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58 HIGHER PRESENTATION ACUITY AND MEDICAL COMORBIDITIES LIMIT UTILIZATION OF EARLY INVASIVE THERAPIES IN ACUTE MYOCARDIAL INFARCTION WITH CARDIOGENIC SHOCK, DECREASING SURVIVAL TO HOSPITAL DISCHARGE
  1. O. D'Silva1,
  2. S. Nathan1,
  3. A. Gupta1,
  4. A. Amin2,
  5. L. W. Klein2
  1. 1Rush University Medical Center and the
  2. 2John H. Stroger Jr. Hospital of Cook County, IL., LA

Abstract

Background Although early invasive therapies are beneficial in myocardial infarction (MI) complicated by cardiogenic shock (CS), the interaction between clinical factors, selection for angiography and mortality is unclear. Current treatment patterns and predictors of early mortality in CS were investigated via retrospective cohort analysis.

Methods Data from 181 patients admitted for MI with CS over 54 months at 2 tertiary care centers were compiled and analyzed via multivariate logistic regression. CS, identified by DRG code and adjudicated by chart review, was defined as sustained peri-infarct SBP < 90 or MAP < 60 mm Hg.

Results 56.9% of patients survived to hospital discharge. 84.0% patients underwent angiography, 37.6% patients received IABP support and 69.1% patients were revascularized (53.6% PCI, 15.5% CABG). Deferral of angiography (O.R. 2.56, p = .037), presenting SBP ≤ 100 (O.R. 2.16, p = .030), any SBP ≤ 70 (O.R. 134.8, p < .001) or DBP ≤ 30 mm Hg (18.28, p = .016) and LVEF ≤ 30% (O.R. 3.67, p < .001) each independently predicted in-hospital mortality. Prior CABG or CHF (O.R. 0.26, p < .05 both), earlier development of CS (O.R. 1.014 per hour elapsed from admission to CS onset, p = .031) and pressor use (O.R. 0.30, p = .031) were linked with deferral of angiography. Advanced age and DM did not increase mortality, irrespective of revascularization status. IABP (O.R. 29.3, p = .002) and GpIIb/IIIa use (O.R. 11.2, p = .005) were both strongly linked with selection for angiography; however, neither predicted survival.

Conclusions Deferral of angiography was more likely in patients with earlier onset of hypotension, prior CABG, CHF or pressor needs, which in turn was strongly predictive of early mortality. This suggests that selection bias may limit utilization of life-saving therapies in the most critically ill patients, who have the most adverse prognosis overall.

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