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Jhand AS, Abusnina W, Tak HJ, Ahmed A, Ismayl M, Altin SE, Sherwood MW, Alexander JH, Rao SV, Abbott JD, Carson JL, Goldsweig AM. Impact of anemia on outcomes and resource utilization in patients with myocardial infarction: A national database analysis. Int J Cardiol 2024; 408:132111. [PMID: 38697401 DOI: 10.1016/j.ijcard.2024.132111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/29/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Although anemia is common in patients with myocardial infarction (MI), management remains controversial. We quantified the association of anemia with in-hospital outcomes and resource utilization in patients admitted with MI using a large national database. METHODS All hospitalizations with a primary diagnosis code for acute MI in the National Inpatient Sample (NIS) between 2014 and 2018 were identified. Among these hospitalizations, patients with anemia were identified using a secondary diagnosis code. Data on demographic and clinical variables were collected. Outcomes of interest included in-hospital adverse events, length of stay (LOS), and total cost. Multivariable logistic regression and generalized linear models were used to evaluate the relationship between anemia and outcomes. RESULTS Among 1,113,181 MI hospitalizations, 254,816 (22.8%) included concomitant anemia. Anemic patients were older and more likely to be women. After adjustment for demographics and comorbidities, anemia was associated with higher mortality (7.1 vs. 4.3%; odds ratio 1.09; 95% confidence interval [CI] 1.07-1.12, p < 0.001). Anemia was also associated with a mean of 2.71 days longer LOS (average marginal effects [AME] 2.71; 95% CI 2.68-2.73, p < 0.05), and $ 9703 mean higher total costs (AME $9703, 95% CI $9577-$9829, p < 0.05). Anemic patients who received blood transfusions had higher mortality as compared with those who did not (8.2% vs. 7.0, p < 0.001). CONCLUSION In MI patients, anemia was associated with higher in-hospital mortality, adverse events, total cost, and length of stay. Transfusion was associated with increased mortality, and its role in MI requires further research.
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Affiliation(s)
- Aravdeep S Jhand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Waiel Abusnina
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hyo Jung Tak
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Arslan Ahmed
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Elissa Altin
- Division of Cardiovascular Medicine, Yale University, New Haven, CT, USA
| | - Matthew W Sherwood
- Division of Cardiology, Duke University and Duke Clinical Research Institute, Durham, NC, USA; Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - John H Alexander
- Division of Cardiology, Duke University and Duke Clinical Research Institute, Durham, NC, USA
| | - Sunil V Rao
- Division of Cardiology, New York University Langone Health System, New York, NY, USA
| | - J Dawn Abbott
- Division of Cardiology, Brown University and Lifespan Cardiovascular Institute, Providence, RI, USA
| | - Jeffrey L Carson
- Department of Internal Medicine, Rutgers University, New Brunswick, NJ, USA
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA, USA; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
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Comoglu M, Acehan F, Katipoglu B, Demir BF, Guven Cetin Z, Ates I. Is eGFR ≥60 mL/min/1.73 m 2 in Patients Undergoing Coronary Angiography Really Safe for Contrast Nephropathy? Angiology 2024; 75:666-672. [PMID: 37144892 DOI: 10.1177/00033197231174497] [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] [Indexed: 05/06/2023]
Abstract
The aim of the present study was to define the risk factors associated with contrast-induced acute kidney injury (CI-AKI) in patients who underwent coronary artery angiography (CAG). In this retrospective cohort study, patients who underwent CAG between March 2014 and January 2022 were evaluated. A total of 2923 eligible patients were included in the study. Univariate and multivariate logistic regression analysis was used to identify the predictive factors. CI-AKI developed in 77 (2.6%) of 2923 patients. In multivariate analysis, diabetes mellitus (DM), chronic kidney disease (CKD), and estimated glomerular filtration rate (eGFR) were found to be independent factors associated with CI-AKI. In the subgroup analysis of patients with eGFR ≥60 mL/min/1.73 m2, eGFR remained a predictor of CI-AKI (Odds ratio (OR): .89, 95% CI: .84-.93; that is, a lower eGFR remains a risk factor for CI-AKI). In the receiving operating characteristic (ROC) analysis of patients with eGFR ≥60 mL/min/1.73 m2, the area under the curve of the eGFR was .826. Using the ROC curve based on Youden's index, the eGFR cut-off was found to be 70 mL/min/1.73 m2 for patients with eGFR ≥60 mL/min/1.73 m2. eGFR is also an important risk factor in patients with eGFR 60-70 mL/min/1.73 m2.
