bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical utility of the SCAI classification in cardiogenic shock patients of any etiology treated by a multidisciplinary team
Authors: Lozano Jimenez S , Hernandez Perez FJ , Escudier Villa JM , Iranzo R , Oteo Dominguez JF , Torres Ramos M , Mitroi C , Rivas Lasarte M , Vieitez JM , Gomez Bueno M , Forteza A , Segovia Cubero J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The recently proposed classification of the Society of Cardiovascular Angiography and Interventions (SCAI) stratifies cardiogenic shock (CS) in 5 stages from least to greatest severity (1,2). The aim of this project is to apply the SCAI classification to a cohort of patients in CS and analyze the results among the different stages.

Methods

Retrospective study of CS patients attended by our multidisciplinary team between September 2014-December 2020. The patients were assigned to one of the 5 stages by two independent cardiologists. SCAI subgroups were interpreted considering the recent consensus statement; based on clinical, laboratory, and hemodynamic parameters. In-hospital mortality was the main outcome analyzed.

Results

163 patients were included. Mean age was 55 years (44-62), 76% were male. 9 patients (6%) were assigned to SCAI class C, 55 (34%) D and 99 (61%) in E. There was an almost perfect concordance between the two independent cardiologists when performing the classification (kappa =0.93, p <0.001).

In-hospital mortality was 11%, 31%, and 59% in stages C, D, and E respectively (p <0.001) Figure 1. The SCAI classification had an area under the ROC curve of 0.65 to predict hospital mortality. In the multivariate analysis, SCAI stage E and initial lactate levels were independent predictors of in-hospital mortality.

Conclusion

The SCAI classification is easy to apply in clinical practice and provides a firm prediction of the prognosis of patients in CS. Each SCAI class was significantly associated with the primary endpoint. Its widespread use would allow the optimization of communication between professionals, as well as serve as the basis for the design of future research projects.
Long-term prognostic impact of new-onset atrial fibrillation in patients with preserved and mildly reduced ejection fraction following myocardial infarction
Authors: Savic L , Mrdovic I , Asanin M , Krljanac G , Lasica R , Rajic D , Kastel B
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/aim

It is well known that atrial fibrillation (AF) significantly increases risk of short- and long-term mortality in patients with ST-elevation myocardial infarction (STEMI), especially in those with reduced left ventricular ejection fraction (EF), but its prognostic impact in patients with STEMI and preserved or mildly reduced EF is not well defined. The aim of this study was to analyse the prognostic impact of new-onset AF on long-term mortality in patients with preserved and mildly reduced EF after STEMI.

Method

we included 1874 consecutive STEMI patients treated with primary percutaneous coronary intervention (pPCI). New-onset AF was defined as electrocardiographic or monitoring evidence of a AF lasting at least 30 seconds in patients with no medical history of previous AF. Echocardiographic examination was performed before discharge, EF was calculated using bi-plane method. Preserved EF was defined as ≥50% and midly reduced EF was defined as EF 41-49%. Patients with cardiogenic shock at admission and patients with previous AF of any form (paroxysmal, persistent or permanent) were excluded. The follow-up period was 6 years.

Results

Among all analysed patients 491 (26.6%) patients were women and 1375 (73.4%) were men. The median age of all analysed patients was 58 (IQR 46, 69) years and median EF was 52% (IQR 45%, 57%). New-onset AF was registered in 78 (4.2%) patients. Among them 27 (34.6%) patients had AF at admission and 51 (65.4%) patients develop AF later at a median time 4 (IQR 1, 25) hours. Median duration of AF was 17 (IQR 6, 25) hours. All of the analyzed patients with new-onset AF were converted into sinus rhythm with medication (amiodarone) or they converted spontaneously upon myocardial revascularization. As compared with patients without AF, those with AF were older and presented more often with Killip class II and III; they had lower systolic blood pressure and creatinine clearance at admission; they had more often 3-vessel coronary artery disease (at initial angiogram), preprocedural flow TIMI=0 and postprocedural flow TIMI<3. EF values were similar among patients with and without AF 50% (IQR 44%, 55%) and 51% (IQR 45%, 55%) respectively, p=0.93. Six-year mortality was significantly higher in patients with new-onset AF as compared with patients without AF (14.1% vs 2.6%, respectively, p<0.001) as shown in Figure 1. In Cox regression model new-onset AF was an independent predictor of 6-year mortality–HR 4.53 (95% CI 2.29-8.94), p<0.001. Other independent predictors for 6-year mortality were older age, Killip class II and III at admission and baseline creatinine clearance <60ml/min/m2.

Conclusion

New-onset AF was a strong indepedent predictor for 6-year mortality in analyzed patients with preserved and mildly reduced EF after STEMI.
A new marker of risk for ischemic events
Authors: Ferraz LM , Faustino A , Carvalho P , Carvalho D , Pacheco A , Viana J , Neves A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Although dobutamine stress echocardiography (SE) has a high specificity, there is still a subset of patients (P) with false positive tests (FP) and their prognosis remains unclear.

Purpose

To identify the clinical and echocardiographic predictors of FP on SE and to evaluate the prognostic impact of FP on SE.

