Occurrence Of Shock Research Articles

Reduction in inappropriate therapies through device programming in subcutaneous implantable defibrillator patients: data from clinical practice.

In subcutaneous implantable cardioverter defibrillator (S-ICD) recipients, the UNTOUCHED study demonstrated a very low inappropriate shock rate on programming a conditional zone between 200 and 250 bpm and a shock zone for arrhythmias >250 bpm. The extent to which this programming approach is adopted in clinical practice is still unknown, as is its impact on the rates of inappropriate and appropriate therapies. We assessed ICD programming on implantation and during follow-up in a cohort of 1468 consecutive S-ICD recipients in 56 Italian centres. We also measured the occurrence of inappropriate and appropriate shocks during follow-up. On implantation, the median programmed conditional zone cut-off was set to 200 bpm (IQR: 200-220) and the shock zone cut-off was 230 bpm (IQR: 210-250). During follow-up, the conditional zone cut-off rate was not significantly changed, while the shock zone cut-off was changed in 622 (42%) patients and the median value increased to 250 bpm (IQR: 230-250) (P < 0.001). UNTOUCHED-like programming of detection cut-offs was adopted in 426 (29%) patients immediately after device implantation, and in 714 (49%, P < 0.001) at the last follow-up. UNTOUCHED-like programming was independently associated with fewer inappropriate shocks (hazard ratio 0.50, 95%CI 0.25-0.98, P = 0.044), and had no impact on appropriate and ineffective shocks. In recent years, S-ICD implanting centres have increasingly programmed high arrhythmia detection cut-off rates, at the time of implantation in the case of new S-ICD recipients, and during follow-up in the case of pre-existing implants. This has contributed significantly to reducing the incidence of inappropriate shocks in clinical practice. Rordorf: Programming of the S-ICD. URL: http://clinicaltrials.gov/Identifier: NCT02275637.

Optimal reinsurance and investment with a common shock and a random exit time

Under the mean-variance framework, we study the continuous-time optimal reinsurance and investment problem with a common shock and a random exit time. To describe the influence of the common shock, we propose a new interdependence mechanism between the insurance market and the financial market. It can reflect both the impact of the occurrence of a common shock and its influence degree on the two markets. Both the termination times of reinsurance and investment are random, and the random exit time is affected simultaneously by exogenous and endogenous random events. The insurer’s objective is to minimize the variance of her terminal wealth under a given level of expected terminal wealth. We derive the explicit optimal reinsurance-investment strategy by employing stochastic optimal control and Lagrange duality techniques. The influences of the market interdependence and the random exit time on the optimal strategy are demonstrated through numerical experiments. The results reveal some meaningful phenomena and provide insightful guidance for reinsurance and investment practice in reality.

Relationship between Transition Shock, Professional Stressors, and Intent to Leave the Nursing Profession during the COVID-19 Pandemic

Background and Objectives: Moving nurses to a COVID-19 department may cause the phenomenon of transition shock, which occurs when already employed nurses change jobs. A set of confusing and uncertain feelings arise due to the unfamiliar work environment, which may lead to their intention to leave the nursing profession. The aim of this study was to examine transition shock and the contribution of both the respondents' characteristics and the presence of stressors to the occurrence of transition shock in nurses assigned to work in COVID-19 departments. Materials and Methods: A cross-sectional study with 120 nurses employed in COVID-19 departments was conducted. Several linear regression models were used to assess the association between transition shock, personal and professional COVID-19 stressors, and the intention to leave the nursing profession. Results: Nurses who intended to leave the profession showed higher transition shock and higher personal and professional stressors (p < 0.001). Female nurses had lower transition shock (β = -0.16; p = 0.036) and higher personal COVID-19 stressors (β = 0.27; p < 0.001). University education contributes to the lowering of nurses' transition shock (β = -0.16; p = 0.038). Nurses who did not intend to leave the nursing profession had lower personal COVID-19 stressors (β = -0.15; p = 0.044). Transition shock was associated with personal COVID-19 stressors (β = 0.39; p < 0.001) and professional COVID-19 stressors (β = 0.29; p < 0.001), and vice versa. Conclusions: The phenomenon of transition shock was present after nurses transitioned to working in COVID-19 departments. Transition shock may cause more nurses to leave the profession, which may have a strong impact on the health system in many countries that are already facing a shortage of nurses. Additional education on and preparation for adapting to new working conditions with psychological support could have an influence by lowering the level of nurses' transition shock.

