Outcomes of cardiac surgery in patients age ≥80 years: results from the National Cardiovascular Network

AbstractOBJECTIVESThe purpose of this study was to evaluate characteristics and outcomes of patients age ≥80 undergoing cardiac surgery.BACKGROUNDPrior single-institution series have found high mortality rates in octogenarians after cardiac surgery. However, the major preoperative risk factors in this age group have not been identified. In addition, the additive risks in the elderly of valve replacement surgery at the time of bypass are unknown.METHODSWe report in-hospital morbidity and mortality in 67,764 patients (4,743 octogenarians) undergoing cardiac surgery at 22 centers in the National Cardiovascular Network. We examine the predictors of in-hospital mortality in octogenarians compared with those predictors in younger patients.RESULTSOctogenarians undergoing cardiac surgery had fewer comorbid illnesses but higher disease severity and surgical urgency than younger patients. Octogenarians had significantly higher in-hospital mortality after cardiac surgery than younger patients: coronary artery bypass grafting (CABG) only (8.1% vs. 3.0%), CABG/aortic valve (10.1% vs. 7.9%), CABG/mitral valve (19.6% vs. 12.2%). In addition, they had twice the incidence of postoperative stroke and renal failure. The preoperative clinical factors predicting CABG mortality in the very elderly were quite similar to those for younger patients with age, emergency surgery and prior CABG being the powerful predictors of outcome in both age categories. Of note, elderly patients without significant comorbidity had in-hospital mortality rates of 4.2% after CABG, 7% after CABG with aortic valve replacement (CABG/AVR), and 18.2% after CABG with mitral valve replacement (CABG/MVR).CONCLUSIONSRisks for octogenarians undergoing cardiac surgery are less than previously reported, especially for CABG only or CABG/AVR. In selected octogenarians without significant comorbidity, mortality approaches that seen in younger patients

790-2 Baseline Electrocardiogram Predicts 30-day Mortality Among 32,812 Patients with Acute Myocardial Infarction Treated with Thrombolysis

To determine the initial electrocardiographic variables predictive of survival among patients with acute myocardial infarction, we analyzed the baseline 12-lead ECGs in 32,812 patients enrolled into the GUSTO trial. All patients had≥0.1mV of ST segment elevation in at least one lead and received thrombolytic therapy. Those with LBBB or ventricular rhythm were excluded from analysis. Clinical follow-up was > 99.5% complete. 2218 (6.8%) patients died within 30 days of the initial ECG. Death within 30 days was more common in patients with RBBB (17%), LAFB (14%), and LPFB (17%), than in those with a normal conduction pattern (6%). Patients with ECG evidence of previous MI in a location distinct from the acute MI had a higher risk of death (9.8% vs. 5.9%) than those without prior infarction (p<0.0001). The variable having the greatest univariate predictive power for 30-day survival was the sum of the absolute ST-segment deviation in each lead (x2=341), as shown in the following mortality curve.Other ST segment variables that predicted 30-day survival were the sum of ST-segment elevation in each lead (x2=287). the maximum ST elevation in anyone lead (X2=257), and the number of leads with ST elevation (x2=250). When multivariate modeling was performed the sum of the absolute ST deviations, number of leads with ST elevation, prior ECG MI, RBBB, and LAFB each added independent prognostic information.We conclude that an ECG at the time of presentation contains substantial prognostic information which can be used to help stratify risk among thrombelytic-treated patients with acute myocardial infarction

Habitat Persistence Underlies Intraspecific Variation in the Dispersal Strategies of Planthoppers

Dispersal is considered a vital life history characteristic for insects exploiting temporary habitats, and life history theorists have often hypothesized an inverse relationship between dispersal capability and habitat persistence. Most often, this hypothesis has been tested using interspecific comparisons of dispersal capability and qualitative estimates of habitat persistence. Consequently, most assessments have failed to control for possible phylogenetic nonindependence and they also lack quantitative rigor. We capitalized on existing intraspecific variation on the dispersal capability of Prokelisia planthoppers to examine the relationship between habitat persistence and dispersal, thereby minimizing possible phylogenetic effects. Two congeneric species (Prokelisia marginata and P. dolus) occur in the intertidal marshes of North America, where they feed exclusively on cordgrasses (Spartina). Because these planthoppers exhibit wing dimorphism, flight-capable adults (macropters with fully developed wings). Thus, dispersal capability can be readily estimated by the percentage of macropters in a population. At a regional spatial scale, we found a highly significant negative relationship between dispersal capability (present macroptery) and habitat persistence. In this system, habitat persistence is influenced by a combination of marsh elevation, winter severity, and tidal range, which interact to determine the ability of planthoppers to endure through winter in their primary habitat for development. P. marginata develops primarily in low-marsh habitats during summer, habitats that can be subjected to pronounced winter disturbance due to ice scouring and/or extensive tidal inundation. Levels of winter disturbance of the low marsh are extreme along the Atlantic coast, intermediate along the Pacific, and low along the Gulf. Both the failure of P. marginata populations to remain through winter in the habitat, and the dispersal ability of these populations (92%, 29%, and 17% macroptery, respectively), are correlated with levels of disturbance. Thus, in regions where winter disturbance is high, levels of dispersal are correspondingly high to allow for recolonization of extirpated habitats from overwintering sites on the high marsh. Unlike P. marginata, P. dolus develops primarily in high-marsh habitats, which are much less disturbed on all coasts during winter. Consequently, this species remains year-round in its primary habitat for development, and most populations exhibit relatively low levels of macroptery (\u3c10%). When raised under common garden conditions, many more macropters of both species were produced from Atlantic compared to Gulf populations. Thus the proportion of macropters produced from the populations used in this experiment paralleled the incidence of macroptery measured in the field, providing evidence that the geographic variation in dispersal capability in both species has in part a genetic basis. The results of this study provide strong intraspecific evidence for an inverse relationship between the dispersal capability of insects and the persistence of their habitats

