1
|
Outcome of Temporary Circulatory Support As a Bridge-to-Left Ventricular Assist Device Strategy in Cardiogenic Shock Patients. Crit Care Med 2021; 50:e426-e433. [PMID: 34974497 DOI: 10.1097/ccm.0000000000005424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Temporary circulatory support (TCS) as a bridge-to-left ventricular assist device (BTL) in cardiogenic shock patients has been increasing, but limited data exists on this BTL strategy. We aimed at analyzing the outcome of BTL patients in a population of cardiogenic shock patients compared with those without TCS at the time of the left ventricular assist device (LVAD) surgery and identify predictors of postoperative mortality in this specific population. DESIGN A multicenter retrospective observational study conducted in 19 centers from 2006 to 2016. SETTING Nineteen French centers. PATIENTS A total of 329 cardiogenic shock patients at the time of LVAD implantation were analyzed. Patients were divided in three groups: those under TCS at the time of LVAD implantation (n = 173), those with TCS removal before LVAD surgery (n = 24), and those who did not undergo a bridging strategy (n = 152). Primary endpoint was 30-day mortality. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among the BTL group, 68 (39.3%), 18 (10.4%), and 15 (8.7%) patients were under venoarterial extracorporeal membrane oxygenation, Impella, and IABP support alone, and 72 patients (20.6%) were under multiple TCS support. BTL patients presented similar 30 days survival compared with the TCS removal and non-BTL groups. However, BTL group had a significantly longer ICU duration stay, with two-fold duration of mechanical ventilation time, but the three groups experienced similar postoperative complications. Multivariate analysis identified three independent predictors of mortality in the BTL group: combined surgery with LVAD, body mass index (BMI), and heart failure (HF) duration. BTL strategy was not an independent predictor of mortality in cardiogenic shock patients who underwent LVAD. CONCLUSIONS BTL strategy is not associated with a lower survival among cardiogenic shock patients with LVAD implantation. Predictors of mortality are combined surgery with LVAD, higher BMI, and HF duration.
Collapse
|
2
|
den Uil CA, Akin S, Jewbali LS, dos Reis Miranda D, Brugts JJ, Constantinescu AA, Kappetein AP, Caliskan K. Short-term mechanical circulatory support as a bridge to durable left ventricular assist device implantation in refractory cardiogenic shock: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2017; 52:14-25. [DOI: 10.1093/ejcts/ezx088] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
3
|
THOMAZ PETRONIOGENEROSO, MOURA JÚNIOR LEONELADELINO, MURAMOTO GIOVANA, ASSAD RENATOSAMY. Intra-aortic balloon pump in cardiogenic shock: state of the art. Rev Col Bras Cir 2017; 44:102-106. [DOI: 10.1590/0100-69912017001006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/03/2016] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The clinical definition of cardiogenic shock is that of a low cardiac output and evidence of tissue hypoxia in the presence of adequate blood volume. Cardiogenic shock is the main cause of death related to acute myocardial infarction (AMI), with a mortality rate of 45-70% in the absence of aggressive and highly specialized technical care. The intra-aortic balloon pump (IABP) is one of the most widely used mechanical assisting devices. During the last two decades, about 42% of patients with AMI who evolved with cardiogenic shock received mechanical circulatory assistance with IABP. Its clinical indication has been based on non-randomized studies and registry data. Recent studies have shown that the use of IABP did not reduce 30-day mortality in patients with AMI and cardiogenic shock treated with the strategy of early myocardial revascularization as the planned primary objective. The guidelines of the American Heart Association and of the European Society of Cardiology have reassessed their recommendations based on the results of meta-analyzes, including the IABP-SCHOCK II Trial study, which did not evidence an increase in survival of patients who received mechanical support with IABP. This review article addresses the clinical impact of IABP use in the cardiogenic shock caused by AMI.
