scholarly journals STEMI patients in the first and second wave of COVID-19 pandemic in Slovenia

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Sinkovic ◽  
M Krasevec ◽  
J Golub ◽  
D Suran ◽  
M Marinsek ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Hospital Admissions ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Funding Sources ◽  
Complications And Mortality ◽  
Second Wave ◽  
Primary Percutaneous Intervention

Abstract Introduction Countries, severly hit by COVID-19 pandemic in spring 2020, reported reduced admissions and increased mortality of STEMI patients. The first wave of COVID-19 pandemic in Slovenia was mild, but in the second wave (October to December 2020) COVID-19 cases and fatalities significantly increased. To overcome the pandemic, restrictions to full lockdown, rapid redeployment and mobilization of healthcare resources, as well as reduction or delayed hospital admissions for acute non-communicable conditions were were undertaken. Purpose To evaluate STEMI admissions, the delay in treatment, complications and mortality of STEMI patients in the first and second wave of COVID-19 pandemic and comparison of data to 3 months (March-May) in 2019. Methods We retrospectively analysed the data of STEMI patients, admitted in March to May 2019 and in the first (March-May) and in the second wave (October-December) of the COVID-19 pandemic in 2020. We compared STEMI admissions, age, gender, comorbidities, time to primary coronary intervention (PPCI), the rate of PPCI, TIMI III flow after PPCI, prior resuscitations, hospital complications such as heart failure, arrhythmias, bleedings, acute kidney injury and mortality between 2019 and both waves of COVID-19 pandemic. Results Between STEMI patients in 2019 and patients in the first and the second wave of COVID-19 pandemic there were nonsignificant differences in STEMI admissions (90 patients vs 96 patients vs 81 patients), in gender, age, comorbidities, the rate of primary percutaneous intervention (PPCI, 94.4% vs 94.8% vs 91.4%), TIMI III flow after PPCI, anterior STEMI, in prior resuscitations (10% vs 10.4% vs 16%). Compared to 2019, admission acute heart failure was nonsignificantly increased in COVID-19 pandemic (30% vs 34.4% vs 39.5%). Within the first 3 hours of STEMI PPCI was performed nonsignificantly less likely in the first wave and significantly less likely in the second wave (35.5%* vs 30.2% vs 19.8%*, *p=0.037) in comparison to 2019. The incidence of acute kidney injury was similar in the first wave, but nonsignificantly increased in the second wave (6.6% vs 5.2% vs 9.8%), compared to 2019 and hospital infection was nonsignificantly increased in both COVID-19 periods (15.6% vs 20.8% vs 27.2%). In hospital heart failure was nonsignificantly increased in the first wave and significantly increased in the second one (23.3%* vs 27.1% vs 42%*, *p=0.015), as well as mitral regurgitation (10%* vs 18.8% vs 26.9%*, *p=0.008). Hospital mortality was nonsignificantly increased in bothe waves of the pandemic (8.9% vs 9.4% vs 13.6%). Conclusions In paralell to the increased severity of COVID-19 pandemic in the second wave there was less STEMI admissions, significantly less timely performed PPCI with significantly increased hospital heart failure, resulting in nonsignificantly increased hospital mortality. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Reduced Mortality Associated with Acute Kidney Injury Requiring Dialysis in the United States

2016 ◽  
Vol 43 (4) ◽  
pp. 261-270 ◽  
Author(s):  
Jeremiah R. Brown ◽  
Michael E. Rezaee ◽  
William M. Hisey ◽  
Kevin C. Cox ◽  
Michael E. Matheny ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Incidence Rate ◽  
Hospital Admissions ◽  
Population Attributable Risk ◽  
Kidney Injury ◽  
The United States ◽  
Attributable Risk ◽  
Discharge Data ◽  
The Us

