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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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Oliveira M, Seringa J, Pinto FJ, Henriques R, Magalhães T. Machine learning prediction of mortality in Acute Myocardial Infarction. BMC Med Inform Decis Mak 2023; 23:70. [PMID: 37072766 PMCID: PMC10111317 DOI: 10.1186/s12911-023-02168-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/04/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Acute Myocardial Infarction (AMI) is the leading cause of death in Portugal and globally. The present investigation created a model based on machine learning for predictive analysis of mortality in patients with AMI upon admission, using different variables to analyse their impact on predictive models. METHODS Three experiments were built for mortality in AMI in a Portuguese hospital between 2013 and 2015 using various machine learning techniques. The three experiments differed in the number and type of variables used. We used a discharged patients' episodes database, including administrative data, laboratory data, and cardiac and physiologic test results, whose primary diagnosis was AMI. RESULTS Results show that for Experiment 1, Stochastic Gradient Descent was more suitable than the other classification models, with a classification accuracy of 80%, a recall of 77%, and a discriminatory capacity with an AUC of 79%. Adding new variables to the models increased AUC in Experiment 2 to 81% for the Support Vector Machine method. In Experiment 3, we obtained an AUC, in Stochastic Gradient Descent, of 88% and a recall of 80%. These results were obtained when applying feature selection and the SMOTE technique to overcome imbalanced data. CONCLUSIONS Our results show that the introduction of new variables, namely laboratory data, impacts the performance of the methods, reinforcing the premise that no single approach is adapted to all situations regarding AMI mortality prediction. Instead, they must be selected, considering the context and the information available. Integrating Artificial Intelligence (AI) and machine learning with clinical decision-making can transform care, making clinical practice more efficient, faster, personalised, and effective. AI emerges as an alternative to traditional models since it has the potential to explore large amounts of information automatically and systematically.
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Affiliation(s)
- Mariana Oliveira
- NOVA National School of Public Health, Universidade NOVA Lisboa, Lisbon, Portugal
| | - Joana Seringa
- NOVA National School of Public Health, Universidade NOVA Lisboa, Lisbon, Portugal
| | - Fausto José Pinto
- Serviço de Cardiologia, Centro Hospitalar Universitário de Lisboa Norte (CHULN), CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Roberto Henriques
- NOVA Information Management School (NOVA IMS), Universidade Nova de Lisboa, 1070-312, Lisbon, Portugal.
| | - Teresa Magalhães
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, Nova University of Lisbon, Lisbon, Portugal
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Radu RI, Ben Gal T, Abdelhamid M, Antohi E, Adamo M, Ambrosy AP, Geavlete O, Lopatin Y, Lyon A, Miro O, Metra M, Parissis J, Collins SP, Anker SD, Chioncel O. Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature. ESC Heart Fail 2021; 8:4717-4736. [PMID: 34664409 PMCID: PMC8712803 DOI: 10.1002/ehf2.13643] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/08/2021] [Accepted: 09/19/2021] [Indexed: 01/09/2023] Open
Abstract
Cardiogenic shock (CS) is a complex multifactorial clinical syndrome, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large phenotypic variability in CS, as a result of the diverse aetiologies, pathogenetic mechanisms, haemodynamics, and stages of severity. Although early revascularization remains the most important intervention for CS in settings of acute myocardial infarction, the administration of timely and effective antithrombotic therapy is critical to improving outcomes in these patients. In addition, other clinical settings or non-acute myocardial infarction aetiologies, associated with high thrombotic risk, may require specific regimens of short-term or long-term antithrombotic therapy. In CS, altered tissue perfusion, inflammation, and multi-organ dysfunction induce unpredictable alterations to antithrombotic drugs' pharmacokinetics and pharmacodynamics. Other interventions used in the management of CS, such as mechanical circulatory support, renal replacement therapies, or targeted temperature management, influence both thrombotic and bleeding risks and may require specific antithrombotic strategies. In order to optimize safety and efficacy of these therapies in CS, antithrombotic management should be more adapted to CS clinical scenario or specific device, with individualized antithrombotic regimens in terms of type of treatment, dose, and duration. In addition, patients with CS require a close and appropriate monitoring of antithrombotic therapies to safely balance the increased risk of bleeding and thrombosis.
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Affiliation(s)
- Razvan I. Radu
- ICCU DepartmentEmergency Institute for Cardiovascular Diseases ‘Prof. Dr. C.C. Iliescu’BucharestRomania
| | - Tuvia Ben Gal
- Department of Cardiology, Rabin Medical Center (Beilinson Campus), Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Magdy Abdelhamid
- Cardiology Department, Kasr Alainy School of MedicineCairo UniversityCairoEgypt
| | - Elena‐Laura Antohi
- ICCU DepartmentEmergency Institute for Cardiovascular Diseases ‘Prof. Dr. C.C. Iliescu’BucharestRomania
- University for Medicine and Pharmacy ‘Carol Davila’ BucharestBucharestRomania
| | - Marianna Adamo
- Cardiothoracic Department, Civil Hospitals and Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Andrew P. Ambrosy
- Department of CardiologyKaiser Permanente San Francisco Medical CenterSan FranciscoCAUSA
- Division of Research, Kaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Oliviana Geavlete
- ICCU DepartmentEmergency Institute for Cardiovascular Diseases ‘Prof. Dr. C.C. Iliescu’BucharestRomania
- University for Medicine and Pharmacy ‘Carol Davila’ BucharestBucharestRomania
| | - Yuri Lopatin
- Cardiology CentreVolgograd Medical UniversityVolgogradRussian Federation
| | - Alexander Lyon
- Cardio‐Oncology ServiceRoyal Brompton Hospital and Imperial College LondonLondonUK
| | - Oscar Miro
- Emergency Department, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain
| | - Marco Metra
- Cardiology, Cardiothoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - John Parissis
- Second Department of Cardiology, Attikon University HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Sean P. Collins
- Department of Emergency Medicine; Vanderbilt University Medical CentreNashvilleTNUSA
| | - Stefan D. Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site BerlinCharité—Universitätsmedizin BerlinBerlinGermany
| | - Ovidiu Chioncel
- ICCU DepartmentEmergency Institute for Cardiovascular Diseases ‘Prof. Dr. C.C. Iliescu’BucharestRomania
- University for Medicine and Pharmacy ‘Carol Davila’ BucharestBucharestRomania
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Clinical Outcomes According to ECG Presentations in Infarct-Related Cardiogenic Shock in the Culprit Lesion Only PCI vs Multivessel PCI in Cardiogenic Shock Trial. Chest 2020; 159:1415-1425. [PMID: 33248059 DOI: 10.1016/j.chest.2020.10.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/15/2020] [Accepted: 10/18/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The impact of ECG presentations of acute myocardial infarction (AMI) in cardiogenic shock is unknown. RESEARCH QUESTION In myocardial infarction with cardiogenic shock, is there a difference in the outcomes and effect of revascularization strategies between non-ST-segment elevation myocardial infarction (NSTEMI) and left bundle branch block myocardial infarction (LBBBMI) vs ST-segment elevation myocardial infarction (STEMI)? STUDY DESIGN AND METHODS Cardiogenic shock patients from the CULPRIT-SHOCK trial with NSTEMI or LBBBMI were compared with STEMI patients for 30-day and 1-year all-cause mortality. The interaction between ECG presentation and the effect of revascularization strategies on outcomes was evaluated. RESULTS Of 665 cardiogenic shock patients analyzed, 55.9% demonstrated STEMI, 29.3% demonstrated NSTEMI, and 14.7% demonstrated LBBBMI. Patients differed in mean age (68.0 years in STEMI patients, 71.0 years in NSTEMI patients, and 73.5 years in LBBBMI patients; P = .015), cardiovascular risk factors, and angiographic severity. No difference was found in the 30-day risk of death between NSTEMI and STEMI patients (48.7% vs 43.0%; adjusted OR [aOR], 1.05; 95% CI, 0.66-1.67; P = .85), nor between LBBBMI and STEMI patients (59.2% vs 43.0%; aOR, 1.31; 95% CI, 0.73-2.34; P = .36). Although the univariate risk of death by 1 year was higher in NSTEMI and LBBBMI patients compared with STEMI patients, ECG presentation was not an independent risk factor of mortality after adjustment (NSTEMI vs STEMI: 56.4% vs 46.8%; aOR, 1.21; 95% CI, 0.76-1.92; P = .42; LBBBMI vs STEMI: 69.4% vs 46.8%; aOR, 1.59; 95% CI, 0.89-2.84; P = .12). ECG presentation did not modify the effect of the revascularization strategy on 30-day and 1-year mortality (P = .91 and P = .97 for interaction). INTERPRETATION In patients with cardiogenic shock, NSTEMI and LBBBMI presentations reflect higher-risk profiles than STEMI presentations, but are not independent risk factors of mortality. ECG presentations did not modify the treatment effect, supporting culprit-lesion-only percutaneous coronary intervention as the preferred strategy across the AMI spectrum.
