scholarly journals Risk factors of adverse outcomes of various interventions when treating patients with concomitant lesions of the coronary bed and carotid arteries in 30-day follow-up

2018 ◽  
Vol 22 (1) ◽  
pp. 36 ◽  
Author(s):  
R. S. Tarasov ◽  
A. N. Kazantsev ◽  
S. V. Ivanov ◽  
A. A. Golovin ◽  
N. N. Burkov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Conflict Of Interest ◽  
Carotid Arteries ◽  
Bypass Graft ◽  
Prognostic Significance ◽  
Atherosclerotic Lesion ◽  
Adverse Outcomes ◽  
Comorbid Condition ◽  
Wide Range

<p><strong>Aim.</strong> The study looks at clinical and instrumental factors associated with adverse outcomes in the hospital and long-term follow-up when using various surgical strategies for treatment of patients with multifocal atherosclerosis.<br /><strong>Methods.</strong> From 2011 to 2015, three hundred ninety-one patients with combined hemodynamically significant atherosclerotic lesion of the coronary bed and internal carotid arteries were included in this study in a continuous sampling mode. A detailed analysis of the prognostic significance of a wide range of clinical-instrumental, anatomical-angiographic and perioperative factors was performed.<br /><strong>Results.</strong> Against the background of patients’ initially severe comorbid condition, the most significant hospital risk factors were III–IV functional class angina and stroke in the anamnesis. It is important to note a high risk of complications, with bleeding reaching three points or higher on the Bleeding Academic Research Consortium (BARC) scale during simultaneous coronary artery bypass graft surgery and carotid endarterectomy. At the same time, EuroSCORE II value not higher than 2% and the duration of artificial circulation 74 minutes or less turned out to be protective factors. <br /><strong>Conclusion.</strong> The study is not randomized and requires further research on the algorithms for choosing the optimal option of revascularization in this group of patients. The results obtained can form the basis for further research aimed at developing optimal surgical protocols for patients with multifocal atherosclerosis.</p><p>Received 2 August 2017. Revised 16 October 2017. Accepted 25 October 2017.</p><p><strong>Funding:</strong> The research was done with support of the grant (No. 12090ГУ/2017) awarded by the Fund for Facilitation of Innovations within the framework of the “Umnik-2016” project (Kemerovo).</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: R.S. Tarasov<br />Data collection and analysis: A.A. Golovin, N.N. Burkov, M.G. Zinets<br />Drafting the article: A.N. Kazantsev<br />Critical revision of the article: S.V. Ivanov, A.I. Anoufriev<br />Final approval of the version to be published: R.S. Tarasov, A.N. Kazantsev, S.V. Ivanov, A.A. Golovin, N.N. Burkov, A.I. Anoufriev, M.G. Zinets, L.S. Barbarash</p>

The combined impact of Type D personality and depression on cardiovascular events after acute myocardial infarction

2021 ◽  
pp. 1-11
Author(s):  
Yini Wang ◽  
Xueqin Gao ◽  
Zhenjuan Zhao ◽  
Ling Li ◽  
Guojie Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Significant Risk ◽  
Type D Personality ◽  
Adverse Outcomes ◽  
Combined Effect ◽  
Continuous Variables ◽  
Type D

Abstract Background Type D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI). Methods This prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period. Results A total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (−) groups had a higher risk of MACE [95% confidence interval (CI) 1.74–6.07] (95% CI 1.25–2.96) and ISR (95% CI 3.09–8.28) (95% CI 1.85–6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (−) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients. Conclusions These findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.

scholarly journals Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e025840 ◽  
Author(s):  
Natasa Gisev ◽  
Sallie-Anne Pearson ◽  
Timothy Dobbins ◽  
David C Currow ◽  
Fiona Blyth ◽  
...  
Keyword(s):  
Risk Factors ◽  
Opioid Dependence ◽  
Service Use ◽  
Population Level ◽  
Ethics Committee ◽  
Adverse Outcomes ◽  
Opioid Use ◽  
Research Committee ◽  
Services Research ◽  
Wide Range

