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Zhao R, Sun W, Li Y, Wu A, Chen X, Lou J, Zhang S, Tan Y, Zhang L, Xie M, Lv Q. Application of apical myocardial perfusion quantitative analysis by contrast-enhanced ultrasound utilizing high-frequency linear probe. Echocardiography 2024; 41:e15886. [PMID: 39007877 DOI: 10.1111/echo.15886] [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] [Received: 04/25/2024] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Due to insufficient near-field resolution and artifacts, it is challenging to evaluate the left ventricular apical perfusion with phased-array probes. By combining high-frequency linear probe and contrast-enhanced ultrasound (CEUS), imaging of apical myocardial perfusion could be improved. The study aims to evaluate the preliminary application of CEUS by high-frequency linear probes to assess the apical perfusion. METHODS The study enrolled retrospectively 91 patients to test the feasibility of the novel method. In protocol 1, patients were stratified into a group with left anterior descending artery (LAD) stenosis (N = 40) and a group without LAD stenosis or coronary artery disease (N = 41) based on the degree of coronary artery narrowing, quantified by >50% stenosis in coronary angiography. Receiver operating characteristics (ROC) analysis was performed to test the diagnostic value of perfusion parameters. In protocol 2, the reproducibility of high-frequency linear probe in apical perfusion analysis was compared with the conventional phased-array probe in 30 patients. RESULTS (1) The novel method is feasible in 81(89.01%) patients. (2) In protocol 1, to detect LAD stenosis, the best cut-off of β, T, A, and MBF were 10.32, 3.28, 9.39, and 4.99, respectively. Area under the curve of β, T, A, and MBF were .880, .881, .761, and .880, respectively. (3) In protocol 2, compared with phased-array probe, the quantitative analysis of high-frequency linear probe is of high reproducibility and could get good curve fitting (R2 = .29 vs. R2 = .71, P < .01). CONCLUSION Observation of apical perfusion using this method is feasible and quantitative analysis allows an accurate and convenient identification of LAD stenosis. This method provides an alternative for patients who have difficulties in visualizing the apical region with a phased-array probe.
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Affiliation(s)
- Ruohan Zhao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wei Sun
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Anjun Wu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xin Chen
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jie Lou
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Siyi Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuting Tan
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Smith E, Tamis-Holland JE. Sex differences in the presentation and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock: a critical review of contemporary data and a look towards future directions. Curr Opin Crit Care 2024; 30:344-353. [PMID: 38841913 DOI: 10.1097/mcc.0000000000001166] [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: 06/07/2024]
Abstract
PURPOSE OF REVIEW Cardiogenic shock (CS) is a devasting complicating of acute myocardial infarction (AMI), associated with significant mortality. Prior studies have reported sex differences in the presentation, management and outcomes of patients with AMI and CS. These differences are likely due to a variety of factors influencing therapeutic decision-making and impacting survival. This review highlights the more contemporary studies exploring differences in women and men with AMI-CS, providing a critical perspective towards understanding the factors that might lead to these differences and outlining potential opportunities to reduce disparities in treatment and improve survival for women with AMI-CS. RECENT FINDINGS Recent reports demonstrate that women with AMI-CS are older than men and have more cardiovascular comorbidities. When examining an unselected population of patients with AMI-CS, women receive less aggressive treatment compared to men and have poorer outcomes. However, when examining a selected population of patients with AMI-CS treated with mechanical circulatory support (MCS) and/or admitted to centers that implement CS protocols to manage AMI-CS, these sex-based differences in outcomes are largely mitigated. SUMMARY Standardizing protocols for the diagnosis and treatment of patients with AMI-CS, with an emphasis on early revascularization and appropriate invasive therapies, can improve outcomes in women and narrow the gender gap.
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Affiliation(s)
- Emily Smith
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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3
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Fisher T, Hill N, Kalakoutas A, Lahlou A, Rathod K, Proudfoot A, Warren A. Sex differences in treatments and outcomes of patients with cardiogenic shock: a systematic review and epidemiological meta-analysis. Crit Care 2024; 28:192. [PMID: 38845019 PMCID: PMC11157877 DOI: 10.1186/s13054-024-04973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Women are at higher risk of mortality from many acute cardiovascular conditions, but studies have demonstrated differing findings regarding the mortality of cardiogenic shock in women and men. To examine differences in 30-day mortality and mechanical circulatory support use by sex in patients with cardiogenic shock. MAIN BODY Cochrane Central, PubMed, MEDLINE and EMBASE were searched in April 2024. Studies were included if they were randomised controlled trials or observational studies, included adult patients with cardiogenic shock, and reported at least one of the following outcomes by sex: raw mortality, adjusted mortality (odds ratio) or use of mechanical circulatory support. Out of 4448 studies identified, 81 met inclusion criteria, pooling a total of 656,754 women and 1,018,036 men. In the unadjusted analysis for female sex and combined in-hospital and 30-day mortality, women had higher odds of mortality (Odds Ratio (OR) 1.35, 95% confidence interval (CI) 1.26-1.44, p < 0.001). Pooled unadjusted mortality was 35.9% in men and 40.8% in women (p < 0.001). When only studies reporting adjusted ORs were included, combined in-hospital/30-day mortality remained higher in women (OR 1.10, 95% CI 1.06-1.15, p < 0.001). These effects remained consistent across subgroups of acute myocardial infarction- and heart failure- related cardiogenic shock. Overall, women were less likely to receive mechanical support than men (OR = 0.67, 95% CI 0.57-0.79, p < 0.001); specifically, they were less likely to be treated with intra-aortic balloon pump (OR = 0.79, 95% CI 0.71-0.89, p < 0.001) or extracorporeal membrane oxygenation (OR = 0.84, 95% 0.71-0.99, p = 0.045). No significant difference was seen with use of percutaneous ventricular assist devices (OR = 0.82, 95% CI 0.51-1.33, p = 0.42). CONCLUSION Even when adjusted for confounders, mortality for cardiogenic shock in women is approximately 10% higher than men. This effect is seen in both acute myocardial infarction and heart failure cardiogenic shock. Women with cardiogenic shock are less likely to be treated with mechanical circulatory support than men. Clinicians should make immediate efforts to ensure the prompt diagnosis and aggressive treatment of cardiogenic shock in women.
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Affiliation(s)
- Thomas Fisher
- North Bristol NHS Trust, Southmead Rd, Bristol, BS10 5NB, UK
| | - Nicole Hill
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, Avon, BA1 3NG, UK
| | | | - Assad Lahlou
- Barts Health Library Services, W Smithfield, London, EC1A 7BE, UK
| | - Krishnaraj Rathod
- Barts Health NHS Trust, W Smithfield, London, EC1A 7BE, UK
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry, Queen Mary University of London, W Smithfield, London, EC1A 7BE, UK
| | - Alastair Proudfoot
- Barts Health NHS Trust, W Smithfield, London, EC1A 7BE, UK
- Critical Care and Perioperative Medicine Group, School of Medicine and Dentistry, Queen Mary University London, W Smithfield, London, EC1A 7BE, UK
| | - Alex Warren
- Barts Health NHS Trust, W Smithfield, London, EC1A 7BE, UK.
- Critical Care and Perioperative Medicine Group, School of Medicine and Dentistry, Queen Mary University London, W Smithfield, London, EC1A 7BE, UK.
- Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
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Yamga E, Mantena S, Rosen D, Bucholz EM, Yeh RW, Celi LA, Ustun B, Butala NM. Optimized Risk Score to Predict Mortality in Patients With Cardiogenic Shock in the Cardiac Intensive Care Unit. J Am Heart Assoc 2023; 12:e029232. [PMID: 37345819 PMCID: PMC10356069 DOI: 10.1161/jaha.122.029232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/01/2023] [Indexed: 06/23/2023]
Abstract
Background Mortality prediction in critically ill patients with cardiogenic shock can guide triage and selection of potentially high-risk treatment options. Methods and Results We developed and externally validated a checklist risk score to predict in-hospital mortality among adults admitted to the cardiac intensive care unit with Society for Cardiovascular Angiography & Interventions Shock Stage C or greater cardiogenic shock using 2 real-world data sets and Risk-Calibrated Super-sparse Linear Integer Modeling (RiskSLIM). We compared this model to those developed using conventional penalized logistic regression and published cardiogenic shock and intensive care unit mortality prediction models. There were 8815 patients in our training cohort (in-hospital mortality 13.4%) and 2237 patients in our validation cohort (in-hospital mortality 22.8%), and there were 39 candidate predictor variables. The final risk score (termed BOS,MA2) included maximum blood urea nitrogen ≥25 mg/dL, minimum oxygen saturation <88%, minimum systolic blood pressure <80 mm Hg, use of mechanical ventilation, age ≥60 years, and maximum anion gap ≥14 mmol/L, based on values recorded during the first 24 hours of intensive care unit stay. Predicted in-hospital mortality ranged from 0.5% for a score of 0 to 70.2% for a score of 6. The area under the receiver operating curve was 0.83 (0.82-0.84) in training and 0.76 (0.73-0.78) in validation, and the expected calibration error was 0.9% in training and 2.6% in validation. Conclusions Developed using a novel machine learning method and the largest cardiogenic shock cohorts among published models, BOS,MA2 is a simple, clinically interpretable risk score that has improved performance compared with existing cardiogenic-shock risk scores and better calibration than general intensive care unit risk scores.
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Affiliation(s)
- Eric Yamga
- Department of Medicine Centre Hospitalier de l'Université de Montréal (CHUM) Montreal QC Canada
| | | | - Darin Rosen
- Johns Hopkins School of Medicine Baltimore MD USA
| | - Emily M Bucholz
- University of Colorado School of Medicine Aurora CO USA
- Heart Institute, Children's Hospital of Colorado Aurora CO USA
| | - Robert W Yeh
- Harvard Medical School Boston MA USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology Beth Israel Deaconess Medical Center Boston MA USA
| | - Leo A Celi
- Harvard Medical School Boston MA USA
- Laboratory for Computational Physiology, MIT Institute for Medical Engineering and Science, Massachusetts Institute of Technology Cambridge MA USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health Boston MA USA
| | - Berk Ustun
- Halıcıoğlu Data Science Institute University of California San Diego CA USA
| | - Neel M Butala
- University of Colorado School of Medicine Aurora CO USA
- Rocky Mountain Regional VA Medical Center Aurora CO USA
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5
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Saleiro C, de Campos D, Ribeiro JM, Lopes J, Puga L, Sousa JP, Gomes ARM, Siserman A, Lourenço C, Gonçalves L. Glycoprotein IIb/IIIa inhibitor use in cardiogenic shock complicating myocardial infarction: The Portuguese Registry of Acute Coronary Syndromes. Rev Port Cardiol 2023; 42:113-120. [PMID: 36163139 DOI: 10.1016/j.repc.2021.09.018] [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: 06/27/2021] [Revised: 08/23/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Cardiogenic shock (CS) complicates 5-10% of cases of myocardial infarction (MI). Whether glycoprotein IIb/IIIa inhibitors (GPIs) are beneficial in these patients is controversial. Our aim is to assess the prognostic impact of GPI use on in-hospital mortality and outcomes in patients with MI and CS undergoing percutaneous coronary intervention (PCI). METHODS Between October 2010 and December 2019, 27578 acute coronary syndrome (ACS) patients were included in the multicenter Portuguese Registry of Acute Coronary Syndromes. Of these, 357 with an MI complicated by CS were included in the analysis and grouped based on whether they received GPI therapy (with GPI, n=107 and without GPI, n=250). The primary endpoint was in-hospital mortality. Secondary endpoints included successful PCI and in-hospital reinfarction and major bleeding. RESULTS Demographics and cardiovascular risk factors did not differ between groups. ST-elevation MI patients were more likely to receive GPIs (95% vs. 83%, p=0.002). In-hospital mortality was similar between groups (OR 1.80, 95% CI 0.96-3.37). Only age and the use of inotropes or intra-aortic balloon pump were predictors of mortality. Also, no differences between groups were noted for successful PCI (OR 0.33, 95% CI 0.62-4.06), reinfarction (OR 0.77, 95% CI 0.15-3.90), or major bleeding (OR 1.68, 95% CI 0.75-3.74). CONCLUSION The use of GPIs in the context of MI with CS did not significantly impact in-hospital outcomes.
