A. Tada, T. Nagai, Yoshiya Kato, N. Oyama-Manabe, S. Tsuneta, M. Nakai, Y. Yasui, S. Kazui, Y. Takahashi, K. Saiin, S. Naito, S. Takenaka, Y. Mizuguchi, Y. Kobayashi, S. Ishizaka, K. Omote, Takuma Sato, T. Konishi, K. Kamiya, K. Kudo, T. Anzai
Several liver fibrotic markers are associated with prognosis in patients with heart failure (HF). However, the optimal markers for outcome prediction remain unclear. This study aimed to simultaneously investigate the prognostic value of liver fibrotic markers and the associations between these markers and clinical parameters in patients with HF without organic liver disease. We prospectively examined 211 consecutive patients with chronic HF between April 2018 and August 2021, excluding those with organic liver disease, using liver magnetic resonance imaging and ultrasound. A total of 7 representative liver fibrotic markers were measured in all patients. The primary outcome of interest was the composite of all-cause death and hospitalization for worsening HF. During a median follow-up period of 747 (interquartile range 465 to 1,042) days, the primary outcome occurred in 45 patients. Patients with higher hyaluronic acid and type III procollagen N-terminal peptide (P-III-P) levels showed a significantly higher incidence of the primary outcome than those without (p <0.001 and p = 0.005, respectively). The multivariable Cox regression analysis revealed that hyaluronic acid and P-III-P levels were independently associated with the risk of adverse events (hazard ratio 1.84, 95% confidence interval 1.18 to 2.87 and hazard ratio 2.89, 95% confidence interval 1.32 to 6.34, respectively) even after adjustment for a mortality prediction model, whereas the other 5 markers were not associated with the primary outcome. In conclusion, among the representative liver fibrotic markers, hyaluronic acid and P-III-P might be the optimal markers for outcome prediction in patients with HF.
{"title":"Prognostic Value of Liver Fibrotic Markers in Patients With Heart Failure.","authors":"A. Tada, T. Nagai, Yoshiya Kato, N. Oyama-Manabe, S. Tsuneta, M. Nakai, Y. Yasui, S. Kazui, Y. Takahashi, K. Saiin, S. Naito, S. Takenaka, Y. Mizuguchi, Y. Kobayashi, S. Ishizaka, K. Omote, Takuma Sato, T. Konishi, K. Kamiya, K. Kudo, T. Anzai","doi":"10.2139/ssrn.4333060","DOIUrl":"https://doi.org/10.2139/ssrn.4333060","url":null,"abstract":"Several liver fibrotic markers are associated with prognosis in patients with heart failure (HF). However, the optimal markers for outcome prediction remain unclear. This study aimed to simultaneously investigate the prognostic value of liver fibrotic markers and the associations between these markers and clinical parameters in patients with HF without organic liver disease. We prospectively examined 211 consecutive patients with chronic HF between April 2018 and August 2021, excluding those with organic liver disease, using liver magnetic resonance imaging and ultrasound. A total of 7 representative liver fibrotic markers were measured in all patients. The primary outcome of interest was the composite of all-cause death and hospitalization for worsening HF. During a median follow-up period of 747 (interquartile range 465 to 1,042) days, the primary outcome occurred in 45 patients. Patients with higher hyaluronic acid and type III procollagen N-terminal peptide (P-III-P) levels showed a significantly higher incidence of the primary outcome than those without (p <0.001 and p = 0.005, respectively). The multivariable Cox regression analysis revealed that hyaluronic acid and P-III-P levels were independently associated with the risk of adverse events (hazard ratio 1.84, 95% confidence interval 1.18 to 2.87 and hazard ratio 2.89, 95% confidence interval 1.32 to 6.34, respectively) even after adjustment for a mortality prediction model, whereas the other 5 markers were not associated with the primary outcome. In conclusion, among the representative liver fibrotic markers, hyaluronic acid and P-III-P might be the optimal markers for outcome prediction in patients with HF.","PeriodicalId":443997,"journal":{"name":"The American journal of cardiology","volume":"131 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121563208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The economic burden of heart failure (HF) is enormous, but studies of HF costs typically consider the disease to be a single entity. We sought to distinguish the medical costs for patients with HF with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF). We identified 16,516 adult patients with an incident HF diagnosis and an echocardiogram from 2005 to 2017 in the electronic medical record of Kaiser Permanente Northwest. Using the echocardiogram nearest to the first diagnosis date, we classified patients with HFrEF (ejection fraction [EF] ≤40%), HFmrEF (EF 41% to 49%), or HFpEF (EF ≥50%). We calculated annualized inpatient, outpatient, emergency, pharmaceutical medical utilization and costs and total costs in $2,020, adjusted for age and gender using generalized linear models, with further analysis of the effects of co-morbid chronic kidney disease (CKD) and type 2 diabetes (T2D). For all HF types, 1 in 5 patients were affected by both CKD and T2D, and costs were significantly higher when both co-morbidities were present. Total per-person costs were significantly higher for HFpEF ($33,740, 95% confidence interval $32,944 to $34,536) than HFrEF ($27,669, $25,649 to $29,689) or HFmrEF ($29,484, $27,166 to $31,800), driven by in- and outpatient visits. Across HF types, visits approximately doubled with the presence of both co-morbidities. Due to greater prevalence, HFpEF accounted for the majority of total and resource-specific treatment costs of HF, regardless of the presence of CKD and/or T2D. In summary, the economic burden was greater per HFpEF patient and was further amplified by co-morbid CKD and T2D. HFpEF accounted for the large majority of total HF costs, underscoring the need to implement effective treatments.
