European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Answer: Three thunderclaps in a quiescent myocardium.","authors":"Simon Fitouchi, Halim Marzak, Laurence Jesel","doi":"10.1093/ehjacc/zuaf055","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf055","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211912","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":"Hemodynamic Monitoring and Management of the Hypotensive Out-of-Hospital Cardiac Arrest Patient in the Adult Intensive Care Unit.","authors":"Johannes Grand, Alessandro Sionis, Christian Hassager, Pablo Jorge Perez, Janine Poess, Hannah Schaubroeck, Steffen Desch, Konstantin A Krychtiuk, Jan Belohlavek, Alexandre Mebazaa, Kurt Huber, Sean van Diepen, Christophe Vandenbriele, David Morrow, Guido Tavazzi","doi":"10.1093/ehjacc/zuaf125","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf125","url":null,"abstract":"<p><p>Out-of-hospital cardiac arrest (OHCA) represents a major public health challenge, with high mortality and significant neurological impairments among survivors. Hemodynamic instability, particularly hypotension (a mean arterial blood pressure <65mmHg), may be a key contributor to post-resuscitation morbidity and mortality. After return of spontaneous circulation, hypotension can result from various causes, including arrhythmias, mechanical complications, thromboembolism, or different types of shock, as well as sedation, temperature control and positive pressure ventilation. Differentiating between hypotension with vs. without hypoperfusion is critical to avoid unnecessary interventions while ensuring adequate cerebral and myocardial perfusion. Clinical assessment and repeated echocardiography should be routine in all patients. Therapeutic targets should include evidence of preserved end-organ function, including urine output, and normal or decreasing lactate. In selected cases, advanced hemodynamic monitoring with pulmonary artery catheters may be necessary to diagnose the shock-type and monitor treatment effects. Causal treatment of the precipitating cause of hypotension is crucial as well as symptomatic treatment with fluids, vasopressors and inotropes if needed. Mechanical circulatory support may be employed for refractory shock unresponsive to other treatment. This clinical consensus statement by the Association for Acute CardioVascular Care (ACVC) of the European Society of Cardiology (ESC) provides clinical guidance for the hemodynamic monitoring and management of hypotension in OHCA patients in intensive care. The document advocates for a multidisciplinary approach that integrates clinical assessment, imaging, and hemodynamic parameters to guide treatment, with the overarching goal of improving survival rates and neurological outcomes.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181938","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":"Question: Three thunderclaps in a quiescent myocardium.","authors":"Simon Fitouchi, Halim Marzak, Laurence Jesel","doi":"10.1093/ehjacc/zuaf054","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf054","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148417","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":"Mild Induced Hypothermia in Patients with Infarct-Related Cardiogenic Shock and Cardiac Arrest: Insights from the CULPRIT-SHOCK Trial.","authors":"Daniel Zeymer-von Metnitz, Taoufik Ouarrak, Kurt Huber, Marko Noc, Steffen Desch, Anne Freund, Uwe Zeymer, Holger Thiele, Janine Pöss","doi":"10.1093/ehjacc/zuaf124","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf124","url":null,"abstract":"<p><strong>Background: </strong>Mild induced hypothermia (MIH) is often applied in patients with cardiac arrest (CA), but its impact on patients with infarct-related cardiogenic shock (CS) and CA remains unclear.</p><p><strong>Objectives: </strong>To evaluate the characteristics and outcomes of patients with infarct-related CS and CA who received MIH versus those who did not in the randomized CULPRIT-SHOCK trial and the accompanying registry.</p><p><strong>Methods: </strong>We included patients with CS and CA from the CULPRIT-SHOCK trial and registry. The primary endpoint was 1-year mortality. Secondary endpoints included death or renal replacement therapy within 30 days. A multivariate regression analysis was performed for 1-year mortality, adjusted for relevant baseline parameters.</p><p><strong>Results: </strong>Among 550 patients with CA, 288 (52.4%) received MIH. Patients treated with MIH were younger (64 vs. 67 years, P=0.03), had higher rates of mechanical ventilation (94.5% vs. 78.8%, p<0.01), and higher mean arterial pressure (82 vs. 76 mmHg, P=0.002). The unadjusted hazard ratio (HR) for 1-year mortality favored MIH (HR: 0.77, 95% confidence interval [CI]: 0.61-0.97, P=0.024); however, after multivariate adjustment, this effect was not statistically significant (HR: 0.83, 95% CI: 0.64-1.09, P=0.18). MIH was associated with a higher need for renal replacement therapy (15.2% vs. 7.5%, P=0.005) and less use of mechanical circulatory support (21.2% vs. 34.2%, P<0.001).