Simulations of the OzDES AGN reverberation mapping project

As part of the Australian spectroscopic dark energy survey (OzDES) we are carrying out a large-scale reverberation mapping study of ≥500 quasars over five years in the 30 deg2 area of the Dark Energy Survey (DES) supernova fields. These quasars have redshifts ranging up to 4 and have apparent AB magnitudes between 16.8 mag < r < 22.5 mag. The aim of the survey is to measure time lags between fluctuations in the quasar continuum and broad emission-line fluxes of individual objects in order to measure black hole masses for a broad range of active galactic nuclei (AGN) and constrain the radius-luminosity (R-L) relationship. Here we investigate the expected efficiency of the OzDES reverberation mapping campaign and its possible extensions. We expect to recover lags for-35-45 per cent of the quasars. AGN with shorter lags and greater variability aremore likely to yield a lag measurement, and objects with lags ≲6 months or-1 yr are expected to be recovered the most accurately. The baseline OzDES reverberation mapping campaign is predicted to produce an unbiased measurement of the R-L relationship parameters for H β, MgII λ2798, and CIV λ1549. Extending the baseline survey by either increasing the spectroscopic cadence, extending the survey season, or improving the emission-line flux measurement accuracy will significantly improve the R-L parameter constraints for all broad emission lines

Prior Antithrombotic Use Is Associated With Favorable Mortality and Functional Outcomes in Acute Ischemic Stroke

Acknowledgments Drs Myint and Smith conceived the idea and developed the analysis plan with critical input from coauthors. A.S. Hellkamp analyzed the data. Drs Myint and Smith drafted the article with input from all coauthors. All authors contributed in interpretation of results and in making an important intellectual contribution to the article. Sources of Funding The Get With The Guidelines (GWTG)-Stroke program is currently supported, in part, by a charitable contribution from Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership and the American Heart Association Pharmaceutical Roundtable. GWTG-Stroke has been funded in the past through support from Boehringer-Ingelheim and Merck. These funding agencies did not participate in design or analysis, article preparation, or approval of this study.Peer reviewedPostprin

A worldwide phylogenetic classification of the Poaceae (Gramineae) III: An update

We present an updated worldwide phylogenetic classification of Poaceae with 11 783 species in 12 subfamilies, 7 supertribes, 54 tribes, 5 super subtribes, 109 subtribes, and 789 accepted genera. The subfamilies (in descending order based on the number of species) are Pooideae with 4126 species in 219 genera, 15 tribes, and 34 subtribes; Panicoideae with 3325 species in 242 genera, 14 tribes, and 24 subtribes; Bambusoideae with 1698 species in 136 genera, 3 tribes, and 19 subtribes; Chloridoideae with 1603 species in 121 genera, 5 tribes, and 30 subtribes; Aristidoideae with 367 species in three genera and one tribe; Danthonioideae with 292 species in 19 genera and 1 tribe; Micrairoideae with 192 species in nine genera and three tribes; Oryzoideae with 117 species in 19 genera, 4 tribes, and 2 subtribes; Arundinoideae with 36 species in 14 genera and 3 tribes; Pharoideae with 12 species in three genera and one tribe; Puelioideae with 11 species in two genera and two tribes; and the Anomochlooideae with four species in two genera and two tribes. Two new tribes and 22 new or resurrected subtribes are recognized. Forty-five new (28) and resurrected (17) genera are accepted, and 24 previously accepted genera are placed in synonymy. We also provide an updated list of all accepted genera including common synonyms, genus authors, number of species in each accepted genus, and subfamily affiliation. We propose Locajonoa, a new name and rank with a new combination, L. coerulescens. The following seven new combinations are made in Lorenzochloa: L. bomanii, L. henrardiana, L. mucronata, L. obtusa, L. orurensis, L. rigidiseta, and L. venusta.Fil: Soreng, Robert J.. National Museum of Natural History; Estados UnidosFil: Peterson, Paul M.. National Museum of Natural History; Estados UnidosFil: Zuloaga, Fernando Omar. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Botánica Darwinion. Academia Nacional de Ciencias Exactas, Físicas y Naturales. Instituto de Botánica Darwinion; ArgentinaFil: Romaschenko, Konstantin. National Museum of Natural History; Estados UnidosFil: Clark, Lynn G.. IOWA STATE UNIVERSITY (ISU);Fil: Teisher, Jordan K.. No especifíca;Fil: Gillespie, Lynn J.. No especifíca;Fil: Barberá, Patricia. No especifíca;Fil: Welker, Cassiano A. D.. No especifíca;Fil: Kellogg, Elizabeth A.. Donald Danforth Plant Science Center; Estados UnidosFil: Li, De Zhu. No especifíca;Fil: Davidse, Gerrit. No especifíca