New insights in the management of cardiogenic shock complicating myocardial infarction: Role of urgent heart transplantation

Objective: This study assessed the role of heart transplantation (HTx) in the management of patients with acute myocardial infarction (MI) complicated by refractory cardiogenic shock despite percutaneous coronary intervention (PCI). The primary end-point of the study was mortality at the I-year follow-up. Methods: Between January 2001 and December 2005, 74 consecutive patients with acute MI complicated with cardiogenic shock were retrospectively analyzed. Thirty-nine patients did not have a contraindication for HTx and qualified for the study (age < 65 years, no comorbidities). Results: Urgent HTx was performed in 10 patients. The remaining 29 patients served as controls. The HTx vs no HTx groups were well balanced in age (50 vs 53 years), proportion of multivessel disease (30% vs 10%), cardiac index (2.2 vs 2.4 liters/min/m(2)), and left ventricular ejection fraction (23% vs 25%). Mortality rates were significantly lower in the HTx group, both in the hospital (10% vs 45%, p < 0.03) and at 1 year (10% vs 52%, p < 0.03). Survival at 1 year among patients alive at hospital discharge was 100% in the HTx group vs 94% in the no HTx group. Conclusions: Urgent HTx dramatically improves survival of acute MI patients presenting with refractory cardiogenic shock despite early PCI. Therefore, this approach-wherever feasible-needs to be considered in the management of this particular subset of patients.