Risk factors for in-hospital death after primary PCI of patients with acute myocardial infarction and combined with cardiogenic shock

Objective To understand the risk factors for in-hospital death of patients suffering with acute myocardial infarction(AMI) complicated with cardiogenic shock (CS) after they were treated by emergency percutaneous coronary intervention(PCI).

Methods The clinical data of 98 patients, including 28 death cases and 70 alive cases, were retrospectively analyzed. The data of clinical characteristics, laboratory examination, myocardial infarction lesions, the treatment and the occurrence of complicated diseases were compared between the death and alive groups. Multivariate logistic regression analysis was performed to analyze the risk factors for in-hospital death of patients with AMI and CS after primary PCI.

Results Univariate analysis showed that the age, the shock index, the white blood cell count, the serum creatinine level and occurrence of hyperlipidemia, IABP-assisted ratio, and the occurrence of anterior myocardial infarction, coronary artery disease, acute kidney injury, and gastrointestinal bleeding in the in-hospital death group were higher than that in the survival group (P < 0.05), while the hemoglobin, left ventricular ejection fraction (LVEF), and TIMI blood flow grade III ratio after emergency PCI were lower than that in the survival group (P < 0.05). There was no significant difference of the distribution of culprit vessels, the ratio of treatment with vasoactive drugs, and occurrence of arrhythmia, heart failure, acute liver injury and lung infection in the two groups(P>0.05). Multivariate logistic regression analysis showed major risk factors included the senior (age >75 years old, OR=4.71), the lower LVEF (< 35%, OR=5.53), the occurrence of anterior myocardial infarction (OR=1.86), the lower postoperative TIMI blood flow (< III, OR=7.10), the occurrence of acute kidney injury (OR=2.97), the occurrence of coronary artery disease (OR=5.81), and the occurrence of gastrointestinal bleeding (OR=2.08).

Conclusion Before emergency PCI, the patients suffering with AMI complicated with CS should receive individualized treatment plus multiple adjuvant therapies, based on the comprehensive assessment of the patients' condition, specifically focusing on risk factors for in-hospital death mentioned above. Therefore, the risk factors of death will be reduced or eliminated, and the efficacy of emergency PCI can be improved.