Elective primary angioplasty in cardiogenic shock: Results from a single center

Introduction. Cardiogenic shock is the leading cause of death among patient s hospitalized for acute myocardial infarction. Conventional treatment for acute myocardial infarction does not achieve a better outcome in these pati ents, but prior studies with emergency revascularization by coronary angiop lasty seem to provide encouraging results. Patients and method. A retrospective study of the clinical and angiographic results of elective primary angioplasty in 48 patients with cardiogenic sh ock complicating acute myocardial infarction of less than 12 hours is descr ibed. Intraaortic balloon counterpulsation was used in 79% of the patients. Patients with cardiogenic shock secondary to mechanical complications were excluded. Results. Angiographic success, defined as a residual stenosis <50% and fina l TIMI flow <greater than or equal to>2, was achieved in 85% of the culprit lesions, and stents; were implanted in 76%. Multivessel angioplasty was pe rformed in 25% of the patients, and abciximab was used in 35% of the cases. Mean time from the onset of symptoms to angioplasty was 7.4 +/- 3.1 hours. In-hospital survival was 58%, and was 54% at six months follow-up. Conclusions. Emergency coronary revascularization with primary angioplasty and intracoronary stenting is effective in patients with acute myocardial i nfarction and cardiogenic shock. TIMI flow greater than or equal to2 is ach ieved in most patients, and mortality is reduced when compared with conserv ative treatment in historical series.