</p><p><strong>Conclusions: </strong>In this retrospective analysis MIH was not significantly associated with lower 1-year mortality in patients with infarct-related CS and CA. Because of the numerically lower mortality rate, further research is necessary to clarify the role of MIH in this patient population.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT01927549.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130068","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":"Cardiogenic shock as a complication of acute myocardial infarction: a nationwide cohort study.","authors":"Jarle Jortveit, Peder L Myhre, Geir Øystein Andersen, Sigrun Halvorsen","doi":"10.1093/ehjacc/zuaf118","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf118","url":null,"abstract":"<p><strong>Background and aims: </strong>Cardiogenic shock (CS) is a life-threatening complication of acute myocardial infarction (AMI). This study aimed to assess real-world incidence, characteristics, and outcomes in relation to age among patients with AMI complicated by CS (AMI-CS) compared to those without CS in a nationwide cohort.</p><p><strong>Methods: </strong>Cohort study of all patients <85 years with AMI registered in the Norwegian Myocardial Infarction Registry 2013-2022. Outcomes were short- and long-term all-cause mortality. Mortality was assessed by Kaplan-Meier survival curves, Life Tables, and multivariable Cox regression models.</p><p><strong>Results: </strong>Among 86,730 AMI patients (40% women), 1,645 (2.7%) patients <75 years and 969 (3.9%) patients 75-84 years developed CS. Regardless of age, patients with AMI-CS were more likely to have previous heart failure, diabetes, renal failure, and ST-elevation AMI compared to patients without CS. In-hospital mortality was 47.5% in AMI-CS patients <75 years and 71.4% in patients 75-84 years, and the estimated one year cumulative mortality rates were 54.7% (95% CI: 52.3-57.1%) and 79.8% (95% CI: 77.2-82.3), respectively. Patients with AMI-CS who survived to hospital discharge remained at a higher long-term mortality risk compared to patients without CS (<75 years: adjusted HR 1.91 (95% CI 1.67-2.18), 75-84 years: adjusted HR 1.65 (95% CI: 1.41-1.93)).</p><p><strong>Conclusion: </strong>The in-hospital mortality rates for AMI-related CS remain high, especially in patients ≥75 years. However, long-term mortality in CS patients surviving to hospital discharge was only moderately higher compared to AMI patients without CS.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091281","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":"A prospective study on the impact of high-grade atrioventricular block (HAVB) on outcomes in patients with acute myocardial infarction (AMI).","authors":"Nicola Olivito, Fabienne Foster Witassek, Hans Rickli, Marco Roffi, Dragana Radovanovic, Giovanni Pedrazzini","doi":"10.1093/ehjacc/zuaf123","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf123","url":null,"abstract":"<p><strong>Background: </strong>Contemporary data on the impact of high-grade atrioventricular blocks (HAVB) in acute myocardial infarction (AMI) are scarce. Therefore, we investigated this in the Swiss national AMI registry (AMIS Plus) cohort.</p><p><strong>Methods: </strong>We included all AMI patients enrolled from January 2005 to September 2024 with available ECG information. Primary outcome was in-hospital mortality; secondary outcomes included in-hospital major adverse cardiac or cerebrovascular events (MACCE) defined as cardiogenic shock, stroke, re-infarction or death.</p><p><strong>Results: </strong>Among 50'279 AMI patients, 747 (1.5%) patients presented with HAVB and 407 (0.8%) developed HAVB during hospitalisation. Patients presenting with HAVB had increased in-hospital mortality (15% vs. 4.9%; p<0.001) and MACCE (17% vs. 6.0%; p<0.001) compared with those without HAVB. HAVB on admission was an independent predictor for in-hospital mortality (OR 1.89;95% CI, 1.42-2.49; p<0.001), with a stronger impact on mortality in the setting of anterior compared to non-anterior AMI (OR 3.69; 95% CI, 1.99-6.81; pinteraction=0.02). Independent predictors for HAVB on admission included STEMI and female sex. Rates of permanent pacemaker implantation during hospitalisation in patients with HAVB on admission were higher in NSTEMI than STEMI patients (20% vs. 4.4%; p< 0.001). HAVB occurring during hospital stay was associated with higher mortality (20% vs. 15%; p=0.031) and higher permanent pacemaker rate (25% vs. 8%; p< 0.001) than HAVB on admission.