IntroductionOpioid prescribing has increased 15-fold in Australia in the past two decades, alongside increases in a range of opioid-related harms such as opioid dependence and overdose. However, despite concerns about increasing opioid use, extramedical use and harms, there is a lack of population-level evidence about the drivers of long-term prescribed opioid use, dependence, overdose and other harms.Methods and analysisWe will form a cohort of all adult residents in New South Wales (NSW), Australia, who initiated prescribed opioids from 2002 using Pharmaceutical Benefits Scheme dispensing records. This cohort will be linked to a wide range of other datasets containing information on sociodemographic and clinical characteristics, health service use and adverse outcomes (eg, opioid dependence and non-fatal and fatal overdose). Analyses will initially examine patterns and predictors of prescribed opioid use and then apply regression and survival analysis to quantify the risks and risk factors of adverse outcomes associated with prescribed opioid use.Ethics and disseminationThis study has received full ethical approval from the Australian Institute of Health and Welfare Ethics Committee, the NSW Population and Health Services Research Committee and the ACT Health Human Research Ethics Committee. This will be the largest postmarketing surveillance study of prescribed opioids undertaken in Australia, linking exposure and outcomes and examining risk factors for adverse outcomes of prescribed opioids. As such, this work has important translational promise, with direct relevance to regulatory authorities and agencies worldwide. Project findings will be disseminated at scientific conferences and in peer-reviewed journals. We will also conduct targeted dissemination with policy makers, professional bodies and peak bodies in the pain, medicine and addiction fields through stakeholder workshops and advisory groups. Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely collected Data (RECORD) Statement.

scholarly journals Results after Repair of Functional Tricuspid Regurgitation with a Three-Dimensional Annuloplasty Ring

2021 ◽  
Vol 10 (21) ◽  
pp. 5080
Author(s):  
Elda Dzilic ◽  
Thomas Guenther ◽  
Amel Bouziani ◽  
Bernhard Voss ◽  
Stephanie Voss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tricuspid Regurgitation ◽  
Three Dimensional ◽  
Annuloplasty Ring ◽  
Recommended Treatment ◽  
Functional Tricuspid Regurgitation ◽  
Cardiac Procedure ◽  
Wide Range ◽  
Reoperation Rates

Background: Tricuspid valve (TV) repair is the recommended treatment for severe functional tricuspid regurgitation (fTR) in patients undergoing left-sided surgery. For this purpose, a wide range of annuloplasty devices differing in form and flexibility are available. This study reports the results using a three-dimensional annuloplasty ring (Medtronic, Contour 3D Ring) for TV repair and analysis of risk factors. Methods: A cohort of 468 patients who underwent TV repair (TVr) with a concomitant cardiac procedure from December 2010 to January 2017 was retrospectively analyzed. Results: At follow-up, 96.1% of patients had no/trivial or mild TR. The 30-day mortality was 4.7%; it significantly differed between electively performed operations (2.7%) and urgent/emergent operations (11.7%). Risk factors for recurrent moderate and severe TR were LVEF < 50%, TAPSE < 16 mm, and moderate mitral valve (MV) regurgitation at follow-up. Preoperatively reduced renal function lead to a higher 30-day and overall mortality. Reoperation of the TV was required in six patients (1.6%). Risk factors for TV related reoperations were preoperative TV annulus over 50 mm and an implanted permanent pacemaker. Conclusions: TVr with the Contour 3D annuloplasty ring shows low TR recurrence and reoperation rates. Risk-factor analysis for the recurrence of TR revealed the importance of left- and right-ventricular function.

scholarly journals Delirium in Critically ill Patients in a Tertiary Care Centre in Western Region of Nepal

2015 ◽  
Vol 12 (2) ◽  
pp. 117-120
Author(s):  
P Thapa ◽  
PK Chakraborty ◽  
JB Khattri ◽  
K Ramesh ◽  
P Sharma
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
Significant Proportion ◽  
Adverse Outcomes ◽  
Tube Placement ◽  
Tertiary Care Centre ◽  
Cross Sectional

