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Abstract
To provide synthesized evidence on the association of diabetes with clinical outcomes of patients with acute myocardial infarction (AMI) and associated cardiogenic shock (CS). We analyzed observational studies on patients with AMI and CS, identified through a systematic search using PubMed and Scopus databases. The main outcome was mortality and other outcomes of interest were risk of major bleeding, re-infarction, cerebrovascular adverse events, and need for revascularization. We conducted the meta-analysis with data from 15 studies. Compared to patients without diabetes, those with diabetes had an increased risk of in-hospital mortality (OR, 1.34; 95% CI, 1.17-1.54) and cerebrovascular complications (OR, 1.28; 95% CI, 1.11-1.48). We found similar risk of major bleeding (OR, 0.68; 95% CI, 0.43-1.09), re-infarction (OR, 0.98; 95% CI, 0.48-1.98) and need for re-vascularization (OR, 0.96; 95% CI, 0.75-1.22) as well as hospital stay lengths (in days) (WMD 0.00; 95% CI, -0.27-0.28; n = 4; I2 = 99.7%) in the two groups of patients. Patients with diabetes, acute MI and associated cardiogenic shock have increased risks of mortality and adverse cerebrovascular events than those without diabetes.
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Affiliation(s)
- Chao Luo
- Department of General Practice, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China
| | - Feng Chen
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China
| | - Lingpei Liu
- Department of General Practice, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China
| | - Zuanmin Ge
- Department of General Practice, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China
| | - Chengzhen Feng
- Department of General Practice, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China
| | - Yuehua Chen
- Department of General Practice, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China
- Yuehua Chen, Department of General Practice, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, 365 Renming East Road, Jinhua, Zhejiang 321000, China.
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Yang JQ, Ran P, Li J, Zhong Q, Smith SC, Wang Y, Fonarow GC, Qiu J, Morgan L, Wei XB, Chen XB, Huang JL, Hao YC, Zhou YL, Siu CW, Zhao D, Chen JY, Yu DQ. A Risk Stratification Scheme for In-Hospital Cardiogenic Shock in Patients With Acute Myocardial Infarction. Front Cardiovasc Med 2022; 9:793497. [PMID: 35310985 PMCID: PMC8931535 DOI: 10.3389/fcvm.2022.793497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveCardiogenic shock (CS) is the leading cause of death in patients with acute myocardial infarction (AMI) despite advances in care. This study aims to derive and validate a risk score for in-hospital development of CS in patients with AMI.MethodsIn this study, we used the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome (CCC–ACS) registry of 76,807 patients for model development and internal validation. These patients came from 158 tertiary hospitals and 82 secondary hospitals between 2014 and 2019, presenting AMI without CS upon admission. The eligible patients with AMI were randomly assigned to derivation (n = 53,790) and internal validation (n = 23,017) cohorts. Another cohort of 2,205 patients with AMI between 2014 and 2016 was used for external validation. Based on the identified predictors for in-hospital CS, a new point-based CS risk scheme, referred to as the CCC–ACS CS score, was developed and validated.ResultsA total of 866 (1.1%) and 39 (1.8%) patients subsequently developed in-hospital CS in the CCC–ACS project and external validation cohort, respectively. The CCC–ACS CS score consists of seven variables, including age, acute heart failure upon admission, systolic blood pressure upon admission, heart rate, initial serum creatine kinase-MB level, estimated glomerular filtration rate, and mechanical complications. The area under the curve for in-hospital development of CS was 0.73, 0.71, and 0.85 in the derivation, internal validation and external validation cohorts, respectively.ConclusionThis newly developed CCC–ACS CS score can quantify the risk of in-hospital CS for patients with AMI, which may help in clinical decision making.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT02306616.
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Affiliation(s)
- Jun-qing Yang
- Guangdong Provincial Key Laboratory of Coronary Heart Disease, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Peng Ran
- Guangdong Provincial Key Laboratory of Coronary Heart Disease, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jie Li
- Guangdong Provincial Key Laboratory of Coronary Heart Disease, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qi Zhong
- Guangdong Provincial Key Laboratory of Coronary Heart Disease, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Sidney C. Smith
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States
| | - Yan Wang
- Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Ministry of Education, Shanghai, China
| | - Gregg C. Fonarow
- Division of Cardiology, Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, United States
| | - Jia Qiu
- Guangdong Provincial Key Laboratory of Coronary Heart Disease, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Louise Morgan
- International Quality Improvement Department, American Heart Association, Dallas, TX, United States
| | - Xue-biao Wei
- Guangdong Provincial Key Laboratory of Coronary Heart Disease, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao-bo Chen
- Department of Pediatrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jie-leng Huang
- Guangdong Provincial Key Laboratory of Coronary Heart Disease, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong-chen Hao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Ying-ling Zhou
- Guangdong Provincial Key Laboratory of Coronary Heart Disease, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Ji-yan Chen
- Guangdong Provincial Key Laboratory of Coronary Heart Disease, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Ji-yan Chen
| | - Dan-qing Yu
- Guangdong Provincial Key Laboratory of Coronary Heart Disease, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Dan-qing Yu
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Otaal PS, Shah A, Batta A, Sood A, Pal A. Clinical and Angiographic Prophesy of Hemodynamic Status in Patients with Acute Anterior Wall ST-Segment-Elevation Myocardial Infarction and Totally Occluded Left Anterior Descending Artery. Integr Blood Press Control 2021; 14:89-97. [PMID: 34168494 PMCID: PMC8219224 DOI: 10.2147/ibpc.s315050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Left anterior descending artery (LAD) is the most common occluded vessel in a patient presenting with acute anterior wall ST-segment elevated myocardial infarction (STEMI). Acute occlusion of LAD usually results in hemodynamic compromise. However, some patients maintain hemodynamic stability despite its proximal occlusion. As the factors associated with hemodynamic status in such patients are poorly understood, our study sought to determine the clinical and angiographic parameters associated with hemodynamic stability in these patients. Methods In this prospective observational study, 60 consecutive patients of acute anterior wall STEMI with completely occluded LAD on coronary angiography were included. Various clinical and angiographic parameters associated with hemodynamic status were evaluated. Results Of the 60 patients, 30 patients each were included in the hemodynamically stable (group I) and hemodynamically unstable group (group II). The mean age of the patients in group I and group II was 51.07±13.78 years and 55.47±11.69 years, respectively. The hemodynamically unstable group had a significantly higher number of patients with diabetes mellitus, elevated Troponin T level, and lower left ventricular ejection fraction as compared to the stable group (p<0.05). In contrast, 11 (36.7%) patients in the hemodynamically stable group had rich collaterals compared to 4 (13.3%) patients in the hemodynamically unstable group. The difference was statistically significant (p=0.037). Conclusion The present study showed that the presence of diabetes, severe LV systolic dysfunction, elevated Troponin-T level, and poor collaterals were associated with hemodynamic instability, whereas the presence of better collaterals predicted hemodynamic stability in patients presenting with anterior wall STEMI and total LAD occlusion.
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Affiliation(s)
- Parminder Singh Otaal
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amit Shah
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Akash Batta
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arnab Pal
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Singh SK, Witer L, Kaku Y, Masoumi A, Fried JA, Yuzefpolskaya M, Colombo PC, Sayer G, Uriel N, Naka Y, Takayama H, Takeda K. Temporary surgical ventricular assist device for treatment of acute myocardial infarction and refractory cardiogenic shock in the percutaneous device era. J Artif Organs 2021; 24:199-206. [PMID: 33459913 DOI: 10.1007/s10047-020-01236-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/06/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acute myocardial infarction with refractory cardiogenic shock (AMI-RCS) is associated with poor outcomes. Several percutaneous mechanical circulatory support devices exist; however, limitations exist regarding long-term use. Herein, we describe our experience with the temporary surgical CentriMag VAD. METHODS We reviewed 74 patients with AMI-RCS who underwent CentriMag VAD insertion as bridge-to-decision device from 2007 to 2020. Patients were divided into groups based on introduction of the "shock team" model: Era 1 (2007-2014, n = 51) and Era 2 (2015-2020, n = 23). RESULTS Era 2 had higher proportion of patients with INTERMACS Profile I. The use of percutaneous MCS as bridge to VAD and the use of minimally invasive VAD were higher in Era 2. There were fewer postoperative bleeding events in Era 2 (80% vs 61%, p = .07). Thirty-day mortality was 23% and 1-year survival was 55%, which were no differences between eras. Destinations after CentriMag VAD included myocardial recovery (39%), durable LVAD (27%), and transplantation (5%). CONCLUSION CentriMag VAD device represents a viable bridge-to-decision device with acceptable short- and long-term outcomes for patients with AMI-RCS. Stable outcomes in a progressively sicker population may be related to changes in practice patterns as well as introduction of the "shock team" concept.
