Pub Date : 2024-06-15eCollection Date: 2024-01-01DOI: 10.62347/ZTXC5809
Azad Mojahedi, Afsaneh Mirshekari
Supraventricular tachycardia (SVT) is the most prevalent arrhythmia observed in infants, impacting individuals with or without congenital cardiac dysfunction. Infantile-onset SVT typically manifests within the initial one to two months of life. A variety of anti-arrhythmic medications are employed to treat SVT in infants during their first year of life. Nevertheless, a consensus has yet to be reached on the most efficacious drug, and treatment approaches continue to vary considerably As SVT remains a frequent problem around the world, with different management approaches and no obvious optimal option, we conducted a systematic review of the new update of antiarrhythmic drugs for managing SVT in infants under one year old.
{"title":"Evaluating antiarrhythmic drugs for managing infants with supraventricular tachycardia; a review.","authors":"Azad Mojahedi, Afsaneh Mirshekari","doi":"10.62347/ZTXC5809","DOIUrl":"10.62347/ZTXC5809","url":null,"abstract":"<p><p>Supraventricular tachycardia (SVT) is the most prevalent arrhythmia observed in infants, impacting individuals with or without congenital cardiac dysfunction. Infantile-onset SVT typically manifests within the initial one to two months of life. A variety of anti-arrhythmic medications are employed to treat SVT in infants during their first year of life. Nevertheless, a consensus has yet to be reached on the most efficacious drug, and treatment approaches continue to vary considerably As SVT remains a frequent problem around the world, with different management approaches and no obvious optimal option, we conducted a systematic review of the new update of antiarrhythmic drugs for managing SVT in infants under one year old.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Disparities in acute myocardial infarction (AMI)-related outcomes have been reported before the COVID-19 pandemic. We studied in-hospital outcomes of AMI across demographic groups in the United States during the early COVID-19 pandemic.
Methods: The National Inpatient Sample (NIS) database was queried for 2020 to identify AMI-related hospitalizations based on appropriate ICD-10-CM codes categorized by sex, race, and hospital region categories. The primary outcome was in-hospital mortality in females, racial and ethnic minority groups, and Northeast hospital region compared with males, White patients, and Midwest hospital region, respectively. Multivariable regression analysis was used to calculate the adjusted odds ratio and mean difference.
Results: A total of 820,893 AMI-related hospitalizations were identified during the study period. On adjusted analysis, during the early COVID-19 pandemic, females had lower odds of in-hospital mortality [aOR 0.89 (0.85-0.92); P < 0.01] and revascularization [aOR 0.68 (0.66-0.69); P < 0.01] than males. Racial and ethnic based analysis showed that Asian/Pacific Islander patients had higher odds of in-hospital mortality [aOR 1.13 (1.03-1.25); P < 0.01] than White patients. During the early COVID-19 pandemic, Northeast and Western region hospitals had higher odds of in-hospital mortality, lower odds of revascularization, longer length of stay, and higher total hospitalization costs than Midwest region hospitals.
Conclusions: Our study disclosed disparities in AMI-related mortality and revascularization by sex, race and ethnic, and region during the early COVID-19 pandemic. Special attention should be given to at-risk populations. Whether these disparities continue in the post-vaccination era warrants further study.
背景:在COVID-19大流行之前,就有报道称急性心肌梗死(AMI)相关结果存在差异。我们研究了 COVID-19 大流行早期美国不同人口群体的急性心肌梗死院内预后:方法:我们查询了 2020 年全国住院病人抽样(NIS)数据库,根据适当的 ICD-10-CM 编码,按性别、种族和医院所在地区分类,确定与急性心肌梗死相关的住院病例。主要结果是女性、少数种族和少数民族群体以及东北部医院地区的住院死亡率分别与男性、白人患者和中西部医院地区的住院死亡率进行比较。采用多变量回归分析计算调整后的几率比例和平均差异:结果:研究期间共发现 820,893 例急性心肌梗死相关住院病例。经调整分析,在COVID-19大流行早期,女性的院内死亡率[aOR 0.89 (0.85-0.92); P < 0.01]和血管重建率[aOR 0.68 (0.66-0.69); P < 0.01]低于男性。基于种族和民族的分析显示,亚太裔患者的院内死亡率[aOR 1.13 (1.03-1.25); P < 0.01]高于白人患者。在COVID-19大流行的早期,东北部和西部地区医院的院内死亡几率比中西部地区医院高,血管重建几率比中西部地区医院低,住院时间比中西部地区医院长,住院总费用比中西部地区医院高:我们的研究揭示了在 COVID-19 大流行早期,不同性别、种族、民族和地区在急性心肌梗死相关死亡率和血管再通方面的差异。应特别关注高危人群。这些差异是否会在疫苗接种后继续存在,还需要进一步研究。
{"title":"Disparities by sex, race, and region in acute myocardial infarction-related outcomes during the early COVID-19 pandemic: the national inpatient sample analysis.","authors":"Harshith Thyagaturu, Amro Taha, Shafaqat Ali, Nicholas Roma, Sanchit Duhan, Neel Patel, Yasar Sattar, Karthik Gonuguntla, Harigopal Sandhyavenu, Irisha Badu, Erin D Michos, Sudarshan Balla","doi":"10.62347/WKBJ1501","DOIUrl":"10.62347/WKBJ1501","url":null,"abstract":"<p><strong>Background: </strong>Disparities in acute myocardial infarction (AMI)-related outcomes have been reported before the COVID-19 pandemic. We studied in-hospital outcomes of AMI across demographic groups in the United States during the early COVID-19 pandemic.</p><p><strong>Methods: </strong>The National Inpatient Sample (NIS) database was queried for 2020 to identify AMI-related hospitalizations based on appropriate ICD-10-CM codes categorized by sex, race, and hospital region categories. The primary outcome was in-hospital mortality in females, racial and ethnic minority groups, and Northeast hospital region compared with males, White patients, and Midwest hospital region, respectively. Multivariable regression analysis was used to calculate the adjusted odds ratio and mean difference.</p><p><strong>Results: </strong>A total of 820,893 AMI-related hospitalizations were identified during the study period. On adjusted analysis, during the early COVID-19 pandemic, females had lower odds of in-hospital mortality [aOR 0.89 (0.85-0.92); P < 0.01] and revascularization [aOR 0.68 (0.66-0.69); P < 0.01] than males. Racial and ethnic based analysis showed that Asian/Pacific Islander patients had higher odds of in-hospital mortality [aOR 1.13 (1.03-1.25); P < 0.01] than White patients. During the early COVID-19 pandemic, Northeast and Western region hospitals had higher odds of in-hospital mortality, lower odds of revascularization, longer length of stay, and higher total hospitalization costs than Midwest region hospitals.</p><p><strong>Conclusions: </strong>Our study disclosed disparities in AMI-related mortality and revascularization by sex, race and ethnic, and region during the early COVID-19 pandemic. Special attention should be given to at-risk populations. Whether these disparities continue in the post-vaccination era warrants further study.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-15eCollection Date: 2024-01-01DOI: 10.62347/XDDB4510
