tbuckley/cabot-search huggingface dataset:
Abstract 9395: Depression and Disease Severity in Patients With Premature Acute Coronary Syndrome: Findings From the PRAXY Study
Authors: Roxanne Pelletier, George Thanasoulis, Kim L Lavoie, Simon L Bacon, Nadia Khan, Louise Pilote
Journal: Circulation (2013)

Background: Some studies demonstrate that depression is a risk factor for adverse outcomes in patients with acute coronary disease (ACS). However, it remains unclear if this association is confounded by ACS severity. The association between depression and ACS severity in younger patients has not been assessed, and sex differences in this potential relationship are unknown. Objectives: To assess whether major depression and depressive symptoms were associated with ACS severity in premature ACS patients; and to assess potential sex differences in these relationships. Methods: We enrolled 1023 patients (55 years or less) with ACS from January 2009 to September 2012 through the GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-Premature Acute Coronary SYndrome) study. Patients hospitalized for premature ACS were recruited from 26 centres in Canada, the US, and Switzerland. Main Outcome Measures included left ventricular ejection fraction (LVEF), Killip class, cardiac troponin levels, and Global Registry of Acute Coronary Events (GRACE) score. Univariate and multivariate regressions adjusting for sociodemographic and clinical variables were computed. Interaction terms between sex and major depression/depressive symptoms were added to the models to assess sex differences in the relationship between depression and severity. Results: The sample comprised 302 (30%) women and 248 (25%) patients with major depression; the median age was 49 years. Univariate analyses revealed that major depression was associated with a higher probability of normal LVEF (OR=1.70, 95% CI: 1.51-1.97, p=0.03) and lower troponin-I levels (estimate= -4.04, 95% CI: -8.01- -0.06, p=0.05). After adjustment for sociodemographic and clinical characteristics, neither major depression nor depressive symptoms were associated with LVEF, Killip class, Troponin-I levels, or GRACE score. The interaction analyses also revealed no sex differences in these relationships. Conclusion: We did not identify any association between major depression or depressive symptoms and ACS severity. The increased risk of mortality and CVD events in depressed patients may be explained by other mechanisms.
Abstract 348: Defining the ’Golden Hour’: How Much Fluid Do Septic Shock Patients Need in the First Hour?
Authors: James H Paxton, Cheryl Courage, Nathan Hunt, Robert L Sherwin
Journal: Circulation (2013)

Background: Early fluid challenge and antimicrobial administration are essential in the treatment of septic shock (SS) patients. Delayed vascular access can prevent appropriate care for SS patients. Study Objectives: The primary objective of this study was to determine time to adequate vascular access (AVA; either a central venous line or 2 peripheral IV lines) in the treatment of SS in the emergency department (ED). Secondary objectives included determination of time elapsed to empiric antibiotic and IV fluid challenge from time of ED arrival. Methods: A retrospective chart review was conducted including all adult patients admitted to an urban Level II trauma center from the ED with an admission diagnosis of SS between June 1 st , 2011 and September 31 st , 2012. Data on time to AVA, fluid administration, and antibiotic administration were obtained from the electronic medical record. Results: We identified 96 patients who met inclusion criteria. Median time from diagnosis to AVA was 30.5 minutes (mean=75 min, SD=127.0), with 34% of patients still without AVA 1 hour after SS diagnosis. Median time from diagnosis to antibiotic administration was 69.5 minutes (SD=84.9), and only 43.8% of patients received antibiotics within 1 hour of diagnosis. The median volume of IV fluid infused within 1 hour of SS diagnosis was 18.6 mL/kg (SD=14.6). Patients who survived to hospital discharge received significantly more fluid during their first hour in the ED than patients who died prior to hospital discharge (20.1 ml/kg vs. 12.7 ml/kg; t (1)=2.5, p &lt;.05). We observed a 41.5% decrease in mortality among patients who received greater than 10 ml/kg of IV fluid within their first hour in the ED ( p &lt;.01). At later time points (2, 4, or 6 hours after ED arrival), no mortality difference was observed. Conclusion: Early fluid resuscitation within 1 hour of ED arrival is associated with reduced inpatient mortality among septic shock patients. Based upon our data, there appears to be a critical threshold for the volume of IV fluid infused that is related to mortality. Strategies for earlier vascular access and antibiotic administration are needed.
Abstract 92: Documentation Discrepancies of Time-Dependent Critical Events in Out of Hospital Cardiac Arrest
Authors: Adam Frisch, Joshua C Reynolds, Joseph Condle, Danielle Gruen, Clifton Callaway
Journal: Circulation (2013)

