European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Diabetes in resuscitated comatose out-of-hospital cardiac arrest patients - A substudy of the randomized BOX trial.","authors":"Jakob Josiassen, Jacob E Møller, Henrik Schmidt, Rasmus P Beske, Johannes Grand, Jesper Kjaergaard, Christian Hassager","doi":"10.1093/ehjacc/zuaf073","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf073","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study aimed to assess mortality rates in resuscitated comatose out-of-hospital cardiac arrest patients with and without diabetes randomized to targets of blood pressure, oxygen and duration of fever prevention.</p><p><strong>Methods: </strong>Diabetic and non-diabetic patients from the BOX trial was compared. The BOX trial was a randomized, controlled, multi-centre study comparing two mean arterial blood pressure targets (63vs77 mm Hg) in a double-blinded intervention and two open labelled targets including a liberal and restrictive oxygenation (9-10vs13-14 kPa) target and two regimes for length of fever-control (36vs72 hours). The primary outcome for this substudy is 365-day survival. Multiple logistic regression models were used to adjust for factors known to be associated with outcome including age, sex, witnessed arrest (y/n) and time to return of spontaneous circulation (min).</p><p><strong>Results: </strong>A total of 110 (14%) patients had preexisting diabetes. Compared to the non-diabetic group, the patients with diabetes were older (median years (IQR) 67 (59;73)) vs 63 (53;72)) and had more comorbidities.The diabetic patients had an overall increased 365-day all-cause mortality (45 % vs 34 %, p=0.02). The logistic regression model adjusting for age and sex, witnessed arrest (y/n) and place of arrest of arrest gave an estimated adjusted odds ratio of 1.47 (0.93-2.30), p=0.10. No significant interactions were observed among interventions and outcomes related to diabetes status, p ranging from 0.10 to 0.80.</p><p><strong>Conclusions: </strong>Preexisting diabetes was associated with an increased crude 365-day mortality. No differences in outcome were observed among diabetic OHCA patients depending on the assessed blood pressure targets, oxygen levels and durations of fever control.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985811","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":"Prognostic factors for out-of-hospital cardiac arrest patients with prolonged low-flow time undergoing extracorporeal cardiopulmonary resuscitation.","authors":"Kasumi Shirasaki, Masaki Okajima, Tasuku Hada, Shutaro Isokawa, Akihiko Inoue, Tetsuya Sakamoto, Yasuhiro Kuroda, Tadashi Toyama, Toru Hifumi, Norio Otani","doi":"10.1093/ehjacc/zuaf072","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf072","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to examine factors associated with favourable neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients with low-flow time (LFT) exceeding 60 minutes following extracorporeal cardiopulmonary resuscitation (ECPR).</p><p><strong>Methods: </strong>This was a secondary analysis of the SAVE-J II study, a retrospective, multicentre, registry study involving 36 participating institutions in Japan. OHCA patients ≥18 years old who underwent ECPR in Japan between January, 2013 and December, 2018 were registered. This study selected the non-hypothermic patients with LFT ≥ 60 minutes. The primary outcome was a favourable neurological outcome (cerebral performance categories 1-2). Multivariable logistic regression analyses were performed to assess the factors associated with a favourable neurological outcome.</p><p><strong>Results: </strong>In total, 708 patients met the inclusion criteria, with favourable neurological outcomes at hospital discharge in 71 cases (10.0%). Age, shockable rhythm on hospital arrival, signs of life (SOLs) on hospital arrival, and transient return of spontaneous circulation (ROSC) were significantly associated with a favourable neurological outcome.</p><p><strong>Conclusions: </strong>Approximately 10% of OHCA patients who underwent ECPR with LFT ≥ 60 minutes had favourable neurological outcomes. ECPR for non-hypothermic OHCA patients might be considered even with prolonged LFT based on age, shockable rhythm on hospital arrival, SOLs on hospital arrival, and presence of transient ROSC before ECMO initiation.