Mechanical Circulatory Support Devices for the Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction—A Review

Bruoha, Sharon; Yosefy, Chaim; Taha, Louay; Dvir, Danny; Shuvy, Mony; Jubeh, Rami; Carasso, Shemy; Glikson, Michael; Asher, Elad

doi:10.3390/jcm11175241

Cited by 12 publications

(11 citation statements)

References 64 publications

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“…28 The risk of major bleeding increases with the use of all Impella devices and is typically higher for AMI patients. 1,7,10 However, newer Impella models have lower rates of bleeding, and Impella 5.5 has demonstrated a lower rate than Impella 5.0 in a recent comparison. 14,24 Most instances of pump replacement in this study can be attributed to irreparable purge line damage that was potentially related to an early device design that has since been updated.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9] However, these studies were conducted in AMI patients with early Impella models that provide only partial support (peak flow up to 4.3 L/min). 10 Data to guide current practice in CS management of a heterogenous patient population with updated devices is largely limited to smaller scale retrospective studies. Impella 5.5 support has shown initial promise as a CS intervention in early analyses, however thorough comparison of Impella 5.5 outcomes in AMI-CS and ADHF-CS has yet to be published.…”

Section: Introductionmentioning

confidence: 99%

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Cardiogenic shock etiology and exit strategy impact survival in patients with Impella 5.5

Sicke,

Modi,

Hong

et al. 2023

Int J Artif Organs

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Background: Despite historical differences in cardiogenic shock (CS) outcomes by etiology, outcomes by CS etiology have yet to be described in patients supported by temporary mechanical circulatory support (MCS) with Impella 5.5. Objectives: This study aims to identify differences in survival and post-support destination for these patients in acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF) CS at a high-volume, tertiary, transplant center. Methods: A retrospective review of patients who received Impella 5.5 at our center from November 2020 to June 2022 was conducted. Results: Sixty-seven patients underwent Impella 5.5 implantation for CS; 23 (34%) for AMI and 44 (66%) for ADHF. AMI patients presented with higher SCAI stage, pre-implant lactate, and rate of prior MCS devices, and fewer days from admission to implantation. Survival was lower for AMI patients at 30 days, 90 days, and discharge. No difference in time to all-cause mortality was found when excluding patients receiving transplant. There was no significant difference in complication rates between groups. Conclusions: ADHF-CS patients with Impella 5.5 support have a significantly higher rate of survival than patients with AMI-CS. ADHF patients were successfully bridged to heart transplant more often than AMI patients, contributing to increased survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiogenic shock etiology and exit strategy impact survival in patients with Impella 5.5

Sicke,

Modi,

Hong

et al. 2023

Int J Artif Organs

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“…Septic cardiomyopathy defined as a decrease in left, right, or biventricular ejection fraction followed by a recovery of function over a period of days to weeks [2,82] Cardiogenic shock defined as a persistently low blood pressure with evidence of end-organ hypoperfusion and inadequate response to fluid resuscitation [83] Decreases in right ventricular ejection fraction can be detected with a simplified ellipsoid geometric method [56] This table includes the current treatment options, mechanisms of action, benefits and limitations of each treatment, and each article's definition or indication criteria for septic cardiomyopathy. The type of recommendation for each therapy (strong, medium, or weak) and quality of the evidence (high, moderate, or low) are also provided.…”

Section: Complications Associated With Mechanical Support Devices Inc...mentioning

