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1.
Medicine (Baltimore) ; 98(39): e16982, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574797

RESUMO

To investigate factors predicting the onset of major adverse cardiovascular and cerebrovascular events (MACCEs) after primary percutaneous coronary intervention (pPCI) for patients with non-ST-segment elevation infarction (NSTEMI) and single concomitant chronic total occlusion (CTO). Neutrophil gelatinase-associated lipocalin (NGAL) and glycosylated hemoglobin (HbA1c) both play essential role in cardiovascular and cerebrovascular homoeostasis. However, current knowledge of its predictive prognostic value is limited.422 patients with NSTEMI and CTO (59.7 ±â€Š12.4 years, 74.2% men) who underwent successful pPCI were enrolled and followed for 2 years. Multivariate cox regression analysis and receiver operating characteristic (ROC) curve analysis were performed to determine the factors predicting MACCEs.140 patients (33.2%) experienced MACCEs in the follow-up period. Multivariate cox regression analysis found when we process the model with NGAL at admission, low left ventricular ejection fraction (LVEF, HR = 0.963, 95% CI 0.940 to 0.987, P = .003) and fasting blood glucose (HR = 1.078, 95% CI 1.002 to 1.159, P = .044), but not NGAL at admission, were independent predictors of 2 years MACCEs. While HbA1C (HR = 1.119, 95% CI 1.014 to 1.234, P = .025), LVEF (HR = 0.963, 95% CI 0.939 to 0.987, P = .003), estimated glomerular filtration rate (HR = 1.020, 95% CI 1.006 to 1.035, P = .006) and NGAL value 7 day (HR = 1.020, 95% CI 1.006 to 1.035, P = .006) showed their predictive value in another model. ROC analysis indicated NGAL 7 day (AUC = 0.680, P = .0054 and AUC = 0.622, P = .0005) and LVEF (AUC = 0.691, P = .0298 and AUC = 0.605, P = .0021) could predict both in-hospital and 2 years MACCEs, while higher NGAL at admission could only predict poorer in-hospital prognosis (AUC = 0.665, P = .0103). Further analysis showed the prognostic value of NGAL was particularly remarkable among those HbA1C<6.5%.Patients with NSTEMI and single concomitant CTO receiving pPCI with higher NGAL on 7 days during hospitalization are more likely to suffer 2 years MACCEs, particularly in those with lower HbA1C.


Assuntos
Oclusão Coronária/sangue , Oclusão Coronária/cirurgia , Hemoglobina A Glicada/metabolismo , Lipocalina-2/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Intervenção Coronária Percutânea , Idoso , Biomarcadores/sangue , Glicemia/metabolismo , Oclusão Coronária/complicações , Oclusão Coronária/fisiopatologia , Morte Súbita Cardíaca/etiologia , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Prognóstico , Estudos Prospectivos , Choque Cardiogênico/etiologia , Acidente Vascular Cerebral/etiologia , Volume Sistólico
2.
Int Heart J ; 60(5): 1184-1188, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484860

RESUMO

We report the case of a 79-year-old man with acute myocardial infarction caused by left main trunk lesion, who experienced cardiogenic shock during percutaneous coronary intervention (PCI). To reverse the cardiogenic shock, we initiated veno-arterial extra corporeal membrane oxygenation (VA-ECMO) without an intra-aortic balloon pump (IABP) due to the severe tortuosity of the left external iliac artery. Although PCI was successful, arterial pressure monitoring revealed that the pulse pressure was too low to recover from the cardiogenic shock of decreased cardiac contraction function (the left ventricular ejection fraction was 30%). Thus, we decided to use IABP from the brachial artery to improve the hemodynamics. Immediately after the deployment of a 6-Fr IABP system (Takumi) from the left brachial artery, the pulse pressure was restored and finally VA-ECMO was withdrawn from the patient without complications. Although using IABP in combination with VA-ECMO is a reasonable strategy for cardiogenic shock, the effectiveness of this combination remains controversial. In this case, IABP added to VA-ECMO clearly achieved an improvement of pulse pressure and vital signs. Based on this result, monitoring of the pulse waveform is an effective tool to determine whether the concomitant use of IABP with VA-ECMO is indicated. Moreover, when it is difficult to insert IABP from the femoral arteries, the use of a 6-Fr IABP system (Takumi) approaching from the brachial artery should be considered.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Balão Intra-Aórtico/métodos , Infarto do Miocárdio/complicações , Intervenção Coronária Percutânea/efeitos adversos , Choque Cardiogênico/terapia , Idoso , Pressão Sanguínea/fisiologia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Terapia Combinada , Serviço Hospitalar de Emergência , Seguimentos , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/métodos , Medição de Risco , Choque Cardiogênico/etiologia , Resultado do Tratamento
3.
Heart Surg Forum ; 22(4): E281-E282, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31398091

