European Heart Journal: Acute Cardiovascular Care最新文献

{"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":4.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365599/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bleeding complications in patients with out-of-hospital cardiac arrest treated with cangrelor and oral P2Y12 inhibitors.","authors":"Georg Gelbenegger, Alexandra Julia Lipa, Anselm Jorda, Robert Zilberszac, Gottfried Heinz, Thomas Staudinger, Christian Zauner, Michael Holzer, Guy Friedrich, Fabian Plank, Irene M Lang, Bernd Jilma, Jolanta M Siller-Matula","doi":"10.1093/ehjacc/zuaf082","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf082","url":null,"abstract":"<p><strong>Background: </strong>Cangrelor is used to bridge the gap of insufficient platelet inhibition in patients with out-of-hospital cardiac arrest (OHCA) undergoing percutaneous coronary intervention (PCI).</p><p><strong>Methods: </strong>In a retrospective chart review study, we investigated the incidence of bleeding and stent thrombosis in patients with OHCA undergoing PCI who received either cangrelor and transition to an oral P2Y12 inhibitor or an oral P2Y12 inhibitor alone. Subgroups consisted of patients treated with conventional cardiopulmonary resuscitation (CPR) and extracorporeal CPR. The primary endpoint was BARC 3-5 bleeding at 30 days.</p><p><strong>Results: </strong>Between January 2016 and March 2025, 414 patients were included of which 267 received cangrelor and an oral P2Y12 inhibitor and 147 received an oral P2Y12 inhibitor alone. BARC 3-5 bleeding at 30 days occurred at a similar rate in the cangrelor group and the oral P2Y12 inhibitor group (18.4% versus 19.0%, respectively; adjusted OR, 0.79; 95%CI, 0.45-1.39). BARC 3-5 bleeding at 6, 24 and 48 hours was similar between the cangrelor group and the oral P2Y12 inhibitor group in patients treated with conventional and extracorporeal CPR. In patients treated with extracorporeal CPR, stent thrombosis occurred less frequently in the cangrelor group compared with the oral P2Y12 inhibitor group (2.1% versus 4.5%, respectively; adjusted OR, 0.32, 95% CI, 0.03-3.14), but without reaching statistical significance.</p><p><strong>Conclusion: </strong>In patients with OHCA undergoing PCI, BARC 3-5 bleeding occurred at a similar rate in patients receiving either cangrelor and transition to an oral P2Y12 inhibitor or an oral P2Y12 inhibitor alone.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247060","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 infarction secondary to coronary embolism: etiology, clinical characteristics, and prognosis.","authors":"Maria Calvo-Barceló, Èlia Rifé-Pardo, Laia Milà, Yassin Belahnech, Claudia Alvarez-Martin, Bruno García-Del-Blanco, Ignacio Ferreira-González, José A Barrabés","doi":"10.1093/ehjacc/zuaf081","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf081","url":null,"abstract":"<p><strong>Background: </strong>Limited data is available regarding etiology, clinical characteristics, and prognosis of coronary embolism (CE). This study aimed to describe the clinical features of embolic myocardial infarction (MI) and compare them with non-embolic MI.</p><p><strong>Methods: </strong>All admissions for acute MI in a single tertiary center between January 2010 and December 2023 were reviewed. CE was diagnosed by established criteria.</p><p><strong>Results: </strong>Among 8160 patients, 89 (1.1%) were diagnosed with CE. The most common attributable cause was atrial fibrillation (52.8%), followed by prosthetic valve thrombosis (11.2%) and endocarditis (7.9%). Compared with the remaining patients, those with CE were more frequently female, had a lower prevalence of cardiovascular risk factors, and presented more often with ST-segment elevation (79.8% vs. 58.6%, p<0.001). CE patients had a high frequency of unsuccessful reperfusion and higher rates of mechanical complications (5.6% vs. 2.2%, p=0.031) and strokes/transient ischemic attacks (6.7% vs. 1.3%, p<0.001) than those with non-CE MI, although in-hospital mortality was not statistically different (9.0% vs. 6.4%, respectively, p=0.321). In a propensity-matched analysis among hospital survivors (77 in each group), no differences were observed over a median follow-up of 59.6 months in overall mortality or thromboembolic events after discharge, although more patients in the CE group were admitted for heart failure.</p><p><strong>Conclusions: </strong>CE is mostly caused by atrial fibrillation, usually presents with ST-segment elevation, and is associated with higher rates of mechanical complications and in-hospital embolic events, but not of recurrent thromboembolism after discharge. No significant differences in mortality were observed between CE and non-CE MI.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215257","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 N 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>Aims: </strong>The complexity of the contemporary cardiac intensive care unit has increased due to a growing prevalence of multisystem, non-cardiac illnesses. Despite this increase, patients with cardiovascular disease (CVD) are often under-represented in intensive care randomized controlled trials (RCT). We sought to quantify the representation of patients with CVD comorbidities in intensive care RCTs.