bluuebunny/crossref_metadata_2025 huggingface dataset:
Levels of high-sensitive troponin T and mid-regional pro-adrenomedullin after COVID-19 vaccination
Authors: Mockel M , Pudasaini S , Le N H , Huscher D , Holert F , Kurth F , Lau P T , Hillus D , Sander L E
Published: May 2024

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Federal Ministry of Education and Research.

Background/Introduction

To increase vaccine safety, adverse events of COVID-19 vaccines are continuously monitored. This also includes rare complications of the cardiovascular system. However, it has so far been scarcely investigated whether chronic and subtle, clinically inapparent myocardial and/or vascular injury occurs in a COVID-19 vaccinated population on a broader basis.

Purpose

The aim of this study was to analyse chronic and subclinical adverse effects of COVID-19 vaccines on the cardiovascular system. Vaccine-associated myocardial involvement was examined by measuring high-sensitive troponin T (hsTnT) while mid-regional pro-adrenomedullin (MR-proADM) levels were evaluated to assess endothelial dysfunction.

Methods

This was a prospective observational study with a vulnerable population of healthcare workers (HCWs) and elderly (> 70 years) patients who were vaccinated with either the ChAdOx1 nCov-19 adenoviral vector vaccine (AZ) and the BNT162b2 mRNA vaccine (BNT), or with BNT/BNT between the 12th of January and 30th of November 2021 (Figure 1). HsTnT and MR-proADM was measured in blood samples at three visits (V1: 1st baseline, immediately before vaccination; V2: 3-4 weeks after 1st vaccination; V3: 3-4 weeks after 2nd vaccination). HsTnT levels were further compared with a healthy reference cohort.

Results

120 participants were included (V1=119, V2=120, V3=120). 50 (41.7%) received AZ/BNT. 70 (58.3%) were vaccinated with BNT/BNT of whom 20 (16.7%) were elderly and 50 (41.7%) were HCWs. Median hsTnT levels were at 4ng/L, 5ng/L and 4ng/L (V1-V3) for AZ/BNT and at 6ng/L, 6ng/L and 6ng/L (V1-V3) for BNT/BNT, respectively (Figure 2). Levels of MR-proADM were 0.43nmol/L, 0.46nmol/L and 0.44nmol/L (V1-V3) in the AZ/BNT cohort and 0.49nmol/L, 0.43nmol/L and 0.49nmol/L in the BNT/BNT group. Change of hsTnT and MR-proADM values between visits did not show significant increases. Two cases had a transient (7ng/L, 19ng/L, 5ng/L; male, 29 years) or permanent (15ng/L, 21ng/L, 25ng/L; male, 37 years) increase in hsTnT levels, exceeding the upper reference limit (≥ 14ng/L). Compared to the reference population (n=300), median hsTnT was significantly higher at all visits for both vaccination groups (p<0.05), without significant differences between the AZ/BNT and BNT/BNT cohorts.

Conclusion(s)

With two individual exceptions, no overall chronic myocardial injury or endothelial involvement was observed up to 4 weeks after the 2nd SARS-CoV-2 vaccination when comparing hsTnT and MR-proADM after both vaccinations to baseline values.Figure 1Vaccination scheme.Figure 2.hsTnT values at V1-V3.
Predicting survival with scales for in-hospital extracorporeal cardiopulmonary resuscitation
Authors: Alonso Fernandez De Gatta M , Hernandez Martos A V , Diego Nieto A , Gonzalez Cebrian M , Toranzo Nieto I , Barrio Rodriguez A , Gonzalez Calle D , Merchan Gomez S , Martin Herrero F , Sanchez P L
Published: May 2024

Funding Acknowledgements

None.

Background

Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue option in cardiac arrest (CA) refractory to advanced life support. Patient selection is challenging, and anecdotal scores are specific to this situation.

Purpose

Our objective was to analyse the usefulness of different scales used in shock and venoarterial extracorporeal membrane oxygenator (VA-ECMO) support in in-hospital ECPR.

Methods

Retrospective analysis of consecutive ECPR cases in a referal center. The ECPR alert includes in-hospital cardiologist/intensivist, on-call interventional cardiologist/cardiac surgeon for cannulation, and on-call perfusionist. We analysed hospital survival based on our own and other literature-based mortality scales calculated prior to VA-ECMO implantation: SCAI, INTERMACS, CardShock, CSS, SAVE-ECMO, RESCUE-IHCA.

Results

Out of 222 VA-ECMO implanted, we included 66 ECPR cases between 2014-oct 2023. Baseline, admission and ECPR characteristics are collected in the table.

Overall in-hospital survival was 16.7% (n=11) (cerebral performance cathegory 1-2).

We developed a sumative mortality scale including factors related to survival in our population and the literature (lactate >10.05, >60 minutes CA, peripheral arterial disease (PAD), and on-call time for ECPR alert activation) (figure A). This scale was significantly related to survival to discharge (figure A).

Regarding the scales and their association with survival, only RESCUE-IHCA showed a trend towards statistical significance (16 [15] points in survivors vs 19 [15] in died patients, p=0.096). The remaining scores showed no relationship with survival to discharge: SAVE-ECMO -15,73±4.8 in survivors vs -14,07±4.1 in died patients (p= 0.301), CSS 10,09±1.9 vs 10.40±2.7 (p=0.651), CardShock 4.82±1.3 vs 5.27±1.2 (p=0.287). INTERMACS (all patients 1) and SCAI classification (all patients stage E) are not valid for discriminating survival in this situation.

We compared the scales using the ROC curve for hospital survival, and we found that our own scale had the best discriminatory ability (Figure B).

