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Patterns of Disease Progression and Outcomes of Inferior ST-Elevation Myocardial Infarction Complicated by
Giulia Botti1,2, Marina Pieri3, Luigi Cappannoli4
1School of Medicine, Vita Salute San Raffaele University, 20132 Milan, Italy.
Insights
Cardiogenic shock following inferior ST-elevation myocardial infarction has a 22.3% in-hospital mortality rate. Worsening shock, prolonged CPR, low blood pressure, and elevated lactates predict poor outcomes in these critical patients.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Emergency Medicine
Background:
- Cardiogenic shock (CS) is a known complication of anterior ST-elevation myocardial infarction (STEMI).
- Limited data exist on the progression and outcomes of inferior STEMI complicated by CS.
- This study addresses the knowledge gap regarding inferior STEMI-CS.
Purpose of the Study:
- To determine the prevalence of cardiogenic shock in inferior STEMI.
- To analyze disease progression patterns in inferior STEMI-CS.
- To identify outcomes and mortality predictors in inferior STEMI-CS.
Main Methods:
- Retrospective analysis of the INSTINCT Registry (2015-2023).
- Inclusion of consecutive patients with inferior STEMI and subsequent CS.
- Data collection on CS stage (SCAI), progression, and in-hospital outcomes.
Main Results:
- 130 patients with inferior STEMI-CS were analyzed (mean age 69.8 years, 31.5% female).
- In-hospital mortality was 22.3%. Predictors included prolonged CPR, persistent low SBP, and rising lactates.
- Worsening CS (15.4% of patients) was rare but associated with significantly higher mortality and complications.
Conclusions:
- Inferior STEMI complicated by CS carries a substantial in-hospital mortality risk (22.3%).
- Prolonged CPR, persistently low SBP, and elevated lactates are key mortality predictors.
- While rare, CS progression portends a worse prognosis and increased complications.
Abstract:
Background: Cardiogenic shock (CS) is a frequent presentation of anterior ST-elevation myocardial infarction (STEMI); however, data regarding disease progression and outcomes in inferior STEMI complicated by CS are scarce. The present study aims to analyze the prevalence, patterns of disease progression, and outcomes of inferior STEMI-CS. Methods: The INSTINCT (Inferior ST-elevation myocardial Infarction complicated by Cardiogenic shock) Registry retrospectively included consecutive patients who developed CS following inferior STEMI treated at three centers in Italy from 2015 to 2023. Data regarding CS stage according to the Society of Cardiovascular Angiography and Interventions (SCAI) upon diagnosis of shock and during disease progression and in-hospital outcomes were collected. Patients were defined "worsening" (WPs) if the SCAI stage increased. Results: A total of 130 patients developed CS after inferior STEMI and were included in the analysis, the mean age was 69.8 ± 12.4 years, and 31.5% were female. The rate of in-hospital mortality was 22.3%; predictors of in-hospital mortality were cardiopulmonary resuscitation (CPR) > 20 min or refractory cardiac arrest (CA) (OR [CI]: 9.67 [3.17-29.51]), persistently low systolic blood pressure (SBP) (OR [CI]: 12.91 [2.47-68.82]), and increase in lactates (OR [CI]: 3.53 [1.42-7.87]) during medical management. Twenty (15.4%) patients experienced worsening CS; WPs had a significantly higher rate of in-hospital mortality (13 [65%] vs. 15 [13.6%], p < 0.001), major bleeding (4 [20%] vs. 7 [6.4%], p = 0.044), and mechanical circulatory support weaning failure (7 [35%] vs. 3 [2.7%], p = 0.032). Conclusions: The in-hospital mortality rate of inferior STEMI complicated by CS was 22.3%. Predictors of in-hospital mortality included prolonged CPR, persistently low SBP, and elevated lactates. Progression through SCAI stages was rare but associated with significantly higher mortality and complication rates.
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