[Mechanical cardiac-assist devices in ST segment elevation myocardial infarction].
A 49-year-old woman was admitted for an anterior ST segment elevation myocardial infarction (STEMI). At hospital arrival, she presented with cardiogenic shock. An immediate coronary angiogram showed an occluded ostial left anterior descending artery. During percutaneous coronary intervention (PCI), ventricular fibrillation occurred requiring multiple electrical counter-shocks. The coronary artery was opened during cardiopulmonary resuscitation and two drug-eluting stents were implanted. At the end of the procedure, an Impella CP® mechanical cardiac-assist device was inserted. Rapid and marked improvement in the hemodynamic status was noted in the following days. The Impella CP® was withdrawn after five days and the patient was discharged two weeks later. Despite limited data, mechanical cardiac assistance is recommended in cardiogenic shock. Several devices are currently available; the choice of the system is based on the clinical presentation and the experience of each center. The Impella CP® is a microaxial pump which is inserted percutaneously and delivers up to 3.5L/min of continuous flow. In cardiogenic shock due to STEMI, this device allows temporary support while awaiting left ventricular recovery after primary PCI.
Inserm U 970, département de cardiologie, centre d'expertise de la mort subite, hôpital Européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France. Electronic address: christian.spaulding@aphp.fr.
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D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology*; D006353:Heart-Assist Devices; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome
Angioplastie coronaire; Assistance circulatoire; Cardiac-assist devices; Cardiogenic shock; Choc cardiogénique; Infarctus du myocarde; Myocardial infarction; Percutaneous coronary intervention