Risk factors for cardiovascular death after elective surgery under general anaesthesia

Abstract Purpose Difficult mask ventilation (DMV) is a potentially life-threatening situation that can arise during anesthesia. However, most clinical predictors of DMV are based on European and US populations. On the other hand, most predictive models consist of multiple factors and complicated assessments. Since obstructive sleep apnea (OSA) is among the most important risk factors associated with DMV, the apnea-hypopnea index (AHI) may play an important role in determining patient risk.The purpose of this study was to investigate the relationship between DMV and AHI, and to determine preoperative risk factors for DMV in Chinese patients. Methods A prospective cohort trial enrolled patients scheduled for elective surgery. After obtaining informed consent, patient demographic information was collected, and patients were tested with pre-operative polysomnography. The anesthesiologist who managed the airway graded the mask ventilation. The difficult mask ventilation was defined as the mask ventilation provided by an unassisted anesthesiologist without oral airway or other adjuvant. A logistic regression model was used to analyze the association between AHI and DMV. Results A total of 159 patients were analyzed. For both primary and secondary outcomes, the unadjusted and adjusted odds ratio for DMV showed significant increases by 5 AHI units. AHI, age, and the Mallampati classification were found to be independent predictive factors for DMV. Conclusions AHI is associated with DMV as a novel independent risk factor in Chinese patients. Along with age and Mallampati classification, AHI should be included in establishing a superior predictive strategy for DMV screening. Trial registration Chinese Clinical Trial Registry ChiCTR-DDD-17013076

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Cardiovascular family history increases the risk of disease recurrence after a first myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.2979 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Wahrenberg ◽

P Magnusson ◽

R Kuja-Halkola ◽

H Habel ◽

K Hambraeus ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Family History ◽

Cardiovascular Events ◽

Cardiovascular Death ◽

Funding Source ◽

History Of ◽

First Time ◽

Early Family

Abstract Background Despite recent advances in secondary prevention, recurrent cardiovascular events are common after a myocardial infarction (MI). It has been reported that genetic risk scores may predict the risk of recurrent cardiovascular events. Although patient-derived family history is a composite of both genetic and environmental heritability of atherosclerotic cardiovascular disease (ASCVD), it is an easily accessible information compared to genetically based risk models but the association with recurrent events is unknown. Purpose To evaluate whether a register-verified family history of ASCVD is associated with recurrent cardiovascular events (rASCVD) in patients after a first-time MI. Methods We included patients with a first-time MI during 2005 – 2014, registered in the SWEDEHEART SEPHIA registry and without prior ASCVD. Follow-up was available until Dec 31st, 2018. Data on relatives, diagnoses and prescriptions were extracted from national registers. A family history of ASCVD was defined as a register-verified hospitalisation due to MI, angina with coronary revascularization procedures, stroke or cardiovascular death in any parent. Early history was defined as such an event before the age of 55 years in fathers and 65 years in mothers. The association between family history and a composite outcome including recurrent MI, angina requiring acute revascularization, ischaemic stroke and cardiovascular death during follow-up was studied with Cox proportional hazard regression with time from SEPHIA registry completion as underlying time-scale, adjusted for age with splines, gender and year of SEPHIA registry. Regression models were then further adjusted for hypertension, diabetes, smoking and for a subset of patients, LDL-cholesterol (LDL_C) at time of first event. Results Of 25,615 patients, 2.5% and 32.1% had an early and ever-occurring family history of ASCVD, respectively. Patients with early family history were significantly younger than other patients and were more likely to be current smokers and have a higher LDL-C (Median (IQR) 3.5 (1.1) vs 3.3 (1.1) mmol/L). In total, 3,971 (15.5%) patients experienced the outcome. Early family history of ASCVD was significantly associated with rASCVD (Hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.23–1.87), and the effect was sustained when adjusted for cardiovascular risk factors (HR 1.48, 95% CI 1.20–1.83) and LDL-C (HR 1.35, 95% CI 1.04–1.74). Ever-occurring family history was weakly associated with ASCVD (HR 1.09, 95% CI 1.02 – 1.17) and the association remained unchanged with adjustments for risk factors. Conclusions Early family history of cardiovascular disease is a potent risk factor for recurrent cardiovascular events in a secondary prevention setting, independent of traditional risk factors including LDL-C. This is a novel finding and these patients may potentially benefit from intensified secondary preventive measures after a first-time MI. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): This work was funded by grants from The Swedish Heart and Lung Association

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Utilization of apnea-hypopnea index as a novel predictive factor for difficult mask ventilation in the Chinese population under general anesthesia

10.21203/rs.3.rs-59557/v1 ◽

2020 ◽

Author(s):

Jia-Yi Wang ◽

Jing-Jie Li ◽

Peng-Cheng Zhao ◽

Jia-Li Peng ◽

Rong Hu ◽

...

