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Judith S Hochman - One of the best experts on this subject based on the ideXlab platform.
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rates of invasive management of Cardiogenic shock in new york before and after exclusion from public reporting
JAMA Cardiology, 2016Co-Authors: Sripal Bangalore, Jinfeng Xu, Saul Blecker, Navdeep Gupta, Frederick Feit, Judith S HochmanAbstract:Importance Reduced rates of cardiac catheterization, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) are an unintended consequence of public reporting of Cardiogenic shock outcomes in New York. Objectives To evaluate whether the referral rates for cardiac catheterization, PCI, or CABG have improved in New York since Cardiogenic shock was excluded from public reporting in 2008 and compare them with corresponding rates in Michigan, New Jersey, and California. Design, Setting, and Participants Patients with Cardiogenic shock complicating acute myocardial infarction from 2002 to 2011 were identified using the National Inpatient Sample. Propensity score matching was used to assemble a cohort of patients with Cardiogenic shock with similar baseline characteristics in New York and Michigan. Main Outcomes and Measures Percutaneous coronary intervention (primary outcome), invasive management (cardiac catheterization, PCI, or CABG), revascularization (PCI or CABG), and CABG were evaluated with reference to 3 calendar year periods: 2002-2005 (time 1: Cardiogenic shock included in publicly reported outcomes), 2006-2007 (time 2: Cardiogenic shock excluded on a trial basis), and 2008 and thereafter (time 3: Cardiogenic shock excluded permanently) in New York and compared with Michigan. Results Among 2126 propensity score–matched patients representing 10 795 (weighted) patients with myocardial infarction complicated by Cardiogenic shock in New York and Michigan, 905 (42.6%) were women and mean (SE) age was 69.5 (0.3) years. A significantly higher proportion of the patients underwent PCI (time 1 vs 2 vs 3: 31.1% vs 39.8% vs 40.7% [OR, 1.50; 95% CI, 1.12-2.01; P = .005 for time 3 vs 1]), invasive management (time 1 vs 2 vs 3: 59.7% vs 70.9% vs 73.8% [OR, 1.84; 95% CI, 1.37-2.47; P P P P P Conclusions and Relevance Although the rates of PCI, invasive management, and revascularization have increased substantially after the exclusion of Cardiogenic shock from public reporting in New York, these rates remain consistently lower than those observed in other states without public reporting.
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management of refractory Cardiogenic shock
Nature Reviews Cardiology, 2016Co-Authors: Alex Reyentovich, Maya H Barghash, Judith S HochmanAbstract:Cardiogenic shock is a life-threatening condition that occurs in response to reduced cardiac output in the presence of adequate intravascular volume and results in tissue hypoxia. Cardiogenic shock has several underlying aetiologies, with the most common being acute myocardial infarction (AMI). Refractory Cardiogenic shock presents as persistent tissue hypoperfusion despite administration of adequate doses of two vasoactive medications and treatment of the underlying aetiology. Investigators of the SHOCK trial reported a long-term mortality benefit of emergency revascularization for shock complicating AMI. Since the publication of the SHOCK trial and subsequent guideline recommendations, the increase in community-based use of percutaneous coronary intervention for this condition has resulted in a significant decline in mortality. Despite these successes in the past 15 years, mortality still remains exceptionally high, particularly in patients with refractory Cardiogenic shock. In this Review, we discuss the aetiology and pathophysiology of Cardiogenic shock and summarize the data on the available therapeutics and their limitations. Although new mechanical circulatory support devices have been shown to improve haemodynamic variables in patients with shock complicating AMI, they did not improve clinical outcomes and are associated with high costs and complications.
