This was a retrospective cohort study conducted in the intensive care unit (ICU) of CHUO. This polyvalent ICU admits both medical and surgical patients, with a significant proportion of female patients from the gynecology-obstetrics department.

The study covered a four-year period, from January 1, 2021, to December 31, 2024.

The target population included all records of patients admitted to the CHUO ICU for a cardiovascular emergency during the study period.

2.3.1. Inclusion Criteria

Medical records meeting the following criteria were selected for the study:

Age 18 years or older.Documented cardiovascular emergency.Management within the CHUO intensive care unit.Usable medical record (including at least age, sex, length of hospitalization, diagnosis, and evolutionary outcomes).

2.3.2. Non-Inclusion Criteria

Medical records meeting the following criteria were not selected:Non-cardiovascular pathologies;

2.3.3. Exclusion Criteria

Incomplete medical records that did not allow documentation of the main variables or evolutionary outcomes were excluded.

Data were extracted from medical records using a standardized collection form.

The collected variables included:

Sociodemographic data: age, sex, obstetric status (pregnancy, postpartum).Clinical data: reason for admission, clinical signs, comorbidities.Cardiovascular risk factors (hypertension, obesity, diabetes, smoking).Paraclinical data: results of biological tests, electrocardiogram and imaging. These examinations, which were not systematic, were carried out when indicated.The retained diagnosis

Some diagnoses that could qualify as emergencies in more than one category were classified in only one group.

Evolutionary data: length of stay in intensive care, outcome, mortality.

The diagnoses retained based on clinical and/or paraclinical data were as follows:

Coronary emergencies: acute coronary syndrome (ACS).Vascular emergencies: ischemic or hemorrhagic stroke (IS/HS), aortic dissection, pulmonary embolism (PE).Hypertensive emergencies: hypertensive encephalopathy, pregnancy-related hypertensive disorders (severe preeclampsia, eclampsia, retroplacental hematoma, HELLP syndrome).Hemodynamic emergencies: acute heart failure, acute pulmonary edema (APE), pericardial tamponade.Rhythmic emergencies: severe rhythm or conduction disorders.

For patients transferred with a previously established diagnosis, this was considered, unless a subsequent change was noted in the file.

The sample was exhaustive, including all patient records meeting the eligibility criteria during the study period. No prior calculation was performed due to the retrospective nature of the study.

Data were entered into an Excel file and analyzed using R, SPSS, and Epi Info 7 software*.

Qualitative variables were expressed as frequencies and percentages. Quantitative variables were expressed as means ± standard deviations or medians and ranges, depending on the distribution. Statistical associations were tested using the Chi² test or Fisher’s exact test for qualitative variables, and Student’s t-test or non-parametric tests for quantitative variables.

A univariate analysis was conducted to identify variables associated with mortality. Clinically relevant variables were introduced into a multivariate logistic regression model.

A stratified analysis comparing obstétric and non obstétric cases was performed to explore the influence of the obstetric contexton the profile of cardiovascular emergencies.

A significance threshold of 5% (p < 0.05) was adopted.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Official authorization was obtained from the hospital administration for access to patient records. Data were anonymized prior to analysis, ensuring patient confidentiality.

During the study period, 1334 patients were admitted to the CHUO intensive care unit, of whom 311 were for cardiovascular emergencies, representing a hospital frequency of 23.3% (Figure 1).

The mean age of the patients was 34.8 ± 14.2 years, with a predominance of the 26 - 45 year age group (56.6%; Figure 2).

Women represented 86.8% of the sample (n = 270), resulting in a sex ratio of 0.15. Among the female patients, 16 (5.9%) were pregnant and 205 (75.9%) were in the postpartum period.

In 78.1% of cases, patients came from the Gynecology-Obstetrics services, emergency reception, and operating room (Table 1).

Figure 1. Flowchart of patient file selection for patients presenting with a cardiovascular emergency in the intensive care unit of the CHUO.

Figure 2. Distribution of cardiovascular emergencies admitted to intensive care according to age group.

Table 1. Distribution of patients according to their origin.

The reason for admission was dominated by continuation of care for an already established diagnosis (87.1%). When specified, dyspnea was the most frequent reason for admission (6.1%) (Table 2).

