Journal of the American Heart Association
-
Multicenter Study Comparative Study Observational Study
Rapid Successful Reperfusion of Basilar Artery Occlusion Strokes With Pretreatment Diffusion-Weighted Imaging Posterior-Circulation ASPECTS <8 Is Associated With Good Outcome.
Background The association between time to reperfusion and clinical outcome is well known in anterior circulation strokes, whereas the impact of main time metrics remains unknown in posterior circulation strokes. We investigated the clinical effect of different time intervals from symptom onset to reperfusion on the 90-day clinical outcome in acute ischemic stroke patients with basilar artery occlusion, and especially in the subset population presenting a low stroke volume on baseline diffusion-weighted imaging. Methods and Results We studied patients included in the prospective, multicenter, observational ETIS (Endovascular Treatment in Ischemic Stroke) registry who had had basal artery occlusion and had achieved successful reperfusion (modified Thrombolysis In Cerebral Infarction 2b-3). ⋯ In all patients, no significant association was found between the different time intervals and outcome. In patients evaluated with diffusion-weighted imaging (n=61) at baseline, a significant negative association was found between imaging-to-reperfusion time for patients with pc- ASPECTS <8 (adjusted odds ratio=0.4 per 30-minute increase; 95% CI 0.18-0.85; P=0.02) compared with those with pc- ASPECTS ≥8. Conclusions In patients with basilar artery occlusion and pc- ASPECTS <8 at baseline diffusion-weighted imaging, clinical outcome is highly dependent on the time from imaging to reperfusion, which suggests that rapid endovascular reperfusion should be performed after imaging in these patients.
-
Background The contemporary incidence of and reasons for early readmission after infective endocarditis ( IE ) are not well known. Therefore, we analyzed 30-day readmission demographics after IE from the US Nationwide Readmission Database. Methods and Results We examined the 2010 to 2014 Nationwide Readmission Database to identify index admissions for a primary diagnosis of IE with survival at discharge. ⋯ Conclusions Almost 1 in 4 patients was readmitted within 30 days of admission for IE. The most common reasons were IE , other infectious causes, and cardiac causes. A multidisciplinary approach to determine the surgical indications and close monitoring are necessary to improve outcomes and reduce complications in in-hospital and postdischarge settings.
-
Meta Analysis
Silent Brain Infarcts Following Cardiac Procedures: A Systematic Review and Meta-Analysis.
Background Silent brain infarcts ( SBI ) are increasingly being recognized as an important complication of cardiac procedures as well as a potential surrogate marker for studies on brain injury. The extent of subclinical brain injury is poorly defined. Methods and Results We conducted a systematic review and meta-analysis utilizing studies of SBI s and focal neurologic deficits following cardiac procedures. ⋯ Conclusions SBI s are a very common complication following cardiac procedures, particularly those involving the aortic valve. The high frequency of SBI s compared with strokes highlights the importance of recording this surrogate measure in cardiac interventional studies. We suggest that further work is required to standardize reporting in order to facilitate the use of SBI s as a routine outcome measure.
-
Background Cardiogenic shock ( CS ) following acute myocardial infarction ( AMI ) portends a poor prognosis. Both venoarterial extracorporeal membrane oxygenation ( VA - ECMO ) and a percutaneous ventricular assist device ( pVAD ) provide hemodynamic support for patients with CS, but little is known about the best device for this population. We sought to compare outcomes of AMI patients treated with these devices. ⋯ Survival at 1 and 2 years did not differ significantly between device groups ( P=0.42). Conclusions Following AMI -related CS , pVAD - and VA - ECMO -treated patients had similar outcomes. The use of both devices simultaneously was common, with almost half of patients in persistent CS after first device deployment.
-
Multicenter Study Observational Study
Prognostic Implications of Door-to-Balloon Time and Onset-to-Door Time on Mortality in Patients With ST -Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention.
Background In patients with ST-segment-elevation myocardial infarction, timely reperfusion therapy with door-to-balloon (D2B) time <90 minutes is recommended by the current guidelines. However, whether further shortening of symptom onset-to-door (O2D) time or D2B time would enhance survival of patients with ST-segment-elevation myocardial infarction remains unclear. Therefore, the current study aimed to evaluate the prognostic impact of O2D or D2B time in patients with ST-segment-elevation myocardial infarction who underwent primary percutaneous coronary intervention. ⋯ Reducing D2B time within 45 minutes showed further decreased risk of mortality compared with D2B time >90 minutes (adjusted hazard ratio, 0.30; 95% CI , 0.19-0.42; P<0.001). Every reduction of D2B time by 30 minutes showed continuous reduction of 1-year mortality (90 to 60 minutes: absolute risk reduction, 2.4%; number needed to treat, 41.9; 60 to 30 minutes: absolute risk reduction, 2.0%; number needed to treat, 49.2). Conclusions Shortening D2B time was significantly associated with survival benefit, and the survival benefit of shortening D2B time was consistently observed, even <60 to 90 minutes.