Occurrence Of Cardiogenic Shock Research Articles

Long-term outcomes of cardiogenic shock and cardiac arrest complicating ST-elevation myocardial infarction according to timing of occurrence.

Cardiogenic shock (CS) and cardiac arrest (CA) are serious complications in ST-elevation myocardial infarction (STEMI) patients, with lack of long-term data according to their timing of occurrence. This study sought to determine the incidence and relationship between the timing of occurrence and prognostic impact of CS and CA complicating STEMI in the long-term follow-up. We conducted a retrospective analysis of consecutive STEMI patients treated between 2004 and 2017. Patients were divided into four groups based on the occurrence of neither CA nor CS, CA only, CS only, and both CA and CS (CA-CS-, CA+, CS+, and CA+CS+, respectively). Adjusted Cox regression analysis was used to assess the independent association between the CS and CA categories and mortality. A total of 1603 STEMI patients were followed for a median of 3.6 years. CA and CS occurred in the 12.2% and 15.9% of patients, and both impacted long-term mortality [adjusted hazard ratio (HR) = 2.59, 95% confidence interval (CI): 1.53-4.41, P < 0.001; HR = 3.16, 95% CI: 2.21-4.53, P < 0.001, respectively). CA+CS+ occurred in 7.3%, with the strongest association with higher mortality (adjusted HR = 5.36; 95% CI: 3.80-7.55, P < 0.001). Using flexible parametric models with B-splines, the increased mortality was restricted to the first ∼10 months. In addition, overall mortality rates were higher at all timings (all with P < 0.001), except for CA during initial cardiac catheterization (P < 0.183). CS and CA complicating patients presenting with STEMI were associated with higher long-term mortality rate, especially in the first 10 months. Both CS+ and CA+ at any timeframe impacted outcomes, except for CA+ during the initial cardiac catheterization, although this will have to be confirmed in larger future studies, given the relatively small number of patients.

Prognostic value of first 24-hour urine output in patients with acute myocardial infarction in intensive care units: a retrospective study based on the MIMIC-IV database.

To investigate the effect of first 24-hour (24-h) urine output (UO) on in-hospital and 1-year mortality in patients admitted to intensive care units due to acute myocardial infarction. This was a retrospective cohort study based on the medical information mart for intensive care IV database involving patients admitted to intensive care units due to acute myocardial infarction. Patients were classified as low UO (LUO), high UO (HUO), and middle UO with a first 24-h UO below 800ml, over 2500ml, or in between, respectively. The primary outcome was in-hospital mortality and the secondary outcome was 1-year mortality. A total of 4337 patients were involved. Taking middle UO group as reference, after adjusting for confounders including age, gender, height, weight, comorbidity, occurrence of cardiogenic shock, revascularization, blood pressure, creatinine, N-terminal pro-brain natriuretic peptide, and use of loop diuretics, LUO was independently associated with higher in-hospital mortality [odds ratio 4.05, 95% confidence interval (CI): 3.12-5.26], while HUO was an independent protective factor (odds ratio 0.52, 95% CI: 0.35-0.77). In the multivariant Cox regression model, LUO was an independent risk factor for 1-year mortality (hazard ratio 2.65, 95% CI: 2.16-3.26), while HUO did not show significant association. In patients admitted to intensive care units due to acute myocardial infarction, first 24-h UO <800ml was a strong predictor for higher in-hospital and 1-year mortality, while first 24-h UO over 2500ml was associated with lower in-hospital mortality but not long-term mortality.

Risk factors for immediate and delayed cardiogenic shock in patients with ventricular septal rupture after myocardial infarction

BackgroundVentricular septal rupture (VSR) is a serious complication occurring after myocardial infarction (MI). Cardiogenic shock (CS) is a common complication of VSR and an important factor affecting its prognosis. CS can occur in either an immediate or delayed manner after VSR; however, studies on the risk factors associated with immediate or delayed CS are scarce.MethodsWe retrospectively studied patients diagnosed with VSR after MI and admitted to the West China Hospital between September 2009 and August 2023. Demographic data, medical history, physical examination results, electrocardiograms, and echocardiographic and hematological data were extracted from electronic medical records or archived records. CS was defined as hypotension (&amp;lt;90 mmHg) and/or the requirement for catecholamines, pulmonary congestion, and signs of end-organ failure. The CS onset time was defined as the time at which catecholamines were initiated.ResultsA total of 88 patients with VSR after MI, including 49 males (55.7%), were enrolled. The average age was 70.2 years. Of these patients, 32 (36.4%) who already had CS at the time of VSR discovery were defined as immediate CS, and 28 (31.8%) who developed CS within 2 weeks after VSR discovery were defined as delayed CS. A smaller left ventricular end-diastolic diameter (LVEDD) and VSR discovered after admission were independent risk factors for immediate CS. Elevated heart rate and higher levels of creatine kinase-MB isoenzyme on admission were independent risk factors for delayed CS in patients without immediate CS after VSR.ConclusionsThe occurrence of CS in patients with VSR after MI has an evident time course. Thus, an early identification of patients at risk of immediate or delayed CS and optimization of treatment procedures may help improve the prognosis.

