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Non-STEMI vs. STEMI Cardiogenic Shock: Clinical Profile and Long-Term Outcomes

María José Martínez1,2,3, Ferran Rueda1, Carlos Labata1

  • 1Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain.

Journal of Clinical Medicine
|June 24, 2022
PubMed

Insights

Cardiogenic shock (CS) following acute myocardial infarction (AMI) has higher 30-day mortality in ST-segment elevation (STEMI-CS) cases compared to non-ST-segment elevation (NSTEMI-CS). However, long-term outcomes at 3 years are similar for both STEMI-CS and NSTEMI-CS patients.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Critical Care Medicine

Background:

  • Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI).
  • The ST segment deviation on electrocardiogram (ECG) in AMI-CS can be elevated (STEMI-CS) or non-elevated (NSTEMI-CS), potentially impacting prognosis.
  • Understanding differences in clinical profiles and outcomes between STEMI-CS and NSTEMI-CS is crucial for patient management.

Purpose of the Study:

  • To analyze the clinical characteristics, acute-phase prognosis, and long-term outcomes of cardiogenic shock based on ST-segment deviation patterns in patients with acute myocardial infarction.
  • To compare the 30-day case fatality and 3-year mortality between STEMI-CS and NSTEMI-CS.

Main Methods:

  • Prospective registry of 4647 AMI patients admitted to an intensive cardiac care unit from 2010 to 2019.
  • Comparison of clinical characteristics, 30-day case fatality, and long-term outcomes between AMI-CS patients with and without ST-segment deviation.
  • Multivariable adjustment was used to analyze 30-day mortality differences.

Main Results:

  • Cardiogenic shock developed in 239 (5.1%) AMI patients, with 190 (79.5%) classified as STEMI-CS and 49 (20.5%) as NSTEMI-CS.
  • STEMI-CS patients exhibited larger infarcts and more mechanical complications, while NSTEMI-CS patients had a higher prevalence of comorbidities and complex coronary artery disease.
  • STEMI-CS patients had significantly higher 30-day mortality (59.5%) compared to NSTEMI-CS patients (36.7%), even after multivariable adjustment (HR 1.91).

Conclusions:

  • ST-segment elevation myocardial infarction-cardiogenic shock (STEMI-CS) is associated with higher short-term (30-day) case-fatality compared to non-ST-segment elevation myocardial infarction-cardiogenic shock (NSTEMI-CS).
  • Despite initial differences in mortality, long-term outcomes at 3 years were similar between STEMI-CS and NSTEMI-CS groups.
  • The ST-segment pattern on admission provides important prognostic information regarding acute-phase outcomes in cardiogenic shock complicating AMI.

Keywords:
NSTEMISTEMIcardiogenic shockprognosis

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