European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Efficacy of early use of Percutaneous Stellate Ganglion Block for electrical storms.","authors":"Enrico Baldi, Veronica Dusi, Roberto Rordorf, Alessia Currao, Sara Compagnoni, Antonio Sanzo, Francesca Romana Gentile, Simone Frea, Carol Gravinese, Filippo Angelini, Filippo Maria Cauti, Gianmarco Iannopollo, Francesco De Sensi, Edoardo Gandolfi, Laura Frigerio, Pasquale Crea, Domenico Zagari, Matteo Casula, Giulio Binaghi, Giuseppe Sangiorgi, Lucy Barone, Simone Persampieri, Gabriele Dell'Era, Giuseppe Patti, Claudia Colombo, Giacomo Mugnai, Domenico Tavella, Francesco Notaristefano, Alberto Barengo, Roberta Falcetti, Giulia Girardengo, Giuseppe D'Angelo, Nikita Tanese, Vito Sgromo, Gaetano Maria De Ferrari, Simone Savastano","doi":"10.1093/ehjacc/zuae109","DOIUrl":"10.1093/ehjacc/zuae109","url":null,"abstract":"<p><strong>Background: </strong>Electrical Storm (ES) is a life-threatening condition requiring a rapid management. Percutaneous Stellate Ganglion Block (PSGB) proved to be safe and effective on top of standard therapy, but no data are available about its early use.</p><p><strong>Methods: </strong>We considered all patients enrolled from 1st July 2017 to 30th April 2024 in the STAR registry (STellate ganglion block for Arrhythmic stoRm), a multicentre, international, observational, prospective registry. We aimed to assess the effectiveness of the first PSGB only. Patients were divided into two groups depending on whether they received PSGB before (Early-PSGB, often due to AAD contraindication) or after (Delayed-PSGB) intravenous antiarrhythmic drugs (AADs other than beta-blockers).</p><p><strong>Results: </strong>We considered 180 PSGB (26 Early-PSGB and 154 AAD-first). In the early-PSGB group we observed a statistically significant reduction of treated arrhythmic events in the hour after PSGB compared to the hour before: 0 (0-0) vs 4.5 (1-10), p<0.001 and the extent of the reduction was similar in the Early-PSGB and delayed-PSGB group [-4.5 (-7 to -2) vs. -2.5 (-3.5 to -1.5), p=ns]. The percentage of patients free from arrhythmias was similar in the two groups up to 12 hours after PSGB (81%vs 84%, p=0.6 after one hour; 77% vs 79%, p=0.8 at three hours and 65% vs 69%, p= 0.7 after 12 hours).</p><p><strong>Conclusions: </strong>PSGB proved to be effective also when used early in the treatment of ES. Due to its rapidity of action, our results may suggest its early use to reduce the number of defibrillations and possibly to reduce the likelihood of a refractory ES.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344002","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":"Cardiogenic shock in general intensive care unit: a Nationwide prospective analysis of epidemiology and outcome.","authors":"Guido Tavazzi, Giovanni Tricella, Elena Garbero, Anna Zamperoni, Michele Zanetti, Stefano Finazzi","doi":"10.1093/ehjacc/zuae108","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae108","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock (CS) is a life-threatening disease burdened by a mortality up to 50%. The epidemiology has changed with non-ischemic aetiologies being predominant although data was mainly derived from patients admitted to dedicated acute cardiac care. We report the epidemiology and outcome of patients with CS admitted to general intensive care unit (ICU).</p><p><strong>Methods: </strong>Prospective multicentric epidemiological study including 314 general ICU adhering to the GiViTI Nationwide registry from 2011 to 2018, excluding cardiac arrest. The primary endpoint of the study was mortality. The association between clinical factors and mortality was evaluated using a logistic regression model. The Odds Ratios of the covariates quantify their association with mortality during hospitalization.</p><p><strong>Results: </strong>11052 patients admitted to general ICU (incidence 2.17%; median age 72 (IQR [66-81]), 38.7% were women) with CS were included. Fourthy-seven percent of patients had more than 3 organ insufficiency at the time of admission. The most common CS aetiologies were: left heart failure LHF- 5247-47.5%), acute myocardial infarction (AMI - 3612-32.6%); right heart failure (RHF- 515-4.6%) and biventricular failure (532- 4.8%). 85.5% were mechanically ventilated during the ICU hospitalization. The overall ICU mortality was 44.8%, increasing to 53.4% during the hospitalization in the index hospital and to 54.3% at the latest hospital. RHF-CS patients exhibited the highest mortality risk (OR: 1.19 95% CI [0.94 - 1.50]; p < 0.001), followed by biventricular-CS OR 1.04 95% CI [0.82-1.32]. Respiratory failure (OR 1.13 [95%CI 1.08-1.19]), coagulation disorder (1.17 (95% CI 1.1-1.24), renal dysfunction (OR 1.55 [95% CI 1.50-1.61] and neurological alteration (OR 1.45 [95% CI 1.39-1.50]) were associated with worsen outcome along with severe hypotension (systolic blood pressure < 70 mmHg- OR 2.35 95% CI [2.06-2.67]), increasing age (OR 2.21 95% CI [2.01-2.42] and longer ICU stay prior to admission (2-fold increase for each 4.7 days).