European Heart Journal: Acute Cardiovascular Care最新文献

Background: Cocaine use disorder prevalence is around 2.2% for individuals age 12 and older, with higher rates reaching 6.2% in young adults ages 18-25. In 2021 around 23% of all US overdose deaths were related to cocaine. Cannabis use disorder is more prevalent than cocaine use disorder with prevalence reaching 14.7%. This study aims to evaluate the impact of cocaine and cannabis on clinical cardiovascular outcomes. Specifically, it investigates the incidence of new-onset cardiac arrhythmia between the cocaine and cannabis users, as well as the incidence of cardiac arrest events, major adverse cardiovascular events including myocardial infarction (MI) and stroke, and all-cause mortality.

Methods: We did a retrospective cohort analysis using the TriNetX database of cocaine and cannabis users patients and created two cohorts: cocaine and cannabis. Propensity score matching was employed to reduce baseline disparities.The primary outcome was the incidence of new-onset cardiac arrhythmia. Secondary outcomes included cardiac arrest events, all cause mortality, and occurrence of major adverse cardiovascular events (MI and stroke).

Results: After matching, 248,769 patients were included in each cohort (cocaine and cannabis users). New-onset cardiac arrhythmia occurred more frequently in the cocaine group (0.2%) compared to the cannabis group (0.15%) (HR: 1.067; 95% CI: 1.022-1.115, P < 0.035). Cocaine use was also associated with higher rates of the secondary outcomes: cardiac arrest (HR: 1.442; 95% CI: 1.346-1.545, P < 0.001), all-cause mortality (HR: 1.215; 95% CI: 1.187-1.243, P < 0.013), and major adverse cardiovascular events (HR: 1.147; 95% CI: 1.116-1.178, P < 0.001).

Conclusions: Cocaine users experience significantly higher rates of new-onset cardiac arrhythmias, cardiac arrest, and major adverse cardiovascular events (MI and stroke) compared to cannabis users. These findings highlight the differing outcomes associated with substance use. Future research should aim to validate our findings through prospective, multicenter studies with standardized diagnostic methods as well as longer-term follow-up to more accurately define the outcomes.

Each year, the European Heart Journal - Acute Cardiovascular Care publishes key studies shaping contemporary understanding of CS pathophysiology, patient selection, optimal timing of intervention, and outcomes associated with CS and various MCS strategies. This review highlights the papers published in EHJ Acute Cardiovascular Care between 2024 and 2025 focusing on CS and MCS. These contributions provide essential insights for clinicians navigating the complexity of CS management and underscore the continued need for high-quality, research in the field of CS and MCS.

Background: Female underrepresentation in clinical trials of acute coronary syndromes (ACS) may hinder the assessment of sex-based differences in the outcomes of long-term pharmacological therapy. The presence of these differences and their potential association with female representation in clinical trials remain unclear.

Methods: A systematic search of Embase, Medline Ovid, and Cochrane Central was conducted through July 1, 2025, in accordance with the reporting standards of the PRISMA guidelines. Eligible randomized controlled trials (RCTs) compared long-term pharmacological therapy for ACS with placebo or standard care, included ≥1-year follow-up, and reported a clinical event as the primary outcome. Sex differences in treatment effects were analysed using a random-effects meta-analysis, while meta-regression was used to assess the association between the proportion of females in each trial and these differences. The main outcome was the sex difference in the relative effect measure (REM; mostly a hazard ratio) for the primary efficacy endpoint.

Results: Among 102 RCTs, female representation ranged from 10% to 52%. Forty-eight trials provided sex-stratified data. Pooled analysis showed no evidence of sex-related differences in efficacy: the mean difference in the log of the REM of males minus females was 0.00 (95% confidence interval, -0.05 to 0.05; P = 0.98; heterogeneity I² = 0%). Meta-regression indicated no relationship between female trial participation and sex-specific treatment effects.

Conclusions: In RCTs of long-term pharmacological therapy after ACS, treatment efficacy was comparable between sexes, irrespective of sex distribution. These findings support current guidelines recommending equivalent long-term pharmacological strategies for secondary prevention in both sexes.

Background: In patients with intermediate-risk pulmonary embolism (PE), there are limited tools to assess therapeutic response following catheter-based intervention. This study evaluates pulmonary vascular resistance (PVR), an invasive marker of right ventricular (RV) afterload, and its prognostic significance in acute PE.

Methods: This single-center retrospective study included patients from October 2020-May 2025 with intermediate-high risk PE undergoing large bore mechanical thrombectomy (LBMT) with pulmonary artery catheter-derived hemodynamic indices obtained pre- and post-procedure. The primary objective was to evaluate the effect of LBMT on PVR. Secondary objective was to evaluate the predictors of post procedure elevated PVR (defined as PVR >2 Wood units, WU) and its effect on clinical composite outcome (PE mortality, resuscitated cardiac arrest, hemodynamic instability and 90-day hospital readmission) and hospital length of stay (LOS).

Results: A total of 131 patients were included. Following LBMT, median PVR decreased significantly from 2.9 to 1.8 WU (p < 0.001), with greater reduction in patients with higher baseline PVR (baseline PVR tertile 3 to 1: 50% vs. 40% vs. 20%; p < 0.001). Persistently elevated post procedure PVR (>2 WU) was seen in 43.6% of patients. However, the incidence of post-procedure severe PVR >5 WU was extremely low (11.5% pre-procedure, 0.8% post-procedure). Multivariable predictors of elevated post-procedural PVR were pre-procedural mean pulmonary artery pressure (OR: 1.07, 95% CI 1.01-1.14, p = 0.026) and pre-procedural PVR (OR 2.20, 95% CI: 1.20-4.04, p = 0.011). In an age and sex adjusted model, elevated post-procedure PVR was associated with a longer in-hospital LOS of 4.2 days (95% CI: 0.60-7.88; p = 0.023) and a 4-fold higher risk of the composite outcome (20.7% vs 5.3%, adjusted hazard ratio: 4.02, 95% CI: 1.28-12.61, p = 0.017).

Conclusions: In patients with intermediate-high risk PE, LBMT significantly reduced PVR and may be a valuable hemodynamic marker of disease severity and treatment response. Elevated post-procedural PVR identified patients at increased risk of adverse outcomes.