When to Achieve Complete Revascularization in Infarct-Related Cardiogenic Shock

Masiero, Giulia; Cardaioli, Francesco; Rodinò, Giulio; Tarantini, Giuseppe

doi:10.3390/jcm11113116

Cited by 8 publications

(4 citation statements)

References 92 publications

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“…15,16 The evidence from a meta-analysis conducted in this aspect has shown that the risk of adverse outcomes can be reduced by achieving complete revascularization in STEMI patientsparticularly in those with MVD. 17 In our study, patients had a mean age of 50.10±10.74 years with a mean age of 49.56±10.24 years in cases and 50.64±11.25 years in controls. The majority of the patients were males (68%), 36%in the case group and 32% in the control group with an insignificant p-value of 0.225.…”

Section: Discussionmentioning

confidence: 60%

Residual Syntax Score as a Predictor of 30-Day Mortality after Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction

Satti¹,

Mohsin²,

Ijaz³

et al. 2022

PJMHS

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Objective: To evaluate residual SYNTEX score as a predictor of 30-day mortality after primarypercutaneous coronary intervention (P-PCI) in ST-elevation myocardial infarction (STEMI) patients. Methodology: It was a quasi-experimental study conducted in the Emergency department of Rawalpindi Institute of Cardiology from September 2019 to September 2020. After the study approval from the ethics committee and informed consent, 200 patients presenting with acute STEMI were included by convenient sampling. Primary PCI was done in all patients by theconsultant cardiologists, and then the residual SYNTEX score (rSS) was calculated for each patient. Patients were allocated the case or control group based on rSS: patients with complete revascularization were included in controls and those with incomplete revascularization were labeled as cases. All patients were followed after primary PCI for 30-day mortality. The analysis of data was carried out by the Statistical Package for Social Sciences (SPSS) version 25. Results: The 30-day mortality occurred in 11(5.5%) patients. Mortality occurred in 9(4.5%) patients in the case group and 2(1%) patients in the control group with a significant p-value of 0.03There was a significant association between diabetes mellitus & 30-day mortality (0.032) and a family history of ischemic heart disease & 30-day mortality (0.026). This shows that rSS can be used as a reliable predictor of 30-day mortality after P-PCI in STEMI patients. The patients with high rSS score and risk factors of diabetes mellitus and history of ischemic heart disease are at higher risk of 30-day mortality. Conclusion: The residual Syntax score is a simple, reliable and significant marker of 30-day mortality after P-PCI in STEMI patients. It provides an accurate assessment of the extent of revascularization needed to prevent coronary artery disease and enhance the prognosis following P-PCI. It may also serve as a guide for additional PCI decisions. Keywords: Residual Syntax score; rSS; Primary percutaneous coronary intervention;Acute ST-elevation myocardial infarction; STEMI; P-PCI

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Section: Discussionmentioning

confidence: 60%

Residual Syntax Score as a Predictor of 30-Day Mortality after Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction

Satti¹,

Mohsin²,

Ijaz³

et al. 2022

PJMHS

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“…The CULPRIT-SHOCK (Culprit Lesion Only PCI Versus Multi-vessel PCI in Cardiogenic Shock) trial demonstrated that culprit-only percutaneous coronary intervention (PCI) was superior to immediate multivessel PCI in terms of short-term mortality [29]; however, when and how to employ non-culprit lesion revascularization strategy in refractory CS requiring MCS remains controversial [30,31]. Future randomized trials are warranted to determine the definitive role of a tailored complete revascularization (whether anatomical or functional) in an AMI with CS scenario and the timing of complete revascularization during MCS-supported index PCI or in a staged PCI after the acute phase [32,33]. Although the role of emergency coronary artery bypass grafting is currently underrated, surgical revascularization still represents an important treatment option in selective scenarios, and the research on surgical revascularization of refractory CS requiring MCS is lacking [34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Differential Prognostic Impact of IABP-SHOCK II Scores According to Treatment Strategy in Cardiogenic Shock Complicating Acute Coronary Syndrome: From the RESCUE Registry

