bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulmonary arterial hemodynamic in patients with or without pulmonary disease admitted after cardiac arrest - a sub study of the BOX trial
Authors: Arentz Taraldsen I , Grand J , Moeller J E , Schmidt H , Kjaergaard J , Hassager C
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation

Background

Patients with pulmonary disease may have altered pulmonary hemodynamic compared to patients without pulmonary disease. We hypothesize that these patients with pre-existing pulmonary disease have significantly elevated pulmonary arterial pressure during the first 48 hours of ICU-stay.

Methods

The BOX-trial was an investigator-initiated, randomized, controlled study of targeted MAP (63 vs 77 mmHg) and PaO2 (9-10 vs 13-14 kPa) interventions in 789 comatose OHCA (of presumed cardiac origin) patients. Pre-existing, significant pulmonary disease was recorded at baseline. Patients underwent serial hemodynamic assessments with pulmonary artery catheter at time of insertion (0 h), 6 h, 12 h, 24 h, 36 h and 48 h. Among parameters recorded was cardiac output (CO). Pulmonary arterial pressures and central venous pressure were measured continuously. Patient characteristics included age, time to return of spontaneous circulation (ROSC) and initial rhythm.

Results

Hemodynamic parameters from 730 patients were analysed, of which 89 (12%) had pulmonary disease. Of these, 57 (8%) had COPD, 26 (4%) had asthma and 6 (1%) had non-obstructive pulmonary disease. Patients with pulmonary disease were older (66±12 vs 62±14 years) and had similar time to ROSC (20±14 vs 23±16 minutes). Initial shockable rhythm was present in 73/89 (82%) with pulmonary disease and in 580/641 (90%) without, p=0.015. At 12 hours, mean pulmonary artery pressure (27±5 vs 24±6 p<0.0001, see Figure 1), systolic pulmonary pressure (36±7 vs 33±8 p=0.0004), and diastolic pulmonary pressure (21±5 vs 18±5 p<0.0001) were all significantly higher for patients with pulmonary disease than patients without. This association remain statistically significant, when adjusting for primary rhythm, time to ROSC and age. Also, heart rate (72±21 vs 66±17 bpm, p<0.0056) was significantly higher in patients with pulmonary disease. Cardiac index (cardiac output adjusted for body surface), central mixed venous saturation and CVP was similar between groups.

Conclusions

Pre-existing pulmonary disease in resuscitated OHCA-patients is associated with significantly elevated pulmonary pressures.
Estimated plasma volume status is an independent predictor for in-hospital mortality in COVID-19 patients with hypoxemic respiratory failure and heart failure
Authors: Candrasatria R , Juzar D , Widyantoro B , Zamroni D , Irmalita I
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Heart failure and hypoxemic respiratory failure were the leading causes for hospital admission and death in COVID-19 patients. Frequently, it is challenging to assess the plasma volume status in limited resource settings especially in times of COVID-19 pandemics. Thus, a practical and simple evaluation of congestion status is of importance to guide early management and risk stratification. Estimated plasma volume status (ePVS) has been associated with mortality in heart failure population. However, no study investigated the association between ePVS and prognosis in COVID-19 patients with hypoxemic respiratory failure and heart failure.

Purpose

To study the association between ePVS and in-hospital mortality in COVID-19 patients with hypoxemic respiratory failure and heart failure. We hypothesized that higher ePVS level which reflected a congested status could worsen the prognosis in severe COVID-19 patients with hypoxemic respiratory failure and heart failure.

Methods

We included severe COVID-19 subjects with hypoxemic respiratory failure and heart failure using our institution COVID-19 registry. Sample size was calculated using comparing two means hypothesis testing accordingly. The calculation of ePVS was performed using simple Duarte Formula; (100-hematocrit)/hemoglobin, which were taken at the time of admission. A logistic regression model was used to demonstrate the association between ePVS levels and in-hospital mortality. ROC curve analysis was used to assess the discrimination of ePVS for predicting in-hospital mortality.

Results

We enrolled 53 eligible subjects with an average age of 61 ± 10.3 years old with predominant male (69.8%). Thirty five patients died in hospital with the prevalence of in-hospital mortality was 66%. The ROC curve indicated that ePVS has acceptable discrimination for predicting in-hospital mortality. The AUC value was found to be 0.665 and ePVS value cut off was 4.5 ml/g with sensitivity of 77.8% and specificity of 65.7%. In the unadjusted model, high-level of ePVS (> 4.5 ml/g) was associated with higher OR (6.7; 95% CI 1.8–24.9; P 0.003) compared with low-level of ePVS (≤ 4.5 ml/g).After adjusted the vital signs data, laboratory and echocardiogram data, and treatment, high-level of ePVS was independently associated with increased OR of in-hospital mortality, 21.6 (95% CI 2.6–177.9; P < 0.004).

Conclusions

This study demonstrated that high ePVS level, calculated with a simple Duarte Formula, was associated with higher in-hospital mortality in COVID-19 patients with hypoxemic respiratory failure and heart failure. Thus, this finding could help physicians for a better risk stratification in managing COVID-19 patients in limited resource settings or in early phase of hospitalization.
BUN/albumin ratio (BAR) has a better prognostic predictor than other laboratory makers in severe COVID-19 patients with heart failure
Authors: Wardhani L F K , Alsagaff M Y , Dewi I P , Oktaviono Y H , Budianto C P , Susilo H , Dharmadjati B B , Subagjo A , Pikir B S , Luthfah N , Nugraha R A , Putra T S , Noor Y A , Mulia E P B , Suwanto D
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Dr. Soetomo General Hospital, Surabaya, Indonesia

Abbott

Background

Heart failure (HF) is a common comorbidity in critically ill COVID-19 patients admitted to the intensive care unit (ICU) and it carries an extremely poor prognosis. COVID-19 has been described as a thrombo-inflammatory syndrome that may be related to myocardial damage. There are shared cardiovascular comorbidities and pathophysiology between HF and COVID-19 severity.

