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Ferrer-Curriu G, Rueda F, Revuelta-López E, García-García C, Codina P, Gálvez-Montón C, Roura S, Aimo A, Emdin M, Planavila A, Bayés-Genís A. Meteorin-like protein is associated with a higher risk profile and predicts a worse outcome in patients with STEMI. Rev Esp Cardiol (Engl Ed) 2023; 76:891-900. [PMID: 37105412 DOI: 10.1016/j.rec.2023.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/17/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION AND OBJECTIVES Meteorin-like protein (Metrnl) is a cytokine involved in the attenuation of inflammation. In patients with heart failure, high levels of this biomarker are associated with a worse outcome. In this study, we evaluated the circulating levels and prognostic value of Metrnl in patients with ST-segment elevation myocardial infarction (STEMI). METHODS We enrolled STEMI patients undergoing primary percutaneous coronary intervention. Circulating Metrnl levels were measured in peripheral blood 12hours after symptom onset. The primary endpoint was a composite of all-cause mortality or nonfatal myocardial infarction (MI) at 3 years. RESULTS We studied 381 patients (mean age 61 years, 21% female, 8% Killip class III/IV). Metrnl levels were associated with age, cardiovascular risk factors and the extent of coronary artery disease, as well as with STEMI complications, particularly heart failure and cardiogenic shock. Multivariable Cox regression analysis revealed that Metrnl independently predicted all-cause death or nonfatal MI at 3 years (HR, 1.86; 95%CI, 1.23-2.81; P=.003). Moreover, patients in the highest tertile (> 491.6 pg/mL) were at higher risk for the composite endpoint than those in the lowest tertiles (HR, 3.24; 95%CI, 1.92-5.44; P <.001), even after adjustment by age, diabetes mellitus, cardiac arrest, Killip-Kimball III/IV class, left ventricular ejection fraction, and creatinine clearance (HR, 1.90; 95%CI, 1.10-3.29; P=.021). CONCLUSIONS Circulating Metrnl levels are associated with complications during the acute phase of STEMI and independently predict a worse outcome in these patients.
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Affiliation(s)
- Gemma Ferrer-Curriu
- ICREC Research Program, Institut de Recerca Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Barcelona, Spain
| | - Ferran Rueda
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elena Revuelta-López
- ICREC Research Program, Institut de Recerca Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Barcelona, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Cosme García-García
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pau Codina
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Carolina Gálvez-Montón
- ICREC Research Program, Institut de Recerca Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Barcelona, Spain; Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Santiago Roura
- ICREC Research Program, Institut de Recerca Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Barcelona, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Vic, Barcelona, Spain
| | - Alberto Aimo
- Interdisciplinary Center of Health Science, Scuola Superiore Sant'Anna, Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Emdin
- Interdisciplinary Center of Health Science, Scuola Superiore Sant'Anna, Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Anna Planavila
- Departament de Bioquímica i Biologia Molecular; Institut de Biomedicina (IBUB), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación en Red de Fisiopatología de la Obesidad y Nutrición (CIBERON), Spain
| | - Antoni Bayés-Genís
- ICREC Research Program, Institut de Recerca Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Barcelona, Spain; Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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de Diego O, Rueda F, Carrillo X, Oliveras T, Andrea R, El Ouaddi N, Serra J, Labata C, Ferrer M, Martínez-Membrive MJ, Montero S, Mauri J, García-Picart J, Rojas S, Ariza A, Tizón-Marcos H, Faiges M, Cárdenas M, Lidón RM, Muñoz-Camacho JF, Jiménez Fàbrega X, Lupón J, Bayés-Genís A, García-García C. Performance analysis of a STEMI network: prognostic impact of the type of first medical contact facility. Rev Esp Cardiol (Engl Ed) 2023; 76:708-718. [PMID: 36623690 DOI: 10.1016/j.rec.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION AND OBJECTIVES Prognosis in ST-elevation myocardial infarction (STEMI) is determined by delay in primary percutaneous coronary intervention (PPCI). The impact of first medical contact (FMC) facility type on reperfusion delays and mortality remains controversial. METHODS We performed a prospective registry of primary coronary intervention (PCI)-treated STEMI patients (2010-2020) in the Codi Infart STEMI network. We analyzed 1-year all-cause mortality depending on the FMC facility type: emergency medical service (EMS), community hospital (CH), PCI hospital (PCI-H), or primary care center (PCC). RESULTS We included 18 332 patients (EMS 34.3%; CH 33.5%; PCI-H 12.3%; PCC 20.0%). Patients with Killip-Kimball classes III-IV were: EMS 8.43%, CH 5.54%, PCI-H 7.51%, PCC 3.76% (P <.001). All comorbidities and first medical assistance complications were more frequent in the EMS and PCI-H groups (P <.05) and were less frequent in the PCC group (P <.05 for most variables). The PCI-H group had the shortest FMC-to-PCI delay (median 82 minutes); the EMS group achieved the shortest total ischemic time (median 151 minutes); CH had the longest reperfusion delays (P <.001). In an adjusted logistic regression model, the PCI-H and CH groups were associated with higher 1-year mortality, OR, 1.22 (95%CI, 1.00-1.48; P=.048), and OR, 1.17 (95%CI 1.02-1.36; P=.030), respectively, while the PCC group was associated with lower 1-year mortality than the EMS group, OR, 0.71 (95%CI 0.58-0.86; P <.001). CONCLUSIONS FMC with PCI-H and CH was associated with higher adjusted 1-year mortality than FMC with EMS. The PCC group had a much lower intrinsic risk and was associated with better outcomes despite longer revascularization delays.
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Affiliation(s)
- Oriol de Diego
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic Barcelona, Barcelona, Spain; Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Doctorando, Programa de doctorado, Department de Medicina, Universitat Autònoma de Barcelona, Spain.
| | - Ferran Rueda
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Xavier Carrillo
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Teresa Oliveras
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Rut Andrea
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic Barcelona, Barcelona, Spain; Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Nabil El Ouaddi
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jordi Serra
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Carlos Labata
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marc Ferrer
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - María J Martínez-Membrive
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Santiago Montero
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Josepa Mauri
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Servei Català de Salut, Generalitat de Catalunya, Registre del Codi Infart, Barecelona, Spain
| | - Joan García-Picart
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sergio Rojas
- Servicio de Cardiología, Hospital Joan XXIII, Tarragona, Spain
| | - Albert Ariza
- Servicio de Cardiología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Helena Tizón-Marcos
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Heart Diseases Biomedical Research Group, Instituto de investigaciones Hospital del Mar (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Marta Faiges
- Servicio de Cardiología, Hospital de Tortosa Verge de la Cinta, IISPV, Tarragona, Spain
| | - Mérida Cárdenas
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, Spain
| | - Rosa María Lidón
- Servicio de Cardiología, Hospital Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | | | - Josep Lupón
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Cosme García-García
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
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Rueda F, Maqueda L, Domínguez V, Rodriguez E, Alonso D, Núñez C, Vallory J, Poitevin Y, Fantini F. An update on the latest and most relevant improvements achieved in the European helium-cooled ceramic breeder TBM design. Fusion Engineering and Design 2023. [DOI: 10.1016/j.fusengdes.2023.113660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Ouaddi NE, de Diego O, Labata C, Rueda F, Martínez MJ, Cámara ML, Berastegui E, Oliveras T, Ferrer M, Montero S, Serra J, Muñoz-Guijosa C, Lupón J, Bayés-Genis A, García-García C. Mechanical complications in STEMI: prevalence and mortality trends in the primary PCI era. The Ruti-STEMI registry. Rev Esp Cardiol (Engl Ed) 2023; 76:427-433. [PMID: 36228958 DOI: 10.1016/j.rec.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/22/2022] [Indexed: 05/28/2023]
Abstract
INTRODUCTION AND OBJECTIVES Mechanical complications confer a dreadful prognosis in ST-elevation myocardial infarction (STEMI). Their prevalence and prognosis are not well-defined in the current era of primary percutaneous coronary intervention (pPCI) reperfusion networks. We aimed to analyze prevalence and mortality trends of post-STEMI mechanical complications over 2 decades, before and after the establishment of pPCI networks. METHODS Prospective, consecutive registry of STEMI patients within a region of 850 000 inhabitants over 2 decades: a pre-pPCI period (1990-2000) and a pPCI period (2007-2017). We analyzed the prevalence of mechanical complications, including ventricular septal rupture, papillary muscle rupture, and free wall rupture (FWR). Twenty eight-day and 1-year mortality trends were compared between the 2 studied decades. RESULTS A total of 6033 STEMI patients were included (pre-pPCI period, n=2250; pPCI period, n=3783). Reperfusion was supported by thrombolysis in the pre-pPCI period (99.1%) and by pPCI in in the pPCI period (95.7%). Mechanical complications developed in 135 patients (2.2%): ventricular septal rupture in 38 patients, papillary muscle rupture in 24, and FWR in 73 patients. FWR showed a relative reduction of 60% in the pPCI period (0.8% vs 2.0%, P<.001), without significant interperiod changes in the other mechanical complications. After multivariate adjustment, FWR remained higher in the pre-pPCI period (OR, 1.93; 95%CI, 1.10-3.41; P=.023). At 28 days and 1 year, mortality showed no significant changes in all the mechanical complications studied. CONCLUSIONS The establishment of regional pPCI networks has modified the landscape of mechanical complications in STEMI. FWR is less frequent in the pPCI era, likely due to reduced transmural infarcts.
