Percutaneous coronary intervention in acute myocardial infarction with cardiogenic shock: immediate and late outcomes.

BACKGROUND: Acute myocardial infarction (AMI) with cardiogenic shock carries a high mortality rate. Early revascularization shows better results than conservative medical treatment. OBJECTIVE: To determine short and long term results of patients with cardiogenic shock from AMI who underwent percutaneous coronary intervention (PCI). METHODS: Patients were identified from the PCI registry from 1993 to 1999. Follow-up data were collected from medical records and/or phone calls. RESULTS: From 1993 to 1999, there were 1211 PCI procedures performed at King Chulalongkorn Memorial Hospital. Seventeen of these cases (M9, F8) had cardiogenic shock. Mean age was 59 +/- 14 yrs. Fourteen patients had AMI. The other 3 cases developed shock more than 24 hours after AMI. Primary PCI was done in 11 cases. Thirteen patients (76.5%) needed intra-aortic balloon pump support. Average peak CPK and CK-MB were 5393 and 580 u/l, respectively. Five patients (29.4%) died in hospital, 3 of whom died on the first day due to pump failure. Twelve patients were followed for a mean duration of 412 days (range 12 - 1,464). One patient died 6 months after PTCA because of in-stent restenosis of the left main coronary artery. CONCLUSION: AMI with cardiogenic shock has a high mortality rate. However, in this group of patients who had early revascularization by PCI, mortality seemed to be lower than previously reported. If PCI is available, the procedure should be offered for this subset of AMI patients.

Initial outcomes of coronary angioplasty in diabetic patients.

Diabetes is one of the controllable risk factors of coronary artery disease. Many reports have shown that diabetes is a poor prognostic indicator for coronary events and revascularization among patients who undergo PTCA or coronary artery bypass surgery. The present work, the first prospective study in Thailand, was conducted to compare the demographic data and initial outcomes of diabetic patients (DM) with those of non-diabetic ones (non-DM) who underwent percutaneous coronary angioplasty (PTCA). Data between January 1993 and December 1998 were prospectively collected after each procedure and before discharge. During the 6-year period, 812 patients (DM-280, non-DM-532) were enrolled. The DM group had significantly more female patients (45.4 vs 21.1%, p < 0.0001), older age (62.5 +/- 8.2 vs 60.5 +/- 10.8 y, p < 0.007), less smoking (21.8 vs 43.2%, p < 0.0001), more dyslipidemia (56.8 vs 41.9%, p < 0.0001) and a higher incidence of hypertension (51.8 vs 42.5%, p = 0.01). The left ventricular ejection fraction, indication for PTCA, size of attempted vessel, and number of diseased vessels were similar in both groups. The case success rate was 93.9 per cent in the DM group and 92.3 per cent in the non-DM group (P=NS). Two patients (0.7%) in the DM and three cases (0.6%) in the non-DM group died during hospitalization. Overall major adverse cardiac events were not different between both groups (1.4 vs 1.9%, P =NS). In conclusion, there were some demographic differences in DM compared with non-DM patients who undergo PTCA; but initial outcomes, major adverse cardiac events, and mortality rates were not significantly different.