The in-hospital mortality rate among patients with acute myocardial infarction complicated by cardiogenic shock who underwent percutaneous coronary intervention (PCI) increased from 27.6 percent between 2005 and 2006 to 30.6 percent between 2011 and 2013, according to a study published Jan. 20 in JACC: Cardiovascular Interventions.

Using data from ACC’s CathPCI Registry, researchers assessed records from 56,497 patients between January 2005 and December 2012. Results showed that the use of bivalirudin instead of other anti-coagulants such as heparin increased (12.6 percent earlier vs. 45.6 percent later), while the use of an intra-aortic balloon pump declined (49.5 percent vs. 44.9 percent). In addition, in the 2005-2006 time period, 31.5 percent of patients had more than one lesion treated during PCI, while in the 2011-2013 period, the number decreased to 25.8 percent. Furthermore, only a small fraction of these patients had the procedure done via radial access.   

Siddharth A. Wayangankar, MD, the study’s lead author, expresses concern about the increased mortality rates, noting that “despite evolution of medical technology and utilization of contemporary measures, in-hospital mortality continues to rise.” Moving forward, he explains that there is a need for additional research and targeted efforts to improve outcomes in this high-risk group.

In an accompanying editorial, Tanveer Rab, MD, FACC, suggests several reasons for the increased in-hospital mortality rates. He points to increased use of bivalirudin and incomplete revascularization as two possible causes. Utilizing heparin as an anti-coagulant instead of bivalirudin; performing complete revascularizations when possible; utilizing glycoprotein inhibitors during cardiogenic shock; and switching to radial access are among the strategies he believes could reverse the mortality trends. 

Keywords: Coagulants, Heparin, Hirudins, Hospital Mortality, Intra-Aortic Balloon Pumping, Peptide Fragments, Percutaneous Coronary Intervention, Registries, Shock, Cardiogenic, CathPCI Registry, National Cardiovascular Data Registries

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