Download PDF
Aktuelle Kardiologie 2019; 8(04): 286-292
DOI: 10.1055/a-0938-3104
Kurzübersicht
Georg Thieme Verlag KG Stuttgart · New York

Myokardrevaskularisierung im infarktbedingten kardiogenen Schock

Myocardial Revascularization in Infarct-related Cardiogenic Shock
Anne Freund
Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig – Universität Leipzig
,
Steffen Desch
Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig – Universität Leipzig
,
Holger Thiele
Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig – Universität Leipzig
› Author Affiliations
Further Information

Publication History

Publication Date:
15 August 2019 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Circa 10% der Patienten mit akutem Myokardinfarkt entwickeln einen kardiogenen Schock. Der wichtigste Eckpfeiler zur Therapie des infarktbedingten Schockes ist die frühzeitige Revaskularisierung. Es konnte in randomisierten Studien eine signifikante Verbesserung des Überlebens im Vergleich zu einer alleinigen medikamentösen Therapie belegt werden. Die perkutane Koronarintervention ist die dominierende Methode der Revaskularisierung. Bei mechanischen Komplikationen oder komplexer Koronaranatomie wird eine zeitnahe Konsultation des Heartteams empfohlen. Im Falle einer perkutanen Intervention bei koronarer Mehrgefäßerkrankung konnte in der randomisierten CULPRIT-SHOCK-Studie ein Überlebensvorteil für Patienten mit initial alleiniger Versorgung des infarktverursachenden Gefäßes im Vergleich zur sofortigen Mehrgefäßintervention gezeigt werden. Die Evidenz zu Therapieregimen bezüglich Antikoagulation und Thrombozytenaggregationshemmung ist gering.

Abstract

Acute myocardial infarction is complicated by cardiogenic shock in about 10% of patients. The most important causal treatment in these patients as shown in a randomized trial is early revascularization which is associated with improved survival in comparison to medical therapy alone. Percutaneous coronary intervention is the predominant method of revascularization in cardiogenic shock. In cases of mechanical infarct-related complications or complex coronary anatomy, early consultation of the heart team is recommended. The randomized CULRPIT-SHOCK study found that intervention of the culprit lesion only improves survival in patients with multivessel coronary artery disease compared to additional intervention of non-culprit lesions in the emergency setting. Evidence addressing anticoagulant and antiplatelet therapy in cardiogenic shock is scarce.

Was ist wichtig?

  • In ca. 10% der Fälle entwickeln Patienten mit akutem Myokardinfarkt einen kardiogenen Schock. In den meisten Fällen liegt diesem ein Linksherzversagen zugrunde.

  • Eine frühestmögliche Diagnostik und Therapie ist essenziell, um den entstehenden Circulus vitiosus der „Schockspirale“ zu durchbrechen. Die wichtigste Therapiesäule stellt die frühestmögliche Durchführung einer koronaren Revaskularisierung dar.

  • Bei 70 – 80% der Patienten mit infarktbedingtem Schock besteht eine koronare Mehrgefäßerkrankung. In diesen Fällen sollte im akuten Setting lediglich das infarktverursachende Gefäß („Culprit Lesion“) wiedereröffnet werden.

