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

Circulation ◽  
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.

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

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 &lt;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&lt;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

scholarly journals Cardiogenic Shock Due to ST Elevation Myocardial Infarction: How Far Are We?

2021 ◽  
Vol 01 (01) ◽  
pp. 003-0010
Author(s):  
Rohit Mody
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Hemodynamic Instability ◽  
St Elevation Myocardial Infarction ◽  
Treatment Modalities ◽  
Circulatory Support ◽  
Low Cardiac Output ◽  
Body Tissues ◽  
Early Revascularization ◽  
St Elevation

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.

P264 Comparison of in-hospital mortality between acute inferior wall STEMI patients with right ventricular infarction and without right ventricular infarction undergoing a primary PCI in KCMH

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
S Preechawuttidej ◽  
S Srimahachota
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Right Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Hospital Death ◽  
Inferior Wall ◽  
Right Ventricular Infarction ◽  
St Elevation ◽  
Ventricular Infarction

Abstract Background Patients with acute inferior wall ST elevation myocardial infarction, if there is a right ventricular myocardial infarction involvement, they have pretended a worse prognosis with hemodynamic and electrophysiologic complications causing higher in-hospital morbidity and mortality. However most patients in previous studies were mainly treated with intravenous fibrinolysis and also studied in the Caucasian populations. Objectives To compare the in-hospital mortality rate of patients with acute inferior wall ST elevation myocardial infarction with and without right ventricular infarction involvement, whom were treated with primary percutaneous coronary intervention (PPCI). Methods The study was a retrospective descriptive study which enrolled patients with acute inferior wall ST elevation myocardial infarction who were treated with PPCI in our hospital from 1 January 2007 - 31 December 2016. Results Among 452 acute inferior wall ST elevation myocardial infarction patients who were treated with PPCI, there were 99 patients who had right ventricular infarction involvement, the in-hospital mortality rate was 23.2%, mainly due to cardiogenic shock, compared with 5.1 % in patients who had no right ventricular infarction (p &lt; 0.001). Patients with right ventricular infarction had a significantly higher incidence of cardiogenic shock (48.5% versus 15.6%, P &lt; 0.001), the lower number of left ventricle ejection fraction (51.15 ± 17.27% versus 55.79 ± 12.46%, p = 0.037), the higher incidence of complete heart block (33.3% versus 11.9%, p &lt; 0.001) and ventricular tachycardia (15.2% versus 5.9%, p = 0.003). After adjustment for age, female sex, diabetes, hypertension, previous myocardial infarction, cardiogenic shock on admission, left ventricular ejection fraction, ventricular tachycardia and complete heart block, the right ventricular infarction remained the independent predictor of in-hospital death (adjusted hazard ratio, 1.69; 95% confidence interval, 0.38 to 7.48; P = 0.489) and significant independent predictor for 1-year mortality (adjusted hazard ratio, 2.76; 95% confidence interval, 1.08 to 7.03; P = 0.034). Conclusion Patients with acute inferior wall STEMI whom were treated with PPCI, if there was right ventricular infarction involvement, the in-hospital death and 1-year mortality were significantly higher than who were without right ventricular infarction.

scholarly journals In-hospital mortality of cardiogenic shock complicating ST-elevation myocardial infarction in Malaysia: a retrospective analysis of the Malaysian National Cardiovascular Database (NCVD) registry

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e025734 ◽  
Author(s):  
Padmaa Venkatason ◽  
Yong Z Zubairi ◽  
Wan Azman Wan Ahmad ◽  
Muhammad Imran Hafidz ◽  
Muhammad Dzafir Ismail ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Risk Reduction ◽  
Retrospective Analysis ◽  
Mortality Risk ◽  
St Elevation Myocardial Infarction ◽  
Invasive Therapy ◽  
St Elevation ◽  
National Cardiovascular

ObjectivesCardiogenic shock (CS) complicating ST-elevation myocardial infarction (STEMI) carries an extremely high mortality. The clinical pattern of this life threatening complication has never been described in Malaysian setting. This study is to investigate the incidence, clinical characteristics and outcome of STEMI patients with CS in our population.DesignA retrospective analysis of STEMI patients from 18 hospitals across Malaysia contributing to the Malaysian National Cardiovascular Database-acute coronary syndrome) registry (NCVD-ACS) year 2006–2013.Participants16 517 patients diagnosed of STEMI from 18 hospitals in Malaysia from the year 2006 to 2013.Primary outcome measuresIn-hospital and 30 day post-discharge mortality.ResultsCS complicates 10.6% of all STEMIs in this study. They had unfavourable premorbid conditions and poor outcomes. The in-hospital mortality rate was 34.1% which translates into a 7.14 times mortality risk increment compared with STEMI without CS. Intravenous thrombolysis remained as the main urgent reperfusion modality. Percutaneous coronary interventions (PCI) in CS conferred a 40% risk reduction over non-invasive therapy but were only done in 33.6% of cases. Age over 65, diabetes mellitus, hypertension, chronic lung and kidney disease conferred higher risk of mortality.ConclusionMortality rates of CS complicating STEMI in Malaysia are high. In-hospital PCI confers a 40% mortality risk reduction but the rate of PCI among our patients with CS complicating STEMI is still low. Efforts are being made to increase access to invasive therapy for these patients.

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