Mechanical circulatory assistance in myocardial infarction with refractory cardiogenic shock: clinical experience in 10 patients at a teaching hospital in Rouen.
BACKGROUND
In patients with acute myocardial infarction (MI), cardiogenic shock (CS) remains associated with a high mortality (close to 50%) despite optimal therapeutic strategy. For those patients who are unlikely to survive, mechanical circulatory support (MCS) might be an additional life saving strategy.


OBJECTIVE
To evaluate the efficacy of circulatory assistance in myocardial infarction complicated by cardiogenic shock.


METHODS
We retrospectively studied the characteristics and clinical outcome of 10 patients hospitalized with acute MI and CS who required MCS. Mean age was 52+/-8 years; location of MI was anterior in 80% of cases. Immediate coronary angiography was performed in all cases 5.8+/-7.0 hours from the onset of symptoms. Intra-aortic balloon pumping was used in 70% of patients and 30% received thrombolysis. Angioplasty with stent implantation was performed in 8 patients.


RESULTS
In all patients MCS was placed within a mean of 57+/-92 hours after admission for hemodynamic instability (systolic aortic pressure: 85+/-13 mmHg; mean: 64+/-10 mmHg). Extracorporeal membrane oxygenation (ECMO) was implanted in 8 patients followed by Thoratec in one. The other 2 patients received a Thoratec and a Heartmate II system respectively. Survival rate was 40% (4 patients): 3 patients underwent heart transplantation at a mean of 93+/-97 days and one patient is alive with definitive implantable Heartmate. The other six patients died in hospital.


CONCLUSIONS
Mechanical circulatory support appeared life saving in 4 out of 10 patients with acute MI and cardiogenic shock refractory to optimal treatment. In this situation, circulatory assistance deserves discussion and the choice of optimal device should be further evaluated.
Brunet
D
D
Département de cardiologie, Hôpital Charles Nicolle, Rouen, France.
Eltchaninoff
H
H
Kerkeni
M
M
Tron
C
C
Baala
B
B
Litzler
P Y
PY
Bessou
J P
JP
Cribier
A
A
D000328:Adult; D017130:Angioplasty / Q000295:instrumentation*; D001794:Blood Pressure; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D017023:Coronary Angiography; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005602:France; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018579:Patient Selection; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D015607:Stents; D015912:Thrombolytic Therapy; D013997:Time Factors; D017211:Treatment Failure
D002317:Cardiovascular Agents