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Abstract
Fibrinolytic agents provide an important alternative therapeutic strategy in individuals presenting with ST-elevation myocardial infarction (STEMI). Ultimately, primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for most patients with STEMI, including elderly patients and patients with coronavirus disease 2019 (COVID-19) infection. Fibrinolytic therapy should always be considered when timely primary PCI cannot be delivered appropriately. Clinicians should promptly recognize the signs of fibrinolytic therapy failure and consider rescue PCI. When fibrinolytics are used, coronary angiography and revascularization should not be conducted within the initial 3 hours after fibrinolytic administration.
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Affiliation(s)
- Chayakrit Krittanawong
- Section of Cardiology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA
| | - Joshua Hahn
- Section of Cardiology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA
| | - Waleed Kayani
- Section of Cardiology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA
| | - Hani Jneid
- Section of Cardiology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA; Interventional Cardiology Fellowship Program, Interventional Cardiology Research, Baylor College of Medicine, Interventional Cardiology, The Michael E. DeBakey VA Medical Center, MEDVAMC - 2002 Holcombe Boulevard, Cardiology 3C-320C, Houston, TX 77030, USA.
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Kawashima H, Hara H, Wang R, Ono M, Gao C, Takahashi K, Suryapranata H, Walsh S, Cotton J, Carrie D, Sabate M, Steinwender C, Leibundgut G, Wykrzykowska J, Hamm C, Jüni P, Vranckx P, Valgimigli M, Windecker S, Winter RJ, Sharif F, Onuma Y, Serruys PW. Usefulness of updated logistic clinical SYNTAX score based on MI‐SYNTAX score in patients with ST‐elevation myocardial infarction. Catheter Cardiovasc Interv 2020; 97:E919-E928. [DOI: 10.1002/ccd.29383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/20/2020] [Revised: 10/07/2020] [Accepted: 10/22/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Hideyuki Kawashima
- Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam Amsterdam Netherlands
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
| | - Hironori Hara
- Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam Amsterdam Netherlands
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
| | - Rutao Wang
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
- Department of Cardiology Radboudumc Nijmegen Netherlands
| | - Masafumi Ono
- Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam Amsterdam Netherlands
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
| | - Chao Gao
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
- Department of Cardiology Radboudumc Nijmegen Netherlands
| | - Kuniaki Takahashi
- Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam Amsterdam Netherlands
| | | | - Simon Walsh
- Department of Cardiology Belfast Health and Social Care Trust Belfast UK
| | - James Cotton
- Heart and Lung Centre New Cross Hospital Wolverhampton UK
| | - Didier Carrie
- Department of Cardiology, Rangueil hospital Paul Sabatier University Toulouse 3 Toulouse France
| | | | - Clemens Steinwender
- Department of Cardiology Kepler University Hospital Linz Medical Faculty Johannes Kepler University Linz Linz Austria
| | - Gregor Leibundgut
- Department of Cardiology Kantonsspital Baselland, Standort Liestal Liestal Switzerland
| | | | - Christian Hamm
- Kerckhoff Heart Center Campus University of Giessen Bad Nauheim Germany
| | - Peter Jüni
- Université Paris‐Diderot, Hôpital Bichat Assistance Publique–Hôpitaux de Paris, INSERM U‐1148, FACT (French Alliance for Cardiovascular Trials) Paris France
| | - Pascal Vranckx
- Jessa Ziekenhuis Faculty of Medicine and Life Sciences at the Hasselt University Hasselt Belgium
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Inselspital University of Bern Bern Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital University of Bern Bern Switzerland
| | - Robbert J. Winter
- Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam Amsterdam Netherlands
| | - Faisal Sharif
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
| | - Yoshinobu Onuma
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
| | - Patrick W. Serruys
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
- NHLI Imperial College London London UK
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3
