Odds Of In-hospital Mortality Research Articles

Abstract 4144555: Atrial Fibrillation Catheter Ablation among Patients with Mediastinal Radiation; Insight from The National Inpatient Database (2015-2020)

Introduction/Background: Radiation therapy (RT) is one of the most common treatment modalities for mediastinal cancers. RT has multiple adverse cardiovascular effects and it has been identified as an independent risk factor for atrial fibrillation (AF). The efficacy of catheter ablation in AF is well established, however there is limited data on procedural safety and outcomes in patients with mediastinal cancers and history of radiation Methods: The National Inpatient Sample (NIS) was analyzed from 2015-2020 to identify admissions for AF catheter ablation among patients with previous history of mediastinal radiation exposure using the 10-PCS (International Classification of Diseases, procedure coding system) codes. Baseline characteristics were compared between the two groups and multivariate logistic regression was used to analyze hospitalization outcomes. Results: We identified 257,240 admissions for AF catheter ablation of which 1720 patients (0.67%) had a history of mediastinal radiation exposure. In the adjusted analysis, the odds of in-hospital mortality (aOR 0.639, 95% CI 0.34-1.20, p 0.1637), major complications (aOR 0.876, 95% CI 0.73-1.05, p 0.1443), any gastrointestinal or hematological complication (aOR 0.853, 95% CI 0.63-1.15, p 0.3017), renal complications (aOR 1.017, 95% CI 0.88-1.18, p 0.0509) were similar in both cohorts. The odds of any cardiovascular complication (aOR 0.825, 95% CI 0.70-0.97, p 0.0208) was lower and odds of any pulmonary complication (aOR 1.433, 95% CI 1.27-1.62, p<.001) was higher in the mediastinal radiation cohort. Conclusion: AF catheter ablation in patients with history of mediastinal radiation is a safe treatment modality. It is not associated with higher in-hospital mortality or cardiac complications in a nationwide registry.

Abstract 4134267: Effects of GLP-1 Receptor Agonists and SGLT2 Inhibitors on In-Hospital Mortality and 30-Day Readmission in Type 2 Diabetic Patients with Acute Coronary Syndrome

Background: The effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium–glucose cotransporter 2 inhibitors (SGLT2is) on reducing cardiovascular events in heart failure patients are well-established; however, less is known about their effects after a myocardial infarction. This study aims to investigate the effects of GLP-1RAs and SGLT2is on in-hospital mortality and 30-day readmission in type 2 diabetic patients with/without heart failure who were hospitalized for acute coronary syndrome (ACS). Methods: We conducted a multicenter retrospective cohort on type 2 diabetic patients who were admitted to the hospital for ACS from 01/01/2020 to 01/31/2024 across 16 West Florida hospitals. Patients receiving a GLP-1RA alone, SGLT2i alone, or both were compared to those taking neither. Chi-square and binary logistic regression were used to predict the clinical outcomes of in-hospital mortality, all-cause readmission within 30 days, and cardiac readmission within 30 days. Results: Among 7,481 type 2 diabetics with ACS, 392 (5.24%) were taking GLP-1RA monotherapy, 577 (7.71%) were taking SGLT2i monotherapy, 144 (1.92%) were taking both, and 6,362 (85.12%) were taking neither. The likelihood of in-hospital mortality was similar among patients on neither medication compared to patients on both (χ 2 = 0.06, p = 0.802), GLP-1RA monotherapy (χ 2 = 0.61, p = 0.435), and SGLT2i monotherapy (χ 2 = 0.002, p = 0.968). The odds of all-cause readmission within 30 days was similar among patients on neither medication compared to patients on both (χ 2 = 0.0004, p = 0.983), GLP-1RAs monotherapy (χ 2 = 0.07, p = 0.791), and SGLT2i monotherapy (χ 2 = 3.10, p = 0.078). The likelihood of cardiac readmission within 30 days was similar among patients on neither medication compared to patients on both medications (χ 2 = 1.63, p = 0.202), GLP-1RA monotherapy (χ 2 = 0.95, p = 0.329), and SGLT2i monotherapy (χ 2 = 0.94, p = 0.332). Conclusion: Our study found no significant differences in the odds of in-hospital mortality or 30-day readmission among type 2 diabetics with ACS who were taking GLP-1RAs, SGLT2is, or both, when compared to those taking neither. These findings further support the outcomes discovered in the EMPACT-MI trial.

