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Open AccessArticle

Outcomes Associated with Respiratory Failure for Patients with Cardiogenic Shock and Acute Myocardial Infarction: A Substudy of the CULPRIT-SHOCK Trial

1
Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, 04289 Leipzig, Germany
2
Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, 4031 Basel, Switzerland
3
Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06520-8017, USA
4
Yale National Clinician Scholars Program, New Haven, CT 06510-8088, USA
5
The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY 10016, USA
6
Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB 8440, Canada
7
Cardiology Department, Duke Clinical Research Institute, Durham, NC 27701, USA
8
Department of Cardiology, Institut de Cardiologie (AP-HP), Hôpital Pitié Salpêtrière, Sorbonne Université, ACTION study group, 75013 Paris, France
9
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
10
Department of Cardiology, University Hospital Regensburg, 93077 Regensburg, Germany
11
Faculty of Medicine, Vilnius University and Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania
12
Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, UK
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Cardiology Department, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia
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Cardiology Department, University Heart Center Luebeck, 23538 Luebeck, Germany
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3rd Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital and Sigmund Freud University, Medical School, 2301 Vienna, Austria
16
Statistical department, Institut für Herzinfarktforschung, 67063 Ludwigshafen, Germany
17
Hospital of the city of Ludwigshafen, Medical Clinic B and Institut für Herzinfarktforschung, 67063 Ludwigshafen, Germany
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
J. Clin. Med. 2020, 9(3), 860; https://doi.org/10.3390/jcm9030860
Received: 3 February 2020 / Revised: 16 March 2020 / Accepted: 17 March 2020 / Published: 20 March 2020
(This article belongs to the Special Issue Management of Cardiogenic Shock)
Background: Little is known about clinical outcomes of patients with acute myocardial infraction (AMI) complicated by cardiogenic shock (CS) requiring mechanical ventilation (MV). The aim of this study was to identify the characteristics, risk factors, and outcomes associated with the provision of MV in this specific high-risk population. Methods: Patients with CS complicating AMI and multivessel coronary artery disease from the CULPRIT-SHOCK trial were included. We explored 30 days of clinical outcomes in patients not requiring MV, those with MV on admission, and those in whom MV was initiated within the first day after admission. Results: Among 683 randomized patients included in the analysis, 17.4% received no MV, 59.7% were ventilated at admission and 22.8% received MV within or after the first day after admission. Patients requiring MV had a different risk-profile. Factors independently associated with the provision of MV on admission included higher body weight, resuscitation within 24 h before admission, elevated heart rate and evidence of triple vessel disease. Conclusions: Requiring MV in patients with CS complicating AMI is common and independently associated with mortality after adjusting for covariates. Patients with delayed MV initiation appear to be at higher risk of adverse outcomes. Further research is necessary to identify the optimal timing of MV in this high-risk population. View Full-Text
Keywords: cardiogenic shock; respiratory failure; mechanical ventilation; non-invasive ventilation cardiogenic shock; respiratory failure; mechanical ventilation; non-invasive ventilation
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Rubini Giménez, M.; Miller, P.E.; Alviar, C.L.; van Diepen, S.; Granger, C.B.; Montalescot, G.; Windecker, S.; Maier, L.; Serpytis, P.; Serpytis, R.; Oldroyd, K.G.; Noc, M.; Fuernau, G.; Huber, K.; Sandri, M.; de Waha-Thiele, S.; Schneider, S.; Ouarrak, T.; Zeymer, U.; Desch, S.; Thiele, H. Outcomes Associated with Respiratory Failure for Patients with Cardiogenic Shock and Acute Myocardial Infarction: A Substudy of the CULPRIT-SHOCK Trial. J. Clin. Med. 2020, 9, 860.

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