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Parras JI, Onocko M, Traviesa LM, Fernández EG, Morel PM, Cristaldo NG, Coronel ML, Macín SM, Perna ER. Lung ultrasound in acute myocardial infarction. Updating Killip & Kimball. Indian Heart J 2020; 73:104-108. [PMID: 33714393 PMCID: PMC7961256 DOI: 10.1016/j.ihj.2020.11.148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/08/2020] [Accepted: 11/20/2020] [Indexed: 12/22/2022] Open
Abstract
Background Heart failure complicating acute myocardial infarction marks an ominous prognosis. Killip and Kimball's classification of heart failure remains a useful tool in these patients. Lung ultrasound can detect pulmonary congestion but its usefulness in this scenario is unknown. Objective To investigate the diagnostic accuracy of lung ultrasound to predict heart failure in patients with acute myocardial infarction. Methods Patients admitted with acute myocardial infarction and without heart failure were evaluated with a lung ultrasound. The presence of B-lines was recorded and counted. The presence of new heart failure (Killip Class B, C, or D) during hospitalization was evaluated by a cardiologist blinded to the results of lung ultrasound. A ROC curve analysis was done to evaluate the diagnostic accuracy of B-lines to predict heart failure. Results 200 patients were included. Three patients were diagnosed with cardiogenic shock, 5 with acute pulmonary edema, and 17 with mild heart failure. Patients who develop heart failure had a median of 14 B-lines, however, patients who remained in Killip class A had a median of 2 (p = 0,0001). The area under the ROC curve of the sum of B-lines to predict any form of heart failure was 0,91 (CI95% 86–97). The best cut-off value was 5 B-lines, with a sensitivity of 88% (IC95% 68,8–97,5) and specificity of 81% (IC95% 73,9–86,2). Conclusion Lung ultrasound done at admission can help to predict heart failure In patients with acute myocardial infarction.
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Affiliation(s)
- Jorge I Parras
- Coronary Care Unit, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina.
| | - Mariela Onocko
- Coronary Care Unit, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | - Liliana M Traviesa
- Emergency Department, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | - Eva G Fernández
- Emergency Department, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | - Pablo M Morel
- Emergency Department, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | - Natalia G Cristaldo
- Emergency Department, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | - María L Coronel
- Coronary Care Unit, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | - Stella M Macín
- Coronary Care Unit, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | - Eduardo R Perna
- Coronary Care Unit, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
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Zilberszac R, Heinz G. [Cardiogenic shock]. Wien Klin Wochenschr 2020; 132:333-48. [PMID: 32095880 DOI: 10.1007/s00508-020-01612-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cardiogenic shock (CS) is defined as end-organ hypoperfusion as the consequence of primary myocardial dysfunction. Among the diagnostic criteria are a systolic blood pressure < 90 mmHg, acute renal failure (oligoanuria), ischemic hepatitis, cyanosis and cold, clammy skin. Accepted hemodynamic cutoffs are a cardiac index < 2,2 (l/min)/m2 and a pulmonary capillary wedge pressure > 15 mmHg. It should be acknowledged, that a normal blood pressure does not rule out CS; there is a nonhypotensive variant of CS demonstrating all the signs mentioned above (including elevated lactate levels) while the blood pressure is compensated due to vasoconstriction.The single most frequent cause of CS is pump failure in the setting of an acute myocardial infarction and its mortality rate has been lowered to 40-50%, owing to the widespread availability of primary PCI. Regarding PCI, it has been demonstrated recently that a "culprit-lesion only strategy" should be followed in the setting of CS. Other important causes of CS to take into account are mechanical complications of myocardial infarction (papillary and ventricular septal rupture as well as rupture of the myocardial free wall leading to tamponade), valvular heart disease (mostly decompensated aortic stenosis) as well as myocarditis and end stage cardiomyopathy.The diagnosis of CS is made by patient history, physical examination, ECG, echocardiography and coronary angiography. Echocardiography should always be performed before coronary angiography because, in the case of mechanical complications, it significantly alters the management of the patients. Patients with clinical signs of CS but paradoxically preserved ejection fraction must be thoroughly evaluated for the presence of a papillary muscle rupture, particularly in the setting of a lateral wall infarction.Noradrenaline and dobutamine are the first-line agents for medical stabilization. When such conventional measures fail, extracorporeal support devices such as ECMO or Impella© may be used. Currently, trials are underway to assess wheter these devices confer a survival benefit in this high-risk population.
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Lauridsen MD, Rorth R, Butt JH, Kristensen SL, Schmidt M, Moller JE, Hassager C, Torp-Pedersen C, Gislason G, Kober L, Fosbol EL. Five-year risk of heart failure and death following myocardial infarction with cardiogenic shock: a nationwide cohort study. Eur Heart J Acute Cardiovasc Care 2020; 10:40-49. [PMID: 33721017 DOI: 10.1093/ehjacc/zuaa022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/07/2020] [Accepted: 09/08/2020] [Indexed: 01/13/2023]
Abstract
AIMS More patients survive myocardial infarction (MI) with cardiogenic shock (CS), but long-term outcome data are sparse. We aimed to examine rates of heart failure hospitalization and mortality in MI hospital survivors. METHODS AND RESULTS First-time MI patients with and without CS alive until discharge were identified using Danish nationwide registries between 2005 and 2017. One-, 5-, and 1- to 5-year rates of heart failure hospitalization and mortality were compared using landmark cumulative incidence curves and Cox regression models. We identified 85 865 MI patients of whom 2865 had CS (3%). Cardiogenic shock patients were of similar age as patients without CS (median age years: 68 vs. 67), and more were men (70% vs. 65%). Cardiogenic shock was associated with a higher 5-year rate of heart failure hospitalization compared with patients without CS [40% vs. 20%, adjusted hazard ratio (HR) 2.90 (95% confidence interval (CI) 2.67-3.12)]. The increased rate of heart failure hospitalization was evident after 1 year and in the 1- to 5-year landmark analysis among 1-year survivors. All-cause mortality was higher at 1 year among CS patients compared with patients without CS [18% vs. 8%, adjusted HR 3.23 (95% CI 2.95-3.54)]. However, beyond the first year, the mortality for CS was not markedly different compared with patients without CS [12% vs. 13%, adjusted HR 1.15 (95% CI 1.00-1.33)]. CONCLUSION Among MI hospital survivors, CS was associated with a markedly higher rate of heart failure hospitalization and 1-year mortality compared with patients without CS. However, among 1-year survivors, the remaining 5-year mortality was similar for MI patients with and without CS.
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Affiliation(s)
- Marie Dam Lauridsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Rasmus Rorth
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jawad Haider Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Soren Lund Kristensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle 43-45, 8200 Aarhus N, Denmark.,Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jacob Eifer Moller
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Cardiology, Odense University Hospital, J.B Winslowsvej 4, 5000 Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Dyrhavevej 29, 3400 Hillerød, Denmark.,Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hospitalsvej 1, 2900 Hellerup, Denmark.,The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Lars Kober
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark
| | - Emil Loldrup Fosbol
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Guzmán-Rodríguez R, Polo-Lecca G, Aráoz-Tarco O, Alayo-Lizana C, Chacón-Diaz M. [Current Features and Mortality Risk Factors in Cardiogenic Shock due to Myocardial Infarction in a Latin-American hospital]. Arch Peru Cardiol Cir Cardiovasc 2020; 1:206-214. [PMID: 38268514 PMCID: PMC10804818 DOI: 10.47487/apcyccv.v1i4.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/14/2020] [Indexed: 01/26/2024]
Abstract
Objective To know the clinical characteristics and determine the related factors to higher in-hospital mortality in patients with cardiogenic shock (CS) due to myocardial infarction in a Peruvian reference hospital. Materials and methods . We conducted a prospective single-center cohort study, to evaluate the clinical characteristics, treatment, and complications of patients with CS due to myocardial infarction from March 2019 to August 2020 at the Instituto Nacional Cardiovascular INCOR. Factors related to higher in-hospital mortality and during follow-up were evaluated. Also, the IABP shock II score was applied to stratify the cohort. Results Forty patients were included in the study, 75% of cases were due to left ventricular dysfunction, most of the men and with a median age of 75 (69-82) years. Fifty percent of cases presented CS after admission to the emergency room. Patients stratified by the IABP shock II score as low, intermediate, and high risk, had in-hospital mortality of 37.5%, 71.4%, and 91.6% respectively. In a hospital, mortality was 70%, higher in women, in those over 75 years old, and in those who developed CS during their hospitalization. Serum lactate > 4 mmol/L in univariate analysis was associated with higher mortality risk (HR: 2.8; IC:1.6-3.6, p=0.009). Survival to the end of the study was 12.8%. Conclusions CS due to myocardial infarction is a clinical entity with high mortality in spite of revascularization and the available treatment in our reality. The highest mortality predictor was the serum lactate at admission > 4 mmol/L. The IABP shock II score showed to be an accurate parameter to stratify the death risk in our population.
