Pub Date : 2024-05-09DOI: 10.1093/ehjacc/zuae036.096
D Bae, S Y Lee, J H Yang, H C Gwon
Funding Acknowledgements None. Purpose Dedicated intensive care unit (ICU) physician staffing is assocated with a reduction in ICU mortality rates in general medical and surgical ICUs. However, limited data area available on the role of cardiac intensivist in the cardiac intensive care unit (CICU). We investigated the association of cardiac intensivist-directed care with clinical outcomes in adult patients admitted to the CICU. Methods The SMART-RESCUE study is a multicenter, retrospective and prosective registry of patients that presented witth cardiogenic shock (CS). Between January 2014 and December 2018, 1,247 patients with CS were enrolled from 12 major centers in Korea. The study population was divided into 2 groups, according to the presence of a cardiac intensivist. The primary outcome was in-hospital mortality. Results THe analysis with SMART-RESCUE registry included 1,247 patients with CS (n=552 in the group with cardiac intensivist and n=695 in the group without cardiac intensivist) (Table 1). The in-hospital survival rate was significant higher in the group with intensivist than that in the group without intensivist (72.1% vs 59.2%, p < 0.001) (Figure 1). Cardiac intensive care with cardiac intensivist was associated with a reduction in risk-adjusted in-hospital mortality (adjusted odds ratio for in hospital death, 0.53; 95% confidence interval: 0.401 to 0.704; p < 0.001). Survival analysis also revealed significantly higher death free survival in te group with intensitivst. In multivariable analysis, cardiac intensivist, chronic kidney disease, ECMO-cardiopulmonary resuscitation, ST elevation myocardial infarction presentation and vasotrope-inotrope score were selected to be significant prognostic predictors for death in the CICU. Concluison: The presence of a dedicated cardiac intensivist was associated with a reduction in hospital mortality rates in patients with cardiovascular disease who required critical care.
{"title":"Clinical impact of a cardiac intensivist in an adult cardiac care unit from the RESCUE registry","authors":"D Bae, S Y Lee, J H Yang, H C Gwon","doi":"10.1093/ehjacc/zuae036.096","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae036.096","url":null,"abstract":"Funding Acknowledgements None. Purpose Dedicated intensive care unit (ICU) physician staffing is assocated with a reduction in ICU mortality rates in general medical and surgical ICUs. However, limited data area available on the role of cardiac intensivist in the cardiac intensive care unit (CICU). We investigated the association of cardiac intensivist-directed care with clinical outcomes in adult patients admitted to the CICU. Methods The SMART-RESCUE study is a multicenter, retrospective and prosective registry of patients that presented witth cardiogenic shock (CS). Between January 2014 and December 2018, 1,247 patients with CS were enrolled from 12 major centers in Korea. The study population was divided into 2 groups, according to the presence of a cardiac intensivist. The primary outcome was in-hospital mortality. Results THe analysis with SMART-RESCUE registry included 1,247 patients with CS (n=552 in the group with cardiac intensivist and n=695 in the group without cardiac intensivist) (Table 1). The in-hospital survival rate was significant higher in the group with intensivist than that in the group without intensivist (72.1% vs 59.2%, p &lt; 0.001) (Figure 1). Cardiac intensive care with cardiac intensivist was associated with a reduction in risk-adjusted in-hospital mortality (adjusted odds ratio for in hospital death, 0.53; 95% confidence interval: 0.401 to 0.704; p &lt; 0.001). Survival analysis also revealed significantly higher death free survival in te group with intensitivst. In multivariable analysis, cardiac intensivist, chronic kidney disease, ECMO-cardiopulmonary resuscitation, ST elevation myocardial infarction presentation and vasotrope-inotrope score were selected to be significant prognostic predictors for death in the CICU. Concluison: The presence of a dedicated cardiac intensivist was associated with a reduction in hospital mortality rates in patients with cardiovascular disease who required critical care.","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140934778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.1093/ehjacc/zuae036.137
A Gomez Gonzalez, G Padilla Rodriguez, M Nunez Ruiz, F Altarejos Salido, L E Lopez Cortes, A Pena Rodriguez
Funding Acknowledgements None. Introduction In infective endocarditis, microbial isolation can be related to the prognosis of the disease. Identify the cause of endocarditis can help decide further management appropriate. Our purpose was to evaluate the most frequent microbiological findings in our healthcare area, as well as their association with prognostic determinants. Material and Methods Retrospective, observational, single-center study*. Based on a registry of patients diagnosed with infective endocarditis during the years 2016-2022 in a reference hospital with cardiac surgery. Patients with infective endocarditis were analyzed according to their type of microbial isolation, observing the microbial epidemiology and comparing these groups according to their baseline characteristics (age, sex, risk factors), the different therapeutic management in each group (type of antibiotic treatment used, surgical intervention, surgical indication etc.) and compared the groups according to the frequency of different prognostic determinants and events (Reinfection, Embolism, Shock, Mortality, local complications, etc.). To analyze the differences in events between different groups of microorganisms, the Chi square statistic of Homogeneity was used, and a significance level of p<0.05 was established. Results 162 patients were analyzed for an average of 66 years. The rate of positive blood cultures was 93%. The most frequently isolated microorganisms were, Figure 1. Patients who suffered from S. aureus endocarditis (with a mean age also of 66±10 years) had a higher prevalence of pacemaker infections and were complicated by septic shock more frequently (43%, p<0.01) than patients with other types of microorganism isolation. However, we did not have high surgery rates, and we did not observe significant differences in terms of recurrence or mortality, despite being a very virulent microorganism. On the other hand, S.Epidermidis (which is associated with early prosthetic valve endocarditis) is the microorganism most closely related with abscesses, fistulas or other perivalvular involvements (34%, p=0.04), in relation to endocarditis after valve surgery. This group also appears to have a greater tendency, although not significant, to cause AV blocks. Furthermore, S.Epidermidis was the group of patients that most frequently underwent surgery (62% p<0.001) Figure 2. Conclusions In this study, we have observed a higher frequency of isolation of E. feacalis, with significant differences in comparison to other series, and a significantly higher number of recurrences in comparison to other microorganisms. S. aureus is the microorganism most linked to shock, but it is also the one with the lowest number of undergone surgeries, despite being comparable populations. In valve prosthetic endocarditis, S. epidermidis was the most frequent pathogen isolated, and was more frequently associated with perivalvular involvement and the need for surgery.
