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Jeopardized Myocardium and Survival in Patients Presenting to the Catheterization Laboratory With ST-Elevation Myocardial Infarction and Shock.
Joshi, Francis R; Pedersen, Frants; Räder, Sune; Raunsø, Jakob; Kjaergaard, Jesper; Lindholm, Matias; Hassager, Christian; Engstrøm, Thomas; Holmvang, Lene; Helqvist, Steffen; Jørgensen, Erik.
Afiliação
  • Joshi FR; Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark. Electronic address: frj230@gmail.com.
  • Pedersen F; Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
  • Räder S; Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
  • Raunsø J; Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
  • Kjaergaard J; Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
  • Lindholm M; Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
  • Hassager C; Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
  • Engstrøm T; Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
  • Holmvang L; Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
  • Helqvist S; Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
  • Jørgensen E; Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
Cardiovasc Revasc Med ; 21(7): 843-848, 2020 07.
Article em En | MEDLINE | ID: mdl-31759911
OBJECTIVE: We aimed to relate the amount of jeopardized myocardium to mortality in shocked patients presenting to the catheterization laboratory with ST-elevation myocardial infarction (STEMI) and cardiogenic shock. BACKGROUND: In contrast with historical data and previous professional guidance, contemporary randomized data suggest that multi-vessel revascularization in such patients does not improve survival; mechanistic insight is incomplete. METHODS: Clinical databases identified cases of STEMI and shock triaged for primary percutaneous coronary intervention (PPCI) in Eastern Denmark from June 2011 to December 2014 (n = 128). British Cardiovascular Intervention Society (BCIS)-1 jeopardy scores were calculated from angiography. The study endpoint was 30-day mortality. RESULTS: Median lactate values were 6.0 [2.9-10.7] mmol/L. 30-day mortality was 53.9%. 68% of patients had multi-vessel coronary disease. Median pre-PCI BCIS-1 myocardial jeopardy scores were 8 [6-10]. After multiple logistic regression increasing age (p = 0.008; odds ratio [OR] 1.06), lactate values (p = 0.017; OR 1.02), mechanical ventilation (p = 0.011; OR 1.25) and a systolic blood pressure ≤ 90 mmHg at end-case (p = 0.005; OR 1.26) were predictive of 30-day mortality. Post-PPCI culprit vessel TIMI 3 flow was associated with reduced mortality (p < 0.001; OR 0.66). There was no association between pre-PCI jeopardy scores and the primary endpoint. CONCLUSIONS: In patients with STEMI and shock, myocardial jeopardy scores do not relate to patient outcomes. Jeopardy scores may be applied to existing datasets in order to understand why multi-vessel revascularization does not lead to the anticipated clinical benefits in cardiogenic shock.
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Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 6_ODS3_enfermedades_notrasmisibles Base de dados: MEDLINE Assunto principal: Choque Cardiogênico / Angiografia Coronária / Infarto do Miocárdio com Supradesnível do Segmento ST / Miocárdio Tipo de estudo: Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Revista: Cardiovasc Revasc Med Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 6_ODS3_enfermedades_notrasmisibles Base de dados: MEDLINE Assunto principal: Choque Cardiogênico / Angiografia Coronária / Infarto do Miocárdio com Supradesnível do Segmento ST / Miocárdio Tipo de estudo: Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Revista: Cardiovasc Revasc Med Ano de publicação: 2020 Tipo de documento: Article