title: Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock.
abstract: 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.
authors.affiliation: Coronary Care Unit, Heart and Vessel Department, Viale Morgagni 85, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy. seravalente@hotmail.com <seravalente@hotmail.com>
authors.forename: Serafina
authors.initials: S
authors.lastname: Valente
authors.forename: Chiara
authors.initials: C
authors.lastname: Lazzeri
authors.forename: Sabine
authors.initials: S
authors.lastname: Vecchio
authors.forename: Cristina
authors.initials: C
authors.lastname: Giglioli
authors.forename: Massimo
authors.initials: M
authors.lastname: Margheri
authors.forename: Pasquale
authors.initials: P
authors.lastname: Bernardo
authors.forename: Marco
authors.initials: M
authors.lastname: Comeglio
authors.forename: Silvia
authors.initials: S
authors.lastname: Chiocchini
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
mesh_terms: 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*