Higher Incidence Of Cardiogenic Shock Research Articles

Racial disparities among patients with cardiac sarcoidosis and arrhythmias in the United States: A propensity matched-analysis from the national inpatient sample database 2016-2020

BackgroundCardiac sarcoidosis (CS) is frequently associated with conduction abnormalities and arrhythmias. In this study, we aim to evaluate racial disparities in the frequency of arrhythmias, and associated co-morbidities, among patients with CS. MethodsWhite and African American (AA) patients diagnosed with CS were identified and compared from the 2016-2020 National Inpatient Sample (NIS) database whilst adjusting for confounders via logistic regression models. ResultsA total of 7,935 patients with CS were included in the study. The propensity-matched sample comprised of 5,570 patients, of whom 2,785 were White and 2,785 were AA. AA patients had a longer mean length of hospital stay (LOS) (7.84 vs. 6.94, p<0.01), a higher mean Charlson Comorbidity Index (CCI) score (3.10 vs. 2.84, p<0.01), and significantly higher incidences of cardiogenic shock [(9.2% vs 6.3%, p<0.01), aOR 1.45 (95% CI 1.17-1.78), p<0.01] and acute kidney injury (AKI) [(34.3% vs. 26.9%, p<0.01), aOR 1.41 (95% CI 1.24-1.61), p<0.01]. From an arrhythmia perspective, AA CS patients were shown to have a lower frequency of: (1) ventricular tachycardia (32.5% vs. 37.9%, p<0.01), (2) ventricular fibrillation (5.4% vs.7.2%, p<0.01), (3) first-degree AV block (1.8% vs. 4.1%, p<0.01), (4) complete AV block (6.3% vs. 14.2%, p<0.01), and (5) atrial fibrillation (31.8% vs. 34.8%, p=0.016) when compared to Whites with CS. Mortality remained higher for AAs (3.8% vs. 2.7%, p=0.024). ConclusionOur study demonstrates a higher incidence of cardiac arrhythmias among White patients but a higher incidence of cardiogenic shock, AKI, mean LOS, and mortality among AA patients with cardiac sarcoidosis.

Klinički rezultati perkutanog lečenja stenoze na glavnom stablu leve koronarne arterije u akutnom infarktu miokarda

Introduction: Acute myocardial infarction due to left main coronary artery stenosis is a rare, but life-threatening event often accompanied by sudden cardiac death and/or cardiogenic shock. The optimal revascularization strategy for unprotected left main coronary artery disease is the subject of ongoing debate, especially in urgent settings, where immediate optimal acute angiographic result is required to ensure patient survival and improve prognosis. Aim: This study aims to investigate patient characteristics and procedural and clinical variables associated with favorable outcomes of percutaneous treatment. Material and methods: A number of 40 patients undergoing PCI with acute myocardial infarction due to left main coronary artery stenosis were reviewed retrospectively from 1st January 2019 to 21st December 2022. Results: There was a total of 40 patients with a mean age of 70.83 ± 11.415. Cardiogenic shock occurred in 20 (50%) patients. Two patients (5%) died in the catheterization laboratory and 16 (40%) died during hospitalization. Twenty-two patients survived to be discharged; five patients died during the follow-up period. The overall mortality rate was 23 (57.5%). Factors associated with increased mortality included female gender (p = 0.008), cardiogenic shock (p = 0.025) and inotropes (p = 0.000). Conclusion: Acute myocardial infarction caused by left main coronary artery stenosis is complicated by high incidence of cardiogenic shock and mortality. In univariate analysis, cardio-genic shock, female gender and usage of inotropes correlated with death. Emergency PCI provides an important treatment option in these high-risk patients, but mortality remains high.

Abstract 12803: Disparities in Care Among COVID-19 Patients With ST-Elevation Myocardial Infarction Admitted in Rural and Urban Teaching Centers

