B-4 | Clinical Outcomes of Patients with Transient Loss of Pulsatility During Hemodynamically Supported High Risk PCI
Notice bibliographique
Résumé
BackgroundHigh risk percutaneous coronary intervention (HRPCI) is typically defined by patient risk factors, anatomic complexity, and hemodynamic status. Patients experiencing loss of pulsatility (LOP) during coronary intervention are transiently dependent on mechanical circulatory support (MCS). Examining these patients may allow better understanding of those most at risk of hemodynamic collapse during HRPCI.MethodsPatients enrolled into the Protect III study who underwent HRPCI with MCS and had automated Impella controller logs capturing real time hemodynamics, were included in the study. LOP was defined as an average pulse pressure <20 mmHg for ≥ 5 seconds. Clinical characteristics and outcomes were then compared.Results302 patients were treated at 38 sites between 2017-2020. 148 patients (49.0%) experienced LOP. Age, gender and comorbidities including baseline left ventricular ejection fraction were similar between groups. Systolic blood pressure (SBP) (118.6 vs 129.8 p<0.01), mean arterial pressure (MAP) (86.9 vs 91.6, p=0.01), and cardiac output (CO) (4.4 vs 5.5, p=0.02) were lower in patients with LOP; while cardiac output deficit (COD) (-0.3 vs -1.1, p<0.01) and heart rate (HR) (78.0 vs 73.0 bpm, p=0.01) were higher. Anatomic complexity including the vessel treated, number of vessels treated, use of atherectomy, PCI of a last remaining conduit, pre-PCI syntax score, and change in syntax score were all similar between groups. Patients experiencing LOP had longer procedural times (2.5 vs 2.1 hours, p<0.01) and ICU duration (5.7 vs 3.6 days, p<0.01). Patients with LOP had higher rates of mortality during the hospitalization (8.1 vs 2.6%, p=0.04) and 90-day major adverse cardiac and cerebrovascular events (MACCE) (23.5 vs 8.8%, p<0.01).ConclusionsHemodynamic status at the time of HRPCI as opposed to patient comorbidities or anatomic complexity is associated with LOP. Patients undergoing HRPCI with decreased SBP, MAP, CO and increased COD and HR are more likely to experience LOP which was associated with increasing rates of MACCE. The value of obtaining invasive hemodynamics pre-PCI requires further study and will be investigated in a sub-study of the Protect IV randomized control trial.DisclosuresM. B. Basir: consultant for Abbott Vascular, Abiomed, Cardiovascular Systems, Chiesi, and Zoll.: Consulting; D. Bentley: Abiomed: Employed or Salary; K. Kunkel: Abiomed: Consulting; Cardiovascular Systems, Inc.: Consulting; Shockwave: Consulting; K. Alaswad: consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and CSI: Consulting; A. Kaki: Abiomed: Consulting and Speaker Bureau; Shockwave: Consulting and Speaker Bureau; G. W. Stone: Cook Medical: Speaker Bureau; Terumo: Speaker Bureau; Valfix Medical: Consulting; TherOx: Consulting; Vascular Dynamics: Consulting; Robocath: Consulting; HeartFlow: Consulting; Gore: Consulting; Ablative Solutions: Consulting; Miracor: Consulting; Neovasc: Consulting; V-Wave: Consulting; Abiomed: Consulting; MAIA Pharmaceuticals: Consulting; Vectorious: Consulting; Reva: Consulting; Cardiomech: Consulting; W. W. O’Neill: Abiomed: Consulting; Abbott: Consulting; Boston Scientific Corp.: Consulting; Medtronic: Consulting; A. Lemor Nothing to disclose. M. S. Megaly Nothing to disclose. M. Alqarqaz Nothing to disclose. A. K. Khandelwal Nothing to disclose. S. Kalra Nothing to disclose. D. Burkhoff Nothing to disclose. J. W. Moses Nothing to disclose. D. S. Pinto Nothing to disclose. BackgroundHigh risk percutaneous coronary intervention (HRPCI) is typically defined by patient risk factors, anatomic complexity, and hemodynamic status. Patients experiencing loss of pulsatility (LOP) during coronary intervention are transiently dependent on mechanical circulatory support (MCS). Examining these patients may allow better understanding of those most at risk of hemodynamic collapse during HRPCI. High risk percutaneous coronary intervention (HRPCI) is typically defined by patient risk factors, anatomic complexity, and hemodynamic