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992825","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":"Acute and long-term outcomes of patients with high-risk pulmonary embolism treated with advanced therapies.","authors":"Andreas Verstraete, Pascal Frederiks, Lorenz Van der Linden, Tom Verbelen, Peter Verhamme, Thomas Vanassche","doi":"10.1093/ehjacc/zuaf071","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf071","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119086","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":"Role of sub-clinical inflammation and defective cholesterol efflux in myocardial infarction patients without standard modifiable risk factors.","authors":"Vincent Roule, Farzin Beygui, Maryse Guerin, Clément Materne, Niki Procopi, Ghilas Rahoual, Paul Guedeney, Michel Zeitouni, Mathieu Kerneis, Gilles Montalescot, Johanne Silvain","doi":"10.1093/ehjacc/zuaf070","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf070","url":null,"abstract":"<p><strong>Background and aims: </strong>Sub-clinical inflammation and defective high-density lipoprotein (HDL) function have emerged as potential risk factors for a first cardiovascular event. We evaluated their role in the pathogenesis of ST-segment elevation myocardial infarction (STEMI) patients with no standard modifiable cardiovascular risk factors (SMuRF).</p><p><strong>Methods: </strong>Using our STEMI biobank registry, we compared baseline characteristics and markers of sub-clinical inflammation (interleukin (IL)-1β, high sensitivity C Reactive Protein (hsCRP) and defective HDL function using serum cholesterol efflux capacity) in patients with and without SMuRF. Determinants of 1-year all-cause mortality were assessed using multivariable Cox regression analyses.</p><p><strong>Results: </strong>Among the 1604 patients included, 178 (11.1%) were SMuRF-less. Compared to patients with SMuRF, SMuRF-less patients had lower serum cholesterol efflux capacity (0.79 ± 0.16 vs 0.83 ± 0.16, respectively, p<0.001), were more often in the highest tertile of IL-1β (28.7% vs 18.9%, respectively, p=0.002) with a trend towards more patients within the highest hs-CRP level tertile (24.7% vs 19.1%, respectively, p=0.077). Crude rates of mortality were higher in the SMuRF-less group (18.5% vs 7.7%, p<0.001). After multivariable adjustment with traditional prognostic risk factors, high tertiles of hs-CRP (HR 1.83 (1.28-2.63), p=0.001) or of IL-1β (HR 1.54 (1.06-2.24), p=0.024), and SMuRF-less status (HR 1.56 (1.05-2.38), p=0.029) were associated with mortality while higher serum cholesterol efflux capacity was protective (HR 0.27 (0.09-0.87); p=0.028).</p><p><strong>Conclusion: </strong>Sub clinical inflammation and defective cholesterol efflux were associated with SMuRF-less status of STEMI patients and had prognostic impact. This highlights the need to explore new therapeutic strategies in this high-risk population.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959429","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":"External validation of the simple NULL-PLEASE clinical score in predicting outcomes in men and women with out-of-hospital cardiac arrest - a nationwide registry-based study.","authors":"Christina Byrne, Carlo A Barcella, Maria Lukacs Krogager, Manan Pareek, Kristian Bundgaard Ringgren, Mads Wissenberg, Fredrik Folke, Gunnar Gislason, Lars Køber, Jesper Kjærgaard, Christian Hassager, Christian Torp-Pedersen, Gregory Y H Lip, Kristian Kragholm","doi":"10.1093/ehjacc/zuaf069","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf069","url":null,"abstract":"<p><strong>Aim: </strong>The NULL-PLEASE score (Nonshockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood pH <7.2, Lactate >7.0 mmol/L, End-stage renal disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) was developed to predict survival in out-of-hospital cardiac arrest (OHCA) patients. Because survival differs between sexes, we aimed to validate NULL-PLEASE separately in men and women.