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Article ; Online: The Impact of Novel X-Ray Systems and X-Ray System Optimization on Patient Radiation Dose Administered During Cardiac Catheterization.

Vemmou, Evangelia / Nikolakopoulos, Ilias / Xenogiannis, Iosif / Megaly, Michael / Omer, Mohamed A / Stanberry, Larissa / Garberich, Ross / Rangan, Bavana V / Baran, Kenneth W / Gössl, Mario / Sorajja, Paul / Chavez, Ivan / Mooney, Michael / Traverse, Jay / Wang, Yale / Garcia, Santiago / Poulose, Anil / Burke, M Nicholas / Brilakis, Emmanouil S

The Journal of invasive cardiology

2020 Volume 32, Issue 6, Page(s) 218–221

Abstract: Introduction: The effect of x-ray system optimization on patient radiation dose has received limited study.: Methods: We analyzed patient radiation dose in 1786 cardiac catheterization procedures (diagnostic coronary angiography and/or percutaneous ... ...

Abstract	Introduction: The effect of x-ray system optimization on patient radiation dose has received limited study. Methods: We analyzed patient radiation dose in 1786 cardiac catheterization procedures (diagnostic coronary angiography and/or percutaneous coronary intervention [PCI]) performed at a single tertiary-care center before and after x-ray system optimization. Results: After optimization, cineangiography dose-area product (DAP) dose was lower in the overall group of patients who underwent diagnostic angiography and/or PCI (1347 μGy•m² [IQR, 645-2345 μGy•m²] vs 1658 μGy•m² [IQR, 640- 2757 μGy•m²]; P=.03), as well as in the diagnostic angiography group (1795 μGy•m² [IQR, 1140-2994 μGy•m²] vs 2356 μGy•m² [IQR, 311-3576 μGy•m²]; P<.01) and PCI group (2152 μGy•m² [IQR, 1338-3477 μGy•m²] vs 2562 μGy•m² [IQR, 1681-3859 μGy•m²]; P=.02). Cineangiography DAP per exposure was also lower in the overall group (143 μGy•m² [IQR, 91-212 μGy•m²] vs 164 μGy•m² [IQR, 106-233 μGy•m²] per exposure; P<.01) and in the diagnostic angiography group (158 μGy•m² [IQR, 102-225 μGy•m²] vs 184 μGy•m² [IQR, 125-271 μGy•m²] per exposure; P<.01). After optimization, cineangiography air kerma (AK) dose (319 mGy [IQR, 197-531 mGy] vs 421 mGy [IQR, 241-600 mGy]; P=.01) and cineangiography AK per exposure (20.7 mGy [IQR, 12.9-29.0 mGy] vs 23.6 mGy [IQR, 14.1-32.9 mGy] per exposure; P=.03) were also lower in the PCI group. There was no significant change in fluoroscopy AK dose after optimization (20.7 mGy [IQR, 12.7-30.1 mGy] vs 20.4 mGy [IQR, 12.8-31.3 mGy] per minute; P=.71) and fluoroscopy DAP dose (156 μGy•m² [IQR, 101-242 μGy•m²] vs 156 μGy•m² [IQR, 102-236 μGy•m²] per minute; P=.91). Conclusion: X-ray system optimization was associated with lower cineangiography DAP, but similar fluoroscopy radiation dose.
MeSH term(s)	Cardiac Catheterization ; Cineangiography ; Coronary Angiography ; Fluoroscopy ; Humans ; Percutaneous Coronary Intervention ; Radiation Dosage ; Radiation Exposure ; X-Rays
Language	English
Publishing date	2020-05-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	1154372-3
ISSN	1557-2501 ; 1042-3931
ISSN (online)	1557-2501
ISSN	1042-3931
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Article ; Online: Real-time decision support to guide percutaneous coronary intervention bleeding avoidance strategies effectively changes practice patterns.

