71 Outcome in patients undergoing high-risk pci using impella circulatory support - 10 year experience
Notice bibliographique
Résumé
Introduction The use of Impella in the setting of high-risk percutaneous coronary intervention (PCI) has been introduced in clinical practice in the last few years in selected hospitals, giving a chance for revascularization to a sensible number of patients who are usually unsuitable for cardiac surgery due to high risks. In addition, some of these patients present pre-procedural cardiogenic shock, further increasing the rate of morbidity and mortality. Our purpose was to assess outcome of patients undergoing Impella-assisted high-risk PCI in our 10 year experience and to assess possible predictors of adverse events. Methods From May 2008 to September 2018 patients undergoing Impella-assisted high-risk PCI were enrolled. Clinical, laboratory, echocardiographic, angiographic and procedural data were collected. Coronary artery disease burden was graded using the British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS). In-hospital MACCE were recorded. During routine follow-up visits data including MACCE, hospital admissions for heart failure, Canadian Cardiovascular Society (CCS) angina grade and New York Heart Association (NYHA) functional class were recorded. Long-term survival Kaplan Meier analysis was performed according to national registry death data. Results A total of 80 consecutive patients were enrolled (71.2±13.7 years, male gender 73.8%), 21 (26.3%) presenting with stable angina, 53 (66.3%) with NSTE-ACS and 6 (7.5%) with STEMI. 67 (83.8%) of them showed multivessel disease, 42 (52.5%) unprotected left main disease, 47 (58.8%) severe left ventricle systolic dysfunction (LVEF<30%), 10 (12.5%) pre-procedural cardiogenic shock. Median BCIS-JS was 10 [8,00; 12,00]. In-hospital MACCE occurred in 16 (20%) patients with death in 15 (18.8%). Median time to first follow-up visit for survivors was 105 (64.5; 282.0) days: at this time 11 (13.8%) patients had MACCE, 3 (3.8%) had hospital admissions for heart failure, median CCS was 0.00 (0.00; 0.00) and median NYHA was 1.00 (1.00; 2.00). Mean survival time (procedure to death, months) was 21 months (C.I. 14.4 - 29.0). Multivariate logistic regression analysis for possible predictors of in-hospital MACCE was performed including the variables showing a p value <0.100 at univariate analysis, i.e. pre-procedural cardiogenic shock [OR 9.00, C.I. (2.1–37.6), p=0.003] and CK peak [OR 1.00, C.I. (1.0–1.0), p=0.051]. Pre-procedural cardiogenic shock was the only predictor [OR 7.058, C.I. (1.2–40.6), p=0.029] of in-hospital MACCE. No significant predictors of MACCE at follow-up were found at logistic regression analysis. Conclusion In our 10 year experience of Impella-assisted high-risk PCI, 20% patients had in-hospital MACCE and mean survival was 21 months. At follow up, MACCE rate was less than 4% and both angina and heart failure symptoms were well controlled. Pre-procedural cardiogenic shock was the only predictor of in-hospital MACCE. Conflict of Interest No conflict of interest
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».