Myocardial infarction with cardiogenic shock---the experience of a primary PCI centre from North-East Romania
1Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
2Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iasi, Romania
DOI: 10.22514/sv.2021.070 Vol.17,Issue 5,September 2021 pp.64-70
Submitted: 25 February 2021 Accepted: 16 March 2021
Published: 08 September 2021
Objectives: To evaluate the severity of acute myocardial infarction (AMI) complicated with cardiogenic shock (CS), by comparison with inferior and right ventricular AMI, which is also considered a severe form of myocardial infarction.
Methods: In an observational study, from 774 patients with STEMI hospitalized in our Cardiology Institute, over one year and a half, only 120 patients met the inclusion and exclusion criteria (60 patients with CS and 60 patients with right ventricular AMI). Data collected included age, sex, vital signs, oxygen saturation, respiratory rate, left ventricular ejection fraction, right ventricular dysfunction, complications during hospitalization and coronarography results.
Results: Patients with CS had a more severe systolic dysfunction (median ejection fraction 22.72 ± 12.30% vs. 41.93 ± 10.50%, P < 0.0001). Single-vessel disease was the most common in both groups, left anterior descending artery being the culprit artery in most patients with cardiogenic shock, 25% of them having residual lesions with a severity >75%. Using a multivariate analysis, we observed that for patients with CS, delayed coronary angiography evaluation, as well as the presence of severe triple-vessel disease, were associated with a higher risk of death. In-hospital mortality (53.33% vs. 8.33%, P < 0.0001) and ventricular arrhythmia were significantly higher in patients with CS (48.3% vs. 11.3%, P < 0.0001).
Conclusions: Our study suggests that patients with AMI and CS can be considered the most severe form of myocardial infarction and should, therefore, benefit of prompt and appropriate treatment, to improve the outcome.
Cardiogenic shock; Ischaemic heart disease; Mortality; Right ventricular myocardial infarction
Larisa Anghel,Radu Sascău,Cristian Stătescu. Myocardial infarction with cardiogenic shock---the experience of a primary PCI centre from North-East Romania. Signa Vitae. 2021. 17(5);64-70.
 van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation. 2017; 136: e232–e268.
 Kolte D, Khera S, Aronow WS, Mujib M, Palaniswamy C, Sule S, et al. Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States. Journal of the American Heart Association. 2014; 3: e000590.
 Berg DD, Bohula EA, van Diepen S, Katz JN, Alviar CL, Baird-Zars VM, et al. Epidemiology of shock in contemporary cardiac intensive care units: data from the critical care cardiology trials network registry. Circulation: Cardiovascular Quality and Outcomes. 2019; 12: e005618.
 Vahdatpour C, Collins D, Goldberg S. Cardiogenic shock. Journal of the American Heart Association. 2019; 8: e011991.
 Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli C, Bueno H, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. 2018; 39: 119–177.
 Hartley A, Marshall DC, Salciccioli JD, Sikkel MB, Maruthappu M, Shalhoub J. Trends in mortality from ischemic heart disease and cerebrovascular disease in Europe: 1980 to 2009. Circulation. 2016; 133: 1916–1926.
 Vrints CJ. Cardiogenic shock: the next frontier in acute cardiovascular care! European Heart Journal. 2018; 7: 3–6.
 Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. New England Journal of Medicine. 1999; 341: 625–634.
 Baran DA, Grines CL, Bailey S, Burkhoff D, Hall SA, Henry TD, et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock: this document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019. Catheterization and Cardiovascular Interventions. 2019; 94: 29–37.
 Schrage B, Dabboura S, Yan I, Hilal R, Neumann JT, Sörensen NA, et al. Application of the SCAI classification in a cohort of patients with cardiogenic shock. Catheterization and Cardiovascular Interventions. 2020; 96: E213–E219.
 Albulushi A, Giannopoulos A, Kafkas N, Dragasis S, Pavlides G, Chatzizisis YS. Acute right ventricular myocardial infarction. Expert Review of Cardiovascular Therapy. 2018; 16: 455–464.
 Liao H, Chen Q, Liu L, Zhong S, Deng H, Xiao C. Impact of concurrent right ventricular myocardial infarction on outcomes among patients with left ventricular myocardial infarction. Scientific Reports. 2020; 10: 1736.
 Kakouros N, Cokkinos DV. Right ventricular myocardial infarction: pathophysiology, diagnosis, and management. Postgraduate Medical Journal. 2010; 86: 719–728.
 Harnett DT, LaHaye SA, Wilkinson JS. Isolated right ventricular myocardial infarction: a sheep in wolf’s clothing. JAMA Internal Medicine. 2016; 176: 1207–1210.
 Kosuge M, Kimura K. Differences in electrocardiographic findings between acute isolated right ventricular myocardial infarction and acute anterior myocardial infarction. JAMA Internal Medicine. 2016; 176: 1875.
