P5504Comparison of in-hospital clinical outcomes of acute myocardial infarction between nonagenarians and octogenarians: a propensity-score matched analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Seguchi ◽  
K Sakakura ◽  
K Yamamoto ◽  
Y Taniguchi ◽  
H Wada ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Length Of Hospital Stay ◽  
Hospital Death ◽  
Very Elderly ◽  
Hospital Outcomes

Abstract Background Acute myocardial infarction (AMI) in the very elderly is associated with high morbidity and mortality. Because the majority of study population in clinical researches focusing on the very elderly with AMI were octogenarians, clinical evidences regarding AMI in nonagenarians are sparse. The aim of the present study was to compare in-hospital clinical outcomes of AMI between octogenarians and nonagenarians. Methods We included consecutive 415 very elderly (≥80 years) patients with AMI, and divided into the nonagenarian group (n=38) and the octogenarian group (n=377). Clinical characteristics and in-hospital outcomes were compared between the 2 groups. Furthermore, we used propensity-score matching to find the matched octogenarian group (n=38). Results Percutaneous coronary interventions (PCI) to the culprit of AMI were similarly performed between the nonagenarian (86.8%) and octogenarian (87.0%) groups The incidence of in-hospital death in the nonagenarian group (13.2%) was similar to that in the octogenarian group (14.6%) (P=0.811). The length of hospital stay was significantly shorter in the nonagenarian group (7.4±4.2 days) than that in the octogenarian group (15.4±19.4 days) (P<0.001). After using the propensity-score matching, the incidence of in-hospital death was less in the nonagenarian group (13.2%) than in the matched octogenarian group (21.1%) without reaching statistical significance (P=0.361). The length of hospitalization was significantly shorter in the nonagenarian group (7.4±4.2 days) than in the matched octogenarian group (17.8±37.0 days) (P=0.01). Clinical outcomes Nonagenarian group (n=38) Octogenarian group (n=377) P value In-hospital death, n (%) 5 (13.2) 55 (14.6) 0.811 Length of hospital stay (days) 7.4±4.2 15.4±19.4 <0.001 Length of CCU stay (days) 3.3±2.5 4.7±5.1 0.109 LVEF (%) 48.2±9.2 50.8±13.7 0.152 Peak CPK (U/L) 1424.8±1580.8 1640.1±2394.4 0.912 CCU indicates Coronary care unit; LVEF, Left ventricular ejection fraction; CPK, Creatine kinase. Flow-chart Conclusions The in-hospital mortality of nonagenarians with AMI was comparable to that of octogenarians with AMI. In-hospital outcomes in nonagenarians with AMI may be acceptable as long as acute medical management including PCI to the culprit of AMI is performed. Acknowledgement/Funding None

scholarly journals A kórelőzményben szereplő revascularisatiós műtét rövid és hosszú távú prognosztikai jelentősége szívinfarktus miatt kezelt betegekben

2021 ◽  
Vol 162 (5) ◽  
pp. 177-184
Author(s):  
András Jánosi ◽  
Tamás Ferenci ◽  
András Komócsi ◽  
Péter Andréka
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
St Elevation

