Correlates for mortality in patients presented with acute myocardial infarct complicated by cardiogenic shock.
OBJECTIVE
This study aimed to explore the correlates for mortality in patients treated with both primary percutaneous coronary intervention (PCI) and intra-aortic balloon pump counter-pulsation (IABP).


BACKGROUND
Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is associated with high mortality rates.


METHODS
From a cohort of patients with AMI, treated with both primary PCI and IABP and who met strict definitions for CS to identify correlates associated with mortality, the study compared patients who died in-hospital to those who survived to discharge.


RESULTS
A cohort of 93 patients met the inclusion/exclusion criteria. Of them, 66.7% were male, and the average age was 64.96±13.06years. The overall in-hospital mortality rate for this cohort was 33%. The baseline characteristics were balanced save for older average age and left ventricular ejection fraction in those who died (p=0.049 and p=0.014, respectively). Insertion of IABP pre-PCI and cardiac arrest at the catheterization lab were more frequent in those who died (p=0.027 and p=0.008, respectively). The insertion of IABP pre-PCI, cardiac arrest at the cath lab, and lower ejection fraction were correlated with in-hospital mortality (ORs 2.68, 5.93, and 0.02, respectively).


CONCLUSIONS
In the era of primary PCI and IABP as standard of care in AMI complicated by CS, patients with low EF, those who necessitate IABP insertion pre-PCI, and those who necessitate cardiopulmonary resuscitation during PCI are at higher risk for in-hospital mortality and should be considered for more robust hemodynamic support devices with an attempt to improve their prognosis.
Interventional Cardiology, MedStar Washington Hospital Center, Washington DC.
Sa'ar
S
Minha
Interventional Cardiology, MedStar Washington Hospital Center, Washington DC.
Israel M
IM
Barbash
Interventional Cardiology, MedStar Washington Hospital Center, Washington DC.
Danny
D
Dvir
Interventional Cardiology, MedStar Washington Hospital Center, Washington DC.
Itsik
I
Ben-Dor
Interventional Cardiology, MedStar Washington Hospital Center, Washington DC.
Joshua P
JP
Loh
Interventional Cardiology, MedStar Washington Hospital Center, Washington DC.
Lakshmana K
LK
Pendyala
Interventional Cardiology, MedStar Washington Hospital Center, Washington DC.
Lowell F
LF
Satler
Interventional Cardiology, MedStar Washington Hospital Center, Washington DC.
Augusto D
AD
Pichard
Interventional Cardiology, MedStar Washington Hospital Center, Washington DC.
Rebecca
R
Torguson
Interventional Cardiology, MedStar Washington Hospital Center, Washington DC. Electronic address: ron.waksman@medstar.net.
Ron
R
Waksman
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000401:mortality; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D010351:Patient Discharge; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
Acute myocardial infarction; Cardiogenic shock; Intra-aortic-balloon-pump