Post-operative atrial fibrillation (POAF) is common after coronary artery bypass graft (CABG) surgery, occurring in 20% to 40% of patients and significantly increasing morbidity. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, a composite nutritional-inflammatory index, is a prognostic marker in cardiovascular disease. However, its predictive value for POAF remains unestablished. We aimed to evaluate the predictive performance of 5 nutritional-inflammatory indices (HALP, Naples score, Systemic Immune-Inflammation Index [SII], neutrophil percentage-to-albumin ratio [NPAR], and C-reactive protein-albumin-lymphocyte [CALLY] index) for POAF and internally validate a novel prediction model incorporating HALP. Among 448 patients undergoing CABG, POAF occurred in 131 (29.2%). The HALP score demonstrated the highest discriminative ability (area under curve [AUC] 0.812), significantly ( P < .001) outperforming Naples (AUC 0.676), NPAR (AUC 0.730), SII (AUC 0.726), and CALLY (AUC 0.684). Adding HALP to the Least Absolute Shrinkage and Selection Operator (LASSO)-derived base model significantly improved discriminative ability (AUC 0.813-0.897; P < .001) and net clinical benefit across threshold probabilities. The combined model achieved a bootstrap-corrected AUC of 0.885 with a calibration slope of 0.909, reflecting excellent internal validity. HALP was the strongest POAF predictor in the combined model. The HALP-integrated model showed excellent performance, offering a practical tool for preoperative POAF risk stratification.
Infective endocarditis (IE) in patients with malignancy represents a high-risk clinical cohort, yet nationwide data on outcomes and predictors of mortality remain limited. Using the United States National Inpatient Sample (2016-2022), we identified hospitalizations involving IE and a malignancy diagnosis. Inpatient mortality, complications, and temporal trends were analyzed overall and across malignancy subtypes, causative organisms, and prosthetic valve status. Survey-weighted multivariable logistic regression was performed across the full IE cohort. Of 635 715 IE hospitalizations, 44 060 (6.9%) involved a malignancy diagnosis. Inpatient mortality was higher in this group than among IE hospitalizations without malignancy (13.5% vs 9.8%; P < .001), and malignancy remained associated with mortality after adjustment (adjusted odds ratio 1.29; 95% CI 1.19-1.39; P < .001). The proportion of IE hospitalizations involving malignancy increased from 6.7% in 2016 to 7.7% in 2022. Fungal infection, shock, acute kidney injury, and stroke were associated with mortality. Prosthetic-valve IE had lower mortality than non-prosthetic-valve IE (7.7% vs 13.9%; P < .001). These findings identify a high-risk, heterogeneous phenotype and support earlier diagnostic evaluation and coordinated oncology, cardiology, and infectious diseases management.
Chronic limb-threatening ischemia (CLTI) carries 1-year mortality of 20% to 25%, comparable with many solid-organ malignancies. Technically successful revascularization, defined by anatomical patency, does not reliably deliver pain relief, restored function, or sustained quality of life. This narrative review synthesizes landmark randomized trials (BEST-CLI, BASIL-1, BASIL-2) and current European and United States guidelines, grading every claim with a scheme in which population indirectness downgrades design strength. We examine 4 domains of morbidity persisting after anatomically successful revascularization: mechanistically heterogeneous pain; functional and quality-of-life decline; psychological burden; and sustained health care use, including chronic opioid use (approximately 35%), unhealed wounds at 1 year (10%-32%), and unplanned 30-day readmission (approximately 25%). No patient-reported outcome measure has been validated specifically for CLTI or used as a co-primary trial endpoint. We propose an accountability gap: the under-measured transfer of unresolved morbidity from vascular services to primary care. We state it as a falsifiable prediction about the discrimination of patency rather than prevalence, with a pre-specified effect size, explicit treatment of death as a competing risk, and a core outcome battery justified against COSMIN criteria. Patient co-production is the indispensable next step.
This single-center retrospective case series assessed early ulnar artery patency by Doppler ultrasonography (DUS) after coronary angiography via distal ulnar access (DUA), described flow evolution in patients with follow-up, and reported access-related complications. Thirty-eight consecutive patients with a day-3 DUS after coronary angiography via DUA between September 2023 and March 2024 were included. All procedures were performed by 1 operator using a short 6F sheath and 5000 IU intra-arterial heparin. Flow was categorized as thrombosis/no flow, monophasic, or triphasic; the primary endpoint was day-3 non-triphasic flow, and month-1 and month-3 DUS were selective. Mean age was 58.8 ± 10.1 years and 47.4% were male; 21.1% underwent same-session percutaneous coronary intervention. On day 3, thrombosis/no flow occurred in 18.4% (7/38), monophasic flow in 5.3% (2/38), and triphasic flow in 76.3% (29/38); non-triphasic flow was 23.7% (9/38). Month-1 DUS (n = 35) showed no thrombosis/no flow and 94.3% triphasic flow; month-3 DUS (n = 4) was triphasic in all. No clinically relevant hematoma, neuropathy, hand ischemia, or functional impairment was documented. After coronary angiography via DUA, day-3 non-triphasic flow occurred in 23.7%; selective follow-up suggested recanalization without major clinical complications, but limits generalizability.
