ST-Elevation Myocardial Infarction & Cardiogenic Shock. - What Should We Do?
|
|
- Holly Barton
- 5 years ago
- Views:
Transcription
1 ST-Elevation Myocardial Infarction & Cardiogenic Shock - What Should We Do? Advanced Angioplasty 2008 Dan Blackman Leeds General Infirmary
2 Conflicts of interest Advisory Boards Cordis Boston Scientific Medtronic Nycomed Lilly St Jude Travel/Sponsorship Cordis Boston Scientific Medtronic Abbott St Jude
3 Causes of Cardiogenic Shock Tamponade/rupture 1.7% Isolated RV Shock 3.4% Other 7.5% VSD 4.6% Acute Severe MR 8.3% Shock Registry JACC :1063 Predominant LV Failure 74.5%
4 Survival from mechanical causes 100% 90% 94% No Surgery Surgery Percutaneous closure In-hospital Mortality (%) 80% 70% 60% 50% 40% 30% 47% 28% 71% 39% 20% 10% 0% VSD Shock Registry JACC 2000;36:1104 & 36: 1110 Acute Severe MR GUSTO 1 Circulation 2000;101:27 Holzer R CCI 2004;61:196
5 Emergency revascularisation - SHOCK Trial 70% 60% 50% p= % 56% 50% 63% p= % 66% ERV IMS Mortality (%) 40% 30% 20% 10% 0% 30 days (n=302) 6 months (n=301) 12 months (n=299) 85% of survivors NYHA Class I/II at 12 months Hochman JAMA 2000;285:190
6 Emergency revascularisation in the Elderly - SHOCK Trial 80% 70% 75% p=0.01 ERV IMS 30-day Mortality (%) 60% 50% 40% 30% 20% p= % 57% 53% 10% 0% <75 years (n=246) >75 years (n=56) >75 years ERV vs IMS baseline characteristics LVEF 28% vs 36% p=0.051 Anterior MI 63% vs 41% p=0.18 Female 54% vs 31% p=0.11
7 Elderly - SHOCK & other registry data 90% 80% 81% ERV IMS 30-day Mortality (%) 70% 60% 50% 40% 30% 20% 10% 48% 47% 46% 0% SHOCK Registry Mayo Clinic Northern New n=44 n=233 n=61 England n=74
8 Single vessel or Multivessel PCI? - SHOCK Trial 81% of PCI patients multivessel disease 85% PCI IRA only; 23% complete revascularisation 90% 1-year mortality (%) 80% 70% 60% 50% 40% 30% 20% 80% p< % 46% p=ns 54% MV PCI SV PCI 10% 0% Shock Trial Shock Registry
9 The panel believes that all accessible vessels should be treated in patients with cardiogenic shock Current Recommendations:- 1-2 vessel disease: PCI IRA 3VD: PCI IRA + staged complete revascularisation Early MV PCI may be warranted if shock persists despite IRA PCI
10 Is there a role for CABG SHOCK Data 60% 53% p=ns 50% 48% 46% 1-year mortality (%) 40% 30% 20% 10% 24% PCI CABG 0% SHOCK Trial SHOCK Registry n=81 n=47 n=276 n=109 SHOCK Trial CABG vs PCI baseline characteristics LMS Disease 41% vs 13% p= VD 80% vs 60% p=0.18 Diabetes 49% vs 27% p=0.11
11 Intra-aortic balloon pump counterpulsation TT only TT + IABP Mortality (%) Shock Registry (n=292) NRMI Registry (n=23,180) TACTICS GUSTO I & III Kovack (n=46)
12 IABP in Cardiogenic Shock Primary PCI Retrospective analysis of 23,180 patients from NRMI database 7268 treated by IABP In-hospital Mortality (%) Thrombolysis only Thrombolysis + IABP Primary PCI only Primary PCI + IABP
13 Timing of IABP in Cardiogenic Shock Primary PCI 40% 35% 35% IABP pre (n=62) IABP post/none (n=57) 35% 30% 30% Event rate (%) 25% 20% 15% 15% 13% 15% 10% 5% 0% CPR VF/VT arrest Any event Single centre registry Primary PCI for shock Brodie AJC 1999;84:18
14 Inotropes and Vasopressors No meaningful data! ACC/AHA Guidelines SBP <70:- Norepinephrine ( µg/min) Switch to Dopamine (5-15 µg/kg/min) once SBP 80 SBP Dopamine (5-15 µg/kg/min) Add dobutamine (2-20 µg/kg/min) once SBP 90
15 Percutaneous left ventricular assist devices Even with revascularisation and IABP support mortality from cardiogenic shock post STEMI remains 50% Recovery of myocardial performance following successful revascularisation may take several days. During this time many patients succumb to low cardiac output If effective, active cardiac support could be provided while awaiting the beneficial effects of revascularisation, survival rates may be enhanced
16 Left atrial-to-femoral arterial LVAD Low speed centrifugal continuous flow pump 21F venous transeptal cannula 17F arterial cannula Maximum flow 4L/minute Cost: 7.5K Tandem Heart plvad
17 Tandem Heart Outcome Data 50% 45% 42% 45% p=ns 47% Tandem Heart IABP 30 day mortality (%) 40% 35% 30% 25% 20% 15% 36% 10% 5% 0% Thiele (n=41) Burkhoff (n=33) Improved haemodynamic parameters Increase in bleeding, limb ischaemia, and sepsis Thiele EHJ 2005;26:1276. Burkhoff AHJ 2006;152:e1
18 Axial flow pump Impella Much simpler to use Increases cardiac output & unloads LV LP F percutaneous approach; Maximum 2.5 L flow LP F surgical cutdown; Maximum 5L flow Cost: 3-5K Blood Inlet Motor Blood outlet Pressure Lumen
