[Coronary angioplasty for primary cardiogenic schock following myocardial infraction]

ABSTRACT

In the setting of acute myocardial infarction [AMI], several investigators have demonstrated that emergency coronary angioplasty [PTCA] reduces in-hospital mortality of primary cardiogenic shock [CS] from 90% to less than 50% however, few studies have focused on the current outcome of non selected patients in whom the onset of AMI is immediately complicated by CS.To evaluate in-hospital mortality of the patients admitted to our institution for Q wave AMI presented in CS. Between 05/93 and 05/03, 30 consecutive pts, 26 men and 4 women, in CS following AMI were treated with direct PTCA, 26 without thrombolysis and 4 as rescue after failed streptokinase. AMI was defined by prolonged chest pain and 1 mm ST segment elevation in 2 contiguous peripheral leads or 2 mm for precordial leads on the admission ECG. The diagnosis of CS was based on the combination of systolic blood pressure of r 90 mm Hg, unresponsive to volume expansion, signs of acute circulatory failure [cyanosis, cold extremities, restlessness, mental confusion or coma] and congestive heart failure secondary to myocardial dysfunc-tion. In 40% of cases the diagnosis of CS was only clinical and in 60% of cases was confirmed by a Swan Ganz catheter. Mean age was 62,3 +/- 12,3 years, 7 had triple vessel disease, 14 a double vessel disease, 8 a single vessel disease and in one case a left main disease. The AMI was anterior in 22 pts [73%], inferior in 8 [27%]. Intraaortic balloon was used in 3 pts, CPR in 16 [47%], transitory pacemaker in 1 pt, inotropes in 25 pts, emergency coronary artery bypass grafting [CABG] in 1 pt. Success for PTCA with a residual stenosis r 50% and a TIMI flow III was obtained in 26 pts [87%]. Mean time between CS and revascularization was 219 +/- 302 minutes. 19 pts [63%] survived and 11 pts [37%] died while at the hos-pital, 6 from intractable shock, 4 from multiple organ failure and in 1 case from pulmonary hemorrhage. Mean time of revascularization for the surviving was 190 +/- 329 min, and for the dead 295 +/- 212 min. Hospital mortality for inferior infarction is 12.5% after successful angioplasty. Comparison of surviving and non surviving number of patients according to revascularization time showed a significant difference of these groups whether the revascularization was accomplished before or after 120 minutes