Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 173
Filtrar
1.
J Formos Med Assoc ; 119(1 Pt 2): 327-334, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31255419

RESUMO

BACKGROUND: To determine the association between amiodarone or lidocaine and outcomes in adult in-hospital cardiac arrest (IHCA) with shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). METHODS: A retrospective study in a single medical centre was conducted. Patients experiencing an IHCA between 2006 and 2015 were screened. Shock-refractory ventricular tachyarrhythmias were defined as VF/pVT requiring more than one defibrillation attempt. A multivariate logistic regression analysis was used to study the associations between the independent variables and outcomes. RESULTS: A total of 130 patients were included. Among these, 113 patients (86.9%) were administered amiodarone as the first antiarrhythmic agent (amiodarone first) following VF/pVT, and the other patients were administered lidocaine (lidocaine first). The median time to the first defibrillation and first antiarrhythmic drug administration were 2 and 9 min, respectively. The analysis demonstrated that the amiodarone-first group experienced a higher likelihood of terminating the VF/pVT within three shocks (odds ratio: 11.61, 95% confidence interval: 1.34-100.84; p-value = 0.03), as compared with the lidocaine-first group. However, there were no significant differences between the amiodarone- and lidocaine-first groups in sustained return of spontaneous circulation, survival for 24 h, survival, or favourable neurological outcomes at hospital discharge. CONCLUSION: For patients with IHCA and shock-refractory VF/pVT, the adoption of an amiodarone-first strategy seemed to be associated with the termination of VF/pVT using fewer shocks. Nonetheless, because of the small sample size, additional large-scale studies should be conducted to investigate whether this advantage could be translated into a long-term benefit in survival or neurological outcomes.

2.
Resuscitation ; 146: 103-110, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31786236

RESUMO

AIM: We attempted to examine the association between intra-arrest blood glucose (BG) level and outcomes of in-hospital cardiac arrest (IHCA). The interaction between diabetes mellitus (DM) and BG level as well as between dextrose administration and BG level were investigated. METHODS: This single-centred retrospective study reviewed IHCA patients between 2006 and 2015. Patients with measured intra-arrest BG levels were included. Multivariable logistic regression analyses were conducted. Generalised additive models were used to identify appropriate cut-off points for continuous variables. Interactions between independent variables were assessed during the model-fitting process. RESULTS: Among the 580 included patients, 34 (5.9%) achieved neurologically intact survival. There were 197 DM patients (34.0%). The mean intra-arrest BG level was 191.5 mg/dl, with 57 patients (9.8%) experiencing hypoglycaemia (BG level ≤ 70 mg/dl). A total of 165 patients (28.4%) received a dextrose injection. An intra-arrest BG level ≤ 150 mg/dl was inversely associated with favourable neurological outcomes at hospital discharge (odds ratio [OR]: 0.28, 95% confidence interval [CI]: 0.11-0.73; p-value = 0.01). In analyses of interactions, non-DM × BG level ≤ 168 mg/dl was inversely associated with favourable neurological outcomes (OR: 0.30, 95% CI: 0.11-0.80; p-value = 0.02). There were no significant interactions between BG level and dextrose administration. CONCLUSION: IHCA patients with intra-arrest BG level ≤ 150 mg/dl had worse neurological recovery. Intra-arrest hypoglycaemia might be a marker of critical illness. Dextrose administration was not shown to improve outcomes of IHCA patients with intra-arrest BG level ≤ 150 mg/dl, indicating the need to develop new therapeutics other than dextrose administration for these patients.

