Yoriyasu Suzuki, A. Murata, S. Tsujimoto, Y. Ochiumi, Tatsuya Ito
Abstract Background: There is no known therapy with proven efficacy for improving clinical outcomes in elderly patients with heart failure (HF) and preserved ejection fraction (HFpEF). In this study, we aimed to evaluate the efficacy of tolvaptan (TLV) in elderly HFpEF patients. Methods: This retrospective observational study involved 100 consecutive elderly HFpEF patients hospitalized at the Nagoya Heart Center, Japan. Inclusion criteria were: (1) patients aged ≥75 years; (2) first hospitalization secondary to HF; (3) received medical therapy for HF, without invasive treatment; and (4) clinical follow-up for >6 months after discharge. The primary endpoint was rehospitalization due to worsening HF, and the secondary endpoint was worsening renal function (WRF) during hospitalization and at 6 months after discharge. Sixty background-matched HFpEF patients were divided into 2 groups: with TLV therapy (TLV (+), n = 29) and without TLV therapy (TLV (–), n = 31). In the TLV (+) group, TLV therapy was continued after discharge. Clinical outcomes of these patients were evaluated. Results: Bed rest period and length of hospital stay were significantly shorter in the TLV (+) group than in the TLV (−) group. The dose of loop diuretics, mean serum creatinine levels, and incidence of WRF development were significantly lower in the TLV (+) group. Incidence of rehospitalization was also significantly lower in the TLV (+) group (log-rank test; p = 0.018). The multivariate logistic regression analysis demonstrated that TLV therapy reduces the incidence of rehospitalization in elderly patients with HFpEF. Conclusions: TLV therapy reduced the bed rest period, length of hospital stay, and rate of rehospitalization without WRF in elderly HFpEF patients, suggesting that TLV could represent an effective therapy for this group of patients.
背景:对于老年心力衰竭(HF)和保留射血分数(HFpEF)患者的临床结果，目前还没有已知的治疗方法被证实有效。在本研究中，我们旨在评估托伐普坦(TLV)在老年HFpEF患者中的疗效。方法:本回顾性观察研究纳入日本名古屋心脏中心连续住院的100例老年HFpEF患者。纳入标准:(1)患者年龄≥75岁;(2)继发心力衰竭首次住院;(3)接受药物治疗的心衰患者，未进行有创治疗;(4)出院后6个月临床随访。主要终点是HF恶化导致的再住院，次要终点是住院期间和出院后6个月肾功能(WRF)恶化。60例背景匹配的HFpEF患者分为两组:TLV治疗组(TLV (+)， n = 29)和未TLV治疗组(TLV (-)， n = 31)。TLV(+)组在出院后继续TLV治疗。评估这些患者的临床结果。结果:TLV(+)组的卧床休息时间和住院时间明显短于TLV(-)组。TLV(+)组的袢利尿剂剂量、平均血清肌酐水平和WRF发生的发生率均显著降低。TLV(+)组再住院的发生率也显著降低(log-rank检验;P = 0.018)。多因素logistic回归分析显示，TLV治疗可降低老年HFpEF患者再住院的发生率。结论:TLV治疗可减少老年HFpEF患者的卧床时间、住院时间和无WRF的再住院率，提示TLV治疗可能是该类患者的有效治疗方法。
{"title":"Efficacy of Tolvaptan in Elderly Patients with Heart Failure and Preserved Ejection Fraction","authors":"Yoriyasu Suzuki, A. Murata, S. Tsujimoto, Y. Ochiumi, Tatsuya Ito","doi":"10.2478/jce-2019-0007","DOIUrl":"https://doi.org/10.2478/jce-2019-0007","url":null,"abstract":"Abstract Background: There is no known therapy with proven efficacy for improving clinical outcomes in elderly patients with heart failure (HF) and preserved ejection fraction (HFpEF). In this study, we aimed to evaluate the efficacy of tolvaptan (TLV) in elderly HFpEF patients. Methods: This retrospective observational study involved 100 consecutive elderly HFpEF patients hospitalized at the Nagoya Heart Center, Japan. Inclusion criteria were: (1) patients aged ≥75 years; (2) first hospitalization secondary to HF; (3) received medical therapy for HF, without invasive treatment; and (4) clinical follow-up for >6 months after discharge. The primary endpoint was rehospitalization due to worsening HF, and the secondary