bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mechanical circulatory support devices in left main occlusion: a multicenter study from 2008 to 2020
Authors: Oliveira Campinas A , Braga M , Alexandre A , Costa R , Dias De Frias A , Calvao J , Brandao M , Passos Silva M , Pires De Morais G , Carlos Silva J , Brochado B , Luz A , Silveira J , Gomes C , Torres S 
Published: October 2022

Abstract

Introduction
Evidence of benefit in the use of mechanical circulatory support devices (MCS) in patients with acute myocardial infarction (AMI) is scarce. We aimed to evaluate the clinicalcharacteristics, prognosis and factors associated with the use of MCS in patients with AMI due to left main (LM) occlusion.

Methods
We performed a retrospective multicenter study of 128 consecutive patients with AMI with ≤12h of presentation with LM occlusion submitted to immediate reperfusion between January 1, 2008, until December 31, 2020 in three terciary hospitals of Portugal. Among this cohort, we divided patients into two groups according to the use of MCS devices.

Results
Regarding the baseline characteristics no statistically significant differences were found, except for the presence of cerebrovascular disease (2.9% in group with vs 16.9% in group without MCS, p=0.007) and peripheral artery disease (8.8% in group with vs 22% in group without MCS, p=0.037). We observed that the use of MCS devices was statistically different between the three centers (47.8%, 42%, 8.7%, p&lt;0.001). No differences were found at presentation for ST-segment elevation vs non-ST segment elevation AMI (p=NS). The presence of cardiogenic shock (72.4% vs 45.8%, p=0.002), cardiac arrest (27.5% vs 23.7%, p=0.034) and more severe thrombolysis in myocardial infarction (TIMI) flow at presentation (55.1% vs 35.6%, p=0.015) were more frequent in group with MCS. The rate of 1-year cumulative mortality was high in both groups (31/59=52.5% in the group without vs 47/69=68.1%, p=NS). Also, no statistically significant differences were found in terms of survival, but we observed a trend to higher mortality in those who received MCS as Kaplan-Meier survival curves show (log rank=0.062). Finally, in multivariable analysis, older age [odds ratio (OR), 0.935; 95% CI, 0.87–0.99], the presence of diabetes (OR, 0.223; 95% CI, 0.056–0.88), peripheral artery disease (OR, 0.070; 95% CI, 0.009–0.566) and extra-hospitalar cardiac arrest (OR, 0.06; 95% CI, 0.007–0.543) were characteristics associated with lower odds of receiving MCS. Contrarily, male sex (OR, 5; 95% CI, 1–20.4) and the presence of cardiogenic shock (OR, 5.7; 95% CI, 1.42–23) were factors associated with higher use of MCS.

Conclusion
The use of MCS does not seem to modify prognosis in patients admitted withAMI due to left main occlusion. Only cardiogenic shock and male gender were predictors of MCS use.

Funding Acknowledgement
Type of funding sources: None.
Utility of the Age Shock Index in 27312 patients with an acute coronary syndrome
Authors: Rocha Carvalho P , Monteiro J , Carvalho C , Mateus P , Goncalves F , Fontes P , Moreira J I 
Published: October 2022

Abstract

Introduction
The Shock Index (SI), defined as the ratio of heart rate (HR) to systolic blood pressure (SBP), represents a bedside reflection of the integrated response from the cardiovascular and autonomic systems and has been reported to predict adverse prognosis in patients with acute coronary syndromes (ACS).
Age Shock Index (ASI), the product of SI multiplied with age, could also be useful in this setting, but its prognostic value is yet to be determined in ACS patients.

Methods
Acute myocardial infarction patients included in a national registry between October 2010 and January 2022. Optimal shock index cutoff was determined according to ROC curve analysis. Patients were categorized into two groups based on their initial ASI. Baseline characteristics, management and outcomes were compared between the two groups. The primary outcome was in-hospital cardiovascular death.