</p><p><strong>Methods: </strong>Men and women with return of spontaneous circulation (ROSC) or ongoing cardiopulmonary resuscitation at hospital arrival from 2001-2019 were identified using Danish nationwide registries. The primary outcome was 1-day mortality. Secondary outcomes were defined as 30-day mortality and the combination of 1-year mortality or anoxic brain damage. Logistic regression was used for outcome risk estimation (reference: NULL-PLEASE=0). Interaction analyses was performed between the NULL-PLEASE score and sex. The predictive ability was assessed using area under the receiver operating characteristics (AUCROC) curves.</p><p><strong>Results: </strong>We included 2,599 men and 1,280 women. One-day mortality for men and women was 36% and 50%; 30-day mortality was 56% and 71%; and 63% and 78% experienced the combined 1-year outcome. AUCROC values for 1-day mortality were for men: 0.828 (95% CI: 0.813-0.844); and for women: 0.754 (95% CI: 0.728-0.780). Results were similar for secondary outcomes. We found significant interaction between the NULL-PLEASE score and sex: 1-day mortality: P<0.001, 30-day mortality: P=0.04, combined outcome: P=0.09.</p><p><strong>Conclusions: </strong>In a nationwide OHCA-cohort, the predictive ability of the NULL-PLEASE score was higher in men than in women.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990483","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":"Zero-hour thresholds to risk stratify patients for acute myocardial infarction using a point-of-care high-sensitivity troponin assay.","authors":"Jaimi H Greenslade, William Parsonage, Niranjan Gaikwad, Laura Stephensen, Emily Brownlee, Ellyse McCormick, Emma J Hall, Megan Van Niekerk, Maryam Khorramshahi Bayat, Ehsan Mahmoodi, Louise Cullen","doi":"10.1093/ehjacc/zuaf068","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf068","url":null,"abstract":"<p><strong>Background and aims: </strong>High-sensitivity cardiac troponin (hs-cTn) assays are crucial in assessing suspected myocardial infarction (MI). International recommendations recommend evaluating new assays to identify metrics for clinical use. Our primary aim was to identify patients at low risk of index MI using a point of care (POC) hs-cTnI (Abbott i-STAT® hs-TnI) assay at presentation. We also sought to examine the diagnostic accuracy of a single value for identifying patients at high risk for AMI.</p><p><strong>Methods: </strong>This prospective multi-centre observational trial enrolled patients with suspected acute coronary syndrome. 967 patients had blood drawn on presentation to the ED for hs-cTnI measurement. The primary outcome was index MI including type one or two non-ST segment elevation MI (NSTEMI). Diagnostic accuracy statistics were calculated at a range of hs-cTnI values.</p><p><strong>Results: </strong>5.6% of patients met the criteria for MI. A cutoff of <8 ng/L was the highest threshold to achieve an NPV >99.5%. This threshold had a sensitivity of 94.4% (95% CI: 84.6-98.8%). A hs-cTnI concentration of <5ng/L provided a sensitivity of 100% (95% CI: 93.4% to 100.0%). For identifying high-risk patients, the PPV is highest at a troponin of >60ng/L (68.3%, 95% CI: 51.9-81.9%). A PPV of 50% (95% CI: 38.0-62.0%) is achieved at a cut-off of >25 ng/L.</p><p><strong>Conclusions: </strong>This study identified two hs-cTnI thresholds (<5ng/L or <8ng/L) to identify patients at low risk and two thresholds (>25ng/L and >60ng/L) to identify patients at high risk for MI. Our findings provide promise for improving care in rural and inner-city medical settings.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974144","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":"Implications of a new clinical classification of acute myocardial infarction.","authors":"Alexander J F Thurston, Jasper Boeddinghaus, Andrew R Chapman, Bertil Lindahl, Nicholas L Mills","doi":"10.1093/ehjacc/zuaf065","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf065","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978846","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 Repolarization Pattern in Post-Resuscitation ECG and Outcomes in Cardiac Arrest Survivors: A Propensity Score Matching Analysis.","authors":"Dongju Kim, Dong Hun Lee, Hanna Park, Yong Hun Jung, Byung Kook Lee, Won Young Kim","doi":"10.1093/ehjacc/zuaf066","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf066","url":null,"abstract":"<p><strong>Background: </strong>Early repolarization patterns (ERP) are a known risk factor for sudden cardiac death; however, their prognostic significance in cardiac arrest survivors remains unclear. This study aimed to investigate the clinical characteristics and outcomes of ERP in post-cardiac arrest survivors.