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Infarktbedingter kardiogener Schock

Prognose und Behandlung

Infarct-related cardiogenic shock

Prognosis and treatment

  • Leitthema
  • Published:
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Zusammenfassung

Patienten mit ST-Strecken-Hebungs-Infarkt (STEMI) und Nicht-ST-Strecken-Hebungs-Infarkt (NSTEMI) erleiden in etwa 6–10 % der Fälle im Krankenhaus einem kardiogenen Schock. In den letzten Jahren scheint sich die Inzidenz aufgrund der invasiven Diagnostik und Therapie nach Myokardinfarkt zu reduzieren. Wichtig ist die frühzeitige Diagnose und die umgehende Einleitung einer Revaskularisation mittels perkutaner koronarer Intervention (PCI) und Stent im Rahmen des kardiogenen Schocks. So kann eine deutliche Verbesserung des Überlebens erreicht werden. Pharmakologische und mechanische Unterstützung sind notwendig, um die Perfusion des Myokards und der Organe aufrecht zu erhalten. Als medikamentöse Therapie bei infarktbedingtem kardiogenem Schock haben sich Dobutamin als Inotropikum und Noradrenalin als Vasopressor etabliert. Zur weiteren Unterstützung liegen Daten zu Levosimendan vor. Die pharmakologische Therapie wird durch mechanische Unterstützungssysteme, wie Impella (ABIOMED, Danvers, MA, USA) oder extrakorporale Membranoxygenierung (ECMO), ergänzt. Die intraaortale Ballonpumpe (IABP) spielt kaum noch eine Rolle. Die Mehrzahl der Überlebenden des kardiogenen Schocks haben langfristig nur eine geringe funktionelle kardiale Einschränkung. Dies zeigt die passagere Schädigungskomponente („stunning“, Inflammation), was die Notwendigkeit einer schnellen kreislaufunterstützenden Therapie unterstreicht.

Abstract

Patients with ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) experience cardiogenic shock in about 6–10% of cases during the hospital treatment. In recent years, the incidence seems to be decreasing due to invasive diagnostics and therapy after myocardial infarction. Early diagnosis is important to initiate immediate revascularization using percutaneous coronary intervention (PCI) with stent implantation as part of cardiogenic shock treatment. Thus, a significant improvement in survival can be achieved. Pharmacological and mechanical support is needed to maintain perfusion of the myocardium and organs. Drug therapy for infarct cardiogenic shock relies on dobutamine for inotropic agent and norepinephrine as a vasopressor. For further inotropic support, data on additional levosimendan treatment are available. The pharmacological therapy is supplemented by mechanical support systems such as Impella (ABIOMED, Danvers, MA, USA) or extracorporeal membrane oxygenation (ECMO). The intra-aortic balloon pump (IABP) is hardly used anymore. The majority of cardiogenic shock survivors have little functional cardiac impairment in the long term. This shows the transient damage component (stunning, inflammation), which underlines the need for a fast and effective cardiovascular supportive therapy.

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Literatur

  1. Reynolds HR, Hochman JS (2008) Cardiogenic shock: current concepts and improving outcomes. Circulation 117:686

    Article  PubMed  Google Scholar 

  2. Goldberg RJ, Spencer FA, Gore JM et al (2009) Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation 119:1211

    Article  PubMed  PubMed Central  Google Scholar 

  3. Goldberg RJ, Gore JM, Alpert JS et al (1991) Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988. N Engl J Med 325:1117

    Article  CAS  PubMed  Google Scholar 

  4. Hochman JS, Boland J, Sleeper LA et al (1995) Current spectrum of cardiogenic shock and effect of early revascularization on mortality. Results of an international registry. SHOCK registry investigators. Circulation 91:873

    Article  CAS  PubMed  Google Scholar 

  5. Goldberg RJ, Gore JM, Thompson CA, Gurwitz JH (2001) Recent magnitude of and temporal trends (1994–1997) in the incidence and hospital death rates of cardiogenic shock complicating acute myocardial infarction: the second national registry of myocardial infarction. Am Heart J 141:65