Introduction: During the pandemic of COVID-19, resources ran scarce in various regions, which impacted access and availability of treatment options. Our study aims to compare outcomes of COVID-19-positive patients (CPP) who reported a diagnosis of ST-elevation myocardial infarction (STEMI) in either rural centers (RC) or urban teaching centers(UTC). Methods: De-identified data of CPP adults with STEMI from the 2020 National Inpatient Sample for admissions between April-December 2020 were analyzed. Patient characteristics and outcomes between RC and UTC were compared. Results: We found 4690 STEMI cases among CPP. Most cases were hospitalized in UTC(4255 cases, 90.7%), with 9.3% seeking care RC (Table 1). Cases in UTC were younger (mean age 66.28 years) and with a higher mean Charlson Comorbidity Index (CCI) score (mean score 4.31) than those at RC (mean age 71.75 years, p&lt;0.01, mean CCI score 4.00, p&lt;0.01). Medicare primarily covered both centers. A higher proportion of patients in RC were Whites (77.4%), while 50.0% of AMI cases at UTC were Whites. Patients at UTC also had a higher prevalence of prior stroke (6.3% vs. 3.4%, p=0.016) and lipid disorder (53.3% vs. 43.7%, p&lt;0.01) than those in RC but showed a lower prevalence of diabetes (44.3% vs. 50.6%, p=0.012). No differences in the prevalence of prior myocardial infarction, hypertension, smoking, obesity, chronic kidney disease, and sex were noted. Cases in UTC reported a higher incidence of cardiogenic shock (18.2% vs. 3.4%, aOR 6.631, 95% CI 3.850-11.421, p&lt;0.01), PCI use (42.1% vs. 20.7%, aOR 2.482, 95% CI 1.910-3.225, p&lt;0.01), and death (44.4% vs. 40.2%, aOR 1.513, 95% CI 1.197-1.912, p&lt;0.01). Conclusions: Adults with COVID-19 with STEMI admitted UTC were sicker with a higher mean CCI score and reported higher PCI use and mortality. Further studies investigating the distribution of resources during the pandemic and proposals to improve care access in rural and urban teaching hospitals should be conducted.

Cardiac arrest in patients with acute left main coronary artery occlusion: a real-world multicenter registry

Abstract Funding Acknowledgements Type of funding sources: None. Introduction and objective Acute coronary syndrome (ACS) patients with unprotected left main coronary artery (LMCA) occlusion are at increased risk of mortality. Most studies have shown an association between LMCA occlusion and cardiac arrest. We aimed to evaluate the clinical characteristics and the prognosis of patients with ACS due to LMCA occlusion with cardiac arrest at presentation. Methods We performed a retrospective multicenter study of 128 consecutive patients with ACS due to LMCA occlusion admitted in three Portuguese tertiary hospitals between 2008 and 2020. Patients were divided according to the presentation with cardiac arrest. Results Among this cohort, 26% patients presented with cardiac arrest. Regarding baseline characteristics, they were younger (58 vs 65 years; p=0.001) but no other significant differences were found. Cardiac arrest was associated to shorter symptoms-to-balloon time (150 vs 195 minutes; p=0.042) and higher recourse to fibrinolysis (12.1% vs 0%, p=0.004). They also had higher prevalence of cardiogenic shock (88% vs 51%; p&amp;lt;0.001) and need for aminergic support (91% vs 64%; p=0.004). Furthermore, in-hospital (79% vs 45%; p=0.001) and 5-year (97% vs 73%; p=0.008) mortality were significantly higher, as predicted by Kaplan-Meier survival curves (p=0.002; log-rank test). Finally, in multivariable analysis, younger age [odds ratio (OR),1.12;95% CI,1.04-1.20] and lower median symptoms-to-balloon time (OR, 1.35;95% CI,1.02-1.82) were independently associated to cardiac arrest at presentation. Conclusion In our real-world cohort, more than one quarter of patients with ACS due to LMCA occlusion presented with cardiac arrest, which correlates to a higher incidence of cardiogenic shock, as well as higher short- and long-term mortality. Only younger age and lower symptoms-to-balloon time were independently associated to cardiac arrest. Despite cardiac care improvements, technological evolution, and better patient/system-delay times, this is still a subpopulation with poor prognosis. Further studies are needed to find innovative strategies that can make a difference in this subgroup of patients.

IN-HOSPITAL OUTCOMES OF PATIENTS PRESENTING WITH ANTERIOR WALL MYOCARDIAL INFARCTION WITH RIGHT BUNDLE BRANCH BLOCK

BACKGROUND: Acute myocardial infarction is a common heart disease associated with signicant morbidity and mortality. Data on the Clinical, Electrocardiographic and Angiographic prole of acute anterior wall ST-elevation myocardial infarction with Right Bundle Branch Block with q waves in leads v1, v2 are scarce. The aim of this study is to compare the mortality and in hospital outcomes of patients with anterior wall myocardial infarction with RBBB and without RBBB. The study design is a METHODS: retrospective study among the patients admitted with acute anterior wall STEMI with qRBBB and non qRBBB pattern on ECG during the time period March to August 2022. All relevant clinical and treatment data were collected from the medical records department, Government Royapettah Hospital. ECGs taken during the hospitalization of the patient were subjected to detailed analysis and their outcomes were recorded. RESULTS: Among the 50 patients with anterior wall myocardial infarction 11 patients presented with qRBBB pattern. Out of these 11patients, 7 patients had higher Killip score at presentation and 4 of them succumbed to death (57%).The in-hospital mortality rate was higher among those who had anterior wall myocardial infarction with qRBBB pattern when compared to non qRBBB pattern. There was a higher incidence of cardiogenic shock (54%) among patients with qRBBB pattern. Acute anterior wall MI wit CONCLUSION: h qRBBB myocardial infarction is a severe form of acute coronary syndrome with higher in-hospital mortality and morbidity necessitating early recognition and prompt institution of reperfusion therapy. Cardiogenic shock, ventricular tachycardia, higher Killip and TIMI scores at presentation are signicant predictors of inhospital mortality

