1
|
Martínez León A, Bazal Chacón P, Herrador Galindo L, Ugarriza Ortueta J, Plaza Martín M, Pastor Pueyo P, Alonso Salinas GL. Review of Advancements in Managing Cardiogenic Shock: From Emergency Care Protocols to Long-Term Therapeutic Strategies. J Clin Med 2024; 13:4841. [PMID: 39200983 PMCID: PMC11355768 DOI: 10.3390/jcm13164841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/08/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
Cardiogenic shock (CS) is a complex multifactorial clinical syndrome of end-organ hypoperfusion that could be associated with multisystem organ failure, presenting a diverse range of causes and symptoms. Despite improving survival in recent years due to new advancements, CS still carries a high risk of severe morbidity and mortality. Recent research has focused on improving early detection and understanding of CS through standardized team approaches, detailed hemodynamic assessment, and selective use of temporary mechanical circulatory support devices, leading to better patient outcomes. This review examines CS pathophysiology, emerging classifications, current drug and device therapies, standardized team management strategies, and regionalized care systems aimed at optimizing shock outcomes. Furthermore, we identify gaps in knowledge and outline future research needs.
Collapse
Affiliation(s)
- Amaia Martínez León
- Cardiology Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain; (A.M.L.); (P.B.C.); (J.U.O.)
- Navarrabiomed (Miguel Servet Foundation), Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Pablo Bazal Chacón
- Cardiology Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain; (A.M.L.); (P.B.C.); (J.U.O.)
- Navarrabiomed (Miguel Servet Foundation), Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Heath Sciences Department, Universidad Pública de Navarra (UPNA-NUP), 31006 Pamplona, Spain
| | - Lorena Herrador Galindo
- Advanced Heart Failure and Cardiology Department, Hospital Universitario de Bellvitge, Carrer de la Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Spain;
| | - Julene Ugarriza Ortueta
- Cardiology Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain; (A.M.L.); (P.B.C.); (J.U.O.)
- Navarrabiomed (Miguel Servet Foundation), Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - María Plaza Martín
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Av Ramón y Cajal 3, 47003 Valladolid, Spain;
| | - Pablo Pastor Pueyo
- Cardiology Department, Hospital Universitari Arnau de Vilanova, Av Alcalde Rovira Roure, 80, 25198 Lleida, Spain;
| | - Gonzalo Luis Alonso Salinas
- Cardiology Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain; (A.M.L.); (P.B.C.); (J.U.O.)
- Navarrabiomed (Miguel Servet Foundation), Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Heath Sciences Department, Universidad Pública de Navarra (UPNA-NUP), 31006 Pamplona, Spain
| |
Collapse
|
2
|
Chien SC, Wang CA, Liu HY, Lin CF, Huang CY, Chien LN. Comparison of the prognosis among in-hospital survivors of cardiogenic shock based on etiology: AMI and Non-AMI. Ann Intensive Care 2024; 14:74. [PMID: 38735891 PMCID: PMC11089020 DOI: 10.1186/s13613-024-01305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Current data on post-discharge mortality and rehospitalization is still insufficient among in-hospital survivors of cardiogenic shock (CS), including acute myocardial infarction (AMI) and non-AMI survivors. METHODS Patients with CS who survived after hospital discharge were selected from the Taiwan National Health Insurance Research Database. Each patient was followed up at 3-year intervals. Mortality and rehospitalization were analyzed using Kaplan-Meier curves and Cox regression models. RESULTS There were 16,582 eligible patients. Of these, 42.4% and 57.6% were AMI-CS and non-AMI-CS survivors, respectively. The overall mortality and rehospitalization rates were considerably high, with reports of 7.0% and 22.1% at 30 days, 24.5% and 58.2% at 1 year, and 38.9% and 73.0% at 3 years, respectively, among in-hospital CS survivors. Cardiovascular (CV) problems caused approximately 40% mortality and 60% rehospitalization. Overall, the non-AMI-CS group had a higher mortality burden than the AMI-CS group owing to older age and a higher prevalence of comorbidities. In multivariable models, the non-AMI-CS group exhibited a lower risk of all-cause mortality (adjusted hazard ratio [aHR] 0.69, 95% confidence interval [CI] 0.60 to 0.78) and CV mortality (aHR 0.65, 95% CI 0.54 to 0.78) compared to the AMI-CS group. However, these risks diminished and even reversed after one year (aHR 1.13, 95% CI 1.03 to 1.25 for all-cause mortality; aHR 1.27, 95% CI 1.09 to 1.49 for CV mortality).This reversal was not observed in all-cause and CV rehospitalization. For rehospitalization, AMI-CS was associated with the risk of CV rehospitalization in the entire observation period (aHR:0.80, 95% CI:0.76-0.84). CONCLUSIONS In-hospital AMI-CS survivors had an increased risk of CV rehospitalization and 30-day mortality, whereas those with non-AMI-CS had a greater mortality risk after 1-year follow-up.
Collapse
Affiliation(s)
- Shih-Chieh Chien
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Cheng-An Wang
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Wan Fang Hospital, Taipei, Taiwan
| | - Hung-Yi Liu
- Health and Clinical Research Data Center, Office of Data Center, Taipei Medical University, Taipei, Taiwan
| | - Chao-Feng Lin
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chun-Yao Huang
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Li-Nien Chien
- Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
3
|
Senman B, Jentzer JC, Barnett CF, Bartos JA, Berg DD, Chih S, Drakos SG, Dudzinski DM, Elliott A, Gage A, Horowitz JM, Miller PE, Sinha SS, Tehrani BN, Yuriditsky E, Vallabhajosyula S, Katz JN. Need for a Cardiogenic Shock Team Collaborative-Promoting a Team-Based Model of Care to Improve Outcomes and Identify Best Practices. J Am Heart Assoc 2024; 13:e031979. [PMID: 38456417 PMCID: PMC11009990 DOI: 10.1161/jaha.123.031979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/17/2024] [Indexed: 03/09/2024]
Abstract
Cardiogenic shock continues to carry a high mortality rate despite contemporary care, with no breakthrough therapies shown to improve survival over the past few decades. It is a time-sensitive condition that commonly results in cardiovascular complications and multisystem organ failure, necessitating multidisciplinary expertise. Managing patients with cardiogenic shock remains challenging even in well-resourced settings, and an important subgroup of patients may require cardiac replacement therapy. As a result, the idea of leveraging the collective cognitive and procedural proficiencies of multiple providers in a collaborative, team-based approach to care (the "shock team") has been advocated by professional societies and implemented at select high-volume clinical centers. A slowly maturing evidence base has suggested that cardiogenic shock teams may improve patient outcomes. Although several registries exist that are beginning to inform care, particularly around therapeutic strategies of pharmacologic and mechanical circulatory support, none of these are currently focused on the shock team approach, multispecialty partnership, education, or process improvement. We propose the creation of a Cardiogenic Shock Team Collaborative-akin to the successful Pulmonary Embolism Response Team Consortium-with a goal to promote sharing of care protocols, education of stakeholders, and discovery of how process and performance may influence patient outcomes, quality, resource consumption, and costs of care.
Collapse
Affiliation(s)
| | | | - Christopher F. Barnett
- Division of Cardiology, Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Jason A. Bartos
- Department of Medicine‐Cardiovascular DivisionUniversity of MinnesotaMinneapolisMNUSA
| | - David D. Berg
- Division of Cardiovascular MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | | | - Stavros G. Drakos
- Department of Medicine, Division of Cardiovascular Medicine and Nora Eccles Harrison Cardiovascular Research and Training InstituteUniversity of Utah School of MedicineSalt Lake CityUTUSA
| | | | - Andrea Elliott
- Department of Medicine‐Cardiovascular DivisionUniversity of MinnesotaMinneapolisMNUSA
| | - Ann Gage
- Department of Cardiovascular MedicineCentennial Medical CenterNashvilleTNUSA
| | - James M. Horowitz
- Division of CardiologyNew York University Grossman School of MedicineNew YorkNYUSA
| | - P. Elliott Miller
- Section of Cardiovascular Medicine, Yale School of MedicineNew HavenCTUSA
| | - Shashank S. Sinha
- Inova Schar Heart and Vascular, Inova Fairfax Medical CampusFalls ChurchVAUSA
| | - Behnam N. Tehrani
- Inova Schar Heart and Vascular, Inova Fairfax Medical CampusFalls ChurchVAUSA
| | - Eugene Yuriditsky
- Division of CardiologyNew York University Grossman School of MedicineNew YorkNYUSA
| | - Saraschandra Vallabhajosyula
- Division of Cardiology, Department of MedicineWarren Alpert Medical School of Brown University and Lifespan Cardiovascular InstituteProvidenceRIUSA
| | - Jason N. Katz
- Division of CardiologyNYU Grossman School of Medicine & Bellevue Hospital CenterNew YorkNYUSA
| |
Collapse
|
4
|
Matsushita K, Delmas C, Marchandot B, Roubille F, Lamblin N, Leurent G, Levy B, Elbaz M, Champion S, Lim P, Schneider F, Khachab H, Carmona A, Trimaille A, Bourenne J, Seronde M, Schurtz G, Harbaoui B, Vanzetto G, Biendel C, Labbe V, Combaret N, Mansourati J, Filippi E, Maizel J, Merdji H, Lattuca B, Gerbaud E, Bonnefoy E, Puymirat E, Bonello L, Morel O. Optimal Heart Failure Medical Therapy and Mortality in Survivors of Cardiogenic Shock: Insights From the FRENSHOCK Registry. J Am Heart Assoc 2024; 13:e030975. [PMID: 38390813 PMCID: PMC10944045 DOI: 10.1161/jaha.123.030975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The effects of pharmacological therapy on cardiogenic shock (CS) survivors have not been extensively studied. Thus, this study investigated the association between guideline-directed heart failure (HF) medical therapy (GDMT) and one-year survival rate in patients who are post-CS. METHODS AND RESULTS FRENSHOCK (French Observatory on the Management of Cardiogenic Shock in 2016) registry was a prospective multicenter observational survey, conducted in metropolitan French intensive care units and intensive cardiac care units. Of 772 patients, 535 patients were enrolled in the present analysis following the exclusion of 217 in-hospital deaths and 20 patients with missing medical records. Patients with triple GDMT (beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists) at discharge (n=112) were likely to have lower left ventricular ejection fraction on admission and at discharge compared with those without triple GDMT (n=423) (22% versus 28%, P<0.001 and 29% versus 37%, P<0.001, respectively). In the overall cohort, the one-year mortality rate was 23%. Triple GDMT prescription was significantly associated with a lower one-year all-cause mortality compared with non-triple GDMT (adjusted hazard ratio 0.44 [95% CI, 0.19-0.80]; P=0.007). Similarly, 2:1 propensity score matching and inverse probability treatment weighting based on the propensity score demonstrated a lower incidence of one-year mortality in the triple GDMT group. As the number of HF drugs increased, a stepwise decrease in mortality was observed (log rank; P<0.001). CONCLUSIONS In survivors of CS, the one-year mortality rate was significantly lower in those with triple GDMT. Therefore, this study suggests that intensive HF therapy should be considered in patients following CS.
Collapse
Affiliation(s)
- Kensuke Matsushita
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
| | - Clément Delmas
- Intensive Cardiac Care UnitRangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR‐1048, INSERMToulouseFrance
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology DepartmentCHU de MontpellierMontpellierFrance
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de CardiologieCHU Lille, University of Lille, Inserm U1167LilleFrance
| | - Guillaume Leurent
- Department of CardiologyCHU Rennes, Inserm, LTSI‐UMR 1099RennesFrance
| | - Bruno Levy
- Réanimation Médicale BraboisCHRU NancyNancyFrance
| | - Meyer Elbaz
- Intensive Cardiac Care UnitRangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR‐1048, INSERMToulouseFrance
| | | | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRBAP‐HP, Hôpital Universitaire Henri‐Mondor, Service de CardiologieCréteilFrance
| | - Francis Schneider
- Médecine Intensive‐RéanimationHôpital de Hautepierre, Hôpitaux Universitaires de StrasbourgStrasbourgFrance
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of CardiologyCH d’Aix en ProvenceAix‐en‐ProvenceFrance
| | - Adrien Carmona
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
| | - Antonin Trimaille
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
| | - Jeremy Bourenne
- Aix Marseille UniversitéService de Réanimation des Urgences, CHU La Timone 2MarseilleFrance
| | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de CardiologieCHU Lille, University of Lille, Inserm U1167LilleFrance
| | - Brahim Harbaoui
- Cardiology DepartmentHôpital Croix‐Rousse and Hôpital Lyon Sud, Hospices Civils de LyonLyonFrance
- University of Lyon, CREATIS UMR5220, INSERM U1044, INSA‐15LyonFrance
| | | | - Caroline Biendel
- Intensive Cardiac Care UnitRangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR‐1048, INSERMToulouseFrance
| | - Vincent Labbe
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Département Médico‐Universitaire APPROCHESAssistance Publique‐Hôpitaux de Paris (APHP), Sorbonne UniversitéParisFrance
| | - Nicolas Combaret
- Department of CardiologyHU Clermont‐Ferrand, CNRS, Université Clermont AuvergneClermont‐FerrandFrance
| | - Jacques Mansourati
- Department of CardiologyUniversity Hospital of Brest and University of Western BrittanyOrphyFrance
| | - Emmanuelle Filippi
- Department of CardiologyGeneral Hospital of Atlantic BrittanyVannesFrance
| | - Julien Maizel
- Intensive Care DepartmentCHU Amiens‐PicardieAmiensFrance
| | - Hamid Merdji
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
- Medical Intensive Care UnitNouvel Hôpital Civil, Centre Hospitalier UniversitaireStrasbourgFrance
| | - Benoit Lattuca
- Department of CardiologyNîmes University Hospital, Montpellier UniversityNîmesFrance
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional CardiologyHôpital Cardiologique du Haut Lévêque, Bordeaux Cardio‐Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier ArnozanPessacFrance
| | - Eric Bonnefoy
- Intensive Cardiac Care UnitLyon Brom University HospitalLyonFrance
| | - Etienne Puymirat
- Cardiology DepartmentEuropean Georges Pompidou HospitalParisFrance
| | - Laurent Bonello
- Department of Cardiology, Aix‐Marseille Université, Intensive Care Unit, Assistance Publique‐Hôpitaux de MarseilleHôpital Nord, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio)MarseilleFrance
| | - Olivier Morel
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
| |
Collapse
|
5
|
Coughlan JJ, Rossello X. Anaemia in patients with cardiogenic shock complicating acute myocardial infarction: Surrogate marker of poor outcome or therapeutic target? Eur J Heart Fail 2024; 26:458-459. [PMID: 38247170 DOI: 10.1002/ejhf.3135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Affiliation(s)
- J J Coughlan
- Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain
- Faculty of Medicine, Universitat de les Illes Balears (UIB), Palma, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| |
Collapse
|
6
|
Lauridsen MD, Rørth R, Butt JH, Strange JE, Schmidt M, Kristensen SL, Kragholm K, Johnsen SP, Møller JE, Hassager C, Køber L, Fosbøl EL. Need for home care or nursing home admission after myocardial infarction complicated by cardiogenic shock and/or out-of-hospital cardiac arrest. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:707-715. [PMID: 36509229 DOI: 10.1093/ehjqcco/qcac084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/25/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
AIMS Myocardial infarction (MI) with cardiogenic shock (CS) and/or out-of-hospital cardiac arrest (OHCA) are conditions with potential loss of autonomy. In patients with MI, the association between CS and OHCA and need for home care or nursing home admission was examined. METHODS AND RESULTS Danish nationwide registries identified patients with MI (2008-19), who prior to the event lived at home without home care and discharged alive. One-year cumulative incidences and hazard ratios (HRs) were reported for home care need or nursing home admission, a composite proxy for disability in activities of daily living (ADL), along with all-cause mortality. The study population consisted of 67 109 patients with MI (by groups: -OHCA/-CS: 63 644; -OHCA/+CS: 1776; +OHCA/-CS: 968; and +OHCA/+CS: 721). The 1-year cumulative incidences of home care/nursing home were 7.1% for patients who survived to discharge with -OHCA/-CS, 20.9% for -OHCA/+CS, 5.4% for +OHCA/-CS, and 8.2% for those with +OHCA/+CS. The composite outcome was driven by home care. With the -OHCA/-CS as reference, the adjusted HRs for home care/nursing home were 2.86 (95% CI: 2.57-3.19) for patients with -OHCA/+CS; 1.31 (95% CI: 1.00-1.73) for + OHCA/-CS; and 2.18 (95% CI: 1.68-2.82) for those with +OHCA/+CS. The 1-year cumulative mortality were 5.1% for patients with -OHCA/-CS, 9.8% for -OHCA/+CS, 3.0% for +OHCA/-CS, and 3.4% for those with +OHCA/+CS. CONCLUSION In patients discharged alive after a MI, CS, and to a lesser degree OHCA were associated with impaired ADL with a two-fold higher 1-year incidence of home care or nursing home admission compared with MI patients without CS or OHCA.
