Journal: Eur Heart J Acute Cardiovasc Care

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Abstract

Prognostic relevance of GRACE risk score in Takotsubo syndrome.

Scudiero F, Arcari L, Cacciotti L, De Vito E, ... Di Mario C, Parodi G
Background
Takotsubo syndrome is an increasingly recognised cardiac condition that clinically mimics an acute coronary syndrome, but data regarding its prognosis remain controversial. It is currently unknown whether acute coronary syndrome risk scores could effectively be applied to Takotsubo syndrome patients. This study aims to assess whether the Global Registry of Acute Coronary Events (GRACE) score can predict clinical outcome in Takotsubo syndrome and to compare the prognosis with matched acute coronary syndrome patients.
Methods
A total of 561 Takotsubo syndrome patients was included in this prospective registry. According to the GRACE score, the population was divided into quartiles. The primary endpoint was all-cause mortality and the secondary endpoints were cardiocerebrovascular events (a composite of all-cause mortality, cardiovascular death, recurrence of Takotsubo syndrome and stroke).
Results
The median GRACE risk score was 139±27. Takotsubo syndrome patients with a higher GRACE risk score mostly have a higher rate of physical triggers and lower left ventricular ejection fraction on admission. During long-term follow-up, all-cause mortality rates were 5%, 11%, 12% and 22%, respectively, in the first, second, third and fourth quartile (<0.001). After multivariate analysis, the GRACE risk score was found to be a strong predictor of all-cause mortality (odds ratio (OR) 1.68, 95% confidence interval (CI) 1.28-2.20; =0.001) and cardiocerebrovascular events (OR 1.63, 95% CI 1.26-2.11; =0.001). Moreover, all-cause mortality in Takotsubo syndrome patients was comparable with the matched acute coronary syndrome cohort.
Conclusion
In Takotsubo syndrome, the GRACE risk score allows us to predict all-cause mortality and cardiocerebrovascular events at long-term follow-up.



Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:721-728
Scudiero F, Arcari L, Cacciotti L, De Vito E, ... Di Mario C, Parodi G
Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:721-728 | PMID: 31642689
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Abstract

Predictors and prognosis of delirium among older subjects in cardiac intensive care unit: focus on potentially preventable forms.

Mossello E, Baroncini C, Pecorella L, Giulietti C, ... Marchionni N, Bari MD
Background
Delirium is a common and potentially preventable condition in older individuals admitted to acute and intensive care wards, associated with negative prognostic effects. Its clinical relevance is being increasingly recognised also in cardiology settings. The aim of the present study was to assess the prevalence, incidence, predictors and prognostic role of delirium in older individuals admitted to two cardiology intensive care units.
Methods
All patients aged over 65 years consecutively admitted to the two participating cardiology intensive care units were enrolled. Assessment on admission included acute physiological derangement (modified rapid emergency medicine score, REMS), chronic comorbidity, premorbid disability and dementia. The Confusion Assessment Method-Intensive Care Unit was applied daily for delirium detection.
Results
Of 497 patients (40% women, mean age 79 years), 18% had delirium over the entire cardiology intensive care unit course, half of whom more than 24 hours after admission (incident delirium). Advanced age, a main diagnosis of ST-segment elevation myocardial infarction or acute respiratory failure, modified REMS, comorbidity and dementia were independent predictors of delirium. Adjusting for patient\'s features on admission, incident delirium was predicted by invasive procedures (insertion of peripheral arterial catheter, urinary catheter, central venous catheter, naso-gastric tube and intra-aortic balloon pump). In a logistic regression model, delirium was an independent predictor of inhospital mortality (odds ratio 3.18, 95% confidence interval 1.02, 9.93).
Conclusions
Eighteen per cent of older cardiology intensive care unit patients had delirium, with half of the cases being incident, thus potentially preventable. Invasive procedures were independently associated with incident delirium. Delirium was an independent predictor of inhospital mortality. Awareness of delirium should be increased in the cardiology intensive care unit setting and prevention studies are warranted.



Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:771-778
Mossello E, Baroncini C, Pecorella L, Giulietti C, ... Marchionni N, Bari MD
Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:771-778 | PMID: 31617374
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Abstract

Family history of coronary artery disease is associated with acute coronary syndrome in 28,188 chest pain patients.

Wahrenberg A, Magnusson PK, Discacciati A, Ljung L, ... Linder R, Svensson P
Background
The value of family history of coronary artery disease (CAD) in diagnosing acute coronary syndrome (ACS) in chest pain patients is uncertain, especially in relation to high-sensitivity assays for cardiac troponin T (hs-cTnT), which have improved ACS diagnostics. Our objective was to investigate the association between verified family history of CAD and ACS in chest pain patients, overall and in different strata of initial hs-cTnT.
Methods
Data on chest pain patients visiting four emergency departments in Sweden during 2013-2016 were cross-referenced with national registers of kinship, diseases and prescriptions. Family history of early CAD was defined as the occurrence of myocardial infarction or coronary revascularization before the age of 55 years in male and 65 years in female first-degree relatives. The outcome was combined including ACS and cardiovascular death within 30 days of presentation.
Results
Of 28,188 patients, 4.7% of patients had ACS. In total, 8.2% and 32.4% had a family history of early and ever-occurring CAD, respectively. Family history of CAD was positively associated with the outcome, independently of age, gender, cardiovascular risk factors and electrocardiogram findings. The strongest association was observed for family history of early CAD (odds ratio 1.62, 95% confidence interval 1.35-1.94). Stronger associations were observed in young patients (e.g. <65 years) and in patients with non-elevated initial hs-cTnT levels (-value for interaction = 0.004 and 0.001, respectively).
Conclusions
Family history of CAD is associated with ACS in chest pain patients, especially in patients of young age or with non-elevated initial hs-cTnT levels.



Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:741-747
Wahrenberg A, Magnusson PK, Discacciati A, Ljung L, ... Linder R, Svensson P
Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:741-747 | PMID: 31124704
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Abstract

Incidence, predictors and prognostic impact of intracranial bleeding within the first year after an acute coronary syndrome in patients treated with percutaneous coronary intervention.

Raposeiras-Roubín S, Abu-Assi E, Caneiro Queija B, Cobas Paz R, ... Kedev S, Íñiguez-Romo A
Background
The rate of intracranial haemorrhage after an acute coronary syndrome has been studied in detail in the era of thrombolysis; however, in the contemporary era of percutaneous coronary intervention, most of the data have been derived from clinical trials. With this background, we aim to analyse the incidence, timing, predictors and prognostic impact of post-discharge intracranial haemorrhage in patients with acute coronary syndrome undergoing percutaneous coronary intervention.
Methods
We analysed data from the BleeMACS registry (patients discharged for acute coronary syndrome and undergoing percutaneous coronary intervention from Europe, Asia and America, 2003-2014). Analyses were conducted using a competing risk framework. Uni and multivariate predictors of intracranial haemorrhage were assessed using the Fine-Gray proportional hazards regression analysis. The endpoint was 1-year post-discharge intracranial haemorrhage.
Results
Of 11,136 patients, 30 presented with intracranial haemorrhage during the first year (0.27%). The median time to intracranial haemorrhage was 150 days (interquartile range 55.7-319.5). The fatality rate of intracranial haemorrhage was very high (30%). After multivariate analysis, only age (subhazard ratio 1.05, 95% confidence interval 1.01-1.07) and prior stroke/transient ischaemic attack (hazard ratio 3.29, 95% confidence interval 1.36-8.00) were independently associated with a higher risk of intracranial haemorrhage. Hypertension showed a trend to associate with higher intracranial haemorrhage rate. The combination of older age (⩾75 years), prior stroke/transient ischaemic attack, and/or hypertension allowed us to identify most of the patients with intracranial haemorrhage (86.7%). The annual rate of intracranial haemorrhage was 0.1% in patients with no risk factors, 0.2% in those with one factor, 0.6% in those with two factors and 1.3% in those with three factors.
Conclusion
The incidence of intracranial haemorrhage in the first year after an acute coronary syndrome treated with percutaneous coronary intervention is low. Advanced age, previous stroke/transient ischaemic attack, and hypertension are the main predictors of increased intracranial haemorrhage risk.



Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:764-770
Raposeiras-Roubín S, Abu-Assi E, Caneiro Queija B, Cobas Paz R, ... Kedev S, Íñiguez-Romo A
Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:764-770 | PMID: 31042052
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Abstract

Proposal for a standardized discharge letter after hospital stay for acute myocardial infarction.

Schiele F, Lemesle G, Angoulvant D, Krempf M, ... Ferrières J,

In patients admitted for acute myocardial infarction, the communication and transition from specialists to primary care physicians is often delayed, and the information imparted to subsequent healthcare providers (HCPs) may be sub-optimal. A French group of cardiologists, lipidologists and diabetologists decided to establish a consensus to optimize the discharge letter after hospitalization for acute myocardial infarction. The aim is to improve both the timeframe and the quality of the content transmitted to subsequent HCPs, including information regarding baseline assessment, procedures during hospitalization, residual risk, discharge treatments, therapeutic targets and follow-up recommendations in compliance with European Society of Cardiology guidelines. A consensus was obtained regarding a template discharge letter, to be released within two days after patient\'s discharge, and containing the description of the patient\'s history, risk factors, acute management, risk assessment, discharge treatments and follow-up pathway. Specifically for post acute MI patients, tailored details are necessary regarding the antithrombotic regimen, lipid-lowering and anti-diabetic treatments, including therapeutic targets. Lastly, the follow-up pathway needs to be precisely mentioned in the discharge letter. Additional information such as technical descriptions, imaging, and quality indicators may be provided separately. A template for a standardized discharge letter based on 8 major headings could be useful for implementation in routine practice and help to improve the quality and timing of information transmission between HCPs after acute MI.



Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:788-801
Schiele F, Lemesle G, Angoulvant D, Krempf M, ... Ferrières J,
Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:788-801 | PMID: 30990337
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Abstract

Prognostic value of automated pupillometry: an unselected cohort from a cardiac intensive care unit.

Obling L, Hassager C, Illum C, Grand J, ... Kondziella D, Kjaergaard J
Background
Patients admitted to a cardiac intensive care unit are often unconscious with uncertain prognosis. Automated infrared pupillometry for neurological assessment in the intensive care unit may provide early prognostic information. This study aimed to determine the prognostic value of automated pupillometry in different subgroups of patients in a cardiac intensive care unit with 30-day mortality as the primary endpoint and neurological outcome as the secondary endpoint.
Methods
A total of 221 comatose patients were divided into three groups: out-of-hospital cardiac arrest, in-hospital cardiac arrest and others (i.e. patients with cardiac diagnoses other than cardiac arrest). Automated pupillometry was serially performed until discharge or death and pupil measurements were analysed using the neurological pupil index algorithm. We applied receiver operating characteristic curves in univariable and multivariable logistic regression models and a calculated Youden index identified neurological pupil index cut-off values at different specificities.
Results
In out-of-hospital cardiac arrest patients higher neurological pupil index values were independently associated with lower 30-day mortality. The univariable model for 30-day mortality had an area under the curve of 0.87 and the multivariable model achieved an area under the curve of 0.94. The Youden index identified a neurological pupil index cut-off in out-of-hospital cardiac arrest patients of 2.40 for a specificity of 100%. For patients with in-hospital cardiac arrest and other cardiac diagnoses, we found no association between neurological pupil index values and 30-day mortality, and the univariable models showed poor predictive values.
Conclusion
Automated infrared pupillometry has promising predictive value after out-of-hospital cardiac arrest, but poor predictive value in patients with in-hospital cardiac arrest or cardiac diagnoses unrelated to cardiac arrest. Our data suggest a possible neurological pupil index cut-off of 2.40 for poor outcome in out-of-hospital cardiac arrest patients.



Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:779-787
Obling L, Hassager C, Illum C, Grand J, ... Kondziella D, Kjaergaard J
Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:779-787 | PMID: 30950641
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Abstract

Impact of body temperature at admission on inhospital outcomes in patients with takotsubo syndrome: insights from the Tokyo Cardiovascular Care Unit Network Registry.

Kimura A, Yoshikawa T, Isogai T, Tanaka H, ... Yamamoto T, Takayama M
Background
Takotsubo syndrome occasionally occurs in patients with fever due to underlying diseases. However, the impact of body temperature on inhospital prognosis of patients with takotsubo syndrome remains unknown.
Methods
Using the patient cohort in the Tokyo Cardiovascular Care Unit Network Registry from 2013 to 2015, we identified 421 eligible patients whose data on body temperature at admission were available and classified them into three groups: high body temperature group (≥37.5°C; =27), normal body temperature group (36.0-37.4°C; =319), and low body temperature group (≤35.9°C; =75). We compared the patient characteristics and inhospital outcomes among the three groups.
Results
On admission, the high body temperature group showed a higher proportion of men and preceding physical triggers, higher heart and respiratory rates, and higher C-reactive protein level than the other groups. Inhospital all-cause mortality was significantly higher in the high body temperature group than in the normal or low body temperature group (18.5% vs. 2.2% vs. 4.0%, respectively, <0.001). Both cardiac mortality (11.1% vs. 1.3% vs. 1.3%, =0.001) and non-cardiac mortality (7.4% vs. 0.9% vs. 2.7%, =0.031) were also significantly higher in the high body temperature group. Multivariable logistic regression analysis showed that high body temperature (reference: normal body temperature) was significantly associated with higher inhospital mortality (adjusted odds ratio 4.22; 95% confidence interval 1.15-15.51; =0.030).
Conclusions
Our findings suggest that high body temperature at admission is a strong predictor of inhospital mortality in patients with takotsubo syndrome. Febrile takotsubo syndrome patients may need to be managed with recognition of life-threatening conditions from the time of diagnosis, no matter what the causes of fever are.



Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:703-710
Kimura A, Yoshikawa T, Isogai T, Tanaka H, ... Yamamoto T, Takayama M
Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:703-710 | PMID: 31691595
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Abstract

Clinical outcomes of patients presenting with spontaneous coronary artery dissection versus takotsubo syndrome: a propensity score analysis.

Macaya F, Vedia Ó, Salazar CH, Mejía-Rentería H, ... Escaned J, Núñez-Gil IJ
Background
Spontaneous coronary artery dissection and takotsubo syndrome are non-atherosclerotic causes of acute coronary syndromes. They share clinical features including female predominance and frequent triggers. We compared the outcomes of patients with spontaneous coronary artery dissection and patients with takotsubo syndrome with similar clinical characteristics.
Methods
Patients with spontaneous coronary artery dissection (=81) or takotsubo syndrome (=341) were 1:1 propensity matched according to age, sex, cardiovascular risk factors and clinical presentation. We compared baseline characteristics, effects on left ventricular function, and recurrence of major adverse cardiovascular events; defined as a composite of new hospitalisation for cardiac cause, clinical recurrence (spontaneous coronary artery dissection/takotsubo syndrome), myocardial infarction and death.
Results
Propensity score yielded 78 pairs: 85% were women, whose average age was 55.3±12.6 years, 28% had two or more cardiovascular risk factors, 37% presented with ST-segment elevation and 5% presented with cardiogenic shock. In the spontaneous coronary artery dissection group, 50% (39/78) of cases involved the left anterior descending artery and 18% (14/78) underwent revascularisation. After a median follow-up of 5 years (interquartile range 2.4-5), major adverse cardiovascular events were significantly higher in the spontaneous coronary artery dissection group (18% (14/78) vs. 8% (6/78); hazard ratio 3.40, 95% confidence interval 1.2-9.4). This was mainly driven by early readmissions for cardiac causes (17% vs. 5%, =0.007). Spontaneous coronary artery dissection was associated with higher peak values of creatinine kinase during admission (creatinine kinase/upper limit of normality 2.49 vs. 1.21, <0.001). Binary left ventricular systolic dysfunction was more prevalent in the takotsubo syndrome group (22% vs. 53%, <0.001), but no significant differences were noted at follow-up (6% vs. 1%, =0.181).
Conclusions
In this cohort of middle-aged predominantly female patients presenting with acute coronary syndromes, the diagnosis of spontaneous coronary artery dissection compared to takotsubo syndrome conferred a worse long-term clinical outcome, mainly driven by an increased risk of rehospitalisation for cardiac causes.



Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:694-702
Macaya F, Vedia Ó, Salazar CH, Mejía-Rentería H, ... Escaned J, Núñez-Gil IJ
Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:694-702 | PMID: 31729884
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Abstract

Impact of previous coronary artery bypass grafting in patients presenting with an acute coronary syndrome: Current trends and clinical implications.

Ribeiro JM, Teixeira R, Siserman A, Puga L, ... Belo A, Gonçalves L
Background
Among patients presenting with an acute coronary syndrome, those with previous coronary artery bypass grafting are a particular subset.
Aims
The purpose of this study was to investigate the prognostic impact of previous coronary artery bypass grafting in acute coronary syndrome patients and to identify the current trends in their clinical management.
Methods
We performed a cohort analysis of patients prospectively enrolled in the Portuguese Registry of acute coronary syndrome between 2010-2019 with known previous coronary artery bypass grafting status. The co-primary endpoints were in-hospital and one-year mortality.
Results
A total of 19,334 (962 coronary artery bypass grafting and 18,372 non-coronary artery bypass grafting) and 9402 (479 coronary artery bypass grafting and 8923 non-coronary artery bypass grafting) patients were included in the analyses of in-hospital and mid-term outcomes, respectively. Coronary artery bypass grafting patients were older and had a higher incidence of comorbidities. They were less likely to undergo invasive angiography (74.9 vs 84.6%, <0.001), but were equally likely to receive dual antiplatelet therapy (91.0 vs 90.8%, =0.823). In-hospital mortality was similar between groups (3.6 vs 3.4%, =0.722). Unadjusted one-year mortality was higher in the coronary artery bypass grafting group (hazard ratio 1.48, 95% confidence interval 1.09-2.01, =0.012), but similar in both groups after propensity-matching and multivariate analysis (hazard ratio 0.63, 95% confidence interval 0.37-1.09, =0.098).
Conclusions
Among patients with acute coronary syndrome, a previous history of coronary artery bypass grafting was associated with a high burden of comorbidities and a high-risk profile but was not an independent predictor of adverse events. Treatment decisions should be made on a case-by-case basis, and should not be based on previous coronary artery bypass grafting status alone.



Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:731-740
Ribeiro JM, Teixeira R, Siserman A, Puga L, ... Belo A, Gonçalves L
Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:731-740 | PMID: 32180440
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Abstract

\"Takotsubo effect\" in patients with ST segment elevation myocardial infarction.

