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Updated: Feb 11, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
[Risk factors and treatment of patients with ST-segment elevation myocardial infarction with cardiogenic shock]
Insights
Cardiogenic shock (CS) significantly increases mortality in ST-segment elevation myocardial infarction (STEMI) patients. Early invasive treatment within six hours of symptom onset is crucial for improving survival rates in STEMI with CS.
Area of Science:
- Cardiology
- Acute Coronary Syndromes
- Critical Care Medicine
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring prompt management.
- Cardiogenic shock (CS) is a severe complication of STEMI, significantly impacting patient outcomes.
- Understanding risk factors and prognosis in STEMI patients with CS is vital for improving survival.
Purpose of the Study:
- To evaluate risk factors and prognosis in STEMI patients experiencing cardiogenic shock in Poland.
- To compare treatment outcomes and survival rates between STEMI patients with and without CS.
- To analyze the specific prognosis of men and women diagnosed with CS.
Main Methods:
- Analysis of data from the Polish Registry of Acute Coronary Syndromes (PL-ACS) between 2008-2012.
- Inclusion of 57,400 consecutive STEMI patients.
- Comparative analysis of treatment results and prognosis for patients with and without CS, including a subgroup analysis for sex differences.
Main Results:
- Cardiogenic shock (CS) was diagnosed in 6.3% of STEMI patients, with a higher prevalence in women (7.3%) versus men (5.7%).
- CS was identified as the strongest predictor of both in-hospital (OR 2.51) and 12-month mortality (OR 2.09).
- Factors associated with the worst prognosis included pulmonary edema, advanced age, bundle branch block, atrial fibrillation, and anterior MI; however, early invasive strategy within six hours reduced mortality.
Conclusions:
- Cardiogenic shock remains a significant complication of STEMI, adversely affecting both short-term and long-term prognosis despite treatment advancements.
- The time from symptom onset to treatment is a critical determinant in managing STEMI patients with CS.
- Improved survival chances are linked to prompt diagnosis, effective management, and the implementation of a comprehensive interventional strategy, warranting further research into novel treatments and risk identification.
Aim:
To assess risk factors and prognosis in patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (CS) in Poland.
Methods:
Data from The Polish Registry of Acute Coronary Syndromes (PL-ACS) were analysed in 2008-2012. A total of 57400 consecutive STEMI patients included. The results of treatment and prognosis of patients with and without CS were compared. An additional analysis of the prognosis of men and women with CS was performed.
Results:
There were 34.2% of women and 65.8% of men. CS was diagnosed in 3589 (6.3%) patients (females 7.3% vs. males 5.7%, p<0.003). In multivariate analysis CS was the strongest factor affecting both inhospital (OR 2.51; 95%CI 2.25-2.80; p<0.0001) and 12-month (OR 2.09; 95%CI 1.96-2.24; p<0.0001) mortality. The worst prognosis was associated with pulmonary edema, advanced age, left or right bundle branch block, atrial fibrillation, and anterior MI. An early invasive strategy up to six hours from the symptom onset were the only factors reducing in-hospital and 12-month mortality. Despite of high female ratio in the group with CS and higher mortality in the female group, the female sex did not influence the in-hospital prognosis.
Conclusion:
In spite of enormous progress in the treatment of STEMI cardiogenic shock remains an important complication affecting the in-hospital and long-term prognosis. A symptom onset-to-treatment time is the key element in the management of patients with CS. Proper diagnosis and management including wide interventional strategy implementation increase the survival chance. An intensive study on novel treatment modalities and on effective identification methods of patients at risk and are warranted.
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