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Affiliation(s)
- Carolina Saleiro
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Diana de Campos
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joana M Ribeiro
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - João Lopes
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Luís Puga
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José P Sousa
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Rita M Gomes
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Alexandrina Siserman
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carolina Lourenço
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal; Coimbra Institute for Biomedical Research (ICBR), Coimbra, Portugal
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Ranard LS, Guber K, Fried J, Takeda K, Kaku Y, Karmpaliotis D, Sayer G, Rabbani L, Burkhoff D, Uriel N, Kirtane AJ, Masoumi A. Comparison of Risk Models in the Prediction of 30-Day Mortality in Acute Myocardial Infarction–Associated Cardiogenic Shock. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Muzafarova T, Motovska Z. Laboratory Predictors of Prognosis in Cardiogenic Shock Complicating Acute Myocardial Infarction. Biomedicines 2022; 10:biomedicines10061328. [PMID: 35740350 PMCID: PMC9220203 DOI: 10.3390/biomedicines10061328] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 12/02/2022] Open
Abstract
Cardiogenic shock is a state of reduced cardiac output leading to hypotension, pulmonary congestion, and hypoperfusion of tissues and vital organs. Despite the advances in intensive care over the last years, the morbidity and mortality of patients remain high. The available studies of patients with cardiogenic shock suggest a connection between clinical variables, the level of biomarkers, the results of imaging investigations, strategies of management and the outcome of this group of patients. The management of patients with cardiogenic shock initially complicating acute myocardial infarction is challenging, and the number of studies in this area is growing fast. The purpose of this review is to summarize the currently available evidence on cardiogenic shock initially complicating acute myocardial infarction with particular attention to predictors of prognosis, focusing on laboratory variables (established and new), and to discuss the practical implementation. Currently available scoring systems developed during the past few decades predict the clinical outcome of this group of patients using some of the established biomarkers among other variables. With the new laboratory biomarkers that have shown their predictive value in cardiogenic shock outcomes, a new design of scoring systems would be of interest. Identifying high-risk patients offers the opportunity for early decision-making.
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Abstract
ABSTRACT Despite advances in early revascularization, percutaneous hemodynamic support platforms, and systems of care, cardiogenic shock (CS) remains associated with a mortality rate higher than 50%. Several risk stratification models have been derived since the 1990 s to identify patients at high risk of adverse outcomes. Still, limited information is available on the differences between scoring systems and their relative applicability to both acute myocardial infarction and advanced decompensated heart failure CS. Thus, we reviewed the similarities, differences, and limitations of published CS risk prediction models and herein discuss their suitability to the contemporary management of CS care.
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9
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Wang J, Shen B, Feng X, Zhang Z, Liu J, Wang Y. A Review of Prognosis Model Associated With Cardiogenic Shock After Acute Myocardial Infarction. Front Cardiovasc Med 2021; 8:754303. [PMID: 34957245 PMCID: PMC8702644 DOI: 10.3389/fcvm.2021.754303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/21/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: Cardiogenic shock seriously affects the survival rate of patients. However, few prognostic models are concerned with the score of cardiogenic shock, and few clinical studies have validated it. In order to optimize the diagnosis and treatment of myocardial infarction complicated with cardiogenic shock and facilitate the classification of clinical trials, the prognosis score model is urgently needed. Methods: Cardiogenic shock, severe case, prognosis score, myocardial infarction and external verification were used as the search terms to search PubMed, Embase, Web of Science, Cochrane, EBSCO (Medline), Scopus, BMC, NCBI, Oxford Academy, Science Direct, and other databases for pertinent studies published up until 1 August 2021. There are no restrictions on publication status and start date. Filter headlines and abstracts to find articles that may be relevant. The list of references for major studies was reviewed to obtain more references. Results and Conclusions: The existing related models are in urgent need of more external clinical verifications. In the meanwhile, with the development of molecular omics and the clinical need for optimal treatment of CS, it is urgent to establish a prognosis model with higher differentiation and coincidence rates.
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Affiliation(s)
| | | | | | | | | | - Yushi Wang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
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10
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Kalra S, Ranard LS, Memon S, Rao P, Garan AR, Masoumi A, O'Neill W, Kapur NK, Karmpaliotis D, Fried JA, Burkhoff D. Risk Prediction in Cardiogenic Shock: Current State of Knowledge, Challenges and Opportunities. J Card Fail 2021; 27:1099-1110. [PMID: 34625129 DOI: 10.1016/j.cardfail.2021.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/22/2022]
Abstract
Cardiogenic shock (CS) is a condition associated with high mortality rates in which prognostication is uncertain for a variety of reasons, including its myriad causes, its rapidly evolving clinical course and the plethora of established and emerging therapies for the condition. A number of validated risk scores are available for CS prognostication; however, many of these are tedious to use, are designed for application in a variety of populations and fail to incorporate contemporary hemodynamic parameters and contemporary mechanical circulatory support interventions that can affect outcomes. It is important to separate patients with CS who may recover with conservative pharmacological therapies from those in who may require advanced therapies to survive; it is equally important to identify quickly those who will succumb despite any therapy. An ideal risk-prediction model would balance incorporation of key hemodynamic parameters while still allowing dynamic use in multiple scenarios, from aiding with early decision making to device weaning. Herein, we discuss currently available CS risk scores, perform a detailed analysis of the variables in each of these scores that are most predictive of CS outcomes and explore a framework for the development of novel risk scores that consider emerging therapies and paradigms for this challenging clinical entity.
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Affiliation(s)
- Sanjog Kalra
- The Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
| | - Lauren S Ranard
- Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York
| | - Sehrish Memon
- Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Prashant Rao
- Beth Israel Deaconess Medical Center, Boston, Masschusetts
| | - A Reshad Garan
- Beth Israel Deaconess Medical Center, Boston, Masschusetts
| | - Amirali Masoumi
- Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York
| | | | - Navin K Kapur
- Tufts University Medical Center, Boston, Massachusetts
| | - Dimitri Karmpaliotis
- Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Justin A Fried
- Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York
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11
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Sheikh O, Nguyen T, Bansal S, Prasad A. Acute kidney injury in cardiogenic shock: A comprehensive review. Catheter Cardiovasc Interv 2021; 98:E91-E105. [PMID: 32725874 DOI: 10.1002/ccd.29141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/14/2020] [Accepted: 06/27/2020] [Indexed: 11/09/2022]
Abstract
Acute kidney injury (AKI) is an ominous predictor of mortality in cardiogenic shock. The present review examines the pathophysiology of AKI in cardiogenic shock (CS), summarizes the pertinent literature including the diagnostic criteria/definitions for AKI and possible role of biomarkers, and identifies risk factors and possible therapeutic interventions for AKI in CS. Our review finds that AKI is common in patients with CS and is associated with increased morbidity and mortality. Urinary biomarkers of renal tubular injury appear more sensitive for detection of AKI but have yet to be incorporated into daily practice. Emerging data would suggest vasopressor choices, mechanical circulatory support, and renal replacement therapy may have important therapeutic roles in the management of CS.
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Affiliation(s)
- Omar Sheikh
- Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Tung Nguyen
- Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Shweta Bansal
- Division of Nephrology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Anand Prasad
- Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
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12
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Ceglarek U, Schellong P, Rosolowski M, Scholz M, Willenberg A, Kratzsch J, Zeymer U, Fuernau G, de Waha-Thiele S, Büttner P, Jobs A, Freund A, Desch S, Feistritzer HJ, Isermann B, Thiery J, Pöss J, Thiele H. The novel cystatin C, lactate, interleukin-6, and N-terminal pro-B-type natriuretic peptide (CLIP)-based mortality risk score in cardiogenic shock after acute myocardial infarction. Eur Heart J 2021; 42:2344-2352. [PMID: 33647946 DOI: 10.1093/eurheartj/ehab110] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/21/2020] [Accepted: 02/10/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) still reaches excessively high mortality rates. This analysis is aimed to develop a new easily applicable biomarker-based risk score. METHODS AND RESULTS A biomarker-based risk score for 30-day mortality was developed from 458 patients with CS complicating AMI included in the randomized CULPRIT-SHOCK trial. The selection of relevant predictors and the coefficient estimation for the prognostic model were performed by a penalized multivariate logistic regression analysis. Validation was performed internally, internally externally as well as externally in 163 patients with CS included in the randomized IABP-SHOCK II trial. Blood samples were obtained at randomization. The two trials are registered with ClinicalTrials.gov (NCT01927549 and NCT00491036), are closed to new participants, and follow-up is completed. Out of 58 candidate variables, the four strongest predictors for 30-day mortality were included in the CLIP score (cystatin C, lactate, interleukin-6, and N-terminal pro-B-type natriuretic peptide). The score was well calibrated and yielded high c-statistics of 0.82 [95% confidence interval (CI) 0.78-0.86] in internal validation, 0.82 (95% CI 0.75-0.89) in internal-external (temporal) validation, and 0.73 (95% CI 0.65-0.81) in external validation. Notably, it outperformed the Simplified Acute Physiology Score II and IABP-SHOCK II risk score in prognostication (0.83 vs 0.62; P < 0.001 and 0.83 vs. 0.76; P = 0.03, respectively). CONCLUSIONS A biomarker-only score for 30-day mortality risk stratification in infarct-related CS was developed, extensively validated and calibrated in a prospective cohort of contemporary patients with CS after AMI. The CLIP score outperformed other clinical scores and may be useful as an early decision tool in CS.
