Turk Kardiyol Dern Ars. 2010; 38(4): 250-257

Primary percutaneous coronary intervention in patients admitted with cardiogenic shock and ST-elevation myocardial infarction: prognosis and predictors of in-hospital mortality

Mehmet Ergelen¹, Hüseyin Uyarel², Emre Akkaya¹, Ersin Yıldırım¹, Duygu Ersan¹, Deniz Demirci¹, Ceyhan Türkkan¹, Nurten Sayar¹, Şükrü Akyüz¹, Tuna Tezel^1
1Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Cardiology Department, Istanbul, Turkey
²Balıkesir University Medical School of Medicine, Cardiology Department Balıkesir, Turkey

OBJECTIVES
We investigated the efficacy and outcome of primary percutaneous coronary intervention (PCI) in patients admitted with cardiogenic shock and ST-elevation myocardial infarction (STEMI).

STUDY DESIGN
We reviewed 91 consecutive patients (66 males, 25 females; mean age 61±11 years) treated with primary PCI for cardiogenic shock due to STEMI. All clinical, angiographic data, and in-hospital and long-term outcomes were collected. The patients were classified into two groups depending on the presence (n=59, 64.8%) or absence (n=32, 35.2%) of in-hospital mortality.

RESULTS
Hospital nonsurvivors were older (mean age 62.7±11.1 vs. 57.7±11.4 years; p=0.04) and exhibited higher frequencies of diabetes mellitus (DM), renal failure, and history of myocardial infarction. Multi-vessel disease (p=0.004) and circumflex artery involvement (p=0.03) were more frequent and the rates of tirofiban administration (p=0.02) and stenting (p=0.007) were lower in nonsurvivors. Procedural success rate was substantially lower in nonsurvivors (39% vs. 84.4%; p<0.001). Of 32 survivors, cardiovascular mortality occurred in only three patients (9.4%) during a median follow-up of 26 months. In multivariate regression analysis, unsuccessful procedure (OR 7.2, 95% CI 1.77-29.27; p=0.006) and DM (OR 3.92, 95% CI 1.13-13.62; p=0.03) were the independent predictors of in-hospital mortality.

CONCLUSION
Mortality rate is considerably higher and successful procedure yields a two-fold decrease in in-hospital mortality in patients with cardiogenic shock complicated by STEMI. Unsuccessful procedure and DM represent as two independent predictors of in-hospital mortality.

Keywords: Angioplasty, transluminal, percutaneous coronary, hospital mortality; myocardial infarction/therapy/complications; prognosis; shock, cardiogenic/therapy/mortality; stents

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