ESC Guidelines on Management of Acute Myocardial Infarction in Patients Presenting With Persistent ST-Segment Elevation

Werf, Frans Van de; Bax, Jeroen J.; Betriu, Amadeo; Blomström‐Lundqvist, Carina; Crea, Filippo; Falk, Volkmar; Filippatos, Gerasimos; Fox, Keith A.A.; Huber, Kurt; Kastrati, Adnan; Rosengren, Annika; Steg, P. Gabriel; Tubaro, Marco; Verheugt, Freek W.A.; Weidinger, Franz; Weis, Michael

doi:10.1016/s1885-5857(09)71559-2

Cited by 47 publications

(41 citation statements)

References 242 publications

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“…5 Some observational studies had reported much better outcomes in patients receiving IABP therapy than in those not receiving it. The 2008 European 6 and 2009 American guidelines 7 issued class I recommendations for the use of IABP in acute myocardial infarction with cardiogenic shock. Within the past 5 years, however, new randomized clinical trial (RCT) data from the IABP-SHOCK II trial 2,8 prompted these guideline systems to soften their recommendations.…”

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confidence: 99%

Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction

et al. 2015

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IMPORTANCE Intra-aortic balloon pump (IABP) therapy is a widely used intervention for acute myocardial infarction with cardiogenic shock. Guidelines, which previously strongly recommended it, have recently undergone substantial change.OBJECTIVE To assess IABP efficacy in acute myocardial infarction.DATA SOURCES Human studies found in Pubmed, Embase, and Cochrane libraries through December 2014 and in reference lists of selected articles. Search strings were "myocardial infarction" or "acute coronary syndrome" and "intra-aortic balloon pump" or "counterpulsation."STUDY SELECTION Randomized clinical trials (RCTs) and observational studies comparing use of IABP with no IABP in patients with acute myocardial infarction. DATA EXTRACTION AND SYNTHESISTwo reviewers independently extracted the data, and risk of bias in RCTs was assessed using the Cochrane risk of bias tool. We conducted separate meta-analyses of the RCTs and observational studies. Data were quantitatively synthesized using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES Thirty-day mortality.RESULTS There were 12 eligible RCTs randomizing 2123 patients. In the RCTs, IABP use had no statistically significant effect on mortality (odds ratio [OR], 0.96 [95% CI, 0.74-1.24]), with no significant heterogeneity among trials (I 2 = 0%; P = .52). This result was consistent when studies were stratified by the presence (OR, 0.94 [95% CI, 0.69-1.28]; P = .69, I 2 = 0%) or absence (OR, 0.98 [95% CI, 0.57-1.69]; P = .95, I 2 = 17%) of cardiogenic shock. There were 15 eligible observational studies totaling 15 530 patients. Their results were mutually conflicting (heterogeneity I 2 = 97%; P < .001), causing wide uncertainty in the summary estimate for the association with mortality (OR, 0.96 [95% CI, 0.54-1.70]). A simple index of baseline risk marker imbalance in the observational studies appeared to explain much of the heterogeneity in the observational data (R 2 meta = 46.2%; P < .001).CONCLUSIONS AND RELEVANCE Use of IABP was not found to improve mortality among patients with acute myocardial infarction in the RCTs, regardless of whether patients had cardiogenic shock. The observational studies showed a variety of mutually contradictory associations between IABP therapy and mortality, much of which was explained by the differences between studies in the balance of risk factors between IABP and non-IABP groups.

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Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction

et al. 2015

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“…Sin embargo, al considerar la actual recomendación en pacientes coronarios (LDL < 70 mg/dl), sólo 30% alcanza esta cifra 49 . El empleo de aspirina y betabloquedores -fármacos de reconocida eficacia en reducir la morbimortalidad post-infarto 50 -fue cercano a 70% y 90%, pero aún no se indican en todos los pacientes que no presentan contraindicaciones, especialmente en los de mayor edad.…”

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Prevención secundaria post infarto agudo de miocardio en hospitales públicos: implementación y resultados de las garantías GES

et al. 2013

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“…Doses were titrated to achieve a systolic blood pressure of at least 80 mm Hg. 20,21 The decision to institute circulatory support with the Impella-2.5 was made in patients with refractory CS unresponsive to high-dose inotropes and IABP-support at the time of primary PCI.…”

Section: Inclusion Criteria and Treatmentmentioning

confidence: 99%

Percutaneous Left-Ventricular Support With the Impella-2.5–Assist Device in Acute Cardiogenic Shock

Lauten

Engström

Jung

et al. 2013

Circ: Heart Failure

282

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Background-Acute cardiogenic shock after myocardial infarction is associated with high in-hospital mortality attributable to persisting low-cardiac output. The Impella-EUROSHOCK-registry evaluates the safety and efficacy of the Impella-2.5-percutaneous left-ventricular assist device in patients with cardiogenic shock after acute myocardial infarction. Methods and Results-This multicenter registry retrospectively included 120 patients (63.6±12.2 years; 81.7% male) with cardiogenic shock from acute myocardial infarction receiving temporary circulatory support with the Impella-2.5-percutaneous left-ventricular assist device. The primary end point evaluated mortality at 30 days. The secondary end point analyzed the change of plasma lactate after the institution of hemodynamic support, and the rate of early major adverse cardiac and cerebrovascular events as well as long-term survival. Thirty-day mortality was 64.2% in the study population. After Impella-2.5-percutaneous left-ventricular assist device implantation, lactate levels decreased from 5.8±5.0 mmol/L to 4.7±5.4 mmol/L (P=0.28) and 2.5±2.6 mmol/L (P=0.023) at 24 and 48 hours, respectively. Early major adverse cardiac and cerebrovascular events were reported in 18 (15%) patients. Major bleeding at the vascular access site, hemolysis, and pericardial tamponade occurred in 34 (28.6%), 9 (7.5%), and 2 (1.7%) patients, respectively. The parameters of age >65 and lactate level >3.8 mmol/L at admission were identified as predictors of 30-day mortality. After 317±526 days of follow-up, survival was 28.3%. Conclusions-In patients with acute cardiogenic shock from acute myocardial infarction, Impella 2.5-treatment is feasible and results in a reduction of lactate levels, suggesting improved organ perfusion. However, 30-day mortality remains high in these patients. This likely reflects the last-resort character of Impella-2.5-application in selected patients with a poor hemodynamic profile and a greater imminent risk of death. Carefully conducted randomized controlled trials are necessary to evaluate the efficacy of Impella-2.5-support in this high-risk patient group. (Circ Heart Fail. 2013;6:23-30.)Key Words: cardiogenic shock ■ Impella-2.5-device ■ mechanical circulatory support ■ percutaneous left-ventricular assist device

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ESC Guidelines on Management of Acute Myocardial Infarction in Patients Presenting With Persistent ST-Segment Elevation

Cited by 47 publications

References 242 publications

Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction

Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction

Prevención secundaria post infarto agudo de miocardio en hospitales públicos: implementación y resultados de las garantías GES

Percutaneous Left-Ventricular Support With the Impella-2.5–Assist Device in Acute Cardiogenic Shock

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