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Prognostic impact of angiographic results in cardiogenic shock

Session Poster Session 3

Speaker Tuija Sabell

Event : Heart Failure 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease: Treatment, Revascularization
  • Session type : Poster Session

Authors : T Javanainen (Helsinki,FI), M Banaszewski (Warsaw,PL), J Lassus (Helsinki,FI), M Nieminen (Helsinki,FI), H Tolppanen (Helsinki,FI), T Jantti (Helsinki,FI), A Kataja (Helsinki,FI), M Hongisto (Helsinki,FI), L Kober (Copenhagen,DK), A Sionis (Barcelona,ES), J Parissis (Athens,GR), T Tarvasmaki (Helsinki,FI), V-P Harjola (Helsinki,FI), R Jurkko (Helsinki,FI)

Authors:
T Javanainen1 , M Banaszewski2 , J Lassus1 , M Nieminen1 , H Tolppanen1 , T Jantti1 , A Kataja3 , M Hongisto3 , L Kober4 , A Sionis5 , J Parissis6 , T Tarvasmaki1 , V-P Harjola3 , R Jurkko1 , 1Helsinki University Central Hospital, Heart and Lung Center, Helsinki University - Helsinki - Finland , 2Institute of Cardiology, Intensive Cardiac Therapy Clinic - Warsaw - Poland , 3Helsinki University Central Hospital, Department of Emergency Medicine and Services, Helsinki University - Helsinki - Finland , 4University of Copenhagen, Department of Cardiology, Rigshospitalet - Copenhagen - Denmark , 5Hospital de la Santa Creu i Sant Pau, Cardiology Department, IIB-SantPau, CIBER-CV, Universitat Autonoma de Barcelona - Barcelona - Spain , 6Attikon University Hospital, ER and Heart Failure Clinic - Athens - Greece ,

On behalf: CardShock

Citation:

Background

In acute coronary syndrome (ACS) related cardiogenic shock (CS) urgent coronary angiography is essential. The aim was to investigate the association of angiographic results with 90-day mortality in CS patients.

Methods

This CardShock (NCT0137486) substudy included 158 patients with ACS aetiology and data on coronary angiography. Survival analysis was conducted with Kaplan-Meier curves and Cox regression analysis.

Results

Median age was 67±11 years and 121 (77%) were men. During the 90-day follow-up 66 (42%) patients died. Patients with one-vessel disease (n=49) had lower mortality than patients with two- (n=59) or three-vessel (n=50) disease (25% vs. 48% vs. 52%, p=0.011, Figure A). Successful revascularization (post-procedural TIMI grade 3 flow) was achieved more often in survivors than non-survivors (81% vs. 60%, p=0.019, Figure B).  Median symptom-to-balloon time was similar between survivors and non-survivors (335 [210-641] min vs. 340 [190-660] min, p=0.70). In multivariable mortality analysis, the CardShock risk score (HR 1.76, CI 1.45-2.13), multivessel disease (HR 2.24, CI 1.13-4.44) and post-procedural TIMI < 3 (HR 1.85, CI 1.08-3.16) were associated with 90-day mortality.

Conclusion

Multivessel disease is associated with worse survival in ACS-related CS. Successful revascularization of the IRA had a positive effect on outcome despite delay from symptom onset.

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