The dependence of radial diffusion coefficients on solar/interplanetary drivers

Radial diffusion driven by Ultra Low Frequency (ULF) waves is very important for magnetospheric dynamics, as it contributes to both acceleration and loss of relativistic electrons in the outer Van Allen radiation belt, as well as to other planetary magnetospheres. The dependence of ULF wave power spectral density and radial diffusion coefficients (DLL) on solar wind parameters has already been investigated but their dependence on the various solar and interplanetary drivers is poorly studied. In this study, we conduct a statistical analysis of radial diffusion coefficients DLL to look into their dependence on different interplanetary drivers, i.e. Interplanetary Coronal Mass Ejections (ICMEs) and Stream Interaction Regions (SIRs), which originate from different solar drivers: CMEs and coronal holes. We use the ”SafeSpace” database (https://synergasia.uoa.gr/modules/document/?course=PHYS120), which includes radial diffusion coefficients DLL and ULF wave power spectral density, created using magnetic and electric field measurements by the THEMIS satellites in the 2011–2019 time period. We study how the properties of these solar wind drivers influence the behavior of radial diffusion coefficients. The results indicate significant differences between drivers of different solar origin at the ratio of the electric over the magnetic DLL component (DLLE over DLLB), especially when the solar wind dynamic pressure is maximized due to shock existence. Furthermore, differences are observed between SIRs with shock and SIRs without shock. This feature introduces a significant energy dependence to the radial diffusion coefficients, which is further depending on the radial distance and the different first adiabatic invariant (μ) values. These results emphasize the importance of the energy dependence of the magnetic component of the DLL, especially during the occurrence of interplanetary shocks, which is neglected by most semi-empirical models used in radiation belt simulations.

Association Between Multidrug-Resistant Bacteria and Mortality in Critically Ill Patients.

Multidrug-resistant bacteria (MDRB) carriage may impact the outcomes of intensive care unit (ICU) patients. In this study, we aimed to assess the effect of MDRB-related infection and colonization on the day60 mortality rate. We conducted a retrospective, observational study in a single university hospital ICU. From January 2017 to December 2018, we screened all patients admitted to the ICU for at least 48h for MDRB carriage. The primary outcome was the mortality rate on day60 after MDRB-related infection. The secondary outcome was the mortality rate on day60 of non-infected but colonized patients with MDRB. We considered the effect of potential confounders, such as the occurrence of septic shock, inadequate antibiotic therapy, Charlson score, and life-sustaining limitation order. We included 719 patients during the aforementioned period; of this number, 281 (39%) had a microbiologically documented infection. MDRB was found in 40 (14%) patients. The crude mortality rate in the MDRB-related infection group was 35% vs. 32% in the non-MDRB-related infection group (p = 0.1). Logistic regression showed that MDRB-related infection was not associated with excess mortality, with an odds ratio of 0.52 and a 95% confidence interval from 0.17 to 1.39 (p = 0.2). Charlson score, septic shock, and life-sustaining limitation order were significantly associated with an increased mortality rate on day60. No effect of MDRB colonization on mortality rate on day60 was highlighted. MDRB-related infection or colonization was not associated with an increased mortality rate on day60. Other confounders, such as comorbidities, may account for a higher mortality rate.

Plasma riboflavin fluorescence as a diagnostic marker of mesenteric ischemia-reperfusion injury in rats

Due to the delayed and vague symptoms, it is difficult to early diagnose mesenteric ischemia injuries in the dynamics of acute illness, leading to a 60–80 % mortality rate. Here, we found plasma fluorescence spectra can rapidly assess the severity of mesenteric ischemia injury in animal models. Ischemia-reperfusion damage of the intestine leads to multiple times increase in NADH, flavins, and porphyrin auto-fluorescence of blood. The fluorescence intensity ratio between blue-fluorophores and flavins can reflect the occurrence of shock. Using liquid chromatography and mass spectroscopy, we confirm that riboflavin is primarily responsible for the increased flavin fluorescence. Since humans absorb riboflavin from the intestine, its increase in plasma may indicate intestinal mucosa injury. Our work suggests a self-calibrated and reagent-free approach to identifying the emergence of fatal mesenteric ischemia in emergency departments or intensive care units.

