Mortality and deciding factors for no revascularization in cardiogenic shock patients; a cross sectional study
Zohaib Akhter1, Sajid Hussain1, Saba Aijaz1
1Tabba Heart Institute, Karachi, Pakistan.
Insights
Acute coronary syndrome patients with cardiogenic shock not receiving revascularization had a high in-hospital mortality rate of 81.8%. Many patients died before or during the revascularization process, with common reasons for non-treatment including cardiac arrest and multi-organ failure.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Clinical Research
Background:
- Acute coronary syndrome (ACS) can precipitate cardiogenic shock (CS), a life-threatening condition.
- Revascularization is a cornerstone in managing ACS, but its role in CS is complex.
- Understanding outcomes and decision-making for ACS patients with CS who do not receive revascularization is crucial.
Observation:
- A retrospective study analyzed 383 ACS patients with hypotension, identifying 55 (14.3%) who did not undergo revascularization.
- The in-hospital mortality rate for this subgroup was high at 81.8%.
- Among those intended for revascularization, a significant proportion died before or after cardiac catheterization but before the procedure.
Findings:
- Common reasons for not considering revascularization included hypoxic brain injury post-cardiac arrest, patient refusal, frailty, multi-organ failure, sepsis, or pre-existing conditions.
- In many cases (two-thirds), cardiac arrest occurred before treatment initiation, with failed resuscitation or poor recovery.
- The study highlights a very poor early outcome for cardiogenic shock complicating myocardial infarction when revascularization is not performed.
Implications:
- These findings underscore the critical condition of ACS patients with CS who are not revascularized.
- The data suggests a need for improved risk stratification and timely management decisions in this high-mortality group.
- Further research may explore alternative or optimized treatment strategies for non-revascularized CS patients.
Objective:
To assess the frequency of acute coronary syndrome patients with cardiogenic shock and not undergoing revascularisation, their in- hospital outcome and reasons underlying management decisions.
Methods:
The retrospective cross-sectional study was conducted at Tabba Heart Institute, Karachi, and comprised data from July 2013 to December 2017 of acute coronary syndrome with hypotension and not having under gone revascularisation. Data was analyzed using Stata 12.1.
Results:
Of the 383 patients, 55(14.3%) did not undergo revascularisation. Overall mean age was 63.2±9.8years. Overall mortality was 45(81.8%). Revascularisation was intended in 28(51%) patients of whom 19(68%) died before undergoing cardiac catheterisation. Another 9(32%) patients died after cardiac catheterisation but before revascularisation. Common clinical reasons in the remaining 27(49%) patients not considered for revascularisation were hypoxic brain injury secondary to cardiac arrest, patient refusal, perceived patient frailty, multi-organ failure, sepsis or pre-existing stroke/ malignancy.
Conclusions:
Cardiogenic shock complicating myocardial infarction not treated by revascularization had a very poor early outcome. In the two-third of patients before treatment was initiated, there was cardiac arrest with failed resuscitation or poor recovery.
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