Category: Research/Journals


Early Impella Support Associated with Increased Survival in Cardiogenic Shock

Key Takeaways

  • This retrospective study evaluated observational data of patients receiving either early or delayed initiation of Impella for the management of acute myocardial infarction complicated by cardiogenic shock (AMICS).
  • Receiving mechanical circulatory support (MCS) prior to percutaneous coronary intervention (PCI) compared with post-PCI initiation was associated with a higher survival rate to discharge among AMICS patients.
  • Overall survival to discharge for the cohort was 44%.
  • Additionally, early initiation of MCS at the first signs of shock and before inotropes, vasopressors, and PCI correlated with a higher rate of survival.
The use of mechanical circulatory support (MCS) in cardiogenic shock (CS) has been consistently shown to correlate with improved survival and assist interventionalists achieve complete revascularization.1,2,3 The use of MCS devices for the treatment of acute myocardial infarction complicated by cardiogenic shock (AMICS) may also provide hemodynamic support for some patients.4 Continue readingEarly Impella Support Associated with Increased Survival in Cardiogenic Shock

Improving Survival in Cardiogenic Shock by Adopting a Uniform Approach to Systems of Care

Reference: J Am Coll Cardiol 2018; 72:1972-80 Cardiogenic shock continues to be the leading cause of death in patients with acute myocardial infarction (AMI).1 Despite implementation of guideline-recommended early revascularization, mortality rates in AMI complicated by cardiogenic shock (AMICS) remains constant at about 50%. Given that about 60,000 patients with AMI develop CS every year,2 … Continue reading “Improving Survival in Cardiogenic Shock by Adopting a Uniform Approach to Systems of Care”

PCI vs CABG in Patients with Unprotected Left Main Coronary Artery Disease

Key Takeaways

  • This meta-analysis evaluated 6 randomized controlled trials to determine outcome differences between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) among patients with unprotected left main coronary artery disease ([ULMCAD] n = 4686).
  • Compared with CABG, PCI correlated with significantly lower rates of 30-day stroke (P = 0.007), death or MI (P = 0.04), or all-cause death, MI, or stroke (P = 0.01).
  • In the PCI group, there was a significantly lower rate of 30-day stroke incidence (P = 0.007) and all-cause death, MI, or stroke (P = 0.01).
  • The authors found no significant difference in outcomes at long-term follow-up (median 39 months) between the two groups.
Reference: Palmerini T et al. Am Heart J. 2017;190:54-63.
Continue readingPCI vs CABG in Patients with Unprotected Left Main Coronary Artery Disease

Characteristics of Cardiogenic Shock Subtypes for Guiding Clinical Practice

Key Takeaways Patients with cardiogenic shock (CS) due to end-stage heart failure (ESHF) who receive mechanical circulatory support (MSC) have lower global oxygen delivery, greater anaerobic metabolism, lower pulmonary capacitance, and higher pulmonary vascular resistance than patients with CS due to acute myocardial infraction (AMI). Table 1. Types of Supporta Primary Support (n, %) CS … Continue reading “Characteristics of Cardiogenic Shock Subtypes for Guiding Clinical Practice”

Safety and Feasibility of the Impella® Device in High-Risk Percutaneous Coronary Intervention

Reference: Ait Ichou J et al. Catheter Cardiovasc Interv [published online September 20, 2017]. Key Takeaways Hemodynamic support with the Impella® device is associated with low mortality and low adverse events in patients undergoing high-risk percutaneous coronary intervention (HRPCI), according to a systematic review. According to findings from a systematic review by Ichou et al, … Continue reading “Safety and Feasibility of the Impella® Device in High-Risk Percutaneous Coronary Intervention”

Utility of the SYNTAX II Score for Deciding Between PCI and CABG

Reference: Escaned J et al. Eur Heart J. 2017;38(42):3124-3134. Patients selected for percutaneous coronary intervention (PCI) using the Syntax Score II in the SYNTAX II trial showed favorable 1-year post-intervention clinical outcomes compared to patients selected for PCI in the SYNTAX I trial, according to findings from the SYNTAX II trial.1 SYNTAX II The SYNTAX … Continue reading “Utility of the SYNTAX II Score for Deciding Between PCI and CABG”

Impella® Device Support During High-Risk Unprotected Left Main Percutaneous Coronary Intervention Demonstrates Favorable Safety and Efficacy Outcomes

Reference: Schreiber T et al. Catheter Cardiovasc Interv. 2017;90(4):576-581. The use of prophylactic Impella® device support during unprotected left main (ULM) percutaneous coronary intervention (PCI) is safe and effective for improving hemodynamic variables in high-risk, non-cardiogenic shock (CS) patients, according to findings from a large, single-center, retrospective review of the USpella registry from Schreiber et … Continue reading “Impella® Device Support During High-Risk Unprotected Left Main Percutaneous Coronary Intervention Demonstrates Favorable Safety and Efficacy Outcomes”

The MATRIX Trial: AKI After Radial or Femoral Access for Invasive ACS Management

Key Takeaways In a group of patients undergoing radial access, 15.4% developed acute kidney injury (AKI) after percutaneous coronary intervention (PCI) compared with 17.4% in the femoral access group. Randomized clinical trials demonstrating the effectiveness of radial access (RA) on improved outcomes following percutaneous coronary intervention (PCI) have increased interventionalists’ utilization of RA.1,2 Despite the … Continue reading “The MATRIX Trial: AKI After Radial or Femoral Access for Invasive ACS Management”

Culprit-Lesion-Only PCI Compared with Multivessel PCI is Associated with Better Survival in Multivessel Disease, CS, and AMI

According to findings from a multicenter trial presented by Dr. Holger Thiele, MD, at TCT 2017 (published simultaneously online at NEJM.org), percutaneous coronary intervention (PCI) of the culprit lesion only is associated with a lower 30-day composite risk for severe renal failure or death compared with multivessel PCI in patients with multivessel disease, cardiogenic shock … Continue reading “Culprit-Lesion-Only PCI Compared with Multivessel PCI is Associated with Better Survival in Multivessel Disease, CS, and AMI”

Hospitalization Outcomes Among Nonagenarians Undergoing PCI after AMI

Key Takeaways Elderly patients between ages 90 and 99 have a high risk for mortality after percutaneous coronary intervention (PCI) compared with younger patients. This study evaluated nonagenarians from the Veterans Affairs Clinical Assessment, Reporting, and Tracking program undergoing PCI (n = 274) and evaluated mortality outcomes (30 days and 1 year) and predictors of … Continue reading “Hospitalization Outcomes Among Nonagenarians Undergoing PCI after AMI”