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Maimaitiming M, Li S, Huang K, Maimaitiming M, Liu F, Smith SC, Zheng ZJ, Jin Y. Risk factors for cardiogenic shock incidence and mortality after acute myocardial infarction: a systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2025; 5:200. [PMID: 40425745 DOI: 10.1038/s43856-025-00874-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/17/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND Cardiogenic shock (CS) is a serious complication of acute myocardial infarction (AMI), which could lead to severe health loss. This systematic review aimed to analyze the risk factors related to the incidence and poor outcomes of cardiogenic shock after acute myocardial infarction (AMI-CS), including in-hospital death, 30-day death and 1-year death. METHODS Original studies were systematically searched in PubMed and Embase up to November 2022. The summary odds ratio (OR) and 95% confidence interval (CI) of all studies were acquired based on a random effect model or fixed effect model. Subgroup analyses were conducted according to the study design, followed by sensitive analyses. The protocol was registered on PROSPERO (registration number: CRD42023466123). RESULTS There are 25 studies enrolled, including 12 cross-sectional studies, ten retrospective cohort studies, and three case-control studies. The pooled results reveal that female sex (OR, 1.10; 95% CI, 1.09-1.11), advanced age (OR, 1.06; 95% CI, 1.03-1.09), smoking (OR, 1.36; 95% CI, 1.26-1.45), diabetes (OR, 1.45; 95% CI, 1.08-1.82), and ST-segment elevation myocardial infarction (STEMI; OR, 1.99; 95% CI, 1.34-2.63) are significantly associated with the development of AMI-CS. Among these factors, all except smoking increase the risk of in-hospital death among AMI-CS patients. Advanced age (OR, 1.08; 95% CI, 1.04-1.12) and diabetes (OR, 1.77; 95% CI, 1.25-2.29) have negative impacts on 30-day death, while advanced age (OR, 2.10; 95% CI, 1.70-2.50) and STEMI (OR, 1.55; 95% CI, 1.15-1.95) are associated with 1-year death. CONCLUSIONS Our findings highlight the significance of risk factors in predicting the incidence and prognosis of AMI-CS. Early identification and targeted interventions for individuals with these risk factors could potentially help prevent the occurrence of AMI-CS and improve patient outcomes.
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Affiliation(s)
- Mailikezhati Maimaitiming
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Siwen Li
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Kepei Huang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | | | - Feng Liu
- Suzhou Kowloon Hospital, School of Medicine Shanghai Jiaotong University, Suzhou, Jiangsu, China
| | - Sidney C Smith
- Division of Cardiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China.
- Institute for Global Health and Development, Peking University, Beijing, China.
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Fang D, Chen H, Geng H, Chen X, Liu M. Development and validation of a nomogram for predicting survival in patients with cardiogenic shock. Front Cardiovasc Med 2025; 12:1538395. [PMID: 40364823 PMCID: PMC12069261 DOI: 10.3389/fcvm.2025.1538395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Accepted: 04/04/2025] [Indexed: 05/15/2025] Open
Abstract
Background There is currently a lack of easy-to-use tools for assessing the severity of cardiogenic shock (CS) patients. This study aims to develop a nomogram for evaluating severity in CS patients regardless of the underlying cause. Methods and results The MIMIC-IV database was used to identify 1,923 CS patients admitted to the ICU. A multivariate Cox model was developed in the training cohort (70%) based on LASSO regression results. Factors such as age, systolic blood pressure, arterial oxygen saturation, hemoglobin, serum creatinine, blood glucose, arterial pH, arterial lactate, and norepinephrine use were incorporated into the final model. This model was visualized as a Cardiogenic Shock Survival Nomogram (CSSN) to predict 30-day survival rates. The model's c-statistic was 0.75 (95% CI: 0.73-0.77) in the training cohort and 0.73 (95% CI: 0.70-0.77) in the validation cohort, demonstrating good predictive accuracy. The AUC of the CSSN for 30-day survival probabilities was 0.76 in the training cohort and 0.73 in the validation cohort. Calibration plots showed strong concordance between predicted and actual survival rates, and decision curve analysis (DCA) affirmed the model's clinical utility. The CSSN outperformed the Cardiogenic Shock Score (CSS) in various metrics, including c-statistic, time-dependent ROC, calibration plots, and DCA (c-statistic: 0.75 vs. 0.72; AUC: 0.76 vs. 0.73, P < 0.01 by Delong test). Subgroup analysis confirmed the model's robustness across both AMI-CS and non-AMI-CS subgroups. Conclusions The CSSN was developed to predict 30-day survival rates in CS patients irrespective of the underlying cause, showing good performance and potential clinical utility in managing CS.
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Affiliation(s)
- Dingfeng Fang
- Department of Geriatrics, Peking University First Hospital, Beijing, China
- Peking University Health Science Center, Beijing, China
| | - Huihe Chen
- Department of Sports Medicine and Cardiopulmonary Rehabilitation Center, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Hui Geng
- Department of Geriatrics, Peking University First Hospital, Beijing, China
| | - Xiahuan Chen
- Department of Geriatrics, Peking University First Hospital, Beijing, China
| | - Meilin Liu
- Department of Geriatrics, Peking University First Hospital, Beijing, China
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Ughetto A, Cherbi M, Lamblin N, Bonello L, Leurent G, Levy B, Elbaz M, Manzo-Silberman S, Lim P, Schneider F, Cariou A, Khachab H, Bourenne J, Seronde MF, Harbaoui B, Vanzetto G, Quentin C, Merdji H, Combaret N, Marchandot B, Lattuca B, Henry P, Gerbaud E, Tomasevic D, Puymirat E, Roubille F, Delmas C. Features and outcomes of hypertrophic cardiomyopathy complicated by cardiogenic shock: an analysis of the FRENSHOCK multicenter prospective registry. Hellenic J Cardiol 2025:S1109-9666(25)00077-6. [PMID: 40122520 DOI: 10.1016/j.hjc.2025.03.005] [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: 08/04/2024] [Revised: 01/11/2025] [Accepted: 03/17/2025] [Indexed: 03/25/2025] Open
Abstract
OBJECTIVE Cardiogenic shock (CS) in patients with left ventricular hypertrophy (LVH) due to hypertrophic cardiomyopathy (HCM) or hypertensive heart disease, is underreported in the literature. This study aimed to delineate the characteristics, management strategies, and outcomes of patients experiencing CS with preexisting LVH and HCM. METHODS FRENSHOCK is a prospective multicenter registry including 772 unselected CS patients from 49 centers. Baseline characteristics, management, and 1-year outcomes were analyzed according to the occurrence on preexisting LVH. RESULTS Among the 772 included patients with CS, CS occurred in 34 patients with preexisting LVH (4.4%, 1.4% with HCM). Clinical characteristics, medical history, usual medications, and hemodynamic parameters upon inclusion did not differ between the patients with or without LVH. Left ventricular ejection fraction in patients with CS and LVH was 27.3 ± 14.5% indicating a non-obstructive cause of CS. In-hospital management according to the LVH and non-LVH groups indicated no differences between the groups. The 1-month and 1-year mortality did not differ between patients with CS with and without LVH (26.5% vs. 26%, adjusted HR [hazard ratio] [95% CI]: 0.87 [0.44-1.72]) and 55.9% vs. 44.7%, respectively (adjusted HR [95% CI]:0.88 [0.54-1.42]). Subgroup analyses comparing HCM (n = 11) and hypertensive LVH (n = 23) revealed similar clinical characteristics, in-hospital management, and one-year rehospitalization rates in these patients. CONCLUSION In a large and unselected CS population, the prevalence of patients with LVH was low (4.4%) with less than half having HCM (1.4%). The presentation, management, and outcomes of CS were similar to the broader CS population in our series. However, HCM-CS represents a distinct clinical entity necessitating tailored management approaches.
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Affiliation(s)
- Aurore Ughetto
- Anesthesia and Intensive Cardiac Care Unit, Montpellier University Hospital, Montpellier, France
| | - Miloud Cherbi
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse 31059, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille F-59000, France
| | - Laurent Bonello
- Aix-Marseille Université, Marseille F-13385, France; Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille F-13385, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, Rennes F-35000, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse 31059, France
| | | | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, Créteil F-94010, France; AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil F-94010, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Centre - Université de Paris, Medical School, Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Avenue des Tamaris 13616 Aix-en-Provence cedex 1, Aix en Provence, France
| | - Jeremy Bourenne
- Service de Réanimation des Urgences, Aix Marseille Université, CHU La Timone 2, Marseille, France
| | | | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, France; INSERM U1044, France; INSA-15 Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, La Tronche 38700, France
| | - Charlotte Quentin
- Service de Reanimation Polyvalente, Centre Hospitalier Broussais St Malo, 1 rue de la Marne, St Malo 35400, France
| | - Hamid Merdji
- Réanimation Chirurgicale Polyvalente, Pôle Anesthésie - Réanimation chirurgicale - Médecine Péri-opératoire, Les Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil 1, Porte de l'Hôpital, Strasbourg Cedex F-67091, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg 67091, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Patrick Henry
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Department of Cardiology, Paris, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue de Magellan, Pessac 33604, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, Pessac 33600, France
| | - Danka Tomasevic
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Paris 75015, France; Université de Paris, Paris 75006, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, INI-CRT, CHU de Montpellier, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse 31059, France; REICATRA, Institut Saint Jacques, CHU de Toulouse, France; Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France.
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Sassani K, Syntila S, Waechter C, Kreutz J, Markus B, Patsalis N, Schieffer B, Chatzis G. Venoarterial Membrane Oxygenation in Cardiogenic Shock Complicated from an Acute Myocardial Infarction: An Overview and Comprehensive Meta-Analysis. Biomedicines 2025; 13:237. [PMID: 39857820 PMCID: PMC11760826 DOI: 10.3390/biomedicines13010237] [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: 12/15/2024] [Revised: 01/09/2025] [Accepted: 01/16/2025] [Indexed: 01/27/2025] Open
Abstract
Background: Cardiogenic shock remains a significant cause of mortality in patients with acute coronary syndrome, despite early interventions, such as coronary revascularization. Mechanical circulatory support devices, particularly venoarterial extracorporeal membrane oxygenation (VA-ECMO), are increasingly being utilized to address this issue. Limited randomized controlled trials (RCTs) exist to evaluate the efficacy of VA-ECMO in cardiogenic shock related to acute coronary syndrome. Methods: A meta-analysis was conducted to assess the effectiveness of VA-ECMO in adult patients with infarct-related cardiogenic shock. Trials were identified through database searches and selected based on specific inclusion criteria. The primary outcome was 30-day all-cause mortality, with secondary outcomes including bleeding and vascular complications. Results: A total of 24 studies met the inclusion criteria and were included in the meta-analysis, involving 4706 patients. The median age of the patients was 61.8 ± 4.1 years, with 76% of them being males. The analysis revealed that 30-day mortality rates for patients with cardiogenic shock receiving ECMO were still high, with a mortality of 63%. Vascular complications were identified as factors associated with a worse prognosis. Conclusions: The meta-analysis highlights the ongoing challenge of high mortality rates in cardiogenic shock patients despite the use of VA-ECMO. While VA-ECMO shows promise in providing circulatory support, further research is needed to explore ways to improve outcomes and reduce complications associated with the use of these devices. The complexity of patient management in cardiogenic shock cases underscores the need for a multidisciplinary approach to optimize treatment strategies and enhance patient outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Georgios Chatzis
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (K.S.); (S.S.); (C.W.); (N.P.)
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Sassani K, Waechter C, Syntila S, Kreutz J, Markus B, Patsalis N, Di Vece D, Schieffer B, Templin C, Chatzis G. The Role of Impella in Cardiogenic Shock Complicated by an Acute Myocardial Infarction: A Meta-Analysis. J Clin Med 2025; 14:611. [PMID: 39860617 PMCID: PMC11766096 DOI: 10.3390/jcm14020611] [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: 12/15/2024] [Revised: 01/11/2025] [Accepted: 01/14/2025] [Indexed: 01/27/2025] Open
Abstract
Background: Emerging evidence suggests the role of mechanical circulatory support (MCS) devices in the therapy of refractory cardiogenic shock (CS). However, largerandomized trials addressing the role of Impella in the therapy of infarct-associated CS are sparse. As such, evidence coming from comprehensive retrospective studies or meta-analyses is of major importance in order to clarify the role of the Impella device in this setting. Methods: Only clinical trials involving patients receiving Impella 2.5 and Impella CP for treatment of CS caused in terms of acute coronary syndrome (ACS) were included in this meta-analysis. The primary endpoint was 30-day mortality, with major bleeding and ischemic vascular complications serving as secondary endpoints. Results: A total of 18 observational retrospective studies (2617 patients with CS and Impella implantation) were included in this analysis. The mean age of the total participants was 64.7 ± 2.93 years. A mean mortality incidence of 45% was found between all included participants. The ischemia rate was in total 8.5 ± 4.4%, and the incidence of bleeding was 13.9 ± 5.6%. Conclusions: The 30-day mortality rate for patients with ACS-associated CS treated with Impella remains high. The high complication rates underline the importance of Impella use in only a very well-selected population of patients.