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Affiliation(s)
- Nabil El Ouaddi
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Oriol de Diego
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, España; PhD program, Department of Medicine Autonomous University of Barcelona, Barcelona, España
| | - Carlos Labata
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ferran Rueda
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - María José Martínez
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - María Luisa Cámara
- Cirugía Cardiaca, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elisabet Berastegui
- Cirugía Cardiaca, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Teresa Oliveras
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Marc Ferrer
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Santiago Montero
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jordi Serra
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Christian Muñoz-Guijosa
- Cirugía Cardiaca, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Lupón
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Antoni Bayés-Genis
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Cosme García-García
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Maqueda L, Almenara J, Piñeiro D, Rodríguez E, Rueda F, Yáñez A, Villone F, Baldrís M, Herrero I, Serrano M, Bender S, Iglesias D, Nikolaeva D, Sadakov S. Feasibility evaluation and pre-conceptual design of the Iter Tokamak systems monitor. Fusion Engineering and Design 2023. [DOI: 10.1016/j.fusengdes.2023.113435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Diego OD, Rueda F, Carrillo X, Oliveras T, Andrea R, Ouaddi NE, Serra J, Labata C, Ferrer M, Martínez-Membrive MJ, Montero S, Mauri J, García-Picart J, Rojas S, Ariza A, Tizón-Marcos H, Faiges M, Cárdenas M, Lidón RM, Muñoz-Camacho JF, Fàbrega XJ, Lupón J, Bayés-Genís A, García-García C. Análisis de una red de atención al IAMCEST: impacto pronóstico del tipo de primer contacto médico. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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El Ouaddi N, de Diego O, Labata C, Rueda F, Martínez MJ, Cámara ML, Berastegui E, Oliveras T, Ferrer M, Montero S, Serra J, Muñoz-Guijosa C, Lupón J, Bayés-Genis A, García-García C. Complicaciones mecánicas en el IAMCEST: tendencias de prevalencia y mortalidad en la era de la angioplastia primaria. Registro Ruti-STEMI. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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De Diego Soler O, Garcia-Garcia C, Rueda F, Carrillo X, Andrea R, Regueiro A, Mauri F, Lidon RM, Tizon H, Garcia-Pitarch J, Bayes-Genis A. First medical contact facility type as a determinant of prognosis in a regional ST elevation myocardial infarction network. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Delay in primary percutaneous coronary intervention (PPCI) in ST elevation myocardial infartion (STEMI) is associated with worse prognosis. In our regional STEMI network, the first medical contact (FMC) facility type defines 4 different assistance pathways (i.e. emergency medical services'diagnosis on the field and direct transfer to the catheterization laboratory (cath. lab) of a PCI hospital (EMS group); direct admission to a PCI hospital (PCI-H group); admission to community hospital and transfer to the cath lab of the PCI-H (CH group); diagnosis in a primary care centre and transfer to the cath lab of the PCI-H (PCC group). Each different FMC has been associated with different degrees in reperfusion delay.
Objective
To determine the influence of FMC facility type on 1-year mortality in patients with STEMI in our regional STEMI network.
Methods
This is a retrospective study based on the STEMI network registry, a mandatory registry conducted since its implantation and supervised by the regional health authorities. We included STEMI patients treated with PPCI from January 2010 to December 2020. We analyzed differences in clinical variables, reprefusion times and 1-year all-cause mortality regarding the FMC facility type.
Results
We included 18332 patients (EMS 34.25%, PCI-H 12.28%, CH 33.47%, PCC 20.01%). Initial Killip classes III–IV: EMS 8.43%, PCI-H 7.51%, CH 5.54%, PCC 3.76%; p<0.001. All comorbidities and complications in first medical assistance were more frequent in EMS and PCI-H groups (p<0.05). PCC group had the lowest risk profile regarding comorbidities and first medical assistance complications (p<0.05 for most of variables). The PCI-H group had the shortest system delay (median 82 min, p<0.001), the EMS group had the shortest total ischemic time (median 151 min, p<0.001). Crude 1-year mortality was EMS 8.6%, PCI-H 9.11%, CH 8.25%, and PCC 4.77% (p<0.001). After adjusting for several covariables with a logistic regression model, PCI-H and CH groups were associated with higher 1-year mortality compared to EMS group (OR 1.23 (IC95% 1.01–1.49; p=0.04) and OR 1.16 (IC95% 1.01–1.34; p=0.04) respectively), while PCC group was associated with lower 1-year mortality (OR 0.69 (IC95% 0.57–0.84; p<0.01)).
Conclusions
First medical contact with EMS and direct transfer to the cath lab was associated with lower adjusted 1-year mortality compared to first medical contact with a PCI hospital or a community hospital.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - C Garcia-Garcia
- Germans Trias i Pujol Hospital, Cardiology , Badalona (Barcelona) , Spain
| | - F Rueda
- Germans Trias i Pujol Hospital, Cardiology , Badalona (Barcelona) , Spain
| | - X Carrillo
- Germans Trias i Pujol Hospital, Cardiology , Badalona (Barcelona) , Spain
| | - R Andrea
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - A Regueiro
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - F Mauri
- Germans Trias i Pujol Hospital, Cardiology , Badalona (Barcelona) , Spain
| | - R M Lidon
- University Hospital Vall d'Hebron , Barcelona , Spain
| | - H Tizon
- Hospital del Mar , Barcelona , Spain
| | | | - A Bayes-Genis
- Germans Trias i Pujol Hospital, Cardiology , Badalona (Barcelona) , Spain
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El Ouaddi N, Escabia C, Rueda F, Oliveras T, Montero S, Labata C, Ferrer M, Garcia-Garcia C, Bayes-Genis A. Impact of COVID-19 on mechanical complications in ST elevation myocardial infarction. Eur Heart J 2022. [PMCID: PMC9619490 DOI: 10.1093/eurheartj/ehac544.1445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Mechanical complications (MC) give a poor prognosis for ST elevation myocardial infarction (STEMI). Its prevalence had decreased in the era of primary angioplasty, at the expense of free wall rupture (FWR). Purpose To analyse the prevalence of post-STEMI MC for two periods, before and after the COVID-19 pandemic. Methods Unicentric prospective registration of patients with STEMI admitted between January-2018 and December-2021. They are classified into two groups according to the onset of the pandemic by COVID-19: Pre-COVID: January-2018 to December-2019, and Post-COVID: January-2020 to December-2021. The prevalence of post-STEMI MC is analysed, including ventricular septal rupture (VSR), papillary muscle rupture (PMR) and FWR, and 30-day mortality. Results 1507 consecutive patients with STEMI (Pre-COVID n=775, Post-COVID n=732) are included. Age 62.9 years vs 63.3 years (p=0.5097). Men 78.1% Vs 79.5% (p=0.493). No differences in cardiovascular risk factors, previous heart infarction or anterior wall STEMI. Primary angioplasty was similar in both groups (92%). The Post-COVID group has a higher prevalence of Killip>I (21.7% vs 17.2% p=0.025) and LVEF ≤40% (27.2% vs 20% p=0.001), and longer symptom onset to balloon dilatation interval (316 min vs 257 min p=0.0004). MC are most developed in Post-COVID (2.6% vs 1.2% p=0.039), at the expense of FWR (1.91% vs 0.3% p=0.001). No significant changes in VSR and PMR prevalence or 30-day mortality. Multivariate analysis identifies the independent predictors of FWR: Age (OR 1.05, p=0.024), Primary angioplasty (OR 0.09, p<0.001), and Post-COVID (OR 6.8, p=0.013). Conclusions The COVID-19 pandemic is independently associated with a higher prevalence of FWR, probably due to delayed reperfusion. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- N El Ouaddi
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - C Escabia
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - F Rueda
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - T Oliveras
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - S Montero
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - C Labata
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - M Ferrer
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - C Garcia-Garcia
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - A Bayes-Genis
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
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Martínez MJ, Rueda F, Labata C, Oliveras T, Montero S, Ferrer M, El Ouaddi N, Serra J, Lupón J, Bayés-Genís A, García-García C. Non-STEMI vs. STEMI Cardiogenic Shock: Clinical Profile and Long-Term Outcomes. J Clin Med 2022; 11:jcm11123558. [PMID: 35743628 PMCID: PMC9224589 DOI: 10.3390/jcm11123558] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/12/2022] [Accepted: 06/17/2022] [Indexed: 11/21/2022] Open
Abstract
Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI). In AMI-CS, the ST segment deviation on ECG may be elevated (STEMI-CS) or non-elevated (NSTEMI-CS), which may influence prognosis. Our aim was to analyze the clinical profile, acute-phase prognosis, and long-term outcomes of CS relative to the ST pattern on admission. In a prospective registry of 4647 AMI patients admitted to the intensive cardiac care unit of a university hospital between 2010 and 2019, we compared the clinical characteristics, 30-days case fatality, and long-term outcomes of AMI-CS, based on the presence of ST-segment deviation. AMI-CS developed in 239 (5.1%) patients (26.4% women): 190 (79.5%) STEMI-CS and 49 (20.5%) NSTEMI-CS. The mean age was 69.7 years. The STEMI-CS patients had larger infarcts and more mechanical complications than the NSTEMI-CS patients. The NSTEMI-CS patients had a greater prevalence of hypertension, diabetes, peripheral vascular disease, previous cardiovascular comorbidities, three-vessel disease, and left main disease than the STEMI-CS patients. The STEMI-CS patients had higher 30-day mortality than the NSTEMI-CS (59.5% vs. 36.7%; p = 0.004), even after multivariable adjustment (HR 1.91; 95% CI 1.16–3.14), but no differences in mortality were observed at 3 years. In conclusion, the 30-day case-fatality is higher in STEMI-CS, but the long-term outcome is similar in both groups.
