Risultati per: Nuovi farmaci per il danno renale acuto (Acute kidney injury – AKI)

Circulation, Volume 150, Issue Suppl_1, Page A4145880-A4145880, November 12, 2024. Background:Patients with hematological malignancies may face increased cardiovascular risks, including acute myocardial infarction (AMI). This systematic review and meta-analysis aims to evaluate the incidence and outcomes of AMI in patients with hematological malignancies compared with the general population.Methods:A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Random effect models were utilized to calculate Mantel-Haenszel odds ratios (ORs) with 95% confidence intervals (CIs). The inverse variance method with DerSimonian–Laird (DL) of Tau2 was used to calculate standardized mean differences (SMDs) with CIs. Statistical significance was set at p < 0.05. The primary endpoint was the incidence of AMI, while secondary outcomes included in-hospital mortality, length of hospital stay, likelihood of undergoing invasive procedures, total hospital costs, bleeding events, and stroke outcomes.Results:Twenty-six articles, including approximately 6.33 million patients with hematological malignancies, were included in the meta-analysis. Hematological malignancies were not associated with an increased incidence of AMI compared with the general population (OR = 0.91; 95% CI 0.80 to 1.03; p

Circulation, Volume 150, Issue Suppl_1, Page A4141475-A4141475, November 12, 2024. Background:Acute Kidney Injury (AKI) is a multifactorial complication following repair of Stanford Type A aortic dissection (TAAD) with an alarmingly high incidence, varying from 20 to 77%. Postoperative AKI following life-threatening disease tends to be much more complex. However, the exact role of postprocedural AKI in the prognosis of patients undergoing TAAD repair has not been elucidated.Aims:This meta-analysis aimed to evaluate the prognostic significance of postprocedural AKI in patients undergoing TAAD repair.Methods:A literature search was conducted using PubMed, EMBASE, and SCOPUS databases. The primary endpoint was 30-day mortality with several secondary endpoints. Risk ratios (RR) with 95% confidence intervals (CIs) were pooled using Review Manager software. Statistical significance was set at p

Circulation, Volume 150, Issue Suppl_1, Page A4140169-A4140169, November 12, 2024. Background:Although neurologic injury commonly occurs following neonatal aortic arch reconstruction, the mechanism(s) are poorly understood. A decrease or inter-hemispheric difference in the electroencephalogram (EEG) Alpha:Delta ratio (A:D) precedes cerebral ischemia during antegrade cerebral perfusion (ACP). However, it is unknown if A:D changes precede neurologic injury during deep hypothermic circulatory arrest (DHCA). We hypothesized during DHCA, the A:D would decrease and that a significant A:D inter-hemispheric difference would precede neurologic injury.Methods:Neonates requiring aortic arch reconstruction underwent simultaneous quantitative EEG monitoring. Left vs. right hemispheric, anterior, and posterior A:Ds were recorded at baseline, arterial cannulation, cooling, ACP vs. DHCA, and the rewarming phases of the operation. Left vs. right A:D differences > 25% were considered significant for ischemia and the cumulative duration of a significant A:D inter-hemispheric difference was calculated. Post-operative neurologic injury was defined as either stroke or seizure.Results:From 86 neonates, 16.2 % (14) required DHCA and 83.8 % (72) ACP. There were no significant differences in the pre-operative demographics or baseline A:Ds between groups. Although the A:Ds remained similar during ACP, after 15 minutes the hemispheric A:Ds decreased significantly during DHCA (Figure 1). Eleven neonates (ACP-7 vs. DHCA-4) developed neurologic injury. The duration of an anterior A:D inter-hemispheric difference > 25% was significantly greater within neonates that developed neurologic injury (25 {IQR:0,65 minutes} vs. 5 {IQR: 0, 15 minutes}; p 25% was independently associated with neurologic injury using either ACP or DHCA (Odds Ratio:1.081, 95% CI: 1.025, 1.141; p-value=0.004).Conclusion:Unlike ACP, the A:D decreased significantly during DHCA. During either DHCA or ACP, a significant anterior inter-hemispheric A:D difference was independently associated with neurologic injury and suggests the importance of quantifying the A:D during neonatal arch reconstruction.