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Affiliation(s)
- Uta Ceglarek
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, P.-List-Str. 13, 04103 Leipzig, Germany
| | - Paul Schellong
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, P.-List-Str. 13, 04103 Leipzig, Germany
| | - Maciej Rosolowski
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, P.-List-Str. 13, 04103 Leipzig, Germany
| | - Markus Scholz
- Institute of Medical Informatics, Statistics and Epidemiology, University Leipzig, Germany
| | - Anja Willenberg
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, P.-List-Str. 13, 04103 Leipzig, Germany
| | - Jürgen Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, P.-List-Str. 13, 04103 Leipzig, Germany
| | - Uwe Zeymer
- Klinikum Ludwigshafen und Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | - Suzanne de Waha-Thiele
- University Heart Center Lübeck, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Lübeck, Germany
| | - Petra Büttner
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Strümpellstr.. 39, 04289 Leipzig, and Leipzig Heart Institute, Leipzig, Germany
| | - Alexander Jobs
- German Center for Cardiovascular Research (DZHK), Lübeck, Germany.,Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Strümpellstr.. 39, 04289 Leipzig, and Leipzig Heart Institute, Leipzig, Germany
| | - Anne Freund
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Strümpellstr.. 39, 04289 Leipzig, and Leipzig Heart Institute, Leipzig, Germany
| | - Steffen Desch
- German Center for Cardiovascular Research (DZHK), Lübeck, Germany.,Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Strümpellstr.. 39, 04289 Leipzig, and Leipzig Heart Institute, Leipzig, Germany
| | - Hans-Josef Feistritzer
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Strümpellstr.. 39, 04289 Leipzig, and Leipzig Heart Institute, Leipzig, Germany
| | - Berend Isermann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, P.-List-Str. 13, 04103 Leipzig, Germany
| | - Joachim Thiery
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, P.-List-Str. 13, 04103 Leipzig, Germany
| | - Janine Pöss
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Strümpellstr.. 39, 04289 Leipzig, and Leipzig Heart Institute, Leipzig, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Strümpellstr.. 39, 04289 Leipzig, and Leipzig Heart Institute, Leipzig, Germany
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13
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Otaal PS, Shah A, Batta A, Sood A, Pal A. Clinical and Angiographic Prophesy of Hemodynamic Status in Patients with Acute Anterior Wall ST-Segment-Elevation Myocardial Infarction and Totally Occluded Left Anterior Descending Artery. Integr Blood Press Control 2021; 14:89-97. [PMID: 34168494 PMCID: PMC8219224 DOI: 10.2147/ibpc.s315050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Left anterior descending artery (LAD) is the most common occluded vessel in a patient presenting with acute anterior wall ST-segment elevated myocardial infarction (STEMI). Acute occlusion of LAD usually results in hemodynamic compromise. However, some patients maintain hemodynamic stability despite its proximal occlusion. As the factors associated with hemodynamic status in such patients are poorly understood, our study sought to determine the clinical and angiographic parameters associated with hemodynamic stability in these patients. Methods In this prospective observational study, 60 consecutive patients of acute anterior wall STEMI with completely occluded LAD on coronary angiography were included. Various clinical and angiographic parameters associated with hemodynamic status were evaluated. Results Of the 60 patients, 30 patients each were included in the hemodynamically stable (group I) and hemodynamically unstable group (group II). The mean age of the patients in group I and group II was 51.07±13.78 years and 55.47±11.69 years, respectively. The hemodynamically unstable group had a significantly higher number of patients with diabetes mellitus, elevated Troponin T level, and lower left ventricular ejection fraction as compared to the stable group (p<0.05). In contrast, 11 (36.7%) patients in the hemodynamically stable group had rich collaterals compared to 4 (13.3%) patients in the hemodynamically unstable group. The difference was statistically significant (p=0.037). Conclusion The present study showed that the presence of diabetes, severe LV systolic dysfunction, elevated Troponin-T level, and poor collaterals were associated with hemodynamic instability, whereas the presence of better collaterals predicted hemodynamic stability in patients presenting with anterior wall STEMI and total LAD occlusion.
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Affiliation(s)
- Parminder Singh Otaal
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amit Shah
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Akash Batta
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arnab Pal
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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14
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Marashly Q, Taleb I, Kyriakopoulos CP, Dranow E, Jones TL, Tandar A, Overton SD, Tonna JE, Stoddard K, Wever-Pinzon O, Kemeyou L, Koliopoulou AG, Shah KS, Nourian K, Richins TJ, Burnham TS, Welt FG, McKellar SH, Nativi-Nicolau J, Drakos SG. Predicting mortality in cardiogenic shock secondary to ACS requiring short-term mechanical circulatory support: The ACS-MCS score. Catheter Cardiovasc Interv 2021; 98:1275-1284. [PMID: 33682308 DOI: 10.1002/ccd.29581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/20/2021] [Accepted: 02/14/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To identify predictors of 30-day all-cause mortality for patients with cardiogenic shock secondary to acute coronary syndrome (ACS-CS) who require short-term mechanical circulatory support (ST-MCS). BACKGROUND ACS-CS mortality is high. ST-MCS is an attractive treatment option for hemodynamic support and stabilization of deteriorating patients. Mortality prediction modeling for ACS-CS patients requiring ST-MCS has not been well-defined. METHODS The Utah Cardiac Recovery (UCAR) Shock database was used to identify patients admitted with ACS-CS requiring ST-MCS devices between May 2008 and August 2018. Pre-ST-MCS clinical, laboratory, echocardiographic, and angiographic data were collected. The primary endpoint was 30-day all-cause mortality. A weighted score comprising of pre-ST-MCS variables independently associated with 30-day all-cause mortality was derived and internally validated. RESULTS A total of 159 patients (mean age, 61 years; 78% male) were included. Thirty-day all-cause mortality was 49%. Multivariable analysis resulted in four independent predictors of 30-day all-cause mortality: age, lactate, SCAI CS classification, and acute kidney injury. The model had good calibration and discrimination (area under the receiver operating characteristics curve 0.80). A predictive score (ranging 0-4) comprised of age ≥ 60 years, pre-ST-MCS lactate ≥2.5 mmol/L, AKI at time of ST-MCS implementation, and SCAI CS stage E effectively risk stratified our patient population. CONCLUSION The ACS-MCS score is a simple and practical predictive score to risk-stratify CS secondary to ACS patients based on their mortality risk. Effective mortality risk assessment for ACS-CS patients could have implications on patient selection for available therapeutic strategy options.
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Affiliation(s)
- Qussay Marashly
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Iosif Taleb
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Christos P Kyriakopoulos
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Elizabeth Dranow
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tara L Jones
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Anwar Tandar
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Sean D Overton
- Cardiovascular intensive care unit (CVICU), University of Utah School of Medicine, Salt Lake City, Utah, USA.,Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Cardiovascular intensive care unit (CVICU), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kathleen Stoddard
- Cardiovascular intensive care unit (CVICU), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Omar Wever-Pinzon
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Cardiovascular intensive care unit (CVICU), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Line Kemeyou
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Cardiovascular intensive care unit (CVICU), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Antigone G Koliopoulou
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Cardiovascular intensive care unit (CVICU), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kevin S Shah
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Cardiovascular intensive care unit (CVICU), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kimiya Nourian
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tyler J Richins
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tyson S Burnham
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Frederick G Welt
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Stephen H McKellar
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Cardiovascular intensive care unit (CVICU), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jose Nativi-Nicolau
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Cardiovascular intensive care unit (CVICU), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Stavros G Drakos
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Cardiovascular intensive care unit (CVICU), University of Utah School of Medicine, Salt Lake City, Utah, USA
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15
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Semaan C, Charbonnier A, Pasco J, Darwiche W, Saint Etienne C, Bailleul X, Bourguignon T, Fauchier L, Angoulvant D, Ivanes F, Genet T. Risk Scores in ST-Segment Elevation Myocardial Infarction Patients with Refractory Cardiogenic Shock and Veno-Arterial Extracorporeal Membrane Oxygenation. J Clin Med 2021; 10:jcm10050956. [PMID: 33804450 PMCID: PMC7957612 DOI: 10.3390/jcm10050956] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 12/14/2022] Open
Abstract
Although many risk models have been tested in patients implanted by veno-arterial extracorporeal membrane oxygenation (VA-ECMO), few scores assessed patients’ prognosis in the setting of ST-segment elevation myocardial infarction (STEMI) with refractory cardiogenic shock. We aimed at assessing the performance of risk scores, notably the prEdictioN of Cardiogenic shock OUtcome foR AMI patients salvaGed by VA-ECMO (ENCOURAGE) score, for predicting mortality in this particular population. This retrospective observational study included patients admitted to Tours University Hospital for STEMI with cardiogenic shock and requiring hemodynamic support by VA-ECMO. Among the fifty-one patients, the 30-day and 6-month survival rates were 63% and 56% respectively. Thirty days after VA-ECMO therapy, probabilities of mortality were 12, 17, 33, 66, 80% according to the ENCOURAGE score classes 0–12, 13–18, 19–22, 23–27, and ≥28, respectively. The ENCOURAGE score (AUC of the Receiving Operating Characteristic curve = 0.83) was significantly better compared to other risk scores. The hazard ratio for survival at 30 days for each point of the ENCOURAGE score was 1.10 (CI 95% (1.06, 1.15); p < 0.001). Decision curve analysis indicated that the ENCOURAGE score had the best clinical usefulness of the tested risk scores and the Hosmer–Lemeshow test suggested an accurate calibration. Our data suggest that the ENCOURAGE score is valid and the most relevant score to predict 30-day mortality after VA-ECMO therapy in STEMI patients with refractory cardiogenic shock. It may help decision-making teams to better select STEMI patients with shock for VA-ECMO therapy.
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Affiliation(s)
- Carl Semaan
- Service de Cardiologie, Centre Hospitalier Régional, Universitaire de Tours, 37044 Tours, France; (C.S.); (A.C.); (W.D.); (C.S.E.); (L.F.); (D.A.); (T.G.)
- Faculté de Médecine, Université de Tours, 37032 Tours, France;
| | - Arthur Charbonnier
- Service de Cardiologie, Centre Hospitalier Régional, Universitaire de Tours, 37044 Tours, France; (C.S.); (A.C.); (W.D.); (C.S.E.); (L.F.); (D.A.); (T.G.)
| | - Jeremy Pasco
- Service d’Informatique Médicale, Épidémiologie et Économie de la Santé, Centre Hospitalier Régional, Universitaire de Tours, 37044 Tours, France;
| | - Walid Darwiche
- Service de Cardiologie, Centre Hospitalier Régional, Universitaire de Tours, 37044 Tours, France; (C.S.); (A.C.); (W.D.); (C.S.E.); (L.F.); (D.A.); (T.G.)
- Faculté de Médecine, Université de Tours, 37032 Tours, France;
| | - Christophe Saint Etienne
- Service de Cardiologie, Centre Hospitalier Régional, Universitaire de Tours, 37044 Tours, France; (C.S.); (A.C.); (W.D.); (C.S.E.); (L.F.); (D.A.); (T.G.)
| | - Xavier Bailleul
- Service de Chirurgie Cardiaque, Centre Hospitalier Régional, Universitaire de Tours, 37044 Tours, France;
| | - Thierry Bourguignon
- Faculté de Médecine, Université de Tours, 37032 Tours, France;
- Service de Chirurgie Cardiaque, Centre Hospitalier Régional, Universitaire de Tours, 37044 Tours, France;
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Régional, Universitaire de Tours, 37044 Tours, France; (C.S.); (A.C.); (W.D.); (C.S.E.); (L.F.); (D.A.); (T.G.)
