Elective coronary stent implantation in cardiogenic shock complicating acute myocardial infarction: In-hospital and six-month clinical and angiographic results

Effective treatment of patients with acute myocardial infarction and cardio genic shock depends on restoring persistent patency of the infarct-related artery, Coronary stenting, reducing abrupt or delayed closure related to di ssection and suboptimal result, may improve PTCA results in cardiogenic sho ck. Eighteen patients (14 males and 4 females, mean age 59 +/- 7 years), re ferred to catheterization laboratory for acute myocardial infarction and sh ock, had elective stent implantation during 14 primary and 4 rescue PTCA. T ime delay between shock onset and PTCA was 4.1 +/- 3 hr (range, 30 min to 1 2 hr). The IRA was LAD in seven patients (38%), LCx in two (11%), and RCA i n eight (45%). One patient (5.%) had distal LMCA occlusion. Stent deploymen t was successful in 100% of patients and resulted in TIMI 3 flow in 13 (72% ) patients. In 13 (72%) cases, cardiogenic shock gradually resolved and the patients were discharged alive. Five patients (28%) died because of irreve rsible hemodynamic deterioration without evidence of reinfarction. At 6-mon th follow-up, all the discharged patients were alive and no patient had rei nfarction or recurrent angina. Heart transplant was required in one patient 5 months after stenting because of refractory congestive heart failure, An giography demonstrated patency of all the coronary arteries treated, with T IMI 3 flow in all patients. Stent restenosis rate was 30%, and target lesio n revascularization with CABG or re-PTCA was not required in any case, LV f unction improved from 39% +/- 15% to 51% +/- 15% (P < 0.01). Elective coron ary stenting is an effective treatment for acute myocardial infarction comp licated by cardiogenic shock and may improve acute and long-term survival. Cathet Cardiovasc. Intervent 50:384-389, 2000. (C) 2000 Wiley-Liss, Inc.