Methods

Retrospective study of 355 consecutive adult P who underwent SE for ischemia assessment over a one-year period: 134 (37,7%) women, 70,3 ± 0,57 years, body surface area (ASC) 1,85±0,01 cm2. Demographics, risk factors, clinical and laboratorial parameters and SE variables were evaluated. A FP result was defined as a positive SE for ischemia in the absence of ≥50% coronary artery (CA) lesion in a major artery of the corresponding coronary territory on subsequent angiography. P were divided into 2 groups regarding the presence (FP+) or the absence (FP0: 15,5% true positives, 79,7% true negatives, 0,3% false negatives ) of a FP result on SE and a comparative analysis was performed in order to characterize the groups and identify potencial predictors of FP results. P were followed for 2 years to assess acute myocardial infarction (AMI), hospitalization for acute heart failure (HF) and mortality (M).

Results

The FP rate was 4,5% (16P). Comparing to F0, P in group FP+ were younger (65,1±2,4 vs 70,5±0,6 years; p=0,045), baseline wall motion abnormalities were more frequent (75,0% vs 41,6%; p=0,009), had higher mean blood pressure values at rest (99,3±5,4 vs 82,0±1,3 mmHg; p=0,004) and at peak stage (140,3±5,6 vs 102,8±2,3 mmHg; p<0,001) and more often hypertensive response (37,5% vs 7,1%; p<0,001). There were no significant differences regarding previous CA disease, medication or complete left bundle branch block. By multivariate analysis, only mean blood pressure values at rest (OR 0,01; 95%CI 0,005-0,02; p=0,003) and at peak stage (OR 0,02; 95%CI 0,000-0,004; p=0,003) were independente predictors of FP. During follow-up was observed: AMI (FP+: 12,5% vs FP0: 1,8%, p=0,046), HF (FP+: 6,3% vs FP0: 11,5%, p=0,44) and M (FP+: 6,3% vs FP0: 6,2%, p=0,65). After adjustment for age, sex and comorbidities, there were no diferences between the groups regarding HF (p=0,45) and M (p=0,77), but the group FP+ mantained a higher rate of AMI (OR 0,21; 95%CI 0,065-0,354; p=0,005).

Conclusion

A FP result on SE is associated with higher mean blood pressure values during the test and with higher rates of AMI during follow-up. This result on SE should therefore be faced as a risk marker for ischemic events and can identify P that may benefit from aggressive risk factor control and careful clinical follow-up.
New-onset atrial fibrillation predicts poor prognosis in critically ill COVID-19 patients
Authors: Lopes V , Baptista J P , Moreira N , Goncalves L
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

The association between new-onset atrial fibrillation (AF) and prognosis in critically ill non-COVID-19 patients and non-critically ill patients has been studied, but few studies reflect the reality of COVID-19 patients admitted to a general intensive care unit (ICU).

Purpose

This study sought to investigate the relationship between new-onset AF in COVID-19 patients admitted to an ICU and prognosis.

Methods

We retrospectively analyzed patients consecutively admitted to an ICU with COVID-19, with a median follow-up of 10 months. Two groups were identified, with new-onset AF and without new-onset AF. Groups were compared, with special interest regarding ICU mortality, duration of mechanical ventilation, in-hospital diagnosis of heart failure, NT-proBNP value in the first 48 hours after admission, and length of hospitalization. Mortality rate and re-hospitalization during follow-up were compared.

Results

From a total of 219 patients, AF was identified in 17.8% (n=39) of patients, of whom 69.2% (n=27) presented new-onset AF.

Patients with new-onset AF were older (66.4 ±9.0 vs 61.5 ±12.2, p <0.001), with no differences regarding sex distribution. During hospitalization, patients with new-onset AF presented more often with new-onset heart failure (33.3% vs 6.3%, p <0.001), had a longer duration of mechanical ventilation (19.5 ±11 vs 9 ±12 days, p <0.001), longer ICU length of stay (20 ±12 vs 12 ±10 days, p<0.001), higher ICU mortality rate (55.6% vs 29.3%, p=0.006), and higher global mortality (55.6% vs 33.0%, p=0.022). Re-hospitalization rates were similar among groups (7.4% vs 6.3%, p=0.686). NT-proBNP in the first 48 hours was not statistically different among groups, although clinically new-onset AF patients presented higher values [median 1372 (IQR 3664) vs 246 (IQR 893), p=0.455). Main results are presented in Table 1.

In multivariate logistic regression, after adjustment for age and APACHE II score, new-onset AF was identified as an independent predictor of ICU mortality (OR=2.475, 95% CI 1.05-5.84, p=0.039).

Conclusion(s)

The present study shows that new-onset AF in critically ill patients is not a trivial phenomenon and is closely related to the risk of death and worse in-hospital outcomes.
Patient characteristics and periprocedural outcomes of percutaneous coronary intervention of the left main coronary artery
Authors: Costa D , Barbosa B , Tapia K , Matsudo M , Dadlicandro A , Acosta MF , Sero B , Sardan O , Rossini A , Notrica M , Muzzio M , Coronel R
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Left main (LM) disease is found in 5 to 6% of all coronary angiograms. Revascularization has a class IA recommendation, but the choice of the revascularization method whether by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is currently under debate. The selection depends on patient’s characteristics (age, sex, comorbidities, frailty), as well as anatomical considerations.

We aim to describe the patients with LM disease that were treated with PCI and report their short-term outcomes in a tertiary center.

Methods

Single-center retrospective study including all patients who underwent LM PCI from 2013 to 2019. The basal characteristics were retrieved from the electronic medical records. Acute kidney injury was defined as an absolute increase in serum creatinine of ≥ 0.3 mg/dL or ≥ 1.5-fold from baseline. Type IVa myocardial infarction was assessed by the Third Universal Definition.