</p><p><strong>Methods: </strong>This observational cohort study included adult out-of-hospital cardiac arrest survivors (aged ≥18 years) who underwent targeted temperature management at two South Korean tertiary care centers between February 2018 and May 2023. Clinical, ECG, and outcome characteristics were compared between patients with and without ERP. Propensity score matching (PSM) was used to minimize confounding, followed by logistic regression analysis. The primary outcome was survival until the hospital discharge.</p><p><strong>Results: </strong>Among the 693 post-resuscitation patients, 127 (18.3%) had ERP. The ERP cohort was characterized by a younger average age (59.0 years vs. 64.1 years) and had lower peak levels of troponin I (1.7 vs. 4.5) and creatinine (1.2 vs. 1.4). Multivariable logistic regression analysis revealed that the ERP pattern independently predicted decreased mortality at discharge (Odds Ratio: 1.68; 95% Confidence Interval: 1.04-2.72; p=0.034) after adjusting for potential confounders. However, the difference in achieving favorable neurological outcomes was not statistically significant. These results were consistent within the matched cohort. After matching, groups showed no significant differences in post-resuscitation care variables or adverse events, except for maximum vasopressor doses.</p><p><strong>Conclusions: </strong>The presence of ERP in post-resuscitation ECG was associated with a greater likelihood of survival until hospital discharge.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973759","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 intersection of obesity and acute heart failure: Cardiac structure and function and congestion across BMI categories.","authors":"Sofie Bøgh-Sørensen, Ross T Campbell, Brian L Claggett, Eldrin F Lewis, Kieran F Docherty, Matthew M Y Lee, Moritz Lindner, Tor Biering-Sørensen, Scott D Solomon, Elke Platz","doi":"10.1093/ehjacc/zuaf067","DOIUrl":"10.1093/ehjacc/zuaf067","url":null,"abstract":"<p><strong>Background: </strong>Overweight/obesity are important risk factors for heart failure (HF), however, the pathophysiologic consequences of obesity in patients with acute HF (AHF) are incompletely understood.</p><p><strong>Methods: </strong>We examined cardiac structure and function, and congestion-related markers in adults hospitalized for AHF across 3 body mass index (BMI) groups: 18.5-24.9 kg/m2 (normal weight), 25-29.9 kg/m2 (overweight), ≥30 kg/m2 (obese), and based on left ventricular ejection fraction (LVEF) >40% (HF with mildly reduced/preserved EF (HFmrEF/HFpEF)) vs. ≤40% (HF with reduced EF (HFrEF)). Echocardiography, 4-zone lung ultrasound, and patient-reported symptoms were assessed at baseline, and 6-month outcomes (HF hospitalizations and all-cause death) were collected.</p><p><strong>Results: </strong>Among 354 participants (median age 75, 59% men), 36% were normal weight, 29% overweight and 35% obese. Higher BMI was associated with younger age, more comorbidities, a higher proportion of prior HF, and worse patient-reported symptoms. Patients with HFmrEF/HFpEF were older, more likely female, had a higher BMI and higher proportions of hypertension and atrial fibrillation. Both patients with HFmrEF/HFpEF and HFrEF had greater biventricular volumes/area and LV mass, similar degrees of elevated LV filling pressure and lower degrees of pulmonary congestion with higher BMI. The risk of the composite outcome was similar across BMI groups both in the overall cohort and when stratified by LVEF.</p><p><strong>Conclusions: </strong>Among patients with AHF, those with overweight/obesity had greater biventricular volumes/area and LV mass, similar sonographic evidence of hemodynamic congestion and less pulmonary congestion than those with normal weight. The risk of 6-month HF hospitalization or death was similar across BMI groups.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986914","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}