- Faculté de Médecine, Université de Tours, 37032 Tours, France;
| | - Denis Angoulvant
- Service de Cardiologie, Centre Hospitalier Régional, Universitaire de Tours, 37044 Tours, France; (C.S.); (A.C.); (W.D.); (C.S.E.); (L.F.); (D.A.); (T.G.)
- Faculté de Médecine, Université de Tours, 37032 Tours, France;
| | - Fabrice Ivanes
- Service de Cardiologie, Centre Hospitalier Régional, Universitaire de Tours, 37044 Tours, France; (C.S.); (A.C.); (W.D.); (C.S.E.); (L.F.); (D.A.); (T.G.)
- Faculté de Médecine, Université de Tours, 37032 Tours, France;
- Correspondence:
| | - Thibaud Genet
- Service de Cardiologie, Centre Hospitalier Régional, Universitaire de Tours, 37044 Tours, France; (C.S.); (A.C.); (W.D.); (C.S.E.); (L.F.); (D.A.); (T.G.)
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16
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Jentzer JC, Schrage B, Holmes DR, Dabboura S, Anavekar NS, Kirchhof P, Barsness GW, Blankenberg S, Bell MR, Westermann D. Influence of age and shock severity on short-term survival in patients with cardiogenic shock. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:604-612. [PMID: 33580778 DOI: 10.1093/ehjacc/zuaa035] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/28/2020] [Accepted: 12/10/2020] [Indexed: 12/27/2022]
Abstract
AIMS Cardiogenic shock (CS) is associated with poor outcomes in older patients, but it remains unclear if this is due to higher shock severity. We sought to determine the associations between age and shock severity on mortality among patients with CS. METHODS AND RESULTS Patients with a diagnosis of CS from Mayo Clinic (2007-15) and University Clinic Hamburg (2009-17) were subdivided by age. Shock severity was graded using the Society for Cardiovascular Angiography and Intervention (SCAI) shock stages. Predictors of 30-day survival were determined using Cox proportional-hazards analysis. We included 1749 patients (934 from Mayo Clinic and 815 from University Clinic Hamburg), with a mean age of 67.6 ± 14.6 years, including 33.6% females. Acute coronary syndrome was the cause of CS in 54.0%. The distribution of SCAI shock stages was 24.1%; C, 28.0%; D, 33.2%; and E, 14.8%. Older patients had similar overall shock severity, more co-morbidities, worse kidney function, and decreased use of mechanical circulatory support compared to younger patients. Overall 30-day survival was 53.3% and progressively decreased as age or SCAI shock stage increased, with a clear gradient towards lower 30-day survival as a function of increasing age and SCAI shock stage. Progressively older age groups had incrementally lower adjusted 30-day survival than patients aged <50 years. CONCLUSION Older patients with CS have lower short-term survival, despite similar shock severity, with a high risk of death in older patients with more severe shock. Further research is needed to determine the optimal treatment strategies for older CS patients.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Benedikt Schrage
- Department of Interventional and General Cardiology, University Heart Centre Hamburg, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), University Heart Centre Hamburg, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Salim Dabboura
- Department of Interventional and General Cardiology, University Heart Centre Hamburg, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), University Heart Centre Hamburg, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Paulus Kirchhof
- Department of Interventional and General Cardiology, University Heart Centre Hamburg, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), University Heart Centre Hamburg, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Stefan Blankenberg
- Department of Interventional and General Cardiology, University Heart Centre Hamburg, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), University Heart Centre Hamburg, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Dirk Westermann
- Department of Interventional and General Cardiology, University Heart Centre Hamburg, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), University Heart Centre Hamburg, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
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17
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Farhan S, Vogel B, Montalescot G, Barthelemy O, Zeymer U, Desch S, de Waha-Thiele S, Maier LS, Sandri M, Akin I, Fuernau G, Ouarrak T, Hauguel-Moreau M, Schneider S, Thiele H, Huber K. Association of Culprit Lesion Location With Outcomes of Culprit-Lesion-Only vs Immediate Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Cardiol 2020; 5:1329-1337. [PMID: 32845312 DOI: 10.1001/jamacardio.2020.3377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Myocardial infarction with a culprit lesion located in the left main or proximal left anterior descending artery compared with other coronary segments is associated with more myocardium at risk and worse clinical outcomes. Objective To evaluate the association of culprit lesion location with outcomes of culprit-lesion-only percutaneous coronary intervention with optional staged revascularization vs immediate multivessel percutaneous coronary intervention in patients with multivessel disease, myocardial infarction, and cardiogenic shock. Design, Setting, and Participants Post hoc analysis of the Culprit Lesion Only Coronary Intervention vs Multivessel Coronary Intervention in Cardiogenic Shock (CULPRIT-SHOCK), an investigator-initiated randomized, open-label clinical trial. Patients with multivessel disease, acute myocardial infarction, and cardiogenic shock were enrolled at 83 European centers from April 2013 through April 2017. Interventions Patients were randomized to culprit-lesion-only percutaneous coronary intervention with optional staged revascularization or immediate multivessel percutaneous coronary intervention (1:1). For this analysis, patients were stratified by culprit lesion location in the left main or proximal left anterior descending artery group and other-culprit-lesion location group. Main Outcomes and Measures End points included a composite of death or kidney replacement therapy at 30 days and death at 1 year. Results The median age of the study population was 70 (interquartile range, 60-78 years) and 524 of the study participants were men (76.4%). Of the 685 patients, 33.4% constituted the left main or proximal left anterior descending artery group and 66.6% the other-culprit-lesion location group. The left main or proximal left anterior descending artery group had worse outcomes compared with the other-culprit-lesion location group (56.8% vs 47.5%; P = .02 for the composite end point at 30 days and 59.8% vs 50.1%; P = .02 for death at 1 year). In both groups, culprit-lesion-only vs immediate multivessel percutaneous coronary intervention was associated with a reduced risk of the composite end point at 30 days (49.1% vs 64.3% and 44.1% vs 50.9%; P for interaction = .27). At 1 year, culprit-lesion-only vs immediate multivessel percutaneous coronary intervention was associated with a significantly reduced risk of death in the left main or proximal left anterior descending artery but not the other-culprit-lesion location group (50.0% vs 69.6%; P = .003 and 49.8% vs 50.4%; P = .89; P for interaction = 0.02). Conclusions and Relevance In patients with multivessel disease with myocardial infarction and cardiogenic shock, a culprit lesion located in the left main or proximal left anterior descending artery vs other coronary segments was associated with worse outcomes. These patients may especially benefit from culprit-lesion-only percutaneous coronary intervention with optional staged revascularization, although further investigation is needed to confirm this finding. Trial Registration ClinicalTrials.gov Identifier: NCT01927549.
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Affiliation(s)
- Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Wilhelminenspital, Department of Cardiology, Vienna, Austria
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Wilhelminenspital, Department of Cardiology, Vienna, Austria
| | - Gilles Montalescot
- ACTION Study Group, Centre Hospitalier Universitaire Pitié-Salpêtrière, Sorbonne Université Paris 6, Paris, France
| | - Olivier Barthelemy
- ACTION Study Group, Centre Hospitalier Universitaire Pitié-Salpêtrière, Sorbonne Université Paris 6, Paris, France
| | - Uwe Zeymer
- Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Steffen Desch
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Suzanne de Waha-Thiele
- Department of Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany
| | - Lars S Maier
- Department of Cardiology, Pneumology, and Intensive Care, University Hospital Regensburg, Regensburg, Germany
| | - Marcus Sandri
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Ibrahim Akin
- University Medical Centre Mannheim, First Department of Medicine, Faculty of Medicine, University of Heidelberg, Mannheim, Germany
| | - Georg Fuernau
- Department of Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany
| | | | - Marie Hauguel-Moreau
- ACTION Study Group, Centre Hospitalier Universitaire Pitié-Salpêtrière, Sorbonne Université Paris 6, Paris, France
| | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Kurt Huber
- Wilhelminenspital, Department of Cardiology, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
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18
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Glycoprotein IIb/IIIa inhibitors for cardiogenic shock complicating acute myocardial infarction: a systematic review, meta-analysis, and meta-regression. J Intensive Care 2020; 8:85. [PMID: 33292610 PMCID: PMC7656750 DOI: 10.1186/s40560-020-00502-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/26/2020] [Indexed: 01/11/2023] Open
Abstract
Background Cardiogenic shock complicates 5–10% of myocardial infarction (MI) cases. Data about the benefit of glycoprotein IIb/IIIa inhibitors (GPI) in these patients is sparse and conflicting. Methods We performed a systematic review, meta-analysis, and meta-regression of studies assessing the impact of GPI use in the setting of MI complicated cardiogenic shock on mortality, angiographic success, and bleeding events. We systematically searched for studies comparing GPI use as adjunctive treatment versus standard care in this setting. Random-effects meta-analysis and meta-regression were performed. Results Seven studies with a total of 1216 patients (GPI group, 720 patients; standard care group, 496 patients) were included. GPI were associated with a 45% relative reduction in the odds of death at 30 days (pooled OR 0.55; 95% CI 0.35–0.85; I2 = 57%; P = 0.007) and a 49% reduction in the odds of death at 1 year (pooled OR 0.51; 95% CI 0.32–0.82; I2 = 58%; P = 0.005). Reduction in short-term mortality seemed to be more important before 2000, as this benefit disappears if only the more recent studies are analyzed. GPI were associated with a 2-fold increase in the probability of achieving TIMI 3 flow (pooled OR, 2.05; 95% CI 1.37–3.05; I2 = 37%, P = 0.0004). Major bleeding events were not increased with GPI therapy (pooled OR, 1.0; 95% CI 0.55–1.83; I2 = 1%, P = 0.99). Meta-regression identified that patients not receiving an intra-aortic balloon pump seemed to benefit the most from GPI use (Z = − 1.57, P = 0.005). Conclusion GPI therapy as an adjunct to standard treatment in cardiogenic shock was associated with better outcomes, including both short- and long-term survival, without increasing the risk of bleeding.
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19
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Zhang X, Guo T, Zhang K, Guo W, An X, Gao P. Effect of shenfu injection on microcirculation in shock patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22872. [PMID: 33120828 PMCID: PMC7581111 DOI: 10.1097/md.0000000000022872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Shock is a major public health problem worldwide. At present, the morbidity and mortality of shock patients are relatively high. Vasomotor dysfunction is 1 of the key pathological aspects of shock. Shenfu injection has been widely used for the treatment of shock in China. Pharmacological studies have suggested that Shenfu injection can reduce peripheral circulation resistance and improve microcirculation. The purpose of this study is to evaluate the effect and safety of Shenfu injection on the microcirculation of patients with shock. METHODS This review summarizes and meta-analyzes randomized controlled trials of Shenfu injection for the treatment of shock.Searched the following electronic databases: PubMed, Cochrane Library, Embase, CNKI, VIP and Wanfang Data. The Cochrane risk assessment tool was used to evaluate the methodological quality of randomized controlled trials. All tests are analyzed according to the standards of the Cochrane Handbook. Review Manager 5.3, R-3.5.1 software and Grading of Recommendations Assessment, Development, and Evaluation pro GDT web solution are used for data synthesis and analysis. RESULTS This review focuses on the effects of Shenfu injection on the microcirculation of shock patients (blood lactic acid level, arteriovenous oxygen saturation, arteriovenous carbon dioxide partial pressure difference, sublingual microcirculation), 28-day mortality, 28-day ICU hospitalization and adverse reaction rate. CONCLUSION This review provides a clear basis for evaluating the impact of Shenfu injection on the microcirculation of shock patients, as well as the effectiveness and safety of the treatment.
