Shock Timing in STEMI-CS: Management and Outcomes in a Resource-Limited Setting

Cardiogenic shock complicating ST-segment elevation myocardial infarction (STEMI) carries high in-hospital mortality, but evidence from low- and middle-income countries remains limited.

The objective of the study was to compare clinical presentation, pharmacological treatment use, and in-hospital outcomes according to shock onset before vs after arrival at a reperfusion center (ARC).

We performed a retrospective cohort analysis with data from RECUIMA, a multicenter registry of patients with STEMI admitted to 4 Cuban hospitals. Patients with cardiogenic shock complicating STEMI were classified as having shock prior to arrival at a reperfusion center (PRC) or ARC. Multivariable logistic regression assessed the association between shock timing and in-hospital mortality.

Among 4,113 patients with STEMI, 435 (10.6%) developed cardiogenic shock; 134 (30.8%) were PRC and 301 (69.2%) ARC. PRC patients had greater clinical severity, including lower systolic blood pressure and left ventricular ejection fraction, worse renal function, and higher Global Registry of Acute Coronary Events scores (all P < 0.01). Inpatient best available medical therapy was less frequent in PRC than ARC patients (32.8% vs 51.8%; relative risk: 0.63; 95% CI: 0.49-0.83; P < 0.001). Unadjusted mortality was higher in PRC patients (50.0% vs 38.2%; relative risk: 1.31; 95% CI: 1.05-1.63; P = 0.021). In the multivariable logistic regression model, shock timing was not statistically significantly associated with mortality (OR: 1.65; 95% CI: 0.86-3.18; P = 0.13).

PRC patients presented with greater severity, received less inpatient best available medical therapy, and had higher unadjusted mortality. However, in the multivariable logistic regression model, shock timing was not statistically significantly associated with mortality.