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Management of refractory Cardiogenic shock
Nature Reviews Cardiology, 2016Co-Authors: Alex Reyentovich, Maya H Barghash, Judith S HochmanAbstract:Cardiogenic shock is characterized by acute hypoperfusion and end-organ dysfunction owing to reduced cardiac output, and is commonly caused by acute myocardial infarction (AMI) with left ventricular dysfunction Emergent revascularization is the only therapy that has been shown to reduce mortality in patients with Cardiogenic shock complicating AMI Refractory Cardiogenic shock can be defined as ongoing evidence of tissue hypoperfusion despite administration of adequate doses of two vasoactive medications and treatment of the underlying aetiology Refractory Cardiogenic shock carries a poor prognosis, with an inhospital mortality of ∼50% despite pharmacological and mechanical circulatory support The use of mechanical circulatory support devices for Cardiogenic shock is increasing, but there is currently no evidence showing that they improve clinical outcomes Novel therapeutics and robust randomized trial data are needed to address the persistently high mortality in patients with refractory Cardiogenic shock Refractory Cardiogenic shock carries a poor prognosis, with an inhospital mortality of ∼50%. In this Review, Reyentovich and colleagues discuss the current therapeutic and management options available for patients with refractory Cardiogenic shock. Cardiogenic shock is a life-threatening condition that occurs in response to reduced cardiac output in the presence of adequate intravascular volume and results in tissue hypoxia. Cardiogenic shock has several underlying aetiologies, with the most common being acute myocardial infarction (AMI). Refractory Cardiogenic shock presents as persistent tissue hypoperfusion despite administration of adequate doses of two vasoactive medications and treatment of the underlying aetiology. Investigators of the SHOCK trial reported a long-term mortality benefit of emergency revascularization for shock complicating AMI. Since the publication of the SHOCK trial and subsequent guideline recommendations, the increase in community-based use of percutaneous coronary intervention for this condition has resulted in a significant decline in mortality. Despite these successes in the past 15 years, mortality still remains exceptionally high, particularly in patients with refractory Cardiogenic shock. In this Review, we discuss the aetiology and pathophysiology of Cardiogenic shock and summarize the data on the available therapeutics and their limitations. Although new mechanical circulatory support devices have been shown to improve haemodynamic variables in patients with shock complicating AMI, they did not improve clinical outcomes and are associated with high costs and complications.
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Thrombolysis in acute myocardial infarction complicated by Cardiogenic shock
Journal of Thrombosis and Thrombolysis, 1995Co-Authors: Glenn N. Levine, Judith S HochmanAbstract:The adverse impact of the development of Cardiogenic shock in the setting of acute myocardial infarction was first described by Killip and Kimball in 1967. While the inhospital mortality rate in patients with myocardial infarction and no evidence of heart failure was only 6%, the mortality rate in those patients who developed Cardiogenic shock was 81%. Despite advances in cardiovascular care and therapy since that initial report, including universal institution of cardiac care units, advances in hemodynamic monitoring, new inotropic and vasodilating agents, and even increasing utilization of thrornbolytic therapy, the mortality from acute myocardial infarction, when complicated by Cardiogenic shock, remains disturbingly high, and Cardiogenic shock remains the leading cause of death of hospitalized patients following acute myocardial infarction. The grave prognosis associated with this condition has resulted in increased interest in potential therapeutic interventions, particularly in the area of reperfusion therapy. Several studies suggest that, in contrast to the beneficial effects of thrombolytic therapy in most patient populations suffering acute myocardial infarction, mortality rates are not decreased in those patients with Cardiogenic shock at the time of lytic administration. Thrombolytic administration does, however, appear to lead to a modest reduction in the percent of patients with myocardial infarction who will subsequently develop Cardiogenic shock during hospitalization. Reperfusion rates with lytic therapy in patients with Cardiogenic shock are disappointingly low, in the range of 42–48%, significantly lower than those achieved in patients without Cardiogenic shock. These low perfusion rates may, in part, be explained by decreased coronary blood flow and perfusion pressure in patients with left ventricular pump failure. Although promising as adjunctive therapy, it is unclear whether institution of balloon counterpulsation has any long-term benefit in patients with Cardiogenic shock treated with thrombolytic therapy. Whether other or additional interventions, such as coronary angioplasty and coronary artery bypass graft (CABG), decrease mortality rates in patients with Cardiogenic shock remains to be determined.
Jorge L Yarzebski - One of the best experts on this subject based on the ideXlab platform.
