European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Current state in acute aortic syndromes: year in review 2024.","authors":"David A Morrow, Milica Aleksic","doi":"10.1093/ehjacc/zuaf008","DOIUrl":"10.1093/ehjacc/zuaf008","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"104-106"},"PeriodicalIF":3.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002571","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":"Device-related adverse events and flow capacity of percutaneous ventricular assist devices.","authors":"Yuki Ikeda, Shunsuke Ishii, Shohei Nakahara, Saeko Iikura, Teppei Fujita, Yuichiro Iida, Takeru Nabeta, Nobuhiro Sato, Junya Ako","doi":"10.1093/ehjacc/zuae132","DOIUrl":"10.1093/ehjacc/zuae132","url":null,"abstract":"<p><strong>Aims: </strong>Complication management is crucial in patients receiving mechanical circulatory devices. However, there are limited data on the association between the risks of complications and device type in patients with percutaneous ventricular assist devices (PVAD).</p><p><strong>Methods and results: </strong>The Japanese registry for PVAD (J-PVAD) is a nationwide ongoing registry that enrols consecutive patients with cardiogenic shock treated with PVAD. We analysed 5717 patients in the J-PVAD from 1 February 2020 to 31 December 2022, to compare the incident risks of device-related problems and all-cause mortality within 30 days after PVAD introduction based on flow capacities of first-line PVAD (low: Impella 2.5/CP, n = 5375; high: Impella 5.0/5.5, n = 342). The overall incidence of major device-related problems, including haemolysis, major bleeding, kidney injury, sepsis, and pump stop, was 13%, 21%, 7%, 3%, and 1%, respectively. The all-cause mortality rate was 34%. The incident risks of haemolysis [hazard ratio (HR) 0.38, 95% confidence interval (CI) 0.24-0.58], kidney injury (HR 0.32, 95% CI 0.18-0.57), and pump stop (HR 0.38, 95% CI 0.16-0.91) were lower in patients with high-flow PVAD compared with those with low-flow PVAD. The risks of major bleeding or sepsis did not differ significantly between groups. The risk of all-cause mortality was lower in patients with high-flow PVAD compared with those with low-flow PVAD (HR 0.79, 95% CI 0.65-0.96).</p><p><strong>Conclusion: </strong>Compared with those with low-flow PVAD, patients with high-flow PVAD had lower incident risks of device-related problems, including haemolysis, kidney injury, and pump stop, as well as lower risk of all-cause mortality.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"93-103"},"PeriodicalIF":3.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667609","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":"Ischaemic cardiogenic shock: should we consider basal inflammation-and how? An editorial on the manuscript entitled: 'C-reactive protein levels and outcomes in infarct-related cardiogenic shock: data from the ECLS-SHOCK trial'.","authors":"François Roubille","doi":"10.1093/ehjacc/zuae149","DOIUrl":"10.1093/ehjacc/zuae149","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"71-73"},"PeriodicalIF":3.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893125","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 mysterious cause of myocardial infarction: look beyond his coronary vessels.","authors":"Grace H T Kwok, Kevin K H Kam","doi":"10.1093/ehjacc/zuae118","DOIUrl":"10.1093/ehjacc/zuae118","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"126-127"},"PeriodicalIF":3.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079060","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":"Weakness acquired in the cardiac intensive care unit: still the elephant in the room?","authors":"Nathalie Van Aerde, Greet Hermans","doi":"10.1093/ehjacc/zuae146","DOIUrl":"10.1093/ehjacc/zuae146","url":null,"abstract":"<p><p>Over the past two decades, the cardiac critical care population has shifted to increasingly comorbid and elderly patients often presenting with nonprimary cardiac conditions that exacerbate underlying advanced cardiac disease. Consequently, the modern cardiac intensive care unit (CICU) patient has poor outcome regardless of left ventricular ejection fraction. Importantly, delayed liberation from organ support, independent from premorbid health status and admission severity of illness, has been associated with increased morbidity and mortality up to years post-general critical care. Although a constellation of several acquired morbidities is at play, the most prominent enactor of poor long-term outcome in this population appears to be intensive care unit acquired weakness. Although the specific burden of ICU-acquired morbidities in CICU patients is yet to be clearly defined, it seems unfathomable that patients will not accrue some sort of ICU-related morbidity. There is hence an urgent need to better establish the exact benefit and cost of resource-intensive strategies in both short- and long-term survival of the CICU patient. Consequent and standardized documentation of admission comorbidities, severity of illness indicators, relevant ICU-related complications including weakness, and long-term post-ICU morbidity outcomes can help our understanding of the disease continuum and how to better care for the CICU survivor and their families and caregivers. Given increasing budgetary pressure on healthcare systems worldwide, interventions targeting CICU patients should focus on improving patient-centred long-term outcomes in a cost-effective manner. It will require a holistic and transmural continuity of care model to meet the challenges associated with treating critically ill cardiac patients in the future.