scholarly journals Comparative effectiveness of simultaneous and staged operations in patients with atherosclerotic lesions of carotid and coronary arteries

2021 ◽  
Vol 14 (2) ◽  
pp. 263-269
Author(s):  
A. B. Ismoilova ◽  
N. M.U. Sultanbaeva ◽  
A. A. Abdurakhmanov ◽  
Sh. Z. Umarova ◽  
D. Kh. Dzhalalova ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Stenosis ◽  
Literature Search ◽  
Systematic Analysis ◽  
Risk Of Death ◽  
Atherosclerotic Lesions ◽  
Risk Of Mortality ◽  
Simultaneous Group ◽  
Significant Difference ◽  
Simultaneous Procedures

Objective: comparative systematic analysis of clinical trials of staged and simultaneous approaches in the surgical treatment of combined carotid and coronary stenosis based on the literature search.Material and methods. A systematic literature search was performed in PubMed/MEDLINE, Google Scholar and Scopus using predefined acceptance criteria. To compare data of simultaneous and staged surgery cumulative indicators of heart attack, stroke and mortality, expressed as percentages and absolute numbers, were analyzed; the Mantel–Hensel formula and the χ2 method were used to assess the relative risk of major adverse cardio-cerebral events development and mortality.Results. The analysis included 7 studies containing one intervention (4 simultaneous and 3 stage methods). The risk of developing myocardial infarction was RR 0.13 (95% CI 0.02–0.67) for simultaneous tactics, and RR 7.79 (95% CI 1.5–40.43) for staged tactics (p˂0.005). The risk of stroke developing was RR 1.29 (95% CI 0.56–2.99) for a simultaneous approach, and RR 0.78 (95% CI 0.33–1.8) for stage approach (p˃0.05). The risk of mortality was RR 0.77 (95% CI 0.31–1.88) for simultaneous procedures, and RR 1.3 (95% CI 0.53–3.18) for staged procedures (p˃0.05).Conclusion. Staged tactics for combined carotid and coronary stenosis may be accompanied by a significantly higher risk of myocardial infarction. There was no statistically significant difference between the groups in terms of the risk of stroke and mortality, but there was a trend towards a higher risk of stroke in the simultaneous group and a higher risk of death from all causes in the staged group.

scholarly journals The effect of unguided de-escalation of P2Y12 receptor inhibitor therapy after acute myocardial infarction in patients undergoing percutaneous coronary intervention: a nationwide cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.S Yeh ◽  
C.Y Hsu ◽  
C.Y Huang ◽  
W.T Chen ◽  
Y.C Hsieh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Funding Source ◽  
P2y12 Inhibitor ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Significant Difference

Abstract Aims To examine the effect of de-escalation of P2Y12 inhibitor in dual antiplatelet therapy (DAPT) on major adverse cardiovascular events (MACE) and bleeding complications after acute myocardial infarction (AMI) in Taiwanese patients undergoing percutaneous coronary intervention (PCI). Methods and results We retrospectively evaluated patients who had received PCI during AMI hospitalisation and were initially on aspirin and ticagrelor and without adverse events at 3 months between 2013 and 2016. In total, 1,901 and 8,199 patients were identified as switched DAPT (switched to aspirin and clopidogrel) and unswitched DAPT (continued on aspirin and ticagrelor) cohorts, respectively. With a mean follow-up of 8 months, the incidence rates (per 100 person-year) of death, AMI readmission and MACE were 2.89, 3.68 and 4.91 in the switched cohort and 2.42, 3.28 and 4.72 in the unswitched cohort, respectively based on an inverse probability of treatment weighted method. (Table) After adjustment for patients' clinical variables, two groups were no significant difference in death (A), AMI admission (B) and MACE (C). Additionally, there was no difference in the risk of major (D) or non-major clinically relevant bleeding (E) (Figure 1). Conclusions Unguided de-escalation of P2Y12 inhibitor in DAPT was not associated with higher risk of death, MACE, AMI readmission in Taiwanese patients with AMI undergoing PCI. Figure 1 Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Taipei Medical University