Table 2. Patient distribution according to reason for admission.

The categorry of continued management of diagnosis corresponded mainly to hypertensive disorders of pregnancy in 230 (84.9%) cases, hemorragic (31; 11.4%) or ischemic (6; 2.2%) strokes and hypertensive encephalopathy (4; 1.5%)

The most frequently identified cardiovascular risk factors were overweight and obesity (27.7%), hypertension (22.5%), and alcohol consumption (19.6%). No known cardiovascular risk factors were identified in 48.4% of patients.

An electrocardiogram was available in the record of 18 patients, showing sinus tachycardia in four patients, a rhythm disorder consistent with atrial fibrillation in one patient, and an S1Q3 pattern in two patients. Doppler echocardiography, found in the record of 22 patients, revealed cardiac chamber dilation with left ventricular systolic dysfunction in 12 patients. It showed a large pericardial effusion with signs of compression in one patient. A mobile intimal flap separating two channels was visible in the ascending aorta, associated with a dilated aorta, moderate aortic regurgitation, and a pericardial effusion with signs of compression in another patient. A thoracic angio-CT, available in six patients, confirmed pulmonary embolism in two patients, signs of right heart failure in two patients, and an aortic dissection involving the ascending aorta in one patient. A cranio-encephalic CT scan, available in 26 patients, revealed lesions suggestive of strokes in 25 patients, including 8 ischemic and 17 hemorrhagic.

Overall, hypertensive emergencies (76.2%; n = 237) were the most frequent CVEs, followed by vascular emergencies (17.7%; n = 55) and hemodynamic emergencies (6.1%; n = 19) (Table 3).

Hypertensive emergencies were dominated by pregnancy-related hypertensive disorders. Strokes accounted for 87.3% of vascular emergencies. Ischemic stroke was due to an embolic rhythm disorder (atrial fibrillation) in one patient (0.3%). Pulmonary embolism occurred in the context of pelvic trauma in one patient and vertebro-medullary trauma in another. Aortic dissection, revealed by chest pain, occurred in a 38-year-old man with no particular history. It involved the ascending aorta (Stanford type A). Pericardial tamponade occurred in a young woman in the context of immunosuppression due to human immunodeficiency virus. The diagnosis of peripartum cardiomyopathy had been suggested in five patients (1.6%) with heart failure, and hypertensive heart disease in the same proportion.

Table 3. Distribution of patients according to the type of cardiovascular emergency.

WA: weeks of amenorrhea.

The median length of stay was three days (interquartile range (2 - 10 days) with extremes of 0 and 262 days).

A favorable outcome was observed in 90% of cases, marked by transfer to a peripheral service within the hospital (gynecology/obstetrics, neurosurgery, traumatology) or to an outpatient cardiology service for continuation of care before returning home. The overall hospital mortality was 9% (n = 28).

In univariate analysis, several factors were associated with mortality, including age, male sex, and hypertension. Patients with hemorrhagic stroke had a 15.7 times higher risk of death compared to others (OR: 15.7; 95% CI [6.7 - 37.4]; p = 0.001, Table 4).

Table 4.Univariate analysis of factors associated with hospital mortality.

CI: confidence interval; OR: odds ratio.

In multivariate analysis, none of the variables in the final model reached the threshold of statistical significance, although a trend toward association was observed for hypertension (Table 5).

Table 5. multivariate analysis of factors associated with mortality.

CI: confidence interval; OR: odds ratio.

Mortality varied significantly according to the diagnosis (p < 0.0001). Hemorrhagic stroke had the highest mortality in absolute numbers (16 deaths out of 38 cases, or 42.1%), accounting for 57.1% of all deaths. (Table 6)

Table 6. comparative analysis of outcomes according to diagnosis.

The analysis reveals two distinct profiles within the service:

The obstetric profile, accounting for 71.1% of cases, dominated by pregnancy-related hypertensive disorders, with low mortality.

The medical and vascular profile, 28.9% of cases, with a majority of strokes and heart failure, and rarer pathologies such as aortic dissection and pericardial tamponade, where mortality is higher, particularly with hemorrhagic strokes.