Cardiogenic Shock in Patients With Acute Ischemic Syndromes With and Without ST-Segment Elevation

Holmes, David R.; Berger, Peter B.; Hochman, Judith S.; Granger, Christopher B.; Thompson, Trevor; Califf, Robert M.; Vahanian, Alec; Bates, Eric R.; Topol, Eric J.

doi:10.1161/01.cir.100.20.2067

Cited by 219 publications

(97 citation statements)

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“…[1][2][3][4] Although predictors of cardiogenic shock have been determined, 5 there are limited data on early markers of outcome in this disease. Although echocardiographic evaluation is widely used in MI, assessing its value acutely in cardiogenic shock has been more challenging, and thus it has not been established whether specific features of cardiac structure or function early in the course of cardiogenic shock provide prognostic value.…”

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Echocardiographic Predictors of Survival and Response to Early Revascularization in Cardiogenic Shock

et al. 2003

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for the SHOCK Trial Background-Although echocardiography is used in diagnosis and management of myocardial infarction, it has not been established whether specific features of cardiac structure or function early in the course of cardiogenic shock provide prognostic value. The purposes of this substudy of the SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK (SHOCK) trial were to describe the echocardiographic features of cardiogenic shock, identify findings on early echocardiograms associated with outcome, examine the interaction of such features with treatment, and determine whether these features could provide insights into the survival benefit observed with early revascularization and guide selection of patients for this strategy. Methods and Results-One hundred seventy-five echocardiograms performed within 24 hours of randomization to the early revascularization (ERV) or initial medical stabilization (IMS) arms of the trial were submitted for quantitative assessment, and 169 were suitable for analysis. The 2 groups were similar in terms of clinical and early echocardiographic characteristics. Mean left ventricular ejection fraction (LVEF) was 31%, and moderate or greater mitral regurgitation (MR) was noted in 39.1%. On multivariate analysis, the only independent predictors of survival were MR severity and LVEF. A survival benefit for the ERV strategy was observed at all levels of LVEF and MR. Conclusions-A wide range of cardiac structural and functional abnormalities exists in patients presenting with acute cardiogenic shock. Both short-and long-term mortality appear to be associated with initial left ventricular systolic function and MR as assessed by echocardiography, and a benefit of ERV is noted regardless of baseline LVEF or MR.

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Echocardiographic Predictors of Survival and Response to Early Revascularization in Cardiogenic Shock

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“…El tipo de infarto fue catalogado ST elevado en 62,5% coincidiendo con lo reportado por Holmes DR Jr, quien señala que la incidencia de ChC en IMA ST no elevado es menor, aproximadamente 50% de los vistos en el ST elevado (4,7,8).…”

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“…El ChC se da tanto en síndrome coronario agudo con segmento ST elevado (SCASTE) como ST no elevado (SCASTNE) (7,8). La incidencia de pacientes con SCASTE que desarrollaron ChC, en el estudio GUSTO II-b, fue casi el doble de los SCASTNE (4,43 y 2,56% respectivamente) (8).…”

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Choque cardiogénico en síndrome coronario agudo: causas, criterios diagnósticos, tratamiento y mortalidad en el Instituto Nacional del Corazón en Lima- Perú.

Aguirre¹,

Díaz²,

Farfán³

2012

Rev Med Hered

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Choque cardiogénico en síndrome coronario agudo: causas, criterios diagnósticos, tratamiento y mortalidad en el Instituto Nacional del Corazón en Lima-Perú.Cardiogenic shock in coronary acute syndrome: Causes, diagnostic criteria, treatment and mortality at the Instituto Nacional del Corazón in Lima -Peru.Aranda Aguirre Ernesto Luis 1 , Reyes Díaz Jacqueline Vanessa 1 , Téllez Farfán David 2 . RESUMENObjetivo: Determinar las causas, criterios diagnósticos, tratamiento y mortalidad del choque cardiogénico (ChC) como complicación del síndrome coronario agudo (SCA) en el Instituto Nacional del Corazón, en Lima -Perú. Material y métodos: Se realizó un estudio observacional, descriptivo tipo serie de casos de fuentes secundarias en pacientes con diagnóstico de ChC por SCA del Instituto Nacional del Corazón desde febrero 2004 hasta 31 diciembre 2005. Para seleccionar los pacientes, se utilizaron las palabras clave: choque cardiogénico, balón intraaórtico (BIA) e infarto de miocardio agudo (IMA) más muerte. Los datos obtenidos de las historias clínicas seleccionadas, fueron procesados en el programa SPSS. Resultados: Se encontraron 24 pacientes. Veinte tuvieron ecocardiografía y 70,0%, presentaron disfunción ventricular izquierda (DVI) como causa de ChC, las demás fueron por complicaciones mecánicas. El 95% de pacientes tuvieron criterios clínicos (hipotensión o signos de hipoperfusión tisular); 11 tuvieron estudio hemodinámico, y cumplieron el criterio hemodinámico de choque. El tratamiento fue con vasopresores en 95,8% de los pacientes, inotrópicos en 66,7%, BIA en 50%. Trece pacientes tuvieron cinecoronariografia siendo revascularizados el 69,2%. Todos los pacientes fallecieron. Conclusiones: La causa principal de ChC fue DVI. El diagnóstico fue predominantemente clínico. El tratamiento en su mayoría fue médico y la tasa de mortalidad fue del 100%. Estos datos concuerdan con los descritos en otros estudios excepto que la mortalidad fue mayor en nuestro estudio. (Rev Med Hered 2008;19:138-144).PALABRAS CLAVE: Choque cardiogénico, balón intraaórtico, infarto de miocardio, síndrome coronario agudo. SUMMARYObjective: To determine causes, diagnostic criteria, treatment and mortality of cardiogenic shock complicating coronary acute syndrome (CSCCAS), at the Instituto Nacional del Corazón Lima -Peru. Material and methods: Observationaldescriptive (case series) study of secondary sources was conducted on patients with CSCCAS. To select patients we used key words: cardiogenic shock, intraaortic balloon pumping (IABP), myocardial infarction plus death. Data of clinic charts

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“…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.…”

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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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Cardiogenic Shock in Patients With Acute Ischemic Syndromes With and Without ST-Segment Elevation

Cited by 219 publications

References 29 publications

Echocardiographic Predictors of Survival and Response to Early Revascularization in Cardiogenic Shock

Echocardiographic Predictors of Survival and Response to Early Revascularization in Cardiogenic Shock

Choque cardiogénico en síndrome coronario agudo: causas, criterios diagnósticos, tratamiento y mortalidad en el Instituto Nacional del Corazón en Lima- Perú.

Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

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