Principles for management of hip fracture for older adults taking direct oral anticoagulants: an international consensus statement

Hip fracture is a common serious injury among older adults, yet the management of hip fractures for patients taking direct oral anticoagulants remains inconsistent worldwide. Drawing from a synthesis of available evidence and expert opinion, best practice approaches for managing patients with a hip fracture and who are taking direct oral anticoagulants pre-operatively were considered by a working group of the Fragility Fracture Network Hip Fracture Audit Special Interest Group. The literature and related clinical guidelines were reviewed and a two-round modified Delphi study was conducted with a panel of experts from 16 countries and involved seven clinical specialities. Four consensus statements were achieved: peripheral nerve blocks can reasonably be performed on presentation for patients with hip fracture who are receiving direct oral anticoagulants; hip fracture surgery can reasonably be performed for patients taking direct oral anticoagulants < 36 h from last dose; general anaesthesia could reasonably be administered for patients with hip fracture and who are taking direct oral anticoagulants < 36 h from last dose (assuming eGFR > 60 ml.min-1.1.73 m-2); and it is generally reasonable to consider recommencing direct oral anticoagulants (considering blood loss and haemoglobin) < 48 h after hip fracture surgery. No consensus was achieved regarding timing of spinal anaesthesia. The consensus statements were developed to aid clinicians in their decision-making and to reduce practice variations in the management of patients with hip fracture and who are taking direct oral anticoagulants. Each statement will need to be considered specific to each individual patient's treatment.

Improvement of the anthropogenic emission rate estimate in Ulaanbaatar, Mongolia, for 2020-21 winter

Ulaanbaatar (UB), the fast-growing capital of Mongolia, is known for its world's worst level of particulate matter (PM) concentrations in winter. However, current anthropogenic emission inventories over the UB are based on data from more than fifteen years ago, and satellite observations are scarce because UB is in high latitudes. During the winter of 2020-21, the first period of the Fine Particle Research Initiative in East Asia considering the National Differences (FRIEND), several times higher concentrations of PM in UB compared to other urban sites in East Asia were observed but not reproduced with a chemical transport model mainly due to the underestimated anthropogenic emissions. Therefore, we devised a method for sequentially adjusting emissions based on the reactivity of PM precursors using ground observations. We scaled emission rates for the inert species (CO, elemental carbon (EC), and organic carbon (OC)) to reproduce their observed ambient concentrations, followed by SO2 to reproduce the concentration of SO42-, which was examined to have the least uncertainty based on the abundance of observed NH3, and finally NO and NH3 for NO3-, and NH4+. This improved estimation is compared to regional inventories for Asia and suggests more than an order of magnitude increase in anthropogenic emissions in UB. Using the improved emission inventory, we were able to successfully reproduce independent observation data on PM2.5 concentrations in UB in December 2021 from the U.S. Embassy. During the campaign period, we found more than 50% of the SO42-, NO3-, and NH4+ increased in UB due to the improvement could travel to Beijing, China (BJ), and about 20% of the SO42- could travel to Noto, Japan (NT), more than 3000 km away. Also, the anthropogenic emissions in UB can effectively increase OC, NO3-, and NH4+ concentrations in BJ when Gobi dust storms occur.

Effects of volatile organic compounds and new particle formation on real-time hygroscopicity of PM2.5 particles in Seosan, Republic of Korea

The hygroscopicity of PM2.5 particles plays an important role in PM2.5 haze in Northeast Asian countries by influencing particle growth and chemical composition. New particle formation (NPF) and atmospheric volatile organic compounds (VOCs) are factors that influence particle hygroscopicity. However, the lack of real-time hygroscopicity measurements has deterred the understanding of their effects on particle hygroscopicity. In this study, two intensive monitoring campaigns were conducted during the summer of 2021 and spring of 2022 using real-time aerosol instruments, including a humidified tandem differential mobility analyzer (HTDMA), in Seosan, Republic of Korea. The hygroscopicity parameter κ was calculated from the real-time HTDMA measurement data (κGf). The diurnal variations in κGf exhibited strong inverse linear correlations with the total concentration of VOCs (CTVOC) during the two campaigns. The higher atmospheric CTVOC in summer increased the growth rate of the particle diameter from 10 to 40 nm (6 nm/h) compared with that in spring (2.7 nm/h), resulting in a faster change in κGf for 40-nm particles in summer than in spring because of the increase in organic matter in the chemical compositions of particles. In addition, NPF events introduced additional tiny fresh particles into the atmosphere, which reduced the κGf of 40-nm particles and increased the intensity of the less hygroscopic peaks (κGf < 0.1) of κ-probability density functions (κ-PDF) in NPF days. However, 100-nm particles exhibited fewer changes in κGf than 40-nm particles, resulting in additional dominant hygroscopic peaks (κ ∼ 0.2) of κ-PDFs in both NPF and non-NPF days. When κGf values measured in Seosan were compared with those in other Northeast Asian countries in the literature, the κ values for 40-nm particles were lower than those (κ > 0.2) measured in Beijing and Guangzhou, but those for 100-nm particles were close to those measured in the two cities.

Impact of Age on the Occurrence of Vascular Complications in Patients Undergoing Anterior Lumbar Approach Surgery

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To investigate the impact of age on incidence of vascular complications in patients undergoing anterior lumbar approach surgery.

SUMMARY OF BACKGROUND DATA

Anterior approach lumbar spinal surgery may facilitate use of intervertebral devices with larger endplate coverage and increased lordosis. Despite the advantages of this approach, risks related to vascular injury in older patients have been described in the literature.

METHODS

In total, 751 consecutive patients with degenerative spinal pathology who underwent stand-alone anterior lumbar interbody fusion (ALIF), ALIF combined with posterior fusion and/or instrumentation (360), total disc replacement (TDR), or hybrid procedures (ALIF and TDR) were included. Data collected included general patient descriptive data, surgery details, intraoperative vascular injury, and post-operative vascular complications (deep vein thrombosis (DVT) and/or pulmonary embolism (PE)). Rates of vascular complications were compared across age groups. Additionally, the mean age of patients was compared between those with vs. without vascular complications.

RESULTS

Overall mean age was 50.4 years (range 20-83 years). Mean estimated blood loss was 91.3 ml (range 10 to 2800 ml). A total of 15 patients, 2.0%, had vascular complications. There were 10 cases (1.3%) of intraoperative injury to iliac arteries or iliolumbar veins (mean blood loss was 721 mL and all were repaired intraoperatively). Postoperatively, 6 patients (0.8%) developed DVT and/or PE (one patient had both). With respect to age, there were no significant differences in rates of intra-operative, post-operative, or combined vascular complication rates across the age group (P>0.38). Additionally, there were no statistically significant differences in the mean ages of patients with vs. those without vascular complications (P>0.17).

CONCLUSION

Overall incidence of vascular complications was 2.0%. No relationship between vascular complications and age was demonstrated. These data suggest that increased age may not necessarily be an absolute contraindication for anterior lumbar approach surgery.