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Affiliation(s)
- Rosario Guzmán-Rodríguez
- Servicio de Cardiología Clínica, Instituto Nacional Cardiovascular INCOR. Lima, Perú.Servicio de Cardiología ClínicaInstituto Nacional Cardiovascular INCORLimaPerú
| | - Gracia Polo-Lecca
- Servicio de Cardiología Clínica, Instituto Nacional Cardiovascular INCOR. Lima, Perú.Servicio de Cardiología ClínicaInstituto Nacional Cardiovascular INCORLimaPerú
| | - Ofelia Aráoz-Tarco
- Servicio de Cardiología Clínica, Instituto Nacional Cardiovascular INCOR. Lima, Perú.Servicio de Cardiología ClínicaInstituto Nacional Cardiovascular INCORLimaPerú
| | - Carlos Alayo-Lizana
- Servicio de Cardiología Clínica, Instituto Nacional Cardiovascular INCOR. Lima, Perú.Servicio de Cardiología ClínicaInstituto Nacional Cardiovascular INCORLimaPerú
| | - Manuel Chacón-Diaz
- Servicio de Cardiología Clínica, Instituto Nacional Cardiovascular INCOR. Lima, Perú.Servicio de Cardiología ClínicaInstituto Nacional Cardiovascular INCORLimaPerú
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sharma YP, Krishnappa D, Kanabar K, Kasinadhuni G, Sharma R, Kishore K, Mehrotra S, Santosh K, Gupta A, Panda P. Clinical characteristics and outcome in patients with a delayed presentation after ST-elevation myocardial infarction and complicated by cardiogenic shock. Indian Heart J 2019; 71:387-393. [PMID: 32035521 PMCID: PMC7013184 DOI: 10.1016/j.ihj.2019.11.256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/25/2019] [Accepted: 11/11/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Delayed presentation after ST-elevation myocardial infarction (STEMI) and complicated by cardiogenic shock (CS-STEMI) is commonly encountered in developing countries and is a challenging scenario because of a delay in revascularization resulting in infarction of a large amount of the myocardium. We aimed to assess the clinical characteristics, angiographic profile, and predictors of outcome in patients with a delayed presentation after CS-STEMI. Methods A total of 147 patients with CS-STEMI with time to appropriate medical care ≥12 h after symptom onset were prospectively recruited at a tertiary referral center. Results The median time to appropriate care was 24 h (interquartile range 18–48 h). The mean age was 58.7 ± 11.1 years. Left ventricular pump failure was the leading cause of shock (67.3%), whereas mechanical complications accounted for 14.9% and right ventricular infarction for 13.6% of cases. The overall in-hospital mortality was 42.9%. Acute kidney injury [Odds ratio (OR) 8.04; 95% confidence intervals (CI) 3.08–20.92], ventricular tachycardia (OR 7.04; CI 2.09–23.63), mechanical complications (OR 6.46; CI 1.80–23.13), and anterior infarction (OR 3.18; CI 1.01–9.97) were independently associated with an increased risk of mortality. Coronary angiogram (56.5%) revealed single-vessel disease (45.8%) as the most common finding. Percutaneous coronary intervention was performed in 53 patients (36%), at a median of 36 h (interquartile range 30–72) after symptom onset. Conclusion Patients with a delayed presentation after CS-STEMI were younger and more likely to have single-vessel disease. We found a high in-hospital mortality of 42.9%. Appropriate randomized studies are required to evaluate the optimal treatment strategies in these patients.
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Affiliation(s)
- Yash Paul Sharma
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Darshan Krishnappa
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Kewal Kanabar
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rakesh Sharma
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Kamal Kishore
- Department of Biostatistics, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Saurabh Mehrotra
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Krishna Santosh
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ankur Gupta
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Prashant Panda
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Helgestad OKL, Josiassen J, Hassager C, Jensen LO, Holmvang L, Sørensen A, Frydland M, Lassen AT, Udesen NLJ, Schmidt H, Ravn HB, Møller JE. Temporal trends in incidence and patient characteristics in cardiogenic shock following acute myocardial infarction from 2010 to 2017: a Danish cohort study. Eur J Heart Fail 2019; 21:1370-1378. [PMID: 31339222 DOI: 10.1002/ejhf.1566] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/11/2019] [Accepted: 06/30/2019] [Indexed: 11/09/2022] Open
Abstract
AIM We sought to describe the contemporary annual incidence of cardiogenic shock (CS) following acute myocardial infarction (AMICS), the proportion of patients developing CS following ST-elevation myocardial infarction (STEMI), and other temporal changes in AMICS in Denmark between 2010 and 2017. METHODS AND RESULTS Medical records of patients suspected of having AMICS during 2010-2017 were reviewed to identify consecutive patients with AMICS in a cohort corresponding to two-thirds of the Danish population. Due to changes in recruitment area over the study period, population-based incidence could only be calculated from 2012 to 2017. A total of 1716 patients with AMICS were identified and an increase in the annual incidence was observed, from a nadir 65.3 per million person-years in 2013 to 80.0 per million person-years in 2017 (P-value for trend < 0.001). This trend corresponded to an increase in patients with non-STEMI and a decrease in patients developing CS after STEMI (10.0-6.6%, P-value for trend < 0.001) Also, mean arterial blood pressure at the time of AMICS was lower (63 ± 11 mmHg to 61 ± 13 mmHg, P-value for trend = 0.001) and the frequency of patients with left ventricular ejection fraction ≤ 30% increased (61.8%-71.4%, P-value for trend = 0.004). The annual 30-day mortality during the study period remained unchanged at about 50%. CONCLUSION The incidence rate of AMICS increased in the Danish population between 2012 and 2017. Fewer patients with STEMI developed CS, and haemodynamic severity of CS increased during the study period; however, survival rates remained unchanged.
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Affiliation(s)
- Ole K L Helgestad
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Jakob Josiassen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Sørensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Martin Frydland
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Annmarie T Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Nanna L J Udesen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Henrik Schmidt
- Department of Cardiothoracic Anaesthesia, Odense University Hospital, Odense, Denmark
| | - Hanne B Ravn
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiac Anaesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
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12
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Venkatason P, Zubairi YZ, Wan Ahmad WA, Hafidz MI, Ismail MD, Hadi MF, Zuhdi ASM. In-hospital mortality of cardiogenic shock complicating ST-elevation myocardial infarction in Malaysia: a retrospective analysis of the Malaysian National Cardiovascular Database (NCVD) registry. BMJ Open 2019; 9:e025734. [PMID: 31061031 PMCID: PMC6502239 DOI: 10.1136/bmjopen-2018-025734] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Cardiogenic shock (CS) complicating ST-elevation myocardial infarction (STEMI) carries an extremely high mortality. The clinical pattern of this life threatening complication has never been described in Malaysian setting. This study is to investigate the incidence, clinical characteristics and outcome of STEMI patients with CS in our population. DESIGN A retrospective analysis of STEMI patients from 18 hospitals across Malaysia contributing to the Malaysian National Cardiovascular Database-acute coronary syndrome) registry (NCVD-ACS) year 2006-2013. PARTICIPANTS 16 517 patients diagnosed of STEMI from 18 hospitals in Malaysia from the year 2006 to 2013. PRIMARY OUTCOME MEASURES In-hospital and 30 day post-discharge mortality. RESULTS CS complicates 10.6% of all STEMIs in this study. They had unfavourable premorbid conditions and poor outcomes. The in-hospital mortality rate was 34.1% which translates into a 7.14 times mortality risk increment compared with STEMI without CS. Intravenous thrombolysis remained as the main urgent reperfusion modality. Percutaneous coronary interventions (PCI) in CS conferred a 40% risk reduction over non-invasive therapy but were only done in 33.6% of cases. Age over 65, diabetes mellitus, hypertension, chronic lung and kidney disease conferred higher risk of mortality. CONCLUSION Mortality rates of CS complicating STEMI in Malaysia are high. In-hospital PCI confers a 40% mortality risk reduction but the rate of PCI among our patients with CS complicating STEMI is still low. Efforts are being made to increase access to invasive therapy for these patients.
