Cardiogenic Shock Complicating Acute Myocardial Infarction; Aetiology, Treatment and Prognosis
Kerbala Journal of Medicine,
Volume 10, Issue 2, Pages 2771-2784
Abstractbackground: Cardiogenic shock is the leading cause of death in patients hospitalized for acute myocardial infarction. Treatment strategies using intra-aortic balloon counter pulsation and emergency revascularization by percutaneous coronary interventions or coronary bypass surgery have been shown to improve outcomes.
Aim: to provide an overview of patients with cardiogenic shock complicating acute myocardial infarction admitted to Ibn Al-Bitar center for cardiac surgery in Baghdad.
Methods: This is a prospective observational study conducted at Ibn Al-Bitar center for cardiac surgery in Baghdad. The criteria of the British cardiovascular intervention society were used to identify patients who were admitted to the hospital within one year period with the main focus of the study was on patients with cardiogenic shock complicating acute myocardial infarction. Full clinical assessment was done at bedside. Twelve leads electrocardiography and basic biochemical tests were obtained and echocardiography was done for every patient.
Results: During a period of one year from March 2010 through March 2011 One hundred seventeen patients with cardiogenic shock were identified. Acute myocardial infarction accounted for shock in 78(66.7%). In this patients population there were good percentages of history of myocardial infarction, hypertension, diabetes and smoking. Anterior ST–elevation myocardial infarction was found in two-thirds of them. Predominant left ventricular failure caused cardiogenic shock in 54(69.2%), while ventricular septal rupture, acute mitral regurgitation and right ventricular failure accounted for the rest. The overall mortality rate of cardiogenic shock was 64 (82.1%). Intra-aortic balloon pumping (IABP) was placed in 28 (35.9%) and Thrombolytic therapy was used in 19 patients (24.4%), while Both IABP and thrombolytic therapy were used in 8 (10.3%). Coronary angiography was done in 18 (23.07%). Percutanous coronary intervention was used in 10 (12.8%), while coronary artery bypass grafting was done in 3(3.8%) of the patients.
Conclusions: This study shows a high in-hospital mortality for patients with cardiogenic shock complicating acute myocardial infarction and despite the proven benefit of revascularization procedures there were only few patients had undergone these
Procedures. The utilization rates of thrombolytic therapy and intra-aortic balloon pump were also low.
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