Cardiogenic Shock, Outcomes and Stents

National Cardiogenic Shock Initiative Study Results Show Significant Increase in Heart Attack Survival

DAIC

DECEMBER 14, 2023

Henry Ford Health's National Cardiogenic Shock Initiative research team. Cardiogenic shock is a critical condition in which the heart is unable to pump enough blood to sustain the body’s needs, depriving vital organs of blood supply. This can cause those organs to eventually stop functioning.

Cardiogenic Shock

Cardiogenic Shock Heart Attack Heart attacks Myocardial Infarction

A more-Comers populAtion trEated with an ultrathin struts polimer-free Sirolimus stent: an Italian post-maRketing study (the CAESAR registry)

Frontiers in Cardiovascular Medicine

JANUARY 7, 2024

Introduction The use of contemporary drug-eluting stents (DES) has significantly improved outcomes of patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). Patients with left main (LM) disease, cardiogenic shock (CS), or severely reduced left-ventricular ejection fraction (LVEF) were excluded.

Stent

Stent Stents Cardiogenic Shock Coronary Artery Disease

3 days of shoulder and chest pain, and now cardiogenic shock

Dr. Smith's ECG Blog

AUGUST 28, 2020

Now appears to be in cardiogenic shock." However, cardiogenic shock usually takes some time to develop, so it is probably subacute." Cardiogenic shock and ACS is an indication for the cath lab, even if you don't think there is OMI. I was texted these ECGs. Then SOB and nausea the next day.

Cardiogenic Shock

Cardiogenic Shock Chest Pain Ischemia Stenosis

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Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis

Frontiers in Cardiovascular Medicine

MARCH 10, 2024

There are conflicting sources regarding the relationship between hyperglycemia and outcomes in STEMI patients. We aimed to compile evidence to assess the association between hyperglycemia and adverse outcomes. Mortality was the most often outcome reported related to hyperglycemia. 3.45) and 4.47 (95% CI: 2.54–7.87),

Myocardial Infarction

Myocardial Infarction Cardiogenic Shock Article STEMI

Outcomes of PCI of all comers: the experience of a Kuwaiti independent healthcare institution

The British Journal of Cardiology

APRIL 16, 2024

As a low-volume PCI centre in the Middle East, we wanted to find out if the outcomes of our PCI procedures are different from those of high-volume PCI centres in the UK and the Western world. and the average number of stents 2.6. Prospectively collected data of all comers for PCI (urgent and elective) were retrospectively analysed.

Outcomes

Outcomes Cardiogenic Shock Angina STEMI

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. The notes now refer to the patient being in cardiogenic shock, on pressors. Am J Emerg Med. 2014;32:e5–e8. J Cardiol Cases.

Chest Pain

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction

Should we activate the cath lab? A Quiz on 5 Cases.

Dr. Smith's ECG Blog

OCTOBER 8, 2023

ECG#1 ECG#2 ECG#3 ECG#4 ECG#5 See outcomes of all 5 below, with the Queen of Hearts AI Bot interpretation. The patient was referred immediately for cath which revealed RCA occlusion that was stented. The patient died of cardiogenic shock within 24 hours despite mechanical circulatory support. Troponin T >42.000ng/L.

Ischemia

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest

Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

Dr. Smith's ECG Blog

MAY 30, 2023

Angiogram: Culprit Lesion (s): Thrombotic occlusion of the proximal RCA -- stented. The primary outcomes were sensitivity/specificity of 1) STD in lead I ≥ 0.5 mm and 2) STE in lead V1 ≥ 0.5 mm, stratified by presence or absence of posterior (inferobasal) MI, as determined by ≥0.5 mm STD in lead V2, for differentiating RVMI from non-RVMI.

Chest Pain

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock

A man in his 70s with chest pain

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

He was taken to the cath lab where he was found to have acute total occlusion of his saphenous vein graft to his RCA, which was stented. He was in cardiogenic shock requiring an impella for several days after cath. No further troponins were measured.

Chest Pain

Chest Pain Cardiac Arrest Cardiogenic Shock Heart Attack

A man in his 70s with acute chest pain and paced rhythm.

Dr. Smith's ECG Blog

MAY 8, 2023

So the patient was taken for emergent cath, showing: Culprit artery: LAD (100% stenosis, TIMI 0) requiring thrombectomy and stent. Queen of Hearts Interpretation: Would 20 minutes earlier diagnosis have made a difference in his clinical outcome? Queen of Hearts interpretation: Now the cardiologist considered it "STEMI"!