</p><p><strong>Methods and results: </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. A total of 412 eligible RCTs were identified for analysis, 132 (32.0%) of which included specific CVD-related exclusion criteria with a history of heart failure (29.5%) and of ischaemic heart disease (26.5%) being the most common exclusions. Exclusions were more likely in multicentre 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, ischaemic heart disease and heart failure were 15.7%, 13.2%, and 10.2%, respectively.</p><p><strong>Conclusion: </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":"259-267"},"PeriodicalIF":3.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082296/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac patients in intensive care unit research: an urgent call for inclusion.","authors":"Steven M Hollenberg, Joseph E Parrillo","doi":"10.1093/ehjacc/zuaf042","DOIUrl":"10.1093/ehjacc/zuaf042","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"268-269"},"PeriodicalIF":3.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669482","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: Triphasic radial pulse in a patient with abdominal pain.","authors":"Jonathan Chun-Hei Cheung, Geoffrey Chi Chun Tang, Albert Kam Ming Chan","doi":"10.1093/ehjacc/zuae129","DOIUrl":"10.1093/ehjacc/zuae129","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"306-307"},"PeriodicalIF":3.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556228","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 with mechanical circulatory support devices among patients with mechanical complications of acute myocardial infarction.","authors":"Ahmed M Younes, Ahmed K Mahmoud, Ibrahim Kamel, Linus Williams, Ahmed Maraey, Mahmoud Khalil, Ahmed Elzanaty, Rodrigo Bagur, Abdulla A Damluji, Jacqueline E Tamis-Holland, Islam Y Elgendy","doi":"10.1093/ehjacc/zuaf039","DOIUrl":"10.1093/ehjacc/zuaf039","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study is to examine the trends and outcomes of mechanical circulatory support (MCS) device use among patients with mechanical complications of acute myocardial infarction (AMI).</p><p><strong>Methods and results: </strong>Using data from the National Inpatient Sample (a large admirative database in the USA) years 2016-20, we identified AMI admissions (ST-elevation and non-ST-elevation myocardial infarction) with mechanical complications (ventricular septal defect, free wall rupture, or papillary muscle rupture). Among 4 450 219 AMI patients, 7025 (0.2%) had a mechanical complication of which 3115 patients (44.3%) received at least one MCS device. There was a rising trend in MCS use (39.3% in 2016 to 48.9% in 2020, Ptrend = 0.02), but there was no corresponding reduction in the incidence of in-hospital mortality (36.9% in 2016 vs. 43.4% in 2020, Ptrend = 0.75). There was no significant difference in in-hospital mortality between those who received MCS vs. those who did not (48.4 vs. 34.5%, respectively).</p><p><strong>Conclusion: </strong>In this large observational analysis of AMI hospitalizations, mechanical complications were rare and associated with very high in-hospital mortality. Although the use of MCS has increased, in-hospital mortality rates remain high even among patients who received MCS. Further investigations are needed to clarify the role of MCS devices among patients with mechanical complications of AMI.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"288-294"},"PeriodicalIF":3.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630242","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":"Breaking barriers, bridging gaps, and redefining acute cardiovascular care: May issue highlights.","authors":"Pascal Vranckx, David A Morrow, Sean van Diepen, Frederik H Verbrugge","doi":"10.1093/ehjacc/zuaf062","DOIUrl":"10.1093/ehjacc/zuaf062","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"257-258"},"PeriodicalIF":3.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984047","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":"Impressions and voices from the Acute CardioVascular Care congress 2025.","authors":"Michelle Roßberg, Milica Aleksic, Janine Pöss, Alessandro Galluzzo","doi":"10.1093/ehjacc/zuaf047","DOIUrl":"10.1093/ehjacc/zuaf047","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"308-309"},"PeriodicalIF":3.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763474","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":"10.1093/ehjacc/zuaf022","url":null,"abstract":"<p><strong>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 poorly represent patients with AMI. This study aimed to compare the use of early sedation with dexmedetomidine with usual care sedation in patients with AMI requiring IMV.</p><p><strong>Methods and results: </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. We identified 15 928 patients, of which 1620 (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 with usual care (both, P < 0.05). After IPTW, patients receiving early dexmedetomidine had an 11.0% [95% confidence interval (CI): 8.6-13.5%] 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 with 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":"270-278"},"PeriodicalIF":3.9,"publicationDate":"2025-05-16","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}