ST-Segment Elevation Acute Myocardial Infarction Complicated by Cardiogenic Shock: Early Predictors of Very Long-Term
Nicola Cosentino1, Marta L Resta1, Alberto Somaschini2,3
1Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy.
Insights
Long-term mortality remains high for ST-segment elevation myocardial infarction (STEMI) patients with cardiogenic shock (CS). A simple clinical risk score accurately predicts long-term death risk in these high-risk patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Outcomes Research
Background:
- Cardiogenic shock (CS) is a major cause of death in ST-segment elevation myocardial infarction (STEMI).
- Limited data exist on long-term outcomes for STEMI patients with CS receiving contemporary treatments.
- This study investigates long-term mortality and predictors in STEMI patients with CS.
Purpose of the Study:
- To assess long-term mortality in STEMI patients with CS.
- To identify independent predictors of long-term mortality.
- To develop a clinical risk score for predicting long-term mortality.
Main Methods:
- Retrospective analysis of 465 STEMI patients with CS treated with primary angioplasty and intra-aortic balloon pump (2005-2018).
- Primary endpoint: long-term mortality (in-hospital and post-discharge).
- Multivariate analysis to identify predictors; development of a risk score.
Main Results:
- Long-term mortality was 60% (median follow-up 4 years), with 34% in-hospital mortality.
- Independent predictors of long-term mortality: age, lower ejection fraction, higher creatinine, and acute kidney injury.
- Developed risk score showed good predictive accuracy (AUC 0.79 for long-term mortality).
Conclusions:
- STEMI patients with CS face substantial long-term mortality risk.
- A simple clinical risk score derived from baseline variables accurately predicts long-term mortality.
- This score can aid in risk stratification and management of STEMI patients with CS.
Background:
Cardiogenic shock (CS) is the leading cause of in-hospital mortality in ST-segment elevation myocardial infarction (STEMI). Only limited data are available on the long-term outcome of STEMI patients with CS undergoing contemporary treatment. We aimed to investigate long-term mortality and its predictors in STEMI patients with CS and to develop a risk score for long-term mortality prediction.
Methods And Results:
We retrospectively included 465 patients with STEMI complicated by CS and treated with primary angioplasty and intra-aortic balloon pump between 2005 and 2018. Long-term mortality, including both in-hospital mortality and all-cause mortality following discharge from the index hospitalization, was the primary endpoint. The long-term mortality (median follow-up 4 (2.0-5.2) years) was 60%, including in-hospital mortality (34%). At multivariate analysis, independent predictors of long-term mortality were age (HR 1.41, each 10-year increase), admission left ventricular ejection fraction (HR 1.51, each 10%-unit decrease) and creatinine (HR 1.28, each mg/dl increase), and acute kidney injury (HR 1.81). When these predictors were pooled together, the area under the curve (AUC) for long-term mortality was 0.80 (95% CI 0.75-0.84). Using the four variables, we developed a risk score with a mean (cross-validation analysis) AUC of 0.79. When the score was applied to in-hospital mortality, its AUC was 0.79, and 0.76 when the score was applied to all-cause mortality following discharge.
Conclusions:
In STEMI patients with CS, the risk of death is still substantial in the years following the index event. A simple clinical score at the time of the index event accurately predicts long-term mortality risk.
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