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Masi P, Gendreau S, Moyon Q, Leguyader M, Lebreton G, Ropers J, Dangers L, Sitruk S, Bréchot N, Pineton de Chambrun M, Chommeloux J, Schmidt M, Luyt CE, Leprince P, Combes A, Frere C, Hékimian G. Bleeding complications, coagulation disorders, and their management in acute myocardial infarction-related cardiogenic shock rescued by veno-arterial ECMO: A retrospective cohort study. J Crit Care 2024; 82:154771. [PMID: 38471248 DOI: 10.1016/j.jcrc.2024.154771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/21/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Management of dual antiplatelet therapy (DAPT) in patients on venoarterial-extracorporeal membrane (VA-ECMO) after acute myocardial infarction (AMI) is challenging. Our objective was to describe the frequency, management and outcomes of severe bleeding complications and determine their occurrence risk factors. MATERIAL AND METHODS We conducted a retrospective observational cohort study including post-AMI cardiogenic shock patients requiring VA-ECMO. Severe bleeding was defined based on the Bleeding Academic Research Consortium classification. We calculated multivariable Fine-Gray models to assess factors associated with risk of severe bleeding. RESULTS From January 2015 to July 2019, 176 patients received VA-ECMO after AMI and 132 patients were included. Sixty-five (49%) patients died. Severe bleeding occurred in 39% of cases. Severe thrombocytopenia (< 50 G/L) and hypofibrinogenemia (<1,5 g/L) occurred in respectively 31% and 19% of patients. DAPT was stopped in 32% of patients with a 6% rate of stent thrombosis. Anticoagulation was stopped in 39% of patients. Using a multivariate competing risk model, female sex, time on ECMO, troponin at admission and Impella® implantation were independently associated with severe bleeding. CONCLUSIONS Bleeding complications and coagulation disorders were frequent and severe in patients on VA-ECMO after AMI, leading of antiplatelet therapy withdrawal in one third of patients.
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Affiliation(s)
- Paul Masi
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010 Créteil, France.
| | - Ségolène Gendreau
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010 Créteil, France
| | - Quentin Moyon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Maxence Leguyader
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France
| | - Guillaume Lebreton
- Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Cardiothoracic surgery department, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, F-75013 Paris, France
| | - Jacques Ropers
- Assistance Publique Hôpitaux de Paris, Unité de Recherche Clinique des Hôpitaux Universitaires Pitié Salpêtrière -Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Laurence Dangers
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Samuel Sitruk
- Assistance Publique Hôpitaux de Paris, Unité de Recherche Clinique des Hôpitaux Universitaires Pitié Salpêtrière -Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Nicolas Bréchot
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Marc Pineton de Chambrun
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Juliette Chommeloux
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Matthieu Schmidt
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Charles Edouard Luyt
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Pascal Leprince
- Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Cardiothoracic surgery department, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, F-75013 Paris, France
| | - Alain Combes
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Corinne Frere
- Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Department of Hematology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, F-75013 Paris, France
| | - Guillaume Hékimian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
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2
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Cherbi M, Bouisset F, Bonnefoy E, Lamblin N, Gerbaud E, Bonello L, Levy B, Lim P, Joffre J, Beuzelin M, Roland Y, Niquet L, Favory R, Khachab H, Harbaoui B, Vanzetto G, Combaret N, Marchandot B, Lattuca B, Leurent G, Lairez O, Puymirat E, Roubille F, Delmas C. Characteristics, management, and mid-term prognosis of older adults with cardiogenic shock admitted to intensive care units: Insights from the FRENSHOCK registry. Int J Cardiol 2024; 395:131578. [PMID: 37956759 DOI: 10.1016/j.ijcard.2023.131578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/25/2023] [Accepted: 11/09/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The incidence of heart failure and cardiogenic shock (CS) in older adults is continually increasing due to population aging. To date, prospective data detailing the specific characteristics, management and outcomes of CS in this population are scarce. METHODS FRENSHOCK is a prospective registry including 772 CS patients from 49 centers. We studied 1-month and 1-year mortality among patients over 75-year-old, adjusted for independent predictors of 1-month and 1-year mortalities. RESULTS Out of 772 patients included, 236 (30.6%) were 75 years old or more (mean age 81.9 ± 4.7 years, 63.6% male). Compared to patients <75 years old, older adults had a higher prevalence of comorbidities including hypertension, dyslipidemia, chronic kidney disease, and history of heart disease. Older adults were characterized by a lower blood pressure, as well as higher creatinine and lower haemoglobin levels at presentation. Yet, they were less likely to be treated with norepinephrine, epinephrine, invasive ventilation, and renal replacement therapy. They showed a higher 1-month (aHR: 2.5 [1.86-3.35], p < 0.01) and 1-year mortality (aHR: 2.01 [1.58-2.56], p < 0.01). Analysis of both 1-month and 1-year mortality stratified by age quartiles showed a gradual relationship between aging and mortality in CS patients. CONCLUSION A third of patient with CS in critical care unit are older than 75 years and their risk of death at one month and one year is more than double compared to the younger ones. Further research is essential to identify best therapeutic strategy in this population. NCT02703038.
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Affiliation(s)
- Miloud Cherbi
- Intensive Cardiac Care Unit, Cardiology department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 31059 Toulouse, France
| | - Frédéric Bouisset
- Intensive Cardiac Care Unit, Cardiology department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 31059 Toulouse, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000 Lille, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, 5 Avenue de Magellan, 33600 Pessac, France
| | - Laurent Bonello
- Aix-Marseille Université, Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), F-13385 Marseille, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France
| | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, F-94010 Créteil, France
| | | | | | - Yves Roland
- IHU HealthAge, Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Louis Niquet
- Intensive Care Unit, CH Intercommunal des Vallées de l'Ariège, France
| | - Raphael Favory
- Intensive Care Unit, Hôpital Roger Salengro, CHU de Lille, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Avenue des Tamaris, 13616, Aix-en-Provence cedex 1, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091 Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, F-35000 Rennes, France
| | - Olivier Lairez
- Cardiology department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse 31059, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, 75015 Paris, Université de Paris, 75006 Paris, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 31059 Toulouse, France; REICATRA, Institut Saint Jacques, CHU de Toulouse, Toulouse, France.
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Behnes M, Rusnak J, Egner-Walter S, Ruka M, Dudda J, Schmitt A, Forner J, Mashayekhi K, Tajti P, Ayoub M, Weiß C, Akin I, Schupp T. Effect of Admission and Onset Time on the Prognosis of Patients With Cardiogenic Shock. Chest 2024; 165:110-127. [PMID: 37579943 DOI: 10.1016/j.chest.2023.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/22/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The spectrum of patients with cardiogenic shock (CS) has changed significantly over time. CS has become especially more common in the absence of acute myocardial infarction (AMI), while this subset of patients was typically excluded from recent studies. Furthermore the prognostic impact of onset time and onset place due to CS has rarely been investigated. RESEARCH QUESTION Do the place of CS onset (out-of-hospital, ie, primary CS vs in-hospital, ie, secondary CS) and the onset time of out-of-hospital CS (ie, on-hours vs off-hours admission) affect the risk of all-cause mortality at 30 days? STUDY DESIGN AND METHODS This prospective monocentric registry included consecutive patients with CS of any cause from 2019 until 2021. First, the prognostic impact of the place of CS onset (out-of-hospital, ie, primary CS vs during hospitalization, ie, secondary CS) was investigated. Thereafter, the prognostic impact of the onset time of out-of-hospital CS was investigated. Furthermore, the prognostic impact of causative AMI vs non-AMI was investigated. Statistical analyses included Kaplan-Meier analyses, and univariable and multivariable Cox regression analyses. RESULTS Two hundred seventy-three patients with CS were included prospectively (64% with primary out-of-hospital CS). The place of CS onset was not associated with increased risk of all-cause mortality within the entire study cohort (secondary in-hospital CS: hazard ratio [HR], 1.532; 95% CI, 0.990-2.371; P = .06). However, increased risk of 30-day all-cause mortality was seen in patients with AMI related secondary in-hospital CS (HR, 2.087; 95% CI, 1.126-3.868; P = .02). Furthermore, primary out-of-hospital CS admitted during off-hours was associated with lower risk of all-cause mortality compared to primary CS admitted during on-hours (HR, 0.497; 95% CI, 0.302-0.817; P = .01), irrespective of the presence or absence of AMI. INTERPRETATION Primary and secondary CS were associated with comparable, whereas primary out-of-hospital CS admitted during off-hours was associated with lower risk of all-cause mortality at 30 days. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT05575856; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim
| | - Sascha Egner-Walter
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim
| | - Marinela Ruka
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim
| | - Jonas Dudda
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim
| | - Alexander Schmitt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, Lahr
| | - Péter Tajti
- Gottsegen György National Cardiovascular Center, Budapest, Hungary
| | - Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, Bad Oeynhausen, Germany
| | - Christel Weiß
- Institute of Biomathematics and Medical Statistics, Faculty of Medicine Mannheim, University Medical Center, Mannheim
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim.
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim
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Schupp T, Behnes M, Rusnak J, Ruka M, Dudda J, Forner J, Egner-Walter S, Barre M, Abumayyaleh M, Bertsch T, Müller J, Akin I. Does Albumin Predict the Risk of Mortality in Patients with Cardiogenic Shock? Int J Mol Sci 2023; 24:ijms24087375. [PMID: 37108536 PMCID: PMC10138505 DOI: 10.3390/ijms24087375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/02/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
This study investigates the prognostic impact of albumin levels in patients with cardiogenic shock (CS). Intensive care unit (ICU) related mortality in CS patients remains unacceptably high despite improvement concerning the treatment of CS patients. Limited data regarding the prognostic value of albumin in patients with CS is available. All consecutive patients with CS from 2019 to 2021 were included at one institution. Laboratory values were retrieved from the day of disease onset (day 1) and days 2, 3, 4, and 8 thereafter. The prognostic impact of albumin was tested for 30-day all-cause mortality. Moreover, the prognostic performance of albumin decline during ICU treatment was examined. Statistical analyses included univariable t-test, Spearman's correlation, Kaplan-Meier analyses, multivariable mixed analysis of variance (ANOVA), C-Statistics, and Cox proportional regression analyses. In total, 230 CS patients were included, with an overall all-cause mortality at 30 days of 54%. The median albumin on day 1 was 30.0 g/L. Albumin on day 1 was able to discriminate between 30-day survivors and non-survivors (area under the curve (AUC) 0.607; 0.535-0.680; p = 0.005). CS patients with albumin < 30.0 g/L were associated with an increased risk of 30-day all-cause mortality (63% vs. 46%; log-rank p = 0.016; HR = 1.517; 95% CI 1.063-2.164; p = 0.021), which was demonstrated even after multivariable adjustment. Moreover, a decrease of albumin levels by ≥20% from day 1 to day 3 was accompanied by a higher risk of 30-days all-cause mortality (56% vs. 39%; log-rank p = 0.036; HR = 1.645; 95% CI 1.014-2.669; p = 0.044). Especially when combined with lactate, creatinine, and cardiac troponin I, reliable discrimination of 30-day all-cause mortality was observed, including albumin in CS risk stratification models (AUC = 0.745; 95% CI 0.677-0.814; p = 0.001). In conclusion, low baseline albumin levels as well as a decay of albumin levels during the course of ICU treatment, deteriorate prognostic outcomes in CS patients. The additional assessment of albumin levels may further improve risk stratification in CS patients.
