Coronary artery disease in patients dying from cardiogenic shock or congestive heart failure in the setting of acute myocardial infarction.

Abstract

Pathological findings in the heart and particularly in the coronary arteries are reported from 70 patients dying from pump failure after acute myocardial infarction. Fifty of the patients had died in cardiogenic shock, the remainder from refractory congestive heart failure. Three-vessel al., 1970;Page et al., 1971;Alonso et al., 1973). Fatal pump failure after acute myocardial infarction occurs in two distinct clinical syndromes, namely cardiogenic shock and refractory congestive heart failure. Most patients die from cardiogenic shock, but some, without developing the clinical picture of cardiogenic shock, die from persistent refractory congestive heart failure. In order to treat these syndromes, several investigators have advocated use of circulatory assistance (such as intra-aortic balloon counterpulsation) followed by coronary bypass surgery (Dunkman et al., 1972;Scheidt et al., 1973;Miller et al., 1974;O'Rourke et al., 1975;Willerson et al., 1975). However, the efficacy of these procedures remains controversial (Cohen, 1974;Kuhn, 1974). It seemed to us that Received 28 January 1976. the success or failure of these measures could well relate to the underlying cardiac pathology. We have, therefore, studied the hearts of 70 patients who died either from cardiogenic shock or refractory congestive heart failure in the setting of acute myocardial infarction, paying particular attention to the state of the coronary arteries. Subjects and methodsThe material studied was derived from a group of 1050 patients consecutively admitted with acute myocardial infarction. Table 1 shows age, sex distribution, localization, and number of infarctions in patients who died from cardiogenic shock, congestive heart failure, necropsied and not necropsied, and other causes, and those who survived. Patients who died either from cardiogenic shock or other causes had a higher mean age (P < 0.05) than those who survived. Patients who died from cardiogenic shock and congestive heart failure had a higher incidence of both previous infarction (P < 0.01) and

Cardiogenic Shock in Patients with Myocardial Infarction

“…При ИМ с подъемом сегмента ST (ИМпST) КШ развивается в среднем через 5-6 ч от начала заболевания [9], у больных ИМ без подъема ST -в среднем через 94 ч [10]. Согласно данным аутопсии, требуется потеря >40 % миокарда для развития КШ [11]. Большой вклад в развитие КШ вносят механические осложнения ИМ: разрыв межжелудочковой перегородки, отрыв или дисфункция папиллярных мышц с митральной регургитацией [12].…”

Coronary Revascularization Strategy for ST Elevation Myocardial Infarction with Multivessel Disease: Experience and Results at 1-Year Follow-Up

“…[1][2][3] It has also been reported that up to 90% of acute coronary syndrome patients 1 presenting with cardiogenic shock have multivessel or left main disease. [4][5][6] Current American College of Cardiology/American Heart Association consensus panel recommends that in the absence of hemodynamic compromise, acute interventions during STEMI should focus on the culprit lesion (CL) only. 7 However, data on optimal coronary revascularization strategy for non-CLs in MVD in the setting of acute STEMI are scarce and ambiguous, with studies reporting variable and inconsistent results.…”

Cardiogenic shock

“…In the 70's, Mirowski et al 7 , in a community hospital, observed that, from 1,246 patients admitted consecutively with a diagnosis of AMI, 12% developed cardiogenic shock, with a hospital mortality rate of 87%. Comparing patients with AMI complicated by cardiogenic shock and those not in shock, the former were older, with infarction in the anterior wall, and frequent history of previous infarction, angina and HF [8][9][10] . Other studies also show that those who develop shock after hospital admission are generally diabetic, older, female patients and have a history of previous infarction, with high levels of cardiac enzymes, mainly CKMB, and anterior infarction 11,12 .…”