Abstract 14054: Pre-Hospital Predictors of Cardiogenic Shock Among ST-Segment Elevation Myocardial Infarction Patients With and Without Cardiac Arrest: Implications for Shock Teams

Introduction: Cardiogenic shock (CS) develops in up to 8.6% of patients with STEMI and is associated with poor outcomes. Early identification of patients at risk of CS is paramount to enable timely mobilization of shock teams to improve outcomes. Hypothesis: We hypothesized that pre-hospital clinical parameters can predict development of CS in STEMI patients undergoing primary PCI. Using these predictors, we developed a risk score to rapidly identify patients at risk of developing CS. Methods: We performed a retrospective cohort study using prospective data from a centralized STEMI registry of a healthcare system serving 1.25 million people. Patients presenting with STEMI with intent to receive primary PCI between 2012 to 2020 were included. Logistic regression was used to assess the relationship between predictors and the occurrence of CS at any point from first medical contact to hospital discharge. The prediction model was converted to a risk score by scaling of the regression coefficients. The accuracy of the risk score was determined using C-statistic. Results: Among 2736 consecutive STEMI patients, 15.2% (n=415) developed CS. Overall, 10.9% of patients had prehospital cardiac arrest, which was more likely in those with CS (46.5% vs. 4.5%, p&lt;0.001). Patients with CS were more likely to have prolonged first medical contact-to-device time per national guidelines (74.7% vs. 53.3%, p&lt;0.001). Regression analysis identified 8 parameters that predict CS as shown in Table 1. Two models, with and without cardiac arrest, were developed. Both models show C-statistics of 0.80 and above. Conclusions: Among STEMI patients with intent to undergo primary PCI, we identified 8 clinical parameters that strongly predict CS. This has been developed into a scoring system which can be easily used by emergency service providers to rapidly identify patients with CS and enable timely shock team activation.

30-day outcomes of P2Y12 inhibitor pretreatment in patients with STEMI submitted to primary PCI – systematic review and meta-analysis

Abstract Introduction Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the cornerstone of antithrombotic therapy in patients with ST-segment elevation myocardial infarction (STEMI). Yet, there is uncertainty surrounding the optimal timing for the initiation of the P2Y12 inhibitor. This study aims to evaluate the effectiveness and safety of P2Y12 pretreatment by means of a systematic review and meta-analysis of studies in primary percutaneous coronary intervention (PCI) in STEMI. Methods We performed a systematic search of electronic databases Pubmed, CENTRAL and Scopus until March of 2021. Studies were considered eligible if they were: a) comparing P2Y12 inhibitor upstream administration vs. treatment during PCI; b) patients enrolled for STEMI and submitted to primary PCI. Studies with patients treated with fibrinolysis or medical therapy only were excluded. Major clinical outcomes included 30-day occurrence of all-cause death, definite stent thrombosis and re-infarction. Thrombolysis in myocardial infarction (TIMI) flow-grade pre-PCI and post-PCI, in-hospital cardiogenic shock and major bleeding events were analysed. Results Out of 2193 articles, 18 studies were included (1 randomized clinical trial [RCT] and 17 observational studies [non-RCT]), with a total of 76,836 patients, 52,181 in the pretreatment arm. At 30 days, pretreatment was associated with a reduction in definite stent thrombosis (1 RCT &amp; 4 Non-RCT: OR 0.40; 95% CI 0.18–0.90), but no significant reduction in all-cause death (1 RCT &amp; 7 Non-RCT: OR 0.77; 95% CI 0.56–1.04) or re-infacrtion (1 RCT &amp; 4 Non-RCT: OR 0.73; 95% CI 0.49–1.09). Regarding in-hospital outcomes, pretreatment showed a significant reduction in the occurrence of cardiogenic shock (5 Non-RCT: 0.62; 95% CI 0.51–0.79), major bleeding events (1 RCT &amp; 14 Non-RCT: 0.83; 95% CI 0.75–0.92) and in the number of patients with TIMI flow &amp;lt;3 postPCI (1 RCT &amp; 8 Non-RCT: 0.82; 95% CI 0.73–0.93). Pretreatment was not associated with lower number of patients with TIMI flow &amp;lt;3 pre-PCI (1 RCT &amp; 5 Non-RCT: 0.85; 95% CI 0.66–1.09). Conclusion Pretreatment with DAPT, including a P2Y12 inhibitor, was associated with lower risk for definite stent thrombosis and cardiogenic shock, but was not associated with lower all-cause death or re-infarction. Funding Acknowledgement Type of funding sources: None.

