Noncardiac Complications Research Articles

Elevated Troponin: A Marker for Noncardiac Complications After Resection of Head and Neck Cancers.

To examine if troponin positivity (TP) in patients who undergo head and neck cancer mucosal resections (HNS) predicts noncardiac complications (NCC). Major HNSs are arduous operations that place stress on the patient's hemodynamic system. TP after noncardiac surgery previously has been shown in up to 25% of patients, which may signal cardiac complications (CC) or NCC. Although CC after HNS has been observed, no study has investigated the relationship of TP to NCC. All patients who underwent HNS at a tertiary-care cancer center from July 2014 to July 2016 were included and underwent postoperative troponin measurements as part of an institutional cardiac protocol. Comparative and multivariate regression analysis were used to compare TP and troponin-negative (TN) patients for NCC. One hundred seventy-two patients underwent HNS. Of those, 15% developed TP during the postoperative period. There was no significant difference between TP and TN for gender, tumor-node-metastasis staging, Charlson comorbidity index, and smoking status. Risk of NCC in TP was 73.1% versus 28.1% in TN (P < 0.001). A significant difference (P < 0.05) in wound complications, length of hospital stay (LOHS), and incidence of pneumonia was found between both groups. Nonparametric testing confirmed significant difference in pneumonia (Z = -3.469, P = 0.001) and LOHS (-3.110, P = 0.002). Multivariate regression analysis confirmed a significant difference in LOHS independent of CC (R2 = 0.122, P < 0.0001). TP is not an uncommon occurrence after HNS and is associated with statistically significant increases in wound complications, LOHS, and pneumonia. However, the overall significance of these findings remains unclear, and further research is warranted to determine if outcomes may be improved by closely monitoring these patients for TP. 4 Laryngoscope, 130:2148-2152, 2020.

Diagnosing Perioperative Cardiovascular Risks in Noncardiac Surgery Patients.

Every year, over 200 million adults are undergoing noncardiac surgery. These noncardiac surgery patients may face the risk of cardiac mortality and morbidity during the perioperative and recovery periods. Around ten million patients who underwent noncardiac surgery experience cardiac complications within the first 30 days of the postoperative period; the complications are myocardial infarction, cardiac death, and cardiac arrest. This cardiovascular risk is mostly faced by the patients having cerebrovascular or cardiac disease and the patients with the age greater than 50 years. Monitoring and treating cardiac diseases with a suitable biomarker during the perioperative period is necessary for the early recovery of noncardiac surgery patients. This review discussed the risk factors and the key guidelines to avoid the cardiovascular risks during the perioperative period of noncardiac surgery patients. In addition, the biomarkers and identification strategies for cardiac diseases are discussed.

Abnormal Left-Hemispheric Sulcal Patterns Correlate with Neurodevelopmental Outcomes in Subjects with Single Ventricular Congenital Heart Disease.

Neurodevelopmental abnormalities are the most common noncardiac complications in patients with congenital heart disease (CHD). Prenatal brain abnormalities may be due to reduced oxygenation, genetic factors, or less commonly, teratogens. Understanding the contribution of these factors is essential to improve outcomes. Because primary sulcal patterns are prenatally determined and under strong genetic control, we hypothesized that they are influenced by genetic variants in CHD. In this study, we reveal significant alterations in sulcal patterns among subjects with single ventricle CHD (n= 115, 14.7 ± 2.9years [mean ± standard deviation]) compared with controls (n= 45, 15.5 ± 2.4years) using a graph-based pattern-analysis technique. Among patients with CHD, the left hemisphere demonstrated decreased sulcal pattern similarity to controls in the left temporal and parietal lobes, as well as the bilateral frontal lobes. Temporal and parietal lobes demonstrated an abnormally asymmetric left-right pattern of sulcal basin area in CHD subjects. Sulcal pattern similarity to control was positively correlated with working memory, processing speed, and executive function. Exome analysis identified damaging de novo variants only in CHD subjects with more atypical sulcal patterns. Together, these findings suggest that sulcal pattern analysis may be useful in characterizing genetically influenced, atypical early brain development and neurodevelopmental risk in subjects with CHD.

Prolonged Air Leak After Pulmonary Resection Increases Risk of Noncardiac Complications, Readmission, and Delayed Hospital Discharge: A Propensity Score-adjusted Analysis.

