RESUMO
Objective:To investigate the risk of stroke in elderly hypertensive(HTN)patients with varying baseline triglyceride glucose(TYG)index, and to identify the risk factors associated with stroke in this population.Methods:This study was a prospective cohort study that included 459 elderly patients with hypertension who were admitted to Beijing Anzhen Hospital from January 2018 to January 2020.The patients were divided into four groups based on their quartile of TYG index: Q1 group(TYG index≤8.02, 114 cases), Q2 group(8.02<TYG ≤ 8.37, 115 cases), Q3 group(8.37<TYG≤8.85, 115 cases)and Q4 group(TYG>8.85, 115 cases). The study compared the baseline clinical data and incidence of stroke(hemorrhagic or ischemic stroke)after two years of follow-up among the four groups, and analyzed the risk factors of stroke using Cox regression analyses.Results:This study examined 459 elderly patients with hypertension, of which 251(54.7%)were male and 208(45.3%)were female, with an average age of(71.7 ± 6.2)years(65-79 years). The study found significant differences among the four groups in various factors( P<0.05 for all). The study followed up with patients for a median of 33 months, 55 cases were lost to follow-up.Out of the remaining patients, 10.9% experienced stroke, with 3.7% being hemorrhagic stroke and 7.2% being ischemic stroke.The occurrence of stroke was observed in 5.3%, 8.7%, 13.0%, and 16.2% of patients in the Q1, Q2, Q3, and Q4 groups, respectively.The results of Kaplan-Meier survival analysis demonstrated that the risk of stroke increased gradually as the quartile increased.Specifically, compared to the Q1 group, the risk of stroke increased by 1.016 times(95% CI: 0.933-1.106, P=0.715), 1.264 times(95% CI: 1.067-1.497, P=0.007), and 1.472 times(95% CI: 1.119-1.936, P=0.006)in the Q2, Q3, and Q4 groups, respectively.Notably, both Q3 and Q4 groups showed a significant increase in the risk of ischemic stroke( HR=1.313, 95% CI: 1.016-1.697, P=0.037; HR=1.509, 95% CI: 1.113-2.046, P=0.008), while the Q4 group showed a significant increase in the risk of hemorrhagic stroke( HR=1.132, 95% CI: 1.021-1.255, P=0.019). Multivariate Cox regression analysis showed that male( HR=1.336), smoking history( HR=1.485), hyperlipidemia( HR=1.216), previous stroke( HR=1.547), sleep apnea( HR=1.484), diastolic blood pressure( HR=1.114), hemoglobin( HR=0.962), albumin/creatinine ratio( HR=1.318), low-density lipoprotein cholesterol( HR=1.125), TYG index( HR=1.293), left ventricular mass index( HR=1.103), and anti-platelet therapy( HR=0.874)were all found to be independent risk factors for stroke. Conclusions:In elderly patients with hypertension, there is a significant positive correlation between TYG index and stroke risk, particularly ischemic stroke.This suggests that TYG index could be clinically valuable in improving cerebrovascular risk stratification.
RESUMO
Objective:To evaluate the effect of Empagliflozin on the incidence of major adverse cardiovascular events(MACE)in elderly patients with heart failure and reduced ejection fraction(HFrEF)over a period of 1 year.Additionally, the study will analyze the influence of frailty on MACE.Methods:This study is a retrospective analysis of 577 elderly patients with type 2 diabetes and heart failure with reduced ejection fraction(HFrEF)who were consecutively admitted to Beijing Anzhen Hospital from January 2018 to December 2020.The patients were divided into three groups according to frailty index(FI): non-frailty(FI ≤ 0.210, 301 cases), moderate frailty(FI 0.211-0.310, 184 cases), and severe frailty(FI>0.311, 92 cases).Additionally, a control group of 300 elderly HFrEF patients with T2DM who did not receive Sodium glucose co-transporter type 2(SGLT-2)inhibitors was included.The MACE outcomes of different patient groups who were followed up for a year after discharge were compared.The composite outcomes of cardiac death, worsening heart failure readmission, non-fatal myocardial infarction, and non-fatal stroke were recorded and analyzed.The study also includes Cox regression analysis of relevant factors that may affect MACE outcomes.Results:A total of 877 patients were monitored for a period of 7-14 months, with a median follow-up duration of(11.4±2.3)months.Out