Blood lactate is a predictor of short-term mortality in patients with myocardial infarction complicated by heart failure but without cardiogenic shock

Background: Early revascularisation of the culprit lesion is the therapeutic cornerstone in cardiogenic shock complicating acute myocardial infarction. The optimal management of additional non-culprit lesions is unclear. This systematic review and meta-analysis aims to summarise current evidence on the comparison of immediate multivessel percutaneous coronary intervention (MV-PCI) or culprit lesion only PCI with possible staged revascularisation (C-PCI) in patients with cardiogenic shock complicating acute myocardial infarction. Methods: Medical literature databases were screened to identify analyses comparing MV-PCI with C-PCI in patients with cardiogenic shock complicating acute myocardial infarction and multivessel coronary artery disease. In absence of randomised trials, 10 cohort studies were included in the current meta-analysis. The primary outcome of short-term mortality was assessed at hospital discharge or 30 days after hospital admission. Secondary outcomes were long-term mortality as well as myocardial re-infarction, stroke, acute renal failure, and bleeding at short-term follow-up. Results: Of 6051 patients, 1194 (19.7%) received MV-PCI and 4857 (80.3%) C-PCI. Short-term mortality was 37.5% in patients undergoing MV-PCI compared with 28.8% in C-PCI patients (risk ratio 1.26, 95% confidence interval 1.12–1.41, p=0.001). Long-term mortality ( p=0.77), myocardial re-infarction ( p=0.77), stroke ( p=0.12), acute renal failure ( p=0.17) and bleeding ( p=0.53) did not differ significantly between the two revascularisation groups. Conclusions: Results of this first meta-analysis on the interventional management of patients with cardiogenic shock complicating acute myocardial infarction and multivessel coronary artery disease do not support MV-PCI over C-PCI. However, possible treatment selection bias in the individual studies must be taken into account.

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Prognosis of Patients With Cardiogenic Shock Following Acute Myocardial Infarction: The Difference Between ST-Segment Elevation Myocardial Infarction And Non-ST-Segment Elevation Myocardial Infarction

10.21203/rs.3.rs-841985/v1 ◽

2021 ◽

Author(s):

Ming-Lung Tsai ◽

Ming-Jer Hsieh ◽

Chun-Chi Chen ◽

Victor Chien-Chia Wu ◽

Wen-Ching Lan ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiogenic Shock ◽

Short Term ◽

Bleeding Rate ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Short Term Mortality

Abstract Background: Acute myocardial infarction (AMI) complicated with cardiogenic shock has high mortality and is a challenging topic even in the revascularization era. We conducted this study to understand patients’ outcomes.Method: We retrospectively analyzed electronic medical records data from 1,175 patients with AMI complicated with cardiogenic shock developed within 3 days of admission to a multicenter medical care system between January 1, 2000, and July 31, 2018. AMI patients were classified into ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) group. The short-term and 1-year mortality and adverse event after the index admission were analyzed via logistic regression and Cox proportional hazards model. Results: Comparing to NSTEMI, patients with STEMI tended to be younger (65.68 ± 14.05 vs. 70.70 ± 12.99, p < .001), men (73.29 vs. 60.87, p < .001), and have fewer underlying chronic diseases. Short-term mortality at index hospitalization was 14.83% in the STEMI group and 21.30% in the NSTEMI group; long-term mortality was 17.06% for the STEMI group and 24.13% for the NSTEMI group. No difference was observed between the 2 groups for patients who developed a cerebral vascular accident (CVA) during the admission period; however, the major bleeding rate and gastrointestinal bleeding rate were higher in the STEMI group (2.66 vs. 0.22, p = .014; 3.36 vs. 0.22, p = .007, respectively). Conclusion: In patients with AMI with cardiogenic shock, NSTEMI was associated with a significantly higher mortality rate in both the short-and long-term results. Age and respiratory failure were the most significant risk factors for short-term mortality. Revascularization may be beneficial for the short-term outcome but did not reach significance in multivariable analysis.

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