Predictors Of 30-day Survival Research Articles

Predictors of 30-day survival after emergent percutaneous coronary intervention following ventricular tachyarrhythmias complicating acute myocardial infarction

BackgroundLittle has been reported on the predictors of 30-day survival after emergent percutaneous coronary intervention (PCI) following life-threatening ventricular tachyarrhythmias associated with acute myocardial infarction (AMI). MethodsWe analyzed 55 consecutive patients who underwent an emergent PCI after ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) complicating AMI between September 2014 and March 2023 in our hospital. These patients were categorized into two groups: survival group (S group) who survived >30 days after the emergent PCI and death group (D group) who died by 30 days after the emergent PCI. We compared the patient characteristics, coronary angiographic findings, and PCI procedures between the two groups. ResultsS group consisted of 40 patients. In the univariate analysis, absence of diabetes mellitus, presence of immediate cardiopulmonary resuscitation (CPR), low arterial lactate, and single-vessel coronary artery disease (CAD) were associated with 30-day survival after the emergent PCI (P = 0.048, P < 0.001, P = 0.009, and P = 0.003, respectively). In the multivariate analysis, presence of immediate CPR and single-vessel CAD were independently associated with 30-day survival after the emergent PCI (P = 0.023 and P = 0.032, respectively). ConclusionsImmediate CPR and single-vessel CAD were significant predictors of 30-day survival after the emergent PCI following VF or pulseless VT complicating AMI. Absence of diabetes mellitus and low arterial lactate were associated with 30-day survival in the univariate analysis.

Influence of age and shock severity on short-term survival in patients with cardiogenic shock.

Cardiogenic shock (CS) is associated with poor outcomes in older patients, but it remains unclear if this is due to higher shock severity. We sought to determine the associations between age and shock severity on mortality among patients with CS. Patients with a diagnosis of CS from Mayo Clinic (2007-15) and University Clinic Hamburg (2009-17) were subdivided by age. Shock severity was graded using the Society for Cardiovascular Angiography and Intervention (SCAI) shock stages. Predictors of 30-day survival were determined using Cox proportional-hazards analysis. We included 1749 patients (934 from Mayo Clinic and 815 from University Clinic Hamburg), with a mean age of 67.6 ± 14.6 years, including 33.6% females. Acute coronary syndrome was the cause of CS in 54.0%. The distribution of SCAI shock stages was 24.1%; C, 28.0%; D, 33.2%; and E, 14.8%. Older patients had similar overall shock severity, more co-morbidities, worse kidney function, and decreased use of mechanical circulatory support compared to younger patients. Overall 30-day survival was 53.3% and progressively decreased as age or SCAI shock stage increased, with a clear gradient towards lower 30-day survival as a function of increasing age and SCAI shock stage. Progressively older age groups had incrementally lower adjusted 30-day survival than patients aged <50 years. Older patients with CS have lower short-term survival, despite similar shock severity, with a high risk of death in older patients with more severe shock. Further research is needed to determine the optimal treatment strategies for older CS patients.

Prediction of survival of patients in cardiogenic shock treated by surgically implanted Impella 5+ short-term left ventricular assist device.

