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1. Impact of the use of plaque modification techniques on coronary microcirculation using an angiography-derived index of microcirculatory resistance

Author

Teira Calderón, Andrea, Sans-Roselló, Jordi, Fernández-Peregrina, Estefanía, Sanz Sánchez, Jorge, Bosch-Peligero, Eduardo, Sánchez-Ceña, Juan, Sorolla Romero, Jose, Valcárcel-Paz, Daniel, Jiménez-Kockar, Marcelo, Diez Gil, José Luis, Asmarats, Lluís, Millan-Álvarez, Xavier, Vilchez-Tschischke, Jean Paul, Martinez-Rubio, Antonio, and Garcia-Garcia, Héctor M.

Published
2024
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2. Impact of age on the outcomes of Takotsubo syndrome

Author

Simon Frances, Blanca, Sans-Roselló, Jordi, Brugaletta, Salvatore, Cerrato, Enrico, Alfonso, Fernando, Gonzalo, Nieves, Amat-Santos, Ignacio J., Fernández-Peregrina, Estefanía, Teira Calderón, Andrea, Varghese, Jobin Joseph, Garg, Mohil, and García-García, Héctor M.

Published
2024
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5. miR‐619‐5p and cardiogenic shock in patients with ST‐segment elevation myocardial infarction.

Author

Escate, Rafael, Padró, Teresa, Suades, Rosa, Sans‐Roselló, Jordi, Devaux, Yvan, Lakkisto, Päivi, Harjola, Veli‐Pekka, Sionis, Alessandro, and Badimon, Lina

Subjects
ST elevation myocardial infarction, CARDIOGENIC shock, DISEASE risk factors
Abstract

Background: Cardiogenic shock (CS) is a severe myocardial dysfunction secondary to various cardiac conditions including ST‐segment elevation acute myocardial infarction (STEMI) and associated with a high risk of death. Little is known on epigenetic determinants in CS. Here, we investigated plasma miRNAs in relation to CS stratification in STEMI‐patients. Methods: STEMI‐patients (n = 49), with (CS, n = 25) and without CS (non‐CS, n = 24) fulfilling inclusion criteria were included from HSCSP‐cohort (Derivation‐cohort). CS‐miRNAs were analysed by Affymetrix‐microarray and RT‐PCR. Results were validated in a second cohort of CS‐patients (CardShock: n = 35) with similar inclusion/exclusion criteria as the derivation cohort. In silico analysis were performed to identify potential miRNA target genes. Results: Of the 5‐miRNA signature obtained from microarray analysis, miR‐619‐5p showed higher levels in CS than in Non‐CS patients (p =.003) and discriminating power for CS by ROC (AUC:.752, p =.003). miR‐619‐5p directly associated with risk scores [GRACE, p =.001; CardShock, p <.001]. Furthermore, miR‐619‐5p showed discrimination power for death in CS. Thus, miRNA levels were significantly higher in patients with mortality outcome both in the Derivation HSCSP‐cohort (p =.02; AUC:.78 ±.095) and the Validation CardShock‐cohort (p =.017; AUC:.737 ±.086) By in silico analysis, miR‐619‐5p target genes and TNF‐alpha were involved in the regulation of inflammation. miR‐619‐5p and TNF‐alpha levels discriminated mortality outcome in CS‐patients during 30‐day follow‐up (Validation‐Cohort: ROC:.812, p =.002; HR: 9.99, p =.003). Conclusions: Up‐regulation of miR‐619‐5p is found in the plasma of STEMI‐patients with CS and mortality outcome. These findings highlight the specificity of epigenetic regulation of inflammation on the disease severity of MI. [ABSTRACT FROM AUTHOR]

Published
2024
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6. Comorbidity and low use of new antiplatelets in acute coronary syndrome

Author

Aboal, Jaime, Llaó, Isaac, García García, Cosme, Sans-Roselló, Jordi, Sambola, Antonia, Andrea, Rut, Tomás, Carlos, Bonet, Gil, Ariza-Solé, Albert, Viñas, David, Oliveras Vilà, Teresa, Montero, Santiago, Cantalapiedra, Javier, Pujol-López, Margarida, Hernández, Isabel, Pérez-Rodriguez, María, Loma-Osorio, Pablo, and Sánchez-Salado, José Carlos

