Left ventricular support device for cardiogenic shock during myocardial infarction due to stent thrombosis: a single centre experience.
BACKGROUND
Stent thrombosis (ST) is a new, rare, cause of STEMI. Few data are available about incidence and clinical impact of shock complicating acute myocardial infarction due to ST (st-STEMI).


METHODS
From January 2004 to March 2007, 92 st-STEMI patients were observed: 14 (15.2%) of them presented with cardiogenic shock and were evaluated in the present analysis. In particular, clinical and angiographic characteristics of survivors and non-survivors to PCI were compared.


RESULTS
St-STEMI was related to left main or multivessels stent thrombosis in 35.7% of cases; whereas in 93% of cases st-STEMI occurred in a territory with previous myocardial infarction. All patients underwent IABP implantation immediately before coronary angiography, whereas Impella LP 2.5 pump was used in 21% of cases when persistent cardiac low-output signs were recorded. PCI was successful in 80% of cases. In-hospital survival was 28.6%. Death occurred within the first 48 h in the majority of patients. At six-months all patients survived to the acute phase were alive. Survivors had significantly lower thrombus grade after wire passage (p=0.03) and, albeit not significant, they showed a higher rate of very late ST, longer times from symptoms onset to revascularization, and higher TIMI flow grade either before and after PCI.


CONCLUSIONS
The incidence of cardiogenic shock in st-STEMI is high, particulary it seems to be two times higher than the rate reported during myocardial infarction. One third of cases is related to left main or multiple vessels ST. Shock in st-STEMI represents a dramatic event with very low in-hospital and early survival.
Lilli
Alessio
A
Cardiology and Invasive Cardiology 2, Careggi Hospital, Post-graduate school of Cardiology, University of Florence, Florence, Italy. lilli.alessio@libero.it
Vecchio
Sabine
S
Chechi
Tania
T
Vittori
Guido
G
Giuliani
Gabriele
G
Spaziani
Gaia
G
Consoli
Lorenzo
L
Giannotti
Federica
F
Baldereschi
Giorgio
G
Margheri
Massimo
M
D000368:Aged; D016208:Databases, Factual; D017147:Defibrillators, Implantable; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*