Percutaneous Left-Ventricular Support With the Impella-2.5-Assist Device in Acute Cardiogenic Shock Results of the Impella-EUROSHOCK-Registry

被引：251

作者：

Lauten, Alexander ^{[1
]}

Engstrom, Annemarie E. ^{[2
]}

Jung, Christian ^{[1
]}

Empen, Klaus ^{[3
]}

Erne, Paul ^{[4
]}

Cook, Stephane ^{[5
]}

Windecker, Stephan ^{[5
]}

Bergmann, Martin W. ^{[6
]}

Klingenberg, Roland ^{[7
]}

Luescher, Thomas F. ^{[7
]}

Haude, Michael ^{[8
]}

Rulands, Dierk ^{[9
]}

Butter, Christian ^{[10
]}

Ullman, Bengt ^{[11
]}

Hellgren, Laila ^{[12
]}

Modena, Maria Grazia ^{[13
]}

Pedrazzini, Giovanni ^{[14
]}

Henriques, Jose P. S. ^{[2
]}

Figulla, Hans R. ^{[1
]}

Ferrari, Markus ^{[1
]}

机构：

[1] Univ Jena, Dept Internal Med 1, Jena, Germany

[2] Univ Amsterdam, Acad Med Ctr, Dept Cardiol, NL-1105 AZ Amsterdam, Netherlands

[3] Ernst Moritz Arndt Univ Greifswald, Dept Cardiol, Greifswald, Germany

[4] Luzerner Kantonsspital, Div Cardiol, Luzern, Switzerland

[5] Swiss Cardiovasc Ctr, Bern, Switzerland

[6] Asklepios Klin St Georg, Dept Cardiol, Hamburg, Germany

[7] Univ Zurich Hosp, Dept Cardiol, CH-8091 Zurich, Switzerland

[8] Lukaskrankenhaus, Staedt Kliniken Neuss, Neuss, Germany

[9] Kliniken Maria Hilf, Monchengladbach, Germany

[10] Heart Ctr Brandenburg, Bernau, Germany

[11] Soder Sjukhuset, Dept Cardiol, Stockholm, Sweden

[12] Univ Uppsala Hosp, Uppsala, Sweden

[13] Univ Hosp Modena, Modena, Italy

[14] Fdn Cardioctr Ticino, Div Cardiol, Lugano, Switzerland

来源：

CIRCULATION-HEART FAILURE | 2013年 / 6卷 / 01期

关键词：

cardiogenic shock; Impella-2.5-device; mechanical circulatory support; percutaneous left-ventricular assist device; ACUTE MYOCARDIAL-INFARCTION; INTRAAORTIC BALLOON COUNTERPULSATION; ASSIST DEVICE; CORONARY INTERVENTION; HIGH-RISK; MANAGEMENT; TRIAL; TRENDS; FAILURE; SAFETY;

D O I：

10.1161/CIRCHEARTFAILURE.112.967224

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background-Acute cardiogenic shock after myocardial infarction is associated with high in-hospital mortality attributable to persisting low-cardiac output. The Impella-EUROSHOCK-registry evaluates the safety and efficacy of the Impella-2.5-percutaneous left-ventricular assist device in patients with cardiogenic shock after acute myocardial infarction. Methods and Results-This multicenter registry retrospectively included 120 patients (63.6 +/- 12.2 years; 81.7% male) with cardiogenic shock from acute myocardial infarction receiving temporary circulatory support with the Impella-2.5-percutaneous left-ventricular assist device. The primary end point evaluated mortality at 30 days. The secondary end point analyzed the change of plasma lactate after the institution of hemodynamic support, and the rate of early major adverse cardiac and cerebrovascular events as well as long-term survival. Thirty-day mortality was 64.2% in the study population. After Impella-2.5-percutaneous left-ventricular assist device implantation, lactate levels decreased from 5.8 +/- 5.0 mmol/L to 4.7 +/- 5.4 mmol/L (P=0.28) and 2.5 +/- 2.6 mmol/L (P=0.023) at 24 and 48 hours, respectively. Early major adverse cardiac and cerebrovascular events were reported in 18 (15%) patients. Major bleeding at the vascular access site, hemolysis, and pericardial tamponade occurred in 34 (28.6%), 9 (7.5%), and 2 (1.7%) patients, respectively. The parameters of age >65 and lactate level >3.8 mmol/L at admission were identified as predictors of 30-day mortality. After 317 +/- 526 days of follow-up, survival was 28.3%. Conclusions-In patients with acute cardiogenic shock from acute myocardial infarction, Impella 2.5-treatment is feasible and results in a reduction of lactate levels, suggesting improved organ perfusion. However, 30-day mortality remains high in these patients. This likely reflects the last-resort character of Impella-2.5-application in selected patients with a poor hemodynamic profile and a greater imminent risk of death. Carefully conducted randomized controlled trials are necessary to evaluate the efficacy of Impella-2.5-support in this high-risk patient group.

引用

页码：23 / 30

页数：8

共 39 条

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