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  1. Rajan R, Al Jarallah M, Daoulah A, Panduranga P, Elmahrouk A, Mohamed Al Rawahi AS, et al.
    J Soc Cardiovasc Angiogr Interv, 2025 Jan;4(1):102461.
    PMID: 40061415 DOI: 10.1016/j.jscai.2024.102461
    BACKGROUND: Outcomes of patients with acute myocardial infarction-related cardiogenic shock (AMICS) stratified by the Society for Cardiovascular Angiography & Interventions (SCAI) shock stages in the Gulf region are not well known.

    METHODS: We analyzed data from patients with AMICS presenting to multiple centers across the Gulf region between January 2020 and December 2022. Patients were grouped according to SCAI-Cardiogenic Shock Working Group classification: group 1 (SCAI shock stages B/C) and group 2 (SCAI shock stages D/E). Primary end points were survival at 6, 12, 18, and 24 months. Both univariate and multivariate statistical methods were employed in the analysis.

    RESULTS: A total of 1513 patients from the Gulf Cardiogenic Shock registry, were included with 31.1% in group 1 and 68.9% in group 2. The median follow-up was 6 months. Survival rates in group 1 were 87%, 72%, 56%, and 48% at 6, 12, 18, and 24 months, respectively, whereas group 2 exhibited survival rates of 66%, 29%, 14%, and 4%, respectively, over the same periods. Survival progressively declined with advancing SCAI shock stages, with stage B having the highest survival rates and stage E the lowest (P < .001). Multivariable Cox regression analysis identified higher SCAI stages as strong predictors of increased mortality, with patients in group 2 having a more than 3-fold higher risk of mortality compared to those in group 1 (hazard ratio, 3.13; 95% CI, 2.40-4.07; P < .001). Additionally, lower left ventricular ejection fraction, advanced age, and the presence of tachyarrhythmias were associated with increased mortality risk.

    CONCLUSIONS: This is the first study to validate SCAI-Cardiogenic Shock Working Group stages in a large cohort of patients with AMICS. The SCAI shock staging classification was significantly associated with higher short- and long-term mortality in this cohort, with patients in more advanced stages (D/E) experiencing markedly worse survival outcomes. These findings underscore the utility of SCAI staging in stratifying long-term risk among AMICS patients in the Gulf region. Identification of cardiogenic shock patients at SCAI stages D and E with early hemodynamic monitoring and treating them aggressively with newer mechanical circulatory support in the early stages may improve patient survival.

  2. Ranade M, Foster MT, Brady PS, Sokol SI, Butty S, Klein A, et al.
    J Soc Cardiovasc Angiogr Interv, 2025 Jan;4(1):102463.
    PMID: 40061412 DOI: 10.1016/j.jscai.2024.102463
    BACKGROUND: There is a need for additional data to assess procedural efficacy and risks associated with mechanical thrombectomy for treating pulmonary embolism (PE) due to its increased utilization and diversity of patient populations presenting with PE. This study evaluated the safety and efficacy of percutaneous mechanical aspiration thrombectomy with the AlphaVac F1885 System (AngioDynamics) in patients with acute intermediate-risk PE.

    METHODS: Patients with acute intermediate-risk PE and a right ventricular (RV)/left ventricular (LV) diameter ratio of ≥0.9 were eligible for enrollment in this prospective, multicenter, single-arm study. The primary effectiveness end point was reduction in the RV/LV ratio at 48 hours. The primary safety end point was the rate of major adverse events (MAEs) defined as subjects who experienced major bleeding, device-related deaths, clinical deterioration, or pulmonary vascular or cardiac injury within 48 hours postprocedurally.

    RESULTS: In total, 122 subjects were enrolled at 25 sites. Mean procedure time was 37.2 ± 17.7 minutes. There were statistically significant reductions in mean 48-hour postprocedural RV/LV diameter ratio (-0.45 ± 0.27; P < .001). Postprocedural mean pulmonary arterial pressure also significantly declined from 27.8 ± 7.8 mm Hg before the procedure to 21.8 ± 7.2 mm Hg (P < .001). There was a 35.5% mean reduction in clot burden as measured by the modified Miller index score. Five (4.1%) subjects developed 7 MAEs during the postprocedural 48-hour assessment period, the majority of which were access site bleeding.

    CONCLUSIONS: Percutaneous mechanical aspiration thrombectomy with the AlphaVac system provided a safe and effective treatment for acute intermediate-risk PE with a significant reduction in RV/LV ratio and clot burden with a low rate of adverse events.

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