Drug-eluting stents versus bare-metal stents in acute myocardial infarction with cardiogenic shock

Ledwoch, Jakob; Fuernau, Georg; Desch, Steffen; Eitel, Ingo; Jung, Christian; Waha, Suzanne de; Poess, Janine; Schneider, Steffen; Schuler, Gerhard; Werdan, Karl; Zeymer, Uwe; Thiele, Holger

doi:10.1136/heartjnl-2016-310403

Cited by 20 publications

(11 citation statements)

References 26 publications

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“…174 In a recent subanalysis of the IABP-SHOCK II trial, no differences in outcomes between DES and bare metal stent were observed. 175 The outcome differences associated with complete revascularization versus culprit-only PCI remain unclear. In stable patients with STEMI undergoing primary PCI, treatment of culprit and nonculprit vessels appears to be safe and may be associated with improved outcomes.…”

Section: Pci Strategymentioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

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Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. Cardiogenic shock (CS) is a low-cardiac-output state resulting in life-threatening end-organ hypoperfusion and hypoxia.1,2 Acute myocardial infarction (MI) with left ventricular (LV) dysfunction remains the most frequent cause of CS. 1,3 Advances in reperfusion therapy have been associated with improvements in survival, but significant regional disparities in evidence-based care have been reported, and in-hospital mortality remains high (27%-51%).1,4-9 Management recommendations are distributed between disease-specific statements and guidelines, and a dedicated and comprehensive clinical resource in this area is lacking. Thus, consolidating the evidence to define contemporary best medical and surgical CS practices for both MI-associated CS and other types of CS may be an important step in knowledge translation to help attenuate disparities in evidence-based care.Regional systems of care coupled with treatment algorithms have improved survival in high-acuity time-sensitive conditions such as MI, out-of-hospital cardiac arrest (OHCA), and trauma.10-12 Applying a similar framework to CS management may lead to similar improvements in survival, and CS systems of care are emerging within existing regional cardiovascular emergency care networks; however, guidance from a national expert group on structure and systems of care has not been available. 13,14 Accordingly, the purposes of this American Heart Association (AHA) scientific statement on CS are to summarize our contemporary understanding of the epidemiology, pathophysiology, and in-hospital best care practices into a single clinical resource document; to suggest a stepwise management algorithm that integrates medical, surgical, and mechanical circulatory support (MCS) therapies; and to propose a Mission: Lifelinesupported pathway for the development of integrated regionalized CS systems of care. DEFINITION OF CSAcute cardiac hemodynamic instability may result from disorders that impair function of the myocardium, valves, conduction system, or pericardium, either in isolation HISTORICAL PERSPECTIVESBefore the routine use of early revascularization, MIassociated CS had an in-hospital mortality exceeding 80%. A registry trial of 250 patients with acute MI described the association between bedside physical examination (Killip classification) for the as...

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Section: Pci Strategymentioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

Self Cite

1,274

1,165

View full text Add to dashboard Cite

show abstract

“…However, the roles of DES and BMS are still indefinite. All the long-term causes of mortality were better in those who underwent DES implantation, while the other two were neutral in a retrospective analysis [86,87]. Still, even though using DES instead of BMS does not have any adverse effect, the use of DES is still recommended in CSMI patients.…”

