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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Survival after early surgical revascularization in patients with both acute myocardial infarction and cardiogenic
1Department of Surgery, National Taiwan University Hospital and Far Eastern Memorial Hospital, Taipei.
Insights
Early surgical revascularization significantly improves survival for patients experiencing cardiogenic shock after failed percutaneous transluminal coronary angioplasty (PTCA). This intervention offers a better outcome compared to mechanical circulatory support alone.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Critical Care Medicine
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) shows limited success in acute myocardial infarction (AMI) with cardiogenic shock, carrying over 80% mortality.
- The efficacy of early surgical revascularization following failed PTCA in this critical patient group remains unclear.
Purpose of the Study:
- To evaluate the impact of early surgical revascularization on survival rates.
- To compare outcomes between surgical intervention and mechanical circulatory support in patients with cardiogenic shock and failed PTCA.
Main Methods:
- A cohort of 19 patients with cardiogenic shock and failed PTCA were analyzed.
- Seven patients received extracorporeal membrane oxygenation (ECMO) without surgery, while 12 underwent emergency surgical revascularization.
- Patient demographics and in-hospital mortality were compared between the groups.
Main Results:
- In-hospital mortality was 100% for patients treated with ECMO alone versus 25% for those undergoing surgical revascularization (p = 0.003).
- No significant baseline differences were observed between the groups regarding age, sex, or comorbidities.
- Surgical revascularization, even when performed over 18 hours post-AMI, maintained a 25% in-hospital mortality rate.
Conclusions:
- Early surgical revascularization is associated with improved survival in patients with cardiogenic shock and failed PTCA.
- This study suggests surgical intervention is a viable option for this high-risk population.
Background And Purpose:
Previous studies have reported encouraging results with percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock. However, PTCA is often unsuccessful and the mortality rate is more than 80%. The success rate of early surgical revascularization in patients with cardiogenic shock and failed PTCA is not clear. This study assessed the effect of early surgical revascularization on survival chances in patients with cardiogenic shock and failed PTCA.
Patients And Methods:
Nineteen patients referred to our hospital by cardiologists due to cardiogenic shock and failed PTCA were included in this study. During the period from February 1995 through August 1997, seven patients were treated using mechanical circulatory support with extracorporeal membrane oxygenation (ECMO) and no surgical revascularization, and from August 1997 through June 1999, 12 patients underwent emergency surgical revascularization. The patient characteristics and in-hospital mortality were compared between groups.
Results:
Ten patients were treated after acute infarction and nine were treated after cardiac intervention. No significant differences were found between the two groups in age, sex, hypertension, diabetes, smoking, and previous infarction. The in-hospital mortality rates were 100% in patients receiving mechanical circulatory support with ECMO and 25% in patients who underwent emergency surgical revascularization (p = 0.003). In the emergency revascularization group, four of 12 patients had surgical revascularization more than 18 hours after AMI and the in-hospital mortality rate was 25%.
Conclusion:
Surgical revascularization improved survival in patients with cardiogenic shock and failed PTCA.
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