Srikulmontri, Thitiphan

Background/Objectives: In the United States, HF prevalence is projected to progressively rise by 2030. Prior research suggests a strong association between reduced sleep duration and increased cardiovascular disease and HF risk. This study introduces an alternative parameter, the weekend sleep recovery (WSR), measured by the weekend-to-weekday sleep duration ratio (SDR), to evaluate its association with HF risk. Methods: We conducted a cross-sectional analysis of NHANES (National Health and Nutrition Examination Survey) 2017–2023 to examine self-reported sleep patterns. Participants were classified as WSR (SDR > 1) or non-WSR (SDR ≤ 1). Multivariate logistic regression assessed the association between WSR and HF, adjusting for demographics and comorbidities. Results: Among 8320 participants included in the fully adjusted analysis, WSR was associated with lower odds of HF compared with non-WSR (adjusted OR 0.73, 95% CI 0.55–0.96; p = 0.026). A significant interaction was observed between WSR and weekday sleep duration (P for interaction = 0.003), whereas no interaction was found with weekend sleep duration. In exploratory subgroup analyses, nominally significant associations were observed in several clinical subgroups; however, after correction for multiple comparisons, only participants without dyslipidemia retained statistical significance. No significant effect modification by race/ethnicity was observed (P for interaction = 0.436). Conclusions: Weekend sleep recovery was associated with lower odds of HF in this cross-sectional study. The association varied according to weekday sleep duration but was generally consistent across racial/ethnic groups. Given the observational design, these findings should be interpreted as associative rather than causal and warrant confirmation in prospective studies.

Background: Revascularization of small vessel coronary artery disease (SvCAD) is still challenging despite the extensive use of drug-eluting stents (DESs), mainly because of an increase in target vessel failure. Drug-coated balloon (DCB) has emerged as an alternative strategy in SvCAD. However, the safety and efficacy of DCB in SvCAD is still controversial. We conducted a meta-analysis comparing the clinical outcomes of DCB and DES in SvCAD patients. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2024. Included studies were published randomized control trials (RCTs) that compared major adverse cardiac events (MACE), target-lesion revascularization (TLR), and target-vessel revascularization (TVR) between DCB and DES in SvCAD patients. Data from each study were combined using the random-effects model. Results: Six RCTs were included in this meta-analysis involving 1,534 SvCAD patients (775 underwent revascularization with DCB and 759 with DES). There was no difference in MACE, TLR, and TVR between DCB and DES groups ([OR] 1.14, 95% CI 0.64-2.00, I 2 =58.2%, p=0.657, [OR] 1.34, 95% CI 0.56-3.23, I 2 =48.5%, p=0.516, and [OR] 1.09, 95% CI 0.59-2.01, I 2 =49.6%, p=0.795, respectively) (Figure 1). There was no publication bias observed in Funnel plot as well as no small-study effect observed in Egger’s test. Conclusions: As compared to DES, our study showed that DCB was associated with similar clinical outcomes and could be a potential alternative strategy in SvCAD patients.

Introduction: Chronic total coronary occlusion (CTO) management remains a challenge. Several studies have reported the benefits of percutaneous coronary intervention (PCI) in CTO. However, the outcomes of PCI vs optimal medical therapy (OMT) are still controversial. We conducted an extensive review and meta-analysis to compare the clinical outcomes between PCI and OMT in CTO. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2024. Included studies were published cohort (prospective or retrospective) with propensity score matching analysis and randomized trials that reported all-cause death, cardiac death, and myocardial infarction (MI) with PCI and OMT in CTO patients. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate odd ratios and 95% confidence intervals. Results: Sixteen studies, 6 randomized controlled trials (RCTs) and 11 observational studies with propensity score with matching (PSMs), were included in this meta-analysis involving 8,316 CTO patients (4,332 underwent PCI and 4,084 received OMT). In the overall analysis, all-cause death, cardiac death, and MI were significantly reduced in PCI compared to OMT group, respectively ([OR] 0.65, 95% CI 0.55-0.76, I 2 =0.0%, p<0.001, [OR] 0.60, 95% CI 0.49-0.74, I 2 =0.0%, p<0.001, and [OR] 0.72, 95% CI 0.52-0.99, I 2 =19.0%, p=0.041). Conclusions: Our study is the most updated meta-analysis to assess the impact of PCI compared to OMT in patients with CTO, analyzing the data being derived from PSMs and RCTs, that demonstrated significant impact of PCI on all-cause death, cardiac mortality, and MI.

