Acute kidney injury as the most important predictor of poor prognosis after interventional treatment for aortic stenosis.

BACKGROUND: Aortic stenosis (AS) is the most common acquired valvular disease. There are two methods of interventional treatment: surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). The choice between SAVR and TAVI depends on the assessment of individual perioperative risk and long-term treatment outcomes. It is essential to identify factors that may influence the outcomes of the treatment to minimize their negative effects. AIMS: The study aimed to identify the most important risk factor which affects treatment outcomes in patients with AS undergoing SAVR/TAVI. METHODS: This study reviewed retrospectively patients with AS who underwent SAVR or TAVI. The primary outcomes included incidences of major adverse cardiovascular events (MACE) defined as cardiovascular death, stroke, and hospitalization for cardiovascular issues assessed over a one-year follow-up period. An occurrence of postprocedural AKI (acute kidney injury) was identified as an independent predictor of MACE. RESULTS: The study included 78 patients, with the same number of subjects in each group (SAVR/TAVI [n = 39]). Twenty-nine patients developed AKI. It was similar in both groups (SAVR [n = 15]; TAVR [n = 14]). In the SAVR group, 13 (33%) patients developed at least one MACE compared to 5 (13%) patients in the TAVI group. AKI and the type of procedure (SAVR) were shown to be significantly and independently associated with the development of MACE (P = 0.01 and P = 0.03, respectively) as shown in the Cox multivariable regression model. CONCLUSIONS: Our study demonstrated that AKI is the strongest predictor of major adverse cardiovascular events after using both methods of aortic valve replacement (SAVR/TAVI).

Thirty-year risk of cardiovascular disease in senior medical students - based on the StudHeart study.

INTRODUCTION: Long-term risk functions highlight the need of prophylaxis in youth before the first symptoms of cardiovascular disease (CVD) occur. AIM: On the basis of data obtained in the StudHeart study, the aim of this report was to evaluate the 30-year risk of CVD based on the risk scale developed by the Framingham Heart Study (FHS). MATERIAL AND METHODS: Seven hundred and one students aged 22-27 (mean age: 24 ±1.42) from the 5(th) and 6(th) year of the medical faculties of the Medical University of Lodz were included in the study. The StudHeart study was based on an anonymous survey comprising 12 questions. Based on the answers the authors evaluated the 30-year risk of CVD in each respondent using an on-line calculator that allows one to evaluate: general CVD risk including coronary death, myocardial infarction, coronary insufficiency, angina, ischemic stroke, hemorrhagic stroke, transient ischemic attack, peripheral artery disease, heart failure and hard CVD risk including coronary death, myocardial infarction and stroke. RESULTS: Elevated general 30-year CVD risk occurred in 23.18% of students, while hard CVD risk was elevated in 16.91% of respondents. In both cases elevated risk occurred more often in men (general CVD risk: 43.46% male vs. 8.93% female, p < 0.001 and hard CVD risk: 29.33% male vs. 8.19% female, p < 0.001). Elevation of the risk was mainly caused by overweight, obesity and smoking cigarettes. CONCLUSIONS: Based on FHS 30-Year CVD risk, elevated risk occurred in almost one-fourth of students. Prophylactic actions should be performed, especially in men.

EuroSCORE II does not show better accuracy nor predictive power in comparison to original EuroSCORE: a single-centre study.

BACKGROUND: EuroSCORE is used to predict postoperative mortality in patients undergoing cardiac surgery. Its updated version was published in 2011. AIM: To assess whether EuroSCORE II (ESII) predicts more accurately postoperative mortality after cardiac surgery in comparison with additive (addES) and logistic EuroSCORE (logES). METHODS: A total of 461 patients (aged 21-88 years, 63.4% of men) who underwent cardiac surgery (December 2010 - June 2011) were included into the prospective research. For each patient ESII, addES and logES were calculated. Accuracy, calibration, and clinical performance of these models were assessed with receiver operating characteristics analyses using the area under the curve and the Hosmer-Lemeshow test. Out of this population, a group of 300 coronary artery bypass grafting (CABG) patients (aged 42-85 years, 73% of men) was selected and statistically analysed using the same methods. RESULTS: The mortality rate was 5.21%. Predicted mortality rates were as follows: addES 4.68%, logES 4.57%, and ESII 1.89%; the accuracy was: 0.589, 0.728, and 0.726, respectively. Only logES presented good predictive power (Hosmer-Lemeshow test: c2 = 12.79, p = 0.12). In the CABG patients, the postoperative mortality rate was 5.33%. Predicted mortality rates were as follows: addES 4.69%, logES 4.59%, and ESII 1.88%; the accuracy was: 0.512, 0.691, and 0.687, respectively. In the Hosmer-Lemeshow test also logES presented good predictive power (c2 = 10.72, p = 0.218). CONCLUSIONS: EuroSCORE II did not estimate mortality risk better in comparison to its previous versions, in the entire studied population or in the CABG patients. On the basis of the analysed data, it seems that the closest to the actual risk of death for the Polish population is the EuroSCORE logistic model.