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Revascularisation strategy and long-term prognosis in pacients with myocardial infarction and cardiogenic shock

Session Moderated Poster 4: Cardiogenic shock

Speaker Carmen Fernandez Diaz

Event : Acute Cardiovascular Care 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes: Shock
  • Session type : Moderated Posters

Authors : C Fernandez Diaz (Valencia,ES), JV Vilar-Herrero (Valencia,ES), A Berenguer-Jofresa (Valencia,ES), A Cubillos-Arango (Valencia,ES), D Escribano-Alarcon (Valencia,ES), L Facila-Rubio (Valencia,ES), S Sanchez-Alvarez (Valencia,ES), J Vano-Bodi (Valencia,ES), S Morell-Jofresa (Valencia,ES), E Rumiz-Gonzalez (Valencia,ES)

Authors:
C Fernandez Diaz1 , JV Vilar-Herrero1 , A Berenguer-Jofresa1 , A Cubillos-Arango1 , D Escribano-Alarcon1 , L Facila-Rubio1 , S Sanchez-Alvarez1 , J Vano-Bodi1 , S Morell-Jofresa1 , E Rumiz-Gonzalez1 , 1University General Hospital of Valencia, Cardiology - Valencia - Spain ,

Citation:

Introduction: Current Guidelines recommend that immediate percutaneous coronary intervention (PCI) of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) complicated by cardiogenic shock (CS) should be considered. A recent trial has showed lower mortality among patients in which primary PCI was restricted to culprit lesions only.
Purpose: The aim of this study was to assess differences in cardiovascular mortality and the composite endpoint of cardiovascular death and/or admission for heart failure (HF) in a real population of CS patients who underwent complete revasularization (CR) vs incomplete revasularization (IR) during primary angioplasty (PA)
Methods: We included 105 consecutive patients with a STEMI and CS who underwent PA. Clinical and angiographic variables on admission,  as well as events occuring during follow up were registered. The primary end point was cardiac death and the secondary endpoint was a composite of cardiac death and/or admission for HF. 
Results: Patients included in our cohort had a median age of 70 years (IQR 59-77) and 72.4% were men. Prevalence of diabetes mellitus was 45.6% and mean left ejection fraction was 34.2% ± 15. The most common location of STEMI was anterior (62.9%), and the most common culprit artery was the left anterior descending artery (LAD), followed by  the right coronary artery (RCA). Intra aortic balloon pump was used in almost a half of the cases. 58 (52.4%) patients underwent CR in PA and 47 (41%) underwent IR.  
Furthermore,no variable was significantly associated to CR performance. During a median follow-up of 11 months, 55 (52.3%) patients died. 36 (34%) of them suffered cardiac death and 44 (42%) presented the composite endpoint. Event rates in patients undergoing the CR versus the IR strategy were comparable, although a trendtowards less cardiac death (36% vs. 50%; p=0.14) and a lower incidence of  the composite endpoint (38.9% vs. 56.1%; p=0.07) was observed in patients who underwent CR.
Conclusions: No significant differences were observed in major cardiovascular events between patients undergoing either a CR strategy or PCI limited to the culprit lesion in patients with CS and MVD. Until further evidence emerges treatment options should be individualised.

Total (N= 105)

Complete revascularisation (N = 58)

Incomplete revascularisation (N= 47)

p- value

Cardiac death, n (%)

36 (34)

18 (36)

18 (50)

0.14

Intrahospital death, n (%)

38(36)

18 (31)

20 (42)

0.10

Cardiac death and/or admission for heart failure, n (%)

44 (42)

21 (38.9)

23 (56.8)

0.07

Admission for heart failure, n (%)

12 (11,4)

6 (10)

6 (12)

0.47

Endpoints at discharge and during follow-up

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