Superiority of Admission Blood Urea Nitrogen over Serum Creatinine in Predicting In-Hospital Outcome of Patients with Acute Coronary Syndrome

Background: Serum creatinine and blood urea nitrogen (BUN) are the common markers of renal function and also one of the known predictors of adverse outcomes of acute coronary syndrome (ACS). The aim of this study is to assess the impact of elevated BUN on in-hospital outcome of ACS patients and superiority of BUN over creatinine for the assessment of in-hospital outcome in our setting. Methods: This prospective observational study with purposive sampling of a total of 184 patients was conducted from October, 2009 to September, 2010. Based on normal cut off values (BUN and serum creatinine was &lt;20 mg/dl and &lt;1.4 mg/dl respectively) all the patients were divided into four groups; group I- both BUN and serum creatinine are normal, group-II- normal BUN and high serum creatinine, group-III- high BUN and normal serum creatinine, group-IV- - both BUN and serum creatinine are high. In-hospital data like hemodynamic conditions, heart failure, arrhythmias, conduction abnormalities, death etc. were noted. Assessment of in-hospital outcome of ACS patients and comparison to elevated serum creatinine and elevated BUN was done. Results: ACS patients with only raised BUN level had more occurrence of cardiogenic shock (p=0.008), left ventricular failure (p=0.020), ventricular Tachycardia (p=0.022), ventricular fibrillation (P=0.037) and complete AV block (p=0.022) than those with only raised serum creatinine. In hospital mortality and hospital stay was also increased in ACS patients with elevated BUN than elevated serum creatinine (p value is 0.022 and 0.007 respectively). Conclusion: Incidence of in-hospital death, cardiogenic shock, left ventricular failure, arrhythmia and duration of hospital stay were significantly (p&lt;0.05) higher in patients who had raised BUN than raised serum creatinine. It is observed that elevated BUN is a better predictor of in-hospital outcome of ACS patients than elevated creatinine. Cardiovasc j 2022; 14(2): 135-142

Elevated Plasma Bioactive Adrenomedullin and Mortality in Cardiogenic Shock: Results from the OptimaCC Trial.

Aims: Bioactive adrenomedullin (bio-ADM) was recently shown to be a prognostic marker in patients with acute circulatory failure. We investigate the association of bio-ADM with organ injury, functional impairment, and survival in cardiogenic shock (CS). Methods: OptimaCC was a multicenter and randomized trial in 57 patients with CS. In this post-hoc analysis, the primary endpoint was to assess the association between bio-ADM and 30-day all-cause mortality. Secondary endpoints included adverse events and parameters of organ injury or functional impairment. Results: Bio-ADM values were higher in 30-day non-survivors than 30-day survivors at inclusion (median (interquartile range) 67.0 (54.6–142.9) pg/mL vs. 38.7 (23.8–63.6) pg/mL, p = 0.010), at 24 h (p = 0.012), and up to 48 h (p = 0.027). Using a bio-ADM cutoff of 53.8 pg/mL, patients with increased bio-ADM had a HR of 3.90 (95% confidence interval 1.43–10.68, p = 0.008) for 30-day all-cause mortality, and similar results were observed even after adjustment for severity scores. Patients with the occurrence of refractory CS had higher bio-ADM value at inclusion (90.7 (59.9–147.7) pg/mL vs. 40.7 (23.0–64.7) pg/mL p = 0.005). Bio-ADM values at inclusion were correlated with pulmonary vascular resistance index, estimated glomerular filtration rate, and N-terminal pro-B-type natriuretic peptide (r = 0.49, r = –0.47, and r = 0.64, respectively; p < 0.001). Conclusions: In CS patients, the values of bio-ADM are associated with some parameters of organ injury and functional impairment and are prognostic for the occurrence of refractory CS and 30-day mortality.

Admissions and In-hospital Outcomes of Acute Coronary Syndromes during Corona Virus Disease 19 Pandemic in Albania