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Rivas-Lasarte M, Sans-Roselló J, Collado-Lledó E, González-Fernández V, Noriega FJ, Hernández-Pérez FJ, Fernández-Martínez J, Ariza A, Lidón RM, Viana-Tejedor A, Segovia-Cubero J, Harjola VP, Lassus J, Thiele H, Sionis A. External validation and comparison of the CardShock and IABP-SHOCK II risk scores in real-world cardiogenic shock patients. Eur Heart J Acute Cardiovasc Care 2020; 10:2048872619895230. [PMID: 32004078 DOI: 10.1177/2048872619895230] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/26/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mortality from cardiogenic shock remains high and early recognition and risk stratification are mandatory for optimal patient allocation and to guide treatment strategy. The CardShock and the Intra-Aortic Balloon Counterpulsation in Acute Myocardial Infarction Complicated by Cardiogenic Shock (IABP-SHOCK II) risk scores have shown good results in predicting short-term mortality in cardiogenic shock. However, to date, they have not been compared in a large cohort of ischaemic and non-ischaemic real-world cardiogenic shock patients. METHODS The Red-Shock is a multicentre cohort of non-selected cardiogenic shock patients. We calculated the CardShock and IABP-SHOCK II risk scores in each patient and assessed discrimination and calibration. RESULTS We included 696 patients. The main cause of cardiogenic shock was acute coronary syndrome, occurring in 62% of the patients. Compared with acute coronary syndrome patients, non-acute coronary syndrome patients were younger and had a lower proportion of risk factors but higher rates of renal insufficiency; intra-aortic balloon pump was also less frequently used (31% vs 56%). In contrast, non-acute coronary syndrome patients were more often treated with mechanical circulatory support devices (11% vs 3%, p<0.001 for both). Both risk scores were good predictors of in-hospital mortality in acute coronary syndrome patients and had similar areas under the receiver-operating characteristic curve (area under the curve: 0.742 for the CardShock vs 0.752 for IABP-SHOCK II, p=0.65). Their discrimination performance was only modest when applied to non-acute coronary syndrome patients (0.648 vs 0.619, respectively, p=0.31). Calibration was acceptable for both scores (Hosmer-Lemeshow p=0.22 for the CardShock and 0.68 for IABP-SHOCK II). CONCLUSIONS In our cohort, both the CardShock and the IABP-SHOCK II risk scores were good predictors of in-hospital mortality in acute coronary syndrome-related cardiogenic shock.
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Affiliation(s)
- Mercedes Rivas-Lasarte
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Spain
| | - Jordi Sans-Roselló
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Spain
| | | | | | | | | | - Juan Fernández-Martínez
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Spain
| | - Albert Ariza
- Cardiology Service, Universitari Bellvitge Hospital-IDIBELL, Spain
| | - Rosa-Maria Lidón
- Cardiovascular Critical Care Unit, CIBER-CV Vall d'Hebron Hospital, Spain
| | | | - Javier Segovia-Cubero
- Advanced Heart Failure and Transplant Unit, Hospital Universitario Puerta de Hierro, Spain
| | | | - Johan Lassus
- Heart and Lung Centre, Helsinki University Hospital, Finland
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Spain
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4
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Sionis A, Rivas-Lasarte M, Mebazaa A, Tarvasmäki T, Sans-Roselló J, Tolppanen H, Varpula M, Jurkko R, Banaszewski M, Silva-Cardoso J, Carubelli V, Lindholm MG, Parissis J, Spinar J, Lassus J, Harjola VP, Masip J. Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients: Results From the CardShock Study. J Intensive Care Med 2019; 35:1426-1433. [PMID: 30732522 DOI: 10.1177/0885066619828959] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 12/17/2022]
Abstract
BACKGROUND Cardiogenic shock (CS) is the most life-threatening manifestation of acute heart failure. Its complexity and high in-hospital mortality may justify the need for invasive monitoring with a pulmonary artery catheter (PAC). METHODS Patients with CS included in the CardShock Study, an observational, prospective, multicenter, European registry, were analyzed, aiming to describe the real-world use of PAC, evaluate its impact on 30-day mortality, and the ability of different hemodynamic parameters to predict outcomes. RESULTS Pulmonary artery catheter was used in 82 (37.4%) of the 219 patients. Cardiogenic shock patients who managed with a PAC received more frequently treatment with inotropes and vasopressors, mechanical ventilation, renal replacement therapy, and mechanical assist devices (P < .01). Overall 30-day mortality was 36.5%. Pulmonary artery catheter use did not affect mortality even after propensity score matching analysis (hazard ratio = 1.17 [0.59-2.32], P = .66). Cardiac index, cardiac power index (CPI), and stroke volume index (SVI) showed the highest areas under the curve for 30-day mortality (ranging from 0.752-0.803) and allowed for a significant net reclassification improvement of 0.467 (0.083-1.180), 0.700 (0.185-1.282), 0.683 (0.168-1.141), respectively, when added to the CardShock risk score. CONCLUSIONS In our contemporary cohort of CS, over one-third of patients were managed with a PAC. Pulmonary artery catheter use was associated with a more aggressive treatment strategy. Nevertheless, PAC use was not associated with 30-day mortality. Cardiac index, CPI, and SVI were the strongest 30-day mortality predictors on top of the previously validated CardShock risk score.