PS-C16-1: COURSE OF ACS IN PATIENTS CO-INFECTED WITH COVID-19

Aim: To study and compare the features of the course of ACS in patients who underwent COVID19 infection. Material and Methods: The study included ACS patients with ST segment elevation admitted from January 2021 to February 2022. Patients were compared with a group of patients who did not suffer from COVID 19 infection and were hospitalized for ACS in a similar period of time. The study included 114 patients. In all patients, the presence of IgG antibodies to the agent of the coronavirus infection COVID-19 was determined, which indicates that the person has already had a coronavirus infection or not. Patients were divided into 2 groups: 1 - patients who had COVID19 infection; 2 - not recovered from coronavirus infection. All patients were assessed the following indicators: the presence of coronary artery disease before hospitalization, the incidence of cardiogenic shock, the presence of STEMI, as well as the number of deaths during hospitalization. Results: In the first group, only 39.5% (45) of patients were examined, of which men - 80.0% (36). Prior to hospitalization, coronary artery disease was present in 64.4% (29) of patients. STEMI was present in 75.5% (34) of patients. The incidence of cardiogenic shock in 4.4% (2) of patients. The number of deaths during hospitalization is 4.4% (2). In the second group, only 60.5% (69) of patients were examined, of which 78.3% (54) were men. Prior to hospitalization, CAD was present in 55.07% (38) of patients. STEMI was recorded in 59.4% (41) of patients. The incidence of cardiogenic shock is 1.45% of patients. The number of deaths during hospitalization was 1.45%. Conclusion: Before hospitalization, CAD was present in the majority of patients 39.5% (45) who had COVID 19, who did not have COVID19 patients 60.5% (69). STEMI was present in 75.5% (34) of patients who had COVID19 and 59.4% (41) of those who did not have COVID 19 infection (p &lt; 0.05). During the pandemic, there is a high incidence of cardiogenic shock in 4.4% (2) of patients who have had COVID19 and 1.45% (1) of those who have not been ill. The percentage of deaths during hospitalization in COVID19 survivors is higher compared to 4.4% with 1.45% who did not recover.

Abstract 12160: Sex Differences in Outcomes of Percutaneous Coronary Intervention in Octogenarians: A Retrospective Cohort Study From National Inpatient Sample 2016-2019

Introduction: The role of sex-based differences in the outcomes after principal percutaneous coronary intervention (PCI) in octogenarians is not well studied. Hypothesis: There are no differences in outcomes of PCI in octogenarians based on sex. Methods and Results: From 2016 to 2019, 37,147 hospitalizations (unweighted sample) for principal PCI procedures were identified. Among the principal PCI procedures performed, 44.9% (n = 16,660) were performed in females, and 55.2% (n = 20,487) in males (p &lt; 0.001), 82.4% in Whites, 5.4% in Blacks, 6.4% in Hispanics, and 2.6% in Asians. 20,986 (56.5%) principal PCI hospitalizations had a Charlson comorbidity index (CCI) of three or higher. The mean age for Octogenarians was 83.6 ± 2.7 years. Compared to males, the females were slightly older (mean age: 83.8 vs. 83.5; p &lt; 0.001), had higher prevalence of diabetes mellitus (20.5% vs 18%, p&lt;0.001) and lower Charlson comorbidity index (CCI) of three or higher (53.6% vs. 58.9%, p &lt;0.001). Females had higher incidence of cardiogenic shock (4.9% vs 4.2%, p=0.002), higher in-hospital mortality (4% vs 3%, p&lt;0.001) and longer length of stay (LOS) (4.4 days vs 4.1 days, p&lt;0.001). Multivariate regression analysis showed that, compared to males, females had a significantly higher odds of in-hospital mortality (aOR: 1.23; 95% CI: 1.10, 1.37; p &lt;0.001) and cardiogenic shock (aOR: 1.17; 95% CI: 1.06, 1.30; p=0.002) after controlling for age, race, hospital region, hospital teaching status, income, insurance provider, and CCI. From 2016-2019, in octogenarians, the annual incidence of principal PCI hospitalizations increased from 127 per 100,000 hospitalizations in 2016 to 137 per 100,000 hospitalizations in 2019, p&lt;0.001. Conclusions: The incidence of PCI done in octogenarians is rising every year. Females have an increased likelihood of in-hospital mortality, longer LOS, and cardiogenic shock.

Hypoglycemia is associated with a higher risk of mortality and arrhythmias in ST-elevation myocardial infarction, irrespective of diabetes.

