European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Model for end-stage liver disease incorporating albumin score is associated with short- and long-term all-cause mortality in patients with acute myocardial infarction complicated by cardiogenic shock.","authors":"Zakaria Alaoui-Ismaili, Joakim Bo Kunkel, Anika Klein, Jakob Josiassen, Ole Kristian Lerche Helgestad, Karoline Korsholm Jeppesen, Henrik Schmidt, Lene Holmvang, Peter Laursen Graversen, Emil Fosbøl, Hanne Berg Ravn, Lisette Okkels Jensen, Jacob Eifer Møller, Christian Hassager","doi":"10.1093/ehjacc/zuaf063","DOIUrl":"10.1093/ehjacc/zuaf063","url":null,"abstract":"<p><strong>Aims: </strong>Liver injury is a frequent complication in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS). The model for end-stage liver disease incorporating albumin (MELD-albumin) quantifies liver injury. This study assesses the association between MELD-albumin score and all-cause mortality among patients with AMICS.</p><p><strong>Methods and results: </strong>From a retrospective cohort of 1716 consecutive patients with AMICS admitted between 2010 and 2017, we included patients who survived until Day 3 and had complete laboratory data available (n = 717). The MELD-albumin was calculated using 0 to 72 h peak s-bilirubin and s-creatinine values and the lowest s-albumin value. Patients were stratified into tertiles: low, intermediate, and high MELD-albumin. The primary outcome was all-cause mortality with a follow-up of up to 14 years. Patients in the high-score group were more often female, had lower left ventricular ejection fraction, had higher lactate levels, and less suffered out-of-hospital cardiac arrest. The high-score group had a significantly higher all-cause mortality rate than the intermediate- and low-score groups at 30 days (49 vs. 35 vs. 26%, P < 0.001) and 10 years for 30-day survivors (58 vs. 46 vs. 37%, P < 0.001). Adjusted hazard ratios for mortality in the high-score group were 2.02 at 30 days [95% confidence interval (CI): 1.49-2.74, P < 0.001] and 1.86 at 10 years (95% CI: 1.18-2.92, P < 0.001). The MELD-albumin score demonstrated an area under the receiver operating curve of 0.63 (95% CI: 0.59-0.67) for predicting 30-day mortality.</p><p><strong>Conclusion: </strong>Liver injury, quantified as MELD-albumin score, was significantly associated with short- and long-term all-cause mortality among patients with AMICS.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"342-350"},"PeriodicalIF":3.9,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988819","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: Silent stenosis to sudden shock: the unplanned culprit.","authors":"Narendran Dhanasekaran, Bharath Raj Kidambi, Yeriswamy Mogalahally Channabasappa","doi":"10.1093/ehjacc/zuaf030","DOIUrl":"10.1093/ehjacc/zuaf030","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"377-378"},"PeriodicalIF":3.9,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208044","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":"Femoral vs. radial approach for primary percutaneous intervention in cardiogenic shock: a subanalysis from the ECLS-SHOCK trial.","authors":"Mohammad Abumayyaleh, Holger Thiele, Tienush Rassaf, Amir Abbas Mahabadi, Ralf Lehmann, Ingo Eitel, Carsten Skurk, Peter Clemmensen, Marcus Hennersdorf, Ingo Voigt, Axel Linke, Eike Tigges, Peter Nordbeck, Christian Jung, Philipp Lauten, Hans-Josef Feistritzer, Janine Pöss, Taoufik Ouarrak, Steffen Schneider, Michael Behnes, Daniel Duerschmied, Steffen Desch, Anne Freund, Uwe Zeymer, Ibrahim Akin","doi":"10.1093/ehjacc/zuaf035","DOIUrl":"10.1093/ehjacc/zuaf035","url":null,"abstract":"<p><strong>Aims: </strong>Cardiogenic shock (CS) is a life-threatening complication of acute coronary syndromes. Early revascularization with treating the culprit lesion improves survival. Nevertheless, the impact of access site (femoral vs. radial) on outcomes in infarct-related CS also in conjunction with extracorporeal life support (ECLS) remains unclear.</p><p><strong>Methods and results: </strong>This subanalysis of the ECLS-SHOCK trial included patients with infarct-related CS treated with or without ECLS, divided into femoral and radial access groups. The primary endpoint was 30-day mortality. Secondary endpoints included renal replacement therapy, repeat revascularization, reinfarction, rehospitalization for congestive heart failure, and poor neurological outcome (Cerebral Performance Categories 3-5) within 30 days. Safety outcomes included bleeding and peripheral vascular complications. Among 415 patients, percutaneous coronary intervention was initially intended through femoral (n = 304; 72.9%) or radial (n = 111; 26.6%) access. In the intended access site analysis, 25 patients (22.5%) in the radial group switched to femoral access, while 3 patients (1%) in the femoral group switched to radial access prior to or after coronary angiography. At 30 days, the overall mortality rate was higher in the femoral group compared with the radial group (52.0 vs. 37.8%) with a relative risk (RR) of 1.37, a 95% confidence interval (CI) of 1.06-1.78, and a P-value of 0.011 with no significant differences in the crude rates of secondary and safety endpoints. In the analysis based on the actual access site (as opposed to intended access site used), 7.8% of patients in the ECLS arm switched from radial to femoral, while 7.5% of patients in the conservative arm switched from radial to femoral for or after coronary angiography. Mortality rates were higher in the femoral group for both ECLS arm (52.7 vs. 26.8%; P = 0.003; RR, 1.96; 95% CI, 1.16-3.32) and conservative arm (52.2 vs. 37.5%; P = 0.074; RR, 1.39; 95% CI, 0.94-2.06). In a multivariate analysis, femoral access was associated with a trend for predicting adjusted 30-day mortality (RR, 1.22; 95% CI, 0.95-1.55; P = 0.11).