Journal of cardiology最新文献

{"title":"Extensive ablation for elderly patients with persistent atrial fibrillation: insights from the EARNEST-PVI prospective randomized trial","authors":"Yuki Matsuoka MD, Yohei Sotomi MD PhD, Shungo Hikoso MD PhD, Akihiro Sunaga MD PhD, Daisaku Nakatani MD PhD, Katsuki Okada MD PhD, Tomoharu Dohi MD PhD, Taiki Sato MD PhD, Hirota Kida MAS, Daisuke Sakamoto MD, Tetsuhisa Kitamura MD MSc DrPH, Nobuaki Tanaka MD, Masaharu Masuda MD PhD, Tetsuya Watanabe MD PhD, Hitoshi Minamiguchi MD, Yasuyuki Egami MD, Takafumi Oka MD PhD, Miwa Miyoshi MD PhD, Masato Okada MD, Yasuhiro Matsuda MD, Masato Kawasaki MD, Koichi Inoue MD PhD, Yasushi Sakata MD PhD FJCC, OCVC-Arrhythmia Investigators","doi":"10.1016/j.jjcc.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.jjcc.2024.09.001","url":null,"abstract":"In patients with persistent atrial fibrillation (AF), extensive ablation for substrate modification, such as linear ablation or complex fractionated atrial electrogram ablation in addition to pulmonary vein isolation (PVI) remains controversial. Previous studies investigating extensive ablation have demonstrated its varying efficacy, suggesting the possible heterogeneity of its efficacy. Aging is a major risk factor for AF and is associated with atrial remodeling. We aimed to compare the efficacy and safety of the extensive ablation strategy compared with PVI alone strategy between young and elderly patients. This study is a post-hoc analysis of the multicenter, randomized controlled, noninferiority trial investigating the efficacy and safety of PVI-only (PVI-alone arm) compared with extensive ablation (PVI-plus arm) in patients with persistent AF (EARNEST-PVI trial). We divided the overall population into 2 groups based on age and assessed treatment effects. In the young group (age <65 years, = 206), there was no significant difference in the recurrence rate between the PVI-alone group and PVI-plus group [hazard ratio (HR): 1.00, 95 % CI: 0.57–1.73, = 0.987], whereas the recurrence rate was significantly lower in the PVI-plus group compared to the PVI-alone group in the elderly group (age ≥65 years, = 291) (HR: 0.47, 95 % CI: 0.29–0.76, = 0.0021) ( for interaction = 0.0446). There were no fatal procedural complications. In patients with persistent AF, the extensive ablation strategy was more effective than the PVI-alone strategy in elderly patients, while the effectiveness of both approaches was comparable in young patients. URL: ; Unique identifier: .","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142265370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic tortuosity and pacemaker requirement after transcatheter aortic valve replacement: Mediating effects of anatomical variations.","authors":"Kazuyuki Yamaguchi, Takamitsu Nakamura, Tsuyoshi Kobayashi, Toru Yoshizaki, Manabu Uematsu, Takeo Horikoshi, Kazuto Nakamura, Akira Sato","doi":"10.1016/j.jjcc.2024.08.012","DOIUrl":"10.1016/j.jjcc.2024.08.012","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of hypochloremia at the time of discharge to predict prognosis in patients with chronic heart failure after hospitalization.","authors":"Kayo Misumi, Yuya Matsue, Kazutaka Nogi, Yudai Fujimoto, Nobuyuki Kagiyama, Takatoshi Kasai, Takeshi Kitai, Shogo Oishi, Eiichi Akiyama, Satoshi Suzuki, Masayoshi Yamamoto, Keisuke Kida, Takahiro Okumura, Maki Nogi, Satomi Ishihara, Tomoya Ueda, Rika Kawakami, Yoshihiko Saito, Tohru Minamino","doi":"10.1016/j.jjcc.2024.08.011","DOIUrl":"10.1016/j.jjcc.2024.08.011","url":null,"abstract":"<p><strong>Background: </strong>Hypochloremia has been suggested as a strong marker of mortality in hospitalized patients with heart failure (HF). This study aimed to clarify whether incorporating hypochloremia into pre-existing prognostic models improved the performance of the models.</p><p><strong>Methods: </strong>We tested the prognostic value of hypochloremia (<97 mEq/L) measured at discharge in hospitalized patients with HF registered in the REALITY-AHF and NARA-HF studies. The primary outcome was 1-year mortality after discharge.