- Email: [email protected]
This abstract has been withdrawn
Abstracts
640 Performance of Endocarditis-Specific Risk Scores in Surgery for Infective Endocarditis T. Wang ∗ , T. Oh, J. Voss, N. Kang, J. Pemberton Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand Background: Risk models can play an important part in the decision-making of surgery for infective endocarditis, but they remain under-utilised. Several endocarditis-specific risk models have been recently published, and our previous study found two of these to be superior to the generalised EuroSCORE and EuroSCORE II. We compared the prognostic utility of mortality and morbidities of four endocarditis specific risk scores for endocarditis surgery. Methods: The additive Society of Thoracic surgeon’s (STS) Endocarditis Score, Costa Score, De Feo Score and Pulsuse Score were calculated for consecutive active infective endocarditis patients undergoing cardiac surgery during 2005-2011 at Auckland City Hospital and their discriminative value assessed. Results: Mean scores for the 146 patients studied with operative mortality 6.8% were additive STS Score: 32.2+/-13.5, Costa Score: 12.0+/-6.8, De Feo Score: 14.6+/-9.2 and Pulsuse Score 2.2+/-1.3. The c-statistics for operative mortality were 0.699, 0.596, 0.744 and 0.673; mortality at mean follow-up of 4.1 years 0.735, 0.651, 0.751 and 0.653; and composite morbidity 0.714, 0.662, 0.774 and 0.626. The De Feo Score was also the best model for predicting postoperative stroke (c=0.770), prolonged ventilation>24 hours (c=0.821), and return to theatre (c=0.712); and the Pulsuse Score for postoperative renal failure (c=0.645). Conclusion: Endocarditis-specific risk models vary in their prognostic utility for adverse outcomes. The De Feo Score has the best overall performance and should be used in risk stratification for endocarditis surgery. Publication of logistic models would also allow calibration testing of these scores. http://dx.doi.org/10.1016/j.hlc.2016.06.642 641 Predictors of In-Hospital Outcomes in Patients Post Out-of-Hospital Cardiac Arrest S. Biswas 1,∗ , R. Anderson 1 , D. Tsang 2 , J. Lefkovits 1 1 Royal
Melbourne Hospital, Melbourne, Australia 2 Western Health, Melbourne, Australia Background: Resuscitated patients post out-of-hospital cardiac arrest (OOHCA) remain a management challenge and have a high mortality rate. Patient demographic and biochemical factors are often used to estimate prognosis. We sought to identify predictors of in-hospital mortality in patients post OOHCA.
S275
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
Methods: Resuscitated patients post-OOHCA brought to Royal Melbourne Hospital between 01/01/2011 and 31/12/2015 were included and their medical records reviewed. Patients with an obvious non-cardiac cause for arrest or those transferred from another hospital postOOHCA were excluded. Results: 198 patients were included; 127 (64.1%) survived to discharge. Overall, 36.9% had ST elevation on the initial post-resuscitation ECG.
N (%)
Survived (n = 127)
Died in-hospital (n = 71)
P
............................................. Male 1st rhythm VT/VF Unfavourable features: • Age ≥60 years • Time to ROSC ≥35 minutes • pH <7.2 • Lactate ≥5 No unfavourable features
112 (88.2)
57 (80.3)
0.15
117 (92.1)
48 (67.6)
< 0.001
63 (49.6)
46 (64.8)
0.04
9 (7.1)
17 (23.9)
0.002
44 (38.2)
54 (76.1)
< 0.001
19 (21.3)
30 (60.0)
< 0.001
35 (27.6)
1 (1.4)
< 0.001
A scoring system was devised giving 1 point to each of the 4 key unfavourable clinical characteristics. 81/82 patients who scored 0 survived (99.7% negative predictive value). 29/39 (74.4%) patients who scored 3-4 died. Conclusion: Age ≥60yrs, time to ROSC ≥35 minutes, pH<7.2 and lactate ≥5 are all associated with lower hospital survival rates. These characteristics may be combined as a risk score to help predict in-hospital survival after cardiac arrest. http://dx.doi.org/10.1016/j.hlc.2016.06.643 642 This abstract has been withdrawn
643 Prognostic impact of atrial fibrillation in the emergency chest pain presentation D. Lancini 1,∗ , P. Martin 1 , L. Cullen 2 , J. Greenslaide 2 , J. Hammett 1 , S. Prasad 1 , M. Than 3 , W. Parsonage 1 1 Royal Brisbane and Women’s Hospital, Brisbane, Australia 2 Royal Brisbane and Women’s Hospital, Emergency Department, Brisbane, Australia 3 Christchurch Hospital, Emergency Department, Christchurch, New Zealand
