Outcomes of Valvular Endocarditis in Patients With and Without Pericardial Effusion: A National Inpatient Sample Study.

Over the last decade, hospitalizations for infective endocarditis (IE) have been steadily increasing, leading to a significant healthcare burden. Pericardial effusion (PCE) has been identified as a serious complication of IE, yet no significant association with mortality has been established. Our study aims to further analyze and understand the significance of PCE in patients with IE. We performed a retrospective analysis using the national inpatient sample database to identify all the hospital admissions with IE using ICD 10 codes and stratified them into 2 groups based on the presence of PCE. The outcomes of interest were inhospital mortality, inhospital complications, need for cardiac surgery, and length of stay. From 2015 Q4-2019, a total of 76,260 hospitalizations were included (weighted: 381,300), of which 2.7% included a PCE diagnosis. Hospitalizations with a PCE diagnosis included patients that were younger (51 vs 61, P < 0.001), as well as slightly more males (58.0% vs 55.2%, P = 0.011), and black patients (16.9% vs 12.9%, P < 0.001). PCE was associated with higher in-hospital death (12.7% vs 9.0%, P < 0.001), longer lengths of stay (12 days vs 7 days, P < 0.001), higher rates of cardiac surgery (22.4% vs 7.3%, P < 0.001). The rates of heart failure, heart block, renal failure, cardiogenic shock, and embolic stroke were higher on PCE group. We found that presence of PCE is associated with higher inhospital mortality, longer length of stay, and greater utilization of cardiac surgery, as well as presence of heart failure, heart block, cardiogenic shock, and embolic stroke.

Sex difference in clinical and procedural outcomes in patients undergoing coronary atherectomy: a systematic review and meta-analysis.

BACKGROUND: Rotational and orbital coronary atherectomy (CA) are commonly utilized to treat complex calcified coronary lesions. We conducted a meta-analysis to evaluate sex differences in procedural complications and clinical outcomes after CA. METHODS: PubMed, Google Scholar, and Cochrane databases were searched for all studies comparing sex differences in procedural and clinical outcomes following CA. The outcomes of interest were procedural complications (coronary dissection, stroke, major bleeding, coronary perforation, cardiac tamponade, and slow or no flow in target vessel) and the clinical outcomes (including early mortality, mid-term all-cause mortality, stroke, myocardial infarction, and target vessel revascularization). Pooled risk ratios (RRs) with their corresponding 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel random-effects model. RESULTS: Six observational studies with 3517 patients (2420 men and 1035 women) were included in this meta-analysis. While there was no significant difference in the early mortality (RR, 1.14; 95% CI, 0.37-3.53; P = 0.83) between men and women, at a mean follow-up of 2.9 years, all-cause mortality was significantly higher in women (RR, 1.29; 95% CI, 1.11-1.49; P = 0.0009). Women had an increased risk of procedure-related stroke (RR, 3.98; 95% CI, 1.06-14.90; P = 0.04), coronary dissection (RR, 2.10; 95% CI, 1.23-3.58; P = 0.006), and bleeding (RR, 2.26; 95% CI, 1.30-3.93; P = 0.004), whereas the rates of coronary perforation, cardiac tamponade, and the risk of slow or no flow in the revascularized artery were similar in both. CONCLUSION: In our analysis, women undergoing CA are at increased risk of mid-term mortality and procedure-related complications including stroke, coronary dissection, and major bleeding.

Impact of renal dysfunction on the prognostic value of the TIMI risk score in patients with non-ST elevation acute coronary syndrome.

BACKGROUND: The thrombolysis-in-myocardial-infarction risk score (TRS) is a validated risk-assessment tool based on randomized clinical trials. Its applicability to an unselected group of patients seen in general clinical practice may be limited as renal dysfunction was an exclusion criteria in the original trials upon which the TRS was determined. MATERIALS AND METHODS: Consecutive patients with non-ST elevation acute coronary syndrome were stratified based on renal function. Normal renal function was defined as a creatinine clearance (CrCl) of more than 60 ml/min, moderate renal dysfunction was defined as a CrCl of at least 30 ml/min but 60 ml/min or less, and severe renal dysfunction was defined as a CrCl of less than 30 ml/min. A TRS was calculated using the original seven criteria (TRS-7) which did not consider renal function. A second TRS was calculated using the original seven criteria plus the addition of renal dysfunction if the CrCl was 60 ml/min or less (TRS-8 ≤ 60). A third TRS was calculated using the original seven criteria plus renal dysfunction if the CrCl was less than 30 ml/min (TRS-8<30). In the calculation of both of the TRS-8, the presence of renal dysfunction was given weight equal to each of the original seven criteria. Comparisons between groups stratified by renal function were made using Pearson's χ² test or Fisher's exact test for categorical variables (presented as counts and percentages) and the unpaired t-test for continuous variables (presented as the mean ± standard deviation). The χ² test was used to compare the statistical differences between each of the three TRS and the percentage of patients achieving the primary composite outcome during the index hospitalization. The primary outcome was the composite of cardiovascular death, nonfatal myocardial infarction, or urgent coronary revascularization for documented myocardial ischemia. RESULTS: Of the 798 patients included in the analysis, 281 (35%) patients had renal dysfunction (26% had moderate dysfunction and 9% had severe dysfunction). When considered categorically, patients with moderate or severe renal dysfunction had significantly higher rates of the primary composite outcome. The three TRS (TRS-7, TRS-8 ≤ 60, and TRS-8<30) were significantly correlated with the primary composite outcome. With a calculated TRS of 5 or less, the TRS-8 ≤ 60 and the TRS<30 were not associated with a significantly higher prevalence of the composite outcome (all comparisons P>0.05). At a calculated TRS of 6 or 7, the TRS-8<30 was associated with a significantly greater prevalence of the composite outcome compared with the TRS-7 (P=0.02) and the TRS-8 ≤ 60 (P=0.02). There was no significant difference in the frequency of the composite outcome with a calculated TRS of 6 or 7 using the TRS-7 compared with the TRS-8 ≤ 60 (P=0.79). At a calculated TRS of 8, both the TRS-8<30 and TRS-8 ≤ 60 had a significantly higher prevalence of the composite outcome compared with a calculated TRS of 7 using the TRS-7 (P=0.002 for the TRS-8<30 and P=0.045 for the TRS-8 ≤ 60). At a TRS of 8, the TRS-8<30 was associated with a significantly higher composite outcome compared with the TRS-8 ≤ 60 (P=0.035). CONCLUSION: The addition of renal dysfunction to the TRS-7 as an eighth clinical criterion was associated with a higher prevalence of the primary composite outcome primarily at scores of 6 or more. When considered in the context of clinical practice, the use of the TRS-8 ≤ 60 and TRS-8<30 rather than the TRS-7 would not be expected to substantially change the management strategy for patients presenting with non-ST elevation acute coronary syndrome.