Review of the Association Between Long-Term and Current Systemic Steroid Use With Electromechanical Complications and Inpatient Mortality After ST-Elevation Myocardial Infarction.

Background The impact of long-term systemic steroid use on electrical and mechanical complications following ST-segment elevation myocardial infarction (STEMI) has not been extensively studied. Methods In a retrospective cohort study of the National Inpatient Sample (NIS) from 2018 to 2020, adults admitted with STEMI were dichotomized based on the presence of long-term (current) systemic steroid (LTCSS) use. The primary outcome was all-cause mortality. Secondary outcomes included a composite of mechanical complications, electrical, hemodynamic, and thrombotic complications, as well as revascularization complexity, length of stay (LOS), and total charge. Multivariate linear and logistic regressions were used to adjust for confounders. Results Out of 608,210 admissions for STEMI, 5,310 (0.9%) had LTCSS use. There was no significant difference in the odds of all-cause mortality (aOR: 0.89, 95%CI: 0.74-1.08, p-value: 0.245) and the composite of mechanical complications (aOR: 0.74, 95%CI: 0.25-2.30, p-value: 0.599). LTCSS use was associated with lower odds of ventricular tachycardia, atrioventricular blocks, new permanent-pacemaker insertion, cardiogenic shock, the need for mechanical circulatory support, mechanical ventilation, cardioversion, a reduced LOS by 1 day, and a reduced total charge by 34,512 USD (all p-values: <0.05). There were no significant differences in the revascularization strategy (coronary artery bypass graft (CABG) vs. percutaneous coronary interventions (PCI)) or in the incidence of composite thrombotic events. Conclusion LTCSS use among patients admitted with STEMI was associated with lower odds of electrical dysfunction and hemodynamic instability but no difference in the odds of mechanical complications, CABG rate, all-cause mortality, cardiac arrest, or thrombotic complications. Further prospective studies are needed to evaluate these findings further.

Timing of Nonurgent Transesophageal Echocardiography and The Risk of Embolic Events Among Patients Admitted With Infective Endocarditis. A Review of the National Inpatient Sample.

In patients hospitalized for infective endocarditis (IE), timing of nonurgent transesophageal echocardiography (TEE) to reduce embolic events (EE) is unclear. In a retrospective cohort from the 2016 to 2018 combined National Inpatient Sample (NIS), Low-risk adults with IE who underwent nonurgent (>48 hours) TEE were stratified into 3 cohorts based on the timing of the first TEE: early-TEE (3-5 days), intermediate-TEE (5-7 days) and late-TEE (>7). The primary outcome was a composite of an embolic event. Each day before TEE led to 3% increased odds of composite-embolic-events (P < 0.001), 1.21-day extra LOS (P < 0.001) and 14,186 USD increased total charge (P < 0.001). Early compared to late TEE led to reduced LOS by 10 days (P < 0.001) and total cost by 102,273 USD (P < 0.001), odds reduction of 27% in embolic strokes, 21% in septic arterial embolization and 50% reduction in preoperative time (P < 0.001). Among patients hospitalized for suspected IE, the time to TEE was correlated with increased odds of all EE, prolonged preoperative time for valve surgery, LOS, and total charge. Early TEE compared to late TEE led to the largest reduction in length of stay and total cost.