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Zeymer U, Heer T, Ouarrak T, Akin I, Noc M, Stepinska J, Oldroyd K, Serpytis P, Montalescot G, Huber K, Windecker S, Savonitto S, Vrints C, Schneider S, Desch S, Thiele H. Current spectrum and outcomes of infarct-related cardiogenic shock: insights from the CULPRIT-SHOCK registry and randomized controlled trial. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:335-346. [PMID: 38349233 DOI: 10.1093/ehjacc/zuae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 05/09/2024]
Abstract
AIMS We analysed consecutive patients with acute myocardial infarction complicated by cardiogenic shock (CS) who were enrolled into the CULPRIT-SHOCK randomized controlled trial (RCT) and those with exclusion criteria who were included into the accompanying registry. METHODS AND RESULTS In total, 1075 patients with infarct-related CS were screened for CULPRIT-SHOCK in 83 specialized centres in Europe; 369 of them had exclusion criteria for the RCT and were enrolled into the registry. Patients were followed over 1 year. The mean age was 68 years and 260 (25%) were women. 13.5%, 30.9%, and 55.6% had one-vessel, two-vessel, and three-vessel coronary artery disease (CAD), respectively. Significant left main (LM) coronary artery stenosis was present in 8.0%. 54.2% of the patients had cardiac arrest before admission. Thrombolysis in myocardial infarction (TIMI) 3 patency of the infarct vessel after percutaneous coronary intervention was achieved in 83.6% of all patients. Mechanical circulatory support was applied in one-third of patients. Total mortality after 30 days and 1 year was 47.6% and 52.9%. Mortality after 1 year was highest in patients with LM coronary artery stenosis (63.5%), followed by three-vessel (56.6%), two-vessel (49.8%), and one-vessel CAD (38.6%), respectively. Mechanical complications were rare (21/1008; 2.1%) but associated with a high mortality of 66.7% after 1 year. CONCLUSION In specialized centres in Europe, short- and long-term mortality of patients with infarct-related CS treated with an invasive strategy is still high and mainly depends on the extent of CAD. Therefore, there is still a need for improvement of care to improve the prognosis of infarct-related CS.
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Affiliation(s)
- Uwe Zeymer
- Department of Cardiology, Klinikum der Stadt Ludwigshafen am Rhein, Bremserstraße 79, 67063 Ludwigshafen, Germany
- Stiftung Institut für Herzinfarktforschung, Bremserstraße 79, 67063 Ludwigshafen, Germany
| | - Tobias Heer
- Department of Cardiology, München Klinik Neuperlach, Academic Teaching Hospital, LMU University of Munich, Oskar-Maria-Graf-Ring 51, 81737 Munich, Germany
| | - Taoufik Ouarrak
- Stiftung Institut für Herzinfarktforschung, Bremserstraße 79, 67063 Ludwigshafen, Germany
| | - Ibrahim Akin
- Department of Cardiology, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Marko Noc
- Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Janina Stepinska
- Department of Cardiology, Institute of Cardiology, Warsaw, Poland
| | - Keith Oldroyd
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK
| | - Pranas Serpytis
- Department of Cardiology, Vilnius University Hospital Santaros Klinikos, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Giles Montalescot
- Department of Cardiology, ACTION Study Group, Sorbonne Université Paris 6, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France
| | - Kurt Huber
- Department of Cardiology, Wilhelminenspital, Vienna, Austria
- Department of Cardiology, Medical School, Sigmund Freud University, Vienna, Austria
| | - Stephan Windecker
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | | | - Christiaan Vrints
- Department of Cardiology, Universitair Ziekenhuis Antwerp, Antwerp, Belgium
| | - Steffen Schneider
- Stiftung Institut für Herzinfarktforschung, Bremserstraße 79, 67063 Ludwigshafen, Germany
| | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig, University Hospital, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University Hospital, Leipzig, Germany
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Schupp T, Rusnak J, Egner-Walter S, Ruka M, Dudda J, Bertsch T, Müller J, Mashayekhi K, Tajti P, Ayoub M, Akin I, Behnes M. Prognosis of cardiogenic shock with and without acute myocardial infarction: results from a prospective, monocentric registry. Clin Res Cardiol 2024; 113:626-641. [PMID: 37093246 DOI: 10.1007/s00392-023-02196-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE The study investigates the prognostic impact of cardiogenic shock (CS) stratified by the presence or absence of acute myocardial infarction (AMI). BACKGROUND Intensive care unit (ICU) related mortality in CS patients remains unacceptably high despite improvement concerning the treatment of CS patients. METHODS Consecutive patients with CS from 2019 to 2021 were included monocentrically. The prognostic impact of CS related to AMI was compared to patients without AMI-related CS. The primary endpoint was 30-day all-cause mortality. Statistical analyses included Kaplan-Meier analyses, multivariable Cox proportional regression analyses and propensity score matching. RESULTS 273 CS patients were included (AMI-related CS: 49%; non-AMI-related CS: 51%). The risk of 30-day all-cause mortality was increased in patients with AMI-related CS (64% vs. 47%; HR = 1.653; 95% CI 1.199-2.281; p = 0.002), which was still observed after multivariable adjustment (HR = 1.696; 95% CI 1.153-2.494; p = 0.007). Even after propensity score matching (i.e., 87 matched pairs), AMI was still an independent predictor of 30-day mortality (HR = 1.524; 95% CI 1.020-2.276; p = 0.040). In contrast, non-ST-segment AMI (NSTEMI) and STEMI were associated with comparable prognosis (log-rank p = 0.528). CONCLUSION AMI-related CS was associated with increased 30-day all-cause mortality compared to patients with CS not related to AMI. In contrast, the prognosis of STEMI- and NSTEMI-CS patients was comparable.
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Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, First Department of Medicine, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, First Department of Medicine, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Sascha Egner-Walter
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, First Department of Medicine, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Marinela Ruka
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, First Department of Medicine, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Dudda
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, First Department of Medicine, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Julian Müller
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Bad Neustadt a. d. Saale, Germany
- Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, Lahr, Germany
| | - Péter Tajti
- Gottsegen György National Cardiovascular Center, Budapest, Hungary
| | - Mohammed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum-Bad, Oeynhausen, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, First Department of Medicine, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, First Department of Medicine, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
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Alviar CL, Li BK, Keller NM, Bohula-May E, Barnett C, Berg DD, Burke JA, Chaudhry SP, Daniels LB, DeFilippis AP, Gerber D, Horowitz J, Jentzer JC, Katrapati P, Keeley E, Lawler PR, Park JG, Sinha SS, Snell J, Solomon MA, Teuteberg J, Katz JN, van Diepen S, Morrow DA. Prognostic performance of the IABP-SHOCK II Risk Score among cardiogenic shock subtypes in the critical care cardiology trials network registry. Am Heart J 2024; 270:1-12. [PMID: 38190931 PMCID: PMC11032171 DOI: 10.1016/j.ahj.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Risk stratification has potential to guide triage and decision-making in cardiogenic shock (CS). We assessed the prognostic performance of the IABP-SHOCK II score, derived in Europe for acute myocardial infarct-related CS (AMI-CS), in a contemporary North American cohort, including different CS phenotypes. METHODS The critical care cardiology trials network (CCCTN) coordinated by the TIMI study group is a multicenter network of cardiac intensive care units (CICU). Participating centers annually contribute ≥2 months of consecutive medical CICU admissions. The IABP-SHOCK II risk score includes age > 73 years, prior stroke, admission glucose > 191 mg/dl, creatinine > 1.5 mg/dl, lactate > 5 mmol/l, and post-PCI TIMI flow grade < 3. We assessed the risk score across various CS etiologies. RESULTS Of 17,852 medical CICU admissions 5,340 patients across 35 sites were admitted with CS. In patients with AMI-CS (n = 912), the IABP-SHOCK II score predicted a >3-fold gradient in in-hospital mortality (low risk = 26.5%, intermediate risk = 52.2%, high risk = 77.5%, P < .0001; c-statistic = 0.67; Hosmer-Lemeshow P = .79). The score showed a similar gradient of in-hospital mortality in patients with non-AMI-related CS (n = 2,517, P < .0001) and mixed shock (n = 923, P < .001), as well as in left ventricular (<0.0001), right ventricular (P = .0163) or biventricular (<0.0001) CS. The correlation between the IABP-SHOCK II score and SOFA was moderate (r2 = 0.17) and the IABP-SHOCK II score revealed a significant risk gradient within each SCAI stage. CONCLUSIONS In an unselected international multicenter registry of patients admitted with CS, the IABP- SHOCK II score only moderately predicted in-hospital mortality in a broad population of CS regardless of etiology or irrespective of right, left, or bi-ventricular involvement.