Allistair Nathan, Mehrtash Hashemzadeh, Mohammad Reza Movahed
Background: Percutaneous coronary intervention (PCI) in patients with bifurcation lesions is associated with higher complexity and adverse outcomes. The goal of this study was to evaluate the inpatient outcomes of patients with PCI of bifurcation lesions.
Methods: The National Inpatient Sample (NIS) database, years 2016-2020, was studied using ICD 10 codes. Patients undergoing PCI for bifurcation lesions were compared to those undergoing PCI for non-bifurcation lesions, excluding chronic total occlusion lesions. We evaluated post-procedural inpatient mortality and complications.
Results: PCI in patients with bifurcation lesions was associated with higher mortality and post-procedural complications. A weighted total of 9,795,154 patients underwent PCI; of those, 43,480 had a bifurcation lesion. The bifurcation cohort had a 3.79% mortality rate, and the rate in those with non-bifurcation lesions was 2.56% (OR, 1.50; CI: 1.34-1.68; P<0.001). Upon conducting multivariate analysis, which adjusted for age, sex, race, and significant comorbidities, PCI for bifurcation lesions remained significantly associated with a higher mortality rate compared to non-bifurcation lesion PCI (OR, 1.68; 95% CI, 1.49-1.88; P<0.001). Furthermore, PCI for bifurcation lesions was associated with higher rates of myocardial infarction (OR, 2.26; 95% CI, 1.68-3.06; P<0.001), coronary perforation (OR, 7.97; 95% CI, 6.25-10.17; P<0.001), tamponade (OR, 3.46; 95% CI, 2.49-4.82; P<0.001), and procedural bleeding (OR, 5.71; 95% CI, 4.85-6.71; P<0.001). Overall, post-procedural complications were 4 times more in patients with bifurcation lesions than in those without (OR, 4.33; 95% CI, 3.83-4.88; P<0.001).
Conclusion: Using a large, national inpatient database, we demonstrate that both mortality rates and post-procedural complication rates were significantly higher in patients undergoing PCI for bifurcation lesions than in those undergoing PCI for non-bifurcation lesions.
{"title":"Percutaneous coronary intervention involving coronary bifurcation is associated with higher mortality and complications.","authors":"Allistair Nathan, Mehrtash Hashemzadeh, Mohammad Reza Movahed","doi":"10.62347/XDDB4510","DOIUrl":"10.62347/XDDB4510","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous coronary intervention (PCI) in patients with bifurcation lesions is associated with higher complexity and adverse outcomes. The goal of this study was to evaluate the inpatient outcomes of patients with PCI of bifurcation lesions.</p><p><strong>Methods: </strong>The National Inpatient Sample (NIS) database, years 2016-2020, was studied using ICD 10 codes. Patients undergoing PCI for bifurcation lesions were compared to those undergoing PCI for non-bifurcation lesions, excluding chronic total occlusion lesions. We evaluated post-procedural inpatient mortality and complications.</p><p><strong>Results: </strong>PCI in patients with bifurcation lesions was associated with higher mortality and post-procedural complications. A weighted total of 9,795,154 patients underwent PCI; of those, 43,480 had a bifurcation lesion. The bifurcation cohort had a 3.79% mortality rate, and the rate in those with non-bifurcation lesions was 2.56% (OR, 1.50; CI: 1.34-1.68; P<0.001). Upon conducting multivariate analysis, which adjusted for age, sex, race, and significant comorbidities, PCI for bifurcation lesions remained significantly associated with a higher mortality rate compared to non-bifurcation lesion PCI (OR, 1.68; 95% CI, 1.49-1.88; P<0.001). Furthermore, PCI for bifurcation lesions was associated with higher rates of myocardial infarction (OR, 2.26; 95% CI, 1.68-3.06; P<0.001), coronary perforation (OR, 7.97; 95% CI, 6.25-10.17; P<0.001), tamponade (OR, 3.46; 95% CI, 2.49-4.82; P<0.001), and procedural bleeding (OR, 5.71; 95% CI, 4.85-6.71; P<0.001). Overall, post-procedural complications were 4 times more in patients with bifurcation lesions than in those without (OR, 4.33; 95% CI, 3.83-4.88; P<0.001).</p><p><strong>Conclusion: </strong>Using a large, national inpatient database, we demonstrate that both mortality rates and post-procedural complication rates were significantly higher in patients undergoing PCI for bifurcation lesions than in those undergoing PCI for non-bifurcation lesions.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-15eCollection Date: 2024-01-01DOI: 10.62347/PTMD5117
Saliha Erdem, Amro Taha, Neel Patel, Dhruvil Ashishkumar Patel, Anoop Titus, Khaled M Harmouch, Yasemin Bahar, Sanchit Duhan, Bijeta Keisham, Moinuddin Syed, Juan Carlo Avalon, Yasar Sattar, M Chadi Alraies
Background: Transcatheter patent foramen ovale (PFO) occluder device is a procedure mostly performed to prevent secondary stroke as a result of paradoxical emboli traversing an intracardiac defect into the systemic circulation. The complications and outcomes following the procedure remain poorly studied. We aimed to investigate morbidity and mortality associated with occluder device procedures using hospital frailty index score stratification.
