The association between frailty and in-hospital mortality in critically ill patients with congestive heart failure: results from MIMIC-IV database.

Background: Frailty correlates with adverse outcomes in many cardiovascular diseases and is prevalent in individuals with heart failure (HF). The Hospital Frailty Risk Score (HFRS) offers an integrated, validated solution for frailty assessment in acute care settings, but its application in critically ill patients with congestive HF lacks exploration. This study aimed to identify the association between frailty assessed by the HFRS and in-hospital mortality in critically ill patients with congestive HF. Methods: This observational study retrospectively enrolled 12,179 critically ill patients with congestive HF. Data from the Medical Information Mart for Intensive Care IV database was used. The HFRS was calculated to assess frailty. Patients were categorized into three groups: non-frailty (HFRS < 5, n = 7,961), pre-frailty (5 ≤ HFRS < 15, n = 3,684), and frailty (HFRS ≥ 15, n = 534). Outcomes included in-hospital mortality, length of intensive care unit stay, and length of hospital stay. Multiple logistic regression and Locally Weighted Scatterplot Smoothing (LOWESS) smoother were used to investigate the association between frailty and outcomes. Subgroup analysis was employed to elucidate the correlation between frailty levels and in-hospital mortality across diverse subgroups. Results: 12,179 patients were enrolled, 6,679 (54.8%) were male, and the average age was 71.05 ± 13.94 years. The overall in-hospital mortality was 11.7%. In-hospital mortality increased with the escalation of frailty levels (non-frailty vs. pre-frailty vs. frailty: 9.7% vs. 14.8% vs. 20.2%, P < 0.001). The LOWESS curve demonstrated that the HFRS was monotonically positively correlated with in-hospital mortality. Upon controlling for potential confounders, both pre-frailty and frailty statuses were found to be independently linked to a heightened risk of mortality during hospitalization (odds ratio [95% confidence interval]: pre-frailty vs. non-frailty: 1.27 [1.10-1.47], P = 0.001; frailty vs. non-frailty: 1.40 [1.07-1.83], P = 0.015; P for trend < 0.001). Significant interactions between frailty levels and in-hospital mortality were observed in the following subgroups: race, heart rate, creatinine, antiplatelet drug, diabetes, cerebrovascular disease, chronic renal disease, and sepsis. Conclusion: In critically ill patients with congestive HF, frailty as assessed by the HFRS emerged as an independent predictor for the risk of in-hospital mortality. Prospective, randomized studies are required to determine whether improvement of frailty levels could improve clinical prognosis.

Long noncoding RNA metastasis-associated lung adenocarcinoma transcript 1 correlates with microRNA-125b/microRNA-146a/microRNA-203 and predicts 2-year restenosis risk in coronary heart disease patients.

Aim: To investigate correlations of long noncoding RNA metastasis-associated lung adenocarcinoma transcript 1 (lnc-MALAT1) and its target microRNAs with clinical features and restenosis risk in coronary heart disease (CHD) patients post drug-eluting stent-percutaneous coronary intervention (DES-PCI). Materials & methods: A total of 274 CHD patients undergoing DES-PCI were enrolled, pre-operative plasma samples were obtained to detect lnc-MALAT1, miR-125b, miR-146a, miR-203 by RT-qPCR; 2-year restenosis was determined by quantitative coronary angiography. Results: Lnc-MALAT1 negatively correlated with miR-125b, miR-146a and miR-203. Furthermore, lnc-MALAT1, miR-125b, miR-146a and miR-203 correlated with diabetes mellitus, hyperuricemia, lesion properties, cholesterol, inflammation and cardiac function indexes. Additionally, lnc-MALAT1 was increased, while miR-125b and miR-146a were decreased in patients with 2-year restenosis than patients without 2-year restenosis; however, miR-203 did not differ. Conclusion: Lnc-MALAT1 and its target miRNAs might help manage restenosis risk in CHD patients post DES-PCI.

Evaluation on curative effect and safety of interventional treatment for patients with acute myocardial infarction.

To evaluate the effectiveness and recent safety of emergency and selective percutaneous coronary intervention (PCI) in elderly patients (>80 years old) with acute myocardial infarction (AMI). 120 elderly patients with coronary heart disease (CHD) were divided into AMI group (with 55 cases) and non-myocardial infarction group (control group with 65 cases). Among the AMI group, there were 18 cases underwent emergency PCI within 12 hours after the onset, (AMI emergency PCI group), the rest 37 cases were AMI selective PCI group. In the control group, 2 cases had stable angina pectoris, 59 cases unstable angina pectoris and 4 patients old myocardial infarction. The lesions were classified according to the practice guidelines of American College of Cardiology/American Heart Association (ACC/AHA). The hospitalized major adverse cardiac events (MACE) and complications in the patients were recorded and statistically analyzed. The AMI group had a higher total Gensini score, lower left ventricular ejection fraction (LVEF), less mean stents and contrast agent dosage and shorter operation time, compared with the control group. The difference was statistically significant. Though the average postoperative length of stay in AMI emergency PCI group was longer than that of AMI selective PCI group, but the difference had no statistical significance. To all the included patients, there were 50 cases with lesions in one branch, 43 cases in two branches and 27 cases in three branches. And the immediate PCI success ratio in AMI group was lower than that in control group (80% VS. 96.9%, P= 0.003), without significant difference in the distribution number of diseased vessels and complete reconstruction ratio (P>0.05). The incidence of the total complications in AMI emergency PCI group was higher, compared with the non-emergency group (with 102 cases) and AMI selective PCI group (P<0.001, P=0.039); and the occurrence rate of complication in AMI group was higher than that of the control group (P<0.001). The emergency PCI for elder patients with AMI is safe and worthy of promotion.