Metrics

  • citations in SCIndeks: 0
  • citations in CrossRef:0
  • citations in Google Scholar:[]
  • visits in previous 30 days:0
  • full-text downloads in 30 days:0

Contents

article: 4 from 26  
Back back to result list
2019, vol. 76, iss. 2, pp. 152-160
Complete percutaneous myocardial revascularization in patients with STEMI complicated by cardiogenic shock
aUniversity of Novi Sad, Faculty of Medicine + University of Novi Sad, Faculty of Medicine, Institute for Cardiovascular Disease
bUniversity of Novi Sad, Faculty of Medicine, Institute for Cardiovascular Disease
cUniversity of Novi Sad, Faculty of Medicine

emailmilovan.petrovic@mf.uns.ac.rs
Abstract
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.
References
Babaev, A., Frederick, P.D., Pasta, D.J., Every, N., Sichrovsky, T., Hochman, J.S., NRMI, I.for the (2005) Trends in Management and Outcomes of Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock. JAMA, 294(4): 448
Bonnow, R.O., Mann, DL., Zipes, D.P., Libby, P. (2011) Braunwald's heart disease: A textbook of cardiovascular medicine. Philadelphia: Elsevier Science, 9th ed
Filho, F.H.F., Conejo, F., Santos, L.N.dos, Campos, C.A., Neto, P.A.L. (2013) In-hospital Outcomes of Patients with Cardiogenic Shock due to ST-Segment Elevation Myocardial Infarction. Revista Brasileira de Cardiologia Invasiva (English Edition), 21(3): 265-269
Garcia-Alvarez, A., Arzamendi, D., Loma-Osorio, P., Kiamco, R., Masotti, M., Sionis, A., Betriu, A., Brugada, J., Bosch, X. (2009) Early Risk Stratification of Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction Who Undergo Percutaneous Coronary Intervention. American Journal of Cardiology, 103(8): 1073-1077
Gershlick, A.H., Khan, J.N., Kelly, D.J., Greenwood, J.P., Sasikaran, T., Curzen, N., i dr. (2015) Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial. J Am Coll Cardiol, 65(10): 963-72
Goldberg, R.J., Spencer, F.A., Gore, J.M., Lessard, D., Yarzebski, J. (2009) Thirty-Year Trends (1975 to 2005) in the Magnitude of, Management of, and Hospital Death Rates Associated With Cardiogenic Shock in Patients With Acute Myocardial Infarction. Circulation, 119(9): 1211-1219
Goldberg, R.J., Samad, N.A., Yarzebski, J., Gurwitz, J., Bigelow, C., Gore, J.M. (1999) Temporal Trends in Cardiogenic Shock Complicating Acute Myocardial Infarction. New England Journal of Medicine, 340(15): 1162-1168
Ibanez, B., James, S., Agewall, S., Antunes, M.J., Bucciarelli-Ducci, K., Bueno, H., i dr. (2018) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the ESC. Eur Heart J, 39(2): 119-77
Ibrahim, H., Sharma, P.K., Cohen, D.J., Fonarow, G.C., Kaltenbach, L.A., Effron, M.B., Zettler, M.E., Peterson, E.D., Wang, T.Y. (2017) Multivessel Versus Culprit Vessel-Only Percutaneous Coronary Intervention Among Patients With Acute Myocardial Infarction: Insights From the TRANSLATE‐ACS Observational Study. Journal of the American Heart Association, 6(10):
Institute of Public Health of Serbia Dr Milan Jovanović Batut (2015) Incidence and mortality of acute coronary syndrome in Serbia. in: Serbian Acute Coronary Syndrome Registry: Report No. 10, Belgrade
Kolte, D., Khera, S., Aronow, W.S., Mujib, M., Palaniswamy, C., Sule, S., Jain, D., Gotsis, W., Ahmed, A., Frishman, W.H., Fonarow, G.C. (2014) Trends in Incidence, Management, and Outcomes of Cardiogenic Shock Complicating ST‐Elevation Myocardial Infarction in the United States. Journal of the American Heart Association, 3(1):
Leor, J., Goldbourt, U., Reicher-Reiss, H., Kaplinsky, E., Behar, S. (1993) Cardiogenic shock complicating acute myocardial infarction in patients without heart failure on admission: Incidence, risk factors, and outcome. American Journal of Medicine, 94(3): 265-273