Purpose

The study aimed to investigate the relationship between the laboratory markers and the prognosis of COVID-19 patients with HF admitted to the ICU.

Methods

We performed an observational, single-center prospective cohort study from February 1st – July 31st, 2021. Subjects of this study were recruited according to WHO criteria for severe COVID-19 and ESC criteria for HF who admitted to ICU. Blood samples were taken to measure hs-Troponin, NT-proBNP, Neutrophil to Lymphocyte Ratio (NLR), BUN/albumin ratio (BAR), and D-dimer/fibrinogen ratio (DFR). Subjects were then followed to assess in-hospital mortality and 90-day mortality.

Results

A total of 43 subjects were included in this study. This research showed that severe COVID-19 patients, who have mortality events at any cause, have significantly higher hs-Troponin, NT-proBNP, NLR, BAR, and DFR (P-value 0.022, 0.027, 0.029, <0.001, and 0.032 respectively). Pairwise comparison of receiver operating characteristic (ROC) curves showed that BAR was better at predicting mortality outcome (Area under curve 0.849, 95% CI 0.732-0.966, P-value <0.001). Multiple COX regression analyses found a relationship between BAR and all-cause mortality at 90-day follow-up (HR 1.306, 95% CI 1.004–1.069, P-value= 0.026). Kaplan-Meier also showed similar results as well (P-value 0.001).

Conclusions

Increasing hs-Troponin, NT-proBNP, NLR, BAR, and DFR are associated with increased mortality among severe COVID-19 patients with HF. However, BAR is the best predictor for mortality events in severe COVID-19 patients with HF.
Correlation between heart failure symptoms and parameters of myocardial deformation in patients with cardiac amyloidosis
Authors: Gonzalez Gonzalez A M , Garcia Bellon A M , Claros Ruiz J A , Sanchez Sanchez C , Vivancos Delgado R , Urbano Carrillo C A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction and objectives

Cardiac amyloidosis (CA) causes a restrictive cardiomyopathy, generally associated with symptoms and poor prognosis. Echocardiography plays a fundamental role in its diagnosis, and can also provide important prognostic information. Although left ventricular global longitudinal strain (GLS) has been studied using speckle-tracking echocardiography, and is known to be predictive of outcome, RV and LA involvement evaluated by deformation pattern is not yet well defined.

The aim of this study is to characterize LV, RV and LA involvement in patients with CA, and to evaluate whether parameters of myocardial deformation of these cavities are correlated with functional class and/or number of hospitalizations in this group of patients.

Material and methods

We included 19 patients diagnosed with CA between 2021 and 2022. Demographic, clinical data and echocardiographic parameters were collected, including diastolic function parameters and study of myocardial deformation, using the speckle tracking technique of left ventricle, right ventricle, and left atrium. Statistical analysis was performed to evaluate the association between symptoms and imaging parameters.

Results

The mean age was 66 y.o. 77% male. The percentage of Cardiovascular risk factors was HTN 77%, DM 23%, dyslipidemia 23%. CAD 15%. Hospital admission in last year 23%. NYHA functional class II 23%. All echocardiographyc parameters and and significant correlations are showed in table 1. Regarding basic echocardiographic parameters, mean LV and RV systolic function was in normal range: LVEF 64%; RV TAPSE 21mm; mean Tricuspid annular peak systolic velocity 11,6cm/seg; RV fractional area change 40%. Concerning deformation parameters RV and LA parameters were decreased, RV free wall longitudinal strain -26,8%; RV four-chamber longitudinal strain -21,7%; LA reservoir strain 26,6%; LA conduit strain -15,1%; LA contractile strain -11%, although not significantly associated with a worse NYHA functional class or a higher number of hospital admissions, possibly due to a low sample size. In addition, a larger LA area and volume, shorter deceleration time and worse GLS correlated statistically significantly with a worse NYHA functional class, while a larger LA diameter and mean E/e' correlated with a higher number of admissions.

Conclusions

Echocardiography is a non-invasive, fast and simple diagnostic tool. Strain data from different cardiac chambers would allow early detection, or at least suspicion, of this entity. In addition, strain data of left atrium and right ventricle would allow to predict evolution and to be an important prognostic factor. Atrial and ventricular strain have promise for clinical utility.
Dysrhythmic profile of drugs with a positive inotropic effect in patients with acute coronary syndrome
Authors: Carias M , Almeida A , Paralta M , Claudio F , Rocha R , Bento A , Trinca M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients with acute coronary syndrome (ACS) may develop ventricular dysfunction and need to use drugs with a positive inotropic effect during the acute phase. Despite the hemodynamic benefit of the use of these drugs, positive inotropic drugs may have several side effects. Among these, ventricular arrhythmias and atrial fibrillation. Levosimendan is a drug that increases the sensitivity of the myocardium to calcium, producing a positive inotropic effect.

Purpose

This study aims to assess the frequency of occurrence of dysrhythmic complications with the use of positive inotropic drugs in patients hospitalized for ACS.

Methods

We performed a 6-year retrospective, observational, multicenter study. We included patients with ACS who used positive or not inotropic drugs during hospitalization, dividing the sample into two groups respectively (Group 1 and Group 2).

