Management of cardiogenic shock complicating myocardial infarction

Mebazaa, Alexandre; Combes, Alain; Diepen, Sean van; Hollinger, Alexa; Katz, Jaon N.; Landoni, Giovanni; Hajjar, Ludhmila Abrahão; Lassus, Johan; Lebreton, Guillaume; Montalescot, Gilles; Park, Jin Joo; Price, Susanna; Sionís, Alessandro; Yannopolos, Demetris; Harjola, Veli Pekka; Lévy, Bruno; Thiele, Holger

doi:10.1007/s00134-018-5214-9

Cited by 152 publications

(139 citation statements)

References 80 publications

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“…Expert recommendations encouraging implementation of shock teams in cardiac centres might be a way to improve outcomes in the future …”

Section: Discussionmentioning

confidence: 99%

“…systolic blood pressure <90 mmHg, or vasopressors required to achieve a blood pressure ≥90 mmHg), and signs of impaired organ perfusion (e.g. central nervous system abnormalities including confusion or lack of alertness, or even loss of consciousness; oliguria; cold, clammy skin and extremities, increased arterial lactate >2 mmol/L) in the state of normovolaemia or hypervolaemia …”

Section: Methodsmentioning

confidence: 99%

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Trends in cardiogenic shock complicating acute myocardial infarction

Aïssaoui

Puymirat

Delmas

et al. 2020

European J of Heart Fail

101

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Aims Few studies describe recent changes in the prevalence, management, and outcomes of cardiogenic shock (CS) patients complicating acute myocardial infarction (AMI) in the era of widespread use of invasive strategies. The aim of the present study was to analyse trends observed in CS complicating AMI over the past 10 years, focusing on the timing of CS occurrence (i.e. primary CS, CS on admission vs. secondary CS, CS developed subsequently during hospitalization). Methods and results Three nationwide French registries conducted and designed to evaluate AMI management and outcomes in ‘real‐life’ practice included consecutive AMI patients (n = 9951) admitted to intensive cardiovascular care units (ICCUs) over a 1‐month period, 5 years apart. The prevalence of CS complicating AMI decreased from 2005 to 2015: 5.9%, mean age 74.1 ± 12.7 in 2005; 4.0%, mean age 73.9 ± 12.7 in 2010, 2.8%, mean age 71.1 ± 15.0 in 2015 (P < 0.001). It decreased for both primary (1.8% to 1.0%) and secondary CS (4.1% to 1.8%). The profile of CS patients also changed over time with more patients presenting out‐of‐hospital cardiac arrest. In both primary and secondary CS, the use of percutaneous coronary intervention increased markedly over time, as did the use of mechanical ventilation and cardiac assist devices. Over the 10‐year period, in‐hospital mortality remained unchanged for both primary CS (41.8% to 37.8%) or secondary CS (57.3% to 58.8%). However, 1‐year mortality decreased in patients with primary CS (from 60% to 37.8%, P = 0.038), and remained unchanged in patients developing secondary CS (from 64.5% to 69.1%, P = 0.731). Conclusion Cardiogenic shock complicating AMI has become less frequent but, if present, CS, and particularly secondary CS, carries a very high mortality, which has not substantially improved over the past 10 years, in spite of the more frequent use of invasive strategies.

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“…Expert recommendations encouraging implementation of shock teams in cardiac centres might be a way to improve outcomes in the future …”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Trends in cardiogenic shock complicating acute myocardial infarction

Aïssaoui

Puymirat

Delmas

et al. 2020

European J of Heart Fail

101

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“…Some of those patients present a worsened clinical condition during the initial days and develop refractory CS. The latter is defined as CS with persistent high dose of vasopressor(s) . Recently, worsening CS was also classified as category D (deteriorating/doom) with the need of an escalating number or intensity of intravenous therapies to address hypoperfusion or addition of MCS .…”

Section: Discussionmentioning

confidence: 99%

“…The latter is defined as CS with persistent high dose of vasopressor(s). [26][27][28] Recently, worsening CS was also classified as category D (deteriorating/doom) with the need of an escalating number or intensity of intravenous therapies to address hypoperfusion or addition of MCS. 29 Our study shows that two early measures of cDPP3 at inclusion and a day later may indicate either a potential need for escalating therapies if cDPP3 is continuously high or de-escalating therapies if high cDPP3 at ICU admission rapidly returns toward normal values.…”

