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El Nasasra A, Hochadel M, Zahn R, Schneider A, Thiele H, Darius H, Behrens S, Schumacher B, Ince H, Zeymer U. Outcomes After Left Main Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock (from the German ALKK PCI Registry). Am J Cardiol 2023; 197:77-83. [PMID: 37173201 DOI: 10.1016/j.amjcard.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/05/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023]
Abstract
Early revascularization therapy with percutaneous coronary intervention (PCI) has been shown to improve outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Data from consecutive patients with AMI and CS treated with PCI enrolled into the prospective Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte-PCI registry were centrally collected and analyzed. Patients were divided into 4 groups with PCI for left main (LM), 1-vessel, 2-vessel, and 3-vessel diseases. Patients' characteristics, procedural features, antithrombotic therapies, and in-hospital complications were compared between the 4 groups. Between 2010 and 2015 a total of 2,348 consecutive patients with AMI and CS were treated by PCI in 51 hospitals, 295 for LM (15 for protected, 280 for unprotected) and single-vessel (n = 491), 2-vessel (n = 524), and 3-vessel disease (n = 1,038). Thrombolysis in myocardial infarction 3 patency of the culprit lesion after PCI was 84.3%, 84.0%, 80.8%, and 84.6% in single-vessel, 2-vessel, 3-vessel disease, and LM PCI, respectively, whereas in-hospital mortality was 27.9%, 33.9%, 46.5%, and 55.9%. Bleeding rates were low (2.0%-2.3 %) and not different between groups. In a multivariate analysis a higher age, thrombolysis in myocardial infarction flow <3 after PCI, 3-vessel disease, and LM PCI were independent predictors of mortality. In conclusion, PCI of the LM is performed in about 12.5% of patients with AMI and CS and was associated with a high procedural success rate, whereas mortality is increased with LM PCI.
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Affiliation(s)
- Aref El Nasasra
- Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany; Department of Cardiology, Soroka University Medical Center, Be'er Sheva, Israel.
| | - Mathias Hochadel
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Ralf Zahn
- Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | | | | | - Uwe Zeymer
- Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
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Martínez MJ, Rueda F, Labata C, Oliveras T, Montero S, Ferrer M, El Ouaddi N, Serra J, Lupón J, Bayés-Genís A, García-García C. Non-STEMI vs. STEMI Cardiogenic Shock: Clinical Profile and Long-Term Outcomes. J Clin Med 2022; 11:jcm11123558. [PMID: 35743628 PMCID: PMC9224589 DOI: 10.3390/jcm11123558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/12/2022] [Accepted: 06/17/2022] [Indexed: 11/21/2022] Open
Abstract
Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI). In AMI-CS, the ST segment deviation on ECG may be elevated (STEMI-CS) or non-elevated (NSTEMI-CS), which may influence prognosis. Our aim was to analyze the clinical profile, acute-phase prognosis, and long-term outcomes of CS relative to the ST pattern on admission. In a prospective registry of 4647 AMI patients admitted to the intensive cardiac care unit of a university hospital between 2010 and 2019, we compared the clinical characteristics, 30-days case fatality, and long-term outcomes of AMI-CS, based on the presence of ST-segment deviation. AMI-CS developed in 239 (5.1%) patients (26.4% women): 190 (79.5%) STEMI-CS and 49 (20.5%) NSTEMI-CS. The mean age was 69.7 years. The STEMI-CS patients had larger infarcts and more mechanical complications than the NSTEMI-CS patients. The NSTEMI-CS patients had a greater prevalence of hypertension, diabetes, peripheral vascular disease, previous cardiovascular comorbidities, three-vessel disease, and left main disease than the STEMI-CS patients. The STEMI-CS patients had higher 30-day mortality than the NSTEMI-CS (59.5% vs. 36.7%; p = 0.004), even after multivariable adjustment (HR 1.91; 95% CI 1.16–3.14), but no differences in mortality were observed at 3 years. In conclusion, the 30-day case-fatality is higher in STEMI-CS, but the long-term outcome is similar in both groups.