</p><p><strong>Conclusions: </strong>In the general ICU the aetiology of CS, excluding cardiac arrest, remains characterized mostly by LHF with RHF-CS burdened by higher mortality. Multiorgan failure at admission and longer hospital stay before ICU admission predispose to worsen outcome.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282331","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":"ICU Diary - Insights from a young couple.","authors":"Michelle Rossberg,Uwe Janssens,Jannik Kuzma,Larissa Kuzma,Janine Pöss","doi":"10.1093/ehjacc/zuae106","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae106","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":"25 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258706","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 Bayesian Reanalysis of the CULPRIT-SHOCK Trial","authors":"Christian Jung, Bernhard Wernly, Maryna Masyuk, Malte Kelm, Anne Freund, Janine Pöss, Steffen Desch, Steffen Schneider, Ibrahim Akin, Sabrina Schlesinger, Benedikt Schrage, Uwe Zeymer, Holger Thiele","doi":"10.1093/ehjacc/zuae104","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae104","url":null,"abstract":"Background The optimal revascularization strategy for patients with acute myocardial infarction (AMI), cardiogenic shock (CS), and multivessel disease remains controversial. The CULPRIT-SHOCK trial compared culprit-lesion-only versus immediate multivessel percutaneous coronary intervention (PCI), providing important data but leaving efficacy questions unresolved. To address lingering uncertainties and gain deeper insights, we performed a Bayesian reanalysis of the CULPRIT-SHOCK trial data. Methods We conducted a Bayesian re-analysis of the CULPRIT-SHOCK trial data using non-informative, skeptical, and enthusiastic priors. Relative risks (RR) with 95% highest posterior density intervals were calculated. We defined the Minimally Clinically Important Difference (MCID) as RR &amp;lt;0.84. We performed subgroup analyses for key patient characteristics and assessed secondary outcomes and safety endpoints. Probabilities of benefit, achieving MCID, and harm were computed. Results are presented as median RR with probabilities of effect sizes. Results Bayesian re-analysis showed a median relative risk of 0.82 (95% HPD: 0.66-1.04) with a non-informative prior, indicating a 95% probability of benefit and 59% probability of achieving MCID. Subgroup analyses revealed potentially stronger effects in males (RR: 0.78, 73% probability of MCID), patients without diabetes (RR: 0.76, 79% probability of MCID), and those with non-anterior STEMI (RR: 0.74, 76% probability of MCID). Secondary outcomes suggested potential benefits in mortality (RR: 0.85) and need for renal replacement therapy (RR: 0.72), but increased risks of recurrent MI (RR: 2.84) and urgent revascularization (RR: 2.88). Conclusion Our Bayesian reanalysis provides intuitive insights by quantifying probabilities of treatment effect sizes, offering further evidence favoring the culprit-lesion-only PCI strategy in AMI patients with cardiogenic shock and multivessel disease. The analysis demonstrates a high probability of overall benefit, with a notable chance of achieving a minimally clinically important difference, particularly in specific subgroups. These findings not only support the consideration of culprit-lesion-only PCI in certain patient populations but also underscore the need for careful risk-benefit assessment. Furthermore, our hypothesis-generating subgroup analyses, which show varying probabilities of achieving MCID, illuminate promising avenues for future targeted investigations in this critical patient population.","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":"1 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258705","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":"Do we have our FACTTs straight about Cor Pulmonale in ARDS?","authors":"Maxwell A Hockstein,Abhijit Duggal,Matthew Siuba","doi":"10.1093/ehjacc/zuae105","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae105","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":"16 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258675","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":"Should renin-angiotensin system inhibitors be stopped or not before non-cardiac surgery?","authors":"Sigrun Halvorsen,Pascal Vranckx,Sean van Diepen","doi":"10.1093/ehjacc/zuae101","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae101","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":"3 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214139","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":"Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Aortic Stenosis and Cardiogenic Shock","authors":"Mahmoud Ismayl, Hasaan Ahmed, Andrew M Goldsweig, Mackram F Eleid, Mayra Guerrero, Charanjit S Rihal","doi":"10.1093/ehjacc/zuae103","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae103","url":null,"abstract":"Background Patients with aortic stenosis (AS) and cardiogenic shock (CS) are an extremely high-risk population with a poor prognosis in the absence of definitive therapy. Aims To compare the outcomes of transcatheter aortic valve replacement (TAVR) with surgical AVR (SAVR) in