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Revista chilena de cardiología

versão On-line ISSN 0718-8560

Resumo

VALDEBENITO, Martín et al. Clinical characteristics and predictors of early and global mortality in patients with ST segment elevation Myocardial Infarction and Cardiogenic Shock undergoing Primary Angioplasty. Rev Chil Cardiol [online]. 2014, vol.33, n.2, pp.116-122. ISSN 0718-8560.  http://dx.doi.org/10.4067/S0718-85602014000200005.

Background. Cardiogenic shock in acute myocardial infarction (AMI) is associated with a high mortality rate (40-60%). An improvement in this prognosis has followed the introduction of primary angioplasty. The aim of this study was to analyze the clinical and angiographic characteristics as well as to determine the early and late mortality in patients with St elevation AMI and cardiogenic shock undergoing primary angioplasty in 3 hospital centers where this procedure was available on a 24hr basis. Methods and Results. We analyzed the clinical an angiographic data of patients treated with primary PTCA for AMI and cardiogenic shock from January 2009 to August 2013. Mortality was confirmed by the data from a National Statistics Office. 101 patients were included and followed for an average of 1.6 years after primary PTCA. Early and total mortality rates were 40.8% and 53.5%, respectively. No differences were found between survivors and non survivors regarding age, risk factors, previous cardiovascular disease, renal failure, CRP and time to PTCA. Intracoronary thrombus aspiration, use of intra-aortic balloon pumping or final angiographic findings were also similar between groups. Compared to survivors, deceased patients had more vessels involved (>= 2 vessels in 83.3% vs 63.2%, respectively, p=0.012) and lower EF (under 30% in 66.7% vs 22.5%, respectively, p<0.001). Predictors of hospital mortality were the presence of >= 2 vessel disease (OR 2.9, 95% C.I. 1.19 - 7.1, p=0.012) and EF under 30% (OR 6.8, C.I. 2.23 - 21.27, p= 0.001). Global mortality predictors were EF < 30% (HR 3.6, IC 95% 1.4-9.2; P= 0.02) and the presence of >= 2 vessel disease (HR 3.2, IC 95% 1.1-10.7). No difference in hospital mortality was observed between patients undergoing intra-aortic balloon pumping (16.5%) as opposed to those without such support (47.6% vs 38.75 P= 0.299, respectively). Similar absence of effect from IABP applied to global mortality. Survival curves up to 1.6 years of follow-up were also similar in both groups. Conclusion. Cardiogenic shock in AMI leads to a high hospital and global mortality. Significant predictors of mortality were severe left ventricular dysfunction and multivessel disease.

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