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Affiliation(s)
- Carlos L Alviar
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY;.
| | - Boyangzi K Li
- Division of Cardiology, University of Miami, Miami, FL
| | - Norma M Keller
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY
| | - Erin Bohula-May
- Levine Cardiac Intensive Care Unit, Brigham and Women's Hospital, Boston, MA
| | - Christopher Barnett
- Division of Cardiology, University of California San Francisco, San Francisco, CA
| | - David D Berg
- Levine Cardiac Intensive Care Unit, Brigham and Women's Hospital, Boston, MA
| | - James A Burke
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | | | - Lori B Daniels
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA
| | | | - Daniel Gerber
- Division of Cardiology, Stanford University, Stanford, CA
| | - James Horowitz
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY
| | - Jacob C Jentzer
- Division of Cardiovascular Medicine, Mayo Clinic, Minnesota, CA
| | | | - Ellen Keeley
- Division of Cardiology, University of Florida, Gainesville, FL
| | - Patrick R Lawler
- McGill University Health Centre, Montreal, Quebec, Canada;; Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jeong-Gun Park
- Levine Cardiac Intensive Care Unit, Brigham and Women's Hospital, Boston, MA
| | - Shashank S Sinha
- Inova Fairfax Medical Campus, Inova Heart and Vascular Institute, Falls Church, VA
| | - Jeffrey Snell
- Division of Cardiology, Rush University, Chicago, IL
| | - Michael A Solomon
- Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, MD
| | | | - Jason N Katz
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - David A Morrow
- Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Laghlam D, Benghanem S, Ortuno S, Bouabdallaoui N, Manzo-Silberman S, Hamzaoui O, Aissaoui N. Management of cardiogenic shock: a narrative review. Ann Intensive Care 2024; 14:45. [PMID: 38553663 PMCID: PMC10980676 DOI: 10.1186/s13613-024-01260-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/06/2024] [Indexed: 04/02/2024] Open
Abstract
Cardiogenic shock (CS) is characterized by low cardiac output and sustained tissue hypoperfusion that may result in end-organ dysfunction and death. CS is associated with high short-term mortality, and its management remains challenging despite recent advances in therapeutic options. Timely diagnosis and multidisciplinary team-based management have demonstrated favourable effects on outcomes. We aimed to review evidence-based practices for managing patients with ischemic and non-ischemic CS, detailing the multi-organ supports needed in this critically ill patient population.
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Affiliation(s)
- Driss Laghlam
- Research & Innovation Department, RIGHAPH, Service de Réanimation polyvalente, CMC Ambroise Paré-Hartmann, 48 Ter boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France.
| | - Sarah Benghanem
- Service de médecine intensive-réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre & Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- AfterROSC, Paris, France
| | - Sofia Ortuno
- Service Médecine intensive-réanimation, Hopital Européen Georges Pompidou, Paris, France
- Université Sorbonne, Paris, France
| | - Nadia Bouabdallaoui
- Institut de cardiologie de Montreal, Université de Montreal, Montreal, Canada
| | - Stephane Manzo-Silberman
- Université Sorbonne, Paris, France
- Sorbonne University, Institute of Cardiology- Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group, Paris, France
| | - Olfa Hamzaoui
- Service de médecine intensive-réanimation polyvalente, Hôpital Robert Debré, CHU de Reims, Reims, France
- Unité HERVI "Hémostase et Remodelage Vasculaire Post-Ischémie" - EA 3801, Reims, France
| | - Nadia Aissaoui
- Service de médecine intensive-réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre & Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- AfterROSC, Paris, France
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5
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Kim Y, Jang WJ, Park IH, Oh JH, Yang JH, Gwon HC, Ahn CM, Yu CW, Kim HJ, Bae JW, Kwon SU, Lee HJ, Lee WS, Jeong JO, Park SD. Prognostic effect of sex according to shock severity in patients with acute myocardial infarction complicated by cardiogenic shock. Hellenic J Cardiol 2023:S1109-9666(23)00226-9. [PMID: 38072307 DOI: 10.1016/j.hjc.2023.11.007] [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: 06/02/2023] [Revised: 08/31/2023] [Accepted: 11/29/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Sex disparities in cardiogenic shock (CS) treatment are controversial, and the prognostic implications of sex remain unclear in CS caused by acute myocardial infarction (AMI). OBJECTIVES This study aimed to evaluate the prognostic effect of sex according to the severity of CS in patients undergoing percutaneous coronary intervention (PCI) for AMI complicated by CS. METHODS We assessed 695 patients from 12 tertiary centers in South Korea who underwent PCI for AMI complicated by CS, and analyzed outcomes by sex (female [n = 184] vs. male [n = 511]). We compared a 12-month patient-oriented composite endpoint (POCE, defined as a composite of all-cause mortality, myocardial infarction, re-hospitalization due to heart failure, and repeat revascularization) between the sexes, respective of SCAI shock stage C&D or E. Propensity score-matched analysis was performed to reduce bias. RESULTS We found that the female group was older and had higher vasoactive-inotropic and IABP-SHOCK II scores than the male group, with findings consistent across SCAI shock stages. During the 12-month follow-up period, multivariate analysis revealed no significant differences in POCE (HR 1.01, 95% CI 0.67-1.53, p = 0.963 for SCAI stage C&D, HR 1.24, 95% CI 0.84-1.84, p = 0.286 for SCAI stage E) between females and males. After propensity score matching, the incidence of POCE (HR 1.47, 95% CI 0.79-2.72, p = 0.220 for SCAI stage C&D, HR 0.88, 95% CI 0.49-1.57, p = 0.665 for SCAI stage E) was similar between sexes. CONCLUSIONS Sex does not appear to influence the risk of 12-month POCE in patients treated with PCI for CS caused by AMI, irrespective of shock severity. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT02985008. RESCUE (REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock), NCT02985008, Registered December 5, 2016 - retrospectively and prospectively. IRB INFORMATION This study was approved by the institutional review board of Samsung Medical Center (Reference number: 2016-03-130).
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Affiliation(s)
- Yeji Kim
- Department of Cardiology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Jang
- Department of Cardiology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
| | - Ik Hyun Park
- Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Ju Hyeon Oh
- Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sung Uk Kwon
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, University of Inje College of Medicine, Goyang, Republic of Korea
| | - Hyun-Jong Lee
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Wang Soo Lee
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Republic of Korea
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Abukalam N, Kannan Sudha R, Al Marzooqi M. Traumatic Brain Injury With Concomitant Myocardial Infarction: A Clinical Dilemma. Cureus 2023; 15:e50898. [PMID: 38249258 PMCID: PMC10799652 DOI: 10.7759/cureus.50898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
A 51-year-old male patient was brought to the emergency department (ED) by paramedics after an unwitnessed fall from a height while he was working. He sustained a severe head injury with a low Glasgow Coma Scale (GCS). After securing his airway and stabilizing the patient, a CT scan of the brain was done that revealed bilateral subdural hematomas, and an electrocardiogram (EKG) revealed an ST elevation inferior wall myocardial infarction (MI), which was suggested to be the cause of his fall. With the presence of two concomitant life-threatening medical conditions, it was a predicament which of the two pathologies to target first in treatment. Ultimately, a management plan was decided following a multidisciplinary urgent meeting in the ED, which was attended by all respective teams. Initial conservative management with close neurological and cardiovascular monitoring in the intensive care unit (ICU) was deemed the safest option in this case.
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7
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Arnold JH, Perl L, Assali A, Codner P, Greenberg G, Samara A, Porter A, Orvin K, Kornowski R, Vaknin Assa H. The Impact of Sex on Cardiogenic Shock Outcomes Following ST Elevation Myocardial Infarction. J Clin Med 2023; 12:6259. [PMID: 37834902 PMCID: PMC10573491 DOI: 10.3390/jcm12196259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Cardiogenic shock (CS) remains the leading cause of ST elevation myocardial infarction (STEMI)-related mortality. Contemporary studies have shown no sex-related differences in mortality. METHODS STEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) were included based on a dedicated prospective STEMI database. We compared sex-specific differences in CS characteristics at baseline, during hospitalization, and in subsequent clinical outcomes. Endpoints included all-cause mortality and major adverse cardiac events (MACE). RESULTS Of 3202 consecutive STEMI patients, 210 (6.5%) had CS, of which 63 (30.0%) were women. Women were older than men (73.2 vs. 65.5% y, p < 0.01), and more had hypertension (68.3 vs. 52.8%, p = 0.019) and diabetes (38.7 vs. 24.8%, p = 0.047). Fewer were smokers (13.3 vs. 41.2%, p < 0.01), had previous PCI (9.1 vs. 22.3% p = 0.016), or required IABP (35.3 vs. 51.1% p = 0.027). Women had higher rates of mortality (53.2 vs. 35.3% in-hospital, p = 0.01; 61.3 vs. 41.9% at 1 month, p = 0.01; and 73.8 vs. 52.6% at 3 years, p = 0.05) and MACE (60.6 vs. 41.6% in-hospital, p = 0.032; 66.1 vs. 45.6% at 1 month, p = 0.007; and 62.9 vs. 80.3% at 3 years, p = 0.015). After multivariate adjustment, female sex remained an independent factor for death (HR-2.42 [95% CI 1.014-5.033], p = 0.042) and MACE (HR-1.91 [95% CI 1.217-3.031], p = 0.01). CONCLUSIONS CS complicating STEMI is associated with greater short- and long-term mortality and MACE in women. Sex-focused measures to improve diagnosis and treatment are mandatory for CS patients.
