Background Mechanical complications (MC) give a poor prognosis for ST elevation myocardial infarction (STEMI). Its prevalence had decreased in the era of primary angioplasty, at the expense of free wall rupture (FWR). Purpose To analyse the prevalence of post-STEMI MC for two periods, before and after the COVID-19 pandemic. Methods Unicentric prospective registration of patients with STEMI admitted between January-2018 and December-2021. They are classified into two groups according to the onset of the pandemic by COVID-19: Pre-COVID: January-2018 to December-2019, and Post-COVID: January-2020 to December-2021. The prevalence of post-STEMI MC is analysed, including ventricular septal rupture (VSR), papillary muscle rupture (PMR) and FWR, and 30-day mortality. Results 1507 consecutive patients with STEMI (Pre-COVID n=775, Post-COVID n=732) are included. Age 62.9 years vs 63.3 years (p=0.5097). Men 78.1% Vs 79.5% (p=0.493). No differences in cardiovascular risk factors, previous heart infarction or anterior wall STEMI. Primary angioplasty was similar in both groups (92%). The Post-COVID group has a higher prevalence of Killip>I (21.7% vs 17.2% p=0.025) and LVEF ≤40% (27.2% vs 20% p=0.001), and longer symptom onset to balloon dilatation interval (316 min vs 257 min p=0.0004). MC are most developed in Post-COVID (2.6% vs 1.2% p=0.039), at the expense of FWR (1.91% vs 0.3% p=0.001). No significant changes in VSR and PMR prevalence or 30-day mortality. Multivariate analysis identifies the independent predictors of FWR: Age (OR 1.05, p=0.024), Primary angioplasty (OR 0.09, p<0.001), and Post-COVID (OR 6.8, p=0.013). Conclusions The COVID-19 pandemic is independently associated with a higher prevalence of FWR, probably due to delayed reperfusion. Funding Acknowledgement Type of funding sources: None.
Funding Acknowledgements Type of funding sources: None. Background In VA-ECMO supported patients because of refractory cardiogenic shock (CS), there is a lack of evidence on what is the "optimal" ECMO flow. Purpose To describe the evolution of VA-ECMO flow in a CS population according to the degree of support and analyze the impact of early high-ECMO flows on short-term outcomes. Methods We performed a retrospective, single-center study including patients in refractory CS supported with peripheral VA-ECMO admitted at an University Hospital. Based on the median flow over the first 48 hours of ECMO run, patients were classified as "high-flow" or "low-flow" when median ECMO flow was ⋝ or < than 3.6 L/min, respectively. All statistical tests were two-sided, with a p value ≤ 0.05 considered significant. Results Two hundred and nine patients were included. Median age was 51 (40-59) years, 78% were males, and the median SAPS II was 51 (32 - 66). The most frequent etiology leading to CS was end-stage-dilated cardiomyopathy (57%). "High-flow" and "low-flow" groups each represented 50% of the study population, respectively (Figure 1). Median flows between both groups were continuously lower in "low-flow" patients at any time-point, with the "low-flow" group maintaining VA-ECMO flows around 3.0-3.1 L/min. The "high-flow" group had a higher frequency of ischemic etiology and was significantly sicker at admission. Almost 70% of the study population was managed with LV unloading. More than 40% of patients were managed with an awake strategy, with much higher rates of awake ECMO in the "low-flow" group (52% vs 30%, p<0.001). Patients with "high-flow" had 50% more VAP than "low-flow" patients and median days on mechanical ventilation were significantly less in the "low-flow" group (4 [1.5 - 7.5] vs 6 [3 - 12] days, p=0.009, respectively). No differences were either found in total days in ICU or days of hospitalization. Finally, global in-hospital mortality was 46%, with less but not statistically significant differences in the "low-flow" group (41% vs 51%, p=0.144, respectively). Mortality at 60-days were alike for both groups. Conclusions In patients with refractory CS supported with VA-ECMO, sicker patients were managed with higher degree of support from early phases. Patients with high flows presented with higher rates of VAP, but presented similar in-hospital and short-term survival compared to patients with lower flows. Future research is now warranted to address the specific, direct, impact of higher flows in lung injury or length of MV.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.