Section: Discussionmentioning

confidence: 99%

Circulating dipeptidyl peptidase 3 and alteration in haemodynamics in cardiogenic shock: results from the OptimaCC trial

Takagi

Blet

Lévy

et al. 2019

European J of Heart Fail

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Aims Dipeptidyl peptidase 3 (DPP3) is a protease involved in the degradation of cardiovascular mediators. Its administration has been shown to be associated with impaired cardiac contraction and kidney haemodynamics while its inhibition restored cardiac contraction in a pre‐clinical model of severe heart failure in mice. Circulating DPP3 (cDPP3) was found to be elevated in shock. The present study aims to assess the association between cDPP3 and worsening haemodynamics, namely refractory shock, in a cohort of cardiogenic shock (CS). Methods and results This is an ancillary study of OptimaCC, a prospective, double‐blind, multicentre, randomized study assessing efficacy and safety of catecholamines in 57 patients with CS after acute myocardial infarction. cDPP3 was measured in plasma at inclusion, 24 h, 48 h, and 72 h, and haemodynamic and biological parameters were recorded at inclusion. cDPP3 values were higher in refractory CS than non‐refractory CS at inclusion (median [interquartile range]; 76.1 [37.9–238.7] ng/mL vs. 32.8 [23.9–47.6] ng/mL, P = 0.014), at 24 h (P < 0.001) and up to 48 h (P = 0.027). Furthermore, cDPP3 at inclusion discriminated CS patients who did develop refractory shock vs. non‐refractory with an area under the curve of 0.73 (95% confidence interval [CI] 0.55–0.92). The high cDPP3 group (cDPP3 ≥59.1 ng/mL) at inclusion had a higher Simplified Acute Physiology Score II (SAPS II), lower cardiac index and lower estimated glomerular filtration rate. More importantly, in CS patients with high cDPP3 at inclusion, those who rapidly decreased cDPP3 at 24 h exhibited a striking reduction in the occurrence of refractory shock and death. Conclusion In CS patients, cDPP3 gives an early prediction of outcome, including development of refractory status and/or survival. Clinical Trial Registration: http://clinicaltrials.gov Identifier NCT01367743

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“…Echocardiography showed rapid RV size and IVC size reduction, consistent with RV effective unloading. Patient 2 also required inotropic support (low dose and short term, according to current guidelines) to achieve a satisfactory optimization, possibly due to preexistence of RV systolic dysfunction. In both cases, the NT‐proBNP reduction and absence of liver and kidney function deterioration confirmed the reduction in systemic venous congestion.…”

Section: Discussionmentioning

confidence: 99%

Early cardiac unloading with ImpellaCP™ in acute myocardial infarction with ventricular septal defect

et al. 2020

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Despite a relative contraindication, mechanical support with Impella ™ left ventricular assist device has already been described for ischaemic ventricular septal defect treatment, either as a bridge to surgery, as intraoperative mechanical haemodynamic support, or to ensure intraprocedural haemodynamic stability during device closure. We describe two cases of ventricular septal defect complicating acute myocardial infarction, where the percutaneous ImpellaCP was implanted early (differently than previously described) with the aim of preventing haemodynamic instability, while deferring surgical repair. We present a report of haemodynamic, echocardiographic, biochemical, and clinical data of two consecutive cases of ImpellaCP use, within a minimally invasive monitoring and therapeutic approach. In two cases of subacute myocardial infarction-related ventricular septal defect not amenable to percutaneous device closure, the use ImpellaCP was successful: it was followed by effective and rapid right and left ventricular unloading, by major haemodynamic instability prevention and protection from systemic venous congestion, from kidney and splanchnic organ failures. This allowed bridging to appropriately timed surgical repair. These cases suggest a potentially effective, clinically grounded strategy in the early management of ischaemic ventricular septal defect patients, with the aim of deferring surgery beyond the safer 7 days cutoff associated with a lower perioperative mortality.

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Management of cardiogenic shock complicating myocardial infarction

Cited by 152 publications

References 80 publications

Trends in cardiogenic shock complicating acute myocardial infarction

Trends in cardiogenic shock complicating acute myocardial infarction

Circulating dipeptidyl peptidase 3 and alteration in haemodynamics in cardiogenic shock: results from the OptimaCC trial

Early cardiac unloading with ImpellaCP™ in acute myocardial infarction with ventricular septal defect

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