Abstract 74: Prognostic markers in Myocardial Infarction complicated by Cardiogenic Shock
Objectives. Despite aggressive therapy (including PCI and IABP use), survival following acute myocardial infarction complicated by cardiogenic shock (MI-CS) is poor. Early identification of survivors from non-survivors enables better, patient tailored therapy. We hypothesised that APACHE II scoring and other common markers may provide prognostic information in patients receiving contemporary, PCI based therapy for MI-CS.
Methods. We conducted the IABP-shock-trial (a monocentric, prospective, randomized, controlled, IABP intervention trial) and analysed potential prognostic markers amongst the whole study population. Forty consecutive patients with acute MI-CS were enrolled and APACHE II scores, Cardiac index (CI), BNP and IL-6 levels were measured at enrolment and daily for 4 days before correlation with subsequent 28 day mortality.
Results. The mean age was 64±1.9 years, 52% were mechanically ventilated, the mean ejection fraction was 27±2.1% and overall 28 day survival was 67%. The initial (on admission to hospital) and serial (over the 4 days) APACHE II scores successfully discriminated between survivors and non-survivors (initial APACHE II scores, 18.1±1.66 and 29.9±2.88, respectively, p<0.05). Following receiver operating curve (ROC) analysis, APACHE II scores were most predictive of survival followed (in order of predictive value) by CI, IL-6 and BNP (Table 1⇓). Values for APACHE II scores and cardiac index were significantly predictive of survival.
Conclusions. We conclude that both initial and serial APACHE II scores provide reliable prognostic information for MI-CS patients treated with contemporary, PCI centred therapy. Cardiac index was also of some predictive value. However, in contrast to previous data (applicable mainly to chronic heart failure patients), serial BNP values were not predictive of mortality in this cohort of patients.