Pub Date : 2024-06-11DOI: 10.1016/j.rec.2024.04.017
María Anguita Gámez, Juan L Bonilla Palomas, Alejandro Recio Mayoral, Rafael González Manzanares, Javier Muñiz García, Nieves Romero Rodríguez, Francisco J Elola Somoza, Ángel Cequier Fillat, Luis Rodríguez Padial, Manuel Anguita Sánchez
Introduction and objectives: The development of specific heart failure (HF) units has improved the management of patients with this disease due to improved organization and resource management. The Spanish Society of Cardiology (SEC) has defined 3 types of HF units (community, specialized, and advanced) based on their complexity and service portfolio. Our aim was to compare the characteristics, treatment, and outcomes of patients with HF according to the type of unit.
Methods: We analyzed data from the SEC-Excelente-IC quality accreditation program registry, with 1716 patients consecutively included in two 1-month cutoffs (March and October) from 2019 to 2021 by 45 SEC-accredited HF units. We compared the characteristics, treatment and 1-year outcomes between the 3 types of units.
Results: Of the 1716 patients, 13.2% were treated in community units, 65.9% in specialized units, and 20.9% in advanced units. The rates of mortality (27.5 vs 15.5/100 patients-year; P<.001), admissions for HF (39.7 vs 29.2/100 patients-year; P=.019), total decompensations (56.1 vs 40.5/100 patients-year; P=.003), and combined death/admission for HF (45.2 vs 31.4/100 patients-year; P=.005) were higher in community units than in specialized/advanced units. Follow-up in a community unit was an independent predictor of higher mortality and admissions at 1 year.
Conclusions: Compared with follow-up by more specialized units, follow-up in a community unit was associated with a higher decompensation rate and increased 1-year mortality.
{"title":"Outcomes of patients with heart failure followed in units accredited by the SEC-Excelente-IC quality program according to the type of unit.","authors":"María Anguita Gámez, Juan L Bonilla Palomas, Alejandro Recio Mayoral, Rafael González Manzanares, Javier Muñiz García, Nieves Romero Rodríguez, Francisco J Elola Somoza, Ángel Cequier Fillat, Luis Rodríguez Padial, Manuel Anguita Sánchez","doi":"10.1016/j.rec.2024.04.017","DOIUrl":"10.1016/j.rec.2024.04.017","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>The development of specific heart failure (HF) units has improved the management of patients with this disease due to improved organization and resource management. The Spanish Society of Cardiology (SEC) has defined 3 types of HF units (community, specialized, and advanced) based on their complexity and service portfolio. Our aim was to compare the characteristics, treatment, and outcomes of patients with HF according to the type of unit.</p><p><strong>Methods: </strong>We analyzed data from the SEC-Excelente-IC quality accreditation program registry, with 1716 patients consecutively included in two 1-month cutoffs (March and October) from 2019 to 2021 by 45 SEC-accredited HF units. We compared the characteristics, treatment and 1-year outcomes between the 3 types of units.</p><p><strong>Results: </strong>Of the 1716 patients, 13.2% were treated in community units, 65.9% in specialized units, and 20.9% in advanced units. The rates of mortality (27.5 vs 15.5/100 patients-year; P<.001), admissions for HF (39.7 vs 29.2/100 patients-year; P=.019), total decompensations (56.1 vs 40.5/100 patients-year; P=.003), and combined death/admission for HF (45.2 vs 31.4/100 patients-year; P=.005) were higher in community units than in specialized/advanced units. Follow-up in a community unit was an independent predictor of higher mortality and admissions at 1 year.</p><p><strong>Conclusions: </strong>Compared with follow-up by more specialized units, follow-up in a community unit was associated with a higher decompensation rate and increased 1-year mortality.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318528","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}
{"title":"Importance of sudden cardiac death risk assessment: the wearable cardioverter defibrillator as a bridge to transplant.","authors":"Borja Guerrero Cervera, Raquel López-Vilella, Víctor Donoso Trenado, Maite Izquierdo, Joaquín Osca Asensi, Luis Almenar-Bonet","doi":"10.1016/j.rec.2024.04.015","DOIUrl":"10.1016/j.rec.2024.04.015","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318527","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 : 2024-06-10DOI: 10.1016/j.rec.2024.05.008
{"title":"Nutritional status on admission and role in prognosis of cardiogenic shock","authors":"","doi":"10.1016/j.rec.2024.05.008","DOIUrl":"10.1016/j.rec.2024.05.008","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311892","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 : 2024-06-04DOI: 10.1016/j.rec.2024.05.007
Yang Xu, Xiaochen Liu, Yingying Guo, Yuyao Qiu, Yushi Zhang, Xiao Wang, Shaoping Nie
Introduction and objectives: Coronary microvascular dysfunction (CMD) is highly prevalent and is recognized as an important clinical entity in patients with coronary heart disease (CHD). Nevertheless, the association of CMD with adverse cardiovascular events in the spectrum of CHD has not been systemically quantified.
