Clinical outcomes of acute myocardial infarction cardiogenic shock: A contemporary single center experience
Mawri S, Basir B, Nona P, Parikh M, Alqarqaz M, Zaidan M, Frisoli T, Koenig G, Kim H, Eng M, Khandelwal A, Voeltz M, Greenbaum A, Alaswad K, O'Neill W. Clinical outcomes of acute myocardial infarction cardiogenic shock: A contemporary single center experience. Catheter Cardiovasc Interventions. 2018;91:S34-S35.
Catheter Cardiovasc Interventions
Background: Acute myocardial infarction cardiogenic shock(AMICS) continues to carry high morbidity and mortality, despite advances in revascularization strategies. Recent data shows several trends in the field of AMICS, including increased patient complexity, overall low utilization ofpercutaneous mechanical circulatory support (MCS), and increased mortality rates. We sought to study the clinicalcharacteristics and outcomes of AMICS patients at our institution. Methods: From January 2014 to June, 2017, 120 consecutive patients admitted to Henry Ford Hospital's Cardiac Intensive Care Unit with a primary diagnosis ofcardiogenic shock in the setting of myocardial infarctionwere identified and retrospectively studied. Cardiogenicshock diagnosis was confirmed in accordance with definition in the SHOCK trial. Results: Mean age was 66±12 years; 80 (67%) were males and 60 (50%) were Caucasian. 83 (69%) of patients presented with STEMI and 37 (31%) with NSTEMI. Cardiac arrest on admission occurred in 27 (22.5%) of patients. Average hospital length of stay was 10.5±10.3 days. Percutaneous MCS was used in 110 (92%) ofpatients as follows: IABP=65; Impella=31; upgrade from IABP to other advanced MCS514. Vital signs and perfusion parameters immediately before MCS placement were: mean systolic BP 91±18.3 mmHg, mean diastolic BP 69±19 mmHg, mean HR 91.8±18.3 bpm, mean creatinine level 1.85±1.2, mean AST level 546±977 and mean lactate level 4.0±3.3. The in-hospital survival of the entire AMICS population was 41%, and among those successfully revascularized it was 50%. Patients who were admitted directly from within the health system had a significantly better survival (N=45; survival555.6%) than patients who presented as transfers from outside reffering institutions (N=75; survival534.7%), p=0.0310. Among 10 AMICS patients treated with vasopressors and no MCS, only 1 patient survived. Conclusion: In this real-world experience, we find that AMICS continues to carry high overall mortality. Hemodynamic stabilizatin with MCS was feasible; however, timing of MCS initiation was not standardized and was often delayed. Improved clinical outcomes were observed among AMICS patients receiving early hemodynamic support and revascularization.