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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Risk factors for immediate and delayed cardiogenic shock in patients with ventricular septal rupture after myocardial
Si Wang1, Jing Zhang1, Qian-Feng Xiao1
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Insights
Ventricular septal rupture after myocardial infarction can lead to immediate or delayed cardiogenic shock. Smaller left ventricular size predicts immediate shock, while elevated heart rate and creatine kinase-MB predict delayed shock.
Area of Science:
- Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- Ventricular septal rupture (VSR) is a severe complication post-myocardial infarction (MI).
- Cardiogenic shock (CS) frequently complicates VSR, significantly impacting patient prognosis.
- Risk factors for immediate versus delayed CS following VSR remain understudied.
Purpose of the Study:
- To identify independent risk factors for immediate and delayed cardiogenic shock in patients with VSR post-MI.
- To understand the temporal patterns of CS development after VSR.
- To inform early risk stratification and treatment optimization.
Main Methods:
- Retrospective study of 88 patients with VSR post-MI admitted between 2009 and 2023.
- Data collection included demographics, medical history, ECG, echocardiography, and hematology.
- CS defined by hypotension and/or catecholamine requirement, with onset time based on catecholamine initiation.
Main Results:
- Immediate CS (n=32) was associated with smaller left ventricular end-diastolic diameter and VSR discovered post-admission.
- Delayed CS (n=28) in patients without immediate CS was linked to elevated heart rate and higher admission creatine kinase-MB levels.
- The study identified distinct risk factors for immediate and delayed CS onset.
Conclusions:
- CS in VSR post-MI exhibits a clear temporal progression.
- Early identification of patients at risk for immediate or delayed CS is crucial.
- Optimizing treatment strategies based on CS timing may improve outcomes for VSR patients.
Background:
Ventricular septal rupture (VSR) is a serious complication occurring after myocardial infarction (MI). Cardiogenic shock (CS) is a common complication of VSR and an important factor affecting its prognosis. CS can occur in either an immediate or delayed manner after VSR; however, studies on the risk factors associated with immediate or delayed CS are scarce.
Methods:
We retrospectively studied patients diagnosed with VSR after MI and admitted to the West China Hospital between September 2009 and August 2023. Demographic data, medical history, physical examination results, electrocardiograms, and echocardiographic and hematological data were extracted from electronic medical records or archived records. CS was defined as hypotension (<90 mmHg) and/or the requirement for catecholamines, pulmonary congestion, and signs of end-organ failure. The CS onset time was defined as the time at which catecholamines were initiated.
Results:
A total of 88 patients with VSR after MI, including 49 males (55.7%), were enrolled. The average age was 70.2 years. Of these patients, 32 (36.4%) who already had CS at the time of VSR discovery were defined as immediate CS, and 28 (31.8%) who developed CS within 2 weeks after VSR discovery were defined as delayed CS. A smaller left ventricular end-diastolic diameter (LVEDD) and VSR discovered after admission were independent risk factors for immediate CS. Elevated heart rate and higher levels of creatine kinase-MB isoenzyme on admission were independent risk factors for delayed CS in patients without immediate CS after VSR.
Conclusions:
The occurrence of CS in patients with VSR after MI has an evident time course. Thus, an early identification of patients at risk of immediate or delayed CS and optimization of treatment procedures may help improve the prognosis.
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