Henriques J.P.S.: Low output in acute coronary syndromes

Project Details


Acute myocardial infarction
In the Netherlands, 28500 patients suffer from an acute myocardial infarction every year and around 2400 patients present with cardiogenic shock.

Cardiogenic shock
Cardiogenic shock is a state of insufficient circulation to the organs due to poor pump function of the heart. This condition requires intensive care management, including mechanical ventilation, renal function replacement (dialysis), and various other supportive therapies.
Despite all efforts, these patients have a poor prognosis with a short term mortality of around 50%. Pharmacological support and the use of intra-aortic counterpulsation (IABP) improve hemodynamic parameters, but have failed to demonstrate better outcome in patients with cardiogenic shock.

A temporary heartpump during the acute event may support the heart and circulation until the heart is recovered and able to resume its function. Especially nowadays where all patients with an acute myocardial infarction undergo immediate revascularization, recovery is a real option. Temporary heartpumps can support the circulation during a limited time period, up one or two weeks

Clinical course
The clinical course of these patients can be summarized into 3 categories:
1) functional recovery, after which the patient can leave the hospital
2) insufficient cardiac recovery with need for a permanent cardiac function replacement by a permanent surgical left ventricular assist device (LVAD or in dutch ‘steunhart’) or heart transplantation
3) death as a result of heart failure, multi-organ failure or other complications.

It is clear that the best option for the patient is functional recoveery. Biochemical and hemodynamic parameters that predicht clinical outcome are needed to predict and further define patients that respond to tempororay mechanical assistance.

An open Coronary Artery is always better than an occluded one

An acute occlusion of a coronary artery is the main reason for an acute myocardial infarction. In the Netherlands, 28500 patients suffer from an acute myocardial infarction every year. Half of these patients have additional coronary artery disease, defined as multivessel disease. A total of 10% of all patients with an acute myocardial infarction have an additional chronic total coronary occlusion. These patients have reduced pump function and additional revascularization may improve the pumping and overall function of the heart. It is important to further define those patients who might beenfit from such therapy in a variety of clinical entities.
Effective start/end date1/01/2013 → …