bluuebunny/crossref_metadata_2025_split huggingface dataset:
Centralisation of post-resuscitation care after out-of-hospital cardiac arrest at heart centres - a nationwide follow-up study
Authors: Rasalingam Mork S , Gregers E , Kragholm K , Kjaergaard J , Folke F , Torp-Pedersen C , Kober L , Boas Soja A M , Juhl Terkelsen C , Michalik F , Eifer Moller J , Lund Henriksen F , Bundgaard Ringgren K , Hassager C , Soholm H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Recent guidelines recommend centralisation of post-resuscitation care in out-of-hospital cardiac arrest (OHCA) patients in dedicated Cardiac Arrest Centres (CACs) aiming to improve outcome.

Purpose
To describe the process of implementation of the centralisation policy and impact on 30-day mortality rate.

Methods
This nationwide study included all adult OHCA patients (&gt;18 years) based on the Danish Cardiac Arrest Registry. Centralisation was introduced in 2009, 2010, and 2012 in four regions (A, B, C, D), and one region has not yet implemented the policy (control). Parallel trends assumption was made and a difference-in-difference model with repeated cross-sections was used to estimate the average treatment effect on the treated patients. The 30-day mortality was compared between patients living in regions that introduced centralisation versus control region without centralisation.

Results
A total of 20,566 patients with OHCA were identified between 2007 and 2020. The majority were between 50 to 75 years (53.7%) and 67.8% male. Bystander cardiopulmonary resuscitation was performed in 55.3%. Shockable rhythm was present in 34.6% of the patients. The policy of centralisation of OHCA in CACs has been gradually and not yet completely implemented (Figure 1A). Patients with shockable rhythms (72%), and younger patients &lt; 50 years (64%) were more frequently transported to CACs. The 30-day mortality was lower among patients transported to CACs (Figure 1B). Centralisation significantly improved survival by 6% (95% CI: 2%-10%) percentage points compared to the control region after controlling for all known covariates (sex, age, Charlson Comobidity Index, shockable rhythm, and bystander cardiopulmonary resuscitation).

Conclusions
In this nationwide study, centralisation of post-resuscitation care of OHCA in dedicated CACs has been gradually implemented over time. Although, OHCA patients with favorable prognostic factors were more frequently transported to CACs, centralisation increased survival by 6 absolute percentage points.
Antiplatelet de-escalation switch in patients with acute coronary syndrome and percutaneous revascularisation in real life
Authors: Padilla Rodriguez G , Escalona Garcia F J , Arroyo Monino D F , Lorenzo Lopez B , Hidalgo Urbano R J , Garcia Rubira J C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The current indication for the use of potent antiplatelet agents as the first choice after drug-eluting stent implantation in acute coronary syndrome (ACS) is sometimes difficult to achieve due to clinical problems in patients. The switch between higher and lower potency antiplatelet drugs (de-escalation) is particularly relevant and it is usually performed when there are contraindications or adverse effects related to the use of more potent P2Y12 inhibitors (iP2Y12).

Purpose
Our aim is to analyse the incidence and possible causes of in-hospital de-escalation switching in patients with ACS, as well as to compare the characteristics of these patients with those who continue with the higher potency antiplatelet drug initially indicated.

Methods
Observational, retrospective, single-centre study of a cohort of 3139 patients admitted to a Coronary Care Unit with ACS, treated with Ticagrelor or Prasugrel as a second antiplatelet agent at admission. Patients were classified according to whether or not they switched to Clopidogrel during their hospitalisation, comparing the characteristics between each group and the clinical events that potentially have caused that switch.

Results
From 3139 admitted patients, 188 (5.99%) were switched from Ticagrelor or Prasugrel to Clopidogrel. The majority of these occurred among patients receiving Ticagrelor (4.21 vs. 1.78%). Patients with de-escalation switch (mean age 64±11 years, 69% male) were similar to the non-switch group, with no statistical differences in baseline characteristics including the CRUSADE score (25 vs 27), except for the presence of a lower GRACE score (153 vs 146, P=0.02). The diagnosis of ST-elevation ACS as an ischaemic event was more prevalent in the "switch group". Regarding possible causes of de-escalation, a higher frequency of bleeding (9.3 vs 20.7%, P&lt;0.01), new-onset atrial fibrillation (4.14 vs 20.21%, P&lt;0.01) and indication for anticoagulation at discharge (6.64 vs 31.91 %, P&lt;0.01) were observed in the "switch group" compared to the other one.