Methods: The Nationwide Readmission Database was employed to identify patients admitted for PFO closure from 2016 to 2020. Two groups divided by index frailty score were compared to report adjusted odds ratio (aOR) for primary and secondary cardiovascular outcomes. Outcomes included in-hospital mortality, acute kidney injury, acute ischemic stroke, and post-procedure bleeding. Statistical analysis was performed using STATA v.17.
Results: Of the 2,063 total patients who underwent the procedure, 45% possessed intermediate to high frailty scores while the other 55% had low frailty scores. The first cohort had higher odds of in-hospital mortality (aOR 6.3, 95% CI 2.05-19.5), acute kidney injury (aOR 17.6, 95% CI 9.5-32.5), and stroke (aOR 3.05, 95% CI 1.5-5.8) than the second cohort. There was no difference in the incidence of post-procedural bleeding and cardiac tamponade and 30/90/180-day readmission rates between the two cohorts. Hospitalizations in the first cohort were associated with a higher median length of stay and total cost.
Conclusion: High to intermediate frailty scores may predict an increased risk of in-hospital mortality in patients undergoing PFO occluder device procedures.
背景:经导管卵圆孔(PFO)封堵器是一种手术,主要用于预防矛盾性栓子穿越心内缺损进入体循环而导致的继发性中风。有关该手术的并发症和结果的研究仍然很少。我们旨在利用医院虚弱指数评分分层法研究与闭塞器手术相关的发病率和死亡率:方法:采用全国再入院数据库来识别 2016 年至 2020 年期间因 PFO 闭合而入院的患者。对按虚弱指数评分划分的两组患者进行比较,以报告主要和次要心血管结局的调整几率比(aOR)。结果包括院内死亡率、急性肾损伤、急性缺血性卒中和术后出血。统计分析使用 STATA v.17 进行:在接受手术的 2,063 名患者中,45% 的患者拥有中度至高度虚弱评分,而另外 55% 的患者拥有低度虚弱评分。第一组患者的院内死亡率(aOR 6.3,95% CI 2.05-19.5)、急性肾损伤(aOR 17.6,95% CI 9.5-32.5)和中风(aOR 3.05,95% CI 1.5-5.8)发生率高于第二组。两个队列的术后出血和心脏填塞发生率以及 30/90/180 天再入院率没有差异。第一组住院患者的中位住院时间和总费用较高:结论:高至中等体弱评分可预测接受 PFO 闭塞装置手术的患者院内死亡风险增加。
{"title":"Impact of frailty index on cardiovascular outcomes and readmissions of patent foramen ovale closure procedure: a propensity matched national analysis.","authors":"Saliha Erdem, Amro Taha, Neel Patel, Dhruvil Ashishkumar Patel, Anoop Titus, Khaled M Harmouch, Yasemin Bahar, Sanchit Duhan, Bijeta Keisham, Moinuddin Syed, Juan Carlo Avalon, Yasar Sattar, M Chadi Alraies","doi":"10.62347/PTMD5117","DOIUrl":"10.62347/PTMD5117","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter patent foramen ovale (PFO) occluder device is a procedure mostly performed to prevent secondary stroke as a result of paradoxical emboli traversing an intracardiac defect into the systemic circulation. The complications and outcomes following the procedure remain poorly studied. We aimed to investigate morbidity and mortality associated with occluder device procedures using hospital frailty index score stratification.</p><p><strong>Methods: </strong>The Nationwide Readmission Database was employed to identify patients admitted for PFO closure from 2016 to 2020. Two groups divided by index frailty score were compared to report adjusted odds ratio (aOR) for primary and secondary cardiovascular outcomes. Outcomes included in-hospital mortality, acute kidney injury, acute ischemic stroke, and post-procedure bleeding. Statistical analysis was performed using <i>STATA v.17</i>.</p><p><strong>Results: </strong>Of the 2,063 total patients who underwent the procedure, 45% possessed intermediate to high frailty scores while the other 55% had low frailty scores. The first cohort had higher odds of in-hospital mortality (aOR 6.3, 95% CI 2.05-19.5), acute kidney injury (aOR 17.6, 95% CI 9.5-32.5), and stroke (aOR 3.05, 95% CI 1.5-5.8) than the second cohort. There was no difference in the incidence of post-procedural bleeding and cardiac tamponade and 30/90/180-day readmission rates between the two cohorts. Hospitalizations in the first cohort were associated with a higher median length of stay and total cost.</p><p><strong>Conclusion: </strong>High to intermediate frailty scores may predict an increased risk of in-hospital mortality in patients undergoing PFO occluder device procedures.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-15eCollection Date: 2024-01-01DOI: 10.62347/YBJN2231
Resha Khanal, Mohammad Hamza, Maria Najam, Salman Abdul Basit, Zarghoona Wajid, Amna Rashdi, Neel Patel, Saman Razzaq, Rajendra Shah, Khaled M Harmouch, Bandar Alyami, Yasemin Bahar, Muhammad Aamir, Mohammed Abu-Mahfouz, Yasar Sattar, M Chadi Alraies
Introduction: Around 15-20% of lesions necessitating percutaneous coronary interventions (PCI) are attributed to coronary bifurcation lesions. We aim to study gender-based differences in PCI outcomes among bifurcation stents.