Effect of education on anxiety and depression in patients with myocardial infarction

2011 ◽  
Vol 26 (S2) ◽  
pp. 133-133
Author(s):  
N. Aghakhani
Keyword(s):  
Myocardial Infarction ◽  
Medical Science ◽  
Anxiety And Depression ◽  
Control Group ◽  
Face To Face ◽  
Risk Of Death ◽  
Increased Risk ◽  
Significant Difference ◽  
Quasi Experimental ◽  
Experimental Group

IntroductionAbout 65 percent of patients with myocardial infarction experience mental and emotional problems like depression and anxiety that causes delay in the return to work, decreased quality of life and increased risk of death.The purpose of this study was to determine the effect of education on anxiety and depression in patients with myocardial infarction in Urmia hospitals in 2009.MethodsThis study was a quasi-experimental study that compares the effect of education on anxiety and depression in patients with myocardial infarction in the Urmia University of medical science hospitals. 124 patients were selected randomly and divided into two groups. The experimental group was educated through face to face training and educational booklet. Control group did not receive any intervention.Level of anxiety and depression was evaluated by using HADS questionnaire at 3 intervals after 48 hours of admission, discharge day and 2 months after discharge.ResultsThere was no significant difference between control and experimental groups before the intervention, But after the intervention, anxiety and depression in the experimental group was significantly less than controls, p < 0.05.ConclusionConsidering the beneficial results obtained from education on reducing anxiety and depression in patients with myocardial infarction, it should be one of the health care goals.

scholarly journals Impact of ST‐Segment–Elevation Myocardial Infarction Regionalization Programs on the Treatment and Outcomes of Patients Diagnosed With Non–ST‐Segment–Elevation Myocardial Infarction

2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Juan Carlos C. Montoy ◽  
Yu‐Chu Shen ◽  
Ralph G. Brindis ◽  
Harlan M. Krumholz ◽  
Renee Y. Hsia
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Infarctions ◽  
St Segment Elevation ◽  
Risk Of Death ◽  
Segment Elevation Myocardial Infarction ◽  
Risk Of Mortality ◽  
St Segment ◽  
Changes In Risk ◽  
The Impact ◽  
Improve Access

Background Many communities have implemented systems of regionalized care to improve access to timely care for patients with ST‐segment–elevation myocardial infarction. However, patients who are ultimately diagnosed with non–ST‐segment–elevation myocardial infarctions (NSTEMIs) may also be affected, and the impact of regionalization programs on NSTEMI treatment and outcomes is unknown. We set out to determine the effects of ST‐segment–elevation myocardial infarction regionalization schemes on treatment and outcomes of patients diagnosed with NSTEMIs. Methods and Results The cohort included all patients receiving care in emergency departments diagnosed with an NSTEMI at all nonfederal hospitals in California from January 1, 2005 to September 30, 2015. Data were analyzed using a difference‐in‐differences approach. The main outcomes were 1‐year mortality and angiography within 3 days of the index admission. A total of 293 589 patients with NSTEMIs received care in regionalized and nonregionalized communities. Over the study period, rates of early angiography increased by 0.5 and mortality decreased by 0.9 percentage points per year among the overall population (95% CI, 0.4–0.6 and −1.0 to −0.8, respectively). Regionalization was not associated with early angiography (−0.5%; 95% CI, −1.1 to 0.1) or death (0.2%; 95% CI, −0.3 to 0.8). Conclusions ST‐segment–elevation myocardial infarction regionalization programs were not statistically associated with changes in guideline‐recommended early angiography or changes in risk of death for patients with NSTEMI. Increases in the proportion of patients with NSTEMI who underwent guideline‐directed angiography and decreases in risk of mortality were accounted for by secular trends unrelated to regionalization policies.