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decade long trends 2001 2011 in the incidence and hospital death rates associated with the in hospital development of Cardiogenic shock after acute myocardial infarction
Circulation-cardiovascular Quality and Outcomes, 2016Co-Authors: Robert J Goldberg, Darleen M Lessard, Jorge L Yarzebski, Raghavendra Makam, David D Mcmanus, Joel M GoreAbstract:Background— Limited information is available about relatively contemporary trends in the incidence and hospital case-fatality rates of Cardiogenic shock in patients hospitalized with acute myocardial infarction. The purpose of this population-based study was to describe decade long trends (2001–2011) in the incidence and hospital case-fatality rates for patients who developed Cardiogenic shock during hospitalization for an acute myocardial infarction. Methods and Results— The study population consisted of 5686 residents of central Massachusetts hospitalized with acute myocardial infarction at all 11 medical centers in the Worcester, MA, metropolitan area during 6 biennial periods between 2001 and 2011, who did not have Cardiogenic shock at the time of hospital presentation. On average, 3.7% of these patients developed Cardiogenic shock during their acute hospitalization with nonsignificant and inconsistent trends noted over time in both crude (3.7% in 2001/2003; 4.5% in 2005/2007; 2.7% in 2009/2011; P =0.19) and multivariable adjusted analyses. The overall in-hospital case-fatality rate for patients who developed Cardiogenic shock was 41.4%. The crude and multivariable adjusted odds of dying after Cardiogenic shock declined during the most recent study years (47.1% dying in 2001/2003, 42.0% dying in 2005/2007, and 28.6% dying in 2009/2011). Increases in the use of evidence-based cardiac medications, and interventional procedures paralleled the increasing hospital survival trends. Conclusions— We found suggestions of a decline in the death, but not incidence, rates of Cardiogenic shock over time. These encouraging trends in hospital survival are likely because of advances in the early recognition and aggressive management of patients who develop Cardiogenic shock.
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thirty year trends 1975 to 2005 in the magnitude of management of and hospital death rates associated with Cardiogenic shock in patients with acute myocardial infarction a population based perspective
Circulation, 2009Co-Authors: Robert J Goldberg, Frederick A Spencer, Joel M Gore, Darleen M Lessard, Jorge L YarzebskiAbstract:BACKGROUND: Limited information is available about potentially changing and contemporary trends in the incidence and hospital death rates of Cardiogenic shock complicating acute myocardial infarction. The objectives of our study were to examine 3-decade-long trends (1975 to 2005) in the incidence rates of Cardiogenic shock complicating acute myocardial infarction, patient characteristics and treatment practices associated with this clinical complication, and hospital death rates in residents of a large central New England community hospitalized with acute myocardial infarction at all area medical centers. METHODS AND RESULTS: The study population consisted of 13 663 residents of the Worcester (Mass) metropolitan area hospitalized with acute myocardial infarction at all greater Worcester medical centers during 15 annual periods between 1975 and 2005. Overall, 6.6% of patients developed Cardiogenic shock during their index hospitalization. The incidence rates of Cardiogenic shock remained stable between 1975 and the late 1990s but declined in an inconsistent manner thereafter. Patients in whom Cardiogenic shock developed had a significantly greater risk of dying during hospitalization (65.4%) than those who did not develop Cardiogenic shock (10.6%) (P<0.001). Encouraging increases in hospital survival in patients with Cardiogenic shock, however, were observed from the mid-1990s to our most recent study years. Several patient demographic and clinical characteristics were associated with an increased risk for developing Cardiogenic shock. CONCLUSIONS: Our findings indicate improving trends in the hospital prognosis associated with Cardiogenic shock. Given the high death rates associated with this clinical complication, monitoring future trends in the incidence and death rates and the factors associated with an increased risk for developing Cardiogenic shock remains warranted.
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thirty year trends 1975 to 2005 in the magnitude of management of and hospital death rates associated with Cardiogenic shock in patients with acute myocardial infarction a population based perspective
Circulation, 2009Co-Authors: Robert J Goldberg, Frederick A Spencer, Joel M Gore, Darleen M Lessard, Jorge L YarzebskiAbstract:Background— Limited information is available about potentially changing and contemporary trends in the incidence and hospital death rates of Cardiogenic shock complicating acute myocardial infarction. The objectives of our study were to examine 3-decade-long trends (1975 to 2005) in the incidence rates of Cardiogenic shock complicating acute myocardial infarction, patient characteristics and treatment practices associated with this clinical complication, and hospital death rates in residents of a large central New England community hospitalized with acute myocardial infarction at all area medical centers. Methods and Results— The study population consisted of 13 663 residents of the Worcester (Mass) metropolitan area hospitalized with acute myocardial infarction at all greater Worcester medical centers during 15 annual periods between 1975 and 2005. Overall, 6.6% of patients developed Cardiogenic shock during their index hospitalization. The incidence rates of Cardiogenic shock remained stable between 197...
