Early Risk Stratification of Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction Who Undergo Percutaneous Coronary Intervention

The mortality rate of patients with cardiogenic shock complicating acute myocardial infarction remains exceedingly high despite early mechanical revascularization. Early risk stratification is of great importance to identify patients who could benefit from ventricular assist devices and urgent heart transplantation (UHT). All consecutive patients with cardiogenic shock complicating acute myocardial infarction admitted from June 2001 to December 2007 were prospectively included. Clinical, hemodynamic, and echocardiographic variables were registered on admission and patients were followed for a median of 297 days. A total of 74 patients were included. One-year mortality was 55% and 7 patients (9%) underwent UHT. One-year mortality or need for UHT for patients with postprocedural Thrombolysis In Myocardial Infarction (TIMI) grade 3, 2, and 0 or 1 flows were 38%, 92%, and 90%, respectively (p <0.001). After adjustment by multivariate analysis, the most important predictors of mortality or need for UHT were age >75 years (hazard ratio [HR] 3.56, 95% confidence interval [CI] 1.07 to 11.80), left main coronary artery occlusion (HR 3.75, 95% CI 1.09 to 12.84), left ventricular ejection fraction <25% (HR 2.70, 95% CI 1.17 to 6.22), and postprocedural TIMI grade <3 flow (HR 3.37, 95% CI 1.48 to 7.72). A simple risk score constructed with these 4 variables effectively predicted 1-year survival without the need for UHT (83% for score 0, 19% for score 1, and 6% for score 2, p <0.001). In conclusion, age >75 years, left main coronary artery occlusion, left ventricular ejection fraction <25%, and postprocedural TIMI grade <3 flow were significantly associated with worse prognosis. A simple risk score rapidly available in the catheterization laboratory can efficiently estimate prognosis.