Kim,

Jang,

Choi

et al. 2024

Medicina

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Background: Early risk stratification is necessary for optimal determination of the treatment strategy in cardiogenic shock (CS) complicating acute coronary syndrome (ACS). Therefore, we evaluated the prognostic impact of an intra-aortic balloon pump on the cardiogenic shock (IABP-SHOCK) II score according to the treatment strategies in ACS complicated by CS using the RESCUE (REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock) registry. Methods: The RESCUE registry contains multicenter observational retrospective and prospective cohorts that include 1247 patients with CS from 12 centers in Korea. A total of 865 patients with ACS complicated by CS were selected and stratified into low-, intermediate- and high-risk categories according to their IABP-SHOCK II scores and then according to treatment: non-mechanical support, IABP, and extracorporeal membrane oxygenators (ECMOs). The primary outcome was all-cause mortality during follow-up. Results: The observed mortality rates for the low-, intermediate-, and high-IABP-SHOCK II score risk categories were 28.8%, 52.4%, and 69.8%, respectively (p < 0.01). Patients in the non-mechanical support and IABP groups showed an increasingly elevated risk of all-cause mortality as their risk scores increased from low to high. In the ECMO group, the risk of all-cause mortality did not differ between the intermediate- and high-risk categories (HR = 1.21, 95% CI: 0.81–1.81, p = 0.33). The IABP-SHOCK II scores for the non-mechanical support and IABP groups showed a better predictive performance (area under curve [AUC] = 0.70, 95% CI: 0.65–0.76) for mortality compared with the EMCO group (AUC = 0.61, 95% CI 0.54–0.67; p-value for comparison = 0.02). Conclusions: Risk stratification using the IABP-SHOCK II score is useful for predicting mortality in ACS complicated by CS when patients are treated with non-mechanical support or IABP. However, its prognostic value may be unsatisfactory in severe cases where patients require ECMOs.

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“…It is obvious that the policy of COVID-19 virus nucleic acid testing normalization has shocked the conventional emergency, surgical, and other medical practices because of prolonged preoperative waiting (6). Patients under life-threatening emergent circumstances, such as acute myocardial infarction and strangulated intestinal obstruction, cannot bear such a long wait, while patients with other emergent situations, including ruptured intracranial aneurysm, were reported to tolerate the wait and exhibit similar outcomes as patients without the wait for result of virus nuclei acid detection (20)(21)(22)(23). However, there remains little literature discussing the influence of the policy of COVID-19 virus nucleic acid testing normalization on emergency digit replantation.…”

Section: Discussionmentioning

confidence: 99%

Influence on emergency digit replantation and outcome assessment after COVID-19 virus nucleic acid testing normalization

Zhang

et al. 2023

Front. Surg.

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ObjectiveThe study aims to compare the implementation and prognosis of emergency digit replantation surgery before and after normalized corona virus disease 2019 (COVID-19) nucleic acid testing for patients taking emergency operation and to explore the influence of normalized COVID-19 nucleic acid testing on replantation surgery.MethodNormalized COVID-19 nucleic acid testing for patients taking emergency operation has been carried out since 1 August 2021 at our hospital, which means each patient who needs emergency surgical treatment has to obtain either positive or negative results of COVID-19 nucleic acid before entering the operating room. This research reviewed and compared the prognosis of the injured extremity that had emergency severed digit replantation between June and September 2021, at the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and analyzed the impact of normalized COVID-19 nucleic acid testing on the outcome of the replanted fingers of different severity using disability of arm-shoulder-hand (DASH) and hand injury severity scoring (HISS) scoring systems.ResultsA total of 54 cases with 74 severed replanted phalanges were included replanted by the research group between 1 August and 30 September 2021, without any COVID-19 suspected/confirmed case detected. Compared with previous period (1 June to 31 July, 2021), although the interval between emergency visits and emergency replantation did increase significantly after normalized COVID-19 nucleic acid testing [(3.83 ± 0.94) to (1.77 ± 0.67) h, P < 0.05], we observed no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively (P = 0.538) nor in the complication rate (P = 0.344). Moreover, there was no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively in patients with different traumatic severities before and after normalized COVID-19 nucleic acid testing (moderate P = 0.269, severe P = 0.055, major P = 0.149).ConclusionDespite the preoperative delay, the policy of COVID-19 nucleic acid testing normalization does not have explicit influence on the short-term outcomes of emergency digit replantation surgery. With this evidence, microsurgeons could pay attention to the patients' anxiety and spend more effort in comforting them during the prolonged preoperative wait. These insights may have implications for other emergency department resource management whenever a social crisis occurs.

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When to Achieve Complete Revascularization in Infarct-Related Cardiogenic Shock

Cited by 8 publications

References 92 publications

Residual Syntax Score as a Predictor of 30-Day Mortality after Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction

Residual Syntax Score as a Predictor of 30-Day Mortality after Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction

Differential Prognostic Impact of IABP-SHOCK II Scores According to Treatment Strategy in Cardiogenic Shock Complicating Acute Coronary Syndrome: From the RESCUE Registry

Influence on emergency digit replantation and outcome assessment after COVID-19 virus nucleic acid testing normalization

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