Risultati per: Sindromi coronariche acute

Circulation, Volume 146, Issue Suppl_1, Page A11912-A11912, November 8, 2022. Introduction:Pregabalin, a structural analog to λ-aminobutyric acid, is prescribed for neurological disorders. Through actions to cause sodium/water retention, the agent may increase the risk of acute heart failure (AHF).Methods:We performed a retrospective cohort study using a repository of healthcare records obtained from a large U.S. academic healthcare system. HF patients were identified between 1/1/2016-12/31/2020. Patients who had initiated treatment with pregabalin were compared to patients with no post-HF pregabalin over a 365-day post-pregabalin period or post-HF period. Study outcomes were per-patient per-year (PPPY) emergency department (ED) admissions or PPPY hospitalizations, time-to first ED admission, and time-to hospitalizations. Outcomes encounters were adjudicated by a HF diagnosis (ICD-10, I50.x) at any position. We tested the association between the pregabalin exposure and outcomes using generalized linear regression and Cox-proportional hazard regression approach.Results:The study cohort included 483 pregabalin-HF patients and 21,150 pregabalin-naïve HF patients. The pregabalin-HF patients age was (mean±SEM: 62.2±0.7 vs. 66.2±0.1 years,p

Circulation, Volume 146, Issue Suppl_1, Page A14084-A14084, November 8, 2022. Background:There is a paucity of data about the outcomes of performing Percutaneous coronary intervention (PCI) for Liver transplant (LT) patients presenting with acute coronary syndrome (ACS).Methods:We queried the national readmission database for patients who underwent PCI hospitalized between 2016 and 2019, patient were classified into two groups based on prior LT status. International classification of disease codes (ICD-10) were used for diagnosis and procedures codes. Our outcomes were In-hospital mortality and 90-day readmission rate. A multivariate adjusted regression model was performed to risk adjust for predictors of 90-day readmission (all-cause).Results:A total of 1400,861 patients underwent PCI between the years 2016 and 2019 for ACS and underwent PCI. 1,532 patients had a history of LT (0.1%). Hospitalized patients with prior LT were of similar age (65.2 ±0.31 vs 65.3 ±0.04 years, p=0.9), and less likely to be women (20.8.6% vs. 32.5%, p

Circulation, Volume 146, Issue Suppl_1, Page A11206-A11206, November 8, 2022. Background:Translational studies showed positive results of stem cell therapy against myocardial infarction (MI)-induced cardiac dysfunction. Programmed death ligand 1 (PD-L1) is a key immune receptor, which modulates immune system and maintain the stability of coronary plaques. Akt is one of the signaling that exert its cardioprotective effect through regulating PD-L1. In the present study, we overexpressed PD-L1 and Akt in adipose-derived mesenchymal stem cells (AdMSC) and determined the protection against MI.Methods and Results:Adult Wistar rats were randomly separated into four groups: sham, MI, treatment of AdMSC or AdMSC overexpressed with PD-L1 and Akt (AdMSC-PDL1-Akt) immediately after MI. MI was induced by LAD ligation and ADMSC were injected into the heart around the area at risk. After 4 weeks, rats were examined by echocardiography, pressure-volume analysis, infarct size measurement, and immunohistochemistry to evaluate the efficacy of the ADMSCs on myocardium. Results demonstrated AdMSC-PDL1-Akt was more resistant to ROSin vitro, and could restore MI-induced contractile dysfunctionin vivoby increasing ESPVR (P=0.048) and PRSW (P=0.015). AdMSC-PDL1-Akt could also protect hearts from MI-increased infarct size (P=0.002). Immunohistochemistry staining with caspase 3 and NFκB were upregulated in MI hearts and significantly reversed in AdMSC-PDL1-Akt group (P

