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Long-Term Clinical Impact of Cardiogenic Shock and Heart Failure on Admission for Acute Myocardial Infarction

Hideki Wada1, Manabu Ogita1, Satoru Suwa1

  • 1Department of Cardiology, Juntendo University Shizuoka Hospital.

International Heart Journal
|May 17, 2021
PubMed

Insights

Patients with cardiogenic shock (CS) after acute myocardial infarction (AMI) have worse long-term outcomes. Early heart failure (HF) without CS also impacts survival, necessitating focused care for better long-term AMI outcomes.

Area of Science:

  • Cardiology
  • Clinical Outcomes Research
  • Acute Myocardial Infarction

Background:

  • Long-term outcomes for acute myocardial infarction (AMI) patients surviving cardiogenic shock (CS) and heart failure (HF) are not well-defined.
  • Understanding post-discharge prognosis is crucial for managing these high-risk patients.

Purpose of the Study:

  • To evaluate the long-term clinical outcomes of AMI patients with and without CS.
  • To identify factors associated with 30-day mortality in AMI patients with CS.
  • To compare long-term mortality between AMI patients with CS, those with HF but no CS, and those with neither.

Main Methods:

  • Analysis of 3263 AMI patients from the prospective J-MINUET registry (Japan, 2012-2014).
  • Patients categorized into CS-/HF-, CS-/HF+, and CS+ groups.
  • Multivariate logistic and Cox hazard regression models used to assess 30-day and long-term mortality, respectively.

Main Results:

  • Thirty-day mortality was 32.8% in the CS+ group.
  • Pre-admission statin use, renal deficiency, and final thrombolysis in myocardial infarction flow grade were associated with 30-day mortality in CS+ patients.
  • Long-term mortality (up to 3 years) was comparable between CS+ and CS-/HF+ groups, and significantly higher than in the CS-/HF- group.

Conclusions:

  • AMI patients with CS who survive the initial 30 days face worse long-term outcomes compared to those without CS.
  • Patients with heart failure but no cardiogenic shock also have poorer long-term prognosis than those without HF or CS.
  • Clinical attention should focus on improving long-term outcomes for AMI patients, particularly those presenting with HF without CS.

Keywords:
Acute coronary syndromeAsian population, Long-term outcomesCoronary artery disease

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