Keyword(s):

Risk Factors ◽

General Anesthesia ◽

Elective Surgery ◽

Chinese Patients ◽

Apnea Hypopnea Index ◽

Mask Ventilation ◽

Clinical Trial Registry ◽

Difficult Mask Ventilation ◽

Physical Status Classification ◽

Obstructive Sleep

Abstract Background: Difficult Mask Ventilation (DMV) is a potentially life-threatening situation that can arise during anesthesia. Accordingly, the majority of current airway management guidelines include risk assessments for DMV. Although Obstructive Sleep Apnea (OSA) is among the most important risk factors associated with DMV, other measurements such as the Apnea-Hypopnea Index (AHI) may play an important role in determining patient risk.This study investigated the relationship between DMV and AHI, and determined preoperative risk factors for DMV in Chinese patients.Methods: A prospective cohort trial enrolled patients scheduled for elective surgery. After obtaining informed consent, patient demographic information was collected, and patients were tested with pre-operative polysomnography. Inclusion criteria: Patients >18 years of age, American Society of Anesthesiologists Physical Status Classification (ASA) I-III, and planned elective surgery with general anesthesia. Exclusion criteria: malformations of the airway, patients undergoing regional anesthesia, and patients with contraindications to mask ventilation (i.e. planned awake intubation). A logistic regression model was used to analyze the association between AHI and DMV. Results: A total of 159 patients were analyzed. For both primary and secondary outcomes, the unadjusted and adjusted odds ratio for DMV showed significant increases of 5 AHI units. AHI, age, and the Mallampati classification were found to be independent predictive factors for DMV.Conclusions AHI is associated with DMV as a novel independent risk factor in Chinese patients. Along with age and Mallampati classification, AHI should be included in establishing a superior predictive strategy DMV screening.Trial registration: Chinese Clinical Trial Registry (Registration number # ChiCTR17013076; Date of Registration on October 22nd, 2017).

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Effect of regional living conditions on middle-term cardiovascular outcomes: data from prospective stage of the ESSE-RF study

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2021-2965 ◽

2021 ◽

Vol 20 (5) ◽

pp. 2965

Author(s):

S. A. Maksimov ◽

S. A. Shalnova ◽

V. A. Kutsenko ◽

Yu. A. Balanova ◽

G. A. Muromtseva ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Composite Endpoint ◽

Potential Effect ◽

Cardiovascular Death ◽

Cardiovascular Outcomes ◽

Living Conditions ◽

Individual Risk ◽

Middle Term ◽

Wide Range

Aim. To assess regional living conditions with cardiovascular outcomes based on prospective stage of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study.Material and methods. We used data from a 3- and 5-year prospective stage of the ESSE-RF study (2012-2013). For initial screening, 16210 people aged 25-64 were included. To characterize the regions of residence, 5 regional indices (RIs) were used. The following endpoints were considered: cardiovascular death, myocardial infarction, stroke, composite endpoint (cardiovascular death + myocardial infarction + stroke). To assess the correlations, generalized estimating equations with nested data structure (individuals in the regions) were used. The studied associations were adjusted for a wide range of potential effect modifiers.Results. There are multiple direct associations of RIs with the likelihood of all endpoints. The exception was the reverse association of Industrial RI with cardiovascular death. The most stable associations regarded Mixed RI, Industrial RI and Socio-geographical RI, with a high RI significance in endpoint development, compared with well-known individual cardiovascular risk factors. Separate associations were noted for Economic RI and Demographic RI.Conclusion. The results indicate a significant contribution of a number of regional living conditions to individual risk of fatal and non-fatal cardiovascular outcomes.

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Investigation of the Adherence to Prescribed Treatment of the Patients with Coronary Heart Disease

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs06.05.263 ◽

2021 ◽

Vol 6 (5) ◽

pp. 263-269

Author(s):

V. O. Shuper ◽

◽

S. V. Shuper ◽

I. V. Trefanenko ◽

G. I. Shumko ◽

...

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Secondary Prevention ◽

Cardiovascular Mortality ◽

Healthcare Professionals ◽

Complete Information ◽

Cardiovascular Death ◽

Medical Risk ◽

Medical Risk Factors

The purpose of the study was to investigate the adherence to secondary prevention medications among patients with coronary heart disease and identify factors associated with it. Materials and methods. We examined 40 patients diagnosed with coronary heart disease of more than 50 years old, who were prescribed with optimal medication for 1 year during hospitalization. Patients` adherence was defined according to MMS-8 Morisky values for secondary prevention medications prescribed by doctors. Also, questionnaires about individual reasons of non-compliance and for individual patient`s opinion about importance and usefulness of knowledge according to risk factors of the increase of cardiovascular mortality were designed and proposed to the patients. Simple descriptive statistics were used to elucidate the characteristics of the patient population and results from individual adherence tools. Final score was analyzed and correlation between patients’ data and level of adherence to prescribed treatment were identified. A correlation matrix (using Spearman’s coefficient) was reviewed for any evidence of collinearity. Results and discussion. Our study demonstrated higher level of non-adherence with secondary prevention medications in patients with coronary heart disease (60.0%). This fact can be explained by the socioeconomic reasons, less informative strategies from the medical staff to the patients. Severe regress of adherence was demonstrated after discharge from the hospital due to subjective improvement of the patients` condition with absence of supervision by out-patient specialists. Demographic characteristics of the patients suggested that some non-modified factors can affect compliance with the prescribed treatment. Better adherence was demonstrated by female married patients with higher educational level, with family history about cardiovascular death. Also, too much prescribed medications with difficult regime of usage with non-adequate out-patient supervision may significantly decrease adherence causing development of complications which may lead to re-hospitalizations and cardiovascular death. Our investigation demonstrated also non-complete information of the patients about lifestyle and medical risk factors of the cardiovascular mortality increase. Conclusion. The results of our study can provide useful practical information on the prevalence and severity of non-adherence among patients with coronary heart disease. Analysis of the factors influencing the adherence demonstrated the main reasons from patients and healthcare professionals affecting the level of compliance with the prescribed treatment. The step towards improving adherence can be initiated by the healthcare professional to overcome the patient's concerns about the prescribed medication. It is important to continue personal monitoring of patients by healthcare professionals in the form of regular inspections of intentional and unintentional non-adherence, including factors and reasons that may change and lead to such behavior

