Early revascularization improves survival in cardiogenic shock complicating acute myocardial infarction

Abstract

The effects of coronary revascularization by percutaneous transluminal coronary angioplasty or coronary bypass grafting, or both, on survival were evaluated in 81 patients with cardiogenic shock complicating acute myocardial infarction. Thirty-two patients had successful revascularization and 49 patients had unsuccessful or no revascularization. Revascularization was achieved by coronary angioplasty in 22 patients, coronary bypass surgery in 2 and angioplasty followed by bypass surgery in 8. No significant differences were noted between the two groups with regard to baseline clinical or hemodynamic variables. Intraaortic balloon counterpulsation was employed in 27 (84%) of the 32 patients in the group with revascularization and in 19 (39%) of the 49 patients without revascularization (p = 0.0006). The in-hospital survival was significantly better in the patients with--18 (56%) of 32--than in the patients without revascularization--4 (8%) of 49 (p less than 0.0001). At a mean follow-up period of 21 +/- 15 months, this survival difference persisted--16 (50%) of 32 patients with revascularization survived versus 1 (2%) of 49 patients without revascularization (p less than 0.0001). The mean time from the onset of shock to revascularization differed significantly between survivors (12.4 +/- 15 h) and nonsurvivors (58.5 +/- 93 h) in the group with revascularization (p = 0.0004). In the revascularization group, the in-hospital survival rate was 77% (17 of 22) when revascularization was performed within 24 h but only 10% (1 of 10) when it was performed after 24 h (p = 0.0006).(ABSTRACT TRUNCATED AT 250 WORDS)

Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock

“…The trial was designed in the early 1990s in the context of a high mortality rate among patients with cardiogenic shock, as well as reported reductions in mortality of 30 percent or more among patients undergoing angioplasty or coronary-artery surgery in nonrandomized series. [5][6][7][8][9][10][11][12][13][14][15] These large reductions clearly reflected bias related to selection for treatment.…”

“…3,4 Nonrandomized studies report markedly lower mortality rates among patients who have undergone revascularization for shock. [5][6][7][8][9][10][11][12][13][14][15][16] However, selection bias is evident. 17,18 In small series of patients undergoing early primary angioplasty for cardiogenic shock, in-hospital mortality rates ranged from 26 percent to 72 percent.…”

Factors Predicting Mortality in Patients after Myocardial Infarction Caused by Left Main Coronary Artery Occlusion. Significance of ST Segment Elevation in Both aVR and aVL Leads.

“…9) Moreover, Moosvi, et al reported that early revascularization, particularly within 24 hours from the onset of cardiogenic shock, improved survival in patients with cardiogenic shock complicating acute myocardial infarction. 10) However, of 4 patients with cardiogenic shock who had successful angioplasty within 6 hours, 3 patients (75%) died during hospitalization. Overall, 5 of 6 patients (86%) with cardiogenic shock died during hospitalization.…”

Predictors of In-Hospital Prognosis After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction Requiring Mechanical Support Devices

“…We retrospectively compared the clinical background, coronary risk factors, angiographic findings, acute results of primary PCI, and in-hospital prognosis between primary PCI-treated patients requiring mechanical support devices during primary PCI and/or admission period (with-IABP/PCPS group, n=275) and those without mechanical support devices (without-IABP/PCPS group, n=1,510). The diagnosis of AMI required the presence of 2 of the following 3 criteria: (1) characteristic clinical history; (2) serial changes on the ECG suggesting infarction (Q-waves) or injury (ST-segment elevations); and (3) transient increase in cardiac enzymes to more than 2-fold the normal laboratory value.…”