Background: There is suspicion that estrogen may protect against atherosclerosis. Women who experience menarche earlier, and thus have earlier estrogen exposure, might develop atherosclerosis later. The relationship between menarche age and the onset of angina pectoris, a symptom of coronary artery disease, remains unknown. Goal: This study aims to find the correlation between menarche age and the onset age of angina pectoris, and the association between early menarche (onset of menarche ≤ 10 y/o) and early onset of angina pectoris (onset of angina pectoris ≤ 40 y/o). Methods: A cross-sectional study using a population from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). The question collects self-reported data on onset of menarche and onset of angina pectoris. The relationship between menarche age and age in onset of angina pectoris was analyzed by linear and logistic regression analysis. Multivariate analysis adjusted for race, age, body mass index (BMI), smoking , diabetes mellitus (DM), hypertension, and dyslipidemia status. Results: Among 4,816 females who reported their menarche age, 88(1.8 %) have had an angina pectoris. The study involved 82 females who reported both the age of menarche and the age of onset of angina pectoris. The mean ± SD of the age at menarche and the age at onset of angina pectoris was 12.53 ± 1.79 y/o and 51.66 ± 15.16 y/o, respectively. The study found a significant association between the menarche age and the age at onset of angina pectoris. After adjusting for confounders, we found that every 1-year increase in the age of menarche will delay the onset of angina pectoris by 1.43 years, with a 95% CI of 0.01 to 2.86.(Table 1A,Graph 1A-1B) We also found that early menarche has a significantly increased risk 2.8 times (95%CI: 1.3, 6.2) of early onset of angina pectoris.After adjusting for confounders, the association became even stronger. The odds ratio (OR) increased to 3.3 (95%CI: 1.4, 8.0), indicating that women with early menarche were 3.3 times more likely to experience early angina pectoris compared to those with later menarche.(Table 2A) Conclusion: In contrast to our hypothesis, age at menarche is positively associated with onset of angina pectoris. The earlier onset of menarche is linked to the earlier onset of angina pectoris. We suspected that factors beyond estrogen levels may contribute to this unexpected finding. Additional studies are needed to examine the cause of this correlation.

29 Background: Previous research highlights central nervous system (CNS) malignancy as significant contributors to disability-adjusted life-years. However, there's a lack of information on the impact of COVID-19 infection in hospitalized CNS malignancy patients. Methods: Using the 2020 U.S. National Inpatient Sample (NIS), we investigated the impact of COVID-19 infection affected patients primarily hospitalized for CNS malignancy. We calculated adjusted odds ratios (aORs) for specific outcomes using multivariable logistic and linear regression analyses. The primary outcome was inpatient mortality, with secondary outcomes including system-based complications. Results: We identified 37,385 patients diagnosed with CNS malignancy, averaging 53.6 years old, with 57.76% being female. Among them, 0.84% (315/37,385) were also diagnosed with COVID-19. After adjusting for patient and hospital factors, COVID-19 infection was linked to higher in-hospital mortality (aOR 4.12, 95% CI: 1.55, 10.89, p = 0.004), longer stays (Beta-coefficient 6.06, 95% CI: 2.97, 9.14, p < 0.001), increased total hospital costs (Beta-coefficient 11,855, 95% CI: 1,410, 22,301, p = 0.026), elevated risks of shock (aOR 3.96, 95% CI 1.03, 15.10, p = 0.018), acute respiratory failure (aOR 4.33, 95% CI: 1.83, 10.22, p = 0.001), and sepsis (aOR 3.96, 95% CI: 1.03, 15.10, p = 0.044). Conclusions: Our study reveals that COVID-19 infection is associated with higher in-hospital mortality and multiple adverse outcomes in patients hospitalized for CNS malignancy. Further longitudinal studies are necessary to thoroughly investigate the causality of these clinical outcomes in this population.

