European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Resource utilization associated with extracorporeal membrane oxygenation vs. microaxial flow pump for infarct-related cardiogenic shock.","authors":"Margriet Bogerd, Luc Ten Hoorn, Sanne Ten Berg, Elma J Peters, Annemarie E Engström, Arjan Malekzadeh, Holger Thiele, Jacob E Møller, Christian Hassager, Alexander P J Vlaar, José P S Henriques","doi":"10.1093/ehjacc/zuaf024","DOIUrl":"10.1093/ehjacc/zuaf024","url":null,"abstract":"<p><strong>Aims: </strong>Microaxial flow pump and venoarterial extracorporeal membrane oxygenation (VA-ECMO) are increasingly used in infarct-related cardiogenic shock. This study provides a comparative overview of real-world resource utilization associated with these devices (PROSPERO: CRD42024505174).</p><p><strong>Methods and results: </strong>EMBASE, MEDLINE, and Cochrane Library were sought from inception to 13 November 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. 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). Intensive care unit-length of stay 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>Conclusion: </strong>Microaxial flow pump was associated with lower resource utilization compared with VA-ECMO. Resource utilization 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":"279-287"},"PeriodicalIF":3.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082289/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telecardiology unleashed: probing the depths of effectiveness in remote monitoring and telemedicine applications for acute cardiac conditions.","authors":"Michiel De Wever, Henri Gruwez, Sebastiaan Dhont, Laurent Pison, Pieter Vandervoort, Peter Haemers","doi":"10.1093/ehjacc/zuaf060","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf060","url":null,"abstract":"<p><p>Telecardiology has emerged as a promising approach in acute cardiac care through advancements in digital health technologies. This review explores the current evidence of telemedicine applications in acute coronary syndrome, arrhythmias, and acute heart failure. Telecardiology strategies are already implemented in clinical practice today. Examples such as pre-hospital electrocardiogram transmission and remote monitoring using non-invasive and invasive devices have shown to enhance diagnostic accuracy, reduce treatment delays, and improve outcomes. However, despite multiple meta-analyses, the effectiveness of telecardiology remains uncertain due to heterogeneity in study designs and lack of high-quality randomized controlled trials. Increasingly, the integration of artificial intelligence offers unprecedented opportunities for diagnostic precision, predictive analytics, and personalized care yet requires rigorous validation and ethical considerations. This article underscores the pivotal role of the cardiologist in bridging the gaps between technology and clinical practice by providing an evidence-based scaffold on telecardiology effectiveness and clinical implementation.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":"14 5","pages":"295-303"},"PeriodicalIF":3.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076742","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: Triphasic radial pulse in a patient with abdominal pain.","authors":"Jonathan Chun-Hei Cheung, Geoffrey Chi Chun Tang, Albert Kam Ming Chan","doi":"10.1093/ehjacc/zuae128","DOIUrl":"10.1093/ehjacc/zuae128","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"304-305"},"PeriodicalIF":3.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482449","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":"Cracking the clot: the RIVAWAR trial challenges warfarin's reign in left ventricular thrombus post-acute coronary syndrome.","authors":"Pascal Vranckx, Sigrun Halvorsen","doi":"10.1093/ehjacc/zuaf052","DOIUrl":"10.1093/ehjacc/zuaf052","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"243-244"},"PeriodicalIF":3.9,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763473","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 left ventricular unloading after venoarterial extracorporeal membrane oxygenation: 1-year outcomes of the EARLY-UNLOAD randomized clinical trial.","authors":"Yongwhan Lim, Min Chul Kim, Seung Hun Lee, Seongho Park, Joon Ho Ahn, Dae Young Hyun, Kyung Hoon Cho, Yong Hun Jung, In-Seok Jeong, Youngkeun Ahn","doi":"10.1093/ehjacc/zuae150","DOIUrl":"10.1093/ehjacc/zuae150","url":null,"abstract":"<p><strong>Aims: </strong>The long-term effects of early left ventricular (LV) unloading after venoarterial extracorporeal membrane oxygenation (VA-ECMO) remain unclear.