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Despite advances in the treatment of acute myocardial infarction (AMI), cardiogenic shock (CS) is still the most serious clinical complication leading to extremely high mortality.
We evaluated short- and long-term clinical outcomes in patients with AMI complicating CS who were enrolled in the CREDO-Kyoto AMI Registry between 2005 and 2007.
The CREDO-Kyoto AMI registry was a large scale multi-center cohort that enrolled consecutive AMI patients undergoing coronary revascularization within 7 days of the symptom onset between 2005 and 2007 across 26 tertiary hospitals in Japan. Among consecutive 5206 AMI patients having primary percutaneous coronary intervention (PCI) in this registry, 712 patients developed CS. Compared to the patients without CS, the patients with CS had a significantly higher risk for all-cause mortality (25.1% versus 2.4% at 30 days, and 42.0% versus 9.8% at 3 years, p<0.001). In patients with CS, anterior infarction was significantly associated with higher all-cause mortality compared with non-anterior infarction (55.6% versus 31.7% at 3 years, p<0.001). After adjusting by potential confounding factors, independent predictors for all-cause mortality were anterior infarction (HR:2.2 (1.7–2.8)), more than 75 years of age (HR:1.6 (1.2–2.1)), presence of complete AV block (HR:0.6 (0.4–0.8)), BMI less than 25 (HR:1.5 (1.04–2.2)), insulin treated diabetes mellitus (HR:1.5 (1.03–2.1)), renal insufficiency (HR:1.7 (1.3–2.3)), and multivessel disease (HR:1.4 (1.1–1.8)).
The mortality in AMI patients complicating CS was still high. However, the clinical outcome in these patients might be quite different among patients risk profiles or various clinical situations.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: MI Complications: Shock, Arrest and Cardiac Rupture
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1126-182
- 2013 American College of Cardiology Foundation