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  • 1
    Online Resource
    Online Resource
    Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients
    Oxford University Press (OUP) ; 2018
    In:  European Heart Journal: Acute Cardiovascular Care Vol. 7, No. 1 ( 2018-02), p. 7-15
    Details
    In: European Heart Journal: Acute Cardiovascular Care, Oxford University Press (OUP), Vol. 7, No. 1 ( 2018-02), p. 7-15
    Abstract: The incidence of cardiogenic shock (CS) in patients with ST-segment elevation myocardial infarction (STEMI) is as high as 10%. The majority of patients are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for primary percutaneous intervention remains unknown. Aim: The aim of this study was to assess the incidence and time of CS onset in patients with suspected STEMI admitted in two high-volume tertiary heart centres and to assess the variables associated with the development of late CS. Methods: We included consecutive patients admitted for acute coronary angiography with suspected STEMI in a 1-year period. Cardiogenic shock was based on clinical criteria and subdivided into patients with shock on admission, patients developing shock during catheterisation and patients developing shock later during hospitalisation. Follow-up for all-cause mortality was done using registries. Results: A total of 2247 patients with suspected STEMI were included, whereof 225 (10%) developed CS. The majority (56%) had CS on admission, 16% developed CS in the catheterisation laboratory and 28% developed late CS. Thirty-day mortality was 3.1% versus 47% in non-CS versus CS patients ( p logrank 〈 0.0001). Age, stroke, time from symptom onset to intervention, anterior STEMI, heart rate/systolic blood pressure ratio and being comatose after resuscitation from cardiac arrest were independently associated with the development of late CS. Conclusion: In this study, 10% of patients admitted with suspected STEMI for acute coronary angiography presented with or developed CS. Most were in shock on admission. Irrespective of the timing of shock, mortality was high.
    Type of Medium: Online Resource
    ISSN: 2048-8726 , 2048-8734
    URL: Article
    DOI: 10.1177/2048872617706503
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
    detail.hit.zdb_id: 2663340-1
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  • 2
    Online Resource
    Online Resource
    Prognostic value of automated pupillometry: an unselected cohort from a cardiac intensive care unit
    Oxford University Press (OUP) ; 2020
    In:  European Heart Journal. Acute Cardiovascular Care Vol. 9, No. 7 ( 2020-10-01), p. 779-787
    Details
    In: European Heart Journal. Acute Cardiovascular Care, Oxford University Press (OUP), Vol. 9, No. 7 ( 2020-10-01), p. 779-787
    Abstract: Patients admitted to a cardiac intensive care unit are often unconscious with uncertain prognosis. Automated infrared pupillometry for neurological assessment in the intensive care unit may provide early prognostic information. This study aimed to determine the prognostic value of automated pupillometry in different subgroups of patients in a cardiac intensive care unit with 30-day mortality as the primary endpoint and neurological outcome as the secondary endpoint. Methods: A total of 221 comatose patients were divided into three groups: out-of-hospital cardiac arrest, in-hospital cardiac arrest and others (i.e. patients with cardiac diagnoses other than cardiac arrest). Automated pupillometry was serially performed until discharge or death and pupil measurements were analysed using the neurological pupil index algorithm. We applied receiver operating characteristic curves in univariable and multivariable logistic regression models and a calculated Youden index identified neurological pupil index cut-off values at different specificities. Results: In out-of-hospital cardiac arrest patients higher neurological pupil index values were independently associated with lower 30-day mortality. The univariable model for 30-day mortality had an area under the curve of 0.87 and the multivariable model achieved an area under the curve of 0.94. The Youden index identified a neurological pupil index cut-off in out-of-hospital cardiac arrest patients of 2.40 for a specificity of 100%. For patients with in-hospital cardiac arrest and other cardiac diagnoses, we found no association between neurological pupil index values and 30-day mortality, and the univariable models showed poor predictive values. Conclusion: Automated infrared pupillometry has promising predictive value after out-of-hospital cardiac arrest, but poor predictive value in patients with in-hospital cardiac arrest or cardiac diagnoses unrelated to cardiac arrest. Our data suggest a possible neurological pupil index cut-off of 2.40 for poor outcome in out-of-hospital cardiac arrest patients.
    Type of Medium: Online Resource
    ISSN: 2048-8734 , 2048-8726
    URL: Article
    DOI: 10.1177/2048872619842004
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2663340-1
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
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