endpoint was worsening renal function (WRF) during hospitalization and at 6 months after discharge. Sixty background-matched HFpEF patients were divided into 2 groups: with TLV therapy (TLV (+), n = 29) and without TLV therapy (TLV (–), n = 31). In the TLV (+) group, TLV therapy was continued after discharge. Clinical outcomes of these patients were evaluated. Results: Bed rest period and length of hospital stay were significantly shorter in the TLV (+) group than in the TLV (−) group. The dose of loop diuretics, mean serum creatinine levels, and incidence of WRF development were significantly lower in the TLV (+) group. Incidence of rehospitalization was also significantly lower in the TLV (+) group (log-rank test; p = 0.018). The multivariate logistic regression analysis demonstrated that TLV therapy reduces the incidence of rehospitalization in elderly patients with HFpEF. Conclusions: TLV therapy reduced the bed rest period, length of hospital stay, and rate of rehospitalization without WRF in elderly HFpEF patients, suggesting that TLV could represent an effective therapy for this group of patients.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"151 1","pages":"59 - 65"},"PeriodicalIF":0.4,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77489677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Çanga, A. Emre, M. Karataş, A. Çalık, N. S. Yelgeç, U. Yıldız, S. Terzi
Abstract Background: Acute ST-elevation myocardial infarction (STEMI) is an uncommon diagnosis in patients less than 40 years of age. Over the last two decades, there is an increase in the frequency of cardiovascular events among young adults. However, at present there is only limited clinical data on the clinical characteristics and outcomes of STEMI in young patients who were treated with primary percutaneous coronary intervention (pPCI). Plaque erosion is the underlying pathological mechanism leading to STEMI in the vast majority of young adults. Thrombi that complicate superficial erosion seem more platelet-rich than the fibrinous clots precipitated by plaque rupture. Mean platelet volume (MPV) is recognized as a marker of the platelet activation process and may be a better indicator of short-term prognosis than the inflammatory markers in young patients with STEMI. Therefore, we aimed to investigate clinical and angiographic characteristics, risk factors and the independent value of MPV on predicting short-term major adverse cardiovascular events (MACEs) in young adults with STEMI. Methods: A total of 349 patients aged 40 years or younger who underwent pPCI at our center between 2010–2015 with the diagnosis of STEMI were retrospectively analyzed. Results: The mean age of the patients was 36.4 ± 3.6 years and 90% of them were men. Smoking was by far the most frequent cardiovascular risk factor. MACEs were observed in 23 patients (6.6%), and according to the multivariate regression analysis, Killip IIIIV (OR 7.52, 95% CI 1.25–45.24, p = 0.03), lower admission SBP (OR 0.94, 95% CI 0.90–0.98, p <0.01) and increased MPV (OR 1.67, 95% CI 1.05–2.67, p = 0.03) were found to be independently correlated with MACE in the study population. Conclusion: Our results indicate that MPV is an independent predictor of MACEs at the short-term follow-up in young patients with STEMI undergoing pPCI. Accordingly, we suggested that MPV, a marker of platelet activation, could play a significant role in predicting clinical evolution in young patients with STEMI.