Short-term mechanical circulatory support is a life-saving treatment for acute cardiogenic shock (CS). This multicentre study investigates the preoperative predictors of 30-day mortality in CS patients treated with Impella 5.0 and 5.5 short-term left ventricular assist devices. Data of patients in CS (n = 70) treated with the Impella 5 (n = 63) and 5.5 (n = 7) in 2 centres in Berlin between October 2016 and October 2019 were collected retrospectively. CS was caused by acute myocardial infarction (n = 16), decompensated chronic heart failure (n = 41), postcardiotomy syndrome (n = 5) and acute myocarditis (n = 8). Before implantation 12 (17%) patients underwent cardiopulmonary resuscitation and 32 (46%) patients were ventilated. INTERMACS level 1, 2 and 3 was established in 35 (50%), 29 (41%) and 6 (9%) of patients, respectively. The mean preoperative lactate level was 4.05 mmol/l. The median support time was 7 days (IR= 4-15). In 18 cases, the pump was removed for myocardial recovery, in 22 cases, durable left ventricular assist devices were implanted, and 30 patients died on support. The overall 30-day survival was 51%. Statistical analysis showed that an increase in lactate per mmol/l [odds ratio (OR) 1.217; P = 0.015] and cardiopulmonary resuscitation before implantation (OR 16.74; P = 0.009) are predictors of 30-day survival. Based on these data, an algorithm for optimal short-term mechanical circulatory support selection is proposed. Impella treatment is feasible in severe CS. Severe organ dysfunction, as well as the level and duration of shock predict early mortality. An algorithm based on these parameters may help identify patients who would benefit from Impella 5+ support.

Elevated neopterin levels are associated with acute-on-chronic liver failure and mortality in patients with liver cirrhosis

BackgroundMacrophage activation plays a central role in hepatic and systemic inflammation and is involved in the pathogenesis of acute-on-chronic liver failure (ACLF). AimsThis study aimed to investigate neopterin levels in patients admitted for acute decompensation (AD) of cirrhosis, evaluating its relationship with ACLF and prognosis. MethodsThis prospective cohort study included 205 adult subjects hospitalized for AD of cirrhosis. Twenty-one healthy subjects and 89 patients with stable cirrhosis were evaluated as controls. ResultsCirculating neopterin was higher in AD as compared to stable cirrhosis and healthy controls (p<0.001). ACLF was independently associated with higher neopterin levels (OR 1.015, 95% CI 1.002–1.028, p = 0.025). In the multivariate Cox regression analysis, neopterin levels (HR = 1.002, IC 95% 1.000–1.004, p = 0.041), Child–Pugh class C, and ACLF were predictors of 30-day survival. Among patients with ACLF, the Kaplan–Meier survival probability was 71.4% in those with neopterin levels < 25 nmol/L and 31.0% if neopterin ≥ 25 nmol/L (p<0.001). ConclusionsHigher circulating neopterin was associated with ACLF in patients hospitalized for AD of cirrhosis. Neopterin levels were also independently predictors of high short-term mortality, especially among patients with ACLF, and could represent a useful biomarker of macrophage activation in clinical practice.

Predictors of 30-day Survival in Cardiogenic Shock Patients on Impella 5.0 and 5.5 Circulatory Support

Nowadays a variety of different circulatory support strategies can be involved in cardiogenic shock therapy. Impella 5.0 and 5.5 microaxial pumps became a reliable instrument at disposal of cardiothoracic surgeons. The aim of this study is to reveal preoperative parameters that may influence the outcomes of Impella support. Data of 85 consecutive patients treated with Impella 5.0 (n=78) and 5.5 (n=7) devices between October 2016 and August 2019 at the German Heart Center Berlin and the Cardiology Department of the Berlin Charité Virchow campus university clinic were collected retrospectively. The mean age was 57.4±13.4 years, 86% were male, 26 patients had a BMI &gt30 kg/m2. CS was caused by acute myocardial infarction (n=20), decompensated chronic heart failure (n=46), postcardiotomy syndrome (n=8), and acute myocarditis (n=11). The Impella device was implanted in addition to ECLS for LV distension in 18 patients; in 8 of these patients ECLS was explanted and Impella continued working as LVAD. Preoperative parameters of 67 patients who received isolated Impella support for CS were included into analysis. Prior to implantation, the mean lactate level was 4.1±3.9 mmol/l, 12 (18%) patients received cardiopulmonary resuscitation (CPR), 53 (79%) received inotropic support (mean inotropic index 5.3±4.1), and 30 (45%) underwent invasive ventilation. The mean support time was 11.5±10.7 days. In 18 cases the pump was removed for myocardial recovery and 20 patients underwent long-term LVAD implantation, 29 died on support. Preoperative lactate level &lt7.8 mmol/l (survial 58% vs 15% p=0.002; OR 4.7, p=0.03) and absence of preoperative CPR (survival 58% vs 8%, p=0.001) predicted 30-days survival. Temporary MCS with Impella 5+ is a reliable tool for treatment of CS in selected patients. In patients after CPR and with more severe CS, ECLS may be more effective. Further prospective studies should be initiated.