3.
Nutr Metab Cardiovasc Dis ; 29(12): 1400-1407, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31648884

RESUMO

BACKGROUND: Systemic lupus erythematosus (SLE) is associated with a higher risk of cardiovascular disease. However, it is not clear whether or not SLE is associated with poor outcomes after acute myocardial infarction (AMI). METHODS AND RESULTS: Using the Taiwan National Health Insurance Database, we identified the SLE group as patients with AMI who have a concurrent discharge diagnosis of SLE. We also selected an age-, sex-, hospital level-, and admission calendar year-matched non-SLE group at a ratio of 1:3 from the total non-SLE group. One hundred fifty-one patients with SLE, 113,791 patients without SLE, and 453 matched patients without SLE were admitted with a diagnosis of AMI. Patients with SLE were significantly younger, predominantly female, and more likely to have chronic kidney disease than those without SLE. The in-hospital mortality rates were 12.6%, 9.0%, and 4.2% in the SLE, total non-SLE, and matched non-SLE groups, respectively. The in-hospital mortality was significantly higher in the SLE group than in the total non-SLE group (OR = 1.98; 95% CI = 1.2-3.26) and the matched non-SLE group (mortality OR = 2.20; 95% CI = 1.06-4.58). In addition, the SLE group was associated with a borderline significant risk of prolonged hospitalization when compared with the non-SLE group. CONCLUSION: SLE is associated with a higher risk of in-hospital mortality and a borderline significantly higher risk of prolonged hospitalization after AMI.

4.
J Formos Med Assoc ; 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31493983

RESUMO

BACKGROUND: Resuscitation guidelines list acidaemia as a potentially reversible cause of cardiac arrest without specifying the threshold defining acidaemia. We examined the association between early intra-arrest arterial blood gas (ABG) data and outcomes of in-hospital cardiac arrest (IHCA). METHODS: This single-centred retrospective study reviewed patients with IHCA between 2006 and 2015. Early intra-arrest ABG data were measured within 10 min of initiating cardiopulmonary resuscitation. The ABG analysis included measurements of blood pH, PaCO2, and HCO3-. RESULTS: Among the 1065 included patients, 60 (5.6%) achieved neurologically intact survival. Mean blood pH was 7.2. Mean PaCO2 and HCO3- levels were 59.7 mmHg and 22.1 mmol/L, respectively. A blood pH of 7.2 was identified by a generalised additive models plot to define severe acidaemia. The PaCO2 level was higher in patients with severe acidaemia (mean: 74.5 vs. 44.1 mmHg) than in those without. Multivariable logistic regression analyses indicated that blood pH > 7.2 was associated with a favourable neurological recovery (odds ratio [OR]: 2.79, 95% confidence interval [CI]: 1.43-5.46; p-value = 0.003) and blood pH was positively associated with survival at hospital discharge (OR: 5.80, 95% CI: 1.62-20.69; p-value = 0.007). CONCLUSION: Early intra-arrest blood pH was associated with IHCA outcomes, while levels of PaCO2 and HCO3- were not. A blood pH of 7.2 could be used as the threshold defining severe acidaemia during arrest and help profile patients with IHCA. Innovative interventions should be developed to improve the outcomes of patients with severe acidaemia, such as novel ventilation methods.

5.
J Formos Med Assoc ; 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31526656

RESUMO

BACKGROUND: The role of body mass index (BMI) in clinical outcomes in patients resuscitated from cardiac arrest (CA) has recently drawn attention. We evaluated the effect of BMI on the prognosis of patients successfully resuscitated from cardiogenic arrest. METHODS: This retrospective cohort study included 273 non-traumatic adult cardiogenic arrest survivors receiving coronary angiography after return of spontaneous circulation in three hospitals from January 2011 to September 2017. These patients were classified as underweight, normal-weight, overweight, and obese, based on BMI (<18.5; 18.5-24.9; 25.0-29.9; and ≥30 kg/m2, respectively). In-hospital mortality and poor neurological outcomes were compared among groups. RESULTS: The obese group had significantly higher rates of in-hospital mortality and poor neurological outcomes (cerebral performance scale = 3-5) than did the other groups (for underweight, normal-weight, overweight, and obese groups, in-hospital mortality rates were 38.5%, 29.8%, 39.0%, and 64.1%, respectively, p = 0.002; poor neurological outcomes were 53.9%, 43.8%, 47.0%, and 71.8%, respectively, p = 0.02). The obese group exhibited higher risks of in-hospital mortality and poor neurological outcomes than did the normal-weight group (in-hospital mortality: adjusted hazard ratio (aHR) = 5.21, 95% confidence interval (CI) 2.16-10.32, p < 0.001; poor neurological outcomes: aHR = 3.77, 95% CI 1.69-8.36, p = 0.002). CONCLUSION: Obesity was associated with higher risks of in-hospital mortality and poor neurological recovery.

