Bhatia, Subir

Introduction: Role of therapeutic hypothermia in out of hospital cardiac arrest is well studied but data is sparse for in-hospital cardiac arrest (IHCA). Methods: Nationwide Inpatient Sample (NIS) database from 2011-2014 was utilized to identify ICHA using the ICD-9-CM procedural codes 99.60(CPR) and 99.63(closed cardiac massage) in any procedural fields. Therapeutic hypothermia was identified by 99.81 in any procedural field. Patient with age<18 years and missing information on age, gender and mortality was removed. Primary outcome was hospitalization survival. We used Greedy’s algorithm for propensity score match (1:20) to adjust for extensive list of clinically important confounders. We used simple logistic regression to generate odds ratio on matched cohort. Results: 86,593 patients (Age>65 years: 58.48%, female: 44.12%) with In hospital cardiac arrest was identified,of which 1777 (2.05 %) received therapeutic hypothermia. Overall survival was 30%- with or without hypothermia. After propensity score matching (1:20) we identified 1537 matched pairs (32,277 patients) without any statically significant difference in baseline characteristics between two groups. C- index for the model was 0.714. Worse survival was observed in patients with hypothermia in matched cohort [Survival: (31.82% without hypothermia vs. 28.1% with hypothermia with p-value- 0.002) (OR:0.84, 95% CI:0.75-0.94, p-0.002)]. About a quarter of in-hospital cardiac arrest were Vfib/Vtach arrest and Subgroup propensity score match analysis in Vfib/Vtach arrest showed better survival without hypothermia, similar results were observed in PEA/asystole cardiac arrest. Conclusion: Worst survival was observed with hypothermia in hospital cardiac arrest patients. Risk of hypothermia complications outweighs the benefit of preserving brain in patients who received almost immediate resuscitation. Future clinical trials and prospective studies will be needed to concur our results.

Background Chronic kidney disease ( CKD ) remains an independent predictor of cardiovascular morbidity and mortality. CKD complicates referral for percutaneous coronary intervention ( PCI ) in non–ST‐segment–elevation myocardial infarction ( NSTEMI ) patients because of the risk for acute kidney injury and the need for dialysis, with American College of Cardiology/American Heart Association guidelines underscoring the limited data on these patients. Methods and Results Using the National Inpatient Sample to analyze hospitalizations in the United States from 2004 to 2014, we sought to assess PCI utilization and in‐hospital outcomes in NSTEMI admissions with CKD . NSTEMI admissions were identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD‐9‐CM) code 410.7. CKD admissions were identified by ICD‐9‐CM code 585. Propensity score–matched cohorts of patients with NSTEMI were matched for age, sex, comorbidities, race, median household income, primary payer status, and hospital characteristics. Of 4 488 795 hospitalizations for NSTEMI , 31% underwent PCI . Overall, 89% of admissions had no CKD . In addition, 32% of NSTEMI admissions with no CKD and 23%, 14%, and 22% with CKD stages 3, 4, and 5 underwent PCI , respectively. Hospitalized NSTEMI patients with CKD stages 4 and 5 had 41% and 20% less likelihood, respectively, of undergoing PCI compared with those with no CKD . Among hospitalized NSTEMI patients with no CKD or CKD stage 3, 4, or 5, PCI ‐treated groups had 63%, 57%, 39%, and 59% lower likelihood, respectively, of all‐cause, in‐hospital mortality compared with propensity score–matched medically managed groups. Conclusions PCI use decreased among hospitalized NSTEMI patients as CKD severity increased, and all‐cause, in‐hospital mortality was greater for NSTEMI patients admitted with more severe CKD regardless of treatment strategy.