Prognostic value of serum albumin to creatinine ratio in patients undergoing carotid artery stenting.

BACKGROUND: We aimed to investigate the prognostic value of serum albumin-to-creatinine ratio (sACR) in carotid artery stenting (CAS) patients regarding in-hospital and 5-year outcomes. METHODS: This is a retrospective study. Baseline characteristics were compared between patients by admission albumin to creatinine ratio and categorized accordingly: T1, T2 and T3. 609 patients were included in the study. Serum albumin and creatinine levels at hospital admission were used to calculate the sACR. The primary endpoint was all-cause mortality. MACE consisted of stroke, transient ischemic attack (TIA), myocardial infarction (MI) and death. All follow-up data were obtained from electronic medical records or by interview. The study was terminated after 60 months of follow-up. RESULTS: Serum albumin levels were found to be significantly lower in T1, while creatinine was found to be significantly higher in T1. T1 has the lowest sACR while T3 has the highest. In hospital, ipsilateral stroke, major stroke, MI and death were significantly higher in T1. In long-term outcomes, ipsilateral stroke, major stroke, and death were significantly higher in T1. CONCLUSIONS: Low sACR values at hospital admission was independently associated with in-hospital and long-term mortality and major stroke in patients underwent CAS.

Comparison of choroidal thickness and choroidal vascular index in normotensive dippers and nondippers.

OBJECTIVE: The aim of this study was to evaluate the choroidal thickness and choroidal vascular index in normotensive individuals with dipping and nondipping patterns. METHODS: Patients who applied to the cardiology clinic for routine checkups and underwent 24-h blood pressure monitoring were included in our study. They were divided into two groups based on their dipper status. The patients in whom systolic blood pressure decreased during the nocturnal time by 10% or more of the daily blood pressure were defined as dippers. On the contrary, patients whose nocturnal systolic blood pressure decreased by less than 10% were defined as nondippers. Choroidal thickness and choroidal vascular index were measured by spectral-domain optical coherence tomography. Central macular thickness, retinal nerve fiber layer, and ganglion cell layer (GCL) analyses were also recorded. RESULTS: In total, 35 patients with dipper pattern and 34 patients with nondipper pattern were recruited. The mean subfoveal choroidal thickness was 349.72±90 µm in the dipper group and 358.54±132.5 µm in the nondipper group. The groups had no significant difference in choroidal thickness, central macular thickness, retinal nerve fiber layer, and ganglion cell layer analyses. However, the choroidal vascular index was statistically significantly lower in the nondipper group when compared to the dipper group (0.61±0.02 vs. 0.64±0.02; p<0.001). Also, the choroidal vascular index was negatively correlated with subfoveal choroidal thickness in the nondipper group (Spearman; r=-0.419; p=0.033). CONCLUSION: Our study showed that the choroidal vascular index was significantly lower in nondippers than in dippers. Nondipper individuals may be affected by vascular dysregulation, leading to alterations in the choroidal circulation.

Comparison of the effects of resistance, aerobic and mixed exercise on athlete's heart.

BACKGROUND: There are various changes in cardiac physiology in athletes compared to the normal population. These physiological changes may differ according to the exercise content. The aim of this study was to compare the effects of different exercise methods on the heart. METHODS: A total of 122 male athletes from various sports were evaluated. Depending on the sorts of sports, these participants were split into aerobic, mixed, and resistance groups. Each athlete had to meet the inclusion criteria of having participated in the present sport for at least a year and having trained for at least 600 minutes per week over the previous three months. Transthoracic echocardiography was used to investigate the effects of different exercise types. RESULTS: The aerobic group's heart rate and ejection fraction were found to be lower than those of the resistance and mixed groups (F(2.105)=23.487, P=0.001). The end-diastolic thicknesses of the interventricular septum (8.7 SD 0.8 vs. 10.0 SD 0.7), interventricular septum (11.3 SD 0.9 vs. 13.0 SD 0.9), left ventricular posterior wall (8.6 SD 0.7 vs. 9.9 SD 0.8), and interventricular septum (11.1 SD 0.9 vs. 13.3 SD 0.9) were all found to be lower in the aerobic group than in the resistance group (P=0.0001). The effect of resistance exercise on heart rate was not observed as clearly as other groups. CONCLUSIONS: Resistance exercise has a more dominant effect on ventricular thickness than aerobic exercise. In mixed exercise groups, this increase in thickness is similar to resistance exercise. The content of the training should be considered in the evaluation of the athlete's heart. Identifying the subgroups of the athlete's heart will be useful in the differentiation of pathologies and also in the follow-up of the athletes.

