Abstract
Objectives: The mortality of patients with cardiogenic shock (CS) complicating ST elevation acute myocardial infarction (STEMI) remains high, despite early revascularization. Current knowledge of predictors of death is limited. Background: The pathophysiologic understanding of CS after acute myocardial infarction has shifted from a mere hemodynamic disorder to a more complex approach including imbalance in metabolic functions. Methods: In 45 consecutive patients (71.4 ± 13 years) with CS complicating STEMI treated with primary percutaneous coronary intervention (PCI) serum levels of lactate, glucose and uric acid on coronary care unit (CCU) admission were measured. The end-point was in-hospital death. Results: The following parameters, on CCU admission, were univariate predictors of in-hospital mortality: serum glucose > 200 mg/dl (OR = 11.3, p = 0.002), serum creatinine > 1.5 mg/dl (OR = 12.7, p = 0.003), uric acid > 6.5 mg/dl (OR = 6.7, p = 0.016), lactate > 6.5 mmol/l (OR = 54, p <0.0001), age ≥ 75 years (OR = 8.5, p = 0.002), history of hypertension (OR = 8.3, p = 0.003) and TIMI flow post PCI ≤ 2 (OR = 12.9, p = 0.02). At multivariate analysis, after adjustment for sex, age, hypertension and diabetes, lactate > 6.5 mmol/l and TIMI flow post PCI ≤ 2 were still independent predictors of in-hospital mortality (OR = 295, p = 0.01; OR = 19.5, p = 0.04, respectively). Conclusions: Hyperlactatemia, hyperglycemia and increased levels of uric acid on CCU admission are univariate predictors of in-hospital death. Moreover, at multivariate analysis, hyperlactatemia (> 6.5 mmol/l) is an independent indicator of in-hospital death in CS patients complicating STEMI.
| Original language | English |
|---|---|
| Pages (from-to) | 176-182 |
| Number of pages | 7 |
| Journal | International Journal of Cardiology |
| Volume | 114 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Jan 8 2007 |
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Keywords
- Cardiogenic shock
- In-hospital mortality
- Percutaneous coronary intervention
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock. / Valente, Serafina; Lazzeri, Chiara; Vecchio, Sabine; Giglioli, Cristina; Margheri, Massimo; Bernardo, Pasquale; Comeglio, Marco; Chiocchini, Silvia; Gensini, Gian Franco.
In: International Journal of Cardiology, Vol. 114, No. 2, 08.01.2007, p. 176-182.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock
AU - Valente, Serafina
AU - Lazzeri, Chiara
AU - Vecchio, Sabine
AU - Giglioli, Cristina
AU - Margheri, Massimo
AU - Bernardo, Pasquale
AU - Comeglio, Marco
AU - Chiocchini, Silvia
AU - Gensini, Gian Franco
PY - 2007/1/8
Y1 - 2007/1/8
N2 - Objectives: The mortality of patients with cardiogenic shock (CS) complicating ST elevation acute myocardial infarction (STEMI) remains high, despite early revascularization. Current knowledge of predictors of death is limited. Background: The pathophysiologic understanding of CS after acute myocardial infarction has shifted from a mere hemodynamic disorder to a more complex approach including imbalance in metabolic functions. Methods: In 45 consecutive patients (71.4 ± 13 years) with CS complicating STEMI treated with primary percutaneous coronary intervention (PCI) serum levels of lactate, glucose and uric acid on coronary care unit (CCU) admission were measured. The end-point was in-hospital death. Results: The following parameters, on CCU admission, were univariate predictors of in-hospital mortality: serum glucose > 200 mg/dl (OR = 11.3, p = 0.002), serum creatinine > 1.5 mg/dl (OR = 12.7, p = 0.003), uric acid > 6.5 mg/dl (OR = 6.7, p = 0.016), lactate > 6.5 mmol/l (OR = 54, p <0.0001), age ≥ 75 years (OR = 8.5, p = 0.002), history of hypertension (OR = 8.3, p = 0.003) and TIMI flow post PCI ≤ 2 (OR = 12.9, p = 0.02). At multivariate analysis, after adjustment for sex, age, hypertension and diabetes, lactate > 6.5 mmol/l and TIMI flow post PCI ≤ 2 were still independent predictors of in-hospital mortality (OR = 295, p = 0.01; OR = 19.5, p = 0.04, respectively). Conclusions: Hyperlactatemia, hyperglycemia and increased levels of uric acid on CCU admission are univariate predictors of in-hospital death. Moreover, at multivariate analysis, hyperlactatemia (> 6.5 mmol/l) is an independent indicator of in-hospital death in CS patients complicating STEMI.
AB - Objectives: The mortality of patients with cardiogenic shock (CS) complicating ST elevation acute myocardial infarction (STEMI) remains high, despite early revascularization. Current knowledge of predictors of death is limited. Background: The pathophysiologic understanding of CS after acute myocardial infarction has shifted from a mere hemodynamic disorder to a more complex approach including imbalance in metabolic functions. Methods: In 45 consecutive patients (71.4 ± 13 years) with CS complicating STEMI treated with primary percutaneous coronary intervention (PCI) serum levels of lactate, glucose and uric acid on coronary care unit (CCU) admission were measured. The end-point was in-hospital death. Results: The following parameters, on CCU admission, were univariate predictors of in-hospital mortality: serum glucose > 200 mg/dl (OR = 11.3, p = 0.002), serum creatinine > 1.5 mg/dl (OR = 12.7, p = 0.003), uric acid > 6.5 mg/dl (OR = 6.7, p = 0.016), lactate > 6.5 mmol/l (OR = 54, p <0.0001), age ≥ 75 years (OR = 8.5, p = 0.002), history of hypertension (OR = 8.3, p = 0.003) and TIMI flow post PCI ≤ 2 (OR = 12.9, p = 0.02). At multivariate analysis, after adjustment for sex, age, hypertension and diabetes, lactate > 6.5 mmol/l and TIMI flow post PCI ≤ 2 were still independent predictors of in-hospital mortality (OR = 295, p = 0.01; OR = 19.5, p = 0.04, respectively). Conclusions: Hyperlactatemia, hyperglycemia and increased levels of uric acid on CCU admission are univariate predictors of in-hospital death. Moreover, at multivariate analysis, hyperlactatemia (> 6.5 mmol/l) is an independent indicator of in-hospital death in CS patients complicating STEMI.
KW - Cardiogenic shock
KW - In-hospital mortality
KW - Percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=33751318212&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33751318212&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2006.01.024
DO - 10.1016/j.ijcard.2006.01.024
M3 - Article
C2 - 16737749
AN - SCOPUS:33751318212
VL - 114
SP - 176
EP - 182
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
IS - 2
ER -