Dr. Jeffrey Fowler of the University of Pittsburg Medical Center presents a case describing a patient who had been in the CCU for 8 hours before experiencing an output of pink-tinged urine. Dr. Fowler was paged with concerns about the patient’s risk for hemolysis. Tune in to learn more about Dr. Fowler’s management strategy for … Continue reading “Complications Management: Hemolysis in AMI Complicated by Cardiogenic Shock”
Tag: Acute Myocardial Infarction
Key Takeaways This substudy of the IABP-SHOCK II trial sought to develop an easy-to-use, readily available risk prediction score for short-term mortality in patients with AMI-related CS undergoing PCI. The observed 30-day mortality rates were 23.8% (low risk score), 49.2% (intermediate risk score), and 76.6% (high risk score). The IABP-SHOCK II risk score, which is … Continue reading “Risk Stratification for CS After AMI”
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.
For patients with cardiogenic shock (CS), intra-aortic balloon pump (IABP) had been an important tool for maintaining patients and improving survival after percutaneous coronary intervention (PCI). Randomized controlled trials, however, have found very little evidence to support the notion that IABP is helpful for reducing mortality or improving hemodynamics for patients with CS.1,2 The Impella® … Continue reading “IMPRESS in Severe Shock Trial: Looking Closer at the Data”
Retrospective Registry Data Suggests that Early Impella® Support is Associated with Increased Survival in Cardiogenic Shock
- 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.
- Early reperfusion for STEMI patients complicated by cardiogenic shock results in lower mortality compared to prolonged reperfusion.
- Shorter onset-to-balloon (OTB) and door-to-balloon (DTB) times are recommended to improve patient survival.
- A shorter OTB was associated with longer overall survival in patients vs prolonged OTB (43.3% and 55.5%, respectively).
- Mortality rates for short vs long DTB in this study were 44.9% and 55.8%, respectively.