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Affiliation(s)
| | | | | | | | - Xing An
- Department of Respiratory, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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20
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Kim HS, Park KH, Ha SO, Lee SH, Choi HM, Kim SA, Park S, Jo SH, Kim HS, Han SJ, Park WJ. Predictors of survival following veno-arterial extracorporeal membrane oxygenation in patients with acute myocardial infarction-related refractory cardiogenic shock: clinical and coronary angiographic factors. J Thorac Dis 2020; 12:2507-2516. [PMID: 32642158 PMCID: PMC7330300 DOI: 10.21037/jtd.2020.03.51] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aimed to identify the determinant factors of survival in patients with acute myocardial infarction (AMI) and refractory cardiogenic shock (RCS) who underwent veno-arterial extracorporeal membrane oxygenation (ECMO). Methods Sixty-nine consecutive patients with AMI-related RCS were enrolled in the study. They were treated with ECMO and primary percutaneous coronary intervention (PCI). The clinical scores and coronary angiography (CAG) factors related to 100-day survival were evaluated. Results Thirty patients (43.5%) survived for more than 100 days. The CAG showed that 19 (27.5%) patients had left main disease (LMD). There were 17 (24.6%), 27 (39.1%), and 25 (36.3%) patients with one-vessel, two-vessel, and three-vessel disease, respectively. There were significant differences between the survivors and non-survivors in the simplified acute physiology score II (SAPSII) (65.4±17.2 vs. 83.1±13.0, P<0.001), sepsis-related organ failure assessment score (SOFA) (10.4±2.7 vs. 12.3±2.5, P=0.004), survival after veno-arterial extracorporeal membrane oxygenation score (SAVE) (-4.4±4.3 vs. -8.4±3.1, P<0.001), CPR time (15.8±16.6 vs. 30.0±29.5, P=0.048), LMD [4 (13.3%) vs. 15 (38.5%), P=0.029], and number of coronary artery disease (NCAD) (P<0.001). Multivariate logistic regression analysis showed that NCAD (OR 3.788, P=0.008) was one of the independent predictors of mortality. The ROC analysis showed that SAPSII (AUC 0.786, P<0.001), SOFA (AUC 0.715, P=0.002), and SAVE (AUC 0.766, P<0.001) equally predict mortality. The combined NCAD parameters more accurately predicted mortality and differences in the AUC values (d-AUC) between SAPSII plus NCAD vs. SAPSII (d-AUC 0.073, z=2.256, P=0.024), SOFA plus NCAD vs. SOFA (d-AUC 0.058, z=2.773, P=0.006), and SAVE plus NCAD vs. SAVE (d-AUC 0.036, z=2.332, P=0.020). Conclusions The SAPSII, SOFA, and SAVE scores predict the prognosis of ECMO-treated AMI patients with RCS. The CAG findings reinforce the predictive power of each score.
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Affiliation(s)
- Hyoung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi, Korea
| | - Kyoung-Ha Park
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Anyang, Gyeonggi, Korea
| | - Sang Ook Ha
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi, Korea
| | - Sun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi, Korea
| | - Hong-Mi Choi
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Anyang, Gyeonggi, Korea
| | - Sung-Ai Kim
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Anyang, Gyeonggi, Korea
| | - Sunghoon Park
- Department of Pulmonary and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi, Korea
| | - Sang Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Anyang, Gyeonggi, Korea
| | - Hyun-Sook Kim
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Anyang, Gyeonggi, Korea
| | - Sang Jin Han
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Anyang, Gyeonggi, Korea
| | - Woo Jung Park
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Anyang, Gyeonggi, Korea
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21
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Noaman S, Andrianopoulos N, Brennan AL, Dinh D, Reid C, Stub D, Biswas S, Clark D, Shaw J, Ajani A, Freeman M, Yip T, Oqueli E, Walton A, Duffy SJ, Chan W. Outcomes of cardiogenic shock complicating acute coronary syndromes. Catheter Cardiovasc Interv 2020; 96:E257-E267. [PMID: 32017332 DOI: 10.1002/ccd.28759] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/24/2019] [Accepted: 01/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We aimed to assess the outcomes of cardiogenic shock (CS) complicating acute coronary syndromes (ACS). BACKGROUND CS remains the leading cause of mortality in patients presenting with ACS despite advances in care. METHODS We studied 13,184 patients undergoing percutaneous coronary intervention (PCI) for all subtypes of ACS enrolled prospectively in a large multicentre Australian registry (Melbourne Interventional Group registry) from 2005 to 2013. All-cause mortality was obtained via linkage to the National Death Index. Patients were divided into those with and those without CS. RESULTS Compared to the non-CS group (n = 12,548, 95.2%), the CS group (n = 636, 4.8%) had a higher proportion of out-of-hospital cardiac arrest (OHCA) (31.1 vs. 2.2%) and ST-elevation myocardial infarction (STEMI) presentation (89 vs. 34%), both p < .01. Patients in the CS group had higher rates of in-hospital (40.4 vs. 1.2%) and 30-day (41 vs. 1.7%) mortality compared to the non-CS group. Long-term mortality over a median follow-up of 4.2 years was higher in the CS group (50.6 vs. 13.8%), p < .001. Trends of in-hospital and 30-day mortality rates of CS complicating ACS were relatively stable from 2005 to 2013. Predictors of long-term NDI-linked mortality within the CS group include severe left ventricular systolic dysfunction (HR 3.0), glomerular filtration rate (GFR) <30 (HR 2.56), GFR 30-59 (HR 1.94), OHCA (HR 1.46), diabetes (HR 1.44), and age (HR 1.02), all p < .05. CONCLUSIONS Rates of CS-related mortality complicating ACS have remained very high and steady over nearly a decade despite progress in STEMI systems of care, PCI techniques, and medical therapy.
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Affiliation(s)
- Samer Noaman
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Research Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - Christopher Reid
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - Sinjini Biswas
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - James Shaw
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Clinical Research Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andrew Ajani
- Clinical Research Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Thomas Yip
- Department of Cardiology, Geelong University Hospital, Geelong, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Clinical Research Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
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22
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Sharma YP, Krishnappa D, Kanabar K, Kasinadhuni G, Sharma R, Kishore K, Mehrotra S, Santosh K, Gupta A, Panda P. Clinical characteristics and outcome in patients with a delayed presentation after ST-elevation myocardial infarction and complicated by cardiogenic shock. Indian Heart J 2019; 71:387-393. [PMID: 32035521 PMCID: PMC7013184 DOI: 10.1016/j.ihj.2019.11.256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/25/2019] [Accepted: 11/11/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Delayed presentation after ST-elevation myocardial infarction (STEMI) and complicated by cardiogenic shock (CS-STEMI) is commonly encountered in developing countries and is a challenging scenario because of a delay in revascularization resulting in infarction of a large amount of the myocardium. We aimed to assess the clinical characteristics, angiographic profile, and predictors of outcome in patients with a delayed presentation after CS-STEMI. METHODS A total of 147 patients with CS-STEMI with time to appropriate medical care ≥12 h after symptom onset were prospectively recruited at a tertiary referral center. RESULTS The median time to appropriate care was 24 h (interquartile range 18-48 h). The mean age was 58.7 ± 11.1 years. Left ventricular pump failure was the leading cause of shock (67.3%), whereas mechanical complications accounted for 14.9% and right ventricular infarction for 13.6% of cases. The overall in-hospital mortality was 42.9%. Acute kidney injury [Odds ratio (OR) 8.04; 95% confidence intervals (CI) 3.08-20.92], ventricular tachycardia (OR 7.04; CI 2.09-23.63), mechanical complications (OR 6.46; CI 1.80-23.13), and anterior infarction (OR 3.18; CI 1.01-9.97) were independently associated with an increased risk of mortality. Coronary angiogram (56.5%) revealed single-vessel disease (45.8%) as the most common finding. Percutaneous coronary intervention was performed in 53 patients (36%), at a median of 36 h (interquartile range 30-72) after symptom onset. CONCLUSION Patients with a delayed presentation after CS-STEMI were younger and more likely to have single-vessel disease. We found a high in-hospital mortality of 42.9%. Appropriate randomized studies are required to evaluate the optimal treatment strategies in these patients.
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Affiliation(s)
- Yash Paul Sharma
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Darshan Krishnappa
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Kewal Kanabar
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rakesh Sharma
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Kamal Kishore
- Department of Biostatistics, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Saurabh Mehrotra
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Krishna Santosh
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ankur Gupta
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Prashant Panda
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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23
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Choi KH, Yang JH, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Choi JH, Cho YH, Sung K, Carriere K, Ahn J, Gwon HC. Modelo de predicción de riesgo de mortalidad hospitalaria para pacientes con infarto de miocardio tratados con oxigenador extracorpóreo de membrana venoarterial. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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24
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Moraes PIM, Alves CR, Souza MT, Kawakami SE, Goncalves I, Barbosa AHP, Moreno AC, Caixeta AM, Carvalho AC. Cardiogenic shock after ST elevation myocardial infarction and IABP-SHOCK II risk score validation in a cohort treated with pharmacoinvasive strategy. Open Heart 2019; 6:e001069. [PMID: 31413846 PMCID: PMC6667936 DOI: 10.1136/openhrt-2019-001069] [Citation(s) in RCA: 2] [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] [Received: 04/18/2019] [Revised: 06/12/2019] [Accepted: 07/04/2019] [Indexed: 11/04/2022] Open
Abstract
Objective To validate the Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) score in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI) treated with pharmacoinvasive strategy (PhIS) and to analyse the influence of ischaemia time on different risk strata. Methods We analysed 2143 patients with STEMI who underwent reperfusion with tenecteplase in primary health services between May 2010 and April 2017 and were transferred to a tertiary hospital for cardiac catheterisation and continuity of care. Those who evolved to cardiogenic shock were scored as low (0-2), moderate (3-4) or high (5-9) risk of death in 30 days and pairwise-log-rank test was used to compare strata. Time intervals between symptoms onset and lytic (pain-to-needle) and fibrinolytic-catheterisation were also compared. Results Cardiogenic shock occurred in 212 (9.9%) individuals. The 30-day mortality using the IABP-SHOCK II score was 26.6% for low-risk (n=94), 53.2% for moderate-risk (n=62) and 76% for high-risk (n=25) analysed patients (p<0.001). Validation of the score showed good discrimination for death, area under the curve of 0.73 (CI: 0.66 to 0.81; p<0.001). The median intervals of pain-to-needle and fibrinolytic-catheterisation showed no association with the group stratification (220 vs 251 vs 200 min; p=0.22 and 390 vs 435 vs 315 min; p=0.18, respectively). Conclusions In patients with cardiogenic shock after STEMI treated with PhIS, risk stratification using IABP-SHOCK II score was adequate. There was no influence of pain-to-needle and fibrinolytic-catheterisation times on the ability to the score model stratification.
