- 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
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”
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”
- 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.
More than one-third of the adult population in the United States (35.7%) are considered clinically obese.1
The increasing prevalence of obesity has become difficult to ignore as research continues to support the association of obesity--defined as a body mass index of 30 or greater--with poor cardiovascular health.Despite obesity having a direct link to known cardiovascular risk factors, including diabetes, hypertension, and hypercholesterolemia, previous research has shown a paradoxical protective association between obesity and established cardiovascular disease.2
This “obesity paradox” states that patients with obesity may have better outcomes following a cardiovascular event when compared with nonobese patients. Continue readingThe Association Between Obesity and In-Hospital Mortality in Patients with Cardiogenic Shock Complicating Acute Myocardial Infarction
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”
- 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.
The significant reduction of in-hospital mortality related to ST-segment elevation acute myocardial infarction (STEMI) has been greatly attributed to the overwhelming adoption of primary percutaneous intervention (PCI). STEMI patients with cardiogenic shock (CS) tend to experience a higher mortality even after PCI and the implantation of mechanical circulatory support (MCS) devices.A recent retrospective study published in European Heart Journal: Acute Cardiovascular Care
assessed the mortality benefit, if any, of reperfusion via primary PCI for patients with STEMI complicated with CS of 466 patients enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) acute myocardial infarction (AMI) registry. Continue readingMortality Remains High for STEMI Patients Complicated by Cardiogenic Shock
At TCT on Tuesday, October 13, Drs. Navin Kapur, Anuradha Lala, Yu Gho, Noam Josephy, Richard Karas, and Daniel Burkhoff were awarded the Top 50 Abstract and Poster Awards for their poster entitled “The Recover Right Trial Criteria for Right Ventricular Failure: An Analysis of the Should we emergently revascularize Occluded coronaries for Cardiogenic shock (SHOCK) Trial and Registry.”The number of deaths associated with cardiogenic shock during acute myocardial infarction is high, even with the use of the intra-aortic balloon pump and revascularization. These authors hypothesized that right ventricular dysfunction may contribute to poor clinical outcomes in patients with cardiogenic shock during acute myocardial infarction.With the availability of a right ventricular support device called the Impella RP, it may be possible to provide support for the right ventricle if patients with right ventricular dysfunction could be identified. This study was conducted to determine the prevalence of right ventricular dysfunction among patients with cardiogenic shock during acute myocardial infarction.Continue readingStudy on Cardiogenic Shock during Acute MI Wins Top 50 Abstract and Posters Award at TCT 2015