European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Advanced reperfusion therapies for acute pulmonary embolism in pregnancy and postpartum.","authors":"Ioannis T Farmakis, Konstantinos C Christodoulou, Stefano Barco, Karsten Keller, Stavros V Konstantinides, Lukas Hobohm","doi":"10.1093/ehjacc/zuag047","DOIUrl":"10.1093/ehjacc/zuag047","url":null,"abstract":"<p><strong>Aims: </strong>Pulmonary embolism (PE) remains the leading preventable cause of maternal death in high-income countries. Data on the management of acute PE during pregnancy are limited because pregnant women are systematically excluded from interventional trials. We evaluated the use and outcomes of advanced reperfusion therapies in pregnancy-associated PE.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of the US Nationwide Inpatient Sample from 2016 through 2020. Pregnancy- and puerperium-related hospitalizations were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. High-risk PE was defined by shock, mechanical ventilation, cardiac arrest, cardiopulmonary resuscitation, or vasopressor support. Advanced reperfusion therapies included systemic thrombolysis (ST), catheter-directed therapy (CDT), surgical embolectomy, and venoarterial extracorporeal membrane oxygenation (VA-ECMO).</p><p><strong>Results: </strong>Among 19 741 880 pregnancy- or puerperium-related hospitalizations, 12 715 (0.06%) were complicated by PE, corresponding to 6.7 (95% CI, 6.6-6.8) hospitalizations per 10 000 live births. The overall in-hospital mortality rate was 0.86% (0.058 [95% CI, 0.048-0.070] deaths per 10 000 live births). Mortality was 0.2% among patients without haemodynamic instability and 29.1% among those with high-risk PE. Advanced reperfusion therapies were used in 3.4% of all pregnancy-associated PE cases and in 32.7% of high-risk cases. In-hospital mortality was 9.8% after ST, 10.7% after CDT, and 50% after VA-ECMO. Major bleeding occurred in 15.7%, 10.7%, and 50%, respectively.</p><p><strong>Conclusion: </strong>Pregnancy-associated PE is rare but associated with high mortality in high-risk presentations. Advanced reperfusion therapies are used infrequently, reflecting the limited evidence, highlighting the need for multidisciplinary management, and further research and guidance.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"701-705"},"PeriodicalIF":7.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580812","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":"Safety and efficacy of ivabradine in the treatment of patients with acute myocardial infarction: a real-world propensity score matching study.","authors":"Tianshu Gu, Wanlin Feng, Xian Shao, Jun-Yu Liu, Yu-Kun Zhang, Su-Tao Hu, Wen-Bo Dai, Tong Liu, Kang-Yin Chen","doi":"10.1093/ehjacc/zuag084","DOIUrl":"10.1093/ehjacc/zuag084","url":null,"abstract":"<p><strong>Aims: </strong>Ivabradine, a selective If channel inhibitor, reduces heart rate without impairing myocardial contractility. Evidence regarding its safety and efficacy in the acute phase of acute myocardial infarction (AMI) remains limited and conflicting.</p><p><strong>Methods and results: </strong>We analysed data from 136 033 patients with AMI admitted to 82 hospitals in Tianjin, China, between 2010 and 2024. Primary outcomes were in-hospital mortality and 1-year cardiac mortality; secondary outcomes included 1-year all-cause mortality and other adverse events. Propensity score matching (PSM) was used to balance baseline characteristics between patients receiving ivabradine during hospitalization and controls. Logistic regression and Cox proportional hazards models were used to estimate outcome associations. Pre-specified subgroup analyses were conducted. Robustness was assessed using inverse probability of treatment weighting, overlap weighting, E-value analysis, complete-case analysis, treatment-pattern comparator analysis according to background beta-blocker use, and beta-blocker dose-intensity analysis. After PSM, in-hospital ivabradine use was associated with higher in-hospital mortality [aOR, 1.66 (95% CI, 1.19-2.32); P = 0.003], 1-year cardiac mortality [aHR, 1.22 (95% CI, 1.01-1.47); P = 0.043], and 1-year all-cause mortality [aHR, 1.19 (95% CI, 1.01-1.40); P = 0.040] in the fully adjusted model. No significant differences were observed in other secondary outcomes. Subgroup analyses suggested stronger associations among patients aged ≥65 years. Additional analyses showed that the mortality association was most pronounced among patients receiving ivabradine without concomitant beta-blocker. Sensitivity analyses yielded directionally consistent findings.