RESUMO

We report a 62-year-old male who had severe aortic insufficiency after a homograft root replacement, requiring venoarterial extracorporeal membrane oxygenation prior to surgery due to profound cardiogenic shock. Severe aortic insufficiency is a contraindication for venoarterial extracorporeal membrane oxygenation, but we were able to stabilize the patient and successfully perform an urgent reoperative surgery.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Oxigenação por Membrana Extracorpórea/métodos , Complicações Pós-Operatórias/cirurgia , Falha de Prótese/efeitos adversos , Reoperação , Choque Cardiogênico/etiologia , Aloenxertos , Insuficiência da Valva Aórtica/etiologia , Contraindicações de Procedimentos , Ponte de Artéria Coronária , Oxigenação por Membrana Extracorpórea/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Terapia de Salvação/métodos , Choque Cardiogênico/cirurgia
4.
J Cardiothorac Surg ; 14(1): 153, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438988

RESUMO

BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used increasingly to support patients with cardiogenic shock (CS). There has been growing recognition of the favorable and unfavorable hemodynamic effects of this therapy and recent interest in the use of other percutaneous circulatory support devices to offset some of the potentially harmful hemodynamic effects. Herein, we provide visual evidence of the effects of intra-aortic balloon pump (IABP) counterpulsation for a patient with peripheral VA-ECMO cannulation. CASE PRESENTATION: A 68 year old man who had undergone orthotopic heart transplantation presented with 2 days of fatigue, orthopnea, and paroxysmal nocturnal dyspnea. On examination, he was tachycardic, hypotensive and hypoxic with cool extremities, consistent with CS. Transthoracic echocardiogram (TTE) showed new severe biventricular dysfunction with a left ventricular ejection fraction of 15%, right heart catheterization demonstrated elevated filling pressures and low output. An IABP was inserted via the left femoral artery with minimal improvement in hemodynamics. He was escalated to VA-ECMO. Repeat TTE demonstrated aortic valve (AV) opening with each cardiac cycle and mild MR. With placement of the IABP on standby Additional file 1: Video 1 (video 0:03), the AV no longer opened. Re-initiation of balloon counterpulsation resulted in resumed AV opening with each beat Additional file 1: Video 1 (video 0:17). He was treated for presumed acute allograft rejection with methylprednisolone, thymoglobulin, intravenous immunoglobulin and plasmapheresis with improvement in allograft function. However, he developed an Enterobacter aerogenes pneumonia and rapidly fatal septic shock. CONCLUSIONS: This case visually demonstrates effective LV decompression by IABP counterpulsation in VA-ECMO support. While the overall effects of LV decompression in patients on VA-ECMO with IABP are still unclear, this report demonstrates one potential mechanism of benefit in the prevention of stagnation of blood flow that may lead to intra-cardiac or aortic root thrombus formation.


Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Balão Intra-Aórtico , Choque Cardiogênico/terapia , Idoso , Descompressão Cirúrgica , Evolução Fatal , Transplante de Coração/efeitos adversos , Ventrículos do Coração/cirurgia , Hemodinâmica , Humanos , Masculino , Choque Cardiogênico/etiologia , Função Ventricular Esquerda/fisiologia
5.
BMJ Case Rep ; 12(7)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340947

