Published online Aug 12, 2009.
https://doi.org/10.4068/cmj.2009.45.2.92
Predictors of Mortality in Acute Myocardial Infarction Patients with Cardiogenic Shock Who Underwent Percutaneous Coronary Intervention with the Aid of an Intra-Aortic Balloon Pump
Abstract
Despite recent advances in the treatment of acute myocardial infarction (AMI), the mortality of AMI patients with cardiogenic shock remains high, especially in those who fail to receive adequate coronary revascularization. Even though it is reported that coronary revascularization with an intra-aortic balloon pump (IABP) support improves survival, such patients are still at high risk of early mortality. Therefore, the present study aimed to discover predictors of death in AMI patients with cardiogenic shock undergoing percutaneous coronary intervention (PCI) with the aid of an IABP. Of AMI patients presenting with cardiogenic shock between June 2005 and September 2007, 51 patients (67.4±9.9 years of age, 30 males) who underwent PCI with IABP support were grouped into in-hospital survivors and non-survivors and were compared for clinical, laboratory, echocardiographic, and coronary angiographic characteristics. The overall in-hospital mortality rate of the study patients was 52.9%. There were no statistically significant differences between the two groups in the indices of baseline clinical characteristics, laboratory findings, echocardiographic findings, and coronary angiographic findings. Non-survivors received more mechanical ventilation (25 vs. 15, p=0.009), the duration of stay in the coronary care unit was shorter in the non-survivors (3.6±2.9 vs. 9.0±6.7 days, p=0.001), and systolic blood pressure was lower in non-survivors (75.6±57.2 vs. 105.3±44.5 mmHg, p=0.045). Multivariate regression analysis for predictors of in-hospital mortality demonstrated that diabetes mellitus (OR: 6.51, 1.225~34.632 95% CI: p=0.028) was significantly associated with in-hospital death. In AMI patients with cardiogenic shock who underwent PCI with IABP support, diabetes mellitus was a significant predictor of mortality.
Table 1
Baseline clinical characteristics
Table 2
Laboratory findings and left ventricular function
Table 3
Coronary angiographic findings
Table 4
Multivariate logistic regression analysis for predictive factors of hospital mortality
References
-
Barron HV, Every NR, Parsons LS, Angeja B, Goldberg RJ, Gore JM, et al. The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2. Am Heart J 2001;141:933–939.
-
-
Sanborn TA, Sleeper LA, Bates ER, Jacobs AK, Boland J, French JK, et al. Impact of thrombolysis, intraaortic balloon pump counter-pulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK trial registry. J Am Coll Cardiol 2000;36(3) Suppl 1:1123–1129.
-
-
Hoffman JI, Spaan JA. Pressure-flow relation in coronary circulation. Physiol Rev 1990;70:331–390.
-
-
Corral CH, Vaughn CC. Intraaortic balloon counterpulsation: an eleven year review and analysis of determinants of survival. Tex Heart Inst J 1986;13:39–44.
-
-
Ahn MS, Yoo BS, Kim JY, Ko JY, Lee KH, Kim WJ, et al. Predictive factors of survival for intra-aortic balloon pump in acute myocardial infarction treated with angioplasty. Korean Circ J 2003;33:22–29.
-
-
Kim JY, Jeong MH, Cho JH, Hong YJ, Kim JH, Ahn YK, et al. Predictors of hospital mortality for patient with acute myocardial infarction that was treated with an artificial ventilator and/or an intra-aortic balloon pump. Korean Circ J 2008;38:257–263.
-