{"title":"Medical Costs of Chronic Kidney Disease and Type 2 Diabetes Among Newly Diagnosed Heart Failure Patients With Reduced, Mildly Reduced, and Preserved Ejection Fraction.","authors":"G. Nichols, Q. Qiao, S. Linden, B. Kraus","doi":"10.2139/ssrn.4107080","DOIUrl":"https://doi.org/10.2139/ssrn.4107080","url":null,"abstract":"The economic burden of heart failure (HF) is enormous, but studies of HF costs typically consider the disease to be a single entity. We sought to distinguish the medical costs for patients with HF with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF). We identified 16,516 adult patients with an incident HF diagnosis and an echocardiogram from 2005 to 2017 in the electronic medical record of Kaiser Permanente Northwest. Using the echocardiogram nearest to the first diagnosis date, we classified patients with HFrEF (ejection fraction [EF] ≤40%), HFmrEF (EF 41% to 49%), or HFpEF (EF ≥50%). We calculated annualized inpatient, outpatient, emergency, pharmaceutical medical utilization and costs and total costs in $2,020, adjusted for age and gender using generalized linear models, with further analysis of the effects of co-morbid chronic kidney disease (CKD) and type 2 diabetes (T2D). For all HF types, 1 in 5 patients were affected by both CKD and T2D, and costs were significantly higher when both co-morbidities were present. Total per-person costs were significantly higher for HFpEF ($33,740, 95% confidence interval $32,944 to $34,536) than HFrEF ($27,669, $25,649 to $29,689) or HFmrEF ($29,484, $27,166 to $31,800), driven by in- and outpatient visits. Across HF types, visits approximately doubled with the presence of both co-morbidities. Due to greater prevalence, HFpEF accounted for the majority of total and resource-specific treatment costs of HF, regardless of the presence of CKD and/or T2D. In summary, the economic burden was greater per HFpEF patient and was further amplified by co-morbid CKD and T2D. HFpEF accounted for the large majority of total HF costs, underscoring the need to implement effective treatments.","PeriodicalId":443997,"journal":{"name":"The American journal of cardiology","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134138906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-03DOI: 10.1101/2023.02.28.23286600
E. Shibahashi, T. Abe, K. Kamishima, S. Ebihara, T. Moriyama, K. Shimazaki, Katsumi Saito, Y. Uchigata, K. Jujo
Background: Inappropriately high activated clotting time (ACT) during percutaneous coronary intervention (PCI) is associated with an increased risk of bleeding events. However, whether the prescription of direct oral anticoagulants (DOAC) affects ACT kinetics during heparin use and adverse clinical events in patients undergoing PCI remains unclear. To evaluate the ACT changes during and adverse clinical events after PCI in patients who were prescribed DOAC. Methods: This observational study included 246 patients undergoing PCI at the two cardiovascular centers who were not receiving warfarin and whose ACT was recorded immediately before and 30 min after injection of unfractionated heparin (UFH). Patients were divided into two groups according to DOAC prescription at the time of the index PCI: DOAC users (n=31) and non-users (n=215). Any bleeding and systemic thromboembolic events were investigated until 30 days after PCI. Results: The average age of this population was 70.5 years, and 66.3% were male. Average ACT was significantly higher in DOAC users than non-users both before and 30 min after UFH induction (157.2 {plus minus} 30.1 vs. 131.8 {plus minus} 25.1 sec, p<0.001; 371.1 {plus minus} 122.2 vs. 308.3 {plus minus} 82.2 sec, p<0.001; respectively). The incidence of post-PCI systemic thromboembolism was low and comparable between the two groups (0% vs. 3.7%, p=0.60). However, the rate of any bleeding event was significantly higher in DOAC users than non-users (16.1% vs. 4.7%, p=0.028). Conclusion: Patients receiving DOAC have higher ACTs during PCI and higher incidence of bleeding events than those not receiving DOAC.