Strauss, Craig E / Porten, Brandon R / Chavez, Ivan J / Garberich, Ross F / Chambers, Jeffrey W / Baran, Kenneth W / Poulose, Anil K / Henry, Timothy D

Circulation. Cardiovascular quality and outcomes

2014 Volume 7, Issue 6, Page(s) 960–967

MeSH term(s)	Blood Loss, Surgical/prevention & control ; Coronary Artery Disease/surgery ; Decision Support Systems, Clinical ; Humans ; Percutaneous Coronary Intervention/standards ; Practice Guidelines as Topic ; Program Evaluation
Language	English
Publishing date	2014-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2483197-9
ISSN	1941-7705 ; 1941-7713
ISSN (online)	1941-7705
ISSN	1941-7713
DOI	10.1161/CIRCOUTCOMES.114.001275
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Article ; Online: A clinical risk score for the prediction of very late stent thrombosis in drug eluting stent patients.

Baran, Kenneth W / Lasala, John M / Cox, David A / Mascioli, Stephen R / Song, Aijun / Deshpande, Mahesh C / Jacoski, Mary V / Dawkins, Keith D

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

2011 Volume 6, Issue 8, Page(s) 949–954

Abstract: Aims: Very late stent thrombosis (VLST; >1 year) is an infrequent but potentially serious complication, whose risk factors have not been fully elucidated. This investigation sought to develop a clinically useful risk stratification score for VLST ... ...

Abstract	Aims: Very late stent thrombosis (VLST; >1 year) is an infrequent but potentially serious complication, whose risk factors have not been fully elucidated. This investigation sought to develop a clinically useful risk stratification score for VLST following drug eluting stent (DES) placement. Methods and results: A Cox proportional hazards multivariate model of VLST was developed based on follow-up into a second year of patients enrolled in the ARRIVE registries, utilising readily available baseline clinical and angiographic characteristics. ST predictors between one and two years were identified among 7,459 consecutively enrolled patients who received a TAXUS® Express2™ (Boston Scientific, Natick, MA, USA) DES. Six significant predictors were found: presence of renal disease, prior myocardial infarction, multiple stenting, bifurcation lesions, prior CABG, and smoking at baseline. Each predictor was assigned a score, then summed for a maximum possible score of 10. Stratification into low and high risk groups revealed that VLST developed in 0.5% of 6,759 patients with scores<5, and 2.6% of 700 patients with scores≥5. Conclusions: We defined a VLST risk score for patients during the second year post DES-placement that provides a useful tool for risk stratification.
MeSH term(s)	Angioplasty, Balloon, Coronary/adverse effects ; Angioplasty, Balloon, Coronary/statistics & numerical data ; Coronary Artery Disease/epidemiology ; Coronary Thrombosis/diagnosis ; Coronary Thrombosis/epidemiology ; Drug-Eluting Stents/adverse effects ; Drug-Eluting Stents/statistics & numerical data ; Follow-Up Studies ; Humans ; Predictive Value of Tests ; Proportional Hazards Models ; ROC Curve ; Registries/statistics & numerical data ; Risk Assessment ; Risk Factors
Language	English
Publishing date	2011-03
Publishing country	France
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2457174-X
ISSN	1969-6213 ; 1774-024X
ISSN (online)	1969-6213
ISSN	1774-024X
DOI	10.4244/EIJV6I8A165
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Zs.A 6680: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: TIME Trial: Effect of Timing of Stem Cell Delivery Following ST-Elevation Myocardial Infarction on the Recovery of Global and Regional Left Ventricular Function: Final 2-Year Analysis.

Circulation research

2017 Volume 122, Issue 3, Page(s) 479–488

Abstract: Rationale: The TIME trial (Timing in Myocardial Infarction Evaluation) was the first cell therapy trial sufficiently powered to determine if timing of cell delivery after ST-segment-elevation myocardial infarction affects recovery of left ventricular ( ... ...

