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Objective: The Killip classification and the Thrombolysis in Myocardial Infarction (TIMI) score have been proven to be useful tools for the early risk stratification of patients with acute myocardial infarction (MI). The Killip classification is simpler and less time consuming compared to the TIMI score. We sought to evaluate the added value of applying the TIMI score to patients prestratified with the Killip classification. Methods: A total of 1,773 consecutive acute MI patients were hospitalized in 25 coronary care units operating in Israel, and were followed up to 1 year. Results: Higher Killip class was associated with increased 1-year mortality: 6, 24, 42 and 60% in Killip 1-4, respectively. Applying the TIMI score to Killip 1 patients resulted in further stratifying the patients to low-, medium- and high-risk patient groups with 1, 8 and 19% 1-year mortality rates. Conclusions: The Killip classification is a useful tool for early risk stratification of acute MI patients. Applying the TIMI score to patients classified as Killip 1 further stratified them into low-, medium- and high-risk subgroups significantly improving stratification by the Killip classification alone. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: The perioperative assessment and management of elderly patients with hip fracture and significant aortic stenosis (AS) is an increasingly common clinical problem with little data available to guide perioperative management. Objectives: It was the aim of this study to examine the incidence of perioperative events in an elderly population of patients with severe AS undergoing repair of hip fracture as compared with controls without severe AS. Methods: Patients over the age of 70 with an echocardiographic diagnosis of severe AS defined as an aortic valve area ≤1.0 cm2 who underwent surgery for hip fracture repair were retrospectively identified. An age-matched group of patients without a history of AS who underwent surgical repair of hip fracture was the control group. The primary outcome of the incidence of postoperative cardiac events defined as death, acute coronary syndrome or pulmonary edema within 30 days was compared. Results: Thirty-two patients with AS (median age 84.5 years, range 72–94; 27 females and 5 males) and 88 controls (median age 86 years, range 80–95; 67 females and 21 males) were entered into the study. There were no significant differences between the AS group and controls for 30-day mortality (6.2 vs. 6.8%) or for the total cardiac event rate (18.7 vs. 11.8%). Conclusions: Our results demonstrate that elderly patients with severe AS can safely undergo repair of hip fractures with a mortality and morbidity comparable with a control population. These patients should not be denied surgery on the basis of their aortic valve disease. [ABSTRACT FROM AUTHOR]

Objectives: Brain natriuretic peptide (BNP) levels correlate with prognosis in patients with cardiac disease and may be useful in the risk stratification of cardiac patients undergoing noncardiac surgery (NCS). The objective of this study was to examine whether BNP levels predict perioperative events in cardiac patients undergoing NCS. Methods: Patients undergoing NCS with at least 1 of the following criteria were included: a clinical history of congestive heart failure (CHF), ejection fraction <40%, or severe aortic stenosis. All patients underwent echocardiography and measurement of BNP performed using the ADVIA-Centaur BNP assay (Bayer HealthCare). Clinical endpoints were death, myocardial infarction or pulmonary congestion requiring intravenous diuretics at 30 days of follow-up. Results: Forty-four patients were entered into the study; 15 patients (34%) developed cardiac postoperative complications. The mean BNP level was 1,366 ± 1,420 pg/ml in patients with events and 167 ± 194 pg/ml in patients without events, indicating a highly significant difference (p < 0.001). The ROC area under the curve was 0.91 (95% CI 0.83–0.99) with an optimal cutoff of >165 pg/ml (100% sensitivity, 70% specificity). Conclusions: BNP levels may predict perioperative complications in cardiac patients undergoing NCS, and the measurement of BNP should be considered to assess the preoperative cardiac risk. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We compared the characteristics, management and outcome of patients with or without prior coronary artery bypass graft surgery (CABG) presenting with AMI to any coronary care unit in Israel, from four national surveys performed during 1992-1998. Of 5,396 patients, 171 (3.2%) had prior CABG, 39 of whom received thrombolysis. Thrombolysis was administered less often in patients with prior CABG, but the utilization of coronary angiography was similar. Mortality rates were higher in patients with prior CABG, particularly among those given thrombolysis. The use of coronary angiography was a strong independent predictor of survival, but its utilization was similar in patients with or without prior CABG. Patients with prior CABG constitute a small minority among current AMI patients. They are sicker and their mortality is higher compared to patients without prior surgery, especially among those given thrombolysis. Coronary angiography is associated with improved outcome in these patients but is currently used to the same extent as in patients without prior surgery. [ABSTRACT FROM AUTHOR]