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Clement A, Pezel T, Lequipar A, Guiraud-Chaumeil P, Singh M, Poinsignon H, El Beze N, Gall E, Goncalves T, Lafont A, Henry P, Dillinger JG. [Recreative drug use and cardiovascular disease]. Ann Cardiol Angeiol (Paris) 2023; 72:101638. [PMID: 37738755 DOI: 10.1016/j.ancard.2023.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/24/2023]
Abstract
Widely spread, and continuously increasing, recreational drug use in general population has been associated with cardiovascular events, as illustrated by clinical studies and supported by a pathophysiological rationale. Understanding the cardiovascular effects of drugs, screening, and secondary prevention are crucial components in the management of those patients in cardiology.
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Affiliation(s)
- Arthur Clement
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Theo Pezel
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Antoine Lequipar
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Paul Guiraud-Chaumeil
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Manveer Singh
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Hugo Poinsignon
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Nathan El Beze
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Emmanuel Gall
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Trecy Goncalves
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Alexandre Lafont
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Patrick Henry
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Jean-Guillaume Dillinger
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France.
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Barrionuevo-Sánchez MI, Viana-Tejedor A, Ariza-Solé A, Del Prado N, Rosillo N, Sánchez-Salado JC, Lorente V, Jorge-Pérez P, Noriega FJ, Ferrera C, Alegre O, Llaó I, Bernal JL, Triguero L, Fernández-Pérez C, González-Costello J, Marcos M, de la Cuerda F, Carmona J, Cequier A, Fernández-Ortiz A, Pérez-Villacastín J, Comin-Colet J, Elola FJ. Impact of annual volume of cases and Intensive Cardiac Care Unit availability on mortality of patients with acute myocardial infarction- related cardiogenic shock treated at revascularization capable centers. Eur Heart J Acute Cardiovasc Care 2023:7192937. [PMID: 37294681 DOI: 10.1093/ehjacc/zuad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/02/2023] [Accepted: 06/07/2023] [Indexed: 06/11/2023]
Abstract
BACKGROUND Cardiogenic shock (CS) is associated with high mortality. The purpose of this study was to assess the impact of Hospital structure-related variables on mortality in patients with CS treated at percutaneous and surgical revascularization capable centers (psRCC) from a large nationwide registry. METHODS Retrospective observational study including consecutive patients with main or secondary diagnosis of CS and ST elevation myocardial infarction (STEMI). Patients discharged from Spanish National Healthcare System psRCC were included (2016-2020). The association between the volume of CS cases attended by each center, availability of Intensive Cardiac Care Unit (ICCU) and heart transplantation (HT) programs and in-hospital mortality was assessed by multilevel logistic regression models. RESULTS The study population consisted of 3,074 CS-STEMI episodes, of whom 1,759 (57.2%) occurred in 26 centers with ICCU. A total of 17/44 hospitals (38.6%) were high-volume centers and 19/44 (43%) centers had HT programs availability. Treatment at HT centers was not associated with a lower mortality (p = 0.121). Both high volume of cases and ICCU showed a trend to an association with lower mortality in the adjusted model (OR: 0.87 and 0.88, respectively). The interaction between both variables was significantly protective (OR 0.72; p = 0.024). After propensity score matching, mortality was lower in high volume hospitals with ICCU [OR = 0.79; p = 0.007]. CONCLUSIONS Most CS-STEMI patients were attended at psRCC with high volume of cases and ICCU available. The combination of high-volume and ICCU availability showed the lowest mortality. These data should be taken into account when designing regional networks for CS management.
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Affiliation(s)
- M Isabel Barrionuevo-Sánchez
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Albert Ariza-Solé
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Nicolás Rosillo
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Carlos Sánchez-Salado
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Victòria Lorente
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pablo Jorge-Pérez
- Hospital Universitario de Canarias. La Laguna, Santa Cruz de Tenerife, Spain
| | | | | | - Oriol Alegre
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Isaac Llaó
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Laura Triguero
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- Servicio de Medicina Preventiva, Área Sanitaria de Santiago y Barbanza, Instituto de Investigaciones Sanitarias de Santiago. Santiago de Compostela (A Coruña), Spain
| | - José González-Costello
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Marcos
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco de la Cuerda
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jesús Carmona
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Angel Cequier
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
| | | | | | - Josep Comin-Colet
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
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Barrionuevo-Sánchez MI, Ariza-Solé A, Prado ND, García M, Sánchez-Salado JC, Lorente V, Alegre O, Llaó I, Bernal JL, Fernández-Pérez C, Galván-Román F, Cuerda F, Pascual J, Cequier A, Comin-Colet J, Elola FJ. Impact of shock aetiology and hospital characteristics on the clinical profile, management and prognosis of patients with non ACS-related cardiogenic shock. Hellenic J Cardiol 2023; 69:16-23. [PMID: 36334704 DOI: 10.1016/j.hjc.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/08/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND A significant proportion of cases of cardiogenic shock (CS) are due aetiologies other than acute coronary syndromes (non ACS-CS). We assessed differences regarding clinical profile, management, and prognosis according to the cause of CS among nonselected patients with CS from a large nationwide database. METHODS We performed an observational study including patients admitted from the hospitals of the Spanish National Health System (SNHS) with a principal or secondary diagnosis code of CS (2016-2019). Data were obtained from the Minimum Basic Data Set (MBDS). Hospitals were classified according to the availability of cardiology related resources, as well as the availability of Intensive Cardiac Care Unit (ICCU). RESULTS A total of 10,826 episodes of CS were included, of whom 5,495 (50.8%) were non-ACS related. Non ACS-CS patients were younger (71.5 vs. 72.4 years) and had a lower burden of arteriosclerosis-related comorbidities. Non ACS-CS cases underwent less often invasive procedures and presented lower in-hospital mortality (57.1% vs. 61%,p < 0.001). The most common main diagnosis among non ACS-CS was acute decompensation of chronic heart failure (ADCHF) (35.4%). A lower risk-adjusted in-hospital mortality rate was observed in high volume hospitals (52.6% vs. 56.7%; p < 0.001), as well as in centers with ICCU (OR: 0.71; CI 95%: 0.58-0.87; p < 0.001). CONCLUSIONS More than a half of cases of CS were due to non-ACS causes. Non ACS-CS cases are a very heterogeneous group, with different clinical profile and management. Management at high-volume hospitals and availability of ICCU were associated with lower risk adjusted mortality among non ACS-CS patients.
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