The aim of the study was to determine whether prolonged air leak (PAL) is associated with postoperative morbidity and mortality following pulmonary resection after adjusting for differences in baseline characteristics using propensity score analysis. Patients with PAL after lung resection have worse outcomes than those without PAL. However, adverse postoperative outcomes may also be secondary to baseline risk factors, such as poor lung function. Patients who underwent pulmonary resection for lung cancer/nodules (1/2009-6/2014) were stratified by the presence of PAL [n = 183 with/1950 without; defined as >5 d postoperative air leak; n = 189 (8.3%)]; probability estimates for propensity for PAL from 31 pretreatment/intraoperative variables were generated. Inverse probability-of-treatment weights were applied and outcomes assessed with logistic regression. Standardized bias between groups was significantly reduced after propensity weighting (mean = 0.18 before vs 0.08 after, P < 0.01). After propensity weighting, PAL was associated with increased odds of empyema (OR = 8.5; P < 0.001), requirement for additional chest tubes for pneumothorax (OR = 7.5; P < 0.001), blood transfusion (OR = 2; P = 0.03), pulmonary complications (OR = 4; P < 0.001), unexpected return to operating room (OR = 4; P < 0.001), and 30-day readmission (OR = 2; P = 0.009). Among other complications, odds of cardiac complications (P = 0.493), unexpected ICU admission (P = 0.156), and 30-day mortality (P = 0.270) did not differ. Length of hospital stay was prolonged (5.04 d relative effect, 95% confidence interval, 3.77-6.30; P < 0.001). Pulmonary complications, readmission, and delayed hospital discharge are directly attributable to having a PAL, whereas cardiac complications, unexpected admission to the ICU, and 30-day mortality are not after propensity score adjustment.

Apoptotic cell death in heart failure associated with diabetes

Diabetes is a serious public health problem. Improvements in the treatment of noncardiac complications from diabetes have resulted in heart disease becoming a leading cause of death in diabetic patients. Several cardiovascular pathological consequences of diabetes such as hypertension affect the heart to varying degrees. Furthermore, hyperglycemia as a sole risk factor may directly cause cardiovascular damage and lead to a complication such as diabetic cardiomyopathy. Alterations in myocardial structure and function occur during the late stage of diabetes. These chronic alterations are believed to result from acute cardiac responses to suddenly increased glucose levels at the early stage of diabetes. In failing hearts, cardiomyocytes degenerate and interstitial fibrosis, which indicates cardiomyocyte loss, becomes more prominent in the myocardium. Various mechanisms may establish an association of diabetes mellitus and heart failure as follows: first, comorbidities such as hypertension may play a role, diabetes also accelerates the development of coronary atherosclerosis, and experimental, clinical studies support the existence of microangiopathy, metabolic factors, or myocardial fibrosis influencing diabetic cardiomyopathy. Apoptosis of adult cardiac muscle cells can have lasting adverse consequences on overall cardiac performance. It is possible that autophagic degeneration may also be one of the mechanisms of myocardial cell death.

Extra-cardiac comorbidities or complications in adults with congenital heart disease: a nationwide inpatient experience in the United States.

With a great interest, we read the article by Neidenbach et al. on non-cardiac comorbidities in German adults with congenital heart disease (ACHD). ACHD always bear an increased risk of developing concomitant non-cardiac comorbidities and complications and impose a great healthcare burden. Limited large-scale data from the United States (US) on this focus incited us to write this brief report. Gilboa et al. estimated nearly 2.4 million people living with CHD (1.4 million adults, 1 million children) in the US in 2010. To have a better nationwide prospect of the current scenario, we looked at the extra-cardiac comorbidities among ACHD patients hospitalized in the US using the National Inpatient Sample database (NIS) for years 2013-2014. The burden of extracardiac comorbidities among the NIS cohort in the US was diverse as compared to the German outpatient ACHD cohort. Our study reports a higher burden of endocrinological, hematological, metabolic, pulmonary, psychiatric, renal and rheumatological comorbidities as compared to the German cohort. However, the burden of gastrointestinal and hepatological comorbidities was higher in the German outpatient cohort. In addition, ACHD patients with non-cardiac comorbidities were older except for those suffering from the psychiatric illnesses as compared to ACHD hospitalizations without comorbidities. It is imperative for the clinicians to understand the non-cardiac complications which a patient might encounter during a lifetime, and which could further complicate the management of ACHD and increases the risk of mortality.

