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Alushi B, Douedari A, Froehlig G, Knie W, Wurster TH, Leistner DM, Stahli BE, Mochmann HC, Pieske B, Landmesser U, Krackhardt F, Skurk C. Impella versus IABP in acute myocardial infarction complicated by cardiogenic shock. Open Heart 2019; 6:e000987. [PMID: 31218000 PMCID: PMC6546200 DOI: 10.1136/openhrt-2018-000987] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/29/2019] [Accepted: 04/14/2019] [Indexed: 11/09/2022] Open
Abstract
Objective We investigated the benefit of Impella, a modern percutaneous mechanical support (pMCS)
device, versus former standard intra-aortic balloon pump (IABP) in acute myocardial
infarction complicated by cardiogenic shock (AMICS). Methods This single-centre, retrospective study included patients with AMICS receiving pMCS
with either Impella or IABP. Disease severity at baseline was assessed with the
IABP-SHOCK II score. The primary outcome was all-cause mortality at 30 days. Secondary
outcomes were parameters of shock severity at the early postimplantation phase. Adjusted
Cox proportional hazards models identified independent predictors of the primary
outcome. Results Of 116 included patients, 62 (53%) received Impella and 54 (47%)
IABP. Despite similar baseline mortality risk (IABP-SHOCK II high-risk score
of 18 % vs 20 %; p = 0.76), Impella significantly reduced the inotropic
score (p < 0.001), lactate levels (p < 0.001) and SAPS II (p =0.02) and improved left ventricular ejection fraction (p = 0.01).
All-cause mortality at 30 days was similar with Impella and IABP (52 % and 67
%, respectively; p = 0.13), but bleeding complications were more frequent in the
Impella group (3 vs 4 units of transfused erythrocytes concentrates due to bleeding
complications, p = 0.03). Previous cardiopulmonary resuscitation (HR 3.22,
95% CI 1.76 to 5.89; p < 0.01) and an estimated intermediate (HR
2.77, 95% CI 1.42 to 5.40; p < 0.01) and high (HR 4.32
95% CI 2.03 to 9.24; p = 0.01) IABP-SHOCK II score were independent
predictors of all-cause mortality. Conclusions In patients with AMICS, haemodynamic support with the Impella device had no significant
effect on 30-day mortality as compared with IABP. In these patients, large randomised
trials are warranted to ascertain the effect of Impella on the outcome.
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Affiliation(s)
- Brunilda Alushi
- Department of Cardiology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Andel Douedari
- Department of Cardiology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Georg Froehlig
- Department of Cardiology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Wulf Knie
- Department of Cardiology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Thomas H Wurster
- Department of Cardiology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - David M Leistner
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany
| | - Barbara Elisabeth Stahli
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany
| | - Hans-Christian Mochmann
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Florian Krackhardt
- Department of Cardiology (CVK), Charité University Medicine, Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany
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Keeble TR, Karamasis GV, Rothman MT, Ricksten SE, Ferrari M, Hullin R, Scherstén F, Reitan O, Kirking ST, Cleland JG, Smith EJ. Percutaneous haemodynamic and renal support in patients presenting with decompensated heart failure: A multi-centre efficacy study using the Reitan Catheter Pump (RCP). Int J Cardiol 2019; 275:53-58. [DOI: 10.1016/j.ijcard.2018.09.085] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 09/07/2018] [Accepted: 09/24/2018] [Indexed: 01/11/2023]
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Nuding S, Werdan K, Prondzinsky R. Optimal course of treatment in acute cardiogenic shock complicating myocardial infarction. Expert Rev Cardiovasc Ther 2018; 16:99-112. [PMID: 29310471 DOI: 10.1080/14779072.2018.1425141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION About 5% of patients with myocardial infarction suffer from cardiogenic shock as a complication, with a mortality of ≥30%. Primary percutaneous coronary intervention as soon as possible is the most successful therapeutic approach. Prognosis depends not only on the extent of infarction, but also - and even more - on organ hypoperfusion with consequent development of multiple organ dysfunction syndrome. Areas covered: This review covers diagnostic, monitoring and treatment concepts relevant for caring patients with cardiogenic shock complicating myocardial infarction. All major clinical trials have been selected for review of the recent data. Expert commentary: For optimal care, not only primary percutaneous intervention of the occluded coronary artery is necessary, but also best intensive care medicine avoiding the development of multiple organ dysfunction syndrome and finally death. On contrary, intra-aortic balloon pump - though used for decades - is unable to reduce mortality of patients with cardiogenic shock complicating myocardial infarction.
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Affiliation(s)
- Sebastian Nuding
- a Department of Medicine III , University Hospital Halle (Saale) , Halle (Saale) , Germany
| | - Karl Werdan
- a Department of Medicine III , University Hospital Halle (Saale) , Halle (Saale) , Germany
| | - Roland Prondzinsky
- b Department of Medicine I , Carl-von-Basedow Hospital Merseburg , Germany
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de Waha S, Desch S, Fuernau G, Pöss J, Ledwoch J, Jobs A, Eitel I, Thiele H. Interventional therapies in acute myocardial infarction complicated by cardiogenic shock. Herz 2017; 42:11-17. [PMID: 27909767 DOI: 10.1007/s00059-016-4511-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cardiogenic shock remains the most common cause of death in patients with acute myocardial infarction. Early revascularization of the infarct-related artery has been shown to reduce mortality and is the therapeutic cornerstone. The optimal revascularization strategy of additional non-culprit lesions remains yet to be determined. Further, uncertainties exist with respect to access site choice, antiplatelet regimen as well as mechanical support devices. This review outlines current evidence on the interventional management of cardiogenic shock complicating acute myocardial infarction.
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Affiliation(s)
- S de Waha
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany. .,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany.
| | - S Desch
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
| | - G Fuernau
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
| | - J Pöss
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
| | - J Ledwoch
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
| | - A Jobs
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
| | - I Eitel
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
| | - H Thiele
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
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