Published
2020
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8. Global Longitudinal Strain Predicts Outcomes in Patients with Reduced Left Ventricular Function Undergoing Transcatheter Edge-to-Edge Mitral Repair

Author

Fernandez-Peregrina, Estefania, primary, Asmarats, Luis, additional, Estevez-Loureiro, Rodrigo, additional, Pascual, Isaac, additional, Bastidas, Diana, additional, Benito-González, Tomas, additional, Caneiro-Queija, Berenice, additional, Avanzas, Pablo, additional, De Agustin, Jose Alberto, additional, Fernández-Vazquez, Felipe, additional, Barreiro-Pérez, Manuel, additional, Leon, Victor, additional, Nombela-Franco, Luis, additional, Garrote, Carmen, additional, Li, Chi-Hion, additional, Baz, José Antonio, additional, Adeba, Antonio, additional, Sans-Roselló, Jordi, additional, Gualis, Javier, additional, and Arzamendi, Dabit, additional

Published
2023
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9. Frequency and Prognostic Significance of Abnormal Liver Function Tests in Patients With Cardiogenic Shock

Author

Koniari, Katerina, Voumvourakis, Astrinos, Karavidas, Apostolos, Sans-Rosello, Jordi, Vila, Montserrat, Duran-Cambra, Albert, Metra, Marco, Bulgari, Michela, Lazzarini, Valentina, Parenica, Jiri, Stipal, Roman, Ludka, Ondrej, Palsuva, Marie, Ganovska, Eva, Kubena, Petr, Lindholm, Matias G., Hassager, Christian, Bäcklund, Tom, Jurkko, Raija, Järvinen, Kristiina, Nieminen, Tuomo, Pulkki, Kari, Soininen, Leena, Sund, Reijo, Tierala, Ilkka, Tolonen, Jukka, Varpula, Marjut, Korva, Tuomas, Pitkälä, Anne, Marino, Rossella, Sousa, Alexandra, Sousa, Carla, Paiva, Mariana, Rangel, Inês, Almeida, Rui, Pinho, Teresa, Maciel, Maria Júlia, Stepinska, Janina, Skrobisz, Anna, Góral, Piotr, Jäntti, Toni, Tarvasmäki, Tuukka, Harjola, Veli-Pekka, Parissis, John, Sionis, Alessandro, Silva-Cardoso, Jose, Køber, Lars, Banaszewski, Marek, Spinar, Jindrich, Fuhrmann, Valentin, Carubelli, Valentina, diSomma, Salvatore, Mebazaa, Alexandre, and Lassus, Johan

Published
2017
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11. Adrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock

Author

Tolppanen, Heli, Rivas-Lasarte, Mercedes, Lassus, Johan, Sans-Roselló, Jordi, Hartmann, Oliver, Lindholm, Matias, Arrigo, Mattia, Tarvasmäki, Tuukka, Köber, Lars, Thiele, Holger, Pulkki, Kari, Spinar, Jindrich, Parissis, John, Banaszewski, Marek, Silva-Cardoso, Jose, Carubelli, Valentina, Sionis, Alessandro, Harjola, Veli-Pekka, and Mebazaa, Alexandre

Published
2017
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12. In-Hospital Heart Failure in Patients With Takotsubo Cardiomyopathy Due to Coronary Artery Disease: An Artificial Intelligence and Optical Coherence Tomography Study

Author

Kumar, Sant, primary, Chu, Miao, additional, Sans-Roselló, Jordi, additional, Fernández-Peregrina, Estefanía, additional, Kahsay, Yirga, additional, Gonzalo, Nieves, additional, Salazar, Carlos Hernando, additional, Alfonso, Fernando, additional, Tu, Shengxian, additional, and Garcia-Garcia, Hector M., additional

Published
2023
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15. Soluble urokinase-type plasminogen activator receptor improves early risk stratification in cardiogenic shock

Author

Hongisto, Mari, Lassus, Johan, Tarvasmäki, Tuukka, Sans-Roselló, Jordi, Tolppanen, Heli, Kataja, Anu, Jäntti, Toni, Sabell, Tuija, Banaszewski, Marek, Silva-Cardoso, Jose, Parissis, John, Jurkko, Raija, Spinar, Jindrich, Castrén, Maaret, Mebazaa, Alexandre, Masip, Josep, Harjola, Veli-Pekka, Universitat Autònoma de Barcelona, HUS Emergency Medicine and Services, Department of Diagnostics and Therapeutics, University of Helsinki, HUS Heart and Lung Center, Department of Medicine, Kardiologian yksikkö, and Clinicum