Circulation, Volume 150, Issue Suppl_1, Page A4140120-A4140120, November 12, 2024. Background:Acute kidney injury (AKI) often complicates acute type A aortic dissection (ATAAD), with elevated comorbidity rates and a significant tie to in-hospital mortality. Identifying risk factors early can mitigate AKI severity.Research Questions:This research endeavors to develop and corroborate predictive models leveraging Machine Learning (ML) techniques from Artificial Intelligence to forecast AKI occurrences in ATAAD-afflicted individuals.Methods:The study employed various machine learning (ML) algorithms including Gradient Boosting Machine (GBM), LightGBM, Random Forest (RF), K-Nearest Neighbors (KNN), Multi-Layer Perceptron Neural Network (MLP-NN), Naive Bayes (NB), Logistic Regression (LR), and ensemble methods (combining LR&LightGBM), employing tenfold cross-validation. Model performance was evaluated using SHapley Additive exPlanations (SHAP). A web-based tool for predicting AKI incidence was developed using Streamlit, based on the most effective model. The analysis involved 1350 ATAAD patients, among whom 586 (43.4%) developed post-operative AKI. Patients were divided into two cohorts: 85% for training and 15% for testing, with 126 features included in the predictive model.Results:Incorporating top 10 features, LightGBM (AUROC=0.886, 95% CI 0.841-0.930) excelled in predictive accuracy, calibration, and clinical utility, identifying key factors such as ventilation time in ICU, hourly urine output post-surgery, diuretic use, Scr, heart rate, urea, administration of recombinant human brain natriuretic peptide and ebrantil, MCHC, and blood glucose as associated with ATAAD-AKI.Conclusion(s):These ML models are robust tools for predicting AKI in ATAAD patients, with LightGBM’s superior predictive ability standing out. They offer valuable support for clinical decision-making in ATAAD management, helping optimize postoperative strategies to minimize AKI occurrence after surgery.

Circulation, Volume 150, Issue Suppl_1, Page A4124931-A4124931, November 12, 2024. Background:The AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been introduced to predict all-cause death (ACD) in patients with heart failure. There is no information available on the utility of this score for the prediction of ACD in patients with coronary artery disease (CAD).Hypothesis:The AHEAD score may provide superior predictive value for ACD compared to the CHADS2score, which has been reported to be useful for predicting poor clinical outcomes in patients with acute (ACS) and chronic coronary syndromes (CCS).Methods:This retrospective multicenter cohort study analyzed data of the patients who underwent percutaneous coronary intervention for ACS or CCS between April 2013 and March 2019 using the Clinical Deep Data Accumulation System (CLIDAS) database. The AHEAD score was calculated by assigning 1 point each for atrial fibrillation, hemoglobin 130 μmol/L), and diabetes mellitus. The CHADS2score was calculated as previously reported. The study endpoint was ACD.Results:In total, 9,033 patients were enrolled (median age, 72 years; 77% male; 3,920 with ACS and 5,113 with CCS). Higher AHEAD or CHADS2scores were significantly associated with a higher rate of left main disease or three-vessel disease in both patients with ACS and CCS. In addition, after accounting for multiple variables using Cox multivariate analysis, both the AHEAD (hazard ratio [HR], 1.83 [95% confidence interval, 1.63–2.06] for ACS and 1.66 [1.49–1.85] for CCS) and CHADS2scores (HR 1.27 [1.15–1.40] for ACS and 1.23 [1.12–1.35] for CCS) remained significantly associated with ACD. However, receiver operating characteristic curve analysis for predicting ACD revealed that the predictive value of the AHEAD score was significantly higher than that of the CHADS2score in both ACS and CCS (Figure). A significant difference was found in the rate of ACD among patients stratified by the AHEAD score in both groups (bothP

