The evolving treatment and outcomes of patients presenting with STEMI and cardiogenic shock: a regional experience

To examine treatment trends and outcomes over time for patients with ST-elevation myocardial infarction-related cardiogenic shock (STEMI-CS) in a regional centre.

This retrospective study analysed data from patients with STEMI and Killip class IV cardiogenic shock at a Victorian regional tertiary hospital over 10 years (2014-2024). Patients treated with percutaneous coronary intervention (PCI) or surgical revascularisation (coronary artery bypass grafting) were identified using state-wide registries. The primary outcome was 30-day mortality with secondary outcomes of door-to-balloon time, mechanical circulatory support (MCS) use, ICU/hospital length of stay and revascularisation technique.

One hundred and seventy-two adult patients (74% male) had STEMI-CS. The number of patients presenting with STEMI-CS increased over the 10-year period; however, 30-day mortality remained unchanged at 49%. In addition, 69% achieved a door-to-balloon time <90 min, and the median door-to-balloon time did not differ significantly over time. However, 19% required MCS, with similar numbers for intra-aortic balloon pump and extra (corporeal membrane oxygenation. The median intensive care unit and hospital length of stay was 5 days (IQR = 2-9) and 8 days (IQR = 3-13) respectively and was unchanged over time. There was a strongly positive and statistically significant trend towards increased use of PCI over the 10-year study period.

With timely revascularisation and increasing use of PCI, STEMI-CS patients in regional settings with access to a 24-h catheter lab have outcomes consistent with metropolitan and global trends. Despite medical advancements, outcomes for patients with STEMI-CS are largely unchanged over time, with 30-day mortality rates that remain unacceptably high. There is an urgent need for innovative strategies and system-level improvements to address the increasing burden of STEMI-CS.