Impact of intra-aortic balloon pump on short-term clinical outcomes in ST-elevation myocardial infarction complicated by cardiogenic shock: A ‘real life’ single center experience / Impacto del balón de contrapulsación intraaórtico en el pronóstico clínico a corto plazo de pacientes con infarto agudo de miocardio con elevación del segmento ST complicado con shock cardiogénico: experiencia de «vida real»

OBJECTIVE: To analyze the use and impact of the intra-aortic balloon pump (IABP) upon the 30-day mortality rate and short-term clinical outcome of non-selected patients with ST-elevation acute myocardial infarction (acute STEMI) complicated by cardiogenic shock (CS). DESIGN: A single-center retrospective case-control study was carried out. SETTING: Coronary Care Unit. PATIENTS: Data were collected from 825 consecutive patients with acute STEMI admitted to a Coronary Care Unit from January 2009 to August 2015. Seventy-three patients with CS upon admission subjected to emergency percutaneous coronary intervention (PCI) were finally included in the analysis and were stratified according to IABP use (44 patients receiving IABP). VARIABLES: Cardiovascular history, hemodynamic situation upon admission, angiographic and procedural characteristics, and variables derived from admission to the Coronary Care Unit. RESULTS: Cumulative 30-day mortality was similar in the patients subjected to IABP and in those who received conventional medical therapy only (29.5% and 27.6%, respectively; HR with IABP 1.10, 95% CI 0.38-3.11; p = 0.85). Similarly, no significant differences were found in terms of the short-term clinical outcome between the groups: time on mechanical ventilation, days to hemodynamic stabilization, vasoactive drug requirements and stay in the Coronary Care Unit. Poorer renal function (HR 3.9, 95% CI 1.4-10.6; p = 0.008), known peripheral artery disease (HR 3.3, 95% CI 1.2-9.1; p = 0.019) and a history of diabetes mellitus (HR 3.2, 95% CI 1.2-8.1; p = 0.018) were the only variables independently associated to increased 30-day mortality. CONCLUSION: In our 'real life' experience, IABP does not modify 30-day mortality or the short-term clinical outcome in patients presenting STEMI complicated with CS and subjected to emergency percutaneous coronary revascularization

OBJETIVO: Analizar el uso e impacto del balón de contrapulsación intraaórtico (BCIA) en la mortalidad a 30 días y en los desenlaces clínicos a corto plazo de pacientes con infarto agudo de miocardio con elevación del segmento ST complicado con shock cardiogénico. DISEÑO: Estudio de casos y controles unicéntrico y retrospectivo. Ámbito: Unidad Coronaria. PACIENTES: Los datos fueron obtenidos de 825 pacientes consecutivos admitidos en una unidad coronaria con diagnóstico de infarto agudo de miocardio con elevación del segmento ST desde enero de 2009 hasta agosto de 2015. Un total de 73 pacientes en situación de shock cardiogénico al ingreso derivados a una revascularización coronaria percutánea urgente fueron incluidos para el análisis y estratificados en función de la utilización del BCIA (44 pacientes recibieron BCIA). VARIABLES: Antecedentes cardiológicos, situación hemodinámica al ingreso, características angiográficas y periprocedimiento, y variables derivadas de la estancia en la Unidad Coronaria. RESULTADOS: La mortalidad a 30 días fue similar entre los tratados con BCIA y aquellos con tratamiento convencional (29,5 y 27,6%, respectivamente; HR con BCIA 1,10, IC 95% 0,38-3,11; p = 0,85). Así mismo, no encontramos diferencias significativas con respecto a los desenlaces clínicos a corto plazo: días en ventilación mecánica, tiempo hasta la estabilidad hemodinámica, requerimiento de fármacos vasoactivos y días de estancia en la Unidad Coronaria. En el análisis multivariante, las únicas variables asociadas de forma independiente con una mayor mortalidad a 30 días fueron peor función renal al ingreso (HR 3,9, IC 95% 1,4-10,6; p = 0,008), antecedentes de enfermedad arterial periférica (HR 3,3, IC 95% 1,2-9,1; p = 0,019) y diabetes mellitus (HR 3,2, IC 95% 1,2-8,1; p = 0,018). CONCLUSIÓN: En nuestra experiencia de la «vida real», la utilización del BCIA no modifica la mortalidad a 30 días ni los desenlaces clínicos a corto plazo en pacientes con infarto agudo de miocardio con elevación del segmento ST complicado con shock cardiogénico que son derivados a una estrategia de revascularización coronaria percutánea urgente

Impact of intra-aortic balloon pump on short-term clinical outcomes in ST-elevation myocardial infarction complicated by cardiogenic shock: A "real life" single center experience.