Subjects
Supar, MYOCARDIAL-INFARCTION, PREDICTION, MORTALITY, Biomarker, General Medicine, 3126 Surgery, anesthesiology, intensive care, radiology, Cardiology and Cardiovascular Medicine, Critical Care and Intensive Care Medicine, Cardiogenic shock, Risk stratification, suPAR
Abstract

Aims Soluble urokinase–type plasminogen activator receptor (suPAR) is a biomarker reflecting the level of immune activation. It has been shown to have prognostic value in acute coronary syndrome and heart failure as well as in critical illness. Considering the complex pathophysiology of cardiogenic shock (CS), we hypothesized suPAR might have prognostic properties in CS as well. The aim of this study was to assess the kinetics and prognostic utility of suPAR in CS. Methods and results SuPAR levels were determined in serial plasma samples (0–96 h) from 161 CS patients in the prospective, observational, multicentre CardShock study. Kinetics of suPAR, its association with 90-day mortality, and additional value in risk-stratification were investigated. The median suPAR-level at baseline was 4.4 [interquartile range (IQR) 3.2–6.6)] ng/mL. SuPAR levels above median were associated with underlying comorbidities, biomarkers reflecting renal and cardiac dysfunction, and higher 90-day mortality (49% vs. 31%; P = 0.02). Serial measurements showed that survivors had significantly lower suPAR levels at all time points compared with nonsurvivors. For risk stratification, suPAR at 12 h (suPAR12h) with a cut-off of 4.4 ng/mL was strongly associated with mortality independently of established risk factors in CS: OR 5.6 (95% CI 2.0–15.5); P = 0.001) for death by 90 days. Adding suPAR12h > 4.4 ng/mL to the CardShock risk score improved discrimination identifying high-risk patients originally categorized in the intermediate-risk category. Conclusion SuPAR associates with mortality and improves risk stratification independently of other previously known risk factors in CS patients.

Published
2022

18. “Impact of age on management and prognosis of resuscitated sudden cardiac death patients”

Author

Sans Roselló, Jordi, primary, Vidal-Burdeus, Maria, additional, Loma-Osorio, Pablo, additional, Pons Riverola, Alexandra, additional, Bonet Pineda, Gil, additional, El Ouaddi, Nabil, additional, Aboal, Jaime, additional, Ariza Solé, Albert, additional, Scardino, Claudia, additional, García-García, Cosme, additional, Fernández-Peregrina, Estefanía, additional, and Sionis, Alessandro, additional

Published
2022
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19. Risk Assessment after ST-Segment Elevation Myocardial Infarction : can Biomarkers Improve the Performance of Clinical Variables?

Author

García Osuna, Álvaro, Sans Roselló, Jordi, Ferrero-Gregori, Andreu, Alquézar Arbé, Aitor, Sionis, Alessandro, Ordoñez Llanos, Jorge, Universitat Autònoma de Barcelona, García Osuna, Álvaro, Sans Roselló, Jordi, Ferrero-Gregori, Andreu, Alquézar Arbé, Aitor, Sionis, Alessandro, Ordoñez Llanos, Jorge, and Universitat Autònoma de Barcelona

Abstract

Introduction: Myocardial infarction with ST-segment elevation (STEMI) is the coronary artery disease associated with the highest risk of morbimortality; however, this risk is heterogeneous, usually being evaluated by clinical scores. Risk assessment is a key factor in personalized clinical management of patients with this disease. Aim: The aim of this study was to assess whether some new cardiac biomarkers considered alone, combined in a multibiomarker model or in association with clinical variables, improve the short- and long-term risk stratification of STEMI patients. Materials and Methods: This was a retrospective observational study of 253 patients with STEMI. Blood samples were obtained before or during the angiography. The assessed biomarkers were C-terminal fragment of insulin-like growth factor binding protein-4 (CT-IGFBP4), high sensitive cardiac troponin T (hs-cTnT), N-terminal fragment of probrain natriuretic peptide (NT-proBNP), and growth differentiation factor 15 (GDF-15); they reflect different cardiovascular (CV) physiopathological pathways and underlying pathologies. We registered in-hospital and follow-up mortalities and their causes (cardiovascular and all-cause) and major adverse cardiac events (MACE) during a two year follow-up. Discrimination, survival analysis, model calibration, and reclassification of the biomarkers were comprehensively evaluated. Results and Discussion: In total, 55 patients (21.7%) died, 33 in-hospital and 22 during the follow-up, most of them (69.1%) from CV causes; 37 MACE occurred during follow-up. Biomarkers showed good prognostic ability to predict mortality, alone and combined with the multibiomarker model. A predictive clinical model based on age, Killip-Kimball class, estimated glomerular filtration rate (eGFR), and heart rate was derived by multivariate analysis. GDF-15 and NT-proBNP significantly improved risk assessment of the clinical model, as shown by discrimination, calibration, and reclassification of all

