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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Prognostic Analysis for Cardiogenic Shock in Patients with Acute Myocardial Infarction Receiving Percutaneous
Mao-Jen Lin1, Chun-Yu Chen2, Hau-De Lin3
1The Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; Department of Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan.
Insights
Cardiogenic shock (CS) in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) is linked to worse outcomes. Key predictors for mortality and repeat procedures include CS, age, SYNTAX score, and stroke history.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Cardiogenic shock (CS) is a rare but serious complication of acute myocardial infarction (AMI).
- Long-term outcomes and predictors of adverse events in AMI patients with CS undergoing percutaneous coronary intervention (PCI) remain incompletely understood.
Purpose of the Study:
- To investigate the long-term outcomes and identify adverse predictors in AMI patients who experienced CS after PCI.
- To analyze factors associated with recurrent myocardial infarction (MI), cardiovascular (CV) mortality, all-cause mortality, and the need for repeat PCI in this patient cohort.
Main Methods:
- Retrospective analysis of 482 AMI patients who underwent PCI, comparing 53 patients with CS to 429 without CS.
- Statistical analysis to identify predictors for recurrent MI, CV mortality, all-cause mortality, and repeated PCI.
Main Results:
- The CS group exhibited lower central systolic and diastolic pressures and a lower prevalence of hypertension history.
- Higher Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) scores, CV mortality, and all-cause mortality were observed in the CS group.
- Stroke history predicted recurrent MI; CS, age, SYNTAX score, and diabetes predicted CV mortality; CS, age, SYNTAX score, and stroke history predicted all-cause mortality; CS, age, and smoking predicted repeat PCI.
Conclusions:
- Cardiogenic shock is a significant adverse predictor for mortality and repeat PCI in AMI patients undergoing PCI.
- Factors such as age, SYNTAX score, diabetes, and stroke history further stratify risk within this high-risk population.
Abstract:
Cardiogenic shock (CS) is uncommon in patients suffering from acute myocardial infarction (AMI). Long-term outcome and adverse predictors for outcomes in AMI patients with CS receiving percutaneous coronary interventions (PCI) are unclear. A total of 482 AMI patients who received PCI were collected, including 53 CS and 429 non-CS. Predictors for AMI patients with CS including recurrent MI, cardiovascular (CV) mortality, all-cause mortality, and repeated-PCI were analyzed. The CS group had a lower central systolic pressure and central diastolic pressure (both P < 0.001). AMI patients with hypertension history were less prone to develop CS (P < 0.001). Calcium channel blockers and statins were less frequently used by the CS group than the non-CS group (both P < 0.05) after discharge. Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, CV mortality, and all-cause mortality were higher in the CS group than the non-CS group (all P < 0.005). For patients with CS, stroke history was a predictor of recurrent MI (P = 0.036). CS, age, SYNTAX score, and diabetes were predictors of CV mortality (all P < 0.05). CS, age, SYNTAX score, and stroke history were predictors for all-cause mortality (all P < 0.05). CS, age, and current smoking were predictors for repeated-PCI (all P < 0.05).
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