Robert J Goldberg - One of the best experts on this subject based on the ideXlab platform.
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decade long trends 2001 2011 in the incidence and hospital death rates associated with the in hospital development of Cardiogenic shock after acute myocardial infarction
Circulation-cardiovascular Quality and Outcomes, 2016Co-Authors: Robert J Goldberg, Darleen M Lessard, Jorge L Yarzebski, Raghavendra Makam, David D Mcmanus, Joel M GoreAbstract:Background— Limited information is available about relatively contemporary trends in the incidence and hospital case-fatality rates of Cardiogenic shock in patients hospitalized with acute myocardial infarction. The purpose of this population-based study was to describe decade long trends (2001–2011) in the incidence and hospital case-fatality rates for patients who developed Cardiogenic shock during hospitalization for an acute myocardial infarction. Methods and Results— The study population consisted of 5686 residents of central Massachusetts hospitalized with acute myocardial infarction at all 11 medical centers in the Worcester, MA, metropolitan area during 6 biennial periods between 2001 and 2011, who did not have Cardiogenic shock at the time of hospital presentation. On average, 3.7% of these patients developed Cardiogenic shock during their acute hospitalization with nonsignificant and inconsistent trends noted over time in both crude (3.7% in 2001/2003; 4.5% in 2005/2007; 2.7% in 2009/2011; P =0.19) and multivariable adjusted analyses. The overall in-hospital case-fatality rate for patients who developed Cardiogenic shock was 41.4%. The crude and multivariable adjusted odds of dying after Cardiogenic shock declined during the most recent study years (47.1% dying in 2001/2003, 42.0% dying in 2005/2007, and 28.6% dying in 2009/2011). Increases in the use of evidence-based cardiac medications, and interventional procedures paralleled the increasing hospital survival trends. Conclusions— We found suggestions of a decline in the death, but not incidence, rates of Cardiogenic shock over time. These encouraging trends in hospital survival are likely because of advances in the early recognition and aggressive management of patients who develop Cardiogenic shock.
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thirty year trends 1975 to 2005 in the magnitude of management of and hospital death rates associated with Cardiogenic shock in patients with acute myocardial infarction a population based perspective
Circulation, 2009Co-Authors: Robert J Goldberg, Frederick A Spencer, Joel M Gore, Darleen M Lessard, Jorge L YarzebskiAbstract:BACKGROUND: Limited information is available about potentially changing and contemporary trends in the incidence and hospital death rates of Cardiogenic shock complicating acute myocardial infarction. The objectives of our study were to examine 3-decade-long trends (1975 to 2005) in the incidence rates of Cardiogenic shock complicating acute myocardial infarction, patient characteristics and treatment practices associated with this clinical complication, and hospital death rates in residents of a large central New England community hospitalized with acute myocardial infarction at all area medical centers. METHODS AND RESULTS: The study population consisted of 13 663 residents of the Worcester (Mass) metropolitan area hospitalized with acute myocardial infarction at all greater Worcester medical centers during 15 annual periods between 1975 and 2005. Overall, 6.6% of patients developed Cardiogenic shock during their index hospitalization. The incidence rates of Cardiogenic shock remained stable between 1975 and the late 1990s but declined in an inconsistent manner thereafter. Patients in whom Cardiogenic shock developed had a significantly greater risk of dying during hospitalization (65.4%) than those who did not develop Cardiogenic shock (10.6%) (P<0.001). Encouraging increases in hospital survival in patients with Cardiogenic shock, however, were observed from the mid-1990s to our most recent study years. Several patient demographic and clinical characteristics were associated with an increased risk for developing Cardiogenic shock. CONCLUSIONS: Our findings indicate improving trends in the hospital prognosis associated with Cardiogenic shock. Given the high death rates associated with this clinical complication, monitoring future trends in the incidence and death rates and the factors associated with an increased risk for developing Cardiogenic shock remains warranted.
