Heartfelt discoveries for winter nights: December's game-changers in acute cardiovascular care

Abstract

With warmth and excitement, we proudly present the final issue of European Heart Journal: Acute Cardiovascular Care in 2024! As the year closes, we are excited to bring you a collection of thought-provoking and impactful articles-perfect reading for winter nights. This issue features 3 groundbreaking Research Papers, one in perspectives on a leading-edge clinical trial, and an insightful educational piece on ethics in cardiac care research. Leading the lineup, Mads Dam Lyhne's study (reference) takes a closer look at the prognostic power of the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio in evaluating patients with acute pulmonary embolism. Drawing from the extensive RIETE (Registro Informatizado de Enfermedad TromboEmbólica) registry data, this study spans 4478 patients across European Society of Cardiology-defined risk groups. A decrease in TAPSE/PASP ratio emerged as a significant predictor of 30-day mortality , particularly in intermediate-high-risk patients where rates escalated to 3.4%. Impressively, each 0.1 decrease in TAPSE/PASP ratio upped mortality odds by 26%. This finding confirms TAPSE/PASP as a valuable risk-stratification tool for clinical care, enabling safer decision-making on the need for hospitalization. Another notable contribution comes from Jarle Jortveit's (reference) extensive Norwegian cohort study, which highlights the stark outcomes for patients with acute myocardial infarction (AMI) complicated by either out-of-hospital (OHCA) or in-hospital cardiac arrest (IHCA). Analysing over 105 000 AMI patients, the study found in-hospital mortality rates of 28% for OHCA and a striking 49% for IHCA. While survivors of OHCA achieved long-term survival comparable to those without cardiac arrest. In contrast, IHCA survivors continue to face elevated long-term mortality. These results emphasize the need for targeted interventions, particularly for IHCA patients who remain vulnerable post-discharge. Also in this issue, John W. Pickering's team (reference) brings a real-world evaluation of point-of-care (POC) high-sensitivity troponin I (hs-cTnI) testing. Implemented as the primary troponin assay in the emergency department (ED), POC hs-cTnI testing reduced patient length of stay by an average of 32 min, translating to 21.4 fewer patient-hours each day. With comparable safety outcomes to traditional methods , these findings highlight the promise of POC hs-cTnI in boosting ED efficiency and patient flow. This efficient approach could transform patient care by easing ED crowding without compromising safety. Our "In Perspective" feature highlights the SYNERGY (OASIS-9) trial, which investigates the effects of colchicine and spironolactone on post-AMI outcomes. It also includes a trial interpretation by Dr. JC Tardif, the principal investigator of the COLCOT trial 1 , who shares his insights and contextualizes the findings in relation to his own trial results. Lastly, an educational piece by Neal Dickert (reference) tackles ethical complexities in cardiac critical care research, focusing on informed consent in high-stakes scenarios. Dickert's review outlines practical strategies to respect patient autonomy while advancing urgently needed cardiac research, spotlighting scenarios where prospective consent may be waived responsibly. We are proud to have gotten your attentive readership throughout this year and hope that this issue may again inform and inspire you. Enjoy, and here's to a meaningful year ahead in acute cardiovascular care! Enjoy!