Journal
EUROPEAN HEART JOURNAL
Volume 26, Issue 13, Pages 1276-1283Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehi161
Keywords
shock; heart-assist device; extracorporeat circulation; myocardial infarction
Categories
Ask authors/readers for more resources
Aims Mortality in cardiogenic shock (CS) following acute myocardial infarction (AMI) remains unacceptably high despite percutaneous coronary intervention (PCI) of the infarcted artery and use of intra-aortic balloon pump (IABP) counterpulsation. A newly developed percutaneous left ventricular assist device (VAD) (Tandem Heart (TM), Cardiac Assist, Pittsburgh, PA, USA) with active circulatory support might have positive haemodynamic effects and decrease mortality. Methods and results Patients in CS after AMI, with intended PCI of the infarcted artery, were randomized to either IABP (n = 20) or percutaneous VAD support (n 21). The primary outcome measure cardiac power index, as welt as other haemodynamic and metabolic variables,, could be improved more effectively by VAD support from 0.22 [interquartite range (IQR) 0.19-0.30] to 0.37W/m(2) (IQR 0.30-0.47, P < 0.001) when compared with IABP from 0.22 (IQR 0.18-0.30) to 0.28 W/m(2) (IQR 0.24-0.36, P = 0.02; P = 0.004 for intergroup comparison). However, complications like severe bleeding (n = 19 vs. n = 8, P = 0.002) or limb ischaemia (n = 7 vs. n = 0, P = 0.009) were encountered more frequently after VAD support, whereas 30 day mortality was similar (IABP 45% vs. VAD 43%, log-rank, P = 0.86). Conclusion Haemodynamic and metabolic parameters can be reversed more effectively by VAD than by standard treatment with IABP. However, more complications were encountered by the highly invasive procedure and by the extracorporeal support.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available