Collapse
|
4
|
Interêt du ballon de contre-pulsion intra-aortique dans le choc cardiogénique. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1181-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
5
|
Schwarz B, Abdel-Wahab M, Robinson DR, Richardt G. Predictors of mortality in patients with cardiogenic shock treated with primary percutaneous coronary intervention and intra-aortic balloon counterpulsation. Med Klin Intensivmed Notfmed 2015; 111:715-722. [PMID: 26596273 DOI: 10.1007/s00063-015-0118-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/11/2015] [Accepted: 09/30/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiogenic shock remains the most serious complication of patients hospitalized with acute myocardial infarction (AMI). Early revascularization is the cornerstone of invasive therapy, while mechanical support with intra-aortic balloon pump (IABP) is debatable. From our institutional shock registry we sought to determine predictors of in-hospital mortality-including the aspect of IABP timing-and to develop a clinical risk score for shock patients with AMI. METHODS From January 2005 till December 2010, 102 patients with cardiogenic shock due to AMI treated with primary percutaneous coronary intervention (PCI) and IABP were analyzed. Univariate and multivariate logistic regression analyses were used to identify independent predictors of in-hospital mortality. Logistic regression analysis and receiver-operating curves were used to generate a mortality risk score. RESULTS The mean age of the cohort was 70.1 ± 11.0 years and 70 % were men. One third of patients had a non-ST segment elevation myocardial infarction and 30 % had to be resuscitated before coronary intervention. Mean left ventricular ejection fraction was 25 %. After admission, 23 % of patients developed an acute renal failure and 10 % needed renal dialysis during hospital stay. In 52 % of patients IABP therapy was initiated after primary PCI, while the remaining patients had an IABP-assisted primary PCI. All-cause in-hospital mortality was 40.2 %. Using multivariate analysis, age (odds ratio [OR] 1.08, p = 0.006), resuscitation before PCI (OR 3.46, p = 0.045), vasopressor use (OR 7.88, p = 0.003), acute renal failure (OR 11.18, p = 0.001), and IABP implantation after PCI (OR 4.36, p = 0.011) were independently associated with in-hospital mortality. Based on these predictors, a mortality-risk score was calculated as follows: 1.5 × IABP timing before PCI + 0.1 × age + resuscitation before PCI + 2 × vasopressor use + 2.5 × acute renal failure. Using a cut-off value of 10.4, this score had a specificity of 83 % and a sensitivity of 82 % for prediction of in-hospital death. CONCLUSIONS We identified age, vasopressor use, resuscitation before PCI, acute renal failure and IABP implantation after PCI as independent predictors of in-hospital mortality in patients with cardiogenic shock due to AMI. The timing of IABP insertion was the only modifiable factor predicting in-hospital mortality in our cohort. Consequently, balloon pumping should be started before PCI to improve outcome of cardiogenic shock patients.
Collapse
Affiliation(s)
- B Schwarz
- Heart Center, Herzzentrum, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Am Kurpark 1, 23795, Bad Segeberg, Germany.
| | - M Abdel-Wahab
- Heart Center, Herzzentrum, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - D R Robinson
- Mathematics Department, University of Sussex, Brighton, UK
| | - G Richardt
- Heart Center, Herzzentrum, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Am Kurpark 1, 23795, Bad Segeberg, Germany
| |
Collapse
|
6
|
Cheng JM, Helming AM, van Vark LC, Kardys I, Den Uil CA, Jewbali LSD, van Geuns RJ, Zijlstra F, van Domburg RT, Boersma E, Akkerhuis KM. A simple risk chart for initial risk assessment of 30-day mortality in patients with cardiogenic shock from ST-elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:101-7. [DOI: 10.1177/2048872615568966] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/02/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Jin M Cheng
- Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands
| | | | - Laura C van Vark
- Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands
| | - Isabella Kardys
- Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands
| | | | - Lucia SD Jewbali
- Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands
| | | | - Felix Zijlstra
- Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands
| | | | - Eric Boersma
- Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands
| | | |
Collapse
|
7
|
Mizuno M, Sato N, Kajimoto K, Sakata Y, Minami Y, Munakata R, Hagiwara N, Takano T. Intra-aortic balloon counterpulsation for acute decompensated heart failure. Int J Cardiol 2014; 176:1444-6. [PMID: 25223815 DOI: 10.1016/j.ijcard.2014.08.154] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 08/09/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Masayuki Mizuno