背景:急性st段抬高型心肌梗死(STEMI)在40岁以下的患者中是一种罕见的诊断。在过去的二十年中，年轻人心血管事件的发生频率有所增加。然而，目前关于STEMI在接受原发性经皮冠状动脉介入治疗(pPCI)的年轻患者中的临床特征和预后的临床数据有限。斑块侵蚀是导致绝大多数年轻人STEMI的潜在病理机制。使表面侵蚀复杂化的血栓似乎比由斑块破裂沉淀的纤维性凝块含有更多的血小板。平均血小板体积(MPV)被认为是血小板活化过程的标志，可能是年轻STEMI患者短期预后的更好指标。因此，我们旨在研究STEMI青年患者的临床和血管造影特征、危险因素以及MPV在预测短期主要心血管不良事件(mace)方面的独立价值。方法:回顾性分析2010-2015年在我中心接受pPCI治疗、诊断为STEMI的40岁及以下患者349例。结果:患者平均年龄36.4±3.6岁，男性占90%。吸烟是迄今为止最常见的心血管风险因素。23例(6.6%)患者出现MACE，根据多因素回归分析，Killipⅲⅲⅳ(OR 7.52, 95% CI 1.25 ~ 45.24, p = 0.03)、入院收缩压降低(OR 0.94, 95% CI 0.90 ~ 0.98, p <0.01)和MPV升高(OR 1.67, 95% CI 1.05 ~ 2.67, p = 0.03)与研究人群的MACE独立相关。结论:我们的研究结果表明，MPV是年轻STEMI患者接受pPCI短期随访时mes的独立预测因子。因此，我们认为血小板活化标志物MPV可能在预测年轻STEMI患者的临床演变中发挥重要作用。
{"title":"Mean Platelet Volume Predicts Short-term Prognosis in Young Patients with St-segment Elevation Myocardial Infarction","authors":"Y. Çanga, A. Emre, M. Karataş, A. Çalık, N. S. Yelgeç, U. Yıldız, S. Terzi","doi":"10.2478/jce-2019-0008","DOIUrl":"https://doi.org/10.2478/jce-2019-0008","url":null,"abstract":"Abstract Background: Acute ST-elevation myocardial infarction (STEMI) is an uncommon diagnosis in patients less than 40 years of age. Over the last two decades, there is an increase in the frequency of cardiovascular events among young adults. However, at present there is only limited clinical data on the clinical characteristics and outcomes of STEMI in young patients who were treated with primary percutaneous coronary intervention (pPCI). Plaque erosion is the underlying pathological mechanism leading to STEMI in the vast majority of young adults. Thrombi that complicate superficial erosion seem more platelet-rich than the fibrinous clots precipitated by plaque rupture. Mean platelet volume (MPV) is recognized as a marker of the platelet activation process and may be a better indicator of short-term prognosis than the inflammatory markers in young patients with STEMI. Therefore, we aimed to investigate clinical and angiographic characteristics, risk factors and the independent value of MPV on predicting short-term major adverse cardiovascular events (MACEs) in young adults with STEMI. Methods: A total of 349 patients aged 40 years or younger who underwent pPCI at our center between 2010–2015 with the diagnosis of STEMI were retrospectively analyzed. Results: The mean age of the patients was 36.4 ± 3.6 years and 90% of them were men. Smoking was by far the most frequent cardiovascular risk factor. MACEs were observed in 23 patients (6.6%), and according to the multivariate regression analysis, Killip IIIIV (OR 7.52, 95% CI 1.25–45.24, p = 0.03), lower admission SBP (OR 0.94, 95% CI 0.90–0.98, p <0.01) and increased MPV (OR 1.67, 95% CI 1.05–2.67, p = 0.03) were found to be independently correlated with MACE in the study population. Conclusion: Our results indicate that MPV is an independent predictor of MACEs at the short-term follow-up in young patients with STEMI undergoing pPCI. Accordingly, we suggested that MPV, a marker of platelet activation, could play a significant role in predicting clinical evolution in young patients with STEMI.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"56 1","pages":"50 - 58"},"PeriodicalIF":0.4,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81554648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"New ICCUs – a Modern Perspective on Acute Cardiac Care","authors":"T. Benedek, R. Hodaș","doi":"10.2478/jce-2019-0010","DOIUrl":"https://doi.org/10.2478/jce-2019-0010","url":null,"abstract":"","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"20 1","pages":"47 - 49"},"PeriodicalIF":0.4,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89606358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Rațiu, N. Raț, Tiberiu Nyulas, Geanina Moldovan, V. Rus, T. Benedek, I. Benedek
Abstract The aim of our study was to investigate the correlation between volumes of thoracic fat distributed in different compartments and the geometry of vulnerable coronary plaques assessed by coronary computed tomography angiography (CCTA), in patients with acute chest pain. Methods: This was a non-randomized, observational, single-center study, including 50 patients who presented in the emergency department with acute chest pain who underwent 128-slice single-source CCTA. Plaque geometry was evaluated in transversal and longitudinal planes, and the assessment of adipose tissue was performed using the Syngo.via Frontier (Siemens AG, Healthcare Sector, Forchheim, Germany) research platform. Results: Eccentric plaques presented a significantly higher incidence of spotty calcification (40% vs. 22%, p = 0.018), whereas positive remodeling, volume of low attenuation plaque, and incidence of napkin-ring sign were not significantly different between the study groups or in ascending versus descending plaques. The volume of pericoronary fat around the plaque was significantly larger near eccentric lesions (707.68 ± 454.08 mm3 vs. 483.25 ± 306.98 mm3, p = 0.046) and descendent plaques (778.26 ± 479.37 mm3 vs. 473.60 ± 285.27 mm3, p = 0.016). Compared to ascending lesions, descendent ones presented a significantly larger volume of thoracic fat (1,599.25 ± 589.12 mL vs. 1,240.71 ± 291.50 mL), while there was no significant correlation between thoracic fat and cross-sectional eccentricity. Conclusions: The phenotype of plaque distribution and geometry seems to be associated with a higher vulnerability of coronary lesions and may be influenced by the local accumulation of inflammatory mediators released by the pericoronary epicardial adipose tissue.
