Treatment Intensity for the Management of Cardiogenic Shock: Comparison Between STEMI and Non-STEMI
Shashank S Sinha1, Mohit Pahuja2, Rachna Kataria3
1Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.
Insights
Cardiogenic shock complicating acute myocardial infarction (AMI-CS) has high mortality. This study found similar in-hospital mortality rates for ST-segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) and non-ST-segment elevation myocardial infarction cardiogenic shock (NSTEMI-CS).
Area of Science:
- Cardiology
- Critical Care Medicine
Background:
- Cardiogenic shock is a significant cause of death in patients with acute myocardial infarction (AMI).
- Understanding the differences and similarities between STEMI-CS and NSTEMI-CS is crucial for improving patient outcomes.
Purpose of the Study:
- To compare clinical characteristics, hospital course, and treatment strategies for patients with STEMI-CS versus NSTEMI-CS.
- To identify factors influencing in-hospital mortality in these patient groups.
Main Methods:
- Analysis of data from 1,110 adult admissions with AMI-CS across 17 centers.
- Comparison of in-hospital mortality, clinical features, and use of medical and device therapies between STEMI-CS and NSTEMI-CS cohorts.
Main Results:
- In-hospital mortality was 41% and similar between STEMI-CS (43%) and NSTEMI-CS (39%) groups.
- Patients experiencing out-of-hospital or in-hospital cardiac arrest had higher mortality, particularly in the NSTEMI-CS group.
- Early use of combined drug and mechanical circulatory support was low but increased significantly during hospitalization for both groups.
Conclusions:
- Both STEMI-CS and NSTEMI-CS patients face high in-hospital mortality despite advanced support.
- Further research, including randomized controlled trials, is needed to optimize the timing and sequence of interventions for AMI-CS.
Background:
Cardiogenic shock is a leading cause of mortality in patients with acute myocardial infarction.
Objectives:
The authors sought to compare clinical characteristics, hospital trajectory, and drug and device use between patients with ST-segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) and those without (non-ST-segment elevation myocardial infarction complicated by cardiogenic shock [NSTEMI-CS]).
Methods:
We analyzed data from 1,110 adult admissions with cardiogenic shock complicating acute myocardial infarction (AMI-CS) across 17 centers within Cardiogenic Shock Working Group. The primary end point was in-hospital mortality.
Results:
Our study included 1,110 patients with AMI-CS, of which 731 (65.8%) had STEMI-CS and 379 (34.2%) had NSTEMI-CS. Most patients were male (STEMI-CS: 71.6%, NSTEMI-CS: 66.5%) and White (STEMI-CS: 53.8%, NSTEMI-CS: 64.1%). In-hospital mortality was 41% and was similar among patients with STEMI-CS and NSTEMI-CS (43% vs 39%, P = 0.23). Patients with out-of-hospital cardiac arrest had higher in-hospital mortality in patients with NSTEMI-CS (63% vs 36%, P = 0.006) as compared to patients with STEMI-CS (52% vs 41%, P = 0.16). Similar results were observed for in-hospital cardiac arrest in patients with STEMI-CS (63% vs 33%, P < 0.001) and NSTEMI-CS (60% vs 32%, P < 0.001). Only 27% of patients with STEMI-CS and 12% of NSTEMI-CS received both a drug and temporary mechanical circulatory support device during the first 24 hours, which increased to 78% and 61%, respectively, throughout the course of the hospitalization (P < 0.001 for both).
Conclusions:
Despite increasing use of inotropic and vasoactive support and mechanical circulatory support throughout the hospitalization, both patients with STEMI-CS and NSTEMI-CS remain at increased risk for in-hospital mortality. Randomized controls trials are needed to elucidate whether timing and sequence of escalation of support improves outcomes in patients with AMI-CS.
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