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Background: Patient presenting with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) have extremely high mortality rates., Objectives: We sought to assess the impact of prior revascularization by either coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) on the in-hospital and 12-month outcomes and compare them with revascularization-naïve patients., Methods and Results: Between 1/2010 and 5/2017, a total of 241 consecutive patients were admitted to our institution with STEMI and CS as defined by New York State Percutaneous Coronary Interventions Reporting System (PCIRS) and underwent primary PCI. Baseline clinical, angiographic and procedural characteristics, as well as in-hospital outcomes were prospectively collected among all patients undergoing primary PCI as part of the New York State PCIRS data collection. Patients with a history of prior bypass graft surgery were older and had a history of heart failure, hypertension, dyslipidemia, and diabetes. The left anterior descending coronary artery was usually the culprit vessel in post PCI and revascularization naïve patients, whereas it was a vein graft in patients with a prior history of surgical bypass. In-hospital mortality rates were different in the three groups and there was no significant difference in major adverse cardiac and cerebrovascular events rates among the three groups (p = 0.87). Notably, revascularization-naïve patients had higher rates of major bleeding complications (p = 0.006). By multivariable analysis, only age (OR 1.03; CI = 1.0-1.06), a prior history of congestive heart failure (OR 4.36, CI = 1.04-18.38) and dyslipidemia (OR 0.32 CI = 0.15-0.64) were independent predictors of 12-month mortality. Prior revascularization had no impact on rates of stroke, death or MACCE., Conclusions: Patients with acute STEMI and CS had similar in-hospital and one year mortality, stroke or major adverse cardiac and cerebrovascular events rates irrespective of their prior revascularization status., (Copyright © 2018. Published by Elsevier Inc.)

Pregnant women with underlying heart disease (HD) are at increased risk for adverse maternal and fetal outcomes. In this study, we sought to identify the risk and risk factors for adverse maternal and fetal events in pregnant women with underlying HD. Pregnant women referred for echocardiogram with known or suspected HD were categorized into those with (1) cardiomyopathy, (2) other HD (congenital, coronary, arrhythmia, or valvular), and (3) no HD. Primary outcome was major adverse cardiovascular events (MACE), defined as a composite of death, sustained arrhythmia, myocardial infarction, heart failure, and transient ischemic attack/stroke. Secondary outcome was fetal adverse clinical events (FACE), a composite of infant death, prematurity, underweight status, intracranial hemorrhage, and respiratory distress. Of the 173 pregnancies, 37 (21%) had cardiomyopathy, 65 (38%) had other HD, and 68 (39%) had no HD. MACE was higher in pregnancies with cardiomyopathy (p <0.001) because of higher rates of heart failure and cardiac arrest (up to 6 months postpartum, p <0.001 and 0.023, respectively). FACE rates were higher in cardiomyopathy pregnancies (p <0.001). In multivariate analysis, cardiomyopathy (odds ratio [OR] 11.5, 95% confidence interval [CI] 3.7 to 35.4), hypertension (OR 10.69, 95% CI 3.70 to 30.90), and arrhythmia (OR 7.6, 95% CI 2.1 to 27) were independently associated with higher MACE. Cardiomyopathy (OR 2.7, 95% CI 1.1 to 7.0) and hypertension (OR 3.6, 95% CI 1.4 to 9.0) were also independently predictive of higher FACE. In conclusion, pregnant women with cardiomyopathy had higher rates of adverse MACE and FACE rates. Cardiomyopathy, hypertension, and arrhythmia were independently associated with adverse cardiovascular and fetal clinical events, whereas other HD was not., (Copyright © 2015 Elsevier Inc. All rights reserved.)