• Deep Chandh Raja, Aashish Chopra, Vijayakumar Subban, Rashmi Maharajan, Harini Anandhan, Nandhakumar Vasu, Jawahar Farook, Ramachandran Paramasivam, Srinivasan Narayanan, Kalaichelvan Uthayakumaran, Balaji Pakshirajan, Suma Victor, Ramkumar Solirajaram, Jaishankar Krishnamoorthy, Ezhilan Janakiraman, Ulhas M Pandurangi, Latchumanadhas Kalidoss, and Ajit Sankaradas Mullasari.
• Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India.
• Indian Heart J. 2018 Dec 1; 70 Suppl 3: S259-S264.

BackgroundStudying the outcomes in patients presenting with cardiogenic shock with ST-segment elevation myocardial infarction (CS-STEMI) and undergoing primary or rescue percutaneous coronary intervention (PCI) may give an insight to the unmet needs in STEMI-care in our region and may help in future recommendations in improving survival.Materials And MethodolgyDuring the period from January 2001- June 2017, there were 114 patients included in the study. The demographic, clinical and angiographic characteristics were compared between the survivors and non-survivors. All these variables were also compared between two-time frames (Phase 1- January 2001 to June 2007; Phase 2- July 2007 to June 2017).ResultsAmong patients undergoing PCI for STEMI, 7.5% were in cardiogenic shock. In-hospital mortality for the patients included in the study was 53.5%. Total ischemic time (OR=0.99, 0.99-1; p=0.02), left ventricular ejection fraction (LVEF) (OR=0.90, 0.82-0.98; p=0.02), need for cardio-pulmonary resuscitation (OR=0.12, 0.24-0.66; p=0.01), and post PCI TIMI flows (OR=0.08, 0.02-0.29; p<0.001) were the significant determinants of in-hospital mortality in the regression analysis. There was no significant change in mortality between the two phases of the study, though there was a reduction in total ischemic and door-to-balloon times, transfer admissions, use of thrombolytics, glycoprotein IIb/IIIa inhibitors, intra-aortic balloon pump, and mechanical ventilation in phase 2.ConclusionPatients presenting in CS-STEMI and undergoing PCI continue to experience high mortality rates, despite improvements in total ischemic times. Further improvement in the systems-of-care are required to bring about reduction in mortality in this high-risk subset.Copyright © 2018. Published by Elsevier B.V.

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