1
|
Costa YC, Delfino F, Mauro V, Charask A, Fairman E, Macín SM, Perea J, D'Imperio H, Fernández A, Barrero C. ARGEN SHOCK: Mortality related to the use of Swan Ganz and to the hemodynamic pattern found in patients with AMICS. Curr Probl Cardiol 2024; 49:102418. [PMID: 38281675 DOI: 10.1016/j.cpcardiol.2024.102418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/30/2024]
Abstract
The Swan Ganz Catheter (SGC) allows us to diagnose different types of cardiogenic shock (CS). OBJECTIVES 1) Determine the frequency of use of SGC, 2) Analyze the clinical characteristics and mortality according to its use and 3) Analyze the prevalence, clinical characteristics and mortality according to the type of Shock. METHODS The 114 patients (p) from the ARGEN SHOCK registry were analyzed. A "classic" pattern was defined as PCP > 15 mm Hg, CI < 2.2 L/min/ m2, SVR > 1,200 dynes × sec × cm-5. A "vasoplegic/mixed" pattern was defined when p did not meet the classic definition. CS due to right ventricle (RV) was excluded. RESULTS SGC was used in 35 % (n:37). There were no differences in clinical characteristics according to SGC use, but those with SGC were more likely to receive dobutamine, levosimendan, and intra aortic balloon pump (IABP). Mortality was similar (59.4 % vs 61.3 %). The pattern was "classic" in 70.2 %. There were no differences in clinical characteristics according to the type of pattern or the drugs used. Mortality was 54 % in patients with the classic pattern and 73 % with the mixed/vasoplegic pattern, but the difference did not reach statistical significance (p:0.23). CONCLUSIONS SGC is used in one third of patients with CS. Its use does not imply differences in the drugs used or in mortality. Most patients have a classic hemodynamic pattern. There are no differences in mortality or in the type of vasoactive agents used according to the CS pattern found.
Collapse
Affiliation(s)
| | - Flavio Delfino
- Research Area- Argentine Society of Cardiology, Argentina
| | - Víctor Mauro
- Research Area- Argentine Society of Cardiology, Argentina
| | - Adrián Charask
- Research Area- Argentine Society of Cardiology, Argentina
| | | | | | - Joaquín Perea
- Research Area- Argentine Society of Cardiology, Argentina
| | | | | | - Carlos Barrero
- Research Area- Argentine Society of Cardiology, Argentina
| |
Collapse
|
2
|
Smith RJ, Sarma D, Padkins MR, Gajic O, Lawler PR, Van Diepen S, Kashani KB, Jentzer JC. Admission Total Leukocyte Count as a Predictor of Mortality in Cardiac Intensive Care Unit Patients. JACC. ADVANCES 2024; 3:100757. [PMID: 38939813 PMCID: PMC11198230 DOI: 10.1016/j.jacadv.2023.100757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/14/2023] [Accepted: 09/28/2023] [Indexed: 06/29/2024]
Abstract
Background Inflammation is a sequela of cardiovascular critical illness and a risk factor for mortality. Objectives This study aimed to evaluate the association between white blood cell count (WBC) and mortality in a broad population of patients admitted to the cardiac intensive care unit (CICU). Methods This retrospective cohort study included patients admitted to the Mayo Clinic CICU between 2007 and 2018. We analyzed WBC as a continuous variable and then categorized WBC as low (<4.0 × 103/mL), normal (≥4.0 to <11.0 × 103/mL), high (≥11.0 to <22.0 × 103/mL), or very high (≥22.0 × 103/mL). The association between WBC and in-hospital mortality was evaluated using multivariable logistic regression and random forest models. Results We included 11,699 patients with a median age of 69.3 years (37.6% females). Median WBC was 9.6 (IQR: 7.4-12.7). Mortality was higher in the low (10.5%), high (12.0%), and very high (33.3%) WBC groups relative to the normal WBC group (5.3%). A rising WBC was incrementally associated with higher in-hospital mortality after adjustment (AICc adjusted OR: 1.03 [95% CI: 1.02-1.04] per 1 × 103 increase in WBC). After adjustment, only the high (AICc adjusted OR: 1.37 [95% CI: 1.15-1.64]) and very high (AICc adjusted OR: 1.99 [1.47-2.71]) WBC groups remained associated with increased risk of in-hospital mortality. Conclusions Leukocytosis is associated with an increased mortality risk in a diverse cohort of CICU patients. This readily available marker of systemic inflammation may be useful for risk stratification within the increasingly complex CICU patient population.