Collapse
Affiliation(s)
- Marie D Lauridsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Rasmus Rørth
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jarl E Strange
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, 2900 Hellerup, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Søren L Kristensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Søren P Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Jacob E Møller
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| |
Collapse
|
7
|
Mahtta D, Manandhar P, Wegermann ZK, Wojdyla D, Megaly M, Kochar A, Virani SS, Rao SV, Elgendy IY. Outcomes and Institutional Variation in Arterial Access Among Patients With AMI and Cardiogenic Shock Undergoing PCI. JACC Cardiovasc Interv 2023; 16:1517-1528. [PMID: 37380235 DOI: 10.1016/j.jcin.2023.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Contemporary data comparing the outcomes of transradial access (TRA) vs transfemoral access (TFA) among patients presenting with acute myocardial infarction and cardiogenic shock (AMI-CS) undergoing percutaneous coronary intervention (PCI) are limited. OBJECTIVES This study examines in-hospital outcomes and institutional variation among patients with AMI-CS undergoing TRA-PCI vs TFA-PCI. METHODS Patients admitted with AMI-CS from the NCDR CathPCI registry between April 2018 and June 2021 were included. Multivariable logistic regression and inverse probability weighting models were used to assess the association between access site and in-hospital outcomes. A falsification analysis using non-access site-related bleeding was performed. RESULTS Among 35,944 patients with AMI-CS undergoing PCI, 25.6% were performed with TRA. The proportion of TRA-PCI increased over the study period (22.0% in the second quarter of 2018 vs 29.1% in the second quarter of 2021; P-trend <0.001). Significant institutional-level variability in the use of TRA-PCI was also observed: 20.9% of all sites using TRA in <2% of PCIs (low utilization) vs 1.9% of all sites using TRA in >80% of PCIs (high utilization). Patients undergoing TRA-PCI had a significantly lower adjusted incidence of major bleeding (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.67-0.76), mortality (OR: 0.73; 95% CI: 0.69-0.78), vascular complications (OR: 0.67; 95% CI: 0.54-0.84), and new dialysis (OR: 0.86; 95% CI: 0.77-0.97). There was no difference in non-access site related bleeding (OR: 0.93; 95% CI: 0.84-1.03). Sensitivity analyses revealed similar benefit with TRA-PCI among patients without arterial cross-over. There were no significant interactions observed between TRA-PCI with mechanical circulatory support and in-hospital outcomes. CONCLUSIONS In this large nationwide contemporary analysis of patients with AMI-CS, about quarter of PCIs were performed via TRA with wide variability across US institutions. TRA-PCI was associated with significantly lower incidence of in-hospital major bleeding, mortality, vascular complications, and new dialysis. This benefit was observed irrespective of mechanical circulatory support use.
Collapse
Affiliation(s)
- Dhruv Mahtta
- Division of Cardiovascular Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | | | - Zachary K Wegermann
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel Wojdyla
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Megaly
- Willis Knighton Heart Institute, Shreveport, Louisiana, USA
| | - Ajar Kochar
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA; Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Salim S Virani
- Division of Cardiovascular Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Sunil V Rao
- NYU Langone Health System, New York, New York, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky HealthCare, Lexington, Kentucky, USA.
| |
Collapse
|
8
|
George TJ, Sheasby J, DiMaio JM, Kabra N, Rawitscher DA, Afzal A. Outcomes of surgical Impella placement in acute cardiogenic shock. Proc AMIA Symp 2023; 36:415-421. [PMID: 37334083 PMCID: PMC10269385 DOI: 10.1080/08998280.2023.2205817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Although a role for percutaneous Impella devices has been established, there is a paucity of data regarding the utility and outcomes of larger surgically implanted Impella devices. Methods We conducted a retrospective review of all surgical Impella implants at our institution. All Impella 5.0 and Impella 5.5 devices were included. The primary outcome was survival. Secondary outcomes included hemodynamic and end-organ perfusion as well as commonly encountered surgical complications. Results From 2012 to 2022, 90 surgical Impella devices were implanted. The median age was 63 [53-70] years, the mean creatinine was 2.07 ± 1.22 mg/dL, and the average lactate level was 3.32 ± 2.90 mmol/L. Prior to implantation, 47 patients (52%) were supported with vasoactive agents, while 43 (48%) were also supported with another device. The most common etiology of shock was acute on chronic heart failure (50, 56%), followed by acute myocardial infarction (22, 24%), and postcardiotomy (17, 19%). Overall, 69 patients (77%) survived to device removal, and 57 (65%) survived to hospital discharge. One-year survival was 54%. Neither etiology of heart failure nor device strategy was associated with 30-day or 1-year survival. On multivariable modeling, the number of vasoactive medications prior to device implantation was strongly associated with 30-day mortality (hazard ratio 1.94 [1.27-2.96], P < 0.01). Surgical Impella placement was associated with a significant decreased need for vasoactive infusions (P < 0.01) and decreased acidosis (P = 0.01). Conclusions Surgical Impella support for patients in acute cardiogenic shock is associated with lower vasoactive medication use, improved hemodynamics, increased end-organ perfusion, and acceptable morbidity and mortality.
Collapse
Affiliation(s)
- Timothy J. George
- Department of Advanced Heart Failure and Mechanical Circulatory Support, Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
| | - Jenelle Sheasby
- Department of Advanced Heart Failure and Mechanical Circulatory Support, Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
| | - J. Michael DiMaio
- Department of Advanced Heart Failure and Mechanical Circulatory Support, Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
| | - Nitin Kabra
- Department of Advanced Heart Failure and Mechanical Circulatory Support, Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
| | - David A. Rawitscher
- Department of Advanced Heart Failure and Mechanical Circulatory Support, Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
| | - Aasim Afzal
- Department of Advanced Heart Failure and Mechanical Circulatory Support, Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
| |
Collapse
|
9
|
Ardito V, Sarucanian L, Rognoni C, Pieri M, Scandroglio AM, Tarricone R. Impella Versus VA-ECMO for Patients with Cardiogenic Shock: Comprehensive Systematic Literature Review and Meta-Analyses. J Cardiovasc Dev Dis 2023; 10:jcdd10040158. [PMID: 37103037 PMCID: PMC10142129 DOI: 10.3390/jcdd10040158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 04/28/2023] Open
Abstract
Impella and VA-ECMO are two possible therapeutic courses for the treatment of patients with cardiogenic shock (CS). The study aims to perform a systematic literature review and meta-analyses of a comprehensive set of clinical and socio-economic outcomes observed when using Impella or VA-ECMO with patients under CS. A systematic literature review was performed in Medline, and Web of Science databases on 21 February 2022. Nonoverlapping studies with adult patients supported for CS with Impella or VA-ECMO were searched. Study designs including RCTs, observational studies, and economic evaluations were considered. Data on patient characteristics, type of support, and outcomes were extracted. Additionally, meta-analyses were performed on the most relevant and recurring outcomes, and results shown using forest plots. A total of 102 studies were included, 57% on Impella, 43% on VA-ECMO. The most common outcomes investigated were mortality/survival, duration of support, and bleeding. Ischemic stroke was lower in patients treated with Impella compared to the VA-ECMO population, with statistically significant difference. Socio-economic outcomes including quality of life or resource use were not reported in any study. The study highlighted areas where further data collection is needed to clarify the value of complex, new technologies in the treatment of CS that will enable comparative assessments focusing both on the health impact on patient outcomes and on the financial burden for government budgets. Future studies need to fill the gap to comply with recent regulatory updates at the European and national levels.
Collapse
Affiliation(s)
- Vittoria Ardito
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
| | - Lilit Sarucanian
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
| | - Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
- Department of Social and Political Science, Bocconi University, 20136 Milan, Italy
| |
Collapse
|
10
|
De Luca L, Mistrulli R, Scirpa R, Thiele H, De Luca G. Contemporary Management of Cardiogenic Shock Complicating Acute Myocardial Infarction. J Clin Med 2023; 12:2184. [PMID: 36983185 PMCID: PMC10051785 DOI: 10.3390/jcm12062184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
Despite an improvement in pharmacological therapies and mechanical reperfusion, the outcome of patients with acute myocardial infarction (AMI) is still suboptimal, especially in patients with cardiogenic shock (CS). The incidence of CS accounts for 3-15% of AMI cases, with mortality rates of 40% to 50%. In contrast to a large number of trials conducted in patients with AMI without CS, there is limited evidence-based scientific knowledge in the CS setting. Therefore, recommendations and actual treatments are often based on registry data. Similarly, knowledge of the available options in terms of temporary mechanical circulatory support (MCS) devices is not equally widespread, leading to an underutilisation or even overutilisation in different regions/countries of these treatment options and nonuniformity in the management of CS. The aim of this article is to provide a critical overview of the available literature on the management of CS as a complication of AMI, summarising the most recent evidence on revascularisation strategies, pharmacological treatments and MCS use.
Collapse
Affiliation(s)
- Leonardo De Luca
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, A.O. San Camillo-Forlanini, 00152 Rome, Italy
- Faculty of Medicine and Dentistry, UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | - Raffaella Mistrulli
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, A.O. San Camillo-Forlanini, 00152 Rome, Italy
| | - Riccardo Scirpa
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, A.O. San Camillo-Forlanini, 00152 Rome, Italy
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, 04289 Leipzig, Germany
| | - Giuseppe De Luca
- Division of Cardiology, AOU “Policlinico G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, 98166 Messina, Italy
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant’Ambrogio, 20161 Milan, Italy
| |
Collapse
|
11
|
Bazmpani MA, Papanastasiou CA, Kamperidis V, Zebekakis PE, Karvounis H, Kalogeropoulos AP, Karamitsos TD. Contemporary Data on the Status and Medical Management of Acute Heart Failure. Curr Cardiol Rep 2022; 24:2009-2022. [PMID: 36385324 PMCID: PMC9747828 DOI: 10.1007/s11886-022-01822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE OF REVIEW Acute heart failure (AHF) is among the leading causes for unplanned hospital admission. Despite advancements in the management of chronic heart failure, the prognosis of AHF remains poor with high in-hospital mortality and increased rates of unfavorable post-discharge outcomes. With this review, we aim to summarize current data on AHF epidemiology, focus on the different patient profiles and classifications, and discuss management, including novel therapeutic options in this area. RECENT FINDINGS There is significant heterogeneity among patients admitted for AHF in their baseline characteristics, heart failure (HF) aetiology and precipitating factors leading to decompensation. A novel classification scheme based on four distinct clinical scenarios has been included in the most recent ESC guidelines, in an effort to better risk stratify patients and guide treatment. Intravenous diuretics, vasodilators, and inotropes remain the cornerstone of management in the acute phase, and expansion of use of mechanical circulatory support has been noted in recent years. Meanwhile, many treatments that have proved their value in chronic heart failure demonstrate promising results in the setting of AHF and research in this field is currently ongoing. Acute heart failure remains a major health challenge with high in-hospital mortality and unfavorable post-discharge outcomes. Admission for acute HF represents a window of opportunity for patients to initiate appropriate treatment as soon as possible after stabilization. Future studies are needed to elucidate which patients will benefit the most by available therapies and define the optimal timing for treatment implementation.
