Trends and Outcomes of PCI for Cardiogenic Shock

Study Questions:

What are the contemporary trends and outcomes of patients undergoing percutaneous coronary intervention (PCI) for cardiogenic shock in the United States?

Methods:

The authors used the National Cardiovascular Data Registry (NCDR) CathPCI Registry to evaluate the characteristics and outcome of 56,497 patients who underwent PCI between 2005-2013 for cardiogenic shock complicating myocardial infarction.

Results:

Over the study period, there was an increase in the prevalence of diabetes, hypertension, dyslipidemia, previous PCI, and dialysis, and a decline in the prevalence of chronic lung disease, peripheral vascular disease, or prior heart failure among patients undergoing PCI for cardiogenic shock. Over the study period, there was a decline in intra-aortic balloon pump use (49.5-44.9%; p < 0.01) and drug-eluting stents (65-46%; p < 0.01), while the use of bivalirudin increased (12.6-45.6%). There was an increase in the adjusted in-hospital mortality over the study period (27.6% in 2005-2006 vs. 30.6% in 2011-2013, adjusted odds ratio: 1.09; 95% confidence interval, 1.005-1.173; p = 0.04).

Conclusions:

The mortality among patients undergoing PCI for cardiogenic shock continues to be high and has increased slightly over the last few years.

Perspective:

This study provides a contemporary snapshot of the outcome of patients undergoing PCI for cardiogenic shock in the United States. It is sobering that the mortality in this cohort has increased slightly and it is not clear if this is related to changes in patient profile or is due to changes in patient care. Further research is needed to understand the reasons for this change and to define strategies to improve the outcome of this population.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Diabetes and Cardiometabolic Disease, Clinical Topic Collection: Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Aortic Surgery, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support , Interventions and ACS, Interventions and Vascular Medicine, Hypertension

Keywords: Acute Coronary Syndrome, CathPCI Registry, Diabetes Mellitus, Drug-Eluting Stents, Dyslipidemias, Heart Failure, Hospital Mortality, Hypertension, Intra-Aortic Balloon Pumping, Lung Diseases, Myocardial Infarction, Percutaneous Coronary Intervention, Peripheral Vascular Diseases, Renal Dialysis, Shock, Cardiogenic


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