Differences Between STEMI and NSTEMI Complicated by Cardiogenic Shock: Insights From a Contemporary Multilevel
Serdar Farhan1, Sanjay Sivalokanathan2, Abduljabar Adi1
1Northwell Health, Cardiovascular Institute, New Hyde Park, New York, USA; Lenox Hill Hospital at Northwell Health, New York, New York, USA.
JACC. Advances
|July 17, 2026
Summary
Patients with cardiogenic shock (CS) from ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) have different profiles but similar mortality. Management strategies and mechanical support outcomes vary by AMI type, informing future CS research and care.
Area of Science:
- Cardiology
- Critical Care Medicine
- Health Services Research
Background:
- Understanding clinical trajectories in cardiogenic shock (CS) based on acute myocardial infarction (AMI) type is crucial for contemporary practice.
- Contemporary data on CS patient characteristics, management, and outcomes stratified by AMI type are limited.
Purpose of the Study:
- To compare clinical characteristics, management strategies, and outcomes of patients experiencing CS due to ST-segment elevation myocardial infarction (STEMI) versus non-ST-segment elevation myocardial infarction (NSTEMI).
Main Methods:
- Retrospective analysis of adult patients treated for CS due to STEMI or NSTEMI across an 11-hospital system from 2016-2022.
- Primary outcome: 6-month all-cause mortality; Secondary outcome: in-hospital all-cause mortality.
Main Results:
- 1,375 patients identified: 57% STEMI-CS, 43% NSTEMI-CS. STEMI-CS patients presented with more severe shock (cardiac arrest, higher lactate). NSTEMI-CS patients were older, with more comorbidities and severe coronary disease.
- NSTEMI-CS patients received more coronary artery bypass grafting (33% vs. 8%) and less percutaneous coronary intervention (35% vs. 73%). In-hospital and 6-month mortality rates were similar between STEMI-CS (37.1%) and NSTEMI-CS (34.0%).
- Revascularization improved 6-month survival in both groups. Intra-aortic balloon pump/percutaneous ventricular assist device use lowered mortality only in STEMI-CS. Venoarterial extracorporeal membrane oxygenation increased mortality in both AMI types.
Conclusions:
- STEMI-CS and NSTEMI-CS patients exhibit distinct clinical profiles and receive different management strategies.
- Despite similar mortality rates, the impact of mechanical circulatory support varies by AMI type, suggesting a need for phenotype-specific treatment approaches.
- Findings underscore the importance of considering AMI type in CS management strategies and clinical trial design.
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