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Affiliation(s)
- María José Martínez
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
- Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain
- PhD Program, Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Ferran Rueda
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Carlos Labata
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Teresa Oliveras
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Santiago Montero
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Marc Ferrer
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Nabil El Ouaddi
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Jordi Serra
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Josep Lupón
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
- CIBER Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Antoni Bayés-Genís
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
- CIBER Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Cosme García-García
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
- CIBER Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-497-86-62; Fax: +34-93-497-89-39
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11
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Katona I, Tóth M, Castellanos J, Arbeiter F, Dézsi T, Zsákai A, Micciche G, Qiu Y, Siwek M, Alonso D, Melendez C, Rueda F, Ibarra A. Preliminary finite element analysis of the stainless-steel liner of the maintainable test cell concept of IFMIF-DONES. Nuclear Materials and Energy 2022. [DOI: 10.1016/j.nme.2022.101186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Oliveras T, Revuelta-López E, García-García C, Cserkóová A, Rueda F, Labata C, Ferrer M, Montero S, El-Ouaddi N, Martínez MJ, Roura S, Gálvez-Montón C, Bayes-Genis A. Circulating virome and inflammatory proteome in patients with ST-elevation myocardial infarction and primary ventricular fibrillation. Sci Rep 2022; 12:7910. [PMID: 35552514 PMCID: PMC9098642 DOI: 10.1038/s41598-022-12075-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/05/2022] [Indexed: 11/09/2022] Open
Abstract
Primary ventricular fibrillation (PVF) is a life-threatening complication of ST-segment elevation myocardial infarction (STEMI). It is unclear what roles viral infection and/or systemic inflammation may play as underlying triggers of PVF, as a second hit in the context of acute ischaemia. Here we aimed to evaluate whether the circulating virome and inflammatory proteome were associated with PVF development in patients with STEMI. Blood samples were obtained from non-PVF and PVF STEMI patients at the time of primary PCI, and from non-STEMI healthy controls. The virome profile was analysed using VirCapSeq-VERT (Virome Capture Sequencing Platform for Vertebrate Viruses), a sequencing platform targeting viral taxa of 342,438 representative sequences, spanning all virus sequence records. The inflammatory proteome was explored with the Olink inflammation panel, using the Proximity Extension Assay technology. After analysing all viral taxa known to infect vertebrates, including humans, we found that non-PVF and PVF patients only significantly differed in the frequencies of viruses in the Gamma-herpesvirinae and Anelloviridae families. In particular, most showed a significantly higher relative frequency in non-PVF STEMI controls. Analysis of systemic inflammation revealed no significant differences between the inflammatory profiles of non-PVF and PVF STEMI patients. Inflammatory proteins associated with cell adhesion, chemotaxis, cellular response to cytokine stimulus, and cell activation proteins involved in immune response (IL6, IL8 CXCL-11, CCL-11, MCP3, MCP4, and ENRAGE) were significantly higher in STEMI patients than non-STEMI controls. CDCP1 and IL18-R1 were significantly higher in PVF patients compared to healthy subjects, but not compared to non-PVF patients. The circulating virome and systemic inflammation were not associated with increased risk of PVF development in acute STEMI. Accordingly, novel strategies are needed to elucidate putative triggers of PVF in the setting of acute ischaemia, in order to reduce STEMI-driven sudden death burden.
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Affiliation(s)
- Teresa Oliveras
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain. .,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Elena Revuelta-López
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Sciences Research Institute Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Cosme García-García
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Adriana Cserkóová
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Sciences Research Institute Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Ferran Rueda
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Carlos Labata
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Marc Ferrer
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Santiago Montero
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Nabil El-Ouaddi
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Maria José Martínez
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Santiago Roura
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Sciences Research Institute Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Carolina Gálvez-Montón
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Sciences Research Institute Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Antoni Bayes-Genis
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain. .,Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Sciences Research Institute Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain. .,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain. .,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.
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13
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Garcia-Garcia C, Andrea R, Sanz E, Sanchez-Salado JC, Aboal J, Pastor P, Buera I, Sionis A, Lopez T, Perez-Rodriguez M, Ariza A, Baneras J, Tomas C, Cediel G, Rueda F. Mortality risk in cardiogenic shock depending on aetiology in a Mediterranean cohort. Prognostic accuracy of CardShock vs IABP score: the Shock CAT study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mortality in cardiogenic shock (CS) remains very high. Several risk scores have been purposed to early stratification, although the CS aetiology could influence in this prediction.
Purpose
The aim is to investigate in-hospital prognosis and mortality risk in CS patients depending on the CS aetiology comparing the prognostic accuracy of CardShock and IABP scores in a Mediterranean cohort.
Method
Shock CAT study was a multicentre, prospective, observational study conducted between December 2018 and December 2019 in eight public University hospitals in Catalonia (Spain), including CS patients due to acute coronary syndrome (ACS) and other aetiologies. Data on clinical presentation, biomarkers, management, including mechanical assistance support were analyzed comparing ACS and non-ACS patients. Cardshock and IABP score have been compared to assess 90-days mortality risk in both groups.
Results
A total of 382 CS patients were included, mean age was 65.3 (SD 13.9) years and 75.1% were men. Patient were classified in ACS (n=232, 60.7%) and non-ACS (n=150, 39.3%). In ACS group, 77.6% were STEMI, reperfussion in 84.7% of cases, all with primary angioplasty, 9% developed mechanical complications and 19.4% primary ventricular fibrillation. Main non-ACS aetiologies were severe heart failure (36.2%), malignant arrhythmias (22.1%), valve disease (8.0%) and myocarditis (7.4%). ACS group had less prevalence of women (17.7% vs 36%, p=0.001) and previous myocardial infarction (13.9% vs 24.8%, p=0.007). Mechanical assistance device was implanted more in ACS patients (43.1% vs 16.7%, p<0.001, mainly intraaortic balloon pump (35.6% vs 9.8%, p<0.001) and ECMO (10.7% vs 3%, p=0.01). Both shock risk scores were higher in ACS patients, Cardshock (4.5 vs 4.0, p=0.006) and IABP (2.4 vs 1.9, p=0.005). In-hospital mortality was higher in ACS (37.1 vs 26.7%, p=0.035) although this difference loss the significance at 90-days (40.9 vs 31.8%, p=0.074) and 6-months (45.2 vs 35.8%, p=0.176). Receiver-operating characteristic curves demonstrated that IABP shock score had superior prognostic power for predicting 90-days mortality when compared with Cardshock score in ACS patients (area under the curve -AUC- 0.74 vs 0.66) respectively, p=0.047, although both scores were similar in non-ACS (AUC 0.64 vs 0.62, p=0.693), Figures 1–2.
Conclusions
Cardiogenic shock due to ACS had higher in-hospital mortality than non-ACS CS, although this difference decreased at 90 days and 6 months. IABP score provided better 90-days mortality risk prediction than CardShock score in ACS patients, but both scores are similar in non-ACS cardiogenic shock.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
| | - R Andrea
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Sanz
- University Hospital of Taragona Joan XXIII, Tarragona, Spain
| | | | - J Aboal
- University Hospital de Girona Dr. Josep Trueta, Regiό Sanitaria de Girona, Girona, Spain
| | - P Pastor
- Hospital Arnau de Vilanova, Lleida, Spain
| | - I Buera
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - T Lopez
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - A Ariza
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Baneras
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - C Tomas
- Hospital Arnau de Vilanova, Lleida, Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - F Rueda
- Germans Trias i Pujol University Hospital, Barcelona, Spain
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14
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Garcia-Garcia C, Lopez T, Sanz E, Sanchez-Salado JC, Aboal J, Tomas C, Baneras J, Sionis A, Andrea R, Perez-Rodriguez M, Ariza A, Pastor P, Buera I, Cediel G, Rueda F. Mortality risk in cardiogenic shock: head to head comparision CardShock vs IABP score in a Mediterranean cohort: the Shock CAT study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mortality in cardiogenic shock (CS) remains very high. Several risk scores have been purposed to early stratification.
Purpose
The aim is to investigate in-hospital prognosis and mortality risk in CS patients comparing the prognostic accuracy of CardShock and IABP scores in a Mediterranean cohort.
Method
Shock CAT study was a multicentre, prospective, observational study conducted between December 2018 and December 2019 in eight public University hospitals in Catalonia (Spain), including CS patients due to acute coronary syndrome (ACS) and other aetiologies. Data on clinical presentation, biomarkers, management, including mechanical assistance support were analyzed. Cardshock and IABP score have been compared to assess 90-days mortality risk in a Mediterranean cohort.
Results
A total of 382 CS patients were included, mean age was 65.3 (SD 13.9) years and 75.1% were men. The most common cause of CS was ACS (61%, n=233); of them, 77.6% were STEMI, 9% developed mechanical complications and 19.4% primary ventricular fibrillation. STEMI patients were reperfused in 84.7% of cases, all with primary angioplasty. Main non-ACS aetiologies were severe acute heart failure, malignant arrhythmias and myocarditis. Mechanical assistance device was implanted in one third of patients (n=119), mainly intraaortic balloon pump (26.1%), ECMO in 7.8% and Impella in 4.5%. Average Cardshock score was 4.3 (SD 1.74) and mean IABP score was 2.2 (SD 1.61). In-hospital mortality was 33% (126 patients) and 90-days mortality was 37.3% (141 patients). Receiver-operating characteristic curves demonstrated that IABP shock score had superior prognostic power for predicting 90-days mortality when compared with Cardshock score (area under the curve 0.72 vs 0.66) respectively, p=0.042; Figure 1.
Conclusions
Even though invasive management with STEMI reperfusion and mechanical assistance devices, cardiogenic shock in-hospital mortality remains 33% in a contemporary Mediterranean cohort. In this population, IABP shock score provided better 90-days mortality risk prediction than CardShock score
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - T Lopez
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Sanz
- University Hospital of Taragona Joan XXIII, Tarragona, Spain
| | | | - J Aboal
- University Hospital de Girona Dr. Josep Trueta, Girona, Spain
| | - C Tomas
- Hospital Arnau de Vilanova, Lleida, Spain
| | - J Baneras
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Andrea
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - A Ariza
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - P Pastor
- Hospital Arnau de Vilanova, Lleida, Spain
| | - I Buera
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - F Rueda
- Germans Trias i Pujol University Hospital, Barcelona, Spain
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15
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Aubert J, Aiello G, Alonso D, Batal T, Boullon R, Burles S, Cantone B, Cismondi F, Del Nevo A, Maqueda L, Morin A, Rodríguez E, Rueda F, Soldaini M, Vallory J. Design and preliminary analyses of the new Water Cooled Lithium Lead TBM for ITER. Fusion Engineering and Design 2020. [DOI: 10.1016/j.fusengdes.2020.111921] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Garcia-Garcia C, Rueda F, Lupon J, Oliveras T, Labata C, Ferrer M, Cediel G, De Diego O, Rodriguez-Leor O, Carrillo X, Bayes-Genis A. Growth differentiation factor-15 is a predictive biomarker in primary ventricular fibrillation: The RUTI-STEMI-PVF study. European Heart Journal. Acute Cardiovascular Care 2020; 9:S161-S168. [DOI: 10.1177/2048872618797599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background:
Primary ventricular fibrillation is an ominous complication of ST-segment elevation myocardial infarction, and proper biomarkers for risk prediction are lacking. Growth differentiation factor-15 is a marker of inflammation, oxidative stress and hypoxia with well-established prognostic value in ST-segment elevation myocardial infarction patients. We explored the predictive value of growth differentiation factor-15 in a subgroup of ST-segment elevation myocardial infarction patients with primary ventricular fibrillation.
Methods:
Prospective registry of ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention from February 2011–August 2015. Growth differentiation factor-15 concentrations were measured on admission. Logistic regression and Cox proportional regression analyses were used.