Methods: We searched electronic databases for studies on patients with CHD in whom coronary microvascular function was measured invasively, and clinical events were recorded. The primary endpoint was major adverse cardiac events (MACE), and the secondary endpoint was all-cause death. Estimates of effect were calculated using a random-effects model from published risk ratios.
Results: We included 27 studies with 11 404 patients. Patients with CMD assessed by invasive methods had a higher risk of MACE (RR, 2.18; 95%CI, 1.80-2.64; P<.01) and all-cause death (RR, 1.88; 95%CI, 1.55-2.27; P<.01) than those without CMD. There was no significant difference in the impact of CMD on MACE (interaction P value=.95) among different invasive measurement modalities. The magnitude of risk of CMD assessed by invasive measurements for MACE was greater in acute coronary syndrome patients (RR, 2.84, 95%CI, 2.26-3.57; P<.01) than in chronic coronary syndrome patients (RR, 1.77, 95%CI, 1.44-2.18; P<.01) (interaction P value<.01).
Conclusions: CMD based on invasive measurements was associated with a high incidence of MACE and all-cause death in patients with CHD. The magnitude of risk for cardiovascular events in CMD as assessed by invasive measurements was similar among different methods but varied among CHD populations.
{"title":"Invasive assessment of coronary microvascular dysfunction and cardiovascular outcomes across the full spectrum of CHD: a meta-analysis.","authors":"Yang Xu, Xiaochen Liu, Yingying Guo, Yuyao Qiu, Yushi Zhang, Xiao Wang, Shaoping Nie","doi":"10.1016/j.rec.2024.05.007","DOIUrl":"10.1016/j.rec.2024.05.007","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Coronary microvascular dysfunction (CMD) is highly prevalent and is recognized as an important clinical entity in patients with coronary heart disease (CHD). Nevertheless, the association of CMD with adverse cardiovascular events in the spectrum of CHD has not been systemically quantified.</p><p><strong>Methods: </strong>We searched electronic databases for studies on patients with CHD in whom coronary microvascular function was measured invasively, and clinical events were recorded. The primary endpoint was major adverse cardiac events (MACE), and the secondary endpoint was all-cause death. Estimates of effect were calculated using a random-effects model from published risk ratios.</p><p><strong>Results: </strong>We included 27 studies with 11 404 patients. Patients with CMD assessed by invasive methods had a higher risk of MACE (RR, 2.18; 95%CI, 1.80-2.64; P<.01) and all-cause death (RR, 1.88; 95%CI, 1.55-2.27; P<.01) than those without CMD. There was no significant difference in the impact of CMD on MACE (interaction P value=.95) among different invasive measurement modalities. The magnitude of risk of CMD assessed by invasive measurements for MACE was greater in acute coronary syndrome patients (RR, 2.84, 95%CI, 2.26-3.57; P<.01) than in chronic coronary syndrome patients (RR, 1.77, 95%CI, 1.44-2.18; P<.01) (interaction P value<.01).</p><p><strong>Conclusions: </strong>CMD based on invasive measurements was associated with a high incidence of MACE and all-cause death in patients with CHD. The magnitude of risk for cardiovascular events in CMD as assessed by invasive measurements was similar among different methods but varied among CHD populations.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141284911","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 : 2024-06-04DOI: 10.1016/j.rec.2024.05.006
Fabian Tran, Francisco Javier Ruperti-Repilado, Philip Haaf, Pedro Lopez-Ayala, Matthias Greutmann, Markus Schwerzmann, Judith Bouchardy, Harald Gabriel, Dominik Stambach, Juerg Schwitter, Kerstin Wustmann, Michael Freese, Christian Mueller, Daniel Tobler
Introduction and objectives: The role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the risk prediction of patients with systemic right ventricles (sRV) is not well defined. The aim of this study was to analyze the prognostic value of NT-proBNP in patients with an sRV.