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Serdechnaya AY, Sukmanova IA. Modern approaches to the diagnosis and treatment of cardiogenic shock complicating acute myocardial infarction. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Cardiogenic shock (CS) is the most severe complication of myocardial infarction, manifested by an acute tissue hypoperfusion as a result of impaired contractile function of the heart. CS occupies a leading place in the patterns of mortality in patients with myocardial infarction, despite all the advances in medicine. This review presents a modern classification of CS and a risk assessment score, considers the main aspects of epidemiology and pathophysiology of CS, discusses issues of its diagnosis and treatment.
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Affiliation(s)
| | - I. A. Sukmanova
- Altai Regional Cardiological Dispensary; Altai State Medical University
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Qiao S, Zhang J, Kong Z, Wu H, Gu R, Zheng H, Xu B, Wei Z. Comparison of the prognosis for different onset stage of cardiogenic shock secondary to ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2020; 20:302. [PMID: 32560702 PMCID: PMC7304156 DOI: 10.1186/s12872-020-01583-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Abstract
Objectives The study was conducted to evaluate the outcomes of different onset stage of cardiogenic shock (CS) in the patients with ST-segment elevation myocardial infarction (STEMI). Methods Total 675 STEMI patients who had undergone primary percutaneous coronary intervention (pPCI) from November 2010 to December 2017 in Nanjing Drum Tower Hospital were enrolled. According to the onset time of CS, the cohort was divided into three groups: Non-CS group, CS on admission group and Developed CS group. The short-term (30 days), middle-term (12 months) and long-term (80 months) outcomes were analyzed. COX proportional hazard models were established for identification of the predictors. Results The all cause death, cardiac death and major adverse cardiac events (MACE) at 30 days were similar among the three groups. The incidence of MACE in the CS on admission group was significantly higher than the other two groups at 12 months. As to the long-term outcomes, the CS on admission group had lower survival rate than the other two groups. The Develop CS group had lower survival rate than Non-CS group numerically with a trend towards statistical significance. The incidence of cardiac death in the Non-CS group was the lowest. The incidence of MACE in the CS on admission group was much higher compared with the other two groups. After multivariate analysis, the independent predictors of all cause death included age, male sex, prior stroke and LVEF. The independent predictors of cardiac death included age, male sex, prior stroke, LVEF, CS on admission and developed CS. The independent predictors of MACE included age, prior stroke, LVEF, multivessel lesions, post-PCI TIMI grade 1 and CS on admission. Conclusions The long-term outcomes of CS on admission group were the worst of all. The outcomes of Developed CS group laid between the other two groups. The consequences highlighted the importance of prevention for CS developing in the STEMI patients during hospitalization.
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Affiliation(s)
- Shuaihua Qiao
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Jingmei Zhang
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China.,Department of Cardiology, Yizheng Hospital, Nanjing Drum Tower Hospital Group, Yizheng, 211900, China
| | - Zhenzhen Kong
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Han Wu
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Rong Gu
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Hongyan Zheng
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Biao Xu
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China.
| | - Zhonghai Wei
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China.
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7
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Scholz KH, Maier SKG, Maier LS, Lengenfelder B, Jacobshagen C, Jung J, Fleischmann C, Werner GS, Olbrich HG, Ott R, Mudra H, Seidl K, Schulze PC, Weiss C, Haimerl J, Friede T, Meyer T. Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial. Eur Heart J 2019; 39:1065-1074. [PMID: 29452351 PMCID: PMC6018916 DOI: 10.1093/eurheartj/ehy004] [Citation(s) in RCA: 224] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 01/18/2018] [Indexed: 01/06/2023] Open
Abstract
Aims The aim of this study was to investigate the effect of contact-to-balloon time on mortality in ST-segment elevation myocardial infarction (STEMI) patients with and without haemodynamic instability. Methods and results Using data from the prospective, multicentre Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) trial, we assessed the prognostic relevance of first medical contact-to-balloon time in n = 12 675 STEMI patients who used emergency medical service transportation and were treated with primary percutaneous coronary intervention (PCI). Patients were stratified by cardiogenic shock (CS) and out-of-hospital cardiac arrest (OHCA). For patients treated within 60 to 180 min from the first medical contact, we found a nearly linear relationship between contact-to-balloon times and mortality in all four STEMI groups. In CS patients with no OHCA, every 10-min treatment delay resulted in 3.31 additional deaths in 100 PCI-treated patients. This treatment delay-related increase in mortality was significantly higher as compared to the two groups of OHCA patients with shock (2.09) and without shock (1.34), as well as to haemodynamically stable patients (0.34, P < 0.0001). Conclusions In patients with CS, the time elapsing from the first medical contact to primary PCI is a strong predictor of an adverse outcome. This patient group benefitted most from immediate PCI treatment, hence special efforts to shorten contact-to-balloon time should be applied in particular to these high-risk STEMI patients. Clinical Trial Registration NCT00794001. ![]()
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Affiliation(s)
- Karl Heinrich Scholz
- Department of Cardiology, Medizinische Klinik I, St. Bernward Hospital, Treibestraße 9, 31134 Hildesheim, Germany
| | - Sebastian K G Maier
- Department of Cardiology, Medizinische Klinik II, Klinikum Straubing and Comprehensive Heart Failure Center Würzburg, Würzburg, St.-Elisabeth-Straße 23, 94315 Straubing, Germany
| | - Lars S Maier
- Department of Cardiology, Universitätsklinikum Regensburg, Klinik und Poliklinik für Innere Medizin II, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Björn Lengenfelder
- Department of Cardiology, Universitätsklinikum Würzburg and Comprehensive Heart Failure Center Würzburg, Medizinische Klinik und Poliklinik I, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Claudius Jacobshagen
- Department of Cardiology and Pneumology, Heart Center, University of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - Jens Jung
- Department of Cardiology, Medizinische Klinik I, Klinikum Worms, Gabriel-von-Seidl-Straße 81, 67550 Worms, Germany
| | - Claus Fleischmann
- Department of Cardiology, Klinikum Wolfsburg, Medizinische Klinik I, Sauerbruchstraße 7, 38440 Wolfsburg, Germany
| | - Gerald S Werner
- Department of Cardiology, Medizinische Klinik I, Klinikum Darmstadt, Grafenstraße 9, 64283 Darmstadt, Germany
| | - Hans G Olbrich
- Department of Cardiology, Asklepios Klinik Langen, Röntgenstraße 20, 63225 Langen, Germany
| | - Rainer Ott
- Department of Cardiology, HELIOS Klinikum Krefeld, Medizinische Klinik I, Lutherplatz 40, 47805 Krefeld, Germany
| | - Harald Mudra
- Department of Cardiology, Klinikum Neuperlach, Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Oskar-Maria-Graf-Ring 51, 81737 München, Germany
| | - Karlheinz Seidl
- Department of Cardiology, Klinikum Ingolstadt, Medizinische Klinik I und IV, Krumenauerstraße 25, 85049 Ingolstadt, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Am Klinikum 1, 07740 Jena, Germany
| | - Christian Weiss
- Department of Cardiology, Klinikum Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany
| | - Josef Haimerl
- Department of Cardiology, Krankenhaus Landshut-Achdorf, Medizinische Klinik I, Achdorfer Weg 3, 84036 Landshut, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, University of Göttingen, and DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, University of Göttingen, and DZHK, partner site Göttingen, Waldweg 33, 37073 Göttingen, Germany
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O'Neill BP, Cohen MG, Basir MB, Schreiber T, Kapur NK, Dixon S, Khandelwal AK, Grines C, Ohman EM, O'Neill WW. Outcomes Among Patients Transferred for Revascularization With Impella for Acute Myocardial Infarction With Cardiogenic Shock from the cVAD Registry. Am J Cardiol 2019; 123:1214-1219. [PMID: 30777319 DOI: 10.1016/j.amjcard.2019.01.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/05/2019] [Accepted: 01/09/2019] [Indexed: 11/28/2022]
Abstract
The outcomes for patients transferred with cardiogenic shock and later treated with revascularization and Impella support have not previously been studied. To evaluate these outcomes, patients in cardiogenic shock were recruited from the catheter-based ventricular assist device registry, a prospective registry enrolling patients who underwent percutaneous coronary intervention with hemodynamic support using Impella 2.5 or CP. Analysis was performed on subgroups of patients who were characterized as those directly admitted to a tertiary care hospital (direct), or those transferred from an outside hospital (transfer). Patients who were transferred with acute myocardial infarction with cardiogenic shock (AMICS) more often presented in shock were in shock longer than 24 hours, and were more likely to be on intra-aortic balloon pump but were less likely to sustain cardiac arrest. The number of pressors, EF, diseased, and treated vessels were similar between the 2 groups. Despite baseline differences, the mortality was similar in the transfer versus direct patients (47.0% vs 53.5% p = 0.19). In a multivariate model, the factors independently associated with 30-day mortality in AMICS treated with revascularization and Impella support were cardiopulmonary resuscitation (CPR) (p <0.01), age (p <0.01), and ST-segment elevation myocardial infarction (STEMI) (p = 0.02). Whether the patient was transferred or directly admittedly with AMICS was not an independent predictor of death. In conclusion, these findings suggest that considerations should be given to transfer patients with AMICS to allow them to be treated in a contemporary manner.