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Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Marinela Ruka
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jonas Dudda
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Sascha Egner-Walter
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Max Barre
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Julian Müller
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, 97616 Bad Neustadt a. d. Saale, Germany
- Department of Cardiology and Angiology, Philipps-University Marburg, 35037 Marburg, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
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Incognito C, Martens P, Hedley J, Parker JD, Posadas K, Gangidi S, Wazni O, Menon V, Rickard J, Hussein A, Tang WHW. Predictors and outcome of electrical storm-induced cardiogenic shock. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:906-915. [PMID: 36173893 DOI: 10.1093/ehjacc/zuac121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/11/2022] [Accepted: 09/27/2022] [Indexed: 12/30/2022]
Abstract
AIM Limited information is available about the short- and long-term outcomes in electrical storm (ES)-induced cardiogenic shock (CS) and its predictors. METHODS AND RESULTS This is a retrospective, single-centre cohort study of consecutive patients with ES admitted to the Cardiac Intensive Care Unit between 2015 and 2020. The proportion of ES patients who developed CS was adjudicated, and clinical predictors of in-hospital ventricular arrhythmia (VA)-related mortality and 1-year all-cause mortality were investigated. Of the 214 patients with ES, 33.6% developed CS. Left-ventricular ejection fraction, admission lactate, absence of an implantable cardioverter defibrillator, and admission central venous pressure were independently associated with development of CS (P < 0.03 for all). Based on these variables, a FLIC score was developed (https://riskcalc.org/FLICscore/) to predict ES-induced CS [area under the curve (AUC) = 0.949, with AUC = 0.954 in a validation cohort, both P < 0.001]. Patients who developed CS had a 11.3-fold [95% confidence interval (CI) 2.7-12.8] increased odds for in-hospital VA-related mortality and 9.4-fold (95% CI 4.0-22.4) increased odds for in-hospital all-cause mortality. A FLIC score above 0.62 was associated with a 6.2- and 5.8-fold increased odds for respectively similar endpoints. Patients with ES-induced CS received more treatment modalities to manage the ES (4.5 ± 1.8 vs. 2.3 ± 1.2, P < 0.001) and had longer length of stay [14 (8-27) vs. 8 (5-13), P < 0.001] than patients without CS. Interestingly, if patients with ES-induced CS survived to discharge, their outcomes were similar to those without CS at 1 year. CONCLUSION Cardiogenic shock in ES is a frequent and potentially life-threatening complication with high short-term mortality. A novel risk score could identify patient at risk, generating a potential for early risk-based interventions.
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Affiliation(s)
- Cameron Incognito
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Pieter Martens
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
| | - Jeffrey Hedley
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
| | - Joshua D Parker
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
| | - Kristine Posadas
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Shravani Gangidi
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
| | - John Rickard
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
| | - Ayman Hussein
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
| | - Wai Hong Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
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Bailleul C, Puymirat E, Aegerter P, Guidet B, Guerot E, Augy JL, Brechot N, Diehl JL, Fagon JY, Hermann B, Novara A, Ortuno S, Younan R, Danchin N, Cariou A, Aissaoui N. In-hospital cardiac arrests admitted alive in intensive care units: Insights from the CubRéa database. J Crit Care 2022; 69:154003. [DOI: 10.1016/j.jcrc.2022.154003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/21/2022] [Accepted: 01/30/2022] [Indexed: 11/26/2022]
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Rong F, Xiang H, Qian L, Xue Y, Ji K, Yin R. Machine Learning for Prediction of Outcomes in Cardiogenic Shock. Front Cardiovasc Med 2022; 9:849688. [PMID: 35600489 PMCID: PMC9120613 DOI: 10.3389/fcvm.2022.849688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/07/2022] [Indexed: 11/28/2022] Open
Abstract
Objective The management of cardiogenic shock (CS) in the elderly remains a major clinical challenge. Existing clinical prediction models have not performed well in assessing the prognosis of elderly patients with CS. This study aims to build a predictive model, which could better predict the 30-day mortality of elderly patients with CS. Methods We extracted data from the Medical Information Mart for Intensive Care III version 1.4 (MIMIC-III) as the training set and the data of validation sets were collected from the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University. Three models, including the cox regression model, the Least Absolute Shrinkage and Selection Operator (LASSO) regression model, and the CoxBoost model, were established using the training set. Through the comparison of area under the receiver operating characteristic (ROC) curve (AUC), C index, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and median improvement in risk score, the best model was selected. Then for external validation, compared the best model with the simplified acute physiology score II (SAPSII) and the CardShock risk score. Results A total of 919 patients were included in the study, of which 804 patients were in the training set and 115 patients were in the verification set. Using the training set, we built three models: the cox regression model including 6 predictors, the LASSO regression model including 4 predictors, and the CoxBoost model including 16 predictors. Among them, the CoxBoost model had good discrimination [AUC: 0.730; C index: 0.6958 (0.6657, 0.7259)]. Compared with the CoxBoost model, the NRI, IDI, and median improvement in risk score of other models were all<0. In the validation set, the CoxBoost model was also well-discriminated [AUC: 0.770; C index: 0.7713 (0.6751, 0.8675)]. Compared with the CoxBoost model, the NRI, IDI, and median improvement in risk score of SAPS II and the CardShock risk score were all < 0. And we constructed a dynamic nomogram to visually display the model. Conclusion In conclusion, this study showed that in predicting the 30-day mortality of elderly CS patients, the CoxBoost model was superior to the Cox regression model, LASSO regression model, SAPS II, and the CardShock risk score.
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Falco L, Fabris E, Gregorio C, Pezzato A, Milo M, Massa L, Lardieri G, Korcova R, Cominotto F, Vitrella G, Rakar S, Perkan A, Sinagra G. Early prognostic stratification and identification of irreversibly shocked patients despite primary percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2022; 23:247-253. [PMID: 34907143 PMCID: PMC10414156 DOI: 10.2459/jcm.0000000000001282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/18/2021] [Accepted: 10/31/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite prognostic improvements in ST-elevation myocardial infarction (STEMI), patients presenting with cardiogenic shock (CS) have still high mortality. Which are the relevant early prognostic factors despite revascularization in this high-risk population is poorly investigated. METHODS We analyzed STEMI patients treated with primary percutaneous coronary intervention (PCI) and enrolled at the University Hospital of Trieste between 2012 and 2018. A decision tree based on data available at first medical contact (FMC) was built to stratify patients for 30-day mortality. Multivariate analysis was used to explore independent factors associated with 30-day mortality. RESULTS Among 1222 STEMI patients consecutively enrolled, 7.5% presented with CS. CS compared with no-CS patients had worse 30-day mortality (33% vs 3%, P < 0.01). Considering data available at FMC, CS patients with a combination of age ≥76 years, anterior STEMI and an expected ischemia time > 3 h and 21 min were at the highest mortality risk, with a 30-day mortality of 85.7%. In CS, age (OR 1.246; 95% CI 1.045-1,141; P = 0.003), final TIMI flow 2-3 (OR 0.058; 95% CI 0.004-0.785; P = 0.032) and Ischemia Time (OR = 1.269; 95% CI 1.001-1.609; P = 0.049) were independently associated with 30-day mortality. CONCLUSIONS In a contemporary real-world population presenting with CS due to STEMI, age is a relevant negative factor whereas an early and successful PCI is positively correlated with survival. However, a subgroup of elderly patients had severe prognosis despite revascularization. Whether pPCI may have an impact on survival in a very limited number of irreversibly critically ill patients remains uncertain and the identification of irreversibly shocked patients remains nowadays challenging.
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Affiliation(s)
| | | | - Caterina Gregorio
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste
| | | | | | | | - Gerardina Lardieri
- Division of Cardiology, Emergency Department, Gorizia–Monfalcone Hospital
| | | | - Franco Cominotto
- Emergency Department, University Hospital of Trieste, Trieste, Italy
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9
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Vallabhajosyula S, Bhopalwala HM, Sundaragiri PR, Dewaswala N, Cheungpasitporn W, Doshi R, Prasad A, Sandhu GS, Jaffe AS, Bell MR, Holmes DR. Cardiogenic shock complicating non-ST-segment elevation myocardial infarction: An 18-year study. Am Heart J 2022; 244:54-65. [PMID: 34774802 DOI: 10.1016/j.ahj.2021.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/05/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the epidemiology and outcomes of non-ST-segment-elevation myocardial infarction-cardiogenic shock (NSTEMI-CS) in the United States. METHODS Adult (>18 years) NSTEMI-CS admissions were identified using the National Inpatient Sample (2000-2017) and classified by tertiles of admission year (2000-2005, 2006-2011 and 2012-2017). Outcomes of interest included temporal trends of prevalence and in-hospital mortality, use of cardiac procedures, in-hospital mortality, hospitalization costs, and length of stay. RESULTS In over 7.3 million NSTEMI admissions, CS was noted in 189,155 (2.6%). NSTEMI-CS increased from 1.5% in 2000 to 3.6% in 2017 (adjusted odds ratio 2.03 [95% confidence interval 1.97-2.09]; P < .001). Rates of non-cardiac organ failure and cardiac arrest increased during the study period. Between 2000 and 2017, coronary angiography (43.9%-63.9%), early coronary angiography (13.6%-25.6%), percutaneous coronary intervention (14.8%-31.6%), and coronary artery bypass grafting use (19.0%-25.8%) increased (P < .001). Over the study period, the use of intra-aortic balloon pump remained stable (28.6%-28.8%), and both percutaneous left ventricular assist devices (0%-9.1%) and extra-corporeal membrane oxygenation (0.1%-1.6%) increased (all P < .001). In hospital mortality decreased from 50.2% in 2000 to 32.3% in 2017 (adjusted odds ratio 0.27 [95% confidence interval 0.25-0.29]; P < .001). During the 18-year period, hospital lengths of stay decreased, and hospitalization costs increased. CONCLUSIONS In the United States, prevalence of CS in NSTEMI has increased 2-fold between 2000 and 2017, while in-hospital mortality has decreased during the study period. Use of coronary angiography and percutaneous coronary intervention increased during the study period.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
| | | | - Pranathi R Sundaragiri
- Department of Primary Care Internal Medicine, Wake Forest Baptist Health, High Point, NC
| | - Nakeya Dewaswala
- Division of Cardiovascular Medicine, Department of Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Rajkumar Doshi
- Division of Cardiovascular Medicine, Department of Medicine, Saint Joseph University Medical Center, Paterson, NJ
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Allan S Jaffe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Lemor A, Basir MB, Gorgis S, Todd J, Marso S, Gelormini J, Akhtar Y, Baker J, Chahin J, Abdul-Waheed M, Thukral N, O'Neill W. Impact of Age in Acute Myocardial Infarction Cardiogenic Shock: Insights From the National Cardiogenic Shock Initiative. Crit Pathw Cardiol 2021; 20:163-167. [PMID: 33606413 DOI: 10.1097/hpc.0000000000000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute myocardial infarction complicated by cardiogenic shock (AMICS) is associated with high mortality. Patients ≥75 years old represent an increasing proportion of those who present with AMICS and are at high risk for adverse outcomes. METHODS The National Cardiogenic Shock Initiative includes patients with AMICS treated using a standard shock protocol with early invasive hemodynamic monitoring, mechanical circulatory support (MCS), and percutaneous coronary intervention (PCI). We evaluated the outcomes of patients based on their age group, dividing them into <75 and ≥75 years old. RESULTS We included 300 consecutive patients: 238 were <75 years old (79.3%) and 62 patients ≥75 years old. There were significant differences in survival; patients <75 years old had a 75.6% survival, while those ≥75 years old had a 50% survival (adjusted OR: 10.4, P = 0.001). SCAI shock classification impacted survival as well; those <75 years old with class C or D shock had a survival of 84%, compared with 57% in those ≥75 years old. Patients ≥75 years old requiring 1 or 2 vasopressors had significantly lower survival rates (36% and 25%, respectively) when compared with patients <75 years old (76.7% with 1 and 60.5% with >1 vasopressor). CONCLUSIONS Age is inversely proportional to survival; patients <75 years old have high rates of survival if treated using best practices with invasive hemodynamic monitoring, early MCS, and PCI. However, using a standardized protocol can improve survival in the elderly; therefore, age on its own should not be a reason to withhold PCI or MCS use.
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Affiliation(s)
- Alejandro Lemor
- From the Department of Cardiology, Henry Ford Hospital, Detroit, MI
| | - Mir B Basir
- From the Department of Cardiology, Henry Ford Hospital, Detroit, MI
| | - Sarah Gorgis
- From the Department of Cardiology, Henry Ford Hospital, Detroit, MI
| | - Josh Todd
- Department of Cardiology, Fort Sanders Medical Center, Knoxville, TN
| | - Steve Marso
- Department of Cardiology, Overland Park Regional Medical Center, Overland Park, KS
| | - Joseph Gelormini
- Department of Cardiology, Mercy Hospital of Buffalo, Buffalo, NY
| | - Yasir Akhtar
- Department of Cardiology, North Knoxville Medical Center, Knox County, TN
| | - John Baker
- Department of Cardiology, Jackson/Madison Co. General Hospital, Jackson, TN
| | - Juan Chahin
- Department of Cardiology, Excela Health Westmoreland, Greensburg, PA
| | | | - Nandish Thukral
- Department of Cardiology, Methodist Heart Hospital, San Antonio, TX
| | - William O'Neill
- From the Department of Cardiology, Henry Ford Hospital, Detroit, MI
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Abstract
PURPOSE OF REVIEW Mechanical ventilation is frequently needed in patients with cardiogenic shock. The aim of this review is to summarize and discuss the current evidence and the pathophysiological mechanism that a clinician should consider while setting the ventilator. RECENT FINDINGS Little attention has been placed specifically to ventilatory strategies in patients with cardiogenic shock undertaking mechanical ventilation. Lung failure in patients with cardiogenic shock is associated with worsening outcome as well as a delay in mechanical ventilation institution. The hemodynamic profile and cardiogenic shock cause, considering the preload dependency of the failing heart, must be defined to adjust ventilatory setting. SUMMARY Evidence is growing regarding the role of lung failure as adverse prognostic factor and beneficial effect of positive pressure ventilation as part of first-line treatment in patients with cardiogenic failure.
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12
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Hongisto M, Lassus J, Tarvasmäki T, Sionis A, Sans‐Rosello J, Tolppanen H, Kataja A, Jäntti T, Sabell T, Lindholm MG, Banaszewski M, Silva Cardoso J, Parissis J, Di Somma S, Carubelli V, Jurkko R, Masip J, Harjola V. Mortality risk prediction in elderly patients with cardiogenic shock: results from the CardShock study. ESC Heart Fail 2021; 8:1398-1407. [PMID: 33522124 PMCID: PMC8006692 DOI: 10.1002/ehf2.13224] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/14/2020] [Accepted: 01/07/2021] [Indexed: 12/23/2022] Open
Abstract
AIMS This study aimed to assess the utility of contemporary clinical risk scores and explore the ability of two biomarkers [growth differentiation factor-15 (GDF-15) and soluble ST2 (sST2)] to improve risk prediction in elderly patients with cardiogenic shock. METHODS AND RESULTS Patients (n = 219) from the multicentre CardShock study were grouped according to age (elderly ≥75 years and younger). Characteristics, management, and outcome between the groups were compared. The ability of the CardShock risk score and the IABP-SHOCK II score to predict in-hospital mortality and the additional value of GDF-15 and sST2 to improve risk prediction in the elderly was evaluated. The elderly constituted 26% of the patients (n = 56), with a higher proportion of women (41% vs. 21%, P < 0.05) and more co-morbidities compared with the younger. The primary aetiology of shock in the elderly was acute coronary syndrome (84%), with high rates of percutaneous coronary intervention (87%). Compared with the younger, the elderly had higher in-hospital mortality (46% vs. 33%; P = 0.08), but 1 year post-discharge survival was excellent in both age groups (90% in the elderly vs. 88% in the younger). In the elderly, the risk prediction models demonstrated an area under the curve of 0.75 for the CardShock risk score and 0.71 for the IABP-SHOCK II score. Incorporating GDF-15 and sST2 improved discrimination for both risk scores with areas under the curve ranging from 0.78 to 0.84. CONCLUSIONS Elderly patients with cardiogenic shock have higher in-hospital mortality compared with the younger, but post-discharge outcomes are similar. Contemporary risk scores proved useful for early mortality risk prediction also in the elderly, and risk stratification could be further improved with biomarkers such as GDF-15 or sST2.
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Affiliation(s)
- Mari Hongisto
- Division of Emergency Medicine, Department of Emergency Medicine and ServicesHelsinki University HospitalPO Box 900Helsinki00029 HUSFinland
| | - Johan Lassus
- Cardiology, University of Helsinki and Heart and Lung CentreHelsinki University HospitalHelsinkiFinland
| | - Tuukka Tarvasmäki
- Cardiology, University of Helsinki and Heart and Lung CentreHelsinki University HospitalHelsinkiFinland
| | - Alessandro Sionis
- Cardiology DepartmentHospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Biomedical Research Institute IIB‐Sant Pau, CIBER‐CVBarcelonaSpain
| | - Jordi Sans‐Rosello
- Cardiology DepartmentHospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Biomedical Research Institute IIB‐Sant Pau, CIBER‐CVBarcelonaSpain
| | - Heli Tolppanen
- Cardiology, University of Helsinki and Heart and Lung CentreHelsinki University HospitalHelsinkiFinland
| | - Anu Kataja
- Division of Emergency Medicine, Department of Emergency Medicine and ServicesHelsinki University HospitalPO Box 900Helsinki00029 HUSFinland
| | - Toni Jäntti
- Cardiology, University of Helsinki and Heart and Lung CentreHelsinki University HospitalHelsinkiFinland
| | - Tuija Sabell
- Cardiology, University of Helsinki and Heart and Lung CentreHelsinki University HospitalHelsinkiFinland
| | | | - Marek Banaszewski
- Intensive Cardiac Therapy ClinicNational Institute of CardiologyWarsawPoland
| | - Jose Silva Cardoso
- CINTESIS—Center for Health Technology and Services Research, Department of Cardiology, Faculty of MedicineUniversity of Porto, São João University Medical CentrePortoPortugal
| | - John Parissis
- ER and Heart Failure UnitAttikon University HospitalAthensGreece
| | - Salvatore Di Somma
- Department of Medical Surgery, Sciences and Translational MedicineSapienza University of RomeRomeItaly
| | - Valentina Carubelli
- Cardiology Division, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity and Civil Hospital of BresciaBresciaItaly
| | - Raija Jurkko
- Cardiology, University of Helsinki and Heart and Lung CentreHelsinki University HospitalHelsinkiFinland
| | - Josep Masip
- Critical Care DepartmentHospital Sant Joan Despi Moisès Broggi, Consorci Sanitari Integral, University of BarcelonaBarcelonaSpain
| | - Veli‐Pekka Harjola
- Division of Emergency Medicine, Department of Emergency Medicine and ServicesHelsinki University HospitalPO Box 900Helsinki00029 HUSFinland
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13
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Vallabhajosyula S, Verghese D, Bell MR, Murphree DH, Cheungpasitporn W, Miller PE, Dunlay SM, Prasad A, Sandhu GS, Gulati R, Singh M, Lerman A, Gersh BJ, Holmes DR, Barsness GW. Fibrinolysis vs. primary percutaneous coronary intervention for ST-segment elevation myocardial infarction cardiogenic shock. ESC Heart Fail 2021; 8:2025-2035. [PMID: 33704924 PMCID: PMC8120407 DOI: 10.1002/ehf2.13281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/27/2021] [Accepted: 02/12/2021] [Indexed: 12/29/2022] Open
Abstract