19 Impella outcome data 1 RCT of Impella 2.5 in AMI Cardiogenic Shock ISAR-SHOCK 26 patient RCT Impella vs IABP Cardiac Index, MAP (by 10mmHg) vs IABP Complications IABP No difference in mortality
20 What we should do about STEMI Cardiogenic Shock Emergency angiography and revascularisation: Primary PCI preferably All patients <75 years Selected patients 75 years On-table echo to rule out mechanical defects Stabilise the patient in the lab before revascularisation IABP Pressors if required (Norepinephrine/dopamine) Anaesthetic support Consider calling the surgeon for true surgical disease PCI culprit artery. Other vessels if shock persists Use abciximab for PCI Consider percutaneous LVAD if shock persists with IABP + multi-vessel revascularisation
How to do Primary Angioplasty. - Patients with Cardiogenic Shock
How to do Primary Angioplasty - Patients with Cardiogenic Shock Advanced Cardiovascular Intervention 2011 Dan Blackman Leeds General Infirmary MY CONFLICTS OF INTEREST ARE: Research Grants Medicines Company
More informationAssist Devices in STEMI- Intra-aortic Balloon Pump
Assist Devices in STEMI- Intra-aortic Balloon Pump Ioannis Iakovou, MD, PhD Onassis Cardiac Surgery Center Athens, Greece Cardiogenic shock 5-10% of pts after a heart attack 60000-70000 pts in Europe/year
More informationIntraaortic Balloon Counterpulsation- Supportive Data for a Role in Cardiogenic Shock ( Be Still My Friend )
Intraaortic Balloon Counterpulsation- Supportive Data for a Role in Cardiogenic Shock ( Be Still My Friend ) Stephen G. Ellis, MD Section Head, Interventional Cardiology Professor of Medicine Cleveland
More informationCardiogenic Shock. Carlos Cafri,, MD
Cardiogenic Shock Carlos Cafri,, MD SHOCK= Inadequate Tissue Mechanisms: Perfusion Inadequate oxygen delivery Release of inflammatory mediators Further microvascular changes, compromised blood flow and
More informationRationale for Prophylactic Support During Percutaneous Coronary Intervention
Rationale for Prophylactic Support During Percutaneous Coronary Intervention Navin K. Kapur, MD, FACC, FSCAI Assistant Director, Interventional Cardiology Director, Interventional Research Laboratories
More informationCath Lab Essentials : LV Assist Devices for Hemodynamic Support (IABP, Impella, Tandem Heart, ECMO)
Cath Lab Essentials : LV Assist Devices for Hemodynamic Support (IABP, Impella, Tandem Heart, ECMO) Michael A. Gibson, MD Assistant Professor of Medicine University of California, Irvine Division of Cardiology
More informationCirculatory Support: From IABP to LVAD
Circulatory Support: From IABP to LVAD Howard A Cohen, MD, FACC, FSCAI Director Division of Cardiovascular Intervention Co Director Cardiovascular Interventional ti Laboratories Lenox Hill Heart & Vascular
More informationCardiogenic Shock. Dr. JPS Henriques. Academic Medical Center University of Amsterdam The Netherlands
Cardiogenic Shock Dr. JPS Henriques Academic Medical Center University of Amsterdam The Netherlands Conflict of interest disclosure Research grant Abbott Vascular Research grant Abiomed Inc. Global Impella
More informationManagement of Acute Shock and Right Ventricular Failure
Management of Acute Shock and Right Ventricular Failure Nader Moazami, MD Department of Thoracic and Cardiovascular Surgery and Biomedical Engineering, Cleveland Clinic NONE Disclosures CARDIOGENIC SHOCK
More informationPUMP FAILURE COMPLICATING AMI: ISCHAEMIC VSR
PUMP FAILURE COMPLICATING AMI: ISCHAEMIC VSR Dr Susanna Price MD PhD MRCP ESICM FFICM FESC Consultant Cardiologist & Intensivist Royal Brompton & Harefield NHS Foundation Trust DECLARATIONS Educational
More informationManagement of Cardiogenic shock. Prof. Christian JM Vrints
Management of Cardiogenic shock Prof. Christian JM Vrints none conflicts Management of Cardiogenic Shock Incidence and trends Importance of early revascularization Multivessel disease Left main disease
More informationA Future for the IABP in Cardiogenic Shock? Holger Thiele Medical Clinic II (Cardiology/Angiology/Intensive Care) University of Lübeck, Germany
A Future for the in Cardiogenic Shock? Holger Thiele Medical Clinic II (Cardiology/Angiology/Intensive Care) University of Lübeck, Germany Disclosures Funding: German Research Foundation German Heart Research
More informationThe Role of Mechanical Circulatory Support in Cardiogenic Shock: When to Utilize
