查看更多>>摘要：? 2022Background: Risk-stratifying patients with cardiogenic shock (CS) is a major unmet need。 The recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) staging system for CS severity lacks uniform criteria defining each stage。 Objectives: The purpose of this study was to test parameters that define SCAI stages and explore their utility as predictors of in-hospital mortality in CS。 Methods: The CS Working Group registry includes patients from 17 hospitals enrolled between 2016 and 2021 and was used to define clinical profiles for CS。 We selected parameters of hypotension and hypoperfusion and treatment intensity， confirmed their association with mortality， then defined formal criteria for each stage and tested the association between both baseline and maximum Stage and mortality。 Results: Of 3，455 patients， CS was caused by heart failure (52%) or myocardial infarction (32%)。 Mortality was 35% for the total cohort and higher among patients with myocardial infarction， out-of-hospital cardiac arrest， and treatment with increasing numbers of drugs and devices。 Systolic blood pressure， lactate level， alanine transaminase level， and systemic pH were significantly associated with mortality and used to define each stage。 Using these criteria， baseline and maximum stages were significantly associated with mortality (n = 1，890)。 Lower baseline stage was associated with a higher incidence of stage escalation and a shorter duration of time to reach maximum stage。 Conclusions: We report a novel approach to define SCAI stages and identify a significant association between baseline and maximum stage and mortality。 This approach may improve clinical application of the staging system and provides new insight into the trajectory of hospitalized CS patients。 (Cardiogenic Shock Working Group Registry [CSWG]; NCT04682483)
查看更多>>摘要：? 2022Background: The utility of performing early myocardial revascularization among patients presenting with inducible myocardial ischemia and low left ventricular ejection fraction (LVEF) is currently unknown。 Objectives: In this study， we sought to assess the relationship between stress-induced myocardial ischemia， revascularization， and all-cause mortality (ACM) among patients with normal vs low LVEF。 Methods: We evaluated 43，443 patients undergoing stress-rest single-photon emission computed tomography myocardial perfusion imaging from 1998 to 2017。 Median follow-up was 11。4 years。 Myocardial ischemia was assessed for its interaction between early revascularization and mortality。 A propensity score was used to adjust for nonrandomization to revascularization， followed by multivariable Cox modeling adjusted for the propensity score and clinical variables to predict ACM。 Results: The frequency of myocardial ischemia varied markedly according to LVEF and angina， ranging from 6。7% among patients with LVEF ≥55% and no typical angina to 64。0% among patients with LVEF <45% and typical angina (P < 0。001)。 Among 39，883 patients with LVEF ≥45%， early revascularization was associated with increased mortality risk among patients without ischemia and lower mortality risk among patients with severe (≥15%) ischemia (HR: 0。70; 95% CI: 0。52-0。95)。 Among 3，560 patients with LVEF <45%， revascularization was not associated with mortality benefit among patients with no or mild ischemia， and was associated with decreased mortality among patients with moderate (10%-14%) (HR: 0。67; 95% CI: 0。49-0。91) and severe (≥15%) (HR: 0。55; 95% CI: 0。38-0。80) ischemia。 Conclusions: Within this cohort， early myocardial revascularization was associated with a significant reduction in mortality among both patients with normal LVEF and severe inducible myocardial ischemia and patients with low LVEF and moderate or severe inducible myocardial ischemia。