摘要:本研究旨在探讨急性胸痛患者不同腔室的胸廓脂肪体积与冠状动脉ct血管造影(CCTA)评估的易损斑块几何形状之间的相关性。方法:这是一项非随机、观察性、单中心研究，包括50例急诊科急性胸痛患者，他们接受了128层单源CCTA。在横向和纵向平面上评估斑块的几何形状，并使用Syngo评估脂肪组织。通过Frontier (Siemens AG，医疗保健部门，德国福尔海姆)研究平台。结果:偏心斑块的点状钙化发生率明显较高(40%比22%，p = 0.018)，而正重构、低衰减斑块的体积和餐巾环征象的发生率在研究组之间或上升斑块与下降斑块之间无显著差异。斑块周围的冠状动脉脂肪体积在偏心病变附近(707.68±454.08 mm3 vs. 483.25±306.98 mm3, p = 0.046)和下降斑块附近(778.26±479.37 mm3 vs. 473.60±285.27 mm3, p = 0.016)明显较大。与上升病变相比，下降病变的胸部脂肪量明显增加(1,599.25±589.12 mL vs 1,240.71±291.50 mL)，而胸部脂肪与横截面偏心率无显著相关性。结论:斑块分布的表型和几何形状似乎与冠状动脉病变的易感性有关，并可能受到冠状动脉周围心外膜脂肪组织释放的炎症介质的局部积累的影响。
{"title":"Coronary Plaque Geometry and Thoracic Fat Distribution in Patients with Acute Chest Pain – a CT Angiography Study","authors":"M. Rațiu, N. Raț, Tiberiu Nyulas, Geanina Moldovan, V. Rus, T. Benedek, I. Benedek","doi":"10.2478/jce-2019-0001","DOIUrl":"https://doi.org/10.2478/jce-2019-0001","url":null,"abstract":"Abstract The aim of our study was to investigate the correlation between volumes of thoracic fat distributed in different compartments and the geometry of vulnerable coronary plaques assessed by coronary computed tomography angiography (CCTA), in patients with acute chest pain. Methods: This was a non-randomized, observational, single-center study, including 50 patients who presented in the emergency department with acute chest pain who underwent 128-slice single-source CCTA. Plaque geometry was evaluated in transversal and longitudinal planes, and the assessment of adipose tissue was performed using the Syngo.via Frontier (Siemens AG, Healthcare Sector, Forchheim, Germany) research platform. Results: Eccentric plaques presented a significantly higher incidence of spotty calcification (40% vs. 22%, p = 0.018), whereas positive remodeling, volume of low attenuation plaque, and incidence of napkin-ring sign were not significantly different between the study groups or in ascending versus descending plaques. The volume of pericoronary fat around the plaque was significantly larger near eccentric lesions (707.68 ± 454.08 mm3 vs. 483.25 ± 306.98 mm3, p = 0.046) and descendent plaques (778.26 ± 479.37 mm3 vs. 473.60 ± 285.27 mm3, p = 0.016). Compared to ascending lesions, descendent ones presented a significantly larger volume of thoracic fat (1,599.25 ± 589.12 mL vs. 1,240.71 ± 291.50 mL), while there was no significant correlation between thoracic fat and cross-sectional eccentricity. Conclusions: The phenotype of plaque distribution and geometry seems to be associated with a higher vulnerability of coronary lesions and may be influenced by the local accumulation of inflammatory mediators released by the pericoronary epicardial adipose tissue.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"36 1","pages":"18 - 24"},"PeriodicalIF":0.4,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75456802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Smart Technology – a Future Field in Acute Cardiac Care","authors":"Monica Marton-Popovici, Aura-Gabriela Casu","doi":"10.2478/jce-2019-0003","DOIUrl":"https://doi.org/10.2478/jce-2019-0003","url":null,"abstract":"","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"60 1","pages":"32 - 34"},"PeriodicalIF":0.4,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74482296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Anghel, C. Prisăcariu, R. Sascău, L. Macovei, E. Cristea, Georgiana Prisacariu, C. Stătescu
Abstract Coronary heart disease occurs more often in patients over the age of 45. However, recent data shows a growing incidence of coronary events in younger patients also. Young patients with acute myocardial infarction (AMI) represent a relatively small proportion of subjects suffering from an acute ischemic event. However, they represent a subset that is distinguished from elderly patients by a different profile of risk factors, often atypical clinical presentation, and different prognosis. The prevalence of risk factors such as smoking, dyslipidemia, and a family history of coronary events is higher in this group of patients compared to the general population with AMI. Because of an important negative impact on the patients’ psychology, impaired working abilities, and a high socioeconomical burden, myocardial infarction in young patients represents an important cardiovascular pathology. This manuscript aims to present the particularities of AMI occuring at a young age, in comparison with the rest of the population with AMI.
