Risk Of Arrest Research Articles

Addressing the ‘Dirty Little Secret’ of Deterrence: Testing the Effects of Increased Police Presence on Perceptions of Arrest Risk

Addressing the ‘Dirty Little Secret’ of Deterrence: Testing the Effects of Increased Police Presence on Perceptions of Arrest Risk

Predicting Cardiac Arrest in Children with Heart Disease: A Novel Machine Learning Algorithm

Children with congenital and acquired heart disease are at a higher risk of cardiac arrest compared to those without heart disease. Although the monitoring of cardiopulmonary resuscitation quality and extracorporeal resuscitation technologies have advanced, survival after cardiac arrest in this population has not improved. Cardiac arrest prevention, using predictive algorithms with machine learning, has the potential to reduce cardiac arrest rates. However, few studies have evaluated the use of these algorithms in predicting cardiac arrest in children with heart disease. We collected demographic, laboratory, and vital sign information from the electronic health records (EHR) of all the patients that were admitted to a single-center pediatric cardiac intensive care unit (CICU), between 2010 and 2019, who had a cardiac arrest during their CICU admission, as well as a comparator group of randomly selected non-cardiac-arrest controls. We compared traditional logistic regression modeling against a novel adaptation of a machine learning algorithm (functional gradient boosting), using time series data to predict the risk of cardiac arrest. A total of 160 unique cardiac arrest events were matched to non-cardiac-arrest time periods. Using 11 different variables (vital signs and laboratory values) from the EHR, our algorithm's peak performance for the prediction of cardiac arrest was at one hour prior to the cardiac arrest (AUROC of 0.85 [0.79,0.90]), a performance that was similar to our previously published multivariable logistic regression model. Our novel machine learning predictive algorithm, which was developed using retrospective data that were collected from the EHR and predicted cardiac arrest in the children that were admitted to a single-center pediatric cardiac intensive care unit, demonstrated a performance that was similar to that of a traditional logistic regression model. While these results are encouraging, future research, including prospective validations with multicenter data, is warranted prior to the implementation of this algorithm as a real-time clinical decision support tool.

Trends and in-hospital cardiac complications in patients with atrial fibrillation undergoing allogeneic stem cell transplant: A National Inpatient Sample analysis (2002-2019).

Cardiovascular comorbidities increase the risk of transplant-associated complications. However, the impact of atrial fibrillation (AF) as an independent risk factor remains limited. The National Inpatient Sample (NIS) database was queried using the International Classification of Diseases codes to identify patients admitted for allogeneic stem cell transplant (ASCT). The patients were then subclassified into with and without AF. Subsequently, a multivariate logistic regression model was constructed to account for patient demographics, comorbidities, and hospital characteristics to evaluate the impact of AF on the primary outcome of interest: all-cause mortality, and secondary outcomes of interest that included common hospitalization complications. The data for 77 157 cases of ASCT were collected between 2002 and 2019. Among these 5086 (6.6%) cases had concurrent AF. Multivariate logistic regression revealed patients undergoing ASCT with AF had almost a three times higher risk of all-cause mortality (odds ratio = 2.99 [95% confidence interval: 2.73-3.28]; p < .01). AF patients also had a higher risk for cardiac arrest, cardiogenic shock, acute kidney injury, and need for hemodialysis (all p < .01). AF causes a higher risk of death and cardiovascular complications among patients undergoing ASCT. This signifies the importance of pretransplant consultation and optimization for cardiovascular comorbidities to improve hospitalization outcomes.

Association between the vaginal and uterine microbiota and the risk of early embryonic arrest.

