European Heart Journal: Acute Cardiovascular Care最新文献

{"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}

{"title":"Reperfusion Therapy for ST Elevation Myocardial Infarction in Low to Middle-Income Countries. A Clinical Consensus Statement of the Association for Acute CardioVascular Care (ACVC), the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Association of Preventive Cardiology (EAPC), the ESC Working Group on Thrombosis, and the Stent - Save a Life! Initiative.","authors":"Diego Araiza-Garaygordobil, Thomas Alexander, Kurt Huber, Sigrun Halvorsen, Ingo Ahrens, Carlos Alviar, Alexandra Arias-Mendoza, Andre Dippenaar, Diana A Gorog, Gianluca Campo, Amina Rakisheva, Najat Mouine, Rahima Gabulova, Dejan Orlić, Helder Pereira, Emanuele Barbato, Alfonsina Candiello, Mohamed Sobhy, Jan J Piek","doi":"10.1093/ehjacc/zuaf114","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf114","url":null,"abstract":"<p><p>Suboptimal care for ST-elevation myocardial infarction (STEMI) in low- and middle-income countries is a significant problem. Registries from Latin America, Africa, and Asia show that less than 65% of patients receive reperfusion therapy, and widespread treatment delays and a lack of access to optimal therapies lead to preventable deaths and complications. While current guidelines provide a blueprint for care, their implementation in low-resource settings requires specific guidance that considers geographical, logistical, and economic realities. This clinical consensus offers a new framework for developing STEMI care systems in these countries. We propose a flexible, three-model pathway, based on the initiatives like STEMI India and Stent Save a Life. The models include a fibrinolysis model, a pharmaco-invasive strategy model, and a primary percutaneous coronary intervention (PCI) model. This approach emphasizes adaptability, allowing local STEMI systems to be tailored to specific circumstances. The framework also addresses specific, common challenges, such as delayed access to primary PCI, reperfusion in patients with cardiogenic shock and expected delayed PCI, fibrinolysis in patients with a high risk of bleeding, and the absence of fibrin-specific fibrinolytics, catheterization labs, or reperfusion therapies at all. The consensus also highlights the importance of continuous improvement, patient education, and adopting secondary prevention strategies. Ultimately, this framework is designed to help healthcare providers and leaders in developing countries improve their regional STEMI care systems.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023099","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 Novel Device for Temporary Cardiac Stimulation Using Permanent Pacemaker Generators and Active-Fixation Leads: The TEMPACE Multi-Center Prospective Study.","authors":"Raimundo Vicente-Miralles, Nuria Rivas-Gándara, Pablo Jordán Marchite, Raquel Adeliño, María Ángeles Carmona, Mónica Díaz Barranco, Alicia Ascensión Ibañez Criado, Juan Miguel Ruiz Nodar, María Ajo Ferrer, Amaya García-Fernández, Vicente Bertomeu-Gonzalez, Juan Gabriel Martínez Martínez","doi":"10.1093/ehjacc/zuaf111","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf111","url":null,"abstract":"<p><strong>Aims: </strong>To determine the safety and effectiveness of the KronoSafe® permanent pacemaker adapter for temporary cardiac pacing (TCP) with active-fixation leads (TCPAFL).</p><p><strong>Methods: </strong>This was a multicenter, prospective, descriptive clinical investigation involving a medical device (ClinicalTrials.gov Identifier: NCT05351658). Between January 2023 and December 2024, all consecutive patients who underwent implantation of a temporary active-fixation pacemaker were included. The devices were secured using the KronoSafe® adapter throughout the period of use. Complications during TCPAFL were recorded, and R-wave sensing, lead impedance, and pacing threshold were determined every 48 hours.</p><p><strong>Results: </strong>Thirty patients (10 with atrioventricular block, 9 TAVI, 5 alcohol septal ablations, 2 slow atrial fibrillations, 2 bradycardia-tachycardia syndrome, and 2 pacemaker infections) who required TCP were included. Two centers participated in the study. The mean duration of TCP was 7.8 days (maximum 22 days), with 79.2% of the time spent in the cardiology ward. One complication (3%) was recorded, due to accidental traction of the system associated with an episode of agitation.</p><p><strong>Conclusions: </strong>TCPAFL using the KronoSafe® adapter is safe and effective, and its use can be extended outside the Intensive Care Unit.