of these patients, 47(5.4%)were lost to follow-up.During the follow-up period, 108 patients(18.7%)in the Empagliflozin group experienced major adverse cardiovascular events(MACE), which included 43 patients(7.5%)with heart failure readmission, 29 patients(5.0%)with non-fatal myocardial infarction, 23 patients(4.0%)with non-fatal stroke, and 13 patients(2.3%)with cardiovascular death.The control group had 73 cases of major adverse cardiac events(MACE), which included 33 cases(11.0%)of readmission due to heart failure, 18 cases(6.0%)of non-fatal myocardial infarction, 14 cases(4.7%)of non-fatal stroke, and 8 cases(2.7%)of cardiovascular death.The Kaplan-Meier survival analysis revealed significant differences in the risk of readmission for heart failure exacerbation and MACE among the groups.The study found that the Empagliflozin group had a significantly lower risk of MACE(18.7% vs.24.3%, HR=0.792, 95% CI: 0.639-0.982, P=0.033)compared to the control group.Additionally, as frailty level increased, the risk of MACE in each empagliflozin subgroup also increased significantly(14.6% vs.19.6% vs.30.4%, P<0.001).The moderate and severe frailty groups had a 1.342 times( HR=1.342, 95% CI: 1.116-1.768, P=0.022)and 1.933 times( HR=1.933, 95% CI: 1.207-3.854, P=0.019)higher risk of MACE compared to the non-frailty group.The study conducted a multivariate Cox regression analysis and found that several factors were independently associated with the risk of MACE, including age( HR=1.164), duration of heart failure( HR=1.225), B-type natriuretic peptide level( HR=1.221), albumin/creatinine ratio( HR=1.158), renin-angiotensin-aldosterone system blocker( HR=0.891), frailty index( HR=1.764), and empagliflozin( HR=0.792)( P<0.05 for all). Conclusions:Empagliflozin has been shown to reduce the risk of major adverse cardiovascular events(MACE)in patients with heart failure with reduced ejection fraction(HFrEF).However, it is important to note that the cardiovascular benefits of SGLT-2 inhibitors may be affected by frailty in elderly patients with heart failure.As frailty worsens, the risk of readmission and MACE may increase significantly.
RESUMO
Objective:To examine the predictive value of the intra-aortic balloon counterpulsation-shock Ⅱ(IABP-SHOCK Ⅱ)score for 30-day mortality of acute myocardial infarction(AMI)complicated by cardiogenic shock(CS)in elderly patients.Methods:Clinical data of 138 elderly patients with AMI complicated by CS admitted to our hospital and undergone IABP from January 2010 to January 2019 were retrospectively analyzed.According to the IABP-SHOCK Ⅱ score, they were divided into a low-risk group(scoring 0 to 2 points, 72 cases), a middle-risk group(scoring 3 to 4 points, 39 cases)and a high-risk group(scoring 5 to 9 points, 27 cases). Baseline data, drug therapy, interventional therapy, and IABP were used in the three groups.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of IABP-SHOCK Ⅱ for 30-day mortality.Results:Of the 138 patients, 71(51.4%)were male.There were significant differences in age, left ventricular end-diastolic diameter, left ventricular ejection fraction, levels of troponin, serum creatinine, urea nitrogen, B-type natriuretic peptide and lactic acid, Gensini score, rate of thrombolysis in myocardia infarction(TIMI)no-reflow, and rates of IABP insertion, invasive ventilation and bedside hemofiltration between the intermediate-risk group and the low-risk group and between the high-risk group and the low-risk group(each P<0.05). During hospitalization, proportions of patients receiving vasoactive drugs such as norepinephrine and dopamine in the three groups were similar(each P>0.05). After 30 days of follow-up, 25 patients(34.7%), 20 patients(51.3%), and 23 patients(85.2%)died in the low-risk group, the intermediate-risk group, and the high-risk group, respectively, with the Kaplan-Meier survival curve and the log-rank test showing statistically significant differences between the death rates(χ2=20.09, P<0.01). The ROC curve showed that the area under the curve was 0.883(95% CI: 0.702~0.942, P<0.01). Conclusions:The IABP-SHOCK Ⅱ score may be used for short-term risk stratification after IABP implantation in elderly patients with AMI and CS.
