Hemodynamic Support in PCI: From Chronic Heart Failure to Cardiogenic Shock

  • Jooby John
  • Kirk N. Garratt


Inotrope and vasopressor therapies have been demonstrated to adversely impact infarct size and survival in return for a modest increase in short-term survival. Earlier institution of mechanical support devices may allow the heart to rest while preserving systemic perfusion. Preliminary studies indicate that such a strategy would decrease final infarct size, particularly if implemented early, and should lower mortality rates.


Percutaneous Coronary Intervention Cardiogenic Shock Left Ventricular Assist Device Primary Percutaneous Coronary Intervention Myocardial Oxygen Demand 
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  1. 1.
    Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics–2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18–209.PubMedCrossRefGoogle Scholar
  2. 2.
    Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8(1):30–41.PubMedCrossRefGoogle Scholar
  3. 3.
    Torabi A, Rigby AS, Cleland JG. Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction. J Am Coll Cardiol. 2009;55(1):79–81; author reply 81.PubMedCrossRefGoogle Scholar
  4. 4.
    Wu C, Hannan EL, Walford G, et al. A risk score to predict in-hospital mortality for percutaneous coronary interventions. J Am Coll Cardiol. 2006;47(3):654–60.PubMedCrossRefGoogle Scholar
  5. 5.
    Singh M, Rihal CS, Selzer F, Kip KE, Detre K, Holmes DR. Validation of Mayo Clinic risk adjustment model for in-hospital complications after percutaneous coronary interventions, using the National Heart, Lung, and Blood Institute dynamic registry. J Am Coll Cardiol. 2003;42(10):1722–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Holper EM, Blair J, Selzer F, et al. The impact of ejection fraction on outcomes after percutaneous coronary intervention in patients with congestive heart failure: an analysis of the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry and Dynamic Registry. Am Heart J. Jan 2006;151(1):69–75.PubMedCrossRefGoogle Scholar
  7. 7.
    Hochman JS. Cardiogenic shock complicating acute myocardial infarction: expanding the paradigm. Circulation. 2003;107(24):2998–3002.PubMedCrossRefGoogle Scholar
  8. 8.
    Babaev A, Frederick PD, Pasta DJ, Every N, Sichrovsky T, Hochman JS. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA. 2005;294(4):448–54.PubMedCrossRefGoogle Scholar
  9. 9.
    Lowes BD, Minobe W, Abraham WT, et al. Changes in gene expression in the intact human heart. Downregulation of alpha-myosin heavy chain in hypertrophied, failing ventricular myocardium. J Clin Invest. 1997;100(9):2315–24.PubMedCrossRefGoogle Scholar
  10. 10.
    Meyer M, Schillinger W, Pieske B, et al. Alterations of sarcoplasmic reticulum proteins in failing human dilated cardiomyopathy. Circulation. 1995;92(4):778–84.PubMedCrossRefGoogle Scholar
  11. 11.
    Liao R, Nascimben L, Friedrich J, Gwathmey JK, Ingwall JS. Decreased energy reserve in an animal model of dilated cardiomyopathy. Relationship to contractile performance. Circ Res. 1996;78(5):893–902.PubMedCrossRefGoogle Scholar
  12. 12.
    Dibner-Dunlap ME, Thames MD. Control of sympathetic nerve activity by vagal mechanoreflexes is blunted in heart failure. Circulation. 1992;86(6):1929–34.PubMedCrossRefGoogle Scholar
  13. 13.
    Vogel RA, Shawl F, Tommaso C, et al. Initial report of the National Registry of Elective Cardiopulmonary Bypass Supported Coronary Angioplasty. J Am Coll Cardiol. 1990;15(1):23–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Califf RM, Phillips 3rd HR, Hindman MC, et al. Prognostic value of a coronary artery jeopardy score. J Am Coll Cardiol. 1985;5(5):1055–63.PubMedCrossRefGoogle Scholar
  15. 15.
