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[Coronary stenting in acute myocardial infarction complicated with cardiogenic shock]
Insights
Urgent coronary stenting combined with intra-aortic balloon pumping (IABP) effectively treated cardiogenic shock, achieving 83% in-hospital survival. This approach demonstrated significant success in managing acute myocardial infarction complicated by shock.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Acute Myocardial Infarction Management
Context:
- Cardiogenic shock, a severe complication of myocardial infarction, has high mortality rates.
- Intra-aortic balloon pumping (IABP) is a supportive measure for hemodynamic instability.
- Urgent percutaneous coronary intervention (PCI) is increasingly utilized in acute coronary syndromes.
Purpose:
- To evaluate the efficacy and outcomes of urgent coronary stenting in patients experiencing cardiogenic shock.
- To assess both immediate procedural success and long-term clinical results.
- To determine the impact of stenting combined with IABP on survival and revascularization rates.
Summary:
- Twenty-three patients with myocardial infarction and cardiogenic shock underwent urgent coronary stenting with IABP support.
- Successful stent implantation was achieved in all cases, with improved TIMI flow post-procedure.
- In-hospital survival was 83%, with 61% freedom from repeat revascularization at four months.
Impact:
- Urgent stenting with IABP offers a viable and effective treatment strategy for cardiogenic shock.
- This intervention significantly improves survival rates in a high-risk patient population.
- The procedure demonstrates a favorable balance between efficacy and the need for subsequent revascularization.
Aim:
To assess immediate and long-term results of urgent coronary stenting in patients with cardiogenic shock.
Material And Methods:
Twenty three patients (15 men, 8 women mean age 58-/+12 years) with myocardial infarction and cardiogenic shock treated with vasopressors and intraaortic balloon pumping (IABP). Culprit lesions were localized in left anterior descending and right coronary arteries in 16 and 7 cases, respectively. Prior to stenting 18 and 5 patients had TIMI grade 0 and 1 flow, respectively.
Results:
Stents (n=26, Seaquence and Ephesos, length 12-28 mm, diameter 2-3.5 mm) were successfully implanted in all patients after balloon predilation. After stenting TIMI grade 3 flow was achieved in 15 patients, 8 patients had TIMI-2 flow without angiographic signs of dissection or residual stenosis. There were 4 inhospital deaths and 19 patients (83%) were discharged. One angioplasty and 2 coronary artery bypass grafting procedures because of restenosis and reocclusion were successfully performed during first 4 months of follow-up.
Conclusion:
Urgent stenting combined with IABP was effective method of treatment of cardiogenic shock with 83% inhospital survival and 61% freedom from repeat revascularization.