Between the two groups we compared the occurrence of ventricular tachycardia and atrial fibrillation. In addition, we performed an analysis for the use of levosimendan.

Results

We analyzed a sample of 5860 patients. Of these, 70.3% were male. In Group 1 we included 377 patients and in Group 2 5329 patients. The occurrence of ventricular tachycardia in Group 1 was higher than in Group 2 (15.5% vs 1.6%; p<0.001; OR: 11.472; 95% CI [8.212;16.027]). The rate of occurrence of atrial fibrillation in Group 1 was higher than in Group 2 (19.3% vs 5.1%; p<0.001; OR:4.413; 95% CI [3.388;5.749]). Regarding the use of levosimendan, 50 patients were analyzed. Ventricular tachycardia was more frequent with the use of this drug than without it (18.0% vs 2.5%; p<0.001; OR: 8.576 95% CI [4.092;17.976]). Atrial fibrillation was more frequent with levosimendan use than with no use (34.0% vs 6.0%; p>0.001; OR: 8.137; 95% CI [4.487;14.754]).

Conclusion

Arrhythmic complications were much more frequent in the group that used positive inotropic drugs, namely ventricular tachycardia and atrial fibrillation. Levosimendan stands out, related to the increase in the occurrence of atrial fibrillation and the remaining inotropes with an increased risk of ventricular tachycardia. These arrhythmic complications pose a challenge in the management of these patients.
Admission heart failure and coronary perfusion in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention
Authors: Elkammash A , Abdelhamid M , Sobhy M , Zaki A , Sadaka M , Omoniyi O , Alsinan M , Farahat R , Al Sattouf A , Abbas A , Madi K
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Studies demonstrated a link between the presence of HF on the admission of ACS patients and increased in-hospital morbidity and mortality. However, the literature did not establish the connection between the admission HF and the angiographic burden and the coronary vessel perfusion post-PPCI.

Purpose

To establish the correlation between acute HF on admission of STEMI patients, the coronary thrombus burden and the final coronary perfusion post PPCI.

Methods

We retrospectively studied 210 STEMI patients who presented to a single PPCI centre. We excluded post-fibrinolysis patients, patients with old stents and those who presented more than 24 hours after the onset of pain. We divided the studied cohort into two subgroups based on the presence of HF on presentation to the emergency department. We obtained Informed consent from all patients, and all procedures were done in compliance with the Helsinki declaration for research on human beings. Two blinded interventional cardiology consultants assessed the thrombus burden and coronary flow using TIMI grades of both variables.

Results

20 patients (10%) of the studied group had HF on admission. There was no significant difference between the two subgroups regarding other cardiovascular risk factors (figure 1). The coronary thrombus burden did not differ significantly between the HF and no HF subgroups (50% vs 43.16%, respectively, p=0.557). However, the incidence of impaired coronary flow post-PPCI was significantly higher in the HF group (25% vs 8.4%, p=0.019) (figure 2). Multivariate logistic regression analysis showed that admission HF is an independent predictor of impaired perfusion post-PPCI ( OR= 5.49, 95% CI=1.54-19.49, p=0.01). Our study demonstrates the association between admission HF in STEMI patients undergoing PPCI and increased incidence of impaired coronary flow after PPCI. This finding was independent of the heavy coronary thrombus burden on angiography. Animal studies have demonstrated impaired coronary flow even in HF secondary to non-ischaemic causes.1,2 Possible mechanisms include impaired nitric oxide-mediated endothelium-dependent vasodilatation and enhanced vasoconstriction to mediators of neurohumoral activation.3 These mechanisms can explain our study's impaired coronary flow in HF patients.

Conclusion

Admission HF is an independent predictor of reduced coronary blood flow after PPCI. Timely treatment of STEMI patients can prevent HF development and improve their prognosis.
The impact of kidney function on the slow-flow/no-reflow phenomenon in patients treated with primary percutaneous coronary intervention: registry analysis
Authors: Savic L , Mrdovic I , Asanin M , Lasica R , Krljanac G , Rajic D , Kastel B , Simic D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Objective

To analyze the impact of declining kidney function on the occurrence of the slow-flow/no-reflow phenomenon, in patients with ST elevation myocardial infarction (STEM) who had been treated with primary PCI (pPCI), and to analyze the prognostic impact of the slow-flow/no-reflow phenomenon on short- and long-term mortality in these patients.

Methods

We analyzed 3,115 consecutive patients. A value of estimation of the glomerular filtration rate (eGFR) at admission eGFR<90ml/min/m2 was considered to be a reduced baseline eGFR. The follow-up period was 8 years.

Results

The slow-flow/no-reflow phenomenon through the IRA was registered in 146 (4.7%) patients. Stimated GFR<90ml/min/m2 was an independent predictor for the occurrence of slow-flow/no-reflow phenomenon (OR2.91, 95%CI 1.25-3.95, p<0.001), and the risk for the occurrence of the slow-flow/no-reflow phenomenon increased with the decline of the kidney function: eGFR 60-89 ml/min/m2: OR1.94 (95%C 1.22-3.07, p=0.005), eGFR 45-59ml/min/m2: OR 2.55(95%CI 1.55-4.94, p<0.001), eGFR 30-44 ml/min/m2; OR 2.77(95%CI 1.43-5.25, p<0.001), eGFR 15-29 ml/min/m2: OR 5.84 (95%CI 2.84-8.01, p<0.001). In-hospital, 30-day, 1-year, and 8-year mortality were significantly higher in patients with the slow-flow/no-reflow phenomenon, as compared to patients with TIMI flow grade 3 – in-hospital mortality of 30.1% vs 2.9%, respectively, p<0.001; 30-day mortality: 31.5% vs 3.2%, respectively, p<0.001; 8-year mortality: 38.1% vs 6.9%, respectively, p<0.001 (Figure 1). The slow-flow/no-reflow phenomenon was a strong independent predictor of short-and long-term all-cause mortality: 30-day mortality (HR 2.62, 95%CI 1.78-3.57, p<0.001), 8-year mortality (HR 2.09, 95%CI 1.49-2.09, p<0.001).

