Cardiogenic shock cs is the most common cause of death for patients hospitalized with acute myocardial infarction mi. Angiopoietin2 in acute myocardial infarction complicated. The results of the intraaortic balloon pump in cardiogenic shock ii iabpshock ii trial, 1 now reported in the journal, show that in patients with acute myocardial infarction and hemodynamic. Cardiogenic shock classification baran 2019 emcrit. In the largest randomised trial iabp shock ii, iabp. There was neither improvement in 30day mortality, nor 1year mortality, nor in any of the secondary outcomes eg. The intraaortic balloon pump in cardiogenic shock ii iabpshock ii trial randomized 600 patients with acute mi complicated by cardiogenic.
The iabpshock ii trial failed to show that mechanical support with iabp improved outcomes in ami with cardiogenic. Longterm 6year outcome of the randomized iabpshock ii trial. In patients with acute mi complicated by cardiogenic shock, does an intraaortic. It is a major, and frequently fatal, complication of a variety of acute and chronic disorders, occurring most commonly following acute myocardial infarction mi. Intraaortic balloon pump in cardiogenic shock complicating acute myocardial infarction. The iabpshock ii trial failed to show that mechanical support with iabp. The iabpshock ii trial is a multicenter, randomized, open label trial. Data from the 302 patients enrolled in the randomized shock trial between april 1993 and november 1998 are presented. The trial randomised postangio patients n 600 to either iabp or no iabp. Also, previous t rials showed that the concomitant presence of hem odynamic shock plus hyperlactatemia 4.
Percutaneous coronary intervention for cardiogenic shock in. One of the new clinical trial updates we will hear about is the 1year data from the intraaortic balloon pump in cardiogenic shock ii iabp shock ii trial, an important, some would say seminal, trial in patients with cardiogenic shock and acute myocardial infarction mi. Extracorporeal life support during cardiac arrest and. In the largest randomised trial iabpshock ii, iabp support did not. Despite this rise in cardiogenic shock, the proportion of patients with cardiogenic shock who were treated using mechanical circulatory support. Acknowledgements the authors gratefully acknowledge stimulating discussions. Largest randomized mult icenter trial in cs complicating ami no significant difference primary endpoint 30day mortality 39. Therefore, public education regarding early warning signs of ami is a duty of all health care professionals. The balloon pump has been the flagship modality for treating cardiogenic shock in spite of scant evidence supporting its use. In this study, the incidence of cardiogenic shock after hospitalization was 7. In icu patients, in the absence of physical exertion, a blood lactate level 6 mmoll for more than. Intraaortic balloon pump in cardiogenic shock ii american college. A model was developed on the randomized population of the iabpshock ii trial n 600 using a stepwise multivariable cox proportional hazards regression analysis with forward selection technique. Angiopoietin2 in acute myocardial infarction complicated by.
Principles of intraaortic balloon pump counterpulsation. Intraaortic balloon pump in cardiogenic shock complicating acute. Percutaneous coronary intervention for cardiogenic shock. The primary goal of intraaortic balloon pump iabp treatment is to increase myocardial oxygen supply and decrease myocardial oxygen demand. Intraaortic balloon counterpulsation in acute myocardial. Intraaortic balloon pump in cardiogenic shock ii full text view. Objective to assess iabp efficacy in acute myocardial infarction data sources human studies found in pubmed, embase, and cochrane libraries through. Intraaortic balloon pumps in patients with cardiogenic stroke. Key takeaways this substudy of the iabpshock ii trial sought to develop an easytouse, readily available risk prediction score for shortterm mortality in patients with amirelated cs undergoing pci. Iabpshock ii trial 2012 the link above points to the evenmoreinteresting 1year followup of the iabpshockii patients. Randomized comparison of optimal medical therapy in addition. Decreased urine output after the insertion of iabp can occur because of juxtarenal balloon positioning. Haemolysis from mechanical damage to red blood cells can reduce the haematocrit by up to 5%. Iabp failed to reduce 30day mortality in patients with cardiogenic shock.
