Culprit or multivessel revascularisation in ST-elevation myocardial infarction with cardiogenic shock

Park, Jin Sup; Soo, Kwang; Lee, Dong Hoon; Shin, Donghun; Lee, Hye Won; Oh, Jun-Hyok; Kim, Jeong Su; Choi, Jung Hyun; Park, Yong Hyun; Lee, Han Cheol; Kim, June Hong; Chun, Kook‐Jin; Hong, Taek Jong; Jeong, Myung Ho; Chae, Shung Chull; Kim, Young Jo

doi:10.1136/heartjnl-2014-307220

Cited by 56 publications

(36 citation statements)

References 20 publications

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“…This data is gathered from a large prospective multicentre registry in Korea with substantial volume and experienced PCI facilities and provides a number of important findings. First, similar to other registry data and despite the clear guideline recommendations, less than 25% of the patients with STEMI with MVD and cardiogenic shock were revascularised 8 9. Second, although both study arms were well matched and evenly distributed, the results demonstrate the challenges of interpreting registry data with clearly different conclusions based on adjusted versus unadjusted rates.…”

supporting

confidence: 68%

“…In a recent Heart paper, investigators from the Korean Acute Myocardial Infarction Registry (KAMIR), report outcomes of 510 patients with STEMI with cardiogenic shock and MVD, comparing 386 patients who received ‘culprit only’ PCI with 124 patients receiving multivessel PCI 8. The unadjusted MACE rate, (all-cause death, recurrent MI, any revascularisation) did not differ between groups.…”

mentioning

confidence: 99%

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Complete revascularisation or culprit artery only in cardiogenic shock: the real shock is the lack of data!

Henry

Uberoi²

2015

Heart

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supporting

confidence: 68%

mentioning

confidence: 99%

Complete revascularisation or culprit artery only in cardiogenic shock: the real shock is the lack of data!

Henry

Uberoi²

2015

Heart

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“…176 Some observational studies have reported potential benefits with multivessel PCI in CS, whereas clinical practice guidelines recommend nonculprit PCI for "critical (≥90% diameter) stenoses or highly unstable lesions." 145,[177][178][179][180][181] The CULPRIT-SHOCK trial (Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock), designed to be the largest CS trial ever, is currently enrolling patients to test this question in a prospective, randomized fashion. Historically, diagnostic angiography and PCI have been performed with a femoral arterial access site, although radial access has been more recently advocated as a safer alternative for arterial access.…”

Section: Pci Strategymentioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

1,343

1,165

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Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. Cardiogenic shock (CS) is a low-cardiac-output state resulting in life-threatening end-organ hypoperfusion and hypoxia.1,2 Acute myocardial infarction (MI) with left ventricular (LV) dysfunction remains the most frequent cause of CS. 1,3 Advances in reperfusion therapy have been associated with improvements in survival, but significant regional disparities in evidence-based care have been reported, and in-hospital mortality remains high (27%-51%).1,4-9 Management recommendations are distributed between disease-specific statements and guidelines, and a dedicated and comprehensive clinical resource in this area is lacking. Thus, consolidating the evidence to define contemporary best medical and surgical CS practices for both MI-associated CS and other types of CS may be an important step in knowledge translation to help attenuate disparities in evidence-based care.Regional systems of care coupled with treatment algorithms have improved survival in high-acuity time-sensitive conditions such as MI, out-of-hospital cardiac arrest (OHCA), and trauma.10-12 Applying a similar framework to CS management may lead to similar improvements in survival, and CS systems of care are emerging within existing regional cardiovascular emergency care networks; however, guidance from a national expert group on structure and systems of care has not been available. 13,14 Accordingly, the purposes of this American Heart Association (AHA) scientific statement on CS are to summarize our contemporary understanding of the epidemiology, pathophysiology, and in-hospital best care practices into a single clinical resource document; to suggest a stepwise management algorithm that integrates medical, surgical, and mechanical circulatory support (MCS) therapies; and to propose a Mission: Lifelinesupported pathway for the development of integrated regionalized CS systems of care. DEFINITION OF CSAcute cardiac hemodynamic instability may result from disorders that impair function of the myocardium, valves, conduction system, or pericardium, either in isolation HISTORICAL PERSPECTIVESBefore the routine use of early revascularization, MIassociated CS had an in-hospital mortality exceeding 80%. A registry trial of 250 patients with acute MI described the association between bedside physical examination (Killip classification) for the as...

