Long-term Follow-up Of The Patients With Acute Myocardial Infarction Complicated By Cardiogenic Shock

Objective: To study the risk factors of the in-hospital mortality rates and long-term prognosis for the patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).Methods: 108 hospitalized patients with AMI complicated by CS in cardiovascular wards of the first affiliated hospital of Soochow University from Jan. 2000 to Dec. 2007 were selected, and then divided into 2 subgroups: death group (n=56), and survival group (n=52). The mean age was 71.9±8.9 years old, including 76 males and 32 females. Analyze the risk factors of in-hospital mortality rates for the patients with AMI complicated by CS by using binary logistic regression analysis, while comparing the clinical characteristics and angiographic findings of the 2 subgroups. Follow up the patients in the survival group, and draw the survival curve by using Kaplan-Meier method. Cox proportional hazards regression modeling was used for multivariable modeling of risk factors for the long-term prognosis.Results:1. Significant differences were found between the death group and the survival group in age (74.5±9.68, 69.0±6.97, respectively, p=0.001), sex composition (Male/female: 32:24, 44:8, respectively, p=0.003), essential hypertension history (80.4%, 57.7%, respectively, p=0.013), diabetes mellitus history (32.1%, 13.5%, respectively, p=0.018), time from chest pain onset to admission (22.4±37.2h, 5.4±4.0h, respectively, p=0.001), anterior wall infarction (57.1%, 38.5%, respectively, p=0.04), heart rate (91.1±23.3bpm, 80.4±30.3bpm, respectively, p=0.044), mean artery blood pressure (64.6±9.7mmHg, 69.9±11.4mmHg, respectively, p=0.002), serum glucose concentrations (9.53±4.12mmol/L, 7.28±3.05mmol/ L, respectively, p=0.002), left ventricular ejection fraction (0.32±0.13, 0.36±0.12, respectively, p=0.001), CK-MB peak concentration (403.6±314.7U/L,162.2±113.1U/L, respectively, p=0.012).2. In total 45 patients who underwent percutaneous coronary intervention (PCI) for whom the infarction related artery (IRA) was identified, this was most often the left anterior descending coronary artery (20 patients, 44.4%), followed by the circumflex artery (11 patients, 14.4%), the right coronary artery (10 patients, 22.2%), and the left main artery (4 patients, 9.0%). The majority (35 patients, 77.8%) of patients underwent PCI had multivessel disease. 37 patients had a Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow after PCI, 4 patients had a TIMI grade 2 flow, and 4 patients had a TIMI grade 0-1 flow. There were significant differences between the death group and the survival group in time from sydrome onset to PCI, left main coronary artery,the number of diseased arteries, three vessel disease,and TIMI grade after PCI.3. By using binary logistic regression analysis, it was shown that ages, diabetes mellitus history, time from chest pain onset to PCI, 3 diseased arteries, and TIMI grade after PCI were correlated with the in-hospital mortality rates of the patients with AMI complicated by CS.4. Of total 52 patients in the survival group, the mean survival time was 29.0±2.7 months, and the median survival time was 28.0±4.8 months. 80.8% patients survived after 6 months follow-up, and 73.1% after 1 year follow-up. It was shown in Cox proportional hazards regression modeling that ages, time from chest pain onset to admission, and TIMI grade after PCI were correlated with the long-term prognosis of the patients in the survival group.Conclusions:1. The in-hospital mortality rate of patients with AMI complicated by CS was 51.9%, and the risk factors included ages, diabetes mellitus history, time from sydrome onset to PCI, 3 diseased arteries, and TIMI grade after PCI.2. Early PCI treatment had benefits for prolonging the survival time of the patients with AMI complicated by CS. The risk factors of long-term prognosis for the patients with AMI complicated by CS included ages, time from sydrome onset to PCI, and TIMI grade after PCI.