Deadly association of cardiogenic shock and chronic total occlusion in acute ST-elevation myocardial infarction
| Autor: | Olivier F. Bertrand, Jean-Pierre Déry, Guy Proulx, Eric Larose, Bernard Noël, Eltigani Abdelaal, Josep Rodés-Cabau, Jimmy MacHaalany, Olivier Costerousse, Can M. Nguyen, Ugo Déry, Onil Gleeton, Yoann Bataille |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Shock Cardiogenic Percutaneous Coronary Intervention Internal medicine Odds Ratio Prevalence medicine Clinical endpoint Humans Myocardial infarction Aged business.industry Cardiogenic shock Percutaneous coronary intervention Odds ratio Middle Aged medicine.disease medicine.anatomical_structure Coronary Occlusion Shock (circulatory) Cardiology Myocardial infarction complications Female medicine.symptom Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | American Heart Journal. 164:509-515 |
| ISSN: | 0002-8703 |
| DOI: | 10.1016/j.ahj.2012.07.008 |
| Popis: | The association between cardiogenic shock and 1 or1 chronic total occlusion (CTO) in unselected patients presenting with ST-elevation myocardial infarction (MI) (STEMI) has not been characterized.Patients with STEMI referred with or without cardiogenic shock were categorized into no CTO, 1 CTO, and1 CTO. The primary end point was the 30-day mortality.Between 2006 and 2011, 2,020 consecutive patients were included. A total of 141 patients (7%) presented with cardiogenic shock on admission. The prevalence of 1 CTO and1 CTO in a non-infarct-related artery was 23% and 5%, respectively, among patients with shock compared with 6% and 0.5% in patients without shock (P.0001). Independent predictors of cardiogenic shock included left main-related MI (odds ratio [OR] 6.55, 95% CI 1.39-26.82, P = .019), CTO (OR 4.20, 95% CI 2.64-6.57, P.001), creatinine clearance60 mL/min (OR 3.41, 95% CI 2.32-4.99, P.0001), and left anterior descending-related MI (OR 2.20, 95% CI 1.51-3.23, P.0001). Thirty-day mortality was 100% in shock patients with1 CTO, 65.6% with 1 CTO, and 40.2% in patients without CTO (P.0001). After adjustment for left ventricular ejection fraction and renal function, CTO remained an independent predictor for 30-day mortality (hazard ratio [HR] 1.83; 95% CI 1.10-3.01, P = .02).In patients with STEMI, CTO was strongly associated with cardiogenic shock on admission. In this setting, mortality was substantially higher in patients with 1 CTO and exceedingly high in those with1 CTO. The presence of CTO was an independent predictor of early mortality. |
| Databáze: | OpenAIRE |
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