The aim of this study was to explore the microecological distribution and differences in the uterus and vaginal microbiome in women with early embryonic arrest and those with normal pregnancy by high-throughput sequencing. We systematically sampled the vaginal and uterine microbiomes of 56 pregnant women, namely, 38 patients with early embryonic arrest and 18 pregnant women with normal pregnancy-induced abortion. We obtained colonization data by 16S rRNA gene amplicon sequencing. In the vagina, Lactobacillus, Bacteroidetes and Helicobacter exhibited significant differences between the groups. We further found that Lactobacillus iners, Lactobacillus crispatus, Lactobacillus gasseri and Lactobacillus jensenii were the most dominant Lactobacillus species and that L. iners was significantly different between the groups. Receiver operating characteristic (ROC) curve analysis confirmed that Ensifer had the highest predictive value for early embryonic arrest. In the uterine cavity, we determined that Proteobacteria, Bacteroidetes, Firmicutes and Actinobacteria were the dominant bacteria at the phylum level and that Bacteroides, Pseudarthrobacter, Lactobacillus and Ralstonia were the dominant genera. Further classification of Lactobacillus revealed that L. iners, L. crispatus, L. gasseri, and L. jensenii were the main species. There was a significant difference in L. jensenii between the normal pregnancy group and early embryonic arrest group. Random forest analysis revealed 18 different genera in the uterus, and ROC curve analysis indicated that Candidatus Symbiobacter, Odoribacter, Blautia, Nocardioides and Ileibacterium had a certain predictive value.

Defibrillation effectiveness and safety of the shock waveform used in a contemporary wearable cardioverter defibrillator: Results from animal and human studies.

The wearable cardioverter defibrillator (WCD) is used to protect patients at risk for sudden cardiac arrest. We examined defibrillation efficacy and safety of a biphasic truncated exponential waveform designed for use in a contemporary WCD in three animal studies and a human study. Animal (swine) studies: #1: Efficacy comparison of a 170J BTE waveform (SHOCK A) to a 150J BTE waveform (SHOCK B) that approximates another commercially available waveform. Primary endpoint first shock success rate. #2: Efficacy comparison of the two waveforms at attenuated charge voltages in swine at three prespecified impedances. Primary endpoint first shock success rate. #3: Safety comparison of SHOCK A and SHOCK B in swine. Primary endpoint cardiac biomarker level changes baseline to 6 and 24 hours post-shock. Human Study: Efficacy comparison of SHOCK A to prespecified goal and safety evaluation. Primary endpoint cumulative first and second shock success rate. Safety endpoint adverse events. Animal Studies #1: 120 VF episodes in six swine. First shock success rates for SHOCK A and SHOCK B were 100%; SHOCK A non-inferior to SHOCK B (entire 95% CI of rate difference above -10% margin, p < .001). #2: 2,160 VF episodes in thirty-six swine. Attenuated SHOCK A was non-inferior to attenuated SHOCK B at each impedance (entire 95% CI of rate difference above -10% margin, p < .001). #3: Ten swine, five shocked five times each with SHOCK A, five shocked five times each with SHOCK B. No significant difference in troponin I (p = 0.658) or creatine phosphokinase (p = 0.855) changes from baseline between SHOCK A and SHOCK B. Human Study: Thirteen patients, 100% VF conversion rate. Mild skin irritation from adhesive defibrillation pads in three patients. The BTE waveform effectively and safely terminated induced VF in swine and a small sample in humans. Human study clinical trial registration: URL: https://clinicaltrials.gov; Unique identifier: NCT04132466.

Identification Problems in Probabilistic Measures of Perceived Arrest Risk: Estimating a Partially-Identified Certainty Effect

Identification Problems in Probabilistic Measures of Perceived Arrest Risk: Estimating a Partially-Identified Certainty Effect

Long-term increase in fasting blood glucose is associated with increased risk of sudden cardiac arrest

