Ten-year mortality risk of patients undergoing elective PCI: long-term follow-up of the GENetic Determinants of Restenosis (GENDER) study

Abstract Background Acute kidney injury (AKI) complicating transcatheter aortic valve implantation (TAVI) is relatively frequent and associated with significant morbidity. Previous studies have shown a higher 30-day and 1-year mortality risk in patients with periprocedural AKI. Our aim was to identify the prognostic impact of periprocedural AKI on long-term follow-up. Methods This is a single-center prospective study evaluating patients undergoing TAVI for severe aortic stenosis. AKI was defined according to the Valve Academic Research Consortium 2 definition, as an absolute increase in serum creatinine ≥0.3 mg/dL or an increase >50% within the first week following TAVI. Mortality data were compared between patients who developed AKI and those who did not. Logistic and Cox regressions were used for survival analysis. Results The final analysis included 1086 consecutive TAVI patients. AKI occurred in 201 patients (18.5%). During the follow-up period, 289 patients died. AKI was associated with an increased risk of 30-day mortality {4.5 versus 1.9% in the non-AKI group; hazard ratio [HR] 3.70 [95% confidence interval (CI) 1.35–10.13]}. Although 1-year mortality was higher in the AKI group in univariate analysis, it was not significant after a multivariate regression. AKI was a strong predictor of longer-term mortality [42.3 versus 22.7% for 7-year mortality; HR 1.71 (95% CI 1.30–2.25)]. In 189 of 201 patients we had data regarding recovery from AKI up to 30 days after discharge. In patients with recovery from AKI, the mortality rate was lower (38.2 versus 56.6% in the nonrecovery group; P = 0.022). Conclusions Periprocedural AKI following TAVI is a strong risk factor for short-term as well as long-term mortality (up to 7 years). Therefore more effort is needed to reduce this complication.

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Body Composition by CT vs. DXA: Long-Term Prediction of Mortality in the Health Health ABC Cohort

Innovation in Aging ◽

10.1093/geroni/igaa057.770 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 239-239

Author(s):

Samaneh Farsijani ◽

Lingshu Xue ◽

Robert Boudreau ◽

Adam Santanasto ◽

Stephen Kritchevsky ◽

...

Keyword(s):

Body Composition ◽

Fat Mass ◽

Mortality Risk ◽

Subcutaneous Fat ◽

Thigh Muscle ◽

Muscle Area ◽

Muscle Density ◽

Long Term Follow Up

Abstract Background: Early work in the Health ABC cohort found that strength, but not muscle size predicted mortality. Recent literature suggests that body composition by computerized tomography (CT) and magnetic resonance imaging (MRI) predicts adverse health outcomes in diverse populations, but has not been directly compared to dual-energy X-ray absorptiometry (DXA) for predicting mortality. Objective: With long term follow-up, we reexamined body composition and mortality in Health ABC, comparing DXA and CT measures of muscle and fat. Methods: The Health ABC study assessed body composition in 2911 older adults (age 73.6±2.9 years) in 1996-97. Mid-thigh CTs were read for muscle area, inter-muscular, subcutaneous-fat areas and muscle density (HU). DXAs were read for whole body fat mass and appendicular lean mass (ALM). Mortality was assessed every 6-months through 2014 (maximum 17.4 years). Cox proportional hazards models, adjusting for age, sex, race, height, weight, physical activity, smoking and comorbidities were used to assess mortality risk. Results: Strong correlations were observed between mid-thigh muscle and subcutaneous fat areas by CT and leg lean and fat mass by DXA (P<0.05). Lower mortality rates, per SD, were associated with higher CT muscle area (HR-men=0.76 [95%CI: 0.68-0.86]; HR-women=0.84 [0.75-0.94]), muscle density (HR-men=0.86 [0.79-0.93]; HR-women=0.89 [0.81-0.97]) and higher subcutaneous-fat (HR-men=0.90 [0.81-0.99]; HR-women=0.87 [0.77-0.98]), adjusting for covariates. Similarly for DXA, greater ALM (HR-men=0.56 [0.44-0.71]; HR-women=0.77 [0.59-1.01]) and higher total fat mass (HR-men=0.53 [0.40-0.72]; HR-women=0.58 [0.37-0.90]) were associated with lower risk of death. Conclusion: With long term follow-up, both CT and DXA assessments of body composition predicted all-cause mortality risk.

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Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

Behavioral and Brain Sciences ◽

10.1017/s0140525x1800105x ◽

2019 ◽

Vol 42 ◽

Cited By ~ 2

Author(s):

John P. A. Ioannidis

Keyword(s):

Mental Health ◽

Mental Disease ◽

Brain Disorders ◽

Social Stressors ◽

Labor Education ◽

Mental Diseases ◽

Long Term Follow Up ◽

Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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