Methods: 3 studies were included after thorough systematic search using MEDLINE (EMBASE and PubMed). CRAN-R software using the Metabin module was used for statistical analysis. Pooled odds ratios (OR) were calculated using the random effect model and the Mantel-Haenszel method, with a 95% confidence interval (CI) used to determine statistical significance. Heterogeneity was assessed using Higgins I2.
Result: Women exhibited a higher risk of in-hospital mortality (OR 0.67, 95% CI 0.58-0.76, I2 = 0%, P < 0.0001), post-procedural bleeding (OR 0.53, 95% CI 0.47-0.6, I2 = 0%, P < 0.0001) and post-procedure stroke (OR 0.72, 95% CI 0.52-1.0, I2 = 0%, P < 0.06) as compared to men. However, there were no significant differences in terms of myocardial infarction (OR 0.84, 95% CI 0.22-3.27, I2 = 49.4%, P < 0.80) and cardiac tamponade (OR 0.63, 95% CI 0.06; 5.72, I2 = 0%, P < 0.6821) in both groups.
Conclusion: Our study reveals a noteworthy increase in in-hospital mortality in women, which could be attributed to a higher rate of major bleeding, advanced age, increased co-morbidities, and complex pathophysiology of the lesion in comparison to men. Further studies are required to gain a better understanding of the precise mechanisms thus enhancing procedural outcomes.
导言:在需要进行经皮冠状动脉介入治疗(PCI)的病变中,约 15-20% 属于冠状动脉分叉病变。我们旨在研究分叉支架 PCI 治疗效果的性别差异。使用 Metabin 模块的 CRAN-R 软件进行统计分析。采用随机效应模型和 Mantel-Haenszel 方法计算汇总的几率比(OR),并用 95% 的置信区间(CI)来确定统计显著性。异质性采用希金斯I2进行评估:与男性相比,女性发生院内死亡(OR 0.67,95% CI 0.58-0.76,I2 = 0%,P < 0.0001)、术后出血(OR 0.53,95% CI 0.47-0.6,I2 = 0%,P < 0.0001)和术后中风(OR 0.72,95% CI 0.52-1.0,I2 = 0%,P < 0.06)的风险较高。然而,两组患者在心肌梗死(OR 0.84,95% CI 0.22-3.27,I2 = 49.4%,P < 0.80)和心脏填塞(OR 0.63,95% CI 0.06; 5.72,I2 = 0%,P < 0.6821)方面无明显差异:我们的研究显示,与男性相比,女性的院内死亡率显著增加,这可能是由于女性的大出血率较高、年龄较大、合并疾病增加以及病变的病理生理学复杂所致。要更好地了解其确切机制,从而提高手术效果,还需要进一步的研究。
{"title":"Gender-based disparities in outcomes of coronary bifurcation stenting in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis.","authors":"Resha Khanal, Mohammad Hamza, Maria Najam, Salman Abdul Basit, Zarghoona Wajid, Amna Rashdi, Neel Patel, Saman Razzaq, Rajendra Shah, Khaled M Harmouch, Bandar Alyami, Yasemin Bahar, Muhammad Aamir, Mohammed Abu-Mahfouz, Yasar Sattar, M Chadi Alraies","doi":"10.62347/YBJN2231","DOIUrl":"10.62347/YBJN2231","url":null,"abstract":"<p><strong>Introduction: </strong>Around 15-20% of lesions necessitating percutaneous coronary interventions (PCI) are attributed to coronary bifurcation lesions. We aim to study gender-based differences in PCI outcomes among bifurcation stents.</p><p><strong>Methods: </strong>3 studies were included after thorough systematic search using MEDLINE (EMBASE and PubMed). CRAN-R software using the Metabin module was used for statistical analysis. Pooled odds ratios (OR) were calculated using the random effect model and the Mantel-Haenszel method, with a 95% confidence interval (CI) used to determine statistical significance. Heterogeneity was assessed using Higgins I<sup>2</sup>.</p><p><strong>Result: </strong>Women exhibited a higher risk of in-hospital mortality (OR 0.67, 95% CI 0.58-0.76, I<sup>2</sup> = 0%, P < 0.0001), post-procedural bleeding (OR 0.53, 95% CI 0.47-0.6, I<sup>2</sup> = 0%, P < 0.0001) and post-procedure stroke (OR 0.72, 95% CI 0.52-1.0, I<sup>2</sup> = 0%, P < 0.06) as compared to men. However, there were no significant differences in terms of myocardial infarction (OR 0.84, 95% CI 0.22-3.27, I<sup>2</sup> = 49.4%, P < 0.80) and cardiac tamponade (OR 0.63, 95% CI 0.06; 5.72, I<sup>2</sup> = 0%, P < 0.6821) in both groups.</p><p><strong>Conclusion: </strong>Our study reveals a noteworthy increase in in-hospital mortality in women, which could be attributed to a higher rate of major bleeding, advanced age, increased co-morbidities, and complex pathophysiology of the lesion in comparison to men. Further studies are required to gain a better understanding of the precise mechanisms thus enhancing procedural outcomes.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-15eCollection Date: 2024-01-01DOI: 10.62347/YTCI7645
Abdullah Mohamed Niyas, Fathima Haseefa, Mohammad Reza Movahed, Mehrtash Hashemzadeh, Mehrnoosh Hashemzadeh
Background: PTSD leads to increased levels of stress hormones and dysregulation of the autonomic nervous system which may trigger cardiac events. The goal of this study is to evaluate any association between PTSD and the occurrence of STEMI and NSTEMI using a large database.
