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Frain K, Rees P. Intra-aortic balloon pump versus percutaneous Impella © in emergency revascularisation for myocardial infarction and cardiogenic shock: systematic review. Perfusion 2024; 39:45-59. [PMID: 34479465 DOI: 10.1177/02676591211037026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Mortality rates in patients with acute myocardial infarction and cardiogenic shock (AMI-CS) remain persistently high despite advances over the past decade in percutaneous mechanical circulatory support. This systematic review aims to analyse the existing literature to compare mortality outcomes in patients mechanically supported by intra-aortic balloon pump or percutaneous Impella 2.5/CP© for AMI-CS undergoing emergency revascularisation. METHODS The following MeSH terms were applied to the databases Ovid Medline, Ovid Embase, Cochrane and Web of Science: 'Intra-aortic balloon pump', 'Impella', 'Cardiogenic shock', 'Myocardial Infarction' and 'Mortality'. This yielded 2643 studies. Using predefined inclusion and exclusion criteria, the studies were initially screened by title and abstract before full text analysis. RESULTS Fourteen studies met eligibility criteria: two randomised controlled trials (RCTs) and 12 observational studies. Data from a total of 21,006 patients were included across the studies. Notably, one study claimed reduced mortality with IABP versus control, and one study concluded that Impella© improved survival rates over the IABP. The average 30-day all-cause mortality in patients supported by IABP was 38.1%, 54.3% in Impella© groups and 39.4% in control groups. CONCLUSION AMI-CS presents an important cohort of patients in whom conducting RCTs is difficult. As a result, the literature is limited. Analysis of the available literature suggests that there is insufficient evidence to support superior survival in those supported by IABP or Impella© when compared to control despite suggestions that the Impella© offers superior haemodynamic support. Limitations of the studies have been discussed to outline suggestions for future research.
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Affiliation(s)
- Kristina Frain
- Faculty of Medicine, University of St Andrews, St Andrews, UK
| | - Paul Rees
- Academic Department of Military Medicine, Barts Heart Centre, London, UK
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2
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El Nasasra A, Hochadel M, Zahn R, Schneider A, Thiele H, Darius H, Behrens S, Schumacher B, Ince H, Zeymer U. Outcomes After Left Main Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock (from the German ALKK PCI Registry). Am J Cardiol 2023; 197:77-83. [PMID: 37173201 DOI: 10.1016/j.amjcard.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/05/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023]
Abstract
Early revascularization therapy with percutaneous coronary intervention (PCI) has been shown to improve outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Data from consecutive patients with AMI and CS treated with PCI enrolled into the prospective Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte-PCI registry were centrally collected and analyzed. Patients were divided into 4 groups with PCI for left main (LM), 1-vessel, 2-vessel, and 3-vessel diseases. Patients' characteristics, procedural features, antithrombotic therapies, and in-hospital complications were compared between the 4 groups. Between 2010 and 2015 a total of 2,348 consecutive patients with AMI and CS were treated by PCI in 51 hospitals, 295 for LM (15 for protected, 280 for unprotected) and single-vessel (n = 491), 2-vessel (n = 524), and 3-vessel disease (n = 1,038). Thrombolysis in myocardial infarction 3 patency of the culprit lesion after PCI was 84.3%, 84.0%, 80.8%, and 84.6% in single-vessel, 2-vessel, 3-vessel disease, and LM PCI, respectively, whereas in-hospital mortality was 27.9%, 33.9%, 46.5%, and 55.9%. Bleeding rates were low (2.0%-2.3 %) and not different between groups. In a multivariate analysis a higher age, thrombolysis in myocardial infarction flow <3 after PCI, 3-vessel disease, and LM PCI were independent predictors of mortality. In conclusion, PCI of the LM is performed in about 12.5% of patients with AMI and CS and was associated with a high procedural success rate, whereas mortality is increased with LM PCI.
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Affiliation(s)
- Aref El Nasasra
- Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany; Department of Cardiology, Soroka University Medical Center, Be'er Sheva, Israel.
| | - Mathias Hochadel
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Ralf Zahn
- Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | | | | | - Uwe Zeymer
- Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
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3
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Leon SA, Rosen JL, Ahmad D, Austin MA, Vishnevsky A, Rajapreyar IN, Ruggiero NJ, Rame JE, Entwistle JW, Massey HT, Tchantchaleishvili V. Microaxial circulatory support for percutaneous coronary intervention: A systematic review and meta-analysis. Artif Organs 2023. [PMID: 36691820 DOI: 10.1111/aor.14494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/03/2022] [Accepted: 12/19/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Microaxial circulatory support devices have been used to support patients treated with percutaneous coronary intervention (PCI) for acute myocardial infarction complicated by cardiogenic shock (AMICS). The purpose of this systematic review and meta-analysis was to pool and analyze the existing evidence on the baseline characteristics, periprocedural data, and outcomes of microaxial support before and after PCI in AMICS. METHODS An electronic database search was performed to identify all cohort studies on Impella and PCI for cardiogenic shock in the English language. A total of five articles comprising 543 patients were included. These patients received microaxial support either before (pre-PCI) or after (post-PCI) undergoing PCI. Comparative analyses were done between both groups. RESULTS The mean patient age was 66 years [95% Confidence Interval (58-74)], and 22% (89/396) of patients were female. ST-elevation myocardial infarctions (MI) comprised 64% (44-80) of MIs and 50% (44-56) of MIs involved the left anterior descending artery. The mean number of diseased vessels was 2.21 (1.62-2.80). The mean left ventricular ejection fraction was 31% (23.4-38.6). The mean arterial pressure was 66.3 mm Hg (54.1-78.5). Mean serum lactate [6.1 mmol/L (3.3-8.9)] and serum creatinine [1.4 mg/dl (1.0-1.7)] were similar between groups. 30-day mortality was lower in the pre-PCI group [41% (34%-49%)] compared to the post-PCI group [61% (42%-77%), p < 0.01]. Pooled Kaplan-Meier analysis showed better early survival in the pre-PCI group (p < 0.001). CONCLUSION Patients presenting with AMICS were similar at baseline in both pre-PCI and post-PCI groups. Nevertheless, pre-PCI group showed better early survival compared to post-PCI group.
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Affiliation(s)
- Sophie A Leon
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jake L Rosen
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Danial Ahmad
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Melissa A Austin
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alec Vishnevsky
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Pennsylvania, Philadelphia, USA
| | - Indranee N Rajapreyar
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Pennsylvania, Philadelphia, USA
| | - Nicholas J Ruggiero
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Pennsylvania, Philadelphia, USA
| | - J Eduardo Rame
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Pennsylvania, Philadelphia, USA
| | - John W Entwistle
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Howard T Massey
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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4
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Chahdi HO, Berbach L, Boivin-Proulx LA, Hillani A, Noiseux N, Matteau A, Mansour S, Gobeil F, Nauche B, Jolicoeur EM, Potter BJ. Percutaneous Mechanical Circulatory Support in Post-Myocardial Infarction Cardiogenic Shock: A Systematic Review and Meta-Analysis. Can J Cardiol 2022; 38:1525-1538. [DOI: 10.1016/j.cjca.2022.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 02/01/2023] Open
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5
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Lemor A, Hosseini Dehkordi SH, Alrayes H, Cowger J, Naidu SS, Villablanca PA, Basir MB, O'Neill W. Outcomes, Temporal Trends, and Resource Utilization in Ischemic versus Nonischemic Cardiogenic Shock. Crit Pathw Cardiol 2022; 21:11-17. [PMID: 34907938 DOI: 10.1097/hpc.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cardiogenic shock (CS) is associated with significant morbidity and mortality. Differentiating the etiologic factors driving CS has epidemiological significance and aids in optimization of therapeutic strategies, prognostication, and resource utilization. The aim herein is to investigate the epidemiology and clinical outcomes of CS in those with ischemic and nonischemic CS etiologies. Using International Classification of Diseases codes, we queried the national inpatient sample for CS hospitalization from 2007 to 2018 and divided the study sample into cohorts of ischemic (I-CS) and nonischemic cardiogenic shock (NI-CS). We then compared the primary outcome of in-hospital mortality between these 2 cohorts. Two groups of secondary outcomes (clinical and procedural) were also assessed between the 2 cohorts. CS was present in 557,860 hospitalizations; 84% of these were I-CS and 15.8% NI-CS. Patients with I-CS were older, more commonly males, with more risk factors for coronary artery disease (P < 0.05). NI-CS had higher prevalence of preexisting systolic heart failure and atrial fibrillation. The in-hospital mortality was significantly higher in patients with I-CS (32.2% vs. 29.5%, adjusted odds ratio 1.10, P < 0.001). Frequencies of acute ischemic stroke, mechanical ventilation, ventricular arrhythmias, and vascular complications were higher in I-CS versus NI-CS, while acute kidney injury and acute liver failure were more common in NI-CS (P < 0.05). The use of mechanical circulatory support devices was higher in the I-CS group. In conclusion, patients with I-CS comprise the vast majority of CS and are associated with higher mortality and higher resource utilization. Conversely, patients with NI-CS appear to have higher survival but with a higher prevalence of end-organ dysfunction.
