title: Acute myocardial infarction complicated by cardiogenic shock. In-hospital and mid-term results of invasive treatment in the National Institute of Cardiology, Warsaw-Anin.
abstract: 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.
authors.affiliation: 2nd Catheterisation Laboratory, National Institute of Cardiology, Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Karcz
authors.forename: Paweł
authors.initials: P
authors.lastname: Bekta
authors.forename: Cezary
authors.initials: C
authors.lastname: Kepka
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.forename: Anna
authors.initials: A
authors.lastname: Konopka
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Chmielak
authors.forename: Marcin
authors.initials: M
authors.lastname: Demkow
authors.forename: Artur
authors.initials: A
authors.lastname: Debski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Ciszewski
authors.forename: Michał
authors.initials: M
authors.lastname: Ciszewski
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Cedro
authors.forename: Mirosław
authors.initials: M
authors.lastname: Skwarek
authors.forename: Jakub
authors.initials: J
authors.lastname: Przyłuski
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kruk
authors.forename: Jacek
authors.initials: J
authors.lastname: Kadziela
authors.forename: Tomasz
authors.initials: T
authors.lastname: Deptuch
authors.forename: Marek
authors.initials: M
authors.lastname: Banaszewski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Szajewski
authors.forename: Janina
authors.initials: J
authors.lastname: Stepińska
authors.forename: Witold
authors.initials: W
authors.lastname: Ruzyłło
mesh_terms: 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