AIMS There are limited contemporary data on the use of initial fibrinolysis in ST-segment elevation myocardial infarction cardiogenic shock (STEMI-CS). This study sought to compare the outcomes of STEMI-CS receiving initial fibrinolysis vs. primary percutaneous coronary intervention (PPCI). METHODS Using the National (Nationwide) Inpatient Sample from 2009 to 2017, a comparative effectiveness study of adult (>18 years) STEMI-CS admissions receiving pre-hospital/in-hospital fibrinolysis were compared with those receiving PPCI. Admissions with alternate indications for fibrinolysis and STEMI-CS managed medically or with surgical revascularization (without fibrinolysis) were excluded. Outcomes of interest included in-hospital mortality, development of non-cardiac organ failure, complications, hospital length of stay, hospitalization costs, use of palliative care, and do-not-resuscitate status. RESULTS During 2009-2017, 5297 and 110 452 admissions received initial fibrinolysis and PPCI, respectively. Compared with those receiving PPCI, the fibrinolysis group was more often non-White, with lower co-morbidity, and admitted on weekends and to small rural hospitals (all P < 0.001). In the fibrinolysis group, 95.3%, 77.4%, and 15.7% received angiography, PCI, and coronary artery bypass grafting, respectively. The fibrinolysis group had higher rates of haemorrhagic complications (13.5% vs. 9.9%; P < 0.001). The fibrinolysis group had comparable all-cause in-hospital mortality [logistic regression analysis: 28.8% vs. 28.5%; propensity-matched analysis: 30.8% vs. 30.3%; adjusted odds ratio 0.97 (95% confidence interval 0.90-1.05); P = 0.50]. The fibrinolysis group had comparable rates of acute organ failure, hospital length of stay, rates of palliative care referrals, do-not-resuscitate status use, and lesser hospitalization costs. CONCLUSIONS The use of initial fibrinolysis had comparable in-hospital mortality than those receiving PPCI in STEMI-CS in the contemporary era in this large national observational study.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA,Division of Pulmonary and Critical Care Medicine, Department of MedicineMayo ClinicRochesterMNUSA,Center for Clinical and Translational ScienceMayo Clinic Graduate School of Biomedical SciencesRochesterMNUSA,Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of MedicineEmory University School of Medicine1364 Clifton Road NEAtlantaGA30322USA,Department of MedicineAmita Health Saint Joseph HospitalChicagoILUSA
| | - Dhiran Verghese
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of MedicineEmory University School of Medicine1364 Clifton Road NEAtlantaGA30322USA,Department of MedicineAmita Health Saint Joseph HospitalChicagoILUSA
| | - Malcolm R. Bell
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | | | - Wisit Cheungpasitporn
- Division of Nephrology, Department of MedicineUniversity of Mississippi School of MedicineJacksonMSUSA
| | - Paul Elliott Miller
- Division of Cardiovascular Medicine, Department of MedicineYale University School of MedicineNew HavenCTUSA
| | - Shannon M. Dunlay
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA,Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | - Abhiram Prasad
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | | | - Rajiv Gulati
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | - Mandeep Singh
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | - Amir Lerman
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | | | - David R. Holmes
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
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14
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Analysis of potential factors contributing to refusal of invasive strategy after ST-segment elevation myocardial infarction in China. Chin Med J (Engl) 2021; 134:524-531. [PMID: 33652458 PMCID: PMC7929575 DOI: 10.1097/cm9.0000000000001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Reduced application of percutaneous coronary intervention (PCI) is associated with higher mortality rates after ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China. Methods: We studied 957 patients diagnosed with STEMI in the emergency departments (EDs) of six public hospitals in China. The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI. Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI. Results: The potential factors contributing to refusing PCI were older than 65 years (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.56–4.52, P < 0.001), low body mass index (BMI) (OR 0.91, 95% CI 0.84–0.98, P = 0.013), not being married (OR 0.29, 95% CI 0.17–0.49, P < 0.001), history of myocardial infarction (MI) (OR 2.59, 95% CI 1.33–5.04, P = 0.005), higher heart rate (HR) (OR 1.02, 95% CI 1.01–1.03, P = 0.002), cardiac shock in the ED (OR 5.03, 95% CI 1.48–17.08, P = 0.010), pre-hospital delay (>12 h) (OR 3.31, 95% CI 1.83–6.02, P < 0.001) and not being hospitalized in a tertiary hospital (OR 0.45, 95% CI 0.27–0.75, P = 0.002). Compared to men, women were older, were less often married, had a lower BMI and were less often hospitalized in tertiary hospitals. Conclusions: Patients who were older, had lower economic or social status, and had poorer health status were more likely to refuse PCI after STEMI. There was a sex difference in the potential predictors of refusing PCI. Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.
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15
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Wang JI, Lu DY, Mhs, Feldman DN, McCullough SA, Goyal P, Karas MG, Sobol I, Horn EM, Kim LK, Krishnan U. Outcomes of Hospitalizations for Cardiogenic Shock at Left Ventricular Assist Device Versus Non-Left Ventricular Assist Device Centers. J Am Heart Assoc 2020; 9:e017326. [PMID: 33222608 PMCID: PMC7763759 DOI: 10.1161/jaha.120.017326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Cardiogenic shock (CS) is a complex syndrome associated with high morbidity and mortality. In recent years, many US hospitals have formed multidisciplinary shock teams capable of rapid diagnosis and triage. Because of preexisting collaborative systems of care, hospitals with left ventricular assist device (LVAD) programs may also represent "centers of excellence" for CS care. However, the outcomes of patients with CS at LVAD centers have not been previously evaluated. Methods and Results Patients with CS were identified in the 2012 to 2014 National Inpatient Sample. Clinical characteristics, revascularization rates, and use of mechanical circulatory support were analyzed in LVAD versus non-LVAD centers. The association between hospital type and in-hospital mortality was examined using multivariable logistic regression models. Of 272 075 hospitalizations, 26.0% were in LVAD centers. CS attributable to causes other than acute myocardial infarction represented most cases. In-hospital mortality was lower in LVAD centers (38.9% versus 43.3%; P<0.001). In multivariable analysis, the odds of mortality remained significantly lower for hospitalizations in LVAD centers (odds ratio, 0.89; P<0.001). In patients with CS secondary to acute myocardial infarction, revascularization rates were similar between LVAD and non-LVAD centers. The use of intra-aortic balloon pump (18.7% versus 18.8%) and Impella/TandemHeart (2.6% versus 1.9%) was similar between hospital types, whereas extracorporeal membrane oxygenation was used more frequently in LVAD centers (4.3% versus 0.2%; P<0.001). Conclusions Risk-adjusted mortality was lower in patients with CS who were hospitalized at LVAD centers. These centers likely represent specialized, shock team capable institutions across the country that may be best suited to manage patients with CS.
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Affiliation(s)
- Joseph I Wang
- Division of Cardiology Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Daniel Y Lu
- Division of Cardiology Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Mhs
- Division of Cardiology Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Dmitriy N Feldman
- Division of Cardiology Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Stephen A McCullough
- Division of Cardiology Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Parag Goyal
- Division of Cardiology Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Maria G Karas
- Division of Cardiology Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Irina Sobol
- Division of Cardiology Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Evelyn M Horn
- Division of Cardiology Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Luke K Kim
- Division of Cardiology Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Udhay Krishnan
- Division of Cardiology Weill Cornell Medical College New York Presbyterian Hospital New York NY
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Diabetes mellitus, revascularization and outcomes in elderly patients with myocardial infarction-related cardiogenic shock. J Geriatr Cardiol 2020; 17:604-611. [PMID: 33224179 PMCID: PMC7657943 DOI: 10.11909/j.issn.1671-5411.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background The prognostic role of diabetes mellitus (DM) in elderly patients with myocardial infarction-related cardiogenic shock (MI-CS) remains controversial. Little information exists about the impact of intensive cardiac care unit (ICCU) and revascularization on outcomes of elderly patients with MI-CS. We aimed to assess the prognostic impact of DM according to age in patients with MI-CS, and to analyze the impact ICCU management and revascularization on in-hospital mortality in MI-CS patients at older ages. Methods Discharge episodes with diagnosis of CS associated with MI were selected from the Spanish National Health System's Basic Data Set. Centers were classified according to their availability of ICCU. Main outcome measured was in-hospital mortality. Results A total of 23, 590 episodes of MI-CS were identified, of whom 12, 447 (52.8%) were in patients aged ≥ 75 years. The impact of DM on in-hospital mortality was different among age subgroups. While in younger patients, DM was associated to a higher mortality risk (0.52 vs. 0.47, OR = 1.12, 95% CI: 1.06-1.18, χ2 < 0.001), this association became non-significant in older patients (0.76 vs. 0.81, χ2 = 0.09). Adjusted mortality rate of MI-CS aged ≥ 75 years was lower in patients admitted to hospitals with ICCU (adjusted mortality rate: 74.2% vs. 77.7%, P < 0.001) and in patients undergoing revascularization (74.9% vs. 77.3%, P < 0.001). Conclusions Prognostic impact of DM in patients with MI-CS was different according to age, with a significantly lower impact at older ages. The availability of ICCU and revascularization were associated with better outcomes in these complex patients.
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Aissaoui N, Puymirat E, Delmas C, Ortuno S, Durand E, Bataille V, Drouet E, Bonello L, Bonnefoy‐Cudraz E, Lesmeles G, Guerot E, Schiele F, Simon T, Danchin N. Trends in cardiogenic shock complicating acute myocardial infarction. Eur J Heart Fail 2020; 22:664-672. [DOI: 10.1002/ejhf.1750] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/18/2019] [Accepted: 12/28/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nadia Aissaoui
- Department of Critical Care, Assistance Publique‐Hôpitaux de Paris (APHP) Hôpital Européen Georges Pompidou (HEGP) Paris France
- Faculty of Medicine University Paris Descartes Paris France
- INSERM U970, Paris Cardiovascular Research Center PARCC Paris France
| | - Etienne Puymirat
- Faculty of Medicine University Paris Descartes Paris France
- Department of Cardiology Assistance Publique‐Hôpitaux de Paris, Hôpital Européen Georges Pompidou Paris France
| | - Clément Delmas
- Intensive Cardiac Care Unit, CHU Rangueil Toulouse France
| | - Sofia Ortuno
- Department of Critical Care, Assistance Publique‐Hôpitaux de Paris (APHP) Hôpital Européen Georges Pompidou (HEGP) Paris France
- Faculty of Medicine University Paris Descartes Paris France
| | - Eric Durand
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST‐CRB‐CRC) APHP‐Sorbonne Université, Hôpital St Antoine Paris France
- Hôpital Charles Nicolle Rouen France
| | | | - Elodie Drouet
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST‐CRB‐CRC) APHP‐Sorbonne Université, Hôpital St Antoine Paris France
- Hôpital Charles Nicolle Rouen France
| | | | | | | | - Emmanuel Guerot
- Department of Critical Care, Assistance Publique‐Hôpitaux de Paris (APHP) Hôpital Européen Georges Pompidou (HEGP) Paris France
- Faculty of Medicine University Paris Descartes Paris France
| | | | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST‐CRB‐CRC) APHP‐Sorbonne Université, Hôpital St Antoine Paris France
- Unité INSERM U‐1148 Paris France
- FACT (French Alliance for Cardiovascular Trials), An F‐CRIN Network Paris France
- Sorbonne‐Université, UPMC Paris France
| | - Nicolas Danchin
- Faculty of Medicine University Paris Descartes Paris France
- Department of Cardiology Assistance Publique‐Hôpitaux de Paris, Hôpital Européen Georges Pompidou Paris France
- FACT (French Alliance for Cardiovascular Trials), An F‐CRIN Network Paris France
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Gerbaud E, Elbaz M, Lattuca B. New insights into cardiogenic shock and coronary revascularization after acute myocardial infarction. Arch Cardiovasc Dis 2020; 113:276-284. [PMID: 32088156 DOI: 10.1016/j.acvd.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
Cardiogenic shock complicating acute myocardial infarction is challenging, and continues to be associated with high rates of in-hospital and long-term mortality. Coronary revascularization is critical for improving prognosis in CS. Thus, a systematic protocol-driven approach to cardiogenic shock, the development of specialized cardiac care centres, technical advances in interventional cardiology enabling treatment of more complex and severe lesions, the availability of recent antithrombotic therapies and the evolution of new haemodynamic support devices are important considerations in current management of cardiogenic shock complicating acute ischaemic heart disease. Despite these potentially meaningful developments, several substantial gaps in knowledge still exist regarding optimal coronary revascularization of patients with cardiogenic shock. This review will describe current principles in the revascularization of these patients, with a focus on: the time to transfer and revascularize; the choice of vascular access site; the need for complete revascularization or only a culprit lesion strategy; the optimal antithrombotic therapy; the type, place and timing of haemodynamic support; and the medical care system network.