AimsWe aimed to assess the impact of hypoglycemia in ST-elevation myocardial infarction (STEMI).BackgroundHypoglycemia increases the risk of mortality in patients with diabetes and high cardiovascular risk.MethodsWe used the National Inpatient Sample (2005–2017) database to identify adult patients with STEMI as the primary diagnosis. The secondary diagnosis was hypoglycemia. We compared cardiovascular and socio-economic outcomes between STEMI patients with and without hypoglycemia and assessed temporal trends.ResultsHypoglycemia tends to complicate 0.17% of all cases hospitalized for STEMI. The mean age (±SD) of STEMI patients hospitalized with hypoglycemia decreased from 67 ± 15 in 2005 to 63 ± 12 in 2017 (p = 0.046). Mortality was stable with time, but the prevalence of ventricular tachycardia, ventricular fibrillation, acute renal failure, cardiogenic shock, total charges, and length of stay (LOS) increased with time (p < 0.05 for all). Compared to non-hypoglycemic patients, those who developed hypoglycemia were older and more likely to be black; only 6.7% had diabetes compared to 28.5% of STEMI patients (p = 0.001). Cardiovascular events were more likely to occur in hypoglycemia: mortality risk increased by almost 2.5-fold (adjusted OR = 2.625 [2.095–3.289]). There was a higher incidence of cardiogenic shock (adjusted OR = 1.718 [1.387–2.127]), atrial fibrillation (adjusted OR = 1.284 [1.025–1.607]), ventricular fibrillation (adjusted OR = 1.799 [1.406–2.301]), and acute renal failure (adjusted OR = 2.355 [1.902–2.917]). Patients who developed hypoglycemia were less likely to have PCI (OR = 0.596 [0.491–0.722]) but more likely to have CABG (OR = 1.792 [1.391–2.308]). They also had a longer in-hospital stay and higher charges/stay.ConclusionHypoglycemia is a rare event in patients hospitalized with STEMI. However, it was found to have higher odds of mortality, arrhythmias, and other comorbidities, irrespective of diabetes.

Association of Neutrophil to Lymphocyte Ratio with In- hospital Outcome of Acute Heart Failure due to Acute Anterior ST-elevation Myocardial Infarction

Background: Early detection and appropriate management play a key role in reducing the morbidity and mortality of acute heart failure in patients with acute myocardial infarction. Many prognostic factors have been assessed till date. This study aimed to evaluate the prognostic effect of NLR on in-hospital outcomes in patients with acute heart failure due to acute anterior ST elevation myocardial infarction. Methods: The present study was carried out in the Department of cardiology, Sir Salimullah Medical College &amp; Mitford Hospital, Dhaka from January 2020 to December 2020. A total of 88 cases of acute heart failure due to acute anterior ST elevation Myocardial infarction patients are enrolled in this study. NLR was estimated and patients were divided into two groups based on the NLR (Group I NLR &lt;6; Group II NLR ≥6). Then in-hospital outcome was observed and compared between two groups. Results: In-hospital mortality and length of hospital stay were higher among NLR ≥6 patients with statistical significance (11.6% vs. 40.9%, p&lt;0.001). These patients also had high incidence of cardiogenic shock (25% vs. 43%, p&gt;0.072), Arrhythmia (18% vs. 34%, p&gt;0.089) but without statistically significant difference. Conclusion: In this study, we observed that in-hospital outcomes were worse in patients with acute heart failure due to acute anterior myocardial infarction with NLR ≥6. So NLR can be used as a predictor of outcome in acute heart failure patients. This association is independent of conventional cardiovascular risk factors. Cardiovasc j 2022; 15(1): 13-19

Incidence and outcomes of cardiogenic shock among women with spontaneous coronary artery dissection.

There is a paucity of data on cardiogenic shock (CS) incidence and outcomes among patients with spontaneous coronary artery dissection (SCAD). Women admitted to the hospital for acute myocardial infarction (AMI) with and without SCAD were identified from the United States National Readmission Database from October 1, 2015 to December 31, 2018. We calculated the incidence of CS among women with AMI with and without SCAD and odds for developing CS after adjusting for baseline characteristics. In addition, we report the utilization of percutaneous coronary intervention, mechanical circulatory support, severe disability surrogates, and 30-day readmission rates. A total of 664,292 patients admitted for AMI were eligible for analysis, including 6643 patients with SCAD and 657,649 without SCAD. Patients with SCAD were younger (57 years [interquartile range,IQR 48-68] vs. 71 years [IQR 60-81], p < 0.01) and had fewer comorbidities yet had a higher incidence of CS as compared to patients without SCAD (9% vs. 5%, p < 0.01) and remained at elevated risk after adjusting for baseline comorbidities (adjusted odds ratio 1.5 [95% confidence interval,CI 1.2-1.7]). Among patients who developed CS, those with SCAD had lower in-hospital mortality than non-SCAD (31% vs. 39%, p < 0.01), and were more likely to receive mechanical circulatory support. In a nationally representative sample of women admitted for AMI, we found that patients with SCAD had a higher risk of developing CS and required more frequent use of mechanical circulatory support but were more likely to survive to discharge than women suffering AMI from causes other than SCAD.