Results

A total of 110 procedures were performed during the study period (table 1). Most of the patients were male, with a median age of 61 years. A considerable number of patients showed a reduced ejection fraction (41.2%). The left main lesions were most frequently distal and associated with left anterior descending artery disease. Radial access was used in a minority of cases (33.6%), although most were IVUS-guided (93.6%). Complete revascularization was achieved in 55.5%. The number of procedures over time is depicted in figure 1.

There was only 1 death (0.9%) during index hospitalization. There was a high incidence of type IVa myocardial infarction (19.1%) and acute kidney injury (10%), and a low incidence of TIMI major bleeding (1.8%).

Conclusion

Current practice shows an increase of left main PCI over time, particularly from 2016, after the EXCEL trial results were published. This can be due to improved technical aspects such as IVUS guidance, which was used in most patients. Noticeable, almost half of the patients had a reduced ejection fraction.

Although there was a very low short-term mortality associated with the procedure (1%), as well as a low bleeding risk (4.8%), there was a high incidence of type IVa myocardial infarction (20.2%). Only 55.5% archived a complete revascularization. Despite promising immediate results in clinical practice, long term follow up will be essential to determine the future role of left main PCI.
Clinical outcomes and predictors of acute cerebrovascular strokes after coronary artery bypass graft surgery
Authors: Laimoud M , Maghirang M , Alanazi M , Al-Mutlaq S , Althibait S , Alanazi B , Alhalees Z
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Coronary artery bypass graft (CABG) surgery still carries a significant risk acute cerebrovascular stroke despite advances in anesthetic, surgical and medical managements.

Objective

To study the risk factors and get the predictors of acute stroke after CABG and study the clinical outcomes during hospitalization and follow up.

Methods

This retrospective study included 410 patients who underwent CABG at our tertiary care hospital from January 2016 to August 2020. The patients were divided into two groups according to the occurrence of acute cerebrovascular stroke.

Results

The study included 410 patients with a median age of 60(55-68) years with a male predominance (82.2%). Thirty-one (7.5%) patients developed strokes after CABG. The stroke group had significantly higher initial sequential organ failure assessment (SOFA) score [ 3(2-4) vs. 2(1-3), p=0.002], SOFA after 48 hours [5(1-7) vs. 1(0-2), p<0.001], higher peak blood lactate level [12.5(7.6-14.7) vs. 5.1(3.7-8.5),p<0.001], longer ICU stay [11(6-42) vs. 4(3-5), p<0.001], more ventilator days [10(2-32) vs. 1(1-2), p<0.001], more tracheostomies (38.7 vs. 0, p<0.001) ,longer post ICU ward stay [11(2-57) vs. 5(3-7), p=0.015] and greater hospital mortality (25.8 vs. 0.8, p<0.001) compared to the non-stroke group respectively. Both groups showed insignificant mortality during a follow up period of 41.5(26.5-54.5) months. Multivariate regression revealed that early hospital stroke was independently predicted with carotid artery disease (OR:8.22, 95%CI:2.92-23.1, p<0.001), CPB time (OR:5.64, 95%CI:1.97-16.11, p<0.001), initial SOFA score (OR:1.643, 95%CI:1.194-2.26, p=0.002), prior stroke (OR:4.412, 95%CI:1.286-15.14, p=0.018), postoperative new AF (OR: 3.014, 95%CI:1.158-7.84, p=0.024) and CKD (OR:1.28,95%CI:1.05-3.75, p=0.017). Late cerebrovascular stroke was independently predicted with CAD (OR:9.38, 95%CI:3.72-23.66, p<0.001), postoperative AF (OR: 2.35,95%CI:1.0125-5.41, p=0.016), prior stroke (OR:3.725,95%CI:1.179-11.768, p=0.025), CABG plus valve surgery (0R:7.44, 95%CI:2.75-20.145, p<0.001), HBA1c (OR:1.431, 95%CI:1.071-1.914, p=0.016) and CKD (OR:2.33, 95%CI:1.056-5.165, p=0.036).

Conclusion

Acute cerebrovascular stroke is a serious complication after CABG and associated with increased mortality, longer hospital stays with multiple morbidities and resources consumption. Appropriate assessment and management of carotid artery disease, and post-operative atrial fibrillation should be routinely implemented to reduce the risk of early and late strokes in patients undergoing CABG.
What is the clinical benefit of left main coronary artery treatment by percutaneous coronary intervention?
Authors: Costa H , Fernandes R , Mota T , Santo ME , Palmeiro H , Bispo J , Carvalho D , Guedes J , Mimoso J , Vinhas H , Jesus I
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The treatment of choice of left main coronary artery (LMCA) disease has been subject to intense debate and investigation in the last decade. More recent studies showed benefit of percutaneous coronary intervention (PCI) in patients with less complex coronary anatomy. Although it is not the standard treatment, the use of this technique has been increasing.

Objectives

Characterize the patient population undergoing LMCA PCI and analyze its clinical benefit. Also, try to identify patient profiles according to the composite outcome (angor, heart failure symptoms (HF), myocardial infarction (MI) or death) in short and medium term (30 days (D) and 180D).

Methods

Observational and retrospective study of patients submitted to LMCA PCI, between 1 January 2019 and 31 December 2020. A descriptive analysis was carried out. Chi-Square test was used for categorical variables and the T-Student test for numerical variables, with a significance level of 95%. CHIAD algorithm was applied to identify patient profiles – composite outcome was the dependent variable (fixed 15 parent nodes and 5 children nodes). For statistical analysis, SPSS 24.0 was used.