Results:
A total of 1165 ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention (men 78.5%, age 62.3±13.1 years) and 72 patients with primary ventricular fibrillation (6.2%) were included. Compared to patients without primary ventricular fibrillation, median growth differentiation factor-15 concentration was two-fold higher in ST-segment elevation myocardial infarction patients with primary ventricular fibrillation (2655 vs 1367 pg/ml, p<0.001). At 30 days, mortality was 13.9% and 3.6% in patients with and without primary ventricular fibrillation, respectively (p<0.001), and median growth differentiation factor-15 concentration in patients with primary ventricular fibrillation was five-fold higher among those who died vs survivors (13,098 vs 2415 pg/ml, p<0.001). In a comprehensive multivariable analysis including age, sex, clinical variables, reperfusion time, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T, growth differentiation factor-15 remained an independent predictor of 30-day mortality, with odds ratios of 3.92 (95% confidence interval 1.35–11.39) in patients with primary ventricular fibrillation (p=0.012) and 1.72 (95% confidence interval 1.23–2.40) in patients without primary ventricular fibrillation (p=0.001).
Conclusions:
Growth differentiation factor-15 is a robust independent predictor of 30-day mortality in ST-segment elevation myocardial infarction patients with primary ventricular fibrillation.
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Affiliation(s)
- C Garcia-Garcia
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER Enfermedades Cardiovasculares (CIBERCV), Spain
| | - F Rueda
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
| | - J Lupon
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
| | - T Oliveras
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - C Labata
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - M Ferrer
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - G Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - O De Diego
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - O Rodriguez-Leor
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER Enfermedades Cardiovasculares (CIBERCV), Spain
| | - X Carrillo
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER Enfermedades Cardiovasculares (CIBERCV), Spain
| | - A Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
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17
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García-García C, Oliveras T, Serra J, Vila J, Rueda F, Cediel G, Labata C, Ferrer M, Carrillo X, Dégano IR, De Diego O, El Ouaddi N, Montero S, Mauri J, Elosua R, Lupón J, Bayes-Genis A. Trends in Short- and Long-Term ST-Segment-Elevation Myocardial Infarction Prognosis Over 3 Decades: A Mediterranean Population-Based ST-Segment-Elevation Myocardial Infarction Registry. J Am Heart Assoc 2020; 9:e017159. [PMID: 33054490 PMCID: PMC7763375 DOI: 10.1161/jaha.120.017159] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Coronary artery disease remains a major cause of death despite better outcomes of ST-segment-elevation myocardial infarction (STEMI). We aimed to analyze data from the Ruti-STEMI registry of in-hospital, 28-day, and 1-year events in patients with STEMI over the past 3 decades in Catalonia, Spain, to assess trends in STEMI prognosis. Methods and Results Between February 1989 and December 2017, a total of 7589 patients with STEMI were admitted consecutively. Patients were grouped into 5 periods: 1989 to 1994 (period 1), 1995 to 1999 (period 2), 2000 to 2004 (period 3), 2005 to 2009 (period 4), and 2010 to 2017 (period 5). We used Cox regression to compare 28-day and 1-year STEMI mortality and in-hospital complication trends across these periods. Mean patient age was 61.6±12.6 years, and 79.3% were men. The 28-day all-cause mortality declined from period 1 to period 5 (10.4% versus 6.0%; P<0.001), with a 40% reduction after multivariable adjustment (hazard ratio [HR], 0.6; 95% CI, 0.46-0.80; P<0.001). One-year all-cause mortality declined from period 1 to period 5 (11.7% versus 9.0%; P=0.001), with a 24% reduction after multivariable adjustment (HR, 0.76; 95% CI, 0.60-0.98; P=0.036). A significant temporal reduction was observed for in-hospital complications including postinfarct angina (-78%), ventricular tachycardia (-57%), right ventricular dysfunction (-48%), atrioventricular block (-45%), pericarditis (-63%), and free wall rupture (-53%). Primary ventricular fibrillation showed no significant downslope trend. Conclusions In-hospital STEMI complications and 28-day and 1-year mortality rates have dropped markedly in the past 30 years. Reducing ischemia-driven primary ventricular fibrillation remains a major challenge.
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Affiliation(s)
- Cosme García-García
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain
| | - Teresa Oliveras
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Jordi Serra
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Joan Vila
- Grup d'Epidemiologia i Genètica Cardiovasculars (EGEC) REGICOR Study Group IMIM (Institut Hospital del Mar d'Investigacions Mèdiques) Barcelona Spain
| | - Ferran Rueda
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - German Cediel
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Carlos Labata
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Marc Ferrer
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Xavier Carrillo
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain
| | - Irene R Dégano
- CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain.,Grup d'Epidemiologia i Genètica Cardiovasculars (EGEC) REGICOR Study Group IMIM (Institut Hospital del Mar d'Investigacions Mèdiques) Barcelona Spain
| | - Oriol De Diego
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Nabil El Ouaddi
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Santiago Montero
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Josepa Mauri
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,Catalan Health Service Generalitat de Catalunya Barcelona Spain
| | - Roberto Elosua
- CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain.,Grup d'Epidemiologia i Genètica Cardiovasculars (EGEC) REGICOR Study Group IMIM (Institut Hospital del Mar d'Investigacions Mèdiques) Barcelona Spain
| | - Josep Lupón
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain.,Department of Medicine Autonomous University of Barcelona Barcelona Spain
| | - Antoni Bayes-Genis
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain.,Department of Medicine Autonomous University of Barcelona Barcelona Spain
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18
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Quintana C, Rull N, Deniro PJ, Frontini P, Rueda F. Process Simulation-Based Design, Mold Construction and Mechanical Performance Evaluation of an Insert-Injection Molded Thermoplastic Polyurethane Part. INT POLYM PROC 2020. [DOI: 10.3139/217.3949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
This paper presents a case study of simulation-based design and experimental validation of the insert-injection molding process of a complex polyurethane part. The part under consideration is a dowel holder which is a machine element used in the concrete railway sleepers production. A simulation study was carried out to define the relevant mold design options and optimal molding parameters as well as to evaluate their influence on the part's quality indexes. Simulation was performed using the software Moldex3D. The mold was constructed according to the optimization analysis and a batch of pieces was manufactured under the optimized conditions. A mechanical testing experiment – representing the actual service loading conditions – was designed and performed to validate the mold and process designs and the part performance. Simulation and statistical analysis results allowed determining those conditions that lead to a better assembly between the part and the metallic insert and to its structural integrity. The mechanical performance evaluation demonstrated that the part meets all its functional and structural requirements, validating simulation predictions.
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Affiliation(s)
- C. Quintana
- Instituto de Investigaciones en Ciencia y Tecnología de Materiales , Mar del Plata , Argentina
| | - N. Rull
- Instituto de Investigaciones en Ciencia y Tecnología de Materiales , Mar del Plata , Argentina
| | - P. J. Deniro
- Instituto de Investigaciones en Ciencia y Tecnología de Materiales , Mar del Plata , Argentina
| | - P. Frontini
- Instituto de Investigaciones en Ciencia y Tecnología de Materiales , Mar del Plata , Argentina
| | - F. Rueda
- Instituto de Investigaciones en Ciencia y Tecnología de Materiales , Mar del Plata , Argentina
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19
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Ferrer M, García-García C, El Ouaddi N, Rueda F, Serra J, Oliveras T, Labata C, Dégano IR, Montero S, De Diego O, Elosúa R, Lupón J, Bayes-Genis A. Transitioning from a coronary to a critical cardiovascular care unit: trends over the past three decades. Eur Heart J Acute Cardiovasc Care 2020; 10:2048872620936038. [PMID: 32672051 DOI: 10.1177/2048872620936038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/31/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary care units were established in the 1960s to reduce acute-phase mortality in acute coronary syndrome. In the 21st century, the original coronary care unit concept has evolved into an intensive cardiovascular care unit. The aim of this study was to analyse trend changes in characteristics and mortality of patients admitted to a coronary care unit over the past three decades. METHOD Between February 1989 and December 2017, a total of 18,334 patients was consecutively admitted to the coronary care unit of a university hospital in Barcelona. Data were analysed in five time frames: 1989-1994, 1995-1999, 2000-2004, 2005-2009 and 2010-2017. We analysed demographic profile, diagnoses at admission and trend changes in mortality across periods. RESULTS During the periods, the patients' ages and comorbidities increased. Diagnoses at admission have evolved. Acute coronary syndrome cases declined from the first to the last period (72.6% vs. 62.8%) while heart failure (6.0% vs. 8.6%) and malignant arrhythmias (0.8% vs. 4.0%) increased significantly. Overall, coronary care unit mortality decreased 34% from the first to the last period (6.8% vs. 4.5%, P<0.001). Furthermore, the cause of death has changed, those due to acute coronary syndrome declining (66.7% vs. 45.5%), and death from malignant arrhythmias increasing (1.9% vs. 16.2%) from the first to the last period. CONCLUSIONS Although acute coronary syndrome remained the main diagnosis, heart failure and arrhythmias have increased. Despite the aging and comorbidities, overall mortality in the coronary care unit decreased by 34% in the past three decades. Deaths due to acute coronary syndrome have declined, whereas those due to malignant arrhythmias have increased.
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Affiliation(s)
- Marc Ferrer
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Cosme García-García
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER. Enfermedades Cardiovasculares (CIBERCV). Cardiology department. Spain
| | - Nabil El Ouaddi
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Ferran Rueda
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Jordi Serra
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Teresa Oliveras
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Carlos Labata
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Irene R Dégano
- CIBER. Enfermedades Cardiovasculares (CIBERCV). Cardiology department. Spain
- REGICOR Study Group, IMIM (Institut Hospital Del Mar d'Investigacions Mèdiques, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Spain
| | - Santiago Montero
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Oriol De Diego
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Roberto Elosúa
- CIBER. Enfermedades Cardiovasculares (CIBERCV). Cardiology department. Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Spain
- Cardiovascular Epidemiology and Genetics Group, IMIM, Spain
| | - Josep Lupón
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER. Enfermedades Cardiovasculares (CIBERCV). Cardiology department. Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER. Enfermedades Cardiovasculares (CIBERCV). Cardiology department. Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
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20
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Sala-Vila A, Lázaro-López I, Rueda F, Cediel G, Bayés-Genís A. Circulating Marine and Vegetable Omega-3 at the Time of ST-Segment Elevation Myocardial Infarction and Incident Hard Clinical Endpoints. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa061_111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Dietary marine omega-3 eicosapentaenoic acid (EPA) is readily incorporated into cardiac cell membranes, partially replacing the omega-6 arachidonic acid (AA). Blood omega-3 is an objective marker of their intake over the last days. Increasing blood EPA at the time of a ST-segment elevation myocardial infarction (STEMI) relates to a smaller infarct size and preserved long-term left ventricular ejection fraction. We explored whether blood EPA at the time of STEMI also relates to a lower incidence of hard clinical endpoints. We also explored whether blood alpha-linolenic acid (ALA, the vegetable omega-3) modulates such association.
