Percutaneous coronary intervention in cardiogenic shock complicating acute ST-elevation myocardial infarction—a single centre experience

Abstract

A B S T R A C TBackground: Mortality in acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) approaches 70 − 80%, regardless of the type of pharmacological treatment. Early revascularisation improves survival in AMI with CS. Our aim is to assess the predictors of mid-term outcome after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and CS.Methods: Forty-one patients who underwent primary or rescue PCI for CS were analysed comparing their baseline, angiographic, PCI data, 30-day and 1-year survival.Results: There were no significant differences between survivors and non-survivors in baseline characters, except for more number of transfer admissions (P = 0.0005), and cardiopulmonary resuscitations (P = 0.015) in the later group. The mean time between myocardial infarction (MI) onset to shock and MI onset to revascularisation were 12.8 ± 12.9 hours and 17.0 ± 16.8 hours, respectively. Patients with better pre-procedure thrombolysis in myocardial infarction (TIMI) flow in the infarctrelated artery (IRA) had better survival (P = 0.0005). Successful PCI was achieved in 48.8% of patients. The 30-day mortality was 56.1% and all were prior to hospital discharge. Patients with successful PCI had better short-term survival in comparison with patients with failed PCI (80% vs 9.6%). Eighteen patients who survived at 30 days were followed up for 12-72 months (mean 28.5 ± 5.4 months). Fifteen patients survived at 1 year after PCI and all were in good functional status. Conclusion:Mortality remains high even with PCI. Achieving IRA patency with TIMI 3 flow is the main determinant of survival. Survival and functional status are good in patients who are discharged from hospital.

Predictors of short-term outcomes in patients undergoing percutaneous coronary intervention in cardiogenic shock complicating STEMI—A tertiary care center experience

“…It is already known that post procedural TIMI flow ≤ 2 is strongly associated with adverse outcome during hospitalization and at 6-month follow-up 13, 14. In our earlier study (Phase 1), 8 as well as in the present study (inclusive of both phases), post PCI TIMI flow was the only consistent and most significant marker of prognosis for in-hospital mortality. Our procedural success rate, comprising of post-PCI TIMI flow of 3, had increased from 48.8% in phase 1 to 63% in phase 2, though this rate is lesser than that observed in the developed world 9 .…”

“…The incidence of CS in these patients was 7.2% (47 out of 646 patients of STEMI undergoing PCI) in phase 1 and 7.6% (79 out of 1035 patients of STEMI undergoing PCI) in phase 2. The results of phase 1 study have been published earlier 8 . Of these, 114 patients were included for the study and 12 patients with CS secondary to mechanical complications like ventricular septal rupture or free wall rupture or severe MR secondary to papillary muscle dysfunction were excluded from the analysis.…”

Clinical characteristics and outcome in patients with a delayed presentation after ST-elevation myocardial infarction and complicated by cardiogenic shock

“…The in-hospital mortality in this study is similar to the published literature 6 , 8 , 21 , 26 and may be a consequence of late presentation of these patients and limited use of mechanical circulatory support devices. The delay in seeking medical care leads to infarction of a significant amount of myocardium and attendant end-organ dysfunction, which contributes to the adverse outcomes.…”

Acute care for the three leading causes of mortality in lower-middle-income countries: A systematic review

“…Patients in cardiogenic shock can be supported with inotropes, however, overall mortality is high, whether treated with PCI[ 12 34 ] or CABG. [ 35 ] Furthermore, for patients who present in cardiac arrest, survival to hospital discharge is around 5%.…”

“…The range of treatment options for ACS is not mutually exclusive. Thrombolysis can be administered during preparation for PCI,[ 34 ] with similar outcomes with primary PCI and thrombolysis followed by PCI. [ 37 ] In addition, PCI can treat occluded grafts that cause cardiac arrest following CABG.…”