Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI) Results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)

Zeymer, Uwe; Vogt, A.; Zahn, Ralf; Weber, Michael A.; Tebbe, Ulrich; Gottwik, Martin; Bonzel, T.; Senges, Jochen; Neuhaus, Karl-Ludwig

doi:10.1016/j.ehj.2003.12.008

Cited by 223 publications

(114 citation statements)

References 29 publications

(28 reference statements)

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“…In agreement with other data, a low EF as well as hemodynamic instability were associated with a higher mortality. 20 The poorer prognosis in case of nonsmoking for both genders was not anticipated, and may be due to the study size as well as to the veracity of the information given by the patient.…”

Section: Discussionmentioning

confidence: 95%

Gender‐Related Differences in Patients With ST‐Elevation Myocardial Infarction: Results From the Registry Study of the ST Elevation Myocardial Infarction Network Essen

Hailer¹,

Naber

Koslowski³

et al. 2011

Clinical Cardiology

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Background:The Myocardial Infarction Network Essen was initiated in order to establish a standardized procedure with immediate reopening of the infarcted vessel for patients with ST-elevation myocardial infarction (STEMI) in the city of Essen, Germany. The present study aims to evaluate gender-related differences in presentation of disease and clinical outcome. Hypothesis: Gender is associated with differences in presentation and outcome of STEMI. Methods: All patients with STEMI were included without exception. Parameters such as risk profile, mortality, and relevant time intervals were documented. The follow-up period was 1 year. Results: For this study, 1365 patients (72.1% male) were recruited. Women were significantly older, with higher prevalence of diabetes (28.1% vs 20.3%, P = 0.004) and hypertension (76.5% vs 64.8%, P < 0.0005). Analysis of time intervals between symptoms to actions showed no significant differences. However, women tended to wait longer before calling for medical assistance (358 vs 331 min, P = 0.091). In-hospital mortality was comparable with respect to gender, whereas women had higher 1-year mortality (18.6% vs 13.2%). Age and diabetes were associated with a higher mortality. Adjusted for age, gender is no longer an independent risk factor. In the follow-up period, significantly more women were readmitted to the hospital without a difference in the frequency of reangiography, surgery, or target-vessel revascularization. Conclusions: The present data display a successful implementation of a standardized procedure in patients with STEMI. Although differences between genders are not as obvious as expected, efforts should be taken to perform a gender-specific risk analysis as well as to promote education about proper behavior in case of new onset of angina. IntroductionAlthough gender-related differences in treatment and prognosis of acute myocardial infarction (MI) have been documented for more than a decade, the results are still conflicting. Some investigations have described a generally consistent pattern of less-intensive treatment in acute MI

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Section: Discussionmentioning

confidence: 95%

Gender‐Related Differences in Patients With ST‐Elevation Myocardial Infarction: Results From the Registry Study of the ST Elevation Myocardial Infarction Network Essen

Hailer¹,

Naber

Koslowski³

et al. 2011

Clinical Cardiology

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“…Presentation 0 to 6 hours after symptom onset was associated with the lowest mortality among CS patients undergoing primary PCI in the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK) registry, in which door-to-angiography times were Ͻ90 minutes in approximately three fourths of patients. 57 In the SHOCK trial, there appeared to be increasing long-term mortality as time to revascularization increased from 0 to 8 hours. 55 However, there is a survival benefit as long as 48 hours after MI and 18 hours after shock onset.…”

Section: Timing Of Pcimentioning

confidence: 99%

Cardiogenic Shock

2008

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ardiogenic shock (CS) occurs in Ϸ5% to 8% of patients hospitalized with ST-elevation myocardial infarction (STEMI). Recent research has suggested that the peripheral vasculature and neurohormonal and cytokine systems play a role in the pathogenesis and persistence of CS. Early revascularization for CS improves survival substantially. New mechanical approaches to treatment are available, and clinical trials are feasible even in this high-risk population. Most importantly, hospital survivors have an excellent chance for long-term survival with good quality of life. This review will outline the causes, pathophysiology, and treatment of CS with a focus on CS complicating myocardial infarction (MI.) The case will be made for viewing CS as a serious disorder with a high early death rate, but one that is treatable and that, if approached aggressively, can result in full recovery. The diagnosis is usually made with the help of pulmonary artery (PA) catheterization; however, Doppler echocardiography may also be used to confirm elevation of LV filling pressures. 1 Hypoperfusion may be manifest clinically by cool extremities, decreased urine output, and/or alteration in mental status. Hemodynamic abnormalities form a spectrum that ranges from mild hypoperfusion to profound shock, and the short-term outcome is directly related to the severity of hemodynamic derangement. MI with LV failure remains the most common cause of CS. It is critical to exclude complicating factors that may cause shock in MI patients. Chief among these are the mechanical complications: ventricular septal rupture, contained free wall rupture, and papillary muscle rupture. Mechanical complications must be strongly suspected in patients with CS complicating nonanterior MI, particularly a first MI. Echocardiography is the technique of choice to rule out these entities and should be performed early unless the diagnosis is extensive anterior MI and the patient is undergoing prompt percutaneous coronary intervention (PCI). In addition, the detection of valvular disease before angiography may alter the revascularization approach. Diagnosis and CausesHemorrhage, infection, and/or bowel ischemia may contribute to shock in the setting of MI. As with mechanical complications, a high index of suspicion is required to make these diagnoses in MI patients, and survival may depend on timely recognition and treatment.Any cause of acute, severe LV or RV dysfunction may lead to CS. Acute myopericarditis, tako-tsubo cardiomyopathy, and hypertrophic cardiomyopathy may all present with ST elevation, release of cardiac markers, and shock in the absence of significant coronary artery disease. Stress-induced cardiomyopathy, also known as apical ballooning or takotsubo cardiomyopathy, is a syndrome of acute LV dysfunction after emotional or respiratory distress that leads to CS in 4.2% of cases. 2 Acute valvular regurgitation, typically caused by endocarditis or chordal rupture due to trauma or degenerative disease, may also cause CS. Aortic dissection may lead to CS via acute,...