Abstract 4138242: Association of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with procedural complications and in-hospital outcomes from left atrial appendage occlusion (LAAO) device implantation in elderly (>80 yrs) patients with atrial fibrillation (AF)

Background: LAAO has been used as an alternative strategy for stroke prevention in selected patients with AF, however there is very limited data about the outcomes in elderly patients with kidney disease. Methods: The National Inpatient Sample was queried for LAAO in the US between 2015–2020. Hospital outcomes were assessed for elderly patients undergoing LAAO in three cohorts; no CKD, CKD and ESRD. Results: A total of 31,360 elderly patients undergoing LAAO were identified in the study period; 23,250 (74.1%) had no CKD, 7,610 (24.2%) had CKD, and 500 (1.5%) had ESRD. CKD and ESRD were independently associated with higher odds of in-hospital mortality [aOR 3.06, 95 % CI (1.805-5.207), p <0.001)] & [ aOR 9.69 ,95% CI (3.52-26.64), p <0.001], cardiovascular complications [ aOR 1.43 ,95% CI (1.208-1.696), p <0.001] &[ aOR 3.41 ,95% CI (2.12-5.48), p <0.001], p <0.001], neurological complications [aOR 1.2 ,95% CI (1.05-1.36), p=0.006] &[aOR 1.58 ,95% CI (1.07-2.33), p=0.019], gastrointestinal and hematological complications [aOR 1.22 ,95% CI (1.06-1.39), p=0.003] &[ aOR 1.71 ,95% CI (1.16-2.52), p <0.001] respectively when compared to patients with no CKD. CKD was independently associated with higher odds of renal complications compared to patients with no CKD [aOR 5.34 ,95% CI (4.532-6.303), p <0.001]. In comparison to patients with ESRD, patients with CKD had significantly higher odds of renal complications [aOR 8.01 ,95% CI (3.28-19.57), p <0.001] with no significant difference in the odds of in-hospital mortality [aOR 0.4 ,95% CI (0.14-1.12), p=0.08]. In terms of resource utilization, length of stay didn’t differ with different kidney functions (1(1-1) for the three cohorts). However the ESRD cohort had the highest hospitalization costs compared to the CKD and no CKD cohorts ($26.113 ($19.728 -$34.362) vs. $25.799 ($20.231-$32.943) vs. $24.894 ($19.641-$31.373), p <0.001). Conclusion: The prevalence of CKD and ESRD was around 25.7% in elderly patients with AF undergoing LAOO. CKD and ESRD were independently associated with higher odds of in-hospital mortality compared to patients with no CKD while CKD was independently associated with higher odds of renal complications after LAAO.

Abstract 4124974: Small delays in door-to-balloon time for patients presenting with STEMI do not impact mortality: a quasi-experimental study

Introduction: Observational studies have consistently demonstrated a strong association between longer door-to-balloon (DTB) times and increased mortality in patients presenting with ST-elevation myocardial infarction (STEMI). However, the extent to which this association is attributable to unmeasured differences between patients with different DTB times (i.e., confounding), as opposed to a causal impact of longer DTBs is unclear. Aim: In this study, we exploit a natural experiment using an instrumental variable (IV) approach based on weekday vs weekend presentation to evaluate whether incremental delays in DTB times have a causal effect on patient outcomes. Methods: We performed a retrospective analysis of patients undergoing immediate percutaneous coronary intervention (PCI) for STEMI in the CathPCI Registry from 1/2010 to 12/2021 at 1,422 sites. Time of presentation with STEMI (weekday daytime vs weekend daytime) was used as an IV to address potential confounding. A 2-stage IV analysis was used. In-hospital all-cause mortality was the primary outcome. Results: A total of 447,355 patients presented with STEMI during the study period. The average difference in weekend (N=125,787) minus weekday (N=321,568) daytime DTB times was 10.5 minutes. Patient, procedural, and hospital characteristics were well balanced between groups. Overall, in-hospital mortality was 3.5%. In the IV analysis, delays in DTB time were not associated with increased odds of in-hospital mortality (OR 0.99, 95% CI 0.95 to 1.03, P = 0.70). This null association was also observed when limited to hospitals with larger differences (19.5 minutes) between weekend and weekday DTB time (OR 1.00, 95% CI 0.96 to 1.03, P = 0.85) and among patients predicted to have the longest (mean 70.8 minutes) DTB times (OR 1.00, 95% CI 0.94 to 1.07, P = 0.96). Conclusions: Contrary to prior findings, incremental delays in DTB time for patients presenting with STEMI are not associated with increased in-hospital mortality when analyzed using quasi-experimental methods less likely to be influenced by unmeasured confounding. Efforts to further reduce DTB times in patients presenting to hospitals with STEMI are unlikely to improve outcomes. In the current era, policies intended to incentivize better care for STEMI patients should prioritize other measures of quality beyond DTB.

Abstract 4134825: Diabetic ketoacidosis and hyperglycemic hyperosmolar state outcomes in diabetes patients hospitalized with ST-elevation myocardial infarction