Results

N120 patients, mean age of 70,4 years (standard deviation of 10.8), 76% were male. 81.7% had multivessel disease, with LMCA-anterior descendig artery injury being the most frequent (31.7%). The average LVEF was 49%. The complication rate was 15.8%, most vessel dissections. The most serious complications (cardio-respiratory arrest and cardiogenic shock) occurred in 0.8% of cases. The composite outcome occurred in 25,2% (30D) and 13,3% (180D), regardless of past medical history and number/type of vessels affected. The presence of angor was 9.9% (30D) and 1.3% (180D); HF symptoms in 13.5% (30D) and 4.8% (180D); MI in 2.7% (30D) and 1.2% (180D) and mortality in 2.7% (30D) and 2.4% (180D). In a logic of dependence and profiles, patients with LVEF [45-55%] (95.6%-p=0.003) who treated the lesions in first intention (AdHoc) (100%-p=0.009) presented fewer occurrences at 30D. Patients with occurrences at 30D (65.2%-p=0.001) or without PV of LVEF (66.7%-p = 0.016) and dyslipidemia (53.8%-p = 0.027) were those with most occurrences at 180D.

Conclusion

This analysis highlights the experience of the angiography laboratory. The majority of patients experienced evident clinical improvement and recovered in shortand medium term. The rate of serious events was low. The analysis suggests that the greatest benefit were found in the profile of patients with LVEF [45-55%] with an AdHoc approach.
Single-centre experience with the Impella CP, in patients with cardiogenic shock
Authors: Jimenez Rodriguez GM , Kraaijeveld AO , Voskuil M , Vlachojannis GJ , Rittersma ZH , Stella PR
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Short-term percutaneous mechanical circulatory support devices are increasingly used in cardiogenic shock. The choice between Impella or extra-corporeal membrane oxygenation (ECMO) is still a matter of concern. The purpose of this work was to identify the characteristics and clinical outcomes of Impella CP in patients with cardiogenic shock in a real world setting.

Methods

A retrospective single center study was performed on all cardiogenic shock patients that were treated with Impella CP from January 01th 2020 to April 30th 2021, the primary outcome was 30-day mortality. Secondary endpoint was the occurrence of device-related complications (limb ischemia, access site-related bleeding or dissection, access site-related infection).

Results

We identified 16 patients with cardiogenic shock who underwent placement of an Impella CP device. 8 patients (50%) underwent support in the setting of previously known chronic heart failure and acute decompensation, 5 patients (31.2%) for the assistance of a recent acute myocardial infarction, 2 (12.5%) for high-risk PCI and one case (6.25%) of hemodynamic support for an acute rejection following heart transplantation. In 10 cases (62.5%) the main indication was bridge to decision. The combination of Impella and ECMO (ECPELLA) as a unloading therapy was used in 7 patients (43.7%). The 30-day mortality was 37.5%. There were three vascular complications (18.7%) two dissections and one vascular occlusion, solved with good final results.

Conclusions

The application of the Impella CP is feasible in profound cardiogenic shock in multiple scenarios with an acceptable rate of complications. More data is needed to extend and standardize its use.
Diagnostic value of cardiac magnetic resonance functional parameters to predict the presence of microvascular damage in the setting of reperfusion injury in STEMI
Authors: Igual Munoz BIM , Ferre Vallverdu MFV , Berenguer Jofesa ABJ , Rumiz Gonzalez ERG , Fernandez Diaz CFD , Gradoli Palmero JGP , Sepulveda Sanchez PSS , Ridocci Soriano FRS , Perez Bosca JLPB , Paya Serrano RPS
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Microvascular damage is a poor prognostic factor after STEMI and is a goal to improve its diagnosis and treatment. The aim of this work is to analyze the value of cardiac magnetic resonance (CMR) functional parameters to predict the presence of microvascular damage in the setting of reperfusion injury.

Methods

A cohort of patients with acute STEMI was prospectively included and systolic and diastolic blood pressure at catheterization laboratory during reperfusion procedures were assessed . All patients underwent cardiac MRI during the first week post reperfusion with a standardized protocol including functional evaluation with b-SSFP sequences and also 8-10 short axis slices in IR-FGRE sequences assessing the area of necrosis as area of signal hyper intensity> 5 Sds relative to the remote myocardium and microvascular obstruction (MVO) as signal hypointensity in the infarct core . Functional derived parameters as left ventricle (LV) and right ventricle (RV) volumes, mass and ejection fraction (LVEF, RVE ) , biventricular stroke volumes (SV), systolic and diastolic relative LV parietal mass ) and end systolic and diastolic pressure /volume (P/V) ratio were calculated and assessed in this clinical setting.

Results

94 patients with reperfused STEMI were included. Forty nine of them (51%) have microvascular obstruction detected by CMR. Univariate analysis was performed showing that presence of MVO was significantly related to LV and RV ejection fraction, LVSV, end systolic biventricular volumes , systolic P / V ratio and systolic relative parietal mass. Area under ROC curve and statistic significance of analyzed data was shown in the picture. A multivariate regression model adjusted by LV ejection fraction was performed showing that LVSV (CI: 0.6-0.8 p=0.02) and systolic P / V ratio (p=0.01 CI: 0.8-0.9) as the most powerful functional predictors improving diagnostic accuracy of MVO in this clinical setting.

Conclusions

In addition to LV ejection fraction, LV stroke volume and systolic P / V ratio were the most powerful functional predictors associated to presence of microvascular damage in the setting of reperfused STEMI.
Endothelial function improvement associated with the new European Society of Cardiology LDL target levels in STEMI patients
Authors: Stepura AO , Parkhomenko AN , Lutai YAM , Bilyi DO , Dovhan OV
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

According to current guidelines, statin therapy is indicated for all ACS patients regardless of the initial cholesterol level. However, the effects of different lipid-lowering regimes on endothelial function in patients after STEMI have been insufficiently studied.