Method: Using the Nationwide Inpatient Sample (NIS) and ICD-9 codes from 2005 to 2014 (n=1,621,382), we performed a univariate chi-square analysis of in-hospital occurrence of STEMI and NSTEMI in patients greater than 40 years of age with and without PTSD. We also performed a multivariate analysis adjusting for baseline characteristics including age, gender, diabetes, race, hyperlipidemia, hypertension, and tobacco use.
Results: The 2005-2014 dataset contained 401,485 STEMI patients (745, or 0.19%, with PTSD) and 1,219,897 NSTEMI patients (2,441, or 0.15%, with PTSD). In the 2005 dataset, 0.5% of PTSD patients had STEMI compared to 1.0% of non-PTSD patients (OR=0.46, 95% C.I., 0.36-0.59). Similarly, 0.6% of patients with PTSD and 2.2% of patients without PTSD had NSTEMI (OR=0.28, 95% C.I., 0.23-0.35). In the 2014 dataset, 0.3% of PTSD patients had STEMI compared to 0.7% of non-PTSD patients (OR=0.43, 95% C.I., 0.35-0.51). Similarly, 1.4% of patients with PTSD versus 2.9% of patients without PTSD had NSTEMI (OR=0.48, 95% C.I., 0.44-0.52). Similar trends were seen throughout the ten-year period. After adjusting for age, gender, diabetes, race, hyperlipidemia, hypertension, and tobacco use, PTSD was associated with a lower occurrence of STEMI (2005: OR=0.50, 95% C.I., 0.37-0.66; 2014: OR=0.35, 95% C.I., 0.29-0.43) and NSTEMI (2005: OR=0.44, 95% C.I., 0.34-0.57; 2014: OR=0.63, 95% C.I., 0.58-0.69).
Conclusion: Using a large inpatient database, we did not find an increased occurrence of STEMI or NSTEMI in patients diagnosed with PTSD, suggesting that PTSD is not an independent risk factor for myocardial infarction.
{"title":"The occurrence of ST elevation myocardial infarction (STEMI) and non-STEMI in patients with post traumatic stress disorder (PTSD) using the large nationwide inpatient sample (NIS).","authors":"Abdullah Mohamed Niyas, Fathima Haseefa, Mohammad Reza Movahed, Mehrtash Hashemzadeh, Mehrnoosh Hashemzadeh","doi":"10.62347/YTCI7645","DOIUrl":"10.62347/YTCI7645","url":null,"abstract":"<p><strong>Background: </strong>PTSD leads to increased levels of stress hormones and dysregulation of the autonomic nervous system which may trigger cardiac events. The goal of this study is to evaluate any association between PTSD and the occurrence of STEMI and NSTEMI using a large database.</p><p><strong>Method: </strong>Using the Nationwide Inpatient Sample (NIS) and ICD-9 codes from 2005 to 2014 (n=1,621,382), we performed a univariate chi-square analysis of in-hospital occurrence of STEMI and NSTEMI in patients greater than 40 years of age with and without PTSD. We also performed a multivariate analysis adjusting for baseline characteristics including age, gender, diabetes, race, hyperlipidemia, hypertension, and tobacco use.</p><p><strong>Results: </strong>The 2005-2014 dataset contained 401,485 STEMI patients (745, or 0.19%, with PTSD) and 1,219,897 NSTEMI patients (2,441, or 0.15%, with PTSD). In the 2005 dataset, 0.5% of PTSD patients had STEMI compared to 1.0% of non-PTSD patients (OR=0.46, 95% C.I., 0.36-0.59). Similarly, 0.6% of patients with PTSD and 2.2% of patients without PTSD had NSTEMI (OR=0.28, 95% C.I., 0.23-0.35). In the 2014 dataset, 0.3% of PTSD patients had STEMI compared to 0.7% of non-PTSD patients (OR=0.43, 95% C.I., 0.35-0.51). Similarly, 1.4% of patients with PTSD versus 2.9% of patients without PTSD had NSTEMI (OR=0.48, 95% C.I., 0.44-0.52). Similar trends were seen throughout the ten-year period. After adjusting for age, gender, diabetes, race, hyperlipidemia, hypertension, and tobacco use, PTSD was associated with a lower occurrence of STEMI (2005: OR=0.50, 95% C.I., 0.37-0.66; 2014: OR=0.35, 95% C.I., 0.29-0.43) and NSTEMI (2005: OR=0.44, 95% C.I., 0.34-0.57; 2014: OR=0.63, 95% C.I., 0.58-0.69).</p><p><strong>Conclusion: </strong>Using a large inpatient database, we did not find an increased occurrence of STEMI or NSTEMI in patients diagnosed with PTSD, suggesting that PTSD is not an independent risk factor for myocardial infarction.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15eCollection Date: 2024-01-01DOI: 10.62347/YGQQ8696
Hamayak S Sisakian, Ani R Tavaratsyan
The current traditional pathophysiologic concept of pulmonary edema of cardiogenic origin explains its development by a hydrostatic effect due to increased pulmonary capillary pressure resulting in fluid flux to alveolar and interstitial areas from capillaries. However, several experimental studies and clinical data of poor response to hemodynamic and diuretic treatment in many scenarios provide further evidence of the involvement of several other contributing factors to the development of cardiogenic pulmonary edema. Several experimental and clinical studies have found that sympathetic overactivity with elevated plasma catecholamine concentrations may play an important role in the development of cardiovascular-associated pulmonary edema. Catecholamine-induced pulmonary injury may be one of the key mechanisms in acute cardiogenic pulmonary edema triggering proinflammatory cytokine overactivation, oxidative stress and myocardial injury. In the everyday treatment of acute heart failure, physicians should consider the possibility of other noncardiogenic mechanisms involved in the progression of acute pulmonary edema, particularly catecholamine overactivity, lymphatic drainage, inflammatory and oxidative stress, high surfactant protein. The classic, hemodynamic treatment approach in pulmonary edema with the coexistence of other contributing factors may not provide adequate clinical benefit during treatment.