Background: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are acute life-threatening hyperglycemia conditions. Aims: We aimed to assess their impact on type 2 diabetes patients admitted for ST-elevation myocardial infarction (STEMI). Methods: Data was extracted from the National Readmission Database (2016-2019). The primary endpoint was in-hospital mortality. Secondary endpoints included in-hospital arrhythmias, cardiogenic shock, and 30-day readmission and mortality. Results: A total of 112,829 patients hospitalized for STEMI with a concomitant diagnosis of type 2 diabetes were hospitalized between 2016 and 2019, of whom 112,799 were included in our analysis after the exclusion of patients with missing data ( Figure 1 ). Of those patients, 330 had a diagnosis of DKA, and 292 had a diagnosis of HHS. After 30 days from the initial hospitalization, 118 (35.7%) out of the initial DKA group, 102 (34.9%) out of the initial HHS group, and 26,523 (23.6%) of STEMI patients with diabetes were readmitted. The presence of DKA increased the odds of in-hospital mortality and cardiogenic shock by almost 2-fold (aOR = 2.30 [1.70-3.12], 2.055 [1.602-2.637], respectively) and renal failure by almost 5-fold (aOR = 5.175 [4.090-6.546]) ( Table 1 ). HHS was also associated with higher odds of mortality, acute renal failure, and cardiogenic shock. Within 30 days of initial admission, DKA and HHS increased the risk of readmission (aOR= 1.815 [1.449-2.75], 1.751 [1.376 - 2.228], respectively), but not mortality. Cardiovascular disease was the most common etiology of readmission in all patients ( Figure 2) . The prevalence of non-STEMI was the highest in DKA patients (22.9%), and the prevalence of STEMI was the highest in the HHS group (37.9%). Conclusion: The presence of diabetic ketoacidosis or hyperglycemic hyperosmolar states is associated with higher odds of mortality, renal failure, cardiogenic shock, and 30-day readmission in STEMI patients with type 2 diabetes.

Abstract 4124532: A Meta-Analysis on the Effect of Chronic Total Occlusion of Coronary Arteries on Cardiovascular Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement

Background and Aims: Transcatheter aortic valve replacement (TAVR) has revolutionized the management of severe aortic stenosis, particularly prevalent in elderly patients. These patients often present with coexisting coronary artery disease (CAD) due to shared risk factors. There is evidence suggesting that underlying CAD may result in poorer outcomes for patients undergoing TAVR. Chronic total occlusion (CTO), representing a severe manifestation of CAD, could therefore be hypothesized to worsen prognosis in TAVR patients, although data supporting this hypothesis are limited. Our meta-analysis aims to consolidate all available data concerning patients undergoing TAVR with concurrent CTO. Methods: We conducted a thorough literature search across major bibliographic databases, including PubMed, Embase, Cochrane Library, and SCOPUS, from their inception until May 15, 2024, to identify studies comparing outcomes of TAVR in patients with and without CTO. Pooled odds ratios (OR) with 95% confidence intervals (CIs) were calculated using the random-effects model via Comprehensive Meta-Analysis Software. The primary outcome assessed was in-hospital mortality, with several secondary endpoints also evaluated. Statistical significance was determined at p<0.05. Results: Eight studies, encompassing a total of 540,910 patients undergoing TAVR (11,679 with CTO; 529,231 without CTO), were included in this meta-analysis. TAVR in patients with CTO was associated with significantly increased odds of in-hospital mortality (OR: 1.25; 95% CI: 1.05, 1.49; p=0.011; I 2 =0%) and acute myocardial infarction (periprocedural) (OR: 1.68; 95% CI: 1.48, 1.91; p<0.001; I 2 =0%). However, no significant difference was observed in all-cause mortality (OR: 1.18; 95% CI: 0.71, 1.96; p=0.525; I 2 =59.37%), acute kidney injury (OR: 1.32; 95% CI: 0.94, 1.85; p=0.11; I 2 =72.12%), and stroke (OR: 1.06; 95% CI: 0.89, 1.28; p=0.509; I 2 =0%) (see Figures 1 and 2). Conclusion: CTO emerges as a substantial risk factor for patients undergoing TAVR, elevating the risk of in-hospital mortality and acute myocardial infarction. Considering a heart team's multidisciplinary approach in patients with underlying CTO may be advisable during TAVR, allowing for a comprehensive assessment of the benefits versus risks of revascularization prior to TAVR.

Abstract 4114372: Is Takotsubo syndrome associated with a favorable in-hospital outcome among patients with cardiogenic shock? A propensity score-matched analysis of the National Inpatient Sample Data (2016-2020)

Background: Takotsubo cardiomyopathy (TTC) is characterized by impaired left ventricular function due to typical, regional wall motion abnormalities in the absence of significant obstructive coronary artery disease. Previous small-sized retrospective studies reported favorable outcomes of cardiogenic shock in patients with TTC. We aimed to investigate whether the presence of TTC is associated with a favorable in-hospital outcome among patients admitted for cardiogenic shock using a large nationally representative dataset. Methods: Utilizing data from the National Inpatient Sample (NIS) spanning from 2016 to 2020, we identified patients admitted for cardiogenic shock using ICD-10 codes. Patients with TTC were also identified using ICD-10 codes. Using sociodemographic variables, and comorbid medical conditions, and performed procedures as matching variables, we conducted a 1:1 nearest-neighbor propensity score matching to mitigate potential confounders. The success of matching was evaluated based on standardized mean differences. In-hospital mortality was the primary outcome, while in-hospital complications, length of stay (LOS), and cost of hospitalization were secondary outcomes. We employed the Cochrane-Mantel-Haenszel method to assess the odds ratio (OR) for in-hospital mortality and complications. Simple linear regression models were used to evaluate differences in LOS and cost of hospitalization. Results: The final sample included 22,594 patients, evenly distributed between the groups with and without TTC. The mean age of the cohort was 65.4 years (SD = 15.9), with 74.7% being males. Ethnic composition indicated 75.7% Whites, 9.3% Blacks, and 8.1% Hispanics. The overall in-hospital mortality rate was 32.7%. The TTS group had a lower mortality rate (38.4% Vs 27%, p<0.001). Patients with TTC had lower odds of in-hospital mortality, cardiac arrest, ventricular tachycardia, and acute kidney injury. However, they were noted to have higher odds of deep vein thrombosis, stroke, slightly higher LOS, and cost of hospitalization. Conclusion: In summary, our study suggests that Takotsubo Cardiomyopathy is associated with significantly lower in-hospital mortality rates among patients admitted for cardiogenic shock, indicating a favorable prognosis in this clinical setting.