Methods

The study involved 135 STEMI patients admitted an average of 4.5 hours after symptoms onset and treated with primary PCI. Lipid-lowering treatment was prescribed immediately after admittance. Patients were randomly assigned to one of two patients groups – 50 pts with intermediate (atorvastatin 10 mg /ezetimibe 10 mg or atorvastatin 40 mg), and 85 pts with high intensity treatment (atorvastatin 40 mg/ ezetimibe 10 mg or atorvastatin 80 mg). Endothelial function assessment by flow-dependent vasodilation (FDV) was performed on the 1st, 10th days of the hospital period and within the 90th day of onset of the disease.

Results

The average level of low-density lipoprotein cholesterol (LDL) on the 90th day in patients was 1,66 ± 0.11 mmol /l. On that time frame the growth of the diameter of the brachial artery and FDV were increased by 66.2% in patients who reached LDL cholesterol <1.8 mmol/l and 85% in patients with LDL cholesterol <1.4 mmol/l versus 26.8% in patients with LDL cholesterol ≥1.8 mmol/l, p<0.05. Growth in the diameter of the brachial artery according to the results of the test with FDV more than 10% was statistically significant and more frequently observed in patients who reached the level of LDL less than 1.4 mmol /l on the 90th day (Fig.1).

Conclusions

Patients with STEMI who achieved a reduction in LDL cholesterol <1.4 mmol/l on the 90th day of follow-up were more likely to have a complete recovery of endothelial function. It may be dependent on early initiation of high intensity lipid-lowering treatment.
Association between serum potassium levels and short-term mortality in out-of-hospital cardiac arrest survivors
Authors: Byrne C , Krogager ML , Kragholm KH , Pareek M , Mohr GH , Ringgren KB , Wissenberg M , Folke F , Gislason G , Koeber L , Lippert F , Torp-Pedersen C , Lip GYH , Barcella CA
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation

The Danish Foundation TrygFonden

Background

Serum potassium levels outside the normal range are associated with increased short-term mortality in patients with acute cardiovascular disease such as acute heart failure. In survivors of out-of-hospital cardiac arrest (OHCA), the initial serum potassium concentration is often outside the normal range. However, it is unknown whether there is an association between initial serum potassium level and short-term mortality in OHCA survivors.

Purpose

The aim of this study was to describe potential associations between serum potassium level and 30-day survival in patients surviving OHCA.

Methods

We identified 1630 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001-2015. Thirty-day survival was analyzed according to the following seven predefined potassium levels: <2.5, 2.5-2.9, 3.0-3.4, 3,5-4.6, 4.7-5.5, 5.5-6.0, >6.0 mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5–4.6 mmol/L). The multivariable model included age, sex, Charlson comorbidity index, witnessed status, performance of CPR and first registered heart rhythm.

Results

During 30-day follow-up, survival in the seven strata was 29 (55.8%), 52 (61.9%), 167 (63.3%), 543 (58.7%), 66 (35.5%), 12 (28.6%), and 18 (23.4%), respectively. Standardized average risk ratios (ARR) of 30-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7-5.5 mmol/L: (ARR: 0.86, 95% confidence interval (95% CI): 0.74–0.96); 5.5-6.0 mmol/L: (ARR: 0.76, 95% CI: 0.52–0.98); >6.0 mmol/L: (ARR: 0.64, 95% CI: 0.50–0.79). Survival did not differ significantly in patients with hypokalemia compared with normokalemia: <2.5 mmol/L: (ARR: 0.87, 95% CI: 0.68–1.06); 2.5-2.9 mmol/L: (ARR: 1.06, 95% CI: 0.93–1.19); 3.0-3.4 mmol/L: (ARR: 1.01, 95% CI: 0.93–1.10).

Conclusions

In OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia. This association was independent of age, sex, Charlson comorbidity index, witnessed status, performance of CPR and first registered heart rhythm. Conversely, hypokalemia was not associated with reduced 30-day survival in this patient population.
Impact of high admission glucose on LV function and in-hospital heart failure in patients with AMI
Authors: Luvsansuren B , Chimed S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Patients with acute myocardial infarction (AMI) often had high admission glucose, regardless previous history of diabetes mellitus (DM). Previous studies demonstrated that hyperglycemia in patients AMI is associated with adverse outcomes. In this study, we aimed to reveal relationship between high admission gluocse and in-hospital heart failure (HF) in patients with AMI.

Material and methods

Patients with AMI who treated by primary PCI were prospectively selected. Plasma glucose level is measured on admission in all patients. Hyperglycemia was defined as admission plasma glucose ≥11.1 mmol/l. In-hospital HF was defined according to the Killip classification. Multiple logistic regression analysis was used to assess relationship between admission glucose level and in-hospital HF.

Results

A total of 428 patients (59±13, 84% male) were included in this study. 122 patients had high plasma glucose (≥11.1 mmol/l) on admission and classified as a hyperglycemia. 306 patients had normal plasma glucose (<11.1mmol/l) on admission and classified as a normoglycemia. Left ventricular global longitudinal strain was significantly impaired in patients with hyperglycemia compared with patients with normoglycemia (-13.8±4.4% vs. -15.7±3.7%, p<0.001). Occurrence of in-hospital HF was significantly higher in patients with hyperglycemia compared with normoglycemia (30% vs. 21%, p<0.05). In multivariable logistic regression analysis was showed that admission glucose level is independently associated with in-hospital HF after adjustment of age, gender, hypertension, previous myocardial infarction, previous heart failure, previous coronary artery disease, chronic kidney disease, heart rate, multivessel disease, LAD culprit vessel and final TIMI flow grade in non-diabetic patients (OR 1.10, 95% CI 1.02-1.18, p<0.01). Furthermore, univariable logistic regression analysis revealed that every 1 unit increase of admission glucose level is associated with 1.07 fold increased probability of in-hospital HF (OR 1.07, 95% CI 1.01-1.15, p<0.05) in non-diabetic patients.

