0337 : Predictors of early mortality in acute myocardial infarction complicated by cardiogenic shock

Abstract

The most serious complication during myocardial infarction (MI) is cardiogenic shock. It's the result of myocardial and/or mechanical failure complication. The aim of our study was to investigate the epidemiological and clinical characteristics of a serie of patients hospitalized for MI complicated by cardiogenic shock as well as the predictive factors of early mortality. It was a single-center retrospective study of 70 patients hospitalized in the service of cardiology of the military hospital for myocardial infarction complicated by cardiogenic shock, between 2005 and 2012. The mean age was 63±10 years, 80% were men. Cardiovascular risk factors were as follows: 89% were smokers, 62% presented diabetes mellitus, 50% had hypertension, 40% had dyslipidemia and 10% had a family history of coronary artery disease. 24% of patients had renal insuffisancy. 39% were admitted before the 6th hour from beginning of chest pain, 12% were admitted between the 6th and the 12th hour and 45% were admitted beyond the 12th hour. On admission 41% were in left ventricular failure, and 59% in shock. The majority of myocardial infarction (45%) were anteriors. Angiography had identified a single truncal achieved in 28% of cases, bi- vessel in 44% of cases and tri- truncal in 28% of cases. The trans-coronary angiolpasty (TCA) was primary in 27% of cases and of rescue in 73% of cases. Revascularization was complete in 37% of cases. The mean LVEF was 49±14.4%. The average of hospital stay was 7±8 days. Hospital mortality was 47%, occurring on average in the sixth day of hospitalization (6±9 days). We found that renal failure, late onset of shock, hyperglycemia, leukocytosis, use of vasopressors, and the anterior territory of MI were significantly predictive of hospital mortality. Despite advances in the treatment of myocardial infarction, particularly reperfusion techniques, and medical care in intensive care units, cardiogenic shock mortality in acute phase of myocardial infarction remains high. Renal failure, late onset of shock, hyperglycemia and the anterior territory of MI were the major predictive of hospital mortality. A multidisciplinary approach including medical actors and pre-hospital centers specialized in the treatment of this condition is actually necessary. The author hereby declares no conflict of interest