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Affiliation(s)
- Kiarash Sassani
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany
- Department of Internal Medicine B (Cardiology, Angiology, Pneumology and Intensive Care Medicine), University Medicine Greifswald, 17475 Greifswald, Germany
| | - Christian Waechter
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany
| | - Styliani Syntila
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany
| | - Julian Kreutz
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany
| | - Birgit Markus
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany
| | - Nikolaos Patsalis
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany
| | - Davide Di Vece
- Department of Internal Medicine B (Cardiology, Angiology, Pneumology and Intensive Care Medicine), University Medicine Greifswald, 17475 Greifswald, Germany
| | - Bernhard Schieffer
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany
| | - Christian Templin
- Department of Internal Medicine B (Cardiology, Angiology, Pneumology and Intensive Care Medicine), University Medicine Greifswald, 17475 Greifswald, Germany
| | - Georgios Chatzis
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany
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Guido T, Giovanni T, Elena G, Anna Z, Michele Z, Stefano F. Cardiogenic shock in general intensive care unit: a nationwide prospective analysis of epidemiology and outcome. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:768-778. [PMID: 39302432 DOI: 10.1093/ehjacc/zuae108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/30/2024] [Accepted: 09/18/2024] [Indexed: 09/22/2024]
Abstract
AIMS Cardiogenic shock (CS) is a life-threatening disease burdened by a mortality up to 50%. The epidemiology has changed with non-ischaemic aetiologies being predominant, although data were mainly derived from patients admitted to dedicated acute cardiac care. We report the epidemiology and outcome of patients with CS admitted to general intensive care unit (ICU). METHODS AND RESULTS Prospective multicentric epidemiological study including 314 general ICU adhering to the GiViTI nationwide registry from 2011 to 2018, excluding cardiac arrest. The primary endpoint of the study was mortality. The association between clinical factors and mortality was evaluated using a logistic regression model. The odds ratios (ORs) of the covariates quantify their association with mortality during hospitalization. A total of 11 052 patients admitted to general ICU {incidence 2.17%; median age 72 [interquartile range (66-81)], 38.7% were women} with CS were included. Forty-seven per cent of patients had more than three organ insufficiency at the time of admission. The most common CS aetiologies were left heart failure (LHF, 5247-47.5%); acute myocardial infarction (3612-32.6%); right heart failure (RHF, 515-4.6%); and biventricular failure (532-4.8%). A total of 85.5% were mechanically ventilated during the ICU hospitalization. The overall ICU mortality was 44.8%, increasing to 53.4% during the hospitalization in the index hospital and to 54.3% at the latest hospital. Right heart failure-cardiogenic shock patients exhibited the highest mortality risk [OR: 1.19, 95% confidence interval (CI) (0.94-1.50); P < 0.001], followed by biventricular CS [OR 1.04, 95% CI (0.82-1.32)]. Respiratory failure [OR 1.13 (95% CI 1.08-1.19)], coagulation disorder [1.17 (95% CI 1.1-1.24)], renal dysfunction [OR 1.55 (95% CI 1.50-1.61)], and neurological alteration [OR 1.45 (95% CI 1.39-1.50)] were associated with worsen outcome along with severe hypotension [systolic blood pressure < 70 mmHg-OR 2.35, 95% CI (2.06-2.67)], increasing age [OR 2.21 95% CI (2.01-2.42)], and longer ICU stay prior to admission (two-fold increase for each 4.7 days). CONCLUSION In the general ICU, the aetiology of CS, excluding cardiac arrest, remains characterized mostly by LHF with RHF-CS burdened by higher mortality. Multiorgan failure at admission and longer hospital stay before ICU admission predispose to worsen outcome.
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Affiliation(s)
- Tavazzi Guido
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Golgi 19, 27100 Pavia, Italy
- Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Viale Golgi 19, 27100 Pavia, Italy
| | - Tricella Giovanni
- Laboratory of Clinical Data Science, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, BG, Italy
| | - Garbero Elena
- Laboratory of Clinical Data Science, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, BG, Italy
| | | | - Zanetti Michele
- Unit of Computer Science for Clinical Knowledge Sharing, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Finazzi Stefano
- Laboratory of Clinical Data Science, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, BG, Italy
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Volle K, Merdji H, Bataille V, Lamblin N, Roubille F, Levy B, Champion S, Lim P, Schneider F, Labbe V, Khachab H, Bourenne J, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Quentin C, Combaret N, Marchandot B, Lattuca B, Biendel C, Leurent G, Bonello L, Gerbaud E, Puymirat E, Bonnefoy E, Aissaoui N, Delmas C. Ventilation strategies in cardiogenic shock: insights from the FRENSHOCK observational registry. Clin Res Cardiol 2024:10.1007/s00392-024-02551-x. [PMID: 39441346 DOI: 10.1007/s00392-024-02551-x] [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: 02/06/2024] [Accepted: 09/20/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND Despite scarce data, invasive mechanical ventilation (MV) is widely suggested as first-line ventilatory support in cardiogenic shock (CS) patients. We assessed the real-life use of different ventilation strategies in CS and their influence on short and mid-term prognosis. METHODS FRENSHOCK was a prospective registry including 772 CS patients from 49 centers in France. Patients were categorized into three groups according to the ventilatory supports during hospitalization: no mechanical ventilation group (NV), non-invasive ventilation alone group (NIV), and invasive mechanical ventilation group (MV). We compared clinical characteristics, management, and occurrence of death and major adverse event (MAE) (death, heart transplantation or ventricular assist device) at 30 days and 1 year between the three groups. RESULTS Seven hundred sixty-eight patients were included in this analysis. Mean age was 66 years and 71% were men. Among them, 359 did not receive any ventilatory support (46.7%), 118 only NIV (15.4%), and 291 MV (37.9%). MV patients presented more severe CS with more skin mottling, higher lactate levels, and higher use of vasoactive drugs and mechanical circulatory support. MV was associated with higher mortality and MAE at 30 days (HR 1.41 [1.05-1.90] and 1.52 [1.16-1.99] vs NV). No difference in mortality (HR 0.79 [0.49-1.26]) or MAE (HR 0.83 [0.54-1.27]) was found between NIV patients and NV patients. Similar results were found at 1-year follow-up. CONCLUSIONS Our study suggests that using NIV is safe in selected patients with less profound CS and no other MV indication. NCT02703038.
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Affiliation(s)
- Kim Volle
- Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, 31059, Toulouse, France
| | - Hamid Merdji
- Faculté de Médecine, Medical Intensive Care Unit, Université de Strasbourg (UNISTRA), Strasbourg University Hospital, Nouvel Hôpital Civil, Strasbourg, France
| | - Vincent Bataille
- Association pour la diffusion de la médecine de prévention (ADIMEP)-INSERM UMR1295 CERPOP -Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - Nicolas Lamblin
- Urgences Et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, 59000, Lille, France
| | - François Roubille
- PhyMedExp, Cardiology Department, Université de Montpellier, INSERM, CNRS, INI-CRT, CHU de Montpellier, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-Les Nancy, France
| | - Sebastien Champion
- Clinique de Parly 2, Ramsay Générale de Santé, 21 Rue Moxouris, 78150, Le Chesnay, France
| | - Pascal Lim
- Service de Cardiologie, Univ Paris Est Créteil, INSERM, IMRB, AP-HP, Hôpital Universitaire Henri-Mondor, F-94010, Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Vincent Labbe
- Medical Intensive Care Unit, Tenon Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Avenue Des Tamaris 13616, cedex 1, Aix-en-Provence, France
| | - Jeremy Bourenne
- Service de Réanimation Des Urgences, Aix Marseille Université, CHU La Timone 2, Marseille, France
| | | | - Guillaume Schurtz
- Urgences Et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, 59000, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, University of Lyon, CREATISUMR 5220INSERM U1044INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700, La Tronche, France
| | - Charlotte Quentin
- Service de Reanimation Polyvalente, Centre Hospitalier Broussais St Malo, 1 Rue de La Marne, 35400, St Malo, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091, Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Caroline Biendel
- Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, 31059, Toulouse, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, 35000, Rennes, France
| | - Laurent Bonello
- Intensive Care Unit, Department of Cardiology, Aix-Marseille UniversitéAssistance Publique-Hôpitaux de Marseille, Hôpital NordMediterranean Association for Research and Studies in Cardiology (MARS Cardio), F-13385, Marseille, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue de Magellan, 33604, Pessac, France
- Bordeaux Cardio, Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, 33600, Pessac, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, 75015, Paris, France
- Université de Paris, 75006, Paris, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Nadia Aissaoui
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Medical School, Paris, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, 31059, Toulouse, France.
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France.
- Recherche Et Enseignement en Insuffisance Cardiaque Avancée Assistance Et Transplantation (REICATRA), Institut Saint Jacques, CHU Toulouse, France.
- Université Paul Sabatier, Toulouse III, Toulouse, France.
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Castillo Costa Y, Delfino F, Mauro V, D Imperio H, Adamowski M, Cortez Sandoval MA, Pow Chon Long F, Macín SM, Burgos Acosta J, Chacón-Díaz M, Soldán Patiño CP. Cardiogenic shock in the context of acute coronary syndromes in Latin America ("LATIN Shock"). Curr Probl Cardiol 2024; 49:102745. [PMID: 39128226 DOI: 10.1016/j.cpcardiol.2024.102745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 08/13/2024]
Abstract
Cardiogenic shock (CS) is a serious complication of heart attack and constitutes one of its main causes of death. To date, there is no data on its treatment and evolution in Latin America. OBJECTIVES To know the clinical characteristics, treatment strategies, evolution and in-hospital mortality of CS in Latin America. MATERIALS AND METHODS This is a prospective, multicenter registry of patients hospitalized with CS in the context of acute coronary syndromes (ACS) with and without ST segment elevation for 24 months. RESULTS 41 Latin American centers participated incorporating patients during the period between October 2021 and September 2023. 278 patients were included. Age: 66 (59-75) years, 70.1 % men. 74.8 % of the cases correspond to ACS with ST elevation, 14.4 % to ACS without ST elevation, 5.7 % to right ventricular infarction and 5.1 % to mechanical complications. CS was present from admission in 60 % of cases. Revascularization: 81.3 %, inotropic use: 97.8 %, ARM: 52.5 %, Swan Ganz: 17 %, intra-aortic balloon pump: 22.2 %. Overall in-hospital mortality was 52.7 %, with no differences between ACS with or without ST. CONCLUSIONS Morbidity and mortality is very high despite the high reperfusion used.
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9
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Zhang H, Shah A, Ravandi A. Cardiogenic shock-sex-specific risk factors and outcome differences. Can J Physiol Pharmacol 2024; 102:530-537. [PMID: 38663027 DOI: 10.1139/cjpp-2023-0382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Cardiogenic shock (CS) remains a high-mortality condition despite technological and therapeutic advances. One key to potentially improving CS prognosis is understanding patient heterogeneity and which patients may benefit most from different treatment options, a key element of which is sex differences. While cardiovascular diseases (CVDs) have historically been considered a male-dominant condition, the field is increasingly aware that females are also a substantial portion of the patient population. While estrogen has been implicated in protective roles against CVD and tissue hypoxia, its role in CS remains unclear. Clinically, female CS patients tend to be older, have more severe comorbidities and are more likely to have non-acute myocardial infarction etiologies with preserved ejection fractions. Female CS patients are more likely to receive pharmacotherapy while less likely to receive mechanical circulatory support. There is increased short-term mortality in females, although long-term mortality is similar between the sexes. More sex-specific and age-stratified research needs to be done to fully understand the relevant pathophysiological differences in CS, to better recognize and manage CS patients and reduce its mortality.
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Affiliation(s)
- Hannah Zhang
- Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Precision Cardiovascular Medicine Group, Institute of Cardiovascular Sciences, Boniface Hospital Research Centre, Winnipeg, MB, Canada
| | - Ashish Shah
- Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Precision Cardiovascular Medicine Group, Institute of Cardiovascular Sciences, Boniface Hospital Research Centre, Winnipeg, MB, Canada
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Amir Ravandi
- Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Precision Cardiovascular Medicine Group, Institute of Cardiovascular Sciences, Boniface Hospital Research Centre, Winnipeg, MB, Canada
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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10
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Nozaki YO, Yatsu S, Ogita M, Wada H, Takahashi D, Nishio R, Yasuda K, Takeuchi M, Takahashi N, Sonoda T, Shitara J, Tsuboi S, Dohi T, Suwa S, Miyauchi K, Minamino T. Outcome after primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction complicated by cardiogenic shock. J Cardiol 2024; 84:189-194. [PMID: 38373539 DOI: 10.1016/j.jjcc.2024.02.005] [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: 07/17/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) may reduce the risk of subsequent cardiovascular events but remains challenging. The study aim was to evaluate the clinical characteristics and long-term outcomes of patients undergoing primary PCI for STEMI with CS. METHODS We conducted an observational cohort study of patients with STEMI who underwent primary PCI between April 2004 and December 2017 at Juntendo University Shizuoka Hospital. The primary outcome was cardiovascular death (CVD) during the median 3-year follow-up. We performed a landmark analysis for the incidence of CVD from 0 day to 1 year and from 1 to 10 years. RESULTS Among the 1758 STEMI patients in the cohort, 212 (12.1 %) patients with CS showed significantly higher 30-day CVD rate on admission than those without (26.4 % vs 2.9 %). Landmark Kaplan-Meier analysis showed that CVD from day 0 to year 1 was significantly higher in the patients with CS (log-rank p < 0.0001). Multivariate Cox regression analysis showed that CS was significantly associated with higher cardiovascular mortality (adjusted hazard ratio, 11.8; 95%confidence intervals, 7.78-18.1; p < 0.0001), but the mortality rates from 1 to 10 years were comparable (log-rank p = 0.68). CONCLUSION The cardiovascular 1-year mortality rate for patients with STEMI was higher for those with CS on admission than without, but the mortality rates of >1 year were comparable. Surviving the early phase is essential for patients with STEMI and CS to improve long-term outcomes.
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Affiliation(s)
- Yui Okada Nozaki
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Manabu Ogita
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan.
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Daigo Takahashi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Ryota Nishio
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Kentaro Yasuda
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Mitsuhiro Takeuchi
- Cardiovascular Medicine and Biology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Norihito Takahashi
- Cardiovascular Medicine and Biology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taketo Sonoda
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Shuta Tsuboi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Katsumi Miyauchi
- Cardiovascular Medicine and Biology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Cardiovascular Medicine and Biology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Soussi S, Ahmadiankalati M, Jentzer JC, Marshall JC, Lawler PR, Herridge M, Mebazaa A, Gayat E, Lu Z, dos Santos CC, the French and European Outcome Registry in Intensive Care Units (FROG‐ICU) and CCCTBG trans‐trial group study for InFACT – the International Forum for Acute Care Trialists. Clinical phenotypes of cardiogenic shock survivors: insights into late host responses and long-term outcomes. ESC Heart Fail 2024; 11:1242-1248. [PMID: 38050658 PMCID: PMC10966268 DOI: 10.1002/ehf2.14596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 12/06/2023] Open
Abstract
AIMS An elevated risk of adverse events persists for years in cardiogenic shock (CS) survivors with high mortality rate and physical/mental disability. This study aims to link clinical CS-survivor phenotypes with distinct late host-response patterns at intensive care unit (ICU) discharge and long-term outcomes using model-based clustering. METHODS AND RESULTS In the original prospective, observational, international French and European Outcome Registry in Intensive Care Units (FROG-ICU) study, ICU patients with CS on admission were identified (N = 228). Among them, 173 were discharged alive from the ICU and included in the current study. Latent class analysis was applied to identify distinct CS-survivor phenotypes at ICU discharge using 15 readily available clinical and laboratory variables. The primary endpoint was 1 year of mortality after ICU discharge. Secondary endpoints were readmission and physical/mental disability [short form-36 questionnaire (SF-36) score] within 1 year after ICU discharge. Two distinct phenotypes at ICU discharge were identified (A and B). Patients in Phenotype B (38%) were more anaemic and had higher circulating levels of lactate, sustained kidney injury, and persistent elevation in plasma markers of inflammation, myocardial fibrosis, and endothelial dysfunction compared with Phenotype A. They had also a higher rate of non-ischaemic origin of CS and right ventricular dysfunction on admission. CS survivors in Phenotype B had higher 1 year of mortality compared with Phenotype A (P = 0.045, Kaplan-Meier analysis). When adjusted for traditional risk factors (i.e. age, severity of illness, and duration of ICU stay), Phenotype B was independently associated with 1 year of mortality [adjusted hazard ratio = 2.83 (95% confidence interval 1.21-6.60); P = 0.016]. There was a significantly lower physical quality of life in Phenotype B patients at 3 months (i.e. SF-36 physical component score). CONCLUSIONS A phenotype with sustained inflammation, myocardial fibrosis, and endothelial dysfunction at ICU discharge was identified from readily available data and was independently associated with poor long-term outcomes in CS survivors.
