Are all patients with cardiogenic shock prognostically equal?

摘要

In this issue of Cardiology, Tsai et al. [1] report on a large series of patients with cardiogenic shock due to AMI of <12 h duration, all treated with primary PCI, recruited over a period of 7 years. All were followed up to 30 days after admission. After excluding those with left main coronary artery as a culprit, and (apparently) those with significant mechanical complications, they were left with 97 patients with anterior MI - in whom the culprit was LAD and 115 patients with 'inferior' MI in whom the culprit artery was either the RCA or LCX. There were no significant differences between both groups in TIMI flow before PCI, culprit lesion length, procedural success rate, time to the 1st balloon dilatation, procedural time and final TIMI-3 flow. Patients with anterior MI had lower LVEF and required ECMO more frequently but had mul-tivessel disease less frequently. Interestingly, 30-day mortality did not significantly differ between groups (33 vs. 27%, respectively). These observations are intriguing and are in discordance with previous reports, although, as the authors correctly point out, there are no studies evaluating this issue in a prospective fashion.