Long-term outcome after angioplasty in cardiogenic shock

Background

Early revascularization in the setting of acute myocardial infarction complicated by cardiogenic shock improves 6-month survival. In the absence of available data on the long-term outcome (more than 16 months) of this strategy, we studied the 5-year outcome in a consecutive group of patients undergoing percutaneous transluminal coronary angioplasty (PTCA) in cardiogenic shock due to myocardial ischemia.

Methods

The study period covers 1986–2002. The survival status on March 2003 was available for all 123 patients. The median follow-up was 4.7 years. The mean age was 64 ± 10 years. Major comorbidities were diabetes (15%), peripheral vascular disease (18%), cerebrovascular disease (13%), renal failure (18%), and chronic pulmonary disease (10%). Nineteen per cent had previous coronary artery bypass grafting (CABG), 11% previous PTCA. Myocardial infarction occurred within less than 7 days in 80% and less than 24 hours in 60%. One vessel was treated in 83% of the cases. The ratio of stented segments was 0.56. The success/segment was 84%. Full procedural success was obtained in 80%, incomplete success in 4%. Sixteen per cent of the attempts failed.

Results

Inhospital mortality was 54%. Inhospital major adverse events (death, CABG, myocardial infarction) occurred in 62%. Survival at 1 year and 5 years was 41 ± 4% and 40 ± 4% (NS), respectively. Survival at 5 years after a successful procedure was 44 ± 5% versus 17 ± 8% after incomplete success/failure (P < 0.001). Multivariate analysis showed four independent variables for the long-term outcome: age, left ventricular dysfunction, extent of coronary artery disease and procedural result.

Conclusions

(1) Survivors at hospital discharge after PTCA in cardiogenic shock have an excellent long-term outcome. (2) The favourable impact of successful PTCA procedures and the excellent long-term outcome of hospital survivors are strong arguments in favour of an 'invasive' approach in the presence of cardiogenic shock.