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Affiliation(s)
- Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 33600 Pessac, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, 33000 Bordeaux, France
| | - Meyer Elbaz
- Department of Cardiology, CARDIOMET Institute, Rangueil Medical School, University Paul Sabatier, 31059 Toulouse, France.
| | - Benoit Lattuca
- Cardiology Department, Caremeau University Hospital, ACTION Study Group, Montpellier University, 30029 Nîmes, France
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Rivas-Lasarte M, Sans-Roselló J, Collado-Lledó E, González-Fernández V, Noriega FJ, Hernández-Pérez FJ, Fernández-Martínez J, Ariza A, Lidón RM, Viana-Tejedor A, Segovia-Cubero J, Harjola VP, Lassus J, Thiele H, Sionis A. External validation and comparison of the CardShock and IABP-SHOCK II risk scores in real-world cardiogenic shock patients. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2020; 10:2048872619895230. [PMID: 32004078 DOI: 10.1177/2048872619895230] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/26/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mortality from cardiogenic shock remains high and early recognition and risk stratification are mandatory for optimal patient allocation and to guide treatment strategy. The CardShock and the Intra-Aortic Balloon Counterpulsation in Acute Myocardial Infarction Complicated by Cardiogenic Shock (IABP-SHOCK II) risk scores have shown good results in predicting short-term mortality in cardiogenic shock. However, to date, they have not been compared in a large cohort of ischaemic and non-ischaemic real-world cardiogenic shock patients. METHODS The Red-Shock is a multicentre cohort of non-selected cardiogenic shock patients. We calculated the CardShock and IABP-SHOCK II risk scores in each patient and assessed discrimination and calibration. RESULTS We included 696 patients. The main cause of cardiogenic shock was acute coronary syndrome, occurring in 62% of the patients. Compared with acute coronary syndrome patients, non-acute coronary syndrome patients were younger and had a lower proportion of risk factors but higher rates of renal insufficiency; intra-aortic balloon pump was also less frequently used (31% vs 56%). In contrast, non-acute coronary syndrome patients were more often treated with mechanical circulatory support devices (11% vs 3%, p<0.001 for both). Both risk scores were good predictors of in-hospital mortality in acute coronary syndrome patients and had similar areas under the receiver-operating characteristic curve (area under the curve: 0.742 for the CardShock vs 0.752 for IABP-SHOCK II, p=0.65). Their discrimination performance was only modest when applied to non-acute coronary syndrome patients (0.648 vs 0.619, respectively, p=0.31). Calibration was acceptable for both scores (Hosmer-Lemeshow p=0.22 for the CardShock and 0.68 for IABP-SHOCK II). CONCLUSIONS In our cohort, both the CardShock and the IABP-SHOCK II risk scores were good predictors of in-hospital mortality in acute coronary syndrome-related cardiogenic shock.
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Affiliation(s)
- Mercedes Rivas-Lasarte
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Spain
| | - Jordi Sans-Roselló
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Spain
| | | | | | | | | | - Juan Fernández-Martínez
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Spain
| | - Albert Ariza
- Cardiology Service, Universitari Bellvitge Hospital-IDIBELL, Spain
| | - Rosa-Maria Lidón
- Cardiovascular Critical Care Unit, CIBER-CV Vall d'Hebron Hospital, Spain
| | | | - Javier Segovia-Cubero
- Advanced Heart Failure and Transplant Unit, Hospital Universitario Puerta de Hierro, Spain
| | | | - Johan Lassus
- Heart and Lung Centre, Helsinki University Hospital, Finland
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Spain
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Eckman PM, Katz JN, El Banayosy A, Bohula EA, Sun B, van Diepen S. Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Circulation 2019; 140:2019-2037. [DOI: 10.1161/circulationaha.119.034512] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Extracorporeal membrane oxygenation has evolved, from a therapy that was selectively applied in the pediatric population in tertiary centers, to more widespread use in diverse forms of cardiopulmonary failure in all ages. We provide a practical review for cardiovascular clinicians on the application of veno-arterial extracorporeal membrane oxygenation in adult patients with cardiogenic shock, including epidemiology of cardiogenic shock, indications, contraindications, and the extracorporeal membrane oxygenation circuit. We also summarize cannulation techniques, practical management and troubleshooting, prognosis, and weaning and exit strategies, with attention to end of life and ethical considerations.
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Affiliation(s)
| | - Jason N. Katz
- Department of Medicine, Duke University Medical Center, Durham, NC (J.N.K.)
| | - Aly El Banayosy
- Department of Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, OK (A.E.B.)
| | - Erin A. Bohula
- Thrombosis in Myocardial Infarction Study Group, Department of Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (E.A.B.)
| | | | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (S.V.D.)
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de la Torre Hernández JM, Brugaletta S, Gómez Hospital JA, Baz JA, Pérez de Prado A, López Palop R, Cid B, García Camarero T, Diego A, Gutiérrez H, Fernández Diaz JA, Sanchis J, Alfonso F, Blanco R, Botas J, Navarro Cuartero J, Moreu J, Bosa F, Vegas Valle JM, Elízaga J, Arrebola AL, Ruiz Arroyo JR, Hernández F, Salvatella N, Monteagudo M, Gómez Jaume A, Carrillo X, Martín Reyes R, Lozano F, Rumoroso JR, Andraka L, Domínguez AJ. Estratificación basal de riesgo en pacientes mayores de 75 años con infarto y shock cardiogénico referidos para angioplastia primaria. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Advancing Procedural Success in Cardiogenic Shock Among Elderly Patients: How Can We Improve? JACC Cardiovasc Interv 2019; 12:1860-1862. [PMID: 31537287 DOI: 10.1016/j.jcin.2019.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 11/22/2022]
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23
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Vyshlov EV, Ryabov VV. [Cardiogenic Shock in Patients with Myocardial Infarction]. ACTA ACUST UNITED AC 2019; 59:64-71. [PMID: 31397231 DOI: 10.18087/cardio.2019.8.2631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/08/2019] [Indexed: 11/18/2022]
Abstract
This review article contains presentation of modern diagnostic criteria and prognostic scales for cardiogenic shock in patients with myocardial infarction as well as analysis of current clinical guidelines. Main results of clinical trials underlying recommendations of these guidelines are discussed. The article focuses on controversial and unfounded recommendations and issues requiring further research.
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Affiliation(s)
- E V Vyshlov
- Сardiology Research Institute, Tomsk National Research Medical Centre
| | - V V Ryabov
- Сardiology Research Institute, Tomsk National Research Medical Centre
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24
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Abouelwafa M, Radwan W, Abdelfattah A, Abdelbary A, Khaled M, Samy W, Yousry M, Saeed A, Saad M. The usefulness of Veno-Arterial Extracorporeal Membranous Oxygenation in Patients with Cardiogenic Shock. Open Access Maced J Med Sci 2019; 7:1768-1773. [PMID: 31316656 PMCID: PMC6614275 DOI: 10.3889/oamjms.2019.547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/09/2019] [Accepted: 06/10/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND: Venoarterial extracorporeal membranous oxygenation is a form of temporary mechanical circulatory support that gets as a salvage technique in patients with cardiogenic shock, we intended to evaluate the effect of (VA ECMO) support on hemodynamics and lactate levels in patients with cardiogenic shock. AIM: The aim of our study is to detect the ability to introduce veno-arterial extracorporeal membranous oxygenation (VA ECMO) as a temporary extracorporeal life support system (ECLS) in our unit, demonstrate the role of ECMO in cardiogenic shock patients regarding improving hemodynamics and microcirculation, and demonstrate the complications and drawbacks in our first center experience regarding VA ECMO. MATERIAL AND METHODS: This was a single-centre observational study that included 10 patients admitted with cardiogenic shock for which VA ECMO was used as mechanical circulatory support. RESULTS: The MAP increased after initiation of the support. It was 41.8 ± 9.3 mmHg and 59.5 ± 6.8 mmHg (P = 0.005). The use of VA ECMO support was associated with a statistically significant decrease in the base deficit (-10.6 ± 4.2 and -6.3 ± 7.4, P = 0.038). The serum lactate declined from 5.9 ± 3.5 mmoL/L to 0.6 ± 4.4 mmoL/L by the use of VA ECMO; a statistically significant change (P = 0.005). CONCLUSIONS: We concluded that VA ECMO as mechanical support for patients with cardiogenic shock might improve mean arterial blood pressure, base deficit and lactate clearance.
