treated diabetes in patients with a reduced ejection fraction after ST-elevation myocardial infarction

BackgroundInsulin- and non-insulin treated diabetes (ITDM and NITDM) have different prognostic impact in patients with myocardial infarction and/or heart failure. The aim of this study was to analyze the prognostic impact of ITDM and NTIDM on the incidence of all-cause mortality and major adverse cardiovascular events (MACE- cardiovascular death, non-fatal infarction, non-fatal stroke and target vessel revascularization) in the eight-year follow-up of patients with ST-elevation myocardial infarction (STEMI) with a reduced ejection fraction (EF). MethodsWe analysed 2,230 consecutive STEMI patients treated with primary PCI and with EF <50%. Echocardiographic examination was performed after pPCI. Patients were divided in three groups: ITDM, NITDM and no DM. Patients presenting with cardiogenic shock were excluded. ResultsThe incidence of DM was 20.7%; among the patients with DM, 103 (22.3%) had ITDM. Patients with ITDM and NITDM had higher mortality and MACE compared with patients without DM. Also, at eight year follow-up all-cause mortality and MACE were significantly higher in patients with ITDM as compared with patients with NITDM (37.8%vs13.1% p<0.001 and 40.8%vs18.9%, p<0.001, respectively). Multivariable analysis showed ITDM to be an independent predictor for long-term mortality (HR 1.76, 95%CI 1.15-2.69) and MACE (HR 1.72, 95%CI 1.15-2.62). ConclusionITDM was an independent predictor of long-term mortality and MACE in patients with STEMI and reduced EF. NITDM was not an independent predictor for the occurrence of adverse events in analyzed patients.

Contextualizing the results of HELIOS-B in the broader landscape of clinical trials for the treatment of transthyretin cardiac amyloidosis.

This focused review will highlight the results of HELIOS-B, the first randomized outcomes trial evaluating a gene silencing treatment for transthyretin cardiac amyloidosis (ATTR-CM). In HELIOS-B, vutrisiran was tested against placebo and demonstrated a 28% reduction in the composite of all-cause mortality and recurrent cardiovascular events. Additionally, there were clinically significant benefits on the 6-min walk test, Kansas City Cardiomyopathy Questionnaire, and NYHA class. Discontinuation rates and adverse events were similar between treatment and control arms, suggesting that vutrisiran is well tolerated. In this review, these promising results are explored and compared with other treatment trials in ATTR-CM.

Outcomes of Prosthetic and Biological Grafts Compared to Arm Vein Grafts in Patients with Chronic Limb Threatening Ischemia

ObjectivesThe optimal conduit for infrainguinal bypass (IIB) is single segment great saphenous vein (GSV). Unfortunately, GSV is not always available in patients with chronic limb threatening ischemia (CLTI). Other graft choices include arm vein grafts (AV), prosthetic grafts (PG) or biologic grafts (BG). Current data regarding the durability and limb salvage rates of those options is scarce, hence we aimed to investigate the impact of alternative graft types on post-operative and long-term outcomes on IIB in patients with CLTI. MethodsThe Vascular Quality Initiative (VQI) database was queried for patients undergoing IIB from January 2003 to April 2024. Patients were stratified into three groups: arm vein (cephalic, basilic), prosthetic grafts [Dacron, polytetrafluoroethylene (PTFE)], and biologic grafts (cadaveric, homograft, or xenograft). Saphenous vein grafts (greater and lesser saphenous) were excluded. Multivariate logistic regression analyzed postoperative outcomes: 30-day mortality, major adverse cardiovascular events (MACE), graft occlusion, prolonged length of stay >7days (PLOS), packed red blood cell (pRBC) transfusion >2 units, and infection. Cox Regression was used to report one-year outcomes: mortality, major amputation (above-ankle), and major adverse limb events (MALE defined as major amputation, thrombectomy or reintervention). ResultsA total of 9165 IIB procedures have been analyzed: AV 417 (4.55%); PG 7520 (82.05%); BG 1228 (13.40%). Compared to AV, patients receiving PG had higher odds of infection (aOR 2.89, p=0.045) and higher hazard of one-year mortality (aHR 1.51, p=0.035). On the other hand, patients receiving BG had higher risk of graft occlusion (aOR 4.55, p=0.040) and infection (aOR 2.78, p=0.046) as well higher hazard of one-year mortality (aHR 1.53, p=0.040), amputation (aHR 1.72, p=0.019) and amputation or death (aHR 1.52, p=0.005) compared to AV. After stratifying by bypass configuration, AV had the highest overall survival and amputation-free survival among the three alternative conduits in below-knee popliteal and tibial bypass targets. ConclusionsIn this large multi-institutional study investigating alternative conduits to GSV, AV are found to be the most resistant to infections and are associated with the best overall survival and limb salvage outcomes compared to PG and BG particularly in below-knee distal targets. In cases where no GSV is available, AV and PG are acceptable alternatives with comparable one-year amputation-free survival and MALE-free survival rates. On the other hand, BG are associated with higher risk of graft occlusion and lower freedom from major amputation and death compared to AV.

