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PCI Improves Outcome in AMI Patients with Cardiogenic Shock

For 10 years, researchers tracked early revascularization rates among more than 7000 patients who presented with acute myocardial infarction complicated by cardiogenic shock.

Cardiogenic shock accounts for the majority of in-hospital deaths among acute MI (AMI) patients. For patients younger than age 75 in the SHOCK trial, early revascularization was associated with lower 6- and 12-month mortality rates than was initial medical stabilization (Journal Watch Cardiology Mar 16 2001). Now, in a partially industry-supported study, researchers for the National Registry of Myocardial Infarction have tracked early revascularization rates among 7356 AMI patients who presented to U.S. hospitals with cardiogenic shock over 10 years (representing 2.5% of all STEMI patients and 29.1% of all shock patients).

From 1995 to 2004, the cardiogenic-shock population showed gradual increases in hypertension and dyslipidemia prevalence, and slight decreases in mean age and the number of women. The population’s catheterization rate increased from 52% to 74%, whereas the fibrinolysis rate decreased from 20% to 6%. The rates of primary and total PCI increased from 27% to 54% and 34% to 64%, respectively. The rate of immediate CABG remained low.

In-hospital mortality among cardiogenic-shock patients decreased from 60% in 1995 to 48% in 2004; the decline was significant in both the <75 and 75 age subgroups. In a multivariable analysis, primary PCI was independently associated with a survival benefit, except among patients older than 75. The September 1999 publication of ACC-AHA AMI guidelines did not appear to influence the revascularization rate for patients with cardiogenic shock.

Comment: In this large observational study, in-hospital mortality declined among patients with AMI complicated by cardiogenic shock; parallel increases in primary and total PCI likely explain this decline. The data support randomized-trial results and guideline recommendations, and justify further efforts to promote guideline adherence and early mechanical revascularization in AMI patients who present with cardiogenic shock.

— Howard C. Herrmann, MD

Published in Journal Watch Cardiology August 26, 2005

Citation(s):

Babaev A et al. for the NRMI Investigators. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA 2005 Jul 27; 294:448-54.

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