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Updated: Oct 4, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
[Elective primary angioplasty in cardiogenic shock: results from a single center]
F Hernández Hernández1, P Hernández Simón, J Andreu Dussac
1Sección de Hemodinámica y Cardiología Intervencionista. Servicio de Cardiología. Hospital Universitario 12 de Octubre. Madrid. fhernandezh@medynet.com
Insights
Emergency coronary angioplasty with stenting effectively treats cardiogenic shock after heart attack, improving outcomes compared to conservative methods. This revascularization strategy offers a better prognosis for high-risk acute myocardial infarction patients.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Cardiogenic shock is a primary cause of mortality in acute myocardial infarction (AMI) patients.
- Conventional treatments for AMI with cardiogenic shock show limited efficacy.
- Emergency revascularization via coronary angioplasty shows promise for improving outcomes.
Purpose of the Study:
- To evaluate the clinical and angiographic outcomes of primary angioplasty in patients with cardiogenic shock complicating AMI.
- To assess the effectiveness of emergency coronary revascularization in reducing mortality.
Main Methods:
- Retrospective analysis of 48 patients with AMI and cardiogenic shock (symptom onset < 12 hours).
- Primary angioplasty with intracoronary stenting was the main intervention.
- Exclusion of patients with cardiogenic shock due to mechanical complications.
Main Results:
- Angiographic success (stenosis < 50%, TIMI flow ≥ 2) achieved in 85% of culprit lesions.
- Stent implantation in 76% of patients; multivessel angioplasty in 25%.
- In-hospital survival was 58%, with 54% survival at six-month follow-up.
Conclusions:
- Emergency coronary revascularization with primary angioplasty and stenting is effective for AMI with cardiogenic shock.
- Achieving TIMI flow ≥ 2 is common, and mortality is reduced compared to historical conservative treatments.
Introduction:
Cardiogenic shock is the leading cause of death among patients hospitalized for acute myocardial infarction. Conventional treatment for acute myocardial infarction does not achieve a better outcome in these patients, but prior studies with emergency revascularization by coronary angioplasty seem to provide encouraging results.
Patients And Method:
A retrospective study of the clinical and angiographic results of elective primary angioplasty in 48 patients with cardiogenic shock complicating acute myocardial infarction of less than 12 hours is described. Intraaortic balloon counterpulsation was used in 79% of the patients. Patients with cardiogenic shock secondary to mechanical complications were excluded.
Results:
Angiographic success, defined as a residual stenosis < 50% and final TIMI flow >/= 2, was achieved in 85% of the culprit lesions, and stents were implanted in 76%. Multivessel angioplasty was performed in 25% of the patients, and abciximab was used in 35% of the cases. Mean time from the onset of symptoms to angioplasty was 7.4 +/- 3.1 hours. In-hospital survival was 58%, and was 54% at six months follow-up.
Conclusions:
Emergency coronary revascularization with primary angioplasty and intracoronary stenting is effective in patients with acute myocardial infarction and cardiogenic shock. TIMI flow >/= 2 is achieved in most patients, and mortality is reduced when compared with conservative treatment in historical series.
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