Conclusions

Scales developed for shock or VA-ECMO support were not significantly related to survival in patients undergoing in-hospital ECPR. The specific ECPR scale RESCUE-IHCA, and our own scale developed in this population showed better discriminatory ability in survival to discharge.Table.Baseline, admission and ECPRFigure.A: Own scale. B: ROC curves
Current post-resuscitation management of out-of-hospital cardiac arrest patients admitted to intensive cardiovascular care units
Authors: Andrea Riba R , Loma-Osorio P , Sanz-Girgas E , Garcia-Garcia C , Soriano T , Sionis A , Llao I , Pastor P , Izquierdo-Ribas M , Moreno E , Roca-Guerrero C , Lopez-Sobrino T , Ortiz-Perez J T , Freixa X , De Diego O
Published: May 2024

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Consell Català de Resucitació 2022.

Background

Out-of-hospital cardiac arrest (OHCA) accounts the 50% of cardiovascular deaths. Neuroprognostication must be done in a multimodal approach as recommended by ILCOR guidelines but its application in real life is challenging.

Aim

To investigate current post-resuscitation care and neurological prognostication of OHCA patients admitted to a mediterranean Intensive Cardiac Care Unit (ICCU) during the 2020s.

Methods

PCR-Cat was a prospective observational multicenter registry. OHCA patients admitted to the ICCU of 8 catalan hospitals were included from October/2020 to December/2021. Post-OHCA management in the ICCU was analyzed including neuroprognostication tools and targeted temperature management (TTM) approach. Patients were classified into 2 groups according to main outcome at 6-month follow-up: good (CPC 1-2, GO) or poor outcome (death or CPC 3-4, PO).

Results

288 patients were included, mean age 61.45 ± 13.76 and only 17.36% were female. GO at 6-month follow-up occurred in 48.95% of patients. Total medium time until ROSC was 28 min and first rhythm was shockable in 80%. An emergent coronary angiography was done in 68.9% and during any moment of the hospitalization in 83.5% (PCI 56.5%). There was no association between the presence and type of significant coronary artery disease and the main outcome. TTM was applied in 65.33% and the target temperature was 33ºC in 71.76%, 34ºC in 3.53%, 35ºC in 2.35% and 36ºC in 22.35%, with no statistically significant differences between the GO and PO groups. The neuronal specific enolase (NSE) was determined in 57 % of patients at 24 hours, 45% at 48h and 57% at 72 h. Myoclonus were statistically significant more frequent in patients with PO (51.20% vs. 7.52%, p<0.001). Almost one electroencephalogram was performed in 60.4% of patients, somato-sensorial evoked potentials in 53.01%, a cerebral computed tomography in 57.75% and a cerebral magnetic resonance imaging in 19.38%. As expected, an abnormal result of all those neurological tests, when performed, were related to poor outcome (Table 1). In-hospital mortality was 46%. Main cause of death was neurological in 72.90%. The percentage of CPC 1-2 increased throughout the follow-up period (Figure 1).

Conclusions

Although ILCOR guidelines clearly indicate the use of a multimodal approach for neuroprognostication, in real-life setting, the conventional tests for neurological evaluation are used in a differently in every center, depending on their expertise and facility of resources.Figure 1
Intra-abdominal hypertension in acute decompensated heart failure - an overlooked piece in the puzzle of diuretic resistance
Authors: Lagosz P , Biegus J , Zymlinski R
Published: May 2024

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Wroclaw Medical University, Insitute of Heart Diseases, Wroclaw, Poland.

Introduction

Intra-abdominal pressure (IAP) is a frequently overlooked aspect in clinical assessment which can have a significant impact on organ dysfunction in patients with acute decompensated heart failure (ADHF).

Purpose

To investigate prevalence and dynamics of IAP in patients with ADHF and its impact on diuretic response.

Methods

30 patients admitted for ADHF, class III or IV in New York Heart Association classification were enrolled into a prospective, observational pilot study. In every individual serial transurethral IAP measurements, blood and urine samples were taken upon admission, on the second and the third day of hospitalization.

Results

The study showed 63.3% prevalence of intra-abdominal hypertension (IAH) defined as IAP ≥ 12 mmHg upon admission, while only roughly 13% presented overt signs of abdominal congestion. Patients diagnosed with IAH upon admission had significantly poorer diuresis in the first day of hospitalization, despite receiving similar doses of loop diuretics (p = 0.038). Moreover, IAP was negatively correlated with urine output (p = 0.011) and positively correlated with urine osmolality (p = 0.033), while there was no relationship between IAP and natriuresis. There was a significant reduction of IAP among patients with IAH treated according to the European Society of Cardiology guidelines.

Conclusions

The investigation revealed an exepctionally high prevalence of elevated IAP among patients hospitalized for ADHF and highlights the limitations of physical examination in assessing abdominal congestion, as most patients remain asymptomatic. The observed poorer diuresis in patients diagnosed with IAH and the established association between IAP and the reduced urinary output, despite achieving target levels of natriuresis, add another piece to the puzzle of understanding the phenomenon of diuretic resistance in ADHF and set directions for future studies.
Coronary manual thrombectomy - a 12-year single centre experience
Authors: Rocha De Almeida A , Carias De Sousa M , Neves D , Congo K , Patricio L
Published: May 2024

Funding Acknowledgements

None.

Background/Introduction

Coronary manual thrombectomy is not routinely recommended, due to the risk of stroke, as supported by some dedicated clinical trials. It is, however, a simple and delicate technique that gives the opportunity to improve angioplasty results by decreasing thrombus burden and potentially improving stent apposition and decreasing no-reflow phenomenon, protecting coronary microcirculation.

Purpose

To describe a single-centre experience on coronary manual thrombectomy, regarding clinical context, anatomic/technical features, procedure success and in-hospital occurrence of stroke.

Methods

Retrospective study of procedures in which coronary manual thrombectomy was performed from 2009 to 2021. Procedure and patient characteristics were analyzed and related with hospital records of new stroke diagnosis.

Results

Manual thrombectommy was performed on 1136 procedures, in 1111 patients (77% male). As expected, the vast majority of cases were acute coronary syndromes: STEMI (1031 cases; 90,8%) and NSTEMI (78; 6,9%). The device used was predominantly 6F (81,7%). Most frequent reference diameters were 3,0mm (529; 46,6%) and 3,5mm (244; 21,5%). The vessel was initially completely occluded in about two thirds of the cases (747; 65,8%) and the left anterior descending artery was the most frequent culprit (541; 47,7%), followed by the right coronary (386; 33,9%). Revascularization was considered completely successful in 1017 (89,5%) of cases. There were no cases of new stroke diagnosis during admission in these patients.

Conclusions

Coronary manual thrombectomy should not be routinely performed, as recommended by international guidelines. However, fear of stroke should not hamper its use whenever the benefits seem clear, such as the presence of a flow-limiting thrombus in a culprit artery, with a retrievable size and good catheter engagement of the coronary artery. In this relatively large sample, we report a good single centre experience with this technique, with no clinical stroke occurrence during admission.
Differences in mortality between patients with cardiogenic shock due to STEMI treated with PCI vs thrombolysis
Authors: Fonseca Robles R , Gopar Nieto R , Arias Mendoza M , Gonzalez Pacheco H , Loaisiga Saenz A , Araiza Garaygordobil D , Sierra Lara Martinez J , Mendoza Garcia S , Arzate Ramirez A , Altamirano Castillo A , Briseno De La Cruz J , Baeza Herrera L , Montanez Orozco A , Diaz Herrera B , Tovar Jimenez A
Published: May 2024

Funding Acknowledgements

None.

Introduction

STEMI is complicated with cardiogenic shock (CS) in approximately 5-10% of cases and mortality is about 40% at 30-day and 50% at 1 year worldwide. In Mexico the incidence of CS in STEMI that received revascularization therapy (PCI or thrombolysis) is between 4.4-4.8%. In our country, pharmacoinvasive strategy (PIs) is the preferred modality due to the lack of PCI centers and demographics.

Purpose

To demonstrate differences in total ischemia time and 30-day in-hospital mortality in patients treated with PIs or PCI.

Methods

This was a retrospective observational study of patients that arrived to the emergency room and coronary care unit of the National Institute of Cardiology from January 2018 to March 2023 with CS due to STEMI at presentation, who received reperfusion therapy (PCI or PIs) during the first 12 hours of symptom onset.

Results

We included 61 patients with CS due to STEMI at presentation, 60.7% received PIs and 39.3% underwent PCI. The prevalence of type 2 diabetes was 38%, hypertension was 28% and obesity was 10% with no significant differences between groups, however the presence of CKD differed significantly with approximately 3% in PCI group versus 0% in PIs group. 21% were smokers and 13% previous smokers. Only 8 patients (13.1%) had a previous MI, 5 patients (8.2%) had previous angioplasty and 4 patients (6.6%) had previous HF.

The first medical contact (FMC) occurred at a median of 120 minutes (IQR 75-240 min) overall. For patients undergoing PIs, the FMC was 120 minutes (IQR 70-185 min), whereas for those undergoing PCI, it was 185 minutes (IQR 87-300 min). The total ischemia time was 270 minutes (IQR 180-470 min) overall, with a median of 229 minutes (IQR 163-405 min) for PIs and 396 minutes (IQR 267-592 min) for PCI. The 30-day in-hospital mortality rate was 27.9% overall, significantly lower at 18.9% in the PIs group compared to 41.7% in the PCI group (p=0.01). The average length of hospital stay was 8 days for the PIs population, slightly longer than the 6.5 days observed in the PCI group (p=0.09).

Conclusion

In this real-world retrospective analysis conducted in our center in a middle-income country showed that PIs impacted positively in 30-day in-hospital mortality of patients who arrived with CS due to STEMI at presentation compared to those that underwent PCI. This effect seems to be secondary to shorter ischemic times since symptom onset due to the use of a prompt reperfusion therapy.
Gender differences in KAsH score in acute myocardial infarction
Authors: Paula S , Figueiredo M , Santos M , Almeida S , Almeida L
Published: May 2024

Funding Acknowledgements

None.

Introduction

Risk stratification at admission in patients with myocardial infarction (MI) is crucial in the prognosis assessment. KAsH score is a useful and simple tool to predict in-hospital mortality.

Objective

To evaluate KAsH score predictive power according to gender in patients (P) who suffered MI (either STEMI or NSTEMI)

Methods

Based on a single-center retrospective study, data collected from P admitted in the Cardiology department with MI between 2016 and 2019. P without or uncompleted data were excluded. We compared 2 groups: Group 1 (G1) – male patients; Group 2 (G2) – female patients. Major adverse cardiac events (MACE) were defined as the composite of nonfatal stroke, nonfatal myocardial infarction and cardiovascular death. Statistical analysis used T test, chi-square, logistic regression and ROC curve analysis.

