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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Characteristics, Treatment Strategies and Outcome in Cardiogenic Shock Complicating Acute Myocardial Infarction: A
Elma J Peters1, Sanne Ten Berg1, Margriet Bogerd1
1Heart Center, Department of Cardiology, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands.
Insights
Cardiogenic shock (CS) following acute myocardial infarction (AMI) has high mortality. This study identified patient factors and treatments, noting frequent use of multivessel PCI and IABPs without clear evidence.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI).
- CS significantly increases patient morbidity and mortality rates.
Purpose of the Study:
- To investigate patient characteristics, treatment strategies, and outcomes in CS patients undergoing percutaneous coronary intervention (PCI).
- To identify factors associated with mortality in this high-risk population.
Main Methods:
- Retrospective analysis of a nationwide registry data from 2017-2021.
- Inclusion of 2328 patients with CS undergoing PCI.
- Assessment of medical history, laboratory values, angiographic features, and outcomes.
Main Results:
- The cohort had a mean age of 66 years, with 73% males. 30-day mortality was 39%.
- Non-survivors exhibited lower blood pressure, higher heart rate, lactate, and glucose levels.
- Diabetes, multivessel coronary artery disease, and prior coronary events were more prevalent in non-survivors.
Conclusions:
- Hemodynamic, biochemical, and patient-related factors are significantly associated with mortality in CS patients.
- Multivessel PCI and intra-aortic balloon pumps (IABPs) were commonly used, despite limited supporting evidence.
Abstract:
Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) is associated with high morbidity and mortality. Our study aimed to gain insights into patient characteristics, outcomes and treatment strategies in CS patients. Patients with CS who underwent percutaneous coronary intervention (PCI) between 2017 and 2021 were identified in a nationwide registry. Data on medical history, laboratory values, angiographic features and outcomes were retrospectively assessed. A total of 2328 patients with a mean age of 66 years and of whom 73% were male, were included. Mortality at 30 days was 39% for the entire cohort. Non-survivors presented with a lower mean blood pressure and increased heart rate, blood lactate and blood glucose levels (p-value for all <0.001). Also, an increased prevalence of diabetes, multivessel coronary artery disease and a prior coronary event were found. Of all patients, 24% received mechanical circulatory support, of which the majority was via intra-aortic balloon pumps (IABPs). Furthermore, 79% of patients were treated with at least one vasoactive agent, and multivessel PCI was performed in 28%. In conclusion, a large set of hemodynamic, biochemical and patient-related characteristics was identified to be associated with mortality. Interestingly, multivessel PCI and IABPs were frequently applied despite a lack of evidence.
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