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947510","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":"Endovascular Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis in Pulmonary Embolism: Insights from the National Readmission Database.","authors":"Monil Majmundar, Vidit Majmundar, Vivek Bhat, Kunal N Patel, Gaurav Parmar, Adam Alli, Aaron Rohr, Peter Monteleone, Sanjum S Sethi, Kamal Gupta","doi":"10.1093/ehjacc/zuaf110","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf110","url":null,"abstract":"<p><strong>Introduction: </strong>Catheter-based therapies for pulmonary embolism (PE), including endovascular mechanical thrombectomy (MT) and catheter-directed thrombolysis (CDT) are increasingly being used in clinical practice. However, real-world comparative data between these two modalities are scarce. We aimed to evaluate and compare the outcomes of MT and CDT in patients with PE.</p><p><strong>Methods: </strong>This retrospective cohort study utilized the 2021 National Readmission Database (NRD) to identify adults with a primary diagnosis of PE who underwent either MT or CDT. The primary outcome was in-hospital mortality, while secondary outcomes included major bleeding, cardiac arrest, vascular complications, and post-discharge readmissions. Propensity-score matching was applied, followed by logistic and Cox proportional hazard regression analyses. Subgroup analyses were conducted based on hospital procedural volume.</p><p><strong>Results: </strong>After propensity-score matching, 7,376 patients who underwent MT and 7,355 who underwent CDT were included. MT was associated with higher odds of in-hospital mortality (4.4% vs. 3.4%; OR: 1.31, 95% CI: 1.01-1.68; p=0.04) and major bleeding (6.3% vs. 3.6%; OR: 1.79, 95% CI: 1.39-2.32; p<0.001) compared to CDT. No significant differences were observed in post-discharge mortality, although all-cause readmissions were higher in the MT group. Higher hospital procedural volume was associated with lower in-hospital mortality and lower major bleeding rates in both MT and CDT.</p><p><strong>Conclusions: </strong>Endovascular CDT was associated with lower in-hospital mortality and major bleeding compared to MT in PE. As hospital procedural volume increased, both these outcomes improved, with reduced difference between MT and CDT.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947502","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 Link between Venous Thromboembolism and Atherothrombosis: Epidemiology, Pathophysiology, and Implications for Clinical Care.","authors":"Antoine Bejjani, Candrika D Khairani, Darsiya Krishnathasan, Samantha M Rizzo, Alyssa Sato, Bassil Bacare, Giovanni Scimeca, Anthony Tristani, Andre Armero, Nicole Porio, Behnood Bikdeli, Gregory Piazza","doi":"10.1093/ehjacc/zuaf109","DOIUrl":"10.1093/ehjacc/zuaf109","url":null,"abstract":"<p><p>Venous thromboembolism (VTE), comprised of deep vein thrombosis (DVT) and pulmonary embolism (PE), remains a significant public health burden in the United States with an estimated 1,200,000 VTE cases in 2020. Atherothrombosis refers to thrombosis in the setting of atherosclerotic cardiovascular disease and includes type I myocardial infarction, ischemic stroke, and acute limb events with an estimated 720,000 myocardial infarctions annually in the US. Despite the historical view of VTE and atherothrombosis as unrelated entities recognized by \"red versus white clots\", these conditions are closely interconnected and share many pathophysiological features and clinical risk factors. This review provides a critical appraisal of the current evidence for the relationship between VTE and atherothrombosis, exploring potential mechanisms and risk factors linking the disorders, recent discoveries from basic and translational research, clinical investigation highlighting their commonalities, as well as the therapies that address both.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144872068","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":"Catheter Ablation for Refractory Ventricular Tachycardia Early After Acute Myocardial Infarction: Management, electrophysiological characteristics and outcomes.","authors":"Mengmeng Li, Yang Yang, Yujing Cheng, Chenxi Jiang, Wei Wang, Ribo Tang, Caihua Sang, Xin Zhao, Changyi Li, Songnan Li, Xueyuan Guo, Changqi Jia, Man Ning, Li Feng, Dan Wen, Hui Zhu, Yuexin Jiang, Tong Liu, Fang Liu, Deyong Long, Jianzeng Dong, Changsheng Ma","doi":"10.1093/ehjacc/zuaf102","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf102","url":null,"abstract":"<p><strong>Background and aims: </strong>Refractory ventricular tachycardia (VT) is a rare but lethal condition in the early phase of acute myocardial infarction (AMI). Its intracardiac mechanism and role of catheter ablation is under-determined. The current study is to evaluate the feasibility and safety of catheter ablation for refractory ventricular tachycardia in early AMI.