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Affiliation(s)
- Brian P O'Neill
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania. Brian.O'
| | - Mauricio G Cohen
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Mir Babar Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | | | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, MA
| | - Simon Dixon
- Department of Cardiology, Beaumont Hospital, Royal Oak, Michigan
| | | | - Cindy Grines
- Northwell Health, North Shore University Hospital, Manhasset, New York
| | - Erik Magnus Ohman
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
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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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Hashmi KA, Abbas K, Hashmi AA, Irfan M, Edhi MM, Ali N, Khan A. In-hospital mortality of patients with cardiogenic shock after acute myocardial infarction; impact of early revascularization. BMC Res Notes 2018; 11:721. [PMID: 30309379 PMCID: PMC6182779 DOI: 10.1186/s13104-018-3830-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/09/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The purpose of this study was to determine the frequency of in-hospital mortality in 351 patients who developed cardiogenic shock after acute myocardial infarction and by determining this; we might find that how efficiently we could manage this serious condition in our population by knowing the factors which are associated with high mortality after cardiogenic shock. Moreover impact of early revascularization like thrombolytic therapy or angioplasty was also evaluated. RESULTS Mean age was 65.41 ± 7.78 years in our study. In-hospital mortality with cardiogenic shock after acute myocardial infarction was found to be 44.73%. Significant association of in-hospital mortality was noted with age, hypertension, diabetes mellitus and BMI. Patients receiving early revascularization were noted to have lower in-hospital mortality compared to those in whom revascularization was not done due to delayed presentation. This study concluded that there is a high frequency (44.73%) of in-hospital mortality in patients with cardiogenic shock after acute myocardial in our population. So, we recommend that for achieving a good outcome and to reduce in-hospital mortality; in addition to rapid diagnosis of this condition, underlying risk factors like hypertension and diabetes should be evaluated and managed accordingly and early revascularization should be done when possible.
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Affiliation(s)
- Kashif Ali Hashmi
- Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, Punjab, Pakistan
| | - Khawar Abbas
- Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, Punjab, Pakistan
| | - Atif Ali Hashmi
- Liaquat National Hospital and Medical College, Karachi, Sindh, Pakistan
| | - Muhammad Irfan
- Liaquat National Hospital and Medical College, Karachi, Sindh, Pakistan
| | | | - Nauman Ali
- Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, Punjab, Pakistan
| | - Amir Khan
- Kandahar University, Kandahar, Afghanistan.
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11
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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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12
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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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Abadeer AI, Kurlansky P, Chiuzan C, Truby L, Radhakrishnan J, Garan R, Topkara V, Yuzefpolskaya M, Colombo P, Takeda K, Naka Y, Takayama H. Importance of stratifying acute kidney injury in cardiogenic shock resuscitated with mechanical circulatory support therapy. J Thorac Cardiovasc Surg 2017; 154:856-864.e4. [DOI: 10.1016/j.jtcvs.2017.04.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 03/05/2017] [Accepted: 04/12/2017] [Indexed: 11/30/2022]
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Abstract
Cardiogenic shock represents a state of low cardiac output and systemic hypoperfusion resulting in insufficient end-organ perfusion and consequent multiorgan failure. The main cause of this complication in the context of acute ST-elevation myocardial infarction is left ventricular dysfunction secondary to poor myocardial perfusion. In over 50% of cardiogenic shock cases, there is evidence of significant coronary stenosis within noninfarct-related arteries. Persistent ischemia in the noninfarct territory may contribute to ongoing hypotension. Currently, ESC and ACC/AHA/SCAI guidelines advocate complete revascularization in the context of multivessel coronary artery disease in the context of cardiogenic shock, although the evidence is weak.
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15
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Davierwala PM, Leontyev S. Response by Davierwala and Leontyev to Letter Regarding Article, "Temporal Trends in Predictors of Early and Late Mortality after Emergency Coronary Artery Bypass Grafting for Cardiogenic Shock Complicating Acute Myocardial Infarction". Circulation 2017; 135:e816-e817. [PMID: 28348095 DOI: 10.1161/circulationaha.117.026958] [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: 11/16/2022]
Affiliation(s)
- Piroze M Davierwala
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Germany
| | - Sergey Leontyev
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Germany
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16
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Bouki KP, Pavlakis G, Papasteriadis E. Management of Cardiogenic Shock Due to Acute Coronary Syndromes. Angiology 2016; 56:123-30. [PMID: 15793600 DOI: 10.1177/000331970505600201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite advances in the treatment of patients with acute coronary syndromes, there has been no significant decrease in the incidence of cardiogenic shock, while its mortality remains frustratingly high. Shock is a progressive state of hypotension (systolic blood pressure <90 mm Hg) lasting at least 30 minutes, which leads to systemic hypoperfusion. It is more common in patients with ST-segment elevation myocardial infarction than in patients with other acute coronary syndromes. Revascularization is associated with better outcomes than intensive medical therapy, especially in patients <75 years of age with cardiogenic shock. Adjunctive therapies include inotropes, vasopressor therapy, intra-aortic balloon pump counterpulsation, and IIb/IIIa blockade to prevent no-reflow phenomenon during primary percutaneous transluminal coronary angioplasty. Other adjunctive therapies which are investigated are improved mechanical support devices, and as medical therapy for myocyte protection nicorandil, glucose/insulin/potassium infusions and direct inhibition of Na+/H+ exchanger.