Conclusion

Reduced baseline kidney function was an independent predictor for the occurrence of the slow-flow/no-reflow phenomenon, and its prognostic impact started with the mildest decrease of eGFR (below 90ml/min/m2), and increased with its further decline. The slow-flow/no-reflow phenomenon was a strong independent predictor for mortality in the short- and long-term follow-up of the analyzed patients.
Adding value of the Charlson comorbidity index to the Grace score for mortality risk prediction in patients with acute coronary syndrome
Authors: Campanile A , Prota C , Tedeschi M , Giano A , Pianese B , Cristiano M , Pompa A , Sorrentino R , Vigorito F , Ravera A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assessment in patients with acute coronary syndrome (ACS). The Charlson Comorbidity Index (CCI) is a recognized measure of comorbid burden, and a useful tool for estimating prognosis in patients with multiple coexisting illnesses. Despite it has been validated in the context of ACS-related mortality, scarce and conflicting data still exist about the role of the CCI when added to the traditional GRACE risk score for outcome prediction in patients with acute coronary syndrome (ACS).

Purpose

The assessment of the potential predictive value of the CCI both for short, and long term all-cause mortality, in a contemporary ACS population, and its potential adding value beyond the GRACE risk score.

Methods

All consecutive admission due to ST-elevation myocardial infarction-STEMI, non ST elevated myocardial infarction-NSTEMI, and unstable angina-UA, from 01/01/2018 to 31/12/2020 were retrospectively reviewed from an internal database of a tertiary cardiac center in Italy. Logistic and Cox proportional regression analysis were performed in order to assess the contribution of the CCI on short and long term mortality. In order to specify the CCI adding value to the GRACE score, several measures of improvement in discrimination (increase in the area under the receiver-operating characteristic curve-AUC, the integrated discrimination improvement-IDI, and the continuous net reclassification improvement-cNRI>0) , were implemented. Robustness of the results were assessed through an internal validation procedure with bootstrapping.

Results

A total of 1310 patients (646 STEMI, 588 NSTEMI, and 76 UA) were identified. Almost 28% were female, and the median age was 68 (58-78). 97 (7,4%) and 136 (11,2%) deaths occurred, respectively, in hospital and during long term follow-up (median follow-up time: 12 months; IQR: 8-23). After multivariate logistic regression analysis the CCI was not associated with in-hospital death, while it was significantly and independently associated with the long-term mortality along with GRACE score (HR: 1,33, 95% CI: 1,22-1,43; p<0,001, Fig.1). An additive effect of CCI with the GRACE risk score was observed in predicting long-term mortality with an AUC from 0,762 to 0.821 (p < 0,001). The incremental predictive value of combining CCI and the GRACE risk score for the long term mortality was significantly improved, as shown by the net reclassification improvement (cNRI>0: 0.678, p < 0.001, Table 1) and integrated discrimination improvement (IDI: 0.08, p < 0.001).

Conclusion

The CCI is a predictor of long-term mortality and improves risk stratification of patients with ACS over the GRACE risk score.
Gender differences in prognosis and treatment in acute coronary syndrome at the coronary care unit
Authors: Pelaz Sanchez M , Olivares Martinez B , Lorenzo Lopez B , Cortes Cortes F J , Hidalgo Urbano R J , Garcia Rubira J C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Women who suffer Acute Coronary Syndrome (ACS) have worse prognosis, with higher mortality and more complications. These results might be partially influenced by an older age and a higher number of comorbidities in women.

Purpose

The aim of the study is to analyse gender differences among patients with ACS admitted to our Coronary Care Unit (CCU).

Methods

Retrospective cohort of all patients with ACS admitted to a CCU between July 2011 and August 2022. Univariate analyses to assess gender influence in intrahospital mortality and complications were carried out. We also performed a multivariate analysis to identify predictive factors of intrahospital mortality.

Results

3161 patients were included, with a mean age of 63 years old. Women accounted for 26.4% of patients. Women were older than men (68.9 vs. 61.71 years old), had a higher prevalence of hypertension (72.52% vs. 55.92%), diabetes mellitus (37.5% vs. 32.31%), heart failure and chronic kidney disease. On the other hand, smoking and chronic obstructive pulmonary disease were more frequent in men.

In-hospital mortality was higher in women (OR 2.18, IC95% 1.63-2.92; p<0.001). In respect of complications, women showed a higher rate of bleeding (OR 1.35, IC95% 1.05-1.73; p<0.017) and cardiogenic shock (OR 1.43, IC95% 1.1-1.84; p<0.006). There were no significant gender-differences regarding ischemic complications (reinfarction, stent thrombosis, ischemic stroke…), atrial fibrillation or ventricular arrhythmias during hospital admission.

Treatment differences were observed in the study. Prasugrel, statins, beta-blockers and IECAS were less prescribed in women, while clopidogrel was prescribed more frequently for them. Ticagrelor was prescribed less for women at hospital discharge but no gender differences in in-hospital prescription were identified.