The Adult Patient with Congenital Heart Disease in the Emergency Department

It is well recognized that adult survivors with congenital heart disease are at risk for several cardiac and noncardiac complications that can impact their long-term outcomes. Emergency departments are increasingly being used for the evaluation and management of acute complications in these patients. However, there are several issues that are unique to adults with congenital heart disease related to the complexity of their cardiac anatomy, previous surgical intervention, and residual hemodynamic lesions that can complicate their presentation and management. This review examines the many challenges faced in caring for adults with congenital heart disease presenting to the emergency department, including the issues related to underlying cardiac lesion, access to care, and the evaluation and management of common clinical presentations.

1024. First Episode Infective Endocarditis in Persons Who Inject Drugs (PWIDs); A Retrospective Cohort Study

BackgroundPersons who inject drugs (PWID) represent a distinct demographic of patients with infective endocarditis (IE). Many centers do not perform valvular surgery on these patients due to concerns about poor outcomes.MethodsRetrospective cohort study comparing PWID patients to non-PWID patients presenting between February 2007 and March 2016 in London, Ontario, among adult (>18) inpatients with first episode IE.ResultsIn 370 first episode IE cases, 53.9% occurred in PWIDs. PWID patients were younger (35.4 SD 10.0 vs. 59.4 SD 14.9) (P < 0.001), more likely to have right-sided infection [125/202 (62%), vs. 16/168 (9.5%) (P < 0.001)], and more often due to S. aureus (156/202 (77.3%) vs. 54/168 (32.1%), P < 0.001). Myocardial and aortic root abscesses were less common in PWIDs [17/202 (8.4%) vs. 50/168 (30%) (P < 0.01)]. There was no difference in the frequency of noncardiac complications. In total, 36.5% of patients were treated surgically with PWID patients less likely to undergo surgery [39/202 (19.3%) vs. 98/168 (58%) P < 0.001]. Cox regression analysis identified the protective effect of cardiac surgery with regards to survival in all patients, with a hazard ratio of 0.49 (95% CI 0.31–0.76, P < 0.001), as well as among PWIDs (HR 0.39, 95% CI 0.17–0.87, P = 0.02). Among all patients, lower survival was associated with older age (HR 1.03, 95% CI 1.00–1.05, P < 0.001), injection drug use (HR 2.72, 95% CI 1.52–4.88, P < 0.001), left-sided infection (HR 3.48, 95% CI 2.01–6.03, P < 0.001), and bilateral infection (HR 3.19, 95% CI 1.45–7.01, P = 0.004). The lower survival of left-sided infection (HR 4.01, 95% CI 1.97–8.18, P < 0.001) or bilateral infection (HR 6.94, 95% CI 2.39–20.2,P < 0.001) was re-demonstrated in PWIDs.ConclusionThis study identifies important clinical differences between PWIDs and nondrug users with respect to valve involvement, causative organism, complications, and management strategies. Our results highlight the important role of surgical treatment in a carefully selected PWID patient population.Disclosures All authors: No reported disclosures.

Clinical Characteristics and Factors Associated With Mortality in First-Episode Infective Endocarditis Among Persons Who Inject Drugs

