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Archives of cardiovascular diseases
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 20 février 2020
Doi : 10.1016/j.acvd.2019.12.005
Received : 17 June 2019 ;  accepted : 2 December 2019
New insights into cardiogenic shock and coronary revascularization after acute myocardial infarction
Actualités de la revascularisation coronaire après choc cardiogénique secondaire à un infarctus aigu du myocarde
 

Edouard Gerbaud a, b, Meyer Elbaz c, , Benoit Lattuca d
a Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 33600 Pessac, France 
b Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, 33000 Bordeaux, France 
c Department of Cardiology, CARDIOMET Institute, Rangueil Medical School, University Paul Sabatier, 31059 Toulouse, France 
d Cardiology Department, Caremeau University Hospital, ACTION Study Group, Montpellier University, 30029 Nîmes, France 

Corresponding author at: Cardiology Department, Toulouse University Hospital, avenue J. Poulhes, 31059 Toulouse cedex, France.Cardiology Department, Toulouse University Hospital, avenue J. PoulhesToulouse cedex31059France
Graphical abstract

Cardiogenic shock management and guidelines. The green boxes represent class I recommendations and the orange boxes represent class II recommendations from the European Society of Cardiology guidelines; the grey boxes represent management suggestions from the authors based on data presented in this review. ACS: acute coronary syndrome; LVEF: left ventricular ejection fraction; NSTEMI: non-ST-segment elevation myocardial infarction; PCI: percutaneous coronary intervention; STEMI: ST-segment elevation myocardial infarction; UFH: unfractionated heparin.

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Summary

Cardiogenic shock complicating acute myocardial infarction is challenging, and continues to be associated with high rates of in-hospital and long-term mortality. Coronary revascularization is critical for improving prognosis in CS. Thus, a systematic protocol-driven approach to cardiogenic shock, the development of specialized cardiac care centres, technical advances in interventional cardiology enabling treatment of more complex and severe lesions, the availability of recent antithrombotic therapies and the evolution of new haemodynamic support devices are important considerations in current management of cardiogenic shock complicating acute ischaemic heart disease. Despite these potentially meaningful developments, several substantial gaps in knowledge still exist regarding optimal coronary revascularization of patients with cardiogenic shock. This review will describe current principles in the revascularization of these patients, with a focus on: the time to transfer and revascularize; the choice of vascular access site; the need for complete revascularization or only a culprit lesion strategy; the optimal antithrombotic therapy; the type, place and timing of haemodynamic support; and the medical care system network.

The full text of this article is available in PDF format.
Résumé

La survenue d’un choc cardiogénique après un infarctus du myocarde aigu reste une situation clinique fréquente et grave dont le pronostic est associé à une morbi-mortalité élevée. La revascularisation coronaire peut en théorie permettre d’améliorer le devenir de ces patients mais la rapidité du transfert, la précocité du geste, les modalités ainsi que le choix et le moment d’une éventuelle assistance restent des points essentiels. En conséquence, il paraît indispensable de construire une organisation en réseau avec des protocoles de prise en charge des patients présentant un choc cardiogénique constitué ou un infarctus du myocarde avec risque évolutif rapide vers le choc. L’organisation de soins doit tendre vers le développement de centres spécialisés comportant un environnement optimal de réanimation cardiologique, de support hémodynamique, pharmacologique et chirurgical. Dans cette revue de la littérature récente, nous discuterons des principes actuels de la revascularisation, en insistant particulièrement sur: (1) les délais de mise en œuvre; (2) la voie d’abord vasculaire; (3) le caractère ciblé de la revascularisation; (4) l’environnement anti-thrombotique; (5) la place de l’assistance et notamment le type d’assistance, le moment idéal du support hémodynamique; et (6) l’organisation du réseau de soins critique.

The full text of this article is available in PDF format.

Keywords : Cardiogenic shock, Acute myocardial infarction, Coronary revascularization, Cardiac shock centre

Mots clés : Choc cardiogénique, Infarctus aigu du myocarde, Revascularisation coronaire, Réanimation cardiologique

Abbreviations : CABG, CI, CS, CTO, ESC, IABP, MI, NSTEMI, STEMI, MCS, PCI, TIMI, VA-ECMO




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