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Affiliation(s)
- Alejandro Lemor
- From the Department of Cardiology, Henry Ford Health System, Detroit, MI
| | | | - Hussayn Alrayes
- From the Department of Cardiology, Henry Ford Health System, Detroit, MI
| | - Jennifer Cowger
- From the Department of Cardiology, Henry Ford Health System, Detroit, MI
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | | | - Mir B Basir
- From the Department of Cardiology, Henry Ford Health System, Detroit, MI
| | - William O'Neill
- From the Department of Cardiology, Henry Ford Health System, Detroit, MI
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6
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Zhang Q, Han Y, Sun S, Zhang C, Liu H, Wang B, Wei S. Mortality in cardiogenic shock patients receiving mechanical circulatory support: a network meta-analysis. BMC Cardiovasc Disord 2022; 22:48. [PMID: 35152887 PMCID: PMC8842943 DOI: 10.1186/s12872-022-02493-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Mechanical circulatory support (MCS) devices are widely used for cardiogenic shock (CS). This network meta-analysis aims to evaluate which MCS strategy offers advantages. Methods A systemic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials was performed. Studies included double-blind, randomized controlled, and observational trials, with 30-day follow-ups. Paired independent researchers conducted the screening, data extraction, quality assessment, and consistency and heterogeneity assessment. Results We included 39 studies (1 report). No significant difference in 30-day mortality was noted between venoarterial extracorporeal membrane oxygenation (VA-ECMO) and VA-ECMO plus Impella, Impella, and medical therapy. According to the surface under the cumulative ranking curve, the optimal ranking of the interventions was surgical venting plus VA-ECMO, medical therapy, VA-ECMO plus Impella, intra-aortic balloon pump (IABP), Impella, Tandem Heart, VA-ECMO, and Impella plus IABP. Regarding in-hospital mortality and 30-day mortality, the forest plot showed low heterogeneity. The results of the node-splitting approach showed that direct and indirect comparisons had a relatively high consistency. Conclusions IABP more effectively reduce the incidence of 30-day mortality compared with VA-ECMO and Impella for the treatment of CS. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02493-0.
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Wongthida T, Lumkul L, Patumanond J, Wongtheptian W, Piyayotai D, Phinyo P. Development of a Clinical Risk Score for Prediction of Life-Threatening Arrhythmia Events in Patients with ST Elevated Acute Coronary Syndrome after Primary Percutaneous Coronary Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041997. [PMID: 35206186 PMCID: PMC8872110 DOI: 10.3390/ijerph19041997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 12/10/2022]
Abstract
ST-elevated acute coronary syndrome (STEACS) is a serious condition requiring timely treatment. Reperfusion with primary percutaneous coronary intervention (pPCI) is recommended and preferred over fibrinolysis. Despite its efficacy, lethal complications, such as life-threatening arrhythmia (LTA), are common in post-PCI patients. Although various risk assessment tools were developed, only a few focus on LTA prediction. This study aimed to develop a risk score to predict LTA events after pPCI. A risk score was developed using a retrospective cohort of consecutive patients with STEACS who underwent pPCI at Chiangrai Prachanukroh Hospital from January 2012 to December 2016. LTA is defined as the occurrence of malignant arrhythmia that requires advanced cardiovascular life support (ACLS) within 72 h after pPCI. Logistic regression was used for model derivation. Among 273 patients, 43 (15.8%) developed LTA events. Seven independent predictors were identified: female sex, hemoglobin < 12 gm/dL, pre- and intra-procedural events (i.e., respiratory failure and pulseless arrest), IABP insertion, intervention duration > 60 min, and desaturation after pPCI. The LTA score showed an AuROC of 0.93 (95%CI 0.90, 0.97). The score was categorized into three risk categories: low (<2.5), moderate (2.5–4), and high risk (>4) for LTA events. The LTA score demonstrated high predictive performance and potential clinical utility for predicting LTA events after pPCI.
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Affiliation(s)
- Thanutorn Wongthida
- Office of Research and Knowledge Management, Chiang Rai Hospital, Chiang Rai 57000, Thailand;
| | - Lalita Lumkul
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.L.); (J.P.)
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.L.); (J.P.)
| | - Wattana Wongtheptian
- Cardiology Unit, Department of Medicine, Chiang Rai Hospital, Chiang Rai 57000, Thailand;
| | - Dilok Piyayotai
- Cardiology Unit, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 10120, Thailand;
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.L.); (J.P.)
- Department of Family Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence:
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Rossini R, Valente S, Colivicchi F, Baldi C, Caldarola P, Chiappetta D, Cipriani M, Ferlini M, Gasparetto N, Gilardi R, Giubilato S, Imazio M, Marini M, Roncon L, Scotto di Uccio F, Somaschini A, Sorini Dini C, Trambaiolo P, Usmiani T, Gulizia MM, Gabrielli D. ANMCO POSITION PAPER: Role of intra-aortic balloon pump in patients with acute advanced heart failure and cardiogenic shock. Eur Heart J Suppl 2021; 23:C204-C220. [PMID: 34456647 PMCID: PMC8387780 DOI: 10.1093/eurheartj/suab074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The treatment of patients with advanced acute heart failure is still challenging. Intra-aortic balloon pump (IABP) has widely been used in the management of patients with cardiogenic shock. However, according to international guidelines, its routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian Association of Hospital Cardiologists, reviews the available data derived from clinical studies. It also provides practical recommendations for the optimal use of IABP in the treatment of cardiogenic shock and advanced acute heart failure.
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Affiliation(s)
- Roberta Rossini
- Division of Cardiology, Emergency Department and Critical Areas, Azienda Ospedaliera Santa Croce e Carle, Via Michele Coppino 26, 12100 Cuneo, Italy
| | - Serafina Valente
- Clinical-Surgical-CCU Cardiology Department, Azienda Ospedaliero-Universitaria Senese Ospedale Santa Maria alle Scotte, Siena, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri-, ASL Roma 1, Roma, Italy
| | - Cesare Baldi
- Interventional Cardiology-Cath Lab Department, Azienda Ospedaliera Universitaria San Giovanni di Dio-Ruggi d'Aragona, Salerno, Italy
| | | | | | - Manlio Cipriani
- Cardiology 2-Heart Failure and Transplants, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Rossella Gilardi
- Department of Cardiac Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Simona Giubilato
- Cardiology-CCU -Cath Lab Department, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | - Massimo Imazio
- Division of Cardiology, Presidio Molinette, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Marini
- Cardiology-CCU -Cath Lab Department, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Loris Roncon
- U.O.C. Cardiologia, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | | | - Alberto Somaschini
- Department of Cardiology and Cardiac Intensive Care Unit, Ospedale San Paolo, Savona, Italy
| | | | - Paolo Trambaiolo
- Cardiology-ICU Department, Presidio Ospedaliero Sandro Pertini, Roma, Italy
| | - Tullio Usmiani
- Division of Cardiology, Presidio Molinette, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania, Italy.,Fondazione per il Tuo cuore-Heart Care Foundation, Firenze, Italy
| | - Domenico Gabrielli
- Cardiology Unit, Cardiotoracovascular Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
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Shi Y, Wang Y, Sun X, Tang Y, Jiang M, Bai Y, Liu S, Jiang W, Yuan H, Lu Y, Cai J. Effects of mechanical circulatory support devices in patients with acute myocardial infarction undergoing stent implantation: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2021; 11:e044072. [PMID: 34187815 PMCID: PMC8245450 DOI: 10.1136/bmjopen-2020-044072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The survival benefit of using mechanical circulatory support (MCS) in patients with acute myocardial infarction (AMI) is still controversial. It is necessary to explore the impact on clinical outcomes of MCS in patients with AMI undergoing stenting. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, Cochrane Library, Medline, PubMed, Web of Science, ClinicalTrials.gov and Clinicaltrialsregister.eu databases were searched from database inception to February 2021. ELIGIBILITY CRITERIA Randomised clinical trials (RCTs) on MCS use in patients with AMI undergoing stent implantation were included. DATA EXTRACTION AND SYNTHESIS Data were extracted and summarised independently by two reviewers. Risk ratios (RRs) and 95% CIs were calculated for clinical outcomes according to random-effects model. RESULTS Twelve studies of 1497 patients with AMI were included, nine studies including 1382 patients compared MCS with non-MCS, and three studies including 115 patients compared percutaneous ventricular assist devices (pVADs) versus intra-aortic balloon pump (IABP). Compared with non-MCS, MCS was not associated with short-term (within 30 days) (RR=0.90; 95% CI 0.57 to 1.41; I2=46.8%) and long-term (at least 6 months) (RR=0.82; 95% CI 0.57 to 1.17; I2=37.6%) mortality reductions. In the subset of patients without cardiogenic shock (CS) compared with non-MCS, the patients with IABP treatment significantly had decreased long-term mortality (RR=0.49; 95% CI 0.27 to 0.90; I2=0), but without the short-term mortality reductions (RR=0.51; 95% CI 0.22 to 1.19; I2=17.9%). While in the patients with CS, the patients with MCS did not benefit from the short-term (RR=1.09; 95% CI 0.67 to 1.79; I2=46.6%) or long-term (RR=1.00; 95% CI 0.75 to 1.33; I2=22.1%) survival. Moreover, the application of pVADs increased risk of bleeding (RR=1.86; 95% CI 1.15 to 3.00; I2=15.3%) compared with IABP treatment (RR=1.86; 95% CI 1.15 to 3.00; I2=15.3%). CONCLUSIONS In all patients with AMI undergoing stent implantation, the MCS use does not reduce all-cause mortality. Patients without CS can benefit from MCS regarding long-term survival, while patients with CS seem not.