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Affiliation(s)
- Sabri Soussi
- Department of Anaesthesiology and Pain MedicineUniversity of TorontoTorontoONCanada
- Department of Anaesthesia and Pain ManagementToronto Western Hospital, University Health Network399 Bathurst Street, Room McL2‐405TorontoONM5T 2S8Canada
- Inserm UMR‐S 942, Cardiovascular Markers in Stress Conditions (MASCOT)University of Paris CitéParisFrance
| | | | - Jacob C. Jentzer
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - John C. Marshall
- Interdepartmental Division of Critical Care, St Michael's Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, Faculty of MedicineUniversity of Toronto36 Queen St ETorontoONM5B 1W8Canada
| | - Patrick R. Lawler
- McGill University Health CentreMontrealQCCanada
- Peter Munk Cardiac Centre, University Health Network, Interdepartmental Division of Critical Care Medicine and Division of CardiologyUniversity of TorontoTorontoONCanada
| | - Margaret Herridge
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health NetworkUniversity of TorontoTorontoONCanada
| | - Alexandre Mebazaa
- Inserm UMR‐S 942, Cardiovascular Markers in Stress Conditions (MASCOT)University of Paris CitéParisFrance
- Department of Anaesthesiology, Critical Care, Lariboisière ‐ Saint‐Louis Hospitals, DMU Parabol, AP–HP NordUniversity of Paris CitéParisFrance
| | - Etienne Gayat
- Inserm UMR‐S 942, Cardiovascular Markers in Stress Conditions (MASCOT)University of Paris CitéParisFrance
- Department of Anaesthesiology, Critical Care, Lariboisière ‐ Saint‐Louis Hospitals, DMU Parabol, AP–HP NordUniversity of Paris CitéParisFrance
| | - Zihang Lu
- Department of Public Health SciencesQueen's UniversityKingstonONCanada
| | - Claudia C. dos Santos
- Interdepartmental Division of Critical Care, St Michael's Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, Faculty of MedicineUniversity of Toronto36 Queen St ETorontoONM5B 1W8Canada
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Hlinomaz O, Motovska Z, Kala P, Hromadka M, Precek J, Mrozek J, Červinka P, Kettner J, Matejka J, Zohoor A, Bis J, Jarkovsky J. Outcomes of patients with myocardial infarction and cardiogenic shock treated with culprit vessel-only versus multivessel primary PCI. Hellenic J Cardiol 2024; 76:1-10. [PMID: 37633488 DOI: 10.1016/j.hjc.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Multivessel primary percutaneous coronary intervention (pPCI) is still often used in patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS). The study aimed to compare the characteristics and prognosis of patients with CS-STEMI and multivessel coronary disease (MVD) treated with culprit vessel-only pPCI or multivessel-pPCI during the initial procedure. MATERIAL AND METHODS From 2016 to 2020, 23,703 primary PCI patients with STEMI were included in a national all-comers registry of cardiovascular interventions. Of them, 1,213 (5.1%) patients had CS and MVD at admission to the hospital. Initially, 921 (75.9%) patients were treated with culprit vessel (CV)-pPCI and 292 (24.1%) with multivessel (MV)-pPCI. RESULTS Patients with 3-vessel disease and left main disease had a higher probability of being treated with MV-pPCI than patients with 2-vessel disease and patients without left main disease (28.5% vs. 18.6%; p < 0.001 and 37.7% vs. 20.6%; p < 0.001). Intra-aortic balloon pump, extracorporeal membrane oxygenation (ECMO), and other mechanical circulatory support systems were more often used in patients with MV-pPCI. Thirty (30)-day and 1-year all-cause mortality rates were similar in the CV-pPCI and MV-pPCI groups (odds ratio, 1.01; 95% confidence interval [CI] 0.77 to 1.32; p = 0.937 and 1.1; 95% CI 0.84 to 1.44; p = 0.477). The presence of 3-vessel disease and the use of ECMO were the strongest adjusted predictors of 30-day and 1-year mortality. CONCLUSIONS Our data from an extensive all-comers registry suggests that selective use of MV-pPCI does not increase the all-cause mortality rate in patients with CS-STEMI and MVD compared to CV-pPCI.
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Affiliation(s)
- Ota Hlinomaz
- International Clinical Research Center and Department of Cardioangiology, St. Anne University Hospital and Masaryk University, Brno, Czech Republic
| | - Zuzana Motovska
- Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
| | - Petr Kala
- University Hospital Brno and Faculty of Medicine of Masaryk University, Department of Internal Medicine and Cardiology, Brno, Czech Republic
| | - Milan Hromadka
- University Hospital and Faculty of Medicine, Pilsen, Czech Republic
| | - Jan Precek
- University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Jan Mrozek
- University Hospital and Faculty of Medicine, Ostrava, Czech Republic
| | | | - Jiri Kettner
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Matejka
- Regional Hospital, Pardubice, Czech Republic
| | | | - Josef Bis
- University Hospital and Faculty of Medicine, Hradec Kralové, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses of Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Czech Republic
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13
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van Diepen S, Zheng Y, Senaratne JM, Tyrrell BD, Das D, Thiele H, Henry TD, Bainey KR, Welsh RC. Reperfusion in Patients With ST-Segment-Elevation Myocardial Infarction With Cardiogenic Shock and Prolonged Interhospital Transport Times. Circ Cardiovasc Interv 2024; 17:e013415. [PMID: 38293830 DOI: 10.1161/circinterventions.123.013415] [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: 07/04/2023] [Accepted: 11/09/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND In patients with ST-segment-elevation myocardial infarction complicated by cardiogenic shock, primary percutaneous coronary intervention (pPCI) is the preferred revascularization option. Little is known about the efficacy and safety of a pharmacoinvasive approach for patients with cardiogenic shock presenting to a non-PCI hospital with prolonged interhospital transport times. METHODS In a retrospective analysis of geographically extensive ST-segment-elevation myocardial infarction network (2006-2021), 426 patients with cardiogenic shock and ST-segment-elevation myocardial infarction presented to a non-PCI-capable hospital and underwent reperfusion therapy (53.8% pharmacoinvasive and 46.2% pPCI). The primary clinical outcome was a composite of in-hospital mortality, renal failure requiring dialysis, cardiac arrest, or mechanical circulatory support, and the primary safety outcome was major bleeding defined as an intracranial hemorrhage or bleeding that required transfusion was compared in an inverse probability weighted model. The electrocardiographic reperfusion outcome of interest was the worst residual ST-segment-elevation. RESULTS Patients with pharmacoinvasive treatment had longer median interhospital transport (3 hours versus 1 hour) and shorter median symptom-onset-to-reperfusion (125 minute-to-needle versus 419 minute-to-balloon) times. ST-segment resolution ≥50% on the postfibrinolysis ECG was 56.6%. Postcatheterization, worst lead residual ST-segment-elevation <1 mm (57.3% versus 46.3%; P=0.01) was higher in the pharmacoinvasive compared with the pPCI cohort, but no differences were observed in the worst lead ST-segment-elevation resolution ≥50% (77.4% versus 81.8%; P=0.57). The primary clinical end point was lower in the pharmacoinvasive cohort (35.2% versus 57.0%; inverse probability weighted odds ratio, 0.44 [95% CI, 0.26-0.72]; P<0.01) compared with patients who received pPCI. An interaction between interhospital transfer time and reperfusion strategy with all-cause mortality was observed, favoring a pharmacoinvasive approach with transfer times >60 minutes. The incidence of the primary safety outcome was 10.1% in the pharmacoinvasive arm versus 18.7% in pPCI (adjusted odds ratio, 0.41 [95% CI, 0.14-1.09]; P=0.08). CONCLUSIONS In patients with ST-segment-elevation myocardial infarction presenting with cardiogenic shock and prolonged interhospital transport times, a pharmacoinvasive approach was associated with improved electrocardiographic reperfusion and a lower rate of death, dialysis, or mechanical circulatory support without an increase in major bleeding.
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Affiliation(s)
- Sean van Diepen
- Department of Critical Care (S.v.D., J.M.S.), University of Alberta, Edmonton, Canada
- Division of Cardiology, Department of Medicine (S.v.D., J.M.S., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
- Canadian VIGOUR Center (S.v.D., Y.Z., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
| | - Yinggan Zheng
- Canadian VIGOUR Center (S.v.D., Y.Z., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
| | - Janek M Senaratne
- Department of Critical Care (S.v.D., J.M.S.), University of Alberta, Edmonton, Canada
- Division of Cardiology, Department of Medicine (S.v.D., J.M.S., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
| | | | - Debraj Das
- CK Hui Heart Center, Edmonton, Alberta, Canada (B.D.T., D.D.)
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Germany (H.T.)
| | - Timothy D Henry
- Carl and Edyth Lindner Research Center at the Christ Hospital, Cincinnati, OH (T.D.H.)
| | - Kevin R Bainey
- Division of Cardiology, Department of Medicine (S.v.D., J.M.S., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
- Canadian VIGOUR Center (S.v.D., Y.Z., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
| | - Robert C Welsh
- Division of Cardiology, Department of Medicine (S.v.D., J.M.S., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
- Canadian VIGOUR Center (S.v.D., Y.Z., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
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14
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Goyal A, Shahbaz H, Jain H, Fatima L, Abbasi HQ, Ullah I, Sheikh AB, Sohail AH. The impact of chronic total occlusion in non-infarct related arteries on patient outcomes following percutaneous coronary intervention for STEMI superimposed with cardiogenic shock: A pilot systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102237. [PMID: 38042227 DOI: 10.1016/j.cpcardiol.2023.102237] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION Chronic total occlusion (CTO) is defined as a near-total blockage of a coronary artery and often occurs in arteries that are not directly responsible for the event, known as non-infarct-related arteries (NIRA). Cardiogenic shock (CS) is a complication of ST-elevated myocardial infarction (STEMI) that carries significant mortality. We performed a meta-analysis to find an association between mortality in patients undergoing PCI for STEMI that have superimposed CS, with the presence of CTO in the NIRA. MATERIALS AND METHODOLOGY A comprehensive literature search was conducted using PubMed, EMBASE, Google Scholar and clinicaltrials.gov from inception till October 2023 to retrieve studies that compare the presence of CTO with the absence of CTO in NIRA in STEMI with CS patients undergoing PCI. The primary endpoint was 30-day mortality and the secondary endpoints were risk of all-cause mortality (ACM) and repeat myocardial infarction (MI). Forest plots were generated using the random effects model by pooling odds ratios (ORs) with a 95 % confidence interval. Statistical significance was set at p < 0.05. RESULTS 5 observational studies with a total of 5186 patients (1031 with CTO in NIRA and 4155 with no CTO in NIRA) were included. The presence of CTO in NIRA was associated with higher odds of 30-day mortality [OR: 3.10; 95 % CI: 1.52, 6.32; p < 0.002], and ACM [OR: 2.37; 95 % CI: 1.83, 3.08; p < 0.00001]. The odds of repeat MI were comparable between the two groups [OR: 1.61, 95 % CI: 0.03, 74.36, p = 0.81]. CONCLUSIONS The presence of CTO in the NIRA serves as an independent indicator of unfavorable clinical outcomes including increased risk of 30-day mortality and all-cause mortality. The risk of repeat MI was comparable between the two groups. Large-scale, multicenter trials are warranted to identify the most effective management approach for these patients.
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Affiliation(s)
- Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Haania Shahbaz
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS)-Jodhpur, Jodhpur, Rajasthan, India
| | - Laveeza Fatima
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Irfan Ullah
- Department of Internal Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences, Albuquerque, NM, USA
| | - Amir Humza Sohail
- Department of Surgery, University of New Mexico Health Sciences, Albuquerque, NM, USA.
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Manzi L, Sperandeo L, Forzano I, Castiello DS, Florimonte D, Paolillo R, Santoro C, Mancusi C, Di Serafino L, Esposito G, Gargiulo G. Contemporary Evidence and Practice on Right Heart Catheterization in Patients with Acute or Chronic Heart Failure. Diagnostics (Basel) 2024; 14:136. [PMID: 38248013 PMCID: PMC10814482 DOI: 10.3390/diagnostics14020136] [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: 11/13/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Heart failure (HF) has a global prevalence of 1-2%, and the incidence around the world is growing. The prevalence increases with age, from around 1% for those aged <55 years to >10% for those aged 70 years or over. Based on studies in hospitalized patients, about 50% of patients have heart failure with reduced ejection fraction (HFrEF), and 50% have heart failure with preserved ejection fraction (HFpEF). HF is associated with high morbidity and mortality, and HF-related hospitalizations are common, costly, and impact both quality of life and prognosis. More than 5-10% of patients deteriorate into advanced HF (AdHF) with worse outcomes, up to cardiogenic shock (CS) condition. Right heart catheterization (RHC) is essential to assess hemodynamics in the diagnosis and care of patients with HF. The aim of this article is to review the evidence on RHC in various clinical scenarios of patients with HF.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (L.S.); (I.F.); (D.S.C.); (D.F.); (R.P.); (C.S.); (C.M.); (L.D.S.); (G.E.)
