Solangi BA, Shah JA, Kumar R, Batra MK, Ali G, Butt MH, Nisar A, Qamar N, Saghir T, Sial JA. Immediate in-hospital outcomes after percutaneous revascularization of acute myocardial infarction complicated by cardiogenic shock. World J Cardiol 2023; 15(9): 439-447 [PMID: 37900262 DOI: 10.4330/wjc.v15.i9.439]
Corresponding Author of This Article
Bashir Ahmed Solangi, FCPS, Associate Professor, Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Rafiqi H.J. Shaheed Road, Karachi 75510, Pakistan. bashir1981.ba@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Sep 26, 2023; 15(9): 439-447 Published online Sep 26, 2023. doi: 10.4330/wjc.v15.i9.439
Immediate in-hospital outcomes after percutaneous revascularization of acute myocardial infarction complicated by cardiogenic shock
Bashir Ahmed Solangi, Jehangir Ali Shah, Rajesh Kumar, Mahesh Kumar Batra, Gulzar Ali, Muhammad Hassan Butt, Ambreen Nisar, Nadeem Qamar, Tahir Saghir, Jawaid Akbar Sial
Bashir Ahmed Solangi, Jehangir Ali Shah, Rajesh Kumar, Mahesh Kumar Batra, Gulzar Ali, Muhammad Hassan Butt, Ambreen Nisar, Nadeem Qamar, Tahir Saghir, Jawaid Akbar Sial, Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
Author contributions: Solangi BA, Shah JA, Kumar R, Batra MK, Ali G, Butt MH, and Nisar A contributed to the concept and design of study; Saghir T, Sial JA, and Qamar N contributed to the analysis and interpretation of data; Solangi BA, Shah JA, Kumar R, Batra MK, Ali G, Nisar A, and Butt MH collected data and drafted the manuscript; Saghir T, Sial JA, and Qamar N critically analysed for content; All author approved the final draft of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the National Institute of Cardiovascular Diseases (NICVD), Karachi.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors have no conflict of interest to disclose.
Data sharing statement: Data and material will be available upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bashir Ahmed Solangi, FCPS, Associate Professor, Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Rafiqi H.J. Shaheed Road, Karachi 75510, Pakistan. bashir1981.ba@gmail.com
Received: June 9, 2023 Peer-review started: June 9, 2023 First decision: July 19, 2023 Revised: July 31, 2023 Accepted: August 29, 2023 Article in press: August 29, 2023 Published online: September 26, 2023 Processing time: 103 Days and 21.5 Hours
Abstract
BACKGROUND
Cardiogenic shock (CS) is a life-threatening complication of acute myocardial infarction with high morbidity and mortality rates. Primary percutaneous coronary intervention (PCI) has been shown to improve outcomes in patients with CS.
AIM
To investigate the immediate mortality rates in patients with CS undergoing primary PCI and identify mortality predictors.
METHODS
We conducted a retrospective analysis of 305 patients with CS who underwent primary PCI at the National Institute of Cardiovascular Diseases, Karachi, Pakistan, between January 2018 and December 2022. The primary outcome was immediate mortality, defined as mortality within index hospitalization. Univariate and multivariate logistic regression analyses were performed to identify predictors of immediate mortality.
RESULTS
In a sample of 305 patients with 72.8% male patients and a mean age of 58.1 ± 11.8 years, the immediate mortality rate was found to be 54.8% (167). Multivariable analysis identified Killip class IV at presentation [odds ratio (OR): 2.0; 95% confidence interval (CI): 1.2-3.4; P = 0.008], Multivessel disease (OR: 3.5; 95%CI: 1.8-6.9; P < 0.001), and high thrombus burden (OR: 2.6; 95%CI: 1.4-4.9; P = 0.003) as independent predictors of immediate mortality.
CONCLUSION
Immediate mortality rate in patients with CS undergoing primary PCI remains high despite advances in treatment strategies. Killip class IV at presentation, multivessel disease, and high thrombus burden (grade ≥ 4) were identified as independent predictors of immediate mortality. These findings underscore the need for aggressive management and close monitoring of patients with CS undergoing primary PCI, particularly in those with these high-risk characteristics.
Core Tip: Cardiogenic shock (CS) is a severe form of acute myocardial infarction (AMI) associated with low blood pressure, poor organ perfusion, and high mortality rates. Overall, primary percutaneous coronary intervention (PCI) plays a crucial role in the management of patients with CS by improving blood flow to the heart, restoring cardiac function, and reducing mortality rates. However, the success of primary PCI depends on several factors, including the timeliness of treatment, the skill and experience of the operators performing the procedure, and the patient's overall health status. Therefore, it is essential to identify high-risk patients and provide timely appropriate treatment to achieve the best outcomes. Therefore, we conducted a retrospective analysis of 305 patients with CS complicated AMI undergone primary PCI at our center. It has been observed the immediate mortality rate was unacceptably high at 54.8% with cardiac arrest followed by renal failure, multi-organ dysfunction, sepsis, hypoxic brain injury and cerebrovascular accident as a cause of mortality. Killip class IV at presentation, multivessel disease, and high thrombus burden (grade ≥ 4) were identified as independent predictors of immediate mortality in multivariable analysis.
