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  • 1
    Article
    Article
    2021
    ISSN: 0870-2551 
    Language: English
    In: Revista portuguesa de cardiologia, 2021-11, Vol.40 (11), p.863-864
    ISSN: 0870-2551
    E-ISSN: 2174-2030
    Source: DOAJ Directory of Open Access Journals - Not for CDI Discovery
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  • 2
    Article
    Article
    2021
    ISSN: 2174-2049 
    Language: English
    In: Revista portuguesa de cardiologia (English ed.), 2021-11, Vol.40 (11), p.863-864
    ISSN: 2174-2049
    E-ISSN: 2174-2049
    Source: Alma/SFX Local Collection
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  • 3
    Language: English
    In: Journal of the American College of Cardiology, 2017, Vol.69 (15), p.1913-1920
    Description: Abstract Background Mortality in cardiogenic shock (CS) remains high. Early risk stratification is crucial to make adequate treatment decisions. Objectives This study sought to develop an easy-to-use, readily available risk prediction score for short-term mortality in patients with CS, derived from the IABP-SHOCK II (Intraaortic Balloon Pump in Cardiogenic Shock) trial. Methods The score was developed using a stepwise multivariable regression analysis. Results Six variables emerged as independent predictors for 30-day mortality and were used as score parameters: age 〉73 years, prior stroke, glucose at admission 〉10.6 mmol/l (191 mg/dl), creatinine at admission 〉132.6 μmol/l (1.5 mg/dl), Thrombolysis In Myocardial Infarction flow grade 〈3 after percutaneous coronary intervention, and arterial blood lactate at admission 〉5 mmol/l. Either 1 or 2 points were attributed to each variable, leading to a score in 3 risk categories: low (0 to 2), intermediate (3 or 4), and high (5 to 9). The observed 30-day mortality rates were 23.8%, 49.2%, and 76.6%, respectively (p 〈 0.0001). Validation in the IABP-SHOCK II registry population showed good discrimination with an area under the curve of 0.79. External validation in the CardShock trial population (n = 137) showed short-term mortality rates of 28.0% (score 0 to 2), 42.9% (score 3 to 4), and 77.3% (score 5 to 9; p 〈 0.001) and an area under the curve of 0.73. Kaplan-Meier analysis revealed a stepwise increase in mortality between the different score categories (0 to 2 vs. 3 to 4: p = 0.04; 0 to 2 vs. 5 to 9: p = 0.008). Conclusions The IABP-SHOCK II risk score can be easily calculated in daily clinical practice and strongly correlated with mortality in patients with infarct-related CS. It may help stratify patient risk for short-term mortality and might, thus, facilitate clinical decision making. (Intraaortic Balloon Pump in Cardiogenic Shock II [IABP-SHOCK II]; NCT00491036 )
    Subject(s): Abridged Index Medicus ; acute coronary syndrome ; Age ; Aged ; Aorta ; Biomarkers ; Capes (landforms) ; Cardiogenic shock ; Cardiology ; Cardiovascular ; Categories ; Catheterization ; Clinical trials ; Congestion ; Coronary artery ; Death ; Diabetes ; Diabetes mellitus ; Electrocardiography ; Emergency medicine ; Ethics ; Etiology ; Female ; Germany ; Glucose ; Hazards ; Health risks ; Heart ; Heart attacks ; Heart diseases ; Humans ; Hypotension ; Injection ; Insertion ; Internal Medicine ; Intra-Aortic Balloon Pumping - methods ; Intra-Aortic Balloon Pumping - statistics & numerical data ; Intubation ; Kaplan-Meier Estimate ; Kidney transplantation ; Laboratories ; Life span ; Male ; Mathematical models ; Middle Aged ; Mortality ; Myocardial infarction ; Myocardial Infarction - complications ; Outcome and Process Assessment (Health Care) ; Patients ; percutaneous coronary intervention ; Percutaneous Coronary Intervention - methods ; Percutaneous Coronary Intervention - statistics & numerical data ; Plotting ; Population studies ; Predictions ; prognosis ; Quality ; Regression analysis ; Renal function ; Research Design ; Resuscitation ; Risk assessment ; Risk Assessment - methods ; risk score ; Shock ; Shock, Cardiogenic - etiology ; Shock, Cardiogenic - mortality ; Shock, Cardiogenic - therapy ; Statistical analysis ; Statistical tests ; Studies ; Thrombolytic Therapy - methods ; Thrombolytic Therapy - statistics & numerical data ; TIMI flow grade ; Variables
