Mechanical ventilation in the early phase of ST elevation myocardial infarction treated with mechanical revascularization.

BACKGROUND: So far, few data have been available on the incidence and outcome of patients with acute myocardial infarction (MI) requiring mechanical ventilation (MV). The aim of the study was to assess the clinical and prognostic impact of MV at short and long term in 106 patients with ST elevation MI (STEMI) requiring mechanical ventilation.
RESULTS: The incidence of mechanical ventilation was 7.6%. Reasons for intubation were as follows: cardiogenic shock in 64 (60.4%) patients, ventricular fibrillation in 32 (30.1%) patients and acute pulmonary edema in 10 (9.5%) patients. Patients submitted to MV were older (p = 0.016), more frequently had a previous percutaneous coronary intervention (PCI;p = 0.014) and a previous MI (p = 0.001). A higher in-Intensive Cardiac Care Unit death was observed in MV patients (44.3% vs. 1.5%, p < 0.001), as well as a higher mortality at follow-up (36.7% vs. 14.8%, p < 0.001). MV was associated with higher mortality rates both at short and long term.
CONCLUSIONS: In a large series of consecutive STEMI patients submitted to MV, the need of MV is a strong prognostic indicator of mortality both at short and long term. Among mechanically ventilated STEMI patients infarct size (as inferred by TnI values) and PCI failure were independent predictors of early death, while the duration of MV was related to death at longterm.