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thirty year trends 1975 to 2005 in the magnitude of management of and hospital death rates associated with Cardiogenic shock in patients with acute myocardial infarction a population based perspective
Circulation, 2009Co-Authors: Robert J Goldberg, Frederick A Spencer, Joel M Gore, Darleen M Lessard, Jorge L YarzebskiAbstract:Background— Limited information is available about potentially changing and contemporary trends in the incidence and hospital death rates of Cardiogenic shock complicating acute myocardial infarction. The objectives of our study were to examine 3-decade-long trends (1975 to 2005) in the incidence rates of Cardiogenic shock complicating acute myocardial infarction, patient characteristics and treatment practices associated with this clinical complication, and hospital death rates in residents of a large central New England community hospitalized with acute myocardial infarction at all area medical centers. Methods and Results— The study population consisted of 13 663 residents of the Worcester (Mass) metropolitan area hospitalized with acute myocardial infarction at all greater Worcester medical centers during 15 annual periods between 1975 and 2005. Overall, 6.6% of patients developed Cardiogenic shock during their index hospitalization. The incidence rates of Cardiogenic shock remained stable between 197...
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the use of intra aortic balloon counterpulsation in patients with Cardiogenic shock complicating acute myocardial infarction data from the national registry of myocardial infarction 2
American Heart Journal, 2001Co-Authors: Hal V Barron, Robert J Goldberg, Joel M Gore, Nathan R Every, Lori Parsons, Brad G Angeja, Tony M ChouAbstract:Abstract Background Cardiogenic shock complicating acute myocardial infarction (AMI) remains the leading cause of death in patients hospitalized with AMI. Although several studies have demonstrated the importance of establishing and maintaining a patent infarct-related artery, it remains unclear as to whether intra-aortic balloon counterpulsation (IABP) provides incremental benefit to reperfusion therapy. The purpose of this study was to determine whether IABP use is associated with lower in-hospital mortality rates in patients with AMI complicated by Cardiogenic shock in a large AMI registry. Methods We evaluated patients participating in the National Registry of Myocardial Infarction 2 who had Cardiogenic shock at initial examination or in whom Cardiogenic shock developed during hospitalization (n = 23,180). Results The mean age of patients in the study was 72 years, 54% were men, and the majority were white. The overall mortality rate in all patients who had Cardiogenic shock or in whom Cardiogenic shock developed was 70%. IABP was used in 7268 (31%) patients. IABP use was associated with a significant reduction in mortality rates in patients who received thrombolytic therapy (67% vs 49%) but was not associated with any benefit in patients treated with primary angioplasty (45% vs 47%). In a multivariate model, the use of IABP in conjunction with thrombolytic therapy decreased the odds of death by 18% (odds ratio, 0.82; 95% confidence interval, 0.72 to 0.93). Conclusions Patients with AMI complicated by Cardiogenic shock may have substantial benefit from IABP when used in combination with thrombolytic therapy. (Am Heart J 2001;141:933-9.)
Joel M Gore - One of the best experts on this subject based on the ideXlab platform.