Disease burden of bacteraemia with extended-spectrum beta-lactamase-producing and carbapenem-resistant Enterobacterales in Korea

BACKGROUND

Despite the significant impact of multi-drug-resistant bacteraemia, especially extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and carbapenem-resistant Enterobacterales (CRE), the burden of disease has not been investigated thoroughly.

AIM

To evaluate the clinical outcomes and socio-economic burden of ESBL-E and CRE bacteraemia nationwide in the Republic of Korea.

METHODS

A search was undertaken for all cases of ESBL-E and CRE bacteraemia and matched controls in 10 hospitals in the Republic of Korea over 6 months. Patients with ESBL-E or CRE bacteraemia were classified as the R group, and matched controls with antibiotic-susceptible bacteraemia and without infection were classified as the S and N groups, respectively. Patients' clinical data were collected, and the economic burden was estimated based on medical expenses, loss of productivity and total costs.

FINDINGS

In total, 795 patients were identified, including 265 patients with ESBL-E or CRE bacteraemia and their matched controls. The mean total length of stay for patients with ESBL-E and CRE in the R group was 1.53 and 1.90 times that of patients in the S group, respectively. The 90-day mortality rates for ESBL-E in the R and S groups were 12.1% and 5.6%, respectively, and the corresponding figures for CRE were 28.6% and 12.0%. There were significant differences in the total costs between the R, S and N groups for both ESBL-E and CRE (ESBL-E: $11,151 vs $8712 vs $6063, P=0.004; CRE: $40,464 vs $8748 vs $7279, P=0.024).

CONCLUSION

The clinical and economic burden imposed by ESBL-E or CRE bacteraemia was extremely high. These findings suggest that efforts to control resistant bacteraemia are necessary to reduce this burden.

The Effect of High-Normal Preoperative International Normalized Ratios on Outcomes and Complications After Anterior Cervical Spine Surgery

Hematoma after anterior cervical spine surgery can result in neurologic and airway compromise. Current guidelines recommend an international normalized ratio (INR) <1.5 before elective spine surgery because of increased complications. The risk associated with an INR of 1.25 is not well studied. The purpose of this study was to determine the risk of complications associated with a preoperative INR >1.25 and ≤1.5 in patients undergoing elective anterior cervical spine surgery. The American College of Surgeons National Surgical Quality Improvement Program database was queried. Patients undergoing elective anterior cervical spine surgery from 2012 to 2016 who had an INR recorded within 24 hours of surgery were included. Outcomes of interest included postoperative hematoma requiring surgery, 30-day mortality, and 30-day readmissions and reoperations. A total of 2949 patients were included. The incidence of a postoperative hematoma that required surgical management was 0.2%, 0.6%, and 4.5% in the INR≤1, 11.25 and ≤1.5 before elective anterior cervical spine surgery is associated with significantly higher rates of postoperative hematoma formation as well as 30-day readmission and reoperation; there was a trend toward significance in mortality rate. [Orthopedics. 2024;47(1):e26-e32.].

Prediction of Clinical Remission with Adalimumab Therapy in Patients with Ulcerative Colitis by Fourier Transform-Infrared Spectroscopy Coupled with Machine Learning Algorithms

We aimed to develop prediction models for clinical remission associated with adalimumab treatment in patients with ulcerative colitis (UC) using Fourier transform-infrared (FT-IR) spectroscopy coupled with machine learning (ML) algorithms. This prospective, observational, multicenter study enrolled 62 UC patients and 30 healthy controls. The patients were treated with adalimumab for 56 weeks, and clinical remission was evaluated using the Mayo score. Baseline fecal samples were collected and analyzed using FT-IR spectroscopy. Various data preprocessing methods were applied, and prediction models were established by 10-fold cross-validation using various ML methods. Orthogonal partial least squares-discriminant analysis (OPLS-DA) showed a clear separation of healthy controls and UC patients, applying area normalization and Pareto scaling. OPLS-DA models predicting short- and long-term remission (8 and 56 weeks) yielded area-under-the-curve values of 0.76 and 0.75, respectively. Logistic regression and a nonlinear support vector machine were selected as the best prediction models for short- and long-term remission, respectively (accuracy of 0.99). In external validation, prediction models for short-term (logistic regression) and long-term (decision tree) remission performed well, with accuracy values of 0.73 and 0.82, respectively. This was the first study to develop prediction models for clinical remission associated with adalimumab treatment in UC patients by fecal analysis using FT-IR spectroscopy coupled with ML algorithms. Logistic regression, nonlinear support vector machines, and decision tree were suggested as the optimal prediction models for remission, and these were noninvasive, simple, inexpensive, and fast analyses that could be applied to personalized treatments.

Association between Hashimoto's thyroiditis and melanoma: a retrospective matched cohort study

An inflammatory microenvironment has been shown to increase risk for malignant melanoma, suggesting that melanoma may be related to a pro-inflammatory state. Though Hashimoto's thyroiditis is one of the most common autoimmune diseases, there are no investigations of its relationship with melanoma. We aim to determine if Hashimoto's increases risk of developing melanoma. A retrospective, validated cohort of patients with a diagnosis of Hashimoto's between 2005 and 2020 were identified using the Olmsted County database. Patients were age and sex matched to controls without a Hashimoto's diagnosis. The primary outcomes were development of melanoma and time to first melanoma diagnosis. 4805 patients were included in the study, with 1726 (36%) having a diagnosis of Hashimoto's. Hashimoto's patients had no significant difference in risk of melanoma (relative risk 0.96, 95% CI 0.78-1.17) or nonmelanoma skin cancer (relative risk 0.95, 95% CI 0.86-1.06) compared with matched controls. This suggests that the local proinflammatory environment present in Hashimoto's does not contribute significantly to melanoma risk. Larger studies may be needed to further characterize the relationship between these diseases.

Characterization of chemoresistant human non-small cell lung cancer cells by metabolic and lipidomic profiling

INTRODUCTION

Lung cancer is one of the most malignant cancers and the leading cause of cancer-related deaths worldwide, while acquired chemoresistance would represent a major problem in the treatment of non-small cell lung cancer (NSCLC) because of the reduced treatment effect and increased rates of recurrence.

METHODS

To establish the chemoresistant NSCLC cells, doxorubicin was treated to A549 cells over 3 months at gradually increasing concentrations from 0.03 to 0.5 µM. Real-time PCR and Western blotting were employed for investigating mRNA and protein expression of the glutathione peroxidase (GPX) protein family and multidrug resistance protein 1 (MRP1) in A549 and A549/CR cells. We also employed gas chromatography mass-spectrometry and nano electrospray ionization mass-spectrometry coupled with multivariate statistical analysis to characterize the unique metabolic and lipidomic profiles of chemoresistant NSCLC cells in order to identify potential therapeutic targets.

