Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Rev Cardiovasc Med. 2013;14(2-4):e144-9. doi: 10.3909/ricm0675.
Patients with high-risk coronary lesions may be denied coronary artery bypass grafting due to excessive comorbidities. Percutaneous coronary intervention (PCI) may be a feasible revascularization strategy in high-risk patients who present with ST-elevation myocardial infarction and cardiogenic shock. Historically, the use if intra-aortic balloon pump (IABP) has been used in high-risk PCI and cardiogenic shock. However, recent data has shown that elective IABP insertion did not reduce the incidence of major cardiovascular events following PCI. The use of a left ventricular assist device is a reasonable and safe alternative compared with IABP counterpulsation, giving greater cardiac output and hemodynamic support in patients undergoing high-risk PCI and in those with severe cardiogenic shock. This review outlines a case of severe cardiogenic shock and hemodynamic instability where high-risk PCI is a reasonable option.
高危冠状动脉病变的患者可能因合并症过多而被拒绝进行冠状动脉旁路移植术。对于伴有 ST 段抬高型心肌梗死和心源性休克的高危患者，经皮冠状动脉介入治疗（PCI）可能是一种可行的血运重建策略。在过去，主动脉内球囊反搏（IABP）曾被用于高危 PCI 和心源性休克患者。然而，最近的数据表明，选择性 IABP 插入并不能降低 PCI 后主要心血管事件的发生率。与 IABP 反搏相比，左心室辅助装置的使用是一种合理且安全的替代方法，它可为高危 PCI 患者和严重心源性休克患者提供更大的心输出量和血流动力学支持。本综述概述了一例严重心源性休克和血流动力学不稳定的病例，其中高危 PCI 是一种合理的选择。