scholarly journals Trends and sex differences in characteristics and outcomes in myocardial infarction: a 20-year analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Li ◽  
Y K Tse ◽  
Q W Ren ◽  
M Z Wu ◽  
S Y Yu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Sex Differences ◽  
Ischemic Stroke ◽  
Ischaemic Stroke ◽  
Public Institution ◽  
Risk Of Death ◽  
Time Interaction ◽  
Increased Risk ◽  
Significant Difference ◽  
Over Time

Abstract Background There are considerable sex differences in patients with myocardial infarction (MI). However, the recent temporal trends in characteristics and outcomes in women vs. men, particularly in an Asian population, remain poorly understood. Purpose We aim to evaluate the sex differences in characteristics and outcomes, and how have these differences evolved over the past 2 decades in patients with MI. Methods From a well-validated territory-wide database in Hong Kong, we included patients with incident acute MI from 1999/01/01 to 2018/12/31. Outcomes of interest include, at 30 days, all-cause death, new-onset heart failure (HF), and ischaemic stroke. Trends in sex differences in baseline characteristics were evaluated using linear and Poisson regression, while differences in outcomes were evaluated using Cox proportional hazard model, adjusted with demographics, comorbidities, and baseline medications. A Fine-Gray model was used to evaluate HF and ischaemic stroke to account for competing risk, with all-cause death defined as competing event. Results A total of 130,218 patients (age 73.6±13.9 years, 40.0% female) were included. Women were older (79.5±11.7 vs. 69.6±13.8 years, P&lt;0.001) and had a more pronounced increasing trend in age over time (interaction P&lt;0.001). Women were also more comorbid overall (Charlson Comorbidity Index [CCI] 1.25 vs 0.85, age-adjusted P&lt;0.001), but the rising trend in CCI over time was less pronounced than in men (interaction P&lt;0.001) (Figure 1). Women had more baseline hypertension, diabetes, and severe renal disease than men (age-adjusted P&lt;0.001), while the increasing trends in these comorbidities were all more pronounced in men than in women (all interaction P&lt;0.001). Women were more likely to have ST-elevation overall (P&lt;0.001). Although the crude 30-day mortality rate was higher in women (32.6% vs 23.9%), after adjustment for confounders, they had a lower risk of death (hazard ratio [HR] 0.97, 95% CI [0.96 to 0.99], P=0.003). There was no significant difference in the decreasing trend in 30-day mortality between both sexes (interaction P=0.787) (Figure 1). Women had a higher risk of developing HF (HR 1.04 [1.01 to 1.08], P=0.012) and ischemic stroke (HR 1.36 [1.24 to 1.48], P&lt;0.001) in 30 days. Among patients aged ≤55 (N=15,324), women (N=2,161, 14.1%) had higher risks of all-cause death (HR 1.61 [1.40 to 1.85], P&lt;0.001), HF (HR 1.64 [1.17 to 2.32], P=0.004), and ischemic stroke (HR 1.69 [1.14 to 2.51], P=0.010) in 30 days, even after adjustment for covariates. The excess mortality in women declined over time (interaction P=0.002). Conclusions Women MI patients were older and more comorbid compared to men, which contributed to the higher risk of death, HF, and ischemic stroke among women. Among young MI patients, the increased risk for adverse outcomes among women was particularly pronounced, though the sex differences in mortality reduced over time. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The Shenzhen Key Medical DisciplineThe Sanming Project of HKU-SZH Cardiology

Perioperative Myocardial Infarction and Risk of Death with and without Preoperative Beta Blockers

2007 ◽  
Vol 73 (11) ◽  
pp. 1166-1168
Author(s):  
Michael A. Goldfarb ◽  
Mark Cavaretta ◽  
Thomas Baker
Keyword(s):  
Myocardial Infarction ◽  
Beta Blockers ◽  
Perioperative Period ◽  
Perioperative Myocardial Infarction ◽  
Risk Of Death ◽  
Medical Clearance ◽  
Significant Difference ◽  
Type Of Surgery