Abstract 4135273: Frailty increases the risk of in-hospital mortality and post-procedural complications in patients undergoing Cardiac Implantable Electronic Devices placement

Background: Heart failure with reduced ejection fraction (HFrEF) often necessitates the use of cardiac implantable electronic devices (CIED) such as cardiac resynchronization therapy defibrillators (CRT-D) or implantable cardioverter-defibrillators (ICD). These devices are proven to reduce mortality, prevent hospitalizations, and improve symptoms and quality of life. Frailty, characterized by an age-associated decline in physiological reserve, significantly impacts outcomes in these patients. This study uses the Hospital Frailty Risk Score (HFRS) to assess the effect of frailty on mortality and post-procedural complications in HFrEF patients undergoing CIED implantation. Hypothesis: Frail patients with HFrEF have worse in-hospital outcomes after CIED placement Methods: We conducted a retrospective cohort study using the 2020 National Inpatient Sample database from the Healthcare Utilization Project. Our population included patients aged 18 years or older with HFrEF who underwent CRT-D or ICD placement, identified using ICD-10 procedure codes. The primary risk factor was frailty, classified by an HFRS score of ≥5 (frail) or <5 (not frail). The primary outcome was in-hospital mortality, and the secondary outcome was the composite of post-procedural complications. Multivariate regression analysis was used to estimate the odds ratio. Results: Out of 24,809 patients who underwent ICD or CRT-D placement, 48.8% were frail. Non-Frail patients had lower mean age compared to Frail patients (66.2 vs 67.3 years old, p=0.003). In-hospital mortality was 1.1%, and 7% experienced post-procedural complications. In-hospital mortality was higher in frail patients compared to non-frail patients (2% vs 0.3%, p<0.001). In the multivariate analysis, frail patients had higher odds of in-hospital mortality compared to the non-frail group subset (OR=5.97; 95% CI: 2.77-12.88, p<0.001). Additionally, frailty was associated with higher odds of post-procedural complications (OR=1.28; 95% CI: 1.01-1.63, p<0.001), increased length of stay (5 vs 11.6 days, p<0.001), and total hospital charges (215,668 vs 324,474 , p<0.001). Conclusion: Frailty significantly increases the risk of in-hospital mortality and post-procedural complications in HFrEF patients. This highlights the importance of considering frailty as part of a pre-procedural risk stratification assessment and tailoring management strategies to improve outcomes for these high-risk patients.

Abstract 4134641: Door-in to door-out time and in-hospital mortality in patients with ST-elevation myocardial infarction

Background: Although current guidelines recommend achieving a door-in to door-out (DIDO) time within 30 minutes for 75% of patients with ST-elevation myocardial infarction (STEMI) who require interhospital transfer for primary percutaneous coronary intervention (PCI), disparities between guidelines and clinical performance persist. Methods: We analyzed the association between the DIDO time and in-hospital mortality using data from the Get With The Guidelines® – Coronary Artery Disease STEMI and NSTEMI Registry covering 232,935 admissions between the fourth quarter of 2019 and the third quarter of 2022. We determined the cut-off value of the DIDO time at which the odds of in-hospital mortality markedly increased by a likelihood ratio (LR) and an area under the curve (AUC) derived by generalized linear regression. Results: Of the 103,838 patients with STEMI, 23,865 (23%) required interhospital transfer. The median DIDO time was 63 (interquartile range 43–105) minutes and was within 30 minutes in 9% of cases. Generalized linear mixed models showed that a DIDO time delay of 5 minutes was significantly associated with higher in-hospital mortality (adjusted odds ratio [OR], 1.88; 95% confidence interval [CI], 1.56–2.27; p<0.001). The LR test and AUC showed that DIDO time cut-offs at 30, 42, 63, and 93 minutes were associated with increased in-hospital mortality. Compared with a reference DIDO time of within 30 minutes, the in-hospital mortality did not significantly differ for a DIDO time from 30 to 42 minutes (adjusted OR, 1.20; 95% CI, 0.83–1.73; p=0.340), but it was significantly higher for DIDO times from 42 to 63 minutes (adjusted OR, 1.48; 95% CI, 1.06–2.06; p=0.020), 63 to 93 minutes (adjusted OR, 1.89; 95% CI, 1.36–2.63; p<0.001), and over 93 minutes (adjusted OR, 2.85; 95% CI, 2.08–3.90; p<0.001). Conclusion: A delayed DIDO time was significantly associated with higher in-hospital mortality, particularly beyond 42 minutes.

