Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock

Objectives The mortality of patients with cardiogenic shock (CS) complicating ST elevation acute myocardial infarction (STEMI) remains high, despite early revascularization. Current knowledge of predictors of death is limited. Background The pathophysiologic understanding of CS after acute myocardial infarction has shifted from a mere hemodynamic disorder to a more complex approach including imbalance in metabolic functions. Methods In 45 consecutive patients (71.4 ± 13 years) with CS complicating STEMI treated with primary percutaneous coronary intervention (PCI) serum levels of lactate, glucose and uric acid on coronary care unit (CCU) admission were measured. The end-point was in-hospital death. Results The following parameters, on CCU admission, were univariate predictors of in-hospital mortality: serum glucose > 200 mg/dl (OR = 11.3, p = 0.002), serum creatinine > 1.5 mg/dl (OR = 12.7, p = 0.003), uric acid > 6.5 mg/dl (OR = 6.7, p = 0.016), lactate > 6.5 mmol/l (OR = 54, p < 0.0001), age ≥ 75 years (OR = 8.5, p = 0.002), history of hypertension (OR = 8.3, p = 0.003) and TIMI flow post PCI ≤ 2 (OR = 12.9, p = 0.02). At multivariate analysis, after adjustment for sex, age, hypertension and diabetes, lactate > 6.5 mmol/l and TIMI flow post PCI ≤ 2 were still independent predictors of in-hospital mortality (OR = 295, p = 0.01; OR = 19.5, p = 0.04, respectively). Conclusions Hyperlactatemia, hyperglycemia and increased levels of uric acid on CCU admission are univariate predictors of in-hospital death. Moreover, at multivariate analysis, hyperlactatemia (> 6.5 mmol/l) is an independent indicator of in-hospital death in CS patients complicating STEMI.