</p><p><strong>Methods and results: </strong>The EARLY-UNLOAD trial was a single-centre, investigator-initiated, open-label, randomized clinical trial involving 116 patients with cardiogenic shock (CS) undergoing VA-ECMO. The patients were randomly assigned to undergo either early routine LV unloading by transseptal left atrial cannulation within 12 h after randomization or the conventional approach, which permitted rescue transseptal cannulation in case of an increased LV afterload. The pre-specified secondary endpoints at 1 year included all-cause mortality, cardiac mortality, non-cardiac mortality, rehospitalization for heart failure (HF), and the composite of all-cause mortality or rehospitalization for HF. At 1 year, data for 114 of 116 patients (98.3%) were available for analysis. All-cause death had occurred in 33 of 58 patients (56.9%) in early group and 32 of 56 patients (57.1%) in conventional group {hazard ratio [HR], 0.97 [95% confidence interval (CI), 0.60 to 1.58], P = 0.887}. There was no significant difference in cardiac or non-cardiac mortality. Among 61 survivors at 30 days, the incidence of rehospitalization for HF at 1 year was comparable between two groups [HR, 1.17 (95% CI 0.43 to 3.24), P = 0.758]. The incidence of the composite outcome of all-cause mortality or rehospitalization for HF also did not differ between the groups [HR, 1.01 (95% CI 0.69 to 1.76), P = 0.692].</p><p><strong>Conclusion: </strong>Among patients with CS undergoing VA-ECMO, early routine LV unloading did not improve clinical outcomes at 1 year of follow-up.</p><p><strong>Registration: </strong>ClinicalTrials.gov: NCT04775472.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"203-211"},"PeriodicalIF":3.9,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921284","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":"Ten-year prognosis of acute atrial fibrillation in ST-elevation myocardial infarction: recurrence and risk stroke.","authors":"María José Martínez Membrive, Isaac Subirana, Edgar Fadeuilhe, Ferran Rueda, José Carreras-Mora, Teresa Oliveras, Teresa Giralt, Carlos Labata, Marc Ferrer, Nabil El Ouaddi, Santiago Montero, Roberto Elosúa, Núria Ribas, Antoni Bayés-Genís, Cosme García-García","doi":"10.1093/ehjacc/zuae072","DOIUrl":"10.1093/ehjacc/zuae072","url":null,"abstract":"<p><strong>Aims: </strong>Atrial fibrillation (AF) often complicates ST-elevation acute myocardial infarction (STEMI), with associated risks including stroke and mortality. Anticoagulation therapy for these patients and AF prognosis remain controversial. The aim was to evaluate long-term prognosis of STEMI patients complicated with AF in the acute phase.</p><p><strong>Methods and results: </strong>We performed a retrospective analysis on a prospective register involving 4184 patients admitted for STEMI to the intensive cardiac care unit of two tertiary centres from 2007 to 2015. Patients with pre-existing permanent AF were excluded. Out of these, 269 (6.4%) patients developed AF within the first 48 h after STEMI and were matched with a control group based on age and left ventricular ejection fraction. After matching, a total of 470 patients were included (n = 235, AF-STEMI; n = 235, control group). Mean age was 69.0 years, and 31.7% were women. No differences were found in gender, cardiovascular risk factors, or ischaemic heart disease. AF-STEMI patients experienced more sustained ventricular tachycardia, advanced atrioventricular block, heart failure, and cardiogenic shock. In-hospital mortality was also higher in AF-STEMI patients (11.9% vs. 7.2%, P = 0.008). After a 10-year follow-up, the AF-STEMI group had remained with higher mortality (50.5% vs. 36.2%; P = 0.003) and a greater recurrence of AF (44.2% vs. 14.7%; P < 0.001), without differences in stroke incidence (10.1% vs. 9.3%).</p><p><strong>Conclusion: </strong>As a conclusion, patients with AF complicating STEMI have higher rates of heart failure, cardiogenic shock, and in-hospital mortality. After a 10-year follow-up, they exhibit a high risk of AF recurrence and mortality, with no significant differences in stroke incidence.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"214-222"},"PeriodicalIF":3.9,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199934","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: Diagnostic dilemma in a critical extracorporeal membrane oxygenation patient: a case of uncertain aortic pathology.","authors":"Catarina Gregório, José António Duarte, Fausto J Pinto, Doroteia Silva","doi":"10.1093/ehjacc/zuaf016","DOIUrl":"10.1093/ehjacc/zuaf016","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"252-253"},"PeriodicalIF":3.9,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763469","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":"Intra-aortic balloon pump in patients with heart failure-related cardiogenic shock: the Altshock-2 trial in perspective.","authors":"Uwe Zeymer, David A Morrow","doi":"10.1093/ehjacc/zuaf056","DOIUrl":"10.1093/ehjacc/zuaf056","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"237-239"},"PeriodicalIF":3.9,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771656","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":"Association between air pollutants and out-of-hospital cardiac arrest: a 5-year time series analysis.","authors":"Jingjing Wang, Qiang Zhou, Song Ni, Jie Li, Chongzhen Qin, Wangsheng Deng, Zhe Deng","doi":"10.1093/ehjacc/zuaf013","DOIUrl":"10.1093/ehjacc/zuaf013","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to analyse the yet unclear correlation between air pollutant concentrations and out-of-hospital cardiac arrest (OHCA) in Shenzhen, China.