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.
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.
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.
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.