Immediate in-hospital outcomes after percutaneous revascularization of acute myocardial infarction complicated by cardiogenic shock

Abstract

BACKGROUND

Cardiogenic shock (CS) is a life-threatening complication of acute myocardial infarction with high morbidity and mortality rates. Primary percutaneous coronary intervention (PCI) has been shown to improve outcomes in patients with CS.

AIM

To investigate the immediate mortality rates in patients with CS undergoing primary PCI and identify mortality predictors.

METHODS

We conducted a retrospective analysis of 305 patients with CS who underwent primary PCI at the National Institute of Cardiovascular Diseases, Karachi, Pakistan, between January 2018 and December 2022. The primary outcome was immediate mortality, defined as mortality within index hospitalization. Univariate and multivariate logistic regression analyses were performed to identify predictors of immediate mortality.

RESULTS

In a sample of 305 patients with 72.8% male patients and a mean age of 58.1 ± 11.8 years, the immediate mortality rate was found to be 54.8% (167). Multivariable analysis identified Killip class IV at presentation [odds ratio (OR): 2.0; 95% confidence interval (CI): 1.2-3.4; P = 0.008], Multivessel disease (OR: 3.5; 95%CI: 1.8-6.9; P < 0.001), and high thrombus burden (OR: 2.6; 95%CI: 1.4-4.9; P = 0.003) as independent predictors of immediate mortality.

CONCLUSION

Immediate mortality rate in patients with CS undergoing primary PCI remains high despite advances in treatment strategies. Killip class IV at presentation, multivessel disease, and high thrombus burden (grade ≥ 4) were identified as independent predictors of immediate mortality. These findings underscore the need for aggressive management and close monitoring of patients with CS undergoing primary PCI, particularly in those with these high-risk characteristics.

Keywords: Acute myocardial infarction; Cardiogenic shock; Primary percutaneous coronary intervention; Mortality; Predictors

Core Tip: Cardiogenic shock (CS) is a severe form of acute myocardial infarction (AMI) associated with low blood pressure, poor organ perfusion, and high mortality rates. Overall, primary percutaneous coronary intervention (PCI) plays a crucial role in the management of patients with CS by improving blood flow to the heart, restoring cardiac function, and reducing mortality rates. However, the success of primary PCI depends on several factors, including the timeliness of treatment, the skill and experience of the operators performing the procedure, and the patient's overall health status. Therefore, it is essential to identify high-risk patients and provide timely appropriate treatment to achieve the best outcomes. Therefore, we conducted a retrospective analysis of 305 patients with CS complicated AMI undergone primary PCI at our center. It has been observed the immediate mortality rate was unacceptably high at 54.8% with cardiac arrest followed by renal failure, multi-organ dysfunction, sepsis, hypoxic brain injury and cerebrovascular accident as a cause of mortality. Killip class IV at presentation, multivessel disease, and high thrombus burden (grade ≥ 4) were identified as independent predictors of immediate mortality in multivariable analysis.