    ISSN: 0735-1097
    E-ISSN: 1558-3597
    Source: Alma/SFX Local Collection
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  • 4
    Language: English
    In: The Lancet (British edition), 2013, Vol.382 (9905), p.1638-1645
    Description: Summary Background In current international guidelines the recommendation for intra-aortic balloon pump (IABP) use has been downgraded in cardiogenic shock complicating acute myocardial infarction on the basis of registry data. In the largest randomised trial (IABP-SHOCK II), IABP support did not reduce 30 day mortality compared with control. However, previous trials in cardiogenic shock showed a mortality benefit only at extended follow-up. The present analysis therefore reports 6 and 12 month results. Methods The IABP-SHOCK II trial was a randomised, open-label, multicentre trial. Patients with cardiogenic shock complicating acute myocardial infarction who were undergoing early revascularisation and optimum medical therapy were randomly assigned (1:1) to IABP versus control via a central web-based system. The primary efficacy endpoint was 30 day all-cause mortality, but 6 and 12 month follow-up was done in addition to quality-of-life assessment for all survivors with the Euroqol-5D questionnaire. A masked central committee adjudicated clinical outcomes. Patients and investigators were not masked to treatment allocation. Analysis was by intention to treat. This trial is registered at ClinicalTrials.gov , NCT00491036. Findings Between June 16, 2009, and March 3, 2012, 600 patients were assigned to IABP (n=301) or control (n=299). Of 595 patients completing 12 month follow-up, 155 (52%) of 299 patients in the IABP group and 152 (51%) of 296 patients in the control group had died (relative risk [RR] 1·01, 95% CI 0·86–1·18, p=0·91). There were no significant differences in reinfarction (RR 2·60, 95% CI 0·95–7·10, p=0·05), recurrent revascularisation (0·91, 0·58–1·41, p=0·77), or stroke (1·50, 0·25–8·84, p=1·00). For survivors, quality-of-life measures including mobility, self-care, usual activities, pain or discomfort, and anxiety or depression did not differ significantly between study groups. Interpretation In patients undergoing early revascularisation for myocardial infarction complicated by cardiogenic shock, IABP did not reduce 12 month all-cause mortality. Funding German Research Foundation; German Heart Research Foundation; German Cardiac Society; Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte; University of Leipzig—Heart Centre; Maquet Cardiopulmonary; Teleflex Medical.
    Subject(s): Abridged Index Medicus ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular disease ; Care and treatment ; Coronary heart disease ; Coronary vessels ; Drug therapy ; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care ; Female ; Follow-Up Studies ; General aspects ; Heart ; Heart attack ; Heart attacks ; Humans ; Intensive care medicine ; Internal Medicine ; Intra-aortic balloon counterpulsation ; Intra-Aortic Balloon Pumping - mortality ; Male ; Medical sciences ; Middle Aged ; Mortality ; Myocardial Infarction - complications ; Myocardial Infarction - mortality ; Myocardial Infarction - therapy ; Myocardial Revascularization ; Patient outcomes ; Quality of Life ; Risk Factors ; Shock, Cardiogenic - complications ; Surveys and Questionnaires ; Time Factors ; Treatment Outcome
    ISSN: 0140-6736
    E-ISSN: 1474-547X
    Source: Backfile Package - All of Back Files EBS [ALLOFBCKF]
    Source: Elsevier Journal Backfiles on ScienceDirect (DFG Nationallizenzen)
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  • 5
    Language: English
    In: Journal of the American College of Cardiology, 2014, Vol.64 (12), p.1217-1226
