One-Year Outcomes after PCI Strategies in Cardiogenic Shock

Thiele, Holger; Akın, İbrahim; Sandri, Monica; Waha‐Thiele, Suzanne de; Meyer‐Saraei, Roza; Fuernau, Georg; Eitel, Ingo; Nordbeck, Peter; Geisler, Tobias; Landmesser, Ulf; Skurk, Carsten; Fach, Andreas; Jobs, Alexander; Lapp, Harald; Piek, Jan J.; Noč, Marko; Goslar, Tomaž; Felix, Stephan B.; Maier, Lars S.; Stępińska, Janina; Oldroyd, Keith G.; Šerpytis, Pranas; Montalescot, Gilles; Barthélémy, Olivier; Huber, Kurt; Windecker, Stephan; Hunziker, Lukas; Savonitto, Stefano; Torremante, Patrizia; Vrints, Christiaan J.; Schneider, Steffen; Zeymer, Uwe; Desch, Steffen

doi:10.1056/nejmoa1808788

Cited by 346 publications

(222 citation statements)

References 26 publications

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Section: Introductionmentioning

confidence: 99%

“…Unfortunately, despite these efforts, CS mortality remains unacceptably high, and there are no prospective randomized trials showing that percutaneous mechanical circulatory support devices change the mortality in this clinical state. [3][4][5][6][7][8][9] It has been difficult to prove therapeutic benefit, in part, because CS patients are a heterogeneous population, and prognosis may vary widely based on etiology, severity of illness and comorbidities. CS encompasses a spectrum spanning from those at high risk of developing shock due to isolated myocardial dysfunction to those critically ill patients with severe multi-organ dysfunction and hemodynamic collapse to those with ongoing cardiac arrest.…”

Section: Introductionmentioning

confidence: 99%

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SCAI clinical expert consensus statement on the classification of cardiogenic shock

Baran

Grines

Bailey

et al. 2019

Cathet Cardio Intervent

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Background The outcome of cardiogenic shock complicating myocardial infarction has not appreciably changed in the last 30 years despite the development of various percutaneous mechanical circulatory support options. It is clear that there are varying degrees of cardiogenic shock but there is no robust classification scheme to categorize this disease state. Methods A multidisciplinary group of experts convened by the Society for Cardiovascular Angiography and Interventions was assembled to derive a proposed classification schema for cardiogenic shock. Representatives from cardiology (interventional, advanced heart failure, noninvasive), emergency medicine, critical care, and cardiac nursing all collaborated to develop the proposed schema. Results A system describing stages of cardiogenic shock from A to E was developed. Stage A is “at risk” for cardiogenic shock, stage B is “beginning” shock, stage C is “classic” cardiogenic shock, stage D is “deteriorating”, and E is “extremis”. The difference between stages B and C is the presence of hypoperfusion which is present in stages C and higher. Stage D implies that the initial set of interventions chosen have not restored stability and adequate perfusion despite at least 30 minutes of observation and stage E is the patient in extremis, highly unstable, often with cardiovascular collapse. Conclusion This proposed classification system is simple, clinically applicable across the care spectrum from pre‐hospital providers to intensive care staff but will require future validation studies to assess its utility and potential prognostic implications.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

SCAI clinical expert consensus statement on the classification of cardiogenic shock

Baran

Grines

Bailey

et al. 2019

Cathet Cardio Intervent

Self Cite

780

358

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“…still failed to recover from malignant complication. 4 There is no doubt that understanding the mechanism and pathology will provide new clues for clinical treatment.…”

mentioning

confidence: 99%

Overexpression of lncRNA Gm2691 attenuates apoptosis and inflammatory response after myocardial infarction through PI3K/Akt signaling pathway

