Vijay Kunadian1, Weiliang Qiu2, Peter Ludman3, Simon Redwood4, Nick Curzen5, Rodney Stables6, Julian Gunn7, Anthony Gershlick8. 1. Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, United Kingdom; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals, National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom. Electronic address: vijay.kunadian@newcastle.ac.uk. 2. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts. 3. Queen Elizabeth Hospital, Birmingham, United Kingdom. 4. Cardiothoracic Centre, St. Thomas' Hospital, Westminster Bridge Road, London, United Kingdom. 5. University Hospital Southampton, National Health Service Foundation Trust, University of Southampton, Southampton, United Kingdom; Faculty of Medicine, University of Southampton, Southampton, United Kingdom. 6. Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom. 7. Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom. 8. National Institute for Health Research, Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester Trust, Leicester Department of Cardiology, University Hospitals of Leicester, Glenfield Hospital, Leicester, United Kingdom.
Abstract
OBJECTIVES: This study sought to determine mortality rates among cardiogenic shock (CGS) patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome in the contemporary treatment era and to determine predictors of mortality. BACKGROUND: It is unclear whether recent advances in pharmacological and interventional strategies have resulted in further improvements in short- and long-term mortality and which factors are associated with adverse outcomes in patients presenting with CGS and undergoing PCI in the setting of acute coronary syndrome. METHODS: This study analyzed prospectively collected data for patients undergoing PCI in the setting of CGS as recorded in the BCIS (British Cardiovascular Intervention Society) PCI database. RESULTS: In England and Wales, 6,489 patients underwent PCI for acute coronary syndrome in the setting of CGS. The mortality rates at 30 days, 90 days, and 1 year were 37.3%, 40.0%, and 44.3%, respectively. On multiple logistic regression analysis, age (for each 10-year increment of age: odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.51 to 1.68; p < 0.0001), diabetes mellitus (OR: 1.47, 95% CI: 1.28 to 1.70; p < 0.0001), history of renal disease (OR: 2.03, 95% CI: 1.63 to 2.53; p < 0.0001), need for artificial mechanical ventilation (OR: 2.56, 95% CI: 2.23 to 2.94; p < 0.0001), intra-aortic balloon pump use (OR: 1.57, 95% CI: 1.40 to 1.76; p < 0.0001), and need for left main stem PCI (OR: 1.90, 95% CI: 1.62 to 2.23; p < 0.0001) were associated with higher mortality at 1 year. CONCLUSIONS: In this large U.K. cohort of patients undergoing PCI in the context of CGS, mortality remains high in spite of the use of contemporary PCI strategies. The highest mortality occurs early, and this time period may be a particular target of therapeutic intervention.
OBJECTIVES: This study sought to determine mortality rates among cardiogenic shock (CGS) patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome in the contemporary treatment era and to determine predictors of mortality. BACKGROUND: It is unclear whether recent advances in pharmacological and interventional strategies have resulted in further improvements in short- and long-term mortality and which factors are associated with adverse outcomes in patients presenting with CGS and undergoing PCI in the setting of acute coronary syndrome. METHODS: This study analyzed prospectively collected data for patients undergoing PCI in the setting of CGS as recorded in the BCIS (British Cardiovascular Intervention Society) PCI database. RESULTS: In England and Wales, 6,489 patients underwent PCI for acute coronary syndrome in the setting of CGS. The mortality rates at 30 days, 90 days, and 1 year were 37.3%, 40.0%, and 44.3%, respectively. On multiple logistic regression analysis, age (for each 10-year increment of age: odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.51 to 1.68; p < 0.0001), diabetes mellitus (OR: 1.47, 95% CI: 1.28 to 1.70; p < 0.0001), history of renal disease (OR: 2.03, 95% CI: 1.63 to 2.53; p < 0.0001), need for artificial mechanical ventilation (OR: 2.56, 95% CI: 2.23 to 2.94; p < 0.0001), intra-aortic balloon pump use (OR: 1.57, 95% CI: 1.40 to 1.76; p < 0.0001), and need for left main stem PCI (OR: 1.90, 95% CI: 1.62 to 2.23; p < 0.0001) were associated with higher mortality at 1 year. CONCLUSIONS: In this large U.K. cohort of patients undergoing PCI in the context of CGS, mortality remains high in spite of the use of contemporary PCI strategies. The highest mortality occurs early, and this time period may be a particular target of therapeutic intervention.
Authors: Alexander G Truesdell; Behnam Tehrani; Ramesh Singh; Shashank Desai; Patricia Saulino; Scott Barnett; Stephen Lavanier; Charles Murphy Journal: Interv Cardiol Date: 2018-05
Authors: Wayne Batchelor; David E Kandzari; Scott Davis; Luis Tami; John C Wang; Islam Othman; Osvaldo S Gigliotti; Amir Haghighat; Sarabjeet Singh; Mario Lopez; Gregory Giugliano; Phillip A Horwitz; Jaya Chandrasekhar; Paul Underwood; Craig A Thompson; Roxana Mehran Journal: JAMA Cardiol Date: 2017-12-01 Impact factor: 14.676
Authors: Georg Fuernau; Karl Fengler; Steffen Desch; Ingo Eitel; Franz-Josef Neumann; Hans-Georg Olbrich; Antoinette de Waha; Suzanne de Waha; Gert Richardt; Marcus Hennersdorf; Klaus Empen; Rainer Hambrecht; Christian Jung; Michael Böhm; Janine Pöss; Ruth H Strasser; Steffen Schneider; Taoufik Ouarrak; Gerhard Schuler; Karl Werdan; Uwe Zeymer; Holger Thiele Journal: Clin Res Cardiol Date: 2016-07-04 Impact factor: 5.460