To analyze the use and impact of the intra-aortic balloon pump (IABP) upon the 30-day mortality rate and short-term clinical outcome of non-selected patients with ST-elevation acute myocardial ...infarction (acute STEMI) complicated by cardiogenic shock (CS).
A single-center retrospective case-control study was carried out.
Coronary Care Unit.
Data were collected from 825 consecutive patients with acute STEMI admitted to a Coronary Care Unit from January 2009 to August 2015. Seventy-three patients with CS upon admission subjected to emergency percutaneous coronary intervention (PCI) were finally included in the analysis and were stratified according to IABP use (44 patients receiving IABP).
Cardiovascular history, hemodynamic situation upon admission, angiographic and procedural characteristics, and variables derived from admission to the Coronary Care Unit.
Cumulative 30-day mortality was similar in the patients subjected to IABP and in those who received conventional medical therapy only (29.5% and 27.6%, respectively; HR with IABP 1.10, 95% CI 0.38-3.11; p=0.85). Similarly, no significant differences were found in terms of the short-term clinical outcome between the groups: time on mechanical ventilation, days to hemodynamic stabilization, vasoactive drug requirements and stay in the Coronary Care Unit. Poorer renal function (HR 3.9, 95% CI 1.4-10.6; p=0.008), known peripheral artery disease (HR 3.3, 95% CI 1.2-9.1; p=0.019) and a history of diabetes mellitus (HR 3.2, 95% CI 1.2-8.1; p=0.018) were the only variables independently associated to increased 30-day mortality.
In our "real life" experience, IABP does not modify 30-day mortality or the short-term clinical outcome in patients presenting STEMI complicated with CS and subjected to emergency percutaneous coronary revascularization.
Abstract Objective To analyze the use and impact of the intra-aortic balloon pump (IABP) upon the 30-day mortality rate and short-term clinical outcome of non-selected patients with ST-elevation ...acute myocardial infarction (acute STEMI) complicated by cardiogenic shock (CS). Design A single-center retrospective case–control study was carried out. Setting Coronary Care Unit. Patients Data were collected from 825 consecutive patients with acute STEMI admitted to a Coronary Care Unit from January 2009 to August 2015. Seventy-three patients with CS upon admission subjected to emergency percutaneous coronary intervention (PCI) were finally included in the analysis and were stratified according to IABP use (44 patients receiving IABP). Variables Cardiovascular history, hemodynamic situation upon admission, angiographic and procedural characteristics, and variables derived from admission to the Coronary Care Unit. Results Cumulative 30-day mortality was similar in the patients subjected to IABP and in those who received conventional medical therapy only (29.5% and 27.6%, respectively; HR with IABP 1.10, 95% CI 0.38–3.11; p = 0.85). Similarly, no significant differences were found in terms of the short-term clinical outcome between the groups: time on mechanical ventilation, days to hemodynamic stabilization, vasoactive drug requirements and stay in the Coronary Care Unit. Poorer renal function (HR 3.9, 95% CI 1.4–10.6; p = 0.008), known peripheral artery disease (HR 3.3, 95% CI 1.2–9.1; p = 0.019) and a history of diabetes mellitus (HR 3.2, 95% CI 1.2–8.1; p = 0.018) were the only variables independently associated to increased 30-day mortality. Conclusion In our “real life” experience, IABP does not modify 30-day mortality or the short-term clinical outcome in patients presenting STEMI complicated with CS and subjected to emergency percutaneous coronary revascularization.
Aims
Fluoroscopy is the standard and almost unique tool used for cardiac imaging during permanent pacemaker implantation, and its use implies exposure of patients and operators to radiation. The ...usefulness for this purpose of electroanatomic systems not based on fluoroscopy is unknown. Our aim was to study the feasibility of implanting single-lead VDD pacemakers without the use of fluoroscopy.
Methods and results
EnSite NavX®, a catheter navigation tool based on the creation of a voltage gradient across the thorax of the patient, was used as an exclusive imaging tool during the implantation of single-lead atrioventricular (VDD) permanent pacemakers in 15 consecutive patients with atrioventricular block and normal sinus node function. A retrospective series of 15 consecutive patients in whom VDD pacemakers were implanted under fluoroscopic guidance was used as a control group. The pacemaker could be implanted in all patients. Time spent to obtain the right ventricle anatomy was 10.1 ± 5.4 min and time to place the lead in an adequate position was 10.1 ± 7.8 min. Total implant time was 59.3 ± 15.6 min (51.5 ± 12.3 min in the control group; P = 0.14). In one patient, a short pulse of radioscopy was needed for a correct catheterization of the subclavian vein. No complications were observed during the procedure. One lead dislodgement that required re-operation was detected 24 h after implantation. At 3 months follow-up, all pacemakers were functioning properly, with adequate pacing and sensing thresholds.
Conclusion
Electroanatomic navigation systems such as NavX can be used for cardiac imaging during single-lead atrioventricular pacemaker implantation as a reliable and safe alternative to fluoroscopy.
Fluoroscopic guidance is the standard tool used for transvenous pacemaker implantations and for electrophysiological and ablation procedures. It implies X‐ray exposure, occasionally with high dose of ...radiation for the patient and operator. We describe the case of a 47‐year‐old man with uncontrollable permanent atrial fibrillation to whom ablation of the AV conduction and a permanent ventricular pacemaker implantation were successfully performed under the guidance of an electroanatomic navigation EnSite NavX® system and with no use of fluoroscopy. This case illustrates the stand‐alone use of one of the new non‐fluoroscopic navigation systems for a complete procedure such as AV ablation and pacemaker implantation.
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