In-hospital Outcomes of Patients with Cardiogenic Shock due to ST-Segment Elevation Myocardial Infarction

Abstract

Background: Cardiogenic shock is a clinical condition of inadequate tissue perfusion due to cardiac dysfunction. The most common etiology is ST-segment elevation myocardial infarction (STEMI) leading to left ventricular failure, but it may also be caused by mechanical complications such as acute mitral regurgitation, ventricular septal rupture or rupture of the left ventricular free wall. Despite therapeutic advances, mortality rates remain high. Methods: Retrospective, observational, single-center study, including consecutive patients admitted with a diagnosis of STEMI and cardiogenic shock treated by percutaneous coronary intervention (PCI) at a tertiary hospital specialized in cardiology. The primary objective was to evaluate in-hospital clinical outcomes. Results: A total of 78 patients were included, most of them were male (67.9%), mean age was 67.5 ± 13,4 years and 41.0% were diabetic. Primary PCI was performed in 46.2% of the patients, rescue PCI in 25.6% and elective PCI in 28.2% of the cases. The most frequently involved arteries were the left anterior descending artery and the right coronary artery, with 44.9% each. Intra-aortic balloon pump was used in 32.1% of cases and glycoprotein IIb/ IIIa inhibitors in 30.8% of the cases. The incidence of acute renal failure was 61.5%. The need for reintervention was observed in 9.0% and the rate of acute/subacute thrombosis was 3.8%. Death due to cardiogenic shock was observed in 46.2%. Conclusions: Cardiogenic shock remains a frequent and serious condition with almost 50% of in-hospital mortality despite the therapeutic advances.

Complete percutaneous myocardial revascularization in patients with STEMI complicated by cardiogenic shock

“…The results of our study showed a high intra-hospital mortality in the patients with acute myocardial infarction complicated by cardiogenic shock (62.6%), despite the use of primary percutaneous coronary intervention, which are significantly higher than the results of other randomized studies and registers where the intra-hospital mortality rate was 42%-48% [5][6][7][8][9] .…”

“…Despite the significant therapeutic progress, primarily in the sense of early myocardial revascularization strategy and aggressive inotropic and vasopressor support, cardiogenic shock continues to be the leading cause of death in acute myocardial infarction with the mortality rate of 42%-48% [5][6][7][8][9] .…”