Impella in Acute Myocardial Infarction Complicated by Cardiogenic Shock: History and Current Controversies

In this review, the authors discuss a brief history of the Impella mechanical circulatory support device, a mechanistic role for the device in the context of the underlying pathophysiology of acute myocardial infarction cardiogenic shock (AMI-CS), the current body of literature evaluating its role in AMI-CS, and upcoming efforts to identify a role more clearly for the device in AMI-CS.

Mortality in STEMI Patients With Cardiogenic Shock: Results From a Nationwide PCI Registry and Focus on Left Main PCI

BACKGROUND

The study aims to assess real-life short- and long-term outcomes of patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) complicated with cardiogenic shock (CS). Outcome after left main (LM) PCI is of particular interest.

METHODS

Procedural, 30-day, and >30-day mortality rates were assessed in 2744 CS-STEMI patients enrolled between 2012 and 2019 in a nationwide registry involving 49 centers.

RESULTS

Procedural, 30-day, and >30-day mortality rates were 6.9%, 39.8%, and 12.6%, respectively. The mortality rates were significantly higher in the 348 patients (12.7%) who underwent LM-PCI (13.5%, 59.5%, and 18.4%, respectively). LM-PCI, a suboptimal PCI result, and transfemoral access were independent predictors of procedural and 30-day mortality. Operator experience was an independent predictor of procedural mortality, but not 30-day mortality.

CONCLUSIONS

Mortality remains high in CS-STEMI patients, especially within the first month. Patients undergoing LM-PCI are particularly at risk. Operator experience is predictive of procedural mortality.

Basal Takotsubo syndrome induced by pheochromocytoma rupture

Takotsubo syndrome (TTS), characterised by transient left ventricular systolic dysfunction, is divided into five types: (1) apical ballooning, (2) mid-ventricular, (3) basal or inverted, (4) and focal wall-motion patterns, and (5) other types, including biventricular type, isolated right ventricular and global type. The common clinical features of TTS are similar to acute coronary syndrome, which makes them indistinguishable in the early stages. TTS has a wide spectrum of emotional or physical triggers. Pheochromocytoma has been widely recognised as a distinct physical trigger of TTS. Although reports of pheochromocytoma causing TTS are not uncommon, spontaneous rupture of pheochromocytoma causing TTS is extremely rare because of the low incidence of tumour rupture. Here we report on a case of a 31-year-old man with adrenal pheochromocytoma rupture developing basal TTS.