This study compares patients who have had a myocardial infarction in the perioperative period who were on perioperative beta blockers with those who had a myocardial infarction and were not on perioperative beta blockers. The charts of 68 patients were reviewed retrospectively. The timing and diagnosis of the myocardial infarction, gender, age, type of surgery, type of anesthesia, diabetics, preoperative medical clearance, and deaths were recorded. A subgroup of patients who had significant bleeding perioperatively or postoperatively were compared with patients with no bleeding problems. From 1998 through 2006, there were 46,003 patients who had surgery and 68 perioperative infarcts. Of the 68 patients, 25 received perioperative beta blockers and 11 died. Of the 43 patients who did not receive beta blockers, 22 died. There was no statistically significant difference when the patients were analyzed for concomitant bleeding or nonbleeding with regards to survival and beta blockers.

scholarly journals Radical Nephrectomy Provides a Worse Prognosis Than Partial Nephrectomy in T3aN0M0 Renal Cancer of Small (≤4 cm) Size and No Invasion of Perisinus Fat

2020 ◽  
Author(s):  
Shiliang Liu ◽  
Zhixian Wang ◽  
Chang Liu
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Partial Nephrectomy ◽  
Tumor Size ◽  
Radical Nephrectomy ◽  
Risk Of Death ◽  
Recommended Treatment ◽  
Risk Of Mortality ◽  
Significant Difference

Abstract Background: Radical nephrectomy (RN) is the recommended treatment for T3aN0M0 renal cell carcinoma (RCC). However, it is not necessarily the best treatment for small T3aN0M0 RCCs. We evaluated the effect of tumor size combined with consideration of anatomic types of extrarenal-fat invasion on the surgical decision-making between partial nephrectomy (PN) vs. RN in T3aN0M0 RCC.Methods: Data were obtained from the Surveillance, Epidemiology, and End Results database (2004 to 2015) with 6125 patients suffering from T3aN0M0 RCC. Cox and Fine and Gray models were used for survival analyses. Propensity-score matching was used for PN vs. RN.Results: A larger T3aN0M0 RCC was associated with higher risk of mortality (hazard ratio (HR)all-cause mortality: 1.07, 95% confidence interval (CI): 1.02–1.13, P = 0.011; HRRCC-cause mortality: 1.13, 95%CI: 1.06–1.21, P < 0.001) compared with a small T3aN0M0 RCC. After propensity-score matching, in T3aN0M0 ≤4 cm, RN compared with PN significantly increased the risk of death (HR: 1.77; 95%CI: 1.14–2.74, P = 0.011) and offered no significant difference in RCC-specific survival (HR: 1.57, 95%CI: 0.74–3.36, P = 0.240). However, RN and PN showed no significant difference in overall survival in T3aN0M0 RCC >4 cm (HR: 0.98; 95%CI: 0.59–1.62, P= 0.929) or in T3aN0M0 RCC with sinus/perisinus-fat invasion (HR: 1.18; 95%CI: 0.61–2.27, P = 0.631).Conclusion: PN provided better overall survival compared with RN for small (≤4 cm) T3aN0M0 RCCs without sinus/perisinus-fat invasion. Focusing only on anatomic-invasion characteristics rather than type and tumor size is not sufficient for treatment decisions in T3aN0M0 RCC.

scholarly journals Early Aspirin Discontinuation After Coronary Stenting: A Systematic Review and Meta‐Analysis

2021 ◽  
Author(s):  
Jens Wiebe ◽  
Gjin Ndrepepa ◽  
Sebastian Kufner ◽  
Anna L. Lahmann ◽  
Erion Xhepa ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Control Therapy