The Role of Mechanical Circulatory Support in Cardiogenic Shock: Presented by Nancy Scroggins ACNP, CNS-CC CV Surgery ACNP Bayshore Medical Center The Role of Mechanical Circulatory Support in Cardiogenic
More informationPercutaneous Mechanical Circulatory Support for Cardiogenic Shock. 24 th Annual San Diego Heart Failure Symposium Ryan R Reeves, MD FSCAI
Percutaneous Mechanical Circulatory Support for Cardiogenic Shock 24 th Annual San Diego Heart Failure Symposium Ryan R Reeves, MD FSCAI The Need for Circulatory Support Basic Pathophysiologic Problems:
More informationΟξύ στεφανιαίο σύνδρομο και καρδιογενής καταπληξία. Επεμβατική προσέγγιση. Σωτήριος Πατσιλινάκος Κωνσταντοπούλειο Γ.Ν. Ν. Ιωνίας
Οξύ στεφανιαίο σύνδρομο και καρδιογενής καταπληξία. Επεμβατική προσέγγιση Σωτήριος Πατσιλινάκος Κωνσταντοπούλειο Γ.Ν. Ν. Ιωνίας ACUTE HEART FAILURE AND CAD: ACS / LV ischaemic dysfunction Mechanical complications
More informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST Cardiogenic Shock Mechanical Support Eulàlia Roig FESC Heart Failure and HT Unit Hospital Sant Pau - UAB Barcelona. Spain No conflics of interest Mechanical Circulatory
More informationSTEMI and Cardiogenic Shock. The rules and solution. Dave Kettles St Dominics and Frere Hospitals East London ZA
STEMI and Cardiogenic Shock. The rules and solution Dave Kettles St Dominics and Frere Hospitals East London ZA Definitions: Shock is a life threatening, but initially reversible state of cellular and
More informationCardiogenic Shock in Acute MI
Cardiogenic Shock in Acute MI Mark Sheldon, MD UNMH Interventional Cardiology Objectives Overview Treatment Definition Shock profiles Causes Medical Mechanical Illustrative case Questions? Revascularization
More informationAcute Myocardial Infarction Complicated by Cardiogenic Shock
Acute Myocardial Infarction Complicated by Cardiogenic Shock Navin K. Kapur, MD, FACC, FSCAI Assistant Professor, Division of Cardiology Director, Acute Circulatory Support Program Director, Interventional
More informationManagement of Cardiogenic Shock. Dr Stephen Pettit, Consultant Cardiologist
Dr Stephen Pettit, Consultant Cardiologist Cardiogenic shock Management of Cardiogenic Shock Outline Definition, INTERMACS classification Medical management of cardiogenic shock PA catheters and haemodynamic
More informationPercutaneous Mechanical Circulatory Support Devices
Percutaneous Mechanical Circulatory Support Devices Daniel Vazquez RN, RCIS Miami Cardiac & Vascular Institute FINANCIAL DISCLOSURES none CASE STUDY CASE STUDY 52 year old gentlemen Complaining of dyspnea
More informationRationale for Left Ventricular Support During Percutaneous Coronary Intervention
Rationale for Left Ventricular Support During Percutaneous Coronary Intervention Navin K. Kapur, MD, FACC, FSCAI Associate Professor, Division of Cardiology Director, Acute Circulatory Support Program
More informationCounterpulsation. John N. Nanas, MD, PhD. Professor and Head, 3 rd Cardiology Dept, University of Athens, Athens, Greece
John N. Nanas, MD, PhD Professor and Head, 3 rd Cardiology Dept, University of Athens, Athens, Greece History of counterpulsation 1952 Augmentation of CBF Adrian and Arthur Kantrowitz, Surgery 1952;14:678-87
More informationBridging With Percutaneous Devices: Tandem Heart and Impella
Bridging With Percutaneous Devices: Tandem Heart and Impella DAVID A. BARAN, MD, FACC, FSCAI SYSTEM DIRECTOR, ADVANCED HEART FAILURE, TX AND MCS SENTARA HEART HOSPITAL NORFOLK, VA PROFESSOR OF MEDICINE
More informationTREATMENT OPTIONS IN CARDIOGENIC SHOCK WITH INTRA-AORTIC BALLOON COUNTERPULSATION
TREATMENT OPTIONS IN CARDIOGENIC SHOCK WITH INTRA-AORTIC BALLOON COUNTERPULSATION *Markus W. Ferrari Clinic of Internal Medicine I, HELIOS Dr-Horst-Schmidt-Clinic, Wiesbaden, Germany *Correspondence to
More informationIntroduction to Acute Mechanical Circulatory Support
Introduction to Acute Mechanical Circulatory Support Navin K. Kapur, MD, FACC, FSCAI, FAHA Associate Professor, Department of Medicine Interventional Cardiology & Advanced Heart Failure Programs Executive
More informationLow cardiac output & Mechanical Support นายแพทย อรรถภ ม ส ศ ภอรรถ ศ ลยศาสตร ห วใจและทรวงอก โรงพยาบาล ราชว ถ
Low cardiac output & Mechanical Support นายแพทย อรรถภ ม ส ศ ภอรรถ ศ ลยศาสตร ห วใจและทรวงอก โรงพยาบาล ราชว ถ Low cardiac output/cardiogenic Shock State of end-organ hypoperfusion due to cardiac failure.
