Related Experiment Video
Updated: Oct 10, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Early prognostic stratification and identification of irreversibly shocked patients despite primary percutaneous
Luca Falco1, Enrico Fabris1, Caterina Gregorio2
1Cardiothoracovascular Department.
Insights
Early prognostic factors for ST-elevation myocardial infarction (STEMI) with cardiogenic shock (CS) are crucial. Advanced age and prolonged ischemia increase mortality risk, while timely percutaneous coronary intervention (PCI) improves survival in STEMI patients with CS.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- ST-elevation myocardial infarction (STEMI) patients with cardiogenic shock (CS) face high mortality despite advancements.
- Early prognostic factors in this high-risk group, even after revascularization, remain poorly understood.
Purpose of the Study:
- To identify early prognostic factors for 30-day mortality in STEMI patients presenting with CS.
- To stratify risk using data available at first medical contact (FMC).
Main Methods:
- Analysis of 1222 STEMI patients treated with primary percutaneous coronary intervention (PCI) from 2012-2018.
- Development of a decision tree for 30-day mortality risk stratification based on FMC data.
- Multivariate analysis to determine independent predictors of mortality.
Main Results:
- Cardiogenic shock (CS) occurred in 7.5% of STEMI patients, with significantly higher 30-day mortality (33% vs 3%).
- A high-risk subgroup (age ≥76 years, anterior STEMI, ischemia time >3h 21min) showed 85.7% 30-day mortality.
- Independent predictors of mortality in CS patients were older age (OR 1.246), final TIMI flow 2-3 (OR 0.058), and longer ischemia time (OR 1.269).
Conclusions:
- In STEMI with CS, advanced age is a negative prognostic factor, while early and successful PCI improves survival.
- A subset of elderly patients experiences poor prognosis despite revascularization.
- Identifying irreversibly critically ill patients remains challenging, and the impact of PCI in this group is uncertain.
Background:
Despite prognostic improvements in ST-elevation myocardial infarction (STEMI), patients presenting with cardiogenic shock (CS) have still high mortality. Which are the relevant early prognostic factors despite revascularization in this high-risk population is poorly investigated.
Methods:
We analyzed STEMI patients treated with primary percutaneous coronary intervention (PCI) and enrolled at the University Hospital of Trieste between 2012 and 2018. A decision tree based on data available at first medical contact (FMC) was built to stratify patients for 30-day mortality. Multivariate analysis was used to explore independent factors associated with 30-day mortality.
Results:
Among 1222 STEMI patients consecutively enrolled, 7.5% presented with CS. CS compared with no-CS patients had worse 30-day mortality (33% vs 3%, P < 0.01). Considering data available at FMC, CS patients with a combination of age ≥76 years, anterior STEMI and an expected ischemia time > 3 h and 21 min were at the highest mortality risk, with a 30-day mortality of 85.7%. In CS, age (OR 1.246; 95% CI 1.045-1,141; P = 0.003), final TIMI flow 2-3 (OR 0.058; 95% CI 0.004-0.785; P = 0.032) and Ischemia Time (OR = 1.269; 95% CI 1.001-1.609; P = 0.049) were independently associated with 30-day mortality.
Conclusions:
In a contemporary real-world population presenting with CS due to STEMI, age is a relevant negative factor whereas an early and successful PCI is positively correlated with survival. However, a subgroup of elderly patients had severe prognosis despite revascularization. Whether pPCI may have an impact on survival in a very limited number of irreversibly critically ill patients remains uncertain and the identification of irreversibly shocked patients remains nowadays challenging.
More Related Videos
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations