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Updated: Jan 3, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Outcome predictors of cardiogenic shock complicating ST-segment elevation myocardial infarction
Insights
Cardiogenic shock following ST-elevation myocardial infarction has high mortality. Immediate multivessel percutaneous coronary intervention was the sole predictor of early death in these high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Critical Care Medicine
Background:
- Cardiogenic shock complicating ST-elevation myocardial infarction (STEMI) carries a high mortality rate.
- Limited evidence exists for optimal management beyond early revascularization, with intra-aortic balloon pumps showing limited effectiveness.
- Understanding predictors of early mortality is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the outcomes of patients with STEMI complicated by cardiogenic shock.
- To identify predictors of early (30-day) all-cause mortality in this patient population.
Main Methods:
- A prospective study included 122 consecutive patients presenting with STEMI and cardiogenic shock within 48 hours, receiving invasive management.
- Data collected included patient demographics, etiology of shock, procedural details, and 30-day mortality.
- Statistical analysis identified predictors of early mortality.
Main Results:
- The cohort had a mean age of 65 years, with 74.5% males. Left ventricular failure was the most common cause (72.1%).
- 30-day mortality was high at 58.2%.
- Immediate multivessel percutaneous coronary intervention was the only identified predictor of early mortality (OR=4.1, p=0.031).
Conclusions:
- Despite current invasive management strategies, mortality for STEMI with cardiogenic shock remains high at 58.2%.
- Immediate multivessel percutaneous coronary intervention emerged as the sole predictor of early mortality.
- Further research may be needed to refine treatment strategies for this critical condition.
Background:
Cardiogenic shock complicating ST elevation myocardial infarction is burdened by a high mortality. There is only limited evidence for the management except for early revascularization and the relative ineffectiveness of intra-aortic balloon pump.
Aim:
Our objectives were to evaluate outcome and predictors of early all-cause 30-day mortality in the setting of cardiogenic shock complicating ST elevation myocardial infarction.
Methods:
From January 2009 to August 2018, all patients who presented within the first 48 hours of ST elevation myocardial infarction complicated by cardiogenic shock and receiving invasive management were prospectively included.
Results:
The study cohort comprised 122 consecutive patients. The mean age was 65±12 years and 74.5% of patients were males. Left ventricular failure was the most common etiology of cardiogenic shock (72.1%) and mechanical complications occurred in 8.2% of cases. Percutaneous coronary interventions were proposed for all patients and performed in a primary setting in 72.1%. A high prevalence of no reflow was noted (15.6%). Multivessel coronary artery disease was noted in 64.8% and multivessel percutaneous coronary interventions at the index procedure were performed in 22.1% of cases. Intra-aortic balloon pump was used in 17.2% of patients. The 30-day mortality was 58.2%. The only predictor of early mortality was the immediate multivessel percutaneous coronary intervention (OR=4.1, 95%CI 1.1-14.5; p=0.031).
Conclusion:
Despite invasive management strategies, 30-day mortality of cardiogenic shock complicating ST elevation myocardial infarction remained as high as 58.2%. Immediate multivessel percutaneous coronary intervention was the only predictor of early mortality.
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