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Affiliation(s)
- Joshua H. Arnold
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Abid Assali
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
- Department of Cardiology, Meir Medical Center, Kfar-Saba 4428164, Israel
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Gabriel Greenberg
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Abid Samara
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Avital Porter
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Katia Orvin
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Hana Vaknin Assa
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
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Bruno RR, Wolff G, Kelm M, Jung C. Pharmacological treatment of cardiogenic shock - A state of the art review. Pharmacol Ther 2022; 240:108230. [PMID: 35697151 DOI: 10.1016/j.pharmthera.2022.108230] [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: 05/13/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 12/14/2022]
Abstract
Cardiogenic shock is a clinical syndrome of impaired tissue perfusion caused by primary cardiac dysfunction and inadequate cardiac output. It represents one of the most lethal clinical conditions in intensive care medicine with mortality >40%. Management of different clinical presentations of cardiogenic shock includes guidance of cardiac preload, afterload, heart rate and contractility by differential pharmacological modulation of volume, systemic and pulmonary vascular resistance and cardiac output besides reversing the triggering cause. Data from large registries and randomized controlled trials on optimal diagnostic guidance as well as choice of pharmacological agents has accrued significantly in recent years. This state-of-the-art review summarizes the basic concepts of cardiogenic shock, the diagnostic work-up and currently available evidence and guideline recommendations on pharmacological treatment of cardiogenic shock.
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Affiliation(s)
- Raphael Romano Bruno
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - Georg Wolff
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - Malte Kelm
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany; Cardiovascular Research Institute Düsseldorf (CARID), Duesseldorf, Germany
| | - Christian Jung
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany.
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Galván‐Román F, Fernández‐Herrero I, Ariza‐Solé A, Sánchez‐Salado JC, Puerto E, Lorente V, Gómez‐Lara J, Martín‐Asenjo R, Gómez‐Hospital JA, Comín‐Colet J. Prognosis of cardiogenic shock secondary to culprit left main coronary artery lesion-related myocardial infarction. ESC Heart Fail 2022; 10:111-120. [PMID: 36151843 PMCID: PMC9871657 DOI: 10.1002/ehf2.14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/20/2022] [Accepted: 08/15/2022] [Indexed: 01/27/2023] Open
Abstract
AIMS This study aimed to assess, in patients with cardiogenic shock secondary to unprotected left main coronary artery-related myocardial infarction (ULMCA-related AMICS), the incidence and predictors of no recovery of left ventricular function during the admission. METHODS AND RESULTS This was an observational study conducted at two tertiary care centres (2012-20). The main outcome measured was death or requirement for heart transplantation (HT) or left ventricular assist devices (LVAD) during the admission. A total of 70 patients were included. Percutaneous coronary intervention (PCI) was successful in 53/70 patients (75.7%). The combined endpoint of death or requirement of HT or LVAD during the admission occurred in 41/70 patients (58.6%). The highest incidence of the primary endpoint was observed among patients with profound shock and occluded left main coronary artery (LMCA) (20/23, 87%, P < 0.001). Although a successful PCI reduced the incidence of the event in the whole cohort (51.9% vs. 82.4% in failed PCI, P = 0.026), this association was not observed among this last group of complex patients (86.7% vs. 87.5% in failed PCI, P = 0.731). The predictive model included left ventricular ejection fraction, baseline ULMCA Thrombolysis In Myocardial Infarction flow, and severity of shock and showed an optimal ability for predicting death or requirements for HT or LVAD during the admission (area under the curve 0.865, P < 0.001). CONCLUSIONS ULMCA-related AMICS was associated with a high in-hospital mortality or need for HT or LVAD. Prognosis was especially poor among patients with profound shock and baseline occluded LMCA, with a low probability of recovery regardless of successful PCI.
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Affiliation(s)
- Francisco Galván‐Román
- Department of CardiologyBellvitge University Hospital, L'Hospitalet de LlobregatBarcelonaSpain,Bioheart, Grup de Malalties CardiovascularsInstitut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de LlobregatFeixa Llarga s/n08907BarcelonaSpain
| | - Ignacio Fernández‐Herrero
- Department of CardiologyDoce de Octubre University Hospital, Instituto de Investigación IMAS 12MadridSpain
| | - Albert Ariza‐Solé
- Department of CardiologyBellvitge University Hospital, L'Hospitalet de LlobregatBarcelonaSpain,Bioheart, Grup de Malalties CardiovascularsInstitut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de LlobregatFeixa Llarga s/n08907BarcelonaSpain
| | - José Carlos Sánchez‐Salado
- Department of CardiologyBellvitge University Hospital, L'Hospitalet de LlobregatBarcelonaSpain,Bioheart, Grup de Malalties CardiovascularsInstitut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de LlobregatFeixa Llarga s/n08907BarcelonaSpain
| | - Elena Puerto
- Department of CardiologyDoce de Octubre University Hospital, Instituto de Investigación IMAS 12MadridSpain
| | - Victòria Lorente
- Department of CardiologyBellvitge University Hospital, L'Hospitalet de LlobregatBarcelonaSpain,Bioheart, Grup de Malalties CardiovascularsInstitut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de LlobregatFeixa Llarga s/n08907BarcelonaSpain
| | - Josep Gómez‐Lara
- Department of CardiologyBellvitge University Hospital, L'Hospitalet de LlobregatBarcelonaSpain,Bioheart, Grup de Malalties CardiovascularsInstitut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de LlobregatFeixa Llarga s/n08907BarcelonaSpain
| | - Roberto Martín‐Asenjo
- Department of CardiologyDoce de Octubre University Hospital, Instituto de Investigación IMAS 12MadridSpain
| | - Joan A. Gómez‐Hospital
- Department of CardiologyBellvitge University Hospital, L'Hospitalet de LlobregatBarcelonaSpain,Bioheart, Grup de Malalties CardiovascularsInstitut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de LlobregatFeixa Llarga s/n08907BarcelonaSpain
| | - Josep Comín‐Colet
- Department of CardiologyBellvitge University Hospital, L'Hospitalet de LlobregatBarcelonaSpain,Bioheart, Grup de Malalties CardiovascularsInstitut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de LlobregatFeixa Llarga s/n08907BarcelonaSpain
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10
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Masiero G, Cardaioli F, Rodinò G, Tarantini G. When to Achieve Complete Revascularization in Infarct-Related Cardiogenic Shock. J Clin Med 2022; 11:jcm11113116. [PMID: 35683500 PMCID: PMC9180947 DOI: 10.3390/jcm11113116] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/21/2022] [Accepted: 05/26/2022] [Indexed: 12/20/2022] Open
Abstract
Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is a life-threatening condition frequently encountered in patients with multivessel coronary artery disease (CAD). Despite prompt revascularization, in particular, percutaneous coronary intervention (PCI), and therapeutic and technological advances, the mortality rate for patients with CS related to AMI remains unacceptably high. Differently form a hemodynamically stable setting, a culprit lesion-only (CLO) revascularization strategy is currently suggested for AMI–CS patients, based on the results of recent randomized evidence burdened by several limitations and conflicting results from non-randomized studies. Furthermore, mechanical circulatory support (MCS) devices have emerged as a key therapeutic option in CS, especially in the case of their early implantation without delaying revascularization and before irreversible organ damage has occurred. We provide an in-depth review of the current evidence on optimal revascularization strategies of multivessel CAD in infarct-related CS, assessing the role of different types of MCS devices and highlighting the importance of shock teams and medical care system networks to effectively impact on clinical outcomes.
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11
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Sieweke JT, Akin M, Beheshty JA, Flierl U, Bauersachs J, Schäfer A. Unloading in Refractory Cardiogenic Shock After Out-Of-Hospital Cardiac Arrest Due to Acute Myocardial Infarction-A Propensity Score-Matched Analysis. Front Cardiovasc Med 2021; 8:704312. [PMID: 34504877 PMCID: PMC8421736 DOI: 10.3389/fcvm.2021.704312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/28/2021] [Indexed: 12/28/2022] Open
Abstract
Aims: Unclear neurological outcome often precludes severely compromised patients after out-of-hospital cardiac arrest (OHCA) from mechanical circulatory support (MCS), while it may be considered as rescue therapy for patients with refractory cardiogenic shock (rCS) in the absence of OHCA. This analysis sought to investigate the role of left ventricular (LV) unloading in patients with rCS related to acute myocardial infarction (AMI) after OHCA. Methods: Of 273 consecutive patients receiving microaxial pumps in the Hannover Cardiac Unloading Registry between January 2013 and August 2018, 47 presented with AMI-rCS following successful resuscitation. Subsequently, the patients were compared by propensity score matching to patients with OHCA AMI-rCS without MCS. The patient data for OHCA without LV unloading was available from 280 patients of the Hannover Cooling Registry for the same time period. Furthermore, the patients with OHCA without rCS were compared to the patients with OHCA AMI-rCS and LV unloading. Results: In total, 15 OHCA AMI-rCS patients without MCS were matched to patients with AMI-rCS and Impella. Patients without LV support had a higher proportion of a cardiac cause of death (n = 7 vs. n = 3; p = 0.024). LV unloading with Impella counteract rCS status and was associated with a preferable 30-day survival (66.7 vs. 20%, p = 0.01) and a favorable neurological outcome after 30 days (Cerebral Performance Category ≤2, 47 vs. 27%). Impella support is associated with a higher 30-day survival (odds ratio, 2.67; 95% confidence interval, 1.02-13.66). Conclusion: In patients after OHCA with AMI-rCS, Impella support incorporated in a strict standardized treatment algorithm results in a preferable 30-day survival and counteracts severe rCS status.