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Naoki Sato
- Department of Cardiology, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | | | | | - Yuichiro Minami
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryo Munakata
- Intensive and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Teruo Takano
- Intensive and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan
| | | |
Collapse
|
8
|
Kamiński KA, Tycińska AM, Stepek T, Szpakowicz A, Olędzka E, Dobrzycki S, Musiał WJ. Natural history and risk factors of long-term mortality in acute coronary syndrome patients with cardiogenic shock. Adv Med Sci 2014; 59:156-60. [PMID: 25323750 DOI: 10.1016/j.advms.2013.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 12/11/2013] [Indexed: 01/10/2023]
Abstract
PURPOSE Cardiogenic shock (CS) is a severe complication of acute coronary syndromes (ACS). Intra-aortic balloon pump (IABP) is considered important mechanical therapy for acute CS. We aimed to analyze the natural history and possible prognostic factors in patients with CS complicating ACS. PATIENTS/METHODS All 126 patients (mean age 65.8 ± 12.5 years), who were hospitalized in single center due to an episode of CS in the course of ACS, had IABP and were scheduled for coronary angiography. The assessed end-point was 5-year death from any cause. RESULTS Median left ventricle ejection fraction (LVEF) 28% (interquartile range (IQR) 23-35%), 39 patients (31%) were female, in 91 (72%) the initial diagnosis was ST-elevation myocardial infarction (STEMI). Mean time on the IABP was 3.8 ± 3 days. During index hospitalization there were 56 deaths (44%). Other 27 patients (out of 70 discharged - 38.5%) died during 5-year follow-up. In univariate logistic regression, the significant effect on long term mortality had age, female gender, reduced ejection fraction below 31% and hypotension on admission. The out of hospital survival was also determined by age, gender and hypotension, while LVEF lost its predictive value The multivariate survival analysis both in whole group and in patients discharged from hospital was independently affected by age and hypotension on the admission. CONCLUSIONS The mortality of patients with CS despite treatment with IABP remains very high, especially during the in-hospital period and early after discharge. Among assessed parameters age and hypotension on the admission are the most important predictors of adverse long term prognosis.
Collapse
Affiliation(s)
- Karol A Kamiński
- Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
| | | | - Tomasz Stepek
- Department of Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Anna Szpakowicz
- Department of Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Ewa Olędzka
- Department of Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | | |
Collapse
|
9
|
Patel H, Shivaraju A, Fonarow GC, Xie H, Gao W, Shroff AR, Vidovich MI. Temporal trends in the use of intraaortic balloon pump associated with percutaneous coronary intervention in the United States, 1998-2008. Am Heart J 2014; 168:363-373.e12. [PMID: 25173549 DOI: 10.1016/j.ahj.2014.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND With conflicting evidence regarding the usefulness of intraaortic balloon pump (IABP), reports of IABP use in the United States have been inconsistent. Our objective was to examine trends in IABP usage in percutaneous coronary intervention (PCI) in the United States and to evaluate the association of IABP use with mortality. METHODS This is a retrospective, observational study using patient data obtained from the Nationwide Inpatient Sample database from 1998 to 2008. Patients undergoing any PCI (1,552,602 procedures) for a primary diagnosis of symptomatic coronary artery disease and acute coronary syndrome, including non-ST-elevation myocardial infarction and ST-elevation myocardial infarction, were evaluated. RESULTS The overall use of IABP significantly decreased during the study period from 0.99% in 1998 to 0.36% in 2008 (univariate and multivariate P for trend < .0001). Patients who received IABP had substantially higher rates of shock compared with those who did not receive IABP (38.09% vs 0.70%; P < .0001), which was associated with markedly higher inhospital mortality rates (20.31% vs 0.72%; P < .0001). However, IABP use significantly decreased in patients with shock (36.5%-13.4%) and acute myocardial infarction (2.23%-0.84%) (univariate and multivariate P for trend for both < .0001). A temporal reduction in all-cause PCI-associated mortality from 1.1% in 1998 to 0.86% in 2008 (univariate and multivariate P for trend < .0001) was also observed. CONCLUSIONS The utilization of IABP associated with PCI significantly decreased between 1998 and 2008 in the United States, even among patients with acute myocardial infarction and shock.