    Fang J, Alderman MH, Keenan NL, Ayala C. Acute myocardial infarction hospitalization in the United States, 1979 to 2005. Am J Med. 2010;123(3):259–66.PubMedCrossRefGoogle Scholar
  16. 16.
    Floyd KC, Yarzebski J, Spencer FA, et al. A 30-year perspective (1975–2005) into the changing landscape of patients hospitalized with initial acute myocardial infarction: Worcester Heart Attack Study. Circ Cardiovasc Qual Outcomes. 2009;2(2):88–95.PubMedCrossRefGoogle Scholar
  17. 17.
    Cheng JM, Valk SD, den Uil CA, et al. Usefulness of intra-aortic balloon pump counterpulsation in patients with cardiogenic shock from acute myocardial infarction. Am J Cardiol. 2009;104(3):327–32.PubMedCrossRefGoogle Scholar
  18. 18.
    Goldberg RJ, Samad NA, Yarzebski J, Gurwitz J, Bigelow C, Gore JM. Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med. 1999;340(15):1162–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Dunser MW, Hasibeder WR. Sympathetic overstimulation during critical illness: adverse effects of adrenergic stress. J Intensive Care Med. 2009;24(5):293–316.PubMedCrossRefGoogle Scholar
  20. 20.
    Petersen JW, Felker GM. Inotropes in the management of acute heart failure. Crit Care Med. 2008;36(1 Suppl):S106–11.PubMedCrossRefGoogle Scholar
  21. 21.
    Fincke R, Hochman JS, Lowe AM, et al. Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry. J Am Coll Cardiol. 2004;44(2):340–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Mendoza DD, Cooper HA, Panza JA. Cardiac power output predicts mortality across a broad spectrum of patients with acute cardiac disease. Am Heart J. 2007;153(3):366–70.PubMedCrossRefGoogle Scholar
  23. 23.
    Kantrowitz A, Tjonneland S, Freed PS, Phillips SJ, Butner AN, Sherman Jr JL. Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. JAMA. 1968;203(2):113–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Scheidt S, Wilner G, Mueller H, et al. Intra-aortic balloon counterpulsation in cardiogenic shock. Report of a co-operative clinical trial. N Engl J Med. 1973;288(19):979–84.PubMedCrossRefGoogle Scholar
  25. 25.
    Kern MJ, Aguirre F, Bach R, Donohue T, Siegel R, Segal J. Augmentation of coronary blood flow by intra-aortic balloon pumping in patients after coronary angioplasty. Circulation. 1993;87(2):500–11.PubMedCrossRefGoogle Scholar
  26. 26.
    Weber KT, Janicki JS. Intraaortic balloon counterpulsation. A review of physiological principles, clinical results, and device safety. Ann Thorac Surg. 1974;17(6):602–36.PubMedCrossRefGoogle Scholar
  27. 27.
    Cohen M, Urban P, Christenson JT, et al. Intra-aortic balloon counterpulsation in US and non-US centres: results of the Benchmark Registry. Eur Heart J. 2003;24(19):1763–70.PubMedCrossRefGoogle Scholar
  28. 28.
    Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation. 2004;110(9):e82–292.PubMedGoogle Scholar
  29. 29.
    Van de Werf F, Bax J, Betriu A, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J. 2008;29(23):2909–45.PubMedCrossRefGoogle Scholar
  30. 30.
    Barron HV, Every NR, Parsons LS, et al. The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2. Am Heart J. 2001;141(6):933–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Sanborn TA, Sleeper LA, Bates ER, et al. Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in 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. 2000;36(3 Suppl A):1123–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Sjauw KD, Engstrom AE, Vis MM, et al. A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? Eur Heart J. 2009;30(4):459–68.PubMedCrossRefGoogle Scholar
  33. 33.
    Ferguson 3rd JJ, Cohen M, Freedman Jr RJ, et al. The current practice of intra-aortic balloon counterpulsation: results from the Benchmark Registry. J Am Coll Cardiol. 2001;38(5):1456–62.PubMedCrossRefGoogle Scholar
  34. 34.