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decade long trends 2001 2011 in the incidence and hospital death rates associated with the in hospital development of Cardiogenic shock after acute myocardial infarction
Circulation-cardiovascular Quality and Outcomes, 2016Co-Authors: Robert J Goldberg, Darleen M Lessard, Jorge L Yarzebski, Raghavendra Makam, David D Mcmanus, Joel M GoreAbstract:Background— Limited information is available about relatively contemporary trends in the incidence and hospital case-fatality rates of Cardiogenic shock in patients hospitalized with acute myocardial infarction. The purpose of this population-based study was to describe decade long trends (2001–2011) in the incidence and hospital case-fatality rates for patients who developed Cardiogenic shock during hospitalization for an acute myocardial infarction. Methods and Results— The study population consisted of 5686 residents of central Massachusetts hospitalized with acute myocardial infarction at all 11 medical centers in the Worcester, MA, metropolitan area during 6 biennial periods between 2001 and 2011, who did not have Cardiogenic shock at the time of hospital presentation. On average, 3.7% of these patients developed Cardiogenic shock during their acute hospitalization with nonsignificant and inconsistent trends noted over time in both crude (3.7% in 2001/2003; 4.5% in 2005/2007; 2.7% in 2009/2011; P =0.19) and multivariable adjusted analyses. The overall in-hospital case-fatality rate for patients who developed Cardiogenic shock was 41.4%. The crude and multivariable adjusted odds of dying after Cardiogenic shock declined during the most recent study years (47.1% dying in 2001/2003, 42.0% dying in 2005/2007, and 28.6% dying in 2009/2011). Increases in the use of evidence-based cardiac medications, and interventional procedures paralleled the increasing hospital survival trends. Conclusions— We found suggestions of a decline in the death, but not incidence, rates of Cardiogenic shock over time. These encouraging trends in hospital survival are likely because of advances in the early recognition and aggressive management of patients who develop Cardiogenic shock.
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thirty year trends 1975 to 2005 in the magnitude of management of and hospital death rates associated with Cardiogenic shock in patients with acute myocardial infarction a population based perspective
Circulation, 2009Co-Authors: Robert J Goldberg, Frederick A Spencer, Joel M Gore, Darleen M Lessard, Jorge L YarzebskiAbstract:BACKGROUND: Limited information is available about potentially changing and contemporary trends in the incidence and hospital death rates of Cardiogenic shock complicating acute myocardial infarction. The objectives of our study were to examine 3-decade-long trends (1975 to 2005) in the incidence rates of Cardiogenic shock complicating acute myocardial infarction, patient characteristics and treatment practices associated with this clinical complication, and hospital death rates in residents of a large central New England community hospitalized with acute myocardial infarction at all area medical centers. METHODS AND RESULTS: The study population consisted of 13 663 residents of the Worcester (Mass) metropolitan area hospitalized with acute myocardial infarction at all greater Worcester medical centers during 15 annual periods between 1975 and 2005. Overall, 6.6% of patients developed Cardiogenic shock during their index hospitalization. The incidence rates of Cardiogenic shock remained stable between 1975 and the late 1990s but declined in an inconsistent manner thereafter. Patients in whom Cardiogenic shock developed had a significantly greater risk of dying during hospitalization (65.4%) than those who did not develop Cardiogenic shock (10.6%) (P<0.001). Encouraging increases in hospital survival in patients with Cardiogenic shock, however, were observed from the mid-1990s to our most recent study years. Several patient demographic and clinical characteristics were associated with an increased risk for developing Cardiogenic shock. CONCLUSIONS: Our findings indicate improving trends in the hospital prognosis associated with Cardiogenic shock. Given the high death rates associated with this clinical complication, monitoring future trends in the incidence and death rates and the factors associated with an increased risk for developing Cardiogenic shock remains warranted.
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thirty year trends 1975 to 2005 in the magnitude of management of and hospital death rates associated with Cardiogenic shock in patients with acute myocardial infarction a population based perspective
Circulation, 2009Co-Authors: Robert J Goldberg, Frederick A Spencer, Joel M Gore, Darleen M Lessard, Jorge L YarzebskiAbstract:Background— Limited information is available about potentially changing and contemporary trends in the incidence and hospital death rates of Cardiogenic shock complicating acute myocardial infarction. The objectives of our study were to examine 3-decade-long trends (1975 to 2005) in the incidence rates of Cardiogenic shock complicating acute myocardial infarction, patient characteristics and treatment practices associated with this clinical complication, and hospital death rates in residents of a large central New England community hospitalized with acute myocardial infarction at all area medical centers. Methods and Results— The study population consisted of 13 663 residents of the Worcester (Mass) metropolitan area hospitalized with acute myocardial infarction at all greater Worcester medical centers during 15 annual periods between 1975 and 2005. Overall, 6.6% of patients developed Cardiogenic shock during their index hospitalization. The incidence rates of Cardiogenic shock remained stable between 197...
