ST-Elevation Myocardial Infarction With Cardiogenic Shock and Severe Acute Ischemic Mitral Regurgitation Rescued by Primary Coronary Intervention Under Hemodynamic Support With Impella.
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ABSTRACT:
SUBMITTER: Koiwaya H
PROVIDER: S-EPMC8099668 | biostudies-literature | 2021 Apr
REPOSITORIES: biostudies-literature
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ST-Elevation Myocardial Infarction With Cardiogenic Shock and Severe Acute Ischemic Mitral Regurgitation Rescued by Primary Coronary Intervention Under Hemodynamic Support With Impella.
Koiwaya Hiroshi H Watanabe Nozomi N Nishihira Kensaku K Goriki Yuhei Y Shibata Yoshisato Y
Circulation reports 20210410 5
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Project description:BackgroundDespite limited randomized trial data demonstrating clinical efficacy, the utilization of Impella in ST-elevation myocardial infarction (STEMI) patients complicated with cardiogenic shock (CS) has increased over time.MethodsWe identified 75,769 hospitalizations with STEMI complicated by CS between October 2015 and December 2018 using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. From this cohort, hospitalizations were stratified according to IABP or Impella placement. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were divided into efficacy, safety, and device-related complications. Propensity-score matching was used to account for differences in the baseline characteristics between the groups. Logistic regression was performed to get the odds ratio and confidence intervals.ResultsAmong 75,769 admissions with STEMI and CS, hospitalizations with <18 years old, both IABP and Impella placement, and who underwent ECMO and/or LVAD implantation were excluded. After the exclusion, out of 72,791 admissions, 25,260 (34.70%) hospitalizations received IABP, and 7825 (10.75%) received Impella support. After propensity score-matched analysis, 7345 hospitalizations were included in each group. All-cause in-hospital mortality was higher in the hospitalizations requiring Impella support as compared to IABP (42.10% vs. 31.54%, adjusted OR 1.71; 95% confidence interval (CI) 1.60-1.84, P < 0.0001). Impella was associated with a higher risk of in-hospital complications and hospitalization cost compared with IABP.ConclusionImpella compared with IABP in STEMI patients with CS was associated with higher in-hospital mortality and other adverse clinical and procedural outcomes.
| S-EPMC10978134 | biostudies-literature
Project description:BackgroundCardiogenic shock complicating acute myocardial infarction is associated with reduced survival despite advancements in the treatment of acute coronary syndromes. Characterizing predictors of morbidity and mortality in this setting is crucial to improving risk stratification and management. Notwithstanding, the interplay of factors determining survival in this condition remains poorly studied.MethodsEmbase, MEDLINE, and CINAHL databases were searched for original studies evaluating predictors of short-term (30-day or in-hospital) survival in ST elevation myocardial infarction with cardiogenic shock (STEMI-CS). Included studies were analyzed by way of vote counting, identifying variables that predicted mortality or survival.ResultsTwenty-four studies, consisting of 14,735 patients (5649 nonsurvivors and 9086 survivors) were included. All studies were observational by design (17 retrospective and 7 prospective) with clinical and statistical heterogeneity. Unsuccessful revascularization, reduced left ventricular ejection fraction, renal impairment, and other variables were identified as key independent predictors of mortality.ConclusionSeveral key variables have been shown to independently increase mortality in STEMI-CS populations. Future prospective studies examining the prognostic role of multivariate scoring systems incorporating these domains are required.
