One-Year Survival Following Early Revascularization for Cardiogenic Shock

Hochman, Judith S.; Sleeper, Lynn A.; White, Harvey D.; Džavík, Vladimir; Wong, S. Chiu; Menon, Venu; Webb, John G.; Steingart, Richard M.; Picard, Michael H.; Menegus, Mark; Boland, Jean; Sanborn, Timothy A.; Buller, Christopher E.; Modur, Sharada P.; Forman, Robert; Desvigne‐Nickens, Patrice; Jacobs, Alice K.; Slater, James; LeJemtel, Thierry H.

doi:10.1001/jama.285.2.190

Cited by 584 publications

(168 citation statements)

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“…The primary endpoint (all-cause mortality at 30 days) did not differ between the initial medical stabilisation and early revascularisation treatment groups; however, there was a significant decrease in mortality rates at 3 and 6 years in patients assigned to early revascularisation. 14,17,18 The number needed to save one life at 1 year by early revascularisation in comparison with initial medical stabilisation is less than eight, and this benefit remained with long-term follow-up.…”

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confidence: 99%

“…However, the overall benefit of revascularisation in cardiogenic shock may extend past the traditional 12-hour window to potentially 54 hours post-MI and 18 hours after the onset of shock. 18,19 In current European Society of Cardiology (ESC) guidelines, early revascularisation by either PCI or CABG for cardiogenic shock is recommended, 20 but despite a general increase in the trend to perform early revascularisation, real-world rates remain relatively low (50-70 %). 2,14,21 Anti-platelet and Anti-thrombotic Medication…”

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confidence: 99%

“…Studies have demonstrated some benefit of thrombolytic therapy compared with placebo, but superiority of PCI or CABG over thrombolytic therapy. 18,27,28 Therefore, thrombolytic therapy is recommended only if PCI is not possible or if it is delayed (>90 min) and presenting early after symptom onset (<3 hours), followed by emergent transfer to a PCI facility. 20 The prognosis of patients with cardiogenic shock is related to the procedural success of PCI and importantly, patients with cardiogenic shock are less likely to have successful PCI than patients without shock.…”

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confidence: 99%

“…Among the 128 patients with cardiogenic shock receiving emergency revascularisation (63 % PCI and 37 % CABG) there was a similar mortality rate at 30 days, 1 year and 6 years regardless of the method of revascularisation. 14,17,18 However, in current practice, few patients with cardiogenic shock and three-vessel disease are referred for CABG, ranging from 3.2 % to 8.8 %, 32 possibly reflecting the real-world difficulties of arranging emergency CABG for patients who often present with cardiogenic shock overnight and at weekends. …”

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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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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

Joseph¹,

Patterson²,

Arri³

et al. 2016

Interventional Cardiology Review

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“…8 Recently, the SHOCK trial showed that early revascularization with a high utilization of IABP led to a significant improvement of 6-month and 1-year mortality rates. 9,10 In the 23 180 patients in the National Registry of Myocardial Infarction 2 (NRMI-2) with cardiogenic shock, the use of IABP in conjunction with thrombolytic therapy decreased the odds of death by 18%. 3 The outcome of selected medical procedures is increasingly associated with hospital and operator volume, particularly in the setting of coronary artery bypass graft (CABG) surgery.…”

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Relation Between Hospital Intra-Aortic Balloon Counterpulsation Volume and Mortality in Acute Myocardial Infarction Complicated by Cardiogenic Shock

et al. 2003

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Background-Increasing evidence suggests an inverse relationship between outcome and the total number of invasive cardiac procedures performed at a given hospital. The purpose of the present study was to determine if a similar relationship exists between the number of intra-aortic balloon counterpulsation (IABP) procedures performed at a given hospital per year and the in-hospital mortality rate of patients with acute myocardial infarction complicated by cardiogenic shock. Methods and Results-We

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Systemic Inflammatory Response Syndrome After Acute Myocardial Infarction Complicated by Cardiogenic Shock

et al. 2005

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Almost one fifth of patients with acute myocardial infarction complicated by CS showed clinical signs of severe systemic inflammation, and those who were culture-positive for sepsis had twice the risk of death. The observation of lower SVR at the onset of shock in patients who subsequently had culture-positive systemic inflammation suggests that inappropriate vasodilation may play an important role in the pathogenesis and persistence of shock and in the risk of infection.

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One-Year Survival Following Early Revascularization for Cardiogenic Shock

Abstract: For patients with AMI complicated by CS, ERV resulted in improved 1-year survival. We recommend rapid transfer of patients with AMI complicated by CS, particularly those younger than 75 years, to medical centers capable of providing early angiography and revascularization procedures.

Cited by 584 publications

References 13 publications

Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

Relation Between Hospital Intra-Aortic Balloon Counterpulsation Volume and Mortality in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Systemic Inflammatory Response Syndrome After Acute Myocardial Infarction Complicated by Cardiogenic Shock

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