220: Improvement in Survival with Implantation of Levitronix CentriMag Biventricular Circulatory Support in Patients with Acute ST-Elevation Myocardial Infarction (STEMI) and Refractory Cardiogenic Shock

Cardiogenic shock (CS) due to acute ST-elevation myocardial infarction is a complex state of low cardiac output and hemodynamic instability that transmutes to hypoperfusion of various body tissues leading to multi-organ dysfunction and death. Mortality rates due to CS remain high despite many recent advances in treatment. In the management of CS, early revascularization is the mainstay of the treatment. The patient can be stabilized using fl uids, vasopressors or inotropes, mechanical circulatory support, and general intensive care techniques. Due to only few randomized trials on CS patients, there is lack of concrete evidence supporting various treatment modalities, except for revascularization. Thus, CS and its management is a topic with more controversies than conclusions regarding optimal treatment and management.

Download Full-text

Abstract 13861: Trends in Utilization of Mechanical Circulatory Assist Devices in Patients Presenting with ST Elevation Myocardial Infarction

Circulation ◽

10.1161/circ.130.suppl_2.13861 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Shikhar Agarwal ◽

Venu Menon

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

St Elevation Myocardial Infarction ◽

Circulatory Support ◽

Hierarchical Regression ◽

Study Duration ◽

Circulatory Assist Devices ◽

St Elevation ◽

Small Decline

Despite significant controversy about the efficacy, mechanical circulatory support (MCS) is often utilized in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI). We aimed to characterize the trends and outcomes following the use of MCS devices in patients presenting with STEMI. Methods: We used the 2003-2011 US Nationwide Inpatient Sample for this study. All admissions with a principal diagnosis of STEMI were identified using standard ICD codes. MCS devices included intra aortic balloon pump or Impella and were identified using ICD procedure codes. Results: Of a total of 372984 admissions with STEMI, we identified 35685 (9.3%) cases that required MCS. Over the study duration, there was a significant increase in the utilization of MCS from 7.6% in 2003 to 10.5% in 2011 (Panel A). This increase in the use of MCS was accompanied by a significant increase in the incidence of cardiogenic shock in the study population (Panel A). Despite an increase in the overall cardiogenic shock incidence, there was a significant increase in the relative utilization of MCS in cardiogenic shock (Panel B) during the study duration. Of all the cardiogenic shock cases, utilization of MCS increased from 48.6% in 2003 to 57.4% in 2009, followed by a small decline to 54.7% in 2011. Among patients with cardiogenic shock, in-hospital mortality rate was 31.5% in patients with MCS as compared to 42.4% in those treated without MCS (p<0.001). Using multivariable hierarchical regression modeling, we found a significant reduction in adjusted in-hospital mortality with MCS, among patients with cardiogenic shock [OR (95% CI): 0.82 (0.77-0.88), p<0.001]. Conclusions: Over the last decade, there has been a significant increase in the utilization of MCS in patients with STEMI. In contrast to the results of the IABP trial, the use of MCS was associated with a significant reduction in in-hospital mortality in this real world nationwide experience.

Download Full-text

TCT-554 Contemporary trends on the impact of short term circulatory support on length of stay in patients with ST elevation myocardial infarction complicated by cardiogenic shock

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.09.730 ◽

2017 ◽

Vol 70 (18) ◽

pp. B229

Author(s):

Gursukhmandeep Sidhu ◽

Samir Pancholy

Keyword(s):

Myocardial Infarction ◽

Length Of Stay ◽

Cardiogenic Shock ◽

St Elevation Myocardial Infarction ◽

Circulatory Support ◽

Short Term ◽

St Elevation ◽

The Impact

Download Full-text

Cardiogenic shock and radial access in patients with an acute ST elevation myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1791 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Zahn ◽

M Hochadel ◽

B Schumacher ◽

M Pauschinger ◽

C Stellbrink ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

St Elevation Myocardial Infarction ◽

Strong Variation ◽

Access Site ◽

Femoral Access ◽

Radial Access ◽

St Elevation ◽

The Difference

Abstract Background Cardiogenic shock (CS) in patients (pts) with acute ST elevation myocardial infarction (STEMI) is the strongest predictor of hospital mortality. Radial in contrast to femoral access in STEMI pts might be associated with a lower mortality. However, little is known on radial access in CS pts. Methods We retrospectively analysed all STEMI pts between 2009 and 2015 who sufferend from CS and who were included into the ALKK PCI registry. Pts treated via a radial access were compared to those treated via a femoral access. Results Between 2009 and 2015 23796 STEMI pts were included in the registry. 1763 (7.4%) of pts were in CS. The proportion of radial access was 6.6%: in 2009 4.0% and in 2015 19.6%, p for trend <0.0001 with a strong variation between the participating centres (0% to 37%). Conclusions Radial access was only used in 6.6% of STEMI pts presenting in CS. However, a significant increase in the use of radial access was observed over time (2009: 4%, 2015 19.6%, p<0.001), with a great variance in its use between the participating hospitals. Despite similar pt characteristics the difference in hospital mortality according to access site has to be interpretated with caution. Funding Acknowledgement Type of funding source: None

Download Full-text