Multivariate analysis adjusting for age, comorbidities and complications demonstrated that diabetes mellitus, age, previous chronic kidney disease, severe bleeding and Killip-Kimball category were predictors of mortality. Female sex however did not reach significance in multivariate analysis (OR 1.28, IC95% 0.89-1.84; p=0.169).

Conclusion

In our sample, women had higher intrahospital mortality and bleeding rates, although mortality differences disappeared after adjusting by age, complications and comorbidities. Pharmacological treatment was lower and less intensive in them. It is crucial to know these differences in order to guarantee a more equitable medical assistance.
Prevalence, clinical characteristics and factors predicting major cardiovascular events in patients with coronary artery ectasia
Authors: Robles-Ledesma M , Favela-Garcia K , Najera-Rojas N A , De Los Rios-Arce L F , Alonso-Bringas A P , Gopar-Nieto R , Gonzalez-Pacheco H , Sierra-Lara Martinez D , Briseno-De La Cruz J L , Berrios-Barcenas E A , Arias-Sanchez E A , Arias-Mendoza A , Araiza-Garaygordobil D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Coronary artery ectasia (CAE) is an uncommon angiographic finding associated with the occurrence of severe cardiovascular outcomes during the long term. However, the factors that predict major adverse cardiovascular events after the diagnosis of CAE are not well understood.

Purpose

To define the prevalence, clinical characteristics and factors predicting major cardiovascular events in a large series of patients with coronary artery ectasia.

Methods

Retrospective, observational, cohort study of patients who underwent coronary angiography between April 2018 and April 2021 at a national cardiovascular center in Latin America. CAE was defined as segmental dilation of a coronary artery with caliber discrepancy 1.5 greater compared to an adjacent segment. Baseline clinical variables were assessed during index hospital stay. The primary outcome of the study was the composite of cardiovascular death, acute myocardial infarction and angina.

Results

Among 4,435 patients undergoing coronary angiography during the study period, 298 (6.73%) were diagnosed with CAE and constituted the final analytic sample. The main reason for performing coronary angiography was ACS (78%). Patients were mostly male (87.1%), and the prevalence of cardiovascular risk factors was high. During a median follow up of 17 months (1-151), 31 (12.0%) patients developed at least one component of the primary endpoint (Figure 1.) Bivariate analysis identified chronic kidney disease (CKD) (p=0.006) and initial presentation in the form of ACS (p<0.001) as predictors of MACE during follow up.

Conclusions

In our study, we found a high prevalence of CAE. Cardiovascular risk factors during baseline evaluation were frequent; CKD and initial presentation in the form of ACS were identified as predictors for the occurrence of long term events.
Outcome with early invasive versus conservative approach in patients over 75 years of age with non-ST-segment elevation myocardial infarction
Authors: Gjana A , Pavli E , Kristo A , Zebi A , Duka A , Sharka I , Seiti J , Kresto L , Xhafaj M , Hasimi E , Voci A , Pane E , Zaimi G , Kastrati A , Dibra A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Non-ST elevation myocardial infarction (NSTEMI) is a common cause of hospitalization for patients aged 75 years or older. The current guidelines recommend an early invasive approach for patients with NSTEMI who are at moderate to high risk, but have no specific consideration for the elderly. Data from clinical trials for this group of patients are lacking. We present short term outcomes of patients aged 75 years or older diagnosed with NSTEMI treated with an early invasive strategy versus conservative strategy.

Purpose

To evaluate short term outcome in NSTEMI patients >75 years of age who were treated with early invasive strategy versus conservative strategy.

Methods

We reviewed data from 201 patients > 75 years of age who presented with NSTEMI from August 2021 to February 2022. 96 (47%) patients underwent early invasive treatment and 105 (53%) were treated conservatively. The decision for the conservative treatment was based on the decision of the attending cardiologist and the preference of the patient. Primary endpoint was mortality at 3-month follow-up. Secondary endpoints were recurrent myocardial infarction, re-intervention and length of hospital stay.

Results

The mean age was 80.74 ± 3.7 years, ranging from 75 to 92 years old. Patients in the conservative group were more frequently affected from hypertension, heart failure, stroke and acute renal failure. Other basal characteristics were not statistically significant different between two groups. In-hospital mortality in the conservative group was higher than the invasive group (1.04% vs. 2.8%, p=0.037). 30-day survival was higher in the invasive group compared to the conservative group (94.8% vs. 82.4%, p=0.007) and 90-day survival was also higher in the invasive group compared to the conservative group (91.9% vs. 71%, p=0.001).There were no statistically significant differences with regard to secondary endpoints. In the multivariate analysis, ejection fraction <40% and hemoglobin level <10 mg/dL were inversely related to survival while an early invasive strategy was associated with improved survival at 3 months.

Conclusion

Among NSTEMI patients older than 75 years, an early invasive treatment is associated with a lower in-hospital mortality and better 3-month survival.
Inotropic support after Acute Coronary Syndrome. Levosimendan or dobutamine? Experience in our center
Authors: Paez Munoz R , Cortes Cortes F J , Garcia Gonzalez N , Rivadeneira Ruiz M , Garcia Rubira J C , Lorenzo Lopez B
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Inotropic support after Acute Coronary Syndrome (ACS) is commonly used in Cardiac Critical Care Units (CCU). In this context, dobutamine is widely used, given the large experience with this drug, however recently levosimendan has emerged as a safe and effective alternative.

Objective

Our objective is to analyze the clinical and prognostic differences between patients treated with dobutamine or levosimendan. We wanted to detect the pattern of use of these drugs and determine the best therapeutic option in our patients.

