European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Defining Myocardial Infarction: Grades of Severity or Different Etiology.","authors":"Andrew P DeFilippis, Michael J Blaha","doi":"10.1093/ehjacc/zuaf025","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf025","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432758","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":"Underrepresentation and Exclusion of Patients with Cardiovascular Disease in Intensive Care Randomized Controlled Trials.","authors":"Tariq Ali, Alyssa A Grimshaw, Alexander Thomas, Michael A Solomon, Joseph S Ross, P Elliott Miller","doi":"10.1093/ehjacc/zuaf023","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf023","url":null,"abstract":"<p><strong>Background: </strong>The complexity of the contemporary cardiac intensive care unit (CICU) has increased due a growing prevalence of multisystem, noncardiac illnesses. Despite this increase, patients with cardiovascular disease (CVD) are often underrepresented from intensive care randomized controlled trials (RCT). We sought to quantify the representation of patients with cardiovascular disease comorbidities in intensive care RCTs.</p><p><strong>Methods: </strong>We searched MEDLINE for trials published from 2007 to 2019 with the five highest journal impact factors in the disciplines of critical care medicine, general internal medicine, and cardiovascular disease. Prospective RCTs in the adult (age ≥18 years), intensive care setting with ≥50 individuals were included. Study characteristics, proportion of patients with CVD and cardiovascular exclusion criteria were extracted independently by two reviewers. We used multivariable logistic regression analysis to identify independent predictors of cardiovascular exclusion and representation.</p><p><strong>Results: </strong>A total of 412 eligible RCTs were identified for analysis, 132 (32.0%) of which included specific CVD-related exclusion criteria with history of heart failure (29.5%) and of ischemic heart disease (26.5%) being the most common exclusions. Exclusions were more likely in multicenter trials and varied substantially across study intervention categories. Representation of CVD, reflected by the reporting of any CVD history, was noted in 150 (36.4%) RCTs. Of those reporting, the prevalence of any CVD, ischemic heart disease and heart failure were 15.7%, 13.2% and 10.2%, respectively.</p><p><strong>Conclusions: </strong>Those with comorbid CVD are both frequently excluded and underrepresented in intensive care RCTs, limiting the application of RCTs to this physiologically complex patient population.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413718","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":"Resource utilisation associated with extracorporeal membrane oxygenation versus microaxial flow pump for infarct-related cardiogenic shock.","authors":"M Bogerd, L Ten Hoorn, S Ten Berg, E J Peters, A E Engström, A Malekzadeh, H Thiele, J E Møller, C Hassager, A P J Vlaar, J P S Henriques","doi":"10.1093/ehjacc/zuaf024","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf024","url":null,"abstract":"<p><strong>Background: </strong>Microaxial flow pump and venoarterial extracorporeal membrane oxygenation (VA-ECMO) are increasingly used in infarct-related cardiogenic shock (AMICS). This study provides a comparative overview of real-world resource utilisation associated with these devices (PROSPERO: CRD42024505174).</p><p><strong>Methods: </strong>EMBASE, MEDLINE and Cochrane Library were sought from inception to 13-11-2024 for studies reporting at least one primary outcome, including intensive care unit (ICU) length of stay (LOS), hospital LOS, in-hospital costs and discharge destination. In-hospital mortality was included as secondary outcome. This study was guided by the PRISMA-2020 guideline. Study selection and data extraction were independently performed by two researchers. Risk-of-bias assessments were done using the Newcastle-Ottawa-Scale. Data were pooled using random-effect models.</p><p><strong>Results: </strong>In total, 12 retrospective cohorts were identified encompassing 92,262 microaxial flow pump- and 16,474 VA-ECMO patients data. The meta-analysis of hospital LOS and in-hospital costs revealed favourable results for the microaxial flow pump, with mean differences (MD) of -5.3 days (95%CI: -6.6, -4.1) and -$113,983 (95%CI: -$143,153, -$84,812) respectively. Microaxial flow pump survivors were also 45% more likely to be discharged home (95%CI: 1.28 - 1.64). ICU-LOS was reported by one study, reporting a 10 days MD in favour of the microaxial flow pump. The averaged in-hospital mortality rates were 44% and 57% for the microaxial flow pump and VA-ECMO respectively. An inherent limitation of observational studies is confounding by indication.