Schlüsselwörter

akuter Myokardinfarkt - Revaskularisierung - kardiogener Schock

Key words

acute myocardial infarction - revascularization - cardiogenic shock
 

  • Literatur

  • 1 Aissaoui N, Puymirat E, Tabone X. et al. Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: a report from the USIK 1995, USIC 2000, and FAST-MI French nationwide Registries. Eur Heart J 2012; 33: 2535-2543 doi:10.1093/eurheartj/ehs264
    CrossrefPubMedGoogle Scholar
  • 2 Backhaus T, Fach A, Schmucker J. et al. Management and predictors of outcome in unselected patients with cardiogenic shock complicating acute ST-segment elevation myocardial infarction: results from the Bremen STEMI Registry. Clin Res Cardiol 2018; 107: 371-379 doi:10.1007/s00392-017-1192-0
    CrossrefPubMedGoogle Scholar
  • 3 Jeger RV, Radovanovic D, Hunziker PR. et al. Ten-year incidence and treatment of cardiogenic shock. Ann Intern Med 2008; 149: 618-626
    CrossrefPubMedGoogle Scholar
  • 4 Rathod KS, Koganti S, Iqbal MB. et al. Contemporary trends in cardiogenic shock: Incidence, intra-aortic balloon pump utilisation and outcomes from the London Heart Attack Group. Eur Heart J Acute Cardiovasc Care 2018; 7: 16-27 doi:10.1177/2048872617741735
    CrossrefPubMedGoogle Scholar
  • 5 Thiele H, Allam B, Chatellier G. et al. Shock in acute myocardial infarction: the Cape Horn for trials?. Eur Heart J 2010; 31: 1828-1835 doi:10.1093/eurheartj/ehq220
    CrossrefPubMedGoogle Scholar
  • 6 Thiele H, Zeymer U, Neumann FJ. et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367: 1287-1296 doi:10.1056/NEJMoa1208410
    CrossrefPubMedGoogle Scholar
  • 7 Thiele H, Akin I, Sandri M. et al. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock. N Engl J Med 2017; 377: 2419-2432 doi:10.1056/NEJMoa1710261
    CrossrefPubMedGoogle Scholar
  • 8 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. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?. J Am Coll Cardiol 2000; 36 (Suppl. 01) 1063-1070 doi:10.1016/S0735-1097(00)00879-2
    CrossrefPubMedGoogle Scholar
  • 9 Rao SV, Jollis JG, Harrington RA. et al. Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA 2004; 292: 1555-1562 doi:10.1001/jama.292.13.1555
    CrossrefPubMedGoogle Scholar
  • 10 Hochman JS, Sleeper LA, Webb JG. et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 1999; 341: 625-634
    CrossrefPubMedGoogle Scholar
  • 11 Hochman JS, Sleeper LA, Webb JG. et al. Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA 2006; 295: 2511-2515
    CrossrefPubMedGoogle Scholar
  • 12 Jeger RV, Harkness SM, Ramanathan K. et al. Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry. Eur Heart J 2006; 27: 664-670 doi:10.1093/eurheartj/ehi729
    CrossrefPubMedGoogle Scholar
  • 13 Zeymer U, Vogt A, Zahn R. et al. Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI); Results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK). Eur Heart J 2004; 25: 322-328 doi:10.1016/j.ehj.2003.12.008
    CrossrefPubMedGoogle Scholar
  • 14 Neumann FJ, Sousa-Uva M, Ahlsson A. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2019; 40: 87-165 doi:10.1093/eurheartj/ehy394
    CrossrefPubMedGoogle Scholar
  • 15 van Diepen S, Katz JN, Albert NM. et al. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2017; 136: e232 doi:10.1161/CIR.0000000000000525
    CrossrefPubMedGoogle Scholar
  • 16 Ibanez B, James S, Agewall S. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119-177 doi:10.1093/eurheartj/ehx393
    CrossrefPubMedGoogle Scholar
  • 17 Thiele H, Ohman EM, Desch S. et al. Management of cardiogenic shock. Eur Heart J 2015; 36: 1223-1230 doi:10.1093/eurheartj/ehv051
    CrossrefPubMedGoogle Scholar
  • 18 Sanborn TA, Sleeper LA, Webb JG. et al. Correlates of one-year survival in patients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial. J Am Coll Cardiol 2003; 42: 1373-1379
    CrossrefPubMedGoogle Scholar
  • 19 Thiele H, Akin I, Sandri M. et al. One-Year Outcomes after PCI Strategies in Cardiogenic Shock. N Engl J Med 2018; 379: 1699-1710 doi:10.1056/NEJMoa1808788
