EARLY REVASCULARIZATION IMPROVES SURVIVAL IN CARDIOGENIC-SHOCK COMPLICATING ACUTE MYOCARDIAL-INFARCTION

The effects of coronary revascularization by percutaneous transluminal coronary angioplasty or coronary bypass grafting, or both, on surviva l were evaluated in 81 patients with cardiogenic shock complicating ac ute myocardial infarction. Thirty-two patients had successful revascul arization and 49 patients had unsuccessful or no revascularization. Re vascularization was achieved by coronary angioplasty in 22 patients, c oronary bypass surgery in 2 and angioplasty followed by bypass surgery in 8. No significant differences were noted between the two groups wi th regard to baseline clinical or hemodynamic variables. Intraaortic b alloon counterpulsation was employed in 27 (84%) of the 32 patients in the group with revascularization and in 19 (39%) of the 49 patients w ithout revascularization (p = 0.0006). The in-hospital survival was si gnificantly better in the patients with-18 (56%) of 32-than in the pat ients without revascularization-4 (8%) of 49 (p < 0.0001). At a mean f ollow-up period of 21 +/- 15 months, this survival difference persiste d-16 (50%) of 32 patients with revascularization survived versus 1 (2% ) of 49 patients without revascularization (p < 0.0001). The mean time from the onset of shock to revascularization differed significantly b etween survivors (12.4 +/- 15 h) and nonsurvivors (58.5 +/- 93 h) in t he group with revascularization (p = 0.0004). In the revascularization group, the in-hospital survival rate was 77% (17 of 22) when revascul arization was performed within 24 h but only 10% (1 of 10) when it was performed after 24 h (p = 0.0006). These data suggest that the combin ation of successful coronary revascularization and intraaortic balloon pumping is associated with improved survival in patients with cardiog enic shock complicating acute myocardial infarction. This improvement in survival is most evident if revascularization is performed early, p articularly within 24 h of the onset of cardiogenic shock.