Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock

• Published in: International journal of cardiology Vol. 114; no. 2; pp. 176 - 182
• Main Authors: Valente, Serafina, Lazzeri, Chiara, Vecchio, Sabine, Giglioli, Cristina, Margheri, Massimo, Bernardo, Pasquale, Comeglio, Marco, Chiocchini, Silvia, Gensini, Gian Franco
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 08-01-2007; Elsevier Science
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiogenic shock; Cardiology. Vascular system; Cardiovascular; Coronary heart disease; Diseases of the cardiovascular system; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Epidemiology; Female; General aspects; Heart; Hospital Mortality; Humans; In-hospital mortality; Intensive care medicine; Male; Medical sciences; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - complications; Myocardial Infarction - therapy; Percutaneous coronary intervention; Predictive Value of Tests; Public health. Hygiene; Public health. Hygiene-occupational medicine; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Shock, Cardiogenic - blood; Shock, Cardiogenic - etiology; Shock, Cardiogenic - mortality; Shock, Cardiogenic - therapy; CS; intra-aortic balloon pump; percutaneous coronary intervention; In-hospital mortality; IABP; ST elevation acute myocardial infarction; PCI; STEMI; cardiogenic shock; ultrafiltration; CVVHDF; Cardiogenic shock; Percutaneous coronary intervention; Prognosis; Angioplasty; Predictor; Mortality; Coronary artery; Prediction; Instrumentation therapy; Cardiovascular disease; Hospitalization; Coronary heart disease; Epidemiology; Phlebology; Stent; Circulatory system; Hospital; Cardiology; Predictive factor; Public health
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2006.01.024

Abstract Objectives The mortality of patients with cardiogenic shock (CS) complicating ST elevation acute myocardial infarction (STEMI) remains high, despite early revascularization. Current knowledge of predictors of death is limited. Background The pathophysiologic understanding of CS after acute myocardial infarction has shifted from a mere hemodynamic disorder to a more complex approach including imbalance in metabolic functions. Methods In 45 consecutive patients (71.4 ± 13 years) with CS complicating STEMI treated with primary percutaneous coronary intervention (PCI) serum levels of lactate, glucose and uric acid on coronary care unit (CCU) admission were measured. The end-point was in-hospital death. Results The following parameters, on CCU admission, were univariate predictors of in-hospital mortality: serum glucose > 200 mg/dl (OR = 11.3, p = 0.002), serum creatinine > 1.5 mg/dl (OR = 12.7, p = 0.003), uric acid > 6.5 mg/dl (OR = 6.7, p = 0.016), lactate > 6.5 mmol/l (OR = 54, p < 0.0001), age ≥ 75 years (OR = 8.5, p = 0.002), history of hypertension (OR = 8.3, p = 0.003) and TIMI flow post PCI ≤ 2 (OR = 12.9, p = 0.02). At multivariate analysis, after adjustment for sex, age, hypertension and diabetes, lactate > 6.5 mmol/l and TIMI flow post PCI ≤ 2 were still independent predictors of in-hospital mortality (OR = 295, p = 0.01; OR = 19.5, p = 0.04, respectively). Conclusions Hyperlactatemia, hyperglycemia and increased levels of uric acid on CCU admission are univariate predictors of in-hospital death. Moreover, at multivariate analysis, hyperlactatemia (> 6.5 mmol/l) is an independent indicator of in-hospital death in CS patients complicating STEMI.