Usefulness of Intra-aortic Balloon Pump in Patients With Cardiogenic Shock

Gul, Burcu; Bellumkonda, Lavanya

doi:10.1016/j.amjcard.2018.11.041

Cited by 32 publications

(31 citation statements)

References 19 publications

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“…It is essential to underline that both studies were mainly assessing the outcomes of BAV. This observation is in keeping with prior reports assessing the timing of mechanical support use in cardiogenic shock [20,21], as earlier restoration of tissue perfusion can prevent irreversible end-organ damage. However, it remains unclear whether the suggested 48 hours window by the two studies is, in fact the one associated with the best outcomes.…”

Section: Discussionsupporting

confidence: 90%

“…Cardiac unloading using mechanical circulatory support devices in order to restore and maintain tissue perfusion early improved outcomes in patients with CS [20][21][22]. In our review, the studies that discussed the use of mechanical circulatory support for CS management, whether IABP by Aksoy et al [11], or Impella 2.5 by Karatolios et al [18], were focused on feasibility and did not have a control group for outcome comparison.…”

Section: Discussionmentioning

confidence: 99%

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A Systematic Review of Cardiogenic Shock in the Setting of Severe Aortic Stenosis: Prevalence, Management, and Outcomes

Essa¹,

Berardi²,

Aneni³

et al. 2020

AJCR

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Objective: The objective of this study was to summarize the prevalence and the available management strategies for cardiogenic shock in the setting of severe aortic stenosis and their outcome. Introduction: Aortic stenosis (AS) is the most common valvular heart disease in older adults. Cardiogenic shock (CS) is a medical emergency, and while management for these two conditions has evolved over the years, little is known about the prevalence, management, and mortality of AS in combination with CS. Methods: We performed a systematic review to identify studies that included patients with severe AS presenting with CS using EMBASE, MEDLINE, and Scopus. Primary outcomes included in-hospital, 30-day, and 1-year mortality. Additional outcomes included procedure-related complications. We registered the study protocol at PROSPERO (CRD42018112245). Results: We included a total of 10 studies representing 338 patients. In-hospital mortality ranged from 43% to 77% in patients treated with Balloon Aortic Valvuloplasty (BAV), 0% in patients who underwent surgical valve replacement (SAVR), and 11% and Transcatheter aortic valve replacement (TAVR). In patients undergoing BAV, 30-day mortality varied between 50% and 55%, and between 19% and 33% in those treated with TAVR. There was limited evidence on the use of Mechanical Circulatory Support (MCS). Conclusion: AS presenting with CS is a rare but fatal condition, and no consensus exists regarding management strategy. Time to intervention on the valve is critical. Valve replacement through either SAVR or TAVR had better outcomes compared to BAV alone. There is limited evidence on MCS as a management strategy in patients with AS complicated by CS.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Cardiogenic Shock in the Setting of Severe Aortic Stenosis: Prevalence, Management, and Outcomes

Essa¹,

Berardi²,

Aneni³

et al. 2020

AJCR

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“…In the present study, although the relationship between absolute risk and pathophysiology may not be parallel, diuretics were administered less frequently in low-risk patients, while vasodilators were routinely used irrespective of individuals' absolute risks. Several studies have described the value of a risk-based management approach for patients with AHF [14,[27][28][29]; however, to our knowledge, a risk-based approach involving early intervention has not been assessed prospectively or in a randomized manner in the context of designing therapies to alter the natural history of AHF. Further investigations are needed in the near future that prospectively confirm the improvement of outcomes for patients with AHF using a risk-based approach.…”

Section: Discussionmentioning

confidence: 99%

Derivation and Validation of Clinical Prediction Models for Rapid Risk Stratification for Time-Sensitive Management for Acute Heart Failure