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Risk factors for incisional surgical site infections in elective surgery for colorectal cancer: focus on intraoperative meticulous wound management

Surgery Today ◽

10.1007/s00595-013-0677-3 ◽

2013 ◽

Vol 44 (7) ◽

pp. 1242-1252 ◽

Cited By ~ 17

Author(s):

Keita Itatsu ◽

Gen Sugawara ◽

Yuji Kaneoka ◽

Takehito Kato ◽

Eiji Takeuchi ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Elective Surgery ◽

Surgical Site Infections ◽

Wound Management

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Abstract 2656: Copeptin Predicts Cardiovascular Death in STEMI Independent of Clinical Factors and NT-proBNP

Circulation ◽

10.1161/circ.118.suppl_18.s_762 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Nihar R Desai ◽

David A Morrow ◽

Songtao Jiang ◽

Christoph Bode ◽

Nader Rifai ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Death ◽

Mortality Prediction ◽

Clinical Factors ◽

Killip Class ◽

C Statistic ◽

St Elevation ◽

Baseline Characteristics ◽

Traditional Risk Factors ◽

Circulating Levels

Background : Elevated levels of copeptin, the c-terminal portion of provasopressin, add significantly to natriuretic peptides for mortality prediction in heart failure. We hypothesized that elevated levels would predict mortality in ST-elevation myocardial infarction (STEMI). Methods : Circulating copeptin levels were measured at baseline in a case-cohort of 535 STEMI patients undergoing fibrinolysis in CLARITY-TIMI 28. Patients were stratified into quartiles by baseline copeptin. Multivariable logistic regression was used to examine the association between copeptin and 30-d cardiovascular (CV) mortality independent of clinical factors and NT-proBNP. Results : The median level of copeptin was 615 pg/ml (IQR 333–728 pg/ml). Baseline levels of copeptin tended to be higher in patients who were older, had a prior MI, were treated sooner after sx onset, and were in Killip class II-IV. For each 1-SD increase in log-transformed copeptin, the OR for CV death was 1.45 (p=0.01). After adjusting for differences in baseline characteristics patients in the highest copeptin quartile were at a significantly higher risk of CV death compared with patients in quartiles 1–3 (OR 1.99 [1.05–3.78]). Copeptin was not significantly correlated with NT-proBNP (r=0.09). In a multivariable model, copeptin and NT-proBNP were each significant independent predictors of CV death (Figure ); the c-statistic went from 0.75 to 0.81 with their addition to a model containing clinical risk factors. Conclusion : In a multimarker model, circulating levels of copeptin and NT-proBNP at presentation were powerful and complementary predictors of CV death beyond traditional risk factors in patients with STEMI.

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Epidemiology of extended spectrum β-lactamase producing Enterobacter bacteremia in a brazilian hospital

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822010000400022 ◽

2010 ◽

Vol 43 (4) ◽

pp. 452-454 ◽

Cited By ~ 11

Author(s):

Felipe Francisco Tuon ◽

Leila Carolina Bianchet ◽

Sergio Ricardo Penteado-Filho

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Urinary Catheter ◽

Elective Surgery ◽

Survival Curve ◽

Factors Associated ◽

Extended Spectrum ◽

Length Of Hospitalization

INTRODUCTION: Enterobacter can be included in the group of extended spectrum β-lactamases (EBSL)-producing bacteria, though few studies exist evaluating risk factors associated with this microorganism. A retrospective cohort study was conducted to determine risk factors associated with ESBL-producing-Enterobacter and mortality METHODS: A retrospective cohort study with 58 bacteremia caused by ESBL-producing-Enterobacter (28 cases) and non-ESBL (30 cases) RESULTS: Risk factors associated with ESBL-Enterobacter were trauma, length of hospitalization, admission to the intensive care unit, urinary catheter and elective surgery (p< 0.05). The survival curves were similar for ESBL and non-ESBL CONCLUSIONS: ESBL-producing-Enterobacter bacteremia is prevalent and the survival curve was similar to non-ESBL-producing strains.

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