RESULTS

Reactive oxygen species levels were decreased, and mRNA and protein levels of GPX2 and multidrug resistance protein 1 (MRP1) were increased in A549/CR. We identified 87 metabolites and intact lipid species in A549 and A549/CR. Among these metabolites, lactic acid, glutamic acid, glycine, proline, aspartic acid, succinic acid, and ceramide, alongside the PC to PE ratio, and arachidonic acid-containing phospholipids were suggested as characteristic features of chemoresistant NSCLC cells (A549/CR).

CONCLUSIONS

This study reveals characteristic feature differences between drug-resistance NSCLC cells and their parental cells. We suggest potential therapeutic targets in chemoresistant NSCLC. Our results provide new insight into metabolic and lipidomic alterations in chemoresistant NSCLC. This could be used as fundamental information to develop therapeutic strategies for the treatment of chemoresistant NSCLC patients.

Sub-1.4 cm3 capsule for detecting labile inflammatory biomarkers in situ

Transient molecules in the gastrointestinal tract such as nitric oxide and hydrogen sulfide are key signals and mediators of inflammation. Owing to their highly reactive nature and extremely short lifetime in the body, these molecules are difficult to detect. Here we develop a miniaturized device that integrates genetically engineered probiotic biosensors with a custom-designed photodetector and readout chip to track these molecules in the gastrointestinal tract. Leveraging the molecular specificity of living sensors1, we genetically encoded bacteria to respond to inflammation-associated molecules by producing luminescence. Low-power electronic readout circuits2 integrated into the device convert the light emitted by the encapsulated bacteria to a wireless signal. We demonstrate in vivo biosensor monitoring in the gastrointestinal tract of small and large animal models and the integration of all components into a sub-1.4 cm3 form factor that is compatible with ingestion and capable of supporting wireless communication. With this device, diseases such as inflammatory bowel disease could be diagnosed earlier than is currently possible, and disease progression could be more accurately tracked. The wireless detection of short-lived, disease-associated molecules with our device could also support timely communication between patients and caregivers, as well as remote personalized care.

YouTube as a source of information on pediatric scoliosis: a reliability and educational quality analysis

PURPOSE

To assess the reliability and educational quality of YouTube videos related to pediatric scoliosis.

METHODS

In December 2020, searches of "pediatric scoliosis", "idiopathic scoliosis", "scoliosis in children", and "curved spine in children" were conducted using YouTube. The first 50 results of each search were analyzed according to upload source and content. The Journal of the American Medical Association (JAMA) Benchmark Criteria were used to assess reliability (score 0-4), and educational quality was evaluated using the Global Quality Score (GQS; score 0-5) and Pediatric Scoliosis-Specific Score (PSS; score 0-15). Differences in scores based on upload source and content were determined by Analysis of Variance (ANOVA) or Kruskal-Wallis tests. Multivariate linear regressions identified any independent predictors of reliability and educational quality.

RESULTS

After eliminating duplicates, 153 videos were analyzed. Videos were viewed 28.5 million times in total, averaging 186,160.3 ± 1,012,485.0 views per video. Physicians (54.2%) and medical sources (19.0%) were the most common upload sources, and content was primarily categorized as disease-specific (50.0%) and patient experience (25.5%). Videos uploaded by patients achieved significantly lower JAMA scores (p = 0.004). Conversely, academic or physician-uploaded videos scored higher on PSS (p = 0.003) and demonstrated a trend towards improved GQS (p = 0.051). Multivariate analysis determined longer video duration predicted higher scores on all measures. However, there were no independent associations between upload source or content and assessment scores.

CONCLUSION

YouTube contains a large repository of videos concerning pediatric scoliosis; however, the reliability and educational quality of these videos were low.

LEVEL OF EVIDENCE

V.

Acute Lower Extremity Fracture Management in Chronic Spinal Cord Injury: 2022 Delphi Consensus Recommendations

Our objective was to develop a clinical practice guideline (CPG) for the treatment of acute lower extremity fractures in persons with a chronic spinal cord injury (SCI).

METHODS

Information from a previous systematic review that addressed lower extremity fracture care in persons with an SCI as well as information from interviews of physical and occupational therapists, searches of the literature, and expert opinion were used to develop this CPG. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to determine the quality of evidence and the strength of the recommendations. An overall GRADE quality rating was applied to the evidence.

CONCLUSIONS

Individuals with a chronic SCI who sustain an acute lower extremity fracture should be provided with education regarding the risks and benefits of operative and nonoperative management, and shared decision-making for acute fracture management should be used. Nonoperative management historically has been the default preference; however, with the advent of greater patient independence, improved surgical techniques, and advanced therapeutics and rehabilitation, increased use of surgical management should be considered. Physical therapists, kinesiotherapists, and/or occupational therapists should assess equipment needs, skills training, and caregiver assistance due to changes in mobility resulting from a lower extremity fracture. Therapists should be involved in fracture management as soon as possible following fracture identification. Pressure injuries, compartment syndrome, heterotopic ossification, nonunion, malunion, thromboembolism, pain, and autonomic dysreflexia are fracture-related complications that clinicians caring for patients who have an SCI and a lower extremity fracture may encounter. Strategies for their treatment are discussed. The underlying goal is to return the patient as closely as possible to their pre-fracture functional level with operative or nonoperative management.

External validation of the biomarker based ABCD score in atrial fibrillation patients with a non gender CHA2DS2 VASc score 0 to 1, A Korean multicenter retrospective cohort

Background

Patients with low to intermediate risk atrial fibrillation (AF), defined as non-gender CHA2DS2-VASc score of 0–1, are still at risk of stroke. This study verified the usefulness of ABCD score (Age [≥60 years], B-type natriuretic peptide [BNP] or N-terminal pro-BNP [≥300 pg/ml], Creatinine clearance [&lt;50 ml/min/1.73 m2], and Dimension of the left atrium [≥45 mm]) for stroke risk stratification in non-gender CHA2DS2-VASc score 0–1.

Methods

This multi-center cohort study retrospectively analyzed AF patients with non-gender CHA2DS2-VASc score 0–1. The primary endpoint was the incidence of stroke with or without anti-thrombotic treatment (ATT). An ABCD score was also validated.

Results

Overall, 2694 patients (56.3±9.5 years; female, 726 [26.9%]) were followed-up for 4.0±2.8 years. The overall stroke rate was 0.84/100 person-years (P-Y), stratified as follows: 0.46/100P-Y for an ABCD score 0; 1.02/100P-Y for an ABCD score≥1. The ABCD score was superior to the non-gender CHA2DS2-VASc score in stroke risk stratification (C-index=0.618, P=0.015; net reclassification improvement=0.576, P=0.040; integrated differential improvement=0.033, P=0.066). ATT was prescribed in 2353 patients (86.5%), and the stroke rate was significantly lower in patients receiving non-vitamin K antagonist oral anticoagulant (NOAC) therapy and an ABCD score≥1 than in those without ATT (0.44/100P-Y versus 1.55/100 P-Y; hazard ratio=0.26, 95% confidence interval 0.11–0.63, P=0.003).

