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Background: Hemodynamic values from right heart catheterization aid diagnosis and clinical decision-making but may not predict outcomes. Mixed venous oxygen saturation percentage and pulmonary capillary wedge pressure relate to cardiac output and congestion, respectively. We theorized that a novel, simple ratio of these measurements could estimate cardiovascular prognosis. Methods: We queried Veterans Affairs' databases for clinical, hemodynamic, and outcome data. Using the index right heart catheterization between 2010 and 2016, we calculated the ratio of mixed venous oxygen saturation-to-pulmonary capillary wedge pressure, termed ratio of saturation-to-wedge (RSW). The primary outcome was time to all-cause mortality; secondary outcome was 1-year urgent heart failure presentation. Patients were stratified into quartiles of RSW, Fick cardiac index (CI), thermodilution CI, and pulmonary capillary wedge pressure alone. Kaplan-Meier curves and Cox proportional hazards models related comparators with outcomes. Results: Of 12 019 patients meeting inclusion criteria, 9826 had values to calculate RSW (median 4.00, interquartile range, 2.67-6.05). Kaplan-Meier curves showed early, sustained separation by RSW strata. Cox modeling estimated that increasing RSW by 50% decreases mortality hazard by 19% (estimated hazard ratio, 0.81 [95% CI, 0.79-0.83], P <0.001)> P <0.001).> Conclusions: In a large national database, RSW was superior to conventional right heart catheterization indices at assessing risk of mortality and urgent heart failure presentation. This simple calculation with routine data may contribute to clinical decision-making in this population. * In a large sample of US veterans, the ratio of saturation-to-wedge (RSW) can be calculated easily from parameters obtained from most right heart catheterizations by dividing the percentage of mixed venous oxygen saturation by the pulmonary capillary wedge pressure. * Larger values of RSW were associated with significantly lower risks of all-cause mortality and hospitalization/emergency department presentation, with and without adjustment for clinical characteristics. * In comparison to other hemodynamic measurements, including cardiac index measured by Fick and thermodilution methods, and pulmonary capillary wedge pressure alone, RSW had the strongest association with clinical outcomes. * The principle of RSW relates mixed venous oxygen saturation and pulmonary capillary wedge pressure, lower values indicating a hemodynamic profile of cold and wet and poor outcomes. * The RSW is a superior and easy to calculate index that offers prognostic value over conventional hemodynamic measurements for risk stratification of patients undergoing right heart catheterization. [ABSTRACT FROM AUTHOR]

The article presents a study assessing the impact of stent fracture (SF) relative to non-SF on four-year clinical outcomes after treatment with sirolimus-eluting stent (SES) of comparable unselected lesions. The study involves 874 lesions in 793 patients undergoing SES implantation and subsequent angiography six to nine months after index procedure analysis. It finds that SF of SES was associated with higher major adverse cardiac events (MACE) rate up to one year only.

Objectives: The neutrophil-to-lymphocyte ratio (NLR) predicts short-term and long-term mortalities in patients with stable and unstable coronary artery disease. However, it has been reported that white blood cell and neutrophil counts vary considerably among different races. We aimed to assess the impact of racial difference on NLR in our diverse population with non-ST-segment elevation myocardial infarction (NSTEMI)., Methods: We carried out a retrospective analysis of 456 consecutive NSTEMI patients who had undergone coronary angiography. The patients were divided into four groups on the basis of self-reported race: White, Hispanic, African-American, and Asian. NLR was compared among the four groups. Univariate and multivariate linear regression analyses were carried out between NLR and baseline clinical characteristics and angiographic findings. The primary outcome was inhospital mortality., Results: The median NLR in the entire study population was 3.47 (interquartile range, 2.16-5.57). NLR differed significantly among the four groups according to the Kruskal-Wallis test (P=0.03). NLR was significantly lower in the African-American group compared with the White group according to the Steel-Dwass test (P=0.03). Multivariate analysis revealed that African-American ethnicity was negatively associated with NLR (P=0.04). The second multivariate analysis using the White group as a reference also revealed that African-American ethnicity was negatively associated with NLR (P=0.04). There was no significant difference in inhospital mortality among the four groups., Conclusion: The present study demonstrated an independent association between race and NLR in patients with NSTEMI, suggesting that a tailored cutoff value according to race would provide more precise prognostic information.