叶轮
心源性休克
医学
心肌梗塞
心脏病学
内科学
经皮
卫生棉条
心室辅助装置
临床终点
心脏压塞
血流动力学
心力衰竭
随机对照试验
作者
Alexander Lauten,Annemarie E. Engström,Christian Jung,Klaus Empen,Paul Erné,Stéphane Cook,Stephan Windecker,Martin Bergmann,Roland Klingenberg,Thomas F. Lüscher,Michael Haude,Dierk Rulands,Christian Butter,Bengt Ullman,Laila Hellgren,Maria Grazia Modena,Giovanni Pedrazzini,José P.S. Henriques,Hans R. Figulla,Markus Ferrari
出处
期刊:Circulation-heart Failure
[Ovid Technologies (Wolters Kluwer)]
日期:2013-01-01
卷期号:6 (1): 23-30
被引量:278
标识
DOI:10.1161/circheartfailure.112.967224
摘要
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.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%.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.
科研通智能强力驱动
Strongly Powered by AbleSci AI