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Affiliation(s)
- Jan-Thorben Sieweke
- Department of Cardiology and Angiology, Cardiac Arrest Center and Advanced Heart Failure Unit, Hannover Medical School, Hanover, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Cardiac Arrest Center and Advanced Heart Failure Unit, Hannover Medical School, Hanover, Germany
| | - Julian-Arman Beheshty
- Department of Cardiology and Angiology, Cardiac Arrest Center and Advanced Heart Failure Unit, Hannover Medical School, Hanover, Germany
| | - Ulrike Flierl
- Department of Cardiology and Angiology, Cardiac Arrest Center and Advanced Heart Failure Unit, Hannover Medical School, Hanover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Cardiac Arrest Center and Advanced Heart Failure Unit, Hannover Medical School, Hanover, Germany
| | - Andreas Schäfer
- Department of Cardiology and Angiology, Cardiac Arrest Center and Advanced Heart Failure Unit, Hannover Medical School, Hanover, Germany
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12
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Singh H, Mehta RH, O'Neill W, Kapur NK, Lalonde T, Ohman M, Ghiu I, Chen-Hsing Y, Dutcheshen K, Schreiber T, Rosman H, Kaki A. Clinical features and outcomes in patients with cardiogenic shock complicating acute myocardial infarction: early vs recent experience with impella. Am Heart J 2021; 238:66-74. [PMID: 33848505 DOI: 10.1016/j.ahj.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To compare clinical features and outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) treated in the early experience with Impella percutaneous ventricular assist device and patients treated recently. BACKGROUND Since pre-market approval (PMA) of Impella device as treatment for AMICS, use of the device has grown considerably. METHODS We retrospectively analyzed 649 AMICS patients treated with perioperative Impella, with 291 patients treated from 2008 to 2014 comprising the early experience cohort and 358 patients treated from 2017 to 2019 comprising the recent experience cohort. The primary end point was risk adjusted in-hospital mortality. RESULTS Mean age and gender distribution of patients was similar in the two cohorts. The recent cohort had more invasive hemodynamic monitoring (64% vs 46%; P < .001) and less use of an intra-aortic balloon pump prior to Impella (15% vs 41%; P < .001). Recently treated patients were significantly more likely to receive Impella support prior to PCI (58% vs 44%; P = .005). In-hospital mortality was lower in the recent cohort (48% vs 56%; P = .043). This difference was however no longer significant after risk adjustment (adjusted OR 0.89, 95% CI 0.59-1.34, P = .59). Rates of acute kidney injury, major bleeding, and vascular complications requiring surgery were also significantly lower in the recent cohort. CONCLUSIONS Use of Impella for AMICS during recent years is associated with lower unadjusted in-hospital mortality, which may reflect better patient selection, earlier device implantation, and improved management algorithms. In-depth understanding of these factors may inform the development of future treatment protocols.
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13
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Werdan K, Buerke M, Geppert A, Thiele H, Zwissler B, Ruß M. Infarction-Related Cardiogenic Shock- Diagnosis, Monitoring and Therapy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:88-95. [PMID: 33827749 DOI: 10.3238/arztebl.m2021.0012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 08/26/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The second edition of the German-Austrian S3 guideline contains updated evidence-based recommendations for the treatment of patients with infarction-related cardiogenic shock (ICS), whose mortality is several times higher than that of patients with a hemodynamically stable myocardial infarction (1). METHODS In five consensus conferences, the experts developed 95 recommendations-including two statements-and seven algorithms with concrete instructions. RESULTS Recanalization of the coronary vessel whose occlusion led to the infarction is crucial for the survival of patients with ICS. The recommended method of choice is primary percutaneous coronary intervention (pPCI) with the implantation of a drug-eluting stent (DES). If multiple coronary vessels are diseased, only the infarct artery (the "culprit lesion") should be stented at first. For cardiovascular pharmacotherapy-primarily with dobutamine and norepinephrine-the recommended hemodynamic target range for mean arterial blood pressure is 65-75 mmHg, with a cardiac index (CI) above 2.2 L/min/m2. For optimal treatment in intensive care, recommendations are given regarding the type of ventilation (invasive rather than non-invasive, lungprotective), nutrition (no nutritional intake in uncontrolled shock, no glutamine supplementation), thromboembolism prophylaxis (intravenous heparin rather than subcutaneous prophylaxis), und further topics. In case of pump failure, an intra-aortic balloon pump is not recommended; temporary mechanical support systems (Impella pumps, veno-arterial extracorporeal membrane oxygenation [VA-ECMO], and others) are hemodynamically more effective, but have not yet been convincingly shown to improve survival. CONCLUSION Combined cardiological and intensive-care treatment is crucial for the survival of patients with ICS. Coronary treatment for ICS seems to have little potential for further improvement, while intensive-care methods can still be optimized.
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Affiliation(s)
- Karl Werdan
- * Guideline group see eBox 1; Department of Internal Medicine III, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany; Department of Cardiology, Angiology and Internal Intensive Care Medicine, St. Marienkrankenhaus Siegen, Siegen, Germany; Department of Cardiology, Clinic Ottakring, Vienna Healthcare Group, Vienna, Austria; Department of Cardiology, University of Leipzig, Heart Center Leipzig, Leipzig, Germany; Department of Anesthesiology, University Hospital, LMU, Munich, Germany; Internists at the Maxplatz, Traunstein/Affiliate Cardiology Traunstein, Traunstein, Germany
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14
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El Nasasra A, Zeymer U. Current clinical management of acute myocardial infarction complicated by cardiogenic shock. Expert Rev Cardiovasc Ther 2021; 19:41-46. [PMID: 33289436 DOI: 10.1080/14779072.2021.1854733] [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] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Cardiogenic shock (CS) remains the leading cause of death among patients admitted with acute myocardial infarction (AMI). Early restoration of blood flow of the infarct-related artery is of paramount importance, either with percutaneous coronary intervention (PCI) or with coronary artery bypass grafting (CABG). In addition, early risk stratification is a critical task and required to guide complex decisions on management and therapy of CS after AMI. The use of short-term mechanical circulatory support (MCS) is increasing, although evidence for their effectiveness is limited. AREAS COVERED We review the evidence for early revascularization of the culprit-lesion and risk stratification in patients with AMI complicated by cardiogenic shock. The current data for the use of MCS will be discussed and put into clinical perspective. EXPERT OPINION The SHOCK trial has introduced an early invasive strategy with subsequent revascularization as standard of care in patients with AMI complicated by CS. In clinical practice PCI is the by far the most often used revascularization therapy in CS. Most important is restoration of normal flow (so called TIMI 3 patency) of the infarct artery to reduce mortality. Therefore, all efforts including intense antithrombotic therapy should be made to achieve TIMI 3 patency. Around three quarters of patients with CS have multivessel coronary artery disease. According to the results of the CULPRIT-SHOCK trial PCI of the culprit lesion only is recommended as the preferred revascularization strategy in these patients, while additional lesions can be revascularized during a staged procedure. Immediate multivessel PCI could be performed in some specific angiographic scenarios, such as subtotal non-culprit lesions with reduced Thrombolysis In Myocardial Infarction (TIMI)-flow, or multiple possible culprit lesions. However, this should be considered on an individual basis. CABG should be performed only in case of failed PCI and coronary anatomies not suitable for PCI. However, small case series report good outcomes in selected patients with CS undergoing CABG. Therefore, a randomized trial comparing PCI and CABG in patients with CS and multivessel disease seems warranted. Hopefully such a trial will take place to determine the optimal revascularization therapy in CS. One problem might be to find a sufficient number of cardiac surgeons who are willing to operate such high-risk surgical patients.
