Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients. Issue 1 (1st February 2018)

• Record Type: Journal Article
• Authors: Obling, Laust; Frydland, Martin; Hansen, Rikke; Møller-Helgestad, Ole Kristian; Lindholm, Matias Greve; Holmvang, Lene; Ravn, Hanne Berg; Wiberg, Sebastian; Thomsen, Jakob Hartvig; Jensen, Lisette Okkels; Kjærgaard, Jesper; Møller, Jacob Eifer; Hassager, Christian
• Is Part Of: European heart journal. Volume 7:Issue 1(2018)
• Page Start: 7
• Page End: 15
• Publication Date: 2018-02-01
• Subjects: Cardiogenic shock -- STEMI -- prediction -- mortality -- prognosis; 616.1205
• DOI: 10.1177/2048872617706503
• Languages: English
• ISSNs: 2048-8726

Abstract

Abstract: Background: The incidence of cardiogenic shock (CS) in patients with ST-segment elevation myocardial infarction (STEMI) is as high as 10%. The majority of patients are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for primary percutaneous intervention remains unknown. Aim: The aim of this study was to assess the incidence and time of CS onset in patients with suspected STEMI admitted in two high-volume tertiary heart centres and to assess the variables associated with the development of late CS. Methods: We included consecutive patients admitted for acute coronary angiography with suspected STEMI in a 1-year period. Cardiogenic shock was based on clinical criteria and subdivided into patients with shock on admission, patients developing shock during catheterisation and patients developing shock later during hospitalisation. Follow-up for all-cause mortality was done using registries. Results: A total of 2247 patients with suspected STEMI were included, whereof 225 (10%) developed CS. The majority (56%) had CS on admission, 16% developed CS in the catheterisation laboratory and 28% developed late CS. Thirty-day mortality was 3.1% versus 47% in non-CS versus CS patients ( p logrank < 0.0001). Age, stroke, time from symptom onset to intervention, anterior STEMI, heart rate/systolic blood pressure ratio and being comatose after resuscitation from cardiac arrest were independently associated with the development of late CS. Conclusion: In this study, 10% of patients admitted with suspected STEMI for acute coronary angiography presented with or developed CS. Most were in shock on admission. Irrespective of the timing of shock, mortality was high.