Impact of Chronic Kidney Disease Severity on Outcomes in STEMI-Associated Cardiogenic Shock Requiring Mechanical...

Patients with chronic kidney disease (CKD) presenting with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock have significantly worse outcomes when compared with those without CKD. In recent years, mechanical circulatory support (MCS) has been increasingly used in STEMI and cardiogenic shock; however, outcomes in this vulnerable CKD population remain poorly studied.

To evaluate the association between CKD severity and in-hospital outcomes among patients with STEMI-associated cardiogenic shock receiving MCS, and to determine whether these associations differ by MCS device type.

We analyzed hospitalizations in the National Inpatient Sample from 2016 through 2023 with STEMI, percutaneous coronary intervention, cardiogenic shock, and treatment with an MCS. We categorized CKD as no CKD, stages 1-3, or advanced CKD (stages 4-5/end-stage renal disease). Survey-weighted multivariable logistic regression evaluated in-hospital outcomes.

Among 63,755 weighted hospitalizations, 80.8% had no CKD, 14.6% had CKD stages 1-3, and 4.6% had advanced CKD. Crude mortality increased across groups (30.7%, 36.0%, and 40.7%; p < 0.001), as did acute kidney injury (AKI) (43.3%, 81.0%, and 87.6%; p < 0.001) and renal replacement therapy (RRT) use (3.4%, 7.8%, and 15.8%; p < 0.001). Advanced CKD was associated with higher adjusted mortality overall (aOR 1.26, 95% CI 1.02-1.57) and with IABP (aOR 1.63, 95% CI 1.24-2.15), as well as increased odds of bleeding and mechanical ventilation. Both CKD categories had markedly higher odds of AKI and RRT utilization across most MCS subgroups. Sensitivity analysis also showed higher mortality with advanced CKD in the overall cohort and the IABP subgroup.

CKD severity identifies progressively higher-risk STEMI-shock patients receiving MCS, with renal complications consistently increased across device groups and broader adverse outcomes concentrated in advanced CKD.