Percutaneous Left-Ventricular Support With the Impella-2.5–Assist Device in Acute Cardiogenic Shock

Circulation: Heart Failure - Tập 6 Số 1 - Trang 23-30 - 2013
Alexander Lauten1, Annemarie E. Engström1, Christian Jung1, Klaus Empen1, Paul Erné1, Stéphane Cook1, Stephan Windecker1, Martin Bergmann1, Roland Klingenberg1, Thomas F. Lüscher1, Michael Haude1, Dierk Rulands1, Christian Butter1, Bengt Ullman1, Laila Hellgren2,1, Maria Grazia Modena3,1, Giovanni Pedrazzini1, José P.S. Henriques1, Hans R. Figulla1, Markus Ferrari1
1From the Department of Internal Medicine I (Cardiology, Angiology, Pneumology), Friedrich-Schiller University, Erlanger Allee, Jena, Germany (A.L., C.J., H.R.F., M.F.); Department of Cardiology, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands (A.E.E., J.P.S.H.); Department of Cardiology, Ernst-Moritz-Arndt University, Greifswald, Germany (K.E.); Division of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (P.E.); Swiss Cardiovascular Center, Bern, Switzerland (S.C....
2Akademiska Sjukhuset, Uppsala, Sweden
3Azienda Ospedaliero - Universitaria di Modena Policlinico, Modena, Italy

Tóm tắt

Background— Acute cardiogenic shock after myocardial infarction is associated with high in-hospital mortality attributable to persisting low-cardiac output. The Impella–EUROSHOCK-registry evaluates the safety and efficacy of the Impella-2.5–percutaneous left-ventricular assist device in patients with cardiogenic shock after acute myocardial infarction. Methods and Results— This multicenter registry retrospectively included 120 patients (63.6±12.2 years; 81.7% male) with cardiogenic shock from acute myocardial infarction receiving temporary circulatory support with the Impella-2.5–percutaneous left-ventricular assist device. The primary end point evaluated mortality at 30 days. The secondary end point analyzed the change of plasma lactate after the institution of hemodynamic support, and the rate of early major adverse cardiac and cerebrovascular events as well as long-term survival. Thirty-day mortality was 64.2% in the study population. After Impella-2.5–percutaneous left-ventricular assist device implantation, lactate levels decreased from 5.8±5.0 mmol/L to 4.7±5.4 mmol/L ( P =0.28) and 2.5±2.6 mmol/L ( P =0.023) at 24 and 48 hours, respectively. Early major adverse cardiac and cerebrovascular events were reported in 18 (15%) patients. Major bleeding at the vascular access site, hemolysis, and pericardial tamponade occurred in 34 (28.6%), 9 (7.5%), and 2 (1.7%) patients, respectively. The parameters of age >65 and lactate level >3.8 mmol/L at admission were identified as predictors of 30-day mortality. After 317±526 days of follow-up, survival was 28.3%. Conclusions— In patients with acute cardiogenic shock from acute myocardial infarction, Impella 2.5–treatment is feasible and results in a reduction of lactate levels, suggesting improved organ perfusion. However, 30-day mortality remains high in these patients. This likely reflects the last-resort character of Impella-2.5–application in selected patients with a poor hemodynamic profile and a greater imminent risk of death. Carefully conducted randomized controlled trials are necessary to evaluate the efficacy of Impella-2.5–support in this high-risk patient group.

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Tài liệu tham khảo

10.1056/NEJM199904153401504

10.1001/jama.294.4.448

10.1016/S0735-1097(00)00874-3

10.1161/01.CIR.100.20.2067

10.1161/circulationaha.108.814947

10.1093/eurheartj/ehi161

10.1093/eurheartj/ehp030

10.1093/eurheartj/ehn416

Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; Canadian Cardiovascular Society. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation. 2004;110:e82–292.

10.1093/eurheartj/ehn602

10.1067/mhj.2001.115295

10.1097/CCM.0b013e3181b78671

10.1007/s11239-005-0938-0

10.1016/j.jacc.2009.09.018

10.1016/j.amjcard.2005.10.037

10.1016/j.jcin.2008.11.005

10.1016/j.jacc.2007.10.050

10.1016/j.jacc.2008.05.065

10.1056/NEJM199908263410901

Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K, Kastrati A, Rosengren A, Steg PG, Tubaro M, Verheugt F, Weidinger F, Weis M. ESC guidelines on management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. Rev Esp Cardiol. 2009;62:293, e291–247.

10.1161/circulationaha.107.188209

10.1016/0735-1097(95)00215-P

10.1016/j.jacc.2004.07.002

10.1016/j.ehj.2003.12.008

Zeymer U, Zahn R, Gitt R, Weidinger F, Hochadel M, Marco J. Use and impact of intra aortic balloon pump on outcome of patients with PCI for myocardial infarction complicated by cardiogenic shock. Results of the Euro Heart PCI survey. Eur Heart J. 2009;30:893.

10.1093/eurheartj/ehq220

10.1038/ncpcardio1060

10.1056/NEJMoa012175

10.1016/j.athoracsur.2004.02.030

10.1016/j.ejcts.2004.03.003

10.1002/ccd.22263

10.1016/j.resuscitation.2009.05.012

10.1055/s-2003-45422

10.1016/j.ahj.2006.05.031

10.1016/j.jacc.2010.08.613

10.1097/CCM.0b013e31821e89b5

10.1161/hc4901.100361

10.1093/eurheartj/ehp292

10.1093/eurheartj/ehm191

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Circulation: Heart Failure

Tập 6 Số 1

23-30

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