Collapse
Affiliation(s)
- Maria Anna Bazmpani
- First Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 1 Stilponos Kyriakides Str, 54636, Thessaloniki, Greece
| | - Christos A Papanastasiou
- First Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 1 Stilponos Kyriakides Str, 54636, Thessaloniki, Greece
| | - Vasileios Kamperidis
- First Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 1 Stilponos Kyriakides Str, 54636, Thessaloniki, Greece
| | - Pantelis E Zebekakis
- Division of Nephrology and Hypertension, 1St Department of Medicine, Medical School, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haralambos Karvounis
- First Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 1 Stilponos Kyriakides Str, 54636, Thessaloniki, Greece
| | | | - Theodoros D Karamitsos
- First Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 1 Stilponos Kyriakides Str, 54636, Thessaloniki, Greece.
| |
Collapse
|
12
|
Vallabhajosyula S, Verghese D, Henry TD, Katz JN, Nicholson WJ, Jaber WA, Jentzer JC. Contemporary Management of Concomitant Cardiac Arrest and Cardiogenic Shock Complicating Myocardial Infarction. Mayo Clin Proc 2022; 97:2333-2354. [PMID: 36464466 DOI: 10.1016/j.mayocp.2022.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 06/08/2022] [Accepted: 06/24/2022] [Indexed: 12/03/2022]
Abstract
Cardiogenic shock (CS) and cardiac arrest (CA) are the most life-threatening complications of acute myocardial infarction. Although there is a significant overlap in the pathophysiology with approximately half the patients with CS experiencing a CA and approximately two-thirds of patients with CA developing CS, comprehensive guideline recommendations for management of CA + CS are lacking. This paper summarizes the current evidence on the incidence, pathophysiology, and short- and long-term outcomes of patients with acute myocardial infarction complicated by concomitant CA + CS. We discuss the hemodynamic factors and unique challenges that need to be accounted for while developing treatment strategies for these patients. A summary of expert-based step-by-step recommendations to the approach and treatment of these patients, both in the field before admission and in-hospital management, are presented.
Collapse
Affiliation(s)
- Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Dhiran Verghese
- Section of Advanced Cardiac Imaging, Division of Cardiovascular Medicine, Department of Medicine, Harbor UCLA Medical Center, Torrance, CA, USA; Department of Cardiovascular Medicine, NCH Heart Institute, Naples, FL, USA
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital Health Network, Cincinnati, OH, USA
| | - Jason N Katz
- Divisions of Cardiovascular Diseases and Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - William J Nicholson
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Wissam A Jaber
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
13
|
Rahamim E, Carasso S, Amir O, Elbaz-Greener G. The Battle against Cardiogenic Shock. J Clin Med 2022; 11:jcm11236958. [PMID: 36498533 PMCID: PMC9741228 DOI: 10.3390/jcm11236958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Cardiogenic shock (CS) is a life-threatening condition characterized by hypoperfusion and hypoxia caused by low cardiac output [...].
Collapse
Affiliation(s)
- Eldad Rahamim
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
- Correspondence: (E.R.); (G.E.-G.)
| | - Shemy Carasso
- Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem 9103102, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Offer Amir
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
- Correspondence: (E.R.); (G.E.-G.)
| |
Collapse
|
14
|
Schurtz G, Delmas C, Fenouillet M, Roubille F, Puymirat E, Bonello L, Leurent G, Verdier B, Levy B, Ternacle J, Harbaoui B, Vanzetto G, Combaret N, Lattuca B, Bruel C, Bourenne J, Labbé V, Henry P, Bonnefoy-Cudraz É, Lamblin N, Lemesle G. Impact of Pre-Existing History of Heart Failure on Patient Profile, Therapeutic Management, and Prognosis in Cardiogenic Shock: Insights from the FRENSHOCK Registry. Life (Basel) 2022; 12:life12111844. [PMID: 36430979 PMCID: PMC9698880 DOI: 10.3390/life12111844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/25/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
There is a large heterogeneity among patients presenting with cardiogenic shock (CS). It is crucial to better apprehend this heterogeneity in order to adapt treatments and improve prognoses in these severe patients. Notably, the presence (or absence) of a pre-existing history of chronic heart failure (CHF) at time of CS onset may be a significant part of this heterogeneity, and data focusing on this aspect are lacking. We aimed to compare CS patients with new-onset HF to those with worsening CHF in the multicenter FRENSHOCK registry. Altogether, 772 CS patients were prospectively included: 433 with a previous history of CHF and 339 without. Worsening CHF patients were older (68 +/− 13.4 vs. 62.7 +/− 16.2, p < 0.001) and had a greater burden of extra-cardiac comorbidities. At admission, acute myocardial infarction was predominantly observed in the new-onset HF group (49.9% vs. 25.6%, p < 0.001). When focusing on hemodynamic parameters, worsening CHF patients showed more congestion and higher ventricular filling pressures. Worsening CHF patients experienced higher in-hospital all-cause mortality (31.3% vs. 24.2%, p = 0.029). Our results emphasize the great heterogeneity of the patients presenting with CS. Worsening CHF patients had higher risk profiles, and this translated to a 30% increase in in-hospital all-cause mortality. The heterogeneity of this population prompts us to better determine the phenotype of CS patients to adapt their management.
Collapse
Affiliation(s)
- Guillaume Schurtz
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, 59000 Lille, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 1 Avenue Jean Poulhes, 31059 Toulouse, France
| | - Margaux Fenouillet
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, 59000 Lille, France
| | - François Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique des Hôpitaux de Paris, 75000 Paris, France
| | - Laurent Bonello
- Cardiology Department, APHM, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Aix-Marseille University, INSERM 1263, INRA 1260, 13000 Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, University Rennes 1, 35000 Rennes, France
| | - Basile Verdier
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, 59000 Lille, France
| | - Bruno Levy
- Service de Réanimation Médicale Brabois, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, INSERM U1116, Faculté de Médecine, Vandoeuvre-les-Nancy, Université de Lorraine, 54000 Nancy, France
| | - Julien Ternacle
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 33318 Pessac, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, 69000 Lyon, France
- CREATIS UMR5220, INSERM U1044, INSA-15, University of Lyon, 69000 Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38000 Grenoble, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Benoît Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, 30000 Nîmes, France
| | - Cedric Bruel
- Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, 75000 Paris, France
| | - Jeremy Bourenne
- Service de Réanimation des Urgences, CHU La Timone 2, Aix Marseille Université, 13000 Marseille, France
| | - Vincent Labbé
- Medical Intensive Care Unit, AP-HP, Tenon University Hospital, 75000 Paris, France
| | - Patrick Henry
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, INSERM U942, University of Paris, 75000 Paris, France
| | - Éric Bonnefoy-Cudraz
- Intensive Cardiological Care Division, Hospices Civils de Lyon-Hôpital Cardiovasculaire et Pulmonaire, 69000 Lyon, France
| | - Nicolas Lamblin
- Cardiology Department, Heart and Lung Institute, University Hospital of Lille, 59000 Lille, France
- INSERM U1167, Institut Pasteur of Lille, 59000 Lille, France
| | - Gilles Lemesle
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, 59000 Lille, France
- Heart and Lung Institute, University Hospital of Lille, 59000 Lille, France
- Inserm U1011, Institut Pasteur of Lille, 59000 Lille, France
- FACT (French Alliance for Cardiovascular Trials), 75000 Paris, France
- Correspondence: ; Tel.: +33-320445330; Fax: +33-320444898
| |
Collapse
|
15
|
Effect Analysis of Nursing Method Based on Stratified Emergency Knowledge in Emergency Myocardial Infarction. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3505228. [PMID: 36246970 PMCID: PMC9553482 DOI: 10.1155/2022/3505228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 12/02/2022]
Abstract
First aid is to give immediate first aid to patients who have suffered accidental injuries or sudden diseases before the emergency medical personnel arrive at the scene or are sent to the hospital for treatment; myocardial infarction is a severe and emergency of coronary heart disease. It is often because of coronary atherosclerosis, plaque rupture, bleeding, or thrombosis, which leads to the acute and complete occlusion of the coronary arteries and acute necrosis of the myocardium. This article aims to investigate the effectiveness of a stratified emergency care team assisted by multidisciplinary first aid knowledge in acute myocardial infarction first aid, hoping to reduce the probability of acute myocardial infarction through first aid and nursing care. Business process reengineering is a management idea that reached its heyday in the 1990s and is usually defined as achieving workflow and productivity through the reorganization and optimization of corporate strategies, value-added operational processes, and the systems, policies, organizations, and structures that support them. This article first outlines the concepts and steps of medical image registration, analyzes the characteristics of current medical image registration methods, and uses the two most commonly used medical registration methods today; in this study, the BPR theory was used to construct the AMI emergency care process in the hospital, which effectively reduced the emergency delay time of AMI patients, improved the patient's emergency response, and increased the efficiency of emergency nurses' rescue work. The experimental results in this paper show that the sensitivities of the first four groups of ST↑III > II, ST ↓ aVL > I, STV3 ↓ /STIII↑≤1.2, STI ↓ ≥0.05 mV are 82.1%, 80%, 75.3%, and 60.3%, respectively. Their sensitivities are relatively close, both are greater than 50%; among them, ST↑III > II has the highest sensitivity, which is 80%. In terms of specificity, ST↑III > II, ST ↓ aVL > I, STV3 ↓ /STIII↑≤1.2, and STI ↓ ≥0.05 mV were 82.1%, 89.2%, 82.7%, and 65.2%, respectively. ST ↓ ≥0.05 mV has the lowest specificity, and ST ↓ aVL > I has the highest specificity.
Collapse
|
16
|
Establishing a Cardiac ICU Recovery Clinic: Characterizing a Model for Continuity of Cardiac Critical Care. Crit Pathw Cardiol 2022; 21:135-140. [PMID: 35994722 DOI: 10.1097/hpc.0000000000000294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Care in the cardiovascular intensive care unit (CICU) has become increasingly intricate due to a temporal rise in noncardiac diagnoses and overall clinical complexity with high risk for short-term rehospitalization and mortality. Survivors of critical illness are often faced with debility and limitations extending beyond the index hospitalization. Comprehensive ICU recovery programs have demonstrated some efficacy but have primarily targeted survivors of acute respiratory distress syndrome or sepsis. The efficacy of dedicated ICU recovery programs on the CICU population is not defined. METHODS We aim to describe the design and initial experience of a novel CICU-recovery clinic (CICURC). The primary outcome was death or rehospitalization in the first 30 days following hospital discharge. Self-reported outcome measures were performed to assess symptom burden and independence in activities of daily living. RESULTS Using standardized criteria, 41 patients were referred to CICURC of which 78.1% established care and were followed for a median of 88 (56-122) days. On intake, patients reported a high burden of heart failure symptoms (KCCQ overall summary score 29.8 [18.0-47.5]), and nearly half (46.4%) were dependent on caretakers for activities of daily living. Thirty days postdischarge, no deaths were observed and the rate of rehospitalization for any cause was 12.2%. CONCLUSIONS CICU survivors are faced with significant residual symptom burden, dependence upon caretakers, and impairments in mental health. Dedicated CICURCs may help prioritize treatment of ICU related illness, reduce symptom burden, and improve outcomes. Interventions delivered in ICU recovery clinic for patients surviving the CICU warrant further investigation.
Collapse
|
17
|
Tehrani BN, Drakos SG, Billia F, Batchelor WB, Luk A, Stelling K, Tonna J, Rosner C, Hanff T, Rao V, Brozzi NA, Baran DA. The Multicenter Collaborative to Enhance Biologic Understanding, Quality, and Outcomes in Cardiogenic Shock (VANQUISH Shock): Rationale and Design. Can J Cardiol 2022; 38:1286-1295. [PMID: 35288292 PMCID: PMC10625804 DOI: 10.1016/j.cjca.2022.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Despite efforts to advance therapies in cardiogenic shock (CS), outcomes remain poor. This is likely due to several factors, including major gaps in our understanding of the pathophysiology, phenotyping of patients, and challenges with conducting adequately powered clinical studies. An unmet need exists for a comprehensive multicentre "all-comers" prospective registry to facilitate characterising contemporary presentation, treatment (in a device-agnostic fashion), and short- and intermediate-term outcomes and quality of life (QOL) of CS patients. METHODS The Multicenter Collaborative to Enhance Biological Understanding, Quality and Outcomes in Cardiogenic Shock (VANQUISH Shock) registry is a prospective observational registry that will study unrestricted adult patients with a primary diagnosis of CS at 4 North American centres with multidisciplinary shock programs. Both acute myocardial infarction (AMI-CS) and acute heart failure (HF-CS) etiologies will be included, and the registry will be device agnostic and widely inclusive. The primary end point will be survival at 30 days after hospital discharge. Secondary outcomes will include in-hospital adverse events and survival to 6 and 12 months. Patients will also undergo neurologic and health-related QOL assessments with the Cerebral Performance Category (CPC) and Short-Form 36 (SF-36) health survey tools before discharge and during follow-up. Serial biospecimens will facilitate biomarker studies. CONCLUSIONS The VANQUISH Shock registry provides a unique opportunity to study the pathophysiology, contemporary management, clinical course, and outcomes of CS. By capturing detailed and high-quality longitudinal data, the registry will address existing knowledge gaps and serve as a springboard for future mechanistic clinical studies to advance the field.
Collapse
Affiliation(s)
| | | | - Filio Billia
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada.
| | | | - Adriana Luk
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kelly Stelling
- Sentara Norfolk General Hospital, Norfolk, Virginia, USA
| | | | | | | | - Vivek Rao
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nicolas A Brozzi
- Cleveland Clinic Heart, Vascular, and Thoracic Institute, Weston, Florida, USA
| | - David A Baran
- Cleveland Clinic Heart, Vascular, and Thoracic Institute, Weston, Florida, USA.
| |
Collapse
|
18
|
Rajaguru V, Kim TH, Shin J, Lee SG, Han W. Ability of the LACE Index to Predict 30-Day Readmissions in Patients with Acute Myocardial Infarction. J Pers Med 2022; 12:jpm12071085. [PMID: 35887582 PMCID: PMC9318277 DOI: 10.3390/jpm12071085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Aims: This study aimed to utilize the existing LACE index (length of stay, acuity of admission, comorbidity index and emergency room visit in the past six months) to predict the risk of 30-day readmission and to find the associated factors in patients with AMI. Methods: This was a retrospective study and LACE index scores were calculated for patients admitted with AMI between 2015 and 2019. Data were utilized from the hospital’s electronic medical record. Multivariate logistic regression was performed to find the association between covariates and 30-day readmission. The risk prediction ability of the LACE index for 30-day readmission was analyzed by receiver operating characteristic curves with the C statistic. Results: A total of 205 (5.7%) patients were readmitted within 30 days. The odds ratio of older age group (OR = 1.78, 95% CI: 1.54–2.05), admission via emergency ward (OR = 1.45; 95% CI: 1.42–1.54) and LACE score ≥10 (OR = 2.71; 95% CI: 1.03–4.37) were highly associated with 30-day readmissions and statistically significant. The receiver operating characteristic curve C statistic of the LACE index for AMI patients was 0.78 (95% CI: 0.75–0.80) and showed favorable discrimination in the prediction of 30-day readmission. Conclusion: The LACE index showed a good discrimination to predict the risk of 30-day readmission for hospitalized patients with AMI. Further study would be recommended to focus on additional factors that can be used to predict the risk of 30-day readmission; this should be considered to improve the model performance of the LACE index for other acute conditions by using the national-based administrative data.
