Right Ventricular Dysfunction in Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Hemodynamic Analysis of the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) Trial and Registry
| Autor: | Stuart D. Katz, Judith S. Hochman, Daniel Burkhoff, Richard H. Karas, Anuradha Lala, Navin K. Kapur, Michele Esposito, Yu Guo, Kevin J. Morine, Jinfeng Xu |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Ventricular Dysfunction Right Decision Making Myocardial Infarction Shock Cardiogenic Hemodynamics 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine.artery Myocardial Revascularization medicine Humans Prospective Studies Registries cardiovascular diseases 030212 general & internal medicine Myocardial infarction Pulmonary wedge pressure Aged business.industry Cardiogenic shock Central venous pressure Prognosis medicine.disease Coronary Vessels Heart failure Shock (circulatory) Pulmonary artery Cardiology Female Emergencies medicine.symptom Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Journal of Cardiac Failure. 24:148-156 |
| ISSN: | 1071-9164 |
| DOI: | 10.1016/j.cardfail.2017.10.009 |
| Popis: | The prevalence and significance of right ventricular dysfunction (RVD) in patients with cardiogenic shock due to acute myocardial infarction (AMI-CS) have not been well characterized. We hypothesized that RVD is common in AMI-CS and associated with worse clinical outcomes.We retrospectively analyzed patients with available hemodynamics enrolled in the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial (n = 139) and registry (n = 258) to identify RVD in AMI-CS. RVD was defined by an elevated central venous pressure (CVP), elevated CVP-pulmonary capillary wedge pressure (PCWP) ratio, decreased pulmonary artery pulsatility index, and decreased right ventricular stroke work index. A P value of.01 was used to infer significance. In the SHOCK trial and registry, respectively, 38% and 37% of patients had RVD, but RVD was not associated with 30-day or 6-month survival (hazard ratio [HR] 1.51, (99% CI 0.92-2.49; P = .10). RV failure with the use of inclusion criteria from the Recover Right Trial for RV Failure (RR-RVF) requiring percutaneous mechanical circulatory support included elevated CVP and CVP/PCWP and a low cardiac index despite ≥1 inotrope or vasopressor. In the SHOCK trial and registry, respectively, 45% (n = 63/139) and 38% (n = 98/258) of patients met RR-RVF criteria. The RR-RVF criteria were not significantly associated with 30-day mortality in the registry cohort (HR 1.44, 99% CI 1.01-2.04; P = .04), or in the trial cohort (HR 1.51, 99% CI 0.92-2.49; P = .10).Hemodynamically defined RVD is common in AMI-CS. Routine assessment with pulmonary artery catherization allows detection of RVD; however, further work is needed to identify interventions that will result in improved outcomes for these patients. |
| Databáze: | OpenAIRE |
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