</p><p><strong>Conclusion: </strong>In myocardial infarction-related CS, nearly one-fifth of patients with intended radial access switched to femoral. In multivariate analysis, femoral access was associated with a trend to adversely affect 30-day mortality.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"351-358"},"PeriodicalIF":3.9,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556264","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":"Outcomes of patients with cancer admitted with heart failure-associated cardiogenic shock.","authors":"Olivia Liu, Steven Soo, Michelle Bloom, Jose Alvarez-Cardona, Jason N Katz, Richard K Cheng, Eric H Yang, Orly Leiva","doi":"10.1093/ehjacc/zuaf027","DOIUrl":"10.1093/ehjacc/zuaf027","url":null,"abstract":"<p><strong>Aims: </strong>Acute decompensated heart failure (HF) can progress to cardiogenic shock, and patients with cancer are at an increased risk of HF compared with patients without cancer. However, limited data exist on outcomes of patients admitted for HF-related cardiogenic shock (HF-CS) with cancer vs. without cancer.</p><p><strong>Methods and results: </strong>Adult patients admitted for HF-CS between 2014 and 2020 were identified using the National Readmission Database. Propensity score matching (PSM) was used to match 1 patient with cancer to 10 patients without cancer. Primary outcomes were in-hospital death, major bleeding, and thrombotic complications. Exploratory outcomes were 90-day readmission rates among patients who survived initial hospitalization. Temporal trends were also explored. Of the 137 316 admissions for HF-CS, 7306 (5.3%) had active cancer. After PSM, patients with cancer had increased odds of in-hospital death [odds ratio (OR) 1.12, 95% confidence interval (CI) 1.06-1.18], thrombotic complications (OR 1.12, 95% CI 1.03-1.21), and major bleeding (OR 1.23, 95% CI 1.17-1.31) compared with patients without cancer, with risks differing by cancer type. In exploratory analyses, rates of readmission were similar for patients with and without cancer. From 2014 to 2020, patients with cancer had no significant change in in-hospital mortality (Ptrend = 0.43), while patients without cancer had decreased mortality over time (Ptrend < 0.001).</p><p><strong>Conclusion: </strong>Among patients admitted for HF-CS, patients with cancer are at increased risk of in-hospital death, thrombotic complications, and major bleeding compared with patients without cancer. Future studies are needed to guide nuanced evaluation and management of this population to improve outcomes.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"318-326"},"PeriodicalIF":3.9,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491386","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":"Pioneering progress in cardiogenic shock: a bold leap into the future of acute cardiovascular care.","authors":"Pascal Vranckx, David A Morrow, Sean van Diepen, Frederik H Verbrugge","doi":"10.1093/ehjacc/zuaf078","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf078","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":"14 6","pages":"311-312"},"PeriodicalIF":3.9,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552694","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: Silent stenosis to sudden shock: the unplanned culprit.","authors":"Narendran Dhanasekaran, Bharath Raj Kidambi, Yeriswamy Mogalahally Channabasappa","doi":"10.1093/ehjacc/zuaf029","DOIUrl":"10.1093/ehjacc/zuaf029","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"375-376"},"PeriodicalIF":3.9,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150026","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 validation of a risk score in acute myocardial infarction-related cardiogenic shock.","authors":"Elma J Peters, Joakim B Kunkel, Margriet Bogerd, Sanne Ten Berg, Marijke J C Timmermans, Ole K L Helgestad, Hanne B Ravn, Adriaan O Kraaijeveld, Luuk C Otterspoor, Krischan D Sjauw, Erik Lipšic, Annemarie E Engström, Alexander P J Vlaar, Christian Hassager, Jacob E Møller, José P S Henriques","doi":"10.1093/ehjacc/zuaf043","DOIUrl":"10.1093/ehjacc/zuaf043","url":null,"abstract":"<p><strong>Aims: </strong>Mortality in patients with acute myocardial infarction-related cardiogenic shock (AMICS) is high, but a widely accepted tool for individual risk assessment is lacking. A reliable prediction model could assist in clinical decision-making, patient selection for clinical trials, and comparison of AMICS populations. Therefore, the aim of this study was to develop and externally validate a prediction model for 30-day mortality in AMICS patients.