scholarly journals Rapid Classification and Treatment Algorithm of Cardiogenic Shock Complicating Acute Coronary Syndromes: The SAVE ACS Classification

2022 ◽  
Vol 2022 ◽  
pp. 1-10
Author(s):  
Vasileios Panoulas ◽  
Charles Ilsley
Keyword(s):  
Cardiogenic Shock ◽  
Acute Coronary Syndromes ◽  
Validation Cohort ◽  
Conditional Logistic Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Circulatory Support ◽  
Ventricular Ejection Fraction ◽  
Arterial Blood ◽  
Coronary Syndromes

Introduction. We aimed to identify the independent “frontline” predictors of 30-day mortality in patients with acute coronary syndromes (ACS) and propose a rapid cardiogenic shock (CS) classification and management pathway. Materials and Methods. From 2011 to 2019, a total of 11439 incident ACS patients were treated in our institution. Forward conditional logistic regression analysis was performed to determine the “frontline” predictors of 30 day mortality. The C-statistic assessed the discriminatory power of the model. As a validation cohort, we used 431 incident ACS patients admitted from January 1, 2020, to July 20, 2020. Results. Independent predictors of 30-day mortality included age (OR 1.05; 95% CI 1.04 to 1.07, p < 0.001 ), intubation (OR 7.4; 95% CI 4.3 to 12.74, p < 0.001 ), LV systolic impairment (OR severe_vs_normal 1.98; 95% CI 1.14 to 3.42, p = 0.015 , OR moderate_vs_normal 1.84; 95% CI 1.09 to 3.1, p = 0.022 ), serum lactate (OR 1.25; 95% CI 1.12 to 1.41, p < 0.001 ), base excess (OR 1.1; 95% CI 1.04 to 1.07, p < 0.001 ), and systolic blood pressure (OR 0.99; 95% CI 0.982 to 0.999, p = 0.024 ). The model discrimination was excellent with an area under the curve (AUC) of 0.879 (0.851 to 0.908) ( p < 0.001 ). Based on these predictors, we created the SAVE (SBP, Arterial blood gas, and left Ventricular Ejection fraction) ACS classification, which showed good discrimination for 30-day AUC 0.814 (0.782 to 0.845) and long-term mortality p log − rank < 0.001 . A similar AUC was demonstrated in the validation cohort (AUC 0.815). Conclusions. In the current study, we introduce a rapid way of classifying CS using frontline parameters. The SAVE ACS classification could allow for future randomized studies to explore the benefit of mechanical circulatory support in different CS stages in ACS patients.

Cardiogenic shock in patients with acute coronary syndromes

2015 ◽  
Author(s):  
Holger Thiele ◽  
Uwe Zeymer
Keyword(s):  
Intensive Care ◽  
Cardiogenic Shock ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Intensive Care Treatment ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.

P6393Differences in coronary inflammation between the culprit and non-culprit vessels assessed by fat attenuation index on computed tomography in patients with acute coronary syndromes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Sugiyama ◽  
M Hoshino ◽  
Y Kanaji ◽  
T Horie ◽  
H Yuki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Acute Coronary Syndromes ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Perivascular Adipose Tissue ◽  
Ventricular Ejection Fraction ◽  
Attenuation Index ◽  
Coronary Syndromes

Abstract Background Inflammation is linked with progression of coronary atherosclerosis. Recent studies have reported the association between elevated perivascular fat attenuation index (FAI) on computed tomography (CT) and worse cardiac outcomes in patients with coronary artery disease. Purpose We aimed to investigate the differences in FAI-defined peri-coronary inflammation status between the culprit and non-culprit vessels in patients with acute coronary syndromes (ACS). Methods A total of 78 ACS patients with left anterior descending coronary arteries (LAD) as a culprit vessel who underwent coronary CT angiography and invasive coronary angiography were studied. Proximal 40-mm segments of the LAD and the right coronary artery (RCA) were traced. Coronary inflammation was assessed by the FAI defined as the mean CT attenuation value of perivascular adipose tissue (−190 to −30 Hounsfield units [HU]) in a layer of tissue within a radial distance from the outer coronary artery wall equal to the diameter of the vessel. All patients were divided into two groups according to the values of FAI in the LAD: high FAI group (FAI-LAD > median; n=39) and low FAI group (FAI-LAD ≤ median; n=39). Patient characteristics, angiographic and CT findings were compared between the two groups. Results In a total of 78 patients, median FAI in the LAD was −70.20 (interquartile range, −74.81 to −64.58) HU. High FAI group was associated with male sex and lower left ventricular ejection fraction compared with Low FAI group. Minimal lumen diameter, reference diameter, diameter stenosis, and lesion length on quantitative coronary angiography analysis and coronary artery calcium score on CT was not different between the groups. FAI in the RCA was also higher in High FAI group than that in Low FAI group (−67.64±8.31 vs. −76.47±6.25 HU, P<0.001). Paired t-test comparison demonstrated that culprit vessel showed higher FAI than the non-culprit vessel (−69.85±7.74 vs. −72.11±8.54 HU, P=0.013). Conclusions In ACS patients with culprit LAD lesions, FAI-defined peri-coronary inflammation status is higher in the culprit vessel than in the non-culprit vessel.