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Affiliation(s)
- Padmaa Venkatason
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Yong Z Zubairi
- Foundation Studies in Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Ahmad
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | - Mohd Firdaus Hadi
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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13
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Boccalandro F, Cedeno FA. Successful Re-Initiation of Therapeutic Hypothermia as Adjunctive Salvage Therapy in a Case of Refractory Cardiogenic Shock Due to Acute Myocardial Infarction. Am J Case Rep 2019; 20:323-329. [PMID: 30858348 PMCID: PMC6421978 DOI: 10.12659/ajcr.913459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) complicated by cardiogenic shock has a high mortality rate, despite prompt revascularization, advanced medical therapy and the use of mechanical circulatory support devices. Therapeutic hypothermia is associated with physiological cellular changes in the ischemic myocardium, and a trend towards improved hemodynamics in patients with AMI and cardiogenic shock, but is currently not considered to be a therapeutic modality. A case is presented that supports the role of therapeutic hypothermia as salvage therapy in patients with cardiogenic shock following AMI. CASE REPORT A 37-year-old man who presented with cardiac arrest following an anterior wall AMI due to occlusion of the left anterior descending coronary artery complicated by cardiogenic shock, underwent emergent percutaneous revascularization with placement of a stent, a percutaneous left ventricular-assist device (LVAD), and a pulmonary artery catheter. Therapeutic hypothermia was initiated to achieve a target core body temperature of between 32-34°C for 24 hours, followed by slow re-warming. However, after rewarming, the patient developed refractory cardiogenic shock, despite revascularization, pharmacological and mechanical circulatory support. A second cycle of therapeutic hypothermia was initiated as salvage therapy, leading to clinical improvement. The patient had a favorable outcome, was discharged from hospital and was able to return to work. CONCLUSIONS The first successful case is described in which therapeutic hypothermia was re-initiated as salvage therapy for cardiogenic shock where no other hemodynamic support resources were available.
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Affiliation(s)
- Fernando Boccalandro
- Procare, Odessa Heart Institute, Odessa, TX, USA.,Permian Research Fundation, Odessa, TX, USA.,Department of Internal Medicine, Texas Tech University Health Science Center, Odessa, TX, USA
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14
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Abstract
Myocardial infarction (MI) complicated by cardiogenic shock (MI-CS) is a major cause of cardiovascular morbidity and mortality. Predictors of outcomes in MI-CS include clinical, laboratory, radiologic variables, and management strategies. This article reviews the existing literature on short- and long-term predictors and risk stratification in MI complicated by CS.
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Affiliation(s)
- Deepak Acharya
- From the Section of Advanced Heart Failure, Mechanical Circulatory Support, and Pulmonary Vascular Disease, University of Alabama at Birmingham, Birmingham, AL
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15
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Na SJ, Park TK, Lee GY, Cho YH, Chung CR, Jeon K, Suh GY, Ahn JH, Carriere KC, Song YB, Choi JO, Hahn JY, Choi SH, Gwon HC, Yang JH. Impact of a cardiac intensivist on mortality in patients with cardiogenic shock. Int J Cardiol 2017; 244:220-5. [PMID: 28666601 DOI: 10.1016/j.ijcard.2017.06.082] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/06/2017] [Accepted: 06/20/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study aimed to evaluate the association between high-intensity staffing by a dedicated cardiac intensivist and clinical outcomes in CS. METHODS We enrolled 2923 consecutive patients admitted to a cardiac care unit (CCU) from January 1, 2012 to December 31, 2015. In January 2013, the CCU changed from a low-intensity to high-intensity staffing unit managed by a dedicated cardiac intensivist. Patients were eligible if they required inotropes or vasopressors to maintain a systolic blood pressure>90mmHg, and had serum lactate≥2.0mmol/L. Eligible patients (n=513) were treated by low-intensity CCU (n=352) or high-intensity CCU (n=161). The primary outcome was CCU mortality. RESULTS CCU mortality occurred in 49 patients (30.6%) of the low-intensity group versus 62 patients (17.6%) of the high-intensity group (adjusted odds ratio [aOR] 0.44, 95% confidence interval [CI] 0.25-0.75, p<0.001). In-hospital mortality was not significantly different between the groups (33.1% vs 24.4%, aOR 0.75, 95% CI 0.43-1.29, p=0.29). Among 135 patients treated with extracorporeal membrane oxygenation, the high-intensity model was associated with lower CCU mortality (54.5% vs 22.5%, aOR 0.24, 95% CI 0.07-0.77, p=0.02) and in-hospital mortality (57.6% vs 29.4%, aOR 0.28, 95% CI 0.10-0.81, p=0.02). CONCLUSION High-intensity staffed CCU managed by a dedicated cardiac intensivist was associated with a significant reduction of CS-related mortality.
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16
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Abstract
This review explores the usefulness of multivessel revascularization with percutaneous coronary intervention in patients with multivessel obstructive coronary artery disease (CAD) presenting with and without cardiogenic shock. We also evaluate the literature regarding complete versus incomplete revascularization for patients with cardiogenic shock, acute coronary syndromes, and stable coronary artery disease.
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Affiliation(s)
- Sandeep K Krishnan
- Division of Cardiology, University of Washington, School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Robert F Riley
- Division of Cardiology, University of Washington, School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Ravi S Hira
- Division of Cardiology, University of Washington, School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - William L Lombardi
- Division of Cardiology, University of Washington, School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA.
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17
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Obling L, Frydland M, Hansen R, Møller-Helgestad OK, Lindholm MG, Holmvang L, Ravn HB, Wiberg S, Thomsen JH, Jensen LO, Kjærgaard J, Møller JE, Hassager C. Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients. European Heart Journal: Acute Cardiovascular Care 2017; 7:7-15. [DOI: 10.1177/2048872617706503] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The incidence of cardiogenic shock (CS) in patients with ST-segment elevation myocardial infarction (STEMI) is as high as 10%. The majority of patients are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for primary percutaneous intervention remains unknown. Aim: The aim of this study was to assess the incidence and time of CS onset in patients with suspected STEMI admitted in two high-volume tertiary heart centres and to assess the variables associated with the development of late CS. Methods: We included consecutive patients admitted for acute coronary angiography with suspected STEMI in a 1-year period. Cardiogenic shock was based on clinical criteria and subdivided into patients with shock on admission, patients developing shock during catheterisation and patients developing shock later during hospitalisation. Follow-up for all-cause mortality was done using registries. Results: A total of 2247 patients with suspected STEMI were included, whereof 225 (10%) developed CS. The majority (56%) had CS on admission, 16% developed CS in the catheterisation laboratory and 28% developed late CS. Thirty-day mortality was 3.1% versus 47% in non-CS versus CS patients ( plogrank < 0.0001). Age, stroke, time from symptom onset to intervention, anterior STEMI, heart rate/systolic blood pressure ratio and being comatose after resuscitation from cardiac arrest were independently associated with the development of late CS. Conclusion: In this study, 10% of patients admitted with suspected STEMI for acute coronary angiography presented with or developed CS. Most were in shock on admission. Irrespective of the timing of shock, mortality was high.
