PTCA Acute Myocardial Infarction with Cardiogenic Shock

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Abstract

Background

In recent years, the usefulness of coronary revascularization through percutaneous transluminal coronary angioplasty in acute myocardial infarction complicated by cardiogenic shock, has been proposed in as an effective method to improve in-hospital survival. The aim of this report was to analize the experience performed in our institution since October '87 to May '94 with this coronary angioplasty prospective strategy on this population. The secondary end-point was to examine clinical and angiographic factors that could influence in-hospital outcome among the successfully treated patients.

Material and method In 19 consecutive patients with acute myocardial infarction and cardiogenic shock, conventional angioplasty was performed. Mean age was 60 years old (range 36-70), and 16 (84%) were males. Myocardial infarction localization was: anterolateral in14 patients (74%)and inferior-posterior-lateral in 5 patients (26%). The variables analized were age, myocardial infarction localization, previous myocardial infarction, hours from shock's symptomson set to angioplasty, number of vessel disease, previous thrombolytic administration and residualTIMI grade flow. Results Primary success was obtained in 17/19 patients (89%). During in-hospital period 10/19 (53%) patients survived. The presence of previous myocardial infarction and multiple vessel disease showed a significant difference (p< 0.017 and p<0.02) as indicators of a worse in-hospital outcome in the subgroup of patients successfully treated. Conclusions In this study the coronary angioplasty prove as an effective method in decreasing in-hospital mortality. In the subgroup of patients who underwent successful angioplasty, previous myocardial infarction and multiple vessel disease were identified as poor prognostic factors.