P5738Multicenter analysis of left ventricular unloading on top of VA-ECMO for treatment of cardiogenic shock

Abstract Background Veno-arterial extracorporeal membrane oxygenation therapy (VA-ECMO) is increasingly used for treatment of severe cardiogenic shock, although it causes an increase in left ventricular (LV) afterload and might therefore hamper myocardial recovery. Recently, the addition of catheter-based left ventricular assist device (cLVAD) on top of VA-ECMO has been used to unload the LV and to improve outcome measures. However, there is limited data on predictors of outcome in this high-risk population. Aim The aim of this study was to evaluate predictors of 30-day survival in a multicentre cohort of severe cardiogenic shock patients treated with cLVADon top of VA-ECMO. Material and methods We report on consecutive patients from six tertiary care centers being treated with cLVAD in addition to VA-ECMO for treatment of cardiogenic shock. The primary endpoint is 30-day all-cause mortality. To identify predictors of the primary endpoint, multivariate analysis using an “elastic net” variable selection algorithm was done after imputation of missing variables. Results A total of 220 patients treated with cLVAD on top of VA-ECMO were included in the analysis. Of these, 79.1% were male with a median age of 55.5 (25thpercentile 48.0, 75thpercentile 65.6) years. In 60.5% of the patients, acute myocardial infarction was the underlying cause of cardiogenic shock and in 44.6% VA-ECMO was used for refractory cardiac arrest (eCPR). In the multivariable analysis, the following baseline parameters were significantly associated with the primary endpoint: Age (odds ratio of 1.68 per standard deviation), duration of cardiopulmonary resuscitation (OR 2.08 per SD), lactate (OR 1.04 per SD) and time from onset of shock to VA-ECMO (OR 1.30 per SD). Conclusion and outlook In this large-scale multicentre analysis of severe cardiogenic shock patients treated with VA-ECMO plus additional cLVAD unloading, age, duration of cardiopulmonary resuscitation, lactate and time from onset of shock to VA-ECMO were significantly associated with 30-day all-cause mortality. To further investigate this topic, we will evaluate predictors of outcome in distinct patient populations such as acute myocardial infarction vs. acute heart failure and patients without vs. patients with prior cardiopulmonary association.

Prevalence and Outcome of Secondary Hemophagocytic Lymphohistiocytosis Among SIRS Patients: Results from a Prospective Cohort Study.

Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening condition clinically presenting as SIRS (Systemic Inflammatory Response Syndrome). However, there is no comprehensive data concerning diagnostic algorithms, prevalence, outcome and biomarker performance in SIRS patients. We conducted a prospective observational cohort study on 451 consecutive patients fulfilling ≥2 SIRS criteria. The Hscore and the HLH-2004 criteria were used to determine the presence of sHLH, and the correlation of the screening-biomarkers ferritin, sCD25, and sCD163 with both scores was assessed. Out of 451 standard-care SIRS patients, five patients had high Hscores (≥169), suggesting incipient or HLH-like disease, and these patients were in urgent need for intensified therapy. However, none of these patients fulfilled five HLH-2004 criteria required for formal diagnosis. From the studied biomarkers, ferritin correlated strongest to both the HLH-2004 criteria and the Hscore (rs = 0.72, 0.41, respectively), and was the best predictor of 30-day survival (HR:1.012 per 100 μg/L, 95% CI: 1.004–1.021), when adjusted for patient’s age, sex, bacteremia and malignant underlying-disease. Also, the HLH-2004 (HR per point increase: 1.435, 95% CI: 1.1012–2.086) and the Hscore (HR per point increase:1.011, 95% CI: 1.002–1.020) were independent predictors of 30-day-survival. The Hscore detected patients in hyperinflammatory states requiring urgent therapy escalation. Degrees of hyperinflammation, as assessed by ferritin and both HLH scores, are associated with worse outcomes.