</p><p><strong>Conclusion: </strong>In this large real-world AMI cohort, in-hospital ivabradine use was associated with higher in-hospital and 1-year mortality, without clear evidence of benefit for other secondary outcomes.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"690-700"},"PeriodicalIF":7.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249736","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":"Clinical impact of seasonal and environmental factors in patients with acute heart failure.","authors":"Akito Okabe, Akiomi Yoshihisa, Yu Sato, Naoto Ohashi, Satoshi Okochi, Toranosuke Sekine, Ryo Ogawara, Yukiko Sugawara, Akihiko Sato, Shunsuke Miura, Tetsuro Yokokawa, Takeshi Shimizu, Tomofumi Misaka, Takamasa Sato, Takashi Kaneshiro, Masayoshi Oikawa, Atsushi Kobayashi, Kazuhiko Nakazato, Yasuchika Takeishi","doi":"10.1093/ehjacc/zuag059","DOIUrl":"10.1093/ehjacc/zuag059","url":null,"abstract":"<p><strong>Aims: </strong>Seasonal factors, particularly during winter, have been associated with worsened heart failure (HF). However, seasonal differences in clinical characteristics, clinical outcomes, and environmental mechanisms remain unclear.</p><p><strong>Methods and results: </strong>We analysed 2857 patients hospitalized for HF. Patients were classified into four groups by season of admission: spring (March to May, n = 788, 27.6%), summer (June to August, n = 699, 24.5%), fall (September to November, n = 645, 22.6%), and winter (December to February, n = 725, 25.4%). Baseline characteristics, clinical outcomes, and environmental factors corresponding to the admission month-such as temperature, atmospheric pressure, relative humidity, sunshine duration, influenza activity, and PM2.5 concentration-were compared among the groups. The winter group was older and more frequently had hypertension, diabetes, chronic kidney disease, and thyroid disease. No seasonal differences were observed in sex, body mass index, HF aetiology, other comorbidities, B-type natriuretic peptide levels, or left ventricular ejection fraction. Compared with the fall group, the winter group was associated with higher risk of in-hospital cardiac and all-cause, 90-day cardiac, and all-cause mortality (odds ratio 2.13, 1.85, 1.69, 2.01, 1.80, respectively, P < 0.05). With respect to environmental factors, (i) lower temperature was associated with 90-day cardiac and all-cause mortality; (ii) shorter sunshine duration was associated with 90-day all-cause mortality; and (iii) higher PM2.5 concentrations were associated with in-hospital cardiac mortality. In contrast, atmospheric pressure, relative humidity, and influenza activity were not associated with clinical outcomes.</p><p><strong>Conclusion: </strong>Winter admission for HF was associated with older age, more comorbidities, and higher in-hospital and short-term mortality, which may be partly explained by lower temperatures and shorter sunlight.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"660-670"},"PeriodicalIF":7.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697875","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 impact of direct pre-hospital conveyance of patients with out-of-hospital cardiac arrest and a shockable rhythm to a regional cardiac arrest centre.","authors":"Uzma Sajjad, Rupert Simpson, Guilherme Movio, Abdalla Ibrahim, Haroun Butt, Sarosh Khan, Kamran Dawood, Humaiyun Sabih, Tudor Sandutu, Michael Osondu, Ahmed Omar, Dana Prisenznakova, Tom W Johnson, Nick Curzen, Gerald Clesham, Maria Maccaroni, Marco Mion, Paul Rees, Johannes Vonn Vopelius Feldt, Ahmed Alsinbili, Rohan Jagathesan, Christopher Cook, Ozan M Demir, Mohamed O Mohamed, Grigoris Karamasis, David Hildick-Smith, John R Davies, Nilesh Pareek, Thomas R Keeble","doi":"10.1093/ehjacc/zuag057","DOIUrl":"10.1093/ehjacc/zuag057","url":null,"abstract":"<p><strong>Aims: </strong>Guidelines recommend that survivors of out-of-hospital cardiac arrest (OHCA) be transported to a cardiac arrest centre (CAC), though supporting evidence remains limited. This study evaluated whether implementation of the BCIS conveyance algorithm, based on initial rhythm, improves survival outcomes.