</p><p><strong>Conclusions: </strong>Microaxial flow pump was associated with lower resource utilisation compared to VA-ECMO. Resource utilisation should be incorporated in prospective RCTs and taken into account when considering these devices.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406453","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":"Early Sedation with Dexmedetomidine in Patients with Acute Myocardial Infarction Requiring Mechanical Ventilation.","authors":"Soumya Banna, Christopher Schenck, Avinainder Singh, Israel Safiriyu, Jose Victor Jimenez, Ashley Franko, Alexander Thomas, Cory Heck, Jonathan Ludmir, Ann Gage, Tariq Ali, Jason N Katz, David M Dudzinski, Joseph S Ross, P Elliott Miller","doi":"10.1093/ehjacc/zuaf022","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf022","url":null,"abstract":"<p><strong>Background and aims: </strong>Patients with acute myocardial infarction (AMI) who require invasive mechanical ventilation (IMV) represent a critically ill population with limited data on optimal sedative and analgesic use. Clinical trials assessing dexmedetomidine use exclude or poorly represent patients with AMI. This study aimed to compare the use of early sedation with dexmedetomidine to usual-care sedation in patients with AMI requiring IMV.</p><p><strong>Methods: </strong>We utilized the Vizient® Clinical Data Base to identify patients aged ≥18 years admitted between 2015 and 2019 with a primary diagnosis of AMI who required IMV. Patients receiving dexmedetomidine on the first day of IMV were included in the early dexmedetomidine group while the remaining patients were assigned to the usual care group. Inverse probability of treatment weighting (IPTW) was used to estimate adjusted risk differences between groups.</p><p><strong>Results: </strong>We identified 15,928 patients, of which 1,620 (10.2%) received early dexmedetomidine. Patients who received early dexmedetomidine were more likely to present with cardiogenic shock (52.0% vs. 47.7%, P=0.001). In unadjusted analyses, patients receiving early dexmedetomidine had lower in-hospital mortality (33.0% vs 42.1%) and more ventilator-free days (13.6 vs 12.1) compared to usual care (both, P<0.05). After IPTW, patients receiving early dexmedetomidine had a 11.0% (95% confidence interval [CI]: 8.6% to 13.5%) lower mortality and more ventilator-free days (mean difference: +2.2 days, 95% CI: 1.6-2.8 days).</p><p><strong>Conclusion: </strong>Early sedation with dexmedetomidine was associated with lower mortality compared to usual care in patients with AMI requiring IMV. A randomized controlled trial of sedative agents in this population is warranted.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370733","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":"Answer: A mysterious cause of myocardial infarction: look beyond his coronary vessels.","authors":"Grace H T Kwok, Kevin K H Kam","doi":"10.1093/ehjacc/zuae118","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae118","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079060","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":"Neurohormonal response is associated with mortality in women with ST-elevation myocardial infarction.","authors":"Joakim Bo Kunkel, Helle Søholm, Sarah L D Holle, Jens P Goetze, Lene Holmvang, Lisette O Jensen, Annam P Sheikh, Jacob E Møller, Christian Hassager, Martin Frydland","doi":"10.1093/ehjacc/zuae141","DOIUrl":"10.1093/ehjacc/zuae141","url":null,"abstract":"<p><strong>Aims: </strong>Women continue to have a worse prognosis following ST-elevation myocardial infarction (STEMI) compared to men, despite advancements in treatment. This study investigates whether neurohormonal biomarker differences contribute to sex-related disparities in mortality.</p><p><strong>Methods and results: </strong>A total of 1892 consecutive STEMI patients from two tertiary heart centres were included. Admission neurohormonal activation defined as pro-atrial natriuretic peptide (proANP) and mid-regional pro-adrenomedullin (MR-proADM) was measured in blood drawn prior to acute coronary angiography (CAG). The primary endpoint was 1-year mortality stratified according to sex and biomarker level. Of 1782 (94%) with biomarkers available, 476 (27%) of patients were women. They were older (68 vs. 62 years), had longer symptom-to-angiography delay (211 vs. 181 min), and displayed a higher one-year mortality rate (12% vs. 7.4%, P < 0.001) compared to men. The neurohormonal response was higher in women compared to men [median (interquartile range) proANP 1050 (671-1591) vs. 772 (492-1294) pmol/L, P < 0.001); MR-proADM 0.80 (0.63-1.03) vs. 0.70 (0.58-0.89) nmol/L, P < 0.001]. In women, a level at or above the median was independently associated with a significantly higher mortality risk when adjusting for age, left ventricular ejection fraction, diabetes, heart failure, symptom onset to CAG, left-sided culprit lesion, obesity, renal dysfunction, primary percutaneous intervention, admission systolic blood pressure, and multivessel disease (HR proANP 6.05, 95% CI 1.81-20.3, P = 0.004; HR MR-proADM 3.49, 95% CI 1.42-8.62, P = 0.007). In men, there was an independent prognostic association for proANP but not for MR-proADM (HR proANP 2.38, 95% CI 1.18-4.81, P = 0.015; HR MR-proADM 1.74, 95% CI 0.89-3.40, P = 0.11).