TCT-176 Comparative Analysis of Predictive Accuracies of SYNTAX and SYNTAX-II Score for Mortality and Major Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Meta-Analysis

TCT-176 Comparative Analysis of Predictive Accuracies of SYNTAX and SYNTAX-II Score for Mortality and Major Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Meta-Analysis

Do seabirds dream of artificial lights? Understanding light preferences of Procellariiformes.

Seabirds, and particularly fledglings of burrow-nesting species, are greatly impacted by light pollution. During their inaugural flights from colony to sea, fledglings become grounded after encountering artificial light. Such groundings, or fallout events, affect many fledglings each year, causing mass mortality events. To mitigate this light-induced mortality, rescue programmes have been implemented for decades at many locations worldwide. Despite the notoriety of fallouts and their conservation implications, the contributing behavioural and biological factors remain mostly unknown. How the mechanisms of light attraction and light avoidance interact and how they manifest in different groups (e.g. age, personality, populations) or light pollution levels remain open questions. We tested behavioural choices of Cory's shearwater Calonectris borealis fledglings, rescued after being grounded in urban areas, and choices of breeding adults for contrasting light sources. Fledglings and adults were exposed to one of three treatments in an experimental Y-maze set-up: white light versus no light, blue versus red light, and a control with no light on each arm of the Y-maze. Both age groups clearly chose the no-light arms and the red light arm. This choice for longer wavelengths and darker environments, along with slower responses by fledglings, suggests that close range artificial light causes disorientation in seabirds. Our study helps to clarify the behavioural components of fallouts and provides further evidence on the disruptive effects of nocturnal artificial light on sensitive species like Procellariiformes.

Contemporary characteristics, outcomes and novel risk score for Takotsubo cardiomyopathy: a national inpatient sample analysis

BackgroundTakotsubo cardiomyopathy (TC) is an established differential diagnosis of myocardial infarction with non-obstructive coronaries with significant interest but limited data on prognostication. We reviewed the characteristics and in-hospital outcomes and...

Climate change stands as the new challenge for whale watching and North Pacific gray whales (Eschrichtius robustus) in Bahia Magdalena, Mexico, after their recovery from overexploitation

IntroductionSocial-ecological systems (SES) recognize the intricate relationship between human activities and the environment and advocate for comprehensive approaches to address complex environmental issues. This study investigates the factors influencing whale watching, particularly the gray whale (Eschrichtius robustus) in northern Mexico, after significant recovery following overexploitation. Despite reaching a peak in 2015, the eastern North Pacific gray whales experienced unusual mortality events (UME), the most recent from 2019 to 2023, leading to a population decline and historically low calf production in 2022. This decline is evident in the reduced presence of whales and calves in winter breeding lagoons. Concurrently, whale watching has become a significant tourist attraction in these areas.MethodsOur objective was to develop a mental model of the SES of gray whale watching, integrating ecological and socioeconomic data to identify key variables and interactions that support system resilience. From an ecological perspective, we analyzed the long-term temporal trends of eight years of gray whale counts in the southernmost breeding and nursing lagoons within the Bahía Magdalena–Bahía Almejas Complex, Mexico. Additionally, we incorporated the current discussion in the literature about the potential impact of global climate change on gray whale populations. In the socioeconomic subsystem, we used participatory methods, including interviews, surveys, and workshops with government officials, tourism operators, and visitors. We also added on-site assessments of compliance with welfare regulations to understand tourism dynamics. ResultsOur findings identified as main external stressors the changes in ice levels in feeding areas and sea warming in breeding areas, and as internal stressors the compliance with official regulations and the number of vessels observing whales at the same time. The key socioeconomic factor of the system was tourist satisfaction, influenced by factors such as the quality of the information provided by operators. DiscussionUltimately, our mental model provides a framework for further exploration of relevant interactions and trajectories, offering insights for developing effective management strategies.

Quantifying intra-annual changes in abundance and distribution to identify the magnitude and scale of potential mortality events.