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Affiliation(s)
- Alessandro Sionis
- Cardiology Department, Intensive Cardiac Care Unit, 16689Hospital de la Santa Creu i Sant Pau, IIB-SantPau, CIBER-CV, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Mercedes Rivas-Lasarte
- Cardiology Department, Intensive Cardiac Care Unit, 16689Hospital de la Santa Creu i Sant Pau, IIB-SantPau, CIBER-CV, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Alexandre Mebazaa
- INSERM U942, Hopital Lariboisiere, APHP and University Paris Diderot, Paris, France
| | - Tuukka Tarvasmäki
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.,Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Jordi Sans-Roselló
- Cardiology Department, Intensive Cardiac Care Unit, 16689Hospital de la Santa Creu i Sant Pau, IIB-SantPau, CIBER-CV, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Heli Tolppanen
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland.,Heart Center, Päijät-Häme Central Hospital, Lahti, Finland
| | - Marjut Varpula
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Raija Jurkko
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Marek Banaszewski
- Institute of Cardiology, Intensive Cardiac Therapy Clinic, Warsaw, Poland
| | - Jose Silva-Cardoso
- Department of Cardiology, Faculty of Medicine, CINTESIS-Center for Health Technology and Services Research, University of Porto, São João Medical Center, Porto, Portugal
| | - Valentina Carubelli
- Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy
| | - Matias Greve Lindholm
- Division of Heart Failure, Pulmonary Hypertension and Heart Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John Parissis
- Heart Failure Clinic and Secondary Cardiology Department, Attikon University Hospital, Athens, Greece
| | - Jindrich Spinar
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Johan Lassus
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Josep Masip
- Critical Care Department, Hospital Sant Joan Despi Moisès Broggi, Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain
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van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e232-e268. [PMID: 28923988 DOI: 10.1161/cir.0000000000000525] [Citation(s) in RCA: 901] [Impact Index Per Article: 128.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities.
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6
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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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7
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Nguyen HL, Yarzebski J, Lessard D, Gore JM, McManus DD, Goldberg RJ. Ten-Year (2001-2011) Trends in the Incidence Rates and Short-Term Outcomes of Early Versus Late Onset Cardiogenic Shock After Hospitalization for Acute Myocardial Infarction. J Am Heart Assoc 2017; 6:JAHA.117.005566. [PMID: 28592462 PMCID: PMC5669173 DOI: 10.1161/jaha.117.005566] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Cardiogenic shock (CS) is a serious complication of acute myocardial infarction, and the time of onset of CS has a potential role in influencing its prognosis. Limited contemporary data exist on this complication, however, especially from a population‐based perspective. Our study objectives were to describe decade‐long trends in the incidence, in‐hospital mortality, and factors associated with the development of CS in 3 temporal contexts: (1) before hospital arrival for acute myocardial infarction (prehospital CS); (2) within 24 hours of hospitalization (early CS); and (3) ≥24 hours after hospitalization (late CS). Methods and Results The study population consisted of 5782 patients with an acute myocardial infarction who were admitted to all 11 hospitals in central Massachusetts on a biennial basis between 2001 and 2011. The overall proportion of patients who developed CS was 5.2%. The proportion of patients with prehospital CS (1.6%) and late CS (1.5%) remained stable over time, whereas the proportion of patients with early CS declined from 2.2% in 2001–2003 to 1.2% in 2009–2011. In‐hospital mortality for prehospital CS increased from 38.9% in 2001–2003 to 53.6% in 2009–2011, whereas in‐hospital mortality for early and late CS decreased over time (35.9% and 64.7% in 2001–2003 to 15.8% and 39.1% in 2009–2011, respectively). Conclusions Development of prehospital and in‐hospital CS was associated with poor short‐term survival and the in‐hospital death rates among those with prehospital CS increased over time. Interventions focused on preventing or treating prehospital and late CS are needed to improve in‐hospital survival after acute myocardial infarction.