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Affiliation(s)
- Aref El Nasasra
- Medizinische Klinik B, Klinikum Ludwigshafen , Ludwigshafen, Germany
| | - Uwe Zeymer
- Medizinische Klinik B, Klinikum Ludwigshafen , Ludwigshafen, Germany.,Stiftung, Institut Für Herzinfarktforschung Ludwigshafen , Germany
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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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Palliative care referral in ST-segment elevation myocardial infarction complicated with cardiogenic shock in the United States. Heart Lung 2020; 49:25-29. [DOI: 10.1016/j.hrtlng.2019.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/13/2019] [Accepted: 10/16/2019] [Indexed: 01/11/2023]
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17
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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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Bendz B, Gude E, Ragnarsson A, Endresen K, Aaberge L, Geiran O, Simonsen S. Intra-aortic balloon pump in acute chest pain and cardiogenic shock - a long-term follow-up. SCAND CARDIOVASC J 2019; 53:337-341. [PMID: 31476881 DOI: 10.1080/14017431.2019.1657938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives. Coronary revascularisation and intra-aortic balloon pump (IABP) has been considered the gold standard treatment of acute coronary syndrome with cardiogenic shock, recently challenged by the SHOCK II study. The aim of this non-randomised study was to investigate the long term prognosis after immediate IABP supported angiography, in patients with acute chest pain and cardiogenic shock, treated with percutaneous coronary intervention (PCI), cardiac surgery or optimal medical treatment. We assessed data from 281 consecutive patients admitted to our department from 2004 to 2010. Results. Mean (±SD) age was 63.8 ± 11.5 (range 30-84) years with a follow-up of 5.6 ± 4.4 (0-12.7) years. Acute myocardial infarction was the primary diagnosis in 93% of the patients, 4% presented with unstable angina pectoris and 3% cardiomyopathy or arrhythmias of non-ischemic aetiology. Systolic blood pressure at admittance was 85 ± 18 mmHg and diastolic 55 ± 18 mmHg. Thirty day, one- and five-year survival was 71.2%, 67.3% and 57.7%, respectively. PCI was performed immediately in 70%, surgery was done in 17%, and 13% were not eligible for any revascularisation. Independent variables predicting mortality were medical treatment vs revascularisation, out-of-hospital cardiac arrest, and advanced age. Three serious non-fatal complications occurred due to IABP treatment, i.e. 0.001 per treatment day. Conclusions. We report the use of IABP in patients with acute chest pain admitted for angiography. Long-term survival is acceptable and discriminating factors were no revascularisation, out-of-hospital cardiac arrest and age. IABP was safe and feasible and the complication rate was low.
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Affiliation(s)
- Bjørn Bendz
- Department of Cardiology.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | - Odd Geiran
- Department of Cardio-Thoracic Surgery, Heart-Lung Clinic, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Chioncel O, Collins SP, Ambrosy AP, Pang PS, Radu RI, Ahmed A, Antohi EL, Masip J, Butler J, Iliescu VA. Therapeutic Advances in the Management of Cardiogenic Shock. Am J Ther 2019; 26:e234-e247. [PMID: 30839372 PMCID: PMC6404765 DOI: 10.1097/mjt.0000000000000920] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cardiogenic shock (CS) is a life-threatening state of tissue hypoperfusion, associated with a very high risk of mortality, despite intensive monitoring and modern treatment modalities. The present review aimed at describing the therapeutic advances in the management of CS. AREAS OF UNCERTAINTY Many uncertainties about CS management remain in clinical practice, and these relate to the intensity of invasive monitoring, the type and timing of vasoactive therapies, the risk-benefit ratio of mechanical circulatory support (MCS) therapy, and optimal ventilation mode. Furthermore, most of the data are obtained from CS in the setting of acute myocardial infarction (AMI), although for non-AMI-CS patients, there are very few evidences for etiological or MCS therapies. DATA SOURCES The prospective multicentric acute heart failure registries that specifically presented characteristics of patients with CS, distinct to other phenotypes, were included in the present review. Relevant clinical trials investigating therapeutic strategies in post-AMI-CS patients were added as source information. Several trials investigating vasoactive medications and meta-analysis providing information about benefits and risks of MCS devices were reviewed in this study. THERAPEUTIC ADVANCES Early revascularization remains the most important intervention for CS in settings of AMI, and in patients with multivessel disease, recent trial data recommend revascularization on a "culprit-lesion-only" strategy. Although diverse types of MCS devices improve hemodynamics and organ perfusion in patients with CS, results from almost all randomized trials incorporating clinical end points were inconclusive. However, development of new algorithms for utilization of MCS devices and progresses in technology showed benefit in selected patients. A major advance in the management of CS is development of concept of regional CS centers based on the level of facilities and expertise. The modern systems of care with CS centers used as hubs integrated with emergency medical systems and other referee hospitals have the potential to improve patient outcomes. CONCLUSIONS Additional research is needed to establish new triage algorithms and to clarify intensity and timing of pharmacological and mechanical therapies.
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Affiliation(s)
- Ovidiu Chioncel
- University of Medicine Carol Davila, Bucharest; Emergency Institute for Cardiovascular Diseases-“Prof. C.C.Iliescu”, Bucharest, Romania
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Andrew P Ambrosy
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - Peter S Pang
- Department of Emergency Medicine and Indianapolis EMS, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Razvan I Radu
- University of Medicine Carol Davila, Bucharest; Emergency Institute for Cardiovascular Diseases-“Prof. C.C.Iliescu”, Bucharest, Romania
| | - Ali Ahmed
- Veteran Affairs Medical Center and George Washington University, Washington DC, USA
| | - Elena-Laura Antohi
- University of Medicine Carol Davila, Bucharest; Emergency Institute for Cardiovascular Diseases-“Prof. C.C.Iliescu”, Bucharest, Romania
| | - Josep Masip
- Cardiology Department, Hospital Sanitas CIMA, Barcelona, Spain; Department of Intensive Care, Consorci Sanitari Integral, Barcelona, Spain
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MI, USA
| | - Vlad Anton Iliescu
- University of Medicine Carol Davila, Bucharest; Emergency Institute for Cardiovascular Diseases-“Prof. C.C.Iliescu”, Bucharest, Romania
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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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Erbel R, Buerke M, Mohr-Kahaly S, Oelert H, Uebis R. [Therapy of cardiogenic shock : A success story of German cardiology]. Herz 2019; 44:22-28. [PMID: 30627739 DOI: 10.1007/s00059-018-4773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In contrast to the situation in the 1960s and 1970s, the mortality risk for patients with myocardial infarction has been clearly reduced, particularly for those with myocardial infarction with cardiogenic shock (MICS). Approximately 5‑10 % of patients with a myocardial infarction are affected by a MICS and the mortality risk is between 30 % and 50 %. The primary percutaneous coronary intervention with stent implantation should be carried out as quickly as possible in order to reduce the mortality to around 20 %. This article gives an overview of the currently available options for conservative and fibrinolytic treatment of MICS, of the interventional treatment of cardiogenic shock in the era of intravenous and intracoronary infarct treatment as well as without thrombolysis. In addition, the currently available mechanical support systems and the possibilities for surveillance and monitoring of patients are presented.
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Affiliation(s)
- R Erbel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - M Buerke
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Marien Kliniken, Kampenstr. 5, 57072, Siegen, Deutschland
| | - S Mohr-Kahaly
- Praxis für Innere Medizin, Kardiologie und Klinische Pharmakologie, Alwinenstr. 16, 65189, Wiesbaden, Deutschland
| | - H Oelert
- , Silvaner Str. 5a, 55129, Mainz, Deutschland
| | - R Uebis
- Praxis für Innere Medizin und Kardiologie, Maximilianstr. 5a, 63739, Aschaffenburg, Deutschland
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Glazier JJ, Kaki A. The Impella Device: Historical Background, Clinical Applications and Future Directions. Int J Angiol 2018; 28:118-123. [PMID: 31384109 DOI: 10.1055/s-0038-1676369] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The Impella device is a catheter-based miniaturized ventricular assist device. Using a retrograde femoral artery access, it is placed in the left ventricle across the aortic valve. The device pumps blood from left ventricle into ascending aorta and helps to maintain a systemic circulation at an upper rate between 2.5 and 5.0 L/min. This results in almost immediate and sustained unloading of the left ventricle, while increasing overall systemic cardiac output. The most common indications for using the Impella device are in the treatment of acute myocardial infarction complicated by cardiogenic shock and to facilitate high risk coronary angioplasty. Other indications include the treatment of cardiomyopathy with acute decompensation, postcardiotomy shock, and off-pump coronary bypass surgery. A growing body of observational and registry data suggest a potentially valuable role for the Impella system in reducing the mortality associated with cardiogenic shock. However, there are, as of yet, no randomized controlled trial data supporting this observation.