More informationTed Feldman, M.D., MSCAI FACC FESC
Support Technologies and High Risk Intervention Patient Selection: When Not to Use Them Ted Feldman, M.D., MSCAI FACC FESC Evanston Hospital SCAI Fall Fellows Course Las Vegas December 7-10 th, 2014 Ted
More information8th Emirates Cardiac Society Congress in collaboration with ACC Middle East Conference Dubai: October Acute Coronary Syndromes
8th Emirates Cardiac Society Congress in collaboration with ACC Middle East Conference 2017 OSPEDALE Dubai: 19-21 October 2017 Acute Coronary Syndromes Antonio Colombo Centro Cuore Columbus and S. Raffaele
More informationWho is the high risk patient?
Who is the high risk patient? High risk of periprocedural death or other major complications (hemodynamic compromise, MI, stroke, dialysis) Contributors of Risk Lesion/Procedure Governed by 1. Patient
More informationCardiogenic Shock and Initiatives to Reduce Mortality
Cardiogenic Shock and Initiatives to Reduce Mortality Tanveer Rab, MD, FACC William O Neill, MD, FACC Perwaiz Meraj, MD, FACC Alex Truesdell, MD, FACC The Golden Hours? 50% dead within 10 hours Overall
More informationNew Horizons in Cardiogenic Shock. Timothy D. Henry, MD Director of Cardiology Cedars-Sinai Heart Institute
New Horizons in Cardiogenic Shock Timothy D. Henry, MD Director of Cardiology Cedars-Sinai Heart Institute AMI Shock Mortality Unchanged in > 20 years 74355 US AMI/CGS cases per year 1,2 78954 78500 79823
More informationMechanical circulatory support in cardiogenic shock The Cardiologist s view ACCA Masterclass 2017
Mechanical circulatory support in cardiogenic shock The Cardiologist s view ACCA Masterclass 2017 Pascal Vranckx MD, PhD. Medical director Cardiac Critical Care Services Hartcentrum Hasselt Belgium Disclosure
More informationMechanical Cardiac Support in Acute Heart Failure. Michael Felker, MD, MHS Associate Professor of Medicine Director of Heart Failure Research
Mechanical Cardiac Support in Acute Heart Failure Michael Felker, MD, MHS Associate Professor of Medicine Director of Heart Failure Research Disclosures Research Support and/or Consulting NHLBI Amgen Cytokinetics
More informationMANAGEMENT OF CARDIOGENIC SHOCK
MANAGEMENT OF CARDIOGENIC SHOCK CASE PRESENTATION 37 year old Dutch female No known coronary artery disease risk factors 1 week post partum at time of presentation (G3P3) after an uncomplicated normal
More informationCardiogenic shock: Current management
Cardiogenic shock: Current management Janine Pöss Universitätsklinikum des Saarlandes Klinik für Innere Medizin III Kardiologie, Angiologie und internistische Intensivmedizin Homburg/Saar I have nothing
More informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST Multivessel disease and cardiogenic shock: CABG is the optimal revascularization therapy. Contra Prof. Christian JM Vrints Cardiogenic Shock Spiral Acute Myocardial
More informationMechanics of Cath Lab Support Devices
Mechanics of Cath Lab Support Devices Issam D. Moussa, MD Chief Medical Officer First Coast Cardiovascular Institute, Jacksonville, FL Professor of Medicine, UCF, Orlando, FL None DISCLOSURE Percutaneous
More informationA case of post myocardial infarction ventricular septal rupture CHRISTOFOROS KOBOROZOS, MD
A case of post myocardial infarction ventricular septal rupture CHRISTOFOROS KOBOROZOS, MD NAVAL HOSPITAL OF ATHENS case presentation Female, 81yo Hx: diabetes mellitus, hypertension, chronic anaemia presented
More informationPercutaneous mechanical circulatory support for treatment and prevention of hemodynamic instability Engström, A.E.
