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Updated: Jan 3, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Jeopardized Myocardium and Survival in Patients Presenting to the Catheterization Laboratory With ST-Elevation
Francis R Joshi1, Frants Pedersen1, Sune Räder1
1Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
Insights
Myocardial jeopardy scores did not predict mortality in patients with ST-elevation myocardial infarction and cardiogenic shock. Further research is needed to understand why multi-vessel revascularization lacks clinical benefit in these high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Contemporary data challenge historical guidance on multi-vessel revascularization in ST-elevation myocardial infarction (STEMI) with cardiogenic shock.
- Survival benefits of multi-vessel revascularization in this patient group remain unclear, necessitating further mechanistic investigation.
Purpose of the Study:
- To investigate the relationship between the extent of jeopardized myocardium and mortality in patients with STEMI and cardiogenic shock.
- To assess the predictive value of myocardial jeopardy scores in this high-risk population.
Main Methods:
- Retrospective analysis of 128 patients with STEMI and cardiogenic shock undergoing primary percutaneous coronary intervention (PPCI) in Eastern Denmark (June 2011–December 2014).
- Calculation of British Cardiovascular Intervention Society (BCIS)-1 jeopardy scores from angiography.
- Evaluation of 30-day mortality as the primary endpoint.
Main Results:
- 30-day mortality was 53.9%.
- Predictors of mortality included increasing age, elevated lactate levels, mechanical ventilation, and low systolic blood pressure.
- Successful reperfusion (TIMI 3 flow) post-PPCI was associated with reduced mortality.
- Pre-PCI BCIS-1 jeopardy scores did not correlate with 30-day mortality.
Conclusions:
- Myocardial jeopardy scores are not associated with patient outcomes in STEMI complicated by cardiogenic shock.
- Jeopardy scores may be useful for analyzing existing data to elucidate the reasons behind the lack of survival benefit from multi-vessel revascularization in cardiogenic shock.
Objective:
We aimed to relate the amount of jeopardized myocardium to mortality in shocked patients presenting to the catheterization laboratory with ST-elevation myocardial infarction (STEMI) and cardiogenic shock.
Background:
In contrast with historical data and previous professional guidance, contemporary randomized data suggest that multi-vessel revascularization in such patients does not improve survival; mechanistic insight is incomplete.
Methods:
Clinical databases identified cases of STEMI and shock triaged for primary percutaneous coronary intervention (PPCI) in Eastern Denmark from June 2011 to December 2014 (n = 128). British Cardiovascular Intervention Society (BCIS)-1 jeopardy scores were calculated from angiography. The study endpoint was 30-day mortality.
Results:
Median lactate values were 6.0 [2.9-10.7] mmol/L. 30-day mortality was 53.9%. 68% of patients had multi-vessel coronary disease. Median pre-PCI BCIS-1 myocardial jeopardy scores were 8 [6-10]. After multiple logistic regression increasing age (p = 0.008; odds ratio [OR] 1.06), lactate values (p = 0.017; OR 1.02), mechanical ventilation (p = 0.011; OR 1.25) and a systolic blood pressure ≤ 90 mmHg at end-case (p = 0.005; OR 1.26) were predictive of 30-day mortality. Post-PPCI culprit vessel TIMI 3 flow was associated with reduced mortality (p < 0.001; OR 0.66). There was no association between pre-PCI jeopardy scores and the primary endpoint.
Conclusions:
In patients with STEMI and shock, myocardial jeopardy scores do not relate to patient outcomes. Jeopardy scores may be applied to existing datasets in order to understand why multi-vessel revascularization does not lead to the anticipated clinical benefits in cardiogenic shock.
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