medigraphic.com
ISSN 0188-2198 (Print)

2011, Number 2

<< Back Next >>

Rev Mex Cardiol 2011; 22 (2)

In hospital mortality in cardiogenic shock. Patients with acute myocardial infarction treated witn coronary angioplasty

Galván-García JE, Palacios-Rodríguez JM, Cantú-Ramírez S, Vargas-Ramírez JF, Medellín-Moreno BJ, Baena-Santillán E, Sánchez-Rodríguez IA, Ficker-Lacayo GB, Méndez-Chávez JA, Cetina-Domínguez G, Morán-Benavente EA, Melano-Carranza E, Leos A, Tolosa-Dzul G, Ontiveros R, López G

Language: Spanish
References: 29
Page: 74-82
PDF size: 334.40 Kb.


ABSTRACT

Introduction: Primary angioplasty in acute myocardial infarction (AMI) complicated with cardiogenic shock has proven to be a successful strategy at short and long term, with extended benefit at 6 years. The frequency of this reperfusion modality has increased in past several years, unlike the coronary by-pass surgery for the treatment of this complication. Methods: Patients with cardiogenic shock secondary to acute myocardial infarction treated with primary angioplasty from February 1996 to November 2009 were included. We studied clinical, demographic and angiographic variables, as well as in-hospital mortality. Statistical analysis was made with chi square, Mann-Whitney U, ANOVA test and linear logistic regression for defining independent risk factors associated to mortality. Results: We included 142 patients, 71.1% were men, global mortality was 46.6%. The independent predictors of death were: failed angioplasty OR (odds ratio) 4.34 (CI 1.77-10.64) p = 0.001, disease of coronary circumflex artery OR 2.60 (CI 1.29-5.62) p = 0.008 and in-hospital acute pulmonary edema OR 4.35 (CI 1.23-15.3) p = 0.022. Conclusions: In our study, cardiogenic shock frecuency and associated mortality in AMI patients treated with primary angioplasty, was similar to other studies of high volume angioplasty centers, the clinic and angiographic success are the most important predictive variables of mortality. The appropriate use of pharmacologic therapy with new antiplatelet agents, use of new invasive hemodynamic support devices, and an increase in stenting, represent the factors for enhance success rate in angioplasty, and extend survival in this group of patients.


REFERENCES

  1. Babaev A, Frederick PD, Pasta DJ, Every N, Sichrovsky T, Hochman JS et al. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA 2005; 294: 448-454.

  2. Hochman J, Sleeper LA, Webb JG Sanborn TA, White HD, Talley JD et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. NEJM 1999; 137: 313-321.

  3. Zeymer U, Vogt A, Zahn R, Weber MA, Tebbe U, Gottwik M et al. Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI). EHJ 2004; 25: 322-328.

  4. Goldberg RJ, Gore JM, Alpert JS, Osganian V, Groot J, Bade J et al. Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988. N Eng J Med 1991; 325: 1117-1116.

  5. Holmes DR, Bates ER, Kleiman NS, Sadowsky Z, Horgan JHS, Morris DC et al. Contemporary reperfusion therapy for cardiogenic shock: The GUSTO-I trial experience. J Am Coll Cardiol 1995; 26: 668-74.

  6. Lindholm MG, Kober L, Boesgaard S, Torp-Pedersen C, Aldershvile J et al. Cardiogenic shock complicating acute myocardial infarction prognostic impact of early and late shock development. Eur Heart J 2003; 24: 258-265.

  7. Goldberg RJ, Samad NA, Yarzebski J, Gurwitz J, Bigelow C, Gore JM et al. Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Eng J Med 1999; 340: 1162-1168.

  8. Lupi-Herrera E. El Registro Nacional de los Síndromes Isquémicos Coronarios Agudos. Arch Cardiol Mex 2002; 72(Supl 2): S45-S64.

  9. García-Castillo A, Jerges-Sánchez C, Martínez BP, Azpiri-López JR, Autrey-Caballero A, Martínez/Sánchez C et al. RENASICA II Registro Mexicano de Síndromes Coronarios Agudos. Arch Cardiol Mex 2005; 75(Supl 1): S6-S19.

  10. Metha RH, Grab JD, O’Brien SM, Glower DD, Haan CK, Gammie JS et al. Clinical characteristics and in-hospital outcomes of patients with cardiogenic shock undergoing coronary artery bypass surgery. Circulation 2008; 117: 876-885.