UvA-DARE (Digital Academic Repository) Percutaneous mechanical circulatory support for treatment and prevention of hemodynamic instability Engström, A.E. Link to publication Citation for published version
More informationRay Matthews MD Professor of Clinical Medicine Chief of Cardiology University of Southern California
High Risk PCI Making Possible the Impossible Ray Matthews MD Professor of Clinical Medicine Chief of Cardiology University of Southern California Disclosures Abiomed Research Support Consulting Agreement
More informationMechanics of Cath Lab Support Devices
Mechanics of Cath Lab Support Devices Issam D. Moussa, MD Professor of Medicine Mayo Clinic College of Medicine Chair, Division of Cardiovascular Diseases Mayo Clinic Jacksonville, Florida DISCLOSURE Presenter:
More informationGuideline compliance, utilization trends
Guideline compliance, utilization trends and device selection Tilmann Schwab Cardiology / Intensive care Cardiac support IABP LVAD Transluminal l LVAD Cardiac support Emergency cardiac life support (ECLS)
More informationPHARMACOLOGICAL MANAGEMENT OF CARDIOGENIC SHOCK
PHARMACOLOGICAL MANAGEMENT OF CARDIOGENIC SHOCK Doron Zahger, MD Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva,
More informationIABP SHOCK II trial:
IABP SHOCK II trial: Randomized comparison of intraaortic balloon counterpulsation versus optimal medical therapy in addition to early revascularization in acute myocardial infarction complicated by cardiogenic
More informationAllinaHealthSystem 1
: Definition End-organ hypoperfusion secondary to cardiac failure Venoarterial ECMO: Patient Selection Michael A. Samara, MD FACC Advanced Heart Failure, Cardiac Transplant & Mechanical Circulatory Support
More informationTREATMENT OF HIGHER RISK PATIENTS INTRODUCTION TO PROTECTED PCI WITH IMPELLA. IMP v4
1 TREATMENT OF HIGHER RISK PATIENTS INTRODUCTION TO PROTECTED PCI WITH IMPELLA FDA APPROVES IMPELLA FOR HIGH-RISK PCI 2 Impella is the only hemodynamic support device proven safe and effective in elective
More informationClinical Seminar. Which Diabetic Patient is a Candidate for Percutaneous Coronary Intervention - European Perspective
Clinical Seminar Which Diabetic Patient is a Candidate for Percutaneous Coronary Intervention - European Perspective Stephan Windecker Department of Cardiology Swiss Cardiovascular Center and Clinical
More informationThe development of cardiogenic shock portends an extremely poor prognosis. Cardiogenic Shock: A Lethal Complication of Acute Myocardial Infarction
TREATMENT UPDATE Cardiogenic Shock: A Lethal Complication of Acute Myocardial Infarction David R. Holmes, Jr, MD Mayo Graduate School of Medicine, Mayo Clinic, Rochester, MN Cardiogenic shock is a serious
More informationLV Assist in High Risk PCI and Cardiogenic Shock: Is it Worth the Effort?
LV Assist in High Risk PCI and Cardiogenic Shock: Is it Worth the Effort? Vincent J. Pompili, MD, FACC, FSCAI Professor of Internal Medicine Director of Interventional Cardiovascular Medicine and Cardiac
More informationMatching Patient and Pump in the New Era of Percutaneous Mechanical Circulatory Support
Matching Patient and Pump in the New Era of Percutaneous Mechanical Circulatory Support Navin K. Kapur, MD, FACC, FSCAI, FAHA Associate Professor, Department of Medicine Interventional Cardiology & Advanced
More informationAcute Mechanical Circulatory Support Right Ventricular Support Devices
Acute Mechanical Circulatory Support Right Ventricular Support Devices Navin K. Kapur, MD, FACC, FSCAI, FAHA Associate Professor, Department of Medicine Interventional Cardiology & Advanced Heart Failure
More informationCase - Advanced HF and Shock (INTERMACS 1)
Case - Advanced HF and Shock (INTERMACS 1) Navin K. Kapur, MD, FACC, FSCAI, FAHA Associate Professor, Department of Medicine Interventional Cardiology & Advanced Heart Failure Programs Executive Director,
More informationUniversity of Leipzig Heart Center
Randomized comparison of intraaortic balloon counterpulsation versus optimal medical therapy in addition to early revascularization in acute myocardial infarction complicated by cardiogenic shock Holger
More informationPercutaneous mechanical circulatory support for treatment and prevention of hemodynamic instability Engström, A.E.
