Article
作者: Roule, Vincent ; Dupasquier, Valentin ; Sabir, Attou ; Boccara, Albert ; Léo, Lemarchand ; Marc, Goralski ; Fabien, Huet ; Nabil, Amri ; Christophe, Thuaire ; Damien, Millischer ; Fédérico, Swedsky ; Franck, Boccara ; Claire, Bouleti ; Marie, Hauguel-Moreau ; Eugénie, Thevenet ; Tanissia, Boukertouta ; Sonia, Azzakani ; Victoria, Tea ; Elena, De Angelis ; Swedsky, Fédérico ; Christophe, Tron ; Nabil, Bouali ; Thomas, Levasseur ; Pascal, Nhan ; Alexandre, Coppens ; François, Roubille ; Benoit, Merat ; Dillinger, Jean-Guillaume ; David, Martinez ; Schurtz, Guillaume ; Guillaume, Schurtz ; Puymirat, Etienne ; Simon, Auvray ; Bochaton, Thomas ; Thomas, Moine ; Nacim, Ezzouhairi ; Julien, Fabre ; Albert, Boccara ; Vincent, Roule ; Etienne, Puymirat ; Thomas, Landemaine ; Océane, Bouchot ; Antoine, Deney ; Jean, Claude Dib ; Clement, Charbonnel ; Charles, Fauvel ; Chaussade, Anne Solene ; Fauvel, Charles ; Henry, Patrick ; Pascal, Lim ; Antonin, Trimaille ; Guillaume, Viboud ; Eric, Bonnefoy-Cudraz ; Antony, El Hadad ; Nathalie, Noirclerc ; Bouleti, Claire ; Reza, Rossanaly Vasram ; Yves, Cottin ; Clément, Delmas ; Nissim, Grinberg ; Gerbaud, Edouard ; Mathilde, Stevenard ; Damien, Fard ; Arthur, Ramonatxo ; Anne, Solene Chaussade ; Martinez, David ; Jean-Guillaume, Dillinger ; Meune, Christophe ; Thevenet, Eugénie ; Alain, Grentzinger ; Thuaire, Christophe ; Nicolas, Piliero ; Ruben, Azencot ; Martine, Gilard ; Clemence, Docq ; Jean, Baptiste Brette ; Thibaut, Pommier ; Coisne, Augustin ; Benoit, Lattuca ; Cyril, Zakine ; Nicolas, Mansencal ; Laura, Delsarte ; Aures, Chaib ; Sean, Alvain ; Delmas, Clément ; Trimaille, Antonin ; Christophe, Meune ; Guillaume, Bonnet ; Stevenard, Mathilde ; Patrick, Henry ; Hauguel-Moreau, Marie ; Édouard, Gerbaud ; Charbonnel, Clément ; Emeric, Albert ; Meyer, Elbaz ; Arthur, Darmon ; Marc, Bedossa ; Franck, Albert ; Stéphane, Andrieu ; Fabien, Picard ; Marjorie, Canu ; Thomas, Bochaton ; Victor, Aboyans ; Pommier, Thibaut ; David, Sulman ; Tron, Christophe ; Théo, Pezel ; Amine, El Ouahidi ; Pezel, Théo ; Benjamin, Marie ; Maitre Ballesteros, Laura ; Valentin, Dupasquier ; El Ouahidi, Amine ; Laura, Maitre Ballesteros ; Millischer, Damien ; Dominique, Yomi ; Patrick, Ohlmann
AbstractAimsAlthough several studies have shown that the right ventricular to pulmonary artery (RV-PA) coupling, assessed by the ratio between tricuspid annular plane systolic excursion and systolic pulmonary artery pressure (TAPSE/sPAP) using echocardiography, is strongly associated with cardiovascular events, its prognostic value is not established in acute coronary syndrome (ACS). We aimed to assess the in-hospital prognostic value of TAPSE/sPAP among patients hospitalized for ACS in a retrospective analysis from the prospective ADDICT-ICCU study.Methods and resultsA total of 481 consecutive patients hospitalized in intensive cardiac care unit [mean age 65 ± 13 years, 73% of male, 46% ST-elevation myocardial infarction (STEMI)] for ACS [either STEMI or non-STEMI (NSTEMI)] with TAPSE/sPAP available were included in this prospective French multicentric study (39 centres). The primary outcome was in-hospital major adverse cardiovascular events (MACEs) defined as all-cause death, resuscitated cardiac arrest, or cardiogenic shock and occurred in 33 (7%) patients. Receiver operating characteristic curve analysis identified 0.55 mm/mmHg as the best TAPSE/sPAP cut-off to predict in-hospital MACEs. TAPSE/sPAP <0.55 was associated with in-hospital MACEs, even after adjustment with comorbidities [odds ratio (OR): 19.1, 95% confidence interval (CI) 7.78–54.8], clinical severity including left ventricular ejection fraction (OR: 14.4, 95% CI 5.70–41.7), and propensity-matched population analysis (OR: 22.8, 95% CI 7.83–97.2, all P < 0.001). After adjustment, TAPSE/sPAP <0.55 showed the best improvement in model discrimination and reclassification above traditional prognosticators (C-statistic improvement: 0.16; global χ2 improvement: 52.8; likelihood ratio test P < 0.001) with similar results for both STEMI and NSTEMI subgroups.ConclusionA low RV-PA coupling defined as TAPSE/sPAP ratio <0.55 was independently associated with in-hospital MACEs and provided incremental prognostic value over traditional prognosticators in patients hospitalized for ACS.Trial RegistrationClinicalTrials.gov Identifier: NCT05063097