Abstract	Rationale: The TIME trial (Timing in Myocardial Infarction Evaluation) was the first cell therapy trial sufficiently powered to determine if timing of cell delivery after ST-segment-elevation myocardial infarction affects recovery of left ventricular (LV) function. Objective: To report the 2-year clinical and cardiac magnetic resonance imaging results and their modification by microvascular obstruction. Methods and results: TIME was a randomized, double-blind, placebo-controlled trial comparing 150 million bone marrow mononuclear cells versus placebo in 120 patients with anterior ST-segment-elevation myocardial infarctions resulting in LV dysfunction. Primary end points included changes in global (LV ejection fraction) and regional (infarct and border zone) function. Secondary end points included changes in LV volumes, infarct size, and major adverse cardiac events. Here, we analyzed the continued trajectory of these measures out to 2 years and the influence of microvascular obstruction present at baseline on these long-term outcomes. At 2 years (n=85), LV ejection fraction was similar in the bone marrow mononuclear cells (48.7%) and placebo groups (51.6%) with no difference in regional LV function. Infarct size and LV mass decreased ≥30% in each group at 6 months and declined gradually to 2 years. LV volumes increased ≈10% at 6 months and remained stable to 2 years. Microvascular obstruction was present in 48 patients at baseline and was associated with significantly larger infarct size (56.5 versus 36.2 g), greater adverse LV remodeling, and marked reduction in LV ejection fraction recovery (0.2% versus 6.2%). Conclusions: In one of the longest serial cardiac magnetic resonance imaging analyses of patients with large anterior ST-segment-elevation myocardial infarctions, bone marrow mononuclear cells administration did not improve recovery of LV function over 2 years. Microvascular obstruction was associated with reduced recovery of LV function, greater adverse LV remodeling, and more device implantations. The use of cardiac magnetic resonance imaging leads to greater dropout of patients over time because of device implantation in patients with more severe LV dysfunction resulting in overestimation of clinical stability of the cohort. Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00684021.
MeSH term(s)	Adult ; Aged ; Bone Marrow Transplantation/methods ; Double-Blind Method ; Female ; Follow-Up Studies ; Heart Ventricles/pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Microcirculation ; Middle Aged ; Organ Size ; ST Elevation Myocardial Infarction/complications ; ST Elevation Myocardial Infarction/pathology ; ST Elevation Myocardial Infarction/therapy ; Stroke Volume ; Time Factors ; Ventricular Dysfunction, Left/etiology ; Ventricular Dysfunction, Left/therapy
Language	English
Publishing date	2017-12-05
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	80100-8
ISSN	1524-4571 ; 0009-7330 ; 0931-6876
ISSN (online)	1524-4571
ISSN	0009-7330 ; 0931-6876
DOI	10.1161/CIRCRESAHA.117.311466
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Article: A clinical risk score for prediction of stent thrombosis.

Baran, Kenneth W / Lasala, John M / Cox, David A / Song, Aijun / Deshpande, Mahesh C / Jacoski, Mary V / Mascioli, Stephen R

The American journal of cardiology

2008 Volume 102, Issue 5, Page(s) 541–545

Abstract: The aim was to develop a clinically useful patient risk score predictive for stent thrombosis (ST). Using readily available baseline clinical and angiographic characteristics, a Cox proportional hazards multivariate model was used to identify significant ...