UvA-DARE (Digital Academic Repository) Percutaneous mechanical circulatory support for treatment and prevention of hemodynamic instability Engström, A.E. Link to publication Citation for published version
More informationImpella Ins & Outs. CarVasz November :45 12:15
Impella Ins & Outs CarVasz November 21 2014 10:45 12:15 Nicolas M. Van Mieghem, MD, PhD, FESC Clinical Director of Interventional Cardiology Thoraxcenter, Erasmus MC Rotterdam Background IABP is widely
More informationWhy we need a consensus document on cardiogenic shock? ACCA Masterclass 2017
Why we need a consensus document on cardiogenic shock? ACCA Masterclass 2017 Holger Thiele Cardiogenic Shock STEMI Guidelines Steg et al. Eur Heart J.2012;33:2569-2619 Cardiogenic Shock CHF Guidelines
More informationRole of echocardiography in the assessment of ischemic heart disease 분당서울대학교병원윤연이
Role of echocardiography in the assessment of ischemic heart disease 분당서울대학교병원윤연이 Outline Evaluation of Chest pain Evaluation of MI complications Prediction of Outcomes Evaluation of Chest pain Evaluation
More informationAndrew Civitello MD, FACC
Timing the Transition from Short Term to Long Term Mechanical Circulatory Support Andrew Civitello MD, FACC Medical Director, Heart Transplant Program Director, Fellowship Co-Director, Baylor St. Luke's
More informationA National Cardiogenic Shock Initiative (CSI):
A National Cardiogenic Shock Initiative (CSI): Insights from the Impella Quality (IQ) Program, cvad Registry and the Detroit CSI Experience William O Neill, MD, FACC Medical Director Structural Heart Disease
More informationMODULE 2 THE CLINICAL ENIGMA: RANDOMIZED TRIALS vs CLINICAL PRACTICE. Nico H. J. Pijls, MD, PhD Catharina Hospital Eindhoven The Netherlands
MODULE 2 THE CLINICAL ENIGMA: RANDOMIZED TRIALS vs CLINICAL PRACTICE Nico H. J. Pijls, MD, PhD Catharina Hospital Eindhoven The Netherlands Disclosure All presenters have a speaker agreement with Maquet
More informationVentricular tachycardia and ischemia. Martin Jan Schalij Department of Cardiology Leiden University Medical Center
Ventricular tachycardia and ischemia Martin Jan Schalij Department of Cardiology Leiden University Medical Center Disclosure: Research grants from: Boston Scientific Medtronic Biotronik Sudden Cardiac
More informationRecovering Hearts. Saving Lives.
Recovering Hearts. Saving Lives ṬM The Door to Unload (DTU) STEMI Safety & Feasibility Pilot Trial November 218 Recovering Hearts. Saving Lives. LEGAL DISCLAIMERS This presentation includes select slides
More informationCase Report Treatment of a Distal Left Main Trifurcation Supported by the TandemHeartì Left Ventricular Assist Device
Hellenic J Cardiol 48: 110-114, 2007 Case Report Treatment of a Distal Left Main Trifurcation Supported by the TandemHeartì Left Ventricular Assist Device STEVE RAMCHARITAR, SOPHIA VAINA, PATRICK W. SERRUYS,
More informationCARDIOGENIC SHOCK. Antonio Pesenti. Università degli Studi di Milano Bicocca Azienda Ospedaliera San Gerardo Monza (MI)
CARDIOGENIC SHOCK Antonio Pesenti Università degli Studi di Milano Bicocca Azienda Ospedaliera San Gerardo Monza (MI) Primary myocardial dysfunction resulting in the inability of the heart to mantain an
More informationRhondalyn C. McLean. 2 ND YEAR RESEARCH ELECTIVE RESIDENT S JOURNAL Volume VII, A. Study Purpose and Rationale
A Randomized Clinical Study To Compare The Intra-Aortic Balloon Pump To A Percutaneous Left Atrial-To-Femoral Arterial Bypass Device For Treatment Of Cardiogenic Shock Following Acute Myocardial Infarction.
More informationThe Pathophysiology of Cardiogenic Shock Knowledge Gaps & Opportunities
The Pathophysiology of Cardiogenic Shock Knowledge Gaps & Opportunities Navin K. Kapur, MD, FACC, FSCAI, FAHA Associate Professor, Department of Medicine Interventional Cardiology & Advanced Heart Failure
More informationWhat is new in the Treatment of STEMI? Malcolm R. Bell, MBBS Mayo Clinic Rochester, MN
What is new in the Treatment of STEMI? Malcolm R. Bell, MBBS Mayo Clinic Rochester, MN October 2011 Part 2 Summary of newer antithrombotic and antiplatelet agents in STEMI Role of thrombectomy in PPCI
More informationKing s Research Portal
King s Research Portal DOI: 10.15420/icr.2016.11.1.39 Document Version Peer reviewed version Link to publication record in King's Research Portal Citation for published version (APA): Joseph, J., Patterson,
More informationApproach to Multi Vessel disease with STEMI
Approach to Multi Vessel disease with STEMI MANAGEMENT OF ST-ELEVATION MYOCARDIAL INFARCTION Dr. Thomas Alexander, M.D; D.M; F.A.C.C. Senior Consultant and Interventional Cardiologist Kovai Medical Centre
More informationImages have been removed from the PowerPoint slides in this handout due to copyright restrictions.
