Abstract 2655: Activated Protein C as Adjunctive Therapy in Cardiogenic Shock Complicating Acute Myocardial Infarction Treated with Percutaneous Coronary Intervention
BACKGROUND It has been hypothesized the systemic inflammatory activation invariably present in patients with cardiogenic shock (CS) may have a strong impact on outcome after successful percutaneous coronary intervention (PCI). Activated protein C (APC) has been extensively used in severe sepsis complicated by shock, and possesses both systemic anticoagulant and anti-inflammatory properties. This study sougth to determine the effects of ACP treatment in patients with CS complicating acute myocardial infarction (AMI) and treated with PCI.
METHODS and RESULTS Patients with AMI complicated by CS and treated with successful PCI were considered eligible for adjunctive APC treatment if CS and end-organ hypoperfusion persisted after PCI despite standard pharmacological and mechanical support, while CS patients who were responsive to the standard treatment constitute the control group. Out of 50 consecutive patients with successful PCI, 20 patients with persistent CS received APC therapy, while 30 received the standard treatment. Patients of the APC group were older, and the baseline echocardiographic left ventricular ejection was lower (24 ± 10% vs 31 ± 11%, P = 0.027) as compared to the control group. Most patients of both groups received stents, intraaortic balloon counterpulsation, and abciximab as adjunctive therapy. Multivessel PCI was performed in nearly half of patients of the APC group. The 2 group 1-month cardiac mortality rates were similar (45% vs 40%, P = 0.726) despite the higher risk profile of the APC group as compared to the control group. Major bleeding rate were identical in the 2 groups (10%), and no fatal bleeding occurred in the APC group.
CONCLUSIONS The results of the study both in terms of mortality and safety may be considered encouraging and suggest a potential benefit of APC therapy in CS complicating AMI.