{"title":"Microbiological findings in infective endocarditis, event predictor and prognostic value","authors":"A Gomez Gonzalez, G Padilla Rodriguez, M Nunez Ruiz, F Altarejos Salido, L E Lopez Cortes, A Pena Rodriguez","doi":"10.1093/ehjacc/zuae036.137","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae036.137","url":null,"abstract":"Funding Acknowledgements None. Introduction In infective endocarditis, microbial isolation can be related to the prognosis of the disease. Identify the cause of endocarditis can help decide further management appropriate. Our purpose was to evaluate the most frequent microbiological findings in our healthcare area, as well as their association with prognostic determinants. Material and Methods Retrospective, observational, single-center study*. Based on a registry of patients diagnosed with infective endocarditis during the years 2016-2022 in a reference hospital with cardiac surgery. Patients with infective endocarditis were analyzed according to their type of microbial isolation, observing the microbial epidemiology and comparing these groups according to their baseline characteristics (age, sex, risk factors), the different therapeutic management in each group (type of antibiotic treatment used, surgical intervention, surgical indication etc.) and compared the groups according to the frequency of different prognostic determinants and events (Reinfection, Embolism, Shock, Mortality, local complications, etc.). To analyze the differences in events between different groups of microorganisms, the Chi square statistic of Homogeneity was used, and a significance level of p&lt;0.05 was established. Results 162 patients were analyzed for an average of 66 years. The rate of positive blood cultures was 93%. The most frequently isolated microorganisms were, Figure 1. Patients who suffered from S. aureus endocarditis (with a mean age also of 66±10 years) had a higher prevalence of pacemaker infections and were complicated by septic shock more frequently (43%, p&lt;0.01) than patients with other types of microorganism isolation. However, we did not have high surgery rates, and we did not observe significant differences in terms of recurrence or mortality, despite being a very virulent microorganism. On the other hand, S.Epidermidis (which is associated with early prosthetic valve endocarditis) is the microorganism most closely related with abscesses, fistulas or other perivalvular involvements (34%, p=0.04), in relation to endocarditis after valve surgery. This group also appears to have a greater tendency, although not significant, to cause AV blocks. Furthermore, S.Epidermidis was the group of patients that most frequently underwent surgery (62% p&lt;0.001) Figure 2. Conclusions In this study, we have observed a higher frequency of isolation of E. feacalis, with significant differences in comparison to other series, and a significantly higher number of recurrences in comparison to other microorganisms. S. aureus is the microorganism most linked to shock, but it is also the one with the lowest number of undergone surgeries, despite being comparable populations. In valve prosthetic endocarditis, S. epidermidis was the most frequent pathogen isolated, and was more frequently associated with perivalvular involvement and the need for surgery.","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140932063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.1093/ehjacc/zuae036.185
A Sakalidis, K Dimitriadis, M Bora, A E Karanikola, K Aznaouridis, A Papanikolaou, I Dris, I Leontsinis, E Mantzouranis, P Iliakis, P K Vlachakis, P Tsioufis, A Koulouriotis, K Aggeli, K Tsioufis
Funding Acknowledgements None. Introduction The impairment of microvascular function present in coronary microcirculation with chronic angina without obstructive coronary arteries. There are insufficient data in the literature regarding possible generalized microangiopathy in this population. Aim The aim of this study is to demonstrate whether patients with Angina with No Obstructive Coronary Artery Disease (ANOCA) compared to individuals without coronary microvascular dysfunction (CMD) are characterized by a different level of nailfold capillaroscopy abnormalities. Methods We examined 18 participants without CMD - non-CMD group [9 female, 50%, mean age: 54.4±8.1 years) and 26 patients with ANOCA - CMD group (22 female, 84,6%, mean age : 53.2±10.7 years). Functional coronary angiography was performed for the assessment of coronary microcirculation in all patients. Coronary flow reserve (CFR) and index of microvascular resistance (IMR) were measured in the left anterior descending coronary artery using a temperature/pressure sensor-tipped guidewire. In addition, the assessment of skin microcirculation was performed by capillaroscopy, a non-invasive technique to evaluate small vessels of the microcirculation in the nailfold, using stereomicroscope in all patients. Results In CMD group, mean CFR and IMR were 1.34±0.6 and 44.8±28, respectively. Out of the 26 MVD patients with abnormal CFR, 7 of them (27%) had a normal value of IMR, indicating functional microvascular dysfunction. On the other hand, 18 patients (69%) had an abnormal IMR, indicating structural microvascular dysfunction. Capillary density in patients with MVD was significantly decreased compared to the control group (7.6±2.2 vs 10.9±1.8 vessels/mm, p=0.04). The difference in capillary density between the two groups was statistically significant after adjustment for multiple comparisons (p<0.05). No significant difference was found in body mass index, renal function, medical history of dyslipidemia, diabetes mellitus and smoking status between the two groups (p<0.05). Conclusion Nailfold capillary density was reduced in ANOCA patients compared to control group. These data may provide new insights regarding possible generalized microangiopathy in CMD patients. These results suggest that there is an association between microcirculatory impairment at both heart and peripheral vascular bed level.
{"title":"Microvascular dysfunction associated with reduced nailfold capillary density in patients with ischemia with no obstructive coronary artery disease","authors":"A Sakalidis, K Dimitriadis, M Bora, A E Karanikola, K Aznaouridis, A Papanikolaou, I Dris, I Leontsinis, E Mantzouranis, P Iliakis, P K Vlachakis, P Tsioufis, A Koulouriotis, K Aggeli, K Tsioufis","doi":"10.1093/ehjacc/zuae036.185","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae036.185","url":null,"abstract":"Funding Acknowledgements None. Introduction The impairment of microvascular function present in coronary microcirculation with chronic angina without obstructive coronary arteries. There are insufficient data in the literature regarding possible generalized microangiopathy in this population. Aim The aim of this study is to demonstrate whether patients with Angina with No Obstructive Coronary Artery Disease (ANOCA) compared to individuals without coronary microvascular dysfunction (CMD) are characterized by a different level of nailfold capillaroscopy abnormalities. Methods We examined 18 participants without CMD - non-CMD group [9 female, 50%, mean age: 54.4±8.1 years) and 26 patients with ANOCA - CMD group (22 female, 84,6%, mean age : 53.2±10.7 years). Functional coronary angiography was performed for the assessment of coronary microcirculation in all patients. Coronary flow reserve (CFR) and index of microvascular resistance (IMR) were measured in the left anterior descending coronary artery using a temperature/pressure sensor-tipped guidewire. In addition, the assessment of skin microcirculation was performed by capillaroscopy, a non-invasive technique to evaluate small vessels of the microcirculation in the nailfold, using stereomicroscope in all patients. Results In CMD group, mean CFR and