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Outcomes in Patients With Cardiogenic Shock Following Percutaneous Coronary Intervention in the Contemporary Era An Analysis From the BCIS Database (British Cardiovascular Intervention Society)

Lookup NU author(s): Dr Vijay Kunadian


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OBJECTIVES This study sought to determine mortality rates among cardiogenic shock (CGS) patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome in the contemporary treatment era and to determine predictors of mortality.BACKGROUND It is unclear whether recent advances in pharmacological and interventional strategies have resulted in further improvements in short-and long-term mortality and which factors are associated with adverse outcomes in patients presenting with CGS and undergoing PCI in the setting of acute coronary syndrome.METHODS This study analyzed prospectively collected data for patients undergoing PCI in the setting of CGS as recorded in the BCIS (British Cardiovascular Intervention Society) PCI database.RESULTS In England and Wales, 6,489 patients underwent PCI for acute coronary syndrome in the setting of CGS. The mortality rates at 30 days, 90 days, and 1 year were 37.3%, 40.0%, and 44.3%, respectively. On multiple logistic regression analysis, age (for each 10-year increment of age: odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.51 to 1.68; p < 0.0001), diabetes mellitus (OR: 1.47, 95% CI: 1.28 to 1.70; p < 0.0001), history of renal disease (OR: 2.03, 95% CI: 1.63 to 2.53; p < 0.0001), need for artificial mechanical ventilation (OR: 2.56, 95% CI: 2.23 to 2.94; p < 0.0001), intra-aortic balloon pump use (OR: 1.57, 95% CI: 1.40 to 1.76; p < 0.0001), and need for left main stem PCI (OR: 1.90, 95% CI: 1.62 to 2.23; p < 0.0001) were associated with higher mortality at 1 year.CONCLUSIONS In this large U. K. cohort of patients undergoing PCI in the context of CGS, mortality remains high in spite of the use of contemporary PCI strategies. The highest mortality occurs early, and this time period may be a particular target of therapeutic intervention. (C) 2014 by the American College of Cardiology Foundation.

Publication metadata

Author(s): Kunadian V, Qiu WL, Ludman P, Redwood S, Curzen N, Stables R, Gunn J, Gershlick A, Natl Inst Cardiovasc Outcomes Res

Publication type: Article

Publication status: Published

Journal: JACC: Cardiovascular Interventions

Year: 2014

Volume: 7

Issue: 12

Pages: 1374-1385

Print publication date: 01/12/2014

Online publication date: 15/12/2014

Acceptance date: 08/06/2014

ISSN (print): 1936-8798

ISSN (electronic): 1876-7605

Publisher: Elsevier


DOI: 10.1016/j.jcin.2014.06.017


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