Összefoglaló. Bevezetés: A szívinfarktust megelőző revascularisatiós beavatkozások prognosztikai jelentőségével kapcsolatban kevés elemzés ismeretes, hazai adatokat eddig nem közöltek. Célkitűzés: A szerzők a Nemzeti Szívinfarktus Regiszter adatait felhasználva elemezték a koszorúér-revascularisatiós szívműtétet (CABG) túlélt betegek prognózisát heveny szívinfarktusban. Módszer: Az adatbázisban 2014. 01. 01. és 2017. 12. 31. között 55 599 beteg klinikai és kezelési adatait rögzítették: 23 437 betegnél (42,2%) ST-elevációval járó infarktus (STEMI), 32 162 betegnél (57,8%) ST-elevációval nem járó infarktus (NSTEMI) miatt került sor a kórházi kezelésre. Vizsgáltuk a CABG után fellépő infarktus miatt kezelt betegek klinikai adatait és prognózisát, amelyeket azon betegek adataival hasonlítottunk össze, akiknél nem szerepelt szívműtét a kórelőzményben (kontrollcsoport). Eredmények: A betegek többsége mindkét infarktustípusban férfi volt (62%, illetve 59%). Az indexinfarktust megelőzően a betegek 5,33%-ánál (n = 2965) történt CABG, amely az NSTEMI-betegeknél volt gyakoribb (n = 2357; 7,3%). A CABG-csoportba tartozó betegek idősebbek voltak, esetükben több társbetegséget (magas vérnyomás, diabetes mellitus, perifériás érbetegség) rögzítettek. Az indexinfarktus esetén a katéteres koszorúér-intervenció a kontrollcsoport STEMI-betegeiben gyakoribb volt a CABG-csoporthoz viszonyítva (84% vs. 71%). Az utánkövetés 12 hónapja során a betegek 4,7–12,2%-ában újabb infarktus, 13,7–17,3%-ában újabb katéteres koszorúér-intervenció történt. Az utánkövetés alatt a CABG-csoportban magasabbnak találtuk a halálozást. A halálozást befolyásoló tényezők hatásának korrigálására Cox-féle regressziós analízist, illetve ’propensity score matching’ módszert alkalmaztunk. Mindkét módszerrel történt elemzés azt mutatta, hogy a kórelőzményben szereplő koszorúér-revascularisatiós műtét nem befolyásolta a túlélést. Amennyiben a beteg kórelőzményében szerepelt a koszorúérműtét, az indexinfarktus nagyobb eséllyel volt NSTEMI, mint STEMI (HR: 1,612; CI 1,464–1,774; p<0,001). Következtetés: A kórelőzményben szereplő koszorúér-revascularisatiós műtét nem befolyásolta a szívinfarktus miatt kezelt betegek életkilátásait. Orv Hetil. 2021; 162(5): 177–184. Summary. Introduction: Little analysis is known about the prognostic significance of revascularization interventions before myocardial infarction; no domestic data have been reported so far. Method: The authors use data from the Hungarian Myocardial Infarction Registry to analyze the prognosis of patients with acute myocardial infarction who had previous coronary artery bypass grafting (CABG). Between 01. 01. 2014. and 31. 12. 2017, 55 599 patients were recorded in the Registry: 23 437 patients (42.2%) had ST-elevation infarction (STEMI) and 31 162 patients (57.8%) had non-ST-elevation infarction (NSTEMI). The clinical data and prognosis of patients treated for infarction after CABG were compared with those of patients without a CABG history. Results: The majority of patients were male (59% and 60%, respectively). Prior to index infarction, CABG occurred in 5.33% of patients (n = 2965), which was more common in NSTEMI (n = 2357; 7.3%). The CABG patients were older and had more comorbidities (hypertension, diabetes mellitus, peripheral vascular disease). For index infarction, percutaneous coronary intervention was more common in STEMI patients in the control group compared to CABG (84% vs. 71%). At 12 months of follow-up, 4.7–12.2% of patients had reinfarction, and 13.7–17.3% had another percutaneous coronary intervention. During the full follow-up, the CABG group had higher mortality. Cox regression analysis and propensity score matching were used to correct for the effect of other factors influencing mortality. Both analyses showed CABG did not affect survival. In the CABG group, the index infarction was more likely to be NSTEMI than STEMI (HR: 1.612; CI 1.464–1.774; p<0.001). Conclusion: The history of CABG does not affect the life expectancy of patients treated for an acute myocardial infarction. Orv Hetil. 2021; 162(5): 177–184.

Early Oral Switch to Linezolid for Low-risk Patients With Staphylococcus aureus Bloodstream Infections: A Propensity-matched Cohort Study

2018 ◽  
Vol 69 (3) ◽  
pp. 381-387 ◽  
Author(s):  
Rein Willekens ◽  
Mireia Puig-Asensio ◽  
Isabel Ruiz-Camps ◽  
Maria N Larrosa ◽  
Juan J González-López ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Propensity Score ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Length Of Hospital Stay ◽  
Low Risk ◽  
Significant Difference ◽  
Risk Patients ◽  
Oral Switch

Abstract Background Oral switch to linezolid is a promising alternative to standard parenteral therapy (SPT) in Staphylococcus aureus bacteremia (SAB). Methods We conducted a prospective cohort study of all adult cases of SAB between 2013 and 2017 in a Spanish university hospital. We compared the efficacy, safety, and length of hospital stay of patients receiving SPT and those where SPT was switched to oral linezolid between days 3 and 9 of treatment until completion. We excluded complicated SAB and osteoarticular infections. A k-nearest neighbor algorithm was used for propensity score matching with a 2:1 ratio. Results After propensity score matching, we included 45 patients from the linezolid group and 90 patients from the SPT group. Leading SAB sources were catheter related (49.6%), unknown origin (20.0%), and skin and soft tissue (17.0%). We observed no difference in 90-day relapse between the linezolid group and the SPT group (2.2% vs 4.4% respectively; P = .87). No statistically significant difference was observed in 30-day all-cause mortality between the linezolid group and the SPT group (2.2% vs 13.3%; P = .08). The median length of hospital stay after onset was 8 days in the linezolid group and 19 days in the SPT group (P < .01). No drug-related events leading to discontinuation were noted in the linezolid group. Conclusions Treatment of SAB in selected low-risk patients with an oral switch to linezolid between days 3 and 9 of treatment until completion yielded similar clinical outcomes as SPT, allowing earlier discharge from the hospital.