Survival and neurological outcome in the elderly after in-hospital cardiac arrest

BackgroundThere have been few studies of the outcome in elderly patients who have suffered in-hospital cardiac arrest (IHCA) and the association between cardiac arrest characteristics and survival. AimThe aim of this large observational study was to investigate the survival and neurological outcome in the elderly after IHCA, and to identify which factors were associated with survival. MethodsWe investigated elderly IHCA patients (≥70years of age) who were registered in the Swedish Cardiopulmonary Resuscitation Registry 2007–2015. For descriptive purposes, the patients were grouped according to age (70–79, 80–89, and ≥90years). Predictors of 30-day survival were identified using multivariable analysis. ResultsAltogether, 11,396 patients were included in the study. Thirty-day survival was 28% for patients aged 70–79 years, 20% for patients aged 80–89 years, and 14% for patients aged ≥90years. Factors associated with higher survival were: patients with an initially shockable rhythm, IHCA at an ECG-monitored location, IHCA was witnessed, IHCA during daytime (8 a.m.–8 p.m.), and an etiology of arrhythmia. A lower survival was associated with a history of heart failure, respiratory insufficiency, renal dysfunction and with an etiology of acute pulmonary oedema. Patients over 90 years of age with VF/VT as initial rhythm had a 41% survival rate.We found a trend indicating a less aggressive care with increasing age during cardiac arrest (fewer intubations, and less use of adrenalin and anti-arrhythmic drugs) but there was no association between age and delay in starting cardiopulmonary resuscitation (CPR). In survivors, there was no significant association between age and a favourable neurological outcome (CPC score: 1–2) (92%, 93%, and 88% in the three age groups, respectively). ConclusionsIncreasing age among the elderly is associated with a lower 30-day survival after IHCA. Less aggressive treatment and a worse risk profile might contribute to these findings. Relatively high survival rates among certain subgroups suggest that discussions about advanced directives should be individualized. Most survivors have good neurological outcome, even patients over 90 years of age.

Out-of-hospital cardiac arrest in Hong Kong: a territory-wide study.

Out-of-hospital cardiac arrest is a global health care problem. Like other cities in the world, Hong Kong faces the impact of such events. This study is the first territory-wide investigation of the epidemiology and outcomes of out-of-hospital cardiac arrest in Hong Kong. It is hoped that the findings can improve survival of patients with cardiac arrest. This study was a retrospective analysis of the prospectively collected data on out-of-hospital cardiac arrest managed by the emergency medical service from 1 August 2012 to 31 July 2013. The characteristics of patients and cardiac arrests, timeliness of emergency medical service attendance, and survival rates were reported with descriptive statistics. Predictors of 30-day survival were evaluated with logistic regression. A total of 5154 cases of out-of-hospital cardiac arrest were analysed. The median age of patients was 80 years. Most arrests occurred at the patient's home. Ventricular fibrillation or ventricular tachycardia was identified in 8.7% of patients. The median time taken for the emergency services to reach the patient was 9 minutes. The median time to first defibrillation was 12 minutes. Of note, 2.3% of patients were alive at 30 days or survived to hospital discharge; 1.5% had a good neurological outcome. Location of arrest, initial electrocardiogram rhythm, and time to first defibrillation were independent predictors of survival at 30 days. The survival rate of out-of-hospital cardiac arrest patients in Hong Kong is low. Territory-wide public access defibrillation programme and cardiopulmonary resuscitation training may help improve survival.

