Percutaneous Coronary Intervention in Older Patients With ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock

Damluji, Abdulla; Bandeen‐Roche, Karen; Berkower, Carol; Boyd, Cynthia M.; Al‐Damluji, Mohammed Salim; Cohen, Mauricio G.; Forman, Daniel E.; Chaudhary, Rahul; Gerstenblith, Gary; Walston, Jeremy D.; Resar, Jon R.; Moscucci, Mauro

doi:10.1016/j.jacc.2019.01.055

Cited by 53 publications

(34 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For instance, patients at advanced age, with increased comorbidities, and underlying left ventricular dysfunction, may pose a clinical challenge, as complex PCI among these patients may incur a substantial risk that overweighs any benefit achieved from revascularization [4]. On the other hand, utilization of PCI even in older adults with AMI and cardiogenic shock has been shown to be associated with substantial reduction in mortality in a recent contemporary analysis involving older adults ≥75 years of age [9]. Although clinical judgment is important, one should not, therefore, exclude patients from PCI solely based on advanced age in the absence of clear contraindications.…”

Section: High-risk Percutaneous Coronary Interventionsmentioning

confidence: 99%

Utilization of Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock Complicating Acute Myocardial Infarction and High-Risk Percutaneous Coronary Interventions

Asleh

Resar

2019

JCM

View full text Add to dashboard Cite

Given the tremendous progress in interventional cardiology over the last decade, a growing number of older patients, who have more comorbidities and more complex coronary artery disease, are being considered for technically challenging and high-risk percutaneous coronary interventions (PCI). The success of performing such complex PCI is increasingly dependent on the availability and improvement of mechanical circulatory support (MCS) devices, which aim to provide hemodynamic support and left ventricular (LV) unloading to enable safe and successful coronary revascularization. MCS as an adjunct to high-risk PCI may, therefore, be an important component for improvement in clinical outcomes. MCS devices in this setting can be used for two main clinical conditions: patients who present with cardiogenic shock complicating acute myocardial infarction (AMI) and those undergoing technically complex and high-risk PCI without having overt cardiogenic shock. The current article reviews the advancement in the use of various devices in both AMI complicated by cardiogenic shock and complex high-risk PCI, highlights the available hemodynamic and clinical data associated with the use of MCS devices, and presents suggestive management strategies focusing on appropriate patient selection and optimal timing and support to potentially increase the clinical benefit from utilizing these devices during PCI in this high-risk group of patients.

show abstract

Section: High-risk Percutaneous Coronary Interventionsmentioning

confidence: 99%

Utilization of Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock Complicating Acute Myocardial Infarction and High-Risk Percutaneous Coronary Interventions

Asleh

Resar

2019

JCM

View full text Add to dashboard Cite

show abstract

“…When patients complained chest pain, the criteria of the tertiary emergency were mostly based on the abnormal vital signs such as low blood pressure (< 90 mmHg). Since it is well known that shock was a strong determinant of in-hospital death in patients with STEMI [ 15 – 17 ], it is not surprising that STEMI patients with abnormal vital signs had worse clinical outcomes. Moreover, STEMI patients with low SpO 2 (< 90%) were also categorized to the tertiary emergency.…”

Section: Discussionmentioning

confidence: 99%

Comparison of in-hospital death following ST-elevation myocardial infarction between secondary emergency and tertiary emergency

Yoshida

Sakakura

Yamamoto

et al. 2020

Cardiovasc Interv and Ther

View full text Add to dashboard Cite

In most areas in Japan, patients with ST-elevation myocardial infarction (STEMI) would be transferred to the secondary hospitals or tertiary hospitals according to the judgement of emergency medical service (EMS) staff members. We hypothesized that in-hospital outcomes would be worse in STEMI patients judged as tertiary emergency than in those judged as secondary emergency, which may support the judgement of the current EMS systems. The purpose of this study was to compare in-hospital outcomes of STEMI between patients judged as secondary emergency and those judged as tertiary emergency. We included 238 STEMI patients who were transferred to our institution using EMS hotline, and divided those into the secondary emergency group ( n = 106) and the tertiary emergency group ( n = 132). The primary endpoint was in-hospital death. The prevalence of shock was significantly higher in the tertiary emergency group than in the secondary emergency group (32.6% vs. 10.4%, p < 0.001). The GRACE score was significantly higher in the tertiary emergency group than the secondary emergency group [146 (118–188) vs. 134 (101–155), p < 0.001]. The incidence of in-hospital death was significantly higher in the tertiary emergency group than in the secondary emergency group (8.0% vs. 2.1%, p = 0.014). The multivariate logistic regression analysis revealed that the tertiary emergency was significantly associated with in-hospital death (OR 3.52, 95% CI 1.24–10.02, p = 0.018) after controlling age and gender. In conclusion, the tertiary emergency was significantly associated with in-hospital death. Our results might validate the judgement of levels of emergency by local EMS staff members.

show abstract

“…3 Despite such benefits, variability in the definitions of comorbidities, interventions, and outcomes exists because of its inherent dependency on billing practices by hospitals, providers, and coders. 3 While the finding that bleeding was associated with a lower mortality rate is not often seen in clinical practice, this study highlights an essential fact that major bleeding requiring transfusion is quite common during invasive care of cardiogenic shock, and the occurrence of acute limb ischemia is not insignificant. While the estimates reported in this study are not small, it still may have underestimated major bleeding and limb ischemia during cardiogenic shock.…”

mentioning

confidence: 99%

“…The use of claims‐based data is quite useful in large populations with the aim to (a) improve healthcare delivery and appropriate utilization of resources; (b) identify and eliminate inequality of care in vulnerable subgroups; and (c) maximize benefits associated with therapies and interventions 3 . Despite such benefits, variability in the definitions of comorbidities, interventions, and outcomes exists because of its inherent dependency on billing practices by hospitals, providers, and coders 3 .…”

mentioning

confidence: 99%

Lies, damned lies, and statistics, but bleeding and acute limb ischemia are facts!

Damluji

Gilchrist

2021

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

show abstract

Percutaneous Coronary Intervention in Older Patients With ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock

Cited by 53 publications

References 40 publications

Utilization of Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock Complicating Acute Myocardial Infarction and High-Risk Percutaneous Coronary Interventions

Utilization of Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock Complicating Acute Myocardial Infarction and High-Risk Percutaneous Coronary Interventions

Comparison of in-hospital death following ST-elevation myocardial infarction between secondary emergency and tertiary emergency

Lies, damned lies, and statistics, but bleeding and acute limb ischemia are facts!

Contact Info

Product

Resources

About