Randomized clinical trials of patients with acute myocardial infarction-related cardiogenic shock: a systematic review of used cardiogenic shock definitions and outcomes

Abstract

Background: Cardiogenic shock (CS) is a critical complication to acute myocardial infarction (AMI), with short-term mortality rates exceeding 40%. However, no international consensus of a CS definition exists. This may compromise interstudy comparability. Aims:The aim of the current study was to review differences and similarities of CS enrolment criteria in AMI-related CS randomized clinical trials (RCT).Methods: From the electronic databases MEDLINE and EMBASE we identified all AMI-related CS trials.Results: A total of 19 trials comprising a total of 2674 unique patients with CS were identified. Seven trials investigated left ventricular assist devices, eight investigated medical treatments, three percutaneous coronary intervention (PCI), and one trial investigated targeted temperature management. The inclusion criteria, baseline hemodynamics, endpoints, and mortality varied markedly between trials. Hypotension was the most frequent overall inclusion criterion (17 [90%] trials), and a systolic blood pressure <90 mm Hg (and/or need of vasopressors) was the most frequently used limit. Twelve (63%) trials had signs of impaired end-organ perfusion as an inclusion criterion and 10 (53%) signs of impaired cardiovascular function most frequently low cardiac index and reduced left ventricular ejection fraction. Ten (53%) trials included patients resuscitated from a cardiac arrest, three trials excluded cardiac arrest patients whereas six trials did not state whether cardiac arrest was an exclusion criterion. Mortality ranged from 8% to 73%. Conclusions:The RCTs of AMI-related CS have marked heterogeneity in enrolment criteria and outcomes potentially hampering interstudy comparability. The overall consensus of CS enrolment criteria appears needed for future selection of patients.

Venoarterial extracorporeal membrane oxygenation improves survival in a rat model of acute myocardial infarction

“…The primary goals for AMI patients with CS are to ensure end‐organ perfusion, restore circulation and unload the left ventricle 30–32 . A recent study by Kim et al found that ECMO support before revascularization was associated with an improved short‐term survival rate 33 .…”

“…The primary goals for AMI patients with CS are to ensure end-organ perfusion, restore circulation and unload the left ventricle. [30][31][32] A recent study by Kim et al found that ECMO support before revascularization was associated with an improved short-term survival rate. 33 In our study, VA-ECMO support was also associated with a higher survival rate, although the effect was not statistically significant.…”

Vasodilators for acute heart failure—A protocol for a systematic review of randomized clinical trials with meta‐analysis and Trial Sequential Analysis

“…19 Symptoms of severe forward failure are life threatening and related to organ hypoperfusion with confusion, decreased urine output, and increased lactate. 20,21 This systematic review will focus on the "warm and wet" syndromes of acute heart failure, whereas cardiogenic shock and isolated right ventricular failure will be out of the scope.…”

“…Cardiogenic shock (cold and wet/dry), involving 2%–5% of acute decompensated heart failure cases, is associated with severe forward failure of the left ventricle with consequently decreased cardiac output by means of either impaired myocardial function, acute mechanical failure of the cardiac structural integrity, or both 19 . Symptoms of severe forward failure are life threatening and related to organ hypoperfusion with confusion, decreased urine output, and increased lactate 20,21 …”

Differences in Management and Prognostication of Cardiogenic Shock Patients in the Presence and Absence of Out-of-Hospital Cardiac Arrest

“…The incidence of AMICS has been constant during the last decade and occurs in 5% to 10% of patients with acute myocardial infarction (MI), and it still remains the leading cause of mortality in this patient population with 30 days mortality rate of 40%-50% (2-5). In the majority of published studies, patients presenting with and without out-of-hospital cardiac arrest (OHCA) are included (6,7). Because of improved prehospital treatment, the number of AMICS patients who survive to hospital arrival after OHCA has increased and comprised up to 75% of the cohorts in recent observational studies as well as randomized clinical trials (2,(8)(9)(10).…”