Outcome of patients presenting with ST elevation myocardial infarct and cardiogenic shock: a contemporary single center's experience

Acute ST elevation myocardial infarction (STEMI) presenting with cardiogenic shock (CS) is associated with dismal prognosis. In the last years, significant advances have been made in reperfusion techniques and pharmacological treatment. Therefore, we aimed to assess the outcome of these patients during the past decade and identify major factors that impact their prognosis.

We identified 170 patients who presented with STEMI, CS, and underwent primary percutaneous coronary intervention (PCI) between 2001 and 2011. Patients were allocated into two groups based on period of presentation: 2001-2005 (n = 70) and 2006-2011 (n = 100). Clinical outcomes up to 6 months were evaluated.

Patients in the latter period were younger, and had lower rates of renal failure and higher rates of stent use. Despite these differences, mortality did not differ and remained high in both periods (52-59% at 6 months). Time frames from onset of symptoms to arrival to the emergency department and to performance of coronary intervention were similar in both periods. Intra-aortic balloon pump use was similar in both periods. In multivariate analysis, factors associated with 1-month mortality were: diabetes (OR = 3.6, 1.4-9.4, p = 0.007), LVEF <40% (OR = 1.8, 1.3-2.6, p = 0.001), GFR <60 ml/min/m(2) (OR = 1.8, 1.3-2.4, p < 0.009) and glycoprotein IIb/IIIa inhibitor use (OR = 0.5, 0.2-1.1, p = 0.08). The combination of diabetes and renal failure was associated with particularly high mortality.

Prognosis of patients presenting with STEMI, CS, and treated with primary PCI during the past decade, remains poor. Better risk-stratification may help improve their grave outcome.