title: Long-term clinical outcomes in patients with ST-segment elevation acute myocardial infarction complicated by cardiogenic shock due to acute pump failure.
abstract: Cardiogenic shock remained the leading cause of death in ST-segment elevation acute myocardial infarction (STEMI) patients even in the primary percutaneous coronary intervention era.
  Among 3942 STEMI patients with primary percutaneous coronary intervention within 24 h after symptom-onset in the Coronary Revascularization Demonstrating Outcome Study in Kyoto acute myocardial infarction registry, the study population of the current analysis consisted of 466 STEMI patients who were complicated by cardiogenic shock due to acute pump failure.
  The cumulative incidence of all-cause death of cardiogenic shock due to acute pump failure was 25.4% at 30 days, 38.7% at one year, and 51.4% at five years. Cumulative five-year incidence of all-cause death in patients with left main coronary artery culprit lesion was extremely high (left main coronary artery: 70.4%, left anterior descending artery: 52.5%, left circumflex artery: 50.6%, and right coronary artery; 44.3%, respectively, log-rank p<0.001). The cumulative five-year incidence of all-cause death in patients with onset-to-balloon time ⩽3 h as well as those with door-to-balloon time ⩽90 min were significantly lower than those without (43.3% versus 55.5%, log-rank p=0.008, and 44.9% versus 55.8%, log-rank p=0.003, respectively). After adjusting for confounders, onset-to-balloon time ⩽3 h and door-to-balloon time ⩽90 min were independently associated with lower long-term risk for all-cause death (hazard ratio: 0.69, 95% confidence interval: 0.49-0.96, p=0.03, and hazard ratio: 0.73, 95% confidence interval: 0.53-0.98, p=0.04, respectively).
  The long-term mortality of STEMI patients complicated by cardiogenic shock due to acute pump failure remains high even in the current clinical practice. In this high-risk category of patients, shorter onset-to-balloon and door-to-balloon time were associated with significantly lower long-term risk for mortality.
authors.affiliation: 1 Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Tetsuma
authors.initials: T
authors.lastname: Kawaji
authors.affiliation: 1 Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.affiliation: 2 Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.affiliation: 3 Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.affiliation: 4 Tenri Hospital, Tenri, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.affiliation: 5 Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.affiliation: 6 Kokura Memorial Hospital, Kokura, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Ando
authors.affiliation: 7 Mitsubishi Kyoto Hospital, Kyoto, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Mizoguchi
authors.affiliation: 8 National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Abe
authors.affiliation: 9 Shimabara Hospital, Kyoto, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: 1 Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000208:Acute Disease; D000368:Aged; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000601:surgery; D012770:Shock, Cardiogenic / Q000453:epidemiology* / Q000209:etiology; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: ST-segment elevation myocardial infarction; cardiogenic shock; door-to-balloon time; onset-to-balloon time