Efficacy of reperfusion therapy in acute myocardial infarction complicated by cardiogenic shock]

Efficacy of reperfusion therapy was studied in 40 patients with acute myocardial infarction complicated with cardiogenic shock. Among them, 27 were treated with intracoronary thrombolysis (ICT) and/or coronary angioplasty (Group I), and 13 were untreated by reperfusion therapy (Group II). In Group I, reperfusion was successful in 17 (Group Ia). It was unsuccessful in the other 10 (Group Ib). Patients' characteristics such as age, sex, infarct location, previous myocardial infarction, peak creatine kinase, and the extent of coronary artery disease were similar in Groups Ia and Ib. The in-hospital survival rate was significantly higher in Group Ia (76.5% vs 40.0%, p < 0.01). There was no significant difference in the average hospital and CCU stays, total or maximal dosage of catecholamines (dopamine and dobutamine), and duration of IABP treatment of the discharged patients between Groups Ia and Ib. Cardiac index under pressure support (IABP, catecholamines, etc) in both Groups did not differ significantly. One patient in Group Ia had re-infarction. However, no patient in either group died during a mean follow-up period of 747 days. Among the surviving patients, 3 (23%) of Group Ia and all (100%) of Group Ib suffered from congestive heart failure. These findings suggested that reperfusion therapy improves the in-hospital survival rate in patients with cardiogenic shock. Therefore, reperfusion therapy may be recommended for cardiogenic shock secondary to acute myocardial infarction.