bluuebunny/crossref_metadata_2025_split huggingface dataset:
Targeted temperature management after resuscitated cardiac arrest: survival and neurological outcome at follow-up
Authors: Olivares Martinez B , Rivadeneira Ruiz M , Garcia Gonzalez N , Fernandez Valenzuela MI , Lopez Flores L , Garcia Rubira JC 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
According to the most recent resuscitation guidelines, targeted temperature management (TTM) is recommended for comatous patients after resuscitated cardiac arrest (CA). Some studies have shown benefitial effects on survival in shockable rhythm as well as an improvement on neurological outcome regardless of the initial rhythm. Nevertheless there is less information about long term outcome of these patients.

Purpose
This study aims to analyse survival and neurological prognosis after discharge as well as the readmission rates in patients who received TTM in our Coronary Care Unit (CCU).

Methods
Retrospective cohort of 188 patients admitted at our CCU from 2006-2021 in coma (Glasgow Coma Scale ≤10) after resuscitated CA. TTM with a target core temperature of 33ºC was applied for 24 hours in all comatous patients since 2011, with intravascular cooling catheter. We assessed mortality, neurological outcome at 1 year and readmissions after discharge in those treated with TTM. We evaluated neurological outcome with the Cerebral Performance Categories Scale (CPC), which considers CPC 1-2 as favourable neurological outcome – survival without severe cerebral disability. We also performed a multivariate analysis to identify predictive factors of mortality, CPC 1-2 and readmissions at follow-up.

Results
TTM was applied in 75 patients, 63% of them presented with initial shockable rhythm and 37% with non-shockable rhythm. 43 patients were discharged, which represents an intrahospital mortality of 43%. Good neurological outcome at discharge was 49%.
The median of the follow-up was 29.5 months (6.4-68.4 months). Mortality after discharge was 5% and the readmission rate was 10%. Moreover 22% of all patients remained with severe neurological impairment at 1 year.
We performed a multivariate analysis of all comatous patients who were discharged and observed a tendency towards lower mortality after discharge in patients who had been treated with TTM (p=0.071). Neurological outcome at 1 year was significantly associated with early awakening -before 5th day- (p=0.042). We didn’t identify any predictive factors of readmission.

Conclusions
Even though mortality in comatous patients after CA is high, those who were treated with TTM in our centre and discharged had low mortality and readmission rates on the follow up. The proportion of severe neurological impairment at 1 year remained similar to the proportion we observed at discharge and was significantly associated with early awakening.
Use of first bicarbonate after out-of-hospital cardiac arrest to predict mortality
Authors: Lopez-Sobrino T , Izquierdo Ribas M , Jimenez Trinidad FR , Cepas Guillen PL , Flores Umanzor E J , De Diego Soler O , Villela Dantas A P , Eder Salazar A , Camino Castrillo L , Ayala Borges B J , Moreno Monterde E , Gillermo Galvez C , Martinez Gea C , Valerio Rojas J C , Andrea Riba R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Recovered out-of-hospital cardiac arrest (OHCA) is associated with high morbidity and mortality. Having prognostic tools within the first hours of admission to hospital is critical. The pH is a widespread arterial blood gas marker, but the influence of its respiratory/metabolic components has not yet been established.

Purpose
The objective of the study is to analyze the utility of first bicarbonate measure as a predictor of in-hospital mortality after OHCA.

Methods
This is a prospective observational study carried out on survivors to the initial phase of an OHCA, who were admitted to the Acute Cardiovascular Care Unit of our single terciary center. Clinical characteristics and initial blood gas data were analyzed. The primary objective was in-hospital mortality.

Results
A total of 50 patients were included (2019-2021), of which 40% died during the course of the hospitalization. First pH determination showed significant differences between survivors and dead. Of its two components, the bicarbonate was lower in the patients who died (13.93 ± 3.01 vs. 18.48 ± 4.15, p &lt;0.001) while the CO2 partial pressure (PCO2) did not show differences (53.89 ± 14.43 vs. 50.31 ± 13.07, p = 0.377). A ROC analysis was performed, and the bicarbonate had the best AUC as a mortality predictor (0.819, CI 95% 0.695-0.944, p&lt;0.0001), compared to lactate (0.793, CI 95% 0.663-0.923, p=0.001) and pH (0.781, CI 95% 0.650-0.913, p=0.001). The best cut-off value for bicarbonate was 16.5 mmol / L (Log-rank &lt; 0.0001), with a sensitivity of 84% and a specificity of 79% to predict survival.