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Affiliation(s)
- Pedro Ivo M Moraes
- Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Claudia Rodrigues Alves
- Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Marco Tulio Souza
- Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Suzi Emiko Kawakami
- Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Iran Goncalves
- Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Antonio Celio Moreno
- Department of Cardiology, Hospital do Servidor Público Municipal, Sao Paulo, Brazil
| | - Adriano Mendes Caixeta
- Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.,Department of Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Antonio Carlos Carvalho
- Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
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25
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Thiele H, Ohman EM, de Waha-Thiele S, Zeymer U, Desch S. Management of cardiogenic shock complicating myocardial infarction: an update 2019. Eur Heart J 2019; 40:2671-2683. [DOI: 10.1093/eurheartj/ehz363] [Citation(s) in RCA: 234] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/17/2019] [Accepted: 05/11/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Cardiogenic shock (CS) remains the most common cause of death in patients admitted with acute myocardial infarction (AMI) and mortality remained nearly unchanged in the range of 40–50% during the last two decades. Early revascularization, vasopressors and inotropes, fluids, mechanical circulatory support, and general intensive care measures are widely used for CS management. However, there is only limited evidence for any of the above treatment strategies except for revascularization and the relative ineffectiveness of intra-aortic balloon pumping. This updated review will outline the management of CS complicating AMI with major focus on state-of-the art treatment.
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Affiliation(s)
- Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany
| | - E Magnus Ohman
- Duke Heart Center, Duke University Medical Center, Box 3126 DUMC, Durham, NC 27710, USA
| | - Suzanne de Waha-Thiele
- Department of Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, University Heart Center Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Uwe Zeymer
- Klinikum Ludwigshafen, Medizinische Klinik B, Bremserstraße 79, D-67063 Ludwigshafen, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany
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26
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Acute Noncardiac Organ Failure in Acute Myocardial Infarction With Cardiogenic Shock. J Am Coll Cardiol 2019; 73:1781-1791. [DOI: 10.1016/j.jacc.2019.01.053] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/03/2019] [Accepted: 01/08/2019] [Indexed: 11/24/2022]
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Avtaar Singh SS, Das De S, Nappi F, Al-Adhami A, Hegazy Y, Dalzell J, Doshi H, Sinclair A, Curry P, Petrie M, Berry C, Al-Attar N. Mechanical circulatory support for refractory cardiogenic shock post-acute myocardial infarction-a decade of lessons. J Thorac Dis 2019; 11:542-548. [PMID: 30962998 DOI: 10.21037/jtd.2019.01.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background There are 0.9 catheterization labs per 100,000 inhabitants in Scotland for percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), which are much less accessible to patients in remote and rural areas. An uncommon but sinister sequalae following AMI is cardiogenic shock (CS) that could be refractory to inotropic support. CS complicates 5-15% of AMIs occurring in ST-segment elevation myocardial infarctions (STEMIs). Outcomes of CS are poor with mortalities of up to 90% reported in the literature in the absence of experienced care. We report our experience as the tertiary referral centre in Scotland for MCS and heart transplantation over 8 years. Methods A retrospective review of prospectively collected data was undertaken on all patients registered to the MCS service. The database was interrogated for patient demographics, type of mechanical circulatory support (MCS) and duration of MCS support, PCI-outcomes and survival to 30 days. A time-to-event analysis was performed using patient survival as the primary outcome measure. Results Twenty-three patients (16 male, 7 females) were included. The median age of the patients as 50 years (range, 45-56 years). VA-ECMO was the initial MCS of choice in 17 (73.9%) patients with BIVAD for 4 (17.4%) patients and LVAD for 2 (8.7%) patients. Thirty-day mortality was 21.8% in this cohort, however survival to discharge was 52.2%. Eleven (47.8%) patients recovered without the need for any further support, however only 9 (81.8%) patients in this subgroup survived to discharge. Three (13.0%) patients received a durable LVAD. In this subgroup, one patient was transplanted whereas two patients died due to complications while on support. The median length of in-hospital MCS support was 4 days. Median in-hospital stay was 27 days. Long-term follow up of up to 8 years demonstrates a high mortality beyond 30-day up to the first 6-month post MCS support. Conclusions MCS usage in these patients carries a high mortality in the early post-implantation period. However, there is a significant benefit to patients who survive the initial bridging period to recovery or destination therapy.
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Affiliation(s)
- Sanjeet Singh Avtaar Singh
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sudeep Das De
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Francesco Nappi
- Department of Cardiothoracic Surgery, Centre Cardiologique du Nord St Denis, Paris, France
| | - Ahmed Al-Adhami
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Yasser Hegazy
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK
| | - Jonathan Dalzell
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK
| | - Harikrishna Doshi
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew Sinclair
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK.,Department of Anaesthesiology, Golden Jubilee National Hospital, Glasgow, UK
| | - Philip Curry
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK
| | - Mark Petrie
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Nawwar Al-Attar
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK
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28
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Weipert KF, Bauer T, Nef HM, Hochadel M, Weidinger F, Gitt AK, Zeymer U, Hamm CW. Incidence and outcome of peri-procedural cardiogenic shock: results from the international Euro Heart Survey PCI registry. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 9:120-127. [PMID: 30618264 DOI: 10.1177/2048872618822460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a large body of literature on acute myocardial infarction complicated by cardiogenic shock. However, very little is known about patients who are initially haemodynamically stable and develop cardiogenic shock during percutaneous coronary intervention. METHODS A total of 47,407 consecutive patients were prospectively enrolled in the PCI Registry of the Euro Heart Survey Programme. We analysed interventions with peri-procedural complications that were classified as 'shock induced by procedure' on the case report form. Clinical and procedural characteristics as well as hospital outcomes of haemodynamically stable patients who developed cardiogenic shock during percutaneous coronary intervention were evaluated. Patients with haemodynamic instability at presentation prior to intervention were excluded. RESULTS A total of 68 patients (0.2%) developed cardiogenic shock as a complication of percutaneous coronary intervention. The majority of cases comprised acute coronary syndrome (60.3%) with complex lesions (93.1%). Most patients had multi-vessel disease (82.1%) and an ejection fraction less than 40% (58.1%). In the multivariate analysis, left main disease (odds ratio (OR) 9.51), ST-segment elevation myocardial infarction (OR 5.31) and multi-vessel disease without left main involvement (OR 3.32) were the strongest independent predictors of peri-procedural cardiogenic shock. Among these patients procedural success was low (66.1%) and in-hospital mortality was very high (39.7%). CONCLUSIONS In this real-world registry the rate of haemodynamically stable patients who developed cardiogenic shock during percutaneous coronary intervention was very low. Patients at a priori high risk were more likely to be affected by this complication. The in-hospital mortality rate of these patients was very high.
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Affiliation(s)
- Kay F Weipert
- Department of Cardiology, Justus-Liebig University of Giessen, Germany.,Department of Cardiology, Kerckhoff Klinik Bad Nauheim, Germany
| | - Timm Bauer
- Department of Cardiology, Justus-Liebig University of Giessen, Germany
| | - Holger M Nef
- Department of Cardiology, Justus-Liebig University of Giessen, Germany
| | | | - Franz Weidinger
- Department of Cardiology, Rudolfstiftung Hospital, Vienna, Austria
| | - Anselm K Gitt
- Institut für Herzinfarktforschung, Germany.,Department of Cardiology, Heart Center Ludwigshafen, Germany
| | - Uwe Zeymer
- Institut für Herzinfarktforschung, Germany.,Department of Cardiology, Heart Center Ludwigshafen, Germany
| | - Christian W Hamm
- Department of Cardiology, Justus-Liebig University of Giessen, Germany.,Department of Cardiology, Kerckhoff Klinik Bad Nauheim, Germany
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29
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Abstract
Myocardial infarction (MI) complicated by cardiogenic shock (MI-CS) is a major cause of cardiovascular morbidity and mortality. Predictors of outcomes in MI-CS include clinical, laboratory, radiologic variables, and management strategies. This article reviews the existing literature on short- and long-term predictors and risk stratification in MI complicated by CS.
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Affiliation(s)
- Deepak Acharya
- From the Section of Advanced Heart Failure, Mechanical Circulatory Support, and Pulmonary Vascular Disease, University of Alabama at Birmingham, Birmingham, AL
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Choi KH, Yang JH, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Choi JH, Cho YH, Sung K, Carriere K, Ahn J, Gwon HC. Risk Prediction Model of In-hospital Mortality in Patients With Myocardial Infarction Treated With Venoarterial Extracorporeal Membrane Oxygenation. ACTA ACUST UNITED AC 2018; 72:724-731. [PMID: 30037538 DOI: 10.1016/j.rec.2018.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 05/28/2018] [Indexed: 01/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES There are limited data to develop a risk prediction model of in-hospital mortality for acute myocardial infarction (AMI) patients treated with venoarterial (VA)-extracorporeal membrane oxygenation (ECMO). We aimed to develop a risk prediction model for in-hospital mortality in patients with AMI who were treated with VA-ECMO. METHODS A total of 145 patients with AMI who underwent VA-ECMO between May 2004 and April 2016 were included from the Samsung Medical Center ECMO registry. The primary outcome was in-hospital mortality. To develop a new predictive scoring system, named the AMI-ECMO score, backward stepwise elimination and β coefficient-based scoring were used based on logistic regression analyses. The leave-one-out cross-validation method was performed for internal validation. RESULTS In-hospital mortality occurred in 69 patients (47.6%). On multivariable logistic regression analysis, the AMI-ECMO score comprised 6 pre-ECMO or angiographic parameters: age> 65 years, body mass index> 25 kg/m2, Glasgow coma score <6, lactic acid> 8 mmol/L, anterior wall infarction, and no or failed revascularization. The C-statistic value of AMI-ECMO score for predicting in-hospital mortality was 0.880 (95%CI, 0.820-0.940). The incidence of in-hospital mortality after VA-ECMO insertion was 6.2%, 28.1%, 51.6%, and 93.8% for AMI-ECMO score quartiles (0 to 16, 17 to 19, 20 to 26, and> 26), respectively (P <.001 for trend). The AMI-ECMO scores were also significantly associated with the estimated rate of all-cause mortality during follow-up (per 1 increase, HR, 1.11; 95%CI, 1.08-1.14; P <.001). CONCLUSIONS The AMI-ECMO score can help predict early prognosis in AMI patients who undergo VA-ECMO.
