Acute myocardial infarction complicated by cardiogenic shock. In-hospital and mid-term results of invasive treatment in the National Institute of Cardiology, Warsaw-Anin.
BACKGROUND
Mortality in acute myocardial infarction (MI) complicated by cardiogenic shock approaches 90%, regardless of the type of pharmacological treatment.


OBJECTIVE
To assess in-hospital and mid-term results of invasive treatment of patients with acute MI with ST segment elevation (STEMI) complicated by cardiogenic shock.


METHODS
From a prospective registry of all patients admitted to our institution for urgent coronary angiography due to acute coronary syndrome between February 2001 and June 2002, patients with STEMI, symptom duration up to 12 hours and cardiogenic shock diagnosed on admission were identified. The in-hospital and mid-term outcome of 37 patients (mean age 65 years, range 54-77, 68% of males) treated with primary percutaneous coronary intervention (PCI) was analysed.


RESULTS
Of the 41 patients with STEMI and cardiogenic shock, total occlusion or critical stenosis of a coronary artery were found in 38 patients. One patient with the occlusion of three main coronary arteries underwent urgent surgical revascularisation and remains alive after an 18-month follow-up. In the remaining 37 patients primary PCI of an infarct-related artery was performed (stent implantation in 70%, abciximab administration in 54%) which restored normal blood flow (TIMI grade 3 flow) in 54% of subjects. In patients with TIMI grade 3 flow the in-hospital mortality was 25%. Of the whole PCI-treated group, 18 (48.6%) patients died during stay in our institution, an additional two - after transfer to another hospital, and one - during a 19-month follow-up period. The remaining 16 patients remain alive (median follow-up of 8 months).


CONCLUSIONS
Invasive treatment of patients with STEMI complicated by cardiogenic shock significantly reduces mortality in this high-risk population. The mid-term results in patients discharged from hospital are good. Invasive treatment of acute MI should be accessible for all patients with extensive acute MI.
Karcz
Maciej
M
2nd Catheterisation Laboratory, National Institute of Cardiology, Warsaw, Poland.
Bekta
Paweł
P
Kepka
Cezary
C
Witkowski
Adam
A
Konopka
Anna
A
Chmielak
Zbigniew
Z
Demkow
Marcin
M
Debski
Artur
A
Ciszewski
Andrzej
A
Ciszewski
Michał
M
Cedro
Krzysztof
K
Skwarek
Mirosław
M
Przyłuski
Jakub
J
Kruk
Mariusz
M
Kadziela
Jacek
J
Deptuch
Tomasz
T
Banaszewski
Marek
M
Szajewski
Tomasz
T
Stepińska
Janina
J
Ruzyłło
Witold
W
D017677:Age Distribution; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy*; D011044:Poland / Q000453:epidemiology; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000453:epidemiology* / Q000628:therapy*; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome