Emergency percutaneous transluminal coronary angioplasty in acute myocardial infarction complicated with cardiogenic shock

Objective. To approach the efficacy of emergency percutaneous transluminal coronary angioplasty (PTCA) In Chinese patients with acute myocardial infarction (MI) complicated by cardiogenic shock. Methods. Twelve patients with cardiogenic shock treated by emergency PTCA in this institution from January 1990 to May 1994 were retrospectively reviewed. There were anterio-lateral MI in 4 cases, inferio-posterial MI in 7, anterial and inferial MI in 1, of which triple vessel disease in 4 cases, double vessel disease in 6, single vessel disease in 1 and left main coronary artery (LM) disease in 1. PTCA was performed under assistance of IABP in 7 cases and of centrifugal pump in 1. Only infarct-related Coronary artery (IRCA) was dilated during acute phase. Direct PTCA was done in 7 cases and rescue PTCA after failure of thrombolytic therapy in 5. Results. PTCA was successful in 11 (91.7%) of the 12 cases, in 1 case with failure of PTCA the IRCA was reperfused by intracoronary thrombolytic therapy. Cardiogenic shock was reverted in 7 (63.6%) of the 11 cases reperfused by PTCA, among whom 6 (54.5%) survived. Four died of irreversible shock after 3 hours-9 days and 1 case with reversed shock died of cardiac rupture after 4 days. During a period of 13-55 months follow-up, long-term survivals were obtained in 4 cases. Conclusions. Emergensy PTCA can achieve a high success rate and significantly decrease the mortality rate to less than 50% in Chinese patients with acute MI complicated with cardiogenic shock. The patients tolerate the PTCA procedure very well under the assistance of intra-aortic balloon counterpulsation (IABP) even in very severe condition.