Conclusions
Although not very frequent, in-hospital de-escalation switch between iP2Y12 antiplatelet agents is sometimes required because of medical conditions, such as the presence of haemorrhages or the need for anticoagulation due to atrial fibrillation or other reasons; although, other times it happens due to a medical decision, without an objective event. In addition, in our sample, patients who underwent anti-platelet de-escalation switch had a lower ischaemic risk.
Differences in population characteristics and prognosis between cardiogenic shock in right ventricular infarction and anterior infarction
Authors: Lucas Garcia M , Rivas Garcia A P , Arroyo Monino D F , Garcia Gonzalez N , Hidalgo Urbano R J , Garcia Rubira J C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
According to the literature, cardiogenic shock in the setting of right ventricular infarction (RV) has a high mortality, even equal to that related to left ventricular anterior infarction in some series. However, as well as many of the topics in acute cardiovascular care, more information is still necessary.

Purpose
We aim to assess the presence of differences in a cohort of patients with cardiogenic shock due to RV infarction versus anterior infarction. In order to achieve it, we analyzed the differences in baseline characteristics, in-hospital complications and mortality.

Methods
Descriptive, retrospective, observational, and single-center analysis of patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock admitted to our Coronary Care Unit between July 2011 and August 2022. We collected the data of patients with cardiogenic shock and compared basal characteristics and prognosis according to the infarction location (anterior or RV).

Results
A total of 241 patients were included, 30.7% with RV infarction. The mean age of our patients was 68.6 years and 68% were male. There were no differences in the main cardiovascular risk factors between the two groups. Regarding complications during their hospitalization, there was a significantly higher percentage of patients requiring invasive mechanical ventilation and hemodialysis in patients with shock due to anterior infarction. There was also no significant differences in the frequency of ventricular arrhythmias or atrioventricular block. At last, in our cohort, there is a higher in-hospital mortality rate among patients with shock associated with anterior infarction.

Conclusions
Despite the fact that in some series the high mortality in shock due to RV infarction is similar to the shock caused by anterior infarction, in our study cardiogenic shock related to anterior infarction involve worse prognosis with higher in-hospital mortality, as well as a higher need of mechanical ventilation and renal replacement therapy.
Sex differences in outcome after targeting mean arterial blood-pressures and oxygenation in comatose patients after out-of-hospital cardiac arrest
Authors: Holle S , Winther-Jensen M , Kjaergaard J , Moeller J E , Hassager C , Schmidt H 
Published: May 2023

Abstract

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

Background
Previous studies have found lower survival rate and neurological outcomes for female patients with out-of-hospital cardiac arrest (OHCA) compared to males. Recently, the effect of liberal or restrictive oxygenation and lower or higher mean arterial blood-pressures (MAP) on outcome in comatose OHCA patients were investigated; showing no differences between the target groups. Evidence concerning sex differences in outcome after appropriate oxygenation and different MAP levels in comatose OHCA patients is limited.

Purpose
The aim of this study was to investigate whether female sex was associated with higher rates of unfavourable outcome after treatment with oxygenation and MAP in comatose patients after OHCA related to outcome.

Methods
Adult comatose OHCA patients (age ≥18 years) of presumed cardiac cause were included in a dual-center, double-blind, randomized trial with a 2-by-2 factorial design. Patients were allocated by a 1:1:1:1 ratio into a MAP target of 63 mm Hg or 77 mm Hg and arterial oxygen concentration during mechanical ventilation of 9–10 kPa (restrictive) or 13–14 kPa (liberal). The primary outcome was a composite of all causes of death within a year or hospital discharge with a cerebral performance category (CPC) of 3 or 4.