IMR were 1.34±0.6 and 44.8±28, respectively. Out of the 26 MVD patients with abnormal CFR, 7 of them (27%) had a normal value of IMR, indicating functional microvascular dysfunction. On the other hand, 18 patients (69%) had an abnormal IMR, indicating structural microvascular dysfunction. Capillary density in patients with MVD was significantly decreased compared to the control group (7.6±2.2 vs 10.9±1.8 vessels/mm, p=0.04). The difference in capillary density between the two groups was statistically significant after adjustment for multiple comparisons (p&lt;0.05). No significant difference was found in body mass index, renal function, medical history of dyslipidemia, diabetes mellitus and smoking status between the two groups (p&lt;0.05). Conclusion Nailfold capillary density was reduced in ANOCA patients compared to control group. These data may provide new insights regarding possible generalized microangiopathy in CMD patients. These results suggest that there is an association between microcirculatory impairment at both heart and peripheral vascular bed level.","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140932141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.1093/ehjacc/zuae036.108
E Minguez De La Guia, N Vallejo Calcerrada, M J Corbi Pascual, C Bonanad Lozano, P Cepas Guillen, A Cordero Fort, I Nunez Gil, M Thiscal Lopez, S Raposeiras Roubin, J L Ferreiro Gutierrez, E Moreno, F Diez Del Hoyo, A Ayesta, J A Perez Rivera, P Diez Villanueva
Funding Acknowledgements None. Introduction The prevalence of atrial fibrillation (AF) and ischaemic heart disease (IHD) increases with age, conditioning a complex and relatively frequent scenario in clinical practice. Our objective was to know the variables associated with prognosis in a cohort of patients with AF and IHD in our country after a year of follow-up. Methods An observational, prospective and multicentre study that included patients with AF and IHD in Spain. Baseline, clinical, laboratory and echocardiographic characteristics were assessed, as well as the clinical management and the choice of antithrombotic treatment. We studied long-term mortality. Results 290 patients were included (mean age 77.7±9.7 years, 28% women). 84% of the patients were hypertensive, 42% diabetic, 69.7% dyslipidemic. The average comorbidity, characterized by the Charlson index, was 2.3±2. The average score on the CHADSVASC and HASBLED scales was 4.28±1.62 and 2.94±1, respectively. The clinical presentation of ischaemic heart disease was NSTEMI (45%), STEMI (22%) and stable angina (33%). 65.6% of patients underwent revascularisation, mostly percutaneously (92%). 42% of patients were discharged with triple therapy (double antiplatelet + anticoagulation), 30.1% with double therapy (antiplatelet + anticoagulation). After an average follow-up of 325±5.7 days, 35 patients (12%) died. The variables independently associated (multivariate analysis) with mortality during follow-up are shown in the Table (creatinine, leukocyte count, troponin elevation, number of diseased vessels, ventricular function, and comorbidity were mortality predictors in our study). Conclusions The presence of a series of simple variables identifies patients with AF and IHD as having a greater risk of mortality during follow-up.Variables independentily associated AF
{"title":"Variables associated with mortality in patients with atrial fibrillation and ischaemic heart disease in Spain","authors":"E Minguez De La Guia, N Vallejo Calcerrada, M J Corbi Pascual, C Bonanad Lozano, P Cepas Guillen, A Cordero Fort, I Nunez Gil, M Thiscal Lopez, S Raposeiras Roubin, J L Ferreiro Gutierrez, E Moreno, F Diez Del Hoyo, A Ayesta, J A Perez Rivera, P Diez Villanueva","doi":"10.1093/ehjacc/zuae036.108","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae036.108","url":null,"abstract":"Funding Acknowledgements None. Introduction The prevalence of atrial fibrillation (AF) and ischaemic heart disease (IHD) increases with age, conditioning a complex and relatively frequent scenario in clinical practice. Our objective was to know the variables associated with prognosis in a cohort of patients with AF and IHD in our country after a year of follow-up. Methods An observational, prospective and multicentre study that included patients with AF and IHD in Spain. Baseline, clinical, laboratory and echocardiographic characteristics were assessed, as well as the clinical management and the choice of antithrombotic treatment. We studied long-term mortality. Results 290 patients were included (mean age 77.7±9.7 years, 28% women). 84% of the patients were hypertensive, 42% diabetic, 69.7% dyslipidemic. The average comorbidity, characterized by the Charlson index, was 2.3±2. The average score on the CHADSVASC and HASBLED scales was 4.28±1.62 and 2.94±1, respectively. The clinical presentation of ischaemic heart disease was NSTEMI (45%), STEMI (22%) and stable angina (33%). 65.6% of patients underwent revascularisation, mostly percutaneously (92%). 42% of patients were discharged with triple therapy (double antiplatelet + anticoagulation), 30.1% with double therapy (antiplatelet + anticoagulation). After an average follow-up of 325±5.7 days, 35 patients (12%) died. The variables independently associated (multivariate analysis) with mortality during follow-up are shown in the Table (creatinine, leukocyte count, troponin elevation, number of diseased vessels, ventricular function, and comorbidity were mortality predictors in our study). Conclusions The presence of a series of simple variables identifies patients with AF and IHD as having a greater risk of mortality during follow-up.Variables independentily associated AF","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140932130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.1093/ehjacc/zuae036.058
M Yildirim, C Salbach, B R Milles, C Reich, N Frey, E Giannitsis, M Mueller-Hennessen
Funding Acknowledgements None. Background The clinical chemistry score (CCS) comprising high-sensitivity (hs) cardiac troponins (cTn), glucose and estimated glomerular filtration rate has been previously validated with superior accuracy for detection and risk stratification of acute myocardial infarction (AMI) compared to hs-cTn alone. Methods The CCS was directly compared to other biomarker-based algorithms for rapid rule-out and prognostication of AMI including the hs-cTnT limit-of-blank (LOB, <3 ng/L) or limit-of-detection (LOD, <5 ng/L) and the dual marker strategy (DMS) (copeptin <10 pmol/L and hs-cTnT ≤14 ng/L) in 1506 patients presenting to the emergency department (ED) with symptoms suggestive of acute coronary syndrome. Negative predictive values (NPV) and sensitivities for rule-out of AMI were assessed and outcomes included rates of the combined end-point of all-cause mortality, myocardial re-infarction and stroke within 12 months. Results NPVs of 100% (98.3-100%) could be found for a CCS=0, hs-cTnT LoB and hs-cTnT LoD with rule-out efficacies of 11.1%, 7.6% and 18.3% as well as specificities of 13.0% (9.9-16.6%), 8.8% (7.3-10.5%) and 21.4% (19.2-23.8%), respectively. A CCS≤ 1 achieved a rule-out in 32.2% of all patients with a NPV of 99.6% (98.4-99.9%) and specificity of 37.4% (34.2-40.5%) compared to a rule-out efficacy of 51.2%, NPV of 99.0 (98.0-99.5) and specificity of 59.7% (57.0-62.4%) for the DMS. Rates of the combined end-point of death/AMI within 30 days ranged between 0.0% and 0.5% for all fast-rule-out protocols. Conclusions The CCS enables a reliable rule-out of AMI with low outcome rates in short and long-term follow-up for a specific population of ED patients. However, compared to a single or dual biomarker strategy, the CCS rule-out is attenuated by a loss of specificity and lower efficacy. Thus, the clinical benefit of the CCS in clinical practice seems to be negligible.