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“…It is important to note that a recent study reported significantly better outcomes in cases of multivessel revascularization as compared with revascularization of the culprit lesion alone in patients with cardiogenic shock [10]. Another study showed that in STEMI patients with cardiogenic shock and cardiac arrest, multi-vessel revascularization during primary PCI significantly improved the clinical outcome and survival rate [11].…”

Section: Discussionmentioning

confidence: 99%

Predictors Of Mortality In Patients With ST-Segment Elevation Acute Myocardial Infarction And Resuscitated Out-Of-Hospital Cardiac Arrest

Barcan

Chițu

Benedek

et al. 2016

The Journal of Critical Care Medicine

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Introduction: In patients with out-of-hospital cardiac arrest (OHCA) complicating an ST-segment elevation myocardial infarction (STEMI), the survival depends largely on the restoration of coronary flow in the infarct related artery. The aim of this study was to determine clinical and angiographic predictors of in-hospital mortality in patients with OHCA and STEMI, successfully resuscitated and undergoing primary percutaneous intervention (PCI). Methods: From January 2013 to July 2015, 78 patients with STEMI presenting OHCA, successfully resuscitated, transferred immediately to the catheterization unit and treated with primary PCI, were analyzed. Clinical, laboratory and angiographic data were compared in 28 non-survivors and 50 survivors. Results:The clinical baseline characteristics of the study population showed no significant differences between the survivors and non-survivors in respect to age (p=0.06), gender (p=0.8), the presence of hypertension (p=0.4), dyslipidemia (p=0.09) obesity (p=1), smoking status (p=0.2), presence of diabetes (p=0.2), a clinical history of acute myocardial infarction (p=0.7) or stroke (p=0.17). Compared to survivors, the non-survivor group exhibited a significantly higher incidence of cardiogenic shock (50% vs 24%, p=0.02), renal failure (64.3% vs 30.0%, p=0.004) and anaemia (35.7% vs 12.0%, p=0.02). Three-vessel disease was significantly higher in the non-survivor group (42.8% vs. 20.0%, p=0.03), while there was a significantly higher percentage of TIMI 3 flow postPCI in the infarct-related artery in the survivor group (80.% vs. 57.1%, p=0.03). The time from the onset of symptoms to revascularization was significantly higher in patients who died compared to those who survived (387.5 +/-211.3 minutes vs 300.8 +/-166.1 minutes, p=0.04), as was the time from the onset of cardiac arrest to revascularization (103.0 +/-56.34 minutes vs 67.0 +/-44.4 minutes, p=0.002). Multivariate analysis identified the presence of cardiogenic shock (odds ratio [OR]: 3.17, p=0.02), multivessel disease (OR: 3.0, p=0.03), renal failure (OR: 4.2, p=0.004), anaemia (OR: 4.07, p=0.02), need for mechanical ventilation >48 hours (OR: 8.07, p=0.0002) and a duration of stay in the ICU longer than 5 days (OR: 9.96, p=0.0002) as the most significant independent predictors for mortality in patients with OHCA and STEMI. Conclusion: In patients surviving an OHCA in the early phase of a myocardial infarction, the presence of cardiogenic shock, renal failure, anaemia or multivessel disease, as well as a longer time from the onset of symptoms or of cardiac arrest to revascularization, are independent predictors of mortality. However, the most powerful predictor of death is the duration of stay in the ICU and the requirement of mechanical ventilation for more than forty-eight hours.

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Culprit or multivessel revascularisation in ST-elevation myocardial infarction with cardiogenic shock

Cited by 56 publications

References 20 publications

Complete revascularisation or culprit artery only in cardiogenic shock: the real shock is the lack of data!

Complete revascularisation or culprit artery only in cardiogenic shock: the real shock is the lack of data!

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Predictors Of Mortality In Patients With ST-Segment Elevation Acute Myocardial Infarction And Resuscitated Out-Of-Hospital Cardiac Arrest

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