BACKGROUND: Cardiologists and surveys from all over the world have reported an important drop in admissions of patients with acute coronary syndromes (ACS) and related coronary procedures during the outbreak of coronavirus disease 19 (COVID 19) pandemic. AIM: We investigated the impact of the COVID 19 pandemic on hospitalizations for ACS and related invasive procedures in a country with low COVID 19 incidence. METHODS: We conducted a single-center, observational retrospective study including all consecutive patients admitted for ACS in the Cardiology Department of University Hospital Center Mother Theresa from March 9, 2020 (1st day of application of social distance measures) to April 30th (period of total lockdown). Patients admitted in the same time period in 2019 served as controls. All data were collected from the medical files. Admissions were classified as ST-elevation myocardial infarction (STEMI) or non-ST-elevation ACS (NSTEACS). Total and weekly admissions and invasive procedures were assessed. Mean incidence difference (MID) in weekly ACS admissions and procedures was also calculated. RESULTS: Overall, 781 patients were included in this analysis: 321 patients (37%) were admitted during study period and 550 patients (63%) were admitted during the control period (overall reduction of 41.6%; weekly MID of 28.6 (95% confidence interval [CI] 13.3 to 44.0; p = 0.001). The occurrence of all ACS types was reduced: STEMI, by 28.1%; weekly MID 7.3 [0.6-15.2]; p = 0.048]; NSTEACS by 50.5%, weekly MID 19.1 [13.9-24.4]; p &lt; 0.001]. Invasive procedures were also reduced: coronary angiography by 42.5%, weekly MID 26.6 [13.4-39.2]; p = 0.001]; percutaneous coronary intervention (PCI) by 42.3%, weekly MID 16.1 [5.9-26.3], p = 0.004]. Compared to 2019, during the COVID-19 period, there was a 2.4 fold increase in the inhospital death (3% vs 7.2%) with a significant weekly MID 1.4 [0.2-2.7) P=0.032]. A 2.6-fold increase in the occurrence of cardiogenic shock was also observed (13.1% vs. 5.1%, p &lt; 0.0001). CONCLUSIONS: The admissions for ACS and invasive revascularization procedures were significantly reduced, whereas the death rate was increased during COVID 19 pandemic outbreak in Albania compared with the same period in 2019.

Renin-angiotensin-aldosterone system blockers could contribute to the gender-related disparities in STEMI outcomes

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Romanian Ministry of Education and Research, CNCS - UEFISCDI BACKGROUND Women with ST-segment elevation myocardial infarction (STEMI) have been shown to present higher in-hospital mortality compared to their male counterparts. However, most of these data were obtained in the pre-percutaneous coronary intervention (PCI) or even in the pre-thrombolytic era. PURPOSE We aimed to investigate the contribution of female gender to the occurrence of in-hospital complications in STEMI patients treated by primary PCI. METHODS Data regarding in-hospital outcomes (i.e., mortality, inotropic and diuretic drugs usage, occurrence of cardiogenic shock, cardiac arrest) were evaluated in 848 consecutive patients treated by primary PCI for STEMI. Occurrence of new-onset kidney dysfunction and length of hospital stay were also analysed. The relationship between gender and the occurrence of STEMI-related complications was evaluated. RESULTS Out of the 848 patients included in the study, 254 (29.9%) were women. Compared to their male counterparts, female STEMI patients were older (65.7 ± 11.3 vs. 60.1 ± 11.8 years; p&amp;lt; 0.0001), had more often pre-existing heart failure, hypertension, diabetes mellitus, and chronic kidney disease (all p&amp;lt; 0.05), longer symptom onset-to-cardiac catheterization laboratory time intervals (7.9 ± 6.7 vs. 6.4 ± 5.0 h; p&amp;lt; 0.001), and higher Killip class on admission (p = 0.02). Cardiogenic shock, inotropic and diuretic drugs usage, kidney dysfunction, and cardiac arrest occurred more often in female than in male patients (all p&amp;lt; 0.01). The length of hospital stay (p&amp;lt; 0.01) and in-hospital death (RR 1.89 [95%CI 1.43-2.50], p&amp;lt; 0.001) were also higher in female compared to male patients, whereas renin-angiotensin-aldosterone system (RAAS) blockers were used more rarely in female patients (p = 0.01). When corrected for potential confounders, female gender remained an independent predictor of in-hospital mortality (p = 0.01). However, when in-hospital RAAS blockers usage was included in the model, female gender was no longer associated with increased in-hospital mortality (p = 0.15). CONCLUSIONS Female patients with STEMI continue to display significantly higher in-hospital mortality rates compared to their male peers including in the primary PCI era. The difference in in-hospital mortality between female and male patients with STEMI could be at least partially due to the significantly lower usage of RAAS blockers in women. Increasing in-hospital RAAS blockers usage in female patients with STEMI may improve survival in this high-risk population.

Complications des procédures invasives coronaires chez les nonagénaires : une étude cas-témoins

IntroductionCoronary heart disease is the leading cause of morbidity and mortality in nonagenarians, whose numbers have doubled in twenty years. In the absence of recommendations, the place of coronary invasive strategy in this population remains a therapeutic challenge and its interest as well as its risks are poorly established. The aim of our study was to evaluate the safety of coronary invasive practice in the nonagenarian population for all indications. Population and methodsThis was a monocentric case-control study conducted from January 1, 2010 to May 30, 2019. The patients included were all nonagenarians who had undergone coronary angiography at the centre hospitalier de Troyes during this period. For each patient included, two controls matched on sex, date of procedure and procedure were drawn at random. The main judgment criterion was the occurrence of immediate per- or post-procedure complications during the stay in which the procedure was performed. The main secondary outcome measures were average length of stay, occurrence of intercurrent events during the stay (nosocomial infections, confusional syndrome), and loss of autonomy. ResultsIn all, 59 nonagenarians and 118 controls were included in our study. We identified 30.5% major complications in the nonagenarians versus 10.2% in the controls (P=0.001; OR=0.26 [0.1–0.6]), with a significant difference in the occurrence of cardiogenic shock (P=0.04), heart failure (P=0.02) and ventricular rhythm disorders (P=0.04). Post-procedure acute renal failure was greater in the nonagenarians (P=0.02; OR=0.20 [0.05–1.57]). The mean length of stay was on average twice as long in the nonagenarians. ConclusionNonagenarian patients are subject to more complications when undergoing coronary invasive procedures compared to patients under 75.