Background The clinical impact of early aspirin discontinuation compared with dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention with stenting remains poorly studied. We investigated the clinical outcomes of patients assigned to either early aspirin discontinuation or DAPT after percutaneous coronary intervention with stenting. Methods and Results We performed a meta‐analysis of aggregate data from randomized clinical trials enrolling participants receiving a percutaneous coronary intervention with stenting and assigned to either early aspirin discontinuation or DAPT. Scientific databases were searched from inception through March 30, 2020. Trial‐level hazard ratios (HRs) and 95% CIs were pooled using a random effects model with inverse variance weighting. The primary outcome was all‐cause death. Secondary outcomes were myocardial infarction, stent thrombosis, stroke, and major bleeding. Overall, 36 206 participants were allocated to either early aspirin discontinuation (experimental therapy, n=18 088) or DAPT (control therapy, n=18 118) in 7 trials. Median follow‐up was 12 months. All‐cause death occurred in 2.5% of patients assigned to experimental and 2.9% of patients assigned control therapy (hazard ratio [HR], 0.91, 95% CI, 0.75–1.11; P =0.37). Overall, patients treated with experimental versus control therapy showed no significant difference in terms of myocardial infarction (HR, 1.02 [0.85–1.22], P =0.81), stent thrombosis (HR, 1.02 [0.87–1.20], P =0.83), or stroke (HR, 1.01 [0.68–1.49], P =0.96). However, the risk for major bleeding (HR, 0.58 [0.43–0.77], P <0.01) was significantly reduced by experimental as compared with control therapy. Conclusions In patients treated with percutaneous coronary intervention and stenting, assigned to a strategy of early aspirin discontinuation versus DAPT, the risk of death and ischemic events is not significantly different but the risk of bleeding is lower.

scholarly journals Managing Nonagenarians with Acute Myocardial Infarction: Invasive versus Conservative Treatment

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jooho Lee ◽  
Kyoung-Woo Seo ◽  
Jin-Sun Park ◽  
Hyoung-Mo Yang ◽  
Hong-Seok Lim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Treatment Group ◽  
Medical Treatment ◽  
Treatment Strategy ◽  
St Segment Elevation ◽  
Risk Of Death ◽  
St Segment ◽  
Significant Difference ◽  
One Year

Background. Limited data are available to support an invasive treatment strategy in nonagenarians with acute myocardial infarction (AMI). We aimed to investigate whether percutaneous coronary intervention (PCI) is beneficial in this frail population. Methods. We retrospectively analyzed 41 nonagenarians with AMI (both ST-segment-elevation and non-ST-segment-elevation MI) between 2006 and 2015 in a single center. We assessed 30-day and one-year mortality rates according to the treatment strategy. Results. Among study subjects, 24 (59%) were treated with PCI (PCI group) and 17 (41%) were treated with conservative management (medical treatment group) per the clinician’s discretion. The median follow-up duration was 30 months (0–74 months). Thirty-day mortality was lower in the PCI group than in the medical treatment group (17% vs. 65%; P < 0.001 ). One-year mortality was also lower in the PCI group than in the medical treatment group (21% vs. 76%; P < 0.001 ). The PCI group presented a 73% decreased risk of death (adjusted hazard ratio: 0.269; 95% confidence interval: 0.126–0.571; P < 0.001 ). In the Killip class 1 through 3 subgroups (n = 36), 30-day and one-year mortality were still higher among those in the medical treatment group (13% vs. 54% at 30 days; P < 0.001 and 17% vs. 69% at one year; P < 0.001 ). Landmark analysis after 30 days revealed no significant difference in the cumulative mortality rate between the two groups, indicating that the mortality difference was mainly determined within the first 30 days after AMI. Conclusion. Mortality after AMI was decreased in correlation with the invasive strategy relative to the conservative strategy, even in nonagenarians. Regardless of age, PCI should be considered in AMI patients. However, large-scale randomized controlled trials are needed to support our conclusion.

scholarly journals Comparison of clinical outcomes after transcarotid and transsubclavian versus transfemoral TAVI: a propensity-matched analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Villecourt ◽  
L Faroux ◽  
A Muneaux ◽  
S Tassan-Mangina ◽  
V Heroguelle ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
P Value ◽  
Long Term Outcomes ◽  
Risk Of Death ◽  
Acute Kidney Injury Stage ◽  
Significant Difference ◽  
All Cause Mortality