Published
2022

21. Transcatheter edge-to-edge mitral valve repair in patients with mitral annulus calcification

Author

Fernández-Peregrina, Estefanía, primary, Pascual, Isaac, additional, Freixa, Xavier, additional, Tirado-Conte, Gabriela, additional, Estévez-Loureiro, Rodrigo, additional, Carrasco-Chinchilla, Fernando, additional, Benito-González, Tomás, additional, Asmarats, Lluis, additional, Sanchís, Laura, additional, Jiménez-Quevedo, Pilar, additional, Avanzas, Pablo, additional, Caneiro-Queija, Berenice, additional, Molina-Ramos, Ana Molina-Ramos, additional, Fernández-Vázquez, Felipe, additional, Li, Chi-Hion, additional, Flores-Umanzor, Eduardo, additional, Sans-Roselló, Jordi, additional, Nombela-Franco, Luis, additional, and Arzamendi, Dabit, additional

Published
2022
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24. The Capacity of APOB-Depleted Plasma in Inducing ATP-Binding Cassette A1/G1-Mediated Macrophage Cholesterol Efflux—But Not Gut Microbial-Derived Metabolites—Is Independently Associated with Mortality in Patients with ST-Segment Elevation Myocardial Infarction

Author

Canyelles, Marina, primary, García-Osuna, Álvaro, additional, Junza, Alexandra, additional, Yanes, Oscar, additional, Puig, Núria, additional, Ordóñez-Llanos, Jordi, additional, Sionis, Alessandro, additional, Sans-Roselló, Jordi, additional, Alquézar-Arbé, Aitor, additional, Santos, David, additional, Rotllan, Noemi, additional, Julve, Josep, additional, Tondo, Mireia, additional, Escolà-Gil, Joan Carles, additional, and Blanco-Vaca, Francisco, additional

Published
2021
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27. Soluble urokinase-type plasminogen activator receptor improves early risk stratification in cardiogenic shock .

Author

Hongisto, Mari, Lassus, Johan, Tarvasmäki, Tuukka, Sans-Roselló, Jordi, Tolppanen, Heli, Kataja, Anu, Jäntti, Toni, Sabell, Tuija, Banaszewski, Marek, Silva-Cardoso, Jose, Parissis, John, Jurkko, Raija, Spinar, Jindrich, Castrén, Maaret, Mebazaa, Alexandre, Masip, Josep, Harjola, Veli-Pekka, for the CardShock Study Investigators and the GREAT Network, Virogates, and Diagnostics, Roche

Published
2022
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29. Anemia in patients with high-risk acute coronary syndromes admitted to Intensive Cardiac Care Units

Author

Lorente, Victòria, Aboal, Jaime, García, Cosme, Sans-Roselló, Jordi, Sambola, Antonia, Andrea, Rut, Tomás, Carlos, Bonet, Gil, Viñas, David, El Ouaddi, Nabil, Montero, Santiago, Cantalapiedra, Javier, Pujol, Margarida, Hernández, Isabel, Pérez-Rodriguez, María, Llaó, Isaac, Sánchez-Salado, José C.., Gual, Miquel, Ariza-Solé, Albert, and Universitat Autònoma de Barcelona

Subjects
Intensive cardiac care units, hemic and lymphatic diseases, Anemia, Acute coronary syndromes, Prognosis
Abstract