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Affiliation(s)
- Mustafa Comoglu
- Department of Internal Medicine, Ankara City Hospital, Cankaya, Turkey
| | - Fatih Acehan
- Department of Internal Medicine, Ankara City Hospital, Cankaya, Turkey
| | - Bilal Katipoglu
- Department of Geriatrics, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Burak F Demir
- Department of Internal Medicine, Ankara City Hospital, Cankaya, Turkey
| | | | - Ihsan Ates
- Department of Internal Medicine, Ankara City Hospital, Cankaya, Turkey
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Kazaryan S, Bazarbekova R, Dossanova A, Kainarbekova N, Zhakebayeva A. Functional state of the kidneys in patients with acute coronary syndrome against the background of newly identified disorders of carbohydrate metabolism: a multidisciplinary problem. Expert Rev Endocrinol Metab 2024:1-9. [PMID: 38831703 DOI: 10.1080/17446651.2024.2363543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/30/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Determining the relationship between cardiovascular risks, carbohydrate metabolism disorders, and renal dysfunction can help in creating new tools for their management and for better interaction of specialists in a multidisciplinary team. The purpose of this study was to determine the functional state of the kidneys and carbohydrate metabolism in patients with acute coronary syndrome without a history of such disorders. METHODS 200 patients of the cardiology department of the City Clinical Hospital No. 7 in Almaty were examined using laboratory diagnostics and subsequent statistical data processing. RESULTS Acute coronary syndrome develops in 63% of cases against the background of previous disorders of carbohydrate metabolism - prediabetes (45.5%) and type 2 diabetes mellitus (17.5%). In this group of patients, in the presence of disorders of carbohydrate metabolism, in all cases, it is accompanied by acute renal damage. It was noted that diabetes mellitus in newly diagnosed patients actually had a certain duration and occurred much earlier than cardiovascular complications - this was evidenced by an increased level of glycated hemoglobin. CONCLUSIONS Such results indicate the need for early diagnosis of cardio-reno-metabolic syndrome in patients with cardiovascular complications, as well as timely administration of drugs that simultaneously have antidiabetic, cardio- and nephroprotective effects.
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Affiliation(s)
- Svetlana Kazaryan
- Department of General Practice with a Focus on Endocrinology, Kazakhstan Medical University "KSPH", Almaty, Republic of Kazakhstan
| | - Rimma Bazarbekova
- Department of General Practice with a Focus on Endocrinology, Kazakhstan Medical University "KSPH", Almaty, Republic of Kazakhstan
| | - Ainur Dossanova
- Department of General Practice with a Focus on Endocrinology, Kazakhstan Medical University "KSPH", Almaty, Republic of Kazakhstan
| | | | - Aigerim Zhakebayeva
- Department of General Practice with a Focus on Endocrinology, Kazakhstan Medical University "KSPH", Almaty, Republic of Kazakhstan
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Maksimczuk J, Galas A, Krzesiński P. What Promotes Acute Kidney Injury in Patients with Myocardial Infarction and Multivessel Coronary Artery Disease-Contrast Media, Hydration Status or Something Else? Nutrients 2022; 15:nu15010021. [PMID: 36615678 PMCID: PMC9824824 DOI: 10.3390/nu15010021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Multivessel coronary artery disease (MVCAD) is found in approximately 50% of patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Although we have data showing the benefits of revascularization of significant non-culprit coronary lesions in patients with AMI, the optimal timing of angioplasty remains unclear. The most common reason for postponing subsequent percutaneous treatment is the fear of contrast-induced acute kidney injury (CI-AKI). Acute kidney injury (AKI) is common in patients with AMI undergoing PCI, and its etiology appears to be complex and incompletely understood. In this review, we discuss the definition, pathophysiology and risk factors of AKI in patients with AMI undergoing PCI. We present the impact of AKI on the course of hospitalization and distant prognosis of patients with AMI. Special attention was paid to the phenomenon of AKI in patients undergoing multivessel revascularization. We analyze the correlation between increased exposure to contrast medium (CM) and the risk of AKI in patients with AMI to provide information useful in the decision-making process about the optimal timing of revascularization of non-culprit lesions. In addition, we present diagnostic tools in the form of new biomarkers of AKI and discuss ways to prevent and mitigate the course of AKI.
