Clinical Outcomes of Patients with Acute Myocardial Infarction Complicated by Severe Refractory Cardiogenic Shock Assisted with Percutaneous Cardiopulmonary Support.
10.3349/ymj.2014.55.4.920
- Author:
Taek Kyu PARK
1
;
Jeong Hoon YANG
;
Seung Hyuk CHOI
;
Young Bin SONG
;
Joo Yong HAHN
;
Jin Ho CHOI
;
Kiick SUNG
;
Young Tak LEE
;
Hyeon Cheol GWON
;
Sang Hoon LEE
Author Information
1. Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. cardiochoi@skku.edu
- Publication Type:Original Article
- Keywords:
Myocardial infarction;
cardiogenic shock;
percutaneous cardiopulmonary support
- MeSH:
Aged;
Cardiopulmonary Bypass;
Cardiopulmonary Resuscitation;
Female;
Humans;
Male;
Middle Aged;
Myocardial Infarction/*complications/*mortality/surgery/therapy;
Shock, Cardiogenic/*complications;
Treatment Outcome
- From:Yonsei Medical Journal
2014;55(4):920-927
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Limited data are available on the role of percutaneous cardiopulmonary support (PCPS) for the treatment of acute myocardial infarction (AMI) patients with cardiogenic shock. We investigated the clinical outcomes and predictors of in-hospital mortality after PCPS in patients with AMI complicated by severe refractory cardiogenic shock. MATERIALS AND METHODS: From January 2004 to December 2011, we analyzed data from 96 consecutive AMI patients with cardiogenic shock assisted by a PCPS system. The primary outcome was in-hospital mortality. The predictors of in-hospital mortality were determined by a Cox proportional-hazards model. RESULTS: In-hospital mortality occurred in 51 (53.1%) patients and 58 (60.4%) patients were able to be weaned from PCPS. Cardiopulmonary resuscitation (CPR) was performed in 61 (63.5%) patients before PCPS initiation. On multivariate analysis, age > or =67 years [adjusted hazard ratio (HR), 4.74; 95% confidence interval (CI), 2.27-9.93; p<0.001], CPR (adjusted HR, 2.32; 95% CI, 1.11-4.85; p=0.03), lactate clearance for 48 hours <70% (adjusted HR, 2.50; 95% CI, 1.04-6.05; p=0.041), and unsuccessful revascularization (adjusted HR, 3.57; 95% CI, 1.85-6.90; p=0.002) were independent predictors of in-hospital mortality after PCPS in patients with AMI complicated by cardiogenic shock. CONCLUSION: In spite of PCPS management, AMI patients complicated by severe refractory cardiogenic shock demonstrated high mortality. Older age, CPR, lower lactate clearance for 48 hours, and unsuccessful revascularization were independent predictors of in-hospital mortality.
