Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock.
OBJECTIVE
The mortality of patients with cardiogenic shock (CS) complicating ST elevation acute myocardial infarction (STEMI) remains high, despite early revascularization. Current knowledge of predictors of death is limited.


BACKGROUND
The pathophysiologic understanding of CS after acute myocardial infarction has shifted from a mere hemodynamic disorder to a more complex approach including imbalance in metabolic functions.


METHODS
In 45 consecutive patients (71.4+/-13 years) with CS complicating STEMI treated with primary percutaneous coronary intervention (PCI) serum levels of lactate, glucose and uric acid on coronary care unit (CCU) admission were measured. The end-point was in-hospital death.


RESULTS
The following parameters, on CCU admission, were univariate predictors of in-hospital mortality: serum glucose >200 mg/dl (OR=11.3, p=0.002), serum creatinine >1.5 mg/dl (OR=12.7, p=0.003), uric acid >6.5 mg/dl (OR=6.7, p=0.016), lactate >6.5 mmol/l (OR=54, p<0.0001), age > or =75 years (OR=8.5, p=0.002), history of hypertension (OR=8.3, p=0.003) and TIMI flow post PCI < or = 2 (OR=12.9, p=0.02). At multivariate analysis, after adjustment for sex, age, hypertension and diabetes, lactate >6.5 mmol/l and TIMI flow post PCI < or = 2 were still independent predictors of in-hospital mortality (OR=295, p=0.01; OR=19.5, p=0.04, respectively).


CONCLUSIONS
Hyperlactatemia, hyperglycemia and increased levels of uric acid on CCU admission are univariate predictors of in-hospital death. Moreover, at multivariate analysis, hyperlactatemia (>6.5 mmol/l) is an independent indicator of in-hospital death in CS patients complicating STEMI.
Valente
Serafina
S
Coronary Care Unit, Heart and Vessel Department, Viale Morgagni 85, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy. seravalente@hotmail.com <seravalente@hotmail.com>
Lazzeri
Chiara
C
Vecchio
Sabine
S
Giglioli
Cristina
C
Margheri
Massimo
M
Bernardo
Pasquale
P
Comeglio
Marco
M
Chiocchini
Silvia
S
Gensini
Gian Franco
GF
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications* / Q000628:therapy*; D011237:Predictive Value of Tests; D012770:Shock, Cardiogenic / Q000097:blood / Q000209:etiology / Q000401:mortality* / Q000628:therapy*