RESUMO

The Cabrol technique employs a synthetic graft to connect the coronary arteries to an aortic graft in patients with complex disease of the ascending aorta. Acute Cabrol graft thrombosis is a life-threatening situation that presents as acute coronary syndrome, as it leads to acute coronary hypoperfusion. We present a patient with unstable anginal symptoms who had undergone aortic surgery 6 months prior to presentation. Cardiac catheterisation was concerning for aortic dissection yet was later revealed to be acute occlusion of a Cabrol graft. The patient ultimately died of cardiogenic shock. We review the Cabrol technique, complications and management of acute graft thrombosis.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Implante de Prótese Vascular/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Estenose Coronária/cirurgia , Oclusão de Enxerto Vascular/diagnóstico por imagem , Choque Cardiogênico/diagnóstico , Síndrome Coronariana Aguda/etiologia , Angina Pectoris/diagnóstico , Angina Pectoris/etiologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Ponte de Artéria Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Serviço Hospitalar de Emergência , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Choque Cardiogênico/etiologia , Trombose
6.
J Cardiothorac Surg ; 14(1): 129, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272456

RESUMO

BACKGROUND: Extracorporeal membrane oxygenation offers temporary hemodynamic support for patients with refractory cardiogenic shock after cardiovascular surgery. However, the initiation time for such patients is controversial. Changing the initiation time might improve the outcomes. This study aimed to investigate whether early extracorporeal membrane oxygenation could improve postoperative outcomes in patients at a high risk of cardiogenic shock. METHODS: In this retrospective study, 173 patients with cardiovascular diseases at a high risk of refractory cardiogenic shock which assessed via empirical risk evaluation from 2010 to 2017 were included. After propensity matching, 36 patients, who were matched to patients initiated with extracorporeal membrane oxygenation after cardiovascular operation (delayed extracorporeal membrane oxygenation group, n = 36), were also initiated with such early in the operating room (early extracorporeal membrane oxygenation group, n = 36). The primary outcome was death. The secondary outcomes included receiving continuous renal replacement therapy, ventricular arrhythmia, and pulmonary infection. RESULTS: The demographic and baseline variables were similar between the matched groups. The early extracorporeal membrane oxygenation group showed lower mortality (69.44% vs 41.67%, P = 0.03), pulmonary infection morbidity (86.11% vs 55.56%, P < 0.01), and continuous renal replacement therapy rate(88.89% vs 66.67%, P = 0.04). Moreover, they showed improved cardiac index (P = 0.01) and lactate clearance (P < 0.01). CONCLUSIONS: Extracorporeal membrane oxygenation provides effective support for cardiogenic failure refractory to medical management; early initiation improves cardiac output and promotes lactate clearance, thus increasing survival in patients with cardiogenic shock after cardiovascular surgery. TRIAL REGISTRATION: This is a retrospective study. It was not registered.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Oxigenação por Membrana Extracorpórea , Choque Cardiogênico/terapia , Adulto , Idoso , Feminino , Humanos , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Terapia de Substituição Renal , Infecções Respiratórias/etiologia , Estudos Retrospectivos , Choque Cardiogênico/etiologia , Taxa de Sobrevida , Fatores de Tempo
8.
Emerg Med Clin North Am ; 37(3): 493-509, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262417

RESUMO

Although cardiogenic shock is uncommon in the emergency department, it is associated with high mortality. Most cardiogenic shock is caused by ischemia, but nonischemic etiologies are essential to recognize. Clinicians should optimize preload, contractility, and afterload. Volume-responsive patients should be resuscitated in small aliquots, although some patients may require diuresis to improve cardiac output. Vasopressors are important to restore end-organ perfusion, and inotropes improve contractility. Intubation and positive pressure ventilation impact hemodynamics, which, depending on volume status, may be beneficial or deleterious. Knowing indications for mechanical circulatory support is important for timely consultation or transfer as indicated.


Assuntos
Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Algoritmos , Antiarrítmicos/uso terapêutico , Cardiotônicos/uso terapêutico , Cateterismo , Ecocardiografia , Eletrocardiografia , Medicina de Emergência , Cardiopatias/complicações , Cardiopatias/diagnóstico , Cardiopatias/terapia , Humanos , Ácido Láctico/sangue , Anamnese , Monitorização Fisiológica , Peptídeos Natriuréticos/sangue , Exame Físico , Sistemas Automatizados de Assistência Junto ao Leito , Troponina/sangue , Vasoconstritores/uso terapêutico
10.
Cardiol Rev ; 27(4): 198-201, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31180939

RESUMO

The pathogenesis of cardiogenic shock (CS) has evolved from an acute event due to a large myocardial infarction to a semiacute event due to rapid hemodynamic deterioration on a background of preexisting left ventricular systolic dysfunction. Pre-CS refers to the period of rapid hemodynamic deterioration that precedes overt CS with hypotension, inflammatory response, and end-organ failure. Mortality remains extremely high in CS and has not improved over the past decades. Pre-CS offers a unique opportunity to initiate early treatment that may result in better clinical outcomes. The present review addresses the definition, recognition, and management of pre-CS with the pharmacologic or mechanical support of the failing left ventricle.


Assuntos
Insuficiência Cardíaca/complicações , Hemodinâmica/fisiologia , Infarto do Miocárdio/complicações , Choque Cardiogênico , Saúde Global , Humanos , Incidência , Choque Cardiogênico/epidemiologia , Choque Cardiogênico/etiologia , Choque Cardiogênico/fisiopatologia , Taxa de Sobrevida/tendências
11.
J Card Surg ; 34(7): 632-634, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31212380

RESUMO

OBJECTIVES: Administration of heparin is standard in coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (OPCABG). In some circumstances, the risk of heparinization may outweigh its benefits, and there is scarce literature on how to proceed in these cases. We describe the technique used for OPCABG without heparin. METHODS: We report the case of a patient with a gunshot wound to the chest resulting in multiple lung lacerations and transection of the proximal left anterior descending coronary artery (LAD) leading to hemorrhagic shock with tamponade, and cardiogenic shock due to myocardial ischemia who received OPCABG without heparin. RESULTS: A 23-year-old patient suffered multiple gunshot wounds to the chest and was admitted in shock with massive left hemothorax. Emergency left thoracotomy revealed multiple lung lacerations and transection of the proximal left anterior coronary artery. The patient presented acute myocardial ischemia and progressed to cardiogenic shock requiring insertion of intra-aortic balloon pump (IABP) to try to support hemodynamics. OPCABG with a segment of reversed saphenous vein graft to the LAD coronary artery was performed using standard techniques but without heparinization. The graft was flushed with normal saline before completing both anastomosis. Myocardial ischemic changes reversed, and the patient stabilized immediately after completing OPCABG, allowing to wean off IABP in the operating room. Postoperative recovery was unremarkable, and the patient was discharged home on postoperative day 9. CONCLUSION: Benefits of OPCABG include decreased bleeding and lower requirement of blood transfusions. This experience shows that OPCABG can be performed without systemic heparinization in selected cases.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Vasos Coronários/lesões , Vasos Coronários/cirurgia , Traumatismos Cardíacos/cirurgia , Traumatismos Torácicos/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adulto , Traumatismos Cardíacos/complicações , Heparina , Humanos , Balão Intra-Aórtico , Masculino , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Traumatismos Torácicos/complicações , Resultado do Tratamento , Ferimentos por Arma de Fogo/complicações , Adulto Jovem
12.
Int Heart J ; 60(4): 1009-1012, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31204372

RESUMO

Spontaneous coronary artery rupture (SCAR) is an extremely rare, life-threatening entity without any previous underlying diseases. The clinical presentation may differ according to the site of the rupture and some patients may deteriorate early into sudden death due to the abrupt evolution of the associated cardiac tamponade and cardiogenic shock.1) The correct diagnosis of SCAR deserves a high level of suspicion. It may be confirmed as a differential diagnosis in patients with cardiac tamponade using transthoracic echocardiography (TTE) and computed tomography angiography (CTA) following emergency pericardiocentesis, and a definite diagnosis can be achieved by selective angiography. Although SCAR is associated with a dismal prognosis, some patients have recovered through emergency surgical operations or catheter interventions.2) We report the case of a patient presenting cardiac tamponade and cardiogenic shock due to spontaneous rupture of the circumflex branch of the left coronary artery, which was successfully isolated by bilateral ligation.