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Dodoo SN, Kwapong YA, Agyemang-Sarpong A, Amoran E, Egolum UO, Ghasemzadeh N, Ramadan R, Henry G, Samady H. Comparative Healthcare Resource Utilization of Percutaneous Mechanical Circulatory Support Using Impella Versus Intra-aortic Balloon Pump Use for Patients With Acute Coronary Syndrome and Cardiogenic Shock Undergoing Percutaneous Coronary Interventions: Insights From National Inpatient Sample. Curr Probl Cardiol 2024; 49:102053. [PMID: 37640173 DOI: 10.1016/j.cpcardiol.2023.102053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
The use of percutaneous mechanical circulatory support (MCS) devices, including Impella and Intra-aortic balloon pump (IABP), in patients with cardiogenic shock has increased in recent times. We aimed to evaluate the impact of the choice of an MCS device on healthcare resource utilization. We queried the National Inpatient Sample registry between October 2016 and December 2018 to identify adults admitted for acute coronary syndrome-related cardiogenic shock and who received percutaneous coronary intervention (PCI). The study population was segregated into Impella and IABP groups using ICD 10 diagnosis codes. The primary endpoint was high healthcare resource utilization (HRU), while secondary outcomes included periprocedural complications. Propensity scoring matching was used to determine which patients in the Impella cohort had similar health to IABP patients. During the study period, 439,610 patients were admitted who received hemodynamic support using, Impella or IABP on account of acute coronary syndrome complicated by cardiogenic shock (CS). The median age (years) of the Impella cohort and IABP cohorts were similar (64.1 vs 65.1, P = 0.08). Gender distribution of the Impella CS patients was like IABP patients with female majorities in both groups, (71.9% vs 67.9%, P = 0.05). Impella CS patients had a higher representation of those with hypertension (P = 0.002), smoking (P = 0.040), obesity (P = 0.034), diabetes mellitus (P = 0.009), CHF (P = 0.030), COPD (P = 0.034), chronic liver disease (P = 0.028), and chronic kidney disease (P = 0.031). 1:1 Propensity score matching identified 2620 Impella patients' comparable severity index with the IABP patients. Patients with hemodynamic support using Impella had higher healthcare resource utilization, (HRU), the surrogate of length of stay (LOS) ≥7 or nonhome disposition at discharge, when compared with those with IABP (57.41% vs 42.76%, P < 0.0001). Impella CS patients had higher in-hospital mortality as compared to the IABP patients (55.45% vs 45.86%, P < 0.0001). Impella CS patients developed more periprocedural complications, including vascular injury (4.8% vs 1.4%, P < 0.0001), acute kidney injury (58.36% vs 41.64%, P < 0.0001), end-stage renal disease requiring dialysis (8.75% vs 1.25%, P = 0.002) when compared to the IABP patients. Among patients with ACS undergoing PCI and receiving MCS devices, those receiving Impella demonstrated higher healthcare resource utilization, higher LOS ≥7 days, and more nonhome disposition at discharge compared to patients receiving IABP. Further investigation is warranted to elucidate factors associated with these findings.
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Affiliation(s)
- Sheriff N Dodoo
- Georgia Heart Institute, Northeast Georgia Medical Center, Gainesville, GA.
| | - Yaa Adoma Kwapong
- Ciccarone Center for the Prevention of Cardiovascular Disease, School of Medicine, Johns Hopkins University, Lutherville, MD
| | | | - Emmanuel Amoran
- Georgia Heart Institute, Northeast Georgia Medical Center, Gainesville, GA
| | - Ugochukwu O Egolum
- Division of Cardiology, Advanced Heart Failure, and Transplantation, Georgia Heart Institute, Northeast Georgia Medical Center, Gainesville, GA
| | - Nima Ghasemzadeh
- Division of Cardiology, Interventional Cardiology, Georgia Heart Institute, Northeast Georgia Medical Center, Gainesville, GA
| | - Ronnie Ramadan
- Division of Cardiology, Interventional Cardiology, Georgia Heart Institute, Northeast Georgia Medical Center, Gainesville, GA
| | - Glen Henry
- Division of Cardiology, Interventional Cardiology, Georgia Heart Institute, Northeast Georgia Medical Center, Gainesville, GA
| | - Habib Samady
- Division of Cardiology, Interventional Cardiology, Georgia Heart Institute, Northeast Georgia Medical Center, Gainesville, GA
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Rusnak J, Schupp T, Weidner K, Ruka M, Egner-Walter S, Forner J, Bertsch T, Kittel M, Mashayekhi K, Tajti P, Ayoub M, Akin I, Behnes M. Outcome of Patients With Cardiogenic Shock and Previous Right Ventricular Impairment Represented by Decreased Tricuspid Annular Plane Systolic Excursion and Tricuspid Annular Plane Systolic Excursion to Pulmonary Artery Systolic Pressure Ratio. Am J Cardiol 2023; 207:431-440. [PMID: 37797550 DOI: 10.1016/j.amjcard.2023.08.118] [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: 02/10/2023] [Revised: 08/12/2023] [Accepted: 08/20/2023] [Indexed: 10/07/2023]
Abstract
This study investigates the prognostic impact of known decreased ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) and TAPSE in patients with cardiogenic shock (CS). In patients with pulmonary artery hypertension and in critically ill patients, decreased TAPSE and TAPSE/PASP ratio are known to be negative predictors. However, studies regarding the prognostic impact in patients with CS are limited. Consecutive patients with CS from June 2019 to May 2021 treated at a single center were included. Medical history including echocardiographic parameters such as TAPSE and PASP was documented for each patient. The primary endpoint was all-cause mortality at 30 days. Statistical analyses included univariable t test, Spearman's correlation, C-statistics, Kaplan-Meier analyses, and Cox proportional regression analyses. A total of 90 patients with CS and measurement of TAPSE and TAPSE/PASP ratio were included. TAPSE and TAPSE/PASP ratio measured several months before intensive care unit admission were both able to predict 30-day survival in CS patients, and were both lower in 30-day nonsurvivors. TAPSE/PASP ratio <0.4 mm/mmHg (log-rank p = 0.006) and TAPSE <18 mm (log-rank p = 0.004) were associated with increased risk of 30-day all-cause mortality. After multivariable adjustment, TAPSE/PASP ratio <0.4 mm/mmHg was not able to predict 30-day all-cause mortality, whereas TAPSE <18 mm was still significantly associated with the primary endpoint (hazard ratio 2.336, confidence interval 1.067 to 5.115, p = 0.034). In consecutive patients presenting with CS, compared to TAPSE alone, previously determined TAPSE/PASP ratio did not improve risk prediction for 30-day all-cause mortality.
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Affiliation(s)
- Jonas Rusnak
- Department of Cardiology, Angiology, Hemostaseology and Internal Intensive Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; European Center for Angioscience (ECAS) and German Centre for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
| | - Tobias Schupp
- Department of Cardiology, Angiology, Hemostaseology and Internal Intensive Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; European Center for Angioscience (ECAS) and German Centre for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Hemostaseology and Internal Intensive Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; European Center for Angioscience (ECAS) and German Centre for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Marinela Ruka
- Department of Cardiology, Angiology, Hemostaseology and Internal Intensive Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; European Center for Angioscience (ECAS) and German Centre for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Sascha Egner-Walter
- Department of Cardiology, Angiology, Hemostaseology and Internal Intensive Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; European Center for Angioscience (ECAS) and German Centre for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Hemostaseology and Internal Intensive Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; European Center for Angioscience (ECAS) and German Centre for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Maximilian Kittel
- Institute for Clinical Chemistry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, MEDICLIN Heart Centre Lahr, Lahr, Germany
| | - Péter Tajti
- Gottsegen György National Cardiovascular Center, Budapest, Hungary
| | - Mohamed Ayoub
- Division of Cardiology and Angiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Hemostaseology and Internal Intensive Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; European Center for Angioscience (ECAS) and German Centre for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Hemostaseology and Internal Intensive Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; European Center for Angioscience (ECAS) and German Centre for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
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18
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Arnold JH, Perl L, Assali A, Codner P, Greenberg G, Samara A, Porter A, Orvin K, Kornowski R, Vaknin Assa H. The Impact of Sex on Cardiogenic Shock Outcomes Following ST Elevation Myocardial Infarction. J Clin Med 2023; 12:6259. [PMID: 37834902 PMCID: PMC10573491 DOI: 10.3390/jcm12196259] [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: 08/20/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Cardiogenic shock (CS) remains the leading cause of ST elevation myocardial infarction (STEMI)-related mortality. Contemporary studies have shown no sex-related differences in mortality. METHODS STEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) were included based on a dedicated prospective STEMI database. We compared sex-specific differences in CS characteristics at baseline, during hospitalization, and in subsequent clinical outcomes. Endpoints included all-cause mortality and major adverse cardiac events (MACE). RESULTS Of 3202 consecutive STEMI patients, 210 (6.5%) had CS, of which 63 (30.0%) were women. Women were older than men (73.2 vs. 65.5% y, p < 0.01), and more had hypertension (68.3 vs. 52.8%, p = 0.019) and diabetes (38.7 vs. 24.8%, p = 0.047). Fewer were smokers (13.3 vs. 41.2%, p < 0.01), had previous PCI (9.1 vs. 22.3% p = 0.016), or required IABP (35.3 vs. 51.1% p = 0.027). Women had higher rates of mortality (53.2 vs. 35.3% in-hospital, p = 0.01; 61.3 vs. 41.9% at 1 month, p = 0.01; and 73.8 vs. 52.6% at 3 years, p = 0.05) and MACE (60.6 vs. 41.6% in-hospital, p = 0.032; 66.1 vs. 45.6% at 1 month, p = 0.007; and 62.9 vs. 80.3% at 3 years, p = 0.015). After multivariate adjustment, female sex remained an independent factor for death (HR-2.42 [95% CI 1.014-5.033], p = 0.042) and MACE (HR-1.91 [95% CI 1.217-3.031], p = 0.01). CONCLUSIONS CS complicating STEMI is associated with greater short- and long-term mortality and MACE in women. Sex-focused measures to improve diagnosis and treatment are mandatory for CS patients.
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Affiliation(s)
- Joshua H. Arnold
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Abid Assali
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
- Department of Cardiology, Meir Medical Center, Kfar-Saba 4428164, Israel
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Gabriel Greenberg
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Abid Samara
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Avital Porter
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Katia Orvin
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | - Hana Vaknin Assa
- Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel; (L.P.)
- School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
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19
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Fang D, Yu D, Xu J, Ma W, Zhong Y, Chen H. Effects of intra-aortic balloon pump on in-hospital outcomes and 1-year mortality in patients with acute myocardial infarction complicated by cardiogenic shock. BMC Cardiovasc Disord 2023; 23:425. [PMID: 37644466 PMCID: PMC10466728 DOI: 10.1186/s12872-023-03465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The role of intra-aortic balloon counterpulsation (IABP) in cardiogenic shock complicating acute myocardial infarction (AMI) is still a subject of intense debate. In this study, we aim to investigate the effect of IABP on the clinical outcomes of patients with AMI complicated by cardiogenic shock undergoing percutaneous coronary intervention (PCI). METHODS From the Medical Information Mart for Intensive Care (MIMIC)-IV 2.2, 6017 AMI patients were subtracted, and 250 patients with AMI complicated by cardiogenic shock undergoing PCI were analyzed. In-hospital outcomes (death, 24-hour urine volumes, length of ICU stays, and length of hospital stays) and 1-year mortality were compared between IABP and control during the hospital course and 12-month follow-up. RESULTS An IABP was implanted in 30.8% (77/250) of patients with infarct-related cardiogenic shock undergoing PCI. IABP patients had higher levels of Troponin T (3.94 [0.73-11.85] ng/ml vs. 1.99 [0.55-5.75] ng/ml, p-value = 0.02). IABP patients have a longer length of ICU and hospital stays (124 [63-212] hours vs. 83 [43-163] hours, p-value = 0.005; 250 [128-435] hours vs. 170 [86-294] hours, p-value = 0.009). IABP use was not associated with lower in-hospital mortality (33.8% vs. 33.0%, p-value = 0.90) and increased 24-hour urine volumes (2100 [1455-3208] ml vs. 1915 [1110-2815] ml, p-value = 0.25). In addition, 1-year mortality was not different between the IABP and the control group (48.1% vs. 48.0%; hazard ratio 1.04, 95% CI 0.70-1.54, p-value = 0.851). CONCLUSION IABP may be associated with longer ICU and hospital stays but not better short-and long-term clinical prognosis.
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Affiliation(s)
- Dingfeng Fang
- Shenzhen University Health Science Center, Shenzhen, 518060, China
- Department of Cardiology, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Dongdong Yu
- Department of Cardiology, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Jiabin Xu
- Department of Cardiology, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Wei Ma
- Department of Cardiology, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Yuxiang Zhong
- Department of Cardiology, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Haibo Chen
- Department of Cardiology, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China.
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20
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Zuin M, Pinto DS, Nguyen T, Chatzizisis YS, Pasquetto G, Daggubati R, Bilato C, Rigatelli G. Trends in Cardiogenic Shock-Related Mortality in Patients With Acute Myocardial Infarction in the United States, 1999 to 2019. Am J Cardiol 2023; 200:18-25. [PMID: 37271120 DOI: 10.1016/j.amjcard.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/28/2023] [Accepted: 05/16/2023] [Indexed: 06/06/2023]
Abstract
Data on mortality trends in patients with acute myocardial infarction (AMI) with cardiogenic shock (CS) are scant. This study aimed to assess the trends in CS-AMI-related mortality in United States (US) subjects over the latest 21 years. Mortality data of US subjects with AMI listed as the underlying cause of death and CS as contributing cause were obtained from the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiologic Research) dataset from January 1999 to December 2019. CS-AMI-related age-adjusted mortality rates (AAMRs) per 100,000 US population were stratified by gender, race and ethnicity, geographic areas, and urbanicity. Nationwide annual trends were assessed as annual percent change (APC) and average APC with relative 95% confidence intervals (CIs). Between 1999 and 2019, CS-AMI was listed as the underlying cause of death in 209,642 patients, (AAMR of 3.01 per 100,000 people [95% CI 2.99 to 3.02]). AAMR from CS-AMI remained stable from 1999 to 2007 (APC -0.2%, [95% CI -2.0 to 0.5], p = 0.22) and then significantly increased (APC 3.1% [95% CI 2.6 to 3.6], p <0.0001), especially in male patients. Starting in 2009, the AAMR increase was more pronounced in those <65 years, Black Americans, and residents of rural areas. The higher AAMRs were clustered in the South (average APC 4.5%, [95% CI 4.4 to 4.6]) of the country. In conclusion, CS-AMI-related mortality in US patients increased from 2009 to 2019. Targeted health policy measures are needed to address the rising burden of CS-AMI in US subjects.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; Department of Cardiology, West Vicenza Hospital, Arzignano, Italy.
| | - Duane S Pinto
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Thach Nguyen
- Cardiovascular Research, Methodist Hospital, Merrillville, Indiana; School of Medicine, Tan Tao University, Long An, Vietnam
| | - Yiannis S Chatzizisis
- Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | - Giampaolo Pasquetto
- Interventional Cardiology Unit, Department of Cardiology, AULSS 6 Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Ramesh Daggubati
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
| | - Gianluca Rigatelli
- Interventional Cardiology Unit, Department of Cardiology, AULSS 6 Ospedali Riuniti Padova Sud, Monselice, Italy
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21
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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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22
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Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Heart Lung Transplant 2023; 42:e1-e64. [PMID: 36805198 DOI: 10.1016/j.healun.2022.10.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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23
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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.
