Prevalence and risk factors for postoperative stress-related cardiomyopathy in adults

<div><p>Stress-related cardiomyopathy can develop during the postoperative period due to surgery-related stress factors. However, the prevalence and risk factors for this condition are not yet known. During a retrospective, observational study, patients older than 19 years who underwent procedures from January 2011 to December 2015 at a tertiary hospital were included. The main aim was to identify the prevalence and related risk factors for postoperative stress-related cardiomyopathy. To estimate the incidence per risk factor, univariate and multivariate Poisson regression analyses were performed. During the 5-year period, 95,840 patients older than 19 years underwent 125,314 procedures, and the prevalence of postoperative stress-related cardiomyopathy was 17.74 per 100,000 (95% confidence interval, 9.31–26.17), with an in-hospital mortality of 23.5%. As a result, three risk factors were significantly associated: preoperative American Society of Anesthesiologists classification (incidence rate ratio, 5.901 for American Society of Anesthesiologists class 1–2 [ref] versus 3–6; 95% confidence interval,1.289–27.002; <i>P</i> = 0.022); preoperative body mass index (incidence rate ratio, 1.247 for increases of 18.5 [ref] to 30; 95% confidence interval, 1.067–1.458; <i>P</i> = 0.006); and preoperative serum sodium (incidence rate ratio, 0.830 for each increase of 10 mmol/L from 130; 95% confidence interval, 0.731–0.942; <i>P</i> = 0.004). The incidence rate ratio for age for each increase of 10 years from 50 years was 1.057, but it was not statistically significant (<i>P</i> = 0.064). Our study found that the prevalence of postoperative stress-related cardiomyopathy was 17.74 patients per 100,000 adult patients over the course of 5 years, with four cases of in-hospital mortality. Factors that increased the risk of postoperative stress-related cardiomyopathy included higher American Society of Anesthesiologists class (≥3), preoperative hyponatremia, and higher preoperative body mass index.</p></div

Crude prevalence per 100,000 postoperative stress-related cardiomyopathies over the course of 5 years.

<p>ASA, American Society of Anesthesiologists; BUN, blood urea nitrogen; ICU, intensive care unit; IHD, ischemic heart disease; NU disease, neurologic disease; postop, postoperative.</p

Intravascular Ultrasound and Angiographic Predictors of In-Stent Restenosis of Chronic Total Occlusion Lesions

<div><p>Despite the benefits of successful percutaneous coronary interventions (PCIs) for chronic total occlusion (CTO) lesions, PCIs of CTO lesions still carry a high rate of adverse events, including in-stent restenosis (ISR). Because previous reports have not specifically investigated the intravascular ultrasound (IVUS) predictors of ISR in CTO lesions, we focused on these predictors. We included 126 patients who underwent successful PCIs, using drug-eluting stents, and post-PCI IVUS of CTO lesions. Patient and lesion characteristics were analyzed to elucidate the ISR predictors. In each lesion, an average of 1.7 ± 0.7 (mean length, 46.4 ± 20.3 mm) stents were used. At 9 months follow-up, 14 (11%) patients demonstrated ISR, and 8 (6.3%) underwent target lesion revascularization. Multivariate logistic regression analysis showed that the independent predictors of ISR were the post-PCI minimal luminal diameter (MLD) and the stent expansion ratio (SER; minimal stent cross-sectional area (CSA) over the nominal CSA of the implanted stent), measured using quantitative coronary angiography (QCA) and IVUS, respectively. A receiver operating characteristic analysis indicated that the best post-PCI MLD and SER cut-off values for predicting ISR were 2.4 mm (area under the curve [AUC], 0.762; 95% confidence interval (CI), 0.639–0.885) and 70% (AUC, 0.714; 95% CI, 0.577–0.852), respectively. Lesions with post-PCI MLD and SER values less than these threshold values were at a higher risk of ISR, with an odds ratio of 23.3 (95% CI, 2.74–198.08), compared with lesions having larger MLD and SER values. Thus, the potential predictors of ISR, after PCI of CTO lesions, are the post-PCI MLD and SER values. The ISR rate was highest in lesions with a post-PCI MLD ≤2.4 mm and an SER ≤70%.</p></div

Predictors of in-stent restenosis in non-acute myocardial infarction patients.

<p>MLD, minimal luminal diameter; PCI, percutaneous coronary intervention; SER, stent expansion ratio</p><p>Predictors of in-stent restenosis in non-acute myocardial infarction patients.</p

Baseline characteristics of total study population.

<p>Data are mean±SD, median (IQR; Q1–Q3) or number (%).</p><p>*Chronic kidney disease was defined as estimated glomerular filtration rate (GFR) <60 mL/min/1.73m².</p><p>^†Calculations of the laboratory tests and coronary artery calcium score were performed for those with available data of each component.</p><p>^‡A composite of all-cause mortality and late coronary revascularization (>90 days after CCTA), including percutaneous coronary intervention and coronary artery bypass graft operation.</p><p>Abbreviations: COPD, chronic obstructive pulmonary disease; ACEi, angiogensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; CCB, calcium channel blocker; HDL, high-density lipoprotein; LDL, low-density lipoprotein; hsCRP, high-sensitivity C-reactive protein; GFR, glomerular filtration rate; CACS, coronary artery calcium score; CCTA, coronary computed tomography angiography.</p><p>Baseline characteristics of total study population.</p

Frequency of in-stent restenosis (ISR), according to post-percutaneous coronary intervention (PCI) minimal luminal diameter (MLD) and stent expansion ratio (SER).

<p>Lesions with smaller post-PCI MLDs and SERs had significantly higher risks of ISR. Lesions with post-PCI MLDs ≤2.4 mm and SERs ≤70% were at the highest risk of ISR, with an odds ratio of 23.3 (95% confidence interval, 2.74–198.08) compared with lesions with larger MLDs and SERs. There was a significant interaction between post-PCI MLD and SER (p = 0.038) on ISR.</p

Final risk factors for occurrence of postoperative SICMP using multivariate stepwise poisson regression analysis.

<p>Final risk factors for occurrence of postoperative SICMP using multivariate stepwise poisson regression analysis.</p

Optimal cut-off values.

<p>Optimal cut-off values were obtained using a receiver operating characteristics analysis for (A) post- percutaneous coronary intervention (PCI) minimal luminal diameter (MLD), (B) stent expansion ratio (SER), and (C) total stent length.</p

Multivariable Cox proportional hazard model for the composite endpoint^*.

<p>* Composite endpoint: a composite of all-cause mortality and late coronary revascularization.</p><p>Abbreviations: ACEi, angiogensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; CCB, calcium channel blocker; CI, confidence interval; HR, hazard ratio.</p><p>Multivariable Cox proportional hazard model for the composite endpoint^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0129584#t003fn001" target="_blank">*</a>}.</p

Predictors of in-stent restenosis using logistic regression analysis.

<p>MLD, minimal luminal diameter; PCI, percutaneous coronary intervention; SER, stent expansion ratio</p><p>Predictors of in-stent restenosis using logistic regression analysis.</p