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Coronary anatomy: Difference between revisions
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→Other circulatory assist devices: Impella
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In one meta-analyses including 7 randomized trials with STEMI patients with cardiogenic shock, IABP showed neither a 30-day survival benefit nor improved left ventricular ejection fraction, and was associatied with more complications (higher stroke, higher bleeding rates). Another meta-analysis included 9 cohorts with STEMI patients with cardiogenic shock, and showed that IABP was associated with an 18% decrease in 30 day mortality, but with significantly higher revascularization rates and higher mortality in the PCI group<cite>EurHeart2</cite>. In the randomized controlled trial Shock II, publiced in the NEJM in 2012, the use of IABP did not significantly reduce the 30-day mortality in patients with cardiogenic shock complicating acute myocardial infarction for whom an early revascularization strategy was planned<cite>Thiele</cite>. | In one meta-analyses including 7 randomized trials with STEMI patients with cardiogenic shock, IABP showed neither a 30-day survival benefit nor improved left ventricular ejection fraction, and was associatied with more complications (higher stroke, higher bleeding rates). Another meta-analysis included 9 cohorts with STEMI patients with cardiogenic shock, and showed that IABP was associated with an 18% decrease in 30 day mortality, but with significantly higher revascularization rates and higher mortality in the PCI group<cite>EurHeart2</cite>. In the randomized controlled trial Shock II, publiced in the NEJM in 2012, the use of IABP did not significantly reduce the 30-day mortality in patients with cardiogenic shock complicating acute myocardial infarction for whom an early revascularization strategy was planned<cite>Thiele</cite>. | ||
= Other circulatory assist devices: Impella = | = Other circulatory assist devices: Impella = | ||
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In 2012, the PROTECT II trial randomized 452 patients with 3-vessel of left main coronary artery disease and severely depressed left ventricular function to an Impella (2.5L) or an IABP. The Impella provided superior hemodynamic support, but with no difference in the 30 days endpoint of major adverse events<cite>Cardiol</cite>. | In 2012, the PROTECT II trial randomized 452 patients with 3-vessel of left main coronary artery disease and severely depressed left ventricular function to an Impella (2.5L) or an IABP. The Impella provided superior hemodynamic support, but with no difference in the 30 days endpoint of major adverse events<cite>Cardiol</cite>. | ||
In 2008, a multicenter registry showed the Impella 2.5 to be safe and potentially useful in hemodynamic support in high-risk PCI (multivessel, left main, last remaining vessel, low LV function) with rates of myocardial infarction, stroke, bleeding and vascular complications at 30 days of 6.2%<cite>Oneill</cite>. [[File:Impella.jpg|thumb|400px|Example of a 2.5L Impella system<cite>McCulloch</cite>]] | In 2008, a multicenter registry showed the Impella 2.5 to be safe and potentially useful in hemodynamic support in high-risk PCI (multivessel, left main, last remaining vessel, low LV function) with rates of myocardial infarction, stroke, bleeding and vascular complications at 30 days of 6.2%<cite>Oneill</cite>. | ||
[[File:Impella.jpg|thumb|400px|Example of a 2.5L Impella system<cite>McCulloch</cite>]] | |||
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= References = | = References = | ||