Dynamics and head-on collisions of multidimensional dust acoustic shock waves in a self-gravitating magnetized electron-depleted dusty plasma

The dynamics and collisions of dust acoustic (DA) shock excitations traveling in opposite directions are theoretically investigated in a three-dimensional self-gravitating magnetized electron-depleted dusty plasma whose ingredients are extremely warm positively and negatively charged massive dust grains as well as ions that follow the q-nonextensive distribution. A linear analysis and the extended Poincare–Lighthill–Kuo method are used to derive the dispersion relation, the two-sided Korteweg–de Vries Burgers equations, and the phase shift that occurs due to the wave interaction. It is found that gravitation introduces Jeans-like instability, reduces the wave damping rate, decays the aperiodic oscillatory structure of DA excitations, and strongly affects the amplitude, steepness, and occurrence of monotonic compressive and rarefactive shocks. Numerical simulations also highlighted the stabilizing role of the magnetic field and the singularities of the collision process of monotonic shock fronts as well as the undeniable influence of viscosity, ion nonextensivity, and obliqueness between counter-traveling waves on the phase shift and collision profiles. The present results may be useful to better understand interactions of dust acoustic shock waves in the laboratory and astrophysical scenarios, such as dust clouds in the galactic disk, photo-association regions separating H II regions from dense molecular clouds, Saturn's planetary ring, and Halley Comet.

The Effects of Tax Shocks on GNP and Inflation in Iran, A DSGE Approach

This study investigates indirect tax shocks' influences on GDP and inflation in Iran’s economy, using a DSGE (Dynamic Stochastic General Equilibrium) model. The results indicate that a shock cause equal to one standard deviation in tax on consumption can reduce GDP by 0.006% and inflation by 0.018%. Also, a shock in the import tax causes the GDP to decrease by 0.089% due to the decrease in demand for imported goods. Moreover, imported goods reduce by 0.4% with the occurrence of import tax shock; meanwhile, inflation increases by 0.89% in the short term. Accordingly, a possible reform for indirect taxes should be more carefully considered.

Information shocks, market returns and volatility: a comparative analysis of developed equity markets in Asia.

This research explores the function of information shocks in equity returns and integrated volatility of emerging Asian markets using Swap Variance (SwV) approach on the period of 20years (Feb 2001-Feb 2020). It compares average monthly returns and volatility of shock periods with non-shock periods after separating negative and positive shocks. Findings reveal frequent occurrence of information shocks in all Asian developed equity markets with positive shocks than that of negative shocks. Moreover, highly volatile Asian developed markets earn higher returns during shocks periods, while markets with higher volatility and lower continuous returns are adversely affected during shocks periods. The ratio of total realized volatility and the average ratio of shocks volatility establish that shocks account for a considerable amount of volatility, and integrated volatility is higher during negative shocks phases. The study has implications for all stakeholders of financial markets for rational investment decisions.

Pulmonary embolism: the Pulmonary Embolism Severity Index (PESI) score and mortality predictors

pulmonary embolism is a real public health problem because of its high morbidity and mortality rate. The purpose of this study is to evaluate the impact of PESI score on the prognosis of pulmonary embolism. we conducted a retrospective study of 146 cases of formally confirmed embolism. Pulmonary embolism severity index (PESI) score was calculated for the entire study population. The patients were divided into 2 groups: a low-risk group (LR) comprising patients in risk classes I and II: 83 patients; a high-risk group (HR) comprising patients in risk classes III, IV and V: 63 patients; the primary endpoint of the study (MACE) was the occurrence of shock, the need for mechanical ventilation, and the occurrence of in-hospital death. total in-hospital mortality was 15.1%, significantly higher in the HR group (25.4% versus 7.2%, p=0.001). In logistic regression analysis, being in the HR group (OR=5.1; 95% CI: [1,637 - 16,093]; p=0.005)) and having renal impairment (OR=4.5; 95% CI: [1.457 - 14.075]; p=0.009) were the independent factors for the occurrence of MACE. After a mean follow-up of 18 ± 8 months, there were more deaths in the HR group (68.4% versus 33%, p=0.004). the results of our study show that the PESI score is correlated with the severity of PE. This should encourage the widespread use of this risk score.

Nadoknada tečnosti kod bolesnika sa opekotinama - praćenje formule ili individualizovani pristup pacijentima?