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Affiliation(s)
- Hoa L Nguyen
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Joel M Gore
- Department of Quantitative Sciences, Baylor Scott and White Health, Dallas, TX
| | - David D McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.,Department of Quantitative Sciences, Baylor Scott and White Health, Dallas, TX
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA .,Department of Quantitative Sciences, Baylor Scott and White Health, Dallas, TX
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8
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Lin MJ, Chen CY, Lin HD, Wu HP. Prognostic Analysis for Cardiogenic Shock in Patients with Acute Myocardial Infarction Receiving Percutaneous Coronary Intervention. Biomed Res Int 2017; 2017:8530539. [PMID: 28251160 DOI: 10.1155/2017/8530539] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/04/2017] [Indexed: 11/17/2022]
Abstract
Cardiogenic shock (CS) is uncommon in patients suffering from acute myocardial infarction (AMI). Long-term outcome and adverse predictors for outcomes in AMI patients with CS receiving percutaneous coronary interventions (PCI) are unclear. A total of 482 AMI patients who received PCI were collected, including 53 CS and 429 non-CS. Predictors for AMI patients with CS including recurrent MI, cardiovascular (CV) mortality, all-cause mortality, and repeated-PCI were analyzed. The CS group had a lower central systolic pressure and central diastolic pressure (both P < 0.001). AMI patients with hypertension history were less prone to develop CS (P < 0.001). Calcium channel blockers and statins were less frequently used by the CS group than the non-CS group (both P < 0.05) after discharge. Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, CV mortality, and all-cause mortality were higher in the CS group than the non-CS group (all P < 0.005). For patients with CS, stroke history was a predictor of recurrent MI (P = 0.036). CS, age, SYNTAX score, and diabetes were predictors of CV mortality (all P < 0.05). CS, age, SYNTAX score, and stroke history were predictors for all-cause mortality (all P < 0.05). CS, age, and current smoking were predictors for repeated-PCI (all P < 0.05).
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9
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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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10
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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. EUROINTERVENTION 2015; 10:1024-94. [PMID: 25187201 DOI: 10.4244/eijy14m09_01] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [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: 01/10/2023]
Affiliation(s)
- Stephan Windecker
- Cardiology, Bern University Hospital, Freiburgstrasse 4, CH-3010 Bern, Switzerland
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11
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Siriwardena M, Pilbrow A, Frampton C, Macdonald SM, Wilkins GT, Richards AM. Complications of Intra-Aortic Balloon Pump Use: Does the Final Position of the IABP Tip Matter? Anaesth Intensive Care 2015; 43:66-73. [DOI: 10.1177/0310057x1504300110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report results of a retrospective review of intra-aortic balloon pump (IABP) use in two Australasian centres and evaluate the effect of final IABP tip position on outcome. Indications for counterpulsation, patient demographics and in-hospital outcomes and complications were retrospectively collected. The chest X-ray reports provided the ‘final’ position of the IABP tip. The position was defined as acceptable (tip was seen just below the aortic arch, at T2–T5 vertebrae), malpositioned (tip >5 cm below aortic arch or at T5–T6) or severely malpositioned (tip >10 cm below aortic arch or at T7 or below). Major complications were considered a composite of death secondary to IABP, major limb ischaemia, major IABP malfunction, balloon rupture or haemorrhage, severe renal dysfunction (rise in creatinine >200 μmol/l), stroke and mesenteric ischaemia. Six hundred and forty-five cases were reviewed. The overall major complication rate was 26.2% and 24.3%. Severe renal impairment was the most common complication (16.6%), and second, severe catheter dysfunction (5.4%). Final IABP position was acceptable in 39.9%, malpositioned in 11.1%, severely malpositioned in 6.7% and unavailable for 42.4%. Logistic regression analysis showed IABP tip malposition (compared with satisfactory position odds ratio=3.9 [95% confidence interval=2.0–7.6, P <0.001] and severely malpositioned odds ratio=13.0 [95% confidence interval=5.3–31.7, P <0.001]) were associated with major complications more than the presence of shock (odds ratio=3.8, confidence interval 2.1–6.8 P <0.001). The acceptance of a less than ideal final position was highly predictive of morbidity directly related to IABP device therapy.
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Affiliation(s)
- M. Siriwardena
- Cardiology and Intensive Care, Christchurch School of Medicine, University of Otago, New Zealand
| | - A. Pilbrow
- Christchurch School of Medicine, University of Otago, New Zealand
| | - C. Frampton
- Christchurch School of Medicine, University of Otago, New Zealand
| | - S. M. Macdonald
- Department of Radiology, Christchurch Public Hospital, Christchurch, New Zealand
| | - G. T. Wilkins
- Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand
| | - A. M. Richards
- Department of Cardiology, Christchurch School of Medicine, University of Otago, New Zealand
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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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Brugts JJ, Caliskan K. Short-term mechanical circulatory support by veno-arterial extracorporeal membrane oxygenation in the management of cardiogenic shock and end-stage heart failure. Expert Rev Cardiovasc Ther 2014; 12:145-53. [DOI: 10.1586/14779072.2014.880051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tehrani S, Malik A, Hausenloy DJ. Cardiogenic Shock and the ICU Patient. J Intensive Care Soc 2013. [DOI: 10.1177/175114371301400312] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cardiogenic shock is one of the most important complications of acute myocardial infarction (MI) and acute left ventricular failure (LVF). It threatens the life of 5–10% of patients with ST-segment elevation myocardial infarction (STEMI) particularly in the presence of inappropriately low peripheral vascular resistance. Cardiogenic shock results in poor tissue perfusion, end-organ damage and carries a high mortality risk. The goal of therapy is to prevent end-organ dysfunction and severe metabolic derangement by raising mean arterial blood pressure, which is achieved with the use of inotropes and vasopressors, often at the expense of tachycardia, elevated myocardial oxygen consumption and extended myocardial ischaemia. Current therapeutic approaches include early coronary artery revascularisation (which has significantly improved the survival rate), fluid resuscitation, inotropic support and mechanical circulatory support using intra-aortic balloon pumps or ventricular assist devices. In this article, we review the pathophysiology, diagnosis and management of cardiogenic shock.
