Subject(s)
Atrial Fibrillation , Stroke , Electrocardiography , Electrocardiography, Ambulatory , HumansSubject(s)
Cardiomyopathy, Hypertrophic , Coronary Vessel Anomalies , Myocardial Bridging , Coronary Angiography , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessels/diagnostic imaging , Coronary Vessels/surgery , Humans , Myocardial Bridging/diagnosis , Myocardial Bridging/diagnostic imagingABSTRACT
BACKGROUND: Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation is a major cause of postoperative morbidity and mortality. Despite the availability of multiple imaging parameters, none of these parameters had adequate predictive accuracy for post-LVAD RVF. AIM: To study whether right ventricular pressure-dimension index (PDI), which is a novel echocardiographic index that combines both morphologic and functional aspects of the right ventricle, is predictive of post-LVAD RVF and survival. METHODS: 49 cases that underwent elective LVAD implantation were retrospectively analyzed using data from an institutional registry. PDI was calculated by dividing systolic pulmonary artery pressure to the square of the right ventricular minor diameter. Cases were categorized according to tertiles. RESULTS: Patients within the highest PDI tertile (PDI>3.62 mmHg/cm2 ) had significantly higher short-term mortality (42.8%) and combined short-term mortality and severe RVF (50%) compared to other tertiles (P < .05 for both, log-rank p for survival to 15th day 0.014), but mortality was similar across tertiles in the long-term follow-up. PDI was an independent predictor of short-term mortality (HR:1.05-26.49, P = .031) and short-term composite of mortality and severe RVF (HR:1.37-38.87, P = .027). CONCLUSIONS: Increased PDI is a marker of an overburdened right ventricle. Heart failure patients with a high PDI are at risk for short-term mortality following LVAD implantation.
Subject(s)
Heart Failure , Heart-Assist Devices , Ventricular Dysfunction, Right , Heart Failure/diagnostic imaging , Heart Ventricles/diagnostic imaging , Humans , Retrospective Studies , Ventricular Dysfunction, Right/diagnostic imagingSubject(s)
Aneurysm/diagnostic imaging , Atrial Septum/pathology , Heart Aneurysm/pathology , Rheumatic Heart Disease/complications , Aneurysm/etiology , Echocardiography, Doppler, Color/methods , Echocardiography, Transesophageal/methods , Female , Humans , Middle Aged , Rheumatic Heart Disease/surgerySubject(s)
Anti-Bacterial Agents/administration & dosage , Defibrillators, Implantable/adverse effects , Pacemaker, Artificial/adverse effects , Prosthesis-Related Infections/prevention & control , Anti-Infective Agents, Local/administration & dosage , Cardiac Resynchronization Therapy Devices/adverse effects , Disinfection/methods , Humans , Skin , Surgical Procedures, Operative/methodsSubject(s)
Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/physiopathology , Echocardiography/methods , Heart Atria/physiopathology , Heart Ventricles/physiopathology , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/etiology , Blood Flow Velocity/physiology , Diastole , Electrocardiography , Female , Follow-Up Studies , Heart Conduction System/physiopathology , Humans , Male , Prevalence , Stroke Volume , Systole , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/physiopathologyABSTRACT
Background: Development of contrast-induced acute kidney injury (CI-AKI) in patients with ST-elevation myocardial infarction (STEMI) treated via primary percutaneous coronary intervention (PCI) is a major cause of morbidity and mortality worldwide. The neutrophil-to-lymphocyte ratio (NLR), which is a marker of inflammation, has been demonstrated to be associated with the development of major adverse cardiovascular outcomes in many studies. From this point of view, in this study, we aimed to evaluate the predictive value of the NLR as regards the occurrence of CI-AKI in patients with STEMI undergoing primary PCI. Methods: This study was conducted at Dr. Siyami Ersek Training and Research Hospital from May 2008 to June 2016. A total of 2000 patients with STEMI treated via primary PCI were enrolled in the study. The NLR was calculated as the ratio of the number of neutrophils to the number of lymphocytes. All venous blood samples were obtained within 8 hours after admission. CI-AKI was the primary end point of the study. Then, the relationship between CI-AKI and the NLR was assessed. Results: CI-AKI was detected in 148 (7.4%) patients. The patients who developed CI-AKI had a significantly higher NLR than those who did not (7.08±4.43 vs. 6.18±3.98; P=0.011). In the multivariate logistic regression analyses, the NLR remained a significant independent predictor of CI-AKI (OR: 1.78, 95% CI: 1.21-2.61, and P=0.003). Conclusion: The NLR may be a significant independent predictor of CI-AKI in patients with STEMI treated via primary PCI and higher NLR values could be independently associated with a greater risk for CI-AKI.