Circulation, Volume 150, Issue Suppl_1, Page A4144554-A4144554, November 12, 2024. INTRODUCTION:Coronary CT angiography (CCTA) is a powerful noninvasive tool for identifying high-risk plaque, such as low-density non-calcified plaque (LD-NCP). Though, the optimal treatment of patients with LD-NCP remains unclear. This study explored the association of revascularization in the setting of LD-NCP with the occurrence of acute coronary syndrome (ACS).Methods:This was a post-hoc analysis of the ICONIC study. A subset of 234 patients that underwent CCTA with subsequent ACS were matched to 234 control patients who also underwent CCTA but did not have ACS during follow-up. Patients were also followed for occurrence of revascularization, either coronary artery bypass graft or percutaneous coronary intervention. Atherosclerosis imaging-enabled quantitative CT (AI-QCT) was used to measure diameter stenosis, and LD-NCP, non-calcified plaque, and calcified plaque volumes from each CCTA. LD-NCP was defined as plaque with -190 to 30 Hounsfield Units. Patients were stratified based on the presence of LD-NCP. Subgroup analysis was conducted to compare the occurrence of ACS with the rate of revascularization. Kaplan-Meier survival curves and extended Cox regression analysis were used to evaluate the effect size of revascularization and LD-NCP on occurrence of ACS.Results:AI-QCT was completed in 448/468 subjects (follow-up time [MEAN±SD] 2.44±2.48 years). The median of LD-NCP was 1.2 mm3for patients with >0 mm3LD-NCP. There were 85 patients with LD-NCP >1.2 mm3and 363 patients with LD-NCP ≤1.2 mm3. In patients with LD-NCP >1.2 mm3, the rate of revascularization in patients with and without ACS was 3/52 (5.8%) versus 14/33 (42.4%) (p1.2 mm3and revascularization were less likely to have ACS during follow-up (adjusted HR: 0.20 [0.07, 0.61]; p=0.005). Additionally, patients with LD-NCP >1.2 mm3who did not undergo revascularization were more likely to have ACS (adjusted HR: 1.47 [1.03, 2.12]; p=0.036). Hazard ratios were adjusted for diameter stenosis, and non-calcified and calcified plaque volume. Time-dependent coefficients were included for diameter stenosis.Conclusion:Revascularization of patients with LD-NCP >1.2 mm3identified on CCTA with AI-QCT was associated with less risk for ACS.

Circulation, Volume 150, Issue Suppl_1, Page ASa1107-ASa1107, November 12, 2024. Introduction:Lung donation after uncontrolled circulatory death (uDCD) following a witnessed cardiac arrest is feasible after resuscitation and assessment with ex vivo lung perfusion (EVLP). This bench study explores the efficacy of expiratory flow modulation in minimizing damage caused by mechanical power during volume-controlled ventilation within the EVLP procedure.Methods:Donor lungs were simulated using the ASL 5000 lung simulator (IngMar Medical) and ventilated in volume-controlled mode using the ViX-ventilator (KU Leuven), set at 7 breaths per minute with a positive end-expiratory pressure of 5 cmH2O. (Figure 1) Baseline measurements were obtained to deliver tidal volumes (VT) of 300, 400, and 500 mL. These measurements were then compared to an intervention where expiratory flow was modulated using an in-house designed device, the flow modulator. Mechanical power (J/min) was calculated using the pressure-volume curve. Differences in power between the baseline and various levels of flow modulation were assessed using a one-sided t-test.Results:No clinically relevant differences were observed in VT delivery between baseline settings and during expiratory flow modulation. (Table 1) However, significant differences in mechanical power were noted between baseline and flow modulation across the three VT settings (p

Circulation, Volume 150, Issue Suppl_1, Page A4140123-A4140123, November 12, 2024. Background/Introduction:Microvascular obstruction (MVO), due to damage to the coronary microvasculature, is a key determinant of infarct size, heart failure and poor outcomes following acute myocardial infarction, and there is currently no treatment for preventing MVO. Real-timein vivoimaging of MVO in the beating rodent heart is challenging due to the limited spatial and temporal resolution from movement artifacts. Here, we apply, for the first time, fiber-optic confocal laser endomicroscopy (CLM) for real-time imaging of the microvasculature in a beating murine heart with acute ischemia/reperfusion injury (IRI), and then monitoring the development of MVO.Methods:Anin vivomurine acute myocardial IRI model (45 min ligation of left coronary artery (LCA) and 30 min reperfusion) was applied. At 10 min prior to ischaemia, 150 µl Dextran-FITC (150 kDa, 10 mg/ml) was injected retro-orbitally, and then CLM imaging with a flexible miniprobe (ProFlex S-1500 with CellVizio system) was applied to the epicardial surface at multiple sites at 5 min post-injection (baseline), 30 min post-ischemia and 30 min post-reperfusion. A nitric oxide donor(NO) nanoparticle (NONP) was synthesized and IV bolus injected into IRI mice 5min prior to reperfusion to prevent MVO.Results:We confirmed visualization of the macro- and microvasculature at various sites on the epicardial surface of the beating heart. Next, we observed reduced microvasculature blood flow below LCA ligature as evidenced by reduced or even totally absence of FITC within the vessels at 30min post-ischemia. The microvasculature at the non-ischemic myocardium was unaffected. Furthermore, at 30 min post-reperfusion, we visualised patchy areas of reduced FITC signal suggesting MVO, and damaged microvasculature as evidenced by leakage of FITC outside the vessel. Interestingly, NONP treatment preserved the microvascular network and prevented MVO at 30 min post-reperfusion with even greater FITC, suggesting increased microvascular blood flow and penetration into cardiac tissue because of the vasodilatory effect of NO in the ischemic area.Conclusion:With CellVizio CLM system, we have demonstrated the MVO development during IRI, and damage to the microvasculature with leakage of dye from vessels into cardiac interstitium, thereby providing a pre-clinical platform to test novel therapeutic agents for preventing MVO. Importantly, we have shown an effective MVO prevention with NO-donor nanoparticle following IRI in mice.