Conclusions
Bicarbonate was the best initial predictor of mortality after an OHCA, above pH, which, although being a good predictor, is potentially altered by PCO2 (which was not a good predictor).
MircoRNA-9-3p: a novel predictor of neurological outcome after cardiac arrest
Authors: Paulin Beske R , Bache S , Olsen MH , Rossing M , Nielsen FC , Meyer MAS , Moeller K , Kjaergaard J , Jeppesen JB , Nielsen N , Hassager C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Resuscitated out-of-hospital cardiac arrest (OHCA) patients who remain comatose after hospital arrival are at high risk of mortality due to anoxic brain injury. Markers of neurological outcome and consequently, neuroprotective targets are of great interest, and novel approaches are warranted.
MicroRNA are small non-coding RNA molecules, ultimately involved in gene-silencing. They show promise as biomarkers, as they are stable in body fluids. The microRNA 9-3p (miR-9-3p) is associated to neurological injury in trauma and subarachnoid hemorrhage.
Hypothesis: MiR-9-3p changes following OHCA and is associated with neurological outcome.

Methods
This post hoc analysis included 171 comatose patients included at a single center in the target temperature management (TTM) trial. Patients were randomized to TTM at either 33◦C or 36◦C for 24 h. MicroRNA-9-3p (miR-9-3p) was measured in plasma sampled at admission and at 28, 48 and 72 h.

Results
miR-9-3p levels changed markedly following OHCA with a peak at 48h. There were no significant differences in median miR-9-3p levels between TTM 33◦C vs. 36◦C at any of the four time points. Elevated miR-9-3p levels were strongly associated with a poor neurological outcome (see figure, p&lt;0.0001). There were no significant differences in age, gender, comorbidities, and pre-hospital data, including lactate level at admission, between miR-9-3p level quartiles. Creatinine and C-reactive protein were not correlated with miR-9-3p levels at 48 h.

Conclusion
MiR-9-3p is strongly associated with the neurological outcome following OHCA, and the levels are highest 48 hours following cardiac arrest.
MicroRNAs, including miR-9-3p, may be involved in upstream regulatory processes and its potential as a therapeutic target should be investigated
Invasive mechanical ventilation in the coronary unit, does the sex matters?
Authors: Arroyo Monino DF , Rivadeneira Ruiz M , Paez Munoz R , Garcia Gonzalez N , Garcia Rubira JC 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
In the recent years, we have assisted to a change of the prototype of the patient admitted to a Critical Coronary Care Unit (CCCU), with an increasing number of patients admitted due to acute heart failure (AHF) and the reduction of the patients diagnosed of acute coronary syndrome (ACS). It is common in these patients the requirement of ventilatory support, both invasive (IMV) and non-invasive. As a consequence, our knowledge about this technique must be improved. Furthermore, we frequently observe differences in the profile and the prognosis of the patients according to their sex.

Objective
Our aim is to describe the differences according to the sex in patients treated with IMV.

Methods
Observational, retrospective study, using a cohort of patients admitted to a CCCU between January 2.018 and April 2.021 who needed IMV. Data related with the personal history, basal situation and events in the follow-up during the hospitalization were collected.

Results
A total number of 140 patients were included, being 103 (73,6%) male and with a mean age of 67 years old. In the Abstract Picture 1, we show the most interesting characteristics of the population (previous history, complications during the hospitalization and in-hospital mortality). The most frequent cause of intubation was cardiac arrest (CA) with a 47,9% of the cases (67 patients). Mean stay in the CCCU was 12 days, with a median of 8 days. Only 8 patients (5,7%) needed the performation of a tracheostomy and 53 (37,9%) died during the hospitalization. When comparing sex (Picture 1), we did not find any significative differences according to age of the patients, the cause of their admission (Picture 2) or their previous history but the presence of Chronic Obstructive Pulmonary Disease (COPD), which was significatively more frequent in male (21 vs 2, p = 0,035). There were no differences in the cause of the hospitalization, the intra-hospitalary mortality or the main complications during this hospitalization (shock, sepsis, needing of renal sustitutive therapy).