Subject(s)
Arteriovenous Fistula , Pulmonary Arterial Hypertension , Aged , Aorta/diagnostic imaging , Aorta/pathology , Arteriovenous Fistula/complications , Arteriovenous Fistula/diagnostic imaging , Arteriovenous Fistula/pathology , Arteriovenous Fistula/surgery , Computed Tomography Angiography , Female , Humans , Pulmonary Arterial Hypertension/diagnosis , Pulmonary Arterial Hypertension/etiology , Renal Artery/diagnostic imaging , Renal Artery/pathologyABSTRACT
We retrospectively analyzed short- and long-term outcomes of patients who received bailout tirofiban during primary percutaneous intervention (pPCI). A total of 2681patients who underwent pPCI between 2009 and 2014 were analyzed; 1331 (49.6%) out of 2681 patients received bailout tirofiban. Using propensity score matching, 2100 patients (1050 patient received bail-out tirofiban) with similar preprocedural characteristics were identified. Patients who received bailout tirofiban had a significantly higher incidence of acute stent thrombosis, myocardial infarction, and major cardiac or cerebrovascular events during the in-hospital period. There were numerically fewer deaths in the bailout tirofiban group in the unmatched cohort (1.7% vs 2.5%, P = .118). In the matched cohort, in-hospital mortality was significantly lower (1.1% vs 2.4%, P = .03), and survival at 12 and 60 months were higher (96.9% vs 95.2%, P = .056 for 12 months and 95.1% vs 92.0%, P = .01 for 60 months) in the bailout tirofiban group. After multivariate adjustment, bailout tirofiban was associated with a lower mortality at 12 months (odds ratio [OR]: 0.554, 95% confidence interval [CI], 0.349-0.880, P = .012) and 60 months (OR: 0.595, 95% CI, 0.413-0.859, P = .006). In conclusion, bailout tirofiban strategy during pPCI is associated with a lower short- and long-term mortality, although in-hospital complications were more frequent.
Subject(s)
Percutaneous Coronary Intervention , Platelet Aggregation Inhibitors/therapeutic use , ST Elevation Myocardial Infarction/surgery , Tirofiban/therapeutic use , Adult , Aged , Cerebrovascular Disorders/etiology , Coronary Thrombosis/etiology , Female , Hospital Mortality , Humans , Male , Middle Aged , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Platelet Aggregation Inhibitors/adverse effects , Recurrence , Retrospective Studies , Risk Assessment , Risk Factors , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/mortality , Time Factors , Tirofiban/adverse effects , Treatment OutcomeABSTRACT
OBJECTIVE: The aim of the present study was to evaluate in-hospital and long-term outcomes of ST-segment elevation myocardial infarction (STEMI) survivors who experienced out-of-hospital cardiac arrest (OHCA) and underwent primary percutaneous coronary intervention (PCI) at a high-volume center within the STEMI network. METHODS: The records of 2681 consecutive STEMI patients who underwent primary PCI between January 2009 and December 2014 at a single center in the STEMI network were retrospectively analyzed. Patients with STEMI complicated by OHCA were compared with a reference group of STEMI patients who did not experience OHCA. RESULTS: Compared with STEMI survivors without OHCA (n=2587, 96.5%), the frequency of anterior myocardial infarction, duration of hospitalization, rate of in-hospital major adverse cardiovascular and cerebrovascular events, and the incidence of ischemic cerebrovascular disease and major bleeding during in-hospital follow-up were significantly greater in those with OHCA (n=94, 3.5%). The distribution of age and gender was similar between the 2 groups. The primary PCI success rate was high and was similar in both groups. In-hospital mortality was significantly higher (18.1% vs. 1.5%; p<0.001) and survival at the 12th and 60th months was lower (74.5% vs. 96.5%; p<0.001 and 71.3% vs. 93.7%; p<0.001) in STEMI survivors with OHCA. OHCA was an independent predictor for in-hospital mortality (Odds ratio [OR]: 3.413; 95% confidence interval [CI]: 1.534-7.597; p=0.003) and all-cause mortality at 60 months (OR: 3.285; 95% CI: 2.020-5.340; p<0.001). CONCLUSION: Mortality was high in patients with STEMI complicated by OHCA, even though PCI was performed with the same success rate seen in patients without OHCA.
