Background Despite substantial recent improvement in mortality from cardiovascular disease, due primarily to success of primary and secondary prevention strategies, it remains the leading cause of death in the developed world. Among those patients hospitalised with acute myocardial infarction (AMI), cardiogenic shock (CS) is the foremost cause of death complicating up to 10% of admissions. Introduction of early revascularisation strategies and mechanical ventricular support have seen short-term mortality due to CS fall from 70% to 80% in the 1970s to around 50%–60% in the 1990s. Previous studies suggest that women experience more CS than men (11.6% vs 8.3%) in the setting of ST elevation MI. Whether primary percutaneous coronary intervention (PPCI) for AMI has resulted in further reduction in in-hospital mortality and whether there are gender differences in outcomes due to CS is not known.
Aims The aim of this study is to determine the rate of in-hospital mortality following primary PCI in the setting of CS and examine the gender differences in the incidence of CS and the rate of in-hospital mortality.
Methods Data were collected prospectively among all patients presenting with AMI to a large UK tertiary cardiac centre and undergoing PPCI between April 2008 and October 2011.
Results In total 2866 patients (male: 2023 [70.6%] vs female: 843 [29.4%]) underwent PPCI. In total, 141/2866 (4.9%) had percutaneous coronary procedures (balloon angioplasty only or stenting) in the setting of cardiogenic shock. There were 81/2023 [4%] male patients and 60/843 [7.1%]) female patients with CS undergoing PPCI. There were no significant differences in the baseline characteristics between male and female patients except female patients were older than men (male: mean age 64.1 years vs female 69.9 years, p=0.004). The overall unadjusted in-hospital mortality rate was 35.4% with no difference in the genders (male: 35.8% vs female: 35%, p=0.730).
Conclusion The present analysis demonstrates that in the PPCI era, there is reduction in the incidence of cardiogenic shock with reduced unadjusted in-hospital mortality rates following primary PCI. The unadjusted in-hospital mortality rates did not differ between the genders despite the fact that there were more women that had presented with cardiogenic shock.
- Cardiogenic shock
- primary percutaneous coronary intervention
- myocardial infarction