Collapse
Affiliation(s)
- Vasuki Rajaguru
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea; (V.R.); (T.H.K.)
| | - Tae Hyun Kim
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea; (V.R.); (T.H.K.)
| | - Jaeyong Shin
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea; (J.S.); (S.G.L.)
| | - Sang Gyu Lee
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea; (J.S.); (S.G.L.)
| | - Whiejong Han
- Department of Global Health Security, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea
- Correspondence:
| |
Collapse
|
19
|
Masiero G, Cardaioli F, Rodinò G, Tarantini G. When to Achieve Complete Revascularization in Infarct-Related Cardiogenic Shock. J Clin Med 2022; 11:jcm11113116. [PMID: 35683500 PMCID: PMC9180947 DOI: 10.3390/jcm11113116] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/21/2022] [Accepted: 05/26/2022] [Indexed: 12/20/2022] Open
Abstract
Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is a life-threatening condition frequently encountered in patients with multivessel coronary artery disease (CAD). Despite prompt revascularization, in particular, percutaneous coronary intervention (PCI), and therapeutic and technological advances, the mortality rate for patients with CS related to AMI remains unacceptably high. Differently form a hemodynamically stable setting, a culprit lesion-only (CLO) revascularization strategy is currently suggested for AMI–CS patients, based on the results of recent randomized evidence burdened by several limitations and conflicting results from non-randomized studies. Furthermore, mechanical circulatory support (MCS) devices have emerged as a key therapeutic option in CS, especially in the case of their early implantation without delaying revascularization and before irreversible organ damage has occurred. We provide an in-depth review of the current evidence on optimal revascularization strategies of multivessel CAD in infarct-related CS, assessing the role of different types of MCS devices and highlighting the importance of shock teams and medical care system networks to effectively impact on clinical outcomes.
Collapse
|
20
|
Yerasi C, Case BC, Pahuja M, Ben-Dor I, Waksman R. The Need for Additional Phenotyping When Defining Cardiogenic Shock. JACC Cardiovasc Interv 2022; 15:890-895. [PMID: 35450689 DOI: 10.1016/j.jcin.2021.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/12/2021] [Accepted: 12/21/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Mohit Pahuja
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
| |
Collapse
|
21
|
Sex Differences in Management and Outcomes of Acute Myocardial Infarction Patients Presenting With Cardiogenic Shock. JACC Cardiovasc Interv 2022; 15:642-652. [PMID: 35331456 DOI: 10.1016/j.jcin.2021.12.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The aim of this study was to examine the sex differences in the risk profile, management, and outcomes among patients presenting with acute myocardial infarction cardiogenic shock (AMI-CS). BACKGROUND Contemporary clinical data regarding sex differences in the management and outcomes of AMI patients presenting with CS are scarce. METHODS Patients admitted with AMI-CS from the National Cardiovascular Data Registry Chest Pain-MI registry between October 2008 to December 2017 were included. Sex differences in baseline characteristics, in-hospital management, and outcomes were compared. Patients ≥65 years of age with available linkage data to Medicare claims were included in the analysis of 1-year outcomes. Multivariable logistic regression and Cox proportional hazards models adjusting for patient and hospital-related covariates were used to estimate sex-specific differences in in-hospital and 1-year outcomes, respectively. RESULTS Among 17,195 patients presenting with AMI-CS, 37.3% were women. Women were older, had a higher prevalence of comorbidities, and had worse renal function at presentation. Women were less likely to receive guideline-directed medical therapies within 24 hours and at discharge, undergo diagnostic angiography (85.0% vs 91.1%), or receive mechanical circulatory support (25.4% vs 33.8%). Women had higher risks of in-hospital mortality (adjusted OR: 1.10; 95% CI: 1.02-1.19) and major bleeding (adjusted OR: 1.23; 95% CI: 1.12-1.34). For patients ≥65 years of age, women did not have a higher risk of all-cause mortality (adjusted HR: 0.98; 95% CI: 0.88-1.09) and mortality or heart failure hospitalization (adjusted HR: 1.01; 95% CI: 0.91-1.12) at 1 year compared with men. CONCLUSIONS In this large nationwide analysis of patients with AMI-CS, women were less likely to receive guideline recommended care, including revascularization, and had worse in-hospital outcomes than men. At 1 year, there were no sex differences in the risk of mortality. Efforts are needed to address sex disparities in the initial care of AMI-CS patients.
Collapse
|
22
|
Bertaina M, Galluzzo A, Rossello X, Sbarra P, Petitti E, Prever SB, Boccuzzi G, D'Ascenzo F, Frea S, Pidello S, Morici N, Sacco A, Oliva F, Valente S, De Ferrari GM, Ugo F, Rametta F, Attisani M, Zanini P, Noussan P, Iannaccone M. Prognostic implications of pulmonary artery catheter monitoring in patients with cardiogenic shock: A systematic review and meta-analysis of observational studies. J Crit Care 2022; 69:154024. [PMID: 35344825 DOI: 10.1016/j.jcrc.2022.154024] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To investigate the impact of pulmonary artery catheter (PAC) monitoring on survival of cardiogenic shock(CS), in the light of the controversies in available evidence. MATERIALS AND METHODS MEDLINE, EMBASE, Cochrane library and Web of Science were systematically screened to identify most relevant studies on patients with CS comparing PAC use to non-use during hospital stay. Short-term mortality was the primary endpoint and the use of Mechanical Circulatory Support (MCS) devices was the secondary one. RESULTS Six observational studies including 1,166,762 patients were selected. The most frequent etiology of CS was post-myocardial infarction (75% [95% CI 55-89%] in PAC-group and 81%[95% CI 47-95%] in non-PAC group). Overall, PAC was used in 33%(95% CI 24-44%) of cases. Pooling data adjusted for confounders, a significant association between the PAC-group and a reduction in short-term mortality emerged when compared to the non-PAC group (36%[95% CI 27-45%] vs 47%[95% CI 35-59%];AdjustedOR 0.71, 95% CI 0.59-0.87, p < 0.01). MCS use was significantly higher in PAC vs non-PAC group (59% [95% CI 54-65%]) vs 48% [95% CI 43-53%]);OR 1.60 [95% CI 1.27-2.02, p < 0.01]). CONCLUSIONS PAC was associated with lower incidence of short-term mortality in CS pooling adjusted observational studies. Prospective studies are needed to confirm our hypothesis and better clarify the mechanisms of this potential prognostic benefit.
Collapse
Affiliation(s)
- Maurizio Bertaina
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy.
| | | | - Xavier Rossello
- Cardiology Department, Institut d'Investigació Sanitària Illes Balears, Hospital Universitari Son Espases, Palma, Spain
| | - Pierluigi Sbarra
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | | | | | - Giacomo Boccuzzi
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Italy
| | - Simone Frea
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Italy
| | - Stefano Pidello
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Italy
| | - Nuccia Morici
- Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; IRCCS S. Maria Nascente, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
| | - Alice Sacco
- Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabrizio Oliva
- Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Serafina Valente
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Italy
| | - Fabrizio Ugo
- Department of Cardiology, Sant'Andrea Hospital, Vercelli, Italy
| | | | - Matteo Attisani
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Italy; Department of cardiovascular surgery, San Giovanni Bosco Hospital, Turin, Italy
| | - Paola Zanini
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Patrizia Noussan
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Mario Iannaccone
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| |
Collapse
|
23
|
Fanaroff AC, Li S, Marquis-Gravel G, Giri J, Lopes RD, Piccini JP, Wang TY. Atrial Fibrillation and Coronary Artery Disease: A Long-Term Perspective on the Need for Combined Antithrombotic Therapy. Circ Cardiovasc Interv 2021; 14:e011232. [PMID: 34932388 DOI: 10.1161/circinterventions.121.011232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Older adults with atrial fibrillation (AF) are often treated with the shortest possible duration of antiplatelet/anticoagulant therapy after myocardial infarction (MI) or percutaneous coronary intervention (PCI) due to concern for bleeding. However, the risk of recurrent MI or PCI prompting antiplatelet therapy extension is unknown in this population. METHODS Using the National Cardiovascular Data Registry linked to Medicare claims, we described the cumulative incidence of recurrent MI or PCI over a median of 7-year follow-up for patients ≥65 years old with AF discharged alive after acute MI between 2008 and 2017. We used pharmacy fill data to describe the proportion of patients filling prescriptions for both oral anticoagulants and P2Y12 inhibitors for ≥50% of the indicated duration after MI or PCI. RESULTS Of 187 622 older patients discharged alive after MI, 50 539 (26.9%) had AF. Over a median of 7-year follow-up in patients with AF, the cumulative incidence was 14.5% for recurrent MI, 12.1% for PCI, 7.9% for stroke, and 9.5% for bleeding hospitalization. Among 7998 patients with AF and recurrent MI or PCI, 1668 (20.9%) had >1 MI or PCI during follow-up. Assuming each MI or PCI should be followed by 6 months of P2Y12 inhibitor therapy, patients with AF who had a recurrent MI/PCI had a median estimated indication for antiplatelet/anticoagulant treatment of 287 days (194, 358), but filled both P2Y12 inhibitor and oral anticoagulant for a median of 0 days (0, 21). In this cohort, 12.2% of patients filled prescriptions for both a P2Y12 inhibitor and oral anticoagulant for ≥50% of the indicated duration. CONCLUSIONS Older adults with AF and MI have high incidences of downstream recurrent MI or PCI requiring extended antiplatelet/anticoagulant therapy durations, yet many appear to be under-treated. These results highlight the need for better thrombosis prevention strategies in this group of patients.
Collapse
Affiliation(s)
- Alexander C Fanaroff
- Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, Leonard Davis Institute of Health Economics, Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia (A.C.F., J.G.)
| | - Shuang Li
- Duke Clinical Research Institute (S.L., G.M.-G., R.D.L., J.P.P., T.Y.W.), Duke University, Durham, NC
| | - Guillaume Marquis-Gravel
- Duke Clinical Research Institute (S.L., G.M.-G., R.D.L., J.P.P., T.Y.W.), Duke University, Durham, NC
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, Leonard Davis Institute of Health Economics, Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia (A.C.F., J.G.)
| | - Renato D Lopes
- Duke Clinical Research Institute (S.L., G.M.-G., R.D.L., J.P.P., T.Y.W.), Duke University, Durham, NC.,Department of Medicine (R.D.L., J.P.P., T.Y.W.), Duke University, Durham, NC
| | - Jonathan P Piccini
- Duke Clinical Research Institute (S.L., G.M.-G., R.D.L., J.P.P., T.Y.W.), Duke University, Durham, NC.,Department of Medicine (R.D.L., J.P.P., T.Y.W.), Duke University, Durham, NC
| | - Tracy Y Wang
- Duke Clinical Research Institute (S.L., G.M.-G., R.D.L., J.P.P., T.Y.W.), Duke University, Durham, NC.,Department of Medicine (R.D.L., J.P.P., T.Y.W.), Duke University, Durham, NC
| |
Collapse
|
24
|
Bossi E, Marini C, Gaetti G, Diamanti L, Alessio D, Bertoldi LF, Pappalardo F, Odone A. Efficacy and safety of Impella 5.0 in cardiogenic shock: an updated systematic review. Future Cardiol 2021; 18:253-264. [PMID: 34713720 DOI: 10.2217/fca-2021-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The impact on safety and efficacy outcomes of Impella 5.0 in cardiogenic shock (CS) has not been systematically assessed. Materials & methods: We conducted a systematic review of the literature (PROSPERO protocol: CRD42020164680) to critically appraise available evidence on Impella 5.0 comparative safety, efficacy and effectiveness. Results: Of 244 retrieved citations, 17 original articles met the a priori defined inclusion criteria. All included studies had a retrospective study design and, overall, reported on, respectively, 52 and 67 different safety and efficacy/effectiveness outcomes. Thirty-day survival rates ranged from 40 to 94%, myocardial recovery from 18 to 93%. Conclusion: Impella 5.0 provides a full cardiac support, it is associated with a lower rate of vascular complications, it represents a valuable bridge-to-decision and allows for resolution of intercurrent clinical conditions. As available data suggest Impella 5.0 good performance in CS of various etiologies, more solid evidence will come from much-needed large-scale all-comer registries and prospective multicenter randomized trials.
Collapse
Affiliation(s)
- Eleonora Bossi
- HTA Committee, Health Directorate, IRCCS San Raffaele Hospital, Milan, 20132, Italy.,School of Public Health, Vita-Salute San Raffaele University, Milan, 20132, Italy
| | - Claudia Marini
- Advanced Heart Failure & Mechanical Circulatory Support Program, IRCCS San Raffaele Hospital, Milan, 20132, Italy.,Department of Cardiovascular, ASST Santi Paolo e Carlo, Milan, 20142, Italy
| | - Giovanni Gaetti
- HTA Committee, Health Directorate, IRCCS San Raffaele Hospital, Milan, 20132, Italy.,School of Public Health, Vita-Salute San Raffaele University, Milan, 20132, Italy
| | - Luca Diamanti
- HTA Committee, Health Directorate, IRCCS San Raffaele Hospital, Milan, 20132, Italy
| | - Davide Alessio
- HTA Committee, Health Directorate, IRCCS San Raffaele Hospital, Milan, 20132, Italy
| | - Letizia Fausta Bertoldi
- Advanced Heart Failure & Mechanical Circulatory Support Program, IRCCS San Raffaele Hospital, Milan, 20132, Italy.,Department of Cardiovascular, Humanitas Clinical & Research Center IRCCS, Rozzano, 20089, Italy
| | - Federico Pappalardo
- Advanced Heart Failure & Mechanical Circulatory Support Program, IRCCS San Raffaele Hospital, Milan, 20132, Italy.,Department of Cardiothoracic & Vascular Anesthesia & Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, 15121, Alessandria
| | - Anna Odone
- HTA Committee, Health Directorate, IRCCS San Raffaele Hospital, Milan, 20132, Italy.,Department of Public Health, Experimental & Forensic Medicine, University of Pavia, Pavia, 27100, Italy
| |
Collapse
|
25
|
Loforte A, Comentale G, Botta L, Gliozzi G, Cavalli GG, Mariani C, Pilato E, Suarez SM, Pacini D. How Would the Authors Treat Their Own Temporary Left Ventricular Failure With Mechanical Circulatory Support? J Cardiothorac Vasc Anesth 2021; 36:1238-1250. [PMID: 34785126 DOI: 10.1053/j.jvca.2021.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/23/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022]
Abstract
In the last 20 years, mechanical circulatory supports (MCS) have overturned completely the outcomes and the clinical recovery of patients with isolated acute left ventricle failure (iALVF). This usually occurs more frequently than right-sided heart failure or biventricular dysfunction, and it mainly is caused by acute myocardial infarction. The primary role of MCS is to restore the tissue metabolism to preserve the vital organs' function but, on the other hand, they also have to relieve the workload stress on the heart. In this way, they allow not only the heart to recover from the acute event, but MCS also can stabilize the patient toward cardiac transplantation. The short-term MCS devices currently used in clinical practice are the intraaortic balloon pump, the Impella (Abiomed, Danvers, MA), and venoarterial extracorporeal membrane oxygenation (VA-ECMO), but the choice of the right and tailored device for each patient, as well as the timing to use it, is actually one of the most debated topics of MCS management.