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Affiliation(s)
- Shana Tehrani
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Medicine, University College London
| | - Abdul Malik
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Medicine, University College London
| | - Derek J Hausenloy
- Reader in Cardiovascular Medicine
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Medicine, University College London
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Affiliation(s)
- Ian Jones
- Cardiac Nursing, School of Nursing, Midwifery and Social Work, and
| | - Melanie Rushton
- School of Nursing, Midwifery and Social Work University of Salford
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Ramanathan K, Farkouh ME, Cosmi JE, French JK, Harkness SM, Džavík V, Sleeper LA, Hochman JS. Rapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction. Am Heart J 2011; 162:268-75. [PMID: 21835287 DOI: 10.1016/j.ahj.2011.04.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 04/06/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND In patients with cardiogenic shock (CS) complicating an acute myocardial infarction, a strategy of early revascularization (ERV) versus initial medical stabilization (IMS) improves survival. Intra-aortic balloon counterpulsation (IABC) provides hemodynamic support and facilitates coronary angiography and revascularization in CS patients. METHODS AND RESULTS We evaluated 499 patients with record of systemic hypoperfusion status as an early response to IABC from the SHOCK trial (n = 185) and registry (n = 314) to determine the association between rapid complete reversal of systemic hypoperfusion (CRH) after 30 minutes of IABC and in-hospital, 30-day and 1-year mortality. Rapid complete reversal of systemic hypoperfusion was highly associated with lower in-hospital mortality (29% versus 65%, P < .001) in all patients. In the SHOCK trial, among patients assigned to ERV versus IMS, 30-day mortality was 26% versus 29%, respectively, with CRH and 61% versus 81%, respectively, without CRH after commencing IABC. The corresponding 1-year mortality rates were 35% versus 52% for ERV and 69% versus 87% for IMS (interaction P ≥ .25 at both time points). After adjusting for important correlates of outcome (left ventricular ejection fraction, age, and randomization to ERV), a significant association remained between CRH and registry and trial in-hospital mortality (odds ratio 0.23, 95% CI 0.14-0.39, P < .001) and trial 1-year mortality (odds ratio .28, 95% CI 0.12-0.67, P < .001). CONCLUSIONS In CS patients, CRH after commencing IABC was independently associated with improved in-hospital, 30-day and 1-year survival regardless of early revascularization. In CS patients, CRH with IABC is an important early prognostic feature.
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Tsagalou EP, Anastasiou-Nana MI, Nanas JN. Intra-aortic balloon counterpulsation for the treatment of myocardial infarction complicated by acute severe heart failure. ACTA ACUST UNITED AC 2010; 15:35-40. [PMID: 19187406 DOI: 10.1111/j.1751-7133.2008.00033.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Intractable heart failure (HF) remains a leading fatal complication of acute myocardial infarction (AMI). Intra-aortic balloon pump (IABP) counterpulsation assists the failing left ventricle and accelerates the functional recovery of stunned myocardium. Despite its remarkable performance, the beneficial effects of the IABP in the setting of acute HF or cardiogenic shock complicating AMI have not been confirmed in a randomized clinical trial. Instead, large amounts of information have been collected in observational studies or in retrospective analyses of randomized trials of reperfusion strategies in patients with AMI. The strategy of "stabilize with IABP, treat with reperfusion, and transfer for complete revascularization" has, thus far, yielded the best outcomes, and every effort should be made to implement this strategy in all patients presenting with AMI and severe HF.
