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

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.

scholarly journals INTRA-AORTIC BALLOON PUMP OR IMPELLA FOR ACUTE ST-ELEVATION MYOCARDIAL INFARCTION COMPLICATED BY CARDIOGENIC SHOCK

2021 ◽  
Vol 77 (18) ◽  
pp. 1256
Author(s):  
Samarthkumar Thakkar ◽  
Harsh Patel ◽  
Bryan E-Xin Tan ◽  
Smit Patel ◽  
Kirtenkumar Patel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
St Elevation Myocardial Infarction ◽  
Intra Aortic Balloon Pump ◽  
St Elevation

P1726A gender perspective on incidence, management, short- and long term outcome of cardiogenic shock complicating ST-elevation myocardial infarction - A report from the SWEDEHEART register

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Sederholm Lawesson ◽  
D Venetsanos ◽  
M Fredriksson ◽  
T Jernberg ◽  
N Johnston ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Gender Difference ◽  
Cardiogenic Shock ◽  
Cox Regression ◽  
Elderly Women ◽  
Reperfusion Therapy ◽  
St Elevation Myocardial Infarction ◽  
Term Outcome ◽  
Long Term Outcome ◽  
St Elevation

Abstract Background Cardiogenic shock [CS] is a severe complication of ST-elevation myocardial infarction [STEMI]. An increased use of primary percutaneous coronary intervention [PPCI] has been associated with a decline in CS incidence, and a better prognosis. Female gender has been associated with a worse prognosis in STEMI, but whether there is a gender difference in incidence and outcome of CS complicating STEMI is not known. Purpose The objectives of this study were to compare the genders regarding incidence, management, and prognosis of CS complicating STEMI. Methods Patients with STEMI and CS were identified in SWEDEHEART 2005–2014. Cardiogenic shock was defined as any of; 1) systolic blood pressure [BP] <90 mm Hg ≥30 min, 2) signs of tissue hypoperfusion, 3) cardiac index <1,8 l/min/m2, 4) ionotropic drugs and/or need of intra-aortic balloon pump. Multiple logistic and cox regression analyses were done with reperfusion therapy, in-hospital and 1-year mortality as dependent variables. Results Among 56072 STEMI patients 3134 CS cases were identified. Women more often than men developed CS (6.3 vs 5.2%, p<0.001). The age-adjusted incidence of CS did not change in women, whereas in men the incidence increased by 2.7% yearly. Women had a less chance of receiving reperfusion therapy, OR 0.77 (95% CI 0.65–0.92), but had neither higher in-hospital mortality (OR 1.01, 95% CI 0.85–1.19), nor higher 1-year mortality (OR 0.97, 95% CI 0.70–1.33). Upon age stratification the gender difference in reperfusion was only evident among the oldest (>80 years). Conclusion Women had higher risk of CS than men when stricken by STEMI, but whereas CS incidence increased in men it was stable in women. Although women had less likelihood of receiving reperfusion therapy, adjusted in-hospital, and 1-year mortality was without any gender difference. The rate of reperfusion was especially low in elderly women, where there seems to be room for improvement.

scholarly journals Double Jeopardy : Acute myocardial infarction complicated by cardiogenic shock and contrast mediated anaphylactoid reaction

2013 ◽  
Vol 1 (2) ◽  
pp. 30
Author(s):  
Ha-uyen Thi Nguyen ◽  
Andrew B Civitello ◽  
Cihan Cevik ◽  
Leo Simpson
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Contrast Media ◽  
Anaphylactoid Reaction ◽  
Cardiopulmonary Arrest ◽  
Anterior Wall ◽  
St Elevation Myocardial Infarction ◽  
Iodinated Contrast ◽  
St Elevation ◽  
Radiocontrast Agents

A 63 year-old woman who developed a severe anaphylactoidreaction to iodinated contrast in the setting of emergent percutaneous intervention(PCI) for a large anterior wall ST elevation myocardial infarction (STEMI) resulting incardiogenic shock followed by cardiopulmonary arrest necessitating placement of the patient on the arterio-venous extra corporeal membrane oxygenation (ECMO). While anaphylactoid/anaphylactic reactions to radiocontrast agents have been well documentedin literature, the development of an anaphylactoid reaction secondary to radiocontrastmedia in the setting of an ST elevation myocardial infarction (STEMI) and resultingin cardiogenic shock has never been reported. We discuss naphylactoidreactions to contrast media occurs by non-immunologic (i.e. non IgE ) mechanisms. Premedication does not abate or prevent all types of iodinated contrastmediated reactions. However, studies have shown that premedication is effective fora cutaneous reaction to iodinated contrast media (ICM). Due to the relative excellentsafety profiles of the premedication, physicians should continue to use them prior to asuspected ICM reaction.

Sign in / Sign up

Export Citation Format

Share Document