Abstract	The aim was to develop a clinically useful patient risk score predictive for stent thrombosis (ST). Using readily available baseline clinical and angiographic characteristics, a Cox proportional hazards multivariate model was used to identify significant (p <0.10) predictors of ST through 1 year in 2,487 patients receiving a TAXUS Express (Boston Scientific Corp., Natick, Massachusetts) drug-eluting stent (DES) in the ARRIVE 1 registry. Hazard ratios of significant predictors were rounded to an integer value ranging from 2 to 5. These values were summed for a maximum possible score of 24. The model was validated using 1-year data from a similar DES data set (ARRIVE 2, n = 4,820 patients). The 8 significant predictors found were thienopyridine therapy discontinuation before 6 months, insulin-requiring diabetes, smoker at baseline, left main stent placement, multiple stent placement, lesion length >28 mm, moderate to severe lesion calcification, and reference vessel diameter <3 mm. Model discrimination was high, indicated by an area under the receiver-operator characteristic curve of 0.819. Stratification of patients into low-, medium-, and high-risk groups showed that ST developed in 0.8% of patients with a score <6, 3.6% of patients with a score of 7 to 13, and 12.6% of patients with a score >or=14. In conclusion, using 8 readily available clinical and angiographic characteristics, we defined an ST risk score for patients receiving a DES during the first year. Analysis of patients from ARRIVE 1 and 2 showed that most (73%) were in the lowest risk category, with 25% in the moderate risk category. Less than 2% were at highest risk of developing ST.
MeSH term(s)	Blood Vessel Prosthesis ; Coated Materials, Biocompatible ; Coronary Angiography ; Coronary Restenosis/diagnostic imaging ; Coronary Restenosis/epidemiology ; Follow-Up Studies ; Graft Occlusion, Vascular/diagnostic imaging ; Graft Occlusion, Vascular/epidemiology ; Humans ; Incidence ; Male ; Middle Aged ; Prosthesis Failure ; ROC Curve ; Risk Factors ; Severity of Illness Index ; Stents ; United States/epidemiology
Chemical Substances	Coated Materials, Biocompatible
Language	English
Publishing date	2008-09-01
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2008.04.068
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Article ; Online: Very rapid treatment of ST-segment-elevation myocardial infarction: utilizing prehospital electrocardiograms to bypass the emergency department.

Baran, Kenneth W / Kamrowski, Kathryn A / Westwater, Jay J / Tschida, Victor H / Alexander, Charles F / Beahrs, Margaret M / Biggs, Thomas A / Koller, Patrick T / Mahoney, Brian D / Murray, Sara T / Raya, Thomas E / Rusterholz, Peter K / Valeti, Uma S / Wiberg, Thomas A

Circulation. Cardiovascular quality and outcomes

2010 Volume 3, Issue 4, Page(s) 431–437

MeSH term(s)	American Heart Association ; Angioplasty ; Brugada Syndrome ; Competency-Based Education ; Emergency Medical Services/methods ; Emergency Medical Services/trends ; Guideline Adherence ; Health Personnel ; Humans ; Myocardial Infarction/diagnosis ; Myocardial Infarction/mortality ; Myocardial Infarction/physiopathology ; Myocardial Infarction/surgery ; Patient Transfer ; Physician's Role ; Practice Guidelines as Topic ; Program Evaluation ; Survival Analysis ; United States
Language	English
Publishing date	2010-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2483197-9
ISSN	1941-7705 ; 1941-7713
ISSN (online)	1941-7705
ISSN	1941-7713
DOI	10.1161/CIRCOUTCOMES.110.942631
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Article ; Online: Randomized Comparison of a CrossBoss First Versus Standard Wire Escalation Strategy for Crossing Coronary Chronic Total Occlusions: The CrossBoss First Trial.

Karacsonyi, Judit / Tajti, Peter / Rangan, Bavana V / Halligan, Sean C / Allen, Raymond H / Nicholson, William J / Harvey, James E / Spaedy, Anthony J / Jaffer, Farouc A / Grantham, J Aaron / Salisbury, Adam / Hart, Anthony J / Safley, David M / Lombardi, William L / Hira, Ravi / Don, Creighton / McCabe, James M / Burke, M Nicholas / Alaswad, Khaldoon /

Koenig, Gerald C / Sanghvi, Kintur A / Ice, Daniel / Kovach, Richard C / Varghese, Vincent / Murad, Bilal / Baran, Kenneth W / Resendes, Erica / Martinez-Parachini, Jose R / Karatasakis, Aris / Danek, Barbara A / Iwnetu, Rahel / Roesle, Michele / Khalili, Houman / Banerjee, Subhash / Brilakis, Emmanouil S

JACC. Cardiovascular interventions

2018 Volume 11, Issue 3, Page(s) 225–233

Abstract: Objectives: The authors performed a multicenter, randomized-controlled, clinical trial comparing upfront use of the CrossBoss catheter versus antegrade wire escalation for antegrade crossing of coronary chronic total occlusions.: Background: There is ...