Fragmented QRS complex frequency and location as predictor of cardiogenic shock and mortality following acute coronary syndrome

BackgroundWorldwide, coronary heart disease (CHD) is topping the foremost important chief causes of mortality. Fragmented QRS (f-QRS) is a pattern of QRS complex in 12 leads surface ECG which showed a promising value in predicting the outcome in cardiac diseases including ischemic heart disease.We aimed to research the importance of using f-QRS as a non-invasive and cheap tool for the prediction of cardiogenic shock and mortality in acute coronary syndrome (ACS).MethodsA retrospective study includes eighty four critically ill ACS patients. Patients were classified consistent with the presence or absence of fragmented QRS into two groups (46 and 38 patients respectively). Exclusion criteria include past history of important ischemic events (MI, PCI, and CABG), permanent AF, and/or cardiomyopathy.No statistical significant differences were detected between the 2 groups as regards the age, gender, major risk factors of ischemic heart condition, cardiac bio-markers, Killip class, LVEF, updated GRACE risk score of ACS, and in-hospital mortality.ResultsA number value of f-QRS leads > 3 yields sensitivity and specificity (83.3% and 72.5% respectively) for predicting hospital mortality. The f-QRS group was further split-up according to the numbers of f-QRS leads into 2 subgroups; subgroup (A1) including patients with > 3 f-QRS leads and subgroup (A2) including patients ≤ 3 f-QRS leads. Subgroup (A2) showed considerable difference as regards some important variables including a higher SBP (P = 0.016), a slower HR (P = 0.014), a lower up-dated GRACE risk score (3.22 ± 6.95 vs 6.81 ± 12, P value 0.048), and a lower rate of hospital death (1/30 vs. 5/16, P = 0.015). Anterior f-QRS showed statistically significant higher HR, lower SBP, a higher frequency of shock, a higher updated GRACE risk score, and a higher chance of in-hospital mortality (P = 0.004) compared to non-anterior f-QRS.ConclusionThe position and number of f-QRS leads provide a non-invasive and a readily accessible tool to predict the prognosis, occurrence of cardiogenic shock, and in-hospital mortality.

Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction

BackgroundVasopressor agents could have certain specific effects in patients with cardiogenic shock (CS) after myocardial infarction, which may influence outcome. Although norepinephrine and epinephrine are currently the most commonly used agents, no randomized trial has compared their effects, and intervention data are lacking. ObjectivesThe goal of this paper was to compare in a prospective, double-blind, multicenter, randomized study, the efficacy and safety of epinephrine and norepinephrine in patients with CS after acute myocardial infarction. MethodsThe primary efficacy outcome was cardiac index evolution, and the primary safety outcome was the occurrence of refractory CS. Refractory CS was defined as CS with sustained hypotension, end-organ hypoperfusion and hyperlactatemia, and high inotrope and vasopressor doses. ResultsFifty-seven patients were randomized into 2 study arms, epinephrine and norepinephrine. For the primary efficacy endpoint, cardiac index evolution was similar between the 2 groups (p = 0.43) from baseline (H0) to H72. For the main safety endpoint, the observed higher incidence of refractory shock in the epinephrine group (10 of 27 [37%] vs. norepinephrine 2 of 30 [7%]; p = 0.008) led to early termination of the study. Heart rate increased significantly with epinephrine from H2 to H24 while remaining unchanged with norepinephrine (p < 0.0001). Several metabolic changes were unfavorable to epinephrine compared with norepinephrine, including an increase in cardiac double product (p = 0.0002) and lactic acidosis from H2 to H24 (p < 0.0001). ConclusionsIn patients with CS secondary to acute myocardial infarction, the use of epinephrine compared with norepinephrine was associated with similar effects on arterial pressure and cardiac index and a higher incidence of refractory shock. (Study Comparing the Efficacy and Tolerability of Epinephrine and Norepinephrine in Cardiogenic Shock [OptimaCC]; NCT01367743)

Predictive factors of cardiogenic shock in children with supraventricular tachycardia

