Sudden cardiac arrest is a major cause of death predominantly caused by ventricular tachyarrhythmia in patients with coronary artery disease.Despite advancements in resuscitation care,the rate of survival after cardia...Sudden cardiac arrest is a major cause of death predominantly caused by ventricular tachyarrhythmia in patients with coronary artery disease.Despite advancements in resuscitation care,the rate of survival after cardiac arrest remains low.There is a growing body of observational data suggesting early coronary angiography reduces delay to revascularization and may improve outcomes.Most survivors present comatose,and neurologic outcome is uncertain;therefore it is often challenging to identify patients who will benefit from early coronary angiography.Several variables and risk scores that predict a favorable neurologic outcome have been identified.The rationale and current evidence for early angiography are reviewed,and a suggested approach to the selection of patients is presented.展开更多
BACKGROUND Gastrointestinal bleeding(GIB)is a major concern in patients hospitalized with acute coronary syndrome(ACS)due to the common use of both antiplatelet medications and anticoagulants.Studies evaluating the sa...BACKGROUND Gastrointestinal bleeding(GIB)is a major concern in patients hospitalized with acute coronary syndrome(ACS)due to the common use of both antiplatelet medications and anticoagulants.Studies evaluating the safety of gastrointestinal endoscopy(GIE)in ACS patients with GIB are limited by their relatively small size,and the focus has generally been on upper GIB and esophago-gastroduodenoscopy(EGD)only.AIM To evaluate the safety profile and the hospitalization outcomes of undergoing GIE in patients with ACS and concomitant GIB using the national database for hospitalized patients in the United States.METHODS The Nationwide Inpatient Sample database was queried to identify patients hospitalized with ACS and GIB during the same admission between 2005 and 2014.The International Classification of Diseases Code,9th Revision Clinical Modification was utilized for patient identification.Patients were further classified into two groups based on undergoing endoscopic procedures(EGD,small intestinal endoscopy,colonoscopy,or flexible sigmoidoscopy).Both groups were compared regarding demographic information,outcomes,and comorbidities.Multivariate analysis was conducted to identify factors associated with mortality and prolonged length of stay.Chi-square test was used to compare categorical variables,while Student’s t-test was used to compare continuous variables.All analyses were performed using SAS 9.4(Cary,NC,United States).RESULTS A total of 35612318 patients with ACS were identified between January 2005 and December 2014.269483(0.75%)of the patients diagnosed with ACS developed concomitant GIB during the same admission.At least one endoscopic procedure was performed in 68%of the patients admitted with both ACS and GIB.Patients who underwent GIE during the index hospitalization with ACS and GIB had lower mortality(3.8%)compared to the group not undergoing endoscopy(8.6%,P<0.001).A shorter length of stay(LOS)was observed in patients who underwent GIE(mean 6.59±7.81 d)compared to the group not undergoing endoscopy(mean 7.84±9.73 d,P<0.001).Multivariate analysis showed that performing GIE was associated with lower mortality(odds ratio:0.58,P<0.001)and shorter LOS(-0.36 factor,P<0.001).CONCLUSION Performing GIE during the index hospitalization of patients with ACS and GIB was correlated with a better mortality rate and a shorter LOS.Approximately twothirds of patients with both ACS and GIB undergo GIE during the same hospitalization.展开更多
Two-year survival rate was assessed among 1,038 patients who had acute coronary syndromes that were classified by discharge hematocrit values as normal(>39%, n=360, 34.7%), mildly anemic(33.1%to 39%, n=430, 41.4%),...Two-year survival rate was assessed among 1,038 patients who had acute coronary syndromes that were classified by discharge hematocrit values as normal(>39%, n=360, 34.7%), mildly anemic(33.1%to 39%, n=430, 41.4%), or moderately/severely anemic(≤33%, n=248, 23.9%). Worsening anemia was associated with a decreased 2-year survival rate(normal 95.8%,mild anemia 91.2%, moderate/severe anemia 81.5%, p< 0.001). In multivariable analyses, adjusted hazard ratios for all-cause mortality were 1.57(95%confidence interval 0.82 to 2.96) for mild anemia and 2.46(95%confidence interval 1.25 to 4.85) for moderate/severe anemia.展开更多
Background： Despite the rapid growth in the incidence of acute myocardial infarction （AMI） in China, there is limited information about patients＇ experiences after AMI hospitalization, especially on long-tern1 adv...Background： Despite the rapid growth in the incidence of acute myocardial infarction （AMI） in China, there is limited information about patients＇ experiences after AMI hospitalization, especially on long-tern1 adverse events and patient-reported outcomes （PROs）. Methods： The China Patient-centered Evaluative Assessment of Cardiac Events （PEACE）-Prospective AMI Study will enroll 4000 consecutive AM I patients from 53 diverse hospitals across China and follow them longitudinally for 12 months to docunlent their treatment, recovery, and outcomes. Details of patients＇ medical history, treatment, and in-hospital outcomes are abstracted from medical charts. Comprehensive baseline interviews are being conducted to characterize patient demographics, risk factors, presentation, and healthcare utilization. As part of these interviews, validated instruments are administered to measure PROs, including quality of life, symptoms, mood, cognition, and sexual activity. Follow-up interviews, measuring PROs, medication adherence, risk factor control, and collecting hospitalization events are conducted at 1, 6, and 12 months after discharge. Supporting documents for potential outcomes are collected for adjudication by clinicians at the National Coordinating Center. Blood and urine samples are also obtained at baseline, 1 - and 12-month follow-up. In addition, we are conducting a survey of participating hospitals to characterize their organizational characteristics. Conclusion： The China PEACE-Prospective AMI study will be uniquely positioned to generate new information regarding patient＇s experiences and outcomes alter AMI in China and seiwe as a foundation for quality improveinent activities.展开更多
文摘Sudden cardiac arrest is a major cause of death predominantly caused by ventricular tachyarrhythmia in patients with coronary artery disease.Despite advancements in resuscitation care,the rate of survival after cardiac arrest remains low.There is a growing body of observational data suggesting early coronary angiography reduces delay to revascularization and may improve outcomes.Most survivors present comatose,and neurologic outcome is uncertain;therefore it is often challenging to identify patients who will benefit from early coronary angiography.Several variables and risk scores that predict a favorable neurologic outcome have been identified.The rationale and current evidence for early angiography are reviewed,and a suggested approach to the selection of patients is presented.