Results
A total of 27312 patients were included with a mean age of 66±13 years, 72.3% male, 47.5% with ST-elevation myocardial infarction. Based on ROC analysis, which showed AUC=0.80, the optimal ASI cutoff was 44 (with a sensitivity of 73% and a specificity of 74%); 19997 patients (73.2%) had an ASI &lt;44 and 26.8% had an ASI ≥44. The former group was older (mean age of 75±10.0 vs 63±13.0 years, p&lt;0.001), and had more comorbidities: arterial hypertension (77.3% vs 66.3%, p&lt;0.001), diabetes mellitus (39.8% vs 28.1%, p&lt;0.001), peripheral artery disease (7.1% vs 4.4%, p&lt;0.001) and previous history of heart failure (11.0% vs 4.3%, p&lt;0.001).
Patients with ASI ≥44 had higher Killip class at admission and worse left ventricular ejection fraction on discharge (46.0±13.0 vs 53.0±11.0, p&lt;0.001).
In a multivariate regression analysis, after adjusting for possible confounders, ASI ≥44 was an independent predictor of cardiovascular death (HR 3.09, 95% CI: 2.56–3.71, p&lt;0.001).
ASI was a significantly better predictor of cardiovascular death than Shock Index (AUCASI = 0,80 vs AUCSI = 0.72, p&lt;0,0001), but not in comparison to GRACE score (AUCASI=0.80 vs AUCGRACE=0.85, p&lt;0.001) and TIMI (score AUCASI=0.80 vs AUCGRACE=0.84, p&lt;0.001).
At one year, using a Kaplan Meyer survival analysis, mortality was higher in patients with ASI ≥44 (log rank p&lt;0.001)

Conclusion
ASI can identify almost immediately ACS patients at high risk of cardiovascular death, and combined with its simple use, makes it a practical tool for early risk stratification in these patients.

Funding Acknowledgement
Type of funding sources: None.
Acute total occlusion of the unprotected left main coronary artery – patient characteristics and outcomes
Authors: Calvao J , Braga M , Brandao M , Campinas A , Alexandre A , Amador A F , Costa C , Carvalho M M , Pinto R A , Proenca T , Silva J C , Pires-Morais G , Silva M P , Brochado B , Macedo F 
Published: October 2022

Abstract

Background
Acute total occlusion of the unprotected left main coronary artery (ATOLMCA) is a dramatic entity with very high mortality. Owing to its infrequency, there is limited and inconsistent data regarding this population.

Purpose
To describe the clinical presentation, short- and long-term outcomes of patients with ATOLMCA.

Methods
This retrospective multicentric cohort study included all patients presenting with acute (&lt;12h) myocardial infarction (MI) due to ATOLMCA (Thrombolysis In Myocardial Infarction - TIMI=0) between January 2008 and December 2020 in three tertiary hospitals.

Results
In the period of the study, 11,036 emergent coronary angiographies were performed in the participating centers, 59 of which were ATOLMCA (0.5%). Mean age of patients at the time of the event was 61.2 (±12.2) years. Seventy-three percent were male. At presentation, 72.9% of patients were in cardiogenic shock, and aborted cardiac arrest occurred in 27.1%. Right dominance was present in all patients except one, who had a balanced dominance. Primary percutaneous coronary intervention (PCI) was performed in 89.8% of the patients, with angiographic success being achieved in 55.6% of the procedures. Overall, the in-hospital mortality rate was 57.6%. Mortality was significantly higher in patients without angiographic criteria for PCI success (87.5 vs 36.7%, p&lt;0.001). Among survivors, 91.7% were still alive at 1-year and 66.7% at 5 years of follow-up.

Conclusion
Patients with ATOLMCA have a dismal prognosis. Most patients present with cardiogenic shock, and a significant number develop cardiac arrest during the acute phase. Despite medical care, in-hospital mortality is high. Patients with left dominance may not even reach the hospital. Among survivors, long term outcomes are reasonable. Further studies are needed in order to improve the management and outcomes of patients with ATOLMCA.

Funding Acknowledgement
Type of funding sources: None.
Binary endocardial appearance for Fabry disease diagnosis: a systematic review and meta-analysis
Authors: Segura P , Alvarez-Vargas M , Nieto-Gutierrez W , Quispe-Vicuna C , Pariona M , Bulwer B 
Published: October 2022

Abstract

Objective
This study aimed to determine the performance of the endocardial binary appearance (binary sign [BS]) on echocardiography for Fabry-Anderson disease (FD) diagnosis.

Methods
A diagnostic systematic review was performed, which included studies with &gt;20 patients selected, with enough reported data to compute the 2 × 2 tables, and with a BS evaluation against a genetic test. Evidence was searched up to October 4, 2020, in the following databases: PubMed, Scopus, EMBASE, and Web of Science. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 tool and certain evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results
Four studies were included in the systematic review. All studies were cross-sectional that included 524 patients that compared the BS vs. the alpha-galactosidase-A and/or genetic test, alpha-galactosidase-A and globotriaosylceramide isoform, and genetic test alone. The BS was found to have a sensitivity of 41% (confidence interval [CI] 95% = 17–71) and specificity of 91% (CI 95% = 60–99) and area under the curve of 0.71 (CI 95% = 0.64–0.78) for diagnostic of FD, with a certain of evidence low.

