title: Impaired microcirculation predicts poor outcome of patients with acute myocardial infarction complicated by cardiogenic shock.
abstract: OBJECTIVE
  we investigated the relationship between sublingual perfused capillary density (PCD) as a measure of tissue perfusion and outcome (i.e. occurrence of organ failure and mortality) in patients with cardiogenic shock from acute myocardial infarction.
  
  
  RESULTS
  we performed a prospective study in 68 patients. Using Sidestream Dark Field imaging, PCD was measured after hospital admission (T0, baseline) and 24 h later (T1). We compared patients with baseline PCD ≤ median to patients with baseline PCD > median. Sequential organ failure assessment (SOFA) scores were calculated at both time points. The Kaplan-Meier 30-day survival analyses were performed and predictors of 30-day mortality were identified. The baseline PCD was a predictor of the change in the SOFA score between T0 and T1 (ΔSOFA; ρ = -0.25, P = 0.04). Organ failure recovered more frequently in patients with PCD > median (>10.3 mm mm(-2); n = 33) than in patients with PCD ≤ median (n = 35; 52 vs. 29%, P < 0.05). Twenty-two patients (32%) died: 17 patients (49%) with PCD ≤ median vs. 5 patients (15%) with PCD > median (P = 0.004). After adjustment, the cardiac power index [odds ratio (OR): 0.48, 95% CI: 0.24-0.94) and PCD (OR: 0.65, 95% CI: 0.45-0.92) remained significant predictors of 30-day outcome. Patients with baseline sublingual PCD ≤ median that improved at T1 had a considerable better prognosis relative to patients who had a persistently low PCD.
  
  
  CONCLUSIONS
  diminished sublingual PCD, at baseline or following treatment, is associated with development of multi-organ failure and is a predictor of poor outcome in patients with acute myocardial infarction complicated by cardiogenic shock.
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Room V-017, s-Gravendijkwal 230, Rotterdam NL-3015 CE, The Netherlands. c.denuil@erasmusmc.nl
authors.forename: Corstiaan A
authors.initials: CA
authors.lastname: den Uil
authors.forename: Wim K
authors.initials: WK
authors.lastname: Lagrand
authors.forename: Martin
authors.initials: M
authors.lastname: van der Ent
authors.forename: Lucia S D
authors.initials: LS
authors.lastname: Jewbali
authors.forename: Jin M
authors.initials: JM
authors.lastname: Cheng
authors.forename: Peter E
authors.initials: PE
authors.lastname: Spronk
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
mesh_terms: D000368:Aged; D002196:Capillaries; D003326:Coronary Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000150:complications* / Q000401:mortality; D013361:Sublingual Gland / Q000098:blood supply