Living alone predicts poor prognosis among patients with acute myocardial infarction.

BACKGROUND: Living alone as a proxy for social isolation has been considered to increase the risk of cardiovascular disease. We thus investigated the impact of living alone on mortality in acute myocardial infarction (AMI) patients. METHODS: Subjects comprised 277 AMI patients who underwent percutaneous coronary intervention (PCI). Associations between all-cause and cardiac deaths after PCI and baseline characteristics including living alone and Global Registry of Acute Coronary Events (GRACE) risk score were assessed. RESULTS: Eighty-three patients (30%) were living alone. Thirty patients died after PCI, including 20 cardiac deaths. Patients living alone showed higher incidences of both all-cause and cardiac deaths compared with patients not living alone (18% vs. 8%, P  = 0.019 and 14% vs. 4%, P  = 0.004). Multivariate Cox proportional hazards regression analysis models showed living alone [hazard ratio (HR), 2.60; 95% confidence interval (CI), 1.20-5.62; P  = 0.016 and HR, 4.17; 95% CI, 1.60-10.84; P  = 0.003] and GRACE risk score (HR, 1.02; 95% CI, 1.01-1.03; P  = 0.003 and HR, 1.03; 95% CI, 1.01-1.04; P  < 0.001) correlated significantly with all-cause and cardiac deaths. Cox proportional hazards modeling revealed that patients living alone with GRACE risk score ≥162 derived from the receiver-operating characteristic curve showed a significantly greater risk of all-cause death than patients not living alone with GRACE risk score <162 (HR 16.57; 95% CI 6.67-41.21; P  < 0.001). CONCLUSION: Among AMI patients, living alone represents an independent risk factor for all-cause and cardiac deaths after PCI, separate from GRACE risk score. Furthermore, AMI patients living alone with high GRACE risk scores may experience an additively increased risk of mortality after PCI.

Secondary rotational atherectomy is associated with reduced occurrence of prolonged ST-segment elevation following ablation.

Elevation of the ST segment after percutaneous coronary intervention (PCI) using rotational atherectomy (RA) for severely calcified lesions often persists after disappearance of the slow-flow phenomenon on angiography. We investigated clinical factors relevant to prolonged ST-segment elevation following RA among 152 patients with stable angina undergoing elective PCI. PCI procedures were divided into two strategies, RA without (primary RA strategy) or with (secondary RA strategy) balloon dilatation before RA. Incidence of prolonged ST-segment elevation after disappearance of slow-flow phenomenon was higher in the 56 patients with primary RA strategy (13%) than in the 96 patients with secondary RA strategy (3%, p = 0.039). Univariate logistic regression analysis showed levels of low-density lipoprotein cholesterol (LDL-C) (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.93-0.99; p = 0.013), levels of triglycerides (OR 0.97, 95%CI 0.94-0.99; p = 0.040), and secondary RA strategy (OR 0.23, 95% CI 0.05-0.85; p = 0.028) were inversely associated with occurrence of prolonged ST-segment elevation following ablation. However, hemodialysis, diabetes mellitus, left-ventricular ejection fraction, lesion length ≥ 20 mm, and burr size did not show significant associations. Multivariate logistic regression analysis modeling revealed that secondary RA strategy was significantly associated with the occurrence of prolonged ST-segment elevation (Model 1: OR 0.24, 95% CI 0.05-0.95, p = 0.042; Model 2: OR 0.17, 95% CI 0.03-0.68, p = 0.018; Model 3: OR 0.21, 95% CI 0.03-0.87, p = 0.041) even after adjusting for levels of LDL-C and triglycerides. Secondary RA strategy may be useful to reduce the occurrence of prolonged ST-segment elevation following RA.

Prognostic predictors in patients with cardiopulmonary arrest: A novel equation for evaluating the 30-day mortality.