Methods: The prognostic value of NT-proBNP was assessed in 98 patients from the SERVE trial. We used an adjusted Cox proportional hazards model, survival analysis, and c-statistics. The composite primary outcome was the occurrence of clinically relevant arrhythmia, heart failure, or death. Correlations between baseline NT-proBNP values and biventricular volumes and function were assessed by adjusted linear regression models.
Results: The median age [interquartile range] at baseline was 39 [32-48] years and 32% were women. The median NT-proBNP was 238 [137-429] ng/L. Baseline NT-proBNP concentrations were significantly higher among the 20 (20%) patients developing the combined primary outcome compared with those who did not (816 [194-1094] vs 205 [122-357]; P=.003). In patients with NT-proBNP concentrations> 75th percentile (> 429 ng/L), we found an exponential increase in the sex- and age-adjusted hazard ratio for the primary outcome. The prognostic value of NT-proBNP was comparable to right ventricular ejection fraction and peak oxygen uptake on exercise testing (c-statistic: 0.71, 0.72, and 0.71, respectively).
Conclusions: In patients with sRVs, NT-proBNP concentrations correlate with sRV volumes and function and may serve as a simple tool for predicting adverse outcomes.
{"title":"NT-proBNP in systemic right ventricles: a new cutoff level for risk stratification?","authors":"Fabian Tran, Francisco Javier Ruperti-Repilado, Philip Haaf, Pedro Lopez-Ayala, Matthias Greutmann, Markus Schwerzmann, Judith Bouchardy, Harald Gabriel, Dominik Stambach, Juerg Schwitter, Kerstin Wustmann, Michael Freese, Christian Mueller, Daniel Tobler","doi":"10.1016/j.rec.2024.05.006","DOIUrl":"10.1016/j.rec.2024.05.006","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>The role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the risk prediction of patients with systemic right ventricles (sRV) is not well defined. The aim of this study was to analyze the prognostic value of NT-proBNP in patients with an sRV.</p><p><strong>Methods: </strong>The prognostic value of NT-proBNP was assessed in 98 patients from the SERVE trial. We used an adjusted Cox proportional hazards model, survival analysis, and c-statistics. The composite primary outcome was the occurrence of clinically relevant arrhythmia, heart failure, or death. Correlations between baseline NT-proBNP values and biventricular volumes and function were assessed by adjusted linear regression models.</p><p><strong>Results: </strong>The median age [interquartile range] at baseline was 39 [32-48] years and 32% were women. The median NT-proBNP was 238 [137-429] ng/L. Baseline NT-proBNP concentrations were significantly higher among the 20 (20%) patients developing the combined primary outcome compared with those who did not (816 [194-1094] vs 205 [122-357]; P=.003). In patients with NT-proBNP concentrations> 75th percentile (> 429 ng/L), we found an exponential increase in the sex- and age-adjusted hazard ratio for the primary outcome. The prognostic value of NT-proBNP was comparable to right ventricular ejection fraction and peak oxygen uptake on exercise testing (c-statistic: 0.71, 0.72, and 0.71, respectively).</p><p><strong>Conclusions: </strong>In patients with sRVs, NT-proBNP concentrations correlate with sRV volumes and function and may serve as a simple tool for predicting adverse outcomes.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141284912","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 : 2024-06-04DOI: 10.1016/j.rec.2024.04.014