| S-EPMC11256274 | biostudies-literature
Project description:BackgroundCardiogenic shock (CS) remains the leading cause of ST elevation myocardial infarction (STEMI)-related mortality. Contemporary studies have shown no sex-related differences in mortality.MethodsSTEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) were included based on a dedicated prospective STEMI database. We compared sex-specific differences in CS characteristics at baseline, during hospitalization, and in subsequent clinical outcomes. Endpoints included all-cause mortality and major adverse cardiac events (MACE).ResultsOf 3202 consecutive STEMI patients, 210 (6.5%) had CS, of which 63 (30.0%) were women. Women were older than men (73.2 vs. 65.5% y, p < 0.01), and more had hypertension (68.3 vs. 52.8%, p = 0.019) and diabetes (38.7 vs. 24.8%, p = 0.047). Fewer were smokers (13.3 vs. 41.2%, p < 0.01), had previous PCI (9.1 vs. 22.3% p = 0.016), or required IABP (35.3 vs. 51.1% p = 0.027). Women had higher rates of mortality (53.2 vs. 35.3% in-hospital, p = 0.01; 61.3 vs. 41.9% at 1 month, p = 0.01; and 73.8 vs. 52.6% at 3 years, p = 0.05) and MACE (60.6 vs. 41.6% in-hospital, p = 0.032; 66.1 vs. 45.6% at 1 month, p = 0.007; and 62.9 vs. 80.3% at 3 years, p = 0.015). After multivariate adjustment, female sex remained an independent factor for death (HR-2.42 [95% CI 1.014-5.033], p = 0.042) and MACE (HR-1.91 [95% CI 1.217-3.031], p = 0.01).ConclusionsCS complicating STEMI is associated with greater short- and long-term mortality and MACE in women. Sex-focused measures to improve diagnosis and treatment are mandatory for CS patients.
| S-EPMC10573491 | biostudies-literature
Project description:Affymetrix microarray (GeneChip microRNA 4.0) profilling of circulating miRNAs. We used miRNA arrays to profile miRNAs isolated from plasma of ST-segment elevation acute myocardial infarction (STEMI)-patients with cardiogenic shock (CS) or without cariogenic shock (Non-CS)
2024-03-26 | GSE254068 | GEO
Project description:Acute myocardial infarction (AMI) complicated by cardiogenic shock has high mortality and remains challenging even in the revascularization era. We conducted this study to understand patients' outcomes. We retrospectively analyzed electronic medical records data from 1175 patients with AMI complicated by cardiogenic shock that developed within 3 days of admission to a multicenter medical care system between January 1, 2000, and July 31, 2018. Patients with AMI were classified into the ST-segment elevation MI (STEMI) group or the non-ST-segment elevation MI (NSTEMI) group. The short-term and 1-year mortality and adverse events after index admission were analyzed via logistic regression and a Cox proportional hazards model. When compared with NSTEMI, patients with STEMI tended to be younger (65.68 ± 14.05 years vs 70.70 ± 12.99 years, P < .001), men (73.29% vs 60.87%, P < .001), and have fewer underlying chronic diseases. Short-term mortality at index hospitalization was 14.83% in the STEMI group and 21.30% in the NSTEMI group; long-term mortality was 17.06% for the STEMI group and 24.13% for the NSTEMI group. No difference was observed between the 2 groups for patients who developed a cerebral vascular accident during the admission period. However, the major and gastrointestinal bleeding rates were higher in the STEMI group (2.66% vs 0.22%, P = .014; 3.36% vs 0.22%, P = .007, respectively). Age and respiratory failure were the most significant risk factors for short-term mortality. Revascularization may be beneficial for the short-term outcome but did not reach significance in multivariable analysis. In patients with AMI with cardiogenic shock, NSTEMI was associated with a significantly higher mortality rate in short-term results.
| S-EPMC10980438 | biostudies-literature
Project description:Background: Cardiogenic shock (CS) is the most frequent cause of in-hospital mortality after ST-elevation myocardial infarction (STEMI). Data about CS in very elderly (age ≥ 85 years) STEMI patients are scarce. We sought to assess the prognostic factors and the short- and mid-term impact of CS in this population. Methods: Consecutive very elderly STEMI patients undergoing invasive treatment were included in a retrospective multicenter registry. Results: Among 608 patients, 72 (11.8%) fulfilled experienced CS. Peripheral artery disease (PAD) (OR: 2.25, 95% CI: 1.29-3.92, p < 0.01) and cardiac arrest at presentation (OR: 4.36, 95% CI: 2.32-8.21, p < 0.01) were the major independent predictors of CS. Age (HR: 1.07, 95% CI: 1.03-1.11, p < 0.001), PAD (HR: 1.29, 95% CI: 1.01-1.66, p = 0.045), previous MI (HR: 2.16, 95% CI: 1.32-3.55, p = 0.002), and cardiac arrest at presentation (HR: 1.59, 95% CI: 1.29-1.96, p < 0.001) were the major independent predictors of death. CS was associated with a higher risk of mortality at 30 days (adjusted HR: 4.21, 95% CI: 2.19 to 7.78, p < 0.01) mostly driven by higher intraprocedural and in-hospital mortality. Among patients who survived the acute phase and hospitalization, CS at presentation was not associated with a higher mortality risk during the remaining follow-up period (log-rank p = 0.78). Conclusions: At short-term follow-up, very elderly STEMI patients presenting with CS had a higher risk of mortality when compared to non-CS patients. Interestingly, CS patients surviving the acute phase showed a similar survival rate to non-CS patients after discharge.