Background: The timing of and interval between prehospital interventions and patient-related events during out of-hospital cardiac arrest (OHCA) resuscitation are important for system design and patient outcome. Since most prehospital research relies on data abstraction from the medical record, it is imperative to assure the accuracy and precision of time-stamped events in prehospital documentation. Austere environments and/or limited human resources may impair the accuracy and precision of this documentation. OHCA is a time-sensitive disease that necessitates rapid interventions; even small errors in timing documentation may introduce unrecognized bias into analysis. Objective: Determine the accuracy and precision of EMS documentation of time-stamped events during OHCA. Hypothesis: Times of critical events (CE) in OHCA documented by EMS are inaccurate when compared to audio documentation of the same cases. Methods: We reviewed prehospital documentation of OHCA resuscitation from two regional EMS agencies. We abstracted the documented times of CE in the prehospital medical record, as well as synchronized, time-stamped audio recordings from the monitor/defibrillator corresponding to each case. CE included IV/IO access, first epinephrine administration, successful airway placement, and return of spontaneous circulation. We compared the difference in minutes between medical record and audio sources, rounding down to the whole minute. Results: A total of 411 patients suffered OOHCA during the study period. Of these, 192 patients had both documentation times and audio times for at least one CE. A total of 422 CEs were documented. A median absolute difference of 2 minutes (IQR 1-4 minutes) was found for all CE. 136 (32.8%) of the cardiac arrest cases had 2 or more CE documented. There was a median discrepancy of 4.5 minutes (Range 0-27, IQR 1-4.5) in the interval between CE in the same case. Within case error shows that the differences are random, and not simply related to synchronization of timing devices. Conclusion: Documentation may introduce an error of 2 minutes in the times of CE and 4.5 minutes in the estimated intervals between CE. These errors are meaningful for studies of time dependent diseases like OHCA.
Abstract 15788: Percutaneous and Surgical Carotid Artery Revascularization in Patients With Moderate and Severe (Stage 3 and 4) Chronic Kidney Disease: Insights of the Healthcare Cost and Utilization Project’s National Inpatient Sample
Authors: Fabio V Lima, Tzyy Y Yen, Luis Gruberg
Journal: Circulation (2015)

Background: Carotid artery stenting (CAS) has evolved into an alternative modality for the treatment of symptomatic and asymptomatic high-grade internal carotid artery stenosis, particularly in patients considered to be at a high surgical risk for carotid endarterectomy (CEA). Hypothesis: There is limited data on the outcomes of patients with moderate and severe chronic kidney disease (CKD) (GFR=15-59 mL/min/1.73m 2 ) (Stage 3 and 4) undergoing CEA or CAS. Methods: The Healthcare Cost and Utilization Project’s National Inpatient Sample was screened for hospital admissions of patients undergoing CAS and CEA from 2003-2012. Clinical characteristics and outcomes were identified in patients with stage 3 and 4 CKD. The primary outcome of interest was in-hospital major adverse cardiac and cerebrovascular events (MACCE) defined as the composite of in-hospital death, acute myocardial infarction (AMI) and acute cerebrovascular accident (CVA). Results: Our study population consisted of 3,608 patients that underwent CEA and 746 patients that underwent CAS. Patients undergoing CAS had significantly higher rates of coronary artery disease and peripheral vascular disease with similar rates of hypertension, diabetes and hyperlipidemia. There was a higher rate of in-hospital MACCE in patients undergoing CAS compared with patients that underwent CEA, mainly driven by a higher rate of in-hospital strokes (Fig. 1). AMI and mortality rates were similar in both groups. In a multivariable analysis, CAS (OR 1.52, 95% CI 1.25-1.84) was independently predictive of MACCE. Conclusions: In patients with moderate and severe CKD, CAS was associated with similar rates of in-hospital mortality and AMI rates but higher rates of stroke when compared with CEA.
Abstract 301: Tc-99m ECD SPECT Brain Perfusion as a Novel Indicator Predicting Neurological Prognosis in Patients Resuscitated From Cardiac Arrest
Authors: Wei-Tien Chang, Ping-Hsun Yu, Yen-Wen Wu, Mei-Fang Cheng, Chien-Hua Huang, Ang Yuan, Min-Shan Tsai, Chih-Hung Wang, Hsiu-O Kao, Matthew Huei-Ming Ma, Shyr-Chyr Chen, Wen-Jone Chen
Journal: Circulation (2013)

