Precardiogenic Shock: A New Clinical Entity
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.
Conclusion: In Mexico, only 5 out of 10 patients with STEMI have access to reperfusion therapy. Pharmacoinvasive strategy is takes advantage of the accessibility of fibrinolysis and the effectiveness of PCI. The present research protocol aims to provide information that serves as a link between information derived from controlled clinical trials and records derived from real world experience. PMID: 32459215 [PubMed - as supplied by publisher]
This study sought to investigate the impact of elective, uncomplicated target lesion revascularization (TLR) on long-term cardiac mortality after percutaneous coronary intervention (PCI) of unprotected left main coronary artery (ULMCA) disease. Consecutive patients undergoing PCI for ULMCA disease between January 2003 and December 2015 in one interventional center in Northern Italy were include. Patients presenting with cardiogenic shock, ST-segment elevation myocardial infarction (MI), as well as those undergoing urgent or complicated TLR were excluded.
CONCLUSIONS: Among inoperable patients with severe MR and cardiogenic shock, percutaneous leaflet repair with MitraClip is associated with acceptable short-term effectiveness. PMID: 32385191 [PubMed - as supplied by publisher]
Conclusion: The use of V-A ECMO among patients with AMI-induced cardiogenic shock may provide survival benefits. However, V-A ECMO treatment effects are inconclusive because of limitations in cohort design and reporting. PMID: 32382560 [PubMed - in process]
Publication date: Available online 3 May 2020Source: American Heart JournalAuthor(s): Nathaniel R. Smilowitz, Aubrey C. Galloway, E. Magnus Ohman, Sunil V. Rao, Sripal Bangalore, Stuart D. Katz, Judith S. Hochman
ConclusionThis article presents key clinical trials completed during 2019 and should be valuable to clinicians and researchers working in cardiology.
Publication date: Available online 30 April 2020Source: American Heart JournalAuthor(s): Paul Guedeney, Holger Thiele, Mathieu Kerneis, Olivier Barthélémy, Stefan Baumann, Marcus Sandri, Suzanne de Waha-Thiele, Georg Fuernau, Stéphanie Rouanet, Jan J. Piek, Ulf Landmesser, Marie Hauguel-Moreau, Michel Zeitouni, Johanne Silvain, Benoit Lattuca, Stephan Windecker, Jean-Philippe Collet, Steffen Desch, Uwe Zeymer, Gilles Montalescot
r Harst P, Juarez-Orozco LE Abstract BACKGROUND: Obstructive sleep apnea (OSA) conveys worse clinical outcomes in coronary artery disease patients. The STOP-BANG score is a simple tool that evaluates the risk of OSA and can be added to the large number of clinical variables and scores obtained during the management of myocardial infarction (MI) patients. Currently, machine learning (ML) is able to select and integrate numerous variables to optimize prediction tasks. RESEARCH QUESTION: Can the integration of STOP-BANG score with clinical data and scores through ML better identify patients who suffered an in-ho...
Abstract Diffuse alveolar hemorrhage after percutaneous coronary intervention is a rare but fatal complication. Although timely application of extracorporeal membrane oxygenator and discontinuation of antiplatelet/anticoagulation is the treatment of choice, bleeding is often irreversible. Herein, we introduce a patient with refractory diffuse alveolar hemorrhage after prolonged extracorporeal membrane oxygenator and percutaneous coronary intervention, who was eventually rescued with heart-lung transplantation. PMID: 32308141 [PubMed - as supplied by publisher]
Abstract Cardiogenic shock is a complex clinical entity associated with very high mortality and intensive resource utilization. Despite the widespread use of timely reperfusion and appropriate pharmacotherapy, the survival rate remains at around 50%. Recently, percutaneous axial flow pumps have been integrated into the therapeutic spectrum of cardiogenic shock management. However, most of the literature supporting their use stems from observational studies. To date, attempts to perform randomized controlled trials with percutaneous axial flow pumps have failed. This underlines the challenge of performing a well-co...