Percutaneous Coronary Intervention https://www.youtube.com/watch?v=bssqnhylvma Types of PCI Procedures Balloon Angioplasty Rotational Atherectomy Coronary Stent Balloon Inflation Rotational Atherectomy
More informationAcute heart failure: ECMO Cardiology & Vascular Medicine 2012
Acute heart failure: ECMO Cardiology & Vascular Medicine 2012 Lucia Jewbali cardiologist-intensivist 14 beds/8 ICU beds Acute coronary syndromes Heart failure/ Cardiogenic shock Post cardiotomy Heart
More informationCardiogenic shock (CS) remains
The Impella 2.5 and 5.0 devices for ST-elevation myocardial infarction patients presenting with severe and profound cardiogenic shock: The Academic Medical Center intensive care unit experience* Annemarie
More informationSubsequent management and therapies
ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation Subsequent management and therapies Marco Valgimigli, MD, PhD University of Ferrara ITALY
More informationเอกราช อร ยะช ยพาณ ชย
30 July 2016 เอกราช อร ยะช ยพาณ ชย Heart Failure and Transplant Cardiology aekarach.a@chula.ac.th Disclosure Speaker, CME service: Merck, Otsuka, Servier Consultant, non-cme service: Novartis, Menarini
More informationECMELLA. Associate Prof. Dirk Westermann, MD, PhD. Department of General and Interventional Cardiology Hamburg, Germany. Department of Medicine
ACS in Women ECMELLA Combined Impella and ECMO in Cardiogenic Shock Prof. Peter Clemmensen, MD, DMSc, FESC, FSCAI Associate Prof. Dirk Westermann, MD, PhD University Heart Center Hamburg-Eppendorf Department
More informationExtra Corporeal Life Support for Acute Heart failure
Extra Corporeal Life Support for Acute Heart failure Benjamin Medalion, MD Director Heart and Lung Transplantation Department of Cardiothoracic Surgery Rabin Medical Center, Beilinson Campus, Israel Mechanical
More informationCardiogenic Shock Protocol
Cardiogenic Shock Protocol Impella Devices Best Practices in AMI Cardiogenic Shock Identify 1-3 SBP < 90 mmhg or on inotropes /pressors Cold, clammy, tachycardia Lactate elevated > 2 mmoi /L Stabilize
More informationMechanical circulatory support in cardiogenic shock
European Heart Journal (2014) 35, 156 167 doi:10.1093/eurheartj/eht248 REVIEW Novel devices Mechanical circulatory support in cardiogenic shock Karl Werdan 1 *, Stephan Gielen 1, Henning Ebelt 1, and Judith
More informationCan Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO!
Can Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO! Young-Hak Kim, MD, PhD Heart Institute, University of Ulsan College of Medicine Asan Medical Center,
More informationBY AMAR R. CHADAGA, MD, AND TIMOTHY A. SANBORN, MD
Percutaneous Coronary Intervention in Cardiogenic Shock A review of the current and evolving percutaneous interventions. BY AMAR R. CHADAGA, MD, AND TIMOTHY A. SANBORN, MD Cardiogenic shock represents
More informationCARDIOGENIC SHOCK 2017 Eric Adler MD Associate Clinical Professor, UCSD
CARDIOGENIC SHOCK 2017 Eric Adler MD Associate Clinical Professor, UCSD CARDIOGENIC SHOCK Definition INADEQUATE TISSUE PERFUSION RESULTING FROM CARDIAC DYSFUNCITON IN SETTING OF EUVOLEMIA HEMODYAMIC
More informationHow to approach non-infarct related artery disease in patients with STEMI in a limited resource setting
How to approach non-infarct related artery disease in patients with STEMI in a limited resource setting Ahmed A A Suliman, MBBS, FACP, FESC Associate Professor, University of Khartoum Interventional Cardiologist,
More informationMechanical Circulatory Support (MCS): What Every Pharmacist Needs to Know!