Background: To date there are limited prognostic indicators that well predict the neurological outcomes in patients resuscitated from cardiac arrest. 99m Tc-ethylcysteinate dimer (ECD) brain perfusion scan has been shown to implicate the viability of neurons. We therefore investigate the role of this novel indicator in predicting post-resuscitation neurological prognoses. Methods: Post-cardiac arrest patients who remained unconsciousness after CPR were prospectively enrolled from Jan. 2010 to May 2013. Brain perfusion scan with 99m Tc ECD SPECT were performed within 3-10 days post-CPR. All images were interpreted and scored independently by two nuclear medicine physicians blinded to the patients’ clinical information. Nine distinct regions of the brain were scored, including upper brain stem and bilateral thalamus, basal ganglia, cerebral cortex and cerebellum. The scores ranged from 0 (normal) to 4 (worst), and were correlated with all clinical factors and the neurological outcome of the patients. Results: Ninety-one patients (64.1 ± 16.3 years old; 62 men) were enrolled during the study period. Fifty-nine survived to hospital discharge and 23 had neurological recovery with cerebral performance category (CPC) scale 1 or 2. Younger age, Vf/VT, shorter CPR time, lower epinephrine dose and therapeutic hypothermia were associated with good neurological recovery. For brain perfusion scan, the scores in all 9 areas were significantly lower in patients with good neurological recovery (all P &lt; 0.05). Patients receiving therapeutic hypothermia (n=69) had better survival and neurological outcomes (both P &lt; 0.05). The 99m Tc ECD perfusion was significantly better in the upper brain stem and bilateral basal ganglia in these patients (all P &lt; 0.05). In binary logistic regression analysis, the 99m Tc ECD perfusion in the upper brain stem, together with age, Vf/VT and CPR time, served as independent prognostic factors for neurological recovery. The perfusion score of greater than 2 in the upper brain stem exclusively predicted a poor neurological prognosis. Conclusions: 99m Tc ECD brain perfusion may serve as a novel independent indicator for post-resuscitation neurological prognosis. Poor perfusion in upper brain stem predicts a poor neurological outcome.
Abstract 90: Pyruvate Dehydrogenase is Inhibited in Post Cardiac Arrest Patients
Authors: Michael W Donnino, Tyler Giberson, Michael Cocchi, Katherine Berg, Lars Anderson, Xiaowen Liu
Journal: Circulation (2013)

Introduction: Pyruvate Dehydrogenase (PDH) activity has been shown to be inhibited in animal models of post-cardiac arrest. This depressed activity has been postulated to be directly related to neurologic injury secondary to aerobic metabolic dysfunction and accumulation of toxic metabolites. The objective of this study was to determine if PDH inhibition occurs after cardiac arrest (CA) in humans. Methods: Patients were enrolled as part of a prospective observational trial of CA at a single urban academic medical center from 1/13 to 4/13. A blood sample was collected as early after ROSC as informed consent could be obtained (&lt;24 hours). Our control group consisted of volunteers with no significant medical history. We used a novel method to measure PDH activity from peripheral blood mononuclear cells isolated from fresh blood. We quantified total PDH in 15mg / ml of isolated protein and determined overall PDH activity (PDH activity / total protein) and specific PDH activity (PDH activity / PDH protein). Wilcoxon rank sum test was used to compare median quantity and activity between the two groups. A p-value &lt; 0.05 was considered statistically significant. All tests of the data were performed in SAS v. 9.3 (SAS Institute Inc., Cary, NC, USA). Results: We enrolled 10 post-arrest patients; average age was 48 and 50% were female. Mortality was 50%. Overall PDH activity was significantly lower in the CA group (2.20 IQR 1.70 - 3.49) compared to controls (8.40 IQR 5.51 - 8.67) (p = .007). PDH quantity was also significantly lower in the CA group (1.26 IQR 0.90 - 2.02) compared to controls (4.88 IQR 3.08 - 6.09) (p = .009). There was no difference in specific PDH activity between the groups (p = 0.84). Conclusions: PDH activity is inhibited in the post-arrest period compared to healthy controls. The main driver of inhibition may be loss of PDH protein as opposed to changes in intrinsic activity. These findings are pertinent as animal models suggest PDH inhibition may drive neurologic injury after CA.
Abstract 289: Geographic Factors Associated With High Risk for Out-Of Hospital Cardiac Arrests and Provision of Bystander Cardio-Pulmonary Resuscitation in Singapore
Authors: Marcus Eng Hock Ong, Win Wah, Arul Earnest, Li Yang Hsu, Yih Yng Ng, Benjamin Sieu-Hon Leong, E Shaun Goh, Han Nee Gan, Sharon Lai Peng Tham, Rabind A Charles, David Chee Guan Foo
Journal: Circulation (2013)