7.
Sci Rep ; 9(1): 12443, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455862

RESUMO

The role of vasodilator myocardial perfusion imaging (MPI) for aortic stenosis (AS) is controversial due to safety and accuracy concerns. In addition, its utility after aortic valve (AV) interventions remains unclear. Patients with AS who underwent thallium-201-gated dipyridamole MPI using a cadmium-zinc-telluride camera were retrospectively reviewed and divided into three groups: mild AS, moderate-to-severe AS, and prior AV interventions. Patients with coronary artery disease with ≥50% stenosis, severe arrhythmia, left ventricular ejection fraction (LVEF) <40%, left bundle branch block or no follow-up were excluded. Relationships between the severity of AS, clinical characteristics, hemodynamic response, serious adverse events (SAE) and MPI parameters were analyzed. None of the 47 patients had SAE, including significant hypotension or LVEF reduction. The moderate-to-severe AS group had higher summed stress scores (SSSs) and depressed LVEF than the mild AS group, however there were no differences after AV interventions. SSS was positively correlated with AV mean pressure gradient, post-stress lung-heart ratio (LHRs), and post-stress end-diastolic volume (EDVs) (P < 0.05). In multivariate analysis, LHRs and EDVs were independent contributors to SSS. Dipyridamole-induced ischemia and LV dysfunction is common, and dipyridamole stress could be a safe diagnostic tool in evaluation and follow-up in patients with AS.

8.
Resuscitation ; 143: 42-49, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31422106

RESUMO

AIM: The simplified cardiac arrest hospital prognosis (sCAHP) score is a validated tool for predicting neurological outcomes after out-of-hospital cardiac arrest (OHCA). We used the sCAHP score to evaluate whether the effects of early coronary angiography (CAG) and targeted temperature management (TTM) for OHCA were modulated by immediate neuroprognosis. METHODS: This was a single-centre retrospective observational study. Consecutive OHCA patients were screened between 2011 and 2017. Multivariate logistic regression analysis and generalised additive models (GAMs) were used to examine the associations between independent variables and outcomes. Early CAG was defined as CAG performed within 24 h after return of spontaneous circulation (ROSC). RESULTS: A total of 412 patients were included in the study, and 94 (22.8%) patients had neurologically intact survival. The GAM plot identified a sCAHP score of 185 as the cut-off point to differentiate high-risk (sCAHP score ≧185) from low-risk (sCAHP score <185) patients. Regression models indicated that early CAG was significantly associated with favourable neurological [odds ratio (OR) 4.43, 95% confidence interval (CI) 2.28-8.60, p < 0.001] and survival outcomes (OR 3.47, 95% CI 1.93-6.25, p < 0.001), independent of the sCAHP score. Although TTM was associated with favourable neurological outcome only in low-risk patients (OR 2.13, 95% CI 1.10-4.13, p = 0.02), TTM was associated with improved survival for all patients (OR 2.66, 95% CI 1.54-4.59, p < 0.001), independent of the sCAHP score. CONCLUSIONS: Early CAG and TTM should be considered for all OHCA patients as suggested by guidelines, irrespective of the immediately predicted neuroprognosis after ROSC.

9.
Eur J Nucl Med Mol Imaging ; 46(12): 2601-2609, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31410543

RESUMO

PURPOSE: Dynamic 18F-fluorodeoxyglucose (FDG) PET can be used to quantitatively assess the rate of myocardial glucose uptake (MRGlu). The aim of this study was to evaluate the clinical significance and prognostic value of right ventricular (RV) MRGlu in patients with coronary artery disease and heart failure with reduced ejection fraction. METHODS: Patients with left ventricular ejection fraction (LVEF) ≤ 40% were consecutively enrolled for FDG PET between November 2012 and May 2017. Global LV and RV MRGlu (µmol/min/100 g) were analyzed. Outcome events were independently assessed using electronic medical records to determine hospitalization for revascularization, new-onset ischemic events, heart failure, cardiovascular, and all-cause death. Differences between LV and RV MRGlu and associations with clinical characteristics and echocardiographic data were evaluated. Associations among FDG PET findings and outcomes were analyzed using Kaplan-Meier survival analysis. RESULTS: Seventy-five patients (mean age 62.2 ± 12.7 years, male 85.3%, LVEF 19.3 ± 8.6%) were included for analysis. The mean glucose utilization ratio of RV-to-LV (RV/LV MRGlu) was 89.5 ± 264.9% (r = 0.77, p < 0.001). Positive correlations between RV MRGlu and maximal tricuspid regurgitation peak gradient (r = 0.28, p = 0.033) and peak tricuspid regurgitation jet velocity (r = 0.29, p = 0.021) were noted. LVEF was positively correlated with LV MRGlu (r = 0.27, p = 0.018), but negatively correlated with end-diastolic volume (r = - 0.37, p = 0.001), end-systolic volume (r = - 0.54, p < 0.001), and RV/LV MRGlu (r = - 0.40, p < 0.001). However, RV MRGlu was not well correlated with LVEF. Forty-three patients received revascularization procedures after FDG PET, and 13 patients died in a mean follow-up period of 496 ± 453 days (1-1788 days), including nine cardiovascular deaths. Higher RV and LV MRGlu values, LVEF ≤ 16% and LV end-diastolic volume ≥ 209 ml of gated-PET were associated with poor overall survival and cardiac outcomes. CONCLUSIONS: In patients with coronary artery disease and ischemic cardiomyopathy, RV glucose utilization was positively correlated with RV pressure overload, but not LVEF. Global LV and RV MRGlu, LVEF, and LV end-diastolic volume showed significant prognostic value.

