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Culprit lesion location and outcome in patients with cardiogenic shock complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial.
- Source :
-
Clinical research in cardiology : official journal of the German Cardiac Society [Clin Res Cardiol] 2016 Dec; Vol. 105 (12), pp. 1030-1041. Date of Electronic Publication: 2016 Jul 04. - Publication Year :
- 2016
-
Abstract
- Background: In myocardial infarction without cardiogenic shock (CS), the affected coronary vessel has significant influence on the final infarct size and patient prognosis. CS data on this relation are scarce. The objective of this study was to determine the prognostic relevance of the culprit lesion location in patients with CS complicating acute myocardial infarction.<br />Methods: In the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial patients with CS were randomized to therapy with intraaortic balloon pump or control. Additional CS patients not eligible for the randomized trial were included in a registry. We compared the location of the culprit lesions in these patients with regard to the affected coronary vessel [left main (LM), left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA)] and location within the vessel (proximal, mid or distal) regarding short- and long-term outcome.<br />Results: Of 758 patients, the majority had the culprit lesion in the LAD (44 %) compared to RCA (27 %), LCX (19 %) or LM (10 %). Proximal lesions were more frequent than mid or distal culprit lesions (60 vs. 27 vs. 13 %, p < 0.001). No differences were observed for mortality with respect to either culprit vessel (log-rank p value = 0.54). In contrast, a higher mortality was observed for patients with distal culprit lesions after 1 year (log-rank p value = 0.04). This difference persisted after multivariable adjustment (hazard ratio for distal lesions 1.40; 95 % confidential interval 1.03-1.90; p = 0.03).<br />Conclusion: For patients with CS complicating myocardial infarction, the culprit vessel seems to be unrelated with mortality whereas distal culprit lesions may have a worse outcome.
- Subjects :
- Aged
Chi-Square Distribution
Coronary Artery Disease complications
Coronary Artery Disease diagnostic imaging
Coronary Artery Disease mortality
Female
Humans
Kaplan-Meier Estimate
Middle Aged
Multivariate Analysis
Myocardial Infarction diagnosis
Myocardial Infarction etiology
Myocardial Infarction mortality
Proportional Hazards Models
Prospective Studies
Registries
Risk Assessment
Risk Factors
Shock, Cardiogenic diagnosis
Shock, Cardiogenic etiology
Shock, Cardiogenic mortality
Time Factors
Treatment Outcome
Coronary Artery Bypass adverse effects
Coronary Artery Bypass mortality
Coronary Artery Disease therapy
Intra-Aortic Balloon Pumping adverse effects
Intra-Aortic Balloon Pumping mortality
Myocardial Infarction therapy
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention mortality
Shock, Cardiogenic therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1861-0692
- Volume :
- 105
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Clinical research in cardiology : official journal of the German Cardiac Society
- Publication Type :
- Academic Journal
- Accession number :
- 27378612
- Full Text :
- https://doi.org/10.1007/s00392-016-1017-6