</p><p><strong>Conclusion: </strong>HAVB in AMI was associated with high in-hospital mortality, especially in anterior AMI or if occurring during hospitalisation. Permanent pacemaker implantation was more frequent in the setting of NSTEMI and among patients developing HAVB during hospital stay.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091292","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":"Development and external validation of a prognostic model for new-onset atrial fibrillation complicating acute myocardial infarction: insights from the NOAFCAMI-China registry.","authors":"Jiachen Luo, Xiaoming Qin, Yuan Fang, Xingxu Zhang, Yiwei Zhang, Jieyun Liu, Yaoxin Wang, Guojun Zhao, Lili Xiao, Wentao Shi, Lei Qin, Baoxin Liu, Yidong Wei","doi":"10.1093/ehjacc/zuaf122","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf122","url":null,"abstract":"<p><strong>Background: </strong>There is no specifically developed model to predict the risk of major adverse cardiac events (MACEs) in patients with new-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI). We aimed to develop and validate a prediction model for 5-year risk of MACE in patients with post-MI NOAF.</p><p><strong>Methods: </strong>The derivation cohort comprised 457 patients, and the external validation cohort consisted of 206 patients between January 2014 and January 2022. Stepwise multivariable Cox regression analysis was used to identify candidate predictors and to establish the model for 5-year MACE prediction. Model performance was assessed using time-dependent area under the receiver-operating characteristic curve (AUC), C-index, and calibration curves.</p><p><strong>Results: </strong>According to the stepwise multivariable Cox regression analysis, 7 variables were included in the prediction model (NOAFCAMI score): age, prior HF, Killip class, undergoing percutaneous coronary intervention, peak level of NT-pro BNP, AF burden, and symptomatic AF. The 5-year AUC was 0.83 (95% confidence interval [CI]: 0.77 to 0.88). Internal validation by optimism bootstrap-corrected C-index was 0.72 (95% CI: 0.68 to 0.76). External validation showed a 5-year AUC of 0.79 (95% CI: 0.69 to 0.89). The calibration of the NOAFCAMI score for 5-year MACE prediction was acceptable in the derivation (Brier score: 0.17 [95%CI: 0.15 to 0.19]) and the external validation (Brier score: 0.19 [95%CI: 0.16 to 0.22]) cohorts, respectively.</p><p><strong>Conclusions: </strong>The NOAFCAMI score is the first externally validated prediction model to personalize MACE risk assessment in patients with post-MI NOAF, offering actionable insights for tailored management.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091297","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":"Intensive Care After Cardiac Arrest.","authors":"Christian Hassager, Martin A S Meyer, Sarah M Perman, Jacob E Møller, Jesper Kjaergaard, Niklas Nielsen, Rasmus P Beske, Jannike Horn, Gisela Lilja, Markus Skrifvars","doi":"10.1093/ehjacc/zuaf119","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf119","url":null,"abstract":"<p><p>Cardiac arrest causes an abrupt cessation of circulation which rapidly leads to global ischemia and hypoxia. Immediate and competent care is vital, and even when the circulation has been restored, there is a profound risk of patients never regaining consciousness due to hypoxic-ischemic brain injury, or death due recurrent cardiac arrest or multi-organ failure. The complex pattern of symptoms seen in resuscitated cardiac arrest patients, has been termed post-cardiac arrest syndrome, and encompasses brain injury, myocardial dysfunction, systemic ischemia and reperfusion response, and the pathological process that caused the cardiac arrest. This educational review describes the intensive care for resuscitated cardiac arrest patients and provides discussions of current evidence, and emerging trends for key therapeutic areas.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091212","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":"Best of Cardiovascular Biomarkers.","authors":"Johannes Mair, Nicholas L Mills","doi":"10.1093/ehjacc/zuaf120","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf120","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091251","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":"Is It Time to Rethink Early Catheter Ablation in Refractory Ventricular Tachycardia Following Acute Myocardial Infarction?","authors":"Filippo Donato, Manuel De Lazzari, Federico Migliore","doi":"10.1093/ehjacc/zuaf121","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf121","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091242","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}