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Guo C, Teng H, Xu H, Wang X, Zhang J, Li J, Duan X, Wang J, Yuan J, Wu Y, Yang W, Shubin Q. Impact of shock index before IABP implantation on recent prognosis of patients with cardiogenic shock complicating acute myocardial infarction. Acta Cardiol 2022; 78:241-247. [PMID: 35501998 DOI: 10.1080/00015385.2022.2064955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To investigate the impact of shock index before Intra-Aortic Balloon Pump (IABP) implantation on recent prognosis of patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) underwent primary percutaneous coronary intervention (PCI). METHODS A total of 103 patients with CS complicating AMI admitted in our hospital from June 2014 to May 2019 who underwent primary PCI with IABP support were enrolled in the study. We collected the data according to the medical records and collected their clinical manifestation and laboratory examination, as well as 28-day mortality, and also calculated the shock index (ratio of heart rate to systolic blood pressure) before IABP implantation. RESULTS Patients with higher SI at IABP insertion were associated with higher proportion of anterior infarction (81.5% vs. 61.2%, p = 0.022), previous history of PCI (24.1% vs. 8.16%, p = 0.030), culprit leision at left main (31.5% vs. 12.2%, p = 0.019), and final TIMI flow ≤ 2(55.5% vs. 26.5%, p = 0.003), invasive ventilation(40.7% vs. 20.4%, p = 0.026) as well as 28-day-mortality (81.5% vs. 61.2%, p = 0.022). SI at insertion may help predict recent outcome, with a cutoff value of 1.625, a sensitivity of 0.655 and a specificity of 0.708, and areas under the receiver-operating characteristic curve (AUCROC) was 0.713. On multiple analysis, SI, together with final TIMI flow, arterial pH and creatinine were independent predictive factors of recent prognosis among this population. CONCLUSION Among CS patients complicating AMI undergoing PCI with the support of IABP, higher SI before IABP implantation was associated with poorer prognosis, SI was an independent risk factor of 28-day mortality and may predict the 28-day outcome.
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Affiliation(s)
| | | | - Haobo Xu
- Centre of Coronary Heart Disease, National Centre for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinyu Wang
- Centre of Coronary Heart Disease, National Centre for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Zhang
- Centre of Coronary Heart Disease, National Centre for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia Li
- Centre of Coronary Heart Disease, National Centre for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Duan
- Centre of Coronary Heart Disease, National Centre for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juan Wang
- Centre of Coronary Heart Disease, National Centre for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiansong Yuan
- Centre of Coronary Heart Disease, National Centre for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Wu
- Centre of Coronary Heart Disease, National Centre for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weixian Yang
- Centre of Coronary Heart Disease, National Centre for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiao Shubin
- Centre of Coronary Heart Disease, National Centre for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Cengic S, Zuberi M, Bansal V, Ratzlaff R, Rodrigues E, Festic E. Hypotension after intensive care unit drop-off in adult cardiac surgery patients. World J Crit Care Med 2020; 9:20-30. [PMID: 32577413 PMCID: PMC7298587 DOI: 10.5492/wjccm.v9.i2.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypotension is a frequent complication in the intensive care unit (ICU) after adult cardiac surgery.
AIM To describe frequency of hypotension in the ICU following adult cardiac surgery and its relation to the hospital outcomes.
METHODS A retrospective study of post-cardiac adult surgical patients at a tertiary academic medical center in a two-year period. We abstracted baseline demographics, comorbidities, and all pertinent clinical variables. The primary predictor variable was the development of hypotension within the first 30 min upon arrival to the ICU from the operating room (OR). The primary outcome was hospital mortality, and other outcomes included duration of mechanical ventilation (MV) in hours, and ICU and hospital length of stay in days.