BACKGROUND: Early prediction of outcomes after cardiopulmonary arrest (CPA) is important for considering the best support. Our purpose was to evaluate predictors of the 30-day mortality in patients with CPA after return of spontaneous circulation (ROSC) and to assess an equation for calculating the 30-day mortality using clinical parameters. METHODS: We retrospectively analyzed the data of 194 consecutive patients with CPA and ROSC in a derivation study (2015-2022). We compared clinical parameters between the survived (n = 78) and dead (n = 116) patients. We derived an equation for estimated probability of death based on clinical parameters, using multivariate logistic regression analysis. The reliability of the equation was validated in 80 additional patients with CPA. RESULTS: The 30-day mortality was associated with sex, witnessed cardiac arrest, bystander cardiopulmonary resuscitation (CPR), CPA due to acute myocardial infarction, pupil diameter, Glasgow Coma Scale score (GCS), presence of light reflex, arterial or venous pH, lactate levels, initial ventricular fibrillation (VF), CPA time, and age. The derived logistic regression equation was as follows: Estimated probability of death = 1 / (1 + e-x), x = (0.25 × bystander CPR) + (0.44 × pupil diameter) - (0.14 × GCS) + (0.09 × lactate) - (1.87 × initial VF) + (0.07 × CPA time) + (0.05 × age) - 7.03. The cut-off value for estimated probability of death calculated by this equation was 54.5 %, yielding a sensitivity, specificity, and accuracy of 86.2 %, 80.8 %, and 84.5 %, respectively. In the validation model, these values were 81.8 %, 85.7 %, and 82.5 %, respectively. CONCLUSIONS: The 30-day mortality may be calculated after ROSC in patients with CPA using simple clinical parameters. This equation may facilitate further best support for patients with CPA.

Impact of Malnutrition on Prognosis and Coronary Artery Calcification in Patients with Stable Coronary Artery Disease.

Nutritional status is an important factor affecting prognosis of cardiovascular diseases. We compared major cardiovascular and cerebrovascular events (MACCE) between the malnutrition (geriatric nutritional risk index <92) and non-malnutrition (geriatric nutritional risk index ≥92) groups in 500 stable coronary artery disease patients undergoing percutaneous coronary intervention and evaluated coronary calcification by intravascular ultrasound. Incidences of all-cause death and MACCE differed between the malnutrition and non-malnutrition groups (22% vs 5%, P < 0.001 and 24% vs 6%, P < 0.001). In multivariate Cox proportional hazards regression, malnutrition significantly correlated with all-cause death (P = 0.006) and MACCE (P = 0.010). The proportion of moderate/severe calcification differed between the malnutrition (64%) and non-malnutrition groups (33%, P < 0.001). Multivariate logistic analysis identified age (P < 0.001), malnutrition (P = 0.048), and hemodialysis (P < 0.001) as significantly related to moderate/severe calcification. Malnutrition was an independent risk factor for all-cause death and MACCE in coronary artery disease patients after percutaneous coronary intervention and was associated with moderately/severely calcified lesions.

Angle-tipped guidewire-induced vascular perforation at branch of superior thoracic artery during sheath insertion: Case report.

An 84-year-old woman was admitted to our hospital because of congestive heart failure, rapid atrial fibrillation, and ischemic heart disease. Percutaneous coronary intervention (PCI) via the left radial artery was performed, and a stent was deployed successfully into left anterior descending coronary artery (LAD). She got into shock state one hour after PCI. Chest X-ray and computed tomography scan revealed increase of soft tissue around the left axilla and implied the existence of hematoma. Hemoglobin level decreased from 13.3 g/dL to 8.2 g/dL and hemorrhagic shock was suspected. Angiography of the left axillary artery demonstrated contrast extravasation, and selective angiography using a micro-catheter identified bleeding from a branch of the superior thoracic artery. Hemostasis was performed successfully by embolization using a gelatin sponge, and improvement of the general condition was obtained. Aberration of 0.025-in. angle tipped guidewire was considered to induce arterial perforation during sheath insertion. .

Evaluation and medical therapy for coronary endothelial dysfunction induced by sirolimus-eluting stent in patient with an atherosclerotic lesion of the left main coronary artery: Case report.

Sirolimus-eluting stents (SES), especially those deployed at distal sites, cause more coronary vasospasm and endothelial dysfunction in the chronic phase compared to bare-metal stents (BMS). In comparison, endothelial dysfunction is less frequently induced by the Biolimus-A9 eluting stent (BES). A 75-year-old man with effort-induced angina pectoris previously underwent a total of three SES implantations in the left anterior descending coronary artery (LAD) and right coronary artery (RCA) in 2010 and 2011. He was referred to our hospital for the management of chest discomfort at rest in August 2014. We diagnosed this patient with coronary spastic angina (CSA) and coronary endothelial dysfunction (CED) induced by the SES, together with an atherosclerotic lesion in the left main coronary artery (LMCA). Adequate medication for CSA and CED and intervention for the atherosclerotic lesion contributed to improvement of vascular function and disappearance of his symptoms. .