Results

Among the 611 P admitted with MI mean age was 66.6±12.7 years old and 64.8% were male. G1 was younger (64.7 ±12.8 years vs 64.7±12.8, p<0.001). The groups were similar regarding the other variables that compose the KAsH score, namely Killip-Kimbal class (p=0.668), systolic blood pressure (p=0.378), and heart rate (p=0.265). The mean KAsH categorization was 1.48 for G1 and 1.54 for G2 (p=0.05). The groups were also similar regarding other (CV) factors namely arterial hypertension, diabetes mellitus, dyslipidaemia, smoking and previous MI. In general, KAsH score was able to predict in-hospital mortality in our sample p=0.03, OR 2.45, CI 1.09-5.55 but with poor accuracy (AUC 0.355). However, the score did not predict 1 year mortality (p=0.337) or 1 year readmission (p=0.943). Regarding the groups, KAsH score did not predict in-hospital mortality for G1 (p=0.465) but it did predict the occurrence of MACE events, p=0.01, OR 2.20, CI 1.20-4.09, AUC 0.634.

Considering G2 KAsH score predicted in-hospital mortality p=0.02, OR 4.10, CI 1.24-13.87 but with poor accuracy (AUC 0.211). It also predicted the occurrence of MACE events p=0.001, OR 4.61, CI 1.83-11.63 with fair accuracy (AUC 0.77). Such as in G1 the score did not predict 1 year mortality or readmission (p=0.178)

Conclusion

In our center, KAsH score performed better in female patients in predicting in-hospital mortality and MACE events. The score also predicted MACE events in male patients, but did not predict in-hospital mortality. More studies are needed to validate additional variables to the score and to validate KAsH score as a long-term prognostic tool.
Improving pericardial effusion detection: evaluating sensitivity and specificity of traditional and novel ECG criteria
Authors: Biasin M , Cordioli N , Varriale A , Zayalah J , Comuzzi A , Pilan M , Gambaro A , Ribichini F
Published: May 2024

Funding Acknowledgements

None.

Introduction

Historical studies have demonstrated that conventional low voltage criteria on ECG have high specificity but limited sensitivity in detecting pericardial effusion (PE). Indeed, an ECG showing low voltage can be indicative of several conditions, including PE.

Purpose

This study aimed to introduce new ECG criteria organized into a score called ARENA, to improve ECG diagnostic performance in detecting PE. Furthermore, we compared the sensitivity and specificity of traditional low voltage ECG criteria with the ARENA score using a test cohort.

Methods

This retrospective case-control study was conducted at our public University hospital from January 2022 to May 2023. Inclusion criteria were: age ≥18 years old, an available 12 lead ECG and an echocardiogram performed within 5 days from the recorded ECG. Exclusion criteria were: ventricular paced rhythm, heart transplantation, poor subcostal echocardiographic window. In the cohort of patients were selected: patients with ≥1.0 cm of PE on echocardiography and patients without effusion on echocardiography. ECG parameters were evaluated by two cardiologists blinded for the presence or absence of PE. Echocardiographic images were reviewed by an expert echocardiographer.

Optimal ECG criteria with the highest ROC curve area were selected from the test cohort to develop the ARENA score. Patients were assessed using both traditional low voltage ECG criteria and the novel ARENA score.

Statistical analysis showed that with 96 patients in the test cohort, there would be >90% power to detect a significant area under the curve (AUC) of 0.7 (vs. the null hypothesis of AUC of 0.5) to detect a moderate effect size.

We used the AUC analysis to estimate the predicted performance of the proposed criteria. The McNemar test was used to assess the lack of agreement between the ECG criteria and the gold standard (echocardiography), and the results were reported as percentages with their respective 95% confidence intervals (CI). A p-value < 0.05 was considered statistically significant.

Results

The patient population consisted of 97 patients: 50 patients with PE, and 47 patients without it. The ARENA score showed a sensitivity of 52.0% (95% CI: 39.2% to 64.8%), compared to 14.0% (95% CI: 6.2% to 21.8%) of the traditional criteria. Specificity was 94% (95% CI: 84.1% to 100%) for ARENA Score and 100% (95% CI: 96.3% to 100%) for traditional criteria. Accuracy of the ARENA score was 70.0%, compared to 57% of the traditional criteria. The McNemar test indicated a p-value of <0.001 in the performance comparison. The AUC for the ARENA score was 0.781.

Conclusion

The novel ARENA score demonstrated an improved sensitivity while maintaining high specificity in detecting PE. This new score could become a valuable diagnostic tool for detecting PE by ECG in daily practice.ROC Curve ARENA ScoreECG criteria for pericardial effusion
Acute kidney injury in acute decompensated heart failure related cardiogenic shock: data from the Alt-Shock2 registry
Authors: Milani M , Tavecchia G A , Frea S , Sorini Dini C , Briani M , Bertaina M , Pullara A , Petrini L , Garatti L , Potena L , De Ferrari G M , Tavazzi G , Pappalardo F , Morici N , Sacco A
Published: May 2024

Funding Acknowledgements

None.

Background

Acute kidney injury (AKI) is one of the most common complications in patients with cardiogenic shock (CS), proving the strict relationship between heart and kidney (the so-called cardio-renal syndrome). AKI is a marker of shock severity, but also independently associated with worse outcomes.

Purpose

Many data are available on the prevalence of AKI in acute heart failure, but very few studies assessed the role of AKI in CS and they were mainly focused on acute myocardial infarction (AMI)-related CS. Aim of our study was to analyze the impact of AKI on acute decompensated heart failure (ADHF)-CS.

Methods

Between March 2020 and August 2022, we prospectively enrolled 375 CS patients from a Cardiac Intensive Care Units Network of 12 centers. Among these patients 121 (33.9% of the whole cohort) with ADHF-CS were included for the present analysis. AKI was defined according to KDIGO 2012 criteria as serum creatinine increase ≥ 0.3 mg/dl or 1.5 times compared to admission value, or urinary output < 0.5 ml/kg/h.