Evaluation of electrocardiographic P wave parameters in predicting long-term atrial fibrillation in patients with acute ischemic stroke.

BACKGROUND: Electrocardiographic parameters, such as P wave peak time (PWPT), P wave duration (PWD), and P wave amplitude in lead DI, have been utilized to assess left atrial anomalies linked to the development of atrial fibrillation (AF) in different cohort settings. OBJECTIVE: To compare electrocardiographic parameters, such as P waves, in predicting long-term AF risk in acute ischemic stroke cases. METHODS: The data of 231 consecutive acute ischemic stroke cases were retrospectively collected. Two independent cardiologists interpreted the electrocardiography recordings for PWPT, PWD, and P wave amplitude in lead DI. The median follow-up study period was 16 (interquartile range [IQR]: 11-24) months. RESULTS: In total, AF was detected in 43 (18.6%) cases. All studied P wave parameters were found to be statistically significant in cases with AF. Based on multivariable logistic regression analysis, dementia, left atrium volume index, PWD (razão de chances [RC]: 1.11; 95% confidence interval [CI]: 1.058-1.184; p = 0.003), PWPT in lead DII (RC: 1.030; 95%CI: 1.010-1.050; p = 0.003), and advanced interatrial block morphology were independent predictors of long-term AF. P wave duration had the highest area under the curve value, sensitivity, and specificity for long-term AF in such cases compared with the other P wave parameters. CONCLUSIONS: Our head-to-head comparison of well-known P wave parameters demonstrated that PWD might be the most useful P wave parameter for long-term AF in acute ischemic stroke cases.

ANTECEDENTES: Parâmetros eletrocardiográficos, como tempo de pico da onda P (PWPT, na sigla em inglês), duração da onda P (PWD, na sigla em inglês) e amplitude da onda P na derivação DI, têm sido utilizados para avaliar anomalias atriais esquerdas ligadas ao desenvolvimento de fibrilação atrial (FA) em diferentes cenários de coortes. OBJETIVO: Comparar os parâmetros eletrocardiográficos destas ondas P na predição do risco de FA de longo prazo em casos de acidente vascular cerebral (AVC) isquêmico agudo. MéTODOS: Os dados de 231 casos consecutivos de AVC isquêmico agudo foram coletados retrospectivamente. Dois cardiologistas independentes interpretaram os registros eletrocardiográficos para PWPT, PWD e amplitude da onda P na derivação DI. O período médio do estudo de acompanhamento foi de 16 (intervalo interquartil [IQR, na sigla em inglês]: 11­24) meses. RESULTADOS: No total, FA foi detectada em 43 (18,6%) casos. Todos os parâmetros da onda P estudados foram considerados estatisticamente significativos nos casos com FA. Com base na análise de regressão logística multivariável, demência, índice de volume do átrio esquerdo, PWD (razão de chances [RC]: 1,112; intervalo de confiança [IC] 95%: 1,058­1,184; p = 0,003), PWPT na derivação DII (RC: 1,030; IC95%: 1,010­1,050; p = 0,003) e avançada morfologia do bloqueio interatrial foram preditores independentes de FA de longo prazo. A PWD teve a maior área sob o valor da curva, sensibilidade e especificidade para FA de longo prazo em tais casos em comparação com os outros parâmetros da onda P. CONCLUSõES: Nossa comparação direta de parâmetros da onda P bem conhecidos demonstrou que a PWD pode ser o parâmetro da onda P mais útil para FA de longa duração em casos de AVC isquêmico agudo.

Evaluation of cardiac-electrophysiological balance according to National Institutes of Health Stroke Scale score at admission and discharge in acute ischemic stroke patients: A pilot study.