Methods
We prospectively included 944 consecutive patients treated with primary percutaneous coronary intervention in a single tertiary referral hospital. We determined fatty acids in serum phosphatidylcholine (PC) at 12 hours of evolution. The primary outcomes were cardiovascular disease-related hospital readmission and all-cause mortality after 3 years of follow-up. We constructed multivariable Cox proportional hazards models, calculating risk estimates as hazard ratios (HR).
Results
The mean age of the cohort was 61 years and 209 (22.1%) were women. During follow-up, 130 patients (13.8%) were readmitted for cardiovascular disease, and 108 (11.4%) died. After adjustment for known clinical predictors, multivariate analysis showed that EPA in serum PC at the time of STEMI inversely related to incident hospital readmission (HR, 0.74; 95% CI, 0.56–0.96; P = 0.024, for a 1 SD increase). Further adjustment for serum PC AA and ALA did not change the association. EPA in serum PC was found to be unrelated to 3-y total mortality. However, after including serum PC proportions of AA and ALA into the model, we observed a significantly decreased risk of mortality for ALA (HR, 0.65; 95% CI, 0.44–0.96; P = 0.030, for a 1 SD increase).
Conclusions
Increasing proportions of EPA and ALA in serum PC at the time of STEMI inversely relate to 3-y cardiovascular disease-hospital readmission and all-cause mortality, respectively. Dietary EPA and ALA act synergistically and are partners rather than competitors in improving prognosis in case of a STEMI.
Funding Sources
Instituto de Salud Carlos III, Spain; California Walnut Commission.
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Affiliation(s)
| | | | - Ferran Rueda
- Department of Cardiology, Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Germán Cediel
- Department of Cardiology, Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Antoni Bayés-Genís
- Department of Cardiology, Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
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21
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Iborra-Egea O, Rueda F, García-García C, Borràs E, Sabidó E, Bayes-Genis A. Molecular signature of cardiogenic shock. Eur Heart J 2019; 41:3839-3848. [DOI: 10.1093/eurheartj/ehz783] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/16/2019] [Accepted: 10/25/2019] [Indexed: 12/24/2022] Open
Abstract
AbstractThe incidence of cardiogenic shock (CS) has increased remarkably over the past decade and remains a challenging condition with mortality rates of ∼50%. Cardiogenic shock encompasses cardiac contractile dysfunction; however, it is also a multiorgan dysfunction syndrome, often complicated by a systemic inflammatory response with severe cellular and metabolic dysregulations. Here, we review the evidence on the biochemical manifestations of CS, elaborating on current gold standard biomarkers and novel candidates from molecular signatures of CS. Glucose and lactate, both identified over a century ago, remain the only clinically used biomarkers in current predictive risk scores. Novel genomic, transcriptomic, and proteomic data are discussed, and a recently reported molecular score derived from unbiased proteomic discovery, the CS4P, which includes liver fatty acid-binding protein, beta-2-microglobulin, fructose-bisphosphate aldolase B, and SerpinG1 is comprehensively described. Recent advances in -omics technologies provide new insight into a more holistic molecular signature of CS. Thus, we need to open new diagnostic and therapeutic avenues if we aim to improve outcomes.
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Affiliation(s)
- Oriol Iborra-Egea
- Department of Cardiology, Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n 08916, Barcelona, Spain
- Department of Medicine, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ferran Rueda
- Department of Cardiology, Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n 08916, Barcelona, Spain
- Department of Medicine, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cosme García-García
- Department of Cardiology, Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n 08916, Barcelona, Spain
- Department of Medicine, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Borràs
- Proteomics Unit, Centre de Regulació Genòmica (CRG), Barcelona Institute of Science and Technology (BIST), Dr Aiguader 88, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Dr Aiguader 88, Barcelona, Spain
| | - Eduard Sabidó
- Proteomics Unit, Centre de Regulació Genòmica (CRG), Barcelona Institute of Science and Technology (BIST), Dr Aiguader 88, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Dr Aiguader 88, Barcelona, Spain
| | - Antoni Bayes-Genis
- Department of Cardiology, Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n 08916, Barcelona, Spain
- Department of Medicine, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
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22
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Rueda F, Cediel G, García-García C, Aranyó J, González-Lopera M, Aranda Nevado MC, Serra Gregori J, Oliveras T, Labata C, Ferrer M, El Ouaddi N, Bayés-Genís A. Growth differentiation factor 15 and early prognosis after out-of-hospital cardiac arrest. Ann Intensive Care 2019; 9:119. [PMID: 31624933 PMCID: PMC6797678 DOI: 10.1186/s13613-019-0593-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/05/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Growth differentiation factor 15 (GDF-15) is an inflammatory cytokine released in response to tissue injury. It has prognostic value in cardiovascular diseases and other acute and chronic conditions. Here, we explored the value of GDF-15 as an early predictor of neurologic outcome after an out-of-hospital cardiac arrest (OHCA). METHODS Prospective registry study of patients in coma after an OHCA, admitted in the intensive cardiac care unit from a single university center. Serum levels of GDF-15 were measured on admission. Neurologic status was evaluated according to the cerebral performance category (CPC) scale. The relationship between GDF-15 levels and poor neurologic outcome at 6 months was analyzed. RESULTS Among 62 patients included, 32 (51.6%) presented poor outcome (CPC 3-5). Patients with CPC 3-5 exhibited significantly higher GDF-15 levels (median, 17.1 [IQR, 11.1-20.4] ng/mL) compared to those with CPC 1-2 (7.6 [IQR, 4.1-13.1] ng/mL; p = 0.004). Multivariable logistic regression analyses showed that age (OR, 1.09; 95% CI 1.01-1.17; p = 0.020), home setting arrest (OR, 8.07; 95% CI 1.61-40.42; p = 0.011), no bystander cardiopulmonary resuscitation (OR, 7.91; 95% CI 1.84-34.01; p = 0.005), and GDF-15 levels (OR, 3.74; 95% CI 1.32-10.60; p = 0.013) were independent predictors of poor outcome. The addition of GDF-15 in a dichotomous manner (≥ 10.8 vs. < 10.8 ng/mL) to the resulting clinical model improved discrimination; it increased the area under the curve from 0.867 to 0.917, and the associated continuous net reclassification improvement was 0.90 (95% CI 0.48-1.44), which allowed reclassification of 37.1% of patients. CONCLUSIONS After an OHCA, increased GDF-15 levels were an independent, early predictor of poor neurologic outcome. Furthermore, when added to the most common clinical factors, GDF-15 improved discrimination and allowed patient reclassification.
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Affiliation(s)
- Ferran Rueda
- Heart Institute, Germans Trias i Pujol University Hospital, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain.,PhD Program in Internal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Germán Cediel
- Heart Institute, Germans Trias i Pujol University Hospital, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Cosme García-García
- Heart Institute, Germans Trias i Pujol University Hospital, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Júlia Aranyó
- Heart Institute, Germans Trias i Pujol University Hospital, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Marta González-Lopera
- Heart Institute, Germans Trias i Pujol University Hospital, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - M Cruz Aranda Nevado
- Heart Institute, Germans Trias i Pujol University Hospital, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Judith Serra Gregori
- Heart Institute, Germans Trias i Pujol University Hospital, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Teresa Oliveras
- Heart Institute, Germans Trias i Pujol University Hospital, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Carlos Labata
- Heart Institute, Germans Trias i Pujol University Hospital, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Marc Ferrer
- Heart Institute, Germans Trias i Pujol University Hospital, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Nabil El Ouaddi
- Heart Institute, Germans Trias i Pujol University Hospital, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Heart Institute, Germans Trias i Pujol University Hospital, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain. .,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain.
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23
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Garcia-Garcia C, Rueda F, Vila J, De Diego O, Oliveras T, Labata C, Serra J, Ferrer M, El Ouaddi N, Cediel G, Elosua R, Lupon J, Bayes-Genis A. P1729Cardiogenic shock in ST elevation myocardial infarction: prevalence, management and acute phase and one-year mortality over the last three decades. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiogenic shock (CS) is an ominous complication of ST elevation myocardial infarction (STEMI). However, the widespread use of reperfusion therapies and invasive management could have reduced the prevalence of CS and improved the prognosis of these patients in the last decades.
Purpose
The aim is to analyze the changes over last three decades in the prevalence, management and acute phase prognosis and 1-year mortality of STEMI patients complicated with CS.
Method
Between February 1989 and December 2017, 7,589 STEMI patients were consecutively admitted in the Coronary Care Unit of a University Hospital and were included in a prospective registry. Depending on the year of admission, patients were classified in five groups: 1989–1994: n=1,337, period 1; 1995–1999: n=960, period 2; 2000–2004: n=1,059, period 3; 2005–2009: n=1,535, period 4 and 2010–2015: n=2,698, period 5). We analyze the trend in prevalence of CS, management and 28-day and 1-year mortality over these five periods.
Results
The global prevalence of CS was 6.1% (466 patients), mean age was 67.7 (SD 11.7) years and 68.7% were men. Prevalence of CS in STEMI decreased from period 1 to 5 (7.3%, 6.4%, 5.5%, 5.8%, 6.0%, p<0.001), although it has been reduced more in women (10.1% in period 1 vs 8.3%, period 5, p<0.001) than in men (6.5% vs 5.4%, period 1 vs 5, respectively (p<0.001). Reperfusion therapy increased from 25.8% in period 1 (all with thrombolysis) vs 83.8% in period 5 (all with primary angioplasty). Intra-aortic balloon contrapulsation was only available from period 3 to 5, and it's used were firstly increased (20.7%, 36% and 37.9%, respectively, p<0.001). Ventricular assistance device (Impella CP) it was only available in 2017 and it was implanted in 10.5% of CS due to STEMI. Although 28-day case fatality is very high (60.7%, 283 patients), it has been reduced from period 1 to 5 (69.6%, 77.3%, 64.7%, 55.9% and 57.8%, respectively, p=0.012). This reduction in 28-day case fatality was higher in women (75.5% in period 1 vs 58.6% in period 5, p=0.12) than in men (66.8% vs 57.3, period 1–5, p=0.019). One-year mortality has been reduced between periods 1–5 (73.7% vs 61.8%, p=0.012). After multivariate adjustment, both 28-day (HR 0.63, 95% CI: 0.45–0.89, p=0.008) and 1-year mortality (HR 0.64, 95% CI: 0.45–0.90, p=0.010) have declined in the last period.
