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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Correlates for mortality in patients presented with acute myocardial infarct complicated by cardiogenic shock
Sa'ar Minha1, Israel M Barbash1, Danny Dvir1
1Interventional Cardiology, MedStar Washington Hospital Center, Washington DC.
Insights
Patients undergoing primary percutaneous coronary intervention (PCI) and intra-aortic balloon pump (IABP) for acute myocardial infarction with cardiogenic shock face high mortality. Low ejection fraction and cardiac arrest during PCI predict in-hospital death.
Area of Science:
- Cardiology
- Interventional Cardiology
- Critical Care Medicine
Background:
- Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) presents a significant clinical challenge with high mortality rates.
- Primary percutaneous coronary intervention (PCI) and intra-aortic balloon pump (IABP) counter-pulsation are established treatments for such cases.
- Identifying factors associated with mortality is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the correlates of in-hospital mortality in patients with AMI and CS who received both primary PCI and IABP.
- To compare characteristics and outcomes between patients who survived and those who died during hospitalization.
Main Methods:
- A retrospective cohort study was conducted on 93 patients meeting strict criteria for AMI, CS, primary PCI, and IABP.
- Patients were categorized into in-hospital survivors and non-survivors.
- Statistical analysis was performed to identify baseline characteristics and procedural factors associated with mortality.
Main Results:
- The overall in-hospital mortality rate was 33%.
- Patients who died were older and had a lower left ventricular ejection fraction (LVEF) compared to survivors.
- Insertion of IABP before PCI and cardiac arrest during catheterization were significantly more frequent in the non-survivor group.
Conclusions:
- Low LVEF, pre-PCI IABP insertion, and cardiac arrest during PCI are significant predictors of in-hospital mortality in patients with AMI and CS treated with primary PCI and IABP.
- These high-risk patients may benefit from more advanced hemodynamic support strategies to improve prognosis.
Objective:
This study aimed to explore the correlates for mortality in patients treated with both primary percutaneous coronary intervention (PCI) and intra-aortic balloon pump counter-pulsation (IABP).
Background:
Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is associated with high mortality rates.
Methods:
From a cohort of patients with AMI, treated with both primary PCI and IABP and who met strict definitions for CS to identify correlates associated with mortality, the study compared patients who died in-hospital to those who survived to discharge.
Results:
A cohort of 93 patients met the inclusion/exclusion criteria. Of them, 66.7% were male, and the average age was 64.96±13.06years. The overall in-hospital mortality rate for this cohort was 33%. The baseline characteristics were balanced save for older average age and left ventricular ejection fraction in those who died (p=0.049 and p=0.014, respectively). Insertion of IABP pre-PCI and cardiac arrest at the catheterization lab were more frequent in those who died (p=0.027 and p=0.008, respectively). The insertion of IABP pre-PCI, cardiac arrest at the cath lab, and lower ejection fraction were correlated with in-hospital mortality (ORs 2.68, 5.93, and 0.02, respectively).
Conclusions:
In the era of primary PCI and IABP as standard of care in AMI complicated by CS, patients with low EF, those who necessitate IABP insertion pre-PCI, and those who necessitate cardiopulmonary resuscitation during PCI are at higher risk for in-hospital mortality and should be considered for more robust hemodynamic support devices with an attempt to improve their prognosis.
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