Iabp shock ii trial 2012 the link above points to the evenmoreinteresting 1year followup of the iabp shock ii patients. Despite rapid invasive treatment, circulatory support using positive inotropes and mechanical support with intraaortic balloon counterpulsation iabp, and evaluation of several new treatments during the last decade, the mortality in patients with cardiogenic shock still exceeds 50%. Patients in cardiogenic shock complicating acute myocardial infarction ami are. Cardiogenic shock, the most severe form of acute heart failure, is characterized by i myocardial contractile dysfunction resulting in the inability of the left ventricle to maintain adequate cardiac output i. Jun 25, 2007 intraaortic balloon pump in cardiogenic shock ii iabp shock ii the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Thiele h1, zeymer u, neumann fj, ferenc m, olbrich hg, hausleiter j, richardt g, hennersdorf m, empen k, fuernau g, desch s, eitel i, hambrecht r, fuhrmann j, bohm m, ebelt h, schneider s, schuler g, werdan k. However, previous trials in cardiogenic shock showed a mortality benefit only. Iabp shock ii trial and the 30day and 12month results, including the primary end point have been previously published. Oct 28, 2012 the balloon pump has been the flagship modality for treating cardiogenic shock in spite of scant evidence supporting its use. Listing a study does not mean it has been evaluated by the u. Unselected extensive univariable testing was performed including all database variables potentially associated with mortality. Nov 16, 20 however, previous trials in cardiogenic shock showed a mortality benefit only at extended followup. Iabpshock ii trial strength largest randomized shock trial 600 patients included within 32 month contemporary cs treatment 95 % revasc.
The results of the intraaortic balloon pump in cardiogenic shock ii iabp shock ii trial, 1 now reported in the journal, show that in patients with acute myocardial infarction and hemodynamic. The primary end point of the study, 30day allcause mortality, was monitored by. Intraaortic balloon pump in cardiogenic shock ii iabp. The trial design of the randomized, openlabel, multicenter iabp shock ii trial and the 30day and 12month results, including the primary end point have been previously published. Cardiogenic shock a serious complication of a heart attack myocardial infarction. In the only adequately powered randomized trial of iabp in cs secondary to myocardial infarctioniabpshock ii intraaortic balloon pump in cardiogenic shock ii trialshort and midterm followup data at 30 days and 1 year showed no survival benefit with iabp support in comparison to control, nor any benefit with respect to secondary.
Magnusohman2,steffendesch1,ingoeitel1,andsuzannedewaha1 1medical clinic ii. Time to event kaplanmeier thiele et al, lancet, 20 1 pt border to get rid of zen logo. The iabpshock ii trial is a multicenter, randomized, openlabel trial. Methods study design the trial design of the prospective, randomised, openlabel, controlled iabpshock ii trial at 37 german centres, and the 30 day results including the primary. Between june 16, 2009, and march 3, 2012, we screened 790 patients with. Mechanical circulatory support in cardiogenic shock. Randomized comparison of optimal medical therapy in. Apr 11, 2017 a model was developed on the randomized population of the iabp shock ii trial n 600 using a stepwise multivariable cox proportional hazards regression analysis with forward selection technique.
Evidence for overturning the guidelines in cardiogenic shock. In a contemporary randomized controlled trial in cs, iabpshock ii, the median dose of adrenaline was 0. The interest in the use of noncatecholamine vasopressors for the treatment of hypotension and shock has increased in recent years. Intraaortic balloon counterpulsation in acute myocardial infarction. This randomised trial concludes with what ive always thought. Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock iabp shock ii. Data extracted from this multicenter study show that, in the patients with ami, 1. Aug 06, 2019 cardiogenic shock is a physiologic state in which inadequate tissue perfusion results from cardiac dysfunction, most often systolic. Intraaortic balloon pump in cardiogenic shock ii full text. Intraaortic balloon pump in cardiogenic shock ii full.