Mechanical Circulatory Support (MCS): What Every Pharmacist Needs to Know! Matthew A. Wanat, PharmD, BCPS, BCCCP, FCCM Clinical Assistant Professor University of Houston College of Pharmacy Clinical Pharmacy
More informationCULPRIT-SHOCK: A Randomized Trial of Multivessel PCI in Cardiogenic Shock. Holger Thiele, MD on behalf of the CULPRIT-SHOCK Investigators
CULPRIT-SHOCK: A Randomized Trial of Multivessel PCI in Cardiogenic Shock Holger Thiele, MD on behalf of the CULPRIT-SHOCK Investigators Disclosure Statement of Financial Interest Within the past 12 months,
More informationDefinition. Low-cardiac-output state resulting in life threatening end-organ hypoperfusion. Criteria: MAP 30 mm Hg lower than baseline)
Definition Low-cardiac-output state resulting in life threatening end-organ hypoperfusion Criteria: 1. Persistent hypotension (SBP
More informationFacilitated Percutaneous Coronary Intervention in Acute Myocardial Infarction. Is it beneficial to patients?
Facilitated Percutaneous Coronary Intervention in Acute Myocardial Infarction Is it beneficial to patients? Seung-Jea Tahk, MD. PhD. Suwon, Korea Facilitated PCI.. background Degree of coronary flow at
More informationEcho assessment of patients with an ECMO device
Echo assessment of patients with an ECMO device Evangelos Leontiadis Cardiologist 1st Cardiology Dept. Onassis Cardiac Surgery Center Athens, Greece Gibbon HLM 1953 Goldstein DJ et al, NEJM 1998; 339:1522
More information27th Annual ELSO Conference San Diego, CA
27th Annual ELSO Conference San Diego, CA VA ECMO in the cath lab best timing? Impella or ECMO? Michael R. Mooney, MD, FACC, FSCAI, FAHA Director, Coronary Therapeutics Minneapolis Heart Institute at Abbott
More informationManagement of High-Risk Coronary Artery Disease
Management of High-Risk Coronary Artery Disease Jeffrey J. Popma, MD Director, Interventional Cardiology Clinical Services Beth Israel Deaconess Medical Center Associate Professor of Medicine Harvard Medical
More informationM/39 CC D. => peak CKMB (12 hr later) ng/ml T.chol/TG/HDL/LDL 180/150/48/102 mg/dl #
Acute Coronary Syndrome - Case Review - Young-Guk Ko, MD Yonsei Cardiovascular Center Yonsei University College of Medicine Case 1 M/39 #4306212 CC D : Severe squeezing chest pain : 4 hours, aggravated
More informationVentricular Assisting Devices in the Cathlab. Unrestricted
Ventricular Assisting Devices in the Cathlab Unrestricted What is a VAD? A single system device that is surgically attached to the left ventricle of the heart and to the aorta for left ventricular support
More informationIschemic Heart Disease Interventional Treatment
Ischemic Heart Disease Interventional Treatment Cardiac Catheterization Laboratory Procedures (N = 89) is a regional and national referral center for percutaneous coronary intervention (PCI). A total of
More informationLi Xu 1, MD, Hao Sun 1, MD, Le-Feng Wang 1, MD, Xin-Chun Yang 1, MD, Kui-Bao Li 1, MD, Da-Peng Zhang 1, MD, Hong-Shi Wang 1, MD, Wei-Ming Li 1, MD
Singapore Med J 2016; 57(7): 396-400 doi: 10.11622/smedj.2016121 Long-term prognosis of patients with acute myocardial infarction due to unprotected left main coronary artery disease: a single-centre experience
More information4/22/2016 Updated. AllinaHealthSystem. Cardiogenic Shock: Definition. No Disclosures. Cardiogenic Shock: Declining (But Still High) Case Fatality Rate
4/22/216 Updated Definition End-organ hypoperfusion secondary to cardiac failure Advanced Cardiopulmonary Support for the Critically Ill Adult April 22, 216 Cardiogenic Shock Michael A. Samara, MD FACC
More informationConsensus Core Set: Cardiovascular Measures Version 1.0
Consensus Core Set: Cardiovascular s NQF 0330 Hospital 30-day, all-cause, riskstandardized readmission rate (RSRR) following heart failure hospitalization 0229 Hospital 30-day, all-cause, riskstandardized
More informationWhich mechanical assistance for cardiogenic shock?
Which mechanical assistance for cardiogenic shock? Alain Combes, MD, PhD, Hôpital Pitié-Salpêtrière, AP-HP Inserm UMRS 1166, ican, Institute of Cardiometabolism and Nutrition Pierre et Marie Curie Sorbonne
More informationSTEMI Stents What next? Arshad Khan - HNE Clinical Research Fellow. Supervisors: Prof Boyle and Attia.
STEMI Stents What next? Arshad Khan - HNE Clinical Research Fellow. Supervisors: Prof Boyle and Attia. PART 1 Systems of care for STEMI. STEMI Management Coronary angiogram +/- stenting. Prehospital thrombolysis
More informationEmergency surgery in acute coronary syndrome
Emergency surgery in acute coronary syndrome Teerawoot Jantarawan Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
More information