Assuntos
Tamponamento Cardíaco/etiologia , Doença da Artéria Coronariana/complicações , Vasos Coronários/diagnóstico por imagem , Choque Cardiogênico/etiologia , Doença Aguda , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/cirurgia , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/cirurgia , Humanos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Pericardiocentese , Ruptura Espontânea , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos
13.
J Artif Organs ; 22(3): 249-252, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30937678

RESUMO

We recently experienced a 70-year-old woman with left main trunk-acute coronary syndrome who was initially supported by Impella 5.0 which converted to paracorporeal left ventricular assist device (LVAD) implantation as a bridge to recovery. Optimized guideline-directed medical therapy with cardiac rehabilitation resulted in successful explantation of LVAD and she discharged on foot.


Assuntos
Síndrome Coronariana Aguda/complicações , Coração Auxiliar , Choque Cardiogênico/terapia , Idoso , Feminino , Humanos , Choque Cardiogênico/etiologia , Resultado do Tratamento
14.
J Invasive Cardiol ; 31(5): E95, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31034443
16.
Am J Cardiol ; 123(11): 1816-1821, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30967283

RESUMO

In the setting of cardiogenic shock (CS), impaired biventricular function can cause acute decrease in renal function via reduced renal perfusion and increased renal venous pressure. We sought to analyze the characteristics and outcomes of patients hospitalized with CS who utilized renal replacement therapy (hemodialysis) for acute kidney injury (AKI-HD). We utilized data from the National Inpatient Sample to calculate national rates of in-hospital mortality, use of temporary mechanical support, vascular injury requiring surgery, length of stay (LOS) and hospitalization cost from 2010 to September 2015. We compared the in-hospital outcomes between CS with AKI-HD and a propensity score-matched group without AKI-HD. We identified 6,076 hospitalizations (weighted n = 24,272) with CS and AKI-HD and 76,878 (weighted n = 378,553) with CS not AKI-HD. Among these cases 48.1% (n = 39,403, weighted n = 193,746) had ST elevation myocardial infarction as the cause of CS. Patients with CS and AKI-HD had higher comorbidity burden and they were also more likely to receive mechanical circulatory support device (absolute standardized difference >10% for all comparisons) compared with CS patients without AKI-HD. After matching 4,457 cases for patient-level and hospital-level characteristics, CS with AKI-HD was associated with significantly higher in-hospital mortality (75.74% vs 51.58%, p <0.001), use of temporary mechanical support (24.0% vs 19.3%, p <0.001), LOS (21.4 vs14.4 days, p <0.001) and cost ($80,406 vs $52,833, p <0.0001). AKI-HD occurred in approximately 6% of patients with CS in years 2010 to 2015 and was associated with significantly increased in-hospital morbidity and mortality, LOS, and cost.


Assuntos
Lesão Renal Aguda/complicações , Lesão Renal Aguda/terapia , Diálise Renal , Choque Cardiogênico/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
17.
Int J Artif Organs ; 42(9): 521-524, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30968739

RESUMO

Refractory cardiogenic and vasoplegic shock after congenital heart surgery is a threatening condition leading to high morbidity and mortality. Control of hemodynamic and inflammatory response is fundamental in medical strategy. We report the case of a newborn with cardiogenic and vasoplegic shock secondary to cardiopulmonary bypass for atrioseptostomy and prostaglandin treatment in the context of hypoplastic left heart syndrome, successfully treated with a combination of mechanical circulatory support and cytokine hemoadsorption column (CytoSorb®). Vasopressor support was weaned during the time of treatment without multiple organ failure occurrence. The use of CytoSorb® cartridge inserted in an extra-corporeal circuit even in a newborn is easy and feasible, as long as some precautions are considered. Routine monitoring of drugs levels is mandatory during the use of the cartridge and immediately after.


Assuntos
Ponte Cardiopulmonar/efeitos adversos , Oxigenação por Membrana Extracorpórea , Cardiopatias Congênitas/cirurgia , Choque Cardiogênico/terapia , Desintoxicação por Sorção , Humanos , Recém-Nascido , Masculino , Complicações Pós-Operatórias , Choque Cardiogênico/etiologia
18.
Br J Hosp Med (Lond) ; 80(4): 204-210, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30951425

RESUMO

Cardiogenic shock remains a major problem affecting a large proportion of patients with acute coronary syndromes, with a persistent high mortality rate. Although mechanical reperfusion with percutaneous coronary intervention has improved outcomes following acute coronary syndromes, there is limited evidence supporting the other current treatments used to manage patients with cardiogenic shock (intra-aortic balloon pumps, percutaneous left ventricular assist devices and extracorporeal membrane oxygenation). This article looks at these options, assessing current evidence and recent advances. It also discusses areas that still require research to ensure there is improvement in these high-risk patients, such as coordinated regionalised approaches to cardiogenic shock management with multidisciplinary care provided in designated tertiary shock centres.