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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
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24
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Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Card Fail 2023; 29:304-374. [PMID: 36754750 DOI: 10.1016/j.cardfail.2022.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Clinical characteristics and evolution of patients with cardiogenic shock in Argentina in the context of an acute myocardial infarction with ST segment elevation. Data from the nationwide ARGEN-IAM-ST Registry. Curr Probl Cardiol 2023; 48:101468. [PMID: 36261099 DOI: 10.1016/j.cpcardiol.2022.101468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023]
Abstract
Cardiogenic Shock is one of the main causes of death in ST segment Elevation Myocardial Infarction. To know the clinical characteristics, in-hospital evolution and mortality of patients with Cardiogenic Shock. Patients enrolled in the ARGEN-IAM-ST Registry were analyzed. Predictors of Cardiogenic Shock and death during hospital stay were established. A total of 6122 patients were admitted between 2015 and 2022. Cardiogenic Shock was present in 10.75% of cases. Patients with CS were older (64.5 vs 60 years), more females (41% vs 36%), with more antecedents of infarction and a higher prevalence of anterior location of infarction and multivessel disease. They were also less revascularized (88.5% vs 91.5%) and had a higher incidence of failed angioplasty (15.7% vs 2.7%). They also evidenced a higher occurrence of mechanical complications (6.8% vs 0.4%), ischemic recurrence (7.4% vs 3.4%) and cardiac arrest on admission (44.8% vs 2.6%). All the differences described showed statistical significance with P < 0.05. Overall mortality was 58% in contrast to 2.77% in patients without Cardiogenic Shock (P < 0.001). Only age, DBT, and early cardiac arrest were independent predictors of shock on admission whereas age, female gender, cardiac arrest on admission and failed angioplasty were independent predictors of death. One out of 10 patients with ST Elevation Myocardial Infarction presented cardiogenic shock. Its clinical characteristics were similar to those described more than 20 years ago. Despite a high use of reperfusion strategy cardiogenic shock continues to have a very high mortality Argentina.
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Saleiro C, de Campos D, Ribeiro JM, Lopes J, Puga L, Sousa JP, Gomes ARM, Siserman A, Lourenço C, Gonçalves L. Glycoprotein IIb/IIIa inhibitor use in cardiogenic shock complicating myocardial infarction: The Portuguese Registry of Acute Coronary Syndromes. Rev Port Cardiol 2023; 42:113-120. [PMID: 36163139 DOI: 10.1016/j.repc.2021.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/23/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Cardiogenic shock (CS) complicates 5-10% of cases of myocardial infarction (MI). Whether glycoprotein IIb/IIIa inhibitors (GPIs) are beneficial in these patients is controversial. Our aim is to assess the prognostic impact of GPI use on in-hospital mortality and outcomes in patients with MI and CS undergoing percutaneous coronary intervention (PCI). METHODS Between October 2010 and December 2019, 27578 acute coronary syndrome (ACS) patients were included in the multicenter Portuguese Registry of Acute Coronary Syndromes. Of these, 357 with an MI complicated by CS were included in the analysis and grouped based on whether they received GPI therapy (with GPI, n=107 and without GPI, n=250). The primary endpoint was in-hospital mortality. Secondary endpoints included successful PCI and in-hospital reinfarction and major bleeding. RESULTS Demographics and cardiovascular risk factors did not differ between groups. ST-elevation MI patients were more likely to receive GPIs (95% vs. 83%, p=0.002). In-hospital mortality was similar between groups (OR 1.80, 95% CI 0.96-3.37). Only age and the use of inotropes or intra-aortic balloon pump were predictors of mortality. Also, no differences between groups were noted for successful PCI (OR 0.33, 95% CI 0.62-4.06), reinfarction (OR 0.77, 95% CI 0.15-3.90), or major bleeding (OR 1.68, 95% CI 0.75-3.74). CONCLUSION The use of GPIs in the context of MI with CS did not significantly impact in-hospital outcomes.
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Affiliation(s)
- Carolina Saleiro
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Diana de Campos
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joana M Ribeiro
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - João Lopes
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Luís Puga
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José P Sousa
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Rita M Gomes
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Alexandrina Siserman
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carolina Lourenço
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal; Coimbra Institute for Biomedical Research (ICBR), Coimbra, Portugal
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Sandhyavenu H, Ullah W, Badu I, Taha A, Polam AR, Mir T, Brailovsky Y, Rajapreyar IN, Vallabhajosyula S, Alraies MC. Trends and outcomes of cardiogenic shock in Asian populations compared with non-Asian populations in the US: NIS Analysis (2002-2019). Expert Rev Cardiovasc Ther 2023; 21:67-74. [PMID: 36597921 DOI: 10.1080/14779072.2023.2162040] [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] [Indexed: 01/05/2023]
Abstract
BACKGROUND Current understanding of outcomes of cardiogenic shock (CS) in Asian populations is limited. We aim to study the clinical outcomes of CS in Asian population compared with non-Asians in the US. METHODS The National Inpatient Sample (NIS) database was queried between 2002-2019 to identify hospitalizations with CS. Race was classified as Asians and non-Asians. The adjusted odds ratios (aOR) for in-hospital outcomes were calculated using multivariate logistic regression analysis. RESULTS Results Of 1,573,285 CS hospitalizations, 48,398 (3%) were Asians and 1,524,887 (97%) were non-Asians between 2002-2019. Adjusted odds of in-hospital mortality (aOR 1.03, 95% CI 1.01-1.05), and use of intra-aortic balloon pump (IABP) (aOR 1.15, 95% CI 1.12-1.17) were significantly higher among Asians compared with non-Asians. The in-hospital mean cost of hospitalization was higher in Asian population ($63,787±$80,261) with CS compared with non-Asians ($56,207±$76,120, p < 0.001). The use of Impella (aOR 0.90, 95% CI 0.86-0.95) and left ventricular assist devices (LVAD) (aOR 0.71, 95% CI 0.65-0.77) were lower with no difference in the use of extracorporeal membrane oxygenation (ECMO) compared with non-Asians. CONCLUSION Asian populations with CS have higher in-hospital mortality, increased requirement of IABP and higher mean cost of hospitalization compared with non-Asians.
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Affiliation(s)
| | - Waqas Ullah
- Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Irisha Badu
- Internal Medicine, Onslow Memorial Hospital, Jacksonville, NC, USA
| | - Amro Taha
- Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | | | - Tanveer Mir
- Internal Medicine, Wayne State University, Detroit, MI, USA
| | | | | | | | - M Chadi Alraies
- Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, USA
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Impact of shock aetiology and hospital characteristics on the clinical profile, management and prognosis of patients with non ACS-related cardiogenic shock. Hellenic J Cardiol 2023; 69:16-23. [PMID: 36334704 DOI: 10.1016/j.hjc.2022.11.001] [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: 07/02/2022] [Revised: 09/08/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND A significant proportion of cases of cardiogenic shock (CS) are due aetiologies other than acute coronary syndromes (non ACS-CS). We assessed differences regarding clinical profile, management, and prognosis according to the cause of CS among nonselected patients with CS from a large nationwide database. METHODS We performed an observational study including patients admitted from the hospitals of the Spanish National Health System (SNHS) with a principal or secondary diagnosis code of CS (2016-2019). Data were obtained from the Minimum Basic Data Set (MBDS). Hospitals were classified according to the availability of cardiology related resources, as well as the availability of Intensive Cardiac Care Unit (ICCU). RESULTS A total of 10,826 episodes of CS were included, of whom 5,495 (50.8%) were non-ACS related. Non ACS-CS patients were younger (71.5 vs. 72.4 years) and had a lower burden of arteriosclerosis-related comorbidities. Non ACS-CS cases underwent less often invasive procedures and presented lower in-hospital mortality (57.1% vs. 61%,p < 0.001). The most common main diagnosis among non ACS-CS was acute decompensation of chronic heart failure (ADCHF) (35.4%). A lower risk-adjusted in-hospital mortality rate was observed in high volume hospitals (52.6% vs. 56.7%; p < 0.001), as well as in centers with ICCU (OR: 0.71; CI 95%: 0.58-0.87; p < 0.001). CONCLUSIONS More than a half of cases of CS were due to non-ACS causes. Non ACS-CS cases are a very heterogeneous group, with different clinical profile and management. Management at high-volume hospitals and availability of ICCU were associated with lower risk adjusted mortality among non ACS-CS patients.
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Fichera CF, Fürnau G. [Mechanical Assist Devices in Cardiogenic Shock Complicating Myocardial Infarction]. Dtsch Med Wochenschr 2022; 147:1182-1187. [PMID: 36070735 DOI: 10.1055/a-1726-1252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In acute myocardial infarction cardiogenic shock is still one of the most feared complications. Although medical and interventional treatment of myocardial infarction improved significantly over the last decades mortality of cardiogenic shock patients remains on unacceptable high levels with 30-day mortality rates of 40-50 %. To date only an early revascularization of the culprit infarct lesion is the only intervention with proven survival benefit for patients. Active mechanical assist devices were introduced more than two decades ago to support left ventricular function as addition to medical treatment with inotropes and vasopressors. Yet, to date only insufficient date exists for these devices in cardiogenic shock patients and therefore no general recommendation can be given. This viewpoint gives an overview about the most used devices. The different mechanism of left ventricular support will be explained, and the current evidence discussed. Furthermore, ongoing randomized controlled trials are highlighted.
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Gauthier V, Montaye M, Ferrières J, Kai SHY, Biasch K, Moitry M, Amouyel P, Dallongeville J, Meirhaeghe A. Sex differences in time trends in acute coronary syndrome management and in 12-month lethality: Data from the French MONICA registries. Int J Cardiol 2022; 361:103-108. [PMID: 35597493 DOI: 10.1016/j.ijcard.2022.05.040] [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] [Received: 09/30/2021] [Revised: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Sex differences in clinical presentation, patient care and fatal outcomes after an acute coronary syndrome (ACS) have been reported. However, recent improvements in the care and treatment of ACSs have not been assessed with regard to possible sex differences. AIM To assess sex differences in trends between 2006 and 2016 in the characteristics of ACSs, their management, and the associated mortality. METHODS We assessed all men and women (aged 35-74) covered by the MONICA registries in north, east and south-west France and having been hospitalized for an incident (first) ACS during a 12-month period in 2006 or a 6-month period in 2016. We analyzed the patients' clinical, biochemical, electrocardiographic and care-related data, and their vital status 28 days and 12 months after the ACS. RESULTS In 2006, women were older (<0.0001) and had more atypical symptoms than men (p < 0.01). These differences were no longer statistically significant in 2016. Medical care improved in both men and women. However, revascularization treatment, prescriptions of platelet aggregation inhibitors, statins, and functional rehabilitation were still more frequently provided to men than to women (p < 0.01) in 2016, independently of confounders. The 28-day or 12-month case fatality was not different between men and women in both 2006 and 2016. CONCLUSIONS The results of the present study evidenced an improvement over time in the management of ACS. However, although there were no longer sex differences in the patients' age and clinical presentation, women with ACS were still less likely than men to receive revascularization and pharmacological treatments in 2016.
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Affiliation(s)
- Victoria Gauthier
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Michèle Montaye
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Jean Ferrières
- Department of Cardiology, Toulouse Rangueil University Hospital, Toulouse, France.; CERPOP, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Samantha Huo Yung Kai
- CERPOP, Université de Toulouse, INSERM, UPS, Toulouse, France.; Department of Epidemiology, Toulouse University Hospital, Toulouse, France
| | - Katia Biasch
- Department of Epidemiology and Public Health, University of Strasbourg, Strasbourg, France
| | - Marie Moitry
- Department of Epidemiology and Public Health, University of Strasbourg, Strasbourg, France.; Department of Public Health, University Hospital of Strasbourg, Strasbourg, France
| | - Philippe Amouyel
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Jean Dallongeville
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Aline Meirhaeghe
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France..
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Batchelor RJ, Wheelahan A, Zheng WC, Stub D, Yang Y, Chan W. Impella versus Venoarterial Extracorporeal Membrane Oxygenation for Acute Myocardial Infarction Cardiogenic Shock: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11143955. [PMID: 35887718 PMCID: PMC9317942 DOI: 10.3390/jcm11143955] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 01/09/2023] Open
Abstract
Objectives: Despite an increase in the use of mechanical circulatory support (MCS) devices for acute myocardial infarction cardiogenic shock (AMI-CS), there is currently no randomised data directly comparing the use of Impella and veno-arterial extra-corporeal membrane oxygenation (VA-ECMO). Methods: Electronic databases of MEDLINE, EMBASE and CENTRAL were systematically searched in November 2021. Studies directly comparing the use of Impella (CP, 2.5 or 5.0) with VA-ECMO for AMI-CS were included. Studies examining other modalities of MCS, or other causes of cardiogenic shock, were excluded. The primary outcome was in-hospital mortality. Results: No randomised trials comparing VA-ECMO to Impella in patients with AMI-CS were identified. Six cohort studies (five retrospective and one prospective) were included for systematic review. All studies, including 7093 patients, were included in meta-analysis. Five studies reported in-hospital mortality, which, when pooled, was 42.4% in the Impella group versus 50.1% in the VA-ECMO group. Impella support for AMI-CS was associated with an 11% relative risk reduction in in-hospital mortality compared to VA-ECMO (risk ratio 0.89; 95% CI 0.83–0.96, I2 0%). Of the six studies, three studies also adjusted outcome measures via propensity-score matching with reported reductions in in-hospital mortality with Impella compared to VA-ECMO (risk ratio 0.72; 95% CI 0.59–0.86, I2 35%). Pooled analysis of five studies with 6- or 12-month mortality data reported a 14% risk reduction with Impella over the medium-to-long-term (risk ratio 0.86; 95% CI 0.76–0.97, I2 0%). Conclusions: There is no high-level evidence comparing VA-ECMO and Impella in AMI-CS. In available observation studies, MCS with Impella was associated with a reduced risk of in-hospital and medium-term mortality as compared to VA-ECMO.
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Affiliation(s)
- Riley J. Batchelor
- Department of Cardiology, The Alfred Hospital, 55 Commercial Road, Melbourne 3004, Australia; (R.J.B.); (W.C.Z.); (D.S.)
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne 3004, Australia
| | - Andrew Wheelahan
- Department of Cardiology, Western Health, Melbourne 3004, Australia;
| | - Wayne C. Zheng
- Department of Cardiology, The Alfred Hospital, 55 Commercial Road, Melbourne 3004, Australia; (R.J.B.); (W.C.Z.); (D.S.)
| | - Dion Stub
- Department of Cardiology, The Alfred Hospital, 55 Commercial Road, Melbourne 3004, Australia; (R.J.B.); (W.C.Z.); (D.S.)
- Department of Cardiology, Western Health, Melbourne 3004, Australia;
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Yang Yang
- Intensive Care Unit, Western Health, Melbourne 3004, Australia;
| | - William Chan
- Department of Cardiology, The Alfred Hospital, 55 Commercial Road, Melbourne 3004, Australia; (R.J.B.); (W.C.Z.); (D.S.)