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the use of intra aortic balloon counterpulsation in patients with Cardiogenic shock complicating acute myocardial infarction data from the national registry of myocardial infarction 2
American Heart Journal, 2001Co-Authors: Hal V Barron, Robert J Goldberg, Joel M Gore, Nathan R Every, Lori Parsons, Brad G Angeja, Tony M ChouAbstract:Abstract Background Cardiogenic shock complicating acute myocardial infarction (AMI) remains the leading cause of death in patients hospitalized with AMI. Although several studies have demonstrated the importance of establishing and maintaining a patent infarct-related artery, it remains unclear as to whether intra-aortic balloon counterpulsation (IABP) provides incremental benefit to reperfusion therapy. The purpose of this study was to determine whether IABP use is associated with lower in-hospital mortality rates in patients with AMI complicated by Cardiogenic shock in a large AMI registry. Methods We evaluated patients participating in the National Registry of Myocardial Infarction 2 who had Cardiogenic shock at initial examination or in whom Cardiogenic shock developed during hospitalization (n = 23,180). Results The mean age of patients in the study was 72 years, 54% were men, and the majority were white. The overall mortality rate in all patients who had Cardiogenic shock or in whom Cardiogenic shock developed was 70%. IABP was used in 7268 (31%) patients. IABP use was associated with a significant reduction in mortality rates in patients who received thrombolytic therapy (67% vs 49%) but was not associated with any benefit in patients treated with primary angioplasty (45% vs 47%). In a multivariate model, the use of IABP in conjunction with thrombolytic therapy decreased the odds of death by 18% (odds ratio, 0.82; 95% confidence interval, 0.72 to 0.93). Conclusions Patients with AMI complicated by Cardiogenic shock may have substantial benefit from IABP when used in combination with thrombolytic therapy. (Am Heart J 2001;141:933-9.)
Graham Nichol - One of the best experts on this subject based on the ideXlab platform.
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systematic review of percutaneous cardiopulmonary bypass for cardiac arrest or Cardiogenic shock states
Resuscitation, 2006Co-Authors: Graham Nichol, Riyad Karmyjones, Chris Salerno, Lisa Cantore, Lance B BeckerAbstract:Summary Background Cardiogenic shock and cardiac arrest are common, lethal, debilitating and costly. Percutaneous cardiopulmonary bypass is an innovative strategy for treating these disorders that consists of rapid initiation of cardiopulmonary bypass and extracorporeal maintenance of circulation until restoration of an effective cardiac output. Multiple case reports suggest that percutaneous bypass is efficacious in patients with these disorders but these experiences have not been collated. Therefore, we have reviewed systematically the published experience with percutaneous bypass in patients with Cardiogenic shock or cardiac arrest. Objectives The objectives were to describe the proportion of patients with Cardiogenic shock or cardiac arrest who achieved restoration of spontaneous circulation or survival to discharge with percutaneous bypass. A secondary objective was to describe adverse effects associated with percutaneous bypass, if feasible. Design Articles were identified by using a comprehensive search of English-language MEDLINE from 1966 to September 2005. Patients Individuals in Cardiogenic shock or cardiac arrest. Interventions Percutaneous cardiopulmonary bypass. Analysis Effects were summarized as inverse-variance weighted means, standard errors, median and interquartile range. Results Included were 85 studies of 1494 patients with Cardiogenic shock, cardiac arrest or both. Studies were case reports, case-series or case-control studies of heterogeneous interventions in heterogeneous patients. The proportion of patients weaned was mean, 76.8±4.2%, and median, 66.0% (IQR 50%, 100%). The proportion of patients who survived to discharge was mean, 47.4±4.5%, and median 40.0% (IQR 20%, 75%). Fifty-two studies included 533 patients in Cardiogenic shock. The proportion of patients who survived to discharge was mean, 51.6±6.5%, and median 38.5% (IQR 23.4%, 76.3%). Fifty-four studies included 675 patients in cardiac arrest. The proportion of patients who survived to discharge was mean, 44.9±6.7%, and median, 42.3% (IQR 15.4%, 75%). Five studies with 286 subjects had both patients with Cardiogenic shock or cardiac arrest. Conclusions Percutaneous bypass is an efficacious intervention in patients with cardiac arrest or Cardiogenic shock. Adequately-powered experimental studies of current percutaneous bypass technologies are required to demonstrate whether it is safe, effective and cost-effective.