Conclusion

The biomarker-based ABCD score demonstrated improved stroke risk stratification in AF patients with non-gender CHA2DS2-VASc score 0–1. Furthermore, NOAC with an ABCD score≥1 was associated with significantly lower stroke rate in AF patients with a non-gender CHA2DS2-VASc score 0–1.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korean Disease Control and Prevention Agency

Clinical and radiological outcome of the locked plate osteosynthesis in distal metadiaphyseal tibial fracture according to the severity of comminution: Varus reduction would not be preferable with lower clinical outcomes

BACKGROUND

The optimal treatment for distal tibial fractures remains a matter of debate. Nonetheless, plate osteosynthesis produces favorable results to intramedullary stabilization in aspects of alignment restoration.

AIM

The aim of the study was to compare the radiologic and clinical outcomes of distal metadiaphyseal tibial fracture between a simple/wedge fracture (SWF) and a comminuted fracture (CF) using minimally invasive plate osteosynthesis (MIPO).

PATIENTS AND METHODS

This retrospective study analyzed patients with SWF or CF of the distal tibial metadiaphysis that was surgically treated with a locking compression plate. Postoperative radiographic assessments and the time to radiologic union were noted. Clinical assessments were evaluated using both the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the foot function index (FFI). Postoperative complications were documented.

RESULTS

Seventy-one cases were analyzed over a mean follow-up period of 20.9 months. Thirty-six patients had SWF and 35 patients presented with CF. The mean time to radiologic union, amounts of postoperative coronal angulation, and incidence of malunion showed no statistical differences. Fibular fixation was more applied in the CF group (P < 0.001). Moreover, the clinical scores revealed no differences. Nonetheless, in the valgus union group, the AOFAS ankle-hindfoot score was 90.9 compared to 84.1 in the varus union group (P = 0.042) and the FFI was 9.2% compared to 20.2% in the varus union group (P = 0.017).

CONCLUSION

Plate osteosynthesis for SWF or CF of the distal tibial metadiaphysis led to high union rates and good clinical outcomes. There was no significant difference in the radiologic and clinical results according to the presence of fracture comminution. Nonetheless, the valgus union group showed better clinical outcomes than the varus union group. Clinically, it would be preferred to avoid intraoperative varus reduction.

End group Functionality of 95 to 99%: Epoxide Functionalization of Polystyryl-Lithium Evaluated via Solvent Gradient Interaction Chromatography (SGIC)

End group functionality is a key parameter of functional polymer chains. The end-capping efficiency of living polystyryl lithium with various epoxides, namely ethylene oxide (EO), ethoxy ethyl glycidyl ether (EEGE) and isopropylidene glyceryl glycidyl ether (IGG), is investigated with solvent gradient interaction chromatography (SGIC). Generally, end-capping efficiencies > 95% are observed. Hydroxyl functional polystyrene (PS-OH, PS-EEGE-OH and PS-IGG-OH) with molar masses ranging from 13.8 to 15 kg mol^-1 are obtained, with dispersities of 1.05-1.06. Deprotection of the acetal (PS-EEGE-OH) and ketal protective group (PS-IGG-OH) is investigated. Nearly quantitative deprotection (> 99%) resulting in the corresponding multihydroxy functional PS (PS-(OH)₂ and PS-(OH)₃ ) are observed via SGIC. Esterification of PS-OH with succinic anhydride shows a conversion of 98% to the corresponding ester. A detailed picture of side reactions during the carbanionic polymer synthesis subsequent epoxide termination is obtained, demonstrating 95-99% terminal functionality. Depending on the polarity of the end group, an elution order of PS-OH < PS-(OH)₂ < PS-(OH)₃ < PS-COOH is obtained in SGIC. The study demonstrates both the analytical power of SGIC and the exceptionally high terminal functionalization efficiency of anionic polymerization methods. This article is protected by copyright. All rights reserved.

Dysphagia May Attenuate Improvements in Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion

BACKGROUND

Past studies outline potential risk factors for dysphagia following anterior cervical discectomy and fusion (ACDF). Few studies explored the impact of dysphagia, as measured by the swallowing quality of life (SWAL-QOL), on postoperative patient-reported outcome measure (PROM) improvement. This study aimed to determine the relationship between dysphagia and improvement in pain, disability, physical function, and mental health following ACDF.

METHODS

A retrospective review of patients undergoing primary 1- or 2-level ACDF was performed. Individuals without a completed preoperative SWAL-QOL were excluded. Outcomes were collected for visual analog scale (VAS) neck and arm pain, Neck Disability Index (NDI), Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF), 12-Item Short Form Physical Component Score (SF-12 PCS), 9-Item Patient Health Questionnaire (PHQ-9), and SWAL-QOL. Postoperative improvement from preoperative values was evaluated using a paired t test. The impact of SWAL-QOL on each PROM was assessed using linear regression.

RESULTS

A total of 91 patients were included. Mean preoperative SWAL-QoL was 90.4, which worsened at 6 weeks and resolved by 6 months (P ≤ 0.007, both). VAS neck and arm scores significantly improved postoperatively (P < 0.001), as did the NDI score (P < 0.001). Physical function significantly improved at 12 weeks and 6 months (P ≤ 0.021, both). Depressive symptoms improved at 6 weeks and 12 weeks (P ≤ 0.007, both). Preoperatively, SWAL-QOL demonstrated significant relationships with all PROMs (P ≤ 0.005, all). At 6 weeks, 12 weeks, and 6 months (P ≤ 0.048, all), SWAL-QoL again demonstrated a similar significant association with all PROMs. Multiple regression did not demonstrate common demographic or operative variables that were significant predictors of PROMs.

CONCLUSION

Following ACDF, patients experienced a worsening of dysphagia but resolved by 12 weeks. All PROMs demonstrated significant improvements by the 6-month timepoint, except for PHQ-9. SWAL-QoL demonstrated a significant effect on all postoperative outcomes, which may suggest that this questionnaire could effectively evaluate dysphagia and predict positive or negative outcomes following ACDF.

LEVEL OF EVIDENCE

3 CLINICAL RELEVANCE: The severity of dysphagia has a significant association with pain, disability, mental health, and physical function patient-reported outcome measures in patients undergoing ACDF.

Postoperative Pneumonia and Aspiration Pneumonia Following Elderly Hip Fractures

OBJECTIVES

The present study aimed to investigate the incidence of and risk factors for postoperative pneumonia and aspiration pneumonia after hip fracture surgery.

DESIGN

Retrospective cohort study from 2005 to 2021.

SETTING

Asan Medical Center in Seoul, Republic of Korea.

PARTICIPANTS

A total 1,208 patients aged ≥ 65 years who underwent hip fracture surgery.