Results

Table 1 shows the baseline characteristics of the cohort. Patients with AKI were older (70 years old [55.5; 76] vs 61 [54; 69], p<0.05), had more comorbidities and a worse CS profile on admission. On multivariable analysis, SCAI stage D-E on admission was independently associated with a higher risk of AKI 24 hours after admission (OR 5.54 and p = 0.01). Treatment with mechanical circulatory support did not prevent AKI (OR 0.84 and p = 0.8). Notably, patients with a greater reduction in central venous pressure (CVP) 24 hours after admission had a lower risk of AKI (deltaCVP in AKI group 0 [-3;0] versus deltaCVP in no-AKI group -3 [-6;0], p = 0.025). Kaplan-Meier curves showed significantly worse survival in patients with AKI (Figure 1A). Cox regression analysis confirmed an association between AKI and increased risk of death (HR 2.14, CI 95% 1.16-3.96, p = 0.01). Notably, this association was even more pronounced in patients with SCAI stages A-B-C (HR 2.81, CI 95% 1.30-6.09, p = 0.01). Finally, in patients treated with renal replacement therapy (RRT) there was no association with lower survival at 180-days follow up (Figure 1B).

Conclusions

Our study confirms that AKI is a predictor of adverse outcomes in patients with ADHF-CS. Effective decongestion 24 hours after admission was associated with a lower risk of AKI. Considering that AKI had a negative impact even at lower SCAI stages, our findings underscore the importance of early identification of renal injury to promptly target decongestion with pharmacologic therapy and, ultimately, early use of RRT.
Characteristics, management and prognosis of patients with coronary artery disease undergoing coronary intervention and atrial fibrillation
Authors: Minguez De La Guia E , Vallejo Calcerrada N , Moreno Monterde E , Esteve Claramunt F , Cordero Fort A , Nunez Gil I , Corbi Pascual M J , Lopez Lluva M T , Diez Del Hoyo F , Diez Villanueva P , Raposeiras Roubin S , Ayesta Lopez A , Goniz Magana J , Cepas Guillen P L , Bonanad Lozano C
Published: May 2024

Funding Acknowledgements

None.

Introduction

The selection of antithrombotic treatment in patients with ischaemic heart disease (IHD) and atrial fibrillation (AF) represents a challenge when trying to balance ischaemic and haemorrhagic risk. However, there is little "real-life" data on the selected antithrombotic treatment and its short and long-term prognosis.

Methods

A Prospective multicentre study that includes patients with IHD [acute coronary syndrome (ACS) or chronic coronary syndrome (CCS)] and AF admitted to 13 Spanish centres. The objective is to describe the characteristics, antithrombotic treatment and prognosis of patients undergoing PCI and AF.

Results

373 patients were included. The average age was 77.6 ± 9.8 years (28% women). Patients had a high ischaemic and haemorrhagic risk [CHA2DS2VASc 4 (2-5) and HASBLED 3 (2-4)], with 25.5% being frail according to the Clinical Frailty Scale. The main reason for admission was ACS (44.8% NSTEMI, 22.2% STEMI and 33% CCS ), and 49.8% of patients had multivessel disease. 70.3% of patients underwent revascularisation, mainly percutaneously (92.2%). Among those percutaneously revascularised, the most used antithrombotic treatment was triple therapy with double antiplatelet therapy (DAPT) + oral anticoagulant (OAC) (62.5%), followed by double therapy with monoantiplatelet therapy + OAC (29.2%). In revascularised patients over 80, the most selected antithrombotic therapy was similar: 60.5% and 28.9%, respectively. The most used OAC was apixaban (42.3%), followed by vitamin K antagonists (17.3%).

One-year survival was 88.5%. 2.6% of patients presented an ischemic stroke, and 4.8% suffered a new ACS. At the same time, haemorrhagic events (BARC ≥2) were 8.9%.

Conclusions

A high ischaemic and haemorrhagic risk co-exists in patients with IHD and AF. In our setting, triple therapy, mainly with the use of DOACs over VKA, is the preferred therapy. The long-term mortality of this subgroup of patients with IHD is high (>10%), with a rate of haemorrhagic events (8.9%) higher than ischaemic events (4.8%).Characteristics of patients
Safety and efficacy of percutaneous lead extraction of infected cardiac electronic devices: a single-center study
Authors: Mpatsouli A , Papakonstantinou P , Megarisiotou A , Xydonas S
Published: May 2024

Funding Acknowledgements

None.

Background

Infections of implanted cardiac electronic devices (CIEDs) are associated with increased morbidity and mortality. Current guidelines recommend either percutaneous or surgical lead removal.

Purpose

To assess and document the safety and efficacy of percutaneous lead extraction within our Electrophysiology (EP) Lab over the past 2 years.

Methods

We enrolled consecutive patients with CIED-related infections who underwent percutaneous lead extractions at our EP lab.

Results

A total of 26 consecutive patients were included in the study, of whom 21 (81%) were males, with a median age of 67 years. Among these patients, 9 (35%) had permanent pacemakers, 11 (42%) had implantable defibrillator systems, and 6 (23%) had biventricular defibrillator systems. Device extrusion was observed in 17 patients (65%), while the remaining 9 (35%) had lead vegetations. Among the 17 patients with device extrusion, 3 (18%) also had lead vegetations, but only 2 (12%) had positive blood cultures. Among the 9 patients without device extrusion, 5 (56%) had vegetations in the leads and tricuspid valve, while 4 (44%) had positive blood cultures. The mean duration from CIED implantation to infection was 81.5 months. Percutaneous lead extraction of CIEDs was successful in 25 patients (96%) using transvenous rotational dilators and endovascular lead extraction tools. In one patient, femoral access with a snare was required for lead retrieval. In another case, where complete lead removal was necessary, the patient developed a massive pulmonary embolism, leading to surgical removal. Additionally, in one patient with a 20-year-old permanent pacemaker, lead extraction was not successful; however, surgical removal was avoided due to the high risk involved.