scholarly journals Serum lactic acid level predicts poor myocardial perfusion and in-hospital outcomes in patients undergoing primary percutaneous coronary intervention

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Y Liu ◽  
C F Dai ◽  
Z W Chen ◽  
J Y Qian ◽  
J B Ge
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Lactic Acid ◽  
Risk Score ◽  
Acid Level ◽  
Coronary Intervention ◽  
Hospital Death ◽  
Lactic Acid Level ◽  
Hospital Outcomes ◽  
Grace Risk Score

Abstract Background Elevated serum lactic acid level is associated with poor outcomes in patients with critical diseases like shock. However, the clinical implication of this biomarker in patients with acute myocardial infarction remains unclear. Purpose We aimed to explore the predictive power of serum lactic acid level on admission for in-hospital outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (pPCI). Methods Consecutive patients undergoing pPCI with available data on serum lactid acid level were evaluated for eligbility in this retrospective cohort study. The primary outcome was all-cause death during hospitalization. Enzymatic infarct size and major adverse cardiovascular events (MACE, defined as a combination of all-cause death, recurrent myocardial infarction, and unplanned repeated revascularization) were considered secondary outcomes. Independent preditors of in-hospital death were determined by multiple logisic regression analysis. Odds ratio (OR) with 95% confidence interval (CI) was used to demonstrate the association. The predictive power of serum latictic acid level for in-hospital death was evaluated through receiver operator characteristic curve, which generated C-statictic. A combination model was further constructed by adding serum latictic acid level to the Global Registry of Acute Coronary Events (GRACE) risk score (LA-GRACE risk score). The linear dependence between serum lactic acids level and othe clinical variables was analysed using Spearman rank correlation. Results Of the 302 patients enrolled in the current analysis, 15 (5.0%) died during hospitalization. Serum lactic acid level (OR=1.657, 95% CI: 1.115 to 2.463, p=0.012)and left ventricular ejection fraction (OR=0.858, 95% CI: 0.767 to 0.959, p=0.007) were the only two independent predictors of in-hospital death. The C-statistic of serum lactic acid level for predicting in-hospital death was 0.886 (95% CI: 0.793 to 0.979). The LA-GRACE risk score improved the C-statistic of the GRACE score from 0.898 to 0.911 (p=0.294), with continuous net reclassification improvement of 0.567 (p=0.023) and integrated discrimination improvement of 0.206 (p=0.003). High serum lactic acid level was also asscoiated with larger enzymatic infarct size (p=0.002) and MACE (p=0.004). Further, it significantly correlated with white blood cell counts (r=0.264, p&lt;0.001), serum creatinine level (r=0.189, p=0.001), and systolic blood pressure (r=−0.122, p=0.034). Conclusion Serum lactic acid level on admission is asscoiated with poor myocardial perfusion and in-hospital outcomes in patients with acute myocardial infarction undergoing pPCI. It may contribute to better risk stratification in these populations. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported by the National Program on Key Basic Research Project of China (Grant No: 2019YFC0840601 and 2014CBA02003), National Natural Science Foundation of China (Grant No: 81870267, 81970295, 81521001, 81670318 and 81570314), Grant of Shanghai Shenkang on Key Clinical Research Project (Grant No: SHDC2020CR2015A and SHDC12019104), Grant of Shanghai Science and Technology Committee (Grant No: 19MC1910300, 18411950200 and 20JC1410800), Key Medical and Health Projects of Xiamen Province (No: 3502Z20204004), Grant of Shanghai Municipal Commission of Health and Family Planning (Grant No: 2017YQ057), Grant of Zhongshan Hospital Affiliated to Fudan University (Grant No: 2018ZSLC01), VG Funding of Clinical Trials (2017-CCA-VG-036) and Merck Funding (Xinxin-merck-fund-051). ROC of lactic acid and GRACE score

scholarly journals In-hospital outcomes of self-expanding and balloon-expandable transcatheter heart valves in Germany

2021 ◽  
Author(s):  
Peter Stachon ◽  
Philip Hehn ◽  
Dennis Wolf ◽  
Timo Heidt ◽  
Vera Oettinger ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Major Bleeding ◽  
Postoperative Delirium ◽  
Kidney Injury ◽  
Length Of Hospital Stay ◽  
Hospital Outcomes

