Author + information
- Ruben Vergara1,
- Renato Valenti2,
- Angela Migliorini3,
- Guido Parodl4,
- Maria Grazia De gregorio5,
- Maria Raffaella Aicale6,
- Elena De Vito7,
- Eleonora Gabrielli8 and
- David Antoniucci9
- 1DivCardiology-Careggi Hospital, Florence, Italy
- 2Careggi Hospital, Florence, Italy
- 3careggi Hospital, Florence, Florence, Italy
- 4Division of Cardiology Careggi Hospital
- 5Division of Cardiology Careggi Hospital
- 6Division of Cardiology Careggi Hospital
- 7Division of Cardiology Careggi Hospital
- 8Division of Cardiology Careggi Hospital
- 9Careggi Hospital, Florence, Italy
Primary percutaneous coronary intervention (p-PCI) is the sole treatment that may improve cardiac survival in AMI complicated by cardiogenic shock (CS). In this setting of patients poor data exist about predictors of long-term cardiac mortality after p-PCI and current risk-adjustment models are not adequate. The aim of this study was to define the independent predictors of 2-year cardiac mortality after AMI complicated by CS treated with p-PCI, and their individual clinical impact in order to create an updated risk score.
From the Florence primary PCI registry consecutive patients treated with p-PCI for AMI complicated by CS were included. End point of the study was to identify the independent variables related with cardiac mortality at 2-year of follow-up by Cox regression analysis. A Risk Score was created assigning at any variable a value directly correlated with its power according to the Cox proportional hazard model. In order to validate the result, a c-index analysis was performed by a ROC Curve test.
From 1995 to 2013, 4,078 consecutive patients underwent primary PCI for AMI. Out of these, 388 (10.5%) patients had cardiogenic shock on admission and were included in this analysis. The p-PCI procedural success (TIMI 3) rate was 85%. At 2-year follow up, the overall cardiac mortality rate was 48%. The independent predictors related with mortality resulted: out of hospital cardiac arrest (HR 1.51; p=.04), age >75 yrs (HR 2.09; p=<.001), failure p-PCI (HR 2.30; p<.001). On the basis of the HR obtained, we assigned an incremental value by 0.5 point to each independent variable identified, reflecting its intrinsic power to increase mortality. The incremental mortality rate among different score risk level were highly significant (p<.001): 32% (score risk 1 [points 0]), 58% (score risk 2 [points 0.5-2]) and 83% (score risk 3 [points >2]) respectively. The ROC test showed an area under the curve of 0.66 (0.62-0.72; p<.001).
Out of hospital cardiac arrest, age > 75 years, and failure of p-PCI are strong predictors of 2-year cardiac mortality. A rapid score tool that include the three predictors of mortality could be useful to identify patients at major risk of death and consequently to lead to an optimization of health resources allocation.
CORONARY: Acute Coronary Syndromes