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Affiliation(s)
- Laust Obling
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Martin Frydland
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rikke Hansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Matias Greve Lindholm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hanne Berg Ravn
- Department of Thoracic Anesthesiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sebastian Wiberg
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Jesper Kjærgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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18
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Davierwala PM, Leontyev S, Verevkin A, Rastan AJ, Mohr M, Bakhtiary F, Misfeld M, Mohr FW. Temporal Trends in Predictors of Early and Late Mortality After Emergency Coronary Artery Bypass Grafting for Cardiogenic Shock Complicating Acute Myocardial Infarction. Circulation 2017; 134:1224-1237. [PMID: 27777292 DOI: 10.1161/circulationaha.115.021092] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 07/26/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiogenic shock after acute myocardial infarction is an indication for emergent coronary artery bypass grafting in patients not amenable to percutaneous coronary intervention. Our study aimed to evaluate and identify risk factors for early and long-term outcomes in such patients. METHODS A total of 508 patients who underwent coronary artery bypass grafting for cardiogenic shock complicating acute myocardial infarction between January 2000 and June 2014 were divided into 3 time cohorts: 2000 to 2004 (n=204), 2005 to 2009 (n=166), and 2010 to 2014 (n=138). Predictors of in-hospital mortality for each time cohort and long-term mortality for all patients were identified by logistic and Cox regression analyses, respectively. RESULTS Mean age was 68.3±9.8 years. Of the 508 patients, 78.5% had 3-vessel and 47.1% had left main disease. Left ventricular function <30% was observed in 44.1% of patients, with 30.4%, 37.9%, 52.9%, and 3.1% requiring preoperative resuscitation, ventilation, intra-aortic balloon pump, and extracorporeal membrane oxygenation support, respectively. Overall in-hospital mortality was 33.7%; declined from 42.2% to 30.7% to 24.6%, respectively, for the 3 time cohorts (P=0.02); and was independently predicted by serum lactate >4 mmol/L (odds ratio [OR], 4.78; 95% confidence interval, 2.88-7.95; P<0.0001), ST-segment-elevation myocardial infarction (OR, 2.10; 95% confidence interval, 1.36-3.26; P=0.001), age >75 years (OR, 2.01; 95% confidence interval, 1.06-3.85; P=0.03), and left ventricular ejection fraction <30% (OR, 1.83; 95% confidence interval, 1.15-2.91; P=0.01). Cumulative survival was 42.6±2.0% and 33.4±2.0% at 5 and 10 years, respectively, and correspondingly improved to 64.3±3.0% and 49.8±3.0% in hospital survivors. Serum lactate >4 mmol/L (OR, 2.2; P<0.0001), incremental age (OR, 1.05; P<0.0001), New York Heart Association class IV (OR, 1.33; P=0.02), diabetes mellitus (OR, 1.39; P=0.005), and preoperative inotropic (OR, 2.61; P=0.001) and extracorporeal membrane oxygenation (OR, 1.68; P=0.05) support predicted late mortality. CONCLUSIONS Emergency coronary artery bypass grafting in patients with acute myocardial infarction complicated by cardiogenic shock is associated with a high in-hospital mortality, which showed a significant decline with time. Hospital survivors have good long-term outcomes, which demonstrate the beneficial effect of surgical revascularization. Preoperative serum lactate >4 mmol/L is a strong predictor of both early and late mortality.
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Affiliation(s)
- Piroze M Davierwala
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr).
| | - Sergey Leontyev
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr)
| | - Alexander Verevkin
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr)
| | - Ardawan J Rastan
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr)
| | - Matthias Mohr
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr)
| | - Farhad Bakhtiary
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr)
| | - Martin Misfeld
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr)
| | - Friedrich W Mohr
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr)
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19
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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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20
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Rossello X, Vila M, Rivas-Lasarte M, Ferrero-Gregori A, Sans-Roselló J, Duran-Cambra A, Sionis A. Impact of Pulmonary Artery Catheter Use on Short- and Long-Term Mortality in Patients with Cardiogenic Shock. Cardiology 2016; 136:61-69. [PMID: 27553044 DOI: 10.1159/000448110] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/30/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The impact of pulmonary artery catheterization (PAC) on survival in patients with cardiogenic shock (CS) is not well established. This study aimed to assess whether Swan-Ganz catheter monitoring is related to short- and long-term mortality in patients with CS. METHODS One hundred and twenty-nine consecutive patients with a first admission for CS were prospectively enrolled in a single-center registry between December 2005 and May 2009, and were subsequently followed up over 5.3 years. RESULTS PAC was used in 64% of all patients with a mean age of 68 years (65% men). After adjustment for age, gender and the presence of CS upon admission, PAC was associated with lower short-term mortality [hazard ratio (HR) = 0.55, 95% confidence interval (CI) 0.35-0.86, p = 0.008] as well as lower mortality rates in the long-term follow-up (HR = 0.63, 95% CI 0.41-0.97, p = 0.035). In a subgroup analysis, the use of PAC was associated with reduced mortality in patients without acute coronary syndrome (ACS), i.e. 49% in the Swan-Ganz group vs. 82% (p = 0.010), but there was no difference within the ACS group. CONCLUSIONS The use of PAC in patients with CS was associated with lower short- and long-term mortality rates after adjustment for age, gender and the presence of shock upon admission. This benefit was only significant in those patients without ACS.
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Affiliation(s)
- Xavier Rossello
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Goldberg RJ, Makam RCP, Yarzebski J, McManus DD, Lessard D, Gore JM. Decade-Long Trends (2001-2011) in the Incidence and Hospital Death Rates Associated with the In-Hospital Development of Cardiogenic Shock after Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2016; 9:117-25. [PMID: 26884615 DOI: 10.1161/circoutcomes.115.002359] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited information is available about relatively contemporary trends in the incidence and hospital case-fatality rates of cardiogenic shock in patients hospitalized with acute myocardial infarction. The purpose of this population-based study was to describe decade long trends (2001-2011) in the incidence and hospital case-fatality rates for patients who developed cardiogenic shock during hospitalization for an acute myocardial infarction. METHODS AND RESULTS The study population consisted of 5686 residents of central Massachusetts hospitalized with acute myocardial infarction at all 11 medical centers in the Worcester, MA, metropolitan area during 6 biennial periods between 2001 and 2011, who did not have cardiogenic shock at the time of hospital presentation. On average, 3.7% of these patients developed cardiogenic shock during their acute hospitalization with nonsignificant and inconsistent trends noted over time in both crude (3.7% in 2001/2003; 4.5% in 2005/2007; 2.7% in 2009/2011; P=0.19) and multivariable adjusted analyses. The overall in-hospital case-fatality rate for patients who developed cardiogenic shock was 41.4%. The crude and multivariable adjusted odds of dying after cardiogenic shock declined during the most recent study years (47.1% dying in 2001/2003, 42.0% dying in 2005/2007, and 28.6% dying in 2009/2011). Increases in the use of evidence-based cardiac medications, and interventional procedures paralleled the increasing hospital survival trends. CONCLUSIONS We found suggestions of a decline in the death, but not incidence, rates of cardiogenic shock over time. These encouraging trends in hospital survival are likely because of advances in the early recognition and aggressive management of patients who develop cardiogenic shock.
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Affiliation(s)
- Robert J Goldberg
- From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester.
| | - Raghavendra Charan P Makam
- From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester
| | - Jorge Yarzebski
- From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester
| | - David D McManus
- From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester
| | - Darleen Lessard
- From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester
| | - Joel M Gore
- From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester
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O'Connor SA, Garot P, Sanguineti F, Hoebers LP, Unterseeh T, Benamer H, Chevalier B, Hovasse T, Morice MC, Lefèvre T, Louvard Y. Meta-Analysis of the Impact on Mortality of Noninfarct-Related Artery Coronary Chronic Total Occlusion in Patients Presenting With ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2015; 116:8-14. [PMID: 26068700 DOI: 10.1016/j.amjcard.2015.03.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/24/2015] [Accepted: 03/24/2015] [Indexed: 01/02/2023]
Abstract
Several observational studies have compared clinical outcome in patients with a co-existing noninfarct-related artery chronic total occlusion (n-IRA CTO) versus those without, suggesting increased all-cause mortality. The goal of this study was to provide a systematic review and meta-analysis evaluating the impact of the presence of an n-IRA CTO on short- and long-term mortality after primary percutaneous coronary intervention. Studies published from January 1980 to January 2014 that compared the incidence of all-cause mortality in patients with ST-segment elevation myocardial infarction with co-existing n-IRA CTO versus those without were identified using an electronic search and reviewed using meta-analytical techniques. Seven studies (5 observational studies and 2 observational analyses of randomized controlled trials) comprising 14,117 patients and 1,554 patients (11.7%) with n-IRA CTO were included. The presence of n-IRA CTO was associated with increased incidence of all-cause mortality at a median follow-up of 25.2 months (interquartile range 24 to 60) compared with no CTO (absolute risk 23.5% vs 9.0%; odds ratio [OR] 2.90, 95% confidence interval [CI] 2.09 to 4.01; p <0.0001). This finding was consistent in the analysis of studies reporting 30-day follow-up (absolute risk 17.2% vs 4.7%; OR 3.79, 95% CI 3.13 to 4.59; p <0.0001). Co-existing n-IRA CTO was also associated with increased mortality in a subanalysis of patients with multivessel disease only (absolute risk 24.2% vs 11.3%; OR 2.23, 95% CI 1.90 to 2.63; p <0.0001). In conclusion, coronary CTO in the nonculprit artery in patients presenting with ST-segment elevation myocardial infarction is associated with increased short- and long-term all-cause mortality.
