[Clinical features and treatment of cardiogenic shock complicated with acute myocardial infarction].

Objective: To identify the clinical features and the outcome of patients with cardiogenic shock complicating acute myocardial infarction (AMI).

Methods: One hundred and eight consecutive patients with AMI were included in this retrospective analysis. The characteristics, management, and outcome of patients with AMI were compared between patients with cardiogenic shock (group A, n=11) and without cardiogenic shock (group B, n=9).

Results: There was no difference in the age and other characteristics including proportion of women, diabetics, prior myocardial infarction and the position of myocardial infarction. The levels of peak creatine kinase and troponin I were (31979.7+/-22271.1)nmol x s(-1) x L(-1) and (90.7+/-61.1) microg/L respectively in group A, they were higher than those in group B (17795.2+/-14979.7)nmol.s-1.L-1 and (39.9+/-52.1) microg/L, respectively (both P<0.05). The left ventricular ejection fraction was significantly lower in group A than that in group B (0.46+/-0.12 vs. 0.55+/-0.12, P<0.05). Patients in group A had a higher proportion of pump failure, arrhythmia and pneumonia (64% vs. 14%, P<0.001; 55% vs. 21 %, P<0.05; and 46% vs. 12%, P<0.01, respectively) than those in group B. In addition, in group A patients often underwent thrombolysis of urokinase, coronary angiography and intra-aortic balloon counterpulsation (46% vs. 18%, 73% vs. 26% and 36% vs. 4%, all P<0.05, respectively). There was no difference in in-hospital mortality between group A and group B (0 vs. 4%, P>0.05).

Conclusion: Shock patients more likely have pump failure, arrhythmia, and pneumonia and more often underwent intra-aortic balloon counterpulsation. If cardiogenic shock complicating AMI is managed with rapid evaluation and prompt initiation of supportive measures and definitive therapy, outcomes can be improved.