Background: Dialysis-requiring acute kidney injury (AKI-D) is a documented complication of hospitalization and procedures. Temporal incidence of AKI-D and related hospital mortality in the US population has not been recently characterized. We describe the epidemiology of AKI-D as well as associated in-hospital mortality in the US. Methods: Retrospective cohort of a national discharge data (n = 86,949,550) from the Healthcare Cost and Utilization Project's National Inpatient Sample, 2001-2011 of patients' hospitalization with AKI-D. Primary outcomes were AKI-D and in-hospital mortality. We determined the annual incidence rate of AKI-D in the US from 2001 to 2011. We estimated ORs for AKI-D and in-hospital mortality for each successive year compared to 2001 using multiple logistic regression models, adjusted for patient and hospital characteristics, and stratified the analyses by sex and age. We also calculated population-attributable risk of in-hospital mortality associated with AKI-D. Results: The adjusted odds of AKI-D increased by a factor of 1.03 (95% CI 1.02-1.04) each year. The number of AKI-D-related (19,886-34,195) in-hospital deaths increased almost 2-fold, although in-hospital mortality associated with AKI-D (28.0-19.7%) declined significantly from 2001 to 2011. Over the same period, the adjusted odds of mortality for AKI-D patients were 0.60 (95% CI 0.56-0.67). Population-attributable risk of mortality associated with AKI-D increased (2.1-4.2%) over the study period. Conclusions: The incidence rate of AKI-D has increased considerably in the US since 2001. However, in-hospital mortality associated with AKI-D hospital admissions has decreased significantly.

Abstract 16151: Acute Kidney Injury is a Powerful and an Independent Determinant of In-Hospital Mortality in Patients Undergoing Percutaneous Coronary Interventions

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Judith Kooiman ◽  
Milan Seth ◽  
Brahmajee K Nallamothu ◽  
Michael Heung ◽  
David Humes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Matched Cohort ◽  
Primary Endpoints ◽  
Percutaneous Coronary ◽  
Common Risk Factors ◽  
Using Data

Introduction: Acute kidney injury (AKI) is a common complication of percutaneous coronary intervention (PCI) and is associated with increased mortality. Previous studies analysing mortality risk in patients with AKI were hampered by common risk factors for both outcomes. The aim of our study was to analyse the association between AKI and in-hospital mortality post PCI after adjustment for confounding by common risk factors. Methods: This study was performed using data from a regional registry of patients undergoing PCI in the state of Michigan. The primary endpoints were AKI and all-cause in-hospital mortality. Propensity matching was performed, with each AKI patient matched to four controls. Attributive risk (AR) and the exposed impact number of AKI for mortality were calculated in the propensity-matched cohort. Results: Between January 2009 and June 2013, 92,317 patients were included, of whom 2,141(2.3%) developed AKI. We matched 1,371/2,141 patients with AKI to 5,484 controls. AKI was strongly associated with mortality (OR = 12.52, 95% CI 9.29 - 16.86, p < 0.0001) after adjustment for baseline covariates in the propensity-matched cohort. The association between AKI and mortality was present in all subgroups and strata of baseline AKI-risk (Figure 1). The estimated AR for mortality of AKI was 31.4% (95% CI 26.8% - 37.5%). Among matched patients with AKI, one death could be prevented for every 9 cases of AKI successfully eliminated. Conclusion: Our results indicate that AKI attributes to nearly one-third of the in-hospital mortality post PCI. Preventing nine cases of AKI could potentially prevent one death. These study findings stress the need for highly effective AKI preventive strategies.

Acute Kidney Injury and In-Hospital Mortality after Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention: A Nationwide Study

2017 ◽  
Vol 45 (3) ◽  
pp. 217-225 ◽  
Author(s):  
Wen Shen ◽  
Rodrigo Aguilar ◽  
Alex R. Montero ◽  
Stephen J. Fernandez ◽  
Allen J. Taylor ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Percutaneous Coronary

Background: Post-procedural acute kidney injury (AKI) is associated with significantly increased short- and long-term mortalities, and renal loss. Few studies have compared the incidence of post-procedural AKI and in-hospital mortality between 2 major modalities of revascularization - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - and results have been inconsistent. Methods: We generated a propensity score-matched cohort that includes a total of 286,670 hospitalizations with multi-vessel coronary disease undergoing CABG or PCI (2004-2012) from the National Inpatient Sample database. We compared incidence of AKI, AKI requiring renal replacement therapy (RRT), in-hospital mortality, hospital stay, and charges between CABG and PCI groups. Results: The incidence of AKI after CABG was higher than PCI (8.9 vs. 4.5%, OR 2.05, 95% CI 1.99-2.12, p < 0.001). The incidence of AKI requiring RRT was also higher after CABG (1.1 vs. 0.5%, OR 2.14, 95% CI 1.96-2.34, p < 0.001). Likewise, in-hospital mortality was higher after CABG than PCI (2.0 vs. 1.4%, OR 1.44, 95% CI 1.35-1.52, p < 0.001). Among patients with pre-existing chronic kidney disease (stages I-IV), those undergoing CABG was associated with 2.0-2.3-fold higher odds of developing AKI than those undergoing PCI. The patients treated with CABG had a significantly longer hospital stay and higher hospital charges. Conclusions: Patients undergoing CABG are associated with (1) increased risk of developing post-procedural AKI, (2) higher likelihood of receiving RRT, and (3) worse short-term survival. Long-term renal outcome remains to be studied.

