Cardiogenic Shock Complicating Acute Myocardial Infarction

Background: Cardiogenic shock (CS) is still the leading cause of in-hospital mortality in patients presenting with acute myocardial infarction (AMI). Aim: To investigate the epidemiological and clinical characteristics of a series of patients hospitalized for AMI complicated by CS and to determine the in-hospital mortality. Methods: We retrospectively analysed 70 patients affected by AMI complicated by CS admitted to cardiology department of the military hospital between October 2005 and April 2015. Results: A total of 70 patients were included in the study, 56 (80%) patients were male. The mean age was 63±10 years. Diabetes mellitus (62%) and hypertension (50%) were the predominant risk factors. On admission, 41% of patients were in left ventricular failure and 59% in shock. The mean LVEF was 49±14.4%. Thrombolysis was performed in 51% of patients. Seventy-two (72%) of patients underwent angiography and 56.6% had percutaneous coronary intervention (PCI). Of these, 27% were taken for primary PCI and 73% had rescue PCI. Revascularization was complete in 37% of cases. The success rate of PCI was 85%. The average of hospital stay was 7±8 days. Patients revealed a mortality rate of 47%, occurring on average in the 6th day of hospitalization. We found that renal failure (p=0.014), late onset of shock (p=0.031), hyperglycemia (p=0.014), leukocytosis (p=0.02), use of vasopressors (p=0.003), and the anterior territory of MI (p=0.003) were significantly predictive of hospital mortality. Conclusion: Despite significant advances in the treatment of myocardial infarction, the in-hospital mortality of patients in CS complicating MI remains high. Renal failure, late onset of shock, hyperglycemia and the anterior territory of MI were the major predictive of hospital mortality. A multidisciplinary approach including medical actors and pre-hospital centers specialized in the treatment of this condition is actually necessary.