Primary PCI in Patients Admitted with Cardiogenic Shock and STEMI: Outcome and Predictors of In-hospital Mortality

Abstract

<i>Background</i>: It is a well-known phenomenon that cardiogenic shock (CS) is a serious complication of acute myocardial infarction. The mortality rate is approximately 50% even with rapid revascularization, optimal medical care, and use of mechanical support. <i>Aim of the Work</i>: To investigate the outcome of primary percutaneous coronary intervention (PCI) in patients admitted with cardiogenic shock and ST-segment elevation myocardial infarction (STEMI) and the predictors of in-hospital mortality. <i>Patients and Methods</i>: This prospective, observational study was conducted in the national heart Institute, Alazhar University, and Military hospitals in the period from 6/2019 to 9/2021 on fifty six consecutive patients presenting to Alazhar University hospitals, National Heart Institute (NHI), Military hospitals. <i>Results</i>: The prevalence of dyslipidemia and diabetes mellitus were significantly higher among died patients than those who survived. The degree of LV impairment was significantly higher among patients who died than those who survived. As regard to PCI procedure characteristics, TIMI flow post PCI (<Grade III), multi-vessel disease, and procedural failure were significantly associated with high in-hospital mortality rate. Patients who received treatment with IABP were significantly older. <i>Conclusion</i>: Multi-vessel coronary artery disease, TIMI flow after PCI (grade III), and ↑ CK-MB (72-hour serial measurement), were all found to be significant predictors of in-hospital mortality. The onset from chest pain to ED arrival and the door-to-balloon time were higher than that reported in the previous studies. The use of IABP was not found to have a significant predictor effect on the different outcome among our patients with STEMI.