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Abnousi F, Yong CM, Fearon W, Banerjee D. The Evolution of Temporary Percutaneous Mechanical Circulatory Support Devices: a Review of the Options and Evidence in Cardiogenic Shock. Curr Cardiol Rep 2015; 17:40. [DOI: 10.1007/s11886-015-0594-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jensen JK, Thayssen P, Antonsen L, Hougaard M, Junker A, Pedersen KE, Jensen LO. Influence of cardiogenic shock with or without the use of intra-aortic balloon pump on mortality in patients with ST-segment elevation myocardial infarction. Int J Cardiol Heart Vasc 2015; 6:19-24. [PMID: 28785621 PMCID: PMC5497164 DOI: 10.1016/j.ijcha.2014.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 12/07/2014] [Accepted: 12/20/2014] [Indexed: 11/17/2022]
Abstract
Background Cardiogenic shock is a serious complication of a ST-segment elevation myocardial infarction (STEMI). We compared short- and long-term mortality among (1) STEMI patients with and without cardiogenic shock and (2) STEMI patients with cardiogenic shock with and without the use of an intra-aortic balloon pump (IABP). Methods From January 1, 2002 to December 31, 2010, all patients presenting with STEMI and treated with primary percutaneous coronary intervention (PCI) were identified. The hazard ratio (HR) for death was estimated using a Cox regression model, controlling for potential confounding. Results The study cohort consisted of 4293 STEMI patients: 286 (6.7%) with and 4007 (93.3%) without cardiogenic shock. Compared with patients without cardiogenic shock, patients with cardiogenic shock were older, and more likely to have diabetes mellitus, multi-vessel disease, anterior myocardial infarction (MI) or bundle-branch block MI and a reduced creatinine clearance. Among patients with cardiogenic shock vs. without shock, 30-day cumulative mortality was 57.3% vs. 4.5% (p < 0.001), one-year cumulative mortality was 60.7% vs. 8.2% (p < 0.001) and five-year mortality was 65.0% vs. 18.9% (p < 0.001). STEMI with cardiogenic shock was associated with higher 30-day mortality (adjusted HR = 12.89 [95% CI: 9.72–16.66]), 1-year mortality (adjusted HR = 8.83 [95% CI: 7.06–11.05]) and five-year mortality (adjusted HR = 6.39 [95% CI: 5.22–7.80]). IABP was used in 71 (25%) patients with cardiogenic shock and was associated with improved 30-day outcome (adjusted HR = 0.48 [95% CI: 0.28–0.83]). Conclusion Patients with STEMI and cardiogenic shock had substantial short- and long-term mortality that may be improved with IABP implantation. More studies on use of IABP in such patients are warranted.
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Affiliation(s)
| | - Per Thayssen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Mikkel Hougaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Anders Junker
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Movahed MR, Khan MF, Hashemzadeh M, Hashemzadeh M. Age adjusted nationwide trends in the incidence of all cause and ST elevation myocardial infarction associated cardiogenic shock based on gender and race in the United States. Cardiovascular Revascularization Medicine 2015; 16:2-5. [DOI: 10.1016/j.carrev.2014.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/11/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022]
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Pyka L, Pres D, Przybylski R, Pacholewicz J, Poloński L, Zembala M, Gąsior M. Mechanical circulatory support in cardiogenic shock - what every interventional cardiologist should know. Postepy Kardiol Interwencyjnej 2014; 10:195-200. [PMID: 25489306 DOI: 10.5114/pwki.2014.45147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 06/08/2014] [Accepted: 07/18/2014] [Indexed: 11/17/2022] Open
Abstract
Cardiogenic shock (CS) remains the main cause of death in patients with myocardial infarction. Conservative treatment alone does not sufficiently improve prognosis. Mortality in CS can only be significantly reduced with revascularization, both surgical and percutaneous. However some patients present with haemodynamic instability despite optimal medical treatment and complete revascularization, resulting in very high mortality rates. These patients require the implementation of mechanical circulatory support in order to increase systemic blood flow, protect against organ hypoperfusion and protect the myocardium through a decrease in oxygen consumption. In contemporary interventional cardiology it seems that every operator should be aware of all available mechanical circulatory support methods for their patients. This article aims to present the current state of knowledge and technical possibilities in this area.
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Ostenfeld S, Lindholm MG, Kjaergaard J, Bro-Jeppesen J, Møller JE, Wanscher M, Hassager C. Prognostic implication of out-of-hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction. Resuscitation 2014; 87:57-62. [PMID: 25475249 DOI: 10.1016/j.resuscitation.2014.11.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/20/2014] [Accepted: 11/13/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare outcome in patients with acute myocardial infarction (MI) and cardiogenic shock (CS) presenting with and without out-of-hospital cardiac arrest (OHCA). BACKGROUND Despite general improvement in outcome after acute MI, CS remains a leading cause of death in acute MI patients with a high 30-day mortality rate. OHCA on top of cardiogenic shock may further increase mortality in these patients resulting in premature withdrawal of supportive therapy, but this is not known. METHODS AND RESULTS In a retrospective study from 2008 to 2013, 248 consecutive patients admitted alive to a tertiary centre with the diagnosis of CS and acute MI were enrolled, 118 (48%) presented with OHCA and 130 (52%) without (non-OHCA patients). Mean lactate level at admission was significantly higher in OHCA patients compared with non-OCHA patients (9mmol/l (SD 6) vs. 6mmol/l (SD 4) p<0.0001). Co-morbidities were more prevalent in the non-OHCA group. By univariate analysis age (Hazard ratio (HR)=1.02 [CI 1.00-1.03], p=0.01) and lactate at admission (HR=1.06 [CI 1.03-1.09], p<0.001), but not OHCA (HR=1.1 [CI 0.8-1.4], p=NS) was associated with mortality. In multivariate analysis, only age (HR=1.02 [CI 1.01-1.04], p=0.003) and lactate level at admission (HR=1.06 [1.03-1.09], p<0.001) were independent predictors of mortality. One-week mortality was 63% in the OHCA group and 56% in the non-OHCA group, p=NS. CONCLUSION OHCA is not an independent predictor of mortality in patients with acute MI complicated by cardiogenic shock. This should encourage active intensive treatment of CS patients regardless of OHCA.
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Affiliation(s)
- Sarah Ostenfeld
- Department of Thoracic Anaesthesia, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark.
| | - Matias Greve Lindholm
- Department of Cardiology, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark
| | | | - Michael Wanscher
- Department of Thoracic Anaesthesia, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark
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Abstract
Cardiogenic shock is the deadliest complication of acute ST-elevation myocardial infarction. Prompt recognition and intervention are critical for patient survival. The diagnosis of cardiogenic shock is primarily a clinical one based on signs and symptoms of low cardiac output and heart failure, and can be confirmed with placement of a pulmonary arterial catheter. Vasopressor and inotropic therapies are typically required, and in severe cases, an intra-aortic balloon pump can provide additional haemodynamic support. Although mortality for cardiogenic shock associated with ST-elevation myocardial infarction remains high, early reperfusion strategies primarily via percutaneous coronary intervention or coronary artery bypass graft surgery have led to improved outcomes.
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Affiliation(s)
| | - Robert Yeh
- Cardiology Division, Massachusetts General Hospital, Boston, US
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35:2541-619. [PMID: 25173339 DOI: 10.1093/eurheartj/ehu278] [Citation(s) in RCA: 3275] [Impact Index Per Article: 327.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Aissaoui N, Puymirat E, Simon T, Bonnefoy-Cudraz E, Angoulvant D, Schiele F, Benamer H, Quandalle P, Prunier F, Durand E, Berard L, Blanchard D, Danchin N. Long-term outcome in early survivors of cardiogenic shock at the acute stage of myocardial infarction: a landmark analysis from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) Registry. Crit Care 2014; 18:516. [PMID: 25246084 PMCID: PMC4192440 DOI: 10.1186/s13054-014-0516-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/28/2014] [Indexed: 12/21/2022]
Abstract
Introduction There are little data about patients with cardiogenic shock (CS) who survive the early phase of acute myocardial infarction (AMI). The aim of this study was to assess long-term (5-year) mortality among early survivors of AMI, according to the presence of CS at the acute stage. Methods We analyzed 5-year follow-up data from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 registry, a nationwide French survey including consecutive patients admitted for ST or non-ST-elevation AMI at the end of 2005 in 223 institutions. Results Of 3670 patients enrolled, shock occurred in 224 (6.1%), and 3411 survived beyond 30 days or hospital discharge, including 99 (2.9%) with shock. Early survivors with CS had a more severe clinical profile, more frequent concomitant in-hospital complications, and were less often managed invasively than those without CS. Five-year survival was 59% in patients with, versus 76% in those without shock (adjusted hazard ratio (HR) = 1.72 [1.24-2.38], P = 0.001). The excess of death associated with CS, however, was observed only during the first year (one-year survival: 77% vs 93%, adjusted HR: 2.87 [1.85 to 4.46] P <0.001), while survival from one to 5 years was similar (76% vs 82%, adjusted HR: 1.06 [0.64 to 1.74]). Propensity score-matched analyses yielded similar results. Conclusions In patients surviving the early phase of AMI, CS at the initial stage carries an increased risk of death up to one year after the acute event. Beyond one year, however, mortality is similar to that of patients without shock. Trial registration ClinicalTrials.gov number, NCT00673036, Registered May 5, 2008. Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0516-y) contains supplementary material, which is available to authorized users.
