Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock

Serafina Valente, Chiara Lazzeri, Sabine Vecchio, Cristina Giglioli, Massimo Margheri, Pasquale Bernardo, Marco Comeglio, Silvia Chiocchini, Gian Franco Gensini

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)176-182
Number of pages7
JournalInternational Journal of Cardiology
Volume114
Issue number2
DOIs
Publication statusPublished - Jan 8 2007

Keywords

  • Cardiogenic shock
  • In-hospital mortality
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Valente, S., Lazzeri, C., Vecchio, S., Giglioli, C., Margheri, M., Bernardo, P., Comeglio, M., Chiocchini, S., & Gensini, G. F. (2007). Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock. International Journal of Cardiology, 114(2), 176-182. https://doi.org/10.1016/j.ijcard.2006.01.024