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Fractional Flow Reserve-Guided Multivessel Angioplasty in Myocardial Infarction High-Resolution Cardiac Magnetic Resonance Imaging Techniques for the Identification of Coronary Microvascular Dysfunction Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk A prediction model of simple echocardiographic variables to screen for potentially correctable shunts in adult patients with pulmonary arterial hypertension associated with atrial septal defects: a cross-sectional study Bench testing and coronary artery bifurcations: a consensus document from the European Bifurcation Club Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes: A Scientific Statement From the American Heart Association Sildenafil added to pirfenidone in patients with advanced idiopathic pulmonary fibrosis and risk of pulmonary hypertension: A Phase IIb, randomised, double-blind, placebo-controlled study - Rationale and study design Autologous CD34+ Stem Cell Therapy Increases Coronary Flow Reserve and Reduces Angina in Patients With Coronary Microvascular Dysfunction Plaque Rupture, compared to Plaque Erosion, is associated with Higher Level of Pan-coronary Inflammation Cardiovascular risk prediction in type 2 diabetes: a comparison of 22 risk scores in primary care settings

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.