Primary percutaneous coronary intervention in patients admitted with cardiogenic shock and ST-elevation myocardial infarction: prognosis and predictors of in-hospital mortality

Objectives: We investigated the efficacy and outcome of primary percutaneous coronary intervention (PCI) in patients admitted with cardiogenic shock and ST-elevation myocardial infarction (STEMI). Study design: We reviewed 91 consecutive patients (66 males, 25 females; mean age 61 +/- 11 years) treated with primary PCI for cardiogenic shock due to STEMI. All clinical, angiographic data, and in-hospital and long-term outcomes were collected. The patients were classified into two groups depending on the presence (n=59, 64.8%) or absence (n=32, 35.2%) of in-hospital mortality. Results: Hospital nonsurvivors were older (mean age 62.7 +/- 11.1 vs. 57.7 +/- 11.4 years; p=0.04) and exhibited higher frequencies of diabetes mellitus (DM), renal failure, and history of myocardial infarction. Multi-vessel disease (p=0.004) and circumflex artery involvement (p=0.03) were more frequent and the rates of tirofiban administration (p=0.02) and stenting (p=0.007) were lower in nonsurvivors. Procedural success rate was substantially lower in nonsurvivors (39% vs. 84.4%; p<0.001). Of 32 survivors, cardiovascular mortality occurred in only three patients (9.4%) during a median follow-up of 26 months. In multivariate regression analysis, unsuccessful procedure (OR 7.2, 95% CI 1.77-29.27; p=0.006) and DM (OR 3.92, 95% CI 1.13-13.62; p=0.03) were the independent predictors of in-hospital mortality. Conclusion: Mortality rate is considerably higher and successful procedure yields a two-fold decrease in in-hospital mortality in patients with cardiogenic shock complicated by STEMI. Unsuccessful procedure and DM represent as two independent predictors of in-hospital mortality.