</p><p><strong>Results: </strong>Among 2496 patients with HF, 316 (12.6 %) had hypochloremia at the time of discharge, and 387 (15.5 %) deaths were observed within 1 year of discharge. The presence of hypochloremia was strongly associated with higher 1-year mortality compared to those without hypochloremia (log-rank: p < 0.001), and this association remained even after adjustment for the Get With the Guideline-HF risk model (GWTG-HF), anemia, New York Heart Association (NYHA) classification, and log-brain natriuretic peptide (BNP) [hazard ratio (HR) 1.64; p < 0.001]. Furthermore, adding hypochloremia to the prediction model composed of GWTG-HF + anemia + NYHA class + log-BNP yielded a numerically larger area under the curve (0.740 vs 0.749; p = 0.059) and significant improvement in net reclassification (0.159, p = 0.010).</p><p><strong>Conclusions: </strong>Incorporating the presence of hypochloremia at discharge into pre-existing risk prediction models provides incremental prognostic information for hospitalized patients with HF.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of exercise stress echocardiography for predicting cardiovascular events and atrial fibrillation in hypertrophic cardiomyopathy.","authors":"Tomohiro Yoshii, Masashi Amano, Kenji Moriuchi, Shoko Nakagawa, Hitomi Nishimura, Yurie Tamai, Ayaka Mizumoto, Aiko Koda, Yutaka Demura, Yoshito Jo, Yuki Irie, Takahiro Sakamoto, Makoto Amaki, Hideaki Kanzaki, Teruo Noguchi, Kunihiro Nishimura, Takeshi Kitai, Chisato Izumi","doi":"10.1016/j.jjcc.2024.08.010","DOIUrl":"10.1016/j.jjcc.2024.08.010","url":null,"abstract":"<p><strong>Background: </strong>In hypertrophic cardiomyopathy (HCM), the determinants of exercise tolerance and the usefulness of exercise stress echocardiography (ESE) for predicting hard endpoints have not been fully investigated. We aimed to assess the key parameters of ESE for exercise tolerance and the factors predictive of cardiovascular events and new-onset atrial fibrillation (AF) in patients with HCM.</p><p><strong>Methods: </strong>Seventy-four consecutive patients with HCM who underwent ESE and with an ejection fraction ≥50 % were enrolled. The primary endpoint was a composite of cardiovascular death, heart failure hospitalization, ventricular fibrillation or tachycardia, and ventricular assist device implantation. The secondary endpoint was new-onset AF.</p><p><strong>Results: </strong>The primary endpoint occurred in 13 patients. The left and right ventricular functions during exercise were responsible for decreased exercise tolerance. Peak exercise e' and tricuspid annular plane systolic excursion (TAPSE) significantly predicted increased primary outcome risk (hazard ratio 1.35, 95 % confidence interval 1.10-1.76, p = 0.003; hazard ratio 1.19, 95 % confidence interval 1.07-1.32, p = 0.002, respectively), and the results were consistent even after adjustment by maximum workload. These ESE parameters improved the prognostic model containing estimated glomerular filtration rate (eGFR) and left atrial (LA) volume index. In AF-naive patients (n = 58), LA volume, peak exercise LA reservoir strain, and left ventricular outflow tract (LVOT) pressure gradient predicted new-onset AF.</p><p><strong>Conclusions: </strong>In patients with HCM, ESE parameters related to left and right ventricular function were responsible for low exercise tolerance. Furthermore, e' and TAPSE at peak workload could be useful for predicting cardiovascular events in addition to eGFR and LA volume index. LVOT pressure gradient and LA function during exercise predicted new-onset AF.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How the trabecular layer impacts on left ventricular function.","authors":"Ionela Simona Visoiu, Bjarke Jensen, Roxana Cristina Rimbas, Sorina Mihaila-Baldea, Alina Ioana Nicula, Dragos Vinereanu","doi":"10.1016/j.jjcc.2024.08.008","DOIUrl":"10.1016/j.jjcc.2024.08.008","url":null,"abstract":"<p><p>The ventricular trabecular layer is crucial in embryonic life. In adults, the proportion of trabecular-to-compact myocardium varies substantially between individuals, within individuals over time, and yet exhibits almost no correlation to pump function since most individuals with excessive trabeculation are