    Patel MR, Thiele H, Smalling RW, et al. A multicenter, randomized, controlled study of mechanical left ventricular unloading with counterpulsation to reduce infarct size prepercutaneous coronary intervention for acute myocardial infarction: rationale and design of the Counterpulsation Reduces Infarct Size Acute Myocardial Infarction trial. Am Heart J. 2011;162(1):47–55 e41.PubMedCrossRefGoogle Scholar
  35. 35.
    Thiele H, Zeymer U, Nuemann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf HG, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Bohm M, Ebeit H, Schneider S, Schuler G, Werdan K. Intraaortic balloon support for cardiogenic shock. N Engl J Med. 2012;367:1287–96.PubMedCrossRefGoogle Scholar
  36. 36.
    Thiele H, Lauer B, Hambrecht R, Boudriot E, Cohen HA, Schuler G. Reversal of cardiogenic shock by percutaneous left atrial-to-femoral arterial bypass assistance. Circulation. 2001;104(24):2917–22.PubMedCrossRefGoogle Scholar
  37. 37.
    Henriques JP, Remmelink M, Baan Jr J, et al. Safety and feasibility of elective high-risk percutaneous coronary intervention procedures with left ventricular support of the Impella Recover LP 2.5. Am J Cardiol. 2006;97(7):990–2.PubMedCrossRefGoogle Scholar
  38. 38.
    Cheng JM, den Uil CA, Hoeks SE, et al. Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J. 2009;30(17):2102–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Thiele H, Sick P, Boudriot E, et al. 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. 2005;26(13):1276–83.PubMedCrossRefGoogle Scholar
  40. 40.
    Al-Husami W, Yturralde F, Mohanty G, et al. Single-center experience with the TandemHeart percutaneous ventricular assist device to support patients undergoing high-risk percutaneous coronary intervention. J Invasive Cardiol. 2008;20(6):319–22.PubMedGoogle Scholar
  41. 41.
    Morley D, Litwak K, Ferber P, et al. Hemodynamic effects of partial ventricular support in chronic heart failure: results of simulation validated with in vivo data. J Thorac Cardiovasc Surg. 2007;133(1):21–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Fonger JD, Zhou Y, Matsuura H, Aldea GS, Shemin RJ. Enhanced preservation of acutely ischemic myocardium with transseptal left ventricular assist. Ann Thorac Surg. 1994;57(3):570–5.PubMedCrossRefGoogle Scholar
  43. 43.
    Sjauw KD, Remmelink M, Baan Jr J, et al. Left ventricular unloading in acute ST-segment elevation myocardial infarction patients is safe and feasible and provides acute and sustained left ventricular recovery. J Am Coll Cardiol. 2008;51(10):1044–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Dixon SR, Henriques JP, Mauri L, et al. A prospective feasibility trial investigating the use of the Impella 2.5 system in patients undergoing high-risk percutaneous coronary intervention (The PROTECT I Trial): initial U.S. experience. JACC Cardiovasc Interv. 2009;2(2):91–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Seyfarth M, Sibbing D, Bauer I, et al. 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. 2008;52(19):1584–8.PubMedCrossRefGoogle Scholar
  46. 46.
    O’Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J, Palacios I, Maini B, Mulukutla S, Dzavik V, Popma J, Douglas PS, Ohman M. A prospective, randomized clinical trial of hemodynamic support with impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the protect ii study. Circulation. 2012;126:1717–27.PubMedCrossRefGoogle Scholar
  47. 47.
    Sjauw KD, Konorza T, Erbel R, et al. Supported high-risk percutaneous coronary intervention with the Impella 2.5 device the Europella registry. J Am Coll Cardiol. 2009;54(25):2430–4.PubMedCrossRefGoogle Scholar
  48. 48.
    Cyrus T, et al. Use of mechanical assist during high-risk PCI and STEMI with cardiogenic shock. Cathet Cardiovasc Interv. 2010;75:S1–6.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Interventional CardiologyLenox Hill HospitalNew YorkUSA

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