RESULTS Of 417 patients, more than half (54%) experienced hypotension within 30 min upon arrival to the ICU. Presence of OR hypotension immediately prior to ICU transfer was significantly associated with ICU hypotension (odds ratio = 1.9; 95% confidence interval: 1.21-2.98; P < 0.006). ICU hypotensive patients had longer MV, 5 (interquartile ranges 3, 15) vs 4 h (interquartile ranges 3, 6), P = 0.012. The patients who received vasopressor boluses (n = 212) were more likely to experience ICU drop-off hypotension (odds ratio = 1.45, 95% confidence interval: 0.98-2.13; P = 0.062), and they experienced longer MV, ICU and hospital length of stay (P < 0.001, for all).
CONCLUSION Hypotension upon anesthesia-to-ICU drop-off is more frequent than previously reported and may be associated with adverse clinical outcomes.
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Affiliation(s)
- Sabina Cengic
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
- Department of General Surgery, Stadtspital Triemli, Zurich 8063, Switzerland
| | - Muhammad Zuberi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Vikas Bansal
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Robert Ratzlaff
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Eduardo Rodrigues
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Emir Festic
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
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Sumarjaya IDGD, Nadha IKB, Lestari AAW. High Lipoprotein(a) Levels as a Predictor of Major Adverse Cardiovascular Events in Hospitalized-Acute Myocardial Infarction Patients. Vasc Health Risk Manag 2020; 16:125-132. [PMID: 32308405 PMCID: PMC7152732 DOI: 10.2147/vhrm.s233503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 03/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background Risk stratification models with incorporation of biochemical markers have received attention recently. In acute myocardial infarction (AMI) one such marker is lipoprotein(a) (Lp(a)). Lp(a) has prothrombotic and proinflammatory properties. High levels of Lp(a) probably contribute to the additional adverse effects in AMI, as it enhances the damaging effect of acute thrombosis. This study aimed to evaluate serum Lp(a) as a predictor of major adverse cardiovascular events (MACE) in hospitalized-acute myocardial infarction patients. Methods A prospective cohort study was conducted at Sanglah Hospital, Denpasar, during June–August 2018, among 66 people by consecutive sampling. Samples that met the inclusion and exclusion criteria were examined for serum Lp(a) at the time of admission and the occurrence of MACE during hospitalization was observed. Data regarding serum Lp(a), demography, smoking history, dyslipidemia, hypertension, diabetes mellitus, and MACE were collected. Log rank test and Cox proportional hazards regression were conducted with SPSS version 20 for Windows. Results During observation, MACE occurred in 25 (38%) patients, including cardiogenic shock in 7 (10.6%) patients, heart failure in 20 (30.3%) patients, cardiovascular death in 5 (7, 6%) patients, malignant arrhythmias in 5 (7.6%) patients, and postinfarction angina in 5 (7.6%) patients. After the Log rank test, a significant difference in survival was observed (p = 0.001) between groups of high Lp(a) (survival rate of 60.6 hours; 95% CI 43.3–77.9) and low Lp(a) (average survival of 104.3 hours, 95% CI 91.4–117.2). The hazard ratio of high Lp(a) against MACE was 4.63 (p=0.002), and it increased to 4.69 in multivariate analysis with Cox proportional hazards regression test (p=0.003). Conclusion The high level of Lp(a) in AMI patients was a risk factor for the occurrence of MACE during hospitalization. Patients with high Lp(a) also had worse survival compared to patients with low Lp(a). ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/LUESRF3Zdcc
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Affiliation(s)
- I Dewa Gde Dwi Sumarjaya
- Specialist Program of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia
| | - I Ketut Badjra Nadha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia
| | - Anak Agung Wiradewi Lestari
- Department of Clinical Pathology, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia
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Samanidis G, Georgiopoulos G, Bousounis S, Zoumpourlis P, Perreas K. Outcomes after intra-aortic balloon pump insertion in cardiac surgery patients. Rev Bras Ter Intensiva 2020; 32:542-550. [PMID: 33470355 PMCID: PMC7853672 DOI: 10.5935/0103-507x.20200091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/04/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To assess whether preoperative versus intraoperative insertion of an intra-aortic balloon pump is associated with lower 30-day mortality or reduced length of hospital stay among patients who had an intra-aortic balloon pump inserted for cardiac surgery. Methods This was an observational study of patients who had an intra-aortic balloon pump inserted in the preoperative or intraoperative period of cardiac surgery in our department between 2000 and 2012. We assessed the association between preoperative versus intraoperative insertion of an intra-aortic balloon pump and 30-day mortality in a multivariable logistic regression analysis, including preoperative New York Heart Association class, postoperative atrial fibrillation, reoperation, postoperative creatinine and isolated coronary bypass grafting as cofactors. We used a multivariate linear model to assess whether a preoperative versus intraoperative intra-aortic balloon pump was associated with length of postoperative hospital stay, adjusting for reoperation, isolated coronary bypass grafting, heart valve surgery, sex, age, cardiopulmonary bypass time, aortic cross-clamp time, preoperative patients’ status (elective, urgency or emergency surgery) and preoperative myocardial infarction. Results Overall, 7,540 consecutive patients underwent open heart surgery in our department, and an intra-aortic balloon pump was inserted pre- or intraoperatively in 322 (4.2%) patients. The mean age was 67 ± 10.2 years old, the 30-day mortality was 12.7%, and the median length of hospital stay was 9 days (7 - 13). Preoperative versus intraoperative intra-aortic balloon pump insertion did not affect the incidence of 30-day mortality (adjusted OR = 0.69; 95% CI, 0.15 - 3.12; p = 0.63) and length of postoperative hospital stay (β = 5.3; 95%CI, -1.6 to 12.8; p = 0.13). Conclusion Preoperative insertion of an intra-aortic balloon pump was not associated with a lower 30-day mortality or reduced length of postoperative hospital stay compared to intraoperative insertion.
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Affiliation(s)
- George Samanidis
- Serviço de Cirurgia Cardíaca em Adultos, Onassis Cardiac Surgery Center - Atenas, Grécia
| | | | - Stefanos Bousounis
- Serviço de Cirurgia Cardíaca em Adultos, Onassis Cardiac Surgery Center - Atenas, Grécia
| | - Panagiotis Zoumpourlis
- Serviço de Cirurgia Cardíaca em Adultos, Onassis Cardiac Surgery Center - Atenas, Grécia
| | - Konstantinos Perreas
- Serviço de Cirurgia Cardíaca em Adultos, Onassis Cardiac Surgery Center - Atenas, Grécia
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Benedek T, Dobreanu D. Current Concepts and New Trends in the Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction. ACTA ACUST UNITED AC 2015; 1:5-10. [PMID: 29967809 DOI: 10.1515/jccm-2015-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/15/2015] [Indexed: 11/15/2022]
Abstract
Cardiogenic shock (CS) is a critical condition which often complicates the evolution of an acute myocardial infarction (AMI). At the same time, co-existence of chronic multi-vessel disease can lead to the development of cardiogenic shock in cases with pronounced haemodynamic instability. Different clinical studies have tried to identify the most appropriate treatment for critical cases of CS complicating AMI. This review aims to present the current status of recommended therapeutic strategies for severe cases of CS presenting as a complication of AMI, and try to shed light on the most appropriate therapeutic strategy as outlined in the current literature. The paper will discuss the different current strategies available for use in the treatment of this condition, includig interventional revascularisation, (complete or culprit), the role of new devices for providing mechanical circulatory support, and the potential role of new drug therapies and of hypothermia.
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Affiliation(s)
- Theodora Benedek
- University of Medicine and Pharmacy of Tirgu Mures, 38 Gheorghe Marinescu street, Tirgu Mures, 540139, Romania
| | - Dan Dobreanu
- University of Medicine and Pharmacy of Tirgu Mures, 38 Gheorghe Marinescu street, Tirgu Mures, 540139, Romania
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