| S-EPMC11766001 | biostudies-literature
Project description:AimsThere are limited contemporary data on the use of initial fibrinolysis in ST-segment elevation myocardial infarction cardiogenic shock (STEMI-CS). This study sought to compare the outcomes of STEMI-CS receiving initial fibrinolysis vs. primary percutaneous coronary intervention (PPCI).MethodsUsing the National (Nationwide) Inpatient Sample from 2009 to 2017, a comparative effectiveness study of adult (>18 years) STEMI-CS admissions receiving pre-hospital/in-hospital fibrinolysis were compared with those receiving PPCI. Admissions with alternate indications for fibrinolysis and STEMI-CS managed medically or with surgical revascularization (without fibrinolysis) were excluded. Outcomes of interest included in-hospital mortality, development of non-cardiac organ failure, complications, hospital length of stay, hospitalization costs, use of palliative care, and do-not-resuscitate status.ResultsDuring 2009-2017, 5297 and 110 452 admissions received initial fibrinolysis and PPCI, respectively. Compared with those receiving PPCI, the fibrinolysis group was more often non-White, with lower co-morbidity, and admitted on weekends and to small rural hospitals (all P < 0.001). In the fibrinolysis group, 95.3%, 77.4%, and 15.7% received angiography, PCI, and coronary artery bypass grafting, respectively. The fibrinolysis group had higher rates of haemorrhagic complications (13.5% vs. 9.9%; P < 0.001). The fibrinolysis group had comparable all-cause in-hospital mortality [logistic regression analysis: 28.8% vs. 28.5%; propensity-matched analysis: 30.8% vs. 30.3%; adjusted odds ratio 0.97 (95% confidence interval 0.90-1.05); P = 0.50]. The fibrinolysis group had comparable rates of acute organ failure, hospital length of stay, rates of palliative care referrals, do-not-resuscitate status use, and lesser hospitalization costs.ConclusionsThe use of initial fibrinolysis had comparable in-hospital mortality than those receiving PPCI in STEMI-CS in the contemporary era in this large national observational study.
| S-EPMC8120407 | biostudies-literature
Project description:The reduction in patients presenting with ST-elevation myocardial infarction (STEMI) during the COVID19 crisis could have resulted from fears about developing COVID-19 infection in hospital. Patients who delay presenting with STEMI are more likely to develop mechanical complications, including acute ischemic mitral regurgitation (MR). We present a 69-year-old women with an inferior STEMI and cardiogenic shock due to acute ischemic MR who delayed presenting to hospital due to the fear of COVID-19. Early identification of this mechanical complication using transthoracic echocardiography in the Emergency Department enabled the team to target her optimisation. Ultimately these patients require urgent surgery to repair the mitral valve and revascularize the myocardium but they are often too unwell to undergo surgery and even when it is feasible the outcomes are poor.
| S-EPMC8084113 | biostudies-literature
Project description:A 26-year-old woman presented at 26 weeks of pregnancy with severe mitral regurgitation (MR) and cardiogenic shock in the setting of profound hyperthyroidism. An intra-aortic balloon pump was placed, and surgical intervention was considered. However, with management of thyrotoxicosis and delivery, complete resolution of MR and cardiogenic shock was achieved. (Level of Difficulty: Intermediate.).
| S-EPMC9666752 | biostudies-literature
Project description:In the setting of ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock, three primary treatment objectives include providing circulatory support, ventricular unloading, and restoring myocardial perfusion. In addition to primary percutaneous coronary intervention, each of these three objectives can be achieved with appropriate use of an acute mechanical circulatory support (AMCS) pump. Over the past decade, utilization of percutaneously-delivered AMCS devices including the Impella axial-flow catheter, TandemHeart left atrial-to-femoral artery bypass system, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has grown exponentially. In this review, we will discuss the hemodynamic impact of each AMCS device and clinical data surrounding their use in the setting of STEMI complicated by cardiogenic shock.
| S-EPMC5650570 | biostudies-other