{"title":"Particularities of Acute Myocardial Infarction in Young Adults","authors":"L. Anghel, C. Prisăcariu, R. Sascău, L. Macovei, E. Cristea, Georgiana Prisacariu, C. Stătescu","doi":"10.2478/jce-2019-0005","DOIUrl":"https://doi.org/10.2478/jce-2019-0005","url":null,"abstract":"Abstract Coronary heart disease occurs more often in patients over the age of 45. However, recent data shows a growing incidence of coronary events in younger patients also. Young patients with acute myocardial infarction (AMI) represent a relatively small proportion of subjects suffering from an acute ischemic event. However, they represent a subset that is distinguished from elderly patients by a different profile of risk factors, often atypical clinical presentation, and different prognosis. The prevalence of risk factors such as smoking, dyslipidemia, and a family history of coronary events is higher in this group of patients compared to the general population with AMI. Because of an important negative impact on the patients’ psychology, impaired working abilities, and a high socioeconomical burden, myocardial infarction in young patients represents an important cardiovascular pathology. This manuscript aims to present the particularities of AMI occuring at a young age, in comparison with the rest of the population with AMI.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"21 1","pages":"25 - 31"},"PeriodicalIF":0.4,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90437128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with multivessel disease and acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) present one of the worst outcomes in the field of cardiac critical care, with mortality rates reported as high as 45– 50% even in the presence of the most modern facilities for advanced cardiac support.1 The main recent directions of development in the field of emergency care for critical patients with CS and AMI are represented by: the change introduced by the new European recommendations regarding the revascularization of culprit lesions only in patients with AMI and CS, the implementation of regional networks for reducing time delays from symptom onset to revascularization, and the use of modern equipment for advanced cardiac support.1–3 The first major change in the therapeutic strategy for CS-AMI patients is related to the recent change in the European recommendation for primary revascularization in patients with multivessel disease and CS complicating AMI. Several years ago, the SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) trial demonstrated that emergency revascularization can significantly improve survival in patients with CS complicating AMI.2 However, in the presence of multivessel disease, there were inconclusive data to support the need for complete revascularization of all lesions in emergency conditions.3 Until recently, while major international guidelines recommended against urgent revascularization of non-culprit lesions in hemodynamically stable patients with STEMI, European guidelines recommended that revascularization of non-culprit arteries should be considered in patients with CS (indication class IIa).4 The recent guidelines on myocardial revascularization published by the European Society of Cardiology clearly advise against complete revascularization in patients with CS, recommending revascularization of the culprit lesion only (the lesion that caused infarction) and staged procedures for the non-culprit lesions.5 This change in recommendations is mainly caused by the recently published results of the CULPRIT-SHOCK trial, which demonstrated that in patients