Circulation, Volume 150, Issue Suppl_1, Page ASa1104-ASa1104, November 12, 2024. Introduction:Head-to-pelvis “sudden death computed tomography” angiography (SDCT) has a high diagnostic yield to identify causes and complications of out-of-hospital cardiac arrest (OHCA). The differences in yields of non-contrast head CT (H-CT) and pulmonary embolism chest CT (CT PE) angiography alone or in combination is not clear.Methods:Our prospective observational cohort enrolled patients that survived OHCA resuscitation and had a SDCT (H-CT, ECG-gated chest CT, and non-ECG gated venous phase abdomen/pelvis CT) within 6 hours of arrival (December 2015 – February 2018). For this sub-study, we assessed the same scans for diagnoses obtainable from routine H-CT and CT PE axial coverage alone, excluding any added (SDCT) findings from ECG-gating and abdomen/pelvis assessment. The primary outcome was the difference in diagnostic yield of time-critical and non-time-critical diagnoses by CT PE with or without H-CT compared to SDCT.Results:SDCT identified 86 time-critical diagnoses in 104 enrolled patients, including 39 pneumonias (45% of diagnoses), 13 myocardial infarctions [MI] (15%), 8 pulmonary embolisms (9%), 8 pneumothoraces (9%), 8 abdominal catastrophes (9%), 3 intracranial hemorrhages (3%), and 1 vascular access hemorrhage (1%) [Table]. CT PE alone identified 61 of the 86 time-critical diagnoses (71%), missing 25 diagnoses (29%) compared to SDCT. Missing diagnoses included MI (13/13), abdominal catastrophe (8/8), and active vascular access hemorrhage (1/1). H-CT diagnosed all 3 intracranial hemorrhages. Of the 208 non-time-critical diagnoses identified by SDCT, CT PE identified 183 non-time critical diagnoses (88%), missing 25 diagnoses (12%). H-CT did not identify any non-time-critical diagnoses.Conclusions:CT PE imaging with H-CT identifies a majority—but not all—time-critical and non-time-critical diagnoses in OHCA patients, mainly failing to capture coronary and intra-abdominal pathologies. SDCT, which includes ECG-gated chest CT and abdomen/pelvis CT, improves total diagnostic yield, but its incremental utility requires further study.

Circulation, Volume 150, Issue Suppl_1, Page A4140142-A4140142, November 12, 2024. Background:Cardiovascular-kidney metabolic (CKM) syndrome is exacerbated among individuals experiencing chronic exposure to both environmental and psychosocial stressors. Both neighborhood and individual-level stressors increase chronic inflammation resulting in worsened CKM factors, such as hypertension, diabetes, and dys/hyperlipidemia. However, associations between neighborhood perceptions (NP) and lipid profiles remain understudied. Therefore, we examined associations between NP domains and lipid profiles among African-American (AA) women with ≥Stage 1 CKM syndrome (overweight/obesity) residing in resource-limited neighborhoods within the Washington, DC area.Methods:Participants were enrolled in Step It Up, a technology-enabled, community-engaged physical activity (PA) intervention. Fasting blood samples were drawn at baseline to measure lipoproteins using Nuclear Magnetic Resonance (NMR) spectroscopy. Factor analysis of overall NP identified four perception sub-scores: disorder, social cohesion, violence, and safety (higher score=favorable perception). Associations between NP domains and lipoprotein particles were analyzed using multivariable regression adjusting for BMI, ASCVD 10-year risk score, and lipid-lowering therapy.Results:Participants (n=169) had mean age=57.16 ± 12.00 and BMI 35.99 ± 6.57. Perceptions of safety were positively associated with LDL concentrations (LDLc) and large LDL particles (L-LDLp) (β=4.70 [SD=2.41], p=0.05, β= 43.75 [17.70], p= 0.01), respectively). Perceptions about neighborhood violence were positively associated with L-LDLp (marginally) and very-low-density lipoprotein size (VLDLz) (β= 7.10 [3.96], p=0.08, β= 0.31 [0.14], p= 0.02, respectively). No associations were found between disorder and social cohesion with lipid biomarkers.Conclusions:After adjusting for BMI, ASCVD risk, and lipid-lowering therapy, there were significant associations between neighborhood perceptions of safety and violence with lipid profiles among AA women with CKM syndrome. Greater perceived safety was associated with higher LDLc and L-LDLp while more favorable perception about neighborhood violence was associated with higher L-LDLp. Future work should examine whether improving neighborhood resources and perceptions may improve CKM health among urban AA women.