{"title":"The state of cardiac rehabilitation in Spain. Results of the AULARC registry","authors":"","doi":"10.1016/j.rec.2024.04.014","DOIUrl":"10.1016/j.rec.2024.04.014","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141284914","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 : 2024-06-04DOI: 10.1016/j.rec.2024.03.017
Miriam Estrada Ledesma, Diana Bastidas Plaza, Eduardo Pozo Osinalde, Pedro Marcos-Alberca, Carmen Olmos Blanco, Patricia Mahía Casado, María Luaces, José Juan Gómez de Diego, Luis Nombela-Franco, Pilar Jiménez-Quevedo, Gabriela Tirado, Luis Collado Yurrita, Antonio Fernández-Ortiz, Julián Villacastín, José Alberto de Agustín
Introduction and objectives: There is limited evidence to identify the most accurate method for measuring the mitral valve area (MVA) after percutaneous edge-to-edge mitral repair. Our objective was to evaluate the optimal method in this context and its correlation with the mean transmitral gradient.
Methods: A registry of patients undergoing percutaneous mitral repair was conducted, analyzing different methods of measuring MVA and their correlation with the mean gradient.
Results: We analyzed data from 167 patients. The mean age was 76±10.3 years, 54% were men, and 46% were women. Etiology was degenerative in 45%, functional in 39%, and mixed in 16%. Postclip MVA measurements were 1.89±0.60 cm2 using pressure half-time (PHT), 2.87±0.83 cm2 using 3D planimetry, and the mean gradient was 3±1.19mmHg. MVA using 3D planimetry showed a stronger correlation with the mean gradient (r=0.46, P<.001) than MVA obtained by PHT (r=0.19, P=.048). Interobserver agreement was also higher with 3D planimetry than with PHT (intraclass correlation coefficient of 0.90 vs 0.81 and variation coefficient of 9.6 vs 19.7%, respectively).
Conclusions: Our study demonstrates that the PHT method significantly underestimates MVA after clip implantation compared with direct measurement using transesophageal 3D planimetry. The latter method also correlates better with postimplantation gradients and has less interobserver variability. These results suggest that 3D planimetry is a more appropriate method for assessing postclip mitral stenosis.
{"title":"Superiority of 3D planimetry over pressure half-time method for the assessment of mitral valve area after percutaneous edge-to-edge mitral repair.","authors":"Miriam Estrada Ledesma, Diana Bastidas Plaza, Eduardo Pozo Osinalde, Pedro Marcos-Alberca, Carmen Olmos Blanco, Patricia Mahía Casado, María Luaces, José Juan Gómez de Diego, Luis Nombela-Franco, Pilar Jiménez-Quevedo, Gabriela Tirado, Luis Collado Yurrita, Antonio Fernández-Ortiz, Julián Villacastín, José Alberto de Agustín","doi":"10.1016/j.rec.2024.03.017","DOIUrl":"10.1016/j.rec.2024.03.017","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>There is limited evidence to identify the most accurate method for measuring the mitral valve area (MVA) after percutaneous edge-to-edge mitral repair. Our objective was to evaluate the optimal method in this context and its correlation with the mean transmitral gradient.</p><p><strong>Methods: </strong>A registry of patients undergoing percutaneous mitral repair was conducted, analyzing different methods of measuring MVA and their correlation with the mean gradient.