Prognostic role of procalcitonin in ST-elevation myocardial infarction complicated by cardiogenic shock

Abstract

Objective Cardiogenic shock accounts for the majority of deaths amongst patients with ST-elevation myocardial infarction. Procalcitonin is elevated in acute myocardial infarction, especially when complicated by left heart failure, cardiogenic shock, resuscitated cardiac arrest, and bacterial infections. However, the prognostic utility of procalcitonin in ST-elevation myocardial infarction complicated by cardiogenic shock has not been systematically evaluated. Methods We performed a retrospective registry review of 125 patients with ST-elevation myocardial infarction and cardiogenic shock over 2 years at a tertiary referral hospital to examine the prognostic value of serum procalcitonin measurement at 24 hours after the onset of infarction for in-hospital mortality. Results The mean age of the study population was 57.75 ± 11.1 years, and the median delay from onset to hospital admission was 15 hours. The in-hospital mortality was 28.8%. Receiver operating characteristic analysis revealed a strong relationship between elevated procalcitonin and in-hospital mortality (area under the curve = 0.676; p = 0.002). Although procalcitonin was found to be higher in non-survivors in univariate analysis, it was not an independent predictor of mortality in multivariate regression analysis. Acute kidney injury, left ventricular ejection fraction, and non-revascularization were independently associated with mortality after adjusting for covariates. Conclusion Although procalcitonin was higher in non-survivors, static procalcitonin measurement at 24 hours after the onset of ST-elevation myocardial infarction complicated by cardiogenic shock was not an independent predictor of in-hospital mortality. Additional prospective studies are required to assess the role of serial procalcitonin monitoring in ST-elevation myocardial infarction complicated by cardiogenic shock.

From Classic to Modern Prognostic Biomarkers in Patients with Acute Myocardial Infarction

“…The study found that serum PCT levels were not correlated with LV remodeling and negative clinical outcomes after an AMI [ 40 ]. Pavasini et al [ 41 ] confirmed the role of PCT in predicting bacterial infection in patients hospitalized for ACS and cardiogenic shock ( p < 0.001), even if its levels were greater in this group of patients despite not being associated with long-term outcomes or in-hospital mortality [ 42 ]. In addition, Hashemipour et al assessed the association between the Gensini score as a measure of the severity and extent of CAD and PCT levels as a marker of inflammation in patients.…”

Novel markers of COVID-19 mortality-A comparative study with patients of acute coronary syndrome

“…Patients of ACS constitute a cohort with a high risk of mortality in the published data and the demonstration of mortality higher than the ACS group is alarming. [ 22 30 31 ] Like in any observational study, outcomes may also be influenced by unmeasured quality elements. The study population is small and larger prospective studies may provide more accurate answers.…”

Procalcitonin Predicts Bacterial Infection, but Not Long-Term Occurrence of Adverse Events in Patients with Acute Coronary Syndrome

“…The mechanism related to the increase in PCT blood levels in cardiogenic shock is related to the exposure to bacterial endotoxins due to bowel ischemia and alteration of gut permeability. In these critically ill patients, a dynamic assessment of PCT was more useful than a static approach [1] considering that it was shown that static PCT measurements at 24 h after the onset of ST-elevation MI complicated by cardiogenic shock were not an independent predictor of in-hospital mortality [19]. By contrast, our data shows that one systematic measurement of PCT, usually at the first day of admission after an ACS event, is predictive of the development of infection, while it is not related to the long-term outcome of patients.…”