Little information exists about the role of anemia in patients with acute coronary syndromes (ACS) admitted to Intensive Cardiac Care Units (ICCU). The aim of this study was to assess the prevalence of anemia and its impact on management and outcomes in this clinical setting. All consecutive patients admitted to eight different ICCUs with diagnosis of non-ST segment elevation ACS (NSTEACS) were prospectively included. Anemia was defined as hemoglobin < 130 g/L in men and < 120 g/L in women. The association between anemia and mortality or readmission at six months was assessed by the Cox regression method. A total of 629 patients were included. Mean age was 66.6 years. A total of 197 patients (31.3%) had anemia. Coronary angiography was performed in most patients (96.2%). Patients with anemia were significantly older, with a higher prevalence of comorbidities, poorer left ventricle ejection fraction and higher GRACE score values. Patients with anemia underwent less often coronary angiography, but underwent more often intraaortic counterpulsation, non-invasive mechanical ventilation and renal replacement therapies. Both ICCU and hospital stay were significantly longer in patients with anemia. Both the incidence of mortality (HR = 3.36, 95% CI: 1.43-7.85, P = 0.001) and the incidence of mortality/readmission were significantly higher in patients with anemia (HR = 2.80, 95% CI: 2.03-3.86, P = 0.001). After adjusting for confounders, the association between anemia and mortality/readmission remained significant (P = 0.031). Almost one of three NSTEACS patients admitted to ICCU had anemia. Most patients underwent coronary angiography. Anemia was independently associated to poorer outcomes at 6 months.

Published
2020

30. Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients:Results From the CardShock Study

Author

Sionis, Alessandro, Rivas-Lasarte, Mercedes, Mebazaa, Alexandre, Tarvasmäki, Tuukka, Sans-Roselló, Jordi, Tolppanen, Heli, Varpula, Marjut, Jurkko, Raija, Banaszewski, Marek, Silva-Cardoso, Jose, Carubelli, Valentina, Lindholm, Matias Greve, Parissis, John, Spinar, Jindrich, Lassus, Johan, Harjola, Veli Pekka, Masip, Josep, Sionis, Alessandro, Rivas-Lasarte, Mercedes, Mebazaa, Alexandre, Tarvasmäki, Tuukka, Sans-Roselló, Jordi, Tolppanen, Heli, Varpula, Marjut, Jurkko, Raija, Banaszewski, Marek, Silva-Cardoso, Jose, Carubelli, Valentina, Lindholm, Matias Greve, Parissis, John, Spinar, Jindrich, Lassus, Johan, Harjola, Veli Pekka, and Masip, Josep

Abstract

Background: Cardiogenic shock (CS) is the most life-threatening manifestation of acute heart failure. Its complexity and high in-hospital mortality may justify the need for invasive monitoring with a pulmonary artery catheter (PAC). Methods: Patients with CS included in the CardShock Study, an observational, prospective, multicenter, European registry, were analyzed, aiming to describe the real-world use of PAC, evaluate its impact on 30-day mortality, and the ability of different hemodynamic parameters to predict outcomes. Results: Pulmonary artery catheter was used in 82 (37.4%) of the 219 patients. Cardiogenic shock patients who managed with a PAC received more frequently treatment with inotropes and vasopressors, mechanical ventilation, renal replacement therapy, and mechanical assist devices (P <.01). Overall 30-day mortality was 36.5%. Pulmonary artery catheter use did not affect mortality even after propensity score matching analysis (hazard ratio = 1.17 [0.59-2.32], P =.66). Cardiac index, cardiac power index (CPI), and stroke volume index (SVI) showed the highest areas under the curve for 30-day mortality (ranging from 0.752-0.803) and allowed for a significant net reclassification improvement of 0.467 (0.083-1.180), 0.700 (0.185-1.282), 0.683 (0.168-1.141), respectively, when added to the CardShock risk score. Conclusions: In our contemporary cohort of CS, over one-third of patients were managed with a PAC. Pulmonary artery catheter use was associated with a more aggressive treatment strategy. Nevertheless, PAC use was not associated with 30-day mortality. Cardiac index, CPI, and SVI were the strongest 30-day mortality predictors on top of the previously validated CardShock risk score.