Results
Of the 789 included comatose OHCA patients, 152 (19%) were women. Mean age of women and men were similar, 61±14 years and 63±13 years, respectively. Comorbidities and characteristics of the cardiac arrest were comparable between sexes except for ischemic heart disease, which was more frequent in men (12% women, 24% men) and pulseless electrical activity, which was more frequent in women (8% women, 4% men). CPC 3 or 4 occurred equally in women and men (both 3%). Women had a higher, but non-significant one-year all-cause mortality (women: 42%, men: 35%), Figure 1. In a univariate Cox regression model, the difference in all-cause mortality was not significant (HR: 1.25, CI: 0.95-1.63), but showed significance after adjustment for age (HR: 1.31, CI: 1.004-1.72).

Conclusion
Men and women in comatose after OHCA had similar unfavourable outcome when treated in the same manner with oxygenation and MAP.
Predictors of delirium in patients with acute decompensated heart failure at a cardiac intensive care unit
Authors: Carvalho M , Cabral M , Goncalves C , Vazao A , Fernandes S , Graca Santos L , Morais J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Delirium is commonly observed in critically ill patients and is associated with a worse overall prognosis in patients hospitalized with acute decompensated heart failure. However, in patients with acute decompensated heart failure (ADHF), the impact of delirium on prognosis and the factors that influence it have not been thoroughly examined.

Objective
To study the predictors of delirium in patients hospitalized in the cardiac intensive care unit (CICU) due to acute decompensated heart failure.

Methods
We retrospectively analyzed 105 patients admitted to a CICU due to ADHF. Delirium was diagnosed based on the Confusion Assessment Method for ICU (CAM­-ICU) during CICU stay. Echocardiography and laboratory measurements were performed during hospitalization. A logistic regression analysis was performed, looking for independent predictors of delirium development.

Results
Delirium was observed in 25 patients (23.8%) during CICU hospitalization. Multivariable analysis revealed that older age (odds ratio [OR]: 7.6; 95% confidence interval [CI]: 3.2-21.2; p&lt;0.001), previous diagnosis of dementia (OR: 7.31, 95% CI: 3.65­-14.91, p&lt;0.001), high plasma level of C reactive protein &gt; 79 mg/L (OR: 1.26, 95% CI: 1.09-­1.61, p=0.031), and prior alcohol misuse (OR: 5.4; 95% CI: 2.76-13.40; p=0.003) as significant independent determinants of delirium. Furthermore, we determined that delirium was an independent predictor of in-hospital mortality (OR: 1.93, 95% CI 1.1-3.4.1, p=0.033). There was no relationship to the previous medical history of arterial hypertension, diabetes mellitus, or left ventricular ejection fraction.

Conclusions
In patients with ADHF, the development of delirium during CICU stay is associated with a higher risk of in-hospital mortality. Older age, dementia, high levels of C reactive protein, and alcohol misuse were identified as predictors of delirium. Therefore, this clinical entity's early diagnosis and proper management are essential.
Blood pressure targets in out-of-hospital cardiac arrest according to the time to return of spontaneous circulation
Authors: Paulin Beske R , Grand J G , Schmidt H S , Moeller J E M , Kjaergaard J K , Hassager C H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation and Lundbeck Foundation.

Introduction
Time to return of spontaneous circulation (ROSC) in patients resuscitated after out-of-hospital cardiac arrest (OHCA) is associated with the severity of brain damage and is an important predictor of mortality. We have recently shown no difference in mortality or neurological outcome with different mean arterial blood pressure targets (63 or 77 mmHg) in the initial phase of post-cardiac arrest management in resuscitated OHCA patients who remained comatose. Accordingly, in this post-hoc analysis, we explored whether time to ROSC modifies the effect of different blood pressure targets on mortality and neurological outcome.

Method
In a double-blind, randomized trial, a mean arterial blood-pressure target of 63 mm Hg vs. 77 mm Hg in comatose adults who had been resuscitated after an out-of-hospital cardiac arrest of presumed cardiac cause was investigated (BOX-trial, N Engl J Med 2022). Primary outcome for the present analysis was a composite of discharge from hospital severe brain damage or death from any cause within 365 days from randomization for the blood pressure target intervention was analyzed in a proportional hazard model with time to ROSC (tertiles: short, medium, and long) as a subgroup following testing for interaction. The analysis was conducted in the intention to treat the population.

