Influence of Cardiogenic Shock with or Without the Use of Intra-aortic Balloon Pump on Mortality in Patients with ST-segment Elevation Myocardial Infarction

Overview

Journal Int J Cardiol Heart Vasc

Date 2017 Aug 9

PMID 28785621

Citations 1

Authors

Jesper Khedri Jensen

Per Thayssen

Lisbeth Antonsen

Mikkel Hougaard

Anders Junker

Knud Erik Pedersen

Lisette Okkels Jensen

Affiliations

Soon will be listed here.

Abstract

Background: Cardiogenic shock is a serious complication of a ST-segment elevation myocardial infarction (STEMI). We compared short- and long-term mortality among (1) STEMI patients with and without cardiogenic shock and (2) STEMI patients with cardiogenic shock with and without the use of an intra-aortic balloon pump (IABP).

Methods: From January 1, 2002 to December 31, 2010, all patients presenting with STEMI and treated with primary percutaneous coronary intervention (PCI) were identified. The hazard ratio (HR) for death was estimated using a Cox regression model, controlling for potential confounding.

Results: The study cohort consisted of 4293 STEMI patients: 286 (6.7%) with and 4007 (93.3%) without cardiogenic shock. Compared with patients without cardiogenic shock, patients with cardiogenic shock were older, and more likely to have diabetes mellitus, multi-vessel disease, anterior myocardial infarction (MI) or bundle-branch block MI and a reduced creatinine clearance. Among patients with cardiogenic shock vs. without shock, 30-day cumulative mortality was 57.3% vs. 4.5% (p < 0.001), one-year cumulative mortality was 60.7% vs. 8.2% (p < 0.001) and five-year mortality was 65.0% vs. 18.9% (p < 0.001). STEMI with cardiogenic shock was associated with higher 30-day mortality (adjusted HR = 12.89 [95% CI: 9.72-16.66]), 1-year mortality (adjusted HR = 8.83 [95% CI: 7.06-11.05]) and five-year mortality (adjusted HR = 6.39 [95% CI: 5.22-7.80]). IABP was used in 71 (25%) patients with cardiogenic shock and was associated with improved 30-day outcome (adjusted HR = 0.48 [95% CI: 0.28-0.83]).

Conclusion: Patients with STEMI and cardiogenic shock had substantial short- and long-term mortality that may be improved with IABP implantation. More studies on use of IABP in such patients are warranted.

Citing Articles

ST Elevation Myocardial Infarction Complicated by Cardiogenic Shock: Systematic Review of Survival Predictors.

Khoo J, Trewin B, Adji A, Wong Y, Hungerford S Am J Med Open. 2024; 10:100057.

PMID: 39035242 PMC: 11256274. DOI: 10.1016/j.ajmo.2023.100057.

References

Zeymer U, Bauer T, Hamm C, Zahn R, Weidinger F, Seabra-Gomes R . Use and impact of intra-aortic balloon pump on mortality in patients with acute myocardial infarction complicated by cardiogenic shock: results of the Euro Heart Survey on PCI. EuroIntervention. 2011; 7(4):437-41. DOI: 10.4244/EIJV7I4A72. View

Hochman J, Sleeper L, WEBB J, Sanborn T, White H, Talley J . Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999; 341(9):625-34. DOI: 10.1056/NEJM199908263410901. View

Bahekar A, Singh M, Singh S, Bhuriya R, Ahmad K, Khosla S . Cardiovascular outcomes using intra-aortic balloon pump in high-risk acute myocardial infarction with or without cardiogenic shock: a meta-analysis. J Cardiovasc Pharmacol Ther. 2011; 17(1):44-56. DOI: 10.1177/1074248410395019. View

Prondzinsky R, Lemm H, Swyter M, Wegener N, Unverzagt S, Carter J . Intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: the prospective, randomized IABP SHOCK Trial for attenuation of multiorgan dysfunction syndrome. Crit Care Med. 2009; 38(1):152-60. DOI: 10.1097/CCM.0b013e3181b78671. View

Holmes Jr D, Bates E, Kleiman N, Sadowski Z, Horgan J, Morris D . Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. The GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. J Am Coll Cardiol. 1995; 26(3):668-74. DOI: 10.1016/0735-1097(95)00215-p. View

Thiele H, Zeymer U, Neumann F, Ferenc M, Olbrich H, Hausleiter J . Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012; 367(14):1287-96. DOI: 10.1056/NEJMoa1208410. View

Lindholm M, Kober L, Boesgaard S, Torp-Pedersen C, Aldershvile J . Cardiogenic shock complicating acute myocardial infarction; prognostic impact of early and late shock development. Eur Heart J. 2003; 24(3):258-65. DOI: 10.1016/s0195-668x(02)00429-3. View

Steg P, James S, Atar D, Badano L, Blomstrom-Lundqvist C, Borger M . ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012; 33(20):2569-619. DOI: 10.1093/eurheartj/ehs215. View

Andersen H, Nielsen T, Rasmussen K, Thuesen L, Kelbaek H, Thayssen P . A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003; 349(8):733-42. DOI: 10.1056/NEJMoa025142. View

10.

Jensen L, Maeng M, Thayssen P, Tilsted H, Terkelsen C, Kaltoft A . Influence of diabetes mellitus on clinical outcomes following primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Am J Cardiol. 2011; 109(5):629-35. DOI: 10.1016/j.amjcard.2011.10.018. View

11.

Barron H, Every N, Parsons L, Angeja B, Goldberg R, Gore J . 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(6):933-9. DOI: 10.1067/mhj.2001.115295. View

12.

Goldberg R, Samad N, Yarzebski J, Gurwitz J, Bigelow C, Gore J . Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med. 1999; 340(15):1162-8. DOI: 10.1056/NEJM199904153401504. View

13.

Pedersen C, Gotzsche H, Moller J, Mortensen P . The Danish Civil Registration System. A cohort of eight million persons. Dan Med Bull. 2006; 53(4):441-9. View

14.

FRANK L . Epidemiology. When an entire country is a cohort. Science. 2000; 287(5462):2398-9. DOI: 10.1126/science.287.5462.2398. View

15.

Jeger R, Radovanovic D, Hunziker P, Pfisterer M, Stauffer J, Erne P . Ten-year trends in the incidence and treatment of cardiogenic shock. Ann Intern Med. 2008; 149(9):618-26. DOI: 10.7326/0003-4819-149-9-200811040-00005. View

16.

Jensen L, Maeng M, Kaltoft A, Thayssen P, Hansen H, Bottcher M . Stent thrombosis, myocardial infarction, and death after drug-eluting and bare-metal stent coronary interventions. J Am Coll Cardiol. 2007; 50(5):463-70. DOI: 10.1016/j.jacc.2007.06.002. View

17.

Schiele F, Hochadel M, Tubaro M, Meneveau N, Wojakowski W, Gierlotka M . Reperfusion strategy in Europe: temporal trends in performance measures for reperfusion therapy in ST-elevation myocardial infarction. Eur Heart J. 2010; 31(21):2614-24. DOI: 10.1093/eurheartj/ehq305. View

18.

Thiele H, Allam B, Chatellier G, Schuler G, Lafont A . Shock in acute myocardial infarction: the Cape Horn for trials?. Eur Heart J. 2010; 31(15):1828-35. DOI: 10.1093/eurheartj/ehq220. View