739-1 Multivessel Supported Coronary Angioplasty in Cardiogenic Shock

Abstract

Coronary Angioplasty (CA) of the only infarct-related vessel (IRV) in pts with multivessel (MV) Coronary Artery Disease (CAD) and Cardiogenic Shock (CS) has been associated with a poor prognosis. No report exists on multivessel CA in the setting of acute myocardial infarction (MI) with C.S. Eleven consecutive pts (ages 41–77 yrs) with MVCAD and acute MI (anterior in 9: inferior in 2) had percutaneous cardiopulmonary bypass support (PCPS) instituted 30–240 minutes after the onset of C.S. Eight had prior MI, 4 were on balloon pump and 4 had recent cardiac arrest. Ejection fraction (EF) ranged from 11–40% (mean 24.7 ± 3%) and TIMI flow was diminished to grade I or II in 12 of 17 non IRVs. A mean flow rate of 4.0 L/min was achieved with mean BP 6885 mmHg on PCPS prior to CA, which was attempted in 28 vessels (2.5 per ptl with angiographic success in 27 of 28 vessels. All IRV were successfully dilated. Total bypass time ranged from 41–360 min (mean 138 ± 72 min). Four pts died post CA: 2 due to acute closure of IRV, 1 due to CVA and 1 due to sepsis. All 7 survivors are alive at a mean follow-up of 24 ± 6 months, with EF increased to mean 38 ± 5% (p < 0.05). Five pts are functional class I and have required no interventions. Two other pts have required repeat interventions for restenosis. PCPS can stabilize pts in CS and facilitate MVCA which may result in improved survival.