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Vasoactive pharmacological management according to SCAI class in patients with acute myocardial infarction and cardiogenic shock
BACKGROUND: Vasoactive treatment is a cornerstone in treating hypoperfusion in cardiogenic shock following acute myocardial infarction (AMICS). The purpose was to compare the achievement of treatment targets and outcome in relation to vasoactive strategy in AMICS patients stratified according to the...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9352108/ https://www.ncbi.nlm.nih.gov/pubmed/35925990 http://dx.doi.org/10.1371/journal.pone.0272279 |
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author | Udesen, Nanna Louise Junker Helgestad, Ole Kristian Lerche Josiassen, Jakob Hassager, Christian Højgaard, Henrik Frederiksen Linde, Louise Kjaergaard, Jesper Holmvang, Lene Jensen, Lisette Okkels Schmidt, Henrik Ravn, Hanne Berg Møller, Jacob Eifer |
author_facet | Udesen, Nanna Louise Junker Helgestad, Ole Kristian Lerche Josiassen, Jakob Hassager, Christian Højgaard, Henrik Frederiksen Linde, Louise Kjaergaard, Jesper Holmvang, Lene Jensen, Lisette Okkels Schmidt, Henrik Ravn, Hanne Berg Møller, Jacob Eifer |
author_sort | Udesen, Nanna Louise Junker |
collection | PubMed |
description | BACKGROUND: Vasoactive treatment is a cornerstone in treating hypoperfusion in cardiogenic shock following acute myocardial infarction (AMICS). The purpose was to compare the achievement of treatment targets and outcome in relation to vasoactive strategy in AMICS patients stratified according to the Society of Cardiovascular Angiography and Interventions (SCAI) shock classification. METHODS: Retrospective analysis of patients with AMICS admitted to cardiac intensive care unit at two tertiary cardiac centers during 2010–2017 with retrieval of real-time hemodynamic data and dosages of vasoactive drugs from intensive care unit databases. RESULTS: Out of 1,249 AMICS patients classified into SCAI class C, D, and E, mortality increased for each shock stage from 34% to 60%, and 82% (p<0.001). Treatment targets of mean arterial blood pressure > 65mmHg and venous oxygen saturation > 55% were reached in the majority of patients; however, more patients in SCAI class D and E had values below treatment targets within 24 hours (p<0.001) despite higher vasoactive load and increased use of epinephrine for each severity stage (p<0.001). In univariate analysis no significant difference in mortality within SCAI class D and E regarding vasoactive strategy was observed, however in SCAI class C, epinephrine was associated with higher mortality and a significantly higher vasoactive load to reach treatment targets. In multivariate analysis there was no statistically association between individually vasoactive choice within each SCAI class and 30-day mortality. CONCLUSION: Hemodynamic treatment targets were achieved in most patients at the expense of increased vasoactive load and more frequent use of epinephrine for each shock severity stage. Mortality was high regardless of vasoactive strategy; only in SCAI class C, epinephrine was associated with a significantly higher mortality, but the signal was not significant in adjusted analysis. |
format | Online Article Text |
id | pubmed-9352108 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-93521082022-08-05 Vasoactive pharmacological management according to SCAI class in patients with acute myocardial infarction and cardiogenic shock Udesen, Nanna Louise Junker Helgestad, Ole Kristian Lerche Josiassen, Jakob Hassager, Christian Højgaard, Henrik Frederiksen Linde, Louise Kjaergaard, Jesper Holmvang, Lene Jensen, Lisette Okkels Schmidt, Henrik Ravn, Hanne Berg Møller, Jacob Eifer PLoS One Research Article BACKGROUND: Vasoactive treatment is a cornerstone in treating hypoperfusion in cardiogenic shock following acute myocardial infarction (AMICS). The purpose was to compare the achievement of treatment targets and outcome in relation to vasoactive strategy in AMICS patients stratified according to the Society of Cardiovascular Angiography and Interventions (SCAI) shock classification. METHODS: Retrospective analysis of patients with AMICS admitted to cardiac intensive care unit at two tertiary cardiac centers during 2010–2017 with retrieval of real-time hemodynamic data and dosages of vasoactive drugs from intensive care unit databases. RESULTS: Out of 1,249 AMICS patients classified into SCAI class C, D, and E, mortality increased for each shock stage from 34% to 60%, and 82% (p<0.001). Treatment targets of mean arterial blood pressure > 65mmHg and venous oxygen saturation > 55% were reached in the majority of patients; however, more patients in SCAI class D and E had values below treatment targets within 24 hours (p<0.001) despite higher vasoactive load and increased use of epinephrine for each severity stage (p<0.001). In univariate analysis no significant difference in mortality within SCAI class D and E regarding vasoactive strategy was observed, however in SCAI class C, epinephrine was associated with higher mortality and a significantly higher vasoactive load to reach treatment targets. In multivariate analysis there was no statistically association between individually vasoactive choice within each SCAI class and 30-day mortality. CONCLUSION: Hemodynamic treatment targets were achieved in most patients at the expense of increased vasoactive load and more frequent use of epinephrine for each shock severity stage. Mortality was high regardless of vasoactive strategy; only in SCAI class C, epinephrine was associated with a significantly higher mortality, but the signal was not significant in adjusted analysis. Public Library of Science 2022-08-04 /pmc/articles/PMC9352108/ /pubmed/35925990 http://dx.doi.org/10.1371/journal.pone.0272279 Text en © 2022 Udesen et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Udesen, Nanna Louise Junker Helgestad, Ole Kristian Lerche Josiassen, Jakob Hassager, Christian Højgaard, Henrik Frederiksen Linde, Louise Kjaergaard, Jesper Holmvang, Lene Jensen, Lisette Okkels Schmidt, Henrik Ravn, Hanne Berg Møller, Jacob Eifer Vasoactive pharmacological management according to SCAI class in patients with acute myocardial infarction and cardiogenic shock |
title | Vasoactive pharmacological management according to SCAI class in patients with acute myocardial infarction and cardiogenic shock |
title_full | Vasoactive pharmacological management according to SCAI class in patients with acute myocardial infarction and cardiogenic shock |
title_fullStr | Vasoactive pharmacological management according to SCAI class in patients with acute myocardial infarction and cardiogenic shock |
title_full_unstemmed | Vasoactive pharmacological management according to SCAI class in patients with acute myocardial infarction and cardiogenic shock |
title_short | Vasoactive pharmacological management according to SCAI class in patients with acute myocardial infarction and cardiogenic shock |
title_sort | vasoactive pharmacological management according to scai class in patients with acute myocardial infarction and cardiogenic shock |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9352108/ https://www.ncbi.nlm.nih.gov/pubmed/35925990 http://dx.doi.org/10.1371/journal.pone.0272279 |
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