Conclusions

The use of transvenous rotational dilators and endovascular lead extraction tools for transvenous removal of CIEDs due to extrusion and/or endocarditis is safe and highly effective, avoiding high-risk cardiac surgical interventions.
Gender differences in ST-segment elevation myocardial infarction: an analysis on treatment, complications and acute-phase mortality
Authors: Carrete A , El Ouaddi N , Ferrero Molina C , Perez Montoliu C , Grama E , Casquete Sanchez D , Rueda Sobella F , Montero Aradas S , Oliveras Vila T , Labata Salvador C , Ferrer Massot M , Collado Lledo E , Bayes-Genis A , Garcia-Garcia C
Published: May 2024

Funding Acknowledgements

None.

Background

Primary angioplasty is the gold-standard treatment in ST-segment elevation myocardial infarction (STEMI). Previous studies have shown differences in the treatment of STEMI between men and women.

Purpose

To analyze the differences in the management of STEMI between both genders in a mediterranean settlement when it comes to angioplasty, timing of revascularization, complication rates and 30-day mortality.

Methods

A prospective, unicentric study of consecutive STEMI patients that were admitted to an Acute Cardiac Care Unit was performed from January 2010 to December 2022. We compared the differences between genders on timing of revascularization, complication rates and 30-day mortality.

Results

A total of 4616 patients were included between 01/01/2010 and 31/12/2022, 21.75% were women. Women were older than men (68.5 vs 61.4 years, p<0,001), but there were no differences on cardiovascular risk factors, infarct location or ejection fraction. Female sex was associated with higher Killip class (Killip ≥2 on admission 22.6% vs 17.9%, p=0.005), less angioplasty rates (88.4% vs 93.1%, p<0.001), longer timing of revascularization (median time 223 minutes vs 178 minutes, p<0.001), higher rates of heart failure during admission (16.2% vs 11.3%, p<0,001), mechanical complications (2.9% vs 1.4%, p=0.001) and higher 30-day mortality (8.8% vs 5.7%, p<0,001).

Conclusions

Women with STEMI are less likely to receive revascularization therapy, are admitted with a higher Killip class and have higher rates of post-STEMI complications and 30-day mortality than men.
Prognosis of type A acute aortic syndrome in elderly patients
Authors: Ramos Gonzalez-Cristobal I , Ferrera C , Vilacosta I , Carrero A , Gutierrez F , Gonzalez Del Castillo J , Dominguez M J , Alvarez E , Fernandez F , Martinez I , Cobiella J , Noriega F J , Viana-Tejedor A , Perez Villacastin J , Maroto-Castellanos L
Published: May 2024

Funding Acknowledgements

None.

Introduction

Type A acute aortic syndrome (AAS-A) is associated with a high mortality. Emergent surgery is the treatment of choice for patients with AAS-A. However, this surgery is a highly complex procedure associated with a significant morbidity. There are uncertainties about the best treatment strategy for elderly patients, which pose a challenge in clinical practice.

Purpose

The aim of this study is to evaluate the prognosis of elderly patients with AAS-A and to analyse the impact and outcome of surgery in this patient population.

Methods

Patients with AAS-A were prospectively and consecutively collected from April-2019 to March-2023 in a four-hospital network with a tertiary care referral centre for cardiac surgery. Patients were classified according to age into two groups: ≥75 years and under 75 years. Clinical, diagnostic, treatment and prognostic variables were analysed.

Results

A total of 113 patients with AAS were included, of whom 82 were AAS-A patients. Of these, 27 were aged 75 years or older.

Older patients had more comorbidities: COPD, atrial fibrillation, renal failure and stroke (table). Elderly patients were diagnosed later (symptom-to-diagnosis time: 10 hours (6.2-62) vs. 4 hours (2.2-23), p=0.004). At diagnosis, older patients had more complications: cardiac tamponade (33% vs 23%, p= 0.352), hemopericardium (69% vs 38%, p= 0.01), shock (45% vs 30%, p=0.180) and renal failure (40% vs 20%, p= 0.132). The surgical risk of older patients was higher (table) and they underwent surgery in a lower proportion (59.3% vs. 87.3%, p= 0.004). Once diagnosed, time to surgery was similar between groups (3.2h (1.6-10) vs. 2.7h (2.1-5.7), p= 0.728).

Despite the increased risk, surgery was associated with a mortality reduction in both patient groups (figure). In patients who underwent surgery, the incidence of post-surgical atrial fibrillation was higher in the group of older patients, with no significant differences in the remaining complications (table).

Conclusion

Elderly patients with AAS-A have more comorbidities, are diagnosed later and have a higher mortality than those with younger age. Despite this, surgery is associated with a mortality reduction even in the older population. Age alone should not be a contraindication for surgical treatment of AAS-A.Mortality in SAA by age and treatment
Midazolam as mean sedative agent in out-of-hospital cardiac arrest shock: is it associated to increased mortality?
Authors: Moreno Monterde E , Lopez-Sobrino T , Jimenez-Trinidad F J , Cubells Pastor M , Martinez-Guisado A , Rodriguez-Eguren A , Arenas Lorente A , Anduaga Elorza I , Roca Guerrero C , De Diego O , Andrea R
Published: May 2024

Funding Acknowledgements

None.