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Affiliation(s)
- Yunmin Shi
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yujie Wang
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuejing Sun
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan Tang
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mengqing Jiang
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuanyuan Bai
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Suzhen Liu
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weihong Jiang
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong Yuan
- Clinical Research Center, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yao Lu
- Clinical Research Center, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jingjing Cai
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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10
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Lemor A, Ya'qoub L, Basir MB. Mechanical Circulatory Support in Acute Myocardial Infarction and Cardiogenic Shock. Interv Cardiol Clin 2021; 10:169-184. [PMID: 33745667 DOI: 10.1016/j.iccl.2020.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Mechanical circulatory support devices are increasingly used for the treatment of acute myocardial infarction complicated by cardiogenic shock. These devices provide different levels of univentricular and biventricular support, have different mechanisms of actions, and provide different physiologic effects. Institutions require expert teams to safely implant and manage these devices. This article reviews the mechanism of action, physiologic effects, and data as they relate to the utilization of these devices.
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Affiliation(s)
- Alejandro Lemor
- Henry Ford Health Care System, 2799 West Grand Blvd, K-2 Cath Lab, Detroit, MI 48202, USA
| | - Lina Ya'qoub
- Louisiana State University, One University Place, Shreveport, LA 71115, USA
| | - Mir B Basir
- Henry Ford Health Care System, 2799 West Grand Blvd, K-2 Cath Lab, Detroit, MI 48202, USA; Henry Ford Hospital, 2799 West Grand Boulevard (K-2 Cath Lab), Detroit, MI 48202, USA.
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11
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Zeymer U, Hochadel M, Karcher AK, Thiele H, Darius H, Behrens S, Schumacher B, Ince H, Hoffmeister HM, Werner N, Zahn R. Procedural Success Rates and Mortality in Elderly Patients With Percutaneous Coronary Intervention for Cardiogenic Shock. JACC Cardiovasc Interv 2019; 12:1853-1859. [DOI: 10.1016/j.jcin.2019.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/12/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
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12
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Na SJ, Chung CR, Cho YH, Jeon K, Suh GY, Ahn JH, Carriere KC, Park TK, Lee GY, Lee JM, Song YB, Hahn JY, Choi JH, Choi SH, Gwon HC, Yang JH. La escala de vasoactivos inotrópicos como predictora de mortalidad de adultos con shock cardiogénico tratados con y sin ECMO. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2017.12.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Vasoactive Inotropic Score as a Predictor of Mortality in Adult Patients With Cardiogenic Shock: Medical Therapy Versus ECMO. ACTA ACUST UNITED AC 2018; 72:40-47. [PMID: 29463462 DOI: 10.1016/j.rec.2018.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES This study investigated whether the vasoactive inotropic score (VIS) is independently predictive of mortality in cardiogenic shock (CS). METHODS This study was retrospective, observational study. Patients who were admitted to the cardiac intensive care unit from January 2012 to December 2015 were screened, and 493 CS patients were finally enrolled. To quantify pharmacologic support, the patients were divided into 5 groups based on a quintile of VIS: 1 to 10, 11 to 20, 21 to 38, 39 to 85, and > 85. The primary outcome was in-hospital mortality. RESULTS In-hospital mortalities in the 5 VIS groups in increasing order were 8.2%, 14.1%, 21.1%, 32.0%, and 65.7%, respectively (P < .001). Multivariable analysis indicated that VIS ranges of 39 to 85 (aOR, 3.85; 95%CI, 1.60-9.22; P = .003) and over 85 (aOR, 10.83; 95%CI, 4.43-26.43; P < .001) remained significant prognostic predictors for in-hospital mortality. With multiple logistic regression to remove any confounding effects, we found that the localized regression lines regarding the odds of death intersected each other's (medical therapy alone and combined extracorporeal membrane oxygenation group) path at VIS = 130. In contrast to linear correlation between VIS and mortality for patients treated with medical therapy alone, there was little association between a VIS of 130 or more and the probability of in-hospital mortality for patients who were treated with extracorporeal membrane oxygenation. CONCLUSIONS A high level of vasoactive inotropic support during the first 48hours was significantly associated with increased in-hospital mortality in adult CS patients.
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Clinical outcomes of patients undergoing primary percutaneous coronary intervention for acute myocardial infarction requiring the intensive care unit. J Intensive Care 2018; 6:5. [PMID: 29416868 PMCID: PMC5784703 DOI: 10.1186/s40560-018-0275-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/18/2018] [Indexed: 01/09/2023] Open
Abstract
Background Outcomes for patients with ST-segment elevation myocardial infarction continue to improve, largely due to timely provision of reperfusion by primary percutaneous coronary intervention (PPCI). However, despite prompt and successful PPCI, a small proportion of patients require ventilatory and hemodynamic support in an intensive care unit (ICU). The outcome of these patients remains poorly defined. Methods A retrospective review of all consecutive admissions post-PPCI pathway to a single ICU between January 2009 and May 2014 was performed. Patients were analysed based on survival and indication for admission. Preadmission characteristics and ICU course were reviewed. Univariate and multivariable regression analysis was performed to determine predictors of outcome. Results During the study period 2902 PPCI were performed and 101 patients were admitted to ICU following PPCI (incidence 3.5%). ICU mortality post-PPCI was 33.7%. Pre-ICU admission factors in a multivariable logistic regression analysis associated with increased mortality included requirement for an intra-aortic balloon pump and a high SOFA score. Conclusions ICU admission post PPCI is associated with significant mortality. Mortality was related to high presenting SOFA score and need for IABP. These results provide important prognostic information and an acceptable method for risk-stratifying patients with acute myocardial infarction requiring intensive care.
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Abstract
Cardiogenic shock is an acute emergency, which is classically managed by medical support with inotropes or vasopressors and frequently requires invasive ventilation. However, both catecholamines and ventilation are associated with a worse prognosis, and many patients deteriorate despite all efforts. Mechanical circulatory support is increasingly considered to allow for recovery or to bridge until making a decision or definite treatment. Of all devices, extracorporeal membrane oxygenation (ECMO) is the most widely used. Here we review features and strategical considerations for the use of ECMO in cardiogenic shock and cardiac arrest.