Comparison of In-Hospital Mortality between Acute Inferior Wall STEMI Patients with and without Right Ventricular Infarction Undergoing Primary PCI

Background: Patients with acute inferior wall ST elevation myocardial infarction (STEMI) with right ventricular infarction (RVI) involvement have a worse prognosis. However, most patients in the previous studies were treated with intravenous fibrinolysis and they were in the Caucasian populations. Objective: To compare the in-hospital mortality rate of patients with acute inferior wall STEMI with and without RVI treated with primary percutaneous coronary intervention (PPCI). Materials and Methods: The present study was a retrospective descriptive study that enrolled patients with acute inferior wall STEMI treated with PPCI in King Chulalongkorn Memorial Hospital between January 1, 2007, and December 31, 2016. Results: Among 452 acute inferior wall STEMI patients treated with PPCI, 99 patients had RVI. The in-hospital mortality rate was 23.2% compared with 5.1% in patients without RVI (p&lt;0.001). Patients with RVI had a significantly higher incidence of cardiogenic shock at 48.5% versus 15.6% (p&lt;0.001), lower left ventricle ejection fraction at 51.15±17.27% versus 55.79±12.46% (p=0.037), higher incidence of complete heart block at 33.3% versus 11.9% (p&lt;0.001), and ventricular tachycardia at 15.2% versus 5.9% (p=0.003). After adjustment for age, female gender, cardiogenic shock on admission, left ventricular ejection fraction (LVEF), ventricular tachycardia, and complete heart block, the RVI had a tendency to be the poor predictor for in-hospital death (adjusted HR 1.96; 95% CI 0.73 to 5.23; p=0.18). Nevertheless, the RVI was the significant independent predictor for 1-year mortality (adjusted HR 2.12; 95% CI 1.03 to 4.36; p=0.041). Conclusion: Patients with acute inferior wall STEMI and RVI treated with PPCI had higher in-hospital mortality compared to no RVI. The RVI tended to have worse outcomes than those without RVI. Keywords: Acute inferior wall STEMI; Right ventricular infarction; Mortality

In-hospital Outcome of Acute Anterior Myocardial Infarction with Right Ventricular Dysfunction

Background: In anterior ST-segment elevation myocardial infarction (STEMI), attention paid mainly to the left ventricle. The predictive significance of right ventricular (RV) dysfunction in patients with anterior STEMI has been frequently neglected. In this study, we evaluated the prognostic effect of RV dysfunction on in-hospital outcomes in patients with first anterior STEMI. Methods: Present study is based on the analysis of 77 patients admitted to Coronary care unit of the Sir Salimullah Medical College &amp; Mitford Hospital, Dhaka during April, 2019 to March, 2020, with acute anterior wall myocardial infarction. 12 lead ECG with thorough physical examination was done along with echocardiographic assessment of RV and LV function within index hospitalization, preferably within 24 hours of admission. Patients were divided into two groups depending on right ventricular function assessment. Group I included anterior MI with right ventricular dysfunction and group II included anterior MI without right ventricular dysfunction. In hospital outcomes were observed and compared between two groups. Results: Patients with RV dysfunction had statistically significant higher incidence of cardiogenic shock (22.2 % vs. 2.4%, p &lt; 0.05), acute heart failure (69.4% vs. 24.4%, p &lt; 0.05), arrhythmia (11.1% vs. 0.0%, p &lt; 0.05), increase length of hospital stay in patients of RV dysfunction group. In-hospital mortality was non significantly higher in RV dysfunction group (8.3% vs. 2.4%, p &gt; 0.305). Conclusion: In this study, we observed that in-hospital outcomes were worse in patients with anterior STEMI with RV dysfunction and demands more intense invasive management. Thus, special care should be given for the assessment function of right ventricle in anterior STEMI. Cardiovasc j 2022; 14(2): 128-134

Clinical impact of pulmonary hypertension on the outcomes of acute myocardial infarction patients with or without chronic obstructive pulmonary disease.