Conclusion

Our results suggest that admission glucose level was independent predictor of in-hospital HF in patients with AMI. However, this relationship is only evident for non-diabetic patients.
Non-invasive hemodynamic evaluation following TAVI for severe aortic stenosis
Authors: Grinberg T , Aviv Y , Perl L , Wiessman M , Kornowski R , Orvin K
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Various hemodynamic changes occur following Transcatheter aortic valve implantation (TAVI) that impact treatment decisions. NICaS, a noninvasive whole-body bio-impedance monitoring system to assess hemodynamics and fluid balance, was tested in patients with severe aortic stenosis (AS) before and after TAVI.

Methods

Between October 2019 and December 2020 all consecutive patients with severe AS undergoing TAVI were assessed by NICaS at several time points – 24 hours before (baseline) and after the procedure, at hospital discharge and at 30 days to 1 year follow-up. Excluded were patients undergoing TAVI due to reasons other than severe AS, patients under general anesthesia and those who died at the catheterization lab or immediately following the procedure.

Results

We performed hemodynamic analysis on 97 consecutive patients who underwent TAVI using either Medtronic Evolut R (54%), Edwards Sapien 3 (32%) or SYMETIS ACURATE neo (13%). Patients were more often women (54%) and had multiple comorbidities including hypertension (83%), dyslipidemia (79%), coronary artery disease (46%), and diabetes mellitus (37%). Compared to baseline NICaS measurements, we observed increases in systolic blood pressure (BP) and total peripheral resistance (TPR) within 24 hours following TAVI (systolic BP 132.5±22.3 mmHg at baseline versus 148.4±23.9 mmHg after TAVI, P<0.001; TPR 1754±520 versus 2094±752 dynes*s/cm5, respectively, P<0.001) while cardiac output (CO), cardiac index (CI) and stroke volume (SV) decreased (CO 4.2±1.2 versus 3.9±1.2 L/min, respectively, P=0.013; SV 62±15 versus 56±15.8 mL, P=0.002). However, opposite trends were demonstrated exclusively in patients with ejection fraction (EF) under 40%. At follow-up (median 59 days, IQR [39.5-91]) these hemodynamic measurements returned to values that were not statistically different from the baseline, despite a significant improvement in EF from baseline to follow-up (55.6±11.6 to 59.4±9.4%, P<0.001).

Conclusion

A unique pattern of short and longer term adaptive hemodynamic changes was demonstrated using the NICaS system among patients undergoing TAVI. These findings require validation and further research to their underlying mechanism if NICaS is to be used as a bedside monitoring tool to guide treatment decisions.
C - reactive protein is a promising indicator of ventricular arrhythmias in pacemaker patients
Authors: Jirak P , Mirna M , Wernly B , Hinterbuchner L , Hauptmann L , Fejzic D , Topf A , Lichtenauer M , Hoppe U , Hoefer K , Schernthaner C , Motloch L
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Ventricular tachyarrhythmias are the main reason for sudden cardiac death to date. Accordingly, tools for risk stratification for ventricular arrhythmias are paramount. Non-sustained ventricular tachycardia (nsVT) represents a predictor of malignant rhythm disorders. Recently, low grade chronic inflammation was shown to predict ventricular arrhythmic events in high risk patients. This study aims to investigate, if inflammatory markers may predict higher arrhythmia burden in a low risk population.

Methods

We prospectively analyzed ventricular arrhythmia burden in pacemaker records of 166 patients (age 79.2 9.3; male 60.2%, 38 with coronary artery disease (CAD)) with preserved ejection fraction (left ventricular ejection fraction≥50%) during a annually pacemaker follow up in a single center. To evaluate potential predictive factors, associations of laboratory values including inflammatory markers (CRP and interleukin 6) with occurrence of nsVT was evaluated using logistic regression. Sensitivity analysis in patients with and without established CAD was performed.

Results

The cumulative incidence of nsVT was 12.7%. Concentrations of BNP (OR 1.00 95%CI 0.99-1.01; p=0.46), troponin (OR 0.98 95%CI 0.95-1.02; p=0.43) or interleukin-6 (OR 1.03 95%CI 0.99-1.07; p=0.16) were not associated with the occurrence of nsVTs. However, the concentration of CRP was associated with increased odds of nsVT (OR 1.26 95%CI 0.97-1.64; p=0.09) in trend. In sensitivity analysis in CAD patients, CRP was associated with increased likelihood of nsVT (OR 3.89 95%CI 1.14-13.29; p=0.03), whereas in patients without CAD there was no association between CRP and rates of nsVTs (OR 1.16 95%CI 0.88-1.54; p=0.30).

Conclusion

Our study shows that inflammatory markers like CRP may be promising predictors of rhythm disorders CAD patients. While CRP was associated with increased odds for nsVTs in pacemaker patients with CAD, IL-6 did not show a significant correlation. This might be based on a more volatile expression of IL-6 while CRP represents a more stable parameter for inflammation.
Safety of SARS-CoV-2 vaccination in people with a history of acute myocarditis
Authors: Abou Saleh I , Hayek A , Azar L , Tomasevic D , Falque H , Prieur C , Kochly F , Bonnefoy-Cudraz E , Mewton N , Bochaton T
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

SARS-CoV-2 is a global health issue. Rare cases of myocarditis following SARS-CoV-2 vaccination have been reported in the literature.