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den Uil CA, Akin S, Jewbali LS, dos Reis Miranda D, Brugts JJ, Constantinescu AA, Kappetein AP, Caliskan K. Short-term mechanical circulatory support as a bridge to durable left ventricular assist device implantation in refractory cardiogenic shock: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2017; 52:14-25. [DOI: 10.1093/ejcts/ezx088] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Impact of a cardiac intensivist on mortality in patients with cardiogenic shock. Int J Cardiol 2017; 244:220-225. [PMID: 28666601 DOI: 10.1016/j.ijcard.2017.06.082] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [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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Timóteo AT, Nogueira MA, Rosa SA, Belo A, Ferreira RC. Role of intra-aortic balloon pump counterpulsation in the treatment of acute myocardial infarction complicated by cardiogenic shock: Evidence from the Portuguese nationwide registry. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:23-31. [DOI: 10.1177/2048872615606600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ana T Timóteo
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Marta A Nogueira
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Silva A Rosa
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Adriana Belo
- National Centre for Data Collection in Cardiology, Portuguese Society of Cardiology, Coimbra, Portugal
| | - Rui C Ferreira
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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de la Espriella-Juan R, Valls-Serral A, Trejo-Velasco B, Berenguer-Jofresa A, Fabregat-Andrés Ó, Perdomo-Londoño D, Albiach-Montañana C, Vilar-Herrero JV, Sanmiguel-Cervera D, Rumiz-Gonzalez E, Morell-Cabedo S. Impact of intra-aortic balloon pump on short-term clinical outcomes in ST-elevation myocardial infarction complicated by cardiogenic shock: A "real life" single center experience. Med Intensiva 2016; 41:86-93. [PMID: 27650459 DOI: 10.1016/j.medin.2016.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/07/2016] [Accepted: 06/17/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To analyze the use and impact of the intra-aortic balloon pump (IABP) upon the 30-day mortality rate and short-term clinical outcome of non-selected patients with ST-elevation acute myocardial infarction (acute STEMI) complicated by cardiogenic shock (CS). DESIGN A single-center retrospective case-control study was carried out. SETTING Coronary Care Unit. PATIENTS Data were collected from 825 consecutive patients with acute STEMI admitted to a Coronary Care Unit from January 2009 to August 2015. Seventy-three patients with CS upon admission subjected to emergency percutaneous coronary intervention (PCI) were finally included in the analysis and were stratified according to IABP use (44 patients receiving IABP). VARIABLES Cardiovascular history, hemodynamic situation upon admission, angiographic and procedural characteristics, and variables derived from admission to the Coronary Care Unit. RESULTS Cumulative 30-day mortality was similar in the patients subjected to IABP and in those who received conventional medical therapy only (29.5% and 27.6%, respectively; HR with IABP 1.10, 95% CI 0.38-3.11; p=0.85). Similarly, no significant differences were found in terms of the short-term clinical outcome between the groups: time on mechanical ventilation, days to hemodynamic stabilization, vasoactive drug requirements and stay in the Coronary Care Unit. Poorer renal function (HR 3.9, 95% CI 1.4-10.6; p=0.008), known peripheral artery disease (HR 3.3, 95% CI 1.2-9.1; p=0.019) and a history of diabetes mellitus (HR 3.2, 95% CI 1.2-8.1; p=0.018) were the only variables independently associated to increased 30-day mortality. CONCLUSION In our "real life" experience, IABP does not modify 30-day mortality or the short-term clinical outcome in patients presenting STEMI complicated with CS and subjected to emergency percutaneous coronary revascularization.
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Affiliation(s)
- R de la Espriella-Juan
- Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - A Valls-Serral
- Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - B Trejo-Velasco
- Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Berenguer-Jofresa
- Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Ó Fabregat-Andrés
- Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - D Perdomo-Londoño
- Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - C Albiach-Montañana
- Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - J V Vilar-Herrero
- Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - D Sanmiguel-Cervera
- Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - E Rumiz-Gonzalez
- Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - S Morell-Cabedo
- Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Interêt du ballon de contre-pulsion intra-aortique dans le choc cardiogénique. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1181-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Intra-Aortic Balloon Pump Counterpulsation during Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction and Cardiogenic Shock: Insights from the British Columbia Cardiac Registry. PLoS One 2016; 11:e0148931. [PMID: 26870950 PMCID: PMC4752444 DOI: 10.1371/journal.pone.0148931] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/18/2016] [Indexed: 12/05/2022] Open
Abstract
Background Cardiogenic shock complicating ST-elevation myocardial infarction (STEMI) is associated with significant morbidity and mortality. In the primary percutaneous coronary intervention (PPCI) era, randomized trials have not shown a survival benefit with intra-aortic balloon pump (IABP) therapy. This differs to observational data which show a detrimental effect, potentially reflecting bias and confounding. Without robust and valid risk adjustment, findings from non-randomized studies may remain biased. Methods We compared long-term mortality following IABP therapy in patients with cardiogenic shock undergoing PPCI during 2008–2013 from the British Columbia Cardiac Registry. We addressed measured and unmeasured confounding using propensity score and instrumental variable methods. Results A total of 12,105 patients with STEMI were treated with PPCI during the study period. Of these, 700 patients (5.8%) had cardiogenic shock. Of the patients with cardiogenic shock, 255 patients (36%) received IABP therapy. Multivariable analyses identified IABP therapy to be associated with increased mortality up to 3 years (HR = 1.67, 95% CI:1.20–2.67, p<0.001). This association was lost in propensity-matched analyses (HR = 1.23, 95% CI: 0.84–1.80, p = 0.288). When addressing measured and unmeasured confounders, instrumental variable analyses demonstrated that IABP therapy was not associated with mortality at 3 years (Δ = 16.7%, 95% CI: -12.7%, 46.1%, p = 0.281). Subgroup analyses demonstrated IABP was associated with increased mortality in non-diabetics; patients not undergoing multivessel intervention; patients without renal disease and patients not having received prior thrombolysis. Conclusions In this observational analysis of patients with STEMI and cardiogenic shock, when adjusting for confounding, IABP therapy had a neutral effect with no association with long-term mortality. These findings differ to previously reported observational studies, but are in keeping with randomized trial data.
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Romeo F, Acconcia MC, Sergi D, Romeo A, Francioni S, Chiarotti F, Caretta Q. Percutaneous assist devices in acute myocardial infarction with cardiogenic shock: Review, meta-analysis. World J Cardiol 2016; 8:98-111. [PMID: 26839661 PMCID: PMC4728111 DOI: 10.4330/wjc.v8.i1.98] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/19/2015] [Accepted: 11/11/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the impact of percutaneous cardiac support in cardiogenic shock (CS) complicating acute myocardial infarction (AMI), treated with percutaneous coronary intervention.
METHODS: We selected all of the studies published from January 1st, 1997 to May 15st, 2015 that compared the following percutaneous mechanical support in patients with CS due to AMI undergoing myocardial revascularization: (1) intra-aortic balloon pump (IABP) vs Medical therapy; (2) percutaneous left ventricular assist devices (PLVADs) vs IABP; (3) complete extracorporeal life support with extracorporeal membrane oxygenation (ECMO) plus IABP vs IABP alone; and (4) ECMO plus IABP vs ECMO alone, in patients with AMI and CS undergoing myocardial revascularization. We evaluated the impact of the support devices on primary and secondary endpoints. Primary endpoint was the inhospital mortality due to any cause during the same hospital stay and secondary endpoint late mortality at 6-12 mo of follow-up.
RESULTS: One thousand two hundred and seventy-two studies met the initial screening criteria. After detailed review, only 30 were selected. There were 6 eligible randomized controlled trials and 24 eligible observational studies totaling 15799 patients. We found that the inhospital mortality was: (1) significantly higher with IABP support vs medical therapy (RR = +15%, P = 0.0002); (2) was higher, although not significantly, with PLVADs compared to IABP (RR = +14%, P = 0.21); and (3) significantly lower in patients treated with ECMO plus IABP vs IABP (RR = -44%, P = 0.0008) or ECMO (RR = -20%, P = 0.006) alone. In addition, Trial Sequential Analysis showed that in the comparison of IABP vs medical therapy, the sample size was adequate to demonstrate a significant increase in risk due to IABP.
CONCLUSION: Inhospital mortality was significantly higher with IABP vs medical therapy. PLVADs did not reduce early mortality. ECMO plus IABP significantly reduced inhospital mortality compared to IABP.
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Fan ZG, Gao XF, Chen LW, Li XB, Shao MX, Ji Q, Zhu H, Ren YZ, Chen SL, Tian NL. The outcomes of intra-aortic balloon pump usage in patients with acute myocardial infarction: a comprehensive meta-analysis of 33 clinical trials and 18,889 patients. Patient Prefer Adherence 2016; 10:297-312. [PMID: 27042021 PMCID: PMC4801154 DOI: 10.2147/ppa.s101945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The effects of intra-aortic balloon pump (IABP) usage in patients with acute myocardial infarction remain controversial. This study sought to evaluate the outcomes of IABP usage in these patients. METHODS Medline, EMBASE, and other internet sources were searched for relevant clinical trials. The primary efficacy endpoints (in-hospital, midterm, and long-term mortality) and secondary endpoints (reinfarction, recurrent ischemia, and new heart failure in the hospital) as well as safety endpoints (severe bleeding requiring blood transfusion and stroke in-hospital) were subsequently analyzed. RESULTS Thirty-three clinical trials involving 18,889 patients were identified. The risk of long-term mortality in patients suffering from acute myocardial infarction was significantly decreased following IABP use (odds ratio [OR] 0.66, 95% confidence interval [CI]: 0.48-0.91, P=0.010). Both in-hospital and midterm mortality did not differ significantly between the IABP use group and no IABP use group (in-hospital: OR 0.87, 95% CI: 0.59-1.28, P=0.479; midterm: OR 1.12, 95% CI: 0.53-2.38, P=0.768). IABP insertion was not associated with the risk reduction of reinfarction, recurrent ischemia, or new heart failure. However, IABP use increased the risk of severe bleeding requiring blood transfusion (OR 2.05, 95% CI: 1.29-3.25, P=0.002) and stroke (OR 1.71, 95% CI: 1.04-2.82, P=0.035). In the thrombolytic therapy and cardiogenic shock subgroups, reduced mortality rates following IABP use were observed. CONCLUSION IABP insertion is associated with feasible benefits with respect to long-term survival rates in patients suffering from acute myocardial infarction, particularly those suffering from cardiogenic shock and receiving thrombolytic therapy, but at the cost of higher incidence of severe bleeding and stroke.
