Outcome of Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients Presenting with Cardiogenic Shock

Abstract

Introduction: Cardiogenic shock is the leading cause of death in patients hospitalized for acute myocardial infarction (MI). Cardiogenic shock can occur in both ST elevated MI (STEMI) and non-ST elevated MI (NSTEMI). In these patients primary percutaneous coronary intervention (PCI) has better outcome and decreased in-hospital mortality compared to thrombolysis, if performed in time.

Methods: This is a retrospective observational study conducted at Manmohan Cardiothoracic Vascular and Transplant Centre, Maharajgunj, Kathmandu, Nepal from September 2012 to December 2014. Patients who presented with acute myocardial infarction and cardiogenic shock and underwent primary

PCI were enrolled in this study. Records from cath lab, Coronary Care Unit (CCU) and discharge notes

were reviewed and analyzed.

Results: A total of 22 patients were enrolled in this study. The mean age of the study population was 61.5±11.5 years and 73% of the participants were male. Four patients were intubated in the emergency department, three received cardiopulmonaryresuscitation (CPR) and one patient received electrical cardio version on presentation. Triple vessel disease was the most common finding and left anterior descending (LAD) artery was the commonest culprit vessel. Procedural success was 91%. In-hospital mortality was 31.2% in the entire study population. Ventilator associated pneumonia and severe sepsis was seen in 5 out of 7 cases that died.

Conclusion: Initial outcome of primary PCI performed in patients with acute MI in cardiogenic shock at our centre is encouraging. In-hospital mortality in patients with acute MI complicated by cardiogenic is high. Primary PCI improves outcome in these patients and should be performed as an initial strategy.