Tian

et al. 2019

IUBMB Life

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Acute myocardial infarction is one of the most threatening disease in the world. In previous studies, numerous dysregulated lncRNAs exposed to ischemic reperfusion injury have been identified. In this differential lncRNAs, Gm2691 attracted our attention due to its high fold change. The aim of the study was to investigate the function and mechanism of lncRNA Gm2691 in ischemic reperfusion injury. AnaeroPack anaerobic system treated neonatal rat ventricular cardiomyocytes were used to analyze the function of lncRNA Gm2691 in vitro. Tunel, Caspase3, and inflammation markers were detected to evaluate apoptosis and inflammatory response. Rat acute myocardial infarction was performed to elucidate the function of lncRNA Gm2691 in vivo. The results showed that LncRNA Gm2691 improved the cardiac function and attenuated the inflammatory response in vivo. We also found that lncRNA Gm2691 reduced the apoptosis and improved cell survival rates in anaeroPack anaerobic system treated neonatal rat ventricular cardiomyocytes. Western blot analysis revealed that lncRNA Gm2691 decreased Akt and ERK1/2 activities, suggesting that lncRNA Gm2691 may functioned through Akt signaling pathway. We verified the function and mechanism of lncRNA Gm2691 and provide evidence that lncRNA Gm2691 may play important role in ischemic reperfusion injury, and understanding the precise role of Gm2691 will undoubtedly shed new light on the clinical treatment.

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“…20 However, CL-PCI was associated with higher rates of repeat revascularization and readmission for heart failure in the long run. 20 This could possibly be due to the fact that MV-PCI leads to improved long-term ventricular function and subsequent reduced rates of heart failure. However, we do not have any definitive data to support this hypothesis and our pooled analysis did not show any benefit in secondary long-term efficacy end points with MV-PCI.…”

Section: Discussionmentioning

confidence: 99%

“…19 1-year outcomes of this landmark trial were recently published and showed that CL-PCI (with the option of staged revascularization of non-culprit lesions) was associated with better short-term outcomes and similar long-term mortality, compared to immediate MV-PCI, thus challenging the existing guidelines. 20 On the basis of this trial, the ESC downgraded MV-PCI in CS from a class II A to a class III B recommendation, in the recently released 2018 ESC guidelines. 21 In contrast to CULPRIT-SHOCK, recently published real world data from the large-scale, KAMIR-NIH registry study showed a significantly lower risk of all-cause mortality at 1 year with MV-PCI, compared to CL-PCI in patients with AMI and CS.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of multivessel vs culprit lesion‐only percutaneous coronary intervention in patients with acute myocardial infarction complicated by cardiogenic shock: Evidence from an updated meta‐analysis

Kundu

Sardar

Kakouros

et al. 2018

Cathet Cardio Intervent

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Objectives This updated meta‐analysis evaluated outcomes with multi‐vessel (MV‐PCI) vs culprit lesion‐only percutaneous coronary intervention (CL‐PCI), in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Background There is considerable debate regarding the optimal revascularization strategy in patients with AMI and CS, particularly regarding management of non‐culprit lesions. Methods Databases were searched for studies comparing MV‐PCI and CL‐PCI in patients with AMI and CS. The primary outcome of interest was short‐term all‐cause mortality. Secondary outcomes included long‐term mortality, repeat revascularization and myocardial reinfarction. Safety outcomes were stroke, acute renal failure and major bleeding. Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using random‐effects models. Results Our meta‐analysis consisting of 14 studies (13 observational, 1 RCT) involving 8,552 patients showed that in comparison to CL‐PCI, MV‐PCI was associated with similar short‐term mortality (OR 1.14; 95% CI 0.9–1.43), as well as similar long‐term mortality (OR 0.94; 95% CI 0.68–1.28). There was no significant difference in the risk of myocardial reinfarction (OR 1.19; 95% CI 0.76–1.86), or repeat revascularization (OR 0.79; 95% CI 0.41–1.55) between the two groups. Compared to CL‐PCI, MV‐PCI was associated with a similar risk of bleeding (OR 1.13; 95% CI 0.91–1.40) and stroke (OR 1.28; 95% CI 0.84–1.96), but a higher risk of developing renal failure (OR 1.32; 95% CI 1.05–1.65). Conclusions Our meta‐analysis suggests that there is a higher risk of renal failure with no additional benefit in efficacy outcomes with MV‐PCI, compared to CL‐PCI in patients with AMI and CS.

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One-Year Outcomes after PCI Strategies in Cardiogenic Shock

Cited by 346 publications

References 26 publications

SCAI clinical expert consensus statement on the classification of cardiogenic shock

SCAI clinical expert consensus statement on the classification of cardiogenic shock

Overexpression of lncRNA Gm2691 attenuates apoptosis and inflammatory response after myocardial infarction through PI3K/Akt signaling pathway

Outcomes of multivessel vs culprit lesion‐only percutaneous coronary intervention in patients with acute myocardial infarction complicated by cardiogenic shock: Evidence from an updated meta‐analysis

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