Elective coronary stent implantation in cardiogenic shock complicating acute myocardial infarction: In-hospital and six-month clinical and angiographic results

Franco Fabbiocchi, Antonio L. Bartorelli, Piero Montorsi, Sergio Cozzi, Daniela Trabattoni, Giuseppe Calligaris, Alessandro Loaldi

Research output: Contribution to journalArticlepeer-review

Abstract

Effective treatment of patients with acute myocardial infarction and cardiogenic shock depends on restoring persistent patency of the infarct- related artery. Coronary stenting, reducing abrupt or delayed closure related to dissection and suboptimal result, may improve PTCA results in cardiogenic shock. Eighteen patients (14 males and 4 females, mean age 59 ± 7 years), referred to catheterization laboratory for acute myocardial infarction and shock, had elective stent implantation during 14 primary and 4 rescue PTCA. Time delay between shock onset and PTCA was 4.1 ± 3 hr (range, 30 min to 12 hr). The IRA was LAD in seven patients (38%), LCx in two (11%), and RCA in eight (45%). One patient (5.%) had distal LMCA occlusion. Stent deployment was successful in 100% of patients and resulted in TIMI 3 flow in 13 (72%) patients. In 13 (72%) cases, cardiogenic shock gradually resolved and the patients were discharged alive. Five patients (28%) died because of irreversible hemodynamic deterioration without evidence of reinfarction. At 6-month follow-up, all the discharged patients were alive and no patient had reinfarction or recurrent angina. Heart transplant was required in one patient 5 months after stenting because of refractory congestive heart failure. Angiography demonstrated patency of all the coronary arteries treated, with TIMI 3 flow in all patients. Stent restenosis rate was 30%, and target lesion revascularization with CABG or re-PTCA was not required in any case. LV function improved from 39% ± 15% to 51% ± 15% (P <0.01). Elective coronary stenting is an effective treatment for acute myocardial infarction complicated by cardiogenic shock and may improve acute and long-term survival. (C) 2000 Wiley-Liss, Inc.

Original languageEnglish
Pages (from-to)384-389
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume50
Issue number4
Publication statusPublished - 2000

Keywords

  • Acute myocardial infarction
  • Cardiogenic shock
  • Coronary stenting

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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