Prognosis of cardiogenic shock secondary to culprit left main coronary artery lesion‐related myocardial infarction

Galván‐Román, Francisco; Fernández‐Herrero, Ignacio; Solé, Albert Ariza; Sánchez‐Salado, José Carlos; Puerto, Elena; Lorente, Victòria; Gómez‐Lara, Josep; Martín‐Asenjo, Roberto; Gómez‐Hospital, Joan Antoni; Comín‐Colet, Josep

doi:10.1002/ehf2.14128

Cited by 5 publications

(22 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the abovementioned studies and the present study, the only common predictor significantly associated with reduced 30-day survival was successful reperfusion (final TIMI flow 3). Although in the present study, the use of mechanical support was found to be associated with 30-day mortality, in the studies by Galván-Román et al [ 40 ] and Gutiérrez-Barrios et al [ 20 ], this was not observed. In the study by Galván-Román et al [ 40 ] and the present study, mechanical support was inserted before PCI in the majority of cases.…”

Section: Discussioncontrasting

confidence: 76%

“…Although in the present study, the use of mechanical support was found to be associated with 30-day mortality, in the studies by Galván-Román et al [ 40 ] and Gutiérrez-Barrios et al [ 20 ], this was not observed. In the study by Galván-Román et al [ 40 ] and the present study, mechanical support was inserted before PCI in the majority of cases. In line, a systematic review and meta-analysis showed that routine use of IABP in STEMI patients complicated by cardiogenic shock is conflicting [ 42 ].…”

Section: Discussioncontrasting

confidence: 76%

“…The ATOLMA registry [ 20 ] is the only study that exclusively included patients with total occlusive (TIMI flow 0) ULMCA-related AMI, but the percentage of cardiogenic shock was “only” 89%. Two other studies exclusively included patients in cardiogenic shock due to ULMCA-related AMI but were liberal in the inclusion of pre-procedural TIMI flow (i.e., 0 to 3) [ 39 , 40 ]. The use of mechanical support was comparable between the studies and the present study, except for the study by Yeoh et al with a remarkably low percentage of merely 8% [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…This was confirmed in the randomized IABP-SHOCK II trial, including approximately 9% of ULMCA STEMI patients, in whom the use of IABP did not significantly reduce mortality in patients with cardiogenic shock complicating AMI [ 43 ]. The study by Galván-Román et al [ 40 ] and the present study also included patients treated with the Impella ® LVAD that increases cardiac output without increasing myocardial work, which might be more suited for use in cardiogenic shock. However, in the randomized IMPRESS trial, the Impella ® CP was compared with the IABP in patients with cardiogenic shock complicating AMI [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

“…Out of the seven patients treated with ECMO, five (71%) survived to the 1-year follow-up. Currently, in several studies, ECMO or TandemHeart support was used, but the comparison of mortality rates is hampered as the inclusion criteria and prevalence of cardiogenic shock varies strongly [ 1 , 13 , 20 , 24 , 29 , 31 , 37 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Clinical Outcomes after Percutaneous Coronary Intervention for Cardiogenic Shock Secondary to Total Occlusive Unprotected Left Main Coronary Artery Lesion-Related Acute Myocardial Infarction

Beijk

Grundeken

Kalkman

et al. 2023

JCM

View full text Add to dashboard Cite

Background: Acute myocardial infarction (AMI) with occlusion of an unprotected left main coronary artery (ULMCA) is a rare condition with a high mortality. The literature on clinical outcomes after percutaneous coronary intervention (PCI) for cardiogenic shock secondary to ULMCA-related AMI is scarce. Methods: In this retrospective analysis, all consecutive patients undergoing PCI for cardiogenic shock secondary to total occlusive ULMCA-related AMI were included between January 1998 and January 2017. The primary endpoint was 30-day mortality. The secondary endpoints were long-term mortality and 30-day and long-term major adverse cardiovascular and cerebrovascular events. The differences in clinical and procedural variables were assessed. A multivariable model was created to search for independent predictors of survival. Results: Forty-nine patients were included, and the mean age was 62 ± 11 years. The majority of patients suffered cardiac arrest prior or during PCI (51%). Thirty-day mortality was 78%, of which 55% died within 24 h. The median follow-up of patients who survived 30 days (n = 11) was 9.9 years (interquartile range 4.7–13.6), and long-term mortality was 84%. Long-term all-cause mortality was independently associated with cardiac arrest prior or during PCI (hazard ratio [HR] 2.02, 95% confidence interval 1.02–4.01, p = 0.043). Patients who survived to the 30-day follow-up with severe left ventricular dysfunction had a significantly higher risk of mortality compared to patients with moderate to mild dysfunction (p = 0.007). Conclusions: Cardiogenic shock secondary to total occlusive ULMCA-related AMI carries a very high 30-day all-cause mortality. Thirty-day survivors with a severe left ventricular dysfunction have a poor long-term prognosis.

show abstract

Section: Discussioncontrasting

confidence: 76%

Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical Outcomes after Percutaneous Coronary Intervention for Cardiogenic Shock Secondary to Total Occlusive Unprotected Left Main Coronary Artery Lesion-Related Acute Myocardial Infarction