with multivessel disease, AMI, and CS, a strategy consisting in primary percutaneous coronary intervention (PCI) of the culprit lesion only is associated with a significant risk reduction in 30-day all-cause mortality (43.3% vs. 51.6%, HR = 0.84, p = 0.03) and with a significantly lower incidence of the composite endpoint consisting in all-cause mortality or severe renal failure, compared to a strategy consisting in complete revascularization of all coronary lesions in emergency.6 Therefore, the current guidelines published this year strongly recommend culprit lesion-only primary PCI in patients with CS complicating AMI. The second major direction for development in cardiac critical care for CS patients is represented by the efforts to implement appropriate logistics for reducing time deMyocardial Revascularization in C
多血管疾病合并急性心肌梗死(AMI)并发心源性休克(CS)的患者是心脏重症监护领域最糟糕的结果之一，即使在最先进的先进心脏支持设施中，死亡率也高达45% - 50%最近在急性心肌梗塞和急性心肌梗死危重患者急诊护理领域的主要发展方向有:新的欧洲建议所带来的变化，即仅在急性心肌梗塞和急性心肌梗死患者中对罪魁祸首病变进行血运重建，实施区域网络以减少从症状发作到血运重建的时间延迟，以及使用现代设备进行高级心脏支持。1-3 CS-AMI患者治疗策略的第一个主要变化与最近欧洲对多血管疾病和CS合并AMI患者的初级血运重建术推荐的变化有关。几年前，SHOCK(我们是否应该为心源性休克对闭塞的冠状动脉进行紧急血运重建)试验表明，紧急血运重建可以显著提高CS合并ami患者的生存率。然而，在存在多血管疾病的情况下，没有确凿的数据支持在紧急情况下对所有病变进行完全血运重建的必要性直到最近，虽然主要的国际指南建议血液动力学稳定的STEMI患者不要对非罪魁祸首病变进行紧急血运重建术，但欧洲指南建议CS患者应考虑对非罪魁祸首动脉进行血运重建术(适应症等级IIa)欧洲心脏病学会(European Society of Cardiology)最近发布的心肌血运重建术指南明确建议CS患者不要进行完全血运重建术，建议只对罪魁祸首病变(引起梗死的病变)进行血运重建术，对非罪魁祸首病变进行分期手术这一建议的改变主要是由最近发表的“罪魁祸首-休克”试验结果引起的，该试验表明，在多血管疾病、AMI和CS患者中，仅对罪魁祸首病变进行初级经皮冠状动脉介入治疗(PCI)的策略与30天全因死亡率的显著降低相关(43.3%对51.6%，HR = 0.84)。P = 0.03)，并且与在紧急情况下对所有冠状动脉病变进行完全血运重建的策略相比，由全因死亡率或严重肾功能衰竭组成的复合终点的发生率显著降低因此，今年发布的现行指南强烈推荐CS合并AMI患者仅行罪魁祸首病变的初级PCI。CS患者心脏危重监护的第二个主要发展方向是努力实施适当的后勤工作，以减少急性心肌梗死和心源性休克危重患者的脱心肌血运重建术时间——从欧洲新建议的角度来看
{"title":"Myocardial Revascularization in Critical Patients with Acute Myocardial Infarction and Cardiogenic Shock – a Perspective on New European Recommendations","authors":"T. Benedek","doi":"10.2478/jce-2019-0004","DOIUrl":"https://doi.org/10.2478/jce-2019-0004","url":null,"abstract":"Patients with multivessel disease and acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) present one of the worst outcomes in the field of cardiac critical care, with mortality rates reported as high as 45– 50% even in the presence of the most modern facilities for advanced cardiac support.1 The main recent directions of development in the field of emergency care for critical patients with CS and AMI are represented by: the change introduced by the new European recommendations regarding the revascularization of culprit lesions only in patients with AMI and CS, the implementation of regional networks for reducing time delays from symptom onset to revascularization, and the use of modern equipment for advanced cardiac support.1–3 The first major change in the therapeutic strategy for CS-AMI patients is related to the recent change in the European recommendation for primary revascularization in patients with multivessel disease and CS complicating AMI. Several years ago, the SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) trial demonstrated that emergency revascularization can significantly improve survival in patients with CS complicating AMI.2 However, in the presence of multivessel disease, there were inconclusive data to support the need for complete revascularization of all lesions in emergency conditions.3 Until recently, while major international guidelines recommended against urgent revascularization of non-culprit lesions in hemodynamically stable patients with STEMI, European guidelines recommended that revascularization of non-culprit arteries should be considered in patients with CS (indication class IIa).4 The recent guidelines on myocardial revascularization published by the European Society of Cardiology clearly advise against complete revascularization in patients with CS, recommending revascularization of the culprit lesion only (the lesion that caused infarction) and staged procedures for the non-culprit lesions.5 This change in recommendations is mainly