背景:经皮冠状动脉介入治疗(PCI)期间不适当的高活化凝血时间(ACT)与出血事件的风险增加有关。然而，直接口服抗凝剂(DOAC)的处方是否会影响肝素使用期间的ACT动力学和PCI患者的不良临床事件尚不清楚。目的:评价服用DOAC的患者在PCI治疗过程中ACT的变化及不良临床事件。方法:本观察性研究纳入246例在两个心血管中心行PCI的患者，这些患者未接受华法林治疗，在注射未分离肝素(UFH)前和注射后30分钟记录ACT。根据PCI指数时DOAC处方将患者分为两组:DOAC使用者(n=31)和非使用者(n=215)。任何出血和全身性血栓栓塞事件的调查直到PCI后30天。结果:本组平均年龄70.5岁，男性占66.3%。在UFH诱导前和诱导后30分钟，DOAC使用者的平均ACT均显著高于非使用者(157.2{正负}30.1比131.8{正负}25.1秒，p<0.001;371.1{正负}122.2秒vs. 308.3{正负}82.2秒，p<0.001;分别)。两组pci术后全身性血栓栓塞发生率较低且具有可比性(0% vs. 3.7%， p=0.60)。然而，任何出血事件的发生率在DOAC使用者中明显高于非使用者(16.1%比4.7%，p=0.028)。结论:与未接受DOAC的患者相比，接受DOAC的患者PCI术中ACTs较高，出血事件发生率较高。
{"title":"Direct Oral Anticoagulants Affect Activated Clotting Time During and Bleeding Events After Percutaneous Coronary Intervention","authors":"E. Shibahashi, T. Abe, K. Kamishima, S. Ebihara, T. Moriyama, K. Shimazaki, Katsumi Saito, Y. Uchigata, K. Jujo","doi":"10.1101/2023.02.28.23286600","DOIUrl":"https://doi.org/10.1101/2023.02.28.23286600","url":null,"abstract":"Background: Inappropriately high activated clotting time (ACT) during percutaneous coronary intervention (PCI) is associated with an increased risk of bleeding events. However, whether the prescription of direct oral anticoagulants (DOAC) affects ACT kinetics during heparin use and adverse clinical events in patients undergoing PCI remains unclear. To evaluate the ACT changes during and adverse clinical events after PCI in patients who were prescribed DOAC. Methods: This observational study included 246 patients undergoing PCI at the two cardiovascular centers who were not receiving warfarin and whose ACT was recorded immediately before and 30 min after injection of unfractionated heparin (UFH). Patients were divided into two groups according to DOAC prescription at the time of the index PCI: DOAC users (n=31) and non-users (n=215). Any bleeding and systemic thromboembolic events were investigated until 30 days after PCI. Results: The average age of this population was 70.5 years, and 66.3% were male. Average ACT was significantly higher in DOAC users than non-users both before and 30 min after UFH induction (157.2 {plus minus} 30.1 vs. 131.8 {plus minus} 25.1 sec, p<0.001; 371.1 {plus minus} 122.2 vs. 308.3 {plus minus} 82.2 sec, p<0.001; respectively). The incidence of post-PCI systemic thromboembolism was low and comparable between the two groups (0% vs. 3.7%, p=0.60). However, the rate of any bleeding event was significantly higher in DOAC users than non-users (16.1% vs. 4.7%, p=0.028). Conclusion: Patients receiving DOAC have higher ACTs during PCI and higher incidence of bleeding events than those not receiving DOAC.","PeriodicalId":443997,"journal":{"name":"The American journal of cardiology","volume":"514 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133634685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1016/s0735-1097(23)02091-0
Julio C Santana, M. Dangl, M. Albosta, R. Colombo
{"title":"Outcomes of Acute Myocardial Infarction in Female Patients With Type 1 Diabetes Mellitus.","authors":"Julio C Santana, M. Dangl, M. Albosta, R. Colombo","doi":"10.1016/s0735-1097(23)02091-0","DOIUrl":"https://doi.org/10.1016/s0735-1097(23)02091-0","url":null,"abstract":"","PeriodicalId":443997,"journal":{"name":"The American journal of cardiology","volume":"37 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120850761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1016/s0735-1097(23)02494-4
S. Kapadia, Haocheng Huang, H. Parise, Mahmoud Ismayl, Zain V. Ahmed, D. Tirziu, S. E. Altin