    Description: Abstract Background Although the prognostic value of findings from cardiac magnetic resonance (CMR) imaging has been established in single-center center studies in patients with ST-segment elevation myocardial infarction (STEMI), a large multicenter investigation to evaluate the prognostic significance of myocardial damage and reperfusion injury is lacking. Objectives The aim of this study was to assess the prognostic impact of CMR in an adequately powered multicenter study and to evaluate the most potent CMR predictor of hard clinical events in a STEMI population treated by primary percutaneous coronary intervention (PCI). Methods We enrolled 738 STEMI patients in this CMR study at 8 centers. The patients were reperfused by primary PCI 〈12 h after symptom onset. Central core laboratory–masked analyses for quantified left ventricular (LV) function, infarct size (IS), microvascular obstruction (MO), and myocardial salvage were performed. The primary clinical endpoint of the study was the occurrence of major adverse cardiac events. Results Patients with cardiovascular events had significantly larger infarcts (p 〈 0.001), less myocardial salvage (p = 0.01), a larger extent of MO (p = 0.009), and more pronounced LV dysfunction (p 〈 0.001). In a multivariate model that included clinical and other established prognostic parameters, MO remained the only significant predictor in addition to the TIMI (Thrombolysis In Myocardial Infarction) risk score. IS and MO provided an incremental prognostic value above clinical risk assessment and LV ejection fraction (c-index increase from 0.761 to 0.801; p = 0.036). Conclusions In a large, multicenter STEMI population reperfused by primary PCI, CMR markers of myocardial damage (IS and especially MO) provide independent and incremental prognostic information in addition to clinical risk scores and LV ejection fraction. (Abciximab i.v. Versus i.c. in ST-elevation Myocardial Infarction [AIDA STEMI]; NCT00712101 ).
    Subject(s): Abridged Index Medicus ; Aged ; Angioplasty ; Cardiovascular ; Confidence intervals ; Female ; Follow-Up Studies ; Heart attack ; Heart attacks ; Humans ; Internal Medicine ; Laboratories ; magnetic resonance imaging ; Magnetic Resonance Imaging, Cine - methods ; Male ; Middle Aged ; Multivariate analysis ; myocardial infarction ; Myocardial Infarction - diagnosis ; Myocardial Infarction - mortality ; Myocardial Infarction - physiopathology ; Prognosis ; Prospective Studies ; Risk assessment ; Sects ; Single-Blind Method ; Survival Rate - trends
    ISSN: 0735-1097
    E-ISSN: 1558-3597
    Source: Alma/SFX Local Collection
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  • 6
    Language: English
    In: Nature genetics, 2013-05, Vol.45 (5), p.531-536
    Description: Pathologic thrombosis is a major cause of mortality. Hemolytic-uremic syndrome (HUS) features episodes of small-vessel thrombosis resulting in microangiopathic hemolytic anemia, thrombocytopenia and renal failure. Atypical HUS (aHUS) can result from genetic or autoimmune factors that lead to pathologic complement cascade activation. Using exome sequencing, we identified recessive mutations in DGKE (encoding diacylglycerol kinase ɛ) that co-segregated with aHUS in nine unrelated kindreds, defining a distinctive Mendelian disease. Affected individuals present with aHUS before age 1 year, have persistent hypertension, hematuria and proteinuria (sometimes in the nephrotic range), and develop chronic kidney disease with age. DGKE is found in endothelium, platelets and podocytes. Arachidonic acid-containing diacylglycerols (DAG) activate protein kinase C (PKC), which promotes thrombosis, and DGKE normally inactivates DAG signaling. We infer that loss of DGKE function results in a prothrombotic state. These findings identify a new mechanism of pathologic thrombosis and kidney failure and have immediate implications for treating individuals with aHUS.
