title: Percutaneous coronary intervention in cardiogenic shock complicating acute ST-elevation myocardial infarction-a single centre experience.
abstract: BACKGROUND
  Mortality in acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) approaches 70 - 80%, regardless of the type of pharmacological treatment. Early revascularisation improves survival in AMI with CS. Our aim is to assess the predictors of mid-term outcome after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and CS.
  
  
  METHODS
  Forty-one patients who underwent primary or rescue PCI for CS were analysed comparing their baseline, angiographic, PCI data, 30-day and 1-year survival.
  
  
  RESULTS
  There were no significant differences between survivors and non-survivors in baseline characters, except for more number of transfer admissions (P= 0.0005), and cardiopulmonary resuscitations (P= 0.015) in the later group. The mean time between myocardial infarction (MI) onset to shock and MI onset to revascularisation were 12.8 ± 12.9 hours and 17.0 ± 16.8 hours, respectively. Patients with better pre-procedure thrombolysis in myocardial infarction (TIMI) flow in the infarct-related artery (IRA) had better survival (P= 0.0005). Successful PCI was achieved in 48.8% of patients. The 30-day mortality was 56.1% and all were prior to hospital discharge. Patients with successful PCI had better short-term survival in comparison with patients with failed PCI (80% vs 9.6%). Eighteen patients who survived at 30 days were followed up for 12-72 months (mean 28.5 ± 5.4 months). Fifteen patients survived at 1 year after PCI and all were in good functional status.
  
  
  CONCLUSIONS
  Mortality remains high even with PCI. Achieving IRA patency with TIMI 3 flow is the main determinant of survival. Survival and functional status are good in patients who are discharged from hospital.
authors.affiliation: Department of Cardiology, Madras Medical Mission, Tamilnadu, India.
authors.forename: Vijayakumar
authors.initials: V
authors.lastname: Subban
authors.forename: Anand
authors.initials: A
authors.lastname: Gnanaraj
authors.forename: Balashankar
authors.initials: B
authors.lastname: Gomathi
authors.forename: Ezhilan
authors.initials: E
authors.lastname: Janakiraman
authors.forename: Ulhas
authors.initials: U
authors.lastname: Pandurangi
authors.forename: Latchumanadhas
authors.initials: L
authors.lastname: Kalidoss
authors.forename: S Mullasari
authors.initials: SM
authors.lastname: Ajit
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000628:therapy*; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency