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Treatment Intensity for the Management of Cardiogenic Shock: Comparison Between STEMI and Non-STEMI.
Sinha, Shashank S; Pahuja, Mohit; Kataria, Rachna; Blumer, Vanessa; Hernandez-Montfort, Jaime; Kanwar, Manreet; Garan, A Reshad; Zhang, Yijing; Marbach, Jeffrey A; Khalif, Adnan; Vallabhajosyula, Saraschandra; Nathan, Sandeep; Abraham, Jacob; Li, Borui; Thayer, Katherine L; Baca, Paulina; Dieng, Fatou; Harwani, Neil M; Yin, Michael Y; Faugno, Anthony J; Faraz, Haroon A; Guglin, Maya; Hickey, Gavin W; Wencker, Detlef; Hall, Shelley; Schwartzman, Andrew D; Khalife, Wissam; Li, Song; Mahr, Claudius; Kim, Ju H; Bhimaraj, Arvind; Ton, Van-Khue; Vorovich, Esther; Burkhoff, Daniel; Kapur, Navin K.
Afiliação
  • Sinha SS; Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.
  • Pahuja M; University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA.
  • Kataria R; Brown University, Lifespan Cardiovascular Center, Providence, Rhode Island, USA.
  • Blumer V; Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio, USA.
  • Hernandez-Montfort J; Advanced Heart Disease Program, Baylor Scott & White Health, Temple, Texas, USA.
  • Kanwar M; Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
  • Garan AR; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
  • Zhang Y; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
  • Marbach JA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
  • Khalif A; Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
  • Vallabhajosyula S; Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
  • Nathan S; University of Chicago Medicine, Chicago, Illinois, USA.
  • Abraham J; Providence Heart Institute, Center for Cardiovascular Analytics, Research, and Data Science (CARDS), Providence St. Joseph Health, Portland, Oregon, USA.
  • Li B; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
  • Thayer KL; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
  • Baca P; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
  • Dieng F; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
  • Harwani NM; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
  • Yin MY; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
  • Faugno AJ; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
  • Faraz HA; Hackensack Meridian Health, Hackensack, New Jersey, USA.
  • Guglin M; Indiana University Health Advanced Heart and Lung Care, Indianapolis, Indiana, USA.
  • Hickey GW; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Wencker D; Advanced Heart Disease Program, Baylor Scott & White Health, Temple, Texas, USA.
  • Hall S; Baylor Scott & White Advanced Heart Failure Clinic, Dallas, Texas, USA.
  • Schwartzman AD; Maine Medical Center, Portland, Maine, USA.
  • Khalife W; University of Texas Medical Branch, Galveston, Texas, USA.
  • Li S; University of Washington Medical Center, Seattle, Washington, USA.
  • Mahr C; University of Washington Medical Center, Seattle, Washington, USA.
  • Kim JH; Houston Methodist Research Institute, Houston, Texas, USA.
  • Bhimaraj A; Houston Methodist Research Institute, Houston, Texas, USA.
  • Ton VK; Massachusetts General Hospital, Boston, MA, USA.
  • Vorovich E; Northwestern Medicine, Chicago, Illinois, USA.
  • Burkhoff D; Cardiovascular Research Foundation, New York, New York, USA.
  • Kapur NK; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
JACC Adv ; 2(3): 100314, 2023 May.
Article em En | MEDLINE | ID: mdl-38939594
ABSTRACT

Background:

Cardiogenic shock is a leading cause of mortality in patients with acute myocardial infarction.

Objectives:

The authors sought to compare clinical characteristics, hospital trajectory, and drug and device use between patients with ST-segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) and those without (non-ST-segment elevation myocardial infarction complicated by cardiogenic shock [NSTEMI-CS]).

Methods:

We analyzed data from 1,110 adult admissions with cardiogenic shock complicating acute myocardial infarction (AMI-CS) across 17 centers within Cardiogenic Shock Working Group. The primary end point was in-hospital mortality.

Results:

Our study included 1,110 patients with AMI-CS, of which 731 (65.8%) had STEMI-CS and 379 (34.2%) had NSTEMI-CS. Most patients were male (STEMI-CS 71.6%, NSTEMI-CS 66.5%) and White (STEMI-CS 53.8%, NSTEMI-CS 64.1%). In-hospital mortality was 41% and was similar among patients with STEMI-CS and NSTEMI-CS (43% vs 39%, P = 0.23). Patients with out-of-hospital cardiac arrest had higher in-hospital mortality in patients with NSTEMI-CS (63% vs 36%, P = 0.006) as compared to patients with STEMI-CS (52% vs 41%, P = 0.16). Similar results were observed for in-hospital cardiac arrest in patients with STEMI-CS (63% vs 33%, P < 0.001) and NSTEMI-CS (60% vs 32%, P < 0.001). Only 27% of patients with STEMI-CS and 12% of NSTEMI-CS received both a drug and temporary mechanical circulatory support device during the first 24 hours, which increased to 78% and 61%, respectively, throughout the course of the hospitalization (P < 0.001 for both).

Conclusions:

Despite increasing use of inotropic and vasoactive support and mechanical circulatory support throughout the hospitalization, both patients with STEMI-CS and NSTEMI-CS remain at increased risk for in-hospital mortality. Randomized controls trials are needed to elucidate whether timing and sequence of escalation of support improves outcomes in patients with AMI-CS.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: JACC Adv Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: JACC Adv Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Estados Unidos