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Cardiogenic shock and heart failure post-percutaneous coronary intervention in ST-elevation myocardial infarction: observations from "Assessment of Pexelizumab in Acute Myocardial Infarction".

Publication ,  Journal Article
French, JK; Armstrong, PW; Cohen, E; Kleiman, NS; O'Connor, CM; Hellkamp, AS; Stebbins, A; Holmes, DR; Hochman, JS; Granger, CB; Mahaffey, KW
Published in: Am Heart J
July 2011

BACKGROUND: Mortality after ST-elevation myocardial infarction (STEMI) has reduced with reperfusion by primary percutaneous coronary intervention (PCI), which may have impacted on the adverse outcomes of cardiogenic shock (CS) and congestive heart failure (CHF). METHODS AND RESULTS: In the APEX-AMI trial, 5,745 patients with STEMI and planned primary PCI were randomly assigned pexelizumab or matching placebo. Post-randomization CS or CHF was adjudicated by a clinical endpoints committee. Treatment assignment to pexelizumab did not influence either endpoint or mortality rates. Cardiogenic shock developed in 196 patients (3.4%) at a median of 6.0 hours (interquartile range 3.9-28.3) post-randomization, and mortality at 90 days was 54.6%. Congestive heart failure occurred in 254 of patients (4.4%) at a median of 2.6 days (IQR 1.0-16.6), and mortality through 90 days was 10.2%; mortality among those with neither endpoint was 2.1%. Patients with CS or CHF were older, were more often female, and had more hypertension and diabetes, but smoked less compared with non-CS/CHF patients (all P < .05). Independent mortality predictors among those with CS or CHF were hyperlipidemia and a history of angina (interaction P = .011 and .008, respectively); procedural predictors among survivors to PCI were pre-PCI Thrombolysis In Myocardial Infarction (TIMI) flow 0-1 and post-PCI TIMI flow <3 (P = .013 and <.0001, respectively). CONCLUSIONS: Survival after CS remains poor despite aggressive reperfusion. Both CS and CHF remain the major causes of death among STEMI patients undergoing primary PCI. Future studies should examine treatments that aim to reduce mortality in these highest risk patients.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

July 2011

Volume

162

Issue

1

Start / End Page

89 / 97

Location

United States

Related Subject Headings

  • Survival Rate
  • Single-Chain Antibodies
  • Shock, Cardiogenic
  • Retrospective Studies
  • Outcome Assessment, Health Care
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Injections, Intravenous
  • Incidence
 

Citation

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French, J. K., Armstrong, P. W., Cohen, E., Kleiman, N. S., O’Connor, C. M., Hellkamp, A. S., … Mahaffey, K. W. (2011). Cardiogenic shock and heart failure post-percutaneous coronary intervention in ST-elevation myocardial infarction: observations from "Assessment of Pexelizumab in Acute Myocardial Infarction". Am Heart J, 162(1), 89–97. https://doi.org/10.1016/j.ahj.2011.04.009
French, John K., Paul W. Armstrong, Eric Cohen, Neal S. Kleiman, Christopher M. O’Connor, Anne S. Hellkamp, Amanda Stebbins, et al. “Cardiogenic shock and heart failure post-percutaneous coronary intervention in ST-elevation myocardial infarction: observations from "Assessment of Pexelizumab in Acute Myocardial Infarction".Am Heart J 162, no. 1 (July 2011): 89–97. https://doi.org/10.1016/j.ahj.2011.04.009.
French JK, Armstrong PW, Cohen E, Kleiman NS, O’Connor CM, Hellkamp AS, Stebbins A, Holmes DR, Hochman JS, Granger CB, Mahaffey KW. Cardiogenic shock and heart failure post-percutaneous coronary intervention in ST-elevation myocardial infarction: observations from "Assessment of Pexelizumab in Acute Myocardial Infarction". Am Heart J. 2011 Jul;162(1):89–97.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

July 2011

Volume

162

Issue

1

Start / End Page

89 / 97

Location

United States

Related Subject Headings

  • Survival Rate
  • Single-Chain Antibodies
  • Shock, Cardiogenic
  • Retrospective Studies
  • Outcome Assessment, Health Care
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Injections, Intravenous
  • Incidence