Methods

Retrospective observational study of patients admitted for ACS at our CCU between August 2011 and September 2022. Patients treated with dobutamine or levosimendan were included, excluding those who required both drugs. We compared baseline characteristics and clinical events in both therapy groups.

Results

Our sample included 184 patients admitted for ACS who needed inotropic support during the admission period, with either dobutamine or levosimendan. In our cohort, the mean age was 67.95 +/- 12.04 years. 126 (68.48%) patients received dobutamine and 58 (31.52%) levosimendan. Regarding baseline characteristics of our population, we only found statistically significant differences in Diabetes Mellitus as a Risk Factor (p=0.0172) and Congestive Heart Failure (p=0.0128). We tended to use dobutamine over levosimendan as an inotropic agent in shocked patients (p=0.036). No significant differences were found in other data collected in the clinical history, including noradrenaline or intra aortic balloon pump use, arrhythmic events or in-hospital mortality. Multivariate analysis adjusted for clinical and epidemiological factors detected cardiogenic shock as the only independient predictor of in-hospital mortality.

Conclusions

In our experience, comparing with levosimendan, dobutamine was the preferred inotropic support in shocked patients. We detected no differences in terms of complications and prognosis between both drugs use.
It is not too late for ... percutaneous angiography in a 90-plus population
Authors: Costa C , Amador A , Calvao J , Pinto R , Proenca T , Carvalho M , Cabrita A , Marques C , Oliveira C , Santos L , Silva M , Silva J , Macedo F
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Elderly people represent a vulnerable but increasing population presenting to percutaneous coronary intervention (PCI). The benefit of revascularization in acute coronary syndromes (ACS) is well-stablished. However, the benefit in elderly patients has been questioned, considering the patient’s expected survival, functional and cognitive status, comorbidities, procedure’s risk and need for extended anti-thrombotic therapy.

Purpose

To evaluate the effect of PCI on the prognosis of a group of very old patients with acute coronary syndrome (ACS).

Methods

We retrospectively analyzed all consecutive very old patients (≥90-year-old) admitted with ACS submitted to coronarography (CA) in one tertiary center, from January 2008 to December 2021. Clinical features were collected, including major adverse cardiac events (MACE), a defined composite endpoint of all-cause death, ischemic stroke, ACS, or hospitalization for acute heart failure, which were compared according if PCI was performed or not. Q-square, Cox regression and Log-rank tests were applied.

Results

A total of 79 patients were enrolled; 43 of them underwent PCI. Groups were comparable in basal characteristics, with similar median age at the event (92 years old, interquartile range IQR: 3), see picture 1.

Most patients with ST-elevation (STE) ACS (n=45) had PCI (70% vs. 41%, p= 0,01), while in non ST-elevation (NSTE) ACS and unstable angina there was higher proportion of non-PCI (30% vs. 58%, p= 0,01). Individuals submitted to PCI were more likely to have single or double lesion vessel (76% vs 27%, p<001), while non-PCI patients presented more complex disease (23% vs 25%, p=0,5). Among the PCI-patients, the majority was singly revascularized (86%) and submitted to stent implantation (83%). Regarding in-hospital mortality, there was no difference between groups: 21% in the PCI group versus 33% in the non-PCI control group (p=0.2).

During median follow-up time of 6 months (IQR: 27), mortality was similar in both groups (79% vs 67%; p=0.1). Nevertheless, overall MACE-free survival was significantly longer in PCI group than in the no-PCI group, and PCI treated patients had a risk of MACE 52% lower than the patients assigned to medical therapy (hazard ratio 0.508, p=0.007); see picture 2.

Conclusion

Very old patients presenting with ACS treated with either PCI presented longer MACE-free survival. These finding suggest that very old patients with ACS and single vessel disease may benefit systematically from PCI with stent. Efforts should be made to optimize care in this under-represented population in the clinical trials.
30 day outcome after early discharge in low risk ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention
Authors: Gjana A , Pavli E , Kristo A , Vasili E , Duka A , Shuka N , Voci A , Pane E , Zaimi G , Kastrati A , Dibra A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Current guidelines for management of patients with ST-segment elevation myocardial infarction (STEMI) encourage an early discharge (48-72 h) after a successful primary percutaneous coronary intervention (PCI) in selected low risk patients. Yet, this strategy is not routinely applied. The evidence on the relative outcome of patients discharged early compared to those discharged later, has been limited.

Purpose

To assess safety of early discharge in low risk STEMI patients treated with primary PCI by analyzing 30 days outcomes relative to early and late discharge strategies.

Methods

We prospectively enrolled 109 patients presented with STEMI from April 2019 to September 2019, who were categorized as low risk according to Zwolle risk score. 60 (55%) patients were discharged after 48-72 hours and 49 (45%) after > 72 hours. We gathered clinical data at 30 days. Primary endpoints were occurrence of a major adverse event - a composite of death from any cause, nonfatal myocardial infarction and acute stent thrombosis. Secondary endpoints were acute angina and re-hospitalization.

Results

The mean age was 59.7 +/- 10.5 years in early discharge group compared to 62.8 +/- 10.5 years in late discharge group (p=0.132). 88 (80.7%) patients were male. 58 (53.2%) of them had inferior MI. Mean ejection fraction was 49.25% +/- 4.95%. Median symptom to balloon time was 9.3 +/- 6.7 hour. Median length of stay was 3.4 days +/-0.6. Primary endpoint occurred in one patient in the early discharge group, who had acute stent thrombosis and nonfatal myocardial infarction. No death from any cause was observed in both groups. Secondary endpoint occurred in 3 patients who had acute angina, 2 in late discharge group and 1 in early discharge group.