Background Delirium affects a significant proportion of critically ill patients admitted in hospital. It is associated with various adverse outcomes. Despite its enormous prognostic significance it tends to be underdiagnosed. There is a dearth of studies on risk factors of delirium in our setting.Objectives The main objectives of this study was to find out the prevalence, rate of non recognition and risk factors associated with delirium in hospitalized critically ill patients.Methods A hospital based cross-sectional study was carried out. Data was collected using a predesigned semi-structured proforma and Intensive care delirium screening checklist was used to screen for delirium in patients admitted in various wards of Manipal teaching hospital, Pokhara, Nepal.Results Ninety five cases were included in the analysis. The mean age of study group was 58.9 ± 19.1 years. Delirium was present in 15/95 cases and it was not recognized by treating physician in about one third of cases. Odds ratio (OR) was statistically significantly increased in patients with history of stroke (OR=4.484 95% CI=1.0896;18.459), alcohol use (OR=10.792 95% CI=2.906;40.072), smoking (OR= 4.836 95% CI= 1.411;16.576), use of restraint (OR=17.143 95% CI=4.401;66.766), nasogastric tube placement (OR= 7.731 95% CI=2.348;25.452) and use of Foley’s catheter (OR=12.000 95% CI= 3.072;46.877).Conclusion About 16% of critically ill patients were found to be delirious. In about one third of the cases delirium was not recognized. Both patient related and iatrogenic factors may increase the risk of delirium in hospitalized critically ill patients.Kathmandu University Medical Journal Vol.12(2) 2014: 117-120

Unexpected deaths and unplanned re-admissions in infants discharged home after cardiac surgery: a systematic review of potential risk factors

2014 ◽  
Vol 25 (5) ◽  
pp. 839-852 ◽  
Author(s):  
Jenifer Tregay ◽  
Jo Wray ◽  
Catherine Bull ◽  
Rodney C. Franklin ◽  
Piers Daubeney ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Hospital Discharge ◽  
Care Pathway ◽  
Early Postoperative Period ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Post Discharge ◽  
Feeding Difficulties ◽  
Wide Range

AbstractBackgroundBabies with CHDs are a particularly vulnerable population with significant mortality in their 1st year. Although most deaths occur in the hospital within the early postoperative period, around one-fifth of postoperative deaths in the 1st year of life may occur after hospital discharge in infants who have undergone apparently successful cardiac surgery.AimTo systematically review the published literature and identify risk factors for adverse outcomes, specifically deaths and unplanned re-admissions, following hospital discharge after infant surgery for life-threatening CHDs.MethodsA systematic search was conducted in MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and PsycINFO electronic databases, supplemented by manual searching of conference abstracts.ResultsA total of 15 studies were eligible for inclusion. Almost exclusively, studies were conducted in single US centres and focussed on children with complex single ventricle diagnoses. A wide range of risk factors were evaluated, and those more frequently identified as having a significant association with higher mortality or unplanned re-admission risk were non-Caucasian ethnicity, lower socio-economic status, co-morbid conditions, age at surgery, operative complexity and procedure type, and post-operative feeding difficulties.ConclusionsStudies investigating risk factors for adverse outcomes post-discharge following diverse congenital heart operations in infants are lacking. Further research is needed to systematically identify higher risk groups, and to develop interventions targeted at supporting the most vulnerable infants within an integrated primary and secondary care pathway.

scholarly journals Predictors of adverse events in the mid-term postoperative period in patients who underwent carotid endarterectomy

2017 ◽  
Vol 21 (4) ◽  
pp. 50 ◽  
Author(s):  
R. S. Tarasov ◽  
A. N. Kazantsev ◽  
A. R. Shabaev ◽  
A. V. Mironov ◽  
N. N. Burkov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Carotid Endarterectomy ◽  
Postoperative Period ◽  
Conflict Of Interest ◽  
Significant Risk ◽  
Common Adverse Event ◽  
Functional Class ◽  
Syntax Score