Purpose

There is a lack of data regarding the risk of myocarditis recurrence after SARS-CoV-2 vaccination in patients with a history of myocarditis. We hypothesized that SARS-CoV-2 vaccination did not increase the risk of myocarditis recurrence in patients with prior history of myocarditis.

Methods

We selected all the patients hospitalized in our hospital for the last five years (from January 2016 to June 2021) with a diagnosis of acute myocarditis. Patients were contacted with a phone call to answer a standardized questionnaire on their vaccination status and events related to the vaccination to assess the safety of SARS-CoV2 vaccination in this population. Data concerning their vital status was collected in their centralized medical file.

Results

We enrolled 142 patients with prior history of confirmed acute myocarditis. 16 patients refused vaccination, 12 of them had a fear of myocarditis recurrence. There were no serious adverse events in the vaccinated group.

Conclusion

We showed that SARS-CoV-2 vaccination in patients with prior history of acute myocarditis is not associated with a risk of myocarditis recurrence or serious side effects. These results provide reassuring data that may incite patients with prior history of myocarditis to get vaccinated against SARS-CoV-2.
Age influence on the results of the treatment of complex coronary bifurcated lesions using the mini-crush two-stent technique
Authors: Sanchez Perez I , Moron Alguacil A , Freites Esteves A , Lozano Ruiz Poveda F , Concepcion Suarez R , Martinez Del Rio J , Munoz Garcia M , Negreira Caamano M , Aguila Gordo D , Mateo Gomez C , Soto Perez M , Cubides Novoa AF , Gonzalvez Garcia A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

There is limited evidence about the benefit of "double stenting" techniques over "provisional stenting" in percutaneous coronary intervention (PCI) of complex coronary bifurcation lesions. Elderly patients (>75 years) represent an unfavourable high-risk subgroup that have typically been under-represented in cardiovascular clinical trials.

Purpose

The aim of this study was to evaluate the influence of age on the rate of major adverse cardiovascular events (MACE): cardiovascular mortality, non-fatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after prolonged follow-up (median 32 months).

Methods

Observational study in wich were included 152 consecutive patients (mean age 69.5 years, 73.7% male) with 152 complex bifurcated coronary severe lesions that underwent PCI with "mini-crush" two-stent technique and in which were compared the subgroup of elder patients (>75 years) from April 2014 to April 2020.

Results

The 53.3% of patients had stable coronary disease and 46.7% acute coronary syndrome (30.1% Non-STEMI and 16.6% STEMI). 35% of patients were >75 years old. We observed a significantly higher proportion of nonsmokers (51.2%), diabetics (38.8%) and hypertensive patients (75.3%). Clinical presentation, basal featured characteristics and antiplatelet pretreatment was similar in both groups. Mean Syntax score was higher in the older group (33.9 ± 13.7 vs. 28.1 ± 12.7, p=0.035). Left main bifurcation was the most frequently coronary artery affected in both groups and circumflex was the most common side vessel. There were no differences in pre-dilation rate either in final kissing balloon post-dilation rate. There were also no differences in the length and diameter of stents implanted and zotarolimus stent was the most commonly used in both groups as well as in the main vessel and in side branch. MACE incidence was higher in the older group (19.3% vs 8.4%, p=0.05), due to higher cardiovascular mortality (10.5% vs 2.1%, p=0.024). There were no differences in the remaining components separately.

Conclusions

Elderly patients with complex bifurcation coronary severe lesions treated with "mini-crush" technique had higher cardiovascular mortality at long-term follow-up compared with younger patients. There were no differences in other lesion-related outcomes.
Comparative validation of the GRACE 2.0 and EUROSCORE II for 6-month mortality risk estimation of patients with acute coronary syndrome undergoing urgent bypass graft surgery
Authors: Szabo D , Magyar L , Szabo A , Merkely B , Hizoh I
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The research was supported by the Ministry of Innovation and Technology NRDI Office within the framework of the Artificial Intelligence National Laboratory Program.

Background

According to the current NSTE-ACS guidelines, the GRACE 2.0 score is used for predicting mortality risk of patients with acute coronary syndrome regardless of treatment modality. However, mortality risk of patients requiring acute bypass graft surgery is usually assessed by the EUROSCORE II model.

Purpose

We aimed to validate comparatively the predictive ability of the two models in NSTE-ACS patients undergoing urgent bypass surgery.

Methods

We analysed data of 99 complete cases of an unicentre registry who underwent acute CABG surgery between 2013 and 2021. Patients were followed-up by means of hospital records, follow-up visits, and records of the National Health Insurance Fund. Besides analysis of the bootstrapped c-statistics, we constructed univariate Cox regression models and compared model fit using Fine’s partial likelihood ratio test for non-nested models. Statistical analysis was performed using R.

Results

Of the ninety-nine cases, two patients were lost to follow-up at 180 days (2.02%). The mortality rate was 16/97 (16.49%) with a c-statistic of 0.82 (95% CI: 0.70 to 0.92) and 0.72 (95% CI: 0.57 to 0.86) for the GRACE 2.0 and EUROSCORE II models, respectively (p=0.11). Analysis of the fitted univariate Cox models revealed that the two models are highly ‘distinguishable’ (p=0.0004, variance test). Yet, with this small sample size, the difference in model fit did not reach statistical significance in the non-nested partial likelihood ratio test (p=0.08, that GRACE 2.0 fits better than EUROSCORE II).

