1. Jeopardized Myocardium and Survival in Patients Presenting to the Catheterization Laboratory With ST-Elevation Myocardial Infarction and Shock.
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Joshi, Francis R., Pedersen, Frants, Räder, Sune, Raunsø, Jakob, Kjaergaard, Jesper, Lindholm, Matias, Hassager, Christian, Engstrøm, Thomas, Holmvang, Lene, Helqvist, Steffen, and Jørgensen, Erik
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MYOCARDIAL infarction , *SYSTOLIC blood pressure , *CARDIOGENIC shock , *PERCUTANEOUS coronary intervention , *MYOCARDIUM , *CATHETERIZATION , *DATABASES , *CARDIAC catheterization , *MEDICAL triage , *PREDICTIVE tests , *TIME , *PROGNOSIS , *MEDICAL care , *RETROSPECTIVE studies , *CORONARY angiography , *RISK assessment , *CARDIOVASCULAR system , *HEMODYNAMICS - Abstract
Objective: We aimed to relate the amount of jeopardized myocardium to mortality in shocked patients presenting to the catheterization laboratory with ST-elevation myocardial infarction (STEMI) and cardiogenic shock.Background: In contrast with historical data and previous professional guidance, contemporary randomized data suggest that multi-vessel revascularization in such patients does not improve survival; mechanistic insight is incomplete.Methods: Clinical databases identified cases of STEMI and shock triaged for primary percutaneous coronary intervention (PPCI) in Eastern Denmark from June 2011 to December 2014 (n = 128). British Cardiovascular Intervention Society (BCIS)-1 jeopardy scores were calculated from angiography. The study endpoint was 30-day mortality.Results: Median lactate values were 6.0 [2.9-10.7] mmol/L. 30-day mortality was 53.9%. 68% of patients had multi-vessel coronary disease. Median pre-PCI BCIS-1 myocardial jeopardy scores were 8 [6-10]. After multiple logistic regression increasing age (p = 0.008; odds ratio [OR] 1.06), lactate values (p = 0.017; OR 1.02), mechanical ventilation (p = 0.011; OR 1.25) and a systolic blood pressure ≤ 90 mmHg at end-case (p = 0.005; OR 1.26) were predictive of 30-day mortality. Post-PPCI culprit vessel TIMI 3 flow was associated with reduced mortality (p < 0.001; OR 0.66). There was no association between pre-PCI jeopardy scores and the primary endpoint.Conclusions: In patients with STEMI and shock, myocardial jeopardy scores do not relate to patient outcomes. Jeopardy scores may be applied to existing datasets in order to understand why multi-vessel revascularization does not lead to the anticipated clinical benefits in cardiogenic shock. [ABSTRACT FROM AUTHOR]- Published
- 2020
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