A burn injury is defined as damage to the skin and subcutaneous tissues caused by heat, electricity, or chemicals. Burns can be classified according to the mechanism and time of occurrence and according to the severity of the injury. The severity of the burn is most often determined about the depth and percentage of the affected surface, taking into account some specificities of the patients (age, presence of comorbidities) and the burns themselves (inhalation, circumferential, burns caused by electricity). Fluid resuscitation is the most important measure of the initial (but, and later) treatment of burn disease, which is carried out to prevent hypovolemia and the occurrence of burn shock. Inadequate or delayed fluid resuscitation leads to multisystemic organ dysfunction. On the other hand, excessive fluid replacement leads to the formation of edema and other complications, such as compartment syndromes, which also increase morbidity and mortality. Crystalloid solutions are the core of burn resuscitation, and the biggest dilemma is whether, when, and how many colloids should be included in therapy.

Modeling of water hammer effect during the single cavitating bubble oscillation

The paper presents the results of an analytical study of the vapor-gas bubble dynamics in cavitation processes, giving consideration to the liquid compressibility. The study is based on the concept that cavitation effects are directly related to the occurrence of hydraulic shock on the surface of an extremely compressed bubble. The purpose of this work is to study cavitation bubble dynamics accounting for the spherical water hammer effects. An equation for the bubble dynamics was obtained, which includes the coefficient of liquid adiabatic compressibility as a basic parameter that is directly related to the liquid compressibility. For this equation reduces to the classical Rayleigh-Plesset equation for incompressible liquids. The results of a computational experiment performed within the framework of the modified model are presented for which the behavior of a cavitation bubble both in compressible and in incompressible water was analyzed. Based on a detailed analysis of the results obtained, it is shown that over time .the compressed bubble is in the state of a supercritical fluid with temperature up to 2000 K and pressure of about 400 MPa. The potential energy of the compressed liquid, in the form of a powerful acoustic pulse, emitted by the bubble at the stage of its collapse, is irreversibly dissipated in the surrounding liquid.

Bone homeostasis disorders increased the mortality of sepsis patients: A preliminary retrospective cohort study.

Sepsis is a common clinical syndrome and nearly 20% of all deaths are related to sepsis. As an important part of the body, bone homeostasis disorders are closely related to inflammatory response, but the correlation between bone homeostasis and sepsis, sepsis shock was unknown. The objective of this study was to explore the relation of bone homeostasis on sepsis and sepsis shock. In this retrospective cohort study, patients were enrolled between April 2018 and May 2022 from Beijing Chaoyang hospital. Primary outcomes were serum indicators reflected bone homeostasis, such as cross-linked carboxy-terminal telopeptide of type I collagen (CTX-I), tartrate-resistant acid phosphatase 5b (TRACP-5b) and piezo-type mechanosensitive ion channel component 1 (PIEZO1). The data were analyzed retrospectively. among 88 evaluable patients, 45 were sepsis (19 were sepsis shock) and 43 were non-sepsis. There was no significant difference in age, gender, BMI, combination diseases, operation time, intraoperative blood loss, and hospital stay. Patients with sepsis or sepsis shock had higher serum CTX-I, TRACP-5b, PIEZO1 (p < 0.05). Spearman's rank correlation test showed that CTX-I, TRACP-5b, PIEZO1 and the three together (CTX-I + TRACP-5b + PIEZO1) had strong correlation with sepsis or sepsis shock (p < 0.05). The receiver operating characteristic curve (ROC) and precision-recall curve (PRC) showed that these indicators could predict the occurrence of sepsis or sepsis shock (p < 0.05). Besides, decision curve analysis (DCA) and interventions avoided curve (IAC) displayed a high net benefit of bone homeostasis disorders indicators on sepsis or sepsis shock. Kaplan-Meier survival curves revealed that sepsis or shock patients with high value indicators (>0.47227) had a higher mortality (p < 0.05). Bone homeostasis disorders could increase the mortality of sepsis and sepsis shock patients.

Unfolding Smart Specialisation for Regional Economic Resilience: the role of Industrial Structure

The European Regional Development Funds for the programmatic cycle 2014-2020 aims to support regions that implement an innovation strategy based on Smart Specialisation. Within this framework, the European Commission emphasises the role of smart specialisation in favouring regional transformation, enhancing competitiveness and fostering resilience. However, the concepts of smart specialisation and resilience have been poorly combined. The article aims at investigating their relationship to understand if a smart specialisation strategy may promote the economic resilience of regions in response to major economic shocks. Drawing upon the concepts of adaptation/adaptability, the analysis investigates the relatedness of new industrial specialisations to the existing industrial structure before and after a shock occurrence. Evaluating the resilience of Italian provinces in relation to the economic crisis of 2008, the analysis aims to understand if provinces that resisted and recovered better followed a smart specialisation framework where new industrial specialisations are related to the existing industrial structure.