Circulation, Volume 146, Issue Suppl_1, Page A9970-A9970, November 8, 2022. Introduction:Accountable Care Organizations (ACOs) aim to improve quality and reduce costs of care, but few studies have described variation across ACOs in hospitalization rates for patients with heart failure (HF) or factors associated with hospitalization rates.Methods:We identified a sample of Medicare fee-for-service beneficiaries with HF who were assigned to a Medicare Shared Savings Program (MSSP) ACO in 2017 and survived at least 30 days into 2018. Using a hierarchical, negative binomial model that accounted for clustering of patients within ACOs, we calculated 2018 risk-standardized, unplanned ACO admission rates (RSAARs) as the ratio of predicted to expected admissions per 100 persons, multiplied by the overall rate of admissions. We then used multiple linear regression to identify ACO characteristics associated with RSAAR variation.Results:Among 1,232,222 beneficiaries with HF, 283,795 were assigned to one of 467 MSSP ACOs (mean age 81 years, 54% female, 86% white, 78% urban). Median RSAAR [IQR] was 87 [82-92] admissions per 100 persons (Figure 1). A 5% increase in the percentage of Black beneficiaries in the ACO corresponded to an increase of 0.65 admissions per 100 HF patients (95% CI 0.31, 0.99, p

Circulation, Volume 146, Issue Suppl_1, Page A13502-A13502, November 8, 2022. Introduction:In patients with acute myocardial infraction (AMI), multivessel coronary artery disease (CAD) is associated with worse prognosis than single-vessel CAD. Several observational studies have reported worse clinical outcomes in AMI patients with non-infarct-related artery chronic total occlusion (n-IRA CTO). We performed a systematic review and meta-analysis to evaluate the prognostic significance of n-IRA CTO in patients with AMI.Methods:Systematic review was performed querying PubMed, Google Scholar, Cochrane and clinicaltrials.gov from Inception through May 2022. Studies comparing AMI patients with and without n-IRA CTO were included. Outcomes included in-hospital, 30-day and long-term mortality, cardiac mortality, major adverse cardiovascular events (MACE), and major bleeding. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random effects models.Results:Five prospective, eight retrospective and 3 subgroup analyses of randomized control trials (RCTs) (n-IRA CTO n=2,521, no CTO n=18,397) were identified. Presence of n-IRA CTO was associated with higher in-hospital (RR 2.86, 95% CI 1.77-4.62, p

Circulation, Volume 146, Issue Suppl_1, Page A14384-A14384, November 8, 2022. Introduction:Epidemiological evidence suggests that obesity is associated with Acute myocardial infarction (AMI). Studies on the incidence and outcomes of patients with premature AMI who are obese are limited with attention to disparities are scarce.Hypothesis:Obesity and Morbid Obesity is associated with increasing premature AMIMethods:This was a trend study of the National Inpatient database from 2010 to 2019. We searched for AMI as primary reason for hospitalization with obesity or morbid obesity as a comorbidity using the ICD codes. We estimated trends, inpatient mortality, mean length of hospital stays (LOS) and mean total hospital charges (THC) over the period. We performed a stratified analysis in categories: sex (male and female), race (Caucasians, Blacks, Hispanics), and median household income for patient’s zip code (low-income quartile [LIQ] vs high-income quartile [HIQ]) to assess disparities in outcomes. Multivariable regression analysis adjusted for age and sex was used to obtain trend statistics on outcomes.Results:There was a total of 173,106 hospitalizations for obesity with early AMI with the proportion of females (63.7%). There was an increase in early MI by 60.9% among obese patients, with mean in-hospital mortality of 1.3%. Female obese patients had a 33% increase in inpatient mortality with premature AMI, with the highest increase among black women compared to white women (78.7% vs. 35.0%). Hospitalization for adult premature AMI in patients with morbid obesity was 64,926 with proportion of female 66.1% from 2010 to 2019. The incidence of hospitalization for premature AMI among morbidly obese patients increased by 120% from 2010 to 2019. The average mortality from 2010 to 2019 among morbidly obese patient with premature AMI was 2.0% in the decade studied. There was a trend toward decreased mortality over the years; however, on subgroup analysis, the decrease in mortality was significant among whites but not among blacks, LIQ, or HIQ in early MI with morbid obesity.Conclusions:Our study shows a significant increase in hospitalization for premature AMI in obese and morbidly obese patients. The female obese patient has higher inpatient mortality with highest among blacks compared to whites.