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Affiliation(s)
| | - Waheed Radwan
- Critical Care Department, Cairo University Hospitals, Cairo, Egypt
| | - Alia Abdelfattah
- Critical Care Department, Cairo University Hospitals, Cairo, Egypt
| | - Akram Abdelbary
- Critical Care Department, Cairo University Hospitals, Cairo, Egypt
| | - Mohamed Khaled
- Critical Care Department, Cairo University Hospitals, Cairo, Egypt
| | - Wael Samy
- Critical Care Department, Cairo University Hospitals, Cairo, Egypt
| | - Mohamed Yousry
- Critical Care Department, Cairo University Hospitals, Cairo, Egypt
| | - Ahmed Saeed
- Critical Care Department, Cairo University Hospitals, Cairo, Egypt
| | - Mahmood Saad
- Critical Care Department, Cairo University Hospitals, Cairo, Egypt
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25
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Delmas C, Orloff E, Bouisset F, Moine T, Citoni B, Biendel C, Porterie J, Carrié D, Galinier M, Elbaz M, Lairez O. Predictive factors for long-term mortality in miscellaneous cardiogenic shock: Protective role of beta-blockers at admission. Arch Cardiovasc Dis 2019; 112:738-747. [PMID: 31155464 DOI: 10.1016/j.acvd.2019.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/08/2019] [Accepted: 04/15/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Despite advances in intensive care medicine, management of cardiogenic shock (CS) remains difficult and imperfect, with high mortality rates, regardless of aetiology. Predictive data regarding long-term mortality rates in patients presenting CS are sparse. AIM To describe prognostic factors for long-term mortality in CS of different aetiologies. METHODS Two hundred and seventy-five patients with CS admitted to our tertiary centre between January 2013 and December 2014 were reviewed retrospectively. Mortality was recorded in December 2016. A Cox proportional-hazards model was used to determine predictors of long-term mortality. RESULTS Most patients were male (72.7%), with an average age of 64±16 years and a history of cardiomyopathy (63.5%), mainly ischaemic (42.3%). Leading causes of CS were myocardial infarction (35.3%), decompensated heart failure (34.2%) and cardiac arrest (20.7%). Long-term mortality was 62.5%. After multivariable analysis, previous use of beta-blockers (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.41-0.89; P=0.02) and coronary angiography exploration at admission (HR 0.57, 95% CI 0.38-0.86; P=0.02) were associated with a lower risk of long-term mortality. Conversely, age (HR 1.02 per year, 95% CI 1.01-1.04; P<0.001), catecholamine support (HR 1.45 for each additional agent, 95% CI 1.20-1.75; P<0.001) and renal replacement therapy (HR 1.66, 95% CI 1.09-2.55; P=0.02) were associated with an increased risk of long-term mortality. CONCLUSIONS Long-term mortality rates in CS remain high, reaching 60% at 1-year follow-up. Previous use of beta-blockers and coronary angiography exploration at admission were associated with better long-term survival, while age, renal replacement therapy and the use of catecholamines appeared to worsen the prognosis, and should lead to intensification of CS management.
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Affiliation(s)
- Clément Delmas
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Intensive cardiac care unit, Rangueil university hospital, 31059 Toulouse, France.
| | - Elisabeth Orloff
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France
| | - Frédéric Bouisset
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France
| | - Thomas Moine
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France
| | | | - Caroline Biendel
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Intensive cardiac care unit, Rangueil university hospital, 31059 Toulouse, France
| | - Jean Porterie
- Department of cardiovascular surgery, Rangueil university hospital, 31059 Toulouse, France
| | - Didier Carrié
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Purpan medical school, university Paul Sabatier, 31300 Toulouse, France
| | - Michel Galinier
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Rangueil medical school, university Paul Sabatier, 31059 Toulouse, France
| | - Meyer Elbaz
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Rangueil medical school, university Paul Sabatier, 31059 Toulouse, France
| | - Olivier Lairez
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Rangueil medical school, university Paul Sabatier, 31059 Toulouse, France; Cardiac imaging centre, Toulouse university hospital, 31059 Toulouse, France; Department of nuclear medicine, Rangueil university hospital, 31059 Toulouse, France
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26
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Delmas C, Puymirat E, Leurent G, Elbaz M, Manzo-Silberman S, Bonello L, Gerbaud E, Bataille V, Levy B, Lamblin N, Bonnefoy E, Henry P, Roubille F. Design and preliminary results of FRENSHOCK 2016: A prospective nationwide multicentre registry on cardiogenic shock. Arch Cardiovasc Dis 2019; 112:343-353. [PMID: 30982720 DOI: 10.1016/j.acvd.2019.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/03/2019] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most data on the epidemiology of cardiogenic shock (CS) have come from patients with acute myocardial infarction admitted to intensive cardiac care units (ICCUs). However, CS can have other aetiologies, and could be managed in intensive care units (ICUs), especially the most severe forms of CS. AIM To gather data on the characteristics, management and outcomes of patients hospitalized in ICCUs and ICUs for CS, whatever the aetiology, in France in 2016. METHODS We included all adult patients with CS between April and October 2016 in metropolitan France. CS was defined (at admission or during hospitalization) by: low cardiac output, defined by systolic blood pressure<90mmHg and/or the need for amines to maintain systolic blood pressure>90mmHg and/or cardiac index<2.2L/min/m2; elevation of the left and/or right heart pressures, defined by clinical, radiological, biological, echocardiographic or invasive haemodynamic overload signs; and clinical and/or biological signs of malperfusion (lactate>2mmol/L, hepatic insufficiency, renal failure). RESULTS Over a 6-month period, 772 patients were included in the survey (mean age 65.7±14.9 years; 71.5% men) from 49 participating centres (91.8% were public, and 77.8% of these were university hospitals). Ischaemic trigger was the most common cause (36.3%). CONCLUSIONS To date, FRENSHOCK is the largest CS survey; it will provide a detailed and comprehensive global description of the spectrum and management of patients with CS in a high-income country.
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Affiliation(s)
- Clément Delmas
- Intensive cardiac care unit, cardiology department, university hospital of Rangueil, 31059 Toulouse, France.
| | - Etienne Puymirat
- Cardiology department, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, 35000 Rennes, France; Inserm LTSI-UMR 1099, Rennes university, 35043 Rennes, France
| | - Meyer Elbaz
- Intensive cardiac care unit, cardiology department, university hospital of Rangueil, 31059 Toulouse, France
| | - Stéphane Manzo-Silberman
- Intensive cardiac care unit, cardiology department, Lariboisière university hospital, AP-HP, 75010 Paris, France; UMR S-942, université Paris Diderot, 75010 Paris, France
| | - Laurent Bonello
- Intensive care unit, department of cardiology, hôpital Nord, AP-HM, 13015 Marseille, France; Mediterranean Association for research and studies in cardiology (MARS Cardio), 13015 Marseille, France; Inserm 1263, Inra 1260, Centre for cardiovascular and nutrition research (C2VN), Aix-Marseille university, 13385 Marseille, France
| | - Edouard Gerbaud
- Cardiology intensive care unit and interventional cardiology, hôpital cardiologique du Haut Lévêque, 33600 Pessac, France; Inserm U1045, Bordeaux cardio-thoracic research centre, Bordeaux university, 33607 Bordeaux, France
| | - Vincent Bataille
- Association pour la diffusion de la médecine de prévention (ADIMEP), 31400 Toulouse, France
| | - Bruno Levy
- Pôle cardio-médico-chirurgical, service de réanimation médicale Brabois, CHRU Nancy, 54500 Vandoeuvre-lès-Nancy, France; Inserm U1116, faculté de médecine, université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | - Nicolas Lamblin
- Inserm U1167, institut Pasteur de Lille, CHU Lille, université de Lille, 59019 Lille, France
| | - Eric Bonnefoy
- Hospices Civils de Lyon, université Claude Bernard Lyon 1, 69002 Lyon, France
| | - Patrick Henry
- Intensive cardiac care unit, cardiology department, Lariboisière university hospital, AP-HP, 75010 Paris, France; UMR S-942, université Paris Diderot, 75010 Paris, France
| | - François Roubille
- Inserm, CNRS, PhyMedExp, cardiology department, université de Montpellier, CHU de Montpellier, 34295 Montpellier, France
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Atti V, Patel NJ, Kumar V, Tripathi B, Basir MB, Voeltz M, Baber U, Kini AS, Sharma SK, O'Neill WW, Bhatt DL. Frequency of 30-day readmission and its causes after percutaneous coronary intervention in acute myocardial infarction complicated by cardiogenic shock. Catheter Cardiovasc Interv 2019; 94:E67-E77. [PMID: 30811833 DOI: 10.1002/ccd.28161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Survival after percutaneous coronary intervention (PCI) in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) has increased over the years. Short-term readmission rates in this high-risk population remain unknown. METHODS We queried the United States (U.S.) Nationwide Readmission Database (NRD) from January 2010 to November 2014 using the International Classification of Diseases-Ninth edition, Clinical Modification (ICD-9 CM) codes to identify all patients ≥18 years readmitted within 30 days after surviving an index hospitalization for PCI in AMI-CS. Incidence, etiologies, and predictors of 30-day readmission were analyzed. RESULTS Among 46,435 patients who survived to discharge after PCI in AMI-CS, 9,020 (19.4%) were readmitted within 30 days. Median time to 30-day readmission was 11 days. Cardiac conditions were the most common causes of readmission (57.8%). Heart failure was the leading readmission diagnosis (24.8%). Private insurance including HMO and self-pay were predictive of lower 30-day readmission. Among other covariates, female sex, comorbidities such as heart failure, atrial fibrillation, in-hospital complications such as major bleeding, sepsis, respiratory complications, AKI requiring dialysis, utilization of mechanical circulatory support (IABP and ECMO) were independently predictive of 30-day readmission. Trend analysis showed decline in 30-day readmission rates from 21.9% in 2010 to 17.9% in 2014 (ptrend < 0.001). CONCLUSION In this large real-world database, one in five patients receiving PCI in AMI-CS was readmitted within 30 days after discharge. Cardiac conditions were the most common causes of readmission. Insurance type had significant influence on 30-day readmission.
