Impact of Prereperfusion Left Ventricle Unloading on ST-Segment Elevation Myocardial Infarction According to the Onset-to-Unloading Time

It is unclear whether the impact of prereperfusion unloading on improving survival is sustained throughout all periods from the onset in patients with ST-segment elevation myocardial infarction. This study is a post hoc analysis of the J-PVAD registry. In all patients registered in J-PVAD between Fe...

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Published in:The American journal of cardiology 2024-12
Main Authors: Okamoto, Naotaka, Egami, Yasuyuki, Sugino, Ayako, Kobayashi, Noriyuki, Abe, Masaru, Osuga, Mizuki, Nohara, Hiroaki, Kawanami, Shodai, Kawamura, Akito, Ukita, Kohei, Yasumoto, Koji, Matsunaga-Lee, Yasuharu, Yano, Masamichi, Nishino, Masami
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container_title The American journal of cardiology
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creator Okamoto, Naotaka
Egami, Yasuyuki
Sugino, Ayako
Kobayashi, Noriyuki
Abe, Masaru
Osuga, Mizuki
Nohara, Hiroaki
Kawanami, Shodai
Kawamura, Akito
Ukita, Kohei
Yasumoto, Koji
Matsunaga-Lee, Yasuharu
Yano, Masamichi
Nishino, Masami
description It is unclear whether the impact of prereperfusion unloading on improving survival is sustained throughout all periods from the onset in patients with ST-segment elevation myocardial infarction. This study is a post hoc analysis of the J-PVAD registry. In all patients registered in J-PVAD between February 2020 and December 2021, patients with ST-segment elevation myocardial infarction complicated with cardiogenic shock and treated with Impella support alone were selected. A total of 2 cohorts were provided based on whether the onset-to-unloading time was
doi_str_mv 10.1016/j.amjcard.2024.12.003
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This study is a post hoc analysis of the J-PVAD registry. In all patients registered in J-PVAD between February 2020 and December 2021, patients with ST-segment elevation myocardial infarction complicated with cardiogenic shock and treated with Impella support alone were selected. A total of 2 cohorts were provided based on whether the onset-to-unloading time was &lt;6 hours. The patients were divided into 2 groups according to prereperfusion or postreperfusion unloading in each cohort. The primary outcome was the 30-day survival rate. The independent factors of survival were identified with a multivariable Cox proportional hazard regression analysis after adjusting for the variables that were statistically significant in the univariable analysis. Patients with prereperfusion unloading had a significantly higher 30-day survival rate than patients with postreperfusion unloading (91% vs 67%, p &lt;0.01) in the cohort with an onset-to-unloading time ≥6 hours, whereas patients with prereperfusion or postreperfusion unloading had similar 30-day survival rates (88% vs 91%, p = 0.64) in the cohort with an onset-to-unloading time &lt;6 hours. A multivariable analysis revealed that prereperfusion use of Impella was an independent factor of survival (hazard ratio 0.249, 95% confidence interval 0.070 to 0.889, p = 0.03) in the onset-to-unloading time ≥6 hours cohort. 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Patients with prereperfusion unloading had a significantly higher 30-day survival rate than patients with postreperfusion unloading (91% vs 67%, p &lt;0.01) in the cohort with an onset-to-unloading time ≥6 hours, whereas patients with prereperfusion or postreperfusion unloading had similar 30-day survival rates (88% vs 91%, p = 0.64) in the cohort with an onset-to-unloading time &lt;6 hours. A multivariable analysis revealed that prereperfusion use of Impella was an independent factor of survival (hazard ratio 0.249, 95% confidence interval 0.070 to 0.889, p = 0.03) in the onset-to-unloading time ≥6 hours cohort. 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Patients with prereperfusion unloading had a significantly higher 30-day survival rate than patients with postreperfusion unloading (91% vs 67%, p &lt;0.01) in the cohort with an onset-to-unloading time ≥6 hours, whereas patients with prereperfusion or postreperfusion unloading had similar 30-day survival rates (88% vs 91%, p = 0.64) in the cohort with an onset-to-unloading time &lt;6 hours. A multivariable analysis revealed that prereperfusion use of Impella was an independent factor of survival (hazard ratio 0.249, 95% confidence interval 0.070 to 0.889, p = 0.03) in the onset-to-unloading time ≥6 hours cohort. In conclusion, prereperfusion left ventricular unloading could be a crucial treatment to improve the short-term survival rate when the onset-to-left ventricular unloading time was ≥6 hours.</abstract><cop>United States</cop><pmid>39674439</pmid><doi>10.1016/j.amjcard.2024.12.003</doi></addata></record>
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title Impact of Prereperfusion Left Ventricle Unloading on ST-Segment Elevation Myocardial Infarction According to the Onset-to-Unloading Time
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