Keane Ryan R, Carnicelli Anthony P, Loriaux Daniel B, Kendsersky Payton, Krasuski Richard A, Brown Kelly M, Arps Kelly, Baird-Zars Vivian, Dixson Jeffrey A, Echols Emily, Granger Christopher B, Harrison Robert W, Kontos Michael, Newby L Kristin, Park Jeong-Gun, Shah Kevin S, Ternus Bradley W, Van Diepen Sean, Katz Jason N, Morrow David A
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
JACC Adv. 2024 Jul 22;3(8):101077. doi: 10.1016/j.jacadv.2024.101077. eCollection 2024 Aug.
Little is known regarding the characteristics, treatment patterns, and outcomes in patients with adult congenital heart disease (ACHD) admitted to cardiac intensive care units (CICUs).
The authors sought to better define the contemporary epidemiology, treatment patterns, and outcomes of ACHD admissions in the CICU.
The Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America. Participating centers contributed prospective data from consecutive admissions during 2-month annual snapshots from 2017 to 2022. We analyzed characteristics and outcomes of admissions with ACHD compared with those without ACHD. Multivariable logistic regression was used to assess mortality in ACHD vs non-ACHD admissions.
Of 23,299 CICU admissions across 42 sites, there were 441 (1.9%) ACHD admissions. Shunt lesions were most common (46.1%), followed by right-sided lesions (29.5%) and complex lesions (28.7%). ACHD admissions were younger (median age 46 vs 67 years) than non-ACHD admissions. ACHD admissions were more commonly for heart failure (21.3% vs 15.7%, < 0.001), general medical problems (15.6% vs 6.0%, < 0.001), and atrial arrhythmias (8.6% vs 4.9%, < 0.001). ACHD admissions had a higher median presenting Sequential Organ Failure Assessment score (5.0 vs 3.0, < 0.001). Total hospital stay was longer for ACHD admissions (8.2 vs 5.9 days, < 0.01), though in-hospital mortality was not different (12.7% vs 13.6%; age- and sex-adjusted OR: 1.19 [95% CI: 0.89-1.59], = 0.239).
This study illustrates the unique aspects of the ACHD CICU admission. Further investigation into the best approach to manage specific ACHD-related CICU admissions, such as cardiogenic shock and acute respiratory failure, is warranted.
关于入住心脏重症监护病房（CICU）的成人先天性心脏病（ACHD）患者的特征、治疗模式和结局，人们了解甚少。
作者试图更好地界定CICU中ACHD入院患者的当代流行病学、治疗模式和结局。
重症监护心脏病学试验网络是北美一个CICU多中心网络。参与中心提供了2017年至2022年每年2个月期间连续入院患者的前瞻性数据。我们分析了ACHD入院患者与非ACHD入院患者的特征和结局。采用多变量逻辑回归评估ACHD与非ACHD入院患者的死亡率。
在42个地点的23299例CICU入院患者中，有441例（1.9%）为ACHD入院患者。分流病变最为常见（46.1%），其次是右侧病变（29.5%）和复杂病变（28.7%）。ACHD入院患者比非ACHD入院患者更年轻（中位年龄46岁对67岁）。ACHD入院患者因心力衰竭（21.3%对15.7%，P<0.001）、一般内科问题（15.6%对6.0%，P<0.001）和房性心律失常（8.6%对4.9%，P<0.001）入院更为常见。ACHD入院患者的初始序贯器官衰竭评估评分中位数更高（5.0对3.0，P<0.001）。ACHD入院患者的总住院时间更长（8.2天对5.9天，P<0.01），尽管住院死亡率没有差异（12.7%对13.6%；年龄和性别调整后的比值比：1.19[95%CI：0.89-1.59]，P=0.239）。
本研究阐明了ACHD入住CICU的独特方面。有必要进一步研究管理特定ACHD相关CICU入院患者的最佳方法，如心源性休克和急性呼吸衰竭。