Circulation, Volume 146, Issue Suppl_1, Page A11239-A11239, November 8, 2022. Introduction:Gender disparities in the utilization of catheter-directed thrombolytic (CDT) therapy vs. systemic thrombolytic (ST) therapy in patients with acute pulmonary embolism (PE) have not been studied before.Methods:Using the National Inpatient Sample database from 2012 to 2018, we identified all adult patients with acute PE who received any thrombolytic therapy. The primary outcome was the utilization of CDT vs. ST therapy in females compared to males. The secondary outcome was the mortality in females compared to males in all patients of acute PE who received any thrombolytic therapy.Results:We identified 45,950 patients who received CDT or ST therapy. The mean age was 59.7 years in females vs. 59 in males (p-value – .03). Males were more likely to have saddle PE (33% vs. 29%, p-value < .01) and less likely to have vasopressor use (3% vs. 5%, p-value < .01). Baseline characteristics are shown inTable 1.Females were less likely to have CDT vs. ST therapy on adjusted analysis (AOR - 0.85, p-value < .01), as shown inTable 2.Females also had 27% higher in-hospital mortality than males in the entire cohort who received any thrombolytic therapy even after adjustment for age, race, comorbidities, and hospital factors (AOR - 1.27, p-value < .01). CDT was associated with a 58% lower risk of in-hospital mortality than systemic thrombolytic therapy in the adjusted model (AOR - 0.42, p-value < .01).Conclusion:Gender disparities exist in the utilization of CDT in patients of acute PE who receive thrombolytic therapy, with lower utilization in females than males, despite significantly reduced in-hospital mortality associated with CDT vs. ST therapy.

Circulation, Volume 146, Issue Suppl_1, Page A9761-A9761, November 8, 2022. Introduction:Recent studies have shown an improvement in survival among Cardiopulmonary resuscitation (CPR) cases in several situations. However, risk factors of CPR among patients admitted for Acute Ischemic Stroke (AIS) remain uncertain.Methods:Our analysis used the most extensive US inpatient database, the 2019 National Inpatient Sample, to identify patients diagnosed with CPR among adults of ages 40 and more admitted with a principal diagnosis of AIS. We also queried the different cardiac arrhythmias seen in these patients. Multivariable analysis was used to find the adjusted odds ratio(aOR) of requiring cardiopulmonary resuscitation.Results:Our study found 1425 AIS patients requiring cardiopulmonary resuscitation, which was also more common in patients of ages 40-60 (aOR 1.168), diabetics (aOR 1.160), with heart failure (aOR 1.130), hypotension (aOR 1.932), hepatic failure (aOR 3.317), renal failure (aOR 1.856), respiratory failure (aOR 18.223), gastrointestinal hemorrhage (aOR 1.960), hyperkalemia (aOR 2.258), and hypokalemia (aOR 1.265). Smokers (aOR 0.663), Females (aOR 0.878), and those with hyperlipidemia (aOR 0.689) were less likely to need CPR. Several cardiac arrhythmias were noted among those who needed CPR, such as supraventricular tachycardia (6.0% vs. 1.4%), and ventricular tachycardia (19.6% vs. 1.6%), paroxysmal atrial fibrillation (11.9% vs. 9.7%), and ventricular fibrillation (13.3% vs. 0.1%). Finally, CPR patients were slightly younger (mean age 69.82 vs. 70.89) with a longer (mean length of stay 11.48 vs. 5.01 days) hospitalization. A higher mortality rate was also found as 1030 patients died (72.3% vs. 3.6%).Conclusions:We observed several significant potential risk factors for CPR among AIS patients. Further studies, strategies, and changes in protocols among AIS admissions may benefit the long-term prognosis.