Acute myocardial infarction (AMI) and chronic obstructive pulmonary disease (COPD) are leading global causes of morbidity and mortality. In patients with both of these conditions, the presence of pulmonary hypertension (PH) can further worsen their prognosis. We examined the outcomes of AMI patients with COPD (AMI+COPD) and without COPD (AMI−COPD), depending on the presence or absence of PH.A total of 318 AMI patients with COPD (AMI+COPD cohort) (n = 109) or without COPD (AMI-COPD cohort) (n = 209) were included in this study and were subdivided into 2 groups according to right ventricular systolic pressure (RVSP) level (PH group [RVSP ≥35 mm Hg] and no PH group [RVSP <35 mm Hg]).We investigated characteristics and clinical outcomes in both the AMI-COPD and AMI+COPD cohorts. When investigating in-hospital clinical outcomes, the PH group had a higher proportion of new-onset heart failure (HF) in both cohorts. In the AMI+COPD cohort, however, the PH group had a higher incidence of cardiogenic shock than the no PH group, which was consistent with the result of the post-inverse probability of treatment weighting (IPTW) analysis. When investigating 1-year clinical outcomes, the PH group had higher incidences of a major adverse cardiac event and all-cause mortality in both cohorts. This finding was mainly driven by cardiac death in the AMI-COPD cohort, whereas it was mainly driven by non-cardiac death in the AMI+COPD cohort. After IPTW adjustment, these differences were statistically attenuated such that all variables were similar between both groups.PH may be associated with the development of new-onset HF (in all patients) and cardiogenic shock (in the AMI+COPD cohort). In addition, PH may be also associated with all-cause mortality, although it was statistically attenuated after IPTW adjustment.

Incidence and clinical predictors of the development of cardiogenic shock after primary angioplasty in patients with ST elevation myocardial infarction

There is a rich literature on ST elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). However, little is known about patients who are initially hemodynamically stable and develop CS after percutaneous coronary intervention (PCI). To determine incidence and evaluate clinical characteristics as well as in-hospital outcomes of patients with STEMI who develop cardiogenic shock after PCI. A total of 352 consecutive patients were retrospectively enrolled in the PAMI registry of the cardiology B department of Fattouma Bourguiba university hospital between January 2000 and March 2017. Patients with hemodynamic instability at presentation prior to PCI were excluded. Out of 352 patients with STEMI, 35 patients (9.9%) develop cardiogenic shock after PCI. These patients were older (age > 65 years; P = 0.021), more often diabetic (68.3% vs. 37.2%; P = 0.002), and had prior stroke/transient ischemic attack (22.2% vs. 10.5%; P = 0.027). Cardiogenic shock after PCI occured more frequently in patients with anterior STEMI ( P = 0.012), door to balloon time > 120 minutes ( P = 0.02), and systolic blood pressure at admission < 120 mmHg ( P < 0.001). On the electrocardiogram, wide QRS at presentation ( P = 0.033), presence of bundle branch block ( P = 0.021) and persistence of ST segment elevation after PCI ( P < 0.001) were associated with higher incidence of CS after PCI. The overall in-hospital mortality of patients with post procedural CS was 64.3% vs. 3.5%, P < 0.001. At multivariate analysis, significant predictors of an increased risk of CS after PCI were: age > 65 years (odd ratio = 1.05;95% CI:0.49-2.33; P = 0.02), systolic blood pressure < 120 mmHg (odd ratio = 3.9,95% CI: 1.95–7.78, P < 0.001) and door to balloon time > 120 minutes (odd ratio =1.07, 95% CI 0.49–2.33; P = 0.02). Cardiogenic shock after PCI in STEMI carries an extremely high mortality. These patients had unfavourable premorbid conditions and poor outcomes.

Abstract 13635: Isolated Right Ventricular Stress Cardiomyopathy: A Systematic Review of Literature

Background: Takotsubo Cardiomyopathy (TTC), also known as stress cardiomyopathy, is characterized by transient systolic and diastolic dysfunction without evidence of significant coronary artery stenosis. In 2012, TTC attributed to about 0.02% of hospitalizations in the United states, largely seen in the elderly female population. Although it primarily affects the left ventricle, there are different variant patterns documented mostly affecting younger individuals. Here we present a systematic review of right ventricle TTC. Methods: On January 7th, 20221, a systematic search without limitation in the time frame was conducted using Pubmed, Google Scholar, CINAHL, Cochrane CENTRAL, and Web of Science databases and a total of 9 cases were identified (1 case was excluded due to duplicity). Results: The mean age of the patients listed was 65.2 ± 23.35 with majority (8/9) 88% of patients being women. Commonest presentation was dyspnea (67%), followed by chest pain (22%), nonspecific discomfort in 11%, and acute heart failure in 11%. Cardiogenic shock was reported in 56% of the cases. Management and treatment included inotropic or vasopressor support in 67% of the cases and 11% requiring venoarterial extracorporeal membrane oxygenation (V-A ECMO). Improvement of right ventricular function was reported in all but 1 patient who died. Conclusion: Isolated right ventricular stress cardiomyopathy is rare but possibly underreported. Though associated with a higher incidence of cardiogenic shock on presentation than traditional stress cardiomyopathy, they do seem to spontaneously recover once out of the acute phase of the syndrome as noted in our study. While the pathogenesis of stress cardiomyopathy is still not fully understood, genetic predispositions may be involved. Current recommendations for management include conventional heart failure medications including beta blockers, ACE inhibitors and diuretics despite limited evidence.