patients with AS-CS. Methods We queried the Nationwide Readmission Database (2016-2021) to identify patients hospitalized for AS-CS who underwent isolated TAVR or SAVR. In-hospital outcomes of TAVR vs SAVR were compared using multivariable regression and propensity-matching analyses. Ninety-day readmissions were compared using Cox proportional hazards regression model. Results Of 16,072 patients hospitalized for AS-CS, 6,381 (39.7%) underwent isolated TAVR, and 9,691 (60.3%) underwent isolated SAVR. From 2016 through 2021, the proportion of TAVR increased from 29.5% to 46.5% and the proportion of SAVR correspondingly decreased in AS-CS (ptrend&amp;lt;0.01). After adjustment for baseline characteristics, TAVR was associated with lower odds of stroke (adjusted odds ratio [aOR] 0.59, 95% confidence interval [CI] 0.44-0.79), acute kidney injury (aOR 0.79, 95% CI 0.68-0.92), and major bleeding (aOR 0.54, 95% CI 0.40-0.72) and higher odds of vascular complications (aOR 1.55, 95% CI 1.22-1.96) compared with SAVR. In-hospital mortality, myocardial infarction, permanent pacemaker placement, and 90-day all-cause and heart failure readmissions were similar. Length of stay was shorter and total costs and nonhome discharges were lower with TAVR. Conclusions This nationwide observational analysis showed that TAVR is increasingly performed in patients with AS-CS and is associated with similar in-hospital mortality and 90-day readmissions, but lower in-hospital complications and resource utilization compared with SAVR.","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":"1 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258707","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":"Revolutionizing cardiac care: insights into shock prognosis, myocardial infarction management, and platelet inhibition.","authors":"Pascal Vranckx, David Morrow, Sean van Diepen, Frederik Verbrugge","doi":"10.1093/ehjacc/zuae083","DOIUrl":"10.1093/ehjacc/zuae083","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"593-594"},"PeriodicalIF":3.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632980","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":"Targeted proteomic profiling of cardiogenic shock in the cardiac intensive care unit.","authors":"Siddharth M Patel, Mathew S Lopes, David A Morrow, Andrea Bellavia, Ankeet S Bhatt, Kayleigh K Butler, Jessica D'Antonio, Michael Dunn, Antonio A Fagundes, Petr Jarolim, Ethan P Marin, Lori Morton, Benjamin O Olenchock, Balimkiz Senman, Danuzia S da Silva, Anubodh S Varshney, Erin A Bohula, David D Berg","doi":"10.1093/ehjacc/zuae068","DOIUrl":"10.1093/ehjacc/zuae068","url":null,"abstract":"<p><strong>Aims: </strong>We sought to characterize circulating protein biomarkers associated with cardiogenic shock (CS) using highly multiplex proteomic profiling.</p><p><strong>Methods and results: </strong>This analysis employed a cross-sectional case-control study design using a biorepository of patients admitted to a cardiac intensive care unit between 2017 and 2020. Cases were patients adjudicated to have CS, and controls were those presenting for cardiac critical care without shock, including subsets of patients with isolated hypotension or heart failure (HF). The Olink platform was used to analyse 359 biomarkers with Bonferroni correction. The analysis included 239 patients presenting for cardiac critical care (69 cases with CS, 170 non-shock controls). A total of 63 biomarkers (17.7%) were significantly associated with CS after Bonferroni correction compared with all controls. Of these, nine biomarkers remained significantly associated with CS when separately cross-validated in subsets of controls presenting with isolated hypotension and HF: cathepsin D, fibroblast growth factor (FGF)-21 and -23, growth differentiation factor (GDF)-15, insulin-like growth factor-binding protein-1, N-terminal pro-B-type natriuretic peptide, osteopontin, oncostatin-M-specific receptor subunit beta (OSMR), and soluble ST2 protein (sST2). Four biomarkers were identified as providing complementary information for CS diagnosis with development of a multi-marker model: sST2, FGF-23, CTSD, and GDF-15.</p><p><strong>Conclusion: </strong>In this pilot study of targeted proteomic profiling in CS, we identified nine biomarkers significantly associated with CS when cross-validated against non-shock controls including those with HF or isolated hypotension, illustrating the potential application of a targeted proteomic approach to identify novel candidates that may support the diagnosis of CS.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"624-628"},"PeriodicalIF":3.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11350432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141179098","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":"Answer: Pericardial double trouble.","authors":"Mariana Martinho, Liliana Brochado, Hélder Pereira","doi":"10.1093/ehjacc/zuae028","DOIUrl":"10.1093/ehjacc/zuae028","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"639-640"},"PeriodicalIF":3.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859358","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}