Circulation, Volume 146, Issue Suppl_1, Page A13504-A13504, November 8, 2022. Introduction:With new legislation becoming more lenient regulating recreational cannabis use in the United States, the prevalence of cannabis has doubled since 2002 and continues to rise. While there have been some reports of the benefits of cannabis, medical literature has identified several adverse cardiovascular events. Cannabis as a significant risk factor for the acute coronary syndrome (ACS) has been suspected to be attributed to vascular inflammation and platelet activation as well as elevation in heart rate and blood pressure through sympathetic stimulation.Methods:We conducted a case-control study utilizing the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2019 database to investigate hospitalizations for patients aged 18 years old or older with the primary diagnosis of ACS. Comorbidities were identified through their international classification of diseases, 10th revision (ICD-10 codes) recorded in the discharge record for each hospitalization. Records having cocaine or other stimulants were excluded. An alpha (p) value less than 0.05 was considered statistically significant.Results:Of the 34,948,093 records included in the study, 225,275 had a primary diagnosis of ACS, and 767,525 had evidence of cannabis use. The rate of cannabis use in the ACS group (2%, n= 4,490) was lower than the non-ACS group (2.2%, n=763,035, p

Circulation, Volume 146, Issue Suppl_1, Page A14879-A14879, November 8, 2022. Introduction:Acute type A aortic dissection (ATAAD) is a devasting cardiovascular disease. Though it is recommended by guidelines, urgent open surgery was not accessible for all patients. Transferring patients to comprehensive aortic centers, inadequate medical assistance in low-resource health systems or financial issues would delay the timing of surgery. There have been several reports about the connection between circadian variation and cardiovascular disease. The study was conducted to examine the circadian variation in pre-procedural rupture of ATAAD in the hospital.Methods:The study enrolled ATAAD patients who died from aortic rupture within 7 days since onset in our center from January 2010 to December 2020. Patients who died within 1 hour after admission were excluded. All patients accepted anti-impulse therapy immediately upon admission. Clinical data were retrospectively collected from medical records.Results:In total, 200 ATAAD patients were enrolled in the retrospective observational study. Mean age of recruiters was 55.98 ± 11.82 years and 159 (78.5%) were men. Mean time from onset to admission was 26.78 ± 24.97 hours and mean time from onset to rupture was 48.27 ± 42.01 hours. Distributions of rupture time were visualized through histogram. The peaks of the occurrence of aortic rupture were in 6:00-8:00 (26%) and 18:00-22:00 (36%). Kernel density estimation was consistent with the results.Conclusions:Rupture of ATAAD does not seem to be a random phenomenon, while the peak of occurrence was consistent with the circadian rhythm. Even when the hemodynamic state was well controlled, fluctuant blood pressure and heart rate that influenced by the circadian rhythm would increase the risk of aortic rupture. During 6:00-8:00 and 18:00-22:00, more frequent blood pressure measurement and does adjustment of intravenous anti-impulse drugs might improve aortic rupture reduction. What’s more, bedtime hypertension treatment might also help.