Collapse
Affiliation(s)
- Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy.
| | - Giuseppe Comentale
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy; Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy
| | - Luca Botta
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Gregorio Gliozzi
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulio Giovanni Cavalli
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Carlo Mariani
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Emanuele Pilato
- Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy
| | - Sofia Martin Suarez
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| |
Collapse
|
26
|
Breen TJ, Padkins M, Bennett CE, Anavekar NS, Murphy JG, Bell MR, Barsness GW, Jentzer JC. Predicting 1-Year Mortality on Admission Using the Mayo Cardiac Intensive Care Unit Admission Risk Score. Mayo Clin Proc 2021; 96:2354-2365. [PMID: 34366138 DOI: 10.1016/j.mayocp.2021.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/10/2021] [Accepted: 01/21/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine whether the Mayo Cardiac Intensive Care Unit (CICU) Admission Risk Score (M-CARS) accurately predicts 1-year mortality. METHODS We retrospectively reviewed adult CICU patients admitted from January 1, 2007, through April 30, 2018, and calculated M-CARS using admission data. We examined the association between admission M-CARS, as continuous and categorical variables, and 1-year mortality. RESULTS This study included 12,428 unique patients with a mean age of 67.6±15.2 years (4686 [37.7%] female). A total of 2839 patients (22.8%) died within 1 year of admission, including 1149 (9.2%) hospital deaths and 1690 (15.0%) of the 11,279 hospital survivors. The 1-year survival decreased incrementally as a function of increasing M-CARS (P<.001), and all components of M-CARS were significant predictors of 1-year mortality (P<.001). The 1-year survival among hospital survivors decreased incrementally as a function of increasing M-CARS for scores below 3 (all P<.001); however, there was no further decrease in 1-year survival for hospital survivors with M-CARS of 3 or more (P=.99). The M-CARS components associated with 1-year mortality among hospital survivors included blood urea nitrogen, red blood cell distribution width, Braden skin score, and respiratory failure (all P<.001). CONCLUSION M-CARS predicted 1-year mortality among CICU admissions, with a plateau effect at high M-CARS of 3 or more for hospital survivors. Significant added predictors of 1-year mortality among hospital survivors included markers of frailty and chronic illness.
Collapse
Affiliation(s)
- Thomas J Breen
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Courtney E Bennett
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Joseph G Murphy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
27
|
Spaulding C. Racial, Ethnic, and Sex Disparities in Cardiogenic Shock Due to STEMI: ACT NOW! JACC Cardiovasc Interv 2021; 14:661-663. [PMID: 33736773 DOI: 10.1016/j.jcin.2021.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Christian Spaulding
- Cardiology Department, Sudden Cardiac Death Expert Center, European Hospital Georges Pompidou, University of Paris, INSERM U 970, Paris, France.
| |
Collapse
|
28
|
Ya'qoub L, Lemor A, Dabbagh M, O'Neill W, Khandelwal A, Martinez SC, Ibrahim NE, Grines C, Voeltz M, Basir MB. Racial, Ethnic, and Sex Disparities in Patients With STEMI and Cardiogenic Shock. JACC Cardiovasc Interv 2021; 14:653-660. [PMID: 33736772 DOI: 10.1016/j.jcin.2021.01.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/18/2020] [Accepted: 01/05/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the combined impact of race, ethnicity, and sex on in-hospital outcomes using data from the National Inpatient Sample. BACKGROUND Cardiogenic shock (CS) is a major cause of mortality following ST-segment elevation myocardial infarction (STEMI). Early revascularization reduces mortality in such patients. Mechanical circulatory support (MCS) devices are increasingly used to hemodynamically support patients during revascularization. Little is known about racial, ethnic, and sex disparities in patients with STEMI and CS. METHODS The National Inpatient Sample was queried from January 2006 to September 2015 for hospitalizations with STEMI and CS. The associations between sex, race, ethnicity, and outcomes were examined using complex-samples multivariate logistic or generalized linear model regressions. RESULTS Of 159,339 patients with STEMI and CS, 57,839 (36.3%) were women. In-hospital mortality was higher for all women (range 40% to 45.4%) compared with men (range 30.4% to 34.7%). Women (adjusted odds ratio [aOR]: 1.11; 95% confidence interval [CI]: 1.06 to 1.16; p < 0.001) as well as Black (aOR: 1.18; 95% CI: 1.04 to 1.34; p = 0.011) and Hispanic (aOR: 1.19; 95% CI: 1.06 to 1.33; p = 0.003) men had higher odds of in-hospital mortality compared with White men, with Hispanic women having the highest odds of in-hospital mortality (aOR: 1.46; 95% CI: 1.26 to 1.70; p < 0.001). Women were older (age: 69.8 years vs. 63.2 years), had more comorbidities, and underwent fewer invasive cardiac procedures, including revascularization, right heart catheterization, and MCS. CONCLUSIONS There are significant racial, ethnic, and sex differences in procedural utilization and clinical outcomes in patients with STEMI and CS. Women are less likely to undergo invasive cardiac procedures, including revascularization and MCS. Women as well as Black and Hispanic patients have a higher likelihood of death compared with White men.
Collapse
Affiliation(s)
- Lina Ya'qoub
- Department of Cardiology, Ochsner-Louisiana State University, Shreveport, Louisiana, USA.
| | - Alejandro Lemor
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohammed Dabbagh
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - William O'Neill
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Akshay Khandelwal
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sara C Martinez
- Providence Medical Group Cardiology Associates, St. Peter Hospital, Olympia, Washington, USA
| | - Nasrien E Ibrahim
- Divisionof Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Cindy Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Michelle Voeltz
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Mir B Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| |
Collapse
|
29
|
Kiefer JJ, Augoustides JG. Acute Myocardial Infarction With Cardiogenic Shock: - Navigating the Invasive Options in Clinical Management. J Cardiothorac Vasc Anesth 2021; 35:3154-3157. [PMID: 34373181 DOI: 10.1053/j.jvca.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Jesse J Kiefer
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
30
|
Omer MA, Brilakis ES, Kennedy KF, Alkhouli M, Elgendy IY, Chan PS, Spertus JA. Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Patients With Non-ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock. JACC Cardiovasc Interv 2021; 14:1067-1078. [PMID: 33933384 DOI: 10.1016/j.jcin.2021.02.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The aim of this study was to compare in-hospital outcomes and long-term mortality of multivessel versus culprit vessel-only percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI), multivessel disease (MVD) and cardiogenic shock. BACKGROUND The clinical benefits of complete revascularization in patients with NSTEMI, MVD, and cardiogenic shock remain uncertain. METHODS Among 25,324 patients included in the National Cardiovascular Data Registry CathPCI Registry from July 2009 to March 2018, the rates of in-hospital procedural outcomes were compared between those undergoing multivessel PCI and those undergoing culprit vessel-only PCI after 1:1 propensity score matching. Among patients aged ≥65 years matched to the Centers for Medicare and Medicaid Services database, long-term mortality was compared using proportional hazards analysis. RESULTS Multivessel PCI was performed in 9,791 patients (38.7%), which increased from 32.2% in 2010 to 44.2% in 2017 (p for trend <0.001). After 1:1 propensity matching (n = 7,864 in each group), those undergoing multivessel PCI had a 3.5% (95% confidence interval [CI]: 2.0% to 5.0%) lower absolute rate of in-hospital mortality (30.9% vs. 34.4%; p < 0.001; odds ratio [OR]: 0.85; 95% CI: 0.80 to 0.91), but a higher risk for bleeding (13.2% vs. 10.8%; p < 0.001; OR: 1.26; 95% CI: 1.15 to 1.40) and new requirement for dialysis (5.7% vs. 4.6%; p = 0.001; OR: 1.26; 95% CI: 1.10 to 1.46). Among those surviving to discharge, all-cause mortality was similar through 7 years (conditional hazard ratio: 0.95; 95% CI: 0.87 to 1.03; p = 0.20). CONCLUSIONS Nearly 40% of patients with NSTEMI with MVD and cardiogenic shock underwent multivessel PCI, which was associated with lower in-hospital mortality but greater peri-procedural complications. Among those surviving to discharge, multivessel PCI did not confer additional long-term mortality benefit.
Collapse
Affiliation(s)
- Mohamed A Omer
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
| | - Emmanouil S Brilakis
- Abbott Northwestern Hospital, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Paul S Chan
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, Missouri, USA
| |
Collapse
|
31
|
Henry TD, Tomey MI, Tamis-Holland JE, Thiele H, Rao SV, Menon V, Klein DG, Naka Y, Piña IL, Kapur NK, Dangas GD. Invasive Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e815-e829. [DOI: 10.1161/cir.0000000000000959] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cardiogenic shock (CS) remains the most common cause of mortality in patients with acute myocardial infarction. The SHOCK trial (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) demonstrated a survival benefit with early revascularization in patients with CS complicating acute myocardial infarction (AMICS) 20 years ago. After an initial improvement in mortality related to revascularization, mortality rates have plateaued. A recent Society of Coronary Angiography and Interventions classification scheme was developed to address the wide range of CS presentations. In addition, a recent scientific statement from the American Heart Association recommended the development of CS centers using standardized protocols for diagnosis and management of CS, including mechanical circulatory support devices (MCS). A number of CS programs have implemented various protocols for treating patients with AMICS, including the use of MCS, and have published promising results using such protocols. Despite this, practice patterns in the cardiac catheterization laboratory vary across health systems, and there are inconsistencies in the use or timing of MCS for AMICS. Furthermore, mortality benefit from MCS devices in AMICS has yet to be established in randomized clinical trials. In this article, we outline the best practices for the contemporary interventional management of AMICS, including coronary revascularization, the use of MCS, and special considerations such as the treatment of patients with AMICS with cardiac arrest.
Collapse
|
32
|
Vallabhajosyula S, Payne SR, Jentzer JC, Sangaralingham LR, Kashani K, Shah ND, Prasad A, Dunlay SM. Use of Post-Acute Care Services and Readmissions After Acute Myocardial Infarction Complicated by Cardiac Arrest and Cardiogenic Shock. Mayo Clin Proc Innov Qual Outcomes 2021; 5:320-329. [PMID: 33997631 PMCID: PMC8105498 DOI: 10.1016/j.mayocpiqo.2020.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE To evaluate post-acute care utilization and readmissions after cardiac arrest (CA) and cardiogenic shock (CS) complicating acute myocardial infarction (AMI). METHODS With use of an administrative claims database, AMI patients from January 1, 2010, to May 31, 2018, were stratified into CA+CS, CA only, CS only, and AMI alone. Outcomes included 90-day post-acute care (inpatient rehabilitation or skilled nursing facility) utilization and 1-year emergency department visits and readmissions. RESULTS Of 163,071 AMI patients, CA+CS, CA only, and CS only were noted in 3965 (2.4%), 8221 (5.0%), and 6559 (4.0%), respectively. In-hospital mortality was noted in 10,686 (6.6%) patients: CA+CS, 1935 (48.8%); CA only, 2948 (35.9%); CS only, 1578 (24.1%); and AMI alone, 4225 (2.9%) (P<.001). Among survivors, post-acute care services were used in 67,799 (44.5%), with higher use in the CS+CA cohort (1310 [64.6%]; hazard ratio [HR], 1.19; 95% CI, 1.06 to 1.33; P=.003) and CA cohort (2738 [51.9%]; HR, 1.27; 95% CI, 1.20 to 1.35; P<.001) but not in the CS cohort (3048 [61.2%]; HR, 1.03; 95% CI, 0.97 to 1.11; P=.35) compared with the AMI cohort (60,703 [43.3%]). Compared with the AMI cohort (48,990 [35.0%]), patients with CS only (2,085 [41.9%]; HR, 1.16; 95% CI, 1.10 to 1.22; P<.001) but not those with CA+CS (724 [35.7%]; HR, 1.07; 95% CI, 0.98 to 1.17; P=.14) had higher rates of readmissions (P=.03). Readmissions were lower in those with CA (1,590 [30.2%]; HR, 0.94; 95% CI, 0.89 to 0.99). Repeated AMI, coronary artery disease, and heart failure were the most common readmission reasons. There were no differences for emergency department visits. CONCLUSION CA is associated with increased post-acute care use, whereas CS is associated with increased readmission risk in AMI survivors.
