Schäfer Andreas, Werner Nikos, Burkhoff Daniel, Sieweke Jan-Thorben, Zietzer Andreas, Masyuk Maryna, Junker Udesen Nanna Louise, Westenfeld Ralf, Møller Jacob Eifer
Cardiac Arrest Center & Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany.
Department of Cardiology, University Heart Center, Bonn, Germany.
Front Cardiovasc Med. 2020 May 14;7:74. doi: 10.3389/fcvm.2020.00074. eCollection 2020.
In-hospital mortality in acute myocardial infarction-related cardiogenic shock (AMI-CS) remains high. The only adequately powered randomized trial showed no benefit of routine use of the intra-aortic balloon pump in AMI-CS. We compared individually predicted mortality using CardShock- and IABP-Shock II-scores in AMI-CS patients treated with an Impella microaxial pump, who met the IABP-Shock II-trials inclusion/exclusion criteria, to observed mortality on circulatory support in order to determine whether standardized use of an Impella microaxial flow-pump in AMI-CS is associated with lower than predicted mortality rates and whether timing of implantation or selecting patients based on predicted risk is meaningful. We analyzed data from 166 consecutive Impella-treated AMI-CS patients meeting the inclusion/exclusion criteria of the IABP-Shock II-trial (age 64 ± 11 years). Thirty-nine percentage of 64 patients had been resuscitated before Impella implantation. Overall 30-day mortality was 42%. Mortality was higher in resuscitated patients (50 vs. 36%, = 0.0452) and when Impella was implanted post-PCI (Impella-pre-PCI: 28%, Impella-post-PCI: 51%, = 0.0039). While in both score systems there was no significant difference between predicted and observed overall 30-day mortality, predicted mortality was significantly higher than observed mortality on Impella support only for individuals with highest predicted risk based on CardShock score (predicted 77 vs. observed 51%, = 0.025). Our retrospective analysis suggests that the use of the Impella microaxial pump may be effective in selected cases of high risk patients with AMI-CS. Mortality is high in acute myocardial infarction-related cardiogenic shock despite rapid revascularization. Haemodynamic support with an intraortic balloon pump does not reduce mortality. In this retrospective registry including 166 consecutive IABP-Shock II-eligible cardiogenic shock patients in four dedicated shock centers, observed mortality on circulatory support with an Impella was significantly lower than predicted in patients with highest mortality risk. Implantation prior to PCI in acute myocardial infarction-related cardiogenic shock seemed to be associated with lower mortality than implantation post PCI.
急性心肌梗死相关的心源性休克（AMI-CS）患者的院内死亡率仍然很高。唯一一项样本量充足的随机试验表明，在AMI-CS患者中常规使用主动脉内球囊泵并无益处。我们比较了符合IABP-Shock II试验纳入/排除标准、接受Impella微轴泵治疗的AMI-CS患者使用CardShock评分和IABP-Shock II评分分别预测的死亡率与循环支持下观察到的死亡率，以确定在AMI-CS患者中标准化使用Impella微轴流泵是否与低于预测的死亡率相关，以及植入时机或根据预测风险选择患者是否有意义。我们分析了166例连续接受Impella治疗且符合IABP-Shock II试验纳入/排除标准的AMI-CS患者的数据（年龄64±11岁）。64例患者中有39%在植入Impella之前接受过心肺复苏。总体30天死亡率为42%。接受过心肺复苏的患者死亡率更高（50%对36%，P = 0.0452），且在PCI术后植入Impella时死亡率也更高（Impella术前PCI：28%，Impella术后PCI：51%，P = 0.0039）。虽然在两个评分系统中，预测的和观察到的总体30天死亡率之间均无显著差异，但仅对于基于CardShock评分预测风险最高的个体，Impella支持下预测的死亡率显著高于观察到的死亡率（预测77%对观察51%，P = 0.025）。我们的回顾性分析表明，在部分高风险的AMI-CS患者中使用Impella微轴泵可能有效。尽管进行了快速血运重建，但急性心肌梗死相关的心源性休克患者死亡率仍然很高。使用主动脉内球囊泵进行血流动力学支持并不能降低死亡率。在这个回顾性登记研究中，纳入了四个专门的休克中心166例连续符合IABP-Shock II标准的心源性休克患者，在接受Impella循环支持时，观察到的死亡率显著低于预测的最高死亡风险患者。在急性心肌梗死相关的心源性休克中，PCI术前植入Impella似乎比PCI术后植入与更低的死亡率相关。
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