Kaplan-Meier curves, 1-year mortality
Conclusions
Cardiogenic shock development in STEMI patients has been reduced from 7.3% to 6.1% in the last three decades. The whole improvement in management of these patients achieves a 37% of reduction in 28-day case fatality and 1-year all-cause mortality. Despite this improvement, acute phase (28-day) case fatality of STEMI complicated with CS remains over 57% in the primary angioplasty era.
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Affiliation(s)
| | - F Rueda
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - J Vila
- Hospital del Mar, Municipal Institute for Medical Research (IMIM), Barcelona, Spain
| | - O De Diego
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - T Oliveras
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - C Labata
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - J Serra
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - M Ferrer
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - N El Ouaddi
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - R Elosua
- Hospital del Mar, Municipal Institute for Medical Research (IMIM), Barcelona, Spain
| | - J Lupon
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol University Hospital, Barcelona, Spain
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24
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El Ouaddi N, Garcia-Garcia C, De Diego O, Labata C, Rueda F, Oliveras T, Camara ML, Serra J, Berastegui E, Ferrer M, Munoz C, Bayes-Genis A. P865Mechanical Complications in ST elevation myocardial infarction: Trends in prevalence, acute phase prognosis and one-year mortality after the onset of reperfusion network. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The development of mechanical complications (MC) following an ST elevation myocardial infarction (STEMI) is associated with a high acute phase and long-term mortality. However, the widespread use of reperfusion therapies with primary angioplasty (pPCI) and surgical management could have reduced the prevalence of MC and improved the prognosis of these patients in the last years.
Purpose
The aim is to analyze the changes in the prevalence, management and acute phase prognosis and 1-year mortality of STEMI patients complicated with MC between two periods, before and after the onset of pPCI reperfusion network.
Method
We included all STEMI patients in a single centre prospective registry. Between 1990 and 2000, 2,251 STEMI patients were consecutively admitted in the Coronary Care Unit of a University Hospital (pre-pPCI period). In 2007, pPCI reperfusion program was onset in our centre. Between 2007 and 2017, 3,783 consecutive STEMI patients were included in the registry (post-pCI period). We analyze the prevalence of MC, management (reperfusion therapies, surgery ...) and 28-day and 1-year mortality among these two periods.
Results
A total of 6,034 STEMI patients were included in the registry (men 78.8%, mean age 61.7 years, SD 12.8). Patients admitted in the post-PCI period were older (62.4 vs 60.4 years, p<0.001) and have more prevalence of hypertension and dyslipidemia. Reperfusion therapy increased in post-pPCI period (89.1% vs 49.7%, p<0.001), due to widespread use of pPCI. A total of 105 patients (1.7%) develop any mechanical complication: 35 with ventricular septal rupture (VSR), 22 with papillary muscle rupture (PMR) and 48 patients with free wall rupture (FWR). Prevalence of MC has not been change between both periods. VSR occurred in 0.6% pre-PCI and 0.6% post-pPCI, p=0.98; PMR 0.3% vs 0.4% post-PCI, p=0.33; and FWR 1% vs 0.7% post-PCI, p=0.22). Overall 28-day STEMI mortality has been reduced in post-pPCI period (5.9% vs 10.1%, p<0.001 in acute phase). This 28-day mortality remains very high and without significant changes when MC appears: VSR: post-pPCI 77.3% vs 58.0%, p=0.25; PMR: 25.0% post-PCI vs 58.3%, p=0.69; and FWR: 66.4% post-PCI vs 73.7%, p=0.84). One-year mortality has not been changed between both periods and stays in a very high ratio (65.7% for VRS, 45.4% for PMR and 66.7% for FWR).
Conclusions
Although reperfusion therapy greatly increased with the onset of a pPCI reperfusion network, prevalence of MC has not been change over three decades in our series. Acute phase (28-day) and one-year mortality remains very high and without significant reduction in post-pPCI period.
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Affiliation(s)
- N El Ouaddi
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | | | - O De Diego
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - C Labata
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - F Rueda
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - T Oliveras
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - M L Camara
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - J Serra
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - E Berastegui
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - M Ferrer
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - C Munoz
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol University Hospital, Barcelona, Spain
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Iborra-Egea O, Rueda F, Lakkisto P, Harjola VP, García-García C, Bayes-Genis A. Dinámica de microARN circulantes en pacientes con infarto agudo de miocardio con elevación del segmento ST con shock cardiogénico. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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26
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Rueda F, Borràs E, García-García C, Iborra-Egea O, Revuelta-López E, Harjola VP, Cediel G, Lassus J, Tarvasmäki T, Mebazaa A, Sabidó E, Bayés-Genís A. Protein-based cardiogenic shock patient classifier. Eur Heart J 2019; 40:2684-2694. [DOI: 10.1093/eurheartj/ehz294] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/04/2019] [Accepted: 04/19/2019] [Indexed: 11/15/2022] Open
Abstract
Abstract
Aims
Cardiogenic shock (CS) is associated with high short-term mortality and a precise CS risk stratification could guide interventions to improve patient outcome. Here, we developed a circulating protein-based score to predict short-term mortality risk among patients with CS.
Methods and results
Mass spectrometry analysis of 2654 proteins was used for screening in the Barcelona discovery cohort (n = 48). Targeted quantitative proteomics analyses (n = 51 proteins) were used in the independent CardShock cohort (n = 97) to derive and cross-validate the protein classifier. The combination of four circulating proteins (Cardiogenic Shock 4 proteins—CS4P), discriminated patients with low and high 90-day risk of mortality. CS4P comprises the abundances of liver-type fatty acid-binding protein, beta-2-microglobulin, fructose-bisphosphate aldolase B, and SerpinG1. Within the CardShock cohort used for internal validation, the C-statistic was 0.78 for the CardShock risk score, 0.83 for the CS4P model, and 0.84 (P = 0.033 vs. CardShock risk score) for the combination of CardShock risk score with the CS4P model. The CardShock risk score with the CS4P model showed a marked benefit in patient reclassification, with a net reclassification improvement (NRI) of 0.49 (P = 0.020) compared with CardShock risk score. Similar reclassification metrics were observed in the IABP-SHOCK II risk score combined with CS4P (NRI =0.57; P = 0.032). The CS4P patient classification power was confirmed by enzyme-linked immunosorbent assay (ELISA).
Conclusion
A new protein-based CS patient classifier, the CS4P, was developed for short-term mortality risk stratification. CS4P improved predictive metrics in combination with contemporary risk scores, which may guide clinicians in selecting patients for advanced therapies.
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Affiliation(s)
- Ferran Rueda
- Heart Institute, Hospital Universitari Germans Trias i Pujol, c/ Canyet SN, 08916 Badalona, Spain
- Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Eva Borràs
- Proteomics Unit, Centre de Regulació Genòmica (CRG), Barcelona Institute of Science and Technology (BIST), Dr Aiguader 88, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Dr Aiguader 88, Barcelona, Spain
| | - Cosme García-García
- Heart Institute, Hospital Universitari Germans Trias i Pujol, c/ Canyet SN, 08916 Badalona, Spain
- Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Oriol Iborra-Egea
- Heart Institute, Hospital Universitari Germans Trias i Pujol, c/ Canyet SN, 08916 Badalona, Spain
- Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Elena Revuelta-López
- Heart Institute, Hospital Universitari Germans Trias i Pujol, c/ Canyet SN, 08916 Badalona, Spain
- Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Veli-Pekka Harjola
- Emergency Medicine, Department of Emergency Medicine and Services, University of Helsinki, Helsinki University Hospital, Finland
| | - Germán Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, c/ Canyet SN, 08916 Badalona, Spain
- Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Johan Lassus
- Cardiology, University of Helsinki, Heart and Lung Center, Helsinki University Hospital, Finland
| | - Tuukka Tarvasmäki
- Cardiology, University of Helsinki, Heart and Lung Center, Helsinki University Hospital, Finland
| | - Alexandre Mebazaa
- U942 Inserm, University Paris Diderot, APHP Hôpitaux Universitaires Saint-Louis-Lariboisière, INI-CRCT, Paris, France
| | - Eduard Sabidó
- Proteomics Unit, Centre de Regulació Genòmica (CRG), Barcelona Institute of Science and Technology (BIST), Dr Aiguader 88, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Dr Aiguader 88, Barcelona, Spain
| | - Antoni Bayés-Genís
- Heart Institute, Hospital Universitari Germans Trias i Pujol, c/ Canyet SN, 08916 Badalona, Spain
- Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
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Aranyo J, Bazan V, Rueda F, Sarrias A, Bisbal F, Villuendas R. Ventricular fibrillation in a patient with Wolff-Parkinson-White syndrome unrelated to pre-excited atrial fibrillation. Ann Noninvasive Electrocardiol 2019; 24:e12662. [PMID: 31141244 DOI: 10.1111/anec.12662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/09/2019] [Accepted: 04/25/2019] [Indexed: 11/28/2022] Open
Abstract
A 52-year-old man was admitted due to out-hospital cardiac arrest. Recurrent ventricular fibrillation (VF) occurred under therapeutic hypothermia thereafter. Previously inadverted full pre-excitation was documented exclusively and immediately prior to 4 out of the 5 VF relapses. Coronary vasospasm and early repolarization were also documented. An electrophysiological study demonstrated poor anterograde conduction over a left-sided accessory pathway. We theorize that maximum pre-excitation favored in-hospital VF by augmenting the repolarization vulnerability induced by therapeutic hypothermia, with coronary vasospasm accounting as the probable cause of out-hospital VF. A plausible VF mechanism in WPW syndrome unrelated to pre-excited atrial fibrillation is discussed.
