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Updated: Jul 3, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Current spectrum and outcomes of infarct-related cardiogenic shock: insights from the CULPRIT-SHOCK registry and
Uwe Zeymer1,2, Tobias Heer3, Taoufik Ouarrak2
1Department of Cardiology, Klinikum der Stadt Ludwigshafen am Rhein, Bremserstraße 79, 67063 Ludwigshafen, Germany.
Insights
High mortality persists for patients with infarct-related cardiogenic shock (CS), particularly those with extensive coronary artery disease (CAD). Improved care strategies are crucial to enhance survival rates in CS patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction
Background:
- Cardiogenic shock (CS) following acute myocardial infarction (AMI) is a critical condition with high mortality.
- The CULPRIT-SHOCK trial provided insights into CS management, but data on patients with exclusion criteria are also valuable.
Purpose of the Study:
- To analyze the outcomes of patients with infarct-related CS, including those not eligible for the CULPRIT-SHOCK trial.
- To identify factors influencing short- and long-term mortality in this high-risk patient population.
Main Methods:
- Analysis of consecutive patients with infarct-related CS from a European registry, including those with exclusion criteria for the CULPRIT-SHOCK RCT.
- 1-year follow-up to assess total mortality and outcomes based on coronary artery disease (CAD) extent.
Main Results:
- Overall 1-year mortality was 52.9% in 1075 screened patients.
- Mortality increased with the extent of CAD: 38.6% for one-vessel, 49.8% for two-vessel, and 56.6% for three-vessel disease.
- Patients with left main coronary artery stenosis had the highest 1-year mortality (63.5%).
Conclusions:
- Despite an invasive strategy in specialized centers, infarct-related CS remains associated with high short- and long-term mortality.
- The extent of coronary artery disease is a primary determinant of mortality in CS patients.
- Further improvements in care are necessary to enhance the prognosis for patients with infarct-related CS.
Aims:
We analysed consecutive patients with acute myocardial infarction complicated by cardiogenic shock (CS) who were enrolled into the CULPRIT-SHOCK randomized controlled trial (RCT) and those with exclusion criteria who were included into the accompanying registry.
Methods And Results:
In total, 1075 patients with infarct-related CS were screened for CULPRIT-SHOCK in 83 specialized centres in Europe; 369 of them had exclusion criteria for the RCT and were enrolled into the registry. Patients were followed over 1 year. The mean age was 68 years and 260 (25%) were women. 13.5%, 30.9%, and 55.6% had one-vessel, two-vessel, and three-vessel coronary artery disease (CAD), respectively. Significant left main (LM) coronary artery stenosis was present in 8.0%. 54.2% of the patients had cardiac arrest before admission. Thrombolysis in myocardial infarction (TIMI) 3 patency of the infarct vessel after percutaneous coronary intervention was achieved in 83.6% of all patients. Mechanical circulatory support was applied in one-third of patients. Total mortality after 30 days and 1 year was 47.6% and 52.9%. Mortality after 1 year was highest in patients with LM coronary artery stenosis (63.5%), followed by three-vessel (56.6%), two-vessel (49.8%), and one-vessel CAD (38.6%), respectively. Mechanical complications were rare (21/1008; 2.1%) but associated with a high mortality of 66.7% after 1 year.
Conclusion:
In specialized centres in Europe, short- and long-term mortality of patients with infarct-related CS treated with an invasive strategy is still high and mainly depends on the extent of CAD. Therefore, there is still a need for improvement of care to improve the prognosis of infarct-related CS.
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