<p><strong>Aim.</strong> Emphasis in the study was placed on the identification of unfavorable prognosis factors associated with carotid endarterectomy (CEE) during mid-term follow-up.<br /><strong>Methods.</strong> Over a period from 2015 to 2016, 222 CEE operations were performed. Most patients (n = 190; 85.5%) underwent CEE using a patch of xenopericardium, 14.4% (n = 32) received eversion CEE, and a temporary shunt was used in 14.4% (n = 32). Hybrid revascularization in the volume of percutaneous coronary intervention (PCI) + CEE was performed in 9.9% (n = 22) patients. The groups under study were compared by using a chi-square test followed by subsequent analysis of the shares, or if ordinal characters or quantitative traits with a distribution different from the normal one occurred—by using a Mann – Whitney U-test. Correction of multiple comparisons was done by calculating an average fraction of false discoveries of the hypotheses (false discovery rate). The analysis of prognostic factors was done using the odds ratio (OR) by means of the 2 × 2 tables.<br /><strong>Results.</strong> Among the complications detected in the mid-term follow-up, the most common adverse event was the development of MI in 3.6% (n = 8) of patients. According to color duplex scanning of brachiocephalic arteries, restenosis of the operated ICA was observed in 4.5% of patients. The following risk factors significantly increased the risk of adverse events: angina pectoris II–III functional class (OR = 3.84%, CI = 1.24–11.9), SYNTAX Score &gt;22 (OR = 2.83, CI = 1.137–7.086).<br /><strong>Conclusion.</strong> Based on the results of a single-center prospective retrospective study, significant risk factors for adverse outcome in the mid-term postoperative period were identified.</p><p>Received 10 May 2017. Revised 27 September 2017. Accepted 5 October 2017.</p><p><strong>Funding:</strong> The research was done with support of the grant (No. 12090ГУ/2017) awarded by the Fund for Facilitation of Innovations within the framework of the “Umnik-2016” project (Kemerovo).</p><p><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: R.S. Tarasov, A.I. Anufriyev <br />Data collection and analysis: A.R. Shabaev<br />Drafting the article: A.N. Kazantsev, N.N. Burkov <br />Critical revision of the article: A.V. Mironov<br />Final approval of the version to be published: L.S. Barbarash</p>

scholarly journals Level of N-terminal fragment of brain natriuretic peptide progenitor and atherosclerotic damage of brachocephalic arteries in patients with rheumatoid arthritis with inefficiency and/or injurability of basic anti - inflammatory treatment

2019 ◽  
Vol 91 (5) ◽  
pp. 34-39
Author(s):  
E V Gerasimova ◽  
T V Popkova ◽  
A V Martynova ◽  
E I Markelova ◽  
D S Novikova ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Diseases ◽  
Natriuretic Peptide ◽  
Prognostic Significance ◽  
Atherosclerotic Lesion ◽  
Control Group ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Traditional Risk Factors

The high prognostic significance of the concentration of the N-terminal - pro-B-type natriuretic peptide (NT-proBNP) in the development of cardiovascular diseases (CVD) was identified for rheumatoid arthritis (RA) and general populations. Aim: to investigate the significance of NT-proBNP level in patients (pts) with RA with the ineffectiveness and/or intolerance of basic anti - inflammatory therapy; compare the level of NT-proBNP with atherosclerotic lesion of the brachiocephalic arteries (BCA), traditional risk factors and inflammatory markers. Materials and methods. The investigation enrolled 28 pts (24women/4men) with the lack of efficacy/resistance and/or intolerance of basic anti - inflammatory drugs (DMARDs); median age was 55 [46; 61] years, median disease duration 114 [60; 168] month; DAS28 6,2 [5.1; 7.0]; SDAI 35.0[23.9; 51.0], CDAI 30.0[21.0; 42.0], serum positivity for rheumatoid factor (RF) (100%)/anti - cyclic citrullinated peptide antibodies (ACCP) (86%). The study did not include RA pts with congestive heart failure. High incidence of traditional risk factors was found in RA pts: arterial hypertension - in 75%, dyslipidemia - 61%, smoking - 17%, overweight - 61%, family history of cardiovascular diseases - 36%, hypodynamia - 68%. Coronary artery disease was diagnosed in 11% RA pts. Lack of efficacy of 3 or more DMARDs was found in 46% of pts, intolerance to previous therapy with DMARDs - in 54% pts. 47% were receiving methotrexate (20 [18; 25] mg/week), 11% - leflunomide, 7% - sulfasalazine, 46% - glucocorticoids, 75% - non - steroidal anti - inflammatory drugs. The control group consisted of 20 healthy donors, comparable to pts by age and sex. Serum levels of of NT-proBNP were measured using electrochemiluminescence method Elecsys proBNP II (Roche Diagnostics, Switzerland). The determination of the intima - media thickness (IMT) BCA were assessed from duplex scanning. Atherosclerotic lesion of BCA was assessed by the presence of atherosclerotic plaque (IMT ≥1.2 mm). Results. NT-proBNP concentrations in RA pts proved to be higher (78.7 [41.4; 101.3] pg/ml) than those in the control group (55.3 [36.6; 67.3] pg/ml, p100 pg/ml - 1 group (n=6) and ≤100 pg/ml - 2 group (n=22). Groups of RA pts did not differ in gender, age, activity of RA, frequency of detection of traditional risk factors. Atherosclerotic lesion of the BCA was detected in 3 (50%) pts of the 1 group and in 8 (36%) pts of the 2 group (p>0.05). In RA pts the level of NT-proBNP correlated with age (r=0.39; p