Beijk

Grundeken

Kalkman

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

Prognosis of cardiogenic shock secondary to culprit left main coronary artery lesion‐related myocardial infarction

et al. 2022

View full text Add to dashboard Cite

Aims This study aimed to assess, in patients with cardiogenic shock secondary to unprotected left main coronary artery‐related myocardial infarction (ULMCA‐related AMICS), the incidence and predictors of no recovery of left ventricular function during the admission. Methods and results This was an observational study conducted at two tertiary care centres (2012–20). The main outcome measured was death or requirement for heart transplantation (HT) or left ventricular assist devices (LVAD) during the admission. A total of 70 patients were included. Percutaneous coronary intervention (PCI) was successful in 53/70 patients (75.7%). The combined endpoint of death or requirement of HT or LVAD during the admission occurred in 41/70 patients (58.6%). The highest incidence of the primary endpoint was observed among patients with profound shock and occluded left main coronary artery (LMCA) (20/23, 87%, P < 0.001). Although a successful PCI reduced the incidence of the event in the whole cohort (51.9% vs. 82.4% in failed PCI, P = 0.026), this association was not observed among this last group of complex patients (86.7% vs. 87.5% in failed PCI, P = 0.731). The predictive model included left ventricular ejection fraction, baseline ULMCA Thrombolysis In Myocardial Infarction flow, and severity of shock and showed an optimal ability for predicting death or requirements for HT or LVAD during the admission (area under the curve 0.865, P < 0.001). Conclusions ULMCA‐related AMICS was associated with a high in‐hospital mortality or need for HT or LVAD. Prognosis was especially poor among patients with profound shock and baseline occluded LMCA, with a low probability of recovery regardless of successful PCI.

show abstract

Twelve‐year trends in unprotected left main coronary artery occlusion: insights from a real‐world multicentre study

Alexandre,

Campinas,

Brochado

et al. 2024

ESC Heart Failure

View full text Add to dashboard Cite

AimsAcute myocardial infarction (AMI) resulting from unprotected left main coronary artery (LMCA) occlusion and subtotal occlusion is a life‐threatening condition. Although AMI management has improved in the past two decades, there is limited information on recent trends in patient characteristics, management, and outcomes for acute unprotected LMCA‐related AMI. This study aims to assess such trends over a 12 year period.Methods and resultsThis retrospective multicentre study includes patients with unprotected LMCA occlusion/subtotal occlusion admitted to three tertiary hospitals between 2008 and 2020. The patients were divided into two groups based on the chronology of presentation: a ‘past group’ (January 2008 to December 2014) and a ‘contemporary group’ (January 2015 to December 2020). The study compares clinical characteristics, management approaches, and outcomes between the two groups. The study includes 128 patients, with 51 (40%) in the ‘past group’ and 77 (60%) in the ‘contemporary group’. Baseline risk factors did not show statistically significant differences between the two groups, except for hypertension (49% vs. 74%; P = 0.005). Chest pain was more frequent in the ‘past group’ (98% vs. 89%; P = 0.014), and a trend towards more cardiac arrests was observed in the ‘contemporary group’ (18% vs. 31%; P = 0.087). Revascularization type did not differ significantly (P = 0.419), but manual thrombectomy was less frequently used (41% vs. 23%; P = 0.032) and stent implantation showed a trend towards higher rates (66% vs. 78%; P = 0.150) in the ‘contemporary cohort’. There was a gradual shift from bare‐metal to drug‐eluting stents, with a significantly higher percentage of ticagrelor/prasugrel loading in the ‘contemporary cohort’ (5% vs. 79%; P < 0.001). The use of mechanical circulatory support (MCS), although not statistically significant, was higher among patients in the ‘past group’ (67% vs. 51%; P = 0.073). The type of MCS differed significantly between groups, with a decrease in intra‐aortic balloon pump use (67% vs. 42%; P = 0.005) and an increase in veno‐arterial extracorporeal membrane oxygenation (4% vs. 22%; P = 0.005) and Impella system (0% vs. 3%) over time. Survival analysis showed no significant differences (P = 0.599; log‐rank test) in all‐cause mortality between the different time groups, with the long‐term survival rate being approximately 30%.ConclusionsIn our real‐world population, despite the progressive use of newer drugs and more advanced devices over time, patients with unprotected LMCA occlusion/subtotal occlusion remain a subpopulation with poor prognosis.

show abstract

Prognosis of cardiogenic shock secondary to culprit left main coronary artery lesion‐related myocardial infarction

Cited by 5 publications

References 31 publications

Clinical Outcomes after Percutaneous Coronary Intervention for Cardiogenic Shock Secondary to Total Occlusive Unprotected Left Main Coronary Artery Lesion-Related Acute Myocardial Infarction

Clinical Outcomes after Percutaneous Coronary Intervention for Cardiogenic Shock Secondary to Total Occlusive Unprotected Left Main Coronary Artery Lesion-Related Acute Myocardial Infarction

Prognosis of cardiogenic shock secondary to culprit left main coronary artery lesion‐related myocardial infarction

Twelve‐year trends in unprotected left main coronary artery occlusion: insights from a real‐world multicentre study

Contact Info

Product

Resources

About