    Article  CAS  PubMed  Google Scholar 

  6. Holmes DR Jr, Bates ER, Kleiman NS et al (1995) Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. The GUSTO-I investigators. Global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries. J Am Coll Cardiol 26:668

    Article  PubMed  Google Scholar 

  7. Goldberg RJ, Samad NA, Yarzebski J et al (1999) Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med 340:1162

    Article  CAS  PubMed  Google Scholar 

  8. Holmes DR Jr, Berger PB, Hochman JS et al (1999) Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation. Circulation 100:2067

    Article  PubMed  Google Scholar 

  9. Babaev A, Frederick PD, Pasta DJ et al (2005) Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA 294:448

    Article  CAS  PubMed  Google Scholar 

  10. Hasdai D, Holmes DR Jr, Califf RM et al (1999) Cardiogenic shock complicating acute myocardial infarction: predictors of death. GUSTO investigators. Global utilization of streptokinase and tissue-plasminogen activator for occluded coronary arteries. Am Heart J 138:21

    Article  CAS  PubMed  Google Scholar 

  11. Fincke R, Hochman JS, Lowe AM et al (2004) Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry. J Am Coll Cardiol 44:340

    Article  PubMed  Google Scholar 

  12. Wong SC, Sanborn T, Sleeper LA et al (2000) Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize occluded coronaries for cardiogenic shocK? J Am Coll Cardiol 36:1077

    Article  CAS  PubMed  Google Scholar 

  13. Sanborn TA, Sleeper LA, Webb JG et al (2003) Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial. J Am Coll Cardiol 42:1373

    Article  PubMed  Google Scholar 

  14. Picard MH, Davidoff R, Sleeper LA et al (2003) Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock. Circulation 107:279

    Article  PubMed  Google Scholar 

  15. Ortolani P, Marzocchi A, Marrozzini C et al (2006) Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction. Eur Heart J 27:1550

    Article  PubMed  Google Scholar 

  16. Hochman JS, Sleeper LA, Webb JG et al (1999) 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 341:625

    Article  CAS  PubMed  Google Scholar 

  17. Ramanathan K, Farkouh ME, Cosmi JE et al (2011) Rapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction. Am Heart J 162:268

    Article  PubMed  PubMed Central  Google Scholar 

  18. Antman EM, Anbe DT, Armstrong PW, et al (2006) ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction. www.acc.org/qualityandscience/clinical/statements.htm. Zugegriffen: 24 August 2006

  19. Hasdai D, Harrington RA, Hochman JS et al (2000) Platelet glycoprotein IIb/IIIa blockade and outcome of cardiogenic shock complicating acute coronary syndromes without persistent ST-segment elevation. J Am Coll Cardiol 36:685

    Article  CAS  PubMed  Google Scholar 

  20. Bonello L, De Labriolle A, Roy P et al (2008) Bivalirudin with provisional glycoprotein IIb/IIIa inhibitors in patients undergoing primary angioplasty in the setting of cardiogenic shock. Am J Cardiol 102:287

    Article  CAS  PubMed  Google Scholar 

  21. TRIUMPH Investigators, Alexander JH, Reynolds HR et al (2007) Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial. JAMA 297:1657

    Article  Google Scholar 

  22. Mueller HS, Chatterjee K, Davis KB et al (1998) ACC expert consensus document. Present use of bedside right heart catheterization in patients with cardiac disease. American College of Cardiology. J Am Coll Cardiol 32:840

    Article  CAS  PubMed  Google Scholar 

  23. Califf RM, Bengtson JR (1994) Cardiogenic shock. N Engl J Med 330:1724

    Article  CAS  PubMed  Google Scholar 

  24. Menon V, White H, LeJemtel T et al (2000) The clinical profile of patients with suspected cardiogenic shock due to predominant left ventricular failure: a report from the SHOCK trial registry. Should we emergently revascularize occluded coronaries in cardiogenic shocK? J Am Coll Cardiol 36:1071

