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Prognosis in cardiogenic shock after acute myocardial infarction in the interventional era
J R Bengtson1, A J Kaplan, K S Pieper
1Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
Insights
Maintaining an open infarct-related artery significantly improves survival for patients experiencing cardiogenic shock. This finding supports aggressive reperfusion therapy to reduce both in-hospital and long-term mortality in these critical cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Critical Care Medicine
Background:
- Cardiogenic shock is a leading cause of mortality in coronary care units.
- While angioplasty has shown promise, data on unselected cardiogenic shock cohorts receiving reperfusion therapy is limited.
Purpose of the Study:
- To evaluate outcomes in patients with cardiogenic shock treated with aggressive reperfusion.
- To identify predictors of in-hospital and long-term mortality in this patient group.
Main Methods:
- A consecutive series of 200 patients with acute myocardial infarction and cardiogenic shock were analyzed.
- Factors associated with in-hospital and post-discharge mortality were assessed.
Main Results:
- Overall in-hospital mortality was 53%.
- Patency of the infarct-related artery was a key predictor of mortality (33% vs. 75% mortality for patent vs. closed arteries).
- Independent predictors of in-hospital death included infarct artery patency, cardiac index, and peak creatine kinase-MB.
- Long-term follow-up (2 years) showed an 18% mortality rate at 1 year post-discharge, with age, peak creatine kinase, ejection fraction, and artery patency being key descriptors.
Conclusions:
- Infarct-related artery patency is strongly linked to both in-hospital and long-term mortality in cardiogenic shock.
- These findings advocate for an aggressive interventional strategy in managing cardiogenic shock.
Objectives:
The purpose of this study is to describe the outcome in cardiogenic shock treated with aggressive reperfusion therapy and to identify factors predictive of in-hospital and long-term mortality.
Background:
Cardiogenic shock is the most common cause of death in patients admitted to the coronary care unit. Although studies have reported lower mortality rates in shock treated with angioplasty, few studies have described a cohort of patients with shock who were not selected because they were most likely to benefit from reperfusion therapy.
Methods:
A consecutive series of 200 patients admitted with acute myocardial infarction complicated by cardiogenic shock were studied.
Results:
The in-hospital mortality rate was 53%. Variables with significant univariable association with in-hospital death included patency of the infarct-related artery, patient age, lowest cardiac index, highest arteriovenous oxygen difference and left main coronary artery disease. The most important independent predictors of in-hospital death were patency of the infarct-related artery, cardiac index and peak creatine kinase, MB fraction. The mortality rate in patients with patent infarct-related arteries was 33% versus 75% in those with closed arteries and 84% in those in whom arterial patency was unknown. Patients who survived to hospital discharge were followed up for a median of 2 years, with a mortality rate of 18% after 1 year. The best descriptors of the relation between these variables and postdischarge mortality included age, peak creatine kinase, ejection fraction and patency of the infarct-related artery.
Conclusions:
In a large consecutive series of patients with cardiogenic shock with complete follow-up, patency of the infarct-related artery was most strongly associated with in-hospital and long-term mortality. This finding supports an aggressive interventional strategy in patients with cardiogenic shock.