Levine, G.N., Bates, E.R., Blankenship, J.C., Bailey, S.R., Bittl, J.A., Cercek, B., i dr. (2016) ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With STElevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for t. J Am Coll Cardiol, 67(10): 1235-50
Lindholm, M. (2003) Cardiogenic shock complicating acute myocardial infarction Prognostic impact of early and late shock development. European Heart Journal, 24(3): 258-265
Longo, DL., Fauci, A.S., Kasper, DL., Hauser, S.L., Jameson, J.L., Loscalzo, J. (2012) Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 18th ed
Mehta, R.H., Ou, F., Peterson, E.D., Shaw, R.E., Hillegass, W.B., Rumsfeld, J.S., Roe, M.T. (2009) Clinical Significance of Post-Procedural TIMI Flow in Patients With Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention. JACC: Cardiovascular Interventions, 2(1): 56-64
Menon, V., Fincke, R. (2012) Cardiogenic Shock: A Summary of the Randomized SHOCK Trial. Congestive Heart Failure, 9(1): 35-39
Rasoul, S., Ottervanger, J.P., de Boer, M., Dambrink, J.E., Hoorntje, J.C.A., Marcel, G.A.T., Zijlstra, F., Suryapranata, H., van ʼt Hof, A.W.J. (2009) Predictors of 30-day and 1-year mortality after primary percutaneous coronary intervention for ST-elevation myocardial infarction. Coronary Artery Disease, 20(6): 415-421
Sorajja, P., Gersh, B. J., Cox, D. A., McLaughlin, M. G., Zimetbaum, P., Costantini, C., Stuckey, T., Tcheng, J. E., Mehran, R., Lansky, A. J., Grines, C. L., Stone, G. W. (2007) Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. European Heart Journal, 28(14): 1709-1716
The, T.I. (2007) Effect of Tilarginine Acetate in Patients With Acute Myocardial Infarction and Cardiogenic Shock. JAMA, 297(15): 1657
Thiele, H., Allam, B., Chatellier, G., Schuler, G., Lafont, A. (2010) Shock in acute myocardial infarction: the Cape Horn for trials?. European Heart Journal, 31(15): 1828-1835
Thiele, H., Akin, I., Sandri, M., Fuernau, G., de Waha, S., Meyer-Saraei, R., Nordbeck, P., Geisler, T., Landmesser, U., Skurk, C., Fach, A., Lapp, H., Piek, J.J., Noc, M., Goslar, T., Felix, S.B. (2017) PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock. New England Journal of Medicine, 377(25): 2419-2432
Thiele, H., Zeymer, U., Neumann, F., Ferenc, M., Olbrich, H., Hausleiter, J., de Waha, A., Richardt, G., Hennersdorf, M., Empen, K., Fuernau, G., Desch, S., Eitel, I., Hambrecht, R., Lauer, B. (2013) Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet, 382(9905): 1638-1645
Thiele, H., Zeymer, U., Neumann, F., Ferenc, M., Olbrich, H., Hausleiter, J., Richardt, G., Hennersdorf, M., Empen, K., Fuernau, G., Desch, S., Eitel, I., Hambrecht, R., Fuhrmann, J., Böhm, M. (2012) Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock. New England Journal of Medicine, 367(14): 1287-1296
Toma, M., Buller, C. E., Westerhout, C. M., Fu, Y., o'Neill W. W., Holmes, D. R., Hamm, C. W., Granger, C. B., Armstrong, P. W. (2010) Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial. European Heart Journal, 31(14): 1701-1707
Vincent, J., de Backer, D. (2013) Circulatory Shock. New England Journal of Medicine, 369(18): 1726-1734
Wald, D.S., Morris, J.K., Wald, N.J., Chase, A.J., Edwards, R.J., Hughes, L.O., Berry, C., Oldroyd, K.G. (2013) Randomized Trial of Preventive Angioplasty in Myocardial Infarction. New England Journal of Medicine, 369(12): 1115-1123
Windecker, S., i dr. (2014) 2014 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal, 35(37): 2541-2619
 

About

article language: English
document type: Original Scientific Paper
DOI: 10.2298/VSP180128183P
published in SCIndeks: 25/04/2019
peer review method: double-blind
Creative Commons License 4.0

Related records