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"107-119"},"PeriodicalIF":3.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885068","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":"Myocardial Ischaemic Syndromes - Time For a New Nomenclature?","authors":"Alessandro Galluzzo, Anna Juliane Buch, Janine Pöss","doi":"10.1093/ehjacc/zuaf026","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf026","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448561","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":"Underrepresentation and Exclusion of Patients with Cardiovascular Disease in Intensive Care Randomized Controlled Trials.","authors":"Tariq Ali, Alyssa A Grimshaw, Alexander Thomas, Michael A Solomon, Joseph S Ross, P Elliott Miller","doi":"10.1093/ehjacc/zuaf023","DOIUrl":"10.1093/ehjacc/zuaf023","url":null,"abstract":"<p><strong>Background: </strong>The complexity of the contemporary cardiac intensive care unit (CICU) has increased due a growing prevalence of multisystem, noncardiac illnesses. Despite this increase, patients with cardiovascular disease (CVD) are often underrepresented from intensive care randomized controlled trials (RCT). We sought to quantify the representation of patients with cardiovascular disease comorbidities in intensive care RCTs.</p><p><strong>Methods: </strong>We searched MEDLINE for trials published from 2007 to 2019 with the five highest journal impact factors in the disciplines of critical care medicine, general internal medicine, and cardiovascular disease. Prospective RCTs in the adult (age ≥18 years), intensive care setting with ≥50 individuals were included. Study characteristics, proportion of patients with CVD and cardiovascular exclusion criteria were extracted independently by two reviewers. We used multivariable logistic regression analysis to identify independent predictors of cardiovascular exclusion and representation.</p><p><strong>Results: </strong>A total of 412 eligible RCTs were identified for analysis, 132 (32.0%) of which included specific CVD-related exclusion criteria with history of heart failure (29.5%) and of ischemic heart disease (26.5%) being the most common exclusions. Exclusions were more likely in multicenter trials and varied substantially across study intervention categories. Representation of CVD, reflected by the reporting of any CVD history, was noted in 150 (36.4%) RCTs. Of those reporting, the prevalence of any CVD, ischemic heart disease and heart failure were 15.7%, 13.2% and 10.2%, respectively.</p><p><strong>Conclusions: </strong>Those with comorbid CVD are both frequently excluded and underrepresented in intensive care RCTs, limiting the application of RCTs to this physiologically complex patient population.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413718","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":"Resource utilisation associated with extracorporeal membrane oxygenation versus microaxial flow pump for infarct-related cardiogenic shock.","authors":"M Bogerd, L Ten Hoorn, S Ten Berg, E J Peters, A E Engström, A Malekzadeh, H Thiele, J E Møller, C Hassager, A P J Vlaar, J P S Henriques","doi":"10.1093/ehjacc/zuaf024","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf024","url":null,"abstract":"<p><strong>Background: </strong>Microaxial flow pump and venoarterial extracorporeal membrane oxygenation (VA-ECMO) are increasingly used in infarct-related cardiogenic shock (AMICS). This study provides a comparative overview of real-world resource utilisation associated with these devices (PROSPERO: CRD42024505174).</p><p><strong>Methods: </strong>EMBASE, MEDLINE and Cochrane Library were sought from inception to 13-11-2024 for studies reporting at least one primary outcome, including intensive care unit (ICU) length of stay (LOS), hospital LOS, in-hospital costs and discharge destination. In-hospital mortality was included as secondary outcome. This study was guided by the PRISMA-2020 guideline. Study selection and data extraction were independently performed by two researchers. Risk-of-bias assessments were done using the Newcastle-Ottawa-Scale. Data were pooled using random-effect models.</p><p><strong>Results: </strong>In total, 12 retrospective cohorts were identified encompassing 92,262 microaxial flow pump- and 16,474 VA-ECMO patients data. The meta-analysis of hospital LOS and in-hospital costs revealed favourable results for the microaxial flow pump, with mean differences (MD) of -5.3 days (95%CI: -6.6, -4.1) and -$113,983 (95%CI: -$143,153, -$84,812) respectively. Microaxial flow pump survivors were also 45% more likely to be discharged home (95%CI: 1.28 - 1.64). ICU-LOS was reported by one study, reporting a 10 days MD in favour of the microaxial flow pump. The averaged in-hospital mortality rates were 44% and 57% for the microaxial flow pump and VA-ECMO respectively. An inherent limitation of observational studies is confounding by indication.