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Master Thesis

Facteurs coronaires anatomiques et procéduraux déterminant la récupération myocardique dans les chocs cardiogéniques réfractaires post infarctus assistés par impella

Abstract : Background. In patients with post-infarction refractory cardiogenic shock and Impella-assisted, it is difficult to predict those whose myocardial function will recover and those who, on the contrary, will require a long-term assistance device or even a transplantation. Objectives. The objective of this study was to determine parameters related to coronary angiography and revascularization, associated with no myocardial recovery in patients with Impella 5.0 for cardiogenic shock after infarction. Methods. A retrospective monocentric cohort study was performed on the Bordeaux University Hospital. It included 39 patients implanted from January 2011 to December 2018 with an Impella 5.0 device for cardiogenic shock secondary to an ST segment elevation myocardial infarction. It compared the 17 patients whose myocardial function had recovered to the 22 whose myocardial function had not recovered. The analyzed parameters focused on the anatomy of the coronary lesions and the characteristics of the associated revascularization. SYNTAX scores before revascularization (basal) and after (residual) revascularization were also compared. Results. The frequency of chronic total occlusions was significantly greater in the non-myocardial recovery group (54.5% vs. 11.8%, p = 0.006, OR = 9, 95% CI: 1.65-49.14). as well as the presence of triple vessel disease (40.9% vs 11.8%, p = 0.04, OR = 5.19, 95% CI: 0.95-28.5). Patients with complete revascularization were less numerous in the no recovery group (13.6% vs 75%, p = 0.00013, OR = 0.05, 95% CI: 0.01-0.28) and patients with a revascularization delay greater than 5.5 hours were more numerous (77.3% vs. 17.6%, p = 0.0007, OR = 15.9, 95% CI 3.2-78.3). A basal SYNTAX score greater than 23.25 and a residual greater than 7.5 were more frequently found in the non-myocardial recovery group (77.3% vs. 29.4%, p = 0.0028, OR = 8.2 95% CI: 1.9 - 34.6, and 90.9% vs 17.6%, p = 0.002, OR = 46.7, 95% CI: 6.9 - 316.8). LVEF was not statistically different in both groups (22.1% versus 24.8%, p = 0.23). Conclusion. In terms of lesion, the presence of triple vessel disease, chronic occlusion and a high basal SYNTAX score was associated with an absence of myocardial recovery. In terms of revascularization, the parameters associated with an absence of myocardial recovery were late revascularisation, incomplete revascularisation, and high residual SYNTAX score.
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https://dumas.ccsd.cnrs.fr/dumas-02496757
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Baptiste Davong. Facteurs coronaires anatomiques et procéduraux déterminant la récupération myocardique dans les chocs cardiogéniques réfractaires post infarctus assistés par impella. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02496757⟩

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