</p><p><strong>Methods and results: </strong>This retrospective cohort study included patients from 2017 to 2021 (development cohort) and 2010-2017 (validation cohort). Patients with AMICS undergoing percutaneous coronary intervention in The Netherlands were identified using the Netherlands Heart Registration. International validation was performed in the Danish Retroshock registry. The main outcome was 30-day mortality. Among 2261 patients, the median age was 67 years [interquartile range (IQR) 58-75], and 1649 (73%) were male. The mortality rate at 30 days was 39% (n = 886). Significant predictors for mortality were: initial lactate, glucose, renal function, haemoglobin, age, blood pressure, heart rate, intubation prior to PCI, intervention in the left main coronary artery, and successful revascularization. The AUC of the initial model was 0.81 (0.79-0.83). The external validation cohort included 1393 patients with 1050 (75%) male and a median age of 67 years (IQR 59-75). The 30-day mortality rate was 49% (n = 680). The model showed good performance on the external validation with an AUC of 0.73 (0.70-0.76).</p><p><strong>Conclusion: </strong>A prediction model was developed and externally validated using data from two large national registries. The model demonstrated good performance and is suitable for clinical decision-making and quality purposes in AMICS.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"327-341"},"PeriodicalIF":3.9,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709224","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: An unexpected cause of left main pattern ST-elevation myocardial infarction.","authors":"Jacqueline Jing Ting Liaw, Lung En Teng, Ella Cockburn","doi":"10.1093/ehjacc/zuaf032","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf032","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526936","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":"Severe Acute Kidney Injury in the Intensive Care Unit: step-to-step management.","authors":"Mauro Riccardi, Matteo Pagnesi, Carlo M Lombardi, Marco Metra","doi":"10.1093/ehjacc/zuaf084","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf084","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is a sudden loss of renal function limited to 7 days with increased basal serum creatinine levels and/or decreased urinary production. AKI is a frequent condition in the intensive care unit (ICU) ranging from 13% to 36% in patients hospitalized with acute heart failure, up to 80% in patients with cardiogenic shock (CS). AKI requiring dialysis is also common (5% to 8%) and can exceed 13% in patients with CS. AKI is consistently associated with increased mortality in both the short term, especially when dialysis is needed, and the long term. The aim of this review is to provide an update on step-by-step management, from pharmacological treatment to renal replacement therapy, in patients with severe AKI in ICU patients with fluid overload.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511718","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":"Quality of Life after Out-of-hospital Cardiac Arrest - A TOMAHAWK Substudy.","authors":"Michelle Rossberg, Anne Freund, Tharusan Thevathasan, Carsten Skurk, Inke R Koenig, Maren Vens, Hanna Grube, Frank Sandig, Kathrin Klinge, Ibrahim Akin, Georg Fuernau, Christian Hassager, Uwe Zeymer, Michael R Preusch, Tobias Graf, Alexander Jobs, Suzanne de Waha, Holger Thiele, Janine Poess, Steffen Desch","doi":"10.1093/ehjacc/zuaf093","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf093","url":null,"abstract":"<p><strong>Background: </strong>The TOMAHAWK trial compared immediate coronary angiography with a delayed/selective strategy in 554 resuscitated patients with out-of-hospital cardiac arrest (OHCA) without ST-segment elevations. Mortality did not differ significantly between the two groups. In addition to survival, health-related quality of life (HRQoL) is a key outcome parameter for OHCA patients.</p><p><strong>Methods: </strong>The analysis included 169 survivors from the TOMAHAWK trial who completed both the 6-month and 12-month follow-up (6M-FU/12M-FU). HRQoL was assessed using a questionnaire based on the EuroQoL-5D-3L. This tool includes a visual analogue scale (EQ-VAS) ranging from 0 to 100 (worst to best imaginable subjective health) and a descriptive system with five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.</p><p><strong>Results: </strong>No relevant differences were found between patients in the immediate angiography group and those in the delayed/selective angiography group regarding EQ-VAS scores at 6M-FU (70 ± 21 vs. 74 ± 18) and 12M-FU (72 ± 19 vs. 74 ± 17). Patients reported the most problems with usual activities (33% and 38%, respectively), and the fewest limitations in self-care (18% and 17%, respectively) at 6M-FU. Women reported more problems than men in all five dimensions. Elderly patients (≥65 years) were more likely than younger OHCA survivors to indicate limitations in mobility, self-care, usual activities, and pain/discomfort.</p><p><strong>Conclusions: </strong>OHCA survivors of the TOMAHAWK trial rated their HRQoL 6 and 12 months after the event as relatively good, but there were notable differences between women and men and between younger and elderly patients. The angiography strategy did not affect HRQoL. www.ClinicalTrials.gov : NCT02750462.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483679","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}