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“…7,9,11,15,16 This benefit is thought to be due to increased use of coronary revascularisation strategies, which, by restoring flow to the ischaemic myocardium, can limit infarct size as well as interrupt the downward spiral that characterises cardiogenic shock. 7,9,15 As such, the cornerstone of the management of cardiogenic shock complicating acute MI is prompt revascularisation, as highlighted in …”

Section: Myocardial Reperfusionmentioning

confidence: 99%

“…20 The prognosis of patients with cardiogenic shock is related to the procedural success of PCI and importantly, patients with cardiogenic shock are less likely to have successful PCI than patients without shock. 16 Since the recruitment for the SHOCK trial (where only 37 % of patients undergoing PCI received stents) there have been many advances in PCI: first, bare-metal stents and more recently drugeluting stents have been associated with a greater likelihood of complete revascularisation, a higher incidence of Thrombolysis In MI-3 flow and improved survival rates in patient in cardiogenic shock. [29][30][31] In the current European guidelines, infarct-related cardiogenic shock is an indication for emergency revascularisation with either PCI or CABG, if the patient has suitable coronary anatomy.…”

mentioning

confidence: 99%

Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

Joseph¹,

Patterson²,

Arri³

et al. 2016

Interventional Cardiology Review

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CoronaryCardiogenic shock is a clinical condition of inadequate end-organ perfusion due to cardiac dysfunction (see Table 1). It most commonly occurs in the setting of acute MI with left ventricular failure (~80 % cases), 1,2 but can also be caused by right ventricular infarction or late mechanical complications, such as acute mitral regurgitation or ventricular rupture (septal or free wall). Non-infarct-related cardiogenic shock is comparatively rare, and may result from decompensated valvular heart disease and arrhythmias, to name a few mechanisms.The pathophysiology of cardiogenic shock is complex. Myocardial ischaemia induces marked depression of myocardial contractility, this sets into motion a downward spiral of reduced cardiac output and hypotension, which in turn drives further myocardial ischaemia. Incidence and Prognosis of Cardiogenic ShockCardiogenic shock complicates 5-10 % of acute MI cases, and despite advances in acute care there remains the same incidence (~60,000-70,000 patients per year in Europe). 2,4 Historically, MI complicated by cardiogenic shock was associated with a mortality rate of 80-90 %. 5 However, with advances in coronary reperfusion techniques over the past few decades, especially with the introduction of primary percutaneous coronary intervention (PCI), the mortality rate has improved to below 50 %. 4,[6][7][8][9][10][11][12] The trend towards better outcomes may also be due to greater awareness of the need for timely treatment, improvements in the medical care of haemodynamically unstable patients as well as the use of mechanical support devices, although this has not yet been clearly demonstrated.Despite this high mortality rate, it is important to note that patients with cardiogenic shock who survive to discharge have a long-term outcome similar to that of patients without cardiogenic shock, with a good functional outcome at 1 year. 13,14 This highlights the importance of improving the chance of early survival among patients in cardiogenic shock. Management Myocardial ReperfusionThere is evidence that the high mortality rates associated with cardiogenic shock have improved over time. 7,9,11,15,16 This benefit is thought to be due to increased use of coronary revascularisation strategies, which, by restoring flow to the ischaemic myocardium, can limit infarct size as well as interrupt the downward spiral that characterises cardiogenic shock. 7,9,15 As such, the cornerstone of the management of cardiogenic shock complicating acute MI is prompt revascularisation, as highlighted in AbstractCardiogenic shock complicates approximately 5-10 % of all MI events and remains the most common cause of death among MI cases. Over the past few decades, the mortality rate associated with cardiogenic shock has decreased with the introduction of early revascularisation, although there are limited data for patients with triple-vessel disease and left main stem disease. In more recent years, there have been a number of advances in the mechanical circulatory support devices that can help improv...

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Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI) Results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)

Cited by 223 publications

References 29 publications

Gender‐Related Differences in Patients With ST‐Elevation Myocardial Infarction: Results From the Registry Study of the ST Elevation Myocardial Infarction Network Essen

Gender‐Related Differences in Patients With ST‐Elevation Myocardial Infarction: Results From the Registry Study of the ST Elevation Myocardial Infarction Network Essen

Cardiogenic Shock

Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

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