BackgroundDiabetes mellitus (DM) is associated with various cardiovascular complications, including sudden cardiac arrest (SCA). Furthermore, the severity of DM, as assessed by fasting blood glucose (FBG), is associated with the risk of SCA. However, whether long-term changes in FBG influence on SCA risk remains to be determined.MethodsThis study used sequential nationwide health screening data from 2009 and 2011. FBG was measured at each health screening, and ΔFBG was calculated as FBG in 2011–FBG in 2009.ResultsOverall, 2,801,153 people were analyzed, and the mean follow-up duration was 6.33 years. Compared with the euglycemic group (− 20 ≤ ΔFBG < 20), the 20 ≤ ΔFBG < 40, 40 ≤ ΔFBG < 100, and ΔFBG ≥ 100 groups had increased SCA risks of 25% (adjusted hazard ratio [HR] = 1.25; 95% confidence interval [CI] 1.16–1.35; p < 0.001), 66% (adjusted HR = 1.66; 95% CI 1.49–1.86; p < 0.001), and 2.9-fold (adjusted HR = 2.85; 95% CI 2.37–3.44; p < 0.001), respectively. The association between ΔFBG and SCA was maintained in people with DM but not in people without DM. However, sex, age, blood pressure, and presence of heart failure did not affect the association between ΔFBG and SCA. A decrease in ΔFBG over time was not associated with reduced risk of SCA: the adjusted HR was 1.11 (95% CI 0.98–1.27; p = 0.113) for the ΔFBG < –40 group and 1.12 (95% CI 1.03–1.22; p = 0.009) for the − 40 ≤ ∆FBG < − 20 group.ConclusionsA long-term increase in ΔFBG can be associated with increased risk of SCA in people with DM. However, a long-term decrease in ΔFBG was not associated with reduced risk of SCA. Actions to prevent increase in FBG can have significant effects on public health in terms of SCA prevention.

Association between low-density lipoprotein cholesterol and sudden cardiac arrest in people with diabetes mellitus

BackgroundDyslipidemia measured as low-density lipoprotein (LDL)-cholesterol is an established risk factor of cardiovascular disease, which is more pronounced in diabetes population. Less is known about the association of LDL-cholesterol level and sudden cardiac arrest (SCA) risk in diabetes mellitus patients. This study investigated the association of LDL-cholesterol level and SCA risk in diabetes population.MethodsThis study was based on Korean National Health Insurance Service database. Patients who received general examination from 2009 to 2012 and diagnosed as type 2 diabetes mellitus were analyzed. Primary outcome was defined as SCA event identified with International Classification of Disease code.ResultsA total of 2,602,577 patients were included, with total follow-up duration of 17,851,797 person * year. Mean follow-up duration was 6.86 years, and 26,341 SCA cases were identified. Overall incidence of SCA was highest in the lowest LDL-cholesterol group (< 70 mg/dL) and decreased in a linear manner as LDL-cholesterol rises, till 160 mg/dL. Adjustment of covariates resulted in U-shape association, with highest risk of SCA in the highest LDL-cholesterol group (≥ 160 mg/dL) followed by lowest LDL-cholesterol group (< 70 mg/dL). In subgroup analysis, U-shape association between SCA risk and LDL-cholesterol was more pronounced in male, non-obese people, and those who did not use statins.ConclusionsIn people with diabetes, the association between SCA and LDL-cholesterol level was U-shaped with highest and lowest LDL-cholesterol group having higher risk of SCA than others. Low LDL-cholesterol level can be a surrogate marker for increased risk of SCA in people with diabetes mellitus and this paradoxical association should be recognized and extended to clinical preventive measures.

Peri-Intubation Arrest in High Risk vs. Standard Risk Pediatric Trauma Patients Undergoing Endotracheal Intubation

