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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Predictors of mortality in patients with acute myocardial infarction and cardiogenic shock
Toshiro Katayama1, Hiroshi Nakashima, Chisa Takagi
1Department of Cardiovascular Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, Nagasaki, Japan. snowman-kt@syd.odn.ne.jp
Insights
High adrenomedullin levels predict mortality in acute myocardial infarction (AMI) patients with cardiogenic shock (CS). This finding aids in identifying high-risk patients early after primary percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Biomarkers
- Critical Care Medicine
Background:
- Cardiogenic shock (CS) is a major cause of mortality in acute myocardial infarction (AMI) patients.
- Reliable acute-stage predictive factors for CS mortality remain unidentified.
Purpose of the Study:
- To investigate predictive factors for 1-year mortality in AMI patients with CS.
- To assess the role of cardiovascular peptides and other factors in predicting outcomes.
Main Methods:
- Studied 42 AMI patients with CS treated by primary percutaneous coronary intervention (PCI).
- Measured plasma concentrations of brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), renin, aldosterone, catecholamines, and adrenomedullin 24 hours after onset.
- Assessed 1-year cardiovascular mortality rates.
Main Results:
- Fifteen patients (35.7%) died within 1 year.
- No significant differences in baseline characteristics, angiographic findings, or left ventricular systolic function were observed between survivors and non-survivors.
- Multivariate analysis identified high adrenomedullin levels as an independent predictor of 1-year mortality (HR: 6.42, p<0.05).
Conclusions:
- Acute-phase plasma adrenomedullin concentration may reliably predict mortality in AMI patients with CS treated by PCI.
- Brain natriuretic peptide (BNP) concentration, peak creatine kinase, and ventricular fibrillation may also predict mortality.
Background:
Although cardiogenic shock (CS) is the leading cause of death for acute myocardial infarction (AMI) patients, reliable predictive factors in the acute stage, such as cardiovascular peptides, have not yet been identified.
Methods And Results:
In 42 consecutive AMI patients with CS on admission, successfully treated by primary percutaneous coronary intervention (PCI) within 12 h of onset, related factors including brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), renin, aldosterone, catecholamines, and adrenomedullin, were investigated 24 h from onset, as well as the 1-year mortality rates. During the 12-month follow-up period, 15 patients died from cardiovascular causes (group D). There were no significant differences in patient characteristics, angiographic findings, and left ventricular systolic function between group D subjects and the survivors (group S: n=27). Multivariate analysis identified high levels of adrenomedullin as an independent predictor of 1-year mortality (risk ratio: 6.42, 95% confidence interval, 1.49-43.31, p<0.05).
Conclusions:
The acute-phase plasma concentration of adrenomedullin may be a reliable predictor of mortality in patients with AMI complicated by CS and successfully treated by direct PCI, as may be BNP concentration, peak-creatine kinase value, and ventricular fibrillation.
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