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COVID-19 pandemic has burdened healthcare systems, necessitating the development of mortality prediction scores to guide clinical decisions and resource allocation. 4C ISARIC mortality score was developed and validated on a British cohort.ObjectivesExternal validation of the score in the setting of a large Saudi Arabian ICU.MethodRetrospective chart review of COVID-19 patients admitted to ICU of King Saud Medical City, Riyadh, Saudi Arabia. Collecting data to calculate the score, then fitting a ROC curve against known patients’ outcome.ResultsCohort included 1493 patients with 38% mortality, AUC of the score was 0.81 (95% CI: 0.79 – 0.83, p < 0.001), correctly classifying 72.67% of the cohort. Cut-off value of > 9 had sensitivity of 70.5% (95% CI: 66.6 – 74.3), specificity 73.97% (95% CI: 71 – 76.8), positive predictive value 62.4% (95% CI: 59.5 – 65.2), and negative predictive value 80.2% (95% CI: 78.2 – 82.4).Conclusion4C ISARIC mortality risk score performed well with a good discriminatory ability for critically ill patients admitted to ICU in our setting. Cut-off > 9 was the optimal criterion.

Critically ill patients are frequently immobilized which exposes them to multiple hazards particularly muscle weakness. Early mobilization of those patients was proposed few years ago and may be associated with improvement of patient’s outcomes, especially reduction of ICU length of stay. Aim: To report the results of a quality improvement project of early mobilization in a tertiary center ICU. Method: A full detailed protocol was developed for the intervention and applied in the ICU as of January 2017. Outcomes of enrolled patients were compared to that of un-enrolled patients. The impact of the program on ICU LOS was evaluated by propensity score matching, using un-enrolled patients as controls. Results: Propensity score matching yielded a significant impact on LOS in the form of average reduction of 8.6 days (95% CI: 3.4-13.8, p=0.001), the average ICU LOS of enrolled patients was significantly lower than that of un-enrolled (15.8±8.2 vs. 21±9, p=0.04), as well as the duration of weaning trials duration (4.1±2.6 vs. 7.6±5.2, p=0.03), there was no difference in ICU mortality (p=0.07). Conclusion: Early mobilization of critically ill patients may be associated with reduced ICU LOS and weaning trial period.

Data comparing the two modalities has shown inconsistent results, with older adults (≥70-year-old) being overall under-represented. We performed aggregate data meta-analyses (on 17 studies with 4880 patients) of clinical outcomes (all-cause mortality, nonfatal myocardial infarction (MI), repeat

Short- and long-term mortality in women who undergo coronary artery bypass grafting (CABG) has been evaluated in multiple studies with conflicting results. The investigators conducted a meta-analysis of all existing studies to evaluate the impact of female gender on mortality in patients who undergo isolated CABG. A comprehensive search of studies published through May 31, 2012 identified 20 studies comparing men and women who underwent isolated CABG. All-cause mortality was evaluated at short-term (postoperative period and/or at 30 days), midterm (1-year), and long-term (5-year) follow-up. Odds ratios (ORs) and 95% confidence interval (CIs) were calculated using a random-effects model. A total of 966,492 patients (688,709 men [71%], 277,783 women [29%]) were included in this meta-analysis. Women were more likely to be older; had significantly greater co-morbidities, including hypertension, diabetes mellitus, hyperlipidemia, unstable angina, congestive heart failure, and peripheral vascular disease; and were more likely to undergo urgent CABG (51% vs 44%, p0.01). Short-term mortality (OR 1.77, 95% CI 1.67 to 1.88) was significantly higher in women. At midterm and long-term follow-up, mortality remained high in women compared with men. Women remained at increased risk for short-term mortality in 2 subgroup analyses including prospective studies (n = 41,500, OR 1.83, 95% CI 1.59 to 2.12) and propensity score-matched studies (n = 11,522, OR 1.36, 95% CI 1.04 to 1.78). In conclusion, women who underwent isolated CABG experienced higher mortality at short-term, midterm, and long-term follow-up compared with men. Mortality remained independently associated with female gender despite propensity score-matched analysis of outcomes.

There is conflicting evidence about the impact of gender on outcomes after coronary artery bypass grafting (CABG).We performed a multivariate logistic regression and propensity score matched analyses in 13,115 patients (75% men) who underwent CABG between January 1, 1995 and December 31, 2009. The primary outcome was in-hospital mortality. Secondary outcomes included post-operative respiratory failure, stroke, myocardial infarction, sternal and leg wound infections, atrial fibrillation (AF), renal failure, need for postoperative intra-aortic balloon pump (IABP) support, and length of hospital stay.A higher proportion of women (184; 5.6%) suffered in-hospital death compared to men (264; 2.7%), p0.0001. After propensity score matching (n=3600 total, 1800 in each group), female gender was an independent predictor of mortality after isolated CABG (odds ratio [OR]=1.84; 95% confidence interval [CI] 1.22-2.78). Women also experienced a higher incidence of postoperative complications including stroke (3.8% vs. 2.3%, OR 1.37; 95% CI 1.08-1.73) and leg wound infection (3.4% vs. 1.7%, OR 1.75; 95% CI 1.36-2.54) on multivariate regression analyses. However, these differences were not significant after propensity score matching. We also observed a lower risk of post-operative AF (21.2% vs. 22.1%, OR 0.78; 95% CI 0.70-0.86) in women that remained significant after propensity matching (O.R. 0.76; 95% C.I. 0.65-0.90). Length of hospital stay was longer in women compared with men (11.9 ± 9.0 vs. 10.4 ± 9.2 days, p0.0001).Female gender is an independent predictor of increased mortality and a lower incidence of post-operative AF after isolated CABG.