RESUMO
Objective To investigate the short-term clinical effect of extracorporeal membrane oxygenation(ECMO) for elderly patients with acute myocardial infarction(AMI)complicated with cardiogenic shock and to analyze its risk factors.Methods Clinical data of 55 elderly patients with AMI complicated with cardiogenic shock admitted into Henan Provincial Chest Hospital from January 2011 to July 2018 were retrospectively analyzed.According to the prognosis,patients were divided into the survival group (n =41) and the death group (n =14).Baseline characteristics were compared between the two groups.The short-term prognosis during hospitalization including use of temporary pacemaker,continuous renal replacement therapy and ventilation treatment and complications were compared.Univariate and multivariate logistic regression analysis were used to assess the risk factors for mortality.Results Of the 55 patients,30 patients were male(54.5％),with a mean ±SD age of (67.2±5.3)years.The time from admission to ECMO insertion was(8.6 ± 6.3)h,and the support time was (143.2 ± 61.7) h.There were significant differences in diabetes incidence,hemodynamic indexes,renal function,troponin,B-type natriuretic peptide,lactate levels and the Acute Physiology and Chronic Health Enquiry (APACHE-Ⅱ) score between the two groups (P ＜ 0.05).The dosage of norepinephrine,dobutamine and other vasoactive agents,and the application frequency of continuous renal replacement therapy,invasive ventilation treatment and intra-aortic balloon counterpulsation during hospitalization were increased in the death group compared with the survival group(P＜0.05) Incidence rates of complications including acute kidney injury,infection and multiple organ dysfunction syndrome were higher in death group than in survival group(P＜0.05).Multiple logistic regression analysis showed that advanced age,low left ventricular ejection fraction (LVEF),acute kidney injury,infection and multiple organ dysfunction syndrome were risk factors for the short-term mortality(P＜0.05).Conclusions The prognosis of elderly patients with AMI complicated with cardiogenic shock are poor.ECMO can significantly improve the hemodynamic indexes,but has no effect on the survival time in elderly patients with AMI complicated with cardiogenic shock.The advanced age,low LVEF,acute kidney injury,infection and multiple organ dysfunction syndrome are risk factors for the short-term mortality.
RESUMO
Objective To evaluate the short-term safety,efficacy and prognosis of different antithrombotic therapy regimens in elderly patients with atrial fibrillation after coronary artery stenting.Methods A total of 272 atrial fibrillation patients with 121 males and a mean age of(67.1 ±5.2)years undergoing coronary artery stenting in our hospital from January 2013 to December 2015 were retrospectively analyzed and rondomized into two antithrombotic therapy regimens:a dual antiplatelet therapy with aspirin and clopidogrel(DT group,n=175)and a triple antithrombotic therapy with warfarin,aspirin and clopidogrel(TT group,n=97).The one-year risk of major bleeding and major adverse cardiac and cerebrovascular event (MACCE) were compared between two groups.Results After one year follow-up,the rate of major bleeding was lower in the DT group (0.6％,n=1)than in the TT group(5.2％,n=5)(x2 =5.92,P =0.01).Nevertheless,the rates of MACCE showed no statistical difference between two groups (all P ＞ 0.05).No statistically significant differences were found between DT group(n=175)and TT group(n=97)in six therapeutic efficacy indexes as the follow[n(％)in DT vs.n(％)in TT]:in in-stent thrombosis[1 (0.6)in DT vs.0 (0.0) in TT],in myocardial infarction relapse [35 (20.0) in DT vs.17 (17.5) in TT],in revascularization once more[28(16.0)in DT vs.17(17.5)in TT],in death[7(4.0)in DT vs.3(3.1)in TT],in adverse cardiac cerebrovascular events[90 (51.4) in DT vs.45 (46.4) in TT],and in ischemic stroke[19(10.9) in DT vs.8 (8.2) in TT] (all P ＞ 0.05).However,the rate of atrial fibrillationinduced ischemic stroke may be increased in patients treated with DT of aspirin and clopidogrel as compared with TT of warfarin,aspirin and clopidogrel.Conclusions For atrial fibrillation after coronary artery stenting,triple antithrombotic treatment can lead to increased risks for major bleeding with similar rate of MACCE to dual antiplatelet therapy,but dual antiplatelet therapy may result in the raised rate of atrial fibrillation induced ischemic stroke.
RESUMO
@#Objective To assess the clinical safety and effectiveness of Boomerang closure device (Boomerang Percutaneous Femoral Access Management System) applied to patients undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI).Methods206 patients undergoing CAG and/or PCI were randomly divided into the heparin group and low molecular heparin (LWMH) group. The hemostasia success rate, hemostasia time, manual pressure time, device dwell time, complication rate and time to ambulation with each other of two groups were compared.ResultsThe heparin group and LWMH group both had high hemostasia success rate (98.06% and 99.03%), there wasn't significant difference between two groups. There was one patient with hematoma formation in the heparin group and LWMH group respectively. There was no significant difference between two groups in hemostasia time, manual pressure time, the device dwell time and time to ambulation.ConclusionAfter CAG and/or PCI, administered heparin and low molecular heparin is no effect on Boomerang closure device, and Boomerang closure device has a high hemostasia success rate.