Abstract	Objectives: The authors performed a multicenter, randomized-controlled, clinical trial comparing upfront use of the CrossBoss catheter versus antegrade wire escalation for antegrade crossing of coronary chronic total occlusions. Background: There is equipoise about the optimal initial strategy for crossing coronary chronic total occlusions. Methods: The primary endpoints were the time required to cross the chronic total occlusion or abort the procedure and the frequency of procedural major adverse cardiovascular events. The secondary endpoints were technical and procedural success, total procedure time, fluoroscopy time required to cross and total fluoroscopy time, total air kerma radiation dose, total contrast volume, and equipment use. Results: Between 2015 and 2017, 246 patients were randomized to the CrossBoss catheter (n = 122) or wire escalation (n = 124) at 11 U.S. centers. The baseline clinical and angiographic characteristics of the study groups were similar. Technical and procedural success were 87.8% and 84.1%, respectively, and were similar in the 2 groups. Crossing time was similar: 56 min (interquartile range: 33 to 93 min) in the CrossBoss group and 66 min (interquartile range: 36 to 105 min) in the wire escalation group (p = 0.323), as was as the incidence of procedural major adverse cardiovascular events (3.28% vs. 4.03%; p = 1.000). There were no significant differences in the secondary study endpoints. Conclusions: As compared with wire escalation, upfront use of the CrossBoss catheter for antegrade crossing of coronary chronic total occlusions was associated with similar crossing time, similar success and complication rates, and similar equipment use and cost.
MeSH term(s)	Aged ; Cardiac Catheterization/adverse effects ; Cardiac Catheterization/economics ; Cardiac Catheterization/instrumentation ; Cardiac Catheterization/methods ; Cardiac Catheters ; Chronic Disease ; Coronary Angiography ; Coronary Occlusion/diagnostic imaging ; Coronary Occlusion/economics ; Coronary Occlusion/physiopathology ; Coronary Occlusion/surgery ; Female ; Hospital Costs ; Humans ; Male ; Middle Aged ; Operative Time ; Percutaneous Coronary Intervention/adverse effects ; Percutaneous Coronary Intervention/economics ; Percutaneous Coronary Intervention/instrumentation ; Percutaneous Coronary Intervention/methods ; Postoperative Complications/etiology ; Risk Factors ; Time Factors ; Treatment Outcome ; United States
Language	English
Publishing date	2018-02-07
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2452157-7
ISSN	1876-7605 ; 1936-8798
ISSN (online)	1876-7605
ISSN	1936-8798
DOI	10.1016/j.jcin.2017.10.023
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Zs.A 6669: Show issues

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Article ; Online: Cell therapy and satellite centers: the Cardiovascular Cell Therapy Research Network experience.

Contemporary clinical trials

2011 Volume 32, Issue 6, Page(s) 841–847

Abstract: Due to the changing population in patients with myocardial infarction, recruiting patients in clinical trials continues to challenge clinical investigators. The Cardiovascular Cell Therapy Research Network (CCTRN) chose to expand the reach and power of ... ...

