Comparison of 30-Day Mortality between Anterior-Wall versus Inferior-Wall ST-Segment Elevation Myocardial Infarction Complicated by Cardiogenic Shock in Patients Undergoing Primary Coronary Angioplasty

Abstract

Objectives: In this study, 30-day mortality from cardiogenic shock caused by left anterior descending artery (LAD) occlusion was compared with that caused by left circumflex (LCX) or right coronary artery (RCA) occlusion after primary percutaneous coronary intervention (PCI). Methods: Between May 2001 and December 2009, 212 consecutive patients with anterior-wall ST-elevation myocardial infarction complicated by cardiogenic shock due to LAD (n = 97) occlusion (group 1) and LCX or RCA (n = 115) occlusion (group 2) undergoing primary PCI were enrolled. Results: The results showed a higher mean peak level of creatine phosphokinase and incidence of extracorporeal membrane oxygenation in group 1 than group 2 (all p < 0.01). However, no significant difference was noted in the achievement of normal blood flow in the infarct-related artery (p = 0.461) and 30-day morality (p = 0.338). Univariate analysis demonstrated a significant association of 30-day morality with age, lower left-ventricular ejection fraction, advanced congestive heart failure and unsuccessful reperfusion (all p < 0.02). Multivariate analysis revealed unsuccessful reperfusion as the most independent predictor of 30-day mortality (p = 0.002). Conclusion: No significant difference was noted in 30-day mortality between patients with acute myocardial infarction and cardiogenic shock caused by LAD occlusion and by either RCA or LCX occlusion undergoing primary PCI.

Mortality of patients with ST-segment elevation myocardial infarction and cardiogenic shock treated by PCI is correlated to the infarct-related artery – Results from the PL-ACS Registry

“…The highest inhospital mortality was observed in the left main (64.7%) and the lowest in the RCA group (30.8%) [17]. In the study by Zeymer [7]. An association between unsuccessful reperfusion and favorable clinical outcomes has been confirmed in previous studies [3,[17][18][19][20][21].…”

“…Relatively limited data are available assessing the relationship between the infarct-related artery (IRA) and the in-hospital and long-term outcomes of patients with MI complicated by CS [6,7].…”

Percutaneous Coronary Intervention for Nonculprit Vessels in Cardiogenic Shock Complicating ST-Segment Elevation Acute Myocardial Infarction*

“…Similar to earlier studies, our large-scale registry showed that 7.1% patients underwent primary PCI presented with cardiogenic shock and, of these, 374 patients (56.6%) had MVD. These findings suggest that recent therapeutic improvements such as early revascularization strategy, inotropic agents, vasoconstrictors, adjunctive medications, and assist devices might contribute to improve survival, although in-hospital mortality of cardiogenic shock remains still high (16,17,23,24). There are several possible explanations for relatively low mortality in our study.…”

“…For patients undergoing primary PCI for STEMI complicated by cardiogenic shock, recent studies showed an in-hospital mortality of 30-40% (16)(17)(18). MVD is noted in 40-65% of patients undergoing primary PCI for STEMI and is associated with adverse prognosis (8,19,20).…”

Are All Patients with Cardiogenic Shock Prognostically Equal

“…Furthermore, as acknowledged by the authors, rightventricular function was not assessed, therefore we do not know how many patients from the 'inferior' group in shock actually had predominant, or even significant, involvement of the right ventricle. Needless to say, these patients have a completely different pathophysiology and In this issue of Cardiology , Tsai et al [1] report on a large series of patients with cardiogenic shock due to AMI of ! 12 h duration, all treated with primary PCI, recruited over a period of 7 years.…”