An artificial micro-pump, the smallest in the world, reduces mortality by more than a quarter in patients suffering from acute myocardial infarction complicated by cardiogenic shock, a condition that occurs when the heart 'shuts down', suddenly stopping pushing blood towards vital organs. In these cases, which affect up to one in 10 heart attack victims, the heart muscle runs out of 'fuel', blood pressure drops, the kidneys and brain stop working and one in two patients dies. The effectiveness of the microaxial flow pump (Impella CP) is confirmed by the Danish study DanGer Shock, published in the 'New England Journal of Medicine' and presented at the 75th Congress of the American College of Cardiology which closed in Atlanta.
What happens after myocardial infarction
“Cardiogenic shock, after an acute myocardial infarction, is a condition of inadequate perfusion of the heart due to necrosis of the muscle cells involved in the contraction of the organ – explains Pasquale Perrone Filardi, president of the Italian Society of Cardiology (Sic) and director of the School of specialization in Cardiology at the Federico II University of Naples – It affects 5% to 10% of patients with acute myocardial infarction and more than half of these patients die during hospitalization”.
Until now – the experts recall – previous research had not highlighted a benefit, in terms of survival, for the use of a mechanical support device based on a particular pump that 'fishes' oxygenated blood from the ventricle and introduces it into the aorta. A device on whose safety the US FDA had launched a 'warning'. The new study involved 355 patients randomly divided into two groups: 179 used the microaxial flow pump and 176 used standard therapy. Death from any cause occurred in 82 of 179 patients (45.8%) in the microaxial flow pump group and in 103 of 176 patients (58.5%) in the standard therapy group.
“After 25 years – comments Ciro Indolfi, past president of Sic and full professor of Cardiology at the Magna Graecia University of Catanzaro – this is the first study to demonstrate that it is possible to reduce mortality by 26% in patients with cardiogenic shock, an extremely serious condition that leads to death in 50% of cases. Patient selection was the key element of the results of this study which documented a real benefit on survival in a disease where medical therapy is usually ineffective. However – specifies the specialist – the use of this catheter, which is large, can cause complications to the arteries, which in the future can be reduced thanks to more careful control of vascular access”.
The study also demonstrated that survival curves separate early, with mortality in controls increasing in the 180 days following the start of observation, while mortality remained stable after 30 days in patients treated with the micropump.
“These additional therapeutic strategies, associated with timely treatment of the heart attack with the coronary stent – conclude Indolfi and Perrone Filardi – will contribute to an increase in survival in subjects affected by this pathology which, unfortunately, still represents the number one cause of death in 'man and woman'.
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