bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute kidney injury in acute decompensated heart failure related cardiogenic shock: data from the Alt-Shock2 registry
Authors: Milani M , Tavecchia G A , Frea S , Sorini Dini C , Briani M , Bertaina M , Pullara A , Petrini L , Garatti L , Potena L , De Ferrari G M , Tavazzi G , Pappalardo F , Morici N , Sacco A 
Published: May 2024

Abstract

Funding Acknowledgements
None.

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

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

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

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

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

Abstract

Funding Acknowledgements
None.

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

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

Results
373 patients were included. The average age was 77.6 ± 9.8 years (28% women). Patients had a high ischaemic and haemorrhagic risk [CHA2DS2VASc 4 (2-5) and HASBLED 3 (2-4)], with 25.5% being frail according to the Clinical Frailty Scale. The main reason for admission was ACS (44.8% NSTEMI, 22.2% STEMI and 33% CCS ), and 49.8% of patients had multivessel disease. 70.3% of patients underwent revascularisation, mainly percutaneously (92.2%). Among those percutaneously revascularised, the most used antithrombotic treatment was triple therapy with double antiplatelet therapy (DAPT) + oral anticoagulant (OAC) (62.5%), followed by double therapy with monoantiplatelet therapy + OAC (29.2%). In revascularised patients over 80, the most selected antithrombotic therapy was similar: 60.5% and 28.9%, respectively. The most used OAC was apixaban (42.3%), followed by vitamin K antagonists (17.3%).
One-year survival was 88.5%. 2.6% of patients presented an ischemic stroke, and 4.8% suffered a new ACS. At the same time, haemorrhagic events (BARC ≥2) were 8.9%.

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

Abstract

Funding Acknowledgements
None.

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

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

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

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

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

Abstract

Funding Acknowledgements
None.

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

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

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

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

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

Abstract

Funding Acknowledgements
None.

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

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

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

Results
A total of 113 patients with AAS were included, of whom 82 were AAS-A patients. Of these, 27 were aged 75 years or older.
Older patients had more comorbidities: COPD, atrial fibrillation, renal failure and stroke (table). Elderly patients were diagnosed later (symptom-to-diagnosis time: 10 hours (6.2-62) vs. 4 hours (2.2-23), p=0.004). At diagnosis, older patients had more complications: cardiac tamponade (33% vs 23%, p= 0.352), hemopericardium (69% vs 38%, p= 0.01), shock (45% vs 30%, p=0.180) and renal failure (40% vs 20%, p= 0.132). The surgical risk of older patients was higher (table) and they underwent surgery in a lower proportion (59.3% vs. 87.3%, p= 0.004). Once diagnosed, time to surgery was similar between groups (3.2h (1.6-10) vs. 2.7h (2.1-5.7), p= 0.728).
Despite the increased risk, surgery was associated with a mortality reduction in both patient groups (figure). In patients who underwent surgery, the incidence of post-surgical atrial fibrillation was higher in the group of older patients, with no significant differences in the remaining complications (table).

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

Abstract

Funding Acknowledgements
None.

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

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

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

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

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

Abstract

Funding Acknowledgements
None.

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

Methods
Patients undergoing transfemoral TAVR in a tertiary centre between 2017 and 2019 were included in this analysis. All patients underwent iliofemoral CTA before the procedure and classical CTA-derived data as well as iliofemoral calcium volume were collected. Clinical data and outcomes regarding bleeding events, as well as vascular complications according to Valve Academic Research Consortium 2 (VARC-2) criteria, were also collected.
207 patients were included in this analysis, of whom 53% were women. The median age was 82 years (IQR 76-86) and the median STS mortality risk score was 3.9% (IQR 2.59-5.99).
In this population, vascular complications according to the VARC-2 criteria occurred in 33% of patients (19% with major complications). Patients with lower body mass index (BMI) were more likely to suffer vascular complications. Vascular access with fluoroscopy was associated with a higher prevalence of complications compared to ultrasound-guided vascular access (62% vs. 38%, p=0.037). When considering radiological criteria, smaller minimum luminal diameter and area of the common femoral and external iliac arteries were associated with a greater risk of vascular complications, as were increased sheath to external iliac artery ratios and luminal attenuation values (p&lt;0.05 for all).
Bleeding complications occurred in 20 patients, with a greater prevalence of bleeding events in female patients (77% vs. 23%, p=0.001). Patients with a lower BMI, a history of obstructive pulmonary disease or coronary artery disease, aortic insufficiency and fluoroscopic valvular access were more likely to have bleeding complications. Regarding radiological criteria, decreased maximal luminal diameter of the common femoral artery and smaller minimal luminal diameters and areas of the external iliac artery were associated with bleeding complications. Increased sheath-to-femoral artery ratios and luminal attenuation values were associated with an increased risk of vascular complications (p&lt;0.05 for all).

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

Abstract

Funding Acknowledgements
None.

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

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

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

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

Conclusions
Acute ischemic mitral regurgitation remains an entity with a high mortality rate. Early identification of underlying etiology, prompt reperfusion treatment and tailored surgery, if needed, are key to improve outcomes.