Prognostic impact of angiographic findings, procedural success, and timing of percutaneous coronary intervention in cardiogenic shock

Abstract

Aims Urgent revascularization is the mainstay of treatment in acute coronary syndrome (ACS) related cardiogenic shock (CS). The aim was to investigate the association of angiographic results with 90-day mortality. Procedural complications of percutaneous coronary intervention (PCI) were also examined. Methods and results This CardShock (NCT01374867) substudy included 158 patients with ACS aetiology and data on coronary angiography and complications during PCI procedure. Survival analysis was conducted with Kaplan-Meier curves and Cox regression analysis. Median age was 67 ± 11 years, and 77% were men. During 90-day follow-up, 66 (42%) patients died. Patients with one-vessel disease (n = 49) had lower mortality than patients with two-vessel (n = 59) or three-vessel (n = 50) disease (25% vs. 48% vs. 52%, P = 0.011). Successful revascularization [Thrombolysis in Myocardial Infarction (TIMI) Flow 3 post-PCI) was achieved more often in survivors than non-survivors (81% vs. 60%, P = 0.019). The median symptom-to-balloon time was 340 (196-660) minutes, with no difference between survivors and non-survivors. In multivariable mortality analysis, multivessel disease (HR 2.59, CI 95% 1.29-5.18) and TIMI flow <3 post-PCI (HR 2.41, CI 95% 1.4-4.15) were associated with 90-day mortality. Procedural PCI complications were recorded in 51 (35%) patients, arrhythmic complications being the most common (n = 32, 63%). The incidence of complications was similar between survivors and non-survivors (31% vs. 42%, P = 0.21). Conclusions Multivessel disease is associated with worse survival in ACS-related CS. In patients undergoing PCI, arrhythmic complications were common, but not associated with excess mortality. Successful revascularization of the IRA had positive effect on outcome despite delay from symptom onset.

Prognostic Utility of Culprit SYNTAX Score in Patients With Cardiogenic Shock Complicating ST-Segment Elevation Myocardial Infarction

“…CardShock substudy 13 also reported no difference between infarct-related arteries for mortality. In contrast to these two studies, a post hoc analysis 12 reported that patients with left main and proximal left anterior descending artery as a culprit lesion had worse mortality rates compared to those with the others and the right coronary artery was more frequent in the survivor group.…”

“…The importance of TIMI flow and no-reflow for cardiovascular outcome have been well-evaluated. 13,25 The current study used blood carbon dioxide content as a biomarker of tissue hypoxemia instead of arterial lactate because all patients have the information about blood total CO 2 content, which has been used in the shock. 25 In the contemporary era, well-validated, IABP-SHOCK II risk score comprised of six factors: age, stroke, glucose, creatinine, TIMI flow, and arterial lactate.…”

The risk score for in-hospital mortality in patients with ST-segment elevation myocardial infarction

“…Также существенным общим недостатком большинства предложенных шкал является тот факт, что они не учитывают результаты проведенного ЧКВ [6][7][8][9][10][11][12][13]. При этом непосредственный успех вмешательства является важнейшим залогом благоприятного прогноза в лечении пациентов с острым ИМпST [14,15].…”