심인성쇼크로 관상동맥 중재술 중 대동맥 내 풍선펌프 사용 시 임상 경과 = Outcome of Percutaneous Coronary Intervention with Intra-Aortic Balloon Pump in Patients with Cardiogenic Shock

다국어 초록 (Multilingual Abstract)

Background/Aims: The mortality of hospitalized patients undergoing treatment with an intra-aortic balloon pump (IABP) due to cardiogenic shock is well known as quite high. The aim of this study was to evaluate the outcome of percutaneous coronary intervention (PCI) with an IABP in patients with acute coronary syndrome (ACS) and cardiogenic shock and identify the predictors of in-hospital mortality. Methods: 134 patients who underwent PCI with IABP due to ACS complicated by cardiogenic shock were consecutively enrolled. Outcomes were obtained and analyzed during hospitalization and after 1 year. Results: The incidence of all-cause mortality was 35.8% (in-hospital mortality, 34.3%, 1-year mortality, 1.5%). The nonsurvival group exhibited higher peak levels of creatine kinase MB, lower ejection fractions, and higher incidences of ST elevation myocardial infarction, ventricular arrhythmia, and use of an assistive device than did the survival group. Aging (hazard ratio 2.839, 95% confidence interval 1.408-5.723, p = 0.004), the use of a temporary pacemaker (2.035, 1.114-3.720, 0.021), the use of a mechanical ventilator (4.376, 1.852-10.341, 0.001), and the performance of cardiopulmonary resuscitation (CPR) (2.219, 1.017-4.839, 0.045) were independent predictors for in-hospital mortality. However, out-of-hospital mortality among in-hospital survivors was not affected by predictors of in-hospital mortality. Conclusions: The incidence of in-hospital mortality was high, as expected in patients undergoing PCI with IABP due to ACS with cardiogenic shock. Aging, CPR, and additional procedures such as pacemaker use and mechanical ventilation were predictors of in-hospital mortality. However, the patients who were successfully discharged after the complex procedure showed acceptable 1-year outcomes. (Korean J Med 2015,89:186-191)

참고문헌 (Reference)

1 Cheng JM, "Usefulness of intraaortic balloon pump counterpulsation in patients with cardiogenic shock from acute myocardial infarction" 104 : 327-332, 2009

2 Ten Berg JM, "Ten-year follow-up of percutaneous transluminal coronary angioplasty for proximal left anterior descending coronary artery stenosis in 351patients" 28 : 82-88, 1996

3 Rogers WJ, "Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3" 36 : 2056-2063, 2000

4 Goldberg RJ, "Temporal trends in cardiogenic shock complicating acute myocardial infarction" 340 : 1162-1168, 1999

5 Goldberg RJ, "Six-month outcomes in a multinational registry of patients hospitalized with an acute coronary syndrome (the Global Registry of Acute Coronary Events [GRACE])" 93 : 288-293, 2004

6 Webb JG, "Percutaneous coronary intervention for cardiogenic shock in the SHOCK Trial Registry" 141 : 964-970, 2001

7 Pi K, "Major determinants of survival and nonsurvival of intraaortic balloon pumping" 130 : 849-853, 1995

8 Corral CH, "Intraaortic balloon counterpulsation:an eleven-year review and analysis of determinants of survival" 13 : 39-44, 1986

9 DeWood MA, "Intraaortic balloon counterpulsation with and without reperfusion for myocardial infarction shock" 61 : 1105-1112, 1980

10 Smalling RW, "Improved regional myocardial blood flow, left ventricular unloading, and infarct salvage using an axialflow, transvalvular left ventricular assist device. A comparison with intra-aortic balloon counterpulsation and reperfusion alone in a canine infarction model" 85 : 1152-1159, 1992

11 Sanborn TA, "Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?" 36 : 1123-1129, 2000

12 Kern MJ, "Enhanced coronary blood flow velocity during intraaortic balloon counterpulsation in critically ill patients" 21 : 359-368, 1993

13 Pfeffer MA, "Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators" 327 : 669-677, 1992

14 Hochman JS, "Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock" 341 : 625-634, 1999

15 Farinha JB, "Disease of the left main coronary artery. Surgical treatment and long-term follow up in 267 patients" 42 : 124-128, 1978

16 Gabriel Steg P, "Determinants of use and outcomes of invasive coronary procedures in acute coronary syndromes: results from ENACT" 24 : 613-622, 2003

17 Kern MJ, "Augmentation of coronary blood flow by intra-aortic balloon pumping in patients after coronary angioplasty" 87 : 500-511, 1993

18 Taylor HA, "Asymptomatic left main coronary artery disease in the Coronary Artery Surgery Study (CASS) registry" 79 : 1171-1179, 1989

19 Gurbel PA, "Arterial diastolic pressure augmentation by intra-aortic balloon counterpulsation enhances the onset of coronary artery reperfusion by thrombolytic therapy" 89 : 361-365, 1994