Differences in the characteristics and outcomes of STEMI versus NSTEMI cardiogenic shock: A systematic review and
1Department of Cardiology, Xinchang County Traditional Chinese Medicine Hospital, Shaoxing City, Zhejiang Province, China.
Insights
In-hospital mortality is similar for ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients with cardiogenic shock (CS). However, STEMI-CS patients are younger and have fewer comorbidities, suggesting tailored treatments are crucial.
Area of Science:
- Cardiology
- Internal Medicine
- Critical Care Medicine
Background:
- Limited evidence exists comparing ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) in patients presenting with cardiogenic shock (CS).
- Understanding differences in patient characteristics and outcomes is crucial for effective management of myocardial infarction (MI) complicated by CS.
Purpose of the Study:
- To compare the clinical characteristics and outcomes of patients with STEMI-CS versus NSTEMI-CS.
- To identify potential differences that may inform individualized treatment strategies for CS patients.
Main Methods:
- A systematic literature search was conducted across Medline, Google Scholar, and ScienceDirect up to March 2025.
- Pooled risk ratios and standardized mean differences were calculated using random-effects models for 12 included studies.
- Risk of bias was assessed using the Newcastle-Ottawa Scale.
Main Results:
- In-hospital mortality rates were comparable between STEMI-CS and NSTEMI-CS patients (OR: 0.82, 95% CI: 0.52-1.30).
- STEMI-CS patients were younger and had a lower incidence of prior heart failure, prior myocardial infarction, and diabetes compared to NSTEMI-CS patients.
- STEMI-CS patients experienced shorter hospital stays.
Conclusions:
- In-hospital mortality does not significantly differ between STEMI-CS and NSTEMI-CS.
- Patient characteristics vary significantly between STEMI-CS and NSTEMI-CS groups.
- Individualized treatment approaches based on MI type and patient profiles are essential for managing cardiogenic shock.
Background:
There is limited evidence exploring the differences in characteristics and outcomes between patients with ST-segment elevation myocardial infarction (STEMI) and with non-ST-segment elevation myocardial infarction (NSTEMI) presenting with cardiogenic shock (CS).
Methods:
Medline, Google Scholar, and ScienceDirect databases were searched up to March 2025. Studies reporting data on STEMI-CS and NSTEMI-CS patient characteristics and clinical outcomes were included. Pooled risk ratios (odds ratios [ORs]) and standardized mean differences (SMDs) were calculated using random-effects models, and the I2 statistic measured heterogeneity. The risk of bias was assessed using the Newcastle-Ottawa Scale.
Results:
The pooled analysis of 12 studies demonstrated that the incidence of in-hospital mortality was comparable between STEMI-CS and NSTEMI-CS patients (pooled OR: 0.82, 95% confidence interval [CI]: 0.52-1.30, I2 = 98.7%, P < .001). However, STEMI-CS patients had a considerably lower age of presentation (pooled SMD: -0.54, 95% CI: -0.67 to -0.42, I2 = 96.9%, P < .001), as well as lower incidence of prior heart failure, prior myocardial infarction, and diabetes, compared to NSTEMI-CS patients (P < .05). Conversely, STEMI-CS was associated with shorter hospital stays (pooled SMD: -0.54, 95% CI: -0.77 to -0.31, I2 = 99.1%, P < .001).
Conclusion:
While the incidence of in-hospital mortality did not significantly differ between STEMI-CS and NSTEMI-CS patients, the study further emphasizes the importance of individualized treatment strategies based on myocardial infarction type and patient characteristics when managing CS patients.
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