Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,m...Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,management and outcomes of these patients and to describe predictors of length of hospital stay(LoS)in this context.Methods Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge(January 2018-December 2022).A TAVI program was implemented in may 2021.Baseline clinical characteristics,management and in-hospital complications were registered.Predictors of long hospital stay(>7 day)were assessed by binary logistic regression.Results We included 614 patients,with mean age 80.5 years.Most patients(438/614,71.2%)presented conditions that precluded an early discharge.Mean hospital stay was 7.6 days.Patients admitted after the implementation of the program had a significantly lower burden of comorbidities.The rate of conduction disturbances after TAVI remained stable around 60%.However,permanent pacemaker requirement declined from 30.3%to 22.5%(P=0.028).LoS was reduced after the implementation of the program both in patients suitable for an early discharge(from 6.5 day to 4 day,P<0.001)and unsuitable patients(from 9.4 day to 7.7 day,P=0.014).The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases,day of the week,emergent procedures,and conduction disturbances and other complications as independent predictors of long stay after TAVI.Conclusions Most patients undergoing TAVI present conditions that preclude an early hospital discharge.The implementation of a TAVI program improved selection of patients,with a lower burden of comorbidities,a lower rate of complications and a marked reduction of hospital stay.展开更多
Background The prognostic role of diabetes mellitus(DM)in elderly patients with myocardial infarction-related cardiogenic shock(MI-CS)remains controversial.Little information exists about the impact of intensive cardi...Background The prognostic role of diabetes mellitus(DM)in elderly patients with myocardial infarction-related cardiogenic shock(MI-CS)remains controversial.Little information exists about the impact of intensive cardiac care unit(ICCU)and revascularization on outcomes of elderly patients with MI-CS.We aimed to assess the prognostic impact of DM according to age in patients with MI-CS,and to analyze the impact ICCU management and revascularization on in-hospital mortality in MI-CS patients at older ages.Methods Discharge episodes with diagnosis of CS associated with MI were selected from the Spanish National Health System’s Basic Data Set.Centers were classified according to their availability of ICCU.Main outcome measured was in-hospital mortality.Results A total of 23,590 episodes of MI-CS were identified,of whom 12,447(52.8%)were in patients aged≥75 years.The impact of DM on in-hospital mortality was different among age subgroups.While in younger patients,DM was associated to a higher mortality risk(0.52 vs.0.47,OR=1.12,95%CI:1.06–1.18,χ^2<0.001),this association became non-significant in older patients(0.76 vs.0.81,χ^2=0.09).Adjusted mortality rate of MI-CS aged≥75 years was lower in patients admitted to hospitals with ICCU(adjusted mortality rate:74.2%vs.77.7%,P<0.001)and in patients undergoing revascularization(74.9%vs.77.3%,P<0.001).Conclusions Prognostic impact of DM in patients with MI-CS was different according to age,with a significantly lower impact at older ages.The availability of ICCU and revascularization were associated with better outcomes in these complex patients.展开更多
BACKGROUND The Impella pump has emerged as a promising tool in patients with cardiogenic shock(CS).Despite its attractive properties,there are scarce data on the specific clinical setting and the potential role of Imp...BACKGROUND The Impella pump has emerged as a promising tool in patients with cardiogenic shock(CS).Despite its attractive properties,there are scarce data on the specific clinical setting and the potential role of Impella devices in CS patients from routine clinical practice.METHODS This is an observational,retrospective,single center,cohort study.All consecutive patients with diagnosis of CS and undergoing support with Impella 2.5?,Impella CP?or Impella 5.0?from April 2015 to December 2020 were included.Baseline characteristics,management and outcomes were assessed according to CS severity,age and cause of CS.Main outcome measured was in-hospital mortality.RESULTS A total of 50 patients were included(median age:59.3±10 years).The most common cause of CS was acute coronary syndrome(ACS)(68%),followed by decompensation of previous cardiomyopathy(22%).A total of 13 patients(26%)had profound CS.Most patients(54%)improved pulmonary congestion at 48 h after Impella support.A total of 19 patients(38%)presented significant bleeding.In-hospital mortality was 42%.Among patients with profound CS(n=13),five patients were previously supported with venoarterial extracorporeal membrane oxygenation.A total of eight patients(61.5%)died during the admission,and no patient achieved ventricular recovery.Older patients(≥67 years,n=10)had more comorbidities and the highest mortality(70%).Among patients with ACS(n=34),35.3%of patients had profound CS;and in most cases(52.9%),Impella support was performed as a bridge to recovery.In contrast,only one patient from the decompensated cardiomyopathy group(n=11)presented with profound CS.In 90.9%of these cases,Impella support was used as a bridge to cardiac transplantation.There were no cases of death.CONCLUSIONS In this cohort of real-life CS patients,Impella devices were used in different settings,with different clinical profiles and management.Despite a significant rate of complications,mortality was acceptable and lower than those observed in other series.展开更多
文摘Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,management and outcomes of these patients and to describe predictors of length of hospital stay(LoS)in this context.Methods Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge(January 2018-December 2022).A TAVI program was implemented in may 2021.Baseline clinical characteristics,management and in-hospital complications were registered.Predictors of long hospital stay(>7 day)were assessed by binary logistic regression.Results We included 614 patients,with mean age 80.5 years.Most patients(438/614,71.2%)presented conditions that precluded an early discharge.Mean hospital stay was 7.6 days.Patients admitted after the implementation of the program had a significantly lower burden of comorbidities.The rate of conduction disturbances after TAVI remained stable around 60%.However,permanent pacemaker requirement declined from 30.3%to 22.5%(P=0.028).LoS was reduced after the implementation of the program both in patients suitable for an early discharge(from 6.5 day to 4 day,P<0.001)and unsuitable patients(from 9.4 day to 7.7 day,P=0.014).The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases,day of the week,emergent procedures,and conduction disturbances and other complications as independent predictors of long stay after TAVI.Conclusions Most patients undergoing TAVI present conditions that preclude an early hospital discharge.The implementation of a TAVI program improved selection of patients,with a lower burden of comorbidities,a lower rate of complications and a marked reduction of hospital stay.
基金the Fundación Interhospitalaria para la Investigación Cardiovascular and Laboratorios Menarini S.L.(RECALCAR Project).All authors had no conflicts of interest to disclose.The authors thank the Spanish Ministry of Health,Consumer Affairs and Social Welfare for the help provided to the Spanish Society of Cardiology to develop the RECALCAR study,with special gratitude to the General Directorate of Public Health,Quality,and Innovation.
文摘Background The prognostic role of diabetes mellitus(DM)in elderly patients with myocardial infarction-related cardiogenic shock(MI-CS)remains controversial.Little information exists about the impact of intensive cardiac care unit(ICCU)and revascularization on outcomes of elderly patients with MI-CS.We aimed to assess the prognostic impact of DM according to age in patients with MI-CS,and to analyze the impact ICCU management and revascularization on in-hospital mortality in MI-CS patients at older ages.Methods Discharge episodes with diagnosis of CS associated with MI were selected from the Spanish National Health System’s Basic Data Set.Centers were classified according to their availability of ICCU.Main outcome measured was in-hospital mortality.Results A total of 23,590 episodes of MI-CS were identified,of whom 12,447(52.8%)were in patients aged≥75 years.The impact of DM on in-hospital mortality was different among age subgroups.While in younger patients,DM was associated to a higher mortality risk(0.52 vs.0.47,OR=1.12,95%CI:1.06–1.18,χ^2<0.001),this association became non-significant in older patients(0.76 vs.0.81,χ^2=0.09).Adjusted mortality rate of MI-CS aged≥75 years was lower in patients admitted to hospitals with ICCU(adjusted mortality rate:74.2%vs.77.7%,P<0.001)and in patients undergoing revascularization(74.9%vs.77.3%,P<0.001).Conclusions Prognostic impact of DM in patients with MI-CS was different according to age,with a significantly lower impact at older ages.The availability of ICCU and revascularization were associated with better outcomes in these complex patients.
文摘BACKGROUND The Impella pump has emerged as a promising tool in patients with cardiogenic shock(CS).Despite its attractive properties,there are scarce data on the specific clinical setting and the potential role of Impella devices in CS patients from routine clinical practice.METHODS This is an observational,retrospective,single center,cohort study.All consecutive patients with diagnosis of CS and undergoing support with Impella 2.5?,Impella CP?or Impella 5.0?from April 2015 to December 2020 were included.Baseline characteristics,management and outcomes were assessed according to CS severity,age and cause of CS.Main outcome measured was in-hospital mortality.RESULTS A total of 50 patients were included(median age:59.3±10 years).The most common cause of CS was acute coronary syndrome(ACS)(68%),followed by decompensation of previous cardiomyopathy(22%).A total of 13 patients(26%)had profound CS.Most patients(54%)improved pulmonary congestion at 48 h after Impella support.A total of 19 patients(38%)presented significant bleeding.In-hospital mortality was 42%.Among patients with profound CS(n=13),five patients were previously supported with venoarterial extracorporeal membrane oxygenation.A total of eight patients(61.5%)died during the admission,and no patient achieved ventricular recovery.Older patients(≥67 years,n=10)had more comorbidities and the highest mortality(70%).Among patients with ACS(n=34),35.3%of patients had profound CS;and in most cases(52.9%),Impella support was performed as a bridge to recovery.In contrast,only one patient from the decompensated cardiomyopathy group(n=11)presented with profound CS.In 90.9%of these cases,Impella support was used as a bridge to cardiac transplantation.There were no cases of death.CONCLUSIONS In this cohort of real-life CS patients,Impella devices were used in different settings,with different clinical profiles and management.Despite a significant rate of complications,mortality was acceptable and lower than those observed in other series.
