Cardiogenic shock after ST elevation myocardial infarction and IABP-SHOCK II risk score validation in a cohort treated with pharmacoinvasive strategy

ObjectiveTo validate the Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) score in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI) treated with pharmacoinvasive strategy (PhIS) and to analyse the influence of ischaemia time on different risk strata.MethodsWe analysed 2143 patients with STEMI who underwent reperfusion with tenecteplase in primary health services between May 2010 and April 2017 and were transferred to a tertiary hospital for cardiac catheterisation and continuity of care. Those who evolved to cardiogenic shock were scored as low (0–2), moderate (3–4) or high (5–9) risk of death in 30 days and pairwise-log-rank test was used to compare strata. Time intervals between symptoms onset and lytic (pain-to-needle) and fibrinolytic-catheterisation were also compared.ResultsCardiogenic shock occurred in 212 (9.9%) individuals. The 30-day mortality using the IABP-SHOCK II score was 26.6% for low-risk (n=94), 53.2% for moderate-risk (n=62) and 76% for high-risk (n=25) analysed patients (p<0.001). Validation of the score showed good discrimination for death, area under the curve of 0.73 (CI: 0.66 to 0.81; p<0.001). The median intervals of pain-to-needle and fibrinolytic-catheterisation showed no association with the group stratification (220 vs 251 vs 200 min; p=0.22 and 390 vs 435 vs 315 min; p=0.18, respectively).ConclusionsIn patients with cardiogenic shock after STEMI treated with PhIS, risk stratification using IABP-SHOCK II score was adequate. There was no influence of pain-to-needle and fibrinolytic-catheterisation times on the ability to the score model stratification.

Download Full-text

Intra-aortic Balloon Pump Therapy for Anterior ST-elevation Myocardial Infarction with Cardiogenic Shock: An Observational Cohort Study

10.21203/rs.2.14258/v1 ◽

2019 ◽

Author(s):

Kuo Zhou ◽

Shuzheng Lyu ◽

Jing Dai ◽

Jinfan Tian ◽

Kongyong Cui ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiogenic Shock ◽

Lower Limb ◽

Cox Regression ◽

Anterior Wall ◽

St Elevation Myocardial Infarction ◽

Rank Test ◽

Control Group ◽

Intra Aortic Balloon Pump ◽

St Elevation

Abstract Background As a mechanical circulatory assistance, intra-aortic balloon pump (IABP) has been widely used for cardiogenic shock (CS), although recent clinical trials questioned its impact on acute myocardial infarction patients, nothing is hitherto known on the contribution of IABP to CS patients after anterior wall infarction. The aim of this study was to investigate the efficacy and safety of IABP therapy in patients presenting with anterior ST-elevation myocardial infarction (STEMI) complicated by CS.Methods We conducted a retrospective study of 215 consecutive patients presenting with CS after STEMI in the anterior wall between January 2006 and August 2017, including 125 patients in the IABP group and 90 patients in the control group.Results At 30 days, 60 (48.0%) patients in the IABP group and 58 (64.4%) patients in the control group had died (P=0.017). The Kaplan-Meier survival curves showed the cumulative survival rate in the IABP group was consistently higher than control group (P=0.009 by Log-Rank test). Nevertheless, IABP increased the occurrence of thrombocytopenia (21.6% vs. 2.2%, P<0.001) and lower limb complications (20.0% vs. 2.2%, P<0.001) at the same time. Subgroup analyses by Cox regression showed a better trend of prognoses in patients aged less than 60 years old (HR=0.49, 95% CI=0.26-0.91, P=0.025), male (HR=0.53, 95% CI=0.34-0.83, P=0.005), no history of hypertension (HR=0.47, 95% CI=0.26-0.87, P=0.017) and systolic blood pressure less than 80 mm Hg (HR=0.40, 95% CI=0.22-0.73, P=0.009). At 12-month follow-up, all-cause mortality in the IABP group was obviously lower than the control group (52.5% vs. 74.1%, P=0.002), there were no significant differences in other adverse cardiovascular events (P=1.000).Conclusions The combination of IABP use is associated with reduced 30-day and 12-month mortality in patients with anterior STEMI complicated by CS, though thrombocytopenia and lower limb complications are frequently observed.

Download Full-text

P2269IABP-SHOCK II risk score validation for cardiogenic shock after myocardial infarction in a cohort treated with pharmaco-invasive therapy

European Heart Journal ◽

10.1093/eurheartj/ehz748.0746 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P I M Moraes ◽

C M R Alves ◽

M T Souza ◽

S E Kawakami ◽

A Galhardo ◽

...

Keyword(s):

Myocardial Infarction ◽

Risk Stratification ◽

Cardiogenic Shock ◽

Validation Cohort ◽

Area Under The Curve ◽

Interquartile Range ◽

Good Discrimination ◽

St Elevation ◽

Score Model ◽

Group Stratification

Abstract Background Risk stratification using scores is a valuable tool in cardiogenic shock after ST elevation myocardial infarction (STEMI). During pharmacoinvasive therapy (PIT) their use is unexplored in the literature. Objective: To validate the IABP-SHOCK II (Intra-aortic Balloon Pump in Cardiogenic Shock) score in patients treated with PIT and to analyze the influence of ischemia time on the different risk strata. Methods and results Of 2,143 STEMI patients seen between May 2010 and April 2017, 212 (9.9%) developed cardiogenic shock. Thirty-one patients (14.6%) with incomplete data were excluded from the analysis and the validation cohort included the remaining 181. Mortality rates were similar between the analyzed and excluded patients (42.5% and 45.1% respectively, p=0.77). The 30-day mortality using the IABP-SHOCK II score was 26.6% for low-risk (n=94), 53.2% for moderate-risk (n=62), and 76% for high-risk (n=25) (p<0.001). The validation of the score showed good discrimination for death, with an area under the curve of 0.73 (95% confidence interval 0.66 to 0.81 p<0.001). Although pain-to-needle time was significantly longer in patients who died within 30 days (251 min, interquartile range 140–528 vs. 210 min, interquartile range 130–343, p=0.032), the median intervals of pain-to-needle and fibrinolytic-catheterization showed no association with the group stratification (220 vs 251 vs 200 min; p=0.22 and 390 vs 435 vs 315 min; p=0.18, respectively). This finding may be explained by the potential of these variables to be more closely associated with the development of cardiogenic shock in STEMI patients treated with PIT, and to be less associated with progression to death when the patient is already in shock. 30-day mortality in scored strata Conclusion In patients with cardiogenic shock after STEMI treated with PIT, risk stratification using the IABP-SHOCK II score was adequate. There was no influence of pain-to-needle and fibrinolytic-catheterization times on the ability to the score model stratification.

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