10.
EBioMedicine ; 46: 236-247, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31401194

RESUMO

BACKGROUND: Myocardial infarction (MI) is a life-threatening disease, often leading to heart failure. Defining therapeutic targets at an early time point is important to prevent heart failure. METHODS: MicroRNA screening was performed at early time points after MI using paired samples isolated from the infarcted and remote myocardium of pigs. We also examined the microRNA expression in plasma of MI patients and pigs. For mechanistic studies, AAV9-mediated microRNA knockdown and overexpression were administrated in mice undergoing MI. FINDINGS: MicroRNAs let-7a and let-7f were significantly downregulated in the infarct area within 24 h post-MI in pigs. We also observed a reduction of let-7a and let-7f in plasma of MI patients and pigs. Inhibition of let-7 exacerbated cardiomyocyte apoptosis, induced a cardiac hypertrophic phenotype, and resulted in worsened left ventricular ejection fraction. In contrast, ectopic let-7 overexpression significantly reduced those phenotypes and improved heart function. We then identified TGFBR3 as a target of let-7, and found that induction of Tgfbr3 in cardiomyocytes caused apoptosis, likely through p38 MAPK activation. Finally, we showed that the plasma TGFBR3 level was elevated after MI in plasma of MI patients and pigs. INTERPRETATION: Together, we conclude that the let-7-Tgfbr3-p38 MAPK signalling plays an important role in cardiomyocyte apoptosis after MI. Furthermore, microRNA let-7 and Tgfbr3 may serve as therapeutic targets and biomarkers for myocardial damage. FUND: Ministry of Science and Technology, National Health Research Institutes, Academia Sinica Program for Translational Innovation of Biopharmaceutical Development-Technology Supporting Platform Axis, Thematic Research Program and the Summit Research Program, Taiwan.


Assuntos
Apoptose/genética , Regulação da Expressão Gênica , MicroRNAs/genética , Infarto do Miocárdio/genética , Infarto do Miocárdio/metabolismo , Proteoglicanas/metabolismo , Receptores de Fatores de Crescimento Transformadores beta/metabolismo , Transdução de Sinais , Animais , Biomarcadores , Modelos Animais de Doenças , Ecocardiografia , Terapia Genética/métodos , Vetores Genéticos/genética , Humanos , Camundongos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Miócitos Cardíacos/metabolismo , Suínos , Fatores de Tempo , Transdução Genética , Remodelação Ventricular/genética , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
11.
PLoS One ; 14(6): e0217444, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31170175