</p><p><strong>Methods: </strong>Between 2022 to 2024, 12,835 consecutive patients with AMI were screened and VT/ventricular fibrillation (VF) was developed in 261(2.0%) patients, among them 51 (19.5%) were identified as refractory VT storm necessitating intensive intervention and finally 19 patients received bailout ablation for incessant VT. Their clinical, electrophysiological characteristics and outcomes were collected and analyzed.</p><p><strong>Results: </strong>For these 19 patients underwent rescue ablation, VT was developed at a median of 4 days after the onset of AMI and became incessant two days after the first VT occurrence, despite revascularization, antiarrhythmic agents, sedation and hemodynamic support. Through intracardiac mapping, VT were all identified as scar-related reentry within the territory of the culprit artery. The endocardial mappable cycle length was 65.3±7.6% to total cycle length. Energy delivery at the either component of critical isthmus from endocardium successfully eliminated VT and no foci trigger was observed after VT termination. Subsequent substrate modification was performed around the termination site. After the index procedure, recurrent sustained VT was documented in 2 and one patient received repeated ablation. After a total of 20 procedures, VTs were all well subsided after the index procedure in all except for one patient who died of cerebral hemorrhage. The remaining patients were discharged alive. After a median of 18-month follow-up, one patient developed recurrent VF, and no sudden cardiac death occurred.</p><p><strong>Conclusions: </strong>Scar-related reentry is responsible for refractory VT early after AMI and ablation at critical isthmus is effective in VT suppression. Its indication and optimal timing of catheter ablation should be evaluated in prospective analysis.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844981","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":"Beyond the Biomarker War: Is a Hybrid, Applicable Strategy the Answer?","authors":"Ahmed B Shamsulddin","doi":"10.1093/ehjacc/zuaf107","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf107","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834535","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 Association of Early or Late Combined Infection with Clinical Outcomes in Cardiogenic Shock Patients.","authors":"Ji Hyun Cha, Ryoung-Eun Ko, Ki Hong Choi, Chi Ryang Chung, Kyungmin Huh, Jeong Hoon Yang","doi":"10.1093/ehjacc/zuaf104","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf104","url":null,"abstract":"<p><strong>Background: </strong>Infections are common predisposing factors for mixed cardiogenic shock (CS) due to their contribution to systemic vasodilation. However, data on the prognosis of mixed CS complicated by infection remain limited. This study compared the clinical picture and outcomes of isolated CS and mixed CS, stratified by the timing of infection.</p><p><strong>Methods: </strong>We analyzed 878 adult CS patients admitted to a cardiac intensive care unit (CICU) between 2012 and 2020. Patients were classified as isolated CS (non-infected), early mixed CS (infection identified within 48 hours of CICU admission), and late mixed CS (infection identified after 48 hours of CICU admission). The primary outcome was in-hospital mortality.</p><p><strong>Results: </strong>Of 878 patients, 591 (67.3%) had isolated CS, while 287 (32.7%) had mixed CS (early: 18.1%; late: 14.6%). Mixed CS patients experienced prolonged mechanical ventilation (isolated: 2.2 vs. early: 4.7 vs. late: 9.5 days; p < 0.001), and indwelling catheterization (2.0 vs. 7.0 vs. 25.2 days; p < 0.001). In late mixed CS patients, an increasing trend of nosocomial infection was observed with increasing of total catheterization day and CICU length of stay. In-hospital mortalities in both mixed CS groups were higher than in isolated CS (both p < 0.001), with no significant difference between early and late mixed CS. Survival rates were also a similar pattern during the follow-up.</p><p><strong>Conclusions: </strong>Mixed CS complicated by infection showed worse clinical outcomes than isolated CS, irrespective of the infection timing. Further research is needed to develop targeted treatment strategies tailored to this condition.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834536","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}