212 Background: Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related deaths globally. Recent data showed the detrimental effects of COVID-19 infection on other neoplasm conditions, causing increased mortality rates and complications. However, data on the precise effects of COVID-19 on hospitalized individuals with lung cancer are scarce. Methods: We analyzed the 2020 U.S. National Inpatient Sample (NIS) to investigate the effects of COVID-19 infection on cases primarily admitted due to lung and bronchus cancer. Adjusted odds ratios (aORs) for specified outcomes were calculated through multivariable logistic and linear regression analyses. The primary outcome was inpatient mortality, with secondary outcomes including system-based complications. Statistical significance was established at a p-value of 0.05. Results: We identified 103,334 patients with a primary discharge diagnosis of lung and bronchus cancer. The mean age was 68.9 years; 50.5% were female. In the non-COVID group, Caucasians accounted for 75%, followed by Hispanics (12%). Of these, 0.36% (374/103,334) had a concurrent diagnosis of COVID-19 infection. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality (aOR 5.39; 95% CI (3.01, 9.64), p < 0.001), higher mean length of stay (b 5.51; 95% CI (2.59, 8.43) p < 0.001), mean total hospital cost (b 10,683; 95% CI (784.32, 20,581.93) p = 0.034), shock (aOR 4.37; 95% CI (1.96, 9.91), p < 0.001), acute respiratory failure (aOR 2.23; 95% CI (1.30, 3.85), p = 0.004), mechanical ventilation usage (aOR 3.12; 95% CI (1.46, 6.66), p = 0.003) and acute kidney injury (aOR 2.71; 95% CI (1.54, 4.74), p < 0.001). We observed non-significant, but increased, risks of sepsis, SIRS, and coagulopathy in COVID-19-positive patients. Conclusions: In conclusion, our study underscores that COVID-19 infection is associated with higher in-hospital mortality and other major clinical outcomes in lung cancer, as well as increased economic burden and cost of stay. To definitively establish causal relationships between the observed factors and the reported clinical outcomes in this population, further longitudinal research is necessary.

182 Background: Recent data showed the detrimental effects of COVID-19 infection on various conditions, resulting in a wide range of health disparities and worsening outcomes, as well as an increased burden of cost. However, limited information exists on the impacts of COVID-19 infection on the most commonly admitted with primary cancer, regarding clinical and economic impact. Methods: We analyzed the 2020 U.S. National Inpatient Sample (NIS) to investigate the effects of COVID-19 infection on cases primarily admitted with the most common admitted with primary cancer, using relevant ICD-10 CM codes. Adjusted odds ratios (aORs) for specified outcomes were calculated through multivariable logistic and linear regression analyses. The primary outcome was inpatient mortality, with secondary outcomes including the cost of hospitalization and length of stay. Statistical significance was established at a p-value of 0.05. Results: We estimated 919,104 hospitalizations with a primary discharge diagnosis of cancer conditions. Of these, 0.54% (4,985/919,104) had a concurrent diagnosis of COVID-19 infection and 46.1% were female. The mean age was 63.6 years old and Caucasians dominated the majority of the records (69.7%), followed by Hispanics (13.1%). In a multivariable logistic and linear regression model adjusting for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality for all cancer conditions and other outcome. The txable denotes all-type and subpopulation analysis. Conclusions: In conclusion, our study encompasses all most common admitted primary cancer conditions and shed light how COVID-19 infection is associated with higher in-hospital mortality, prolonged hospital stays, and increased economic burden in various condition. Future longitudinal studies are warranted to comprehensively assess the long-term health sequelae in this population. [Table: see text]

173 Background: Recent evidence found increase incidence of heart failure in leukemia patients, influenced by various factors such as the underlying disease and medication usage. Nevertheless, there remains a scarcity of data regarding the in-hospital outcome for individuals admitted for leukemia with comorbid acute decompensated heart failure. Thus, we aim to examine the impact of heart failure on clinical outcomes in leukemia patients. Methods: We utilized the 2020 U.S. National Inpatient Sample (NIS) to investigate patients admitted for leukemia with concurrent diagnosis of heart failure, identified through ICD-10 CM codes. Adjusted odds ratios (aORs) for predefined outcomes were determined using multivariable logistic and linear regression model, adjusting for comorbidities. The primary outcome assessed was inpatient mortality, while secondary outcomes included complications related to various body systems. Results: We identified 43,955 patients with a primary discharge diagnosis of leukemia. The mean age was 54.5 years; 49.7% were female. Caucasians accounted for 66%, followed by African Americans (13%). Of these, 11.86% (5,220/43,955) had a concurrent diagnosis of heart failure. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, comorbid acute decompensated heart failure was associated with higher in-hospital mortality (aOR 1.57, 95% CI: 1.2, 1.94, p < 0.001), higher mean length of stay (Beta-coefficient 1.93; 95% CI: 0.65, 3.21, p = 0.003), mean total hospital cost (Beta-coefficient 9,472, 95% CI: 2,339, 16,604, p = 0.004), shock (aOR 2.41, 95% CI: 1.84, 3.15, p < 0.001), sepsis (aOR 1.71, 95%CI: 1.38, 2.12, p < 0.001), acute respiratory failure (aOR 2.37, 95% CI: 1.96, 2.87, p < 0.001), and acute kidney injury (aOR 1.57, 95% CI: 1.32, 1.85, p < 0.001). Conclusions: Our study revealed that hospitalized leukemia patients with concurrent heart failure experience higher risk of in-hospital mortality and various adverse in-hospital outcomes. Close monitoring of this factor during hospitalization is essential, and additional longitudinal research is warranted to fully understand this association.