Journal of the American Heart Association
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Multicenter Study Comparative Study Observational Study
Association of Neighborhood Race and Income With Survival After Out-of-Hospital Cardiac Arrest.
Background For individuals with an out-of-hospital cardiac arrest (OHCA), survival may be influenced by the neighborhood in which the arrest occurs. Methods and Results Within the national CARES (Cardiac Arrest Registry to Enhance Survival) registry, we identified 169 502 patients with OHCA from 2013 to 2017. On the basis of census tract data, OHCAs were categorized as occurring in predominantly white (>80% white), majority black (>50% black), or integrated (neither of these 2) neighborhoods and in low-income (median household <$40 000), middle-income ($40 000 to $80 000), or high-income (>$80 000) neighborhoods. ⋯ Compared with high-income neighborhoods, those in middle-income neighborhoods were 11% (10.1% versus 11.3%; adjusted odds ratio 0.89; 95% CI 0.8-0.94; P<0.001) less likely to survive to discharge, whereas those in low-income neighborhoods were 12% (8.6% versus 11.3%; adjusted odds ratio 95% CI 0.83-0.94; P<0.001) less likely to survive. Differential rates of bystander cardiopulmonary resuscitation only modestly attenuated neighborhood differences in survival. Conclusions OHCAs in majority black and non-high-income neighborhoods have lower survival rates, and these differences were not explained by differential bystander cardiopulmonary resuscitation rates.
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Background Potassium disturbances per se increase the risk of ventricular fibrillation (VF). Whether potassium disturbances in the acute phase of ST-segment-elevation myocardial infarction (STEMI) are associated with VF before primary percutaneous coronary intervention (PPCI) is uncertain. Methods and Results All consecutive STEMI patients were identified in the Eastern Danish Heart Registry from 1999 to 2016. ⋯ Compared with normokalemia, patients with hypokalemia had a significant association with VF during PPCI (odds ratio 1.68, 95% CI 1.01-2.77, P=0.045) after adjustment. Conclusions Hypokalemia and hyperkalemia are associated with increased risk of VF before PPCI during STEMI. For hypokalemia, the association may be independent of the measurement of potassium before or after VF.
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Background The cardiac intensive care unit (CICU) population is no longer composed of only patients with acute coronary syndromes, and includes those with acute heart failure and multiple comorbidities. We hypothesized that the GWTG-HF (Get With The Guidelines-Heart Failure) risk score that predicts inpatient mortality in hospitalized patients with heart failure would predict mortality in CICU patients. Methods and Results We retrospectively analyzed CICU patients at a tertiary care hospital from 2007 to 2015. ⋯ The Hosmer-Lemeshow statistic suggested poor calibration for hospital mortality by the GWTG-HF risk score (P<0.001). Conclusions The GWTG-HF risk score and other heart failure prediction tools demonstrate good discrimination for inpatient and 1-year mortality in a heterogeneous cohort of CICU patients. Our study emphasizes that prognostic variables overlap in cardiac patients, regardless of the admission diagnosis.
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Multicenter Study
Nomogram to Predict Mortality of Endovascular Thrombectomy for Ischemic Stroke Despite Successful Recanalization.
Background The trajectory of ischemic stroke patients attributable to large vessel occlusion is fundamentally altered by endovascular thrombectomy. This study aimed to develop a nomogram for predicting 3-month mortality risk in patients with ischemic stroke attributed to artery occlusion in anterior circulation who received successful endovascular thrombectomy treatment. Methods and Results Patients with successful endovascular thrombectomy (modified Thrombolysis in Cerebral Infarction IIb or III) were enrolled from a multicenter registry as the training cohort. ⋯ Age (odds ratio [OR], 1.07; 95% CI, 1.03-1.10), poor pretreatment collateral status (OR, 2.13; 95% CI, 1.18-3.85), baseline blood glucose level (OR, 1.12; 95% CI, 1.04-1.21), symptomatic intracranial hemorrhage (OR, 9.51; 95% CI, 4.54-19.92), and baseline National Institutes of Health Stroke Scale score (OR, 1.08; 95% CI, 1.03-1.12) were associated with mortality and were incorporated in the nomogram. The c-index of the nomogram was 0.835 (95% CI, 0.785-0.885) in the training cohort and 0.758 (95% CI, 0.667-0.849) in the test cohort. Conclusions The nomogram, composed of age, pretreatment collateral status, baseline blood glucose level, symptomatic intracranial hemorrhage, and baseline National Institutes of Health Stroke Scale score, may predict risk of mortality in patients with ischemic stroke and treated successfully with endovascular thrombectomy.