Management and predictors of outcome in unselected patients with cardiogenic shock complicating acute ST-segment elevation myocardial infarction: results from the Bremen STEMI Registry

Backhaus, Tina; Fach, Andreas; Schmucker, Johannes; Fiehn, Eduard; Garstka, Daniela; Stehmeier, J.; Hambrecht, Rainer; Wienbergen, Harm

doi:10.1007/s00392-017-1192-0

Cited by 73 publications

(73 citation statements)

References 37 publications

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“…Multivessel CAD was associated with worse survival in ACS‐related CS, as previously shown . No difference in mortality between different IRAs was discovered, similar to one previous study, even though mortality rates were numerically higher in LM and LAD in comparison to RCA and LCX.…”

Section: Resultssupporting

confidence: 89%

Prognostic impact of angiographic findings, procedural success, and timing of percutaneous coronary intervention in cardiogenic shock

et al. 2020

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Aims Urgent revascularization is the mainstay of treatment in acute coronary syndrome (ACS) related cardiogenic shock (CS). The aim was to investigate the association of angiographic results with 90-day mortality. Procedural complications of percutaneous coronary intervention (PCI) were also examined. Methods and results This CardShock (NCT01374867) substudy included 158 patients with ACS aetiology and data on coronary angiography and complications during PCI procedure. Survival analysis was conducted with Kaplan-Meier curves and Cox regression analysis. Median age was 67 ± 11 years, and 77% were men. During 90-day follow-up, 66 (42%) patients died. Patients with one-vessel disease (n = 49) had lower mortality than patients with two-vessel (n = 59) or three-vessel (n = 50) disease (25% vs. 48% vs. 52%, P = 0.011). Successful revascularization [Thrombolysis in Myocardial Infarction (TIMI) Flow 3 post-PCI) was achieved more often in survivors than non-survivors (81% vs. 60%, P = 0.019). The median symptom-to-balloon time was 340 (196-660) minutes, with no difference between survivors and non-survivors. In multivariable mortality analysis, multivessel disease (HR 2.59, CI 95% 1.29-5.18) and TIMI flow <3 post-PCI (HR 2.41, CI 95% 1.4-4.15) were associated with 90-day mortality. Procedural PCI complications were recorded in 51 (35%) patients, arrhythmic complications being the most common (n = 32, 63%). The incidence of complications was similar between survivors and non-survivors (31% vs. 42%, P = 0.21). Conclusions Multivessel disease is associated with worse survival in ACS-related CS. In patients undergoing PCI, arrhythmic complications were common, but not associated with excess mortality. Successful revascularization of the IRA had positive effect on outcome despite delay from symptom onset.

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Section: Resultssupporting

confidence: 89%

Prognostic impact of angiographic findings, procedural success, and timing of percutaneous coronary intervention in cardiogenic shock

et al. 2020

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“…Female patients are typically older, and elderly patients exhibit more comorbidities [24,25]. Myocardial infarction is complicated by cardiogenic shock more often in these patients [26]. These comorbidities and hemodynamic instability usually go along with prolonged pre-hospital transportation delay [11].…”

Section: Discussionmentioning

confidence: 99%

Predictors of transportation delay in patients with suspected ST-elevation-myocardial infarction in the VIENNA-STEMI network

et al. 2019

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Objective The emergency medical service (EMS) provides rapid pre-hospital diagnosis and transportation in ST-elevation myocardial infarction (STEMI) systems of care. Aim of the study was to assess temporal and regional characteristics of EMS-related delays in a metropolitan STEMI network. Methods Patient call-to-arrival of EMS at site (call-to-site), transportation time from site to hospital (site-to-door), call-todoor, patient's location, month, weekday, and hour of EMS activation were recorded in 4751 patients referred to a tertiary center with suspicion of STEMI. Results Median call-to-site, site-to-door, and call-to-door times were 9 (7-12), 39 (31-48), and 49 (41-59) minutes, respectively. The shortest transportation times were noted between 08:00 and 16:00 and in general on Sundays. They were significantly prolonged between midnight and 04:00, whereby the longest difference did not exceed 4 min in median. Patient's site of call had a major impact on transportation times, which were shorter in Central and Western districts as compared to Southern and Eastern districts of Vienna (p < 0.001 between-group difference for call-to-site, site-to-door, and call-to-door). After multivariable adjustment, patient's site of call was an independent predictor of call-to-site delay (p < 0.001). Moreover, age and hour of EMS activation were the strongest predictors of call-to-site, site-to-door, and call-to-door delays (p < 0.05). Conclusion In our Viennese STEMI network, the strongest determinants of pre-hospital EMS-related transportation delays were patient's site of call, patient's age, and hour of EMS activation. Due to the significant but small median time delays, which are within the guideline-recommended time intervals, no impact on clinical outcome can be expected.

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“…Dies dürfte in erster Linie einer besseren präklinischen Versorgung geschuldet sein, durch die Patienten im CS nunmehr häufiger noch in ein Krankenhaus transportiert werden können und nicht im häuslichen Umfeld versterben [1 -6]. Trotz aller beim AMI erreichten Verbesserungen mit einer deutlichen Mortalitätsreduktion in den letzten Jahrzehnten [7] ist die Mortalität im Falle eines CS weiterhin sehr hoch und liegt bei einer Rate von 40-50 % nach einem Monat [3,5,8,9]. Die aktuellen Empfehlungen und Therapieansätze für Deutschland und Österreich basieren auf der im Jahr 2010 initial erschienenen S3-Leitlinie, welche gerade in einer aktualisierten Revision veröffentlicht wurde [10,11].…”

Section: Introductionunclassified

Diagnose und Therapie des kardiogenen Schocks im akuten Myokardinfarkt

Fichera¹,

Thelemann²,

Fürnau³

2020

Notf.med. up2date

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Management and predictors of outcome in unselected patients with cardiogenic shock complicating acute ST-segment elevation myocardial infarction: results from the Bremen STEMI Registry

Cited by 73 publications

References 37 publications

Prognostic impact of angiographic findings, procedural success, and timing of percutaneous coronary intervention in cardiogenic shock

Prognostic impact of angiographic findings, procedural success, and timing of percutaneous coronary intervention in cardiogenic shock

Predictors of transportation delay in patients with suspected ST-elevation-myocardial infarction in the VIENNA-STEMI network

Diagnose und Therapie des kardiogenen Schocks im akuten Myokardinfarkt

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