Conclusion
The BS has a good performance in confirming the diagnosis of FD, but not for screening. However, the evidence had low certainty, thus future studies could modify these results.

Funding Acknowledgement
Type of funding sources: None.
Lung ultrasound predicts left-sided filling pressures in patients with cardiogenic shock admitted to the cardiac intensive care unit
Authors: Szekely Y , Brahmbhatt D H , Scolari F L , Doumouras B S , Billia F 
Published: October 2022

Abstract

Background
Left and right filling pressures, as well as cardiac output, are key targets in optimising treatment of cardiogenic shock (CS). Invasive pulmonary artery catheters can provide these data but are associated with complications and are not available in all hospital settings. Lung ultrasound (LUS) can detect pulmonary congestion in patients with heart failure (HF) and may be an alternative to invasive monitoring. We assessed the correlation between LUS score and invasive haemodynamic parameters in patients with CS admitted to the cardiac intensive care unit (CICU) of a North American cardiac centre.

Methods
We prospectively evaluated consecutive patients who underwent pulmonary artery catheter insertion in the CICU. Haemodynamic parameters including right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) were measured and cardiac output (CO) was calculated using the thermodilution method. This was immediately followed by an 8-zones LUS done by a critical care cardiologist who was blinded to the invasive hemodynamic measurements. The LUS score was calculated by counting the total number of B-lines in all 8 zones, with a higher score indicating greater congestion. Correlations between LUS score and hemodynamic parameters were evaluated using Pearson's correlation.

Results
Ninety-six measurements from 60 patients were included, aged 58±14 years with 27% female. The most common diagnosis at admission was cardiogenic shock, followed by acute myocardial infarction and HF exacerbation. Most patients were at SCAI stages C and D at the time of assessment. The mean number of B-lines at LUS was 10.1±8.2. Mean RAP was 8.5±4.6 mmHg, PCWP 16.2±6.3 mmHg and CO of 5.0±1.8 L/min. The total number of B-lines was correlated with PCWP (r=0.66, P&lt;0.001, see Figure 1), RAP (r=0.26, P&lt;0.001) and cardiac output (r=−0.23, p=0.02). Due to the correlation of B-lines in LUS with PCWP, we then evaluated the area under the ROC of the LUS to identify patients with PCWP ≥15 mmHg. The number of positive zones (≥3 B-lines) showed an AUC of 0.81 (0.72–0.89), P&lt;0.001. In 36 patients, we had repeated measurement with more than 12 hours apart. The delta change in PCWP was correlated with delta change in the number of B-lines (r=0.59, P&lt;0.001).

Conclusion
Elevated LUS score in patients with CS is associated with worse invasively-measured LV filling pressures, but less so with RAP or CO. LUS can serve as a useful adjunct to the clinical assessment of patients with CS who do not receive invasive hemodynamic monitoring, either at a single timepoint or to detect changes in clinical status over time, to guide ongoing management.

Funding Acknowledgement
Type of funding sources: None.
A 10-year cohort on prognostic outcomes in patients presenting with acute myocardial infarction complicated by cardiogenic shock and/or cardiac arrest
Authors: Chew N , Teo V , Tan C , Kong G , Chin Y H , Ambhore A , Low A , Lee C H , Chan M Y , Tan H C , Ph L O H 
Published: October 2022

Abstract

Background
Cardiogenic shock (CS) and cardiac arrest (CA) complicating acute myocardial infarction (AMI) portend unfavourable outcomes. This study examined the prognosis of patients presenting with AMI complicated by CS and/or CA.

Methods
Consecutive patients presented with AMI to a percutaneous coronary intervention-capable tertiary institution between 2011 and 2021 were studied. Patients were stratified based on the presence or absence of CS (CS+ or CS−) and CA (CA+ or CA−). The primary outcome was 30-day cardiovascular-related mortality. Subgroup analyses based on AMI-type and sex were conducted. Kaplan-Meier curves for cardiovascular-related mortality based on the AMI-type and sex were constructed.