caused by the recently published results of the CULPRIT-SHOCK trial, which demonstrated that in patients with multivessel disease, AMI, and CS, a strategy consisting in primary percutaneous coronary intervention (PCI) of the culprit lesion only is associated with a significant risk reduction in 30-day all-cause mortality (43.3% vs. 51.6%, HR = 0.84, p = 0.03) and with a significantly lower incidence of the composite endpoint consisting in all-cause mortality or severe renal failure, compared to a strategy consisting in complete revascularization of all coronary lesions in emergency.6 Therefore, the current guidelines published this year strongly recommend culprit lesion-only primary PCI in patients with CS complicating AMI. The second major direction for development in cardiac critical care for CS patients is represented by the efforts to implement appropriate logistics for reducing time deMyocardial Revascularization in C","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"14 1","pages":"5 - 6"},"PeriodicalIF":0.4,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77318217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Cinteză, A. Nicolescu, C. Filip, Georgiana Nicolae, Gabriela Duică, C. Grigore, Hyam Mahmoud
Abstract Cardiac emergencies in children represent an extremely important issue in medical practice. In general, interventional treatment could be optional in many situations, however it can be indicated in emergency conditions. There are many diseases at pediatric age that can benefit from interventional treatment, thus reducing the surgical risks and subsequent complications. Balloon atrioseptostomy, patent ductus arteriosus (PDA) closure, percutaneous or hybrid closure of a ventricular septal defect, pulmonary or aortic valvuloplasty, balloon angioplasty for aortic coarctation, implantation of a stent for coarctation of the aorta, for severe stenosis of the infundibulum of the right ventricle, or for PDA correction are among the procedures that can be performed in emergency situations. This review aims to present the current state of the art in the field of pediatric interventional cardiology.
{"title":"Interventional Treatment of Cardiac Emergencies in Children with Congenital Heart Diseases","authors":"E. Cinteză, A. Nicolescu, C. Filip, Georgiana Nicolae, Gabriela Duică, C. Grigore, Hyam Mahmoud","doi":"10.2478/jce-2019-0002","DOIUrl":"https://doi.org/10.2478/jce-2019-0002","url":null,"abstract":"Abstract Cardiac emergencies in children represent an extremely important issue in medical practice. In general, interventional treatment could be optional in many situations, however it can be indicated in emergency conditions. There are many diseases at pediatric age that can benefit from interventional treatment, thus reducing the surgical risks and subsequent complications. Balloon atrioseptostomy, patent ductus arteriosus (PDA) closure, percutaneous or hybrid closure of a ventricular septal defect, pulmonary or aortic valvuloplasty, balloon angioplasty for aortic coarctation, implantation of a stent for coarctation of the aorta, for severe stenosis of the infundibulum of the right ventricle, or for PDA correction are among the procedures that can be performed in emergency situations. This review aims to present the current state of the art in the field of pediatric interventional cardiology.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"188 1","pages":"17 - 7"},"PeriodicalIF":0.4,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77690606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Can We Reduce the Socioeconomic Burden of Acute Myocardial Infarction Already in the Acute Phase?","authors":"Iosif-Alexandru Samu","doi":"10.2478/jce-2018-0025","DOIUrl":"https://doi.org/10.2478/jce-2018-0025","url":null,"abstract":"","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"115 1","pages":"201 - 202"},"PeriodicalIF":0.4,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86793712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：