Cardiogenic shock at admission in patients with multivessel disease and acute myocardial infarction treated with percutaneous coronary intervention: related factors.

BACKGROUND: Among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), those with multivessel disease have worse prognosis, mainly due to a higher frequency of cardiogenic shock (CS) at admission. The aim of this study was to identify clinical and angiographic characteristics of patients with STEMI, multivessel disease and CS at admission referred to primary PCI.

METHODS: We studied 630 patients with STEMI treated with primary PCI within 12 h after symptoms onset. Multivessel disease was defined as the presence of >or=50% stenosis in >or=2 major epicardial arteries. Multivessel disease was documented in 276 patients (44%), these patients comprising the study population. Clinical, angiographic and procedural variables were compared between those with and without CS. A logistic regression analysis was performed to identify the independent predictors of CS among patients with multivessel disease.

RESULTS: Among patients with multivessel disease, 45 (16%) had CS at admission. The independent predictors of CS in patients with multivessel disease were: STEMI anterior [OR 2.05; 95% CI 1.0 to 4.1; p=0.044], female gender [odds ratio (OR) 2.49; 95% confidence intervals (CI) 1.1 to 5.3; p=0.021], proximal culprit lesion [OR 3.8; 95% CI 1.7 to 8.5; p<0.001], and chronic occlusion of other coronary arteries [OR 4.48; 95% CI 2.1 to 9.1; p<0.001].

CONCLUSIONS: Among patients with STEMI and multivessel disease, CS is especially frequent in STEMI anterior, female gender, proximal culprit lesion, and chronic occlusion of other vessels.