Results
The study included 11,608 AMI patients, 283 of whom had CS+/CA+, 1,068 had CS+/CA−, 54 had CS−/CA+ and 10,203 had CS−/CA−. Cardiovascular-related mortality was significantly higher for CS+/CA+ (57.6%), followed by CS+/CA− (41.6%), CS−/CA+ (20.4%) and CS−/CA− (2.4%). Kaplan-Meier curves demonstrated CS+/CA+ group had the highest mortality (HR=36.26; 95% CI: 29.71–44.25, p&lt;0.001), followed by CS+/CA− (HR=21.59; 95% CI: 18.47–25.24, p&lt;0.001) and CS−/CA+ (HR=9.18; 95% CI: 5.02–16.80, p&lt;0.001), with CS−/CA− as the reference. Those with NSTEMI had consistently higher cardiovascular-related mortality rates than their STEMI counterparts for all groups, apart from the CS+/CA+ group. The sex-specific analysis demonstrated that the survival curves for females with CS+/CA+, CS+/CA− and CS−/CA+ converged, whilst the survival curves for males diverged over time. The multivariable Cox regression revealed the presence of CS and CA are independent predictors of cardiovascular-related mortality, but not NSTEMI, when adjusted for age, gender, diabetes, left ventricular ejection fraction, chronic renal failure, and culprit vessel.

Conclusions
AMI associated with CA and CS portends the least favourable survival, followed by those with CS or CA alone. Excess mortality was observed in the traditionally perceived lower-risk groups, particularly in women. This calls for increased awareness amongst clinicians when managing this subset of high-risk patients.

Funding Acknowledgement
Type of funding sources: None.
Door to support in acute myocardial infarction complicated by cardiogenic shock: an updated meta-analysis
Authors: Iannaccone M , Franchin L , Hanson I D , Boccuzzi G G , Basir M B , Truesdell A G , O'Neil W W 
Published: October 2022

Abstract

Introduction
The impact of time to hemodynamic support in acute myocardial infarction complicated by cardiogenic shock (AMICS) has yet to be defined. The aim of this meta-analysis was to evaluate the impact of timing of Impella mechanical circulatory support (MCS) initiation on early and midterm mortality.

Methods
A systematic literature review and meta-analysis was conducted using PubMed and Cochrane databases. All studies reporting short-term mortality rates and timing of Impella placement in AMICS were included. Meta-regression analysis and sensitivity analysis were performed on the primary endpoint, short-term mortality (≤30 days), and secondary endpoints (midterm mortality, device-related bleeding, and limb ischemia).

Results
Of 1289 studies identified, 13 studies (6810 patients; 2970 patients identified as receiving Impella pre-PCI and 3840 patients receiving Impella during/post-PCI) were included in this analysis. Median age was 63.8 years (IQR, 63–65.7); 76% of patients were male, and a high prevalence of cardiovascular risk factors was noted across the entire population. Short-term mortality was significantly reduced in those receiving pre-PCI vs. during/post-PCI Impella support (37.2% vs 53.6%, RR 0.7; CI 0.56–0.88). Midterm mortality was also lower in the pre-PCI Impella group (47.9% vs 73%, RR 0.81; CI 0.68–0.97). The rate of device-related bleeding (RR 1.05; CI 0.47–2.33) and limb ischemia (RR 1.16; CI 0.63–2.15) were similar between the two groups.

Conclusion
This analysis suggests that Impella MCS placement prior to PCI in AMICS may have a positive impact on short- and midterm mortality compared with post-PCI, with similar safety outcomes.

Funding Acknowledgement
Type of funding sources: None.
The utilization and mortality benefits of pulmonary artery catheterization in patients with cardiogenic shock
Authors: Gill J , Jeelani H , Patel H 
Published: October 2022

Abstract

Introduction
Pulmonary artery catheterization (PAC) can provide essential hemodynamic data to assist in managing critical patients with cardiogenic shock. The use of PAC has been controversial as clinical studies have shown a lack of benefit. However, with the recent widespread availability of mechanical circulatory assists devices, the application and benefits of PAC are expected to rise.

Purpose
To determine the impact of PAC on inpatient outcomes and the utilization of advanced heart failure devices in these patients.

Methods
The National Inpatient Sample from 2016 to 2018 was queried to identify patients with cardiogenic shock. Of these patients, we compared those who received invasive hemodynamic monitoring (IHM) with PAC to those who did not receive PAC. Patients under age 18 and those undergoing surgical or transcatheter cardiac procedures during the same admission were excluded. Multivariate logistic regression was used to select matched samples between groups accounting for patient/hospital demographics and medical comorbidities. The primary endpoint was a comparison of in-hospital mortality, length of hospitalization, and medical costs. The secondary endpoints compared the utilization of mechanical circulatory assists devices: percutaneous ventricular assist devices (pVAD), extracorporeal membrane oxygenation (ECMO), and left ventricular assist device (LVAD), and the incidence of post-PAC complications: pneumothorax, sepsis, and hemorrhage/hematoma.

