The association between LVMD and all-cause mortality in patients after STEMI. (A) Example of LVMD in a survivor patient after STEMI. The culprit vessel was the RCA, and the LVEF was 55%. (B) Example of LVMD in a nonsurvivor patient after STEMI. The culprit vessel was the RCA, and the LVEF was 30%. (C) Prediction of all-cause mortality across a wide range of LVMD values. This is plotted as a fitted spline model with overlaid CIs. The dashed black lines represent 95% CIs. The green dotted line marks the predicted HR at 1, and the dotted red line the value of LVMD above which there is an excess of mortality. (D) Kaplan-Meier curves for all-cause mortality according the median LVMD. Patients with prolonged LVMD (red dotted line) showed worse outcome when compared with their counterparts (green line). RCA, Right coronary artery.
ObjectiveTo investigate the impact of revascularization on long-term survival and renal outcome in non–ST-elevation myocardial infarction (NSTEMI) patients with severe chronic kidney disease (CKD).Patients and MethodsThis study includes NSTEMI patients with an estimated glomerular filtration rate <30 mL/min per 1.73 m2, including those on chronic hemodialysis who were identified from the multicenter Chang Gung Research Database from January 1, 2007, to December 31, 2017. Inverse probability of treatment weighting was used to generate comparable groups. The survival and the risk of progression to chronic hemodialysis between those receiving revascularization, either percutaneous coronary intervention or coronary artery bypass graft, and those receiving medical therapy during index hospitalization were compared.ResultsA total of 2821 NSTEMI patients with severe CKD, including 1141 patients on chronic hemodialysis, were identified. Of these, 1149 patients received revascularization and 1672 received medical therapies. The differences in demographics, comorbidities, and presentations between groups were balanced after inverse probability of treatment weighting. After a mean follow-up of 1.82 years, revascularization was associated with a lower risk of all-cause mortality (adjusted HR, 0.61; 95% CI, 0.54-0.70). For non–dialysis-dependent patients who had survival to discharge, revascularization had a higher risk of progression to chronic hemodialysis (adjusted HR, 1.83; 95% CI, 1.49-2.26) after a mean follow-up of 2.3 years.ConclusionRevascularization was associated with a lower risk of all-cause mortality in NSTEMI patients with severe CKD. For non–dialysis-dependent patients who survived to discharge, revascularization was associated with a higher risk of progression to chronic hemodialysis. 相似文献
Patients with stage 3 and stage 4 CKD demonstrate alterations in LV GLS, LVMI, E/e′, LAVI, and LASr but had normal LVEF. Each of these parameters was evaluated using reported normal values as a cutoff (normal indicated as green) in the figure. Left atrial reservoir strain was the strongest predictor of death and MACE and the only echocardiographic parameter that predicted adverse events.
ObjectiveTo analyze the outcomes of patients presenting with ST-segment elevation myocardial infarction (STEMI) without early (<48 hours) revascularization, according to percutaneous versus surgical revascularization.Patients and MethodsBased on the French administrative hospital discharge database, the study collected information for all consecutive patients seen for a STEMI in France between January 1, 2010, to June 31, 2019, who underwent either a first percutaneous coronary intervention (PCI) or a first coronary artery bypass graft between 48 hours and 90 days after the index hospitalization. Propensity score matching was used for the analysis of outcomes.ResultsOf 71,365 patients with STEMI in the analysis, 59,340 patients underwent PCI and 12,025 patients underwent coronary artery bypass graft. In a matched analysis of 12,012 patients by arm, surgical revascularization was associated with lower rates of all cause (5.1% vs 7.1%; hazard ratio [HR], 0.70; 95% CI, 0.66 to 0.75) and cardiovascular (2.6% vs 3.1%; HR, 0.83; 95% CI, 0.76 to 0.91) death. Rehospitalization for heart failure was less often reported after surgery (5.5% vs 7.5%; HR, 0.76; 95% CI, 0.71 to 0.81) whereas stroke incidence was not statistically different between the two arms (2.1% vs 2.3%; HR, 0.90; 95% CI, 0.80 to 1.00). Major bleeding was less often reported in the PCI arm (4.6% vs 6.1%; HR, 1.31; 95% CI, 1.22 to 1.41).ConclusionIn patients with STEMI who did not undergo urgent revascularization (ie, within 48 hours after presentation), surgical revascularization was associated with better outcomes and should be individually considered as an alternative to PCI. 相似文献
LA function evaluated on 3DE imaging or speckle-tracking echocardiography, but not LA volume, is an independent predictor of new-onset AF in patients with Chagas disease. The reservoir component of LA function measured on 3DE imaging (total LA emptying fraction < 51.8%) can identify a population at high risk for AF as depicted by the cumulative survival curves.