High mechanical thrombectomy procedural volume is not a reliable predictor of improved thrombectomy outcomes in patients with acute ischemic stroke in the United States.

The volume of mechanical thrombectomy (MT) performed at hospitals is used as one of the criteria for advanced-level designation for stroke care. Our study sought to determine the relationship between annual MT procedural volume and in-hospital outcomes in acute ischemic stroke patients undergoing MT in the United States. We analyzed the National Inpatient Sample from 2016 to 2020. The hospitals were grouped into quartiles based on the volume of MT procedures performed within the calendar year. We compared the rates of routine discharge/home health care; in-hospital mortality, and post-treatment intracranial hemorrhage (ICH) between the quartiles after adjusting for potential confounders. Patients undergoing MT ranged from 15,395 in quartile 1 to 78,510 MT in quartile 4. There were lower rates of discharge home/self-care of 22.5%, 20.8%, and 20.8% for quartiles 2, 3, and 4, respectively, compared with 34.9% in quartile 1. The odds of ICH increased to 1.81 (p < 0.001), 1.84 (p < 0.001), and 1.98 (p < 0.001) among the quartiles from lowest to highest procedural volumes. The odds of home discharge/self-care decreased to 0.66 (p < 0.001), 0.60 (p < 0.001), and 0.63 (p < 0.001) among the quartiles from lowest to highest procedural volumes. The odds of in-hospital mortality increased to 1.92 (p < 0.001), 1.99 (p < 0.001), and 1.84 (p < 0.001) among the quartiles from lowest to highest procedural volumes. We observed a paradoxical relationship between adverse outcomes and the annual procedural volume of MT at the hospital presumably due to the higher severity of acute ischemic stroke treated at high-volume hospitals.

Radial versus femoral access for rotational atherectomy angioplasty

Abstract Introduction The transfemoral approach (TFA) is a potentially advantageous acess site for complicated and prolonged percutaneous coronary angioplasty like rotational atherectomy (RA). Despite this, there is mounting data that suggests the transradial approach (TRA), an alternative to the TFA acess, is linked to reduced rates of mortality and access site complications. Aim This study was conducted with the aim of providing a quantitative appraisal of clinical outcomes of TRA for patients undergoing RA procedure. Methods In this retrospective study, we analyzed all RA procedures performed from March 2013 to June 2019 at our single center institution. Primary endpoints were procedural success, in-hospital mortality, and major adverse cardiovascular events (MACE) during hospitalization. Results Of the 98 patients undergoing RA, the TRA approach was chosen for 79% patients, and the TFA approach for 21% patients. No significant difference in procedural success rates was observed (94% vs. 91%, p=0.19). The use of RA via TRA correlated with a lower contrast volume (p=0.027) and a decreased post-procedure hospital stay (p=0.005). After multivariate adjustment, TRA demonstrated a noteworthy reduction in in-hospital mortality odds (OR: 0.62; 95% CI: 0.44 to 0.87; p = 0.003), major bleeding (OR: 0.48; 95% CI: 0.33 to 0.70; p &amp;lt; 0.001), MACE (OR: 0.68; 95% CI: 0.51 to 0.89; p = 0.015), and 30-day mortality (OR: 0.68; 95% CI: 0.51 to 0.89; p = 0.015). Conclusions Even though RA is a complex procedure, employing radial access (TRA) might be associated with favorable outcomes. These include a lower contrast volume, shorter hospital stay, and reduced odds of in-hospital mortality, major bleeding, MACE, and 30-day mortality compared to femoral access (TFA).

Transcatheter versus surgical aortic valve replacement in patients younger than 65 years: analysis from the national inpatient sample database

Abstract Background Data on the relative utilization and outcomes of transcatheter aortic valve replacement (TAVR) versus surgical AVR (SAVR) in patients &amp;lt;65 years are limited. Purpose To compare the relative utilization and outcomes of TAVR versus SAVR in patients &amp;lt;65 years in the United States. Methods We queried the National Inpatient Sample (2016-2020) to identify patients &amp;lt;65 years hospitalized for isolated AVR. In-hospital outcomes of TAVR versus SAVR were compared using multivariable regression and propensity-matching analyses. Results Of 74,155 patients aged &amp;lt;65 years hospitalized for isolated AVR, 17,300 (23.3%) underwent isolated TAVR, and 56,855 (76.7%) underwent isolated SAVR. From 2016-2020, the use of TAVR increased, while the use of SAVR decreased in patients &amp;lt;65 years (both ptrend&amp;lt;0.01). Factors independently associated with TAVR selection in patients &amp;lt;65 years included female sex, congestive heart failure, pulmonary disease, renal failure, liver disease, cancer, and prior revascularization. Factors independently associated with SAVR selection included bicuspid aortic valve. After adjustment for baseline characteristics, TAVR was associated with lower odds of in-hospital mortality (adjusted odds ratio [aOR] 0.61, 95% confidence interval [CI] 0.38-0.97), stroke (aOR 0.58, 95% CI 0.38-0.90), acute kidney injury (aOR 0.41, 95% CI 0.34-0.49), and major bleeding (aOR 0.62, 95% CI 0.38-0.96), and higher vascular complications compared with SAVR (aOR 2.39, 95% CI 1.75-3.24). Length of stay was shorter and nonhome discharges were lower with TAVR (all p&amp;lt;0.01). Similar findings were observed in the propensity-matched cohort. Conclusions This nationwide observational analysis showed that TAVR is a feasible treatment option for patients &amp;lt;65 years with lower in-hospital mortality and resource utilization compared with SAVR.Central Illustration