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17
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Suzuki M, Sumiyoshi T, Miyachi H, Yamashita J, Tanaka H, Yamasaki M, Miyauchi K, Yamamoto T, Nagao K, Takayama M. WITHDRAWN: Mechanical circulatory support with optimal coronary reflow in a cardiogenic shock complicating acute myocardial infarction. J Cardiol 2016. [DOI: 10.1016/j.jjcc.2015.04.013] [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]
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Long-Term Survival and Quality of Life of Patients Undergoing Emergency Coronary Artery Bypass Grafting for Postinfarction Cardiogenic Shock. Ann Thorac Surg 2015; 101:960-6. [PMID: 26518374 DOI: 10.1016/j.athoracsur.2015.08.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 07/12/2015] [Accepted: 08/26/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study evaluated the long-term outcome of patients undergoing emergency coronary artery bypass grafting (eCABG) for cardiogenic shock after acute myocardial infarction. METHODS Sixty-seven consecutive patients underwent eCABG for cardiogenic shock at 2 European institutions during an 11-year period. Preoperative, intraoperative, postoperative, and long-term follow-up data of all patients were prospectively collected. RESULTS Hospital survival was 86% (58 of 67), with all deaths due to cardiac causes. At a mean follow-up of 78 ± 48 months (range, 1 to 153 months), 43 of the 58 patients (74%) discharged from the hospital were alive. Causes of death in 9 of the 15 follow-up deaths (60%) were noncardiac. Overall survival rate at the end of follow-up was 64% (43 of 67). Of the 43 survivors, 41 (95%) were in New York Heart Association Functional Classification I to II, ischemia free, had a Karnofsky performance status exceeding 80, and an excellent quality of life as assessed by the Seattle Angina Questionnaire. The use of cardiopulmonary bypass and the internal thoracic artery were associated with significantly better long-term survival. CONCLUSIONS The long-term survival and quality of life of patients who undergo eCABG for cardiogenic shock after acute myocardial infarction are good, and eCABG should be considered a valuable therapeutic option in this setting. The use of cardiopulmonary bypass and the internal thoracic artery at the time of the operation are strongly advocated.
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Wong CK, Bucciarelli-Ducci C. Q waves and failed ST resolution: Will intra-myocardial haemorrhage be a concern in reperfusing “late presenting” STEMIs? Int J Cardiol 2015; 182:203-10. [DOI: 10.1016/j.ijcard.2014.12.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/24/2014] [Accepted: 12/21/2014] [Indexed: 11/26/2022]
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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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Tchantchaleishvili V, Schubmehl H, Swartz MF, Hallinan W, Massey HT. Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock. Ann Cardiothorac Surg 2014; 3:606-11. [PMID: 25512903 DOI: 10.3978/j.issn.2225-319x.2014.08.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/19/2014] [Indexed: 01/18/2023]
Abstract
Despite advances in medical technology and re-vascularization interventions, the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50%. The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction. The field of mechanical circulatory support (MCS) has evolved within the past decade, with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs). In this paper, we discuss our institutional treatment strategies, the rationale for the protocol development, and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction.
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Affiliation(s)
| | - Heidi Schubmehl
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Michael F Swartz
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - William Hallinan
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - H Todd Massey
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA
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Percutaneous coronary intervention for nonculprit vessels in cardiogenic shock complicating ST-segment elevation acute myocardial infarction. Crit Care Med 2014; 42:17-25. [PMID: 24105454 DOI: 10.1097/ccm.0b013e3182a2701d] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We investigated the clinical impact of multivessel percutaneous coronary intervention in ST-segment elevation myocardial infarction complicated by cardiogenic shock with multivessel disease. DESIGN A prospective, multicenter, observational study. SETTING Cardiac ICU of a university hospital. PATIENTS Between November 2005 and September 2010, 338 patients were selected. Inclusion criteria were as follows: 1) ST-segment elevation myocardial infarction with cardiogenic shock and 2) multivessel disease with successful primary percutaneous coronary intervention for the infarct-related artery. Patients were divided into multivessel percutaneous coronary intervention and culprit-only percutaneous coronary intervention. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Primary outcome was all-cause mortality. Median follow-up duration was 224 days (interquartile range, 46-383 d). Multivessel percutaneous coronary intervention was performed during the primary percutaneous coronary intervention in 60 patients (17.8%). In-hospital mortality was similar in both groups (multivessel percutaneous coronary intervention vs culprit-only percutaneous coronary intervention, 31.7% vs 24.5%; p = 0.247). All-cause mortality during follow-up was not significantly different between the two groups after adjusting for patient, angiographic, and procedural characteristics as well as propensity scores for receiving multivessel percutaneous coronary intervention (35.0% vs 30.6%; adjusted hazard ratio, 1.06; 95% CI, 0.61-1.86; p = 0.831). There were no significant differences between the groups in rates of major adverse cardiac events (41.7% vs 37.1%; adjusted hazard ratio, 1.03; 95% CI, 0.62-1.71; p = 0.908) and any revascularization (6.7% vs 4.7%; adjusted hazard ratio, 1.88; 95% CI, 0.51-6.89; p = 0.344). CONCLUSIONS Multivessel percutaneous coronary intervention could not reduce the prevalence of mortality in patients with cardiogenic shock complicating ST-segment elevation myocardial infarction and multivessel disease during primary percutaneous coronary intervention.
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Moscarelli M, Harling L, Attaran S, Ashrafian H, Casula RP, Athanasiou T. Surgical revascularisation of the acute coronary artery syndrome. Expert Rev Cardiovasc Ther 2014; 12:393-402. [DOI: 10.1586/14779072.2014.890889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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24
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Hoebers LP, Vis MM, Claessen BE, van der Schaaf RJ, Kikkert WJ, Baan J, de Winter RJ, Piek JJ, Tijssen JG, Dangas GD, Henriques JP. The impact of multivessel disease with and without a co-existing chronic total occlusion on short- and long-term mortality in ST-elevation myocardial infarction patients with and without cardiogenic shock. Eur J Heart Fail 2014; 15:425-32. [DOI: 10.1093/eurjhf/hfs182] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | - Jan Baan
- Academic Medical Center Amsterdam; The Netherlands
| | | | - Jan J. Piek
- Academic Medical Center Amsterdam; The Netherlands
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Aggarwal S, Slaughter MS. Acute myocardial infarction complicated by cardiogenic shock: role of mechanical circulatory support. Expert Rev Cardiovasc Ther 2014; 6:1223-35. [DOI: 10.1586/14779072.6.9.1223] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Baek JY, Seo SM, Park HJ, Kim PJ, Park MW, Koh YS, Chang KY, Jeong MH, Park SJ, Seung KB. Clinical outcomes and predictors of unprotected left main stem culprit lesions in patients with acute ST segment elevation myocardial infarction. Catheter Cardiovasc Interv 2013; 83:E243-50. [DOI: 10.1002/ccd.23420] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 09/28/2011] [Accepted: 10/09/2011] [Indexed: 11/07/2022]
Affiliation(s)
- Ju Yeol Baek
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Suk Min Seo
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Hun-Jun Park
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Pum Joon Kim
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Mahn Won Park
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Yoon Seok Koh
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Ki Yuk Chang
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Myung Ho Jeong
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Seung Jung Park
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Ki-Bae Seung
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
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Challenges in retrospective analysis of PCI data in critically ill patients. JACC Cardiovasc Interv 2013; 6:986. [PMID: 24050868 DOI: 10.1016/j.jcin.2013.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 03/29/2013] [Indexed: 11/23/2022]
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28
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Rodriguez-Leor O, Fernandez-Nofrerias E, Carrillo X, Mauri J, Oliete C, Rivas MDC, Bayes-Genis A. Transradial percutaneous coronary intervention in cardiogenic shock: a single-center experience. Am Heart J 2013; 165:280-5. [PMID: 23453093 DOI: 10.1016/j.ahj.2012.08.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 08/24/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Use of the transradial approach (TRA) in percutaneous coronary intervention (PCI) has increased in recent years. TRA has a lower mortality rate than the transfemoral approach (TFA) in patients with acute coronary syndrome. Comparative studies have systematically excluded patients with cardiogenic shock (CS). METHODS We performed a prospective, observational registry study of consecutive patients undergoing emergent revascularization between February 2007 and January 2012. An analysis of the clinical evolution of patients with CS during hospitalization was performed. RESULTS Of 1,400 emergency procedures, 122 had CS, of which 80 underwent PCI by TRA (65.6%) and 42 underwent PCI by TFA (34.3%). The main reason for choosing TFA was the absence of radial pulse (54.9%). Mortality (64.3% vs 32.5%, P = .001), serious access site complications (11.9% vs 2.5%, P = .03), access site complications requiring blood transfusion (7.1% vs 0%, P = .04), and major adverse cardiac events (death, infarction, stroke, serious bleeding, and postanoxic encephalopathy) (73.8% vs 43.8%, P = .001) were greater in patients treated by TFA. In the multivariate analysis, TRA was a predictor of mortality (odds ratio [OR] 0.39 [0.15-0.97]); other predictive factors were age ≥75 years (3.47 [1.35-8.92]), previous treatment with diuretics (3.67 [1.21-11.12]), and success of the procedure (0.07 [0.02-0.24]). CONCLUSIONS Transradial approach for PCI is possible and safe in up to two-thirds of patients with CS. Absence of radial pulse was the main factor preventing use of TRA. In multivariate analysis, TRA was associated with a lower risk of mortality.