 Alhamshari YS, Alnabelsi T, Mulki R, Cepeda-Valery B, Figueredo VM, Romero-Corral A. Right ventricular function measured by TAPSE in obese subjects at the time of acute myocardial infarction and 2 year outcomes. International Journal of Cardiology. 2017; 232: 181–185.
 Marin F, Pighi M, Pesarini G, Piccoli A, Ribichini F. Devices for mechanical circulatory support and strategies for their management in cardiogenic shock. Kardiologia Polska. 2019; 77: 589–595.
 Nadziakiewicz P, Zembala M, Słonka G, Balak W. Successful use of Impella CP® in cardiogenic shock after cardiac arrest: a first in Poland. Kardiologia Polska. 2017; 75: 812.
 Lewicki Ł, Jaguszewski M, Masiewicz E, Targoński R, Rynkiewicz A. The successful treatment of cardiogenic shock with primary percutaneous coronary intervention (T-stenting) of total occluded unprotected left main performed during cardiopulmonary resuscitation. Kardiologia Polska. 2015; 73: 216.
 Namana V, Gupta SS, Abbasi AA, Raheja H, Shani J, Hollander G. Right ventricular infarction. Cardiovascular Revascularization Medicine. 2018; 19: 43–50.
 Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2018; 37: 2129–2200.
 Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U. 2018 ESC/EACTS guidelines on myocardial revasculariza-tion. European Heart Journal. 2019; 40: 87–165.
 Harjola V, Lassus J, Sionis A, Køber L, Tarvasmäki T, Spinar J, et al. Clinical picture and risk prediction of short-term mortality in cardiogenic shock: clinical picture and outcome of cardiogenic shock. European Journal of Heart Failure. 2015; 17: 501–509.
 Thiele H, Ohman EM, de Waha-Thiele S, Zeymer U, Desch S. Management of cardiogenic shock complicating myocardial infarction: an update 2019. European Heart Journal. 2019; 40: 2671–2683.
 Bauer T, Zeymer U, Hochadel M, Möllmann H, Weidinger F, Zahn R, et al. Use and outcomes of multivessel percutaneous coronary intervention in patients with acute myocardial infarction complicated by cardiogenic shock (from the EHS-PCI Registry). American Journal of Cardiology. 2012; 109: 941–946.
 McCallister BD, Christian TF, Gersh BJ, Gibbons RJ. Prognosis of myocardial infarctions involving more than 40% of the left ventricle after acute reperfusion therapy. Circulation. 1993; 88: 1470–1475.
 Menon V, White H, LeJemtel T, Webb JG, Sleeper LA, Hochman JS. The clinical profile of patients with suspected cardiogenic shock due to predominant left ventricular failure: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? Journal of the American College of Cardiology. 2000; 36: 1071–1076.
 Akodad M, Schurtz G, Adda J, Leclercq F, Roubille F. Management of valvulopathies with acute severe heart failure and cardiogenic shock. Archives of Cardiovascular Diseases. 2019; 112: 773–780.
 Thiele H, Akin I, Sandri M, de Waha-Thiele S, Meyer-Saraei R, Fuernau G, et al. One-year outcomes after PCI strategies in cardiogenic shock. New England Journal of Medicine. 2018; 379: 1699–1710.
 Guedeney P, Barthélémy O, Zeitouni M, Hauguel-Moreau M, Hage G, Kerneis M, et al. Prognostic value of SYNTAX score in patients with infarct-related cardiogenic shock: insights from the CULPRIT-SHOCK trial. JACC: Cardiovascular Interventions. 2020; 13: 1198–1206.
 Sakamoto K, Matoba T, Mohri M, Ueki Y, Tsujita Y, Yamasaki M, et al. Clinical characteristics and prognostic factors in acute coronary syndrome patients complicated with cardiogenic shock in Japan: analysis from the Japanese Circulation Society Cardiovascular Shock Registry. Heart and Vessels. 2019; 34: 1241–1249.
 Duchnowski P, Hryniewiecki T, Kuśmierczyk M, Szymański P. High-sensitivity troponin T predicts postoperative cardiogenic shock requiring mechanical circulatory support in patients with valve disease. Shock. 2020; 53: 175–178.
 Ghionzoli N, Sciaccaluga C, Mandoli GE, Vergaro G, Gentile F, D’Ascenzi F, et al. Cardiogenic shock and acute kidney injury: the rule rather than the exception. Heart Failure Reviews. 2020. (in press)
 Mehta RH, Ou F, Peterson ED, Shaw RE, Hillegass WB, Rumsfeld JS, et al. Clinical significance of post-procedural TIMI flow in patients with cardiogenic shock undergoing primary percutaneous coronary intervention. JACC: Cardiovascular Interventions. 2009; 2: 56–64.
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