Abstract	Due to the changing population in patients with myocardial infarction, recruiting patients in clinical trials continues to challenge clinical investigators. The Cardiovascular Cell Therapy Research Network (CCTRN) chose to expand the reach and power of its recruitment effort by incorporating both referral and treatment satellite centers. Eight treatment satellites were successfully identified and they screened patients over a two year period. The result of this effort was an increase in recruitment, with these treatment satellites contributing 30% of the patients to two of the three Network studies. The hurdles that these satellite treatment centers faced and how they surmounted them provide instruction to clinical research groups eager to expand to satellite systems and to health care practitioners who are interested in taking part in multicenter clinical trials.
MeSH term(s)	Biomedical Research/methods ; Cardiovascular Diseases/therapy ; Cell- and Tissue-Based Therapy/methods ; Community Health Centers ; Humans ; Treatment Outcome
Language	English
Publishing date	2011-07-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2182176-8
ISSN	1559-2030 ; 1551-7144
ISSN (online)	1559-2030
ISSN	1551-7144
DOI	10.1016/j.cct.2011.07.001
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Article ; Online: Association of the timing of ST-segment resolution with TIMI myocardial perfusion grade in acute myocardial infarction.

Gibson, C Michael / Karha, Juhana / Giugliano, Robert P / Roe, Mathew T / Murphy, Sabina A / Harrington, Robert A / Green, Cindy L / Schweiger, Marc J / Miklin, Jerry S / Baran, Kenneth W / Palmeri, Sebastian / Braunwald, Eugene / Krucoff, Mitchell W

American heart journal

2004 Volume 147, Issue 5, Page(s) 847–852

Abstract: Background: More complete ST-segment resolution (ST res) in acute myocardial infarction (MI) has been associated with better epicardial and myocardial reperfusion as assessed with the Thrombolysis in Myocardial Infarction (TIMI) flow grade (TFG) and the ...

Abstract	Background: More complete ST-segment resolution (ST res) in acute myocardial infarction (MI) has been associated with better epicardial and myocardial reperfusion as assessed with the Thrombolysis in Myocardial Infarction (TIMI) flow grade (TFG) and the TIMI myocardial perfusion grade (TMPG), respectively. However, no data exist comparing the speed of ST resolution on continuous electrocardiogram (ECG) monitoring with the TMPG on coronary angiography. We hypothesized that delayed ST res is associated with impaired TMPGs. Methods: Continuous 12-lead ECG recordings and 60-minute angiographic data were analyzed in 120 patients with acute MI who received tenectaplase monotherapy or combination therapy with low-dose tenectaplase and eptifibatide in the Integrilin and Tenecteplase in Acute Myocardial Infarction (INTEGRITI) trial. Results: More rapid ST res on continuous ECG monitoring was associated with improved TMPGs on coronary angiography performed 60 minutes after study drug administration. For TMPG 3, the median time to ST resolution was 53 minutes. For TMPG 2, 1, and 0, the corresponding times were 64 minutes, 80 minutes, and 106 minutes, respectively (P =.01 for trend). Likewise, more rapid ST res was also associated with faster epicardial flow. For TFG 3, the median time to ST resolution was 46 minutes, compared with 109 minutes for TIMI flow grades 0 to 2 (P =.001). The corresponding times for a corrected TIMI frame count < or =40 versus >40 were 52 minutes and 112 minutes, respectively (P <.001). Conclusions: Although the static ECG has been associated with epicardial and myocardial blood flow in the past, this study extends these observations to demonstrate that more rapid ST res on continuous ECG monitoring is associated with improved myocardial perfusion after thrombolytic administration.
MeSH term(s)	Aged ; Clinical Trials, Phase II as Topic ; Coronary Angiography ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnostic imaging ; Myocardial Infarction/drug therapy ; Myocardial Infarction/physiopathology ; Myocardial Reperfusion ; Peptides/therapeutic use ; Platelet Aggregation Inhibitors/therapeutic use ; Randomized Controlled Trials as Topic ; Regression Analysis ; Retrospective Studies ; Statistics, Nonparametric ; Time Factors ; Tissue Plasminogen Activator/therapeutic use
Chemical Substances	Peptides ; Platelet Aggregation Inhibitors ; Tissue Plasminogen Activator (EC 3.4.21.68) ; eptifibatide (NA8320J834) ; tenecteplase (WGD229O42W)
Language	English
Publishing date	2004-05
Publishing country	United States
Document type	Clinical Trial ; Controlled Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2003.11.015
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Article ; Online: Electrocardiographic findings in cardiogenic shock, risk prediction, and the effects of emergency revascularization: results from the SHOCK trial.

