Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock

Valente, Serafina; Lazzeri, Chiara; Vecchio, Silvia Lo; Giglioli, Cristina; Margheri, Massimo; Bernardo, Pasquale; Comeglio, Marco; Chiocchini, Silvia; Gensini, Gian Franco

doi:10.1016/j.ijcard.2006.01.024

Cited by 106 publications

(65 citation statements)

References 30 publications

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“…In these patients, increased glucose values hold a prognostic role when measured not only on admission [1], but also throughout hospital stay [6][7][8]. The prognostic role of hyperglycemia has also been reported in cardiogenic shock complicating acute myocardial infarction [9][10][11][12]. Insulin resistance, known to be part of the glyco-metabolic response to stress, has been investigated in a few studies by means of the Homeostatic Model Assessment (HoMA index), in the early phase of acute myocardial infarction [13] and in ACS patients [14].…”

Section: Introductionmentioning

confidence: 84%

Acute hyperglycemia and insulin resistance in acute heart failure syndromes without previously known diabetes

et al. 2011

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No data is so far available on the relation between glucose values and insulin resistance and mortality, both at short-and long-term, in patients with acute heart failure syndromes (AHF). We prospectively assessed in 100 consecutive non-diabetic AHF patients whether acute glucose metabolism, as indicated by fasting glycemia and insulin resistance (HOMA index) was able to affect short-and long-term mortality. In the overall population, 51 patients showed admission glucose values [140 mg/dl. No significant difference was observed in admission and peak glycemia, insulin and C-peptide values and in HOMA-index between dead and survived patients. At multivariate logistic backward stepwise analysis the following variables were independent predictors for in-ICCU mortality (when adjusted for left ventricular ejection frac- In consecutive patients with acute heart failure without previously known diabetes, we documented, for the first time, that fasting glucose and insulin values and insulin resistance do not affect mortality at short-and longterm. Inflammatory activation (as indicated by the leukocyte count and the fibrinogen) and NT-pro BNP levels are independent predictors for early death while the eGFR affects the long-term mortality.

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Section: Introductionmentioning

confidence: 84%

Acute hyperglycemia and insulin resistance in acute heart failure syndromes without previously known diabetes

et al. 2011

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“…Higher vasopressor doses are associated with poorer survival 48 ; this represents both more severe underlying hemodynamic derangement and direct toxic effects.…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Cardiogenic Shock

2008

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ardiogenic shock (CS) occurs in Ϸ5% to 8% of patients hospitalized with ST-elevation myocardial infarction (STEMI). Recent research has suggested that the peripheral vasculature and neurohormonal and cytokine systems play a role in the pathogenesis and persistence of CS. Early revascularization for CS improves survival substantially. New mechanical approaches to treatment are available, and clinical trials are feasible even in this high-risk population. Most importantly, hospital survivors have an excellent chance for long-term survival with good quality of life. This review will outline the causes, pathophysiology, and treatment of CS with a focus on CS complicating myocardial infarction (MI.) The case will be made for viewing CS as a serious disorder with a high early death rate, but one that is treatable and that, if approached aggressively, can result in full recovery. The diagnosis is usually made with the help of pulmonary artery (PA) catheterization; however, Doppler echocardiography may also be used to confirm elevation of LV filling pressures. 1 Hypoperfusion may be manifest clinically by cool extremities, decreased urine output, and/or alteration in mental status. Hemodynamic abnormalities form a spectrum that ranges from mild hypoperfusion to profound shock, and the short-term outcome is directly related to the severity of hemodynamic derangement. MI with LV failure remains the most common cause of CS. It is critical to exclude complicating factors that may cause shock in MI patients. Chief among these are the mechanical complications: ventricular septal rupture, contained free wall rupture, and papillary muscle rupture. Mechanical complications must be strongly suspected in patients with CS complicating nonanterior MI, particularly a first MI. Echocardiography is the technique of choice to rule out these entities and should be performed early unless the diagnosis is extensive anterior MI and the patient is undergoing prompt percutaneous coronary intervention (PCI). In addition, the detection of valvular disease before angiography may alter the revascularization approach. Diagnosis and CausesHemorrhage, infection, and/or bowel ischemia may contribute to shock in the setting of MI. As with mechanical complications, a high index of suspicion is required to make these diagnoses in MI patients, and survival may depend on timely recognition and treatment.Any cause of acute, severe LV or RV dysfunction may lead to CS. Acute myopericarditis, tako-tsubo cardiomyopathy, and hypertrophic cardiomyopathy may all present with ST elevation, release of cardiac markers, and shock in the absence of significant coronary artery disease. Stress-induced cardiomyopathy, also known as apical ballooning or takotsubo cardiomyopathy, is a syndrome of acute LV dysfunction after emotional or respiratory distress that leads to CS in 4.2% of cases. 2 Acute valvular regurgitation, typically caused by endocarditis or chordal rupture due to trauma or degenerative disease, may also cause CS. Aortic dissection may lead to CS via acute,...

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“…In Pres et al [14] research, evaluated BG level on admission (≥ 7.8 mmol/L), resulted in higher in-hospital and long-term mortality in patients with STEMI complicated by CS. Also Valente et al [15] in an univariate analysis showed that hyperglycemia (> 11.1. mmol/L) was an independent predictor of in-hospital mortality. However, multivariate analysis did not confirm this association.…”

Section: Discussionmentioning

confidence: 90%

“…Also higher incidence of CS has been observed among hyperglycemic patients with AMI [11,12]. Although, scientific reports on this issue are still inconsistent, many recent studies confirm that hyperglycemia is an unfavorable prognostic factor in AMI patients complicated by CS [11,[13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Admission hyperglycemia in patients with acute coronary syndrome complicated by cardiogenic shock

et al. 2015

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Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock

Cited by 106 publications

References 30 publications

Acute hyperglycemia and insulin resistance in acute heart failure syndromes without previously known diabetes

Acute hyperglycemia and insulin resistance in acute heart failure syndromes without previously known diabetes

Cardiogenic Shock

Admission hyperglycemia in patients with acute coronary syndrome complicated by cardiogenic shock

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