Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Hochman, Judith S.; Sleeper, L.A.; Webb, John; Ta, Sanborn; White, HD; Talley, J. David; Buller, CE; Jacobs, Alice K.; Slater, James; Col, Jacques; Sm, McKinlay; Th, LeJemtel

doi:10.1056/nejm199908263410901

Cited by 2,543 publications

(728 citation statements)

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“…Our study reinforces the need for more attention to be directed to patients who develop CS in the prehospital setting in clinical guidelines, research, and clinical practice and emphasis placed on the more‐aggressive use of early revascularization in these high‐risk patients 26, 27, 28, 29, 30, 31. The use of IABP is recommended,31, 32 and although newer interventional devices have provided better hemodynamic support than the use of conventional IABP, none of these devices have yet been shown to favorably improve survival compared with the use of IABP 33, 34…”

Section: Discussionsupporting

confidence: 74%

“…Previous studies have suggested that the declining trend in mortality associated with CS complicating AMI was mainly attributed to the early and aggressive use of evidence‐based medications and coronary interventions, including the use of balloon pumps 7, 8, 9, 10, 11, 25, 26, 28, 35. However, a recent report from the National Cardiovascular Database Registry Cath‐PCI registry, which included more than 56 000 patients with CS complicating AMI who underwent a PCI within 24 hours from acute symptom onset, showed that the hospital death rate for this patient group increased between 2005–2006 (27.6%) and 2011–2013 (30.6%) 36.…”

Section: Discussionmentioning

confidence: 99%

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Ten‐Year (2001–2011) Trends in the Incidence Rates and Short‐Term Outcomes of Early Versus Late Onset Cardiogenic Shock After Hospitalization for Acute Myocardial Infarction

Nguyen

Yarzebski

Lessard

et al. 2017

JAHA

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BackgroundCardiogenic shock (CS) is a serious complication of acute myocardial infarction, and the time of onset of CS has a potential role in influencing its prognosis. Limited contemporary data exist on this complication, however, especially from a population‐based perspective. Our study objectives were to describe decade‐long trends in the incidence, in‐hospital mortality, and factors associated with the development of CS in 3 temporal contexts: (1) before hospital arrival for acute myocardial infarction (prehospital CS); (2) within 24 hours of hospitalization (early CS); and (3) ≥24 hours after hospitalization (late CS).Methods and ResultsThe study population consisted of 5782 patients with an acute myocardial infarction who were admitted to all 11 hospitals in central Massachusetts on a biennial basis between 2001 and 2011. The overall proportion of patients who developed CS was 5.2%. The proportion of patients with prehospital CS (1.6%) and late CS (1.5%) remained stable over time, whereas the proportion of patients with early CS declined from 2.2% in 2001–2003 to 1.2% in 2009–2011. In‐hospital mortality for prehospital CS increased from 38.9% in 2001–2003 to 53.6% in 2009–2011, whereas in‐hospital mortality for early and late CS decreased over time (35.9% and 64.7% in 2001–2003 to 15.8% and 39.1% in 2009–2011, respectively).ConclusionsDevelopment of prehospital and in‐hospital CS was associated with poor short‐term survival and the in‐hospital death rates among those with prehospital CS increased over time. Interventions focused on preventing or treating prehospital and late CS are needed to improve in‐hospital survival after acute myocardial infarction.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Ten‐Year (2001–2011) Trends in the Incidence Rates and Short‐Term Outcomes of Early Versus Late Onset Cardiogenic Shock After Hospitalization for Acute Myocardial Infarction

Nguyen

Yarzebski

Lessard

et al. 2017

JAHA

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“…6,7 Echocardiograms were performed both on entry and again later, thus offering a unique opportunity to assess their value and better understand the pathophysiology of this disease. The purposes of this prospectively designed substudy of the SHOCK trial were to identify the echocardiographic features of cardiogenic shock, identify findings on early echocardiograms that are associated with mortality after cardiogenic shock, assess the interaction of such findings and treatment, and determine whether any of these echocardiographic features could provide insights into the survival benefit observed with early revascularization and guide the selection of patients for this strategy.…”

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confidence: 99%

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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“…Rosenfield: If I had been certain that the patient's tissue had completed its infarction, then I probably would not have performed immediate revascularization, not because of increased risk but because of a lack of documented benefit. 15 However, in many patients, the status of the myocardium is not certain. This patient's history was of waxing and waning pain, culminating in recurrence of severe pain after her arrival at home.…”

Section: Pathol O Gic a L Discussionmentioning

confidence: 99%

Case 40-2010

Picard¹,

Rosenfield²,

Digumarthy³

et al. 2010

N Engl J Med

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Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Cited by 2,543 publications

References 31 publications

Ten‐Year (2001–2011) Trends in the Incidence Rates and Short‐Term Outcomes of Early Versus Late Onset Cardiogenic Shock After Hospitalization for Acute Myocardial Infarction

Ten‐Year (2001–2011) Trends in the Incidence Rates and Short‐Term Outcomes of Early Versus Late Onset Cardiogenic Shock After Hospitalization for Acute Myocardial Infarction

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

Case 40-2010

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