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Hu Y, Wang X, Xiao S, Sun N, Huan C, Wu H, Guo M, Xu T, Pan D. A Clinical Nomogram Based on the Triglyceride-Glucose Index to Predict Contrast-Induced Acute Kidney Injury after Percutaneous Intervention in Patients with Acute Coronary Syndrome with Diabetes Mellitus. Cardiovasc Ther 2022; 2022:5443880. [PMID: 36349299 PMCID: PMC9633196 DOI: 10.1155/2022/5443880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/14/2022] [Indexed: 08/02/2023] Open
Abstract
The aim of the study was to investigate the factors influencing contrast-induced acute kidney injury (CI-AKI) after percutaneous intervention (PCI) in patients with acute coronary syndrome (ACS) with diabetes mellitus (DM). A total of 1073 patients with ACS combined with DM who underwent PCI at the Affiliated Hospital of Xuzhou Medical University were included in this study. We divided the patients into the CI-AKI and non-CI-AKI groups according to whether CI-AKI occurred or not. The patients were then randomly assigned to the training and validation sets at a proportion of 7 : 3. Based on the results of the LASSO regression and multivariate analyses, we determined that the subtypes of ACS, age, multivessel coronary artery disease, hyperuricemia, low-density lipoprotein cholesterol, triglyceride-glucose index, and estimated glomerular filtration rate were independent predictors on CI-AKI after PCI in patients with ACS combined with DM. Using the above indicators to develop the nomogram, the AUC-ROC of the training and validation sets were calculated to be 0.811 (95% confidence interval (CI): 0.766-0.844) and 0.773 (95% CI: 0.712-0.829), respectively, indicating high prediction efficiency. After verification by the Bootstrap internal verification, we found that the calibration curves showed good agreement between the nomogram predicted and observed values. And the DCA results showed that the nomogram had a high clinical application. In conclusion, we constructed and validated the nomogram to predict CI-AKI risk after PCI in patients with ACS and DM. The model can provide a scientific reference for predicting the occurrence of CI-AKI and improving the prognosis of patients.
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Affiliation(s)
- Yue Hu
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
| | - Xiaotong Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
| | - Shengjue Xiao
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University 87 Dingjiaqiao, Nanjing, Jiangsu, China 210009
| | - Na Sun
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
| | - Chunyan Huan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
| | - Huimin Wu
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
| | - Minjia Guo
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
| | - Tao Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
| | - Defeng Pan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004
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Transradial versus Transfemoral Access and the Risk of Acute Kidney Injury following Primary Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Propensity-Score-Matched Studies. J Interv Cardiol 2022; 2022:6774439. [PMID: 35360090 PMCID: PMC8930211 DOI: 10.1155/2022/6774439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/25/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of this study is to examine the association between vascular access sites and the incidence of AKI in patients with STEMI undergoing primary PCI. Background Emerging evidence has suggested that transradial access (TRA) may be associated with lower rates of acute kidney injury (AKI) as compared with transfemoral access (TFA). However, most of these studies have included a nonselected study population undergoing diagnostic cardiac catheterization or percutaneous coronary intervention (PCI). Data on the association between TRA and AKI in this setting of STEMI are limited and with conflicting results. Methods We systematically searched PubMed, Embase, and Scopus for abstracts and full-text articles from inception to July 13th of 2021. Studies included were randomized controlled trials (RCTs) and propensity-score-matched (PSM) studies evaluating the association of TRA versus TFA access with AKI in patients undergoing primary PCI for STEMI. Data were integrated using the random effects model and generic inverse‐variance method of DerSimonian and Laird. Results A total of 10,093 studies were found. After applying our inclusion criteria, 5 studies from 2014 to 2021 with a total of 8,536 STEMI patients were included. TRA was not significantly associated with a reduced risk for AKI compared with TFA (odds ratio 0.85, 95% CI 0.71–1.01, p 0.07, I2 = 40%). Conclusions Transradial access was not significantly associated with lower risk of AKI in patients undergoing primary PCI for STEMI compared with TFA. Larger studies are needed to clarify this outcome.
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