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Affiliation(s)
- Julia Aranyo
- Electrophysiology Section, Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Victor Bazan
- Electrophysiology Section, Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Ferran Rueda
- Electrophysiology Section, Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Axel Sarrias
- Electrophysiology Section, Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Felipe Bisbal
- Electrophysiology Section, Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Roger Villuendas
- Electrophysiology Section, Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
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28
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García-García C, Oliveras T, Rueda F, Pérez-Fernández S, Ferrer M, Serra J, Labata C, Vila J, Carrillo X, Rodríguez-Leor O, Fernández-Nofrerias E, Faixedas MT, Jiménez J, Mauri J, Lupón J, Bayes-Genis A. Primary Ventricular Fibrillation in the Primary Percutaneous Coronary Intervention ST-Segment Elevation Myocardial Infarction Era (from the "Codi IAM" Multicenter Registry). Am J Cardiol 2018; 122:529-536. [PMID: 29960663 DOI: 10.1016/j.amjcard.2018.04.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 12/31/2022]
Abstract
Primary ventricular fibrillation (PVF) is a dreadful complication of ST segment elevation myocardial infarction (STEMI). Scarce data are available regarding PVF prognosis since primary percutaneous coronary intervention (PPCI) became routine practice in STEMI. Our aim was to compare 30-day and 1-year mortality for patients with and without PVF (including out-of-hospital and in-hospital PVF) within a regional registry of PPCI-treated STEMI patients. This prospective multicenter registry included all consecutive STEMI patients treated with PPCI from January 2010 to December 2014. Patients were classified as non-PVF or PVF, with further subdivision into out-of-hospital and in-hospital PVF. We analyzed 30-day and 1-year all-cause mortality in groups. The registry included 10,965 patients. PVF occurred in 949 patients (8.65%), including 74.2% out-of-hospital and 25.8% in-hospital PVF. Compared with the non-PVF group, PVF patients were younger; less commonly diabetic; more frequently had anterior wall STEMI, higher Killip-Kimball class, and left main disease; and showed significantly higher 24-hour (5.1% vs 1.1%), 30-day (18.5% vs 4.7%), and 1-year mortality (23.2% vs 7.9%) (all p <0.001). Mortality did not differ in out-of-hospital versus in-hospital PVF. After multivariable adjustment, PVF remained associated with all-cause 30-day (2.32, 95% CI: 1.91 to 2.82, p <0.001) and 1-year (HR: 1.59, 95% CI: 1.13 to 2.24, p = 0.008) mortality. In conclusion, we present the largest registry of PVF patients in the era of routine PPCI in STEMI. Although overall STEMI mortality has declined, PVF emerged as a predictor of both 30-day and 1-year mortality. These data warrant prospective validation and proper identification and protection of high-risk patients.
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Affiliation(s)
- Cosme García-García
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.
| | - Teresa Oliveras
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ferran Rueda
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Marc Ferrer
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jordi Serra
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Carlos Labata
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joan Vila
- IMIM (Institut Hospital del Mar d'Investigacions Mèdiques. Grup d'Epidemiologia i Genètica Cardiovasculars (EGEC). REGICOR Study Group, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Xavier Carrillo
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oriol Rodríguez-Leor
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | | | - Maria Teresa Faixedas
- Catalan Health Service. Generalitat de Catalunya, Codi IAM Registry, Barcelona, Spain
| | - Javier Jiménez
- Catalan Health Service. Generalitat de Catalunya, Codi IAM Registry, Barcelona, Spain
| | - Josepa Mauri
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Catalan Health Service. Generalitat de Catalunya, Codi IAM Registry, Barcelona, Spain
| | - Josep Lupón
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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29
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Labata C, Oliveras T, Berastegui E, Ruyra X, Romero B, Camara ML, Just MS, Serra J, Rueda F, Ferrer M, García-García C, Bayes-Genis A. Unidad de cuidados intermedios tras la cirugía cardiaca: impacto en la estancia media y la evolución clínica. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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30
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Garcia-Garcia C, Oliveras T, Serra J, Rueda F, Labata C, Ferrer M, De Diego O, Aranyo J, Martinez MJ, Mauri J, Fernandez-Nofrerias E, Rodriguez-Leor O, Carrillo X, Abdul-Jawad O, Bayes-Genis A. P3618Early acute phase mortality and complications of STEMI patients: trends over the last three decades. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - T Oliveras
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Serra
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - F Rueda
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - C Labata
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - M Ferrer
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - O De Diego
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Aranyo
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - M J Martinez
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Mauri
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | | | | | - X Carrillo
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - O Abdul-Jawad
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol University Hospital, Badalona, Spain
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31
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Ferrer M, Garcia-Garcia C, Labata C, De Diego O, Serra J, Rueda F, Oliveras T, Fadeuilhe E, Andres J, Bayes-Genis A. P833From coronary to critical cardiovascular care unit: cause of mortality and patients profile analysis over three decades. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Ferrer
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | | | - C Labata
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - O De Diego
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Serra
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - F Rueda
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - T Oliveras
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - E Fadeuilhe
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Andres
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol University Hospital, Badalona, Spain
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32
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Garcia-Garcia C, Rueda F, Oliveras T, Serra J, Labata C, Ferrer M, De Diego O, Cediel G, Rodriguez-Leor O, Carrillo X, Lupon J, Bayes-Genis A. P779Cardiogenic shock in STEMI patients:prevalence, management and acute phase mortality over the last three decades. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - F Rueda
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - T Oliveras
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Serra
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - C Labata
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - M Ferrer
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - O De Diego
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | | | - X Carrillo
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Lupon
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol University Hospital, Badalona, Spain
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33
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Cediel G, Rueda F, Oxvig C, Oliveras T, Labata C, de Diego O, Ferrer M, Aranda-Nevado MC, Serra-Gregori J, Núñez J, García C, Bayes-Genis A. Prognostic value of the Stanniocalcin-2/PAPP-A/IGFBP-4 axis in ST-segment elevation myocardial infarction. Cardiovasc Diabetol 2018; 17:63. [PMID: 29712555 PMCID: PMC5925828 DOI: 10.1186/s12933-018-0710-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/25/2018] [Indexed: 12/21/2022] Open
Abstract
Objective The aim of the present study was to evaluate the prognostic value of the Stanniocalcin-2/PAPP-A/IGFBP-4 axis in patients with ST-segment elevation myocardial infarction (STEMI). Methods Observational cohort study performed in 1085 consecutive STEMI patients treated with early reperfusion between February 2011 and August 2014. Stanniocalcin-2, PAPP-A, and IGFBP-4 were measured using state-of-the art immunoassays. The primary outcome was the composite endpoint of all-cause mortality and readmission due to heart failure (HF). Results Median follow-up was 3.3 years (IQR 1.0–3.7), during which 176 patients (16.2%) presented a composite endpoint. Multivariable cox regression analysis revealed that Stanniocalcin-2 (HR 2.06; 95% CI 1.13–3.75; p = 0.018), IGFBP-4 (HR 1.73; 95% CI 1.14–2.64; p = 0.010), Killip–Kimball class III–IV (HR 1.40; 95% CI 1.13–1.74; p = 0.002), NT-ProBNP (HR 1.21; 95% CI 1.07–1.37; p = 0.002), age (HR 1.06; 95% CI 1.04–1.08; p < 0.001) and left ventricular ejection fraction (HR 0.97; 95% CI 0.95–0.98; p < 0.001) were independent predictors of the composite endpoint. A model containing Stanniocalcin-2 and IGFBP-4 on top of clinical variables significantly improved C-index discrimination (p = 0.036). Stanniocalcin-2 was also identified as independent predictor of all-cause mortality (HR 2.23; 95% CI 1.16–4.29; p = 0.017) and readmission due to HF (HR 3.42; 95% CI 1.22–9.60; p = 0.020). Conclusions In STEMI patients, Stanniocalcin-2 and IGFBP-4 emerged as independent predictors of all-cause death and readmission due to HF. The Stanniocalcin-2/PAPP-A/IGFBP-4 axis exhibits a significant role in STEMI risk stratification.
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Affiliation(s)
- Germán Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Ferran Rueda
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Claus Oxvig
- Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark
| | - Teresa Oliveras
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Carlos Labata
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Oriol de Diego
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Marc Ferrer
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - M Cruz Aranda-Nevado
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Judith Serra-Gregori
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Departamento de Medicina, CIBERCV Universitat de València, Valencia, Spain
| | - Cosme García
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain. .,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain.
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34
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Cediel G, Rueda F, García C, Oliveras T, Labata C, Serra J, Núñez J, Bodí V, Ferrer M, Lupón J, Bayes-Genis A. Prognostic Value of New-Generation Troponins in ST-Segment-Elevation Myocardial Infarction in the Modern Era: The RUTI-STEMI Study. J Am Heart Assoc 2017; 6:JAHA.117.007252. [PMID: 29275366 PMCID: PMC5779038 DOI: 10.1161/jaha.117.007252] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background In ST‐segment–elevation myocardial infarction (STEMI), troponins are not needed for diagnosis: symptoms and ECG data are sufficient to activate percutaneous coronary intervention. This study explored the prognostic value of new‐generation troponins in a real‐life cohort contemporarily treated for STEMI. Methods and Results We studied 1260 consecutive patients with primary STEMI treated with percutaneous coronary intervention between February 22, 2011, and August 31, 2015. We collected data on clinical characteristics and major adverse cardiovascular and cerebrovascular events (MACCEs) at 30 days and 1 year. Peak high‐sensitivity troponin T and sensitive‐contemporary troponin I levels were recorded. MACCEs occurred in 75 patients (6.1%) by day 30 and in 124 patients (10.8%) between day 31 and 1 year. A short‐term (0–30 days) multivariable Cox regression analysis revealed that age, Killip‐Kimball class, and left ventricular ejection fraction were independent predictors of MACCEs. In adjusted analysis, peak high‐sensitivity troponin T and sensitive‐contemporary troponin I were not significant (hazard ratio, 1.23 [95% confidence interval, 0.98–1.54] [P=0.071]; and hazard ratio, 1.15 [95% confidence interval, 0.93–1.43] [P=0.200], respectively). A long‐term (31 days–1 year) multivariable Cox regression analysis revealed that age, female sex, diabetes mellitus, prior coronary artery disease, Killip‐Kimball class, and left ventricular ejection fraction were statistically significantly associated with MACCEs. However, peak high‐sensitivity troponin T and peak sensitive‐contemporary troponin I were not significantly associated with MACCEs (hazard ratio, 1.03 [95% confidence interval, 0.88–1.20] [P=0.715]; and hazard ratio, 0.99 [95% confidence interval, 0.85–1.15] [P=0.856], respectively). Conclusions In the modern era, new‐generation troponins do not provide significant prognostic information for predicting clinical events in STEMI. We should reconsider the value of serial troponin measurements for risk stratification in STEMI.