Cardiogenic shock is a physiologic state in which inadequate tissue perfusion results from cardiac dysfunction, most often systolic. The present analysis therefore reports 6 and 12 month results. Intraaortic balloon support for myocardial infarction with. Time to event kaplanmeier lancet, 20 1 pt border to get rid of zen logo. Oct 04, 2012 intraaortic balloon support for myocardial infarction with cardiogenic shock. The use of vasopressin as an adjunctive vasopressor in shock was reinvigorated by landry and colleagues and then carefully assessed in the vasopressin versus norepinephrine infusion in patients with septic shock vasst trial. Patients ineligible for the trial were enrolled in a prospective shock registry. Differentiating acute coronary syndromes although the government statistics described above are derived from data classified according to chd and ami. Patients were randomly assigned within 12 h of shock diagnosis to initial medical. The iabpshock ii trial was a randomised, openlabel, multicentre trial. The shock trial enrolled patients in 36 centers between 1993 and 1998 68. In the largest randomised trial iabpshock ii, iabp support did not reduce 30 day mortality compared with control.
It has been interesting following the email correspondance between our hospital cardiac intensivists and cardiologists. Angiopoietin 2 ang 2 is a mediator of capillary leakage, and increased ang 2 levels were associated with poor inhospital outcome in a pilot study in cardiogenic shock cs. One of the new clinical trial updates we will hear about is the 1year data from the intraaortic balloon pump in cardiogenic shock ii iabpshock ii trial, an important, some would say seminal, trial in patients with cardiogenic shock and acute myocardial infarction mi. A new study appears to challenge the traditional assertion that. The new engl and journal of medicine 1288 n engl j med 367. Augmentation of diastolic pressure during balloon inflation contributes to the coronary circulation and the presystolic deflation of the balloon reduces the resistance to systolic output. Importance intraaortic balloon pump iabp therapy is a widely used intervention for acute myocardial infarction with cardiogenic shock. Sep 18, 2012 recently nejm published the results from the german shock ii trial. Holger thiele at the european society of cardiology congress, munich, august 27, 2012. Treatment with the intraaortic balloon pump iabp is the most common form of mechanical support for the failing heart. Longterm 6year outcome of the randomized iabp shock ii trial. Jul 04, 2012 cardiogenic shock a serious complication of a heart attack myocardial infarction. In the largest randomised trial iabp shock ii, iabp support did not reduce 30 day mortality compared with control. Intraaortic balloon pump in cardiogenic shock complicating.
Recently, the findings of the iabpshock ii trial have markedly changed recommendations on the use of the intraaortic balloon pump in patients with shock. Eligible patients had predominant left ventricular dysfunction resulting in cardiogenic shock within 36 h of mi. The study suggests intraaortic balloon pumps iabp dont work as well as we think. Cardiogenic shock complicating acute myocardial infarction. Intraaortic balloon support for myocardial infarction with cardiogenic shock. It was for these reasons that the iabp shock ii trial was designed, aiming to show that the iabp can improve. There were no significant differences in reinfarction rr 260, 95% ci.
Based upon results from the iabpshock pilot trial, the 2012 esc stemi guidelines. Iabp may improve mortality among patients with cardiogenic. Guidelines, which previously strongly recommended it, have recently undergone substantial change. Between 2009 and 2012, 600 patients with cardiogenic shock. Following the line of the iabpshock trial and the iabpshock ii trial. Clinical update management of cardiogenic shock holgerthiele1,e. The primary end point of the study, 30day allcause mortality, was monitored by the data and safety monitoring board. The use of angiotensin ii in distributive shock critical. Shock is a clinical syndrome characterised by hypotension i. Intraaortic balloon pump therapy for acute myocardial. It was for these reasons that the iabpshock ii trial was designed, aiming to show that the iabp can improve. Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock iabpshock ii. Patients with cardiogenic shock complicating acute myocardial infarction who were undergoing early revascularisation and optimum medical therapy were randomly assigned 1.
Iabpshock ii risk score american college of cardiology. The iabp shock ii trial was a randomised, openlabel, multicentre trial. Iabpshock ii hotline esc final 082012 clinical trial results. Cardiogenic shock cs is a clinical condition of inadequate tissueend organ perfusion due to cardiac dysfunction hypotension sbp 2. Intraaortic balloon support for myocardial infarction with cardiogenic.
25 1418 205 800 1142 1161 1241 327 866 723 1529 801 1605 472 625 1452 631 625 322 1423 1113 1275 476 1456 1038 995 406 276 130 753 77 699 1345 1009 330