- Department of Cardiology, Western Health, Melbourne 3004, Australia;
- Department of Medicine, University of Melbourne, Melbourne 3052, Australia
- Correspondence: ; Tel.: +61-3-9076-3263
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Zeymer U, Ludman P, Danchin N, Kala P, Laroche C, Gale CP, Maggioni AP, Siabani S, Sadeghi M, Wafa A, Bartus S, Weidinger F. Reperfusion therapy for ST-elevation myocardial infarction complicated by cardiogenic shock: the European Society of Cardiology EurObservational programme acute cardiovascular care-European association of PCI ST-elevation myocardial infarction registry. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:481-490. [PMID: 35593654 DOI: 10.1093/ehjacc/zuac049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
AIMS To determine the current state of the use of reperfusion and adjunctive therapies and in-hospital outcomes in European Society of Cardiology (ESC) member and affiliated countries for patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). METHODS AND RESULTS ESC EurObservational Research Programme prospective international cohort study of admissions with STEMI within 24 h of symptom onset (196 centres; 26 ESC member and 3 affiliated countries). Of 11 462 patients enrolled, 448 (3.9%) had CS. Patients with compared to patients without CS, less frequently received primary percutaneous coronary intervention (PCI) (65.5% vs. 72.2%) and fibrinolysis (15.9% vs. 19.0), and more often had no reperfusion therapy (19.0% vs. 8.5%). Mechanical support devices (intraaortic ballon pump 11.2%, extracoporeal membrane oxygenation 0.7%, other 1.1%) were used infrequently in CS. Bleeding definition academic research consortium 2-5 bleeding complications (10.1% vs. 3.0%, P < 0.01) and stroke (4.2% vs. 0.9%, P < 0.01) occurred more frequently in patients with CS. In-hospital mortality was 10-fold higher (35.5% vs. 3.1%) in patients with CS. Mortality in patients with CS in the groups with PCI, fibrinolysis, and no reperfusion therapy were 27.4%, 36.6%, and 62.4%, respectively. CONCLUSION In this multi-national registry, patients with STEMI complicated by CS less frequently receive reperfusion therapy than patients with STEMI without CS. Early mortality in patients with CS not treated with primary PCI is very high. Therefore, strategies to improve clinical outcome in STEMI with CS are needed.
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Affiliation(s)
- Uwe Zeymer
- Klinikum der Stadt Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Nicolas Danchin
- Hôpital Européen G. Pompidou, Service de Cardiologie, Paris, France
| | - Petr Kala
- Internal Cardiology Department, Faculty of Medicine of Masaryk University, University Hospital Brno, Brno, Czech Republic
| | - Cécile Laroche
- EURObservational Research Program, European Society of Cardiology, Sophia-Antipolis, France
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Aldo P Maggioni
- EURObservational Research Program, European Society of Cardiology, Sophia-Antipolis, France
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Soraya Siabani
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmed Wafa
- Mansoura Faculty of Medicine, Cardiology department, Mansoura, Egypt
| | - Stanislaw Bartus
- Department of Cardiology, Jagiellonian University, Krakow, Poland
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Mierke J, Nowack T, Loehn T, Kluge F, Poege F, Speiser U, Woitek F, Mangner N, Ibrahim K, Linke A, Pfluecke C. Predictive value of the APACHE II score in cardiogenic shock patients treated with a percutaneous left ventricular assist device. IJC HEART & VASCULATURE 2022; 40:101013. [PMID: 35372664 PMCID: PMC8971639 DOI: 10.1016/j.ijcha.2022.101013] [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] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 12/11/2022]
Abstract
Background The APACHE II score assesses patient prognosis in intensive care units. Different disease entities are predictable by using a specific factor called Diagnostic Category Weight (DCW). We aimed to validate the prognostic value of the APACHE II score in patients treated with a percutaneous left ventricular assist device because of refractory cardiogenic shock (CS). Methods From the Dresden Impella Registry, we analyzed 180 patients receiving an Impella CP®. The main outcome was the observed intrahospital mortality (S ^ ( t h o s p ) ), which was compared to the predicted mortality estimated by the APACHE II score. Results The APACHE II score, which was 33.5 ± 0.6, significantly overestimated intrahospital mortality (S ^ ( t h o s p ) 54.4 ± 3.7% vs. APACHE II 74.6 ± 1.6%; p < 0.001). Nevertheless, the APACHE II score showed an acceptable accuracy to predict intrahospital mortality (ROC AUC 0.70; 95% CI 0.62-0.78). Thus, we adapted the formula for calculation of predicted mortality by adjusting DCW. The total registry cohort was randomly divided into derivation group for calculation of adjusted DCW and validation group for testing. Intrahospital mortality was much more precisely predicted using the adjusted DCW compared to the conventional DCW (difference of predicted and observed mortality: -4.7 ± 2.4% vs. -23.2 ± 2.3%; p < 0.001). The new calculated DCW was -1.183 for the total cohort. Conclusion The APACHE II score has an acceptable accuracy for the prediction of intrahospital mortality but overestimates its total amount in CS patients. Adjustment of the DCW can lead to a much more precise prediction of prognosis.
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Affiliation(s)
- Johannes Mierke
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Germany
| | - Thomas Nowack
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Germany
| | - Tobias Loehn
- Kreiskrankenhaus Freiberg, Klinik für Innere Medizin II, Freiberg, Germany
| | - Franziska Kluge
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Germany
| | - Frederike Poege
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Germany
| | - Uwe Speiser
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Germany
| | - Felix Woitek
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Germany
| | - Norman Mangner
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Germany
| | - Karim Ibrahim
- Klinikum Chemnitz, Klinik für Innere Medizin I, Chemnitz, Germany
| | - Axel Linke
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Germany
| | - Christian Pfluecke
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Germany
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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: 1.7] [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.
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Bertaina M, Galluzzo A, Morici N, Sacco A, Oliva F, Valente S, D’Ascenzo F, Frea S, Sbarra P, Petitti E, Brach Prever S, Boccuzzi G, Zanini P, Attisani M, Rametta F, De Ferrari GM, Noussan P, Iannaccone M. Pulmonary Artery Catheter Monitoring in Patients with Cardiogenic Shock: Time for a Reappraisal? Card Fail Rev 2022; 8:e15. [PMID: 35541286 PMCID: PMC9069264 DOI: 10.15420/cfr.2021.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/19/2022] [Indexed: 12/20/2022] Open
Abstract
Cardiogenic shock represents one of the most dramatic scenarios to deal with in intensive cardiology care and is burdened by substantial short-term mortality. An integrated approach, including timely diagnosis and phenotyping, along with a well-established shock team and management protocol, may improve survival. The use of the Swan-Ganz catheter could play a pivotal role in various phases of cardiogenic shock management, encompassing diagnosis and haemodynamic characterisation to treatment selection, titration and weaning. Moreover, it is essential in the evaluation of patients who might be candidates for long-term heart-replacement strategies. This review provides a historical background on the use of the Swan-Ganz catheter in the intensive care unit and an analysis of the available evidence in terms of potential prognostic implications in this setting.
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Affiliation(s)
- Maurizio Bertaina
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, 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
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Simone Frea
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Pierluigi Sbarra
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Elisabetta Petitti
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Silvia Brach Prever
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Giacomo Boccuzzi
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Paola Zanini
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Matteo Attisani
- Department of Cardiac Surgery, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | | | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Patrizia Noussan
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Mario Iannaccone
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
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Mihatov N, Mosarla RC, Kirtane AJ, Parikh SA, Rosenfield K, Chen S, Song Y, Yeh RW, Secemsky EA. Outcomes Associated With Peripheral Artery Disease in Myocardial Infarction With Cardiogenic Shock. J Am Coll Cardiol 2022; 79:1223-1235. [PMID: 35361344 PMCID: PMC9172933 DOI: 10.1016/j.jacc.2022.01.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/11/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mortality rates for patients presenting with acute myocardial infarction (AMI) and cardiogenic shock (CS) remain high despite advances in revascularization strategies and mechanical circulatory support (MCS) devices. OBJECTIVES This study sought to elucidate the association between comorbid lower extremity peripheral artery disease (PAD) and outcomes in CS and AMI. METHODS PAD status was defined in Medicare beneficiaries hospitalized with CS and AMI from October 1, 2015 to June 30, 2018. Primary outcomes ascertained through December 31, 2018 included in- and out-of-hospital mortality. Secondary outcomes included bleeding, amputation, stroke, and lower extremity revascularization. Multivariable regression models with adjustment for confounders were used to estimate risk. Subgroup analyses included patients treated with MCS and those who underwent coronary revascularization. RESULTS Among 71,690 patients, 5.9% (N = 4,259) had PAD. Mean age was 77.8 ± 7.9 years, 58.7% were male, and 84.3% were White. Cumulative in-hospital mortality was 47.2%, with greater risk among those with PAD (56.3% vs 46.6% without PAD; adjusted OR: 1.50; 95% CI: 1.40-1.59). PAD patients also had greater risk of in-hospital amputation (1.6% vs 0.2%; adjusted OR: 7.0; 95% CI: 5.26-9.37) and out-of-hospital mortality (67.9% vs 40.7%; adjusted HR: 1.78; 95% CI: 1.67-1.90). MCS was less frequently utilized in PAD patients (21.5% vs 38.6% without PAD; P < 0.001) and was associated with higher mortality, need for lower extremity revascularization, and amputation risk. Findings were consistent in patients who underwent coronary revascularization. CONCLUSIONS Among patients presenting with AMI and CS, PAD was associated with worse limb outcomes and survival. In addition to lower MCS utilization rates, those with PAD who received MCS had increased mortality, lower extremity revascularization, and amputation rates.
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Affiliation(s)
- Nino Mihatov
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ramya C Mosarla
- Division of Cardiology, New York University Langone Health & Grossman School of Medicine, New York, New York, USA
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Sahil A Parikh
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Kenneth Rosenfield
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Siyan Chen
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Yang Song
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
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Abstract
PURPOSE OF REVIEW Despite novel technologies for treating shock patients, cardiogenic shock mortality remains high. Trends of cardiogenic shock associated with acute myocardial infarction (AMI) have previously been described, though little is known about cardiogenic shock resulting from other causes, which has progressively been documented as a distinct entity from AMI-cardiogenic shock. Herein, we review the evolving epidemiology, novel classification schema, and future perspectives of cardiogenic shock. RECENT FINDINGS While AMI or mechanical complications of AMI are the most common causes, the incidence of etiologies of cardiogenic shock not related to AMI, particularly acute on chronic heart failure, may be increasing, with a growing burden of noncoronary structural heart disease. SUMMARY Mortality in cardiogenic shock remains high. Overall, these findings highlight the need to address the lack of effective treatments in this field, particularly for cardiogenic shock caused by diseases other than AMI. Novel classification systems may facilitate cardiogenic shock research.
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Challenges in the conduct of randomised controlled trials in cardiogenic shock complicating acute myocardial infarction. J Geriatr Cardiol 2022; 19:125-129. [PMID: 35317398 PMCID: PMC8915423 DOI: 10.11909/j.issn.1671-5411.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiogenic shock (CS) following acute myocardial infarction (AMI) is a major challenge in cardiovascular care. Mortality remains high with 40%-50% after thirty days. Randomised controlled trials (RCTs) play a key role to generate evidence on optimal care in this field. However, the number of completed or ongoing RCTs is still relatively low compared to the gaps in evidence. Challenges in the conduct of these trials are in particular the selection of patients and ethical issues in the informed consent process. When determining eligibility criteria, special attention should be paid to the severity of CS, to the inclusion of patients with cardiac arrest and to potential age limits. Median age of AMI-CS patients is increasing. Age limits are therefore controversial as it is important to include elderly patients in RCTs in order to make the results generalisable and to address the special needs of this group. As patients with AMI-CS are in most cases unable to provide informed consent themselves, a step-wise approach with acute consent by a legal representative or independent physicians and later informed consent by the patient if possible might be established depending on regularities of the respective ethical review board and country legislation. Multicenter studies should be sought to generate adequate power.
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Vallabhajosyula S, Bhopalwala HM, Sundaragiri PR, Dewaswala N, Cheungpasitporn W, Doshi R, Prasad A, Sandhu GS, Jaffe AS, Bell MR, Holmes DR. Cardiogenic shock complicating non-ST-segment elevation myocardial infarction: An 18-year study. Am Heart J 2022; 244:54-65. [PMID: 34774802 DOI: 10.1016/j.ahj.2021.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/05/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the epidemiology and outcomes of non-ST-segment-elevation myocardial infarction-cardiogenic shock (NSTEMI-CS) in the United States. METHODS Adult (>18 years) NSTEMI-CS admissions were identified using the National Inpatient Sample (2000-2017) and classified by tertiles of admission year (2000-2005, 2006-2011 and 2012-2017). Outcomes of interest included temporal trends of prevalence and in-hospital mortality, use of cardiac procedures, in-hospital mortality, hospitalization costs, and length of stay. RESULTS In over 7.3 million NSTEMI admissions, CS was noted in 189,155 (2.6%). NSTEMI-CS increased from 1.5% in 2000 to 3.6% in 2017 (adjusted odds ratio 2.03 [95% confidence interval 1.97-2.09]; P < .001). Rates of non-cardiac organ failure and cardiac arrest increased during the study period. Between 2000 and 2017, coronary angiography (43.9%-63.9%), early coronary angiography (13.6%-25.6%), percutaneous coronary intervention (14.8%-31.6%), and coronary artery bypass grafting use (19.0%-25.8%) increased (P < .001). Over the study period, the use of intra-aortic balloon pump remained stable (28.6%-28.8%), and both percutaneous left ventricular assist devices (0%-9.1%) and extra-corporeal membrane oxygenation (0.1%-1.6%) increased (all P < .001). In hospital mortality decreased from 50.2% in 2000 to 32.3% in 2017 (adjusted odds ratio 0.27 [95% confidence interval 0.25-0.29]; P < .001). During the 18-year period, hospital lengths of stay decreased, and hospitalization costs increased. CONCLUSIONS In the United States, prevalence of CS in NSTEMI has increased 2-fold between 2000 and 2017, while in-hospital mortality has decreased during the study period. Use of coronary angiography and percutaneous coronary intervention increased during the study period.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
| | | | - Pranathi R Sundaragiri
- Department of Primary Care Internal Medicine, Wake Forest Baptist Health, High Point, NC
| | - Nakeya Dewaswala
- Division of Cardiovascular Medicine, Department of Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Rajkumar Doshi
- Division of Cardiovascular Medicine, Department of Medicine, Saint Joseph University Medical Center, Paterson, NJ
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Allan S Jaffe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Delmas C, Roubille F, Lamblin N, Bonello L, Leurent G, Levy B, Elbaz M, Danchin N, Champion S, Lim P, Schneider F, Cariou A, Khachab H, Bourenne J, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Quentin C, Delabranche X, Aissaoui N, Combaret N, Manzo-Silberman S, Tomasevic D, Marchandot B, Lattuca B, Henry P, Gerbaud E, Bonnefoy E, Puymirat E. Baseline characteristics, management, and predictors of early mortality in cardiogenic shock: insights from the FRENSHOCK registry. ESC Heart Fail 2021; 9:408-419. [PMID: 34973047 PMCID: PMC8788015 DOI: 10.1002/ehf2.13734] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/15/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022] Open
Abstract
Aims Published data on cardiogenic shock (CS) are scarce and are mostly focused on small registries of selected populations. The aim of this study was to examine the current CS picture and define the independent correlates of 30 day mortality in a large non‐selected cohort. Methods and results FRENSHOCK is a prospective multicentre observational survey conducted in metropolitan French intensive care units and intensive cardiac care units between April and October 2016. There were 772 patients enrolled (mean age 65.7 ± 14.9 years; 71.5% male). Of these patients, 280 (36.3%) had ischaemic CS. Organ replacement therapies (respiratory support, circulatory support or renal replacement therapy) were used in 58.3% of patients. Mortality at 30 days was 26.0% in the overall population (16.7% to 48.0% depending on the main cause and first place of admission). Multivariate analysis showed that six independent factors were associated with a higher 30 day mortality: age [per year, odds ratio (OR) 1.06, 95% confidence interval (CI): 1.04–1.08], diuretics (OR 1.74, 95% CI: 1.05–2.88), circulatory support (OR 1.92, 95% CI: 1.12–3.29), left ventricular ejection fraction <30% (OR 2.15, 95% CI: 1.40–3.29), norepinephrine (OR 2.55, 95% CI: 1.69–3.84), and renal replacement therapy (OR 2.72, 95% CI: 1.65–4‐49). Conclusions Non‐ischaemic CS accounted for more than 60% of all cases of CS. CS is still associated with significant but variable short‐term mortality according to the cause and first place of admission, despite frequent use of haemodynamic support, and organ replacement therapies.