Background

The choice of a sedative agent for patients undergoing invasive ventilation has been widely studied. However, data regarding the optimal sedation strategy after Out-of-Hospital Cardiac Arrest (OHCA) when the patients are suffering from post-OHCA shock is sparse.

Aim

To explore whether the use of midazolam in patients admitted for OHCA that are additionally haemodynamically unstable increases in-hospital mortality, cardiovascular (CV) mortality, cerebral performance status (CPC) at discharge, and days of intubation or admission, when used selectively during the acute phase of deteriorating post-OHCA shock patients.

Methods

We report a prospective, observational, single-centre cohort that included all-comers admitted due to OHCA of presumed cardiac cause between May-2019 and July-2023, that remained comatose at admission. Midazolam was only administrated as the mean sedation agent when the patient was in a hemodynamically deteriorating situation (SCAI D-E). Baseline characteristics, OHCA features, blood samples measurements, in-hospital treatments and neurological condition at discharge were registered. Primary outcome was in-hospital death from any cause. Secondary outcomes included CPC at discharge (1-2 VS 3-5), CV mortality, days of admission, days of intubation, need of tracheostomy, myopathy, enolase at 48h and heart transplant during admission. Patients were stratified according to whether they had received midazolam as mean sedation agent at some stage of admission or not.

Results

103 patients of the 109 admitted were included (6 refused consent), 45 of them (43%) received midazolam at some stage of admission. No differences in baseline characteristics were found. Mean age was 60.6 years, 79.6% were male, most frequent comorbidities were hypertension (53.4%) and dyslipidaemia (46.6%), and 20,4% had had a previous myocardial infarction. OHCA characteristics, shock parameters and administered treatments did not significantly differ between the two groups (Table 1). In-hospital mortality was numerically higher in the midazolam group but did not reach statistical significance (56% vs. 38%, p=0.075) (Figure 1). There were no differences neither in secondary outcomes (CV mortality 4% vs. 5%, p=0.865; CPC 1-2 70% vs. 83%, p=0.244; days of intubation 6 vs. 4, p=0.203; tracheostomy 18% vs. 10%, p=0.275; days of admission 14 vs. 15, p=0.851; 48h enolase 38 vs. 29, p=0.919; heart transplant during admission 0% vs. 1,7%, p=0.376; myopathy 30% vs. 21% p=0.282).

Conclusion

In patients admitted due to OHCA, even though the administration of midazolam is given in unstable patients, it is not related to a higher in-hospital mortality nor poorer outcomes.Table 1.OHCA and shock characteristicsFigure 1.Cumulative Survival
Determining risk factors for vascular and bleeding complications after TAVR using CT angiography
Authors: Aguiar Neves A I , Teixeira R , Ribeiro Silva M , Ferreira N , Pires-Morais G , Santos L , Melica B , Rodrigues A , Braga P , Caeiro D , Fontes-Carvalho R
Published: May 2024

Funding Acknowledgements

None.

Introduction

The use of pre-procedural computed tomography angiography (CTA) of the iliofemoral sector in the planning of transaortic valve replacement (TAVR) has demonstrated a reduction in the risk of vascular complications in patients undergoing TAVR. In this study, we aimed to characterise the clinical and radiological factors associated with bleeding and vascular complications after TAVR.

Methods

Patients undergoing transfemoral TAVR in a tertiary centre between 2017 and 2019 were included in this analysis. All patients underwent iliofemoral CTA before the procedure and classical CTA-derived data as well as iliofemoral calcium volume were collected. Clinical data and outcomes regarding bleeding events, as well as vascular complications according to Valve Academic Research Consortium 2 (VARC-2) criteria, were also collected.

207 patients were included in this analysis, of whom 53% were women. The median age was 82 years (IQR 76-86) and the median STS mortality risk score was 3.9% (IQR 2.59-5.99).

In this population, vascular complications according to the VARC-2 criteria occurred in 33% of patients (19% with major complications). Patients with lower body mass index (BMI) were more likely to suffer vascular complications. Vascular access with fluoroscopy was associated with a higher prevalence of complications compared to ultrasound-guided vascular access (62% vs. 38%, p=0.037). When considering radiological criteria, smaller minimum luminal diameter and area of the common femoral and external iliac arteries were associated with a greater risk of vascular complications, as were increased sheath to external iliac artery ratios and luminal attenuation values (p<0.05 for all).

Bleeding complications occurred in 20 patients, with a greater prevalence of bleeding events in female patients (77% vs. 23%, p=0.001). Patients with a lower BMI, a history of obstructive pulmonary disease or coronary artery disease, aortic insufficiency and fluoroscopic valvular access were more likely to have bleeding complications. Regarding radiological criteria, decreased maximal luminal diameter of the common femoral artery and smaller minimal luminal diameters and areas of the external iliac artery were associated with bleeding complications. Increased sheath-to-femoral artery ratios and luminal attenuation values were associated with an increased risk of vascular complications (p<0.05 for all).

Conclusion

Our study underscores the importance of pre-procedural CTA in TAVR planning and identifies separate risk factors for vascular and bleeding complications.
Acute mitral regurgitation complicating STEMI
Authors: Diaz Herrera B , Cuevas Medina E N , Candia Ramirez M A , Hernandez Pastrana S , Gonzalez Macedo E , Latapi X , Fonseca Robles R , Ezquerra Osorio A , Soliz Uriona L , Gopar Nieto R , Sierra Lara Martinez J D , Briseno De La Cruz J L , Arias Mendoza A , Araiza Garaygordobil D , Gonzalez Pacheco H
Published: May 2024

Funding Acknowledgements

None.

