Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Apr;7(2):768-773.
doi: 10.1002/ehf2.12637. Epub 2020 Mar 12.

Prognostic impact of angiographic findings, procedural success, and timing of percutaneous coronary intervention in cardiogenic shock

Tuija Sabell  1 , Marek Banaszewski  2 , Johan Lassus  1 , Markku S Nieminen  1 , Heli Tolppanen  1 , Toni Jäntti  1 , Anu Kataja  3 , Mari Hongisto  3 , Lars Køber  4 , Alessandro Sionis  5 , John Parissis  6 , Tuukka Tarvasmäki  1 , Veli-Pekka Harjola  3 , Raija Jurkko  1
Affiliations

Prognostic impact of angiographic findings, procedural success, and timing of percutaneous coronary intervention in cardiogenic shock

Tuija Sabell et al. ESC Heart Fail. 2020 Apr.

Abstract

Aims: Urgent revascularization is the mainstay of treatment in acute coronary syndrome (ACS) related cardiogenic shock (CS). The aim was to investigate the association of angiographic results with 90-day mortality. Procedural complications of percutaneous coronary intervention (PCI) were also examined.

Methods and results: This CardShock (NCT01374867) substudy included 158 patients with ACS aetiology and data on coronary angiography and complications during PCI procedure. Survival analysis was conducted with Kaplan-Meier curves and Cox regression analysis. Median age was 67 ± 11 years, and 77% were men. During 90-day follow-up, 66 (42%) patients died. Patients with one-vessel disease (n = 49) had lower mortality than patients with two-vessel (n = 59) or three-vessel (n = 50) disease (25% vs. 48% vs. 52%, P = 0.011). Successful revascularization [Thrombolysis in Myocardial Infarction (TIMI) Flow 3 post-PCI) was achieved more often in survivors than non-survivors (81% vs. 60%, P = 0.019). The median symptom-to-balloon time was 340 (196-660) minutes, with no difference between survivors and non-survivors. In multivariable mortality analysis, multivessel disease (HR 2.59, CI95% 1.29-5.18) and TIMI flow <3 post-PCI (HR 2.41, CI95% 1.4-4.15) were associated with 90-day mortality. Procedural PCI complications were recorded in 51 (35%) patients, arrhythmic complications being the most common (n = 32, 63%). The incidence of complications was similar between survivors and non-survivors (31% vs. 42%, P = 0.21).

Conclusions: Multivessel disease is associated with worse survival in ACS-related CS. In patients undergoing PCI, arrhythmic complications were common, but not associated with excess mortality. Successful revascularization of the IRA had positive effect on outcome despite delay from symptom onset.

Keywords: Acute coronary syndrome; Cardiogenic shock; Percutaneous coronary intervention.

PubMed Disclaimer

Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Kaplan–Meier 90‐day survival curves in different patient groups divided by (A) severity of coronary artery disease, (B) the infarct related artery, and (C) the Thrombolysis in Myocardial Infarction flow post‐percutaneous coronary intervention. (A) Patients with one‐vessel disease had lower 90‐day mortality rates than patients with two‐vessel or three‐vessel disease. (B) Patients with left anterior descending coronary artery or left main coronary artery as the infarct related artery had high mortality rates. (C) Patients with successful revascularization, i.e. TIMI Flow 3, had lower mortality rates than patients with TIMI Flows 0–2.
See this image and copyright information in PMC

References

    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González‐Juanatey JR, Harjola V‐P, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Filippatos G, McMurray JJV, Aboyans V, Achenbach S, Agewall S, Al‐Attar N, Atherton JJ, Bauersachs J, John Camm A. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur Heart J 2016; 37: 2129–2200. - PubMed
    1. Hoebers LP, Vis MM, Claessen BE, van der Schaaf RJ, Kikkert WJ, Baan J, de Winter RJ, Piek JJ, Tijssen JGP, Dangas GD, Henriques JPS, Baan J Jr, de Winter RJ, Piek JJ, Tijssen JGP, Dangas GD, Henriques JPS. The impact of multivessel disease with and without a co‐existing chronic total occlusion on short‐ and long‐term mortality in ST‐elevation myocardial infarction patients with and without cardiogenic shock. Eur J Heart Fail 2013; 15: 425–432. - PubMed
    1. Trzeciak P, Gierlotka M, Ga̧sior M, Lekston A, Wilczek K, Słonka G, Kalarus Z, Zembala M, Hudzik B, Poloński L. Mortality of patients with ST‐segment elevation myocardial infarction and cardiogenic shock treated by PCI is correlated to the infarct‐related artery ‐ results from the PL‐ACS Registry. Int J Cardiol 2013; 166: 193–197. - PubMed
    1. Fuernau G, Fengler K, Desch S, Eitel I, Neumann F‐J, Olbrich H‐G, de Waha A, de Waha S, Richardt G, Hennersdorf M, Empen K, Hambrecht R, Jung C, Böhm M, Pöss J, Strasser RH, Schneider S, Ouarrak T, Schuler G, Werdan K, Zeymer U, Thiele H. Culprit lesion location and outcome in patients with cardiogenic shock complicating myocardial infarction: a substudy of the IABP‐SHOCK II‐trial. Clin Res Cardiol 2016; 105: 1030–1041. - PubMed
    1. Zeymer U, Vogt A, Zahn R, Weber MA, Tebbe U, Gottwik M, Bonzel T, Senges J, Neuhaus K‐L. Predictors of in‐hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI). Eur Heart J 2004; 25: 322–328. - PubMed

Publication types

LinkOut - more resources