Persons who inject drugs (PWID) represent a distinct demographic of patients with infective endocarditis. Many centers do not perform valvular surgery on these patients owing to concerns about poor outcomes. Addiction services are underused in hospitals. To compare clinical characteristics in first-episode infective endocarditis in PWID who are surgically vs medically managed and to identify variables associated with mortality. This case series studied PWID treated for a first episode of infective endocarditis between April 1, 2007, and March 30, 2016. Participants were adult patients (aged ≥18 years) admitted to any of 3 hospitals in London, Ontario, Canada. Analysis occurred between July 2016 and November 2017. Survival among PWID; the causative organisms, site of infection, and cardiac as well as noncardiac complications; referral to addiction services; and surgical vs medical management. Of 370 total first-episode cases of infective endocarditis, 202 (54.6%) were in PWID. Among PWID, 105 (52%) were male, the median (interquartile range) age was 34 (28-42) years, and patients were predominantly positive for the hepatitis C virus (69.8% [141 of 202]). Right-sided infection was more common (61.4% [124 of 202]), and most infections were caused by Staphylococcus aureus (77.2% [156 of 202]). Surgery occurred in 19.3% of patients (39 of 202). The all-cause mortality rate was 33.7% (68 of 202). Adjusting for age and sex, survival analysis demonstrated that surgery was associated with lower mortality (hazard ratio [HR], 0.44; 95% CI, 0.23-0.84; P = .01), as was referral to addiction treatment (HR, 0.29; 95% CI, 0.12-0.73; P = .008). Higher mortality was associated with left-sided infection (HR, 3.26; 95% CI, 1.82-5.84; P < .001) and bilateral involvement (HR, 4.51; 95% CI, 2.01-10.1; P < .001). This study presents the demographic characteristics of first-episode infective endocarditis in PWID. Results highlight the potentially important role of addictions treatment in this population. Further study to optimize selection criteria for surgery in PWID is warranted.

Abstract 17356: Gender Differences in Clinical Presentation and Outcomes of Patients With Acute Myocardial Infarction and Spontaneous Coronary Artery Dissection: A Nationwide Inpatient Sample Matched Analysis

Introduction: Spontaneous Coronary Artery Dissection (SCAD) is reported to occur predominantly in young women. Gender differences in the clinical presentation and outcomes of patients with SCAD have not been studied on a population level. We sought to compare the in-hospital outcomes of men and women presenting with acute myocardial infarction (AMI) and SCAD. Methods: We identified patients from the National Inpatient Sample (NIS) between 2005 and 2015 who presented with primary diagnoses of AMI and SCAD. We identified SCAD with ICD-9 code 414.12. A 1:1 propensity-matched cohort was created to examine the outcomes between men and women. Primary endpoint was in-hospital mortality. Secondary endpoints included in-hospital cardiac and non-cardiac complications. Results: Of the 6617 (32017 weighted national estimates) patients with SCAD over the study period, majority were males 3667 (55.4%). Males were younger than females (60.32 yr vs. 61.59 yr) and presented more often with ST-elevation myocardial infarction (STEMI) (53.0% vs. 45.9% P=&lt;0.001). Propensity matching yielded 2366 males and 2366 females. In the matched group, there was no significant difference in in-hospital mortality between males and females (OR 1.20 95% CI -0.93-1.54). With regards to in-hospital complications, ventricular tachycardia (V-Tach) was significantly less frequent in females as compared to males (8.0% vs. 10.1% OR 0.76 p-value 0.003). There was no significant difference between females and males in the frequency of other complications, including intracranial hemorrhage (0.2% vs 0.2% OR 1.45 p-value 0.50), GI bleed (1.8% vs 1.3% OR 1.35 p-value 0.13), cardiogenic shock (9.8% vs 9.7% OR 1.01 p-value 0.86), acute heart failure (3% vs 2.6% OR 1.18 p-value 0.26), ventricular fibrillation(vfib) (5.6% vs 6.0% OR 0.928 p-value 0.48) or stroke ( 1.5% vs 1.0% OR 1.535 p-value 0.06) Conclusion: In our large population-based analysis, compared to females, males were more likely to present with STEMI as compared to females. With the except of V-Tach, which was higher in males, there were no significant gender differences in hospital outcomes namely inpatient mortality, cardiogenic, Vfib or acute heart failure.

Revised Cardiac Risk Index versus ASA Status as a Predictor for Noncardiac Events After Posterior Lumbar Decompression

