A-50 | Primary Percutaneous Coronary Interventions in ST Elevation Myocardial Infarction and Cardiogenic Shock in a Large Metropolitan Healthcare System

Rates of primary percutaneous coronary intervention (PPCI) among patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS) vary between different reports. We identified patients treated in 13 hospitals (6 PPCI-capable) within our network for STEMI and CS (ICD R57.0) between 2016 and 2022. Details of demographics, treatment received, and discharge status were obtained. We compared the characteristics and outcomes of patients treated with and without PPCI. 691 patients were identified presenting with STEMI-CS throughout the study period, details were available for 648 (93%). Patients not treated with PPCI (31%; n=200) were older, female (38% vs. 28%; p=0.012) and had higher rates of interhospital transfer and cardiac arrest on admission (figure 1). Among them, 65% were admitted on the weekend or after-hours, 34% underwent diagnostic left heart catheterization and had significantly lower rates of mechanical circulatory support compared to the PCI group (54% vs. 74%, p<0.001). Hospital mortality was nearly double the no-PCI group, 47% vs. 23% (p<0.001). Frequent reasons for not performing PPCI were severe neurologic injury (14%), complicating medical condition (21%), no culprit vessel (13%), multi-vessel disease referred for CABG (29%; of which 25% did not receive CABG), and inability to perform PCI due to technical issues or hemodynamic collapse (10%). The overall rate of PPCI for STEMI-CS in our cohort was low due to various clinical reasons with high mortality in the no PCI group. Further research is needed to improve the rates of PPCI in this population.