Results
A total of 789 patients were included in the analysis. The time to ROSC in the three tertiles was: Short [0 min - 13 min], medium [14 min - 22 min], and long [23 min - 117 min]. The three groups were well balanced in the two blood pressure target groups (In the high group (77 mmHg): Short, n=124 (49%); medium, n= 133 (50%), long, n=136 (51%). Age (short: 62.7 (± 14), medium 62.4 (± 13), and 62.6 (± 13) and sex (short: 19.5% female, medium: 19.0% female, long: 19.4% female) were similar in the three groups. The first monitored rhythm did not differ in the three groups (shockable in 82.6%, 86.2%, and 85.3% of patients, respectively). Time to the first defibrillation did, however, differ between the three groups ((short 6.2 min (± 3.3), medium 9.0 min (± 3.8), and long 11.0 min (± 6.6), p&lt;0.0001). The primary outcome occurred in 44 (17.3%), 92 (34.3%), and 153 (57.5%) in the short, medium, and long groups, respectively (p&lt;0.0001). No interaction of time to ROSC and blood pressure target was found (p=0.62). Hazard ratios in the high (77 mmHg) group for the three tertiles were: short: HR 1.34 (95% CI: 0.75 – 2.40), medium: HR: 0.99 (95% CI: 0.68 – 1.45) and long: HR 0.97 (95% CI: 0.71 – 1.32).

Conclusion
Longer time to ROSC is associated with an adverse outcome, but it does not modify the effect of different blood pressure targets in comatose OHCA patients.
The relevance of hs-troponin and global longitudinal strain in predicting the need for mechanical intubation in severe COVID-19 patients
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 , Gunadi R I , Al-Farabi M J , Azmi Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Dr.Soetomo General Hospital Abbott

Background
The occurrence of an imbalance in oxygen supply results in the release of pro-inflammatory cytokines which leads to increased ventilation support requirement. Half of the intubated patients with COVID-19 manifest myocardial injury, which is associated with a graded increase in overall mortality.

Purpose
This study aims to analyze factors that contribute to worse outcomes among severe COVID-19 infections.

Methods
We performed an observational, single-center prospective cohort study from February 1st – July 31st, 2021 at an Isolated ICU. A total of 65 subjects were included. Subjects were recruited according to WHO criteria for severe COVID-19 and CDC criteria for myocarditis. All subjects recruited were examined using echocardiography to measure global longitudinal strain (GLS) and blood samples were taken to measure hs-Troponin. Subjects were then followed to assess their needs for mechanical ventilation and in-hospital mortality.

Results
Severe COVID-19 subjects with cardiac injury were associated with an increased need for intubation (78.5%) and an increased incidence of myocarditis (50.8%). There was an association between the use of intubation and the risk of mortality in patients (66.7% vs. 33.3%, p-value &lt;0.001). Both reduced GLS and increased hs-troponin are associated with increased myocarditis (p-value &lt;0.001 and 0.004 respectively). Reduced GLS is associated with higher mechanical ventilation needs (12.17 + 4.79 vs.15.65 + 4.90, p-value 0.02) and a higher mortality rate (11.36 + 4.64 vs. 14.74 + 4.82; p-value 0.005). Increased hs-troponin is associated with higher mechanical ventilation needs (25.33% vs. 3.56%, p-value 0.002) and a higher mortality rate (34.57% vs. 5.76%, p-value 0.002).

Conclusions
Severe COVID-19 subjects are associated with an increased incidence of myocarditis as indicated by myocardial injury through an increase in hs-troponin and a decrease in GLS. Both increased hs-troponin and reduced GLS are associated with higher mechanical ventilation needs and a higher mortality rate.
Optimal timing of surgery for patients with infective endocarditis
Authors: Manikantan P , Tao M , Despotidis G , Alkhalil A , Parikh P , Pyo R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Infective endocarditis (IE) is a disease associated with high risk of morbidity and mortality. Recent literature suggests that surgery during index hospitalization may be performed safely without increased risk of adverse clinical outcomes. However, risk associated with specific surgical timing during index hospitalization remains unclear.

Purpose
The purpose of this meta-analysis is to assess the association of early surgery with mortality in patients with IE.

Methods
We performed a literature search for studies reporting an association between early surgery and study endpoints. The primary endpoint was in-hospital mortality. The secondary endpoint was long-term mortality. Early surgery was defined as surgery within 14 days of admission. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status.