{"title":"Comparison of the clinical chemistry score to other biomarker algorithms for rapid rule-out of acute myocardial infarction and risk stratification","authors":"M Yildirim, C Salbach, B R Milles, C Reich, N Frey, E Giannitsis, M Mueller-Hennessen","doi":"10.1093/ehjacc/zuae036.058","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae036.058","url":null,"abstract":"Funding Acknowledgements None. Background The clinical chemistry score (CCS) comprising high-sensitivity (hs) cardiac troponins (cTn), glucose and estimated glomerular filtration rate has been previously validated with superior accuracy for detection and risk stratification of acute myocardial infarction (AMI) compared to hs-cTn alone. Methods The CCS was directly compared to other biomarker-based algorithms for rapid rule-out and prognostication of AMI including the hs-cTnT limit-of-blank (LOB, &lt;3 ng/L) or limit-of-detection (LOD, &lt;5 ng/L) and the dual marker strategy (DMS) (copeptin &lt;10 pmol/L and hs-cTnT ≤14 ng/L) in 1506 patients presenting to the emergency department (ED) with symptoms suggestive of acute coronary syndrome. Negative predictive values (NPV) and sensitivities for rule-out of AMI were assessed and outcomes included rates of the combined end-point of all-cause mortality, myocardial re-infarction and stroke within 12 months. Results NPVs of 100% (98.3-100%) could be found for a CCS=0, hs-cTnT LoB and hs-cTnT LoD with rule-out efficacies of 11.1%, 7.6% and 18.3% as well as specificities of 13.0% (9.9-16.6%), 8.8% (7.3-10.5%) and 21.4% (19.2-23.8%), respectively. A CCS≤ 1 achieved a rule-out in 32.2% of all patients with a NPV of 99.6% (98.4-99.9%) and specificity of 37.4% (34.2-40.5%) compared to a rule-out efficacy of 51.2%, NPV of 99.0 (98.0-99.5) and specificity of 59.7% (57.0-62.4%) for the DMS. Rates of the combined end-point of death/AMI within 30 days ranged between 0.0% and 0.5% for all fast-rule-out protocols. Conclusions The CCS enables a reliable rule-out of AMI with low outcome rates in short and long-term follow-up for a specific population of ED patients. However, compared to a single or dual biomarker strategy, the CCS rule-out is attenuated by a loss of specificity and lower efficacy. Thus, the clinical benefit of the CCS in clinical practice seems to be negligible.","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140931974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.1093/ehjacc/zuae036.017
B J David, A E Valencia, F C Cheng
Funding Acknowledgements None. Introduction Peripheral artery disease (PAD) poses a significant challenge in the realm of cardiovascular medicine, necessitating a multifaceted approach to mitigate its impact and enhance patient outcomes. One treatment approach involves the combined use of rivaroxaban, a direct oral anticoagulant, and aspirin, a commonly used antiplatelet agent in decreasing possible complications that can develop in patients with PAD. Methods An extensive search of randomized controlled trials (RCTs) comparing the efficacy of rivaroxaban in combination with aspirin versus aspirin monotherapy among individuals diagnosed with peripheral artery disease. The assessment of this treatment approach involved evaluating the following primary outcomes: a decrease in major adverse cardiovascular events (MACE) and the need for major amputation. Safety profile was also evaluated by examining the rate of major bleeding, utilizing the scoring tool from International Society of Thrombosis and Hemostasis (ISTH). The analyses were performed using a random effects analysis approach via Review Manager V5.4. Results This meta-analysis encompassed three studies involving a total of 9,352 participants. There was reduction of MACE in rivaroxaban with aspirin therapy (RR 0.83 [95% CI: 0.71-0.97] I2 = 29%, p = 0.02] but there was no significant difference in terms of major amputation rates (RR 0.96 [95% CI: 0.80-1.14] I2 = 0%, p = 0.62). However, there was increased risk of bleeding in rivaroxaban with aspirin therapy (RR 1.46 [95% CI: 1.17-1.82] I2=0, p = 0.0009) compared to aspirin alone. Conclusion Rivaroxaban combined with aspirin therapy demonstrated a 17% reduction in MACE compared with aspirin monotherapy but didn’t reduce major amputation rates. Also, doing this strategy poses a higher risk of bleeding. Therefore, a balance between the risks and benefits of this combined therapy necessitates a thorough assessment of individual patient profiles, considering factors such as overall cardiovascular risk, comorbidities, and bleeding tendencies. Further research and long-term studies are needed to establish comprehensive guidelines for the appropriate utilization of this combination therapy in various patient populations.
{"title":"Combining rivaroxaban with aspirin for peripheral artery disease: an in-depth systematic review and meta-analysis","authors":"B J David, A E Valencia, F C Cheng","doi":"10.1093/ehjacc/zuae036.017","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae036.017","url":null,"abstract":"Funding Acknowledgements None. Introduction Peripheral artery disease (PAD) poses a significant challenge in the realm of cardiovascular medicine, necessitating a multifaceted approach to mitigate its impact and enhance patient outcomes. One treatment approach involves the combined use of rivaroxaban, a direct oral anticoagulant, and aspirin, a commonly used antiplatelet agent in decreasing possible complications that can develop in patients with PAD. Methods An extensive search of randomized controlled trials (RCTs) comparing the efficacy of rivaroxaban in combination with aspirin versus aspirin monotherapy among individuals diagnosed with peripheral artery disease. The assessment of this treatment approach involved evaluating the following primary outcomes: a decrease in major adverse cardiovascular events (MACE) and the need for major amputation. Safety profile was also evaluated by examining the rate of major bleeding, utilizing the scoring tool from International Society of Thrombosis and Hemostasis (ISTH). The analyses were performed using a random effects analysis approach via Review Manager V5.4. Results This meta-analysis encompassed three studies involving a total of 9,352 participants. There was reduction of MACE in rivaroxaban with aspirin therapy (RR 0.83 [95% CI: 0.71-0.97] I2 = 29%, p = 0.02] but there was no significant difference in terms of major amputation rates (RR 0.96 [95% CI: 0.80-1.14] I2 = 0%, p = 0.62). However, there was increased risk of bleeding in rivaroxaban with aspirin therapy (RR 1.46 [95% CI: 1.17-1.82] I2=0, p = 0.0009) compared to aspirin alone. Conclusion Rivaroxaban combined with aspirin therapy demonstrated a 17% reduction in MACE compared with aspirin monotherapy but didn’t reduce major amputation rates. Also, doing this strategy poses a higher risk of bleeding. Therefore, a balance between the risks and benefits of this combined therapy necessitates a thorough assessment of individual patient profiles, considering factors such as overall cardiovascular risk, comorbidities, and bleeding tendencies. Further research and long-term studies are needed to establish comprehensive guidelines for the appropriate utilization of this combination therapy in various patient populations.","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140934843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.1093/ehjacc/zuae036.123