Conclusion(s)

Data from our study reveal that an early discharge strategy in selected low risk STEMI patients treated with successful primary PCI is not associated with a significant increase in major adverse events compared to late discharge strategy.
Association between new-onset right bundle branch block and primary or secondary ventricular fibrillation in ST-segment elevation myocardial infarction
Authors: Galcera-Jornet E , Consuegra-Sanchez L , Galcera-Tomas J , Melgarejo-Moreno A , Gimeno-Blanes J R , Jaulent-Huertas L , Wasniewski S , Degea-Garcia J , Vicente-Gilabert M , Padilla-Serrano A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

New-onset right bundle branch block (RBBB) in myocardial infarction (MI) is often associated with ventricular fibrillation (VF) but the nature of this relationship has not been determined.

Aims

To investigate the association between new-onset RBBB and VF in ST-segment elevation MI (STEMI) as well as its peculiarities attending to the permanent or transient character of RBBB and the distinction of VF as primary or secondary.

Methods and results

Between 1998 and 2014, among other data, incidence and duration of RBBB and VF occurrence were prospectively collected in 5301 patients with ST-segment elevation MI (STEMI) admitted to two Coronary Care Units. Multinomial adjusted logistic regression analyses were used to examine the association between RBBB, attending to its duration, and VF according to its primary VF (PVF) (<24h from symptom-onset and Killip I) or secondary VF (SVF) (>24h from symptom-onset and/or Killip>I) character. Among 284 (5.4%) patients with new-onset RBBB, 158 were transient and 126 permanent. VF occurred in 339 (6.4%) patients, 201 PVF and 138 SVF, documented within the first 2 h of symptoms-onset in 78% and 60%, respectively. Newonset RBBB was more frequent in PVF (11.4%) and SVF (20.3%), than in non-VF (4.7%). Transient RBBB incidence was higher in PVF (9.0%) and SVF (9.4) than in non-VF (2.6%), whereas permanent RBBB was higher in SVF (10.9%) than PVF (2.5%) and non-VF (2.1%). New-onset RBBB 1.83 [95% confidence interval (CI): 1.07–3.11] and new-onset transient RBBB 2.39 (95% CI: 1.32–4.32) were independently associated with PVF. New-onset 3.03 (95% CI: 1.83–5.02), transient 2.40 (95% CI: 1.27–4.55), and permanent 2.99 (95% CI: 1.52–5.86) RBBB were independently associated with SVF.

Conclusion

New-onset RBBB and VF in STEMI are independently associated and show particularities based on the duration of the conduction disturbance and/or the primary or secondary character of the arrhythmia.
Prognostic value of brain natriuretic peptide in ST-elevation myocardial infarction
Authors: Paula S , Figueiredo M , Santos M , Santos H , Almeida S , Almeida L
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Prognostic value of brain natriuretic peptide (BNP) in STEMI is not yet fully stablished despite many studies demonstrating its potential in providing additional information.

Purpose

Evaluation of prognostic impact of BNP in coronary anatomy complexity and outcomes in the context of STEMI.

Methods

Retrospective analysis of patients admitted with STEMI in a multicentric registry between 2010-19. Patients were divided into 3 groups regarding BNP: <100pg/ml in Group 1 (39%P); 100≤ BNP <400pg/ml in Group 2 (39.5%); and BNP ≥400pg/ml in Group 3 (21.5%). Demographic and clinical characteristics were compared and outcomes evaluated. A Cox multivariate regression was performed to evaluate predictor factors of stablished endpoints. Survival was evaluated through Kaplan-Meier curve.

Results

1650 patients were reviewed. Group 1 was younger (58±11 vs 66±13 vs 72±12 years, p<0.001). Mostly male (75.4%, p<0.001). Patients with heart failure (HF) and chronic kidney disease (CKD) presented higher BNP: the prevalence of HF and CKD was 0.5 and 1.3% in Group 1; 1.8 and 2.5% in Group 2; 5.9 and 7.8% in Group 3 (p<0.001). Mean BNP at admission was 43±26 in Group 1; 208±81 in Group 2; 1105±1073pg/ml in Group 3 (p<0.001). Group 3 presented lower mean left ventricle ejection fraction (LVEF): 58±11 vs 53±12 vs 44±13% (p<0.001). All patients were submitted to coronary angiography: the anterior descendent was the artery most frequently involved (57.4 vs 66.9 vs 80.3%, p<0.001). The involvement of >1 coronary artery was more frequent in Group 3 (34.4 vs 44.5 vs 51.3%, p<0.001). Acute HF (6.5 vs 16.7 vs 45.4%, p<0.001); cardiogenic shock (3.3 vs 5.1 vs 16.9%, p<0.001), atrial fibrillation (3.0 vs 6.4 vs 16.9%, p<0.001), stroke (0.5 vs 0.6 vs 2%, p 0.032), sustained ventricular tachycardia (1.6 vs 3.7 vs 6.8, p<0.001) and mortality (1.2 vs 2.6 vs 8.5%, p 0.017) were more prevalent in Group 3. Kaplan-Meier curve confirmed that higher BNP was associated with higher rates of 1-year mortality (p<0.001) and cardiovascular and all-cause rehospitalization (p 0.005 and 0.002). Presence of peripheral arterial disease or cancer, Killip Kimball class >I, LVEF <50% and occurrence of mechanical complications were predictor factors.

