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
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%)
منابع مشابه
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عنوان ژورنال:
دوره 3 شماره
صفحات -
تاریخ انتشار 2014