Collapse
Affiliation(s)
- Ryan J. Smith
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota, USA
| | - Dhruv Sarma
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota, USA
| | - Mitchell R. Padkins
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick R. Lawler
- Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Sean Van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta Hospital, Edmonton, Alberta
| | - Kianoush B. Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob C. Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Jentzer JC, Szekely Y, Burstein B, Ballal Y, Kim EY, van Diepen S, Tabi M, Wiley B, Kashani KB, Lawler PR. Peripheral blood neutrophil-to-lymphocyte ratio is associated with mortality across the spectrum of cardiogenic shock severity. J Crit Care 2022; 68:50-58. [PMID: 34922312 DOI: 10.1016/j.jcrc.2021.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/10/2021] [Accepted: 12/05/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the association between the neutrophil-to-lymphocyte ratio (NLR) and mortality across the cardiogenic shock (CS) severity spectrum, defined using the Society of Cardiovascular Interventions and Angiography (SCAI) shock stages. MATERIALS AND METHODS We retrospectively analyzed cardiac intensive care unit (CICU) patients between 2007 and 2015. Predictors of in-hospital mortality were analyzed using logistic regression. RESULTS We included 8280 patients aged 67.3 ± 15.2 years (37.2% females). Elevated NLR (≥7) was present in 45% of patients. NLR increased with worsening SCAI stage and was associated with higher in-hospital mortality in shock stages A to C (all p < 0.001). After multivariable adjustment, NLR remained associated with higher in-hospital mortality (adjusted odds ratio 1.05 per 3.5 NLR units, 95% CI 1.03-1.08, p < 0.001), with an optimal cut-off of ≥7 (in-hospital mortality 13.1% vs. 4.1%, adjusted odds ratio 1.44, 95% CI 1.14-1.81, p = 0.002). Patients in SCAI stage A or B with NLR ≥7 had higher in-hospital mortality than patients in SCAI stage B or C with NLR <7, respectively. CONCLUSIONS Elevated NLR is associated with higher in-hospital mortality in CICU patients with or at risk for CS, emphasizing the importance of systemic inflammation as a determinant of outcomes in CS patients.
Collapse
Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America.
| | - Yishay Szekely
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America.
| | - Barry Burstein
- Division of Cardiology, Trillium Health Partners, University of Toronto, Toronto, Canada.
| | - Yashi Ballal
- Division of Cardiology, Trillium Health Partners, University of Toronto, Toronto, Canada.
| | - Edy Y Kim
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta Hospital, Edmonton, Canada.
| | - Meir Tabi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America.
| | - Brandon Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America.
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America.
| | - Patrick R Lawler
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada; Division of Cardiology, Trillium Health Partners, University of Toronto, Toronto, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Ted Rogers Centre for Heart Research, Toronto, Canada.
| |
Collapse
|
4
|
Tehrani BN, Sherwood MW, Batchelor WB. The heart of the matter: modulating therapeutic effects of adrenomedullin in cardiogenic shock. THE LANCET. RESPIRATORY MEDICINE 2022; 10:224-226. [PMID: 34895482 DOI: 10.1016/s2213-2600(21)00488-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Behnam N Tehrani
- Cardiac Catheterization Laboratories, Falls Church, VA 22042, USA.
| | | | | |
Collapse
|
5
|
Concomitant Sepsis Diagnoses in Acute Myocardial Infarction-Cardiogenic Shock: 15-Year National Temporal Trends, Management, and Outcomes. Crit Care Explor 2022; 4:e0637. [PMID: 35141527 PMCID: PMC8820909 DOI: 10.1097/cce.0000000000000637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES: DESIGN: SETTING: PARTICIPANTS: INTERVENTIONS: MEASUREMENTS AND MAIN RESULTS: CONCLUSIONS:
Collapse
|
6
|
Rahhal A, Omar AS, Aljundi A, Kasem M, Mahfouz A, Alyafei S. Successful use of intravenous B-blocker therapy in cardiogenic shock supported with venoarterial extracorporeal membrane oxygenation: A case series. Curr Probl Cardiol 2021; 47:101071. [PMID: 34838902 DOI: 10.1016/j.cpcardiol.2021.101071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/13/2021] [Accepted: 11/21/2021] [Indexed: 11/19/2022]
Abstract
Tachycardia in cardiogenic shock (CS) might reduce the cardiac output (CO) by decreasing the ventricular filling time. Nevertheless, heart rate (HR) control with agents that possess negative inotropy might decrease the CO. Therefore, controlling the tachycardia in the setting of CS remains controversial. We herein describe four cases of patients presenting with myocardial infarction complicated with CS that required rescue venoarterial extracorporeal membrane oxygenation (VA-ECMO) initiation. Tachycardia was present with HR ∼130-140 beats per minute after VA-ECMO initiation, and hence esmolol was infused continuously at a starting dose of 10-20 mcg/kg/min and titrated according to HR. With the use of esmolol to control the HR in the setting of CS supported with VA-ECMO, lactate cleared, and echocardiographic parameters improved, allowing the four cases to be successfully decannulated from ECMO. Our report indicates that short-acting beta-blocker could be safely used in the complex scenario of severe tachycardia while supported with VA-ECMO.