Assuntos
Síndrome Coronariana Aguda/terapia , Cardiotônicos/uso terapêutico , Oxigenação por Membrana Extracorpórea/métodos , Coração Auxiliar , Balão Intra-Aórtico/métodos , Intervenção Coronária Percutânea/métodos , Choque Cardiogênico/terapia , Vasoconstritores/uso terapêutico , Síndrome Coronariana Aguda/complicações , Cateterismo de Swan-Ganz , Gerenciamento Clínico , Hidratação , Humanos , Choque Cardiogênico/etiologia
19.
Clin Cardiol ; 42(4): 484-493, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30815887

RESUMO

Despite advances in percutaneous coronary interventions and their widespread use, mortality in patients presenting with acute myocardial infarction (MI) complicated by cardiogenic shock (CS) has remained very high, and treatment options are limited. Limited evidences exist, supporting many of the routinely used therapies in treating these patients. In the present article, we discuss CS complicating MI in general and an update on the currently available treatment options, including inotropes and vasopressor, coronary revascularization, mechanical circulatory support devices, mechanical complications, and long-term outcomes.


Assuntos
Gerenciamento Clínico , Infarto do Miocárdio/complicações , Intervenção Coronária Percutânea/métodos , Choque Cardiogênico/terapia , Terapia Trombolítica/métodos , Saúde Global , Humanos , Infarto do Miocárdio/terapia , Choque Cardiogênico/etiologia , Choque Cardiogênico/mortalidade , Taxa de Sobrevida/tendências
20.
Am J Cardiol ; 123(10): 1595-1601, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30846213

RESUMO

In-hospital complications and their predictors in acute coronary syndrome (ACS) patients with cardiogenic shock (CS) have not been fully investigated, particularly in those who underwent invasive revascularization procedures. This study investigated the in-hospital outcomes, along with the volume-outcome relationship of ACS patients with CS, using a contemporary large-scale nationwide percutaneous coronary intervention (PCI) registry in Japan. We analyzed PCI procedural data on ACS patients treated between 2014 and 2016 in a nationwide Japanese PCI registry. Predictors of in-hospital death and major bleeding complications requiring transfusion were identified via multivariable logistic regression analysis. The association of bleeding complications with in-hospital death was also analyzed. This study enrolled 253,355 patients who underwent PCI for ACS, of whom 17,549 (6.9%) were with CS. The rates of in-hospital mortality and access/nonaccess site bleeding complications in CS patients were 13.2%, 1.2%, and 1.3%, respectively. Age, gender, and baseline kidney condition, along with presentation status (e.g., cardiopulmonary arrest and/or acute heart failure) or the number and location of diseased vessels (e.g., left main lesion), were associated with in-hospital mortality and bleeding complications. Of note, the in-hospital mortalities decreased in parallel with the increasing institutional PCI volumes. In-hospital mortality also differed by the presence of concomitant bleeding complications (43.1% and 48.3% with access or nonaccess site bleeding, and 12.9% and 12.7% without, respectively). In conclusion, in-hospital mortality was 13.2% in ACS patients with CS who underwent contemporary PCI. Other than traditional predictors of PCI complications, lower institutional PCI volumes, and concurrent bleeding were associated with higher in-hospital mortality.


Assuntos
Síndrome Coronariana Aguda/complicações , Hospitais/estatística & dados numéricos , Intervenção Coronária Percutânea , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Choque Cardiogênico/epidemiologia , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/cirurgia , Idoso , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Incidência , Japão/epidemiologia , Masculino , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Prognóstico , Estudos Prospectivos , Fatores de Risco , Choque Cardiogênico/etiologia , Taxa de Sobrevida/tendências
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