Collapse
Key Words
- AMI, acute myocardial infarction
- CA, cardiac arrest
- CS, cardiogenic shock
- ED, emergency department
- HR, hazard ratio
- ICD-10-CM, International Classification of Diseases, Tenth Revision, Clinical Modification
- ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification
- MCS, mechanical circulatory support
- PCI, percutaneous coronary intervention
- SNF, skilled nursing facility
Collapse
Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
- Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN
| | - Stephanie R. Payne
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN
| | - Jacob C. Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Lindsey R. Sangaralingham
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN
| | - Kianoush Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Nilay D. Shah
- Department of Health Services Research, Mayo Clinic, Rochester, MN
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN
- OptumLabs, Cambridge, MA
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Shannon M. Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
- Department of Health Services Research, Mayo Clinic, Rochester, MN
| |
Collapse
|
33
|
Morici N, Marini C, Sacco A, Tavazzi G, Cipriani M, Oliva F, Rota M, De Ferrari GM, Campolo J, Frigerio G, Valente S, Leonardi S, Corrada E, Bottiroli M, Grosseto D, Cacciavillani L, Frigerio M, Pappalardo F. Early intra-aortic balloon pump in acute decompensated heart failure complicated by cardiogenic shock: Rationale and design of the randomized Altshock-2 trial. Am Heart J 2021; 233:39-47. [PMID: 33338464 DOI: 10.1016/j.ahj.2020.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/26/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cardiogenic shock (CS) is a systemic disorder associated with dismal short-term prognosis. Given its time-dependent nature, mechanical circulatory support may improve survival. Intra-aortic balloon pump (IABP) had gained widespread use because of the easiness to implant and the low rate of complications; however, a randomized trial failed to demonstrate benefit on mortality in the setting of acute myocardial infarction. Acute decompensated heart failure with cardiogenic shock (ADHF-CS) represents a growing resource-intensive scenario with scant data and indications on the best management. However, a few data suggest a potential benefit of IABP in this setting. We present the design of a study aimed at addressing this research gap. METHODS AND DESIGN The Altshock-2 trial is a prospective, randomized, multicenter, open-label study with blinded adjudicated evaluation of outcomes. Patients with ADHF-CS will be randomized to early IABP implantation or to vasoactive treatments. The primary end point will be 60 days patients' survival or successful bridge to heart replacement therapy. The key secondary end point will be 60-day overall survival; 60-day need for renal replacement therapy; in-hospital maximum inotropic score, maximum duration of inotropic/vasopressor therapy, and maximum sequential organ failure assessment score. Safety end points will be in-hospital occurrence of bleeding events (Bleeding Academic Research Consortium >3), vascular access complications and systemic (noncerebral) embolism. The sample size for the study is 200 patients. IMPLICATIONS The Altshock-2 trial will provide evidence on whether IABP should be implanted early in ADHF-CS patients to improve their clinical outcomes.
Collapse
Affiliation(s)
- Nuccia Morici
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Claudia Marini
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alice Sacco
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Guido Tavazzi
- Emergency Department, Anaesthesia and Intensive Care Unit, Pavia, Italy
| | - Manlio Cipriani
- Heart Failure and Transplant Unit, De Gasperis Cardio Center and Transplant Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabrizio Oliva
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Rota
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | - Jonica Campolo
- CNR Institute of Clinical Physiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gianfranco Frigerio
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Serafina Valente
- Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Sergio Leonardi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Elena Corrada
- Cardiovascular Department, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Maurizio Bottiroli
- Cardiothoracic Anesthesiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Luisa Cacciavillani
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Maria Frigerio
- Heart Failure and Transplant Unit, De Gasperis Cardio Center and Transplant Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico Pappalardo
- Department of Anesthesia and Intensive Care, IRCCS ISMETT, UPMC Italy, Palermo, Italy
| |
Collapse
|
34
|
Banning A, Adriaenssens T, Berry C, Bogaerts K, Erglis A, Distelmaier K, Guagliumi G, Haine S, Kastrati A, Massberg S, Orban M, Myrmel T, Vuylsteke A, Alfonso F, Van de Werf F, Verheugt F, Flather M, Sabaté M, Vrints C, Gershlick A. Veno-arterial extracorporeal membrane oxygenation (ECMO) in patients with cardiogenic shock: rationale and design of the randomised, multicentre, open-label EURO SHOCK trial. EUROINTERVENTION 2021; 16:e1227-e1236. [PMID: 33106225 PMCID: PMC9725005 DOI: 10.4244/eij-d-20-01076] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Cardiogenic shock (CGS) occurs in 6-10% of patients with acute coronary syndromes (ACS). Mortality has fallen over time from 80% to approximately 50% consequent on acute revascularisation but has plateaued since the 1990s. Once established, patients with CGS develop adverse compensatory mechanisms that contribute to the downward spiral towards death, which becomes difficult to reverse. We aimed to test in a robust, prospective, randomised controlled trial whether early support with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides clinical benefit by improving mortality and morbidity. METHODS AND RESULTS The EURO SHOCK trial will test the benefit or otherwise of mechanical cardiac support using VA-ECMO, initiated early after acute percutaneous coronary intervention (PCI) for CGS. The trial sets out to randomise 428 patients with CGS complicating ACS, following primary PCI (P-PCI), to either very early ECMO plus standard pharmacotherapy, or standard pharmacotherapy alone. It will be conducted in 39 European centres. The primary endpoint is 30-day all-cause mortality with key secondary endpoints: 1) 12-month all-cause mortality or admission for heart failure, 2) 12-month all-cause mortality, 3) 12-month admission for heart failure. Cost-effectiveness analysis (including quality of life measures) will be embedded. Mechanistic and hypothesis-generating substudies will be undertaken. CONCLUSIONS The EURO SHOCK trial will determine whether early initiation of VA-ECMO in patients presenting with ACS-CGS persisting after PCI improves mortality and morbidity.
Collapse
Affiliation(s)
- Amerjeet Banning
- Department of Cardiology, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom
| | - Tom Adriaenssens
- University Hospitals Leuven, and Katholieke Universiteit Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - Colin Berry
- University of Glasgow, Institute of Cardiovascular and Medical Sciences and Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - Kris Bogaerts
- Katholieke Universiteit Leuven, Department of Public Health and Primary Care, I-BioStat, and Universiteit Hasselt, I-BioStat, Leuven, Belgium
| | - Andrejs Erglis
- Paula Stradina Kliniska Universitates Slimnica AS, Department of Cardiovascular Sciences, Riga, Latvia
| | - Klaus Distelmaier
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - Giulio Guagliumi
- Azienda Ospedaliera Papa Giovanni XXIII, Department of Cardiovascular Sciences, Bergamo, Italy
| | - Steven Haine
- Antwerp University Hospital, Department of Cardiology and University of Antwerp, Department of Cardiovascular Diseases, Antwerp, Belgium
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Department of Cardiology, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany
| | - Truls Myrmel
- The Heart and Lung Clinic, University Hospital North Norway, Tromsø, Norway
| | - Alain Vuylsteke
- Royal Papworth Hospital, Department of Anaesthesia and Intensive Care, Cambridge, United Kingdom
| | - Fernando Alfonso
- Cardiac Department, La Princesa University Hospital, IIS-IP, CIBERCV, Madrid, Spain
| | - Frans Van de Werf
- University Hospitals Leuven, and Katholieke Universiteit Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - Freek Verheugt
- Heartcenter, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands
| | - Marcus Flather
- University of East Anglia and Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Manel Sabaté
- Consorci Institut D’Investicacions Biomediques August Pi i Sunyer, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Christiaan Vrints
- Antwerp University Hospital, Department of Cardiology and University of Antwerp, Department of Cardiovascular Diseases, Antwerp, Belgium
| | - Anthony Gershlick
- University of Leicester, University Hospitals of Leicester, Leicester Biomedical Research Centre, Leicester, United Kingdom
| | | |
Collapse
|
35
|
Lin Z, Han H, Qin Y, Zhang Y, Yin D, Wu C, Wei X, Cao Y, He J. Outcomes after readmission at the index or nonindex hospital following acute myocardial infarction complicated by cardiogenic shock. Clin Cardiol 2021; 44:200-209. [PMID: 33411357 PMCID: PMC7852161 DOI: 10.1002/clc.23526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/17/2020] [Accepted: 11/27/2020] [Indexed: 12/16/2022] Open
Abstract
Little is known about the prevalence and outcomes of readmission to nonindex hospitals after an admission for acute myocardial infarction complicated by cardiogenic shock (AMI‐CS). We aimed to determine the rate of nonindex readmissions following AMI‐CS and to evaluate its association with clinical factors, hospitalization cost, length of stay (LOS), and in‐hospital mortality rates. Hypothesis Nonindex readmission may lead to worse in‐hospital outcomes. Methods We reviewed the data of inpatients with AMI‐CS between 2010 and 2017 using the National Readmission Database. The survey analytical methods recommended by the Healthcare Cost and Utilization Project were used for national estimates. Multiple regression models were used to evaluate the predictors of nonindex readmission, and its association with hospitalization cost, LOS, and in‐hospital mortality rates. Results Of 238 349 patients with AMI‐CS, 28028 (11.76%) had an unplanned readmission within 30 days. Of these patients, 7423 (26.48%) were readmitted to nonindex hospitals. Compared with index readmission, nonindex readmission was associated with higher hospitalization costs (p < .0001), longer LOS (p < .0001), and increased in‐hospital mortality rates (p = .0016). Patients who had a history of percutaneous coronary intervention, received intubation/mechanical ventilation, or left against medical advice during the initial admission had greater odds of a nonindex readmission. Conclusions Over one‐fourth of readmissions following AMI‐CS were to nonindex hospitals. These admissions were associated with higher hospitalization costs, longer LOS, and higher in‐hospital mortality rates. Further studies are needed to evaluate whether a continuity of care plan in the acute hospital setting can improve outcomes after AMI‐CS.
Collapse
Affiliation(s)
- Zhen Lin
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Hedong Han
- Department of Health Statistics, Second Military Medical University, Shanghai, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yingyi Qin
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Yuan Zhang
- The Fifth Subcenter of Air Force Health Care Center for Special Services Hangzhou, Wuxi, China
| | - Daqing Yin
- Department of Medical Management, General Hospital of Central Theater Command, Beijing, China
| | - Cheng Wu
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Xin Wei
- Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Yang Cao
- Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Jia He
- Department of Health Statistics, Second Military Medical University, Shanghai, China.,Department of Health Statistics, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
36
|
Liu Y, Li CP, Lu PJ, Wang XY, Xiao JY, Gao MD, Wang JX, Li XW, Zhang N, Li CJ, Ma J, Gao J. Percutaneous coronary intervention assisted by invasive mechanical ventilation and intra-aortic balloon pump for acute myocardial infarction with cardiogenic shock: Retrospective cohort study and meta-analyses. Bosn J Basic Med Sci 2020; 20:514-523. [PMID: 31782697 PMCID: PMC7664793 DOI: 10.17305/bjbms.2019.4500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/26/2019] [Indexed: 12/22/2022] Open
Abstract
There is little evidence to recommend the optimal invasive mechanical ventilation (IMV) modes and ideal positive end-expiratory pressure stress levels for acute myocardial infarction-cardiogenic shock (AMI-CS) patients. The aim of this study was to compare the mortality outcome in patients with AMI-CS who were treated with percutaneous coronary intervention (PCI) assisted by intra-aortic balloon pump (IABP) + IMV with historical controls. From January 1, 2016 to June 1, 2017, 60 patients were retrospectively enrolled at Tianjin Chest Hospital. Out of these, 88.3% of patients achieved thrombolysis in myocardial infarction (TIMI) flow 3 after PCI. The all-cause mortality rate in-hospital and at 1 year was 25% (95% CI: 0.14–0.36) and 33.9% (0.22–0.46), respectively. A systematic review followed by meta-analysis was performed with four historical studies of patients treated by PCI + IMV with partial IABP, which found an in-hospital mortality rate of 66.0% (95% CI: 0.62–0.71). Recently, a meta-analysis of patients receiving PCI + IABP with partial IMV showed that the 1 year mortality rate was 52.2% (95% CI: 0.47–0.58). In Cox regression analysis of patient data from the current study, lactic acid level ≥4.5 mmol/L, hyperuricemia, and TIMI flow <3 were independent predictors of death at 1 year. All-cause mortality, in-hospital and at 1 year, in patients with AMI-CS treated with PCI + IABP and IMV was lower than in those treated with PCI + partial IABP or IMV. Larger, longer-term direct comparisons are warranted.
Collapse
Affiliation(s)
- Yin Liu
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Chang-Ping Li
- Tianjin Medical University, Heping District, Tianjin, China
| | - Peng-Ju Lu
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Xu-Ying Wang
- Department of Prevention, Tianjin Children's Hospital, Beichen District, Tianjin, China
| | - Jian-Yong Xiao
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Ming-Dong Gao
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Ji-Xiang Wang
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Xiao-Wei Li
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Nan Zhang
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Chun-Jie Li
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Jun Ma
- Tianjin Medical University, Heping District, Tianjin, China
| | - Jing Gao
- Cardiovascular Institute, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| |
Collapse
|
37
|
Vallabhajosyula S, Payne SR, Jentzer JC, Sangaralingham LR, Yao X, Kashani K, Shah ND, Prasad A, Dunlay SM. Long-Term Outcomes of Acute Myocardial Infarction With Concomitant Cardiogenic Shock and Cardiac Arrest. Am J Cardiol 2020; 133:15-22. [PMID: 32811650 DOI: 10.1016/j.amjcard.2020.07.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022]
Abstract
This study sought to evaluate long-term mortality and major adverse cardiac and cerebrovascular events (MACCE) in patients with cardiac arrest (CA) and cardiogenic shock (CS) complicating acute myocardial infarction (AMI). This was a retrospective cohort study using an administrative claims database. AMI patients from January 1, 2010 to May 31, 2018 were stratified into CA + CS, CA only, CS only, and AMI alone cohorts. Outcomes of interest were long-term mortality and MACCE (death, AMI, cerebrovascular accident, unplanned revascularization) in AMI survivors. A total 163,071 AMI patients were included with CA + CS, CA only, and CS only in 2.4%, 5.0%, and 4.0%, respectively. The CA + CS cohort had higher rates of multiorgan failure, mechanical circulatory support use and less frequent coronary angiography use. In-hospital mortality was noted in 10,686 (6.6%) patients - CA + CS (48.8%), CA only (35.9%), CS only (24.1%), and AMI alone (2.9%; p < 0.001). Over 23.5 ± 21.7 months follow-up after hospital discharge, patients with CA + CS (hazard ratio [HR] 1.36 [95% confidence interval {CI} 1.19 to 1.55]), CA only (HR 1.16 [95% CI 1.08 to 1.25]), CS only (HR 1.39 [95% CI 1.29 to 1.50]) had higher all-cause mortality compared with AMI alone (all p < 0.001). Presence of CS, either alone (HR 1.22 [95% CI 1.16 to 1.29]; p < 0.001) or with CA (HR 1.18 [95% CI 1.07 to 1.29]; p < 0.001), was associated with higher MACCE compared with AMI alone. In conclusion, CA + CS, CA, and CS were associated with worse long-term survival. CA and CS continue to influence outcomes beyond the index hospitalization in AMI survivors.