Collapse
Affiliation(s)
- Alaa Rahhal
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Amr Salah Omar
- Department of Cardiothoracic Surgery/Cardiac Anesthesia and Intensive Care, Heart Hospital, Hamad Medical Corporation, Doha, Qatar; Department of Critical Care Medicine, Beni Suef University, Egypt; Weill Cornell Medical College, Doha, Qatar
| | - Amer Aljundi
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Kasem
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mahfouz
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sumaya Alyafei
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
7
|
Siegel PM, Bender I, Chalupsky J, Heger LA, Rieder M, Trummer G, Wengenmayer T, Duerschmied D, Bode C, Diehl P. Extracellular Vesicles Are Associated With Outcome in Veno-Arterial Extracorporeal Membrane Oxygenation and Myocardial Infarction. Front Cardiovasc Med 2021; 8:747453. [PMID: 34805303 PMCID: PMC8600355 DOI: 10.3389/fcvm.2021.747453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is being increasingly applied in patients with circulatory failure, but mortality remains high. An inflammatory response syndrome initiated by activation of blood components in the extracorporeal circuit may be an important contributing factor. Patients with ST-elevation myocardial infarction (STEMI) may also experience a systemic inflammatory response syndrome and are at risk of developing cardiogenic shock and cardiac arrest, both indications for VA-ECMO. Extracellular vesicles (EV) are released by activated cells as mediators of intercellular communication and may serve as prognostic biomarkers. Cardiomyocyte EV, released upon myocardial ischemia, hold strong potential for this purpose. The aim of this study was to assess the EV-profile in VA-ECMO and STEMI patients and the association with outcome. Methods: In this prospective observational study, blood was sampled on day 1 after VA-ECMO initiation or myocardial reperfusion (STEMI patients). EV were isolated by differential centrifugation. Leukocyte, platelet, endothelial, erythrocyte and cardiomyocyte (caveolin-3+) Annexin V+ EV were identified by flow cytometry. EV were assessed in survivors vs. non-survivors of VA-ECMO and in STEMI patients with normal-lightly vs. moderately-severely reduced left ventricular function. Logistic regression was conducted to determine the predictive accuracy of EV. Pearson correlation analysis of EV with clinical parameters was performed. Results: Eighteen VA-ECMO and 19 STEMI patients were recruited. Total Annexin V+, cardiomyocyte and erythrocyte EV concentrations were lower (p ≤ 0.005) while the percentage of platelet EV was increased in VA-ECMO compared to STEMI patients (p = 0.002). Total Annexin V+ EV were increased in non-survivors of VA-ECMO (p = 0.01), and higher levels were predictive of mortality (AUC = 0.79, p = 0.05). Cardiomyocyte EV were increased in STEMI patients with moderately-severely reduced left ventricular function (p = 0.03), correlated with CK-MBmax (r = 0.57, p = 0.02) and time from reperfusion to blood sampling (r = 0.58, p = 0.01). Leukocyte EV correlated with the number of coronary stents placed (r = 0.60, p = 0.02). Conclusions: Elevated total Annexin V+ EV on day 1 of VA-ECMO are predictive of mortality. Increased cardiomyocyte EV on day 1 after STEMI correlate with infarct size and are associated with poor outcome. These EV may aid in the early identification of patients at risk of poor outcome, helping to guide clinical management.
Collapse
Affiliation(s)
- Patrick M Siegel
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ileana Bender
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Chalupsky
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas A Heger
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marina Rieder
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg Trummer
- Department of Cardiovascular Surgery, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Diehl
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
8
|
Jentzer JC, Lawler PR, van Diepen S, Henry TD, Menon V, Baran DA, Džavík V, Barsness GW, Holmes DR, Kashani KB. Systemic Inflammatory Response Syndrome Is Associated With Increased Mortality Across the Spectrum of Shock Severity in Cardiac Intensive Care Patients. Circ Cardiovasc Qual Outcomes 2020; 13:e006956. [PMID: 33280435 DOI: 10.1161/circoutcomes.120.006956] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The systemic inflammatory response syndrome (SIRS) frequently occurs in patients with cardiogenic shock and may aggravate shock severity and organ failure. We sought to determine the association of SIRS with illness severity and survival across the spectrum of shock severity in cardiac intensive care unit (CICU) patients. METHODS We retrospectively analyzed 8995 unique patients admitted to the Mayo Clinic CICU between 2007 and 2015. Patients with ≥2/4 SIRS criteria based on admission laboratory and vital sign data were considered to have SIRS. Patients were stratified by the 2019 Society for Cardiovascular Angiography and Interventions (SCAI) shock stages using admission data. The association between SIRS and mortality was evaluated across SCAI shock stage using logistic regression and Cox proportional-hazards models for hospital and 1-year mortality, respectively. RESULTS The study population had a mean age of 67.5±15.2 years, including 37.2% women. SIRS was present in 33.9% of patients upon CICU admission and was more prevalent in advanced SCAI shock stages. Patients with SIRS had higher illness severity, worse shock, and more organ failure, with an increased risk of mortality during hospitalization (16.8% versus 3.8%; adjusted odds ratio, 2.1 [95% CI, 1.7-2.5]; P<0.001) and at 1 year (adjusted hazard ratio, 1.4 [95% CI, 1.3-1.6]; P<0.001). After multivariable adjustment, SIRS was associated with higher hospital and 1-year mortality among patients in SCAI shock stages A through D (all P<0.01) but not SCAI shock stage E. CONCLUSIONS One-third of CICU patients meet clinical criteria for SIRS at the time of admission, and these patients have higher illness severity and worse outcomes across the spectrum of SCAI shock stages. The presence of SIRS identified CICU patients at increased risk of short-term and long-term mortality. Further study is needed to determine whether systemic inflammation truly drives SIRS in this population and whether patients with SIRS respond differently to supportive therapies for shock.
Collapse
Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine (J.C.J., G.W.B., D.R.H.), Mayo Clinic, Rochester, MN.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (J.C.J., K.B.K.), Mayo Clinic, Rochester, MN
| | - Patrick R Lawler
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (P.R.L., V.D.).,Ted Rogers Centre for Heart Research, Toronto, Canada (P.R.L.).,Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada (P.R.L.)
| | - Sean van Diepen
- Department of Critical Care Medicine, Division of Cardiology (S.v.D.), University of Alberta Hospital, Edmonton.,Department of Medicine (S.v.D.), University of Alberta Hospital, Edmonton
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital Health Network, Cincinnati, OH (T.D.H.)
| | - Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (V.M.)
| | - David A Baran
- Sentara Heart Hospital, Advanced Heart Failure Center and Eastern Virginia Medical School, Norfolk (D.A.B.)
| | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (P.R.L., V.D.)
| | - Gregory W Barsness
- Department of Cardiovascular Medicine (J.C.J., G.W.B., D.R.H.), Mayo Clinic, Rochester, MN
| | - David R Holmes
- Department of Cardiovascular Medicine (J.C.J., G.W.B., D.R.H.), Mayo Clinic, Rochester, MN
| | - Kianoush B Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (J.C.J., K.B.K.), Mayo Clinic, Rochester, MN.,Division of Nephrology and Hypertension, Department of Internal Medicine (K.B.K.), Mayo Clinic, Rochester, MN
| |
Collapse
|
9
|
Affiliation(s)
- Cyrus Vahdatpour
- Department of MedicinePennsylvania HospitalUniversity of Pennsylvania Health System (UPHS)PhiladelphiaPA
| | - David Collins
- Department of MedicinePennsylvania HospitalUniversity of Pennsylvania Health System (UPHS)PhiladelphiaPA
| | - Sheldon Goldberg
- Department of CardiologyPennsylvania HospitalUniversity of Pennsylvania Health System (UPHS)PhiladelphiaPA
| |
Collapse
|
10
|
Derivation and validation of a simple inflammation-based risk score system for predicting in-hospital mortality in acute coronary syndrome patients. J Cardiol 2018; 73:416-424. [PMID: 30600191 DOI: 10.1016/j.jjcc.2018.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 11/09/2018] [Accepted: 11/23/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Accurate assessment of inflammatory status of patients during acute coronary syndrome (ACS) has become of great importance in their risk classification and in the research of new anti-inflammatory therapies. METHOD The study cohort included 7396 patients with ACS. We sought to derive and internally validate an inflammation-based score that included high-sensitivity C-reactive protein, white blood cell count, and serum albumin level at admission to evaluate the predictive role of systemic inflammation in the clinical outcome of these patients. We randomly assigned patients into derivation (66.6%) and validation (33.4%) cohorts. A total of four categories of systemic inflammation were defined. RESULTS Assessed individually, the three biomarkers were associated with a higher rate of in-hospital mortality. When we combined them into an inflammation score, in-hospital mortality was significantly different across the four categories of inflammation in the derivation cohort (1.8%, 2.8%, 4.1%, and 13.8% for without, mild, moderate, and severe inflammation, respectively; p<0.0001, C-statistic, 0.71). These results were similar in the validation cohort (1.1%, 2.9%, 5.2%, and 12.6%, respectively; p<0.0001, C-statistic, 0.71). After multivariate adjustment, only the category of severe systemic inflammation was associated with a threefold increased risk of in-hospital mortality (odds ratios 3.02, p<0.0001) and was the most powerful predictor of mortality. In the whole cohort, after subsetting patients based on GRACE risk score, the severe inflammation category was associated with a significant increase of in-hospital mortality across all sub-groups, mainly in patients with higher GRACE risk score. The inflammation-based risk score reclassified 25.3% of the population. The net reclassification index was 8.2% (p=0.001). CONCLUSION A risk score system based on biomarkers of inflammation readily available at admission in patients with ACS, could better assess the inflammatory status and predict in-hospital mortality, as well as severe systemic inflammation that contributes to a worse outcome independently of clinical risk factors.
Collapse
|
11
|
Perioperative Assessment and Intraoperative Core Concepts in the Complex Kidney Patient. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0204-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
12
|
Boehme AK, Comeau ME, Langefeld CD, Lord A, Moomaw CJ, Osborne J, James ML, Martini S, Testai FD, Woo D, Elkind MSV. Systemic inflammatory response syndrome, infection, and outcome in intracerebral hemorrhage. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 5:e428. [PMID: 29318180 PMCID: PMC5745360 DOI: 10.1212/nxi.0000000000000428] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/06/2017] [Indexed: 01/09/2023]
Abstract
Objective: Systemic inflammatory response syndrome (SIRS) may be related to poor outcomes after intracerebral hemorrhage (ICH). Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage study is an observational study of ICH in whites, blacks, and Hispanics throughout the United Sates. SIRS was defined by standard criteria as 2 or more of the following on admission: (1) body temperature <36°C or >38°C, (2) heart rate >90 beats per minute, (3) respiratory rate >20 breaths per minute, or (4) white blood cell count <4,000/mm3 or >12,000/mm3. The relationship among SIRS, infection, and poor outcome (modified Rankin Scale [mRS] 3–6) at discharge and 3 months was assessed. Results: Of 2,441 patients included, 343 (14%) met SIRS criteria at admission. Patients with SIRS were younger (58.2 vs 62.7 years; p < 0.0001) and more likely to have intraventricular hemorrhage (IVH; 53.6% vs 36.7%; p < 0.0001), higher admission hematoma volume (25.4 vs 17.5 mL; p < 0.0001), and lower admission Glasgow Coma Scale (GCS; 10.7 vs 13.1; p < 0.0001). SIRS on admission was significantly related to infections during hospitalization (adjusted odds ratio [OR] 1.36, 95% confidence interval [CI] 1.04–1.78). In unadjusted analyses, SIRS was associated with poor outcomes at discharge (OR 1.96, 95% CI 1.42–2.70) and 3 months (OR 1.75, 95% CI 1.35–2.33) after ICH. In analyses adjusted for infection, age, IVH, hematoma location, admission GCS, and premorbid mRS, SIRS was no longer associated with poor outcomes. Conclusions: SIRS on admission is associated with ICH score on admission and infection, but it was not an independent predictor of poor functional outcomes after ICH.