Conclusions

In context of STEMI, higher BNP levels were associated with more complex coronary anatomy and higher in-hospital and 1-year morbimortality.
Women take longuer to seek help when suffering a STEMI
Authors: Lopez Sobrino T , Guilleumes M , Castrillo- Golvano L , Ayala Borges B , Salazar-Rodriguez A , Moreno Monterde E , Arenas A , Anduaga Elorza I , Martinez Guisado A , Roca Guerrero C , De Diego O , Andrea R , Ortiz Perez J T
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Historically, the prognosis of those women suffering a STelevation myocardial infarction (STEMI), has been worse compared to men. Some causal factors are presentation at later ages, atypical symptoms, lower perception of risk and less sensitivity of the health care providers.

Purpose

Our hypothesis is that there are still differences in the presentation of STEMI based on gender, which could be identified to guide new public campaigns in this perspective. Therefore our primary outcome is to find gender differences in symptoms and time delays in a cohort of STEMI patients, and secondary outcomes are differences in mortality and bleeding.

Methods

We conducted a retrospective analysis carried out in the Acute Cardiac Care Unit (ACCU) of a tertiary care hospital, where 50% of the medical staff are women. Patients hospitalized for STEMI for one year were included and a detailed caracterization of symptoms, time delays, and adverse events was recorded. Finally, the patients were classified according to gender, and differences in primary and secondary outcomes between both groups were analyzed.

Results

Between May/2020 and May/2021, 1056 patients were admitted to the ACCU, 33% were women. A total of 115 STEMI patients were included for the analysis, 21% were women. Basal characteristics of both groups were equivalent, except for a non significand trens towards less prevalence of peripheral arterial disease in women (0% vs. 11%; OR 0.890, IC 95% 0.828-0.957; p=0.089). Opressive chest pain was the most frequent symptom, but it was less frequent in women (75% vs. 91.4%, OR 0.284, IC 95% 0.085-0.948; p=0.033), whereas they presented more frequently with stabbing pain (13% vs. 2.4%, OR 6, IC 95% 1.073-38.35; p=0.035), and their pain was more frequently radiated towards the neck (28.6% vs. 4.9%, OR 7.7, IC 95% 1.1936-30.631; p=0.001), and associated to nausea/vomiting (45% vs. 1.3%, OR 5.809, IC 95% 1.930-17.486; p=0.001). There was a non-significant trend towards a longer time delay between pain onset and seek for help in women (185min IQR 747 vs. 60min IQR 454, p=0.098), being the other system time delays equivalent between both gender groups. Women had an increased bleeding risk, with a higher CRUSADE score (47.48 ± 22.92 vs. 28.60 ± 16.72, p=0.001) and higher incidence of bleeding events (12.55% vs. 0%, OR 11.68, IC 95% 9.82-13.29, p=0.001). There were no differences in the treatments administered or in mortality (12.5% vs. 14.3%, p=0.822).

Conclusions

Women suffering a STEMI more often reported stabbing chest pain, radiating to the neck, and associated to nausea/vomiting compared with men, and took longer to seek for help. These findings could help in the design of future campaigns to minimize time delays, targeting these different symptoms in female population.
A novel echo-score for the prediction of cardiovascular outcomes in patients with STEMI
Authors: De Los Rios Arce L , Juarez Najarro S A , Najera Rojas A N , Robles Leedesma M , Alonso Bringas A P , Sanchez Leony G , Gopar Nieto R , Sierra Lara Martinez J D , Briseno De La Cruz J L , Gonzalez Pacheco H , Araiza Garaygordobil D , Arias Mendoza A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Echocardiography is a tool extensively studied for predicting adverse outcomes in heart failure and after MI. However, most studies are focused on predicting long-term events, and tools to predict in-hospital outcomes are needed.

Objectives

to identify echocardiographic parameters associated with the occurrence of in-hospital major adverse cardiovascular events and to develop an echocardiographic score to predict outcomes in patients with STEMI.

Methods

Single-center, observational, descriptive, longitudinal study, including consecutive STEMI patients undergoing reperfusion therapy within 12 hours since symptom onset. An echocardiogram was performed early (<48h) during hospitalization. An echocardiographic score (Echo Score) including LVEF (0 = LVEF <45%, 1 = LVEF between 44% and 35%, 2 <35% ), left ventricular wall motion score index (LVWMSi) (1 = LVWMSi>1.5, 0 = LVWMSi≤1.5) E/e’ ratio (1 = E/e’> 15, 0 = E/e’≤ 15)and RV fractional shortening (RVFS) (1 = RVFS <30%, 0 = RVFS ≥ 30%) was derived. The study's primary objective was to evaluate the primary endpoint (a composite of cardiovascular death, congestive heart failure, cardiogenic shock, and recurrent MI) and its relation with echo score during 30 days follow-up.

Results

A total of 270 consecutive patients participate in this study. The mean echo score was 2 (1-3). Patients with a mean echo score > 2 exhibited an increased risk for the primary endpoint during 30-day follow-up (HR 2.18. 95%CI 0.99-4.86, p= 0.06). Individual components of the primary endpoint exhibited an increased risk of mainly heart failure 5.9 vs. 14.1% (p=0.03). AUC-ROC was analyzed for echo score, and GRACE / TIMI scores on admission; no significant differences were found between these scores (Echo score: 0.65, GRACE 0.66 & TIMI 0.68, p = 0.06).

Conclusion

in patients with STEMI receiving reperfusion, an echocardiographic score including LVEF, LVWMSi, E/e´ratio, and RVFS performed similarly to GRACE and TIMI scores in the prediction of major cardiovascular events in the short term.