Circulation, Volume 150, Issue Suppl_1, Page A4140134-A4140134, November 12, 2024. Background:Cardiovascular diseases are the second leading cause of death among cancer patients, after cancer-related mortality. It has not been well established if a patient’s malignancy status increases their risk of cardiovascular events following a myocardial infarction (MI).Hypothesis:This study aims to assess the impact of cancer on cardiovascular outcomes following an acute myocardial infarction.Methods:We systematically searched electronic databases such as Pubmed, Embase and Cochrane Library from inception until March 2024 using the appropriate Mesh terms, “ cancer,” “myocardial infarction,” and “cardiovascular mortality”, “in-hospital mortality”. Pooled relative risk and their corresponding confidence interval were calculated using the random effect model. A p-value of

Circulation, Volume 150, Issue Suppl_1, Page A4141437-A4141437, November 12, 2024. Background:Acute Type A Aortic Dissection (ATAAD) is a lethal disease with limited predictability globally. Cancer, a severe public health issue worldwide, has now become the second leading cause of death in America. In this study, we aimed to explore potential common mechanisms and therapeutic targets between ATAAD and cancer.Aims:Identify mitochondrial-related diagnostic biomarkers of ATAAD and their roles in various cancers.Methods:ATAAD-related datasets GSE52093, GSE98770, GSE190635 were downloaded from GEO and merged after removing batch effects. We verified 119 mitochondrial-related differentially expressed genes (DEGs), followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Using five machine learning methods (LASSO, SVM, Decision Tree, Random Forest, and Boruta algorithm), we identified two mitochondrial-related diagnostic biomarkers of ATAAD: PPIF and CASQ1. The diagnostic accuracy was performed using receiver operating characteristic (ROC) curves. RT-qPCR was used to detect PPIF and CASQ1 expression. Immune infiltration analysis suggested that PPIF may play a key role in tumor immune microenvironment. We utilized TCGA and GTEx databases, Kaplan-Meier analyses and Cox regression analyses to assess PPIF expression and survival analysis in 33 cancer types. qPCR and Western Blot (WB) assays verified PPIF overexpression in lung adenocarcinoma (LUAD) and uterine corpus endometrial carcinoma (UCEC). CCK-8, wound-healing and transwell assays further verified PPIF’s proliferative, migratory and invasive abilities in LUAD and UCEC.Results:Our study identified PPIF and CASQ1 as hub mitochondrial-related diagnostic biomarkers of ATAAD. Besides its close association with tumor immune infiltration, PPIF also overexpressed in multiple cancer types. Survival analysis suggested the prognostic value of PPIF in most cancers. Experimental results further verified that PPIF promotes the proliferation, migration, and invasion of LUAD and UCEC.Conclusions:PPIF and CASQ1 are potential mitochondrial-related diagnostic biomarkers of ATAAD, not previously reported. Pan-cancer analysis implies that PPIF may serve as a key prognostic and therapeutic target in multiple cancers. PPIF may act as a hub gene linking ATAAD and cancer, offering new insights to reduce ATAAD incidence in cancer patients.

