Dr. Giuseppe Tarantini (Professor and Director of Interventional Cardiology, University of Padua, Italy) speaks on the importance of the early unloading concept in cardiogenic shock (CS), in bringing about improvements in systemic circulation ahead of coronary reperfusion, with the hope that this could improving mortality rates in such patients. The choice of left ventricular mechanical … Continue reading “Impella in Cardiogenic Shock: The Importance of Early Unloading”
- 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.
- 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.
Changes in Public Reporting and Their Impact on Treatment and Outcomes of Acute Myocardial Infarction
- Public reporting of mortality outcomes for coronary revascularization has resulted in significant risk aversion among PCI operators, potentially reducing patient care quality.
- After excluding refractory cardiogenic patients from publicly reported PCI data, New York operators were more likely to perform high-risk PCI for patients with acute coronary syndrome complicated by cardiogenic shock. This change resulted in a trend toward improved mortality.
- There are few studies that demonstrate the full impact of pulmonary arterial proportional pressure (PAPP) on advanced heart failure (HF) outcomes.
- It has been theorized that increases in PAPP would correlate with improved clinical outcomes in patients with advanced HF.
- Researchers evaluated the PAPP of a subset of patients in the ESCAPE trial who had received placement of a pulmonary artery catheter (PAC).
- A lower PAPP score was consistently associated with worse hemodynamics and increased clinical events at 6 months.
- PAPP may be an important risk stratification tool for HF patients, assisting in the prediction of mortality, LVAD transplant, and hospitalization.
The Effect of LVAD Unloading on Cardiac Recovery in Patients with Ischemic and Nonischemic Cardiomyopathy
- Myocardial function improvement following mechanical unloading with durable LVADs may occur in patients with chronic ischemic cardiomyopathy, but at a much lower rate than those with nonischemic cardiomyopathy (21% vs 5%).
- Little is known about the effect of LVADs on myocardial structure and function following treatment for ischemic cardiomyopathy (ICM).
- Peak LVEF can be achieved 6 months after LVAD support.
- Patient characteristics dictate the most favorable duration of mechanical unloading in patients with ICM.
- This study showed that chronic mechanical unloading can improve myocardial structure and function in both nonischemic cardiomyopathy (NICM) and ICM patients.
Use of Impella® Devices During High-Risk PCI is Associated with Reduced Occurrence of Acute Kidney Injury
- Dr. Alexander Truesdell of the INOVA Heart and Vascular Institute discusses how physicians can apply the same shock management principles found on the battlefront into everyday surgical practice.
- Early recognition of shock and early revascularization are two essential elements of successful treatment for shock on the battlefield as well as in conventional care centers.
- Contrast-induced acute kidney injury caused by iodinated contrast medium is associated with high morbidity and mortality in at-risk patients.
- Previous studies note that automated contrast injectors, removal of contrast from the coronary sinus, and pressure-sensitive diversion devices may help reduce contrast exposure and lower the risk for AKI.
The Association Between Obesity and In-Hospital Mortality in Patients with Cardiogenic Shock Complicating Acute Myocardial Infarction
- Obesity is paradoxically associated with favorable mortality outcomes in acute myocardial infarction (AMI).
- Association between obesity and in-hospital mortality among patients with cardiogenic shock (CS) complicating AMI (N=290,894) was retrospectively studied.
- Obese patients had lower in-hospital mortality compared with nonobese patients (28.2% vs 36.5%, respectively), but key baseline differences in the obese group may explain this association.