330 Immediate prognosis of STEMI complicated by cardiogenic shock requiring circulatory assist device. About 2700 patients in the Regional Acute Myocardial Infarction Registry of Brittany (ORBI)

PurposeRecent improvement in management of), and notably reduction of delays to coronary reperfusion, allowed a decrease of the incidence of ischemic. Moreover, (CAD) are more and more accessible. This study aims at determining the actual epidemiology and intra-hospital prognosis of ST-Elevation Myocardial Infarction (STEMI) complicated by cardiogenic shock (CS) requiring circulatory assist device (CAD).MethodsWe analyzed data collected between June 06 and September 09 in the “Observatoire Régional Breton sur l’Infarctus (ORBI)”, a registry of all patients admitted to an interventional cardiology centre of Brittany in the acute phase of a STEMI, within 24h of symptoms onset. Main clinical data and intra hospital outcome were compared between ORBI patients requiring CAD for CS (group 1) and those who didn’t require CAD (group 2).ResultsAmong 2700 patients included in the ORBI registry, 101 patients (3.7%) required CAD: intra aortic balloon pump (IABP), 93 patients (3.4%), extra corporal life support (ECLS), 2 patients (0.07%), IABP and ECLS, 6 patients (0.2%). Main clinical data are summarized in table 1. Group 1 mortality was high (38%), compared to the low mortality in group 2 (4%, p<0.0001). Mean length of hospitalisation was significantly higher in the group 1 than in the group 2 (respectively 8.9±7 and 6.7±4 days, p=0.03). Factors associated with CAD requiring were: age, anterior area STEMI, coronary angioplasty, three-vessel or left main coronary artery disease and haemo dynamic parameters (heart rate, blood pressure, grade 3 or 4 Killip, left ventricular ejection fraction (LVEF)). In group 1, predictive factors of mortality were: age, three-vessel or left main coronary artery disease, blood pressure, grade 3 or 4 Killip and LVEF.Table 1 (abstract 330).nGroup 1n=101Group 2n=2599pGroup 1deceased patients n=38Group 1alive patients n=63pPatientsAge (years)65,7±1262,6±130,0269,4±963,4±130,01Male76 (75%)1998 (77%)0,7228 (74%)48 (76%)0,8Hypertension47 (47%)1051 (40%)0,2115 (40%)32 (51%)0,4Diabetes18 (18%)383 (15%)0,397 (19%)11 (17%)1,0Curent smoker26 (27%)959 (37%)0,056 (17%)20 (33%)0,1Prior myorcardial infection9 (9%)202 (8%)0,21 (3%)8 (13%)0,2STEMIAnterior area71 (70%)1104 (57%)< 0,000124 (63%)47 (75%)0,03Mean delay* (minutes)241,9±221261,9±2430,51243±221241±2280,7Thrombolysis prior to admission12 (12%)485 (19%)0,094 (10%)8 (13%)1,0Coronary angioplasty96 (95%)2244 (86%)0,0136 (95%)60 (95%)1,0Thress-vessel or left main coronary artery disease37 (37%)418 (17%)< 0,000122 (58%)15 (24%)< 0,0001HermondynamicHeart rate at the admission (/min)81,9±2576,1±180,0285,9±3179,5±220,3Blood pressure at the admission (nmHg)108,0±32132,3±26< 0,000195,2±30115,7±320,02Grade 3 and 4 Kilip at the admission41 (43%)108 (4%)< 0,000124 (71%)17 (28%)< 0,0001Left ventricular ejection fraction37,3±1250,9±10< 0,000131,7±1240,6±9< 0,0001*Mean delay is mean delay between onset of symptoms ans admission in the international cardiology centre ST-Elevation Myocardial infarction Group 1: « Circulatory Assist Device requing », Group 2 : « Non circulatory Assist Device requingConclusionDespite recent improvement in the management of STEMI, incidence of patients requiring CAD for CS is still high, and mortality elevated