Objectives: The objectives were to investigate association of individual and population characteristics in the provision of Bystander Cardio-Pulmonary Resuscitation (BCPR) among OHCA cases happened at home and identify high risk residential areas with low risk of BCPR and high risk of Out-of-Hospital Cardiac Arrest (OHCA) at the Development Guide Plan (DGP) census tract levels in Singapore. Methods: This was a retrospective, secondary analysis of two prospectively collected registries in Singapore from 2001 to 2011. We used Bayesian conditional autoregressive spatial models to examine predictors at the DGP level and to calculate smoothed relative risk (RR) to identify high risk clusters. We used multi-level mixed-effects logistic regression models to examine the independent effects of individual and neighborhood factors. Results: We found a total of 3942 OHCA with BCPR rates of 20.3% and 3578 cases eligible for BCPR. OHCA cases receiving BCPR at home were more likely to be witnessed (OR=1.69, 95%CI=1.34-2.12), younger (OR=0.98, 95%CI=0.97-0.98), presumed cardiac etiology (OR=1.48, 95%CI=1.14-1.91) and had longer response time (OR=1.04, 95%CI=1.01-1.06). After adjusting for individual arrest characteristics, an increased risk of provision of BCPR was significantly related to higher proportion of household size five and above at areal level (RR=1.02, 95% Credible Interval=1.01-1.04). We identified 10 high risk residential areas. Conclusion: We found differences in risk of receiving BCPR in different geographic areas. This study supported that neighborhood household size could play a significant role in the provision of BCPR and occurrence of high risk areas. Those high risk residential areas identified could be possible sites to target community based interventions (CPR training and public access defibrillation).
Abstract 299: Trends and Outcomes of In-Patient Pediatric Cardiopulmonary Resuscitation
Authors: Pirouz Shamszad, Bradley S Marino
Journal: Circulation (2013)

Purpose: Continual efforts have aimed to improve outcomes in children requiring cardiopulmonary resuscitation (CPR). However, few data have assessed how these efforts have impacted post-CPR survival in children’s hospitals. The purpose of this study was to describe the incidence, outcomes, and risk factors associated with in-patient mortality after pediatric CPR. Methods: A multi-institutional, retrospective review of the Pediatric Health Information System (PHIS) database, an administrative database of 42 United States tertiary care children’s hospitals, was performed. All hospitalizations in children &lt;18 years during which CPR was performed from 2004-2012 were included. Mortality was the primary outcome measure. Yearly trend analysis was performed using linear regression. Risk factors assessed for their association with mortality included age, sex, and specific cardiac factors (the presence of congenital heart disease [CHD], concurrent cardiac surgery, and cardiomyopathy [CM]). Factors associated with mortality were assessed by Chi-square analysis and expressed as odds ratio (OR) and 95% confidence interval (CI). A CI not crossing 0 was considered significant. Results: There were &gt;4.6 million hospitalizations of which 11,213 (0.2%) involved a CPR event. Overall in-patient mortality after CPR was 50%. Although there was a significant increasing yearly trend in the number of in-patient CPR events (p = 0.003), yearly mortality significantly decreased (p&lt;0.001). Mortality was significantly higher in adolescents (OR 1.5 CI 1.3-1.7) and neonates (OR 1.4 CI 1.3-1.5). Among in-patients, CHD was present in 4,931 hospitalizations (44%), concurrent cardiac surgery in 1,656 (14.8%), and CM in 537 (4.8%). Mortality was lower in hospitalizations involving CHD (OR 0.7, CI 0.6-0.7), CM (OR 0.8, CI 0.7-0.9), and cardiac surgery (OR 0.5, CI 0.4-0.5). Gender was not significantly associated with mortality (p = 0.61). Conclusions: CPR in hospitalized children is a rare event associated with high, but improving mortality. Adolescents and neonates are at higher risk for mortality after CPR. Cardiac risk factors in hospitalized children undergoing CPR are associated with lower mortality.
Abstract XXXXX: Duration of Cardiopulmonary Resuscitation and Illness Category Impact Survival and Neurologic Outcomes for In-hospital Pediatric Cardiac Arrests
Authors: Renée I. Matos, R. Scott Watson, Vinay M. Nadkarni, Hsin-Hui Huang, Robert A. Berg, Peter A. Meaney, Christopher L. Carroll, Richard J. Berens, Amy Praestgaard, Lisa Weissfeld, Philip C. Spinella
Journal: Circulation (2013)