Abstract 17095: Clinical Characteristics and Short-term Outcomes of Aortic Disease Patients With Cardiovascular Shock: Results From the Shock Registry of the Japanese Circulation Society

Background: The mortality rate of aortic disease patients with cardiovascular shock (CVS) is still high. We examined the factors related to short-term outcomes of aortic disease patients with CVS. Methods: The Japanese Circulation Society Shock Registry was a prospective, observational, multi-center (83 institutions), cohort study that enrolled 980 patients presenting with CVS when transported to the emergency room between May 2012 and June 2014. Of those, 82 aortic dissection (AD) and 63 aortic aneurysm (AA) patients were enrolled in this study. Because each institution used a different D-dimer kit, adjusted D-dimer levels were calculated by dividing the measured D-dimer value by the upper limit of the normal range of the kit. Results: The mean age was 76 years and 52% were male. The 30-day mortality rate was 46% (AD, 39%; AA, 56%). In AD, Stanford type A accounted for 95% and surgical intervention was performed in 68%. In AA, 24% were thoracic; 6%, thoracoabdominal; 69%, abdominal AA, and surgical intervention was performed in 57%. In AD, adjusted D-dimer levels on admission of non-survivors were significantly higher than those of survivors [median (interquartile range): 75.6 (19.5-229.4) vs. 25.8 (8.0-61.3) arbitrary units, respectively; P=0.01]. In AD, surgical intervention, a transferred case, absence of aortic rupture, and low D-dimer levels (adjusted D-dimer &lt; 33.2 arbitrary units, which was the median value) were associated with the 30-day survival. In AA, surgical intervention, a transferred case, higher consciousness level, higher systolic blood pressure, and abdominal AA were associated with 30-day survival. Cox proportional hazards analysis indicated that surgical intervention (hazard ratio 0.14; 95%CI, 0.049-0.40; P&lt;0.001) and low D-dimer level (hazard ratio 0.21; 95%CI, 0.067-0.57; P&lt;0.001) were independent predictors of 30-day survival in AD, and surgical intervention (hazard ratio 0.087; 95%CI, 0.023-0.28; P&lt;0.001) was an independent predictor of 30-days survival in AA. Conclusions: Surgical intervention was the only method to improve short-term outcomes of aortic disease patients with CVS. In AD, lower D-dimer level was associated with more favorable short-term outcomes regardless of surgical intervention.

Effect of epigallocatechin gallate on TNFα and TGFβ expression, SOD activity and lung injury in rat radiation model

Objective To assess the factors influencing the early and mid-term survival of patients receiving a second replacement of the left atrioventricular valve,so as to provide guidance for clinical practice.Methods We retrospectively analyzed 55 patients who underwent a second replacement of the left atrioventricular valve between Jan.2005 and Dec.2010 at Changhai Hospital.Their survival rate and its risk factors were analyzed.The control group included patients who received their first left atrioventricular valve replacement at the same hospital and had matched age,sex,and operation time.Univariate and multivariate Cox survival analyses were used to assess the survival risk factors at 30 days and 3 years after operation.Results The 30-day,1-year,3-year and 5-year survival rates of patients after reoperation were 92.7%,89.1%,83.6%,and 81.8%,respectively,which were not significantly different from those of the control group(94.5%,92.7%,90.9%,and 87.3%,respectively).The left ventricular ejection fraction was the only independent predictor of 30-day survival of patients after reoperation(P=0.018,RR=15.33).Diabetes mellitus and left ventricular ejection fraction were the independent predictors of 3-year survival(P=0.039,RR=6.242 and P=0.001,RR=91.957,respectively).Conclusion The early and mid-term mortality rates are not significantly different between the first and second replacement of left atrioventricular valve.Left ventricular ejection fraction is the only independent predictor of early-term survival after re-replacement of left atrioventricular valve;diabetes mellitus and left ventricular ejection fraction are the independent predictors of mid-term survival.

Mo-P4:283 Kidney disease is a negative predictor of 30-day survival after acute ischemic stroke

Mo-P4:283 Kidney disease is a negative predictor of 30-day survival after acute ischemic stroke