The Journal of invasive cardiology · 2026
Hospital outcomes of patients with acute myocardial infarction-related cardiogenic shock with and without revascularization.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Heer Tobias, Hochadel Matthias, Kerber Sebastian, Lauer Bernward, Zahn Ralf, Zeymer Uwe
Аннотация
OBJECTIVES: An early invasive strategy is recommended for patients with acute myocardial infarction-related cardiogenic shock (AMICS). However, data on outcomes of patients undergoing early coronary angiography (CA) without subsequent percutaneous coronary intervention (PCI) are limited. The authors examined the characteristics and outcomes of patients with AMICS who underwent early CA and were treated with or without acute PCI.
METHODS: The authors analyzed data from the prospective Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK) CA registry. Patient characteristics, indications for CA, treatments, and in-hospital outcomes were collected and analyzed. All patients who underwent CA for AMICS were included.
RESULTS: Between January 2009 and December 2020, 4290 patients with AMICS underwent CA within 24 hours after symptom onset. Patients referred to urgent coronary artery bypass grafting (CABG) were excluded. Among the remaining 4075 patients, 3249 (79.7%) underwent acute PCI, 428 (10.5%) had significant coronary artery disease (CAD) but were not treated with PCI, and 398 (9.8%) had no significant CAD. Patients who did not undergo PCI were older and more likely to have a history of prior PCI or CABG. The in-hospital mortality rate was 47.2% among patients without PCI, 41.9% among those treated with PCI, and 36.5% among those without significant CAD.
CONCLUSIONS: In this large, contemporary CA registry, approximately 10% of AMICS patients had significant CAD but did not undergo acute PCI; this subgroup exhibited high in-hospital mortality. Another 10% of patients had no significant CAD, with one-third dying during hospitalization. Further studies are needed to identify strategies to improve outcomes in these populations.
METHODS: The authors analyzed data from the prospective Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK) CA registry. Patient characteristics, indications for CA, treatments, and in-hospital outcomes were collected and analyzed. All patients who underwent CA for AMICS were included.
RESULTS: Between January 2009 and December 2020, 4290 patients with AMICS underwent CA within 24 hours after symptom onset. Patients referred to urgent coronary artery bypass grafting (CABG) were excluded. Among the remaining 4075 patients, 3249 (79.7%) underwent acute PCI, 428 (10.5%) had significant coronary artery disease (CAD) but were not treated with PCI, and 398 (9.8%) had no significant CAD. Patients who did not undergo PCI were older and more likely to have a history of prior PCI or CABG. The in-hospital mortality rate was 47.2% among patients without PCI, 41.9% among those treated with PCI, and 36.5% among those without significant CAD.
CONCLUSIONS: In this large, contemporary CA registry, approximately 10% of AMICS patients had significant CAD but did not undergo acute PCI; this subgroup exhibited high in-hospital mortality. Another 10% of patients had no significant CAD, with one-third dying during hospitalization. Further studies are needed to identify strategies to improve outcomes in these populations.