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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Acute myocardial infarction complicated by cardiogenic shock in Ukraine: multicentre registry analysis 2021-2022
Anton O Bilchenko1, Olga V Gritsenko2, Volodymir O Kolisnyk3
1Department of Prevention and Treatment of Emergency Conditions, L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine.
Insights
Cardiogenic shock following acute myocardial infarction (AMI-CS) has a high mortality rate in low-income countries. Developing nationwide protocols and specialized centers is crucial for improving patient outcomes and management strategies.
Area of Science:
- Cardiology
- Critical Care Medicine
- Public Health
Background:
- Limited data exists on acute myocardial infarction complicated by cardiogenic shock (AMI-CS) in low and lower-middle income countries (LLMICs).
- This knowledge gap impedes the development of effective treatment programs for cardiogenic shock in these regions.
- Understanding regional variations in AMI-CS management and outcomes is vital.
Purpose of the Study:
- To analyze outcomes, therapeutic strategies, and mortality predictors in AMI-CS patients within Ukraine.
- To provide insights into the current management of AMI-CS in a representative LLMIC setting.
- To identify factors contributing to mortality in AMI-CS patients.
Main Methods:
- Analysis of the Ukrainian Multicentre Cardiogenic Shock Registry (2021-2022).
- Inclusion of data from 221 consecutive AMI-CS patients across 6 major Ukrainian reperfusion centers.
- Focus on in-hospital mortality, causes of CS, reperfusion rates, and mechanical circulatory support (MCS) utilization.
Main Results:
- The in-hospital mortality rate for CS was 57.1%.
- ST-elevated myocardial infarction was the primary cause (85.1%).
- Independent predictors of mortality included left main stem occlusion, reperfusion deterioration, Charlson Comorbidity Index >4, and cardiac arrest.
Conclusions:
- Despite advancements in primary percutaneous coronary intervention, CS remains a critical issue in LLMICs with high mortality.
- There is a significant need for a nationwide protocol for CS management.
- Establishing reference CS centers integrated with reperfusion networks and modern MCS technologies is essential.
Background:
Data on the results and management strategies in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) in the Low and Lower-Middle Income Countries (LLMICs) are limited. This lack of understanding of the situation partially hinders the development of effective cardiogenic shock treatment programs in this part of the world.
Materials And Methods:
The Ukrainian Multicentre Cardiogenic Shock Registry was analyzed, covering patient data from 2021 to 2022 in 6 major Ukrainian reperfusion centres from different parts of the country. Analysis was focusing on outcomes, therapeutic modalities and mortality predictors in AMI-CS patients.
Results:
We analyzed data from 221 consecutive patients with CS from 6 hospitals across Ukraine. The causes of CS were ST-elevated myocardial infarction (85.1%), non-ST-elevated myocardial infarction (5.9%), decompensated chronic heart failure (7.7%) and arrhythmia (1.3%), with a total in-hospital mortality rate for CS of 57.1%. The prevalence of CS was 6.3% of all AMI with reperfusion rate of 90.5% for AMI-CS. In 23.5% of cases, CS developed in the hospital after admission. Mechanical circulatory support (MCS) utilization was 19.9% using intra-aortic balloon pump alone. Left main stem occlusion, reperfusion deterioration, Charlson Comorbidity Index >4, and cardiac arrest were found to be independent predictors for hospital mortality in AMI-СS.
Conclusions:
Despite the wide adoption of primary percutaneous coronary intervention as the main reperfusion strategy for AMI, СS remains a significant problem in LLMICs, associated with high in-hospital mortality. There is an unmet need for the development and implementation of a nationwide protocol for CS management and the creation of reference CS centers based on the country-wide reperfusion network, equipped with modern technologies for MCS.
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