Kohsaka

Abe

Nagai

et al. 2020

JCM

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Early and rapid risk stratification of patients with acute heart failure (AHF) is crucial for appropriate patient triage and outcome improvements. We aimed to develop an easy-to-use, in-hospital mortality risk prediction tool based on data collected from AHF patients at their initial presentation. Consecutive patients’ data pertaining to 2006–2017 were extracted from the West Tokyo Heart Failure (WET-HF) and National Cerebral and Cardiovascular Center Acute Decompensated Heart Failure (NaDEF) registries (n = 4351). Risk model development involved stepwise logistic regression analysis and prospective validation using data pertaining to 2014–2015 in the Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure Syndrome (REALITY-AHF) (n = 1682). The final model included data describing six in-hospital mortality risk predictors, namely, age, systolic blood pressure, blood urea nitrogen, serum sodium, albumin, and natriuretic peptide (SOB-ASAP score), available at the time of initial triage. The model showed excellent discrimination (c-statistic = 0.82) and good agreement between predicted and observed mortality rates. The model enabled the stratification of the mortality rates across sixths (from 14.5% to <1%). When assigned a point for each associated factor, the integer score’s discrimination was similar (c-statistic = 0.82) with good calibration across the patients with various risk profiles. The models’ performance was retained in the independent validation dataset. Promptly determining in-hospital mortality risks is achievable in the first few hours of presentation; they correlate strongly with mortality among AHF patients, potentially facilitating clinical decision-making.

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“…IABP) might be bene cial in patients with CS-ADHF. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]28 In particular, a favorable pro le may emerge from IABP, since the risks of the procedure are low, the limited increase of cardiac output that it provides may be su cient for improving tissue perfusion in patients with chronic advanced HF, in whom some adaptation to reduced cardiac output exists, and these effects are not blurred or confounded by the effect of an etiology-directed treatment such as reperfusion in CS associated with acute MI.…”

Section: Discussionmentioning

confidence: 99%

“…However, data on patients with CS not related to AMI, are lacking even in large, well-reported registries [7][8][9][10][11][12][13] and are mostly limited to case-series, [14][15][16][17][18][19][20][21][22] with only one phase II study 23 and one small randomized clinical trial. 24 In addition, only one risk score has been recently validated in a cohort of patients that included a signi cant number of acute decompensated heart failure (ADHF)-CS patients.…”

Section: Introductionmentioning

confidence: 99%

Predicting Survival in Patients With Acute Decompensated Heart Failure Complicated by Cardiogenic Shock

Morici

Viola²,

Antolini

et al. 2020

Preprint

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Background: Acute decompensated heart failure (ADHF) complicated by cardiogenic shock (CS) has unique pathophysiological background requiring specific patient stratification, management and therapeutic targets. Accordingly, the aim of this study was to derive a simple stratification tool to predict survival in patients with ADHF complicated by CS. Methods and results: We analyzed data from a historic cohort of 87 ADHF-CS consecutive patients, eligible to heart replacement therapy (HRT), enrolled between 2015 and 2019. The association between selected independent variables (age, lactates and creatinine, ALC-shock score) and 28-day overall mortality was investigated through a multivariable logistic model. Predictive validity was assessed throughout an internal and external validation and compared to the Cardshock score. A nomogram was developed for predicting 28-day mortality. Overall 28-day mortality was 34%. Among patients who survived, 38 (67%) were treated with HRT: heart transplantation was performed in 68%, the remaining received an LVAD. The ALC-shock score showed better discrimination (Area Under the Curve-AUC- 0.82; 95% CI 0.73-0.91) as compared to the Cardshock score (AUC 0.67; 95% CI 0.55-0.79) (p = 0.009) to predict 28-days overall mortality. In the validation cohort the AUC for the ALC-shock score was 0.66. Conclusions: A model including age, lactates and creatinine on admission (ALC-Shock score) could be considered to predict short-term mortality in CS-ADHF patients in order to drive towards a treatment intensification. Disclosures: Dr. Garan is supported by National Institutes of Health Grant No. KL2TR001874 and has received honoraria from Abiomed. Dr. Colombo reports institutional grant support from Abbott Vascular. None of the listed entities has had any involvement with the development of the manuscript. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.Research ethics: This study was approved by the Local Ethics Committee of Milano Area 3 of the ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milano (reference number: 543-23092020).

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Usefulness of Intra-aortic Balloon Pump in Patients With Cardiogenic Shock

Cited by 32 publications

References 19 publications

A Systematic Review of Cardiogenic Shock in the Setting of Severe Aortic Stenosis: Prevalence, Management, and Outcomes

A Systematic Review of Cardiogenic Shock in the Setting of Severe Aortic Stenosis: Prevalence, Management, and Outcomes

Derivation and Validation of Clinical Prediction Models for Rapid Risk Stratification for Time-Sensitive Management for Acute Heart Failure

Predicting Survival in Patients With Acute Decompensated Heart Failure Complicated by Cardiogenic Shock

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