Supraventricular tachycardia (SVT) is the most common arrhythmia in children. Isolated SVT inducing cardiogenic shock is rare and factors leading to cardiac dysfunction are unknown. We aim to determine the predictive factors of cardiogenic shock in children with SVT. In total, 109 children under the age of 1 [median age 10 days (1 d; 30 d)], who were referred for SVT to our pediatric cardiologic intensive care unit were included. Cardiogenic shock was defined as a systemic ventricular ejection fraction under 50% and the need for inotropes use. Types of SVT, antenatal diagnosis of arrhythmia, demographic data, clinical and biological characteristics and the therapeutic management were reviewed. Seventeen percent of patients had cardiogenic shock [median age 12 days (3.5 d; 17.5 d)]. Heart failure was significantly more frequent in case of flutter (54.5% in flutter; 13.3% in other SVT; P < 0.01). When the heart rate was high, the risk of failure was greater [median heart rate flutter/other SVT: 280 bpm (235; 300)/230 bpm (210; 280); P = 0.04]. Abortive therapy by adenosine worked for 60% of other types of SVT with or without cardiogenic shock but was ineffective for patients with flutter in our sample. On the other hand, almost all cases of flutter were reduced by electrical cardioversion. Twenty-nine percent of patients had experienced fetal tachycardia without any additional risk of cardiogenic shock (on all cardiogenic shock 42.1% with antenatal arrhythmia and 57.9% without antenatal tachycardia). Associated congenital heart diseases were not a risk factor of cardiogenic shock. The occurrence of cardiogenic shock is not uncommon in children with SVT and concerns mainly patients with flutter. Faster heart rate and the ineffectiveness of adenosine are associated with potentially severe outcomes. These predictive factors of shock will help identify higher risk patients and improve the therapeutic management.

069 PREDICTORS OF CONTRAST INDUCED ACUTE KIDNEY INJURY FOLLOWING PERCUTANEOUS CORONARY ANGIOGRAM - SINGLE CENTRE EXPERIENCES

Category: Epidemiology and Outcomes from AKI Presenter: Dr CHYI SHYANG TAN Keywords: predictors, risk factors, CIN, CI-AKI, contrast Contrast induced Acute Kidney Injury (CI-AKI) post percutaneous coronary angiography (PCI) are associated with increase mortality and morbidity. Identify risk factors contributing to CI-AKI helps to stratify patients so that appropriate preventive measures can be taken for high risk patients. This is the key to directly improve patient outcome. To assess risk factors predicting the occurrence of CI-AKI post PCI in a cardiac centre of Northern Malaysia. This is a retrospective observational study. The records of all patients underwent PCI between 1 January 2011 to 31 March 2011 were reviewed. Patients on Renal Replacement Therapy (RRT) were excluded. Data were collected from the electronic medical record system. Statistical analysis was performed using SPSS version 23.0. A total of 188 eligible patients included during the study period. During univariable analysis, significant risk factors associated with CI-AKI were diabetes (P=0.001), hypertension (P= 0.038), and occurrence of cardiogenic shock (P=<0.001), pre-existing chronic kidney disease stage III and above (P=0.023) and anaemia (P=<0.001). However, when using multiple logistic regression analysis by enter method, the independent predictors of CI-AKI were diabetes (OR 8.489, 95% CI 1.78 - 40.47; p=0.007), uses of Angiotensin converting enzyme inhibitors (ACE-i) or Angiotensin II receptor blockers (ARB) (OR 8.088, 95% CI 1.705 - 38.369; p=0.008), anaemia (OR 37.9, 95% CI 5.933 to 242.13, p= <0.001) and occurrence of cardiogenic shock (OR 62.62, 95% CI 7.825 to 501.23, p=<0.001). Diabetes, anaemia and history of cardiogenic shock appeared to be significant risk factors for CI-AKI in both univariable analysis and multivariable logistic regression analysis.

Valores intermediários de BNP são capazes de predizer eventos em pacientes com síndrome coronária aguda?

Introdução: Diversos estudos na literatura têm relacionado valores elevados de peptídeo natriurético cerebral (BNP) com pior prognóstico em pacientes com síndrome coronária aguda (SCA). No entanto, valores entre 100 pg/mL e 400 pg/mL são considerados limítrofes e ainda questionados em relação à diagnóstico e ocorrência de eventos. Métodos: Trata-se de estudo retrospectivo observacional com objetivo de avaliar se o valor intermediário de BNP na admissão hospitalar é capaz de predizer prognóstico intrahospitalar. Os pacientes foram divididos em dois grupos: grupo I: BNP &lt; 100 pg/mL; grupo II: 100 &lt; BNP &lt; 400 pg/mL. Foram incluídos 405 pacientes (235 no grupo I e 170 no grupo II) com SCA. Obtiveram-se dados referentes à comorbidades e medicações utilizadas. Análise estatística: O desfecho primário foi mortalidade por todas as causas. O desfecho secundário foi eventos combinados (choque cardiogênico, reinfarto, morte, acidente vascular cerebral e sangramento). A comparação entre grupos foi realizada através de Q-quadrado e ANOVA. A análise multivariada foi realizada por regressão logística, sendo considerado significativo p &lt; 0,05. Resultados: Na comparação entre os grupos I e II, observaram-se diferenças em relação à prevalência de diabetes mellitus e angioplastia coronária prévia. Na análise multivariada, observaram-se diferenças significativas entre os grupos I e II em relação à ocorrência de choque cardiogênico (2,55% x 10,59%, OR = 4,09, p = 0,01), respectivamente. Conclusão: Valores intermediários de BNP não foram capazes de predizer mortalidade em pacientes com SCA. No entanto, observou-se uma maior incidência de choque cardiogênico.