G Padilla Rodriguez, A Gomez Gonzalez, M Nunez Ruiz, A Feria Mera, L E Lopez Cortes, A Pena Rodriguez
Funding Acknowledgements None. Introduction Cardiac critical care units are essential for the management of complicated infective endocarditis (IE). Objective We set out to analyze the baseline characteristics, clinical complications and prognosis of patients with IE admitted to a Coronary Care Unit (CCU), as well as to compare them with patients admitted to hospital wards. Material and Methods Prospective, single-centre, observational study including patients who were diagnosed of IE from 2016-2022 and admitted in a hospital with cardiac surgery. They were classified into two groups according to whether or not they were admitted to the CCU. We collected data on microbiological isolation, cardiac and systemic complications as well as in-hospital mortality. Patients were followed long-term for cardiovascular (CV) and all-cause mortality, readmission and IE recurrence. All variables (qualitative) were compared by Chi-square test and overall mortality was compared in both groups by the LogRank test. We established a significance level of p<0.05. Results From a total of 162 patients with a median age of 68 years (IQR 68), 28.4% (46) were admitted to the CCU. These patients were similar in age to those not admitted (mean 65 vs 66 years, NS), but had a higher percentage of diabetics (47.8 vs 27.6%, p=0.01). The most frequent previous heart disease in both groups was valvular heart disease. The most frequently isolated microorganisms in CCU patients were Staphylococcus aureus (46.4%) and Streptococcus epidermidis (37.9%) which, in our series, produced the highest percentage of shock (35.7% and 23.3% respectively) in a statistically significant way (p<0.01), with the need for noradrenaline (60.9%) and dobutamine (28.3%); no ventricular assist devices were used. Critically ill patients had a higher incidence of atrioventricular block requiring a permanent pacemaker (32.6% vs 4.3%, p<0.01), valve dysfunction (76.1% vs 55.2%, p=0.014) and were more frequently operated than those admitted to the ward (56.%% vs 38%, p=0.04). Among all IE patients, 24.6% died during admission, most of them (15.7% of the total) were admitted to the coronary unit (p<0.01). In our 36-month mean follow-up, we found significantly higher readmission rates in the CCU group (36.6% vs. 15%, p<0.01), unrelated to IE recurrences. The critically ill group exhibited a higher mortality rate due to cardiovascular disease and all-cause causes (43.5% vs 15.9%, p0.01; 63% vs 23.9%, p0.01). In the CCU group there is significantly lower survival (mean 65 vs 37 months, LogRank p<0.01) with respect to the hospital ward group. Conclusion Our CCU is responsible for treating patients with IE that is highly complex and that progresses poorly, with a higher frequency of shock and in-hospital mortality, which leads to a decreased prognosis during follow-up. Anticipating complications and collaborating with cardiac surgery is essential to improve clinical outcomes
{"title":"Clinical characteristics and prognosis of patients with infective endocarditis admitted to a coronary unit in a hospital with cardiac surgery","authors":"G Padilla Rodriguez, A Gomez Gonzalez, M Nunez Ruiz, A Feria Mera, L E Lopez Cortes, A Pena Rodriguez","doi":"10.1093/ehjacc/zuae036.123","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae036.123","url":null,"abstract":"Funding Acknowledgements None. Introduction Cardiac critical care units are essential for the management of complicated infective endocarditis (IE). Objective We set out to analyze the baseline characteristics, clinical complications and prognosis of patients with IE admitted to a Coronary Care Unit (CCU), as well as to compare them with patients admitted to hospital wards. Material and Methods Prospective, single-centre, observational study including patients who were diagnosed of IE from 2016-2022 and admitted in a hospital with cardiac surgery. They were classified into two groups according to whether or not they were admitted to the CCU. We collected data on microbiological isolation, cardiac and systemic complications as well as in-hospital mortality. Patients were followed long-term for cardiovascular (CV) and all-cause mortality, readmission and IE recurrence. All variables (qualitative) were compared by Chi-square test and overall mortality was compared in both groups by the LogRank test. We established a significance level of p&lt;0.05. Results From a total of 162 patients with a median age of 68 years (IQR 68), 28.4% (46) were admitted to the CCU. These patients were similar in age to those not admitted (mean 65 vs 66 years, NS), but had a higher percentage of diabetics (47.8 vs 27.6%, p=0.01). The most frequent previous heart disease in both groups was valvular heart disease. The most frequently isolated microorganisms in CCU patients were Staphylococcus aureus (46.4%) and Streptococcus epidermidis (37.9%) which, in our series, produced the highest percentage of shock (35.7% and 23.3% respectively) in a statistically significant way (p&lt;0.01), with the need for noradrenaline (60.9%) and dobutamine (28.3%); no ventricular assist devices were used. Critically ill patients had a higher incidence of atrioventricular block requiring a permanent pacemaker (32.6% vs 4.3%, p&lt;0.01), valve dysfunction (76.1% vs 55.2%, p=0.014) and were more frequently operated than those admitted to the ward (56.%% vs 38%, p=0.04). Among all IE patients, 24.6% died during admission, most of them (15.7% of the total) were admitted to the coronary unit (p&lt;0.01). In our 36-month mean follow-up, we found significantly higher readmission rates in the CCU group (36.6% vs. 15%, p&lt;0.01), unrelated to IE recurrences. The critically ill group exhibited a higher mortality rate due to cardiovascular disease and all-cause causes (43.5% vs 15.9%, p0.01; 63% vs 23.9%, p0.01). In the CCU group there is significantly lower survival (mean 65 vs 37 months, LogRank p&lt;0.01) with respect to the hospital ward group. Conclusion Our CCU is responsible for treating patients with IE that is highly complex and that progresses poorly, with a higher frequency of shock and in-hospital mortality, which leads to a decreased prognosis during follow-up. Anticipating complications and collaborating with cardiac surgery is essential to improve clinical outcomes","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140935127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.1093/ehjacc/zuae036.049