</p><p><strong>Methods and results: </strong>A 5-year time series analysis of all OHCA events reported to the Shenzhen Emergency Center was conducted. Quasi-Poisson regression, controlling for meteorological variables (daily mean relative temperature and humidity) with multivariable fractional polynomial and using Fourier series to adjust for long-term trends and account for periodic patterns, was used to assess the association among particulate matter of 2.5 μm (PM2.5), ozone (O3), particulate matter of ≥10 μm (PM10), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and OHCA. Data from 16 769 patients who experienced OHCA were analysed. An increase of 10 μg/m3 in PM2.5 was associated with a higher risk of OHCA (relative risk (RR): 1.026 [95% confidence interval [CI]: 1.001-1.053]) on lag Day 1. A similar increase in PM10 was linked to an immediate risk of OHCA on the onset day (RR: 1.02 [95% CI: 1.005-1.036]) and a cumulative risk on lag Day 1 (RR: 1.021 [95% CI: 1.003-1.039]). An increased risk of OHCA was associated with NO2 and O3 exposure, while a reduced risk of OHCA was associated with SO2 and CO exposure in the subsequent 5 days. The relationship between PM2.5 and OHCA varied by gender and arrest rhythm. A reduction in the average daily PM2.5 concentration by 1 µg/m³ could decrease the incidence of OHCA attributable to PM2.5 exposure by 4.60%, while a reduction by 3 µg/m³ could decrease it by 18.41% on lag Day 1. PM2.5 was significantly associated with the occurrence of OHCA on lag Day 1. This association was modulated by gender and arrest rhythm.</p><p><strong>Conclusion: </strong>Improving the levels of PM2.5, NO2, and O3 could decrease the risk of OHCA and the demand for emergency medical service related to PM2.5 exposure.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"223-231"},"PeriodicalIF":3.9,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022624","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":"Prevalence and prognostic impact of ST-segment elevation in lead aVR among patients with cardiac arrest.","authors":"Soumya Banna, Christopher Schenck, Noah Kim, Tariq Ali, Emily J Gilmore, David M Greer, Rachel Beekman, P Elliott Miller","doi":"10.1093/ehjacc/zuaf018","DOIUrl":"10.1093/ehjacc/zuaf018","url":null,"abstract":"<p><strong>Aims: </strong>In acute coronary syndrome, ST-segment elevation in lead aVR (STE-aVR) indicates global myocardial ischaemia, often related to multivessel or severe left main disease, and correlates with increased mortality. The prevalence and prognostic significance of STE-aVR in cardiac arrest (CA) patients is unknown.</p><p><strong>Methods and results: </strong>We identified patients (≥18 years) with CA between 2011 and 2022 who achieved return of spontaneous circulation (ROSC). The first electrocardiogram post-ROSC was assessed for STE-aVR, defined as ≥1 mm ST-segment elevation at the J point, measured by two trained assessors. Multivariable logistic regression was used to analyse the association between STE-aVR and outcomes (in-hospital mortality and poor neurologic outcome), adjusted for patient and arrest characteristics. Including 443 CA patients, the median (interquartile range) age was 61 years (50-72 years), with 60.5% (n = 268) male, 65.7% (n = 291) presenting with out-of-hospital CA (OHCA), and 29.8% (n = 132) with shockable rhythms. ST-segment elevation in lead aVR was observed in 18.3% (n = 81) of patients. Those with STE-aVR were more likely to present with OHCA and less likely to have a shockable rhythm (both, P < 0.05). ST-segment elevation in lead aVR was associated with higher in-hospital mortality (86.4% vs. 65.8%, P < 0.001) and poor neurologic outcomes (90.1% vs. 72.9%, P = 0.001). After multivariable adjustment, STE-aVR remained associated with higher in-hospital mortality [odds ratio (OR) 2.23; 95% confidence interval (CI): 1.02-4.84, P = 0.04], but not a poor neurologic outcome (OR 2.12; 95% CI: 0.90-4.98, P = 0.09).</p><p><strong>Conclusion: </strong>ST-segment elevation in lead aVR was present in one in five CA survivors and was independently associated with higher in-hospital mortality.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"232-236"},"PeriodicalIF":3.9,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052048","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}