Technical consideration in acute myocardial infarction with cardiogenic shock: A review of antithrombotic and PCI therapies

Marquis‐Gravel, Guillaume; Zeitouni, Michel; Kochar, Ajar; Jones, W. Schuyler; Sketch, Michael H.; Rao, Sunil V.; Patel, Manesh R.; Ohman, E. Magnus

doi:10.1002/ccd.28455

Cited by 24 publications

(22 citation statements)

References 64 publications

(83 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients with acute MI complicated with CS are usually excluded from studies examining PCI arterial access site, stent type or aspiration thrombectomy. Trans-radial access has been endorsed by the AHA and advocated by CS care centres as the access of preference [189,190]. Trans-radial access has been associated with lower rates of mortality, major adverse cardiac and cerebrovascular events [191,192], and major bleeding [191].…”

Section: Other Pci Aspectsmentioning

confidence: 99%

“…Interestingly, in a study from England and Wales the increase in radial access use with primary PCI was from 24.6% in 2007 to 76.5% in 2014 [193]. Routine aspiration thrombectomy is not recommended as there is no convincing evidence to support it in CS [189]. Drug-eluting stents, apparently, are favoured over bare-metal stents despite the indefinite evidence in CS [189,[194][195][196].…”

Section: Other Pci Aspectsmentioning

confidence: 99%

“…Routine aspiration thrombectomy is not recommended as there is no convincing evidence to support it in CS [189]. Drug-eluting stents, apparently, are favoured over bare-metal stents despite the indefinite evidence in CS [189,[194][195][196].…”

Section: Other Pci Aspectsmentioning

confidence: 99%

“…Recommendations for pharmacologic therapy in CS are similar to those for ACS without CS, since there are no dedicated RCTs in CS. Antithrombotic therapy (i.e., antiplatelets and anticoagulation) is a must prior, during, and after PCI [2,90,189]. Once the shock status is resolved, beta-blockers and renin-angiotensin system inhibitors should be considered as tolerated [2].…”

Section: Medications For Treatment Of Acs With Csmentioning

confidence: 99%

“…The evidence for management of patients presenting with MI and CS is usually extrapolated from trials that enrolled hemodynamically stable MI patients. Although not optimal, it is considered an acceptable approach given the lack of other alternatives [189]. Conducting RCTs in CS patients is difficult because CS includes broad spectrum of patients of variable etiologies and severities with consequent variability of treatment outcomes [13].…”

Section: Challengesmentioning

confidence: 99%

See 4 more Smart Citations

Current evidence in the diagnosis and management of cardiogenic shock complicating acute coronary syndrome

Kaddoura¹,

Elbdri²

2021

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

Cardiogenic shock (CS) is a hemodynamically complex and highly morbid syndrome characterized by circulatory collapse and inadequate end-organ perfusion due to impaired cardiac output. It is usually associated with multiorgan failure and death. Mortality rate is still high despite advancement in treatment. CS has been conceptualised as a vicious cycle of injury and decompensation, both cardiac and systemic. Interrupting the vicious cycle and restoring the hemodynamic stability is a fundamental treatment of CS. Acute coronary syndrome (ACS) is the most frequent cause of CS. Early coronary revascularization is a cornerstone therapy that reduces mortality in patients with ACS complicated by CS. Early diagnosis of CS accompanied with invasive hemodynamics, helps in identification of CS phenotype, classification of CS severity, stratification of risk and prognostication. This can guide a tailored and optimized therapeutic approach. Inotropes and vasopressors are considered the firstline pharmacological option for hemodynamic instability. The current availability of the mechanical circulatory support devices has broadened the therapeutic choices for hemodynamic support. To date there is no pharmacological or nonpharmacological intervention for CS that showed a mortality benefit. The clinical practices in CS management remain inconsistent. Herein, this review discusses the current evidence in the diagnosis and management of CS complicating ACS, and features the changes in CS definition and classification.