Abstract   Transcarotid (TC) and transsubclavian (TSc) accesses are increasingly used as alternative approaches for TAVI when the transfemoral (TF) access is not suitable. However, concerns remain about the risk of peri-procedural stroke and long-term outcomes following TC or TSc TAVI. The present study sought to compare early- and long-term outcomes of TC/TSc vs. TF TAVI after propensity-score matching. 260 patients who underwent TAVI through a TF (n=220), TC (n=32) or TSc (n=8) approach at our institution during a 4 years period were identified. A 1:1 matching based on the propensity-score was performed, leading to a population of 40 TF and 40 TC/TSc. Primary endpoints were early complications whereas secondary endpoints were long-term outcomes. There was no difference in the baseline characteristics. At 30-day post-TAVI, there was no difference in mortality and stroke rates between TF and TC/TSc TAVI (5% vs. 5% mortality, p=1.0 and 2 vs. 1 stroke, p=1.0). After a median follow-up of 21 months, the risk of death (p=0.950), stroke (p=0.817) and myocardial infarction (p=0.155) did not differ between the 2 groups. After propensity-score matching, no significant difference in early and long-term outcomes was observed between TF and TSc/TSc TAVI. These findings should encourage Heart-Teams to consider a TC or TSc approach when TF access is not available. Table 1. 30-day and 1-year outcomes according to the arterial access (TF vs. TC/TSc) Variables TF-TAVI (n=40) TC/TSc-TAVI (n=40) p-value 30-day outcomes  All-cause mortality 2 (5.0) 2 (5.0) 1.000  All-stroke 2 (5.0) 1 (2.5) 1.000  Life-threatening bleeding 4 (10.0) 1 (2.5) 0.375  Acute kidney injury stage 2 or 3 2 (5.0) 1 (2.5) 1.000  Major vascular complication 6 (15.0) 6 (15.0) 1.000  Coronary obstruction 0 0 –  Early safety composite endpoint (VARC-2) 10 (25.0) 8 (20.0) 0.804 1-year outcomes  All-cause mortality 6 (15.0) 7 (17.5) 1.000  Cardiovascular mortality 5 (12.5) 3 (7.5) 0.727  Stroke 3 (7.5) 2 (5.0) 1.000  Myocardial infarction 0 (0) 2 (5) 0.500  MACCE 8 (20.0) 9 (22.5) 1.000  Readmission for heart failure 6 (15.0) 2 (5) 0.219 Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Effect of Antipyretic Therapy on Mortality in Critically Ill Patients with Sepsis Receiving Mechanical Ventilation Treatment

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Sheng Ye ◽  
Dan Xu ◽  
Chenmei Zhang ◽  
Mengyao Li ◽  
Yanyi Zhang
Keyword(s):  
Mechanical Ventilation ◽  
Regression Model ◽  
Critically Ill ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Risk Of Death ◽  
External Cooling ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Significant Difference

Purpose. The study aimed to investigate the effectiveness of antipyretic therapy on mortality in critically ill patients with sepsis requiring mechanical ventilation. Methods. In this study, we employed the multiparameter intelligent monitoring in intensive care II (MIMIC-II) database (version 2.6). All patients meeting the criteria for sepsis and also receiving mechanical ventilation treatment were included for analysis, all of whom suffer from fever or hyperthermia. Logistic regression model and R language (R version 3.2.3 2015-12-10) were used to explore the association of antipyretic therapy and mortality risk in critically ill patients with sepsis receiving mechanical ventilation treatment. Results. A total of 8,711 patients with mechanical ventilator were included in our analysis, and 1523 patients died. We did not find any significant difference in the proportion of patients receiving antipyretic medication between survivors and nonsurvivors (7.9% versus 7.4%, p=0.49). External cooling was associated with increased risk of death (13.5% versus 9.5%, p<0.001). In our regression model, antipyretic therapy was positively associated with mortality risk (odds ratio [OR]: 1.41, 95% CI: 1.20–1.66, p<0.001). Conclusions. The use of antipyretic therapy is associated with increased risk of mortality in septic ICU patients requiring mechanical ventilation. External cooling may even be deleterious.

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