Collapse
|
10
|
Kapelios CJ, Terrovitis JV, Siskas P, Kontogiannis C, Repasos E, Nanas JN. Counterpulsation: a concept with a remarkable past, an established present and a challenging future. Int J Cardiol 2014; 172:318-25. [PMID: 24525157 DOI: 10.1016/j.ijcard.2014.01.098] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 01/19/2014] [Indexed: 01/24/2023]
Abstract
The intra-aortic balloon pump (IABP), which is the main representative of the counterpulsation technique, has been an invaluable tool in cardiologists' and cardiac surgeons' armamentarium for approximately half a century. The IABP confers a wide variety of vaguely understood effects on cardiac physiology and mechano-energetics. Although, the recommendations for its use are multiple, most are not substantially evidence-based. Indicatively, the results of recently performed prospective studies have put IABP's utility in the setting of post-infarction cardiogenic shock into question. However, the particular issue remains open to further research. IABP support in high-risk patients undergoing PCI is associated with favorable long-term clinical outcome. In cardiac surgery, the use of IABP in cases of peri-operative low-output syndrome, refractory angina or ischemia-related mechanical complications is a usual, but poorly justified strategy. Anecdotal cases of treatment of incessant ventricular arrhythmias, reversal of right ventricular dysfunction and partial myocardial recovery have also been reported with its use. Converging data demonstrate the potential of safe long-term IABP support as a bridge to decision making or a bridge to transplantation modality in patients with heart failure. The feasibility of IABP insertion via other than the femoral artery sites enhances this potential. Despite the fact that several other counterpulsation devices have been developed and tested overtime none has managed to substitute the IABP, which continues to be most frequently used mechanical assist device.
Collapse
Affiliation(s)
- Chris J Kapelios
- 3rd Department of Cardiology, University of Athens School of Medicine, Greece
| | - John V Terrovitis
- 3rd Department of Cardiology, University of Athens School of Medicine, Greece
| | - Panagiotis Siskas
- 3rd Department of Cardiology, University of Athens School of Medicine, Greece
| | | | - Evangelos Repasos
- 3rd Department of Cardiology, University of Athens School of Medicine, Greece
| | - John N Nanas
- 3rd Department of Cardiology, University of Athens School of Medicine, Greece.
| |
Collapse
|
11
|
Intra-aortic balloon counterpulsation in acute myocardial infarction: old and emerging indications. Neth Heart J 2013; 21:554-60. [PMID: 24170231 PMCID: PMC3833909 DOI: 10.1007/s12471-013-0485-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Recent evidence questions the role of intra-aortic balloon counterpulsation (IABP) in the treatment of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). An area of increasing interest is the use of IABP for persistent ischaemia (PI). We analysed the use of IABP in patients with AMI complicated by CS or PI. Methods From 2008 to 2010, a total of 4076 patients were admitted to our hospital for primary percutaneous coronary intervention (PCI) for AMI. Out of those, 239 patients received an IABP either because of CS or because of PI. Characteristics and outcome of those patients are investigated. Results The mean age of the study population was 64 ± 11 years; 75 % were male patients. Of the patients, 63 % had CS and 37 % had PI. Patients with CS had a 30-day mortality rate of 36 %; 1-year mortality was 41 %. Patients with PI had a 30-day mortality rate of 7 %; 1-year mortality was 11 %. Conclusions Mortality in patients admitted for primary PCI because of AMI complicated by CS is high despite IABP use. Outcome in patients treated with IABP for PI is favourable and mandates further prospective studies.
Collapse
|
12
|
Impact of intra-aortic balloon pump support initiated before versus after primary percutaneous coronary intervention in patients with cardiogenic shock from acute myocardial infarction. Int J Cardiol 2013; 168:3758-63. [DOI: 10.1016/j.ijcard.2013.06.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 04/24/2013] [Accepted: 06/15/2013] [Indexed: 12/15/2022]
|
13
|
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.