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Affiliation(s)
- James J Glazier
- Department of Cardiology, Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Michigan
| | - Amir Kaki
- Department of Cardiology, Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Michigan
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Glazier JJ, Kaki A. Improving Survival in Cardiogenic Shock: Is Impella the Answer? Am J Med 2018; 131:e403-e404. [PMID: 29859134 DOI: 10.1016/j.amjmed.2018.04.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 12/01/2022]
Affiliation(s)
- James J Glazier
- Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Mich.
| | - Amir Kaki
- Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Mich
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Delmas C, Elbaz M, Bonello L, Biendel C, Bouisset F, Lairez O, Silva S, Marcheix B, Galinier M. Place de l’assistance circulatoire dans le choc cardiogénique en France en 2018 : revue de la littérature et perspectives. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Le choc cardiogénique reste de nos jours une entité mal définie, assez fréquente en pratique clinique (60 000–70 000 cas/an en Europe), dont le pronostic est sombre, avec une mortalité souvent supérieure à 40 % à 30 jours. À travers cette revue de la littérature, nous essaierons de définir cette entité et ses étiologies, avant de parler de son incidence et de son pronostic. L’approche physiopathologique du choc cardiogénique nous permettra par la suite d’approcher sa prise en charge thérapeutique classique (gestion de la volémie, amines inotropes et vasoconstrictives, ventilation) et les limites de cette dernière. Ainsi, nous aborderons les assistances circulatoires et cardiocirculatoires disponibles en France, afin de les envisager au sein d’une stratégie globale de prise en charge du patient en choc cardiogénique. Nous discuterons plus spécifiquement leurs indications ainsi que l’importance du moment d’implantation afin d’optimiser leur efficacité. Enfin, nous évoquerons les assistances actuellement en développement, mais également les nouvelles stratégies thérapeutiques qui pourraient arriver dans les prochaines années.
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Isorni MA, Aissaoui N, Angoulvant D, Bonello L, Lemesle G, Delmas C, Henry P, Schiele F, Ferrières J, Simon T, Danchin N, Puymirat É. Temporal trends in clinical characteristics and management according to sex in patients with cardiogenic shock after acute myocardial infarction: The FAST-MI programme. Arch Cardiovasc Dis 2018; 111:555-563. [PMID: 29478810 DOI: 10.1016/j.acvd.2018.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 12/11/2017] [Accepted: 01/10/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) occurs more frequently in women, but little is known about its potential specificities according to sex. AIMS To analyse the incidence, management and 1-year mortality of CS according to sex using the FAST-MI programme. METHODS The FAST-MI programme consists of four nationwide French surveys carried out 5 years apart from 1995 to 2010, including consecutive patients with AMI over a 1-month period, and with a 1-year follow-up. RESULTS Among the 10,610 patients included in the surveys, the incidence of CS was 4.8% in men and 8.2% in women (P<0.001). Absolute incidence of CS decreased from 1995 to 2010 in both sexes. Mean age in patients with CS tended to decrease in men (from 72±12 to 69±13 years) and to increase in women (from 78±10 to 80±9 years). One-year mortality decreased significantly in men (from 70% in 1995 to 48% in 2010) and in women (from 81% to 54%). Using Cox multivariable analysis, female sex was not an independent correlate of 1-year mortality [hazard ratio (HR): 0.98, 95% confidence interval (CI): 0.78-1.22]. Early use of percutaneous coronary intervention was, however, an independent predictor of 1-year survival in women (HR: 0.55, 95% CI: 0.37-0.81), but showed only a non-significant trend in men (HR: 0.85, 95% CI: 0.61-1.19). CONCLUSIONS The incidence of CS-AMI has decreased in both men and women, but remains higher in women. One-year mortality has significantly decreased for both men and women, and the role of early percutaneous coronary intervention as a potential mediator of decreased mortality seems greater in women than in men.
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Affiliation(s)
- Marc-Antoine Isorni
- Department of cardiology, hôpital Marie-Lannelongue, 92350 Le-Plessis-Robinson, France; Université Paris-Sud, 91405 Paris, France
| | - Nadia Aissaoui
- Department of intensive care, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - Denis Angoulvant
- Department of cardiology, Tours University Hospital, 37170 Tours, France; EA4245 - FHU SUPORT, 37032 Tours, France; François-Rabelais university, 37000 Tours, France
| | - Laurent Bonello
- Department of cardiology, hôpital Nord, AP-HM, 13015 Marseille, France; Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France; Inserm UMRS 1076, Aix-Marseille university, 13385 Marseille, France
| | - Gilles Lemesle
- Department of cardiology, Lille regional university hospital, 59000 Lille, France
| | - Clément Delmas
- Department of cardiology, Toulouse university hospital, 31059 Toulouse, France
| | | | - François Schiele
- Department of cardiology, University Hospital Jean-Minjoz, 25030 Besançon, France
| | - Jean Ferrières
- Department of cardiology B and epidemiology, Toulouse university hospital, 31059 Toulouse, France; UMR Inserm 1027, 31000 Toulouse, France
| | - Tabassome Simon
- Unité de recherche clinique (URCEST), department of clinical pharmacology, hôpital Saint-Antoine, AP-HP, 75012 Paris, France; Université Pierre-et-Marie-Curie (UPMC-Paris 06), 75005 Paris, France; Inserm U-698, 75877 Paris, France
| | - Nicolas Danchin
- Department of cardiology, Toulouse university hospital, 31059 Toulouse, France
| | - Étienne Puymirat
- Department of cardiology, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France.
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26
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Sieweke JT, Berliner D, Tongers J, Napp LC, Flierl U, Zauner F, Bauersachs J, Schäfer A. Mortality in patients with cardiogenic shock treated with the Impella CP microaxial pump for isolated left ventricular failure. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 9:138-148. [PMID: 29405734 DOI: 10.1177/2048872618757393] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Cardiogenic shock is still associated with high mortality rates of around 50%. Intra-aortic counterpulsation had been frequently used in cardiogenic shock, but was previously found to provide no mortality benefit. We investigated the effect of an interdisciplinary and multiprofessional routine strategy of early invasive haemodynamic support in combination with complete revascularization in patients with cardiogenic shock before admission to our intensive care unit. METHODS AND RESULTS We analysed all cardiogenic shock patients (mean age 62±13 years) presenting at our institution between 2013 and mid 2016, who received an Impella CP microaxial pump for isolated left ventricle support (n=61). Sixty-one per cent (n=37) had been resuscitated before Impella insertion. Overall mortality was 48% (n=29/61) at 30 days. Thirty-day mortality was higher in resuscitated patients (resuscitated: 65% (n=24/37); non-resuscitated: 21% (n=5/24)). When applying the inclusion/exclusion criteria of the SHOCK-II trial, eligible patients (n=25) had a markedly lower mortality (24% (n=6/25) at 30 days) compared with the published trial (~40% in both arms). The observed mortality of SHOCK-II-like patients in the registry was also lower compared with their predicted mortality using IABP-Shock II score (49%) and CardShock score (36%). CONCLUSION The results of this registry suggest that using a standardized protocol including early active haemodynamic support with Impella CP in cardiogenic shock in patients with isolated left ventricle failure may be associated with improved outcomes and lower than previously reported or predicted mortality rates. Pre-implantation cardiac arrest critically influences observed mortality. The results support the case for a randomized trial.
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Affiliation(s)
- Jan-Thorben Sieweke
- Cardiac Arrest Centre and Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Germany
| | - Dominik Berliner
- Cardiac Arrest Centre and Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Germany
| | - Jörn Tongers
- Cardiac Arrest Centre and Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Germany
| | - L Christian Napp
- Cardiac Arrest Centre and Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Germany
| | - Ulrike Flierl
- Cardiac Arrest Centre and Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Germany
| | - Florian Zauner
- Cardiac Arrest Centre and Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Germany
| | - Johann Bauersachs
- Cardiac Arrest Centre and Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Germany
| | - Andreas Schäfer
- Cardiac Arrest Centre and Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Germany
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Nuding S, Werdan K, Prondzinsky R. Optimal course of treatment in acute cardiogenic shock complicating myocardial infarction. Expert Rev Cardiovasc Ther 2018; 16:99-112. [PMID: 29310471 DOI: 10.1080/14779072.2018.1425141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION About 5% of patients with myocardial infarction suffer from cardiogenic shock as a complication, with a mortality of ≥30%. Primary percutaneous coronary intervention as soon as possible is the most successful therapeutic approach. Prognosis depends not only on the extent of infarction, but also - and even more - on organ hypoperfusion with consequent development of multiple organ dysfunction syndrome. Areas covered: This review covers diagnostic, monitoring and treatment concepts relevant for caring patients with cardiogenic shock complicating myocardial infarction. All major clinical trials have been selected for review of the recent data. Expert commentary: For optimal care, not only primary percutaneous intervention of the occluded coronary artery is necessary, but also best intensive care medicine avoiding the development of multiple organ dysfunction syndrome and finally death. On contrary, intra-aortic balloon pump - though used for decades - is unable to reduce mortality of patients with cardiogenic shock complicating myocardial infarction.