  11. Jeger RV, Harkness SM, Ramanathan K, Buller CE, Pfisterer ME, Sleeper LA et al. Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry. Eur Heart J 2006; 27: 664-670.

  12. Hochman JS, Sleeper LA, Webb JG, Dzavik V, Buller CE, Aylward P et al. Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA 295: 2511-2515.

  13. White HD, Assmann SF, Sanborn TA. Jacobs AK, Webb JG, Sleeper LA et al. Comparison of percutaneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock. Circulation 2004; 112: 1992-2001.

  14. Smith SC, Feldman TE, HirshfeldJW, Jacobs AK, Kern MJ, King SB et al. ACC/AHA/SCAI 2005 Guideline update for percutaneous coronary intervention-summary article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). Circulation 2005; 113: 156-175.

  15. Thygesen K, Alpert JS, Withe HD, Allan SJ, Apple FS, Galvani M et al. Universal definition of myocardial infarction. Circulation 2007; 116: 2634-2653.

  16. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LE, Hand M. ACC/AHA Guidelines for the management of patients with ST-elevation myocardial infarction. J Am Coll Cardiol 2004; 44: 671-719.

  17. Chiu Wong S, Sleeper LA, Monrad ES, Menegus MA, Palazzo A, Dzavik V et al. Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction. A report from the SHOCK trial registry. J Am Coll Cardiol 2001; 38: 1395-1401.

  18. Shindler DM, Palmeri ST, Antonelli TA, Sleeper LA, Boland J, Cocke TP et al. Diabetes mellitus in cardiogenic shock complicating acute myocardial infarction: A report from the SHOCK trial registry. J Am Coll Cardiol 2000; 36: 1097-1103.

  19. Chui-Wong S, Sanborn T, Sleeper LA, Webb JG, Pilchik R, HartD et al. Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK trial registry. J Am Coll Cardiol 2000; 36: 1077-1083.

  20. Antoniucci D, Valenti R, Santoro GM, Bolognese M, Trapani M, Moschi G et al. Systematic direct angioplasty and stent-supported direct angioplasty therapy for cardiogenic shock complicating acute myocardial infarction: In-hospital and long-term survival. J Am Coll Cardiol 1998; 31: 294-300.

  21. Webb JG, Lowe AM, Sanborn TA, White HD, Sleeper LA, Carere RG et al. Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial. J Am Coll Cardiol 2003; 42: 1380-1386.

  22. Sutton AGC, Finn P, Hall JA, Harcombe AA, Wright RA, Belder MA et al. Predictors of outcome after percutaneous treatment for cardiogenic shock. Heart 2005; 91: 339-244.

  23. Doven O, Akkus MN, Camsari A, Pekdemir H, Cicek D, Kanik A et al. Impact of invasive strategy for the management of patients with cardiogenic shock after acute myocardial infarction. Cor Art Dis 2004; 15: 361-366.

  24. Lane GE, Holmes DR. The modern strategy for cardiogenic shock. En: Cannon CP. Management of Acute Coronary Syndromes. Totowa, N Jersey: Humana Press, 2003: 603-65.

  25. Webb JG, Sleeper LA, Buller CE, Boland J, Pallazzo A, Buller E et al. Implications of the timing of onset of cardiogenic shock after acute myocardial infarction: A report from the SHOCK trial registry. J Am Coll Cardiol 2000; 36: 1084-1090.

  26. Chen EW, Canto JG, Parsons LS, Peterson ED, Littrell KA, Every NR et al. Relation between hospital intra-aortic balloon counter pulsation volume and mortality in acute myocardial infarction complicated by cardiogenic shock. Circulation 2003; 108: 951-957.

  27. Giri S, Mitchel J, Azar RR, Kiernan FJ, Fram DB, McKay RG et al. Results of primary percutaneous transluminal coronary angioplasty plus abciximab with or without stenting for acute myocardial infarction complicated by cardiogenic shock. Am J Cardiol 2002; 89: 126-131.

  28. Antoniucci D, Valenti R, Migliorini A, Moschi G, Trapani M, Dovellini EV et al. Abciximab therapy improves survival in patients with acute myocardial infarction complicated by early cardiogenic shock undergoing coronary artery stent implantation. Am J Cardiol 2002; 90: 353-357.

  29. Chan A, Chew DP, Bhatt DL, Moliterno DL, Topol EJ, Ellis SG et al. Long-term mortality benefit with the combination of stents and abciximab for cardiogenic shock complicating acute myocardial infarction. Am J Cardiol 2002; 89: 132-136.




2020     |     www.medigraphic.com