Outcomes of ST-Elevation Myocardial Infarction in Patients with Adrenal Insufficiency

Abstract Background Patients with adrenal insufficiency (AI) have both increased risk of cardiovascular disease and adverse outcomes with many medical emergencies. However, limited data exist specifically regarding ST elevation myocardial infarction (STEMI) in the context of AI. Methods Admissions for STEMI were identified in the 2016-2019 National Inpatient Sample. In-hospital outcomes were compared between patients with and without AI. The primary outcome was in-hospital mortality. Secondary outcomes included percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) intervention, acute kidney injury (AKI), vasopressor use, mechanical circulatory support (MCS), mechanical ventilation, ventricular tachycardia (VT), hospital length of stay (LOS), and total charges. Multivariable regression models were used to adjust for potential confounders. Results Among 690,430 STEMI hospitalizations, 1,382 (0.2%) had a diagnosis of AI. AI was associated with higher odds of in-hospital mortality (adjusted OR [aOR] 1.51, 95% CI 1.03-2.2), lower odds of PCI (aOR 0.73, 95% CI 0.55-0.98), higher odds of CABG (aOR 2.8, 95% CI 1.89-4.2) and, AKI (aOR 2.38, 95% CI 1.72–3.3), VT (aOR 1.55, 95% CI 1.1-2.2), need for vasopressors (aOR 2.34, 95% CI 1.33-4.1), mechanical ventilation (aOR 2.11, 95% CI 1.54-2.89) and MCS (aOR 2.18, 95% CI 1.57–3.03). Patients with AI also had a longer LOS (10 days vs. 4.2 days, p&amp;lt;0.001) and higher charges ($258,475 vs. $115,505, p&amp;lt;0.001). Conclusion Patients with AI admitted for STEMI had higher in-hospital mortality, non-fatal adverse outcomes, and resource utilization compared to patients without AI.

Door-in-Door-Out Times at Referring Hospitals and Outcomes from Hemorrhagic Stroke

Interhospital transfer is often required in the care of patients with hemorrhagic stroke. Guidelines recommend a door-in-door-out (DIDO) time of ≤120 minutes at the transferring emergency department (ED); however, it is unknown whether DIDO times are related to clinical outcomes of hemorrhagic stroke. Retrospective, observational cohort study using US registry data from Get With The Guidelines-Stroke participating hospitals. Patients include those aged ≥18 years with intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) who were transferred from the ED to a Get With The Guidelines participating receiving hospital from January 1, 2019, to July 31, 2022. The primary outcome was ordinal discharge modified Rankin scale (mRS) score and secondary outcomes included dichotomous discharge mRS, ability to ambulate independently at discharge, and inhospital mortality at the receiving hospital. In all, 19,708 ICH and 7,757 patients with SAH were included. For patients with ICH, an increasing DIDO time was associated with greater odds of mRS 0 to 3 versus 4 to 6 at discharge in the unadjusted analyses (DIDO 91 to 180 minutes, odds ratio [OR] 1.15 [1.04 to 1.27]; DIDO 181 to 270 minutes, OR 1.51 [1.33, 1.71]; DIDO >270 minutes, OR 1.83 [1.58, 2.11]; versus DIDO ≤90 minutes). In the adjusted analyses, no associations were observed. Similar results were seen for mRS at discharge in patients with SAH. In both patients with ICH and SAH, longer DIDO times were associated with greater odds of independent ambulation at discharge and lower odds of inhospital mortality in the unadjusted analyses. After adjustment, the effect sizes of these associations were reduced, with some of the results based on quartiles becoming statistically nonsignificant. These findings suggest that EDs currently expedite the transfer of the sickest patients; however, prospective studies and more granular data are needed to understand the impact of early treatment and timing of transfer for patients with hemorrhagic stroke.