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Affiliation(s)
- Oriol Rodriguez-Leor
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
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Hussain F, Nguyen T, Elmayergi N, Ducas J, Minhas K, Vo M, Kass M, Ravandi A, Parmar G, Jassal DS, Tam JW, Freed D, Menkis AH, Philipp RK. The acutely occluded left main coronary artery culprit in cardiogenic shock and initial percutaneous coronary intervention: a substudy of the Manitoba “no option” left main PCI registry. Can J Physiol Pharmacol 2012; 90:1325-31. [DOI: 10.1139/y2012-111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We aim to describe the in-hospital outcomes of the first reported Canadian cohort of patients with cardiogenic shock and acute myocardial infarction (MI) due to acute and total occlusion of the left main coronary artery, treated with initial percutaneous coronary intervention (PCI). Acute left main thromboses with cardiogenic shock were identified (N = 8) from a retrospective consecutive cohort of high risk left main PCI (N = 56) performed at our institution from 2004–2009. The mean age was 62.3 ± 13.2 years, with 6 (75%) male patients. Successful PCI was performed in all patients, with thrombectomy utilized in 4 patients (50%), stenting in 7 patients (88%), and intra-aortic balloon pump augmentation in 7 patients (88%). Two patients (25%) required extracorporeal membrane oxygenation (ECMO) and 2 other patients required ventricular assist devices. Post-PCI coronary artery bypass grafting (CABG) was performed for 2 patients (25%). The mean SYNTAX score was 26.6 ± 10.5. The mean logistic EuroSCORE was 30.4 ± 12.6%. In-hospital mortality occurred in 3 patients (38%). Acute left main occlusion is a rare but devastating presentation of myocardial infarction, invariably with cardiogenic shock. Emergent PCI may be an effective method to acutely revascularize this subset of patients; however, aggressive post-PCI care including ECMO, CABG, and ventricular support may be required to improve patient survival.
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Affiliation(s)
- Farrukh Hussain
- Department of Cardiology, Saint Boniface General Hospital, 409 Tache Avenue, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| | - Thang Nguyen
- Department of Cardiology, Saint Boniface General Hospital, 409 Tache Avenue, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| | - Nader Elmayergi
- Department of Cardiology, Mt. Sinai Hospital, University Health Network, University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada
| | - John Ducas
- Department of Cardiology, Saint Boniface General Hospital, 409 Tache Avenue, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| | - Kunal Minhas
- Department of Cardiology, Saint Boniface General Hospital, 409 Tache Avenue, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| | - Minh Vo
- Department of Cardiology, Saint Boniface General Hospital, 409 Tache Avenue, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| | - Malek Kass
- Department of Cardiology, Saint Boniface General Hospital, 409 Tache Avenue, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| | - Amir Ravandi
- Department of Cardiology, Saint Boniface General Hospital, 409 Tache Avenue, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| | - Gurpreet Parmar
- Department of Cardiology, Saint Boniface General Hospital, 409 Tache Avenue, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| | - Davinder S. Jassal
- Department of Cardiology, Saint Boniface General Hospital, 409 Tache Avenue, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| | - James W. Tam
- Department of Cardiology, Saint Boniface General Hospital, 409 Tache Avenue, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| | - Darren Freed
- Department of Cardiac Surgery, Saint Boniface General Hospital, 409 Tache Avenue, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| | - Alan H. Menkis
- Department of Cardiac Surgery, Saint Boniface General Hospital, 409 Tache Avenue, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| | - Roger K. Philipp
- Department of Cardiology, Saint Boniface General Hospital, 409 Tache Avenue, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
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Effat M, Leesar MA. Left main coronary stenosis and acute myocardial infarction: stent or surgery? An evolving perspective. Catheter Cardiovasc Interv 2012; 79:988-9. [PMID: 22511382 DOI: 10.1002/ccd.24428] [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: 11/10/2022]
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Subban V, Gnanaraj A, Gomathi B, Janakiraman E, Pandurangi U, Kalidoss L, Ajit SM. Percutaneous coronary intervention in cardiogenic shock complicating acute ST-elevation myocardial infarction-a single centre experience. Indian Heart J 2012; 64:152-8. [PMID: 22572491 DOI: 10.1016/s0019-4832(12)60052-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Mortality in acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) approaches 70 - 80%, regardless of the type of pharmacological treatment. Early revascularisation improves survival in AMI with CS. Our aim is to assess the predictors of mid-term outcome after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and CS. METHODS Forty-one patients who underwent primary or rescue PCI for CS were analysed comparing their baseline, angiographic, PCI data, 30-day and 1-year survival. RESULTS There were no significant differences between survivors and non-survivors in baseline characters, except for more number of transfer admissions (P= 0.0005), and cardiopulmonary resuscitations (P= 0.015) in the later group. The mean time between myocardial infarction (MI) onset to shock and MI onset to revascularisation were 12.8 ± 12.9 hours and 17.0 ± 16.8 hours, respectively. Patients with better pre-procedure thrombolysis in myocardial infarction (TIMI) flow in the infarct-related artery (IRA) had better survival (P= 0.0005). Successful PCI was achieved in 48.8% of patients. The 30-day mortality was 56.1% and all were prior to hospital discharge. Patients with successful PCI had better short-term survival in comparison with patients with failed PCI (80% vs 9.6%). Eighteen patients who survived at 30 days were followed up for 12-72 months (mean 28.5 ± 5.4 months). Fifteen patients survived at 1 year after PCI and all were in good functional status. CONCLUSION Mortality remains high even with PCI. Achieving IRA patency with TIMI 3 flow is the main determinant of survival. Survival and functional status are good in patients who are discharged from hospital.
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Bauer T, Zeymer U, Hochadel M, Möllmann H, Weidinger F, Zahn R, Nef HM, Hamm CW, Marco J, Gitt AK. Use and outcomes of multivessel percutaneous coronary intervention in patients with acute myocardial infarction complicated by cardiogenic shock (from the EHS-PCI Registry). Am J Cardiol 2012; 109:941-6. [PMID: 22236463 DOI: 10.1016/j.amjcard.2011.11.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 11/18/2011] [Accepted: 11/18/2011] [Indexed: 11/17/2022]
Abstract
The value of multivessel percutaneous coronary intervention (MV-PCI) in patients with cardiogenic shock (CS) and multivessel disease (MVD) is still unclear because randomized controlled trials are missing. Therefore, we sought to evaluate the impact of MV-PCI on in-hospital outcomes of patients with MVD presenting with CS: 336 patients with acute myocardial infarction complicated by CS and ≥70% stenoses in ≥2 major epicardial vessels were included in this analysis of the Euro Heart Survey PCI registry. Patients undergoing MV-PCI (n = 82, 24%) were compared to those with single-vessel PCI (n = 254, 76%). The rate of 3-vessel disease (60% vs 57%, p = 0.63) was similar in the 2 cohorts. Presentation with resuscitation (48 vs 46%, p = 0.76) and ST-segment elevation myocardial infarction (83 vs 87%, p = 0.31) was frequent in patients with MV-PCI and single-vessel PCI. Patients with ventilation were more likely to receive MV-PCI (30% vs 19%, p = 0.05). There was a tendency toward a higher hospital mortality in patients with MV-PCI (48.8% vs 37.4%, p = 0.07). After adjustment for confounding variables, no significant difference for in-hospital mortality (odd ratio [OR] 1.28, 95% confidence interval [CI] 0.72 to 2.28) could be observed between the 2 groups. Age (OR 1.41, 95% CI 1.13 to 1.77), 3-vessel disease (OR 1.78, 95% CI 1.04 to 3.03), ventilation (OR 3.01, 95% CI 1.59 to 5.68), and previous resuscitation (OR 2.55, 95% CI 1.48 to 4.39) were independent predictors of hospital death. In conclusion, MV-PCI is currently used in only 1/4 of patients with CS and MVD. An additional nonculprit PCI was not associated with a survival benefit in these high risk patients.