{"title":"Supervised Exercise Therapy Versus Percutaneous Transluminal Angioplasty for Claudication by Level of Disease: A Systematic Review and Meta-Analysis.","authors":"S. Kapadia, Haocheng Huang, H. Parise, Mahmoud Ismayl, Zain V. Ahmed, D. Tirziu, S. E. Altin","doi":"10.1016/s0735-1097(23)02494-4","DOIUrl":"https://doi.org/10.1016/s0735-1097(23)02494-4","url":null,"abstract":"","PeriodicalId":443997,"journal":{"name":"The American journal of cardiology","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127652384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1016/s0735-1097(23)01792-8
A. Nielsen, K. Skaarup, Kasper Djernæs, L. S. Duus, C. Espersen, Samuel K. Sørensen, M. Ruwald, M. L. Hansen, R. Worck, A. Johannessen, J. Hansen, P. Nardelli, R. San José Estépar, R. San José Estépar, T. Biering-Sørensen
{"title":"Association Between Pulmonary Vascular Volume and Cardiac Structure and Function in Patients With Atrial Fibrillation.","authors":"A. Nielsen, K. Skaarup, Kasper Djernæs, L. S. Duus, C. Espersen, Samuel K. Sørensen, M. Ruwald, M. L. Hansen, R. Worck, A. Johannessen, J. Hansen, P. Nardelli, R. San José Estépar, R. San José Estépar, T. Biering-Sørensen","doi":"10.1016/s0735-1097(23)01792-8","DOIUrl":"https://doi.org/10.1016/s0735-1097(23)01792-8","url":null,"abstract":"","PeriodicalId":443997,"journal":{"name":"The American journal of cardiology","volume":"205 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129211105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1016/s0735-1097(23)01058-6
Mohil Garg, Mohak Gupta, Neel N. Patel, K. Bansal, F. Sheikh
{"title":"Predictors and Outcomes of Sudden Cardiac Arrest in Heart Failure With Preserved Ejection Fraction: A Nationwide Inpatient Sample Analysis.","authors":"Mohil Garg, Mohak Gupta, Neel N. Patel, K. Bansal, F. Sheikh","doi":"10.1016/s0735-1097(23)01058-6","DOIUrl":"https://doi.org/10.1016/s0735-1097(23)01058-6","url":null,"abstract":"","PeriodicalId":443997,"journal":{"name":"The American journal of cardiology","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115739664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1016/s0735-1097(23)03979-7
A. Stein, Eldon Matthia, Stephen Petty, Brian D. Stewart, J. Vilaro, M. A. Al-Ani, Mustafa M. Ahmed, Juan M Aranda Jr, J. Hiemenz, Alex M. Parker
{"title":"Transthyretin cardiac amyloidosis disguised as light chain amyloidosis, or multiple myeloma?","authors":"A. Stein, Eldon Matthia, Stephen Petty, Brian D. Stewart, J. Vilaro, M. A. Al-Ani, Mustafa M. Ahmed, Juan M Aranda Jr, J. Hiemenz, Alex M. Parker","doi":"10.1016/s0735-1097(23)03979-7","DOIUrl":"https://doi.org/10.1016/s0735-1097(23)03979-7","url":null,"abstract":"","PeriodicalId":443997,"journal":{"name":"The American journal of cardiology","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114381855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1016/s0735-1097(23)04139-6
C. Kersey, Beteal Ashinne, J. Keenan, J. Kirkpatrick
{"title":"Cardiac Interventions in the Absence of Assent: An Ethical Dilemma.","authors":"C. Kersey, Beteal Ashinne, J. Keenan, J. Kirkpatrick","doi":"10.1016/s0735-1097(23)04139-6","DOIUrl":"https://doi.org/10.1016/s0735-1097(23)04139-6","url":null,"abstract":"","PeriodicalId":443997,"journal":{"name":"The American journal of cardiology","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128906103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-07DOI: 10.1101/2023.02.03.23285426
J. Karacsonyi, B. Okeson, K. Alaswad, F. Jaffer, Paul Poomipanit, Jaikirshan J Khatri, M. Patel, Robert F. Riley, A. Sheikh, Jason Wollmuth, R. Yeh, R. Chandwaney, A. ElGuindy, K. Tammam, N. A. Rafeh, D. Schimmel, M. N. Burke, Spyridon Kostantinis, Bahadir Simsek, Karen E. Deffenbacher, K. Benzuly, J. Flaherty, B. Rangan, I. Ungi, E. Brilakis