RESUMO

BACKGROUND: Prescription of guideline-recommended medicines after acute coronary syndrome (ACS) has been suboptimal. Tools for improving the use of medications have been developed, but they mainly targeted physicians. OBJECTIVE: We evaluated the effects of reinforcement of patient and family education on the usage of guideline-recommended secondary prevention medications. METHODS: This was a retrospective analysis of a prospectively collected registry of patients with ACS who were admitted to a regional teaching hospital in Taiwan between February 2015 and April 2017. The control group included 76 patients discharged before implementing the electronic-based patient and family education (PFE) system. The intervention group included 206 patients discharged after implementation. The primary outcome was the prescription rate of all four guideline-recommended drugs. Predictors of adherence were also evaluated. RESULTS: The study cohort included 282 ACS patients (188 men and 94 women) with a mean age of 68.5 years (standard deviation, 14.2). The intervention group patients were younger, had more family history of premature cardiovascular disease, more dyslipidemia, and underwent more reperfusion therapy. The intervention group was prescribed more guideline-recommended drugs than the control group: dual antiplatelet agents, 79.61% vs. 47.37% (p<0.001); statins, 74.76% vs. 34.21% (p<0.001); beta-blockers, 81.07% vs. 46.05% (p<0.001); angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, 62.62% vs. 38.16% (p<0.001); and a combination of all four medications, 39.32% vs. 14.47% (p<0.001). After adjusting baseline variables, the PFE system remained a significant contributor to adherence to these drugs use (P = 0.02). CONCLUSIONS: Reinforcement of patient education was associated with significant improvements in physicians' adherence to guideline-recommended medical therapy after acute coronary syndrome.

12.
Acta Cardiol Sin ; 35(3): 244-283, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31249457

RESUMO

Heart failure is a growing epidemic, especially in Taiwan because of the aging population. The 2016 Taiwan Society of Cardiology - Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry showed that the guideline-recommended therapies were prescribed suboptimally both at the time of hospital discharge and during follow-up. We, therefore, conducted this 2019 focused update of the guidelines of the Taiwan Society of Cardiology for the diagnosis and treatment of heart failure to reinforce the importance of new diagnostic and therapeutic modalities of heart failure. The 2019 focused update discusses new diagnostic criteria, pharmacotherapy, non-pharmacological management, and certain co-morbidities of heart failure. Angiotensin receptor neprilysin inhibitor and If channel inhibitor is introduced as new and recommended medical therapies. Latest criteria of cardiac resynchronization therapy, implantable cardioverter-defibrillator, heart transplantation, and ventricular assist device therapy are reviewed in the non-pharmacological management chapter. Co-morbidities in heart failure are discussed including chronic kidney disease, diabetes, chronic obstructive pulmonary disease, and sleep-disordered breathing. We also explain the adequate use of oxygen therapy and non-invasive ventilation in heart failure management. A particular chapter for chemotherapy-induced cardiac toxicity is incorporated in the focused update to emphasize the importance of its recognition and management. Lastly, implications from the TSOC-HFrEF registry and post-acute care of heart failure are discussed to highlight the importance of guideline-directed medical therapy and the benefits of multidisciplinary disease management programs. With guideline recommendations, we hope that the management of heart failure can be improved in our society.

13.
J Formos Med Assoc ; 2019 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-31113748

RESUMO

Atherosclerotic cardiovascular disease (ASCVD), including coronary artery disease, cerebrovascular disease, and peripheral artery disease, carries a high morbidity and mortality. Risk factor control is especially important for patients with ASCVD to reduce recurrent cardiovascular events. Clinical guidelines have been developed by the Taiwan Society of Cardiology, Taiwan Society of Lipids and Atherosclerosis, and Diabetes Association of Republic of China (Taiwan) to assist health care professionals in Taiwan about the control of hypertension, hypercholesterolemia and diabetes mellitus. This article is to highlight the recommendations about blood pressure, cholesterol, and sugar control for ASCVD. Some medications that are beneficial for ASCVD were also reviewed. We hope the clinical outcomes of ASCVD can be improved in Taiwan through the implementation of these recommendations.