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Affiliation(s)
- Zhong-Guo Fan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xiao-Fei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China; Department of Cardiology, Nanjing Heart Center, Nanjing, People's Republic of China
| | - Li-Wen Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xiao-Bo Li
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China; Department of Cardiology, Nanjing Heart Center, Nanjing, People's Republic of China
| | - Ming-Xue Shao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China; Department of Cardiology, Nanjing Heart Center, Nanjing, People's Republic of China
| | - Qian Ji
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Hao Zhu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yi-Zhi Ren
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China; Department of Cardiology, Nanjing Heart Center, Nanjing, People's Republic of China
| | - Nai-Liang Tian
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China; Department of Cardiology, Nanjing Heart Center, Nanjing, People's Republic of China
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Napp LC, Kühn C, Hoeper MM, Vogel-Claussen J, Haverich A, Schäfer A, Bauersachs J. Cannulation strategies for percutaneous extracorporeal membrane oxygenation in adults. Clin Res Cardiol 2015; 105:283-96. [PMID: 26608160 PMCID: PMC4805695 DOI: 10.1007/s00392-015-0941-1] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 11/03/2015] [Indexed: 12/28/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) has revolutionized treatment of severe isolated or combined failure of lung and heart. Due to remarkable technical development the frequency of use is growing fast, with increasing adoption by interventional cardiologists independent of cardiac surgery. Nevertheless, ECMO support harbors substantial risk such as bleeding, thromboembolic events and infection. Percutaneous ECMO circuits usually comprise cannulation of two large vessels ('dual' cannulation), either veno-venous for respiratory and veno-arterial for circulatory support. Recently experienced centers apply more advanced strategies by cannulation of three large vessels ('triple' cannulation), resulting in veno-veno-arterial or veno-arterio-venous cannulation. While the former intends to improve drainage and unloading, the latter represents a very potent method to provide circulatory and respiratory support at the same time. As such triple cannulation expands the field of application at the expense of increased complexity of ECMO systems. Here, we review percutaneous dual and triple cannulation strategies for different clinical scenarios of the critically ill. As there is no unifying terminology to date, we propose a nomenclature which uses "A" and all following letters for supplying cannulas and all letters before "A" for draining cannulas. This general and unequivocal code covers both dual and triple ECMO cannulation strategies (VV, VA, VVA, VAV). Notwithstanding the technical evolution, current knowledge of ECMO support is mainly based on observational experience and mostly retrospective studies. Prospective controlled trials are urgently needed to generate evidence on safety and efficacy of ECMO support in different clinical settings.
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Affiliation(s)
- L Christian Napp
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Christian Kühn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Andreas Schäfer
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Johann Bauersachs
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Jukema JW, Lettino M, Widimský P, Danchin N, Bardaji A, Barrabes JA, Cequier A, Claeys MJ, De Luca L, Dörler J, Erlinge D, Erne P, Goldstein P, Koul SM, Lemesle G, Lüscher TF, Matter CM, Montalescot G, Radovanovic D, Lopez-Sendón J, Tousek P, Weidinger F, Weston CF, Zaman A, Zeymer U. Contemporary registries on P2Y12 inhibitors in patients with acute coronary syndromes in Europe: overview and methodological considerations: Table 1. EUROPEAN HEART JOURNAL - CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:232-244. [DOI: 10.1093/ehjcvp/pvv024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Kunadian V, Qiu W, Ludman P, Redwood S, Curzen N, Stables R, Gunn J, Gershlick A. Outcomes in patients with cardiogenic shock following percutaneous coronary intervention in the contemporary era: an analysis from the BCIS database (British Cardiovascular Intervention Society). JACC Cardiovasc Interv 2015; 7:1374-85. [PMID: 25523531 DOI: 10.1016/j.jcin.2014.06.017] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/30/2014] [Accepted: 06/08/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study sought to determine mortality rates among cardiogenic shock (CGS) patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome in the contemporary treatment era and to determine predictors of mortality. BACKGROUND It is unclear whether recent advances in pharmacological and interventional strategies have resulted in further improvements in short- and long-term mortality and which factors are associated with adverse outcomes in patients presenting with CGS and undergoing PCI in the setting of acute coronary syndrome. METHODS This study analyzed prospectively collected data for patients undergoing PCI in the setting of CGS as recorded in the BCIS (British Cardiovascular Intervention Society) PCI database. RESULTS In England and Wales, 6,489 patients underwent PCI for acute coronary syndrome in the setting of CGS. The mortality rates at 30 days, 90 days, and 1 year were 37.3%, 40.0%, and 44.3%, respectively. On multiple logistic regression analysis, age (for each 10-year increment of age: odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.51 to 1.68; p < 0.0001), diabetes mellitus (OR: 1.47, 95% CI: 1.28 to 1.70; p < 0.0001), history of renal disease (OR: 2.03, 95% CI: 1.63 to 2.53; p < 0.0001), need for artificial mechanical ventilation (OR: 2.56, 95% CI: 2.23 to 2.94; p < 0.0001), intra-aortic balloon pump use (OR: 1.57, 95% CI: 1.40 to 1.76; p < 0.0001), and need for left main stem PCI (OR: 1.90, 95% CI: 1.62 to 2.23; p < 0.0001) were associated with higher mortality at 1 year. CONCLUSIONS In this large U.K. cohort of patients undergoing PCI in the context of CGS, mortality remains high in spite of the use of contemporary PCI strategies. The highest mortality occurs early, and this time period may be a particular target of therapeutic intervention.
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Affiliation(s)
- Vijay Kunadian
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, United Kingdom; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals, National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Weiliang Qiu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Peter Ludman
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Simon Redwood
- Cardiothoracic Centre, St. Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Nick Curzen
- University Hospital Southampton, National Health Service Foundation Trust, University of Southampton, Southampton, United Kingdom; Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Rodney Stables
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Julian Gunn
- Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom
| | - Anthony Gershlick
- National Institute for Health Research, Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester Trust, Leicester Department of Cardiology, University Hospitals of Leicester, Glenfield Hospital, Leicester, United Kingdom
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Jung C, Janssen K, Kaluza M, Fuernau G, Poerner TC, Fritzenwanger M, Pfeifer R, Thiele H, Figulla HR. Outcome predictors in cardiopulmonary resuscitation facilitated by extracorporeal membrane oxygenation. Clin Res Cardiol 2015; 105:196-205. [PMID: 26303097 DOI: 10.1007/s00392-015-0906-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cardiac arrest is the major cause of sudden death in developed countries. Extracorporeal cardiopulmonary resuscitation (ECPR) employs extracorporeal membrane oxygenation (ECMO) in patients without return of spontaneous circulation (ROSC) by conventional cardiopulmonary resuscitation (CPR). Aim of the current study was to assess short- and long-term outcome in patients treated with ECPR in our tertiary center and to identify predictors of outcome. METHODS We retrospectively collected data of all patients treated with ECPR at our institution from 2002 to 2013. Outcome was assessed according to patient records; good neurological outcome was defined as cerebral performance category 1 or 2. Quality of life data was collected using EQ-5 questionnaire. Uni- and multivariate analysis was applied to identify predictors of outcome. RESULTS One-hundred and seventeen patients were included into the study. Weaning from ECMO was successful in 61 (52 %) patients. Thirty-day survival endpoint was achieved by 27 (23 %) patients. Good neurological outcome was present in 17 (15 %) patients. Multivariate analysis revealed baseline serum lactate as the strongest predictor of outcome, whereas age and out-of-hospital CPR did not predict outcome. The optimal lactate cut-off to discriminate outcome was determined at 4.6 mmol/l [HR 3.55 (2.29-5.49), p < 0.001, log-rank test]. CONCLUSION ECPR represents a treatment option in patients without ROSC after conventional CPR rescuing 15 % of patients with good neurological outcome. Serum lactate may play a crucial role in patient selection for ECPR.
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Affiliation(s)
- Christian Jung
- Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany.
| | - Kyra Janssen
- Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany.
| | - Mirko Kaluza
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
| | - Georg Fuernau
- Clinic for Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, University Heart Center Luebeck, Lübeck, Germany.
| | - Tudor Constantin Poerner
- Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany.
| | - Michael Fritzenwanger
- Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany.
| | - Ruediger Pfeifer
- Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany.
| | - Holger Thiele
- Clinic for Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, University Heart Center Luebeck, Lübeck, Germany.
| | - Hans Reiner Figulla
- Clinic of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, 0774, Jena, Germany.
