Abstract 919: Clinical Significance of Post-Procedural Thrombolysis in Myocardial Infarction Flow in Patients with Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention
The clinical implications and correlate of postprocedural TIMI flow in the infarct-related artery [IRA] in STEMI patients with cardiogenic shock undergoing primary PCI have not been elucidated. We evaluated STEMI patients with cardiogenic shock undergoing primary PCI (n=4731) at 567 hospitals in the ACC-NCDR Cath/PCI registry. Clinical correlate of post-PCI TIMI 0–2 flow and hospital outcomes were assessed using logistic regression. Post PCI TIMI flow 0–2 in the IRA occurred in 14.7% patients. Compared with patients with normal flow, those with TIMI 0–2 flow were more likely to undergo CABG after PCI (20.0% vs. 5.4%), and develop renal failure (10.1% vs. 5.1%), cardiac tamponade (1.0% vs. 0.5%), and bleeding needing transfusion (35.2% vs. 21.6%), Mortality was >2-fold higher with TIMI 0–2 flow vs. TIMI 3 flow (63.0% vs. 27.0%) and there was a graded relationship with worse flow and mortality (adjusted OR TIMI 0/1 flow 5.5 [95% CI 4.1–7.2]; TIMI 2 flow 2.6 [95% CI 2.0–3.4] vs. TIMI 3 flow). Pre-PCI TIMI 0 flow in the IRA, left main, left anterior descending or saphenous vein graft as culprit vessel; longer symptom onset to balloon time; multivessel coronary artery disease, lack of smoking, lack of dyslipidemia, and older age were associated with a higher TIMI 0–2 flow (c-index 0.67). Lack of procedural success (post-PCI TIMI 0–2 flow in the IRA) after primary PCI in patients with cardiogenic shock is associated with a much higher risk of mortality compared with post-PCI TIMI 3 flow. This suggests that interventions designed to improve flow in the IRA may have a significant impact on the high mortality rates among STEMI patients with cardiogenic shock.