MEASUREMENTS

Postoperative pneumonia was defined as cases with new infiltration on chest x-ray or chest computed tomography (CT) after surgery or confirmed by a pulmonologist's consultation and diagnosis. Aspiration pneumonia was defined as: 1) radiologic findings of hospital-acquired pneumonia on chest radiographs or CT, medical record of aspiration pneumonia confirmed by a pulmonologist's consultation, and history of vomiting or aspiration, or 2) gravity-dependent opacity on chest CT when the history of vomiting or aspiration is ambiguous. Patient demographics, past medical history, pre-injury Koval score, Charlson Comorbidity Index (CCI), blood test results, length of hospital stay, and in-hospital mortality were evaluated. A comparison analysis and binary logistic regression were performed to identify the incidence and risk factors for postoperative pneumonia and aspiration pneumonia.

RESULTS

Postoperative pneumonia was diagnosed in 47 patients (3.9%), including 20 with aspiration pneumonia (1.7%). In the multivariate analysis, postoperative delirium (odds ratio [OR], 3.42; P < 0.001), American Society of Anesthesiologists (ASA) scores ≥ 3 (OR, 2.11; P = 0.021), and CCI (OR, 1.21; P = 0.013) were significant risk factors for postoperative pneumonia. Male sex (OR, 3.01; P = 0.017), postoperative delirium (OR, 3.16; P = 0.014), and preoperative serum albumin levels < 3.5 g/dL (OR, 7.00; P = 0.010) were significant risk factors for aspiration pneumonia.

CONCLUSION

ASA classification ≥ 3, higher CCI, and postoperative delirium were the risk factors for postoperative pneumonia. Male sex, postoperative delirium, and lower preoperative serum albumin level were the risk factors for aspiration pneumonia. Thus, physicians should pay attention to patients with the risk factors.

Nonlinear rheometry of entangled polymeric rings and ring-linear blends

We present a comprehensive experimental rheological dataset for purified entangled ring polystyrenes and their blends with linear chains in nonlinear shear and elongation. In particular, data for shear stress growth coefficient, steady-state shear viscosity, and first and second normal stress differences are obtained and discussed as functions of shear rate as well as molecular parameters (molar mass, blend composition and decreasing molar mass of linear component in blend). Over the extended parameter range investigated, rings do not exhibit clear transient undershoot in shear, in contrast to their linear counterparts and ring-linear blends. For the latter, the size of the undershoot and respective strain appear to increase with shear rate. Universal scaling of strain at overshoot and fractional overshoot (ratio of maximum to steady-state shear stress growth coefficient) indicates subtle differences in the shear-rate dependence between rings and linear polymers or their blends. The shear thinning behaviour of pure rings yields a slope nearly identical to predictions (-4/7) of a recent shear slit model and molecular dynamics simulations. Data for the second normal stress difference are reported for rings and ring-linear blends. While N ₂ is negative and its absolute value stays below that of N ₁ , as for linear polymers, the ratio -N ₂ /N ₁ is unambiguously larger for rings compared to linear polymer solutions with the same number of entanglements (almost by factor of two), in agreement with recent non-equilibrium molecular dynamics simulations. Further, -N ₂ exhibits slightly weaker shear rate dependence compared to N ₁ at high rates, and the respective power-law exponents can be rationalized in view of the slit model (3/7) and simulations (0.6), although further work is needed to unravel the molecular original of the observed behaviour. The comparison of shear and elongational stress growth coefficients for blends reflects the effect of ring-linear threading which leads to significant viscosity enhancement in elongation. Along the same lines, the elongational stress is much larger than the first normal stress in shear, and their ratio is much larger for rings and ring-linear blends compared to linear polymers. This conforms the interlocking scenario of rings and their important role in mechanically reinforcing linear matrices.

Insights into collateral susceptibility and collateral resistance in Acinetobacter baumannii during antimicrobial adaptation

The susceptibility of Acinetobacter baumannii exposed to primary antibiotic can be either increased or decreased when exposed to secondary antibiotic. This study was designed to assess the relative fitness, collateral susceptibility and collateral resistance of polymyxin B- (PMB-) adapted A. baumannii to ciprofloxacin (CIP), meropenem (MER), PMB, tetracycline (TET) and tobramycin (TOB). Strains of wild-type A. baumannii KACC 12454 (AB^KACC ), wild-type A. baumannii CCARM 12088 (AB^CCARM ), PMB-adapted AB^KACC , PMB-adapted AB^CCARM , stabilized AB^KACC and stabilized AB^CCARM were used in this study. Compared to the wild-type AB^KACC , the MICs of PMB were increased from 2 to 128 μg ml^-1 against PMB-adapted AB^KACC , while MICs of CIP, MER, TET and TOB were decreased from 2 to 1 μg ml^-1 , 16 to 1 μg ml^-1 , 16 to 2 μg ml^-1 and 64 to 16 μg ml^-1 , respectively. The PMB-adapted AB^CCARM was resistant to CIP (32 μg ml^-1 ) and PMB (64 μg ml^-1 ) compared to the wild-type AB^CCARM . The resistance of stabilized AB^KACC and AB^CCARM to all antibiotics was lost after antibiotic-free culture in the exception of CIP and TET. The susceptibilities of wild-type, PMB-adapted and stabilized AB^KACC and AB^CCARM to CIP, MER, PMB, TET and TOB were increased in the presence of β-lactamase and efflux pump inhibitors. The high levels of relative fitness were observed for stabilized AB^KACC , PMB-adapted AB^CCARM and stabilized AB^CCARM . The stabilized AB^KACC and PMB-adapted AB^CCARM were highly heteroresistance to PMB and TET, respectively. The PMB-adapted AB^KACC and AB^CCARM showed various antibiotic patterns, known as collateral susceptibility and collateral resistance. The results provide useful information for designing effective antibiotic regimens that can enhance the antibiotic activity against A. baumannii infections.

Medical Care Disruptions During the First Six-Months of the COVID19 Pandemic: The Experience of Older Breast Cancer Survivors

Purpose.

Older cancer survivors required medical care during the COVID-19 pandemic despite infection risks, but there are limited data on medical care in this age group.

Methods.

We evaluated care disruptions in a longitudinal cohort of non-metastatic breast cancer survivors ages 60–98 from five US regions (n=321). Survivors completed a web-based or telephone survey from May 27, 2020 to September 11, 2020. Care disruptions included self-reported interruptions in ability to see doctors, receive treatment or supportive therapies, or fill prescriptions. Logistic regression models evaluated bivariate and multivariate associations between care disruptions and education, medical, psychosocial and COVID-19-related factors. Multivariate models included age, county COVID-19 rates, comorbidity and post-diagnosis time.

Results.

