Percutaneous coronary intervention assisted by invasive mechanical ventilation and intra-aortic balloon pump for acute myocardial infarction with cardiogenic shock: Retrospective cohort study and meta-analysis

Abstract

The aim of this study was to compare the mortality outcome in patients with acute myocardial infarction and cardiogenic shock who were treated with percutaneous coronary intervention (PCI) assisted by intra-aortic balloon pump (IABP) + invasive mechanical ventilation (IMV) with historical controls. From January 1, 2016 to June 1, 2017, 60 patients were retrospectively enrolled at Tianjin Chest Hospital. Out of these, 88.3% of patients achieved thrombolysis in myocardial infarction flow 3 after PCI. The all-cause mortality rate in-hospital and at 1 year was 25% (95% CI: 0.14–0.36) and 33.9% (0.22–0.46), respectively. A systematic review followed by meta-analysis was performed with 4 historical studies of patients treated by PCI + IMV with partial IABP, which found an in-hospital mortality rate of 66.0% (95% CI: 0.62–0.71). Recently, a meta-analysis of patients receiving PCI + IABP with partial IMV showed that the 1 year mortality rate was 52.2% (95% CI: 0.47–0.58). In Cox regression analysis of patient data from the current study, lactic acid level ≥4.5 mmol/L, hyperuricemia, and thrombolysis in myocardial infarction flow <3 were independent predictors of death at 1 year. All-cause mortality, in-hospital and at 1 year, in patients with acute myocardial infarction and cardiogenic shock treated with PCI + IABP and IMV was lower than in those treated with PCI + partial IABP or IMV. Larger, longer-term direct comparisons are warranted.

The Association of Serum Lactate Level with the Occurrence of Contrast-Induced Acute Kidney Injury and Long-Term Prognosis in Patients Undergoing Emergency Percutaneous Coronary Intervention

“… 23 Liu et al found that a lactic acid level of ≥4.5 mmol/L was an independent predictor of death in AMI-cardiogenic shock patients at 1 year. 24 Despite the specificity of such a cut-off being addressed, this finding suggested a sensitive power of lactate in predicting cardiac death with AMI patients during different follow-up periods. However, our results were inconsistent with those previous studies.…”

Mechanical ventilation in acute myocardial infarction: Outcomes from a prospective audit at a cardiovascular hospital in Pakistan

“…Another study reports an in-hospital mortality rate of 25% in patients who needed both invasive mechanical ventilation and IABP with PCI, which is comparable to our overall mortality rate, even though not all patients required mechanical ventilator support. The same study reported higher mortality rates of 66% for patients who required PCI with invasive mechanical ventilation and partial IABP [16]. Another study published showed a mortality rate of 37.3% at 30 days and 40.0% at 90 days in patients requiring PCI complicated by cardiogenic shock requiring vasopressors and invasive mechanical ventilation and IABP if needed in the ICU [17].…”

“…Prolonged ventilation time was found to be associated with a high SOFA score (7.9 ± 2.2 vs. 5.7 ± 2.4; p<0.001), PCT (4 [IQR: 1-10] vs. 1 [IQR: 0.335-3]; p = 0.001), CRP (10 [IQR: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] vs. 5 [IQR: 2-10]; p = 0.001), positive balance (800 [IQR: 391-1500] vs. 500 [IQR: 300-1000]; p = 0.013), and negative balance (850 [IQR:1500-500] vs. 600 [IQR: 800-500]; p = 0.017), respectively. Vasopressors/Inotropes use (84.2% vs. 44.4%; p<0.001) and duration (48 [IQR: 24-48] hours vs. 24 [IQR 24 -24] hours; p = 0.001) was higher among patients with prolonged ventilation duration, respectively.…”