The Revised Cardiac Risk Index (RCRI) was designed to predict risk for cardiac events after noncardiac surgery. However, there is a paucity of literature that directly addresses the relationship between RCRI and noncardiac outcomes after posterior lumbar decompression (PLD). The objective of this study is to determine the ability of RCRI to predict noncardiac adverse events after PLD. The American College of Surgeons National Surgical Quality Improvement Program was used to identify patients undergoing PLD from 2006 to 2014. Multivariate and receiver operating characteristic analysis was used to identify associations between RCRI and postoperative complications. A total of 52,066 patients met the inclusion criteria. Membership in the RCRI=1 cohort independently predicted unplanned intubation, ventilation >48 hours, progressive renal insufficiency, acute renal failure, urinary tract infection (UTI), sepsis, septic shock, and readmission. Membership in the RCRI=2 cohort independently predicted for superficial surgical site infection, pneumonia, unplanned intubation, ventilation >48 hours, bleeding transfusion, progressive renal insufficiency, acute renal failure, UTI, sepsis, septic shock, and readmission. Membership in the RCRI=3 cohort independently predicted unplanned intubation (odds ratio [OR], 11.8), ventilation >48 hours (OR, 23.0), acute renal failure (OR, 84.5), and UTI (OR, 3.6). RCRI had a poor discriminative ability (DA) (area under the curve= 0.623), and American Society of Anesthesiologists status had a fair DA (area under the curve= 0.770) to predict a composite of noncardiac complications. RCRI was predictive of a wide range of noncardiac complications after PLD but had a diminished DA to predict a composite of any noncardiac complication than did American Society of Anesthesiologists score. Consideration of the RCRI as a component of preoperative surgical risk stratification can minimize patient morbidity and mortality after lumbar decompression.

Usefulness of Serum Cardiac Biomarkers for Predicting In-Hospital Cardiac Complications in Acute Hip Fracture: A Prospective Cohort in 20 High Surgical Risk patients with Age over 55 Years.

Background. Serum cardiac biomarkers have recently been demonstrated to be useful for predicting perioperative complication after hip fracture (HF). However, no previous study has revealed the comparative efficacy of different cardiac biomarkers in high surgical risk HF patients. Methods. A prospective study was conducted, from June to December 2016, in 20 acute HF patients with American Society of Anesthesiologists (ASA) grade 3 or 4. All patients received blood test for high sensitivity Troponin-I (hsTnI) and N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) at the time of admission and 24 hours postoperatively. Perioperative data and in-hospital, 3-month, and 6-month postoperative complications were collected. The complications were classified as cardiac and noncardiac HF-related complications. Results. The average patients' age was 79±8 years. Six patients (30%) were male. The incidence of PCI was 30% (n=6). None of the patients (0%) died during the 6-month postoperative followup period. In-hospital overall cardiac and noncardiac complications were found in 12(60%), 5(30%), and 7(45%), respectively. The mean serum hsTnI levels in the patients with cardiac complication were significantly greater than those in the patients without cardiac complication at both time of admission (99.5 ng/mL vs 5.5 ng/mL, p=0.006) and 24 hours postoperatively (28.6 ng/mL vs 9.4 ng/mL, p=0.013). The mean serum NT-proBNP levels in patients with cardiac complication were also greater but nonsignificantly compared to those in the patients without cardiac complication at both time of admission (2299 pg/mL vs 281 pg/mL, p=0.239) and 24 hours postoperatively (2266 pg/mL vs 586 pg/mL, p=0.061). The other significant preoperative predictors for cardiac complication were low hemoglobin level (p=0.014), low glomerular filtration rate level (p=0.039), and ASA grade 4 (p=0.005). Conclusion. In-hospital cardiac complication in high-risk HF patients was significantly associated with the abnormal rise of serum hsTnI level. Therefore, we recommended using the hsTnI test in the perioperative evaluation in high-risk HF patients. Trial registration number is TCTR20160711002.

Electrocardiographic diagnosis of atrial infarction in patients with acute inferior ST-segment elevation myocardial infarction.

Patients with atrial myocardial infarction (ATMI) have frequent cardiac and noncardiac complications. However, ATMI is uncommonly diagnosed because of its nonspecific ECG changes. Our objective was to analyze the ECG characteristics of ATMI in patients with inferior STEMI. Electrocardiographic P wave parameters can help in diagnosis of ATMI. We evaluated 932 patients who underwent coronary angiography and recruited 39 patients with ATMI and 33 patients without ATMI with inferior STEMI for a retrospective study. Twelve-lead ECGs were obtained to measure P-wave parameters in diagnosis of ATMI. P-wave parameters and PR-segment displacement were compared in patients with and without ATMI. In inferior leads, PWD and PWDisp were significantly longer in the ATMI group than in the non-ATMI group (limb lead II, 109.79 ±15.51 ms and 86.65 ±5.02 ms, respectively; P < 0.001; limb lead III, 108.31 ±12.51 ms and 85.27 ±7.47 ms, P < 0.001; aVF, 106.49 ±13.68 ms and 83.01 ±7.89 ms, P < 0.001; PWDisp, 41.67 ±10.72 ms and 25.18 ±5.17 ms, P < 0.001). By contrast, PWA was significantly lower in the ATMI group than in the non-ATMI group (limb lead II, 0.96 ±0.18 mV and 1.39 ±0.22 mV, respectively; P < 0.001; limb lead III, 0.90 ±0.11 and 1.21 ±0.23, P < 0.001; aVF, 0.88 ±0.17 and 1.26 ±0.28, P < 0.001). PR-segment displacement was found in 8 (20.5%) patients with ATMI. A PWD ≥95.5 ms in lead DII diagnosed ATMI with a higher sensitivity and specificity (90%, 94%) than did PWA or PWDisp. This study suggests P-wave parameters might be considered ECG findings in diagnosis of ATMI in patients with inferior STEMI.