{"title":"Cardiogenic pulmonary edema - is it lone cardiogenic? \"Missing link\" between hemodynamic and other existing mechanisms.","authors":"Hamayak S Sisakian, Ani R Tavaratsyan","doi":"10.62347/YGQQ8696","DOIUrl":"10.62347/YGQQ8696","url":null,"abstract":"<p><p>The current traditional pathophysiologic concept of pulmonary edema of cardiogenic origin explains its development by a hydrostatic effect due to increased pulmonary capillary pressure resulting in fluid flux to alveolar and interstitial areas from capillaries. However, several experimental studies and clinical data of poor response to hemodynamic and diuretic treatment in many scenarios provide further evidence of the involvement of several other contributing factors to the development of cardiogenic pulmonary edema. Several experimental and clinical studies have found that sympathetic overactivity with elevated plasma catecholamine concentrations may play an important role in the development of cardiovascular-associated pulmonary edema. Catecholamine-induced pulmonary injury may be one of the key mechanisms in acute cardiogenic pulmonary edema triggering proinflammatory cytokine overactivation, oxidative stress and myocardial injury. In the everyday treatment of acute heart failure, physicians should consider the possibility of other noncardiogenic mechanisms involved in the progression of acute pulmonary edema, particularly catecholamine overactivity, lymphatic drainage, inflammatory and oxidative stress, high surfactant protein. The classic, hemodynamic treatment approach in pulmonary edema with the coexistence of other contributing factors may not provide adequate clinical benefit during treatment.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11101961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141064889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15eCollection Date: 2024-01-01DOI: 10.62347/PORE5631
Yasar Sattar, Mohammad Hamza, Farah Yasmin, Sidra Jabeen, Neel Patel, Syed Ishaq, Bandar Alyami, Hassan Ul Hussain, Syeda Tayyaba Rehan, Syed Hasan Shuja, Zayeema Khan, Yasemin Bahar, Islam Y Elgendy, Karthik Gonuguntla, Harshith Thyagaturu, Akram Kawsara, Kevin Felpel, Ramesh Daggubati, M Chadi Alraies
Background: Transcatheter aortic valve replacement (TAVR) has been highly increased as the recommended option for patients with a high surgical risk. This study aims to commit a systematic review and meta-analysis to assess the outcomes in severe aortic stenosis patients following emergency transcatheter aortic valve replacement (emergent TAVR) compared to elective TAVR or eBAV followed by elective TAVR.
Methods: We conducted a systematic literature search of PubMed, Embase, Cochrane CENTRAL, CINAHL, Science Direct, and Google Scholar. We included nine studies in the latest analysis that reported the desired outcomes. Outcomes were classified into primary outcomes: 30-day all-cause mortality and 30-day readmission rate, and secondary outcomes, which were further divided into (a) peri-procedural outcomes, (b) vascular outcomes, and (c) renal outcomes. Statistical analysis was performed using Stata v.17 (College State, TX) software.
Results: A total of 44,731 patients with severe aortic stenosis were included (emergent TAVR n = 4502; control n = 40045). 30-day mortality was significantly higher in the emergent TAVR group (OR: 2.62; 95% CI = 1.76-3.92; P < 0.01). Regarding post-procedural outcomes, the length of stay was significantly higher in the emergent TAVR group (Hedges's g: +4.73 days; 95% CI = +3.35 to +6.11; P < 0.01). With respect to vascular outcomes, they were similar in both groups. Regarding renal outcomes, both acute kidney injury (OR: 2.52; 95% CI = 1.59-4.00; P < 0.01) and use of renal replacement therapy (OR: 2.33; 95% CI = 1.87-2.91; P < 0.01) were significantly higher in emergent TAVR group as compared to the control group.
Conclusion: Our study demonstrated that despite increased 30-day mortality and worse renal outcomes, the post-procedural outcomes were similar in emergent and elective TAVR groups. The increased mortality and worse renal outcomes are likely due to hemodynamic instability in the emergent group. The similarity of post-procedural outcomes is evidence of the safety of TAVR even in emergent settings.