Background: While the anatomically difficult airway has been studied in pediatric trauma patients, physiologic risk factors are poorly understood. Our objective was to evaluate if previously published high risk physiologic criteria for difficult airway in medical patients is associated with adverse outcomes in pediatric trauma patients.Methods: This was a retrospective chart review of patients ≤18 years with traumatic injuries who underwent endotracheal intubation (EI) in a pediatric emergency department (PED) between 2016 and 2021. High risk criteria evaluated included 1) hypotension, 2) concern for cardiac dysfunction, 3) persistent hypoxemia, 4) severe metabolic acidosis (pH < 7.1), 5) post–return of spontaneous circulation. Our primary outcome was peri-intubation cardiac arrest, defined as cardiac arrest within 10 minutes of EI. Secondary outcomes included in-hospital cardiac arrest and mortality and first pass EI success.Results: One third (n = 32; 36.4%) of the 88 patients analyzed had at least one high risk criteria. When compared to the standard risk group, those in the high risk group had a higher incidence of peri-intubation arrest (28.1% vs. 0%, difference: 28.1%, 95% CI: 10.1–46.2), PED/in-hospital arrest (43.8% vs. 3.4%, difference: 38.4%, 95% CI: 17.8–59.0) and in-hospital mortality (33.4% vs. 3.6%, difference: 29.8%, 95% CI: 8.4–46.9). Having multiple high risk criteria progressively increased the odds of post-intubation PED/in-hospital cardiac arrest (1 risk factor: OR = 6.7, 95% CI: 1.5–30.2; 2 risk factors: OR = 12.5, 95% CI: 2.3–70.0; ≥ 3 risk factors: OR = 56.1, 95% CI: 6.0–523.8).Conclusions: The presence of high risk physiologic criteria is associated with increased incidence of peri-intubation, in-hospital arrest, and death in pediatric trauma patients. Children with multiple risk factors are at an incremental risk of cardiac arrest.

Police Extortion and Drug Dealers’ Negotiation Strategies: Exploring the Accounts of Street-Level Dealers in Nigeria

This study explores police extortion and the negotiation strategies of dealers in street drug markets. Analysis of 31 in-depth interviews with male retail drug dealers in Uyo, Nigeria, framed by the theoretical concept of habitus, revealed how bribery and collusion with corrupt police officers offered protection from raids and arrests. Connivance with police was a double-edged sword; it also fostered exploitation of dealers by police officers. Police extortion, motivated by greed and opportunism, undermined profit from drug trade. Dealers negotiated police extortion by walking-away from exploitative collusions and forming new ones, and temporarily desisting from selling drugs to reduce the risk of arrest by vindictive police officers. I argue that street market policing, driven by greed and self-interest, encouraged bribery, extortion, and criminal alliances that effectively redirected policing from the goals of crime control and public order to personal enrichment of police officers. On the other hand, the negotiation of extortion through street habitus suggests that drug dealers are not passive victims of police predation. Improved oversight over patrolling officers and providing viable alternative livelihoods for dealers are suggested as measures for addressing police corruption and retail drug trade.

Increasing Utilization of the Preparticipation Physical Evaluation.

The American Heart Association and American Academy of Pediatrics endorse the preparticipation physical evaluation (PPE) to screen student athletes for the risk of sudden cardiac arrest. We sought to identify barriers precluding its use and improve utilization. We analyzed documentation of PPE elements during well-care visits of patients aged 12 to 18 years from 5 primary care practices. Employing quality improvement (QI) methodology, we focused on improving PPE utilization in 1 practice by assessing the number of PPE elements addressed per chart. We expanded our QI project to 4 additional practices by using the same interventions but assessing the percentage of charts that had a complete PPE documented. A baseline analysis of 5 targeted practices revealed an average of 3.5 of 14 PPE elements documented. Using plan-do-study-act cycles, PPE elements addressed increased from 2.5 to 14 over an 18-month period in the initial practice. By spreading successful interventions to 4 other practices, complete PPE utilization increased from a median baseline of 10.0% to a median of 70.0% over a 12-month period. Postintervention, 12 of 16 patients (75%) required additional follow-up with pediatric cardiology beyond the initial consultation, as compared with 2 of 14 patients (14%) preintervention. The PPE is an underutilized but effective tool in screening student athletes for sudden cardiac arrest. QI methodology was helpful in increasing the use of PPE in the primary care setting.

Atrial Fibrillation and the Risk of Ventricular Arrhythmias and Cardiac Arrest: A Nationwide Population-Based Study.