Quantifying intra-annual changes in abundance and distribution to identify the magnitude and scale of potential mortality events.

Racial disparities in end-of-life care among patients with neuroendocrine tumors.

60 Background: Due to the rising incidence of neuroendocrine tumors (NETs), the prevalence of NETs now surpasses many other malignancies. Due to a slower course of disease and lack of awareness among care teams, end-of-life (EOL) care is typically underutilized in patients with NETs. Owing to a heavy symptom burden (related to disease burden and/or functionality), patients with NETs often struggle due to lack of palliative care and eventually EOL care support. Prior studies have revealed that Black patients with advanced cancer are more likely to receive aggressive care and suffer a significant decline in quality of life at EOL. However, similar data investigating racial differences in EOL among patients with NETs are lacking. Methods: The National Inpatient Sample (NIS) was queried between years 2016-2020 to identify all hospitalizations (regardless of site of origin) with NETs utilizing the appropriate ICD-10 codes (neuroendocrine carcinomas were excluded). Hospitalizations of White and Black patients with documented inpatient mortality events were then extracted. Demographic and clinical data were analyzed using independent sample t-test, Chi-square test, and binary logistic regression (adjusted for age, gender, and Charlson comorbidity index or CCI). NIS discharge weights were applied to calculate national estimates. Statistical analyses were performed with SPSS 28.0. A p-value of &lt;0.05 was considered statistically significant. Results: A total of 6,265 hospitalizations with NETs were included, of which 5,125 (81.8%) and 1,140 (18.2%) had White and Black patients respectively. Black patients were younger, more likely to be females, and less likely to have a do not resuscitate (DNR) code status. There was no significant difference in CCI between the groups. Palliative care consultation was less likely to be performed among Black patients (adjusted OR=0.70, p&lt;.001). Black patients also had longer mean length of stay in the hospital (10.25 vs 8.42 days, p&lt;.001). Black patients were also more likely to receive aggressive care in the form of mechanical ventilation at EOL (Table). Conclusions: This is the largest analysis demonstrating significant racial disparities in EOL care among patients with NETs. Black patients had longer inpatient stay, were less likely to receive inpatient palliative care consultation, have a DNR order and more likely to receive aggressive care at EOL. These findings may have implications for informing healthcare decision making for EOL care among Black patients with NETs. WhiteN=5125 BlackN=1140 aOR (95% CI) p-value Age (years) 67.67 ± 11.89 65.14 ± 11.29 - &lt;.001 Females 46.1% 50.9% - .004 CCI 11.0 ± 3.22 10.9 ± 3.42 - .538 Mean length of stay 8.42 ± 10.03 10.25 ± 15.75 - &lt;.001 Palliative 62.6% 54.5% 0.70 (.61-.80) &lt;.001 DNR 64.9% 60.1% 0.80 (.70-.92) .002 Blood transfusion 13.2% 15.4% 1.18 (.98-1.41) .052 Mechanical ventilation 28.8% 38.6% 1.55 (1.35-1.77) &lt;.001 Vasopressor 9% 9.6% 1.07 (.86-1.33) .47

Comparative Transcriptomic Analyses Reveal Differences in the Responses of Diploid and Triploid Eastern Oysters to Environmental Stress.

Triploid oysters are commonly used as the basis for production in the aquaculture of eastern oysters along the USA East and Gulf of Mexico coasts. While they are valued for their rapid growth, incidents of triploid mortality during summer months have been well documented in eastern oysters, especially at low salinity sites. We compared global transcriptomic responses of diploid and triploid oysters bred from the same three maternal source populations at two different hatcheries and outplanted to a high (annual mean salinity = 19.4 ± 6.7) and low (annual mean salinity = 9.3 ± 5.0) salinity site. Oysters were sampled for gene expression at the onset of a mortality event in the summer of 2021 to identify triploid-specific gene expression patterns associated with low salinity sites, which ultimately experienced greater triploid mortality. We also examined chromosome-specific gene expression to test for instances of aneuploidy in experimental triploid oyster lines, another possible contributor to elevated mortality in triploids. We observed a strong effect of hatchery conditions (cohort) on triploid-specific mortality (field data) and a strong interactive effect of hatchery, ploidy, and outplant site on gene expression. At the low salinity site where triploid oysters experienced high mortality, we observed downregulation of transcripts related to calcium signaling, ciliary activity, and cell cycle checkpoints in triploids relative to diploids. These transcripts suggest dampening of the salinity stress response and problems during cell division as key cellular processes associated with elevated mortality risk in triploid oysters. No instances of aneuploidy were detected in our triploid oyster lines. Our results suggest that triploid oysters may be fundamentally less tolerant of rapid decreases in salinity, indicating that oyster farmers may need to limit the use of triploid oysters to sites with more stable salinity conditions.