640 Performance of Endocarditis-Specific Risk Scores in Surgery for Infective Endocarditis T. Wang ∗ , T. Oh, J. Voss, N. Kang, J. Pemberton Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand Background: Risk models can play an important part in the decision-making of surgery for infective endocarditis, but they remain under-utilised. Several endocarditis-specific risk models have been recently published, and our previous study found two of these to be superior to the generalised EuroSCORE and EuroSCORE II. We compared the prognostic utility of mortality and morbidities of four endocarditis specific risk scores for endocarditis surgery. Methods: The additive Society of Thoracic surgeon’s (STS) Endocarditis Score, Costa Score, De Feo Score and Pulsuse Score were calculated for consecutive active infective endocarditis patients undergoing cardiac surgery during 2005-2011 at Auckland City Hospital and their discriminative value assessed. Results: Mean scores for the 146 patients studied with operative mortality 6.8% were additive STS Score: 32.2+/-13.5, Costa Score: 12.0+/-6.8, De Feo Score: 14.6+/-9.2 and Pulsuse Score 2.2+/-1.3. The c-statistics for operative mortality were 0.699, 0.596, 0.744 and 0.673; mortality at mean follow-up of 4.1 years 0.735, 0.651, 0.751 and 0.653; and composite morbidity 0.714, 0.662, 0.774 and 0.626. The De Feo Score was also the best model for predicting postoperative stroke (c=0.770), prolonged ventilation>24 hours (c=0.821), and return to theatre (c=0.712); and the Pulsuse Score for postoperative renal failure (c=0.645). Conclusion: Endocarditis-specific risk models vary in their prognostic utility for adverse outcomes. The De Feo Score has the best overall performance and should be used in risk stratification for endocarditis surgery. Publication of logistic models would also allow calibration testing of these scores. http://dx.doi.org/10.1016/j.hlc.2016.06.642 641 Predictors of In-Hospital Outcomes in Patients Post Out-of-Hospital Cardiac Arrest S. Biswas 1,∗ , R. Anderson 1 , D. Tsang 2 , J. Lefkovits 1 1 Royal
Melbourne Hospital, Melbourne, Australia 2 Western Health, Melbourne, Australia Background: Resuscitated patients post out-of-hospital cardiac arrest (OOHCA) remain a management challenge and have a high mortality rate. Patient demographic and biochemical factors are often used to estimate prognosis. We sought to identify predictors of in-hospital mortality in patients post OOHCA.
S275
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
Methods: Resuscitated patients post-OOHCA brought to Royal Melbourne Hospital between 01/01/2011 and 31/12/2015 were included and their medical records reviewed. Patients with an obvious non-cardiac cause for arrest or those transferred from another hospital postOOHCA were excluded. Results: 198 patients were included; 127 (64.1%) survived to discharge. Overall, 36.9% had ST elevation on the initial post-resuscitation ECG.
N (%)
Survived (n = 127)
Died in-hospital (n = 71)
P
............................................. Male 1st rhythm VT/VF Unfavourable features: • Age ≥60 years • Time to ROSC ≥35 minutes • pH <7.2 • Lactate ≥5 No unfavourable features
112 (88.2)
57 (80.3)
0.15
117 (92.1)
48 (67.6)
< 0.001
63 (49.6)
46 (64.8)
0.04
9 (7.1)
17 (23.9)
0.002
44 (38.2)
54 (76.1)
< 0.001
19 (21.3)
30 (60.0)
< 0.001
35 (27.6)
1 (1.4)
< 0.001
A scoring system was devised giving 1 point to each of the 4 key unfavourable clinical characteristics. 81/82 patients who scored 0 survived (99.7% negative predictive value). 29/39 (74.4%) patients who scored 3-4 died. Conclusion: Age ≥60yrs, time to ROSC ≥35 minutes, pH<7.2 and lactate ≥5 are all associated with lower hospital survival rates. These characteristics may be combined as a risk score to help predict in-hospital survival after cardiac arrest. http://dx.doi.org/10.1016/j.hlc.2016.06.643 642 This abstract has been withdrawn
643 Prognostic impact of atrial fibrillation in the emergency chest pain presentation D. Lancini 1,∗ , P. Martin 1 , L. Cullen 2 , J. Greenslaide 2 , J. Hammett 1 , S. Prasad 1 , M. Than 3 , W. Parsonage 1 1 Royal Brisbane and Women’s Hospital, Brisbane, Australia 2 Royal Brisbane and Women’s Hospital, Emergency Department, Brisbane, Australia 3 Christchurch Hospital, Emergency Department, Christchurch, New Zealand