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

Jeong Hun Kim; Myung Ho Jeong; Jin Su Choi; Jung Ae Rhee; In Soo Kim; Ok Ja Choi; Eun Jeong Kim; Doo Sun Sim; Young Joon Hong; Ju Han Kim; Young Keun Ahn; Jeong Gwan Cho; Jong Chun Park; Jung Chaee Kang

doi:10.4068/cmj.2009.45.2.92

Journal List > Chonnam Med J > v.45(2) > 1017942

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Kim, Jeong, Choi, Rhee, Kim, Choi, Kim, Sim, Hong, Kim, Ahn, Cho, Park, and Kang: 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

Original Article

Chonnam Medical Journal

Chonnam Medical Journal 2009; 45(2): 92-97.

Published online: 12 August 2009

DOI: 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

Jeong Hun Kim¹, Myung Ho Jeong¹, Jin Su Choi¹, Jung Ae Rhee¹, In Soo Kim, Ok Ja Choi, Eun Jeong Kim, Doo Sun Sim, Young Joon Hong, Ju Han Kim, Young Keun Ahn, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang

The Heart Center of Chonnam National University Hospital, Gwangju, Korea.

¹Department of Public Health, Chonnam National University Graduate School, Gwangju, Korea.

Corresponding author (myungho@chollian.net)

Accepted 9 April 2009

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.

Keywords: Shock, Myocardial infarction, Intra-aortic balloon pump

Figures and Tables

Table 1

Baseline clinical characteristics

STEMI, ST-elevation myocardial infarction; NSTEMI, non ST-elevation myocardial infarction; History of IHD, history of ischemic heart disease; CCU, coronary care unit; ^*Renal insufficiency defined as baseline serum creatinine level >1.4 mg/dL.

Table 2

Laboratory findings and left ventricular function

hs-CRP, high sensitivity C-reactive protein; NT-proBNP, N-terminal pro-brain natriuretic peptide; TnI, troponin I; CIN, contrast induced nephropathy; LVEF, left ventricular ejection fraction; Data were expressed as median (interquartile range), comparisons of variables were tested by means of Mann-Whitney U test; ^*Contrast induced nephropathy defined as an absolute increase in serum creatinine level >0.5 mg/dL within the 72-hour period after angioplasty.

Table 3

Coronary angiographic findings

PCI, percutaneous coronary intervention; LM, left main coronary artery; LAD, left anterior descending coronary artery; LCX, left circumflex coronary artery; RCA, right coronary artery; ACC/AHA, American College of Cardiology/American Heart Association; TIMI, Thrombolysis In Myocardial Infarction.

Table 4

Multivariate logistic regression analysis for predictive factors of hospital mortality

OR, odds ratio; CI, confidence interval; History of IHD, history of ischemic heart disease; CIN, contrast induced nephropathy; LCX, left circumflex coronary artery; ^*Renal insufficiency defined as baseline serum creatinine level >1.4 mg/dL; ^†Contrast induced nephropathy defined as an absolute increase in serum creatinine level >0.5 mg/dL within the 72-hour period after angioplasty.

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