Risk, Management, and Outcomes in PCI-Treated Acute Coronary Syndrome With Cardiogenic Shock.

BACKGROUND

Acute coronary syndrome complicated by cardiogenic shock (ACS-CS) remains associated with high mortality despite advances in percutaneous coronary intervention (PCI) and increasing attention to mechanical circulatory support (MCS).

OBJECTIVES

This study aimed to evaluate temporal trends in patient risk profiles, treatment strategies, and in-hospital outcomes among patients undergoing PCI for ACS-CS.

METHODS

From 2009 to 2019, 24,527 consecutive PCI procedures were recorded in the Keio Interhospital Cardiovascular Studies-PCI registry, including 870 cases (3.5%) with ACS-CS. Patients were categorized into 4 time periods (T1: 2009-2011; T2: 2012-2013; T3: 2014-2016; T4: 2017-2019). Temporal changes in risk profiles were evaluated using National Cardiovascular Data Registry Catheterization PCI mortality and bleeding risk scores. Trends in MCS use, in-hospital mortality, and post-PCI complications were analyzed.

RESULTS

Predicted in-hospital mortality and bleeding risk remained stable over time, at approximately 20% (P for trend = 0.053) and 40% (P for trend = 0.39), respectively. Overall MCS use declined from 66.5% in T1 to 56.7% in T4, primarily due to reduced intra-aortic balloon pump use (46.5% to 31.2%). Despite these changes in management, crude and National Cardiovascular Data Registry risk-adjusted in-hospital mortality remained persistently high at approximately 30% throughout the study period.

CONCLUSIONS

Among patients with ACS-CS selected for PCI in a multicenter Japanese registry, management strategies changed substantially over the past decade, particularly regarding MCS utilization. However, no significant temporal improvement in in-hospital mortality was observed, underscoring the persistent clinical challenges of this high-risk PCI-treated population.