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keumhee Carriere
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada; Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joonghyun Ahn
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Predictors of high Killip class after ST segment elevation myocardial infarction in the era of primary reperfusion. Int J Cardiol 2017; 248:46-50. [DOI: 10.1016/j.ijcard.2017.07.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/30/2017] [Accepted: 07/12/2017] [Indexed: 01/12/2023]
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Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States. Clin Res Cardiol 2017; 107:287-303. [DOI: 10.1007/s00392-017-1182-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
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Advanced Age as a Predictor of Survival and Weaning in Venoarterial Extracorporeal Oxygenation: A Retrospective Observational Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3505784. [PMID: 28484710 PMCID: PMC5397620 DOI: 10.1155/2017/3505784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/16/2017] [Accepted: 03/07/2017] [Indexed: 02/07/2023]
Abstract
Background. In most reports on ECMO treatment, advanced age is classified as a contraindication to VA ECMO. We attempted to investigate whether advanced age would be a main risk factor deciding VA ECMO application and performing VA ECMO support. We determined whether advanced age should be regarded as an absolute or relative contraindication to VA ECMO and could affect weaning and survival rates of VA ECMO patients. Methods. VA ECMO was performed on 135 adult patients with primary cardiogenic shock between January 2010 and December 2014. Successful weaning was defined as weaning from ECMO followed by survival for more than 48 hours. Results. Among the 135 patients, 35 survived and were discharged uneventfully, and the remaining 100 did not survive. There were significant differences in survival between age groups, and older age showed a lower survival rate with statistical significance (P = .01). By multivariate logistic regression analysis, age was not significantly associated with in-hospital mortality (P = .83) and was not significantly associated with VA ECMO weaning (P = .11). Conclusions. Advanced age is an undeniable risk factor for VA ECMO; however, patients of advanced age should not be excluded from the chance of recovery after VA ECMO treatment.
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Pöss J, Köster J, Fuernau G, Eitel I, de Waha S, Ouarrak T, Lassus J, Harjola VP, Zeymer U, Thiele H, Desch S. Risk Stratification for Patients in Cardiogenic Shock After Acute Myocardial Infarction. J Am Coll Cardiol 2017; 69:1913-1920. [DOI: 10.1016/j.jacc.2017.02.027] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 01/19/2017] [Accepted: 02/06/2017] [Indexed: 01/08/2023]
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De Luca L, Marini M, Gonzini L, Boccanelli A, Casella G, Chiarella F, De Servi S, Di Chiara A, Di Pasquale G, Olivari Z, Caretta G, Lenatti L, Gulizia MM, Savonitto S. Contemporary Trends and Age-Specific Sex Differences in Management and Outcome for Patients With ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2016; 5:e004202. [PMID: 27881426 PMCID: PMC5210417 DOI: 10.1161/jaha.116.004202] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/07/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Age- and sex-specific differences exist in the treatment and outcome of ST-elevation myocardial infarction (STEMI). We sought to describe age- and sex-matched contemporary trends of in-hospital management and outcome of patients with STEMI. METHODS AND RESULTS We analyzed data from 5 Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with STEMI. All the analyses were age- and sex-matched, considering 4 age classes: <55, 55 to 64, 65 to 74, and ≥75 years. A total of 13 235 patients were classified as having STEMI (72.1% men and 27.9% women). A progressive shift from thrombolysis to primary percutaneous coronary intervention occurred over time, with a concomitant increase in overall reperfusion rates (P for trend <0.0001), which was consistent across sex and age classes. The crude rates of in-hospital death were 3.2% in men and 8.4% in women (P<0.0001), with a significant increase over age classes for both sexes and a significant decrease over time for both sexes (all P for trend <0.01). On multivariable analysis, age (odds ratio 1.09, 95% CI 1.07-1.10, P<0.0001) and female sex (odds ratio 1.44, 95% CI 1.07-1.93, P=0.009) were found to be significantly associated with in-hospital mortality after adjustment for other risk factors, but no significant interaction between these 2 variables was observed (P for interaction=0.61). CONCLUSIONS Despite a nationwide shift from thrombolytic therapy to primary percutaneous coronary intervention for STEMI affecting both sexes and all ages, women continue to experience higher in-hospital mortality than men, irrespective of age.
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Affiliation(s)
- Leonardo De Luca
- Division of Cardiology, San Giovanni Evangelista Hospital, Tivoli (Rome), Italy
| | - Marco Marini
- Department of Cardiovascular Sciences, Ospedali Riuniti, Ancona, Italy
| | | | | | - Gianni Casella
- Department of Cardiology, Maggiore Hospital, Bologna, Italy
| | - Francesco Chiarella
- Division of Cardiology, Azienda Ospedaliera-Universitaria S. Martino, Genova, Italy
| | - Stefano De Servi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Di Chiara
- Division of Cardiology, Ospedale Sant'Antonio Abate, Tolmezzo, Italy
| | | | - Zoran Olivari
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Giorgio Caretta
- Division of Cardiology, Sant'Andrea Hospital, ASL 5 Liguria, La Spezia, Italy
| | - Laura Lenatti
- Division of Cardiology, Ospedale A. Manzoni, Lecco, Italy
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Minges KE, Herrin J, Fiorilli PN, Curtis JP. Development and validation of a simple risk score to predict 30-day readmission after percutaneous coronary intervention in a cohort of medicare patients. Catheter Cardiovasc Interv 2016; 89:955-963. [PMID: 27515069 DOI: 10.1002/ccd.26701] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/24/2016] [Accepted: 07/11/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To develop a risk model that can be used to identify PCI patients at higher risk of readmission who may benefit from additional resources at the time of discharge. BACKGROUND A high proportion of patients undergoing PCI are readmitted within 30 days of discharge. METHODS The sample comprised patients aged ≥65 years who underwent PCI at a CathPCI Registry®-participating hospital and could be linked with 100% Medicare fee-for-service claims between 01/2007 and 12/2009. The sample (n = 388,078) was randomly divided into risk score development (n = 193,899) and validation (n = 194,179) cohorts. We did not count as readmissions those associated with staged revascularization procedures. Multivariable logistic regression models using stepwise selection models were estimated to identify variables independently associated with all-cause 30-day readmission. RESULTS The mean 30-day readmission rates for the development (11.36%) and validation (11.35%) cohorts were similar. In total, 19 variables were significantly associated with risk of 30-day readmission (P < 0.05), and model c-statistics were similar in the development (0.67) and validation (0.66) cohorts. The simple risk score based on 14 variables identified patients at high and low risk of readmission. Patients with a score of ≥13 (15.4% of sample) had more than an 18.5% risk of readmission, while patients with a score ≤6 (41.9% of sample) had less than an 8% risk of readmission. CONCLUSION Among PCI patients, risk of readmission can be estimated using clinical factors present at the time of the procedure. This risk score may guide clinical decision-making and resource allocation for PCI patients at the time of hospital discharge. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Karl E Minges
- Center for Outcomes Research and Evaluation, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut
| | - Jeph Herrin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.,Health Research & Educational Trust, Chicago, Illinois
| | - Paul N Fiorilli
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeptha P Curtis
- Center for Outcomes Research and Evaluation, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut.,Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Med 2016; 42:370-378. [DOI: 10.1007/s00134-016-4223-9] [Citation(s) in RCA: 269] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/10/2016] [Indexed: 12/22/2022]
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Khan R, Al-Hawwas M, Hatem R, Azzalini L, Fortier A, Joliecoeur EM, Tanguay JF, Lavoie-L'Allier P, Ly HQ. Prognostic impact of the residual SYNTAX score on in-hospital outcomes in patients undergoing primary percutaneous coronary intervention. Catheter Cardiovasc Interv 2016; 88:740-747. [DOI: 10.1002/ccd.26413] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 11/23/2015] [Accepted: 12/26/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Razi Khan
- Interventional Division; Department of Medicine; Montreal Heart Institute and Université De Montréal; Montreal Quebec Canada
| | - Malek Al-Hawwas
- Interventional Division; Department of Medicine; Montreal Heart Institute and Université De Montréal; Montreal Quebec Canada
| | - Raja Hatem
- Interventional Division; Department of Medicine; Montreal Heart Institute and Université De Montréal; Montreal Quebec Canada
| | | | - Annik Fortier
- Montreal Heart Institute Coordinating Center and Université De Montréal; Montreal Quebec Canada
| | | | - Jean-Francois Tanguay
- Interventional Division; Department of Medicine; Montreal Heart Institute and Université De Montréal; Montreal Quebec Canada
| | - Philippe Lavoie-L'Allier
- Interventional Division; Department of Medicine; Montreal Heart Institute and Université De Montréal; Montreal Quebec Canada
| | - Hung Q. Ly
- Interventional Division; Department of Medicine; Montreal Heart Institute and Université De Montréal; Montreal Quebec Canada
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De Luca L, Olivari Z, Farina A, Gonzini L, Lucci D, Di Chiara A, Casella G, Chiarella F, Boccanelli A, Di Pasquale G, De Servi S, Bovenzi FM, Gulizia MM, Savonitto S. Temporal trends in the epidemiology, management, and outcome of patients with cardiogenic shock complicating acute coronary syndromes. Eur J Heart Fail 2015; 17:1124-32. [DOI: 10.1002/ejhf.339] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 07/06/2015] [Accepted: 07/18/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Leonardo De Luca
- Department of Cardiovascular Sciences; European Hospital; Rome Italy
| | - Zoran Olivari
- Department of Cardiology; Ca' Foncello Hospital; Treviso Italy
| | - Andrea Farina
- Division of Cardiology; Ospedale A. Manzoni; Lecco Italy
| | | | | | | | - Gianni Casella
- Department of Cardiology; Maggiore Hospital; Bologna Italy
| | - Francesco Chiarella
- Division of Cardiology; Azienda Ospedaliera-Universitaria; S. Martino Genova Italy
| | | | | | - Stefano De Servi
- Division of Cardiology; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
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Sandhu K, Nadar SK. Percutaneous coronary intervention in the elderly. Int J Cardiol 2015; 199:342-55. [PMID: 26241641 DOI: 10.1016/j.ijcard.2015.05.188] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 05/07/2015] [Accepted: 05/09/2015] [Indexed: 12/20/2022]
Abstract
Our population dynamics are changing. The number of octogenarians and older people in the general population is increasing and therefore the number of older patients presenting with acute coronary syndrome or stable angina is increasing. This group has a larger burden of coronary disease and also a greater number of concomitant comorbidities when compared to younger patients. Many of the studies assessing percutaneous coronary intervention (PCI) to date have actively excluded octogenarians. However, a number of studies, both retrospective and prospective, are now being undertaken to reflect the, "real" population. Despite being a higher risk group for both elective and emergency PCIs, octogenarians have the greatest to gain in terms of prognosis, symptomatic relief, and arguably more importantly, quality of life. Important future development will include assessment of patient frailty, encouraging early presentation, addressing gender differences on treatment strategies, identification of culprit lesion(s) and vascular access to minimise vascular complications. We are now appreciating that the new frontier is perhaps recognising and risk stratifying those elderly patients who have the most to gain from PCI. This review article summarises the most relevant trials and studies.