Conclusion
In our population of patients admitted to a CCCU who require IMV, we can affirm that we find a very homogeneous population when refering to the sex of the patients admitted, not finding any significative differences according to the personal history and prognosis, only COPD being more frequent in male, which can be relevant as these patients may need to be ventilated in a different way.
Prolonged support with Impella 5.0: different pathways of care for acute cardiogenic shock
Authors: Pieri M , Ortalda A , Ajello S , Altizio S , Nardelli P , Scandroglio AM 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Severe acute cardiogenic shock is a life-threatening condition associated with high in-hospital mortality. Impella 5.0 is a transcatheter left ventricular assist device that ensuring up to 5 L/min of blood flow can provide full hemodynamic support as bridge to recovery, heart transplantation or long term mechanical circulatory support (MCS).

Purpose
To assess role and outcomes of Impella 5.0 device as tMCS in deep acute cardiogenic shock and describe the results of different pathways of care in these patients.

Methods
All consecutive patients who underwent Impella 5.0 implantation for cardiogenic shock at our institution between January 2018 and June 2021 were included in the study.

Results
A total of 40 patients, primarily males (85%) with a median age of 62 (54-70) years, underwent axillary Impella 5.0 implantation for severe cardiogenic shock (SCAI CS stage D: n= 12, 30%; stage E: n= 28, 70%), due to de novo onset acute myocardial infarction in 70% of patients. One third of the patients had been resuscitated and 90% were already on short term mechanical circulatory support (35% on V-A ECMO): median ejection fraction at implantation was 10 (5-20)%. Twenty-eight patients survived to next therapy or recovery (70%). Eleven patients (28%) experienced recovery and were weaned from MCS, 10 underwent LVAD implantation (25%), and seven (17%) were bridged to cardiac transplantation. Median duration of Impella support was 13 days (maximum duration 52 days) ,and, thanks to axillary approach, 33% were successfully mobilized during support. Device complications were limited, the most frequent being major haemolysis (28%), bleeding from cannulation site (13%), and device malfunction requiring replacement (20%),and with other complications incidence &lt; 5%. Hospital survival was 60% overall: 100% in recovery patients, 90% in patients bridged to LVAD and 57% in patients underwent heart transplantation. Main cause of death was multiorgan failure (n=6). "Recovery" patients compared to "non-recovery" (figure 1 and2) had lower SCAI CS stage (p= 0.037), lower diabetes incidence (9% vs 48%, p=0.02) were less likely to be already on MCS support (73% vs 96%, p= 0.025) and had undergone a faster upgrade of support to Impella 5.0 (2 vs 4.5 days, p= 0.04).

Conclusions
Temporary support with Impella 5.0 proved to have a key role in the management of cardiogenic shock, and showed high survival with low complication rate in these critical patients. Restoring hemodynamic and end-organ perfusion allows to get over the phase of shock and prolonged support allows pathways towards cardiac recovery or next therapies. The early identification of prognostic factors for hemodynamic recovery is crucial, since it may simplify selection for LVAD vs transplantation listing and in the timing of bridging to next therapy.
Patients with rheumatic disease experiencing ST-elevation myocardial infarction have increased inflammatory- and neurohormonal response and higher 1-year mortality
Authors: Frydland M , Moeller JE , Holmvang L , Goetze JP , Jensen LO , Hassager C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): This work was supported by Righospitalets Forskningsfond (Grant number: 07IO).
Lundbeck Foundation (R186-2015-2132).

Background
Patients with rheumatoid diseases have been reported to have increased risk of ST-elevation myocardial infarction (STEMI). However, little is known about mortality risk following STEMI in these patients. Furthermore, STEMI patients with increased neurohormonal- and inflammatory response have higher mortality compared to patients with low response.

Purpose
We sought to assess whether patients with a rheumatic disease (RD) have an increased inflammatory- and neurohormonal response to a STEMI and whether 1-year mortality was higher in these patients compared to patients without rheumatic disease.

Methods
In 1700 consecutive STEMI patients (comatose cardiac arrest- and cardiogenic shock patients were excluded) from two Danish tertiary heart centres were studied. Biomarkers reflecting neurohormonal activation (pro-atrial natriuretic peptide (proANP), copeptin, and mid-regional pro-adrenomedullin (MRproADM)) and inflammatory response (C-reactive protein (CRP) and ST2) were measured at in the catheterization laboratorium before the acute coronary angiogram was performed. Patients were stratified according to known RD or not.