Results
We identified a total of 279,619 patients admitted with cardiogenic shock, of these patients 25,166 (9%) received IHM with PAC. Patients who had PAC had decreased in-hospital mortality (22.3% vs 29.7%; p&lt;0.001), increased length of hospitalization (12 days vs 9 days; p&lt;0.001), and increased medical costs ($65,884 vs $47,983; p&lt;0.001). Furthermore, in patients with PAC there was increased utilization of pVAD (4.5% vs 1.9%; p&lt;0.001), ECMO (0.07% vs 0.01%; p&lt;0.001), and LVAD (2.2% vs 0.3%; p&lt;0.001). There was no difference in the prevalence of post-PAC complications between both groups.

Conclusions
The use of IHM with PAC was associated with improved mortality and utilization of mechanical circulatory assist devices in patients with cardiogenic shock without increasing risk for post-procedural complications. Therefore, the increased average duration and medical costs of hospitalization with PAC patients likely resulted from improved patient survival. Therefore, the present study indicated that IHM with PAC is safe and beneficial for patients with cardiogenic shock.

Funding Acknowledgement
Type of funding sources: None.
Suture-based vs. pure plug-based vascular closure devices for VA-ECMO decannulation
Authors: Scherer C , Theiss H , Istrefi M , Stocker T J , Kupka D , Luesebrink E , Hausleiter J , Hagl C , Massberg S , Orban M 
Published: October 2022

Abstract

Background
VA-ECMO is a valuable treatment option for patients in cardiogenic shock, but complications during decannulation may worsen the overall outcome. To date, no larger study has ever compared suture-based to pure plug-based vessel closure devices for VA-ECMO decannulation.

Purpose
The aim of the study was to compare the efficacy and safety of suture-based to pure plug-based vascular closure devices for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) decannulation for patients with cardiogenic shock.

Methods
In this retrospective study, the outcome of 33 patients with suture-based closure devices implanted between 02/2019 to 05/2020 were compared to 38 patients with plug-based closured device implanted between 06/2020 to 11/2021.

Results
Closure device success rate was 88% in the suture-based group versus 97% in the plug-based group (Figure 1, p=0.27). Median number of devices used was two for patients with suture-based closure device and 1 for patients with plug-based closure device (p&lt;0.01). Severe bleeding was more frequent in the suture-based (21%) compared to the plug-based group (3%) (Figure 2, p=0.04). Ischemic complications occurred in 6% with suture-based and 5% with plug-based device (p=1.00). Pseudoaneurysm formation was detected in 3% in both groups (p=1.00). Application of the femoral compression system was required in 27% of patient with suture-based closure device and 11% of patients with plug-based closure device (p=0.13). No switch to open vascular surgery due to closure device failure occurred in both groups.

Conclusions
Based on our retrospective analysis, we propose that plug-based vascular closure should be the preferred option for VA-ECMO decannulation. This hypothesis should be further tested in a randomized trial.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft
Use of mechanical circulatory support in patients with non-ischemic cardiogenic shock
Authors: Schrage B , Sundermeyer J , Blankenberg S , Graf T , Kirchhof P , Luedike P , Nordbeck P , Proudfoot A , Orban M , Skurk C , Tavazzi G , Thiele H , Winzer E B , Westenfeld R , Westermann D 
Published: October 2022

Abstract

Background
The aim of this study was to evaluate mechanical circulatory support (MCS) for the treatment of non-ischemic cardiogenic shock (CS).

Methods
Data from 1,030 consecutive patients with non-ischemic CS treated with or without MCS at 16 tertiary-care centers were retrospectively collected. The association between MCS and 30-day mortality was assessed in a 1:1 propensity score matched cohort.

Results
MCS was used in 406 (39%) patients. MCS treated patients presented with more severe CS (lactate 5.4 vs. 4.1 mmol/l, systolic blood pressure 80 vs. 83 mmHg, higher SCAI class) and with more disease modifiers (prior cardiac arrest 42.4 vs. 36.1%, mechanical ventilation 78.4 vs. 56.5%). After matching, 272 patients treated with were compared vs. 272 patients treated without MCS. MCS was associated with a lower 30-day mortality (hazard ratio 0.77, 95% confidence interval 0.60–0.98, Figure 1). This finding was consistent through all tested sub-groups except when ejection fraction was considered, indicating an association especially in patients with an ejection fraction ≤20%. Complications occurred more frequently in patients with MCS; e.g. severe bleedings (21.8 vs. 9.2%) and access-site related ischemia (6.6 vs. 0%).

Conclusion
In patients with non-ischemic CS, MCS use was associated with lower 30-day mortality as compared to medical therapy only, particularly in patients with a lower ejection fraction. This provides rationale for randomized trials to validate these findings.

Funding Acknowledgement
Type of funding sources: None.