Introduction

Acute ischemic mitral regurgitation (aiMR) occurs in 17-40% of patients suffering an acute coronary syndrome. Although severe forms constitute less than 1% of the cases, this complication significantly increases mortality risk. While surgery has been traditionally considered the treatment of choice, heterogeneity in underlying mechanisms and lack of updated evidence questions optimal treatment.

Purpose

The aim of the present study was to describe baseline clinical characteristics, management and outcomes of a contemporary cohort of patients with aiMR.

Methods

A retrospective cohort including patients diagnosed with moderate to severe aiMR presenting from 2006 to 2019 at the National Institute of Cardiology "Ignacio Chavez" in Mexico City.

Results

A total of 10,434 patients presented to the study center with an ACS from 2006 to 2019, out of which 6,448 (61.8%) were diagnosed with STEMI and 3,986 (38.2%) with NSTEMI. Mechanical post-infarction complications occurred in 203 (1.9%). Among these, aiMR was observed in 132 patients (1.3%), categorized as moderate in 49 patients (37.2%) and severe in 83 patients (62.8%). 6 patients were excluded due to incomplete information. Acute ischemic mitral regurgitation was more frequent in patients with STEMI (79.4%) compared with NSTEMI (20.6%) and 88.9% were non-reperfused infarctions. 65.9% of patients were male and 57.1% had hypertension. In-hospital mortality was present in 40 patients (31.7%). Ischemia of the papillary muscle was the most commonly reported mechanism (38.1%), followed by alterations in the left ventricle's geometry (33.3%), mitral annular dilation (14.3%), papillary muscle rupture (7.1%) and chordae tendineae rupture (5.6%). The least frequently reported mechanism was pre existing non-ischemic mitral regurgitation (1.6%). There was no significant difference in mortality based on the mechanism responsible for aiMR. Patients with aiMR managed solely with medical therapy had a higher mortality rate (41.3%) compared to those undergoing mitral valve replacement (37%) (Figure 1). Timely reperfusion (thrombolysis/primary PCI) significantly reduced in-hospital mortality (85% survival) in contrast to those with a non-reperfused MI (66% survival).

Conclusions

Acute ischemic mitral regurgitation remains an entity with a high mortality rate. Early identification of underlying etiology, prompt reperfusion treatment and tailored surgery, if needed, are key to improve outcomes.
PEEP trial and effect on hemodynamic in cardiogenic shock
Authors: Tavazzi G , Costanza C N J C , Corradi C F , Alviar C A
Published: May 2024

Funding Acknowledgements

None.

Introduction

Congestion is a paramount pathophysiological driver in patients with cardiogenic shock. Almost half of patients admitted due to cardiogenic shock undertake mechanical ventilation although ventilatory parameter, and their potential hemodynamic effect on the hemodynamic and congestion profile are often neglected.

Purpose

We sought to evaluate the hemodynamic effect of positive end-expiratory pressure (PEEP) titration on patients admitted to intensive care unit for CS.

Methods

We perform PEEP titration trial on patients undertaking mechanical ventilation for respiratory failure related to CS. The trial consisted in 3 steps of PEEP increase from 5 to 15 cmH2O. For each step arterial saturation, right atrial -RAP- and systemic blood pressure along with heart rate and respiratory mechanics (tidal volume-TV-, dynamic lung compliance- CLdyn, driving- Δ- and plateau pressure- Ppl) were measured. All the measures were taken at end-expiration; RAP trace was analyzed and systolic, mean and diastolic component collected. The final PEEP was decided based on the best matching between saturation, CLdyn and TV. Descriptive and repeated measures with Bonferroni correction were applied as statistical analysis (IBM SPSS 29).

Results

Twelve patients were included (10 male, 66 ± 7 years old; 8 acute myocardial infarction and 4 acute heart failure). At baseline the mean RAP was 8.44 (± 2.32) ; SBP 106 (IQR 92-112), HR 94 (IQR 88 - 102) Δ and Ppl pressures respectively 7.42 (± 0.79) and 12.08 (± 0.79, ),VT 427(± 65.42) and CLdyn 58.3 (± 7.1).

The right atrial pressure (RAP) differed between AMI and AHDF (8.25 ± 2.25 vs 20.25 ± 1.5; p < 0.001), so HR did (113 ± 3.4 versus 96 ± 3.2 betas per minutes; p 0.015).

RAP varied consistently during the PEEP trial (either sRAP, dRAP and mRAP- Table and Figure 1). The TV changed signficnatly between the 1st and 3rd step (p 0.004) and the CLdyn varied consistently throughout the 3 steps of the PEEP trial (p <0.001). A significant difference were observed according to aetiology in RAP (AMI Vs ADHF, eman difference 2.4 versus 4.3 mmHg) and in CLdyn (AMI Vs ADHF mean difference 12.31 vs 8 .65, p < 0.01) but not in the other parameters evaluated (p > 0.05).

Conclusion

This is the first, small, study evaluating the effect of positive pressure ventilation in CS patients according to etiologies. As previously demonstrated PEEP influences the right side hemodynamic by increasing the RAP, although resulting in better CLdyn. The extent of the effect of PEEP increased may be dependent on the underlying aetiology of CS. Considering that the sample size is extremely limited, these results advocate a wider validation. However, the positive pressures induced by the ventilation in patient with CS should be taken in consideration when the comprehensive evaluation of hemodynamic to define congestion profile and phenotype are performed.Table 1.Hemodynamic parametersGraph PEEP vs RAP