Unveiling Factors Influencing Mortality in Irish Hip Fracture Patients: A Comprehensive Five-Year Analysis

BackgroundHip fractures impose a substantial healthcare burden, contributing to increased morbidity, disability, and mortality. The Irish Hip Fracture Standards (IHFS) were officially employed in 2017, providing specialized pathways for hip fracture care to improve patient outcomes. This study evaluated the performance of our unit regarding hip fracture care and analyzed individual outcome parameters. MethodData spanning five years (2015 to 2019) preceding the COVID-19 era was extracted from our hip fracture repository. Patients aged 60 years and older were included. The dataset integrated demographic information and outcomes, validating mortality events using the Irish death events registry. Mortality rates were measured cumulatively and at various time intervals. ResultsThere were 1,685 hip fractures treated during the study timeframe average patient age was 78, with women constituting 68% of the cohort. The one-year mortality rate was 20.8% (n = 350). Adverse outcomes were observed in older patients, men, and those who had higher American Society of Anesthesiologists (ASA)scores. Patients adhering to IHFS 1 (P ≤ 0.05) and IHFS 2 (P ≤ 0.05) exhibited improved outcomes. Our institution displayed lower compliance rates with IHFS 1 and 2 when compared to standards 3 to 6, with the latter standards showing no significant impact on mortality outcomes. ConclusionWhile our unit's hip fracture care outcomes align well with national averages, resource constraints hinder full compliance with IHFS 1 and 2, emphasizing the need for targeted resource allocation in areas with the greatest impact on outcomes.

Reproductive effort affects cellular response in the mantle of Nodipecten subnodosus scallops exposed to acute hyperthermia

In marine ecosystems, temperature regulates the energy metabolism of animals. In the last decades, the temperature increase was related to mass mortality events of marine ectotherms, particularly during high-energy investment for reproduction. In scallops, the mantle has been poorly investigated while this tissue covers more than 40 % of the body mass, contributing to the perception of surrounding environmental stimuli. Our aim was to assess the cellular and molecular responses linked to energy metabolism in the mantle of adult N. subnodosus facing acute hyperthermia during reproductive effort. Scallops collected in spring (late gametogenesis) and summer (ripe gonads) were exposed to a control temperature (22 °C) or acute hyperthermia (30 °C) for 24 h. In spring, increased arginine kinase (AK) activity together with increased pyruvate kinase/citrate synthase ratio (PK/CS) suggested an enhanced carbohydrate, pyruvate, and arginine metabolism to maintain the adenylate energy charge (AEC) in the mantle of scallops coping with acute thermal increase. In summer, animals decreased their AEC (5 %) and arginine phosphate pool (40 %) and increased their anaerobic metabolism as shown by enhanced activities of lactate-dehydrogenase (LDH) and octopine dehydrogenase (ODH), respectively. The abundance of twenty proteins involved in energy metabolism (isocitrate dehydrogenase, ATP synthase subunit β), protein protection (cognates heat shock protein 70), and cytoskeleton (actins and tubulins) were affected only by season. These results underlie the role of the mantle of N. subnodosus in the seasonal responses of this tissue to thermal fluctuations during reproductive effort with possible implications for the physiological performance of scallops under heat waves in wild or harvest conditions.

Prediction of heatwave related mortality magnitude, duration and frequency with climate variability and climate change information

Given the link between climatic factors on one hand, such as climate change and low frequency climate oscillation indices, and the occurrence and magnitude of heat waves on the other hand, and given the impact of heat waves on mortality, these climatic factors could provide some predictive skill for mortality. We propose a new model, the Mortality-Duration-Frequency (MDF) relationship, to relate the intensity of an extreme summer mortality event to its duration and frequency. The MDF model takes into account the non-stationarities observed in the mortality data through covariates by integrating information concerning climate change through the time trend and climate variability through climate oscillation indices. The proposed approach was applied to all-cause mortality data from 1983 to 2018 in the metropolitan regions of Quebec and Montreal in eastern Canada. In all cases, models introducing covariates lead to a substantial improvement in the goodness-of-fit in comparison to stationary models without covariates. Climate change signal is more important than climate variability signal in explaining maximum summer mortality. However, climate indices successfully explain a part of the interannual variability in the maximum summer mortality. Overall, the best models are obtained with the time trend and the North Atlantic Oscillation (NAO) used as covariates. No country has yet integrated teleconnection information in their heat-health watch and warning systems or adaptation plans. MDF modeling has the potential to be useful to public health managers for the planning and management of health services. It allows predicting future MDF curves for adaptive management using the values of the covariates.