confidence: 99%

Clinical implications of septic cardiomyopathy: A narrative review

Hiraiwa,

Kasugai,

Okumura

et al. 2024

Medicine

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Sepsis is caused by the body’s dysregulated response to infection, which can lead to multiorgan injury and death. Patients with sepsis may develop acute cardiac dysfunction, termed septic cardiomyopathy, which is a global but reversible dysfunction of both sides of the heart. This narrative review discusses the mechanistic changes in the heart during septic cardiomyopathy, its diagnosis, existing treatment options regarding severity and course, and emerging treatment approaches. Although no standardized definition for septic cardiomyopathy exists, it is described as a reversible myocardial dysfunction that typically resolves within 7 to 10 days. Septic cardiomyopathy is often diagnosed based on electrocardiography, cardiac magnetic resonance imaging, biomarkers, and direct invasive and noninvasive measures of cardiac output. Presently, the treatment of septic cardiomyopathy is similar to that of sepsis, primarily focusing on acute interventions. Treatments for cardiomyopathy often include angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. However, because of profound hypotension in sepsis, many cardiomyopathy treatments are contraindicated in patients with septic cardiomyopathy. Substantial efforts have been made to study the pathophysiological mechanisms and diagnostic options; however, the lack of a uniform definition for septic cardiomyopathy is challenging for physicians when considering treatments. Another challenge for physicians is that the treatment for septic cardiomyopathy has only focused on acute intervention, whereas the treatment for other cardiomyopathies has been provided on a long-term basis. A better understanding of the underlying mechanisms of septic cardiomyopathy may contribute to the development of a unified definition of the condition and novel treatment options.

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“…Cardiogenic shock (CS) represents the leading cause of death in patients with acute myocardial infarction (AMI) [ 1 , 2 , 3 ]. CS is characterized by low cardiac output leading to tissue hypoperfusion and hypoxia.…”

Section: Introductionmentioning

confidence: 99%

“…CS is characterized by low cardiac output leading to tissue hypoperfusion and hypoxia. CS-related in-hospital mortality rates remain high at about 40–50% despite improved management of CS, including early coronary revascularization, intravenous treatment with vasopressors and inotropes, and the implantation of mechanical circulatory support (MCS) devices [ 2 , 4 , 5 , 6 ]. Recently, serum glucose, lactate, and creatinine were identified as useful biomarkers for risk stratification in CS [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Does Albumin Predict the Risk of Mortality in Patients with Cardiogenic Shock?

Schupp

Behnes

Rusnak

et al. 2023

IJMS

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This study investigates the prognostic impact of albumin levels in patients with cardiogenic shock (CS). Intensive care unit (ICU) related mortality in CS patients remains unacceptably high despite improvement concerning the treatment of CS patients. Limited data regarding the prognostic value of albumin in patients with CS is available. All consecutive patients with CS from 2019 to 2021 were included at one institution. Laboratory values were retrieved from the day of disease onset (day 1) and days 2, 3, 4, and 8 thereafter. The prognostic impact of albumin was tested for 30-day all-cause mortality. Moreover, the prognostic performance of albumin decline during ICU treatment was examined. Statistical analyses included univariable t-test, Spearman’s correlation, Kaplan–Meier analyses, multivariable mixed analysis of variance (ANOVA), C-Statistics, and Cox proportional regression analyses. In total, 230 CS patients were included, with an overall all-cause mortality at 30 days of 54%. The median albumin on day 1 was 30.0 g/L. Albumin on day 1 was able to discriminate between 30-day survivors and non-survivors (area under the curve (AUC) 0.607; 0.535–0.680; p = 0.005). CS patients with albumin < 30.0 g/L were associated with an increased risk of 30-day all-cause mortality (63% vs. 46%; log-rank p = 0.016; HR = 1.517; 95% CI 1.063–2.164; p = 0.021), which was demonstrated even after multivariable adjustment. Moreover, a decrease of albumin levels by ≥20% from day 1 to day 3 was accompanied by a higher risk of 30-days all-cause mortality (56% vs. 39%; log-rank p = 0.036; HR = 1.645; 95% CI 1.014–2.669; p = 0.044). Especially when combined with lactate, creatinine, and cardiac troponin I, reliable discrimination of 30-day all-cause mortality was observed, including albumin in CS risk stratification models (AUC = 0.745; 95% CI 0.677–0.814; p = 0.001). In conclusion, low baseline albumin levels as well as a decay of albumin levels during the course of ICU treatment, deteriorate prognostic outcomes in CS patients. The additional assessment of albumin levels may further improve risk stratification in CS patients.

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Mechanical Circulatory Support Devices for the Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction—A Review

Cited by 12 publications

References 64 publications

Cardiogenic shock etiology and exit strategy impact survival in patients with Impella 5.5

Cardiogenic shock etiology and exit strategy impact survival in patients with Impella 5.5

Clinical implications of septic cardiomyopathy: A narrative review

Does Albumin Predict the Risk of Mortality in Patients with Cardiogenic Shock?

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