scholarly journals Resources for Cardiovascular Healthcare associated with 30-day Mortality in Acute Myocardial Infarction with Cardiogenic Shock

2021 ◽  
Author(s):  
Masanobu Ishii ◽  
Kenichi Tsujita ◽  
Hiroshi Okamoto ◽  
Satoshi Koto ◽  
Takeshi Nishi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Coronary Intervention ◽  
Circulatory Support ◽  
Primary Pci ◽  
Healthcare Resources ◽  
Inverse Probability Weighted ◽  
Healthcare Associated ◽  
Cardiovascular Care

Abstract Background Although primary percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS), such as extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pumping (IABP), have been widely used for acute myocardial infarction patients with cardiogenic shock (AMICS), their in-hospital mortality remains high. This study aimed to investigate the association of cardiovascular healthcare resources with 30-day mortality in AMICS. Methods This was an observational study using a Japanese nationwide administrative data (JROAD-DPC) of 260,543 AMI patients between April 2012 and March 2018. Of these, 45,836 AMICS patients were divided into three categories based on MCS use: with MCS (ECMO with/without IABP), IABP only, or without MCS. Certified hospital density and number of board-certified cardiologists were used as a metric of cardiovascular care supply. We estimated the association of MCS use, cardiovascular care supply, and 30-day mortality. Results The 30-day mortality was 71.2% for the MCS, 23.9% for IABP only, and 37.8% for the group without MCS. The propensity score-matched and inverse probability-weighted Cox frailty models showed that primary PCI was associated with a low risk for mortality. Higher hospital density and larger number of cardiologists in the responsible hospitals were associated with a lower risk for mortality. Conclusions Although the 30-day mortality remained extremely high in AMICS, indication of primary PCI and improvement in providing cardiovascular healthcare resources associated with the short-term prognosis of AMICS.

scholarly journals Early Impella support in post-cardiac arrest cardiogenic shock complicating acute myocardial infarction improves short and long term survival

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Hatzis ◽  
B Markus ◽  
U Luesebrink ◽  
H Ahrens ◽  
D Divchev ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Coronary Intervention ◽  
Circulatory Support ◽  
Survival Outcomes ◽  
Optimal Timing ◽  
Term Survival

Abstract Background Early mechanical circulatory support with Impella may improve survival outcomes in the setting of post-cardiac arrest cardiogenic shock (CS) after out of hospital cardiac arrest (OHCA) complicating acute myocardial infarction (AMI). However, the optimal timing to initiate mechanical circulatory support (MCS) in this particular setting remains unclear. Purpose We aimed to compare survival outcomes of patients supported with Impella 2.5 before percutaneous coronary intervention (PCI) (pre-PCI) to those supported after PCI (post-PCI). Methods Single center study of patients resuscitated from OHCA due to AMI with post-cardiac arrest CS between September 2014 and June 2018. Survival outcomes were compared between those with Impella support before and after PCI. Results A total of 65 consecutive patients with infarct-related post-cardiac arrest shock supported with Impella 2.5 during admission coronary angiogram were included. All patients were in profound CS requiring catecholamines on admission. Overall survival to discharge and at 12-months was 44.6% and 41.5%, respectively. Patients in the pre-PCI group had a higher survival to discharge and at 12-months as compared to patients of the post-PCI group (60.7% versus 32.4%, p=0.03 and 57.1% versus 29.7%, p=0.04, respectively). Moreover, the patients in the early support group demonstrated a greater functional recovery of the left ventricle when Impella support was initiated prior to PCI. Conclusions Our results suggest that the early initiation of MCS with Impella 2.5 prior to PCI is associated with improved hospital and 12-month survival in patients with post-cardiac arrest CS complicating AMI. Figure 1 Funding Acknowledgement Type of funding source: None

Thrombolytic Therapy in the Current ERA: Myocardial Infarction and Beyond

2018 ◽  
Vol 24 (4) ◽  
pp. 414-426 ◽  
Author(s):  
Patrick Proctor ◽  
Massoud A. Leesar ◽  
Arka Chatterjee
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Coronary Intervention ◽  
Evidence Base ◽  
Primary Pci ◽  
Percutaneous Coronary

Thrombolytic therapy kick-started the era of modern cardiology but in the last few decades it has been largely supplanted by primary percutaneous coronary intervention (PCI) as the go-to treatment for acute myocardial infarction. However, these agents remain important for vast populations without access to primary PCI and acute ischemic stroke. More innovative uses have recently come up for the treatment of a variety of conditions. This article summarizes the history, evidence base and current use of thrombolytics in cardiovascular disease.

scholarly journals Mechanical circulatory support with impella in patients with non-acute myocardial infarction related cardiogenic shock

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Haurand ◽  
S Bueter ◽  
C Jung ◽  
M Kelm ◽  
R Westenfeld ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Apache Ii Score ◽  
Hemodynamic Parameters ◽  
Clinical Scores ◽  
Lactate Levels

Abstract Background Percutaneous left ventricular assist devices such as the Impella pump, are used to hemodynamically stabilize patients with cardiogenic shock (CS) caused by acute myocardial infarction (AMI) until cardiac function has recovered after revascularization. Whether Impella mechanical circulatory support (MCS) is effective in stabilizing patients with CS not caused by AMI has so far not been thoroughly investigated. Purpose The aim of this study is to analyze whether MCS with Impella is effective to stabilize patients with non-AMI related CS compared to patients with AMI related CS. Method We retrospectively analyzed 106 patients with CS and Impella support in the years from 2011 to 2018. Efficacy to stabilize the patient was assessed by laboratory values such as lactate, hemodynamic parameters and clinical scores. The difference in mortality was calculated with the Log-Rank-Test, comparing Kaplan-Meier curves. Results 36 patients suffered from non-AMI CS and in 70 patients CS was caused by AMI. Regarding the clinical scores and hemodynamic parameters, both groups were severely ill, with no significant difference in APACHE II score, with a mean score of 17.9 in the non-AMI group compared to 20.5 in the AMI-group (p=0.103), the SOFA score (mean score of 6.3 in non-AMI group vs 6.8 in AMI group, p=0.467) and cardiac index (mean CI of 1.9 l/min/m2 in non-AMI group vs 2.2 l/min/m2 in AMI group, p=0.176). There was a comparable mean decrease in lactate levels in both groups 48 hours after initiation of MCS, from initially 4.1 mmol/l to 1.7 mmol/l (p<0.001) in the non-AMI group and from initially 3.6 mmol/l to 2.2 mmol/l (p=0.025) in the AMI group. The non-ACS group exhibited a trend of lower mortality compared to the AMI group, with 47% in the non-AMI group and 57% in the AMI group (p=0.067). In multivariate analysis, age, lactate levels, cardiopulmonary resuscitation, low platelets and higher doses of inotropes and vasopressors were independent predictors for mortality. An upgrade to LVAD was performed for 22% of the non-AMI group and for 6% of the AMI group (p=0.020). Conclusion Impella support is effective to hemodynamically stabilize patients with non-AMI related CS. Therefore, MCS can be used as bridge to recovery or enables further treatment options as upgrade to longterm mechanical support devices. Funding Acknowledgement Type of funding source: None

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