Atrial fibrillation (AF) has been linked to an increased risk of ventricular arrhythmias (VAs) and sudden death. We investigated this association in hospitalised patients in France. All hospitalised patients from 2013 were identified from the French National database and included if they had at least 5 years of follow-up data. Overall, 3,381,472 patients were identified. After excluding 35,834 with a history of VAs and cardiac arrest, 3,345,638 patients were categorised into two groups: no AF (n = 3,033,412; mean age 57.2 ± 21.4; 54.3% female) and AF (n = 312,226; 78.1 ± 10.6; 44.0% female). Over a median follow-up period of 5.4 years (interquartile range (IQR) 5.0-5.8 years), the incidence (2.23%/year vs. 0.56%/year) and risk (hazard ratio (HR) 3.657 (95% confidence interval (CI) 3.604-3.711)) of VAs and cardiac arrest were significantly higher in AF patients compared to non-AF patients. This was still significant after adjusting for confounders, with a HR of 1.167 (95% CI 1.111-1.226) and in the 1:1 propensity score-matched analysis (n = 289,332 per group), with a HR of 1.339 (95% CI 1.313-1.366). In the mediation analysis, the odds of cardiac arrest were significantly mediated by AF-associated VAs, with an OR of 1.041 (95% CI 1.040-1.042). In hospitalised French patients, AF was associated with an increased risk of VAs and sudden death.

ADHD medication use not associated with risk of cardiovascular disease

A systematic review and meta‐analysis comprising 19 studies has found no significant association between use of medications for attention‐deficit hyperactivity disorder (ADHD) and risk of cardiovascular disease. The findings could not rule out the possibility of a modest increase in risk of cardiac arrest or tachyarrhythmias, the investigators reported. Results were published online Nov. 23, 2022, in JAMA Network Open.

Pro: The Best Induction for the Physiologically Difficult Airway is Ketamine-Propofol Admixture (“Ketofol”)

THE INDUCTION AND INTUBATION of critically ill patients are high-risk interventions, with nearly half of patients experiencing a major adverse event, such as cardiovascular instability, severe hypoxia, or cardiac arrest. 1 Russotto V Myatra SN Laffey JG et al. Intubation practices and adverse peri-intubation events in critically ill patients from 29 countries. JAMA. 2021; 325: 1164-1172 Crossref PubMed Scopus (98) Google Scholar Preexisting physiologic derangements are a major contributor to decompensation, and the term “physiologically difficult airway” is used to describe patients with significant physiologic alterations prior to airway management. 2 Myatra SN Divatia JV Brewster DJ. The physiologically difficult airway: An emerging concept. Curr Opin Anaesthesiol. 2022; 35: 115-121 Crossref PubMed Scopus (6) Google Scholar Although many factors may contribute to a patient with a physiologically difficult airway, the derangements of most concern are hypotension, hypoxia, severe metabolic acidosis, and right ventricular dysfunction. 2 Myatra SN Divatia JV Brewster DJ. The physiologically difficult airway: An emerging concept. Curr Opin Anaesthesiol. 2022; 35: 115-121 Crossref PubMed Scopus (6) Google Scholar Inducing a patient who is already hypotensive can be dangerous, as both the induction agents, as well as positive-pressure ventilation, can worsen hypotension. Risk factors for periintubation hypotension have been explored recently, and one study derived and validated a scoring system for periintubation hypotension in critically ill patients (C-statistic 0.75 [95% CI 0.72-0.78]). 3 Smischney NJ Kashyap R Khanna AK et al. Risk factors for and prediction of post-intubation hypotension in critically ill adults: A multicenter prospective cohort study. PLoS One. 2020; 15e0233852 Crossref PubMed Scopus (15) Google Scholar Given the literature surrounding the negative downstream effects of hypotension on the critically ill, one could argue that preventing further decreases in blood pressure is the most important consideration when faced with intubation in a patient with preexisting hypotension. For example, a multicenter cohort study demonstrated that mean arterial pressures ≤65 mmHg in critically ill patients were associated with an increased risk of 30-day major adverse cardiac or cerebrovascular events and increased 30-day mortality. This held true even for hypotension of limited duration. 4 Smischney NJ Shaw AD Stapelfeldt WH et al. Postoperative hypotension in patients discharged to the intensive care unit after non-cardiac surgery is associated with adverse clinical outcomes. Crit Care. 2020; 24: 682 Crossref PubMed Scopus (12) Google Scholar Preexisting hypoxia is also a significant risk factor for decompensation because any apnea time is tolerated poorly by patients with limited arterial oxygen content reserve. Additionally, induction agents typically worsen the ventilation-perfusion mismatch that is already present to some degree in hypoxic patients. Hypoxia, in general, also places patients at greater risk for hemodynamic instability, arrhythmia, and cardiopulmonary arrest. 3 Smischney NJ Kashyap R Khanna AK et al. Risk factors for and prediction of post-intubation hypotension in critically ill adults: A multicenter prospective cohort study. PLoS One. 2020; 15e0233852 Crossref PubMed Scopus (15) Google Scholar Severe metabolic acidosis contributes to a physiologically difficult airway, as any apnea time will result in an increased PaCO2 and a worsening acidosis. Preexisting right ventricular dysfunction presents many challenges to intubation, as the rise in PaCO2 with induction will result in increases in pulmonary arterial pressures and right ventricular strain. Additionally, positive-pressure ventilation tends to overall reduce preload and may precipitate cardiovascular collapse due to insufficient preload to a poorly functioning right ventricle. Patients with a physiologically difficult airway may possess one or a combination of these physiologic derangements. Once a physiologically difficult airway is identified, the next challenge for the clinician is to design an induction regimen that would be best tolerated by a patient with preexisting physiologic challenges.