Published
2020

31. External validation and comparison of the CardShock and IABP-SHOCK II risk scores in real-world cardiogenic shock patients

Author

Rivas-Lasarte, Mercedes, primary, Sans-Roselló, Jordi, additional, Collado-Lledó, Elena, additional, González-Fernández, Víctor, additional, Noriega, Francisco J, additional, Hernández-Pérez, Francisco J, additional, Fernández-Martínez, Juan, additional, Ariza, Albert, additional, Lidón, Rosa-Maria, additional, Viana-Tejedor, Ana, additional, Segovia-Cubero, Javier, additional, Harjola, Veli-Pekka, additional, Lassus, Johan, additional, Thiele, Holger, additional, and Sionis, Alessandro, additional

Published
2020
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32. Change in neuron specific enolase levels in out-of-hospital cardiopulmonary arrest survivors as a simple and useful tool to predict neurological prognosis

Author

Rafecas, Agnès, primary, Bañeras, Jordi, additional, Sans-Roselló, Jordi, additional, Ortiz-Pérez, José T., additional, Rueda-Sobella, Ferran, additional, Santamarina, Estevo, additional, Milà, Laia, additional, Sionis, Alessandro, additional, Gaig, Carles, additional, García-García, Cosme, additional, Barrabés, José A., additional, García-Dorado, David, additional, and Lidón, Rosa-Maria, additional

Published
2020
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33. Cambio en la enolasa neuroespecífica de los supervivientes de parada cardiorrespiratoria extrahospitalaria: herramienta útil para predecir el pronóstico neurológico

Author

Rafecas, Agnès, primary, Bañeras, Jordi, additional, Sans-Roselló, Jordi, additional, Ortiz-Pérez, José T., additional, Rueda-Sobella, Ferran, additional, Santamarina, Estevo, additional, Milà, Laia, additional, Sionis, Alessandro, additional, Gaig, Carles, additional, García-García, Cosme, additional, Barrabés, José A., additional, García-Dorado, David, additional, and Lidón, Rosa-Maria, additional

Published
2020
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34. Supplemental_Material - Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients: Results From the CardShock Study

Author

Sionis, Alessandro, Rivas-Lasarte, Mercedes, Mebazaa, Alexandre, Tarvasmäki, Tuukka, Sans-Roselló, Jordi, Tolppanen, Heli, Varpula, Marjut, Jurkko, Raija, Banaszewski, Marek, Silva-Cardoso, Jose, Carubelli, Valentina, Lindholm, Matias Greve, Parissis, John, Jindrich Spinar, Lassus, Johan, Veli-Pekka Harjola, and Masip, Josep

Subjects
110203 Respiratory Diseases, FOS: Clinical medicine, 111702 Aged Health Care, FOS: Health sciences, 110305 Emergency Medicine
Abstract

Supplemental_Material for Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients: Results From the CardShock Study by Alessandro Sionis, Mercedes Rivas-Lasarte, Alexandre Mebazaa, Tuukka Tarvasmäki, Jordi Sans-Roselló, Heli Tolppanen, Marjut Varpula, Raija Jurkko, Marek Banaszewski, Jose Silva-Cardoso, Valentina Carubelli, Matias Greve Lindholm, John Parissis, Jindrich Spinar, Johan Lassus, Veli-Pekka Harjola, and Josep Masip in Journal of Intensive Care Medicine

Published
2019
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35. Comorbidity and low use of new antiplatelets in acute coronary syndrome

Author

Aboal, Jaime, primary, Llaó, Isaac, additional, García García, Cosme, additional, Sans-Roselló, Jordi, additional, Sambola, Antonia, additional, Andrea, Rut, additional, Tomás, Carlos, additional, Bonet, Gil, additional, Ariza-Solé, Albert, additional, Viñas, David, additional, Oliveras Vilà, Teresa, additional, Montero, Santiago, additional, Cantalapiedra, Javier, additional, Pujol-López, Margarida, additional, Hernández, Isabel, additional, Pérez-Rodriguez, María, additional, Loma-Osorio, Pablo, additional, and Sánchez-Salado, José Carlos, additional

Published
2019
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36. Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients: Results From the CardShock Study

Author

Sionis, Alessandro, primary, Rivas-Lasarte, Mercedes, additional, Mebazaa, Alexandre, additional, Tarvasmäki, Tuukka, additional, Sans-Roselló, Jordi, additional, Tolppanen, Heli, additional, Varpula, Marjut, additional, Jurkko, Raija, additional, Banaszewski, Marek, additional, Silva-Cardoso, Jose, additional, Carubelli, Valentina, additional, Lindholm, Matias Greve, additional, Parissis, John, additional, Spinar, Jindrich, additional, Lassus, Johan, additional, Harjola, Veli-Pekka, additional, and Masip, Josep, additional

Published
2019
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38. External validation and comparison of the CardShock and IABP-SHOCK II risk scores in real-world cardiogenic shock patients.

