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04.07.2016 | Original Paper | Ausgabe 12/2016

Clinical Research in Cardiology 12/2016

Culprit lesion location and outcome in patients with cardiogenic shock complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial

Zeitschrift:
Clinical Research in Cardiology > Ausgabe 12/2016
Autoren:
Georg Fuernau, Karl Fengler, Steffen Desch, Ingo Eitel, Franz-Josef Neumann, Hans-Georg Olbrich, Antoinette de Waha, Suzanne de Waha, Gert Richardt, Marcus Hennersdorf, Klaus Empen, Rainer Hambrecht, Christian Jung, Michael Böhm, Janine Pöss, Ruth H. Strasser, Steffen Schneider, Taoufik Ouarrak, Gerhard Schuler, Karl Werdan, Uwe Zeymer, Holger Thiele
Wichtige Hinweise
G. Fuernau and K. Fengler contributed equally to the manuscript.

Abstract

Background

In myocardial infarction without cardiogenic shock (CS), the affected coronary vessel has significant influence on the final infarct size and patient prognosis. CS data on this relation are scarce. The objective of this study was to determine the prognostic relevance of the culprit lesion location in patients with CS complicating acute myocardial infarction.

Methods

In the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial patients with CS were randomized to therapy with intraaortic balloon pump or control. Additional CS patients not eligible for the randomized trial were included in a registry. We compared the location of the culprit lesions in these patients with regard to the affected coronary vessel [left main (LM), left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA)] and location within the vessel (proximal, mid or distal) regarding short- and long-term outcome.

Results

Of 758 patients, the majority had the culprit lesion in the LAD (44 %) compared to RCA (27 %), LCX (19 %) or LM (10 %). Proximal lesions were more frequent than mid or distal culprit lesions (60 vs. 27 vs. 13 %, p < 0.001). No differences were observed for mortality with respect to either culprit vessel (log-rank p value = 0.54). In contrast, a higher mortality was observed for patients with distal culprit lesions after 1 year (log-rank p value = 0.04). This difference persisted after multivariable adjustment (hazard ratio for distal lesions 1.40; 95 % confidential interval 1.03–1.90; p = 0.03).

Conclusion

For patients with CS complicating myocardial infarction, the culprit vessel seems to be unrelated with mortality whereas distal culprit lesions may have a worse outcome

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