Cardiogenic shock in patients with acute coronary syndromes

2018 ◽  
Author(s):  
Holger Thiele ◽  
Uwe Zeymer
Keyword(s):  
Intensive Care ◽  
Cardiogenic Shock ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Intensive Care Treatment ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.

scholarly journals 348 Uric acid is associated with acute heart failure and cardiogenic shock at presentation in acute coronary syndrome patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alessandro Maloberti ◽  
Paola Rebora ◽  
Marco Centola ◽  
Nuccia Morici ◽  
Alice Sacco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cross Sectional ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Non Invasive Ventilation ◽  
Coronary Syndromes

Abstract Aims we focused on the role of Uric Acid (UA) as a possible determinant of Heart Failure (HF) related issues in Acute Coronary Syndromes (ACS) patients. Main outcome were acute HF and cardiogenic shock at admission, secondary outcomes were the need of Non Invasive Ventilation (NIV) use and the admission Left Ventricular Ejection Fraction (LVEF). Methods and results we consecutively enrolled 1269 ACS patients admitted to the cardiological Intensive Care Unit of the Niguarda and San Paolo hospitals (Milan, Italy) from June 2016 to June 2019. Hyperuricaemia was defined as a value higher than 6 mg/dl for females and 7 mg/dl for males. All the evaluated outcomes occurred more frequently in the hyperuricemic subjects (n = 292): acute HF 35.8 vs. 11.1% (P &lt; 0.0001), cardiogenic shock 10 vs. 3.1% (P &lt; 0.0001), NIV 24.1 vs. 5.1% (P &lt; 0.0001) with lower admission LVEF (42.9 ± 12.8 vs. 49.6 ± 9.9, P &lt; 0.0001). By multivariable analyses, UA was confirmed to be significantly associated with all the outcomes with the following odds ratio (OR): acute HF OR = 1.119; 95% CI: 1.019–1.229; cardiogenic shock OR = 1.157; 95% CI: 1.001–1.337; NIV use OR = 1.208; 95% CI: 1.078–1.354; LVEF β = −0.999; 95% CI: −1.413 to − 0.586. Conclusions The main result of our study was the finding of a significant association between UA and acute HF, cardiogenic shock, NIV use and LVEF. Due to the cross-sectional nature of our study no definite answer on the direction of these relationship can be drawn and further longitudinal study on UA changes over time during an ACS hospitalization are needed.

Abstract 5592: In Acute Coronary Syndromes Being Totally Revascularized Is As Good As Having A Normal Coronary Angiogram

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Rogerio Teixeira ◽  
Carolina Lourenco ◽  
Elisabete Jorge ◽  
Rui Baptista ◽  
Natalia Antonio ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Angiogram ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Invasive Strategy ◽  
Normal Coronary Angiogram ◽  
Incomplete Revascularization ◽  
Coronary Syndromes

Background: Revascularization is a crucial therapy in acute coronary syndromes (ACS). Purpose: to assess ACS patients outcomes, stratified according to the coronary angiography and/or angioplasty. Population and methods: 786 consecutive ACS patients submitted to an invasive strategy, divided in 3 groups: A (n=111) normal coronary angiogram; B (n=327) fully revascularized; C (n=348) incomplete revascularization. A 1-year follow up targeting major adverse cardiovascular events (MACE) was performed. Results: Group A had more females (38.7 vs 21.1 vs 24.4% p<0.01), patients were more admitted for unstable angina (37.3 vs 14.9 vs 17.9% p<0.01) and had a higher left ventricular ejection fraction (LVEF). Group B were more on previous statin therapy, had more often an admission for ST elevation acute myocardial infarction (17.3 vs 51.7 vs 42.4% p<0.001) and higher peak levels of cardiac biomarkers. Group C were older and had more frequently a previous history of coronary disease. Group C patients had a worse in-hospital mortality (1.8 vs 1.2 vs 7.5% p<0.01) and morbidity. The MACE free survival rate was significantly lower for group C (92.9% vs. 92.9% vs. 78.2%; log rank p<0.001). In a multivariate Cox regression analysis, incomplete revascularization remained an independent predictor of MACE at 1 year (HR 2.74, CI 1.50 – 4.94), in a model that included, age, gender, LVEF, diabetes, coronary anatomy, and admission diagnosis. Conclusion: Our data strongly support the use of an aggressive invasive strategy in ACS, aimed at achieving full revascularization, as these patients had the same medium term prognosis as those with normal coronary angiogram.

scholarly journals Myocardial Infarction in Centenarians. Data from The Polish Registry of Acute Coronary Syndromes

2020 ◽  
Vol 9 (10) ◽  
pp. 3377
Author(s):  
Jacek Piegza ◽  
Lech Poloński ◽  
Aneta Desperak ◽  
Andrzej Wester ◽  
Marianna Janion ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndromes ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Invasive Treatment ◽  
Old Patients ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndromes ◽  
Group 2 ◽  
Group 1

Background: There are no data regarding the mortality rate, risks and benefits of particular reperfusion methods and pharmacological treatment complications in patients aged over 100 years with acute coronary syndromes. We sought to assess the treatment of myocardial infarction (MI) in patients older than 100 years and to determine prognostic factors for this group. Methods: Among the 716,566 patients recorded between 2003 and 2018 in the Polish Registry of Acute Coronary Syndromes, 104 patients aged ≥100 with MI were included. The patients were categorized into two groups: group 1 received conservative treatment (64 patients), and group 2 received invasive strategy (40 patients). Results: The frequencies of in-hospital mortality, MI and stroke were similar in both arms. No difference in the frequency of the combined endpoint (death, reinfarction, stroke) was noted. Invasive treatment was more advantageous for 12-month outcomes; 50 patients in group 1 (79%) and 23 patients in group 2 (57.50%) died (p = 0.017). The multivariate analysis identified the lower left ventricular ejection fraction (EF) (Hazard Ratio (HR) = 0.96; 95% Confidence Interval (CI): 0.94–0.99; p = 0.012), lack of coronary angiography (HR = 0.49; 95% CI: 0.24–0.99; p = 0.048) and cardiac arrest (HR = 4.61; 95% CI: 1.64–12.99; p = 0.0038) as predictors of 12-month mortality in this group. Conclusions: Invasive MI treatment may be beneficial for selected very old patients.

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