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Outcome after primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction complicated

Yui Okada Nozaki1, Shoichiro Yatsu1, Manabu Ogita1

  • 1Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan.

Journal of Cardiology
|February 19, 2024
PubMed

Insights

Patients with ST-segment-elevation myocardial infarction (STEMI) and cardiogenic shock (CS) have higher early cardiovascular death rates after primary percutaneous coronary intervention (PCI). However, long-term survival rates (>1 year) are similar to those without CS.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Primary percutaneous coronary intervention (PCI) is a key treatment for ST-segment-elevation myocardial infarction (STEMI).
  • Cardiogenic shock (CS) is a severe complication of STEMI, posing significant challenges to treatment and outcomes.
  • Evaluating long-term outcomes for STEMI patients with CS undergoing primary PCI is crucial for clinical practice.

Purpose of the Study:

  • To assess the clinical characteristics of patients with STEMI and CS undergoing primary PCI.
  • To evaluate the long-term cardiovascular death (CVD) rates in STEMI patients with and without CS after primary PCI.
  • To identify factors influencing outcomes in this high-risk population.

Main Methods:

  • An observational cohort study included 1758 STEMI patients undergoing primary PCI from April 2004 to December 2017.
  • Patients were categorized based on the presence or absence of cardiogenic shock (CS).
  • Landmark analysis and multivariate Cox regression were used to evaluate cardiovascular death (CVD) at 1-year and 1-10 year intervals.

Main Results:

  • STEMI patients with CS (n=212) had a significantly higher 30-day CVD rate (26.4%) compared to those without CS (2.9%).
  • Landmark analysis revealed significantly higher CVD from day 0 to 1 year in the CS group (log-rank p < 0.0001).
  • CS was a strong predictor of higher cardiovascular mortality (aHR, 11.8; p < 0.0001), but CVD rates from 1 to 10 years were comparable between groups (log-rank p = 0.68).

Conclusions:

  • Patients with STEMI and CS experience a substantially higher risk of cardiovascular death within the first year after primary PCI.
  • Despite the initial high mortality, long-term survival rates (>1 year) for STEMI patients who survive the acute phase with CS are comparable to those without CS.
  • Focusing on early management and survival is critical for improving the long-term prognosis of STEMI patients complicated by cardiogenic shock.
Abstract

Keywords:
Cardiogenic shockCardiovascular mortalityCoronary artery diseaseMyocardial infarctionPercutaneous coronary intervention

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