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

ABSTRACT

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.