There was a high response rate (n=262, 81.6%). Survivors were 32.2 months post-diagnosis (SD 17.5, range 4–73). Nearly half (48%) reported a medical disruption. The unadjusted odds of care disruptions were significantly higher with more education (OR 1.23 per one-year increase, 95% CI 1.09–1.39, p =0.001) and greater depression (OR 1.04 per one-point increase in CES-D score, CI 1.003–1.08, p=0.033); tangible support decreased the odds of disruptions (OR 0.99, 95% CI 0.97–0.99 per one-point increase, p=0.012). There was a trend for associations between disruptions and comorbidity (unadjusted OR 1.13 per 1 added comorbidity, 95% CI 0.99–1.29, p=0.07). Adjusting for covariates, only higher education (p=0.001) and tangible social support (p=0.006) remained significantly associated with having care disruptions.

Conclusions.

Older breast cancer survivors reported high rates of medical care disruptions during the COVID-19 pandemic and psychosocial factors were associated with care disruptions.

Impact of a specialised palliative care intervention in patients with advanced soft tissue sarcoma - a single-centre retrospective analysis

BACKGROUND

Soft tissue sarcomas (STS) account for less than 1% of all malignancies. Approximately 50% of the patients develop metastases with limited survival in the course of their disease. For those patients, palliative treatment aiming at symptom relief and improvement of quality of life is most important. However, data on symptom burden and palliative intervention are limited in STS patients.

AIM

Our study evaluates the effectiveness of a palliative care intervention on symptom relief and quality of life in STS patients.

DESIGN/SETTING

We retrospectively analysed 53 inpatient visits of 34 patients with advanced STS, admitted to our palliative care unit between 2012 and 2018. Symptom burden was measured with a standardised base assessment questionnaire at admission and discharge.

RESULTS

Median disease duration before admission was 24 months, 85% of patients had metastases. The predominant indication for admission was pain, weakness and fatigue. Palliative care intervention led to a significant reduction of pain: median NRS for acute pain was reduced from 3 to 1 (p < 0.001), pain within the last 24 h from 5 to 2 (p < 0.001) and of the median MIDOS symptom score: 18 to 13 (p < 0.001). Also, the median stress level, according to the distress thermometer, was reduced significantly: 7.5 to 5 (p = 0.027).

CONCLUSIONS

Our data underline that specialised palliative care intervention leads to significant symptom relief in patients with advanced STS. Further efforts should aim for an early integration of palliative care in these patients focusing primarily on the identification of subjects at high risk for severe symptomatic disease.

A Comparison of Surgical Outcomes Between Minimally Invasive and Open Thoracolumbar Corpectomy

BACKGROUND

Minimally invasive (MIS) techniques have gained considerable attention for the management of degenerative spinal pathologies. However, few studies have compared the outcomes between MIS and open thoracolumbar corpectomies. The purpose of this study was to compare perioperative variables between MIS and open thoracolumbar corpectomy.

METHODS

Retrospective review of 33 patients who underwent either an MIS or open thoracolumbar corpectomy by a single surgeon between 2005 and 2012 was performed. Patients were separated into anterior-posterior MIS (MIS AP), anterior-posterior open (AP), and posterior open (P) cohorts. Postoperative narcotic use was converted to oral morphine equivalents (OMEs). Demographics, comorbidity, perioperative variables, complications, and computed tomographic analyses were assessed. Fisher exact test was performed for categorical variables and Student t test for continuous variables. A P value of ≤ .05 denoted statistical significance.

RESULTS

Thirty-three patients underwent an MIS AP, AP, or P thoracolumbar corpectomy (39.4% vs 15.2% vs 45.5%, respectively). MIS AP patients were younger with a lower comorbidity burden than either open cohorts. In addition, MIS AP patients demonstrated a decreased procedural time, lower blood loss, and shorter hospitalization than either open cohorts. MIS AP patients required less units of transfusion than P and AP patients while demonstrating lower postoperative narcotics consumption and reoperations rates than open AP patients. Surgical site infection rates, body mass index, intraoperative fluid requirements, and complication rates were similar between cohorts. All patients demonstrated successful arthrodesis at 1 year based upon computed tomography.

CONCLUSIONS

MIS AP thoracolumbar corpectomy patients incurred decreased procedural times, shorter hospitalization, and lower blood loss compared with open patients. MIS AP patients demonstrated decreased postoperative narcotics consumption and reoperation rates compared with traditional AP patients. All patients demonstrated successful arthrodesis.

CLINICAL RELEVANCE

The MIS approach to thoracolumbar corpectomies appears to be a safe and efficacious alternative when compared with traditional methods.

Threading-Unthreading Transition of Linear-Ring Polymer Blends in Extensional Flow

Adding small amounts of ring polymers to a matrix of their linear counterparts is known to increase the zero-shear-rate viscosity because of linear-ring threading. Uniaxial extensional rheology measurements show that, unlike its pure linear and ring constituents, the blend exhibits an overshoot in the stress growth coefficient. By combining these measurements with ex-situ small-angle neutron scattering and nonequilibrium molecular dynamics simulations, this overshoot is shown to be driven by a transient threading-unthreading transition of rings embedded within the linear entanglement network. Prior to unthreading, embedded rings deform affinely with the linear entanglement network and produce a measurably stronger elongation of the linear chains in the blend compared to the pure linear melt. Thus, rings uniquely alter the mechanisms of transient elongation in linear polymers.

Stress relaxation in symmetric ring-linear polymer blends at low ring fractions

We combine linear viscoelastic measurements and modelling in order to explore the dynamics of blends of the same-molecular-weight ring and linear polymers in the regime of the low volume fraction (0.3 or lower) of the ring component. The stress relaxation modulus is affected by the constraint release (CR) of both rings and linear components due to the motion of linear chains. We develop a CR-based model of ring-linear blends that predicts the stress relaxation function in the low fraction regime of ring component in excellent agreement with experiments. Rings trapped by their entanglements with linear chains can only relax by linear-chain-induced constraint release, resulting in much slower relaxation of rings than of linear chains. The relative viscosity η ( ϕ R * ) / η L of the blend with respect to the linear melt viscosity η _L at ring overlap volume fraction ϕ R * increases proportionally to the square root of ring molecular weight M w , R . Our experimental results clearly demonstrate that it is possible to enhance the viscosity and simultaneously the structural relaxation time of linear polymer melts by adding a small fraction of ring polymers. These results not only provide fundamental insights into the physics of the CR process but also suggest ways to fine-tune the flow properties of linear polymers by means of adding rings.

The brief window of time comprising a wheelchair transfer confers a significant fracture risk on elderly Americans

OBJECTIVES

Wheelchairs grant increased mobility to their users but can result in injuries of varying severities, including fractures which are often associated with wheelchair transfers. However, this fracture burden remains poorly characterized in elderly Americans. The purpose of this study was to report demographic and environmental risk factors for these injuries.

STUDY DESIGN

We used data from the National Electronic Injury Surveillance System (NEISS) for the years 2007-2017 to perform a retrospective, cross-sectional analysis of wheelchair transfer fractures in patients aged 65 years and older.