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Affiliation(s)
- Clement 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, Toulouse, 31059, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, Montpellier, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Laurent Bonello
- Aix-Marseille Université; Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, Rennes, France
| | - Bruno Levy
- Réanimation Médicale Brabois, CHRU Nancy, Nancy, France
| | - Meyer Elbaz
- 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, Toulouse, 31059, France
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris, Paris, France
| | | | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB; AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Medical School, Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Aix-en-Provence, France
| | - Jeremy Bourenne
- Aix Marseille Université, Service de Réanimation des Urgences, CHU La Timone 2, Marseille, France
| | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France, University of Lyon, CREATIS UMR5220; INSERM U1044; INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, Grenoble, France
| | - Charlotte Quentin
- Service de Reanimation Polyvalente, Centre Hospitalier Broussais St Malo, Saint-Malo, France
| | - Xavier Delabranche
- Réanimation Chirurgicale Polyvalente, Pôle Anesthésie-Réanimation chirurgicale-Médecine Péri-opératoire, Les Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil 1, Porte de l'Hôpital, Strasbourg, France
| | - Nadia Aissaoui
- Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | | | - Danka Tomasevic
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Patrick Henry
- Department of Cardiology, Université de Paris, Hôpital Lariboisière, AP-HP, Paris, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Pessac, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris, Paris, France
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Hemodynamic Effects of Left-Atrial Venous Arterial Extra-Corporeal Membrane Oxygenation (LAVA-ECMO). ASAIO J 2021; 68:e148-e151. [PMID: 34967778 DOI: 10.1097/mat.0000000000001628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We report a case of a 59-year-old male in post-myocardial infarction cardiogenic shock undergoing left atrial venous arterial extracorporeal membrane oxygenation (LAVA-ECMO) as a bridge to transplantation. The unique feature of this ECMO configuration is use of a single trans-septal cannula to provide biventricular unloading and use of a single arterial access.
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Cardiogenic Shock Among Patients with and without Acute Myocardial Infarction in a Latin American Country: A Single-Institution Study. Glob Heart 2021; 16:78. [PMID: 34900569 PMCID: PMC8641529 DOI: 10.5334/gh.988] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Latin America has limited information about the full spectrum cardiogenic shock (CS) and its hospital outcome. This study sought to examine the temporal trends, clinical features and outcomes of patients with CS in a coronary care unit of single Mexican institution. Methods: This was a retrospective study of consecutive patients hospitalized with CS in a Mexican teaching hospital between 2006–2019. Patients were classified according to the presence or absence of acute myocardial infarction (AMI). Results: Of 22,747 admissions, 833 (3.7%) exhibited CS. Among patients with AMI (n = 12,438), 5% had AMI–CS, and in patients without AMI (n = 10,309), 2.3% developed CS (non-AMI–CS). Their median age was 63 years and 70.5% were men. Cardiovascular risk factors were more frequent among the AMI–CS group, whereas a history of heart failure was greater in non-AMI–CS patients (70.1%). In AMI-CS patients, the median delay time was 17.2 hours from the onset of AMI symptoms to hospital admission. Overall, the median left ventricular ejection fraction (LVEF) was 30%. Patients with CS at admission showed end-organ dysfunction, evidenced by lactic acidosis, renal impairment, and elevated liver transaminases. Of the 620 AMI–CS patients, the main cause was left ventricular dysfunction in 71.3%, mechanical complications in 15.2% and right ventricular infarction in 13.5%. Among the 213 non-AMI–CS patients, valvular heart disease (49.3%) and cardiomyopathies (42.3%) were the most frequent etiologies. In-hospital all-cause mortality rates were 69.7% and 72.3% in the AMI–CS and non-AMI–CS groups, respectively. Among AMI–CS patients, renal dysfunction, diabetes, older age, depressed LVEF, absence of revascularization and the use of mechanical ventilation were independent predictors of in-hospital mortality. However, in the non-AMI–CS group, only low LVEF and high lactate levels proved significant. Conclusions: This study demonstrates differences in the epidemiology of CS compared to high-income countries; the high mortality reflects critically ill patients and the lack of contemporary effective therapies in the population studied.
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Freund A, Pöss J, de Waha-Thiele S, Meyer-Saraei R, Fuernau G, Eitel I, Feistritzer HJ, Rubini M, Huber K, Windecker S, Montalescot G, Oldroyd K, Noc M, Zeymer U, Ouarrak T, Schneider S, Baran DA, Desch S, Thiele H. Comparison of risk prediction models in infarct-related cardiogenic shock. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:890-897. [PMID: 34529043 DOI: 10.1093/ehjacc/zuab054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/25/2021] [Accepted: 06/22/2021] [Indexed: 11/12/2022]
Abstract
AIMS Several prediction models have been developed to allow accurate risk assessment and provide better treatment guidance in patients with infarct-related cardiogenic shock (CS). However, comparative data between these models are still scarce. The objective of the study is to externally validate different risk prediction models in infarct-related CS and compare their predictive value in the early clinical course. METHODS AND RESULTS The Simplified Acute Physiology Score (SAPS) II Score, the CardShock score, the IABP-SHOCK II score, and the Society for Cardiovascular Angiography and Intervention (SCAI) classification were each externally validated in a total of 1055 patients with infarct-related CS enrolled into the randomized CULPRIT-SHOCK trial or the corresponding registry. The primary outcome was 30-day all-cause mortality. Discriminative power was assessed by comparing the area under the curves (AUC) in case of continuous scores. In direct comparison of the continuous scores in a total of 161 patients, the IABP-SHOCK II score revealed best discrimination [area under the curve (AUC = 0.74)], followed by the CardShock score (AUC = 0.69) and the SAPS II score, giving only moderate discrimination (AUC = 0.63). All of the three scores revealed acceptable calibration by Hosmer-Lemeshow test. The SCAI classification as a categorical predictive model displayed good prognostic assessment for the highest risk group (Stage E) but showed poor discrimination between Stages C and D with respect to short-term-mortality. CONCLUSION Based on the present findings, the IABP-SHOCK II score appears to be the most suitable of the examined models for immediate risk prediction in infarct-related CS. Prospective evaluation of the models, further modification, or even development of new scores might be necessary to reach higher levels of discrimination.
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Affiliation(s)
- Anne Freund
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Strümpellstr. 39, D-04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Janine Pöss
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Strümpellstr. 39, D-04289 Leipzig, Germany
| | - Suzanne de Waha-Thiele
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Roza Meyer-Saraei
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Georg Fuernau
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Ingo Eitel
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Hans-Josef Feistritzer
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Strümpellstr. 39, D-04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Maria Rubini
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Strümpellstr. 39, D-04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Kurt Huber
- Department of Cardiology, Wilhelminenspital, and Sigmund Freud University, Medical School, Vienna, Austria
| | | | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France
| | - Keith Oldroyd
- Golden Jubilee National Hospital and University of Glasgow, Scotland, UK
| | - Marko Noc
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Uwe Zeymer
- Medizinische Klinik B, Klinikum Ludwigshafen, Germany.,Stiftung Institut für Herzinfarktforschung (Foundation IHF), Ludwigshafen, Germany
| | - Taoufik Ouarrak
- Stiftung Institut für Herzinfarktforschung (Foundation IHF), Ludwigshafen, Germany
| | - Steffen Schneider
- Stiftung Institut für Herzinfarktforschung (Foundation IHF), Ludwigshafen, Germany
| | - David A Baran
- Sentara Heart Hospital, Advanced Heart Failure Center, Norfolk, USA
| | - Steffen Desch
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Strümpellstr. 39, D-04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Strümpellstr. 39, D-04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
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Heinsar S, Jung JS, Colombo SM, Rozencwajg S, Wildi K, Sato K, Ainola C, Wang X, Abbate G, Sato N, Dyer WB, Livingstone SA, Pimenta LP, Bartnikowski N, Bouquet MJP, Passmore M, Vidal B, Palmieri C, Reid JD, Haqqani HM, McGuire D, Wilson ES, Rätsep I, Lorusso R, Suen JY, Bassi GL, Fraser JF. An innovative ovine model of severe cardiopulmonary failure supported by veno-arterial extracorporeal membrane oxygenation. Sci Rep 2021; 11:20458. [PMID: 34650063 PMCID: PMC8516938 DOI: 10.1038/s41598-021-00087-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/29/2021] [Indexed: 01/17/2023] Open
Abstract
Refractory cardiogenic shock (CS) often requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to sustain end-organ perfusion. Current animal models result in heterogenous cardiac injury and frequent episodes of refractory ventricular fibrillation. Thus, we aimed to develop an innovative, clinically relevant, and titratable model of severe cardiopulmonary failure. Six sheep (60 ± 6 kg) were anaesthetized and mechanically ventilated. VA-ECMO was commenced and CS was induced through intramyocardial injections of ethanol. Then, hypoxemic/hypercapnic pulmonary failure was achieved, through substantial decrease in ventilatory support. Echocardiography was used to compute left ventricular fractional area change (LVFAC) and cardiac Troponin I (cTnI) was quantified. After 5 h, the animals were euthanised and the heart was retrieved for histological evaluations. Ethanol (58 ± 23 mL) successfully induced CS in all animals. cTnI levels increased near 5000-fold. CS was confirmed by a drop in systolic blood pressure to 67 ± 14 mmHg, while lactate increased to 4.7 ± 0.9 mmol/L and LVFAC decreased to 16 ± 7%. Myocardial samples corroborated extensive cellular necrosis and inflammatory infiltrates. In conclusion, we present an innovative ovine model of severe cardiopulmonary failure in animals on VA-ECMO. This model could be essential to further characterize CS and develop future treatments.
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Affiliation(s)
- Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Intensive Care Unit, St Andrews War Memorial Hospital, Brisbane, QLD, Australia.,Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Jae-Seung Jung
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sebastiano Maria Colombo
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Sacha Rozencwajg
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Medical ICU, Pitié-Salpêtrière University Hospital, INSERM UMRS-1166, Sorbonne Université, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Carmen Ainola
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Xiaomeng Wang
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
| | - Gabriella Abbate
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
| | - Noriko Sato
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
| | - Wayne Bruce Dyer
- Research and Development, Australian Red Cross Lifeblood, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Samantha Annie Livingstone
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Leticia Pretti Pimenta
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
| | - Nicole Bartnikowski
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Science and Engineering Faculty, Queensland University of Technology, Brisbane, QLD, Australia
| | - Mahe Jeannine Patricia Bouquet
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Margaret Passmore
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Bruno Vidal
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
| | - Chiara Palmieri
- School of Veterinary Science, The University of Queensland, Gatton, Australia
| | - Janice D Reid
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Haris M Haqqani
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Daniel McGuire
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
| | - Emily Susan Wilson
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Indrek Rätsep
- Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia. .,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. .,Intensive Care Unit, St Andrews War Memorial Hospital, Brisbane, QLD, Australia. .,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,Wesley Medical Research, Brisbane, QLD, Australia.
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia. .,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. .,Intensive Care Unit, St Andrews War Memorial Hospital, Brisbane, QLD, Australia. .,Wesley Medical Research, Brisbane, QLD, Australia.
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Takagi K, Levy B, Kimmoun A, Miró Ò, Duarte K, Asakage A, Blet A, Deniau B, Schulte J, Hartmann O, Cotter G, Davison BA, Gayat E, Mebazaa A. Elevated Plasma Bioactive Adrenomedullin and Mortality in Cardiogenic Shock: Results from the OptimaCC Trial. J Clin Med 2021; 10:4512. [PMID: 34640526 PMCID: PMC8509471 DOI: 10.3390/jcm10194512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Bioactive adrenomedullin (bio-ADM) was recently shown to be a prognostic marker in patients with acute circulatory failure. We investigate the association of bio-ADM with organ injury, functional impairment, and survival in cardiogenic shock (CS). METHODS OptimaCC was a multicenter and randomized trial in 57 patients with CS. In this post-hoc analysis, the primary endpoint was to assess the association between bio-ADM and 30-day all-cause mortality. Secondary endpoints included adverse events and parameters of organ injury or functional impairment. RESULTS Bio-ADM values were higher in 30-day non-survivors than 30-day survivors at inclusion (median (interquartile range) 67.0 (54.6-142.9) pg/mL vs. 38.7 (23.8-63.6) pg/mL, p = 0.010), at 24 h (p = 0.012), and up to 48 h (p = 0.027). Using a bio-ADM cutoff of 53.8 pg/mL, patients with increased bio-ADM had a HR of 3.90 (95% confidence interval 1.43-10.68, p = 0.008) for 30-day all-cause mortality, and similar results were observed even after adjustment for severity scores. Patients with the occurrence of refractory CS had higher bio-ADM value at inclusion (90.7 (59.9-147.7) pg/mL vs. 40.7 (23.0-64.7) pg/mL p = 0.005). Bio-ADM values at inclusion were correlated with pulmonary vascular resistance index, estimated glomerular filtration rate, and N-terminal pro-B-type natriuretic peptide (r = 0.49, r = -0.47, and r = 0.64, respectively; p < 0.001). CONCLUSIONS In CS patients, the values of bio-ADM are associated with some parameters of organ injury and functional impairment and are prognostic for the occurrence of refractory CS and 30-day mortality.