Lei J, Chen J, Dogra M, Gebska MA, ... Wang J, Liu K
Background
Myocardial infarction can be a trigger of Takotsubo syndrome. We recently characterized imaging features of acute myocardial infarction-induced Takotsubo syndrome (\"Takotsubo effect\"). In this study, we investigate diagnostic and prognostic implications of Takotsubo effect in patients with anterior wall ST-segment elevation myocardial infarction.
Methods
We enrolled 111 consecutive patients who developed anterior wall ST-segment elevation myocardial infarction and received percutaneous coronary intervention, and studied systolic/diastolic function, hemodynamic consequences, adverse cardiac events, as well as 30-day and five-year outcomes in patients with and without Takotsubo effect.
Results
Patients with Takotsubo effect showed significantly worse average peak systolic longitudinal strain (-9.5 ± 2.6% vs -11.1 ± 3.6%,  = 0.038), left ventricular ejection fraction (38.5 ± 6.8% vs 47.7 ± 8.7%,  = 0.000) and myocardial performance index (0.54 ± 0.17 vs 0.37 ± 0.15,  = 0.000) within 48 h of myocardial infarction. There was no significant difference between the two groups in diastolic ventricular filling pressures, hemodynamic consequences, and 30-day rehospitalization and mortality (Gehan-Breslow-Wilcoxon test: 0.157). However, patients with Takotsubo effect developed more major adverse cardiac events (log-rank test: 0.019) when tested at the five-year follow-up. Cox regression analysis revealed that age, hypotension, tricuspid annular plane systolic excursion, and Takotsubo effect were independent prediction factors for five-year major adverse cardiac events. The Doppler/tissue Doppler parameter E/e\' correlated with MACE only in patients without Takotsubo effect.
Conclusion
Takotsubo effect secondary to anterior ST-segment elevation myocardial infarction predicts a worse long-term prognosis.



Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:711-720
Lei J, Chen J, Dogra M, Gebska MA, ... Wang J, Liu K
Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:711-720 | PMID: 32508142
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Abstract

Acute cardiorenal syndrome in acute heart failure: focus on renal replacement therapy.

Schaubroeck HA, Gevaert S, Bagshaw SM, Kellum JA, Hoste EA

Almost half of hospitalised patients with acute heart failure develop acute cardiorenal syndrome. Treatment consists of optimisation of fluid status and haemodynamics, targeted therapy for the underlying cardiac disease, optimisation of heart failure treatment and preventive measures such as avoidance of nephrotoxic agents. Renal replacement therapy may be temporarily needed to support kidney function, mostly in case of diuretic resistant fluid overload or severe metabolic derangement. The best timing to initiate renal replacement therapy and the best modality in acute heart failure are still under debate. Several modalities are available such as intermittent and continuous renal replacement therapy as well as hybrid techniques, based on two main principles: haemofiltration and haemodialysis. Although continuous techniques have been associated with less haemodynamic instability and a greater chance of renal recovery, cohort data are conflicting and randomised controlled trials have not shown a difference in recovery or mortality. In the presence of diuretic resistance, isolated ultrafiltration with individualisation of ultrafiltration rates is a valid option for decongestion in acute heart failure patients. Practical tools to optimise the use of renal replacement therapy in acute heart failure-related acute cardiorenal syndrome were discussed.



Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:802-811
Schaubroeck HA, Gevaert S, Bagshaw SM, Kellum JA, Hoste EA
Eur Heart J Acute Cardiovasc Care: 29 Sep 2020; 9:802-811 | PMID: 32597679
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Abstract

Outcomes in non-ST-segment elevation myocardial infarction patients according to heart failure at admission: Insights from a large trial with systematic early invasive strategy.

Popovic B, Sorbets E, Abtan J, Cohen M, ... Steg PG,
Background
Previous studies published before the era of systematic early invasive strategy have reported a higher mortality in non-ST-segment elevation myocardial infarction patients with heart failure. The aim of our study was to compare the clinical characteristics, outcomes and causes of death of patients according to their heart failure status at admission in a large non-ST-segment elevation myocardial infarction population with planned early invasive management.
Methods
We performed a post-hoc analysis of the Treatment of Acute Coronary Syndrome with Otamixaban randomised trial which included non-ST-segment elevation myocardial infarction patients with systematic coronary angiography within 72 h. Patients were categorised according to presence or absence of heart failure (Killip grade ≥2) at admission.
Results
A total of 13,172 patients were enrolled, of whom 944 (7.2%) had heart failure. At day 30, death occurred in 213 patients (1.6%) and cardiovascular death was the dominant cause of death in both groups ((with vs without heart failure) 78.8% vs 78.4%,  = 0.94). At six months, death occurred in 90/944 (9.5%) patients with heart failure and 258/12228 patients without heart failure (2.1%) ( < 0.001). After adjustment on Global Registry of Acute Coronary Events risk score, heart failure was an independent predictor of all-cause mortality at day 30 (odds ratio: 1.58; 95% confidence interval, 1.06-2.36,  = 0.02) and at day 180 (odds ratio: 1.77; 95% confidence interval, 1.3-2.42,  < 0.001) as well as of ischaemic complications (cardiovascular death, myocardial infarction, stent thrombosis or stroke at day 30 (odds ratio: 1.28; 95% confidence interval, 1.01-1.62,  = 0.04).
Conclusion
Non-ST-segment elevation myocardial infarction patients with heart failure at admission still have worse outcomes than those without heart failure, even with systematic early invasive strategy. Further efforts are needed to improve the prognosis of these high risk patients.



