Coronary revascularization and circulatory support strategies in patients with myocardial infarction, multi-vessel coronary artery disease, and cardiogenic shock: Insights from an international survey - 19/06/20
, Aubrey C. Galloway, MD c, E. Magnus Ohman, MD d, Sunil V. Rao, MD d, Sripal Bangalore, MD, MHA a, Stuart D. Katz, MD a, Judith S. Hochman, MD aBackground |
Cardiogenic shock (CS) complicating acute myocardial infarction (MI) is associated with high mortality. In the absence of data to support coronary revascularization beyond the infarct artery and selection of circulatory support devices or medications, clinical practice may vary substantially.
Methods |
We distributed a survey to interventional cardiologists and cardiothoracic surgeons through relevant professional societies to determine contemporary coronary revascularization and circulatory support strategies for MI with CS and multi-vessel coronary artery disease (CAD).
Results |
A total of 143 participants completed the survey between 1/2019 and 8/2019. Overall, 55.2% of participants reported that the standard approach to coronary revascularization was single vessel PCI of the infarct related artery (IRA) with staged PCI of non-culprit lesions. Single vessel PCI of the IRA only (28.0%), emergency multi-vessel PCI (11.9%), and coronary artery bypass grafting (CABG) (4.9%) were standard approaches at some centers. A plurality of survey respondents (46.9%) believed initial PCI with staged CABG for multi-vessel CAD would be associated with the most favorable outcomes. A minority of respondents believed PCI-only strategies (23.1%) and CABG alone (6.3%) provided optimal care, and 23.1% were unsure of the best strategy. After PCI for CS, Impella (76.9%), intra-aortic balloon pump (IABP) (12.8%), and extra-corporeal membrane oxygenation (ECMO) (7.7%) were preferred. After CABG, IABP (34.3%), Impella (32.2%), and ECMO (28%) were preferred.
Conclusions |
This survey indicates substantial heterogeneity in clinical care in CS. There is evidence of provider uncertainty and clinical equipoise regarding the optimal management of patients with MI, multi-vessel CAD, and CS.
Short abstract |
We sought to determine contemporary practice patterns of coronary revascularization and circulatory support in patients with MI, multi-vessel coronary artery disease (CAD), and cardiogenic shock. A survey was distributed to interventional cardiologists and cardiothoracic surgeons through relevant professional societies. Survey respondents identified substantial heterogeneity in clinical care and evidence of provider uncertainty and clinical equipoise regarding the optimal management of patients with MI, multi-vessel CAD, and CS.
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| David R. Holmes, MD, served as guest editor for this article. |
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| Disclosures: Dr Bangalore is on advisory boards for Abbott Vascular, Biotronik, Meril, Pfizer, and Amgen and has received research grants from Abbott Vascular. The other authors report no relationships that could be construed as a conflict of interest. |
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| Sponsor/Funding: Dr Smilowitz is supported in part by an NYU CTSA grant, UL1 TR001445 and KL2 TR001446, from the National Center for Advancing Translational Sciences, National Institutes of Health. |
Vol 225
P. 55-59 - juillet 2020 Retour au numéro
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