Author

Rivas-Lasarte, Mercedes, Sans-Roselló, Jordi, Collado-Lledó, Elena, González-Fernández, Víctor, Noriega, Francisco J., Hernández-Pérez, Francisco J., Fernández-Martínez, Juan, Ariza, Albert, Lidón, Rosa-Maria, Viana-Tejedor, Ana, Segovia-Cubero, Javier, Harjola, Veli-Pekka, Lassus, Johan, Thiele, Holger, and Sionis, Alessandro

Published
2021
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39. Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients: Results From the CardShock Study.

Author

Sionis, Alessandro, Rivas-Lasarte, Mercedes, Mebazaa, Alexandre, Tarvasmäki, Tuukka, Sans-Roselló, Jordi, Tolppanen, Heli, Varpula, Marjut, Jurkko, Raija, Banaszewski, Marek, Silva-Cardoso, Jose, Carubelli, Valentina, Lindholm, Matias Greve, Parissis, John, Spinar, Jindrich, Lassus, Johan, Harjola, Veli-Pekka, and Masip, Josep

Subjects
CARDIOGENIC shock, PULMONARY artery catheters, HOSPITAL mortality, HEMODYNAMICS, ARTIFICIAL respiration
Abstract

Background: Cardiogenic shock (CS) is the most life-threatening manifestation of acute heart failure. Its complexity and high inhospital mortality may justify the need for invasive monitoring with a pulmonary artery catheter (PAC). Methods: Patients with CS included in the CardShock Study, an observational, prospective, multicenter, European registry, were analyzed, aiming to describe the real-world use of PAC, evaluate its impact on 30-day mortality, and the ability of different hemodynamic parameters to predict outcomes. Results: Pulmonary artery catheter was used in 82 (37.4%) of the 219 patients. Cardiogenic shock patients who managed with a PAC received more frequently treatment with inotropes and vasopressors, mechanical ventilation, renal replacement therapy, and mechanical assist devices (P < .01). Overall 30-day mortality was 36.5%. Pulmonary artery catheter use did not affect mortality even after propensity score matching analysis (hazard ratio = 1.17 [0.59-2.32], P = .66). Cardiac index, cardiac power index (CPI), and stroke volume index (SVI) showed the highest areas under the curve for 30-day mortality (ranging from 0.752-0.803) and allowed for a significant net reclassification improvement of 0.467 (0.083-1.180), 0.700 (0.185-1.282), 0.683 (0.168-1.141), respectively, when added to the CardShock risk score. Conclusions: In our contemporary cohort of CS, over one-third of patients were managed with a PAC. Pulmonary artery catheter use was associated with a more aggressive treatment strategy. Nevertheless, PAC use was not associated with 30-day mortality. Cardiac index, CPI, and SVI were the strongest 30-day mortality predictors on top of the previously validated CardShock risk score. [ABSTRACT FROM AUTHOR]

Published
2020
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41. Adrenomedullin:a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock

Author

Tolppanen, Heli, Rivas-Lasarte, Mercedes, Lassus, Johan, Sans-Roselló, Jordi, Hartmann, Oliver, Lindholm, Matias, Arrigo, Mattia, Tarvasmäki, Tuukka, Köber, Lars, Thiele, Holger, Pulkki, Kari, Spinar, Jindrich, Parissis, John, Banaszewski, Marek, Silva-Cardoso, Jose, Carubelli, Valentina, Sionis, Alessandro, Harjola, Veli Pekka, Mebazaa, Alexandre, Tolppanen, Heli, Rivas-Lasarte, Mercedes, Lassus, Johan, Sans-Roselló, Jordi, Hartmann, Oliver, Lindholm, Matias, Arrigo, Mattia, Tarvasmäki, Tuukka, Köber, Lars, Thiele, Holger, Pulkki, Kari, Spinar, Jindrich, Parissis, John, Banaszewski, Marek, Silva-Cardoso, Jose, Carubelli, Valentina, Sionis, Alessandro, Harjola, Veli Pekka, and Mebazaa, Alexandre