Risk factors analysis of prognosis of adult acute severe myocarditis.

BACKGROUNDAdult severe myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock with a high hospital mortality rate.AIMTo analyze the risk factors affecting the short-term prognosis of adult acute severe myocarditis (ASM).METHODSAdult patients with ASM (ASM group, n = 218) and acute nonsevere myocarditis (ANSM group, n = 80) who came to our department from January 2014 to January 2020 were enrolled in this study. Patients with ASM were divided into the ASM survival group (n = 185) and ASM nonsurvival group (n = 33) according to the treatment results during hospitalization. The clinical symptoms, laboratory examinations, treatment methods, complications, and the relationship between the treatment results of the two groups were retrospectively compared and discussed. The risk factors for death in patients with severe myocarditis were analyzed by binary logistic regression. A follow-up to 5.5 years was conducted on patients in the ASM survival group and ANSM group after discharge, and the readmission rate and incidence rate of dilated cardiomyopathy were analyzed.RESULTSCompared with the ASM survival group, the ASM nonsurvival group had longer QRS complex, higher incidence of cardiogenic shock, higher serum creatinine (SCr, 235μmol/L vs 89 μmol/L, P < 0.05), higher sensitive cardiac troponin I (cTnI, 4.45 μg/L vs 1.66 μg/L, P < 0.05) and brain natriuretic peptide (BNP, 1756 pg/mL vs 401 pg/mL, P < 0.05). The binary logistic regression revealed that there were statistical differences between the two groups in SCr, cTnI, and BNP values (all P < 0.05). After discharging from the hospital, patients in the ASM group and ANSM group had no significant differences in the readmission rate and incidence rate of dilated cardiomyopathy.CONCLUSIONElevated SCr, cTnI, and BNP are independent predictors for poor prognosis in patients with ASM. The long-term prognosis of patients in the ASM survival group is good.

Abstract 17005: Early Goal Directed Fluid Therapy for Patients With Heart Failure and Septic Shock

Introduction: The use of aggressive fluid therapy in patients with heart failure and reduced ejection fraction (HFrEF) who develop septic shock is controversial. Methods: This is a retrospective cohort study of 334 patients with heart failure (HF) and septic shock admitted to a tertiary cardiovascular center between 01/2015 and 06/2018. For this study, ejection fraction (EF) was dichotomized into &lt;45% (HFrEF) and ≥45% (HF with preserved EF). The evaluated outcomes included in-hospital mortality, development of pulmonary edema, cardiogenic shock, and 30-day readmission rate. Results: A total of 133(40%) patients had HFrEF, and 201(60%) patients had HFpEF (see Table 1, baseline characteristics). Early goal direct fluid therapy and vasopressors were equally implemented in all patients with HF that developed septic shock. Outcomes: There was no difference in in-hospital mortality for patients with HFrEF that developed septic shock when compared to patients with HFpEF, 64(48%) vs 102(51%) p=0.6542. Patients with HFrEF had a higher incidence of cardiogenic shock 25(19%) vs 9(4.5%) p&lt;0.0001 and 30-day HF-related readmission 25(36%) vs 17(17%) p=0.0096. However, pulmonary edema requiring urgent intravenous diuresis 82(62%) vs 113(56%) p=0.4186 or mechanical ventilation 70(53%) vs 110(55%) p= 0.6543 was similar between groups. Conclusions: Once patients with HF develop septic shock, the mortality is similar for both HFrEF and HFpEF. However, complications such as cardiogenic shock and 30-day readmission are more common in patients with HFrEF. A more individualized treatment approach is needed for this population.

The Impact of Advanced Age on Major Cardiovascular Events and Mortality in Patients with ST-Elevation Myocardial Infarction Undergoing a Pharmaco-Invasive Strategy.