White, Harvey D / Palmeri, Sebastian T / Sleeper, Lynn A / French, John K / Wong, Cheuk-Kit / Lowe, April M / Crapo, Julia W / Koller, Patrick T / Baran, Kenneth W / Boland, Jean L / Hochman, Judith S / Wagner, Galen S

American heart journal

2004 Volume 148, Issue 5, Page(s) 810–817

Abstract: Objectives: To evaluate electrocardiographic (ECG) parameters as predictors of 1-year mortality in patients developing cardiogenic shock after acute myocardial infarction (AMI), and to document associations between these ECG parameters and the survival ... ...

Abstract	Objectives: To evaluate electrocardiographic (ECG) parameters as predictors of 1-year mortality in patients developing cardiogenic shock after acute myocardial infarction (AMI), and to document associations between these ECG parameters and the survival benefit of emergency revascularization versus initial medical stabilization. Background: Emergency revascularization reduces the risk of mortality in patients developing cardiogenic shock after AMI. The prognostic value of ECG parameters in such patients is unclear, and it is uncertain whether emergency revascularization reduces the mortality risk denoted by ECG parameters. Methods: In a prospective substudy of 198 SHOCK (SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK) trial patients, ECGs recorded within 12 hours of shock were interpreted by personnel blinded to the patients' treatment assignment and outcome. Results: The baseline heart rate was higher in non-survivors than in survivors (106 +/- 20 versus 95 +/- 24 beats/minute, P = .001). There was a significant association between the QRS duration and 1-year mortality in medically stabilized patients (115 +/- 28 ms in non-survivors versus 99 +/- 23 ms in survivors, P = .012), but not in emergently revascularized patients (110 +/- 31 versus 116 +/- 27 ms respectively, P = .343). The interaction between the QRS duration, mortality and treatment assignment was significant (P = .009). Among patients with inferior AMI, a greater sum of ST depression was associated with higher 1-year mortality in medically stabilized patients (P = .029), but not in emergently revascularized patients (P = .613, treatment interaction P = .025). On multivariate analysis, the independent mortality predictors were increasing age, elevated pulmonary capillary wedge pressure, heart rate, sum of ST depression in medically stabilized patients, and interaction (P = .016) between a prolonged QRS duration and treatment assignment. The adjusted hazard ratio for 1-year mortality per 20 ms increase in the QRS duration was 1.19 (95% CI 0.98-1.46) in medically stabilized patients and 0.81 (95% CI 0.63-1.03) in emergently revascularized patients. Conclusion: ECG parameters identified patients with cardiogenic shock who were at high risk. Emergency revascularization eliminated the incremental mortality risk associated with cardiogenic shock in patients with a prolonged QRS duration, or inferior AMI accompanied by precordial ST depression. Prospective assessments of the magnitude of the treatment effect based on ECG parameters are required.
MeSH term(s)	Aged ; Electrocardiography ; Emergency Treatment ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/complications ; Myocardial Infarction/diagnosis ; Myocardial Infarction/mortality ; Myocardial Infarction/therapy ; Myocardial Revascularization ; Prognosis ; Prospective Studies ; Risk Factors ; Shock, Cardiogenic/etiology ; Shock, Cardiogenic/mortality ; Shock, Cardiogenic/physiopathology ; Survival Analysis
Language	English
Publishing date	2004-11
Publishing country	United States
Document type	Clinical Trial ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2004.05.012
Database	MEDical Literature Analysis and Retrieval System OnLINE

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