Circulation, Volume 146, Issue Suppl_1, Page A12249-A12249, November 8, 2022. Introduction:Advances in mechanical circulatory support (MCS) devices and several studies showing that early application of MCS devices can improve survival rates in cardogenic shock (CS) patients are increasing interest in the usefulness of MCS devices in CS patients. However, studies on the optimal use and timing of application of MCS device in CS patients are still lacking.Methods:The RESCUE study is multicenter, retrospective, and prospective registry of patients that presented with CS. From January 2014 to December 2018, 1247 patients with CS were enrolled from 12 major centers in Korea. Among enrolled patients, ECMO was applied to 238 of 693 patients who performed percutaneous coronary intervention (PCI) with acute coronary syndrome. The primary endpoint was a composite of in-hospital, 30-day, 6-month and 12-month mortality according to ECMO application timing.Results:There was no difference in the 30-day mortality in ACS patients with CS according to ECMO application timing before and after PCI. However, when stratified by time from CS recognition to ECMO application (Shock to ECMO application time, ≤100 minute vs. >100 minute), 30-day Kaplan-Meier survival curve showed differences according to ECMO application timing. When the time from CS to ECMO application less than 100 minutes, patients who applied ECMO during or after PCI had a 34% reduction in 30-mortality compared to patients who applied ECMO before PCI (HR = 0.64, 95% CI: 0.39-1.03; P = 0.07). And, when the time from CS to ECMO application exceeded 100 minute, patients who applied ECMO during or after PCI had an approximately twice the 30-day mortality compared to patients who applied ECMO before PCI (HR = 2.03, 95% CI: 1.07-3.85; P = 0.03).Conclusions:According to ECMO application timing, prognosis of ACS patients with cardiogenic shock was different. In case of exceed 100 minute, early initiation of ECMO application was associated with improved prognosis in 30-day mortality.

Circulation, Volume 146, Issue Suppl_1, Page A13893-A13893, November 8, 2022. Introduction:Timely management of acute myocardial infarction (AMI) significantly improves outcomes. Patient and community-level characteristics are strong determinants of survival following AMI. The Social Vulnerability Index(SVI) is a robust community assessment tool that reliably ranks counties based on several parameters on a scale from 0 to 1. More vulnerable communities have higher SVI scores.Hypothesis:Higher levels of SVI scores will be associated with higher AMI-related deaths in the USA.Methods:Using the multiple causes of death database from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research(1999-2020), we extracted county-level deaths with any mention of AMI with ICD-10 codes I21 and I22. County-level SVI was obtained from CDC/ATSDR. We fitted segmented regression models to evaluate the association between quintiles of SVI scores and AMI-related age-adjusted mortality rate (AAMR, expressed per 100,000 persons). Analysis was done using STATA v17 and Joinpoint segmented regression softwares with p-values

Circulation, Volume 146, Issue Suppl_1, Page A11896-A11896, November 8, 2022. Introduction:Spontaneous heparin-induced thrombocytopenia (HIT) is a rare clinical variant that develops without prior exposure to heparin. We present a 40-year-old man who was diagnosed with spontaneous HIT after an acute ST-segment elevation myocardial infarction complicated by multiple acute stent thromboses and left ventricular (LV) thrombus.Case:A 40-year-old previously healthy man with no known history of heparin exposure presented to our emergency department with an acute ST-segment elevation myocardial infarction. Emergent coronary angiography revealed a severely thrombotic 100% occlusion of his distal left anterior descending artery for which thrombectomy and percutaneous coronary intervention (PCI) were performed with placement of a drug eluting stent. Prior to angiography, the patient received 4000 units of unfractionated heparin and an additional 2000 units intra-arterially during the case. Labs prior to PCI revealed thrombocytopenia and HIT enzyme-linked immunoassay testing was sent. He underwent repeat angiography two additional times during his course for recurrent chest pain which both revealed acute stent thrombosis. HIT testing eventually returned positive for the presence of platelet factor 4 antibodies. A subsequent serotonin release assay returned positive, confirming the diagnosis of HIT. A transthoracic echocardiogram during his hospitalization also revealed an LV thrombus.Discussion:Heparin-induced thrombocytopenia (HIT) is traditionally diagnosed after thrombocytopenia develops 5 to 10 days after exposure to heparin. However, there have been rare reports of a spontaneous form of HIT that can occur without prior exposure to heparin. This case highlights a rare presentation of spontaneous HIT. Although infrequent, cardiologists should be aware of atypical presentations of HIT, since almost all patients will receive heparin prior to or during coronary angiography and coronary interventions. Spontaneous HIT should be considered in all patients who present with unexplained thrombocytopenia with arterial and/or venous thrombi. Failure to recognize this clinical entity could lead to potentially life-threatening thrombotic complications from further administration of heparin.

