Predictors of mortality in patients with acute myocardial infarction and cardiogenic shock.
BACKGROUND
Although cardiogenic shock (CS) is the leading cause of death for acute myocardial infarction (AMI) patients, reliable predictive factors in the acute stage, such as cardiovascular peptides, have not yet been identified.


RESULTS
In 42 consecutive AMI patients with CS on admission, successfully treated by primary percutaneous coronary intervention (PCI) within 12 h of onset, related factors including brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), renin, aldosterone, catecholamines, and adrenomedullin, were investigated 24 h from onset, as well as the 1-year mortality rates. During the 12-month follow-up period, 15 patients died from cardiovascular causes (group D). There were no significant differences in patient characteristics, angiographic findings, and left ventricular systolic function between group D subjects and the survivors (group S: n=27). Multivariate analysis identified high levels of adrenomedullin as an independent predictor of 1-year mortality (risk ratio: 6.42, 95% confidence interval, 1.49-43.31, p<0.05).


CONCLUSIONS
The acute-phase plasma concentration of adrenomedullin may be a reliable predictor of mortality in patients with AMI complicated by CS and successfully treated by direct PCI, as may be BNP concentration, peak-creatine kinase value, and ventricular fibrillation.
Katayama
Toshiro
T
Department of Cardiovascular Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, Nagasaki, Japan. snowman-kt@syd.odn.ne.jp
Nakashima
Hiroshi
H
Takagi
Chisa
C
Honda
Yukiharu
Y
Suzuki
Shin
S
Yano
Katsusuke
K
D000800:Angioplasty, Balloon; D001241:Aspirin / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D002784:Cholesterol / Q000097:blood; D004562:Electrocardiography; D006728:Hormones / Q000097:blood; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000628:therapy; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000628:therapy; D013988:Ticlopidine / Q000627:therapeutic use; D016896:Treatment Outcome
D006728:Hormones; D010975:Platelet Aggregation Inhibitors; D002097:C-Reactive Protein; D002784:Cholesterol; D013988:Ticlopidine; D001241:Aspirin