OBJECTIVE: The main objectives of this investigation were to determine whether there were any relationships between corrected cardiac-electrophysiological balance value and National Institutes of Health Stroke Scale scores at admission and discharge in patients with acute ischemic stroke and to assess whether cardiac-electrophysiological balance value was an independent predictor of high National Institutes of Health Stroke Scale scores (National Institutes of Health Stroke Scale score ≥5). METHODS: In this retrospective and observational study, 231 consecutive adult patients with acute ischemic stroke were evaluated. The cardiac-electrophysiological balance value was obtained by dividing the corrected QT interval by the QRS duration measured from surface electrocardiography. An experienced neurologist used the National Institutes of Health Stroke Scale score to determine the severity of the stroke at the time of admission and before discharge from the neurology care unit. The participants in the study were categorized into two groups: those with minor acute ischemic stroke (National Institutes of Health Stroke Scale score=1-4) and those with moderate-to-severe acute ischemic stroke (National Institutes of Health Stroke Scale scores ≥5). RESULTS: Acute ischemic stroke patients with National Institutes of Health Stroke Scale score ≥5 had higher heart rate, QT, corrected QT interval, T-peak to T-end corrected QT interval, cardiac-electrophysiological balance, and cardiac-electrophysiological balance values compared with those with an National Institutes of Health Stroke Scale score of 1-4. The cardiac-electrophysiological balance value was shown to be independently related to National Institutes of Health Stroke Scale scores ≥5 (OR 1.102, 95%CI 1.036-1.172, p<0.001). There was a moderate correlation between cardiac-electrophysiological balance and National Institutes of Health Stroke Scale scores at admission (r=0.333, p<0.001) and discharge (r=0.329, p<0.001). CONCLUSIONS: The findings of this study demonstrated that the cardiac-electrophysiological balance value was related to National Institutes of Health Stroke Scale scores at admission and discharge. Furthermore, an elevated cardiac-electrophysiological balance value was found to be an independent predictor of National Institutes of Health Stroke Scale score ≥5.

Effect of the number of parity on right heart chamber quantification.

INTRODUCTION: Pregnancy is a process that can cause several physiologic changes to the cardiovascular system such as ventricular hypertrophy and dilation of cardiac chambers. Although there are studies about pregnancy-related changes in echocardiographic examination; there is no data about the long-term effects of parity on these alterations. Therefore, we evaluated the long-term effect of pregnancy on right ventricular (RV) dilation and RV hypertrophy and their relation to the parity number. METHODS: This prospective study included a total of 600 women (200 consecutive women who had no parity, 200 women who had a parity number of 1 to 4 and 200 women who had a parity number of more than 4). Right chambers' measurements were compared between the groups. RESULTS: In echocardiographic analysis, RV and right atrial dimensions and areas and RV wall thickness were higher in parous women. On the other hand, RV systolic function parameters were significantly lower in parous women. These significant changes showed a gradual increase or decrease by increasing parity number. By multivariate hierarchical logistic regression analysis, the four independent factors that increased the risk of RV dilation were age (OR: 1.16 CI: 1.10-1.20), body mass index (OR: 1.05, CI: 1.02-1.08), smoking (OR: 1.87, CI: 1.28-4.02), and giving a birth (OR: 3.94 CI: 1.82-8.81). There was also independent relationship between the number of parity and RV hypertrophy even after adjustment for several confounders. CONCLUSION: Pregnancy-related physiological changes mostly resolve after delivery. This study about long-term effects of pregnancy on RV has demonstrated that there is a significant relation between the number of parity and either RV dilation or RV hypertrophy. Each parity had also additive effect on these changes.

Systemic immune-inflammation index predicts in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction.

OBJECTIVE: This study examines the predictive value of the novel systemic immune-inflammation index (SII) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 1660 patients with STEMI who underwent primary percutaneous coronary intervention (pPCI) were enrolled in the study. In-hospital and 3-year outcomes were compared between the four groups (Q1-4). The SII was calculated using the following formula: neutrophil*platelet/lymphocyte. RESULTS: The frequency of in-hospital cardiogenic shock, acute respiratory failure, acute kidney injury, ventricular arrhythmia, stent thrombosis, recurrent myocardial infarction, major adverse cardiac events and mortality were significantly higher in the high SII groups (Q3 and Q4). Logistic regression models demonstrated that Q3 and Q4 had an independent risk of mortality and Q4 had an independent risk of cardiogenic shock compared to Q1. Receiver operating characteristic analysis showed that the best cutoff value of SII to predict the in-hospital mortality was 1781 with 66% sensitivity and 74% specificity. Kaplan-Meier overall survivals for Q1, Q2, Q3 and Q4 were 97.6, 96.9, 91.6 and 81.0%, respectively. Cox proportional analysis for 3-year mortality demonstrated that Q3 and Q4 had an independent risk for mortality compared to Q1. CONCLUSION: SII, a novel inflammatory index, was found to be a better predictor for in-hospital and long-term outcomes than traditional risk factors in patients with STEMI undergoing pPCI.

The prognostic value of time from symptom onset to thrombolysis in patients with pulmonary embolism.

BACKGROUND: According to clinical practice guidelines, thrombolysis can be administered during the 14 days after the beginning of symptoms in PE. However, the role of the early thrombolysis in PE has not been comprehensively investigated. In this study we evaluated the effect of short symptom-to-thrombolysis time (STT) in these patients who received the thrombolytic therapy within the 48-h. METHOD: A total of 456 patients with pulmonary embolism who underwent thrombolytic therapy in a tertiary center were included in the current study. The patients were stratified into three groups according to STT as: <12 h (Group 1), 12 to 24 h (Group 2) and > 24 to 48 h (Group 3). In-hospital events and long-term mortality were compared between the groups. RESULTS: Group 3 had higher in-hospital mortality, acute kidney injury, cardiogenic shock, asystole, and the use mechanical ventilation and 3-year mortality compared to the other two groups. The 3-year overall survival for Group 1, 2 and 3 were 82.1%, 77.7% and 25.9% respectively. According to regression analysis, a STT > 24 h was independently associated with in-hospital and long-term mortality. Group 1 and 2 had similar in-hospital outcomes and long-term mortality. CONCLUSION: A short STT has a great importance in patients with PE who treated with thrombolytic therapy. The efficacy of systemic thrombolysis significantly drops after 24 h. Because of this situation, the period between the symptom onset and thrombolytic therapy should be kept short as much as possible.

Association of whole blood viscosity with thrombus presence in patients undergoing transoesophageal echocardiography.

Whole blood viscosity (WBV) is considered as a reasonable proxy measure of blood flow, and it has been investigated in different cohort settings, including in patients with deep venous thrombosis, arterial thrombosis, acute stent thrombosis, and left ventricular apical thrombus formation following acute coronary syndrome. To determine the association between WBV and the presence of thrombus in the left atrium (LA) or left atrial appendage (LAA) in individuals who had transoesophageal echocardiography (TEE). The clinical data from 262 consecutive patients who had TEE at our facility were included in this retrospective cohort study. WBV was determined at both a high shear rate (HSR) and low shear rate (LSR) using hematocrit and total protein levels. In 22 cases (8.3%), the thrombus was detected. According to multivariable analyses, WBV at HSR and LSR were independently linked with thrombus detection in TEE. In a receiver operating characteristic (ROC) analysis, the area under curve (AUC) values of WBV at HSR and LSR were 0.77 and 0.76, respectively. To predict the presence of thrombus in TEE; the ideal value of WBV at HSR was > 16.6 with 81% sensitivity and 69% specificity and the ideal value of WBV at LSR was > 51.4 with 81% sensitivity and 70% specificity. This was the first study to indicate that significantly higher levels of WBV at both the HSR and LSR were linked to the presence of thrombus in the LA and LAA in cases who underwent TEE.

Atrial fibrillation as a preoperative risk factor predicts long-term mortality in elderly patients without heart failure and undergoing hip fracture surgery.

OBJECTIVE: Patients with atrial fibrillation (AF) constitute a significant portion of hip fracture patients, and both diseases tend to present more frequently in older age. Our goal was to evaluate the long-term mortality of patients with AF who were free from heart failure undergoing hip fracture surgery. METHODS: This observational, retrospective study was done in a single research and training hospital setting. Hospital electronic health record data, National Health Registry data, and National Death Registry System data for 233 consecutive patients who were above 65 years of age and were planned to undergo surgery for hip fracture were retrieved and analyzed. An experienced cardiologist evaluated the patients prior to surgery. Each member of the research cohort was categorized into one of the two groups based on their survival status (survivor and non-survivor groups). RESULTS: Of the 233 cases, 89 (38.2%) who were included in the investigation died during the follow-up period. The median long-term follow-up period was 34 (12-42) months. The frequency of AF was significantly higher in the non-survivor group. In multivariable Cox regression analysis, AF (HR: 2.195, 95%CI 1.365-3.415, p<0.001), advanced age, and blood urea level were determined as independent predictors for all-cause long-term mortality. CONCLUSIONS: AF is an independent predictor for long-term death in hip fracture cases above 65 years of age who were free from heart failure.

