Risk, Management, and Outcomes in PCI-Treated Acute Coronary Syndrome With Cardiogenic Shock

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Critical Care Cardiology

Background:

• Acute coronary syndrome complicated by cardiogenic shock (ACS-CS) carries a high mortality rate.
• Despite advancements in percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS), outcomes remain poor.

Purpose of the Study:

• To analyze temporal trends in patient risk profiles, treatment strategies, and in-hospital outcomes for ACS-CS patients undergoing PCI.
• To assess changes in management and their impact on mortality over a decade.

Main Methods:

• Analysis of 870 ACS-CS cases from a 24,527-patient PCI registry (2009-2019).
• Patients categorized into four time periods to evaluate temporal changes.
• Risk profiles assessed using National Cardiovascular Data Registry (NCDR) scores; trends in MCS use and mortality analyzed.

Main Results:

• Predicted mortality and bleeding risk remained stable over the decade.
• Overall MCS use decreased, mainly due to reduced intra-aortic balloon pump utilization.
• Crude and risk-adjusted in-hospital mortality remained persistently high at approximately 30%.

Conclusions:

• Management strategies for ACS-CS patients undergoing PCI evolved, particularly MCS use.
• No significant improvement in in-hospital mortality was observed over the study period.
• This underscores the persistent clinical challenges in treating high-risk ACS-CS patients.