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Lindholm MG, Boesgaard S, Thune JJ, Kelbaek H, Andersen HR, Kober L. Percutaneous coronary intervention for acute MI does not prevent in-hospital development of cardiogenic shock compared to fibrinolysis. Eur J Heart Fail 2014; 10:668-74. [DOI: 10.1016/j.ejheart.2008.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 04/08/2008] [Accepted: 04/28/2008] [Indexed: 11/28/2022] Open
Affiliation(s)
- Matias G. Lindholm
- Medical Department B, Division of Cardiology; Rigshospitalet, University Hospital of Copenhagen; Denmark
| | - Søren Boesgaard
- Medical Department B, Division of Cardiology; Rigshospitalet, University Hospital of Copenhagen; Denmark
| | - Jens Jakob Thune
- Medical Department B, Division of Cardiology; Rigshospitalet, University Hospital of Copenhagen; Denmark
| | - Henning Kelbaek
- Medical Department B, Division of Cardiology; Rigshospitalet, University Hospital of Copenhagen; Denmark
| | - Henning Rud Andersen
- Department of Cardiology, Skejby Hospital; University Hospital of Aarhus; Denmark
| | - Lars Kober
- Medical Department B, Division of Cardiology; Rigshospitalet, University Hospital of Copenhagen; Denmark
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Maini B, Gregory D, Scotti DJ, Buyantseva L. Percutaneous cardiac assist devices compared with surgical hemodynamic support alternatives. Catheter Cardiovasc Interv 2014; 83:E183-92. [DOI: 10.1002/ccd.25247] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 10/10/2013] [Indexed: 11/09/2022]
Affiliation(s)
| | - David Gregory
- Presscott Associates-A Division of ParenteBeard LLC; Avon Connecticut
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Abstract
Despite extraordinary innovations in cardiology and critical care, cardiovascular disease remains the leading cause of death globally, and heart failure has one of the highest disease burdens of any medical condition in the Western world. The lethality of many cardiac conditions, for which symptoms and prognoses are worse than for many malignancies, is widely under-recognized. A number of strategies have been developed within specialties such as oncology to improve the care of patients with life-threatening conditions. For reasons that are multifactorial, these options are often denied to critically ill patients with cardiac disease. Cardiologists and intensivists often regard death as failure, continuing to pursue active treatment while potentially denying patients access to alternatives such as symptom control and end-of-life care. Patient autonomy is central to the delivery of high-quality care, demanding shared decision-making to ensure patient preferences are acknowledged and respected. Although many cardiologists and intensivists do provide thoughtful and patient-centred care, the pressure to intervene can lead to physician-centric care focused around the needs and wishes of medical staff to the detriment of patients, families, health-care workers, and society as a whole.
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Acharji S, Mathur A, Lakshmanadoss U, Prasad H, Singh M, Kaluski E. Have we given up on intra-aortic balloon counterpulsation in post-myocardial infarction cardiogenic shock? Clin Cardiol 2013; 36:704-10. [PMID: 24105878 DOI: 10.1002/clc.22184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/02/2013] [Indexed: 01/19/2023] Open
Abstract
The recently published Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial concluded that intra-aortic counterpulsation (IACP) does not reduce 30-day mortality in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) for whom early revascularization strategy was planned. The study resulted in downgrading IACP in post-AMI CS patients by certain professional organizations like the European Society of Cardiology. Although this is the largest and most important CS study of this decade, it suffers from considerable shortcomings: (1) time intervals from chest-pain onset or AMI recognition to revascularization, enrollment, and IACP initiation are not disclosed; (2) 86.6% of the treatment arm initiated IACP only post-percutaneous coronary intervention (PCI), and 4.3 % did not receive IACP at all; (3) 17.4% of the control arm crossed over to IACP or other mechanical support, mostly due to protocol violations; (4) there is no adjudication of the mortality events; (5) follow-up is limited to 30 days; and (5) both methodology (especially IACP device size) and quality of IACP are not evaluated and documented. Because the study assessed mostly the efficacy and safety of IACP initiated post-PCI, the study conclusions should not be extrapolated to IACP pre-PCI or during PCI in CS. Moreover, IACP had a favorable effect on the mortality of younger patients. Intra-aortic counterpulsation should remain the first line of mechanical circulatory support for the hemodynamically compromised AMI patients with or without CS who are undergoing primary PCI. Early upgrade to more advanced mechanical circulatory support should be considered for selective suitable candidates who remain in refractory CS despite revascularization and IACP.
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Affiliation(s)
- Subasit Acharji
- Division of Cardiology, Robert Packer Hospital, Guthrie Health Services, Sayre, Pennsylvania
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Wadke R, Sanborn TA. Cardiogenic Shock: Background, Shock Trial/Registry, Evolving Data, Changing Survival, Best Medical Therapy. Interv Cardiol Clin 2013; 2:397-406. [PMID: 28582101 DOI: 10.1016/j.iccl.2013.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cardiogenic shock remains associated with unacceptably high mortality, but recent improvements with early revascularization, continued support with pharmacologic agents, and use of an intra-aortic balloon pump have led to improvements in the rate of mortality. Timely intervention with cardiac surgery in patients with mechanical complications, 3-vessel disease, and left main disease is beneficial. Continued research and ever-improving understanding of this once deadly condition have helped further in improving prognosis. Cutting-edge technologies, such as myocyte cell implantation and the use of a cooling system, will help in pushing the boundaries farther.
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Affiliation(s)
- Rahul Wadke
- Hospitalist Division, Department of Internal Medicine, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA.
| | - Timothy A Sanborn
- Head Cardiology Division, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, 2650 Ridge Avenue, Walgreen Building, Third Floor, Evanston, IL 60201, USA
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Mylotte D, Morice MC, Eltchaninoff H, Garot J, Louvard Y, Lefèvre T, Garot P. Primary percutaneous coronary intervention in patients with acute myocardial infarction, resuscitated cardiac arrest, and cardiogenic shock: the role of primary multivessel revascularization. JACC Cardiovasc Interv 2013; 6:115-25. [PMID: 23352816 DOI: 10.1016/j.jcin.2012.10.006] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 10/12/2012] [Accepted: 10/26/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study sought to assess the impact of multivessel (MV) primary percutaneous coronary intervention (PCI) on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) presenting with cardiogenic shock (CS) and resuscitated cardiac arrest (CA). BACKGROUND The safety and efficacy of MV primary PCI in patients with STEMI and refractory CS is unknown. METHODS We conducted a multicenter prospective observational study of consecutive STEMI patients presenting to 5 French centers. Patients were classified as having single-vessel (SVD) or multivessel (MVD) coronary disease, and underwent culprit-only or MV primary PCI. Baseline characteristics and 6-month survival were compared. RESULTS Among 11,530 STEMI patients, 266 had resuscitated CA and CS. Patients with SVD (36.5%) had increased 6-month survival compared to those with MVD (29.6% vs. 42.3%, p = 0.032). Baseline characteristics were similar in those with MVD undergoing culprit-only (60.9%) or MV (39.1%) primary PCI. However, 6-month survival was significantly greater in patients who underwent MV PCI (43.9% vs. 20.4%, p = 0.0017). This survival advantage was mediated by a reduction in the composite of recurrent CA and death due to shock (p = 0.024) in MV PCI patients. In those with MVD, culprit artery PCI success (hazard ratio [HR]: 0.63; 95% confidence interval [CI]: 0.41 to 0.96, p = 0.030) and MV primary PCI (HR: 0.57; 95% CI: 0.38 to 0.84, p = 0.005) were associated with increased 6-month survival. CONCLUSIONS The results of this study suggest that in STEMI patients with MVD presenting with CS and CA, MV primary PCI may improve clinical outcome. Randomized trials are required to verify these results.