Predictive Value of Systemic Immune Inflammation Index for Postoperative Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting.

OBJECTIVE: Inflammation plays an important role in the initiation of postoperative atrial fibrillation (PoAF) in individuals undergoing cardiac surgery, Thus, this study aimed to investigate the predictive value of the systemic immune inflammation index (SII) to develop PoAF in such patients. METHODS: In total, 391 consecutive patients undergoing an isolated coronary artery bypass grafting (CABG) were retrospectively analyzed. PoAF was defined according to the current guideline. The SII is determined using the following equation: neutrophil (N) × platelet (P) ÷ lymphocyte (L). RESULTS: The incidence of PoAF in the present study was 24% (n=97 cases). Multivariate logistic regression analysis revealed that the SII was an independent predictor of PoAF (Odds ratio: 1.002 95% confidence interval: (1.001-1.002), p<0.01). The optimal value of the SII in detecting PoAF was established by a receiver operating characteristic curve assessment, and it was >807.8 with 60.8% sensitivity and 80.9% specificity [area under the curve (AUC): 0.7107]. The AUC value of SII in detecting PoAF was much greater than the AUC values of both the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) (AUC: 0.6740 and AUC: 0.6426, respectively). CONCLUSIONS: This study revealed that SII was an independent predictor of PoAF in patients who were operated on for isolated CABG. Additionally, SII had a better discriminative ability for PoAF compared to either NLR or PLR among these cases.

The significance of the morphology-voltage-P-wave duration (MVP) ECG score for prediction of in-hospital and long-term atrial fibrillation in ischemic stroke.

BACKGROUND: Atrial fibrillation (AF) is the most common preventable cause of stroke. Diagnosis of new AF is frequent after acute ischemic stroke (AIS). We aimed to evaluate the predictive value of the recently developed morphology-voltage-P-wave duration (MVP) ECG risk score for in-hospital and long-term AF diagnosis following AIS. MATERIAL AND METHODS: In this observational investigation, we evaluated the ability of the MVP ECG risk score to predict AF in 266 consecutive patients with AIS. The study population was divided into three groups according to their calculated MVP ECG risk score on admission electrocardiography. The groups were compared in terms of their predictive value for in-hospital and long-term AF diagnosis. RESULTS: After adjustment for confounding baseline variables, MVP ECG risk score 5-6 group had 13.2 times higher rates of in-hospital AF compared to MVP ECG risk score 0-2 group, which was used as the reference group. For long-term follow-up, MVP ECG risk score 5-6 group had 5.2 times higher rates of long-term AF compared to MVP ECG risk score 0-2 group. A ROC analysis showed that the optimal cut-off value of the MVP ECG risk score to predict in-hospital AF was 4 with 78% sensitivity and 76% specificity (AUC: 0.80; 95% CI: 0.64-0.96; p < 0.001), the optimal cut-off value of the MVP ECG risk score to predict long-term AF was 3 with 85% sensitivity and 59% specificity (AUC: 0.81; 95% CI: 0.76-0.86; p < 0.001). CONCLUSION: The MVP ECG risk score, which can be easily calculated from a surface ECG, can be used to guide who needs stricter monitoring for the diagnosis of long-term AF in patients with AIS.

The Predictive Role of a Novel Risk Index in Patients Undergoing Carotid Artery Stenting: Systemic Immune-Inflammation Index.

BACKGROUND: Inflammatory mechanisms play an important role in both atherosclerosis and stroke. There are several inflammatory peripheral blood count markers associated with carotid artery stenosis degree, symptomatic carotid artery lesions and carotid artery stent restenosis that reported in previous studies. However, the prognostic role of the blood cell counts and their ratios in predicting in-hospital and long-term outcomes in patients undergoing carotid artery stenting (CAS) has not been comprehensively investigated. Systemic immune-inflammation index (SII) proved its' efficiency in patients with solid tumors and its' role was rarely examined in cardiovascular disorders and stroke. The current study evaluated the effect of this novel risk index on in-hospital and long-term outcomes in a large patient population who underwent CAS. METHOD: A total of 732 patients with carotid artery stenosis who underwent CAS were enrolled to the study. SII was calculated using the following formula: neutrophil-to-lymphocyte ratio × total platelet count in the peripheral blood (per mm3) and the patients were stratified accordingly: T1, T2 and T3. In-hospital and 5-year outcomes were compared between the tertiles of SII. RESULTS: During the hospitalization, major stroke, ipsilateral stoke, myocardial infarction, death and major adverse cardiovascular events (MACE) rates were significantly higher in high SII level (T3) compared to SII levels (T1 and 2). In long-term outcomes, ipsilateral stroke, major stroke, transient ischemic attack, death, and MACE were significantly higher in the patients with higher SII level (T3). The 5-year Kaplan-Meier overall survival for T1, T2, and T3 were 97.5%, 96.7% and 86.0% respectively. In-hospital and 5-year regression analyses demonstrated that high SII was independently associated with MACE and mortality. CONCLUSION: SII was independently associated with in-hospital and long-term clinical outcomes in patients undergoing CAS. Immune and inflammation status, as assessed easily and quickly using SII, has a good discriminative value in these patients.

Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure.

Introduction: The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF). Methods: A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis. Results: A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95%CI:0.76-0.97). Conclusion: The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases.

Is the use of ACE inb/ARBs associated with higher in-hospital mortality in Covid-19 pneumonia patients?

INTRODUCTION: The present research aimed to determine the relation between the use of angiotensin-converting enzyme inhibitors (ACE inh) and angiotensinogen receptor blockers (ARBs) and in-hospital mortality of hypertensive patients diagnosed with Covid-19 pneumonia. MATERIAL AND METHOD: In this retrospective study, we included 113 consecutive hypertensive patients admitted due to Covid-19 infection. In all patients, Covid-19 infection was confirmed with using reverse-transcription polymerase chain reaction. All patients were on ACE inh/ARBs or other antihypertensive therapy unless no contraindication was present. The primary outcome of the study was the in-hospital all-cause mortality. RESULTS: In total, 113 hypertensive Covid-19 patients were included, of them 74 patients were using ACE inh/ARBs. During in-hospital follow up, 30.9% [n = 35 patients] of patients died. The frequency of admission to the ICU and endotracheal intubation were significantly higher in patients using ACE inh/ARBs. In a multivariable analysis, the use of ACE inh/ARBs was an independent predictor of in-hospital mortality (OR: 3.66; 95%CI: 1.11-18.18; p= .032). Kaplan-Meir curve analysis displayed that patients on ACE inh/ARBs therapy had higher incidence of in-hospital death than those who were not. CONCLUSION: The present study has found that the use of ACE inh/ARBs therapy might be associated with an increased in-hospital mortality in patients who were diagnosed with Covid-19 pneumonia. It is likely that ACE inh/ARBs therapy might not be beneficial in the subgroup of hypertensive Covid-19 patients despite the fact that there might be the possibility of some unmeasured residual confounders to affect the results of the study.

The predictive value of age, creatinine, ejection fraction score for in-hospital mortality in patients with cardiogenic shock.

INTRODUCTION: The aim of the present study was to assess the predictive value of the age, creatinine, ejection fraction score for in-hospital mortality in patients with cardiogenic shock secondary to ST-elevation myocardial infarction. MATERIAL AND METHODS: This single-center, retrospective study was based on a comprehensive analysis of the hospital records of 318 consecutive cardiogenic shock patients. The age, creatinine, ejection fraction score was calculated for each patient using the equation of age/ejection fraction +1 if creatinine level is >2 mg/dl. The study population was stratified into tertiles: T1, T2, and T3, based on the age, creatinine, ejection fraction score. The primary endpoint of the study was the incidence of in-hospital mortality. RESULTS: The incidence of in-hospital mortality was significantly greater in patients with a high age, creatinine, ejection fraction score (T3 group) compared with the intermediate (T2 group) or the low score group (T1 group) [86.8% (n = 92 patients) vs. 57.5% (n = 61 patients) vs. 34.9% (n = 37 patients), respectively; P < 0.05 for each]. In multivariable models, after adjusting for all covariables, the risk of in-hospital mortality was 3.21 (95% confidence interval: 2.29-4.58) for patients allocated to the T3 group. The optimal cutoff for the age, creatinine, ejection fraction score for in-hospital mortality was 2.24, with a sensitivity of 74% and a specificity of 77%. CONCLUSION: To the best of our knowledge, this is the first study that has demonstrated a prognostic value of the age, creatinine, ejection fraction score in patients with ST-elevation myocardial infarction-related cardiogenic shock.