Abstract 3588: Primary Percutaneous Coronary Intervention Does Not Prevent In-Hospital Development of Cardiogenic Shock
Introduction Primary percutaneous interventions (PCI) are superior to fibrinolysis with regards to restoration of blood flow in patients with acute ST-elevation myocardial infarction (STEMI). More than 75% of patients in cardiogenic shock develops cardiogenic shock after admission. It has been speculated whether invasive revascularization prevents the in-hospital development of cardiogenic shock. There is however only limited data from randomised trials comparing PCI to fibrinolysis with regards to the incidence of cardiogenic shock and subsequent mortality.
Hypothesis We assessed the hypothesis that PCI prevents the in-hospital development of cardiogenic shock and reduces mortality from cardiogenic shock developed after treatment, compared with fibrinolysis. Furthermore we described the mortality of patients developing in-hospital cardiogenic shock in the PCI-era.
Methods DANAMI-2 randomly assigned 1572 STEMI patients to fibrinolysis (782 patients) or primary PCI (790 patients). Data on patients with in-hospital development of cardiogenic shock (n=03) after randomization were compared to patients without cardiogenic shock.
Results A total of 103 patients (7%) developed cardiogenic shock after randomization. Of the patients developing cardiogenic shock 57% were randomized to PCI with an odds ratio of 1.49 (0.96–2.31) compared to the fibrinolytic group. When comparing the angiographic results, patients who developed cardiogenic shock after invasive treatment had a significant higher rate of reocclussions, multiple vessel disease and TIMI flow<. We found that 58% of the total mortality in the DANAMI-2 trial was due to cardiogenic shock, and that treatment strategy did not influence the risk associated with shock (hazard ratio of 1.05 (0.67–1.64) for primary PCI vs. fibrinolysis).
Conclusions In conclusion, we found a substantial trend towards an increase in the in-hospital development of cardiogenic shock complicating acute MI in patients randomized to PCI. Secondarily we found that cardiogenic shock is still the leading cause of death in patients hospitalized for acute MI, and that there was no difference in mortality, with regards to treatment strategy in patients developing cardiogenic shock after the initial treatment.