METHODS

Each yearly sample in the NEISS database was queried between 2007 and 2017 for fractures associated with wheelchair transfers in patients aged 65 years or older. The narrative sections of the database were individually read and reviewed to identify cases in which a patient explicitly transferred into or out of a wheelchair while sustaining said fracture.

RESULTS

Between 2007 and 2017, the average number of patients aged 65 years and older presenting to US emergency departments was 3924 (95% confidence interval [CI] = 2792-5055). A significantly higher percentage of fractures (61.8%; 95% CI = 56.7%-66.8%) is associated with transferring out of wheelchairs. Moreover, such fractures were often associated with transferring to and from beds (29.9%; 95% CI = 25.4%-34.3%), with the hip (37.5%; 95% CI = 33.3%-41.6%) being the most commonly fractured anatomical region overall. A majority of patients required admission to the hospital (60.2%; 95%CI = 52.4%-68.0%) and most wheelchair transfer fractures occurred at home (44.1%; 95% CI = 36.7%-51.5%), with women (71.9%; 95% CI = 68.3%-75.6%) comprising the majority of these patients.

CONCLUSIONS

Our findings show that wheelchair transfers are associated with significant risk of severe fracture in elderly Americans. As such, wheelchair transfer events merit extra attention from healthcare providers because they comprise a brief window of time relative to the number of occupancy hours in full-time wheelchair users yet can result in significant morbidity and mortality. Preventative measures and patient education should be encouraged to preserve patient mobility and reduce injury.

P966 Impact of systolic dysfunction and elevated left ventricular end diastolic pressure on three years clinical outcome in patients with atrial fibrillation

Background

Systolic and diastolic dysfunction is related with adverse clinical outcomes in the patients with sinus rhythm. Purpose: The aim of this study is to clarify the prognostic significance of both systolic and diastolic dysfunction in the patients with chronic persistent atrial fibrillation (AF). Methods: A total of 114 consecutive patients who have chronic persistent AF. Whole patients were divided into 2 groups according to left ventricular ejection fraction (LVEF): those with an LVEF &lt; 50 (n = 24) (REF) and those with an LVEF ≥ 50 (n = 90) (PEF). And PEF group was also divided into two groups according to left ventricular end diastolic filling pressure (LVEDP): patients with LVEDP ≥ 15 mmHg (n = 38) and those with &lt; 15 mmHg (n = 52). Results: 3-year clinical outcomes were compared between each groups (PEF groups vs. REF groups and LVEDP ≥ 15 mmHg vs LVEDP &lt; 15 mmHg). The incidence of death, hospitalization, stroke, bleeding, AF with rapid ventricular rhythm (RVR) and heart failure (HF) hospitalization were similar PEF and REF group. However, during 3-year follow up period, the incidence of HF hospitalization (29.2% vs 8.9%, p &lt; 0.02) and AF with RVR (20.8% vs 3.3%, p &lt; 0.01) were frequent in REF group compared with PEF group. In multivariate analysis, REF is an only predictor of HF hospitalization (Table 1). Conclusion: During 3-year follow up period, systolic dysfunction is an important predictor of HF hospitalization in AF patients. However, elevated LVEDP is not related with 3-year adverse clinical outcomes in AF patients without systolic dysfunction.

Table 1 variable Odd Ratio (HR) 95% Confidence Interval (CI) P Age .973 .925-1.023 .286 Diabetes mellitus .487 .138-1.721 .264 BNP 1.000 1.000-1.000 .908 Hypertension 1.061 .330-3.413 .921 LVEDP &gt; 15 mmHg 1.302 .396-4.285 .664 EF &lt; 50 4.712 1.478-15.016 .009 Predictors of 3-year follow-up clinical outcomes of all participants

Regional characteristics of NO2 column densities from Pandora observations during the MAPS-Seoul campaign

Vertical column density (VCD) of nitrogen dioxide (NO2) was measured using Pandora spectrometers at six sites on the Korean Peninsula during the Megacity Air Pollution Studies-Seoul (MAPS-Seoul) campaign from May to June 2015. To estimate the tropospheric NO₂ VCD, the stratospheric NO₂ VCD from the Ozone Monitoring Instrument (OMI) was subtracted from the total NO₂ VCD from Pandora. European Centre for Medium-Range Weather Forecasts (ECMWF) reanalysis wind data was used to analyze variations in tropospheric NO₂ VCD caused by wind patterns at each site. The Yonsei/SEO site was found to have the largest tropospheric NO₂ VCD (1.49 DU on average) from a statistical analysis of hourly tropospheric NO₂ VCD measurements. At rural sites, remarkably low NO₂ VCDs were observed. However, a wind field analysis showed that trans-boundary transport and emissions from domestic sources lead to an increase in tropospheric NO₂ VCD at NIER/BYI and KMA/AMY, respectively. At urban sites, high NO₂ VCD values were observed under conditions of low wind speed, which were influenced by local urban emissions. Tropospheric NO₂ VCD at HUFS/Yongin increases under conditions of significant transport from urban area of Seoul according to a correlation analysis that considers the transport time lag. Significant diurnal variations were found at urban sites during the MAPS-Seoul campaign, but not at rural sites, indicating that it is associated with diurnal patterns of NO₂ emissions from dense traffic.

3334Updated meta-analysis of biodegradable polymer drug-eluting stent versus second-generation durable polymer drug-eluting stent implantations

Background

Data regarding clinical outcomes of biodegradable polymer drug-eluting stent (BP-DES) versus second-generation durable polymer drug-eluting stent (DP-DES) in patients undergoing percutaneous coronary intervention (PCI) are inconclusive.

Purpose

We aimed to perform a meta-analysis to investigate the clinical outcomes of BP-DES compared with second-generation DP-DES in patients who have undergone PCI.

Methods

We searched PubMed, MEDLINE, EMBASE, and Cochrane databases through January 2019 for randomized controlled trials comparing BP-DES with second-generation DP-DES in patients treated with PCI. All-cause death, cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), definite/probable stent thrombosis (ST) were compared between the groups. Additionally, a landmark analysis with the landmark set at 1 year and a subgroup analysis according to stent characteristics were performed.

Results

Data from 23 trials including 28802 randomized patients were analyzed. At a median follow up of 3.1 years, no significant differences were found in terms of all-cause death (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.95–1.16), cardiac death (OR 1.01, 95% CI 0.87–1.17), MI (OR 0.92, 95% CI 0.82–1.03), TVR (OR 0.97, 95% CI 0.86–1.11), TLR (OR 0.97, 95% CI 0.85–1.11), and definite/probable ST (OR 0.86, 95% CI 0.70–1.07) between the groups. Landmark analysis showed that there were similar risks in all-cause death (OR 1.04, 95% CI 0.93–1.17), cardiac death (OR 1.11, 95% CI 0.92–1.36), MI (OR 0.94, 95% CI 0.79–1.13), TVR (OR 0.95, 95% CI 0.73–1.23), TLR (OR 1.00, 95% CI 0.80–1.24), and definite/probable ST (OR 0.92, 95% CI 0.67–1.28) between the groups. The similar tendency of any study endpoints between the groups was consistent in the subgroup, including stent platform (stainless steel vs. alloy), the drug coating distribution (abluminal vs. circumferential), the polymer degradation period (<6 months vs. >6 months), or the drug release duration (<6 months vs. >6 months) of BP-DES, or the DAPT duration (≥6 months vs. ≥12 months). However, the uses of BP-DES with sirolimus-eluting (OR 0.84, 95% CI 0.72–0.98) or ultrathin strut (defined as <70μm; OR 0.81, 95% CI 0.68–0.97) were predictive for lower risk of MI.