The clinical characteristics and angiographic findings of cardiogenic shock following acute myocardial infarction in elderly patients

Objective To investigate the clinical characteristics and angiographic findings of cardiogenic shock(CS)following acute myocardial infarction(AMI)in elderly patients. Methods Between January 2015 and April 2016, we carried out a retrospective observational analysis of consecutive elderly patients in Tianjin Chest Hospital, who suffered CS-complicating AMI.Emergency angiography and percutaneous coronary intervention(PCI)were performed after admission.All selected patients were divided into CS and non-CS groups according to whether CS occurred.Electrocardiograph(ECG), cardiac enzyme testing, and ultrasound cardiography were performed after admission to monitor the occurrence of CS. Results The incidence of CS-complicating AMI was 8.33%(34/408)in elderly patients.Among all CS patients enrolled, the aged patients accounted for 91.89%(34/37). In-hospital mortality rate was 29.41%(10/34). There were significant differences between two groups in WBC, Hs-CRP, blood glucose, CR and ALT(t=2.403, 4.596, 6.778, 6.109, each P<0.05). The NT-Pro BNP level, the time of FMC, the frequency of left main and multivessel disease were higher in the CS group than in the non-CS group(each P<0.05). Conclusions Elderly patients are bearing high risk of CS following AMI.Prolonged FMC time and the presence of left main and/or multivessel lesion are independent risk factors for the development of CS.The optimal revascularisation strategy can improve the clinical outcome of patients with CS. Key words: Myocardial infarction; Shock, cardiogenic; Diseases attributes

Study of Association of Serum Uric Acid with Serum Lipids, Left Ventricular Ejection Fraction and In-hospital Outcome in Patients with Acute ST-Elevation Myocardial Infarction: An Observational Study

Aim: The aim of this study was to assess the clinical value of serum uric acid (SUA) levels in patients with acute ST-elevation myocardial infarction (STEMI). Materials and Methods: Totally 200 consecutive patients with STEMI were prospectively studied from January 2014 to December 2014. The levels of serum lipid, left ventricular ejection fraction (LVEF) and in-hospital major adverse cardiovascular events in patients with hyperuricaemia (n = 56) were compared with those in patients without hyperuricaemia (n = 144). All data were analysed with GraphPad prism version 6.0 software (Graphpad Software, Inc., CA, USA). Results: SUA level was positively correlated with serum triglyceride level (TGL) (r = 0.102, P = 0.042) and negatively with high-density lipoprotein-cholesterol (HDL-C) (r = −0.149, P = 0.0034). Serum TGL was significantly higher in hyperuricaemic patients (153.7 ΁ 63.87 vs. 138.2 ΁ 34.69, P = 0.027). Patients with left ventricular failure (P = 0.006) and cardiogenic shock (P = 0.029) had significantly higher levels of uric acid. There was no significant difference in males and females with respect to serum TGLs, cardiogenic shock and left ventricular failure. However, no significant association was observed between SUA level and diabetes mellitus, hypertension, LVEF, HDL-C, low-density lipoprotein-cholesterol, total cholesterol, acute renal failure and overall mortality. Conclusion: We conclude that high SUA is significantly associated with high serum TGLs and occurrence of cardiogenic shock and left ventricular failure irrespective of the sex.

Analysis of acute myocardioal infarction complicated with cardiogenic shock due to unprotected left-main coronary artery disease