Eur Heart J Acute Cardiovasc Care: 19 Oct 2020:2048872619896205; epub ahead of print
Popovic B, Sorbets E, Abtan J, Cohen M, ... Steg PG,
Eur Heart J Acute Cardiovasc Care: 19 Oct 2020:2048872619896205; epub ahead of print | PMID: 33081496
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Abstract

Use of hospital resources in the care of patients with intermediate risk pulmonary embolism.

Sullivan AE, Holder T, Truong T, Green CL, ... Jones WS, Patel MR
Background
Risk stratification and management of hemodynamically stable pulmonary embolism remains challenging. Professional societies have published stratification schemes, but little is known about the management of patients with intermediate risk pulmonary embolism. We describe the care of these patients at an academic health system.
Methods
Patient encounters from 1 January 2016 to 30 June 2017 were retrospectively identified utilizing a multihospital, electronic health record-based data warehouse. Using the 2019 European Society of Cardiology criteria, differences in hospital resource utilization, defined as intensive care unit admission, use of invasive therapies, and length of stay, were examined in patients with intermediate risk characteristics.
Results
A cohort of 322 intermediate risk patients, including 165 intermediate-low and 157 intermediate-high risk patients, was identified. Intermediate-high risk patients more often underwent catheter-directed therapy (14.0% vs. 1.8%; <0.001) compared to intermediate-low risk patients and had a 50% higher rate of intensive care unit admission (relative risk 1.50; 95% confidence interval 1.06, 2.12; =0.023). There was no difference in median intensive care unit length of stay (2.7 vs. 2.0 days; =0.761) or hospital length of stay (5.0 vs. 5.0 days; =0.775) between intermediate-high risk and intermediate-low risk patients. Patients that underwent invasive therapies had a 3.8-day shorter hospital length of stay (beta -3.75; 95% confidence interval -6.17, -1.32; =0.002).
Conclusion
This study presents insights into the hospital resource utilization of patients with intermediate risk pulmonary embolism. The 2019 European Society of Cardiology risk stratification criteria are a clinically relevant scheme that identifies patients more often treated with intensive care unit admission and advanced therapies.



Eur Heart J Acute Cardiovasc Care: 26 Nov 2020:2048872620921601; epub ahead of print
Sullivan AE, Holder T, Truong T, Green CL, ... Jones WS, Patel MR
Eur Heart J Acute Cardiovasc Care: 26 Nov 2020:2048872620921601; epub ahead of print | PMID: 33242980
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Abstract

Cardiac complications in patients hospitalised with COVID-19.