scholarly journals In Nonagenarians, Acute Kidney Injury Predicts In-Hospital Mortality, while Heart Failure Predicts Hospital Length of Stay

PLoS ONE ◽  
2013 ◽  
Vol 8 (11) ◽  
pp. e77929 ◽  
Author(s):  
Chia-Ter Chao ◽  
Yu-Feng Lin ◽  
Hung-Bin Tsai ◽  
Nin-Chieh Hsu ◽  
Chia-Lin Tseng ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay

scholarly journals Impact of acute kidney injury on in-hospital outcomes among patients hospitalized with acute heart failure: a propensity score matched analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Shetty ◽  
H Malik ◽  
A Abbas ◽  
Y Ying ◽  
W Aronow ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Kidney Injury ◽  
Matched Cohort ◽  
Hospital Outcomes ◽  
Increased Risk ◽  
The Impact

Abstract Background Acute kidney injury (AKI) is frequently present in patients admitted for acute heart failure (AHF). Several studies have evaluated the mortality risk and have concluded poor prognosis in any patient with AKI admitted for AHF. For the most part, the additional morbidity and mortality burden in AHF patients with AKI has been attributed to the concomitant comorbidities, and/or interventions. Purpose We sought to determine the impact of acute kidney injury (AKI) on in-hospital outcomes in patients presenting with acute heart failure (AHF). We identified isolated AKI patients after excluding other concomitant diagnoses and procedures, which may contribute to an increased risk of mortality and morbidity. Methods Data from the National Inpatient Sample (2012- 14) were used to identify patients with the principal diagnosis of AHF and the concomitant secondary diagnosis of AKI. Propensity score matching was performed on 30 baseline variables to identify a matched cohort. The outcome of interest was in-hospital mortality. We further evaluated in-hospital procedures and complications. Results Of 1,470,450 patients admitted with AHF, 24.3% had AKI. After propensity matching a matched cohort of 356,940 patients was identified. In this matched group, the AKI group had significantly higher in-hospital mortality (3.8% vs 1.7%, p&lt;0.001). Complications such as sepsis and cardiac arrest were higher in the AKI group. Similarly, in-hospital procedures including CABG, mechanical ventilation and IABP were performed more in the AKI group. AHF patients with AKI had longer in-hospital stay of ∼1.7 days. Conclusions In a propensity score-matched cohort of AHF with and without AKI, the risk of in-hospital mortality was &gt;2-fold in the AKI group. Healthcare utilization and burden of complications were higher in the AKI group. Funding Acknowledgement Type of funding source: None

Acute Kidney Injury Following Percutaneous Coronary Intervention for Acute Coronary Syndrome: Incidence, Aetiology, Risk Factors and Outcomes

Angiology ◽  
2021 ◽  
pp. 000331972110403
Author(s):  
Elliott J Carande ◽  
Karen Brown ◽  
David Jackson ◽  
Nicholas Maskell ◽  
Loukas Kouzaris ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Acute Kidney Injury ◽  
Cardiogenic Shock ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

