Survival after early surgical revascularization in patients with both acute myocardial infarction and cardiogenic shock.
OBJECTIVE
Previous studies have reported encouraging results with percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock. However, PTCA is often unsuccessful and the mortality rate is more than 80%. The success rate of early surgical revascularization in patients with cardiogenic shock and failed PTCA is not clear. This study assessed the effect of early surgical revascularization on survival chances in patients with cardiogenic shock and failed PTCA.


METHODS
Nineteen patients referred to our hospital by cardiologists due to cardiogenic shock and failed PTCA were included in this study. During the period from February 1995 through August 1997, seven patients were treated using mechanical circulatory support with extracorporeal membrane oxygenation (ECMO) and no surgical revascularization, and from August 1997 through June 1999, 12 patients underwent emergency surgical revascularization. The patient characteristics and in-hospital mortality were compared between groups.


RESULTS
Ten patients were treated after acute infarction and nine were treated after cardiac intervention. No significant differences were found between the two groups in age, sex, hypertension, diabetes, smoking, and previous infarction. The in-hospital mortality rates were 100% in patients receiving mechanical circulatory support with ECMO and 25% in patients who underwent emergency surgical revascularization (p = 0.003). In the emergency revascularization group, four of 12 patients had surgical revascularization more than 18 hours after AMI and the in-hospital mortality rate was 25%.


CONCLUSIONS
Surgical revascularization improved survival in patients with cardiogenic shock and failed PTCA.
Hsu
R B
RB
Department of Surgery, National Taiwan University Hospital and Far Eastern Memorial Hospital, Taipei.
Chien
C Y
CY
Wang
S S
SS
Chu
S H
SH
D015906:Angioplasty, Balloon, Coronary; D004638:Emergency Treatment; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D009204:Myocardial Revascularization / Q000401:mortality*; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000628:therapy; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure