Cor Vasa 2007, 49(12):448-453 | DOI: 10.33678/cor.2007.158

Prognosis of patients with mechanical ventilation in the acute phase of myocardial infarction in the era of primary coronary intervention

Radovan Jirmář, Martin Pěnička, Zuzana Moťovská, Petr Widimský

III. interní-kardiologická klinika, Fakultní nemocnice Královské Vinohrady a 3. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

Aim:
1. To determine the prognosis of patients treated by primary coronary intervention (PCI) for acute myocardial infarction (MI) requiring mechanical ventilation (MV) in the acute phase of MI.
2. To analyze the causes of death of these patients.
3. To compare the long-term mortality of the group of acute IM patients receiving MV with the group without MV.


Patient group:
The long-term prognosis of a group of 510 patients from Prague region, admitted for acute MI (STEMI and non-STEMI) over the period from January 2003 through December 2005, and indicated for PCI, was assessed retrospectively.

Results:
In the group of 510 acute MI patients, resident in Prague, MV in the acute phase was required by 43 (8.4%) patients, with a mean age of 67.4 ± 13 years (Group A). The indications for MV included cardiogenic shock or pulmonary edema in 36 (84%) of these patients, and cardio-pulmo-cerebral resuscitation (CPCR) for primary malignant arrhythmias was indicated 7 (16%) patients. The remaining 467 MI patients, with a mean age of 66.6 ± 12 years, did not require MV (Group B). Total one-month and one-year mortality rates were 48.8% and 60.5% in Group A, and 6.3% and 12.6% in Group B, respectively (A vs. B: HR 6.23; 95% CI /3.95-9.82/; p = 0.000000005).
In the subgroup of patients requiring MV only for malignant arrhythmias, these mortality rates were 28.6% and 28.6%, respectively. Group A patients developed serious extracardiac complications (severe hypoxic encephalopathy, aspiration, severe infection, GIT bleeding) in 34% of cases. The mean length of hospitalization of Group A patients discharged to receive home care was 16.7 days. The cause of death in Group A patients was cardiac in 77%, non-cardiac in 12%, and unidentified in 11%.

Conclusion:
In the current era of AMI management by PCI, the need for MV/CPCR in the acute phase arises in an approx. 8% of cases. These patients are characterized by high mortality rates inherent to the nature of their condition. However, compared with literary data reported in the pre-PCI era, the mortality of these patients receiving current therapy is substantially lower. Patients on MV following CPCR for primary malignant arrhythmias have a relatively favorable prognosis if treated by PCI.

Keywords: Myocardial infarction; Prognosis; Mechanical ventilation; Primary coronary intervention

Published: December 1, 2007  Show citation