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Cardiogenic Shock Among Patients with Acute ST-Segment Elevation Myocardial Infarction in a Middle Eastern Country: A
Ghada Shalaby1, Azmat K Niazi1, Sheeren Khaled1
1Cardiac Center, King Abdullah Medical City, Muzdallfa Road, Makkah, Saudi Arabia.
Insights
Cardiogenic shock (CS) affects 4.3% of acute ST-segment elevation myocardial infarction (STEMI) patients, increasing mortality. Renal impairment, peak troponin, and ejection fraction predict CS, while age predicts mortality in these STEMI patients.
Area of Science:
- Cardiology
- Internal Medicine
- Critical Care Medicine
Background:
- Cardiogenic shock (CS) is the leading cause of mortality in hospitalized patients with acute ST-segment elevation myocardial infarction (STEMI).
- Predicting outcomes in STEMI patients with CS requires analysis of clinical, laboratory, and radiological variables, alongside management strategies.
Purpose of the Study:
- To determine the incidence and characteristics of CS in STEMI patients.
- To identify predictors of CS and mortality within this patient population at a specific medical center.
Main Methods:
- A retrospective, single-center study was conducted at KAMC, Makkah, from 2015 to 2020.
- STEMI patients were categorized into CS and non-CS groups for comparative analysis.
Main Results:
- The study included 3074 STEMI patients, with 132 (4.3%) experiencing CS.
- CS patients were older, more likely to be pilgrims, and had significantly higher rates of in-hospital complications (pulmonary edema, cardiac arrest, ventilation), longer hospital stays, and increased mortality.
- Independent predictors of CS included renal impairment, elevated peak troponin, significant hemoglobin drop (≥3 gm/dl), and reduced left ventricular ejection fraction (EF). For diabetic STEMI patients, STEMI type, left main disease, and EF (≤35%) were predictors.
- Age was the sole independent predictor of mortality in CS patients, while age, female gender, and diabetes predicted in-hospital mortality overall.
Conclusions:
- Middle Eastern countries show comparable STEMI outcomes to Western nations, reflecting improved medical care.
- Key independent predictors of CS in STEMI patients are renal impairment, peak troponin, severe bleeding, and EF.
- Age is the only independent predictor of mortality in CS patients; however, age, female gender, and diabetes are independent predictors of in-hospital mortality.
Background:
Cardiogenic Shock (CS) remains the most common cause of death in hospitalized acute ST-segment elevation myocardial infarction (STEMI) patients. Predictors of outcomes in those patients include clinical, laboratory, radiologic variables, and management strategies. The present study aimed to evaluate the incidence, characteristics, predictors of cardiogenic shock and mortality among acute ST-segment elevation myocardial infarction patients in our center.
Methods:
This was a retrospective, single-center study conducted at KAMC, Makkah during 2015-2020. All acute ST-segment elevation myocardial infarction patients during this era were divided into two groups CS group and non-CS group.
Results:
In this study total 3074 acute ST-segment elevation myocardial infarction patients of which 132(4.3%) patients had CS. CS group tended to have higher ages than non-CS group. Pilgrims were more complicated by CS than nonpilgrims. Subsequently, CS patients had a highly significant (p < 0.001 for all) increase in the incidence of in-hospital complications including pulmonary oedema, cardiac arrest and ventilation. There was a significant increase in hospital stay length and in-hospital mortality among CS patients. Renal impairment, peak troponin level, haemoglobin drop≥3 gm/dl, and Left ventricular ejection fraction (EF) were significant independent predictors of cardiogenic shock among our patients. However, STEMI type, left main disease, and EF was the independent predictors of CS among our patients with diabetes with EF cut-off value of 35% with a sensitivity of 74.6% and a specificity of 65.3%. Age was the only independent predictor of mortality among CS patients. Though age, female gender, and diabetes were found to be the independent predictors for in-hospital mortality among our patients.
Conclusion:
High-income middle eastern countries have comparable outcomes to Europe and USA among patients with acute ST-segment elevation myocardial infarction patients with higher improvement of medical care in the last 2 to 3 decades. Renal impairment, peak troponin, severe bleeding and ejection fraction were significant independent predictors of CS in acute ST-segment elevation myocardial infarction patients. However, STEMI type, left main disease, and ejection fraction were the independent predictors of CS in acute ST-segment elevation myocardial infarction patients with diabetes. Age was the only independent predictor of mortality among CS patients.
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