Abstract 3169: Transfer of ST-Elevation Myocardial Infarction Patients with Cardiogenic Shock for Primary Percutaneous Coronary Intervention
Background: ACC/AHA guidelines recommend early revascularization for patients with STEMI and cardiogenic shock who are >75 years old (class I). Selected patients ≤75 years old may also benefit. The guidelines recommend transfer to PCI centers despite no data on the outcome of STEMI patients transferred with cardiogenic shock.
Methods: We report the results of 1,500 consecutive patients with STEMI transferred to Abbott Northwestern Hospital (Minneapolis, MN) for direct PCI as part of the Level 1 MI integrated transfer program. 12.3% had cardiogenic shock as defined by the SHOCK trial. No patients were excluded from analysis, including patients with cardiac arrest (10.6%) and elderly (≥80 years, 14.3%).
Results: Patients with cardiogenic shock were more likely to be older, female, hypertensive and to have had a cardiac arrest. As expected, patients with cardiogenic shock had a higher 30 day mortality (26.6% v. 2.1%, p<0.0001), but lower than reported in the SHOCK trial. Age >75 years was the most important predictor of mortality in patients with cardiogenic shock when adjusted for gender, hypertension and cardiac arrest.
Conclusions: Our results support the ACC/AHA recommendations for transfer of STEMI patients with cardiogenic shock to PCI centers. Although patients >75 years of age had the highest mortality, it was still significantly lower than expected from published trials.