Pressure response to vasopressors and mortality after direct angioplasty for cardiogenic shock

There is very little known about the relationship between pre-intervention arterial pressure response to vasopressor therapy (PRV) and death rate, after primary angioplasty for immediate cardiogenic shock (CS) complicating acute myocardial infarction (AMI).

We examined data from 32 consecutive cases, admitted to our department within 12 h after the onset of MI and in CS, treated with direct PTCA, from May 1995 to March 2001. Intravenous administration of dobutamine and vasopressor agents was required in all patients before intervention.

Ten patients, after vasopressor therapy, showed a significant improvement in systolic arterial pressure, invasively measured, (>90 mmHg, responders) before undergoing PTCA. Responders were younger and with less impaired pre-procedural LVEF (39.6%+/-10.7 vs. 30.9%+/-8.4, P=0.02). After direct PTCA responders showed an improved final TIMI flow (2.8+/-0.6 vs. 2.2+/-0.7, P=0.04) and blush grade (1.9+/-0.9 vs. 1+/-1, P=0.03). The mortality rate was lower in responders compared with non-responders both in hospital (20% vs. 68%, P=0.02) and at 3.5 years of follow-up (30% vs. 73%, P=0.049). After adjustment by multivariate analysis older age and lower blush grade correlated with in hospital death, while age remained the only predictor of late death.

PRV was not an independent predictor of death after direct PTCA for CS. The association of no PRV with older age and lower post procedural blush grade may explain the difference in mortality rates between responders and non-responders.