Collapse
Affiliation(s)
- Subasit Acharji
- Division of Cardiology, Robert Packer Hospital, Guthrie Health Services, Sayre, Pennsylvania
| | | | | | | | | | | |
Collapse
|
14
|
Tharmaratnam D, Nolan J, Jain A. Management of cardiogenic shock complicating acute coronary syndromes. Heart 2013; 99:1614-23. [PMID: 23468511 DOI: 10.1136/heartjnl-2012-302028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
15
|
Abstract
With a stable frequency (about 5% of acute coronary syndromes) and a mortality of nearly 45%, cardiogenic shock (CS), especially when it occurs in the immediate waning of myocardial infarction, still represents a therapeutic challenge. In this review, will be detailed the actual epidemiologic data of CS, its physiopathology and the different modalities of treatments available to the interventional cardiologist, especially the coronary revascularisation and the percutaneous left ventricular assistance, whether by intra-aortic balloon counterpulsation or by more complex systems.
Collapse
Affiliation(s)
- G Leurent
- Service de cardiologie et maladies vasculaires, CHU de Rennes, 35000 Rennes, France.
| |
Collapse
|
16
|
Potential Therapeutic Targets for Cerebral Resuscitation After Global Ischemia. Transl Stroke Res 2012. [DOI: 10.1007/978-1-4419-9530-8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
17
|
Affiliation(s)
- Dion Stub
- Heart Centre, Alfred Hospital Commercial Rd, Melbourne, Australia 3004.
| | | | | | | |
Collapse
|
18
|
Valk SDA, Cheng JM, den Uil CA, Lagrand WK, van der Ent M, van de Sande M, van Domburg RT, Simoons ML. Encouraging survival rates in patients with acute myocardial infarction treated with an intra-aortic balloon pump. Neth Heart J 2011; 19:112-118. [PMID: 21475411 PMCID: PMC3047716 DOI: 10.1007/s12471-010-0066-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE: To evaluate a 30-day and long-term outcome of patients with acute myocardial infarction (AMI) treated with intra-aortic balloon pump (IABP) counterpulsation and to identify predictors of a 30-day and long-term all-cause mortality. METHODS: Retrospective cohort study of 437 consecutive AMI patients treated with IABP between January 1990 and June 2004. A Cox proportional hazards model was used to identify predictors of a 30-day and long-term all-cause mortality. RESULTS: Mean age of the study population was 61 ± 11 years, 80% of the patients were male, and 68% had cardiogenic shock. Survival until IABP removal after successful haemodynamic stabilisation was 78% (n = 341). Cumulative 30-day survival was 68%. Median follow-up was 2.9 years (range, 6 months to 15 years). In patients who survived until IABP removal, cumulative 1-, 5-, and 10-year survival was 75%, 61%, and 39%, respectively. Independent predictors of higher long-term mortality were prior cerebrovascular accident (hazard ratio (HR), 1.8; 95% confidence interval (CI), 1.0-3.4), need for antiarrhythmic drugs (HR, 2.3; 95% CI, 1.5-3.3), and need for renal replacement therapy (HR, 2.3; 95% CI, 1.2-4.3). Independent predictors of lower long-term mortality were primary percutaneous coronary intervention (PCI; HR, 0.6; 95% CI, 0.4-1.0), failed thrombolysis with rescue PCI (HR, 0.5; 95% CI, 0.3-0.9), and coronary artery bypass grafting (HR, 0.3; 95% CI, 0.1-0.5). CONCLUSIONS: Despite high in-hospital mortality in patients with AMI treated with IABP, a favourable number of patients survived in the long-term. These results underscore the value of aggressive haemodynamic support of patients throughout the acute phase of AMI.
