BACKGROUND

Malnutrition is a component of frailty syndrome characterized by weakness, poor nutritional status, and reduced cognitive function. Frailty has been recognized to adversely affect post-cardiovascular surgery outcomes, with studies primarily in the elderly. To date, there are no published Philippine data on malnutrition and frailty in cardiac surgery patients.

METHODS

Malnutrition and frailty were assessed preoperatively in 111 adult patients undergoing cardiovascular surgery from October 2020 to February 2021. Nutrition Risk Screening (NRS) tool and Clinical Frailty Scale (CFS) were used for assessment, respectively. Their in-hospital postoperative outcomes were then observed.

RESULTS

There were 57 patients (51%) diagnosed with malnutrition, 26 (23%) of whom were also frail. Advanced age, rheumatic heart disease, heart failure, and chronic kidney disease were significantly higher in the malnutrition and frail group. After multivariate analysis, mortality rate (odds ratio [OR], 7.8; 95% confidence interval [CI], 1.45-41.91; P = 0.017), prolonged hospitalization (OR, 5.96; 95% CI, 2.14-16.53; P = 0.001), mechanical ventilation (OR, 7.56; 95% CI, 1.81-31.62; P = 0.006), and nosocomial infections (OR, 13.57; 95% CI, 4.41-41.76; P < 0.001) were found higher in patients with malnutrition and frailty.

CONCLUSION

Evaluation of nutrition and frailty status using NRS and CFS was helpful in predicting postoperative outcomes. With a significant number of this population having malnutrition and frailty, there is a need to strengthen clinical pathways on perioperative nutrition and rehabilitation with the possibility of improving cardiovascular surgery outcomes.

Malnutrition ; Frailty

BACKGROUND

Primary percutaneous coronary intervention (PPCI) may be complicated by heavy intracoronary thrombus burden leading to decrease in myocardial perfusion and increase in infarct size. The current meta-analysis aims to investigate the clinical outcomes of aspiration thrombectomy (AT) with intracoronary tirofiban during PPCI.

METHODS

A systematic search for randomized controlled trials that evaluate the safety and efficacy of AT with intracoronary tirofiban in ST-elevation myocardial infarction (STEMI) patients who underwent PPCI was done using PubMed, MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov., and Herdin PH. Studies included those published between 2010 and 2023 and involved human subjects. Search terms included “aspiration thrombectomy,” “intracoronary tirofiban,” “primary percutaneous coronary intervention,” and “STEMI patients.”

RESULTS

Four randomized controlled trials (n = 490 participants) were included in this metaanalysis comparing AT with intracoronary tirofiban versus AT alone in STEMI patients undergoing PPCI. The results revealed no statistically significant difference in ST-segment resolution (risk ratio [RR], 1.02; 95% confidence interval [CI], 0.97–1.08; P = 0.41, I2 = 0%), myocardial blush grade 2–3, (RR, 1.04; 95% CI, 0.97–1.12; P = 0.22, I2 = 62%), and Thrombolysis In Myocardial Infarction 3 flow (RR, < 1.0; 95% CI, 0.95–1.04; P = 0.87).

The occurrence of major adverse cardiovascular events did not significantly differ between the two groups (RR, 0.46; 95% CI, 0.19–1.09; P = 0.08, I2 = 0%). There was no statistically significant difference in terms of bleeding when combining intracoronary tirofiban to standard medical therapy (RR, 1.35; 95% CI, 0.64–2.84; P = 0.78, four trials [490 patients]).

CONCLUSION

In PPCI, major adverse cardiovascular event outcomes of AT with intracoronary tirofiban were similar to those for AT alone in terms of improving myocardial perfusion in STEMI patients without increasing the risk for bleeding. Our meta-analysis suggests that AT alone may be the more acceptable standard during PPCI when encountering heavy thrombus burden. Future validated studies may help further investigate the strategy of adding tirofiban during AT.

Thrombectomy ; Tirofiban ; Percutaneous Coronary Intervention