show abstract

Section: Other Pci Aspectsmentioning

confidence: 99%

Section: Other Pci Aspectsmentioning

confidence: 99%

Section: Other Pci Aspectsmentioning

confidence: 99%

Section: Medications For Treatment Of Acs With Csmentioning

confidence: 99%

Section: Challengesmentioning

confidence: 99%

See 3 more Smart Citations

Current evidence in the diagnosis and management of cardiogenic shock complicating acute coronary syndrome

Kaddoura¹,

Elbdri²

2021

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

Multicenter and all‐comers validation of a score to select patients for manual thrombectomy, the DDTA score

Cordero

Cid-Álvarez

Alegría

et al. 2021

Cathet Cardio Intervent

View full text Add to dashboard Cite

Background: Routine manual thrombectomy (MT) is not recommended in primary percutaneous coronary intervention (P-PCI) but it is performed in many procedures.The objective of our study was validating the DDTA score, designed for selecting patients who benefit most from MT.Methods: Observational and multicenter study of all consecutive patients undergoing P-PCI in five institutions. Results were compared with the design cohort and the performance of the DDTA was analyzed in all patients. Primary end-point of the analyses was TIMI 3 after MT; secondary endpoints were final TIMI 3, no-reflow incidence, in-hospital mortality and in-hospital major cardiovascular events (MACE).In-hospital prognosis was assessed by the Zwolle risk score.Results: Three hundred forty patients were included in the validation cohort and no differences were observed as compared to the design cohort (618 patients) except for lower use of MT and higher IIb/IIIa inhibitors or drug-eluting stents. The probability of TIMI 3 after MT decreased as delay to P-PCI was higher. If DDTA score, MT was associated to TIMI 3 after MT (OR: 4.11) and final TIMI 3 (OR: 2.44). There was a linear and continuous relationship between DDTA score and all endpoints. DDTA score ≥ 4 was independently associated to lower no-reflow, in-hospital MACE or mortality. The lowest incidence of in-hospital mortality or MACE was in patients who had DDTA score ≥ 4 and Zwolle risk score 0-3.Conclusions: MT is associated to higher rate of final TIMI3 in patients with the DDTA score ≥ 4. Patients with DDTA score ≥ 4 had lower no-reflow and in-hospital complications.

show abstract

Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature

et al. 2021

View full text Add to dashboard Cite

Cardiogenic shock (CS) is a complex multifactorial clinical syndrome, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large phenotypic variability in CS, as a result of the diverse aetiologies, pathogenetic mechanisms, haemodynamics, and stages of severity. Although early revascularization remains the most important intervention for CS in settings of acute myocardial infarction, the administration of timely and effective antithrombotic therapy is critical to improving outcomes in these patients. In addition, other clinical settings or non‐acute myocardial infarction aetiologies, associated with high thrombotic risk, may require specific regimens of short‐term or long‐term antithrombotic therapy. In CS, altered tissue perfusion, inflammation, and multi‐organ dysfunction induce unpredictable alterations to antithrombotic drugs' pharmacokinetics and pharmacodynamics. Other interventions used in the management of CS, such as mechanical circulatory support, renal replacement therapies, or targeted temperature management, influence both thrombotic and bleeding risks and may require specific antithrombotic strategies. In order to optimize safety and efficacy of these therapies in CS, antithrombotic management should be more adapted to CS clinical scenario or specific device, with individualized antithrombotic regimens in terms of type of treatment, dose, and duration. In addition, patients with CS require a close and appropriate monitoring of antithrombotic therapies to safely balance the increased risk of bleeding and thrombosis.

show abstract

Technical consideration in acute myocardial infarction with cardiogenic shock: A review of antithrombotic and PCI therapies

Cited by 24 publications

References 64 publications

Current evidence in the diagnosis and management of cardiogenic shock complicating acute coronary syndrome

Current evidence in the diagnosis and management of cardiogenic shock complicating acute coronary syndrome

Multicenter and all‐comers validation of a score to select patients for manual thrombectomy, the DDTA score

Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature

Contact Info

Product

Resources

About