Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry

Sanborn, Timothy A.; Sleeper, Lynn A.; Bates, Eric R.; Jacobs, Alice K.; Boland, Jean; French, John K.; Dens, Jo; Džavík, Vladimir; Palmeri, Sebastian T.; Webb, John G.; Goldberger, M.; Hochman, Judith S.

doi:10.1016/s0735-1097(00)00875-5

Cited by 277 publications

(73 citation statements)

References 18 publications

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“…Administration of a thrombolytic before PCI did not affect survival in patients undergoing PCI for cardiogenic shock in the SHOCK trial registry, 18 although the registry data as a whole do suggest that patients with cardiogenic shock should be considered for thrombolytic treatment if there is no option for revascularisation. 19 The reasons for the difference between our experience and the SHOCK trial PCI registry are unclear, but part of the explanation may be definition. We use the expression ''rescue angioplasty'' to describe angioplasty delivered for tightly defined failure of thrombolysis.…”

Section: Discussionmentioning

confidence: 86%

Predictors of outcome after percutaneous treatment for cardiogenic shock

Sutton

Finn

Hall

et al. 2005

Heart

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Objectives: To determine predictors of outcome after percutaneous coronary intervention (PCI) in patients with cardiogenic shock complicating acute myocardial infarction. Methods: Retrospective analysis of a cohort of 113 patients undergoing emergency coronary angiography and attempted PCI for cardiogenic shock complicating acute myocardial infarction in a regional cardiothoracic unit. Results: In-hospital mortality was 51% (58 patients). Adverse outcome was associated with previous myocardial infarction, age over 70 years, cardiogenic shock complicating failure to respond to thrombolytic treatment (failed thrombolysis), and multivessel coronary artery disease. Multivariate logistic regression analysis showed that the first three factors were independent predictors of in-hospital death with odds ratios of 5.21 (95% confidence interval (CI) 1.85 to 14.69), 4.02 (95% CI 1.14 to 14.12), and 3.78 (95% CI 1.43 to 9.96), respectively. Conclusion: About 50% of patients with cardiogenic shock undergoing a strategy of urgent coronary angiography and PCI survive to hospital discharge. Survivors do well in the subsequent six months. Emergency PCI for cardiogenic shock reduces mortality from an expected 80% to about 50%. Clinical features can help determine which patients are most likely to gain from urgent coronary angiography and attempted PCI. Alternative strategies are needed to improve the outcome of patients who fare badly.C ardiogenic shock occurs in 7-10% of patients after acute myocardial infarction (AMI). Untreated, it causes an early mortality of about 80% 1 2 and is the leading cause of death among patients hospitalised with AMI.The incidence of cardiogenic shock did not fall significantly during the thrombolytic era. There is some evidence to show that tissue plasminogen activator is more effective than streptokinase in the prevention of cardiogenic shock, 2 but little evidence from randomised trials of thrombolysis in AMI to support the use of these agents when shock is present. Non-randomised studies have consistently suggested that emergency coronary angiography and revascularisation reduce mortality of patients with cardiogenic shock. [4][5][6][7][8][9] Data from randomised controlled trials have been lacking until the publication of the SHOCK (should we emergently revascularise occluded coronaries for cardiogenic shock?) trial. 10 This trial randomly assigned patients with cardiogenic shock to an emergency revascularisation arm or an intensive medical treatment arm. Those in the emergency revascularisation arm fared better at six months than those in the medical arm. Patients in the medical arm also fared better than historical patients receiving standard medical treatment for cardiogenic shock. It is clear that some patients do well with an aggressive revascularisation strategy but many continue to do badly. We studied a consecutive series of patients treated with percutaneous coronary intervention (PCI) for cardiogenic shock caused by left ventricular dysfunction to determine whether clinical features co...

