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Percutaneous coronary intervention in acute myocardial infarction complicated with cardiogenic shock or cardiac arrest is generally an acceptable practice in a capable and well-equipped hospital especially when emergency coronary artery bypass graph is rarely performed.
Multivessel and unprotected left main stem coronary artery disease is not unusual in these group of patients and the interventions are associated with high-risk mortality.
This study aims to describe the pattern and evaluate the immediate outcome following treatment with percutaneous coronary intervention or intended intervention in patients presented with cardiogenic shock or cardiac arrest as a consequence of acute myocardial infarction.
We performed a retrospective registry data review in our Invasive Cardiac Laboratory, Hospital Tengku Ampuan Afzan Kuantan from January 2014 until December 2015. Consecutive cases of emergency Percutaneous Coronary Intervention (PCI) or intended intervention performed on patients with a diagnosis of Cardiogenic Shock - Acute Myocardial Infarction (CS-AMI) or pre-procedure survived Cardiac Arrest - Acute Myocardial Infarction (CA-AMI) were collected, tabulated and analysed. Cases with incomplete data documentations were excluded.
A total of 75 cases were included of which 68/75 (90.6%) were males and mean age at 59.7 ± 8.5 years old. There was 9/75 (12.0%) mortality within 24 hours of the procedure, in which 4/9 (44.4%) had PCI-stenting done; 2 left the main stem, 1 left anterior descending artery and 1 right coronary artery respectively with 5 other cases did not have stenting performed. Within this cohort as well, a total of 7/75 (9.3%) had left main stem stenting and 5/75 (6.7%) had dual vessel stenting performed. The remaining 58/75 (77.3%) of cases had only a single culprit vessel stenting performed. The use of Intra-aortic balloon pump (IABP) was only in 4/75 (5.3%) of cases.
The experience from our center highlighted that in those small samples of a very high-risk group of patient with CS-AMI or CA-AMI, PCI and stenting is a relatively valuable, practical and safe treatment strategy. A larger and more comprehensive real world PCI registry data analysis may contribute to a better understanding of the significant prognostic pattern following the invasive procedures in these groups of patient.