背景:经导管主动脉瓣置换术(TAVR)作为手术风险高的患者的推荐选择,已被广泛采用。本研究旨在通过系统综述和荟萃分析,评估重度主动脉瓣狭窄患者紧急经导管主动脉瓣置换术(紧急 TAVR)与择期 TAVR 或 eBAV 后择期 TAVR 的治疗效果:我们对 PubMed、Embase、Cochrane CENTRAL、CINAHL、Science Direct 和 Google Scholar 进行了系统的文献检索。我们在最新分析中纳入了 9 项报告预期结果的研究。结果分为主要结果:30 天全因死亡率和 30 天再入院率;次要结果又分为 (a) 围手术期结果、(b) 血管结果和 (c) 肾脏结果。统计分析使用Stata v.17 (College State, TX)软件进行:结果:共纳入 44731 名重度主动脉瓣狭窄患者(急诊 TAVR n = 4502;对照组 n = 40045)。急诊 TAVR 组的 30 天死亡率明显更高(OR:2.62;95% CI = 1.76-3.92;P <0.01)。关于术后结果,急诊 TAVR 组的住院时间明显更长(Hedges's g:+4.73 天;95% CI = +3.35 至 +6.11;P < 0.01)。在血管方面,两组的结果相似。在肾脏结果方面,与对照组相比,急诊TAVR组的急性肾损伤(OR:2.52;95% CI = 1.59-4.00;P < 0.01)和肾脏替代疗法的使用(OR:2.33;95% CI = 1.87-2.91;P < 0.01)均显著增加:我们的研究表明,尽管急诊组和择期 TAVR 组的 30 天死亡率和肾脏预后较差,但术后预后相似。急诊组死亡率增加和肾脏预后恶化可能是由于血流动力学不稳定造成的。术后结果的相似性证明了 TAVR 的安全性,即使在急诊情况下也是如此。
{"title":"Cardiovascular outcomes of emergent vs elective transcatheter aortic valve replacement in severe aortic stenosis: regression matched meta-analysis.","authors":"Yasar Sattar, Mohammad Hamza, Farah Yasmin, Sidra Jabeen, Neel Patel, Syed Ishaq, Bandar Alyami, Hassan Ul Hussain, Syeda Tayyaba Rehan, Syed Hasan Shuja, Zayeema Khan, Yasemin Bahar, Islam Y Elgendy, Karthik Gonuguntla, Harshith Thyagaturu, Akram Kawsara, Kevin Felpel, Ramesh Daggubati, M Chadi Alraies","doi":"10.62347/PORE5631","DOIUrl":"10.62347/PORE5631","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve replacement (TAVR) has been highly increased as the recommended option for patients with a high surgical risk. This study aims to commit a systematic review and meta-analysis to assess the outcomes in severe aortic stenosis patients following emergency transcatheter aortic valve replacement (emergent TAVR) compared to elective TAVR or eBAV followed by elective TAVR.</p><p><strong>Methods: </strong>We conducted a systematic literature search of PubMed, Embase, Cochrane CENTRAL, CINAHL, Science Direct, and Google Scholar. We included nine studies in the latest analysis that reported the desired outcomes. Outcomes were classified into primary outcomes: 30-day all-cause mortality and 30-day readmission rate, and secondary outcomes, which were further divided into (a) peri-procedural outcomes, (b) vascular outcomes, and (c) renal outcomes. Statistical analysis was performed using Stata v.17 (College State, TX) software.</p><p><strong>Results: </strong>A total of 44,731 patients with severe aortic stenosis were included (emergent TAVR n = 4502; control n = 40045). 30-day mortality was significantly higher in the emergent TAVR group (OR: 2.62; 95% CI = 1.76-3.92; P < 0.01). Regarding post-procedural outcomes, the length of stay was significantly higher in the emergent TAVR group (Hedges's g: +4.73 days; 95% CI = +3.35 to +6.11; P < 0.01). With respect to vascular outcomes, they were similar in both groups. Regarding renal outcomes, both acute kidney injury (OR: 2.52; 95% CI = 1.59-4.00; P < 0.01) and use of renal replacement therapy (OR: 2.33; 95% CI = 1.87-2.91; P < 0.01) were significantly higher in emergent TAVR group as compared to the control group.</p><p><strong>Conclusion: </strong>Our study demonstrated that despite increased 30-day mortality and worse renal outcomes, the post-procedural outcomes were similar in emergent and elective TAVR groups. The increased mortality and worse renal outcomes are likely due to hemodynamic instability in the emergent group. The similarity of post-procedural outcomes is evidence of the safety of TAVR even in emergent settings.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11101960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141064890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15eCollection Date: 2024-01-01DOI: 10.62347/TAEY9817
Benoit Yu, Nickolas Poulakos, Alexander Beaulieu-Shearer, Pierre Yves Turgeon, Sylvain Trahan, David Belzile, Mario Sénéchal
Arrhythmogenic right ventricular cardiomyopathy is an important differential diagnosis in young patients presenting with palpitations and/or dyspnea and must be appropriately investigated. A 23-year-old man presented with cardiogenic shock and monomorphic ventricular tachycardia. He reported palpitations and progressive dyspnea for more than two years, but those symptoms were attributed to anxiety without any further investigation by his family physician. Investigations after the catastrophic presentation in our center suggested terminal right-sided heart failure with severe hepatic insufficiency and acute kidney injury. The patient benefited from extracorporeal membrane oxygenation, followed by an urgent heart transplant 16 days later after the exclusion of liver cirrhosis. Histopathologic analysis of the explanted heart confirmed arrhythmogenic cardiomyopathy.
{"title":"Young patient presenting with cardiogenic shock and refractory ventricular tachycardia: a case of unsuspected arrhythmogenic cardiomyopathy leading to urgent heart transplantation.","authors":"Benoit Yu, Nickolas Poulakos, Alexander Beaulieu-Shearer, Pierre Yves Turgeon, Sylvain Trahan, David Belzile, Mario Sénéchal","doi":"10.62347/TAEY9817","DOIUrl":"10.62347/TAEY9817","url":null,"abstract":"<p><p>Arrhythmogenic right ventricular cardiomyopathy is an important differential diagnosis in young patients presenting with palpitations and/or dyspnea and must be appropriately investigated. A 23-year-old man presented with cardiogenic shock and monomorphic ventricular tachycardia. He reported palpitations and progressive dyspnea for more than two years, but those symptoms were attributed to anxiety without any further investigation by his family physician. Investigations after the catastrophic presentation in our center suggested terminal right-sided heart failure with severe hepatic insufficiency and acute kidney injury. The patient benefited from extracorporeal membrane oxygenation, followed by an urgent heart transplant 16 days later after the exclusion of liver cirrhosis. Histopathologic analysis of the explanted heart confirmed arrhythmogenic cardiomyopathy.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11101963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141064822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15eCollection Date: 2024-01-01DOI: 10.62347/TWBY9801
Wei Wen, Qing Ye, Li-Xiang Zhang, Li-Kun Ma
Objective: To determine the risk factors affecting the severity of coronary artery disease (CAD) in older postmenopausal women with coronary heart disease (CHD) and to construct a personalized risk predictive model.