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Affiliation(s)
- Koji Takagi
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, 75010 Paris, France; (K.T.); (A.K.); (A.B.); (B.D.); (G.C.); (B.A.D.); (E.G.)
- Momentum Research, Inc., Chapel Hill, NC 27517, USA
| | - Bruno Levy
- Service de Médecine Intensive et Réanimation Brabois, CHRU de Nancy, 54511 Vandœuvre-lès-Nancy, France;
- U1116, Défaillance Circulatoire Aigue et Chronique, Faculté de Médecine de Nancy, 54500 Vandœuvre-lès-Nancy, France;
- Université de Lorraine, CS25233, CEDEX, 54052 Nancy, France
| | - Antoine Kimmoun
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, 75010 Paris, France; (K.T.); (A.K.); (A.B.); (B.D.); (G.C.); (B.A.D.); (E.G.)
- Service de Médecine Intensive et Réanimation Brabois, CHRU de Nancy, 54511 Vandœuvre-lès-Nancy, France;
- U1116, Défaillance Circulatoire Aigue et Chronique, Faculté de Médecine de Nancy, 54500 Vandœuvre-lès-Nancy, France;
- Université de Lorraine, CS25233, CEDEX, 54052 Nancy, France
| | - Òscar Miró
- Emergency Department, Hospital Clínic, 08036 Barcelona, Catalonia, Spain;
- IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), 08036 Barcelona, Catalonia, Spain
- Medical School, University of Barcelona, 08036 Barcelona, Catalonia, Spain
| | - Kévin Duarte
- U1116, Défaillance Circulatoire Aigue et Chronique, Faculté de Médecine de Nancy, 54500 Vandœuvre-lès-Nancy, France;
- Université de Lorraine, CS25233, CEDEX, 54052 Nancy, France
- INSERM, Centre d’Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux, 54500 Vandœuvre-lès-Nancy, France
| | - Ayu Asakage
- Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama 2318682, Japan;
| | - Alice Blet
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, 75010 Paris, France; (K.T.); (A.K.); (A.B.); (B.D.); (G.C.); (B.A.D.); (E.G.)
- Department of Anesthesiology, Critical Care and Burn Center, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, 75010 Paris, France
| | - Benjamin Deniau
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, 75010 Paris, France; (K.T.); (A.K.); (A.B.); (B.D.); (G.C.); (B.A.D.); (E.G.)
- Department of Anesthesiology, Critical Care and Burn Center, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, 75010 Paris, France
| | - Janin Schulte
- SphingoTec, Neuendorfstraße 15A, 16761 Hennigsdorf, Germany; (J.S.); (O.H.)
| | - Oliver Hartmann
- SphingoTec, Neuendorfstraße 15A, 16761 Hennigsdorf, Germany; (J.S.); (O.H.)
| | - Gad Cotter
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, 75010 Paris, France; (K.T.); (A.K.); (A.B.); (B.D.); (G.C.); (B.A.D.); (E.G.)
- Momentum Research, Inc., Chapel Hill, NC 27517, USA
| | - Beth A Davison
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, 75010 Paris, France; (K.T.); (A.K.); (A.B.); (B.D.); (G.C.); (B.A.D.); (E.G.)
- Momentum Research, Inc., Chapel Hill, NC 27517, USA
| | - Etienne Gayat
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, 75010 Paris, France; (K.T.); (A.K.); (A.B.); (B.D.); (G.C.); (B.A.D.); (E.G.)
- Department of Anesthesiology, Critical Care and Burn Center, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, 75010 Paris, France
| | - Alexandre Mebazaa
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, 75010 Paris, France; (K.T.); (A.K.); (A.B.); (B.D.); (G.C.); (B.A.D.); (E.G.)
- Department of Anesthesiology, Critical Care and Burn Center, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, 75010 Paris, France
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Nelson DW, Sundararajan S, Klein E, Joyce LD, Durham LA, Joyce DL, Mohammed AA. Sustained Use of the Impella 5.0 Heart Pump Enables Bridge to Clinical Decisions in 34 Patients. Tex Heart Inst J 2021; 48:469168. [PMID: 34388239 DOI: 10.14503/thij-20-7260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We studied whether sustained hemodynamic support (>7 d) with the Impella 5.0 heart pump can be used as a bridge to clinical decisions in patients who present with cardiogenic shock, and whether such support can improve their outcomes. We retrospectively reviewed cases of patients who had Impella 5.0 support at our hospital from August 2017 through May 2019. Thirty-four patients (23 with cardiogenic shock and 11 with severely decompensated heart failure) underwent sustained support for a mean duration of 11.7 ± 9.3 days (range, ≤48 d). Of 29 patients (85.3%) who survived to next therapy, 15 were weaned from the Impella, 8 underwent durable left ventricular assist device placement, 4 were escalated to venoarterial extracorporeal membrane oxygenation support, and 2 underwent heart transplantation. The 30-day survival rate was 76.5% (26 of 34 patients). Only 2 patients had a major adverse event: one each had an ischemic stroke and flail mitral leaflet. None of the devices malfunctioned. Sustained hemodynamic support with the Impella 5.0 not only improved outcomes in patients who presented with cardiogenic shock, but also provided time for multidisciplinary evaluation of potential cardiac recovery, or the need for durable left ventricular assist device implantation or heart transplantation. Our study shows the value of using the Impella 5.0 as a bridge to clinical decisions.
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Affiliation(s)
- Daniel W Nelson
- Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sakthi Sundararajan
- Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Evan Klein
- Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lyle D Joyce
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lucian A Durham
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David L Joyce
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Asim A Mohammed
- Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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47
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Tsangaris A, Alexy T, Kalra R, Kosmopoulos M, Elliott A, Bartos JA, Yannopoulos D. Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock. Front Cardiovasc Med 2021; 8:686558. [PMID: 34307500 PMCID: PMC8292640 DOI: 10.3389/fcvm.2021.686558] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/11/2021] [Indexed: 12/25/2022] Open
Abstract
Cardiogenic shock accounts for ~100,000 annual hospital admissions in the United States. Despite improvements in medical management strategies, in-hospital mortality remains unacceptably high. Multiple mechanical circulatory support devices have been developed with the aim to provide hemodynamic support and to improve outcomes in this population. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is the most advanced temporary life support system that is unique in that it provides immediate and complete hemodynamic support as well as concomitant gas exchange. In this review, we discuss the fundamental concepts and hemodynamic aspects of VA-ECMO support in patients with cardiogenic shock of various etiologies. In addition, we review the common indications, contraindications and complications associated with VA-ECMO use.
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Affiliation(s)
- Adamantios Tsangaris
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Tamas Alexy
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Rajat Kalra
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Marinos Kosmopoulos
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Andrea Elliott
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Jason A. Bartos
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Demetris Yannopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
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48
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Feng KF, Wu M, Ma LK. Factors Associated with the Prognosis of Patients with Acute Myocardial Infarction and Cardiogenic Shock. Med Sci Monit 2021; 27:e929996. [PMID: 34215715 PMCID: PMC8262259 DOI: 10.12659/msm.929996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/28/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) usually have high mortality. This study aimed to identify factors related to the short-term survival of patients with AMI and CS treated by percutaneous coronary intervention (PCI) under intra-aortic balloon pump (IABP) support. MATERIAL AND METHODS This retrospective study included consecutive patients with AMI and CS treated with PCI under IABP support. Clinical characteristics, including the infarct-related artery, lesion number, aspiration catheter usage, conventional or delayed stenting, and thrombolysis in myocardial infarction (TIMI) flow grade before and after PCI, were collected. Patients were followed up postoperatively for 30 days. Multivariate logistic regression was used to identify factors associated with the 30-day mortality. RESULTS There were marked differences between the nonsurvival group (n=49) and the survival group (n=92) in the no-reflow after surgery (49.0% vs 14.1%, P<0.001), postoperative TIMI grade 3 flow (65.3% vs 91.3%, P<0.001), and delayed stent implantation (18.4% vs 37.0%, P=0.022). Factors associated with 30-day mortality were postoperative TIMI grade 3 flow (odds ratio [OR]: 0.227; 95% confidence interval [CI]: 0.076-0.678; P=0.008), delayed stent implantation (OR: 0.371; 95% CI: 0.139-0.988; P=0.047), and intraoperative no-reflow (OR: 2.737; 95% CI: 1.084-6.911; P=0.033). CONCLUSIONS For patients with AMI complicated by CS treated with emergent PCI under IABP support, prevention of no-reflow during surgery by delayed stent implantation can reduce postoperative 30-day mortality in selected cases.
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Affiliation(s)
- Ke-Fu Feng
- Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
| | - Min Wu
- Department of Respiratory, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, China (mainland)
| | - Li-Kun Ma
- Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
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Sambola A, Elola FJ, Buera I, Fernández C, Bernal JL, Ariza A, Brindis R, Bueno H, Rodríguez-Padial L, Marín F, Barrabés JA, Hsia R, Anguita M. Sex bias in admission to tertiary-care centres for acute myocardial infarction and cardiogenic shock. Eur J Clin Invest 2021; 51:e13526. [PMID: 33621347 DOI: 10.1111/eci.13526] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/17/2021] [Accepted: 02/21/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND There are limited data on sex-specific outcomes and management of cardiogenic shock complicating ST-segment elevation myocardial infarction (CS-STEMI). We investigated whether any sex bias exists in the admission to revascularization capable hospitals (RCH) or intensive cardiac care units (ICCU) and its impact on in-hospital mortality. METHODS We used the Spanish National Health System Minimum Basic Data from 2003 to 2015 to identify patients with CS-STEMI. The primary outcome was sex differences in in-hospital mortality. RESULTS Among 340 490 STEMI patients, 20 262 (6%) had CS and 29.2% were female. CS incidence was higher in women than in men (7.9% vs 5.1%, P = .001). Women were older and had more hypertension and diabetes, and were less often admitted to RCH than men (from 58.7% in 2003 to 79.6% in 2015; and from 61.9% in 2003 to 85.3% in 2015; respectively, P = .01), and to ICCU centres (25.7% vs 29.2%, P = .001). Adjusted mortality was higher in women than men over time (from 79.5 ± 4.3% to 65.8 ± 6.5%; and from 67.8 ± 6% to 58.1 ± 6.5%; respectively, P < .001). ICCU availability was associated with higher use of Percutaneous coronary intervention (PCI) in women (46.8% to 67.2%; P < .001) but was even higher in men (54.8% to 77.4%; P < .001). In ICCU centres, adjusted mortality rates decreased in both sexes, but lower in women (from 74.9 ± 5.4% to 66.3 ± 6.6%) than in men (from 67.8 ± 6.0% to 58.1 ± 6.5%, P < .001). Female sex was an independent predictor of mortality (OR 1.18 95% CI 1.10-1.27, P < .001). CONCLUSIONS Women with CS-STEMI were less referred to tertiary-care centres and had a higher adjusted in-hospital mortality than men.
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Affiliation(s)
- Antonia Sambola
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain
| | | | - Irene Buera
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain
| | - Cristina Fernández
- Foundation Institute for Healthcare Improvement, Madrid, Spain.,Department of Preventive Medicine, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - José Luis Bernal
- Foundation Institute for Healthcare Improvement, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Albert Ariza
- CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain.,Heart Diseases Institute, Hospital Universitario de Bellvitge -IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ralph Brindis
- Department of Medicine & The Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Héctor Bueno
- CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain.,Management Control Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Francisco Marín
- Hospital Universitario Virgen de la Arrixaca, El Palmar, Spain
| | - José Antonio Barrabés
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain
| | - Renee Hsia
- Health Policy Studies in the Department of Emergency Medicine at University of California, San Francisco, CA, USA
| | - Manuel Anguita
- Department of Cardiology, Hospital Universitario Reina Sofía de Cordoba, Córdoba, Spain
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50
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Chu S, Sun P, Zhang Y, Li J, Liu L, Shi Y, Wang H, Chen H, Fu M, Huo Y. Intra-aortic balloon pump on in-hospital outcomes of cardiogenic shock: findings from a nationwide registry, China. ESC Heart Fail 2021; 8:3286-3294. [PMID: 34155835 PMCID: PMC8318473 DOI: 10.1002/ehf2.13479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/09/2021] [Accepted: 06/06/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS The real-world usage of intra-aortic balloon pump (IABP) in various cardiogenic shocks (CS) and the association with outcomes are lacking. We aimed to investigate IABP adoption in CS in a nationwide registry in China. METHODS AND RESULTS We retrospectively retrieved data of 30 106 CS patients (age 67.1 ± 14.6 years, 37.6% female patients) in the Hospital Quality Monitoring System registry from 2013 to 2016. Ischaemic heart disease was the leading cause of CS (73.9%). Hypertension, cardiomyopathy, myocarditis, valvular, and congenital heart disease were seen in 36.0%, 7.5%, 2.6%, 7.3%, and 2.4% of the population. IABP was employed in 2320 (7.7%) subjects. The association between IABP usage and primary outcome of in-hospital mortality and secondary outcomes of expenses and lengths of stay were investigated. The patients with IABP support had similar in-hospital mortality to those without IABP (39.6% vs. 38.3%, P = 0.226), but longer hospital-stay [8.0 (2.0-16.0) vs. 6.0 (2.0-13.0) days, P < 0.001] and higher expenses [7.1(4.4-11.1) vs. 2.3 (0.8-5.5) 10 000RMB, P < 0.001]. IABP support was not associated with reduced mortality in the overall CS population in multivariate regression analysis [odds ratio (OR) 1.05, 95% confidence interval (CI) 0.95-1.17], except for subgroups with myocarditis (OR 0.61, 95% CI 0.39-0.95, P for interaction = 0.010) and those who did not receive the early percutaneous coronary intervention (PCI) (OR 0.86, 95% CI 0.75-0.97, P for interaction < 0.001). Similar results were further confirmed in the propensity-score-matched population. CONCLUSIONS In this nationwide registry of CS patients, IABP was not noted with improved survival but increased healthcare consumption. However, IABP appears protective in those with myocarditis or who failed to receive early PCI.
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Affiliation(s)
- Songyun Chu
- Peking University First Hospital, Beijing, China
| | - Pengfei Sun
- Peking University First Hospital, Beijing, China
| | - Yan Zhang
- Peking University First Hospital, Beijing, China
| | - Jianping Li
- Peking University First Hospital, Beijing, China
| | - Lin Liu
- Peking University First Hospital, Beijing, China
| | - Ying Shi
- China Standard Medical Information Research Centre, Shenzhen, China
| | - Haibo Wang
- First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hu Chen
- Bureau of Medical Administration National Health Commission of the People's Republic of China, Beijing, China
| | - Michael Fu
- Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Yong Huo
- Peking University First Hospital, Beijing, China
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