</p><p><strong>Results: </strong>We analyzed data from 167 patients. The mean age was 76±10.3 years, 54% were men, and 46% were women. Etiology was degenerative in 45%, functional in 39%, and mixed in 16%. Postclip MVA measurements were 1.89±0.60 cm<sup>2</sup> using pressure half-time (PHT), 2.87±0.83 cm<sup>2</sup> using 3D planimetry, and the mean gradient was 3±1.19mmHg. MVA using 3D planimetry showed a stronger correlation with the mean gradient (r=0.46, P<.001) than MVA obtained by PHT (r=0.19, P=.048). Interobserver agreement was also higher with 3D planimetry than with PHT (intraclass correlation coefficient of 0.90 vs 0.81 and variation coefficient of 9.6 vs 19.7%, respectively).</p><p><strong>Conclusions: </strong>Our study demonstrates that the PHT method significantly underestimates MVA after clip implantation compared with direct measurement using transesophageal 3D planimetry. The latter method also correlates better with postimplantation gradients and has less interobserver variability. These results suggest that 3D planimetry is a more appropriate method for assessing postclip mitral stenosis.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141284913","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 : 2024-06-01DOI: 10.1016/j.rec.2024.04.013
Pedro Moliner, Teresa López-Fernández
{"title":"Certification of cardio-oncology-hematology programs: an opportunity to improve the quality of care for patients with cancer.","authors":"Pedro Moliner, Teresa López-Fernández","doi":"10.1016/j.rec.2024.04.013","DOIUrl":"10.1016/j.rec.2024.04.013","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141237890","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 : 2024-05-28DOI: 10.1016/j.rec.2024.05.005
Ki Hong Choi, Sang Yoon Lee, Taek Kyu Park, Joo Myung Lee, Young Bin Song, Joo-Yong Hahn, Seung-Hyuk Choi, Chul-Min Ahn, Cheol Woong Yu, Ik Hyun Park, Woo Jin Jang, Hyun-Joong Kim, Jang-Whan Bae, Sung Uk Kwon, Hyun-Jong Lee, Wang Soo Lee, Jin-Ok Jeong, Sang-Don Park, Tae-Soo Kang, Hyeon-Cheol Gwon, Jeong Hoon Yang
Introduction and objectives: The association of revascularization strategy with clinical outcomes according to the ischemic territory of nonculprit lesion has not been documented in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). This study aimed to compare outcomes between culprit-only and immediate multivessel percutaneous coronary intervention (PCI) according to ischemic territory in patients with AMI-CS.
Methods: A total of 536 patients with AMI-CS and multivessel disease from the SMART-RESCUE registry were categorized according to ischemic territory (nonculprit left main/proximal left anterior descending artery [LM/pLAD] vs culprit LM/pLAD vs no LM/pLAD). The primary outcome was a patient-oriented composite endpoint (POCE) consisting of all-cause death, myocardial infarction, rehospitalization due to heart failure, or repeat revascularization at 1 year.
Results: Among the total population, 108 patients had nonculprit LM/pLAD, 228 patients had culprit LM/pLAD, and 200 patients had no LM/pLAD, with the risk of POCE being higher in patients with large ischemic territory lesions (53.6% vs 53.4% vs 39.6%; P = .02). Multivessel PCI was associated with a significantly lower risk of POCE compared with culprit-only PCI in patients with nonculprit LM/pLAD (40.7% vs 66.9%; HR, 0.52; 95%CI, 0.29-0.91; P=.02), but not in those with culprit LM/pLAD (P=.46) or no LM/pLAD (P=.47). A significant interaction existed between revascularization strategy and large nonculprit ischemic territory (P=.03).
Conclusions: Large ischemic territory involvement was associated with worse clinical outcomes in patients with AMI-CS and multivessel disease. Immediate multivessel PCI might improve clinical outcomes in patients with a large nonculprit ischemic burden.