Renée I. Matos, 2013 Finalist and Presenting Author
Abstract 13251: Experimental Endotoxemia Uncovers a Genomic Basis for Thermoregulation: Chr7p11.2 Locus in Inflammatory Febrile Response and Temperature Homeostasis
Authors: Jane F. Ferguson, Nuala J. Meyer, Liming Qu, Chenyi Xue, Yichuan Liu, Stephanie L. DerOhannessian, Melanie Rushefski, Eric E. Schadt, Mingyao Li, Jason D. Christie, Muredach P. Reilly
Journal: Circulation (2013)

Jane Ferguson, 2013 Finalist and Presenting Author
Regulation of Plasma Lipoprotein Levels in Humans: New Insights Using Methods Pioneered by Bob Levy
Authors: Henry Ginsberg
Journal: Circulation (2013)

In the early 1970s, Robert Levy and colleagues published a series of groundbreaking papers showing, in detail, the metabolic fates of the apolipoproteins on very low density lipoproteins after intravenous injection into normal and hyperlipidemic subjects. These studies were the foundation for the field of human lipoprotein kinetics that has provided very significant insights into the pathophysiology of lipid disorders as well as mechanisms of action of lipid altering diets and drugs. Early studies used mainly exogenously radiolabeled lipoproteins, but more recently, stable isotopes of amino acids have been used to endogenously label the apolipoproteins of interest. Our group has used both approaches for more than three decades and in this lecture, I will highlight the results of several of our studies including very recent unpublished work.
Abstract 296: Hypothermic to Ischemic Ratio as a Predictor for Good Neurologic Outcome From Out-of-Hospital Cardiac Arrest Presenting With a Shockable Rhythm
Authors: Kelly N Sawyer, Michael C Kurz, R K Elswick, Teresa R Camp-Rogers
Journal: Circulation (2013)

Objectives: The Hypothermic to Ischemic Ratio (HI Ratio = total hypothermic time / total ischemic time) has been externally validated as a predictor for survival from out of hospital cardiac arrest (OHCA). We sought to examine its relationship to “good” neurological outcome. Methods: Adult, non-traumatic, OHCA patients presenting with a shockable rhythm and surviving to hospital admission between January 2008 and December 2011 were considered for inclusion. Structured data were collected, including all Utstein criteria and relevant time intervals between initiation of therapeutic hypothermia and rewarming. The outcome of interest was “good” or “poor” neurologic status at discharge, defined as cerebral performance category 1-2 and 3-5, respectively. Logistic regression models were used to evaluate the effect of predictor variables on our primary outcome. Odds ratios (OR) with 95% confidence intervals (CI) are reported. Results: A total of 128 patients were included. Of those who survived to discharge (n=94), 68.1% had good neurologic outcome. Patients had a mean age of 58.3 years (SD 12.95, 95% CI 56.06, 60.59) and 50.8% were black. The majority of patients were male (71.9%) and had witnessed arrest (89.1%), with 61.7% receiving bystander CPR. In multivariable modeling, younger age (OR 0.92, 95% CI 0.88, 0.96), male gender (OR 3.64, 95% CI 1.30, 11.23), bystander CPR (OR 3.12, 95% CI 1.22, 8.52), and a larger HI Ratio were associated with better neurologic outcome. HI Ratio was the most significant predictor (OR 9.88, 95% CI 4.01, 29.85). Conclusions: HI Ratio seems to be a significant predictor for good neurologic outcome after OHCA for patients presenting with a shockable rhythm. Prospective studies should consider HI Ratio as a potential predictor for investigation.