Respiratory arrest after posterior fossa decompression in patients with Chiari malformations: An overview.

Chiari malformation type 1 (CM1) is a structural abnormality in the skull and cerebellum, causing cerebellar tonsils to shift downward. Decompression of the posterior fossa is a common surgical method to relieve symptoms and prevent neurological deterioration. After posterior fossa decompression (PFD), individuals with CM1 were more likely to have respiratory arrest. Here, we present, for the first time, a comprehensive overview of the potential risk factors and causes of respiratory arrest following PFD. A review of the literature highlighting the risk factors for postoperative respiratory arrest in CM1 patients was conducted in the databases of PubMed, Medline, and Google Scholar. Patients with syringomyelia and CM1 are at increased risk for respiratory arrest due to a number of factors, including impaired respiratory mechanics, central respiratory center dysfunction from edema or ischemia, intraoperative brain stem ischemia, and delayed gastric emptying from autonomic dysfunction. Occipitalization of the first cervical vertebra, basilar impression, and fusion of C2-C3 are all risk factors for respiratory arrest. Implications for CM1 patient care and prospects for further investigation of postoperative respiratory arrest's causes and risk factors were discussed.

Dependence of clinical outcomes on time of hospital admission in patients with ST-segment elevation myocardial infarction.

There are conflicting results in studies investigating the effects of percutaneous coronary intervention (PCI) on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI) during or outside of usual hospital working hours. While some researchers have reported higher mortality rates in STEMI patients admitted outside of working hours, others did not find a statistically significant difference. Investigate the short-term endpoints and long-term outcomes of STEMI patients by time of admission. Retrospective SETTING: Tertiary percutaneous coronary intervention center. Patients were grouped by admission, which consisted of four intervals: 06:00 to <12:00, 12:00 to <18:00, 18:00 to <24:00, and 24:00 to <06:00. We analyzed demographic, clinical and mortality by admission time interval and mortality by multivariate analyses, including the time intervals. Clinical data and mortality SAMPLE SIZE: 735 patients; median (IQR) age 62 (22) years; 215 (29.3%) women. Patients admitted at night were 1.37 times more likely to experience pulmonary edema than patients whose symptoms started in the daytime (P=.012); 32.9% of the patients whose symptoms started at night presented with Killip class II-IV, while during the daytime, 21.4% presented with Killip class II-IV (P=.001). Among the patients, the most common was inferior STEMI (38.6%). However, no-reflow was significantly higher during the daytime compared to the nighttime (P=.12). The risk of the cardiac arrest on admission was 1.2 times higher in patients admitted at night (P=.034). Neither time interval of admission nor several other variables had an effect on clinical outcome or mortality. While patients admitted at night presented with pulmonary edema and cardiogenic shock more frequently, no reflow was observed during the day after the procedure. Although patients admitted at night with STEMI presented with worse clinical conditions, similar results were observed between the groups in clinical outcomes. More "real world" results might have been obtained if the study had replicated more typical referral conditions for PCI. None.

Chronic Pancreatitis and Risk of Atherosclerotic Cardiovascular Disease: A US Cohort Propensity-Matched Study.