Linschoten M, Peters S, van Smeden M, Jewbali LS, ... Asselbergs FW,
Aims
To determine the frequency and pattern of cardiac complications in patients hospitalised with coronavirus disease (COVID-19).
Methods and results
CAPACITY-COVID is an international patient registry established to determine the role of cardiovascular disease in the COVID-19 pandemic. In this registry, data generated during routine clinical practice are collected in a standardised manner for patients with a (highly suspected) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requiring hospitalisation. For the current analysis, consecutive patients with laboratory confirmed COVID-19 registered between 28 March and 3 July 2020 were included. Patients were followed for the occurrence of cardiac complications and pulmonary embolism from admission to discharge. In total, 3011 patients were included, of which 1890 (62.8%) were men. The median age was 67 years (interquartile range 56-76); 937 (31.0%) patients had a history of cardiac disease, with pre-existent coronary artery disease being most common (=463, 15.4%). During hospitalisation, 595 (19.8%) patients died, including 16 patients (2.7%) with cardiac causes. Cardiac complications were diagnosed in 349 (11.6%) patients, with atrial fibrillation (=142, 4.7%) being most common. The incidence of other cardiac complications was 1.8% for heart failure (=55), 0.5% for acute coronary syndrome (=15), 0.5% for ventricular arrhythmia (=14), 0.1% for bacterial endocarditis (=4) and myocarditis (=3), respectively, and 0.03% for pericarditis (=1). Pulmonary embolism was diagnosed in 198 (6.6%) patients.
Conclusion
This large study among 3011 hospitalised patients with COVID-19 shows that the incidence of cardiac complications during hospital admission is low, despite a frequent history of cardiovascular disease. Long-term cardiac outcomes and the role of pre-existing cardiovascular disease in COVID-19 outcome warrants further investigation.



Eur Heart J Acute Cardiovasc Care: 20 Nov 2020:2048872620974605; epub ahead of print
Linschoten M, Peters S, van Smeden M, Jewbali LS, ... Asselbergs FW,
Eur Heart J Acute Cardiovasc Care: 20 Nov 2020:2048872620974605; epub ahead of print | PMID: 33222494
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Abstract

An observational study assessing the impact of a cardiac arrest centre on patient outcomes after out-of-hospital cardiac arrest (OHCA).

Kelham M, Jones TN, Rathod KS, Guttmann O, ... Mathur A, Jones DA
Background
Out-of-hospital cardiac arrest (OHCA) is a major cause of death worldwide. Recent guidelines recommend the centralisation of OHCA services in cardiac arrest centres to improve outcomes. In 2015, two major tertiary cardiac centres in London merged to form a large dedicated tertiary cardiac centre. This study aimed to compare the short-term mortality of patients admitted with an OHCA before-and-after the merger of services had taken place and admission criteria were relaxed, which led to managing OHCA in higher volume.
Methods
We retrospectively analysed the data of OHCA patients pre- and post-merger. Baseline demographic and medical characteristics were recorded, along with factors relating to the cardiac arrest. The primary endpoint was in-hospital mortality.
Results
OHCA patients ( =728; 267 pre- and 461 post-merger) between 2013 and 2018 were analysed. Patients admitted pre-merger were older (65.0 . 62.4 years, =0.027), otherwise there were similar baseline demographic and peri-arrest characteristics. There was a greater proportion of non-acute coronary syndrome-related OHCA admission post-merger (10.1% . 23.4%, =0.0001) and a corresponding decrease in those admitted with ST-elevation myocardial infarction (80.2% . 57.0%, =0.0001) and those treated with percutaneous coronary intervention (78.8% . 54.0%, =0.0001). Despite this, in-hospital mortality was lower post-merger (63.7% . 44.3%, =0.0001), which persisted after adjustment for demographic and arrest-related characteristics using stepwise logistic regression (=0.036) between the groups.
Conclusion
Despite an increase in non-acute coronary syndrome-related OHCA cases, the formation of a centralised invasive heart centre was associated with improved survival in OHCA patients. This suggests there may be a benefit of a cardiac arrest centre model of care.



Eur Heart J Acute Cardiovasc Care: 25 Nov 2020:2048872620974606; epub ahead of print
Kelham M, Jones TN, Rathod KS, Guttmann O, ... Mathur A, Jones DA
Eur Heart J Acute Cardiovasc Care: 25 Nov 2020:2048872620974606; epub ahead of print | PMID: 33241716
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This program is still in alpha version.