Renovascular disease (RVD) can lead to hypertension and chronic kidney disease (CKD). Patients with advanced peripheral arterial disease (PAD) have a 5-year mortality of ~30%. Rate and causes of death in patients with significant RVD, who share similar risk factors with PAD patients, are not well defined. We assessed consecutive RVD patients who underwent renal artery stenting at our institution over 6 years. Specific causes of death were ascertained and the probability of survival was estimated. Cox models were fit to identify predictors of outcomes. We identified 281 RVD patients who underwent renal stenting. Follow-up was available for all patients (median 5.1 years). All-cause mortality was 24.2% at 5 years and 33.7% at 7 years (compounded annualized death rate: 5.5%). Of the 68 deaths, 36 (52.9%) were cardiovascular (13.2% acute myocardial infarction, 13.2% stroke, 11.8% sudden death and 10.3% congestive heart failure); 32 (47.1%) deaths had non-cardiovascular causes. In RVD patients undergoing stenting, cardiovascular events are the most common causes of death. Compared with patients with advanced PAD, RVD may have a lower 5-year mortality.

The American Heart Association recommends therapeutic hypothermia for comatose patients with return of spontaneous circulation after out-of-hospital ventricular fibrillation cardiac arrest. While there is a growing body of evidence for the general efficacy of therapeutic hypothermia, the individualized benefit of therapy is not currently predictable. Ninety-one consecutive patients, from April 2011 to July 2014, were treated at the University of Kentucky Medical Center with the therapeutic hypothermia protocol. Medical records were reviewed retrospectively. Data, such as preexisting comorbidities, cardiac arrest characteristics, and hospital course, were used to compose a multivariate logistic regression with mortality serving as the primary endpoint. The overall in-hospital mortality was 64% (n = 58) in this group. The arrest was considered cardiac etiology in 84% (n = 76) of patients, of which 49% (n = 45) were classed as ventricular fibrillation and 9% (n = 8) as ventricular tachycardia. The presence of a shockable rhythm, as well as shorter duration of cardiac arrest, was associated with increased survival, whereas time to target temperature was not. The presence of a preexisting neurologic disease was associated with a 10-fold increase in estimated odds of mortality. Age, serum lactate, ionized calcium, arterial pH, estimated glomerular filtration rate, and APACHE score were all predictors of mortality. Cardiac arrest is a devastating condition with a high mortality rate. Given the limited resources of the resuscitation community, the ability to predict survivors based on routinely obtained measures upon admission would be of tremendous value. In this study, we show a series of admission parameters that demonstrate predictive ability in identifying patients more likely to survive with therapeutic hypothermia.

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Background: Therapeutic hypothermia (TH) is often considered for comatose patients with return of spontaneous circulation after cardiac arrest (CA). While patients undergoing out-of-hospital ventricular fibrillation cardiac arrest are thought to benefit most from TH, the individualized benefit of initiating TH is unknown. Using a combination of clinical and laboratory parameters at presentation, we sought a model to predict survival and discharge to home. Methods: We performed a retrospective study of patients undergoing TH after CA at the University of Kentucky Hospital from 4/1/11 to 12/31/13. Records confirmed by chart review. The primary outcomes were discharge disposition and death. We conducted logistic regression analyses to identify predictors of home discharge and survival. Results: The series included 80 patients (mean±SD age was 55.2±14.9, and 61% were male). The overall mortality rate was 67.9% with survivor home discharge disposition of 21.2%. The Apache II Score (estimated odds ratio [OR] 1.167) was a significant predictor of death; moreover, though not itself a significant predictor of death, troponin improved the ability of Apache II to predict death. The Apache II Score (OR 0.882) and Mean Arterial Pressure (OR 1.049) were significant predictors of home discharge. Figures 1 and 2 display estimated probabilities of survival and home discharge based on two-predictor logistic regression models. Conclusions: In patients undergoing TH, a favorable prognosis is anticipated given certain values for hemodynamic and laboratory parameters. Thus, the patient’s clinical presentation may provide additional guidance when considering initiation of TH after CA.