EARLY REVASCULARIZATION IMPROVES SURVIVAL IN CARDIOGENIC-SHOCK COMPLICATING ACUTE MYOCARDIAL-INFARCTION

The effects of coronary revascularization by percutaneous transluminal coronary angioplasty or coronary bypass grafting, or both, on survival were evaluated in 81 patients with cardiogenic shock complicating acute myocardial infarction. Thirty-two patients had successful revascularization and 49 patients had unsuccessful or no revascularization. Revascularization was achieved by coronary angioplasty in 22 patients, coronary bypass surgery in 2 and angioplasty followed by bypass surgery in 8. No significant differences were noted between the two groups with regard to baseline clinical or hemodynamic variables. Intraaortic balloon counterpulsation was employed in 27 (84%) of the 32 patients in the group with revascularization and in 19 (39%) of the 49 patients without revascularization (p = 0.0006). The in-hospital survival was significantly better in the patients with-18 (56%) of 32-than in the patients without revascularization-4 (8%) of 49 (p < 0.0001). At a mean follow-up period of 21 +/- 15 months, this survival difference persisted-16 (50%) of 32 patients with revascularization survived versus 1 (2%) of 49 patients without revascularization (p < 0.0001). The mean time from the onset of shock to revascularization differed significantly between survivors (12.4 +/- 15 h) and nonsurvivors (58.5 +/- 93 h) in the group with revascularization (p = 0.0004). In the revascularization group, the in-hospital survival rate was 77% (17 of 22) when revascularization was performed within 24 h but only 10% (1 of 10) when it was performed after 24 h (p = 0.0006). These data suggest that the combination of successful coronary revascularization and intraaortic balloon pumping is associated with improved survival in patients with cardiogenic shock complicating acute myocardial infarction. This improvement in survival is most evident if revascularization is performed early, particularly within 24 h of the onset of cardiogenic shock.