Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock

Thiele, Holger; Zeymer, Uwe; Neumann, Franz‐Josef; Ferenc, Mirosław; Olbrich, Hans-Georg; Hausleiter, Jörg; Richardt, Gert; Hennersdorf, Marcus; Empen, Klaus; Fuernau, Georg; Desch, Steffen; Eitel, Ingo; Hambrecht, Rainer; Fuhrmann, Jörg; Böhm, Michael; Ebelt, Henning; Schneider, Steffen; Schuler, Gerhard; Werdan, Karl

doi:10.1056/nejmoa1208410

Cited by 2,282 publications

(1,635 citation statements)

References 31 publications

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“…Die Untersuchung zeigt, dass der Einsatz der IABP zu keiner Reduktion der Dreißigtagesterblichkeit führt [101]. Auch wenn derzeit große klinische Studien zum Einsatz der IABP im Rahmen der septischen Kardiomyopathie fehlen, legt diese Arbeit nahe, dass die IABP im Rahmen des septischen Pumpversagens derzeit keinen Stellenwert hat.…”

Section: Mitochondrien Und Energiehaushaltunclassified

Herz in der Sepsis

et al. 2017

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Section: Mitochondrien Und Energiehaushaltunclassified

Herz in der Sepsis

et al. 2017

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“…4,[33][34][35] As discussed above, the current evidence does not clearly identify an optimal revascularisation strategy for patients with cardiogenic shock with multi-vessel disease. There are four observational reports comparing PCI with CABG that suggest similar mortality rates; 36 however, in current practice, CABG is rarely performed in patients with cardiogenic shock.…”

Section: Revascularisation Of Multi-vessel Coronary Artery Diseasementioning

confidence: 95%

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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“…Inadequate organ perfusion contains at least one of the following criteria: (a) altered mental status; (b) cold, clammy skin; (c) oliguria; and (d) increased serum lactate. Clinical signs of tissue hypoperfusion are apparent through three "windows" of the body: (1) skin (cold and clammy skin, with vasoconstriction and cyanosis), (2) kidney (urine output of <0.5 mL per kilogram of body weight per hour), (3) and brain (altered mental state, which typically includes obtundation, disorientation, and confusion). Hyperlactatemia is typically present, indicating abnormal cellular oxygen metabolism.…”

Section: Definition and Initial Assessmentmentioning

confidence: 99%

“…A full clinical assessment contains skin color and temperature, jugular venous distention, and peripheral edema. Point-of-care echocardiogram offers advanced information for diagnosis via the evaluations of pericardial effusion, left and right ventricular size and function, and respiratory variations in vena cava dimensions, the calculation of the aortic velocity-time integral, and a measure of stroke volume [1][2][3].…”

Section: Definition and Initial Assessmentmentioning

confidence: 99%