Chest Pain

Chest Pain Myocardial Infarction STEMI Pacemaker

How does Acute Total Left Main Coronary occlusion present on the ECG?

Dr. Smith's ECG Blog

AUGUST 9, 2019

TIMI flow 0) is rare in the ED, as most either die before arrival or are recognized clinically due to cardiogenic shock. 67) Less than 3% of anterior STEMI has LM OMI, and most are recognized clinically due to cardiogenic shock. (68, Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease.

Myocardial Infarction

Myocardial Infarction Ischemia STEMI Cardiogenic Shock

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

distal stent patent. The patient went into cardiogenic shock and ultimately died of this MI. Main outcome measures Positive predictive value of an elevated cardiac troponin concentration for a diagnosis of type 1 myocardial infarction. Repeat ECG shows modest ST elevation in I and aVL and depression in inferior leads."

Myocardial Infarction

Myocardial Infarction Chest Pain Cardiogenic Shock STEMI

Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

The axiom of "type 1 (ACS, plaque rupture) STEMIs are not tachycardic unless they are in cardiogenic shock" is not applicable outside of sinus rhythm. Again, not an expected outcome with diltiazem). Diltiazem is not terribly effective for conversion of atrial flutter to sinus, so this should not be an expected result.

Ischemia

Ischemia Atrial Flutter Arrhythmia Tachycardia

Published Research

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Adult Cardiac Surgery Database Lead Author Title Publication Date Jacob Raphael Red Blood Cell Transfusion and Pulmonary Complications: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis The Annals of Thoracic Surgery January 2024 Joseph Sabik Multi-Arterial versus Single-Arterial Coronary Surgery: Ten Year Follow-up of One Million (..)

Research

Research Coronary Artery Bypass Graft Aortic valve Congenital

Published Research

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Program Designations Access and Publications (A&P) 1 Participant User File (PUF) 2 Task Force on Funded Research (TFR) 3 Special Projects 4 Adult Cardiac Surgery Database Lead Author Title Publication Date William Keeling 2 National Trends in Emergency Coronary Artery Bypass Grafting European Journal of Cardiothoracic Surgery October 2023 Jake (..)

Research

Research Coronary Artery Bypass Graft Aortic valve Congenital

The First 60 Minutes of a Heart Attack: The Golden Hour

Wellnest

JULY 19, 2023

It is imperative to act swiftly when faced with such a medical emergency to ensure the best possible outcome. A completely blocked artery is located, a wire is inserted through it, the clot is sucked, the narrowing is widened with a balloon, and then a stent (stainless steel wire mesh) is placed to maintain consistent flow.

Heart Attack

Heart Attack Heart attacks Blood Pressure Myocardial Infarction

Unresponsive and Acidotic: OMI? Acute, subacute, or reperfused? What is the rhythm? Why RV dysfunction? Can CT scan help?

Dr. Smith's ECG Blog

APRIL 6, 2025

Assessment : Cardiology thought this was cardiogenic shock from RV dysfunction. In short with a very guarded likelihood for a positive outcome. The estimated left ventricular ejection fraction is 40-45%. Probable anterior and anterolateral wall hypokinesis. Right ventricular enlargement. There was no pulmonary embolism.

Blood Pressure

Blood Pressure Cardiogenic Shock Ischemia Cardiac Arrest

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

Dr. Smith's ECG Blog

MARCH 25, 2025

A 2017 trial named CULPRIT SHOCK found that in patients with cardiogenic shock, a strategy of culprit vessel PCI only was associated with better outcomes than immediate multivessel PCI. After CULPRIT SHOCK, many shied away from multivessel PCI in the acute setting. In fact, in this elegant study by Heitner et al.

Chest Pain

Chest Pain Ischemia Plaque Stents

Cardiovascular Update

National Cardiogenic Shock Initiative Study Results Show Significant Increase in Heart Attack Survival

A more-Comers populAtion trEated with an ultrathin struts polimer-free Sirolimus stent: an Italian post-maRketing study (the CAESAR registry)

3 days of shoulder and chest pain, and now cardiogenic shock

Webinars

Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis

Outcomes of PCI of all comers: the experience of a Kuwaiti independent healthcare institution

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

Should we activate the cath lab? A Quiz on 5 Cases.

Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

A man in his 70s with chest pain

A man in his 70s with acute chest pain and paced rhythm.

How does Acute Total Left Main Coronary occlusion present on the ECG?

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

Published Research

Published Research

The First 60 Minutes of a Heart Attack: The Golden Hour

Unresponsive and Acidotic: OMI? Acute, subacute, or reperfused? What is the rhythm? Why RV dysfunction? Can CT scan help?

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

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