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Ahmad Y, Sen S, Shun-Shin MJ, Ouyang J, Finegold JA, Al-Lamee RK, Davies JER, Cole GD, Francis DP. Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction: A Meta-analysis. JAMA Intern Med 2015; 175:931-939. [PMID: 25822657 DOI: 10.1001/jamainternmed.2015.0569] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Intra-aortic balloon pump (IABP) therapy is a widely used intervention for acute myocardial infarction with cardiogenic shock. Guidelines, which previously strongly recommended it, have recently undergone substantial change. OBJECTIVE To assess IABP efficacy in acute myocardial infarction. DATA SOURCES Human studies found in Pubmed, Embase, and Cochrane libraries through December 2014 and in reference lists of selected articles. Search strings were "myocardial infarction" or "acute coronary syndrome" and "intra-aortic balloon pump" or "counterpulsation." STUDY SELECTION Randomized clinical trials (RCTs) and observational studies comparing use of IABP with no IABP in patients with acute myocardial infarction. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted the data, and risk of bias in RCTs was assessed using the Cochrane risk of bias tool. We conducted separate meta-analyses of the RCTs and observational studies. Data were quantitatively synthesized using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES Thirty-day mortality. RESULTS There were 12 eligible RCTs randomizing 2123 patients. In the RCTs, IABP use had no statistically significant effect on mortality (odds ratio [OR], 0.96 [95% CI, 0.74-1.24]), with no significant heterogeneity among trials (I2 = 0%; P = .52). This result was consistent when studies were stratified by the presence (OR, 0.94 [95% CI, 0.69-1.28]; P = .69, I2 = 0%) or absence (OR, 0.98 [95% CI, 0.57-1.69]; P = .95, I2 = 17%) of cardiogenic shock. There were 15 eligible observational studies totaling 15 530 patients. Their results were mutually conflicting (heterogeneity I2 = 97%; P < .001), causing wide uncertainty in the summary estimate for the association with mortality (OR, 0.96 [95% CI, 0.54-1.70]). A simple index of baseline risk marker imbalance in the observational studies appeared to explain much of the heterogeneity in the observational data (R2meta = 46.2%; P < .001). CONCLUSIONS AND RELEVANCE Use of IABP was not found to improve mortality among patients with acute myocardial infarction in the RCTs, regardless of whether patients had cardiogenic shock. The observational studies showed a variety of mutually contradictory associations between IABP therapy and mortality, much of which was explained by the differences between studies in the balance of risk factors between IABP and non-IABP groups.
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Affiliation(s)
- Yousif Ahmad
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sayan Sen
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Matthew J Shun-Shin
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jing Ouyang
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Judith A Finegold
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Rasha K Al-Lamee
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Justin E R Davies
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Graham D Cole
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Darrel P Francis
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Kim HK, Jeong MH, Ahn Y, Sim DS, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi DH, Cho MC, Kim CJ, Seung KB, Jang YS, Rha SW, Bae JH, Cho JG, Park SJ. Clinical outcomes of the intra-aortic balloon pump for resuscitated patients with acute myocardial infarction complicated by cardiac arrest. J Cardiol 2015; 67:57-63. [PMID: 25982668 DOI: 10.1016/j.jjcc.2015.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/18/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to investigate the clinical effects of intra-aortic balloon pump (IABP) in patients who received cardiopulmonary resuscitation (CPR) before procedure. METHODS AND RESULTS Between November 2005 and April 2014, 49,542 patients were enrolled in a prospective cohort study for acute myocardial infarction (AMI) in Korea (KAMIR). CPR was performed in 1700 patients with cardiac arrest. Patients were excluded from the study if they had not undergone a coronary angiogram, if extracorporeal membrane oxygenation or thrombolysis was performed, and if mechanical complications presented. The primary end point was 1-month all-cause mortality. A total of 883 patients in the IABP group and 476 in the control group were included. During the 1-month follow-up, all-cause death occurred in 749 patients (55.1%). The IABP group was predominantly male and had a higher prevalence of ST-segment elevation MI and a higher risk of coronary lesions including left main disease and three-vessel disease. Glycoprotein IIb/IIIa inhibitor was administered less in the non-IABP group. In the total population, the IABP group had worse outcomes in terms of mortality rates after multivariate analysis [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.02-1.47, p=0.034] without increasing the incidence of recurrent MI, stroke, and major bleeding. After propensity matching with a pair of 452 patients, no significant differences were observed in baseline characteristics or clinical outcomes (HR 1.21, 95% CI 0.93-1.57, p=0.158). CONCLUSION The use of IABP did not show clinical benefits in patients with AMI complicated by severe cardiogenic shock after propensity matching analysis.
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Affiliation(s)
- Hyun Kuk Kim
- Chonnam National University Hospital, Gwangju, South Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, South Korea.
| | - Youngkeun Ahn
- Chonnam National University Hospital, Gwangju, South Korea
| | - Doo Sun Sim
- Chonnam National University Hospital, Gwangju, South Korea
| | | | - Young Jo Kim
- Yeungnam University Hospital, Daegu, South Korea
| | - Seung Ho Hur
- Keimyung University Hospital, Daegu, South Korea
| | - In Whan Seong
- Chungnam National University Hospital, Daejeon, South Korea
| | | | | | - Myeong Chan Cho
- Chungbuk National University Hospital, Cheongju, South Korea
| | | | - Ki Bae Seung
- Catholic University Hospital, Seoul, South Korea
| | - Yang Soo Jang
- Yonsei University Severans Hospital, Seoul, South Korea
| | | | - Jang Ho Bae
- Konyang University Hospital, Daejeon, South Korea
| | - Jeong Gwan Cho
- Chonnam National University Hospital, Gwangju, South Korea
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Bauer T, Hochadel M, Brachmann J, Schächinger V, Boekstegers P, Zrenner B, Zahn R, Zeymer U. Use and outcome of radial versus femoral approach for primary PCI in patients with acute ST elevation myocardial infarction without cardiogenic shock: results from the ALKK PCI registry. Catheter Cardiovasc Interv 2015; 86 Suppl 1:S8-14. [PMID: 25945803 DOI: 10.1002/ccd.25987] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 03/25/2015] [Accepted: 04/04/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study sought to compare the use and outcome of radial versus femoral access in patients treated with primary percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction (STEMI) in clinical practice. BACKGROUND The radial approach for PCI in patients with STEMI has been suggested to have a lower rate of complications and bleeding and to improve prognosis compared with the femoral approach. However, there still is a large regional and national variation in its use. METHODS Between 2008 and 2012 a total of 17,865 patients with STEMI without cardiogenic shock undergoing primary PCI were prospectively enrolled in the observational German PCI registry of the Arbeitsgemeinschaft leitende kardiologische Krankenhausärzte (ALKK). Transfemoral (TF) access was used in 15,270 (85.5%), transradial (TR) access in 2,530 (14.2%), and other access in 65 (0.3%) patients. In this analysis, 10,264 patients from 20 centers that had performed at least 5 TR-PCI for STEMI were included. This study compared TR-PCI (n = 2,454 23.9%) with TF-PCI (n = 7,810, 76.1%). RESULTS Procedural success was high in both cohorts. Hospital mortality (1.8 vs. 5.1%, P < 0.001) and vascular access complications (0.3 vs. 1.8%, P < 0.001%) were lower in the TR group. In the multivariate analysis radial access was associated with an improved in-hospital survival rate (OR 0.47, 95% CI 0.35-0.65). CONCLUSIONS The radial approach for PCI can be performed with excellent procedural success in selected STEMI patients and is associated with a lower rate of vascular access complications and hospital mortality.
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Affiliation(s)
- Timm Bauer
- Herzzentrum Ludwigshafen, Institut Für Herzinfarktforschung Ludwigshafen, Germany.,Universitätsklinik Gießen, Germany
| | - Matthias Hochadel
- Herzzentrum Ludwigshafen, Institut Für Herzinfarktforschung Ludwigshafen, Germany
| | | | | | | | | | - Ralf Zahn
- Herzzentrum Ludwigshafen, Institut Für Herzinfarktforschung Ludwigshafen, Germany
| | - Uwe Zeymer
- Herzzentrum Ludwigshafen, Institut Für Herzinfarktforschung Ludwigshafen, Germany
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A patient with a rare cause of elevated troponin I. Clin Res Cardiol 2015; 104:794-7. [DOI: 10.1007/s00392-015-0864-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
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Unverzagt S, Buerke M, de Waha A, Haerting J, Pietzner D, Seyfarth M, Thiele H, Werdan K, Zeymer U, Prondzinsky R. Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Syst Rev 2015; 2015:CD007398. [PMID: 25812932 PMCID: PMC8454261 DOI: 10.1002/14651858.cd007398.pub3] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Intra-aortic balloon pump counterpulsation (IABP) is currently the most commonly used mechanical assist device for patients with cardiogenic shock due to acute myocardial infarction. Although there has been only limited evidence from randomised controlled trials, the previous guidelines of the American Heart Association/American College of Cardiology (AHA/ACC) and the European Society of Cardiology (ESC) strongly recommended the use of the IABP in patients with infarction-related cardiogenic shock on the basis of pathophysiological considerations, non-randomised trials and registry data. The recent guidelines downgraded the recommendation based on a meta-analysis which could only include non-randomised trials showing conflicting results. Up to now, there have been no guideline recommendations and no actual meta-analysis including the results of the large randomised multicentre IABP-SHOCK II Trial which showed no survival benefit with IABP support. This systematic review is an update of the review published in 2011. OBJECTIVES To evaluate, in terms of efficacy and safety, the effect of IABP versus non-IABP or other assist devices guideline compliant standard therapy on mortality and morbidity in patients with acute myocardial infarction complicated by cardiogenic shock. SEARCH METHODS Searches of CENTRAL, MEDLINE (Ovid) and EMBASE (Ovid), LILACS, IndMed and KoreaMed, registers of ongoing trials and proceedings of conferences were updated in October 2013. Reference lists were scanned and experts in the field contacted to obtain further information. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials on patients with acute myocardial infarction complicated by cardiogenic shock. DATA COLLECTION AND ANALYSIS Data collection and analysis were performed according to the published protocol. Individual patient data were provided for six trials and merged with aggregate data. Summary statistics for the primary endpoints were hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs). MAIN RESULTS Seven eligible studies were identified from a total of 2314 references. One new study with 600 patients was added to the original review. Four trials compared IABP to standard treatment and three to other percutaneous left assist devices (LVAD). Data from a total of 790 patients with acute myocardial infarction and cardiogenic shock were included in the updated meta-analysis: 406 patients were treated with IABP and 384 patients served as controls; 339 patients were treated without assisting devices and 45 patients with other LVAD. The HR for all-cause 30-day mortality of 0.95 (95% CI 0.76 to 1.19) provided no evidence for a survival benefit. Different non-fatal cardiovascular events were reported in five trials. During hospitalisation, 11 and 4 out of 364 patients from the intervention groups suffered from reinfarction or stroke, respectively. Altogether 5 out of 363 patients from the control group suffered from reinfarction or stroke. Reocclusion was treated with subsequent re-revascularization in 6 out of 352 patients from the intervention group and 13 out of 353 patients of the control group. The high incidence of complications such as moderate and severe bleeding or infection in the control groups has to be attributed to interventions with other LVAD. Possible reasons for bias were more frequent in small studies with high cross-over rates, early stopping and the inclusion of patients with IABP at randomisation. AUTHORS' CONCLUSIONS Available evidence suggests that IABP may have a beneficial effect on some haemodynamic parameters. However, this did not result in survival benefits so there is no convincing randomised data to support the use of IABP in infarct-related cardiogenic shock.
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Affiliation(s)
- Susanne Unverzagt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Magdeburge Straße 8, Halle/Saale, Germany, 06097
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Intraaortic balloon counterpulsation and microcirculation in cardiogenic shock complicating myocardial infarction: an IABP-SHOCK II substudy. Clin Res Cardiol 2015; 104:679-87. [DOI: 10.1007/s00392-015-0833-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
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Kapelios CJ, Terrovitis JV, Nanas JN. Current and future applications of the intra-aortic balloon pump. Curr Opin Cardiol 2014; 29:258-65. [PMID: 24686399 DOI: 10.1097/hco.0000000000000059] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The intra-aortic balloon pump (IABP) has been used for more than 40 years. Although recommended in a wide variety of clinical settings, most of these indications are not evidence-based. This review focuses on studies challenging these traditional indications and evaluates potentially new applications of intra-aortic counterpulsation. RECENT FINDINGS Recent studies have failed to confirm an improvement in clinical outcomes conferred by the IABP in patients developing cardiogenic shock after acute myocardial infarction. This issue is in need of further investigations. While conflicting results of several retrospective studies and meta-analyses have been published regarding the performance of the IABP in high-risk percutaneous coronary interventions, it has recently been found to improve the long-term clinical outcomes of patients in whom it was implanted before the procedure. Small, single-center studies have reported the use of the IABP as a bridge to transplantation or candidacy for left-ventricular assist device implantation. The recently reported feasibility and safety of its insertion via the subclavian or axillary arteries will facilitate these applications. SUMMARY The revisiting of available data and the performance of new, thoughtfully designed trials should clarify the proper indications for the IABP.
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Affiliation(s)
- Chris J Kapelios
- The 3rd Department of Cardiology, University of Athens School of Medicine, Athens, Greece
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Alozie A, Kische S, Birken T, Kaminski A, Westphal B, Nöldge-Schomburg G, Ince H, Steinhoff G. Awake Extracorporeal Membrane Oxygenation (ECMO) as Bridge to Recovery After Left Main Coronary Artery Occlusion: A Promising Concept of Haemodynamic Support in Cardiogenic Shock. Heart Lung Circ 2014; 23:e217-21. [DOI: 10.1016/j.hlc.2014.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/28/2014] [Accepted: 06/10/2014] [Indexed: 11/28/2022]
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Ye L, Zheng M, Chen Q, Li G, Deng W, Ke D. Effects of intra-aortic balloon counterpulsation pump on mortality of acute myocardial infarction. PLoS One 2014; 9:e108356. [PMID: 25268800 PMCID: PMC4182463 DOI: 10.1371/journal.pone.0108356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 08/28/2014] [Indexed: 11/28/2022] Open
Abstract
Background Several randomized controlled trials (RCTs) have evaluated the effect of intra-aortic balloon counterpulsation pump(IABP) on the mortality of acute myocardial infarction (AMI). Objectives To analyze the relevant RCT data on the effect of IABP on mortality and the occurrence of bleeding in AMI. Data Sources Published RCTs on the treatment of AMI by IABP were retrieved in searches of Medline, EMBASE, Cochrane and other related databases. The last search was conducted on July 20, 2014. Study Eligibility Criteria Randomized clinical trials comparing IABP to controls as treatment for AMI. Participants Patients with AMI. Synthesis Methods The primary endpoint was mortality, and the secondary endpoint was bleeding events. To account for to heterogeneity, a random-effects model was used to analyze the study data. Results Ten trials with a total population of 973 patients that were included in the analysis showed no significant difference in 2-month mortality between the IABP and the control groups. The 6-month mortality in the IABP group was not significantly lower than in the control group in the four RCTs that enrolled 59 AMI patients with CS. But in the four that enrolled AMI 66 patients without CS, the data showed opposite conclusion. Conclusions IABP cannot reduce within 2 months and 6–12 months mortality of AMI patients with CS as well as within 2 months mortality of AMI patients without CS, but can reduce 6–12 months mortality of AMI patients without CS. In addition, IABP can increase the risk of bleeding.
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Affiliation(s)
- Liwen Ye
- Department of Geriatrics Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Minming Zheng
- Chongqing Ophthalmology Research Center for the Senile, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Ophthalmology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingwei Chen
- Department of Geriatrics Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- * E-mail:
| | - Guiqion Li
- Department of Geriatrics Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Deng
- Department of Geriatrics Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dazhi Ke
- Department of Geriatrics Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Impact of intra-aortic balloon pump on long-term mortality of unselected patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 10:175-80. [PMID: 25489303 PMCID: PMC4252308 DOI: 10.5114/pwki.2014.45144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 06/17/2014] [Accepted: 07/14/2014] [Indexed: 12/22/2022] Open
Abstract
Introduction A large, randomised trial (IABP-SHOCK II) confirmed no benefit of intra-aortic balloon pump (IABP) on clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock. However, the ‘sickest’ patients are often excluded from randomised clinical trials, so it is difficult to generalise expected outcomes from randomized clinical trials to the real life setting. Aim We sought to evaluate the impact of IABP on 1-year mortality of unselected patients with STEMI presenting in cardiogenic shock. Material and methods Data were gathered for 1,650 consecutive patients with STEMI transferred for primary angioplasty from hospital networks in 7 countries in Europe from November 2005 to January 2007 (the EUROTRANSFER registry population). Of them, 51 patients with cardiogenic shock on admission were identified and stratified based on the use of IABP. Outcome results were adjusted for age and sex, to control possible selection bias. Results At the discretion of the operators, IABP was applied in 30 patients (58.8%, IABP group). The remaining 21 patients were treated without IABP (no-IABP group). The use of IABP was more frequent among males, younger patients, and patients with STEMI of the anterior wall. There was no difference in 30-day mortality in patients with and without IABP (no-IABP vs. IABP: 38.1% vs. 33.3%; adjusted OR 1.79 (95% CI 0.43–7.52); p = 0.43). Similarly, IABP had no impact on 1-year mortality (42.9% vs. 33.3%; adjusted OR 1.27 (95% CI 0.32–5.09); p = 0.74). One-year mortality was comparable among patients who survived hospitalisation (14.3% vs. 13%; p = 0.64). Conclusions We observed no benefit of IABP on short – and long-term mortality of unselected patients with STEMI complicated by cardiogenic shock.