asymptomatic. The question of how functional is the myocardium of the trabecular layer, relative to the myocardium of the compact layer, has been difficult to answer but it is often assumed to be inferior. An answer is now emerging from recent advances and it can improve our understanding of how the trabecular layer impacts on pathogenicity. This narrative review concerns natural variation in trabeculation, tissue organization, transcriptomics, immunohistochemistry, vascularization, electrical propagation, diastolic function and compliance, systolic function, and ejection fraction. There are no overt transcriptional differences in the adult stage, and the myocardium is equally equipped with sarcomeric proteins, mitochondria, and vascular supply. The similar structural features are consistent with myocardium with a similar stroke work per gram tissue, along with a high ejection fraction of the trabecular layer. In conclusion, the myocardium of the trabecular and compact layers is highly similar and this offers a logical explanation for the reproducible observations that most individuals with excessive trabeculation are asymptomatic.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined assessment of fractional flow reserve, resting full-cycle ratio, and resting ratio of distal coronary to aortic pressure for clinical outcomes.","authors":"Tatsuro Yamazaki, Yuichi Saito, Shunsuke Nakamura, Yuya Tanabe, Hideki Kitahara, Yoshio Kobayashi","doi":"10.1016/j.jjcc.2024.08.009","DOIUrl":"10.1016/j.jjcc.2024.08.009","url":null,"abstract":"<p><strong>Background: </strong>Fractional flow reserve (FFR) and non-hyperemic indices are invasive standards for evaluating functional significance of coronary stenosis. However, data are limited about outcomes in vessels with concordant and discordant physiological results, particularly with a ratio of distal coronary to aortic pressure (Pd/Pa) at rest.</p><p><strong>Methods: </strong>This was a single-center, retrospective, observational study. Coronary physiological indices including FFR, resting full-cycle ratio (RFR), and resting Pd/Pa were invasively evaluated in vessels with intermediate coronary artery stenosis. FFR ≤0.80, RFR ≤0.89, and resting Pd/Pa ≤0.92 were considered physiologically positive. Vessels were divided into three groups according to the results of FFR, RFR, and resting Pd/Pa: concordant positive (all positive for FFR, RFR, and resting Pd/Pa), concordant negative (all negative for FFR, RFR, and resting Pd/Pa), and discordant groups. The primary endpoint was target vessel failure (TVF) defined as a composite of cardiac death and target vessel myocardial infarction and unplanned revascularization.</p><p><strong>Results: </strong>Of 987 vessels included, 311 (31.5 %), 263 (26.6 %), and 413 (41.9 %) were in the concordant positive, discordant, and concordant negative groups. During a median follow-up period of 417 (208-756) days, TVF occurred more frequently in the concordant positive group, followed by the discordant and concordant negative groups (7.7 % vs. 4.6 % vs. 2.4 %, p = 0.004). TVF increasingly accrued during long-term follow-up, while discordant results of RFR and resting Pd/Pa did not result in worse outcomes compared with negative RFR and resting Pd/Pa.</p><p><strong>Conclusion: </strong>The combined assessment of FFR with RFR and resting Pd/Pa stratified TVF risks in vessels with intermediate coronary stenosis.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does previous valve replacement affect short-term coronary artery bypass grafting outcomes? A population-based National Inpatient Sample study from 2015 to 2020.","authors":"Renxi Li, Stephen J Huddleston, Deyanira J Prastein","doi":"10.1016/j.jjcc.2024.08.005","DOIUrl":"10.1016/j.jjcc.2024.08.005","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery disease (CAD) and valvular disease frequently coexist due to similar pathophysiology. Effort has been dedicated to comprehending the outcomes of concomitant coronary revascularization and valve replacement procedures. However, the understanding of how prior valve replacement affects the outcomes of coronary artery bypass grafting (CABG) remains limited. Thus, this study aimed to conduct a population-based examination of the in-hospital outcomes in patients with previous valve replacement in CABG.