Section: Types Of Revascularizationmentioning

confidence: 93%

Cardiogenic Shock

Türker¹

2019

Advances in Extra-Corporeal Perfusion Therapies

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Cardiogenic shock (CS) is an end-organ hypoperfusion associated with heart failure. Any reason impairing acute left ventricular (LV) or right ventricular (RV) function may cause CS. The only way to avoid CS is to provide early reperfusion in myocardial infarction (MI) patients. CS is characterized by permanent or transient rearrangement of the entire circulatory system. According to the current IABP-SHOCK II trial, 74% of the patients with CSMI are treated with norepinephrine, 53% of them with dobutamine, 26% of them with epinephrine, 4% of them with levosimendan, and 4% of them with dopamine. Percutaneous circulatory support devices such as intra-aortic balloon pump (IABP), LV assist device (LVAD), or extracorporeal life support (ECLS) create treatment options for selected patients such as CS, cardiopulmonary resuscitation, or high-risk pPCI and CABG. Extracorporeal Life Support Organization (ELSO, 2017) evaluated that the use of ECLS/VA-ECMO should be considered when the mortality risk exceeds 50% despite optimal conventional treatment in case of acute severe heart or pulmonary failure, whereas it should be assessed as a primary indication when it exceeds 80%. Early and effective revascularization is the best treatment option for CS. Thus, the organizations on the national and global basis will play the most effective role for the short-and long-term survival of patients.to survive [2]. CS occurs in approximately 5-8% of inpatients with ST-elevation myocardial infarctions (STEMI) and has a mortality rate of more than 30% [1]. CS is caused by end-organ hypoperfusion due to impaired cardiac pump function. Although CS-related mortality has declined significantly over the past decade, it continues to remain high, especially in cases of its coexistence with ischemic heart disease. Acute coronary syndrome (ACS) is still the most common cause of CS despite significant advances that have been made in its diagnosis and treatment. The most successful form of treatment is primary percutaneous coronary intervention (pPCI), which is carried out as rapidly as possible [3]. The recent research has suggested that the peripheral vasculature and neurohormonal and cytokine systems also play a role in the pathogenesis and persistence of CS.In cases where CS complicates MI (CSMI), only one in two patients survives after 1 year [4,5]. In a large study including 5782 patients, CSMI had developed in 2.5% of the patients with STEMI before admission to hospital, in 4.3% of them on the first day of hospitalization, and in 2.3% of them afterward [6]. For non-STEMI (NSTEMI) patients, these ratios were 1.2% for each condition [6]. Mortality rates were 45.7% before the hospitalization, 32.8% in the early period, and 54.1% in the late period [7]. Of 1422 CSMI patients, in the SHOCK Trial Registry, a shock is developed following left ventricular failure in 78.5% of them, acute mitral insufficiency in 6.9% of them, acute ventricular septal defect in 3.9% of them, right ventricular failure in 2.8% of them, cardiac tamponade in 1.4% of them, and ...

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“…In the contemporary era characterized by near universal stent implantation during PCI, the comparative effectiveness of BMS versus DES has been evaluated in a few observational studies, summarized in Table . In a cohort composed of the IABP‐SHOCK II trial and registry datasets ( n = 652), DES were associated with lower unadjusted rates of the composite of all‐cause mortality or recurrent MI at 1 year compared with BMS, but adjusted rates were similar with BMS and DES (HR: 0.83; p = .14) . In another study from a Taiwanese registry, 1,017 patients with AMICS treated with a DES were matched using propensity score to 2034 patients treated with BMS.…”

Section: Stent Selectionmentioning

confidence: 99%

Technical consideration in acute myocardial infarction with cardiogenic shock: A review of antithrombotic and PCI therapies

Marquis‐Gravel

Zeitouni

Kochar

et al. 2019

Cathet Cardio Intervent

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In this review, we report a contemporary appraisal of the available evidence focusing on adjunctive antithrombotic therapy and technical aspects of percutaneous coronary interventions (PCI) in patients with acute myocardial infarction and cardiogenic shock (AMICS). Only few randomized trials have been conducted to evaluate the optimal arterial access choice, antithrombotic therapy, stent type, or the role of aspiration thrombectomy in this population. Observational data suggest that a transradial approach should be preferred for experienced operators, although knowledge and experience of transfemoral access is required to place any mechanical support device.In the absence of high-quality evidence to guide choice of the adjunctive antithrombotic drugs to support PCI in patients with AMICS, knowledge of the altered pharmacokinetics and pharmacodynamics in shock is required to inform decisions.Drug-eluting stents should be favored over bare-metal stents, and routine thrombectomy is not encouraged. Owing to the challenges inherent to the conduct of randomized trials in this acutely ill patient population, concerted multicenter, and international efforts are paramount to orchestrate the development of high-quality evidence to guide clinical practice.anticoagulant, antiplatelet, aspiration thrombectomy, cardiogenic shock, percutaneous coronary intervention, radial access

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Drug-eluting stents versus bare-metal stents in acute myocardial infarction with cardiogenic shock

Cited by 20 publications

References 26 publications

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Cardiogenic Shock

Technical consideration in acute myocardial infarction with cardiogenic shock: A review of antithrombotic and PCI therapies

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