Collapse
Affiliation(s)
- Amelia K Boehme
- Department of Neurology (A.K.B., M.S.V.E.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Wake Forest University (M.E.C., C.D.L.), NC; Department of Neurology (A.L.), New York University School of Medicine; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati, OH; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Baylor University, Houston, TX (S.M.); and University of Illinois Chicago (F.D.T.)
| | - Mary E Comeau
- Department of Neurology (A.K.B., M.S.V.E.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Wake Forest University (M.E.C., C.D.L.), NC; Department of Neurology (A.L.), New York University School of Medicine; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati, OH; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Baylor University, Houston, TX (S.M.); and University of Illinois Chicago (F.D.T.)
| | - Carl D Langefeld
- Department of Neurology (A.K.B., M.S.V.E.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Wake Forest University (M.E.C., C.D.L.), NC; Department of Neurology (A.L.), New York University School of Medicine; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati, OH; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Baylor University, Houston, TX (S.M.); and University of Illinois Chicago (F.D.T.)
| | - Aaron Lord
- Department of Neurology (A.K.B., M.S.V.E.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Wake Forest University (M.E.C., C.D.L.), NC; Department of Neurology (A.L.), New York University School of Medicine; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati, OH; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Baylor University, Houston, TX (S.M.); and University of Illinois Chicago (F.D.T.)
| | - Charles J Moomaw
- Department of Neurology (A.K.B., M.S.V.E.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Wake Forest University (M.E.C., C.D.L.), NC; Department of Neurology (A.L.), New York University School of Medicine; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati, OH; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Baylor University, Houston, TX (S.M.); and University of Illinois Chicago (F.D.T.)
| | - Jennifer Osborne
- Department of Neurology (A.K.B., M.S.V.E.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Wake Forest University (M.E.C., C.D.L.), NC; Department of Neurology (A.L.), New York University School of Medicine; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati, OH; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Baylor University, Houston, TX (S.M.); and University of Illinois Chicago (F.D.T.)
| | - Michael L James
- Department of Neurology (A.K.B., M.S.V.E.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Wake Forest University (M.E.C., C.D.L.), NC; Department of Neurology (A.L.), New York University School of Medicine; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati, OH; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Baylor University, Houston, TX (S.M.); and University of Illinois Chicago (F.D.T.)
| | - Sharyl Martini
- Department of Neurology (A.K.B., M.S.V.E.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Wake Forest University (M.E.C., C.D.L.), NC; Department of Neurology (A.L.), New York University School of Medicine; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati, OH; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Baylor University, Houston, TX (S.M.); and University of Illinois Chicago (F.D.T.)
| | - Fernando D Testai
- Department of Neurology (A.K.B., M.S.V.E.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Wake Forest University (M.E.C., C.D.L.), NC; Department of Neurology (A.L.), New York University School of Medicine; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati, OH; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Baylor University, Houston, TX (S.M.); and University of Illinois Chicago (F.D.T.)
| | - Daniel Woo
- Department of Neurology (A.K.B., M.S.V.E.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Wake Forest University (M.E.C., C.D.L.), NC; Department of Neurology (A.L.), New York University School of Medicine; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati, OH; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Baylor University, Houston, TX (S.M.); and University of Illinois Chicago (F.D.T.)
| | - Mitchell S V Elkind
- Department of Neurology (A.K.B., M.S.V.E.), College of Physicians and Surgeons, Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Wake Forest University (M.E.C., C.D.L.), NC; Department of Neurology (A.L.), New York University School of Medicine; Department of Neurology and Rehabilitation Medicine (C.J.M., J.O., D.W.), University of Cincinnati, OH; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Baylor University, Houston, TX (S.M.); and University of Illinois Chicago (F.D.T.)
| |
Collapse
|
13
|
Baran DA, Visveswaran GK, Seliem A, DiVita M, Wasty N, Cohen M. Differential responses to larger volume intra-aortic balloon counterpulsation: Hemodynamic and clinical outcomes. Catheter Cardiovasc Interv 2017; 92:703-710. [PMID: 29086475 PMCID: PMC6221162 DOI: 10.1002/ccd.27387] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/05/2017] [Indexed: 12/25/2022]
Abstract
Objectives Examine hemodynamic and clinical correlates of use of an intra‐aortic balloon pump catheter in a single center. Background The intra‐aortic balloon pump catheter (IABC) has been used for 50 years but the clinical benefit is still debated. We reviewed 76 patients with right heart catheter measurements prior to IABC to assess response and outcomes. Methods All patients who received IABC with a 50cc balloon for at least 1 hour were included in this retrospective chart review study. Demographics, comorbidities, lab values, and hemodynamic parameters were recorded at baseline and 15 h postinsertion. Results Seventy‐six patients had paired measurements of cardiac output. 60 patients had a higher cardiac output with IABC treatment (responder group) and 16 did not (nonresponders). In the 60 patients in the responder group, cardiac output and index significantly increased from baseline 3.6 ± 1.3 L/min to 5.2 ± 1.8 L/min, and 1.8 ± 0.5 L/min/m2 to 2.6 ± 0.8 L/min/m2 respectively following IABC placement (P < 0.0001 for both comparisons). Various hemodynamic variables were examined and the best predictor of response to IABC was a cardiac power index of 0.3 or less. Regardless of response, in hospital survival was similar between groups. Conclusions The majority of patients improve their cardiac output with IABC but survival was unchanged. Further work into the pathophysiology of cardiogenic shock is needed.
