scholarly journals Predictors of unfavorable clinical outcomes of myocardial infarction complicated cardiogenic shock: results of single center retrospective study

2020 ◽  
Vol 27 (3) ◽  
pp. 25-35
Author(s):  
I. V. Polivenok ◽  
О. V. Gritsenko ◽  
О. S. Sushkov ◽  
О. О. Berezin ◽  
О. Е. Berezin
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Retrospective Study ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Chronic Total Occlusion ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Total Occlusion ◽  
Single Vessel

The aim – to search for risk factors of adverse clinical outcome of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Materials and methods. In pilot retrospective study 1,292 consecutive patients with AMI treated by emergent percutaneous coronary intervention (PCI) in the reperfusion center of Zaitsev V.T. Institute for General and Emergency Surgery NAMS of Ukraine were selected. 54 out of 1292 patients (4.2 %) matched the Society for Cardiovascular Angiography and Interventions (SCAI) criteria of CS stage C and higher either on admission or during hospitalization. Results and discussion. The overall hospital mortality in patients with CS due to AMI in our series was 59.3 %. Univariant analysis revealed that the age of 65 and higher, left ventricular ejection fraction < 40 %, a single-vessel coronary lesion, absence of concomitant chronic total occlusion (CTO), reperfusion deterioration and cardiac arrest were the only risk factors for hospital death in CS patients. The risk of CS progression was independently associated with anemic syndrome (Hb < 118 g/l), chronic total occlusion, and multivessel coronary disease. In a multivariant logistic regression the preexisting LV EF < 40 %, single-vessel disease and absence of CTO were found as the independent predictors of hospital morta­­­lity in СS. Conclusions. СS in patients with AMI still be a significant challenge even after successful PCI, associated with high in-hospital mortality (59.3 %). There is an unmet need for development and implementation of an adjusted registry-based national protocol for CS management in order to improve patient survival.

scholarly journals Clinical characteristic and management of elderly patients with myocardial infarction

2019 ◽  
Vol 147 (3-4) ◽  
pp. 167-172
Author(s):  
Jadranka Dejanovic ◽  
Igor Ivanov ◽  
Tanja Popov ◽  
Milenko Cankovic ◽  
Aleksandra Vulin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Cardiovascular Diseases ◽  
Ejection Fraction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Treatment Strategies ◽  
The Elderly ◽  
Left Ventricular ◽  
Clinical Characteristic

Introduction/Objective. Population of elderly people is increasing and modern medicine is faced with the problem of large morbidity and mortality from cardiovascular diseases in this age group. Modern treatment strategies have not been sufficiently investigated in the elderly, therefore these people often receive suboptimal treatment. The aim of the study was to evaluate clinical characteristic, cardiac risk factors, management strategies and early outcome in the elderly patient with ST elevated myocardial infarction (STEMI). Methods. This retrospective study included 217 consecutive patients, aged ? 70 years (mean age 77.6 ? 4.9 years, 103 men, 114 women) with STEMI admitted to the Institute of Cardiovascular Diseases of Vojvodina. We have analyzed patients? clinical characteristics, risk factors, left ventricular function and treatment strategies in relation to in-hospital outcome. Results. First clinical symptom was chest pain in 209 (96.3%) of patients. On admission, 35 (16.1%) patients were with severe signs of heart failure (Killip class III?IV). Duration of symptom onset to hospital admission was 14.7 ? 28.6 hours. Out of 217 patients, 168 (77.4%) patients received reperfusion treatment, including primary percutaneous coronary ntervention (PPCI) in 164 (75.6%) patients, and fibrinolytic therapy in 4 (1.8%) patients. Hospital mortality was 26.3% (57 patients). PPCI was univariate predictor of lower in-hospital mortality, whereas multivariate predictors of in-hospital mortality were cardiogenic shock (OR 67.095; 95% CI (6.845?657.646); p < 0.001) and low ejection fraction (OR 0.901; 95% CI (0.853?0.963); p = 0.001). Conclusion. In elederly patients presenting with STEMI, PPCI was asscoiated with lower mortality, whereas cardiogenic shock and lower ejection fraction were independent predictors of worse prognosis after STEMI.

scholarly journals Complete percutaneous myocardial revascularization in patients with STEMI complicated by cardiogenic shock

2019 ◽  
Vol 76 (2) ◽  
pp. 152-160
Author(s):  
Milovan Petrovic ◽  
Milana Jarakovic ◽  
Milenko Cankovic ◽  
Ilija Srdanovic ◽  
Mila Kovacevic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Vessel Disease ◽  
Early Revascularization ◽  
Infarct Related Artery

