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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Predictive value of the baseline electrocardiogram ST-segment pattern in cardiogenic shock: Results from the
Tuija Javanainen1, Heli Tolppanen1, Johan Lassus1
1Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Insights
ST-segment elevation on ECG indicates acute coronary syndrome and higher mortality in cardiogenic shock patients. Non-ST-elevation patterns suggest other causes, requiring different management strategies for better outcomes.
Area of Science:
- Cardiology
- Internal Medicine
- Emergency Medicine
Background:
- Cardiogenic shock (CS) most commonly stems from acute coronary syndrome (ACS), but non-ACS causes account for 20%-50% of cases.
- Electrocardiogram (ECG) ST-segment deviations are well-studied in ACS-related CS, but less so in CS from other etiologies.
- Understanding ST-segment patterns in diverse CS etiologies is crucial for diagnosis and prognosis.
Purpose of the Study:
- To investigate the prevalence of different ST-segment patterns in cardiogenic shock.
- To explore associations between ST-segment patterns, CS etiology, clinical features, and 90-day mortality.
- To differentiate CS etiologies based on ECG findings.
Main Methods:
- Analysis of baseline ECGs from 196 patients in a multinational prospective CS study.
- Classification of patients into ST-segment elevation (STE), ST-segment depression (STDEP), and no ST-segment deviation (NSTD) groups.
- Subgroup analysis of patients with ACS and examination of 90-day mortality.
Main Results:
- ST-segment deviations were observed in 80% of patients (52% STE, 29% STDEP).
- STE was linked to ACS etiology; however, 25% of STDEP cases had non-ACS causes.
- Overall 90-day mortality was 41%, with higher rates in STE (47%) compared to STDEP (36%) and NSTD (33%).
- Multivariate analysis identified STE as the sole predictor of mortality (HR 1.74).
Conclusions:
- ST-segment elevation in cardiogenic shock is associated with ACS and increased mortality.
- Absence of STE warrants consideration of alternative CS etiologies.
- In ACS-related CS, effective revascularization leads to similar prognoses irrespective of the ST-segment pattern.
Background:
The most common aetiology of cardiogenic shock (CS) is acute coronary syndrome (ACS), but even up to 20%-50% of CS is caused by other disorders. ST-segment deviations in the electrocardiogram (ECG) have been investigated in patients with ACS-related CS, but not in those with other CS aetiologies. We set out to explore the prevalence of different ST-segment patterns and their associations with the CS aetiology, clinical findings and 90-day mortality.
Methods:
We analysed the baseline ECG of 196 patients who were included in a multinational prospective study of CS. The patients were divided into 3 groups: (a) ST-segment elevation (STE). (b) ST-segment depression (STDEP). (c) No ST-segment deviation or ST-segment impossible to analyse (NSTD). A subgroup analysis of the ACS patients was conducted.
Results:
ST-segment deviations were present in 80% of the patients: 52% had STE and 29% had STDEP. STE was associated with the ACS aetiology, but one-fourth of the STDEP patients had aetiology other than ACS. The overall 90-day mortality was 41%: in STE 47%, STDEP 36% and NSTD 33%. In the multivariate mortality analysis, only STE predicted mortality (HR 1.74, CI95 1.07-2.84). In the ACS subgroup, the patients were equally effectively revascularized, and no differences in the survival were noted between the study groups.
Conclusion:
ST-segment elevation is associated with the ACS aetiology and high mortality in the unselected CS population. If STE is not present, other aetiologies must be considered. When effectively revascularized, the prognosis is similar regardless of the ST-segment pattern in ACS-related CS.
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