Methods: In this cohort study, clinical records of 527 female patients aged ≥60 with CHD who were hospitalized in the First Affiliated Hospital of the University of Science and Technology of China from March 2018 to February 2019 were analyzed retrospectively. The severity of CAD was determined using the Gensini scores that are based on coronary angiography findings. Patients with Gensini scores ≥40 and <40 were divided into high-risk (n=277) and non-high-risk groups (n=250), respectively. Logistic regression analysis was used to assess independent predictors of CAD severity. The nomogram prediction model of CAD severity was plotted by the R software. The area under the receiver operating characteristic (ROC) and calibration curves were used to evaluate the predictive efficiency of the nomogram model, and the decision curve analysis (DCA) was used to assess the clinical applicability of the nomogram model.
Results: Multivariate analysis showed that high-sensitivity C-reactive protein, RBC count, WBC count, BMI, and diabetes mellitus were independent risk factors associated with CAD severity in older menopausal women (P<0.05); the area under the ROC curve of the nomogram constructed based on the independent risk factors was 0.846 (95% CI: 0.756-0.937). The area under the ROC curve after internal validation of the nomogram by the Bootstrap method after resampling 1000 times was 0.840 (95% CI: 0.741-0.923). The calibration curve suggested that the nomogram had an excellent predictive agreement, and the DCA curve indicated that the net benefit of applying the nomogram was significantly higher than that of the "no intervention" and "all intervention" methods when the risk probability of patients with high-risk CAD severity was 0.30-0.81.
Conclusion: A personalized risk assessment model was constructed based on the risk factors of severe CAD in older menopausal women with CHD, which had good prediction efficiency based on discrimination, calibration, and clinical applicability evaluation indicators. This model could assist cardiology medical staff in screening older menopausal women with CHD who are at a high risk of severe CAD to implement targeted interventions.
目的确定影响绝经后老年冠心病(CHD)女性患者冠状动脉疾病(CAD)严重程度的风险因素,并构建个性化风险预测模型:在这项队列研究中,回顾性分析了2018年3月至2019年2月在中国科学技术大学附属第一医院住院治疗的527名年龄≥60岁的CHD女性患者的临床病历。根据冠状动脉造影结果得出的 Gensini 评分确定了 CAD 的严重程度。Gensini评分≥40分的患者和结果:多变量分析表明,高敏 C 反应蛋白、红细胞计数、白细胞计数、体重指数和糖尿病是与更年期老年妇女(PConclusion:根据患有冠心病的更年期老年妇女严重CAD的危险因素构建了一个个性化的风险评估模型,该模型在判别、校准和临床适用性评价指标方面具有良好的预测效果。该模型可帮助心内科医务人员筛查患有冠心病的更年期老年妇女中的严重冠心病高危人群,从而实施有针对性的干预措施。
{"title":"A risk predictive model for determining the severity of coronary artery lesions in older postmenopausal women with coronary heart disease.","authors":"Wei Wen, Qing Ye, Li-Xiang Zhang, Li-Kun Ma","doi":"10.62347/TWBY9801","DOIUrl":"10.62347/TWBY9801","url":null,"abstract":"<p><strong>Objective: </strong>To determine the risk factors affecting the severity of coronary artery disease (CAD) in older postmenopausal women with coronary heart disease (CHD) and to construct a personalized risk predictive model.</p><p><strong>Methods: </strong>In this cohort study, clinical records of 527 female patients aged ≥60 with CHD who were hospitalized in the First Affiliated Hospital of the University of Science and Technology of China from March 2018 to February 2019 were analyzed retrospectively. The severity of CAD was determined using the Gensini scores that are based on coronary angiography findings. Patients with Gensini scores ≥40 and <40 were divided into high-risk (n=277) and non-high-risk groups (n=250), respectively. Logistic regression analysis was used to assess independent predictors of CAD severity. The nomogram prediction model of CAD severity was plotted by the R software. The area under the receiver operating characteristic (ROC) and calibration curves were used to evaluate the predictive efficiency of the nomogram model, and the decision curve analysis (DCA) was used to assess the clinical applicability of the nomogram model.</p><p><strong>Results: </strong>Multivariate analysis showed that high-sensitivity C-reactive protein, RBC count, WBC count, BMI, and diabetes mellitus were independent risk factors associated with CAD severity in older menopausal women (P<0.05); the area under the ROC curve of the nomogram constructed based on the independent risk factors was 0.846 (95% CI: 0.756-0.937). The area under the ROC curve after internal validation of the nomogram by the Bootstrap method after resampling 1000 times was 0.840 (95% CI: 0.741-0.923). The calibration curve suggested that the nomogram had an excellent predictive agreement, and the DCA curve indicated that the net benefit of applying the nomogram was significantly higher than that of the \"no intervention\" and \"all intervention\" methods when the risk probability of patients with high-risk CAD severity was 0.30-0.81.</p><p><strong>Conclusion: </strong>A personalized risk assessment model was constructed based on the risk factors of severe CAD in older menopausal women with CHD, which had good prediction efficiency based on discrimination, calibration, and clinical applicability evaluation indicators. This model could assist cardiology medical staff in screening older menopausal women with CHD who are at a high risk of severe CAD to implement targeted interventions.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11101962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141064887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}