Causes and Predictors of 30-Day Readmission in Patients With Acute Myocardial Infarction and Cardiogenic Shock.

Acute myocardial infarction (AMI) occurs as a result of irreversible damage to cardiac myocytes secondary to lack of blood supply. Cardiogenic shock complicating AMI has significant associated morbidity and mortality, and data on postdischarge outcomes are limited. We derived the study cohort of patients with AMI and cardiogenic shock from the 2013 to 2014 Healthcare Cost and Utilization Project National Readmission Database. Incidence, predictors, and causes of 30-day readmissions were analyzed. From 43 212 index admissions for AMI with cardiogenic shock, 26 016 (60.2%) survived to discharge and 5277 (20.2% of survivors) patients were readmitted within 30 days. More than 50% of these readmissions occurred within first 10 days. Cardiac causes accounted for 42% of 30-day readmissions (heart failure 20.6%; acute coronary syndrome 11.6%). Among noncardiac causes, respiratory (11.4%), infectious (9.4%), medical or surgical care complications (6.3%), gastrointestinal/hepatobiliary (6.5%), and renal causes (4.8%) were most common. Length of stay ≥8 days (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.70-2.44; P<0.01), acute deep venous thrombosis (OR, 1.26; 95% CI, 1.08-1.48; P<0.01), liver disease (OR, 1.25; 95% CI, 1.03-1.50; P=0.02), systemic thromboembolism (OR, 1.21; 95% CI, 1.02-1.44; P=0.02), peripheral vascular disease (OR, 1.16; 95% CI, 1.07-1.27; P<0.01), diabetes mellitus (OR, 1.16; 95% CI, 1.08-1.24; P<0.01), long-term ventricular assist device implantation (OR, 1.77; 95% CI, 1.23-2.55; P<0.01), intraaortic balloon pump use (OR, 1.10; 95% CI, 1.02-1.18; P<0.01), performance of coronary artery bypass grafting (OR, 0.85; 95% CI, 0.77-0.93; P<0.01), private insurance (OR, 0.72; 95% CI, 0.64-0.80; P<0.01), and discharge to home (OR, 0.85; 95% CI, 0.73-0.98; P=0.03) were among the independent predictors of 30-day readmission. In-hospital mortality and 30-day readmission in cardiogenic shock complicating AMI are significantly elevated. Patients are readmitted mainly for noncardiac causes. Identification of high-risk factors may guide interventions to improve outcomes within this population.

Abstract WMP84: Immune Response Mediates Brain- Heart Interaction After Subarachnoid Hemorrhage