文摘BACKGROUND Gastrointestinal bleeding(GIB)is a major concern in patients hospitalized with acute coronary syndrome(ACS)due to the common use of both antiplatelet medications and anticoagulants.Studies evaluating the safety of gastrointestinal endoscopy(GIE)in ACS patients with GIB are limited by their relatively small size,and the focus has generally been on upper GIB and esophago-gastroduodenoscopy(EGD)only.AIM To evaluate the safety profile and the hospitalization outcomes of undergoing GIE in patients with ACS and concomitant GIB using the national database for hospitalized patients in the United States.METHODS The Nationwide Inpatient Sample database was queried to identify patients hospitalized with ACS and GIB during the same admission between 2005 and 2014.The International Classification of Diseases Code,9th Revision Clinical Modification was utilized for patient identification.Patients were further classified into two groups based on undergoing endoscopic procedures(EGD,small intestinal endoscopy,colonoscopy,or flexible sigmoidoscopy).Both groups were compared regarding demographic information,outcomes,and comorbidities.Multivariate analysis was conducted to identify factors associated with mortality and prolonged length of stay.Chi-square test was used to compare categorical variables,while Student’s t-test was used to compare continuous variables.All analyses were performed using SAS 9.4(Cary,NC,United States).RESULTS A total of 35612318 patients with ACS were identified between January 2005 and December 2014.269483(0.75%)of the patients diagnosed with ACS developed concomitant GIB during the same admission.At least one endoscopic procedure was performed in 68%of the patients admitted with both ACS and GIB.Patients who underwent GIE during the index hospitalization with ACS and GIB had lower mortality(3.8%)compared to the group not undergoing endoscopy(8.6%,P<0.001).A shorter length of stay(LOS)was observed in patients who underwent GIE(mean 6.59±7.81 d)compared to the group not undergoing endoscopy(mean 7.84±9.73 d,P<0.001).Multivariate analysis showed that performing GIE was associated with lower mortality(odds ratio:0.58,P<0.001)and shorter LOS(-0.36 factor,P<0.001).CONCLUSION Performing GIE during the index hospitalization of patients with ACS and GIB was correlated with a better mortality rate and a shorter LOS.Approximately twothirds of patients with both ACS and GIB undergo GIE during the same hospitalization.
文摘Two-year survival rate was assessed among 1,038 patients who had acute coronary syndromes that were classified by discharge hematocrit values as normal(>39%, n=360, 34.7%), mildly anemic(33.1%to 39%, n=430, 41.4%), or moderately/severely anemic(≤33%, n=248, 23.9%). Worsening anemia was associated with a decreased 2-year survival rate(normal 95.8%,mild anemia 91.2%, moderate/severe anemia 81.5%, p< 0.001). In multivariable analyses, adjusted hazard ratios for all-cause mortality were 1.57(95%confidence interval 0.82 to 2.96) for mild anemia and 2.46(95%confidence interval 1.25 to 4.85) for moderate/severe anemia.
文摘Background： Despite the rapid growth in the incidence of acute myocardial infarction （AMI） in China, there is limited information about patients＇ experiences after AMI hospitalization, especially on long-tern1 adverse events and patient-reported outcomes （PROs）. Methods： The China Patient-centered Evaluative Assessment of Cardiac Events （PEACE）-Prospective AMI Study will enroll 4000 consecutive AM I patients from 53 diverse hospitals across China and follow them longitudinally for 12 months to docunlent their treatment, recovery, and outcomes. Details of patients＇ medical history, treatment, and in-hospital outcomes are abstracted from medical charts. Comprehensive baseline interviews are being conducted to characterize patient demographics, risk factors, presentation, and healthcare utilization. As part of these interviews, validated instruments are administered to measure PROs, including quality of life, symptoms, mood, cognition, and sexual activity. Follow-up interviews, measuring PROs, medication adherence, risk factor control, and collecting hospitalization events are conducted at 1, 6, and 12 months after discharge. Supporting documents for potential outcomes are collected for adjudication by clinicians at the National Coordinating Center. Blood and urine samples are also obtained at baseline, 1 - and 12-month follow-up. In addition, we are conducting a survey of participating hospitals to characterize their organizational characteristics. Conclusion： The China PEACE-Prospective AMI study will be uniquely positioned to generate new information regarding patient＇s experiences and outcomes alter AMI in China and seiwe as a foundation for quality improveinent activities.