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Affiliation(s)
- Eleftheria P Tsagalou
- Department of 3rd Cardiology, University of Athens School of Medicine, Makedonias, Athens, Greece
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Chang SN, Hwang JJ, Chen YS, Lin JW, Chiang FT. Clinical experience with intra-aortic balloon counterpulsation over 10 years: A retrospective cohort study of 459 patients. Resuscitation 2008; 77:316-24. [DOI: 10.1016/j.resuscitation.2008.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 12/12/2007] [Accepted: 01/06/2008] [Indexed: 10/22/2022]
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Jeger RV, Lowe AM, Buller CE, Pfisterer ME, Dzavik V, Webb JG, Hochman JS, Jorde UP. Hemodynamic Parameters Are Prognostically Important in Cardiogenic Shock But Similar Following Early Revascularization or Initial Medical Stabilization. Chest 2007; 132:1794-803. [DOI: 10.1378/chest.07-1336] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
Cardiogenic shock (CS) in acute myocardial infarction, after successful coronary angioplasty, still carries a case fatality rate of 50%. These patients succumb to a systemic metabolic storm, superimposed on extensive myocardial necrosis and stunning. Nitric oxide (NO) overproduction contributes to the pathophysiology of this morbid state. Current data regarding the physiologic effects of NO and nitric oxide synthase (NOS) inhibitors on the cardiovascular system are reviewed. Clinical trials assessing the safety and efficacy of NOS inhibitors in CS are summarized.
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Affiliation(s)
- Edo Kaluski
- Department of Cardiology, Assaf Harofeh Medical Center, Zrifin, Israel.
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Burkhoff D, Cohen H, Brunckhorst C, O'Neill WW. A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J 2006; 152:469.e1-8. [PMID: 16923414 DOI: 10.1016/j.ahj.2006.05.031] [Citation(s) in RCA: 396] [Impact Index Per Article: 22.0] [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] [Received: 09/29/2005] [Accepted: 05/02/2006] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM Despite major advances in the treatment of heart failure, cardiogenic shock (CGS) remains associated with substantial mortality. Recent data suggest that the TandemHeart percutaneous ventricular assist device (pVAD) may be useful in the management of CGS. The aim of this prospective randomized study was to test the hypothesis that the TandemHeart (pVAD) provides superior hemodynamic support compared with intraaortic balloon pumping (IABP). METHODS Forty-two patients from 12 centers presenting within 24 hours of developing CGS were included in the study and treated in an initial roll-in phase (n = 9) or randomized to treatment with IABP (n = 14) or TandemHeart pVAD (n = 19). Thirty patients (71%) had persistent CGS despite having an IABP in place at the time of study enrollment. RESULTS Cardiogenic shock was due to myocardial infarction in 70% of the patients and decompensated heart failure in most of the remaining patients. The mean duration of support was 2.5 days. Compared with IABP, the TandemHeart pVAD achieved significantly greater increases in cardiac index and mean arterial blood pressure and significantly greater decreases in pulmonary capillary wedge pressure. Overall 30-day survival and severe adverse events were not significantly different between the 2 groups. CONCLUSION In patients presenting within 24 hours of the development of CGS, TandemHeart significantly improves hemodynamic parameters, even in patients failing IABP. Larger-scale studies are required to assess the influence of improved hemodynamics on survival.
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Burkhoff D, O'Neill W, Brunckhorst C, Letts D, Lasorda D, Cohen HA. Feasibility study of the use of the TandemHeart® percutaneous ventricular assist device for treatment of cardiogenic shock. Catheter Cardiovasc Interv 2006; 68:211-7. [PMID: 16819767 DOI: 10.1002/ccd.20796] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [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
BACKGROUND The mortality of cardiogenic shock (CGS) remains high despite currently available pharmacological and mechanical treatment options. The standard of care in medically refractory situations has been the insertion of an intra-aortic balloon pump. The purpose of this study was to investigate the feasibility, safety, and hemodynamic impact of the TandemHeart percutaneous left ventricular assist device (pVAD) in CGS. METHODS Thirteen patients from five centers in the US with the diagnosis of CGS were enrolled in the study. Hemodynamic measurements, including cardiac index (CI), mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), and central venous pressure (CVP) were performed presupport, during support and after device removal. Patients were monitored for 6 months. RESULTS The pVAD was successfully implanted in all 13 patients, with duration of support averaging 60 +/- 44 hr. During support, CI increased from 2.09 +/- 0.64 at baseline to 2.53 +/- 0.65 (P = 0.02), MAP increased from 70.6 +/- 11.1 to 81.7 +/- 14.6 (P = 0.01), PCWP decreased from 27.2 +/- 12.2 to 16.5 +/- 4.8 (P = 0.01), and CVP from 12.9 +/- 3.7 to 12.6 +/- 3.6 (P = NS). Ten patients survived to device explant, 6 of whom were bridged to another therapy. Seven patients survived to hospital discharge and were all alive at 6 months. The two most common adverse events were distal leg ischemia (n = 3) and bleeding from the cannulation site (n = 4). CONCLUSION The TandemHeart PTVA System may be a useful complementary treatment for patients with CGS, especially as a bridge to another treatment. Further study is needed to definitively establish safety and efficacy.