Background: Estimating the likelihood of urgent mechanical circulatory support (MCS) can facilitate procedural planning and clinical decision making in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We analyzed 2,784 CTO PCIs performed between 2012 and 2021 at 12 centers. The variable importance was estimated by a bootstrap applying a random forest algorithm to a propensity-matched sample (a ratio of 1:5 matching cases with controls on center). The identified variables were used to predict the risk of urgent MCS. The performance of the risk model was assessed in-sample as well as on 2411 out-of-sample procedures who did not require urgent MCS. Results: Urgent MCS was used in 62 (2.2%) of cases. Patients who required urgent MCS were older (70 [63, 77] vs. 66 [58, 73] years, p=0.003) compared with those who did not require urgent MCS. Technical (68% vs. 87%, p<0.001) and procedural successes (40% vs. 85%, p<0.001) were lower in the urgent MCS group compared with no urgent MCS cases. The risk model for urgent MCS use included retrograde crossing strategy, left ventricular ejection fraction, and lesion length. The resulting model demonstrated good calibration and discriminatory capacity with AUC (95%CI) of 0.79 (0.73, 0.86) and specificity and sensitivity of 86% and 52%, respectively. On the out-of-sample set, the specificity of the model was 87%. Conclusion: The PROGRESS CTO MCS score can help estimate the risk of urgent MCS use during CTO PCI.
{"title":"Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention","authors":"J. Karacsonyi, B. Okeson, K. Alaswad, F. Jaffer, Paul Poomipanit, Jaikirshan J Khatri, M. Patel, Robert F. Riley, A. Sheikh, Jason Wollmuth, R. Yeh, R. Chandwaney, A. ElGuindy, K. Tammam, N. A. Rafeh, D. Schimmel, M. N. Burke, Spyridon Kostantinis, Bahadir Simsek, Karen E. Deffenbacher, K. Benzuly, J. Flaherty, B. Rangan, I. Ungi, E. Brilakis","doi":"10.1101/2023.02.03.23285426","DOIUrl":"https://doi.org/10.1101/2023.02.03.23285426","url":null,"abstract":"Background: Estimating the likelihood of urgent mechanical circulatory support (MCS) can facilitate procedural planning and clinical decision making in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We analyzed 2,784 CTO PCIs performed between 2012 and 2021 at 12 centers. The variable importance was estimated by a bootstrap applying a random forest algorithm to a propensity-matched sample (a ratio of 1:5 matching cases with controls on center). The identified variables were used to predict the risk of urgent MCS. The performance of the risk model was assessed in-sample as well as on 2411 out-of-sample procedures who did not require urgent MCS. Results: Urgent MCS was used in 62 (2.2%) of cases. Patients who required urgent MCS were older (70 [63, 77] vs. 66 [58, 73] years, p=0.003) compared with those who did not require urgent MCS. Technical (68% vs. 87%, p<0.001) and procedural successes (40% vs. 85%, p<0.001) were lower in the urgent MCS group compared with no urgent MCS cases. The risk model for urgent MCS use included retrograde crossing strategy, left ventricular ejection fraction, and lesion length. The resulting model demonstrated good calibration and discriminatory capacity with AUC (95%CI) of 0.79 (0.73, 0.86) and specificity and sensitivity of 86% and 52%, respectively. On the out-of-sample set, the specificity of the model was 87%. Conclusion: The PROGRESS CTO MCS score can help estimate the risk of urgent MCS use during CTO PCI.","PeriodicalId":443997,"journal":{"name":"The American journal of cardiology","volume":"205 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128408105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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