Complete Revascularization, AMI Cardiogenic Shock
Importance of Timing and Impact of Extensive Revascularization on Long-term Survival in Cardiogenic Shock
Giuseppe Tarantini, MD, PhD, FESC discusses insights from European multi-center studies regarding the timing and impact of extensive revascularization on long-term survival in cardiogenic shock.
With regard to timing, Dr. Tarantini discusses the ideal window of opportunity for percutaneous ventricular assist device (pVAD) insertion as cardiogenic shock progresses from the compensated stage through the progressive stage to the irreversible stage, noting that the ideal case entails Impella® support before the onset of cardiogenic shock to prevent it from occurring. He emphasizes “DTU” is more important than “DTB.” In other words, restoring patients’ physiology/circulation is more important than immediate opening of an occluded vessel and longer symptom to support (S2S) time is associated with increased mortality. Dr. Tarantini also presents data, including data from the Registry of Patients Treated with IMPella Mechanical Circulatory Support Device in Italy (R-IMP-IT), demonstrating a clear survival advantage at 1 year with more extensive revascularization with Impella support in the setting of cardiogenic shock.
Dr. Tarantini is professor and director of interventional cardiology at the University of Padua in Italy and GISE president.