引言和目的:在急性心肌梗死并发心源性休克(AMI-CS)患者中,根据非罪魁祸首病变的缺血区域确定血管再通策略与临床预后的关系尚未得到证实。本研究旨在根据急性心肌梗死并发心源性休克(AMI-CS)患者的缺血区域,比较单纯罪魁祸首和即刻多血管经皮冠状动脉介入治疗(PCI)的疗效:共有536名AMI-CS和多支血管疾病患者来自SMART-RESCUE登记处,根据缺血部位进行分类(无左主干/近端左前降支[LM/pLAD] vs 有左主干/pLAD vs 无左主干/pLAD)。主要结果是以患者为导向的复合终点(POCE),包括全因死亡、心肌梗死、因心力衰竭再次住院或一年后再次接受血管重建:在所有患者中,108 名患者为非致命性 LM/pLAD,228 名患者为致命性 LM/pLAD,200 名患者无 LM/pLAD,缺血区域病变较大的患者发生 POCE 的风险更高(53.6% vs 53.4% vs 39.6%;P = .02)。与单纯罪魁祸首 PCI 相比,多血管 PCI 与非罪魁祸首 LM/pLAD 患者的 POCE 风险显著降低相关(40.7% vs 66.9%;HR,0.52;95%CI,0.29-0.91;P = .02),但与罪魁祸首 LM/pLAD 患者(P = .46)或无 LM/pLAD 患者(P = .47)无关。血管再通策略与大面积非罪魁祸首缺血区域之间存在明显的交互作用(P = .03):结论:对于AMI-CS和多支血管疾病患者,大面积缺血区域受累与较差的临床预后有关。立即进行多血管 PCI 可改善大面积非微血管缺血患者的临床预后。
{"title":"Cardiogenic shock complicating acute myocardial infarction and multivessel disease: revascularization strategy according to ischemic territory.","authors":"Ki Hong Choi, Sang Yoon Lee, Taek Kyu Park, Joo Myung Lee, Young Bin Song, Joo-Yong Hahn, Seung-Hyuk Choi, Chul-Min Ahn, Cheol Woong Yu, Ik Hyun Park, Woo Jin Jang, Hyun-Joong Kim, Jang-Whan Bae, Sung Uk Kwon, Hyun-Jong Lee, Wang Soo Lee, Jin-Ok Jeong, Sang-Don Park, Tae-Soo Kang, Hyeon-Cheol Gwon, Jeong Hoon Yang","doi":"10.1016/j.rec.2024.05.005","DOIUrl":"10.1016/j.rec.2024.05.005","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>The association of revascularization strategy with clinical outcomes according to the ischemic territory of nonculprit lesion has not been documented in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). This study aimed to compare outcomes between culprit-only and immediate multivessel percutaneous coronary intervention (PCI) according to ischemic territory in patients with AMI-CS.</p><p><strong>Methods: </strong>A total of 536 patients with AMI-CS and multivessel disease from the SMART-RESCUE registry were categorized according to ischemic territory (nonculprit left main/proximal left anterior descending artery [LM/pLAD] vs culprit LM/pLAD vs no LM/pLAD). The primary outcome was a patient-oriented composite endpoint (POCE) consisting of all-cause death, myocardial infarction, rehospitalization due to heart failure, or repeat revascularization at 1 year.</p><p><strong>Results: </strong>Among the total population, 108 patients had nonculprit LM/pLAD, 228 patients had culprit LM/pLAD, and 200 patients had no LM/pLAD, with the risk of POCE being higher in patients with large ischemic territory lesions (53.6% vs 53.4% vs 39.6%; P = .02). Multivessel PCI was associated with a significantly lower risk of POCE compared with culprit-only PCI in patients with nonculprit LM/pLAD (40.7% vs 66.9%; HR, 0.52; 95%CI, 0.29-0.91; P=.02), but not in those with culprit LM/pLAD (P=.46) or no LM/pLAD (P=.47). A significant interaction existed between revascularization strategy and large nonculprit ischemic territory (P=.03).</p><p><strong>Conclusions: </strong>Large ischemic territory involvement was associated with worse clinical outcomes in patients with AMI-CS and multivessel disease. Immediate multivessel PCI might improve clinical outcomes in patients with a large nonculprit ischemic burden.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180661","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}