    Subject(s): Acute Kidney Injury - genetics ; Age ; Amino acids ; Atypical Hemolytic Uremic Syndrome ; Care and treatment ; Child ; Child, Preschool ; Confidence intervals ; Databases ; Diacylglycerol Kinase - genetics ; Exome - genetics ; Female ; Gene mutations ; Genealogy ; Genes, Recessive - genetics ; Genetic aspects ; Genetics ; Genomes ; Health aspects ; Hemolytic-uremic syndrome ; Hemolytic-Uremic Syndrome - etiology ; Hemolytic-Uremic Syndrome - pathology ; Humans ; Immunoenzyme Techniques ; Infant ; Life Sciences ; Male ; Molecular Sequence Data ; Mutation ; Mutation - genetics ; Pediatrics ; Proteins ; Renal Insufficiency, Chronic ; Research ; Risk factors ; Siblings ; Studies ; Thrombocytopenia - genetics ; Thrombotic Microangiopathies - genetics ; Von Willebrand factor
    ISSN: 1061-4036
    E-ISSN: 1546-1718
    Source: Academic Search Ultimate
    Source: Alma/SFX Local Collection
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  • 7
    Language: English
    In: Journal of the American College of Cardiology, 2010, Vol.55 (22), p.2470-2479
    Description: Objectives The aim of the study was to determine the prognostic significance and determinants of myocardial salvage assessed by cardiovascular magnetic resonance (CMR) in reperfused ST-segment elevation myocardial infarction. Background In acute myocardial infarction, CMR can retrospectively detect the myocardium at risk and the irreversible injury. This allows for quantifying the extent of salvaged myocardium after reperfusion as a potential strong end point for clinical trials and outcome. Methods We analyzed 208 consecutive ST-segment elevation myocardial infarction patients undergoing primary angioplasty 〈12 h after symptom onset. T2-weighted and contrast-enhanced CMR was used to calculate the myocardial salvage index (MSI). Patients were categorized into 2 groups defined by the median MSI. The primary end point of the study was occurrence of major adverse cardiovascular events defined as death, reinfarction, and occurrence of new congestive heart failure within 6 months after the index event. Results The median MSI was 48 (interquartile range 27 to 73). Major adverse cardiovascular events were significantly lower in the MSI ≥ median group (2.9% vs. 22.1%, p 〈 0.001). The stepwise Cox proportional hazards model revealed that the MSI was the strongest predictor of major adverse cardiovascular events at 6-month follow-up (p 〈 0.001). All prognostic clinical (symptom onset to reperfusion), angiographic (Thrombolysis In Myocardial Infarction flow grade before angioplasty), and electrocardiographic (ST-segment resolution) parameters showed significant correlations with the MSI (p 〈 0.001 for all). Conclusions This study for the first time demonstrates that the MSI assessed by CMR predicts the outcome in acute reperfused ST-segment elevation myocardial infarction. Therefore, MSI assessment has important implications for patient prognosis as well as for the design of future trials intended to test new reperfusion therapy efficacy. (Myocardial Salvage Assessed by Cardiovascular Magnetic Resonance—Impact on Outcome; NCT00952224 ).
    Subject(s): Abridged Index Medicus ; Aged ; Angioplasty ; Angioplasty, Balloon, Coronary - methods ; Angioplasty, Balloon, Coronary - mortality ; Biological and medical sciences ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; cardiovascular magnetic resonance ; Chi-Square Distribution ; Confidence intervals ; Coronary Angiography - methods ; Coronary heart disease ; Diabetes ; Diagnosis ; Electrocardiography ; Enzymes ; Female ; Follow-Up Studies ; Heart ; Heart attack ; Heart attacks ; Humans ; Hypertension ; Internal Medicine ; magnetic resonance imaging ; Magnetic Resonance Imaging, Cine - methods ; Male ; Medical sciences ; Middle Aged ; myocardial infarction ; Myocardial Infarction - diagnosis ; Myocardial Infarction - mortality ; Myocardial Infarction - therapy ; myocardial salvage ; Myocarditis. Cardiomyopathies ; Myocardium - pathology ; Probability ; prognosis ; Prospective Studies ; Regression analysis ; Risk Assessment ; Salvage ; Severity of Illness Index ; Statistics, Nonparametric ; Survival Analysis ; Time Factors ; Treatment Outcome
    ISSN: 0735-1097
    E-ISSN: 1558-3597
    Source: Alma/SFX Local Collection
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  • 8
    Language: English
    In: The New England journal of medicine, 2018-11-01, Vol.379 (18), p.1699-1710
    Description: In a randomized trial, 706 patients with acute myocardial infarction and cardiogenic shock were assigned to either culprit-lesion-only PCI or immediate multivessel PCI. At 1 year, mortality did not differ significantly between the two groups.