Analysis of the moist air transonic flow in the symmetric and asymmetric nozzle of the low expansion

Condensation has a negative impact on turbomachinery efficiency in many energy processes. This paper compares the expansion of moist air in symmetric and asymmetric nozzles with a low expansion rate. The presented numerical study is supported by analytical and experimental research. The experimental tWesting was carried out using an in-house experimental test rig where two nozzles were examined for moist air with relative humidity of about 25%. The nozzles were tested for a supersonic outlet, as well as for the outlet condition with elevated pressure, which resulted in the occurrence of a normal shock in the test section. The asymmetric nozzle profile is congruent with the symmetric nozzle. However, the nozzle walls are shifted linearly in the flow direction. The Schlieren photography technique and static pressure measurements on the nozzle wall were used for qualitative identification of both condensation and shock waves. The presented numerical modelling was conducted using commercial computational fluid dynamics software extended with an in-house condensation model. The code was validated against in-house experiment as well as against the data available in the literature. The analysis of the flow in the considered two types of nozzles with a very low expansion rate revealed very interesting structures of pressure waves. The impact of the linear shift of the nozzle walls on the condensation process and the interaction of the condensation wave with aerodynamic oblique as well as normal shock waves were investigated.

The role of trigger factors in the occurrence of appropriate ICD shocks and their prognostic implications

Abstract Background The role of triggers in the occurrence of appropriate ICD shocks due to ventricular tachyarrhythmias is not well known. The aim of the study was to assess the prevalence of trigger factors in appropriate ICD shocks and to analyze their prognostic impact on clinical outcome. Methods A total of 710 consecutive patients of a prospective single-centre ICD-registry who received a first appropriate ICD shock between 2000 and 9/2021 were analyzed. Results In 35% of ICD patients with first ICD shock, at least one of the following triggers was found: Ischemia (22%), Compliance (9%), Decompensation (38%), Stress (12%), Technical (5%), Electrolyte/endocrinological disorder (22%) and Medication intoxication (4%) (Table 1). The trigger factors can be summarized under the acronym ICD-STEMi. Patients with trigger associated ICD shocks had a more depressed ejection fraction and presented more often with ventricular fibrillation or electrical storm. The therapy after VT/VF shock in the trigger group comprised trigger optimization in 100% and heart failure optimization in 21% as compared to 0% respectively 10% in the no-trigger group (p&amp;lt;0.001). The ventricular arrhythmia therapy (antiarrhythmics or VT ablation) was not different between both groups (35% in each group). Patients with triggered first ICD shock had an increased 5-year mortality rate (50% versus 38%, p&amp;lt;0.001) (Figure 1). Conclusions In one third of ICD patients with first appropriate ICD shock, at least one trigger can be identified. Finding a trigger strongly influenced therapy after VT/VF shock. Patients with triggered ICD shock have a higher 5-year mortality rate. The evaluation of trigger factors after the occurrence of ICD shocks is mandatory and can be systematically evaluated using the acronym ICD-STEMi. Funding Acknowledgement Type of funding sources: None.

Impact of COVID-19 pandemic on the occurrence and outcome of cardiogenic shock complicating acute myocardial infarction