Conclusion

The GRACE 2.0 score may have a good predictive power to estimate 180-day mortality risk of acute coronary syndrome patients undergoing acute bypass surgery. Our preliminary data may raise the possibility that it also may outperform the EUROSCORE II. Nevertheless, to test this hypothesis with adequate statistical power, larger, preferably multicentre data are needed.
Influence of the clinical context on the results of treatment of complex bifurcation coronary lesions by mini-crush stenting after prolonged follow-up
Authors: Moron Alguacil A , Sanchez Perez I , Lozano Ruiz-Poveda F , Concepcion Suarez R , Freites Esteves A , Martinez Del Rio J , Negreira Caamano M , Munoz Garcia M , Aguila Gordo D , Mateo Gomez C , Maseda Uriza R , Gonzalvez Garcia A , Piqueras Flores J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Contradictory results have been seen regarding the benefit of double stenting techniques over provisional stenting in the treatment of complex bifurcation coronary lesions. There are few results for the "mini-crush" technique when used in acute coronary syndrome.

Purpose

To determine the influence of the clinical context on the results of the "mini-crush" technique, in terms of incidence of all-cause mortality and major cardiac events (MACE): combined event of cardiovascular mortality, AMI due to target lesion, and target lesion revascularization (TLR).

Methods

Observational study with 152 patients (mean age 69.5 ± 12.5 years, 73.7% male) from our hospital, presenting 152 complex severe bifurcation coronary lesions according to the Medina classification (1-0-1; 0-1-1; 1-1-1). Patients were divided into 2 groups: PCI (Percutaneous Coronary Intervention) due to acute coronary syndrome, or PCI scheduled in stable condition, using "mini-crush" technique from March 2014 to December 2020. Median follow-up of 32 months.

Results

The main results are shown in Table 1. 50% of the procedures were performed in patients with acute coronary syndrome. Regarding the baseline characteristics of the patients, no differences were found between the groups in the distribution of cardiovascular risk factors and LVEF (Left Ventricular Ejection Fraction) at the time of PCI.

Complexity of coronary anatomy was similar in both groups according to the SYNTAX I scale. There was a high rate of pretreatment with a second antiplatelet agent in both groups (clopidogrel was the most frequent). In the acute coronary syndrome group, the main bifurcation vessel most frequently affected was the left anterior descending artery (diagonal artery the side branch). In stable patients, the left main, and the circumflex artery the side branch. There were no differences in the rate of predilatation or ending with "Kissing Balloon", neither in the stents used (zotarolimus stent was the most commonly used in both groups in the main vessel and side branch, with no differences in diameter and length).

At the end of follow-up, new angiography had been performed for clinical indication in 13.2% of patients. The incidence of MACE was similar in both groups (13.2% in the acute coronary syndrome vs 11.8% in the group of stable patients, p=0.806). There was also no difference in all-cause mortality (13.2% vs 17.1%, p=0.698).

Conclusions

"Mini-crush" technique for the treatment of complex bifurcation coronary lesions showed similar results whether it was performed in the context of acute coronary syndrome or scheduled in stable condition, with no increase in all-cause mortality.
Elevation in troponin associated with COVID-19 is associated with an adverse long-term outcome
Authors: Deshpande A , Bajomo T , Rathod KS , Baumbach A , Mathur A , Jones D
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Aim

Elevated troponin levels have been shown to predict in-hospital outcomes in patients with COVID-19. However, whether this relates to or predicts longer-term outcomes is unknown. We aimed to investigate the effect of troponin elevation in patients with COVID-19, looking at resource utilisation post discharge, re-hospitalisation and outcomes.

Methods

This was a prospective study of 7650 patients admitted from December 2019 to July 2020 across a large university hospital trust. Patients were stratified according to COVID-19 status and troponin values (elevated = troponin T ≥15 ng/mL). The primary outcome assessed was all-cause mortality.

Results

1005 patients were COVID-19 positive and had elevated troponin levels, with the remaining patients troponin positive but COVID-19 negative. COVID+ patients were more likely to be older, and less likely to be Caucasian (35.7% vs 46.6%, p<0.0001), however, peak troponin did not differ significantly between the groups {54 (28-125) vs 47 (25-130) ng/mL, p=0.121}.

Mortality before first discharge was four times more likely in COVID+ than COVID- patients with elevated troponins {389 (39%) vs 359 (9.9%); p<0.001}. This mortality rate was also significantly higher than in COVID-19 positive patients who were troponin negative (p=6%, P<0.0001). Post-discharge over a follow-up period of 365 days, in the discharged COVID-19 positive troponin positive group, a minority of patients (13.2%) were investigated with outpatient cardiac investigations (echocardiography, CTCA, coronary angiography and cardiac MRI) compared to the COVID-19 negative group (34.5%). Post-discharge mortality was significantly higher among the COVID+ cohort {63 (10.2%) vs COVID-19 negative troponin positive 103 (3.1%); p<0.001}. COVID+ patients who died post discharge were more likely to be Caucasian (55.4% vs 35.2%, p<0.05) and more likely to be older (81 (72-87.5) vs 67 (57-79), p<0.05) than COVID+ patients who survived post discharge.

Conclusion

Elevated troponin levels in patients with COVID-19 is associated with long-term mortality. Patients were unlikely to undergo cardiac investigations and the troponin rise likely reflects illness severity. Further data is needed in this area.