Association of shock index with short-term and long-term prognosis after ST-segment elevation myocardial infarction
Gjin Ndrepepa1, Salvatore Cassese1, Erion Xhepa1
1Department of Adult Cardiology, Deutsches Herzzentrum München.
Insights
Elevated shock index in ST-segment elevation myocardial infarction (STEMI) patients is linked to higher in-hospital cardiogenic shock and eight-year mortality. However, long-term adverse outcomes are primarily driven by early deaths within 30 days post-procedure.
Area of Science:
- Cardiology
- Clinical Medicine
- Mortalitry Research
Background:
- The prognostic value of the shock index for long-term mortality following ST-segment elevation myocardial infarction (STEMI) is not well-established.
- This study investigates the association between the shock index and eight-year mortality in STEMI patients.
Purpose of the Study:
- To determine the relationship between the shock index and long-term mortality after primary percutaneous coronary intervention (PPCI) in STEMI patients.
- To assess the risk of in-hospital cardiogenic shock and mortality up to eight years post-PPCI based on shock index tertiles.
Main Methods:
- A cohort of 1369 STEMI patients undergoing PPCI was analyzed.
- Patients were stratified into three groups based on shock index tertiles (0.21-0.52, >0.52-0.67, >0.67-2.80).
- The primary endpoint was eight-year mortality, with secondary analyses including in-hospital cardiogenic shock and 30-day mortality.
Main Results:
- Higher shock index tertiles were significantly associated with increased rates of in-hospital cardiogenic shock (26.2% in the highest tertile) and 30-day mortality (18.5% in the highest tertile).
- Eight-year mortality also showed a significant association with the shock index (36.1% in the highest tertile).
- Risk estimates for mortality increased per 0.1 unit increment in shock index, but long-term mortality from 30 days to 8 years did not differ significantly between tertiles.
Conclusions:
- An elevated shock index in STEMI patients undergoing PPCI is a significant predictor of in-hospital cardiogenic shock and mortality up to eight years.
- The observed long-term adverse prognosis is predominantly influenced by mortality events occurring within the first 30 days after PPCI.
Background:
The association of shock index with long-term mortality after ST-segment elevation myocardial infarction (STEMI) remains poorly investigated. We aimed to assess the association between shock index and eight-year mortality after STEMI.
Methods:
The study included 1369 patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). Patients were categorized into three groups: a group with shock index in the first tertile (shock index, 0.21 to 0.52; n = 458), a group with shock index in the second tertile (shock index > 0.52 to 0.67; n = 457) and a group with shock index in the third tertile (shock index > 0.67 to 2.80; n = 454). The primary outcome was eight-year mortality.
Results:
In patients with shock index in the first to third tertiles, inhospital cardiogenic shock (n = 153) occurred in 3.5, 3.9 and 26.2% of patients, respectively [adjusted odds ratio = 1.54, 95% confidence interval (CI) 1.40 to 1.69, P < 0.001]; 30-day deaths (n = 122) occurred in 2.8, 5.5 and 18.5% of patients, respectively [adjusted hazard ratio = 1.06 (1.01-1.12); P = 0.024]; eight-year deaths (n = 300) occurred in 22.9, 21.6 and 36.1% of patients, respectively [adjusted hazard ratio = 1.06 (1.02-1.11); P = 0.007] with all risk estimates calculated per 0.1 unit increment in shock index values. From 30 days to 8 years, deaths (n = 178) occurred in 20.7, 17.0 and 21.5% of patients in the first to third shock index tertiles, respectively (the difference was nonsignificant for all intertertile comparisons).
Conclusions:
In patients with STEMI, elevated shock index is associated with the risk of inhospital cardiogenic shock and mortality up to 8 years after PPCI. The long-term adverse prognosis was almost entirely driven by events within the first 30 days.
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