14.
Arterioscler Thromb Vasc Biol ; 39(6): 1240-1252, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30943772

RESUMO

Objective- Basic research indicates that TNFSF14 (tumor necrosis factor superfamily 14) may be involved in the pathogenesis of atherosclerosis. Given the requirements of new biomarkers for risk classification in coronary artery disease (CAD), we conducted a longitudinal analysis to investigate if TNFSF14 levels are associated with the risk of cardiovascular events among patients with stable CAD. Approach and Results- In total, 894 patients with CAD were enrolled in a multicenter prospective study. The primary outcome was the occurrence of cardiovascular death, nonfatal myocardial infarction, and stroke. The secondary outcome was the occurrence of all-cause death, nonfatal myocardial infarction, stroke, revascularization, and hospitalization because of angina or heart failure. During the mean follow-up period of 22±9 months, 32 patients reached the primary outcome and 166 patients reached the secondary outcome. Kaplan-Meier analysis showed that the event-free survival was significantly different in the first and fourth quartile groups in subjects categorized by TNFSF14 levels. In multivariate Cox proportional hazard regression analysis, TNFSF14 was independently associated with the risk of cardiovascular events after adjustment for various relevant factors (adjusted hazard ratio, 1.14; 95% CI, 1.04-1.25). In the validation cohort of 126 multivessel patients with CAD, TNFSF14 was confirmed to provide good prognostic predictive value for composite cardiovascular events (adjusted hazard ratio, 1.11; 95% CI, 1.04-1.19). Conclusions- This is the first study to demonstrate that increased TNFSF14 levels were independently associated with the occurrence of cardiovascular events in patients with stable CAD. Future studies are worthy to validate if TNFSF14 could be a novel prognostic biomarker for CAD outcomes over different populations.

15.
J Am Heart Assoc ; 8(7): e011215, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30905254

RESUMO

Background The aim of this study was to determine the influence of various antidiabetic therapies on the relationship between body mass index and all-cause mortality in patients with diabetes mellitus and acute coronary syndrome. Methods and Results This was a prospective, observational study comprising 1193 patients diagnosed with type 2 diabetes mellitus and acute coronary syndrome. The patients were stratified into 4 body mass index categories, and their mortality rates were compared using time-dependent Cox regression analysis using normal weight (body mass index, 18.5-23.9) as the reference. Subsequently, the influence of antidiabetic therapies on the association between BMI and mortality were analyzed. Seventy-four patients (6.2%) died over 2 years of follow-up. The mortality rate was lowest in the class I obese group (3.35%) and highest in the normal-weight group (9.67%). After adjusting for covariates, class I obesity paradoxically remained significantly protective against mortality compared with normal weight (hazard ratio, 0.141; P=0.049); interaction term analysis showed that insulin therapy influenced this "obesity paradox" ( P=0.045). When the patients were stratified by insulin use, the protective effect of obesity disappeared in the insulin-treated patients but persisted in the non-insulin-treated patients. Conclusions In patients with type 2 diabetes mellitus and acute coronary syndrome, the relationship between body mass index and mortality rate is U-shaped, with class I obesity representing the nadir and normal weight the peak. The protective effect of obesity disappeared in patients treated with insulin.

16.
Sci Rep ; 9(1): 4838, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30862807

RESUMO

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

17.
PLoS One ; 14(3): e0213168, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30845157

RESUMO

BACKGROUND: We attempted to identify factors associated with physicians' decisions to terminate CPR and to explore the role of family in the decision-making process. METHODS: We conducted a retrospective observational study in a single center in Taiwan. Patients who experienced in-hospital cardiac arrest (IHCA) between 2006 and 2014 were screened for study inclusion. Multivariate survival analysis was conducted to identify independent variables associated with IHCA outcomes using the Cox proportional hazards model. RESULTS: A total of 1525 patients were included in the study. Family was present at the beginning of CPR during 722 (47.3%) resuscitation events. The median CPR duration was significantly shorter for patients with family present at the beginning of CPR than for those without family present (23.5 mins vs 30 min, p = 0.01). Some factors were associated with shorter time to termination of CPR, including arrest in an intensive care unit, Charlson comorbidity index score greater than 2, age older than 79 years, baseline evidence of motor, cognitive, or functional deficits, and vasopressors in place at time of arrest. After adjusting for confounding effects, family presence was associated with shorter time to termination of CPR (hazard ratio, 1.25; 95% confidence interval, 1.06-1.46; p = 0.008). CONCLUSION: Clinicians' decisions concerning when to terminate CPR seemed to be based on outcome prognosticators. Family presence at the beginning of CPR was associated with shorter duration of CPR. Effective communication, along with outcome prediction tools, may avoid prolonged CPR efforts in an East Asian society.