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Affiliation(s)
- Timm Bauer
- Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Germany.
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Mazzaferri EL, Rao SV. Cardiogenic shock and awe. Cardiology 2012; 121:43-6. [PMID: 22378244 DOI: 10.1159/000336150] [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] [Received: 12/23/2011] [Indexed: 11/19/2022]
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Marcolino MS, Simsek C, de Boer SPM, van Domburg RT, van Geuns RJ, de Jaegere P, Akkerhuis KM, Daemen J, Serruys PW, Boersma E. Short- and long-term major adverse cardiac events in patients undergoing percutaneous coronary intervention with stenting for acute myocardial infarction complicated by cardiogenic shock. Cardiology 2012; 121:47-55. [PMID: 22378251 DOI: 10.1159/000336154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 11/20/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the risk of short- and long-term mortality and major adverse cardiac events (MACE) in acute myocardial infarction (AMI) patients complicated by cardiogenic shock (CS) in the contemporary practice of primary percutaneous coronary intervention with stenting. METHODS Of the 1,755 consecutive AMI patients undergoing percutaneous coronary intervention with stenting enrolled, 103 had CS at admission. Primary endpoints were early mortality (within 30 days after the index event) and late mortality (from day 31 up to 4 years). Secondary endpoints included MACE [all-cause death, myocardial infarction or target vessel revascularization (TVR)], myocardial infarction, TVR and stent thrombosis. RESULTS Thirty-day mortality was higher among CS patients, and CS was a strong independent predictor of a higher risk of early death (adjusted HR 3.64, 95% CI 2.44-5.44). The late mortality rate was significantly higher in CS patients, and CS was also a predictor of higher risk of death at a 4-year follow-up (adjusted HR 1.95, 95% CI 1.11-3.45). Recurrent AMI, TVR and stent thrombosis rates were similar among patients with and without CS. CONCLUSION CS complicating AMI is still a severe clinical event, mainly with regard to a significant higher risk of early mortality, but also associated with a worse prognosis in 30-day survivors.
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Kim H, Lim SH, Hong J, Hong YS, Lee CJ, Jung JH, Yu S. Efficacy of veno-arterial extracorporeal membrane oxygenation in acute myocardial infarction with cardiogenic shock. Resuscitation 2012; 83:971-5. [PMID: 22322287 DOI: 10.1016/j.resuscitation.2012.01.037] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 01/24/2012] [Accepted: 01/29/2012] [Indexed: 12/13/2022]
Abstract
AIM We analyzed the results of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) necessitating extracorporeal membrane oxygenation (ECMO), and investigated for the associated risk factors for poor clinical outcomes. METHODS We retrospectively reviewed the medical records of 27 patients who required ECMO for AMI associated with CS between April 2006 and July 2010. Mean age was 63.7 ± 11.0 (range: 45-81) years, and there were 16 males (59.3%). RESULTS The mean duration of ECMO support was 30.2 ± 30.1 (range: 1-141)h. Cardiopulmonary resuscitations (CPR) were performed in 21 patients (77.8%) before ECMO initiation. Twenty-two patients (81.5%) were successfully weaned off ECMO, and 16 patients (59.3%) survived to discharge. The 30-day mortality was 37.0% (10/27 patients). Complications developed in 17 patients (63.0%: pneumonia in 10 patients, acute renal failure in 10 patients, massive bleeding in 4 patients, and thromboembolic event in 1 patient). The period between CPR initiation and ECMO commencement was a significant risk factor for ECMO weaning failure. High pre-ECMO serum lactate level was identified as a significant risk factor for poor survival on univariated and multivariated analysis. CONCLUSION ECMO support could improve survival in patients who suffer AMI associated with CS, and early ECMO initiation yields better outcomes (successful ECMO weaning).
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Affiliation(s)
- Hyungtae Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Republic of Korea.
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Lilli A, Vecchio S, Chechi T, Vittori G, Giuliani G, Spaziani G, Consoli L, Giannotti F, Baldereschi G, Margheri M. Left ventricular support device for cardiogenic shock during myocardial infarction due to stent thrombosis: A single centre experience. Int J Cardiol 2011; 148:337-40. [DOI: 10.1016/j.ijcard.2009.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 07/11/2009] [Accepted: 11/29/2009] [Indexed: 11/26/2022]
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Edmond J, Baumbach A. The Management of Cardiogenic Shock. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Percutaneous coronary intervention for unprotected left main disease in very high risk patients: safety of drug-eluting stents. Heart Vessels 2010; 26:17-24. [DOI: 10.1007/s00380-010-0027-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 01/21/2010] [Indexed: 01/19/2023]
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Mehta RH, Lopes RD, Ballotta A, Frigiola A, Sketch MH, Bossone E, Bates ER. Percutaneous coronary intervention or coronary artery bypass surgery for cardiogenic shock and multivessel coronary artery disease? Am Heart J 2010; 159:141-7. [PMID: 20102880 DOI: 10.1016/j.ahj.2009.10.035] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 10/30/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite advances in treatment of cardiogenic shock (CS), the incidence of this serious complication of acute ST-elevation myocardial infarction (STEMI) has stayed relatively constant, and rates of mortality, although somewhat improved in recent decades, remain dauntingly high. Although both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are used in patients with CS with multivessel coronary disease, the optimal revascularization strategy in this setting remains unknown. METHODS We conducted a literature search and review of English language publications on CS in multiple online medical databases. Studies were included if they were (1) randomized controlled trials or observational cohort studies, (2) single-center or multicenter reports, (3) prospective or retrospective studies, and (4) contained information on PCI and CABG. Non-English language studies were excluded. RESULTS Our search retrieved no published findings from randomized clinical trials, and only 4 observational reports evaluating PCI versus CABG. Our review of the limited available data suggests similar mortality rates with CABG and PCI in patients with STEMI and multivessel coronary disease complicated by CS. CONCLUSIONS Limited data from observational studies in patients with CS and multivessel disease suggest that CABG should be considered a complementary reperfusion strategy to PCI and may be preferred, especially when complete revascularization with PCI is not possible. Our data highlight the need for large randomized trials to further evaluate the relative benefit of PCI versus CABG in patients with multivessel coronary disease and CS using contemporary surgical and percutaneous techniques.
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Shiraishi J, Kohno Y, Sawada T, Kimura M, Ariyoshi M, Matsui A, Takeda M, Arihara M, Hyogo M, Shima T, Okada T, Nakamura T, Matoba S, Yamada H, Matsumuro A, Kitamura M, Furukawa K, Matsubara H, The AMI-Kyoto Multi-Center Risk Study Group. Predictors of In-Hospital Prognosis After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction Requiring Mechanical Support Devices. Circ J 2010; 74:1152-7. [DOI: 10.1253/circj.cj-09-0774] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jun Shiraishi
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Yoshio Kohno
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Takahisa Sawada
- Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine
| | | | | | - Akihiro Matsui
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Mitsuo Takeda
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Masayasu Arihara
- Department of Emergency Medicine, Kyoto First Red Cross Hospital
| | - Masayuki Hyogo
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Takatomo Shima
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Takashi Okada
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine
| | - Hiroyuki Yamada
- Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine
| | | | | | | | - Hiroaki Matsubara
- Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine
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Chiu FC, Chang SN, Lin JW, Hwang JJ, Chen YS. Coronary artery bypass graft surgery provides better survival in patients with acute coronary syndrome or ST-segment elevation myocardial infarction experiencing cardiogenic shock after percutaneous coronary intervention: A propensity score analysis. J Thorac Cardiovasc Surg 2009; 138:1326-30. [DOI: 10.1016/j.jtcvs.2009.03.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 02/24/2009] [Accepted: 03/20/2009] [Indexed: 10/20/2022]
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42
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Gender differences in patients with acute ST-elevation myocardial infarction complicated by cardiogenic shock. Clin Res Cardiol 2009; 98:781-6. [PMID: 19856196 DOI: 10.1007/s00392-009-0080-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2009] [Accepted: 09/11/2009] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The aim of our analysis is to assess gender differences in baseline characteristics, acute therapies, and clinical outcome in patients with acute ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock. METHODS The Maximal Individual Therapy of Acute Myocardial Infarction PLUS registry (MITRA PLUS) is a German prospective, multicenter, observational data pool of current treatment of STEMI. RESULTS STEMI was more often (P < 0.0001) complicated by cardiogenic shock in female patients (12.9%) when compared to male patients (9.3%). This was still true after adjusting for confounding variables (OR 1.19, 95% CI 1.09-1.30). Women with STEMI admitted in a cardiogenic shock were older (P < 0.0001) and had more often concomitant diseases (P < 0.0001). There was no differences in rates of reperfusion therapy (OR 0.92, 95% CI 0.77-1.09). Hospital mortality was 67.7% in female patients, when compared to 57.2% in male patients (P < 0.0001). After adjusting for confounding variables in the multivariate analysis hospital mortality did not differ between men and women (OR 1.16, 95% CI 0.98-1.38). Early reperfusion therapy was associated with a significant reduction of hospital mortality in female patients with STEMI complicated by cardiogenic shock (OR 0.68, 95% CI 0.52-0.90) with primary PCI being more effective than thrombolytic therapy (OR 0.46, 95% CI 0.31-0.68). CONCLUSION In women, STEMI was more often complicated by cardiogenic shock when compared to men. However, the use of early reperfusion therapy did not differ between the sexes. Primary PCI was associated with the best outcome in female patients with STEMI complicated by cardiogenic shock and is therefore the therapy of choice.
