n=14
Number of Deaths
n = 14
P Ao
P balloon
1 Systole: Balloon deflated, decrease in afterload and facilitation of left ventricular ejection 2 Diastole: Balloon inflated, increase in coronary flow
G Prospective, multicenter, randomized, open-label, controlled trial (IABP vs. no IABP) G Sample size: 45 patients with acute myocardial infarction and cardiogenic shock G Primary endpoint: change in APACHE II scores (severity of illness)
Prondzinsky R et al. Crit Care Med 2010; 38:152160
G Prospective, multicenter, randomized, open-label, controlled trial G Sample size: 600 patients G Primary endpoint: 30-day all-cause mortality
Thiele H et al. Am Heart J 2012;163:938-45
G Prospective, multicenter, randomized, open-label, controlled trial (Impella vs. IABP) G Sample size: 26 patients with acute myocardial infarction and cardiogenic shock G Primary endpoint: change of the cardiac index (CI)
Seyfarth M et al, J Am Coll Cardiol 2008;52:15848
G Prospective, multicenter, randomized, open-label, controlled trial (VAD vs. IABP) G Sample size: 42 patients G Primary endpoint: change in cardiac power index
Thiele H et al, Eur Heart J 2005;26:12761283
% 40
30 20 10 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
% 40
30 20 10 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Jeger RV et al. Ann Intern Med 2008;149:618-626
Cardiogenic Shock Overall (p=0.01) Cardiogenic Shock on Admission (p=0.009) Cardiogenic Shock During Hospitalization (p=0.094)
% 8
6 4 2 0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Intra-aortic counterpulsation ST-elevation ACS Age (per year increase) Heart rate (per beat per minute increase) Systolic blood pressure (per mmHg increase) Primary PCI Lipid-lowering drug
95% Confidence Interval 11.2-24.6 1.97-4.22 1.02-1.05 1.01-1.02 0.98-1.00 0.39-0.89 0.37-0.73
Cardiogenic Shock: Treat the Disease Nitric Oxide and the Myocardium
G Low levels of NO (eNOS-derived) protect against ischemiareperfusion injury G Large quantities of NO (iNOS-derived) contribute to cardiac reperfusion injury through superoxide and peroxynitrite formation G Myocardial ischemia increase iNOS and NO production G The overproduction of NO may cause both myocardial depression and inappropriate vasodilatation G Thus NO may be a major contributor to cardiogenic shock complicating myocardial infarction