Assuntos
Reanimação Cardiopulmonar , Família/psicologia , Parada Cardíaca/patologia , Idoso , Feminino , Parada Cardíaca/mortalidade , Hospitais , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Análise de Sobrevida , Taiwan
18.
Sci Rep ; 9(1): 3091, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30816213

RESUMO

There is limited information about the association between oat fiber intake and future cardiovascular events in CAD patients after coronary intervention for secondary prevention. This study enrolled 716 patients after coronary intervention in clinical stable status from the CAD cohort biosignature study. Patients were analyzed according to whether the presence of regular oat fiber intake during the follow-up period, and the association with endpoints including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke and revascularization procedures were analyzed. The average follow-up period is 26.75 ± 8.11 months. Patients taking oat fiber were found to have lower serum levels of LDL, triglycerides, ratio of TC/HDL, as well as lower inflammatory markers values. After adjusting for confounders in the proportional hazard Cox model, oat fiber intake was associated with a lower risk of future revascularization (HR = 0.54, 95% CI 0.35-0.85; p = 0.007), and lower risk of major adverse cardiovascular events (HR = 0.62, 95% CI 0.43-0.88; p = 0.008), suggesting the association of oat fiber use and lower risk of future adverse event in CAD patients after coronary intervention.

19.
Resuscitation ; 137: 133-139, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30797049

RESUMO

AIM: The out-of-hospital cardiac arrest (OHCA) and cardiac arrest hospital prognosis (CAHP) scores were developed for early neuroprognostication after OHCA. Calculation of both scores requires estimation of the no-flow interval, which may be imprecise. We aimed to validate simplified OHCA and CAHP scores, which exclude the no-flow interval, in an East Asian cohort. METHODS: This was a single-centre prospective observational study. Consecutive OHCA patients were screened between January 2011 and March 2017. Simplified OHCA and CAHP scores (sOHCA, sCAHP) were calculated as the original scores with the no-flow interval omitted. Association between independent variables and outcomes was examined by multivariate logistic regression analysis, and area under the receiver operating characteristics curve (AUC) values were compared by paired DeLong test. RESULTS: A total of 412 patients were included. An inverse association between sOHCA and sCAHP scores and neurological outcome was confirmed, and most of the variables included in the simplified score calculations were also independently associated with neurological outcomes in our cohort. The AUC values for the simplified scores were similar, and both had excellent discriminatory performance for favourable neurologic outcome (AUC = 0.82, 95% confidence interval 0.77-0.86 for sOHCA and 0.84 with 95% confidence interval 0.80-0.89 for sCAHP, p-value = 0.19). CONCLUSION: The simplified OHCA and CAHP scores predicted neurological outcomes in successfully resuscitated East Asian OHCA patients with similar and excellent accuracy. The simplified OHCA and CAHP scores could potentially serve alongside the original scores as risk-adjustment tools for comparison of outcomes between regional OHCA registries worldwide.

20.
Resuscitation ; 137: 52-60, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30772425

RESUMO

BACKGROUND: The emergent coronary angiography (CAG) is associated with better outcomes in CA survivors. However, the impact of severity and revascularization of coronary artery stenosis on outcomes in cardiac arrest (CA) survivors remains unclear. METHODS: A total of 273 non-traumatic adult CA survivors who underwent emergent CAG from January 2011 to July 2017 were retrospectively recruited. The stenosis and non-revascularization of an individual coronary artery ≥70% were defined as significant in any of the major coronary arteries based on an operator visual estimate. RESULTS: There were 201 patients (73.63%) had ≧1 significant coronary artery stenosis and 58 patients (21.25%) with ≧1 non-revascularized coronary artery. The increased number of stenosed coronary artery was associated with an increased risk for in-hospital mortality [1-vessel: adjusted hazard ration (HR) 2.27, 95% confidence interval (CI) = 1.43-4.04, p = 0.021; 2-vessel: adjusted HR 5.49, 95% CI=2.17-13.89, p < 0.001; 3-vessel: adjusted HR 11.05, 95% CI=4.20-29.04, p < 0.001)] and poor neurological recovery (cerebral performance category = 3-5) [(1-vessel: adjusted odds ration (OR) 1.66, 95% CI 0.67-4.15, =0.275; 2-vessel: adjusted OR 1.81, 95% CI 1.05-3.97, p = 0.045; 3-vessel: adjusted OR 3.19, 95% CI 1.25-8.15, p = 0.001)], which was positively correlated with the number of vessels. The incomplete revascularization were also associated with increased in-hospital mortality and poor neurological function in patients with ≧1vessel stenosis. CONCLUSION: The severity and incomplete revascularization of coronary artery stenosis were associated with increased in-hospital mortality and poor neurological recovery in patients with presumed cardiogenic arrest.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA