ST-Segment Elevation Acute Myocardial Infarction Complicated by Cardiogenic Shock: Early Predictors of Very Long-Term Mortality

Abstract

Background. Cardiogenic shock (CS) is the leading cause of in-hospital mortality in ST-segment elevation myocardial infarction (STEMI). Only limited data are available on the long-term outcome of STEMI patients with CS undergoing contemporary treatment. We aimed to investigate long-term mortality and its predictors in STEMI patients with CS and to develop a risk score for long-term mortality prediction. Methods and Results. We retrospectively included 465 patients with STEMI complicated by CS and treated with primary angioplasty and intra-aortic balloon pump between 2005 and 2018. Long-term mortality, including both in-hospital mortality and all-cause mortality following discharge from the index hospitalization, was the primary endpoint. The long-term mortality (median follow-up 4 (2.0–5.2) years) was 60%, including in-hospital mortality (34%). At multivariate analysis, independent predictors of long-term mortality were age (HR 1.41, each 10-year increase), admission left ventricular ejection fraction (HR 1.51, each 10%-unit decrease) and creatinine (HR 1.28, each mg/dl increase), and acute kidney injury (HR 1.81). When these predictors were pooled together, the area under the curve (AUC) for long-term mortality was 0.80 (95% CI 0.75–0.84). Using the four variables, we developed a risk score with a mean (cross-validation analysis) AUC of 0.79. When the score was applied to in-hospital mortality, its AUC was 0.79, and 0.76 when the score was applied to all-cause mortality following discharge. Conclusions. In STEMI patients with CS, the risk of death is still substantial in the years following the index event. A simple clinical score at the time of the index event accurately predicts long-term mortality risk.

Beneficial Effects of IABP in Anterior Myocardial Infarction Complicated by Cardiogenic Shock

“…Cardiogenic shock due to STEMI still has an unacceptable mortality rate of 40-50% [3][4][5][6][7]. MCS devices represent an interesting therapeutic opportunity, as they offer the chance to assist the failing cardiac pump, limiting the use of intravenous inotropes, which may worsen myocardial ischemia.…”

“…During the last decades, the survival of patients affected by ST-segment elevation myocardial infarction (STEMI) showed a dramatic increase, mainly due to improvements in evidence-based therapies including early revascularization with primary percutaneous coronary intervention (pPCI) [1,2]. Nevertheless, the occurrence of cardiogenic shock (CS) related to STEMI remains one of the major causes of death, with a growing incidence in recent years and with mortality rates approaching 40-50% [3][4][5][6][7]. In this challenging scenario, mechanical circulatory support (MCS) devices are one of the available therapeutic options to improve hemodynamics and prognosis, limiting the toxicity of catecholamines [1,6,8,9].…”

Outcomes of ST-Segment Elevation Myocardial Infarction in a Cohort of Cardiogenic Shock Patients Undergoing Primary Percutaneous Coronary Intervention

“…11 Similarly, a long-term (median 4 (2.0-5.2) years) mortality of 60% was reported in a retrospective study of 465 STEMI patients complicated by CS. 12 In light of the above discussion, more research is needed to monitor and guide the management of patients with STEMI complicated by CS. In this regard, some researchers have proposed risk stratification scoring systems with good predictive value for the risk stratification of 30-day mortality.…”

Development and External Validation of a Nomogram for Predicting Acute Kidney Injury in Cardiogenic Shock Patients in Intensive Care Unit

“…21 Moreover, Reshad et al performed a retrospective study of 293 22 Compared with those studies, the overall incidence of CS-AKI in this study was 50.4%, which was in accordance with previous study and the difference of the morbidity in different studies may at least partly explained by differences in patient populations and severity of disease. Furthermore, considering that AKI could independently increase the prognosis of CS patients, [22][23][24] a novel biomarker or predicting model that could accurately identify patients at high risk of CS-AKI earlier might result in better clinical prognosis and lower hospital care cost. Several potential risk factors of AKI had been identified in previous studies.…”