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Affiliation(s)
- Varunsiri Atti
- Department of Medicine, Michigan State University-Sparrow Hospital, Lansing, Michigan
| | - Nileshkumar J Patel
- Department of Cardiovascular Diseases, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Varun Kumar
- Department of Cardiovascular Diseases, Mt Sinai St Luke's Roosevelt, New York, New York
| | - Byomesh Tripathi
- Department of Cardiovascular Diseases, Mt Sinai St Luke's Roosevelt, New York, New York
| | - Mir B Basir
- Department of Cardiovascular Diseases, Henry Ford Health System, Detroit, Michigan
| | - Michele Voeltz
- Department of Cardiovascular Diseases, Henry Ford Health System, Detroit, Michigan
| | - Usman Baber
- Department of Cardiovascular Diseases, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna S Kini
- Department of Cardiovascular Diseases, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- Department of Cardiovascular Diseases, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - William W O'Neill
- Department of Cardiovascular Diseases, Henry Ford Health System, Detroit, Michigan
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
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Anker MS, von Haehling S, Papp Z, Anker SD. The new Heart Failure Association journal - ESC Heart Failure. Eur J Heart Fail 2018; 20:1657-1663. [PMID: 30561163 DOI: 10.1002/ejhf.1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Markus S Anker
- Department of Cardiology (CBF), Charité, Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Charité, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Zoltán Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Charité, Berlin, Germany
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Raja DC, Chopra A, Subban V, Maharajan R, Anandhan H, Vasu N, Farook J, Paramasivam R, Narayanan S, Uthayakumaran K, Pakshirajan B, Victor S, Solirajaram R, Krishnamoorthy J, Janakiraman E, Pandurangi UM, Kalidoss L, Mullasari AS. Predictors of short-term outcomes in patients undergoing percutaneous coronary intervention in cardiogenic shock complicating STEMI-A tertiary care center experience. Indian Heart J 2018; 70 Suppl 3:S259-S264. [PMID: 30595270 PMCID: PMC6309147 DOI: 10.1016/j.ihj.2018.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/21/2018] [Accepted: 03/23/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Studying the outcomes in patients presenting with cardiogenic shock with ST-segment elevation myocardial infarction (CS-STEMI) and undergoing primary or rescue percutaneous coronary intervention (PCI) may give an insight to the unmet needs in STEMI-care in our region and may help in future recommendations in improving survival. MATERIALS AND METHODOLGY During the period from January 2001- June 2017, there were 114 patients included in the study. The demographic, clinical and angiographic characteristics were compared between the survivors and non-survivors. All these variables were also compared between two-time frames (Phase 1- January 2001 to June 2007; Phase 2- July 2007 to June 2017). RESULTS Among patients undergoing PCI for STEMI, 7.5% were in cardiogenic shock. In-hospital mortality for the patients included in the study was 53.5%. Total ischemic time (OR=0.99, 0.99-1; p=0.02), left ventricular ejection fraction (LVEF) (OR=0.90, 0.82-0.98; p=0.02), need for cardio-pulmonary resuscitation (OR=0.12, 0.24-0.66; p=0.01), and post PCI TIMI flows (OR=0.08, 0.02-0.29; p<0.001) were the significant determinants of in-hospital mortality in the regression analysis. There was no significant change in mortality between the two phases of the study, though there was a reduction in total ischemic and door-to-balloon times, transfer admissions, use of thrombolytics, glycoprotein IIb/IIIa inhibitors, intra-aortic balloon pump, and mechanical ventilation in phase 2. CONCLUSION Patients presenting in CS-STEMI and undergoing PCI continue to experience high mortality rates, despite improvements in total ischemic times. Further improvement in the systems-of-care are required to bring about reduction in mortality in this high-risk subset.
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Affiliation(s)
- Deep Chandh Raja
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Aashish Chopra
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Vijayakumar Subban
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Rashmi Maharajan
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Harini Anandhan
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Nandhakumar Vasu
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Jawahar Farook
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Ramachandran Paramasivam
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Srinivasan Narayanan
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | | | - Balaji Pakshirajan
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Suma Victor
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Ramkumar Solirajaram
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Jaishankar Krishnamoorthy
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Ezhilan Janakiraman
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Ulhas M Pandurangi
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Latchumanadhas Kalidoss
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Ajit Sankaradas Mullasari
- Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India.
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de la Torre Hernández JM, Brugaletta S, Gómez Hospital JA, Baz JA, Pérez de Prado A, López Palop R, Cid B, García Camarero T, Diego A, Gutiérrez H, Fernández Diaz JA, Sanchis J, Alfonso F, Blanco R, Botas J, Navarro Cuartero J, Moreu J, Bosa F, Vegas Valle JM, Elízaga J, Arrebola AL, Ruiz Arroyo JR, Hernández F, Salvatella N, Monteagudo M, Gómez Jaume A, Carrillo X, Martín Reyes R, Lozano F, Rumoroso JR, Andraka L, Domínguez AJ. Baseline Risk Stratification of Patients Older Than 75 Years With Infarction and Cardiogenic Shock Undergoing Primary Angioplasty. ACTA ACUST UNITED AC 2018; 72:1005-1011. [PMID: 30297278 DOI: 10.1016/j.rec.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients older than 75 years with ST-segment elevation myocardial infarction undergoing primary angioplasty in cardiogenic shock have high mortality. Identification of preprocedural predictors of short- and long-term mortality could be useful to guide decision-making and further interventions. METHODS We analyzed a nationwide registry of primary angioplasty in the elderly (ESTROFA MI+75) comprising 3576 patients. The characteristics and outcomes of the subgroup of patients in cardiogenic shock were analyzed to identify associated factors and prognostic predictors in order to derive a baseline risk prediction score for 1-year mortality. The score was validated in an independent cohort. RESULTS A total of 332 patients were included. Baseline independent predictors of mortality were anterior myocardial infarction (HR 2.8, 95%CI, 1.4-6.0 P=.005), ejection fraction<40% (HR 2.3, 95%CI, 1.14-4.50 P=.018), and time from symptom onset to angioplasty >6hours (HR 3.2, 95%CI, 1.6-7.5; P=.001). A score was designed that included these predictive factors (score "6-ANT-40"). Survival at 1 year was 54.5% for patients with score 0, 32.3% for score 1, 27.4% for score 2 and 17% for score 3 (P=.004, c-statistic 0.70). The score was validated in an independent cohort of 124 patients, showing 1-year survival rates of 64.5%, 40.0%, 28.9%, and 22.2%, respectively (P=.008, c-statistic 0.68). CONCLUSIONS A preprocedural score based on 3 simple clinical variables (anterior location, ejection fraction<40%, and delay time >6 hours) may be used to estimate survival after primary angioplasty in elderly patients with cardiogenic shock and to guide preinterventional decision-making.
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Affiliation(s)
- José M de la Torre Hernández
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Salvatore Brugaletta
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clinic, Barcelona, Spain
| | - Joan A Gómez Hospital
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Bellvitge, Barcelona, Spain
| | - José A Baz
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Vigo, Vigo, Spain
| | - Armando Pérez de Prado
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de León, León, Spain
| | - Ramón López Palop
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital San Juan, Alicante, Spain
| | - Belen Cid
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Tamara García Camarero
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Alejandro Diego
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico de Salamanca, Salamanca, Spain
| | - Hipólito Gutiérrez
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, Spain
| | - José A Fernández Diaz
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Puerta de Hierro, Madrid, Spain
| | - Juan Sanchis
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico de Valencia, Valencia, Spain
| | - Fernando Alfonso
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de la Princesa, Madrid, Spain
| | - Roberto Blanco
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Cruces, Bilbao, Spain
| | - Javier Botas
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Alcorcón, Alcorcón, Spain
| | - Javier Navarro Cuartero
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Albacete, Albacete, Spain
| | - José Moreu
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Francisco Bosa
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico de Tenerife, Santa Cruz de Tenerife, Spain
| | - José M Vegas Valle
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Cabueñes, Gijón, Spain
| | - Jaime Elízaga
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Gregorio Marañón, Madrid, Spain
| | - Antonio L Arrebola
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Virgen de las Nieves, Granada, Spain
| | - José R Ruiz Arroyo
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico de Zaragoza, Zaragoza, Spain
| | - Felipe Hernández
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain
| | - Neus Salvatella
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital del Mar, Grup de Recerca Biomèdica en Malalties del Cor, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Marta Monteagudo
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Doctor Peset, Valencia, Spain
| | - Alfredo Gómez Jaume
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Son Espases, Palma de Mallorca, Spain
| | - Xavier Carrillo
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Roberto Martín Reyes
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Fundación Jiménez Díaz, Madrid, Spain
| | - Fernando Lozano
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Ciudad Real, Ciudad Real, Spain
| | - José R Rumoroso
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Galdacano, Bilbao, Spain
| | - Leire Andraka
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Basurto, Bilbao, Spain
| | - Antonio J Domínguez
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
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Aissaoui N, Bougouin W, Dumas F, Beganton F, Chocron R, Varenne O, Spaulding C, Karam N, Montalescot G, Aubry P, Sideris G, Marijon E, Jouven X, Cariou A. Age and benefit of early coronary angiography after out-of-hospital cardiac arrest in patients presenting with shockable rhythm: Insights from the Sudden Death Expertise Center registry. Resuscitation 2018; 128:126-131. [PMID: 29746987 DOI: 10.1016/j.resuscitation.2018.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/02/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Little is known about the association between provision of post-resuscitation care and prognosis of out-of-hospital cardiac arrest (OHCA) in elderly patients. Previous studies have suggested futility after 65 years of age. OBJECTIVES We aimed to evaluate the association of early coronary angiogram (CAG) followed if necessary by percutaneous coronary intervention (PCI), with favorable outcome after OHCA among elderly patients, compared to younger patients. METHODS Using a large French registry, we included all OHCA patients with an initial shockable rhythm, transported to hospital from 2011 to 2015. Favorable outcome was defined as hospital discharge with Cerebral Performance Category (CPC) 1 or 2. and were evaluated by multivariate logistic regression. Subgroup analyses were performed according to age groups: <65, 65-75 and >75 years. RESULTS Among 1502 included patients, 31% were older than 65 and 12% older than 75 years. An early CAG was performed in 79%, 88% and 76% of patients below 65, between 65 and 75 and above 75, respectively (P = 0.002). The rate of patients discharged with CPC1 or 2 was 42% below 65, 38% between 65 and 75 and 24% above 75 (P < 0.001). Among the whole population, early CAG (OR = 6.4, 95% CI = 3.9-10.5, P < 0.001) was associated with favorable outcome. In subgroups analysis, CAG was associated with favorable outcome among patients <65 and 65-75. In patients >75, there was a trend towards a favorable outcome (OR2.9, 95CI = 0.9-9.1). CONCLUSIONS In a large registry of OHCA survivors, the early CAG use was associated with a better prognosis. This benefit was persistent up to 75 years of age, suggesting that age alone should not guide the decision for early invasive strategy.
