Long-term predictive factors of major adverse cardiac events in patients with acute myocardial infarction complicated by cardiogenic shock

Bae, Eun Hui; Lim, Sang Yup; Jeong, Myung Ho; Park, Hyung Wook; Lim, Ji Hyun; Park, Ok Young; Kim, Han Gyun; Hong, Young Joon; Kim, Weon; Kim, Ju Han; Ahn, Young Keun; Cho, Jeong Gwan; Park, Jong Chun; Suh, Soon Pal; Ahn, Byoung Hee; Kim, Sang Hyung; Kang, Jung Chaee

Abstract

BACKGROUND: Cardiogenic shock (CS) after acute myocardial infarction (AMI) is developed in 5~10% of patients and associated with high mortality. The aim of this study is to assess the predictive factors of major adverse cardiac events (MACE) in patients with AMI and CS.
METHODS
Two hundred fifty five AMI patients with CS (66.0 +/- 11.0 years, M:F=156:99) out of 1,268 AMI patients, who admitted at Chonnam National University Hospital between July 2000 and June 2002, were analyzed according to clinical characteristics, coronary angiographic findings and MACE during admission and 1-year clinical follow-up.
RESULTS
Among the enrolled patients, 129 patients survived without MACE (Group I, 64.2 +/- 10.6 years, M:F=76:53) and 126 patients had MACE (Group II, 68.1 +/- 10.0 years, M:F=80:46) during admission and 1-year follow-up period. There were significant differences in age (64.2 +/- 10.6 vs. 68.1 +/- 11.0 years, p=0.004) and previous MI history (0 vs. 17.4%, p<0.001). Left ventricular ejection fraction (EF) was lower in Group II (Group I vs. II: 49.1 +/- 13.0 vs. 39.1 +/- 12.9%, p<0.001). The levels of troponin (Tn) I and C-reactive protein (CRP) were higher in Group II (Group I vs. II: 29.2 +/- 7.72 vs. 50.8 +/- 5.17 ng/dL, p=0.017, 3.8 +/- 0.48 vs. 9.9 +/- 1.21 mg/dL, p<0.001 respectively). Left main stem lesion (LMSL) was more common in Group II than in Group I (0.7% vs. 22.0%, p=0.004). In-hospital death was associated with low Thrombolysis In Myocardial Infarction (TIMI) flow after coronary revascularization.
CONCLUSION
Old age, previous MI history, high Tn and CRP, low EF and LMSL are associated with higher MACE in patients with AMI and CS. Coronary revascularization with TIMI 3 flow lowers in-hospital mortality.