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Jeopardized myocardium and survival in patients presenting to the catheterization laboratory with ST-elevation myocardial infarction and shock

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@article{e1683abaf4fc4437af1545c5ea3cefb3,
title = "Jeopardized myocardium and survival in patients presenting to the catheterization laboratory with ST-elevation myocardial infarction and shock",
abstract = "OBJECTIVE: We aimed to relate the amount of jeopardized myocardium to mortality in shocked patients presenting to the catheterization laboratory with ST-elevation myocardial infarction (STEMI) and cardiogenic shock.BACKGROUND: In contrast with historical data and previous professional guidance, contemporary randomized data suggest that multi-vessel revascularization in such patients does not improve survival; mechanistic insight is incomplete.METHODS: Clinical databases identified cases of STEMI and shock triaged for primary percutaneous coronary intervention (PPCI) in Eastern Denmark from June 2011 to December 2014 (n = 128). British Cardiovascular Intervention Society (BCIS)-1 jeopardy scores were calculated from angiography. The study endpoint was 30-day mortality.RESULTS: Median lactate values were 6.0 [2.9-10.7] mmol/L. 30-day mortality was 53.9%. 68% of patients had multi-vessel coronary disease. Median pre-PCI BCIS-1 myocardial jeopardy scores were 8 [6-10]. After multiple logistic regression increasing age (p = 0.008; odds ratio [OR] 1.06), lactate values (p = 0.017; OR 1.02), mechanical ventilation (p = 0.011; OR 1.25) and a systolic blood pressure ≤ 90 mmHg at end-case (p = 0.005; OR 1.26) were predictive of 30-day mortality. Post-PPCI culprit vessel TIMI 3 flow was associated with reduced mortality (p < 0.001; OR 0.66). There was no association between pre-PCI jeopardy scores and the primary endpoint.CONCLUSIONS: In patients with STEMI and shock, myocardial jeopardy scores do not relate to patient outcomes. Jeopardy scores may be applied to existing datasets in order to understand why multi-vessel revascularization does not lead to the anticipated clinical benefits in cardiogenic shock.",
keywords = "Acute myocardial infarction/STEMI, Cardiogenic, Primary PCI, Shock",
author = "Joshi, {Francis R} and Frants Pedersen and Sune R{\"a}der and Jakob Rauns{\o} and Jesper Kjaergaard and Matias Lindholm and Christian Hassager and Thomas Engstr{\o}m and Lene Holmvang and Steffen Helqvist and Erik J{\o}rgensen",
note = "Copyright {\textcopyright} 2019 Elsevier Inc. All rights reserved.",
year = "2020",
month = jul,
doi = "10.1016/j.carrev.2019.11.002",
language = "English",
volume = "21",
pages = "843--848",
journal = "Cardiovascular Revascularization Medicine",
issn = "1553-8389",
publisher = "Elsevier Inc",
number = "7",

}

RIS

TY - JOUR

T1 - Jeopardized myocardium and survival in patients presenting to the catheterization laboratory with ST-elevation myocardial infarction and shock

AU - Joshi, Francis R

AU - Pedersen, Frants

AU - Räder, Sune

AU - Raunsø, Jakob

AU - Kjaergaard, Jesper

AU - Lindholm, Matias

AU - Hassager, Christian

AU - Engstrøm, Thomas

AU - Holmvang, Lene

AU - Helqvist, Steffen

AU - Jørgensen, Erik

N1 - Copyright © 2019 Elsevier Inc. All rights reserved.

PY - 2020/7

Y1 - 2020/7

N2 - OBJECTIVE: We aimed to relate the amount of jeopardized myocardium to mortality in shocked patients presenting to the catheterization laboratory with ST-elevation myocardial infarction (STEMI) and cardiogenic shock.BACKGROUND: In contrast with historical data and previous professional guidance, contemporary randomized data suggest that multi-vessel revascularization in such patients does not improve survival; mechanistic insight is incomplete.METHODS: Clinical databases identified cases of STEMI and shock triaged for primary percutaneous coronary intervention (PPCI) in Eastern Denmark from June 2011 to December 2014 (n = 128). British Cardiovascular Intervention Society (BCIS)-1 jeopardy scores were calculated from angiography. The study endpoint was 30-day mortality.RESULTS: Median lactate values were 6.0 [2.9-10.7] mmol/L. 30-day mortality was 53.9%. 68% of patients had multi-vessel coronary disease. Median pre-PCI BCIS-1 myocardial jeopardy scores were 8 [6-10]. After multiple logistic regression increasing age (p = 0.008; odds ratio [OR] 1.06), lactate values (p = 0.017; OR 1.02), mechanical ventilation (p = 0.011; OR 1.25) and a systolic blood pressure ≤ 90 mmHg at end-case (p = 0.005; OR 1.26) were predictive of 30-day mortality. Post-PPCI culprit vessel TIMI 3 flow was associated with reduced mortality (p < 0.001; OR 0.66). There was no association between pre-PCI jeopardy scores and the primary endpoint.CONCLUSIONS: In patients with STEMI and shock, myocardial jeopardy scores do not relate to patient outcomes. Jeopardy scores may be applied to existing datasets in order to understand why multi-vessel revascularization does not lead to the anticipated clinical benefits in cardiogenic shock.

AB - OBJECTIVE: We aimed to relate the amount of jeopardized myocardium to mortality in shocked patients presenting to the catheterization laboratory with ST-elevation myocardial infarction (STEMI) and cardiogenic shock.BACKGROUND: In contrast with historical data and previous professional guidance, contemporary randomized data suggest that multi-vessel revascularization in such patients does not improve survival; mechanistic insight is incomplete.METHODS: Clinical databases identified cases of STEMI and shock triaged for primary percutaneous coronary intervention (PPCI) in Eastern Denmark from June 2011 to December 2014 (n = 128). British Cardiovascular Intervention Society (BCIS)-1 jeopardy scores were calculated from angiography. The study endpoint was 30-day mortality.RESULTS: Median lactate values were 6.0 [2.9-10.7] mmol/L. 30-day mortality was 53.9%. 68% of patients had multi-vessel coronary disease. Median pre-PCI BCIS-1 myocardial jeopardy scores were 8 [6-10]. After multiple logistic regression increasing age (p = 0.008; odds ratio [OR] 1.06), lactate values (p = 0.017; OR 1.02), mechanical ventilation (p = 0.011; OR 1.25) and a systolic blood pressure ≤ 90 mmHg at end-case (p = 0.005; OR 1.26) were predictive of 30-day mortality. Post-PPCI culprit vessel TIMI 3 flow was associated with reduced mortality (p < 0.001; OR 0.66). There was no association between pre-PCI jeopardy scores and the primary endpoint.CONCLUSIONS: In patients with STEMI and shock, myocardial jeopardy scores do not relate to patient outcomes. Jeopardy scores may be applied to existing datasets in order to understand why multi-vessel revascularization does not lead to the anticipated clinical benefits in cardiogenic shock.

KW - Acute myocardial infarction/STEMI

KW - Cardiogenic

KW - Primary PCI

KW - Shock

U2 - 10.1016/j.carrev.2019.11.002

DO - 10.1016/j.carrev.2019.11.002

M3 - Journal article

C2 - 31759911

VL - 21

SP - 843

EP - 848

JO - Cardiovascular Revascularization Medicine

JF - Cardiovascular Revascularization Medicine

SN - 1553-8389

IS - 7

ER -

ID: 59117657