Worldwide prevalence of chronic pancreatitis (CP) has risen in recent years, with data suggesting an increased risk of atherosclerotic cardiovascular disease (ASCVD) in these patients. We assessed the incidence and risk of ASCVD in patients with CP. We compared the risk of ischemic heart disease, cerebrovascular accident, and peripheral arterial disease between CP and non-CP cohorts after propensity matching of known risk factors of ASCVD using TriNetX, a multi-institutional database. We also evaluated the risk of outcomes of ischemic heart disease including acute coronary syndrome, heart failure, cardiac arrest, and all-cause mortality between CP and non-CP cohorts. Chronic pancreatitis cohort was also found to have an increased risk of ischemic heart disease (adjusted odds ratio [aOR], 1.08; 95% confidence interval [CI], 1.03-1.12), cerebrovascular accident (aOR, 1.12; 95% CI, 1.05-1.20), and peripheral arterial disease (aOR, 1.17; 95% CI, 1.1-1.24). Chronic pancreatitis patients with ischemic heart disease were also found to have an increased risk of acute coronary syndrome (aOR, 1.16; 95% CI, 1.04-1.30), cardiac arrest (aOR, 1.24; 95% CI, 1.01-1.53), and mortality (aOR, 1.60; 95% CI, 1.45-1.77). Chronic pancreatitis patients are at a higher risk of ASCVD when compared with the general population, matched for confounding etiological, pharmacological, and comorbid variables.

Rationale for Pre-Race Aspirin to Attenuate Risk for Marathon-Related Cardiac Arrest: Confounding the Legacy of Pheidippides

While increasing levels of recreational sports participation are incrementally cardioprotective, strenuous physical exertion transiently increases the risk for acute cardiac events including sudden death. The frequency of marathon-related cardiac arrests has been increasing since the year 2000 mainly in middle-aged men due to atherosclerotic coronary artery disease. Coronary artery calcium scores and post-race cardiac biomarkers are recommended to identify runners who might benefit the most from pre-race aspirin for enhanced primary prevention.

Patient-reported outcomes using a wearable cardioverter-defibrillator: results from a systematic review.

The aim of this study was to assess the effect of the wearable cardioverter-defibrillator (WCD) on patient-reported outcomes (PRO) in adult patients with high risk for sudden cardiac arrest. We performed a systematic literature search in Medline (via PubMed) and Cochrane Library in February 2022 and included studies with a study population ≥18years and prescribed WCD. PRO include health-related quality of life (QoL), symptoms, utilities, or satisfaction ratings. Study selection was done by two reviewers independently using predefined inclusion and exclusion criteria. Quality assessment of studies as well as data extraction was performed by one author and approved by a second author. Results of the included studies are presented quantitatively. One randomized controlled trial (RCT), one comparative non-randomized trial, and three single-arm trials were included. QoL was assessed in four studies, but with different assessment tools. One study additionally evaluated the change in depressive symptoms and anxiety and one study focused on acceptability of WCD but evaluated items that are closely related to QoL. Results of the RCT show no statistically significant difference in QoL assessed by SF-36 and EQ-5D comparing WCD and Guideline-Directed Medical Therapy (GDMT) versus GDMT alone. One comparative study reports an improvement in depressive symptoms and anxiety within groups but no significant difference between groups. Further, one single-arm study reported improvement in QoL between baseline and day 90 and day 180. The available evidence demonstrates that the usage of WCD is not affecting PRO, like QoL, depressive symptoms or anxiety negatively.

