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Cardiogenic shock complicating acute myocardial infarction due to left main coronary artery occlusion: a multicentre study
Session:
Comunicações Orais (Sessão 14) - Doença Coronária e Cuidados Intensivos 3 - Foco na Oclusão do Tronco Comum
Speaker:
Marta Braga
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Marta Braga; João Calvão; João Carlos Silva; Andreia Campinas; André Alexandre; Bruno Brochado; Mariana Brandão; Marisa Passos Silva; Gustavo Pires Morais; Filipe Macedo
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Introduction:</span></strong><span style="font-family:"Calibri",sans-serif"> Cardiogenic shock (CS) complicating acute myocardial infarction (MI) occurs in about 8% of patients and carries a high in-hospital mortality if untreated. Revascularization has improved survival in these patients. Reported data concerning outcomes of CS in setting of MI due left main coronary artery (LMCA) occlusion are scarce. In this study we describe patients with CS due to acute LMCA occlusion and evaluate their in-hospital and 1-year mortality. </span></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Methods:</span></strong><span style="font-family:"Calibri",sans-serif"> We performed a retrospective multicentre study of patients with ST-segment elevation MI (STEMI) or high-risk non-ST segment elevation MI who underwent emergent coronary angiography (eCA) between January 2008 and December 2020 in 3-hospital centres. Among this cohort, 128 patients presented with unprotected LMCA occlusion (Thrombolysis In Myocardial Infarction – TIMI ≤2) and were categorized according to the presence/absence of signs of CS at admission: CS and no-CS. </span></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Results:</span></strong><span style="font-family:"Calibri",sans-serif"> Of 128 patients with acute MI due to LMCA occlusion, 78 patients presented with CS (60.9%). Mean age was 62.4±10.8 years in CS patients and 65.1±12.2 years in no-CS patients, p=0.203. In both groups, most patients were male and have at least 1 cardiovascular risk factor. Previous angina/positive ischemic test were found in only 9.0% of CS patients (vs 24.0% in no-CS patients, p= 0.02). STEMI presentation was more frequent in CS group (81.6% vs. 46.9%, p<0.001). TIMI=0 (55.1% vs. 32.0%, p=0.01) and slow/no-reflow phenomenon (28.8% vs 5.3%, p=0.004) in eCA were also more prevalent in CS group. Primary percutaneous coronary intervention was performed in 92.3% of CS patients and in 76.0% of no-CS patients (p<0.001). Invasive mechanical ventilation (71.8% vs. 22.0%, p<0.001), haemodialysis (18.8% vs. 2.0%, p=0.010) and mechanical circulatory support ([MCS] 65.4% vs. 36.0%, p=0.002) were more frequent in CS group. Haemorrhagic complications were higher in CS patients (14.7% vs. 2.1%, p=0.022). In-hospital mortality in CS group was 73.1%, compared to 18.0% in no-CS group (p<0.001). Almost 80% of CS patients had died at 1-year after index-event, in contrast to 32.7% in no-CS group (p<0.001). MCS use in CS patients, pre/post-LMCA revascularization, was not a survival predictor. </span></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Conclusions:</span></strong><span style="font-family:"Calibri",sans-serif"> CS complicating acute MI due to LMCA occlusion is common and results in an extremely high mortality rate, mainly in the acute phase. Further studies are crucial in this population to refine initial medical treatment in order to improve their prognosis.</span></span></span></p>
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