Journal of the American Heart Association
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Multicenter Study Observational Study
Management of Antithrombotic Agents During Surgery or Other Kinds of Medical Procedures With Bleeding: The MARK Study.
Background Optimal management of antithrombotic agents during surgery has yet to be established. We performed a prospective multicenter observational study to determine the current status of the management of antithrombotic agents during surgery or other medical procedures with bleeding (MARK [Management of Antithrombotic Agents During Surgery or Other Kinds of Medical Procedures With Bleeding] study) in Japan. Methods and Results The participants were 9700 patients who received oral antithrombotic agents and underwent scheduled medical procedures with bleeding at 59 National Hospital Organization institutions in Japan. ⋯ In multivariate analysis, even after adjusting for confounding factors, discontinuation of anticoagulant agents was significantly associated with higher risk for both thromboembolic events (odds ratio: 4.55; 95% CI, 1.67-12.4; P=0.003) and major bleeding (odds ratio: 11.1; 95% CI, 2.03-60.3; P=0.006) in procedures with low bleeding risk. In contrast, heparin bridging therapy was significantly associated with higher risk for both thromboembolic events (odds ratio: 2.03; 95% CI, 1.28-3.22; P=0.003) and major bleeding (odds ratio: 1.36; 95% CI, 1.10-1.68; P=0.005) in procedures with high bleeding risk. Conclusions Discontinuation of oral antithrombotic agents and addition of low-dose heparin bridging therapy appear to be significantly associated with adverse events in the periprocedural period.
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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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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.
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Multicenter Study Observational Study
Prognostic Significance of Serum Cholinesterase Level in Patients With Acute Decompensated Heart Failure With Preserved Ejection Fraction: Insights From the PURSUIT-HFpEF Registry.
Background Malnutrition is one of the most important comorbidities in patients with heart failure with preserved ejection fraction. We recently reported the prognostic significance of serum cholinesterase level and superior predictive power of cholinesterase level to other objective nutritional indices such as the controlling nutritional status score, prognostic nutritional index, and geriatric nutritional risk index in patients with acute decompensated heart failure. The aim of this study was to clarify the prognostic role of cholinesterase in patients with heart failure with preserved ejection fraction/acute decompensated heart failure and investigate incremental cholinesterase value. ⋯ Cholinesterase level showed the best C-statistics (0.703) for prediction of the composite end points among the objective nutritional indices. C-statistics of the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score for prediction of the composite end points were improved when cholinesterase level was added (C-statistics, from 0.601 to 0.705; P=0.0408). Conclusions Cholinesterase was a useful prognostic marker for prediction of adverse outcome in patients with heart failure with preserved ejection fraction/acute decompensated heart failure.
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Multicenter Study Comparative Study
Comparison of Long-Term Clinical Outcome Between Multivessel Percutaneous Coronary Intervention Versus Infarct-Related Artery-Only Revascularization for Patients With ST-Segment-Elevation Myocardial Infarction With Cardiogenic Shock.
Background Data are limited regarding long-term outcomes in patients with ST-segment-elevation myocardial infarction and multivessel disease presenting with cardiogenic shock according to revascularization strategy. We sought to compare the 3-year clinical outcomes of patients with ST-segment-elevation myocardial infarction multivessel disease with cardiogenic shock and patients with multivessel percutaneous coronary intervention (PCI) and infarct-related artery (IRA)-only PCI. Methods and Results Of 13 104 patients from the nationwide, multicenter, prospective KAMIR-NIH (Korea Acute Myocardial Infarction Registry--National Institutes of Health) registry, we selected 659 patients with ST-segment-elevation myocardial infarction who had concomitant non-IRA stenosis and presented with cardiogenic shock. ⋯ The results were consistent after confounder adjustment by propensity score matching and inverse probability weighting analysis. Landmark analysis at 1 year demonstrated that the multivessel PCI group had a lower risk of recurrent MI and non-IRA repeat revascularization beyond 1 year (log-rank P=0.030 and P=0.017, respectively) than the IRA-only PCI group. Conclusions In patients with ST-segment-elevation myocardial infarction and cardiogenic shock, multivessel PCI was associated with a lower risk of all-cause death than IRA-only PCI at 3 years, suggesting potential benefit of non-IRA revascularization during the index hospitalization to improve long-term clinical outcomes.