Percutaneous Coronary Intervention in Acute Myo- cardial Infarction with Cardiogenic Shock: Immediate and Late Outcomes
SUPHOT SRIMAHACHOTA, M.D.*, WASAN UDAYACHALERM, M.D.*, CHALARD SOMABUTR, M.D.*, PUNGCHAI NGARMUKOS, M.D.* SMONPORN BOONYARATAVEJ, M.D.*, WACIN BUDDHARI, M.D.*, DUANCHAI CHAYANONT,M.D.*,
Affiliation : * Cardiac Center and Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkom University, Bangkok I 0330, Thailand.
Background : Acute myocardial infarction (AMI) with cardiogenic shock carries a high
mortality rate. Early revascularization shows better results than conservative medical treatment.
Objective : To determine short and long term results of patients with cardiogenic shock
from AMI who underwent percutaneous coronary intervention (PCI).
Methods : Patients were identified from the PCI registry from 1993 to 1999. Follow-up
data were collected from medical records and/or phone calls.
Results : From 1993 to 1999, there were 1211 PCI procedures performed at King Chula-
longkorn Memorial Hospital. Seventeen of these cases (M9, F8) had cardiogenic shock. Mean age
was 59 ± 14 yrs. Fourteen patients had AMI. The other 3 cases developed shock more than 24
hours after AMI. Primary PCI was done in II cases. Thirteen patients (76.5%) needed intra-
aortic balloon pump support. Average peak CPK and CK-MB were 5393 and 580 u/1, respectively.
Five patients (29.4%) died in hospital, 3 of whom died on the first day due to pump failure. Twelve
patients were followed for a mean duration of 412 days (range 12 - 1,464). One patient died 6
months after PTCA because of in-stent restenosis of the left main coronary artery.
Conclusion : AMI with cardiogenic shock has a high mortality rate. However, in this
group of patients who had early revascularization by PCI, mortality seemed to be lower than pre-
viously reported. If PCI is available, the procedure should be offered for this subset of AMI
patients.
Keywords : Acute Myocardial Infarction, Cardiogenic Shock, Percuteneous Coronary Interven- tion