Objective To analyze the clinical characteristics and prognosis of the patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) due to unprotected left-main coronary artery (ULMCA) disease. Methods From January 1999 to May 2014, 5 798 emergency coronary angiographies were performed. The AMI patients with infarction of related artery of ULMCA conformed by angiography were enrolled. Clinical characteristics and prognosis of the patients were studied. The patients were divided into two groups according to the occurrence of CS during hospitalization. The interventional data and outcome during short term and long term followed up were compared between the two groups. The causes of CS and mortality were analyzed. Results Fifty-eight patients were enrolled, and CS occurred in 31 patients (53.4%). Compared with CS free group, left ventricular ejection fraction, occurrence of TIMI grade 2-3 during diagnostic angiography, collateral circulation with Rentrop grade 2-3 and final flow of TIMI grade 3 were lower in the group with CS. Logistic analysis revealed poor collateral circulation (less than Rentrop grade 2) was related with occurrence of CS (OR=0.19, P=0.02). Twenty-three patients died in hospital, and the mortality in CS group was higher than that in the group without CS (64.5%vs. 11.1%, P <0.01). CS was confirmed as a powerful predictor of in-hospital mortality by Logistic analysis (OR=6.94, P=0.01). Long term follow up was performed in the 35 survivors with the duration of median time of 42.0 (12.0, 60.0) months. The accumulative total survival rate was 20.3% in patients with CS and 51.8% in patients without CS (Log-rank, P <0.01). Multivariable COX regression analysis revealed the only independent predictor of total mortality during long-term follow up was CS during hospitalization (HR=4.67, P=0.004). Conclusions AMI due to ULMCA disease was critically risky with high incidence of CS. The short term and long term prognosis of these patients with AMI caused by ULMCA disease complicated with CS was poor. Key words: Acute myocardial infarction; Cardiacgenic shock; Left-main coronary artery; Percutaneous coronary intervention

Outcome After ST Elevation Myocardial Infarction in Patients With Cancer Treated With Primary Percutaneous Coronary Intervention

The simultaneous occurrence of cancer and coronary heart disease is increasing in the Western world. Nevertheless, the influence of cancer on ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) has not been investigated extensively. This multicenter registry included patients with STEMI treated with primary PCI from 2006 to 2009. Patients were stratified according to history of cancer, and primary focus lay on all-cause and cardiac mortalities during 1-year follow-up. Adjusted effect sizes were calculated using Cox proportional hazard models. In total, 208 patients had a history of cancer (diagnosed ≤6months ago in 20.7%, 6 months to 3 years ago in 21.7%, and >3years ago in 57.6%) and 3,215 patients had no history of cancer. Chemotherapy had been administered previously to 23% of patients with cancer. Patients with cancer were older, more frequently women, and more commonly known with previous myocardial infarction or anemia. Reperfusion rates were similar after PCI. Patients with cancer showed greater all-cause (17.4% vs 6.5% in other patients) and cardiac mortalities at 1 year (10.7% vs 5.4% in other patients) because of high early cardiac death (23.8%) in recently diagnosed patients with cancer. After adjustment, a recent cancer diagnosis predicted cardiac mortality at 7 days (hazard ratio 3.34, 95% confidence interval 1.57 to 7.08). The adverse prognosis was partly explained by anemia and occurrence of cardiogenic shock, whereas outcome was independent of cancer treatment. In conclusion, patients with cancer showed greater mortality after STEMI. A cancer diagnosis in the 6months before primary PCI was strongly associated with early cardiac mortality.

Gender inequality in the clinical outcomes of equally treated acute coronary syndrome patients in Saudi Arabia

BACKGROUND AND OBJECTIVESGender associations with acute coronary syndrome (ACS), remain inconsistent. Gender-specific data in the Saudi Project for Assessment of Coronary Events registry, launched in December 2005 and currently with 17 participating hospitals, were explored.DESIGN AND SETTINGSA prospective multicenter study of patient with ACS in secondary and tertiary care centers in Saudi Arabia were included in this analysis.PATIENTS AND METHODSPatients enrolled from December 2005 until December 2007 included those presented to participating hospitals or transferred from non-registry hospitals. Summarized data were analyzed.RESULTSOf 5061 patients, 1142 (23%) were women. Women were more frequently diagnosed with non ST-segment elevation myocardial infarction (NSTEMI [43%]) than unstable angina (UA [29%]) or ST-segment elevation myocardial infarction (STEMI [29%]). More men had STEMI (42%) than NSTEMI (37%) or UA (22%). Men were younger than women (57 vs 63 years) who had more diabetes, hypertension, and hyperlipidemia. More men had a history of coronary artery disease. More women received angiotensin receptor blockers (ARB) and fewer had percutaneous coronary intervention (PCI). Gender differences in the subset of STEMI patients were similar to those in the entire cohort. However, gender differences in the subset of STEMI showed fewer women given β-blockers, and an insignificant PCI difference between genders. Thrombolysis rates between genders were similar. Overall, in-hospital mortality was significantly worse for women and, by ACS type, was significantly greater in women for STEMI and NSTEMI. However, after age adjustment there was no difference in mortality between men and women in patients with NSTEMI. The multivariate-adjusted (age, risk factors, treatments, door-to-needle time) STEMI gender mortality difference was not significant (OR=2.0, CI: 0.7–5.5; P=.14).CONCLUSIONThese data are similar to other reported data. However, differences exist, and their explanation should be pursued to provide a valuable insight into understanding ACS and improving its management.