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Affiliation(s)
- Darren Mylotte
- Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, and Hôpital Claude Galien, Quincy, France.
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Roos JB, Doshi SN, Konorza T, Palacios I, Schreiber T, Borisenko OV, Henriques JPS. The cost-effectiveness of a new percutaneous ventricular assist device for high-risk PCI patients: mid-stage evaluation from the European perspective. J Med Econ 2013; 16:381-90. [PMID: 23301850 DOI: 10.3111/13696998.2012.762004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE A new and smaller percutaneous ventricular assist device (pVAD, Impella, Abiomed, Danvers, MA) has been developed to provide circulatory support in hemodynamically unstable patients and to prevent hemodynamic collapse during high-risk percutaneous coronary interventions (PCI). The objective of the study was to assess the cost-effectiveness of this specific device compared to the intra-aortic balloon pump (IABP) from the European perspective. Additional analysis on extracorporeal membrane oxygenation was conducted for observational purposes only, given its use in some European countries. METHODS A combination of a decision tree and Markov model was developed to assess the cost-effectiveness of the small, pVAD. The short-term (30-day) effectiveness and safety (early survival, risk of bleeding, and stroke) were modeled, as well as long-term risk of major adverse cardiovascular events (recurrent myocardial infarction, stroke, and heart failure). The short-term effectiveness and safety data for the device were obtained from two registries (the Europella and USpella), both of which are large multi-center studies in high-risk patient groups. Probabilities of long-term major adverse cardiovascular events were obtained from various published clinical studies. The economic analysis was conducted from a German statutory health insurance perspective and only direct medical costs were included. Cost-effectiveness was estimated over a 10-year time horizon. RESULTS Compared with IABP, the pVAD generated an incremental quality-adjusted life-year (QALY) of 0.22 (with Euro-registry data) and 0.27 (with US-registry data). The incremental cost-effectiveness ratio (ICER) of the device varied between €38,069 (with Euro-registry data) and €31,727 (with US-registry data) per QALY compared with IABP. KEY LIMITATIONS Unadjusted, indirect comparisons of short-term effectiveness and safety between the interventions were used in the model. Cost and utility data were retrieved from various sources. Therefore, differences in patient populations may bias the estimated cost-effectiveness. CONCLUSIONS Compared with IABP, the pVAD is a cost-effective intervention for high-risk PCI patients, with ICERs well-below the conventional cost-effectiveness threshold.
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Abstract
With a stable frequency (about 5% of acute coronary syndromes) and a mortality of nearly 45%, cardiogenic shock (CS), especially when it occurs in the immediate waning of myocardial infarction, still represents a therapeutic challenge. In this review, will be detailed the actual epidemiologic data of CS, its physiopathology and the different modalities of treatments available to the interventional cardiologist, especially the coronary revascularisation and the percutaneous left ventricular assistance, whether by intra-aortic balloon counterpulsation or by more complex systems.
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Affiliation(s)
- G Leurent
- Service de cardiologie et maladies vasculaires, CHU de Rennes, 35000 Rennes, France.
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Pang B, Everest E, McGavigan AD. Utility of atrial temporary pacing as an acute treatment for bradyarrhythmias and tachyarrhythmias in the intensive care setting with preservation of atrioventricular synchrony. Intern Med J 2012; 42:581-5. [DOI: 10.1111/j.1445-5994.2012.02767.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Acute myocardial infarction is one of the 10 leading reasons for admission to adult critical care units. In-hospital mortality for this condition has remained static in recent years, and this is related primarily to the development of cardiogenic shock. Recent advances in reperfusion therapies have had little impact on the mortality of cardiogenic shock. This may be attributable to the underutilization of life support technology that may assist or completely supplant the patient's own cardiac output until adequate myocardial recovery is established or long-term therapy can be initiated. Clinicians working in the intensive care environment are increasingly likely to be exposed to these technologies. The purpose of this review is to outline the various techniques of mechanical circulatory support and discuss the latest evidence for their use in cardiogenic shock complicating acute myocardial infarction.
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Affiliation(s)
- Matthew E Cove
- Cardiothoracic Intensive Care Unit, National University Health System, 5 Lower Kent Ridge Road, Singapore.
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Jarai R, Huber K, Bogaerts K, Sinnaeve PR, Ezekowitz J, Ross AM, Zeymer U, Armstrong PW, Van de Werf FJ. Prediction of cardiogenic shock using plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone concentrations in ST elevation myocardial infarction: An analysis from the ASSENT-4 Percutaneous Coronary Intervention Trial: . Crit Care Med 2010; 38:1793-801. [DOI: 10.1097/ccm.0b013e3181eaaf2a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sleeper LA, Reynolds HR, White HD, Webb JG, Džavík V, Hochman JS. A severity scoring system for risk assessment of patients with cardiogenic shock: a report from the SHOCK Trial and Registry. Am Heart J 2010; 160:443-50. [PMID: 20826251 DOI: 10.1016/j.ahj.2010.06.024] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2009] [Accepted: 06/16/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND Early revascularization (ERV) is beneficial in the management of cardiogenic shock (CS) complicating myocardial infarction. The severity of CS varies widely, and identification of independent risk factors for outcome is needed. The effect of ERV on mortality in different risk strata is also unknown. We created a severity scoring system for CS and used it to examine the potential benefit of ERV in different risk strata using data from the SHOCK Trial and Registry. METHODS Data from 1,217 patients (294 from the randomized trial and 923 from the registry) with CS due to pump failure were included in a Stage 1 severity scoring system using clinical variables. A Stage 2 scoring system was developed using data from 872 patients who had invasive hemodynamic measurements. The outcome was in-hospital mortality at 30 days. RESULTS In-hospital mortality at 30 days was 57%. Multivariable modeling identified 8 risk factors (Stage 1): age, shock on admission, clinical evidence of end-organ hypoperfusion, anoxic brain damage, systolic blood pressure, prior coronary artery bypass grafting, noninferior myocardial infarction, and creatinine > or = 1.9 mg/dL (c-statistic = 0.74). Mortality ranged from 22% to 88% by score category. The ERV benefit was greatest in moderate- to high-risk patients (P = .02). The Stage 2 model based on patients with pulmonary artery catheterization included age, end-organ hypoperfusion, anoxic brain damage, stroke work, and left ventricular ejection fraction <28% (c-statistic = 0.76). In this cohort, the effect of ERV did not vary by risk stratum. CONCLUSIONS Simple clinical predictors provide good discrimination of mortality risk in CS complicating myocardial infarction. Early revascularization is associated with improved survival across a broad range of risk strata.
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Harjola VP, Follath F, Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Hochadel M, Komajda M, Lopez-Sendon JL, Ponikowski P, Tavazzi L. Characteristics, outcomes, and predictors of mortality at 3 months and 1 year in patients hospitalized for acute heart failure. Eur J Heart Fail 2010; 12:239-48. [DOI: 10.1093/eurjhf/hfq002] [Citation(s) in RCA: 192] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Veli-Pekka Harjola
- Division of Emergency Care, Department of Medicine; Helsinki University Central Hospital; PO Box 340 Helsinki 00029 HUS Finland
| | - Ferenc Follath
- Department of Internal Medicine; University Hospital Zurich; Zurich Switzerland
| | - Markku S. Nieminen
- Division of Cardiology, Department of Medicine; Helsinki University Central Hospital; Helsinki Finland
| | - Dirk Brutsaert
- Department of Cardiology, A.Z Middelheim Hospital; University of Antwerp; Antwerp Belgium
| | - Kenneth Dickstein
- Stavanger University Hospital; Stavanger Norway
- Institute of Internal Medicine; University of Bergen; Bergen Norway
| | - Helmut Drexler
- Abt. Kardiologie u. Angiologie, Zentrum Innere Medizin, Med. Hochschule Hannover (MHH); Hannover Germany
| | - Matthias Hochadel
- Stiftung Institut für Herzinfarktforschung an der Universität Heidelberg; Ludwigshafen Germany
| | - Michel Komajda
- University Pierre & Marie Curie; Paris VI France
- Cardiology Department; CHU Pitie Salpetriere; Paris France
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Buerke M, Russ M, Prondzinsky R, Werdan K. Infarktbedingter kardiogener Schock – Diagnose, Monitoring und Therapie. ACTA ACUST UNITED AC 2009; 46:132-45. [DOI: 10.1007/s00390-009-0037-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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