status. Patients experiencing loss of pulsatility (LOP) during coronary intervention are transiently dependent on mechanical circulatory support (MCS). Examining these patients may allow better understanding of those most at risk of hemodynamic collapse during HRPCI. MethodsPatients enrolled into the Protect III study who underwent HRPCI with MCS and had automated Impella controller logs capturing real time hemodynamics, were included in the study. LOP was defined as an average pulse pressure <20 mmHg for ≥ 5 seconds. Clinical characteristics and outcomes were then compared. Patients enrolled into the Protect III study who underwent HRPCI with MCS and had automated Impella controller logs capturing real time hemodynamics, were included in the study. LOP was defined as an average pulse pressure <20 mmHg for ≥ 5 seconds. Clinical characteristics and outcomes were then compared. Results302 patients were treated at 38 sites between 2017-2020. 148 patients (49.0%) experienced LOP. Age, gender and comorbidities including baseline left ventricular ejection fraction were similar between groups. Systolic blood pressure (SBP) (118.6 vs 129.8 p<0.01), mean arterial pressure (MAP) (86.9 vs 91.6, p=0.01), and cardiac output (CO) (4.4 vs 5.5, p=0.02) were lower in patients with LOP; while cardiac output deficit (COD) (-0.3 vs -1.1, p<0.01) and heart rate (HR) (78.0 vs 73.0 bpm, p=0.01) were higher. Anatomic complexity including the vessel treated, number of vessels treated, use of atherectomy, PCI of a last remaining conduit, pre-PCI syntax score, and change in syntax score were all similar between groups. Patients experiencing LOP had longer procedural times (2.5 vs 2.1 hours, p<0.01) and ICU duration (5.7 vs 3.6 days, p<0.01). Patients with LOP had higher rates of mortality during the hospitalization (8.1 vs 2.6%, p=0.04) and 90-day major adverse cardiac and cerebrovascular events (MACCE) (23.5 vs 8.8%, p<0.01). 302 patients were treated at 38 sites between 2017-2020. 148 patients (49.0%) experienced LOP. Age, gender and comorbidities including baseline left ventricular ejection fraction were similar between groups. Systolic blood pressure (SBP) (118.6 vs 129.8 p<0.01), mean arterial pressure (MAP) (86.9 vs 91.6, p=0.01), and cardiac output (CO) (4.4 vs 5.5, p=0.02) were lower in patients with LOP; while cardiac output deficit (COD) (-0.3 vs -1.1, p<0.01) and heart rate (HR) (78.0 vs 73.0 bpm, p=0.01) were higher. Anatomic complexity including the vessel treated, number of vessels treated, use of atherectomy, PCI of a last remaining conduit, pre-PCI syntax score, and change in syntax score were all similar between groups. Patients experiencing LOP had longer procedural times (2.5 vs 2.1 hours, p<0.01) and ICU duration (5.7 vs 3.6 days, p<0.01). Patients with LOP had higher rates of mortality during the hospitalization (8.1 vs 2.6%, p=0.04) and 90-day major adverse cardiac and cerebrovascular events (MACCE) (23.5 vs 8.8%, p<0.01). ConclusionsHemodynamic status at the time of HRPCI as opposed to patient comorbidities or anatomic complexity is associated with LOP. Patients undergoing HRPCI with decreased SBP, MAP, CO and increased COD and HR are more likely to experience LOP which was associated with increasing rates of MACCE. The value of obtaining invasive hemodynamics pre-PCI requires further study and will be investigated in a sub-study of the Protect IV randomized control trial. Hemodynamic status at the time of HRPCI as opposed to patient comorbidities or anatomic complexity is associated with LOP. Patients undergoing HRPCI with decreased SBP, MAP, CO and increased COD and HR are more likely to experience LOP which was associated with increasing rates of MACCE. The value of obtaining invasive hemodynamics pre-PCI requires further study and will be investigated in a sub-study of the Protect IV randomized control trial.
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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,214 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 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 tête enseignante, 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 ».