Abstract Background : Cardiogenic shock (CS) is the leading cause of death for patients with acute myocardial infarction who alive until hospitalization. Despite the advantages of early percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG), the mortality rate remains high (~ 50%).In Siriraj Hospital, there were no data about the prevalence of acute coronary syndrome (ACS) with CS.
Objective : The aim of this study is to determine the prevalence of ACS complicated with CS in Siriraj Hospital and to demonstrate the assoiation between the clinical characterisics, treatment strategy and the in-hospital mortality.
Methods : Between January 1999 and December 2004, data were retrospectively collected from 60 consecutive patients admitted with documented acute coronary syndrome (ACS) complicated by shock at Siriraj Hospital.
Results : The study included 60 patients were admitted with ACS with cardiogenic shock, including 32 (53.3%) ST-segment elevation myocardial infarction (STEMI) patients and (46.7%) non ST-segment elevation myocardial infarction (NSTEMI) patients. The mean (SD) age of the patients was 66.4 (10.4) years, 40 (66.7%) patients were men. The overall rate of in-hospital mortality of the study population was 38 (63.3%) patients. Among 41 patients were performed coronary angiogram revealed ; triple vessels disease (TVD) 28 (46.7%) patients, double vessels (DVD) 13 (21.7%) patients, single vessel 8 (13.3%) patients. Treatment strategies included ; percutaneous coronary angioplasty (PTCA) 38 (63.3%) patients, bypass surgery (CABG) 17 (28.3%) patients, intra aortic balloon counter pulsation (IABP) 58 (96.7%) patients, temporary pacemaker 16 (26.7%) patients, dialysis 21 (35%) patients. All STEMI patients were reperfusion therapy ; thrombolysis 8 patients, primary PTCA 20 patients and CABG 5 patients.
Conclusions : Acute STEMI was the leading caused of ACS with cardiogenic shock in Siriraj Hospital. The in-hospitality rate was 63.3%. Although we have many treatment modality for life support, In-hospital mortality was more than previous study. Only one variable that associate with mortality was ST segment elevate myocardial infarction (odds ratio 3.0, [95% confidence interval 1.008,8.927], P=0.045
Keyword : Acute myocaridial infarction, Cardiogenic shock, Complication