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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients
Laust Obling1, Martin Frydland1, Rikke Hansen2
11 Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Insights
Cardiogenic shock (CS) affects 10% of ST-segment elevation myocardial infarction (STEMI) patients, with most experiencing shock on admission. Regardless of onset, CS significantly increases mortality risk.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Emergency Medicine
Background:
- Cardiogenic shock (CS) complicates up to 10% of ST-segment elevation myocardial infarction (STEMI) cases.
- The incidence of late CS in contemporary STEMI cohorts undergoing primary percutaneous intervention is not well-established.
Purpose of the Study:
- To determine the incidence and timing of CS in STEMI patients admitted for primary percutaneous intervention.
- To identify factors associated with the development of late CS.
Main Methods:
- A prospective study included 2247 patients with suspected STEMI undergoing coronary angiography over one year.
- CS was defined by clinical criteria and categorized by onset: on admission, during catheterization, or later hospitalization.
- All-cause mortality follow-up was conducted via registries.
Main Results:
- CS developed in 10% (225/2247) of STEMI patients.
- The majority of CS cases (56%) occurred on admission, with 16% during catheterization and 28% as late CS.
- Thirty-day mortality was significantly higher in CS patients (47%) compared to non-CS patients (3.1%).
- Independent predictors for late CS included age, stroke, symptom-to-intervention time, anterior STEMI, heart rate/systolic blood pressure ratio, and coma post-resuscitation.
Conclusions:
- CS complicates 10% of STEMI admissions, with most patients presenting in shock.
- Mortality remains high for STEMI patients who develop CS, irrespective of shock onset timing.
- Identifying predictors of late CS is crucial for timely intervention and improved outcomes.
Background:
The incidence of cardiogenic shock (CS) in patients with ST-segment elevation myocardial infarction (STEMI) is as high as 10%. The majority of patients are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for primary percutaneous intervention remains unknown.
Aim:
The aim of this study was to assess the incidence and time of CS onset in patients with suspected STEMI admitted in two high-volume tertiary heart centres and to assess the variables associated with the development of late CS.
Methods:
We included consecutive patients admitted for acute coronary angiography with suspected STEMI in a 1-year period. Cardiogenic shock was based on clinical criteria and subdivided into patients with shock on admission, patients developing shock during catheterisation and patients developing shock later during hospitalisation. Follow-up for all-cause mortality was done using registries.
Results:
A total of 2247 patients with suspected STEMI were included, whereof 225 (10%) developed CS. The majority (56%) had CS on admission, 16% developed CS in the catheterisation laboratory and 28% developed late CS. Thirty-day mortality was 3.1% versus 47% in non-CS versus CS patients ( plogrank < 0.0001). Age, stroke, time from symptom onset to intervention, anterior STEMI, heart rate/systolic blood pressure ratio and being comatose after resuscitation from cardiac arrest were independently associated with the development of late CS.
Conclusion:
In this study, 10% of patients admitted with suspected STEMI for acute coronary angiography presented with or developed CS. Most were in shock on admission. Irrespective of the timing of shock, mortality was high.
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