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Abstract
Cardiogenic shock, a devastating consequence of acute myocardial infarction, is associated with extremely high mortality. Treatment strategies should focus on prompt reperfusion and hemodynamic support. The primary approach for therapy is emergent angiography and revascularization using percutaneous coronary intervention or coronary artery bypass surgery, with the assistance of intra-aortic balloon pump counterpulsation. Several adjunctive pharmacologic agents, particularly inotropic drugs and vasopressors, are also helpful for hemodynamic support. However, these agents have not been shown to provide a survival benefit, and their use is primarily based on clinical experience. Since our last publication, several important advances have been made in the understanding and treatment of cardiogenic shock. Recent evidence suggests that a systemic inflammatory response, including the upregulation of inducible nitric oxide synthase, complement activation, and an inflammatory cytokine cascade, play a role in the development of cardiogenic shock. Newer therapeutic strategies, including C5 inhibitors and nitric oxide synthase inhibitors, are being combined with traditional strategies, such as inotropic agents, vasopressors, and circulatory assist, to treat cardiogenic shock.
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Affiliation(s)
- Troy C Ellis
- Department of Cardiology, Methodist Debakey Heart Center, 6565 Fannin, F1090, Houston, TX 77030, USA
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Fincke R, Hochman JS, Lowe AM, Menon V, Slater JN, Webb JG, LeJemtel TH, Cotter G. Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: A report from the SHOCK trial registry. J Am Coll Cardiol 2004; 44:340-8. [PMID: 15261929 DOI: 10.1016/j.jacc.2004.03.060] [Citation(s) in RCA: 382] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2003] [Revised: 03/08/2004] [Accepted: 03/16/2004] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We sought to analyze clinical, angiographic, and outcome correlates of hemodynamic parameters in cardiogenic shock. BACKGROUND The significance of right heart catheterization in critically ill patients is controversial, despite the prognostic importance of the derived measurements. Cardiac power is a novel hemodynamic parameter. METHODS A total of 541 patients with cardiogenic shock who were enrolled in the SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK (SHOCK) trial registry were included. Cardiac power output (CPO) (W) was calculated as mean arterial pressure x cardiac output/451. RESULTS On univariate analysis, CPO, cardiac power index (CPI), cardiac output, cardiac index, stroke volume, left ventricular work, left ventricular work index, stroke work, mean arterial pressure, systolic and diastolic blood pressure (all p < 0.001), coronary perfusion pressure (p = 0.002), ejection fraction (p = 0.013), and pulmonary artery systolic pressure (p = 0.047) were associated with in-hospital mortality. In separate multivariate analyses, CPO (odds ratio per 0.20 W: 0.60 [95% confidence interval, 0.44 to 0.83], p = 0.002; n = 181) and CPI (odds ratio per 0.10 W/m(2): 0.65 [95% confidence interval, 0.48 to 0.87], p = 0.004; n = 178) remained the strongest independent hemodynamic correlates of in-hospital mortality after adjusting for age and history of hypertension. There was an inverse correlation between CPI and age (correlation coefficient: -0.334, p < 0.001). Women had a lower CPI than men (0.29 +/- 0.11 vs. 0.35 +/- 0.15 W/m(2), p = 0.005). After adjusting for age, female gender remained associated with CPI (p = 0.032). CONCLUSIONS Cardiac power is the strongest independent hemodynamic correlate of in-hospital mortality in patients with cardiogenic shock. Increasing age and female gender are independently associated with lower cardiac power.
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Affiliation(s)
- Rupert Fincke
- New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York, USA
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Yazbek NF, Kleiman NS. Therapeutic Strategies for Cardiogenic Shock. Curr Treat Options Cardiovasc Med 2004; 6:29-41. [PMID: 15023282 DOI: 10.1007/s11936-004-0012-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiogenic shock is a devastating consequence of acute myocardial infarction; it is associated with an extremely high mortality. Treatment strategies should be focused on prompt reperfusion, as well as hemodynamic support. The optimal approach for therapy is emergent angiography and revascularization using percutaneous coronary intervention or coronary artery bypass surgery, with the assistance of intra-aortic balloon pump counterpulsation. Several adjunctive pharmacologic agents, particularly inotropic drugs and vasopressors, are also helpful for hemodynamic support. However, these agents have not been shown to provide a survival benefit, and their use is primarily based on clinical experience.
