The American journal of cardiology
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Multicenter Study Comparative Study
Usefulness of postoperative atrial fibrillation as an independent predictor for worse early and late outcomes after isolated coronary artery bypass grafting (multicenter Australian study of 19,497 patients).
Several studies have shown that postoperative atrial fibrillation (POAF) is associated with poorer short- and long-term outcomes after isolated coronary artery bypass grafting surgery. Nevertheless, there is considerable debate as to whether this reflects an independent association of POAF with poorer outcomes or confounding by other factors. We sought to investigate this issue. ⋯ In conclusion, POAF is a risk factor for short-term morbidity and decreased long-term survival. Rigorous evaluation of various therapies that prevent or decrease the impact of POAF is imperative. Moreover, patients who develop POAF should undergo strict surveillance and be routinely screened for complications after discharge.
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Multicenter Study Comparative Study
Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism.
Red cell distribution width (RDW) is strongly associated with prognosis in cardiopulmonary disorders such as coronary artery disease, acute myocardial infarction, acute and chronic heart failure, and pulmonary hypertension. However, its prognostic significance in acute pulmonary embolism (PE) is unknown. The aim of this study was to investigate the relation between admission RDW and early mortality in patients with acute PE. ⋯ Increased RDW >14.6% on admission, age, presence of shock, heart rate, oxygen saturation, and creatinine level were found to have prognostic significance in univariate Cox proportional-hazards analysis. Only increased RDW >14.6% on admission (hazard ratio 15.465, p = 0.012) and the presence of shock (hazard ratio 9.354, p <0.001) remained associated with increased risk for acute PE-related early mortality in a multivariate Cox proportional-hazards model. In conclusion, high RDW was associated with worse hemodynamic parameters, and RDW seems to aid in the risk stratification of patients with acute PE.
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Randomized Controlled Trial Multicenter Study Comparative Study
Impact of iso-osmolar versus low-osmolar contrast agents on contrast-induced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the Contrast Media and Nephrotoxicity Following Primary Angioplasty for Acute Myocardial Infarction [CONTRAST-AMI] Trial).
Conflicting data have been reported on the effects of low-osmolar and iso-osmolar contrast media on contrast-induced acute kidney injury (CI-AKI). In particular, no clinical trial has yet focused on the effect of contemporary contrast media on CI-AKI, epicardial flow, and microcirculatory function in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention. The Contrast Media and Nephrotoxicity Following Coronary Revascularization by Angioplasty for Acute Myocardial Infarction (CONTRAST-AMI) trial is a prospective, randomized, single-blind, parallel-group, noninferiority study aiming to evaluate the effects of the low-osmolar contrast medium iopromide compared to the iso-osmolar agent iodixanol on CI-AKI and tissue-level perfusion in patients with ST-segment elevation acute myocardial infarction. ⋯ No differences between the 2 groups were found in any of the secondary analyses of sCr increase. No significant difference in 1-month major adverse cardiac events was found (8% vs 6%, p = 0.37). In conclusion, in a population of unselected patients with ST-segment elevation acute myocardial infarction who underwent primary percutaneous coronary intervention, iopromide was not inferior to iodixanol in the occurrence of CI-AKI; no significant differences were found in terms of tissue-level reperfusion and major adverse cardiac events between the 2 contrast agents.