Abstract

Background: The clinical CardShock risk score, including baseline lactate levels, was recently shown to facilitate risk stratification in patients with cardiogenic shock (CS). As based on baseline parameters, however, it may not reflect the change in mortality risk in response to initial therapies. Adrenomedullin is a prognostic biomarker in several cardiovascular diseases and was recently shown to associate with hemodynamic instability in patients with septic shock. The aim of our study was to evaluate the prognostic value and association with hemodynamic parameters of bioactive adrenomedullin (bio-ADM) in patients with CS. Methods: CardShock was a prospective, observational, European multinational cohort study of CS. In this sub-analysis, serial plasma bio-ADM and arterial blood lactate measurements were collected from 178 patients during the first 10 days after detection of CS. Results: Both bio-ADM and lactate were higher in 90-day non-survivors compared to survivors at all time points (P < 0.05 for all). Lactate showed good prognostic value during the initial 24 h (AUC 0.78 at admission and 0.76 at 24 h). Subsequently, lactate returned normal (≤2 mmol/L) in most patients regardless of later outcome with lower prognostic value. By contrast, bio-ADM showed increasing prognostic value from 48 h and beyond (AUC 0.71 at 48 h and 0.80 at 5–10 days). Serial measurements of either bio-ADM or lactate were independent of and provided added value to CardShock risk score (P < 0.001 for both). Ninety-day mortality was more than double higher in patients with high levels of bio-ADM (>55.7 pg/mL) at 48 h compared to those with low bio-ADM levels (49.1 vs. 22.6%, P = 0.001). High levels of bio-ADM were associated with impaired cardiac index, mean arterial pressure, central venous pressure, and systolic pulmonary artery pressure during the study period. Furthermore, high levels of bio-ADM at 48 to 96 h were related to persistently impaired cardiac and end-organ func

Published
2017

45. External validation and comparison of the CardShock and IABP-SHOCK II risk scores in real-world cardiogenic shock patients

Author

Rivas-Lasarte, Mercedes, Sans-Roselló, Jordi, Collado-Lledó, Elena, González-Fernández, Víctor, Noriega, Francisco J, Hernández-Pérez, Francisco J, Fernández-Martínez, Juan, Ariza, Albert, Lidón, Rosa-Maria, Viana-Tejedor, Ana, Segovia-Cubero, Javier, Harjola, Veli-Pekka, Lassus, Johan, Thiele, Holger, and Sionis, Alessandro

Abstract

Background: Mortality from cardiogenic shock remains high and early recognition and risk stratification are mandatory for optimal patient allocation and to guide treatment strategy. The CardShock and the Intra-Aortic Balloon Counterpulsation in Acute Myocardial Infarction Complicated by Cardiogenic Shock (IABP-SHOCK II) risk scores have shown good results in predicting short-term mortality in cardiogenic shock. However, to date, they have not been compared in a large cohort of ischaemic and non-ischaemic real-world cardiogenic shock patients.Methods: The Red-Shock is a multicentre cohort of non-selected cardiogenic shock patients. We calculated the CardShock and IABP-SHOCK II risk scores in each patient and assessed discrimination and calibration.Results: We included 696 patients. The main cause of cardiogenic shock was acute coronary syndrome, occurring in 62% of the patients. Compared with acute coronary syndrome patients, non-acute coronary syndrome patients were younger and had a lower proportion of risk factors but higher rates of renal insufficiency; intra-aortic balloon pump was also less frequently used (31% vs 56%). In contrast, non-acute coronary syndrome patients were more often treated with mechanical circulatory support devices (11% vs 3%, p<0.001 for both). Both risk scores were good predictors of in-hospital mortality in acute coronary syndrome patients and had similar areas under the receiver-operating characteristic curve (area under the curve: 0.742 for the CardShock vs 0.752 for IABP-SHOCK II, p=0.65). Their discrimination performance was only modest when applied to non-acute coronary syndrome patients (0.648 vs 0.619, respectively, p=0.31). Calibration was acceptable for both scores (Hosmer-Lemeshow p=0.22 for the CardShock and 0.68 for IABP-SHOCK II).Conclusions: In our cohort, both the CardShock and the IABP-SHOCK II risk scores were good predictors of in-hospital mortality in acute coronary syndrome-related cardiogenic shock.

Published
2024
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