Collapse
Affiliation(s)
- David A Baran
- Division of Advanced Heart Failure, Sentara Heart Hospital, Norfolk, Virginia
| | | | - Ahmed Seliem
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Michael DiVita
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Najam Wasty
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Marc Cohen
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
| |
Collapse
|
14
|
Abstract
BACKGROUND To identify the patients at greatest odds for systemic inflammatory response syndrome (SIRS) and examine the association between SIRS and outcomes in patients presenting with intracerebral hemorrhage (ICH). METHODS We retrospectively reviewed consecutive patients presenting to a tertiary care center from 2008 to 2013 with ICH. SIRS was defined according to standard criteria as 2 or more of the following: (1) body temperature <36 or >38 °C, (2) heart rate >90 beats per minute, (3) respiratory rate >20, or (4) white blood cell count <4000/mm(3) or >12,000/mm(3) or >10 % polymorphonuclear leukocytes for >24 h in the absence of infection. The outcomes of interest, discharge modified Rankin Scale (mRS 4-6), death, and poor discharge disposition (discharge anywhere but home or inpatient rehab) were assessed using logistic regression. RESULTS A total of 249 ICH patients met inclusion criteria and 53 (21.3 %) developed SIRS during their hospital stay. A score was developed (ranging from 0 to 3) to identify patients at greatest risk for developing SIRS. Adjusting for stroke severity, SIRS was associated with mRS 4-6 (OR 5.25, 95 %CI 2.09-13.2) and poor discharge disposition (OR 3.74, 95 %CI 1.58-4.83) but was not significantly associated with death (OR 1.75, 95 %CI 0.58-5.32). We found that 33 % of the effect of ICH score on poor functional outcome at discharge was explained by the development of SIRS in the hospital (Sobel 2.11, p = 0.03). CONCLUSION We observed that approximately 20 % of patients with ICH develop SIRS, and that patients with SIRS were at increased risk of having poor functional outcome at discharge.
Collapse
|
15
|
Lin HJ, Wang TD. Profiling the Evolution of Inflammatory Response and Exploring Its Prognostic Significance in Acute Myocardial Infarction: The First Step to Establishing Anti-Inflammatory Strategy. ACTA CARDIOLOGICA SINICA 2017; 33:486-488. [PMID: 28959100 DOI: 10.6515/acs20170731a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Hung-Ju Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzung-Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
16
|
van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e232-e268. [PMID: 28923988 DOI: 10.1161/cir.0000000000000525] [Citation(s) in RCA: 933] [Impact Index Per Article: 133.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities.
Collapse
|
17
|
Makker P, Shimada YJ, Misra D, Kanei Y. Clinical Effect of Rebound Hyperthermia After Cooling Postcardiac Arrest: A Retrospective Cohort Study. Ther Hypothermia Temp Manag 2017; 7:137-140. [DOI: 10.1089/ther.2015.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Parth Makker
- Department of Cardiology, Mount Sinai Beth Israel, Icahn School of Medicine, New York, New York
| | - Yuichi J. Shimada
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deepika Misra
- Department of Cardiology, Mount Sinai Beth Israel, Icahn School of Medicine, New York, New York
| | - Yumiko Kanei
- Department of Cardiology, Mount Sinai Beth Israel, Icahn School of Medicine, New York, New York
| |
Collapse
|
18
|
Makker P, Kanei Y, Misra D. Clinical Effect of Rebound Hyperthermia After Cooling Postcardiac Arrest: A Meta-Analysis. Ther Hypothermia Temp Manag 2017; 7:206-209. [PMID: 28731840 DOI: 10.1089/ther.2017.0009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Rebound hyperthermia (RH) is frequently seen after completion of targeted temperature management (TTM) in comatose survivors of cardiac arrest. However, its clinical significance is not well understood. Previous studies analyzing the association of RH with clinical outcome have reported conflicting results. The purpose of this meta-analysis is to examine the impact of RH after completion of TTM in patients postcardiac arrest. We reviewed six studies that evaluated the incidence of RH (T > 38°C) with documentation of outcome based on the presence of hyperthermia. We reviewed all six articles and extracted the data for mortality and neurological outcome. A total of 729 patients were analyzed for neurological outcome and 950 patients were analyzed for mortality. RH was found to be associated with a significantly worse neurological outcome (odds ratio [OR] 1.55; 95% confidence interval [CI] 1.13-2.14). RH was not significantly associated with a higher mortality (OR 1.31; 95% CI 1.00-1.72). We also analyzed three studies totaling 206 patients for neurological outcomes and mortality that included patients with severe RH (T > 38.5°C). Severe RH was found to be associated with significantly worse neurological outcome (OR 1.92, 95% CI 1.28-1.90) and significantly worse mortality (OR 2.22, 95% CI 1.50-3.29). RH is common after completion of TTM in comatose patients because of cardiac arrest and is associated with poor neurological outcomes. The clinical impact of RH is likely proportional to the magnitude of RH.