P2644Coronary atherosclerotic burden and risk of major adverse cardiac events in hypertensive patients with erectile dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Ioakeimidis ◽  
C Vlachopoulos ◽  
D Terentes-Printzios ◽  
C Georgakopoulos ◽  
E Oikonomou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Erectile Dysfunction ◽  
Coronary Artery ◽  
Comprehensive Evaluation ◽  
Bypass Graft ◽  
Peak Systolic Velocity ◽  
Sexual Life ◽  
Total Testosterone ◽  
Risk Category

Abstract Purpose Aim of the study is to assess the prevalence of angiographically coronary artery disease (CAD) and the incidence of future cardiovascular (CV) events among hypertensive males with erectile dysfunction (ED) on the basis of calculated total CV risk at first presentation. Methods A total of 392 hypertensive ED patients without diabetes or known cardiovascular disease underwent a comprehensive evaluation for presence of target organ damage (TOD) and stratified into three total CV risk categories based on blood pressure (BP) category, CV risk factors, TOD and presence of chronic kidney disease. Total testosterone (TT) and peak systolic velocity (PSV) at penile arteries were measured as markers of ED severity and predictors of CV risk. All patients underwent exercise treadmill test and stress echocardiography to reveal myocardial ischemia. Men with positive one or both of the two tests were referred for coronary angiography in order to document CAD. Our primary outcome was a composite measure which included acute myocardial infarction (AMI), stroke, congestive heart failure, revascularization with either percutaneous coronary intervention or coronary artery bypass graft surgery. All patients were followed from cohort entry until major CV event, or end of study period (December 2018), whichever occurred first. Results The whole population was divided into high (n=176), intermediate (n=120) and low (n=96) total CV risk groups. The three groups had similar mean age (57 yrs). The prevalence of angiographically documented CAD was significantly higher among patients in the high risk group (n=32, 18%), compared to intermediate (n=15, 12.5%) and low risk (n=4, 4.1%) (overall P<0.05). Furthermore, there was a progressive decrease in penile PSV and TT levels from low to moderate and high total CV risk (35 vs 31 vs 28 cm/s and 5.1 vs 4.3 vs 3.8 ng/ml, respectively, overall P<0.001), indicating significant microvascular damage and androgen deficiency in men with a higher CV risk category. Interestingly, Kaplan-Meier analysis revealed a comparable incidence of major CV events in patients who were at high and intermediate total CV risk at entry (12.5% vs. 11%, respectively, log-rank =0.57) and a greater incidence of major CV events compared to that of low CV risk patients (3.2%), (log-rank P=0.004, for all comparisons) during a 9-year follow-up period (figure). CV events during a 9-year follow-up Conclusion The incidence of future CV events is considerably high among hypertensive ED patients with a intermediate total CV risk at first evaluation. Such patients may require a comprehensive evaluation to reveal occult CAD and they need an aggressive management of BP and concomitant risk factors to reduce their CV risk and improve their sexual life.

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