TY - JOUR
T1 - Important role of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock
AU - Truby, Lauren
AU - Naka, Yoshifumi
AU - Kalesan, Bindu
AU - Ota, Takeyoshi
AU - Kirtane, Ajay J.
AU - Kodali, Susheel
AU - Nikic, Natasha
AU - Mundy, Lily
AU - Colombo, Paolo
AU - Jorde, Ulrich P.
AU - Takayama, Hiroo
N1 - Publisher Copyright:
© The Author 2014, 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - OBJECTIVES: Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains associated with significant mortality despite the widespread application of early revascularization strategies. Recent evidence suggests that the use of intra-aortic balloon pump (IABP) counterpulsation does not improve mortality in this cohort of patients. We summarize our experience with mechanical circulatory support (MCS) therapy for AMI/CS. METHODS: This is a retrospective review of 61 patients who received MCS therapy for AMI/CS at our institution between March 2007 and March 2013. RESULTS: Mean age was 60.2 ± 10.3 years; mean ejection fraction was 24 ± 15% and 29% of patients were receiving active cardiopulmonary resuscitation at the time of support initiation. Prior to the initiation of MCS, 70.5% of patients had an IABP. Mean arterial pressure improved significantly with MCS (63 mmHg prior to MCS, 82 mmHg after MCS, P ≤ 0.01). Mean length of support was 9.5 ± 11.0 days, and overall survival to 30 days was 59.0%. Among 30-day survivors, 44.4% required device exchange to a durable MCS device. Ultimately, only 31% (52.8% of patients who survived to 30 days) achieved myocardial recovery. CONCLUSIONS: Short-term MCS therapy with subsequent aggressive use of durable MCS device may improve the unacceptably high mortality rate in AMI/CS. Rigorous prospective studies of MCS therapy in AMI/CS are warranted.
AB - OBJECTIVES: Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains associated with significant mortality despite the widespread application of early revascularization strategies. Recent evidence suggests that the use of intra-aortic balloon pump (IABP) counterpulsation does not improve mortality in this cohort of patients. We summarize our experience with mechanical circulatory support (MCS) therapy for AMI/CS. METHODS: This is a retrospective review of 61 patients who received MCS therapy for AMI/CS at our institution between March 2007 and March 2013. RESULTS: Mean age was 60.2 ± 10.3 years; mean ejection fraction was 24 ± 15% and 29% of patients were receiving active cardiopulmonary resuscitation at the time of support initiation. Prior to the initiation of MCS, 70.5% of patients had an IABP. Mean arterial pressure improved significantly with MCS (63 mmHg prior to MCS, 82 mmHg after MCS, P ≤ 0.01). Mean length of support was 9.5 ± 11.0 days, and overall survival to 30 days was 59.0%. Among 30-day survivors, 44.4% required device exchange to a durable MCS device. Ultimately, only 31% (52.8% of patients who survived to 30 days) achieved myocardial recovery. CONCLUSIONS: Short-term MCS therapy with subsequent aggressive use of durable MCS device may improve the unacceptably high mortality rate in AMI/CS. Rigorous prospective studies of MCS therapy in AMI/CS are warranted.
KW - Acute myocardial infarction
KW - Mechanical circulatory support
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U2 - 10.1093/ejcts/ezu478
DO - 10.1093/ejcts/ezu478
M3 - Article
C2 - 25480935
AN - SCOPUS:84938560157
SN - 1010-7940
VL - 48
SP - 322
EP - 328
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 2
ER -