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Published on: June 12, 2021
ST Elevation Myocardial Infarction Complicated by Cardiogenic Shock: Systematic Review of Survival Predictors
John King Khoo1, Benjamin Peter Trewin2, Audrey Adji3
1Department of Cardiology, Liverpool Hospital, Sydney, Australia.
Insights
Predictors of mortality in patients with cardiogenic shock complicating ST-elevation myocardial infarction (STEMI-CS) were identified. Key factors include unsuccessful revascularization, reduced ejection fraction, and renal impairment, crucial for improving survival outcomes.
Area of Science:
- Cardiology
- Critical Care Medicine
Background:
- Cardiogenic shock following acute myocardial infarction (MI) significantly reduces survival rates.
- Improving risk stratification and management requires characterizing predictors of morbidity and mortality.
- The complex interplay of factors influencing survival in STEMI-CS remains understudied.
Purpose of the Study:
- To identify key predictors of short-term survival in patients with ST-elevation myocardial infarction complicated by cardiogenic shock (STEMI-CS).
- To synthesize evidence from observational studies on factors associated with mortality in STEMI-CS.
Main Methods:
- A systematic literature search was conducted across Embase, MEDLINE, and CINAHL databases.
- Original studies evaluating predictors of 30-day or in-hospital survival in STEMI-CS were included.
- Vote counting methodology was employed to identify significant predictors of mortality or survival.
Main Results:
- Twenty-four observational studies comprising 14,735 patients were analyzed.
- Key independent predictors of mortality identified include unsuccessful revascularization, reduced left ventricular ejection fraction, and renal impairment.
- Significant clinical and statistical heterogeneity was noted across the included studies.
Conclusions:
- Several variables independently increase mortality risk in STEMI-CS populations.
- Further prospective research is needed to validate multivariate scoring systems incorporating these prognostic domains.
- Enhanced understanding of these predictors can guide improved risk stratification and patient management.
Background:
Cardiogenic shock complicating acute myocardial infarction is associated with reduced survival despite advancements in the treatment of acute coronary syndromes. Characterizing predictors of morbidity and mortality in this setting is crucial to improving risk stratification and management. Notwithstanding, the interplay of factors determining survival in this condition remains poorly studied.
Methods:
Embase, MEDLINE, and CINAHL databases were searched for original studies evaluating predictors of short-term (30-day or in-hospital) survival in ST elevation myocardial infarction with cardiogenic shock (STEMI-CS). Included studies were analyzed by way of vote counting, identifying variables that predicted mortality or survival.
Results:
Twenty-four studies, consisting of 14,735 patients (5649 nonsurvivors and 9086 survivors) were included. All studies were observational by design (17 retrospective and 7 prospective) with clinical and statistical heterogeneity. Unsuccessful revascularization, reduced left ventricular ejection fraction, renal impairment, and other variables were identified as key independent predictors of mortality.
Conclusion:
Several key variables have been shown to independently increase mortality in STEMI-CS populations. Future prospective studies examining the prognostic role of multivariate scoring systems incorporating these domains are required.