</p><p><strong>Methods: </strong>Patients who underwent CABG were identified in the National Inpatient Sample in the USA from Q4 2015-2020. Patients with age < 18 years and concomitant procedures were excluded. A 1:3 propensity-score matching was used to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between patients with and without previous valve replacement. In-hospital postoperative outcomes were assessed.</p><p><strong>Results: </strong>There were 514 patients with previous valve replacement who underwent CABG, who were matched to 1588 out of 167,668 controls. After matching, patients with valve replacement had mostly comparable in-hospital outcomes except for a higher risk of vascular complications (1.75 % vs 0.57 %, p = 0.02), a longer length of stay (10.90 ± 7.04 days vs 9.95 ± 6.53 days, p = 0.01), and higher hospital charges (275,465 ± 229,088 US dollars vs 231,648 ± 189,938 US dollars, p < 0.01).</p><p><strong>Conclusion: </strong>For short-term outcomes, CABG is generally safe for patients who have undergone previous valve replacement, although there is an increased risk of vascular complications that may warrant additional attention. The findings of this study can be valuable for preoperative risk assessment of patients who have had valve replacement and are considering CABG.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early vs. late transcatheter aortic valve replacement in acute heart failure hospitalizations: A comparative nationwide analysis.","authors":"Anas Hashem, Amani Khalouf, Mohamed Salah Mohamed, Saryia Adra, Deya Alkhatib, Mahmoud Ismayl, Anthony Kashou, Devesh Rai, Jeremiah P Depta, Samian Sulaiman, Andrew M Goldsweig, Sudarshan Balla","doi":"10.1016/j.jjcc.2024.08.007","DOIUrl":"10.1016/j.jjcc.2024.08.007","url":null,"abstract":"<p><strong>Background: </strong>Severe aortic stenosis (AS) is the most common valvular disease in the USA. Patients undergoing urgent or emergent transcatheter aortic valve replacement (TAVR) have worse clinical outcomes than those undergoing non-urgent procedures. No studies have examined the impact of procedural TAVR timing on outcomes in AS complicated by acute heart failure (AHF).</p><p><strong>Aims: </strong>We aimed to evaluate differences in in-hospital mortality and clinical outcomes between early (<48 h) vs. late (≥48 h) TAVR in patients hospitalized with AHF using a real-world US database.</p><p><strong>Methods: </strong>We queried the National Inpatient Sample database to identify hospitalizations with a diagnosis of AHF, aortic valve disease, and a TAVR procedure (2015-2020). The associations between TAVR timing and clinical outcomes were examined using logistic regression model.</p><p><strong>Results: </strong>A total of 25,290 weighted AHF hospitalizations were identified, of which 6855 patients (27.1 %) underwent early TAVR, and 18,435 (72.9 %) late TAVR. Late TAVR patients had higher in-hospital mortality rate (2.2 % vs. 2.8 %, p < 0.01) on unadjusted analysis but no significant difference following adjustment for demographic, clinical, and hospital characteristics [aOR 1.00 (0.82-1.23)]. Late TAVR was associated with higher odds of cardiac arrest (aOR 1.50, 95 % CI: 1.18-1.90) and use of mechanical circulatory support (aOR 2.05, 95 % CI: 1.68-2.51). Late TAVR was associated with longer hospital stay (11 days vs. 4 days, p < 0.01) and higher costs ($72,851 vs. $53,209, p < 0.01).</p><p><strong>Conclusion: </strong>Early TAVR was conducted in approximately 25 % of the AS patients admitted with AHF, showing improved in-hospital outcomes before adjustment, with no significant differences observed after adjustment.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Trends in Race and Sex Differences in Cardiac Arrest Mortality in the USA, 1999-2020.","authors":"Karthik Gonuguntla, Muchi Ditah Chobufo, Ayesha Shaik, Nicholas Roma, Mouna Penmetsa, Harshith Thyagaturu, Neel Patel, Amro Taha, Waleed Alruwaili, Raahat Bansal, Muhammad Zia Khan, Yasar Sattar, Sudarshan Balla","doi":"10.1016/j.jjcc.2024.08.006","DOIUrl":"10.1016/j.jjcc.2024.08.006","url":null,"abstract":"<p><strong>Background: </strong>Cardiac arrest (CA) affects over 600,000 patients in the USA annually. Despite large-scale public health and educational initiatives, survival rates are lower in certain racial and socioeconomic groups.