59 THE SHARK-FIN THAT EMERGES AND IMMERGES: A CASE REPORT OF TRANSIENT AND RIPETITIVE TRIANGULAR QRS-ST-T.

Abstract Introduction Shark fin sign, also known as triangular QRS-ST-T waveform (TW), is characterized by a giant R wave (amplitude ≥ 1 mV) resulting from the fusion of the QRS complex, the ST-segment and the T wave and showing triangular morphology. TW pattern is quite uncommon and reveals a life-threatening condition that needs aggressive management. Early recognition is important to prevent acute complications such as ventricular arrhythmias and cardiogenic shock. Case presentation A 45-years old black man with history of arterial hypertension presented with out-of-hospital cardiac arrest (OHCA) at his workplace. Extracorporeal cardiopulmonary resuscitation started immediately and return of spontaneous circulation occurred after 11 minutes and 2 DC shocks. Then he was transferred to our emergency department (ED). At arrival he was hemodynamically stable, ECG showed atrial fibrillation without any repolarization abnormalities and echocardiogram revealed left ventricular hypertrophy (IVS 12mm, PW 12mm) and normal biventricular function. Normal electrolytes and high-sensitivity troponin level of 14 (n.v. 0.01-19.8 ng/L) were found at the blood test. Sedation in the ED was needed due to psychomotor agitation. He was then transferred to the CCU where spontaneous cardioversion to sinus rhythm occurred, and no additional arrhythmias were noted at continuous ECG monitoring. After ten hours, while the patient was still under sedation, ECG monitoring revealed a progressive QRS-ST segment elevation in inferior leads up to a triangular QRS-ST-T giant waveform (“Shark fin sign”), without hemodynamic deterioration. After approximately 3 minutes the ECG showed a progressive and complete regression to a normal waveform. An emergent beside echocardiogram demonstrated inferior wall hypokinesia, but normal pump function. The episode repeated 5 more times in the following hour, waiting for cath lab personnel. Coronary angiography revealed a sub-occlusive mid RCA stenosis without any thrombotic lesion. Percutaneous coronary intervention (PCI) with the implantation of one drug eluting stent (DES) was performed. After the procedure the patient was hemodynamically and electrically stable. ECG did not show any other abnormality and no episodes of recurrent ST-elevation occurred. Sedation was suspended and no focal neurological deficits were noted. Discussion Shark fin sign is the expression of abrupt total deprivation of blood flow in large areas of myocardium that cause massive slowing of transmural electrical conduction. These electrical differences may be at the base of the triangular R waves and predispose to VF induction and cardiogenic shock. This sign is very rare, with an annual incidence of 0.7% in patients admitted for STEMI, and in most of the cases is described in the occlusion of the LAD. In our case we assisted to transient but repetitive inferior triangular ST-elevation with complete regression to normal ECG. The coronary angiogram showed non-obstructive lesion of the RCA. This phenomenon was probably the expression of RCA's plaque coronary vasospasm that caused the ECG shark fin sign and cardiac arrest. Conclusion Shark fin electrocardiographic waveform is an uncommon pattern of STEMI and may be the expression of thrombotic coronary occlusion as well as massive coronary vasospasm. This sign correlates with high risk of cardiogenic shock, electrical instability, and cardiac arrest, thus requiring prompt and aggressive management.