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Affiliation(s)
- María José Martínez
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
- Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain
- PhD Program, Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Ferran Rueda
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Carlos Labata
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Teresa Oliveras
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Santiago Montero
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Marc Ferrer
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Nabil El Ouaddi
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Jordi Serra
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Josep Lupón
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
- CIBER Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Antoni Bayés-Genís
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
- CIBER Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Cosme García-García
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
- CIBER Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-497-86-62; Fax: +34-93-497-89-39
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Holzknecht M, Tiller C, Reindl M, Lechner I, Fink P, Lunger P, Mayr A, Henninger B, Brenner C, Klug G, Bauer A, Metzler B, Reinstadler SJ. Association of C-Reactive Protein Velocity with Early Left Ventricular Dysfunction in Patients with First ST-Elevation Myocardial Infarction. J Clin Med 2021; 10:5494. [PMID: 34884196 PMCID: PMC8658672 DOI: 10.3390/jcm10235494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022] Open
Abstract
C-reactive protein velocity (CRPv) has been proposed as a very early and sensitive risk predictor in patients with ST-elevation myocardial infarction (STEMI). However, the association of CRPv with early left ventricular (LV) dysfunction after STEMI is unknown. The aim of this study was to investigate the relationship between CRPv and early LV dysfunction, either before or at hospital discharge, in patients with first STEMI. This analysis evaluated 432 STEMI patients that were included in the prospective MARINA-STEMI (Magnetic Resonance Imaging In Acute ST-elevation Myocardial Infarction. ClinicalTrials.gov Identifier: NCT04113356) cohort study. The difference of CRP 24 ± 8 h and CRP at hospital admission divided by the time (in h) that elapsed during the two examinations was defined as CRPv. Cardiac magnetic resonance (CMR) imaging was conducted at a median of 3 (IQR 2-4) days after primary percutaneous coronary intervention (PCI) for the determination of LV function and myocardial infarct characteristics. The association of CRPv with the CMR-derived LV ejection fraction (LVEF) was investigated. The median CRPv was 0.42 (IQR 0.21-0.76) mg/l/h and was correlated with LVEF (rS = -0.397, p < 0.001). In multivariable linear as well as binary logistic regression analysis (adjustment for biomarkers and clinical and angiographical parameters), CRPv was independently associated with LVEF (β: 0.161, p = 0.004) and LVEF ≤ 40% (OR: 1.71, 95% CI: 1.19-2.45; p = 0.004), respectively. The combined predictive value of peak cardiac troponin T (cTnT) and CRPv for LVEF ≤ 40% (AUC: 0.81, 95% CI 0.77-0.85, p < 0.001) was higher than it was for peak cTnT alone (AUC difference: 0.04, p = 0.009). CRPv was independently associated with early LV dysfunction, as measured by the CMR-determined LVEF, revealing an additive predictive value over cTnT after acute STEMI treated with primary PCI.
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Affiliation(s)
- Magdalena Holzknecht
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Christina Tiller
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Martin Reindl
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Ivan Lechner
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Priscilla Fink
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Patrick Lunger
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (A.M.); (B.H.)
| | - Benjamin Henninger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (A.M.); (B.H.)
| | - Christoph Brenner
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Gert Klug
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Axel Bauer
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Bernhard Metzler
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
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Grines C, Dupont A. Prognosis after AMI-related cardiogenic shock: myocardial blush score is one piece of the puzzle. EUROINTERVENTION 2021; 16:e1209-e1210. [PMID: 33551375 PMCID: PMC9707446 DOI: 10.4244/eijv16i15a217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Cindy Grines
- Northside Hospital Cardiovascular Institute, 1110 W Peachtree St NW #920, Atlanta, GA 30309, USA
| | - Allison Dupont
- Northside Hospital Cardiovascular Institute, Atlanta, GA, USA
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