Door to Unload: a New Paradigm for the Management of Cardiogenic Shock
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SECONDARY PREVENTION AND INTERVENTION (D. STEINBERG, SECTION EDITOR)
Door to Unload: a New Paradigm for the Management of Cardiogenic Shock Navin K. Kapur 1 & Michele L. Esposito 1
Published online: 24 October 2016 # Springer Science+Business Media New York 2016
Abstract Cardiogenic shock (CS) remains the most common cause of in-hospital mortality in the setting of acute myocardial infarction (AMI). Recent data have identified several concerning trends in the field of AMI-CS that include an overall increase in mortality, an increase in patient complexity, minimal use of acute mechanical circulatory support (AMCS) devices with the majority being implanted as a bailout option. In this review, we will discuss recent trends in CS and the rationale for the use of acute mechanical circulatory support pumps early in the clinical treatment of CS. Keywords Ventricular unloading . Acute mechanical circulatory support . Cardiogenic shock . Hemodynamics . Percutaneous ventricular assist device
patients with higher rates of concomitant diabetes mellitus, hypertension, prior coronary disease, obesity, peripheral vascular disease, and chronic renal failure. Despite increasing prevalence, in-hospital mortality for CS-STEMI decreased from 45 to 34 % in 2010 with the highest prevalence observed in patients over 75 years of age (55 %). In this analysis, early revascularization was performed in only 43 % of patients with an increase from 26 to 54 % between 2003 and 2010. Furthermore, left heart catheterization rates increased from 64 to 74 %, but right heart catheterization rates decreased from 10 to 6 % [2]. These data suggest that CS-STEMI is increasing in prevalence and is persistently associated with excessively high in-hospital mortality rates, especially among the elderly. The lower in-hospital mortality rate in 2010 may be partly due to more aggressive early revascularization, but indicates that new approaches are needed for patients with STEMI-CS.
Introduction Cardiogenic shock (CS) remains the most common cause of in-hospital mortality in the setting of acute myocardial infarction (AMI) [1]. An analysis of the Nationwide Inpatient Sample Database between 2003 and 2010 reported an increase in the prevalence of CS among patients presenting with STEMI (CS-STEMI) from 6 to 10 %. Among patients over the age of 75, CS-STEMI increased from 7 to 12 %. The authors report an increasingly complex profile of CS-STEMI This article is part of the Topical Collection on Secondary Prevention and Intervention * Navin K. Kapur [email protected]
1
The Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Box # 80, Boston, MA 02111, USA
Cardiogenic Shock: a Persistent Problem in Need of New Approaches A more contemporary and consistently sobering analysis of patients with AMI-CS undergoing PCI reported that despite an overall increase in the use of percutaneous coronary intervention (PCI) for AMI-CS, in-hospital mortality increased from 27 to 30 % and deaths occurring in the catheterization laboratory increased f
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