Predictors of in-hospital mortality in patients with acute myocardial infarction complicated by cardiogenic shock in the contemporary era of primary percutaneous coronary intervention

نویسندگان

  • Hee Hwa Ho
  • Heng Ann Ong
  • Punitha Arasaratnam
  • Yau Wei Ooi
  • Julian Tan
  • Kwok Kong Loh
  • David Foo
  • Fahim Haider Jafary
  • Paul Jau Lueng Ong
چکیده

Primary percutaneous coronary intervention (PPCI) is currently the preferred reperfusion therapy for patientswith ST-elevationmyocardial infarction (STEMI). About 5–10% of all acute myocardial infarction (AMI) cases are complicated by cardiogenic shock (CS) which is associated with a high in-hospital mortality rate [1–3]. The mortality benefit of earlymechanical revascularization has been demonstrated in the landmark SHOCK trial [4] which compared emergency revascularization (PCI or coronary artery bypass grafting) versus a strategy of initialmedical stabilization using fibrinolysis and insertion of intra-aortic balloon pump (IABP) inAMI patientswith CS. The SHOCK trial, however,was conducted more than a decade ago and there is limited data [5,6] on the clinical outcome of this group of patients in the contemporary era of PPCI. We therefore sought to evaluate the survival rate and predictors of in-hospitalmortality in our cohort of Asian patientswith AMI complicated by CS who underwent PPCI at our institution from January 2009 to December 2010. Cardiogenic shock was defined as a systolic blood pressure (SBP) of b90 mm Hg for N30 min or the need for supportive measures to maintain a SBP N90mmHg, associated with end-organ hypoperfusion. Clinical data was collected retrospectively on demographic characteristics, presenting signs and symptoms, laboratory investigations, angiographic findings, hospital course and in-hospital mortality. Our study conforms to the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the institution's research committee. Table 1 shows the baseline clinical characteristics, clinical presentation and angiographic findings of our patients. The mean age at presentation was 63.1 ± 12.1 years with male predominance (88%). The majority of patients (51%) presented with anterior MI with 86% found to havemulti-vessel disease on coronary angiography. Diabetesmellitus was present in 50 patients (35%). The mean ejection fraction was 34 ± 12%. 17 patients (12%) presented with out-of-hospital collapse. Table 2 shows the PCI procedural variables and in-hospital clinical outcomes of our patients. The most common target vessel for PPCI was the left anterior descending artery (44%) followed by the right coronary artery (36%), left main artery (11%) and left circumflex artery (9%). The majority of patients (65%) received bare metal stent implantation during PPCIwithpost-procedural Thrombolysis inMyocardial Infarction (TIMI) 3 flow achieved in 77% of patients. Themedian door-to-balloon (D2B) time was 63 ± 30 min. Multi-vessel PCI was performed in 26 patients (18%)

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عنوان ژورنال:

دوره 3  شماره 

صفحات  -

تاریخ انتشار 2014