Collapse
Affiliation(s)
- Parth Makker
- Department of Cardiovascular Disease, Icahn School of Medicine , Mount Sinai Beth Israel, New York, New York
| | - Yumiko Kanei
- Department of Cardiovascular Disease, Icahn School of Medicine , Mount Sinai Beth Israel, New York, New York
| | - Deepkia Misra
- Department of Cardiovascular Disease, Icahn School of Medicine , Mount Sinai Beth Israel, New York, New York
| |
Collapse
|
19
|
Chaikittisilpa N, Krishnamoorthy V, Lele AV, Qiu Q, Vavilala MS. Characterizing the relationship between systemic inflammatory response syndrome and early cardiac dysfunction in traumatic brain injury. J Neurosci Res 2017; 96:661-670. [PMID: 28573763 DOI: 10.1002/jnr.24100] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/30/2017] [Accepted: 05/16/2017] [Indexed: 11/10/2022]
Abstract
Systolic dysfunction was recently described following traumatic brain injury (TBI), and systemic inflammation may be a contributing mechanism. Our aims were to 1) examine the association between the early systemic inflammatory response syndrome (SIRS) and systolic cardiac dysfunction following TBI, and 2) describe the longitudinal change in SIRS criteria, cardiac function, and hemodynamic parameters during the first week of hospitalization. We used a secondary analysis of a prospective cohort study examining cardiac function (with transthoracic echocardiography on the first day and serially over the first week of hospitalization) in 32 moderate-severe isolated TBI patients, and quantified the admission and daily SIRS response to injury. We determined the association of admission SIRS and systolic dysfunction following TBI. Admission SIRS was present in 7 (21%) patients and was associated with systolic dysfunction on multivariable analysis (relative risk 4.01; 95% 1.16-13.79, p = .028). Both SIRS criteria and systolic cardiac function improved over the first week of hospitalization. In conclusion, early SIRS is common among patients with moderate-severe TBI, and the presence of SIRS criteria on admission is associated with systolic cardiac dysfunction following TBI.
Collapse
Affiliation(s)
- Nophanan Chaikittisilpa
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| | - Vijay Krishnamoorthy
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| | - Abhijit V Lele
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Qian Qiu
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| |
Collapse
|
20
|
Wang Y, Shi X, Du R, Chen Y, Zhang Q. Off-pump versus on-pump coronary artery bypass grafting in patients with diabetes: a meta-analysis. Acta Diabetol 2017; 54:283-292. [PMID: 28039582 DOI: 10.1007/s00592-016-0951-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/03/2016] [Indexed: 11/30/2022]
Abstract
AIMS The effects of off-pump CABG (OFF-CABG) versus on-pump CABG (ON-CABG) in diabetic patients remain controversial. The aim of our study was to compare mortality and postoperative morbidity between OFF-CABG and ON-CABG for diabetic patients. METHODS Electronic databases including PubMed, EMBASE and Cochrane Library for studies investigating clinical outcomes of OFF-CABG versus ON-CABG in diabetic patients were searched, collecting data from inception until June 2016. We pooled the odds ratios from individual studies and performed heterogeneity, quality assessment and publication bias analysis. RESULTS A total of 543,220 diabetic patients in 10 studies were included. The overall mortality (OR, 0.87; 95% CI, 0.58-1.31; p = 0.50) was comparable between the OFF-CABG and ON-CABG. OFF-CABG was associated with significantly fewer cerebrovascular accidents (OR, 0.45; 95% CI, 0.31-0.65; p < 0.0001), bleeding complications (OR, 0.59; 95% CI, 0.43-0.80; p < 0.001) and pulmonary complications. However, no differences in myocardial infarction (OR, 0.76; 95% CI, 0.52-1.12; p = 0.16), renal failure (OR, 0.74; 95% CI, 0.50-1.11; p = 0.14) and other postoperative morbidity outcomes were found. CONCLUSIONS OFF-CABG significantly reduces the incidence of postoperative cerebrovascular accidents and bleeding complications compared with ON-CABG in diabetic patients. No differences were found regarding mortality, myocardial infarction and renal failure between these two techniques. Our study suggests that OFF-CABG may be an optimal strategy for diabetic patients although adequately powered randomized trials are needed to further verify the finding.
Collapse
Affiliation(s)
- Yushu Wang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China
| | - Xiuli Shi
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China
| | - Rongsheng Du
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
21
|
Jones DA, Khambata RS, Andiapen M, Rathod KS, Mathur A, Ahluwalia A. Intracoronary nitrite suppresses the inflammatory response following primary percutaneous coronary intervention. Heart 2016; 103:508-516. [DOI: 10.1136/heartjnl-2016-309748] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/27/2016] [Accepted: 08/31/2016] [Indexed: 02/06/2023] Open
|
22
|
Sun XP, Li J, Zhu WW, Li DB, Chen H, Li HW, Chen WM, Hua Q. Impact of Platelet-to-Lymphocyte Ratio on Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction. Angiology 2016; 68:346-353. [PMID: 27381032 DOI: 10.1177/0003319716657258] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We investigated the association between platelet-to-lymphocyte ratio (PLR) and clinical outcomes (including all-cause mortality, recurrent myocardial infarction, heart failure, serious cardiac arrhythmias and ischemic stroke) in patients with ST-segment elevation myocardial infarction (STEMI). Based on PLR quartiles, 5886 patients with STEMI were categorized into 4 groups: <98.8 (n = 1470), 98.8 to 125.9 (n = 1474), 126.0 to 163.3 (n = 1478), >163.3 (n = 1464), respectively. We used Cox proportional hazards models to examine the relation between PLR and clinical outcomes. Mean duration of follow-up was 81.6 months, and 948 patients (16.1%) died during follow-up. The lowest mortality occurred in the lowest PLR quartile group ( P = 0.006), with an adjusted hazard ratio of 1.18 (95% confidence interval [CI], 1.04-1.55), 1.31 (95% CI, 1.18-1.64), and 1.59 (95% CI, 1.33-1.94) in patients with PLR of 98.8 to 125.9, 126.0 to 163.3, >163.3, respectively. Higher levels of PLR were also associated with recurrent myocardial infarction ( Ptrend = .023), heart failure ( Ptrend = .018), and ischemic stroke ( Ptrend = .043). In conclusion, a higher PLR was associated with recurrent myocardial infarction, heart failure, ischemic stroke, and all-cause mortality in patients with STEMI.
