Abstract 15563: Prognostic Impact of Postprocedual TIMI Flow Grade in STEMI Patients With Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention - Analysis From JCS Shock Registry

Abstract

Background: ST-segment elevation myocardial infarction (STEMI) complicated with cardiogenic shock, Killip class 4, is a severe condition with high mortality, for which primary percutaneous coronary intervention (PPCI) is recommended. Cardiogenic shock is a predictor for slow flow/no reflow (TIMI ≤2) during PPCI. Methods and Results: The Japanese Circulation Society Cardiovascular Shock registry (JCS Shock registry) was a prospective, observational, multi-center, cohort study. Between May, 2012 and June, 2014, a total of 980 patients with cardiovascular shock were enrolled from 82 centers in Japan. We assessed the prognostic impact of postprocedual TIMI flow grade in 341 patients who underwent primary PCI (PPCI) among 408 STEMI patients. Ninety percent of PPCI were performed within 120 min of arrival, in which thrombus aspiration (TA), stenting, and distal protection (DP) were applied in 228 (67%), 303 (89%), and 29 (9%) patients, respectively. Postprocedual TIMI grade 3 flow was achieved in 283 (83%) patients, whereas TIMI ≤2 in 58 (17%) patients. Thirty-day mortality in subgroups with TIMI 3, TIMI ≤2, and No PPCI (n=66) was 24.0%, 48.3% and 48.5%, respectively (P<0.01 by Chi-square, Fig. A), which suggest the importance of TIMI 3 achievement in PPCI. We compared the rate of postprocedual TIMI 3 in different PCI strategies; (1) TA and stenting without DP (TIMI 3 achievement 84%, n=179), (2) stenting without TA or DP (83%, n=96), (3) TA and stenting with DP (93%, n=27), (4) TA alone (71%, n=21), and (5) None of 3 devices (67%, n=16), suggesting the therapeutic effects of the devices (Fig. B). Conclusions: In the JCS Shock registry that observed contemporary emergency cardiovascular care in Japan, 30-day mortality of STEMI complicated with cardiogenic shock was 24% in patients underwent PPCI and resulted in TIMI grade 3 flow in the culprit arteries. The use of TA, stent, and DP in PPCI are associated with the better chances of postprocedual TIMI grade 3 flow.