Right to Left Cardiac Power Output- New Prognosticator in STEMI Patients With Cardiogenic Shock (R-Shock)

Area of Science:

• Cardiology
• Critical Care Medicine
• Hemodynamics

Background:

• ST-elevation myocardial infarction (STEMI) frequently leads to cardiogenic shock (CS), a condition with high mortality.
• Cardiac power output (CPO) is a key predictor of outcomes in CS.
• Combined right and left ventricular failure worsens prognosis in CS.

Purpose of the Study:

• To evaluate right-sided CPO and the ratio of left to right CPO as predictors of in-hospital mortality in STEMI patients experiencing CS.
• To investigate the prognostic value of right ventricular performance metrics in this high-risk population.

Main Methods:

• Retrospective observational study of STEMI patients with CS admitted between January 2014 and December 2018.
• Inclusion criteria: STEMI with CS within 24 hours of admission, requiring left and right cardiac catheterization.
• Data analysis included calculation of left and right CPO and logistic regression for mortality prediction.

Main Results:

• The study analyzed 47 patients with STEMI and CS, with 98.9% developing CS within 24 hours.
• Mean left CPO was 0.62 (SD 0.3) and mean right CPO was 0.22 (SD 0.13).
• Logistic regression suggested lower in-hospital mortality with low left CPO, high right CPO, and a low left-to-right CPO ratio (though confidence intervals included 1 for some associations).

Conclusions:

• This is the first study to assess right-sided CPO and its ratio with left-sided CPO in predicting mortality in STEMI with CS.
• Preliminary findings indicate a trend towards higher mortality with high right-sided CPO and a low left-to-right CPO ratio.
• Further validation in larger cohorts is necessary to confirm these exploratory results.