This abstract ( reference A100428RB ) was accepted for EuroPCR
BATCHELOR Riley (1,2,3), BATCHELOR Riley (1,2,3), DINH Diem (2), BALL Jocasta (1,2), BLOOM Jason (1,2), TAYLOR Andrew (3), LEFKOVITS Jeffrey (3), STUB Dion (1,2)
(1) The Alfred, VIC, AUSTRALIA; (2) Monash University Clayton Campus, VIC, AUSTRALIA; (3) The Royal Melbourne Hospital, VIC, AUSTRALIA
AIMS
Acute myocardial infarction complicated by cardiogenic shock (AMI‑CS) remains a time‑critical emergency with persistently high mortality despite advances in reperfusion and mechanical circulatory support (MCS). Clinical outcomes may be influenced by the timing of percutaneous coronary intervention (PCI), with after‑hours procedures potentially affected by logistical and staffing constraints. The impact of PCI timing on AMI-CS outcomes remains unclear.
METHODS AND RESULTS
A retrospective cohort study was conducted using data from the Victorian Cardiac Outcomes Registry including all adults undergoing PCI for ST‑elevation myocardial infarction (STEMI) or non‑ST‑elevation myocardial infarction (NSTEMI) complicated by CS. PCI timing was classified as procedure start time in‑hours (0800–1759 weekdays) or after‑hours (all other times). Baseline, procedural, and outcome data were compared. Multivariable logistic regression was used to identify independent predictors of in‑hospital mortality. Long‑term mortality was determined through linkage with the Australian National Death Index. In total, 2,656 AMI‑CS PCI cases were undertaken from 2013-2024; with 58.5% occurring after‑hours. Baseline characteristics were broadly comparable between groups, although STEMI presentation was more frequent (91.2% vs. 84.4%, p<0.001) and door‑to‑device times were greater (82 [57-116] vs 64 [43-93] minutes, p<0.001). Overall MCS use was comparable overall; intra‑aortic balloon pump use was more frequent after‑hours and veno‑arterial extracorporeal membrane oxygenation was more frequent in‑hours. In‑hospital mortality across the cohort was 39.8% and did not differ between groups (adjusted OR 1.04; 95% CI 0.88–1.24; p=0.62). Adjusted one‑year mortality was also similar.
CONCLUSIONS
The majority of AMI‑CS PCI is performed after‑hours, with in-hospital mortality remaining high over the past decade irrespective of procedure timing. These findings underscore the need continued development of shock management paradigms and strategic deployment of emerging treatments in AMI-CS.
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