We investigated the predictors, aetiology and long-term outcomes of acute kidney injury (AKI) following urgent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Acute kidney injury occurred in 198 (7.2%) of 2917 patients: 14.1% of AKI cases were attributed to cardiogenic shock and 5.1% were classified as atheroembolic renal disease (AERD). Significant risk factors for AKI included age (odds ratio [OR] 1.05, 95% confidence limits [CI] 1.03-1.06), diabetes (OR 1.73, 95% CI 1.20-2.47), hypertension (OR 1.43, 95% CI 1.03-2.00), heart failure (OR 3.01, 95% CI 1.58-5.57), femoral access (OR 1.50, 95% CI 1.03-2.15), cardiogenic shock (OR 2.03, 95% CI 1.19-3.37) and ST-elevation myocardial infarction (STEMI) (OR 3.89, 95% CI 2.80-5.47). One-year mortality after AERD was 44.4% and renal replacement therapy (RRT) requirement 22.2% (compared with mortality 33.3% and RRT requirement 7.4%, respectively, in all other AKI patients). Mortality at 1 year was associated with AKI (OR 4.33, 95% CI 2.89-6.43), age (OR 1.08, 95% CI 1.06-1.09), heart failure (OR 1.92, 95% CI 1.05-3.44), femoral access (OR 2.05, 95% CI 1.41-2.95) and cardiogenic shock (OR 3.63, 95% CI 2.26-5.77). Acute kidney injury after urgent PCI is strongly associated with worse outcomes. Atheroembolic renal disease has a poor outcome and a high likelihood of long-term RRT requirement.

Trends in complications and mortality following catheter ablation of atrial fibrillation: results from 22,582 ablations in Australia and New Zealand from 2010 to 2015

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Ngo ◽  
A Ali ◽  
A Ganesan ◽  
R Woodman ◽  
A McGavigan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Venous Thromboembolism ◽  
Catheter Ablation ◽  
Kidney Injury ◽  
Funding Source ◽  
Complications And Mortality ◽  
Over Time

Abstract Background Recent studies from the United States report rising rates of in-hospital complications and mortality following catheter ablation of atrial fibrillation (AF) but whether such a trend is observed in other populations is uncertain. Purpose To examine the trends in complications and mortality following AF ablations up to 30 days after discharge in Australia and New Zealand (ANZ) using nationwide data. Methods All patients ≥18y undergoing catheter ablation of AF from 2010–2015 were identified using hospitalisation data from all public and most private hospitals in ANZ. The primary endpoint was one or more procedural complications during the hospital stay or within 30 days of discharge. The secondary endpoints were mortality and other specific complications. Unadjusted trend was evaluated using Cochran-Armitage test while that of complications, adjusting for differences in other characteristics, was evaluated using multivariate logistic regression with the year of ablation modelled as a continuous variable. Results are reported as odd ratios (OR) and 95% confidence intervals (CI). Results A total of 22,582 AF ablations were included (mean age 62.2±11.6y, 29.1% female, 94.4% elective procedures). The number of ablations increased by 26.4% during the study period (3,097 in 2010 to 3,915 in 2015). Rates of heart failure (8.98% to 10.09%, p for trend=0.010), diabetes (4.52% to 12.46%, p&lt;0.001), chronic kidney disease (2.36% to 4.29%, p&lt;0.001) significantly increased over time but that of hypertension decreased (15.27% to 12.29%, p&lt;0.001). The incidence of overall complications (6.55% in 2010 to 6.67% in 2015, OR 0.99, 95% CI 0.96–1.03) was unchanged during the study period (Figure 1A). When individual complications were considered, mortality rate was low with no statistically significant change with time (0.19% to 0.15%, OR 1.03, 95% CI 0.84–1.28) (Figure 1A) while the rate of acute kidney injury (0.23% to 0.51%, OR 1.17, 95% CI 1.02–1.34) increased and that of venous thromboembolism (0.16% to 0.0%, OR 0.71, 95% CI 0.54–0.94) decreased (Figure 1B). Though the incidence of any bleeding (4.49% to 3.98%, OR 0.97, 95% CI 0.93–1.01) was unchanged, that of major bleeding requiring blood transfusion (0.97% to 0.64%, OR 0.87, 95% CI 0.79–0.96) declined significantly (Figure 1B). No significant trend was observed in other complications or when in-hospital (5.13% to 5.21%, OR 1.00, 95% CI 0.97–1.04) and post-discharge (1.55% to 1.63%, OR 0.97, 95% CI 0.91–1.03) complications were separately evaluated. Conclusions Though more patients with heart failure, diabetes and chronic kidney disease underwent catheter ablation of AF over time in ANZ, the overall complication rate was unchanged with a significant decrease in the incidences of major bleeding and venous thromboembolism. However, rate of acute kidney injury nearly doubled, and this could be a potential target for efforts to further improve procedural safety. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The National Heart Foundation of Australia

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