Primary Percutaneous Coronary Intervention (PPCI) in acute myocardial infarction complicated with cardiogenic shock in a newly emerging cardiac center in Nepal (original) (raw)
Related papers
Journal of Advances in Internal Medicine, 2013
Percutaneous Coronary Intervention is better than thrombolysis. Our aim was to determine the outcomes of Primary Percutaneous Coronary Intervention in Shahid Gangalal National Heart Centre, Nepal. Methods-Medical records of 212 Primary Percutaneous Coronary Intervention from March 2007 to March 2012 were retrospectively reviewed. The primary end point was in-hospital mortality and secondary end points were 30 day mortality and long term mortality. Results-In the patients presenting to emergency with acute ST elevation myocardial infarction, inferior wall Myocardial Infarction 64 (30%) was the most common. Single vessel disease 168 (79%) predominated in emergency coronary angiogram. In majority of the patients Right Coronary Artery 103 (48.7%) was the culprit vessel. Cardiogenic shock was present in 28 (13.2%) patients. There were 11 deaths (39.2%) in cardiogenic shock group where as only 5 deaths (2.7%) among 184 non cardiogenic shock patients, resulting in in hospital mortality rate of 7.5%. Among the 196 patients who were successfully discharged from the hospital, 21 patients lost to follow up. There was one death reported within a month, non within three months and four within a year post discharge from the hospital. Conclusions-The result of this study is comparable to the findings elsewhere in the world. Primary Percutaneous Coronary Intervention should be the treatment of choice in treating acute myocardial infarction where the facilities and the expertise are available.
Acute Cardiac Care, 2008
Cardiogenic shock is the commonest cause of death in acute myocardial infarction (AMI). Although the syndrome of cardiogenic shock complicating AMI is common to all, the spectrum of underlying pathology is broad. While thrombolysis can be attempted with inotropic support or augmentation of blood pressure with an intra-aortic balloon pump, the greatest mortality benefit is seen after urgent coronary angiography and early revascularization. The long-term SHOCK Trial six-year follow-up results confirm durability of early revascularization over medical stabilization in shock patients. Indeed, cardiogenic shock is a catheter laboratory emergency. Percutaneous left ventricular assist devices may provide an advance in the management of patients with left ventricular dysfunction and cardiogenic shock.
Indian Heart Journal, 2012
Background: Mortality in acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) approaches 70 − 80%, regardless of the type of pharmacological treatment. Early revascularisation improves survival in AMI with CS. Our aim is to assess the predictors of mid-term outcome after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and CS. Methods: Forty-one patients who underwent primary or rescue PCI for CS were analysed comparing their baseline, angiographic, PCI data, 30-day and 1-year survival. Results: There were no significant differences between survivors and non-survivors in baseline characters, except for more number of transfer admissions (P = 0.0005), and cardiopulmonary resuscitations (P = 0.015) in the later group. The mean time between myocardial infarction (MI) onset to shock and MI onset to revascularisation were 12.8 ± 12.9 hours and 17.0 ± 16.8 hours, respectively. Patients with better pre-procedure thrombolysis in myocardial infarction (TIMI) flow in the infarctrelated artery (IRA) had better survival (P = 0.0005). Successful PCI was achieved in 48.8% of patients. The 30-day mortality was 56.1% and all were prior to hospital discharge. Patients with successful PCI had better short-term survival in comparison with patients with failed PCI (80% vs 9.6%). Eighteen patients who survived at 30 days were followed up for 12-72 months (mean 28.5 ± 5.4 months). Fifteen patients survived at 1 year after PCI and all were in good functional status. Conclusion: Mortality remains high even with PCI. Achieving IRA patency with TIMI 3 flow is the main determinant of survival. Survival and functional status are good in patients who are discharged from hospital.
In Hospital Outcomes of Cardiogenic Shock among Patients with Acute Myocardial Infarction
Pakistan Journal of Medical and Health Sciences
Aim: To evaluate in-hospital cardiogenic shock (CS) outcomes after acute myocardial infarction. Study Design: A descriptive study. Place and Duration:InPunjab Institute of Cardiology, Lahorefor six-months duration from 18th June 2021 to 17th December 2021. Materials and Methods: After meeting the inclusion criteria, 200 consecutive patients with cardiogenic shock afterwardsthe acute myocardial infarction were studied. The major group was Group I consisting of 105 (52.5%) subjects; these were CS patients with STEMI. The patients of group-IIcomprised of 80 (40%) subjects, these were cases with CS with Non-STEMI and patients of the group III were 15 (7.5%); with acute left bundle branch block (LBBB) in the CS setting. Results: The mean age of the study people was 57.2 ± 29.40. The males in the studied people were 130 (65%), and women 70 (35%). In group I; 50 (47.6%) was the in-hospital mortality, group II has in-hospital mortality of 57 (71.3%) and in group III it was 7 (46.7%) cases. ...
