The American journal of cardiology
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We evaluated the relation between reperfusion indexes and right ventricular (RV) dysfunction in patients with inferior ST-segment elevation myocardial infarction (STEMI). We included patients with inferior STEMI undergoing percutaneous coronary intervention and right coronary artery as infarct-related artery. Myocardial reperfusion was evaluated by Thrombolysis In Myocardial Infarction (TIMI) flow, TIMI frame count, myocardial blush grade, and ST-segment resolution. ⋯ In an independent cohort of 84 patients with STEMI, postprocedural TIMI flow grade 3 had a limited sensitivity (52%), with a high specificity (74.5%) and negative predictive value (71%) for excluding RV dysfunction. In conclusion, in patients with inferior STEMI undergoing coronary revascularization, RV dysfunction is associated with a worse long-term prognosis. Postprocedural TIMI flow grade may be a useful tool to predict RV dysfunction.
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Hyponatremia portends a poor prognosis in patients with heart failure (HF). The aim of this study was to evaluate prognostic implication of hyponatremia on adverse events in patients with HF receiving cardiac resynchronization therapy (CRT). Additionally, the impact of improvement of hyponatremia after CRT device implantation was also evaluated. ⋯ CRT can resolve hyponatremia in some patients after device implantation. Patients with postimplantation hyponatremia (either newly developed or persistent from baseline) have a poor clinical outcome. Post-CRT improvement of hyponatremia is associated with improved clinical outcomes.
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The percentage of patients with primary percutaneous coronary intervention (PCI) with door-to-balloon (D2B) times ≤90 minutes is used as a hospital performance measure for public reporting. Patients can be excluded from reporting for nonsystem-related delays. How exclusions impact D2B time reporting at the hospital level is unknown. ⋯ If a criterion of having ≥90% of patients with D2B ≤90 minutes was used, excluding patients with nonsystem delays significantly increased the proportion of patients meeting this goal for each group: low, 28% to 37%; intermediate, 17.7% to 37.5%; and high, 14% to 52% (all p <0.01). In conclusion, the proportion of patients excluded from D2B reporting varies substantially among hospitals. This has a greater impact on percentage of patients with D2B time ≤90 minutes than on median D2B times.
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Observational Study
Effect of statin therapy on mortality in patients with infective endocarditis.
The aim of our study was to determine whether pre-emptive statin therapy was associated with improved outcome of infective endocarditis (IE). We conducted a nationwide, population-based, propensity score-matched cohort study with the Taiwan's National Health Insurance Research Database. All patients with IE between January 2000 and December 2010 were enrolled. ⋯ The reduction in mortality from IE remained significant for follow-up 3 months (aHR 0.68, 95% CI, 0.53-0.88), 6 months (aHR 0.73, 95% CI, 0.58-0.91), and 12 months (aHR 0.68, 95% CI, 0.55-0.84). Statin therapy was associated with a reduced risk of ICU admission rates, shock events, the need for mechanical ventilation, but not significantly with the need for heart valvular replacement surgery. In conclusion, our study found that statin therapy is associated with a reduced risk of in-hospital and subsequent mortality of IE.
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Mild therapeutic hypothermia (TH) is an established therapy to improve survival and reduce neurologic injury after cardiac arrest. Adult patients with congenital heart disease (ACHD) are at increased risk of sudden cardiac death. The use of TH in this population has not been extensively studied. ⋯ All 5 patients suffered cardiac arrest due to ventricular arrhythmia and all survived to discharge without significant neurologic impairment. Therapeutic interventions included anomalous left coronary artery from the pulmonary artery ligation, percutaneous coronary intervention, and defibrillator implantation. In conclusion, in 5 patients with ACHD, the use of TH after cardiac arrest resulted in 100% survival to hospital discharge with good neurologic outcome postresuscitation.