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Affiliation(s)
- Sebastian Nuding
- a Department of Medicine III , University Hospital Halle (Saale) , Halle (Saale) , Germany
| | - Karl Werdan
- a Department of Medicine III , University Hospital Halle (Saale) , Halle (Saale) , Germany
| | - Roland Prondzinsky
- b Department of Medicine I , Carl-von-Basedow Hospital Merseburg , Germany
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Risk Aversion and Public Reporting. Part 1: Observations From Cardiac Surgery and Interventional Cardiology. Ann Thorac Surg 2017; 104:2093-2101. [DOI: 10.1016/j.athoracsur.2017.06.077] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 06/25/2017] [Indexed: 11/17/2022]
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Bauersachs J, Schäfer A. [Cardiogenic shock]. Herz 2017; 42:1-2. [PMID: 28101621 DOI: 10.1007/s00059-016-4528-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J Bauersachs
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - A Schäfer
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Characteristics of hospitalizations for cardiogenic shock after acute myocardial infarction in the United States. Int J Cardiol 2017; 244:213-219. [DOI: 10.1016/j.ijcard.2017.06.088] [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: 03/29/2017] [Revised: 05/08/2017] [Accepted: 06/22/2017] [Indexed: 11/17/2022]
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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: 928] [Impact Index Per Article: 132.6] [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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Delmas C, Leurent G, Lamblin N, Bonnefoy E, Roubille F. Cardiogenic shock management: Still a challenge and a need for large-registry data. Arch Cardiovasc Dis 2017; 110:433-438. [PMID: 28479041 DOI: 10.1016/j.acvd.2017.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/11/2017] [Accepted: 03/21/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Clement Delmas
- Intensive Cardiac Care Unit, Cardiology Department, University Hospital of Rangueil, Toulouse, France; Intensive Care Unit Rangueil, Anaesthesia and Critical Care Department, University Hospital of Rangueil, Toulouse, France.
| | - Guillaume Leurent
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes 1, LTSI, INSERM, U1099, Rennes, France
| | - Nicolas Lamblin
- Université de Lille, INSERM, CHU de Lille, Institut Pasteur, U1167, Lille, France
| | - Eric Bonnefoy
- Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Lyon, France
| | - François Roubille
- Cardiology Department, University Hospital of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
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Watanabe Y, Sakakura K, Taniguchi Y, Adachi Y, Noguchi M, Akashi N, Wada H, Momomura SI, Fujita H. Determinants of In-Hospital Death in Acute Myocardial Infarction With Triple Vessel Disease. Int Heart J 2016; 57:697-704. [PMID: 27829643 DOI: 10.1536/ihj.16-170] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Compared to acute myocardial infarction (AMI) with single vessel disease (SVD) or double vessel disease (DVD), AMI with triple vessel disease (TVD) is associated with higher mortality. The aim of this study was to identify the determinants of in-hospital death in AMI with TVD. We identified AMI patients with TVD in our tertiary medical center between January 2009 and December 2014. Baseline patient characteristics including laboratory data, echocardiograms, and coronary angiograms were collected from our hospital records. We divided our study population into a survivor group and non-survivor group. Multivariate stepwise logistic regression analysis was performed to identify the determinants of in-hospital death. A total of 138 AMI patients with TVD were identified and included as the final study population. Fifteen patients died during the hospitalization (mortality rate, 10.9%). Mean systolic blood pressure (134 ± 27 mmHg) was significantly greater in the survivor group compared with the non-survivor group (114 ± 31 mmHg) (P = 0.02). The prevalence of shock on admission was significantly less in the survivor group (15.4%) than in the non-survivor group (66.7%) (P < 0.001). Multivariate stepwise logistic regression analysis revealed that shock status on admission (OR 11.50, 95% CI 3.21-41.14, P < 0.001), the left anterior descending artery (LAD) as the infarct related artery (IRA) (OR 3.83, 95% CI 1.04-14.09, P = 0.04), and serum albumin on admission (OR 0.26, 95% CI 0.08-0.84, P = 0.02) were significantly associated with in-hospital death. In conclusion, shock status on admission, the LAD as the IRA, and a low serum albumin level were the determinants of in-hospital death in AMI patients with TVD.
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Affiliation(s)
- Yusuke Watanabe
- Division of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center
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Masoumi A, Rosenblum HR, Garan AR. Cardiogenic Shock in Older Adults. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0522-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chen DY, Mao CT, Tsai ML, Chen SW, Lin YS, Hsieh IC, Hung MJ, Wang CH, Wen MS, Cherng WJ, Chen TH. Clinical outcomes of drug-eluting stents versus bare-metal stents in patients with cardiogenic shock complicating acute myocardial infarction. Int J Cardiol 2016; 215:98-104. [PMID: 27111168 DOI: 10.1016/j.ijcard.2016.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/02/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND To investigate the cardiovascular (CV) outcomes of drug-eluting stents (DESs) versus bare-metal stents (BMSs) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). METHODS Data from the Taiwan National Health Insurance Research Database was analyzed between January 1, 2007 and December 31, 2011. A total of 3051 AMI patients in CS were selected as the study cohort. Their clinical outcomes were evaluated by comparing 1017 subjects who used DESs to 2034 matched subjects who used BMSs. RESULTS The risk of the primary composite outcome (i.e., death, myocardial infarction, stroke, and coronary revascularization) was significantly lower in the DES group compared with the BMS group [56.1% vs. 66.2%, hazard ratio (HR), 0.74; 95% CI, 0.67-0.81] with a mean follow-up of 1.35years. The patients who received DESs had a lower risk of coronary revascularization (HR, 0.78; 95% CI, 0.67-0.91) and death (HR, 0.70; 95% CI, 0.62-0.79) than those who used BMSs. However, the risks of myocardial infarction (HR, 0.89; 95% CI, 0.66-1.18), ischemic stroke (HR, 1.02; 95% CI, 0.67-1.53) and major bleeding (HR, 0.80; 95% CI, 0.56-1.14) were similar between the two groups. CONCLUSIONS Among patients with CS complicating AMI, DES implantation significantly reduced the risk of percutaneous coronary revascularization and death compared to BMS implantation.
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Affiliation(s)
- Dong-Yi Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Tai Mao
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan,; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Lung Tsai
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Jui Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan,; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chao-Hung Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan,; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Shien Wen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Jin Cherng
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan,; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan,; Chang Gung University College of Medicine, Taoyuan, Taiwan.
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36
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Goldberg RJ, Makam RCP, Yarzebski J, McManus DD, Lessard D, Gore JM. Decade-Long Trends (2001-2011) in the Incidence and Hospital Death Rates Associated with the In-Hospital Development of Cardiogenic Shock after Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2016; 9:117-25. [PMID: 26884615 PMCID: PMC4794369 DOI: 10.1161/circoutcomes.115.002359] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited information is available about relatively contemporary trends in the incidence and hospital case-fatality rates of cardiogenic shock in patients hospitalized with acute myocardial infarction. The purpose of this population-based study was to describe decade long trends (2001-2011) in the incidence and hospital case-fatality rates for patients who developed cardiogenic shock during hospitalization for an acute myocardial infarction. METHODS AND RESULTS The study population consisted of 5686 residents of central Massachusetts hospitalized with acute myocardial infarction at all 11 medical centers in the Worcester, MA, metropolitan area during 6 biennial periods between 2001 and 2011, who did not have cardiogenic shock at the time of hospital presentation. On average, 3.7% of these patients developed cardiogenic shock during their acute hospitalization with nonsignificant and inconsistent trends noted over time in both crude (3.7% in 2001/2003; 4.5% in 2005/2007; 2.7% in 2009/2011; P=0.19) and multivariable adjusted analyses. The overall in-hospital case-fatality rate for patients who developed cardiogenic shock was 41.4%. The crude and multivariable adjusted odds of dying after cardiogenic shock declined during the most recent study years (47.1% dying in 2001/2003, 42.0% dying in 2005/2007, and 28.6% dying in 2009/2011). Increases in the use of evidence-based cardiac medications, and interventional procedures paralleled the increasing hospital survival trends. CONCLUSIONS We found suggestions of a decline in the death, but not incidence, rates of cardiogenic shock over time. These encouraging trends in hospital survival are likely because of advances in the early recognition and aggressive management of patients who develop cardiogenic shock.
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Affiliation(s)
- Robert J Goldberg
- From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester.
| | - Raghavendra Charan P Makam
- From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester
| | - Jorge Yarzebski
- From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester
| | - David D McManus
- From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester
| | - Darleen Lessard
- From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester
| | - Joel M Gore
- From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester
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37
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Wayangankar SA, Bangalore S, McCoy LA, Jneid H, Latif F, Karrowni W, Charitakis K, Feldman DN, Dakik HA, Mauri L, Peterson ED, Messenger J, Roe M, Mukherjee D, Klein A. Temporal Trends and Outcomes of Patients Undergoing Percutaneous Coronary Interventions for Cardiogenic Shock in the Setting of Acute Myocardial Infarction: A Report From the CathPCI Registry. JACC Cardiovasc Interv 2016; 9:341-351. [PMID: 26803418 DOI: 10.1016/j.jcin.2015.10.039] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/17/2015] [Accepted: 10/24/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the temporal trends in demographics, clinical characteristics, management strategies, and in-hospital outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (CS-AMI) who underwent percutaneous coronary intervention (PCI) from the Cath-PCI Registry (2005 to 2013). BACKGROUND The authors examined contemporary use and outcomes of PCI in patients with CS-AMI. METHODS The authors used the Cath-PCI Registry to evaluate 56,497 patients (January 2005 to December 2013) undergoing PCI for CS-AMI. Temporal trends in clinical variables and outcomes were assessed. RESULTS Compared with cases performed from 2005 to 2006, CS-AMI patients receiving PCI from 2011 to 2013 were more likely to have diabetes, hypertension, dyslipidemia, previous PCI, dialysis, but less likely to have chronic lung disease, peripheral vascular disease, or heart failure within 2 weeks (p < 0.01). Between 2005 and 2006 to 2011 and 2013, intra-aortic balloon pump use decreased (49.5% to 44.9%; p < 0.01), drug-eluting stent use declined (65% to 46%; p < 0.01), and the use of bivalirudin increased (12.6% to 45.6%). Adjusted in-hospital mortality; increased (27.6% in 2005 to 2006 vs. 30.6% in 2011 to 2013, adjusted odds ratio: 1.09, 95% confidence interval: 1.005 to .173; p = 0.04) for patients who were managed with an early invasive strategy (<24 h from symptoms). CONCLUSIONS Our study shows that despite the evolution of medical technology and use of contemporary therapeutic measures, in-hospital mortality in CS-AMI patients who are managed invasively continues to rise. Additional research and targeted efforts are indicated to improve outcomes in this high-risk cohort.
