Author + information
- Sa'ar Minha,
- Israel M. Barbash,
- Danny Dvir,
- Itsik Ben-Dor,
- Joshua P. Loh,
- Salem M. Badr,
- Hironori Kitabata,
- Lakshmana K. Pendyala,
- Lowell F. Satler,
- Augusto D. Pichard,
- Kenneth M. Kent,
- William Suddath,
- Rebecca Torguson and
- Ron Waksman
Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is associated with high mortality rates. This study aimed to explore the correlates for mortality in patients presented in CS complicating an AMI who were treated with primary percutaneous intervention (PPCI) and intra-aortic balloon pump counterpulsation (IABP).
The study compared patients who died in-hospital to those who survived to discharge in a cohort of 93 patients meeting strict definitions for CS to identify correlates associated with mortality.
The overall in-hospital mortality rate for the study cohort was 33%. The baseline characteristics were balanced except for older average age and left ventricular ejection fraction in those who died (p=0.049 and p=0.014, respectively). As detailed in the Table, the insertion of IABP pre-PCI, cardiac arrest at the catheterization lab, and lower ejection fraction (EF) were all correlated with in-hospital mortally (odd ratios 2.68, 5.93 and 0.02, respectively).
In the era of PPCI and IABP as standard of care in AMI complicated by CS, patients with low EF, those who necessitate IABP insertion pre-PCI and those who necessitated CPR during PCI are at higher risk for in-hospital mortality and should be considered for more robust devices (e.g. assisted devices) with an attempt to improve their prognosis.
|Variable||Odds Ratio (95% CI)||Lower OR-Upper OR||P Value|
|Body mass index||0.91||0.83-1||0.059|
|Ejection fraction (%)||0.02||0-0.5||0.018|
|Number of diseased vessels||1.54||0.92-2.6||0.102|
|IABP pre PCI||2.68||1.11-6.52||0.029|
|CPR in the catheterization laboratory||5.93||1.66-21.2||0.006|
- 2013 American College of Cardiology Foundation