Aims We investigated the relationship between sublingual perfused capillary density (PCD) as a measure of tissue perfusion and outcome (i.e. occurrence of organ failure and mortality) in patients with cardiogenic shock from acute myocardial infarction. Methods and results We performed a prospective study in 68 patients. Using Sidestream Dark Field imaging, PCD was measured after hospital admission (T0, baseline) and 24 h later (T1). We compared patients with baseline PCD ≤ median to patients with baseline PCD > median. Sequential organ failure assessment (SOFA) scores were calculated at both time points. The Kaplan-Meier 30-day survival analyses were performed and predictors of 30-day mortality were identified. The baseline PCD was a predictor of the change in the SOFA score between T0 and T1 (SOFA; ρ = -0.25, P = 0.04). Organ failure recovered more frequently in patients with PCD > median (>10.3 mm mm-2; n = 33) than in patients with PCD ≤ median (n = 35; 52 vs. 29, P < 0.05). Twenty-two patients (32) died: 17 patients (49) with PCD ≤ median vs. 5 patients (15) with PCD > median (P = 0.004). After adjustment, the cardiac power index [odds ratio (OR): 0.48, 95 CI: 0.24-0.94) and PCD (OR: 0.65, 95 CI: 0.45-0.92) remained significant predictors of 30-day outcome. Patients with baseline sublingual PCD ≤ median that improved at T1 had a considerable better prognosis relative to patients who had a persistently low PCD. Conclusion Diminished sublingual PCD, at baseline or following treatment, is associated with development of multi-organ failure and is a predictor of poor outcome in patients with acute myocardial infarction complicated by cardiogenic shock.

Cardiogenic shock, Microcirculation, Organ failure, Outcome, Perfusion
dx.doi.org/10.1093/eurheartj/ehq324, hdl.handle.net/1765/27787
European Heart Journal
Erasmus MC: University Medical Center Rotterdam

den Uil, C.A, Lagrand, W.K, van der Ent, M, Jewbali, L.S.D, Cheng, J.M, Spronk, P.E, & Simoons, M.L. (2010). Impaired microcirculation predicts poor outcome of patients with acute myocardial infarction complicated by cardiogenic shock. European Heart Journal, 31(24), 3032–3039. doi:10.1093/eurheartj/ehq324