Cardiology Letters 2012, 21(3):204-209
First use of IMPELLA 2.5 supportive circulatory system within patient with acute STEMI in cardiogenic shock, treated at first by thrombolysis and subsequently by percutaneous coronary angioplasty
- 1 Oddelenie akútnej kardiológie NÚSCH, a.s., Bratislava
- 2 Oddelenie intervenčnej kardiológie NÚSCH, a.s., Bratislava, Slovenská republika
For those patients with an acute myocardial infarction with ST elevation (STEMI) it is very important to provide treatment leading to reperfusion of the infarcted coronary artery as soon as possible. Dependent on the recommended time intervals and the accessibility of a catheterization facility, either pharmacological treatment (thrombolysis), direct - catheterization treatment - primary coronary intervention (P-PCI) or, if it is vital, urgent cardiosurgical treatment present themselves for consideration. A problem can occur if the patient goes into cardiogenic shock (CS) and only a very quick and correct decision can reverse the unfavourable progress of the disease. However, even with the application of all of these accessible solutions, hospital mortality in such patients is high, reaching somewhere around 70%, or, in very well equipped cardio centres, 50-60%. In such conditions, either the urgent installation of an intraaortic balloon pump (IABP) during the process of catheterization, or the newer and technically more demanding process - the installation of mechanical left ventricular support - can help to overturn the unfavourable prognosis. By this procedure we can increase the chances of the patient´s survival and other treatment options. In this case study we describe the unusual case of a combination of thrombolytic treatment (TL) with subsequent percutaneous angioplasty (PCI) with the support of the percutaneously inserted intracardiac IMPELLA 2.5 pump in a patient with STEMI in cardiogenic shock and rejected for acute cardiosurgical treatment.
Keywords: Impella intracardiac pump; acute myocardial infarction; cardiogenic shock -thrombolysis
Published: March 1, 2012 Show citation
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References
- Pacák J. Nové trendy v liečbe kardiogénneho šoku. Kardiol. Prax 2007;5(4):255-263.
- Sanborn TA, Sleeper LA, Jacobs AK, et al. Impact of thrombolysis, intra-aortic ballon pump counterpulsation, and their combination in cardiogenic shock camplicating acute myocardial infarction: a report from the SHOCK Trial Registry. J AM Coll Cardiol 2000; 36:1123-1129.
Go to original source... - Pacák J, Fridrich V, Zelenay J, et al. Perkutánny dočasný mechanický ľavokomorový podporný obeh Impella Recover LP 2.5 pri rizikovej perkutánnej koronárnej intervencii. Opis prvej skúsenosti na Slovensku. Cardiol 2007;16(4):172-176.
- Thiele H, Smalling RW, Schuler GC. Percutaneous left ventricular assist devices in acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 2007;28:2057-2063. Go to original source...
- Bonnefoy E, Lapostolle F, Leizorovicz A, et al. Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study. The Lancet 2002;360:825-829. Go to original source...
- Hochman JS, Buller CE, Sleeper LA, et al. Cardiogenic shock complicating acute myocardial infarction - etiologies, management and outcome: a report from the SHOCK Trial Registry. J Am Coll Cardiol 2000;36:1063-1070. Go to original source...
- Cheng JM, Den Uil CA, Hoeks SE, et al. Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials EHJ 2009;30:2102-2108. Go to original source...
- Van de Werf F, Bax J, Betrin A, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation. EHJ 2008;29:2909-2945. Go to original source...