Outcome of Percutaneous Coronary Intervention with Intra-Aortic Balloon Pump in Patients with Cardiogenic Shock / 대한내과학회지

BACKGROUND/AIMS: The mortality of hospitalized patients undergoing treatment with an intra-aortic balloon pump (IABP) due to cardiogenic shock is well known as quite high. The aim of this study was to evaluate the outcome of percutaneous coronary intervention (PCI) with an IABP in patients with acute coronary syndrome (ACS) and cardiogenic shock and identify the predictors of in-hospital mortality. METHODS: 134 patients who underwent PCI with IABP due to ACS complicated by cardiogenic shock were consecutively enrolled. Outcomes were obtained and analyzed during hospitalization and after 1 year. RESULTS: The incidence of all-cause mortality was 35.8% (in-hospital mortality, 34.3%; 1-year mortality, 1.5%). The nonsurvival group exhibited higher peak levels of creatine kinase MB; lower ejection fractions; and higher incidences of ST elevation myocardial infarction, ventricular arrhythmia, and use of an assistive device than did the survival group. Aging (hazard ratio 2.839; 95% confidence interval 1.408-5.723; p = 0.004), the use of a temporary pacemaker (2.035; 1.114-3.720; 0.021), the use of a mechanical ventilator (4.376; 1.852-10.341; 0.001), and the performance of cardiopulmonary resuscitation (CPR) (2.219; 1.017-4.839; 0.045) were independent predictors for in-hospital mortality. However, out-of-hospital mortality among in-hospital survivors was not affected by predictors of in-hospital mortality. CONCLUSIONS: The incidence of in-hospital mortality was high, as expected in patients undergoing PCI with IABP due to ACS with cardiogenic shock. Aging, CPR, and additional procedures such as pacemaker use and mechanical ventilation were predictors of in-hospital mortality. However, the patients who were successfully discharged after the complex procedure showed acceptable 1-year outcomes.

Clinical and Angiographic Factors Affect on In-Stent Restenosis

BACKGROUND AND OBJECTIVES: Percutaneous coronary intervention with stent implantation has been shown to reduce the rate of restenosis as compared with conventional balloon angioplasty, but the risk of in-stent restenosis continues to be a significant limitation of this procedure. Of the numerous studies evaluating the predictors of in-stent restenosis, several have indicated that smaller stent sizes, smaller reference diameters and smaller final stent diameters maybe be associated with an increased risk of restenosis. SUBJECTS AND METHODS: We studied 164 patients with native coronary artery lesions who were treated with coronary stent and underwent angiographic follow up from April 1999 to Jan 2002. Clinical characteristics, angiographic features, and factors related to stenting procedure were analyzed in order to evaluate the affect of predictors on in-stent restenosis. RESULTS: Angiographic analysis presented in-stent restenosis in 86 patients (52.3%). Between the in-stent restenosis group and the non-restenosis group, there were no differences in baseline characteristics except for smoking. The in-stent restenosis group had a significantly smaller reference diameter (2.94+/-0.47 vs. 3.12+/-0.59 mm, p=0.039), smaller stent diameter (3.05+/-0.45 vs. 3.21+/-0.55 mm, p=0.012) and longer stent length (19.98+/-4.12 vs. 17.89+/-4.06 mm, p=0.048) than the non-restenosis group by angiographic analysis (p<0.05). Multivariate analysis revealed that stent length (odds ratio, 1.20) is a predictive factor for in-stent restenosis. In the in-stent restenosis group, the diffuse type, in-stent restenosis group (45.4%) showed more frequent ACC/AHA type C lesions than focal type, in-stent restenosis group (15.2%) (p<0.001). CONCLUSION: Longer coronary stent length is associated with an increased risk of in-stent restenosis and diffuse type, in-stent restenosis. ACC/AHA class C lesions are associated with an increased risk of diffuse type, in-stent restenosis.