查看更多>>摘要：? 2022 American College of Cardiology FoundationBackground: Non-Hispanic Black persons are at greater risk of cardiovascular (CV) events than other racial/ethnic groups; however， their differential vulnerability to early subclinical atherosclerosis is poorly understood。 Objectives: This work aims to study the impact of race/ethnicity on early subclinical atherosclerosis in young socioeconomically disadvantaged adults。 Methods: Bilateral carotid and femoral 3-dimensional vascular ultrasound examinations were performed on 436 adults (parents/caregivers and staff) with a mean age of 38。0 ± 11。1 years， 82。3% female， 66% self-reported as Hispanic， 34% self-reported as non-Hispanic Black， and no history of CV disease recruited in the FAMILIA (Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health) trial from 15 Head Start preschools in Harlem (neighborhood in New York， New York， USA)。 The 10-year Framingham CV risk score was calculated， and the relationship between race/ethnicity and the presence and extent of subclinical atherosclerosis was analyzed with multivariable logistic and linear regression models。 Results: The mean 10-year Framingham CV risk was 4。0%， with no differences by racial/ethnic category。 The overall prevalence of subclinical atherosclerosis was significantly higher in the non-Hispanic Black (12。9%) than in the Hispanic subpopulation (6。6%)。 After adjusting for 10-year Framingham CV risk score， body mass index， fruit and vegetable consumption， physical activity， and employment status， non-Hispanic Black individuals were more likely than Hispanic individuals to have subclinical atherosclerosis (OR: 3。45; 95% CI: 1。44-8。29; P = 0。006) and multiterritorial disease (P = 0。026)。 Conclusions: After adjustment for classic CV risk， lifestyle， and socioeconomic factors， non-Hispanic Black younger adults seem more vulnerable to early subclinical atherosclerosis than their Hispanic peers， suggesting that the existence of emerging or undiscovered CV factors underlying the residual excess risk (Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health [FAMILIA (Project 2)]; NCT02481401)
查看更多>>摘要：? 2022 American College of Cardiology FoundationBackground: Persistent systemic thromboxane generation， predominantly from nonplatelet sources， in aspirin (ASA) users with cardiovascular disease (CVD) is a mortality risk factor。 Objectives: This study sought to determine the mortality risk associated with systemic thromboxane generation in an unselected population irrespective of ASA use。 Methods: Stable thromboxane B2 metabolites (TXB2-M) were measured by enzyme-linked immunosorbent assay in banked urine from 3，044 participants (mean age 66 ± 9 years， 53。8% women) in the Framingham Heart Study。 The association of TXB2-M to survival over a median observation period of 11。9 years (IQR: 10。6-12。7 years) was determined by multivariable modeling。 Results: In 1，363 (44。8%) participants taking ASA at the index examination， median TXB2-M were lower than in ASA nonusers (1，147 pg/mg creatinine vs 4，179 pg/mg creatinine; P < 0。0001)。 TXB2-M were significantly associated with all-cause and cardiovascular mortality irrespective of ASA use (HR: 1。96 and 2。41， respectively; P < 0。0001 for both) for TXB2-M in the highest quartile based on ASA use compared with lower quartiles， and remained significant after adjustment for mortality risk factors for similarly aged individuals (HR: 1。49 and 1。82， respectively; P ≤ 0。005 for both)。 In 2，353 participants without CVD， TXB2-M were associated with cardiovascular mortality in ASA nonusers (adjusted HR: 3。04; 95% CI: 1。29-7。16) but not in ASA users， while ASA use was associated with all-cause mortality in those with low (adjusted HR: 1。46; 95% CI: 1。14-1。87) but not elevated TXB2-M。 Conclusions: Systemic thromboxane generation is an independent risk factor for all-cause and cardiovascular mortality irrespective of ASA use， and its measurement may be useful for therapy modification， particularly in those without CVD。
查看更多>>摘要：? 2022 American College of Cardiology FoundationThe WHI (Women's Health Initiative) enrolled 161，808 racially and ethnically diverse postmenopausal women， ages 50-79 years， from 1993 to 1998 at 40 clinical centers across the United States。 In its clinical trial component， WHI evaluated 3 randomized interventions (menopausal hormone therapy; diet modification; and calcium/vitamin D supplementation) for the primary prevention of major chronic diseases， including cardiovascular disease， in older women。 In the WHI observational study， numerous clinical， behavioral， and social factors have been evaluated as predictors of incident chronic disease and mortality。 Although the original interventions have been completed， the WHI data and biomarker resources continue to be leveraged and expanded through ancillary studies to yield novel insights regarding cardiovascular disease prevention and healthy aging in women。
NSTL
Elsevier