Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Obstructive sleep apnea (OSA) is increasingly recognized in the ageing population, especially with the rising obesity epidemic. The impact of OSA on inpatient mortality in PE is not well understood. We used the Nationwide Inpatient Sample databases from 2005 to 2016 to identify 755,532 acute PE patients (ageï³18 years). Among these 61,050 (8.1%) were OSA+. Temporal trends in length of stay (LOS), inpatient mortality and its association with OSA in PE patients were analyzed. The proportion of PE patients who were OSA+ increased from 2005 to 2016. OSA+ PE patients were younger and predominantly men. Despite a higher prevalence of traditional risk factors for inpatient mortality in OSA+ patients, OSA was associated with a lower risk of mortality in PE patients (OR, 95% CI; p: unadjusted 0.56, 0.53-0.58; p<0.0001 and adjusted 0.55, 0.52-0.58; p<0.0001). Overall mortality and LOS in PE patients decreased over time. Relative to OSA- patients, there was a slight increase in mortality among OSA+ PE patients over time, although the LOS remained unchanged between the 2 groups. In conclusion, OSA+ PE patients had a lower inpatient mortality compared to OSA- patients despite a higher prevalence of traditional mortality risk factors. Secondary pulmonary hypertension related to OSA with pre-conditioning of the right ventricle to elevated afterload may potentially explain the protective effect of OSA on mortality in PE. However, mechanistic studies need to further elucidate the links behind this association.
Mid ventricular ballooning syndrome (MBS) was diagnosed in a 55-year-old woman who was admitted to emergency room due to acute chest pain. The trigger for the chest pain was reported as "bad dream" about her husband. MBS, a variant of Takotsubo Cardiomyopathy is more common in postmenopausal women and the triggers have been linked to stress involving the husband. Sudden catecholamine surge during nightmare augmented by estrogen deficiency in postmenopausal women may be the underlying mechanism. There are many unanswered questions related to the etiology of MBS. With supportive treatment, prognosis is excellent.
Introduction:
Sickle cell disease (SCD) has been shown in multiple studies worldwide to be associated with considerable morbidity and mortality, including a higher risk for acute myocardial infarction (AMI). However, the effect of SCD on outcome in patients with myocardial infarction remains unclear. We sought to investigate the in-hospital mortality in patients with SCD presenting with acute ST elevation myocardial infarction (STEMI) compared to the general population.
Hypothesis:
Short term mortality in patients with SCD presenting with STEMI is higher when compared to the general population.
Methods:
The National Inpatient Sample (NIS), part of the Healthcare Cost and Utilization Project (HCUP), is the largest publicly available inpatient database designed to provide information on characteristics and outcomes of patients discharged from US hospitals. Using the NIS database, we identified 879,108 adult patients with a primary diagnosis of STEMI in the period between 1998 and 2012. Among this patient population, 52 patients also had a diagnosis of SCD.
Results:
Compared to the general population, patients with SCD were significantly younger (55 years vs. 66 years, p<0.001), were more likely to be female (60% vs. 37%, p=0.001), and had a lower prevalence of hypertension (35% vs. 47%, p=0.06) and dyslipidemia (2% vs. 13%, p=0.02). They were less likely to undergo revascularization procedures compared to the general population (38% vs. 53%, p=0.04). The in-hospital mortality for patients with STEMI and SCD was 19.2% compared to 10.0% in patients without SCD (p=0.03). After adjusting for pertinent covariates using logistic regression analysis, SCD remained an independent predictor of higher in-hospital mortality (p=0.02, OR 2.4; 95% CI 1.1-5.1).
Conclusions:
Sickle cell patients have a higher in-hospital mortality compared to the general population when presenting with STEMI.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.