Sarcopenia is associated with worse outcomes in patients with inflammatory bowel disease: insights from US national hospitalization data

Background Inflammatory bowel disease (IBD) is an inflammatory disorder associated with significant morbidity and mortality. Recent studies have reported sarcopenia as a significant factor affecting the quality of life and outcomes of these patients. Methods We used the National Inpatient Sample 2016–2020 to identify adult patients with IBD. The patients were stratified into two groups based on the presence of sarcopenia. Data were collected on patient demographics, hospital characteristics, and comorbidities. The outcomes studied were in-hospital mortality, sepsis, shock, ICU admission, and need for surgery. Multivariate logistic regression analysis was performed. Results A total of 1 524 820 IBD hospitalizations were included. Of these, 209 615 (9%) were noted to have sarcopenia. Patients with sarcopenia had a higher incidence of in-hospital mortality (4.2% vs. 1.2%, P &lt; 0.001), ICU admission (6.5% vs. 2.4%, P &lt; 0.001), and need for abdominal surgery (6.5% vs. 3.5%, P &lt; 0.001). After adjusting for confounders, the presence of sarcopenia was associated with higher odds of in-hospital mortality (adjusted odds ratio: 2.83, 95% confidence interval: 2.66–3.02, P &lt; 0.001) and additional worse outcomes. Conclusion Our study reports that the presence of sarcopenia was associated with an increased risk of death and the need for abdominal surgery. Preventative measures aimed at improving sarcopenia should be taken to prevent worse outcomes in this patient population.

Hypoalbuminemia is a predictor of mortality in patients with cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation.

Hypoalbuminemia is predictive of mortality in critically ill patients, especially those with cardiac etiologies of illness. The objective of this study was to determine the association of albumin level pre-cannulation for veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO) and important clinical hospital outcomes. This was a retrospective, observational cohort study of albumin levels in patients with cardiogenic shock requiring V-A ECMO between December 2015 and August 2021 in a single, high-volume ECMO center. The primary outcome was in-hospital mortality. Of 434 patients assessed, 318 were included. The overall mean pre-ECMO albumin was 3 ± 0.8g/dL and mean albumin at 72 hours post-cannulation was 2.7 ± 0.5g/dL. For patients with pre-ECMO albumin ≤3g/dL vs. >3g/dL, in-hospital mortality was 44.9% vs. 27.5%, respectively (p = .002). In multivariable logistic regression analysis, higher albumin (per 1g/dL increase) at time of V-A ECMO initiation was associated with decreased odds of in-hospital mortality (OR, 0.68; 95% CI, 0.48-0.96; p = .03). Patients with a pre-ECMO albumin ≤3g/dL required significantly more platelet transfusions and had higher incidence of gastrointestinal bleeding during V-A ECMO support (both p < .05). Hypoalbuminemia at time of cannulation is significantly associated with in-hospital mortality and ECMO-related complications including platelet transfusion and gastrointestinal bleeding. Albumin levels at the time of consideration of V-A ECMO may serve as a key prognostic indicator and may assist in effective decision-making regarding this invasive and costly resource.

Sjogren Syndrome and Outcomes of Acute Myocardial Infarction: A Propensity Score-Matched Analysis of the Nationwide Inpatient Sample 2005-2018.

The aim of this study was to evaluate the potential associations between Sjogren syndrome and outcomes of acute myocardial infarction (AMI) hospitalization. This population-based, retrospective observational study extracted data from the US Nationwide Inpatient Sample between 2005 and 2018. Adults aged 20 years or older hospitalized for AMI were eligible for inclusion. Propensity score matching was applied to balance the characteristics between the comparison groups (ie, with and without Sjogren syndrome). Associations between Sjogren syndrome and in-hospital outcomes were determined using univariate and multivariable logistic regression analyses. A total of 1,735,142 patients were included. After propensity score matching, 4740 patients remained for subsequent analyses (948 had Sjogren syndrome and 3792 did not). After adjustment, patients with Sjogren syndrome had significantly lower in-hospital mortality (adjusted OR: 0.52, 95% CI, 0.36-0.73, P < 0.001), prolonged length of stay (aOR: 0.83, 95% CI, 0.69-0.995, P = 0.044), cardiogenic shock (aOR: 0.58, 95% CI, 0.40-0.83, P = 0.004), cardiac dysrhythmias (aOR: 0.77, 95% CI, 0.66-0.90, P < 0.001), acute kidney injury (aOR: 0.56, 95% CI, 0.45-0.70, P < 0.001), or respiratory failure (aOR: 0.63, 95% CI, 0.48-0.81, P < 0.001) than those without Sjogren syndrome. The stratified analysis revealed that Sjogren syndrome was associated with decreased odds of in-hospital mortality in patients with non-ST elevation myocardial infarction or ST-elevation myocardial infarction. In conclusion, among patients admitted to US hospitals for AMI, the patients with Sjogren syndrome have a lowered probability of in-hospital mortality, certain morbidities, and prolonged length of stay. Further investigations should be conducted to establish a robust understanding of the associations observed.

Recurrent stroke admissions with vs without COVID-19 and associated in-hospital mortality: A United States nationwide analysis, 2020.