N Khutsishvili, S A N Amran, F E Cabello Monotya, Y V Stavtseva, M A Davletova, Z H D Kobalava
Funding Acknowledgements None. Background Non-valvular atrial fibrillation (NVAF) and heart failure (HF) frequently coexist. AF management in HF is currently changing with increasing role of rhythm control. Data about clinical characteristics and AF management in hospitalized patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) are lacking. The purpose of the study was to assess the clinical characteristics and AF management in hospitalized patients with NVAF and HFrEF and compare them to those of NVAF and HFpEF. Methods Consecutive NVAF patients hospitalized with HF decompensation between January 2020 and May 2022 were retrospectively evaluated. Patients were divided into two groups: HFrEF and HFpEF (defined as left ventricular ejection fraction > 40%). Clinical characteristics and AF treatment strategy in both groups were studied and compared. Numerical data are expressed as median (interquartile range). P<0.05 was considered significant. Results In a total of 388 AF-HF patients (age 73.5 years [66-82], 59.3% males), 147 (37.9%) had reduced ejection fraction. Patients with HFrEF compared to those with HFpEF were younger (69.3 vs 74.7 years; P < 0.001), more often male and with a higher rate of NYHA classes III-IV (73.9% vs 63.5%; P < 0.05), N-terminal pro-B-type natriuretic peptide level (2658.5 pg/ml vs 1799.1 pg/ml; p<0.001), sum of B-lines by lung ultrasound (35.2 vs 28.9; P<0.05) and prevalence of non-paroxysmal forms of AF (70.4% vs 50.4%; p < 0.05). Patients with HFrEF had a higher burden of coronary artery disease, chronic kidney disease and prior stroke (31.7% vs 19.2%, 83.9% vs 69.0, 18.5% vs 9.7%, respectively; p< 0.05 for all) than HFpEF patients. Patients with HFpEF were more likely than those with HFrEF to have diabetes mellitus (25.9% vs 37.1%; p< 0.05) The subgroup of patients with HFrEF compared to those with HFpEF had higher bleeding risk (HAS-BLED ≥3 in 32.1% vs 20.4%, P<0.05) due to more frequent abnormal renal/liver function, concomitant antithrombotic treatment/alcohol, prior stroke (24.7% vs 10.6%, 28.4% vs 16.8%, 18.5% vs 9.7%, respectively; P<0.05 for all) but lower thromboembolic risk according to CHA 2 DS 2 -VASc (4.0 vs 4.4; p < 0.05). Oral anticoagulants (OAC) were administered in 88% of patients on discharge. Patterns of anticoagulation administration didn’t differ between the two groups. Patients with HFrEF were less likely to receive first-line rhythm control for AF compared to HFpEF patients (36.1% vs 68.1%; p<0.05). Conclusion Hospitalized patients with NVAF and HFrEF compared to those with HFpEF were younger, with greater severity of HF, higher burden of comorbidities and bleeding risk and slightly lower thromboembolic risk. Despite different clinical characteristics, OAC administration patterns were similar and OAC prescription rate was not optimal in both groups. There
致谢 无。背景 非瓣膜性心房颤动（NVAF）和心力衰竭（HF）经常并存。随着节律控制的作用不断增强，心力衰竭患者的房颤治疗正在发生变化。有关射血分数减低型心力衰竭（HFrEF）和射血分数保留型心力衰竭（HFpEF）住院患者的临床特征和房颤管理的数据还很缺乏。本研究旨在评估 NVAF 和 HFrEF 住院患者的临床特征和房颤处理方法，并与 NVAF 和 HFpEF 的临床特征和处理方法进行比较。方法 回顾性评估 2020 年 1 月至 2022 年 5 月期间因 HF 失代偿而住院的连续 NVAF 患者。患者被分为两组：HFrEF 和 HFpEF（定义为左心室射血分数 > 40%）。研究并比较了两组患者的临床特征和房颤治疗策略。数字数据以中位数（四分位间距）表示。P<0.05为显著性差异。结果 在 388 名房颤-房颤患者（年龄 73.5 岁 [66-82]，59.3% 为男性）中，147 人（37.9%）射血分数降低。与 HFpEF 患者相比，HFrEF 患者更年轻（69.3 岁 vs 74.7 岁；P <0.001）、更多为男性、NYHA III-IV 级比例更高（73.9% vs 63.5%；P <0.05）、N末端前B型钠尿肽水平（2658.5 pg/ml vs 1799.1 pg/ml；P<0.001）、肺部超声检查的B线总和（35.2 vs 28.9；P<0.05）以及非阵发性房颤的患病率（70.4% vs 50.4%；P<0.05）。与 HFpEF 患者相比，HFrEF 患者的冠状动脉疾病、慢性肾脏疾病和既往中风负担较重（分别为 31.7% vs 19.2%、83.9% vs 69.0、18.5% vs 9.7%；均为 p<0.05）。HFpEF 患者比 HFrEF 患者更有可能患有糖尿病（25.9% vs 37.1%；P<0.05）。与 HFpEF 患者相比，HFrEF 患者亚组的出血风险更高（HAS-BLED ≥3：32.1% vs 20.4%，P<0.05），原因是更常见的肾/肝功能异常、同时接受抗血栓治疗/饮酒、既往中风（分别为 24.7% vs 10.6%、28.4% vs 16.8%、18.5% vs 9.7%；均为 P<0.05），但根据 CHA 2 DS 2 -VASc 标准，血栓栓塞风险较低（4.0 vs 4.4；P<0.05）。88%的患者在出院时使用了口服抗凝药（OAC）。两组患者的抗凝管理模式没有差异。与 HFpEF 患者相比，HFrEF 患者接受房颤一线节律控制的可能性较低（36.1% vs 68.1%；p<0.05）。结论 与 HFpEF 患者相比，NVAF 和 HFrEF 住院患者更年轻，HF 严重程度更高，合并症和出血风险更高，血栓栓塞风险略低。尽管临床特征不同，但两组患者的 OAC 用药模式相似，OAC 处方率也不尽人意。有必要改进房颤和 HFrEF 一线节律控制策略的指南依从性。
{"title":"Clinical characteristics and atrial fibrillation management in hospitalized patients with heart failure with reduced versus preserved ejection fraction","authors":"N Khutsishvili, S A N Amran, F E Cabello Monotya, Y V Stavtseva, M A Davletova, Z H D Kobalava","doi":"10.1093/ehjacc/zuae036.049","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae036.049","url":null,"abstract":"Funding Acknowledgements None. Background Non-valvular atrial fibrillation (NVAF) and heart failure (HF) frequently coexist. AF management in HF is currently changing with increasing role of rhythm control. Data about clinical characteristics and AF management in hospitalized patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) are lacking. The purpose of the study was to assess the clinical characteristics and AF management in hospitalized patients with NVAF and HFrEF and compare them to those of NVAF and HFpEF. Methods Consecutive NVAF patients hospitalized with HF decompensation between January 2020 and May 2022 were retrospectively evaluated. Patients were divided into two groups: HFrEF and HFpEF (defined as left ventricular ejection fraction &gt; 40%). Clinical characteristics and AF treatment strategy in both groups were studied and compared. Numerical data are expressed as median (interquartile range). P&lt;0.05 was considered significant. Results In a total of 388 AF-HF patients (age 73.5 years [66-82], 59.3% males), 147 (37.9%) had reduced ejection fraction. Patients with HFrEF compared to those with HFpEF were younger (69.3 vs 74.7 years; P &lt; 0.001), more often male and with a higher rate of NYHA classes III-IV (73.9% vs 63.5%; P &lt; 0.05), N-terminal pro-B-type natriuretic peptide level (2658.5 pg/ml vs 1799.1 pg/ml; p&lt;0.001), sum of B-lines by lung