Purpose
Recent improvement in management of ST-elevation myocardial infarction (STEMI), and notably reduction of delays to coronary reperfusion, allowed a decrease of the incidence of complications. This study aims at determining the actual epidemiology and intrahospital prognosis of complicated cardiogenic shock (CS) requiring circulatory assist device (CAD).
Methods
We analyzed data collected in the “Observatoire Régional Breton sur l’Infarctus (ORBI),” a registry of all patients admitted to an interventional cardiology center in Brittany in the acute phase of a STEMI, within 24 h of symptoms onset. Main clinical data and intrahospital outcome were compared between ORBI patients requiring CAD for CS (group 1) and those who did not require CAD (group 2: 2599 pts).
Methods
We analyzed data collected in the “Observatoire Régional Breton sur l’Infarctus (ORBI),” a registry of all patients admitted to an interventional cardiology center in Brittany in the acute phase of a STEMI, within 24 h of symptoms onset. Main clinical data and intrahospital outcome were compared between ORBI patients requiring CAD for CS (group 1) and those who did not require CAD (group 2: 2599 pts).
Results
Among 2700 patients included in the ORBI registry, 101 patients (3.7%) required CAD: intraaortic balloon pump (IABP), 93 patients (3.4%); extracorporal life support (ECLS), 2 patients (0.07%); IABP and ECLS, 6 patients (0.2%). Main clinical data regarding age, sex and risk factors are nonsignificant. Group 1 mortality was high (38%) compared to the low mortality in group 2 (4%, P <.0001). Factors associated with requiring CAD were age, anterior area STEMI, coronary angioplasty, three-vessel or left main coronary artery disease and hemodynamic parameters [heart rate, blood pressure, grade 3 or 4 Killip, left ventricular ejection fraction (LVEF)]. In group 1, predictive factors of mortality were age, three-vessel or left main coronary artery disease, blood pressure, grade 3 or 4 Killip and LVEF.
Conclusion
Despite recent improvement in the management of STEMI, incidence of patients requiring CAD for CS is still high and mortality is elevated
| Gp 1 n =101 | Gp 2 n =2599 | P | Gp 1 deceased pts n =38 | Gp 1 alive pts n =63 | P | |
|---|---|---|---|---|---|---|
| Ant STEMI | 71 | 1104 | <.0001 | 24 (63%)1 | 47 (75%) | .3 |
| Mean delay (min) | 241.9±221 | 261.9± 243 | .51 | 243±22 | 241 ±228 | .7 |
| Thrombolysis | 12 (12%) | 485 (19%) | .09 | 4 (10%) | 8 (13%) | 1.0 |
| PCI | 96 (95%) | 2244 (86%) | .01 | 36 (95%) | 60 (95%) | 1.0 |
| 3-vessel or LM disease | 37 (37%) | 418 (17%) | <.0001 | 22 (58%) | 15 (24%) | <.001 |
| HR at admission (min) | 81.9±25 | 76.1±18 | .02 | 85.9±31 | 79.5±22 | .3 |
| BP at admission (mmHg) | 108.0±32 | 132.3±26 | <.0001 | 95.2±30 | 115.7±32 | .02 |
| Killip 3/4 | 41 (43%) | 108 (4%) | <.0001 | 24 (71%) | 17 (28%) | <.0001 |
| LVEF | 37.3±12 | 50.9±10 | <.0001 | 31.7±12 | 40.6±9 | <.0001 |
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