    CrossrefPubMedGoogle Scholar
  • 20 Jolly SS, Yusuf S, Cairns J. et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet 2011; 377: 1409-1420 doi:10.1016/S0140-6736(11)60404-2
    CrossrefPubMedGoogle Scholar
  • 21 Romagnoli E, Biondi-Zoccai G, Sciahbasi A. et al. Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study. J Am Coll Cardiol 2012; 60: 2481-2489 doi:10.1016/j.jacc.2012.06.017
    CrossrefPubMedGoogle Scholar
  • 22 Valgimigli M, Gagnor A, Calabro P. et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet 2015; 385: 2465-2476 doi:10.1016/S0140-6736(15)60292-6
    CrossrefPubMedGoogle Scholar
  • 23 Pancholy SB, Palamaner Subash Shantha G, Romagnoli E. et al. Impact of access site choice on outcomes of patients with cardiogenic shock undergoing percutaneous coronary intervention: A systematic review and meta-analysis. Am Heart J 2015; 170: 353-361 doi:10.1016/j.ahj.2015.05.001
    CrossrefPubMedGoogle Scholar
  • 24 Thiele H, Zeymer U, Neumann FJ. et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 2013; 382: 1638-1645 doi:10.1016/S0140-6736(13)61783-3
    CrossrefPubMedGoogle Scholar
  • 25 Karagiannidis C, Brodie D, Strassmann S. et al. Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med 2016; 42: 889-896
    CrossrefPubMedGoogle Scholar
  • 26 Thiele H, Jobs A, Ouweneel DM. et al. Percutaneous short-term active mechanical support devices in cardiogenic shock: a systematic review and collaborative meta-analysis of randomized trials. Eur Heart J 2017; 38: 3523-3531
    CrossrefPubMedGoogle Scholar
  • 27 Bonello L, De Labriolle A, Roy P. et al. Bivalirudin with provisional glycoprotein IIb/IIIa inhibitors in patients undergoing primary angioplasty in the setting of cardiogenic shock. Am J Cardiol 2008; 102: 287-291 doi:10.1016/j.amjcard.2008.03.052
    CrossrefPubMedGoogle Scholar
  • 28 Antoniucci D, Valenti R, Migliorini A. et al. Abciximab therapy improves survival in patients with acute myocardial infarction complicated by early cardiogenic shock undergoing coronary artery stent implantation. Am J Cardiol 2002; 90: 353-357
    CrossrefPubMedGoogle Scholar
  • 29 Chan AW, Chew DP, Bhatt DL. et al. Long-term mortality benefit with the combination of stents and abciximab for cardiogenic shock complicating acute myocardial infarction. Am J Cardiol 2002; 89: 132-136 doi:10.1016/S0002-9149(01)02188-9
    CrossrefPubMedGoogle Scholar
  • 30 Huang R, Sacks J, Thai H. et al. Impact of stents and abciximab on survival from cardiogenic shock treated with percutaneous coronary intervention. Catheter Cardiovasc Interv 2005; 65: 25-33 doi:10.1002/ccd.20334
    CrossrefPubMedGoogle Scholar
  • 31 Wiviott SD, Braunwald E, McCabe CH. et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007; 357: 2001-2015 doi:10.1056/NEJMoa0706482
    CrossrefPubMedGoogle Scholar
  • 32 Wallentin L, Becker RC, Budaj A. et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009; 361: 1045-1057 doi:10.1056/NEJMoa0904327
    CrossrefPubMedGoogle Scholar
  • 33 Orban M, Limbourg T, Neumann FJ. et al. ADP receptor antagonists in patients with acute myocardial infarction complicated by cardiogenic shock: a post hoc IABP-SHOCK II trial subgroup analysis. EuroIntervention 2016; 12: e1395 doi:10.4244/EIJY15M12_04
    CrossrefPubMedGoogle Scholar
  • 34 Orban M, Mayer K, Morath T. et al. Prasugrel vs. clopidogrel in cardiogenic shock patients undergoing primary PCI for acute myocardial infarction. Results of the ISAR-SHOCK registry. Thromb Haemost 2014; 112: 1190-1197 doi:10.1160/TH14-06-0489
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Parodi G, Xanthopoulou I, Bellandi B. et al. Ticagrelor crushed tablets administration in STEMI patients: the MOJITO study. J Am Coll Cardiol 2015; 65: 511-512 doi:10.1016/j.jacc.2014.08.056
    CrossrefPubMedGoogle Scholar
  • 36 Bhatt DL, Stone GW, Mahaffey KW. et al. Effect of platelet inhibition with cangrelor during PCI on ischemic events. N Engl J Med 2013; 368: 1303-1313 doi:10.1056/NEJMoa1300815
    CrossrefPubMedGoogle Scholar