Endotracheal intubation and outcome in high-risk patients with acute myocardial infarction undergoing primary angioplasty

Abstract

Background: Patients with acute myocardial infarction (AMI) who undergo endotracheal intubation (ETI) are at high risk for mortality, but the outcome of those patients submitted to primary angioplasty (PCI) has not yet clearly reported. Methods:We collected data about all consecutive patients with AMI within 12 hours who underwent primary PCI and analyzed clinical and procedural characteristics as well as in-hospital mortality of ETI compared to no-ETI patients. Results: From September 2001 to June 2010, 1251 patients underwent primary PCI and 99 (7.9%) of them underwent ETI. ETI patients were more likely to be hypertensive (76.8% vs 67.8%, p=0.003), diabetic 43.4% vs 17.9%, p<0.0001), resuscitated by cardiac arrest (68.7% vs 0.7%, p<0.0001), to present with cardiogenic shock (CS) (61.6% % vs 8.1%, p<0.0001), with a lower left ventricular ejection fraction (LVEF) (38.9±9.4% vs 48.9±9.2%, p<0.0001) and to be treated with intra-aortic balloon counterpulsation (IABP) (60.1% vs 15.4%, p<0.0001). The in-hospital mortality was higher in ETI patients (37.4% vs 4.3%, p<0.0001) and they were more likely to undergo stent thrombosis (3% vs 0.34%, p=0.006). After using the propensity score modelling. Considering the risk profile, ETI was associated to higher in hospital mortality in the patients at higher risk (39.8% vs 18.5%, p=0.003). Moreover, ETI was one of the most powerful predictors of in-hospital mortality at multivariate analysis (OR 37.04, 95% CI 6.0-228.45, p=0.0001). Conclusions: ETI was found to be an independent predictor of mortality in high-risk AMI patients undergoing primary angioplasty. The implications for current clinical care remained undefined.

Development of a Clinical Risk Score for Prediction of Life-Threatening Arrhythmia Events in Patients with ST Elevated Acute Coronary Syndrome after Primary Percutaneous Coronary Intervention

“…The requirement for endotracheal intubation was mainly due to acute pulmonary congestion. The previous study has shown that intubated patients with ACS who underwent pPCI had a higher in-hospital mortality rate than non-intubated patients [ 29 ]. The worsening of in-hospital prognosis in intubated patients can result from both the pathophysiologic changes due to intubation and ventilation [ 30 ] and the severity of acute heart failure and myocardial infarction.…”