</p><p><strong>Conclusion: </strong>Increased neurohormonal activation (MR-proADM and proANP) is associated with higher mortality in women compared to men. Neurohormonal activation may contribute to the observed sex-related differences in mortality.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"31-39"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806712","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":"The top 10 European Heart Journal: Acute Cardiovascular Care papers in cardiogenic shock and resuscitation of 2024.","authors":"Sean van Diepen, Janine Pöss, Venu Menon","doi":"10.1093/ehjacc/zuae144","DOIUrl":"10.1093/ehjacc/zuae144","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"48-50"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846307","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":"Lower vs. higher blood pressure targets during intensive care of comatose patients resuscitated from out-of-hospital cardiac arrest-a Bayesian analysis of the BOX trial.","authors":"Johannes Grand, Anders Granholm, Sebastian Wiberg, Henrik Schmidt, Jacob E Møller, Simon Mølstrøm, Martin A S Meyer, Jakob Josiassen, Rasmus P Beske, Jordi S Dahl, Laust E R Obling, Martin Frydland, Britt Borregaard, Vibeke Lind Jørgensen, Jakob Hartvig Thomsen, Søren Aalbæk Madsen, Benjamin Nyholm, Christian Hassager, Jesper Kjaergaard","doi":"10.1093/ehjacc/zuae142","DOIUrl":"10.1093/ehjacc/zuae142","url":null,"abstract":"<p><strong>Aims: </strong>The Blood Pressure and Oxygenation (BOX) targets after out-of-hospital cardiac arrest trial found no statistically significant differences in mortality or neurological outcomes with mean arterial blood pressure targets of 63 vs. 77 mmHg in patients receiving intensive care post-cardiac arrest. In this study, we aimed to evaluate the effect on 1-year mortality and assess heterogeneity in treatment effects (HTEs) using Bayesian statistics.</p><p><strong>Methods and results: </strong>We analyzed 1-year all-cause mortality, 1-year neurological outcomes, and plasma neuron-specific enolase (NSE) at 48 h using Bayesian logistic and linear regressions primarily with weakly informative priors. HTE was assessed according to age, plasma lactate, time to return of spontaneous circulation, primary shockable rhythm, history of hypertension, and ST-segment elevation myocardial infarction. Absolute and relative differences are presented with probabilities of any clinical benefit and harm. All 789 patients in the intention-to-treat cohort were included. The risk difference (RD) for 1-year mortality was 1.5%-points [95% credible interval (CrI): -5.1 to 8.1], with <33% probability of benefit with the higher target. There was 33% probability for a better neurological outcome (RD: 1.5%-points; 95% CrI: -5.3 to 8.3) and 35.1% for lower NSE levels (mean difference: 1.5 µg/L, 95% CrI: -6.0 to 9.1). HTE analyses suggested potential harms of the higher blood pressure target in younger patients.</p><p><strong>Conclusion: </strong>The effects of a higher blood pressure target on overall mortality among comatose patients resuscitated from out-of-hospital cardiac arrest were uncertain. A potential effect modification according to age warrants additional investigation.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov ID NCT03141099.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"14-23"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806711","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":"Shaping the future of acute coronary syndrome management: a look back at 2024.","authors":"Pascal Vranckx, Marco Valgimigli, Milica Aleksic","doi":"10.1093/ehjacc/zuae143","DOIUrl":"10.1093/ehjacc/zuae143","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"40-43"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846305","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":"Novel troponin fragmentation assay to discriminate between takotsubo syndrome and acute myocardial infarction: reply.","authors":"K E Juhani Airaksinen, Saara Wittfooth","doi":"10.1093/ehjacc/zuae139","DOIUrl":"10.1093/ehjacc/zuae139","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"56"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846289","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}