Prognostic impact of angiographic findings, procedural success, and timing of percutaneous coronary intervention in cardiogenic shock
Sabell, Tuija (Helsinki University Hospital (Finlàndia))
Banaszewski, Marek (Institute of Cardiology)
Lassus, Johan (Helsinki University Hospital (Finlàndia))
Nieminen, Markku S. (Helsinki University Hospital (Finlàndia))
Tolppanen, Heli (Helsinki University Hospital (Finlàndia))
Jäntti, Toni (Helsinki University Hospital (Finlàndia))
Kataja, Anu (Helsinki University Hospital (Finlàndia))
Hongisto, Mari (Helsinki University Hospital (Finlàndia))
Køber, Lars (University of Copenhagen)
Sionis, Alessandro (Institut d'Investigació Biomèdica Sant Pau)
Parissis, John (University General Hospital Attikon (Haidari, Grècia))
Tarvasmäki, Tuukka (Helsinki University Hospital (Finlàndia))
Harjola, Veli-Pekka (Helsinki University Hospital (Finlàndia))
Jurkko, Raija (Helsinki University Hospital (Finlàndia))
Universitat Autònoma de Barcelona

Data:	2020
Resum:	Urgent revascularization is the mainstay of treatment in acute coronary syndrome (ACS) related cardiogenic shock (CS). The aim was to investigate the association of angiographic results with 90-day mortality. Procedural complications of percutaneous coronary intervention (PCI) were also examined. This CardShock (NCT01374867) substudy included 158 patients with ACS aetiology and data on coronary angiography and complications during PCI procedure. Survival analysis was conducted with Kaplan-Meier curves and Cox regression analysis. Median age was 67 ± 11 years, and 77% were men. During 90-day follow-up, 66 (42%) patients died. Patients with one-vessel disease (n = 49) had lower mortality than patients with two-vessel (n = 59) or three-vessel (n = 50) disease (25% vs. 48% vs. 52%, P = 0. 011). Successful revascularization [Thrombolysis in Myocardial Infarction (TIMI) Flow 3 post-PCI) was achieved more often in survivors than non-survivors (81% vs. 60%, P = 0. 019). The median symptom-to-balloon time was 340 (196-660) minutes, with no difference between survivors and non-survivors. In multivariable mortality analysis, multivessel disease (HR 2. 59, CI 1. 29-5. 18) and TIMI flow <3 post-PCI (HR 2. 41, CI 1. 4-4. 15) were associated with 90-day mortality. Procedural PCI complications were recorded in 51 (35%) patients, arrhythmic complications being the most common (n = 32, 63%). The incidence of complications was similar between survivors and non-survivors (31% vs. 42%, P = 0. 21). Multivessel disease is associated with worse survival in ACS-related CS. In patients undergoing PCI, arrhythmic complications were common, but not associated with excess mortality. Successful revascularization of the IRA had positive effect on outcome despite delay from symptom onset.
Nota:	Altres ajuts: This study was supported by grants from the Finnish Foundation for Cardiovascular Research, and Aarne Koskelo Foundation, Helsinki, Finland. Roche Diagnostics provided kits for the analysis of NT-proBNP and TnT. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Tuija Sabell (néeJavanainen) received following personal research grants: Acute Coronary Syndromes and secondary prevention grant from the Finnish Cardiac Society, grant supported by Astra Zeneca and grants from Paavo Nurmi Foundation and Paavo Ilmari Ahvenaisen säätiö. Dr Lassus has served on an advisory board for Boehringer Ingelheim, Medix Biochemica, Novartis, Servier, and Vifor Pharma and received lecture fees from Bayer, Boehringer Ingelheim, Pfizer, Novartis, Orion Pharma, and Vifor Pharma. Dr Parissis has received honoraria from Novartis and Orion Pharma.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Cardiogenic shock ; Acute coronary syndrome ; Percutaneous coronary intervention
Publicat a:	ESC Heart Failure, Vol. 7 (march 2020) , p. 768-773, ISSN 2055-5822

DOI: 10.1002/ehf2.12637
PMID: 32163675

6 p, 288.0 KB

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