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Affiliation(s)
- Kully Sandhu
- Royal Stoke Hospital, University Hospitals of North Midlands, Newcastle Road, Stoke on Trent ST46QG, United Kingdom
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Harjola VP, Lassus J, Sionis A, Køber L, Tarvasmäki T, Spinar J, Parissis J, Banaszewski M, Silva-Cardoso J, Carubelli V, Di Somma S, Tolppanen H, Zeymer U, Thiele H, Nieminen MS, Mebazaa A. Clinical picture and risk prediction of short-term mortality in cardiogenic shock. Eur J Heart Fail 2015; 17:501-9. [DOI: 10.1002/ejhf.260] [Citation(s) in RCA: 390] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/12/2015] [Accepted: 01/23/2015] [Indexed: 01/09/2023] Open
Affiliation(s)
- Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki; Helsinki University Hospital; Helsinki Finland
| | - Johan Lassus
- Cardiology, University of Helsinki, Heart and Lung Center; Helsinki University Hospital; Helsinki Finland
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau; Biomedical Research Institute Sant Pau (IIB Sant Pau); Barcelona Spain
| | - Lars Køber
- Rigshospitalet, Copenhagen University Hospital, Division of Heart Failure; Pulmonary Hypertension and Heart Transplantation; Copenhagen Denmark
| | - Tuukka Tarvasmäki
- Emergency Medicine, University of Helsinki; Helsinki University Hospital; Helsinki Finland
| | - Jindrich Spinar
- University Hospital Brno; Department of Internal Medicine and Cardiology; Brno Czech Republic
| | - John Parissis
- Attikon University Hospital; Heart Failure Clinic and Secondary Cardiology Department; Athens Greece
| | - Marek Banaszewski
- Institute of Cardiology; Intensive Cardiac Therapy Clinic; Warsaw Poland
| | - Jose Silva-Cardoso
- University of Porto, CINTESIS, Department of Cardiology; Porto Medical School, São João Hospital Center; Porto Portugal
| | - Valentina Carubelli
- Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University and Civil Hospital of Brescia; Italy
| | - Salvatore Di Somma
- Department of Medical Sciences and Translational Medicine, University of Rome Sapienza; Emergency Medicine Sant'Andrea Hospital; Rome Italy
| | - Heli Tolppanen
- Cardiology, University of Helsinki, Heart and Lung Center; Helsinki University Hospital; Helsinki Finland
| | - Uwe Zeymer
- Klinikum Ludwigshafen; Medizinische Kinik B; Ludwighafen Germany
| | - Holger Thiele
- University of Lübeck, Medical Clinic II, Cardiology; Angiology and Intensive Care; Lübeck Germany
| | - Markku S Nieminen
- Cardiology, University of Helsinki, Heart and Lung Center; Helsinki University Hospital; Helsinki Finland
| | - Alexandre Mebazaa
- INSERM U942, Hopital Lariboisiere; APHP and University Paris Diderot; Paris France
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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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Acharji S, Mathur A, Lakshmanadoss U, Prasad H, Singh M, Kaluski E. Have we given up on intra-aortic balloon counterpulsation in post-myocardial infarction cardiogenic shock? Clin Cardiol 2013; 36:704-10. [PMID: 24105878 DOI: 10.1002/clc.22184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/02/2013] [Indexed: 01/19/2023] Open
Abstract
The recently published Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial concluded that intra-aortic counterpulsation (IACP) does not reduce 30-day mortality in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) for whom early revascularization strategy was planned. The study resulted in downgrading IACP in post-AMI CS patients by certain professional organizations like the European Society of Cardiology. Although this is the largest and most important CS study of this decade, it suffers from considerable shortcomings: (1) time intervals from chest-pain onset or AMI recognition to revascularization, enrollment, and IACP initiation are not disclosed; (2) 86.6% of the treatment arm initiated IACP only post-percutaneous coronary intervention (PCI), and 4.3 % did not receive IACP at all; (3) 17.4% of the control arm crossed over to IACP or other mechanical support, mostly due to protocol violations; (4) there is no adjudication of the mortality events; (5) follow-up is limited to 30 days; and (5) both methodology (especially IACP device size) and quality of IACP are not evaluated and documented. Because the study assessed mostly the efficacy and safety of IACP initiated post-PCI, the study conclusions should not be extrapolated to IACP pre-PCI or during PCI in CS. Moreover, IACP had a favorable effect on the mortality of younger patients. Intra-aortic counterpulsation should remain the first line of mechanical circulatory support for the hemodynamically compromised AMI patients with or without CS who are undergoing primary PCI. Early upgrade to more advanced mechanical circulatory support should be considered for selective suitable candidates who remain in refractory CS despite revascularization and IACP.
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Affiliation(s)
- Subasit Acharji
- Division of Cardiology, Robert Packer Hospital, Guthrie Health Services, Sayre, Pennsylvania
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Brennan JM, Curtis JP, Dai D, Fitzgerald S, Khandelwal AK, Spertus JA, Rao SV, Singh M, Shaw RE, Ho KK, Krone RJ, Weintraub WS, Weaver WD, Peterson ED. Enhanced Mortality Risk Prediction With a Focus on High-Risk Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2013; 6:790-9. [DOI: 10.1016/j.jcin.2013.03.020] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 03/12/2013] [Accepted: 03/15/2013] [Indexed: 01/29/2023]
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Bataille Y, Déry JP, Larose É, Déry U, Costerousse O, Rodés-Cabau J, Gleeton O, Proulx G, Abdelaal E, Machaalany J, Nguyen CM, Noël B, Bertrand OF. Deadly association of cardiogenic shock and chronic total occlusion in acute ST-elevation myocardial infarction. Am Heart J 2012; 164:509-15. [PMID: 23067908 DOI: 10.1016/j.ahj.2012.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 07/12/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The association between cardiogenic shock and 1 or >1 chronic total occlusion (CTO) in unselected patients presenting with ST-elevation myocardial infarction (MI) (STEMI) has not been characterized. METHODS Patients with STEMI referred with or without cardiogenic shock were categorized into no CTO, 1 CTO, and >1 CTO. The primary end point was the 30-day mortality. RESULTS Between 2006 and 2011, 2,020 consecutive patients were included. A total of 141 patients (7%) presented with cardiogenic shock on admission. The prevalence of 1 CTO and >1 CTO in a non-infarct-related artery was 23% and 5%, respectively, among patients with shock compared with 6% and 0.5% in patients without shock (P < .0001). Independent predictors of cardiogenic shock included left main-related MI (odds ratio [OR] 6.55, 95% CI 1.39-26.82, P = .019), CTO (OR 4.20, 95% CI 2.64-6.57, P < .001), creatinine clearance <60 mL/min (OR 3.41, 95% CI 2.32-4.99, P < .0001), and left anterior descending-related MI (OR 2.20, 95% CI 1.51-3.23, P < .0001). Thirty-day mortality was 100% in shock patients with >1 CTO, 65.6% with 1 CTO, and 40.2% in patients without CTO (P < .0001). After adjustment for left ventricular ejection fraction and renal function, CTO remained an independent predictor for 30-day mortality (hazard ratio [HR] 1.83; 95% CI 1.10-3.01, P = .02). CONCLUSION In patients with STEMI, CTO was strongly associated with cardiogenic shock on admission. In this setting, mortality was substantially higher in patients with 1 CTO and exceedingly high in those with >1 CTO. The presence of CTO was an independent predictor of early mortality.
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Abstract
Cardiogenic shock (CS) describes the physiologic state in which reduced cardiac output and resultant tissue hypoxia occur in the presence of adequate intravascular volume. Among patients hospitalized with myocardial infarction (MI), CS is the foremost cause of death. Women are more susceptible to CS than men in the setting of ST segment increase MI. Introduction of early revascularization strategies and mechanical ventricular support have seen a decrease in short-term mortality from CS. However, the prognosis following CS remains poor. This article examines the prevalence, causes, pathophysiology, and therapeutic options for CS among women.
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Affiliation(s)
- Vijay Kunadian
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Louise Coats
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Annapoorna S Kini
- Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Roxana Mehran
- Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
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48
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Khalid L, Dhakam SH. A review of cardiogenic shock in acute myocardial infarction. Curr Cardiol Rev 2011; 4:34-40. [PMID: 19924275 PMCID: PMC2774583 DOI: 10.2174/157340308783565456] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 01/10/2008] [Accepted: 01/11/2007] [Indexed: 12/12/2022] Open
Abstract
Cardiogenic shock continues to be the most common cause of death in patients hospitalized with acute myocardial infarction. It has also been frequently associated with ST-segment elevation myocardial infarction (STEMI) and patients with co-morbidities. Cardiogenic shock presents with low systolic blood pressure and clinical signs of hypoperfusion. Rapid diagnosis and supportive therapy in the form of medications, airway support and intra-aortic balloon counterpulsation is required. Initial stabilization can be followed by reperfusion by fibrinolytic therapy, emergent percutaneous intervention (PCI) or coronary artery bypass grafting (CABG). The latter two have been found to decrease mortality in the long term. Research is being carried out on the role of inflammatory mediators in the clinical manifestation of cardiogenic shock. Mechanical support devices also show promise in the future.
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Affiliation(s)
- L Khalid
- Department of Medicine, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
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49
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Hussain F, Philipp RK, Ducas RA, Elliott J, Džavík V, Jassal DS, Tam JW, Roberts D, Garber PJ, Ducas J. The ability to achieve complete revascularization is associated with improved in-hospital survival in cardiogenic shock due to myocardial infarction: Manitoba cardiogenic shock registry investigators. Catheter Cardiovasc Interv 2011; 78:540-8. [DOI: 10.1002/ccd.23006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 01/20/2011] [Indexed: 11/08/2022]
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50
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Sleeper LA, Reynolds HR, White HD, Webb JG, Džavík V, Hochman JS. A severity scoring system for risk assessment of patients with cardiogenic shock: a report from the SHOCK Trial and Registry. Am Heart J 2010; 160:443-50. [PMID: 20826251 DOI: 10.1016/j.ahj.2010.06.024] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2009] [Accepted: 06/16/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND Early revascularization (ERV) is beneficial in the management of cardiogenic shock (CS) complicating myocardial infarction. The severity of CS varies widely, and identification of independent risk factors for outcome is needed. The effect of ERV on mortality in different risk strata is also unknown. We created a severity scoring system for CS and used it to examine the potential benefit of ERV in different risk strata using data from the SHOCK Trial and Registry. METHODS Data from 1,217 patients (294 from the randomized trial and 923 from the registry) with CS due to pump failure were included in a Stage 1 severity scoring system using clinical variables. A Stage 2 scoring system was developed using data from 872 patients who had invasive hemodynamic measurements. The outcome was in-hospital mortality at 30 days. RESULTS In-hospital mortality at 30 days was 57%. Multivariable modeling identified 8 risk factors (Stage 1): age, shock on admission, clinical evidence of end-organ hypoperfusion, anoxic brain damage, systolic blood pressure, prior coronary artery bypass grafting, noninferior myocardial infarction, and creatinine > or = 1.9 mg/dL (c-statistic = 0.74). Mortality ranged from 22% to 88% by score category. The ERV benefit was greatest in moderate- to high-risk patients (P = .02). The Stage 2 model based on patients with pulmonary artery catheterization included age, end-organ hypoperfusion, anoxic brain damage, stroke work, and left ventricular ejection fraction <28% (c-statistic = 0.76). In this cohort, the effect of ERV did not vary by risk stratum. CONCLUSIONS Simple clinical predictors provide good discrimination of mortality risk in CS complicating myocardial infarction. Early revascularization is associated with improved survival across a broad range of risk strata.
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