</p><p><strong>Methods: </strong>A county-level cross-sectional longitudinal study using death data of patients aged 15 years or more from the US Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (WONDER) database from 1999 to 2020. CAs were identified using the International Classification of Diseases, tenth revision, clinical modification codes.</p><p><strong>Results: </strong>The CA-related deaths between 1999 and 2020 were 7,710,211 in the entire USA. The annual CA related age-adjusted mortality rates (CA-MR) declined through 2019 (132.9 to 89.7 per 100,000 residents), followed by an increase in 2020 (104.5 per 100,000). White patients constituted 82 % of all deaths and 51 % were female. The overall CA-MR during the study period was 104.48 per 100,000 persons. The CA-MR was higher for men as compared with women (123.5 vs. 89.7 per 100,000) and higher for Black as compared with White adults (154.4 vs. 99.1 per 100,000).</p><p><strong>Conclusions: </strong>CA-MR in the overall population has declined, followed by an increase in 2020, which is likely the impact of the COVID-19 pandemic. There were also significant racial and sex differences in mortality rates.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefit of prehospital electrocardiogram on door-to-device time in ST-segment elevation myocardial infarction with cardiogenic shock: Data from the Kanagawa Acute Cardiovascular Registry.","authors":"Jin Kirigaya, Yasushi Matsuzawa, Toshiaki Ebina, Takeru Abe, Noriaki Iwahashi, Kazuki Fukui, Atsuo Maeda, Yoshihiro Akashi, Junya Ako, Yuji Ikari, Atsuo Namiki, Ichiro Michishita, Teruyasu Sugano, Kouichi Tamura, Kiyoshi Hibi, Kazuo Kimura, Hiroshi Suzuki","doi":"10.1016/j.jjcc.2024.08.004","DOIUrl":"10.1016/j.jjcc.2024.08.004","url":null,"abstract":"<p><strong>Background: </strong>The benefit of prehospital 12‑lead electrocardiogram (PH-ECG) performed by emergency medical service personnel at the site of first medical contact (FMC) in patients with ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock (CS-STEMI) remains unclear. This study aimed to investigate the effect of PH-ECG on door-to-device time in patients with CS-STEMI.</p><p><strong>Methods: </strong>This study enrolled CS-STEMI (Killip class IV) patients who were transferred directly to hospitals by ambulance (n = 517) from the Kanagawa Acute Cardiovascular Registry database. Patients were divided into PH-ECG (+) (n = 270) and PH-ECG (-) (n = 247) groups. Patients who experienced out-of-hospital cardiac arrest, who did not undergo emergent coronary intervention, or whose data were missing were excluded. Patient characteristics, FMC-to-door time, door-to-device time, and in-hospital mortality were compared between the groups.</p><p><strong>Results: </strong>The patient backgrounds of the PH-ECG (+) and PH-ECG (-) groups were comparable. The peak creatinine kinase level was greater in the PH-ECG (+) group than in the PH-ECG (-) group [2756 (1292-6009) IU/ml vs. 2270 (957-5258) IU/ml, p = 0.048]. The FMC-to-door time was similar between the two groups [25 (20-33) min vs. 27 (20-35) min, p = 0.530], while the door-to-device time was significantly shorter in the PH-ECG group [74 (52-103) min vs. 83 (62-111) min, p = 0.007]. In-hospital mortality did not differ between the two groups (18 % vs. 21 %, p = 0.405). Multivariable logistic regression analyses revealed that PH-ECG (+) was independently associated with a door-to-device time < 60 min [odds ratio (95 % confidence intervals): 1.88 (1.24-2.83), p = 0.003].</p><p><strong>Conclusions: </strong>PH-ECG was significantly associated with shorter door-to-device times in patients with CS-STEMI. Further studies with larger populations and more defined protocols are required to evaluate the utility of PH-ECG in patients with CS-STEMI.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}