Collapse
Affiliation(s)
- S. D. A. Valk
- Department of Cardiology, Thorax Center, Erasmus MC, Room Ba 577,’s Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - J. M. Cheng
- Department of Cardiology, Thorax Center, Erasmus MC, Room Ba 577,’s Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - C. A. den Uil
- Department of Cardiology, Thorax Center, Erasmus MC, Room Ba 577,’s Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - W. K. Lagrand
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - M. van der Ent
- Department of Cardiology, Maasstad Hospital, location Zuider, Rotterdam, the Netherlands
| | - M. van de Sande
- Department of Cardiology, Thorax Center, Erasmus MC, Room Ba 577,’s Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - R. T. van Domburg
- Department of Cardiology, Thorax Center, Erasmus MC, Room Ba 577,’s Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - M. L. Simoons
- Department of Cardiology, Thorax Center, Erasmus MC, Room Ba 577,’s Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| |
Collapse
|
19
|
Bahekar A, Singh M, Singh S, Bhuriya R, Ahmad K, Khosla S, Arora R. Cardiovascular Outcomes Using Intra-Aortic Balloon Pump in High-Risk Acute Myocardial Infarction With or Without Cardiogenic Shock. J Cardiovasc Pharmacol Ther 2011; 17:44-56. [DOI: 10.1177/1074248410395019] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amol Bahekar
- Department of Cardiology, Chicago Medical School, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| | - Mukesh Singh
- Department of Cardiology, Chicago Medical School, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| | - Sarabjeet Singh
- Department of Cardiology, Chicago Medical School, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| | - Rohit Bhuriya
- Department of Cardiology, Chicago Medical School, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| | - Khraisat Ahmad
- Department of Cardiology, Chicago Medical School, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| | - Sandeep Khosla
- Department of Cardiology, Chicago Medical School, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| | - Rohit Arora
- Department of Cardiology, Chicago Medical School, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| |
Collapse
|
20
|
den Uil CA, Lagrand WK, van der Ent M, Jewbali LS, Cheng JM, Spronk PE, Simoons ML. Impaired microcirculation predicts poor outcome of patients with acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 2010; 31:3032-3039. [DOI: 10.1093/eurheartj/ehq324] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
21
|
Valente S, Lazzeri C, Chiostri M, Zucchini M, Giglioli C, Gensini GF. Intra-aortic balloon pump in intensive cardiac care: a registry in Florence. Int J Cardiol 2010; 146:238-9. [PMID: 21093943 DOI: 10.1016/j.ijcard.2010.10.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 10/23/2010] [Indexed: 11/17/2022]
|
22
|
Rastan AJ, Thiele H, Schuler G, Mohr FW. Stellenwert der koronaren Bypass operation in der Therapie der akuten Koronarsyndrome. Herz 2010; 35:70-8. [DOI: 10.1007/s00059-010-3327-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
23
|
Cheng JM, den Uil CA. Percutaneous assist devices vs. intra-aortic balloon pump for cardiogenic shock: evidence under construction vs. expert opinion: reply. Eur Heart J 2010. [DOI: 10.1093/eurheartj/ehp523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
24
|
Lazzeri C, Tarquini R, Valente S, Abbate R, Gensini GF. Emerging drugs for acute myocardial infarction. Expert Opin Emerg Drugs 2010; 15:87-105. [PMID: 20055689 DOI: 10.1517/14728210903405619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE OF THE FIELD The present review is aimed at going over the pharmacological profile (and the clinical impact) of the emerging drugs involved in the management of patients with ST-elevation myocardial infarction (STEMI) in order to provide the cardiologists who deal with these patients in the early phase with the most recent evidence on this topic. AREAS COVERED IN THIS REVIEW Anticoagulant and antiplatelet drugs are the main cornerstones of therapy in the treatment of STEMI patients undergoing primary percutaneous coronary intervention (PCI). The main issues that clinicians have to deal with are represented by balancing thrombotic and bleeding risks. In tailoring therapy, variables such as age, sex and previous disease should be taken into account, as well as ongoing complications (such as acute renal failure) that could affect hemostasis. Despite the well-established clinical benefits of antiplatelet agents, questions remain, mainly surrounding potential for variable platelet response, which are strictly related to non-genetic (i.e., diet, drug-drug interaction, clinical factors such as obesity, diabetes mellitus, and inflammation) and genetic determinants. WHAT THE READER WILL GAIN In their daily practice, cardiologists cannot abstract from the knowledge and updating on the ongoing research fields as well as the newly developed drugs, which they should frame in the very patient in the attempt to the develop a personalized medical strategy. These include also the pharmacological option(s) in the treatment of the reperfusion injury, the metabolic aspects and the stem cell therapy. TAKE HOME MASSAGE: In our opinion, the goal of ongoing research on the pharmacological approach to STEMI patients is a personalized medical strategy that relies on critical clinicians who merge newly developed acquisitions on this topic and a more complete, systemic and critical approach to the patient.
Collapse
Affiliation(s)
- Chiara Lazzeri
- University of Florence, Department of Heart and Vessels, Florence, Italy
| | | | | | | | | |
Collapse
|