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Affiliation(s)
| | | | - Lisa A McCoy
- Duke Clinical Research Institute, Durham, North Carolina
| | - Hani Jneid
- Baylor College of Medicine, Houston, Texas
| | - Faisal Latif
- Health Sciences Center and Veterans Affairs Medical Center, University of Oklahoma, Oklahoma City, Oklahoma
| | | | | | - Dmitriy N Feldman
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | | | - Laura Mauri
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - John Messenger
- School of Medicine, University of Colorado, Denver, Colorado
| | - Mathew Roe
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Andrew Klein
- St. Louis VA Medical Center, and Department of Internal Medicine, School of Medicine, Saint Louis University, Saint Louis, Missouri
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38
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Kolte D, Khera S, Dabhadkar KC, Agarwal S, Aronow WS, Timmermans R, Jain D, Cooper HA, Frishman WH, Menon V, Bhatt DL, Abbott JD, Fonarow GC, Panza JA. Trends in Coronary Angiography, Revascularization, and Outcomes of Cardiogenic Shock Complicating Non-ST-Elevation Myocardial Infarction. Am J Cardiol 2016; 117:1-9. [PMID: 26541908 DOI: 10.1016/j.amjcard.2015.10.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/09/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
Early revascularization is the mainstay of treatment for cardiogenic shock (CS) complicating acute myocardial infarction. However, data on the contemporary trends in management and outcomes of CS complicating non-ST-elevation myocardial infarction (NSTEMI) are limited. We used the 2006 to 2012 Nationwide Inpatient Sample databases to identify patients aged ≥ 18 years with NSTEMI with or without CS. Temporal trends and differences in coronary angiography, revascularization, and outcomes were analyzed. Of 2,191,772 patients with NSTEMI, 53,800 (2.5%) had a diagnosis of CS. From 2006 to 2012, coronary angiography rates increased from 53.6% to 60.4% in patients with NSTEMI with CS (ptrend <0.001). Among patients who underwent coronary angiography, revascularization rates were significantly higher in patients with CS versus without CS (72.5% vs 62.6%, p <0.001). Patients with NSTEMI with CS had significantly higher risk-adjusted in-hospital mortality (odds ratio 10.09, 95% confidence interval 9.88 to 10.32) as compared to those without CS. In patients with CS, an invasive strategy was associated with lower risk-adjusted in-hospital mortality (odds ratio 0.43, 95% confidence interval 0.42 to 0.45). Risk-adjusted in-hospital mortality, length of stay, and total hospital costs decreased over the study period in patients with and without CS (ptrend <0.001). In conclusion, we observed an increasing trend in coronary angiography and decreasing trend in in-hospital mortality, length of stay, and total hospital costs in patients with NSTEMI with and without CS. Despite these positive trends, overall coronary angiography and revascularization rates remain less than optimal and in-hospital mortality unacceptably high in patients with NSTEMI and CS.
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39
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Spence N, Abbott JD. Coronary Revascularization in Cardiogenic Shock. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 18:1. [DOI: 10.1007/s11936-015-0423-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Russ M. [Intra-aortic balloon pump (IABP) counterpulsation. Do we still need it and if so when?]. Med Klin Intensivmed Notfmed 2015; 110:402-6. [PMID: 26340798 DOI: 10.1007/s00063-015-0064-5] [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: 05/28/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
Intra-aortic balloon pump (IABP) counterpulsation was for a long time considered to be an indispensable standard for support of drug therapy for all forms of acute left-sided cardiac failure and especially in cardiogenic shock due to infarction. The advantages of the system seemed to be obvious; however, many of the postulated effects on the hemodynamics, microcirculation and coronary perfusion could not be confirmed later in prospective studies. It was found that IABP had no influence on microcirculation disorders in cardiogenic shock due to infarction. In a meta-analysis on the application for acute myocardial infarction without shock, no effect was found on mortality. The benefit as adjunct therapy for percutaneous coronary interventions (PCI) in cardiogenic shock due to infarction places a question mark over both IABP-SHOCK studies; however, in constellations without PCI the additional benefit of IABP cannot be excluded which is why the procedure could be an option in this situation.
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Affiliation(s)
- M Russ
- Kardiologie und Pneumologie, Helios Amper-Klinikum, Krankenhausstr. 15, 85221, Dachau, Deutschland.
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41
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Bangalore S, Gupta N, Guo Y, Lala A, Balsam L, Roswell RO, Reyentovich A, Hochman JS. The reply. Am J Med 2015. [PMID: 26210462 DOI: 10.1016/j.amjmed.2015.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Yu Guo
- New York University School of Medicine, New York
| | | | - Leora Balsam
- New York University School of Medicine, New York
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42
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Champion S. Mostly early invasive management may improve outcomes in patients with myocardial infarction and cardiogenic shock. Am J Med 2015. [PMID: 26210461 DOI: 10.1016/j.amjmed.2015.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sébastien Champion
- Réanimation Polyvalente, CHU de la Réunion, Hôpital Félix Guyon, Saint Denis, France
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43
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Benedek T, Dobreanu D. Current Concepts and New Trends in the Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction. ACTA ACUST UNITED AC 2015; 1:5-10. [PMID: 29967809 DOI: 10.1515/jccm-2015-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/15/2015] [Indexed: 11/15/2022]
Abstract
Cardiogenic shock (CS) is a critical condition which often complicates the evolution of an acute myocardial infarction (AMI). At the same time, co-existence of chronic multi-vessel disease can lead to the development of cardiogenic shock in cases with pronounced haemodynamic instability. Different clinical studies have tried to identify the most appropriate treatment for critical cases of CS complicating AMI. This review aims to present the current status of recommended therapeutic strategies for severe cases of CS presenting as a complication of AMI, and try to shed light on the most appropriate therapeutic strategy as outlined in the current literature. The paper will discuss the different current strategies available for use in the treatment of this condition, includig interventional revascularisation, (complete or culprit), the role of new devices for providing mechanical circulatory support, and the potential role of new drug therapies and of hypothermia.
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Affiliation(s)
- Theodora Benedek
- University of Medicine and Pharmacy of Tirgu Mures, 38 Gheorghe Marinescu street, Tirgu Mures, 540139, Romania
| | - Dan Dobreanu
- University of Medicine and Pharmacy of Tirgu Mures, 38 Gheorghe Marinescu street, Tirgu Mures, 540139, Romania
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Tenzer S, Peters B, Bulik S, Schoor O, Lemmel C, Schatz MM, Kloetzel PM, Rammensee HG, Schild H, Holzhütter HG. Modeling the MHC class I pathway by combining predictions of proteasomal cleavage, TAP transport and MHC class I binding. Cell Mol Life Sci 2005; 62:1025-37. [PMID: 15868101 DOI: 10.1007/s00018-005-4528-2] [Citation(s) in RCA: 244] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Epitopes presented by major histocompatibility complex (MHC) class I molecules are selected by a multi-step process. Here we present the first computational prediction of this process based on in vitro experiments characterizing proteasomal cleavage, transport by the transporter associated with antigen processing (TAP) and MHC class I binding. Our novel prediction method for proteasomal cleavages outperforms existing methods when tested on in vitro cleavage data. The analysis of our predictions for a new dataset consisting of 390 endogenously processed MHC class I ligands from cells with known proteasome composition shows that the immunological advantage of switching from constitutive to immunoproteasomes is mainly to suppress the creation of peptides in the cytosol that TAP cannot transport. Furthermore, we show that proteasomes are unlikely to generate MHC class I ligands with a C-terminal lysine residue, suggesting processing of these ligands by a different protease that may be tripeptidyl-peptidase II (TPPII).
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Affiliation(s)
- S Tenzer
- Institute of Immunology, Johannes Gutenberg University, Obere Zahlbacherstr. 67, 55131, Mainz, Germany
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