</p><p><strong>Conclusions: </strong>Microaxial flow pump was associated with lower resource utilisation compared to VA-ECMO. Resource utilisation should be incorporated in prospective RCTs and taken into account when considering these devices.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406453","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 Sedation with Dexmedetomidine in Patients with Acute Myocardial Infarction Requiring Mechanical Ventilation.","authors":"Soumya Banna, Christopher Schenck, Avinainder Singh, Israel Safiriyu, Jose Victor Jimenez, Ashley Franko, Alexander Thomas, Cory Heck, Jonathan Ludmir, Ann Gage, Tariq Ali, Jason N Katz, David M Dudzinski, Joseph S Ross, P Elliott Miller","doi":"10.1093/ehjacc/zuaf022","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf022","url":null,"abstract":"<p><strong>Background and aims: </strong>Patients with acute myocardial infarction (AMI) who require invasive mechanical ventilation (IMV) represent a critically ill population with limited data on optimal sedative and analgesic use. Clinical trials assessing dexmedetomidine use exclude or poorly represent patients with AMI. This study aimed to compare the use of early sedation with dexmedetomidine to usual-care sedation in patients with AMI requiring IMV.</p><p><strong>Methods: </strong>We utilized the Vizient® Clinical Data Base to identify patients aged ≥18 years admitted between 2015 and 2019 with a primary diagnosis of AMI who required IMV. Patients receiving dexmedetomidine on the first day of IMV were included in the early dexmedetomidine group while the remaining patients were assigned to the usual care group. Inverse probability of treatment weighting (IPTW) was used to estimate adjusted risk differences between groups.</p><p><strong>Results: </strong>We identified 15,928 patients, of which 1,620 (10.2%) received early dexmedetomidine. Patients who received early dexmedetomidine were more likely to present with cardiogenic shock (52.0% vs. 47.7%, P=0.001). In unadjusted analyses, patients receiving early dexmedetomidine had lower in-hospital mortality (33.0% vs 42.1%) and more ventilator-free days (13.6 vs 12.1) compared to usual care (both, P<0.05). After IPTW, patients receiving early dexmedetomidine had a 11.0% (95% confidence interval [CI]: 8.6% to 13.5%) lower mortality and more ventilator-free days (mean difference: +2.2 days, 95% CI: 1.6-2.8 days).</p><p><strong>Conclusion: </strong>Early sedation with dexmedetomidine was associated with lower mortality compared to usual care in patients with AMI requiring IMV. A randomized controlled trial of sedative agents in this population is warranted.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370733","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":"Neurohormonal response is associated with mortality in women with ST-elevation myocardial infarction.","authors":"Joakim Bo Kunkel, Helle Søholm, Sarah L D Holle, Jens P Goetze, Lene Holmvang, Lisette O Jensen, Annam P Sheikh, Jacob E Møller, Christian Hassager, Martin Frydland","doi":"10.1093/ehjacc/zuae141","DOIUrl":"10.1093/ehjacc/zuae141","url":null,"abstract":"<p><strong>Aims: </strong>Women continue to have a worse prognosis following ST-elevation myocardial infarction (STEMI) compared to men, despite advancements in treatment. This study investigates whether neurohormonal biomarker differences contribute to sex-related disparities in mortality.</p><p><strong>Methods and results: </strong>A total of 1892 consecutive STEMI patients from two tertiary heart centres were included. Admission neurohormonal activation defined as pro-atrial natriuretic peptide (proANP) and mid-regional pro-adrenomedullin (MR-proADM) was measured in blood drawn prior to acute coronary angiography (CAG). The primary endpoint was 1-year mortality stratified according to sex and biomarker level. Of 1782 (94%) with biomarkers available, 476 (27%) of patients were women. They were older (68 vs. 62 years), had longer symptom-to-angiography delay (211 vs. 181 min), and displayed a higher one-year mortality rate (12% vs. 7.4%, P < 0.001) compared to men. The neurohormonal response was higher in women compared to men [median (interquartile range) proANP 1050 (671-1591) vs. 772 (492-1294) pmol/L, P < 0.001); MR-proADM 0.80 (0.63-1.03) vs. 0.70 (0.58-0.89) nmol/L, P < 0.001]. In women, a level at or above the median was independently associated with a significantly higher mortality risk when adjusting for age, left ventricular ejection fraction, diabetes, heart failure, symptom onset to CAG, left-sided culprit lesion, obesity, renal dysfunction, primary percutaneous intervention, admission systolic blood pressure, and multivessel disease (HR proANP 6.05, 95% CI 1.81-20.3, P = 0.004; HR MR-proADM 3.49, 95% CI 1.42-8.62, P = 0.007). In men, there was an independent prognostic association for proANP but not for MR-proADM (HR proANP 2.38, 95% CI 1.18-4.81, P = 0.015; HR MR-proADM 1.74, 95% CI 0.89-3.40, P = 0.11).</p><p><strong>Conclusion: </strong>Increased neurohormonal activation (MR-proADM and proANP) is associated with higher mortality in women compared to men. Neurohormonal activation may contribute to the observed sex-related differences in mortality.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"31-39"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806712","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}