Results
In total, 88 (5.2%) STEMI patients had a RD diagnosis. From these 28 (32%) had RA, 9 (10%) had psoriasis arthritis, and 23 (26%) had gout, while 28 (32%) had other RDs. Patients in the two groups were similar of age (no RD vs. RD, mean (SD): 63 (13) vs. 65 (14) years, p=0.22), mostly male (n (%) 1194 (74) vs 57 (66), p=0.08) with similar number of comorbidities, same LVEF (median (IQR) 50 (40-55) vs. 50 (40-55), p=0.58), and similar infarct size (maximum troponin T concentration 3050 (1150-6885) vs. 3030 (1500-7260) ng/L, p=0.79). In RD patients, admission concentration of MRproADM (median (IQR) 0.77 (0.63-0.98) vs. 0.71 (0.58-0.90) nmol/L, p=0.04), ST2 (43 (33-64) vs 39 (29-55) ng/ml, p=0.04), and CRP (6.8 (2.9-14) vs 3.3 (1.4-8.2) mg/L, p&lt;0.0001) was higher compared to patients without RD. No difference in proANP and copeptin was detected. One-year all-cause mortality was higher in patients with RD (11% vs. 5.5%, p=0.02). When including patients with CS and patients comatose after cardiac arrest, the signal remained intact.

Conclusion
STEMI patients with RD have higher admission inflammatory response and neurohormonal activation compared to patients without. Furthermore, patients with RD have higher 1-year all-cause mortality.
Age shock index, a better predictor of prognosis for our patients?
Authors: Arroyo Monino DF , Garcia Gonzalez N , Lorenzo Lopez B , Sayago Silva I , Hidalgo Urbano RJ , Garcia Rubira JC 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Shock is the main cause of in-hospital mortality in the setting of the Acute Coronary Syndromes (ACS). Shock Index (SI) Has been propposed as an useful predictor of shock and prognosis of the patients admitted because of an ACS. Not only this, a new index, derived from the previous one, which is known as Age Shock Index (ASI) seems to be even more accurate when evaluating these patients.

Objetive
Our first aim is to test if ASI is more accurate than SI to predict the occurrence of shock in patients admitted to the hospital with the diagnosis of ACS. Our second aim is to check if ASI is more accurate than SI, GRACE score and CRUSADE score to predict the in-hospital mortality of patients admitted to a hospital with the diagnosis of ACS and the presence of shock in the moment of the admission.

Material and methods
Observational, retrospective and single-center study including patients admitted to a Coronary Critical Care Unit (CCCU) between July 2.011 and March 2.021. ASI was calculated with the following formula: (heart rate x age) / systolic blood pressure.
We calculated receptor-operative curves (ROC) of ASI and SI as predictors of shock for patients not presenting shock at the admision. We also calculated ROC of ASI, SI, GRACE and CRUSADE as predictors of in-hospital mortality of patients admitted in shock situation. We compared the area under the curve (AUC) between them.

Results
For the shock-prediction test we included 2.537 patients, who were admitted in Killip score &lt;4. We found that ASI was a better predictor than SI, with a bigger AUC (0,76 (0,73–079) vs 0,72 (0,68–0,76), p&lt;0,001, Picture 1) , being 44,6 the optimal cut point with better sensibility (0,67) and specificity (0,76).
For the in-hospital mortality in shock patients prediction test we included 240 patients admitted in Killip score = 4. As we show in Picture 2, ASI was found to be a better predictor than SI and GRACE score, but not better than CRUSADE score, being 49,2 the optimal cut point with better sensibility (0,71) and specificity (0,53)

Conclusion
ASI is a better predictor of shock in patients admitted because of ACS than SI and also a better predictor of in-hospital mortality than SI and GRACE score in patients admitted because of ACS and a situation of shock at the admision. Althoug it was not better that CRUSADE score for this purpose, in favour of this index we highlight its simplicity of calculation, which, together with his good prediction capability, make it very useful in the acute setting.
Clinical and angiographic characteristics and short-term outcomes of patients with non-ST elevation acute coronary syndrome with metabolic syndrome
Authors: Uzokov J , Alyavi AL , Alyavi BA , Payziev DD , Mukhitdinova OY , Orziev DZ , Rakhimova DA 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Less evidence is available regarding clinical, angiographic characteristics and outcomes of patients with non-ST elevation acute coronary syndrome (ACS) with metabolic syndrome (MS).

Purpose
We aimed to assess the clinical, angiographic characteristics and short-term outcomes of patients admitted to our hospital with non-ST elevation ACS with MS.