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Patel H, Shivaraju A, Fonarow GC, Xie H, Gao W, Shroff AR, Vidovich MI. Temporal trends in the use of intraaortic balloon pump associated with percutaneous coronary intervention in the United States, 1998-2008. Am Heart J 2014; 168:363-373.e12. [PMID: 25173549 DOI: 10.1016/j.ahj.2014.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND With conflicting evidence regarding the usefulness of intraaortic balloon pump (IABP), reports of IABP use in the United States have been inconsistent. Our objective was to examine trends in IABP usage in percutaneous coronary intervention (PCI) in the United States and to evaluate the association of IABP use with mortality. METHODS This is a retrospective, observational study using patient data obtained from the Nationwide Inpatient Sample database from 1998 to 2008. Patients undergoing any PCI (1,552,602 procedures) for a primary diagnosis of symptomatic coronary artery disease and acute coronary syndrome, including non-ST-elevation myocardial infarction and ST-elevation myocardial infarction, were evaluated. RESULTS The overall use of IABP significantly decreased during the study period from 0.99% in 1998 to 0.36% in 2008 (univariate and multivariate P for trend < .0001). Patients who received IABP had substantially higher rates of shock compared with those who did not receive IABP (38.09% vs 0.70%; P < .0001), which was associated with markedly higher inhospital mortality rates (20.31% vs 0.72%; P < .0001). However, IABP use significantly decreased in patients with shock (36.5%-13.4%) and acute myocardial infarction (2.23%-0.84%) (univariate and multivariate P for trend for both < .0001). A temporal reduction in all-cause PCI-associated mortality from 1.1% in 1998 to 0.86% in 2008 (univariate and multivariate P for trend < .0001) was also observed. CONCLUSIONS The utilization of IABP associated with PCI significantly decreased between 1998 and 2008 in the United States, even among patients with acute myocardial infarction and shock.
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O'Neill WW, Schreiber T, Wohns DHW, Rihal C, Naidu SS, Civitello AB, Dixon SR, Massaro JM, Maini B, Ohman EM. The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: results from the USpella Registry. J Interv Cardiol 2013; 27:1-11. [PMID: 24329756 PMCID: PMC4238821 DOI: 10.1111/joic.12080] [Citation(s) in RCA: 266] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives To evaluate the periprocedural characteristics and outcomes of patients supported with Impella 2.5 prior to percutaneous coronary intervention (pre-PCI) versus those who received it after PCI (post-PCI) in the setting of cardiogenic shock (CS) complicating an acute myocardial infarction (AMI). Background Early mechanical circulatory support may improve outcome in the setting of CS complicating an AMI. However, the optimal timing to initiate hemodynamic support has not been well characterized. Methods Data from 154 consecutive patients who underwent PCI and Impella 2.5 support from 38 US hospitals participating in the USpella Registry were included in our study. The primary end-point was survival to discharge. Secondary end-points included assessment of patients’ hemodynamics and in-hospital complications. A multivariate regression model was used to identify independent predictors for mortality. Results Both groups were comparable except for diabetes (P = 0.02), peripheral vascular disease (P = 0.008), chronic obstructive pulmonary disease (P = 0.05), and prior stroke (P = 0.04), all of which were more prevalent in the pre-PCI group. Patients in the pre-PCI group had more lesions (P = 0.006) and vessels (P = 0.01) treated. These patients had also significantly better survival to discharge compared to patients in the post-PCI group (65.1% vs.40.7%, P = 0.003). Survival remained favorable for the pre-PCI group after adjusting for potential confounding variables. Initiation of support prior to PCI with Impella 2.5 was an independent predictor of in-hospital survival (Odds ratio 0.37, 95% confidence interval: 0.17–0.79, P = 0.01) in multivariate analysis. The incidence of in-hospital complications included in the secondary end-point was similar between the 2 groups. Conclusions The results of our study suggest that early initiation of hemodynamic support prior to PCI with Impella 2.5 is associated with more complete revascularization and improved survival in the setting of refractory CS complicating an AMI.
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Ndrepepa G, Neumann FJ, Cassese S, Fusaro M, Ott I, Schulz S, Hoppmann P, Richardt G, Laugwitz KL, Schunkert H, Kastrati A. Incidence and impact on prognosis of bleeding during percutaneous coronary interventions in patients with chronic kidney disease. Clin Res Cardiol 2013; 103:49-56. [PMID: 24092474 DOI: 10.1007/s00392-013-0622-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/18/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited information exists on the prognostic impact of bleeding after percutaneous coronary intervention (PCI) in patients with chronic kidney disease (CKD). We investigated the impact of bleeding after PCI on the outcome of these patients. METHODS The study included 2,934 patients with estimated creatinine clearance <60 ml/min. Bleeding events within 30 days after PCI were assessed using the Bleeding Academic Research Consortium (BARC) criteria. The primary outcome was 1-year mortality. RESULTS Bleeding events occurred in 485 patients (16.5 %). BARC classes were: class 1 (n = 155), class 2 (n = 73), class 3a (n = 182), class 3b (n = 68), class 3c (n = 6) and class 4 (n = 1). There were 212 deaths over the first year after PCI: 60 deaths in patients who bled and 152 deaths in patients who did not bleed (Kaplan-Meier [KM] estimates, 12.5 and 6.3 %; odds ratio [OR] = 2.11, 95 % confidence interval [CI] 1.57-2.83, P < 0.001). Nonfatal myocardial infarction occurred in 71 patients who bled and in 141 patients who did not bleed (KM estimates, 14.8 and 5.8 %; OR = 2.70 [2.05-3.55], P < 0.001). After adjustment, bleeding was independently associated with increased risk of 1-year mortality (adjusted hazard ratio [HR] = 1.90 [1.33-2.72], P < 0.001) and myocardial infarction (adjusted HR = 2.74 [1.99-3.78], P < 0.001). Bleeding improved the discriminatory power of the multivariable model for prediction of mortality (absolute and relative integrated discrimination improvement [IDI], 0.011 and 15.4 %; P = 0.004) or myocardial infarction (absolute and relative IDI, 0.017 and 70.8 %; P < 0.001). CONCLUSIONS Peri-PCI bleeding in patients with CKD is independently associated with the increased risk of 1-year mortality and nonfatal myocardial infarction.
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Affiliation(s)
- Gjin Ndrepepa
- Deutsches Herzzentrum, Lazarettstrasse 36, 80636, Munich, Germany,
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Chen S, Yin Y, Ling Z, Krucoff MW. Short and long term effect of adjunctive intra-aortic balloon pump use for patients undergoing high risk reperfusion therapy: a meta-analysis of 10 international randomised trials. Heart 2013; 100:303-10. [PMID: 23886602 DOI: 10.1136/heartjnl-2013-304198] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Shaojie Chen
- Department of Cardiology, Evidence Based Medicine, The Second Affiliated Hospital of Chongqing Medical University, , Chongqing, China
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The outcome of intra-aortic balloon pump support in acute myocardial infarction complicated by cardiogenic shock according to the type of revascularization: a comprehensive meta-analysis. Am Heart J 2013; 165:679-92. [PMID: 23622904 DOI: 10.1016/j.ahj.2013.02.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 02/18/2013] [Indexed: 12/13/2022]
Abstract
AIMS Despite the recommendations of the current guidelines, scientific evidence continue to challenge the effectiveness of intra-aortic balloon pump (IABP) in acute myocardial infarction (AMI) complicated by cardiogenic shock. Moreover, 2 recent meta-analyses showed contrasting results. The aim of this study is to test the effect of IABP according to the type of therapeutic treatment of AMI: percutaneous coronary intervention (PCI), thrombolytic therapy (TT), or medical therapy without reperfusion. Articles published from January 1, 1986, to December 31, 2012, were collected and analyzed by meta-analysis. METHODS AND RESULTS We evaluated the IABP impact on inhospital mortality, on safety end points (stroke, severe bleeding) and long-term survival, using risk ratio (RR) and risk difference (RD) estimates. We found that the risk of death was (i) not significantly different between the IABP and control groups (RR 0.95, P = .52; RD -0.04, P = .28), (ii) significantly reduced in the TT subgroup (RR 0.77, P < .0001; RD -0.16, P < .0001), and (iii) significantly increased in the PCI subgroup (RR 1.18, P = .01; RD 0.07, P = .01). There were no significant differences in secondary end points (P, not significant). In addition, we compared the meta-analyses collected over the same search period. CONCLUSION The results show that IABP support is significantly effective in TT reperfusion but is associated with a significant increase of the inhospital mortality with primary PCI. The comparison of the meta-analyses demonstrates the key role of analysing primary clinical treatments to avoid systematic errors.
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