ultrasound (35.2 vs 28.9; P&lt;0.05) and prevalence of non-paroxysmal forms of AF (70.4% vs 50.4%; p &lt; 0.05). Patients with HFrEF had a higher burden of coronary artery disease, chronic kidney disease and prior stroke (31.7% vs 19.2%, 83.9% vs 69.0, 18.5% vs 9.7%, respectively; p&lt; 0.05 for all) than HFpEF patients. Patients with HFpEF were more likely than those with HFrEF to have diabetes mellitus (25.9% vs 37.1%; p&lt; 0.05) The subgroup of patients with HFrEF compared to those with HFpEF had higher bleeding risk (HAS-BLED ≥3 in 32.1% vs 20.4%, P&lt;0.05) due to more frequent abnormal renal/liver function, concomitant antithrombotic treatment/alcohol, prior stroke (24.7% vs 10.6%, 28.4% vs 16.8%, 18.5% vs 9.7%, respectively; P&lt;0.05 for all) but lower thromboembolic risk according to CHA 2 DS 2 -VASc (4.0 vs 4.4; p &lt; 0.05). Oral anticoagulants (OAC) were administered in 88% of patients on discharge. Patterns of anticoagulation administration didn’t differ between the two groups. Patients with HFrEF were less likely to receive first-line rhythm control for AF compared to HFpEF patients (36.1% vs 68.1%; p&lt;0.05). Conclusion Hospitalized patients with NVAF and HFrEF compared to those with HFpEF were younger, with greater severity of HF, higher burden of comorbidities and bleeding risk and slightly lower thromboembolic risk. Despite different clinical characteristics, OAC administration patterns were similar and OAC prescription rate was not optimal in both groups. There ","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140934773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.1093/ehjacc/zuae036.135
A Gomez Gonzalez, C Lopez Flores, M Lucas Garcia, G Padilla Rodriguez, F J Escalona Garcia, M M Martinez Quesada
Funding Acknowledgements None. Introduction Cardiac rehabilitation (CR) has become a fundamental element in the recovery of patients with acute coronary syndrome, since it achieves greater therapeutic adherence and better control of cardiovascular risk factors (CVRF). Purpose We aim to describe the characteristics of patients with ST-elevation acute coronary syndrome (STEACS) included in a cardiac rehabilitation program, as well as the achievement of prevention objectives and the occurrence of mayor adverse cardiovascular events (MACE). Methods We present a prospective registry of 664 patients admitted to a Coronary Unit with a diagnosis of STEACS during the years 2017-2020. They were classified according to their participation in a CR program. We compared history, lipid-lowering treatment (prior, at discharge and titration), lipid levels at discharge and at 1-year follow-up, and degree of compliance with lipid targets. MACE were observed at 2-year follow-up. Results From 664 patients, 351 were excluded due to lack of follow-up or early mortality. From a total of 313 patients (mean age 59.9±11.2 and 81% male), 55.3% were included in the CR program, with this group presenting a lower mean age (55.46±8.7 vs 65.39±11.5 p<0.001), as well as a higher frequency of a history of early ischemic heart disease and smoking, and a lower frequency of arterial hypertension and diabetes (Table). Lipid-lowering treatment at discharge was similar in both groups. In patients undergoing CR there was a lower level of total cholesterol and low-density lipoprotein cholesterol (LDLc) at one year (126.2±27 vs 137.2±34, p=0.002; 57.8±23 vs 67.5±26, p<0.001) compared to the group without CR. A greater reduction in LDLc (41.4% vs 0.86%, p<0.001) was achieved even from higher initial LDLc values. Titration of lipid-lowering treatment was also greater, with the old target of LDLc < 70 being achieved in a greater number of cases (81.5% vs 59.3%, p<0.001). At 1-year follow-up, the new cholesterol reduction target (LDL <55 or 50% reduction) was achieved in only 26.8% of patients, with a greater reduction being obtained in the CR group (34.1% vs 17.9%; p=0.02). At 2-year follow up, in CR group we found low rates of re-infarction (3.2% vs 4.1%), new revascularization (5.8% vs 7.3%), not statistically significant, but we could observe differences in mortality from all causes (0% vs 4.8%, p<0.01). Conclusions Participation in a CR program is associated with better lipid control in patients admitted for STEACS. These programs represent a basic tool for achieving increasingly demanding LDLc targets. Longer follow-up is needed to detect clinically important adverse events.
无。导言：心脏康复（CR）已成为急性冠状动脉综合征患者康复的基本要素，因为它能实现更高的治疗依从性和更好的心血管危险因素（CVRF）控制。目的 我们旨在描述参加心脏康复计划的 STEACS 患者的特征，以及预防目标的实现情况和可能发生的不良心血管事件 (MACE)。方法 我们对 2017-2020 年期间冠心病病房收治的 664 名诊断为 STEACS 的患者进行了前瞻性登记。他们根据是否参与 CR 计划进行分类。我们比较了病史、降脂治疗（之前、出院时和滴定时）、出院时和随访 1 年时血脂水平以及血脂目标的达标程度。观察随访 2 年时的 MACE。结果 664 名患者中有 351 人因缺乏随访或早期死亡而被排除。在总共 313 名患者（平均年龄为 59.9±11.2，81% 为男性）中，55.3% 的患者被纳入 CR 计划，这组患者的平均年龄较低（55.46±8.7 vs 65.39±11.5，p<0.001），有早期缺血性心脏病和吸烟史的频率较高，动脉高血压和糖尿病的频率较低（表）。两组患者出院时的降脂治疗相似。与未接受 CR 治疗的患者相比，接受 CR 治疗的患者一年后的总胆固醇和低密度脂蛋白胆固醇（LDLc）水平较低（126.2±27 vs 137.2±34，p=0.002；57.8±23 vs 67.5±26，p<0.001）。即使初始 LDLc 值较高，但 LDLc 下降幅度更大（41.4% vs 0.86%，p<0.001）。降脂治疗的滴度也更高，更多病例达到了 LDLc < 70 的旧目标（81.5% 对 59.3%，p<0.001）。随访 1 年时，只有 26.8% 的患者达到了新的胆固醇降低目标（LDL<55 或降低 50%），而 CR 组的降低幅度更大（34.1% vs 17.9%；p=0.02）。在 2 年的随访中，我们发现 CR 组的再梗死率（3.2% vs 4.1%）和新血管再形成率（5.8% vs 7.3%）较低，无统计学意义，但我们可以观察到各种原因导致的死亡率差异（0% vs 4.8%，p<0.01）。结论 对于因 STEACS 入院的患者来说，参加 CR 计划与更好地控制血脂有关。这些计划是实现要求越来越高的 LDLc 目标的基本工具。需要更长时间的随访来检测临床上重要的不良事件。
{"title":"Cardiac rehabilitation makes a difference: lipid control targets and prognosis","authors":"A Gomez Gonzalez, C Lopez Flores, M Lucas Garcia, G Padilla Rodriguez, F J Escalona Garcia, M M Martinez Quesada","doi":"10.1093/ehjacc/zuae036.135","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae036.135","url":null,"abstract":"Funding Acknowledgements None. Introduction Cardiac rehabilitation (CR) has become a fundamental element in the recovery of patients with acute coronary syndrome, since it achieves greater therapeutic adherence and better control of cardiovascular risk factors (CVRF). Purpose We aim to describe the characteristics of patients with ST-elevation acute coronary syndrome (STEACS) included in a cardiac rehabilitation program, as well as the achievement of prevention objectives and the occurrence of mayor adverse cardiovascular events (MACE). Methods We present a prospective registry of 664 patients admitted to a Coronary Unit with a diagnosis of STEACS during the years 2017-2020. They were classified according to their participation in a CR program. We compared history, lipid-lowering treatment (prior, at discharge and titration), lipid levels at discharge and at 1-year follow-up, and degree of