Background: Clinical outcomes of percutaneous coronary intervention (PCI) in patients with saphenous vein grafts (SVGs) remain poor despite the use of drug-eluting stents (DES). There is a disparity in clinical outcomes in SVG PCI based on various registries, and randomized clinical data remain scant. We conducted a meta-analysis of all existing randomized controlled trials (RCTS) comparing bare-metal stents (BMS) and DES in SVGPCIs. Hypothesis: PCI in patients with SVG disease using DES may reduce need for repeat revascularization without an excess mortality when compared to BMS. Methods: An aggregate data meta-analysis of clinical outcomes in RCTs comparing PCI with DES vs BMS for SVGs reporting at least 12 months of follow-up was performed. A literature search between Janurary 1, 2003 and September 30, 2011 identified 4 RCTs (812 patients; DES = 416, BMS = 396). Summary odds ratio (OR) and 95% confidence interval (CI) were calculated using the random-effects model. The primary endpoint was all-cause mortality. Secondary outcomes included nonfatal myocardial infarction (MI), repeat revascularization, and major adverse cardiac events (MACE). These outcomes were assessed in a cumulative fashion at 30 days, 18 months, and 36 months. Results: There were no intergroup differences in baseline clinical and sociodemographic characteristics. At a median follow-up of 25 months, patients in the DES and BMS group had similar rates of death (OR: 1.63, 95% CI: 0.45–5.92), MI (OR; 0.83, 95% CI: 0.27-2.60), and MACE (OR: 0.58, 95% CI: 0.25–1.32). Patients treated with DES had lower rates of repeat revascularization (OR: 0.40, 95% CI: 0.22–0.75). Conclusions: In this comprehensive meta-analysis of all RCTs comparing clinical outcomes of PCI using DES vs BMS in patients with SVG disease, use of DES was associated with a reduction in rate of repeat revascularization and no difference in rates of all-cause death and MI. Clin. Cardiol. 2012 DOI: 10.1002/clc.21984 Dr. Virani is supported by a Department of Veterans Affairs Health Services Research and Development Service (HSR&D) Career Development Award (CDA-09-028), and has research support from Merck and National Football League Charities (all grants to the institution and not individual). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Despite being one of the most studied arrhythmias, there is paucity of information regarding atrial fibrillation (AF) control in the general population and the treatment strategies utilized by healthcare providers. REALISE-AF is an ongoing international registry investigating the management of AF and its control in nonhospitalized subjects. The registry has enrolled patients in 26 countries worldwide with the primary aim to determine the control of AF. This article presents a review of the initial results from the REALISE-AF registry and compares it to major practice-changing clinical trials conducted in the past. It also gives an overview of the current management strategies, recent updates in treatment and what further developments portend in the future.

A paucity of published data evaluating the outcomes of older patients (age ≥70 years) undergoing revascularization for unprotected left main coronary artery disease is available. We performed aggregate data meta-analyses of the clinical outcomes (all-cause mortality, nonfatal myocardial infarction, stroke, repeat revascularization, and major adverse cardiac and cerebrovascular events at 30 days and 12 and 22 months) in studies comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with a mean age of ≥70 years and unprotected left main coronary artery disease. A comprehensive, time-unlimited literature search to January 31, 2013 identified 10 studies with a total of 2,386 patients (PCI, n = 909; CABG, n = 1,477). Summary odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using the random-effects model. The patients in the PCI group were more likely than those in the CABG group to present with acute coronary syndrome (59.6% vs 44.8%, p

Short & long term mortality in women undergoing CABG has been evaluated in multiple studies with conflicting results. We conducted meta–analysis of existing literature to evaluate the impact of female sex on mortality in patients undergoing isolated CABG. A comprehensive literature search (PubMed

Background: Patients with unprotected left main coronary artery (LMCA) disease are increasingly treated with percutaneous coronary intervention (PCI) using drug-eluting stents (DES), but its benefits compared with coronary artery bypass grafting (CABG) remain controversial. We hypothesized that PCI with DES for unprotected LMCA disease is safe and effective compared with CABG. Methods and Results: We performed aggregate data meta-analyses of clinical outcomes [death; non-fatal myocardial infarction (MI); stroke; repeat revascularization; and major adverse cardiac and cerebrovascular events (MACCE)] in studies comparing PCI with DES vs. CABG in patients with LMCA disease. A comprehensive literature search (01/01/2003 to 12/01/2011) identified 27 studies comparing PCI and CABG (11,148 patients). Summary odds ratios (OR) were calculated using a random-effects model. At 30 days, PCI for unprotected LMCA disease was associated with lower MACCE [odds ratio (OR) 0.57, 95% confidence interval (CI) 0.36–0.89) and stroke rates (OR 0.22, 95% CI 0.11–0.44) compared with CABG. At 12 months, the PCI group experienced higher rates of repeat revascularization (OR 3.72, 95% CI 2.75–5.03), but lower rates of stroke (OR 0.25, 95% CI 0.14–0.44) and all-cause death (OR 0.69, 95% CI 0.49–0.97). At the longest follow-up of 60 months, PCI was associated with equivalent mortality, lower rates of stroke (OR 0.42, 95% CI 0.28–0.62) and higher rates of MACCE (OR 1.30, 95% CI 1.10–1.55) and repeat revascularization (OR 3.54, 95% CI 2.75–4.54). Conclusions: In the DES era, PCI for unprotected LMCA disease is associated with equivalent mortality and MI, lower stroke rates and higher rates of repeat revascularization compared with CABG. (Circ J 2013; 77: 372–382)