Circulation, Volume 150, Issue Suppl_1, Page A4136963-A4136963, November 12, 2024. Background:There is increasing evidence of a strong association between obstructive sleep apnea (OSA) and ischemic heart disease. Previous studies have demonstrated OSA to be a significant predictor of incident CAD, while recent studies have confirmed individuals with OSA to have 3.9 times greater incidence of major adverse cardiac and cerebrovascular events (MACCE) at one year following acute myocardial infarction (AMI) than individuals without OSA. Whether treatment with continuous positive airway pressure (CPAP) after AMI in OSA patients reduces MACCE is not known. This study investigated the long-term cardiovascular outcomes associated with CPAP therapy after AMI in OSA patients, and is the first study to evaluate the effect of CPAP on secondary prevention after AMI.Methods:This retrospective study was conducted from 2015 to 2019 and included adults with AMI. Patients with at least moderate OSA (n=180) were followed for at least 1 year and categorized as either AMI and compliant to CPAP (54 patients) or AMI and non-compliant to CPAP (126 patients). We estimated the incidence of MACCE (early rehospitalization, re-catheterization, CABG, recurrent MI, CHF, arrhythmia, stroke, and death) in each group during follow-up from the index event. Continuous and categorical variables were analyzed for significance with Wilcoxon’s test and Fisher’s exact test respectively. Multivariate analyses were performed to adjust for confounders.Results:Most participants were male, the average age was 66 years old, and no significant demographic difference was identified between the two groups. Compared with non-compliant patients, CPAP-compliant patients exhibited significantly lower overall MACCE incidence (22.2% vs 40.5%, p=0.03) and repeat catheterization rate (1.9% vs 11.1%, p=0.04) after AMI.Conclusion:Long-term, compliant CPAP therapy, as compared with non-compliant CPAP therapy, significantly reduces recurrent cardiovascular events and provides effective secondary prevention after AMI in patients with at least moderate OSA.

Circulation, Volume 150, Issue Suppl_1, Page A4146753-A4146753, November 12, 2024. Background:The role of digital health interventions (DHI) in addition to usual care (UC) in patients discharged after an acute coronary syndrome (ACS) remains uncertain.Hypothesis:DHI improves medication adherence, and systolic blood pressure (BP) control and reduces mortality in patients after an ACS.Purpose:To ascertain the efficacy of adding DHI to UC in patients discharged after an ACS through a systematic review and meta-analysis.Methods:We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) comparing DHI plus UC versus UC alone in patients discharged after an ACS. We pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for binary and continuous outcomes, respectively. Our outcomes of interest were medication adherence (as per the studies’ definitions), all-cause mortality, and systolic BP. Statistical analyses were performed using R software version 4.4.0.Results:We included 22 RCTs comprising 20,587 patients, of whom 14,079 (68.4%) were randomized to DHI + UC. The mean age was 59.5 years and 58.5% were male. About 15% had diabetes mellitus at baseline while 54% had hypertension. In the pooled analysis, DHI plus UC significantly increased medication adherence (RR 1.06; 95% CI 1.01 to 1.13; p=0.03; Fig. 1) and reduced systolic BP (MD -3.16 mmHg; 95% CI -5.53 to -0.79; p

Circulation, Volume 150, Issue Suppl_1, Page A4140006-A4140006, November 12, 2024. Background:Mechanical circulatory support (MCS) devices have been widely used for managing acute myocardial infarction complicated by cardiogenic shock (AMI-CS). However, their use additionally elevates acute ischemic stroke (AIS) risk. There is insufficient data on the risk of AIS associated with early versus late initiation of MCS in AMI-CS cases.Aims:This study aimed to assess the timing of MCS initiation associated with the risk of AIS in patients with AMI-CS.Methods:A retrospective of the National Inpatient Sample data analysis (January 2016–December 2020) identified AMI-CS hospitalizations: categorized into early MCS initiation (48 h). The primary outcome was AIS; the secondary outcomes included in-hospital mortality, acute kidney injury (AKI), cardiac arrest, major bleeding, and blood transfusion. The outcomes were compared using logistic multivariate regression and 1:1 propensity score-matching analyses between the groups.Results:From 2016 to 2020, the use of IABP decreased from 35.89% to 30.21%, whereas Impella use increased from 8.49% to 15.27% and ECMO use increased from 2.05% to 2.90%.The incidence of AIS in patients with AMI-CS receiving MCS remained stable over the study period; 3.55% in 2016 and 4.54% in 2020 (P trend = 0.277). Among 78,405 weighted patients with AMI-CS receiving MCS, 82.77% (n=64,895) and 17.23% (n=13,510) underwent early and late MCS initiation, respectively. The patients with late MCS initiation had higher risks of AIS (5.74% vs. 3.60%; adjusted odds ratio [aOR] 1.46; 95% confidence interval [CI], 1.19-1.79; p

Circulation, Volume 150, Issue Suppl_1, Page A4140036-A4140036, November 12, 2024. Background:Heart failure with reduced ejection fraction (HFrEF), defined as a left ventricular ejection fraction (LVEF) of