Results
A total of 15 studies with 2491 participants (900 with early surgery vs 1591 with delayed surgery) were included. The mean duration of follow-up was 33 months (ranging between 6 to 66 months). Early surgery was not associated with increased risk of in-hospital or long-term mortality compared to delayed surgery (OR 1.08, 95% CI 0.80, 1.46; P=0.63; OR 1.12, 95% CI 0.68, 1.86; P=0.65). Heterogeneity was low: Chi2 = 7.85, I2 = 0%.
Subgroup analysis by time to surgery demonstrated that early surgery was not associated with increased risk of in-hospital mortality for surgeries performed within 2 days, 7 days, or 14 days of hospitalization (OR 0.87, 95% CI 0.58, 1.32; P=0.51; OR 1.06, 95% CI 0.78, 1.43; P=0.72; OR 0.51, 95% CI 0.21, 1.23; P=0.13). Heterogeneity was low: Chi2 = 4.84, I2 = 0%.

Conclusions
Early surgery performed within 14 days of initial hospitalization is not associated with increased risk of in-hospital mortality or long-term mortality compared to delayed surgery.
Fixed-dose ultrasound-accelerated thrombolysis for acute pulmonary embolism: short- and long-term outcome data from a single-center study
Authors: Zbinden S , Voci D , Kucher N , Barco S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Data on clinical outcomes after fixed-dosed ultrasound-accelerated thrombolysis (USAT) for acute pulmonary embolism (PE) is still limited, particularly concerning safety and long-term course.

Methods
We studied patients with acute PE treated with USAT at a University Hospital between 2018 and 2022. Patients were candidates to USAT if acute PE fulfilled the criteria of high-risk or intermediate-high risk (plus additional markers of clinical severity or early deterioration) as per European guidelines. USAT was given at a standard regimen of 10 mg alteplase/catheter over 15 hours. Early outcomes included: mean pulmonary arterial pressure (mPAP) before and after treatment, National Early Warning Score (NEWS) during USAT; 30-day all-cause death, 30-day hemodynamic decompensation, 30-day PE recurrence, and 30-day major bleeding complications (ISTH definition). Late outcomes were: confirmed CTEPH, persistent post-PE dyspnea, and "post-PE impairment" (PPEI), as defined by the combination of dyspnea with sPAP&gt;35 mm Hg, TAPSE &lt;1.6cm, or RV/RA gradient &gt;36 mmHg, death.

Results
We included 161 patients: the mean age was 67.8 (SD 14.6) years and 96 were men. All had acute bilateral PE and were treated with two catheters for a median alteplase dose of 20 mg. All patients received anti-Xa activity-adjusted unfractionated heparin, except one, who received argatroban. mPAP decreased from a mean of 35.6 (SD 9.8) to 25.6 (SD 8.2) mmHg after a 15-hour course of treatment (absolute difference 10.2 mmHg; SD 8.1). The NEWS decreased from a median of 5 (Q1-Q3: 4-6) points before USAT to 3 (Q1-Q3: 2-4) points after USAT. No hemodynamic decompensations were recorded within 30 days of hospitalization. One (0.6%) recurrence of PE within 30 days occurred. Two major bleeding (1.2%), of which one (0.6%) was intracranial and fatal, were observed. No other deaths were recorded within 30 days of acute PE. Of 125 patients followed at our center and included in the long-term analysis (median follow-up time 104, Q1-Q3 91-200, days), CTEPH was diagnosed in 2 (1.6%) patients. In one patient, CTEPH was most probably pre-existing, namely present already at the time of "acute" PE, based on hemodynamic and radiological findings. CTEPH was incident in the other patient. 24 (19.2%) patients reported persistent dyspnea, of whom 5 (4.0%) fulfilled the PPEI criteria. Death was recorded in 8 (6.4%) patients after a median of 591 (Q1-Q3; 517-710) days and no event was PE-related. One (0.8%) recurrent PE occurred.

Conclusions
USAT rapidly reduced the mean pulmonary arterial pressure in selected intermediate-high and high-risk acute PE with a good safety profile. Only 4.0% patients had residual symptoms and right ventricular dysfunction over long-term follow-up. This data reassures USAT being an effective and safe option for acute PE also in terms of long-term outcomes.