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Section: Discussionmentioning

confidence: 86%

Predictors of outcome after percutaneous treatment for cardiogenic shock

Sutton

Finn

Hall

et al. 2005

Heart

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“…The most robust mortality data on patients with CS comes from the SHOCK trial [1] and registry [2, 3] (Table 6). The SHOCK trial included patients with STEMI complicated by CS due predominantly to left ventricular dysfunction and excluded patients with severe systemic illness, with a mechanical cause of shock, or if they were not suitable for revascularization.…”

Section: Discussionmentioning

confidence: 99%

“…The 30-day mortality was 51% in the trial patients (86% of patients were treated with an IABP) [1]. In-hospital mortality was 60% in the registered patients [2, 3]. More recently, 3 randomized trials compared the IABP to either the Impella or TandemHeart devices [6-9].…”

Section: Discussionmentioning

confidence: 99%

Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience

et al. 2012

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BackgroundPatients with cardiogenic shock (CS) are routinely treated with intra-aortic balloon pumps (IABPs). The utility of 2 new percutaneous left ventricular assist devices (PLVADs), the Impella and TandemHeart, is unknown. The objective of this study was to describe the use of PLVADs for patients with CS at our institution.MethodsAll cases involving PLVADs in patients with CS between between January 1, 2008 and June 30, 2010 at a private, tertiary referral hospital were reviewed retrospectively.ResultsAll 76 cases were identified (50 IABP only, 7 Impella, 19 TandemHeart). Most Impella (5/7) and TandemHeart (10/19) patients were initially treated with an IABP before "upgrading" for increased hemodynamic support. All 76 devices (100%) were initiated successfully. Percutaneous revascularization was attempted in 63 patients with angiographic success in 57 (90%). The incidences of major complications were similar between groups, except bleeding occurred less frequently with the IABP. Mean ejection fraction on presentation was 30.4±16.5% and increased by a mean of 6.6±11.4% (P < 0.001). With the institutional approach of treating patients with CS initially with vasopressors and IABPs, then upgrading to an Impella or TandemHeart device for patients refractory to IABP therapy, the overall mortality rate was 40%.ConclusionThe Impella and TandemHeart devices can be initiated successfully in patients with CS, are associated with high rates of angiographic success during high risk percutaneous interventions and may benefit the myocardium during myocardial infarction. Randomized trials are warranted investigating use of the Impella and TandemHeart devices in patients with CS and in patients refractory to conventional IABP therapy.

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“…Large thrombolytic trials demonstrate 60% mortality with most effective thrombolytic agent. Comparison of 30 day mortality in cardiogenic shock with AMI between Reteplase or Alteplase, 64% of patients treated with Reteplase and 58% treated with Alteplase died within 30 days (p = 0.59) 34…”

mentioning

confidence: 99%

Retracted: Primary Percutaneous Coronary Intervention (PPCI) in Acute Myocardial Infarction Complicated by Cardiogenic Shock in a Newly Emerging Cardiac Centre in Nepal

et al. 2017

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Background: Acute myocardial infarction (AMI) is complicated by cardiogenic shock in 7-10% of patients. Mortality rate is exceedingly high and reaches 70-80% in those treated conservatively. Large thrombolytic trials demonstrate 60% mortality with most effective thrombolytic agent. In between September 2005 to August 2008 total PCI in Shahid gangalal National Heart Centre (SGNHC), Nepal was 452. among them primary PCI (PPCI) in AMI with cardilgenic shock was done in only 16 patients with cardiogenic shock who underwent PPCI, 6 patients are in out of 50% (n=8) patients with cardiogenic shock who underwent PPCI, 6 patients are in routine follow up over 12 months and 2 were doing well in subsequent 6 months but lost in follow up afterwards. Primary PCI in AMI complicated by cardiogenic shock has lower mortality and improved outcome. High cost, high in-hospital mortality, need for trained manpower are the major limitations.

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Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry

Cited by 277 publications

References 18 publications

Predictors of outcome after percutaneous treatment for cardiogenic shock

Predictors of outcome after percutaneous treatment for cardiogenic shock

Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience

Retracted: Primary Percutaneous Coronary Intervention (PPCI) in Acute Myocardial Infarction Complicated by Cardiogenic Shock in a Newly Emerging Cardiac Centre in Nepal

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