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Affiliation(s)
- Germán Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain.,Department of Medicine, CIBERCV Autonomous University of Barcelona, Spain
| | - Ferran Rueda
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain.,Department of Medicine, CIBERCV Autonomous University of Barcelona, Spain
| | - Cosme García
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain.,Department of Medicine, CIBERCV Autonomous University of Barcelona, Spain
| | - Teresa Oliveras
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain.,Department of Medicine, CIBERCV Autonomous University of Barcelona, Spain
| | - Carlos Labata
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain.,Department of Medicine, CIBERCV Autonomous University of Barcelona, Spain
| | - Jordi Serra
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain.,Department of Medicine, CIBERCV Autonomous University of Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Departamento de Medicina, CIBERCV Universitat de València, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Departamento de Medicina, CIBERCV Universitat de València, Spain
| | - Marc Ferrer
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain.,Department of Medicine, CIBERCV Autonomous University of Barcelona, Spain
| | - Josep Lupón
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain.,Department of Medicine, CIBERCV Autonomous University of Barcelona, Spain
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain .,Department of Medicine, CIBERCV Autonomous University of Barcelona, Spain
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Labata C, Oliveras T, Berastegui E, Ruyra X, Romero B, Camara ML, Just MS, Serra J, Rueda F, Ferrer M, García-García C, Bayes-Genis A. Intermediate Care Unit After Cardiac Surgery: Impact on Length of Stay and Outcomes. ACTA ACUST UNITED AC 2017; 71:638-642. [PMID: 29158075 DOI: 10.1016/j.rec.2017.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 10/05/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES Current postoperative management of adult cardiac surgery often comprises transfer from the intensive care unit (ICU) to a conventional ward. Intermediate care units (IMCU) permit hospital resource optimization. We analyzed the impact of an IMCU on length of stay (both ICU and in-hospital) and outcomes (in-hospital mortality and 30-day readmissions) after adult cardiac surgery (IMCU-CS). METHODS From November 2012 to April 2015, 1324 consecutive patients were admitted to a university hospital for cardiac surgery. In May 2014, an IMCU-CS was established for postoperative care. For the purposes of this study, patients were classified into 2 groups, depending on the admission period: pre-IMCU-CS (November 2012-April 2014, n=674) and post-IMCU-CS (May 2014-April 2015, n=650). RESULTS There were no statistically significant differences in age, sex, risk factors, comorbidities, EuroSCORE 2, left ventricular ejection fraction, or the types of surgery (valvular in 53%, coronary in 26%, valvular plus coronary in 11.5%, and aorta in 1.8%). The ICU length of stay decreased from 4.9±11 to 2.9±6 days (mean±standard deviation; P<.001); 2 [1-4] to 1 [0-3] (median [Q1-Q3]); in-hospital length of stay decreased from 13.5±15 to 12.7±11 days (mean±standard deviation; P=.01); 9 [7-13] to 9 [7-11] (median [Q1-Q3]), in pre-IMCU-CS to post-IMCU-CS, respectively. There were no statistically significant differences in in-hospital mortality (4.9% vs 3.5%; P=.28) or 30-day readmission rate (4.3% vs 4.2%; P=.89). CONCLUSIONS After the establishment of an IMCU-CS for postoperative cardiac surgery, there was a reduction in ICU and in-hospital mean lengths of stay with no increase in in-hospital mortality or 30-day readmissions.
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Affiliation(s)
- Carlos Labata
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Teresa Oliveras
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elisabet Berastegui
- Servicio de Cirugía Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Xavier Ruyra
- Servicio de Cirugía Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Bernat Romero
- Servicio de Cirugía Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria-Luisa Camara
- Servicio de Cirugía Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria-Soledad Just
- Servicio de Medicina Intensiva, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jordi Serra
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ferran Rueda
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Marc Ferrer
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Cosme García-García
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Instituto de Investigación en Ciencias de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
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Sarrias A, Villuendas R, Bisbal F, Pereferrer D, Rueda F, Serra J, García C, Bayés-Genís A. From Atrial Fibrillation to Ventricular Fibrillation and Back. Circulation 2015; 132:2035-6. [PMID: 26596979 DOI: 10.1161/circulationaha.115.018891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Axel Sarrias
- From the Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain.
| | - Roger Villuendas
- From the Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain
| | - Felipe Bisbal
- From the Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain
| | - Damià Pereferrer
- From the Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain
| | - Ferran Rueda
- From the Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain
| | - Jordi Serra
- From the Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain
| | - Cosme García
- From the Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain
| | - Antoni Bayés-Genís
- From the Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain
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Carrillo X, Fernandez-Nofrerias E, Rodriguez-Leor O, Oliveras T, Serra J, Mauri J, Curos A, Rueda F, García-García C, Tresserras R, Rosas A, Faixedas MT, Bayes-Genis A. Early ST elevation myocardial infarction in non-capable percutaneous coronary intervention centres:in situfibrinolysis vs. percutaneous coronary intervention transfer. Eur Heart J 2015; 37:1034-40. [DOI: 10.1093/eurheartj/ehv619] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/23/2015] [Indexed: 01/09/2023] Open
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Giralt T, Carrillo X, Rodriguez-Leor O, Fernandez-Nofrerias E, Rueda F, Serra-Flores J, Viguer JM, Mauri J, Curos A, Bayes-Genis A. Time-dependent effects of unfractionated heparin in patients with ST-elevation myocardial infarction transferred for primary angioplasty. Int J Cardiol 2015; 198:70-4. [DOI: 10.1016/j.ijcard.2015.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/22/2015] [Accepted: 06/12/2015] [Indexed: 11/25/2022]
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Olmos P, Rapisarda D, Rueda F, Arranz F, Barrera G, Brañas B, García A, Medrano M, Olalde J, Maqueda L. Stability of the LIPAc beam dump to vibrations induced by the cooling flow. Fusion Engineering and Design 2014. [DOI: 10.1016/j.fusengdes.2014.01.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ariza-Solé A, Formiga F, Vidán MT, Bueno H, Curós A, Aboal J, Llibre C, Rueda F, Bernal E, Cequier A. Impact of frailty and functional status on outcomes in elderly patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: rationale and design of the IFFANIAM study. Clin Cardiol 2013; 36:565-9. [PMID: 24114768 DOI: 10.1002/clc.22182] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/01/2013] [Indexed: 11/12/2022] Open
Abstract
The IFFANIAM study (Impact of frailty and functional status in elderly patients with ST segment elevation myocardial infarction undergoing primary angioplasty) is an observational multicenter registry to assess the impact of frailty and functional status on outcomes of elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty. STEMI patients age 75 years or older undergoing primary angioplasty will be extensively studied during admission in 4 tertiary care Hospitals in Spain, assessing their baseline functional status (Barthel index, Lawton-Brody index), frailty (Fried criteria, FRAIL scale [fatigue, resistance, ambulation, illnesses, and loss of weight]), comorbidities (Charlson index), nutritional status (Mini Nutritional Assessment-Short Form), and quality of life (Seattle Angina Questionnaire). Participants will be managed according current recommendations. The primary outcome will be the description of 1-year mortality, its causes, and associated factors. Secondary outcomes will be functional capacity and quality of life. Results will help to better understand the impact of frailty and functional ability on outcomes in elderly STEMI patients undergoing primary angioplasty, thus potentially contributing to improving their clinical management. Higher life expectancy has resulted in a large segment of elderly population and an increase in myocardial infarction in these patients. This calls attention to healthcare systems to focus on promoting methods to improve the clinical management of this population.
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Affiliation(s)
- Albert Ariza-Solé
- Cardiology Department, Internal Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Rueda F, Domingo J, Mach N. Efectos de los ácidos grasos omega 3 y otros suplementos alimenticios en procesos patológicos relacionados con la tercera edad. Revista Española de Nutrición Humana y Dietética 2011. [DOI: 10.1016/s2173-1292(11)70004-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Affiliation(s)
- J.M. Albella
- a Laboratorio de Física Aplicada, Departamento de Física, Universidad Autónoma de Madrid, Canto Blanco, Madrid, Spain
| | - J.M. Martínez-Duart
- a Laboratorio de Física Aplicada, Departamento de Física, Universidad Autónoma de Madrid, Canto Blanco, Madrid, Spain
| | - F. Rueda
- a Laboratorio de Física Aplicada, Departamento de Física, Universidad Autónoma de Madrid, Canto Blanco, Madrid, Spain
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Belafhaili A, Ait Aouaj M, Diaz R, Belayachi A, Rueda F, Abd-Lefdil M. Cu–Al–O Transparent Thin Films: Preparation by Spray Pyrolysis Technique and Characterization. sens lett 2009; 7:672-675. [DOI: 10.1166/sl.2009.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Aouaj MA, Diaz R, Belayachi A, Rueda F, Abd-Lefdil M. Comparative study of ITO and FTO thin films grown by spray pyrolysis. Materials Research Bulletin 2009; 44:1458-1461. [DOI: 10.1016/j.materresbull.2009.02.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Díaz R, Bisson L, Agulló-Rueda F, Abd Lefdil M, Rueda F. Effect of composition gradient on CuIn3Te5 single-crystal properties and micro-Raman and infrared spectroscopies. Appl Phys A 2005; 81:433-438. [DOI: 10.1007/s00339-005-3245-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Mendialdua J, Casanova R, Rueda F, Rodríguez A, Quiñones J, Alarcón L, Escalante E, Hoffmann P, Taebi I, Jalowiecki L. X-ray photoelectron spectroscopy studies of laterite standard reference material. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.molcata.2004.09.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Galán L, Prieto P, Morant C, Soriano L, Sanz JM, Elizalde E, Rueda F. Composition of oxides and nitrides from line shapes of metal core level x-ray photoelectron spectra. SURF INTERFACE ANAL 2004. [DOI: 10.1002/sia.740190140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rueda F, Bermúdez-Cañete R, Herraiz I, Medrano C, Vázquez N, Díez Balda JI. Balloon pulmonary valvuloplasty. Rev Port Cardiol 2003; 22 Suppl 1:I45-51. [PMID: 12621993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Affiliation(s)
- F Rueda
- Hospital Juan Canalejo, A. Coruña, Spain
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