Arwa Younis

Elevated Admission Potassium Levels and 1-Year and 10-Year Mortality Among Patients With Heart Failure

Background: Limited, contradictory data exist regarding the effect of hyperkalemia on both short‐ and long‐term all‐cause mortality among hospitalized patients with heart failure (HF). Methods: We analyzed 4,031 patients who were enrolled in the Heart Failure Survey in Israel. The study patients were grouped into 3 different potassium (K) categories. Multivariate analysis was used to determine the association of potassium levels as well as 1‐ and 10‐year all‐cause mortality. Results: A total of 3,349 patients (83%) had K < 5 mEq/L, whereas 461 patients (11%) had serum K ≥ 5 mEq/L but≤ 5.5 mEq/L and 221 patients (6%) had K > 5.5 mEq/L. Survival analysis showed that 1‐year mortality rates were significantly higher among patients with K > 5.5 mEq/L (40%) and those with serum K ≥ 5 mEq/L but ≤ 5.5 mEq/L (34%) compared to those with K < 5 mEq/L (27%); (all log rank P < 0.01). Similarly, 10‐year mortality rates among those with K > 5.5 mEq/L were 92%, whereas among those with serum K ≥ 5 mEq/L but ≤ 5.5 mEq/L rates were 88%, and in those with K < 5 mEq/L rates were 82%; (all log rank P < 0.001). Consistently, multivariate analysis showed that compared to patients with K < 5 mEq/L, patients with K > 5.5 mEq/L had an independently 51% and 31% higher mortality risk at 1 year and 10 years, respectively (1‐year hazard ratio = 1.51, 95% CI: 1.04‐2.2; 10‐years hazard ratio = 1.31, 95% CI: 1.035‐1.66), whereas patients with serum K ≥ 5 mEq/L but ≤ 5.5 mEq/L had comparable adjusted mortality risk to patients with K < 5 mEq/L at 1 and 10 years. Conclusions: Among hospitalized patients with HF, admission K > 5.5 mEq/L was independently associated with increased short‐ and long‐term mortality, whereas serum K ≥ 5 mEq/L but ≤ 5.5 mEq/L was not independently associated with worse outcomes.

Long-Term Outcomes of Iliofemoral Artery Stents after Transfemoral Aortic Valve Replacement

PURPOSE To report long-term results of iliofemoral stent placement after transcatheter aortic valve replacement (TAVR). MATERIALS AND METHODS TAVR access-related complications treated with iliofemoral stent placement were recorded in 56 patients (mean age, 81 years; range; 53-93 years; 48% male) of 648 patients who underwent TAVR at a single center. Fifty-six patients treated with stent placement (40 patients with stent grafts and 16 patients with bare metal stents) underwent clinical and ultrasonographic follow-up after a mean of 676 days (range, 60-1840 days). RESULTS During follow-up, none of the 56 patients who had stent placement underwent a vascular reintervention of the affected limb, and none suffered from limb claudication. No decrease was observed in ankle-brachial index (ABI) values to an abnormal value, except in 1 patient (mean preprocedural and postprocedural ABI of 1.2 ± 0.14, range, 0.97-1.4 and 1.19 ± 0.24, range, 0.65-1.54, respectively). Arterial duplex assessment showed normal stent flow velocity (mean, 168.7 ± 63.2 cm/sec; range, 80-345 cm/sec) in all but 1 patient. CONCLUSION Iliofemoral stent implantation is a safe and efficacious treatment for vascular access site and access-related complications during transfemoral TAVR.

The Association of Body Mass Index and 20-Year All-Cause Mortality Among Patients With Stable Coronary Artery Disease

BACKGROUND Limited data exist regarding the long-term association of body mass index (BMI) and all-cause mortality among patients with stable coronary artery disease (CAD). Accordingly, the aim of this study is to explore the association between BMI and long-term all-cause mortality among patients with stable CAD. METHODS Our study included 15,357 patients with stable CAD who were enrolled in the Bezafibrate Infarction Prevention (BIP) registry between February, 1990 and October1992, and subsequently followed-up through December 2014. RESULTS 5,051 (33%) patients were classified as normal weight (BMI 18.5-24.99kg/m2), while 7,841 (51%) patients were classified as overweight (BMI 25-29.99kg/m2), and 2,465 (16%) as obese (BMI≥30). Kaplan-Meier survival analysis showed that at 20 years of follow-up the rate of all-cause mortality was significantly higher among obese patients (67%) compared to overweight (61%) and normal weight (61%); log rank p-value for the overall difference <0.001. Multivariable analysis showed that obese patients had an independently 12% greater mortality risk compared to normal weight patients (HR=1.12; 95% CI 1.02-1.23; p=0.02), whereas, overweight patients experienced a similar mortality risk as normal weight patients (HR=0.99; 95% CI 0.92-1.06; p=0.76). The mortality risk associated with obesity was pronounced among patients younger than 65 years (p-value for interaction<0.05). CONCLUSIONS Our findings indicate that obesity is independently associated with increased risk for long-term mortality among patients with stable coronary artery disease, whereas overweight does not appear to confer an additional risk in this population.