Background: Cardiac dysfunction is evident after Subarachnoid Hemorrhage (SAH). Patients with cardiovascular complications after SAH have 3.5 times increased risk of death compared with non-cardiac complication SAH patients. The immune system may contribute to the cardiac pathological processes post-SAH.This study investigates the possible role of the immune system in mediating cardiac dysfunction after SAH in mice. Methods: Adult male C57BL/6J mice were subjected to SAH model or sham-control. The experimental groups includes (n=15/group): 1) Sham-control; 2) SAH alone; 3) SAH+splenectomy (SAH+SP). Splenectomy was performed one week before SAH. Cardiac hemodynamics and function were measured by echocardiography at 3 days after SAH. The Garcia behavior score was performed . Mice were sacrificed at the third day after SAH. Cardiac tissue immunostaining (n=10/group) and flow cytometry (n=5/group) were performed. Results: We found that: 1) SAH alone induces significant neurological deficit and vasospasm compared to sham-control. SAH+SP significantly decrease neurological deficit, but no significant improvement in the vasospasm compared to SAH mice (p&lt;0.05). 2) SAH mice exhibit significant cardiac dysfunction identified by a decline cardiac ejection fractions (EF) and fraction shortening (FS) compared to the sham. SAH+SP significantly improves cardiac function by increasing EF and FS compared to SAH mice (P&lt;0.05). 3) SAH significantly increases inflammatory cells (CD11b+/CD45+/F480+ macrophages) infiltration into the heart compared to sham-control (p&lt;0.05). The amount of macrophages within the heart tissue was significantly decreased in SAH+SP group when compared with the SAH group. 4) MCP1 expression in the heart was significantly increased in SAH group compared to sham; SAH+SP significantly decreased MCP1 expression compared to SAH (p&lt;0.05). Conclusions: SAH induces cardiac dysfunction; SAH with splenectomy decreases heart inflammatory cell infiltration, inflammatory factor expression as well as decreases cardiac dysfunction after SAH. Immune response may play an important role in SAH-induced cardiac dysfunction.

Comparison of the Kidney Injury Risk Tool to the Clinical Assessment of Contrast Induced Nephropathy Risk

Objective: CIN is the most common non-cardiac complication following coronary angiography, however riskstratification for CIN can be cumbersome. We hypothesize that a computer-based Kidney Injury Risk Tool (KIRT) would assess contrast-induced nephropathy (CIN) risk accurately and may out-perform standard clinical estimation. Methods: This was a prospective study of all-comers undergoing coronary angiography at a single institution. KIRT is based upon an established risk model and risk factors were derived from the electronic medical records using phenotyping rules. Operator reported and KIRT-derived risk factors were compared against adjudicated ground truth obtained by a blinded investigator through chart review and accuracy of the risk model outputs were compared. Operator’s assessment of risk without risk model vs. KIRT assessment were compared and analyzed (Wilcoxon-test, and Spearman's correlation). Results: A total of 132 patients consented for the study, 127 patients were included. KIRT-derived risk factors out-performed or matched the operator-reported for most riskfactors (sensitivity and specificity>0.86). KIRT output accuracy was higher than operator output: 79% vs. 76%. Mean operator-estimated CIN risk was lower than KIRT's estimate: 9% vs. 17% (P<0.001, paired Wilcoxon test), and held true for both high and low risk patients. Conclusion: KIRT has high accuracy in determining individual risk factors for CIN and identification of high-risk patients, and operator-based risk for CIN over-estimated risk compared to KIRT

Incidence and Clinical Profile of Bleeding Among Adult Acute Coronary Syndrome Patients Admitted in a Tertiary Hospital (BLEED-ACS)

Background: Current guidelines recommend the use of multiple antithrombotic drugs and aggressive invasive strategies in the management of patients with acute coronary syndromes (ACS). However, these interventions could result in bleeding, both minor and life-threatening. This study aimed to determine the incidence of bleeding among adult patients admitted for ACS treated with antiplatelets, anticoagulants and/or thrombolytics. Methods: This was a prospective observational study of adult patients admitted in the medical intensive care unit (ICU) for ACS and treated with antiplatelets, anticoagulants and/or thrombolytics from January 2016 to August 2016. The patients were observed for occurrence of any form of bleeding, and factors associated with bleeding were identified. Results: Fifty-eight patients were included in the study. The overall incidence of bleeding was 25.86%. Female sex and prior history of vascular disease or cerebrovascular disease were independently associated with a higher risk of bleeding (RR of 2.45 and 3.1, respectively; p&lt;0.05). There were no statistically significant differences in morbidity and mortality between those with and without bleeding. However, the number of days of ICU hospital stay among patients with bleeding occurrence was higher compared to those without bleeding (median: 6 vs 4 days). Conclusion: Bleeding is a common non-cardiac complication of current management for ACS and is associated with prolonged hospital stay. Simple baseline demographic and clinical characteristics identify patients at increased risk of bleeding.

Invited Commentary

Invited Commentary

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association.

Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.

E‐Poster Presentations – A2) Gastric and Duodenal

E‐Poster Presentations – A2) Gastric and Duodenal