</p><p><strong>Methods and results: </strong>This observational, multicentre study compared consecutive OHCA cases before and after algorithm implementation across Essex. In the Standard Care phase (April-September 2022), CAC transfer was based on clinical discretion, typically for STEMI or suspected cardiac cause. In the BCIS Protocol phase (October 2022-August 2025), all patients with an initial shockable rhythm were conveyed directly to CAC, as were those with STEMI on pre-arrest or post-ROSC ECG irrespective of initial rhythm (standard care); others were taken to district general hospitals (DGHs) or discussed with CAC. The primary outcome was 30-day all-cause mortality; the secondary outcome was survival with favourable neurological status (CPC 1-2). Among 850 patients (mean age, 66.5 ± 13.7 years, 69% male), 162 received standard care and 688 were managed under the BCIS protocol. Initial shockable rhythm conveyance adherence to CAC was seen in 84% cases, resulting in 40% absolute increase in the proportion of patients with an initial shockable rhythm being transported directly to CAC (44% in the standard care group vs. 84% in the BCIS group). Algorithm implementation was associated with significantly reduced 30-day mortality (81% vs. 67%; P < 0.001) and increased survival with favourable neurological outcome (16% vs. 30%; P < 0.001). Improvements were most evident in patients with initial shockable rhythms (62% vs. 42%; P = 0.001). No difference was observed for non-shockable rhythms (94% vs. 93%; P = 0.81).</p><p><strong>Conclusion: </strong>Implementation of the BCIS conveyance algorithm improves 30-day survival and neurological outcomes in OHCA patients with initial shockable rhythms when transported directly to a CAC.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"678-689"},"PeriodicalIF":7.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688939","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: A dangerous beat in the postpartum heart.","authors":"Amin Esmailian, Lung En Teng, Ojas Mehta","doi":"10.1093/ehjacc/zuag053","DOIUrl":"10.1093/ehjacc/zuag053","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"718-719"},"PeriodicalIF":7.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148826397","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 haemodynamic envelope, a novel aviation-inspired safety framework for personalized monitoring in cardiogenic shock.","authors":"Christiaan Lucas Meuwese, Joris Anthonius Melkert, Jacob Eifer Møller","doi":"10.1093/ehjacc/zuag031","DOIUrl":"10.1093/ehjacc/zuag031","url":null,"abstract":"<p><p>Mortality in severe forms of cardiogenic shock remains above 50%, despite substantial advances in mechanical circulatory support strategies that have enabled clinicians to manage levels of patient complexity once thought unattainable. A key obstacle to effectively implementing and individualizing these sophisticated treatments lies in the continued reliance on outdated safety monitoring strategies that apply uniform cut-off values to a limited set of clinical variables. Such approaches fail to account for the dynamic and patient-specific nature of 'safe' haemodynamics. To overcome this, we propose an aviation-inspired safety framework, referred to by 'the haemodynamic envelope', designed to continuously and automatically compute patient- and time-specific thresholds across nine interrelated dimensions. This framework defines a dynamic safety window analogous to the systems that transformed flight safety.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"674-677"},"PeriodicalIF":7.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389887","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":"Too old for intensive care? Challenging age-based decisions in acute cardiology.","authors":"Tharusan Thevathasan, Janine Pöss, Alessandro Galluzzo","doi":"10.1093/ehjacc/zuag101","DOIUrl":"10.1093/ehjacc/zuag101","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"722-723"},"PeriodicalIF":7.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758668","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 dangerous beat in the postpartum heart.","authors":"Amin Esmailian, Lung En Teng, Ojas Mehta","doi":"10.1093/ehjacc/zuag054","DOIUrl":"10.1093/ehjacc/zuag054","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"720-721"},"PeriodicalIF":7.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879626","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 and discrimination of TAPSE and S' for short-term outcomes in acute pulmonary embolism.","authors":"Mads Dam Lyhne, Andrew Liteplo, Alona Muzikansky, Christopher Kabrhel, David M Dudzinski","doi":"10.1093/ehjacc/zuag081","DOIUrl":"10.1093/ehjacc/zuag081","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"706-708"},"PeriodicalIF":7.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149160","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":"PRAGUE-26 in perspective: convincing early stabilization, but durable benefit remains unproven.","authors":"Johannes Grand, David A Morrow","doi":"10.1093/ehjacc/zuag119","DOIUrl":"10.1093/ehjacc/zuag119","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"709-711"},"PeriodicalIF":7.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886293","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}