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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Percutaneous Coronary Intervention Volume and Cardiac Surgery Availability Effect on Acute Coronary Syndrome-Related
Samer Noaman1, Sara Vogrin2, Diem Dinh3
1Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.
Insights
Treatment for cardiogenic shock (CS) after acute coronary syndrome (ACS) is effective regardless of cardiac surgery availability or percutaneous coronary intervention (PCI) volume. This finding supports immediate PCI at the nearest capable hospital for critically ill patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Cardiogenic shock (CS) is a severe complication of acute coronary syndrome (ACS) with high mortality.
- Despite advances in reperfusion and heart failure therapies, outcomes remain poor.
Purpose of the Study:
- To evaluate the impact of cardiac surgery availability on clinical outcomes in patients with ACS-complicated CS.
- To assess the association between percutaneous coronary intervention (PCI) volume for CS and patient outcomes.
Main Methods:
- Analysis of prospectively enrolled patients with CS complicating ACS who underwent PCI.
- Comparison of outcomes between patients treated at cardiac surgical centers (CSCs) and non-CSCs.
- Stratification of outcomes based on annual CS PCI volume (<10, 10-25, >25 cases).
Main Results:
- No significant difference in in-hospital MACCE or mortality between CSCs and non-CSCs.
- No association found between annual CS PCI volume tiers and in-hospital MACCE or mortality.
- Overall in-hospital and long-term mortality rates were 42% and 51%, respectively.
Conclusions:
- PCI treatment for ACS with CS yields comparable short- and long-term mortality regardless of cardiac surgery availability.
- PCI treatment for ACS with CS yields comparable short- and long-term mortality regardless of CS PCI volume.
- These findings support emergent PCI at the presenting PCI-capable hospital for patients with CS complicating ACS.
Objectives:
This study sought to assess the association between cardiac surgery availability and percutaneous coronary intervention (PCI) volume with clinical outcomes of cardiogenic shock (CS) complicating acute coronary syndrome (ACS).
Background:
CS remains a grave complication of ACS with high mortality rates despite timely reperfusion and improved heart failure therapies.
Methods:
The study analyzed data from consecutive patients with CS complicating ACS who underwent PCI and were prospectively enrolled in the VCOR (Victorian Cardiac Outcomes Registry) from 26 hospitals in Victoria. We compared patients treated at cardiac surgical centers (CSCs) versus non-CSCs as well as the annual CS PCI volume (stratified into tiers of <10, 10-25, and >25 cases) for in-hospital major adverse cardiac and cerebrovascular events (MACCE) and long-term mortality.
Results:
Of 1,179 patients with CS, the mean age of patients was 65 years; males comprised 74%, and 22% had diabetes mellitus. Cardiac arrest occurred in 38% of patients, while 90% presented with ST-segment elevation myocardial infarction and 26% received intra-aortic balloon pump support. Overall, in-hospital and long-term mortality were 42% and 51%, respectively. There was no difference among patients treated non-CSCs compared with a CSCs for in-hospital MACCE and mortality (both P > 0.05). Similarly, there was no association between tiers of annual CS PCI volume with in-hospital MACCE and mortality (both P > 0.05).
Conclusions:
Comparable short- and long-term mortality rates among patients with ACS complicated by CS treated by PCI irrespective of cardiac surgery availability and CS PCI volume support the emergent treatment of these gravely ill patients at their presenting PCI-capable hospital.
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