Collapse
|
38
|
Lauridsen MD, Rorth R, Butt JH, Kristensen SL, Schmidt M, Moller JE, Hassager C, Torp-Pedersen C, Gislason G, Kober L, Fosbol EL. Five-year risk of heart failure and death following myocardial infarction with cardiogenic shock: a nationwide cohort study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 10:40-49. [PMID: 33721017 DOI: 10.1093/ehjacc/zuaa022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/07/2020] [Accepted: 09/08/2020] [Indexed: 01/13/2023]
Abstract
AIMS More patients survive myocardial infarction (MI) with cardiogenic shock (CS), but long-term outcome data are sparse. We aimed to examine rates of heart failure hospitalization and mortality in MI hospital survivors. METHODS AND RESULTS First-time MI patients with and without CS alive until discharge were identified using Danish nationwide registries between 2005 and 2017. One-, 5-, and 1- to 5-year rates of heart failure hospitalization and mortality were compared using landmark cumulative incidence curves and Cox regression models. We identified 85 865 MI patients of whom 2865 had CS (3%). Cardiogenic shock patients were of similar age as patients without CS (median age years: 68 vs. 67), and more were men (70% vs. 65%). Cardiogenic shock was associated with a higher 5-year rate of heart failure hospitalization compared with patients without CS [40% vs. 20%, adjusted hazard ratio (HR) 2.90 (95% confidence interval (CI) 2.67-3.12)]. The increased rate of heart failure hospitalization was evident after 1 year and in the 1- to 5-year landmark analysis among 1-year survivors. All-cause mortality was higher at 1 year among CS patients compared with patients without CS [18% vs. 8%, adjusted HR 3.23 (95% CI 2.95-3.54)]. However, beyond the first year, the mortality for CS was not markedly different compared with patients without CS [12% vs. 13%, adjusted HR 1.15 (95% CI 1.00-1.33)]. CONCLUSION Among MI hospital survivors, CS was associated with a markedly higher rate of heart failure hospitalization and 1-year mortality compared with patients without CS. However, among 1-year survivors, the remaining 5-year mortality was similar for MI patients with and without CS.
Collapse
Affiliation(s)
- Marie Dam Lauridsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Rasmus Rorth
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jawad Haider Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Soren Lund Kristensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle 43-45, 8200 Aarhus N, Denmark.,Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jacob Eifer Moller
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Cardiology, Odense University Hospital, J.B Winslowsvej 4, 5000 Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Dyrhavevej 29, 3400 Hillerød, Denmark.,Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hospitalsvej 1, 2900 Hellerup, Denmark.,The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Lars Kober
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark
| | - Emil Loldrup Fosbol
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| |
Collapse
|
39
|
Chioncel O, Parissis J, Mebazaa A, Thiele H, Desch S, Bauersachs J, Harjola V, Antohi E, Arrigo M, Gal TB, Celutkiene J, Collins SP, DeBacker D, Iliescu VA, Jankowska E, Jaarsma T, Keramida K, Lainscak M, Lund LH, Lyon AR, Masip J, Metra M, Miro O, Mortara A, Mueller C, Mullens W, Nikolaou M, Piepoli M, Price S, Rosano G, Vieillard‐Baron A, Weinstein JM, Anker SD, Filippatos G, Ruschitzka F, Coats AJ, Seferovic P. Epidemiology, pathophysiology and contemporary management of cardiogenic shock – a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2020; 22:1315-1341. [DOI: 10.1002/ejhf.1922] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
- Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’ Bucharest Romania
- University of Medicine Carol Davila Bucharest Romania
| | - John Parissis
- Heart Failure Unit, Department of Cardiology Attikon University Hospital Athens Greece
- National Kapodistrian University of Athens Medical School Athens Greece
| | - Alexandre Mebazaa
- University of Paris Diderot, Hôpitaux Universitaires Saint Louis Lariboisière, APHP Paris France
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig Leipzig Germany
- Heart Institute Leipzig Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig Leipzig Germany
- Heart Institute Leipzig Germany
| | - Johann Bauersachs
- Department of Cardiology & Angiology, Hannover Medical School Hannover Germany
| | - Veli‐Pekka Harjola
- Emergency Medicine University of Helsinki, Helsinki University Hospital Helsinki Finland
| | - Elena‐Laura Antohi
- Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’ Bucharest Romania
- University of Medicine Carol Davila Bucharest Romania
| | - Mattia Arrigo
- Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Tuvia B. Gal
- Department of Cardiology, Rabin Medical Center Petah Tiqwa Israel
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University Vilnius Lithuania
| | - Sean P. Collins
- Department of Emergency Medicine Vanderbilt University School of Medicine Nashville TN USA
| | - Daniel DeBacker
- Department of Intensive Care CHIREC Hospitals, Université Libre de Bruxelles Brussels Belgium
| | - Vlad A. Iliescu
- Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’ Bucharest Romania
- University of Medicine Carol Davila Bucharest Romania
| | - Ewa Jankowska
- Department of Heart Disease Wroclaw Medical University, University Hospital, Center for Heart Disease Wroclaw Poland
| | - Tiny Jaarsma
- Department of Health, Medicine and Health Sciences Linköping University Linköping Sweden
- Julius Center University Medical Center Utrecht Utrecht The Netherlands
| | - Kalliopi Keramida
- National Kapodistrian University of Athens Medical School Athens Greece
- Department of Cardiology Attikon University Hospital Athens Greece
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota Murska Sobota Slovenia
- Faculty of Medicine, University of Ljubljana Ljubljana Slovenia
| | - Lars H Lund
- Heart and Vascular Theme, Karolinska University Hospital Stockholm Sweden
- Department of Medicine Karolinska Institutet Stockholm Sweden
| | - Alexander R. Lyon
- Imperial College London National Heart & Lung Institute London UK
- Royal Brompton Hospital London UK
| | - Josep Masip
- Consorci Sanitari Integral, University of Barcelona Barcelona Spain
- Hospital Sanitas CIMA Barcelona Spain
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia Italy
| | - Oscar Miro
- Emergency Department Hospital Clinic, Institut d'Investigació Biomèdica August Pi iSunyer (IDIBAPS) Barcelona Spain
- University of Barcelona Barcelona Spain
| | - Andrea Mortara
- Department of Cardiology Policlinico di Monza Monza Italy
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel Basel Switzerland
| | - Wilfried Mullens
- Department of Cardiology Ziekenhuis Oost Genk Belgium
- Biomedical Research Institute Faculty of Medicine and Life Sciences, Hasselt University Diepenbeek Belgium
| | - Maria Nikolaou
- Heart Failure Unit, Department of Cardiology Attikon University Hospital Athens Greece
| | - Massimo Piepoli
- Heart Failure Unit, Cardiology, Emergency Department Guglielmo da Saliceto Hospital, Piacenza, University of Parma; Institute of Life Sciences, Sant'Anna School of Advanced Studies Pisa Italy
| | - Susana Price
- Royal Brompton Hospital & Harefield NHS Foundation Trust London UK
| | - Giuseppe Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana Rome Italy
| | - Antoine Vieillard‐Baron
- INSERM U‐1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ Villejuif France
- University Hospital Ambroise Paré, AP‐, HP Boulogne‐Billancourt France
| | - Jean M. Weinstein
- Cardiology Department Soroka University Medical Centre Beer Sheva Israel
| | - Stefan D. Anker
- Department of Cardiology (CVK) Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin Berlin Germany
- Charité Universitätsmedizin Berlin Germany
| | - Gerasimos Filippatos
- University of Athens, Heart Failure Unit, Attikon University Hospital Athens Greece
- School of Medicine, University of Cyprus Nicosia Cyprus
| | - Frank Ruschitzka
- Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Andrew J.S. Coats
- Pharmacology, Centre of Clinical and Experimental Medicine IRCCS San Raffaele Pisana Rome Italy
| | - Petar Seferovic
- Faculty of Medicine University of Belgrade Belgrade, Serbia
- Serbian Academy of Sciences and Arts Belgrade Serbia
| |
Collapse
|
40
|
Hanson ID, Tagami T, Mando R, Kara Balla A, Dixon SR, Timmis S, Almany S, Naidu SS, Baran D, Lemor A, Gorgis S, O'Neill W, Basir MB. SCAI
shock classification in acute myocardial infarction: Insights from the National Cardiogenic Shock Initiative. Catheter Cardiovasc Interv 2020; 96:1137-1142. [DOI: 10.1002/ccd.29139] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/09/2020] [Accepted: 06/27/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Ivan D. Hanson
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak Michigan USA
| | - Travis Tagami
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak Michigan USA
| | - Ramy Mando
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak Michigan USA
| | - Abdalla Kara Balla
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak Michigan USA
| | - Simon R. Dixon
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak Michigan USA
| | - Steven Timmis
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak Michigan USA
| | - Steven Almany
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak Michigan USA
| | - Srihari S. Naidu
- Westchester Medical Center and New York Medical College Valhalla New York USA
| | - David Baran
- Division of Cardiology Sentara Heart Hospital Norfolk Virginia USA
| | - Alejandro Lemor
- Division of Cardiology Henry Ford Hospital Detroit Michigan USA
| | - Sarah Gorgis
- Division of Cardiology Henry Ford Hospital Detroit Michigan USA
| | - William O'Neill
- Division of Cardiology Henry Ford Hospital Detroit Michigan USA
| | - Mir B. Basir
- Division of Cardiology Henry Ford Hospital Detroit Michigan USA
| | | |
Collapse
|
41
|
Gurm HS, Wanamaker BL. Surviving the “After-Shock”. JACC Cardiovasc Interv 2020; 13:1220-1222. [DOI: 10.1016/j.jcin.2020.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022]
|
42
|
Fanaroff AC, Chen AY, van Diepen S, Peterson ED, Wang TY. Association Between Intensive Care Unit Usage and Long-Term Medication Adherence, Mortality, and Readmission Among Initially Stable Patients With Non-ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc 2020; 9:e015179. [PMID: 32174210 PMCID: PMC7335514 DOI: 10.1161/jaha.119.015179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Hospitals in the United States vary in their use of intensive care units (ICUs) for hemodynamically stable patients with non–ST‐segment–elevation myocardial infarction (NSTEMI). The association between ICU use and long‐term outcomes after NSTEMI is unknown. Methods and Results Using data from the National Cardiovascular Data Registry linked to Medicare claims, we identified 65 256 NSTEMI patients aged ≥ 65 years without cardiogenic shock or cardiac arrest on presentation between 2011 and 2014. We compared 1‐year medication non‐adherence, cardiovascular readmission, and mortality across hospitals by ICU use using multivariable regression models. Among 520 hospitals, 154 (29.6%) were high ICU users (>70% of stable NSTEMI patients admitted to ICU), 270 (51.9%) were intermediate (30%–70%), and 196 (37.7%) were low (<30%). Compared with low ICU usage hospitals, no differences were observed in the risks of 1‐year medication non‐adherence (adjusted odds ratio 1.08, 95% CI, 0.97–1.21), mortality (adjusted hazard ratio 1.06, 95% CI, 0.98–1.15), and cardiovascular readmission (adjusted hazard ratio 0.99, 95% CI, 0.95–1.04) at high usage hospitals. Patients hospitalized at intermediate ICU usage hospitals had lower rates of evidence‐based therapy and diagnostic catheterization within 24 hours of hospital arrival, and higher risks of 1‐year mortality (adjusted hazard ratio 1.07, 95% CI, 1.02–1.12) and medication non‐adherence (adjusted odds ratio 1.09, 95% CI, 1.02–1.15) compared with low ICU usage hospitals. Conclusions Routine ICU use is unlikely to be beneficial for hemodynamically stable NSTEMI patients; medication adherence, long‐term mortality, and cardiovascular readmission did not differ for high ICU usage hospitals compared with hospitals with low ICU usage rates.
Collapse
Affiliation(s)
- Alexander C Fanaroff
- Cardiovascular Outcomes, Quality and Evaluative Research Center, Leonard Davis Institute of Health Economics, and Cardiovascular Medicine Division University of Pennsylvania Philadelphia PA
| | - Anita Y Chen
- Department of Biostatistics and Computations Biology University of Rochester NY
| | - Sean van Diepen
- Divisions of Critical Care and Cardiology University of Alberta, Edmonton Alberta Canada
| | - Eric D Peterson
- ivision of Cardiology and Duke Clinical Research Institute Duke University Durham NC
| | - Tracy Y Wang
- ivision of Cardiology and Duke Clinical Research Institute Duke University Durham NC
| |
Collapse
|
43
|
Vaduganathan M, Qamar A, Badreldin HA, Faxon DP, Bhatt DL. Cangrelor Use in Cardiogenic Shock: A Single-Center Real-World Experience. JACC Cardiovasc Interv 2020; 10:1712-1714. [PMID: 28838482 DOI: 10.1016/j.jcin.2017.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
|
44
|
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.
Collapse
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
| | | |
Collapse
|
45
|
Jentzer JC, Baran DA, van Diepen S, Barsness GW, Henry TD, Naidu SS, Bell MR, Holmes DR. Admission Society for Cardiovascular Angiography and Intervention shock stage stratifies post-discharge mortality risk in cardiac intensive care unit patients. Am Heart J 2020; 219:37-46. [PMID: 31710843 DOI: 10.1016/j.ahj.2019.10.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND The five-stage Society for Cardiovascular Angiography and Intervention (SCAI) cardiogenic shock classification scheme can stratify hospital mortality risk in patients admitted to the cardiac intensive care unit (CICU). We sought to evaluate the SCAI shock classification for prediction of post-discharge mortality in CICU survivors. METHODS We retrospectively analyzed hospital survivors admitted to a single CICU between 2007 and 2015. SCAI CS stages A through E were classified using CICU admission data using a previously published algorithm. All-cause post-discharge mortality was compared across SCAI stages using Kaplan-Meier analysis and Cox proportional hazards models. RESULTS Among 9096 unique hospital survivors, 43.2% had acute coronary syndrome (ACS), 44.6% had heart failure (HF), and 8.7% had cardiac arrest (CA) on admission. The proportion of patients in each SCAI shock stage was: A, 49.1%; B, 30.6%; C, 15.2; D/E 5.2%. Kaplan-Meier survival at 5 years in each SCAI shock stage was: A, 88.2%; B, 81.6%; C, 76.7%; D/E, 71.7% (P < .001 by log-rank). Each higher SCAI shock stage was associated with increased adjusted post-discharge mortality compared to SCAI shock stage A (all P < .001); results were consistent among patients with ACS or HF. Late hemodynamic deterioration after 24 hours, but not an admission diagnosis of CA, was associated with higher post-discharge mortality. CONCLUSIONS The SCAI shock classification assessed at the time of CICU admission was predictive of post-discharge mortality risk among hospital survivors, although an admission diagnosis of CA was not. The SCAI shock classification can be used for post-discharge mortality risk stratification.