Background/Aim. Despite considerable progress in terms of early myocardial revascularization and the use of mechanical circulatory support, cardiogenic shock continues to be the leading cause of death in acute myocardial infarction. The current recommendations of the European Society of Cardiology advocate early revascularization of all critical stenosis or highly unstable lesions in the state of cardiogenic shock, while recently published studies favour the early revascularization of the infarct related artery only, in patients with acute myocardial infarction with the ST segment elevation (STEMI) presenting with cardiogenic shock. The aim of the study was to assess the impact of the complete early percutaneous myocardial revascularization in an acute myocardial infarction complicated by cardiogenic shock on intra- hospital mortality. Methods. The research was conducted as a retrospective observational analysis of data obtained from the hospital registry for cardiogenic shock. The study group consisted of 235 patients treated in the period from August 2007 until October 2016 for STEMI complicated by cardiogenic shock. Three groups were formed. The first group consisted of patients with one vessel disease who underwent revascularization of infarct related artery; the second group of patients had multi-vessel disease and only culprit lesions were revascularized and the third one consisted of patients with multi-vessel disease and the complete myocardial revascularization performed. Additional subgroups were formed in reference to the intra-aortic balloon pump (IABP) implantation. Intra-hospital mortality was analyzed in all groups and subgroups. Results. Revascularization of the culprit lesion alone among patients with multivessel disease was performed in 142 (60.4%) patients while the complete revascularization (revascularization of ?culprit? and other significant lesions) was performed in 28 (11.9%) patients with multi-vessel disease. There were 65 (27.7%) patients with single-vessel disease who underwent revascularization of infarct related artery. The lowest mortality was found in the group of patients with multi-vessel coronary disease who underwent complete myocardial revascularization and had IABP implanted (mortality was 35.7%). The difference in the mean value of the left ventricular ejection fraction (EF) between the surviving and deceased patients was statistically significant (p < 0.005). The average EF of survivors was 44% (35%?50%) while 30% (25%?39.5%) deceased of patients. Based on the obtained data, the mathematically predictive model was tested. The receiver operating characteristic (ROC) curve showed that our model is a good predictor of fatal outcome (p < 0.0005; AUROC = 0.766) with the sensitivity of 80.3%, and the specificity of 67%. Conclusion. STEMI complicated by cardiogenic shock is still associated with a high mortality rate. Complete myocardial revascularization independently as well as in combination with an IABP, significantly reduces mortality in patients with acute STEMI complicated by cardiogenic shock.

scholarly journals In-hospital results of rheolytic catheter thrombectomy in patients with STEMI

2016 ◽  
Vol 20 (3) ◽  
pp. 54
Author(s):  
M V Malkhasyan ◽  
V A Kuznetsov ◽  
I S Bessonov ◽  
P I Pavlov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Contractile Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Old Myocardial Infarction ◽  
Mean Time

<p><strong>Aim.</strong> The article focuses on the evaluation of short-term efficacy of rheolytic thrombectomy (AngioJet) in patients with STEMI. <br /><strong>Methods.</strong> 188 patients (85.6% men) with STEMI underwent primary PCI by means of rheolytic catheter thrombectomy (AngioJet). The mean age was 54.1 ± 10.7 years. 32 (17 %) of patients had old myocardial infarction. 104 (55.9 %) patients were diagnosed with ST-elevated inferior myocardial infarction. 22 (12 %) patients were operated under cardiogenic shock. Mean time from the appearance of symptoms to admission was 222.5 [70, 584] min. Anterior interventricular artery (38.3 %) and right coronary artery (43.6 %) were the main infarction-related arteries. <br /><strong>Results.</strong> Complete thrombotic occlusion of the coronary artery occurred in 144 (77.4%) patients. Mean “door-to-balloon” time amounted to 41.5 [30; 60]. Coronary thrombus was fully removed in 107 (60.8%) of patients. Stents with antiproliferative effect were implanted in 48.8 % of patients. Immediate angiographic success was achieved in 177 (94.1%) cases. Mean time of PCI was 60 [50; 80] min. PCI complications were registered in 3 (1.6%) patients. Intraoperative life-threatening arrhythmias happened in 22 (11.7 %) patients. The phenomenon of "no-reflow" occurred in 6 (3.2%) PCI cases. The rate of in-hospital mortality was 5.9%, including patients with cardiogenic shock (36.4%) and those without it (1.9 %). MACCE (main adverse cardio-cerebral events) were observed in 15 (8%) cases. According to ECG data obtained postoperatively, 26 % of patients demonstrated no regional asynergy, while a decrease in myocardial contractile function occurred in just 26 % of cases, with the average left ventricular ejection fraction running to 57.5±9 %. Mean in-hospital stay was 9.5±0.6 days.<br /><strong>Conclusion.</strong> The results of this study suggest that rheolytic catheter thrombectomy (AngioJet) is a safe and effective modality. Immediate hospital results show low rate complications and low in-hospital mortality.</p><p>Received 13 April 2016. Accepted 9 June 2016.</p><p><strong>Conflict of interest:</strong> The authors declare no conflict interests.</p>

scholarly journals PREDICTORS OF THE ADVERSE COURSE AT HOSPITAL STAGE OF Q-MYOCARDIAL INFARCTION TREATMENT

2019 ◽  
Vol 42 (3) ◽  
pp. 56-63
Author(s):  
Syvolap V. D. ◽  
Kapshytar N. I.
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Copeptin Level ◽  
Independent Risk Factors