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43
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Lee KW, Norell MS. Cardiogenic shock complicating myocardial infarction and outcome following percutaneous coronary intervention. ACTA ACUST UNITED AC 2009; 10:131-43. [DOI: 10.1080/17482940801983006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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44
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Garcia-Alvarez A, Arzamendi D, Loma-Osorio P, Kiamco R, Masotti M, Sionis A, Betriu A, Brugada J, Bosch X. Early risk stratification of patients with cardiogenic shock complicating acute myocardial infarction who undergo percutaneous coronary intervention. Am J Cardiol 2009; 103:1073-7. [PMID: 19361592 DOI: 10.1016/j.amjcard.2008.12.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 12/21/2008] [Accepted: 12/21/2008] [Indexed: 10/21/2022]
Abstract
The mortality rate of patients with cardiogenic shock complicating acute myocardial infarction remains exceedingly high despite early mechanical revascularization. Early risk stratification is of great importance to identify patients who could benefit from ventricular assist devices and urgent heart transplantation (UHT). All consecutive patients with cardiogenic shock complicating acute myocardial infarction admitted from June 2001 to December 2007 were prospectively included. Clinical, hemodynamic, and echocardiographic variables were registered on admission and patients were followed for a median of 297 days. A total of 74 patients were included. One-year mortality was 55% and 7 patients (9%) underwent UHT. One-year mortality or need for UHT for patients with postprocedural Thrombolysis In Myocardial Infarction (TIMI) grade 3, 2, and 0 or 1 flows were 38%, 92%, and 90%, respectively (p <0.001). After adjustment by multivariate analysis, the most important predictors of mortality or need for UHT were age >75 years (hazard ratio [HR] 3.56, 95% confidence interval [CI] 1.07 to 11.80), left main coronary artery occlusion (HR 3.75, 95% CI 1.09 to 12.84), left ventricular ejection fraction <25% (HR 2.70, 95% CI 1.17 to 6.22), and postprocedural TIMI grade <3 flow (HR 3.37, 95% CI 1.48 to 7.72). A simple risk score constructed with these 4 variables effectively predicted 1-year survival without the need for UHT (83% for score 0, 19% for score 1, and 6% for score 2, p <0.001). In conclusion, age >75 years, left main coronary artery occlusion, left ventricular ejection fraction <25%, and postprocedural TIMI grade <3 flow were significantly associated with worse prognosis. A simple risk score rapidly available in the catheterization laboratory can efficiently estimate prognosis.
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Kim JH, Jeong MH, Choi JS, Rhee JA, Kim IS, Choi OJ, Kim EJ, Sim DS, Hong YJ, Kim JH, Ahn YK, Cho JG, Park JC, Kang JC. Predictors of Mortality in Acute Myocardial Infarction Patients with Cardiogenic Shock Who Underwent Percutaneous Coronary Intervention with the Aid of an Intra-Aortic Balloon Pump. Chonnam Med J 2009. [DOI: 10.4068/cmj.2009.45.2.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jeong Hun Kim
- Department of Public Health, Chonnam National University Graduate School, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Public Health, Chonnam National University Graduate School, Gwangju, Korea
| | - Jin Su Choi
- Department of Public Health, Chonnam National University Graduate School, Gwangju, Korea
| | - Jung Ae Rhee
- Department of Public Health, Chonnam National University Graduate School, Gwangju, Korea
| | - In Soo Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Ok Ja Choi
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Eun Jeong Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Young Keun Ahn
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jung Chaee Kang
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
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Ferrari M, Figulla HR. [Therapy of cardiogenic shock after myocardial infarction]. Internist (Berl) 2008; 49:1047-51. [PMID: 18633582 DOI: 10.1007/s00108-008-2076-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The therapy of infarct related cardiogenic shock should primarily focus on fastest possible revascularization. In addition, rapid restoration of sufficient organ perfusion pressure is recommended for the prevention of a multi-organ dysfunction syndrome (MODS). This can be achieved by mechanical circulatory assist devices as well as individual catecholamine therapy. Since assist devices require specially trained physicians, their use is limited to specialized cardiac care centers. However, future technologies such as portable heart-lung-machines may help to further improve transfer to specialized centers and therapy of shock patients.
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Affiliation(s)
- M Ferrari
- Klinik für Innere Medizin I, Universitätsklinikum, Friedrich-Schiller-Universität, Erlanger Allee 101, Jena, Germany.
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Halmai L, Sepp R, Thury A, Gavallér H, Ungi I, Rudas L. Coronary artery dissection in the postpartum period – a case study. Orv Hetil 2008; 149:457-63. [DOI: 10.1556/oh.2008.28012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A spontán coronaria dissectio ritka kórállapot, amely főleg nőkben, gyakran a peripartum időszakában fordul elő. Specifikus kóroki tényező egyértelműen nem azonosítható e nemritkán fatális kimenetelű betegség hátterében. Bemutatjuk egy fiatal, egy hete szült nőbetegünk esetét, aki mellkasi fájdalom miatt került kórházba, és akut ST-elevációs szívinfarktus EKG-jeleit észlelték rajta. A sürgősségi koronarográfia elzáródás nélküli nem szignifikáns szűkületeket észlelt, emiatt intervenció nem történt. Cardiogen sokk alakult ki, amely mechanikus keringéstámogatás segítségével rendeződött, a beteg állapota stabilizálódott, majd ismételt ischaemiás tünetei jelentkeztek, az újabb angiográfia már egyértelmű coronaria dissectio jelenlétét mutatta a bal közös törzs distalis részén, amely már a ramus circumflexus áramlást is limitálta, emiatt urgens coronaria bypass műtét történt jó eredménnyel. A spontán coronaria dissectióra gondolnunk kell a peripartum időszakában kialakult akut coronariaszindrómák esetén, melyek halálozása magas, kezelésében speciális szempontokat kell figyelembe vennünk.
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Affiliation(s)
- László Halmai
- 1 Szegedi Tudományegyetem, Általános Orvos- és Gyógyszerésztudományi Központ Aneszteziológiai és Intenzív Terápiás Intézet, III. Általános Intenzív Részleg Szeged Korányi fasor 7. 6720
| | - Róbert Sepp
- 2 Szegedi Tudományegyetem, Általános Orvos- és Gyógyszerésztudományi Központ II. Belgyógyászati Klinika és Kardiológiai Központ Szeged
| | - Attila Thury
- 2 Szegedi Tudományegyetem, Általános Orvos- és Gyógyszerésztudományi Központ II. Belgyógyászati Klinika és Kardiológiai Központ Szeged
| | - Henriette Gavallér
- 2 Szegedi Tudományegyetem, Általános Orvos- és Gyógyszerésztudományi Központ II. Belgyógyászati Klinika és Kardiológiai Központ Szeged
| | - Imre Ungi
- 2 Szegedi Tudományegyetem, Általános Orvos- és Gyógyszerésztudományi Központ II. Belgyógyászati Klinika és Kardiológiai Központ Szeged
| | - László Rudas
- 1 Szegedi Tudományegyetem, Általános Orvos- és Gyógyszerésztudományi Központ Aneszteziológiai és Intenzív Terápiás Intézet, III. Általános Intenzív Részleg Szeged Korányi fasor 7. 6720
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Mehta RH, Grab JD, O’Brien SM, Glower DD, Haan CK, Gammie JS, Peterson ED. Clinical Characteristics and In-Hospital Outcomes of Patients With Cardiogenic Shock Undergoing Coronary Artery Bypass Surgery. Circulation 2008; 117:876-85. [DOI: 10.1161/circulationaha.107.728147] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
There exist few studies that characterize contemporary clinical features and outcomes or risk factors for operative mortality in cardiogenic shock (CS) patients undergoing coronary artery bypass grafting (CABG).
