Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: The <scp>D</scp>etroit cardiogenic shock initiative

Basir, Mir B.; Schreiber, Theodore; Dixon, Simon; Alaswad, Khaldoon; Patel, Kirit; Almany, Steven; Khandelwal, Akshay; Hanson, Ivan; George, Augustine; Ashbrook, Michael; Blank, Nimrod; Abdelsalam, Murad; Sareen, Nishtha; Timmis, Steven B.H.; O’Neill, William W.

doi:10.1002/ccd.27427

Cited by 216 publications

(147 citation statements)

References 12 publications

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“…An analysis of the NCDR‐ACTION registry suggested that two of three patients survived the index hospitalization for AMI‐CS . Furthermore, the recent Detroit Cardiogenic Shock Initiative (DCSI) suggested that early use of MCS was associated with a higher survival rate of 76% when compared with previous trials, though this needs to be proven in randomized clinical trials . This may translate into an increasing number of patients with greater burden of comorbidities that are more likely to survive an index hospitalization for PCI in AMI‐CS.…”

Section: Discussionmentioning

confidence: 99%

Frequency of 30‐day readmission and its causes after percutaneous coronary intervention in acute myocardial infarction complicated by cardiogenic shock

Atti

Patel

Kumar

et al. 2019

Cathet Cardio Intervent

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Background Survival after percutaneous coronary intervention (PCI) in acute myocardial infarction complicated by cardiogenic shock (AMI‐CS) has increased over the years. Short‐term readmission rates in this high‐risk population remain unknown. Methods We queried the United States (U.S.) Nationwide Readmission Database (NRD) from January 2010 to November 2014 using the International Classification of Diseases‐Ninth edition, Clinical Modification (ICD‐9 CM) codes to identify all patients ≥18 years readmitted within 30 days after surviving an index hospitalization for PCI in AMI‐CS. Incidence, etiologies, and predictors of 30‐day readmission were analyzed. Results Among 46,435 patients who survived to discharge after PCI in AMI‐CS, 9,020 (19.4%) were readmitted within 30 days. Median time to 30‐day readmission was 11 days. Cardiac conditions were the most common causes of readmission (57.8%). Heart failure was the leading readmission diagnosis (24.8%). Private insurance including HMO and self‐pay were predictive of lower 30‐day readmission. Among other covariates, female sex, comorbidities such as heart failure, atrial fibrillation, in‐hospital complications such as major bleeding, sepsis, respiratory complications, AKI requiring dialysis, utilization of mechanical circulatory support (IABP and ECMO) were independently predictive of 30‐day readmission. Trend analysis showed decline in 30‐day readmission rates from 21.9% in 2010 to 17.9% in 2014 (ptrend < 0.001). Conclusion In this large real‐world database, one in five patients receiving PCI in AMI‐CS was readmitted within 30 days after discharge. Cardiac conditions were the most common causes of readmission. Insurance type had significant influence on 30‐day readmission.

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Section: Discussionmentioning

confidence: 99%

Frequency of 30‐day readmission and its causes after percutaneous coronary intervention in acute myocardial infarction complicated by cardiogenic shock

Atti

Patel

Kumar

et al. 2019

Cathet Cardio Intervent

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“…These devices are a valuable tool in the management of CS due to their ability to maintain vital organ perfusion, decrease LV wall stress and myocardial oxygen consumption, thereby enhancing the likelihood of ventricular recovery . In fact, multiple studies have demonstrated that early initiation of Impella support within 90 minutes of CS onset was associated with higher survival . An additional advantage of early Impella use in CS is the decrease in the use of inotropic agents, thus, reducing the effects of these cardiotoxic drugs .…”

Section: Discussionmentioning

confidence: 99%

“…6,29 In fact, multiple studies have demonstrated that early initiation of Impella support within 90 minutes of CS onset was associated with higher survival. [30][31][32] An additional advantage of early Impella use in CS is the decrease in the use of inotropic agents, thus, reducing the effects of these cardiotoxic drugs. 33 In comparison to the growing evidence base of benefits of the Impella support in CS due to myocardial infarct, very few reports exist on the use of Impella in CS due to PPCM.…”

Section: Discussionmentioning

confidence: 99%

Use of Impella heart pump for management of women with peripartum cardiogenic shock

