Cardiogenic shock with ST-segment elevation acute coronary syndrome (ReNa-Shock ST)

Cardiogenic shock (CS) in the setting of an ST-segment elevation myocardial infarction (STEMI) is a severe complication and constitutes one of the principal causes of death associated with this condition. The aim of this study was to describe the clinical characteristics, treatment strategies and hospital outcome of CS associated with STEMI in Argentina. The Argentine Registry of Cardiogenic Shock (ReNA-Shock) was a prospective and multicenter registry of consecutive patients with CS hospitalized in 64 centers in Argentina between July 2013 and May 2015. Only those with ST-segment elevation myocardial infarction (STEMI) were selected for this analysis. Of the 165 patients included in the ReNa-Shock registry, 124 presented STEMI. Median age was 64 years (IQR 25-75: 56.5-75) and 67% were men; median time from symptom onset to admission was 240 minutes (IQR 25-75: 132-720). 63% of the cases presented CS at admission. Eighty-seven percent underwent reperfusion therapy: 80% primary percutaneous intervention with a median door-to-balloon time of 110 minutes (IQR 25-75: 62-184). Inotropic agents were used in 96%; 79% required mechanical ventilation; a Swan Ganz catheter was inserted in 47% and 35% required intra-aortic balloon pumping. Most patients (59%) presented multivessel disease (MV). Hospital mortality was 54%. Multivariate analysis identified that time from symptom onset to admission (> 240 min) was the only independent predictor of mortality (OR: 3.04; CI 95%: 1.18-7.9). Despite using treatment strategies currently available, morbidity and mortality of STEMI complicated with CS remains high.