Methods and Results—
We evaluated data of 708 593 patients with and without CS undergoing CABG enrolled in the Society of Thoracic Surgeons National Cardiac Database (2002–2005). Clinical, angiographic, and operative features and in-hospital outcomes were evaluated in patients with and without CS. Logistic regression was used to identify predictors of operative mortality and to estimate weights for an additive risk score. Patients with preoperative CS constituted 14 956 (2.1%) of patients undergoing CABG yet accounted for 14% of all CABG deaths. Operative mortality in CS patients was high and surgery specific, rising from 20% for isolated CABG to 33% for CABG plus valve surgery and 58% for CABG plus ventricular septal repair. Although mortality for CABG surgery overall declined significantly over time (
P
for trend <0.0001), mortality for CS patients undergoing CABG did not change significantly during the 4-year study period (
P
=0.07). Factors associated with higher death risk for CS patients undergoing CABG were identified by multivariable analysis and summarized into a simple bedside risk score (c statistic=0.74) that accurately stratified those with low (<10%) to very high (>60%) mortality risk.
Conclusions—
Patients with CS represent a minority of those undergoing CABG yet have persistently high operative risks, accounting for 14% of deaths in CABG patients. Estimation of patient-specific risk of mortality is feasible with the simplified additive risk tool developed in our study with the use of routinely available preprocedural data.
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Affiliation(s)
- Rajendra H. Mehta
- From the Duke Clinical Research Institute (R.H.M., J.D.G., S.M.O., E.D.P.) and Duke University Medical Center (R.H.M., D.D.G., E.D.P.), Durham, NC; University of Florida (C.K.H.), Jacksonville; and University of Maryland (J.S.G.), Baltimore
| | - Joshua D. Grab
- From the Duke Clinical Research Institute (R.H.M., J.D.G., S.M.O., E.D.P.) and Duke University Medical Center (R.H.M., D.D.G., E.D.P.), Durham, NC; University of Florida (C.K.H.), Jacksonville; and University of Maryland (J.S.G.), Baltimore
| | - Sean M. O’Brien
- From the Duke Clinical Research Institute (R.H.M., J.D.G., S.M.O., E.D.P.) and Duke University Medical Center (R.H.M., D.D.G., E.D.P.), Durham, NC; University of Florida (C.K.H.), Jacksonville; and University of Maryland (J.S.G.), Baltimore
| | - Donald D. Glower
- From the Duke Clinical Research Institute (R.H.M., J.D.G., S.M.O., E.D.P.) and Duke University Medical Center (R.H.M., D.D.G., E.D.P.), Durham, NC; University of Florida (C.K.H.), Jacksonville; and University of Maryland (J.S.G.), Baltimore
| | - Constance K. Haan
- From the Duke Clinical Research Institute (R.H.M., J.D.G., S.M.O., E.D.P.) and Duke University Medical Center (R.H.M., D.D.G., E.D.P.), Durham, NC; University of Florida (C.K.H.), Jacksonville; and University of Maryland (J.S.G.), Baltimore
| | - James S. Gammie
- From the Duke Clinical Research Institute (R.H.M., J.D.G., S.M.O., E.D.P.) and Duke University Medical Center (R.H.M., D.D.G., E.D.P.), Durham, NC; University of Florida (C.K.H.), Jacksonville; and University of Maryland (J.S.G.), Baltimore
| | - Eric D. Peterson
- From the Duke Clinical Research Institute (R.H.M., J.D.G., S.M.O., E.D.P.) and Duke University Medical Center (R.H.M., D.D.G., E.D.P.), Durham, NC; University of Florida (C.K.H.), Jacksonville; and University of Maryland (J.S.G.), Baltimore
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49
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Conde-Vela C, Moreno R, Hernández R, Pérez-Vizcayno MJ, Alfonso F, Escaned J, Sabaté M, Bañuelos C, Macaya C. Cardiogenic shock at admission in patients with multivessel disease and acute myocardial infarction treated with percutaneous coronary intervention: Related factors. Int J Cardiol 2007; 123:29-33. [PMID: 17303267 DOI: 10.1016/j.ijcard.2006.11.102] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Accepted: 11/09/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), those with multivessel disease have worse prognosis, mainly due to a higher frequency of cardiogenic shock (CS) at admission. The aim of this study was to identify clinical and angiographic characteristics of patients with STEMI, multivessel disease and CS at admission referred to primary PCI. METHODS We studied 630 patients with STEMI treated with primary PCI within 12 h after symptoms onset. Multivessel disease was defined as the presence of >or=50% stenosis in >or=2 major epicardial arteries. Multivessel disease was documented in 276 patients (44%), these patients comprising the study population. Clinical, angiographic and procedural variables were compared between those with and without CS. A logistic regression analysis was performed to identify the independent predictors of CS among patients with multivessel disease. RESULTS Among patients with multivessel disease, 45 (16%) had CS at admission. The independent predictors of CS in patients with multivessel disease were: STEMI anterior [OR 2.05; 95% CI 1.0 to 4.1; p=0.044], female gender [odds ratio (OR) 2.49; 95% confidence intervals (CI) 1.1 to 5.3; p=0.021], proximal culprit lesion [OR 3.8; 95% CI 1.7 to 8.5; p<0.001], and chronic occlusion of other coronary arteries [OR 4.48; 95% CI 2.1 to 9.1; p<0.001]. CONCLUSIONS Among patients with STEMI and multivessel disease, CS is especially frequent in STEMI anterior, female gender, proximal culprit lesion, and chronic occlusion of other vessels.
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Affiliation(s)
- César Conde-Vela
- Division of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
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50
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Garatti A, Russo C, Lanfranconi M, Colombo T, Bruschi G, Trunfio S, Milazzo F, Catena E, Colombo P, Maria F, Vitali E. Mechanical Circulatory Support for Cardiogenic Shock Complicating Acute Myocardial Infarction: An Experimental and Clinical Review. ASAIO J 2007; 53:278-87. [PMID: 17515715 DOI: 10.1097/mat.0b013e318057fae3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cardiogenic shock (CS) occurs in 7% to 10% of cases after acute myocardial infarction and remains the most common cause of death in these patients. Despite aggressive treatment regimens such as fibrinolysis and percutaneous transluminal coronary angioplasty, mortality rates from CS remain extremely high. It has been shown that intra-aortic balloon pumping can result in initial hemodynamic stabilization. However, in the majority of studies, death was merely delayed. In recent years, efforts have been made to develop ventricular devices (LVAD) capable of providing complete short-term hemodynamic support. Seventeen major studies of LVAD support for CS complicating acute myocardial infarction are reported in the literature, with a mean weaning and survival rate of 58.5% and 40%, respectively. Patients considered in these studies are difficult to compare in terms of demographic and anatomic data, but taking these considerations into account, LVAD support seems to give no survival improvement in these patients compared with early reperfusion alone or associated with intra-aortic balloon pumping. Data emerging from experimental studies of acute myocardial infarction supported with LVAD are intriguing. In this review, we report the LVAD experience in the CS setting, starting from percutaneous extracorporeal support up to bridge therapy with implantable devices.
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Affiliation(s)
- Andrea Garatti
- Cardiac Surgery Division, A. De Gasperis Department, Niguarda Ca'Granda Hospital, Milan, Italy
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