Important role of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

Lauren Truby, Yoshifumi Naka, Bindu Kalesan, Takeyoshi Ota, Ajay J. Kirtane, Susheel Kodali, Natasha Nikic, Lily Mundy, Paolo Colombo, Ulrich P. Jorde, Hiroo Takayama

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article numberezu478
Pages (from-to)322-328
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume48
Issue number2
DOIs
StatePublished - Aug 1 2015
Externally publishedYes

Fingerprint

Cardiogenic Shock
Myocardial Infarction
Equipment and Supplies
Mortality
Counterpulsation
Cardiopulmonary Resuscitation
Therapeutics
Survivors
Arterial Pressure
Prospective Studies
Survival

Keywords

  • Acute myocardial infarction
  • Mechanical circulatory support

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Important role of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock. / Truby, Lauren; Naka, Yoshifumi; Kalesan, Bindu; Ota, Takeyoshi; Kirtane, Ajay J.; Kodali, Susheel; Nikic, Natasha; Mundy, Lily; Colombo, Paolo; Jorde, Ulrich P.; Takayama, Hiroo.

In: European Journal of Cardio-thoracic Surgery, Vol. 48, No. 2, ezu478, 01.08.2015, p. 322-328.

Research output: Contribution to journalArticle

Truby, L, Naka, Y, Kalesan, B, Ota, T, Kirtane, AJ, Kodali, S, Nikic, N, Mundy, L, Colombo, P, Jorde, UP & Takayama, H 2015, 'Important role of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock', European Journal of Cardio-thoracic Surgery, vol. 48, no. 2, ezu478, pp. 322-328. https://doi.org/10.1093/ejcts/ezu478
Truby, Lauren ; Naka, Yoshifumi ; Kalesan, Bindu ; Ota, Takeyoshi ; Kirtane, Ajay J. ; Kodali, Susheel ; Nikic, Natasha ; Mundy, Lily ; Colombo, Paolo ; Jorde, Ulrich P. ; Takayama, Hiroo. / Important role of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock. In: European Journal of Cardio-thoracic Surgery. 2015 ; Vol. 48, No. 2. pp. 322-328.
@article{03208ffba0974d45a927fe73b59166a5,
title = "Important role of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock",
abstract = "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.",
keywords = "Acute myocardial infarction, Mechanical circulatory support",
author = "Lauren Truby and Yoshifumi Naka and Bindu Kalesan and Takeyoshi Ota and Kirtane, {Ajay J.} and Susheel Kodali and Natasha Nikic and Lily Mundy and Paolo Colombo and Jorde, {Ulrich P.} and Hiroo Takayama",
year = "2015",
month = "8",
day = "1",
doi = "10.1093/ejcts/ezu478",
language = "English (US)",
volume = "48",
pages = "322--328",
journal = "European Journal of Cardio-thoracic Surgery",
issn = "1010-7940",
publisher = "Elsevier",
number = "2",

}

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

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

UR - http://www.scopus.com/inward/record.url?scp=84938560157&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84938560157&partnerID=8YFLogxK

U2 - 10.1093/ejcts/ezu478

DO - 10.1093/ejcts/ezu478

M3 - Article

VL - 48

SP - 322

EP - 328

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 2

M1 - ezu478

ER -