The American Journal of Cardiology, 2005
Although percutaneous coronary intervention (PCI) in the setting of cardiogenic shock has a high in-hospital mortality rate, it has been shown to decrease the mortality rate in certain subgroups. The identity and relative importance of variables that are predictive of in-hospital mortality rate after PCI for cardiogenic shock are uncertain. Accordingly, we examined data of >300,000 patients in the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) that were collected from 1998 to 2002 and evaluated the outcomes in 483 consecutive patients who underwent emergency PCI for cardiogenic shock. Patients' mean age was 65 ؎ 13 years, with men predominating (61%). All underwent emergency/salvage PCI in the setting of cardiogenic shock after acute myocardial infarction. Mean left ventricular ejection fraction was 30 ؎ 16%. Stents were placed in 64% of patients, and thrombolytic agents were administered in 26%. Although PCI was angiographically successful in 79% of patients, the in-hospital mortality rate was 59.4%. Length of stay after PCI was 7.2 ؎ 8 days. Logistic regression using all available variables identified 6 multivariate predictors of death: age (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.68 to 3.28, p <0.001) for each 10-year increment, female gender (OR 1.55, 95% CI 1.00 to 2.41, p <0.001), baseline renal insufficiency (creatinine >2.0 mg/dl; OR 4.69, 95% CI 1.96 to 11.23, p <0.001), total occlusion in the left anterior descending artery (OR 1.99, 95% confidence interval 1.28 to 3.09, p <0.01), no stent used (OR 2.55, 95% CI 1.63 to 3.96, p <0.01), and no glycoprotein IIb/IIIa inhibitor used during PCI (OR 1.96, 95% CI 1.30 to 2.98, p <0.01). In a second analysis using only variables known to the clinician at the time of initial presentation, gender, age, renal insufficiency, and total occlusion of the left anterior descending coronary artery were significant. In conclusion, analysis of patients from the ACC-NCDR who underwent emergency PCI for acute myocardial infarction in the presence of cardiogenic shock shows an in-hospital mortality rate of ϳ60% when PCI is attempted. © 2005 Elsevier Inc. All rights reserved. (Am J Cardiol 2005;96:35-41)
Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial
Journal of the American College of Cardiology, 2003
We examined the clinical, angiographic, and procedural characteristics determining survival after percutaneous coronary intervention (PCI) for cardiogenic shock. BACKGROUND The SHOCK (SHould we emergently revascularize Occluded coronaries for Cardiogenic shocK?) trial prospectively enrolled patients with shock complicating acute myocardial infarction (MI). Patients were randomized to a strategy of early revascularization or initial medical stabilization.
Oman Medical Journal, 2016
ardiogenic shock (CS) remains one of the most serious and challenging conditions in cardiology following acute myocardial infarction (AMI). Its incidence has remained constant for 20 years, and it continues to complicate between 5-8% of ST-elevation myocardial infarction (STEMI) and approximately 2.5% of non-ST-elevation myocardial infarction (NSTEMI) cases. 1-5 Mortality rates in patients with CS continue to be high, and inhospital mortality approaches 70-80% among those managed medically. 6-11 The landmark trial "Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK)" showed significant improvement in survival from immediate coronary revascularization in patients with CS. 12-14 Since, emergency revascularization, mainly by percutaneous coronary intervention (PCI), but also by coronary artery bypass graft (CABG) if coronary anatomy is suitable, has become established as the preferred treatment for patients with CS. The American College of Cardiology/American Heart Association (ACC/AHA) 2013 guidelines and European Society of Cardiology (ESC) 2012 guidelines recommend emergency revascularization with either PCI or CABG in suitable patients with CS due to pump failure after STEMI irrespective of the time delay from MI onset (Class IB). 15,16 Despite the interventional advances in cardiology, CS has been reported to cause more than 40% of the in-hospital mortality in different studies of AMI. Currently, there is no published data about CS in original article
Signa Vitae, 2021
Objectives: To evaluate the severity of acute myocardial infarction (AMI) complicated with cardiogenic shock (CS), by comparison with inferior and right ventricular AMI, which is also considered a severe form of myocardial infarction. Methods: In an observational study, from 774 patients with STEMI hospitalized in our Cardiology Institute, over one year and a half, only 120 patients met the inclusion and exclusion criteria (60 patients with CS and 60 patients with right ventricular AMI). Data collected included age, sex, vital signs, oxygen saturation, respiratory rate, left ventricular ejection fraction, right ventricular dysfunction, complications during hospitalization and coronarography results. Results: Patients with CS had a more severe systolic dysfunction (median ejection fraction 22.72 ± 12.30% vs. 41.93 ± 10.50%, P < 0.0001). Single-vessel disease was the most common in both groups, left anterior descending artery being the culprit artery in most patients with cardiogen...