Collapse
Affiliation(s)
- Xi-Peng Sun
- 1 Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- 1 Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei-Wei Zhu
- 1 Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dong-Bao Li
- 2 Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- 2 Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong-Wei Li
- 2 Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wen-Ming Chen
- 3 Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Qi Hua
- 1 Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
23
|
Kamath PS, Mookerjee RP. Individualized care for portal hypertension: Not quite yet. J Hepatol 2015; 63:543-5. [PMID: 26150255 DOI: 10.1016/j.jhep.2015.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Rajeshwar P Mookerjee
- Liver Failure Group, University College London Institute for Liver and Digestive Health, University College London Medical School, Royal Free Hospital, London, United Kingdom
| |
Collapse
|
24
|
Tan Y, Tu Y, Tian D, Li C, Zhong JK, Guo ZG. ST-elevation myocardial infarction following systemic inflammatory response syndrome. Cardiovasc J Afr 2015; 26:e1-3. [PMID: 26592989 PMCID: PMC4763473 DOI: 10.5830/cvja-2014-071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 11/27/2014] [Indexed: 01/04/2023] Open
Abstract
Systemic inflammatory response syndrome (SIRS) complicated with ST-elevation myocardial infarction has rarely been reported, and the precise mechanisms of myocardial injury remain unclear. Here, we present a case involving a 45-year-old man who developed SIRS secondary to diabetes-induced infection, and who ultimately developed ST-elevation myocardial infarction with acute heart failure, fulminant diabetes, acute liver dysfunction, acute kidney dysfunction and rhabdomyolysis. The patient eventually recovered due to early detection, correct diagnosis and powerful treatment. Clinicians should be aware of this new type of myocardial infarction, which is induced by inflammatory injury, but is not due to a primary coronary event such as plaque erosion and/or rupture, fissuring or dissection.
Collapse
Affiliation(s)
- Ying Tan
- Division of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Division of Cardiology, The First People's Hospital of Shunde, Guangdong, China
| | - Yan Tu
- Division of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Di Tian
- Division of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Chen Li
- Division of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jian-Kai Zhong
- Division of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhi-Gang Guo
- Division of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| |
Collapse
|
25
|
Wang J, Gu C, Gao M, Yu W, Li H, Zhang F, Yu Y. Comparison of the incidence of postoperative neurologic complications after on-pump versus off-pump coronary artery bypass grafting in high-risk patients: A meta-analysis of 11 studies. Int J Cardiol 2015; 185:195-7. [PMID: 25797677 DOI: 10.1016/j.ijcard.2015.03.115] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jiayang Wang
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China
| | - Mingxin Gao
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China
| | - Wenyuan Yu
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China
| | - Haitao Li
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China
| | - Fan Zhang
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yang Yu
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China.
| |
Collapse
|
26
|
Ennezat PV, Stewart M, Samson R, Bouabdallaoui N, Maréchaux S, Banfi C, Bouvaist H, Le Jemtel TH. Editor's Choice-Recent therapeutic trials on fluid removal and vasodilation in acute heart failure. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 5:86-95. [PMID: 25414321 DOI: 10.1177/2048872614560504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/14/2014] [Indexed: 01/08/2023]
Abstract
Recent therapeutic trials regarding the management of acute heart failure (AHF) failed to demonstrate the efficacy of newer therapeutic modalities and agents. Low- versus high-dose and continuous administration of furosemide were shown not to matter. Ultrafiltration was not found to be more efficacious than sophisticated diuretic therapy including dose-adjusted intravenous furosemide and metolazone. Dopamine and nesiritide were not shown to be superior to current therapy. Tezosentan and tovalptan had no effect on mortality. The development of rolofylline was terminated due to adverse effect (seizures). Lastly, preliminary experience with serelaxin indicates a mortality improvement at six months that remains to be confirmed. The disappointing findings of these recent trials may reflect the lack of efficacy of newer therapeutic modalities and agents. Alternatively the disappointing findings of these recent trials may be in part due to methodological issues. The AHF syndrome is complex with many clinical phenotypes. Failure to match clinical phenotypes and therapeutic modalities is likely to be partly responsible for the disappointing findings of recent AHF trials.
Collapse
Affiliation(s)
- Pierre V Ennezat
- Cardiology Department, Centre Hospitalier Universitaire de Grenoble, France
| | - Merrill Stewart
- Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Rohan Samson
- Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Nadia Bouabdallaoui
- Department of Cardiovascular Surgery, La Pitié Salpêtrière Hospital, Paris, France
| | - Sylvestre Maréchaux
- Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, Lille, France
| | - Carlo Banfi
- Division of Cardiovascular Surgery and Geneva Hemodynamic Research Group, Geneva University Hospitals, Geneva, Switzerland
| | - Hélène Bouvaist
- Cardiology Department, Centre Hospitalier Universitaire de Grenoble, France
| | - Thierry H Le Jemtel
- Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana, USA
| |
Collapse
|
27
|
|