Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Causes of death in patients treated with PCI for acute myocardial infarction after cardiac arrest and/or with cardiogenic shock.
U. Zeymer1, C. Lober2, S. Richter3, C. Olivier4, K. Huber5, T. Geisler6, für die Studiengruppe: CAN-SHOCK
1Medizinische Klinik B, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein; 2Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein; 3I. Medizinische Klinik, Hegau-Bodensee-Klinikum Singen, Singen; 4Klinik für Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Freiburg im Breisgau; 53. Medizinische Abteilung mit Kardiologie, Klinik Ottakring, Wien, AT; 6Innere Medizin III, Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Tübingen;

Background: There are controversial reports about the causes of death in patients with acute myocardial infarction after cardiac arrest (CA) and/or with cardiogenic shock (CS).

Methods: Patients with acute myocardial infarction treated with PCI after cardiac arrest and/or with cardiogenic shock were enrolled into the CAN-SHOCK registry. Patient characteristics and in-hospital events were centrally collected and analysed.

Results: A total of 293 patients were treated in 10 Austrian and German centers. Of these

148 had CA, 42 CS and 103 both CA+CS. Mean age was 65.2 years and 22.1% were women. Arterial lactate levels were highest in patients with CA+CS. TIMI 3 patency after PCI was 94.1 %, mechanical circulatory support was used in 56 (21%) of patients. Total in-hospital mortality and causes of death in the three groups are given in the table. 

Conclusion: Despite high procedural success in patients undergoing PCI for AMI after CA and/or with CS mortality is still high. While after CA brain damage is the major cause of death in CS cardiac causes are the leading causes of mortality. Earlier neurogical prognosticators are needed to identify patients with poor neurological outcome after CA.  


Indication for PCI

Cardiac arrest

n=148

Cardiogenic shock

n=42

CA + CS

n=103

Total mortality

52 (35.1%)

16 (38.1 %)

55 (53.4%)

Sudden cardiac death

     

2/52 (3.2%)

1/16 (6.3%)

1/55 (1.8%)

Mechanical complications

of AMI

6/52 (11.5%)

1/16 (6.3%)

4/55 (7.3%)

Refractory cardiogenic

shock

0/52 (0%)

5/16 (31.3%)

22/55 (40.0%)

Brain damage

29/52 (55.8%)

5/16 (31.3%)

13/55 (23.6%)

Sepsis

5/52 (9.2%)

2/16 (12.5%)

1/55 (3.6%)

Other causes

7/52 (13.5%)

2/16 (12.5%)

12/55 (21.8%)
https://dgk.org/kongress_programme/jt2023/aP2122.html