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Affiliation(s)
- Naji F. Yazbek
- Section of Cardiology, Baylor College of Medicine, Methodist Debakey Heart Center, 6565 Fannin Boulevard, F1090, Houston, TX 77030, USA.
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Ho TC, Ting CT, Liu TJ, Liang KW, Ho HY, Hsueh CW, Wang KY, Lin WW, Lee WL. Percutaneous coronary revascularization improves the prognosis of patients with cardiogenic shock in acute coronary syndrome: a chronological study. Int J Cardiol 2003; 89:135-43. [PMID: 12767535 DOI: 10.1016/s0167-5273(02)00432-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 10/27/2022]
Abstract
BACKGROUND Cardiogenic shock complicating acute coronary syndrome (ACS) implies grim prognosis with conventional management. Previous studies of coronary intervention yielded controversial results and were rarely analyzed chronologically. This study was to determine the impact of percutaneous coronary revascularization on outcome by studying two time periods 5 years apart in which the revascularization was more frequent and techniques more refined in the later period. METHODS AND MATERIALS All patients admitted to the intensive or coronary care unit for ACS in two 1.5-year study periods (Period I: Jan 1994-Jun 1995, Period II: Oct 1999-Apr 2000) were retrospectively screened. Patients who met strict criteria of cardiogenic shock within 24 h of ACS were enrolled. The demographics, management and in-hospital/3-month outcomes were analyzed. RESULTS Thirty-seven patients (33M/4F, aged 65+/-8 years) were enrolled in Period I and 32 patients (25M/7F, aged 68+/-13 years) in Period II. The incidence of cardiogenic shock was 11.8 and 9.3%, respectively. The demographics were similar except patients in Period II were older. Significantly more coronary angiography and interventions were done in the later period. The in-hospital (68 vs. 44%, P=0.047) and 3-month mortalities (70 vs. 44%, P=0.03) were significantly reduced in Period II. The in-hospital survivors in two study periods differed only in use of coronary angiography (94 vs. 50%, P=0.005) and interventions (83 vs. 33%, P=0.005) but not others. CONCLUSIONS Percutaneous coronary revascularization does improve the clinical outcome of cardiogenic shock when analyzed chronologically. This treatment is warranted in every such patient in the interventional era.
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Affiliation(s)
- Tung-Ching Ho
- Division of Cardiology, Department of Medicine, Taichung Veterans General Hospital, 160, Sector 3, Chung-Kang Road, 407, Taichung, Taiwan
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Affiliation(s)
- Venu Menon
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA
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Koreny M, Karth GD, Geppert A, Neunteufl T, Priglinger U, Heinz G, Siostrzonek P. Prognosis of patients who develop acute renal failure during the first 24 hours of cardiogenic shock after myocardial infarction. Am J Med 2002; 112:115-9. [PMID: 11835949 DOI: 10.1016/s0002-9343(01)01070-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [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: 12/30/2022]
Abstract
PURPOSE Acute renal failure has important prognostic implications in critically ill patients, but the effects of acute renal failure on in-hospital mortality in the subset of patients with cardiogenic shock are not known. SUBJECTS AND METHODS All consecutive patients who presented with acute coronary syndrome at our cardiovascular intensive care unit from 1993 to 2000 and who were in cardiogenic shock were enrolled. Acute renal failure was defined as a urine volume < 20 mL/h associated with an increase in serum creatinine level > or = 0.5 mg/dL or > 50% above the baseline value. RESULTS There were 118 patients (83 men [70%]; mean [+/- SD] age, 66 +/- 10 years), 39 (33%) of whom developed acute renal failure within 24 hours after the onset of shock. In-hospital mortality was 87% (34/39) in patients with acute renal failure and 53% (42/79) in patients without acute renal failure (odds ratio [OR] = 6.0; 95% confidence interval [CI]: 2.1 to 17; P < 0.001). Other significant univariate predictors of mortality included the peak serum lactate level, epinephrine dose, and the maximum serum creatinine level. Multivariate logistic regression analysis identified acute renal failure as the only independent predictor of mortality. CONCLUSION Acute renal failure was common in patients with cardiogenic shock and strongly associated with in-hospital mortality.
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Affiliation(s)
- Maria Koreny
- Cardiovascular Intensive Care Unit, Department of Cardiology, University of Vienna, Vienna, Austria
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