Jeopardized Myocardium and Survival in Patients Presenting to the Catheterization Laboratory With ST-Elevation Myocardial Infarction and Shock.
Cardiovasc Revasc Med
; 21(7): 843-848, 2020 07.
Article
em En
| MEDLINE
| ID: mdl-31759911
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 (nâ¯=â¯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]â¯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 (pâ¯=â¯0.008; odds ratio [OR] 1.06), lactate values (pâ¯=â¯0.017; OR 1.02), mechanical ventilation (pâ¯=â¯0.011; OR 1.25) and a systolic blood pressureâ¯≤â¯90â¯mmHg at end-case (pâ¯=â¯0.005; OR 1.26) were predictive of 30-day mortality. Post-PPCI culprit vessel TIMI 3 flow was associated with reduced mortality (pâ¯<â¯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.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
6_ODS3_enfermedades_notrasmisibles
Base de dados:
MEDLINE
Assunto principal:
Choque Cardiogênico
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Angiografia Coronária
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Infarto do Miocárdio com Supradesnível do Segmento ST
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Miocárdio
Tipo de estudo:
Etiology_studies
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Guideline
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Cardiovasc Revasc Med
Ano de publicação:
2020
Tipo de documento:
Article