compliance with lipid targets. MACE were observed at 2-year follow-up. Results From 664 patients, 351 were excluded due to lack of follow-up or early mortality. From a total of 313 patients (mean age 59.9±11.2 and 81% male), 55.3% were included in the CR program, with this group presenting a lower mean age (55.46±8.7 vs 65.39±11.5 p&lt;0.001), as well as a higher frequency of a history of early ischemic heart disease and smoking, and a lower frequency of arterial hypertension and diabetes (Table). Lipid-lowering treatment at discharge was similar in both groups. In patients undergoing CR there was a lower level of total cholesterol and low-density lipoprotein cholesterol (LDLc) at one year (126.2±27 vs 137.2±34, p=0.002; 57.8±23 vs 67.5±26, p&lt;0.001) compared to the group without CR. A greater reduction in LDLc (41.4% vs 0.86%, p&lt;0.001) was achieved even from higher initial LDLc values. Titration of lipid-lowering treatment was also greater, with the old target of LDLc &lt; 70 being achieved in a greater number of cases (81.5% vs 59.3%, p&lt;0.001). At 1-year follow-up, the new cholesterol reduction target (LDL &lt;55 or 50% reduction) was achieved in only 26.8% of patients, with a greater reduction being obtained in the CR group (34.1% vs 17.9%; p=0.02). At 2-year follow up, in CR group we found low rates of re-infarction (3.2% vs 4.1%), new revascularization (5.8% vs 7.3%), not statistically significant, but we could observe differences in mortality from all causes (0% vs 4.8%, p&lt;0.01). Conclusions Participation in a CR program is associated with better lipid control in patients admitted for STEACS. These programs represent a basic tool for achieving increasingly demanding LDLc targets. Longer follow-up is needed to detect clinically important adverse events.","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140934850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.1093/ehjacc/zuae036.153
S Lee, E Kang, M Heo, C Ahn
Funding Acknowledgements None. Background Veno-arterial extracorporeal membranous oxygenator (VA-ECMO) is one of the most powerful devices that rapidly restore sufficient organ perfusion in patients with cardiogenic shock. Despite abundant experiences of successful resuscitation with VA-ECMO, evidences for clinical benefit of VA-ECMO are still lacking. Purpose We summarised clinical outcomes related to VA-ECMO and investigated predictors regarding survival at discharge. Methods Patients who treated with peripheral VA-ECMO between 2006 and 2022 were included from a Hospital in South Korea. Eligible patients were analysed in stratification with ECMO initiation year (year 2006–2010, year 2011–2016, and year 2017–2022). Survival status at discharge were investigated. Results Among total of 693 patients included, 223 (32.2%) were survived at discharge. Survivors had stayed in hospital for median 28 (19–52) days. The overall volume of ECMO initiation (86 runs vs. 250 runs vs. 357 runs) and the rate of extracorporeal CPR (3.5% vs. 18.4% vs. 38.1%) have increased over time. The median duration of VA-ECMO treatment has increased over time (52.6 hours vs. 63.6 hours vs. 85.8 hours). The serum lactate test has been performed more frequently over time (15.1% vs. 79.6% vs. 99.2%). Among 470 patients who died in the index hospitalization, 154 (32.8%) patients died in the first 24 hours after initiation of VA-ECMO. In a multivariate regression model, age over 70 (OR, 0.54; 95% CI, 0.32–0.89), extracorporeal CPR (OR, 0.42; 95% CI, 0.24–0.71), and lactate level ≥8.0 mmol/L (OR, 0.24; 95% CI, 0.15–0.37) were associated with unfavorable outcome while hemoglobin was a predictor of favorable clinical outcome (OR, 1.16; 95% CI, 1.07–1.25). Conclusion The volume of VA-ECMO has increased and clinical severity has also become higher than before. The rate of survival at discharge after VA-ECMO treatment remains stable; however, the rate of patients who died in the first 24 hours is still high. Age, extracorporeal CPR, hemoglobin and lactate levels were predictors of clinical outcome after VA-ECMO treatment.
{"title":"Real-world clinical outcome related to veno-arterial extracorporeal membranous oxygenator: a single-center experience","authors":"S Lee, E Kang, M Heo, C Ahn","doi":"10.1093/ehjacc/zuae036.153","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae036.153","url":null,"abstract":"Funding Acknowledgements None. Background Veno-arterial extracorporeal membranous oxygenator (VA-ECMO) is one of the most powerful devices that rapidly restore sufficient organ perfusion in patients with cardiogenic shock. Despite abundant experiences of successful resuscitation with VA-ECMO, evidences for clinical benefit of VA-ECMO are still lacking. Purpose We summarised clinical outcomes related to VA-ECMO and investigated predictors regarding survival at discharge. Methods Patients who treated with peripheral VA-ECMO between 2006 and 2022 were included from a Hospital in South Korea. Eligible patients were analysed in stratification with ECMO initiation year (year 2006–2010, year 2011–2016, and year 2017–2022). Survival status at discharge were investigated. Results Among total of 693 patients included, 223 (32.2%) were survived at discharge. Survivors had stayed in hospital for median 28 (19–52) days. The overall volume of ECMO initiation (86 runs vs. 250 runs vs. 357 runs) and the rate of extracorporeal CPR (3.5% vs. 18.4% vs. 38.1%) have increased over time. The median duration of VA-ECMO treatment has increased over time (52.6 hours vs. 63.6 hours vs. 85.8 hours). The serum lactate test has been performed more frequently over time (15.1% vs. 79.6% vs. 99.2%). Among 470 patients who died in the index hospitalization, 154 (32.8%) patients died in the first 24 hours after initiation of VA-ECMO. In a multivariate regression model, age over 70 (OR, 0.54; 95% CI, 0.32–0.89), extracorporeal CPR (OR, 0.42; 95% CI, 0.24–0.71), and lactate level ≥8.0 mmol/L (OR, 0.24; 95% CI, 0.15–0.37) were associated with unfavorable outcome while hemoglobin was a predictor of favorable clinical outcome (OR, 1.16; 95% CI, 1.07–1.25). Conclusion The volume of VA-ECMO has increased and clinical severity has also become higher than before. The rate of survival at discharge after VA-ECMO treatment remains stable; however, the rate of patients who died in the first 24 hours is still high. Age, extracorporeal CPR, hemoglobin and lactate levels were predictors of clinical outcome after VA-ECMO treatment.","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140934783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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