BackgroundThere is little research in the efficacy and safety of a pharmaco-invasive strategy (PIS) in patients ≥75 years versus <75 years of age. We aimed to evaluate and compare the influence of advanced age on the risk of death and major adverse cardiac events (MACE) in patients undergoing PIS.MethodsBetween January 2010 and November 2016, 14 municipal emergency rooms in São Paulo, Brazil, used full-dose tenecteplase to treat patients with STEMI as part of a pharmaco-invasive strategy for a local network implementation.ResultsA total of 1852 patients undergoing PIS were evaluated, of which 160 (9%) were ≥75 years of age. Compared to patients <75 years, those ≥75 years were more often female, had lower body mass index, higher rates of hypertension; higher incidence of hypothyroidism, chronic renal failure, prior stroke, and diabetes. Compared to patients <75 years of age, in-hospital MACE and mortality were higher in patients with ≥75 years (6.5% versus 19.4%; p<0.001; and 4.0% versus 18.2%; p<0.001, respectively). Patients ≥75 years had higher rates of in-hospital major bleeding (2.7% versus 5.6%; p=0.04) and higher incidence of cardiogenic shock (7.0% versus 19.6%; p<0.001). By multivariable analysis, age ≥75 years was independent predictor of MACE (OR 3.57, 95% CI 1.72 to 7.42, p=0.001) and death (OR 2.07, 95% CI 1.12–3.82, p=0.020).ConclusionIn patients with ST-segment elevation myocardial infarction undergoing PIS, age ≥75 years was an independent factor that entailed a 3.5-fold higher MACE and 2-fold higher mortality rate compared to patients <75 years of age.

In-Hospital Outcomes and Trends of Tricuspid Valve Surgery in Heart Transplant Patients

Introduction: Tricuspid valve (TV) regurgitation is the most common valvular pathology after orthotopic heart transplant (OHT). The number of transplants being performed is increasing with patients living longer after heart transplant. Data on TV surgery in OHT recipients is limited. Methods: We sought to analyze the outcomes of patients undergoing TV surgery from a large diverse, multicentric, nationwide cohort using the Nationwide Inpatient Sample (NIS) database. Results:A total of 42,766 TV repair or replacement (bioprosthetic and mechanical) involving adult patients (age ≥18 years) between 2007 and September 2015 were identified. Of these, 366 were performed in patients with OHT. TV repair was the most common surgery performed in both groups (OHT group and native heart group). Compared to the native group, patients with OHT had a significantly higher incidence of cardiogenic shock (20 vs. 11%, p = 0.024), acute kidney injury (AKI) (59 vs. 30%, p < 0.001), and AKI requiring hemodialysis (13 vs. 4%, p < 0.001). Also, the mean length of stay for the index admission was significantly longer in the OHT group (27 vs. 17 days, p = 0.008). The mortality rate was similar between the two groups (7 vs. 8%, p = 0.753). The number of TV surgeries performed in OHT patients from 2007 to 2014 have remained stable (p = 0.803) compared to those in native heart patients which showed a significantly increasing trend (p = 0.019) during the same time period. Conclusions: TV surgery remains an important treatment modality among the OHT population and carries a similar mortality during index hospitalization as that in native heart patients undergoing TV surgery.

P264 Comparison of in-hospital mortality between acute inferior wall STEMI patients with right ventricular infarction and without right ventricular infarction undergoing a primary PCI in KCMH

Abstract Background Patients with acute inferior wall ST elevation myocardial infarction, if there is a right ventricular myocardial infarction involvement, they have pretended a worse prognosis with hemodynamic and electrophysiologic complications causing higher in-hospital morbidity and mortality. However most patients in previous studies were mainly treated with intravenous fibrinolysis and also studied in the Caucasian populations. Objectives To compare the in-hospital mortality rate of patients with acute inferior wall ST elevation myocardial infarction with and without right ventricular infarction involvement, whom were treated with primary percutaneous coronary intervention (PPCI). Methods The study was a retrospective descriptive study which enrolled patients with acute inferior wall ST elevation myocardial infarction who were treated with PPCI in our hospital from 1 January 2007 - 31 December 2016. Results Among 452 acute inferior wall ST elevation myocardial infarction patients who were treated with PPCI, there were 99 patients who had right ventricular infarction involvement, the in-hospital mortality rate was 23.2%, mainly due to cardiogenic shock, compared with 5.1 % in patients who had no right ventricular infarction (p &amp;lt; 0.001). Patients with right ventricular infarction had a significantly higher incidence of cardiogenic shock (48.5% versus 15.6%, P &amp;lt; 0.001), the lower number of left ventricle ejection fraction (51.15 ± 17.27% versus 55.79 ± 12.46%, p = 0.037), the higher incidence of complete heart block (33.3% versus 11.9%, p &amp;lt; 0.001) and ventricular tachycardia (15.2% versus 5.9%, p = 0.003). After adjustment for age, female sex, diabetes, hypertension, previous myocardial infarction, cardiogenic shock on admission, left ventricular ejection fraction, ventricular tachycardia and complete heart block, the right ventricular infarction remained the independent predictor of in-hospital death (adjusted hazard ratio, 1.69; 95% confidence interval, 0.38 to 7.48; P = 0.489) and significant independent predictor for 1-year mortality (adjusted hazard ratio, 2.76; 95% confidence interval, 1.08 to 7.03; P = 0.034). Conclusion Patients with acute inferior wall STEMI whom were treated with PPCI, if there was right ventricular infarction involvement, the in-hospital death and 1-year mortality were significantly higher than who were without right ventricular infarction.