Circulation, Volume 146, Issue Suppl_1, Page A11074-A11074, November 8, 2022. Background:The models for predicting cardiovascular events, including medication data such as dosage and the number of medications, have not been well studied. This study aimed to develop a model, including medication data, for predicting cardiovascular events within one year after discharge in acute decompensated heart failure (ADHF) patients with decreased renal function.MethodsThis study included 443 first-time admitted ADHF patients with decreased renal function in the Showa University Fujigaoka Hospital between January 2015 and December 2019. Decreased renal function was defined as an eGFR < 60 mL/min/1.73 m2at discharge. The primary outcome was cardiovascular events (cardiovascular death and first heart failure rehospitalization) within one year after discharge. The model for predicting events was developed using predictive factors extracted by multivariate analysis. The cardiovascular events curves were visualized using the Kaplan-Meier method and estimated using a log-rank test.ResultsThe incidence of cardiovascular events was 20.1%. By multivariate analysis, atrial fibrillation (AF), weight loss < 5% during admission, brain natriuretic peptide (BNP) ≥ 200 pg/mL at discharge, polypharmacy (≥ 10 drugs), and beta-blockers use below the maintenance dosage were significantly associated with an increased risk of cardiovascular events. The hazard ratios of the five factors for the cardiovascular events were scored (AF, weight loss, polypharmacy, and beta-blockers dosage = 1 point; BNP = 2 points) and patients divided into three groups. The cardiovascular events rate in the high-risk (≥ 4 points) group was four times as high as the rate in the low-risk (≤ 2 point) group (one-year events rate: 41.0% vs 9.2%, p < 0.001, Figure).ConclusionsThe developed model for cardiovascular events, including polypharmacy and beta-blockers dosage, will be useful for planning more aggressive and earlier management in ADHF patients with decreased renal function.

Circulation, Volume 146, Issue Suppl_1, Page A13841-A13841, November 8, 2022. Background:Considering preliminary reports suggesting associations between peripheral atherosclerotic disease (cannabis arteritis) and acute ischemic stroke (AIS) with cannabis use disorder (CUD), we sought to study the burden and impact of CUD on AIS risk and outcomes in the elderly with PVD.Methods:The National Inpatient Sample (2016-2019) was used to identify geriatric PVD admissions with vs. without CUD . We compared the burden and risk of AIS admissions with vs. without CUD and subsequent in-hospital mortality using adjusted multivariable regression analyses.Results:Of 5,115,824 total geriatric admissions with PVD (50.6% males, 77.5% white), 21,405 had CUD. The prevalence of DM was lower in the CUD cohort (19.7% vs 33.7%) with comparable rates of HTN and smoking between groups [Table 1]. Concomitant drug use was higher in CUD vs non-CUD cohort. There was AIS period prevalence of 5.2% in CUD vs 4.0% in non-CUD cohorts (p

Circulation, Volume 146, Issue Suppl_1, Page A14012-A14012, November 8, 2022. Introduction:Ischemic stroke (IS) or intracranial hemorrhage (ICH) has been reported during direct oral anticoagulant (DOAC) therapy. However, data regarding the DOAC level upon acute stroke is lacking.Hypothesis:The DOAC level upon acute IS or ICH may be associated with stroke outcomes.Methods:Patients aged ≥ 20 years, under DOAC therapy and developed acute ischemic or hemorrhagic stroke were enrolled. The DOAC level upon hospital arrival was measured with ultra-high-performance liquid chromatography with tandem mass spectrometry. The primary outcome was the composite outcomes included IS, ICH, major bleeding or death at 3 months. The secondary outcome included modified Rankin Scale (mRS) 0 to 3 at 3 months.Results:During 2018 to 2022, a total of 105 patients who developed IS and 26 patients who developed ICH during DOAC therapy were enrolled. Among the IS cohort, 45 (42.9%) had DOAC level