Collapse
Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - David A Baran
- Sentara Heart Hospital, Advanced Heart Failure Center and Eastern Virginia Medical School, Norfolk, Virginia.
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta Hospital, Edmonton, Alberta.
| | | | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital Health Network, Cincinnati, Ohio.
| | - Srihari S Naidu
- Westchester Medical Center and New York Medical College, Valhalla, New York.
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
46
|
Sud K, Haddadin F, Tsutsui RS, Parashar A, Bandyopadhyay D, Ellis SG, Tuzcu EM, Kapadia S. Readmissions in ST-Elevation Myocardial Infarction and Cardiogenic Shock (from Nationwide Readmission Database). Am J Cardiol 2019; 124:1841-1850. [PMID: 31685215 DOI: 10.1016/j.amjcard.2019.08.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Abstract
Management of ST-elevation myocardial infarction complicated by cardiogenic shock (STEMI-CS) has evolved in the last decade. There is paucity of data on readmissions in this study population. We aimed to assess the burden, major etiologies, and resource utilization for 30-day readmissions among patients with STEMI and CS. The Nationwide Readmission Database was queried from 2010 to 2014. All adult patients with an index admission for STEMI-CS were identified using International Classification of Diseases, ninth edition codes. Patient with mortality on index admission and transfers to other hospitals were excluded. A total of 18,659 admissions were identified with primary diagnosis of STEMI-CS for the study duration. Percutaneous coronary interventions was performed in 78.1% and mechanical circulatory devices were utilized in 53.9% with a mean length of stay of 10.6 (±0.2) days and mean cost of hospitalization of $47,744 (±327). Among these, 2,404 (12.9%) patients were readmitted within 30 days. Major etiologies for readmission include congestive heart failure (25.7%), acute myocardial infarction (9.4%), arrhythmias (4.5%), and sepsis (4.2%). The mean length of stay and cost of hospitalization for 30-day readmission were 5.9 (±0.3) days and $17,043 (±590), respectively. Older age, female gender, lower socioeconomic status, and discharge to home health care were significant predictors for readmission. In conclusion, there is a significant burden of 30-day readmission among patients with STEMI-CS. Percutaneous coronary interventions and mechanical circulatory devices were utilized in a majority of index admissions. Congestive heart failure was the single most common reason for 30-day readmission. Patients discharged to skilled nursing facility, patients with private insurance and higher socioeconomic status were less likely to be readmitted. Moreover, readmissions among STEMI-CS patients contribute to significant resource utilization.
Collapse
|
47
|
Fanaroff AC, Vora AN, Chen AY, Mathews R, Udell JA, Roe MT, Thomas LE, Wang TY. Hospital participation in clinical trials for patients with acute myocardial infarction: Results from the National Cardiovascular Data Registry. Am Heart J 2019; 214:184-193. [PMID: 31234037 DOI: 10.1016/j.ahj.2019.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/21/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Little is known about the proportion of hospitals in the United States that offer clinical trial enrollment opportunities and how patient outcomes differ between hospitals that do and do not participate in clinical trials. METHODS In the nationwide Chest Pain-MI registry, we described the proportion of hospitals that enrolled patients with acute myocardial infarction (MI) in clinical trials from 2009 to 2014. Hospital-level adherence to every eligible MI performance measure was compared between hospitals that did and did not enroll patients in clinical trials. Using linked Medicare data, we also compared 1-year major adverse cardiovascular events (MACE: death, MI, heart failure, or stroke) among patients ≥65 years old treated at trial versus nontrial hospitals. RESULTS Among 766 hospitals, 430 (56.1%) enrolled ≥1 MI patient in a clinical trial during the study period, but the proportion of hospitals enrolling patients in clinical trials declined from 36.8% in 2009 to 26.6% in 2014. Complete adherence to performance measures was delivered to a greater proportion of patients at trial hospitals than nontrial hospitals (72.6% vs 64.9%, P < .001; adjusted OR 1.07, 95% CI 1.03-1.12). One-year MACE rates were also lower for trial hospitals (adjusted HR 0.96, 95% CI 0.93-0.99). CONCLUSIONS Hospitals are becoming less likely to engage in clinical trials for patients with MI. Patients admitted to hospitals that participated in clinical trials more often received guideline-adherent care and had better long-term outcomes.
Collapse
|
48
|
Helgestad OKL, Josiassen J, Hassager C, Jensen LO, Holmvang L, Sørensen A, Frydland M, Lassen AT, Udesen NLJ, Schmidt H, Ravn HB, Møller JE. Temporal trends in incidence and patient characteristics in cardiogenic shock following acute myocardial infarction from 2010 to 2017: a Danish cohort study. Eur J Heart Fail 2019; 21:1370-1378. [PMID: 31339222 DOI: 10.1002/ejhf.1566] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/11/2019] [Accepted: 06/30/2019] [Indexed: 11/09/2022] Open
Abstract
AIM We sought to describe the contemporary annual incidence of cardiogenic shock (CS) following acute myocardial infarction (AMICS), the proportion of patients developing CS following ST-elevation myocardial infarction (STEMI), and other temporal changes in AMICS in Denmark between 2010 and 2017. METHODS AND RESULTS Medical records of patients suspected of having AMICS during 2010-2017 were reviewed to identify consecutive patients with AMICS in a cohort corresponding to two-thirds of the Danish population. Due to changes in recruitment area over the study period, population-based incidence could only be calculated from 2012 to 2017. A total of 1716 patients with AMICS were identified and an increase in the annual incidence was observed, from a nadir 65.3 per million person-years in 2013 to 80.0 per million person-years in 2017 (P-value for trend < 0.001). This trend corresponded to an increase in patients with non-STEMI and a decrease in patients developing CS after STEMI (10.0-6.6%, P-value for trend < 0.001) Also, mean arterial blood pressure at the time of AMICS was lower (63 ± 11 mmHg to 61 ± 13 mmHg, P-value for trend = 0.001) and the frequency of patients with left ventricular ejection fraction ≤ 30% increased (61.8%-71.4%, P-value for trend = 0.004). The annual 30-day mortality during the study period remained unchanged at about 50%. CONCLUSION The incidence rate of AMICS increased in the Danish population between 2012 and 2017. Fewer patients with STEMI developed CS, and haemodynamic severity of CS increased during the study period; however, survival rates remained unchanged.
Collapse
Affiliation(s)
- Ole K L Helgestad
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Jakob Josiassen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Sørensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Martin Frydland
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Annmarie T Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Nanna L J Udesen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Henrik Schmidt
- Department of Cardiothoracic Anaesthesia, Odense University Hospital, Odense, Denmark
| | - Hanne B Ravn
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiac Anaesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
49
|
Vallabhajosyula S, Prasad A, Dunlay SM, Murphree DH, Ingram C, Mueller PS, Gersh BJ, Holmes DR, Barsness GW. Utilization of Palliative Care for Cardiogenic Shock Complicating Acute Myocardial Infarction: A 15-Year National Perspective on Trends, Disparities, Predictors, and Outcomes. J Am Heart Assoc 2019; 8:e011954. [PMID: 31315497 PMCID: PMC6761657 DOI: 10.1161/jaha.119.011954] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background This study sought to evaluate the 15‐year national utilization, trends, predictors, disparities, and outcomes of palliative care services (PCS) use in cardiogenic shock complicating acute myocardial infarction. Methods and Results A retrospective cohort from January 1, 2000 through December 31, 2014 was analyzed using the National Inpatient Sample database. Administrative codes for acute myocardial infarction–cardiogenic shock and PCS were used to identify eligible admissions. The primary outcomes were the frequency, utilization trends, and predictors of PCS. Secondary outcomes included in‐hospital mortality and resources utilization. Multivariable regression and propensity‐matching analyses were used to control for confounding. In this 15‐year period, there were 444 253 acute myocardial infarction–cardiogenic shock admissions, of which 4.5% received PCS. The cohort receiving PCS was older, of white race, female sex, and with higher comorbidity and acute organ failure. The PCS cohort received fewer cardiac procedures, but more noncardiac organ support therapies. Older age, female sex, white race, higher comorbidity, higher socioeconomic status, admission to a larger hospital, and admission after 2008 were independent predictors of PCS use. Use of PCS was independently associated with higher in‐hospital mortality (odds ratio 6.59 [95% CI 6.37–6.83]; P<0.001). The cohort with PCS use had >2‐fold higher in‐hospital mortality, 12‐fold higher use of do‐not‐resuscitate status, lesser in‐hospital resource utilization, and fewer discharges to home. Similar findings were observed in the propensity‐matched cohort. Conclusions PCS use in patients with acute myocardial infarction–cardiogenic shock is low, though there is a trend towards increased adoption. There are significant patient and hospital‐specific disparities in the utilization of PCS.
Collapse
Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN.,Division of Pulmonary and Critical Care Medicine Department of Medicine Mayo Clinic Rochester MN
| | - Abhiram Prasad
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN.,Department of Health Science Research Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester MN
| | - Dennis H Murphree
- Department of Health Science Research Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester MN
| | - Cory Ingram
- Division of General Internal Medicine Department of Medicine Mayo Clinic Rochester MN
| | - Paul S Mueller
- Division of General Internal Medicine Department of Medicine Mayo Clinic Rochester MN
| | - Bernard J Gersh
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - David R Holmes
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | |
Collapse
|
50
|
Fanaroff AC, Peterson ED, Chen AY, Thomas L, Doll JA, Fordyce CB, Newby LK, Amsterdam EA, Kosiborod MN, de Lemos JA, Wang TY. Intensive Care Unit Utilization and Mortality Among Medicare Patients Hospitalized With Non-ST-Segment Elevation Myocardial Infarction. JAMA Cardiol 2019; 2:36-44. [PMID: 27806171 DOI: 10.1001/jamacardio.2016.3855] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Intensive care unit (ICU) utilization may have important implications for the care and outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI). Objectives To examine interhospital variation in ICU utilization in the United States for older adults with hemodynamically stable NSTEMI and outcomes associated with ICU utilization among patients with low, moderate, or high mortality risk. Design, Setting, and Participants This study was a retrospective analysis of 28 018 Medicare patients 65 years or older admitted with NSTEMI to 346 hospitals participating in the Acute Coronary Treatment and Intervention Outcomes Network (ACTION)-Get With the Guidelines from April 1, 2011, through December 31, 2012. Patients with cardiogenic shock or cardiac arrest on presentation were excluded. Data analysis was performed from May 7 through October 8, 2015. Exposures Hospitals with high (>70% of patients with NSTEMI treated in an ICU during the index hospitalization), intermediate (30%-70%), or low (<30%) ICU utilization. Main Outcomes and Measures Thirty-day mortality. Results Of 28 018 patients with NSTEMI 65 years or older (median age, 77 years [interquartile range, 71-84 years]; female, 13 055 [46.6%]; nonwhite race, 3931 [14.0%]), 11 934 (42.6%) had an ICU stay. The proportion of patients with NSTEMI treated in the ICU varied across hospitals (median, 38%; interquartile range, 26%-54%), but no significant differences were found in hospital or patient characteristics among high, intermediate, or low ICU utilization hospitals. Compared with high ICU utilization hospitals, low or intermediate ICU utilization hospitals were only marginally more selective of higher-risk patients, as determined by ACTION in-hospital mortality risk score or initial troponin level. The median ACTION risk score for patients treated in the ICU at low and intermediate ICU utilization hospitals was 34 compared with 33 for patients not treated in the ICU; at high ICU utilization hospitals, the median ACTION mortality risk score was 33 for patients treated in the ICU and 34 for patients not treated in the ICU. Thirty-day mortality rates did not significantly differ based on hospital ICU utilization (high vs low: 8.7% vs 8.7%; adjusted odds ratio, 0.91; 95% CI, 0.76-1.08; intermediate vs low: 9.6% vs 8.7%; adjusted odds ratio, 1.06; 95% CI, 0.94-1.20). The association between hospital ICU utilization and mortality did not change when considered among patients with ACTION risk scores greater than 40, 30 to 40, and less than 30 (adjusted interaction P = .86). Conclusions and Relevance Utilization of the ICU for older patients with NSTEMI varied significantly among hospitals. This variability was not explained by hospital characteristics or driven by patient risk. Mortality after myocardial infarction did not significantly differ among high, intermediate, or low ICU utilization hospitals.
Collapse
Affiliation(s)
- Alexander C Fanaroff
- Division of Cardiology, Duke University, Durham, North Carolina2Duke Clinical Research Institute, Durham, North Carolina
| | - Eric D Peterson
- Division of Cardiology, Duke University, Durham, North Carolina2Duke Clinical Research Institute, Durham, North Carolina
| | - Anita Y Chen
- Duke Clinical Research Institute, Durham, North Carolina
| | - Laine Thomas
- Duke Clinical Research Institute, Durham, North Carolina
| | - Jacob A Doll
- Division of Cardiology, Veterans Affairs Puget Sound Health System and the University of Washington, Seattle
| | - Christopher B Fordyce
- Division of Cardiology, Duke University, Durham, North Carolina2Duke Clinical Research Institute, Durham, North Carolina
| | - L Kristin Newby
- Division of Cardiology, Duke University, Durham, North Carolina2Duke Clinical Research Institute, Durham, North Carolina
| | - Ezra A Amsterdam
- Division of Cardiology, University of California, Davis, Sacramento
| | | | - James A de Lemos
- Division of Cardiology, University of Texas-Southwestern, Dallas
| | - Tracy Y Wang
- Division of Cardiology, Duke University, Durham, North Carolina2Duke Clinical Research Institute, Durham, North Carolina
| |
Collapse
|