Vetrovec George W
VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
Curr Cardiol Rep. 2017 Aug 31;19(10):100. doi: 10.1007/s11886-017-0905-3.
This article addresses evolving devices and uses of hemodynamic support in the management of high-risk PCI and AMI with cardiogenic shock.
Recent publications question the benefit of Intra-aortic Balloon Pump support for AMI Shock. Furthermore, in high-risk PCI, the Impella support system provides better late outcomes than does the intra-aortic balloon pump. We have entered a new era in which larger, higher flow devices that increase cardiac output while unloading the left ventricle provide better outcome. The current PCI population is higher risk, and often without surgical options. Hemodynamic support, most often utilizing Impella support, improves outcomes via providing the hemodynamic stability to allow complete revascularization and optimal lesion treatment. Regarding shock, preliminary data suggests that a concept of early left ventricular unloading before PCI maybe the critical factor for improving the outcome for acute myocardial infarction complicating myocardial infarction.
本文探讨了在高危经皮冠状动脉介入治疗（PCI）和急性心肌梗死（AMI）合并心源性休克的管理中，血流动力学支持设备的不断发展及其应用。
近期发表的文献对主动脉内球囊反搏（IABP）支持治疗AMI休克的益处提出质疑。此外，在高危PCI中，Impella支持系统比IABP能带来更好的远期疗效。我们已进入一个新时代，即更大、更高流量的设备在减轻左心室负荷的同时增加心输出量，能带来更好的治疗效果。当前接受PCI的人群风险更高，且往往没有外科治疗选择。血流动力学支持，多数情况下采用Impella支持，通过提供血流动力学稳定性以实现完全血运重建和优化病变治疗，从而改善治疗效果。对于休克，初步数据表明，PCI前早期左心室减负的理念可能是改善急性心肌梗死合并心源性休克患者预后的关键因素。
