Efficacy of invasive strategy for the management of acute myocardial infarction complicated by cardiogenic shock

This retrospective study evaluates the influence of an invasive strategy of urgent coronary revascularization on the in-hospital mortality of patients with acute myocardial infarction (AMI) complicated early by cardiogenic sh ock. Among 1,981 patients with AMI admitted to our institution from 1994 to 1997, 162 patients (8.2%) developed cardiogenic shock unrelated to mechani cal complications. The strategy of management was considered invasive if an urgent coronary angiography was indicated within 24 hours of symptom onset . Every other strategy was considered conservative. Fifty-seven patients wh o developed the shock late or after a revascularization procedure, or who d ied on admission, were excluded. The strategy was invasive in 73 patients ( 70%). Five of them died before angiography could be performed and 65 underw ent angioplasty (success rate 72%). By univariate analysis the invasive str ategy was associated with a lower mortality than conservative strategy (71% vs 91%, p = 0.03), but this association disappeared after adjustment for b aseline characteristics. Older age, nonsmoking, and previous ischemic heart disease were independent predictors of mortality. In conclusion, we have f ailed to demonstrate that a strategy of urgent coronary revascularization w ithin 24 hours of symptom onset for patients with AMI complicated by cardio genic shock is independently associated with a lower in-hospital mortality. This strategy was limited by the high mortality within 1 hour of admission in patients with cardiogenic shock, the modest success rate of angioplasty in this setting, and the powerful influence of some adverse baseline chara cteristics on prognosis. (C) 1999 by Excerpta Medico, Inc.