Coronavirus disease 2019 (COVID-19) has been shown to increase the risk of stroke. However, the prevalence and risk of recurrent stroke in COVID-19 patients with prior stroke/transient ischemic attack (TIA), as well as its impact on mortality, are not established. To evaluate the impact of COVID-19 on in-hospital mortality, length of stay, and healthcare costs in patients with recurrent strokes. We identified admissions of recurrent stroke (current acute ischemic stroke admissions with at least one prior TIA or stroke) in patients with and without COVID-19 using ICD-10-CM codes using the National Inpatient Sample (2020). We analyzed the impact of COVID-19 on mortality following recurrent stroke admissions by subgroups. Of 97455 admissions with recurrent stroke, 2140 (2.2%) belonged to the COVID-19-positive group. The COVID-19-positive group had a higher prevalence of diabetes and chronic kidney disease vs the COVID-19 negative group (P < 0.001). Among the subgroups, patients aged > 65 years, patients aged 45-64 years, Asians, Hispanics, whites, and blacks in the COVID-19 positive group had higher rates of all-cause mortality than the COVID-19 negative group (P < 0.01). Higher odds of in-hospital mortality were seen in the group aged 45-64 (OR: 8.40, 95%CI: 4.18-16.91) vs the group aged > 65 (OR: 7.04, 95%CI: 5.24-9.44), males (OR: 7.82, 95%CI: 5.38-11.35) compared to females (OR: 6.15, 95%CI: 4.12-9.18), and in Hispanics (OR: 15.47, 95%CI: 7.61-31.44) and Asians/Pacific Islanders (OR: 14.93, 95%CI: 7.22-30.87) compared to blacks (OR: 5.73, 95%CI: 3.08-10.68), and whites (OR: 5.54, 95%CI: 3.79-8.09). The study highlights the increased risk of all-cause in-hospital mortality in recurrent stroke patients with COVID-19, with a more pronounced increase in middle-aged patients, males, Hispanics, or Asians.

Obesity hypoventilation syndrome is associated with worse in-hospital outcomes in patients with acute myocardial infarction: A nationwide study

BackgroundObesity hypoventilation syndrome (OHS) is a condition characterized by obesity, daytime hypercapnia, and sleep-disordered breathing. The impact of OHS on outcomes in patients with acute myocardial infarction (AMI) remains poorly understood. MethodsWe conducted a retrospective analysis using data from the National Inpatient Sample (2016–2020) to evaluate the outcomes of patients with OHS admitted for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). ResultsAmong STEMI and NSTEMI patients, 0.15 % and 0.37 % had OHS, respectively. After adjusting for confounders, OHS was associated with higher odds of in-hospital mortality, cardiac arrest, acute kidney injury, renal replacement therapy, and respiratory failure requiring intubation in NSTEMI patients. In STEMI patients, OHS was associated with higher odds of cardiac arrest, acute kidney injury, and respiratory failure. ConclusionOHS is associated with worse clinical outcomes in patients admitted with AMI, particularly in those with NSTEMI.

Characteristics and outcomes of myocardial infarction among patients with bleeding or hypercoagulable disorders: A nationwide analysis

ObjectiveTo examine the characteristics and outcomes of acute myocardial infarction (AMI) in patients with bleeding and/or hypercoagulable disorders. BackgroundStudies examining the outcomes of AMI in bleeding/hypercoagulable disorders are scarce. MethodsThe Nationwide Readmissions Database was utilized to identify hospitalizations with AMI from 2016 to 2020. The study cohort was divided into 4 groups: (1) MI without bleeding or hypercoagulable disorders, (2) MI with bleeding disorders, (3) MI with hypercoagulable disorders and (4) MI with mixed disorders. The main outcome was all-cause in-hospital mortality. ResultsA total of 4,206,005 weighted hospitalizations with AMI were identified during the study period, of which 382,118 (9.1 %) had underlying bleeding or hypercoagulable disorders.The utilization of invasive strategies for the management of MI was highest in patients without bleeding or hypercoagulable disorders (62.6 %) and lowest in patients with mixed disorders (39.3 %). In-hospital mortality was higher among patients with bleeding (adjusted odds ratio [OR] 1.22; 95 % confidence interval [CI] 1.21, 1.24) and mixed disorders (aOR 3.38; 95 % CI 3.27, 3.49) compared with patients without bleeding or hypercoagulable disorders. Among patients with any bleeding or hypercoagulable disorder, those who underwent invasive strategy had lower adjusted odds of in-hospital mortality (aOR 0.28; 95 % CI 0.27, 0.30), ischemic stroke (aOR 0.60; 95 % CI 0.56, 0.64), bleeding (aOR 0.63; 95 % CI 0.61, 0.65), blood transfusion (aOR 0.95; 95 % CI 0.91, 0.99) and 30-day urgent readmissions (aOR 0.70; 95 % CI 0.68, 0.72). ConclusionsThe inpatient management and outcomes of AMI in patients with bleeding/hypercoagulable disorders differ from patients without those disorders.Revascularization in the setting of AMI was associated with lower in-hospital mortality, which suggests that patients with bleeding/hypercoagulable disorders can be evaluated for standard approaches to managing AMI; however, confounding by indication may be a concern.