Application of Antithrombotic Drugs in Patients with Acute Type B Aortic Dissection Underwent Thoracic Endovascular Aortic Repair.

This study aimed to evaluate the safety and necessity of antithrombotic drugs for acute type B aortic dissection (TBAD) treated with thoracic endovascular aortic repair (TEVAR).The patients of acute TBAD treated with TEVAR were retrospectively enrolled from January 2007 to October 2022 in General Hospital of Northern Theater Command. The primary outcomes such as mortality and aortic adverse events [stroke, paraplegia, limb ischemia, organ failure (renal and intestinal tract), endoleak, redissection, aortic rupture, reintervention, and mortality] were recorded and evaluated at 1 month (early term) and 18 months (late term).The 697 patients of TBAD treated with TEVAR were divided into the antithrombotic (AT) group (n = 208) and nonantithrombotic (NAT) group (n = 489). The incidence of early mortality, early aortic adverse events, and the 18 months of cumulative freedom from all-cause mortality and aortic adverse events were not significantly different between the AT and NAT groups (2.4% versus 1.4%, 2.9% versus 4.5%, 94.7% versus 96.5% and 88.4% versus 89.9%, respectively). Log-rank tests also indicated that there were no significant differences. In multivariate Cox regression models, only pleural effusion, partially thrombosed of false lumen, maximum diameter of false lumen, and branch involvement were independent predictors of mortality, whereas the systolic blood pressure (SBP), pleural effusion, partially thrombosed of false lumen, true lumen compression, maximum diameter of false lumen, branch involvement were independent predictors of adverse aortic events.The antithrombotic drug for acute TBAD treated with TEVAR does not influence the mortality and aortic events in the early and late terms.

Application of a deep-learning marker for morbidity and mortality prediction derived from retinal photographs: a cohort development and validation study

Biological ageing markers are useful to risk stratify morbidity and mortality more precisely than chronological age. In this study, we aimed to develop a novel deep-learning-based biological ageing marker (referred to as RetiPhenoAge hereafter) using retinal images and PhenoAge, a composite biomarker of phenotypic age. We used retinal photographs from the UK Biobank dataset to train a deep-learning algorithm to predict the composite score of PhenoAge. We used a deep convolutional neural network architecture with multiple layers to develop our deep-learning-based biological ageing marker, as RetiPhenoAge, with the aim of identifying patterns and features in the retina associated with variations of blood biomarkers related to renal, immune, liver functions, inflammation, and energy metabolism, and chronological age. We determined the performance of this biological ageing marker for the prediction of morbidity (cardiovascular disease and cancer events) and mortality (all-cause, cardiovascular disease, and cancer) in three independent cohorts (UK Biobank, the Singapore Epidemiology of Eye Diseases [SEED], and the Age-Related Eye Disease Study [AREDS] from the USA). We also compared the performance of RetiPhenoAge with two other known ageing biomarkers (hand grip strength and adjusted leukocyte telomere length) and one lifestyle factor (physical activity) for risk stratification of mortality and morbidity. We explored the underlying biology of RetiPhenoAge by assessing its associations with different systemic characteristics (eg, diabetes or hypertension) and blood metabolite levels. We also did a genome-wide association study to identify genetic variants associated with RetiPhenoAge, followed by expression quantitative trait loci mapping, a gene-based analysis, and a gene-set analysis. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and corresponding 95% CIs for the associations between RetiPhenoAge and the different morbidity and mortality outcomes. Retinal photographs for 34 061UK Biobank participants were used to train the model, and data for 9429participants from the SEED cohort and for 3986participants from the AREDS cohort were included in the study. RetiPhenoAge was associated with all-cause mortality (HR 1·92 [95% CI 1·42-2·61]), cardiovascular disease mortality (1·97 [1·02-3·82]), cancer mortality (2·07 [1·29-3·33]), and cardiovascular disease events (1·70[1·17-2·47]), independent of PhenoAge and other possible confounders. Similar findings were found in the two independent cohorts (HR 1·67 [1·21-2·31] for cardiovascular disease mortality in SEED and 2·07 [1·10-3·92] in AREDS). RetiPhenoAge had stronger associations with mortality and morbidity than did hand grip strength, telomere length, and physical activity. We identified two genetic variants that were significantly associated with RetiPhenoAge (single nucleotide polymorphisms rs3791224 and rs8001273), and were linked to expression quantitative trait locis in various tissues, including the heart, kidneys, and the brain. Our new deep-learning-derived biological ageing marker is a robust predictor of mortality and morbidity outcomes and could be used as a novel non-invasive method to measure ageing. Singapore National Medical Research Council and Agency for Science, Technology and Research, Singapore.