    Subject(s): Abridged Index Medicus ; Aged ; Analysis ; Cardiogenic shock ; Cardiovascular disease ; Care and treatment ; Congestive heart failure ; Coronary artery ; Coronary vessels ; Death ; Fees & charges ; Female ; Follow-Up Studies ; Heart ; Heart attacks ; Heart failure ; Heart Failure - epidemiology ; Heart Failure - etiology ; Human health and pathology ; Humans ; Information sharing ; Kaplan-Meier Estimate ; Kidneys ; Life Sciences ; Male ; Middle Aged ; Mortality ; Myocardial infarction ; Myocardial Infarction - complications ; Patient Readmission ; Patients ; Percutaneous Coronary Intervention - methods ; Recurrence ; Renal failure ; Renal Insufficiency - etiology ; Renal Insufficiency - therapy ; Renal Replacement Therapy ; Shock ; Shock, Cardiogenic - etiology ; Shock, Cardiogenic - mortality ; Shock, Cardiogenic - therapy ; Short term ; Stents ; Surgery ; Treatment outcome ; Usage
    ISSN: 0028-4793
    E-ISSN: 1533-4406
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
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  • 9
    Language: English
    In: Journal of the American College of Cardiology, 2016, Vol.69 (3), p.288-290
    Description: [Display omitted]
    Subject(s): Abridged Index Medicus ; cardiogenic shock ; Cardiovascular ; Electrocardiography ; Heart attacks ; Heart-Assist Devices ; Humans ; Hypotheses ; Impella ; Internal Medicine ; intra aortic balloon pump ; Intra-Aortic Balloon Pumping ; mechanical support ; Mortality ; Myocardial Infarction ; Patients ; Shock, Cardiogenic ; Ventilation
    ISSN: 0735-1097
    E-ISSN: 1558-3597
    Source: Alma/SFX Local Collection
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  • 10
    Language: English
    In: The New England journal of medicine, 2017-12-21, Vol.377 (25), p.2419-2432
    Description: Among patients who had multivessel coronary disease and acute myocardial infarction with cardiogenic shock, the 30-day risk of death or renal-replacement therapy was lower among those who underwent PCI of the culprit lesion only than among those who underwent multivessel PCI.
    Subject(s): Abridged Index Medicus ; Aged ; Analysis ; Angioplasty ; Bleeding ; Calcium-binding protein ; Cardiac patients ; Cardiogenic shock ; Cardiology ; Cardiovascular disease ; Care and treatment ; Catecholamines ; Cerebral infarction ; Clinical outcomes ; Coronary artery ; Coronary artery bypass ; Coronary Artery Disease - complications ; Coronary Artery Disease - therapy ; Coronary vessels ; Creatine ; Creatine kinase ; Death ; Electrocardiography ; Female ; Heart attack ; Heart attacks ; Heart diseases ; Human health and pathology ; Humans ; Kaplan-Meier Estimate ; Kidney transplantation ; Kidneys ; Life Sciences ; Male ; Middle Aged ; Myocardial infarction ; Myocardial Infarction - complications ; Myocardial Infarction - mortality ; Myocardial Infarction - therapy ; Percutaneous Coronary Intervention - methods ; Renal failure ; Renal Insufficiency - etiology ; Renal Insufficiency - therapy ; Renal Replacement Therapy ; Risk ; Shock ; Shock, Cardiogenic - etiology ; Shock, Cardiogenic - mortality ; Stents ; Stroke ; Time-to-Treatment ; Treatment outcome ; Troponin ; Troponin T ; Usage
    ISSN: 0028-4793
    E-ISSN: 1533-4406
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
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