Purpose of the study. Identify predictors of the course adverse at hospital stage of Q-myocardial infarction treatment. Materials and methods. The study involved 139 patients in the acute stage of Q-MI, average age 66 ± 0,97 year, male – 59%. Patients underwent a general clinical examination, determined the level of glycemia on admission, copeptin, NTproBNP, left ventricular ejection fraction (LVEF). 101 patients have reached cumulative endpoint (CEP), average age of 68 ± 1,02 years, of which male were 57%. As the CEP were considered one of the occurrence adverse events: death on the hospital stage (n = 17, average age 70,4 ± 2,37 years, male – 53%),development of acute heart failure (n = 94, Killip II – n = 52, Killip III n = 42, 52% were male, average age 69,2 ± 8,3 years), decreased LVEF < 45% (n = 64, average age 66 ± 1,22 years, male 63%).38 patients did not have a single endpoint, the average age 62 ± 2,2 years, male 67%. Results. According to multivariate logistic regression analysis, independent risk factors for increased risk of intra-hospital mortality were copeptin level more than 0,87 ng/ml, which increased the odds ratio (OR) by 1,4651 times (p = 0,014) and hyperglycemia on admission more than 9,0 mmol/L, which increased intra-hospital mortality by 1,2 times (p = 0,006). Independent risk factors for achieving the CEP were tachycardia (OR = 3,19; p = 0,009), increased copeptin level more than 3,3 pmol/L (OR = 1,52; p = 0,01) and hyperglycemia more than 9,3 mmol/l (OR = 1,20; p = 0,02). Conclusion. Independent risk factors of increasing intra-hospital mortality were the level of copeptin more than 0,87ng/ml and hyperglycemia on admission more than, 9 mmol/l. Dependent and independent risk factors for CEP were tachycardia, an increase in the level of copeptin over 3,3 ng/ml and hyperglycaemia on admission more than 9,3 mmol/l. Keywords. Q-myocardial infarction, acute heart failure, predictors, hyperglycemia, copeptin.

Prognostic role of procalcitonin in ST-elevation myocardial infarction complicated by cardiogenic shock

2021 ◽  
pp. 021849232098791
Author(s):  
Yash Paul Sharma ◽  
Ganesh Kasinadhuni ◽  
Krishna Santosh ◽  
Nitin Kumar Parashar ◽  
Rakesh Sharma ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Independent Predictor ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Left Ventricular Ejection ◽  
Left Heart Failure ◽  
St Elevation

Objective Cardiogenic shock accounts for the majority of deaths amongst patients with ST-elevation myocardial infarction. Procalcitonin is elevated in acute myocardial infarction, especially when complicated by left heart failure, cardiogenic shock, resuscitated cardiac arrest, and bacterial infections. However, the prognostic utility of procalcitonin in ST-elevation myocardial infarction complicated by cardiogenic shock has not been systematically evaluated. Methods We performed a retrospective registry review of 125 patients with ST-elevation myocardial infarction and cardiogenic shock over 2 years at a tertiary referral hospital to examine the prognostic value of serum procalcitonin measurement at 24 hours after the onset of infarction for in-hospital mortality. Results The mean age of the study population was 57.75 ± 11.1 years, and the median delay from onset to hospital admission was 15 hours. The in-hospital mortality was 28.8%. Receiver operating characteristic analysis revealed a strong relationship between elevated procalcitonin and in-hospital mortality (area under the curve = 0.676; p = 0.002). Although procalcitonin was found to be higher in non-survivors in univariate analysis, it was not an independent predictor of mortality in multivariate regression analysis. Acute kidney injury, left ventricular ejection fraction, and non-revascularization were independently associated with mortality after adjusting for covariates. Conclusion Although procalcitonin was higher in non-survivors, static procalcitonin measurement at 24 hours after the onset of ST-elevation myocardial infarction complicated by cardiogenic shock was not an independent predictor of in-hospital mortality. Additional prospective studies are required to assess the role of serial procalcitonin monitoring in ST-elevation myocardial infarction complicated by cardiogenic shock.

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