Elkayam

Schäfer

Chieffo

et al. 2019

Clinical Cardiology

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Background Percutaneous mechanical circulatory support (MCS), such as the Impella heart pump is a valuable option for cardiogenic shock (CS), although the use of Impella in CS due to peripartum cardiomyopathy (PPCM) is limited. Objective To assess outcomes in women with PPCM supported with an Impella device from the global catheter‐based ventricular assist device (cVAD) Registry. Methods and Results A total of 15 women with PPCM supported with Impella devices between November 2008 and October 2015 were included. Of the 15 women, five were treated at Hannover medical school and have been reported previously, the rest were managed at various US hospitals. The mean age was 30.0 ± 7.34 years, eight women were Caucasian, and seven were African‐American. The occurrence of PPCM was post‐delivery in eight (53.3%), at delivery in one (6.7%), and during gestation in four women (26.7%). At admission, all women had severe heart failure with a mean ejection fraction of 14.7 ± 6% and 13 women (86.7%) presented with CS. Prior to Impella, 100% were mechanically ventilated, 79% received inotropes/vasopressors, 20% supported with IABP, and 27% received veno‐arterial extracorporeal membrane oxygenation (VA ECMO) during Impella support. Two women (13.3%) died, and 13 (87.7%) survived to discharge. Eight women (53.3%) had a recovery of native heart function and six (40%) were bridged to durable left ventricular assist device (LVAD). Conclusion MCS with Impella devices can be successfully used as a bridge to early improvement, heart recovery, or successful implantation of durable LVAD in women with PPCM complicated by severe LV dysfunction.

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“…A recent United States population‐based observational study found an increasing use of Impella in the last decade for AMI‐related cardiogenic shock . The Detroit Cardiogenic Shock Initiative evaluated the outcomes of Impella in a cohort of 41 patients with AMI complicated by cardiogenic shock . Rapid early delivery of Impella temporary mechanical circulatory support (prior to PCI in 66% of the cases) allowed for immediate hemodynamic stabilization and effective percutaneous myocardial revascularization leading to an overall 76% survival to hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal life support in the multidisciplinary management of cardiogenic shock complicating acute myocardial infarction

Pozzi

Flagiello

Armoiry

et al. 2019

Cathet Cardio Intervent

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Objectives To analyze the results of extracorporeal life support (ECLS) for cardiogenic shock complicating acute myocardial infarction (AMI) in a single‐center experience. Background Cardiogenic shock is still a leading cause of death for AMI. Conventional management carries mortality rates exceeding 50%. ECLS may be considered as a bridge to decision in the setting of AMI complicated by cardiogenic shock not responsive to standard management. Methods We performed an observational analysis of our local database. The primary end‐point was survival to hospital discharge. All variables were compared between survivors and nonsurvivors. Results Between January 2007 and December 2017, 56 patients were supported for cardiogenic shock complicating AMI. The mean age was 56.7 years and 89.3% were males. Baseline characteristics were comparable between both groups. Of the 50 primary percutaneous coronary interventions that were attempted, 44 (88.0%) were successful. Twenty‐three (41.1%) patients died during ECLS support. The complications’ rate during ECLS support was comparable between both groups. Twenty‐eight (50%) patients were successfully weaned from ECLS after a mean support of 8.7 days. Eight (14.3%) patients eventually died after weaning before hospital discharge. Five (8.9%) patients could not be weaned from ECLS and were switched to a long‐term mechanical circulatory support. Overall survival to hospital discharge was 41.1% (n = 23). Eighteen (32.1%) patients were alive after a mean follow‐up of 38.0 ± 29.9 (range, 4.2–95.4) months. Conclusions ECLS should be considered as a therapeutic solution in the management of AMI‐related cardiogenic shock with a satisfactory short‐ and long‐term survival.

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Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: The Detroit cardiogenic shock initiative

Cited by 216 publications

References 12 publications

Frequency of 30‐day readmission and its causes after percutaneous coronary intervention in acute myocardial infarction complicated by cardiogenic shock

Frequency of 30‐day readmission and its causes after percutaneous coronary intervention in acute myocardial infarction complicated by cardiogenic shock

Use of Impella heart pump for management of women with peripartum cardiogenic shock

Extracorporeal life support in the multidisciplinary management of cardiogenic shock complicating acute myocardial infarction

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