Impact of intra-aortic balloon pump diastolic augmentation on survival in patients with cardiogenic shock
Notice bibliographique
Résumé
Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): PI funded - Jason Katz, MD Background Temporary MCS devices are routinely used in pts with CS. The most commonly used temporary MCS device worldwide is the IABP, which increases DBP, enhances coronary perfusion, and improves cardiac output. No randomized controlled trial has demonstrated its superiority over standard care practices and observational data suggest heterogeneity in its hemodynamic effect. IABP response likely depends on optimizing several pt- and device-related factors, most notably the ability to augment DBP. Unfortunately, a notable gap exists in defining the association of augmented DBP (aDBP) with mortality, and none of the contemporary clinical trials have systematically assessed this concept. Purpose In a cohort of pts with CS, the goal was to investigate the association between aDBP and survival in those supported with an IABP. Methods In a retrospective analysis of prospectively collected data from pts with CS who underwent IABP placement at Duke from 1/2010-6/2021 we describe baseline characteristics and discharge outcomes stratified by aDBP. Pre-insertion DBP was measured immediately prior to IABP, while post-insertion aDBP was collected 2 hrs following device placement. Success was defined as survival to hospital discharge. Death prior to discharge, hospice care, or escalation to ECMO, Impella, durable LVAD, or heart transplant were all considered a non-successful result. A multivariate logistic regression model was created to assess the association of aDBP on outcome, adjusting for pre-IABP DBP, age, sex, race, history of MI and HF. Results 514 CS pts were identified, of which 470 (91%) had available pre-insertion DBP and post-insertion aDBP. The modal age was 65-74 yrs, 75% were male, 54% were white, 85% had prior HF, and 34% had prior MI. Figure 1A shows the distribution of pre-insertion DBP (median 67 mmHg) and post-insertion aDBP (median 106 mmHg). Overall, 49% of pts had a successful outcome. There was a u-shaped relationship between aDBP and the likelihood of success; as an example, for a modeled pt (65-75yo male, pre-insertion DBP of 66 mmHg, no HF or MI), the predicted probability of a successful outcome increased from 10% to 65% as aDBP rose to 120 mmHg, followed by a subsequent decline (Figure 1B). The relationship between either absolute or relative change in aDBP over baseline, on the other hand, was no longer u-shaped, but rather linear. After multivariate adjustment, only aDBP was associated with success such that every 10mmHg increase in aDBP over baseline was associated with improved survival to hospital discharge (OR 1.12, p=0.03). Conclusions In a cohort of pts with CS managed with an IABP, we report for the first time that aDBP is associated with improved survival to hospital discharge. Future prospective and randomized analyses should aim to capture degree of augmentation when studying counterpulsation devices, and this may help to clarify the currently controversial role of the IABP in contemporary CS care.
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 | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| 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 | 0,001 |
| 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 ».