Clinical outcomes

Conclusions

In our updated meta-analysis, BP-DES implantation was associated with comparable clinical outcomes compared with second-generation DP-DES implantation. However, PCI with ultrathin biodegradable polymer sirolimus-eluting stent could reduce the risk of MI.

P1026Risk factors for the occurrence of stroke after atrial fibrillation ablation

Background

Risk factors for the occurrence of embolic stroke (ES) after atrial fibrillation (AF) ablation have not been fully elucidated. Our aim was to assess incidence of ES during long-term follow-up following AF ablation and to identify predicting factors associated with post-ablation ES.

Methods

We enrolled patients who experienced ES after AF ablation and body mass index-matched controls from AF ablation registries. Epicardial adipose tissue (EAT) was assessed using multislice computed tomography prior to ablation.

Results

A total of 3,464 patients who underwent AF ablation were recruited. During a mean follow-up of 47.2 months, ES occurred in 47 patients (1.36%) with a mean CHA2DS2-VAS score of 2.15 and overall incidence of ES was 0.34 per 100 patients/year. Compared with control group (n=190), ES group had more higher prior thromboembolic event and AF recurrence rates, larger LA size, lower creatinine clearance rate (CCr), and greater total and periatrial EAT volumes although no differences in AF type, CHA2DS2-VASc score, ablation extent, and anti-thrombotics use were found. On multivariate regression analysis, a prior history of thromboembolism, CCr, and periatrial EAT volume were independently associated with ES occurrence after AF ablation.

Cox regression analysis Risk factor Univariate Multivariate HR (95% CI) p value HR (95% CI) p value Age 1.017 (0.984–1.051) 0.31 Prior thromboembolism 2.488 (1.134–5.460) 0.023 2.916 (1.178–7.219) 0.021 CHA2DS2-VASc score 1.139 (0.899–1.445) 0.282 CCr 0.984 (0.970–0.999) 0.038 0.982 (0.996–0.998) 0.029 LA diameter (mm) 1.070 (1.012–1.130) 0.017 1.072 (0.999–1.150) 0.054 EAT_total (ml) 1.020 (1.010–1.029) <0.001 1.008 (0.993–1.023) 0.297 EAT_periatrial (ml) 1.085 (1.045–1.126) <0.001 1.065 (1.005–1.128) 0.032 PVI + additional ablation 0.846 (0.460–1.557) 0.592 No anticoagulant use 0.651 (0.346–1.226) 0.184 Recurrence 2.011 (1.007–4.013) 0.048 1.240 (0.551–2.793) 0.603 CCr, creatinine clearance rate; EAT, epicardial adipose tissue; LA, left atrium; PVI, pulmonary vein isolation.

K-M curve for stroke-free survival

Conclusions

Incidence of ES after AF ablation was lower than expected rate based on CHA2DS2-VASc score even though anticoagulants use was limited. Periatrial EAT volume, a prior thromboembolism event, and CCr were independent factors in predicting ES irrespective of AF recurrence and CHA2DS2-VASc score in patients who underwent AF ablation.

P2799Long-term outcomes after percutaneous coronary intervention with biodegradable polymer drug-eluting stent versus second-generation durable polymer drug-eluting stent: evidence from a meta-analysis

Background

The true benefit of biodegradable polymer drug-eluting stent (BP-DES) over second-generation durable polymer drug-eluting stent (DP-DES) expected to be represented during late period of follow-up after percutaneous coronary intervention (PCI), but prior meta-analysis only evaluated short-term outcomes.

Purpose

We aimed to compare the long-term clinical outcomes after PCI with BP-DES versus second-generation DP-DES by a meta-analysis of randomized controlled trials.

Methods

Randomized controlled trials comparing BP-DES with second-generation DP-DES implantations were searched through PubMed, MEDLINE, EMBASE, and Cochrane databases. All-cause death, cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), and definite/probable stent thrombosis (ST) were compared between the groups. In addition, a landmark analysis with the landmark set at 1-year and a subgroup analysis based on stent characteristics were performed.

Results

Fifteen trials that included a total of 21311 randomized patients with at least 2 years follow-up were analyzed. At a median follow-up of 4.2 years, no significant differences in the risks of all-cause death (odds ratio [OR] 1.03, 95% confidence interval [CI] 0.94–1.14), cardiac death (OR 1.03, 95% CI 0.88–1.20), MI (OR 0.90, 95% CI 0.79–1.01), TVR (OR 0.96, 95% CI 0.82–1.12), TLR (OR 0.97, 95% CI 0.85–1.11), and definite/probable ST (OR 0.84, 95% CI 0.67–1.05) were found between the groups. In the 1-year landmark analysis, the rates of all-cause death (OR 1.04, 95% CI 0.93–1.17), cardiac death (OR 1.11, 95% CI 0.92–1.36), MI (OR 0.94, 95% CI 0.79–1.13), TVR (OR 0.95, 95% CI 0.73–1.23), TLR (OR 1.00, 95% CI 0.80–1.24), and definite/probable ST (OR 0.94, 95% CI 0.67–1.31) were similar between the groups. There were comparable rates of any study endpoints between the groups regardless of stent platform (stainless steel vs. alloy), the polymer degradation period (<6 months vs. >6 months) or the drug release duration (<6 months vs. >6 months) of BP-DES, or the DAPT duration (≥6 months vs. ≥12 months). However, the use of BP-DES with sirolimus eluting (OR 0.82, 95% CI 0.70–0.97), circumferential drug distribution (OR 0.79, 95% CI 0.65–0.96), thin strut (defined as <100μm; OR 0.83, 95% CI 0.70–0.97), or ultrathin strut (defined as <70μm; OR 0.78, 95% CI 0.64–0.94) were associated with lower rates of MI than did second-generation DP-DES. Moreover, BP-DES with circumferential drug distribution (OR 0.82, 95% CI 0.69–0.98) was predictive for reduced rates of TVR.

Clinical outcomes

Conclusions

In this meta-analysis, long-term clinical outcomes were equivalent between BP-DES and second-generation DP-DES implantations. However, among BP-DESs, the improved risks of MI in those with sirolimus eluting, circumferential drug distribution, thin strut, or ultrathin strut and decreased rates of TVR in those with circumferential drug distribution were noted.