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Affiliation(s)
- Nadia Aissaoui
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Department of Critical Care Unit, Paris, France; Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France.
| | - Wulfran Bougouin
- Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France
| | - Florence Dumas
- Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; APHP, Emergency Department, Cochin/Hotel-Dieu Hospital, Paris, France
| | | | - Richard Chocron
- Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; APHP, Emergency Department, HEGP, Paris, France
| | - Olivier Varenne
- Université Paris-Descartes, Paris, France; AP-HP, Cochin, Department of Cardiology, Paris, France
| | - Christian Spaulding
- Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; AP-HP, HEGP, Department of Cardiology, Paris, France
| | - Nicole Karam
- Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; AP-HP, HEGP, Department of Cardiology, Paris, France
| | - Gilles Montalescot
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Cardiology, Paris, France; Université Pierre et Marie Curie, Paris, France
| | - Pierre Aubry
- AP-HP, Hôpital Bichat, Department of Cardiology, Paris, France; Université Paris Diderot, Paris, France
| | - Georges Sideris
- Université Paris Diderot, Paris, France; AP-HP, Hôpital Lariboisière, Department of Cardiology, Paris, France
| | - Eloi Marijon
- Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; AP-HP, HEGP, Department of Cardiology, Paris, France
| | - Xavier Jouven
- Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; AP-HP, HEGP, Department of Cardiology, Paris, France
| | - Alain Cariou
- Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; APHP, Hôpital Cochin, Department of Critical Care Unit, Paris, France
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Kalmanovich E, Blatt A, Brener S, Shlezinger M, Shlomo N, Vered Z, Hod H, Goldenberg I, Elbaz-Greener G. Trends in the management and outcomes of patients admitted with acute coronary syndrome complicated by cardiogenic shock over the past decade: Real world data from the acute coronary syndrome Israeli survey (ACSIS). Oncotarget 2018; 8:42876-42886. [PMID: 28476027 PMCID: PMC5522112 DOI: 10.18632/oncotarget.17152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/27/2017] [Indexed: 12/18/2022] Open
Abstract
Registries and other cohorts have demonstrated that early revascularization improve the survival of patients presenting with Cardiogenic Shock (CS) completing Aute coronary syndrome (ACS). Our aim was to describe the change in the clinical characteristics of these patients and their management and their outcome. The study population comprised 224 patients who were admitted with ACS complicated by cardiogenic shock who were enrolled in the prospective biannual Acute Coronary Syndrome Israeli Surveys (ACSIS) between 2000 and 2013 (1.7% of all patients admitted with ACS during the study period). Survey periods were categorized as early (years 2000-2004) and late (year 2006-2013). The rate of cardiogenic shock complicated ACS declined from 1.8% between the years 2000-2004 to 1.5% during the years 2006-2013. The clinical presentation in both the early and late groups was similar. During the index hospitalization primary percutaneous coronary intervention (PPCI) was more frequently employed during the late surveys [31% vs. 58% (p<0.001)], while fibrinolysis therapy was not used in the late surveys group [27% vs. 0.0% (p=<0.001)]. Compared to patients enrolled in the early surveys, those enrolled in the late survey group experienced significantly lower mortality rates at 7-days (44% vs. 30%, respectively; p=0.03). However, this difference was no longer statistically significant at 30-days (52.8% vs. 46.4%, respectively, p=0.34) and 1-year (63% vs. 53.2%, respectively, p=0.14). Similarly, the rate of major adverse cardiac events (MACE) at 30-days was similar between the two groups (57.4% vs. 47.4%, respectively, p=0.13). Our findings indicate that patients admitted with ACS complicated by cardiogenic shock still experience very high rates of MACE and mortality during follow-up, despite a significant increase in the use of PPCI in this population over the past decade.
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Affiliation(s)
- Eran Kalmanovich
- Department of Cardiology, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Alex Blatt
- Department of Cardiology, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Svetlana Brener
- Department of Cardiology, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Meital Shlezinger
- The Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Nir Shlomo
- The Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Zvi Vered
- Department of Cardiology, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Hanoch Hod
- The Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ilan Goldenberg
- The Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Gabby Elbaz-Greener
- Department of Cardiology, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
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Metra M. September 2016 at a glance: pregnancy, hypertrophic cardiomyopathy, epidemiology, medical treatment. Eur J Heart Fail 2018; 18:1091-2. [PMID: 27594173 DOI: 10.1002/ejhf.627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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Guo J, Zhang S, Ma L, Shi H, Zhu J, Wu J, An Y, Ge J. Cardioprotection by Mild Hypothermia Is Abolished in Aged Mice. Ther Hypothermia Temp Manag 2017; 7:193-198. [PMID: 28445087 DOI: 10.1089/ther.2017.0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Junjie Guo
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao University, Shandong, China
| | - Shuning Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Leilei Ma
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hongtao Shi
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianbing Zhu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Wu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi An
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao University, Shandong, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
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Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States. Clin Res Cardiol 2017; 107:287-303. [DOI: 10.1007/s00392-017-1182-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
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Gustafsson F. Management of patients with cardiogenic shock on temporary mechanical circulatory support: urgent transplantation or on to the next pump? Eur J Heart Fail 2017; 20:187-189. [DOI: 10.1002/ejhf.1023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/28/2017] [Indexed: 01/06/2023] Open
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Abstract
This CME article addresses the pathophysiology, incidence, current survival outcome and treatment options for patients with cardiogenic shock as a complication of acute myocardial infarction. The shock spiral of left heart failure due to cardiac infarction, subsequent vasoconstriction and paradoxical vasodilation due to the systemic inflammation response syndrome (SIRS) is a vicious circle which must be interrupted. Treatment focuses on the evidence from randomized clinical trials and the current guideline recommendations. With respect to interventional and surgical treatment the question of culprit lesion vs. complete revascularization is still unsolved. For medicinal treatment acetylsalicylic acid (ASA) and heparin are more often supplemented with prasugrel and ticagrelor. In the case of inotropes, dobutamine remains the first-line treatment option and for vasopressors norepinephrine. The calcium sensitizer levosimendan has not provided the hoped for superiority over conventional treatment in randomized trials. The use of intra-aortic balloon pumps (IABP) is no longer recommended as circulatory support in acute heart failure (reduced to class III). The use of percutaneous implantable mechanical circulatory support devices has not shown a survival benefit in the few randomized trials carried out so far even when compared with IABP, due to increased bleeding complications.
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Affiliation(s)
- H Thiele
- Herzzentrum, Klinik für Innere Medizin/Kardiologie, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland.
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van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e232-e268. [PMID: 28923988 DOI: 10.1161/cir.0000000000000525] [Citation(s) in RCA: 933] [Impact Index Per Article: 133.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities.
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Champion S. Extracorporeal membrane oxygenation in the therapy of cardiogenic shock (ECMO-CS): the need for a better definition of refractory cardiogenic shock. Eur J Heart Fail 2017; 20:197-198. [DOI: 10.1002/ejhf.939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/08/2017] [Accepted: 06/11/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sébastien Champion
- Réanimation, Clinique de Parly 2; Ramsay Générale de Santé; Le Chesnay France
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Metra M. February 2017 at a glance: fibrosis, acute heart failure and neurologic abnormalities. Eur J Heart Fail 2017; 19:165-166. [PMID: 28157268 DOI: 10.1002/ejhf.760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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Hongisto M, Lassus J, Tarvasmaki T, Sionis A, Tolppanen H, Lindholm MG, Banaszewski M, Parissis J, Spinar J, Silva-Cardoso J, Carubelli V, Di Somma S, Masip J, Harjola VP. Use of noninvasive and invasive mechanical ventilation in cardiogenic shock: A prospective multicenter study. Int J Cardiol 2016; 230:191-197. [PMID: 28043661 DOI: 10.1016/j.ijcard.2016.12.175] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 12/22/2016] [Accepted: 12/25/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite scarce data, invasive mechanical ventilation (MV) is widely recommended over non-invasive ventilation (NIV) for ventilatory support in cardiogenic shock (CS). We assessed the real-life use of different ventilation strategies in CS and their influence on outcome focusing on the use of NIV and MV. METHODS 219 CS patients were categorized by the maximum intensity of ventilatory support they needed during the first 24h into MV (n=137; 63%) , NIV (n=26; 12%), and supplementary oxygen (n=56; 26%) groups. We compared the clinical characteristics and 90-day outcome between the MV and the NIV groups. RESULTS Mean age was 67years, 74% were men. The MV and NIV groups did not differ in age, medical history, etiology of CS, PaO2/FiO2 ratio, baseline hemodynamics or LVEF. MV patients predominantly presented with hypoperfusion, with more severe metabolic acidosis, higher lactate levels and greater need for vasoactive drugs, whereas NIV patients tended to be more often congestive. 90-day outcome was significantly worse in the MV group (50% vs. 27%), but after propensity score adjustment, mortality was equal in both groups. Confusion, prior CABG, ACS etiology, higher lactate level, and lower baseline PaO2 were independent predictors of mortality, whereas ventilation strategy did not have any influence on outcome. CONCLUSIONS Although MV is generally recommended mode of ventilatory support in CS, a fair number of patients were successfully treated with NIV. Moreover, ventilation strategy was not associated with outcome. Thus, NIV seems a safe option for properly chosen CS patients.
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Affiliation(s)
- Mari Hongisto
- Emergency Medicine, University of Helsinki, Department of Emergency Care, Helsinki University Hospital, Helsinki, Finland.
| | - Johan Lassus
- Helsinki University Hospital, Heart and Lung Center, Division of Cardiology, Helsinki, Finland
| | - Tuukka Tarvasmaki
- Emergency Medicine, University of Helsinki, Department of Emergency Care, Helsinki University Hospital, Helsinki, Finland
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona, Spain
| | - Heli Tolppanen
- Helsinki University Hospital, Heart and Lung Center, Division of Cardiology, Helsinki, Finland
| | - Matias Greve Lindholm
- Rigshospitalet, Copenhagen University Hospital, Intensive Cardiac Care Unit, Copenhagen, Denmark
| | - Marek Banaszewski
- Institute of Cardiology, Intensive Cardiac Therapy Clinic, Warsaw, Poland
| | - John Parissis
- Attikon University Hospital, Heart Failure Clinic and Secondary Cardiology Department, Athens, Greece
| | - Jindrich Spinar
- University Hospital Brno, Department of Internal Medicine and Cardiology, Brno, Czech Republic
| | - Jose Silva-Cardoso
- University of Porto, CINTESIS, Department of Cardiology, Porto Medical School, São João Hospital Center, Porto, Portugal
| | - Valentina Carubelli
- Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Italy
| | - Salvatore Di Somma
- Department of Medical Sciences and Translational Medicine, University of Rome Sapienza, Emergency Medicine Sant'Andrea Hospital, Rome, Italy
| | - Josep Masip
- University of Barcelona, Hospital Sant Joan Despi Moisès Broggi, Critical Care Department, Consorci Sanitari Integral, Barcelona, Spain
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Care, Helsinki University Hospital, Helsinki, Finland
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Tousoulis D. Pulmonary arterial hypertension and quality of life in cardiology. Do we really need more studies? Hellenic J Cardiol 2016; 57:S1109-9666(16)30191-9. [PMID: 27789214 DOI: 10.1016/j.hjc.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Dimitris Tousoulis
- 1st Cardiology Department, Athens University Medical School, Hippokration Hospital, Athens, Greece.
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