OBJECTIVE: To analyze the use and impact of the intra-aortic balloon pump (IABP) upon the 30-day mortality rate and short-term clinical outcome of non-selected patients with ST-elevation acute myocardial infarction (acute STEMI) complicated by cardiogenic shock (CS). DESIGN: A single-center retrospective case-control study was carried out. SETTING: Coronary Care Unit. PATIENTS: Data were collected from 825 consecutive patients with acute STEMI admitted to a Coronary Care Unit from January 2009 to August 2015. Seventy-three patients with CS upon admission subjected to emergency percutaneous coronary intervention (PCI) were finally included in the analysis and were stratified according to IABP use (44 patients receiving IABP). VARIABLES: Cardiovascular history, hemodynamic situation upon admission, angiographic and procedural characteristics, and variables derived from admission to the Coronary Care Unit. RESULTS: Cumulative 30-day mortality was similar in the patients subjected to IABP and in those who received conventional medical therapy only (29.5% and 27.6%, respectively; HR with IABP 1.10, 95% CI 0.38-3.11; p=0.85). Similarly, no significant differences were found in terms of the short-term clinical outcome between the groups: time on mechanical ventilation, days to hemodynamic stabilization, vasoactive drug requirements and stay in the Coronary Care Unit. Poorer renal function (HR 3.9, 95% CI 1.4-10.6; p=0.008), known peripheral artery disease (HR 3.3, 95% CI 1.2-9.1; p=0.019) and a history of diabetes mellitus (HR 3.2, 95% CI 1.2-8.1; p=0.018) were the only variables independently associated to increased 30-day mortality. CONCLUSION: In our "real life" experience, IABP does not modify 30-day mortality or the short-term clinical outcome in patients presenting STEMI complicated with CS and subjected to emergency percutaneous coronary revascularization.

Valor pronóstico del análisis del vector de bioimpedancia en pacientes ingresados por descompensación aguda de insuficiencia cardiaca: cohorte de validación / Prognostic value of analysing the bioimpedance vector for patients hospitalised for acute decompensated heart failure: a validation cohort

Objetivos. Evaluar el impacto pronóstico del análisis del vector de bioimpedancia (bioelectrical impedance vector analysis [BIVA]) en pacientes ingresados por insuficiencia cardiaca (IC). Material y métodos. Cohorte prospectiva de 105 pacientes ingresados por IC. El BIVA se realizó previo al alta, y la muestra final se dividió en 3 grupos según el valor obtenido: hiperhidratación [hiperH] (>74,3%), normohidratación [normoH] (72,7-74,3%) y deshidratación [desH] (<72,7%). En el seguimiento, se consideraron eventos adversos la mortalidad total y los reingresos por IC. Resultados. Se observó una mayor incidencia de eventos en los pacientes hiperH y desH respecto a los normoH (Kaplan-Meier: log rank 2,1; p=0,04), con un incremento de riesgo independiente en el análisis multivariado (HR 2,6 [1,05-6,44]; p=0,039). Conclusiones. El análisis BIVA en pacientes ingresados por IC permite estratificar el riesgo de reingreso por IC y mortalidad total en el seguimiento a largo plazo (AU)

Objectives. To assess the prognostic impact of the bioimpedance vector (bioelectrical impedance vector analysis [BIVA]) for patients hospitalized for heart failure (HF). Material and methods. A prospective cohort of 105 patients hospitalized for HF. BIVA was performed prior to discharge, and the final sample was divided into 3 groups according to the value obtained: hyperhydration [hyperH] (>74.3%), normal hydration [normoH] (72.7-74.3%) and dehydration [desH] (<72.7%). In the follow-up, total mortality and readmissions for HF were considered adverse events. Results. A higher incidence of events was observed among the patients with hyperH and desH compared with those with normoH (Kaplan-Meier: log-rank, 2.1; p=.04), with an increase in independent risk in the multivariate analysis (HR, 2.6 [1.05-6.44]; p=.039). Conclusions. BIVA helps stratify the risk of readmission for HF and total mortality in the long-term follow-up of patients hospitalized for HF (AU)

Prognostic value of analysing the bioimpedance vector for patients hospitalised for acute decompensated heart failure: A validation cohort.

OBJECTIVES: To assess the prognostic impact of the bioimpedance vector (bioelectrical impedance vector analysis [BIVA]) for patients hospitalized for heart failure (HF). MATERIAL AND METHODS: A prospective cohort of 105 patients hospitalized for HF. BIVA was performed prior to discharge, and the final sample was divided into 3 groups according to the value obtained: hyperhydration [hyperH] (>74.3%), normal hydration [normoH] (72.7-74.3%) and dehydration [desH] (<72.7%). In the follow-up, total mortality and readmissions for HF were considered adverse events. RESULTS: A higher incidence of events was observed among the patients with hyperH and desH compared with those with normoH (Kaplan-Meier: log-rank, 2.1; p=.04), with an increase in independent risk in the multivariate analysis (HR, 2.6 [1.05-6.44]; p=.039). CONCLUSIONS: BIVA helps stratify the risk of readmission for HF and total mortality in the long-term follow-up of patients hospitalized for HF.