Abstract Introduction The effect of valve type on outcomes in transfemoral transcatheter aortic valve replacement (TF-TAVR) has recently been subject of debate. We investigate outcomes of patients treated with balloon-expanding (BE) vs. self-expanding (SE) valves in in a cohort of all these procedures performed in Germany in 2018. Methods All patients receiving TF-TAVR with either BE (N = 9,882) or SE (N = 7,413) valves in Germany in 2018 were identified. In-hospital outcomes were analyzed for the endpoints in-hospital mortality, major bleeding, stroke, acute kidney injury, postoperative delirium, permanent pacemaker implantation, mechanical ventilation > 48 h, length of hospital stay, and reimbursement. Since patients were not randomized to the two treatment options, logistic or linear regression models were used with 22 baseline patient characteristics and center-specific variables as potential confounders. As a sensitivity analysis, the same confounding factors were taken into account using the propensity score methods (inverse probability of treatment weighting). Results Baseline characteristics differed substantially, with higher EuroSCORE (p < 0.001), age (p < 0.001) and rate of female sex (p < 0.001) in SE treated patients. After risk adjustment, no marked differences in outcomes were found for in-hospital mortality [risk adjusted odds ratio (aOR) for SE instead of BE 0.94 (96% CI 0.76;1.17), p = 0.617] major bleeding [aOR 0.91 (0.73;1.14), p = 0.400], stroke [aOR 1.13 (0.88;1.46), p = 0.347], acute kidney injury [OR 0.97 (0.85;1.10), p = 0.621], postoperative delirium [aOR 1.09 (0.96;1.24), p = 0.184], mechanical ventilation > 48 h [aOR 0.98 (0.77;1.25), p = 0.893], length of hospital stay (risk adjusted difference in days of hospitalization (SE instead of BE): − 0.05 [− 0.34;0.25], p = 0.762) and reimbursement [risk adjusted difference in reimbursement (SE instead of BE): − €72 (− €291;€147), p = 0.519)] There is, however, an increased risk of PPI for SE valves (aOR 1.27 [1.15;1.41], p < 0.001). Similar results were found after application of propensity score adjustment. Conclusions We find broadly equivalent outcomes in contemporary TF-TAVR procedures, regardless of the valve type used. Incidence of major complications is very low for both types of valve.

Abstract WP315: Acute Myocardial Infarction Associated With Worse Outcomes in Acute Cerebrovascular Disease

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Sea mi Park ◽  
Shouri Lahiri ◽  
Asma Moheet ◽  
Jaspreet Mann ◽  
Axel Rosengart
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cerebrovascular Disease ◽  
Hospital Stay ◽  
Early Recognition ◽  
Hospital Costs ◽  
Care Facility ◽  
Length Of Hospital Stay ◽  
Female Gender ◽  
Nationwide Inpatient Sample Database

Introduction/Hypothesis: We examined the prevalence and outcomes of patients admitted with acute cerebrovascular disease (ACVD) and concomitant acute myocardial infarction (AMI). Methods: We utilized the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (1998-2009) and identified 1,760,415 adult ACVD patients among 92,848,710 patients enrolled. Using SAS 6.4 and applying SPSS 22 the outcome variables mortality, length of hospital stay (LOS), hospital costs >$20,000, and disposition (home or any care facility) were selected and logistic regression analyses was performed adjusting for the covariates hypertension, diabetes mellitus, age, race, sex, number of comorbidities, and care complexity (numbers of inpatient procedures) among all ACVD with and without AMI. Results: Mean age was 71 years (SD 15) with 76% >65 years old; 54% female gender; 55% Whites, 11% Blacks, and 6% Hispanics. Among all ACVD, 66% had HTN, 28% DM, AMI 4.1%, LOS was 7.6 days (SD 9.8), in-patient mortality 12%; disposition home 42% and facility 44%, and mean hospital costs $36,010 (SD $63,331). After covariate adjustment, ACVD patients with AMI compared to those without AMI had a mortality of 30% vs 12% (P<0.000); LOS ≥7 days 53% vs 30% (P<0.000), facility discharge 68% vs 51% (P<0.000), and adjusted hospital costs 71% vs 44% (P<0.000). Conclusions: Acute myocardial infarction occurred in 4.1% of patients with acute cerebrovascular disease. It was associated with significantly increased risks of in-patient mortality, length of hospital stay, facility disposition and hospital costs. Considering the poor outcomes of ACVD patients with AMI may indicate more aggressive strategies for early recognition and reduction of myocardial injury.

Sign in / Sign up

Export Citation Format

Share Document