Clinical characteristics and outcome in patients with a delayed presentation after ST-elevation myocardial infarction and complicated by cardiogenic shock

Abstract

Objective Delayed presentation after ST-elevation myocardial infarction (STEMI) and complicated by cardiogenic shock (CS-STEMI) is commonly encountered in developing countries and is a challenging scenario because of a delay in revascularization resulting in infarction of a large amount of the myocardium. We aimed to assess the clinical characteristics, angiographic profile, and predictors of outcome in patients with a delayed presentation after CS-STEMI. Methods A total of 147 patients with CS-STEMI with time to appropriate medical care ≥12 h after symptom onset were prospectively recruited at a tertiary referral center. Results The median time to appropriate care was 24 h (interquartile range 18–48 h). The mean age was 58.7 ± 11.1 years. Left ventricular pump failure was the leading cause of shock (67.3%), whereas mechanical complications accounted for 14.9% and right ventricular infarction for 13.6% of cases. The overall in-hospital mortality was 42.9%. Acute kidney injury [Odds ratio (OR) 8.04; 95% confidence intervals (CI) 3.08–20.92], ventricular tachycardia (OR 7.04; CI 2.09–23.63), mechanical complications (OR 6.46; CI 1.80–23.13), and anterior infarction (OR 3.18; CI 1.01–9.97) were independently associated with an increased risk of mortality. Coronary angiogram (56.5%) revealed single-vessel disease (45.8%) as the most common finding. Percutaneous coronary intervention was performed in 53 patients (36%), at a median of 36 h (interquartile range 30–72) after symptom onset. Conclusion Patients with a delayed presentation after CS-STEMI were younger and more likely to have single-vessel disease. We found a high in-hospital mortality of 42.9%. Appropriate randomized studies are required to evaluate the optimal treatment strategies in these patients.

Epidemiological profile, management and outcomes of patients with acute coronary syndrome: Single centre experience from a tertiary care hospital in North India

“…The mortality in patients with cardiogenic shock was 37.3% which is comparable to a similar study done in our institute which showed a mortality of 42.9%. 18 Female gender was associated with increased mortality rates (OR-3.306) which was higher than from other Indian registries like DEMAT 15 (OR-1.4), HP-ACS 8 (OR 1.36 C.I. 0.77–2.38) and Kerala -ACS 7 (OR−1.05, C.I.−0.8–1.38) registries.…”

Acute coronary syndrome treatment delay in low to middle-income countries: A systematic review

“…Heart failure was the most common complication. ** * * Fair Sharma et al, 2019 [29] Prospective, cross-sectional, observational. 1 tertiary care hospital in India.…”

Role of N-terminal pro-B-type natriuretic peptide in the prediction of outcomes in ST-elevation myocardial infarction complicated by cardiogenic shock

“…Patients were treated with dual antiplatelets, statin, and low-molecular-weight heparin. As reported previously, 10 due to the significantly late presentation to our center, the decision of revascularization was based on delay from symptom onset, presence of anginal pain/electrical instability, hemodynamic parameters, end-organ failure, myocardial viability, mechanical complications, coronary anatomy, and patient consent and willingness for revascularization. The primary end-point of the study was in-hospital mortality.…”