The ability to achieve complete revascularization is associated with improved in‐hospital survival in cardiogenic shock due to myocardial infarction: Manitoba cardiogenic shock registry investigators

Objectives: To identify predictors of survival in a retrospective multicentre cohort of patients with cardiogenic shock undergoing coronary angiography and to address whether complete revascularization is associated with improved survival in this cohort. Background: Early revascularization is the standard of care for cardiogenic shock. Coronary bypass grafting and percutaneous intervention have complimentary roles in achieving this revascularization. Methods: A total of 210 consecutive patients (mean age 66 ± 12 years) at two tertiary centres from 2002 to 2006 inclusive with a diagnosis of cardiogenic shock were evaluated. Univariate and multivariate predictors of in‐hospital survival were identified utilizing logistic regression. Results: ST elevation infarction occurred in 67% of patients. Thrombolysis was administered in 34%, PCI was attempted in 62% (88% stented, 76% TIMI 3 flow), CABG was performed in 22% (2.7 grafts, 14 valve procedures), and medical therapy alone was administered to the remainder. The overall survival to discharge was 59% (CABG 68%, PCI 57%, medical 48%). Independent predictors of mortality included complete revascularization ( P = 0.013, OR = 0.26 (95% CI: 0.09–0.76), hyperlactatemia ( P = 0.046, OR = 1.14 (95% CI: 1.002–1.3) per mmol increase), baseline renal insufficiency ( P = 0.043, OR = 3.45, (95% CI: 1.04–11.4), and the presence of anoxic brain injury ( P = 0.008, OR = 8.22 (95% CI: 1.73–39.1). Within the STEMI with concomitant multivessel coronary disease subgroup of this population ( N = 101), independent predictors of survival to discharge included complete revascularization ( P = 0.03, OR = 2.5 (95% CI: 1.1–6.2)) and peak lactate ( P = 0.02). Conclusions: The ability to achieve complete revascularization may be strongly associated with improved in‐hospital survival in patients with cardiogenic shock. © 2011 Wiley‐Liss, Inc.