Methods
128 patients with non-ST elevation ACS were enrolled in the study (Aged 38-75 years; mean age 56.2±16.85 years; male 53%). Patients were divided into two groups according to concomitant metabolic syndrome. Group I consisted of 64 patients with MS and Group II (n=64) without MS. Anthropometric, laboratory and instrumental data were assessed at baseline together with clinical and angiographic characteristics. All statistical analysis were done with STATA software.

Results
Non-ST elevation ACS patients with MS (Group I) tended to be younger (52.5 vs. 58.6, P&lt;0.05), female gender (57% vs. 46%, P&lt;0.05), smoked less (21.0 vs. 28.2%, P&lt;0.05), having greater BMI (30.4 vs 26.8, P&lt;0.05), having less pronounced symptoms (P&lt;0.05) and greater extensive lesions in coronary angiography (P&lt;0.05) than those without MS. There were similar single-vessel (52% vs. 55%, P&gt;0.05) and multi-vessel (28% vs 26%, P&gt;0.05) lesions in both groups in coronary angiography. New revascularization was higher in Group I than Group II (72% vs. 65%, P&lt;0.05). In 12% of patients non-ST elevation ACS was occurred due to vasospasm in Group I and in 11% in Group II. There were similar hospitalization days in both groups (P&gt;0.05), however short-term outcomes was better in Group II in 6 months (P&lt;0.05).

Conclusion
MS is associated with higher rate of revascularization and worse outcome in patients presenting non-ST elevation ACS.
TAVR in patients with cardiogenic shock or severely decompensated aortic stenosis
Authors: Steffen J , Stocker A , Scherer C , Haum M , Fischer J , Theiss H , Braun D , Rizas K , Peterss S , Massberg S , Orban M , Deseive S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Severe aortic stenosis (AS) can result in cardiogenic shock (CS) or severe cardiac decompensation. Although transcatheter aortic valve replacement (TAVR) is the routine procedure for elderly or inoperable patients with severe AS, its role as an emergency therapy for critically ill patients, especially due to CS, needs further investigation.

Purpose
The purpose of this study was to explore clinical characteristics and long-term survival of patients treated with emergency TAVR. We hypothesised that patients surviving the initial interventional and intensive care treatment would have a similar prognosis as elective TAVR patients.

Methods
All patients undergoing TAVR at our centre between 2013 and 2019 were screened for emergency TAVR or treatment on intensive care units (ICU) before TAVR. Selected patients were divided into groups with or without CS, defined as systolic blood pressure &lt;90 mmHg or the use of inotropes and lactate &gt;2 mmol/l. The remaining patients undergoing elective TAVR served as a comparison cohort.

Results
Out of 189 patients with emergency TAVR, 53 patients were in CS (shock group) and 136 patients did not fulfil CS criteria (urgent group). Patients in the shock group were more often male (75.5% vs. 56.6%, p=0.02), had a higher Society of Thoracic Surgeons score (15.6 [IQR, 7.7-30.5] vs. 5.4 [3.8-8.3], p&lt;0.01), and lower left-ventricular ejection fraction (38.0% vs. 48.0%, p&lt;0.01). The rate of coronary artery disease was similar (78.0% vs. 75.2%, p=0.69). Concerning the cause of acute decompensation, a specific condition which resulted in a clinical deterioration triggering hospitalisation could be identified in most patients. These included, among others, volume overload, acute coronary syndromes, arrhythmias, infections, and bleeding.
Before TAVR, patients were treated on an ICU for 3 [2-5] days (shock group) and 2 [1-5] days (urgent group), p=0.01. In the shock group, mechanical ventilation was more frequent (52.8 vs. 14.7%, p&lt;0.01), and more patients received valvuloplasty before TAVR (18.9 vs. 3.7%, p&lt;0.01).
The Valve Academic Research Consortium 3 (VARC-3) composite endpoint of technical failure occurred more often in emergency patients (shock, 13.2% vs. urgent, 9.6%) than in the 2,741 patients after elective TAVR (4.8%, p&lt;0.01). Estimated 2-year mortality was higher in the shock compared to urgent group (hazard ratio, 2.1 [1.3-3.3], p&lt;0.01). In a landmark analysis from day 90, 2-year mortality in these groups was comparable to elective TAVR patients (p=0.41, Figure).

Conclusions
TAVR in CS is associated with increased mortality compared to other cases of urgent TAVR. Procedural complication rates exceed those of elective TAVR patients. However, patients treated with emergency TAVR who survived 90 days after the procedure had a prognosis similar to elective TAVR patients.