Early Coronary Angioplasty for Acute MI Complicated by Cardiogenic Shock
Early Coronary Angioplasty for Acute MI Complicated by Cardiogenic Shock
Patients with acute myocardial infarction (MI) and cardiogenic shock constitute a very high risk subset despite an aggressive management. The objective of this study was to evaluate if the results of early coronary angioplasty in patients with acute myocardial infarction and cardiogenic shock have changed over the last years, and to address which role the recent adjuvant therapies have played in this evolution. From 1991 to April 1999, 94 patients with acute MI and cardiogenic shock were treated with coronary angioplasty within the first 12 hours from the onset of symptoms. Temporal changes of the utilization of adjuvant therapies and operators' experience were studied over these years, as well as their impact on the angiographic results and in-hospital outcome. Over the years, a progressive and significant increase on the use of coronary stents and c7E3Fab was observed, as well as an increased number of primary angioplasties performed per month. The proportion of patients treated with intraaortic balloon pump did not changed significantly over the years. An angiographic successful result (< 50% residual stenosis and TIMI flow 2 or 3) and a final TIMI grade 3 flow were obtained in 76 (80.9%) and 61 (64.9%) patients, respectively. The angiographic success rate progressively increased over the years, from 72.3% in patients treated before 1994 to 94.1% in those admitted in 1998-1999 (p for trend 0.0409). The proportion of patients with a final TIMI grade 3 flow also grew progressively over the years: from 36.4% before 1994 to 76.5% after 1997 (p for trend 0.0209). The overall in-hospital mortality rate was 63.8% (60 patients), and there was no significant change in mortality rate over the years. Therefore, apart from the growing operators' experience, we have observed an incremental change in the use of coronary stents and c7E3 Fab (abciximab) in patients with acute myocardial infarction and cardiogenic shock treated with early coronary angioplasty. All these factors have led to an improvement in the angiographic results, although this change has not meant a significant reduction of mortality.
In patients with acute myocardial infarction (AMI) treated with primary percutaneous transluminal coronary angioplasty (PTCA), the achievement of a successful coronary reperfusion leads to a better prognosis, especially when TIMI flow grade 3 is obtained. In patients with AMI and cardiogenic shock (CS), an early restoration of coronary patency is also associated with lower mortality. Over the last years, the use of coronary stents and c7E3 Fab in the setting of AMI has been strikingly increased, and these adjuvant therapies have recently demonstrated to be associated with better angiographic results and offer an improvement in the outcome of patients with AMI. On the other hand, the results of primary PTCA are better as operators' experience grows. The aim of this study was to evaluate the impact of both the novel therapies and the growing experience on primary PTCA on the angiographic results of early PTCA performed in patients with AMI complicated by CS over the last decade.
Patients with acute myocardial infarction (MI) and cardiogenic shock constitute a very high risk subset despite an aggressive management. The objective of this study was to evaluate if the results of early coronary angioplasty in patients with acute myocardial infarction and cardiogenic shock have changed over the last years, and to address which role the recent adjuvant therapies have played in this evolution. From 1991 to April 1999, 94 patients with acute MI and cardiogenic shock were treated with coronary angioplasty within the first 12 hours from the onset of symptoms. Temporal changes of the utilization of adjuvant therapies and operators' experience were studied over these years, as well as their impact on the angiographic results and in-hospital outcome. Over the years, a progressive and significant increase on the use of coronary stents and c7E3Fab was observed, as well as an increased number of primary angioplasties performed per month. The proportion of patients treated with intraaortic balloon pump did not changed significantly over the years. An angiographic successful result (< 50% residual stenosis and TIMI flow 2 or 3) and a final TIMI grade 3 flow were obtained in 76 (80.9%) and 61 (64.9%) patients, respectively. The angiographic success rate progressively increased over the years, from 72.3% in patients treated before 1994 to 94.1% in those admitted in 1998-1999 (p for trend 0.0409). The proportion of patients with a final TIMI grade 3 flow also grew progressively over the years: from 36.4% before 1994 to 76.5% after 1997 (p for trend 0.0209). The overall in-hospital mortality rate was 63.8% (60 patients), and there was no significant change in mortality rate over the years. Therefore, apart from the growing operators' experience, we have observed an incremental change in the use of coronary stents and c7E3 Fab (abciximab) in patients with acute myocardial infarction and cardiogenic shock treated with early coronary angioplasty. All these factors have led to an improvement in the angiographic results, although this change has not meant a significant reduction of mortality.
In patients with acute myocardial infarction (AMI) treated with primary percutaneous transluminal coronary angioplasty (PTCA), the achievement of a successful coronary reperfusion leads to a better prognosis, especially when TIMI flow grade 3 is obtained. In patients with AMI and cardiogenic shock (CS), an early restoration of coronary patency is also associated with lower mortality. Over the last years, the use of coronary stents and c7E3 Fab in the setting of AMI has been strikingly increased, and these adjuvant therapies have recently demonstrated to be associated with better angiographic results and offer an improvement in the outcome of patients with AMI. On the other hand, the results of primary PTCA are better as operators' experience grows. The aim of this study was to evaluate the impact of both the novel therapies and the growing experience on primary PTCA on the angiographic results of early PTCA performed in patients with AMI complicated by CS over the last decade.