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急性冠脉综合征

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ST-Segment Elevation Myocardial Infarction Patients in the Coronary Care Unit Is it Time to Break Old Habits? Long-Term Prognostic Implications of Previous Silent Myocardial Infarction in Patients Presenting With Acute Myocardial Infarction Comparative Effectiveness of β-Blocker Use Beyond 3 Years After Myocardial Infarction and Long-Term Outcomes Among Elderly Patients Complete Revascularization with Multivessel PCI for Myocardial Infarction Acute Noncardiac Organ Failure in Acute Myocardial Infarction With Cardiogenic Shock Universal Definition of Myocardial Infarction Canadian Multicenter Chronic Total Occlusion Registry: Ten-Year Follow-Up Results of Chronic Total Occlusion Revascularization Efficacy and Safety of Stents in ST-Segment Elevation Myocardial Infarction Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Original Research2019 Jun 1;93(7):1173-1183.

JOURNAL:Catheter Cardiovasc Interv. Article Link

Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative

Basir MB, Kapur NK, National Cardiogenic Shock Initiative Investigators. Keywords: ACS/NSTEMI; ECMO/IABP/Tandem/Impella; acute myocardial infarction/STEMI; heart failure; hemodynamics; mechanical circulatory support; shock, cardiogenic

ABSTRACT


BACKGROUND - The National Cardiogenic Shock Initiative is a single-arm, prospective, multicenter study to assess outcomes associated with early mechanical circulatory support (MCS) in patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) treated with percutaneous coronary intervention (PCI).

 

METHODS - Between July 2016 and February 2019, 35 sites participated and enrolled into the study. All centers agreed to treat patients with AMICS using a standard protocol emphasizing invasive hemodynamic monitoring and rapid initiation of MCS. Inclusion and exclusion criteria mimicked those of the "SHOCK" trial with an additional exclusion criteria of intra-aortic balloon pump counter-pulsation prior to MCS.

 

RESULTS - A total of 171 consecutive patients were enrolled. Patients had an average age of 63 years, 77% were male, and 68% were admitted with AMICS. About 83% of patients were on vasopressors or inotropes, 20% had a witnessed out of hospital cardiac arrest, 29% had in-hospital cardiac arrest, and 10% were under active cardiopulmonary resuscitation during MCS implantation. In accordance with the protocol, 74% of patients had MCS implanted prior to PCI. Right heart catheterization was performed in 92%. About 78% of patients presented with ST-elevation myocardial infarction with average door to support times of 85 ± 63 min and door to balloon times of 87 ± 58 min. Survival to discharge was 72%. Creatinine 2, lactate >4, cardiac power output (CPO) <0.6 W, and age70 years were predictors of mortality. Lactate and CPO measurements at 12-24 hr reliably predicted overall mortality postindex procedure.

 

CONCLUSION - In contemporary practice, use of a shock protocol emphasizing best practices is associated with improved outcomes.

 

© 2019 Wiley Periodicals, Inc.