Predictors and Outcomes of Slow Flow/No Reflow in Acute Myocardial Infarction Patients Treated with Pharmacoinvasive Strategies

Objectives: This study aimed to determine the incidence, predictors, and clinical outcomes of slow flow and no reflow (SF/NR) in patients undergoing a pharmacoinvasive strategy following full-dose thrombolytic therapy for acute myocardial infarction (AMI). Methodology: We conducted a prospective observational study at the Department of Cardiology, Hayatabad Medical Complex, Peshawar, from February 2022 to February 2023. The study cohort comprised 130 patients who received percutaneous coronary intervention (PCI) after thrombolytic therapy. Comprehensive data on patient demographics, clinical presentations, procedural details, and outcomes were systematically collected. Multivariate logistic regression was employed to identify independent predictors of SF/NR. Results: The incidence of SF/NR was 13.8%. Significant predictors included hypertension (Odds Ratio [OR]: 2.31, 95% Confidence Interval [CI]: 1.01-5.29, p = 0.047), high thrombus burden (OR: 3.14, 95% CI: 1.38-7.15, p = 0.006), and longer lesion length (OR: 1.29 per mm increase, 95% CI: 1.11-1.50, p &lt; 0.001). Patients with SF/NR experienced significantly higher in-hospital mortality (16.7% vs. 2.7%, p = 0.012), cardiogenic shock (27.8% vs. 5.4%, p &lt; 0.001), heart failure (33.3% vs. 7.1%, p &lt; 0.001), and major adverse cardiac events (MACE) (44.4% vs. 11.6%, p &lt; 0.001). At 30 days post-discharge, the mortality rate was 22.2% in the SF/NR group compared to 4.5% in the normal flow group (p = 0.004). Conclusion: The study highlights a significant incidence of SF/NR in patients undergoing PCI after thrombolytic therapy for AMI. Identified predictors—hypertension, high thrombus burden, and longer lesion length—underscore the need for targeted risk stratification and management strategies to enhance patient outcomes and mitigate adverse effects.

Trends and outcomes of different mechanical circulatory support modalities for acute myocardial infarction associated cardiogenic shock in patients undergoing early revascularization

BackgroundThe use of Mechanical Circulatory Support (MCS) devices in cardiogenic shock (CS) is growing. However, the recent trends in using different MCS modalities and their outcomes in acute myocardial infarction associated CS (AMI-CS) are unknown. MethodsThe national readmission database (2016–2020) was used to identify AMI-CS requiring MCS. Cohorts were stratified as ECMO compared to Impella. Propensity score matching (PSM) was used to remove confounding factors. Pearson's x2 test was applied to matched cohorts to compare outcomes. We used multivariate regression and reported predictive margins for adjusted trend analysis. ResultsAmong 20,950 AMI-CS hospitalizations requiring MCS, 19,628 (93.7 %) received Impella vs 1322 (6.3 %) were placed only on ECMO. ECMO group was younger (median age: 61 vs. 68 years, p < 0.001) and had a lower comorbidity burden. On propensity-matched cohorts (N 742), the ECMO cohort had higher adverse events, including mortality (51.6 % vs. 41.5 %), sudden cardiac arrest (SCA) (40.9 % vs. 31.8 %), acute stroke (9.2 % vs. 4.6 %) and major bleeding (16 % vs 12.2 %) [p < 0.05]. However, comparing ECPELLA (ECMO + Impella) to Impella alone, mortality (46.2 % vs. 39.4 %) and SCA (44 % vs. 36.4 %) rates were similar, though major bleeding was higher (18.2 % vs. 9.8 %). From 2016 to 2020, mortality trends for AMI-CS in the U.S. showed no significant change (p-trend: 0.071). ConclusionDespite advances in MCS modalities, the overall mortality rate for AMI-CS remains unchanged. ECMO use without LV unloading showed higher mortality and adverse events compared to Impella. Prospective studies are needed to verify these findings.