    Article  CAS  PubMed  Google Scholar 

  25. Hochman JS, Ohman EM (2009) Cardiogenic shock. AHA clinical series

    Book  Google Scholar 

  26. Prondzinsky R, Lemm H, Swyter M, Wegener N, Unverzagt S, Carter JM, Russ M, Schlitt A, Buerke U, Christoph A, Schmidt H, Winkler M, Thiery J, Werdan K, Buerke M (2010) Intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: the prospective, randomized IABP SHOCK Trial for attenuation of multiorgan dysfunction syndrome. Crit Care Med 38(1):152–160

    Article  CAS  PubMed  Google Scholar 

  27. Prondzinsky R, Unverzagt S, Russ M, Lemm H, Swyter M, Wegener N, Buerke U, Raaz U, Ebelt H, Schlitt A, Heinroth K, Haerting J, Werdan K, Buerke M (2012) Hemodynamic effects of intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: the prospective, randomized IABP shock trial. Shock 37(4):378–384

    Article  PubMed  Google Scholar 

  28. Thiele H, Zeymer U, Neumann FJ et al (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 367:1287

    Article  CAS  PubMed  Google Scholar 

  29. Unverzagt S, Buerke M, de Waha A et al (2015) Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007398.pub3

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lauten A, Engström AE, Jung C et al (2013) Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: results of the Impella-EUROSHOCK-registry. Circ Heart Fail 6:23

    Article  PubMed  Google Scholar 

  31. Roffi M, Patrono C, Collet JP et al (2016) 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 37:267

    Article  CAS  PubMed  Google Scholar 

  32. Thiele H, Sick P, Boudriot E et al (2005) Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 26:1276

    Article  PubMed  Google Scholar 

  33. Seyfarth M, Sibbing D, Bauer I et al (2008) A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol 52:1584

    Article  PubMed  Google Scholar 

  34. Zeymer U, Vogt A, Zahn R et al (2004) 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 25:322

    Article  PubMed  Google Scholar 

  35. Bengtson JR, Kaplan AJ, Pieper KS et al (1992) Prognosis in cardiogenic shock after acute myocardial infarction in the interventional era. J Am Coll Cardiol 20:1482

    Article  CAS  PubMed  Google Scholar 

  36. de Waha S, Jobs A, Eitel I et al (2018) Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: a systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care 7:28

    Article  PubMed  Google Scholar 

  37. Thiele H, Akin I, Sandri M et al (2017) PCI strategies in patients with acute myocardial infarction and cardiogenic shock. N Engl J Med 377:2419

    Article  PubMed  Google Scholar 

  38. Wong SC, Sleeper LA, Monrad ES et al (2001) Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction. A report from the SHOCK Trial Registry. J Am Coll Cardiol 38:1395

    Article  CAS  PubMed  Google Scholar 

  39. Sleeper LA, Ramanathan K, Picard MH et al (2005) Functional status and quality of life after emergency revascularization for cardiogenic shock complicating acute myocardial infarction. J Am Coll Cardiol 46:266

    Article  PubMed  Google Scholar 

  40. Hochman JS, Sleeper LA, Webb JG et al (2006) Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA 295:2511

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Medizinische Klinik I, Carl-von-Basedow-Klinikum Saalekreis gGmbH, Weiße Mauer 52, 06217, Merseburg, Deutschland

    R. Prondzinsky

  2. Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Deutschland

    R. Prondzinsky, M. Buerke, M. Russ & K. Werdan

  3. Medizinische Klinik II, Kardiologie, Angiologie, Internistische Intensivmedizin, St. Marien-Krankenhaus, Siegen, Deutschland

    H. Lemm & M. Buerke

  4. 3. Medizinische Abteilung mit Kardiologie, Wilhelminenspital, Wien, Österreich

    A. Geppert

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  1. R. Prondzinsky
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  2. H. Lemm
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Correspondence to R. Prondzinsky.

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Interessenkonflikt

R. Prondzinsky, H. Lemm, A. Geppert, M. Buerke, M. Russ und K. Werdan geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Buerke, Siegen

H. Lemm, Siegen

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Prondzinsky, R., Lemm, H., Geppert, A. et al. Infarktbedingter kardiogener Schock. Med Klin Intensivmed Notfmed 113, 267–276 (2018). https://doi.org/10.1007/s00063-018-0428-8

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  • DOI: https://doi.org/10.1007/s00063-018-0428-8

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