Predicting In-Hospital Mortality in Patients Undergoing Percutaneous Coronary Intervention

Background Standardization of risk is critical in benchmarking and quality improvement efforts for percutaneous coronary interventions (PCI). In 2018, the CathPCI Registry was updated to include additional variables to better classify higher-risk patients. Objectives We sought to develop a model for predicting in-hospital mortality risk following PCI incorporating these additional variables. Methods Data from 706,263 PCIs performed between 7/2018-6/2019 at 1,608 sites were used to develop and validate a new full and pre-catheterization model to predict in-hospital mortality, and a simplified bedside risk score. The sample was randomly split into a development (70%, n=495,005) and validation cohort (30%, n=211,258). We created 1,000 bootstrapped samples of the development cohort and used stepwise selection logistic regression on each sample. The final model included variables that were selected in at least 70% of the bootstrapped samples and those identified a priori due to clinical relevance. Results In-hospital mortality following PCI varied based on clinical presentation. Procedural urgency, cardiovascular instability, and level of consciousness after cardiac arrest were most predictive of in-hospital mortality. The full model performed well, with excellent discrimination (c-index: 0.943) in the validation cohort and good calibration across different clinical and procedural risk cohorts. The median hospital risk-standardized mortality rate was 1.9% and ranged from 1.1% to 3.3% (interquartile range: 1.7%-2.1%). Conclusions The risk of mortality following PCI can be predicted in contemporary practice by incorporating variables that reflect clinical acuity. This model, which includes data previously not captured, is a valid instrument for risk stratification and for quality improvement efforts

Extension of adrenocortical carcinoma into the right atrium

Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignant neoplasm which can produce intravascular extension into the inferior vena cava (IVC) rarely extend into the right atrium (RA). We report a case of a male patient with large ACC with extension into the IVC and RA. Computed tomography showed a large right adrenal mass with contiguous tumor thrombus extending into IVC and RA with extension to the level of tricuspid valve. Patient underwent combined cardiac and abdominal surgical intervention on cardiopulmonary bypass with removal of the mass

Correlación entre déficit auditivo y el rendimiento escolar en estudiantes del Distrito Municipal de Catalina, provincia Peravia

Many children with mild hearing loss may seem to their parents and teachers as hyperactive, distracted, not paying attention, or having a difficult process of learning. If this hearing loss is not detected, the school performance of these children can be affected. In the present study we found 12% of mild hearing loss in students, mostly due to unilateral involvement (75% of cases). There was a significantly greater proportion of hearing impaired students below the average school performance (=76.8 points, p = 0.012). Ear wax blockage and otitis media with effusion, were the most common findings; in terms of background, chronic otitis media, wax blockage and foreign bodies were the most commonly found. This study suggests that hearing deficits, even when mild, can significantly affect the average school performance. The main causes in this population appear to be alterations in outer and middle ear that affect the sound transmission, such as cerumen wad and otitis media. Parents and teachers fail to identify most of those affected. We recommend the implementation of hearing screening programs in school age children in the country.Muchos niños con pérdidas leves de su capacidad auditiva pueden parecer ante sus padres y maestros como hiperactivos, distraídos, que no prestan atención, o que tienen dificultad para aprender. De no ser detectada esta alteración en la capacidad auditiva, el rendimiento escolar de estos niños puede verse afectado. En este estudio encontramos un 12% de hipoacusia leve en los estudiantes, mayormente debida a afectación unilateral (75% de los casos). Hubo una proporción significativamente mayor de hipoacúsicos dentro de los estudiantes con rendimiento escolar promedio por debajo de la media (= 76.8 puntos, p = 0.012). El tapón de cerumen y la otitis media serosa fueron los hallazgos más frecuentes; en cuanto a los antecedentes, la otitis media crónica, tapón de cerumen y cuerpo extraño en oído fueron los más frecuentes. Este estudio sugiere que el déficit auditivo, aún cuando leve, puede afectar significativamente el rendimiento escolar promedio. Las causas principales en nuestra población parecen ser alteraciones en oído externo y medio que impiden la transmisión del estímulo sonoro, como el tapón de cerumen y la otitis media. Los padres y los maestros no logran identificar a la mayor parte de los afectados, por lo que se recomienda la implementación de programas de tamizaje auditivo en los niños en edad escolar en el país

sj-docx-1-vmj-10.1177_1358863X221148521 – Supplemental material for Use of drug-coated balloons and stents in patients with femoropopliteal artery disease and severe chronic kidney disease

Supplemental material, sj-docx-1-vmj-10.1177_1358863X221148521 for Use of drug-coated balloons and stents in patients with femoropopliteal artery disease and severe chronic kidney disease by Yulanka Castro-Dominguez, Kim Smolderen, Gaelle Romain, Jeffrey Turner and Carlos Mena-Hurtado in Vascular Medicine</p

Drug‐Coated Balloon and Drug‐Eluting Stent Safety in Patients With Femoropopliteal and Severe Chronic Kidney Disease

Background Patients with severe‐stage chronic kidney disease (CKD) were excluded from femoropopliteal disease trials evaluating drug‐coated balloons (DCBs) and drug‐eluting stents (DESs) versus plain balloon angioplasty (POBA) and bare metal stents (BMSs). We examined the interaction between CKD status and device type for the association with 24‐month all‐cause mortality and major amputation risk. Methods and Results We studied patients undergoing femoropopliteal interventions (September 2016–December 2018) from Medicare‐linked VQI (Vascular Quality Initiative) registry data. We compared outcomes for: (1) early‐stage CKD (stages 1–3) receiving DCB/DES, (2) early‐stage CKD receiving POBA/BMS, (3) severe‐stage (4 and 5) CKD receiving DCB/DES, and (4) severe‐stage CKD receiving POBA/BMS. We studied 8799 patients (early‐stage CKD: 94%; severe‐stage: 6%). DCB/DES use was 57% versus 51% in patients with early‐stage versus severe‐stage CKD. Twenty‐four‐month mortality risk for patients with early‐stage CKD receiving DCB/DES (reference) was 21% versus 28% (hazard ratio [HR], 1.47 [95% CI, 1.31–1.65]) for those receiving POBA/BMS; patients with severe‐stage CKD: those receiving DCB/DES had a 49% (HR, 2.61 [95% CI, 2.06–3.31]) mortality risk versus 52% (HR, 3.64 [95% CI, 2.91–4.55]) for those receiving POBA/BMS (interaction P<0.001). Adjusted analyses attenuated these results. For severe‐stage CKD, DCB/DES versus POBA/BMS mortality risk was not significant at 24 months (post hoc comparison P=0.06) but was higher for the POBA/BMS group at 18 months (post hoc P<0.05). Patients with early‐stage CKD receiving DCB/DES had the lowest 24‐month amputation risk (6%), followed by 11% for early‐stage CKD‐POBA/BMS, 15% for severe‐stage CKD‐DCB/DES, and 16% for severe‐stage CKD‐POBA/BMS (interaction P<0.001). DCB/DES versus POBA/BMS amputation rates in patients with severe‐stage CKD did not differ (post hoc P=0.820). Conclusions DCB/DES versus POBA/BMS use in patients with severe‐stage CKD was associated with lower mortality and no difference in amputation outcomes