Abstract Background The COVID-19 pandemic had influenced the patient's behavior and impacted the homeostasis to a pro-thrombotic niveau. Aim The study aimed to follow the impact of COVID-19 on the incidence and prognosis of cardiogenic shock complicated initially acute myocardial infarction (CS-AMI). Methods We used data entered into a large national all-comers registry of coronary intervention over five years. From 1/2016 to 12/2020, 50,745 AMI patients were included, and 2,822 (5.6%) initially had CS. Results The incidence of CS-AMI was significantly higher in the COVID period (2020) than the mean incidence in 2016–2019 (5.5% vs 6%, p=0.032). The difference was caused by significant increase of CS in acute STEMI (7.6% vs. 8.7%, p=0.011); it was 7.1% in 2016, 7.8% (2017), 7.6% (2018), 7.8% (2019), and 8.7% (2020). The CS complicated 2.3% (2016), 2.7% (2017), 2.7% (2018), 2.8% (2019), and 2.8% (2020) of NSTEMI. The observed rise in CS-STEMI incidence each month during the pandemic compared to the average incidence in non-pandemic years correlated with the substantial increase in the number of COVID infected/hospitalized (Table 1). In these months, no changes in time delay to reperfusion layout were observed in CS-STEMI patients (Table 2). Except of less frequent history of previous PCI (13.9% and 8.2%, p&amp;lt;0.001), we found no significant differences in the followed CS-STEMI patient characteristics in 2016–2019 and 2020; men 72.7% and 75.4% (p=0.1), mean age (SD) 66.3 (12.3)yrs and 66.3 (12.2) yrs, Diabetes 20.9% and 19.1% (p=0.2), CKD 5.4% and 5.7% (p=0.4), previous CABG 4.5 and 4.2% (p=0.5), left main disease (14.3% and 16%, p=0.5), one vessel disease 24.9% and 32.1% (p=0.9), pre-PCI TIMI flow 0 64.4% and 66.2% (p=0.6), post-PCI TIMI flow 3 76.7% and 76.9%. The COVID pandemic didn't influence the proportions of pre-hospital resuscitated CS-AMI patients (57.5% and 58.7%, p=0.6) and those on mechanical ventilation (67.8% and 68.3%, p=0.8). The 30-day mortality trend of CS-AMI was 53.7% in 2016, 51.6% (2017), 49.7% (2018), 49.3% (2019), and 47.9% (2020). And in CS-STEMI it was 50.8%, 47.1%, 46.4%, 44.1%, and 45.3% (P2019 vs. 2020 =0.8), respectively. Conclusion Data from a large national all-comer registry showed an increase in the proportion of patients admitted to hospitals with STEMI complicated by CS in the year of the COVID pandemic. The CS rise correlated with the increase in the COVID infected population. Factors other than the patient's cardiovascular risk profile or prolongation of a time delay to reperfusion influenced this trend. We suggest that the availability of health care and patient adherence may have affected the risks control. We did not observe any effect of the pandemic on CS-AMI mortality. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic

30-day outcomes of P2Y12 inhibitor pretreatment in patients with STEMI submitted to primary PCI – systematic review and meta-analysis

Abstract Introduction Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the cornerstone of antithrombotic therapy in patients with ST-segment elevation myocardial infarction (STEMI). Yet, there is uncertainty surrounding the optimal timing for the initiation of the P2Y12 inhibitor. This study aims to evaluate the effectiveness and safety of P2Y12 pretreatment by means of a systematic review and meta-analysis of studies in primary percutaneous coronary intervention (PCI) in STEMI. Methods We performed a systematic search of electronic databases Pubmed, CENTRAL and Scopus until March of 2021. Studies were considered eligible if they were: a) comparing P2Y12 inhibitor upstream administration vs. treatment during PCI; b) patients enrolled for STEMI and submitted to primary PCI. Studies with patients treated with fibrinolysis or medical therapy only were excluded. Major clinical outcomes included 30-day occurrence of all-cause death, definite stent thrombosis and re-infarction. Thrombolysis in myocardial infarction (TIMI) flow-grade pre-PCI and post-PCI, in-hospital cardiogenic shock and major bleeding events were analysed. Results Out of 2193 articles, 18 studies were included (1 randomized clinical trial [RCT] and 17 observational studies [non-RCT]), with a total of 76,836 patients, 52,181 in the pretreatment arm. At 30 days, pretreatment was associated with a reduction in definite stent thrombosis (1 RCT &amp; 4 Non-RCT: OR 0.40; 95% CI 0.18–0.90), but no significant reduction in all-cause death (1 RCT &amp; 7 Non-RCT: OR 0.77; 95% CI 0.56–1.04) or re-infacrtion (1 RCT &amp; 4 Non-RCT: OR 0.73; 95% CI 0.49–1.09). Regarding in-hospital outcomes, pretreatment showed a significant reduction in the occurrence of cardiogenic shock (5 Non-RCT: 0.62; 95% CI 0.51–0.79), major bleeding events (1 RCT &amp; 14 Non-RCT: 0.83; 95% CI 0.75–0.92) and in the number of patients with TIMI flow &amp;lt;3 postPCI (1 RCT &amp; 8 Non-RCT: 0.82; 95% CI 0.73–0.93). Pretreatment was not associated with lower number of patients with TIMI flow &amp;lt;3 pre-PCI (1 RCT &amp; 5 Non-RCT: 0.85; 95% CI 0.66–1.09). Conclusion Pretreatment with DAPT, including a P2Y12 inhibitor, was associated with lower risk for definite stent thrombosis and cardiogenic shock, but was not associated with lower all-cause death or re-infarction. Funding Acknowledgement Type of funding sources: None.

Prognostic impact of aborted cardiac arrest in patients with acute myocardial infarction

Abstract Background Aborted cardiac arrest (ACA) during the acute ischaemic phase is a relatively frequent but often undervalued complication of acute myocardial infarction (AMI). The aim of this study was to evaluate the clinical and prognostic impact of aborted cardiac arrest in AMI patients and investigate its correlation with infarct size. Methods We conducted a single-centre retrospective study enrolling consecutive patients admitted for AMI, from January 2016 to December 2018. ACA was defined as the need for advanced life support measures and defibrillation, either out-of-hospital or in-hospital, up until culprit vessel revascularisation. Infarct size was estimated using peak serum troponin T, impact on left ventricular ejection fraction (LVEF ≤50%) and echocardiographic wall motion index (WMI). Clinical outcomes included cardiogenic shock (SCAI C or more), need for mechanical circulatory support (MCS), major bleeding events (BARC ≥3) during in-hospital phase and all-cause mortality during follow-up. Results A total of 571 patients were included (65±13 years old, 72% male). Overall, 237 had anterior STEMI, 39 patients (6,8%) suffered ACA (21 out of hospital), 60 progressed into cardiogenic shock throughout the hospitalisation, 7 needed MCS, and 52 had BARC ≥3 bleeding. During a mean follow-up of 32 months, 96 patients died. ACA was significantly associated with higher peak serum troponin T (4802 [1950; 9420] vs 2659 [555; 6708] ng/L – p=0.004), higher proportion of patients with reduced or mildly reduced LVEF (60% vs. 36.5%, p=0.018) and higher WMI (1.7 [1.4; 2.3] vs. 1.5 [1.2; 1.8], p=0.016). Moreover, ACA was also associated with higher risk of cardiogenic shock occurrence (64.1% vs. 6.6%, p&amp;lt;0.001 – OR 25.357 (12.115–53.073)), higher need for MCS (7.9% vs 0.8%, p&amp;lt;0.001 – OR 11.271 (2.427–52.343)) and higher incidence of BARC ≥3 bleeding events (28.2% vs. 8.4%, p&amp;lt;0.001 – OR 4.705 (2.185–10.128)) – Table 1. On univariate Cox regression, ACA showed significant association with all cause death, which remained highly significant after multivariable adjustment (OR 2.431 (1.181; 5.002); p=0.016). Conclusion The occurrence of aborted cardiac arrest in patients with AMI was associated with increased morbidity and mortality. This may be driven by a larger area of arrhythmia prone ischemic myocardium. Funding Acknowledgement Type of funding sources: None.

Machine learning decision support model for radical cystectomy discharge planning.

Timely and appropriate discharge placement for patients who have undergone radical cystectomy (RC) remains challenging. Our objective was to improve the discharge planning process by creating a machine learning model that helps to predict the need for non-home hospital discharge to a higher level of care. Patients undergoing elective radical cystectomy for bladder cancer from 2014-2019 were identified in the ACS-NSQIP database. A gradient boosted decision tree was trained on selected predischarge variables to predict discharge location, dichotomized into home and non-home. We used threshold-moving to calibrate model predictions and evaluated model performance on a testing set using receiver operating characteristic and precision recall curves. Model performance was further examined in subgroups of interest. A total of 11,881 patients met inclusion criteria with a mean age of 68.6 years. 10.6% of patients undergoing RC had non-home discharges. Our model predicting non-home discharge achieved an area under the receiver operating characteristic curve of 0.80 and an average precision of 0.33. After threshold-moving, our model had a recall of 0.757 and a precision of 0.211. Top variables by importance were septic shock occurrence, ventilator-use greater than 48 hours, organ space surgical site infection and unplanned intubation. Our model shows strong performance in identifying patients who required non-home discharge to higher levels of care, outperforming commonly used clinical indices and prior work. Modern machine learning techniques may be applied to support more timely and appropriate clinical decision making.